Mapa de evidências - Doenças Crônicas Não Transmissíveis

Este mapa de evidências apresenta estratégias para o cuidado de pessoas com as seguintes Doenças Crônicas Não Transmissíveis (DCNT): Diabetes Mellitus Tipo 2, Hipertensão Arterial sistêmica e Obesidade. A partir de uma ampla busca bibliográfica realizada para o desenvolvimento de 7 revisões rápidas, 93 estudos de revisão foram incluídos no mapa (62 revisões sistemáticas, 31 revisões sistemáticas com meta-análise). Com base na ferramenta AMSTAR2, foi avaliado o nível de confiabilidade para a evidência reportada nestes estudos, resultando em 2 revisões de nível alto, 5 revisões de nível moderado, 10 revisões de nível baixo e 76 revisões de nível criticamente baixo. Todos os estudos foram avaliados, caracterizados, categorizados por uma equipe multiprofissional organizada em pares, composta por pesquisadores que atuam nas áreas de Saúde Coletiva e Políticas Informadas por Evidências. Principais Achados: ● As revisões avaliaram o efeito de 26 intervenções distribuídas em 5 grupos: Teleconsulta/eHealth, Tratamento farmacológico, Automonitoramento/autogerenciamento, Educação, e Serviço de saúde; ● As intervenções foram associadas a 22 desfechos relacionados às DCNT distribuídos em 3 grupos: resultados clínicos, resultados não clínicos e segurança; ● No total foram encontradas 196 associações entre intervenções, desfechos e efeitos nos estudos selecionados. A maior parte das associações foi com intervenções de cuidado assistencial (32 associações) e intervenções combinadas (24 associações); ● Os desfechos que receberam maior número de associações foram: Pressão Arterial (36 associações), Peso corporal (34 associações), Adesão ao tratamento farmacológico (29 associações) e Satisfação do paciente (21 associações).

Personalized Cancer Vaccines Directed against Tumor Mutations: Building Evidence from Mice to Humans.

Personalized vaccines directed to tumor mutations have recently gained significant momentum. On the basis of the concept of stimulating T-cell responses against neoantigens encoded by a tumor's host of personal mutations, these vaccines utilize genome or exome sequencing, mutation calling, and epitope prediction followed by manufacturing of a customized vaccine for each patient. In their 2012 Cancer Research publication, Castle and colleagues provided evidence that vaccinating with long peptide vaccines encompassing neoantigens can generate robust immune responses and induce antitumor activity in a mouse B16F10 melanoma. This approach, harnessing the exquisite specificity of mutations to the tumor and thus providing an effective target for cancer vaccines, was subsequently shown to be safe and immunogenic in a series of small first in man trials in patients with melanoma. The field has accelerated and expanded substantially over the last 5 years, propelled by increasing evidence for vaccine-mediated clinical efficacy, leading to ongoing registrational trials using personalized RNA neoantigen vaccines in patients with melanoma and several other malignancies. See related article by Castle and colleagues, Cancer Res 2012;72:1081-91.

Experimental evidence of d-glutamate racemase activity in the uncultivated bacterium Candidatus Saccharimonas aalborgensis.

The Candidate Phyla Radiation (CPR) encompasses widespread uncultivated bacteria with reduced genomes and limited metabolic capacities. Most CPR bacteria lack the minimal set of enzymes required for peptidoglycan (PG) synthesis, leaving it unclear how these bacteria produce this essential envelope component. In this study, we analysed the distribution of d-amino acid racemases that produce the universal PG components d-glutamate (d-Glu) or d-alanine (d-Ala). We also examined moonlighting enzymes that synthesize d-Glu or d-Ala. Unlike other phyla in the domain Bacteria, CPR bacteria do not exhibit these moonlighting activities and have, at most, one gene encoding either a Glu or Ala racemase. One of these 'orphan' racemases is a predicted Glu racemase (MurICPR) from the CPR bacterium Candidatus Saccharimonas aalborgenesis. The expression of MurICPR restores the growth of a Salmonella d-Glu auxotroph lacking its endogenous racemase and results in the substitution of l-Ala by serine as the first residue in a fraction of the PG stem peptides. In vitro, MurICPR exclusively racemizes Glu as a substrate. Therefore, Ca. Saccharimonas aalborgensis may couple Glu racemization to serine and d-Glu incorporation into the stem peptide. Our findings provide the first insights into the synthesis of PG by an uncultivated environmental bacterium and illustrate how to experimentally test enzymatic activities from CPR bacteria related to PG metabolism.

A new combination and synonym in Bupleurum (Apiaceae, Apioideae), based on morphological, molecular and cytological evidence.

Specimen examinations and field observations revealed that Bupleurumsmithiivar.parvifolium was distinctly different from B.smithiivar.smithii in umbel, leaf, and fruit morphology, but was very similar to B.commelynoideumvar.flaviflorum. Based on these morphological evidences, the present study re-examined the taxonomic status of these taxa through morphological, cytological, and phylogenetic analyses. The results showed distinguishable features in the width of middle leaves and bracteoles of B.smithiivar.parvifolium compared to B.smithiivar.smithii. Morphological variation between B.smithiivar.parvifolium and B.commelynoideumvar.flaviflorum was continuous and overlapping. Notably, the chromosome number of B.smithiivar.parvifolium was 2n = 14 (x = 7), consistent with B.commelynoideumvar.flaviflorum, whereas B.smithiivar.smithii was 2n = 64 (x = 8). Additionally, phylogenetic analyses revealed B.commelynoideumvar.flaviflorum nested within B.smithiivar.parvifolium, and that both were distant from the B.smithiivar.smithii and B.commelynoideumvar.commelynoideum. Based on the evidence above, the differences between B.smithiivar.parvifolium and B.smithiivar.smithii extend beyond the level of intraspecific variation, and B.commelynoideumvar.flaviflorum is considered to be identical with B.smithiivar.parvifolium. Hence. A new combination and status, B.parvifolium (Shan & Y.Li) Q.R.Liu & L.H.Wang, comb. et stat. nov., is proposed. Furthermore, B.commelynoideumvar.flaviflorum should be treated as a synonym of B.parvifolium.

An Evidence Based Rationale for Health and Wellness Coaching as a Complementary Certification in Undergraduate Health Education.

Health and wellness coaching (HWC) is an effective intervention for many chronic lifestyle diseases. Chronic diseases represent a majority of our severe national healthcare burden. Yet, HWC certification programs vary in delivery method and degree awarded. The purpose of this paper is to provide an evidence based rationale for HWC as a complementary area of study to non-licensure granting, undergraduate health degrees in higher education. A comprehensive review of the literature related to the efficacy of HWC was completed. In addition, the national program directory was mined for descriptive data for approved HWC programs. Given the growing body of support for HWC as an effective intervention, we recommend that institutions deliver HWC curricula as an academic minor for undergraduate students in non-licensure granting health-related degrees to position graduates for entry level careers in HWC. Evidence from the successful deployment of an undergraduate program in HWC supports our contention that HWC be delivered as an academic minor in support of lifestyle health and wellness education. In doing so, the field can offer HWC in a way that is widely accessible to the undergraduate population, while providing a mechanism for direct employment as a professional health and wellness coach.

Confirmation of the valid specific status of Dolichovespulakuami Kim & Yoon, 1996 (Hymenoptera, Vespidae) based on molecular and morphological evidence.

The taxonomic validity of Dolichovespulakuami, especially in relation to D.flora, has been the subject of a long-term debate. Herein, the valid specific status of the former was supported through an integrated analysis of morphological characters and DNA barcodes. The pronotal rugae and male genitalia of the two species are different, and partial mitochondrial genes (cytochrome oxidase subunit I, COI) indicate that they form significantly distinct lineages. The hitherto unknown male of D.kuami is described for the first time, and a brief discussion of the D.maculata species group is provided.

New psychometric evidence for the thesis advisor abuse scale (EMAT) in Peruvian university students based on classic and modern procedures.

Although evidence of mistreatment toward university students in the academic field has been reported for several years, its study in the context of the development of undergraduate research is still emerging. For this reason, it is necessary to have valid and reliable measurement instruments that allow assessing the magnitude of this problem. The objective of this study was to evaluate the psychometric properties of the Thesis Advisor Abuse Scale (EMAT, for its acronym in Spanish) in Peruvian university students. A total of 753 university students (women = 57.4%) from the 3 regions of Peru participated. The internal structure was analyzed under an analytical-factorial approach, and the discrimination and difficulty characteristics of the items were evaluated from the perspective of item response theory (IRT). The findings showed evidence supporting the original three-dimensional structure. Furthermore, all the items on the EMAT have good discriminatory power. Additionally, the EMAT proved to be strictly invariant according to sex, and the reliability coefficients reached high magnitudes. It is concluded that the EMAT is an instrument that has adequate psychometric properties to be used as a measure of mistreatment by advisors in the thesis preparation processes in Peruvian university students.

College students' satisfaction with online teaching during the COVID-19 pandemic: Evidence from Hubei Province, China.

To evaluate the performance of online teaching during the COVID-19 period, we collected 1886 survey data from college students in Hubei Province, China. The scoring rules of the Framework for Teaching were used to measure college students' satisfaction with online teaching, and an econometric model was constructed to empirically validate its dynamic influences. We found that college students' satisfaction with online teaching during the COVID-19 pandemic was lower than that with offline teaching. Online teaching satisfaction was significantly affected by variables of class size, proportion of online teaching, epidemic severity, college grade, network, course classification, major classification, and the teacher's age and skills. It was further found that as COVID-19 gradually dissipated, offline teaching should be resumed as soon as possible. These findings objectively evaluate the teaching performance of college students during the COVID-19 pandemic and can provide suggestions for optimizing online teaching during future emergencies.

Machine learning approach to identify malaria risk in travelers using real-world evidence.

Background: Pre-travel consultation and chemoprophylaxis measures for malaria are a key component in the prevention of imported malaria in travelers. In this study we report a predictive tool for assessing personalized malaria risk in travelers based on the analysis of electronic medical records from travel consultations. The tool aims to guide physicians in the recommendation of appropriate prophylaxis prior to their trip. We also provide best-practice recommendations for pre-processing noisy and highly sparse real world evidence data. Methods: We leveraged a large EMR dataset, containing demographic information about travelers and their destination. The data has been previously preprocessed using various strategies to handle missing and unbalanced data. We compared multiple machine learning approaches to assess the risk of malaria acquisition in travelers during their travels. Additionally, a feature importance analysis was performed using SHAP (SHapley Additive Explanations) values to identify patterns associated with malaria risk. Results: Our study revealed that our XGB models achieved high predictive capacity (AUC >0.80). The most significant features predicting malaria infection during travel included travel destinations with low malaria risk, vaccination history, number of countries visited, age, and trip duration. Remarkably, we were able to obtain a reduced model with only five features. When comparing this model with a population of travelers recommended for malaria chemoprophylaxis, we observed that it was deemed necessary in only 40% of these travelers. This suggests that 60% received chemoprophylaxis despite having a low personalized risk of malaria. Conclusion: We have developed an algorithmic tool that utilizes a concise survey to generate a personalized travel risk assessment, effectively minimizing the prescription of unnecessary malaria chemoprophylaxis. Through the identification of patterns linked to predictions, our model significantly enhances the efficacy of pre-travel consultations.

State-owned capital and quality of green innovation: Evidence from Chinese listed private firms.

Green innovation is pivotal for global sustainability, with state-owned capital playing a significant role, especially in the Chinese corporate landscape. This study, spanning 2008 to 2020 and leveraging a comprehensive dataset of listed companies, explores the intricate relationship between state-owned capital and the quality of green innovation in Chinese private enterprises. Motivated by the imperative to address crucial issues in green innovation quality in China, this research utilizes empirical data to uncover the mechanisms through which state-owned capital fosters green innovation. The study reveals how state-owned capital optimizes internal governance structures and reinforces environmental consciousness within private firms. Findings underscore the crucial role of state-owned capital in enhancing the quality of green innovation in private enterprises, operating through two primary mechanisms. Firstly, state-owned capital cultivates a heightened inclination towards green innovation within these firms. Secondly, it facilitates the adoption of enhanced internal governance practices, catalyzing the development of high-quality green innovation projects. A battery of mechanism tests provides robust evidence that state-owned capital enhances environmental awareness, restrains self-serving behaviors among major shareholders, mitigates financing constraints, and amplifies the motivation and capability of private enterprises for green innovation. This multifaceted approach ultimately fosters high-quality green innovation within companies. The study reveals the subtle interplay between state capital and private sector green innovation, highlighting its relevance to policymaking and practical considerations. It provides valuable insights into the ongoing pursuit of sustainability and the integration of green practices into the corporate world.

The impact of the free trade zones construction on green technological innovation efficiency --evidence from 288 cities in Chinese.

We measure the green technology innovation efficiency of 288 cities in China from static and dynamic dimensions using the super-SBM model and Malmquist-Luenberger index, and employ "Difference in Difference" (DID) model to evaluate the impact of FTZs construction on green technology innovation efficiency using panel data from 288 prefecture-level cities from 2008 to 2020. The findings show: (1) The FTZs significantly improve green technology innovation efficiency. The decomposition indexes promote the green technology innovation efficiency more from the dynamic productivity dimension (GTFP) functioning on technological advancement. (2) The FTZs can boost the efficiency of green technology innovation through industrial agglomeration, digital economy, and government financial support; (3) The effect of FTZs on the efficiency of green technology innovation differs based on the size and location of the city. Green technology innovation will reach maximum potential when promoting FTZ policy in less developed central, western, and interior regions. This study addresses whether FTZ policies can genuinely support regional green innovation and policy insights to expand opening up and enhance high-quality economic growth.

Measuring the psychosocial impact of COVID-19 by means of the "international student well-being study questionnaire": Evidence on Italian university students.

Background: The COVID-19 pandemic appeared as an unpredictable disruption of daily activities. This situation produced a unique mental health impact for the general population, youth, and vulnerable groups. A documented consequence has been alcohol abuse and impaired mental health. To our knowledge, no published study has yet evaluated the rates of depressive symptoms, academic frustration, and substance abuse in the Italian student population in the COVID era linking them to sociodemographic variables. Aims: To investigate the incidence of depressive symptoms, academic frustration, and substance abuse students developed in one university in Northern Italy during the first COVID-19 outbreak, using a student wellbeing framework borrowed from Allardt's and Bronfenbrenner's theories. Methods: Descriptive statistics, correlations, Wilcoxon test and factorial ANOVA were performed on data gathered through an online questionnaire sent to a convenience sample of university students. Data collection occurred between 18 May and June 21, 2020. Results: According to the framework used, Being was the dimension of sociodemographic variables, Having was economic support and Loving was social support. Students experienced academic frustration and related depressive symptoms. Male gender seemed to be less affected by the depressive syndrome. With regard to economic support and related repercussions on depressive symptoms, students who reported that they could not obtain a loan showed significantly higher depressive symptoms. Students benefiting from greater financial support showed less academic frustration. Age appeared to be a predictor of academic frustration since young students proved to be the most frustrated. The examined students' population showed a significant decrease in alcohol and cigarettes consumption. Conclusions: Having and Being dimensions influenced depression and academic frustration. Having and Loving dimensions were related with use of substances. The study findings support the implementation of interventions to help students, at a psychological, social, financial level aiming at fostering the quality of students' educational life.

Magnetoelectrocatalysis: Evidence from the Hydrogen Evolution Reaction.

Hydrogen evolution reaction (HER) rates are higher where magnetic gradients are established at electrode surfaces. In comparison of literature data for metals with comparable work functions, we note 1000× higher rates for paramagnetic metals than diamagnetic metals. With unpaired electron spins, paramagnetic and ferromagnetic metals establish interfacial magnetic gradients. At diamagnetic electrodes, gradients are induced by addition of magnetized microparticles. Onset of hydrogen evolution for magnetized γ-Fe2O3 microparticles in Nafion on diamagnetic glassy carbon electrodes is lower by 190 mV (-18 kJ mol-1) relative to demagnetized microparticles. Chemically the same as demagnetized particles, the physical distinction of magnetic field and gradient at magnetized microparticles increases electron transfer rate. For magnetized Fe3O4 microparticles, the onset is lower by 280 mV (-27 kJ mol-1). Paramagnetic platinum electrodes are unaffected by addition of magnetized microparticles. Magnetoelectrocatalysis is established by magnetic gradients.

Prevention of cisplatin-induced hearing loss in children: achievements and challenges for evidence-based implementation of sodium Thiosulfate.

Ototoxicity is a devastating direct, irreversible side effect of platinum use in children with cancer, with its consequent effect on speech, language and social development, quality of life and adult productivity. Cisplatin, an essential chemotherapeutic agent for the treatment of solid tumors in children, is a DNA cross-linking agent. Which causes hearing loss in 50-70% of cisplatin treated children. Fortunately, to prevent hearing loss, sodium thiosulfate (STS), which binds to cisplatin, and reduces the superoxides in both tumor and outer hair cells of the cochlea has now been discovered to be an effective and safe otoprotectant if administered correctly. The aim of this perspective paper is to explore the key safety issues and challenges important for pediatric oncologists and pharmacists when considering the clinical use of STS as an otoprotectant for children and adolescents receiving cisplatin. These include: the choice of the formulation; the timing, both that of the STS in relation to cisplatin as well as the timing of the cisplatin infusion itself; the dosing; the challenge left by the definition of localized versus disseminated disease and the difference in indication for STS, between cisplatin treated patients and those receiving another platinum chemotherapeutic agent, carboplatin.

Exploring the association between social isolation and utilization of primary health services by older adults: evidence from China.

Objective: This study aims to investigate the impact of social isolation on the utilization of primary health services among older adults in China. Methods: Data from the China Longitudinal Aging Social Survey (CLASS) conducted in 2018 were utilized. A binary logistic regression model was established, and propensity score matching (PSM) was employed for analysis. Results: The results of the binary logistic regression showed that family isolation within social isolation had a significant negative impact on the utilization of primary health services for older adults. In contrast, there was no significant association between friend isolation, community isolation, and the utilization of primary health services. Furthermore, the PSM results, using three matching methods (nearest neighbor matching, radius matching, and kernel matching), confirmed that family isolation significantly reduced older adults' utilization of primary health services, consistent with the baseline regression findings. Conclusion: Reducing the occurrence of family isolation among older adults may be a cost-effective intervention measure. Efforts should be directed toward improving family support for older adults, promoting the utilization of primary health services, and strengthening disease prevention.

Resveratrol and vascular health: evidence from clinical studies and mechanisms of actions related to its metabolites produced by gut microbiota.

Cardiovascular diseases are among the leading causes of mortality worldwide, with dietary factors being the main risk contributors. Diets rich in bioactive compounds, such as (poly)phenols, have been shown to potentially exert positive effects on vascular health. Among them, resveratrol has gained particular attention due to its potential antioxidant and anti-inflammatory action. Nevertheless, the results in humans are conflicting possibly due to interindividual different responses. The gut microbiota, a complex microbial community that inhabits the gastrointestinal tract, has been called out as potentially responsible for modulating the biological activities of phenolic metabolites in humans. The present review aims to summarize the main findings from clinical trials on the effects of resveratrol interventions on endothelial and vascular outcomes and review potential mechanisms interesting the role of gut microbiota on the metabolism of this molecule and its cardioprotective metabolites. The findings from randomized controlled trials show contrasting results on the effects of resveratrol supplementation and vascular biomarkers without dose-dependent effect. In particular, studies in which resveratrol was integrated using food sources, i.e., red wine, reported significant effects although the resveratrol content was, on average, much lower compared to tablet supplementation, while other studies with often extreme resveratrol supplementation resulted in null findings. The results from experimental studies suggest that resveratrol exerts cardioprotective effects through the modulation of various antioxidant, anti-inflammatory, and anti-hypertensive pathways, and microbiota composition. Recent studies on resveratrol-derived metabolites, such as piceatannol, have demonstrated its effects on biomarkers of vascular health. Moreover, resveratrol itself has been shown to improve the gut microbiota composition toward an anti-inflammatory profile. Considering the contrasting findings from clinical studies, future research exploring the bidirectional link between resveratrol metabolism and gut microbiota as well as the mediating effect of gut microbiota in resveratrol effect on cardiovascular health is warranted.

Association between the gut microbiota, inflammatory factors, and colorectal cancer: evidence from Mendelian randomization analysis.

Background: Colorectal cancer (CRC) is one of the most common malignant tumors primarily affecting individuals over the age of 50 years. Recent studies have suggested that the dysbiosis of the gut microbiota, a community of microorganisms in the human gut, is closely associated with the occurrence and development of CRC. Additionally, inflammatory factors (IFs) have also been reported to play a significant role in the development of CRC. However, the causal relationships between the gut microbiota, IFs, and CRC remain unclear. Methods: In this study, we performed Mendelian randomization (MR) analysis using publicly available genome-wide association study (GWAS) data to explore the causal relationship between the gut microbiota, IFs, and CRC. The gut microbiota GWAS data were obtained from the MiBioGen study, while the IFs GWAS data were derived from the comprehensive analysis of three independent cohorts. Causal relationship analysis was conducted using appropriate instrumental variables (IVs) and statistical models. Results: MR analysis of the gut microbiota and CRC revealed a negative correlation between the Lachnospiraceae species in the gut and CRC risk, while a positive correlation was observed between Porphyromonadaceae species, Lachnospiraceae UCG010 genus, Lachnospira genus, and Sellimonas genus in the gut, and CRC risk. Additionally, we observed a causal relationship between IL-10 and CRC risk. These findings suggest that the dysbiosis of the gut microbiota might be associated with an increased risk of CRC and that specific bacterial groups may play a crucial role in the occurrence and development of CRC. Conclusion: Using MR analysis, this study revealed the causal relationships between the gut microbiota, IFs, and CRC. The negative correlation between the Lachnospiraceae species in the gut and CRC risk, as well as the causal relationship between IL-10 and CRC, provide important clues for the potential roles of gut microbiota regulation and inflammatory factor control in the prevention and treatment of CRC.

Higher serum chromium level may be associated with the presentation of depression in patients with metabolic dysfunction-associated fatty liver disease: evidence from NHANES survey.

Background: Depressive symptoms are frequently observed in patients with Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD), a prevalent metabolic disorder that affects many individuals. It is not yet clear whether there is an association between serum chromium levels and depression. Objective: The purpose of this research was to explore the association between serum chromium level and the manifestation of depression among patients with MAFLD. Methods: The selection of 1837 patients diagnosed with MAFLD was based on data obtained from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) database in this research. The Patient Health Questionnaire-9 (PHQ-9) was employed to evaluate the severity of depression. The researchers utilized logistic regression models that were weighted for multiple variables to investigate the association between depression and serum chromium levels. Results: In our study, we found that 8.98% of US adults with MAFLD were suffering from depression at the time of evaluation. In the logistic regression model, serum chromium levels showed an inverse association with depression (OR=0.82, 95%CI: 0.69-0.96; p=0.016), this relationship remained after adjusting for fully confounding factors (OR=0.83, 95%CI: 0.71-0.97; p=0.021), subgroup analyses showed that the association between serum chromium levels and depression existed in relatively high-prevalence of depression groups. Conclusion: Patients diagnosed with MAFLD have a greater likelihood of experiencing depression, whereas individuals with higher levels of serum chromium are less likely to suffer from depression, and this association persists even after adjusting for other factors. These findings indicate supplementing chromium may be a viable treatment for their depressive symptoms.

Nimodipine prophylaxis in aneurysmal subarachnoid hemorrhage, a question of tradition or evidence: A scoping review.

BACKGROUND: The prophylactic use of nimodipine following subarachnoid hemorrhage is a practice established four decades ago when clinical management differed from current and the concept of Delayed Cerebral Ischemia (DCI) was not established. The applicability of the original studies is limited by the fact of not reflecting current practice; by utilising a dichotomised outcome measure such as good neurological outcome versus death and vegetative state; by applying variable dosing regimens and including all causes of poor neurological outcome different than DCI. This study aims to review the available evidence to discuss the ongoing role of nimodipine in contemporaneous clinical practice. METHODS: PRISMA guidelines based review, evaluated the evidence on the prophylactic use of nimodipine. The following search engines: Medline, Embase, Cochrane, Web of Science and PubMed, identified Randomized Control Trials (RCTs) with neurological benefit as outcome measure and the impact of fixed versus weight-based nimodipine dosing regimens. RESULTS: Eight RCT were selected. Three of those trials with a total of 349 patients, showed a reduction on death and vegetative state (pooled RR: 0.62; 95 % confidence interval-CI: 0.45, 0.86) related to DCI. Amongst all studies, all cause death (pooled RR = 0.73, [95 % CI: 0.56, 0.97]) favoured a fixed-dose regimen (pooled RR: 0.60; [95 % CI: 0.43, 0.85]). CONCLUSION: Available evidence demonstrates that nimodipine only reduces the risk for DCI-related death or vegetative state and that fixed-dose regimens favour all cause infarct and death independent of DCI. Contemporaneous studies assessing the benefit of nimodipine beyond death or vegetative states and applying individualized dosing are warranted.

Evidence-based practice criteria's effect on the implementation of the family first prevention services act in Nebraska and Colorado.

Child abuse, particularly neglect, is often preventable because many causes of harm stem from poverty, lack of social connections, substance use disorders, mental illness, lack of childcare, and other family support shortages. Prevention of child abuse and neglect starts with family support in these areas. The federal government recognized this need for prevention, and through considerable bipartisan support, passed the Family First Prevention Services Act on February 9, 2018. The Family First Prevention Services Act was designed to divert investment away from long-term foster care and toward programs that prevent unnecessary placement and child protective services interventions. The Family First Prevention Services Act restricts the state's use of federal funds for institutional foster care placements and uses those savings to fund reimbursements for evidence-based family preservation. The requirement for evidence-based prevention is a first in child-welfare federal law, and compliance with this requirement requires public-private partnership with agencies implementing the models, infrastructure, and evaluation standards that most states must build to be eligible for the new funding. This evaluation research analyzed how the stringent guidelines for prevention funding and the requirement of federally approved evidence-based practice programming affect the implementation of the Family First Prevention Services Act in Nebraska and Colorado.