Bipolar affective disorder is a very dynamic disease, which is influenced by numerous factors. One of these factors is the age at onset. The age at onset of bipolar affective disorder may play a major role in its course, severity and number of relapses, number of hospitalizations or response to mood stabilizers. Other factors influenced by the age at onset are suicide thoughts or attempted suicide. The aim of this work is to investigate and demonstrate the effect of age of the first symptom on the course of bipolar disorder. In the framework of quantitative research, 116 respondents completed a questionnaire on the course of bipolar affective disorder. Early age at onset (≤ 19 years) correlated significantly with the longer interval between the first symptom and the visit to the doctor, the first symptom and the first diagnosis and the first symptom and the diagnosis of bipolar affective disorder. There were no statistically significant relationships between the age at onset and the number of hospitalizations or the severity of the disease. Although the effect of age at onset on the course and severity of the disease has not been proven, this area should be further explored as it may help to better management the treatment of the disorder.

Lactogenesis II is critical stage of lactation and it is hindered by conditions like caesarean section, premature delivery, obesity, age, and parity. Previous studies have shown a connection between morphological characteristics of breast and nipple-areola complex and lactation onset. Higher number of areolar glands and their non-uniform distribution has been linked to earlier onset of lactation. Extremely large breasts and short nipples has been linked to breastfeeding difficulty. Aim of this study was to investigate relationship between morphological characteristics of breast and nipple-areola complex (number and distribution of areolar glands, nipple, areola, and breast area, protrusion of nipple and areola, and contrast of breast and areola) and lactation onset. For this purpose, we collected breasts and areolae photographs of 141 mothers one day postpartum in maternity ward in Prague and compared the morphological traits to lactogenesis II onset. We have found a non-uniform distribution of areolar glands with the highest abundance on upper lateral quadrant of areola. We found that right breast area tends to be bigger than left, and left nipple and areola tends to be longer than right. Parity had significant effect on lactation onset. No morphological characteristics have been linked to...

In dieser retrospektiven Pilotstudie wurde die Aussagekraft klinischer und paraklinischer Parameter in Prä-, Peri- und früher Postnatalphase für die Diagnostik der klinischen Early-Onset Sepsis beim Neugeborenen untersucht. Der postnatal innerhalb von drei Tagen beim Kind gemessene CRP-Wert mit einem Cut-off von 10 mg/l wurde für die Differenzierung klinische Sepsis / keine Sepsis herangezogen. Die Analyse der zwei nach CRP-Werten getrennten Kollektive erfolgte hinsichtlich verschiedener Faktoren (wie z.B. Kreislauf und Laborparameter der Mutter vor der Geburt bzw. Labor – und Kreislaufparameter des Kindes bis 96 h postnatal). In der Auswertung zeigen sich signifikante Unterschiede der einzeln betrachteten Variablen. In einer Multivarianzanalyse konnten keine statistisch relevanten Differenzen bestätigt werden, daher werden weiterführende, prospektive randomisierte Studien zur Evaluation dieses Ansatzes empfohlen. Aufgrund der hohen und signifikanten Unterschiede bei Einzelbetrachtung und der sehr frühen Verfügbarkeit können die mütterlichen Parameter CRP > 12,3 mg/l und Herzfrequenz > 76,5 Schläge pro Minute sowie die unmittelbar postnatal gemessenen kindlichen Laktatwerte > 3,55 mml/l jedoch als wichtige Indikatoren zur Identifikation von Kindern mit einer Early-Onset Sepsis empfohlen werden.

Doctor Legum - LLD / Although it may seem ironic that a policy affecting so few children should engage so much political and social attention, the symbolic significance of intercountry adoption far outweighs its practical import. This fact is partly demonstrated by the polarised views on intercountry adoption, and opinions continue to be divided over the necessity and propriety of the practice. At present, there can be few who would quibble with the fact that African children are attracting an increasing attention from prospective adoptive parents living in other parts of the world. Celebrity adoptions (the adoptions of Angelina Jolie and Madonna) have contributed to this increased interest in African children. While intercountry adoption from African countries is still quite modest compared to adoptions from the top four countries of origin, there are concrete reasons to believe that interest in adoption from African countries will continue to increase. Thus, while Africa is “the new frontier” for intercountry adoption - it is highly questionable if the continent is equipped to provide its children with the necessary safeguards in respect of the practice. A central thesis of this study was to explore how the best interests of the African child can be upheld in intercountry adoption. In connection with this thesis, a number of related research questions were raised, such as: does the African context present any peculiar situations that are relevant to intercountry adoption? Does the African Children’s Charter (ACRWC) add any value to the provisions of the CRC in addressing African realities relevant for intercountry adoption? What are some of the challenges, lessons, and opportunities for the regulation of intercountry adoption on the African continent? Five themes are considered in dedicated Chapters of this study. They are the African context; the international legal framework; adoptability; the principle of subsidiarity; and illicit activities in respect of intercountry adoption. It is argued that context matters, and there are historical, cultural, social, religious, and legal contexts that are relevant for intercountry adoption in Africa. Since human rights issues are at the core of the current debate over intercountry adoption, international children’s rights law is also very crucial for the discussion. Four countries (Ethiopia, Kenya, Malawi and South Africa) are used in this study in supplementary fashion to demonstrate African countries’ experiences. The study identifies the role of various stakeholders for the promotion and protection of children’s rights in Africa in respect of intercountry adoption. It is concluded that as a predominantly sending continent, Africa’s views on intercountry adoption issues should be seriously considered and taken into account, if a socially and legally sound, and child-centred, intercountry adoption regime is to be formed on the continent. / South Africa

Speech development in autism spectrum disorder (ASD) has rarely been studied, yet residual speech sound errors are over 30 times more common in children with ASD than in the general population. Two main theories could explain this. The Social Feedback Loop proposes that toddlers with ASD vocalize less often and so have fewer opportunities to benefit from adult feedback. Thus, fewer vocalizations and perceptible differences in those vocalizations should be found in toddlers with ASD. The Speech Attunement Framework proposes that while toddlers with ASD “tune in” to their native languages well enough to acquire language normally, they lack the ability to “tune up” their articulation to the same level of precision as typically-developing children. Thus, differences in the vocalizations of toddlers with ASD may be perceptible or not, and should exist irrespective of differences in vocalization rate. This study longitudinally examines vocalization rate, consonant inventory size, and voice-onset time (VOT) in syllable-initial bilabial stops using 30-minute speech samples from toddlers in three groups: those at low risk for ASD (LRC), those at high risk for ASD with ASD themselves (HRA+), and those at high risk for ASD without ASD (HRA ) . Transient delays in consonant development were found in both HRA- and HRA+, but only HRA+ toddlers vocalized less often. Further, the relationship between vocalization rate and consonant inventory was significantly different from LRC only for HRA-. VOT development was similar across groups, except that fewer HRA+ 36-month-olds produced distinct /b/ and /p/ populations, as measured by t-test and by Cohen’s d ≥ 0.8 between mean VOTs in the two populations of stops. Results support the Speech Attunement Framework. Consonant acquisition delays are not related to differences in vocalization rate and are not found only in toddlers who develop ASD. The finding of sub-perceptual acoustic differences in stop production in toddlers who develop ASD, with no accompanying differences in production rate, also supports the Speech Attunement Framework. This suggests that the Social Feedback Loop is not diminished in ASD by lower vocalization rate, but that toddlers with ASD may have diminished ability to monitor their own speech.

Planetary science is often limited to only surface observations of planets requiring the development of modeling techniques to infer information about the planet’s interior. This work outlines three separate scientific problems that arose from planetary surface observations, the methodology utilized to explain the formation of these observation, and what we learned about the planet’s interior by solving these problems. Chapter 1 discusses why lunar mascon basins (impact basins associated with a central freeair gravity positive) form for only a limited range of basin diameters. Modeling the full formation of South-Pole Aitken (SPA) basin using a sequential two-code (hydrocode and Finite Element Model) shows that due to SPA’s great size (long wavelength) and the high geothermal gradient of the Moon at impact, the basin’s relaxation process was controlled by isostatic adjustment with minimal influence from lithospheric rigidity or membrane stresses. Additionally, the modeling shows that the Moon was hot and weak at impact. Chapter 2 addresses why there is a lack of olivine abundance on Mars around large impact basins, and the formation of the megabreccia that is associated with an orthopyroxene signature in the circum-Isidis Planitia region. Hydrocode modeling of the excavation of the Isidis forming impact shows the impact was more than capable of excavating mantle material and reproducing the observed megabreccia. This coupled with the lack of olivine signature indicates that the Martian upper mantle is orthopyroxene-rich. Chapter 3 covers the investigation into why the nitrogen ice sheet on Pluto, Sputnik Planitia, is the youngest observed terrain and why the surface is divided into irregular polygons about 20– 30 kilometers in diameter. The utilization of a new parameterized convection model enables the computation of the Rayleigh number of the nitrogen ice and shows that the nitrogen ice is vigorously convecting, making Rayleigh–Bénard convection the most likely explanation for these polygons (Trowbridge et al., 2016). Additionally, the diameter of Sputnik Planitia’s polygons and the dimensions of its ‘floating mountains’ of water ice suggest that its nitrogen ice is about five to ten kilometers thick (Trowbridge et al., 2016). The estimated convection velocity of 1.5 centimeters a year indicates a surface age of only around a million years (Trowbridge et al., 2016). The accumulation of this work is three chapters that use three separate techniques to further understand three separate planets.

The purposes of this study were to describe the characteristics of the changing male voice in 4th, 5th and 6th grade students using Cooksey's maturation stages and, to compare the age-of-onset of the male voice change in African American, White, and Hispanic male students. Participants included volunteer 4th (n = 61), 5th (n = 73), and 6th grade male students (n = 63) from 2 urban elementary schools, 5 suburban elementary schools, 1 suburban middle school and 1 urban middle school in the North Texas region. The three ethnic groups represented in this study were: African American (n = 62), White (n = 58), and Hispanic (n = 77). Results indicated that approximately 46% of 4th grade participants, 62% of 5th grade participants, and 67% of 6th grade participants were classified as changing voices. A descriptively larger percentage of African American participants were classified as changing voices than Hispanic and White participants. Also, a larger percentage of African American and Hispanic participants were descriptively classified in the more advanced stages of the voice change than White participants. Urban African American, White, and Hispanic participants had a larger percentage of males classified as changing voices than suburban African American, White, and Hispanic participants. Results of a one-way, between subjects ANOVA revealed no significant main effect for ethnicity, F (2, 51) = .42, p = .66, η2 = .02. The overall mean age-of-onset for participants in this study was approximately 11.20 years of age.

Late-onset hypogonadism (LOH) is a pathological disorder that develops in males over the age of 40 and is diagnosed upon strict criteria that requires that the individual have total serum testosterone (T) below the normal limits as well as three symptoms of sexual dysfunction. Recommended therapy for young males with hypogonadism is testosterone replacement therapy (TRT). Treatment of LOH with TRT has increased significantly in the past several years, but studies showing adverse risks associated with TRT have led to a growing concern about the safety of such a treatment. This systematic review will give an overview of the pathology of LOH, clinical diagnosis of LOH, and comorbidities associated with this dysfunction. Benefits of TRT in elderly hypogonadal men have included improvement in cardiovascular function, reduced all-cause mortality, increased sexual function, increased bone mineral density, improved body composition, increased muscle strength, improved quality of life, and improvement in metabolic parameters. However, risks associated with TRT have included infertility, worsening lipid panel parameters, polycythemia, increased risk of prostate cancer, and in some cases, increased risk of adverse cardiovascular events.

This thesis presents the work done to implement new computational tools and methods dedicated to aircraft conceptual design sizing and optimization. These tools have been exercised on different aircraft concepts in order to validate them and assess their relevance and applicability to practical cases. First, a geometry construction protocol has been developed. It is indeed essential to have a geometry description that supports the derivation of all discretizations and idealizations used by the different analysis modules (aerodynamics, weights and balance, stability and control, etc.) for which an aircraft concept is evaluated. The geometry should also be intuitive to the user, general enough to describe a wide array of morphologies and suitable for optimization. All these conditions are fulfilled by an appropriate parameterization of the geometry. In addition, a tool named CADac (Computer Aided Design aircraft) has been created in order to produce automatically a closed and consistent CAD solid model of the designs under study. The produced CAD model is easily meshable and therefore high-fidelity Computational Fluid Dynamics (CFD) computations can be performed effortlessly without need for tedious and time-consuming post-CAD geometry repair.Second, an unsteady vortex-lattice method based on TORNADO has been implemented in order to enlarge to scope of flight conditions that can be analyzed. It has been validated satisfactorily for the sudden acceleration of a flat plate as well as for the static and dynamic derivatives of the Saab 105/SK 60.Finally, a methodology has been developed to compute quickly in a semi-empirical way the buffet envelope of new aircraft geometries at the conceptual stage. The parameters that demonstrate functional sensitivity to buffet onset have been identified and their relative effect quantified. The method uses a combination of simple sweep theory and fractional change theory as well as the buffet onset of a seed aircraft or a provided generic buffet onset to estimate the buffet envelope of any target geometry. The method proves to be flexible and robust enough to predict within mainly 5% (and in any case 9%) the buffet onset for a wide variety of aircrafts, from regional turboprop to long-haul wide body or high-speed business jets.This work was done within the 6th European framework project SimSAC (Simulating Stability And Control) whose task is to create a multidisciplinary simulation environment named CEASIOM (Computerized Environment for Aircraft Synthesis and Integrated Optimization Methods), oriented toward stability and control and specially suited for aircraft conceptual design sizing and optimization. / QC 20101104 / SimSAC

Background: Cardiovascular disease (CVD) is the leading cause of death globally since the turn of the century. One major risk factor is tobacco smoking with a particular risk associated with early initiation/greater duration. Research also indicates that alcohol use can offer both risk or protective cardiovascular benefits depending on consumption characteristics (intensity, frequency, dose, type). The purpose of this study is to examine the early onset of smoking, heavy smoking, and alcohol behavior as they relate to CVD risk. Methods: Using the data from the 2019 National Survey on Drug Use and Health (N=56,136), logistic regression analysis were conducted to examine trends in heavy substance use predictive of CVD risk (Independent variables of heavy substance use: number of cigarettes smoked per day, ≤ 12 years of tobacco smoking, ≥ 5 drinks for males or ≥ 4 drinks for females on each of 5 or more days in the past 30 days; and the dependent variable - ever told by a doctor or other health care professional that you had heart condition) while controlling for sociodemographic factors. Results: Overall, 19.7% of the study population reported CVD conditions, 5.9% heavy alcohol consumption, and 4.9% early onset of smoking. Overall, the odds of having heart condition among heavy alcohol drinkers was 23.6% less than those who were not heavy alcohol drinkers (odds ratio (OR): 0.76, 95% confidence interval (CI): (0.63-0.92), 44% more among those smoked 26 or more cigarettes per day than 25 or less 1.44 (1.01-2.05), 49% more among those with early onset of smoking than none 1.49 (1.15-1.93). By age, we found that heavy alcohol consumption could be either risk factor or protective factor of heart condition or no effect on heart condition across different age groups: for aged 12-18, OR 1.69 (CI 0.69-4.16); 19-25, 0.75 (0.48-1.15), 26-29, 1.21 (0.57-2.53); 30-34, 0.80 (0.36-1.77); 35-49, 0.61 (0.40-0.93); 50-64, 1.12 (0.77-1.62); >64, 0.93 (0.57-1.52). Based on gender, CVD risk was higher in males than females, 1.22 (1.13-1.32). In terms of race, the odds of CVD risk were lower for all groups when compared with non-Hispanic White. Based on income, the odds of CVD risk were higher in high-income earners with at least a college education when compared to low-income earners with high school education or less (≥$50k vs.Conclusion: Study findings demonstrate that the association of heavy alcohol consumption related to CVD risk varied by age. For heavy tobacco smoking, early onset of tobacco smoking, being male, white race, having above high school level education, high income, and advanced age were found to be significant predictors of CVD risk. Future observational studies should be performed to determine the combined effects of heavy alcohol consumption and heavy smoking as it relates to CVD risk by other behavioral risk factors such as types of alcohol consumed (i.e, spirits vs wine) and related behaviors.