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We use the sentinel mangrove crab, Minuca rapax, as a model to investigate the effects of metallic settleable particulate matter (SePM) on wetland. Multiple levels of energetic responses, including (i) metabolic rate and energy budget, (ii) oxidative stress, and (iii) behavioral response by righting time, were assessed as well as the metal and metalloid content in crabs exposed to 0, 0.1 and 1 g.L-1 of SePM, under emerged and submerged conditions over five days, simulating the rigors of the intertidal habitat. Al, Fe, Mn, Cr, and Y exhibited a concentration-dependent increase. Metal concentrations were higher in submerged crabs due to the continuous ingestion of SePM and direct exposure through gills. Exposure concentration up to 1 g.L-1 decreased metabolic rate and enzymatic activities, reduced assimilation efficiency and energy for maintenance, and induces a slower response to righting time, probably by metal effects on nervous system and energy deficits. In conclusion, SePM exposure affects the redox status and physiology of M. rapax depending on he submersion regime and SePM concentration. The disruption to the energy budget and the lethargic behavior in M. rapax exposed to SePM implies potential ecological alterations in the mangrove ecosystem with unknown consequences for the local population.

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Changes to forests due to deforestation, or their replacement by agricultural areas, alter evapotranspiration and the partitioning of available energy. This study investigated seasonal variations in the energy balance and evapotranspiration in landscapes under different levels of anthropogenic intervention in the semi-arid region of Brazil. Micrometeorological data was obtained from September 2020 to October 2022 for three areas of the semi-arid region: preserved Caatinga (CAA, native vegetation), Caatinga under regeneration (REGE) and a deforested area (DEFA). Here, we use the Bowen ratio energy balance method. Measurements were taken of global solar radiation, air temperature, relative humidity, vapour pressure deficit, rainfall, net radiation, latent heat flux, sensible heat flux, soil heat flux, evapotranspiration, volumetric soil water content and Normalised Difference Vegetation Index. Sensible heat flux was the dominant flux in both areas with 66% for preserved Caatinga vegetation, 63% for Caatinga under regeneration and 62% deforested area. The latent heat flux was equivalent to 28% of the net radiation for preserved Caatinga vegetation, Caatinga under regeneration and deforested area. The evapotranspiration in turn responded as a function of water availability, being higher during the rainy seasons, with average values of 1.82 mm day-1 for preserved Caatinga vegetation, 2.26 mm day-1 for Caatinga under regeneration and 1.25 mm day-1 for deforested area. The Bowen ratio presented values > 1 in deforested area, preserved Caatinga vegetation and Caatinga under regeneration. Thus, it can be concluded that the change in land use alters the energy balance components, promoting reductions in available energy and latent and sensible heat fluxes during the rainy-dry transition in the deforested area. In addition, the seasonality of energy fluxes depends on water availability in the environment.

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Activity budget analyses are important for understanding how animals spend their time in daily activities like resting, foraging, moving and socializing. These behaviors are closely linked to energy management, so habitat quality and resource availability are known to influence the activity budgets of species. Therefore, many studies have examined the consequences of habitat loss and fragmentation on the energetic demands and activity budgets of species. However, we still have limited knowledge of how animals behave in large, continuous, and protected environments, as such habitats are currently rare. The present study analyzed how temporal variation, age, sex and reproductive status influenced the activity budget of wild red howler monkeys (Alouatta guariba clamitans), in one of the last Atlantic Forest remnants that remains large and protected. Between November 2017 and December 2018, we monitored two groups, G3 and G4, in Parque Estadual Carlos Botelho, São Paulo, Brazil. The groups were composed of one adult male, two adult females and their offspring and one (G3) or two (G4) subadult males, using scan sampling for behavioral for data collection every 20 min. The most common behavior was resting, followed by foraging, moving and social interactions, with inter-group differences. Temporal variation explained most of the fluctuations in the activity budget, so did age and sex, but to a lesser degree. The reproductive status of females did not alter their activity budget. These findings reveal that even neighboring groups display distinct and intricate relationships with their habitat. Future studies should be conducted in continuous forests to determine what is the expected range of variation in activity budget, particularly in those species considered as flexible and inhabiting endangered habitats, such as the Atlantic Forest.

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Polylepis trees grow at elevations above the continuous tree line (3000-5000 m a.s.l.) across the Andes. They tolerate extreme environmental conditions, making them sensitive bioindicators of global climate change. Therefore, investigating their ecohydrological role is key to understanding how the water cycle of Andean headwaters could be affected by predicted changes in environmental conditions, as well as ongoing Polylepis reforestation initiatives in the region. We estimate, for the first time, the annual water balance of a mature Polylepis forest (Polylepis reticulata) catchment (3780 m a.s.l.) located in the south Ecuadorian páramo using a unique set of field ecohydrological measurements including gross rainfall, throughfall, streamflow, and xylem sap flow in combination with the characterization of forest and soil features. We also compare the forest water balance with that of a tussock grass (Calamagrostis intermedia) catchment, the dominant páramo vegetation. Annual gross rainfall during the study period (April 2019-March 2020) was 1290.6 mm yr-1. Throughfall in the Polylepis forest represented 61.2 % of annual gross rainfall. Streamflow was the main component of the water balance of the forested site (59.6 %), while its change in soil water storage was negligible (<1 %). Forest evapotranspiration was 54.0 %, with evaporation from canopy interception (38.8 %) more than twice as high as transpiration (15.1 %). The error in the annual water balance of the Polylepis catchment was small (<15 %), providing confidence in the measurements and assumptions used to estimate its components. In comparison, streamflow and evapotranspiration at the grassland site accounted for 63.7 and 36.0 % of the water balance, respectively. Although evapotranspiration was larger in the forest catchment, its water yield was only marginally reduced (<4 %) in relation to the grassland catchment. The substantially higher soil organic matter content in the forest site (47.6 %) compared to the grassland site (31.8 %) suggests that even though Polylepis forests do not impair the hydrological function of high-Andean catchments, their presence contributes to carbon storage in the litter layer of the forest and the underlying soil. These findings provide key insights into the vegetation-water­carbon nexus in high Andean ecosystems, which can serve as a basis for future ecohydrological studies and improved management of páramo natural resources considering changes in land use and global climate.

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Large trees in plantations generally produce more wood per unit of resource use than small trees. Two processes may account for this pattern: greater photosynthetic resource use efficiency or greater partitioning of carbon to wood production. We estimated gross primary production (GPP) at the individual scale by combining transpiration with photosynthetic water-use efficiency of Eucalyptus trees. Aboveground production fluxes were estimated using allometric equations and modeled respiration; total belowground carbon fluxes (TBCF) were estimated by subtracting aboveground fluxes from GPP. Partitioning was estimated by dividing component fluxes by GPP. Dominant trees produced almost three times as much wood as suppressed trees. They used 25 ± 10% (mean ± SD) of their photosynthates for wood production, whereas suppressed trees only used 12 ± 2%. By contrast, dominant trees used 27 ± 19% of their photosynthate belowground, whereas suppressed trees used 58 ± 5%. Intermediate trees lay between these extremes. Photosynthetic water-use efficiency of dominant trees was c. 13% greater than the efficiency of suppressed trees. Suppressed trees used more than twice as much of their photosynthate belowground and less than half as much aboveground compared with dominant trees. Differences in carbon partitioning were much greater than differences in GPP or photosynthetic water-use efficiency.

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Partner preferences are an important differential in relationship formation and evolutionary fitness, and vary according to individual, ecological, and social factors. In this study, we evaluated the variation in preference for intelligence, kindness, physical attractiveness, health, and socioeconomic level among individuals of different sexes and sexual orientations in a Brazilian sample. We analyzed the preference scores of 778 heterosexual, bisexual, and homosexual men and women in three budgeted mate design tasks (low vs. medium vs. high budget) and their association with sociosexuality, attachment styles, homogamy, and willingness to engage in short- and long-term relationships. Results indicated a global trait preference order, with intelligence ranking first, followed by kindness, physical attractiveness, health, and lastly by socioeconomic status. Typical sex differences were observed mostly within the heterosexual group, and specific combinations of sex and sexual orientation were linked to variation in preference for physical attractiveness, kindness, and socioeconomic status. We also found unique associations of the other variables with partner preferences and with willingness to engage in short- or long-term relationships. By exploring the partner preferences of non-heterosexual individuals from a Latin American country, an underrepresented group in evolutionary psychology research, our results help understand the universal and specific factors that guide partner preferences and human sexual behavior.

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The Chilean Climate Change Law excludes tree monocultures as a solution to the climate crisis, offering an opportunity for resilience and climate mitigation in Latin America. The Chilean experience with mega-fires in extensive, homogeneous forest plantations provides important lessons that could inform climate policies in other countries.

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Resumo: Escrito sob a forma de um ensaio teórico, o artigo levanta reflexões sobre o modo de gestão do orçamento público no Brasil e sua articulação com dois eixos temáticos: tratamento da dívida pública e promoção de políticas sociais. As considerações finais apontam para a possibilidade de associar as práticas na gestão do orçamento federal brasileiro e um estado de exceção econômica perpetuado ao longo do tempo e, como desdobramento, limitante da promoção de direitos de proteção social.

Abstract: Written in the form of a theoretical essay, the article raises reflections on the way the public budget is managed in Brazil and its articulation with two thematic axes: austerity, treatment of public debt and promotion of social policies. Final considerations point to the possibility of associating practices in the management of the Brazilian federal budget and a state of economic exception perpetuated over time and, as a result, limiting the promotion of social protection rights.

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Resumo Este estudo tem como objetivo analisar criticamente os mecanismos que desidratam o Fundo Nacional de Desenvolvimento Científico e Tecnológico (FNDCT), debilitando-o na sua função de promover o desenvolvimento econômico e social. Os dados foram extraídos das bases do sistema integrado de orçamento e planejamento (SIOP) e do relatório de execução orçamentária, entre 2012 e 2021, disponibilizados pela financiadora de estudos e projetos (FINEP). Os resultados da investigação apontam que, do ponto de vista quantitativo, há um processo de desidratação, por mecanismos como a desvinculação de receitas da união (DRU), a formulação do projeto de lei orçamentária anual (PLOA) e as reservas de contingência. Do lado qualitativo, há descompasso entre a promessa de uma política arrojada e inovadora e uma estrutura de governança centralizada e burocrática. Os fundos setoriais não enfrentam problemas de arrecadação, mas a gestão centralizada e subserviente a políticas fiscais de austeridade leva a uma execução orçamentária quantitativamente insuficiente e qualitativamente pobre em diversificação, quadro que descaracteriza a política de financiamento de ciência, tecnologia e inovação (CT&I), deixando de cumprir a promessa de desenvolvimento via inovação.

Resumen Este estudio tiene como objetivo analizar críticamente los mecanismos que deshidratan el fondo nacional de desarrollo científico y tecnológico (FNDCT), debilitándolo en su función de promover el desarrollo económico y social. Los datos fueron extraídos de las bases del sistema integrado de planificación y presupuesto y del informe de ejecución presupuestaria entre 2012 y 2021, puestos a disposición por la financiadora de estudios y proyectos. Los resultados de la investigación indican que, desde el punto de vista cuantitativo, existe un proceso de deshidratación, a través de mecanismos como la Desvinculación de Ingresos de la Unión Federal, la formulación del proyecto de ley presupuestaria anual y las reservas de contingencia. En el aspecto cualitativo, existe un desajuste entre la promesa de una política audaz e innovadora y una estructura de gobierno centralizada y burocrática. Los fondos sectoriales no enfrentan, en promedio, problemas de recaudación, pero la gestión centralizada supeditada a políticas fiscales de austeridad conduce a una ejecución presupuestaria cuantitativamente insuficiente y cualitativamente pobre en términos de diversificación, situación que descaracteriza la política de financiamiento para la ciencia, tecnología e innovación (CT&I), incumpliendo con la promesa de desarrollo a través de la innovación.

Abstract This study aims to critically analyze the mechanisms that depletethe Brazilian fund for the development of science and technology (FNDCT), jeopardizing its ability to promote economic and social development. Data were extracted from the integrated budget and planning system (SIOP) bases and the budget execution report between 2012 and 2021, made available by the Brazilian funding agency FINEP. The quantitative results indicate a process of "dehydration" due to changes such as the regulation that allows the executive to redirect resources previously earmarked for the fund (called DRU), the formulation of the legislation on the annual budget (PLOA) and the contingency reserves. The qualitative analysis shows a mismatch between the promise of a bold and innovative science and technology policy and a centralized and bureaucratic governance structure. Sectoral funds do not face, on average, problems in raising resources. However, the centralized management subservient to fiscal austerity policies leads to quantitative insufficient budget execution and qualitatively poor diversification. As outcomes, this situation mischaracterizes the ST&I funding policy, failing to comply with the promise of development through innovation.

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Introducción: el programa de vacunación es una intervención de salud pública cuyo propósito es controlar o eliminar enfermedades inmunoprevenibles. El objetivo de este trabajo fue estimar la evolución del presupuesto en vacunas entre 2007 y 2022, y el impacto de potenciales mejoras en el calendario de vacunaciones de Paraguay. Método: se estimó la evolución del presupuesto en vacunas según los cambios entre 2007 y 2022, y el impacto de esquemas alternativos versus el actual, que incluyen la vacuna contra la influenza cuádruple, séxtuple en lactantes, el agregado de la vacuna contra papiloma en varones y meningococo ACYW en adolescentes. La perspectiva del análisis fue la del Ministerio de Salud Pública y el horizonte temporal de un año. Los resultados de las alternativas se expresan como impacto presupuestal versus el año 2022. Resultados: entre 2007 y 2022 la cantidad de biológicos del Programa Ampliado de Inmunizaciones pasó de 11 a 18 e incorporó indicaciones de algunas vacunas. Se estima que el presupuesto se incrementó de 3,8 a 29,9 millones de dólares entre los extremos de la serie. Las alternativas implicarían un incremento de 13%, 35%, 5% y 10%, individualmente. El incremento en conjunto alcanza el 62%. Conclusiones: el aumento del gasto en vacunas fue de ocho veces entre 2007 y 2022. Se estima el impacto presupuestal en diferentes escenarios que se interpretan como mejoras comparadas con el actual de 2022, siendo el incremento más exigente de un 35%. La evidencia generada puede colaborar en el proceso de toma de decisiones acerca de esta política pública en Paraguay.

Introduction: the vaccination program is a public health intervention aimed at controlling or eliminating vaccine-preventable diseases. The objective of the study was to estimate the evolution of the vaccine budget between 2007 and 2022 and the impact of potential improvements in Paraguay's vaccination schedule. Method: the evolution of the vaccine budget was estimated considering the changes introduced between 2007 and 2022 and the impact of alternative schedules versus the current one. These alternatives include the addition of the quadrivalent influenza vaccine, the hexavalent vaccine for infants, the inclusion of the HPV vaccine for boys, and the ACYW meningococcal ACYW vaccine for adolescents. The analysis was conducted from the perspective of the Ministry of Health, with a time horizon of one year. The results of the alternatives are expressed as budget impact compared to the year 2022. Results: between 2007 and 2022, the number of biological products in the EPI increased from 11 to 18, and additional indications for some vaccines were incorporated. The budget is estimated to have increased from 3.8 to 29.9 million USD over the series. The alternatives would result in individual increases of 13%, 35%, 5%, and 10%. The combined increase reaches 62%. Conclusions: the increase in vaccine expenditure was eightfold between 2007 and 2022. The budget impact was estimated in different scenarios, interpreted as improvements compared to the current 2022 scenario, with the most demanding increase being 35%. The generated evidence can assist in the decision-making process regarding this public policy in Paraguay.

Introdução: o programa de vacinação é uma intervenção de saúde pública cuja finalidade é controlar ou eliminar doenças imunopreveníveis. O objetivo deste estudo foi estimar a evolução do orçamento de vacinas entre 2007 e 2022 e o impacto de possíveis melhorias no cronograma de vacinação do Paraguai. Métodos: estimamos a evolução do orçamento de vacinas de acordo com as mudanças ocorridas entre 2007 e 2022 e o impacto de esquemas alternativos em relação ao atual, que incluem a vacina quádrupla contra a gripe, a sextupla em bebês, a adição da vacina contra o papilomavírus em homens e a vacina meningocócica ACYW em adolescentes. A perspectiva da análise foi a do Ministerio de Salud e o intervalo de tempo foi de um ano. Os resultados das alternativas são expressos como impacto orçamentário em relação a 2022. Resultados: Entre 2007 e 2022, o número de produtos biológicos do PAI aumentou de 11 para 18 e incorporou indicações para algumas vacinas. Estima-se que o orçamento tenha aumentado de US$ 3,8 milhões para US$ 29,9 milhões entre os extremos da série. As alternativas implicariam em um aumento de 13%, 35%, 5% e 10% individualmente. O aumento geral chega a 62%. Conclusões: o aumento nos gastos com vacinas foi de oito vezes entre 2007-2022. O impacto orçamentário é estimado em diferentes cenários que são interpretados como melhorias em comparação com o cenário de 2022, sendo que o aumento mais exigente é de 35%. As evidências geradas podem contribuir para o processo de tomada de decisão relacionado a essa política pública no Paraguai.

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Costs of hemophilia A treatment are increasing. Waste of clotting products should be avoided. To estimate the first-year waste of emicizumab prophylaxis for people with hemophilia A and inhibitors (PwHAi) who failed immune tolerance induction (ITI), in Brazil. We evaluated the manufacturer and the Brazilian Ministry of Health (MoH) protocol-recommended regimens in a budget impact model. The loading dose consisted of 3.0 mg/kg/Q1W for 4 weeks, for both recommendations. The manufacturer maintenance regimens comprised 1.5 mg/kg/Q1W, 3.0 mg/kg/Q2W, and 6.0 mg/kg/Q4W. The MoH protocol maintenance regimen encompassed a hybrid Q1W/Q2W administration, depending on the body weight. The Q4W regimen was not recommended by the MoH protocol. Analyses were performed to estimate waste given its expense based on the World Health Organization body weight range (percentiles [P] 15, 50, and 85). The first-year emicizumab waste was estimated individually and for the disclosed PwHAi who failed ITI (n = 114). The highest emicizumab waste was estimated for the lowest body weights and the Q1W regimen. The Q4W regimen resulted in the lowest emicizumab waste, followed by the MoH protocol regimen. The total reconstituted costs estimated for the PwHAi who failed ITI according to the hybrid MoH protocol ranged from US$32,858,777 (P15) to US$47,186,858 (P85), with emicizumab waste ranging from 7.9 % (US$2,594,515) to 3.7 % (US$1,738,750), respectively. Lost resources due to current protocols for emicizumab prophylaxis for PwHAi who failed ITI in Brazil are considerable. Waste was more pronounced due to lower body weight and shorter administration intervals.

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The increase in greenhouse gasses (GHG) anthropogenic emissions and deforestation over the last decades have led to many chemical and physical changes in the climate system, affecting the atmosphere's energy and water balance. A process that could be affected is the Amazonian moisture transport in the South American continent (including La Plata basin), which is crucial to the southeast Brazilian water regime. The focus of our research is on evaluating how local (i.e. Amazon deforestation) and global forcings (increase of atmospheric GHG concentration) may modify this moisture transport under climate change scenarios. We used two coupled land-atmosphere models forced by CMIP6 sea surface temperatures to simulate these processes for two scenarios: i) increase in carbon dioxide (CO2) - RCP8.5 atmospheric levels (00DEF), and ii) total Amazon deforestation simultaneous with atmospheric CO2 levels increased (100DEF). These scenarios were compared with a control simulation, set with a constant CO2 of 388 ppm and present-day Amazon Forest cover. The 30-year Specific Warming Level 2 (SWL2) index evaluated from the simulations is set to be reached 2 years earlier due to Amazon deforestation. A reduction in precipitation was observed in the Amazon basin (-3.1 mm·day-1) as well as in La Plata Basin (-0.5 mm·day-1) due to reductions in the Amazon evapotranspiration (-0.9 mm·day-1) through a stomatal conductance decrease (00DEF) and land cover change (100DEF). In addition, the income moisture transport decreased (22 %) in the northern La Plata basin in both scenarios and model experiments. Our results indicated a worse scenario than previously found in the region. Both Amazon and La Plata hydrological regimes are connected (moisture and energy transport), indicating that a large-scale Amazon deforestation will have additional climate, economic and social implications for South America.

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Ocean warming is expected to occur due to anthropogenic climate change bringing a spatial shift of marine communities. Experimental data that characterize the aerobic power budget via an aerobic scope, thermal metabolic scope, or thermal preferences have been proposed as tools that can describe species distribution since they characterize species fitness or performance under different temperatures. This study tested the potential relationship between observed occurrences and different physiological studies in the Americas for 11 commercially important species in Mexico. Projections were also developed for Mexico's exclusive economic zone under different climate warming scenarios. The physiological data were fitted from optimum up to pejus temperatures and projected to sea surface temperatures for present (2003-2014) and Representative Concentration Pathway (RCP) scenarios (RCP 2.6, RCP 4.5, RCP 6.0, and RCP 8.5) for the period 2040-2050 and 2090-2100. For species with wide distributions in the Americas, the number of occurrences reported decreases at higher latitudes related to the decrease in species performance calculated from laboratory experiments. In addition, higher species occurrences are usually reported around optimum temperatures. Overall, the results suggest that pejus temperatures likely restrict latitudinal distribution, at least for widely distributed taxons. Regarding Mexican projections, the results varied widely by species. For example, in the Atlantic Ocean, Octopus maya and Panulirus argus are vulnerable to warming scenarios, while Centropomus undecimalis is not. Interestingly, northern Campeche Bank, the Gulf of California, and Western Baja California may act as thermal refugia for marine species indicating they could be assigned as protected areas to support fisheries throughout the Mexican exclusive economic zone. This research adds to the increasing evidence of the relationship between thermal niche and wild population distribution.

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Patos Lagoon, located in southern Brazil, is the world's largest choked coastal lagoon. Studies have revealed that plastic pollution affects lagoons; however, to date, they have only focused on a few limited regions of the lagoon. Top-down quantification methods based on socio-economic data from 2010 to 2017 were used to measure the amount of plastic reaching Patos Lagoon, thus broadening the perspective of plastic pollution in this area. According to the findings, Patos Lagoon's hydrographic regions produced an average of 4.54 Mton of plastic during the studied period. 1.86 Mton was consumed on average. High- and low-density polyethylene (HDPE and LDPE, respectively), polypropylene (PP), and polyvinyl chloride (PVC) were the main resins produced. Food-related activities were the largest consumer of plastic (17.98%), indicating a higher amount of single-use plastics being used in the basin. The preforms for plastic bottles, bags, and packaging were the most commonly manufactured plastic utensils. An estimated 8 to 14% of all plastics used to end up as mismanaged waste in the Patos Lagoon hydrographic basin. This resulted in 1.73 and 10.72 Kton, or 0.5 and 3.2 g/per person/per day, of plastic waste flowing into the waters of Patos Lagoon throughout the study period. These findings can help focus on management efforts by providing managers and policymakers with information for better plastic pollution mitigation in this environment.

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1. The time-energy budget method estimates the energy used for physical activity (PA) by integrating behaviour PA patterns with energy cost for specific PAs. Nevertheless, information about individual energy cost by type of PA are not available and so this study estimated the energy cost of PA for growing broilers.2. An indirect calorimetry system for single birds was constructed to measure the variation in the rate of O2 consumption (V˙O2, L/min) and rate of CO2 production (V˙CO2, L/min) produced by these PAs.3. A total of five birds were used in a replicated trial where their body weight (BW) ranged from 1.5 to 2.5 kg to measure the increase in heat production (HP) above resting levels as a result of PA. The procedure in the chamber was divided into five steps: (1) initial baselining, (2) resting metabolic rate, (3) PA such as feeding, drinking and other standing activities, (4) removal of gas exchange produced in step 3, and (5) final baselining. The PA was recorded using a video camera fixed at the chamber's top (and outside).4. The area under V˙CO2 and V˙O2 curves was used to calculate the CO2 production (vCO2, L) and O2 consumption (vO2, L). Then, the HP (cal/kg-0.75) was calculated according to the Brouwer equation. Two observers analysed the video records to estimate the time spent for each PA (seconds and frequency).5. To calculate the energetic coefficients, the HP was regressed with the function of time spent to perform each PA allowing to estimate the energy cost for eating, drinking and stand activities, which were 0.607, 0.352 and 0.938 cal/kg-0.75/s, respectively.

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OBJECTIVES: To conduct cost-utility and budget impact analysis of providing Continuous Positive Airway Pressure (CPAP) therapy versus no treatment for moderate to severe obstructive sleep apnea (OSA) in Colombia from a third-party payer perspective. METHODS: We used a Markov model to assess the cost-utility and budget impact analysis of CPAP in patients over 40 years old with moderate to severe OSA. Data on effectiveness and utility values were obtained from published literature. A discount rate of 5% was applied for outcomes and costs. ICER was calculated and compared against the threshold estimated for Colombia, which is 86% of the GDP per capita. RESULTS: Over a lifetime horizon, the base case analysis showed the incremental cost per quality-adjusted life-years (QALYs) gained with CPAP therapy was COP$3,503,804 (USD$1,011 in 2020 prices). The budget impact analysis showed that the adoption of CPAP therapy in the target population would lead to a cumulative net budget impact of COP$411,722 million (USD$118,784,412 in, 2020 prices) over five years of time horizon. CONCLUSIONS: CPAP was cost-effective compared to no-treatment in OSA. According to the budget impact analysis, adopting this technology would require a budget allocation that is partially offset by reduced number of strokes and traffic accident events.

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Chile has enacted stringent legislation regulating food and beverage labeling and advertising. This study assesses the changes in the average relative allocations of food and beverage budgets for regulated versus not regulated products in households of different socioeconomic and demographic backgrounds. A household fixed effect before-after model is estimated and the marginal effects in the changes of levels and trends in budget shares and purchased volumes after the implementation of the regulations are examined. The results highlight how impactful food policies can shift consumption toward healthier products.

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OBJECTIVE: To estimate the budget impact of covering the FreeStyle Libre Flash Continuous Glucose Monitoring System (FSL) for type 1 Diabetes Mellitus patients (T1DM), compared to self-monitoring of blood glucose (SMBG), from the perspective of public and private third-party payers in Chile. METHODS: A budget impact model was developed to estimate the cost difference between SMBG and FSL over five years. Two FSL coverage schemes were assessed. Input parameters were retrieved from the literature review and complemented by expert opinion. Healthcare costs were estimated by a micro-costing approach and reported in USD. RESULTS: For a public sector third-party payer, incorporating FSL implied a cost increase up to USD 0.013 per member per month (PMPM) for the fifth year under the broad coverage scheme and a net saving of 0.0001 PMPM (all years) under the restricted coverage scheme. From a private sector third-party payer, incorporating FSL implied savings up to USD 0.028 PMPM (fifth year) for the broad coverage scheme and up to USD 0.012 PMPM (fifth year) for the restricted scheme. CONCLUSION: Incorporating the FSL for T1DM patients was associated with a marginal incremental cost for the public sector third-party payer and cost savings in Chile's private healthcare sector.

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OBJECTIVES: Preeclampsia (PE) is a hypertensive disorder of pregnancy that can cause severe complications and adverse fetal/maternal outcomes. We aimed to estimate the annual economic impact of incorporating Elecsys® sFlt-1/PlGF PE ratio, which measures soluble fms-like tyrosine kinase-1 and placental growth factor, into routine clinical practice in Argentina to aid diagnosis of PE and hemolysis, elevated liver enzymes, and low platelets syndrome from second trimester onward in pregnancies with clinical suspicion of PE. METHODS: A decision tree was used to estimate annual economic impact on the Argentine health system as a whole, including relevant costs associated with diagnosis, follow-up, and treatment from initial presentation of clinically suspected PE to delivery. Annual costs of a standard-of-care scenario and a scenario including PE ratio (reference year 2021) were analyzed. RESULTS: The economic model estimated that using the sFlt-1/PlGF ratio would enable the overall health system to save ∼$6987 million Argentine pesos annually (95% confidence interval $12 045-$2952 million), a 39.1% reduction in costs versus standard of care, mainly due to reduced hospitalizations of women with suspected PE. The economic impact calculation estimated net annual savings of approximately $80 504 Argentine pesos per patient with suspected PE. Based on the assumed uncertainty of the parameters, the likelihood the intervention would be cost saving was 100% for the considered scenarios. CONCLUSION: Our analysis suggests that the implementation of the sFlt-1/PlGF ratio in women with suspected PE in Argentina will enable the health system to achieve significant savings, contributing to more efficient clinical management through the likely reduction of unnecessary hospitalizations, depending on assumptions. Results rest on the payers' ability to recover savings generated by the intervention.

Assuntos

RESUMO

Argentina has a long tradition of agricultural systems that use few amounts of fertilizers. However, the crop nutrient balance remains unknown throughout the country. In this study, we estimated the nitrogen (N), phosphorus (P) and sulfur (S) balance at national and subnational scale of the six major grain crops: soybean, maize, wheat, sunflower, barley and sorghum. We found a negative spatio-temporal NPS balance with an annual average deficit of -22.4 kg ha-1 year-1 for N, -6.9 kg ha-1 year-1 for P and -2.1 kg ha-1 year-1 for S. Considering the whole agricultural area analyzed, the balance represented a mean annual negative net outflow of 612 thousand tons (kT) of N, 166 kT of P and 58 kT of S. The nutrient balance was not homogeneous across the country, with significant differences among the three major productive regions: i) the Pampean nucleus region (-32.2, -8.5, -2.92 kg ha-1 year-1, for N, P and S respectively) ii) the non-nucleus Pampean region (-14.3, -3.7, -2.03 kg ha-1 year-1 for N, P and S respectively), and iii) extra-Pampean region (-22.4, -6.3, -2.13 kg ha-1 year-1 for N, P and S respectively). Remarkably, despite having the highest N and P application rate, the Pampean nucleus region has the largest deficit of the analyzed nutrients. Soybean was the main driver of the nutrient mining in the country, accounting for 62 % of the NPS deficits at national scale (-418 kT N year-1, -120 kT P year-1 and -35 kT S year-1). Our findings suggest that the current fertilization practices applied to the major extensive crops in Argentina are far from being sufficient to supply the nutrients they demand, even cultivating soybean that is a N-fixing crop. These results highlight that Argentine main crops' high productivity is reached at the expense of soil nutrient depletion.

Assuntos