Modification of an Existing Breastfeeding Intervention for the Late Preterm Infant

Purpose: The purpose of this dissertation was to modify an existing breastfeeding intervention for the late preterm infant providing maternal guidance for timing of direct breastfeeding or pumping and bottle-feeding, as well as progression to direct breastfeeding alone. Initially, a scoping review was performed to examine current existing literature for antecedents during the prenatal period associated with late preterm birth, as well as neonatal and childhood health consequences of birth. An integrative review was then performed to identify and evaluate existing breastfeeding interventions that promote breastfeeding exclusivity and duration in the late preterm. Once this data was collected, a mixed-methods study was performed to tailor an existing breastfeeding intervention to transition late preterm infants to direct at breast feeds. Problem: Late preterm infants represent one of the largest segments of the preterm population (Mally, Hendricks-Munoz, & Bailey, 2013). Because of their unique physical immaturities, they present with significant morbidities including respiratory distress syndrome, jaundice, hypoglycemia, poor feeding and failure to thrive (Engle, Tomashek, & Wallman, 2007; Harris, Weston, & Harding, 2012; Sahni & Polin, 2013; Santos et al., 2009). These specific morbidities lead to prolonged hospital stays, as well as an increased rate of readmissions when compared to term infants (Young, Korgenski & Buchi, 2013). Many of these morbidities are related to the inability of the breastfeeding late preterm infant to feed adequately and require the mother to use alternative strategies to feed her infant such as the “triple feeding” method (Meier, Patel, Wright, & Engstrom, 2013). With this method, feedings become demanding and time consuming leading to frustration and possible early cessation. The development of a feasible breastfeeding intervention is needed to provide a structured plan to transition to direct breast feeding and increase breastfeeding exclusivity and duration. Specific aims of this dissertation are: • Aim 1: To examine current existing literature for antecedents during the prenatal period associated with late preterm birth (34-36/67 weeks gestation), as well as neonatal and childhood health consequences of birth during this window. • Aim 2: To identify and evaluate the different breastfeeding interventions that promote breastfeeding exclusivity and duration in the late preterm infant, and to synthesize findings from the published empirical literature on late preterm infant breastfeeding interventions. • Aim 3: To tailor an existing breastfeeding intervention to transition late preterm infants to direct at-breast feeds. Design: The dissertation includes a scoping review to examine the existing literature regarding the antecedents and consequences of late preterm birth, an integrative review to examine existing breastfeeding interventions for the late preterm infant, and a two phase, mixed methods study to guide modification and future implementation of a breastfeeding intervention for late preterm infants. The original late preterm breastfeeding intervention by Meier (2010) was designed to replace triple feedings. Mothers were encouraged to delineate consistent “breastfeeding times” during the day from “pumping and bottle-feeding times” during the nighttime. The late preterm mother was encouraged to pump at least 4 to 5 times the first week at home during a 24-hour period with at least 2 to 3 of these during the stretch of “breastfeeding times”. The plan provides instruction on breastfeeding the late preterm infant including identification of hunger signs, when to change clothing or diaper, appropriate position at the breast, use of nipple shields, and provision of practices to keep the late preterm infant awake. At nighttime, the original plan discusses the use of a helper to bottle feed while the mother pumps to promote a quick return to sleep. Mothers were encouraged to adapt the plan to their baby and situation and to decrease the number of bottle feedings if the infant is drinking at least half of the daily amount of milk from the breast or increase if the infant is drinking less than a quarter of daily amount of milk from the breast (Meier, 2010). Phase I of the study included a qualitative descriptive design utilizing the Breastfeeding Self-Efficacy Theory which informed modifications to the original intervention, from the perspective of both mothers and lactation consultants. Phase II was a convergent parallel mixed methods design guided by the Theoretical Domain Framework to identify potential barriers and enablers to future implementation of the modified intervention from the perspective of lactation consultants. Findings: Several antecedents and consequences related to late preterm birth were identified in the scoping review. Preeclampsia and elective cesarean sections were the most common maternal risk factors associated with a late preterm birth. Consequences of late preterm delivery in the neonatal period included respiratory distress syndrome and poor feeding in the infant as significant consequences of late preterm birth. In addition, as a late preterm infant reaches childhood, there is the potential for failure to thrive, hospital readmission and altered developmental outcomes. Because of the poor feeding, breastfeeding challenges, and the risk of significant consequences post birth hospitalization associated with late preterm birth, an integrative review was performed in order to examine literature regarding existing breastfeeding interventions for this infant population that promote exclusivity and duration. The integrative review established skin to skin care, patient educational interventions and rooming to be effective strategies in promoting breastfeeding exclusivity and duration in the late preterm infant. Finally, during the mixed methods study, five themes emerged within the late preterm mothers’ focus group that informed modification of the breastfeeding intervention. These included: Altered sleep/wake cycle leading to prolonged feedings, feeding challenges led to maternal anxiety, need for information on what is normal, step by step guide would be helpful, and need for ways to decrease isolation. A second focus group with board certified lactation consultants highlighted needed changes in the number of pumpings and breastfeedings during the daytime, as well as, identifying additional outcome measures: bilirubin levels, weight, voids and stools. After the modification of the intervention, the second phase with lactation consultants revealed that workload, interruptions, and staff support were significant barriers to implementation of the intervention. Merging of the two types of data revealed these barriers correlated with the domains of the environmental context, knowledge, social roles, and the skills and beliefs about consequences relative to the lactation consultants within the Theoretical Domains Framework. Conclusions: Poor feeding was identified as a consequence of late preterm birth and that breastfeeding interventions promoted exclusivity and duration of breastfeeding in this population. Participants in the modification and theoretical evaluation of this breastfeeding intervention felt the plan would provide better guidance to the mother in breastfeeding a late preterm infant. With modification of the existing breastfeeding intervention using stakeholder input, potential barriers and enablers to implementation were recognized, which will provide guidance for future implementation of the intervention

Feeding common carp Cyprinus carpio with b-glucan supplemented diet stimulates C-reactive protein and complement immune acute phase responses following PAMPs injection

The effect of β-glucan as a feed additive on the serum and gene profile of C-reactive protein (CRP) and complement acute phase responses was ascertained in common carp Cyprinus carpio. In addition effects of subsequent intraperitoneal injections of pathogen-associated molecular patterns (PAMPs), i.e. LPS or poly(I:C), to mimic bacterial or viral infection respectively, were studied. Carp were first orally fed with β-glucan (MacroGard®) with a daily β-glucan intake of 6 mg per kg body weight or with control food for 25 days and then injected with PBS containing either LPS (4 mg/kg) or poly(I:C) (5 mg/kg) or PBS alone. Fish were sampled during the 25 days of the feeding period and up to 7 days post-PAMPs injections for serum and liver, head kidney and mid-gut tissues. Oral administration of β-glucan for 25 days significantly increased serum CRP levels and alternative complement activity (ACP). In addition, the subsequent LPS and poly(I:C) challenges significantly affected CRP and complement related gene expression profiles (crp1, crp2, c1r/s, bf/c2, c3 and masp2), with the greatest effects observed in the β-glucan fed fish. However, in fish fed β-glucan the PAMPs injections had less effects on CRP levels and complement activity in the serum than in control fed fish, suggesting that the 25 days of β-glucan immunostimulation was sufficient enough to reduce the effects of LPS and poly(I:C) injections. Results suggest that MacroGard® stimulated CRP and complement responses to PAMPs immunological challenges in common carp thus highlighting the beneficial β-glucan immunostimulant properties

Discovery of rare variants associated with blood pressure regulation through meta-analysis of 1.3 million individuals

Genetic studies of blood pressure (BP) to date have mainly analyzed common variants (minor allele frequency > 0.05). In a meta-analysis of up to ~1.3 million participants, we discovered 106 new BP-associated genomic regions and 87 rare (minor allele frequency ≤ 0.01) variant BP associations (P < 5 × 10−8), of which 32 were in new BP-associated loci and 55 were independent BP-associated single-nucleotide variants within known BP-associated regions. Average effects of rare variants (44% coding) were ~8 times larger than common variant effects and indicate potential candidate causal genes at new and known loci (for example, GATA5 and PLCB3). BP-associated variants (including rare and common) were enriched in regions of active chromatin in fetal tissues, potentially linking fetal development with BP regulation in later life. Multivariable Mendelian randomization suggested possible inverse effects of elevated systolic and diastolic BP on large artery stroke. Our study demonstrates the utility of rare-variant analyses for identifying candidate genes and the results highlight potential therapeutic targets. © 2020, The Author(s), under exclusive licence to Springer Nature America, Inc. There are 286 authors of this articles not all are listed in this record

Gradual polyploid genome evolution revealed by pan-genomic analysis of Brachypodium hybridum and its diploid progenitors

Our understanding of polyploid genome evolution is constrained because we cannot know the exact founders of a&nbsp;particular polyploid. To differentiate between founder effects and post polyploidization evolution, we use a pan-genomic approach to study the allotetraploid Brachypodium hybridum and its diploid progenitors. Comparative analysis suggests that most B. hybridum whole gene presence/absence variation is part of the standing variation in its diploid progenitors. Analysis of nuclear single nucleotide variants, plastomes and k-mers associated with retrotransposons reveals two independent origins for B. hybridum, ~1.4 and ~0.14 million years ago. Examination of gene expression in the younger B. hybridum lineage reveals no bias in overall subgenome expression. Our results are consistent with a gradual accumulation of genomic changes after polyploidization and a lack of subgenome expression dominance. Significantly, if we did not use a pan-genomic approach, we would grossly overestimate the number of genomic changes attributable to post polyploidization evolution

The gut microbiome of exudivorous marmosets in the wild and captivity

Mammalian captive dietary specialists like folivores are prone to gastrointestinal distress and primate dietary specialists suffer the greatest gut microbiome diversity losses in captivity compared to the wild. Marmosets represent another group of dietary specialists, exudivores that eat plant exudates, but whose microbiome remains relatively less studied. The common occurrence of gastrointestinal distress in captive marmosets prompted us to study the Callithrix gut microbiome composition and predictive function through bacterial 16S ribosomal RNA V4 region sequencing. We sampled 59 wild and captive Callithrix across four species and their hybrids. Host environment had a stronger effect on the gut microbiome than host taxon. Wild Callithrix gut microbiomes were enriched for Bifidobacterium, which process host-indigestible carbohydrates. Captive marmoset guts were enriched for Enterobacteriaceae, a family containing pathogenic bacteria. While gut microbiome function was similar across marmosets, Enterobacteriaceae seem to carry out most functional activities in captive host guts. More diverse bacterial taxa seem to perform gut functions in wild marmosets, with Bifidobacterium being important for carbohydrate metabolism. Captive marmosets showed gut microbiome composition aspects seen in human gastrointestinal diseases. Thus, captivity may perturb the exudivore gut microbiome, which raises implications for captive exudivore welfare and calls for husbandry modifications

Robustness and uncertainties in global multivariate wind-wave climate projections

Understanding climate-driven impacts on the multivariate global wind-wave climate is paramount to effective offshore/coastal climate adaptation planning. However, the use of single-method ensembles and variations arising from different methodologies has resulted in unquantified uncertainty amongst existing global wave climate projections. Here, assessing the first coherent, community-driven, multi-method ensemble of global wave climate projections, we demonstrate widespread ocean regions with robust changes in annual mean significant wave height and mean wave period of 5–15% and shifts in mean wave direction of 5–15°, under a high-emission scenario. Approximately 50% of the world’s coastline is at risk from wave climate change, with ~40% revealing robust changes in at least two variables. Furthermore, we find that uncertainty in current projections is dominated by climate model-driven uncertainty, and that single-method modelling studies are unable to capture up to ~50% of the total associated uncertainty

Gradual polyploid genome evolution revealed by pan-genomic analysis of Brachypodium hybridum and its diploid progenitors

Our understanding of polyploid genome evolution is constrained because we cannot know the exact founders of a particular polyploid. To differentiate between founder effects and post polyploidization evolution, we use a pan-genomic approach to study the allotetraploid Brachypodium hybridum and its diploid progenitors. Comparative analysis suggests that most B. hybridum whole gene presence/absence variation is part of the standing variation in its diploid progenitors. Analysis of nuclear single nucleotide variants, plastomes and k-mers associated with retrotransposons reveals two independent origins for B. hybridum, ~1.4 and ~0.14 million years ago. Examination of gene expression in the younger B. hybridum lineage reveals no bias in overall subgenome expression. Our results are consistent with a gradual accumulation of genomic changes after polyploidization and a lack of subgenome expression dominance. Significantly, if we did not use a pan-genomic approach, we would grossly overestimate the number of genomic changes attributable to post polyploidization evolution

Magma plumbing systems: a geophysical perspective

Over the last few decades, significant advances in using geophysical techniques to image the structure of magma plumbing systems have enabled the identification of zones of melt accumulation, crystal mush development, and magma migration. Combining advanced geophysical observations with petrological and geochemical data has arguably revolutionised our understanding of, and afforded exciting new insights into, the development of entire magma plumbing systems. However, divisions between the scales and physical settings over which these geophysical, petrological, and geochemical methods are applied still remain. To characterise some of these differences and promote the benefits of further integration between these methodologies, we provide a review of geophysical techniques and discuss how they can be utilised to provide a structural context for and place physical limits on the chemical evolution of magma plumbing systems. For example, we examine how Interferometric Synthetic Aperture Radar (InSAR), coupled with Global Positioning System (GPS) and Global Navigation Satellite System (GNSS) data, and seismicity may be used to track magma migration in near real-time. We also discuss how seismic imaging, gravimetry and electromagnetic data can identify contemporary melt zones, magma reservoirs and/or crystal mushes. These techniques complement seismic reflection data and rock magnetic analyses that delimit the structure and emplacement of ancient magma plumbing systems. For each of these techniques, with the addition of full-waveform inversion (FWI), the use of Unmanned Aerial Vehicles (UAVs) and the integration of geophysics with numerical modelling, we discuss potential future directions. We show that approaching problems concerning magma plumbing systems from an integrated petrological, geochemical, and geophysical perspective will undoubtedly yield important scientific advances, providing exciting future opportunities for the volcanological community