Stephanie M. Carpenter

Fengxu Li, Stephanie M. Carpenter, Matthew P. Buman et al.

A common challenge for decision makers is selecting actions whose rewards are unknown and evolve over time based on prior policies. For instance, repeated use may reduce an action's effectiveness (habituation), while inactivity may restore it (recovery). These nonstationarities are captured by the Reducing or Gaining Unknown Efficacy (ROGUE) bandit framework, which models real-world settings such as behavioral health interventions. While existing algorithms can compute sublinear regret policies to optimize these settings, they may not provide sufficient exploration due to overemphasis on exploitation, limiting the ability to estimate population-level effects. This is a challenge of particular interest in micro-randomized trials (MRTs) that aid researchers in developing just-in-time adaptive interventions that have population-level effects while still providing personalized recommendations to individuals. In this paper, we first develop ROGUE-TS, a Thompson Sampling algorithm tailored to the ROGUE framework, and provide theoretical guarantees of sublinear regret. We then introduce a probability clipping procedure to balance personalization and population-level learning, with quantified trade-off that balances regret and minimum exploration probability. Validation on two MRT datasets concerning physical activity promotion and bipolar disorder treatment shows that our methods both achieve lower regret than existing approaches and maintain high statistical power through the clipping procedure without significantly increasing regret. This enables reliable detection of treatment effects while accounting for individual behavioral dynamics. For researchers designing MRTs, our framework offers practical guidance on balancing personalization with statistical validity.

Shovito Barua Soumma, Asiful Arefeen, Stephanie M. Carpenter et al.

Counterfactual explanations (CFEs) provide human-centric interpretability by identifying the minimal, actionable changes required to alter a machine learning model's prediction. Therefore, CFs can be used as (i) interventions for abnormality prevention and (ii) augmented data for training robust models. We conduct a comprehensive evaluation of CF generation using large language models (LLMs), including GPT-4 (zero-shot and few-shot) and two open-source models-BioMistral-7B and LLaMA-3.1-8B, in both pretrained and fine-tuned configurations. Using the multimodal AI-READI clinical dataset, we assess CFs across three dimensions: intervention quality, feature diversity, and augmentation effectiveness. Fine-tuned LLMs, particularly LLaMA-3.1-8B, produce CFs with high plausibility (up to 99%), strong validity (up to 0.99), and realistic, behaviorally modifiable feature adjustments. When used for data augmentation under controlled label-scarcity settings, LLM-generated CFs substantially restore classifier performance, yielding an average 20% F1 recovery across three scarcity scenarios. Compared with optimization-based baselines such as DiCE, CFNOW, and NICE, LLMs offer a flexible, model-agnostic approach that generates more clinically actionable and semantically coherent counterfactuals. Overall, this work demonstrates the promise of LLM-driven counterfactuals for both interpretable intervention design and data-efficient model training in sensor-based digital health. Impact: SenseCF fine-tunes an LLM to generate valid, representative counterfactual explanations and supplement minority class in an imbalanced dataset for improving model training and boosting model robustness and predictive performance

Saman Khamesian, Sri Harini Balaji, Di Yang Shi et al.

Type 1 Diabetes (T1D) management requires continuous adjustment of insulin and lifestyle behaviors to maintain blood glucose within a safe target range. Although automated insulin delivery (AID) systems have improved glycemic outcomes, many patients still fail to achieve recommended clinical targets, warranting new approaches to improve glucose control in patients with T1D. While reinforcement learning (RL) has been utilized as a promising approach, current RL-based methods focus primarily on insulin-only treatment and do not provide behavioral recommendations for glucose control. To address this gap, we propose GUIDE, an RL-based decision-support framework designed to complement AID technologies by providing behavioral recommendations to prevent abnormal glucose events. GUIDE generates structured actions defined by intervention type, magnitude, and timing, including bolus insulin administration and carbohydrate intake events. GUIDE integrates a patient-specific glucose level predictor trained on real-world continuous glucose monitoring data and supports both offline and online RL algorithms within a unified environment. We evaluate both off-policy and on-policy methods across 25 individuals with T1D using standardized glycemic metrics. Among the evaluated approaches, the CQL-BC algorithm demonstrates the highest average time-in-range, reaching 85.49% while maintaining low hypoglycemia exposures. Behavioral similarity analysis further indicates that the learned CQL-BC policy preserves key structural characteristics of patient action patterns, achieving a mean cosine similarity of 0.87 $\pm$ 0.09 across subjects. These findings suggest that conservative offline RL with a structured behavioral action space can provide clinically meaningful and behaviorally plausible decision support for personalized diabetes management.

Shovito Barua Soumma, Asiful Arefeen, Stephanie M. Carpenter et al.

Counterfactual explanations (CFs) offer human-centric insights into machine learning predictions by highlighting minimal changes required to alter an outcome. Therefore, CFs can be used as (i) interventions for abnormality prevention and (ii) augmented data for training robust models. In this work, we explore large language models (LLMs), specifically GPT-4o-mini, for generating CFs in a zero-shot and three-shot setting. We evaluate our approach on two datasets: the AI-Readi flagship dataset for stress prediction and a public dataset for heart disease detection. Compared to traditional methods such as DiCE, CFNOW, and NICE, our few-shot LLM-based approach achieves high plausibility (up to 99%), strong validity (up to 0.99), and competitive sparsity. Moreover, using LLM-generated CFs as augmented samples improves downstream classifier performance (an average accuracy gain of 5%), especially in low-data regimes. This demonstrates the potential of prompt-based generative techniques to enhance explainability and robustness in clinical and physiological prediction tasks. Code base: github.com/shovito66/SenseCF.

Saman Khamesian, Asiful Arefeen, Stephanie M. Carpenter et al.

Maintaining a balanced diet is essential for overall health, yet many individuals struggle with meal planning due to nutritional complexity, time constraints, and lack of dietary knowledge. Personalized food recommendations can help address these challenges by tailoring meal plans to individual preferences, habits, and dietary restrictions. However, existing dietary recommendation systems often lack adaptability, fail to consider real-world constraints such as food ingredient availability, and require extensive user input, making them impractical for sustainable and scalable daily use. To address these limitations, we introduce NutriGen, a framework based on large language models (LLM) designed to generate personalized meal plans that align with user-defined dietary preferences and constraints. By building a personalized nutrition database and leveraging prompt engineering, our approach enables LLMs to incorporate reliable nutritional references like the USDA nutrition database while maintaining flexibility and ease-of-use. We demonstrate that LLMs have strong potential in generating accurate and user-friendly food recommendations, addressing key limitations in existing dietary recommendation systems by providing structured, practical, and scalable meal plans. Our evaluation shows that Llama 3.1 8B and GPT-3.5 Turbo achieve the lowest percentage errors of 1.55\% and 3.68\%, respectively, producing meal plans that closely align with user-defined caloric targets while minimizing deviation and improving precision. Additionally, we compared the performance of DeepSeek V3 against several established models to evaluate its potential in personalized nutrition planning.

Anna L. Trella, Kelly W. Zhang, Stephanie M. Carpenter et al.

Dental disease is still one of the most common chronic diseases in the United States. While dental disease is preventable through healthy oral self-care behaviors (OSCB), this basic behavior is not consistently practiced. We have developed Oralytics, an online, reinforcement learning (RL) algorithm that optimizes the delivery of personalized intervention prompts to improve OSCB. In this paper, we offer a full overview of algorithm design decisions made using prior data, domain expertise, and experiments in a simulation test bed. The finalized RL algorithm was deployed in the Oralytics clinical trial, conducted from fall 2023 to summer 2024.

Supriya Nagesh, Alexander Moreno, Stephanie M. Carpenter et al.

Ecological Momentary Assessments (EMAs) are an important psychological data source for measuring current cognitive states, affect, behavior, and environmental factors from participants in mobile health (mHealth) studies and treatment programs. Non-response, in which participants fail to respond to EMA prompts, is an endemic problem. The ability to accurately predict non-response could be utilized to improve EMA delivery and develop compliance interventions. Prior work has explored classical machine learning models for predicting non-response. However, as increasingly large EMA datasets become available, there is the potential to leverage deep learning models that have been effective in other fields. Recently, transformer models have shown state-of-the-art performance in NLP and other domains. This work is the first to explore the use of transformers for EMA data analysis. We address three key questions in applying transformers to EMA data: 1. Input representation, 2. encoding temporal information, 3. utility of pre-training on improving downstream prediction task performance. The transformer model achieves a non-response prediction AUC of 0.77 and is significantly better than classical ML and LSTM-based deep learning models. We will make our a predictive model trained on a corpus of 40K EMA samples freely-available to the research community, in order to facilitate the development of future transformer-based EMA analysis works.