Thesis (M.S.)--University of Michigan, 1985.

Thesis (M.S.)--University of Michigan, 1994.

Introduction: Several factors have been observed to influence the value of newborn screening analytes (NBS) and should be adjusted for in the interpretation of blood spot samples. The thesis aimed to examine the association of NBS with 1) mode of delivery among term infants and 2) clinical subtypes (i.e., spontaneous onset of labour) of birth among preterm infants. Methods: A retrospective population-based cross-sectional study design was employed. A multivariable logistic regression model was used to examine associations between NBS and mode of delivery among term infants and subtypes among preterm infants. Results: 1) Metabolic profiles of infants born by planned cesarean delivery differ from those born by vaginal delivery following spontaneous onset of labour and 2) Metabolic profiles of preterm infants did not differ by clinical subtype. Conclusions: Our findings conclude that mode of delivery is an important covariate to consider in future modelling studies, but the inclusion of preterm birth subtypes is less compelling.

The therapeutic effect of pulmonary drug delivery systems is limited by its rapid clearance from the lungs by robust clearance mechanisms. By controlling the release of drugs, the therapeutic effect of pulmonary drug delivery systems, as well as patient convenience and compliance could be improved by reducing the number of times drugs need to be administered. In this study, two controlled pulmonary drug delivery systems for drugs of different solubilities were investigated and they were characterised for their viability as effective controlled release pulmonary drug delivery systems, particularly in areas of aerosol performance and dissolution profile. A hybrid protein-polymer controlled release pulmonary drug delivery system was developed to sustain the release of a water-soluble anti-asthma drug, cromolyn sodium (CS). Two excipients with complementary characteristics – a protein, bovine serum albumin, and a polymer, polyvinyl alcohol – were formulated together with CS via co-spray drying, with varying protein-polymer ratios and drug loadings. The hybrid particles showed promise in combining the positive attributes of each excipient, with respirable particles shown to sustain the release of CS with a fine particle fraction of 30%. Combining the two excipients was complex, with further optimisation of the hybrid formulations possible. A commercially available polymer, Soluplus® was spray-dried with a poorly-water soluble corticosteroid, beclomethasone dipropionate (BDP). The resultant respirable powders were shown to have potential for use as a controlled release pulmonary drug delivery system with up to 7-fold improvement in the amount of BDP released compared to spray-dried BDP. The spray-dried BDP-Soluplus® powders were found to be amorphous, and physically stable against re-crystallisation for up to 9 months at accelerated stress test conditions with drug loadings of up to 15 % (w/w). Although it provided a platform to compare between formulations, the USP 4 flow-through cell dissolution apparatus was found to be inadequate to accurately study the dissolution profiles of the pulmonary drug delivery systems due to the formation of a gel in the apparatus. Preliminary work on the use of a novel technique to predict the crystallisation of amorphous formulations with terahertz time-domain spectroscopy was also conducted. The system confirmed the re-crystallisation tendencies of several hybrid CS/BSA/PVA formulations. Modification to the experimental setup to probe the formulations at different relative humidities instead of temperatures could yield improved results.

The immobilization of surface-modified polyamidoamine (PAMAM) dendrimers on the cell surface introduces a novel approach for efficient and specific cellular uptake of therapeutic-carrying nanoparticles. This cell surface-nanoparticle hybridization event takes place via bioorthogonal copper-free click chemistry between a dibenzocyclooctyne (DBCO) group on the dendrimer surface and azide-capped glycans expressed on the cell membrane through metabolic incorporation of azido sugars. This particular cell-nanoparticle hybridization method can be exploited to deliver a variety of therapeutic, genetic or fluorescent payloads directly into cells. Here, this method was employed to deliver plasmid DNA, siRNA and the hydrophobic anticancer drug Camptothecin (CPT) to enhance transfection and therapeutic efficacy. Native, acetylated, and PEGylated generation 4 (G4) PAMAM dendrimers were conjugated with DBCO. When introduced to azide expressing NIH3T3 fibroblasts and HN12 cancer cells, successful surface hybridization was achieved. The physiochemical properties of PAMAM dendrimers allowed for successful hydrophobic drug encapsulation and electrostatic nucleic acid condensation.

The need for delivery grew significantly during the COVID-19 pandemic because people avoided activities in public to limit the spread of the virus. The purpose of this research was to evaluate how the pandemic influenced many individual's delivery preferences through the administration of a stated preference survey targeted at residents in the New River Valley, Virginia. Conclusions revealed from the survey show that people want more efficient and accessible delivery services. A new delivery ecosystem called Delivery as a Service (DaaS) was developed using the input from the survey, existing service-based models being widely implemented in many industries, and emerging technologies. This thesis details a framework for DaaS derived by defining major actors, characteristics, and a method to measure the effectiveness of a DaaS system. This comprehensive definition of integrated delivery services illustrates areas for future research to further optimize the DaaS system. DaaS has the potential to significantly change the current delivery ecosystem through increased delivery accessibility and efficiency. Goods can be brought to users at a faster rate and on a larger scale. Autonomous vehicle and drone delivery technologies can significantly reduce the cost while correspondingly reducing the time of delivery. DaaS is a concept that is needed for people to thrive in modern times and brings the opportunity to provide added benefits to even rural areas. / Master of Science / The need for delivery grew significantly during the COVID-19 pandemic because people avoided activities in public to limit the spread of the virus. The purpose of this research was to evaluate how the pandemic influenced many individual's delivery preferences through the administration of a stated preference survey targeted at residents in the New River Valley, Virginia. Conclusions revealed from the survey show that people want more efficient and accessible delivery services. A new delivery ecosystem called Delivery as a Service (DaaS) was developed using the input from the survey, existing service-based models being widely implemented in many industries, and emerging technologies. This thesis details a framework for DaaS derived by defining major actors, characteristics, and a method to measure the effectiveness of a DaaS system. This comprehensive definition of integrated delivery services illustrates areas for future research to further optimize the DaaS system. DaaS has the potential to significantly change the current delivery ecosystem through increased delivery accessibility and efficiency. Goods can be brought to users at a faster rate and on a larger scale. Autonomous vehicle and drone delivery technologies can significantly reduce the cost while correspondingly reducing the time of delivery. DaaS is a concept that is needed for people to thrive in modern times and brings the opportunity to provide added benefits to even rural areas.

This research explores a higher order of fast tracking, called Flash Tracking, in response to increasing calls for faster, more reliable project deliveries. Flash Tracking is defined as a time-driven project, which by necessity requires a heightened degree of concurrency between engineering, procurement, and construction. In contrast to fast tracking, which entails a level of concurrency between engineering, procurement, and construction that has become a staple of the construction industry, Flash Tracking extends the envelope by requiring a series of innovative practices across the project delivery spectrum. The specific research questions pursued include: 1) identifying which innovative improvements in project delivery methodology could be made to compress project durations, while maintaining safety, quality, and risk tolerance, and 2) addressing how project teams can best overcome barriers to delivering shorter project durations. A multi-method research project was undertaken to address these questions, which entailed an extensive review of the literature, structured case study interviews, and multiple group decision-making exercises. The literature review focused on the construction industry, as well as manufacturing, shipbuilding, and software development, to identify practices and techniques potentially relevant to Flash Tracking that could be extended to the construction industry. Group decision-making exercises included a modified Delphi method study, an Analytic Hierarchy Process, and a series of research charrettes or focus groups. These studies produced a prioritized, two-tiered listing of 47 essential Flash Track practices, providing practitioners with both a measure to assess their readiness for undertaking a Flash Track project and strategies for increasing their readiness. A subsequent study--a semantic network analysis--refined and buttressed the research team’s earlier findings. This two-year study, conducted in concert with industry experts, led to a re-engineered engineering, procurement, and construction (EPC) model which embraces relational contract strategies, improved communications, and the early engagement of key stakeholders.

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ABSTRACT BACKGROUND: Breastfeeding is important to children’s health and development in early years. It may also have implications for health in later life as it has been associated with some chronic non-communicable diseases including hypertension, obesity, diabetes, hypercholesterolemia, and cardiovascular diseases. The prevalence of exclusive breastfeeding in the United States is estimated to be approximately 44% for a 3-month period and 24% for a 6-month period (CDC, 2008). There are many factors that influence whether or not a mother will be successful in exclusive breastfeeding, and one factor that has been identified with the success of this is delivery method. OBJECTIVE: The purpose of this study was to determine whether or not infant delivery method is associated with exclusive breastfeeding. Additionally, other environmental and personal factors examined included: intent, infant-to-breast within two hours of birth, as well as maternal race, parity, and age. METHODOLOGY: Data were obtained from the Wellstar Kennestone Hospital Lactation Department through an agreement. The information was extracted from the patients’ medical charts between March, 2011 and March, 2013 by nurses in the lactation department. Descriptive statistical tests and univariate and multivariate logistic regression analyses were conducted to examine associations between delivery method and exclusive breastfeeding with analytic consideration given to significant environmental and personal maternal characteristics. RESULTS: There was a statistically significant association between delivery method and exclusive breastfeeding (OR= .510, 95% CI= .375-.695) after adjusting for intent, whether or not baby was put to the breast within two hours of birth, maternal race, parity, and maternal age. Mothers who delivered via cesarean section were .510 times as likely to be exclusively breastfeeding at the time of hospital discharge when compared to mothers who delivered vaginally. CONCLUSION: The results of this study indicate that there is a significant association between delivery method and exclusive breastfeeding, in that vaginally delivered babies were more likely to be exclusively breastfeeding compared to babies delivered via cesarean section. This result is consistent with other research, and it further supports recommendations for healthcare professionals to promote breastfeeding for the first six months of life. As aligned with the Baby-Friendly Hospital Initiative and WHO goals, exclusive breastfeeding should be thoroughly encouraged in addition to promoting natural (vaginal) birth options whenever possible. Further research regarding post-partum factors for both types of delivery that can lead to higher rates of exclusive breastfeeding is warranted.

published_or_final_version / Nursing Studies / Master / Master of Nursing