The tap test- an accurate First-line test for fetal lung maturity testing

Objective. To determine the accuracy of near-patient and laboratory- based fetal lung maturity tests in predicting the need for neonatal ventilation.Design. A prospective descriptive study. Subjects. One hundred high-risk obstetric patients where confirmation of fetal lung maturity would initiate delivery.Methods. Fetal weight estimation, placental maturity grading, and amniocentesis were performed. The investigators examined the amniotic fluid visually, and performed the tap test and shake test. Laboratory technicians estimated the lecithin-sphingomyelin (L/S) ratio, determined the presence of a phosphatidyl glycerol (PG) band on gel electrophoresis, and the optical density at 650 nm. Neonates delivered within 1 week of amniocentesis were included in the analysis. The primary end-point was the ability of the lung maturity tests to predict the need for neonatal ventilation.Results. Twelve of 100 neonates required ventilation. The tap test and optical density (OD) shift at 650 nm predicted the need for neonatal ventilation with the greatest accuracy.Conclusion. The tap test is a rapid, easy and accurate predictor of the need for neonatal ventilation. The OD shift at 650 nm is the laboratory-based test with the greatest accuracy in our setting

Cerebral Palsy and Criteria Implicating Intrapartum Hypoxia in Neonatal Encephalopathy – An Obstetric Perspective for the South African Setting

The science surrounding cerebral palsy indicates  that it is a complex medical condition with multiple contributing variables and factors, and causal pathways are often extremely difficult to delineate. The pathophysiological processes are often juxtaposed on antenatal factors, genetics, toxins, fetal priming, failure of neuroscientific autoregulatory mechanisms, abnormal biochemistry and abnormal metabolic pathways. Placing this primed compromised compensated brain through the stresses of an intrapartum process could be the final straw in the pathway  to brain injury and later CP.  It is thus simplistic to base causation of cerebral palsy on only an intrapartum perspective with radiological ‘confirmation’, as is often the practice in medicolegal cases in South African courts. The present modalities (MRI and CTG when available) that retrospectively attempt to determine causation in courts are inadequate when used in isolation. Unless a holistic scientific review of the case including all contributing clinical factors (antepartum, intrapartum and neonatal), fetal heart rate monitoring, neonatal MRI if possible (and preferred) or late MRI, and histology (placental histology if performed) are taken into account, success for plaintiff or defendant currently in a court of law will depend on eloquent legal argument rather than true scientific causality. The 10 criteria set out in this document to implicate acute intrapartum hypoxia in hypoxic ischaemic encephalopathy/neonatal encephalopathy serve as a guideline in the medicolegal setting

Medicolegal cases against obstetricians

We read the article on a retrospective, observational study of medicolegal cases against obstetricians and gynaecologists in South Africa (SA)’s private sector with interest. On the surface, there is some good news for obstetrics. Contrary to expectations and international experience, the article suggests that medicolegal notifications for gynaecological mishaps are now (at least financially) a greater concern than obstetric claims.http://www.samj.org.zadm2022Obstetrics and Gynaecolog

P4‐154: The Protein Quality Control Protein, Ubiquilin‐2, Regulates Tau Accumulation

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152960/1/alzjjalz2019063816.pd

Predictive coding in ASD: inflexible weighting of prediction errors when switching from stable to volatile environments

Individuals with autism spectrum disorder (ASD) have been widely reported to show atypicalities in predictive coding, though there remains a controversy regarding what causes such atypical processing. Suggestions range from overestimation of volatility to rigidity in the reaction to environmental changes. Here, we tested two accounts directly using duration reproduction of volatile and non-volatile interval sequences. Critically, both sequences had the same set of intervals but differed in their stimulus presentation orders. Comparing individuals with ASD vs. their matched controls, we found both groups to respond to the volatility in a similar manner, albeit with a generally reduced prior in the ASD group. Interestingly, though, relative to the control group, the ASD group exhibited a markedly reduced trust in the prior in the volatile trial session when this was performed after the non-volatile session, while both groups performed comparably in the reverse session order. Our findings suggest that it is not the learning of environmental volatility that is compromised in ASD. Rather, it is their response to a change of the volatility regimen from stable to volatile, which causes a highly inflexible weighting of prediction errors.Competing Interest StatementThe authors have declared no competing interest

Effectiveness of method improvements to reduce variability of brood termination rate in honey bee brood studies under semi-field conditions

Quantitative assessments of adverse effects of plant protection products on honey bee brood (Apis mellifera L.) may be carried out according to the methods given by the OECD Guidance Document No. 75 (2007). In recent years a number of studies displayed a strong variability in brood termination rates, a key endpoint. Due to these variances no definite conclusions regarding potential brood effects were possible, and the studies needed to be repeated. Due to this, attempts to improve the methodology were initiated by the Working Group ‘Honey bee brood' of the German AG Bienenschutz. In 2011, honey bee brood studies adapted to these identified possible improvements resulted in better results compared to historical data. Based on the analysed results, the working group recommends to improve the method by using bigger colonies with more brood, using 4 instead of 3 replicates for better interpretation of data, starting the study early in the season, avoiding major modifications of the colonies shortly before application and using larger tunnels with effective crop areas preferably > 80 m². To carry out quicker brood cell assessments to reduce stress for the colonies, it is recommended to use digital brood assessment, which allows marking a higher number of cells (e.g. 200 to 400 cells)

Acquisition and Use of 'Priors' in Autism: Typical in Deciding Where to Look, Atypical in Deciding What Is There

Individuals with Autism Spectrum Disorder (ASD) are thought to under-rely on prior knowledge in perceptual decision-making. This study examined whether this applies to decisions of attention allocation, of relevance for 'predictive-coding' accounts of ASD. In a visual search task, a salient but task-irrelevant distractor appeared with higher probability in one display half. Individuals with ASD learned to avoid 'attentional capture' by distractors in the probable region as effectively as control participants-indicating typical priors for deploying attention. However, capture by a 'surprising' distractor at an unlikely location led to greatly slowed identification of a subsequent target at that location-indicating that individuals with ASD attempt to control surprise (unexpected attentional capture) by over-regulating parameters in post-selective decision-making

Cerebral palsy and criteria implicating intrapartum hypoxia in neonatal encephalopathy – an obstetric perspective for the South African setting

The science surrounding cerebral palsy (CP) indicates that it is a complex medical condition with multiple contributing variables and factors, and causal pathways are often extremely difficult to delineate. The pathophysiological processes are often juxtaposed on antenatal factors, genetics, toxins, fetal priming, failure of neuroscientific autoregulatory mechanisms, abnormal biochemistry and abnormal metabolic pathways. Placing this primed compromised compensated brain through the stresses of an intrapartum process could be the final straw in the pathway to brain injury and later CP. It is therefore simplistic to base causation of CP on only an intrapartum perspective with radiological ‘confirmation’, as is often the practice in medico-legal cases in South African courts. The present modalities (magnetic resonance imaging (MRI) and cardiotocography (CTG)), when available, that retrospectively attempt to determine causation in courts are inadequate when used in isolation. Unless a holistic scientific review of the case including all contributing clinical factors (antepartum, intrapartum and neonatal), fetal heart rate monitoring, neonatal MRI if possible (and preferred) or late MRI, and histology (placental histology if performed) is taken into account, success for the plaintiff or defendant currently in a court of law will depend on eloquent legal argument rather than true scientific causality. The 10 criteria set out in this article to implicate intrapartum hypoxia in hypoxic-ischaemic encephalopathy/neonatal encephalopathy serve as a guideline in the medico-legal setting.http://www.samj.org.zadm2022Obstetrics and Gynaecolog