Identification of Candida species in the clinical laboratory: A review of conventional, commercial, and molecular techniques

In healthy individuals, Candida species are considered commensal yeasts of the oral cavity. However, these microorganisms can also act as opportunist pathogens, particularly the so-called non-albicans Candida species that are increasingly recognized as important agents of human infection. Several surveys have documented increased rates of C. glabrata, C. tropicalis, C. guilliermondii, C. dubliniensis, C. parapsilosis, and C. krusei in local and systemic fungal infections. Some of these species are resistant to antifungal agents. Consequently, rapid and correct identification of species can play an important role in the management of candidiasis. Conventional methods for identification of Candida species are based on morphological and physiological attributes. However, accurate identification of all isolates from clinical samples is often complex and time-consuming. Hence, several manual and automated rapid commercial systems for identifying these organisms have been developed, some of which may have significant sensitivity issues. To overcome these limitations, newer molecular typing techniques have been developed that allow accurate and rapid identification of Candida species. This study reviewed the current state of identification methods for yeasts, particularly Candida species. © 2013 John Wiley & Sons A/S.

Conservative Approach: Using Decompression Procedure for Management of a Large Unicystic Ameloblastoma of the Mandible

Ameloblastoma is a relatively uncommon benign odontogenic tumor, which is locally aggressive and has a high tendency to recur, despite its benign histopathologic features. This pathology can be classified into 4 groups: unicystic, solid or multicystic, peripheral, and malignant. There are 3 variants of unicystic ameloblastoma, as luminal, intraluminal, and mural. Therefore, in mural ameloblastoma, the fibrous wall of the cyst is infiltrated with tumor nodules, and for this reason it is considered the most aggressive variant of unicystic ameloblastomas. Various treatment techniques for ameloblastomas have been proposed, which include decompression, enucleation/curettage, sclerotizing solution, cryosurgery, marginal resection, and aggressive resection. Literature shows treatment of this lesion continues to be a subject of intense interest and some controversy. Thus, the authors aimed to describe a case of a mural unicystic ameloblastoma of follicular subtype in a 19-year-old subject who was successfully treated using conservative approaches, as decompression. The patient has been followed up for 3 years, and has remained clinically and radiographically disease-free.

The contribution of multiple use forest management to small farmers' annual incomes in the Eastern Amazon

Small-scale farmers in the Brazilian Amazon collectively hold tenure over more than 12 million ha of permanent forest reserves, as required by the Forest Code. The trade-off between forest conservation and other land uses entails opportunity costs for them and for the country, which have not been sufficiently studied. We assessed the potential income generated by multiple use forest management for farmers and compared it to the income potentially derived from six other agricultural land uses. Income from the forest was from (i) logging, carried out by a logging company in partnership with farmers' associations; and (ii) harvesting the seeds of Carapa guianensis (local name andiroba) for the production of oil. We then compared the income generated by multiple-use forest management with the income from different types of agrarian systems. According to our calculations in this study, the mean annual economic benefits from multiple forest use are the same as the least productive agrarian system, but only 25% of the annual income generated by the most productive system. Although the income generated by logging may be considered low when calculated on an annual basis and compared to incomes generated by agriculture, the one-time payment after logging is significant (US$5,800 to US$33,508) and could be used to implement more intensive and productive cropping systems such as planting black pepper. The income from forest management could also be used to establish permanent fields in deforested areas for highly productive annual crops using conservation agriculture techniques. These techniques are alternatives to the traditional land use based on periodic clearing of the forest. Nevertheless, the shift in current practices towards adoption of more sustainable conservation agriculture techniques will also require the technical and legal support of the State to help small farmers apply these alternatives, which aim to integrate forest management in sustainable agricultural production systems.

Relationships between company size, types of production system and supply chain management: evidence from electro-electronics sector in Brazil

Purpose – The purpose of this paper is to investigate how company size and the type of production system affect the adoption of supply chain management (SCM) practices in companies in the electro‐electronics sector in Brazil. Design/methodology/approach – An e‐mail survey of 107 companies associated with the Brazilian Electrical and Electronics Industry Association (ABINEE) was conducted. Statistical techniques were employed to verify the adoption of SCM practices according to the size of the company and its production system. Findings – The major results indicate that the larger the size of the company, the higher the level of adoption of SCM practices, and that the choice of SCM practices depends upon the type of production system implemented. Practical implications – The implications of this study are useful to top management leaders of small and medium‐sized enterprises since the findings enable them to identify the most common practices adopted by either large‐, medium‐ or small‐sized companies in order to benchmark the level of adoption of SCM practices. Production managers can also benefit from this study by identifying the SCM practices that may support certain production systems.

Aedes aegypti proliferation in stormwater retained in Best Management Practices

The present study aimed to evaluate the risk of Aedes aegypti proliferation in structures used in compensatory techniques for urban drainage (Best Management PracticesBMPs). These drainage structures are utilised to reduce flood peaks due to surface runoff, and they have been used in many countries. However, many of these structures have been designed to keep water surfaces exposed for a certain period of time, depending on the type of project. Exposed water surfaces may become an ideal environment for A. aegypti proliferation in tropical and subtropical areas where the rainy season occurs during the summer. Thus, data regarding the mosquito life cycle, consecutive rainfall pattern and emptying time of these structures were collected. A comparison of these data led to the evaluation of the associated risk of A. aegypti proliferation in BMP structures. The risk of mosquito proliferation ranged from 1.1% to 3.3%, depending on the rainfall pattern, A. aegypti life cycle phase and BMP activity.

Analysis of effectiveness of three forest interventionist techniques and proposal of a new and integrated model of forest restoration

We assessed the efficacy of three different forest intervention techniques, in terms of phytosociological and edaphic responses, that were implemented in 2007. In a farm where trees are planted and managed for cellulose production as well as set aside for environmental conservation, four stands were analysed: three of them were considered degraded and were managed using different intervention techniques (transposition, perch, and abandonment), and a fourth stand comprising pristine vegetation was considered a control (reference). Floristic and phytosociology data were collected in three 10 × 10 m plots established in each stand. Also, a total of 48 soil samples were collected to analyse physical and chemical attributes of the topsoil for the different stands. In terms of biodiversity, all the treatments showed significantly lower values when compared to the reference area. However, the soils in all the treatment and reference stands are similar in terms of physical and chemical attributes. Taking into account the specificities of each restoration technique, we verified that the integrated use of a set of management practices, constituted by the (1) abandonment of the area and (2) following a selective killing of the eucalyptus, is the most suitable and promising model to provide fast and effective restoration in terms of environmental indicators.

Feral swine damage and damage management in forested ecosystems

Invasive feral swine (Sus scrofa) cause deleterious impacts to ecosystem processes and functioning throughout their worldwide distribution, including forested ecosystems in the United States. Unfortunately, many feral swine damage management programs are conducted in a piecemeal fashion, are not adequately funded, and lack clearly stated or realistic objectives. This review paper identifies damage caused by feral swine to forest resources and presents techniques used to prevent and control feral swine damage. Concluding points related to planning a feral swine damage management program are: (1) the value of using a variety of techniques in an integrated fashion cannot be overstated; (2) there is value in using indices for both feral swine populations and their damage pre and post management activities; (3) innovative technologies will increasing be of value in the pursuit of feral swine damage reduction; and (4) though not appropriate in every situation, there is value in involving the public in feral swine damage management decisions and activities.

Ecology, stable isotopes, and management of grassland songbirds at National Park Service properties on the Great Plains

Grassland ecosystems have been severely reduced and grassland bird populations have experienced consistent declines. National Park Service (NPS) properties on the Great Plains provide breeding habitat for grassland songbirds, though little is known about the quality of this habitat. A short-term study on songbirds at three NPS properties complemented current monitoring, providing an among park comparison addressing grassland bird productivity and fidelity relative to NPS property size. During 2008-2009, I assessed avian species richness, and estimated bird density and grassland songbird nest success. Bird species richness was greatest at small and medium sites, while number of nesting obligate species was greatest at the large site. Species-specific densities varied among sites, with few grassland obligates occurring at all three sites. Nest success estimates for grassland obligates were highest at the small site and lower at the large site. Another method to quantify habitat quality is assessment of breeding site fidelity. Current extrinsic markers used in monitoring site fidelity are inadequate for small birds; stable isotope analyses provide an alternative. I compared two techniques for assigning stable isotope tissue origin and measured grassland songbird site fidelity. My method of assigning origin provided site-specific variances of expected stable isotope values, an improvement over the most commonly used method. Fidelity tended to be higher at the large site, which may indicate a more robust breeding community of grassland birds. The small size of two of my sites precluded large sample sizes and made strong inferences difficult. To quantify how scientists cope with weak inference, I conducted a literature review. Strong inference was rarely observed, and most authors of weak-inference papers provided specific management recommendations. I suggest that adaptive management is an ideal method to resolve uncertainty from weak inference. Managers should consider my results within the context of regional and global management and the extent to which their unit might aide songbird conservation.

Non-invasive brain stimulation for the management of arterial hypertension

The neural control of the cardiovascular system is a complex process that involves many structures at different levels of nervous system. Several cortical areas are involved in the control of systemic blood pressure, such as the sensorimotor cortex, the medial prefrontal cortex and the insular cortex. Non-invasive brain stimulation techniques - repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) - induce sustained and prolonged functional changes of the human cerebral cortex. rTMS and tDCS has led to positive results in the treatment of some neurological and psychiatric disorders. Because experiments in animals show that cortical modulation can be an effective method to regulate the cardiovascular system, non-invasive brain stimulation might be a novel tool in the therapeutics of human arterial hypertension. We here review the experimental evidence that non-invasive brain stimulation can influence the autonomic nervous system and discuss the hypothesis that focal modulation of cortical excitability by rTMS or tDCS can influence sympathetic outflow and, eventually, blood pressure, thus providing a novel therapeutic tool for human arterial hypertension. (C) 2009 Published by Elsevier Ltd.

LIMB REPLANTATION AFTER AVULSION INJURIES: TECHNIQUES AND TACTICS FOR SUCCESS

Objectives: Retrospective evaluation of cases of limb replantation after avulsion injuries. Evaluation of the techniques and tactics used, that contributed to success and good functional results. Methods: Forty-three patients' records were assessed. All the cases had been submitted to limb replantation after avulsion injuries. Results: The majority of the cases were young men. The most common injury was to the thumbs. The surgical techniques and tactics used were: nerve grafting, vein grafting, transposition of the digital vessels, limb shortening, and heterotopic replantation. The most commonly used technique was vein graft. The limb survival rate was high (93%), as was patient satisfaction. Conclusion: Replantation after avulsion injury depends on the correct diagnosis of the limb viability and the use of appropriate surgical techniques and tactics for each case. The experience of the team of surgeons and a good hospital structure are essential for good results. There are few articles in medical literature about the indications, techniques and results of limb replantation after avulsion injuries. We believe that this retrospective evaluation can bring new information and contributions to the correct management of this highly complex situation. Level of evidence IV, Case Series.

Submental Endotracheal Intubation: A Valuable Resource for the Management of Panfacial Fractures

Modern techniques for surgical treatment of midfacial and panfacial fractures in maxillofacial trauma lead to special problems for airway management. Usually, in perioperative management of panfacial fractures, the surgeon needs to control the dental occlusion and nasal pyramid assessment. For these reasons, oral and nasal endotracheal intubations are contraindicated for the management of panfacial fractures. Tracheotomy is considered by many as the preferred route for airway management in patients with severe maxillofacial fractures, but there are often perioperative and postoperative complications concerning this technique. The submental route for endotracheal intubation has been proposed as an alternative to tracheotomy in the surgical management of patients with panfacial fractures, besides it is accompanied by low morbidity. Thus, this paper aimed to describe the submental endotracheal intubation technique in a patient experiencing panfacial fracture. The subject was well treated using the submental endotracheal intubation to get good reconstruction of the fractures because the authors obtained free access of all facial fractures.

Evaluation of the capability of decentralized management of epidemiological surveillance in the state of Bahia

Evaluative research into the capability of decentralized management of epidemiological vigilance (EV) was conducted in the operational, organizational and sustainable dimensions in the state of Bahia, Brazil. The quantitative approach was used in the construction of a baseline, with primary data obtained through an online questionnaire answered by thirty-eight municipal EV managers. In the qualitative approach to analyze the context and assess the management capability of municipalities in two case studies, techniques adapted to the analysis of discursive practices were used. This was done through semi-structured interviews with managers of regional and municipal government, health workers and representatives of the municipal health council. The case studies showed that the municipality with enhanced management capability is that in which the manager has the greatest potential of using the resources of his position, in addition to his ability to control, negotiate and coordinate with other actors. Due to decentralization of EV, considering the shared nature of management between the three spheres of government, there is a marked variation in the management capability of municipalities, determined by social, economic, political inequalities and management mechanisms adopted.

Therapeutic Project at Extra-Hospital Mental Health Services: a critical reflection on the elaboration and management of services' therapeutic projects

Based on a study conducted in Ribeirao Preto, SP, Brazil in extra-hospital mental health services that addressed the organization of these services, therapeutic projects and the inclusion of psychosocial rehabilitation in health actions available, a theoretical-critical reflection concerning the development process of the therapeutic projects by the services' teams is presented. The qualitative study was conducted in an outpatient clinic and a Psychosocial Care Center. Data were collected through semi-structured interviews and focal groups. Data analysis was based on the hermeneutic dialectic philosophy of Jurgen Habermas according to the techniques of reconstruction and interpretation. Data analysis revealed that professionals have difficulty developing and managing therapeutic projects. Health actions are made available without being concretely supported by a proposal guiding the service's practical activities. The therapeutic projects are referred by professionals as the result of guidelines provided by management levels or technical orientations inherent to each profession but not as an activity that represents a philosophy of work of the health team. When the therapeutic project is focused on as a type of consensus that results from a communicative action directed to a mutual and intersubjective understanding among the members of the mental health extra-hospital team, the difficulties of the services' team dialogically organizing themselves to collectively construct the therapeutic project is evidenced.

Frontal-orbital advancement for the management of anterior plagiocephaly

The main purposes of this manuscript are to provide an overview of various modalities of surgical correction of anterior plagiocephaly and to emphasize their differences with the classic open frontal-orbital advancement. Advancement of technology provides development of many other ways to achieve the same results. The authors describe the classic open frontal-orbital advancement and compare with other proposed techniques for correction of frontal plagiocephaly. The main limitation of the use of new forms of treatment of the anterior plagiocephaly is the age of the patient. There is still no consensus on criteria for quantitative evaluation of surgical results, and new forms of treatment do not present results with long follow-up. Frontal-orbital advancement is the preferred procedure to correct unicoronal synostosis due to its universal indication regardless of the age and degree of deformation of the anterior plagiocephaly.

Knowledge management and strategic orientation: leveraging innovativeness and performance

Purpose - The aim of this study is to investigate whether knowledge management (KM) contributes to the development of strategic orientation and to enhance innovativeness, and whether these three factors contribute to improve business performance. Design/methodology/approach - A sample of 241 Brazilian companies was surveyed, using Web-based questionnaires with 54 questions, using ten-point scales to measure the degree of agreement on each item of each construct. Structural equation modeling techniques were applied for model assessment and analysis of the relationships among constructs. Exploratory factor analysis, confirmatory factor analysis, and path analysis using the technique of structural equation modeling were applied to the data. Findings - Effective KM contributes positively to strategic orientation. Although there is no significant direct effect of KM on innovativeness, the relationship is significant when mediated by strategic orientation. Similarly effective KM has no direct effect on business performance, but this relationship becomes statistically significant when mediated by strategic orientation and innovativeness. Research limitations/implications - The findings indicate that KM permeates all relationships among the constructs, corroborating the argument that knowledge is an essential organizational resource that leverages all value-creating activities. The results indicate that both KM and innovativeness produce significant impacts on performance when they are aligned with a strategic orientation that enables the organization to anticipate and respond to changing market conditions. Originality/value - There is a substantial body of research on several types of relationships involving KM, strategic orientation, innovativeness and performance. This study offers an original contribution by analyzing all of those constructs simultaneously using established scales so that comparative studies are possible.