A control systems engineering approach for adaptive behavioral interventions: illustration with a fibromyalgia intervention

abstract: The term adaptive intervention has been used in behavioral medicine to describe operationalized and individually tailored strategies for prevention and treatment of chronic, relapsing disorders. Control systems engineering offers an attractive means for designing and implementing adaptive behavioral interventions that feature intensive measurement and frequent decision-making over time. This is illustrated in this paper for the case of a low-dose naltrexone treatment intervention for fibromyalgia. System identification methods from engineering are used to estimate dynamical models from daily diary reports completed by participants. These dynamical models then form part of a model predictive control algorithm which systematically decides on treatment dosages based on measurements obtained under real-life conditions involving noise, disturbances, and uncertainty. The effectiveness and implications of this approach for behavioral interventions (in general) and pain treatment (in particular) are demonstrated using informative simulations

A Novel Control Engineering Approach to Designing and Optimizing Adaptive Sequential Behavioral Interventions

abstract: Control engineering offers a systematic and efficient approach to optimizing the effectiveness of individually tailored treatment and prevention policies, also known as adaptive or ``just-in-time'' behavioral interventions. These types of interventions represent promising strategies for addressing many significant public health concerns. This dissertation explores the development of decision algorithms for adaptive sequential behavioral interventions using dynamical systems modeling, control engineering principles and formal optimization methods. A novel gestational weight gain (GWG) intervention involving multiple intervention components and featuring a pre-defined, clinically relevant set of sequence rules serves as an excellent example of a sequential behavioral intervention; it is examined in detail in this research.   A comprehensive dynamical systems model for the GWG behavioral interventions is developed, which demonstrates how to integrate a mechanistic energy balance model with dynamical formulations of behavioral models, such as the Theory of Planned Behavior and self-regulation. Self-regulation is further improved with different advanced controller formulations. These model-based controller approaches enable the user to have significant flexibility in describing a participant's self-regulatory behavior through the tuning of controller adjustable parameters. The dynamic simulation model demonstrates proof of concept for how self-regulation and adaptive interventions influence GWG, how intra-individual and inter-individual variability play a critical role in determining intervention outcomes, and the evaluation of decision rules.   Furthermore, a novel intervention decision paradigm using Hybrid Model Predictive Control framework is developed to generate sequential decision policies in the closed-loop. Clinical considerations are systematically taken into account through a user-specified dosage sequence table corresponding to the sequence rules, constraints enforcing the adjustment of one input at a time, and a switching time strategy accounting for the difference in frequency between intervention decision points and sampling intervals. Simulation studies illustrate the potential usefulness of the intervention framework. The final part of the dissertation presents a model scheduling strategy relying on gain-scheduling to address nonlinearities in the model, and a cascade filter design for dual-rate control system is introduced to address scenarios with variable sampling rates. These extensions are important for addressing real-life scenarios in the GWG intervention.Dissertation/ThesisDoctoral Dissertation Chemical Engineering 201

A Novel Engineering Approach to Modelling and Optimizing Smoking Cessation Interventions

abstract: Cigarette smoking remains a major global public health issue. This is partially due to the chronic and relapsing nature of tobacco use, which contributes to the approximately 90% quit attempt failure rate. The recent rise in mobile technologies has led to an increased ability to frequently measure smoking behaviors and related constructs over time, i.e., obtain intensive longitudinal data (ILD). Dynamical systems modeling and system identification methods from engineering offer a means to leverage ILD in order to better model dynamic smoking behaviors. In this dissertation, two sets of dynamical systems models are estimated using ILD from a smoking cessation clinical trial: one set describes cessation as a craving-mediated process; a second set was reverse-engineered and describes a psychological self-regulation process in which smoking activity regulates craving levels. The estimated expressions suggest that self-regulation more accurately describes cessation behavior change, and that the psychological self-regulator resembles a proportional-with-filter controller. In contrast to current clinical practice, adaptive smoking cessation interventions seek to personalize cessation treatment over time. An intervention of this nature generally reflects a control system with feedback and feedforward components, suggesting its design could benefit from a control systems engineering perspective. An adaptive intervention is designed in this dissertation in the form of a Hybrid Model Predictive Control (HMPC) decision algorithm. This algorithm assigns counseling, bupropion, and nicotine lozenges each day to promote tracking of target smoking and craving levels. Demonstrated through a diverse series of simulations, this HMPC-based intervention can aid a successful cessation attempt. Objective function weights and three-degree-of-freedom tuning parameters can be sensibly selected to achieve intervention performance goals despite strict clinical and operational constraints. Such tuning largely affects the rate at which peak bupropion and lozenge dosages are assigned; total post-quit smoking levels, craving offset, and other performance metrics are consequently affected. Overall, the interconnected nature of the smoking and craving controlled variables facilitate the controller's robust decision-making capabilities, even despite the presence of noise or plant-model mismatch. Altogether, this dissertation lays the conceptual and computational groundwork for future efforts to utilize engineering concepts to further study smoking behaviors and to optimize smoking cessation interventions.Dissertation/ThesisDoctoral Dissertation Bioengineering 201