Weight loss intervention for young adults using mobile technology: design and rationale of a randomized controlled trial - Cell Phone Intervention for You (CITY).

BACKGROUND: The obesity epidemic has spread to young adults, leading to significant public health implications later in adulthood. Intervention in early adulthood may be an effective public health strategy for reducing the long-term health impact of the epidemic. Few weight loss trials have been conducted in young adults. It is unclear what weight loss strategies are beneficial in this population. PURPOSE: To describe the design and rationale of the NHLBI-sponsored Cell Phone Intervention for You (CITY) study, which is a single center, randomized three-arm trial that compares the impact on weight loss of 1) a behavioral intervention that is delivered almost entirely via cell phone technology (Cell Phone group); and 2) a behavioral intervention delivered mainly through monthly personal coaching calls enhanced by self-monitoring via cell phone (Personal Coaching group), each compared to 3) a usual care, advice-only control condition. METHODS: A total of 365 community-dwelling overweight/obese adults aged 18-35 years were randomized to receive one of these three interventions for 24 months in parallel group design. Study personnel assessing outcomes were blinded to group assignment. The primary outcome is weight change at 24 [corrected] months. We hypothesize that each active intervention will cause more weight loss than the usual care condition. Study completion is anticipated in 2014. CONCLUSIONS: If effective, implementation of the CITY interventions could mitigate the alarming rates of obesity in young adults through promotion of weight loss. ClinicalTrial.gov: NCT01092364.

Adaptive intervention design in mobile health: Intervention design and development in the Cell Phone Intervention for You trial.

BACKGROUND/AIMS: The obesity epidemic has spread to young adults, and obesity is a significant risk factor for cardiovascular disease. The prominence and increasing functionality of mobile phones may provide an opportunity to deliver longitudinal and scalable weight management interventions in young adults. The aim of this article is to describe the design and development of the intervention tested in the Cell Phone Intervention for You study and to highlight the importance of adaptive intervention design that made it possible. The Cell Phone Intervention for You study was a National Heart, Lung, and Blood Institute-sponsored, controlled, 24-month randomized clinical trial comparing two active interventions to a usual-care control group. Participants were 365 overweight or obese (body mass index≥25 kg/m2) young adults. METHODS: Both active interventions were designed based on social cognitive theory and incorporated techniques for behavioral self-management and motivational enhancement. Initial intervention development occurred during a 1-year formative phase utilizing focus groups and iterative, participatory design. During the intervention testing, adaptive intervention design, where an intervention is updated or extended throughout a trial while assuring the delivery of exactly the same intervention to each cohort, was employed. The adaptive intervention design strategy distributed technical work and allowed introduction of novel components in phases intended to help promote and sustain participant engagement. Adaptive intervention design was made possible by exploiting the mobile phone's remote data capabilities so that adoption of particular application components could be continuously monitored and components subsequently added or updated remotely. RESULTS: The cell phone intervention was delivered almost entirely via cell phone and was always-present, proactive, and interactive-providing passive and active reminders, frequent opportunities for knowledge dissemination, and multiple tools for self-tracking and receiving tailored feedback. The intervention changed over 2 years to promote and sustain engagement. The personal coaching intervention, alternatively, was primarily personal coaching with trained coaches based on a proven intervention, enhanced with a mobile application, but where all interactions with the technology were participant-initiated. CONCLUSION: The complexity and length of the technology-based randomized clinical trial created challenges in engagement and technology adaptation, which were generally discovered using novel remote monitoring technology and addressed using the adaptive intervention design. Investigators should plan to develop tools and procedures that explicitly support continuous remote monitoring of interventions to support adaptive intervention design in long-term, technology-based studies, as well as developing the interventions themselves.

Sensor Planning for Bayesian Nonparametric Target Modeling

Bayesian nonparametric models, such as the Gaussian process and the Dirichlet process, have been extensively applied for target kinematics modeling in various applications including environmental monitoring, traffic planning, endangered species tracking, dynamic scene analysis, autonomous robot navigation, and human motion modeling. As shown by these successful applications, Bayesian nonparametric models are able to adjust their complexities adaptively from data as necessary, and are resistant to overfitting or underfitting. However, most existing works assume that the sensor measurements used to learn the Bayesian nonparametric target kinematics models are obtained a priori or that the target kinematics can be measured by the sensor at any given time throughout the task. Little work has been done for controlling the sensor with bounded field of view to obtain measurements of mobile targets that are most informative for reducing the uncertainty of the Bayesian nonparametric models. To present the systematic sensor planning approach to leaning Bayesian nonparametric models, the Gaussian process target kinematics model is introduced at first, which is capable of describing time-invariant spatial phenomena, such as ocean currents, temperature distributions and wind velocity fields. The Dirichlet process-Gaussian process target kinematics model is subsequently discussed for modeling mixture of mobile targets, such as pedestrian motion patterns.

Novel information theoretic functions are developed for these introduced Bayesian nonparametric target kinematics models to represent the expected utility of measurements as a function of sensor control inputs and random environmental variables. A Gaussian process expected Kullback Leibler divergence is developed as the expectation of the KL divergence between the current (prior) and posterior Gaussian process target kinematics models with respect to the future measurements. Then, this approach is extended to develop a new information value function that can be used to estimate target kinematics described by a Dirichlet process-Gaussian process mixture model. A theorem is proposed that shows the novel information theoretic functions are bounded. Based on this theorem, efficient estimators of the new information theoretic functions are designed, which are proved to be unbiased with the variance of the resultant approximation error decreasing linearly as the number of samples increases. Computational complexities for optimizing the novel information theoretic functions under sensor dynamics constraints are studied, and are proved to be NP-hard. A cumulative lower bound is then proposed to reduce the computational complexity to polynomial time.

Three sensor planning algorithms are developed according to the assumptions on the target kinematics and the sensor dynamics. For problems where the control space of the sensor is discrete, a greedy algorithm is proposed. The efficiency of the greedy algorithm is demonstrated by a numerical experiment with data of ocean currents obtained by moored buoys. A sweep line algorithm is developed for applications where the sensor control space is continuous and unconstrained. Synthetic simulations as well as physical experiments with ground robots and a surveillance camera are conducted to evaluate the performance of the sweep line algorithm. Moreover, a lexicographic algorithm is designed based on the cumulative lower bound of the novel information theoretic functions, for the scenario where the sensor dynamics are constrained. Numerical experiments with real data collected from indoor pedestrians by a commercial pan-tilt camera are performed to examine the lexicographic algorithm. Results from both the numerical simulations and the physical experiments show that the three sensor planning algorithms proposed in this dissertation based on the novel information theoretic functions are superior at learning the target kinematics with

little or no prior knowledge