Recent advancements in statistical and reinforcement learning methods have contributed to superior patient care strategies. However, these methods face substantial challenges in high-stakes contexts, including missing data, stochasticity, and the need for interpretability and patient safety. Our work operationalizes a safe and interpretable approach for optimizing treatment regimes by matching patients with similar medical and pharmacological profiles. This allows us to construct optimal policies via interpolation. Our comprehensive simulation study demonstrates our method’s effectiveness in complex scenarios. We use this approach to study seizure treatment in critically ill patients, advocating for personalized strategies based on medical history and pharmacological features. Our findings recommend reducing medication doses for mild, brief seizure episodes and adopting aggressive treatment strategies for severe cases, leading to improved outcomes.

Neurologic disability level at hospital discharge is an important outcome in many clinical research studies. Outside of clinical trials, neurologic outcomes must typically be extracted by labor intensive manual review of clinical notes in the electronic health record (EHR). To overcome this challenge, we set out to develop a natural language processing (NLP) approach that automatically reads clinical notes to determine neurologic outcomes, to make it possible to conduct larger scale neurologic outcomes studies. We obtained 7314 notes from 3632 patients hospitalized at two large Boston hospitals between January 2012 and June 2020, including discharge summaries (3485), occupational therapy (1472) and physical therapy (2357) notes. Fourteen clinical experts reviewed notes to assign scores on the Glasgow Outcome Scale (GOS) with 4 classes, namely 'good recovery', 'moderate disability', 'severe disability', and 'death' and on the Modified Rankin Scale (mRS), with 7 classes, namely 'no symptoms', 'no significant disability', 'slight disability', 'moderate disability', 'moderately severe disability', 'severe disability', and 'death'. For 428 patients' notes, 2 experts scored the cases generating interrater reliability estimates for GOS and mRS. After preprocessing and extracting features from the notes, we trained a multiclass logistic regression model using LASSO regularization and 5-fold cross validation for hyperparameter tuning. The model performed well on the test set, achieving a micro average area under the receiver operating characteristic and F-score of 0.94 (95% CI 0.93-0.95) and 0.77 (0.75-0.80) for GOS, and 0.90 (0.89-0.91) and 0.59 (0.57-0.62) for mRS, respectively. Our work demonstrates that an NLP algorithm can accurately assign neurologic outcomes based on free text clinical notes. This algorithm increases the scale of research on neurological outcomes that is possible with EHR data.

This paper introduces a novel method for segmentation of clustered partially overlapping convex objects in silhouette images. The proposed method involves three main steps: pre-processing, contour evidence extraction, and contour estimation. Contour evidence extraction starts by recovering contour segments from a binarized image by detecting concave points. After this the contour segments which belong to the same objects are grouped. The grouping is formulated as a combinatorial optimization problem and solved using the branch and bound algorithm. Finally, the full contours of the objects are estimated by a Gaussian process regression method. The experiments on a challenging dataset consisting of nanoparticles demonstrate that the proposed method outperforms three current state-of-art approaches in overlapping convex objects segmentation. The method relies only on edge information and can be applied to any segmentation problems where the objects are partially overlapping and have a convex shape.

Segmentation of partially overlapping objects with a known shape is needed in an increasing amount of various machine vision applications. This paper presents a method for segmentation of clustered partially overlapping objects with a shape that can be approximated using an ellipse. The method utilizes silhouette images, which means that it requires only that the foreground (objects) and background can be distinguished from each other. The method starts with seedpoint extraction using bounded erosion and fast radial symmetry transform. Extracted seedpoints are then utilized to associate edge points to objects in order to create contour evidence. Finally, contours of the objects are estimated by fitting ellipses to the contour evidence. The experiments on one synthetic and two different real data sets showed that the proposed method outperforms two current state-of-art approaches in overlapping objects segmentation.