Publication: Developing an Equitable Machine Learning-Based Music Intervention for Older Adults At Risk for Alzheimer Disease: Protocol for Algorithm Development and Validation

Authors: Chelsea S Brown, Luna Dziewietin, Virginia Partridge, Jennifer Rae Myers Abstract Background: Given the high prevalence and cost of Alzheimer disease (AD), it is crucial to develop equitable interventions to address lifestyle factors associated with AD incidence (eg, depression). While lifestyle interventions show promise for reducing cognitive decline, culturally sensitive interventions are needed to ensure acceptability and engagement. Given the increased risk for AD and health care barriers among rural-residing older adults, tailoring interventions to align with rural culture and distinct needs is important to improve accessibility and adherence. Objective: This protocol aims to develop an intelligent recommendation system capable of identifying the optimal therapeutic music components to elicit engagement and resonate with diverse rural-residing older adults at risk for AD. Aim 1 is to develop culturally inclusive user personas for rural-residing older adults to understand…

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Publication: Passive Measures of Physical Activity and Cadence as Early Indicators of Cognitive Impairment: Observational Study

Authors: Huitong Ding, Stefaniya Brown, David R Paquette, Taylor A Orwig, Nicole Spartano, Honghuang Lin Abstract Background: Emerging research shows regular physical activity reduces cognitive decline risk, but most studies rely on self-reported measures, which are limited by recall bias, subjectivity, and a lack of continuous monitoring capability. Objective: This study aimed to explore passive physical activity measures as early indicators of cognitive impairment by examining their association with cognitive impairment incidence and neuropsychological (NP) test performance. Methods: We included participants from the Framingham Heart Study (FHS), a community-based cohort with longitudinal cognitive impairment surveillance. Participants wore an Actical accelerometer for at least 3 days, excluding bathing. Thirty physical activity measures were grouped into intensity-specific durations, step and cadence summaries, and peak cadence. Cox proportional hazard models were applied to assess their associations with incident…

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Publication: Reinforcement Learning on Dyads to Enhance Medication Adherence

Authors: Ziping Xu, Hinal Jajal, Sung Won Choi, Inbal Nahum-Shani, Guy Shani, Alexandra M. Psihogios, Pei-Yao Hung, Susan A. Murphy Abstract Medication adherence is critical for the recovery of adolescents and young adults (AYAs) who have undergone hematopoietic cell transplantation. However, maintaining adherence is challenging for AYAs after hospital discharge, who experience both individual (e.g. physical and emotional symptoms) and interpersonal barriers (e.g., relational difficulties with their care partner, who is often involved in medication management). To optimize the effectiveness of a three-component digital intervention targeting both members of the dyad as well as their relationship, we propose a novel Multi-Agent Reinforcement Learning (MARL) approach to personalize the delivery of interventions. By incorporating the domain knowledge, the MARL framework, where each agent is responsible for the delivery of one intervention component, allows for faster learning…

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Publication: Proceedings from SOUPS ’25 – Can You Walk Me Through It? Explainable SMS Phishing Detection using LLM-based Agents

Authors: Yizhu Wang, Haoyu Zhai, Chenkai Wang, Qingying Hao, Nick A Cohen, Roopa Foulger, Jonathan A Handler, and Gang Wang. Abstract SMS phishing poses a significant threat to users, especially older adults. Existing defenses mainly focus on phishing detection, but often cannot explain why the SMS is malicious to lay users. In this paper, we use large language models (LLMs) to detect SMS phishing while generating evidence-based explanations. The key challenge is that SMS is short, lacking the necessary context for security reasoning. We develop a prototype called SmishX which gathers external contexts (e.g., domain and brand information, URL redirection, and web screenshots) to augment the chain-of-thought (CoT) reasoning of LLMs. Then, the reasoning process is converted into a short explanation message to help users with their decision-making. Evaluation using real-world SMS datasets shows SmishX can achieve…

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Publication: Causal Directed Acyclic Graph-informed Reward Design

Authors: Luton Zou, Ziping Xu, Daiqi Gao, Susan Murphy Abstract It is well known that in reinforcement learning (RL) different reward functions may lead to the same optimal policy, while some reward functions can be substantially easier to learn. In this paper, we propose a framework for reward design by constructing surrogate rewards with mediators informed by causal directed acyclic graphs (DAGs), which are often available in real-world applications through domain knowledge. We show that under the surrogacy assumption, the proposed reward is unbiased and has lower variance than the primary reward. Specifically, we use an online reward design agent that adaptively learns the target surrogate reward in an unknown environment. Feeding the surrogate rewards to standard online learning oracles, we show that the regret bound can be improved. Our framework provides a theoretical improvement…

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Publication: Digital Twins for Just-in-Time Adaptive Interventions (JITAI-Twins): A Framework for Optimizing and Continually Improving JITAIs

Authors: Asim H. Gazi, Daiqi Gao, Susobhan Ghosh, Ziping Xu, Anna Trella, Predrag Klasnja, Susan A. Murphy Abstract Just-in-time adaptive interventions (JITAIs) are nascent precision medicine systems that extend personalized healthcare support to everyday life. A challenge in designing JITAIs is that personalized support often involves sophisticated decision-making algorithms. These decision-making algorithms can require numerous non-trivial design decisions that must be made between successive JITAI deployments (e.g., hyperparameter selection for an artificial intelligence algorithm). Making design decisions between deployments–rather than during deployment–ensures intervention fidelity and enhances the ability to replicate results. Yet, each deployment can be costly, precluding the use of A/B testing for every design decision. How should design decisions be made strategically between JITAI deployments? This paper introduces digital twins for just-in-time adaptive interventions (JITAI-Twins) to address this question. JITAI-Twins are “digital twins…

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Publication: Returning Individualized Wearable Sensor Results to Older Adult Research Participants: A Pilot Study

Authors: Shelby L Bachman, Krista S Leonard-Corzo, Jennifer M Blankenship, Michael A Busa, Corinna Serviente, Matthew W Limoges, Robert T Marcotte, Ieuan Clay, Kate Lyden Abstract Background: Wearable sensors that monitor physical behaviors are increasingly adopted in clinical research. Older adult research participants have expressed interest in tracking and receiving feedback on their physical behaviors. Simultaneously, researchers and clinical trial sponsors are interested in returning results to participants, but the question of how to return individual study results derived from research-grade wearable sensors remains unanswered. In this study, we (1) assessed the feasibility of returning individual physical behavior results to older adult research participants and (2) obtained participant feedback on the returned results. Methods: Older adult participants (N = 20; ages 67-96) underwent 14 days of remote monitoring with 2 wearable sensors. We then used a semiautomated…

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