Bachelor of Science (BS), Ohio University, 2024, Biological Sciences

Due to increasing industrialization and remaining lead paint and dust in older housing, there is evidence to suggest that human, bovine, and caprine milk could have elevated lead concentrations. Lead is neurotoxic and can cause damage to the developing brains of fetuses and breastfeeding infants, even at low concentrations. The study measured the lead content of breastmilk, cow's milk, and goat's milk samples in Ohio, and compared them to the safety limits set by the World Health Organization (WHO). Twenty lactating women provided samples of human milk and a sample of cow's and goat's milks from local dairies were collected. The milks were digested with nitric acid and hydrogen peroxide using a 1:5:2 ratio and analyzed for lead concentrations using an ICP-MS procedure following standard QA/QC guidelines. Overall, the milk samples' lead levels were within the safety limits set by the WHO and human milk lead levels were comparable to cow's and goat's milk lead levels. In a Pearson's Correlation test, two residence-related factors were found to be significantly correlated with higher lead levels in participants' milk samples, the year the house was built (p=0.001) and the number of years living in the house (p=0.013). The older the house, the more lead was found in milk samples. The longer a person had been living in the same house, the higher the lead concentrations were in milk. The other continuous variables were not significantly correlated with lead levels. In a Spearman's Rho test, a non-parametric test that measures dichotomous variables, there was a significant correlation between having grown up in a house where people smoked and having higher lead levels in milk (p = 0.01). When smoking in the childhood home was examined using a t-test, there was a difference in means although the association was not significant (non-smoking mean level 13.2 (n=17) vs smoking mean level 37.0 (n=3), p=0.26) as the sample was skewed. A non-parametric Mann-Whitney U test wa (open full item for complete abstract)

Committee: Natalie Kruse Daniels (Advisor); Ilana Chertok (Advisor) Subjects: Biology

Doctor of Nursing Practice, Mount St. Joseph University , 2022, Department of Nursing

Consistently low breast pumping initiation scores, within six hours post-delivery, among breastfeeding mothers of preterm Newborn Intensive Care Unit (NICU) newborns have been noted. Breast pumping within six hours post-delivery has been shown to increase breast milk volume. Improved breast milk volume provides essential nutrition and health benefits to the preterm NICU newborn receiving mom's own colostrum and mom's own milk. Antenatal breast pumping education, incorporating NICU Lactation Consultant (L/C) session(s), should be structured and flexible to meet individual patient's need. Health care provider lactation support and breast pumping education during the prenatal, antenatal, and post-partum periods improves breastfeeding and pumping initiation, duration, and exclusivity. A quality improvement practice change was implemented to increase breast pumping initiation scores. An education bundle, to increase breast pumping initiation, was initiated with Advanced Obstetrical Care Unit (AOC) nurses. The bundle included providing nurses with education on breastfeeding, pumping, stability assessment criteria of the high-risk inpatient preterm pregnant woman and the NICU L/C referral process. Post implementation, NICU L/Cs provided 21 AOC patients with a Prime My Pump in 6 (PMP6) kit and an antenatal patient education session(s) on breastfeeding, pumping, and equipment demonstration using the teach back method. Patients were encouraged to initiate breast pumping, within six hours post-delivery. Three months pre and post project implementation, breast pumping initiation scores among mothers of preterm NICU newborns, averaged 46 %, and 38 % respectively. Pre and post implementation averages remained below the organization's breast pumping initiation 65 % target goal. AOC nurses and NICU L/Cs continue to provide antenatal breastfeeding, pumping education and PMP6 kits for high-risk inpatient women to facilitate increasing monthly breast pumping initiation scores.

Committee: Nancy Hinzman (Advisor) Subjects: Health Care; Health Education; Nursing; Nutrition; Obstetrics; Teaching

DNP, Otterbein University, 2023, Nursing

Postoperative breastfeeding recommendations for lactating mothers by anesthesia providers are inconsistent and often inaccurate. Inappropriate recommendations have led to withholding of breastmilk to the infant, unnecessary disposal of breastmilk, surgical delay, exposure of an infant to high levels of drugs in breastmilk, and early cessation of breastfeeding. The purpose of the scholarly project was to develop a set of evidenced-based practice guideline recommendations and a proposed implementation plan for anesthesia providers to use in support of breastfeeding mothers who recover from surgery. Many studies in the literature indicate that there are inconsistencies in postoperative breastfeeding recommendations by anesthesia providers. When postoperative breastfeeding guidelines were implemented, anesthesia staff were more likely to recommend breastfeeding in the immediate postoperative period and feel more confident in their recommendation. In addition, there were fewer preventable delays in breastfeeding resumption and fewer neonatal safety events. Tools from the Johns Hopkins Nursing Evidence-Based Practice model were used to guide a systematic literature review, synthesize evidence, and develop an implementation plan. The literature review included the safety of commonly used perioperative medications in the lactating mother. Overall, almost all medications used in the perioperative period are safe to use in lactating mothers, except for codeine, meperidine, tramadol, diazepam, and hydromorphone. As part of this project, a guideline implementation plan for future use by anesthesia providers was developed and proposed to occur over 11 months. Additionally, a ten-question knowledge and confidence assessment regarding breastfeeding recommendations was proposed to be distributed to all anesthesia providers (e.g., Anesthesiologists and Certified Registered Nurse Anesthetist [CRNAs]) prior to guideline implementation, one month after implementation, and six months af (open full item for complete abstract)

Committee: Kacy Ballard (Advisor) Subjects: Nursing

DNP, Otterbein University, 2023, Nursing

Postoperative breastfeeding recommendations for lactating mothers by anesthesia providers are inconsistent and often inaccurate. Inappropriate recommendations have led to withholding of breastmilk to the infant, unnecessary disposal of breastmilk, surgical delay, exposure of an infant to high levels of drugs in breastmilk, and early cessation of breastfeeding. The purpose of this scholarly project is to develop an evidence-based clinical guideline for anesthesia providers to utilize to make postoperative breastfeeding recommendations and to develop a facility guideline implementation plan. Many studies in the literature indicate that there are inconsistencies in postoperative breastfeeding recommendations by anesthesia providers. When postoperative breastfeeding guidelines were implemented, anesthesia staff were more likely to recommend breastfeeding in the immediate postoperative period and feel more confident in their recommendation. In addition, there were fewer preventable delays in breastfeeding resumption and fewer neonatal safety events. Tools from the Johns Hopkins Nursing Evidence-Based Practice model were used to guide a systematic literature review, synthesize evidence, and develop an implementation plan. The literature review included the safety of commonly used perioperative medications in the lactating mother. Overall, almost all medications used in the perioperative period are safe to use in lactating mothers, except for codeine, meperidine, tramadol, diazepam, and hydromorphone. The guideline implementation will occur over 11 months. A ten-question knowledge of breastfeeding in anesthesia assessment and confidence in providing breastfeeding recommendations will be collected before guideline implementation, one month after implementation, and six months after implementation in all anesthesia providers, including anesthesiologists and certified registered nurse anesthetists. Knowledge and confidence data will be assessed for statistical significance us (open full item for complete abstract)

Committee: Kacy Ballard (Advisor) Subjects: Health; Health Care; Nursing

MS, University of Cincinnati, 2022, Allied Health Sciences: Nutrition

Background: In a randomized trial of docosahexaenoic acid (DHA) supplementation to lactating mothers who delivered preterm, there were significant increases in DHA status in the mother and her infant. Objectives: Our objective here is to characterize the mammary gland transcriptomes from the above study. We hypothesized that pro-inflammatory gene expression would be attenuated in the increased DHA group versus the standard DHA group. Design: In the original trial, mothers delivering at <29 weeks gestation at the University of Cincinnati Medical Center and intending to express their milk were randomly assigned to supplementation with 200 mg/d DHA (STD) or 1000 mg/d DHA (EXP) within 7 days of delivery. Here, we conducted RNA-seq transcriptome analysis of n=5 EXP and n=4 STD extracellular mammary mRNA samples extracted from the fat layer of milk samples obtained 4 weeks post-enrollment. Transcripts were assessed for differential expression (false discovery rate adjusted p-value <0.05) and clustering between EXP versus STD groups. Ontological analysis of all differentially expressed genes (DEGs) was performed with Toppcluster. Results: There were 409 DEGs. We observed 5 main groups of biological processes that were upregulated, including those associated with improved immune regulation and management of oxidative stress; and 3 main groups of biological processes that were downregulated, including one associated with immune dysregulation. For example, we observed up-regulation of inflammation-inhibiting genes including NFKBIA (Fold-change, adjusted p-value, 1.70; p=0.007) and IL18BP (2.2, adjusted p=0.02); and down-regulation of pro-inflammatory genes including IL7R (-1.9, adjusted p=0.02) and IL1RL1 (-13.0, adjusted p=0.02). Conclusion: Increased DHA supplementation during lactation can modulate the expression of inflammation-related genes within the mammary gland. This may translate to milk composition with a more optimal inflammasome prof (open full item for complete abstract)

Committee: Christina Valentine Ph.D. (Committee Member); Laurie Nommsen-Rivers Ph.D. (Committee Member) Subjects: Nutrition

PhD, University of Cincinnati, 2021, Nursing: Nursing - Doctoral Program

Abstract Background: In the United States, many mothers are unable to meet their personal breastfeeding goals, or the national and global recommendations for breastfeeding, due to the well documented barriers and reasons for cessation. However, some mothers are continuing to breastfeed longer than six months despite barriers to breastfeeding and residing within a low breastfeeding initiation rate area in a large metropolitan region. Purpose: The purpose of this study is to acquire a better understanding of the social process of sustaining breastfeeding longer than six months, in primarily African American mothers, in regions of a metropolitan area where few mothers start breastfeeding. Methods: Grounded theory methodology, using a critical constructivist lens, will be used to guide the data collection and the iterative, constant comparative, data collection and analysis phase. Semi-structured interviews will be conducted using an inquiry guide through. Data will be collected until theoretical saturation is achieved. Sample: Participants must be 18 years or older, speak fluent English, have attended, or participated in a session or form of support offered by All Mothers Empowered to Nurse (AMEN) breastfeeding support group. Mothers must be a breastfeeding mother who has provided breastmilk to her child for more than six months of age. Theoretical sampling will be employed and continued until saturation of theoretical categories is sufficiently achieved between 10-15 participants. Aim: To construct a theoretical framework explaining the common factors and social processes for breastfeeding in women who have sustained breastfeeding for longer than six months, in a low-income metropolitan area with low-breastfeeding initiation rates, among primarily African American women.

Committee: Elaine Miller Ph.D. (Committee Chair); Julie Ware (Committee Member); Caroline Morrison Ph.D. (Committee Member); Francoise Knox Kazimierczuk Ph.D. R.D. (Committee Member) Subjects: Nursing

MS, University of Cincinnati, 2019, Allied Health Sciences: Nutrition

Background: An efficient method for measuring milk production is needed to improve research evaluation and clinical management of early postpartum milk supply concerns. Objective: 1) Confirm steady state is reached by hour 2 of the Lai et al. hourly breast expression protocol, and externally validate milk production rate (MPR) can be estimated from the mean of hour 2 and hour 3 milk yield; 2) Determine if an increase in MPR is detectible following 48 hours of increased breast emptying; 3) Assess agreement between maternal milk production estimated by MPR compared to infant test-weighing, and 4) Characterize MPR mean and variance in a sample of mothers exclusively breastfeeding infants achieving appropriate weight gain. Design: Eligible mothers were 4-10 weeks postpartum and exclusively breastfeeding their term infants. In a research clinic, mothers emptied both breasts at baseline (h0), and hourly over 3 subsequent hours (h1, h2, h3) using a hospital-grade pump. We estimated mother's steady-state MPR as mean (h2, h3). “Study A' subset completed MPR measurements before and after 48 hours of increased breast emptying. “Study B” subset test-weighed their infant before and after breastfeeding for 48 hours (1-7 days before clinic visit). We used paired t-test for within-participant comparisons and used the Bland-Altman approach to compare 24-hour milk production (g/24h) measured using TW versus MPRx24h. Results: Among 23 mothers 54±14 days postpartum, milk output was 185±55, 60±26, 47±13, 44±13 g/h at h0, h1, h2, and h3, respectively. Mean paired difference (vs. h3) was significant at h0 and h1 (p<0.05), but not h2 (p>0.05, h3-h2=3±10 g/h). In Study A (n=5), mean MPR declined from 50±13 g/h to 43±16g/h (p=0.003) following increased breast emptying. In Study B (n=16), mean TW milk output=717±119 g/24h, and mean MPRx24h=1085±300 g/24h. Mean difference [95% limits of agreement] was 368 [±468] g/24h; and mean ratio was 1.5[±0.4]; difference and ratio significantly increa (open full item for complete abstract)

Committee: Laurie Nommsen-Rivers Ph.D. (Committee Chair); Sarah Riddle MD FAAP IBCLC (Committee Member) Subjects: Nutrition

Master of Science, The Ohio State University, 2017, Anatomy

Due to high mortality associated with triple negative breast cancer (TNBC), a prevention program has the potential to protect many women against this disease. Recent epidemiological and meta-analysis studies revealed a possible correlation between a lack of breastfeeding and development of TNBC. African-American (AA) women have a disproportionate burden of developing aggressive TNBC, a sub-population with higher parity rates and lower prevalence of breastfeeding. The reasons for why parity and breastfeeding affect breast cancer risk are unclear, but recent studies revealed that the pregnancy-lactation cycle (which leads to remodeling of the mammary glands) alters breast morphology and microenvironment, thereby modifying breast cancer risk. Natural weaning (NW), the gradual cessation of breastfeeding, results in a measured reduction of the ductal structures, termed involution. Conversely, the decision not to breastfeed results in a hastened involution, or abrupt involution (AW). We modeled NW and AW in wild-type mice by restricting breastfeeding to 28 and 7 days respectively. Striking differences in the distribution of cell populations were observed in the mammary glands of AW mice compared to NW mice. Fluorescence activated cell sorting analysis revealed an expansion of the luminal progenitor cells with a concomitant decrease in mammary stem-cell enriched/basal compartment in the glands of the AW cohort. This observation is reminiscent of previous observations in TNBC in both animal models and human pre-neoplastic BRCA1-mutation carrier patients. The AW mammary epithelium is more proliferative, inflammatory, exhibit increased estrogen receptor expression, and is immune active 56 days postpartum. Moreover, we observed more collagen deposition in the AW glands compared with NW, which has been correlated with reduced risk for TNBC. These observations highlight a key difference between the lactating and non-lactating mammary glands at the molecular level that could pred (open full item for complete abstract)

Committee: Bhuvaneswari Ramaswamy MD (Committee Chair); Leone Gustavo PhD (Advisor); Kalmar Eileen PhD (Committee Co-Chair); Majumder Sarmila PhD (Committee Member); McHugh Kirk PhD (Committee Member) Subjects: Anatomy and Physiology; Cellular Biology; Molecular Biology; Oncology

Doctor of Philosophy, The Ohio State University, 1985, Graduate School

Committee: Not Provided (Other) Subjects: Agriculture

Doctor of Philosophy, The Ohio State University, 1981, Graduate School

Committee: Not Provided (Other) Subjects: Health Sciences

Doctor of Philosophy, The Ohio State University, 1975, Graduate School

Committee: Not Provided (Other) Subjects: Agriculture

Doctor of Philosophy, The Ohio State University, 1972, Graduate School

Committee: Not Provided (Other) Subjects: Education

Doctor of Philosophy, The Ohio State University, 1960, Graduate School

Committee: Not Provided (Other) Subjects: Biology

Doctor of Philosophy, Miami University, 2014, Zoology

We investigated the interaction between prolactin (PRL) and the HPA axis. A physiologically relevant, hyperprolactinemic model, i.e. postpartum female rats, or PRL knockout mice were used. Animals housed with or separated from their pups for 1 or 24 hours or 8 days were acutely stressed. Circulating PRL and corticosterone (CORT) and PRL-R mRNA in the choroid plexus were determined. PRL returned to pre-pregnancy values by one hour after pup removal. The HPA axis response was restored after 24 hours of separation, although basal CORT levels remained elevated for 8 days after terminating lactation. PRL-R expression decreased 24 h after pup separation, but returned to pre-pregnancy levels by 8 days. Stress-induced HPA axis activation occurred only when PRL-R expression levels were similar to or lower than levels in virgins indicating PRL-R up-regulation contributes to an attenuated HPA response. The sustained, elevated basal CORT levels suggest the metabolic demands and/or stress of lactation persist in the absence of suckling. Additionally, differential effects of gender, diet and PRL on HPA axis activation were studied using wild-type (wt) and PRL knockout (KO) mice. Male and female mice fed normal chow (C) or high-fat diet (HFD) for 12 weeks were acutely stressed. CORT levels were quantified under basal conditions, during stress and at the time of sacrifice. Serial sampling acted as a non-specific stressor, regardless of gender, genotype or diet; PRL dampened this response in males only. HFD increased body weight and fat accumulation in males, but not in females, regardless of genotype. In chow fed animals, stress increased CORT in both males and females, regardless of genotype, indicating that PRL is not involved in activating the HPA axis. HFD increased PRL-R mRNA in wt and KO females, but only in wt males indicating factors other than PRL regulate PRL-R expression in females. HFD increased leptin levels only in wt males and females, suggesting PRL influences lepti (open full item for complete abstract)

Committee: Phyllis Callahan PhD (Committee Chair); James Janik PhD (Committee Co-Chair) Subjects: Biology; Endocrinology; Neurosciences

MS, University of Cincinnati, 2013, Allied Health Sciences: Nutrition

Adiponectin modulates a range of human physiological processes related to metabolism and inflammation. Human milk is known to contain adiponectin in a wide range of concentrations. Variation in adiponectin concentration remains poorly understood; thus we sought to determine its maternal anthropometric and metabolic correlates. The morning after an overnight fast, lactating mothers (N=20) provided an aliquot of milk from a complete breast expression, and underwent an oral glucose tolerance test (OGTT) and anthropometric measurement. Fasting serum (total and HMW) adiponectin and human milk adiponectin were determined by ELISA. Insulin and glucose concentrations were determined by standard clinical assays. Correlates of human milk adiponectin were evaluated using Spearman rank-order correlation coefficient (r). Adiponectin concentrations (mean [min-max] ng/mL) were: human milk, 30.7 (6.9-92.49) and serum total, 6489 (1356-20257). Human milk adiponectin and serum total adiponectin were positively correlated (r=0.45, p=0.048). Human milk adiponectin was not correlated with other full-body measures of maternal metabolic status (fasting glucose, fasting insulin, insulin sensitivity, or insulin secretion). Likewise, full-body anthropometrics (weight and BMI) were not correlated with milk adiponectin concentration. Reflective of more localized fat depots, body circumference measures became more strongly correlated with human milk adiponectin concentration with increasing proximity to the breast. Spearman correlations of circumferences with human milk adiponectin concentration were hip (r=-0.32, p=0.164); iliac crest (r=-0.46, p=0.039); waist (r=-0.50, p=0.025); under breast (r=-0.56, p=0.011). Our novel finding that under-breast circumference was the strongest correlate of human milk adiponectin suggests that the localized fat depots of the breast may be an important source of adiponectin in human milk. Further studies of how the specific fat depots of the breast and upper (open full item for complete abstract)

Committee: Seung-Yeon Lee Ph.D. (Committee Chair); Laurie Ann Nommsen-Rivers Ph.D. (Committee Member); Ardythe Luxion Morrow Ph.D. (Committee Member); Abigail Peairs Ph.D. (Committee Member) Subjects: Nutrition

Master of Science, The Ohio State University, 2013, Animal Sciences

Transition cows have a high risk for metabolic disease within the first 30 days in milk (DIM). Administration of direct-fed microbials (DFM) may reduce the adverse impacts that fresh cows experience during this transition period. Megasphaera elsdenii is a lactic acid-utilizing bacterium that has shown promise as a potential DFM during the transition period. Primi- and multiparous Holstein cows (n=162) at a commercial dairy herd were assigned to 1 of 4 treatments: 1) control (no dose) (n=44), 2) 200 mL Lactipro (M. elsdenii, 1 x 108 cfu/mL; MSBiotec, Littleton, CO) when cows entered (~ -14 DIM) the close-up pen (n=45), 3) 200 mL Lactipro at 1-3 d postpartum (n=39), and 4) 200 mL Lactipro prepartum and 200 mL at 1-3 d postpartum (n=34). Close-up cows were fed 72% forage (63:37 corn silage and wheat straw), and upon calving, cows entered the high group and were fed 40% forage (90:10 corn silage:wheat straw). The BCS was similar among treatments and no treatment by time interaction occurred. There was no difference in milk yield among treatments (39.7, 39.7, 39.5, and 39.8 + 0.97 kg/d) or peak milk yield. Treatment by parity interactions were detected (P < 0.05) for milk yield and peak milk yield in which mature cows (= 3 lactations) dosed prepartum had higher daily milk yield and peak milk than the control and pre- and postpartum dosed cows but did not differ from the postpartum dosed cows. The test-day milk fat and protein percentages were similar among treatments. Test-day milk fat was higher (P < 0.01) for the first (3.88%) versus second (3.38%) test-day but it was within expected levels, which is reflective of the low incidence of ketosis in the study. There was a treatment by parity interaction (P < 0.01) for milk protein. Milk protein percentage was higher for 2nd lactation cows dosed prepartum than control or cows dosed pre- and postpartum but did not differ from cows dosed postpartum. Control and pre- and postpartum dosed cows with = 3 lactations had higher (open full item for complete abstract)

Committee: Maurice Eastridge PhD (Advisor); Jeffrey Firkins PhD (Committee Member); Kristy Daniels PhD (Committee Member) Subjects: Animal Sciences

PhD, University of Cincinnati, 2012, Medicine: Neuroscience/Medical Science Scholars Interdisciplinary

The discovery of a novel serotonergic system within the mammary gland has led us to investigate central and peripheral serotonergic systems during lactation in an intact, non-depressed phenotype mouse model. During lactation we observed significant changes in both central and peripheral serotonergic physiologies. Platelet serotonin (5-HT) was elevated in lactating dams when compared to virgin animals. 5-HT immunostaining was significantly lower in the dorsal raphe of lactating mice than nulliparous mice. These findings are what led us to probe the serotonergic systems with a selective serotonin reuptake inhibitor (SSRI), citalopram. Lactating, nulliparous, and postpartum/non-lactating mice were all given a subchronic treatment regimen with SSRI and then subjected to behavioral tasks to assess mood-related behavior. Strikingly, only lactating dams responded to SSRI treatment with an improvement of mood-related behaviors. Locomotor and home-cage activity tasks indicated that these changes in behavior were specific to mood-related behaviors, and not due to an alteration of sensorimotor function. The novel findings from these studies are that lactating mice exhibit an elevated mood-related behavioral phenotype and respond to SSRI treatment that is ineffective in non-lactating mice. The current study shows that there is an interaction between lactation status and responsiveness to SSRIs, which has important implications for the treatment of postpartum depression (PPD). The immunostaining and behavioral results provide evidence of the potential enhancement of serotonergic activity into the projection fields of the brains of lactating mice. Using Palkovits micropunch technique we determined that there were changes in 5-HT and 5-HIAA activity within the posterior basolateral amygdala (PBLA), a brain region that may participate in mood regulation, of lactating mice. Furthermore, treatment with SSRI significantly reduced 5-HIAA content and increased 5-HT content within the PB (open full item for complete abstract)

Committee: Karen Gregerson PhD (Committee Chair); James Eliassen PhD (Committee Member); James Herman PhD (Committee Member); Nelson Horseman PhD (Committee Member); Kim Seroogy PhD (Committee Member) Subjects: Neurology

PhD, University of Cincinnati, 2009, Medicine : Molecular and Cellular Physiology

Significance: Understanding and identifying the mechanisms surrounding secretory activation and involution in the mammary gland are important to aid mothers who experience breastfeeding difficulties and to aid the dairy industry in their production of important nutritional products. Background: Recently our lab discovered that serotonin is synthesized by the mammary gland epithelium in response to lumenal distension. This and other findings implied that serotonin acted as a negative feedback inhibitor to lactation, thus regulating the balance between secretory activation and involution. The onset of secretory activation is initiated by the assembly of functional tight junctions. It was therefore hypothesized that serotonin regulates tight junctions in order to regulate lactation. However no suitable models for studying mammary epithelial tight junction regulation were available. In addition, the physiological consequences of altering serotonin activity remain unexplored. Goals: Goals that are met in this dissertation are as follows: (1) Create and characterize an in vitro model for studying mammary epithelial tight junction regulation, (2) Determine whether drugs that alter intrinsic serotonin turnover can recapitulate the effects of exogenously added serotonin and (3) Document the physiological consequences of altering serotonin bioactivity in vivo. Results: An in vitro multipotential, barrier-forming model was developed and displays robustness, predictability, differentiation, and expected genetic changes throughout the development of high-resistance tight junctions. In parallel with characterization of this model, serotonin was shown to regulate tight junction permeability when added exogenously. In addition, drugs that increase serotonin bioavailability (fluoxetine, phenelzine, or dexfenfluramine) affect tight junction permeability in a biphasic manner, similar to exogenous serotonin. When serotonin bioavailability is increased in vivo in lactating mice, preco (open full item for complete abstract)

Committee: Nelson Horseman PhD (Committee Chair); Yana Zavros PhD (Committee Member); Karen Gregerson PhD (Committee Member); Nira Ben-Jonathan PhD (Committee Member); Michael Behbehani PhD (Committee Member) Subjects: Physiological Psychology

Doctor of Philosophy, Case Western Reserve University, 2011, Nursing

Breastfeeding is well established as the optimal feeding practice for all infants and is an innate healthy behavior for human beings. Although the breastfeeding initiation rate in Taiwan is high, the incidence and duration of exclusive breastfeeding does not meet the current recommendations. The aim of this study was to determine if a perinatal breastfeeding program (PBP), which included prenatal breastfeeding education, birth kangaroo mother care (BKMC) with the first breastfeeding, continuous 24-hour rooming-in, ongoing kangaroo mother care (KMC) with breastfeeding on cue, and hospital support visits, would improve breastfeeding outcomes for low risk, primiparous mothers who give birth vaginally to healthy full-term infants at a Baby-Friendly Hospital in southern Taiwan. This study was based on the nonseparation innate mutual self-regulation model, which is adapted from Anderson's mutual caregiving model (Anderson, 1977) and Dennis's breastfeeding self-efficacy framework (Dennis, 1999). The repeated measures longitudinal study used a quasi-experimental cohort design, with the control group receiving current care studied first, following by the experimental group receiving the PBP at a Baby-Friendly Hospital in southern Taiwan. The research concepts included initial breastfeeding experiences (IBE), psychophysiological breastfeeding outcomes, and incidence of exclusive breastfeeding. Three psychophysiological breastfeeding outcomes were examined: perceived onset of lactation (POL), perceived milk supply (PMS), and maternal breastfeeding self-efficacy (MBSE). The major outcome of interest was incidence of exclusive breastfeeding at hospital discharge and one month postpartum. Mothers were contacted at 34-37 weeks' gestation. Data collection points were: prenatal, hospital discharge, and one month postpartum. A total of 60 mother-infant dyads (control = 30, experimental = 30) were included. Mothers who participated in the PBP had a greater incidence of exclusive bre (open full item for complete abstract)

Committee: Donna A. Dowling (Committee Chair); Barbara Morrison (Committee Member); Christopher J. Burant (Committee Member); Lydia Furman (Committee Member); Gene Cranston Anderson (Committee Member) Subjects: Nursing