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A small blue case KUAN: I left a suitcase on the train to London the other day. ATTENDANT: Can you describe it, sir? KUAN: It's a small blue case and it's got a zip. There's a label on the handle with my name and address on it. ATTENDANT: Is this case yours? KUAN: No, that's not mine. ATTENDANT: What about this one? This one's got a label. KUAN: Let me see it. ATTENDANT: What's your name and address? KUAN: Kuan, 83, Bridge Street. ATTENDANT: That's right. Kuan, 83, Bridge Street. ATTENDANT: Three pounds fifty pence, please. KUAN: Here you are. ATTENDANT: Thank you. KUAN: Hey! ATTENDANT: What's the matter? KUAN: This case doesn't belong to me! You've given me the wrong case!Make questions based on the text: A small blue caseMr Hall: I left a suitcase on the train to London the other day. Attendant: Can you describe it, sir? Mr Hall: It's a small blue case and it's got a zip. There's a label on the handle with my name and address on it. Attendant: Is this case yours? Mr Hall: No, that's not mine. Attendant: What about this one? This one's got a label. Mr Hall: Let me see it. Attendant: What's you name and address? Mr Hall: David Hall,83, Bridge Street. Attendant: That's right. D. N. Hall. 83. Bridge Street. Attendant: Three pound and fifty pence please. Mr Hall: Here you are. Attendant: Thank you. Mr Hall: Hey! Attendant: What's the matter? Mr Hall: This case doesn't belong to me! You've given me the wrong case!1. Laquelle des formes juridiques suivantes offre la meilleure protection du patrimoine personnel de l'entrepreneur ? a) Entreprise individuelle b) SociÃĐtÃĐ c) Association de fait d) Aucune de ces rÃĐponses 2. Quel est l'inconvÃĐnient majeur de l'entreprise individuelle ? a) DifficultÃĐ de crÃĐation b) RÃĐgime fiscal complexe c) ResponsabilitÃĐ illimitÃĐe de l'entrepreneur d) ImpossibilitÃĐ d'avoir des employÃĐs 3. Laquelle des affirmations suivantes concernant la sociÃĐtÃĐ est vraie ? a) Elle n'a pas d'existence juridique propre. b) Le patrimoine des associÃĐs est confondu avec celui de la sociÃĐtÃĐ. c) Elle peut poursuivre ses activitÃĐs mÊme aprÃĻs le dÃĐcÃĻs d'un associÃĐ. d) Elle est toujours soumise à l'impÃīt sur le revenu des personnes physiques. 4. Dans une association de fait, que se passe-t-il en cas de mauvaise gestion financiÃĻre de l'un des associÃĐs ? a) Seul l'associÃĐ responsable est tenu de rembourser les dettes. b) Tous les associÃĐs sont solidairement responsables des dettes. c) L'association est automatiquement dissoute. d) Un tribunal dÃĐsigne un administrateur judiciaire pour gÃĐrer les finances. 5. Lequel des ÃĐlÃĐments suivants est un avantage de la sociÃĐtÃĐ par rapport à l'entreprise individuelle ? a) SimplicitÃĐ de crÃĐation et de gestion b) ResponsabilitÃĐ limitÃĐe des associÃĐs c) ContrÃīle total et dÃĐcisions unilatÃĐrales d) FiscalitÃĐ moins avantageuse 6. Qu'est-ce qu'une personne morale ? a) Un individu exerçant une activitÃĐ commerciale en son nom propre b) Une entitÃĐ juridique distincte de ses membres, dotÃĐe de droits et d'obligations c) Un contrat par lequel deux personnes s'engagent à mettre en commun des biens ou leur travail d) Une forme d'entreprise rÃĐservÃĐe aux professions libÃĐrales 7. Laquelle des affirmations suivantes est vraie concernant l'association de fait ? a) Elle nÃĐcessite la crÃĐation d'une personne morale. b) Elle offre une protection du patrimoine personnel des participants. c) Elle peut Être considÃĐrÃĐe comme une entreprise si elle verse des bÃĐnÃĐfices à ses membres. d) Elle est soumise aux mÊmes obligations comptables que les sociÃĐtÃĐs. 8. Quel est l'un des avantages de la sociÃĐtÃĐ en matiÃĻre de continuitÃĐ d'activitÃĐ ? a) Elle est dissoute automatiquement au dÃĐcÃĻs de son fondateur. b) Elle peut Être facilement transmise aux hÃĐritiers en cas de dÃĐcÃĻs d'un associÃĐ. c) Elle cesse son activitÃĐ si un associÃĐ dÃĐcide de se retirer. d) Elle doit Être liquidÃĐe en cas d'incapacitÃĐ de travail d'un associÃĐ. 9. Lequel des critÃĻres suivants peut influencer le choix entre une entreprise individuelle et une sociÃĐtÃĐ ? a) Le montant du capital initial b) Le nombre d'employÃĐs c) Le secteur d'activitÃĐ d) La volontÃĐ de protÃĐger son patrimoine personnel 10. Quel est l'un des risques majeurs liÃĐs à l'absence de sÃĐparation des patrimoines dans l'entreprise individuelle ? a) La responsabilitÃĐ limitÃĐe de l'entrepreneur b) La saisie du patrimoine personnel en cas de dettes de l'entreprise c) L'impossibilitÃĐ de dÃĐduire les charges professionnelles de ses revenus d) La difficultÃĐ d'obtenir un financement bancaireâThereâs No Such Thing as Sound Scienceâ by By Christie Aschwanden was a lead science writer for FiveThirtyEight. FiveThirtyEight, Science, Dec. 6, 2017 Science is being turned against itself. For decades, its twin ideals of transparency and rigor have been weaponized by those who disagree with results produced by the scientific method. Under the Trump administration, that fight has ramped up again. In a move ostensibly meant to reduce conflicts of interest, Environmental Protection Agency Administrator Scott Pruitt has removed a number of scientists from advisory panels and replaced some of them with representatives from industries that the agency regulates. Like many in the Trump administration, Pruitt has also cast doubt on the reliability of climate science. For instance, in an interview with CNBC, Pruitt said that âmeasuring with precision human activity on the climate is something very challenging to do.â Similarly, Trumpâs pick to head NASA, an agency that oversees a large portion the nationâs climate research, has insisted that research into human influence on climate lacks certainty, and he falsely claimed that âglobal temperatures stopped rising 10 years ago.â Kathleen Hartnett White, Trumpâs nominee to head the White House Council on Environmental Quality, said in a Senate hearing last month that she thinks we âneed to have more precise explanations of the human role and the natural roleâ in climate change. The same entreaties crop up again and again: We need to root out conflicts. We need more precise evidence. What makes these arguments so powerful is that they sound quite similar to the points raised by proponents of a very different call for change thatâs coming from within science. This other movement strives to produce more robust, reproducible findings. Despite having dissimilar goals, the two forces espouse principles that look surprisingly alike: Science needs to be transparent. Results and methods should be openly shared so that outside researchers can independently reproduce and validate them. The methods used to collect and analyze data should be rigorous and clear, and conclusions must be supported by evidence. These are the arguments underlying an âopen scienceâ reform movement that was created, in part, as a response to a âreproducibility crisisâ that has struck some fields of science.1 But theyâre also used as talking points by politicians who are working to make it more difficult for the EPA and other federal agencies to use science in their regulatory decision-making, under the guise of basing policy on âsound science.â Scienceâs virtues are being wielded against it. What distinguishes the two calls for transparency is intent: Whereas the âopen scienceâ movement aims to make science more reliable, reproducible and robust, proponents of âsound scienceâ have historically worked to amplify uncertainty, create doubt and undermine scientific discoveries that threaten their interests. âOur criticisms are founded in a confidence in science,â said Steven Goodman, co-director of the Meta-Research Innovation Center at Stanford and a proponent of open science. âThatâs a fundamental difference â weâre critiquing science to make it better. Others are critiquing it to devalue the approach itself.â Calls to base public policy on âsound scienceâ seem unassailable if you donât know the termâs history. The phrase was adopted by the tobacco industry in the 1990s to counteract mounting evidence linking secondhand smoke to cancer. A 1992 Environmental Protection Agency report identified secondhand smoke as a human carcinogen, and Philip Morris responded by launching an initiative to promote what it called âsound science.â In an internal memo, Philip Morris vice president of corporate affairs Ellen Merlo wrote that the program was designed to âdiscredit the EPA report,â âprevent states and cities, as well as businesses from passing smoking bansâ and âproactivelyâ pass legislation to help their cause. The sound science tactic exploits a fundamental feature of the scientific process: Science does not produce absolute certainty. Contrary to how itâs sometimes represented to the public, science is not a magic wand that turns everything it touches to truth. Instead, itâs a process of uncertainty reduction, much like a game of 20 Questions. Any given study can rarely answer more than one question at a time, and each study usually raises a bunch of new questions in the process of answering old ones. âScience is a process rather than an answer,â said psychologist Alison Ledgerwood of the University of California, Davis. Every answer is provisional and subject to change in the face of new evidence. Itâs not entirely correct to say that âthis study proves this fact,â Ledgerwood said. âWe should be talking instead about how science increases or decreases our confidence in something.â The tobacco industryâs brilliant tactic was to turn this baked-in uncertainty against the scientific enterprise itself. While insisting that they merely wanted to ensure that public policy was based on sound science, tobacco companies defined the term in a way that ensured that no science could ever be sound enough. The only sound science was certain science, which is an impossible standard to achieve. âDoubt is our product,â wrote one employee of the Brown & Williamson tobacco company in a 1969 internal memo. The note went on to say that doubt âis the best means of competing with the âbody of factââ and âestablishing a controversy.â These strategies for undermining inconvenient science were so effective that theyâve served as a sort of playbook for industry interests ever since, said Stanford University science historian Robert Proctor. The sound science push is no longer just Philip Morris sowing doubt about the links between cigarettes and cancer. Itâs also a 1998 action plan by the American Petroleum Institute, Chevron and Exxon Mobil to âinstall uncertaintyâ about the link between greenhouse gas emissions and climate change. Itâs industry-funded groupsâ late-1990s effort to question the science the EPA was using to set fine-particle-pollution air-quality standards that the industry didnât want. And then there was the more recent effort by Dow Chemical to insist on more scientific certainty before banning a pesticide that the EPAâs scientists had deemed risky to children. Now comes a move by the Trump administrationâs EPA to repeal a 2015 rule on wetlands protection by disregarding particular studies. (To name just a few examples.) Doubt merchants arenât pushing for knowledge, theyâre practicing what Proctor has dubbed âagnogenesisâ â the intentional manufacture of ignorance. This ignorance isnât simply the absence of knowing something; itâs a lack of comprehension deliberately created by agents who donât want you to know, Proctor said.2 In the hands of doubt-makers, transparency becomes a rhetorical move. âItâs really difficult as a scientist or policy maker to make a stand against transparency and openness, because well, who would be against it?â said Karen Levy, researcher on information science at Cornell University. But at the same time, âyou can couch everything in the language of transparency and it becomes a powerful weapon.â For instance, when the EPA was preparing to set new limits on particulate pollution in the 1990s, industry groups pushed back against the research and demanded access to primary data (including records that researchers had promised participants would remain confidential) and a reanalysis of the evidence. Their calls succeeded and a new analysis was performed. The reanalysis essentially confirmed the original conclusions, but the process of conducting it delayed the implementation of regulations and cost researchers time and money. Delay is a time-tested strategy. âGridlock is the greatest friend a global warming skeptic has,â said Marc Morano, a prominent critic of global warming research and the executive director of ClimateDepot.com, in the documentary âMerchants of Doubtâ (based on the book by the same name). Moranoâs site is a project of the Committee for a Constructive Tomorrow, which has received funding from the oil and gas industry. âWeâre the negative force. Weâre just trying to stop stuff.â Some of these ploys are getting a fresh boost from Congress. The Data Quality Act (also known as the Information Quality Act) was reportedly written by an industry lobbyist and quietly passed as part of an appropriations bill in 2000. The rule mandates that federal agencies ensure the âquality, objectivity, utility, and integrity of informationâ that they disseminate, though it does little to define what these terms mean. The law also provides a mechanism for citizens and groups to challenge information that they deem inaccurate, including science that they disagree with. âIt was passed in this very quiet way with no explicit debate about it â that should tell you a lot about the real goals,â Levy said. But whatâs most telling about the Data Quality Act is how itâs been used, Levy said. A 2004 Washington Post analysis found that in the 20 months following its implementation, the act was repeatedly used by industry groups to push back against proposed regulations and bog down the decision-making process. Instead of deploying transparency as a fundamental principle that applies to all science, these interests have used transparency as a weapon to attack very particular findings that they would like to eradicate. Now Congress is considering another way to legislate how science is used. The Honest Act, a bill sponsored by Rep. Lamar Smith of Texas,3 is another example of what Levy calls a âTrojan horseâ law that uses the language of transparency as a cover to achieve other political goals. Smithâs legislation would severely limit the kind of evidence the EPA could use for decision-making. Only studies whose raw data and computer codes were publicly available would be allowed for consideration. That might sound perfectly reasonable, and in many cases it is, Goodman said. But sometimes there are good reasons why researchers canât conform to these rules, like when the data contains confidential or sensitive medical information.4 Critics, which include more than a dozen scientific organizations, argue that, in practice, the rules would prevent many studies from being considered in EPA reviews.5 It might seem like an easy task to sort good science from bad, but in reality itâs not so simple. âThereâs a misplaced idea that we can definitively distinguish the good from the not-good science, but itâs all a matter of degree,â said Brian Nosek, executive director of the Center for Open Science. âThere is no perfect study.â Requiring regulators to wait until they have (nonexistent) perfect evidence is essentially âa way of saying, âWe donât want to use evidence for our decision-making,ââ Nosek said. Most scientific controversies arenât about science at all, and once the sides are drawn, more data is unlikely to bring opponents into agreement. Michael Carolan, who researches the sociology of technology and scientific knowledge at Colorado State University, wrote in a 2008 paper about why objective knowledge is not enough to resolve environmental controversies. âWhile these controversies may appear on the surface to rest on disputed questions of fact, beneath often reside differing positions of value; values that can give shape to differing understandings of what âthe factsâ are.â Whatâs needed in these cases isnât more or better science, but mechanisms to bring those hidden values to the forefront of the discussion so that they can be debated transparently. âAs long as we continue down this unabashedly naive road about what science is, and what it is capable of doing, we will continue to fail to reach any sort of meaningful consensus on these matters,â Carolan writes. The dispute over tobacco was never about the science of cigarettesâ link to cancer. It was about whether companies have the right to sell dangerous products and, if so, what obligations they have to the consumers who purchased them. Similarly, the debate over climate change isnât about whether our planet is heating, but about how much responsibility each country and person bears for stopping it. While researching her book âMerchants of Doubt,â science historian Naomi Oreskes found that some of the same people who were defending the tobacco industry as scientific experts were also receiving industry money to deny the role of human activity in global warming. What these issues had in common, she realized, was that they all involved the need for government action. âNone of this is about the science. All of this is a political debate about the role of government,â she said in the documentary. These controversies are really about values, not scientific facts, and acknowledging that would allow us to have more truthful and productive debates. What would that look like in practice? Instead of cherry-picking evidence to support a particular view (and insisting that the science points to a desired action), the various sides could lay out the values they are using to assess the evidence. For instance, in Europe, many decisions are guided by the precautionary principle â a system that values caution in the face of uncertainty and says that when the risks are unclear, it should be up to industries to show that their products and processes are not harmful, rather than requiring the government to prove that they are harmful before they can be regulated. By contrast, U.S. agencies tend to wait for strong evidence of harm before issuing regulations. Both approaches have critics, but the difference between them comes down to priorities: Is it better to exercise caution at the risk of burdening companies and perhaps the economy, or is it more important to avoid potential economic downsides even if it means that sometimes a harmful product or industrial process goes unregulated? In other words, under what circumstances do we agree to act on a risk? How certain do we need to be that the risk is real, and how many people would need to be at risk, and how costly is it to reduce that risk? Those are moral questions, not scientific ones, and openly discussing and identifying these kinds of judgment calls would lead to a more honest debate. Science matters, and we need to do it as rigorously as possible. But science canât tell us how risky is too risky to allow products like cigarettes or potentially harmful pesticides to be sold â those are value judgements that only humans can make. [t comes from the GREEK name "Epilepsia" which means "taking hold of or seizing". - It is a disorder characterized by: recurrent seizures. SEIZURES R ectment transient attacks of: R epresent: R esult from: ASSOCIATED WITH: somatic, psychic, or, autonomic clinical featmes. clinical features of abnormally hyperexcitable cortical neurons. paroxvsmal and excessive electrical neuronal discharges. EEG changes & may be disturbance of consciousness. same causes of convulsions 1. Idiopathic epile~ âĒ It is the commonest cause. no cause can be detected ( 65 % ) âĒ It may be associated with positive family history in some cases. âĒ It starts in the l st & 2nd decades in the form of: -- Grand ma! epilepsy. Petit mal epilepsy. Myoclonic epilepsy. Atonic seizures. 2. Secondary epilepsy A. Local causes in the brain: l. Congenital: 2. Traumatic: cerebral palsy. a cause can be detected cerebral contusion or laceration. 3. Inflammatory: 4. Neoplastic: 5. Degenerative: 6. Vascular: encephalitis, brain tumours. mening1t1s, presenile dementia. brain abscess. stroke (especially hemon-hagic), hypertensive encephalopathy. B. General causes with secondary effects on the brain: I. Toxic: 2. Iatrogenic: 3. Metabolic: 4. Endocrinal: 5. Organ failure: 6. Heart disease: 7. Nutritional: - Alcohol, cocaine, lead. - Lidocaine, INH. - j glucose & ! glucose. - Hypoparathyroidism. - Hepatic failme. - Adam's Stoke's attacks. - Pellagra. - Botulism, tetanus. - Ambilhar, Amphetamine, Aminophylline. - j Ca & ! Ca. - Hype1thyroid crisis. - Renal failure. - Fallot's tetralogy. - j Na & ! Na. - Vitamin B6 deficiency. 8. Physical: 9. HYSTERICAL. - High fevers. - Heat stroke. 136 137 CLINICAL PICTURE 1. GENERALISED SEIZURES " Excessive electrical discharges from cortical neurons in BOTH hemispheres simultaneously " I. II. 1. Grand Mal Epile~: 1. Pre-ictal stage "attacks of tonic-clonic convulsions " (aura) It is a warning sign of a coming attack. It may be: âĒ Somatic: âĒ Psychic: âĒ Autonomic: 2. Ictal stage Myoclonus, Hallucinations. Tachycardia, (seizure) Sudden loss of consciousness: Parasthesias. Sweating. for seconds to minutes. -- Tonic phase (few seconds) o The UL & LL: o o o o The HEAD: The JAWS: CYANOSIS: are extended. is retracted to one side & the eye balls rolled up. are firmly clenched, with biting of the TONGUE. due to impaired respiration. There may be incontinence of urine. Clonic phase (few minutes) o The UL & LL: o The HEAD: 3. Post-ictal stage - It may be: âĒ Somatic: âĒ Psychic: âĒ Autonomic: Drug of choice: contract & relax repeatedly & rapidly. jerks forcibly. (sequelae) Todd's paralysis(< 24 hours, due to neuronal exhaustion). Confusion. Vomiting. Carbamazepine (Tegretol) or Phenytoin (Epanutin) Petit Mal Epilepsy: "attacks of loss of consciousness " " Absence " It starts in childhood & improves at puberty & usually disappears at the age of 20. 2. It is NOT PRECEEDED by aura & NOT FOLLOWED by sequelae. 3. It is usually PRECIPITATED by: hyperventilation 4. It is characterized by: or photic stimulation. sudden loss of consciousness of short duration (few seconds). 5. It may be associated with: âĒ High frequency ( 50 attacks / day). âĒ Falling to the ground without warning. âĒ Jerky movements of the head & UL Drug of choice: (myoclonic petit mal). Valproate (Depakine) or Succinimide (Zarontin) 137 138 Ill. M oclonic Seizures: "attacks of involuntary clonic movements " - It is characterized by: sudden, jerky, shock-like INVOLUNTARY muscle contraction. âĒ The jerks are bilateral contractions, mainly of the shoulders and arms. âĒ However, some patients repmtjerking in the lower limbs, trunk, or head. - It may be of 2 types: - Occurs singly âĒ Simple: âĒ As a pait of: I Drug of choice: IV. Atonic seizures: (no loss of consciousness). - Grand mal epilepsy (aura). - Petit mal epilepsy. Valproate (Depakine) or Clonazepam (Rivotril) I - Transient attacks of brief loss of postural tone, often resulting in falls and injuries. 2. PARTIAL SEIZURES "Excessive electrical discharges from cmtical neurons in a ce1tain area in ONE hemisphere" A. Simple seizures: " No disturbance in consciousness " - The CP depends on the site of the hyperexcitable neurones in the cerebral cortex, whether in: "Motor area or Senso,y areas". 1. Motor fits: âĒ Focal fits: âĒ Motor jacksonian fits: 2. General Sensory fits: âĒ Focal fits: âĒ Sensory jacksonian fits: 3. Special Senso1y fits: âĒ Visual hallucinations: âĒ Auditory hallucinations: âĒ Olfactory hallucinations: B. Complex seizures: - SITE: movement of part of a limb or the whole limb. movement of one side of the body (see before). parasthesia of part of a limb or the whole limb. parasthesia of one side of the body (see before). irritation of the visual sensory area. irritation of the auditory sensory area. initation of the uncus. " disturbance in consciousness " The hyperexcitable neurons are in the Temporal lobe "Temporal lobe epilepsy". - DURATION: The seizure lasts few seconds to few minutes. - The seizure starts with A ura, followed by A bsence, Automatism, Amnesia: 1. 2. 3. 4. A ura: A bsence: Automatism: A mnesia: Olfactory hallucinations, Deja-vu phenomenon, Sensation of fear. Absent patient with staring eyes (with no response to conversation). Involuntary Purposeless acts: motor ( eg, lip smacking, chewing) or verbal. No recalling of the seizure. 138 139 3. PARTIAL SEIZURES ~ GENERALISED SEIZURES " Partial seizures may spread to involve the whole brain .- secondarily generalised seizures " . HY-sterical epilepsY âĒ Usually: âĒ The cause: âĒ Incidence: young neurotic Sj2 . psychological & there is no organic lesion. usually occurs in the presence of people. âĒ It is associated with: âĒ EEG: âĒ It is not associated with: normal. âĒ Missed ttt. âĒ Menses. âĒ Alkalosis. anxiety, palpitaion & hyperventilation. tongue biting or incontinence of urine. âĒ Alcohol use & Drug abuse ( e.g. cocaine ). âĒ S timulation by photons & Hyperventilation. âĒ S leep deprivation & Stress & sudden withdrawal of antiepileptic drngs. INVESTIGATIONS 1. EEG: âĒ It is the most specific test for epilepsy because it records the electrical activity of the brain. âĒ It shows specific pattern: 2. LOCAL INVESTIGATIONS: "Epilepsy waves". "CT & MRI of the brain" âĒ To identify or exclude a LOCAL CAUSE of seizures in the brain. 3. GENERAL INVESTIGATIONS: "Laboratory investigations" âĒ To search for a GENERAL CAUSE of seizures, e.g. blood glucose. 139 140 TREATMENT A. General Measures: 1. 2. Moderation of the patient's physical activity. A void the precipitating factors ( Alcohol, hyperventilation, photic stimulation ...... ). 3. A ketogenic diet is encouraged because it will induce acidosis: - Acidosis is beneficial as it raises the threshold of stimulation of the brain cells. B. Specific Treatment: 2. 1. Treatment of the cause in secondary epilepsy. Anti-epileptic drugs: a) Always sta1t with one drug, then add another drug if there is no response. b) Always stop the drugs ONLY if: âĒ The patient stays free of symptoms for at least 2 years. âĒ The patient has a normal EEG. 3. Side effects of Anti-epileptic drugs: I . Skin rash. 2. 3. Bone marrow depression. Ataxia. Drug 1. Barbiturates (Pbenonobarbitone) 2. Hydantoin (Epanutin) 3. Carbamazepine 4. Clonazepam 5. Valproate 6. Succinamide ANTI-EPILEPTIC DRUGS NEW ANTI-EPILEPTIC DRUGS - These drugs are new dtugs that may be used in resistant seizures. 1. Lamotrigine: 200 - 400 mg/ day. 2. Felbamate: 3. Gabapentin: 400- 800 mg/ day. 600 - 1200 mg/ day. \ " General rules for use ": Dose 100-600 mg I day 100-600 mg / day 200-600 mg I day 2-6 mg I day 500-1500 mg I day 500-1000 mg / day Best indicated - Broad spectrum. - Not for petit mal. - Grand mal. - Motor Jacksonian fits. - Grand mal. - Motor Jacksonian fits. - Complex seizures. - Not for petit ma!. - Myoclonic. - Grand mat. - Broad spectrum. - Petit mat. 140 141 STATUS EPILEPTICUS DEFINITION - A medical emergency: 1. Repeated attacks of generalized convulsions, with lack of recove,y of consciousness, 2. Persistent attack of seizure lasting for at least 30 minutes. OR, - If the convulsions are not stopped rapidly, coma deepens & death may occur due to: heart failure or respiratory failure or brain damage or hyperpyrexia. - The most common causes are: sudden withdrawal of anti-epileptic drugs & stroke. TREATMENT A. General Measures: l. Take care of: " ABC " âĒ Place the patient on the ground, to guard against falling from bed. âĒ Mouth gag & 02 inhalation ( endo-tracheal intubation may be needed). âĒ Record the vital signs regularly. 2. Take a sample of: - Venous blood: for the level of: - A.tierial blood: for the level of: 3. a nti-epileptic drugs, a lcohol. pH, p0 2, pC02, HC0 3. Give cerebral dehydrating measures: e.g. Frusemide, cone. Mannitol, Dexamethazone. B. Specific Treatment: - Phenytoin with diazepam (or clonazepam) immediately: 1. Phenytoin: 2. Diazepam: Clonazepam: seizures recur: 15 mg I Kg slow infusion. 5 mg slowly IV, to be repeated after 5 minutes if seizures recur: maximum dose: 20 mg. OR: 2 mg slowly IV, to be repeated after 5 minutes if maximum dose: 6 mg. - If seizures persist after 20 min. of Phenytoin & diazepam: 3. PHENOBARBITONE: - In resistant cases: 200 mg infusion. 4. GENERAL ANAESTHESIA: may be used.A BAD CASE OF THE STRIPES By David Shannon Parts(18): Camilla Narrator 1 Narrator 2 Narrator 3 Narrator 4 Mr. Harms Mother Father Dr. Bumble Old Woman Environmental Therapist Dr. Grop Dr. Gourd Dr. Sponge Mr. Mellon Dr. Cricket Dr. Young <><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><> Narrator 1: A BAD CASE OF THE STRIPES By David Shannon Narrator 2: Camilla Cream loved lima beans. But she never ate them. Narrator 3: All of her friends hated lima beans, and she wanted to fit in. Camilla always worried about what other people thought of her. Narrator 4: Today she was fretting even more than usual. It was the very first day of school, and she couldn't decide what to wear. There were so many people to impress! Narrator 1: She tried on forty-two outfits, but none seemed quite right. She put on a pretty red dress and looked in the mirror. Then she screamed. Narrator 2: Her mother ran into the room, and she screamed, too. Mother: "Oh my heavens! You're completely covered with stripes!" Narrator 3: she cried. This was certainly true. Camilla was striped from head to toe. She looked like a rainbow. Narrator 4: Mrs. Cream felt Camilla's forehead. Mother: "Do you feel all right?" Narrator 1: she asked. Camilla: "I feel fine, but just look at me!" Narrator 2: Camilla answered. Mother: "You get back in bed this instant. You're not going to school today." Narrator 3: her mother ordered. Camilla was relieved. She didn't want to miss the first day of school, but she was afraid of what the other kids would say. And she had no idea what to wear with those crazy stripes. Narrator 4: That afternoon, Dr. Bumble came to examine Camilla. Dr. Bumble: "Most extraordinary! I've never seen anything like it! Are you having any coughing, sneezing, runny nose, aches, pains, chills, hot flashes, dizziness, drowsiness, shortness of breath, or uncontrollable twitching?" Narrator 1: he asked. Camilla: "No, I feel fine." Narrator 2: Camilla told him. Dr. Bumble: "Well then, I don't see any reason why she shouldn't go to school tomorrow. Here's some ointment that should help clear up those stripes in a few days. If it doesn't, you know where to reach me." Narrator 3: Dr. Bumble said, turning to Mrs. Cream. And off he went. Narrator 4: The next day was a disaster. Everyone at school laughed at Camilla. They called her "Camilla Crayon" and "Night of the Living Lollipop." Narrator 1: She tried her best to act as if everything were normal, but when the class said the Pledge of Allegiance, her stripes turned red, white, and blue, and she broke out in stars! Narrator 2: The other kids thought this was great. One yelled out, Narrator 3: "Let's see some purple polka dots!" Narrator 4: Sure enough, Camilla turned all purple polka-dotty. Someone else shouted, Narrator 1: "Checkerboard!" Narrator 4: and a pattern of squares covered her skin. Soon everyone was calling out different shapes and colors, and poor Camilla was changing faster than you can change channels on a T.V. Narrator 2: That night, Mr. Harms, the school principal, called. Mr. Harms: "I'm sorry, Mrs. Cream, I'm going to have to ask you to keep Camilla home from school. She's just too much of a distraction, and I've been getting phone calls from the other parents. They're afraid those stripes may be contagious." Narrator 3: he said. Camilla was so embarrassed. She couldn't believe that two days ago everyone liked her. Now, nobody wanted to be in the same room with her. Narrator 1: Her father tried to make her feel better. Father: "Is there anything I can get you, sweetheart?" Narrator 2: he asked. Camilla: "No, thank you," Narrator 3: sighed Camilla. What she really wanted was a nice plate of lima beans, but she had been laughed at enough for one day. Dr. Bumble: "Hmm, well, yes, I see. I think I'd better bring in the Specialists. We'll be right over.â Narrator 4: said Dr. Bumble to Mr. Cream on the phone. About an hour later, Dr. Bumble arrived with four people in long white coats. He introduced them to the Creams. Dr. Bumble: "This is Dr. Grop, Dr. Sponge, Dr. Cricket, and Dr. Young." Narrator 1: Then the Specialists went to work on Camilla. They squeezed and jabbed, tapped and tested. It was very uncomfortable. Dr. Grop: "Well, it's not the mumps." Dr. Sponge: "Or the measles." Dr. Cricket:"Definitely not chicken pox." Dr. Young: "Or sunburn." Narrator 2: replied the Specialists. Specialists:"Try these. Take one of each before bed." Narrator 4: said the specialists. They each handed her a bottle filled with different colored pills. Then they filed out the front door followed by Dr. Bumble. Narrator 1: That night, Camilla took her medicine. It was awful. Narrator 2: When she woke up the next morning, she did feel different, but when she got dressed, her clothes didn't fit right. She looked in the mirror, and there, staring back at her, was a giant, multi-colored pill with a face on it. Narrator 3: Dr. Bumble rushed over as soon as Mrs. Cream called. But this time, instead of the Specialists, he brought the Experts. Narrator 4: Dr. Gourd and Mr. Mellon were the finest scientific minds in the land. Once again, Camilla was poked and prodded, looked at and listened to. Narrator 1: The Experts wrote down lots of numbers. Then they huddled together and whispered. Dr. Gourd finally spoke. Dr. Gourd: "It might be a virus," Narrator 2: he announced with authority. Suddenly, fuzzy little virus balls appeared all over Camilla. Mr. Mellon: "Or possibly some form of bacteria," Narrator 3: said Mr. Mellon. Out popped squiggly little bacteria tails. Dr. Gourd: "Or it could be a fungus," Narrator 4: added Dr. Gourd. Instantly, Camilla was covered with different colored fungus blotches. The experts looked at Camilla, then each other. Experts: "We need to go over these numbers again back at the lab. Weâll call you when we know something," Narrator 1: said the Experts. But the Experts didn't have a clue, much less a cure. Narrator 2: By now, the T.V. news had found out about Camilla. Reporters from every channel were outside her house, telling the story of "The Bizarre Case of the Incredible Changing Kid." Narrator 3: Soon a huge crowd was camped out on the front lawn. Narrator 4: The Creams were swamped with all kinds of remedies from psychologists, allergists, herbalists, nutritionists, psychics, an old medicine man, a guru, and even a veterinarian. Narrator 1: Each so-called cure only added to poor Camilla's strange appearance until it was hard to even recognize her. She sprouted roots and berries and crystals and feathers and a long furry tail. But nothing worked. Narrator 2: One day, a woman who called herself an Environmental Therapist claimed she could cure Camilla. She said, Environmental Therapist: "Close your eyes, breathe deeply, and become one with your room." Camilla: "I wish you hadn't said that," Narrator 3: Camilla groaned. Slowly, she started to melt into the walls of her room. Her bed became her mouth, her nose was a dresser, and two paintings were her eyes. The therapist screamed and ran from the house. Mother: "What are we going to do? It just keeps getting worse and worse!" Narrator 4: cried Mrs. Cream. She began to sob. Narrator 1: At that moment, Mr. Cream heard a quiet little knock at the front door. He opened it, and there stood an old woman who was just as plump and sweet as a strawberry. Old Woman: "Excuse me, but I think I can help." Narrator 2: she said brightly. Narrator 3: She went into Camilla's room and looked around. Old Woman: "My goodness, what we have here is a bad case of the stripes. One of the worst I've ever seen!" Narrator 4: she said with a shake of her head. She pulled a container of small green beans from her bag. She said, Old Woman: "Here. These might do the trick." Mother: "Are those magic beans?" Narrator 1: asked Mrs. Cream. The old woman replied, Old Woman: "Oh my, no, there's no such thing. These are just plain old lima beans. I'll bet you'd like some, wouldn't you?" Narrator 2: she asked Camilla. Camilla wanted a big, heaping plateful of lima beans more than just about anything, but she was still afraid to admit it. She said, Camilla: "Yuck! No one likes lima beans, especially me!" Old Woman: "Oh, dear, I guess I was wrong about you." Narrator 3: said the old woman sadly. She put the beans back in her bag and started toward the door. Narrator 4: Camilla watched the old woman walk away. Those beans would taste so good. And being laughed at for eating them was nothing, compared to what she'd been going through. She finally couldn't stand it. Camilla: "Wait! The truth is...I really love lima beans." Narrator 1: she cried. The old woman smiled, popping a handful of beans into Camilla's mouth, and said, Old Woman: "I thought so." Camilla: "Mmmmmmm," Narrator 2: said Camilla. Suddenly the branches, feathers, and squiggly tails began to disappear.Then the whole room swirled around. When it stopped, there stood Camilla, and everything was back to normal. Camilla: "I'm cured!" Narrator 3: she shouted. The old woman said, Old Woman: "Yes, I knew the real you was in there somewhere." Narrator 4: She patted Camilla on the head and went outside and vanished into the crowd. Narrator 1: Afterward, Camilla wasn't quite the same. Narrator 2: Some of the kids at school said she was weird, but she didn't care a bit. Narrator 3: She ate all the lima beans she wanted, and she never had even a touch of stripes again. A: Do you have anything to declare? B: No, I don't. A: Do you have more than $10,000 in cash or the equivalent in foreign currency? B: No, all I have is $500. A: That's fine. Please continue to the exit. B: Thank you. A: Do you have anything to declare? B:No, no. A: Do you have more than $10,000 in cash or the equivalent in foreign currency? B: No. I only have $500. A: Okay, you can go to the exit now. B: Thanks.Into the Sea What Is Erosion? Have you ever made a sand castle at the beach? You must pick a good spot for it. If it is too close to the water, waves will quickly wash it away. Ocean waves and wind can also wash away land. They can change the shape of an island, which is land circled by water. When wind and water change the shape of Earth, it is called erosion. Waves are the biggest cause of erosion at the beach. Ocean waves are always active and moving onto the shore. They carry the sand away bit by bit. Strong waves are one of the properties of big storms. These waves explode as they crash onto the beach. Storm waves can move a lot of sand quickly. Erosion of Beaches. Some people build houses near the ocean. Waves take away the sand between the houses and the sea. As the beach disappears, the water gets closer to houses and other solid buildings on the beach. Some buildings can even be washed away. Erosion of Rocks. Erosion also happens on steep, rocky cliffs or sharp slopes. First, waves smash into the bottom of the cliffs. Then they carry away tiny pieces of rock. Over time, many small pieces of rock wash away from the bottom of the cliff. This makes the top of the cliff weak.The cliff can crumble and fall into the sea. Stopping Erosion. Some local communities work to stop erosion to nearby beaches. These towns have built sea walls of large boulders or rocks. The rocks are placed in a row in the sea. When waves hit the sea wall, they slow down. Then the waves can't pull sand away.Some towns make rules about buildings on the beach. New buildings must be far from the water. Then they won't wash away like a sand castle.