SD PA HOURS SEP20 CALCULNS

 

WINTER JASMINE 

POMEGRANATE

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prehistoric cognitive revolution that saw an explosion of inventions was driven by a new, pattern-seeking network in the brain – and that’s highly correlated with autism today,

WINTER 26 WEEKS- RM 14 does some on call shifts

LONG DAYS- COMMENTS – MISSING WK3-MON TUES-RM (1.2 x 2=2.4 every other 13 wk cycle)

                                                     , WK8- SAT( 4.1 pa every other 13 week cycle) -RM= 

WK2- WED  THURS

WK8- FRI

WK9-SUN

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WK15-WED THURS

WK16-MON TUES

WK21-FRI SAT

WK22-SUN

 

TWILIGHT-

WK 3-SAT

WK 4- SUN

WK 5- MON TUES WED THURS FRI

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WK16- SAT

WK17-SUN

WK18- MON TUES WED THURS FRI

 

N1- WARD NIGHT

WK 1 – SUN

WK 6- MON TUES WED THURS

Wk13-FRI SAT

WK14- SUN

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WK13-FRI SAT

WK14-SUN

WK19-MON TUES WED THURS

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WK26-FRI SAT

 

N2-PDU NIGHT

WK7- SAT- (FRI MISSED – 4 pa DONE BY RM)

WK8-SUN

WK10-MON TUES WED THURS

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WK20-FRI SAT

WK21-SUN

WK23-WED THURS (MON-TUES-MISSED –8 pa DONE BY RM)

 

 

SUMMER-26 WEEKS –DOES RM DO SOME ON CALL SHIFTS , WHAT SLOT?

LONG DAYS

WK2- WED THURS

WK3-MON TUES

WK8-FRI SAT

WK9-SUN

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WK15-WED THURS

WK16-MON TUES

WK21-FRI SAT

WK22-SUN

 

TWILIGHT

WK3-SAT

WK4-SUN

WK5-MON TUES WED THURS FRI

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WK16-SAT

WK17-SUN

WK18-MON TUES WED THURS

 

N1- WARD NIGHT

WK6-MON TUES WED THURS

WK13-FRI SAT

WK14-SUN

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WK19-MON TUES WED THURS

WK26-FRI SAT SUN (NEXT WK)

 

N2-PDU NIGHT

WK7-FRI SAT

WK8-SUN

WK10- MON TUES WED THURS

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NO N2 IN 4^TH CYCLE

 

SHORT DAYS- 68 WINTER AND 77 SUMMER

 

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https://www.bma.org.uk/advice/ employment/contracts/sas-contr acts/working-on-call

					PA/wk
N1  Nights-1 wk			pa		2.2
	MTWThSn	2030-0700 0700-0900	10.5/3=3.5 2/3=0.6 ie 4.1  4.1 X 5=20.5
	FSt	2030-0900 (BT)	4.1 x2=8.4	28.9 over 13 wk cycle=2.2
Twilight -1 wk	Weekdays MTWThF	1430-1900 1900-2230	5.62 5.93 =11.5		1.5
	TW StSn	1000-2200	8	19.5 over 13 wk cycles=1,5
Long Days-1 wk	Weekdays MTWThF	1630-1900 1900-2100	0.6 x 5=3 0.7x5=3.5 total 6.5		1.1 >corrected RM now 0.9
	Weekend StSn	0830-2100	4.1 x2=8.2	14.7 pa over 13 week =	Note RM takes over some days  TBC MISSING WK3-MON TUES-RM (1.2 x 2=2.4 every other 13 wk cycle)                                                      , WK8- SAT( 4.1 pa every other 13 week cycle) -RM= she does 6.5 pa in 26 wk cycles -correcting this 1.1 x 26 =28.6 minus 6.5 pa = div by 26 is 0.9
N2 PDU-1 wk	MTWThSn	2030-0700 0700-0830	10.5/3=3.5 1.5/4=0.4 ie 3.9 x 5=19.5	27.5 over 13 wk cycle=2.1  now 2.1 x 39 then div by 52 =1.7	1.7.> RM corrected 1.2
	FSt	2030-0830	12/3=4 x2 =8		RM correction 12 pa over 26 wk cycle
NWD	MTWThF	0830-1630	68+77=145/4= 36.2 SWD minus 8.5 al days =55.4 pa/11=5		5 pa
As part of prospective cover
	Annualised on calls ie nights, TW,LD	2.2 1.5 0.9 1.2 = 5.8 x 52 =301.6then divide by 42 =7,1

VAXN AFTER 1.5 MN PPL DTH X COVID 19

CCC DV X CLOSED SPACES X CROWDED SPACES X CLOSE CONTACT X DURATION IN THESE RISKY SPACES X VOLUME OF CONVERSATION SINGING

 

South Philippine Dwarf Kingfisher.

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FAV REDUCES DM2 RISK X ROAD NOVDECJAN X BB ANOON CRM TV SERIES X NON EXCLUSIVE RELN WITH TRUTH

 

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B MIND

they reminded me that of the 3 gems of refuge (Buddha, Dharma, and Sangha) really what we are taking refuge in is the Dharma. The teachings that lead us to enlightenment, to freedom from our suffering. A Buddha is one that has practiced these teachings and reached the end goal, so when you making offerings to a statue of a Buddha it's not to worship a metal statue, but to mentally train in appreciation/gratitude for ones that have done the hard work to reach an end goal we wish we (and others) could achieve. In that way you're making offerings to reinforce what you wish in your mind.

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You can offer to any Buddhas, a statue is a representation, you can take it to represent all buddhas too. When I say buddha, there's no need to tie it to one buddha or another, it should apply generally, but in most cases, we have to see context. Historically, it should be Shakyamuni, even the see buddha, see dhamma teaching is by him. Although some teachers will be very guarded and insist on only shakyamuni buddha or some other ones

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CHAPMAN PEAK S AF

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BG 2.56: One whose mind remains undisturbed amidst misery, who does not crave for pleasure, and who is free from attachment, fear, and anger, is called a sage of steady wisdom.

CBNAD STONE X HKHKKKHH  HRHRRRHH

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FISH MOST ABUSED ANIMAL ON EARTH X OWN SELF FIRST VICTIM OF OWN ANGER X SOIL -SKIN OF EARTH

 

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URSIFORM

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WHITE ROT FUNGUS ON LEAF-  TANNINS RELEASED- ANIMALS WONT EAT THEM

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ORGANIC MATTER- HUMUS

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250 K EARTHWORMS IN 1 HECTARE OF LAND

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PKZN 

KD children with a high CRP/Alb ratio (≥2.94) had a higher incidence rate of CAL and IVIG resistance than those with a low CRP/Alb ratio (<2.94)

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Give yourself permission to immediately walk away from anything that gives you bad vibes. There is no need to explain or make sense of it. Just trust what you feel."

-- Author Unknown

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PKZN 

Sepsis, defined as life-threatening organ dysfunction resulting from dysregulated host response to infection, affects over 25 million children every year, causing an estimated 3 million deaths in neonates, children and adolescents globally

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The life-time incidence of sepsis is strongly age-dependent, with highest rates observed in preterm neonates, followed by neonates, infants, and children (2).

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In children, sepsis most commonly occurs in the community and the timing when parents seek medical care may influence disease severity and outcomes.

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LOSW SN TV X THIS FAR AND NO FARTHER

 

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PKZN

Fever and blistering rash in a child

A 3-year-old female presented to the ER with fevers and a worsening blistering skin rash. Two weeks prior to presentation, she was seen by her pediatrician for five days of fever to a Tm of 104, as well as small blisters on her hands and feet. She was diagnosed with coxsackie virus, and her fevers began to improve, becoming more intermittent and lower-grade. However, her rash continued to worsen until she had multiple large, painful, fluid-filled blisters, and her mother brought her to the ER for a second opinion. She had no significant past medical or family history, and no other complaints. On exam, she was ill-appearing, with tender bullous lesions on her hands, feet, and the helices of both ears. She was febrile to 101 and slightly tachycardic, with otherwise normal vital signs. Initial labwork was significant for a hemoglobin of 8.1 and an ESR of 145, with negative COVID PCR and antibody. She was admitted for further workup, where she was found to have elevated immunoglobulins, positive ANA, Ro and Sm antibodies, and low C3 and C4. Infectious workup was negative. A biopsy was performed, and the presumed diagnosis was confirmed. What do you think the diagnosis is?

Thank you everyone for the comments! As some of you suggested, the correct diagnosis is BULLOUS SYSTEMIC LUPUS ERYTHEMATOSUS (BSLE). BSLE is an acute vesiculobullous skin eruption in a patient with SLE. Though most patients have known SLE at the time of the skin eruption, there are reports of bullous rash being the initial presentation of lupus, particularly in pediatric and adolescent patients. Lupus is very rare in a child of this age, and often has a genetic component. This particular patient was found to have a compliment deficiency. She was initially treated with prednisone and dapsone, with resolution of her skin lesions, though she did have some residual scarring. She is currently doing well on belimumab with good control of her underlying SLE.

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