Spectroscopic analysis of the sum-frequency response of the carbon-hydrogen stretching modes in collagen type I.

We studied the origin of the vibrational signatures in the sum-frequency generation (SFG) spectrum of fibrillar collagen type I in the carbon-hydrogen stretching regime. For this purpose, we developed an all-reflective, laser-scanning SFG microscope with minimum chromatic aberrations and excellent retention of the polarization state of the incident beams. We performed detailed SFG measurements of aligned collagen fibers obtained from rat tail tendon, enabling the characterization of the magnitude and polarization-orientation dependence of individual tensor elements Xijk2 of collagen's nonlinear susceptibility. Using the three-dimensional atomic positions derived from published crystallographic data of collagen type I, we simulated its Xijk2 elements for the methylene stretching vibration and compared the predicted response with the experimental results. Our analysis revealed that the carbon-hydrogen stretching range of the SFG spectrum is dominated by symmetric stretching modes of methylene bridge groups on the pyrrolidine rings of the proline and hydroxyproline residues, giving rise to a dominant peak near 2942 cm-1 and a shoulder at 2917 cm-1. Weak asymmetric stretches of the methylene bridge group of glycine are observed in the region near 2870 cm-1, whereas asymmetric CH2-stretching modes on the pyrrolidine rings are found in the 2980 to 3030 cm-1 range. These findings help predict the protein's nonlinear optical properties from its crystal structure, thus establishing a connection between the protein structure and SFG spectroscopic measurements.

Softening implantable bioelectronics: Material designs, applications, and future directions.

Implantable bioelectronics, integrated directly within the body, represent a potent biomedical solution for monitoring and treating a range of medical conditions, including chronic diseases, neural disorders, and cardiac conditions, through personalized medical interventions. Nevertheless, contemporary implantable bioelectronics rely heavily on rigid materials (e.g., inorganic materials and metals), leading to inflammatory responses and tissue damage due to a mechanical mismatch with biological tissues. Recently, soft electronics with mechanical properties comparable to those of biological tissues have been introduced to alleviate fatal immune responses and improve tissue conformity. Despite their myriad advantages, substantial challenges persist in surgical handling and precise positioning due to their high compliance. To surmount these obstacles, softening implantable bioelectronics has garnered significant attention as it embraces the benefits of both rigid and soft bioelectronics. These devices are rigid for easy standalone implantation, transitioning to a soft state in vivo in response to environmental stimuli, which effectively overcomes functional/biological problems inherent in the static mechanical properties of conventional implants. This article reviews recent research and development in softening materials and designs for implantable bioelectronics. Examples featuring tissue-penetrating and conformal softening devices highlight the promising potential of these approaches in biomedical applications. A concluding section delves into current challenges and outlines future directions for softening implantable device technologies, underscoring their pivotal role in propelling the evolution of next-generation bioelectronics.

Advances in pediatric anesthesia services over the past 10 years in French-speaking sub-Saharan Africa.

INTRODUCTION: To improve and maintain quality and safety in anesthesia, standards have been proposed regarding human resources, facilities and equipment, medications and intravenous fluids, monitoring, and the conduct of anesthesia. Compliance with these standards remains a challenge in French-speaking sub-Saharan Africa (SSA) and results in high morbidity and mortality particularly in children. This aim of this study was to assess the progress made in improving the pediatric anesthesia infrastructures, human resources, education, medications, and equipment in French-speaking SSA over the past 10 years (2013-2022). METHODS: This is a descriptive, multicenter, cross-sectional study with retrospective data collection, conducted from September 1 to November 5, 2023. Comparative data from 2012 to 2022 were collected through an online survey. Descriptive statistics were used to summarize data. RESULTS: Data were obtained from 12 countries out of 14. The number of hospitals providing pediatric surgery and anesthesia rose from 94 in 2012 to 142 in 2022 (+51%). The total number of physician anesthesiologists rose from 293 (0.1 physician anesthesiologists/100 000 inhabitants) in 2012 to 597 (0.2 physician anesthesiologists/100 000 inhabitants) in 2022 (+103.7%). Five (0.006 physician anesthesiologists/100 000 children) had completed a fellowship in pediatric anesthesia and intensive care in 2012, and 15 (0.01 physician anesthesiologists/100 000 children) in 2022 (+200%). Five physician anesthesiologists had an exclusive pediatric anesthesia practice in 2012, whereas they were 32 in 2022 (+540%). There is no specialized training in pediatric anesthesia and intensive care in any of these countries. Halothane was always available in 81.5% of the hospitals in 2012, and in 50.4% of the hospitals in 2022. Sevoflurane was always available in 5% of the hospitals in 2012, and in 36.2% in 2022. Morphine was always available in 32.2% in 2012, whereas it was available in 52.9% of them in 2022. Pediatric pulse oximeter sensors were available in 36% of the hospitals in 2012, and in 63.4% in 2022. Capnography was available in 5.3% of the hospitals in 2012, and in 48% in 2022. CONCLUSION: Progress have been made over the last 10 years in French-speaking SSA to improve infrastructures, human resources, education, medications, and equipment for pediatric anesthesia in French-speaking SSA. However, major efforts must be continued. Standards adapted to the local context should be formulated.

Body-temperature softening electronic ink for additive manufacturing of transformative bioelectronics via direct writing.

Mechanically transformative electronic systems (TESs) built using gallium have emerged as an innovative class of electronics due to their ability to switch between rigid and flexible states, thus expanding the versatility of electronics. However, the challenges posed by gallium's high surface tension and low viscosity have substantially hindered manufacturability, limiting high-resolution patterning of TESs. To address this challenge, we introduce a stiffness-tunable gallium-copper composite ink capable of direct ink write printing of intricate TES circuits, offering high-resolution (~50 micrometers) patterning, high conductivity, and bidirectional soft-rigid convertibility. These features enable transformative bioelectronics with design complexity akin to traditional printed circuit boards. These TESs maintain rigidity at room temperature for easy handling but soften and conform to curvilinear tissue surfaces at body temperature, adapting to dynamic tissue deformations. The proposed ink with direct ink write printing makes TES manufacturing simple and versatile, opening possibilities in wearables, implantables, consumer electronics, and robotics.

Body Composition, Coronary Microvascular Dysfunction, and Future Risk of Cardiovascular Events Including Heart Failure.

BACKGROUND: Body mass index (BMI) is a controversial marker of cardiovascular prognosis, especially in women. Coronary microvascular dysfunction (CMD) is prevalent in obese patients and a better discriminator of risk than BMI, but its association with body composition is unknown. OBJECTIVES: The authors used a deep learning model for body composition analysis to investigate the relationship between CMD, skeletal muscle (SM), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT), and their contribution to adverse outcomes in patients referred for evaluation of coronary artery disease. METHODS: Consecutive patients (n = 400) with normal perfusion and preserved left ventricular ejection fraction on cardiac stress positron emission tomography were followed (median, 6.0 years) for major adverse events, including death and hospitalization for myocardial infarction or heart failure. Coronary flow reserve (CFR) was quantified as stress/rest myocardial blood flow from positron emission tomography. SM, SAT, and VAT cross-sectional areas were extracted from abdominal computed tomography at the third lumbar vertebra using a validated automated algorithm. RESULTS: Median age was 63, 71% were female, 50% non-White, and 50% obese. Compared with the nonobese, patients with obesity (BMI: 30.0-68.4 kg/m2) had higher SAT, VAT, and SM, and lower CFR (all P < 0.001). In adjusted analyses, decreased SM but not increased SAT or VAT was significantly associated with CMD (CFR <2; OR: 1.38; 95% CI: 1.08-1.75 per -10 cm2/m2 SM index; P < 0.01). Both lower CFR and SM, but not higher SAT or VAT, were independently associated with adverse events (HR: 1.83; 95% CI: 1.25-2.68 per -1 U CFR and HR: 1.53; 95% CI: 1.20-1.96 per -10 cm2/m2 SM index, respectively; P < 0.002 for both), especially heart failure hospitalization (HR: 2.36; 95% CI: 1.31-4.24 per -1 U CFR and HR: 1.87; 95% CI: 1.30-2.69 per -10 cm2/m2 SM index; P < 0.004 for both). There was a significant interaction between CFR and SM (adjusted P = 0.026), such that patients with CMD and sarcopenia demonstrated the highest rate of adverse events, especially among young, female, and obese patients (all P < 0.005). CONCLUSIONS: In a predominantly female cohort of patients without flow-limiting coronary artery disease, deficient muscularity, not excess adiposity, was independently associated with CMD and future adverse outcomes, especially heart failure. In patients with suspected ischemia and no obstructive coronary artery disease, characterization of lean body mass and coronary microvascular function may help to distinguish obese phenotypes at risk for cardiovascular events.

X-ray imaging methods for high-energy density physics applications.

Large scale high-energy density science facilities continue to grow in scale and complexity worldwide. The increase in driver capabilities, including pulsed-power and lasers, continue to push the boundaries of temperature, pressure, and densities, opening up new physics regimes. X-ray imaging is one of the many diagnostic techniques that are used to probe states of matter in these extreme conditions. Improved fabrication and polishing methods have provided improved x-ray microscope performance, while improving detector and x-ray sources now enable pico-second imaging with few micron resolutions. This Review will cover x-ray imaging methods, primarily absorption imaging, and their improvements over the last few decades.

Nutritional and chemical composition of Alpinia zerumbet leaves, a traditional functional food.

Alpinia zerumbet, a species of the Zingiberaceae family, is a common plant in tropical and subtropical areas used in traditional medicine to treat various diseases and also included as food in the traditional Okinawan diet (Japan). The leaves and rhizomes of this plant are used as spice and flavoring in foods such as rice, meats, and pasta. Studies of the chemical and nutritional characteristics of fresh leaves and of leaves submitted to thermal treatments such as boiling and steaming are lacking. In the current study, the leaves of A. zerumbet were subjected to boiling or steaming for 10, 20, and 30 min as part of the thermal treatments. The study also provides noteworthy results regarding the proximate composition, physical-chemical data, minerals, phenolic compounds, antioxidant activity, volatile compounds, and LC-MS chromatographic profiles of the extracts produced with fresh leaves and with thermal treatments. The carbohydrate content of A. zerumbet leaves improved during the thermal treatments, showing an increase after steaming (18.86 to 19.79%) and boiling for 30 min (25.85%). After boiling treatment for 20 min, a significant amount of protein was found (6.79%) and all heat treatments resulted in low content of lipid (<1.0%). The boiling treatment for 10 min (BT10) resulted in the highest concentrations of total phenolic components (TPC), 339.5 mg/g, and flavonoids (TF), 54.6 mg/g, among the three thermal treatments (BT10, BT20 and BT30). The results of the steaming treatments (ST 10, 20, and 30 min) differed, with ST20 leading to higher TPC (150.4 mg/g) and TF (65.0 mg/g). The quantity of total phenolics and flavonoids, as well as the antioxidant activity, were significantly affected by the cooking method and the length of time of sample exposure to heat. The samples boiled for 30 and 10 min had higher concentrations of antioxidant activity as measured by the phosphomolybdenum and DPPH methods (151.5 mg/g of extract and 101.5 µg/mL, respectively). Thirty-eight volatile organic compounds (VOCs) were identified by chromatographic analysis of fresh and thermally treated leaves of A. zerumbet. Terpenoids were the predominant class of volatile compounds in the fresh leaves and in all thermal treatments. p-Cymene, 1,8-cineole, 4-terpineol, linalool, α-copaene and ß-bisabolene have the greatest impact on overall aroma perception, with odor activity values (OAV) greater than five. Among the phenolic compounds identified by LC-HRMS in the extracts of fresh and thermally treated leaves were proanthocyanidins, (+) catechin, (-) epicatechin, quercetin-3-O-glucoronide, isorhamnetin-3-O-glucoronide, kaempferol-3-O-rutinoside, pinocembrin, alpinetin, pinostrobin, and other compounds. The present results support the traditional use of this plant as a potential food with properties that certainly contribute to health improvement.

Design and simulation of multilayer coatings for a multi-channel Wolter-like x-ray imager with large field of view and high resolution.

X-ray diagnostics are key instruments for understanding the physics behind inertial confinement fusion experiments. We report on the multilayer design optimization for the Toroidal X-ray Imager (TXI), a hard x-rays microscope instrument designed by Commissariat à l'énergie atomique (CEA) and Laboratoire Charles Fabry (LCF) to be installed on the National Ignition Facility. TXI includes six channels designed for three different energy bands centered on 8.7, 13, and 17.5 keV. Each channel is made up of two toroidal mirrors arranged in a Wolter-like configuration. The required field of view is 800 × 400 µm2, and the resolution should be better than 5 µm. In addition, we seek to estimate the spatial distribution of the temperature, which requires no spectral overlap of the different energy bands and a good spectral homogeneity of the image produced. The development of the multilayer coatings was performed in a two-step method. First, the coatings were optimized to obtain proper energy bands. Then, an x-ray tracing code was used to calculate the integrated optical response of each channel and adjust the response of the mirror to fulfill the requirements. To fulfill all the specifications, we propose an original design using a combination of two aperiodic coatings, one with a narrow bandwidth and the other one with a larger bandwidth.

Development and Validation of the High Performance Volleyball Self-Efficacy Scale.

In this study, we aimed to develop and psychometrically examine a self-efficacy scale for high-performance volleyball athletes. A literature review and interviews with 16 experts led to construction of item content. A preliminary version of the scale was then administered to 24 high-performing adult athletes, followed by administration of the scale to 300 Brazilian high-performing volleyball athletes (M age = 24.88, SD = 5.51 years; 55% male; 45% female). The definitive model contained 19 items, grouped into three factors (Self-Efficacy in the Game, Defensive Self-Efficacy in Volleyball, and Offensive Self-Efficacy in Volleyball). A Global Self-Efficacy score was evaluated through several statistical procedures that provided evidence of an adequate fit of the model to the data, and we showed internal reliability of the item content and invariance of the instrument for both sexes. These results support the instrument's test content, internal structure, and relation to other variables, indicating that the Volleyball Self-Efficacy Scale (VSES) can now be used to assess the self-efficacy of high performing Brazilian volleyball athletes.

Coronary Flow Reserve, Inflammation, and Myocardial Strain: The CIRT-CFR Trial.

Inflammation is a key determinant of cardiovascular outcomes, but its role in heart failure is uncertain. In patients with cardiometabolic disease enrolled in the prospective, multicenter ancillary study of CIRT (Cardiovascular Inflammation Reduction Trial), CIRT-CFR (Coronary Flow Reserve to Assess Cardiovascular Inflammation), impaired coronary flow reserve was independently associated with increased inflammation and myocardial strain despite well-controlled lipid, glycemic, and hemodynamic profiles. Inflammation modified the relationship between CFR and myocardial strain, disrupting the association between cardiac blood flow and function. Future studies are needed to investigate whether an early inflammation-mediated reduction in CFR capturing microvascular ischemia may lead to heart failure in patients with cardiometabolic disease. (Cardiovascular Inflammation Reduction Trial [CIRT]; NCT01594333; Coronary Flow Reserve to Assess Cardiovascular Inflammation [CIRT-CFR]; NCT02786134).

Design and assembly of an XY-type beam current monitor for cyclotron accelerators.

A water-cooled XY-type beam current monitor was designed, manufactured and assembled in a cyclotron accelerator beam transport line. Tests were performed, demonstrating that apparatus is an instrument of great assistance in proton beam position. The XY-type beam current monitor has been widely used in liquid target irradiations, employing irradiation system which were originally designed for irradiations on 18 MeV cyclotron accelerator (Cyclone 18, IBA) only, however, with this apparatus, the target may be exchanged between the 30 MeV (Cyclone 30, IBA) and 18 MeV cyclotrons.

Fresnel zone plate point spread function approximation for zeroth order mitigation in millimetric field of view x-ray imaging.

High spatial and temporal resolution x-ray radiography images are required at the National Ignition Facility (NIF) for high-energy density experiments. One technique that is in development to achieve the required resolution uses Fresnel zone plate (FZP) optics to image an object that is backlit by an x-ray source. The multiple FZP diffraction orders do not focus on the same plane, which increases the background and reduces the contrast. Understanding the point spread function of the different diffraction orders will allow the prediction of the expected background using simulations. We find that the two-dimensional point spread function of the FZP can be approximated by the addition of a sharp Gaussian with a disk. This allowed for the estimation of the background in NIF experimental images of Rayleigh-Taylor spikes and their interpretation. An alternative design of FZP is discussed to allow the inclusion of a zeroth order blocker to reduce the background.

Real Electrolyte Solutions in the Functionalized Mean Spherical Approximation: A Density Functional Theory for Simple Electrolyte Solutions.

The equation of state based on the mean spherical approximation (MSA) can describe electrolyte solutions as a primitive model, where the ions are charged hard-sphere particles and the solvent is a continuum medium. In recent years, many propositions of the classical density functional theory (cDFT) for electrolyte solutions have been presented. One of these is the functionalized MSA (fMSA) which has proven to be a great functional approach of MSA to calculate the electric double layer structures. This work demonstrates how the fMSA theory can describe real electrolyte solutions (e.g., NaCl, KI, and LiBr) where hydration and solvent concentration effects are present. Experimental data of the mean activity coefficients of different simple salts were successfully reproduced. When the hydrated diameter and the electrolyte solution electric permittivity are used, the fMSA predicts a charge inversion on the electrostatic potential near a charged surface at high salt concentrations.

Accuracy and Reproducibility of Myocardial Blood Flow Quantification by Single Photon Emission Computed Tomography Imaging in Patients With Known or Suspected Coronary Artery Disease.

BACKGROUND: Single photon emission computed tomography (SPECT) has limited ability to identify multivessel and microvascular coronary artery disease. Gamma cameras with cadmium zinc telluride detectors allow the quantification of absolute myocardial blood flow (MBF) and myocardial flow reserve (MFR). However, evidence of its accuracy is limited, and of its reproducibility is lacking. We aimed to validate 99mTc-sestamibi SPECT MBF and MFR using standard and spline-fitted reconstruction algorithms compared with 13N-ammonia positron emission tomography in a cohort of patients with known or suspected coronary artery disease and to evaluate the reproducibility of this technique. METHODS: Accuracy was assessed in 34 participants who underwent dynamic 99mTc-sestamibi SPECT and 13N-ammonia positron emission tomography and reproducibility in 14 participants who underwent 2 99mTc-sestamibi SPECT studies, all within 2 weeks. A rest/pharmacological stress single-day SPECT protocol was performed. SPECT images were reconstructed using a standard ordered subset expectation maximization (OSEM) algorithm with (N=21) and without (N=30) application of spline fitting. SPECT MBF was quantified using a net retention kinetic model' and MFR was derived as the stress/rest MBF ratio. RESULTS: SPECT global MBF with splines showed good correlation with 13N-ammonia positron emission tomography (r=0.81, P<0.001) and MFR estimates (r=0.74, P<0.001). Correlations were substantially weaker for standard reconstruction without splines (r=0.61, P<0.001 and r=0.34, P=0.07, for MBF and MFR, respectively). Reproducibility of global MBF estimates with splines in paired SPECT scans was good (r=0.77, P<0.001), while ordered subset expectation maximization without splines led to decreased MBF (r=0.68, P<0.001) and MFR correlations (r=0.33, P=0.3). There were no significant differences in MBF or MFR between the 2 reproducibility scans independently of the reconstruction algorithm (P>0.05 for all). CONCLUSIONS: MBF and MFR quantification using 99mTc-sestamibi cadmium zinc telluride SPECT with spatiotemporal spline fitting improved the correlation with 13N-ammonia positron emission tomography flow estimates and test/retest reproducibility. The use of splines may represent an important step toward the standardization of SPECT flow estimation.

Rapid meniscus-guided printing of stable semi-solid-state liquid metal microgranular-particle for soft electronics.

Liquid metal is being regarded as a promising material for soft electronics owing to its distinct combination of high electrical conductivity comparable to that of metals and exceptional deformability derived from its liquid state. However, the applicability of liquid metal is still limited due to the difficulty in simultaneously achieving its mechanical stability and initial conductivity. Furthermore, reliable and rapid patterning of stable liquid metal directly on various soft substrates at high-resolution remains a formidable challenge. In this work, meniscus-guided printing of ink containing polyelectrolyte-attached liquid metal microgranular-particle in an aqueous solvent to generate semi-solid-state liquid metal is presented. Liquid metal microgranular-particle printed in the evaporative regime is mechanically stable, initially conductive, and patternable down to 50 µm on various substrates. Demonstrations of the ultrastretchable (~500% strain) electrical circuit, customized e-skin, and zero-waste ECG sensor validate the simplicity, versatility, and reliability of this manufacturing strategy, enabling broad utility in the development of advanced soft electronics.

Detection and estimation of Mastigimas anjosi (Hemiptera: Calophyidae) populations on Cedrela fissilis trees.

Mastigimas anjosi is an important pest of Cedrela fissilis in the southeastern and southern regions of Brazil. The objective of the present study was to investigate the effect of the temperature, relative humidity, rainfall and natural enemies on the flight activity of adults and the movement of M. anjosi nymphs, with two sampling methods, yellow sticky traps and direct collections on the leaves of C. fissilis trees. The sex ratio of this pest was also assessed. The number of M. anjosi individuals was negatively correlated with the minimum and maximum temperatures, with a population peak in late May and early June 2017. The numbers of individuals of this psyllid was positively correlated with the relative humidity and rainfall. Larvae and adults of Cycloneda sanguinea, Hippodamia convergens adults and Atopozelus opsimus nymphs and adults preyed upon M. anjosi adults and nymphs on C. fissilis leaves in the field. Mastigimas anjosi sex ratio was 0.46. Information about sampling methods of M. anjosi and its natural enemies is presented and can contribute to the integrated management of this pest in the field.

Coronary Arterial Function and Disease in Women With No Obstructive Coronary Arteries.

Ischemic heart disease (IHD) is the leading cause of mortality in women. While traditional cardiovascular risk factors play an important role in the development of IHD in women, women may experience sex-specific IHD risk factors and pathophysiology, and thus female-specific risk stratification is needed for IHD prevention, diagnosis, and treatment. Emerging data from the past 2 decades have significantly improved the understanding of IHD in women, including mechanisms of ischemia with no obstructive coronary arteries and myocardial infarction with no obstructive coronary arteries. Despite this progress, sex differences in IHD outcomes persist, particularly in young women. This review highlights the contemporary understanding of coronary arterial function and disease in women with no obstructive coronary arteries, including coronary anatomy and physiology, mechanisms of ischemia with no obstructive coronary arteries and myocardial infarction with no obstructive coronary arteries, noninvasive and invasive diagnostic strategies, and management of IHD.

Cold plasma technique as a pretreatment for drying fruits: Evaluation of the excitation frequency on drying process and bioactive compounds.

The present work aims to evaluate the effect of different excitation frequency (200, 500 and 800 Hz) of cold plasma technique as a pretreatment for drying tucumã. SEM images showed changes on the pretreated tucumã's surface, favoring the drying rate and diffusivity of water as well as reducing the drying time. Marginal variation of color and reduced drying time were observed in the samples treated using 200 and 800 Hz. The pretreatment improved the concentration of phenolic (45.3 mg GAE g-1) and antioxidant compounds (799.8 µM ET) (p-value < 0.05). Carotenoids were more sensitive to the drying time, presenting significant degradation at 500 Hz. For this reason, the propose pretreatment based on the application of cold plasma technique for drying foods can preserve/improve their nutritional quality.

X-ray imaging of Rayleigh-Taylor instabilities using Fresnel zone plate at the National Ignition Facility.

Being able to provide high-resolution x-ray radiography is crucial in order to study hydrodynamic instabilities in the high-energy density regime at the National Ignition Facility (NIF). Current capabilities limit us to about 20 µm resolution using pinholes, but recent studies have demonstrated the high-resolution capability of the Fresnel zone plate optics at the NIF, measuring 2.3 µm resolution. Using a zinc Heα line at 9 keV as a backlighter, we obtained a radiograph of Rayleigh-Taylor instabilities with a measured resolution of under 3 µm. Two images were taken with a time integrated detector and were time gated by a laser pulse duration of 600 ps, and a third image was taken with a framing camera with a 100 ps time gate on the same shot and on the same line of sight. The limiting factors on image quality for these two cases are the motion blur and the signal to noise ratio, respectively. We also suggest solutions to increase the image quality.

Beyond effectiveness of the Strengthening Families Program (10-14): a scoping RE-AIM-based review.

A scoping review, based on the RE-AIM framework, was conducted to analyze evidence of reach, effectiveness, adoption, implementation, and maintenance of the Strengthening Families Program (10-14), a preventive family-based substance abuse program for adolescents. Sixty-five articles were included. The results disclosed that effectiveness, implementation, and maintenance at the individual-level were the most evaluated aspects, while reach, maintenance at the setting-level, and adoption were the least investigated aspects. Positive effects on drug abuse prevention and protective parenting factors were found in the U.S. studies. Likewise, Latin American studies have shown the improvement of parenting practices. However, European studies have produced mixed results, with predominantly null effects on substance abuse. The implementation quality was high. There is no available evidence of adoption and maintenance at the setting-level by the organizations that implemented it. New studies must examine the reach, adoption, and sustainability of the program to lay foundations for its future use as an instrument of public policies.