fI a remg elcl or oaismct lelc dha het iingroal tmaot,iun nthe s'trehe na secenardi rski orf nccaer ni rtoeh trasp fo the ydob It. ofo ylno rlietna cllse ni oen eye si tu,adtme ynlo tath eno eye si at srki ofr cncr.ae

ohicCroin lilvi gnmpsila is eht tgnaik fo cgeenti latimare ithiwn ni teh riociocnh ilivl of the ecnpt.laa oihnrociC gsilpmna si oden ewhn a tiapten is ta ghih isrk orf mhooocrmals amnribtioelsa rsopui(ve .ops es,stt o3y5 or lroe,d mfiayl )hx. driugn eht 3-110 esekw of ren.pgacyn

iCdnnfeo cpantaell maomcsiis uesslrt hnwe eth .CSV.. tsetngi oscme cabk bkca hoigswn a ryti,mos utb lal eetssuubqn netgits (dan eth fuste lfs)eit aevh amnolr mchlooromas c.touns sTih aym eb ued to ereiht a tlctoisobaprh tmniutao, or yb icimosrt" rusce,"e in ihcwh soitrmci lelcs that eerw suspdoep to eb in het etufs are ofncdnie to eht ptanlace ot etrnepv an ramlnbao .efuts

So I heta isht tnqiesou sbaecue uoy nac owkn ahwt the gssoaiind is nda lltsi smis i.t

D;TRL: Tish is aeld ioiginsopn, os theer is hpslioiacb iigpsntpl in a pihplaeerr obdol smaer TU[B rnigde stresalbdosi uwodl oasl eb onfud ni eth enob mrrw]oa

yhW hsti si edal pigis:onno 202A0F( p425)

• yocrticcMi Ainmea duae(cs by aeld nbiiiiohtn fo erlfheaoscrete adn LAA )dhedeastyra
• tnlErnnioevam ouexreps muoiiman(tn at eth n,erag eh si na f)cfoier
• IG fstfece amyrcp( ilanbmdoa )npai
• alerliuNgoco cfetsef ahad,(eche ,ibiriraytlti aidbt,carslitity eou,fftrgl ootmr eswsenka)

hyW it si TON het thero arwnse:s

• uerA ords - chatstecarciri fo cteua oengsuolyme kiuelaem chwhi dulwo srepten wtih cysopnpaaiten i(sh WBCs ear an)olrm ongla wthi tlcncauirgi symlolbaest no irhplepera ;smear ideanm age tenos 65 yeras and he sah no risk socaftr
• lvaO Mcrtacyeso - in yircmotcac niasema (B21 or alefto nyeccei)ifd, hsit is cccyoritmi as adcdiinte yb VMC
• hrmooePplci hymscoypetl - rcouc ni chronci yhylpiotmcc eamklesui nad tucisfinoe omon, boht hwhic vhae fterfndei sylgttoiomomspoe
• idengR srsbsidaotel - era rmof dela ipgnnosio tbu are in het nobe warmor
• eostcsicSyt - echrratsctciia RBC whhci hsa eenb tuorhhg a cdlggoe eselsv and eardhse ,fof fuond ni oapthaocgniicmri omlycihte ameiasn AsH)A(M ikel obcrittmho sahtonagcrimpiioe klei TPT and HSU yllc(itpya cnyrcimoot miaean nad niffteerd tnintpreeso;a a nsoieuqt lowud iellyk giev oyu rmeo onif on teh cmhoilbytort thwyapa fi teyh daewnt uoy to ohoecs hi;st we nddt'i even get a aeltpelt tcuno he)er
• rTaget lelC:s dnouf ni bHC eiessda ciltga(mu diac to nlesyi ni oilmg,nehob cuseas aseuvarlaxrct h)l,sseyiom ilrev issee,da iesapnl,a dan aaTilmhssae toisd(neel ni ihtree plaha ro eabt ahnci of ingalme,hob cssuea aeanim hatt dlowu be sneerpt rfom dhdchiolo adn ldwou nto heav runoe mptmsys)o

oS ohltaguh oMotlpssiro ODSE nreieacs umusc trncoodipu dan si g-tttoaoriespevrc d(na ni AF dsoe satte ttah it aecessedr cadi orp,)tciudno ryteebh snregidcea spomymst nad giaind in g,nlieah marolzepoe si teh rmoe" cetr"cor .ehcioc shTi is eesbcua oeeolrmpaz si a to-pnppromu ioinithbr, hhicw lliw cta rldcyite on teh otrnpo smppu of eht amsthoc nad ecaedres eht iefnfdgno agten eomr anht teh orossilotpm will. hefrTeer,o ti is eth rfits niel urdg ofr .DEGR

Thsi epitatn is gtieernspn ithw whit IESMT FA120(9 p,1)03 usht the erenti eslvse tmsu be odc.deluc ronaroCy moapsasvs iva 1a aliotitmuns icneas(der sotmoh meslcu ranooicnc)tt wdolu dlea ot eesth fdini.ngs

sA afr sa teh riotn e,sactp I knhit itsh uldco be firegnrre to pt hrsityo of hmiicsce htare seea,sdi nad eht irasneco fo ynrrcaoo ltaes, vrewohe I tdno' tnhik uyo ouwld ened thta to areswn hist nisutoqe a(nd I odclu be ongig ndow an nsrcuneayes bbrita oehl of rm)ise.y

rhtOe hleplfu eagsp are F2A109 3,8p2 1a cpiyshmtate uotmtlnaisi tsurels in iarenecds vraclsua soothm uesmlc .ncrtaoontic

,tsLa big usp ot teh brothre rof nstegti ramutesgn siead nda sllit igtnka ish omreanh ot teh ycnmereeg tadrmtp.een ehPraps eyht reew ggauinr ta woh npdoresde ot -VDC1I9O nad dalceim neatcioud eswro: LMSUE ro .itPcerrmo

iThs si my bset titroineneptra itwh a osrceu and aagpaprhr frmo teh seuocr tilsd:e

In e,mnaia hnbmieogol aiveaalbl si deeasdcre. hiTs uceass eddcresae gnoxye ingnbdi, and ytltleiaum ssel gyenox is belaaaliv for eraesle oton su.iests

• P2aO ilwl eb l-haronism sbeeuca hte aeatlirr dlboo lwli lslti beaiuteqlri in teh lgnsu veen uohthg het obieolngmh niidgbn si erdaesced khnit( fo CO pnoioisng wehre O2aP kolos onlr.a)m
• tieraAlr O2 cnoentt si ulacylat seddceear bsuaeec rteeh si sels xygeno talto vbiaaaell le(ss oinbgleohm nudbo to )goynex
• dxieM nsveuo 2O tnnetco )(% si aedsrceed fro a liirsma nsoera adn saol rfo het saoren itelds bwoel
• uesnoV OP2 is tsighyll adredeecs eacseub etehr is rghihe yxnoge natrtcixoe at tiessus eud ot the ryaoesomcptn snhaicsmme orfm lses toalt O2 egbin eeedlrdvi dan sles 2O geinb undladoe cei(ns eehrt si slse lmiohnaegb ubdon O2 ni eth first aclep ni nmaeia)
• COP2 si srman-loih ofr smiarli sosnrea ot teh frsti lelutb

"The itluacrorcy jdstmetsnua ni osrpnees ot ieaamn lliw be lmirsia ot etosh of hte nirpeecdg c.ase In redor ot nmanaiti usstie ygxeon pnsoniucotm ta ebisenla levlse doictseaas hwit a nralom nogyex icryrnga pctaiayc of lo,obd teh rdoticneu in neyogx ydreliev lilw deal ot an saneeric in laiarpycl i,unesfrpo nad exoygn txnrciaoet ilwl asiecn.re oaiAlrtrer dnoltaii dan coitsvyis dtneicrou or(f hte seca of a rtdconeui ni H)tc lwli eusca bdolo oflw dna exongy deleivyr ot eneari.cs othB eoyxgn nrtexotcia nad gneoyx idyrevle liwl nteuocin ot seecnair utiln eth exngyo nreieeqsturm of het seuists are met ro tunli eth ayaictpc to cseiarne geynox atxncetori adn lervdiye ahs eben ed.hrcea heT lugsritne uasitnito is one ni wchhi oesuvn nyeogx nenctto and P2vO rae ssle hant .rlonam nceSi 2PaO si aornlm rof lal hte imecan itnsouitas idnedrsoe,c tish etdcfe si not dneses by the orstriyaerp cheoote.cpesmrr Tu,hs riecgasinn eth idrneisp nxegyo coitnrfa si tno hpfleul cxetep fro teh asec fo CO ogps,ionin erhwe ighh idnsepir yxgneo ..,e(g 1%00 eynoxg ta biatenm otraremcib erupsrse or pclmetnae fo het uscjbte toin a iayrbhcper bchrma)e pcmsoeet wtih CO idbnign ta eth heme iset la(lcer lnas'daeH srtfi )wal". - pN1it/w.//ovnh.4hg.lBKnstks/m53woc./bnb1:iow

fAetr the 4DC+ lelsc oebcme t,edcfnei the 8C+D lcesl klil .emht

ncieS eth fshreat' ingibsl si fadetf,ec we wkno tath teh fter'has naetprs are hbot ecars.rir Ttah asnem teh loisbspe geytospen fo eth aethfr era A,A ,Aa a,A ro .aa

We okwn eth feahtr is tenfaduce,f os hatt nemas eh tannoc be a,a dna tsum be itereh A,A Aa, ro .aA

nieSc reteh ear yoln 3 ifefdrtne ntyogeeps eh ulocd avhe, ithw 2 fo meth ingeb rrreaci yes,peogtn tehre is a 32/ tloypbriabi he si a recr.ira

oS ew nbitao hte blyoriiapbt of het tarefh aissgpn on a esseiverc lellae as 2/3 ilpbtibyaro( of negib a rai)rerc x /12 tyaibrb(lopi fo sipasng no a eecrsisev eelall fi eh is a er.cirra) The 3/2 is ont avrelnte ot the itblaorpiby tath teh mtroeh is a raire.cr

eW nowk het fneueqcry fo ctdefafe davnluiiisd ni teh oaoltniupp ta aerlg is /,000140 (=,)2q^ os 1.20/0q=

q=+,1P so 092/1p09= dan .p)0291/(=0)0212(q290/

To akme totpiiiculnalm iserea ew amsuse 2=19090/,1 :os

/0)p12*=2q200101(/= -;t&g- siht is the ierrrac urenefyqc ak..(a., esoe)zehogtyrt ni the olat,niopup hicwh we acn musesa for eht eh.romt

oS, ot erwsan eht etnrie iqeousnt ew utpmiyll the tbolipraiyb htta raehft si a ecrarri /3)2( and psssea on teh laleel (/2)1 iesmt teh pyabotrliib atht thmroe si a rerraci 01)/1(0 nad psseas no eht leleal 2)1/(; tptingu it all togrhtee we h:eav

2(/1)//(*21)031(*()2/)01* = 002/21 = 16/00

LT:DR; Tsih is Ewign saoamrc seubcea ti si a ygnuo oyb iwht lslam lbue lecl bone mtruo in teh diaspsyhi of eht mufre

winEg crasmoa si a latmnnaig beon rmtuo mcnomo ni ynoug byos .&y;ot.51l patilycly fnduo in teh pdaehissi dd)ile(m fo nlog sbeon rr(iltlaupayc me)urf or eplcvi tfal senob. tI si a asmll ulbe clel ,mtuor nmagein het sdrcoetpir fo lamsl, ,nmrufoi imhortccyeaprh lelsc hiwt hihg asecytps:nlcmouul oar.it It olas ash na onn"oi nks"i aieeotprls raociten ni teh eobn bidsrde(ce as tussie nourresudd yb nintreccco aeyrls of ietarevc noeb in hte euso)q.tni toN eontendim si the tcainsoosai wtih 112;t.2() [AF 2020 p 46]4

hWy eth eosrth rea r:onwg

• moorCsarndcoah is a rtomu of lnitaangm ensyortohcdc g)i(alacte nda uodfn amiyln in eth vpisel, apliormx veer,f dan hsmreuu
• iloEicsphino raauomngl si si a rae,r negbni -urmlkiteo risdoerd creeactihdarz yb llonca itriaolopenfr of rnehsagaLn ecsll nda the smot nmocmo rtanevi of gLresnhnaa elcl ysltWscuoooiihdti.s yllike yas ishgtomen tuboa beBrkci nleusarg ni eth setm adn lwoud vahe eaiosastdc oyspsmtm cush as rhas F[A 0220 34]p4
• eltpulMi melmoya si a lpmsaa ecll asdicrysa A[F 2200 p]143 whit uiocdtopvroenr fo )(lpaycyilt .IgG rtcsihtCcaarsei uldceni ARCB - arcilapey,ehmC nRlae ,lnmteenovvi mni,eAa ckBanB/eo apin ude to dchpneu uot tcyli enob eslisno (ptycylial fo the se)pni
• /bihaslrlos'pmeNaWomt ruTmo is eht stmo mcmono arenl anglincyam of eylar dolohidhc and eesptnsr sa a knlfa msas [AF 2020 p 606]
• rsaOemtaocso or( ctneeooisg )oascmra is a aiyrmpr eobn ruomt oncmom in nme tl&;20. tI si lyytiapcl nofdu in the ypsthasemi si)(tp fo olng obns.e itysHlgoo shows imepholioprc tedoios rdiucgopn l.slec nO -arXy oyu loduw lyeniopltat see a oamdnC aengtilr loniv(etea fo )ueetiopsrm or ussrtubn eratnpt
• lSmal hytlipocycm plymamoh si teasynliesl the eams tghin as nochric yplthmyicco kuelamie. tI si dncdeirose a ogiod-nkHnn mlpahyom fo cBlle-s dna het tsmo cmoonm keliameu of tdalus (sa C.LL) Segdum lcsel oluwd leliky be snee no lerhprepai dbool asmre. It would ont eyllik entsrpe as an oesycoiltt eilsno adn si inlykeul in rild.hnce [020A2F 3]4p2

ibtliyIna to nnaimiat na noeercit = lecrteie ntonifyucds. oS wno hte ontueqsi si ?yW""h

Ftu,geai iftdcyiufl enligeps, fliitcyufd cnncatierontg si gintarts to odnsu like sirneoepds. ifDiytlf"uc anng"icncttreo mghti eb itpdereetrn as arimiped uxeeetvci ctonnufi ro hte sgngebiinn fo uaedaevralscrlt- taenmeid tnmdeia(e rdaeelt to mlals tub ruomusen bleaerrc ,st)rfainc utb on tSep 1 eitdamne llwi be abtatnl e.(.i, o"lts his yaw m"e,oh ndagrein","w e.)c.t

sDrseinpeo si utyallca nmoocm aefrt a dtaibleiingt tenev lkie ,toesrk as ouy hitmg tex.ecp Whti epireodssn ecmos a sols of exalsu stteneri nda edthaitr—es si reeceadsd ioidlb.

neO anc akme eht ageunmrt ttah a raulasv"c i"antpet itghm vhae msoe esissu thwi hsi p"pe"si (scoies,relraotirs /herttaatatsiyiampypmhpcsce nyctdofu)nis ,and for stih ,nrosea alnutrcno onetceir hsdulo be dsecredea; tub onte htta ionhgtn is oenmtiend aotbu -gdgnontisaln acsravlu dsiaese on( xh of none)rhet.yspi

As a ,esrtul het etbs sranwe cocieh ereh is C. Lbdoii( adesreedc utb nuctaolnr ncetoeirs an.rolm) heT gib otquesin I veha i,s ohw eht kche seod shti ugy wkno s'eh hdra enhw hs'e e?!p!slea p:

M:E I hntik I ianlyfl vaeh eetsh pdtsui oergsta dessidrro wdno

MBEN: toN os ,stfa rpnatre