A simple function for maternal-age-specific rates of Down syndrome in the 20-to-49-year age range and its biological implications.

The familial increase in the rate of Down syndrome with maternal age can be represented by a simple equation, consisting of the sum of a constant term plus an exponential term that is a first-order function of masternal age: y = a + exp (b + cx), where y is the rate in live births, x is maternal age, and a, b, and c are constants. Unlikely analyses in which two separate equations were derived from different segments of the 20 to 49 maternal age range, this single, simple equation can be applied to the entire range. An unlike previous complex equations that were derived by regression analysis for the entire age range, the component terms can be readily understood as contributions by different etiologic categories. This model fits the data recently available by 1-year intervals about as well as the approach that used separate equations, but it has fewer parameters and requires no ad hoc division of the age range. However, it does not postulate a sharp transition in biological processes around maternal age 30, but, rather, a process continuously accumulating at a constant exponential rate (analogous to that produced by an infectious mechanism), superimposed upon a constant background rate.     

Differences in maternal age-specific rates of Down syndrome between Jews of European origin and of North African or Asian origin.

Rates of Down syndrome in livebirths in West Jerusalem in 1964-1975 were studied in relation to the mother's continent of birth or, if she was born in Israel, to the maternal grandfather's continent of birth. In women of European origin the crude livebirth rate of Down syndrome was 1.3 per 1,000 livebirths. This crude rate and the maternal age-specific rates in this group were very close to those observed in a Swedish study and two studies of white livebirths in the United States. For West Jerusalem women of North African or Asian origin the crude rate was about 2.4 per 1,000 livebirths, and at all maternal ages except the youngest their rates were higher than for women of European origin. The summary adjusted relative risk for a Down syndrome livebirth for all those of North African or Asian origin, compared to those for women of European origin, was about 1.56. If attention is restricted to mothers born outside of Israel, the adjusted relative risk for mothers born in Europe, the Americas or English speaking countries of the British commonwealth compared to those born in North Africa or Asia was 1.97, consistent with a two-fold difference in the likelihood of a Down syndrome livebirth between thes two groups. To our knowledge this is the first report of ethnic differences in maternal age specific rates of Down syndrome that cannot be plausibly explained by differences in ascertainment.     

异育银鲫体内盐酸双氟沙星血浆蛋白结合率的变化与其药代动力学研究

为了研究盐酸双氟沙星(difloxacin, DIF)在异育银鲫体内血浆蛋白结合率的变化及其与药代动力学之间的关系, 实验采用超滤法测定了DIF在异育银鲫体内血浆蛋白结合率, 运用HPLC测定其对应时间点药物浓度, 并分析了血浆蛋白结合率变化对DIF体内处置的影响。实验以感染嗜水气单胞菌的异育银鲫为感染组, 健康异育银鲫为对照组。结果显示: 感染组各时间点DIF血浆蛋白结合率均高于对照组, 感染组与对照组DIF血浆蛋白结合率与总药物浓度呈对数关系: y=-9.01ln x+74.34和y=-4.81ln x+65.15, DIF血浆蛋白结合率与游离药物浓度的对数关系式分别为: y=-6.36ln x+64.91和y=-4.36ln x+ 60.63; 感染组和对照组血浆药时曲线均可使用开放性二室模型描述; 感染组DIF的吸收和消除慢于对照组, 其表观分布容积和曲线下面积大于对照组。结果显示异育银鲫体内感染嗜水气单胞菌促使DIF血浆蛋白结合率升高; 血浆蛋白结合率升高导致药物以结合药物的形式储存于血液中可能是导致药物组织分布受限、消除缓慢、长时间滞留于血液原因之一。     

Epidemiology of Down syndrome in South Australia, 1960-89.

During 1960-89 687 Down syndrome live births and 46 Down syndrome pregnancy terminations were identified in South Australia. Ascertainment was estimated to be virtually complete. The sex distribution of Down syndrome live births was found to be statistically different from the non-Down syndrome live-birth sex distribution (P less than .01). Smoothed maternal age-specific incidence was derived using both maternal age calculated to the nearest month and a discontinuous-slope regression model. The incidence of Down syndrome at birth for the study period was estimated to be 1.186 Down syndrome births/1,000 live births. Annual population incidence was shown to be correlated with trends in the maternal age distribution of confinements. If current trends in the maternal age distribution of confinements continue, the population incidence of Down syndrome in South Australia is predicted to exceed 1.5 Down syndrome births/1,000 live births during the 1990-94 quinquennium.     

The natural history of Down syndrome conceptuses diagnosed prenatally that are not electively terminated.

The pregnancy outcomes on cases of Down syndrome diagnosed prenatally in which the mother did not elect termination were evaluated in data reported to a comprehensive Register of Down syndrome for England and Wales for 1989-94. In the 168 cases in which placental biopsy was not used, the overall rate of spontaneous loss was 35%, but this figure masks considerable heterogeneity by gestational stage at ascertainment. Data on ages at diagnostic procedure and on pregnancy termination enabled a more precise survival analysis. The loss rates were approximately 50% for those fetuses ascertained at 15-17 completed wk, 43% at 18 wk, 31% at 19 wk, 25% at 20 wk, and then a leveling off at approximately 20%-25% for fetuses ascertained at 21-28 completed wk. For fetuses ascertained prior to 18 wk, there was no evidence that maternal age was associated with fetal loss, consistent with earlier reports. At 18 wk and after, however, maternal age was on the average approximately 3 years greater in fetuses that were lost. Comparison of successive gestational birth cohorts provided no evidence in these 168 cases that the diagnostic procedure itself had any effect on loss or that selective ascertainment of mothers in risk of loss had any effect on the results. In contrast, in the 21 cases in which placental biopsy had been undertaken, the overall loss rates were not only higher when appropriate comparisons could be made, but there was some evidence for selective ascertainment and/or procedure-associated losses.(ABSTRACT TRUNCATED AT 250 WORDS)     

母亲年龄对中国双生子出生率的影响

选用全国人口普查时登报的 1 989年 1月 1日至 1 2月 31日期间中国育龄妇女 ( 1 5— 49岁 )的生产记录 ,用 Weinberg差别法进行双生子卵性分类 ,分析了中国总体、DZ和 MZ双生子出生率与母亲年龄之间的关系以及双生子的出生性别比。结果表明 ,中国总体、 DZ和 MZ双生子的出生率分别为 0 .787± 0 .0 0 2 % ,0 .573± 0 .0 0 2 %和 0 .2 1 4± 0 .0 0 1 % ,DZ双生子出生率在 33岁前随母亲年龄增高单调上升 ,随后下降 ,但在 46岁后又随龄上升 ,MZ双生子出生率在 34岁前相对恒定 ,随后随龄上升。中国双生子出生性别比显著性低于同期群体出生性别比 ,1 5— 1 9岁和 45— 49岁年龄组出生的双生子性别比低于其它年龄组出生的双生子性别比 ,1 5— 1 9岁和 45— 49岁年龄组出生的双生子性别比较低可能是较低的 MZ双生子出生性别比造成的。     

Prenatal diagnosis, pregnancy terminations and prevalence of Down syndrome in Atlanta

BACKGROUND: The impact of prenatal diagnosis on the live birth prevalence of Down syndrome (trisomy 21) has been described. This study examines the prevalence of Down syndrome before (1990-1993) and after inclusion of prenatally diagnosed cases (1994-1999) in a population-based registry of birth defects in metropolitan Atlanta. METHODS: We identified infants and spontaneous fetal deaths with Down syndrome (n = 387), and pregnancies electively terminated after a prenatal diagnosis of Down syndrome (n = 139) from 1990 to 1999 among residents of metropolitan Atlanta from a population-based registry of birth defects, the Metropolitan Atlanta Congenital Defects Program (MACDP). Only diagnoses of full trisomy 21 were included. Denominator information on live births was derived from State of Georgia birth certificate data. We compared the prevalence of Down syndrome by calendar period (1990-1993, 1994-1999), maternal age (<35 years, 35+ years), and race/ethnicity (White, Black, other), using chi-square and Fisher's exact tests. RESULTS: During the period when case ascertainment was based only on hospitals (1990-1993), the prevalence of Down syndrome was 8.4 per 10,000 live births when pregnancy terminations were excluded and 8.8 per 10,000 when terminations were included. When case ascertainment also included perinatal offices (1994-1999), the prevalence of Down syndrome was 10.1 per 10,000 when terminations were excluded and 15.3 when terminations were included. During 1990-1993, the prevalence of Down syndrome was 24.7 per 10,000 among offspring to women 35+ years of age compared to 6.8 per 10,000 among offspring to women <35 years of age (rate ratio [RR] = 3.65, 95% confidence interval [CI] = 2.53-5.28). During 1994-1999, the prevalence of Down syndrome was 55.3 per 10,000 among offspring to women 35+ years compared to 8.5 per 10,000 among offspring to women <35 years (RR = 6.55, 95% CI = 5.36-7.99). There was no statistically significant variation in the prevalence of Down syndrome by race/ethnicity within maternal age and period of birth strata. During 1994-1999, the proportion of cases that were electively terminated was greater for women 35+ years compared to women <35 years (RR = 5.10, 95% CI = 3.14-8.28), and lower for Blacks compared to Whites among women 35+ years of age (RR = 0.33, 95% CI = 0.16-0.66). CONCLUSIONS: In recent years, perinatal offices have become an important source of cases of Down syndrome for MACDP, contributing at least 34% of cases among pregnancies in women 35+ years of age. Variation in the prevalence of Down syndrome by race/ethnicity, before or after inclusion of cases ascertained from perinatal offices, was not statistically significant. Among Down syndrome pregnancies in mothers 35+ years we found a lower proportion of elective termination among Black women compared to White women. We suggest that future reports on the prevalence of Down syndrome by race/ethnicity take into account possible variations in the frequency of prenatal diagnosis or elective termination by race/ethnicity.     

Urinary analyte screening: a noninvasive detection method for Down syndrome?

Prenatal screening for Down syndrome using maternal serum markers achieves detection rates of 60-80% with a 5% false positive rate. Improvement in the accuracy of screening, as well as its ease and safety, will increase the use of such tests. The most effective of the current serum markers is human chorionic gonadotropin (hCG). Studies on beta core fragment (beta CF), the major urinary metabolite of hCG, have indicated that screening with beta CF and other markers measured in maternal urine might improve the detection of Down syndrome and provide a less expensive and simpler test. However, recent results have been unusually variable. Although it has great potential, the true clinical value of maternal urine screening to detect Down syndrome still remains to be determined.     

Spontaneous abortion and subsequent Down syndrome livebirth

Summary Analyses of two data sets are presented, one based on nationwide hospital discharges for the USA for 1970–1971, the other for Upstate New York vital record data for 1976–1981. Summary relative risks of a Down syndrome livebirth were calculated within the three maternal age categories below 20, 20–29, and 30 years and above for those with a history of one spontaneous abortion and for those with a history of two or more, compared to those with no reported previous abortions. There was significant heterogeneity by age and reproductive history in the relative risk of an affected child. In general the trends revealed that the younger the mother and the more the number of abortions, the higher the relative risk of a Down syndrome livebirth compared to the rates for women of the same age for those with no previous abortions. Extrapolation from average maternal age specific rates on Down syndrome imply a rate per 1000 livebirths somewhere in the range of 1.1 to 11.4 for women under 20 years with a history of one spontaneous abortion, of 5.2 to 13.4 for women under 20 years with a history of two or more spontaneous abortions, and of 1.0 to 2.4 for women 20 to 29 years with a history of two or more spontaneous abortions. (Average background livebirth rates in women under 30 years are, in contrast, in the range of about 0.5 to 1.0 per 1000 and for the average woman aged 35 years, at which prenatal diagnosis is usually felt to be indicated, 2.7 per 1000.) For those in the other categories these data did not reveal clinically significant effects upon average maternal age specific rates. It is emphasized that because of limitations in the data it is not possible to refine these risks by adjusting for karyotype, the age at which the abortions occurred, or other biologic and social factors associated with embryonic and fetal death. The implications of the analyses here for genetic counseling should be regarded as preliminary and tentative.     

Down syndrome in British Columbia, 1952-73: incidence and mean maternal age.

Records of children with Down syndrome (DS) at the BC Health Surveillance Registry were linked to their Birth Registrations to derive maternal ages. Incidence and maternal-age specific rates were calculated for 1952-73. Mean maternal age has declined both for normal and DS children, the latter to a marked degree, so that in 1972-73 80% were born to women under 35 years. Using maternal age of 40 and over as an indication for amniocentesis would only detect 10% of DS children. The crude incidence rate (mean 1.28/1000 livebirths) has not changed appreciably over the study period except for 1969 in which a statistically significant peak occurred. The standarized rate showed an increasing trend but it is not clear whether this was a true biological increase or resulted from better ascertainment.     

Down syndrome rates and relaxed selection at older maternal ages.

Preferential survival in older mothers of fetuses with Down syndrome has been proposed as contributing to the maternal-age effect of this condition. If correct, this provocative hypothesis, which may be termed "relaxed selection," has major implications for approaches to prevention of Down syndrome live births in older women. Several predictions of this hypothesis are examined here by comparisons of parental ages among various populations. These revealed that: (1) mean maternal age of Down syndrome live births is slightly lower than that of Down syndrome spontaneous fetal deaths; (2) mean maternal age of those with mutant D/21 translocation Down syndrome is about the same as that of controls; (3) the ages of Down syndrome mothers who have Down syndrome live births is slightly lower than ages of Down syndrome mothers who have unaffected live births; and (4) in recent data on 47, +21 cases in which the extra chromosome 21 is of paternal origin, the mean maternal ages are 4-5 years lower than the maternal ages of cases of maternal origin (in contrast to earlier reports). All of these observations are contrary to the hypothesis that relaxed selection contributes significantly to the maternal-age association of Down syndrome. If there is any effect of relaxed selection, it is likely to be very weak and/or act primarily upon abortions that occur before recognition of pregnancy.     

Lack of maternal folic acid supplementation is associated with heart defects in Down syndrome: a report from the National Down Syndrome Project

BACKGROUND: Maternal folic acid supplementation has been associated with a reduced risk for neural tube defects and may be associated with a reduced risk for congenital heart defects and other birth defects. Individuals with Down syndrome are at high risk for congenital heart defects and have been shown to have abnormal folate metabolism. METHODS: As part of the population‐based case‐control National Down Syndrome Project, 1011 mothers of infants with Down syndrome reported their use of supplements containing folic acid. These data were used to determine whether a lack of periconceptional maternal folic acid supplementation is associated with congenital heart defects in Down syndrome. We used logistic regression to test the relationship between maternal folic acid supplementation and the frequency of specific heart defects correcting for maternal race or ethnicity, proband sex, maternal use of alcohol and cigarettes, and maternal age at conception. RESULTS: Lack of maternal folic acid supplementation was more frequent among infants with Down syndrome and atrioventricular septal defects (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.08–2.63; p = 0.011) or atrial septal defects (OR, 1.69; 95% CI, 1.11–2.58; p = 0.007) than among infants with Down syndrome and no heart defect. Preliminary evidence suggests that the patterns of association differ by race or ethnicity and sex of the proband. There was no statistically significant association with ventricular septal defects (OR, 1.26; 95% CI, 0.85–1.87; p = 0.124). CONCLUSIONS: Our results suggest that lack of maternal folic acid supplementation is associated with septal defects in infants with Down syndrome. Birth Defects Research (Part A), 2011. © 2011 Wiley‐Liss, Inc.     

Maternal cigarette smoking, Down syndrome in live births, and infant race.

Previous studies have suggested that maternal smoking is negatively associated with a Down syndrome live birth. We analyzed the data of the U.S. Perinatal Collaborative Study in a search for racial variation in Down syndrome risk factors. There were 22 cases in 25,346 live births to smoking mothers (4/10,780 blacks, 18/13,320 whites, and 0/1,246 other races) and 42/29,130 live births to nonsmoking mothers (24/14,665 blacks, 14/11,694 whites, and 4/2,771 others). The crude overall rates per 1,000 live births were 0.4 in black smokers and 1.6 in black nonsmokers but 1.4 in white smokers and 1.2 in white non-smokers. Adjusted for maternal age, the summary relative risk for a Down syndrome live birth to a smoking mother was 0.2 in blacks (95% interval 0.1-0.7) but 1.2 in whites (95% interval 0.6-2.5). Stratification on variables associated with socioeconomic status or gestational age at time of entry into the study did not alter the racial difference. A comparison of smokers with those who never smoked revealed essentially the same trends. Among all nonsmokers the ratio of the maternal age-adjusted risks for a Down syndrome live birth in whites compared with blacks was 0.7 (95% interval 0.3-1.3), and among all smokers this ratio was 3.6 (95% interval 1.3-9.9). If the results are not attributable to statistical fluctuation or undetected confounding, then differences in the probability of intrauterine survival of the Down syndrome fetus would appear to be one plausible explanation for the difference.     

Paternal age and Down syndrome in British Columbia

Among Down syndrome cases born in 1964--1976 reported to the British Columbia Registry for Handicapped Children, the mean parental age was about half a year greater than in the entire population of live births after controlling for maternal age, a difference significant at the .05 level. After adjustment for maternal age, a regression analysis was consistent with an increase of 1.024-fold for each year of paternal age. Among Down syndrome cases in 1952--1963, however, for which ascertainment appears likely to be less complete, there was no evidence for a significant paternal age effect. The reasons for the variation between the two groups investigated here and the heterogeneity in results among studies of other populations are discussed.     

Prediction of one repetition maximum strength from multiple repetition maximum testing and anthropometry

The purpose of this study was to quantify the decrease in the load lifted from 1 to 5, 10, and 20 repetitions to failure for the flat barbell bench press (chest press; CP) and plate-loaded leg press (LP). Furthermore, we developed prediction equations for 1 repetition maximum (RM) strength from the multiple RM tests, including anthropometric data, gender, age, and resistance training volume. Seventy subjects (34 men, 36 women), 18-69 years of age, completed 1, 5, 10, and 20RM testing for each of the CPs and LPs. Regression analyses of mean data revealed a nonlinear decrease in load with increasing repetition number (CP: linear S(y.x) = 2.6 kg, nonlinear S(y.x) = 0.2 kg; LP: linear S(y.x) = 11.0 kg, nonlinear S(y.x) = 2.6 kg, respectively). Multiple regression analyses revealed that the 5RM data produced the greatest prediction accuracy, with R(2) data for 5, 10, and 20RM conditions being LP: 0.974, 0.933, 0.915; CP: 0.993, 0.976, and 0.955, respectively. The regression prediction equations for 1RM strength from 5RM data were LP: 1RM = 1.0970 x (5RM weight [kg]) + 14.2546, S(y.x) = 16.16 kg, R(2) = 0.974; CP: 1RM = 1.1307 x (5RM weight) + 0.6999, S(y.x) = 2.98 kg, R(2) = 0.993. Dynamic muscular strength (1RM) can be accurately estimated from multiple repetition testing. Data reveal that no more than 10 repetitions should be used in linear equations to estimate 1RM for the LP and CP actions.     

Appendix: A general regression model for analysis of independent maternal and paternal age effects for 47,+21 and other disorders that may arise from mutant gametes from either parent

Summary Biological considerations suggest that regression equations used to model the rate of mutational outcomes as a possible function of maternal age and paternal age (or other parental factors) are most appropriately additive models of the type: r=(h(x)+j(y) or r=(h(x)+(k(x)·j(y)), where r is the rate of the outcome event, x is maternal age, y is paternal age, and h, j and k are functions to be specified. The first, simpler model assumes that there is no independent maternal age effect upon formation of a gamete or zygote with a paternally derived mutation or upon survival of the consequent conceptus. The second more general model relaxes this assumption. These models appear preferable to those used previously, such as log r=(h(x)+j(y)) or equivalently r=exp (h(x)·j(y)), which posit complex relationships closer to a multiplicative interaction for which it is difficult to suggest obvious biological interpretations.     

Nitric oxide synthase inhibitor L-NAME has no effect on 86Rb accumulation in rat renal cortical slices

The aim of present study was to investigate the effect of the nitric oxide synthase inhibitor L-NAME on the 86Rb uptake in rat renal cortical slices. Rats were divided into three groups: 1. Control. 2. Acute: L-NAME (10 mg/kg i.v.) as a bolus 15 min before the excision of the kidneys. 3. Sub-chronic: L-NAME (10 mg/kg/day) per os for 4 days. Renal cortical slices were incubated for 10, 20, 30, 60, 90, 180 seconds in Krebs-Ringer solution containing 50 kBq 86Rb/100 ml (T = 37 degrees C, PO2 approximately 159 mm Hg). 56Rb accumulation (S/M) was calculated as the ratio of the radioactivity of the cortical slices (S) and the radioactivity of the incubating medium (M). The S/M ratio can be described as a function of time by the following equations. Control: y = 0.265 ln(x) - 0.220, r(xy) = 0.886; acute L-NAME: y = 0.224 ln(x) - 0.171, r(xy) = 0.921; sub-chronic L-NAME: y = 0.331 ln(x) - 0.496, r(xy) = 0.942. (y = S/M, x = t). p < 0.001 in all of the groups, but there is no difference between the groups. In conclusion, L-NAME administered in vivo failed to influence the in vitro 86Rb accumulation in rat renal cortical slices.     

Morphometric evaluation of the number of exocrine pancreatic cells during early postnatal growth in the rat.

The number of the various cell categories of the exocrine pancreas of the rat was evaluated by morphometric methods in paraffin sections of glands from rats aged 2, 5, 15, 20 and 33 days. The evolution of these cell types could be properly expressed by equations of the type y = aoek.x, where y = cell number, and x = age in days. The time necessary for each cell type to duplicate was thus obtained. The percentages (y') of acinar, intercalated duct and connective tissue cells also proved to be age-dependent and could be expressed by second-degree equations.     

The ratio of de novo unbalanced translocation to 47, trisomy 21 Down syndrome. A new method for human mutation surveillance and an apparent recent change in mutation rate resulting in human interchange trisomies in one jurisdiction.

The Down syndrome phenotype may be associated with, among other genotypes, an unbalanced Robertsonian translocation producing an "interchange trisomy" with 46 chromosomes, or 47, trisomy 21. Translocations, like specificlocus point mutations, result from a direct change in structural chromosome elements. In contrast 47, trisomy 21 results from meiotic non-disjunction. Mutation rates for interchange trisomies may be followed indirectly by determining the ratio of instances of Down syndrome associated with a new translocation mutation to those produced by 47, trisomy 21, which accounts for the bulk of the Down syndrome phenotype. This genotypic ratio can be analyzed in data from cytogenetic laboratories, clinics, and chromosome registries and does not depend upon intensive chromosome screening of newborn populations. A similar approach can be adopted to follow trends in Patau syndrome. The genotypic ratio, stratified by maternal age, may in addition, provide a sentinel index for changes in human specific-locus mutations and perhaps other adverse health consequences. Analysis of data from the New York State-North-eastern chromosome registry revealed a two- to three-fold increase in the genotypic ratio for both Down syndrome and Patau syndrome for individuals born in 1973, 1974 and 1975 compared to those born in earlier years.     

Paternal age and Down's syndrome genotypes diagnosed prenatally: No association in New York State data

Summary An investigation of a paternal age effect independent of maternal age was undertaken for 98 cases of Down's syndrome genotypes diagnosed prenatally compared to 10,329 fetuses with normal genotype diagnosed prenatally in data reported to the New York State Chromosome Registry. The mean of the difference (delta) in paternal age of cases compared to those with normal genotypes after controlling for maternal age, was slightly negative,-0.27 with a 95% confidence interval of-1.59 to +1.06. A regression analysis was also done in which the data were first fit to an equation of the type lny=(bx+c) and then to the equation ln y=(bx+dz+c) where y = rate of Down's syndrome, x = maternal age, z = paternal age, and b, d, and c are parameters. This also revealed no evidence for a paternal age effect. The value of d (the paternal age coefficient) was in fact slightly negative,-0.0058, with an asymptotic 95% confidence interval of-0.0379 to +0.0263. Lastly, multiple applications of the Mantel-Haenszel test considering various boundaries in paternal age also revealed no statistically significant evidence for a paternal age effect independent of maternal age. These results are at variance with claims of others elsewhere of a very strong paternal age effect detected in studies at prenatal diagnoses. Five different hypotheses are suggested which may account for discrepancies among studies to date in findings on paternal age effects for Down's syndrome: (i) there are temporal, geographic, or ethnic variations in paternal age effects, (ii) there is no paternal age effect and statistical fluctuation accounts for all trends to date; (iii) methologic artifacts have obscured a paternal age effect in some studies which did not find a positive outcome; (iv) methodologic artifacts are responsible for the positive results in some studies to date; (v) there is a rather weak paternal age effect independent of maternal age in most if not all populations, but because of statistical fluctuation the results are significant only in some data sets. The results of all data sets to date which we have been able to analyze by one year intervals are consistent with a mean delta of +0.04 to +0.48 and in the value of d (the paternal age coefficient) of +0.006 to +0.017, and it appears the fifth hypothesis cannot be excluded. Projections based on this assumption are presented.