A review of herbal and pharmaceutical galactagogues for breast-feeding

Background: Therapeutic approaches to addressing insufficient lactation are available but remain poorly understood. Current trends in maternal health, such as increasing rates of obesity, delayed age at childbearing, and high rates of cesarean section, may be associated with physiological challenges for lactation that cannot be managed by counseling alone. Women who have not had success with counseling alone, including adoptive mothers seeking to induce lactation, may use galactagogues (pharmaceutical and herbal compounds used to increase lactation). We present a review of selected studies of galactagogues and data indicating popular demand for such products. Methods: A systematic search was conducted for published studies on the use of galactagogues for breast-feeding. The following databases were searched: MEDLINE (PubMed), EBSCO (Academic Search Complete), and EMBASE. The search was conducted between July 15, 2015, and August 18, 2015; only English language articles were included, and we imposed no restrictions on publication date. Two authors independently reviewed the studies and extracted data. Results: Blinded, placebo-controlled clinical trials of 2 pharmaceutical galactagogues (domperidone and metoclopramide) and 5 popular herbal galactagogues (shatavari, fenugreek, silymarin, garlic, and malunggay) were identified. All of the studies identified for domperidone showed a significant difference in milk production between the treatment and placebo groups. Of the 6 trials of metoclopramide, only 1 study showed a significant difference in milk production compared to placebo. Results of the clinical trials on herbal galactagogues were mixed. Our review of the evidence for the efficacy of popular pharmaceutical and herbal galactagogues revealed a dearth of high-quality clinical trials and mixed results. Conclusion: Health providers face the challenge of prescribing or recommending galactagogues without the benefit of robust evidence. Given the suboptimal rates of exclusive breast-feeding worldwide and the availability and demand for medical and herbal lactation therapies, controlled trials and analyses investigating these medicines are urgently warranted

Fossil fuels in a trillion tonne world.

The useful energy services and energy density value of fossil carbon fuels could be retained for longer timescales into the future if their combustion is balanced by CO2 recapture and storage. We assess the global balance between fossil carbon supply and the sufficiency (size) and capability (technology, security) of candidate carbon stores. A hierarchy of value for extraction-to-storage pairings is proposed, which is augmented by classification of CO2 containment as temporary (100,000 yr). Using temporary stores is inefficient and defers an intergenerational problem. Permanent storage capacity is adequate to technically match current fossil fuel reserves. However, rates of storage creation cannot balance current and expected rates of fossil fuel extraction and CO2 consequences. Extraction of conventional natural gas is uniquely holistic because it creates the capacity to re-inject an equivalent tonnage of carbon for storage into the same reservoir and can re-use gas-extraction infrastructure for storage. By contrast, balancing the extraction of coal, oil, biomass and unconventional fossil fuels requires the engineering and validation of additional carbon storage. Such storage is, so far, unproven in sufficiency

Investigating atmospheric corrosion behavior of carbon steel in coastal regions of Mauritius using Raman Spectroscopy

Low carbon steel was exposed at two sites in Mauritius, namely Port Louis and Belle Mare. The site at Port Louis is basically an industrial marine one whereas the one at Belle Mare is a purely marine site. Though the corrosion loss trend at both sites follow the power law, the corrosion loss at Port Louis was found to be higher than that at Belle Mare. This study has been performed to investigate the surface characteristics of the rust layers of the samples exposed at the two sites, through Raman spectroscopy and SEM, so as to get a better insight into the mechanism of the atmospheric corrosion process. For Port Louis, it was observed that there was not much change in the corrosion products in the rust layer over the 3 years period. The structure was less compact than that at Belle Mare with the presence of lepidocrocite and akaganeite as commonly observed corrosion products. The corrosion rate at Port Louis is, therefore, expected to follow the same trend over the long term. For Belle Mare, the corrosion products changed significantly after 3 years of exposure. Though lepidocrocite and akaganeite were observed on the surface after 0.2 years of exposure, magnetite was the most probable corrosion product in the more compact rust layer after 3 years of exposure. This compactness of the rust layer is expected to have reduced the corrosion rate as compared to that of Port Louis. Significant changes in the corrosion rate at Belle Mare are, therefore, expected over the medium and the long term

Have We Overestimated Saline Aquifer CO

During future, large scale CO2 geological storage in saline aquifers, fluid pressure is expected to rise as a consequence of CO2 injection, but the pressure build up will have to stay below specified values to ensure a safe and long term containment of the CO2 in the storage site. The pressure build up is the result of two different effects. The first effect is a local overpressure around the injectors, which is due to the high CO2 velocities around the injectors, and which can be mitigated by adding CO2 injectors. The second effect is a regional scale pressure build up that will take place if the storage aquifer is closed or if the formation water that flows away from the pressurised area is not large enough to compensate volumetrically the CO2 injection. This second effect cannot be mitigated by adding additional injectors. In the first section of this paper, we review some major global and regional assessments of CO2 storage capacities in deep saline aquifers, in term of mass and storage efficiency. These storage capacities are primarily based on a volumetric approach: storage capacity is the volumetric sum of the CO2 that can be stored through various trapping mechanisms. We then discuss in Section 2 storage efficiencies derived from a pressure build up approach, as stated in the CO2STORE final report (Chadwick A. et al. (eds) (2008) Best Practice for the Storage of CO2 in Saline Aquifers, Observations and Guidelines from the SACS and CO2STORE Projects, Keyworth, Nottingham, BGS Occasional Publication No. 14) and detailed by Van der Meer and Egberts (van der Meer L.G.H., Egberts P.J.P. (2008) A General Method for Calculating Subsurface CO2 Storage Capacity, OTC Paper 19309, presented at the OTC Conference held in Houston, Texas, USA, 5-8 May). A quantitative range of such storage efficiency is presented, based on a review of orders of magnitudes of pore and water compressibilities and allowable pressure increase. To illustrate the relevance of this approach, it is applied to the Utsira aquifer in the North Sea. In Sections 3 and 4, we discuss possible effects that may lead to higher or lower CO2 storage efficiencies. Water production appears to be an attractive strategy in order to address regional scale pressure build up and, consequently, to increase the storage capacity. Following these quantitative applications, we recommend to evaluate the CO2 storage capacities of an aquifer, during a screening study for ranking purposes, using a pressure and compressibility formula rather than a volumetric approach, in order to avoid large overestimation of the aquifer storage capacity. Further studies are naturally required to validate the storage capacities at a qualification stage

Health provider experiences with galactagogues to support breastfeeding: a cross-sectional survey

Alessandra N Bazzano,1 Lisa Littrell,1 Amelia Brandt,1 Shelley Thibeau,2 Kamala Thriemer,3 Katherine P Theall1 1Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 2Ochsner Health System, New Orleans, LA, USA; 3MLT EpiConsult, Jingili, NT, Australia Background: Exclusive breastfeeding for infants up to 6 months is widely recommended, yet breastfeeding rates are relatively low in the US. The most common reason women stop breastfeeding early is a perceived insufficiency of milk. Galactagogues are herbal and pharmaceutical products that can help increase milk supply; however, data on their efficacy and safety is limited. Lactation consultants, obstetricians, and other health providers are an important point of contact for breastfeeding women experiencing challenges with lactation. This study explored providers’ perceptions, experiences, and practices in relation to galactagogue recommendation. Method: A cross-sectional survey was conducted among a convenience sample of English-speaking health providers in the US who counsel breastfeeding women and their infants. Results: More than 70% of respondents reported to recommend galactagogues. The most frequently recommended galactagogue was fenugreek with respondents indicating that they recommend it either ‘always’ (8.5%) or ‘most of the time’ (14.9%) and ‘sometimes’ (46.8%). More than 80% of the respondents indicated that galactagogues were useful for their clients and only one-third reported side effects. Reasons for refraining from recommending galactagogues were insufficient evidence of its efficacy and safety. Respondents reported a wide variety of sources of information used for their own education about galactagogues. Discussion: Despite little evidence regarding safety and efficacy, some galactagogues are widely recommended and often perceived to be useful. However, concerns about their efficacy and safety remain. In order to assure both providers and users about safety and efficacy, more robust studies as well as better pharmacovigilance systems are needed. Keywords: lactation, human milk, nutrition, clinical decision making, lactogenesi

Maternal experiences with and sources of information on galactagogues to support lactation: a cross-sectional study

Alessandra N Bazzano,1 Lauren Cenac,1 Amelia J Brandt,1 Josephine Barnett,2 Shelley Thibeau,3 Katherine P Theall1 1Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 2City University of New York, CUNY Graduate Center, New York, NY, 3Ochsner Clinic Foundation, New Orleans, LA, USA Abstract: An increase in the marketing and use of herbal galactagogues among breastfeeding mothers in the US has raised the issue of how best to provide support and information on the use of these products, particularly in light of limited availability of certified lactation counselors and continued suboptimal rates of breastfeeding globally. Currently, no cross-sectional data are available on the experiences and attitudes of mothers regarding the use of herbal and pharmaceutical galactagogues for lactation in the US. The findings of an online survey of 188 breastfeeding mothers on experiences with and sources of information on galactagogues are presented. Most mothers (76%) reported that while breastfeeding, they felt as though they were not making enough milk to meet the needs of their child, and yet 54% also indicated that they had not supplemented with formula. A large proportion of respondents reported utilizing galactagogues to increase lactation and finding them useful. The results indicated that most women learned about galactagogues from the Internet or by word of mouth through friends. Lactation consultants were the third-most reported sources of information on these products. While many respondents reported perceiving galactagogues as innocuous, more evidence on safety and efficacy is needed to support women properly who seek out and use them. Large-scale studies of the prevalence of galactagogue use in the US and rigorous evaluation of use globally are needed to ensure that mothers who choose to breastfeed may safely avail themselves of all options when counseling support is insufficient. Keywords: galactagogue, breastfeeding, lactation, lactation suppor

A regional CO 2 containment assessment of the northern Utsira Formation seal and overburden, northern North Sea

Upscaling Carbon Capture and Storage requires identification of suitable storage sites, with robust reservoir seals. The Utsira Formation in the northern North Sea has been flagged as a target for further storage. However, there are no regional studies of seal variability addressing heterogeneities that could facilitate seal bypass. This study aims to: (a) identify, assess and map the elements that promote or restrict fluid migration, (b) develop a matrix to regionally map containment confidence (CC) and (c) rank the different areas for CO2 containment across the Utsira Formation. The seal and overburden were mapped using a high‐resolution, pre‐stack depth‐migrated 3D broadband seismic reflection dataset and 141 exploration wells. Seal geometry, sandstone presence and sandstone connectivity in the seal and overburden were assigned relative CC scores, which were summed to map overall CC of the Utsira Fm. Indicators for shallow gas and migration were mapped and correlated with the other elements. Areas with the lowest CC are in the west of the Utsira Fm. Here, sandstones within the Seal Interval are connected through the overburden via sandy submarine fans. In the southeast, dipping stratigraphy downlaps onto the Utsira Fm., increasing the potential for connection with glacially‐derived channel‐lobe systems in the overburden. The areas with the highest CC are the central and northeast parts of the Utsira Fm., where the Seal Interval is mudstone‐dominated and parallel to the reservoir, and channel‐lobe systems identified in the Overburden Interval are disconnected from the reservoir. This area coincides with a thick depocentre of the northern Utsira Fm. These results can be used to inform CO2 storage site selection and constrain future CO2 plume simulation analyses for the Utsira Fm. The CC matrix outlined here can also be adapted and applied to regionally assess the containment of other potential CO2 storage reservoirs in any setting

Relationships of Maternal Stress with Milk Immune Components in African American Mothers of Healthy Term Infants

Background: In the United States, African American infants experience the highest mortality, and their mothers report the lowest breastfeeding rates. Science reports decreased infant mortality among breastfed infants and suggests that milk immune component (MIC) levels are associated with maternal stressors. Little is known about these relationships among African Americans; therefore the aim was to explore the relationships of African American mothers\u27 stressors and MICs 1–14 days postdelivery. Materials and Methods: Mothers meeting eligibility requirements were approached for consent 48–72 hours postdelivery of a healthy term infant and given instructions to collect milk (Days 3, 9, and 14) and saliva (Day 9), as well as complete three Perceived Stress Scale questionnaires (Days 3, 9, and 14) and a survey of pregnancy stressors experiences. Pearson correlations and linear regressions were performed to assess the relationships of maternal stressors with MICs. Results: There was at least one statistically significant correlation of a maternal stressor with nine of the 10 MICs (effect sizes ranging from r = 0.22 to 0.38) on Days 3 and 9. Of all MICs, epidermal growth factor had the most associations with maternal stress indicators. No mediational relationship of cortisol with MICs was observed. Conclusions: Many of the MIC changes observed could potentially impact the health of term and preterm infants. Further research is warranted