ImportanceOut-of-pocket costs (OOPCs) have been largely eliminated for screening mammography. However, patients still face OOPCs when undergoing subsequent diagnostic tests after the initial screening, which represents a potential barrier to those who require follow-up testing after initial testing.ObjectiveTo examine the association between the degree of patient cost-sharing and the use of diagnostic breast cancer imaging after undergoing a screening mammogram.Design, Setting, and ParticipantsThis retrospective cohort study used medical claims from Optum’s deidentified Clinformatics Data Mart Database, a commercial claims database derived from a database of administrative health claims for members of large commercial and Medicare Advantage health plans. The large commercially insured cohort included female patients aged 40 years or older with no prior history of breast cancer undergoing a screening mammogram examination. Data were collected from January 1, 2015, to December 31, 2017, and analysis was conducted from January 2021 to September 2022.ExposuresA k-means clustering machine learning algorithm was used to classify patient insurance plans by dominant cost-sharing mechanism. Plan types were then ranked by OOPCs.Main Outcomes and MeasuresA multivariable 2-part hurdle regression model was used to examine the association between patient OOPCs and the number and type of diagnostic breast services undergone by patients observed to undergo subsequent testing.ResultsIn our sample, 230 845 women (220 023 [95.3%] aged 40 to 64 years; 16 810 [7.3%] Black, 16 398 [7.1%] Hispanic, and 164 702 [71.3%] White) underwent a screening mammogram in 2016. These patients were covered by 22 828 distinct insurance plans associated with 6 025 741 enrollees and 44 911 473 distinct medical claims. Plans dominated by coinsurance were found to have the lowest mean (SD) OOPCs ($945 [$1456]), followed by balanced plans ($1017 [$1386]), plans dominated by copays ($1020 [$1408]), and plans dominated by deductibles ($1186 [$1522]). Women underwent significantly fewer subsequent breast imaging procedures in dominantly copay (24 [95% CI, 11-37] procedures per 1000 women) and dominantly deductible (16 [95% CI, 5-28] procedures per 1000 women) plans compared with coinsurance plans. Patients from all plan types underwent fewer breast magnetic resonance imaging (MRI) scans than patients in the lowest OOPC plan (balanced, 5 [95% CI, 2-12] MRIs per 1000 women; copay, 6 [95% CI, 3-6] MRI per 100 women; deductible, 6 [95% CI, 3-9] MRIs per 1000 women.Conclusions and RelevanceDespite policies designed to remove financial barriers to access for breast cancer screening, significant financial barriers remain for women at risk of breast cancer.

Shared e-scooters have become a familiar sight in many cities around the world. Yet the role they play in the mobility space is still poorly understood. This paper presents a study of the use of Bird e-scooters in the city of Atlanta. Starting with raw data which contains the location of available Birds over time, the study identifies trips and leverages the Google Places API to associate each trip origin and destination with a Point of Interest (POI). The resulting trip data is then used to understand the role of e-scooters in mobility by clustering trips using 10 collections of POIs, including business, food and recreation, parking, transit, health, and residential. The trips between these POI clusters reveal some surprising, albeit sensible, findings about the role of e-scooters in mobility, as well as the time of the day where they are most popular.

El análisis financiero cobra importancia en el campo contable y administrativo, este aporta con información sobre la situación financiera de la empresa, exponiendo lo correcto o no de la gestión, el problema de las empresas del sector industrial de la ciudad de Cuenca-Ecuador, es el desconocimiento de nuevas formas de análisis financiero con el propósito de conocer su situación financiera real. El objetivo es entregar a los directivos una nueva forma de cálculo de los ratios financieros más importantes, con el apoyo de la lógica borrosa, aplicando intervalos de confianza mediante rango de valores, con el propósito de acotar la incertidumbre dentro de este análisis, con ello se trata de reducir la subjetividad o riesgo que puede tener el cálculo tradicional, ambiguo e impreciso. Los resultados de la aplicación de esta herramienta de vanguardia describen la variabilidad entre el valor obtenido ratio y el valor real del mismo, así, en un intervalo de confianza indica que, dentro del rango establecido, se halla el valor real del ratio financiero, incrementando la objetividad del resultado.

El incumplimiento de los pagos por el otorgamiento de créditos otorgados por las cooperativas de ahorro y crédito, es un problema latente en las instituciones financias ecuatorianas, haciendo referencia en especial a la Cooperativa de Ahorro y Crédito Cacpe Biblian Ltda.-Ecuador, por tal motivo el objetivo de la presente investigación es identificar las acciones y efectos, que permitan definir los aspectos mínimos a considerar para una adecuada gestión del riesgo de crédito, cuya finalidad será el reducir este problema a través de variables escondidas que no fueron consideradas por los agentes de crédito en el momento adecuado, lo que permitirá minimizar el requerimiento de provisiones y por ende incrementar el margen financiero. En la metodología se explica el desarrollo de estas herramientas de vanguardia que ofrece la lógica difusa, se aplica la teoría del expertizaje la cual sirve como elemento base para la construcción de una matriz cuadrada de efectos olvidados, encontrando los efectos omitidos o variables escondidas, de esta aplicación el efecto olvidado resulta ser el Mayor margen financiero, el cual debe ser considerado para un adecuado análisis antes de otorgar un crédito, direccionándolo a una correcta toma de decisión crediticia.