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K
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rticle
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d
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CC B
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li
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se
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C
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p
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ing
A
uth
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:
W
a
rsi
M
a
r
y
a
ti
He
a
lt
h
S
c
ien
c
e
F
a
c
u
lt
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Un
iv
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Du
ta Ba
n
g
sa
Jl.
K.H.
S
a
m
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n
h
u
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9
3
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o
n
d
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k
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n
,
L
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w
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k
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Ja
v
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In
d
o
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Em
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il
:
w
a
rsi_
m
a
r
y
a
ti
@u
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b
.
a
c
.
id
1.
I
NT
RO
D
UCT
I
O
N
T
h
e
d
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s
is
co
d
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A
d
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q
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a
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1
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Diag
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lp
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[
2
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[
5
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Hea
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ca
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m
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s
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th
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f
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5
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5
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0
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[
6
]
.
I
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d
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esia
in
it
s
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v
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as
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m
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le
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w
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ased
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h
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in
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p
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m
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w
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T
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7
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.
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355
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a
clai
m
r
ate
o
f
I
DR
2
,
8
4
3
,
6
3
9
.
I
n
th
is
ca
s
e,
th
e
h
o
s
p
ital g
o
t a
b
ig
g
er
p
r
o
f
it o
f
I
DR
3
,
0
4
1
,
6
5
4
.
P
r
ev
io
u
s
s
tu
d
ie
s
h
av
e
s
h
o
w
n
th
at
t
h
e
d
ia
g
n
o
s
tic
co
d
es
i
n
g
en
er
al
h
o
s
p
ita
ls
ar
e
s
i
g
n
if
ic
an
tl
y
m
o
r
e
p
r
ec
is
e
th
an
t
h
o
s
e
i
n
s
p
ec
ialt
y
h
o
s
p
itals
b
u
t
t
h
e
n
u
m
b
er
o
f
d
iag
n
o
s
is
co
d
es
w
it
h
m
aj
o
r
er
r
o
r
ty
p
es
i
n
g
e
n
er
al
h
o
s
p
itals
is
g
r
ea
ter
[
8
]
.
T
h
u
s
,
ea
ch
h
o
s
p
ita
l
w
it
h
d
if
f
er
e
n
t
c
h
ar
ac
ter
is
tics
h
as
a
d
i
f
f
er
en
t
d
e
g
r
ee
o
f
ac
c
u
r
ac
y
o
f
th
e
d
iag
n
o
s
i
s
co
d
e.
I
n
ad
d
itio
n
to
t
h
e
ac
cu
r
ac
y
o
f
th
e
d
ia
g
n
o
s
is
co
d
e,
d
if
f
er
e
n
ce
s
i
n
h
o
s
p
ital
ch
ar
ac
ter
is
tic
s
s
u
c
h
a
s
cla
s
s
,
t
y
p
e
a
n
d
h
o
s
p
ita
l o
w
n
er
s
h
ip
lead
to
d
if
f
er
en
ce
s
i
n
t
h
e
s
ett
i
n
g
o
f
h
ea
l
th
s
er
v
ic
e
r
ates.
T
h
e
r
es
u
lts
o
f
th
e
p
r
eli
m
i
n
ar
y
s
t
u
d
y
s
h
o
w
t
h
at
s
p
ec
ialized
h
o
s
p
itals
,
p
r
iv
ate
h
o
s
p
itals
a
n
d
h
o
s
p
ital
s
w
i
th
a
h
i
g
h
er
clas
s
ten
d
to
h
av
e
h
i
g
h
er
h
ea
lt
h
s
er
v
ice
r
ates.
T
h
e
d
if
f
er
en
ce
i
n
r
ates
b
et
w
ee
n
h
o
s
p
itals
ca
u
s
e
s
a
g
ap
w
h
er
e
th
er
e
ar
e
h
o
s
p
itals
t
h
at
b
en
e
f
it a
n
d
a
r
e
d
is
ad
v
an
ta
g
ed
b
y
t
h
e
I
N
A
-
C
B
Gs tar
if
f
p
o
lic
y
.
Ho
s
p
itals
i
n
th
e
Su
r
a
k
ar
ta
C
it
y
ar
ea
h
a
v
e
d
if
f
er
en
t
c
h
ar
ac
te
r
is
tics
[
9
]
an
d
b
ased
o
n
th
e
p
r
eli
m
i
n
ar
y
s
u
r
v
e
y
th
e
av
er
a
g
e
p
er
ce
n
ta
g
e
o
f
i
n
ac
c
u
r
ate
d
iag
n
o
s
i
s
co
d
es
is
3
5
%.
T
h
e
p
er
ce
n
tag
e
o
f
in
ac
c
u
r
ac
y
in
t
h
e
d
iag
n
o
s
i
s
co
d
e
is
h
ig
h
er
th
a
n
th
e
av
er
ag
e
o
f
o
t
h
er
d
o
m
e
s
ti
c
h
o
s
p
itals
,
n
a
m
el
y
3
1
.
5
%
[
1
0
]
-
[
1
9
]
an
d
is
s
till
v
er
y
m
u
c
h
h
ig
h
er
th
a
n
o
v
er
s
e
as h
o
s
p
ital
s
,
n
a
m
el
y
1
2
.
7
1
% [
3
]
-
[
6
]
,
[
8
]
.
R
esear
ch
o
n
t
h
e
clai
m
s
o
f
I
NA
-
C
B
Gs
h
as
b
ee
n
co
n
d
u
cte
d
b
y
o
t
h
er
r
esear
ch
er
s
b
ef
o
r
e
,
b
u
t
o
n
l
y
q
u
alitati
v
el
y
a
n
al
y
ze
d
th
e
d
if
f
er
en
ce
i
n
clai
m
r
ate
s
b
ased
o
n
t
h
e
d
ia
g
n
o
s
is
co
d
e
.
A
s
t
u
d
y
w
as
co
n
d
u
cted
b
y
co
m
p
ar
i
n
g
t
h
e
i
m
p
ac
t
o
f
s
ec
o
n
d
ar
y
d
iag
n
o
s
tic
co
d
es
o
n
th
e
p
er
f
o
r
m
a
n
ce
o
f
d
iag
n
o
s
tic
r
ela
ted
g
r
o
u
p
s
(
DR
G
s
)
in
Au
s
tr
alia
a
n
d
i
n
t
h
e
U
S
s
ta
te
o
f
Ma
r
y
la
n
d
.
T
h
e
r
esu
l
ts
o
f
th
i
s
s
tu
d
y
p
r
o
v
e
t
h
at
s
ec
o
n
d
a
r
y
d
iag
n
o
s
i
s
co
d
es
ar
e
m
o
r
e
ab
u
n
d
a
n
t
i
n
Ma
r
y
la
n
d
,
ca
u
s
in
g
t
h
e
p
er
f
o
r
m
an
ce
o
f
DR
Gs
t
h
er
e
to
b
e
b
etter
t
h
an
i
n
Au
s
tr
alia
[
2
0
]
.
Oth
er
r
esear
c
h
h
a
s
b
ee
n
co
n
d
u
cted
to
r
ev
ie
w
t
h
e
i
m
p
ac
t
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f
co
m
p
lica
tio
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n
d
co
m
o
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b
id
it
y
le
v
el
(
C
C
L
)
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n
Ko
r
ea
n
d
iag
n
o
s
tic
r
elate
d
g
r
o
u
p
s
(
KD
R
Gs),
w
h
ic
h
r
es
u
lt
s
s
h
o
w
t
h
at
as
m
a
n
y
as
1
1
4
(
1
9
.
0
3
%),
1
9
0
(
3
1
.
7
2
%)
an
d
2
9
5
(
4
9
.
2
5
%)
r
esp
ec
tiv
el
y
ar
e
in
clu
d
ed
in
v
alid
,
p
ar
tiall
y
v
alid
an
d
n
o
t
v
a
lid
[2
1
].
R
esear
ch
er
s
h
av
e
a
ls
o
co
n
d
u
c
ted
s
i
m
ilar
s
t
u
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ies
w
it
h
t
h
e
r
e
s
u
lt
s
t
h
at
t
h
er
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i
s
a
r
elatio
n
s
h
i
p
b
et
w
ee
n
th
e
ac
c
u
r
ac
y
o
f
t
h
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d
ia
g
n
o
s
is
co
d
e
an
d
th
e
ac
c
u
r
ac
y
o
f
J
K
N
i
n
s
u
r
an
ce
c
lai
m
s
[
2
2
]
,
h
o
wev
er
,
th
e
r
esear
ch
er
d
id
n
o
t
co
n
s
id
er
th
e
d
if
f
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ce
s
in
h
o
s
p
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ch
ar
ac
ter
i
s
tics
an
d
d
id
n
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m
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t
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cu
r
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d
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n
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o
n
th
e
to
tal
h
o
s
p
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r
ev
en
u
e
o
b
tain
ed
f
r
o
m
t
h
e
clai
m
s
.
T
h
is
s
tu
d
y
ai
m
s
to
p
r
o
v
e
th
e
r
elatio
n
s
h
ip
b
et
w
ee
n
t
h
e
ac
cu
r
ac
y
o
f
t
h
e
d
iag
n
o
s
is
co
d
e
an
d
th
e
ac
cu
r
ac
y
o
f
t
h
e
I
N
A
-
C
B
G
s
clai
m
r
ate
a
n
d
its
i
m
p
ac
t o
n
h
o
s
p
ital in
co
m
e
w
it
h
v
ar
io
u
s
ch
ar
ac
ter
i
s
tics
.
2.
RE
S
E
ARCH
M
E
T
H
O
D
T
h
is
w
as
q
u
a
n
ti
tativ
e
r
esear
c
h
w
ith
s
ec
o
n
d
ar
y
d
ata
an
al
y
s
i
s
an
d
cr
o
s
s
-
s
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tio
n
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s
tu
d
y
d
esig
n
.
T
h
e
p
o
p
u
latio
n
s
i
n
th
i
s
s
tu
d
y
w
er
e
in
p
atie
n
t
m
ed
ical
r
ec
o
r
d
d
o
cu
m
e
n
t
s
i
n
2
0
2
0
.
I
n
t
h
is
s
t
u
d
y
,
t
w
o
h
o
s
p
ita
ls
w
er
e
d
eter
m
in
ed
as
r
esear
ch
s
ites
w
it
h
co
n
s
id
er
atio
n
o
f
t
h
e
c
h
a
r
ac
ter
is
tics
o
f
th
e
h
o
s
p
ita
ls
.
S
a
m
p
les
to
b
e
ta
k
en
m
u
s
t
m
ee
t
t
h
e
i
n
cl
u
s
io
n
cr
iter
ia,
n
a
m
e
l
y
:
i
)
N
atio
n
al
h
ea
lt
h
in
s
u
r
an
ce
in
p
atie
n
t
m
ed
ical
r
e
co
r
d
d
o
cu
m
e
n
ts
i
n
2
0
2
0
,
ii
)
Me
d
ical
r
ec
o
r
d
d
o
cu
m
en
ts
th
at
h
av
e
co
m
p
lete
m
e
d
ical
in
f
o
r
m
at
io
n
,
ii
i
)
Me
d
ica
l
r
ec
o
r
d
d
o
cu
m
en
t
s
th
at
ar
e
n
o
t
b
ei
n
g
u
s
ed
d
u
r
i
n
g
th
e
tr
ea
t
m
e
n
t
p
er
io
d
.
Sam
p
les
w
er
e
ta
k
e
n
in
t
w
o
h
o
s
p
itals
w
i
th
d
i
f
f
er
en
t
ch
ar
ac
ter
is
tic
s
th
a
t
w
er
e
s
elec
ted
b
y
s
tr
ati
f
ie
d
r
an
d
o
m
s
a
m
p
lin
g
w
i
th
5
0
d
o
cu
m
en
t
s
f
o
r
ea
ch
h
o
s
p
ita
l.
T
h
e
v
ar
iab
les
i
n
t
h
is
s
t
u
d
y
ar
e;
i
)
T
h
e
ac
cu
r
ac
y
o
f
t
h
e
d
iag
n
o
s
is
co
d
e
is
t
h
e
d
ia
g
n
o
s
is
co
d
e
in
o
n
e
ep
is
o
d
e
o
f
p
atien
t
ca
r
e
ac
co
r
d
in
g
to
th
e
I
n
ter
n
atio
n
al
C
las
s
i
f
icatio
n
o
f
Dis
ea
s
es
a
n
d
R
e
lated
Hea
lth
P
r
o
b
le
m
s
1
0
th
R
ev
i
s
io
n
(
I
C
D
-
1
0
)
,
ii
)
I
NA
-
C
B
Gs r
ates a
r
e
p
ac
k
ag
e
r
ates b
ased
o
n
d
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n
o
s
is
g
r
o
u
p
in
g
.
Data
co
llectio
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f
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th
e
ac
cu
r
ac
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o
f
th
e
d
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g
n
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is
co
d
e
w
a
s
o
b
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b
y
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m
p
ar
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t
h
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d
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is
co
d
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co
n
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in
t
h
e
m
ed
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l
r
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o
r
d
d
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m
en
t
w
it
h
t
h
e
d
iag
n
o
s
tic
co
d
e
d
ata
co
n
tain
ed
in
t
h
e
I
N
A
-
C
B
Gs
b
ased
o
n
I
C
D
-
1
0
.
T
h
e
I
NA
-
C
B
G
r
ate
d
ata
w
er
e
o
b
tain
ed
f
r
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m
co
m
p
ar
in
g
t
h
e
h
o
s
p
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r
ates
w
it
h
th
e
I
N
A
-
C
B
G
g
r
o
u
p
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r
ates.
T
h
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d
ata
o
b
tain
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w
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w
r
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n
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a
ch
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t s
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ap
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.
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F
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
5
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8
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J
.
P
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No
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2
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3
54
–
3
60
356
Fig
u
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1
.
R
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f
lo
w
c
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t
3.
RE
SU
L
T
S
A
ND
AN
AL
Y
SI
S
3
.
1
.
H
o
s
pita
l
ch
a
ra
ct
er
is
t
ic
T
h
e
h
o
s
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4
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esu
lted
in
a
d
i
f
f
er
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t
MY
-
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R
G
co
d
e
ass
ig
n
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e
n
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i
n
7
4
.
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7
/4
1
5
)
ca
s
es.
Of
t
h
ese,
5
2
.
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1
6
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0
7
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o
f
th
e
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s
es
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ad
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er
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e
t
h
o
s
p
ital
r
ates.
I
n
to
tal,
th
e
p
o
ten
tial lo
s
s
o
f
r
e
v
en
u
e
d
u
e
t
o
th
e
MY
-
D
R
G
co
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ed
ch
an
g
e
is
R
M
6
5
4
,
3
0
3
.
9
1
[
2
4
]
.
T
h
e
m
ai
n
f
ac
to
r
ca
u
s
i
n
g
t
h
e
i
n
ac
cu
r
ate
d
iag
n
o
s
i
s
co
d
e
is
th
e
co
m
p
lete
n
ess
o
f
th
e
r
es
u
m
e,
m
ed
ica
l
in
f
o
r
m
atio
n
an
d
m
ed
ical
s
u
p
p
o
r
t.
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h
e
co
m
p
lete
n
es
s
o
f
m
ed
ical
in
f
o
r
m
atio
n
an
d
t
h
e
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cc
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r
ac
y
o
f
m
ed
ical
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ec
o
r
d
d
o
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t
s
ar
e
v
er
y
i
m
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o
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tan
t,
if
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h
e
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ical
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n
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ed
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ec
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n
o
s
tic
co
d
e
w
il
l
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e
in
ac
c
u
r
ate
[
29
]
.
T
h
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o
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p
lete
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e
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o
f
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n
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co
d
in
g
[
1
6
]
,
[
3
0
]
,
[
3
1
]
.
C
o
m
p
l
eten
es
s
o
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m
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ical
in
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n
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e
6
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6
6
3
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m
es t
h
e
ac
cu
r
ac
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o
f
t
h
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d
iag
n
o
s
tic
co
d
e
[
3
2
].
4.
CO
NCLU
SI
O
N
E
ac
h
h
o
s
p
ital
h
a
s
s
et
a
c
o
s
t
f
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h
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lth
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s
.
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lic
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p
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h
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s
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o
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s
.
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r
d
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s
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ain
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ch
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n
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G
Sp
ec
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h
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N
A
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h
a
v
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n
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t
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t
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m
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s
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ec
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v
e
s
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m
clai
m
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es
u
lt
s
.
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r
iv
ate
h
o
s
p
itals
w
it
h
h
i
g
h
er
s
er
v
ice
co
s
ts
ex
p
er
ien
ce
d
a
s
ig
n
i
f
ica
n
t
d
ec
r
ea
s
e
in
in
co
m
e,
w
h
ile
Go
v
er
n
m
e
n
t
h
o
s
p
ita
ls
r
e
m
ai
n
ed
s
tab
le
d
esp
ite
t
h
eir
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n
co
m
e
b
ei
n
g
lo
w
er
t
h
an
th
e
y
s
h
o
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ld
h
a
v
e
b
ee
n
.
T
h
e
r
esu
lts
o
f
t
h
e
an
al
y
s
i
s
p
r
o
v
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at
th
e
ac
c
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r
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o
f
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s
co
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as
a
s
ig
n
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t
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m
p
ac
t
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h
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ac
cu
r
ac
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f
t
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N
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-
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B
Gs
c
l
ai
m
,
w
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ile
th
e
co
d
e
o
f
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tio
n
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as
n
o
t
b
ee
n
s
t
u
d
ied
o
n
th
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s
o
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asio
n
,
s
o
it
is
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m
p
o
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tan
t a
s
a
n
in
p
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t
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.
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NO
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M
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t
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Mi
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R
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to
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Un
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ta
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ted
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p
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licatio
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o
f
th
is
s
cie
n
ti
f
ic
ar
ticle.
RE
F
E
R
E
NC
E
S
[1
]
W
o
rld
He
a
lt
h
Org
a
n
iza
ti
o
n
,
“
In
te
rn
a
ti
o
n
a
l
S
a
ti
stica
l
C
las
sif
ica
ti
o
n
o
f
Dise
a
se
s
a
n
d
Re
late
d
He
a
lt
h
P
ro
b
le
m
s
T
e
n
th
Re
v
isio
n
,
”
v
o
l.
1
,
2
a
n
d
3
,
2
0
1
0
.
[2
]
Ha
tt
a
,
G
.
,
"
G
u
id
e
li
n
e
s
f
o
r
He
a
lt
h
In
f
o
rm
a
ti
o
n
M
a
n
a
g
e
m
e
n
t
in
He
a
lt
h
S
e
rv
ice
F
a
c
il
it
ies
,
"
Un
ive
rs
it
y
o
f
I
n
d
o
n
e
si
a
Pre
ss
,
p
p
.
5
3
-
5
5
,
2
0
1
3
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
.
J
.
P
u
b
lic
Hea
lth
Sci
.
I
SS
N:
2
2
5
2
-
8806
R
ed
u
ce
d
h
o
s
p
ita
l reve
n
u
e
d
u
e
to
err
o
r
co
d
e
d
ia
g
n
o
s
is
in
…
(
W
a
r
s
i Ma
r
ya
ti
)
359
[3
]
Cu
m
m
in
g
s
e
t
a
l.
,
“
Ho
sp
it
a
l
c
o
d
in
g
o
f
De
m
e
n
ti
a
:
is
it
a
c
c
u
ra
te?
,
”
He
a
lt
h
I
n
fo
r
m
a
ti
o
n
M
a
n
a
g
e
me
n
t
J
o
u
rn
a
l,
v
o
l.
4
0
,
n
o
.
3
,
p
p
.
5
-
1
1
,
2
0
1
1
.
[4
]
Da
lal
.
S
a
n
d
Ro
y
.
B
,
“
R
e
li
a
b
il
it
y
o
f
Cli
n
ica
l
Co
d
in
g
o
f
Hip
F
a
c
tu
re
S
u
rg
e
r
y
:
I
m
p
li
c
a
ti
o
n
s
fo
r
P
a
y
m
e
n
t
b
y
Re
su
lt
s?
,
”
In
ter
n
a
t
io
n
a
l
J
o
u
rn
a
l
Ca
re
In
ju
re
d
,
v
o
l.
4
0
,
n
o
.
1
,
p
p
.
7
3
8
-
7
4
1
,
2
0
0
9
.
[5
]
T
h
ig
p
e
n
et
al
.,
"
V
a
li
d
it
y
o
f
In
tern
a
ti
o
n
a
l
Clas
sif
ica
ti
o
n
o
f
Di
se
a
se
Co
d
e
s
to
I
d
e
n
ti
f
y
Isc
h
e
m
ic
S
tro
k
e
a
n
d
In
trac
ra
n
ial
He
m
o
rrh
a
g
e
a
m
o
n
g
In
d
iv
id
u
a
ls
w
it
h
A
ss
o
c
iate
d
Dia
g
n
o
sis
o
f
A
tri
a
l
F
ib
ril
lati
o
n
,
"
Circ
u
la
t
o
ry
Ca
rd
io
v
a
sc
u
la
r Q
u
a
i
li
ty Ou
tc
o
me
s,
v
o
l.
8
,
n
o
.
1
,
p
p
.
8
-
1
4
,
2
0
1
5
.
[6
]
Ch
e
n
g
,
P
.
G
il
c
h
rist,
A
.
,
Ro
b
in
s
o
n
a
n
d
K.M
.
P
a
u
l,
L
.
,
"
T
h
e
Risk
a
n
d
Co
n
se
q
u
e
n
c
e
s
o
f
Cli
n
ica
l
M
isc
o
d
in
g
d
u
e
to
In
a
d
e
q
u
a
te
M
e
d
ica
l
Do
c
u
m
e
n
tatio
n
:
A
Ca
se
S
tu
d
y
o
f
th
e
I
m
p
a
c
t
o
n
He
a
lt
h
S
e
rv
ice
s
F
u
n
d
in
g
,
"
He
a
lt
h
In
f
o
rm
a
ti
o
n
M
a
n
a
g
e
me
n
t
J
o
u
r
n
a
l
,
v
o
l.
3
8
,
n
o
.
1
,
p
p
.
3
5
-
4
6
,
2
0
0
9
.
[7
]
M
in
ister
o
f
He
a
lt
h
RI.
"
Re
g
u
latio
n
o
f
th
e
M
in
ister
o
f
He
a
lt
h
o
f
th
e
Re
p
u
b
li
c
o
f
In
d
o
n
e
sia
N
o
.
7
6
o
f
2
0
1
6
c
o
n
c
e
rn
in
g
G
u
id
e
li
n
e
s
f
o
r
In
d
o
n
e
sia
n
Ca
se
Ba
se
G
ro
u
p
s
(INA
-
C
BG
s)
in
th
e
Im
p
le
m
e
n
tatio
n
o
f
Na
ti
o
n
a
l
He
a
lt
h
In
su
ra
n
c
e
,
"
2
0
1
6
.
[8
]
F
a
rz
a
n
d
ip
o
u
r,
M
.
S
h
e
ik
h
tah
e
ri
a
n
d
A
.
S
a
d
o
u
g
h
i
,
F
.
,
“
Ef
f
e
c
ti
v
e
F
a
c
to
rs
o
n
A
c
c
u
ra
c
y
o
f
P
rin
c
ip
a
l
Dia
g
n
o
sis
Co
d
i
n
g
Ba
se
d
o
n
In
ter
n
a
ti
o
n
a
l
Clas
sif
i
c
a
ti
o
n
o
f
Dise
a
se
s,
th
e
1
0
th
Re
v
isio
n
(ICD
-
10)
,
”
I
n
ter
n
a
t
io
n
a
l
J
o
u
rn
a
l
o
f
In
fo
rm
a
t
io
n
M
a
n
a
g
e
me
n
t
,
v
o
l.
3
0
,
n
o
.
5
,
p
p
.
7
8
-
8
4
,
2
0
1
0
.
[9
]
M
in
ister
o
f
He
a
lt
h
RI.
,
"
Ho
sp
it
a
l
Da
ta
Re
c
a
p
it
u
lat
io
n
,
"
2
0
1
9
[
On
l
in
e
]
,
Av
a
il
a
b
le
:
h
tt
p
:
//
sirs.y
a
n
k
e
s.
k
e
m
k
e
s.
g
o
.
id
/rs
o
n
li
n
e
/rep
o
r
t/
d
a
tars
.
[1
0
]
Ro
h
m
a
n
,
H.
Ha
ri
y
o
n
o
a
n
d
W
.
Ro
s
y
id
a
h
,
"
P
o
l
icie
s f
o
r
F
il
li
n
g
M
a
in
Dia
g
n
o
se
s an
d
A
c
c
u
ra
c
y
o
f
Dia
g
n
o
sis
Co
d
e
s
o
n
M
e
d
ica
l
Re
c
o
rd
s
a
t
P
KU
M
u
h
a
m
m
a
d
i
y
a
h
Ho
sp
it
a
l
Yo
g
y
a
k
a
rta
,
"
KES
M
AS
J
o
u
rn
a
l,
v
o
l
.
5
,
n
o
.
2
,
p
p
.
1
6
2
-
2
3
2
,
2
0
1
1
.
[1
1
]
S
u
d
ra
a
n
d
R.
I.
P
u
ji
h
a
stu
ti
,
A
.
,
"
Th
e
Eff
e
c
t
o
f
W
rit
in
g
a
Dia
g
n
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8
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[2
9
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M
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