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1
0
0
,
0
0
0
d
ea
th
s
)
.
[
1
]
,
[
3
]
.
A
lth
o
u
g
h
s
ev
er
al
v
a
cc
in
es
h
av
e
n
o
w
b
ee
n
d
ev
elo
p
ed
ag
ain
s
t
t
h
e
d
ev
elo
p
m
e
n
t
an
d
s
p
r
ea
d
o
f
th
is
n
o
v
el
co
r
o
n
av
ir
u
s
,
t
h
e
d
ev
elo
p
m
e
n
t
s
o
f
n
e
w
v
ar
ian
ts
o
f
t
h
e
v
ir
u
s
h
av
e
r
ai
s
ed
q
u
esti
o
n
s
a
b
o
u
t
th
e
lo
n
g
-
ter
m
ef
f
icac
y
o
f
s
u
c
h
m
ea
s
u
r
e
s
an
d
h
o
w
th
e
d
is
ea
s
e
m
a
y
a
f
f
ec
t
d
if
f
er
e
n
t
asp
ec
ts
o
f
li
f
e
b
o
th
a
m
o
n
g
i
n
f
ec
ted
in
d
iv
id
u
als a
n
d
at
-
r
i
s
k
p
o
p
u
lat
io
n
s
[
4
]
,
[
5
]
.
C
OVI
D
-
1
9
h
as
m
an
y
p
h
y
s
i
ca
l,
p
s
y
ch
o
lo
g
ical,
an
d
s
o
ci
al
co
n
s
eq
u
e
n
ce
s
at
t
h
e
in
d
i
v
id
u
al
a
n
d
co
m
m
u
n
it
y
le
v
el
[
6
]
.
Fear
a
n
d
an
x
iet
y
r
elate
d
to
t
h
e
d
e
v
elo
p
m
e
n
t
o
f
th
e
d
is
ea
s
e
h
a
s
ca
u
s
ed
p
er
s
o
n
s
to
s
o
ciall
y
is
o
late
t
h
e
m
s
el
v
es
a
n
d
r
ed
u
ce
d
r
eg
u
lar
p
h
y
s
ica
l
ac
t
iv
it
y
[
7
]
.
T
h
o
s
e
w
h
o
h
a
v
e
b
ec
o
m
e
in
f
ec
ted
b
y
th
e
v
ir
u
s
u
s
u
al
l
y
h
av
e
m
u
ltip
le
n
eu
r
o
lo
g
ical
an
d
p
h
y
s
ical
co
m
p
licatio
n
s
s
u
c
h
as
m
u
s
c
le
p
a
in
an
d
f
at
ig
u
e
t
h
at
o
f
ten
p
er
s
i
s
t
f
o
r
m
o
n
t
h
s
a
f
ter
d
is
ch
ar
g
e
f
r
o
m
h
o
s
p
ital
[
8
]
.
I
n
ad
d
itio
n
,
d
u
r
in
g
r
ec
o
v
er
y
p
er
io
d
,
C
OVI
D
-
19
p
atien
ts
o
f
te
n
ex
p
er
ie
n
ce
n
e
g
ati
v
e
f
ee
lin
g
s
as
a
r
es
u
lt
o
f
t
h
ese
p
h
y
s
ical
h
ea
lt
h
co
n
s
eq
u
en
ce
s
a
n
d
b
ein
g
s
o
ciall
y
d
is
cr
i
m
i
n
ated
ag
ai
n
s
t,
p
ar
ticu
lar
l
y
an
x
iet
y
,
d
ep
r
ess
i
o
n
,
an
d
lo
n
eli
n
ess
[
9
]
.
Oth
er
c
o
n
s
eq
u
e
n
ce
s
o
f
t
h
e
d
is
ea
s
e
i
n
clu
d
e
f
o
o
d
s
ec
u
r
it
y
,
r
ed
u
ctio
n
i
n
f
a
m
il
y
i
n
co
m
e,
an
d
u
n
e
m
p
lo
y
m
e
n
t,
co
m
p
lic
atin
g
t
h
e
s
i
tu
at
io
n
f
u
r
t
h
er
a
n
d
r
es
u
lti
n
g
i
n
u
n
ce
r
tain
t
y
ab
o
u
t
th
e
f
u
t
u
r
e
[
1
0
]
.
A
ll
o
f
t
h
ese
f
ac
to
r
s
m
a
y
n
e
g
ati
v
el
y
a
f
f
ec
t
t
h
e
q
u
alit
y
o
f
li
f
e
at
th
e
i
n
d
iv
id
u
al
p
atien
t le
v
el
a
n
d
at
th
e
p
o
p
u
la
tio
n
lev
el
m
o
r
e
g
e
n
er
all
y
.
Sev
er
al
s
tu
d
ie
s
h
a
v
e
f
o
u
n
d
t
h
at
h
ea
lt
h
r
elate
d
q
u
ali
t
y
o
f
l
if
e
(
H
R
Qo
L
)
i
s
d
ec
r
ea
s
ed
a
m
o
n
g
t
h
o
s
e
r
ec
o
v
er
ed
f
r
o
m
t
h
e
d
is
ea
s
e,
in
cl
u
d
in
g
a
r
ed
u
ctio
n
i
n
w
el
l
-
b
ei
n
g
ac
r
o
s
s
p
h
y
s
ical,
e
m
o
tio
n
al,
an
d
s
o
cia
l
d
o
m
ai
n
s
,
f
o
r
ex
a
m
p
le
Qu
et
a
l
.
[
1
1
]
f
o
u
n
d
th
at
ev
en
t
h
r
ee
m
o
n
t
h
s
af
ter
d
is
c
h
ar
g
e
m
o
r
e
th
an
h
al
f
o
f
p
eo
p
le
r
ep
o
r
ted
p
h
y
s
ical
s
y
m
p
to
m
s
an
d
n
ea
r
l
y
a
ll
o
f
H
R
Qo
L
d
o
m
ai
n
s
s
co
r
ed
lo
w
er
t
h
a
n
n
o
r
m
al
p
o
p
u
latio
n
.
T
h
is
f
i
n
d
in
g
in
a
s
a
m
e
w
a
y
f
o
u
n
d
w
h
er
e
C
h
e
n
an
d
co
lleag
u
es
as
s
ess
ed
th
e
p
atie
n
ts
f
o
r
o
n
e
m
o
n
th
a
f
ter
d
is
ch
ar
g
e
u
s
i
n
g
SF
-
3
6
q
u
esti
o
n
n
air
e
[
1
1
]
–
[
1
3
]
.
T
h
er
e
is
a
li
m
ited
b
o
d
y
o
f
e
v
id
en
ce
t
h
at
i
n
d
icate
s
d
e
m
o
g
r
ap
h
ic
f
ac
to
r
s
m
a
y
a
f
f
ec
t
HR
Q
o
L
in
th
o
s
e
w
it
h
C
O
VI
D
-
19
[
1
3
]
,
[
1
4
]
.
U
n
f
o
r
t
u
n
ate
l
y
,
h
o
w
e
v
er
,
th
e
in
d
iv
id
u
al
p
h
y
s
ical
an
d
m
en
tal
co
m
p
o
n
e
n
ts
o
f
HR
Qo
L
i
n
p
atien
t
s
r
ec
o
v
er
in
g
f
r
o
m
th
e
d
is
ea
s
e
r
e
m
ai
n
p
o
o
r
ly
u
n
d
er
s
to
o
d
.
A
s
s
e
s
s
i
n
g
th
e
HR
Q
o
L
i
n
th
e
s
e
p
atien
t
s
w
il
l
i
m
p
r
o
v
e
o
u
r
u
n
d
er
s
ta
n
d
i
n
g
o
f
t
h
e
d
is
ea
s
e
p
r
o
ce
s
s
a
n
d
co
m
p
licatio
n
s
t
h
at
m
a
y
t
h
r
ea
ten
t
h
e
w
ell
-
b
ei
n
g
an
d
r
ec
o
v
er
y
o
f
p
atien
t
s
i
n
w
a
y
s
t
h
at
h
ea
lt
h
ca
r
e
p
r
o
f
es
s
i
o
n
als
a
n
d
d
ec
is
io
n
m
ak
er
s
m
a
y
ad
d
r
ess
[
1
1
]
.
Mo
r
eo
v
er
,
f
o
cu
s
in
g
o
n
HR
Qo
L
a
s
a
co
m
p
r
e
h
e
n
s
i
v
e
h
ea
lt
h
o
u
t
co
m
e
m
a
y
h
elp
to
d
eter
m
in
e
p
atie
n
ts
’
p
er
ce
p
tio
n
s
o
n
d
if
f
er
en
t
d
i
m
e
n
s
io
n
s
o
f
lif
e
d
u
r
i
n
g
r
ec
o
v
er
y
f
r
o
m
C
O
VI
D
-
1
9
an
d
co
n
tr
ib
u
te
to
b
etter
esti
m
a
te
th
e
b
u
r
d
en
o
f
th
i
s
d
is
ea
s
e
[
1
5
]
,
[
1
6
]
.
Ass
es
s
m
en
t
o
f
HR
Qo
L
i
n
p
ati
en
ts
w
it
h
C
OVI
D
-
1
9
w
h
o
ar
e
d
is
ch
ar
g
ed
f
r
o
m
h
o
s
p
ital
an
d
d
u
r
in
g
t
h
e
co
n
v
ale
s
ce
n
ce
p
er
io
d
is
i
m
p
o
r
tan
t
b
ec
au
s
e
th
e
y
m
a
y
ex
p
er
ien
ce
d
ela
y
ed
co
m
p
l
icatio
n
s
th
a
t
m
a
y
n
o
t
b
e
p
r
esen
t
w
it
h
o
t
h
er
i
n
f
ec
tio
n
s
a
n
d
in
c
lu
d
e
n
e
u
r
o
lo
g
ical,
ca
r
d
i
o
v
ascu
lar
,
an
d
d
i
g
esti
v
e
co
m
p
licatio
n
s
[
1
7
]
–
[
1
9
]
.
A
l
s
o
,
th
e
p
o
s
s
ib
ilit
y
o
f
r
ec
u
r
r
en
t
s
y
m
p
to
m
s
s
u
c
h
as
co
u
g
h
,
f
ati
g
u
e
a
n
d
d
y
s
p
n
ea
d
u
r
in
g
r
ec
o
v
er
y
m
a
y
d
is
tin
ct
l
y
af
f
ec
t
HR
Qo
L
in
s
u
ch
p
atie
n
ts
[
2
0
]
.
C
o
n
ti
n
u
ed
r
e
s
p
ir
ato
r
y
s
y
s
te
m
p
r
o
b
le
m
s
m
a
y
d
ec
r
ea
s
e
ab
ilit
y
to
ex
er
cise
t
h
er
eb
y
n
e
g
ativ
e
l
y
i
m
p
ac
tin
g
e
m
o
tio
n
a
l
an
d
p
h
y
s
ical
r
ec
o
v
er
y
[
2
1
]
.
T
h
e
i
m
p
ac
t
o
f
C
OVI
D
-
1
9
o
n
ac
tiv
itie
s
o
f
d
ail
y
li
v
i
n
g
s
ev
er
al
m
o
n
t
h
s
a
f
ter
h
o
s
p
ital
d
is
c
h
ar
g
e,
as
w
el
l
as
th
e
g
e
n
er
al
h
ea
lth
o
f
t
h
o
s
e
w
h
o
h
av
e
r
ec
o
v
er
ed
an
d
th
e
ir
ab
ilit
y
to
r
etu
r
n
to
in
d
i
v
id
u
a
l a
n
d
s
o
cial
r
o
les in
th
e
co
m
m
u
n
it
y
,
r
e
m
ai
n
s
u
n
clea
r
.
Sleep
as
a
p
h
y
s
io
lo
g
ica
l
p
r
o
c
ess
co
n
tr
ib
u
te
s
to
p
h
y
s
ical
h
e
m
o
s
ta
s
is
an
d
m
a
y
d
ir
ec
tl
y
o
r
in
d
ir
ec
tl
y
af
f
ec
t
m
etab
o
lic
an
d
i
m
m
u
n
e
p
r
o
ce
s
s
es
[
2
2
]
.
C
o
n
s
eq
u
en
tl
y
,
i
n
ab
ilit
y
to
o
b
tain
ad
eq
u
ate
s
leep
m
a
y
si
g
n
i
f
ica
n
tl
y
i
m
p
ac
t
th
e
r
ec
o
v
er
y
o
f
p
h
y
s
ical
an
d
m
e
n
tal
f
u
n
ctio
n
i
n
g
i
n
C
OVI
D
-
1
9
p
atie
n
ts
[
2
3
]
.
I
n
s
o
m
n
i
a
an
d
o
th
er
s
leep
p
r
o
b
lem
s
m
a
y
tr
ig
g
er
ad
ap
tiv
e
i
m
m
u
n
e
r
ea
ctio
n
s
an
d
i
n
cr
ea
s
ed
s
y
s
te
m
ic
i
n
f
la
m
m
at
io
n
[
2
4
]
.
L
o
n
g
-
ter
m
s
lee
p
d
ep
r
iv
atio
n
m
a
y
a
ls
o
ad
v
er
s
el
y
a
f
f
ec
t
n
at
u
r
al
k
i
ller
ce
ll
ac
ti
v
it
y
[
2
5
]
.
T
h
u
s
,
p
o
o
r
q
u
alit
y
o
f
s
leep
an
d
an
y
c
h
a
n
g
e
i
n
cir
ca
d
ian
r
h
y
t
h
m
m
a
y
w
ea
k
e
n
th
e
b
o
d
y
’
s
r
esi
s
ta
n
ce
to
an
d
r
ec
o
v
er
y
f
o
r
m
C
OVI
D
-
1
9
s
.
Oth
er
f
ac
to
r
s
s
u
c
h
p
h
y
s
i
ca
l
d
is
ab
ilit
y
,
s
o
cial
is
o
latio
n
,
an
d
p
s
y
c
h
o
lo
g
ica
l
r
ea
ctio
n
s
s
u
ch
as
a
n
x
iet
y
a
n
d
f
ea
r
o
f
d
ea
th
m
a
y
co
n
tr
ib
u
te
to
s
leep
p
r
o
b
lem
s
[
2
3
]
.
A
r
ec
en
t
s
t
u
d
y
r
ep
o
r
ted
th
at
i
m
p
a
ir
ed
s
leep
q
u
alit
y
is
p
r
esen
t
i
n
n
ea
r
l
y
3
4
%
o
f
p
at
ien
ts
w
it
h
C
OVI
D
-
19
[
2
6
]
.
S
leep
d
is
o
r
d
er
s
in
lo
n
g
ti
m
e
m
a
y
also
p
r
ed
is
p
o
s
e
p
eo
p
le
to
m
e
n
tal
i
lln
e
s
s
e
s
t
h
at
s
u
c
h
co
n
d
it
io
n
s
also
m
a
y
in
te
r
f
er
e
in
th
e
n
o
r
m
al
s
el
f
-
ca
r
e
b
eh
av
io
r
s
r
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ltin
g
a
h
ig
h
er
s
u
s
ce
p
tib
ili
t
y
o
f
i
n
f
ec
ti
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n
w
ith
p
at
h
o
g
e
n
s
i
n
cl
u
d
in
g
C
o
r
o
n
av
ir
u
s
[
2
7
]
.
Af
ter
co
n
d
u
cti
n
g
a
l
iter
atu
r
e
r
ev
ie
w
o
n
H
R
Qo
L
i
n
C
OVI
D
-
1
9
p
atien
ts
,
t
h
e
c
u
r
r
en
t
s
t
u
d
y
’
s
au
th
o
r
s
d
ec
id
ed
to
ex
a
m
i
n
e
th
e
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u
al
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li
f
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p
atie
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t
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ad
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er
ed
f
r
o
m
C
OVI
D
-
1
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o
n
e
m
o
n
t
h
a
f
ter
h
o
s
p
ital
d
is
c
h
ar
g
e.
T
h
e
p
u
r
p
o
s
e
o
f
t
h
i
s
s
t
u
d
y
w
as
to
ex
a
m
i
n
e
d
e
m
o
g
r
ap
h
ic
a
n
d
cli
n
ical
f
ac
to
r
s
(
e.
g
.
,
ti
m
e
o
f
d
iag
n
o
s
i
s
an
d
s
leep
d
is
t
u
r
b
an
c
e)
r
elate
d
to
HR
Qo
L
in
t
h
ese
p
atien
ts
.
2.
RE
S
E
ARCH
M
E
T
H
O
D
2
.
1
.
Desig
n a
nd
pa
rt
icipa
nts
B
et
w
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Au
g
u
s
t
an
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No
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er
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0
2
0
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p
atien
ts
w
h
o
h
ad
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ec
o
v
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ed
f
r
o
m
C
OVI
D
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1
9
o
n
e
m
o
n
t
h
af
ter
th
eir
d
is
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h
ar
g
e
f
r
o
m
t
h
e
h
o
s
p
i
tal
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n
t
h
i
s
cr
o
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-
s
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tio
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.
T
h
is
w
a
s
a
c
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v
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ien
ce
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le
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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11
,
No
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1
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M
ar
ch
20
22
:
2
20
-
23
1
222
o
f
all
C
O
VI
D
-
1
9
p
atie
n
ts
at
a
g
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al
h
o
s
p
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r
e
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er
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eh
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r
an
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eh
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a
s
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h
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ca
p
ital
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r
an
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eg
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ter
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m
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C
OVI
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1
9
in
I
r
an
a
n
d
it
is
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h
e
m
o
s
t
cr
o
w
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ed
cit
y
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n
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h
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tr
y
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T
h
e
s
a
m
p
le
s
ize
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o
m
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ted
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ased
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P
ed
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az
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atio
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u
s
t
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t
3
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o
b
s
er
v
atio
n
s
p
er
in
d
ep
en
d
en
t
v
ar
iab
le
[
2
8
]
.
W
i
th
7
-
9
i
n
d
ep
en
d
en
t
v
ar
iab
les
t
h
at
m
a
y
b
e
i
n
cl
u
d
ed
in
t
h
e
m
o
d
el,
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e
ca
lcu
lated
th
at
at
lea
s
t
3
0
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p
atien
ts
w
o
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ld
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ee
d
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e
ap
p
r
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ac
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ed
,
a
n
ticip
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g
a
1
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%
attr
i
tio
n
r
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te.
A
tr
ai
n
ed
n
u
r
s
e
co
n
d
u
cted
t
h
e
f
ir
s
t
i
n
ter
v
ie
w
w
it
h
all
p
atie
n
t
s
w
h
o
w
er
e
to
b
e
d
is
ch
ar
g
ed
d
u
r
in
g
n
e
x
t
f
e
w
d
a
y
s
b
ased
o
n
th
ei
r
p
h
y
s
ician
’
s
d
ec
is
io
n
.
I
f
th
e
y
ag
r
ee
d
to
p
ar
ticip
ate
th
e
co
n
t
ac
t
in
f
o
r
m
at
io
n
w
a
s
o
b
tain
ed
f
o
r
an
an
ticip
ated
f
o
llo
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-
u
p
co
n
tact
i
n
o
n
e
m
o
n
t
h
p
o
s
t
-
d
is
c
h
ar
g
e.
W
h
en
co
n
ta
ctin
g
p
ar
ticip
an
t
s
o
n
e
m
o
n
t
h
l
ater
to
co
m
p
lete
t
h
e
ass
es
s
m
en
t,
o
n
l
y
2
5
8
p
atien
ts
ag
r
ee
d
to
co
m
p
lete
th
e
s
u
r
v
e
y
.
I
n
clu
s
io
n
cr
iter
ia
w
er
e
:
i
)
a
co
n
f
ir
m
ed
d
iag
n
o
s
is
o
f
n
o
v
el
co
r
o
n
av
ir
u
s
in
f
ec
tio
n
b
y
p
o
l
y
m
er
a
s
e
ch
ain
r
ea
ctio
n
test
(
P
C
R
)
,
ii
)
h
o
s
p
ital
s
tay
o
f
at
least
f
o
r
th
r
ee
d
ay
s
,
iii
)
a
g
e
2
5
to
6
5
y
ea
r
s
o
ld
,
an
d
iv
)
a
b
le
to
s
p
ea
k
an
d
r
ea
d
P
er
s
ian
.
E
x
cl
u
d
ed
w
er
e
p
atie
n
ts
w
h
o
ex
p
er
ien
ce
d
s
r
ec
u
r
r
en
ce
o
f
C
OVI
D
-
1
9
,
w
er
e
f
o
r
ce
d
to
b
e
r
e
-
h
o
s
p
italized
d
u
e
to
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m
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licatio
n
s
o
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e
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s
e,
w
er
e
ad
m
itted
to
t
h
e
in
te
n
s
i
v
e
ca
r
e
u
n
it
(
I
C
U)
d
u
r
in
g
h
o
s
p
italizatio
n
,
h
ad
a
h
is
to
r
y
o
f
s
er
io
u
s
p
s
y
ch
o
lo
g
ical
d
is
o
r
d
er
s
s
u
c
h
as
p
s
y
c
h
o
s
is
,
d
e
m
e
n
tia
o
r
m
a
j
o
r
d
ep
r
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io
n
,
r
ec
eiv
ed
tr
ea
tm
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t
f
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in
s
o
m
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ia
b
ef
o
r
e
th
e
y
d
ev
elo
p
ed
C
O
VI
D
-
1
9
,
an
d
t
h
o
s
e
w
h
o
a
n
ticip
a
ted
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e
y
w
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e
a
v
ailab
le
3
0
-
3
5
d
ay
s
a
f
ter
d
is
ch
ar
g
e.
P
atie
n
ts
w
h
o
ag
r
e
ed
to
p
ar
ticip
ate
w
er
e
co
n
tac
ted
b
y
telep
h
o
n
e
ap
p
r
o
x
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m
a
te
l
y
o
n
e
m
o
n
t
h
a
f
ter
d
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ch
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g
e,
an
d
w
er
e
ad
m
in
is
ter
ed
th
e
i
n
ter
v
ie
w
.
T
h
e
p
u
r
p
o
s
e
o
f
th
e
s
tu
d
y
an
d
r
ig
h
t
s
o
f
p
ar
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an
ts
to
w
it
h
d
r
a
w
f
r
o
m
t
h
e
s
tu
d
y
a
t
an
y
s
ta
g
e
w
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e
d
escr
ib
ed
p
r
io
r
to
b
eg
in
n
i
n
g
o
f
d
ata
co
llectio
n
.
A
ll
p
ar
ticip
an
t
s
p
r
o
v
id
ed
w
r
itte
n
i
n
f
o
r
m
ed
co
n
s
e
n
t
w
h
e
n
r
eg
i
s
tr
atio
n
an
d
i
f
an
y
p
er
s
o
n
s
d
id
n
’
t
h
a
v
e
w
i
lli
n
g
n
e
s
s
to
p
ar
ticip
ate
w
e
r
ep
lace
t
h
e
m
w
it
h
o
th
er
v
o
lu
n
teer
p
ar
ticip
an
ts
u
s
in
g
co
n
v
en
ie
n
t
ap
p
r
o
ac
h
o
f
s
a
m
p
l
in
g
.
T
h
e
eth
ical
r
ev
ie
w
b
o
ar
d
o
f
B
aq
iy
atalla
h
U
n
iv
er
s
it
y
o
f
Me
d
ical
Sci
en
ce
s
ap
p
r
o
v
ed
th
e
s
tu
d
y
p
r
o
to
co
l
(
I
D:
I
R
.
B
MSU.
R
E
C
.
1
3
9
9
.
1
8
7
)
.
2
.
2
.
M
e
a
s
ures
De
m
o
g
r
ap
h
ic
an
d
cli
n
ical
i
n
f
o
r
m
atio
n
co
llec
ted
w
er
e
a
g
e,
g
e
n
d
er
,
m
ar
ital
s
tat
u
s
,
ed
u
ca
tio
n
,
e
m
p
lo
y
m
en
t,
s
m
o
k
in
g
,
b
lo
o
d
g
r
o
u
p
,
R
h
es
u
s
f
ac
to
r
,
an
d
ch
r
o
n
ic
co
m
o
r
b
id
m
ed
ical
co
n
d
itio
n
s
,
an
d
s
p
ec
if
ic
in
f
o
r
m
atio
n
ab
o
u
t
C
OVI
D
-
1
9
s
u
c
h
a
s
t
h
e
in
ter
v
al
b
et
w
ee
n
ap
p
ea
r
a
n
ce
o
f
s
y
m
p
to
m
s
a
n
d
f
ir
s
t
p
h
y
s
icia
n
v
i
s
it,
ti
m
e
b
e
f
o
r
e
s
y
m
p
to
m
o
n
s
et
an
d
d
iag
n
o
s
is
,
t
h
e
ti
m
e
b
et
wee
n
s
y
m
p
to
m
o
n
s
et
a
n
d
h
o
s
p
italizatio
n
,
a
n
d
th
e
p
r
im
ar
y
s
y
m
p
to
m
t
h
at
w
as
m
a
n
i
f
ested
p
r
io
r
to
d
iag
n
o
s
is
.
2
.
2
.
1
.
Sh
o
rt
f
o
r
m
h
ea
lt
h
s
urv
ey
(
SF
-
8)
T
h
e
HR
Qo
L
w
a
s
ass
e
s
s
ed
u
s
i
n
g
S
F
-
8
,
w
h
ic
h
is
an
ab
b
r
ev
i
ated
v
er
s
io
n
o
f
th
e
SF
-
3
6
q
u
esti
o
n
n
air
e.
T
h
e
SF
-
8
co
n
s
i
s
ts
o
f
8
ite
m
s
th
at
m
ak
e
u
p
eig
h
t
s
u
b
s
ca
les
:
g
en
er
al
h
ea
lth
(
GH)
,
p
h
y
s
ica
l
f
u
n
ctio
n
i
n
g
(
P
F),
r
o
le
li
m
itatio
n
b
ec
au
s
e
o
f
p
h
y
s
ical
h
ea
lt
h
p
r
o
b
le
m
s
(
R
P
)
,
r
o
le
li
m
itatio
n
b
e
ca
u
s
e
o
f
e
m
o
tio
n
al
p
r
o
b
le
m
s
,
(
R
E
)
,
b
o
d
ily
p
ai
n
(
B
P
)
,
v
italit
y
(
VT
)
,
s
o
cial
f
u
n
ctio
n
i
n
g
(
SF
)
,
an
d
m
e
n
tal
h
ea
lt
h
(
MH
)
.
T
h
ese
s
u
b
s
ca
les
m
a
k
e
u
p
t
w
o
s
u
m
m
ar
y
s
co
r
es
th
a
t
ar
e
d
escr
ib
ed
as
t
h
e
p
h
y
s
ic
al
co
m
p
o
n
e
n
t
s
u
m
m
ar
y
(
P
C
S)
an
d
th
e
m
e
n
tal
co
m
p
o
n
e
n
t
s
u
m
m
ar
y
(
M
C
S
)
.
T
h
e
s
tan
d
ar
d
ized
s
co
r
e
o
f
th
e
s
ca
le
r
an
g
es
f
r
o
m
0
to
1
0
0
w
i
th
a
m
ea
n
v
al
u
e
o
f
5
0
an
d
s
tan
d
ar
d
d
ev
iatio
n
o
f
1
0
.
Hig
h
er
s
co
r
es
in
d
icate
b
etter
q
u
alit
y
o
f
li
f
e
an
d
th
e
s
u
b
s
ca
le
s
co
r
es
as
w
el
l
as
s
u
m
m
ar
y
s
co
r
es
m
a
y
b
e
ca
l
cu
lated
in
d
i
v
id
u
all
y
(
s
ee
d
ata
an
al
y
s
is
b
elo
w
)
[
2
9
]
.
T
h
e
SF
-
1
2
an
d
SF
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2
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Da
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,
h
av
in
g
a
ch
i
ld
,
in
ter
v
al
b
et
w
ee
n
p
h
y
s
icia
n
v
i
s
it
an
d
d
iag
n
o
s
i
s
,
in
ter
v
al
b
et
w
ee
n
in
itial
s
y
m
p
to
m
s
a
n
d
h
o
s
p
ital
izatio
n
,
in
i
tial
s
y
m
p
to
m
p
r
ese
n
tatio
n
,
a
n
d
r
h
es
u
s
f
ac
to
r
(
p
<0
.
0
5
)
.
A
s
s
o
ciatio
n
s
w
er
e
p
r
esen
t
b
et
w
ee
n
g
e
n
d
er
an
d
all
s
u
b
s
ca
le
s
co
r
es
an
d
o
v
er
all
P
C
S
an
d
MCS
to
tal
s
c
o
r
es.
T
h
er
e
w
a
s
also
a
s
ig
n
i
f
ica
n
t
as
s
o
ciatio
n
b
et
w
ee
n
th
e
p
r
ese
n
ti
n
g
s
y
m
p
to
m
o
f
co
u
g
h
an
d
b
o
th
P
C
S
a
n
d
MC
S
to
tal
s
co
r
es.
All
ca
teg
o
r
ies o
f
i
n
s
o
m
n
ia
w
er
e
al
s
o
s
ig
n
i
f
ica
n
tl
y
a
s
s
o
ciate
d
w
it
h
P
C
S a
n
d
MC
S to
tal
s
co
r
es.
R
es
u
lts
o
f
b
i
n
ar
y
lo
g
i
s
tic
r
e
g
r
ess
io
n
ar
e
p
r
ese
n
ted
i
n
T
ab
le
3
(
s
ee
A
p
p
en
d
ix
)
.
T
h
e
m
o
d
el
w
as
s
tatis
t
icall
y
s
i
g
n
i
f
ica
n
t
(
X2
=5
9
.
3
8
;
p
<0
.
0
0
1
)
an
d
ex
p
lai
n
ed
2
1
%
to
2
8
%
o
f
t
h
e
v
ar
ian
ce
i
n
H
R
Qo
L
b
ased
o
n
C
o
x
&
S
n
ell
a
n
d
Na
g
el
k
er
k
e
R
Sq
u
ar
e,
r
esp
ec
tiv
e
l
y
.
P
ar
tici
p
an
ts
a
g
e
4
0
y
ea
r
s
o
r
h
i
g
h
er
w
er
e
n
ea
r
l
y
t
w
ice
a
s
lik
el
y
to
h
a
v
e
p
o
o
r
m
e
n
tal
H
R
QO
L
co
m
p
ar
ed
to
t
h
o
s
e
w
h
o
w
er
e
y
o
u
n
g
er
(
OR
=1
.
9
0
;
9
5
%
C
I
=1
.
0
2
-
3
.
5
4
)
.
W
o
m
e
n
w
er
e
o
v
er
f
o
u
r
ti
m
es
m
o
r
e
li
k
el
y
to
e
x
p
er
ien
ce
p
o
o
r
er
p
h
y
s
ical
H
R
Qo
L
co
m
p
ar
e
d
to
m
e
n
(
O
R
=4
.
5
3
;
9
5
%
C
I
=2
.
2
2
-
9
.
2
1
)
an
d
w
er
e
also
o
v
er
tw
ice
as
li
k
el
y
to
h
av
e
lo
w
m
e
n
tal
H
R
Qo
L
co
m
p
ar
ed
to
m
e
n
(
OR
=2
.
4
8
;
9
5
%
C
I
=1
.
2
6
-
4
.
8
8
)
.
T
h
o
s
e
w
h
o
h
ad
co
u
g
h
as
th
eir
p
r
esen
t
in
g
s
y
m
p
to
m
o
f
C
OVI
D
-
1
9
w
er
e
ap
p
r
o
x
im
a
tel
y
t
h
r
ee
ti
m
es
m
o
r
e
lik
el
y
to
h
a
v
e
a
lo
w
m
en
tal
HR
Qo
L
th
a
n
th
o
s
e
w
it
h
o
t
h
er
p
r
esen
tin
g
s
y
m
p
to
m
s
(
OR
=3
.
1
2
;
9
5
%
C
I
=1
.
4
6
-
6
.
6
8
)
,
a
s
w
e
l
l
a
s
w
o
r
s
e
p
h
y
s
ic
a
l
HR
Q
o
L
(
OR
=
2
.
7
3
;
9
5
%
C
I
=
1
.
2
6
-
5
.
9
4
)
.
W
i
t
h
r
eg
a
r
d
t
o
i
n
s
o
m
n
i
a
s
ev
e
r
i
ty
,
p
a
r
ti
c
i
p
an
ts
w
h
o
r
e
p
o
r
t
e
d
a
m
o
d
e
r
a
t
e
d
e
g
r
e
e
o
f
in
s
o
m
n
ia
w
e
r
e
n
e
a
r
ly
th
r
e
e
t
im
e
s
m
o
r
e
l
ik
e
ly
th
an
o
th
e
r
s
t
o
r
e
p
o
r
t
p
o
o
r
p
h
y
s
i
c
a
l
HR
Q
o
L
(
OR
=
2
.
7
4
;
9
5
%
C
I
=
1
.
2
2
-
6
.
1
4
)
,
a
n
d
t
h
o
s
e
w
ith
s
ev
e
r
e
in
s
o
m
n
i
a
w
e
r
e
n
e
a
r
ly
f
o
u
r
t
im
es
as
li
k
e
ly
t
o
h
av
e
p
o
o
r
m
en
t
al
HR
Q
o
L
(
OR
=
3
.
8
6
;
9
5
%
C
I
=
1
.
3
5
-
1
1
.
0
7
)
.
4.
DIS
CU
SS
I
O
N
T
h
e
p
u
r
p
o
s
e
o
f
th
e
p
r
esen
t
s
tu
d
y
w
a
s
to
ex
a
m
i
n
e
d
e
m
o
g
r
ap
h
ic
an
d
cli
n
ical
f
ac
to
r
s
t
h
a
t
m
a
y
b
e
in
f
lu
e
n
tia
l
i
n
d
eter
m
in
in
g
h
e
alth
-
r
elate
d
q
u
al
it
y
o
f
li
f
e
i
n
th
o
s
e
w
h
o
h
a
v
e
b
ee
n
r
ec
e
n
tl
y
r
ec
o
v
er
ed
f
r
o
m
C
OVI
D
-
1
9
.
Fin
d
i
n
g
s
r
ev
ea
le
d
th
at
s
e
v
er
al
c
h
ar
ac
ter
is
tic
s
w
er
e
as
s
o
ciate
d
w
it
h
a
h
i
g
h
er
lik
eli
h
o
o
d
o
f
p
o
o
r
p
h
y
s
ical
a
n
d
m
en
ta
l
q
u
al
it
y
o
f
li
f
e
at
o
n
e
m
o
n
t
h
a
f
t
er
h
o
s
p
i
tal
d
is
c
h
ar
g
e.
B
ei
n
g
ag
e
4
0
y
ea
r
s
o
r
o
ld
,
f
e
m
ale,
h
av
i
n
g
co
u
g
h
a
s
a
p
r
esen
ti
n
g
s
y
m
p
to
m
,
a
n
d
h
av
in
g
i
n
s
o
m
n
ia
m
a
y
i
n
cr
ea
s
e
h
av
e
p
o
o
r
p
h
y
s
ical
o
r
m
en
tal
HR
Qo
L
at
th
i
s
ti
m
e.
A
lt
h
o
u
g
h
r
esear
ch
i
n
th
i
s
ar
ea
is
li
m
ited
,
a
f
e
w
s
t
u
d
ies
h
av
e
e
x
a
m
in
ed
f
ac
to
r
s
as
s
o
ciate
d
w
it
h
q
u
alit
y
o
f
li
f
e
in
C
OVI
D
-
1
9
p
atien
ts
.
Fo
r
ex
a
m
p
le,
A
r
ab
-
Z
o
za
n
i
et
a
l
.
[
1
4
]
ass
ess
ed
HR
Qo
L
u
s
i
n
g
E
Q
-
5
D
q
u
esti
o
n
n
air
e
i
n
4
2
0
p
atien
ts
2
-
3
w
ee
k
s
a
f
ter
h
o
s
p
ital
d
is
ch
ar
g
e
in
a
s
tu
d
y
t
h
at
to
o
k
p
lace
in
t
h
e
Yaz
d
p
r
o
v
in
ce
o
f
I
r
an
.
C
o
n
s
i
s
t
e
n
t
w
it
h
t
h
e
f
i
n
d
in
g
s
i
n
th
e
p
r
es
en
t
s
t
u
d
y
,
th
e
s
e
in
v
esti
g
ato
r
s
f
o
u
n
d
th
a
t
f
e
m
ale
g
en
d
er
an
d
o
ld
er
ag
e
w
er
e
s
i
g
n
i
f
ican
t
p
r
ed
icto
r
s
o
f
HR
Qo
L
in
s
u
ch
p
atie
n
t
s
.
Ho
w
e
v
er
,
o
th
er
f
ac
to
r
s
s
u
c
h
as
ed
u
ca
tio
n
,
e
m
p
lo
y
m
e
n
t
s
tat
u
s
,
h
av
i
n
g
d
iab
etes
o
r
h
ea
r
t
f
ailu
r
e,
an
d
b
ein
g
ad
m
it
ted
to
th
e
in
te
n
s
i
v
e
ca
r
e
u
n
i
t
w
a
s
also
as
s
o
ciate
d
w
ith
HR
Qo
L
i
n
th
at
s
t
u
d
y
,
i
n
co
n
tr
ast
to
th
e
f
i
n
d
i
n
g
s
h
er
e.
Ho
w
e
v
er
,
th
er
e
w
er
e
s
ev
er
a
l
d
if
f
er
e
n
ce
s
b
et
w
ee
n
th
at
s
t
u
d
y
an
d
th
e
p
r
esen
t
s
tu
d
y
th
a
t
m
a
y
h
elp
to
ex
p
lai
n
th
e
d
i
f
f
er
en
c
e
in
f
i
n
d
i
n
g
s
.
First,
ass
es
s
m
en
t
o
f
HR
Qo
L
w
a
s
ass
es
s
ed
u
s
in
g
d
if
f
er
en
t
m
ea
s
u
r
es,
w
i
th
p
er
h
ap
s
o
n
e
b
ei
n
g
a
m
o
r
e
s
e
n
s
it
iv
e
m
ea
s
u
r
e
o
f
q
u
a
lit
y
o
f
li
f
e
th
a
n
t
h
e
o
t
h
er
.
Seco
n
d
,
w
e
e
x
cl
u
d
ed
p
atien
ts
w
h
o
h
ad
a
h
is
to
r
y
o
f
I
C
U
ad
m
is
s
io
n
d
u
r
in
g
h
o
s
p
ital
izatio
n
.
T
h
er
ef
o
r
e,
th
o
s
e
w
it
h
m
o
r
e
s
er
io
u
s
ca
s
es
o
f
C
OVI
D
-
1
9
w
er
e
ex
clu
d
ed
f
r
o
m
th
e
cu
r
r
en
t
s
a
m
p
le.
T
h
ir
d
,
h
er
e
p
atien
t
s
w
er
e
ass
e
s
s
ed
o
n
e
m
o
n
th
a
f
ter
h
o
s
p
ital
d
is
c
h
ar
g
e
r
a
th
er
th
a
n
2
-
3
w
ee
k
s
Evaluation Warning : The document was created with Spire.PDF for Python.
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224
af
ter
d
is
c
h
ar
g
e,
a
n
d
t
h
er
ef
o
r
e
a
lo
n
g
er
f
o
llo
w
-
u
p
p
er
io
d
m
a
y
lead
to
i
m
p
r
o
v
e
m
en
ts
i
n
o
u
tco
m
e
f
o
r
p
atie
n
ts
w
it
h
ce
r
tai
n
d
e
m
o
g
r
ap
h
ic
a
n
d
clin
ical
c
h
ar
ac
ter
is
tic
s
.
T
h
e
f
a
cto
r
th
at
d
is
ti
n
g
u
i
s
h
ed
t
h
e
p
r
esen
t
s
t
u
d
y
f
r
o
m
t
h
e
A
r
ab
-
Z
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i
et
a
l
.
[
1
4
]
s
tu
d
y
i
s
th
e
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x
a
m
in
at
io
n
o
f
in
s
o
m
n
ia
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a
co
r
r
elate
o
f
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L
,
w
h
ic
h
to
o
u
r
k
n
o
w
led
g
e
is
t
h
e
f
ir
s
t ti
m
e
th
i
s
h
as b
ee
n
ex
a
m
i
n
ed
in
I
r
an
.
I
n
an
o
th
e
r
s
t
u
d
y
,
C
h
en
e
t
a
l
.
[
1
3
]
e
x
am
in
e
d
c
o
r
r
e
l
at
e
s
o
f
HR
Q
o
L
u
s
in
g
th
e
S
F
-
3
6
in
p
a
ti
en
ts
r
e
c
o
v
e
r
e
d
f
r
o
m
C
O
V
I
D
-
1
9
a
t
o
n
e
-
m
o
n
th
f
o
ll
o
w
u
p
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th
e
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o
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t
ig
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s
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d
3
6
1
p
a
ti
en
ts
,
i
n
cl
u
d
i
n
g
p
a
ti
en
ts
w
i
th
s
ev
e
r
e
c
a
s
es
o
f
C
O
V
I
D
-
1
9
w
ith
a
n
av
e
r
a
g
e
ag
e
o
f
4
7
±
1
3
y
e
a
r
s
.
T
h
e
g
en
d
e
r
d
i
s
t
r
i
b
u
t
i
o
n
o
f
th
e
s
am
p
l
e
in
d
i
c
at
e
d
a
n
a
p
p
r
o
x
im
a
t
ely
e
q
u
al
f
r
e
q
u
en
cy
o
f
m
en
an
d
w
o
m
en
.
T
h
ey
f
o
u
n
d
s
ig
n
if
i
c
an
t
a
s
s
o
ci
a
t
i
o
n
s
b
e
t
w
e
en
s
ev
e
r
a
l
s
u
b
s
ca
l
es
o
f
th
e
SF
-
3
6
(
e
.
g
.
,
P
F
,
R
E
,
GH
,
an
d
V
T
)
a
n
d
ag
e,
g
en
d
e
r
,
h
av
i
n
g
a
c
h
r
o
n
i
c
il
ln
es
s
,
le
n
g
t
h
o
f
h
o
s
p
it
a
l
s
t
ay
,
an
d
s
m
o
k
in
g
h
i
s
t
o
r
y
,
th
e
o
n
ly
f
a
c
t
o
r
as
s
o
ci
a
t
e
d
w
i
th
m
en
t
al
h
e
a
lt
h
Q
o
L
(
M
C
S
)
w
as
g
en
d
e
r
.
W
o
m
en
w
e
r
e
o
v
e
r
t
w
i
c
e
a
s
li
k
e
ly
(
O
R
=
2
.
2
)
t
o
h
av
e
a
p
o
o
r
MC
S
as
m
en
.
T
h
i
s
f
in
d
in
g
w
a
s
s
im
il
a
r
t
o
th
a
t
in
th
e
p
r
es
en
t
s
tu
d
y
.
H
o
w
ev
e
r
,
w
i
th
r
eg
a
r
d
t
o
p
h
y
s
ic
a
l
HL
Q
o
L
,
w
e
f
o
u
n
d
th
a
t
w
o
m
en
w
e
r
e
m
o
r
e
t
h
an
f
o
u
r
tim
e
s
l
ik
ely
t
o
h
av
e
p
o
o
r
l
i
f
e
q
u
a
l
ity
in
th
i
s
a
r
e
a
c
o
m
p
a
r
e
d
t
o
m
en
.
T
h
is
f
i
n
d
in
g
in
d
ic
a
t
es
th
at
th
e
p
h
y
s
ic
a
l
c
o
m
p
o
n
e
n
t
o
f
H
R
Q
o
L
m
ay
b
e
b
e
en
m
o
r
e
im
p
a
i
r
e
d
t
h
an
th
e
m
en
t
a
l
h
e
a
lt
h
c
o
m
p
o
n
e
n
t
i
n
w
o
m
en
.
O
th
e
r
r
e
a
s
o
n
s
f
o
r
d
if
f
e
r
e
n
c
e
s
in
th
e
f
i
n
d
i
n
g
s
b
e
t
w
e
en
th
e
p
r
e
s
en
t
a
n
d
th
e
C
h
en
e
t
a
l
.
[
1
3
]
s
tu
d
y
m
ay
h
av
e
b
ee
n
d
i
f
f
e
r
en
t
s
e
tt
in
g
s
,
d
i
f
f
e
r
e
n
t
cu
l
tu
r
a
l
en
v
i
r
o
n
m
en
ts
,
an
d
d
if
f
e
r
en
t
d
em
o
g
r
a
p
h
i
c
ch
a
r
a
ct
e
r
is
t
ic
s
.
A
lt
h
o
u
g
h
to
o
u
r
k
n
o
w
led
g
e
n
o
s
tu
d
ies
h
av
e
y
et
e
x
a
m
in
e
th
e
ef
f
ec
ts
o
f
s
leep
q
u
alit
y
a
n
d
HR
Qo
L
i
n
I
r
an
,
s
ev
er
al
s
tu
d
ies
th
at
a
s
s
e
s
s
ed
th
e
s
e
a
m
o
n
g
C
OVI
D
-
1
9
p
atien
ts
i
n
o
th
er
co
u
n
tr
ie
s
[
1
1
]
,
[
2
3
]
,
[
3
2
]
,
[
3
3
]
.
Ho
w
e
v
er
,
al
m
o
s
t
all
o
f
th
e
s
e
s
tu
d
ie
s
ex
a
m
i
n
e
th
i
s
ass
o
ciat
i
o
n
in
cu
r
r
e
n
tl
y
h
o
s
p
italized
p
atien
t
s
,
n
o
t
a
m
o
n
g
C
OVI
D
-
1
9
p
atien
ts
a
f
ter
h
o
s
p
ital
d
is
ch
ar
g
e.
T
h
er
ef
o
r
e,
as
n
o
ted
ea
r
lier
,
th
e
p
r
esen
t
s
t
u
d
y
i
s
th
e
f
ir
s
t
to
ex
a
m
in
e
s
leep
p
r
o
b
lem
s
i
n
p
atien
ts
d
u
r
i
n
g
th
e
co
n
v
alesce
n
c
e
p
er
io
d
f
o
llo
w
i
n
g
d
is
c
h
ar
g
e.
I
n
a
cr
o
s
s
-
s
ec
t
io
n
al
s
tu
d
y
,
Ak
i
n
ci
a
n
d
B
asar
[
2
3
]
ex
a
m
in
ed
t
h
e
as
s
o
ciatio
n
b
et
w
ee
n
s
leep
q
u
a
lit
y
an
d
p
s
y
ch
o
lo
g
ical
s
tat
u
s
i
n
1
8
9
p
atien
ts
w
it
h
C
OVI
D
-
1
9
.
T
h
e
y
f
o
u
n
d
th
a
t
f
ac
to
r
s
s
u
ch
a
s
ti
m
i
n
g
th
e
h
o
s
p
ital
an
d
d
e
p
r
ess
iv
e
s
y
m
p
to
m
s
co
r
r
elate
d
w
ith
p
o
o
r
er
s
leep
q
u
alit
y
.
T
h
i
s
f
in
d
i
n
g
is
s
i
m
il
ar
to
th
at
i
n
t
h
e
p
r
esen
t
s
t
u
d
y
w
h
ich
f
o
u
n
d
t
h
a
t
p
r
o
b
lem
s
w
i
th
s
leep
m
a
y
b
e
a
r
is
k
f
ac
to
r
f
o
r
r
ed
u
ctio
n
s
i
n
m
en
tal
h
ea
lth
Q
o
L
d
u
r
i
n
g
th
e
r
e
co
v
er
y
p
er
io
d
f
r
o
m
C
OVI
D
-
1
9
.
I
n
an
o
th
er
s
tu
d
y
,
J
ian
g
et
a
l
.
[
3
2
]
ex
a
m
i
n
ed
p
s
y
ch
o
lo
g
ical
d
is
tr
ess
a
n
d
s
l
ee
p
q
u
alit
y
a
m
o
n
g
C
OVI
D
-
1
9
p
atien
t
s
i
n
W
u
h
a
n
,
C
h
i
n
a,
f
i
n
d
in
g
a
s
ig
n
i
f
ica
n
t
r
elatio
n
s
h
ip
b
et
w
ee
n
t
h
e
t
wo
.
I
n
ad
d
itio
n
,
t
h
e
s
e
in
v
e
s
ti
g
ato
r
s
also
f
o
u
n
d
th
at
a
g
e,
g
e
n
d
er
,
an
d
s
ev
er
it
y
o
f
d
is
ea
s
e
s
y
m
p
to
m
s
w
er
e
s
i
g
n
if
ica
n
tl
y
ass
o
ciate
d
w
it
h
m
en
tal
h
ea
lt
h
p
r
o
b
lem
s
s
u
c
h
as
an
x
ie
t
y
an
d
d
ep
r
ess
io
n
in
t
h
ese
p
atien
t
s
.
T
h
ese
f
in
d
i
n
g
s
ar
e
also
s
im
ilar
to
th
o
s
e
f
r
o
m
t
h
e
p
r
esen
t
s
t
u
d
y
,
co
n
f
ir
m
i
n
g
th
at
d
e
m
o
g
r
ap
h
ic
f
ac
to
r
s
m
a
y
p
la
y
an
i
m
p
o
r
tan
t
r
o
le
in
th
e
HR
Qo
L
o
f
C
OVI
D
-
1
9
p
atie
n
ts
d
u
r
i
n
g
th
eir
r
ec
o
v
er
y
p
er
io
d
.
Fu
r
t
h
er
m
o
r
e,
in
s
o
m
n
ia
i
ts
el
f
i
s
a
s
s
o
c
iated
w
ith
p
h
y
s
ica
l
h
ea
lt
h
p
r
o
b
le
m
s
th
at
ca
n
n
e
g
ativ
el
y
a
f
f
ec
t
Q
o
L
i
n
p
atie
n
t
s
w
it
h
C
OVI
D
-
19
[
3
4
]
an
d
m
a
y
also
ad
v
er
s
el
y
af
f
ec
t
i
m
m
u
n
e
f
u
n
ctio
n
i
n
g
,
wh
ich
m
a
y
i
n
ter
f
er
e
w
ith
r
ec
o
v
er
y
f
r
o
m
i
n
f
ec
t
io
n
o
r
r
esis
tan
c
e
to
it
[
3
5
]
.
A
n
o
t
h
er
n
eg
at
iv
e
e
f
f
ec
t
o
f
a
lo
w
s
leep
q
u
alit
y
i
n
s
u
ch
p
atien
ts
is
r
ela
ted
to
c
o
g
n
iti
v
e
ab
ilit
y
o
f
th
es
e
p
atien
ts
.
Stu
d
ie
s
h
av
e
s
h
o
w
n
p
eo
p
le
w
i
th
s
leep
p
r
o
b
lem
s
o
v
er
ti
m
e
m
a
y
lo
s
e
th
eir
co
g
n
iti
v
e
f
u
n
ctio
n
s
a
n
d
th
er
ef
o
r
e
co
u
ld
n
’
t
p
er
f
o
r
m
t
h
eir
j
o
b
ac
tiv
ities
o
r
s
o
cial
r
o
les
n
o
r
m
all
y
th
at
m
a
y
af
f
ec
t
t
h
eir
s
o
cial
h
ea
l
th
a
n
d
m
a
y
b
e
r
esu
lted
to
a
r
ed
u
ctio
n
in
t
h
eir
HR
Qo
L
s
c
o
r
e
[
3
6
]
.
T
h
e
cu
r
r
en
t
s
t
u
d
y
also
f
o
u
n
d
th
at
w
h
en
C
OVI
D
-
1
9
p
r
esen
ts
i
n
itiall
y
w
it
h
t
h
e
s
y
m
p
to
m
o
f
co
u
g
h
(
r
ath
er
th
an
s
h
o
r
tn
e
s
s
o
f
b
r
ea
th
o
r
o
th
er
s
y
m
p
to
m
s
w
as
as
s
o
ciate
d
w
it
h
p
o
o
r
p
h
y
s
ica
l
an
d
m
en
tal
co
m
p
o
n
e
n
t
s
o
f
H
R
Qo
L
)
.
An
e
x
p
la
n
atio
n
f
o
r
th
i
s
f
i
n
d
in
g
m
a
y
b
e
t
h
at
p
atien
ts
w
it
h
co
u
g
h
i
n
g
o
f
te
n
h
a
v
e
m
o
r
e
s
e
v
er
e
r
esp
ir
ato
r
y
s
y
m
p
to
m
s
.
R
esp
ir
ato
r
y
i
n
v
o
l
v
e
m
en
t
m
a
y
h
a
v
e
p
o
o
r
er
o
u
tco
m
e
s
f
r
o
m
t
h
e
d
is
ea
s
e
a
n
d
a
m
o
r
e
p
er
s
is
ten
t
co
u
r
s
e
o
f
s
y
m
p
to
m
s
,
ad
v
er
s
el
y
af
f
ec
ti
n
g
H
R
Qo
L
d
u
r
in
g
r
ec
o
v
er
y
.
C
OVI
D
-
1
9
p
atien
ts
w
i
th
m
o
r
e
ex
ten
s
i
v
e
r
esp
ir
ato
r
y
i
n
f
ec
tio
n
ar
e
k
n
o
w
n
to
h
a
v
e
lo
n
g
er
h
o
s
p
italizatio
n
s
t
h
a
n
t
h
o
s
e
with
n
o
n
-
r
esp
ir
ato
r
y
in
v
o
l
v
e
m
en
t a
n
d
p
o
o
r
er
o
u
tco
m
es
m
o
r
e
g
en
er
al
l
y
[
3
7
]
.
4
.
1
.
Study
l
i
m
it
a
t
io
ns
Sev
er
al
li
m
itat
io
n
s
o
f
th
e
c
u
r
r
en
t
s
t
u
d
y
li
m
it
th
e
g
en
er
aliz
atio
n
an
d
i
n
ter
p
r
etatio
n
o
f
t
h
e
f
in
d
i
n
g
s
.
First,
p
ar
ticip
an
t
s
w
er
e
a
c
o
n
v
e
n
ien
c
e
s
a
m
p
le
o
f
v
o
lu
n
teer
s
f
r
o
m
a
s
i
n
g
le
h
ea
lth
ca
r
e
ce
n
ter
,
li
m
iti
n
g
g
en
er
aliza
b
ili
t
y
to
all
I
r
an
ia
n
p
atie
n
ts
h
o
s
p
italized
a
n
d
d
is
ch
ar
g
ed
f
r
o
m
o
th
er
r
eg
io
n
s
o
f
th
e
co
u
n
tr
y
.
Ho
w
e
v
er
,
n
o
p
ar
ticu
lar
cu
lt
u
r
al
o
r
g
eo
g
r
ap
h
ical
f
ac
to
r
s
ar
e
lik
el
y
a
ll
th
at
d
i
f
f
er
e
n
t
i
n
T
eh
r
an
th
a
n
o
th
er
ar
ea
s
o
f
th
e
co
u
n
tr
y
,
e
x
ce
p
t
b
ei
n
g
a
n
u
r
b
an
s
et
tin
g
.
Seco
n
d
,
th
er
e
w
a
s
r
e
f
u
s
al
r
ate
o
f
1
4
%,
w
h
i
ch
w
as
g
r
ea
ter
t
h
a
n
th
e
1
0
%
esti
m
ated
.
Ho
w
e
v
er
,
an
8
6
%
r
esp
o
n
s
e
r
ate
i
s
r
elati
v
el
y
h
i
g
h
f
o
r
p
atien
ts
i
n
r
ec
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.
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.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
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-
8806
I
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P
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Vo
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11
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No
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1
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1
228
AP
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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:
2252
-
8806
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(
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a
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229
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2
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4
.
4
)
*
*
*
5
0
.
8
(
2
4
.
7
)
*
*
5
1
.
4
(
2
6
.
5
)
3
6
.
9
(
1
7
.
5
)
*
*
*
4
3
.
3
(
1
8
.
5
)
*
*
*
M
a
r
i
t
a
l
st
a
t
u
s
S
i
n
g
l
e
52
3
9
.
3
(
2
1
.
3
)
4
6
.
1
(
2
2
.
9
)
4
1
.
3
(
2
4
.
7
)
4
1
.
5
(
2
8
.
0
)
*
3
5
.
6
(
2
2
.
3
)
4
9
.
0
(
2
9
.
7
)
6
0
.
6
(
2
8
.
2
)
6
1
.
5
(
2
7
.
8
)
*
4
2
.
1
(
1
8
.
5
)
5
1
.
7
(
2
1
.
3
)
M
a
r
r
i
e
d
20
6
4
2
.
3
(
2
0
.
4
)
4
5
.
4
(
2
6
.
4
)
4
6
.
6
(
2
7
.
3
)
5
2
.
6
(
3
2
.
5
)
*
3
9
.
7
(
2
3
.
0
)
5
0
.
1
(
2
5
.
6
)
5
6
.
2
(
2
8
.
0
)
5
1
.
5
(
2
7
.
3
)
*
4
6
.
7
(
2
0
.
6
)
4
9
.
4
(
1
9
.
7
)
E
d
u
c
a
t
i
o
n
H
i
g
h
sch
o
o
l
o
r
l
e
ss
16
2
4
2
.
7
(
2
0
.
8
)
4
4
.
3
(
2
6
.
3
)
4
6
.
1
(
2
7
.
1
)
5
2
.
3
(
3
2
.
5
)
3
8
.
3
(
2
4
.
2
)
5
2
.
8
(
2
4
.
1
)
*
5
8
.
2
(
2
5
.
7
)
5
2
.
5
(
2
5
.
1
)
4
6
.
4
(
2
0
.
7
)
5
0
.
4
(
1
8
.
2
)
U
n
i
v
e
r
si
t
y
96
3
9
.
8
(
2
0
.
0
)
4
7
.
7
(
2
4
.
6
)
4
4
.
5
(
2
6
.
5
)
4
7
.
1
(
3
0
.
8
)
3
9
.
8
(
2
0
.
7
)
4
5
.
0
(
2
9
.
4
)
*
5
5
.
2
(
3
1
.
6
)
5
5
.
2
(
3
1
.
6
)
4
4
.
8
(
1
9
.
5
)
4
8
.
8
(
2
2
.
7
)
E
m
p
l
o
y
m
e
nt
Emp
l
o
y
e
d
12
7
4
1
.
3
(
2
1
.
2
)
4
4
.
9
(
2
8
.
2
)
4
5
.
1
(
2
6
.
9
)
5
1
.
6
(
3
3
.
8
)
4
1
.
5
(
2
3
.
4
)
47
.
4
(
2
9
.
2
)
5
8
.
1
(
3
0
.
2
)
5
3
.
5
(
2
8
.
1
)
4
5
.
7
(
2
1
.
9
)
5
0
.
1
(
2
1
.
6
)
U
n
e
mp
l
o
y
ed
13
1
4
2
.
0
(
2
0
.
0
)
4
6
.
2
(
2
3
.
1
)
4
6
.
0
(
2
6
.
8
)
4
9
.
2
(
3
0
.
0
)
3
6
.
3
(
2
2
.
2
)
5
2
.
3
(
2
3
.
3
)
5
6
.
1
(
2
5
.
8
)
5
3
.
4
(
2
7
.
3
)
4
5
.
8
(
1
8
.
5
)
4
9
.
5
(
1
8
.
4
)
Ha
v
i
n
g
c
h
i
l
d
Y
e
s
21
1
4
1
.
4
(
2
0
.
5
)
4
5
.
0
(
2
6
.
3
)
4
5
.
8
(
2
7
.
2
)
5
2
.
4
(
3
2
.
2
)
*
3
7
.
8
(
2
3
.
2
)
5
1
.
1
(
2
5
.
6
)
5
6
.
6
(
2
7
.
3
)
5
1
.
9
(
2
6
.
8
)
*
4
6
.
2
(
2
0
.
5
)
4
9
.
3
(
1
9
.
3
)
No
47
4
2
.
5
(
2
1
.
1
)
4
7
.
9
(
2
3
.
2
)
4
4
.
1
(
2
5
.
1
)
4
1
.
3
(
2
9
.
0
)
*
4
3
.
6
(
2
1
.
1
)
4
4
.
7
(
2
9
.
5
)
5
9
.
0
(
3
1
.
0
)
6
0
.
9
(
3
0
.
7
2
)
*
4
4
.
0
(
1
9
.
1
)
5
2
.
0
(
2
2
.
9
)
S
m
o
k
i
n
g
Y
e
s
25
3
7
.
6
(
2
0
.
3
)
4
7
.
0
(
2
3
.
2
)
5
1
.
0
(
2
2
.
2
)
6
3
.
2
(
2
9
.
3
)
4
2
.
0
(
1
8
.
7
)
4
7
.
0
(
2
9
.
1
)
4
9
.
0
(
1
9
.
7
)
5
0
.
0
(
1
9
.
1
)
4
9
.
7
(
1
7
.
2
)
4
7
.
0
(
1
7
.
0
)
No
21
1
4
2
.
5
(
2
0
.
7
)
4
6
.
0
(
2
5
.
6
)
4
4
.
4
(
2
6
.
6
)
4
8
.
5
(
3
2
.
2
)
3
8
.
4
(
2
2
.
8
)
5
1
.
3
(
2
6
.
1
)
5
8
.
8
(
2
9
.
1
)
5
3
.
7
(
2
8
.
5
)
4
5
.
4
(
2
0
.
8
)
5
0
.
5
(
2
0
.
6
)
P
r
e
v
i
o
u
sl
y
smo
k
e
22
3
8
.
2
(
1
9
.
4
)
3
9
.
8
(
2
9
.
5
)
5
0
.
0
(
3
2
.
7
)
5
3
.
6
(
2
9
.
8
)
3
9
.
8
(
2
8
.
5
)
3
9
.
8
(
2
5
.
2
)
5
0
.
0
(
2
3
.
1
)
5
5
.
7
(
2
8
.
8
)
4
5
.
4
(
1
8
.
3
)
4
6
.
3
(
1
7
.
1
)
C
h
r
o
n
i
c
C
o
m
o
r
b
i
d
i
t
y
Y
e
s
14
7
4
0
.
8
(
1
9
.
1
)
4
5
.
7
(
2
5
.
9
)
4
6
.
8
(
2
4
.
2
)
5
2
.
4
(
3
4
.
5
)
3
8
.
6
(
2
2
.
1
)
5
0
.
7
(
2
6
.
2
)
5
4
.
6
(
2
5
.
8
)
51
.
7
(
2
6
.
9
)
4
6
.
4
(
1
9
.
3
)
4
8
.
9
(
1
8
.
6
)
No
11
1
4
2
.
7
(
2
2
.
3
)
4
5
.
3
(
2
5
.
6
)
4
3
.
9
(
3
0
.
0
)
4
7
.
7
(
2
8
.
0
)
3
9
.
2
(
2
4
.
0
)
4
8
.
9
(
2
6
.
8
)
6
0
.
4
(
3
0
.
4
)
5
5
.
9
(
2
8
.
6
)
4
4
.
9
(
2
1
.
5
)
5
1
.
1
(
2
1
.
7
)
C
O
V
I
D
-
19
p
e
c
i
f
i
c
d
a
t
a
In
t
e
r
v
a
l
b
e
t
w
e
e
n
sy
m
p
t
o
m
s
a
n
d
a
p
h
y
si
c
i
a
n
v
i
si
t
(
d
a
y
)
<5
18
1
4
3
.
2
(
2
1
.
5
)
*
4
7
.
0
(
2
6
.
0
)
4
5
.
2
(
2
6
.
2
)
5
0
.
6
(
3
1
.
4
)
3
9
.
4
(
2
3
.
0
)
5
1
.
4
(
2
7
.
3
)
5
8
.
7
(
2
6
.
9
)
5
4
.
3
(
2
8
.
6
)
4
6
.
5
(
2
1
.
2
)
5
0
.
9
(
2
0
.
0
)
≥5
77
3
7
.
9
(
1
7
.
6
)
*
4
2
.
2
(
2
4
.
7
)
4
6
.
4
(
2
8
.
3
)
4
9
.
9
(
3
3
.
3
)
3
7
.
7
(
2
2
.
8
)
4
6
.
4
(
2
3
.
9
)
5
3
.
2
(
3
0
.
2
)
5
1
.
6
(
2
5
.
4
)
4
4
.
1
(
1
7
.
6
)
4
7
.
2
(
1
9
.
9
)
In
t
e
r
v
a
l
b
e
t
w
e
e
n
p
h
y
si
c
i
a
n
v
i
si
t
a
n
d
Evaluation Warning : The document was created with Spire.PDF for Python.