Wear Protocol Research Articles

Efficacy of planned moderate to severe torque changes in mandibular central incisors with an initial series of Invisalign aligners: a retrospective cohort study.

To determine whether the achieved mandibular central incisor lingual root torque (LRT) changes matched the planned changes after treatment with an initial series of Invisalign aligners when ≥10° of torque change was planned. A sample of adult patients who underwent treatment with the Invisalign appliance between 2013 and 2021 were evaluated. The pretreatment, planned, and achieved posttreatment digital models were measured using Geomagic Control X metrology software. The effect of age, number of prescribed aligners, sex, the presence of power ridges (PRs), and differing weekly wear protocols (WPs) in relation to the achieved LRT changes were determined. Seventy mandibular central incisors from 35 patients satisfied inclusion criteria. The accuracy of the achieved lower incisor LRT compared with that planned was 58.2%. Underexpression of planned torque changes was observed in most incisors (N = 66; 94.3%), with a clinically significant shortfall (≥5°) observed in 68.6% (N = 42) teeth. Patient age, sex, the WP, or the presence of PRs did not influence the differences between planned and achieved outcomes (P > .05). The prescribed number of aligners was influential in the difference between the planned and achieved torque outcomes (P < .01). Underexpression of mandibular central incisor root torque was observed in most incisors in patients when ≥10° change in LRT was planned. Lower incisor LRT was not significantly affected by the presence of PRs or differences in WPs.

Cross-sectional associations of movement behaviour compositions with health-related quality of life in Australian children

ObjectivesTo examine associations of movement behaviour compositions with health-related quality of life in children. MethodsBaseline data (2018) from the TransformUs study were used. Overall, 891 children aged 7–12 years [69% of consented sample] recorded valid accelerometry data (ActiGraph GT3X+; 4 days, including ≥1 weekend day). Time spent sedentary, and in light-, moderate-, and vigorous-intensity physical activity were extracted. Health-related quality of life was assessed using five EQ-5D-Y health-related quality of life dimensions (mobility, looking after myself, doing usual activities, having pain/discomfort, and feeling worried/sad/unhappy [all dichotomized as no versus any problems]) and one continuous scale assessing overall perceived health. Regression models examined associations between waking movement behaviour compositions, including longer and shorter sedentary (<5 and ≥ 5 min) and physical activity (<1 and ≥ 1 min) bouts, and health-related quality of life. ResultsThe waking movement behaviour composition was associated with overall perceived health (whole sample, and boys and girls separately, but high socio-economic status only) and having pain/discomfort. More relative time in shorter versus longer sedentary bouts was associated with lower overall perceived health and higher odds of pain/discomfort. More relative time in shorter versus longer light-intensity and moderate-intensity bouts, were associated with decreased and increased odds of pain/discomfort, respectively. Finally, more time in shorter versus longer vigorous-intensity physical activity bouts was associated with better perceived health. ConclusionsChildren's movement behaviours seem to be related to health-related quality of life. Longitudinal evidence from more diverse samples with 24-h wear protocols and context-specific measures are needed to better understand this association.

A Cross-Sectional Survey of the Use of Clear Aligners by General Dentists in Australia.

The primary aim of the investigation was to survey clear aligner therapy (CAT) use among general dentists in Australia. A secondary aim was to evaluate the factors that influenced general dentists in Australia not to provide CAT. General dentists registered with the Australian Health Practitioner Regulation Agency were invited to participate in a structured cross-sectional electronic survey. The survey covered demographics, preferred CAT systems and practices, relevant treatment planning and retention protocols, patient-reported CAT issues, pertinent respondent opinions, and reasons for not providing CAT. Descriptive statistics were computed via GraphPad Prism v10 (GraphPad Software Inc., La Jolla, CA, USA). Most of the 264 (n = 172; 65.2%) respondents indicated that they provided CAT. The majority (n = 82; 58.6%) reported that they treated between 1 and 20 patients with CAT annually. Invisalign was the most used system (n = 83; 61.2%), with 55 (41.7%), indicating that they used more than one system. Most (n = 124; 98.4%) were comfortable using CAT for mild crowding, whereas 73.4% (n = 94) were not comfortable in treating severe crowding with CAT. The median (IQR) number of patients per respondent treated with extraction of a permanent incisor or premolar was 0 (0). Issues regarding tooth positions were reportedly always or mostly in need of change in the initial treatment plan by 68.7%. Problems regarding patient compliance with CAT wear protocols (n = 67; 45.6%) and the predictability of treatment outcomes (n = 31; 21.1%) were the most identified themes of the free-text comments. Over 80% of those who did not provide CAT indicated that they preferred to refer to an orthodontist for management. Almost two-thirds of the respondents provided CAT. Invisalign was the most used system. The majority use CAT combined with nonextraction treatment. Most of those who did not provide CAT preferred to refer to an orthodontist for patient management.

Efficacy of planned moderate to severe torque changes in maxillary central incisors with the Invisalign appliance: A retrospective investigation

This study aimed to investigate whether there was a difference between the planned and achieved lingual root torque of the maxillary central incisors in patients treated with an initial series of Invisalign (Align Technology, Santa Clara, Calif) aligners in which>10° change in the inclination of these teeth was prescribed via the ClinCheck facility. The pretreatment, planned, and the digital models after wear of the initial series of aligners regarding adult patients who satisfied selection criteria and were treated using the Invisalign appliance were measured using the Geomagic Control X software (version 2017.0.3; 3D systems, Rock Hill, SC). A sample of 63 patients with 126 maxillary central incisors satisfied the inclusion criteria. The mean accuracy of the planned torque change of the maxillary central incisors that was achieved was 41.9%. A clinically significant shortfall (≥5°) was detected in 78.6% of the incisors, with the majority showing an underexpression between 10°-15°. Linear regression analyses indicated that weekly or biweekly wear protocols or the presence or absence of power ridges did not influence the accuracy of planned torque expression (P>0.05). The changes in torque expression with an initial series of Invisalign aligners were less than half of what was planned in patients in which at least a 10° change in lingual root torque of these teeth was prescribed. The presence of power ridges and the aligner change protocol did not appear to significantly affect the accuracy of maxillary central incisor torque expression.

Analysis of predicted and achieved root angulation changes in teeth adjacent to maxillary premolar extraction sites in patients treated with the Invisalign appliance

This study aimed to investigate the expression of root angulation in canine, premolar, and first molar teeth adjacent to first and second premolar extraction sites in the maxilla after treatment with an initial series of Invisalign aligners (Align Technology, Santa Clara, Calif). Adult patients (aged≥18 years) with at least 1 first and/or second premolar extraction in the maxilla and satisfying strict selection criteria were evaluated. Digital models representing pretreatment, predicted, and posttreatment were obtained from Align Technology's digital interface, ClinCheck. The Geomagic Control X (version 2017.0.3; 3D systems, Rock Hill, NC) software facility was used to determine and compare the root angulation of adjacent canine, premolar, and first molar teeth at different time points. The predicted angulation of teeth was significantly different (P<0.02) than that achieved in most patients. When adjacent teeth roots were planned to tip away from the extraction site, there was an overexpression of the movement. When teeth roots were planned to tip into the extraction site, underexpression occurred, and movement was in the opposite direction in some instances. There was no difference in root angulation outcomes according to the prescribed number of aligners, 1- or 2-week wear protocols, and sex (P>0.05). Attachments were influential in controlling angulation in first-premolar extractions (P= 0.05), but optimized attachments were not any more effective than conventional attachments (P>0.05). The achieved root angulation in teeth adjacent to premolar extraction sites in the maxilla after treatment with an initial series of Invisalign aligners differed significantly from that predicted. Attachments play a minor role in the predictability of root angulation outcomes.

Physical activity cut-points for older adults using the Zio XT onboard accelerometer

IntroductionThe Zio® XT continuous ambulatory electrocardiographic monitor (Zio) contains an accelerometer that can help quantify an individual’s physical activity in the free-living environment.Purpose(1) To estimate activity cut-points to estimate daily time spent performing very light, light, or moderate to vigorous physical activity (VLIPA, LIPA, MVPA) for the Zio accelerometer. (2) To describe how Zio’s 24-h wear protocol affects estimates of daily MVPA relative to a waist-worn accelerometer’s waking-wear protocol.MethodsThree hundred eighty one participants from the Atherosclerosis Risk in Communities (ARIC) study wore a waist-mounted ActiGraph GT3X (except while sleeping or water-based activities) and a Zio (24-h) simultaneously for three to seven days. For each person-minute, physical activity was summarized as the Mean Amplitude Deviation (MAD) for the Zio and Vector Magnitude Counts (VMC) for the GT3X. Cut points previously used in ARIC were mapped from GT3X VMC to Zio MAD using a conditional two-sample quantile–quantile approach.ResultsEvenson VMC cut-points for the GT3X (VLIPA≥76, LIPA≥903, MVPA≥2075 counts/min) were mapped to MAD for Zio (9.04, 28.2, and 58.1 mili-g). Daily hours spent in each intensity category were each strongly correlated (ICC > 0.7) between summaries produced by Zio and GT3X when restricting estimates to overlapping wear time. Zio and GT3X-estimated MVPA had high agreement (ICC = 0.77) when using device-specific wear time, but Zio measured one hour more of daily LIPA and VLIPA (95% CI = 0.83, 1.07 hrs/day).ConclusionsWe recommend the use of our cut-points for clinical research with Zio accelerometry in populations of older adults.

Efficacy of clear aligner wear protocols in orthodontic tooth movement-a systematic review.

Different expedited aligner wear protocols are currently in practice. This review was undertaken to systematically appraise the available evidence on the comparative efficacy of orthodontic tooth movement (OTM) across the different wear protocols. Two assessors conducted comprehensive searches of electronic databases, including MEDLINE (via PubMed), Scopus, Embase, Web of Science, Google Scholar, Directory of Open Access Journals, Cochrane Library, OpenGrey, and Clinical Trial Registry, till 18 February 2024. Titles and abstracts were independently screened. Prospective or retrospective studies comparing expedited wear protocols with the conventional 14-day protocol were included. A pre-piloted data extraction form was used. Risk of bias (RoB) assessment employed the Cochrane RoB 2.0 tool for randomized-controlled trials (RCTs) and the Newcastle-Ottawa scale for non-RCTs. The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation Pro tool. Six studies, including 3 RCTs and 3 non-RCTs, were selected from 9076 records. Four studies (two RCTs and two retrospective cohort) found no statistically significant difference (P > 0.05) in the OTM efficacy between expedited and conventional protocols. Two studies (one RCT and one prospective cohort) found greater efficacy (P < 0.05) with the 14-day protocol, with the RCT reporting greater efficacy for certain movements, such as maxillary posterior intrusion, maxillary posterior distal tipping and buccal torquing, and mandibular posterior intrusion and extrusion. One RCT reported statistically insignificant difference (P > 0.05) in pain perception between the 10-day and 14-day protocols. Two studies demonstrated low RoB, two moderate, and two high RoB. The evidence level was very-low for OTM efficacy and high for pain perception. Meta-analysis was precluded due to significant heterogeneity among the studies. Within the limitations of the study, the 7-day, 10-day, and 14-day protocols did not show any significant difference in OTM efficacy, except for certain movements that exhibited superior outcomes with the 14-day wear. Hence, a 'hybrid aligner-wear protocol', based on clinical judgement, might serve a better alternative in complex situations. PROSPERO CRD42021288179.

Development of a multi-wear-site, deep learning-based physical activity intensity classification algorithm using raw acceleration data.

Accelerometers are widely adopted in research and consumer devices as a tool to measure physical activity. However, existing algorithms used to estimate activity intensity are wear-site-specific. Non-compliance to wear instructions may lead to misspecifications. In this study, we developed deep neural network models to classify device placement and activity intensity based on raw acceleration data. Performances of these models were evaluated by making comparisons to the ground truth and results derived from existing count-based algorithms. 54 participants (26 adults 26.9±8.7 years; 28 children, 12.1±2.3 years) completed a series of activity tasks in a laboratory with accelerometers attached to each of their hip, wrist, and chest. Their metabolic rates at rest and during activity periods were measured using the portable COSMED K5; data were then converted to metabolic equivalents, and used as the ground truth for activity intensity. Deep neutral networks using the Long Short-Term Memory approach were trained and evaluated based on raw acceleration data collected from accelerometers. Models to classify wear-site and activity intensity, respectively, were evaluated. The trained models correctly classified wear-sites and activity intensities over 90% of the time, which outperformed count-based algorithms (wear-site correctly specified: 83% to 85%; wear-site misspecified: 64% to 75%). When additional parameters of age, height and weight of participants were specified, the accuracy of some prediction models surpassed 95%. Results of the study suggest that accelerometer placement could be determined prospectively, and non-wear-site-specific algorithms had satisfactory accuracies. The performances, in terms of intensity classification, of these models also exceeded typical count-based algorithms. Without being restricted to one specific wear-site, research protocols for accelerometers wear could allow more autonomy to participants, which may in turn improve their acceptance and compliance to wear protocols, and in turn more accurate results.

Registered report protocol for an e: Health motor skills and physical activity intervention in early childhood education centers- e: Motor skills At Playtime (MAP).

Children have alarmingly low levels of competency in fundamental motor skills (FMS) and high levels of physical inactivity. e:health interventions, interventions delivered electronically, are useful tools for intervention in the home through parents, but less is known about the effects of these interventions in early childhood education centers or settings. Therefore, we created the Motor skills At Playtime (MAP) e:health intervention (e:MAP) to be delivered in an early childhood education setting. The goals of this pilot study on e:MAP are to (1) determine the intervention effects on children's FMS and physical activity and (2) explore the teachers' perceptions and ability to facilitate e:MAP. This pilot study uses a pretest/posttest randomized cluster control design. We will recruit at least 64 children (3.5-5 years of age) enrolled in a single early childhood education center. Children will be randomly assigned at the level of the classroom to an e:MAP group (n~30) or a control group (n~30). Children in classrooms assigned to e:MAP will complete an 8-week intervention. We will collect measures of child FMS and physical activity, and teacher's perceptions of the program before (pretest) and after the intervention (posttest). FMS measures include process (Test of Gross Motor Development-3rd Edition) and product-oriented scores. Physical activity will be assessed using a 7-day accelerometer wear protocol. Teachers' perceptions will be assessed through a brief survey. Lastly, we will collect data on teachers' ability to facilitate e:MAP through a daily survey. This study will yield novel insights into the effectiveness and feasibility of a health intervention in an early childhood education setting. Results from this work will expand our knowledge of how to harness e:health modalities, which have the potential to significantly expand the distribution and scalability of FMS interventions.

Comparison of labio-palatal incisor movement between two wear protocols: a retrospective cohort study.

To investigate the accuracy of the Invisalign appliance in achieving predicted angular tooth movement of the maxillary central incisors, to locate the center of rotation in a labio-palatal direction, and to investigate any difference between 1-weekly and 2-weekly wear protocols. This study involved a retrospective sample of two groups of 46 Class I adult subjects treated non-extraction with different protocols of 1-weekly and 2-weekly wear. The pretreatment, predicted outcome and achieved outcome digital models were superimposed and measured using metrology software. Angular and center-of-rotation measurements in the sagittal plane for the maxillary right central incisor were analyzed. There was a statistically significant difference between predicted and achieved angular measurements (P < .005) for labial tooth movements regardless of wear protocol. For palatal movements, no statistically significant difference was observed (P > .05). A small amount of overexpression was observed in some cases. Regarding crown and root control, uncontrolled tipping was the most predictable. No statistically significant difference was found between predicted and achieved center of rotation, but the confidence interval was wide. No statistically significant difference (P > .05) was found between the two wear protocols for the parameters measured. For maxillary central incisors, labial angular movements were not as accurate as palatal movements. Overcorrection could be recommended with careful clinical monitoring due to the possibility of overexpression. Control of root movements may be unpredictable, and further research is required to draw stronger conclusions. For the parameters measured in this clinical sample, there was no difference between the two wear protocols.

International Physical Activity Questionnaire Short Form and accelerometer-assessed physical activity: concurrent validity using six cut-points in HF patients.

Physical activity (PA) is an important target for improving clinical outcomes in heart failure (HF) patients. Nonetheless, assessing the daily PA profile in this population is a challenging task, traditionally performed using self-report questionnaires such as the International PA Questionnaire Short Form (IPAQ-SF). This study aimed to evaluate the concurrent validity of the IPAQ-SF and accelerometer-assessed PA using six published cut-points in patients with HF and reduced or mildly reduced ejection fraction. The concordance between the IPAQ-SF and a hip-worn accelerometer regarding daily time spent performing moderate to vigorous PA in bouts of at least 10min was assessed in 53 participants for seven consecutive days using six different cut-points (Barnett, Dibben, Mark, Sanders, Troiano, and Vaha-Ypya). Spearman's correlation and Bland-Altman plots were used to evaluate concurrent validity between methods. Regressions were used to study the association between patient variables, wear protocol (waking hour or 24h), and absolute bias. The kappa index was used to evaluate the concordance between IPAQ-SF and accelerometry for classifying patients as active or non-active. All analyses were re-run using non-bouted metrics to investigate the effect of bouted versus non-bouted analysis. The IPAQ-SF and accelerometry showed low to negligible correlation (ρ=0.12 to 0.37), depending on the cut-point used. The regression analysis showed that the absolute bias was higher in participants following the waking-hour protocol at all cut-points except Dibben's (P≤0.007). The concordance between the two methods to classify patients as active and non-active was low when using Mark (κ=0.23) and Barnett (κ=0.34) cut-points and poor for the remaining cut-points (κ=0.03 to 0.18). The results of the sensitivity analysis showed negligible to low correlation using non-bouted metrics (ρ=0.27 to 0.33). Moderate to vigorous PA measures using IPAQ-SF and accelerometers are not equivalent, and we do not encourage researchers to use IPAQ-SF alone when assessing PA in HF patients. Moreover, applying personalized collection and processing criteria is important when assessing PA in HF patients. We recommend following the 24h protocol and selecting cut-points calibrated in patients with cardiovascular diseases. Finally, it is necessary to develop a new tailored questionnaire that considers walking intensity and is adjusted to the current World Health Organisation recommendations, which use non-bouted metrics.

The Effect of an Electronic Passive Prompt Intervention on Prolonged Occupational Sitting and Light-Intensity Physical Activity in Desk-Based Adults Working from Home during COVID-19 in Ireland

This study aimed to assess the effect of passive prompts on occupational physical behaviours (PBs) and bouts of prolonged sitting among desk-based workers in Ireland who were working from home during the COVID-19 pandemic. Electronic passive prompts were delivered every 45 min, asking participants to walk for five minutes, during working hours. Twenty-eight participants (aged 30–67 years) completed the six-week intervention between October 2020 and April 2021. PBs were measured using an activPAL3TM accelerometer, following a 24 h wear protocol, worn for the duration of the study. Participants were highly sedentary at both baseline (77.71% of work hours) and during the intervention (75.81% of work hours). However, the number of prolonged occupational sedentary bouts &gt; 90 min was reduced compared to baseline (0.56 ± 0.08 vs. 0.77 ± 0.11, p = 0.009). Similar reductions were observed in the time spent in sustained sitting &gt; 60 and &gt;90 min when compared to baseline sedentary patterns (60 min: −31.27 ± 11.91 min, p = 0.014; 90 min: −27.97 ± 9.39 min, p = 0.006). Light-intensity physical activity (LIPA) significantly increased during the intervention (+14.29%, p = 0.001). This study demonstrates that passive prompts, delivered remotely, can both reduce the number and overall time spent in prolonged bouts of occupational sedentary behaviour and increase occupational LIPA.

Contemporary Twin Block appliance wear protocols: A survey of UK orthodontists.

This study was undertaken to determine contemporary trends in the use of the Twin Block appliance among UK orthodontists, including the wear time currently prescribed. In addition, the study explored if there had been any change in wear time prescribed, considering recent research evidence proposing part-time wear. Cross-sectional, online survey. Members of the British Orthodontic Society (BOS). The questionnaire was emailed to all BOS members in November 2021 and hosted on the QualtricsXM platform. The questionnaire was piloted for content validity and tested for reliability. A response rate of 19% was attained. Nearly all (n = 244, 99%) participants used the Twin Block, and 90% (n = 218) prescribed full-time wear including/excluding eating. Although the majority (n = 168, 69%) had not made changes to their wear time prescriptions, nearly one-third (n = 75, 31%) had. Those who reported a change in their prescriptions currently prescribe less wear time than before, and commonly quoted 'research evidence' as the reason. A wide range in success rates (41%-100%) was reported, with patient compliance as the main reason for treatment discontinuation. The Twin Block is a popular functional appliance among orthodontists in the UK, originally designed by Clark to be worn full time to maximise functional forces applied to the dentition. However, this wear regime may place considerable strain on patient compliance. Most participants prescribed full-time Twin Block wear excluding eating. Approximately one-third of orthodontists made changes to their wear time prescriptions during their practising career, and currently instruct less wear time than before.

Comparison of 2 different wear protocols of vacuum-formed retainers with respect to the conventional parameters and 3-dimensional superimpositional analysis

This study aimed to compare the effectiveness of 2 different wear protocols of vacuum-formed retainers (VFR) in terms of angular and linear displacement of teeth using 3-dimensional (3D) superimpositional analysis and conventional model parameters. The study was conducted on 2 groups, each consisting of 17 patients randomly assigned to the part-time group or full-time group of VFR wearing after a nonextraction treatment. While conventional model measurements were assessed on 3D dental casts, 3D tooth movements were evaluated by digitally superimposed scans of casts acquired at 4-time points (debonding and 1, 3, and 6 months after debonding). Regarding conventional parameters, the difference between time-dependent changes among the groups was tested using the nonparametric Brunner-Langer and parametric linear mixed models. Considering 3D measurements, comparisons of groups were made using the Student t tests. There were no significant intergroup differences regarding conventional model parameters at any time (P>0.05). Significant intergroup differences were observed regarding angular and linear relapses in the labiolingual directionfor maxillary and mandibular incisors, as well as the rotational relapses for maxillary left canine and mandibular right lateral incisor, which were greater in the part-time group in the first month and at the end of 6months (P<0.05). Conventional model parameters appear to play a debatable role in evaluating the effectiveness of a retainer wear regimen. Three-dimensional analysis of tooth movements revealed that part-time VFR wear was less effective in retaining labiolingual and rotational tooth movements for the first month after debonding.

A survey of orthodontic clear aligner practices among orthodontists

The purpose of this cross-sectional study was to survey orthodontic clear aligner therapy (CAT) practices among orthodontists in Australia. A pilot-tested electronic questionnaire was distributed to 434 full members of the Australian Society of Orthodontists. Questions were related to demographics, use and choice of aligners, digital treatment planning, patient selection, treatment protocols, refinements/finishing, retention, and patient-reported aligner issues. Factors regarding the decision not to provide CAT were also surveyed. The response rate was 54.6%. Most orthodontists (93.13%) provided CAT, which made up 24.17% of their annual orthodontic caseload. The median percentage of initial digital treatment plans (DTP) approved without changes was 0, with 4-6 changes reported by 24.14%. Orthodontists reported a mean of 2.02 ± 1.76 refinements per patient. Orthodontists were least comfortable treating patients with bilateral crossbite (71.28%) and deep overbite (62.56%). DTP challenges regarding tooth attachments and tooth positions and issues regarding patient compliance with CAT wear protocols were commonly reported. More than 1 CAT system was used by most (63.92%), with in-house systems used by 21.63%. Orthodontists rarely or never (63.68%) performed premolar extraction treatment with CAT. Adjunctive interproximal reduction was reportedly mostly carried out to relieve crowding and reduce open gingival embrasures. The view that fixed appliances provide better outcomes was a major influence (71.43%) on the decision for those who did not provide any CAT. CAT practices among orthodontists varied. Further research is required to investigate the challenges in effective CAT provision highlighted in this survey.

Feasibility and Acceptability of Wearable Sensor Placement for Measuring Screen Time of Children.

Wearables that include a color light sensor are a promising measure of electronic screen use in adults. However, to extend this approach to children, we need to understand feasibility of wear placement. The purpose of this study was to examine parent perceptions of children's acceptability of different sensor placements and feasibility of free-living 3- to 7-day wear protocols. This study was conducted in three phases. In phase 1, caregivers (n=161) of 3- to 8-year-old children completed an online survey to rate aspects of fitting and likelihood of wear for seven methods (headband, eyeglasses, skin adhesive patch, shirt clip/badge, mask, necklace, and vest). In phase 2, children (n=31) were recruited to wear one of the top five prototypes for three days (n=6 per method). In phase 3, children (n=23) were recruited to wear prototypes of the top three prototypes from phase 2 (n=8 per method) for 7 days. In phases 2 and 3, parents completed wear logs and surveys about their experiences. Parents scored each wearable on three domains (ease of use, likelihood of wear, and child enjoyment). Scores were averaged to compute an everyday "usability" score (0, worst, to 200, best). Phase 1 results suggested that the headband, eyeglasses, patch, clip/badge, and vest had the best potential for long-term wear. In phase 2, time spent wearing prototypes and usability scores were highest for the eyeglasses (10.4 hours/day, score=155.4), clip/badge (9.8 hours/day, score=145.8), and vest (7.1 hours/day, score=141.7). In phase 3, wearing time and usability scores were higher for the clip/badge (9.4 hours/day, score=169.6) and eyeglasses (6.5 hours/day, score=145.3) compared to the vest (4.8 hours/day, score=112.5). Results indicate that wearable sensors clipped to a child's shirt or embedded into eyeglasses are feasible and acceptable wear methods in free-living settings. The next step is to asses the quality, validity, and reliability of data captured using these wear methods.

Diaries Compared To Automated Algorithms And Visual Inspection For Bed Time Estimation At 6-months Postpartum

PURPOSE Participant diaries are typically used to identify to-bed time, out-of-bed time, and thus compute total time spent in bed (i.e., ‘bed time’) when using physical activity monitors with 24-hour wear protocols. Automated methods to estimate these transition times and total bed time could reduce researcher and participant burden. This study compared the van Hees and Tracy bed time algorithms and visual inspection to diaries for identification of to-bed time, wake time, and total bed time in postpartum women. METHODS Participants (N = 18) from the PETALS-2 study wore ActiGraph wGT3X-BT devices, initialized at 30 Hz, on the non-dominant wrist for up to 7-days at 6 months postpartum. They logged to-bed and out-of-bed times daily in a paper diary. The van Hees and Tracy algorithms were run on the ActiLife files in R. Visual inspection entailed manual review of the minute-by-minute epoch data. Repeated measures ANOVAs with the Proc Mixed procedure in SAS (to account for repeated data by participant and day of observation, and using an unstructured covariance structure) were used to investigate differences in transition times and total bed time by estimation method. RESULTS Estimated mean to-bed times, out-of-bed times, and total bed times, and their corresponding 95% confidence intervals, are presented in the Table. For total bed time, the van Hees and Tracy algorithms, visual inspection, and diary did not differ from one another (P = .40). For to-bed and out-of-bed times, visual inspection differed from the other methods (P < .0001 for all pair-wise comparisons with visual inspection), but the van Hees and Tracy algorithms did not differ from the diary or each other. CONCLUSION Findings suggest that the van Hees and Tracy algorithms’ estimates of to-bed time, out-of-bed time, and total bed time are comparable to estimates obtained from participant diaries. Replacing participant diaries with these automated methods in large-scale studies is proposed.

Device-assessed sleep and physical activity in individuals recovering from a hospital admission for COVID-19: a multicentre study

BackgroundThe number of individuals recovering from severe COVID-19 is increasing rapidly. However, little is known about physical behaviours that make up the 24-h cycle within these individuals. This study aimed to describe physical behaviours following hospital admission for COVID-19 at eight months post-discharge including associations with acute illness severity and ongoing symptoms.MethodsOne thousand seventy-seven patients with COVID-19 discharged from hospital between March and November 2020 were recruited. Using a 14-day wear protocol, wrist-worn accelerometers were sent to participants after a five-month follow-up assessment. Acute illness severity was assessed by the WHO clinical progression scale, and the severity of ongoing symptoms was assessed using four previously reported data-driven clinical recovery clusters. Two existing control populations of office workers and individuals with type 2 diabetes were comparators.ResultsValid accelerometer data from 253 women and 462 men were included. Women engaged in a mean ± SD of 14.9 ± 14.7 min/day of moderate-to-vigorous physical activity (MVPA), with 12.1 ± 1.7 h/day spent inactive and 7.2 ± 1.1 h/day asleep. The values for men were 21.0 ± 22.3 and 12.6 ± 1.7 h /day and 6.9 ± 1.1 h/day, respectively. Over 60% of women and men did not have any days containing a 30-min bout of MVPA. Variability in sleep timing was approximately 2 h in men and women. More severe acute illness was associated with lower total activity and MVPA in recovery. The very severe recovery cluster was associated with fewer days/week containing continuous bouts of MVPA, longer total sleep time, and higher variability in sleep timing. Patients post-hospitalisation with COVID-19 had lower levels of physical activity, greater sleep variability, and lower sleep efficiency than a similarly aged cohort of office workers or those with type 2 diabetes.ConclusionsThose recovering from a hospital admission for COVID-19 have low levels of physical activity and disrupted patterns of sleep several months after discharge. Our comparative cohorts indicate that the long-term impact of COVID-19 on physical behaviours is significant.

Clinical expression of programmed mandibular canine rotation using various attachment protocols and 1- vs 2-week wear protocols with Invisalign SmartTrack aligners: A retrospective cohort study

Rotation of rounded teeth, particularly canines, is reported as one of the most difficult and inaccurate tooth movements with aligners. This retrospective study aimed to assess the accuracy and reliability of prescribed mandibular canine rotation with Invisalign aligners and the influence of attachment type and wear schedule on accuracy. A sample of 75 subjects with mandibular canines requiring rotation was collected from an existing database. The initial, predicted finish, and achieved finish, were measured using metrology software, and the differences between predicted and achieved mandibular canine rotations were calculated. The sample was divided into 3 groups: optimized rotation attachments using 1-week wear, optimized rotation attachments using 2-week wear, and conventional rectangular attachments using 2-week wear. Rotation was an underexpressed movement, with an overall median sample efficiency of 75.4%. For all groups, predicted rotation was not equivalent to achieved rotation at a ± 5° equivalence margin. This indicates that none of the Invisalign SmartTrack aligner attachment configurations display clinical accuracy in their predicted rotation. By attachment type, median efficiencies of 81.5%, 76.5%, and 63.1% were found for groups 1-week wear, 2-week wear, and 2-week wear, respectively. By wear schedule, there was no significant difference in efficiency for optimized rotation attachments. The clinical expression of canine rotation with SmartTrack aligners is less than the prescribed rotation for all attachment configurations. Vertical rectangular attachments were associated with the least accurate expression of prescribed movement. There was no difference in rotation efficiency between 1- or 2-week aligner wear.

Retention decisions and protocols among orthodontists practicing in Canada: A cross-sectional survey

This study aimed to survey retention protocols and retainer characteristics among orthodontists practicing in Canada. An online questionnaire was distributed to 576 orthodontists registered with the Canadian Association of Orthodontists. It included respondents' demographic details, preferred orthodontic retainers and prescribed wear protocol, adjunctive retention procedures, the timing of retention follow-ups, retainer choice in specific situations, and retainer characteristics. Chi-square tests and Fisher's exact tests were used to test the associations between variables. An 18% response rate was recorded (n= 101). Vacuum-formed retainers were the most commonly used retainers in the maxilla (50.5%), whereas bonded retainers were preferred in the mandible (54.5%). An initial full-time removable retainer wear period was commonly prescribed (63.0%-67.0%). Retainer checks were carried out by 85.1%-89.1% of orthodontists for 1 or 2 years after the end of active orthodontic treatment. Only 44.6%-56.4% were comfortable with general dentists continuing retainer checks. Most (72.5%-84.1%) retainers were fabricated in the orthodontists' office laboratory. Indefinite retainer wear was commonly suggested and was significantly influenced by the number of years in practice. Most orthodontists' preferred retainer was the vacuum-formed retainers in the maxilla and the bonded retainers in the mandible. A variety of retention protocols and retainer characteristics was evident among orthodontists that reflect the considerable variation in malocclusion traits we face day-to-day. There seems to be a potential dichotomy between orthodontists being uncomfortable about allowing general dental practitioners to manage retention and orthodontists unwilling to provide retention care indefinitely.