Psychotropic Medication Use and Polypharmacy Among Children and Adolescents Initiating Intensive Behavioral Therapy for Severe Challenging Behavior.

OBJECTIVE: To evaluate the prevalence, trends, and factors associated with psychotropic medication use and polypharmacy among children and adolescents initiating intensive behavioral therapy for severe challenging behavior over a 10-year period. STUDY DESIGN: In this retrospective observational study, we examined data from caregiver interviews and patient medical records on the number and types of psychotropic medications prescribed to patients initiating intensive behavioral therapy between January 1, 2013, and December 31, 2022. Trends in medication use and polypharmacy across the 10-year period were analyzed using regression analysis, while differences in demographics and clinical factors for patients with use and polypharmacy were analyzed using nonparametric statistical analysis with odds ratios presented for significant factors. RESULTS: Data from all 302 pediatric patients initiating intensive behavioral therapy across the 10-year period were analyzed. Among all patients and all years, 83.8% were taking at least 1 psychotropic medication and 68.2% experienced polypharmacy. There were no changes in the prevalence of use, mean number of medications taken, or polypharmacy across the 10-year period. Patients diagnosed with attention-deficit/hyperactivity disorder or anxiety disorder, as well as those exhibiting self-injurious behavior had higher use of psychotropic medication and polypharmacy and were taking more medications overall. CONCLUSIONS: Psychotropic medication use and polypharmacy were extremely high for children and adolescents with severe challenging behavior, but use and polypharmacy did not change over the 10-year period of data collection. Further research is needed to establish the generality of these findings to other regions of the US.

Mand Modality Preference Assessments among High- and Low-Tech Options for Individuals with Intellectual and Developmental Disabilities: A Systematic Review.

The extant literature demonstrates that individuals with intellectual and developmental disabilities (IDD) exhibit preferences among communication modalities when multiple modalities are available and produce reinforcement on identical reinforcement schedules. High- and low-tech communication options, such as voice output devices and picture cards, are commonly recommended for individuals with limited vocal communication skills. In this study, we conducted a systematic literature review of research studies that implemented mand modality preference assessments (MMPAs) that included both a high- and low-tech communication option with individuals with IDD. We identified 27 studies meeting our inclusion criteria and summarized the participant demographics, MMPA design and procedural variations, and MMPA outcomes. The results suggested that high-tech communication options were generally more preferred over low-tech options. However, there was a high degree of variability in how the studies were conducted and conclusions were reached. We discuss some of the current research gaps and the implications for clinical practice.

[Motivational Reasons and Perceptions about Future Participation of Older People in the Research and Development Process of Health Technologies: a Mixed Methods Study]. / Motivationsgründe und Vorstellungen über eine zukünftige Beteiligung älterer Menschen im Forschungs- und Entwicklungsprozess von Gesundheitstechnologien ­ eine Mixed Methods-Studie.

BACKGROUND: Although digital approaches for disease prevention in older people have a high potential and are being used more often, there are still inequalities in access and use. One reason could be that in technology development future users are insufficiently taken into consideration, or involved very late in the process using inappropriate methods. The aim of this work was to analyze the motivation of older people participating, and their perceptions of future participation in the research and development process of health technologies aimed at health care for older people. METHODOLOGY: Quantitative and qualitative data from one needs assessment and two evaluation studies were analyzed. The quantitative data were analyzed descriptively and the qualitative data were analyzed content-analytically with inductive-deductive category formation. RESULTS: The median age of the 103 participants (50 female) was 75 years (64-90), most of whom were interested in using technology and had prior experience of study participation. Nine categories for participation motivation were derived. A common motivation for participation was to promote and support their own health. Respondents were able to envision participation both at the beginning of the research process and at its end. In terms of technique development, different ideas were expressed, but there was a general interest in technological development. Methods that would enable exchange with others were favored most. CONCLUSIONS: Differences in motivation to participate and ideas about participation were identified. The results provide important information from the perspective of older people and complement the existing state of research.

Designing and applying technology for prevention-Lessons learned in AEQUIPA and its implications for future research and practice.

Almost all Western societies are facing the challenge that their population structure is changing very dynamically. Already in 2019, ten countries had a population share of at least 20 percent in the age group of 64 years and older. Today's society aims to improve population health and help older people live active and independent lives by developing, establishing, and promoting safe and effective interventions. Modern technological approaches offer tremendous opportunities but pose challenges when preventing functional decline. As part of the AEQUIPA Prevention Research Network, the use of technology to promote physical activity in older people over 65 years of age was investigated in different settings and from various interdisciplinary perspectives, including technology development and evaluation for older adults. We present our findings in three main areas: (a) design processes for developing technology interventions, (b) older adults as a user group, and (c) implications for the use of technology in interventions. We find that cross-cutting issues such as time and project management, supervision of participants, ethics, and interdisciplinary collaboration are of vital importance to the success of the work. The lessons learned are discussed based on the experiences gained in the overall AEQUIPA network while building, particularly on the experiences from the AEQUIPA sub-projects TECHNOLOGY and PROMOTE. Our experiences can help researchers of all disciplines, industries, and practices design, study and implement novel technology-based interventions for older adults to avoid pitfalls and create compelling and meaningful solutions.

Measurement System for Unsupervised Standardized Assessments of Timed Up and Go Test and 5 Times Chair Rise Test in Community Settings-A Usability Study.

Comprehensive measurements are needed in older populations to detect physical changes, initiate prompt interventions, and prevent functional decline. While established instruments such as the Timed Up and Go (TUG) and 5 Times Chair Rise Test (5CRT) require trained clinicians to assess corresponding functional parameters, the unsupervised screening system (USS), developed in a two-stage participatory design process, has since been introduced to community-dwelling older adults. In a previous article, we investigated the USS's measurement of the TUG and 5CRT in comparison to conventional stop-watch methods and found a high sensitivity with significant correlations and coefficients ranging from 0.73 to 0.89. This article reports insights into the design process and evaluates the usability of the USS interface. Our analysis showed high acceptance with qualitative and quantitative methods. From participant discussions, suggestions for improvement and functions for further development could be derived and discussed. The evaluated prototype offers a high potential for early detection of functional limitations in elderly people and should be tested with other target groups in other locations.

Requirements for (web-based) physical activity interventions targeting adults above the age of 65 years - qualitative results regarding acceptance and needs of participants and non-participants.

BACKGROUND: It remains unclear how physical activity (PA) interventions need to be designed to reach older adults and to be widely accepted in this target group. The aim of this study was to assess the acceptance of a web-based PA program, including individual intervention components as well as relevant contextual factors, and to specify requirements for future interventions. METHODS: Two hundred sixty-six participants of a PA intervention completed a questionnaire covering individual program components (content, structure, and context). Further, 25 episodic guided interviews focusing on reasons for (non-) participation were conducted with 8 participants and 17 non-participants. Following qualitative content analysis, different requirements were identified and organized based on the social-ecological model, resulting in a profile of requirements. RESULTS: Based on the participants' and non-participants' statements, six different levels of requirements affecting acceptance of and successful participation in a web-based PA intervention were identified. The individual fit was influenced by an interaction of different factors at the intrapersonal, sociocultural, content, spatial, digital and organizational levels. Several age- and gender-specific requirements were noted in the interviewed older adults. Men and women, as well as younger (< 70 years) and older (≥70 years) adults differed in terms of perceived enjoyment and benefits of socializing while exercising together, the time expenditure perceived to be acceptable, previous digital skills, as well as in perceptions that ambience and accessibility of exercise facilities in the neighborhood were important. CONCLUSIONS: To motivate older adults to engage in PA and address different needs in terms of life circumstances and quality of life as well as differences in technical affinity, different requirement profiles should be included in the process of intervention development and implementation. Participatory development loops and modular offer formats are recommended for this.

[Experiences with health technologies to support physical activity in people over the age of 65: A qualitative survey of the requirements for the development of preventive technologies for a heterogeneous target group]. / Erfahrungen mit Gesundheitstechnologien zur Unterstützung der körperlichen Aktivität bei Menschen ab 65 Jahren ­ Eine qualitative Erhebung der Anforderungen für die Entwicklung präventiver Technologien für eine heterogene Zielgruppe.

BACKGROUND: For elderly people, physical activity (PA) is an important prerequisite for a healthy and self-determined life and provides preventive protection against many chronic diseases. Since a high proportion of this group does not exercise sufficiently in everyday life, new preventive strategies have been developed. In recent years, health technologies have also become increasingly important and offer a potential for primary prevention to promote PA. The aim of this study was to analyze experience with and acceptance of the use of technologies to support PA and to monitor health parameters in people over the age of 65. In addition to identifying concerns, uncertainties and subjective ideas about technologies, requirements for preventive technology should be derived. METHOD: Guided (semi-structured) interviews were conducted. Interviewing topics included "PA" and "technology". Recruitment took place through a public call and the distribution of flyers. The evaluation was carried out by content analysis with inductive and deductive category formation. In addition, an interdisciplinary requirements analysis was performed on the basis of the transcripts in order to derive needs and requirements for preventive technologies. RESULTS: The interviews were conducted with 33 persons (19 female). The average age was 75 years. Nine participants with a migration background originated from four countries. All participants were active in everyday life. The barriers identified included a lack of motivation and weather conditions. Many participants used health technologies in their everyday lives and were quite open to these developments. However, concern was expressed regarding topics such as data protection and security. CONCLUSION: Experience and acceptance in dealing with future preventive technologies as well as concerns, ideas and requirements could be inferred from discussions with the heterogeneous target group. General strategies (e.g. notices, press) as well as specific strategies (e.g. multipliers) and sufficient time are important to ensure a target group-specific access to different groups of people.

Therapeutic accuracy of the completely customized lingual appliance WIN : A retrospective cohort study.

OBJECTIVE: The aim of this retrospective cohort study was to assess the accuracy of the completely customized lingual appliance WIN (DW Lingual Systems, Bad Essen, Germany) employing a three-dimensional (3D) comparison between the setup and the final result. MATERIALS AND METHODS: The setup and final models of 20 consecutively debonded patients (40 jaws; 7 males, 13 females; mean age 15.76 ± 4.45 years) with various malocclusions of a private practice specialized in orthodontics were digitalized using a 3D scanner. The 3D models of the setup and the final model of each jaw were then digitally matched using the best fit algorithm and segmented into single teeth. After placing individual coordinate systems, the homologous teeth of the setup and the final model were matched to be able to calculate the exact deviations of all rotational and translational components. The t test for unpaired samples, Kruskal-Wallis tests, U tests, and ANOVA with Duncan post hoc test were applied statistically. RESULTS: Regarding the incisors, the angle discrepancies between the setup and the final result appeared to be less than 3° (torque 2.96°; tip 2.04°; rotation 2.00°). The translations showed mean values less than 0.3 mm (mesiodistal 0.16 mm; buccolingual 0.15 mm; vertical 0.29 mm). Slightly higher values could be measured in the lateral segments regarding rotations (torque 5.18°; tip 3.10°; rotation 3.70°) as well as regarding translations (mesiodistal 0.26 mm; buccolingual 0.64 mm; vertical 0.36 mm). CONCLUSIONS: Using the completely customized lingual appliance WIN, it is possible to achieve the final result predicted by the setup with a high accuracy.

A Comprehensive Model of Electric-Field-Enhanced Jumping-Droplet Condensation on Superhydrophobic Surfaces.

Superhydrophobic micro/nanostructured surfaces for dropwise condensation have recently received significant attention due to their potential to enhance heat transfer performance by shedding positively charged water droplets via coalescence-induced droplet jumping at length scales below the capillary length and allowing the use of external electric fields to enhance droplet removal and heat transfer, in what has been termed electric-field-enhanced (EFE) jumping-droplet condensation. However, achieving optimal EFE conditions for enhanced heat transfer requires capturing the details of transport processes that is currently lacking. While a comprehensive model has been developed for condensation on micro/nanostructured surfaces, it cannot be applied for EFE condensation due to the dynamic droplet-vapor-electric field interactions. In this work, we developed a comprehensive physical model for EFE condensation on superhydrophobic surfaces by incorporating individual droplet motion, electrode geometry, jumping frequency, field strength, and condensate vapor-flow dynamics. As a first step toward our model, we simulated jumping droplet motion with no external electric field and validated our theoretical droplet trajectories to experimentally obtained trajectories, showing excellent temporal and spatial agreement. We then incorporated the external electric field into our model and considered the effects of jumping droplet size, electrode size and geometry, condensation heat flux, and droplet jumping direction. Our model suggests that smaller jumping droplet sizes and condensation heat fluxes require less work input to be removed by the external fields. Furthermore, the results suggest that EFE electrodes can be optimized such that the work input is minimized depending on the condensation heat flux. To analyze overall efficiency, we defined an incremental coefficient of performance and showed that it is very high (∼10(6)) for EFE condensation. We finally proposed mechanisms for condensate collection which would ensure continuous operation of the EFE system and which can scalably be applied to industrial condensers. This work provides a comprehensive physical model of the EFE condensation process and offers guidelines for the design of EFE systems to maximize heat transfer.

Stability of paramedian inserted palatal mini-implants at the initial healing period: a controlled clinical study.

OBJECTIVES: To assess the stability development of paramedian in comparison with midpalatal inserted mini-implants. MATERIAL AND METHODS: The test group consisted of 21 consecutively treated patients (13.7 ± 4.6 years). In each patient, a mini-implant was inserted paramedian in the anterior palate. Measurement of the insertion depth (ID), the maximum insertion torque (IT), and resonance frequency analysis (RFA) was performed at T0. RFA was repeated after 2 weeks (T1), 4 weeks (T2), and 6 weeks (T3). Correlations between measuring methods were calculated. RFA values at different times were tested for statistical differences. Data were compared with a group of patients who received median mini-implants of the same size. RESULTS: Initial stability was 14.06 ± 4.35 Ncm (IT) and 26.60 ± 5.28 ISQ (RFA) with an ID of 7.02 ± 1.04 mm. RFA and IT (r = 0.49, P = 0.023) showed a moderate significant correlation. Stability remained relatively constant, showing no significant differences between measurement times. Overall, RFA values decreased non-significantly by 2.25 ± 6.85 ISQ to a level of 24.35 ± 5.39 after 6 weeks. Comparing development of stability over time, it was found that significant differences were present at T0 and T1 (T0: -9.54 ISQ, P < 0.0001; T1: -3.69, P = 0.041). CONCLUSIONS: Paramedian inserted mini-implants provided sufficient stability. Showing a lower primary stability, RFA values did not differ from the control group from week four on, as no significant decrease in stability occurred at the initial healing period.

Mini-implant stability at the initial healing period: a clinical pilot study.

OBJECTIVE: To evaluate the changes of mini-implant stability over the initial healing period in humans. MATERIAL AND METHODS: A sample of 19 consecutively treated patients (mean age 15.5 ± 7.3 years) was examined. In each patient, a mini-implant of a size of 2 × 9 mm was inserted into the anterior palate. Implant stability was assessed using resonance frequency analysis (RFA) immediately after insertion (T0), 2 weeks later (T1), 4 weeks later (T2), and 6 weeks later (T3). Insertion depth (ID) and the maximum insertion torque (IT) were measured. Data were tested for correlations between RFA, ID, and IT. All RFA values were tested for statistically significant differences between the different times. RESULTS: The mean ID was 7.5 ± 0.6 mm, and the mean IT was 16.8 ± 0.6 Ncm. A correlation was found between RFA and ID (r = .726, P < .0001), whereas no correlations between RFA and IT or between IT and ID were observed. From T0 to T1, the stability (36.1 ± 6.1 implant stability quotient [ISQ]) decreased nonsignificantly by 4.9 ± 6.1 ISQ values (P > .05). Between T1 and T2, the stability decreased highly significantly (P < .001) by 7.9 ± 5.9 ISQ values. From T2 on, RFA remained nearly unchanged (-1.7 ± 3.5 ISQ; P > .05). CONCLUSIONS: Mini-implant stability is subject to changes during the healing process. During weeks 3 and 4, a significant decrease of the stability was observed. After 4 weeks, the stability did not change significantly.

Maxillary protraction using a hybrid hyrax-facemask combination.

BACKGROUND: The aim of this in study was the evaluation of treatment outcomes after using a hybrid hyrax-facemask combination in growing class III patients. METHODS: Treatment of 16 children (mean age 9.5±1.3 years) was investigated clinically and by means of pre- and post-treatment cephalograms. Changes in sagittal and vertical, and dental and skeletal values were evaluated and tested for statistically significant differences. RESULTS: All mini-implants remained stable during treatment. Mean treatment duration was 5.8±1.7 months. There was a significant improvement in skeletal sagittal values: SNA, +2.0°; SNB, -1.2°; ANB, +3.2°; WITS appraisal, +4.1 mm and overjet, +2.7 mm. No significant changes were found concerning vertical skeletal relationships and upper incisor inclination. In relation to A point, the upper first molars moved mesially about 0.4 mm (P=0.134). CONCLUSIONS: The hybrid hyrax-facemask combination seems to be effective for orthopaedic treatment in growing class III patients. Unwanted maxillary dental movements can be avoided due to stable skeletal anchorage.

Effects of wear time recording on the patient's compliance.

OBJECTIVE: To assess the effect of wear-time recording on subjective and objective wear time. MATERIALS AND METHODS: This study retrospectively examined a group of 18 patients and a control group of 14 patients at four appointments over 168 days. The patients were treated with removable appliances with embedded TheraMon-microsensors to be worn for 15 hours per day. The study group was not told about the microsensor until the first appointment after fitting of the appliance. At each appointment patients were asked about their subjective wear time and afterward were told about the objective wear time. The existence of the microsensor was revealed to the control group when the appliance was fitted. Objective wear time was also announced at every appointment. RESULTS: Mean wear times did not significantly differ between groups at any appointment or regarding overall wear time. Highly significant differences between subjective and objective wear time were found when patients did not know that their wear time had been monitored. CONCLUSION: Mean wear times assessed in this study concur with data of previous studies. Patients tend to overestimate their wear times but become more realistic once they know wear time is being monitored. Objective measurement of wear time allows a more realistic view of compliance by patient and orthodontist. Knowing that wear time is recorded does not necessarily increase the amount of time removable appliances are worn by the patient.

Accuracy of torque-limiting devices used for mini-implant placement--an in vitro study.

INTRODUCTION: Mini-implants are used when enhanced orthodontic anchorage is needed. Documented risks include damage inflicted to tooth structures and implant loosening, but also fracture. An important factor in minimizing adverse side effects is to control the insertion torque. The goal of the present study was to investigate the accuracy of various torque-limiting devices available for this purpose. MATERIALS AND METHODS: Eight torque-limiting devices were analyzed, including a group of manually-operated drivers (n=3), a group of battery-operated drivers (n=4), and a surgical unit (n=1). The accuracy of these devices was tested over the entire range of applicable torque levels, using an experimental design simulating the insertion of mini-implants. RESULTS: No significant differences were noted between the group of manually-operated and the group of battery-operated devices within the clinically relevant range of 10-25 Ncm. Comparing the individual devices revealed several significant differences. Some devices yielded both effective torque levels very close to the set levels and small standard deviations. CONCLUSION: Mini-implants can be put in place in a controlled fashion regardless of whether the torque-limiting device used for this purpose is a manual- or battery-operated driver or a surgical unit. However, we observed that the accuracy of torque limitation differed greatly between individual devices across these groups. Our results can therefore help clinicians select an appropriate insertion device for mini-implants.

Impact of mini-implant length on stability at the initial healing period: a controlled clinical study.

INTRODUCTION: Aim of the study was to assess the impact of the length of mini-implants inserted in the midpalatal region on the stability at the initial healing period. METHODS: A sample of 20 consecutively treated patients (15.6 ± 7.2 years) was examined. A long mini-implant with a length of 11 mm and a diameter of 2 mm was inserted into the anterior palate of each patient. Resonance frequency analysis (RFA) was performed after insertion (T0), two weeks (T1), four weeks (T2), and six weeks (T3). Insertion depth (ID) and the maximum insertion torque (IT) were measured. RFA, ID and IT data were tested for correlations. RFA values were tested for statistical differences between the different times. Data was compared to a matched control group of patients who received short mini-implants with a length of 9 mm and a diameter of 2 mm. RESULTS: Mean ID was 9.5 ± 0.6 mm and mean IT was 17.9 ± 3.8 Ncm. A correlation was found between RFA and ID (r = 0.59, P < .01). From T0 to T1 the stability (33.4 ± 3.5 ISQ) decreased highly significantly by 5.3 ± 3.5 ISQ values (P < .001) and significantly from T1 and T2 (P < .05) by 3.5 ± 3.7 ISQ values. From T2 on RFA nearly remained unchanged (-1.7 ± 3.9 ISQ; P > .05). At T1 stability was significantly lower than the control group. From T2 on there were no significant differences between the groups. CONCLUSIONS: Long mini-implants provide high stability when inserted in the midpalatal region. After initial decrease RFA values remained stable from four weeks on and did not differ from the control group. TRIAL REGISTRATION ID: 2013081293 (Clinical study register, University of Düsseldorf, Germany).

Measurement of mini-implant stability using resonance frequency analysis.

OBJECTIVE: To investigate whether resonance frequency analysis (RFA) is suitable to measure orthodontic mini-implant stability. Implant size significantly affects the level of resonance frequency. Regarding the operating mode of RFA, it has to be proven whether the resonance frequency of mini-implants in bone fits the range of frequency emitted by the Osstell ISQ device. MATERIAL AND METHODS: For this purpose the SmartPegs in the Osstell ISQ device were modified to fit with the inner screw thread of orthodontic mini-implants, and 110 mini-implants were inserted into porcine pelvic bone. RFA was performed parallel and perpendicular to the run of superficial bone fibers. A suitability test, Periotest, was also performed in the same directions. Compacta thickness was measured using cone-beam computed tomography. Correlation tests and linear regression analysis were carried out between the three methods. RESULTS: The RFA showed a mean Implant Stability Quotient value of 36.36 ± 2.67, and the Periotest mean value was -2.10 ± 1.17. The differences between the two directions of measurement were statistically significant (P > .001) for RFA and the Periotest. There was a high correlation between RFA and the Periotest (r  =  -0.90) and between RFA and compacta thickness (r  =  0.71). The comparison between the Periotest and compacta thickness showed a correlation coefficient of r  =  -0.64. CONCLUSION: The present results suggest that RFA is feasible as a measurement method for orthodontic mini-implant stability. As a consequence, it could be used for clinical evaluation of current stability and allow stability-related loading of mini-implants to reduce the failure rate.