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Managerial accounting case study, the case discusses Alaknanda Ghaati Shilpi Federation (AAGAAS), a non-profit organization in a small town in the Chamoli district of Uttarakhand, a state in northern India. It discusses how AAGAAS aimed at development in the region through the promotion of sustainable livelihoods aimed at creating a resilient community. The organization also set up a bio-diversity park with the stated objective of promoting bio tourism as a livelihood alternative for the local communities. However, the tragedy that took place at Uttarakhand in June 2013 challenged AAGAAS. This tragedy challenged Maithani to sustain the organization which was already engaged in local craft promotion and many other initiatives for community development including sustainable livelihoods.

Maithani was facing a shortage of funds along with lack of skilled manpower. He wondered whether it was feasible to transform his organization into a for-profit organisation but was skeptical about the transformation in light of the recent tragedy. However, he wondered what would be a viable business model that could generate sustainable livelihood options for the poor while at the same time helping to conserve the fragile ecosystem of the region.

Question 52 How common is it for someone suffering a transient ischaemic attack (TIA) to totally lose consciousness? Also, what is the mechanism for losing consciousness with a TIA? Question 53 What should the management be for a stenosis in the carotid artery causing transient ischaemic attack (TIA), and when is surgery recommended? Question 54 In a patient with central retinal artery branch occlusion with carotid artery stenosis, what is the best management: warfarin, aspirin or carotid endarterectomy? Question 55 If a young patient who has suffered a stroke has a normal mental state, would this exclude a cerebral venous occlusion as an aetiology? Question 56 Does persistent hiccough following cerebrovascular ischaemic stroke localize to the medulla or to any other site? Question 57 By what mechanism is vertebrobasilar insufficiency associated with circumoral numbness? Question 58 Why does lateral medullary syndrome result in ipsilateral diplopia due to cranial nerve VI Question 59 I have seen many established ischaemic stroke patients with CTdocumented capsular infarction and hemi-hypotonia despite exaggerated reflexes. How would you explain the hypotonia? Could it be due to a corticorubral fibre lesion? Question 60 Thrombolytic therapy is used in patients with a cerebral infarct within the first 3 hours, whereas stroke by definition lasts 24 hours. So how do we define that it is infarct and not a transient ischaemic attack (TIA) on a CT scan within the first 3 hours in order to start tissue plasminogen activator (tPA) treatment? Question 61 I want to ask something about cerebrovascular accident (CVA). Can you please tell me how we can rapidly pinpoint the exact anatomical site of the neurological deficit using physical findings in the emergency room? Question 62 Why do you treat dissection of the carotid artery with an anticoagulant in the acute management of stroke secondary to dissection? To me this seems paradoxical as it would increase the severity of dissection.