Unruptured Brain Arteriovenous Malformations: A Systematic Review and Meta-Analysis of Mortality and Morbidity in Aruba-Eligible Studies.

BACKGROUND: Treating unruptured brain arteriovenous malformations (bAVMs) represent significant challenges, with numerous uncertainties still in debate. The ARUBA trial induced further investigation into optimal management strategies for these lesions. Here, we present a systematic-review and meta-analysis focusing on ARUBA-eligible studies, aiming to correlate patient data with outcomes and discuss key aspects of these studies. METHODS: Following PRISMA guidelines, we conducted a systematic-review. Variables analyzed included bAVM Spetzler-Martin (SM) grade, treatment modalities, and outcomes such as mortality and neurological deficits. We compared studies with a minimum of 50% cases classified as SM 1-2 lesions and those with less than 50% in this category. Similarly, a comparison between studies with at least 50% microsurgery-cases and those with less than 50% was performed. We examined correlations between mortality incidence, SM distribution, and treatment modalities. RESULTS: Our analysis included 16 studies with 2.417 patients. The frequency of bAVMs SM-grade 1-2 ranged from 44% to 76%, SM-grade 3 from 19% to 48%, and SM 4-5 from 5 to 23%. Notably, studies with more than 50% cases presenting lesions SM-grade 1-2 presented significantly lower mortality rates than those with less than 50% cases of SM 1-2 lesions (P < 0.001). No significant difference in mortality rates or neurological deficits was identified between studies with more than 50% of microsurgery-cases and those with less than 50%. CONCLUSIONS: The analysis revealed that studies with a higher proportion of bAVMs presenting SM 1-2 lesions were associated with lower mortality rates. Mortality did not show a significant association with treatment modalities.

Enhancing Human Activity Recognition in Smart Homes with Self-Supervised Learning and Self-Attention.

Deep learning models have gained prominence in human activity recognition using ambient sensors, particularly for telemonitoring older adults' daily activities in real-world scenarios. However, collecting large volumes of annotated sensor data presents a formidable challenge, given the time-consuming and costly nature of traditional manual annotation methods, especially for extensive projects. In response to this challenge, we propose a novel AttCLHAR model rooted in the self-supervised learning framework SimCLR and augmented with a self-attention mechanism. This model is designed for human activity recognition utilizing ambient sensor data, tailored explicitly for scenarios with limited or no annotations. AttCLHAR encompasses unsupervised pre-training and fine-tuning phases, sharing a common encoder module with two convolutional layers and a long short-term memory (LSTM) layer. The output is further connected to a self-attention layer, allowing the model to selectively focus on different input sequence segments. The incorporation of sharpness-aware minimization (SAM) aims to enhance model generalization by penalizing loss sharpness. The pre-training phase focuses on learning representative features from abundant unlabeled data, capturing both spatial and temporal dependencies in the sensor data. It facilitates the extraction of informative features for subsequent fine-tuning tasks. We extensively evaluated the AttCLHAR model using three CASAS smart home datasets (Aruba-1, Aruba-2, and Milan). We compared its performance against the SimCLR framework, SimCLR with SAM, and SimCLR with the self-attention layer. The experimental results demonstrate the superior performance of our approach, especially in semi-supervised and transfer learning scenarios. It outperforms existing models, marking a significant advancement in using self-supervised learning to extract valuable insights from unlabeled ambient sensor data in real-world environments.

Treatment outcomes for ARUBA-eligible brain arteriovenous malformations: a comparison of real-world data from the NVQI-QOD AVM registry with the ARUBA trial.

BACKGROUND: Significant controversy exists about the management of unruptured cerebral arteriovenous malformations (AVMs). Results from A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) suggested that intervention increases the risk of stroke/death compared with medical management. However, numerous study limitations raised concerns about the trial's generalizability. OBJECTIVE: To assess the rate of stroke/death and functional outcomes in ARUBA-eligible patients from a multicenter database, the Neurovascular Quality Initiative-Quality Outcomes Database (NVQI-QOD). METHODS: We performed a retrospective analysis of prospectively collected data of ARUBA-eligible patients who underwent intervention at 18 participating centers. The primary endpoint was stroke/death from any cause. Secondary endpoints included neurologic, systemic, radiographic, and functional outcomes. RESULTS: 173 ARUBA-eligible patients underwent intervention with median follow-up of 269 (25-722.5) days. Seventy-five patients received microsurgery±embolization, 37 received radiosurgery, and 61 received embolization. Baseline demographics, risk factors, and general AVM characteristics were similar between groups. A total of 15 (8.7%) patients experienced stroke/death with no significant difference in primary outcome between treatment modalities. Microsurgery±embolization was more likely to achieve AVM obliteration (P<0.001). Kaplan-Meier survival curves demonstrated no difference in overall death/stroke outcomes between the different treatment modalities' 5-year period (P=0.087). Additionally, when compared with the ARUBA interventional arm, our patients were significantly less likely to experience death/stroke (8.7% vs 30.7%; P<0.001) and functional impairment (mRS score ≥2 25.4% vs 46.2%; P<0.01). CONCLUSION: Our results suggest that intervention for unruptured brain AVMs at comprehensive stroke centers across the United States is safe.

Comprehensive neurosurgical treatment of right occipital arteriovenous malformation with advanced angiographic techniques.

/Summary. A 39-year-old female with a notable medical history of smoking and a familial predisposition to unruptured aneurysms presented with clinical symptoms of intermittent right-sided headaches, flashes of light, and pulsatile tinnitus in the right ear. Diagnostic evaluations, including advanced angiographic techniques, identified a right occipital arteriovenous malformation (AVM). The angiogram revealed significant venous flow voids, emphasizing the need for a comprehensive treatment approach. The Spetzler-Martin grading system classified the AVM as Grade 2, indicating a moderate risk profile. A strategic decision was made to undergo partial embolization of two primary arterial feeders from the right posterior cerebral artery (PCA). Subsequent post-embolization angiograms confirmed a marked reduction in arteriovenous shunting, validating the efficacy of the intervention. The surgical approach encompassed an occipital craniotomy, meticulous subarachnoid dissection, and intraoperative angiography to ensure complete resection. Post-operative assessments showcased a successful and complete AVM resection. The patient experienced a brief, transient headache post-surgery, which resolved on its own. She was discharged on the third post-operative day and has since reintegrated into her professional life. However, she reported a minor visual field deficit, which, while noticeable, did not impede her daily activities. This case underscores the importance of a holistic, patient-centric approach in managing AVMs [1-3]. It challenges the conventional wisdom from the ARUBA trial, advocating for a more nuanced, individualized treatment paradigm, especially for young patients with low-grade AVMs [4].

Impact of tailored multimodal treatment for unruptured brain arteriovenous malformation: comparison with a randomized trial of unruptured brain arteriovenous malformations.

PURPOSE: The first randomized controlled study on unruptured brain arteriovenous malformations (bAVM), the ARUBA trial, demonstrate the superiority of medical management; however, it failed to completely rule out the efficacy of therapeutic interventions due to several limitations. This study aimed to examine the outcomes of multimodal interventional treatment for bAVM in terms of safety and efficacy. METHODS: We reviewed 226 consecutive patients with unruptured bAVM admitted to our institute between 2002 and 2022. Treatment methods were divided into medical management and therapeutic intervention, including microsurgery, stereotactic surgery, and endovascular intervention. First, the choice of therapeutic modalities was assessed in the pre-ARUBA (before February 2014) and post-ARUBA (after March 2014) eras. Second, the incidence of symptomatic stroke or death and functional prognosis with a modified Rankin scale (mRS) score of ≥2 at 5 years was compared between the medical management and therapeutic intervention. RESULTS: In the pre- and post-ARUBA groups, 73% and 84% of patients underwent therapeutic interventions, respectively (p = 0.053). The rate of symptomatic stroke or death was lower in patients who underwent interventional therapies than in those who underwent medical management (9.7% vs. 22%, p = 0.022); however, the opposite was observed in the ARUBA trial (31% vs. 10%). The annual incidence of stroke or death was also lower in the interventional therapy group (4.3%/y vs. 1.8%/year, hazard ratio = 0.45, 95% confidence interval: 0.18-1.08, p = 0.032). The rate of mRS score of ≥2 after a 5-year follow-up was 18% and 6% in the medical treatment and intervention groups (p = 0.14). CONCLUSIONS: The therapeutic intervention rate did not decrease, even after the publication of the ARUBA trial. The rate of stroke or death was lower in the intervention group, indicating that a tailored choice of multimodality is safe and effective for managing unruptured bAVM.

CO2 emissions in Latin America: a time series perspective based on fractional integration.

This article deals with the analysis of [Formula: see text] emissions in Latin America by using a long memory process based on fractional integration. Using data of [Formula: see text] emission and [Formula: see text] emissions per capita, for 32 Latin American and Caribbean countries, the results show significant differences according to the variable examined, the model used, and the country under examination. In particular, for the [Formula: see text] emissions, mean reversion is found in Belize and also under some circumstances in Antigua and Barbuda, Colombia, Dominica, Dominican Republic, Ecuador, Grenada, Honduras, Nicaragua, Panama, Peru, and Uruguay. Thus, shocks in these series have a transitory effect. With respect to the time trends, only for some Caribbean countries, namely, Antigua and Barbuda, Aruba, Bahamas, Cuba, and Jamaica, the trend is insignificant; on the other hand, large countries like Brazil, Mexico, and Argentina display the highest time trend coefficients; for the [Formula: see text] emissions per capita, there are eleven countries where mean reversion is detected, and there are ten that share a lack of significance for the trend. The most significant trends now take place in Trinidad and Tobago, British Virgin Islands, Barbados, and Guyana. Policy implications of the results obtained are reported at the end of the paper.

Microsurgical Treatment of Arteriovenous Malformations: A Single-Center Study Experience.

OBJECTIVE: The purpose of the study was to assess the functional outcomes after microsurgical resection of arteriovenous malformations (AVMs) and to compare the results between patients eligible for A Randomized Trial of Unruptured Brain Arteriovenous Malformations in this surgical series to the results reported and the ARUBA study. METHODS: We reviewed the records of 169 patients who underwent microsurgical treatment of arteriovenous malformation (AVMs) in our institution between January 2016 and December 2021. These patients' functional status was assessed using modified Rankin Scale (mRS) scores at the last follow-up and before treatment. The mRS scores at the latest follow-up were classified into good outcomes (mRS < 3) and poor outcomes (mRS ≥ 3). Clinical presentation, patients' demographics, AVM characteristics, follow-up time, and obliteration rate were analyzed. Subgroup analyses were performed on the whole cohort, comparing Spetzler-Martin Grade I and Grade II, and ARUBA-eligible AVMs. RESULTS: The initial hemorrhagic presentation occurred in 71 (42%) out of 169 patients. The majority of the patients presented with headaches (73%). The AVMs were completely obliterated in 166 (98.2%) patients. The series included 65 Spetzler-Martin Grade I (38.5%), 46 Grade II (27.2%), 32 Grade III (18.9%), 22 Grade IV (13%), and 4 Grade V (2.4%) AVMs. There were 98 unruptured and 79 ARUBA-eligible cases. Also, optimal functional outcome was achieved in 145 (85.8%) patients. The overall mortality rate was 5.3% (9/169). The multivariate analysis illustrated that a poor outcome was significantly associated with presurgical mRS ≥3 (p < 0.013; OR, 0.206; 95% CI 0.059-0.713), increasing age (p < 0.045; odds ratio [OR], 1.022; 95% CI 1.000-0.045), and female gender (p < 0.009; OR, 2.991; 95% CI 1.309-6.832). CONCLUSIONS: Our study suggests that better outcomes can be obtained using microsurgical resection in the majority of patients with AVMs. Independent predictors of poor outcomes after surgical resection of AVMs include increasing age at the time of surgery, poor presurgical functional status, and female gender. Supposing that patients are more suitable for microsurgery after presurgical examination, outcomes are normally better in that case than those achieved by multimodal interventions (such as conservative treatment or ARUBA treatment arm). Therefore, we recommend early surgical removal on all surgically accessible AVMs to prevent successive hemorrhages and the consequences of poor neurological outcomes.

A Cross-Sectional Study of the Physical and Mental Well-Being of Long COVID Patients in Aruba.

Objective: To investigate the pattern and prevalence of persistent symptoms of Post-COVID-19 Syndrome (PCS) at 3, 6, 9, and 18 months after discharge. Associated risk factors were further examined to potentially explain the persistence of these symptoms.Design and Setting: A cross-sectional cohort study was conducted at the primary health care facility of Aruba, Dr. Horacio E. Oduber Hospital (HOH).Participants: Inclusion criteria were adults hospitalized at HOH for at least one night between March and July 2021 and laboratory-confirmed COVID-19 diagnosis. Exclusion criteria were deceased before the follow-up, not able to mobilize before or after discharge, living outside of Aruba or in nursing homes, and patients with psychosis, dementia, or hospitalized due to unrelated diseases.Methods: Eligible and willing participants completed a 20-question survey: a self-reported symptoms questionnaire about symptoms during and after COVID-19 infection, level of dyspnea measurement (mMRC-scale), quality of life measurement (EQ-5D-5E with EuroQoL VAS), and mental well-being (WHO-5). Hospitalization related data were gathered via retrospective analysis of patient records. Chi-square test, logistic regression, and ANOVA analyses were conducted; P<0.05 was chosen as level of statistical significance for all analyses.Results: In total, 222 (34.5%) patients were eligible, consenting, and completed the survey. Most participants were interviewed a year or more after their initial COVID-19 infection. Fatigue (37.8%), new-onset dyspnea (38.7%), hair loss (20.3%), and muscle pain (18.0%) were the most frequently reported symptoms at any time post COVID-19 infection. Female participants were found more likely to experience fatigue (P<0.05, OR 2.135, 95% CI 1.154-3.949) and new-onset dyspnea (P<0.05, OR 2.026 95% CI 1.093-3.756) after initial infection. Participants with one or more respiratory comorbidity were more likely to experience new-onset dyspnea (P<0.05, OR 2.681, 95% CI 1.223-5.873). None of the predictor variables was associated with cognitive impairment.Conclusion: This study identified female sex and respiratory comorbidity as crucial risk factors for PCS. Females were also found to have significantly lower health scores. Female participants were more likely to experience fatigue and dyspnea after COVID-19 infection.

Endovascular Management of Brain Arteriovenous Malformations.

Due to the risk of cerebral hemorrhage, and its related morbidity-mortality, brain arteriovenous malformations (bAVMs) are a rare and potentially life-threatening disease. Despite this, there is only one randomized controlled trial on bAVM management, A Randomized trial of Unruptured Brain Arteriovenous malformations (ARUBA). The results of the ARUBA trial favor a noninterventional approach in the case of an unruptured bAVM; however, implementation of these findings is challenging in daily practice. Instead, management of bAVM relies on multidisciplinary discussions that lead to patient-specific strategies based on patient preferences, local expertise, and experience in referral centers. Considering the diverse patterns of presentation and numerous treatment modalities, implementing standardized guidelines in this context proves challenging, notwithstanding the recommendations or expert opinions offered. Endovascular treatment (EVT) of bAVM can be curative, or can serve as an adjunct treatment prior to surgery or radiosurgery ("pre-EVT"). EVT practice is in constant evolution (i.e., venous approach, combination with surgery during the same anesthesia, etc.). Liquid embolic agents such as ethylene vinyl alcohol (EVOH) copolymer and cyanoacrylates (CYA), and their method of injection to increase bAVM occlusion have also benefited from technical evolutions such as the use of adjunctive flow arrest techniques (mini balloons, pressure cooker technique, and multiple catheters). Further research is necessary to evaluate the advantages and disadvantages of EVT for bAVM.

Gamma Knife Radiosurgery in Partially Embolised Arteriovenous Malformations: Management Dilemmas and Outcomes.

Introduction: The role of Gamma Knife radiosurgery (GKRS) in partially embolized arteriovenous malformations (AVMs) has always remained a subject of debate. The aim of this study was to evaluate the efficacy of GKRS in partially embolized AVMs and to analyze factor that influence its obliteration. Methods: This was a retrospective study from a single institute performed over a period of 12 years (2005-2017). It included all patients who underwent GKRS for partially embolized AVMs. Demographic characteristics, treatment profiles, and clinical and radiological data were obtained during treatment and follow-up. Obliteration rates and factors affecting the same were sought and analyzed. Results: A total of 46 patients with a mean age of 30 years (range: 9-60 years) were included in the study. Follow-up imaging was available for 35 patients either by digital subtraction angiography (DSA) or magnetic resonance imaging (MRI). We found complete AVM obliteration in 21 patients (60%): one had near total obliteration (>90% obliteration), 12 had subtotal obliteration (<90%), and one had no change in the volume following GKRS. Following embolization alone, an average of 67% of the AVM volume was obliterated which resulted in an average 79% final obliteration rate after Gamma Knife radiosurgery. Mean duration to complete obliteration was found to be 3.45 years (range: 1-10 years). There was a significant difference (P = 0.04) in the mean interval between embolization and GKRS among cases with complete obliteration (12 months) and those with incomplete obliteration (36 months). There was no significant difference (P = 0.49) in the average obliteration rate between the ARUBA-eligible unruptured AVMs (79.22%) and ruptured AVMs (79.04%). Bleeding after GKRS during the latency period had a negative impact on obliteration (P = 0.05). Other factors like age, sex, Spetzler-Martin (SM)-grade, Pollock Flickinger score (PF-score), nidus volume, radiation dose, or presentation before embolization had no significant influence on obliteration. Three patients had permanent neurological deficits after embolization and none after radiosurgery. Six out of nine patients (66%) presenting with seizures were seizure-free after the treatment. Hemorrhage was noted in three patients following combined treatment and were managed non-surgically. Conclusion: Obliteration rates in partially embolized AVM after Gamma Knife are inferior when compared to Gamma Knife alone; moreover with volume staging and/or dose staging being increasingly plausible due to the new ICON machine, embolization may be completely replaced. However we have shown that in complicated and carefully chosen AVMs, embolization followed by GKRS is a valid modality of management. This study represents a real-world picture of individualized AVM treatment depending on patient choices and resources available.

New species and records of Heterospio (Annelida, Longosomatidae) from continental shelf, slope and abyssal depths of the Atlantic Ocean, Pacific Ocean, Indian Ocean and adjacent seas.

Nineteen species of the rare polychaete genus Heterospio are reported, 15 of which are new to science. The status of H. longissima Ehlers, 1874, the type-species, is reviewed. The specimens examined are from several locations in the North Atlantic Ocean, Gulf of Mexico, Caribbean Sea, off Br azil, the Indian Ocean, the Pacific Ocean off California, New Zealand, Australia, and the South China Sea. Deep-water samples from the western North Atlantic Ocean collected by the late Drs. H.L. Sanders and R.R. Hessler that were reported by Hartman as H. longissima were re-examined and referred to two new species, H. hartmanae n. sp. (abyssal depths, New England to Bermuda transect) and H. guiana n. sp. (bathyal depths off Suriname). Other materials from the Sanders/Hessler North Atlantic collections were also examined and referred to two additional species, H. canariensis n. sp. (deep water off Canary Islands) and H. southwardorum n. sp. (Bay of Biscay) as well as H. cf. reducta from off SW Ireland in bathyal depths. New collections from the North Atlantic region include additional materials of H. hartmanae n. sp. (deep water off the Mid-Atlantic and SE USA), H. aruba n. sp. (Caribbean Sea), H. bathyala n. sp. (deep water off SE USA), and H. dibranchiata n. sp. (deep water, Gulf of Mexico). Heterospio paulolanai n. sp. is from shelf depths off southeastern Brazil. Heterospio knoxi n. sp. is from the North Island of New Zealand, H. ehlersi n. sp. is from the Gulf of Thailand, in the South China Sea, H. bidentata n. sp. is described from deep water in the Coral Sea off eastern Australia, and H. alata n. sp. and H. brunei n. sp. are described from deep water off the Island of Borneo in the South China Sea. Heterospio africana n. sp. and H. antonbruunae n. sp. are described from off east Africa in the Mozambique Channel. New records and descriptions of H. catalinensis, H. indica, and H. peruana are presented. The 15 new species reported here nearly triple the number of previously known species of Heterospio, with 23 species now recognized. All known species are tabulated and compared.

Quantifying phenological landmarks of migration shows nonuniform use of the Caribbean by shorebirds.

Of the boreal- and Arctic-breeding North American shorebirds that migrate south through the Caribbean, most individuals continue farther south. However, for many species, some individuals remain beyond the southbound migration period (i.e., throughout the temperate winter and/or summer). This variation among individuals adds complexity to observation data, obscures migration patterns, and could prevent the examination of the use of different Caribbean regions by various shorebird species during migration and in the nonmigratory seasons. Here, we present a novel method that leverages a well-established statistical approach (generalized additive models) to systematically identify migration phenology even for complex passage migrant species with individuals that remain beyond migration. Our method identifies the active migration period using derivatives of a fitted GAM and then calculates phenology metrics based on quantiles of that migration period. We also developed indices to quantify oversummering and overwintering patterns with respect to migration. We analyzed eBird data for 16 North American shorebird species as they traveled South through the insular Caribbean, identifying separate migratory patterns for Cuba, Puerto Rico, Guadeloupe, Aruba, Bonaire, Curaçao, and Trinidad and Tobago. Our results confirm past reports and provide additional detail on shorebird migration in the Caribbean, and identify several previously unpublished regional patterns. Despite Puerto Rico being farther north and closer to continental North America, most species reached Puerto Rico later than other regions, supporting a long-standing hypothesis that migration strategy (transcontinental vs. transoceanic) leads to geographic differences in migration timing. We also found distinct patterns of migration curves, with some regions and species consistently having either symmetrical or skewed curves; these differences in migration curve shape reflect different migration processes. Our novel method proved reliable and adaptable for most species and serves as a valuable tool for identifying phenological patterns in complex migration data, potentially unlocking previously intractable data.

Outcome of 107 conservatively managed unruptured brain arteriovenous malformations: a single center's 30-year experience.

OBJECTIVE: Since the publication of A Randomized Trial of Unruptured Brain AVMs (ARUBA), the management of unruptured brain arteriovenous malformations (bAVMs) has been controversially discussed. Long-term follow-up data on the exclusively conservative management of unruptured bAVMs are scarce. The authors evaluated the long-term outcomes of patients with unruptured untreated bAVMs in a real-life cohort. METHODS: A retrospective observational cohort of 107 patients (of 897 bAVM patients referred to the authors' institution) with a diagnosis of unruptured and conservatively managed bAVMs is presented. AVMs of all Spetzler-Martin grades were observed. The mean follow-up period was 84 months. In 44% of patients, a follow-up period of 5 years or longer was observed. A national death register comparison completed the outcome analysis. RESULTS: The median age at diagnosis, sex distribution, neurological presentation, and modified Rankin Scale score were comparable to the patients in the medical management arm of the ARUBA study. Patients were mainly young, predominantly male, and in good clinical condition. Similar to the ARUBA cohort, 77% of this study's cohort presented in an excellent clinical status at the time of last follow-up. However, 17% of patients had at least one hemorrhage, resulting in an overall annual hemorrhage risk of 2.7% in the observation period. Moreover, the cumulative 1-, 5-, and 10-year overall hemorrhage rates were 3.0%, 11.3%, and 15.3%, respectively. Consequently, the long-term follow-up AVM-related mortality rate amounted to 8%. The estimated median overall survival after AVM diagnosis was 19.3 years (95% CI 14.0-24.6 years). A multivariate Cox regression model revealed temporal and deep-seated localization as an independent risk factor for AVM hemorrhage, while the presence of seizures reached borderline significance as a risk factor. CONCLUSIONS: The authors' results represent the long-term course of unruptured untreated bAVMs. Their data support the conclusion that even in the post-ARUBA era, tailored active treatment options may be offered to patients with unruptured bAVMs. For patient counseling, individual risk factors should be weighed against the center's treatment-specific risks.

Prevalence of congenital anomalies in the Dutch Caribbean islands of Aruba, Bonaire, and Curaçao.

BACKGROUND: Congenital anomalies represent an important global health issue. Data on the prevalence and pattern of congenital anomalies in the Caribbean region are scarce and lacking altogether in Aruba, Bonaire and Curaçao (ABC islands). METHODS: We performed a population-based surveillance study to determine the prevalence of structural congenital anomalies in the ABC islands, including all live births and stillbirths between January 1, 2008 and December 31, 2017 with major congenital anomalies according to EUROCAT guide 1.5. Terminations of pregnancy for fetal anomaly were included as well. Cases were identified by active case ascertainment, using multiple sources including pediatric patient files and discharge letters, delivery records, and clinical genetic patient files. Total and subgroup prevalence rates were compared between the three islands and to the French West Indies and Northern Netherlands. RESULTS: Total prevalence of congenital anomalies on the ABC islands was 242.97 per 10,000 births. Total prevalence of congenital anomalies in Bonaire (325.15 per 10,000 births) was higher compared to Aruba (233.29 per 10,000 births) and Curaçao (238.58 per 10,000 births), which was mainly attributable to a higher prevalence of limb anomalies, in particular polydactyly, in Bonaire. Total prevalence of congenital anomalies on the ABC islands was comparable to the French West Indies (248.69 per 10,000 births) but significantly lower compared to the Northern Netherlands (298.98 per 10,000 births). In the subgroup prevalence analysis, the prevalence of polydactyly and atrial septal defect on the ABC islands was significantly higher compared with the French West Indies and the Northern Netherlands, while the prevalence of congenital anomalies of the kidney and urinary tract and genetic disorders was significantly lower. CONCLUSIONS: This is the first study to establish the prevalence and pattern of congenital anomalies on the ABC islands, which is important to inform healthcare managers and policymakers and to provide a basis for continuous surveillance of congenital anomalies.

Convolutional Neural Network Bootstrapped by Dynamic Segmentation and Stigmergy-Based Encoding for Real-Time Human Activity Recognition in Smart Homes.

Recently, deep learning (DL) approaches have been extensively employed to recognize human activities in smart buildings, which greatly broaden the scope of applications in this field. Convolutional neural networks (CNN), well known for feature extraction and activity classification, have been applied for estimating human activities. However, most CNN-based techniques usually focus on divided sequences associated to activities, since many real-world employments require information about human activities in real time. In this work, an online human activity recognition (HAR) framework on streaming sensor is proposed. The methodology incorporates real-time dynamic segmentation, stigmergy-based encoding, and classification with a CNN2D. Dynamic segmentation decides if two succeeding events belong to the same activity segment or not. Then, because a CNN2D requires a multi-dimensional format in input, stigmergic track encoding is adopted to build encoded features in a multi-dimensional format. It adopts the directed weighted network (DWN) that takes into account the human spatio-temporal tracks with a requirement of overlapping activities. It represents a matrix that describes an activity segment. Once the DWN for each activity segment is determined, a CNN2D with a DWN in input is adopted to classify activities. The proposed approach is applied to a real case study: the "Aruba" dataset from the CASAS database.

Netherlands

Country located in EUROPE. It is bordered by the NORTH SEA, BELGIUM, and GERMANY. Constituent areas are Aruba, Curacao, and Sint Maarten, formerly included in the NETHERLANDS ANTILLES.

País ubicado en EUROPA. Está bordeado por el MAR DEL NORTE, BÉLGICA Y ALEMANIA. Áreas constituyentes son Aruba, Curasao y Sint Maarten, anteriormente incluidas en las ANTILLAS HOLANDESAS.

País localizado na EUROPA. Faz fronteira com o MAR DO NORTE, BÉLGICA e ALEMANHA. As áreas ultramarinas que os constituem são Aruba, Curaçao, São Martinho, antigamente incluído nas ANTILHAS HOLANDESAS.

Netherlands Antilles

Former Netherlands overseas territory in the Lesser Antilles in the West Indies. It had included the islands of Aruba, Bonaire, Curacao, Saba, St. Eustatius, and the southern part of St. Martin. The Netherlands Antilles dissolved on October 10, 2010.

Antiguo territorio de ultramar de los Países Bajos en las Antillas Menores de las Indias Occidentales. Incluía las islas de Aruba, Bonaire, Curazao, Saba, San Eustaquio y la parte sur de San Martín. Las Antillas Holandesas se disolvieron el 10 de octubre de 2010.

Antigo território ultramarino da Holanda nas Pequenas Antilhas nas Índias Ocidentais. Incluiu as ilhas de Aruba, Bonaire, Curaçao, Saba, St. Eustatius e a parte meridional de St. Martin. As Antilhas Holandesas se desmembraram em 10 de outubro de 2010.

Aruba

Island in the Caribbean Sea, north of Venezuela. In 1986 it became a separate, autonomous member of the Kingdom of the Netherlands.

Isla en el Mar Caribe, al norte de Venezuela. En 1986 se convirtió en un miembro independiente y autónomo del Reino de los Países Bajos.

Ilha no Mar do Caribe, ao norte da Venezuela. Em 1986, tornou-se um membro separado e autônomo do Reino dos Países Baixos.

Caribbean People

People native to or inhabitants of islands in the Caribbean Sea or CARIBBEAN including ANTIGUA AND BARBUDA; ARUBA; BAHAMAS; BARBADOS; BRITISH VIRGIN ISLANDS; CARIBBEAN NETHERLANDS; CUBA; CURACAO; DOMINICA; DOMINICAN REPUBLIC; GRENADA; GUADELOUPE; HAITI; JAMAICA; MARTINIQUE; PUERTO RICO; SAINT KITTS AND NEVIS; SAINT LUCIA; SAINT VINCENT AND THE GRENADINES; SINT MAARTEN; TRINIDAD AND TOBAGO; and UNITED STATES VIRGIN ISLANDS.

Personas nativas o habitantes de islas en el Mar Caribe o CARIBE incluyendo ANTIGUA Y BARBUDA, ARUBA, BAHAMAS, BARBADOS, ISLAS VIRGENES BRITÁNICAS, PAÍSES BAJOS DEL CARIBE, CUBA, CURAZAO, DOMINICA, REPÚBLICA DOMINICANA, GRANADA, GUADALUPE, HAITÍ, JAMAICA, MARTINICA, PUERTO RICO, SAN CRISTÓBAL Y NIEVES, SANTA LUCÍA, SAN VICENTE Y LAS GRANADINAS, SAN MAARTÉN, TRINIDAD Y TOBAGO e ISLAS VIRGENES DE LOS ESTADOS UNIDOS.

Pessoas nativas ou habitantes de ilhas no Mar do Caribe ou CARIBE, incluindo ANTIGUA E BARBUDA, ARUBA, BAHAMAS, BARBADOS, ILHAS VIRGENS BRITÂNICAS, PAÍSES BAIXOS CARIBENHOS, CUBA, CURAÇAO, DOMINICA, REPÚBLICA DOMINICANA, GRANADA, GUADALUPE, HAITI, JAMAICA, MARTINICA, PORTO RICO, SÃO CRISTÓVÃO E NÉVIS, SANTA LÚCIA, SÃO VICENTE E GRANADINAS, SÃO MARTINHO (PAÍSES BAIXOS), TRINIDAD E TOBAGO, e ILHAS VIRGENS AMERICANAS.