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1. The Rarity of Copper Deficiency Myelopathy

   In the U.S, the dietary intake of copper is identified at 1.0 to 1.6 mg per day⁻¹. This amount is found to be sufficient enough to enable individuals meet their nutrient requirements since the minimum amount allowed for adults is 0.9 mg Cuday⁻¹ (Arnold et al., 2019). Copper is highly available in various types of food, and supplementation is not required due to the unlikelihood of suffering from the condition. Also, clinicians will rarely measure the copper levels since they understand how rare the condition is. Although patients who have undergone gastrectomy and gastrointestinal bariatric surgery are at a higher risk of copper deficiency myelopathy, the disease is still rare since the body has been designed in a way that it can easily absorb the copper from various foods that are consumed.

               Copper absorption may be impaired in specific situations, such as when there is a high rate of zinc in the diet, and when an individual has undergone a resection surgery to reduce the stomach capacity. That is because the bioavailability of copper requires an acidic gastric environment. The resection will mostly take place on the duodenum. Unfortunately, this is also the acidic gastric environment where most of the copper absorption takes place. Hence, having undergone the procedure places an individual at a higher risk of suffering from copper deficiency myelopathy (Carroll et al., 2017).

               The prevalence of copper deficiency myelopathy is still quite low. Following the bariatric surgery, the prevalence and incidence has been found to be 9.6% and 18.8% respectively (Arnold et al., 2019).  This can be noted by the low rates experienced in the groups argued to be at higher risk of suffering from the condition. Bariatric surgery refers to an effective treatment for individuals who are suffering from severe obesity. It tends to alleviate some of the major comorbidities and the reduced risk of obese mortality. This medical intervention has been gaining popularity in the U.S due to the effectiveness associated with it.

               The most common procedure is the roux-en-y gastric bypass (RYGB) which alters the gastrointestinal tract in a dramatic way so as to reduce the stomach capacity. It is done to help individuals to restrict their food intake and to re-route the ingested food to bypass the duodenum. The copper deficiency myelopathy is very rare to an extent where most professionals will fail to properly diagnose the patients. That is because the symptoms tend to be similar to other conditions such as iron or vitamin B₁₂ deficiency (Cavallieri et al, 2017). It is rarely measured or considered since the condition is very rare. Healthcare providers will only seek further clarification if a patient does not seem to showcase improvements after a few days. If the condition is diagnosed after it has progressed, the myeloneuropathic signs may end up being irreversible. However, when the rarity causes under-diagnosis, serious complications may be experienced.

               In conclusion, the rarity of this condition may be linked to the fact that copper is readily available in various food stuff. Also, it is usually digested through the duodenum with ease. Therefore, it is unlikely that many people will suffer from this illness, unless there is an underlying condition such as high zinc levels and having undergone a bariatric surgery. Hence, these individuals in the high risk groups will need to undergo frequent screening for copper depletion.

    

    

    

Answer

Assessing Risk and Reward

The Nissan Motor Company is one of the leading automobile makers in the world. The Japanese carmaker has primarily enjoyed a successful run, allowing it to enter various regional and international markets such as the United States. However, the changing business environment was not favorable to the company in 2019. Notably, the cooperation recorded losses amounting to 7.8%. The experience pushed the management into making tough decisions, requiring almost all of its North American workforce to go for unpaid leaves.

In late 2019, the company announced that the decline in sales necessitated a two-day unpaid leave for the North American workers. The stated days for the vacation were January 2 and 3^rd    (Chicago Tribune, 2019).  Notably, this move was a crucial decision for the company because of its conflicting impacts. Whereas on the positive side, it could help the firm minimize expenses, it threatened to affect the public perception of the company regarding employee welfare.

The rewards for the decision involved cutting expenses by not paying the workers on leave, which eventually would translate into reduced expenses. Another reward was that the decision could allow the company to optimize performance by evaluating employee performances then developing new milestones. However, on the low side, the company risked affecting its public image and brand name, especially in the North American market. As per Chakravorti (2010), the way an organization treats its employees influences the firm’s public perception. Thus, Nissan risked eliciting a negative public perception. With a distorted public image, the company could fail to revive its declining sales.

I would have advised the management of Nissan to utilize the Predictive Analytic perspective in determining the right decision to take. Ideally, the approach tries to predict what might happen in the future if particular decisions or actions are undertaken at the moment (Traymbak & Aggarwal, 2019). Looking at the situation at Nissan, the company needed to develop a goal such as increasing sales. After that, they would have made decisions aimed at realizing the set goal. In this regard, the predicted outcome could give the management an overview of whether more risks existed or significant rewards could be realized.

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