Changes In System Research Articles

Endobronchial Phenylephrine in Airway Bleeding During Bronchoscopy Does not Cause Hypertension: A Retrospective Observational Study.

Bleeding is a known complication during bronchoscopy, with increased incidence in patients undergoing a more invasive procedure. Phenylephrine is a potent vasoconstrictor that can control airway bleeding when applied topically and has been used as an alternative to epinephrine. The clinical effects of endobronchial phenylephrine on systemic vasoconstriction have not been clearly evaluated. Here, we compared the effects of endobronchial phenylephrine versus cold saline on systemic blood pressure. In all, 160 patients who underwent bronchoscopy and received either endobronchial phenylephrine or cold saline from July 1, 2017 to June 30, 2022 were included in this retrospective observational study. Intra-procedural blood pressure absolute and percent changes were measured and compared between the 2 groups. There were no observed statistical differences in blood pressure changes between groups. The median absolute change between the median and the maximum intra-procedural systolic blood pressure in the cold saline group was 29mmHg (IQR 19 to 41) compared with 31.8mmHg (IQR 18 to 45.5) in the phenylephrine group. The corresponding median percent changes in SBP were 33.6 % (IQR 18.8 to 39.4) and 28% (IQR 16.8 to 43.5) for the cold saline and phenylephrine groups, respectively. Similarly, there were no statistically significant differences in diastolic and mean arterial blood pressure changes between both groups. We found no significant differences in median intra-procedural systemic blood pressure changes comparing patients who received endobronchial cold saline to those receiving phenylephrine. Overall, this argues for the vascular and systemic safety of phenylephrine for airway bleeding as a reasonable alternative to epinephrine.

In Ukrainian

The relevance of obtaining new samples of nanoscale materials and researching ways to control these processes is supported by constant progress in the fields of nanotechnology, semiconductors, biomedicine, wastewater treatment etc. The Fe0(Steel3)-H2O-O2 system, which is considered promising for use in the specified industries, allows both obtaining a number of nanoscale phases of iron oxygen-containing compounds (IOCs), in particular magnetite, cobalt ferrous ferrite, iron(III) hydroxide oxides, and controlling these processes due to changes in the physicochemical conditions of the process. Taking into account the permanent change in the specified system of phase composition on the metal surface, the method of X-ray diffraction analysis (XRD) was applied using the created additional device for the goniometric attachment GP-13 for the in situ study of IOCs formation processes on the surface of a steel disc in the system Fe0(St3)-H2O-O2. This made it possible to investigate the mechanisms and optimal conditions for the formation of individual ultradisperse and nanosized phases of IOCs under a number of physicochemical conditions. By calculating the area under the characteristic peaks on the in situ XRD patterns, quantitative ratios of IOCs formed under certain physicochemical conditions were found, and the average size of crystallites was calculated according to Scherer's formula, which provided additional information for the analysis of IOCs formation mechanisms. Along with this, the method of scanning electron microscopy (SEM) and the XRD without an additional in situ device were used. Based on the analysis of the obtained kinetic regularities, conclusions were made about the formation of IOCs by the formation of iron (II-III) hydroxycarbonate and hydroxysulfate layered double hydroxides I and II types, followed by their transformation to the final nanoscale phases of magnetite, cobalt ferrous ferrite, and iron(III) hydroxide oxides. The formation and accumulation of ferrous hydroxide phase was not recorded by the XRD in situ, however, in the Fe0(St3)-H2O-O2 system, the formation of iron (II-III) layered double hydroxides based on its monolayers is not excluded. The preference of carbonate anions over chloride anions in the formation processes of iron layered double hydroxides is shown.

DIRECTIONS OF CHANGES WITHIN THE FAMILY FOSTER CARE SYSTEM. REPORT FROM RESEARCH IN THE PROVINCE OF SILESIA

The development of family foster care forms is closely related to the adopted assumptions of changes within the foster care system. The objective of the article is to demonstrate the directions of changes occurring in the family foster care system, to determine the relationship between the indicators of the deinstitutionalization process and the differences in the functioning of foster care system in towns with district rights and country districts. The study was carried out on the basis of financial and material reports on the performance of tasks in terms of family and foster care system support in the province of Silesia. The findings of the study provide a better understanding of the impact of the processes of change in the foster care system on the ongoing regression of the development of family foster care forms.

An entropy based spatial-temporal cube with its application to assess stress of overburden due to mining.

Underground coal seam mining significantly alters the stress and energy distribution within the overlying rock, leading to eventual structural degradation. Therefore, it is imperative to quantitatively identify the temporal and spatial characteristics of stress evolution of overlying rock caused by mining. This paper introduces a novel rock stress model integrating entropy and a spatial-temporal cube. Similar material model tests are used to identify the abrupt entropy changes within the mining rock, and the trend analysis is carried out to describe the spatial-temporal evolution law of stress during mining. Experimental findings indicate elevated stress levels in the unmined rock preceding and following the panel, as well as within specific rock strata above it. Definitively, dynamic stress arches within the surrounding rock of the stope predominantly bear and distribute the load and pressure from the overlying rock, and each stress mutation is accompanied by a sudden stress entropy change. Over time, z-score shows that the noticeable reduction in mining-induced overburden stress becomes increasingly pronounced, especially in the water-conducting fracture zone. The model's bifurcation set serves as the comprehensive criterion for the entropy-induced sudden changes in the rock system, signifying overall failure.

Thoughts on the entanglement of electromagnetism and life: A theoretical study.

Dissection of the matter into its constituents leads us to the smallest particles that we know. These particles form a material structure that is determined by the electromagnetic field generated and carried by those particles. Changes in any of the two major constituents leads to changes in that material system, be it a living organism or a lifeless object. The latter statement carries the mystery of life that is born from a continuous and programmed series of system changes fuelled by an energy source with a yet unknown functioning mechanism. The present work is a theoretical approach towards the understandingand potential discovery of the aforementioned, not-yet-known cellular energetic mechanism. Understanding the energetic basis of intracellular biochemistry is equally important in human and animal therapeutics. Additionally, as all such discoveries offer novel solutions in various fields of the global industry, the final outcome of this theoretical work also brings about the idea of a new discovery in electronics industry.

Interventions to promote mental health in the Occupied Palestinian Territories and Palestinian refugees: A scoping review

Background: The long history of the Palestinian-Israeli conflict has resulted in a public and mental health crisis. Despite the significant mental health burdens facing the Palestinian population in the Occupied Palestinian Territories (OPT) and refugee camps, this issue remains comprehensively unexplored. Aims: This scoping review identified mental health interventions and assessed their effectiveness among populations in the OPT and Palestinian refugee camps, while addressing delivery challenges. Method: A scoping review was conducted using 14 databases to include relevant studies published through March 2024 using PRISMA guidelines for scoping reviews. Results: Analyzing 31 intervention studies meeting the inclusion/exclusion criteria, revealed varied outcomes in interventions targeting post-traumatic stress disorder, depression, and overall mental well-being. Conclusions: While some interventions showed potential, others had limited effectiveness, underscoring the complexity of mental health needs in conflict zones. Gender- and risk-specific effectiveness was observed, emphasizing the need for tailored approaches. Challenges like low attendance rates and systemic barriers hindered intervention success. The profound impact of war on children stresses the urgency for targeted interventions. Empowerment and community connectedness are vital for resilience, along with the importance of family and community involvement and research that balances the need for strong evaluation designs with the need for ongoing mental health services. Advocacy for systemic changes is crucial to implement the complex sustainable interventions necessary to assure mental health in any population. This review highlights the importance of holistic, contextually relevant approaches for mental health intervention in OPT and refugee camps, emphasizing rigorous evaluations and community-driven approaches.

Updating the Montreal walking exoskeleton satisfaction and perspectives questionnaire (MWESP-Q) following a 16-week walking program with the use of a wearable robotic exoskeleton

BACKGROUND: Physical activity as one of the major lifestyle-related health determinants is partially addressed by the Montreal Walking Exoskeleton Satisfaction and Perspectives-Questionnaire (MWESP-Q). OBJECTIVE: To document satisfaction of people with chronic spinal cord injury after the completion of a 10 to 16 weeks of the wearable robotic exoskeleton-assisted walking program, with the MWESP-Q updated to a context of health promotion. METHODS: Following a walking program (10–16 weeks), wheelchair users with chronic SCI completed the MWESP-Q online. Modification of the original questionnaire was conducted with 4 experts to ensure its content validity with a human framework to promote physical activity for health. RESULTS: Ten wheelchair users completed the questionnaire (men = 6; 45.8 ± 13.4 years, SCI duration: 10.1 ± 5.8 years). Participants strongly agreed to be satisfied with the overall program; agreed to be satisfied towards exoskeleton, motivation to engage in physical activity, learnability and program attributes; rated “medium effort” for physical and cognitive exertion during training; reported light improvements for health benefit domain, but light to moderate improvements for general endurance (mean 5.5 /7, SD 1.4) and psychological well-being (mean 5.7 /7, SD 1.3). CONCLUSIONS: The updated MWESP-Q is now better equipped to measure physical and cognitive efforts in physical activity and changes in body and organic systems and in capabilities (health promotion). The updated MWESP-Q has 54 statements (14 additional statements and 1 deleted) organized around seven domains. The original measure was replaced by three 7-point Likert scales, one regarding agreement level (40 statements), level of effort (12 statements), and level of change (2 statements).

Quo Vadis, Historical International Relations? Geopolitical Marxism and the Promise of Radical Historicism

John Maclean’s 1988 call “Marxism and IR: A Strange Case of Mutual Neglect” has generated a rich bounty of Marxist studies and paradigms in International Relations (IR). This cross-pollination merged in the 1990s with the “historical turn” and shaped the sub-fields of International Historical Sociology and International Political Economy. But has it left its mark on how IR is practised today? We argue that while Marxism has spoken significantly to the discipline, mainstream IR, even Historical IR, has been largely impervious to Marxist arguments, drawing the standard charge of economism and structuralism. Rectifying these critiques, we suggest that conventional historical studies of “the international” remain methodologically and substantively impoverished. We exemplify this by showing how leading Historical IR studies of “systems change” fail to explain the inside/outside and public/private differentiations constitutive of the modern international order and to integrate the “levels of analysis” they presuppose. We further argue that this rejection has been facilitated by influential Marxist IR paradigms, which ultimately privilege structuralism over historicism: While Neo-Gramscians initially mobilised “historicism” to dissolve claims about the “sameness” of international relations across time and space, the approach became identified with the reified master-category of “hegemony”. Uneven and Combined Development, in turn, has gravitated towards matching Neo-realism’s claim to theoretical universality by insisting on transhistorical model-building and nomological “grand theory”. Both approaches remain over-sociologised and fail to address international politics. Drawing on radically historicist Political Marxism, this article shows how its substantive socio-political premises explain the historical formation of the contemporary international order and re-unite the “levels of analysis” theoretically to provide a framework for non-reductionist and non-economistic accounts of historical international relations. This requires an answer to the agentic challenge of Neo-Classical Realism by reincorporating grand strategy, diplomacy, and international politics into a reformulated perspective of Geopolitical Marxism to track the full historicity of the making of international orders.

Inclusion explored through student voices within the framework of formal teacher-student conversations

ABSTRACT A great deal of research has addressed the field of inclusive education. However, yet we know little about the phenomenon of inclusion explored though student voices. This qualitative study draws on data from a research-practice partnership in Norway, where the parties together developed a framework for the school’s formal teacher–student conversations to find out more about the students’ experiences of inclusion. As a result of inductive analysis of the voices of three students, we discovered a tension between each student’s current childlike lifeworld and a school system emphasising conformity and future academic achievement. Analysis revealed that there were several barriers to students expressing themselves during the conversations. Despite this, the students asserted their own capability and agency, guiding the subject of those conversations towards their own desires and needs. The findings suggests that teachers ought to be given the opportunity to increase their competency in what should be an ongoing process of listening to and acting upon student voices in inclusive education, potentially going so far as to become agents for change in the school system.

Overview of Indonesian Community Pharmacy: Understanding Practice Changes

<p><span lang="EN-US">Community pharmacy practice in Indonesia has shifted to a patient-centered model, offering a </span><span lang="EN-US">range</span><span lang="EN-US"> of services that include treatment advice, chronic disease management, and public health promotion. This shift benefits consumers who visit community pharmacies as their initial healthcare point. The Indonesian healthcare system, a mix of public and private providers, is governed by a decentralized structure, fostering significant investment in private healthcare despite access limitations due to financial capacity. Medicines distribution, managed by the District Health Office, ensures supply to primary healthcare facilities, with community pharmacies regulated by the Ministry of Health and the Indonesian National Food and Drug Agency. Despite stringent regulations mandating comprehensive services, most pharmacists are not remunerated for their services. Pharmacy staff, including formally qualified pharmacists and pharmacy technicians, are registered professionals, with recent trends indicating a shift towards employing pharmacy technicians to enable pharmacists to focus on clinical roles. Economic factors and innovative service delivery modes, such as telepharmacy and online purchasing, are expected to influence future practices, enhancing the pharmacist's role in chronic disease management and other health conditions. The evolving community pharmacy practice in Indonesia reflects broader changes in the healthcare system and professional roles, with continued progression anticipated.</span></p>

Convergence in action: framing the climate crisis at the 2021 Pre-COP counter-summit in Milan

ABSTRACT With the emergence of Fridays for Future and Extinction Rebellion, youth climate activism has attracted increasing attention. Climate strikes are part of a long trajectory of mobilizations for climate justice, rooted in global justice and environmental struggles. Although research on social movements has analyzed differences and continuities within these, there have been few systematic comparisons between youth climate strikes and ‘traditional’ climate justice marches. Our paper contributes to fill this gap. We focus on the framing of climate change in two different protest actions that took place in Milan, Italy, during the Pre-COP26 of the United Nations Framework Convention on Climate Change in 2021: a climate strike by Fridays for Future, and a ‘traditional’ climate justice march by a wide coalition of actors. Relying on protest surveys and qualitative interviews, we discuss differences, similarities, and spaces for convergence among activists in these different fora, focusing on the framing of climate change, and on the meanings attached to ‘system change’.

Barriers to primary care among immigrants and refugees in Peterborough, Ontario: a qualitative study of provider perspectives

BackgroundCanada’s immigrants and refugees have often settled in large Canadian cities, but this is changing with rising costs of living and rural settlement initiatives. However, little consideration is made regarding systemic changes needed to accommodate this distribution, particularly in healthcare in medium-sized cities or smaller communities. For most Canadians, primary care is an entry point into the healthcare system but immigrants and refugees face unique barriers to accessing care compared to the general Canadian population. This project aimed to better understand the barriers to accessing primary care among newcomers in Peterborough, Ontario from the perspective of newcomer service providers.MethodologyParticipants were recruited from community organizations identified by the local settlement agency, the New Canadians Centre, as having regular interactions with newcomer clients including clinics, not-for-profit organizations, and volunteer groups. Four focus groups were completed, each with three participants (n=12). A coding grid was deductively developed to guide thematic analysis by adapting Levesque et al.’s conceptual framework defining access to healthcare with five specific dimensions: approachability, acceptability, availability and accommodation, affordability, and appropriateness.ResultsParticipants identified lack of awareness of the healthcare system, stigma, competing priorities, and direct costs as some of the barriers for newcomers. Participants highlighted barriers unique to Peterborough including proximity to services, social isolation, and a shortage of family physicians. The results also highlighted strengths in the community such as its maternal-child health programming.ConclusionThe results provide a glimpse of the challenges to accessing primary care among newcomers in medium-sized communities and identify opportunities to prepare for changing settlement patterns.

Synthesis and characterization of cellulose Grewia optiva yarn and woven mat using an alkali solution

PurposeThe production of commodities from renewable organic material has gained enormous interest due to the rising public understanding of conscious development. Natural fibers are accessible in environment, and their parameters depend on their physical traits and chemically engineered makeup. Grewia optiva (GO) comes under the category of bast fibers, also known as Bhimal. This study aims to realize the consequences of alkali treatment on the characterization of natural fibers, their developed yarn and then the woven mat.Design/methodology/approachRaw fiber was treated with 20% alkali solution. After treatment, it was evaluated for changes in the general laboratory system. This treatment is known as mercerization, through which the parameters of cellulose fibers can be enhanced. After this process, the content of cellulose increases due to the removal of the hydroxyl group. The removal of microfibrils, hemicellulose and the introduction of hydrogen bonds increase the interactive capacity of fiber. The job was divided into different sections, including acquiring fiber, developing yarn and creating a mat.FindingsThe quality of the surface of the fiber was enhanced after the treatment. Its diameter was reduced to 54.72 microns. In the developed woven mat, it was densified using water treatment and attained grams per square meter (GSM) of 389.7.Originality/valueThe usage of mercerization softens the fiber to twist into yarn, which is finally woven into a mat. Treatment of fabric or mat makes it denser to impart better strength. A woven mat of natural fibers provides maximum strength to the composites.

Genital Tuberculosis as a Socially Significant Disease (Literature Review)

Globally, TB is the second leading cause of death from infectious diseases after COVID-19. Tuberculosis of the female genital organs is a type of extrapulmonary tuberculosis.It is known that both clinically pronounced and latent forms of this disease can cause both primary and secondary infertility due to pathogenetically caused disruption of the structure of the fallopian tubes and changes in the susceptibility of the uterine endometrium. It can be assumed that the problem of genital tuberculosis in Russia is still very relevant, although its true prevalence is unknown. This assumption is based on the facts of the projected growth of indicators the incidence of extrapulmonary tuberculosis, the obvious discrepancy between the real incidence and the official figures, as well as the increasing incidence of tubal-peritoneal infertility, which is often caused by genital tuberculosis. It is known that tuberculosis of the female genital organs is a difficult disease to diagnose. This is determined, in particular, by the fact that it does not have specific (so-called "marker") manifestations. Low rates of diagnosis of extrapulmonary forms of TB create a false sense of well-being, which does not reflect its true epidemiological picture. An obvious need today is the development of an optimal diagnostic complex, the use of which would contribute to accelerating the diagnosis of genital tuberculosis in women and, as a result, preventing the occurrence of irreversible changes in the female reproductive system caused by it. The authors used the scientific databases CyberLeninka, ELibrary and PubMed. Articles were searched for the following keywords: "tuberculosis", "genital tuberculosis", "infertility and tuberculosis". The paper analyzes articles published over the past 10 years.

Using Community Engagement to Move Upstream to Address Social Determinants of Health.

Given its role as a safety net institution, the University of Florida Health (UF Health) Jacksonville has responded to the community's needs through partnerships with the community for decades. Such academic-community partnerships have a broad emphasis on population health and primary care that expands the model of care to include community engagement, which allows such partnerships to promote health and well-being and reduce health inequalities by addressing social determinants of health (SDOH).This report describes the UF Health Jacksonville and University of Florida College of Medicine - Jacksonville's creation of the Urban Health Alliance (UHA) in June 2019 due to continued poor health outcomes and inequities within the community. The mission of the UHA is to improve community health using community-focused, self-sustainable strategies and solutions to impact SDOH (i.e., more upstream interventions). Using the tenets of the collective impact model, the UHA acts as a backbone organization to achieve these objectives by empowering community partners to affect changes in policy, systems, and other structures necessary for the optimal health of the community. The UHA's work is divided across 4 pillars: services, research, education, and policy. These pillars reflect the traditional missions of academic medical centers-clinical care, research, and education-and the need to address structural changes to improve community health-namely, policy. By addressing the issues that most impact the patients and community of UF Health Jacksonville, the UHA can serve as an example of how an academic medical center can use the traditional missions to improve the community's health and move toward health equity.

‘I didn’t know they could one-shot me!’

This article presents a corpus study spanning 11 years (2011–2022) of language referring to Gwyndolin, a boss in the videogame Dark Souls. Like many aspects of Dark Souls, Gwyndolin’s gender is open to interpretation, and this study tracks how both players’ readings of Gwyndolin’s gender and the pronouns they use to refer to Gwyndolin have changed over the past decade. The results show that, while players overwhelmingly read Gwyndolin as a cis man and use the pronoun ‘he’, there have been significant increases in trans and nonbinary interpretations, as well as the use of ‘they’ after 2015. The observed patterns can be linked to social changes inside and outside videogame culture occurring around 2014–2016. The study provides valuable real-time support for the existence of a change in the pronoun system (and its relation to trans/nonbinary identities), which had previously only been proposed on the basis of apparent-time data.

Functional changes in sleep-related arousal after ketamine administration in individuals with treatment-resistant depression

The glutamatergic modulator ketamine is associated with changes in sleep, depression, and suicidal ideation (SI). This study sought to evaluate differences in arousal-related sleep metrics between 36 individuals with treatment-resistant major depression (TRD) and 25 healthy volunteers (HVs). It also sought to determine whether ketamine normalizes arousal in individuals with TRD and whether ketamine’s effects on arousal mediate its antidepressant and anti-SI effects. This was a secondary analysis of a biomarker-focused, randomized, double-blind, crossover trial of ketamine (0.5 mg/kg) compared to saline placebo. Polysomnography (PSG) studies were conducted one day before and one day after ketamine/placebo infusions. Sleep arousal was measured using spectral power functions over time including alpha (quiet wakefulness), beta (alert wakefulness), and delta (deep sleep) power, as well as macroarchitecture variables, including wakefulness after sleep onset (WASO), total sleep time (TST), rapid eye movement (REM) latency, and Post-Sleep Onset Sleep Efficiency (PSOSE). At baseline, diagnostic differences in sleep macroarchitecture included lower TST (p = 0.006) and shorter REM latency (p = 0.04) in the TRD versus HV group. Ketamine’s temporal dynamic effects (relative to placebo) in TRD included increased delta power earlier in the night and increased alpha and delta power later in the night. However, there were no significant diagnostic differences in temporal patterns of alpha, beta, or delta power, no ketamine effects on sleep macroarchitecture arousal metrics, and no mediation effects of sleep variables on ketamine’s antidepressant or anti-SI effects. These results highlight the role of sleep-related variables as part of the systemic neurobiological changes initiated after ketamine administration. Clinical Trials Identifier: NCT00088699.

Trauma-informed systems change training has transcultural, transcontinental transformative healing power: An analysis of leaders in the United States and Angola, Africa.

The Institute for Trauma-Informed Systems Change (ITISC) facilitated a 2-day, 12-hr trauma-informed workshop, delivered virtually, using the Training for Change curriculum. The workshop took place in Portuguese in September 2021 with a group of Angolan leaders (N = 51) and in May 2022, in English, with neonatal intensive care unit (NICU) workers from the United States (N = 73). Surveys were administered before (Time [T] 0) and after the workshop (T1) and consisted of demographic questions and the Survey for Trauma-Informed Systems Change (STISC), which assesses system-wide knowledge and attitudes about trauma-informed systems change and the intersection of culture, safety, and acceptance in the workplace. At T1, 18 (35.3%) participants in the Angolan leaders' group and 46 (63.0%) in the NICU group completed the surveys. Mean scores on the STISC Self-Assessed Knowledge and Attitudes subscale and STISC System-Wide Knowledge and Attitudes subscale increased significantly in both groups after the training. Effect sizes were large for self-assessed knowledge and attitudes, Angolan leaders: d = 1.11, NICU: d = 1.97, and small-to-medium for system-wide knowledge and attitudes, Angolan leaders: d = 0.52, NICU: d = 0.38. Limitations include the relatively small sample size and low participation rates for survey responses. Future research should examine the efficacy of the curriculum in larger samples that include individuals from diverse professions and additional countries. Together, the findings provide initial support that this training can be directly translated and implemented on a global scale.

Modeling MobilityCoins—Charges, Incentives and Multi-period Budgets in Multimodal Transportation Networks

MobilityCoins are a tradable mobility credit (TMC) scheme variant. TMC schemes are a cap-and-trade scheme for managing mobility that are designed to limit negative externalities, e.g., congestion, of traffic. Next to having link-specific or origin–destination-specific charges for cars as in the common TMC scheme, the MobilityCoin scheme’s distinctive elements are accommodating link-specific and origin-and-destination-specific charges and incentives for all modes of transport as well as being considered a mobility currency that can be earned, saved, and spent in multiple time periods. These distinctive features of the MobilityCoin scheme does not alter the core behavioral mechanism of TMC schemes of increasing car travel costs, but these features interfere with the credit market in terms of market volume and market price that ultimately affects traffic outcomes, e.g., an uncontrolled market volume increase can lower the market price that in turns increases the attractiveness of using the car. In this paper, we develop a mathematical model of multimodal macroscopic network flows and a MobilityCoin market to investigate the impacts of charges, incentives, and multi-period budgets. The model is implemented as a single-day model with an integration of sensitivity for multi-period budgets to study how the outcomes in the transportation system change with charges, incentives, and multi-period budgets. Further, we discuss implications for the policy design of MobilityCoins schemes.

Budget Impact Analysis of Olaparib in Combination with Bevacizumab for Maintenance Therapy for Ovarian Cancer in Argentina.

To perform a budget impact analysis (BIA) of introducing olaparib as maintenance therapy in women who have BRCA mutations (BRCAm) with platinum-sensitive recurrent ovarian cancer (PSROC) in combination with bevacizumab in Argentina. A BIA model was used to analyse over a 5-year time horizon the change in the health system's budget following the adoption of olaparib as maintenance therapy in BRCAm patients with PSROC. The BIA for each year was estimated by comparing the cost difference between the current scenario (treatment with bevacizumab) and the new scenario (the addition of olaparib) for a third-party payer. The BIA is estimated at the national health system level, and by healthcare sectors in Argentina (public sector, social security and private sector). International and national epidemiological data were used to determine the target patient population. Clinical efficacy, safety outcomes and duration of treatments were obtained from the pivotal clinical study report. Relevant direct medical costs were obtained from public data in Argentina and expert consultation. All the costs are reported in US dollars as of October 2022 ($1 = 152.59 Argentine pesos). A scenario analysis assessed the full coverage of the homologous recombination deficiency (HRD) test in Argentina. In addition, one-way sensitivity analysis was conducted to evaluate the model robustness. For a third-party payer with a cohort of 1,000,000 women covered, the estimated target population was 2 individuals in year 1 and 6 individuals in year 5. The incorporation of olaparib, with a wholesale price per pack of $3176.32, was associated with a weighted average of the budget impact per member per month (PMPM) of $0.062 for the national health system, being above the estimated health system budget impact threshold ($0.0153). By healthcare sector, the results of budget impact PMPM for year 5 ranged between $0.08 (public sector) and $0.114 (private sector). For all perspectives, the variables that most influenced the budget impact was the incidence of ovarian cancer, the drug acquisition cost and the treatment duration. The introduction of olaparib for the treatment of BRCAm women with PSROC has a high budget impact for all three health systems in Argentina.