Fertilizantes Tocantins was founded by José Eduardo Motta in 2003, out of his desire of taking advantage of the fast-growing agricultural businesses in the northern region of Brazil. He had previous ...knowledge of the fertilizer sector due to his work in his father’s business for several years. After an impressive success and enormous growth rates until 2016, 50% plus one shares of the company were sold to EuroChem, a European fertilizer producer. This was part of Fertilizantes Tocantins’ strategy to achieve even greater and sustainable growth. In 2020 EuroChem bought the remaining shares of Fertilizantes Tocantins, becoming its sole controller. The company still maintains most of its operational structure and now is fueled with capital and other assets from EuroChem. The challenge ahead lies in being able to maintain the organizational culture and winning position while bringing the best of its controller’s assets to achieve the goal of being a leader in the Brazilian fertilizer market.
Leaders at the VA Puget Sound Health Care System vaccinated Black, Hispanic, and multiracial patients at rates exceeding population averages through outreach efforts that are accessible to other ...health care organizations.
An array of factors hamper equitable Covid-19 vaccine deployment in the United States along racial, ethnic, age, and geographic lines. The Puget Sound Veterans Affairs facility developed a multidisciplinary vaccine delivery strategy to forestall systematic inequities in receipt of vaccination among veterans using methods that can be used by other health care organizations. The VA Puget Sound Health Care System deployed targeted outreach to individual patients on the basis of a simple score consisting of the sum of risk factors for severe Covid-19 disease and high-risk race or ethnicity. The health system then conducted sequential outreach using multiple communication modalities; worked with trusted community stakeholders to publicize and deploy mobile clinics to underserved areas; and monitored vaccination coverage rates by age, race, sex, and rural status at prespecified intervals and adjusted operations to ensure equity. Vaccination rates were highest in Black, multiracial, and Hispanic veterans compared with white veterans during the vaccine drive, a finding that persisted after the drive.
Managing a newborn with lethal congenital anomalies is challenging but handling a parent's request for doctors under oath to terminate the baby's life is another major ethical dilemma requiring ...cautious evaluation. We present a term male neonate who presented on the 7th day of life, with a dark-blue sclera, multiple limb deformities, long bone fractures, beaded ribs, a flattened forehead, a narrow chest, and respiratory distress. A Diagnosis of Type II Osteogenesis imperfecta was made and he was managed by a multidisciplinary team including neonatologists, geneticists/endocrinologists, orthopaedic surgeons, nurses, and medical social workers. Supplemental oxygen, intravenous fluids and antibiotics, analgesia, and bisphosphonates were offered as supportive care. The main concern was the challenges of managing a newborn with lethal OI and balancing the demand for euthanasia by the parents to end the baby's misery. In providing care, the rights of the child to life, the morals of the physician, the best interests of the baby, and the family's role in decision-making in a setting of out-of-pocket expenditures must be weighed. Following extensive multidisciplinary team meetings, it was ultimately decided to allow nature to take her course. Baby subsequently had progressive respiratory distress from pulmonary hypoplasia and died of respiratory failure on the twelfth day of life. In Conclusion, Osteogenesis imperfecta of the perinatal type is usually a lethal disease, with death often occurring within the perinatal period. The physician must, therefore, balance the parental rights, the oath of office, and the existing legal framework to avoid charges of murder or manslaughter.Managing a newborn with lethal congenital anomalies is challenging but handling a parent's request for doctors under oath to terminate the baby's life is another major ethical dilemma requiring cautious evaluation. We present a term male neonate who presented on the 7th day of life, with a dark-blue sclera, multiple limb deformities, long bone fractures, beaded ribs, a flattened forehead, a narrow chest, and respiratory distress. A Diagnosis of Type II Osteogenesis imperfecta was made and he was managed by a multidisciplinary team including neonatologists, geneticists/endocrinologists, orthopaedic surgeons, nurses, and medical social workers. Supplemental oxygen, intravenous fluids and antibiotics, analgesia, and bisphosphonates were offered as supportive care. The main concern was the challenges of managing a newborn with lethal OI and balancing the demand for euthanasia by the parents to end the baby's misery. In providing care, the rights of the child to life, the morals of the physician, the best interests of the baby, and the family's role in decision-making in a setting of out-of-pocket expenditures must be weighed. Following extensive multidisciplinary team meetings, it was ultimately decided to allow nature to take her course. Baby subsequently had progressive respiratory distress from pulmonary hypoplasia and died of respiratory failure on the twelfth day of life. In Conclusion, Osteogenesis imperfecta of the perinatal type is usually a lethal disease, with death often occurring within the perinatal period. The physician must, therefore, balance the parental rights, the oath of office, and the existing legal framework to avoid charges of murder or manslaughter.
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Army cutworm moths (Euxoa auxiliaris; moths) are an important seasonal higher elevational food source for grizzly bears (Ursus arctos horribilis; bears) in the Greater Yellowstone Ecosystem (Wyoming, ...Montana, and Idaho, USA). Increased human interaction with bears at moth sites is an important management issue because of the potential for displacing bears and the concern for human safety. Managers will need better information regarding human–bear interactions at high-density moth sites that are also accessible to humans to mitigate potential conflicts. In the summers of 2017 and 2018, we studied human– bear interactions at 2 of the most human accessible moth sites in the Shoshone National Forest, Wyoming. We completed 293 bear surveys and documented 266 bear observations. We also recorded human-use levels at the 2 study sites (north site: 3 groups/year; south site: 35 groups/year). We documented 43 interactions (at the south site only) and obtained location data for 29 interactions. During human–bear interactions, bears strongly avoided humans 80% of the time and had no apparent reaction 20% of the time. Our results indicated that human safety and bear displacement are valid management concerns at the south site. Human safety concerns were most apparent in mountain climbing groups with small group sizes (<4 people, n = 64/70) that were unprepared for encounters with bears. Management concerns for human safety and bear displacement are much lower at the north site. We recommend placing information kiosks at trailheads to inform hikers of dangers associated with grizzly bear concentrations on moth sites.
Human–bear (Ursus spp.) interactions (HBI) commonly occur in residential areas throughout North America. Negative HBI can be alleviated by using bear-resistant garbage cans (BRC) and by securing ...other bear attractants (e.g., bird feeders). Since the early 2000s, human and Florida black bear (U. americanus floridanus) densities have increased substantially throughout Florida, USA, concurrently producing an increase in HBI. In central Florida, an area with high densities of humans and black bears, we surveyed 2 neighborhoods that occurred in an urban ordinance zone established in 2016 that required residents to secure anthropogenic food sources. Residents were supplied with BRC in 2017, and our surveys in 2017 and 2018 assessed the changes in HBI in the year before and after receiving BRC as well as the attitudes of residents toward ordinance measures and the perceived effectiveness of BRC. We found that a combination of preventive measures practiced by residents along with use of BRC effectively reduced HBI by 54%, especially bears eating garbage (reduced to 0%). Consequently, residents spent more time outdoors in their neighborhoods and experienced an elevated quality of life because fear of HBI lessened. We also analyzed public calls to the Florida Fish and Wildlife Conservation Commission concerning HBI. Public calls declined during the 5 years after the ordinance was established compared to 5 years prior. A reduction in HBI (especially conflicts) and public acceptance of using BRC is a long-term goal for management of black bears in Florida.
Interactions between humans and wildlife include a number of consumptive and non-consumptive forms. In some cases, the increased demand for wildlife viewing can precipitate new human–wildlife ...conflicts. Mountain goats (Oreamnos americanus; goats) are native to a number of North American mountain ranges from southeastern Alaska to southwestern Montana, USA. Goat habitat typically consists of steep terrain and cold weather habitats, which has left them particularly vulnerable to climate change. Their alpine environments also make them vulnerable to disturbance by aircraft and land-based motorized human activity. We reviewed and characterized situations in which goats in close proximity to humans on foot may become a nuisance or dangerous to people. We identify how such interactions might occur, focusing on the array of intensity observed in different settings. We summarize and evaluate interventions that have been attempted and may warrant additional research. Goats that tolerate people along hiking trails, perhaps through a habituation-like process, can typically be kept at a safe distance simply by shouting, clapping hands, or vigorous gestures. Goats that have learned to associate people with a salt reward (e.g., typically urine deposited on the ground, less frequently sweat obtained directly by licking) are more likely to be successfully hazed by tossing small stones, hitting the animal in the flank or rear. Salt-conditioned goats sometimes come within touching distance of humans; we strongly advise against prodding or poking these animals with sharp objects such as trekking poles. The recreating public that ventures into goat habitat is the ultimate source of these conflicts. Education, compliance, and possibly some infrastructure improvements can lessen the potential for conflicts and provide new and safer opportunities to view goats.
Case studies are a high impact educational practice that engage students in collaborative problem solving through storytelling. HITS, an NSF funded research coordination network dedicated to exposing ...students to high-throughput discovery science, drove creation of this case. In this case, students imagine themselves as researchers developing new therapeutic drugs for epilepsy. Specifically, students work with the Allen Cell Types Database, which is the result of collaborative, interdisciplinary open science. Neurosurgeons partnered with the Allen institute to provide living human brain tissue for electrophysiological, morphological, and transcriptomic study. Students collaborate to collect and organize data, investigate a research question they identified, and perform fundamental statistical analyses to address their question. By leveraging the unique Cell Types dataset the case enhances student knowledge of epilepsy, illuminates high-throughput scientific approaches, and builds quantitative and research related skills. The case is also versatile and was implemented in two distinct courses. The case can also be taught in different modalities, in person or remote, with a combination of synchronous and asynchronous work. Indirect and direct measures along with quantitative and qualitative approaches were used for case assessment and improvement. Students performed well on case related exam questions, reported high confidence in their achievement of the learning outcomes, and enjoyed the case's link to neurological disease, real research data and advanced technological approaches. Our assessment findings and instructor implementation experiences are also included to facilitate the adoption or adaptation of the case for a variety of courses and/or modalities in neuroscience and STEM related curricula.
Aims and Objectives
Drawing on ethnographic fieldwork exploring various head and neck cancer treatment pathways of patients with low socio‐economic status being treated with radiation therapy in ...Denmark, our aim was to explore how and why inequality in this treatment pathway might occur in the encounter between these patients and Danish healthcare.
Background
In recent years, inequality in cancer treatment of patients with a low socio‐economic status has been a growing concern worldwide. The majority of patients with head and neck cancer have a relatively low socio‐economic status and are at risk of experiencing inequality in their cancer treatment.
Design/Methods
Using a method proposed by Robert Yin, we performed a multiple case study of five treatment pathways of patients with a low socio‐economic status. The case studies consisted of participant observations and interviews with patients, relatives and health professionals. We applied Herbert Blumer's theory of symbolic interaction as a framework for our analysis.
Results
We identified three concepts that all blocked joint action because patients and health professionals had different perceptions of what interaction required of them in terms of (1) Understanding information; (2) Assuming responsibility for managing practical tasks; and (3) Coordinating one's own treatment pathway.
Conclusions
We identified how different situations challenged the patients' abilities to assume participation in their own treatment pathway. In their encounter with patients, healthcare professionals did not know which situational impediments to joint action patients were facing.
Relevance to clinical practice
We argue that being aware of how challenges unfold in the interaction with patients with low socio‐economic status may serve as a starting point for changing practice to reduce inequality in the treatment of these patients.
Reporting method
This study is reported using consolidated criteria for reporting Qualitative research (SRQR). We used the theory and method of Robert Yin of performing a multi‐case study and we applied Herbert Blumer's theory of Symbolic interactionism as a framework for understanding data.
Patient or public contribution
No patient or public contribution.
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Patients with progressive multifocal leukoencephalopathy (PML) in the context of human immunodeficiency virus-acquired immunodeficiency syndrome (HIV-AIDS) show a partial improvement following ...rehabilitation; however, this improvement is rapidly lost if the patient is not provided with intensive rehabilitation. A 42-year-old patient affected by HIV-AIDS had a clinical worsening within a few months following PML onset, despite being treated with antiretroviral drugs and conventional rehabilitation. He developed severe paraparesis and significant dependency in the activities of daily life. A first cycle of intensive rehabilitation provided the patient with some significant functional outcomes, although he experienced a worsening of the clinical condition after two months of rest, before admission to our rehabilitation unit. We thus sought to evaluate the effects of intensive robot-aided gait training (RAGT) coupled with transcranial direct current stimulation (tDCS). The patient significantly improved when provided with intensive RAGT coupled with tDCS (as per 10-meter Walk Test 10MWT and 6-minute Walk Test 6MWT), and the improvement was maintained at three-month follow-up. As this advanced approach was feasible, safe, and potentially effective, this case suggests that patients with PML-HIV require prolonged multidisciplinary rehabilitation treatment. We can speculate that individuals with PML should also be treated with innovative technology to improve their functional outcomes and therefore quality of life.
Delayed-onset nodules, a potential complication of injectable hyaluronic acid (HA) fillers, can be distressing to both patient and clinician. Current treatment options, including oral corticosteroids ...and antibiotics, have potential side effects and may be ineffective or contraindicated in some patients. Hyaluronidase is an enzyme used to degrade HA fillers. Although it is generally effective for resolving such nodules, it can interfere with the favorable aesthetic effects of filler treatment. This report describes a novel and successful method of treating delayed-onset nodules in facial tissue. Radial sound (shockwave) therapy was used to treat multiple delayed-onset facial nodules in two patients following HA filler injection. Substantial improvement was observed in both patients after the initial 10-minute session, and all nodules resolved fully by the third or fourth treatment. There were no side effects or downtime. Patients were satisfied with the results, particularly because the aesthetic effects of the HA filler were maintained.
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