Infant Feeding Websites and Apps: A Systematic Assessment of Quality and Content

Background: Internet websites and smartphone apps have become a popular resource to guide parents in their children’s feeding and nutrition. Given the diverse range of websites and apps on infant feeding, the quality of information in these resources should be assessed to identify whether consumers have access to credible and reliable information.Objective: This systematic analysis provides perspectives on the information available about infant feeding on websites and smartphone apps.Methods: A systematic analysis was conducted to assess the quality, comprehensibility, suitability, and readability of websites and apps on infant feeding using a developed tool. Google and Bing were used to search for websites from Australia, while the App Store for iOS and Google Play for Android were used to search for apps. Specified key words including baby feeding, breast feeding, formula feeding and introducing solids were used to assess websites and apps addressing feeding advice. Criteria for assessing the accuracy of the content were developed using the Australian Infant Feeding Guidelines.Results: A total of 600 websites and 2884 apps were screened, and 44 websites and 46 apps met the selection criteria and were analyzed. Most of the websites (26/44) and apps (43/46) were noncommercial, some websites (10/44) and 1 app were commercial and there were 8 government websites; 2 apps had university endorsement. The majority of the websites and apps were rated poor quality. There were two websites that had 100% coverage of information compared to those rated as fair or poor that had low coverage. Two-thirds of the websites (65%) and almost half of the apps (47%) had a readability level above the 8th grade level.Conclusions: The findings of this unique analysis highlight the potential for website and app developers to merge user requirements with evidence-based content to ensure that information on infant feeding is of high quality. There are currently no apps available to consumers that address a variety of infant feeding topics. To keep up with the rapid turnover of the evolving technology, health professionals need to consider developing an app that will provide consumers with a credible and reliable source of information about infant feeding, using quality assessment tools and evidence-based content

On modelling the constitutive and damage behaviour of highly non-linear bio-composites - Mesh sensitivity of the viscoplastic-damage law computations

The large strain fracture of non-linear complex solids concerns a wide range of applications, such as material forming, food oral processing, surgical instrumental penetration as well as more recently, the design of biodegradable composites for packaging and bio-medical use. Although simulations are a powerful tool towards understanding and designing such processes, modelling ductile fracture in materials such as soft natural composites imposes a new challenge, particularly when the fracture patterns cannot be pre-defined. Here we bring to light new information on these aspects of benefit to the multidisciplinary community, by characterising and modelling the deformation and fracture of short cellulose fibre starch extruded composites. Hyperviscoelastic-Mullins damage laws show merits in modelling such complex systems. Yet they are inferior to a viscoplastic-damage law able to capture exactly their highly non-linear, rate dependent and pressure dependent pseudo-plastic stress-strain response. The viscoplastic-damage law also predicts fracture based on experimental toughness values without pre-specifying the crack path in a Finite Element (FE) model, displaying superiority over the conventional cohesive zone approach. Yet, despite using a toughness parameter to drive crack propagation, spurious mesh dependency is still observed while other previously unreported sources of error imposed by the finite element aspect ratio are also highlighted. The latter is rectified by developing a novel numerical strategy for calculating the characteristic element length used in the damage computations. Inherent mesh dependency suggests that non-local damage models may be essential to model this newly investigated class of natural composites

A qualitative study of the infant feeding beliefs and behaviours of mothers with low educational attainment

© 2016 Russell et al. Background: Infancy is an important period for the promotion of healthy eating, diet and weight. However little is known about how best to engage caregivers of infants in healthy eating programs. This is particularly true for caregivers, infants and children from socioeconomically disadvantaged backgrounds who experience greater rates of overweight and obesity yet are more challenging to reach in health programs. Behaviour change interventions targeting parent-infant feeding interactions are more likely to be effective if assumptions about what needs to change for the target behaviours to occur are identified. As such we explored the precursors of key obesity promoting infant feeding practices in mothers with low educational attainment. Methods: One-on-one semi-structured telephone interviews were developed around the Capability Opportunity Motivation Behaviour (COM-B) framework and applied to parental feeding practices associated with infant excess or healthy weight gain. The target behaviours and their competing alternatives were (a) initiating breastfeeding/formula feeding, (b) prolonging breastfeeding/replacing breast milk with formula, (c) best practice formula preparation/sub-optimal formula preparation, (d) delaying the introduction of solid foods until around six months of age/introducing solids earlier than four months of age, and (e) introducing healthy first foods/introducing unhealthy first foods, and (f) feeding to appetite/use of non-nutritive (i.e., feeding for reasons other than hunger) feeding. The participants' education level was used as the indicator of socioeconomic disadvantage. Two researchers independently undertook thematic analysis. Results: Participants were 29 mothers of infants aged 2-11 months. The COM-B elements of Social and Environmental Opportunity, Psychological Capability, and Reflective Motivation were the key elements identified as determinants of a mother's likelihood to adopt the healthy target behaviours although the relative importance of each of the COM-B factors varied with each of the target feeding behaviours. Conclusions: Interventions targeting healthy infant feeding practices should be tailored to the unique factors that may influence mothers' various feeding practices, taking into account motivational and social influences

Assessing User Engagement of an mHealth Intervention: Development and Implementation of the Growing Healthy App Engagement Index.

BACKGROUND: Childhood obesity is an ongoing problem in developed countries that needs targeted prevention in the youngest age groups. Children in socioeconomically disadvantaged families are most at risk. Mobile health (mHealth) interventions offer a potential route to target these families because of its relatively low cost and high reach. The Growing healthy program was developed to provide evidence-based information on infant feeding from birth to 9 months via app or website. Understanding user engagement with these media is vital to developing successful interventions. Engagement is a complex, multifactorial concept that needs to move beyond simple metrics. OBJECTIVE: The aim of our study was to describe the development of an engagement index (EI) to monitor participant interaction with the Growing healthy app. The index included a number of subindices and cut-points to categorize engagement. METHODS: The Growing program was a feasibility study in which 300 mother-infant dyads were provided with an app which included 3 push notifications that was sent each week. Growing healthy participants completed surveys at 3 time points: baseline (T1) (infant age ≤3 months), infant aged 6 months (T2), and infant aged 9 months (T3). In addition, app usage data were captured from the app. The EI was adapted from the Web Analytics Demystified visitor EI. Our EI included 5 subindices: (1) click depth, (2) loyalty, (3) interaction, (4) recency, and (5) feedback. The overall EI summarized the subindices from date of registration through to 39 weeks (9 months) from the infant's date of birth. Basic descriptive data analysis was performed on the metrics and components of the EI as well as the final EI score. Group comparisons used t tests, analysis of variance (ANOVA), Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests as appropriate. Consideration of independent variables associated with the EI score were modeled using linear regression models. RESULTS: The overall EI mean score was 30.0% (SD 11.5%) with a range of 1.8% - 57.6%. The cut-points used for high engagement were scores greater than 37.1% and for poor engagement were scores less than 21.1%. Significant explanatory variables of the EI score included: parity (P=.005), system type including "app only" users or "both" app and email users (P<.001), recruitment method (P=.02), and baby age at recruitment (P=.005). CONCLUSIONS: The EI provided a comprehensive understanding of participant behavior with the app over the 9-month period of the Growing healthy program. The use of the EI in this study demonstrates that rich and useful data can be collected and used to inform assessments of the strengths and weaknesses of the app and in turn inform future interventions

Wind Energy Resource Assessment of the Caribbean and Central America

A wind energy resource assessment of the Caribbean and Central America has identified many areas with good to outstanding wind resource potential for wind turbine applications. Annual average wind resource maps and summary tables have been developed for 35 island/country areas throughout the Caribbean and Central America region. The wind resource maps highlight the locations of major resource areas and provide estimates of the wind energy resource potential for typical well-exposed sites in these areas. The average energy in the wind flowing in the layer near the ground is expressed as a wind power class: the greater the average wind energy, the higher the wind power class. The summary tables that are included with each of the 35 island/country wind energy maps provide information on the frequency distribution of the wind speeds (expressed as estimates of the Weibull shape factor, k) and seasonal variations in the wind resource for the major wind resource areas identified on the maps. A new wind power class legend has been developed for relating the wind power classes to values of mean wind power density, mean wind speed, and Weibull k. Guidelines are presented on how to adjust these values to various heights above ground for different roughness and terrain characteristics. Information evaluated in preparing the assessment included existing meteorological data from airports and other weather stations, and from ships and buoys in offshore and coastal areas. In addition, new data from recent measurement sites established for wind energy siting studies were obtained for a few areas of the Caribbean. Other types of information evaluated in the assessment were climatological data and maps on winds aloft, surface pressure, air flow, and topography. The various data were screened and evaluated for their usefulness in preparing the wind resource assessment. Much of the surface data from airports and other land-based weather stations were determined to be from sheltered sites and were thus not very useful in assessing the wind resource at locations that are well exposed to the winds. Ship data were determined to be the most useful for estimating the large-scale wind flow and assessing the spatial distribution of the wind resource throughout the region. Techniques were developed for analyzing and correcting ship wind data and extrapolating these data to coastal and inland areas by considering terrain influences on the large-scale wind flow. In areas where extrapolation of ship wind data was not entirely feasible, such as interior areas of Central America, other techniques were developed for estimating the wind flow and distribution of the wind resource. Through the application of the various innovative techniques developed for assessing the wind resource throughout the Caribbean and Central America region, many areas with potentially good to outstanding wind resource were identified that had not been previously recognized. In areas where existing site data were available from exposed locations, the measured wind resource was compared with the estimated wind resource that was derived using the assessment techniques. In most cases, there was good agreement between the measured wind resource and the estimated wind resource. This assessment project supported activities being pursued by the U.S. Committee for Renewable Energy Commerce and Trade (CORECT), the U.S. government's interagency program to assist in overseas marketing and promote renewable energy exports. An overall goal of the program is to improve U.S. competitiveness in the world renewable energy market. The Caribbean and Central America assessment, which is the first of several possible follow-on international wind energy resource assessments, provides valuable information needed by the U.S. wind energy industry to identify suitable wind resource areas and concentrate their efforts on these areas

Investigating the poor outcomes of BRAF - mutant advanced colorectal cancer: Analysis from 2530 patients in randomised clinical trials

Background: To improve strategies for the treatment of BRAF-mutant advanced colorectal cancer (aCRC) patients we examined individual data from patients treated with chemotherapy alone in three randomised trials to identify points on the treatment pathway where outcomes differ from BRAF wild-types. Patients and Methods: 2530 aCRC patients were assessed from three randomised trials. End-points were progression free survival (PFS), response rate (RR), disease control rate (DCR), post-progression survival (P-PS) and overall survival (OS). Treatments included first-line oxaliplatin/fluorouracil (OxFU), and second-line irinotecan. Clinicians were unaware of BRAF-status Results 231 patients (9.1%) had BRAF-mutant tumours. BRAF-mutation conferred significantly worse survival independent of associated clinicopathological factors known to be prognostic. Compared with wild-type, BRAF-mutant patients treated with first-line OxFU had similar DCR (59.2% vs 72%; adjusted OR=0.76,p=0.24) and PFS (5.7 vs 6.3 months; adjusted HR=1.14, p=0.26). Following progression on first-line chemotherapy, BRAF-mutant patients had a markedly shorter P-PS (4.2 vs 9.2 months, adjusted HR=1.69,p6 months; OS=24.0 months), however 36.5% progressed rapidly through first-line chemotherapy and thereafter, with OS=4.7 months. Conclusions BRAF-mutant aCRC confers a markedly worse prognosis independent of associated clinicopathological features. Chemotherapy provides meaningful improvements in outcome throughout treatment lines. Post-progression survival is markedly worse and vigilance is required to ensure appropriate delivery of treatment after first-line progression

Correction: Metal complexes as a promising source for new antibiotics

Correction for ‘Metal complexes as a promising source for new antibiotics’ by Angelo Frei et al., Chem. Sci., 2020, 11, 2627–2639