OBJECTIVE: To present clinicians at the point-of-care with real-world data on the effectiveness of various treatment options in a precision cohort of patients closely matched to the index patient. MATERIALS AND METHODS: We developed disease-specific, machine-learning, patient-similarity models for hypertension (HTN), type II diabetes mellitus (T2DM), and hyperlipidemia (HL) using data on approximately 2.5 million patients in a large medical group practice. For each identified decision point, an encounter during which the patient's condition was not controlled, we compared the actual outcome of the treatment decision administered to that of the best-achieved outcome for similar patients in similar clinical situations. RESULTS: For the majority of decision points (66.8%, 59.0%, and 83.5% for HTN, T2DM, and HL, respectively), there were alternative treatment options administered to patients in the precision cohort that resulted in a significantly increased proportion of patients under control than the treatment option chosen for the index patient. The expected percentage of patients whose condition would have been controlled if the best-practice treatment option had been chosen would have been better than the actual percentage by: 36% (65.1% vs 48.0%, HTN), 68% (37.7% vs 22.5%, T2DM), and 138% (75.3% vs 31.7%, HL). CONCLUSION: Clinical guidelines are primarily based on the results of randomized controlled trials, which apply to a homogeneous subject population. Providing the effectiveness of various treatment options used in a precision cohort of patients similar to the index patient can provide complementary information to tailor guideline recommendations for individual patients and potentially improve outcomes.

This paper presents a physical model developed to find the directions of forces and moments required to open a plastic bag - which forces will contribute toward opening the knot and which forces will lock it further. The analysis is part of the implementation of aQ(¿)-learning algorithm on a robot system. The learning task is to let a fixed-arm robot observe the position of a plastic bag located on a platform, grasp it, and learn how to shake out its contents in minimum time. The physical model proves that the learned optimal bag shaking policy is consistent with the physical model and shows that there were no subjective influences. Experimental results show that the learned policy actually converged to the best policy.

This paper presents a collaborative reinforcement learning algorithm, CQ(lambda), designed to accelerate learning by integrating a human operator into the learning process. The CQ(lambda) -learning algorithm enables collaboration of knowledge between the robot and a human; the human, responsible for remotely monitoring the robot, suggests solutions when intervention is required. Based on its learning performance, the robot switches between fully autonomous operation, and the integration of human commands. The CQ(lambda) -learning algorithm was tested on a Motoman UP-6 fixed-arm robot required to empty the contents of a suspicious bag. Experimental results of comparing the CQ(lambda) with the standard Q(lambda), indicated the superiority of the CQ(lambda) while achieving an improvement of 21.25% in the average reward.