Living well with diabetes: 24-month outcomes from a randomized trial of telephone-delivered weight loss and physical activity intervention to improve glycemic control

OBJECTIVE: To evaluate the effectiveness of a telephone-delivered behavioral weight loss and physical activity intervention targeting Australian primary care patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Pragmatic randomized controlled trial of telephone counseling (n = 151) versus usual care (n = 151). Reported here are 18-month (end-of-intervention) and 24-month (maintenance) primary outcomes of weight, moderate-to-vigorous-intensity physical activity (MVPA; via accelerometer), and HbA1c level. Secondary outcomes include dietary energy intake and diet quality, waist circumference, lipid levels, and blood pressure. Data were analyzed via adjusted linear mixed models with multiple imputation of missing data. RESULTS: Relative to usual-care participants, telephone counseling participants achieved modest, but significant, improvements in weight loss (relative rate [RR] -1.42% of baseline body weight [95% CI -2.54 to -0.30% of baseline body weight]), MVPA (RR 1.42 [95% CI 1.06-1.90]), diet quality (2.72 [95% CI 0.55-4.89]), and waist circumference (-1.84 cm [95% CI -3.16 to -0.51 cm]), but not in HbA1c level (RR 0.99 [95% CI 0.96-1.02]), or other cardio-metabolic markers. None of the outcomes showed a significant change/deterioration over the maintenance period. However, only the intervention effect for MVPA remained statistically significant at 24 months. CONCLUSIONS: The modest improvements in weight loss and behavior change, but the lack of changes in cardio-metabolic markers, may limit the utility, scalability, and sustainability of such an approach.

Distributed Optimal Control of Cyber-Physical Systems: Controller Synthesis, Architecture Design and System Identification

The centralized paradigm of a single controller and a single plant upon which modern control theory is built is no longer applicable to modern cyber-physical systems of interest, such as the power-grid, software defined networks or automated highways systems, as these are all large-scale and spatially distributed. Both the scale and the distributed nature of these systems has motivated the decentralization of control schemes into local sub-controllers that measure, exchange and act on locally available subsets of the globally available system information. This decentralization of control logic leads to different decision makers acting on asymmetric information sets, introduces the need for coordination between them, and perhaps not surprisingly makes the resulting optimal control problem much harder to solve. In fact, shortly after such questions were posed, it was realized that seemingly simple decentralized optimal control problems are computationally intractable to solve, with the Wistenhausen counterexample being a famous instance of this phenomenon. Spurred on by this perhaps discouraging result, a concerted 40 year effort to identify tractable classes of distributed optimal control problems culminated in the notion of quadratic invariance, which loosely states that if sub-controllers can exchange information with each other at least as quickly as the effect of their control actions propagates through the plant, then the resulting distributed optimal control problem admits a convex formulation.

The identification of quadratic invariance as an appropriate means of "convexifying" distributed optimal control problems led to a renewed enthusiasm in the controller synthesis community, resulting in a rich set of results over the past decade. The contributions of this thesis can be seen as being a part of this broader family of results, with a particular focus on closing the gap between theory and practice by relaxing or removing assumptions made in the traditional distributed optimal control framework. Our contributions are to the foundational theory of distributed optimal control, and fall under three broad categories, namely controller synthesis, architecture design and system identification.

We begin by providing two novel controller synthesis algorithms. The first is a solution to the distributed H-infinity optimal control problem subject to delay constraints, and provides the only known exact characterization of delay-constrained distributed controllers satisfying an H-infinity norm bound. The second is an explicit dynamic programming solution to a two player LQR state-feedback problem with varying delays. Accommodating varying delays represents an important first step in combining distributed optimal control theory with the area of Networked Control Systems that considers lossy channels in the feedback loop. Our next set of results are concerned with controller architecture design. When designing controllers for large-scale systems, the architectural aspects of the controller such as the placement of actuators, sensors, and the communication links between them can no longer be taken as given -- indeed the task of designing this architecture is now as important as the design of the control laws themselves. To address this task, we formulate the Regularization for Design (RFD) framework, which is a unifying computationally tractable approach, based on the model matching framework and atomic norm regularization, for the simultaneous co-design of a structured optimal controller and the architecture needed to implement it. Our final result is a contribution to distributed system identification. Traditional system identification techniques such as subspace identification are not computationally scalable, and destroy rather than leverage any a priori information about the system's interconnection structure. We argue that in the context of system identification, an essential building block of any scalable algorithm is the ability to estimate local dynamics within a large interconnected system. To that end we propose a promising heuristic for identifying the dynamics of a subsystem that is still connected to a large system. We exploit the fact that the transfer function of the local dynamics is low-order, but full-rank, while the transfer function of the global dynamics is high-order, but low-rank, to formulate this separation task as a nuclear norm minimization problem. Finally, we conclude with a brief discussion of future research directions, with a particular emphasis on how to incorporate the results of this thesis, and those of optimal control theory in general, into a broader theory of dynamics, control and optimization in layered architectures.

Physical connection and disconnection control based on hot melt adhesives

Physical connection and disconnection control has practical meanings for robot applications. Compared to conventional connection mechanisms, bonding involving a thermal process could provide high connection strength, high repeatability, and power-free connection maintenance, etc. In terms of disconnection, an established bond can be easily weakened with a temperature rise of the material used to form the bond. Hot melt adhesives (HMAs) are such material that can form adhesive bonds with any solid surfaces through a thermally induced solidification process. This paper proposes a novel control method for automatic connection and disconnection based on HMAs. More specifically, mathematical models are first established to describe the flowing behavior of HMAs at higher temperatures, as well as the temperature-dependent strength of an established HMA bond. These models are then validated with a specific type of HMA in a minimalistic robot setup equipped with two mechatronic devices for automated material handling. The validated models are eventually used for determining open parameters in a feedback controller for the robot to perform a pick-and-place task. Through a series of trials with different wooden and aluminum parts, we evaluate the performance of the automatic connection and disconnection methods in terms of speed, energy consumption, and robustness. © 1996-2012 IEEE.

Continuous weak measurement and feedback control of a solid-state charge qubit: A physical unravelling of non-Lindblad master equation

Conventional quantum trajectory theory developed in quantum optics is largely based on the physical unravelling of a Lindblad-type master equation, which constitutes the theoretical basis of continuous quantum measurement and feedback control. In this work, in the context of continuous quantum measurement and feedback control of a solid-state charge qubit, we present a physical unravelling scheme of a non-Lindblad-type master equation. Self-consistency and numerical efficiency are well demonstrated. In particular, the control effect is manifested in the detector noise spectrum, and the effect of measurement voltage is discussed.

A hierarchical physical model-based approach to predictive control of a thermal power plant for efficient plant-wide disturbance rejection

Extending the work presented in Prasad et al. (IEEE Proceedings on Control Theory and Applications, 147, 523-37, 2000), this paper reports a hierarchical nonlinear physical model-based control strategy to account for the problems arising due to complex dynamics of drum level and governor valve, and demonstrates its effectiveness in plant-wide disturbance handling. The strategy incorporates a two-level control structure consisting of lower-level conventional PI regulators and a higher-level nonlinear physical model predictive controller (NPMPC) for mainly set-point manoeuvring. The lower-level PI loops help stabilise the unstable drum-boiler dynamics and allow faster governor valve action for power and grid-frequency regulation. The higher-level NPMPC provides an optimal load demand (or set-point) transition by effective handling of plant-wide interactions and system disturbances. The strategy has been tested in a simulation of a 200-MW oil-fired power plant at Ballylumford in Northern Ireland. A novel approach is devized to test the disturbance rejection capability in severe operating conditions. Low frequency disturbances were created by making random changes in radiation heat flow on the boiler-side, while condenser vacuum was fluctuating in a random fashion on the turbine side. In order to simulate high-frequency disturbances, pulse-type load disturbances were made to strike at instants which are not an integral multiple of the NPMPC sampling period. Impressive results have been obtained during both types of system disturbances and extremely high rates of load changes, right across the operating range, These results compared favourably with those from a conventional state-space generalized predictive control (GPC) method designed under similar conditions.

Plant-wide predictive control for a thermal power plant based on a physical plant model

A constrained non-linear, physical model-based, predictive control (NPMPC) strategy is developed for improved plant-wide control of a thermal power plant. The strategy makes use of successive linearisation and recursive state estimation using extended Kalman filtering to obtain a linear state-space model. The linear model and a quadratic programming routine are used to design a constrained long-range predictive controller One special feature is the careful selection of a specific set of plant model parameters for online estimation, to account for time-varying system characteristics resulting from major system disturbances and ageing. These parameters act as nonstationary stochastic states and help to provide sufficient degrees-of-freedom to obtain unbiased estimates of controlled outputs. A 14th order non-linear plant model, simulating the dominant characteristics of a 200 MW oil-fired pou er plant has been used to test the NPMPC algorithm. The control strategy gives impressive simulation results, during large system disturbances and extremely high rate of load changes, right across the operating range. These results compare favourably to those obtained with the state-space GPC method designed under similar conditions.

A randomised control trial of experiential learning to promote physical activity

The paucity of training in physical activity (PA) promotion in UK medical schools is a barrier to health professionals' promotion of PA to their patients. Doctors who are more physically active are more likely to counsel patients in this regard. We used a randomised controlled trial (RCT) to examine the effect of an intervention which engaged students in goal-setting, using pedometer step counts, on their PA behaviour and intentions to promote PA in future practice.

Applying Health Locus of Control and Latent Class Modelling to food and physical activity choices affecting CVD risk

Health Locus of Control (HLC) classifies our beliefs about the connection between our actions and health outcomes (Skinner, 1996) into three categories: “internal control”, corresponding to health being the result of an individual's effort and habits; “control by powerful others”, whereby health depends on others, such as doctors; and “chance control”, according to which health depends on fate and chance. Using Choice Experiments we investigate the relationship between HLC and willingness to change lifestyle, in terms of eating habits, physical activity and associated cardiovascular disease risk, in a 384 person sample representative of the 40–65 aged population of Northern Ireland administered between February and July 2011. Using latent class analysis we identify three discrete classes of people based on their HLC: the first class is sceptical about their capacity to control their health and certain unhealthy habits. Despite being unsatisfied with their situation, they are reluctant to accept behaviour changes. The second is a group of individuals unhappy with their current situation but willing to change through exercise and diet. Finally, a group of healthy optimists is identified, who are satisfied with their current situation but happy to take more physical activity and improve their diet. Our findings show that any policy designed to modify people's health related behaviour should consider the needs of this sceptical class which represents a considerable proportion of the population in the region.

Efficient Characterisation and Optimal Control of Open Quantum Systems - Mathematical Foundations and Physical Applications

Since no physical system can ever be completely isolated from its environment, the study of open quantum systems is pivotal to reliably and accurately control complex quantum systems. In practice, reliability of the control field needs to be confirmed via certification of the target evolution while accuracy requires the derivation of high-fidelity control schemes in the presence of decoherence. In the first part of this thesis an algebraic framework is presented that allows to determine the minimal requirements on the unique characterisation of arbitrary unitary gates in open quantum systems, independent on the particular physical implementation of the employed quantum device. To this end, a set of theorems is devised that can be used to assess whether a given set of input states on a quantum channel is sufficient to judge whether a desired unitary gate is realised. This allows to determine the minimal input for such a task, which proves to be, quite remarkably, independent of system size. These results allow to elucidate the fundamental limits regarding certification and tomography of open quantum systems. The combination of these insights with state-of-the-art Monte Carlo process certification techniques permits a significant improvement of the scaling when certifying arbitrary unitary gates. This improvement is not only restricted to quantum information devices where the basic information carrier is the qubit but it also extends to systems where the fundamental informational entities can be of arbitary dimensionality, the so-called qudits. The second part of this thesis concerns the impact of these findings from the point of view of Optimal Control Theory (OCT). OCT for quantum systems utilises concepts from engineering such as feedback and optimisation to engineer constructive and destructive interferences in order to steer a physical process in a desired direction. It turns out that the aforementioned mathematical findings allow to deduce novel optimisation functionals that significantly reduce not only the required memory for numerical control algorithms but also the total CPU time required to obtain a certain fidelity for the optimised process. The thesis concludes by discussing two problems of fundamental interest in quantum information processing from the point of view of optimal control - the preparation of pure states and the implementation of unitary gates in open quantum systems. For both cases specific physical examples are considered: for the former the vibrational cooling of molecules via optical pumping and for the latter a superconducting phase qudit implementation. In particular, it is illustrated how features of the environment can be exploited to reach the desired targets.

Studies about the atomic capabilities concept for linear control systems in physical multi-agent environments

This paper shows the impact of the atomic capabilities concept to include control-oriented knowledge of linear control systems in the decisions making structure of physical agents. These agents operate in a real environment managing physical objects (e.g. their physical bodies) in coordinated tasks. This approach is presented using an introspective reasoning approach and control theory based on the specific tasks of passing a ball and executing the offside manoeuvre between physical agents in the robotic soccer testbed. Experimental results and conclusions are presented, emphasising the advantages of our approach that improve the multi-agent performance in cooperative systems

Improvement of strategies for the management of fire blight (Erwinia amylovora). Evaluation and optimization of physical and chemical control methods, and use of decision support systems

El foc bacterià és una malaltia que afecta a plantes de la família de la rosàcies, causada pel bacteri Erwinia amylovora. El seu rang d'hostes inclou arbres fruiters, com la perera, la pomera o el codonyer, i plantes ornamentals de gran interès comercial i econòmic. Actualment, la malaltia s'ha dispersat i es troba àmpliament distribuïda en totes les zones de clima temperat del món. A Espanya, on la malaltia no és endèmica, el foc bacterià es va detectar per primer cop al 1995 al nord del país (Euskadi) i posteriorment, han aparegut varis focus en altres localitzacions, que han estat convenientment eradicats. El control del foc bacterià, és molt poc efectiu en plantes afectades per la malaltia, de manera que es basa en mesures encaminades a evitar la dispersió del patogen, i la introducció de la malaltia en regions no endèmiques. En aquest treball, la termoteràpia ha estat avaluada com a mètode d'eradicació d'E. amylovora de material vegetal de propagació asimptomàtic. S'ha demostrat que la termoteràpia és un mètode viable d'eradicar E. amylovora de material de propagació. Gairebé totes les espècies i varietats de rosàcies mantingudes en condicions d'humitat sobrevivien 7 hores a 45 ºC i més de 3 hores a 50 ºC, mentre que més d'1 hora d'exposició a 50 ºC amb calor seca produïa danys en el material vegetal i reduïa la brotació. Tractaments de 60 min a 45 ºC o 30 min a 50 ºC van ser suficients per reduir la població epífita d'E. amylovora a nivells no detectables (5 x 102 ufc g-1 p.f.) en branques de perera. Els derivats dels fosfonats i el benzotiadiazol són efectius en el control del foc bacterià en perera i pomera, tant en condicions de laboratori, com d'hivernacle i camp. Els inductors de defensa de les plantes redueixen els nivells de malaltia fins al 40-60%. Els intervals de temps mínims per aconseguir el millor control de la malaltia van ser 5 dies pel fosetil-Al, i 7 dies per l'etefon i el benzotiadiazol, i les dosis òptimes pel fosetil-Al i el benzotiadiazol van ser 3.72 g HPO32- L-1 i 150 mg i.a. L-1, respectivament. Es millora l'eficàcia del fosetil-Al i del benzotiadiazol en el control del foc bacterià, quan es combinen amb els antibiòtics a la meitat de la dosi d'aquests últims. Tot i que l'estratègia de barrejar productes és més pràctica i fàcil de dur a terme a camp, que l'estratègia de combinar productes, el millor nivell de control de la malaltia s'aconsegueix amb l'estratègia de combinar productes. Es va analitzar a nivell histològic i ultrastructural l'efecte del benzotiadiazol i dels fosfonats en la interacció Erwinia amylovora-perera. Ni el benzotiadiazol, ni el fosetil-Al, ni l'etefon van induir canvis estructurals en els teixits de perera 7 dies després de la seva aplicació. No obstant, després de la inoculació d'E. amylovora es va observar en plantes tractades amb fosetil-Al i etefon una desorganització estructural cel·lular, mentre que en les plantes tractades amb benzotiadiazol aquestes alteracions tissulars van ser retardades. S'han avaluat dos models (Maryblyt, Cougarblight) en un camp a Espanya afectat per la malaltia, per determinar la precisió de les prediccions. Es van utilitzar dos models per elaborar el mapa de risc, el BRS-Powell combinat i el BIS95 modificat. Els resultats van mostrar dos zones amb elevat i baix risc de la malaltia. Maryblyt i Cougarblight són dos models de fàcil ús, tot i que la seva implementació en programes de maneig de la malaltia requereix que siguin avaluats i validats per un període de temps més llarg i en àrees on la malaltia hi estigui present.