Stochastic Claims Reserve in the Healthcare System: A Methodology Applied to Italian Data

One of the challenges in the healthcare sector is making accurate forecasts across insurance years for claims reserve. Healthcare claims present huge variability and heterogeneity influenced by random decisions of the courts and intrinsic characteristics of the damaged parties, which makes traditional methods for estimating reserves inadequate. We propose a new methodology to estimate claim reserves in the healthcare insurance system based on generalized linear models using the Overdispersed Poisson distribution function. In this context, we developed a method to estimate the parameters of the quasi-likelihood function using a Gauss–Newton algorithm optimized through a genetic algorithm. The genetic algorithm plays a crucial role in glimpsing the position of the global minimum to ensure a correct convergence of the Gauss–Newton method, where the choice of the initial guess is fundamental. This methodology is applied as a case study to the healthcare system of the Tuscany region. The results were validated by comparing them with state-of-the-art measurement of the confidence intervals of the Overdispersed Poisson distribution parameters with better outcomes. Hence, local healthcare authorities could use the proposed and improved methodology to allocate resources dedicated to healthcare and global management

Neonatal intubation: what are we doing?

: How and when the forces are applied during neonatal intubation are currently unknown. This study investigated the pattern of the applied forces by using sensorized laryngoscopes during the intubation process in a neonatal manikin. Nine users of direct laryngoscope and nine users of straight-blade video laryngoscope were included in a neonatal manikin study. During each procedure, relevant forces were measured using a force epiglottis sensor that was placed on the distal surface of the blade. The pattern of the applied forces could be divided into three sections. With the direct laryngoscope, the first section showed either a quick rise of the force or a discontinuous rise with several peaks; after reaching the maximum force, there was a sort of plateau followed by a quick drop of the applied forces. With the video laryngoscope, the first section showed a quick rise of the force; after reaching the maximum force, there was an irregular and heterogeneous plateau, followed by heterogeneous decreases of the applied forces. Moreover, less forces were recorded when using the video laryngoscope.    Conclusions: This neonatal manikin study identified three sections in the diagram of the forces applied during intubation, which likely mirrored the three main phases of intubation. Overall, the pattern of each section showed some differences in relation to the laryngoscope (direct or video) that was used during the procedure. These findings may provide useful insights for improving the understanding of the procedure. What is Known: • Neonatal intubation is a life-saving procedure that requires a skilled operator and may cause direct trauma to the tissues and precipitate adverse reactions. • Intubation with a videolaryngoscope requires less force than with a direct laryngoscope, but how and when the forces are applied during the whole neonatal intubation procedure are currently unknown. What is New: • Forces applied to the epiglottis during intubation can be divided into three sections: (i) an initial increase, (ii) a sort of plateau, and (iii) a decrease. • The pattern of each section shows some differences in relation to the laryngoscope (direct or videolaryngoscope) that is used during the procedure

Exploring the Prognostic Performance of MECKI Score in Heart Failure Patients with Non-Valvular Atrial Fibrillation Treated with Edoxaban

Introduction: Risk stratification in heart failure (HF) is essential for clinical and therapeutic management. The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score is a validated prognostic model for assessing cardiovascular risk in HF patients with reduced ejection fraction (HFrEF). From the validation of the score, the prevalence of HF patients treated with direct oral anticoagulants (DOACs), such as edoxaban, for non-valvular atrial fibrillation (NVAF) has been increasing in recent years. This study aims to evaluate the reliability of the MECKI score in HFrEF patients treated with edoxaban for NVAF. Materials and Methods: This study included consecutive outpatients with HF and NVAF treated with edoxaban (n = 83) who underwent a cardiopulmonary exercise test (CPET). They were matched by propensity score with a retrospective group of HFrEF patients with NVAF treated with vitamin K antagonists (VKAs) from the MECKI score registry (n = 844). The study endpoint was the risk of cardiovascular mortality, urgent heart transplantation, or Left Ventricle Assist Device (LVAD) implantation. Results: Edoxaban patients were treated with a more optimized HF therapy and had different clinical characteristics, with a similar MECKI score. After propensity score, 77 patients treated with edoxaban were successfully matched with the MECKI-VKA control cohort. In both groups, MECKI accurately predicted the composite endpoint with similar area under the curves (AUC = 0.757 vs. 0.829 in the MECKI-VKA vs. edoxaban-treated group, respectively, p = 0.452). The two populations’ survival appeared non-significantly different at the 2-year follow-up. Conclusions: this study confirms the prognostic accuracy of the MECKI score in HFrEF patients with NVAF treated with edoxaban, showing improved predictive power compared to VKA-treated patients

A communication platform demonstrator for new generation railway traffic management systems: Testing and validation

Current rail traffic management and control systems cannot be easily upgraded to the new needs and challenges of modern railway systems because they do not offer interoperable data structures and standardized communication interfaces. To meet this need, the Horizon 2020 Shift2Rail OPTIMA project has developed a communication platform for testing and validating the new generation of traffic management systems (TMS), whose main innovative features are the interoperability of the data structures used, standardization of communications, continuous access to real-time and persistent data from heterogeneous data sources, modularity of components and scalability of the platform. This paper presents the main components, their functions and characteristics, then describes the testing and validation of the platform, even when federated with other innovative TMS modules developed in separate projects. The successful validation of the system has confirmed the achievement of the objectives set and allowed a new set of objectives to be defined for the reference platform for the railway TMS/Traffic Control systems

Robot-Locust Social Information Transfer Occurs in Predator Avoidance Contexts

Social learning is an evolutionarily important ability increasingly attributed also to invertebrate species. Interfacing robots with animals represents a promising strategy to investigate social learning. Herein, we studied if the gregarious form of Locusta migratoria, a particularly suited model to examine social learning, can use social information provided by robotic demonstrators to optimize their predator avoidance. Robotic demonstrators with different silhouettes and colours (biomimetic or neutral) were used to investigate if their rotation on a rod (e.g. hiding behaviour) elicited the same behaviour in neighbouring locusts. Locusts’ responses were affected by different robotic demonstrators, observing a significant impact of the biomimetic silhouette in reducing the latency duration, and in promoting social learning (e.g. locusts displaying hiding behaviour after observing it in robotic demonstrators). A significant impact of colour patterns in triggering socially induced hiding behaviour was also recorded, especially when the biomimetic silhouette was coloured with the gregarious-like pattern. This research indicates gregarious locusts exploit social information in specific ecological contexts, providing basic knowledge on the complex behavioural ecology and social biology in invertebrates. The proposed animal-robot interaction paradigm shows the role of robots as carrier of social information to living organisms, suggesting social biorobotics as advanced and sustainable approach for socio-biology investigation, and environmental management