What influences the timing of the introduction of solid food to infants?

The aim of the present study was to assess the factors which may influence the timing of the introduction of solid food to infants. The design was a prospective cohort study by interview and postal questionnaire. Primiparous women (n 541) aged between 16 and 40 years were approached in the Forth Park Maternity Hospital, Fife, Scotland. Of these, 526 women agreed to participate and seventy-eight were used as subjects in the pilot study. At 12 weeks we interviewed 338 women of the study sample. The postal questionnaire was returned by 286 of 448 volunteers. At 12 weeks 133 of 338 mothers said that they had introduced solids. Those that said that they had introduced solids early (<12 weeks) were compared with those who had introduced solids late (>12 weeks) by bivariate and multiple regression analysis. Psychosocial factors influencing the decision were measured with the main outcome measure being the time of introduction of solid food. The early introduction of solids was found to be associated with: the opinions of the infant's maternal grandmother; living in a deprived area; personal disagreement with the advice to wait until the baby was 4 months; lack of encouragement from friends to wait until the baby was 4 months; being in receipt of free samples of manufactured food. Answers to open-ended questions indicated that the early introduction appeared to be influenced by the mothers’ perceptions of the baby's needs. Some of the factors influencing a woman's decision to introduce solids are amenable to change, and these could be targeted in educational interventions.

Mothers' perceptions of introducing solids to their infant at six months of age : identifying critical belief-based targets to promote adherence to current infant feeding guidelines

We investigated critical belief-based targets for promoting the introduction of solid foods to infants at six months. First-time mothers (N = 375) completed a Theory of Planned Behaviour belief-based questionnaire and follow-up questionnaire assessing the age the infant was first introduced to solids. Normative beliefs about partner/spouse (β = 0.16) and doctor (β = 0.22), and control beliefs about commercial baby foods available for infants before six months (β = −0.20), predicted introduction of solids at six months. Intervention programs should target these critical beliefs to promote mothers’ adherence to current infant feeding guidelines to introduce solids at around six months.

The timing of solid introduction in an ‘obesogenic’ environment : a narrative review of the evidence and methodological issues.

Objective To evaluate the evidence for association between obesity risk outcomes >12 months of age and timing of solid introduction in healthy term infants in developed countries, the large majority of whom are not exclusively breastfed to 6 months of age. Methods Studies included were published 1990-March 2013. Results Twenty-six papers with weight status or obesity prevalence outcomes were identified. Studies were predominantly cohort design, most with important methodological limitations. Ten studies reported a positive association. Of these only two were large good quality studies and both examined the outcome of early (<4 months) solid introduction. None of the four good quality studies that directly evaluated current guidelines provided evidence of any clinically relevant protective effect of solid introduction from 4-5 versus ≥ 6 months of age. Conclusion Overall the introduction of solids prior to 4 months may result in increased risk of childhood obesity but there is little evidence of adverse weight status outcomes associated with introducing solids at 4-6 rather than at 6 months. Implications More and better quality evidence is required to inform guidelines on the ‘when, what and how’ of complementary feeding.

Factors influencing first-time mothers’ introduction of complementary foods: A qualitative exploration

Background Optimal infant nutrition comprises exclusive breastfeeding, with complementary foods introduced from six months of age. How parents make decisions regarding this is poorly studied. This study begins to address the dearth of research into the decision-making processes used by first-time mothers relating to the introduction of complementary foods. Methods This qualitative explorative study was conducted using interviews (13) and focus groups (3). A semi-structured interview guide based on the Theory of Planned Behaviour (TPB). The TPB, a well-validated decision-making model, identifies the key determinants of a behaviour through behavioural beliefs, subjective norms, and perceived behavioural control over the behaviour. It is purported that these beliefs predict behavioural intention to perform the behaviour, and performing the behaviour. A purposive, convenience, sample of 21 metropolitan parents recruited through advertising at local playgroups and childcare centres, and electronically through the University community email list self-selected to participate. Data were analysed thematically within the theoretical constructs: behavioural beliefs, subjective norms and perceived behavioural control. Data relating to sources of information about the introduction of complementary foods were also collected. Results Overall, first-time mothers found that waiting until six months was challenging despite knowledge of the WHO recommendations and an initial desire to comply with this guideline. Beliefs that complementary foods would assist the infants' weight gain, sleeping patterns and enjoyment at meal times were identified. Barriers preventing parents complying with the recommendations included subjective and group norms, peer influences, infant cues indicating early readiness and food labelling inconsistencies. The most valued information source was from peers who had recently introduced complementary foods. Conclusions First-time mothers in this study did not demonstrate a good understanding of the rationale behind the WHO recommendations, nor did they understand fully the signs of readiness of infants to commence solid foods. Factors that assisted waiting until six months were a trusting relationship with a health professional whose practice and advice was consistent with the recommendations and/or when their infant was developmentally ready for complementary foods at six months and accepted them with ease and enthusiasm. Barriers preventing parents complying with the recommendations included subjective and group norms, peer influences, infant cues indicating early readiness and food labelling inconsistencies.

Introduction of a short writing task to measure and develop academic literacy in first year health undergraduates

This paper describes an initiative in the Faculty of Health at the Queensland University of Technology, Australia, where a short writing task was introduced to first year undergraduates in four courses including Public Health, Nursing, Social Work and Human Services, and Human Movement Studies. Over 1,000 students were involved in the trial. The task was assessed using an adaptation of the MASUS Procedure (Measuring the Academic Skills of University Students) (Webb & Bonanno, 1994). Feedback to the students including MASUS scores then enabled students to be directed to developmental workshops targeting their academic literacy needs. Students who achieved below the benchmark score were required to attend academic writing workshops in order to obtain the same summative 10% that was obtained by those who had achieved above the benchmark score. The trial was very informative, in terms of determining task appropriateness and timing, student feedback, student use of support, and student perceptions of the task and follow-up workshops. What we learned from the trial will be presented with a view to further refinement of this initiative.

Investigation into the introduction of clonal strains of Pseudomonas aeruginosa to the cystic fibrosis population by consumption of raw salad vegetables

Most salad vegetables are eaten fresh by consumers. However, raw vegetables may pose a risk of transmitting opportunistic bacteria to immunocompromised people, including cystic fibrosis (CF) patients. In particular, CF patients are vulnerable to chronic Pseudomonas aeruginosa lung infections and this organism is the primary cause of morbidity and mortality in this group. Clonal variants of P. aeruginosa have been identified as emerging threats to people afflicted with CF; however it has not yet been proven from where these clones originate or how they are transmitted. Due to the organisms‟ aquatic environmental niche, it was hypothesised that vegetables may be a source of these clones. To test this hypothesis, lettuce, tomatoes, mushrooms and bean sprout packages (n = 150) were analysed from a green grocer, supermarket and farmers‟ market within the Brisbane region, availability permitting. The internal and external surfaces of the vegetables were separately analysed for the presence of clonal strains of P. aeruginosa using washings and homogenisation techniques, respectively. This separation was in an attempt to establish which surface was contaminated, so that recommendations could be made to decrease or eliminate P. aeruginosa from these foods prior to consumption. Soil and water samples (n = 17) from local farms were also analysed for the presence of P. aeruginosa. Presumptive identification of isolates recovered from these environmental samples was made based on growth on Cetrimide agar at 42°C, presence of the cytochrome-oxidase enzyme and inability to ferment lactose. P. aeruginosa duplex real-time polymerase chain reaction assay (PAduplex) was performed on all bacterial isolates presumptively identified as P. aeruginosa. Enterobacterial repetitive intergenic consensus strain typing PCR (ERIC-PCR) was subsequently performed on confirmed bacterial isolates. Although 72 P. aeruginosa were isolated, none of these proved to be clonal strains. The significance of these findings is that vegetables may pose a risk of transmitting sporadic strains of P. aeruginosa to people afflicted with CF and possibly, other immunocompromised people.

Wound problems following hip arthroplasty before and after the introduction of a direct thrombin inhibitor for thromboprophylaxis

NICE guidelines have stated that patients undergoing elective hip surgery are at increased risk for venous thromboembolic events (VTE) following surgery and have recommended thromboprophylaxis for 28-35 days1, 2. However the studies looking at the new direct thrombin inhibitors have only looked at major bleeding. We prospectively looked at wound discharge in patients who underwent hip arthroplasty and were given dabigatran postoperatively between March 2010 and April 2010 (n=56). We retrospectively compared these results to a matched group of patients who underwent similar operations six months earlier when all patients were given dalteparin routinely postoperatively until discharge, and discharged home on 150mg aspirin daily for 6 weeks (n=67). Wound discharge after 5 days was significantly higher in the patients taking dabigatran (32% dabigatran n=18, 10% dalteparin n=17, p=0.003) and our rate of delayed discharges due to wound discharge significantly increased from 7% in the dalteparin group (n=5) to 27% for dabigatran (n=15, p=0.004). Patients who received dabigatran were more than five times as likely to return to theatre with a wound complication as those who received dalteparin (7% dabigatran n=4, vs. 1% dalteparin n=1), however, this was not statistically significant (p=0.18). The significantly higher wound discharge and return to theatre rates demonstrated in this study have meant that we have changed our practice to administering dalteparin until the wound is dry and then starting dabigatran. Our study demonstrates the need for further clinical studies regarding wound discharge and dabigatran.

Influence of physical and chemical properties of solids on heavy metal adsorption

Partition of heavy metals between particulate and dissolve fraction of stormwater primarily depends on the adsorption characteristics of solids particles. Moreover, the bioavailability of heavy metals is also influenced by the adsorption behaviour of solids. However, due to the lack of fundamental knowledge in relation to the heavy metals adsorption processes of road deposited solids, the effectiveness of stormwater management strategies can be limited. The research study focused on the investigation of the physical and chemical parameters of solids on urban road surfaces and, more specifically, on heavy metal adsorption to solids. Due to the complex nature of heavy metal interaction with solids, a substantial database was generated through a series of field investigations and laboratory experiments. The study sites for the build-up pollutant sample collection were selected from four urbanised suburbs located in a major river catchment. Sixteen road sites were selected from these suburbs and represented typical industrial, commercial and residential land uses. Build-up pollutants were collected using a wet and dry vacuum collection technique which was specially designed to improve fine particle collection. Roadside soil samples were also collected from each suburb for comparison with the road surface solids. The collected build-up solids samples were separated into four particle size ranges and tested for a range of physical and chemical parameters. The solids build-up on road surfaces contained a high fraction (70%) of particles smaller than 150ìm, which are favourable for heavy metal adsorption. These solids particles predominantly consist of soil derived minerals which included quartz, albite, microcline, muscovite and chlorite. Additionally, a high percentage of amorphous content was also identified in road deposited solids. In comparing the mineralogical data of surrounding soil and road deposited solids, it was found that about 30% of the solids consisted of particles generated from traffic related activities on road surfaces. Significant difference in mineralogical composition was noted in different particle sizes of build-up solids. Fine solids particles (<150ìm) consisted of a clayey matrix and high amorphous content (in the region of 40%) while coarse particles (>150ìm) consisted of a sandy matrix at all study sites, with about 60% quartz content. Due to these differences in mineralogical components, particles larger than and smaller than 150ìm had significant differences in their specific surface area (SSA) and effective cation exchange capacity (ECEC). These parameters, in turn, exert a significant influence on heavy metal adsorption. Consequently, heavy metal content in >150ìm particles was lower than in the case of fine particles. The particle size range <75ìm had the highest heavy metal content, corresponding with its high clay forming minerals, high organic matter and low quartz content which increased the SSA, ECEC and the presence of Fe, Al and Mn oxides. The clay forming minerals, high organic matter and Fe, Al and Mn oxides create distinct groups of charge sites on solids surfaces and exhibit different adsorption mechanisms and bond strength, between heavy metal elements and charge sites. Therefore, the predominance of these factors in different particle sizes leads to different heavy metal adsorption characteristics. Heavy metals show preference for association with clay forming minerals in fine solids particles, whilst in coarse particles heavy metals preferentially associate with organic matter. Although heavy metal adsorption to amorphous material is very low, the heavy metals embedded in traffic related materials have a potential impact on stormwater quality.Adsorption of heavy metals is not confined to an individual type of charge site in solids, whereas specific heavy metal elements show preference for adsorption to several different types of charge sites in solids. This is attributed to the dearth of preferred binding sites and the inability to reach the preferred binding sites due to competition between different heavy metal species. This confirms that heavy metal adsorption is significantly influenced by the physical and chemical parameters of solids that lead to a heterogeneity of surface charge sites. The research study highlighted the importance of removal of solids particles from stormwater runoff before they enter into receiving waters to reduce the potential risk posed by the bioavailability of heavy metals. The bioavailability of heavy metals not only results from the easily mobile fraction bound to the solids particles, but can also occur as a result of the dissolution of other forms of bonds by chemical changes in stormwater or microbial activity. Due to the diversity in the composition of the different particle sizes of solids and the characteristics and amount of charge sites on the particle surfaces, investigations using bulk solids are not adequate to gain an understanding of the heavy metal adsorption processes of solids particles. Therefore, the investigation of different particle size ranges is recommended for enhancing stormwater quality management practices.

The introduction of an interactive teaching and learning activity (TLA) in class and its relationship to students’ learning-outcomes

In the university education arena, it is becoming apparent that traditional methods of conducting classes are not the most effective ways to achieve desired learning outcomes. The traditional class/method involves the instructor verbalizing information for passive, note-taking students who are assumed to be empty receptacles waiting to be filled with knowledge. This method is limited in its effectiveness, as the flow of information is usually only in one direction. Furthermore, “It has been demonstrated that students in many cases can recite and apply formulas in numerical problems, but the actual meaning and understanding of the concept behind the formula is not acquired (Crouch & Mazur)”. It is apparent that memorization is the main technique present in this approach. A more effective method of teaching involves increasing the students’ level of activity during, and hence their involvement in the learning process. This technique stimulates self- learning and assists in keeping these students’ levels of concentration more uniform. In this work, I am therefore interested in studying the influence of a particular TLA on students’ learning-outcomes. I want to foster high-level understanding and critical thinking skills using active learning (Silberman, 1996) techniques. The TLA in question aims to promote self-study by students and to expose them to a situation where their learning-outcomes can be tested. The motivation behind this activity is based on studies which suggest that some sensory modalities are more effective than others. Using various instruments for data collection and by means of a thorough analysis I present evidence of the effectiveness of this action research project which aims to improve my own teaching practices, with the ultimate goal of enhancing student’s learning.

Role of solids in heavy metals build-up on urban road surfaces

Solids are widely identified as a carrier of harmful pollutants in stormwater runoff exerting a significant risk to receiving waters. This paper outlines the findings of an in-depth investigation on heavy metal adsorption to solids surfaces. Pollutant build-up samples collected from sixteen road sites in residential, industrial and commercial land uses were separated into four particle size ranges and analysed for a range of physico-chemical parameters and nine heavy metals including Iron (Fe), Aluminum (Al), Lead (Pb), Zinc (Zn), Cadmium (Cd), Chromium (Cr), Manganese (Mn), Nickel (Ni) and Copper (Cu). High specific surface area (SSA) and total organic carbon (TOC) content in finer particle size ranges was noted, thus confirming strong correlations with heavy metals. Based on their physico-chemical characteristics, two different types of solids originating from traffic and soil sources were identified. Solids generated by traffic were associated with high loads of heavy metals such as Cd and Cr with strong correlation with SSA. This suggested the existence of surface dependent bonds such as cation exchange between heavy metals and solids. In contrast, Fe, Al and Mn which can be attributed to soil inputs showed strong correlation with TOC suggesting strong bonds such as chemsorption. Zn was found to be primarily attached to solids by bonding with the oxides of Fe, Al and Mn. The data analysis also confirmed the predominance of the finer fraction, with 70% of the solids being finer than 150 µm and containing 60% of the heavy metal pollutant load.

Leveraging social network data for analytical CRM strategies : the introduction of social BI

The skyrocketing trend for social media on the Internet greatly alters analytical Customer Relationship Management (CRM). Against this backdrop, the purpose of this paper is to advance the conceptual design of Business Intelligence (BI) systems with data identified from social networks. We develop an integrated social network data model, based on an in-depth analysis of Facebook. The data model can inform the design of data warehouses in order to offer new opportunities for CRM analyses, leading to a more consistent and richer picture of customers? characteristics, needs, wants, and demands. Four major contributions are offered. First, Social CRM and Social BI are introduced as emerging fields of research. Second, we develop a conceptual data model to identify and systematize the data available on online social networks. Third, based on the identified data, we design a multidimensional data model as an early contribution to the conceptual design of Social BI systems and demonstrate its application by developing management reports in a retail scenario. Fourth, intellectual challenges for advancing Social CRM and Social BI are discussed.