College of Allied Health Sciences Theses and Dissertations
Micronutrient and Macronutrient Composition of Breastmilk from Women Delivering PrematurelyObjective: The objective of this study was to measure the macronutrient and micronutrient composition of breastmilk expressed by mothers, including African-American women, delivering preterm infants < 33 weeks gestational age. Our second objective was to use mother’s milk data to determine if preterm breastmilk (lactation day 7 and 28), and donor breastmilk fortified with four commonly available human milk fortifiers met the minimum recommended range of nutrients for the preterm infants. Methods: We collected breastmilk samples from mothers of preterm infants admitted to the NICU at Augusta University Medical Center (AUMC) from January-November 2019. Mother’s milk samples were collected on post-partum days 7, 14, 21, and 28 and analyzed for macronutrients and micronutrients. Using the nutrient data (means) in preterm breastmilk at lactation days 7 and 28, we calculated the nutrient composition of the fortified preterm breastmilk and donor breastmilk after the addition of four commercially available fortifiers; Enfamil® Human Milk Fortifier High Protein Liquid (EHP) (Evansville, IN), Enfamil® Human Milk Fortifier Standard Protein Liquid (ESP) (Evansville, IN), Similac® Human Milk Fortifier Hydrolyzed Protein Liquid Concentrate (SLP) (Columbus, OH), Prolacta +4 H2HMF® (PRO4) (City of Industry, CA). Results: Thirty-eight mothers, average age 27 ± 5.1 years and majority African-American (66%) provided milk for the study. The average EGA and birthweight was 28.2 ± 2.8 weeks and 1098 ± 347 grams respectively, with 42% of infants in the cohort delivering prior to the 28th week of pregnancy. Differences in protein, sodium, potassium, calcium, phosphorus, and zinc concentration based on race, day, and milk volume were identified. Dilution effects for protein, sodium, and chloride, and vitamin D concentration over time were identified. Recommended levels of energy, calcium, phosphorus, and potassium were met with the addition of all four fortifiers. Sodium, chloride, magnesium, Vitamin D, and zinc failed to meet recommendations for mature milk or donor milk and additional supplementation of these nutrients may be warranted Conclusion: Nutrient concentration in preterm breastmilk depends on numerous factors including race, volume of milk produced, lactation stage, and gestational age. These factors should be considered when developing feeding plans for preterm infants.
INDICATORS OF IMPROVING LIFE SCIENCES RESEARCH PERFORMANCE AT US ACADEMIC INSTITUTIONSThe academic research institution has long been recognized as a source of innovation and scientific advancement. The goal of this study is to determine how external and internal influences on university research can best contribute to and benefit society through science, economics, and public health. A systematic review of university ranking systems first outlines the current metrics used to evaluate the productivity of research and their validity for assessing research quality and translation of ideas. A total of 24 ranking systems were identified and 13 eligible ranking systems were evaluated. Ranking systems rely on singular indicators, reputation surveys, and tend to be non-replicable. Rankings influence academic choice yet research performance measures are the most weighted indicators. A new multi-dimensional framework of indicators for evaluation of academic research is then proposed across three factors: contributions to science, public health, and economics is then proposed. Data on faculty size, research expenditure, publications, citations, intellectual property outcomes, clinical trials registration and results, and contributions to clinical practice guidelines were included. National benchmarks are reported for the top ten percentile averages of each indicator. One of the proposed public health indicators utilizes clinical trials reporting. At 167 universities, 16,787 clinical trials were evaluated for planning, execution, and overall quality between 2001 and 2016. Over time, significant quality improvement was observed, however execution quality was much lower than planning quality. For completed intervention trials after 2007, only 21% (95%CI: 20%, 21%) had uploaded results – this is required under certain conditions within one year of completion. NIH funded trials had significantly better quality scores than all others (p<0.001). Finally, latent profile analysis (LPA) identified three university profiles determined by the proposed indicators, which significantly predicted research expenditure and income generated from licensure. The profiles were also linearly associated with the 2015 Carnegie Classification, providing convergent validity. Considering the large ratio of non-reproducible research, and the increasing societal pressure to demonstrate value, broader and more practical indicators for evaluation, as proposed, may better support improvement and attract public trust in research.