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To investigate the role of hydration to prevent contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI), we prospectively included 408 consecutive patients who were randomly assigned to receive either hydration with isotonic saline (1 ml/kg/h since the beginning of the procedure and for 24 hours after it: NS+ group) or not (NS− group). All patients received an iso-osmolar nonionic contrast medium. The primary end point was the development of CIN: ≥25% or ≥0.5 mg/dl increase in serum creatinine within 3 days after the procedure. CIN was observed in 14% of patients: 21% in the NS− group and 11% in the NS+ group (p = 0.016). CIN was significantly associated with death (15.2% vs 2.8%; p <0.0001) and need for dialysis (13.4% vs 0%; p <0.0001). In multivariate analysis, the only predictors of CIN were hydration (OR = 0.29 [0.14 to 0.66]; p = 0.003) and the hemoglobin before the procedure (OR = 0.69 [0.59 to 0.88]; p <0.0001). In conclusion, intravenous saline hydration during PPCI reduced the risk of CIN to 48%. Patients with CIN had increased mortality and need for dialysis. Given the higher incidence of CIN in emergent procedures, and its morbidity and mortality, preventive hydration should be mandatory in them unless contraindicated.

This collection of essays presents an innovative and provocative set of concepts to understand the spaces of the Americas through local lenses. The disciplines of architecture, urban design, landscape, and planning share the fundamental belief that space and place matter; however, the overwhelming majority of canonical knowledge in these fields originates in another continent and is external to the lived experience in such regions. The book introduces seven new concepts that have not been sufficiently addressed, and would make a significant contribution to the field: namely, gridded spaces; spaces of agriculture; space as image; watered spaces; spaces as labor; racialized spaces; and gendered spaces. This book, thus, introduces a broader conceptual framework to foster the analysis of the spatial histories of the Americas.

Cystic echinococcosis (CE) caused by Echinococcus granulosus sensu lato (s.l.) is a neglected and underdiagnosed parasitic zoonosis that has a significant socioeconomic impact on rural communities relying on livestock farming. CE is endemic across Latin America, including Chile, where the Coquimbo region exhibits a relatively high record of hospital-based human cases and infected animals. However, the incidence of hospitalized CE cases may underestimate the real burden of infection in a population, since the majority of cases never reach medical attention or official disease records. In 2019, a cross-sectional, community-based study was conducted with the objectives of estimating for the first time the prevalence of human abdominal CE using abdominal ultrasound (US) screening in volunteers residing in urban and rural localities of the Monte Patria municipality located in Limarí province, Coquimbo region, Chile, and identifying the risk factors associated with human infection. Pre-screening activities included a 16-h lecture/hands-on training aimed at rural physicians that focused on the diagnosis of CE by US, based on current WHO recommendations. A total of 2,439 (~8% of municipality inhabitants) people from thirteen target localities were screened by abdominal US in June-July 2019. We found an overall CE prevalence of 1.6% (95% CI 1.1-2.2) with a significantly higher likelihood of infection in rural localities, older age classes and people drinking non-potable water; 84.6% of infected volunteers were newly diagnosed with CE. Cysts were either in active or inactive stages in equal proportions; active cysts were detected in all age classes, while 95.7% of inactive cysts occurred in >40 years-old subjects. This is the first US survey aimed at detecting human infection caused by Echinococcus granulosus s.l. in Chile. Our findings indicate a high CE prevalence in the area, and contribute to define the demographic and behavioral risk factors promoting the transmission of the parasitic infection within target communities. Our results support the implementation of cost-effective strategies for the diagnosis, treatment and control of CE, and the need to improve the epidemiological surveillance system in Chile.

Predicting and understanding different key outcomes in a student’s academic trajectory such as grade point average, academic retention, and degree completion would allow targeted intervention programs in higher education. Most of the predictive models developed for those key outcomes have been based on traditional methodological approaches. However, these models assume linear relationships between variables and do not always yield accurate predictive classifications. On the other hand, the use of machine-learning approaches such as artificial neural networks has been very effective in the classification of various educational outcomes, overcoming the limitations of traditional methodological approaches. In this study, multilayer perceptron artificial neural network models, with a backpropagation algorithm, were developed to classify levels of grade point average, academic retention, and degree completion outcomes in a sample of 655 students from a private university. Findings showed a high level of accuracy for all the classifications. Among the predictors, learning strategies had the greatest contribution for the prediction of grade point average. Coping strategies were the best predictors for degree completion, and background information had the largest predictive weight for the identification of students who will drop out or not from the university programs.

Training healthcare professionals in human rights approaches is fundamental for humanizing medical practice and promoting patient autonomy. To evaluate the impact of Quality Rights strategy training on human rights engagement, stigma reduction and attitudes towards mental health among medical students in Colombian. A pre-experimental study with pre-post measures was conducted, involving 194 medical students, during the first semester of 2024 in Manizales, Caldas, Colombia. To assess notions and commitment to human rights were used the Human Rights Exposure in Social Work and Human Rights Engagement in Social Work. Attitudes toward people with mental disorders were measured using the Community Attitudes Towards the Mentally III (CAMI) scale, and attitudes toward mental health education were assessed using the Mental Illness Clinicians' Attitude Scale (MICA). The intervention was based on QualityRights, an initiative of the World Health Organization, which aims to improve the quality of care in mental health services and to promote the human rights of people with psychosocial disabilities. Initial data comparisons were made using the Mann-Whitney U test and the Kruskal-Wallis test. Pretest and postest data were compared using the Wilcoxon test. Statistically significant improvements were observed in human rights understanding, reduced stigmatizing attitudes toward mental health and decreased authoritarianism. While students demonstrated enhanced human rights knowledge and less stigmatizing attitudes, we observed a concurrent decrease in benevolence scores. The Quality Rights training strategy shows promise in improving medical students' understanding of mental health conditions and promoting empathetic practices. However, ongoing sustained and monitoring strategies are necessary to ensure long-term adoption of human rights-based attitudes and practices in healthcare settings.

BackgroundPatients with diabetes mellitus (DM) have an elevated risk of late events after percutaneous coronary intervention (PCI). The Second-generation Drug-eluting Stents in Diabetes (SUGAR) trial (NCT03321032) compared amphilimus-eluting stents (AESs) and onyx-zotarolimus-eluting stents (O-ZESs) in this population.ObjectivesTo report the co-primary endpoint comparing target lesion failure (TLF) between AES and O-ZES at 2 years and the extended follow-up at 3 years.MethodsThe SUGAR trial enrolled 1175 patients with DM across 23 centres in a randomised (1:1 AES (Cre8EVO) or O-ZES (Resolute Onyx)) assessor-blinded design. The primary endpoint, assessed with a Cox proportional hazards model, was TLF (a composite of cardiac death, target vessel myocardial infarction or ischaemia-driven target lesion revascularisation). Secondary endpoints included all-cause mortality, stent thrombosis and major adverse cardiac events.ResultsAt 2 years, TLF occurred in 60 (10.4%) patients in the AES group and 71 (12.1%) in the O-ZES group; HR 0.84 (95% CI 0.60 to 1.19), p=0.331. At 3 years, TLF occurred in 66 (11.4%) of the AES group compared with 87 (14.9%) of the O-ZES group (HR 0.77; 95% CI 0.56 to 1.06; p=0.106). Landmark analysis revealed no significant differences in TLF rates between 1 and 3 years (HR 1.07; 95% CI 0.62 to 1.87; p=0.801). Rates of individual components of the primary endpoint were comparable between groups. No significant differences were observed in secondary endpoints.ConclusionsThe SUGAR trial demonstrates that AES and O-ZES provide comparable long-term efficacy in preventing TLF in patients with DM undergoing PCI. These findings support the use of either stent type and highlight the importance of further long-term studies to optimise outcomes.Trial registration numberNCT03321032

Aims The aim of this study was to observe the percentage of thromboembolic and haemorrhagic events over a 2-year follow-up in patients with non-valvular atrial fibrillation (NVAF) undergoing closure of the left atrial appendage (LAA) with an occlusion device. Observed events and CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke history), CHA2DS2-VASc (also adding: vascular disease and sex) and HAS-BLED (hypertension, abnormal liver/renal function, stroke history, bleeding predisposition, labile international normalised ratios, elderly, drugs/alcohol use)-predicted events were compared. Methods LAA closure with an occlusion device was performed in 167 NVAF patients contraindicated for oral anticoagulants and recruited from 12 hospitals between 2009 and 2013. At least two transoesophageal echocardiograms were performed in the first 6 months postimplantation. Antithrombotics included clopidogrel and aspirin. Patients were monitored for death, stroke, major and relevant bleeding and hospitalisation for concomitant conditions. Mean age was 74.68±8.58, median follow-up was 24 months, 5.38% had intraoperative complications and implantation was successful in 94.6% of subjects. Mortality during follow-up was 10.8%, mostly (9.5%) non-cardiac related. Bleeding occurred in 10.1% of subjects, 5.7% major and 4.4% minor though relevant, and 4.4% suffered stroke. Major bleeding and stroke/transient ischaemic attack events within 2 years (annual event rates, 290 patients/year) were less frequent than expected from CHADS2 (2.4% vs 9.6%), CHA2DS2-VASc (2.4% vs 8.3%) and HAS-BLED (3.1% vs 6.6%) risk scores (p<0.001, p=0.003, p=0.047, respectively). Conclusions LAA closure with an occlusion device in patients contraindicated for oral anticoagulants is a therapeutic option associated with fewer thromboembolic and haemorrhagic events than expected from risk scores, particularly in the second year postimplantation.

In the context of recent technological advancements driven by distributed work and open-source resources, computer vision stands out as an innovative force, transforming how machines interact with and comprehend the visual world around us. This work conceives, designs, implements, and operates a computer vision and artificial intelligence method for object detection with integrated depth estimation. With applications ranging from autonomous fruit-harvesting systems to phenotyping tasks, the proposed Depth Object Detector (DOD) is trained and evaluated using the Microsoft Common Objects in Context dataset and the MinneApple dataset for object and fruit detection, respectively. The DOD is benchmarked against current state-of-the-art models. The results demonstrate the proposed method’s efficiency for operation on embedded systems, with a favorable balance between accuracy and speed, making it well suited for real-time applications on edge devices in the context of the Internet of things.

The objective of the present study was to evaluate the effectiveness of mutual help groups in continuity of care, loneliness and psychosocial disability in a Colombian context. For this, a quasi-experimental design is used, with pre- and post-intervention assessments due to non-randomized participant allocation. The study involved 131 individuals with mental disorders. The Psychosocial Disability Scale, The Alberta Scale of Continuity of Services in Mental Health, the UCLA Scale and the Zarit Caregiver Burden Scale were employed. The intervention was based on the core components of mutual aid groups. Significant differences ( p  < 0.001) were observed for the study variables, particularly in Loneliness, Continuity of Care, and various domains of psychosocial disability. A large effect size was found for these variables after the intervention. Most variables exhibited a moderate to large effect. This study demonstrates the effectiveness of mutual groups facilitated by mental health personnel at the primary care level.

Suicidal behavior has increased in the past decade, particularly among Indigenous children and adolescents. This study explores variables associated with spiritual harmony - understood by Indigenous Peoples of Colombia as holistic mental health - among displaced Embera Dobidá youth, focusing on food security, general health, and connection to the land. It also evaluates outcomes of community-led and interculturally coordinated strategies implemented between 2023 and 2025. A descriptive longitudinal study was conducted with all children aged 6 to 17 years (mean 14.97 years) from an Embera Dobidá community displaced by armed conflict. Data were collected at two time points (January 2023 and January 2025) using culturally validated instruments (Parenting, Behavior, Emotions, and Suicide Risk scale, Brief Solastalgia Scale and food security scale) and pediatric assessments. Interventions included traditional ceremonies, sanitation improvements, intercultural mental health support, and psychological first aid adapted to local cosmovision. Bivariate analyses were performed. In 2023, 57.4% of participants had nutritional problems and 30% were at suicide risk. Strong associations (p<0.001) were found between suicide risk and variables such as access to clean water and to food, environmental distress, and physical health. By 2025, significant improvements were observed in mental health (r=0.86), food security (r=0.84), environmental distress (r=0.61), and family dynamics (attachment r=0.58). Suicidal behavior is closely linked to ecological, cultural, and nutritional factors rather than only psychiatric disorders. Forced displacement, disconnection from ancestral territory, and spiritual disharmony are central elements. Restoring mental health in Indigenous communities requires culturally grounded interventions that integrate nutrition, land-based practices, and intercultural collaboration. These strategies demonstrate potential for addressing pediatric suicide risk through culturally grounded, collective healing.