Medical audit: prenatal care program in a health center in southern Brazil

INTRODUCTION: A medical audit on the prenatal care program in the Vila Municipal Health Center, Pelotas, RS, Brazil, was described with the purpose of verifying the aspects of the medical process and improving the program's effectiveness. METHODS: Data from prenatal specific records were collected. Pregnant women with delivery due date in 1997 and in the first semester of 1998 were included in the study. Women registered in the program when they were 4-month pregnant and who had had at least 5 visits were also enrolled. Bivariate analysis was used to detect health care indicators. RESULTS: A total of 73 pregnant women were registered in the program in 1997 and 75 in 1998. In 1997, the average number of medical visits was 5.2, while in 1998 this average was 6.2. The difference between the means was statistically significant (pOBJETIVO: Descreve-se a auditoria médica realizada entre as mulheres que se inscreveram em programa de pré-natal com o objetivo de verificar as características da assistência à gestação e de estabelecer diretrizes de atenção. MÉTODOS: Realizou-se levantamento epidemiológico dos cartões das gestantes inscritas no Programa de Pré-natal do Posto de Saúde da Vila Municipal, Pelotas, RS, com data provável de parto durante 1997 e no primeiro semestre de 1998. Foram incluídas as mulheres ingressadas no Programa até o quarto mês de gestação e que tiveram cinco consultas no mínimo. Foi utilizada a análise bivariada para detectar as condições marcadoras da assistência médica. RESULTADOS: Em 1997, 73 mulheres se inscreveram no Programa de Pré-natal e, em 1998, 75. A média de consultas durante o pré-natal foi de 5,2 em 1997 e 6,2 em 1998. Essa diferença foi significativa (

The S-Matrix in Twistor Space

The simplicity and hidden symmetries of (Super) Yang-Mills and (Super)Gravity scattering amplitudes suggest the existence of a "weak-weak" dual formulation in which these structures are made manifest at the expense of manifest locality. We suggest that this dual description lives in (2,2) signature and is naturally formulated in twistor space. We recast the BCFW recursion relations in an on-shell form that begs to be transformed into twistor space. Our twistor transformation is inspired by Witten's, but differs in treating twistor and dual twistor variables more equally. In these variables the three and four-point amplitudes are amazingly simple; the BCFW relations are represented by diagrammatic rules that precisely define the "twistor diagrams" of Andrew Hodges. The "Hodges diagrams" for Yang-Mills theory are disks and not trees; they reveal striking connections between amplitudes and suggest a new form for them in momentum space. We also obtain a twistorial formulation of gravity. All tree amplitudes can be combined into an "S-Matrix" functional which is the natural holographic observable in asymptotically flat space; the BCFW formula turns into a quadratic equation for this "S-Matrix", providing a holographic description of N=4 SYM and N=8 Supergravity at tree level. We explore loop amplitudes in (2,2) signature and twistor space, beginning with a discussion of IR behavior. We find that the natural pole prescription renders the amplitudes well-defined and free of IR divergences. Loop amplitudes vanish for generic momenta, and in twistor space are even simpler than their tree-level counterparts! This further supports the idea that there exists a sharply defined object corresponding to the S-Matrix in (2,2) signature, computed by a dual theory naturally living in twistor space.Comment: V1: 46 pages + 23 figures. Less telegraphic abstract in the body of the paper. V2: 49 pages + 24 figures. Largely expanded set of references included. Some diagrammatic clarifications added, minor typo fixe

Spectral Parameters for Scattering Amplitudes in N=4 Super Yang-Mills Theory

49 pages, 20 figures; v2: typos fixedPlanar N=4 Super Yang-Mills theory appears to be a quantum integrable four-dimensional conformal theory. This has been used to find equations believed to describe its exact spectrum of anomalous dimensions. Integrability seemingly also extends to the planar space-time scattering amplitudes of the N=4 model, which show strong signs of Yangian invariance. However, in contradistinction to the spectral problem, this has not yet led to equations determining the exact amplitudes. We propose that the missing element is the spectral parameter, ubiquitous in integrable models. We show that it may indeed be included into recent on-shell approaches to scattering amplitude integrands, providing a natural deformation of the latter. Under some constraints, Yangian symmetry is preserved. Finally we speculate that the spectral parameter might also be the regulator of choice for controlling the infrared divergences appearing when integrating the integrands in exactly four dimensions.Peer reviewe

Scattering Amplitudes and BCFW Recursion in Twistor Space

Twistor ideas have led to a number of recent advances in our understanding of scattering amplitudes. Much of this work has been indirect, determining the twistor space support of scattering amplitudes by examining the amplitudes in momentum space. In this paper, we construct the actual twistor scattering amplitudes themselves. We show that the recursion relations of Britto, Cachazo, Feng and Witten have a natural twistor formulation that, together with the three-point seed amplitudes, allows us to recursively construct general tree amplitudes in twistor space. We obtain explicit formulae for $n$-particle MHV and NMHV super-amplitudes, their CPT conjugates (whose representations are distinct in our chiral framework), and the eight particle N^2MHV super-amplitude. We also give simple closed form formulae for the N=8 supergravity recursion and the MHV and conjugate MHV amplitudes. This gives a formulation of scattering amplitudes in maximally supersymmetric theories in which superconformal symmetry and its breaking is manifest. For N^kMHV, the amplitudes are given by 2n-4 integrals in the form of Hilbert transforms of a product of $n-k-2$ purely geometric, superconformally invariant twistor delta functions, dressed by certain sign operators. These sign operators subtly violate conformal invariance, even for tree-level amplitudes in N=4 super Yang-Mills, and we trace their origin to a topological property of split signature space-time. We develop the twistor transform to relate our work to the ambidextrous twistor diagram approach of Hodges and of Arkani-Hamed, Cachazo, Cheung and Kaplan.Comment: v2: minor corrections + extra refs. v3: further minor corrections, extra discussion of signature issues + more ref

Identification of N-acyl-l-homoserine lactones produced by non-pigmented Chromobacterium aquaticum CC-SEYA-1T and pigmented Chromobacterium subtsugae PRAA4-1T

Many members of the genus Chromobacterium produce violacein, a characteristic purple pigment which is induced by small diffusible N-acyl homoserine lactones (AHL) quorum-sensing molecules. In this study, the production of AHL of the non-pigmented C. aquaticum CC-SEYA-1T and the pigmented C. subtsugae PRAA4-1T were determined by using a CV026 biosensor assay. The profile of AHL was identified from the extracts of stationary phase cultures using gas chromatography–mass spectroscopy (GC–MS) and thin layer chromatography (TLC). CV026 biosensor assay revealed that both the non-pigmented C. aquaticum CC-SEYA-1T and the pigmented C. subtsugae PRAA4-1T produced AHL molecules, which were identified, respectively, as N-octanoyl homoserine lactone (OHL) [also known as C-8 homoserine lactone (C8-HSL)] and N-hexanoyl homoserine lactone (HHL) [also known as C-6 homoserine lactone (C6-HSL)]. The pigment produced by C. subtsugae PRAA4-1T was similar to that of Chromobacterium violaceum ATCC12472T but no characteristic visible spectral peaks of the pigment were observed in the extracts of C. aquaticum CC-SEYA-1T. In addition, C. aquaticum CC-SEYA-1T and C. subtsugae PRAA4-1T showed hemolytic activities

Inducible Nitric Oxide Synthase in Heart Tissue and Nitric Oxide in Serum of Trypanosoma cruzi-Infected Rhesus Monkeys: Association with Heart Injury

Chagas disease, a neglected tropical disease caused by the protozoan Trypanosoma cruzi, afflicts from 8 to 15 million people in the Latin America. Chronic chagasic cardiomyopathy (CCC) is the most frequent manifestation of Chagas disease. Currently, patient management only mitigates CCC symptoms. The pathogenic factors leading to CCC remain unknown; therefore their comprehension may contribute to develop more efficient therapies. In patients, high nitric oxide (NO) levels have been associated with CCC severity. In T. cruzi-infected mice, NO, mainly produced via inducible nitric oxide synthase (iNOS/NOS2), is proposed to work in parasite control. However, the participation of iNOS/NOS2 and NO in T. cruzi control and heart injury has been questioned. Here, infected rhesus monkeys and iNOS/NOS2-deficient mice were used to explore the participation of iNOS/NOS2-derived NO in heart injury in T. cruzi infection. Chronically infected monkeys presented electrical abnormalities, myocarditis and fibrosis, resembling the spectrum of human CCC. Moreover, cardiomyocyte lesion correlated with iNOS/NOS2+ cells infiltrating the cardiac tissue. Our findings support that parasite-driven iNOS/NOS2+ cells accumulation in the cardiac tissue and NO overproduction contribute to cardiomyopathy severity, mainly disturbing the pathway involved in electrical synchrony in T. cruzi infection

ELISA versus PCR for diagnosis of chronic Chagas disease: systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Most current guidelines recommend two serological tests to diagnose chronic Chagas disease. When serological tests are persistently inconclusive, some guidelines recommend molecular tests. The aim of this investigation was to review chronic Chagas disease diagnosis literature and to summarize results of ELISA and PCR performance.</p> <p>Methods</p> <p>A systematic review was conducted searching remote databases (MEDLINE, LILACS, EMBASE, SCOPUS and ISIWeb) and full texts bibliography for relevant abstracts. In addition, manufacturers of commercial tests were contacted. Original investigations were eligible if they estimated sensitivity and specificity, or reliability -or if their calculation was possible - of ELISA or PCR tests, for chronic Chagas disease.</p> <p>Results</p> <p>Heterogeneity was high within each test (ELISA and PCR) and threshold effect was detected only in a particular subgroup. Reference standard blinding partially explained heterogeneity in ELISA studies, and pooled sensitivity and specificity were 97.7% [96.7%-98.5%] and 96.3% [94.6%-97.6%] respectively. Commercial ELISA with recombinant antigens studied in phase three investigations partially explained heterogeneity, and pooled sensitivity and specificity were 99.3% [97.9%-99.9%] and 97.5% [88.5%-99.5%] respectively. ELISA's reliability was seldom studied but was considered acceptable. PCR heterogeneity was not explained, but a threshold effect was detected in three groups created by using guanidine and boiling the sample before DNA extraction. PCR sensitivity is likely to be between 50% and 90%, while its specificity is close to 100%. PCR reliability was never studied.</p> <p>Conclusions</p> <p>Both conventional and recombinant based ELISA give useful information, however there are commercial tests without technical reports and therefore were not included in this review. Physicians need to have access to technical reports to understand if these serological tests are similar to those included in this review and therefore correctly order and interpret test results. Currently, PCR should not be used in clinical practice for chronic Chagas disease diagnosis and there is no PCR test commercially available for this purpose. Tests limitations and directions for future research are discussed.</p