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2.
2.
S
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2.
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Da
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C
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too
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US
A
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n
2004
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[
14
-
18]
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T
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P
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109
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n
t
pr
e
d
i
c
t
or
s
f
o
r
pa
t
i
e
n
t
s
a
f
e
t
y
c
u
l
t
ur
e
gr
a
de
.
2.
9.
E
t
h
ical
C
on
s
id
e
r
at
ion
s
B
e
f
o
r
e
s
t
a
r
t
i
n
g
t
h
e
da
t
a
c
o
l
l
e
c
t
i
o
n
pr
o
c
e
s
s
,
e
t
hi
c
a
l
c
l
e
a
r
a
n
c
e
wa
s
o
b
t
a
i
n
e
d
f
r
o
m
t
h
e
i
ns
t
i
t
u
t
i
o
n
a
l
r
e
vi
e
w
b
o
a
r
d
o
f
M
e
ke
ll
e
U
ni
ve
r
s
i
t
y
,
C
o
l
l
e
ge
o
f
He
a
l
t
h
S
c
i
e
n
c
e
s
.
Da
t
a
c
o
l
l
e
c
t
i
o
n
wa
s
t
h
e
n
c
o
n
duc
t
e
d
a
f
t
e
r
e
x
p
l
a
i
n
i
ng
t
h
e
a
im
a
n
d
i
t
s
po
s
s
i
b
l
e
b
e
n
e
f
i
t
s
to
t
h
e
s
t
ud
y
pa
r
t
i
c
i
p
a
n
t
a
n
d
t
o
t
h
e
s
t
udy
h
o
s
p
i
t
a
l
s
’
a
d
m
i
n
i
s
t
r
a
t
i
o
n
s
.
C
o
n
s
e
n
t
wa
s
o
b
t
a
i
n
e
d
a
f
t
e
r
e
x
p
la
i
ni
ng
t
he
i
r
r
i
g
h
t
n
o
t
to
pa
r
t
i
c
i
pa
t
e
i
f
t
h
e
y
wo
u
l
d
n
o
t
b
e
c
o
m
f
o
r
t
a
bl
e
.
T
h
e
n
,
a
f
t
e
r
o
b
t
a
i
ni
ng
c
o
n
s
e
n
t
f
r
o
m
t
he
s
t
udy
s
u
bj
e
c
t
,
i
n
t
e
r
vi
e
w
i
ng
wa
s
c
o
n
duc
t
e
d.
3.
RE
S
UL
T
S
A
ND
AN
AL
YSI
S
3.
1.
S
oc
io
-
De
m
ogr
ap
h
ic
Char
a
c
t
e
r
is
t
ics
of
t
h
e
S
t
u
d
y
S
u
b
j
e
c
t
s
A
tot
a
l
o
f
325
i
n
f
o
r
m
e
d
a
n
d
c
o
n
s
e
n
t
e
d
h
e
a
l
t
h
c
a
r
e
wo
r
ke
r
s
wh
o
we
r
e
wo
r
k
i
n
g
a
t
t
h
r
e
e
go
v
e
r
nm
e
n
t
a
l
h
o
s
p
i
t
a
l
s
o
f
M
e
ke
ll
e
c
i
t
y
we
r
e
e
n
r
o
ll
e
d
i
n
t
hi
s
s
t
ud
y
o
f
w
hi
c
h
176
(
54.
2%
)
we
r
e
f
e
ma
l
e
s
a
n
d
147
(
45.
8%
)
we
r
e
m
a
l
e
s
w
i
t
h
a
r
e
s
po
n
s
e
r
a
t
e
o
f
99.
38%
.
M
a
j
o
r
i
t
i
e
s
(
61.
5%
)
o
f
t
h
e
pa
r
t
i
c
i
pa
n
t
s
we
r
e
r
e
c
r
u
i
t
e
d
f
r
o
m
Ay
de
r
r
e
f
e
r
r
a
l
h
o
s
p
i
t
a
l
a
n
d
88%
we
r
e
i
n
t
h
e
a
ge
c
a
t
e
gor
y
l
e
s
s
t
h
a
n
45
y
e
a
r
s
.
T
h
e
m
a
j
o
r
i
t
y
(
77.
5%
)
we
r
e
B
a
c
h
e
l
o
r
o
f
S
c
i
e
n
c
e
h
o
l
de
r
s
.
W
i
t
h
r
e
ga
r
d
to
p
r
o
f
e
s
s
i
o
n
,
t
h
e
m
a
j
o
r
i
t
y
(
46.
8%
)
o
f
t
h
e
r
e
s
po
n
de
n
t
s
we
r
e
n
ur
s
e
s
a
r
e
pr
e
s
e
n
t
e
d
i
n
T
a
bl
e
1
.
3.
2.
P
at
ien
t
S
af
e
t
y
C
u
l
t
u
r
e
S
c
o
r
e
P
a
t
i
e
n
t
s
a
f
e
t
y
c
u
l
t
ur
e
gr
a
de
o
f
t
h
e
de
pa
r
t
m
e
n
t
s
or
uni
t
s
o
f
t
h
e
s
t
ud
y
h
o
s
p
i
t
a
l
s
wa
s
g
i
v
e
n
by
t
h
e
s
t
udy
pa
r
t
i
c
i
p
a
n
t
s
.
I
n
vi
e
w
o
f
t
h
a
t
,
21.
6%
o
f
pa
r
t
i
c
i
pa
n
t
s
r
a
t
e
d
a
s
s
a
t
i
s
f
a
c
t
o
r
y
a
n
d
78.
4%
r
a
t
e
d
a
s
un
s
a
t
i
s
f
a
c
t
or
y
.
F
o
r
t
h
e
pur
po
s
e
o
f
a
n
a
ly
s
i
s
by
l
o
g
i
s
t
i
c
r
e
gr
e
s
s
i
o
n
,
t
h
e
c
a
t
e
gor
i
e
s
o
f
t
h
e
de
pe
n
d
e
n
t
v
a
r
i
a
bl
e
we
r
e
d
i
c
h
o
to
m
i
z
e
d
i
n
t
o
‘
’
s
a
t
i
s
f
a
c
t
or
y
’
’
a
n
d
‘
’
u
n
s
a
t
i
s
f
a
c
to
r
y
’’
.
S
a
t
i
s
f
a
c
t
or
y
r
e
pr
e
s
e
n
t
s
t
h
e
c
a
t
e
g
o
r
i
e
s
’
e
x
c
e
ll
e
n
t
a
n
d
ve
r
y
go
o
d’
wh
e
r
e
a
s
u
n
s
a
t
i
s
f
a
c
t
or
y
r
e
pr
e
s
e
n
t
s
t
o
t
h
e
c
a
t
e
g
o
r
i
e
s
‘
a
c
c
e
pt
a
bl
e
,
po
or
a
n
d
f
a
il
i
ng’
.
F
i
gur
e
1
s
h
o
ws
P
a
t
i
e
n
t
s
a
f
e
t
y
c
u
l
t
ur
e
s
t
a
t
us
a
s
r
a
t
e
d
by
H
e
a
l
t
h
c
a
r
e
wo
r
ke
r
s
i
n
M
e
ke
ll
e
c
i
t
y
publi
c
h
o
s
p
i
t
a
l
s
,
2017
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
S
N
:
2252
-
8806
I
J
P
HS
V
o
l
.
7
,
N
o.
2
,
J
un
e
2018:
107
–
113
110
T
a
bl
e
1.
S
o
c
i
o
-
De
m
o
gr
a
phi
c
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
o
f
He
a
l
t
h
c
a
r
e
W
o
r
ke
r
s
C
ha
r
a
c
te
r
is
ti
c
s
N
umbe
r
P
e
r
c
e
nt
S
e
x
F
e
ma
l
e
149
45.8
M
a
le
176
54.2
A
ge
<
30
y
e
a
r
s
173
53.2
30
-
45
113
34.8
46
-
55
39
12.0
P
r
of
e
s
s
io
n
P
h
y
s
i
c
ia
n
50
15.4
N
ur
s
e
152
46.8
L
a
b
or
a
to
r
y
t
e
c
hni
c
ia
n/
t
e
c
hn
o
l
o
gi
s
t
39
12
P
ha
r
ma
c
y
24
7.4
O
th
e
r
s
60
18.5
D
e
pa
r
tm
e
nt
E
me
r
ge
n
c
y
d
e
pa
r
tm
e
nt
69
21.2
O
ut
pa
ti
e
nt
d
e
pa
r
tm
e
nt
187
57.5
I
npa
ti
e
nt
d
e
pa
r
tm
e
nt
69
21.2
E
duc
a
ti
o
na
l
l
e
ve
l
10t
h gr
a
de
c
o
mpl
e
t
e
5
1.5
12t
h gr
a
de
c
o
mpl
e
t
e
6
1.8
D
ip
lo
ma
48
14.8
D
e
gr
e
e
252
77.5
M
a
s
te
r
s
14
4.3
W
o
r
k
e
x
p
e
r
i
e
n
c
e
L
e
s
s
t
ha
n o
n
e
y
e
a
r
49
15.1
1
-
5
y
e
a
r
s
157
48.3
6
-
10
y
e
a
r
s
94
28.9
11
-
15
y
e
a
r
s
22
6.8
A
bove
15
y
e
a
r
s
3
0.9
W
o
r
ki
ng h
o
u
r
s
pe
r
w
e
e
k
L
e
s
s
t
ha
n 20 ho
u
r
s
3
0.9
20
-
39 ho
u
r
s
48
14.8
40
-
59 ho
u
r
s
233
71.7
60
-
79 ho
u
r
s
18
5.5
80
-
99 ho
u
r
s
23
7.1
P
a
r
ti
c
ip
a
nt
s
r
o
l
e
i
n t
h
e
h
o
s
pi
ta
l
S
upe
r
v
is
o
r
y
r
o
l
e
77
23.7
N
o
n
-
s
up
e
r
v
is
o
r
y
r
o
l
e
248
76.3
F
i
gur
e
1.
P
a
t
i
e
n
t
s
a
f
e
t
y
c
u
l
t
ur
e
s
t
a
t
us
a
s
r
a
t
e
d
by
h
e
a
l
t
h
c
a
r
e
wo
r
ke
r
s
3.
3.
C
u
l
t
u
r
e
Com
p
o
s
it
e
s
an
d
I
t
e
m
s
Dis
t
r
ib
u
t
ion
of
P
os
it
ive
Re
s
p
on
s
e
s
a
n
d
S
c
or
e
s
T
h
e
t
e
n
c
u
l
t
ur
e
d
im
e
ns
i
o
ns
we
r
e
c
o
m
put
e
d
t
o
pi
n
po
i
n
t
a
r
e
a
s
o
f
s
t
r
e
n
gt
h
(
t
h
o
s
e
wh
e
r
e
p
e
r
c
e
n
t
po
s
i
t
i
v
e
r
a
t
i
n
g
e
x
c
e
e
ds
75%
)
a
n
d
t
h
o
s
e
r
e
qu
i
r
i
ng
i
m
pr
o
v
e
m
e
n
t
(
s
c
or
e
s
b
e
l
o
w
50%
)
[
2]
.
A
c
c
o
r
di
n
g
ly
,
n
o
c
u
l
t
ur
a
l
d
im
e
n
s
i
o
n
c
o
ns
i
de
r
e
d
a
r
e
a
o
f
s
t
r
e
n
gt
h
wa
s
f
o
un
d.
All
d
im
e
n
s
i
o
ns
h
a
v
e
r
e
f
l
e
c
t
e
d
a
s
c
o
r
e
whi
c
h
r
e
ga
r
ds
t
h
e
m
a
s
a
r
e
a
s
r
e
qu
i
r
i
ng
im
pr
o
v
e
m
e
n
t
s
w
i
t
h
t
h
e
d
im
e
ns
i
o
ns
‘
n
o
n
-
puni
t
i
ve
r
e
s
po
ns
e
t
o
e
r
r
o
r
,
s
t
a
f
f
i
ng
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
P
HS
I
S
S
N:
2252
-
8806
P
ati
e
nt
Saf
e
ty
C
ult
ur
e
Stat
us
and
it
s
P
r
e
dictor
s
among
He
alt
hc
ar
e
W
or
k
e
r
s
(
M
e
ngis
tu
M
it
iku
)
111
a
n
d
h
o
s
p
i
t
a
l
m
a
n
a
ge
m
e
n
t
s
uppo
r
t
f
o
r
pa
t
i
e
n
t
s
a
f
e
t
y
c
u
l
t
ur
e
’
p
i
npo
i
n
t
e
d
a
s
t
h
e
l
e
a
s
t
t
h
r
e
e
i
s
pr
e
s
e
n
t
e
d
i
n
T
a
bl
e
2
.
T
a
bl
e
2.
C
r
o
n
ba
c
h
’
s
Al
p
ha
a
n
d
D
i
s
t
r
i
b
ut
i
o
n
o
f
P
o
s
i
t
i
ve
R
e
s
po
ns
e
s
a
n
d
S
c
o
r
e
s
f
o
r
S
ur
v
e
y
C
o
m
po
s
i
t
e
s
a
n
d
I
t
e
m
s
C
o
mp
o
s
it
e
s
a
nd S
ur
ve
y
I
t
e
ms
A
ve
r
a
ge
%
p
o
s
it
i
v
e
r
e
s
p
o
ns
e
M
e
a
n
(
S
ta
nda
r
d
de
v
ia
ti
o
n)
S
upe
r
v
is
o
r
e
x
p
e
c
ta
ti
o
ns
of
pa
ti
e
nt
s
a
f
e
t
y
(
C
r
o
nba
c
h’
s
α =
0.633)
58.2
1.
M
y
s
upe
r
v
is
o
r
/m
a
na
g
e
r
s
a
y
s
a
g
oo
d w
o
r
d w
h
e
n he
/s
h
e
s
e
e
s
a
j
o
b d
o
n
e
a
c
c
o
r
di
ng
to
e
s
ta
bl
is
he
d pa
ti
e
nt
s
a
f
e
t
y
p
r
o
c
e
dur
e
s
59.7
3.39
(
1.17)
2.
M
y
s
upe
r
v
is
o
r
/m
a
na
g
e
r
s
e
r
i
o
us
l
y
c
o
ns
id
e
r
s
s
ta
f
f
s
ugge
s
ti
o
ns
f
or
i
mpr
ov
in
g
pa
ti
e
nt
s
a
f
e
t
y
60.3
3.33
(
1.13)
3.
W
he
ne
ve
r
p
r
e
s
s
ur
e
bui
ld
s
up, m
y
s
upe
r
v
is
o
r
/m
a
na
g
e
r
w
a
nt
s
us
t
o
w
o
r
k
f
a
s
t
e
r
,
e
ve
n i
f
i
t
m
e
a
ns
t
a
ki
ng s
ho
r
t
c
ut
s
36.3
3.03
(
1.26)
4.
M
y
s
upe
r
v
is
o
r
/m
a
na
g
e
r
ove
r
l
oo
ks
pa
ti
e
nt
s
a
f
e
t
y
pr
o
b
le
ms
t
ha
t
ha
ppe
n
ov
e
r
a
nd
ove
r
76.3
4.09
(
1.11)
O
r
ga
ni
z
a
ti
o
na
l
l
e
a
r
n
in
g a
nd c
o
nt
in
u
o
us
i
mp
r
ov
e
m
e
nt
(
C
r
o
nba
c
h’
s
α =
0.593)
47.1
5.
W
e
a
r
e
a
c
ti
ve
l
y
d
o
in
g t
hi
ngs
t
o
i
mp
r
ov
e
pa
ti
e
nt
s
a
f
e
t
y
68
3.84
(
1.04)
6.
M
is
ta
ke
ha
v
e
l
e
d t
o
p
o
s
it
i
ve
c
ha
nge
s
h
e
r
e
33.5
2.96
(
1.19)
7.
A
f
t
e
r
w
e
ma
k
e
c
ha
ng
e
s
t
o
i
mpr
ove
pa
ti
e
nt
s
a
f
e
t
y
, w
e
e
v
a
lu
a
te
t
he
ir
e
f
f
e
c
ti
ve
n
e
s
s
39.7
3.12
(
1.14)
T
e
a
mw
o
r
k w
it
hi
n un
it
s
(
C
r
o
nba
c
h’
s
α =
0.925)
71.8
8.
S
ta
f
f
s
uppor
t
o
n
e
a
no
th
e
r
in
t
hi
s
uni
t
75.1
3.91
(
0.97)
9.
W
he
n a
l
o
t
of
w
o
r
k n
e
e
ds
t
o
b
e
d
o
n
e
qui
c
kl
y
, w
e
w
or
k t
o
ge
th
e
r
a
s
a
t
e
a
m t
o
g
e
t
th
e
w
o
r
k d
o
n
e
75.1
3.93
(
0.85)
10.
I
n t
hi
s
uni
t,
pe
o
pl
e
t
r
e
a
t
e
a
c
h
o
th
e
r
w
i
th
r
e
s
pe
c
t
68.6
3.72
(
1.03)
11.
W
he
n me
mb
e
r
s
of
th
is
uni
t
ge
t
r
e
a
ll
y
bus
y
,
o
th
e
r
m
e
mb
e
r
s
of
t
he
s
a
me
unit
h
e
lp
o
ut
68.3
3.64
(
0.95)
N
o
n
-
puni
t
i
v
e
r
e
s
p
o
ns
e
t
o
e
r
r
o
r
(
C
r
o
nba
c
h’
s
α =
0.802)
36.8
12.
S
ta
f
f
f
e
e
l
li
k
e
t
h
e
ir
mi
s
ta
ke
s
a
r
e
h
e
ld
a
ga
in
s
t
th
e
m (
R
)
32.9
3.02
(
1.17)
13.
W
he
n a
n e
ve
nt
i
s
r
e
p
o
r
t
e
d, i
t
f
e
e
ls
l
ik
e
t
he
p
e
r
s
o
n i
s
be
in
g w
r
it
t
e
n up, n
o
t
th
e
pr
o
bl
e
m
(
R
)
39.7
3.09
(
1.09)
14.
S
ta
f
f
w
o
r
r
y
t
ha
t
mi
s
ta
k
e
s
t
he
y
ma
k
e
a
r
e
ke
pt
in
t
he
ir
p
e
r
s
o
nn
e
l
f
i
le
(
R
)
37.8
3.1
(
1.10)
S
ta
f
f
in
g(
C
r
o
nba
c
h’
s
α =
0.644)
35.8
15.
W
e
ha
ve
e
n
o
ugh s
ta
f
f
t
o
ha
ndl
e
t
he
w
or
kl
o
a
d
24.9
2.46
(
1.20)
16.
S
ta
f
f
i
n t
hi
s
uni
t
w
o
r
k l
o
ng
e
r
h
o
u
r
s
t
ha
n i
s
be
s
t
f
or
pa
ti
e
nt
c
a
r
e
42.2
3.27
(
1.33)
17.
W
e
us
e
a
ge
n
c
y
/t
e
mp
or
a
r
y
s
ta
f
f
t
ha
n i
s
be
s
t
f
o
r
pa
ti
e
nt
c
a
r
e
(
R
)
64.6
3.70
(
1.26)
18.
W
he
n t
he
w
or
k i
s
i
n “
c
r
is
is
m
o
de
”
w
e
t
r
y
t
o
d
o
t
oo
muc
h, t
oo
q
ui
c
kl
y
(
R
)
11.7
2.31
(
1.17)
H
o
s
pi
ta
l
ma
na
ge
m
e
nt
s
uppor
t
f
or
pa
ti
e
nt
s
a
f
e
t
y
(
C
r
o
nba
c
h’
s
α
=
0.457)
37.4
19.
H
o
s
pi
ta
l
ma
na
ge
m
e
nt
pr
ov
id
e
s
a
w
or
k c
l
im
a
te
t
ha
t
p
r
o
m
o
t
e
s
pa
ti
e
nt
s
a
f
e
t
y
32.9
2.64
(
1.20)
20.
T
h
e
a
c
ti
o
ns
of
h
o
s
pi
ta
l
ma
na
ge
m
e
nt
s
ho
w
t
ha
t
pa
ti
e
nt
s
a
f
e
t
y
i
s
a
t
o
p pr
i
or
it
y
32
2.67
(
1.21)
21.
H
o
s
pi
ta
l
ma
na
ge
m
e
nt
s
e
e
ms
i
nt
e
r
e
s
te
d i
n pa
ti
e
nt
s
a
f
e
t
y
o
nl
y
a
f
t
e
r
a
n a
d
v
e
r
s
e
e
ve
nt
ha
ppe
ns
(
R
)
47.4
3.56
(
1.10)
T
e
a
mw
o
r
k a
c
r
o
s
s
ho
s
pi
ta
l
uni
ts
(
C
r
o
nba
c
h’
s
α =
0.587)
51.2
22.
T
h
e
r
e
i
s
g
oo
d
c
oo
pe
r
a
ti
o
n a
m
o
ng h
o
s
pi
ta
l
uni
ts
t
ha
t
ne
e
d t
o
w
or
k t
o
g
e
th
e
r
60.3
3.45
(
0.98)
23.
H
o
s
pi
ta
l
uni
ts
w
or
k w
e
ll
t
o
ge
th
e
r
t
o
pr
ov
id
e
t
h
e
be
s
t
c
a
r
e
f
o
r
pa
ti
e
nt
s
67.7
3.53
(
1.05)
24.
H
o
s
pi
ta
l
uni
ts
do
n
o
t
c
oor
di
na
te
w
e
ll
w
it
h
e
a
c
h
o
th
e
r
a
nd t
hi
s
mi
ght
a
f
f
e
c
t
pa
ti
e
nt
c
a
r
e
(
R
)
43.7
3.24
(
1.27)
25.
I
t
is
of
te
n n
o
t
e
a
s
y
t
o
w
or
k w
it
h s
ta
f
f
f
r
o
m
o
th
e
r
h
o
s
pi
ta
l
uni
ts
(
R
)
32.9
2.97
(
1.05)
H
o
s
pi
ta
l
ha
ndof
f
s
& t
r
a
ns
it
i
o
ns
(
C
r
o
nba
c
h’
s
α =
0.830)
45.8
26.
T
h
in
gs
“
f
a
ll
b
e
tw
e
e
n
th
e
c
r
a
c
ks
”
,
i.
e
., t
hi
ngs
mi
ght
g
o
un
c
o
nt
r
ol
le
d a
nd ge
t
l
o
s
t
(
e
x
:
m
e
di
c
a
l
r
e
c
o
r
ds
, me
di
c
a
l
t
r
e
a
tm
e
nt
, pa
ti
e
nt
i
n
f
or
ma
ti
o
n a
n
d e
du
c
a
ti
o
n,
di
s
c
ha
r
ge
c
r
i
te
r
ia
)
w
he
n
tr
a
ns
f
e
r
r
in
g pa
ti
e
nt
s
f
r
o
m
o
n
e
uni
t
t
o
a
no
th
e
r
(
R
)
30.2
2.88
(
1.19)
27.
I
mpor
ta
nt
pa
ti
e
n
t
c
a
r
e
i
n
f
or
ma
ti
o
n i
s
of
t
e
n l
o
s
t
dur
in
g s
hi
f
t
c
ha
nge
s
(
R
)
51.7
3.3
(
1.28)
28.
P
r
o
bl
e
ms
of
te
n
oc
c
ur
i
n t
h
e
e
xc
ha
nge
of
in
f
o
r
ma
ti
o
n a
c
r
o
s
s
ho
s
pi
ta
l
uni
ts
(
R
)
39.4
3.15
(
1.16)
29.
S
hi
f
t
c
ha
nge
s
a
r
e
p
r
o
bl
e
ma
ti
c
f
or
pa
ti
e
nt
s
i
n t
hi
s
ho
s
pi
ta
l
61.8
3.49
(
1.27)
C
o
mm
uni
c
a
ti
o
n
o
p
e
nne
s
s
(
C
r
o
nba
c
h
’
s
α =
0.65)
39.8
30.
S
ta
f
f
w
il
l
f
r
e
e
l
y
s
p
e
a
k up i
f
t
h
e
y
s
e
e
s
o
m
e
th
in
g t
ha
t
ma
y
n
e
ga
ti
ve
l
y
a
f
f
e
c
t
pa
ti
e
nt
c
a
r
e
56.9
3.45
(
1.09)
31.
S
ta
f
f
f
e
e
l
f
r
e
e
t
o
qu
e
s
ti
o
n t
he
d
e
c
is
i
o
ns
or
a
c
ti
o
ns
of
t
h
o
s
e
w
it
h
mo
r
e
a
ut
h
o
r
i
t
y
29.5
2.72
(
1.23)
32.
S
ta
f
f
a
r
e
a
f
r
a
id
t
o
a
s
k que
s
ti
o
ns
w
he
n s
o
me
th
in
g d
o
e
s
n
o
t
f
e
e
l
r
ig
ht
33.5
2.85
(
1.24)
F
e
e
dba
c
k a
nd
c
o
mm
uni
c
a
ti
o
ns
a
bo
ut
e
r
r
o
r
(
C
r
o
nba
c
h’
s
α =
0.87)
41.3
33.
W
e
a
r
e
gi
ve
n
f
e
e
dba
c
k a
bo
ut
c
ha
ng
e
s
put
i
nt
o
pl
a
c
e
ba
s
e
d
o
n
e
ve
nt
r
e
p
o
r
ts
33.8
2.58
(
1.24)
34.
W
e
a
r
e
i
n
f
or
m
e
d
a
b
o
ut
e
r
r
or
s
t
ha
t
ha
ppe
n i
n t
hi
s
uni
t
43.4
2.83
(
1.28)
35.
I
n t
hi
s
uni
t,
w
e
di
s
c
us
s
w
a
y
s
t
o
pr
e
ve
nt
e
r
r
or
s
f
r
o
m ha
ppe
ni
ng
a
ga
in
46.8
2.98
(
1.38)
R
=
r
e
ve
r
s
e
l
y
c
o
de
d i
te
m
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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:
2252
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8806
I
J
P
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V
o
l
.
7
,
N
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2
,
J
un
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2018:
107
–
113
112
3.
4.
P
r
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s
of
P
at
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S
af
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t
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Cul
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[1
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He
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C
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F
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s
.
S
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y
:
HSE
B
oo
ks
,
1993
.
[2
]
N
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v
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V,
S
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J
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n
s
.
Qua
l
S
a
f
H
e
a
l
t
h
C
a
r
e
:
12:17
-
23
,
20
03
.
[3
]
I
n
s
t
i
t
u
t
e
o
f
M
e
d
i
c
i
ne
,
T
o
e
r
r
i
s
h
u
m
a
n
:
B
u
i
l
d
in
g
a
s
a
f
e
r
h
e
a
l
t
h
s
y
s
t
e
m
,
Na
t
i
o
n
a
l
Ac
a
de
my
P
r
e
s
s
,
W
a
s
hi
ngt
o
n
DC
,
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[4
]
S
hi
ge
r
u
F
,
K
a
na
ko
S
,
S
hi
ny
a
I
,
Y
i
n
g
h
u
i
W
,
C
hi
u
-
C
hi
n
H,
T
o
m
o
n
o
r
i
H.
,
“
T
h
e
c
h
a
r
a
c
t
e
r
i
s
t
i
c
s
o
f
pa
t
i
e
n
t
s
a
f
e
t
y
c
u
l
t
ur
e
i
n
J
a
pa
n
,
T
a
i
wa
n
a
n
d
t
h
e
Uni
t
e
d
S
t
a
tes
”
,
B
M
C
He
a
l
t
h
S
e
r
vi
c
e
s
R
e
s
e
a
r
c
h
,
13:
20
,
2013
.
[5
]
Ya
nli
N,
e
t
a
l
.
,
“
Ho
s
p
i
t
a
l
s
ur
ve
y
o
n
pa
t
i
e
n
t
s
a
f
e
t
y
c
u
l
t
ur
e
i
n
C
hi
na
”,
B
M
C
He
a
l
t
h
S
e
r
vi
c
e
s
R
e
s
e
a
r
c
h
,
13:
228
,
2013
.
[6
]
F
a
d
i
E
,
Ha
ni
D,
D
i
a
n
a
J
,
M
a
h
a
J
.
,
“
P
r
e
d
i
c
t
or
s
a
n
d
o
u
t
c
o
m
e
s
o
f
pa
t
i
e
n
t
s
a
f
e
t
y
c
u
l
t
ur
e
i
n
h
o
s
p
i
t
a
l
s
”
,
B
M
C
He
a
l
t
h
S
e
r
v
R
e
s
,
11:45
,
2011
.
[7
]
As
s
e
f
a
T
,
W
o
l
d
i
e
M
,
O
l
o
l
o
S
,
W
o
l
d
e
m
i
c
ha
e
l
K
.
, “
P
a
t
i
e
n
t
s
a
f
e
t
y
pr
a
c
t
i
c
e
s
a
n
d
m
e
d
i
c
a
l
e
r
r
o
r
s
:
P
e
r
c
e
pt
i
o
n
o
f
h
e
a
l
t
h
c
a
r
e
pr
o
vi
de
r
s
a
t
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i
mm
a
U
ni
ve
r
s
i
t
y
S
pe
c
ia
l
i
z
e
d
Ho
s
p
i
t
a
l
,
S
o
u
t
h
we
s
t
E
t
hi
o
pi
a
”
,
Ope
n
J
our
na
l
o
f
P
r
e
v
e
nti
v
e
M
e
dicine
,
2:
162
-
170
,
2012
.
[8
]
W
HO
R
e
g
i
o
n
a
l
C
o
m
mi
t
t
e
e
f
o
r
Af
r
i
c
a
,
P
a
t
i
e
n
t
s
a
f
e
t
y
i
n
Af
r
i
c
a
n
he
a
l
t
h
s
e
r
vi
c
e
s
:
I
s
s
ue
s
a
n
d
s
o
l
ut
i
o
n
s
.
Ya
o
un
dé
,
R
e
publi
c
o
f
C
a
m
e
r
o
o
n
,
2008
.
[9
]
W
o
r
l
d
He
a
l
t
h
Or
ga
ni
z
a
t
i
o
n
,
F
a
c
t
s
h
e
e
t
o
n
pa
t
i
e
n
t
s
a
f
e
t
y
,
2014.
[1
0
]
W
o
r
l
d
He
a
l
t
h
Or
ga
ni
z
a
t
i
o
n
Af
r
i
c
a
n
r
e
g
i
o
n,
Gu
ide
f
o
r
de
v
e
l
o
p
i
ng
n
a
t
i
o
n
a
l
pa
t
i
e
n
t
s
a
f
e
t
y
po
l
i
c
y
a
n
d
s
t
r
a
t
e
gi
c
p
l
a
n
,
2014.
[1
1
]
C
h
r
i
s
t
i
n
e
E
.
,
S
a
m
m
e
r
,
R
.
,
K
r
i
s
t
i
n
e
P
,
K
a
r
a
n
P
,
Do
ugl
a
s
A
.
,
M
a
i
ns
P
,
e
t
a
l
.
,
“
W
h
a
t
i
s
P
a
t
i
e
n
t
S
a
f
e
t
y
C
u
l
t
ur
e
?
A
R
e
vi
e
w
o
f
t
h
e
L
i
t
e
r
a
t
ur
e
”
J
our
nal
o
f
N
ur
s
ing
Sc
holar
s
hip
,
2009.
[1
2
]
F
e
de
r
a
l
De
m
o
c
r
a
t
i
c
R
e
p
u
bl
i
c
o
f
E
t
hi
o
p
i
a
,
“
E
t
hi
o
pi
a
n
h
o
s
p
i
t
a
l
s
r
e
f
o
r
m
i
m
p
l
e
m
e
n
t
a
t
i
o
n
gu
i
d
e
l
i
ne
”,
2:12
-
14
,
2010.
[1
3
]
M
e
ke
ll
e
He
a
l
t
h
O
f
f
i
c
e
,
Ann
ua
l
He
a
l
t
h
s
e
r
vi
c
e
r
e
por
t,
M
e
ke
l
l
e
,
2014.
[1
4
]
B
o
dur
S
.
,
F
i
li
z
E
.
,
“
A
s
ur
v
e
y
o
n
pa
t
i
e
n
t
s
a
f
e
t
y
c
u
l
t
ur
e
i
n
pr
i
m
a
r
y
h
e
a
l
t
hc
a
r
e
s
e
r
vi
c
e
s
i
n
T
ur
k
e
y
”,
I
nter
nati
onal
J
our
nal
f
o
r
Qualit
y
in
He
alt
h
C
ar
e
,
21:
348
–
355
,
2009
.
[1
5
]
R
o
b
b
G,
S
e
ddo
n
M
.
,
“
M
e
a
s
ur
i
ng
t
h
e
s
a
f
e
t
y
c
u
l
t
ur
e
i
n
a
h
o
s
p
i
t
a
l
s
e
t
t
i
n
g
:
a
c
o
n
c
e
pt
wh
o
s
e
t
i
m
e
h
a
s
c
o
m
e
”
T
he
N
e
w
Z
e
aland
M
e
dical
J
our
nal
,
123
,
2010
.
[1
6
]
S
i
n
ge
r
J
,
G
e
ppe
r
t
J
,
S
i
n
a
i
ko
A
,
Ho
wa
r
d
S
,
P
a
r
k
K
.
,
“
T
h
e
c
u
l
t
ur
e
o
f
s
a
f
e
t
y
:
r
e
s
u
l
t
s
o
f
a
n
o
r
ga
ni
z
a
t
i
o
n
-
w
i
de
s
ur
v
e
y
i
n
15
C
a
li
f
o
r
ni
a
h
o
s
p
i
t
a
l
s
”
,
Qual
Sa
f
He
alt
h
C
ar
e
,
12:
112
-
118
,
2003
.
[1
7
]
He
l
li
ngs
J
,
Kl
a
z
i
nga
N,
V
l
e
uge
l
s
N.
,
“
C
h
a
ll
e
n
g
i
n
g
pa
t
i
e
n
t
s
a
f
e
t
y
c
u
l
t
ur
e
:
s
ur
v
e
y
r
e
s
u
l
t
s
”
,
I
nter
nati
onal
J
our
nal
of
He
alt
h
C
ar
e
,
20:
620
-
632
,
2007
.
[1
8
]
P
a
u
l
i
ne
Oc
c
e
ll
i
,
e
t
a
l
.
,
“
De
v
e
l
o
p
m
e
n
t
o
f
a
s
a
f
e
t
y
c
u
l
t
ur
e
:
I
ni
t
i
a
l
m
e
a
s
ur
e
m
e
n
t
s
a
t
s
i
x
h
o
s
p
i
t
a
l
s
i
n
F
r
a
n
c
e
”,
J
our
nal
of
He
alt
hc
ar
e
r
is
k
manage
me
nt
,
30:4
,
201
1
.
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