Youngest Son Research Articles

27 Our journey, our stories: The lived experiences of parents and caregivers of children with severe neurodevelopmental disorders and behavioural complexity requiring sedation

Abstract Background 40% of children with severe neurodevelopmental disorders (NDD) in British Columbia (BC) are unable to access recommended medical evaluations due to behavioural complexity (aggression/self-injury). Medical evaluations under anesthesia (EUA) are thus often required, however, difficulties in coordination result in inequities and repeated traumatic sedations. Objectives We aim to describe the experiences of parents/caregivers of children with NDD and behavioural complexity undergoing EUA at BC Children’s Hospital (BCCH). Using thematic analysis we aim to identify leverage points for action to address health inequity. Design/Methods Patient oriented research (POR) principles guided study design, with parent partners involved throughout phases of the project including identification of study area, recruitment, development of interviews, data analysis and knowledge translation. Semi-structured interviews were conducted to explore families’ experiences of EUAs. Data collected included the child’s demographics/diagnoses, their experiences of previous EUA, and facilitators and barriers towards this. Results 11 families participated in the study. Key stakeholders involved in care coordination of EUA were identified (Figure 1). An illustration was developed by a parent partner as a more accessible means of presenting families’ narratives (Figure 2), integrated within five emerging themes: 1) The cumulative physical/psychological trauma experienced by families when accessing care (represented by the river which deepens and widens over time); 2) The need for an awareness and understanding from providers of behavioural complexity (represented by child being left behind); 3) Requirement of equitable and not equal care, tailored towards specific needs (represented by the precarious raft and boat); 4) Communication being key (represented by the walky-talky and map); 5) Providers being willing to undertake the role of care coordination (represented by the rescue workers, with safety gear and a rope, representing resources and role of care coordination respectively). Details within each scene (e.g. dad holding up his younger son on his shoulders to shield him from the trauma vs mum holding the hand of her older daughter now immersed in the water due to repeated traumatic experiences with age) attempt to capture the nuanced experiences encountered by families over time. Conclusion Our results highlight the complex journey coordinating EUA for this specific population. Due to resource constraints and lack of formalised pathways, current processes are traumatic and result in missed opportunities. Next steps include advocacy by the EUA Project Group at BCCH for 1) A centralized intake process with a hospital-based coordinator role and 2) Implementation of integrated EUA algorithms and care pathways between services, to improve equitable access and minimise trauma for all involved in EUA.

Bascom Headen Palmer, Jr, MD (1889-1954)

PurposeMost ophthalmologists in the US recognize the name “Bascom Palmer” but few are familiar with the individual for whom the Eye Institute is named. This article reviews the biography of Bascom Headen Palmer, Jr., MD (1889-1954). DesignHistorical review. MethodsHistorical documents were reviewed, including the archives of the University of Miami, the Miami Lighthouse for the Blind and Visually Impaired, and other sources. ResultsPalmer, born in Lake City, FL in 1889, was the younger son of a Florida politician. He graduated from what was then called the College of Medicine of the Tulane University of Louisiana (now the Tulane University School of Medicine) in 1914, followed by a two-year internship at Touro Infirmary, service in the army during World War I, and finally a post-graduate course in ophthalmology at the University of Pennsylvania in 1923. He then moved to Miami, where he became influential in two new organizations: the University of Miami, founded in 1925, and the Florida Association of Workers for the Blind (now the Miami Lighthouse for the Blind and Visually Impaired), founded in 1930. He forged collaborations between these two organizations which eventually led to the foundation of the eponymous Eye Institute. ConclusionsThe decades-long collaboration between the Miami Lighthouse and the University of Miami, facilitated by Palmer, ultimately led to the founding of the Eye Institute.

O-275 Prenatal genetic screening to assess mtDNA disease occurrence in children

Abstract Study question Can prenatal genetic testing accurately predict mtDNA mutation load anddisease transmission to children for families affected by Leigh Syndrome? Summary answer Whole genome mtDNA sequencing for 13513G>A mutation in chorionic villi and amniotic fluid was similar to those measured in babies suggesting accuracy of disease prediction. What is known already Severity of mtDNA disease in children depends on heteroplasmy levels(proportion of mutant to wild-type mtDNA). There is a minimum threshold for the mutant mtDNA heteroplasmy (typically 60%) above which oxidative metabolism is impaired to cause disease. Predicting the disease based on the mutation load measured during embryonic or fetal development is critically needed. However, preimplantation genetics screening for many mtDNA mutations has limitations due to the potential increase in heteroplasmy levels after implantation. We hypothesized that prenatal screening of chorionic villi and/or amniotic fluid during the first trimester of pregnancy could provide more reliable diagnosis of disease occurrence in children. Study design, size, duration We evaluated mtDNA heteroplasmy in biopsies collected from chorionic villi and amniotic fluid at 10- and 16-weeks of gestation, respectively, for two consecutive, naturally conceived pregnancies for a carrier of 13513G>A mutation. Sequencing results were compared to mutations in the blood, skin, and urine of children after birth. Both children were also extensively monitored for a few years for disease occurrence. Participants/materials, setting, methods A family with maternally transmitted Leigh Syndrome including both parents and two existing children were enrolled during the initial phase. Whole mtDNA sequencing was used to confirm the maternal transmission of the mutation by analysis of blood, skin, and urine from asymptomatic parents and the older son and the severely affected younger son. Furthermore, prenatal diagnostics were performed for two consecutive pregnancies and children after birth. Main results and the role of chance The mother carried 13513G>A mutation in the skin (91% heteroplasmy), urine(39%), and blood (6.8%), while no mutation was detected in the father’s samples. The asymptomatic eldest child revealed a low mutation in the skin (14%), urine(23%), and blood (10%). While the younger son diagnosed with Leigh syndrome carried 56% mutation in blood, 86% in skin, and 97% in urine. Heteroplasmy ranging from 0.6% to 40% was also measured in 4 individual immature oocytes retrieved upon hormonal stimulation of the carrier. The family later naturally conceived 2 consecutive pregnancies and requested help with prenatal diagnostics. In the first pregnancy, mutation loads were 27.5% in chorionic villi and 29.5% in amniotic fluid. The family decided to keep the pregnancy which resulted in the birth of a healthy child with low mutations in blood (0.07%) and skin (14.5%). In the second pregnancy, prenatal diagnostics in CVS showed low mutation at 0.11%, resulting in the birth of an unaffected child with mutation loads of 1.4% in blood and 0% in skin. Limitations, reasons for caution Genetic counseling for mtDNA disease transmission is difficult due tocomplex inheritance of heteroplasmic variants for various pathogenicmutations. Inheritance and distribution of mtDNA mutations also influencedby individual family genetics. Therefore, prenatal diagnostic screeningshould be cautiously considered based on the specific circumstances for eachfamily. Wider implications of the findings Prenatal genetic diagnostics for families with mtDNA disease based on whole mtDNA sequencing by the qualified laboratory may accurately predict heteroplasmy levels and disease occurrence in children. However, careful analysis of family history and the likelihood of having low mutation load oocytes was critical for the success of our case. Trial registration number N/A

Metalinguistic Discourse in an Emerging Sign Language

In this paper, I explore metalinguistic discourse in Zinacantec Family Homesign (‘Z sign’), an emergent sign language developed by three deaf siblings and their hearing family members. In particular, I examine how metalinguistic discourse unfolds between a hearing Z signer and various members of her family—including her deaf siblings, her elderly hearing father, and her young hearing son. I do so via a close examination of several snippets of conversation in which the Z signers talk about the “right” way to sign, paying close attention to how they mobilize various semiotic devices, including manual signs, eye gaze, facial expressions, and speech. I aim to understand not only the formal components of metalinguistic discourse in Z sign but also how it functions as a form of social action in this small linguistic community. How do members of this family position themselves and others as (in)competent, (non-)authoritative signers in light of existing social divisions among them? How do they reinforce or challenge those social divisions through metalinguistic discourse? How might metalinguistic discourse contribute to the propagation of emergent linguistic norms throughout the family? I find that a recurrent device for enacting metalinguistic critique among the Z signers is the partial re-production and transformation of others’ utterances and other visible actions, manifested in a way that exploits the availability of multiple, semi-independent manual and non-manual articulators in the visual modality.

«Среди великих философов нет атеистов…»: рассуждения об опыте, знании и вере в письмах Н.О. Лосского Г.В. Флоровскому (1947–1955 гг.). Письма Н.О. Лосского Г.В. Флоровскому (1947–1955). Публикация, археографическая работа и примечания Е.В. Сердюковой

In 1946, Nikolai Onufrievich Lossky moved from France to his younger son Andrey who lived in the United States, where Lossky taught at the St. Vladimir’s Orthodox Theological Seminary for several years. His correspondence with G.V. Florovsky continued, and, as before, they are connected by their friendship, teaching activities, and, most importantly, their scientific and philosophical interests. “Is it true that Russian philosophy is not scientific?” This question became crucial for N.O. Lossky during the “overseas” period of his life and work (1947–1955). His letters sent to G.V. Florovsky from New Haven, New York, and Los Angeles testify to his interest in the concrete metaphysical foundations of holistic (intuitive) worldview, within which faith and knowledge find their indispensable places. Lossky discusses in his letters Florovsky’s upcoming move to America and the organization of teaching philosophical disciplines at the St. Vladimir’s Orthodox Theological Seminary. Furthermore, he draws Florovsky’s attention to how scientists of that time (A. Eddington, B. Bavinck, D. Jeans, M. Planck, P. Leconte du Nouy, and others) try to answer the question of the relationship between natural sciences (physics, biology, etc.) and the transcendental foundations of religious experience. In addition to this, Lossky is interested in Étienne Gilson’s “History of Medieval Philosophy” (which describes specific intellectual attempts to “reconcile” faith and knowledge) and the epistemological experience of Russian Freemasonry presented in G.V. Vernadsky’s book. And, of course, a special place in Lossky’s letters is devoted to the preparation of the book “History of Russian Philosophy” for publication in New York as part of the works series of the St. Vladimir’s Orthodox Theological Seminary.

Литовський рід Монтовтів (Монтовтів Коблинських) на Волині в XV–XVI ст.

The joint development of Lithuanian and Ukrainian lands within the Grand Duchy of Lithuania in the 14th–16th centuries fostered inter-ethnic family ties. One of such cases was the Lithuanian family of Montovt, known in Volhynia since the second half of the 15th century. The article looks at the history of the family of Montovt. The Grand Duke of Luthuania bestowed upon Mykhailo Montovtovych, a member of this family, the most important administrative office in Volhynia – starosta of Lutsk, and the latter’s descendants settled in Volhynia permanently. Jakub Montovtovych, the younger son of Mykhailo Montovovych, whilst serving as starosta of Kremenets, received for his service substantial land holdings – volost of Mlyniv together with the town of Koblyn. After the name of the town Volhynian Montovts started to be called the Montovt Koblynskies. The important status of the family of Montovt in Volhynia is evidenced not only by high offices held by some of its members, but also by matrimonial ties: the Montovts established kinship ties with several ducal families, in particular the families of Holshan, Porytsky, Lubetsky and Sokolsky. The most famous from the family of Montovt in the 16th century was Hanna Montovtivna, the daughter of Yan Yakubovich, who was the son of Yakub Mykhailovych. Hanna's destiny, which began happily, had a very sorrowful continuation. When she was 14, her father gave her in marriage to Duke Bogush Lubetsky. In her second marriage, she was the wife of Duke Vasyli Sokolsky. Altogether Hanna was married four times. After the death of her father, her stepmother and her second husband Oleksandr Semashko, trying to appropriate her inheritance, married her against her will to a cruel and uneducated man Pavel Zglychynsky, who deprived her from her property and kept her in prison for 14 years. Freed from the captivity, Hanna tried to divorce her husband, but according to the decree of Lutsk bishop, Zglychynsky only apologized to his wife and promised to treat her well henceforth. Thus, Hanna was forced to forgive him and to continue to live with him in marriage.

Wilson’s Disease Caused by Previously Undescribed Homozygous Nucleotide Variant of the <i>ATP7B</i> Gene: Clinical Cases

Wilson’s disease is severe autosomal recessive disease manifested primarily by hepatic, neurological, and psychiatric disorders due to excessive copper deposition in organs and tissues. Clinical case description. The variant with uncertain clinical value of the ATP7B gene, c.2111C>T (p.T704I, chr13:52534294G>A (HG19)), was described in the family where parents are cousins. The eldest daughter out of four children died at the age of 11 due to liver cirrhosis. Wilson’s disease was genetically confirmed in two children (clinically — abdominal form). The younger son was diagnosed heterozygous state of the disease (without any clinical manifestations). The revealed variant of the ATP7B gene was previously identified in 3 more patients with Wilson’s disease, however, in a compound heterozygous state with known pathogenic genetic variant. Conclusion. c.2111C>T (p.T704I) variant of the ATP7B gene can be considered as probably pathogenic. Further research is required to evaluate its functional significance in Wilson’s disease pathogenesis.

Maternal intake of paracetamol during pregnancy and biomarkers of male fecundity in young adult sons

Paracetamol is suggested to have endocrine disrupting properties possibly affecting fetal programming of reproductive health that might lead to impaired semen quality and changes in reproductive hormones. In this longitudinal study, we included 1058 young adult men born 1998–2000 into the Danish National Birth Cohort with follow-up at 18–21 years of age. The exposure, maternal intake of paracetamol, was modelled in three ways: dichotomized, trimester-specific, and as duration of exposure categorized into: short (1–2 weeks), medium (3–9 weeks) or long duration (>9 weeks) vs. no intake. Outcomes included semen characteristics, self-measured testis volume, and reproductive hormone levels. We used negative binominal regression to estimate the percentage difference and 95% confidence interval (CI) for each outcome. In total, 547 (48%) sons were prenatally exposed to paracetamol due to maternal intake at least once. Maternal intake of paracetamol during pregnancy was not associated with any of the biomarkers in the dichotomized or trimester-specific exposure models. For duration of exposure, sons of mothers with long duration of maternal intake of paracetamol showed tendencies towards lower semen concentration (-14% [95% CI: -31%; 8%]), a higher proportion of nonprogressive and immotile spermatozoa (8% [95% CI: -4%; 21%]) and higher DNA Fragmentation Index (16% [95% CI: -1%; 36%]) compared to son of mothers with no intake. Maternal intake of paracetamol during pregnancy was not clearly associated with biomarkers of male fecundity in adult sons. However, it cannot be ruled out that long duration of maternal intake of paracetamol might be associated with impaired semen characteristics.

The Genealogy of Play

In 1924, exactly a century ago, the world-famous children’s author Alan Milne wrote this much-loved rhyme about the play activities of his young son: Where am I going? I don’t quite know. Down to the stream where the king-cups grow-Up on the hill where the pine-trees blow-Anywhere, anywhere. I don’t know…Where am I going? The high rooks call: “It’s awful fun to be born at all”. Where am I going? The ring-doves coo: “We do have beautiful things to do”. But in 2024, in much of the Western world, allowing a young child to wander in this manner would be seen by many as dangerous, reckless and negligent. For example, in 2019, Renee Umstattd Meyer and her colleagues found that a large proportion of children in the post-industrial world did not take the recommended amount of exercise in the outdoor environment, and even where spaces were specifically made available to them, parents feared that they would be infiltrated by crime and violence. This article considers the emergent effects of significant cultural change in children’s independent and collaborative free play opportunities. It draws on an ethological and biocultural perspective to argue why independent, active free play, particularly involving peer collaboration, is so important to human development.

Maternal use of nitrosatable drugs during pregnancy and adult male reproductive health: A population-based cohort study.

Prenatal exposures to xenobiotics during the masculinization programming window are suggested to impact male fecundity later in life. Frequently used nitrosatable drugs, such as penicillins and beta2-agonists, contain amines or amides that may form teratogenic compounds in reaction with nitrite. We explored whether maternal nitrosatable drug use during gestation was associated with biomarkers of male fecundity in adulthood; moreover, the potential modifiable effect of nitrate and vitamin intake was investigated. We performed a cohort study in the Fetal Programming of Semen Quality cohort that includes semen characteristics, reproductive hormone concentrations, and measures of testis size on 1058 young adult sons in the Danish National Birth Cohort. Information on maternal use of nitrosatable drugs was obtained from questionnaires and interviews around gestational weeks 11 and 16. A multivariable negative binomial regression model was used to obtain relative differences in biomarkers of male fecundity for those whose mothers used nitrosatable drugs compared to those without such maternal use. In sub-analyses, the exposure was categorized according to nitrosatable drug type: secondary amine, tertiary amine, or amide. We investigated dose dependency by examining the number of weeks with intake and explored potential effect modification by low versus high maternal nitrate and vitamin intake from diet and nitrate concentration in drinking water. We added selection weights and imputed values of missing covariates to limit the risk of selection bias. In total, 19.6% of the study population were born of mothers with an intake of nitrosatable drugs at least once during early pregnancy. Relative differences in biomarkers related to male fecundity between exposed and unexposed participants were negligible. Imputation of missing covariates did not fundamentally alter the results. Furthermore, no sensitive subpopulations were detected. The results suggest that maternal use of nitrosatable drugs does not have a harmful influence on the male fecundity of the offspring.

Emilia Wróblewska’s diaries for children as research material on the Polish language of the 19th-century Vilnius intelligentsia

The article initiates historical, linguistic, and textological research into the rich diaristic legacy of Emilia Wróblewska, née Beniowska (1830–1886), a Polish woman from the circle of Vilnius intelligentsia, who had wrttten intimate diaries for herself and her children for almost 30 years. The subject of exploratory study are the texts of the diaries kept by Wróblewska for her son Tadeusz in the years 1859–1886, and her daughter Maria in the years 1865–1873 (with an entry for Emilia’s younger son, Augustyn, added in 1886). The paper aims at identifying the most prominent features of spelling and linguisƟtic phenomena (regarding phonetics, inflection, syntax, vocabulary, and lexis) that can be qualified as regional features typical of the North-Eastern Borderlands(Kresy) in the diarist’s Polish language. A comparative method was used in the study; the material extracted from the diaries was confronted with the usage and developmental tendencies of the standard Polish language of the 19th century.

The uneasiness of emotion and its representations in Max Porter’s Grief Is the Thing with Feathers

ABSTRACT In Max Porter’s Grief Is the Thing with Feathers (2015) a sense of crisis in a family with two young sons, brought on by the sudden death of their mother, is undisguised. What makes the novel more than a work simply about a subject as fraught as grief is its deployment of intertextual references through which Porter evokes the difficulties inherent to articulating grief and the complexity of the emotions that it encompasses. Grief Is the Thing with Feathers is a novel about the experience of grief as much as about the limitations of linguistic representation, which call to mind not only the energies of postmodern fiction but also the capaciousness of the novel form. This essay attends to the ways in which the affective force of grief is represented in Grief by looking at intertextuality as central to its expression. In other words, it is via intertextual references that the novel makes known the many forms that grief takes as it evolves. In this , the essay considers the reading experience of the active reader, particularly in terms of how the representation of emotion influences not simply a cognitive understanding of grief, but also an affective response.

Learning Our Son’s Language

In this narrative medicine essay, a pediatrician alters how she engages with and measures the developmental progress of her young son after he stops speaking.

Jokowi's Political Dynasties: Impact and its Comparison to Nehru-Gandhi Dynasties

This research focuses on the Jokowi political dynasty that is now underway. The dynasty was marked by the advancement of Jokowi's eldest son, Gibran Rakabuming, as Mayor of Solo some time ago, followed by Jokowi's son-in-law, Bobby Nasution, becoming Mayor of Medan. A few days ago, Jokowi's youngest son, Kaesang Pangarep, was predicted to run in the Depok regional election. The participation of Jokowi's son and son-in-law as regional heads establishes an unprecedented milestone in the annals of Indonesian political dynasties. Because there has never been a similar case since independence, this condition has caused various negative impacts on the Indonesian nation. It starts from opening opportunities for corruption and the difficulty of regenerating new political cadres to injuring democracy. Relatives sitting in strategic seats will perpetuate the dynasty and protect each other. Thus, it will be challenging to prioritize the people because family interests hinder it. In addition, this paper will include a review of the Nehru-Gandhi dynasty of India as a comparison. The dynasty was chosen because it has a long history that lasts for generations. This phenomenon captured Indonesian political dynasties. Carrying the type of qualitative research, this research used various literature reviews as its basis. Hopefully, this research can be the mainstay of literacy for various parties facing the upcoming 2024 political year.

PET TAC and Resting state EEG-fMRI in Evaluation of the Ability to Understand and want in Patients Affected by Dementias with Neuro-psychiatric Disorders and other Mental Disorders

Introduction: We strongly believe that RS-fMRI using independent component analysis (ICA) must be considered as a technique to be systematically used in the near future, as positron emission tomography (PET TC) is today. Unfortunately, this technique is not yet used in Italy because, despite the studies just summarized, it is considered “experimental” and not routine without reasonable justification! Aim of the Study: We present two cases studied with these techniques, after the informed consent obtained by the patients 1) A young woman from Sicily, in whom an RS-fMRI revealed her severe personality disorder, was found capable of insight and strong-willed and was therefore found guilty by the criminal court of the murder of her young son, with a strange motive: RS-fMRI cannot be considered part of the assessment because it is so far considered experimental. PET-TAC was also classified as routine in Italy after a long legal discussion. We hope that all these studies, which are now summarized in this review, will be considered useful, at least in Europe, when a judge has to decide whether to sentence a person with psychological or psychiatric problems or to consider them as a person to be treated in a specific residential home (called REMS in Italy). 2) Another woman from Bergamo, after having killed a neighbor of hers, was, instead, considered not guilty because of her inability to want to kill him, and so admitted to a particular structure (REMS: residence to execution of security measures) to treat her problem, front temporal dementia, with a severe neuropsychiatric disorder (NPS), diagnosed after the crimen was fulfilled. Conclusions: These two interesting cases demonstrate that in Italy nowadays, we do not have a homogeneous methodology to investigate the ability to understand and want, limiting the study only to personality tests. Here we describe new techniques that may help in this objective.

The Divine Role of the Diadem in Rubens’s Marie de’ Medici Cycle

Summary In the 24 paintings for the French Queen Marie de’ Medici, painted by Peter Paul Rubens 1622−1625, historic facts are depicted in the shape of mythological gods and symbols resulting in allegorical scenes. When focusing on headdress, the crowns and the wreaths rarely present a challenge in modern interpretations, but a magnificent diadem does. The grand diadem in these paintings appears to be misread in analyses today. At this point in history, the crowns and the wreaths have been transferred from divine spheres and turned into physical objects. The large diadem has not; it is still only a symbol on a goddess or for goddess-like qualities. Today, it is an easy mistake to believe that Rubens copied what he saw instead of heralding a coming fashion. Here, I suggest that it is the highest goddess Juno the Queen is personifying. Juno, a goddess for women in general, was also the saviour of the country and a special counsellor of the state. These roles are what Queen Marie took on when acting as regent for her young son, Louis XIII. By putting Juno’s diadem on Marie’s head, the divine abilities are manifested according to the allegorical language of the Baroque.

Bingo Was His Name-O

When is it okay to lie to your child? In this work of philosophical short story fiction, Peter is on the phone with his wife, who is at the veterinarian’s office with their dog, Bingo. Bingo has swollen a plastic object which is stuck in his stomach and may not pass. Their young son, Max, is frantic with concern about the family dog, however, the father is concerned about the almost $1,000 bill that will come with a potential surgery to remove the item. Peter leaves the final decision in his wife’s hands, but lies to her son and tells him they are going to do the procedure and that it will be quick and painless with a vacuum cleaner type object to pull the item out. Peter decides to stick to his lie and distract his son by offering him a soft drink as a treat.

Staying in the Family? The Role of the Vienne Kinship in Reclaiming the Neapolitan Heritage under King Charles I

Recent years of research have provided a much clearer understanding of the diplomatic relations of King Charles I. In the dynastic relations of the Angevin rulers of Hungary, the building and exploitation of kinship ties can be seen as an important tool. In this context, previous studies have completely neglected the role of Charles I’s two sisters, Beatrix and Clementia, although the former, as the wife of John II, dauphin of Vienne, and the latter, as the wife of the French king Louis X, had considerable diplomatic potential. The present study examines in more detail the network of relationships that developed through Beatrix. Beatrix is perhaps the more significant of the two sisters in part relations with Clementia were much more limited and also because attempts to recover the Neapolitan inheritance were more indirect in the relations with Clementia. This was not the case with the kinship of Vienne, through which Charles I tried to assert the interests of the Angevins of Hungary in the Neapolitan throne. The present study aims to show the role played by Beatrix’s husband, John II, lord of Tour de Pins, dauphin of Vienne, and his younger son, Humbert II, in achieving the objectives of the Angevins of Naples in Hungary.

L’antiduello, ovvero della morte di Priamo

In the vast bloodshed of the Ilioupersis, the king of Troy Priam – an old man, burdened with sufferances – faces death by the hands of Neoptolemus, Achilles’ young son. Far from the mercy shown by his father towards Priam in Iliad 24, Neoptolemus is eager to slaughter the king on the very altar of Zeus Herkeios, forsaking the protection granted to a suppliant and violating the heroic behavioural ethos. The three accounts of Priam’s death here discussed – Vergil’s Aeneid 2, Quintus of Smyrna’s Posthomerica 13, Triphiodorus’ Halosis Iliou – rather than focusing on the thematic structure of a hikesia-scene, elaborate on the motifs of a paradoxical and perverted monomachia.

Maternal pre-pregnancy BMI and reproductive health in adult sons: a study in the Danish National Birth Cohort.

Is maternal pre-pregnancy BMI associated with semen quality, testes volume, and reproductive hormone levels in sons? Maternal pre-pregnancy BMI was associated with an altered reproductive hormone profile in young adult sons, characterized by higher levels of oestradiol, LH, and free androgen index (FAI) and lower levels of sex hormone-binding globulin (SHBG) in sons born of mothers with pre-pregnancy overweight and obesity. Evidence suggests that maternal pre-pregnancy BMI may influence reproductive health later in life. Only one pilot study has investigated the association between maternal pre-pregnancy BMI and reproductive health outcomes in sons, suggesting that a high BMI was associated with impaired reproductive function in the adult sons. A population-based follow-up study of 1058 young men from the Fetal Programming of Semen Quality (FEPOS) cohort nested within the Danish National Birth Cohort (DNBC), 1998-2019, was carried out. In total, 1058 adult sons (median age 19 years, 2 months), born 1998-2000 by mothers included in the DNBC, participated in FEPOS. At a clinical examination, they provided a semen and blood sample, measured their testes volume, and had height and weight measured. Maternal pre-pregnancy BMI was obtained by self-report in early pregnancy. Semen characteristics, testes volume, and reproductive hormone levels were analysed according to maternal pre-pregnancy BMI categories and as restricted cubic splines using negative binomial and ordinary least square regression models. Mediation analyses examined potential mediation by the sons' birthweight, pubertal timing, fat mass, and BMI. Additional analyses investigated the role of paternal BMI in the potential associations between maternal BMI and reproductive health outcomes. We found no consistent associations between maternal pre-pregnancy BMI and semen characteristics or testes volume. Sons of mothers with higher pre-pregnancy BMI had higher oestradiol and lower SHBG levels, both in a dose-dependent manner. Sons of mothers with pre-pregnancy obesity (≥30 kg/m2) had higher LH levels and a higher FAI than sons born by mothers with normal pre-pregnancy BMI (18.5-24.9 kg/m2). The mediation analyses suggested that the effect of maternal pre-pregnancy BMI on higher levels of oestrogen, LH, and FAI was partly mediated by the sons' birthweight, in addition to adult fat mass and BMI measured at the clinical examination, whereas most of the effect on lower levels of SHBG was primarily mediated by the sons' own fat mass and BMI. Paternal BMI was not a strong confounder of the associations in this study. This study was based in a population-based cohort with a low prevalence of overweight and obesity in both mothers and adult sons. Some men (10%) had blood for reproductive hormone assessment drawn in the evening. While several potential confounding factors were accounted for, this study's inherent risk of residual and unmeasured confounding precludes provision of causal estimates. Therefore, caution should be given when interpreting the causal effect of maternal BMI on sons' reproductive health. Given the widespread occurrence of overweight and obesity among pregnant women, it is imperative to thoroughly examine the potential consequences for reproductive hormone levels in adult sons. The potential effects of maternal pre-pregnancy obesity on sons' reproductive hormone profile may potentially be partly avoided by the prevention of overweight and obesity in the sons. The project was funded by the Lundbeck Foundation (R170-2014-855), the Capital Region of Denmark, Medical doctor Sofus Carl Emil Friis and spouse Olga Doris Friis's Grant, Axel Muusfeldt's Foundation (2016-491), AP Møller Foundation (16-37), the Health Foundation, Dagmar Marshall's Fond, Aarhus University, Independent Research Fund Denmark (9039-00128B), and the European Union (ERC, BIOSFER, 101071773). Views and opinions expressed are, however, those of the authors only and do not necessarily reflect those of the European Union or the European Research Council. Neither the European Union nor the granting authority can be held responsible. The authors declare that they have no conflict of interest. N/A.