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BackgroundDental disease (including dental caries and periodontal disease) is largely preventable and closely linked to inadequate oral health behaviors. Digital health technologies have great potential for unobtrusively monitoring brushing behaviors in home settings and promoting optimal oral self-care routines at scale. ObjectiveThe aim of this study is to leverage the ubiquity of electronic toothbrushes and smartphones with the development of a Remote Oral Behaviors Assessment System (ROBAS) and evaluate its feasibility for passively tracking brushing behaviors in real-world settings. MethodsWe developed ROBAS by linking inertial sensors contained within consumer electronic toothbrushes to a scalable software platform comprised of a smartphone app linked to a cloud platform. First, the criterion validity of ROBAS for accurately capturing brushing details was established in a laboratory setting. Next, real-world performance and usability were evaluated in a stratified community sample of 32 participants who used ROBAS daily for 1 month and maintained a diary of their brushing episodes. Semistructured interviews at baseline and exit captured the user experience. We used regression models and Bland-Altman analyses to assess the criterion validity, functionality, accuracy, and consistency of ROBAS. ResultsUsing a stopwatch as the criterion reference, ROBAS showed a mean absolute percent error (MAPE) of 1.8%, an estimated bias of 0.64 seconds that was not statistically distinguishable from zero (95% CI –0.93 to 2.22 seconds, SE 0.79), and a connection failure rate of 6.7% (95% CI 0.8%-22.1%, SE 4.6%). In real-world testing, ROBAS showed close agreement with the daily diary recordings of brushing episodes; estimated average discrepancies between the diary and ROBAS were 0.13 sessions per day (95% CI 0.01-0.26, SE 0.06), 8.0 seconds per brushing session (95% CI 1.4-14.7, SE 3.3), and 30 seconds of brushing per day (95% CI 9.3-50.1, SE 10.0). Retrospective self-reports produced substantially higher estimates of brushing frequency and duration compared to ROBAS measurements. Participants reported ROBAS was easy to use and expressed an interest in receiving ROBAS-delivered feedback on their brushing behaviors. Most participants were bothered by the use of an additional study phone, and some reported connectivity-related issues. ConclusionsROBAS has a high criterion validity for measuring oral health behaviors. It can accurately and reliably monitor brushing patterns in home settings for extended periods. Unobtrusive data collection through ROBAS sets the stage for automated coaching and optimization of oral self-care practices at the individual and population level.

UNLABELLED: The development and validation studies of new multisensory biomarkers and sensor-triggered interventions requires collecting raw sensor data with associated labels in the natural field environment. Unlike platforms for traditional mHealth apps, a software platform for such studies needs to not only support high-rate data ingestion, but also share raw high-rate sensor data with researchers, while supporting high-rate sense-analyze-act functionality in real-time. We present mCerebrum, a realization of such a platform, which supports high-rate data collections from multiple sensors with realtime assessment of data quality. A scalable storage architecture (with near optimal performance) ensures quick response despite rapidly growing data volume. Micro-batching and efficient sharing of data among multiple source and sink apps allows reuse of computations to enable real-time computation of multiple biomarkers without saturating the CPU or memory. Finally, it has a reconfigurable scheduler which manages all prompts to participants that is burden- and context-aware. With a modular design currently spanning 23+ apps, mCerebrum provides a comprehensive ecosystem of system services and utility apps. The design of mCerebrum has evolved during its concurrent use in scientific field studies at ten sites spanning 106,806 person days. Evaluations show that compared with other platforms, mCerebrums architecture and design choices support 1.5 times higher data rates and 4.3 times higher storage throughput, while causing 8.4 times lower CPU usage. CCS CONCEPTS: • Human-centered computing → Ubiquitous and mobile computing; Ubiquitous and mobile computing systems and tools; • Computer systems organization → Embedded and cyber-physical systems. ACM REFERENCE FORMAT: Syed Monowar Hossain, Timothy Hnat, Nazir Saleheen, Nusrat Jahan Nasrin, Joseph Noor, Bo-Jhang Ho, Tyson Condie, Mani Srivastava, and Santosh Kumar. 2017. mCerebrum: A Mobile Sensing Software Platform for Development and Validation of Digital Biomarkers and Interventions. In Proceedings of SenSys 17, Delft, Netherlands, November 6-8, 2017, 14 pages.

The development and validation studies of new multisensory biomarkers and sensor-triggered interventions requires collecting raw sensor data with associated labels in the natural field environment. Unlike platforms for traditional mHealth apps, a software platform for such studies needs to not only support high-rate data ingestion, but also share raw high-rate sensor data with researchers, while supporting high-rate sense-analyze-act functionality in real-time. We present mCerebrum , a realization of such a platform, which supports high-rate data collections from multiple sensors with realtime assessment of data quality. A scalable storage architecture (with near optimal performance) ensures quick response despite rapidly growing data volume. Micro-batching and efficient sharing of data among multiple source and sink apps allows reuse of computations to enable real-time computation of multiple biomarkers without saturating the CPU or memory. Finally, it has a reconfigurable scheduler which manages all prompts to participants that is burden- and context-aware. With a modular design currently spanning 23+ apps, mCerebrum provides a comprehensive ecosystem of system services and utility apps. The design of mCerebrum has evolved during its concurrent use in scientific field studies at ten sites spanning 106,806 person days. Evaluations show that compared with other platforms, mCerebrum's architecture and design choices support 1.5 times higher data rates and 4.3 times higher storage throughput, while causing 8.4 times lower CPU usage., Ccs Concepts: • Human-centered computing → Ubiquitous and mobile computing ; Ubiquitous and mobile computing systems and tools; • Computer systems organization → Embedded and cyber-physical systems., Acm Reference Format: Syed Monowar Hossain, Timothy Hnat, Nazir Saleheen, Nusrat Jahan Nasrin, Joseph Noor, Bo-Jhang Ho, Tyson Condie, Mani Srivastava, and Santosh Kumar. 2017. mCerebrum: A Mobile Sensing Software Platform for Development and Validation of Digital Biomarkers and Interventions. In Proceedings of SenSys '17, Delft, Netherlands, November 6-8, 2017 , 14 pages.