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

A mixed methods study to explore the effects of program design elements and participant characteristics on parents' engagement with an mHealth program to promote healthy infant feeding: The growing healthy program

Copyright © 2019 Taki, Russell, Lymer, Laws, Campbell, Appleton, Ong and Denney-Wilson. Purpose: Mobile health (mHealth) interventions have great potential to promote health. To increase consumer engagement in mHealth interventions it is necessary to address factors that influence the target demographic. The Growing healthy (GH) program is the first obesity prevention program delivered via a smartphone app and website offering evidence-based information on infant feeding from birth until 9 months of age. This sub-study aimed to explore how the design features, quality of the app and participant characteristics influenced parents' engagement with the GH app. Methods: A sequential mixed methods design was used. The GH app participants (225/301) were considered for this sub-study. Participant app engagement was measured through a purpose-built Engagement Index (EI) using app metrics. Participants were categorized as low, moderately or highly engaged based on their EI score upon completing the 9 months program and were then invited to participate in semi-structured telephone interviews. Participants who used the app program, given an EI score and expressed interest to participate in these interviews were eligible. The interviews explored factors that influenced app engagement including delivery features and quality. Thematic analysis networks was used for analysis. Results: 108/225 expressed interest and 18 interviews were conducted from low (n = 3), moderately (n = 7), or highly (n = 8) engaged participants based on purposeful sampling. Participants defined as highly engaged were likely to be a first-time parent, felt the app content to be trustworthy and the app design facilitated easy navigation and regularly opened the push notifications. Participants defined as having low or moderate engagement were likely to have experience from previous children, felt they had sufficient knowledge on infant feeding and the app did not provide further information, or experienced technological issues including app dysfunction due to system upgrades. Conclusions/Implications: This study demonstrated a novel approach to comprehensively analyse engagement in an mHealth intervention through quantitative (Engagement Index) and qualitative (interviews) methods. It provides an insight on maximizing data collected from these programs for measuring effectiveness and to understand users of various engagement levels interaction with program features. Measuring this can determine efficacy and refine programs to meet user requirements

Evidence for sodium-rich alkaline water in the Tagish Lake parent body and implications for amino acid synthesis and racemization

Understanding the timing and mechanisms of amino acid synthesis and racemization on asteroidal parent bodies is key to demonstrating how amino acids evolved to be mostly left-handed in living organisms on Earth. It has been postulated that racemization can occur rapidly dependent on several factors, including the pH of the aqueous solution. Here, we conduct nanoscale geochemical analysis of a framboidal magnetite grain within the Tagish Lake carbonaceous chondrite to demonstrate that the interlocking crystal arrangement formed within a sodium-rich, alkaline fluid environment. Notably, we report on the discovery of Na-enriched subgrain boundaries and nanometer-scale Ca and Mg layers surrounding individual framboids. These interstitial coatings would yield a surface charge state of zero in more-alkaline fluids and prevent assimilation of the individual framboids into a single grain. This basic solution would support rapid synthesis and racemization rates on the order of years, suggesting that the low abundances of amino acids in Tagish Lake cannot be ascribed to fluid chemistry

Relationships between brain and body temperature, clinical and imaging outcomes after ischemic stroke

Pyrexia soon after stroke is associated with severe stroke and poor functional outcome. Few studies have assessed brain temperature after stroke in patients, so little is known of its associations with body temperature, stroke severity, or outcome. We measured temperatures in ischemic and normal-appearing brain using (1)H-magnetic resonance spectroscopy and its correlations with body (tympanic) temperature measured four-hourly, infarct growth by 5 days, early neurologic (National Institute of Health Stroke Scale, NIHSS) and late functional outcome (death or dependency). Among 40 patients (mean age 73 years, median NIHSS 7, imaged at median 17 hours), temperature in ischemic brain was higher than in normal-appearing brain on admission (38.6°C-core, 37.9°C-contralateral hemisphere, P=0.03) but both were equally elevated by 5 days; both were higher than tympanic temperature. Ischemic lesion temperature was not associated with NIHSS or 3-month functional outcome; in contrast, higher contralateral normal-appearing brain temperature was associated with worse NIHSS, infarct expansion and poor functional outcome, similar to associations for tympanic temperature. We conclude that brain temperature is higher than body temperature; that elevated temperature in ischemic brain reflects a local tissue response to ischemia, whereas pyrexia reflects the systemic response to stroke, occurs later, and is associated with adverse outcomes

Preventing obesity in infants: the Growing healthy feasibility trial protocol

Early childhood is an important period for establishing behaviours that will affect weight gain and health across the life course. Early feeding choices, including breast and/or formula, timing of introduction of solids, physical activity and electronic media use among infants and young children are considered likely determinants of childhood obesity. Parents play a primary role in shaping these behaviours through parental modelling, feeding styles, and the food and physical activity environments provided. Children from low socio-economic backgrounds have higher rates of obesity, making early intervention particularly important. However, such families are often more difficult to reach and may be less likely to participate in traditional programs that support healthy behaviours. Parents across all socio-demographic groups frequently access primary health care (PHC) services, including nurses in community health services and general medical practices, providing unparalleled opportunity for engagement to influence family behaviours. One emerging and promising area that might maximise engagement at a low cost is the provision of support for healthy parenting through electronic media such as the Internet or smart phones. The Growing healthy study explores the feasibility of delivering such support via primary health care services.This paper describes the Growing healthy study, a non-randomised quasi experimental study examining the feasibility of an intervention delivered via a smartphone app (or website) for parents living in socioeconomically disadvantaged areas, for promoting infant feeding and parenting behaviours that promote healthy rather than excessive weight gain. Participants will be recruited via their primary health care practitioner and followed until their infant is 9 months old. Data will be collected via web-based questionnaires and the data collected inherently by the app itself.This study received approval from the University of Technology Sydney Ethics committee and will be disseminated via peer-reviewed publications and conference presentations.Elizabeth Denney-Wilson, Rachel Laws, Catherine Georgina Russell, Kok-leong Ong, Sarah Taki, Roz Elliot, Leva Azadi, Sharyn Lymer, Rachael Taylor, John Lynch, David Crawford, Kylie Ball, Deborah Askew, Eloise Kate Litterbach, Karen J Campbel

IODP workshop: Core-Log Seismic Investigation at Sea – Integrating legacy data to address outstanding research questions in the Nankai Trough Seismogenic Zone Experiment

The first International Ocean Discovery Program (IODP) Core-Log-Seismic Integration at Sea (CLSI@Sea) workshop, held in January–February 2018, brought together an international, multidisciplinary team of 14 early-career scientists and a group of scientific mentors specialized in subduction zone processes at the Nankai Trough, one of the Earth's most active plate-subduction zones located off the southwestern coast of Japan. The goal of the workshop was to leverage existing core, log, and seismic data previously acquired during the IODP's Nankai Trough Seismogenic Zone Experiment (NanTroSEIZE), to address the role of the deformation front of the Nankai accretionary prism in tsunamigenic earthquakes and slow slip in the shallow portion of the subduction interface. The CLSI@Sea workshop was organized onboard the D/V Chikyu concurrently with IODP Expedition 380, allowing workshop participants to interact with expedition scientists installing a long-term borehole monitoring system (LTBMS) at a site where the workshop's research was focused. Sedimentary cores from across the deformation front were brought onboard Chikyu, where they were made available for new description, sampling, and analysis. Logging data, drilling parameters, and seismic data were also available for investigation by workshop participants, who were granted access to Chikyu laboratory facilities and software to perform analyses at sea.Multi-thematic presentations facilitated knowledge transfer between the participants across field areas, and highlighted the value of multi-disciplinary collaboration that integrates processes across different spatiotemporal scales. The workshop resulted in the synthesis of existing geophysical, geologic, and geochemical data spanning IODP Sites C0006, C0007, C0011 and C0012 in the NanTroSEIZE area, the identification of key outstanding research questions in the field of shallow subduction zone seismogenesis, and fostered collaborative and individual research plans integrating new data analysis techniques and multidisciplinary approaches.</p

Dielectric relaxation of a composite with tungsten nano-layered spherical filler particles

The thickness and conductivity of a surface coating on filler particles in a composite material are critical parameters in controlling the frequency at which dielectric relaxation occurs. In this paper, experimental results are presented for composites formed from tungsten-coated glass microbubbles, embedded in a matrix of paraffin wax. The tungsten coating is of the order of 10 nm thick. There is an outer coating of alumina, a few nm thick, to prevent oxidation of the tungsten and to prevent the formation of conducting pathways in the composite. Dielectric relaxation is observed at around 10 GHz. A remarkable feature of the system is the way in which the relaxation frequency is shifted, by approximately six decades, from the calculated value for a similar composite formed with solid tungsten filler particles (/spl ap/10/sup 16/ Hz). This shift is attributed to the geometrical confinement of the conductor within a thin shell, and to the reduction in conductivity of the thin tungsten layer when compared with the conductivity of bulk tungsten.This is a manuscript of a proceeding published as Bowler, N., I. J. Youngs, K. P. Lymer, and S. Hussain. "Dielectric relaxation of a composite with tungsten nano-layered spherical filler particles." In The 17th Annual Meeting of the IEEE Lasers and Electro-Optics Society, 2004. LEOS 2004., pp. 381-384. IEEE, 2004. DOI: 10.1109/CEIDP.2004.1364267. Copyright 2004 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works. Posted with permission