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[
1]
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I
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t
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wor
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pe
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pl
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ge
d
m
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HT
pr
e
v
a
l
e
n
c
e
i
n
2016
a
s
m
a
ny
a
s
10.
43%
i
n
S
ur
a
ba
y
a
o
nly
[
5]
.
M
o
r
bi
d
i
t
y
r
a
t
e
o
f
e
l
de
r
ly
i
n
2015
wa
s
28.
62%
,
m
e
a
ni
ng
t
h
e
r
e
we
r
e
28
s
i
c
k
e
l
de
r
ly
e
v
e
r
y
100
e
l
de
r
ly
po
pu
l
a
t
i
o
n
,
i
n
w
hi
c
h
HT
wa
s
t
h
e
hi
g
h
e
s
t
NC
D
f
o
un
d
i
n
e
l
d
e
r
l
y
[
6]
.
R
e
ga
r
d
i
n
g
DM
,
I
n
do
n
e
s
i
a
i
s
o
ne
o
f
t
h
e
t
o
p
t
e
n
c
o
un
tr
i
e
s
w
i
t
h
hi
g
h
e
s
t
DM
pr
e
v
a
l
e
n
c
e
.
I
n
2000,
pe
o
p
l
e
w
i
t
h
D
M
a
m
o
un
t
e
d
t
o
8,
426
,
000,
a
n
d
W
HO
pr
e
d
i
c
t
e
d
t
h
a
t
i
n
2030
t
hi
s
n
u
m
be
r
w
i
ll
i
nc
r
e
a
s
e
up
to
21
,
257,
000
.
A
n
e
p
i
de
mi
o
l
o
g
i
c
a
l
s
t
ud
y
c
o
n
duc
t
e
d
i
n
I
n
do
n
e
s
i
a
s
h
o
we
d
t
h
a
t
DM
pr
e
va
l
e
n
c
e
wa
s
1.
5
up
to
2
.
3%
i
n
pe
o
p
l
e
a
g
e
d
m
o
r
e
t
h
a
n
15
y
e
a
r
s
o
l
d,
a
n
d
DM
pr
e
v
a
l
e
n
c
e
wa
s
14.
7%
a
n
d
7.
2%
i
n
ur
ba
n
a
n
d
r
ur
a
l
a
r
e
a
r
e
s
pe
c
t
i
v
e
ly
[
7]
.
T
h
a
il
a
n
d
s
t
a
r
t
e
d
to
b
e
a
n
e
l
de
r
ly
s
o
c
i
e
t
y
s
i
nc
e
20
10
i
n
w
hi
c
h
t
he
n
u
m
be
r
o
f
e
l
d
e
r
l
y
w
a
s
15.
3%
in
2014
.
T
h
e
pr
e
va
l
e
n
c
e
o
f
HT
a
n
d
hy
p
e
r
c
h
o
l
e
s
t
e
r
o
l
e
m
i
a
i
s
hi
g
h
,
b
ut
s
e
l
f
-
a
wa
r
e
n
e
s
s
i
s
l
o
w,
e
s
pe
c
i
a
ll
y
i
n
ur
b
a
n
a
r
e
a
.
Al
t
h
o
ugh
s
o
m
e
e
f
f
o
r
t
s
h
a
v
e
m
a
de
t
o
a
ddr
e
s
s
NC
D
pr
o
bl
e
m
s
,
b
ut
i
t
i
s
s
t
e
a
d
i
ly
r
i
s
e
e
a
c
h
y
e
a
r
.
A
m
o
n
g
t
h
e
to
p
t
e
n
c
o
n
d
i
t
i
o
n
s
i
n
t
h
e
d
i
s
e
a
s
e
b
ur
de
n
r
a
n
k
in
g
i
n
T
h
a
il
a
n
d,
ni
ne
a
r
e
NC
D
s
.
I
n
2009,
HT
a
n
d
D
M
pr
e
v
a
l
e
n
c
e
pe
r
-
100,
000
p
o
pul
a
t
i
o
n
we
r
e
981
a
n
d
7
3
6
r
e
s
pe
c
t
i
ve
l
y
.
R
i
s
k
f
a
c
t
o
r
s
f
o
r
NC
D
s
uc
h
a
s
HT
a
n
d
D
M
h
a
v
e
m
o
r
e
t
h
a
n
t
r
i
p
l
e
d
o
v
e
r
t
h
e
l
a
s
t
t
w
o
de
c
a
de
s
.
I
n
2011,
d
i
s
e
a
s
e
s
o
f
c
i
r
c
u
l
a
t
or
y
s
y
s
t
e
m
a
n
d
d
i
s
e
a
s
e
s
o
f
e
n
do
c
r
i
n
e
,
n
ut
r
i
t
i
o
n
a
l
,
a
n
d
m
e
t
a
b
o
l
i
c
w
e
r
e
b
e
i
ng
t
h
e
t
wo
o
f
t
h
e
to
p
t
e
n
l
e
a
d
i
ng
c
a
us
e
s
o
f
h
o
s
p
i
t
a
l
d
e
a
t
h
s
b
y
68.
8
a
n
d
13.
8
pe
r
-
100,
0
00
p
o
pul
a
t
i
o
n
r
e
s
pe
c
t
i
v
e
ly
[
8]
.
T
h
e
i
nc
i
de
n
c
e
o
f
e
l
de
r
ly
w
i
t
h
HT
i
s
c
a
us
e
d
by
many
f
a
c
t
or
s
t
h
a
t
a
r
e
c
l
o
s
e
l
y
r
e
l
a
t
e
d
to
t
h
e
n
a
t
ur
a
l
a
g
i
n
g
pr
o
c
e
s
s
.
S
o
m
e
s
t
ud
i
e
s
c
o
n
c
l
ude
d
t
h
a
t
a
ge
i
s
a
l
s
o
o
n
e
f
a
c
t
o
r
i
n
t
h
e
o
c
c
ur
r
e
n
c
e
o
f
H
T
b
e
c
a
us
e
t
h
e
i
nc
r
e
a
s
e
d
a
ge
o
f
a
pe
r
s
o
n
w
il
l
i
nc
r
e
a
s
e
t
h
e
r
i
s
k
o
f
HT
.
E
l
e
va
t
e
d
B
P
i
n
e
l
de
r
l
y
ha
ppe
ns
due
t
o
t
h
e
f
un
c
t
i
o
n
a
l
c
h
a
n
g
e
s
i
n
t
h
e
pe
r
i
p
h
e
r
a
l
ve
s
s
e
l
s
y
s
t
e
m
,
w
hi
c
h
i
nv
o
l
v
e
s
s
o
m
e
pr
o
c
e
s
s
o
f
a
t
h
e
r
o
s
c
l
e
r
o
s
i
s
,
r
e
duc
e
d
e
l
a
s
t
i
c
i
t
y
o
f
c
o
n
n
e
c
t
i
ve
t
i
s
s
ue
,
a
d
e
c
r
e
a
s
e
d
r
e
l
a
x
a
t
i
o
n
o
f
s
m
o
ot
h
m
us
c
l
e
o
f
bl
o
o
d
v
e
s
s
e
l
s
t
h
a
t
de
c
r
e
a
s
e
t
h
e
a
bil
i
t
y
o
f
d
i
s
t
e
n
t
i
o
n
a
n
d
t
e
ns
i
l
e
s
t
r
e
n
gt
h
[
9]
.
C
o
m
p
li
c
a
t
i
o
ns
w
i
ll
a
l
s
o
o
c
c
ur
i
n
pe
o
p
l
e
w
i
t
h
HT
,
s
uc
h
a
s
c
o
r
o
n
a
r
y
he
a
r
t
d
i
s
e
a
s
e
,
he
a
r
t
f
a
i
l
ur
e
,
b
r
a
i
n
bl
o
o
d
v
e
s
s
e
l
da
m
a
ge
,
a
n
d
k
i
d
ne
y
f
a
il
ur
e
[
10]
.
C
a
t
e
gor
y
o
f
B
P
b
a
s
e
d
o
n
t
h
e
Ne
w
AC
C
/
A
H
A
B
l
o
o
d
P
r
e
s
s
ur
e
Gui
de
li
ne
s
w
hi
c
h
c
o
n
s
i
s
t
s
o
f
:
a
)
N
o
r
m
a
l
=
l
e
s
s
t
h
a
n
120/80
m
m
Hg
.
b
)
E
l
e
v
a
t
e
d
=
s
y
s
t
o
l
i
c
b
e
t
we
e
n
120
-
129
m
m
Hg
a
n
d
d
i
a
s
t
o
l
i
c
l
e
s
s
t
h
a
n
80
mm
Hg
.
c
)
S
t
a
ge
1=
s
y
s
t
o
l
i
c
b
e
t
we
e
n
130
-
139
mm
Hg
o
r
di
a
s
t
o
l
i
c
b
e
t
we
e
n
80
-
89
m
m
Hg
.
d
)
S
t
a
ge
2=
s
y
s
t
o
l
i
c
a
t
l
e
a
s
t
140
m
m
Hg
o
r
di
a
s
t
o
l
i
c
a
t
l
e
a
s
t
90
m
m
Hg,
a
n
d
e
)
hy
pe
r
t
e
ns
i
ve
c
r
i
s
i
s
=
s
y
s
t
o
l
i
c
o
v
e
r
180
m
m
H
g
a
n
d/o
r
d
i
a
s
to
l
i
c
o
v
e
r
120
m
m
Hg
[
11]
.
HT
b
e
g
i
n
s
f
r
o
m
s
t
a
ge
1
i
n
w
hi
c
h
s
y
s
t
o
l
i
c
B
P
b
e
t
we
e
n
130
-
139
mm
Hg
o
r
d
i
a
s
to
l
i
c
B
P
b
e
t
we
e
n
80
-
89
mm
Hg.
T
he
i
nc
i
de
n
c
e
o
f
e
l
de
r
ly
w
i
t
h
D
M
,
e
s
pe
c
i
a
ll
y
t
y
pe
2,
i
s
c
a
us
e
d
by
v
a
r
i
o
us
f
a
c
t
or
s
.
Ge
n
e
r
a
l
ly
,
t
h
e
a
ge
o
f
m
o
r
e
t
h
a
n
40
y
e
a
r
s
o
l
d
h
a
s
hi
g
he
r
pot
e
n
c
y
t
o
de
v
e
l
o
p
DM
,
a
dde
d
b
y
a
f
a
mi
ly
hi
s
t
o
r
y
o
f
D
M
[
9]
.
DM
r
i
s
k
i
nc
r
e
a
s
e
s
to
g
e
t
h
e
r
w
i
t
h
t
h
e
i
n
c
r
e
a
s
e
o
f
a
ge
a
n
d
b
o
d
y
we
i
g
h
t
,
e
s
pe
c
i
a
ll
y
o
b
e
s
i
t
y
(
f
o
u
n
d
i
n
80
-
90%
pa
t
i
e
n
t
s
)
.
I
n
DM
t
y
pe
2
(
80
-
90%
o
f
c
a
s
e
s
)
,
t
h
e
pa
n
c
r
e
a
s
s
t
i
ll
pr
o
duc
e
e
n
o
ugh
i
ns
u
li
n
(
s
o
m
e
t
i
m
e
s
m
o
r
e
t
h
a
n
n
o
r
m
a
l
)
,
b
ut
t
h
e
bo
dy
de
v
e
l
o
p
s
r
e
s
i
s
t
a
n
c
e
due
to
v
a
r
i
o
us
f
a
c
t
or
s
r
e
l
a
t
e
d
to
unh
e
a
l
t
hy
l
if
e
s
t
y
l
e
,
s
uc
h
a
s
l
a
c
k
o
f
e
x
e
r
c
i
s
e
a
n
d
i
m
ba
l
a
n
c
e
d
i
e
t
pa
tt
e
r
n
[
12
-
13]
.
B
a
s
e
d
o
n
P
E
R
K
E
NI
c
o
n
s
e
ns
us
,
n
o
r
m
a
l
v
a
l
ue
o
f
B
GL
if
m
e
a
s
ur
e
d
by
us
i
ng
c
a
p
il
l
a
r
y
bl
o
o
d
a
s
s
pe
c
im
e
n
t
i
s
l
e
s
s
t
h
a
n
200
m
g/dL
(
w
i
t
h
o
ut
f
a
s
t
i
n
g)
[
14]
.
T
h
e
r
e
f
o
r
e
,
t
h
e
c
a
t
e
g
o
r
y
o
f
B
GL
wa
s
hy
pe
r
g
ly
c
e
mi
a
=
≥
200
m
g/dL
,
e
ug
l
y
c
e
mi
a
=
71
-
19
9
m
g/dL
,
a
n
d
hy
po
g
l
y
c
e
mi
a
=
≤
70
m
g/d
L
.
DM
o
f
t
e
n
a
s
s
o
c
i
a
t
e
d
w
i
t
h
hy
p
e
r
g
l
y
c
e
mi
a
i
n
w
hi
c
h
B
GL
≥
2
00
m
g/dL
.
T
hi
s
s
t
ud
y
a
im
e
d
t
o
c
o
m
pa
r
e
a
n
d
a
na
l
y
z
e
t
he
d
i
f
f
e
r
e
n
c
e
s
o
f
B
P
a
n
d
B
G
L
a
m
o
n
g
e
l
de
r
ly
w
i
t
h
H
T
a
n
d/o
r
DM
i
n
B
a
n
gko
k
a
n
d
S
ur
a
b
a
y
a
.
E
l
de
r
ly
w
i
t
h
DM
pot
e
n
t
i
a
ll
y
de
ve
l
o
p
HT
dur
i
n
g
t
h
e
d
i
s
e
a
s
e
pr
o
gr
e
s
s
i
o
n
.
HT
a
n
d/o
r
DM
s
h
a
r
e
s
o
m
e
s
i
mi
l
a
r
po
t
e
n
c
y
o
f
h
a
vi
ng
d
i
s
e
a
s
e
c
o
m
p
l
i
c
a
t
i
o
ns
,
s
uc
h
a
s
c
o
r
o
n
a
r
y
h
e
a
r
t
di
s
e
a
s
e
,
h
e
a
r
t
f
a
il
ur
e
,
b
r
a
i
n
bl
o
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2252
-
8806
C
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N
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249
T
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17]
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[
18
]
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h
DM
a
l
s
o
h
a
v
e
HT
,
a
n
d
pa
t
i
e
n
t
s
w
i
t
h
HT
a
l
o
n
e
o
f
t
e
n
s
h
o
w
e
v
i
de
n
c
e
o
f
i
ns
u
li
n
r
e
s
i
s
t
a
n
c
e
[
1
9
]
.
T
h
us
,
HT
a
n
d
D
M
a
r
e
c
o
m
m
o
n
,
w
hi
c
h
s
h
a
r
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a
s
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g
nif
i
c
a
n
t
o
v
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r
l
a
p
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n
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n
de
r
lyi
ng
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i
s
k
f
a
c
t
or
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i
n
c
l
ud
i
ng
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t
h
ni
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t
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,
f
a
mi
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l
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n
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t
y
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t
s
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n
d
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o
m
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li
c
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t
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o
ns
o
f
m
i
c
r
o
v
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s
c
u
lar
(
i
n
c
l
ud
i
ng
r
e
t
i
n
o
pa
t
hy
,
ne
p
h
r
o
pa
t
hy
,
a
n
d
n
e
ur
o
pa
t
hy
wh
i
c
h
li
nke
d
to
hy
pe
r
g
ly
c
e
mi
a
)
a
n
d
m
a
c
r
o
v
a
s
c
u
l
a
r
c
o
m
p
l
i
c
a
t
i
o
n
s
(
i
n
c
l
ud
i
ng
c
o
r
o
n
a
r
y
a
r
t
e
r
y
d
i
s
e
a
s
e
,
my
o
c
a
r
d
i
a
l
i
n
f
a
r
c
t
i
o
n
,
s
t
r
o
ke
,
c
o
n
ge
s
t
i
v
e
he
a
r
t
f
a
i
l
ur
e
,
a
n
d
pe
r
i
p
h
e
r
a
l
v
a
s
c
u
l
a
r
d
i
s
e
a
s
e
)
.
HT
c
o
n
s
t
i
t
ut
e
s
a
n
im
po
r
t
a
n
t
r
i
s
k
f
a
c
t
o
r
,
e
s
pe
c
i
a
ll
y
f
o
r
n
e
p
h
r
o
pa
t
h
y
.
T
h
e
f
a
mi
li
a
l
pr
e
d
i
s
po
s
i
t
i
o
n
to
DM
a
n
d
HT
a
ppe
a
r
s
to
b
e
po
l
y
ge
ni
c
i
n
o
r
i
g
i
n
.
O
n
t
h
e
o
t
h
e
r
h
a
n
d,
t
h
e
s
h
a
r
e
d
l
if
e
s
t
y
l
e
f
a
c
to
r
s
i
n
t
h
e
e
t
i
o
l
o
g
y
o
f
HT
a
n
d
DM
pr
o
vi
de
a
m
p
l
e
o
ppor
t
uni
t
y
f
o
r
n
o
n
ph
a
r
m
a
c
o
l
o
g
i
c
i
n
t
e
r
v
e
n
t
i
o
n
.
As
a
c
o
m
pa
r
i
s
o
n
t
o
y
o
un
ge
r
a
ge
gr
o
ups
,
w
e
a
n
a
lyze
d
a
s
t
ud
y
o
f
T
OD
A
Y
S
t
ud
y
Gr
o
up
(
2013)
[
20
]
.
T
hi
s
c
o
h
o
r
t
s
t
udy
wa
s
c
o
n
duc
t
e
d
t
o
wa
r
ds
699
a
do
l
e
s
c
e
n
t
s
w
h
o
h
a
d
t
y
p
e
2
D
M
f
o
r
l
e
s
s
t
h
a
n
t
wo
y
e
a
r
s
.
P
r
i
m
a
r
y
s
t
ud
y
o
ut
c
o
m
e
wa
s
l
o
s
s
o
f
g
ly
c
e
mi
c
c
o
n
t
r
o
l
f
o
r
s
i
x
m
o
n
t
h
s
o
r
s
us
t
a
i
ne
d
m
e
t
a
b
o
l
i
c
de
c
o
m
p
e
ns
a
t
i
o
n
r
e
qu
i
r
i
n
g
i
ns
u
li
n
.
R
e
s
u
l
t
s
s
h
o
we
d
t
h
a
t
45.
6%
r
e
s
p
o
n
de
n
t
s
r
e
a
c
h
e
d
pr
im
a
r
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s
t
ud
y
o
ut
c
o
m
e
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,
a
n
d
11.
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we
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pe
r
t
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n
s
i
ve
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li
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33.
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by
t
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n
d
o
f
s
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udy
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a
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-
up
3.
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y
e
a
r
s
)
.
I
t
wa
s
c
o
n
c
l
u
de
d
t
h
a
t
m
a
l
e
s
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x
a
n
d
hi
g
he
r
B
M
I
s
i
g
nif
i
c
a
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t
l
y
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nc
r
e
a
s
e
d
t
h
e
r
i
s
k
f
o
r
HT
i
n
a
do
l
e
s
c
e
n
t
wi
t
h
t
y
p
e
2
DM
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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P
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N:
2252
-
8806
C
ompar
is
on
of
blood
p
r
e
s
s
ur
e
and
blood
glucos
e
l
e
v
e
l
among
e
lder
ly
w
it
h
-
…
(
N
i
P
utu
W
ulan
P
ur
na
ma
Sar
i
)
251
A
s
y
s
t
e
m
a
t
i
c
l
i
t
e
r
a
t
ur
e
r
e
vi
e
w
o
f
C
o
l
o
s
i
a
,
e
t
a
l
.
(
2013)
,
to
wa
r
ds
77
a
r
t
i
c
l
e
s
pr
o
vi
de
d
pr
e
v
a
l
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n
c
e
r
a
t
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s
f
o
r
HT
a
n
d/o
r
o
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e
s
i
t
y
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pe
c
i
f
i
c
a
l
ly
i
n
a
du
l
t
s
w
i
t
h
t
y
pe
2
DM
s
h
o
we
d
t
h
a
t
61s
t
udi
e
s
r
e
po
r
t
e
d
HT
pr
e
v
a
l
e
n
c
e
,
44
r
e
po
r
t
e
d
o
b
e
s
i
t
y
pr
e
v
a
l
e
nc
e
,
a
n
d
12
r
e
po
r
t
e
d
th
e
pr
e
va
l
e
n
c
e
o
f
HT
w
i
t
h
o
b
e
s
i
t
y
[
2
1
]
.
M
o
s
t
o
b
s
e
r
v
a
t
i
o
n
a
l
s
t
udi
e
s
o
f
HT
o
r
o
b
e
s
i
t
y
pr
e
v
a
l
e
n
c
e
we
r
e
f
o
un
d
i
n
E
ur
o
pe
a
n
d
As
i
a
,
whi
c
h
r
e
v
e
a
l
e
d
t
h
a
t
HT
a
n
d
o
b
e
s
i
t
y
r
a
t
e
s
we
r
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hi
g
h
i
n
a
l
l
r
e
g
i
o
n
s
.
Am
o
n
g
o
b
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s
e
a
du
l
t
s
,
HT
r
a
t
e
s
we
r
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a
t
o
r
a
b
o
v
e
70%
i
n
As
i
a
,
80%
in
E
ur
o
pe
,
a
n
d
30%
i
n
No
r
t
h
a
n
d
S
o
ut
h
Am
e
r
i
c
a
.
HT
a
n
d
o
be
s
i
t
y
,
s
e
p
a
r
a
t
e
l
y
o
r
to
ge
t
h
e
r
,
a
r
e
c
o
m
m
o
n
c
o
m
o
r
bi
d
i
t
i
e
s
i
n
a
du
l
t
s
w
i
t
h
t
y
pe
2
DM
g
l
o
ba
l
ly
.
An
o
t
h
e
r
s
t
udy
i
n
S
pa
i
n
c
o
n
duc
t
e
d
by
R
a
m
o
n
-
A
r
b
u
e
s
(
2019)
to
wa
r
d
s
23,
729
wo
r
ke
r
s
(
a
dul
t
s
)
i
n
A
r
a
go
n
s
h
o
we
d
t
h
a
t
pr
e
v
a
l
e
n
c
e
o
f
o
v
e
r
we
i
g
h
t
a
n
d
o
b
e
s
i
t
y
wa
s
38.
6%
a
n
d
18.
4%
r
e
s
pe
c
t
i
ve
ly
w
i
t
h
hi
g
h
e
r
pr
e
v
a
l
e
n
c
e
f
o
u
n
d
i
n
m
a
les
c
o
m
pa
r
e
d
t
o
f
e
m
a
l
e
s
,
a
n
d
a
s
i
g
ni
f
i
c
a
n
t
a
s
s
o
c
i
a
t
i
o
n
wa
s
f
o
u
n
d
b
e
t
we
e
n
o
v
e
r
we
i
g
h
t
a
n
d
o
b
e
s
i
t
y
a
n
d
pr
e
v
a
l
e
n
c
e
o
f
DM
[
22
]
.
M
a
t
s
uda
&
S
him
o
m
ur
a
(
2013)
c
o
n
duc
t
e
d
a
s
t
udy
to
l
i
n
k
o
b
e
s
i
t
y
a
n
d
i
nc
r
e
a
s
e
d
o
xi
da
t
i
v
e
s
t
r
e
s
s
[
2
3
]
.
Ob
e
s
i
t
y
,
e
s
p
e
c
i
a
ll
y
o
f
t
h
e
a
b
do
m
i
na
l
t
y
pe
,
i
s
a
h
e
a
l
t
h
pr
o
bl
e
m
t
h
a
t
c
o
n
s
t
i
t
ut
e
s
m
e
t
a
b
o
l
i
c
s
y
ndr
o
m
e
a
n
d
i
nc
r
e
a
s
e
s
t
h
e
i
nc
i
de
n
c
e
o
f
DM
a
n
d
HT
.
Oxi
da
t
i
v
e
s
t
r
e
s
s
h
a
s
b
e
e
n
po
s
t
ul
a
t
e
d
to
b
e
t
h
e
l
i
nk
i
ng
m
e
c
ha
ni
s
m
o
f
o
b
e
s
i
t
y
a
n
d
v
a
s
c
u
l
a
r
c
o
m
p
l
i
c
a
t
i
o
n
-
pa
nc
r
e
a
t
i
c
β
-
c
e
ll
f
a
il
ur
e
o
f
D
M
.
T
h
e
l
e
v
e
l
s
o
f
o
xi
da
t
i
v
e
s
t
r
e
s
s
pr
e
s
e
n
t
i
n
s
e
v
e
r
a
l
o
t
h
e
r
t
y
pe
s
o
f
c
e
l
l
s
o
r
t
i
s
s
u
e
s
h
a
ve
b
e
e
n
im
p
li
c
a
t
e
d
i
n
t
h
e
pa
t
h
o
ge
n
e
s
i
s
a
s
s
o
c
i
a
t
e
d
wi
t
h
HT
.
An
o
t
h
e
r
s
t
udy
o
f
P
a
n
,
e
t
a
l
.
,
to
wa
r
d
40
t
y
p
e
2
DM
pa
t
i
e
n
t
s
w
i
t
h
o
ut
c
o
m
p
li
c
a
t
i
o
n
s
,
a
n
d
37
d
i
a
b
e
t
i
c
n
e
p
h
r
o
pa
t
hi
e
s
,
f
o
u
n
d
t
h
a
t
c
o
m
pa
r
e
d
w
i
t
h
40
c
o
n
t
r
o
l
s
u
bj
e
c
t
s
,
s
upe
r
o
xi
de
d
i
s
m
ut
a
s
e
,
g
l
ut
a
t
hi
o
n
e
pe
r
o
xi
da
s
e
,
c
a
t
a
l
a
s
e
,
a
n
d
vi
t
a
mi
n
C
we
r
e
de
c
r
e
a
s
e
d
[2
4
]
.
I
t
w
a
s
c
o
n
c
l
ude
d
t
h
a
t
DM
pa
t
i
e
n
t
s
h
a
v
e
m
o
r
e
s
e
v
e
r
e
o
xi
da
t
i
v
e
s
t
r
e
s
s
t
h
a
n
n
o
r
m
a
l
pe
r
s
o
ns
a
n
d
hi
g
h
e
r
o
xi
da
t
i
v
e
s
t
r
e
s
s
i
n
d
i
a
be
t
i
c
n
e
p
h
r
o
pa
t
hy
t
h
a
n
t
h
o
s
e
i
n
DM
pa
t
i
e
n
t
s
w
i
t
h
o
ut
c
o
m
p
li
c
a
t
i
o
ns
.
R
e
a
c
t
i
v
e
o
xy
ge
n
s
pe
c
i
e
s
(
R
OS
)
ma
y
c
o
n
t
r
i
b
ut
e
to
t
h
e
de
v
e
l
o
p
m
e
n
t
o
f
o
b
e
s
i
t
y
-
a
s
s
o
c
i
a
t
e
d
i
ns
u
li
n
r
e
s
i
s
t
a
n
c
e
a
n
d
t
y
pe
2
D
M
b
e
c
a
u
s
e
R
OS
c
a
u
s
e
de
f
e
c
t
i
v
e
a
n
g
i
o
ge
n
e
s
i
s
i
n
r
e
s
po
n
s
e
to
i
s
c
h
e
mi
a
,
a
c
t
i
v
a
t
e
a
n
u
m
be
r
o
f
pr
o
i
nf
l
a
mm
a
t
o
r
y
pa
t
h
wa
y
s
,
a
n
d
c
a
u
s
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ym
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by
R
OS
[
2
5
].
F
o
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,
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t
a
l
.
(
2011)
,
a
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[
2
6
]
.
T
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[
16]
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[
2
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.
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h
r
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pa
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hy
[
2
8
].
M
o
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n
gu
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bi
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[2
8
]
.
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16]
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[
2
9
].
Evaluation Warning : The document was created with Spire.PDF for Python.
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2
,
J
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201
9
:
24
6
–
25
3
252
As
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t
H
T
i
n
D
M
pa
t
i
e
n
t
s
,
d
i
e
t
a
n
d
li
f
e
s
t
y
l
e
i
n
t
e
r
v
e
n
t
i
o
n
s
c
a
n
a
l
s
o
h
a
ve
a
s
i
g
ni
f
i
c
a
n
t
i
m
pa
c
t
o
n
B
P
,
a
n
d
t
h
e
s
e
s
h
o
u
l
d
b
e
r
e
c
o
m
m
e
n
de
d
a
s
t
h
e
f
i
r
s
t
l
i
ne
t
h
e
r
a
p
y
[
16]
.
A
s
t
h
e
e
vi
de
n
c
e
,
r
e
s
u
l
t
s
o
f
a
r
a
n
do
m
i
z
e
d
c
r
o
s
s
o
v
e
r
c
li
n
i
c
a
l
t
r
i
a
l
t
o
wa
r
ds
31
pe
o
pl
e
w
i
t
h
t
y
pe
2
DM
i
n
w
hi
c
h
t
h
e
y
f
o
ll
o
we
d
t
h
e
e
a
t
i
n
g/d
i
e
t
pa
tt
e
r
n
o
f
D
A
S
H
(
D
i
e
t
a
r
y
A
ppr
o
a
c
h
e
s
t
o
S
to
p
Hy
pe
r
t
e
n
s
i
o
n
)
f
o
r
e
i
g
h
t
we
e
ks
s
h
o
we
d
t
h
a
t
i
n
t
h
e
e
n
d
o
f
s
t
ud
y
t
h
e
f
a
s
t
i
n
g
B
G
L
,
A
1C
,
s
y
s
t
o
l
i
c
a
n
d
d
i
a
s
t
o
l
i
c
B
P
de
c
r
e
a
s
e
d
s
i
g
nif
i
c
a
n
t
l
y
,
a
s
w
e
l
l
a
s
H
DL
a
n
d
L
D
L
c
h
o
l
e
s
t
e
r
ol
l
e
v
e
l
s
[
30
].
An
o
t
h
e
r
goo
d
l
i
f
e
s
t
y
l
e
m
o
d
i
f
i
c
a
t
i
o
n
f
o
r
DM
pa
t
i
e
n
t
s
i
s
r
e
gu
l
a
r
e
x
e
r
c
i
s
e
.
A
s
t
ud
y
t
o
wa
r
ds
hy
p
e
r
c
h
o
l
e
s
t
e
r
o
l
e
mi
c
pa
t
i
e
n
t
s
wh
o
e
x
e
r
c
i
s
e
r
e
gu
l
a
r
l
y
s
h
o
we
d
t
h
a
t
t
h
e
i
n
c
i
de
n
c
e
o
f
DM
,
HT
,
a
n
d
c
a
r
d
i
o
v
a
s
c
u
l
a
r
d
i
s
e
a
s
e
de
c
r
e
a
s
e
s
i
g
ni
f
i
c
a
n
t
l
y
[
31]
.
An
i
n
t
e
r
e
s
t
i
n
g
s
t
ud
y
to
wa
r
ds
8,
494
pe
o
pl
e
w
i
t
h
DM
c
o
n
c
l
ude
d
t
h
a
t
i
n
r
e
l
a
t
i
o
n
t
o
m
o
r
t
a
l
i
t
y
o
r
m
a
c
r
o
v
a
s
c
u
l
a
r
e
v
e
n
t
s
,
B
P
m
o
ni
t
o
r
i
n
g/co
n
t
r
o
l
wa
s
m
o
r
e
i
m
po
r
t
a
n
t
t
h
a
n
i
n
t
e
n
s
i
ve
g
ly
c
e
mi
c
c
o
n
t
r
o
l
.
A
t
f
i
r
s
t
f
o
l
l
o
w
up,
t
h
e
r
e
wa
s
n
o
di
f
f
e
r
e
n
c
e
o
f
B
P
a
n
d
g
l
y
c
a
t
e
d
h
e
m
o
g
l
o
bi
n
l
e
v
e
l
s
f
o
u
n
d
be
t
we
e
n
gr
o
ups
.
B
ut
,
a
t
t
h
e
e
n
d
o
f
f
o
l
l
o
w
up,
t
h
e
r
e
duc
t
i
o
ns
i
n
t
h
e
r
i
s
k
o
f
de
a
t
h
f
r
o
m
a
ny
c
a
us
e
a
n
d
o
f
de
a
t
h
f
r
o
m
c
a
r
d
i
o
v
a
s
c
u
l
a
r
c
a
u
s
e
s
w
e
r
e
s
i
g
nif
i
c
a
n
t
b
e
t
we
e
n
g
r
o
ups
.
H
o
we
v
e
r
,
t
h
e
r
e
wa
s
n
o
d
i
f
f
e
r
e
n
c
e
f
o
un
d
b
e
t
we
e
n
t
h
e
i
n
t
e
n
s
i
ve
-
g
l
uc
o
s
e
-
c
o
n
t
r
o
l
gr
o
up
a
n
d
t
h
e
s
t
a
n
d
a
r
d
-
gl
u
c
o
s
e
-
c
o
n
t
r
o
l
gr
o
up
r
e
ga
r
di
n
g
t
h
e
r
i
s
k
o
f
de
a
t
h
f
r
o
m
a
ny
c
a
us
e
o
r
m
a
j
o
r
m
a
c
r
o
v
a
s
c
u
l
a
r
e
v
e
n
t
s
[
32
]
.
A
pr
o
s
pe
c
t
i
v
e
s
t
ud
y
t
o
wa
r
ds
1,
918
c
o
n
s
e
c
ut
i
v
e
pa
t
i
e
n
t
s
w
i
t
h
A
C
S
d
i
a
g
n
o
s
i
s
we
r
e
f
o
l
l
o
we
d
up
a
f
t
e
r
10
y
e
a
r
s
s
ho
we
d
t
h
a
t
DM
wa
s
t
h
e
o
nly
c
li
n
i
c
a
l
f
a
c
to
r
t
h
a
t
a
ggr
a
v
a
t
e
d
A
C
S
pr
o
gn
o
s
i
s
,
whe
r
e
a
s
B
P
a
n
d
d
y
s
li
p
i
de
mi
a
d
i
d
n
o
t
s
e
e
m
t
o
de
t
e
r
m
i
ne
t
h
e
pr
o
gn
o
s
i
s
[
33]
.
I
n
e
l
de
r
ly
w
i
t
h
DM
,
we
f
o
u
n
d
t
h
e
r
i
s
k
o
f
HT
c
o
m
p
li
c
a
t
i
o
n
wa
s
e
x
t
r
e
m
e
ly
hi
g
h
.
S
i
mi
l
a
r
f
i
nd
i
ng
s
we
r
e
a
l
s
o
f
o
un
d
i
n
wo
r
l
dw
i
de
s
t
ud
i
e
s
.
HT
wa
s
p
ot
e
n
t
i
a
ll
y
c
o
e
xi
s
t
e
n
t
wi
t
h
D
M
i
n
t
h
e
i
n
i
t
i
a
l
DM
d
i
a
g
n
o
s
i
s
.
B
ot
h
HT
a
n
d
DM
a
r
e
c
o
m
po
n
e
n
t
s
o
f
m
e
t
a
b
o
l
i
c
s
y
n
dr
o
m
e
.
T
h
e
i
nc
i
d
e
n
c
e
o
f
HT
i
n
pe
o
p
l
e
w
i
t
h
DM
wa
s
e
x
p
l
a
i
ne
d
by
v
a
r
i
o
us
pa
t
h
w
a
y
s
.
M
a
n
a
ge
m
e
n
t
o
f
pe
o
pl
e
w
i
t
h
DM
s
h
o
u
l
d
e
m
p
h
a
s
i
z
e
m
o
r
e
i
n
B
P
c
o
n
t
r
o
l
,
to
ge
t
h
e
r
w
i
t
h
g
ly
c
e
mi
c
c
o
n
t
r
o
l
.
D
i
e
t
a
r
y
m
a
na
ge
m
e
n
t
a
n
d
h
e
a
l
t
hy
li
f
e
s
t
y
l
e
s
h
o
u
l
d
b
e
t
h
e
f
i
r
s
t
l
i
ne
o
f
a
n
t
i
hy
pe
r
t
e
n
s
i
ve
t
h
e
r
a
p
y
i
n
pe
o
p
l
e
w
i
t
h
DM
,
f
o
l
lo
we
d
by
a
n
t
i
hy
pe
r
t
e
n
s
i
ve
dr
ugs
.
B
P
a
n
d
B
G
L
c
o
n
t
r
o
l
s
i
n
pe
o
pl
e
w
i
t
h
DM
a
r
e
im
p
o
r
t
a
n
t
f
o
r
r
e
duc
i
n
g
m
o
r
t
a
l
i
t
y
a
n
d
c
a
r
d
i
o
v
a
s
c
u
l
a
r
c
o
m
p
li
c
a
t
i
o
n
s
,
b
o
th
m
a
c
r
o
a
n
d
m
i
c
r
o
va
s
c
u
l
a
r
.
4.
CONC
L
USI
ON
B
l
o
o
d
pr
e
s
s
ur
e
i
s
s
i
g
nif
i
c
a
n
t
l
y
d
i
f
f
e
r
e
n
t
b
e
t
we
e
n
t
h
e
s
i
ng
l
e
d
i
s
e
a
s
e
gr
o
up
o
f
HT
a
n
d
DM
i
n
t
e
r
m
o
f
s
y
s
t
o
l
e
a
n
d
d
i
a
s
t
o
l
e
,
e
s
pe
c
i
a
ll
y
i
n
e
l
de
r
ly
,
b
ut
B
G
L
i
s
s
i
mi
l
a
r
.
T
h
e
r
i
s
k
o
f
b
e
i
ng
HT
f
o
r
e
l
de
r
ly
w
i
t
h
D
M
i
s
e
x
t
r
e
m
e
ly
hi
g
h
.
E
l
de
r
l
y
w
i
t
h
DM
&
HT
h
a
v
e
hi
g
h
B
P
a
n
d
B
GL
s
im
il
a
r
ly
t
o
t
h
o
s
e
w
i
t
h
s
i
ng
l
e
d
i
s
e
a
s
e
o
f
HT
o
r
DM
.
T
hi
s
s
t
ud
y
f
i
nd
i
ng
i
nd
i
c
a
t
e
t
h
a
t
wh
e
t
he
r
t
h
e
e
l
de
r
ly
h
a
s
a
s
i
ng
l
e
d
i
s
e
a
s
e
o
f
HT
o
r
DM
,
i
n
t
h
e
e
nd
hi
s
B
P
a
n
d
B
GL
a
r
e
n
ot
s
i
g
ni
f
i
c
a
n
t
l
y
d
i
f
f
e
r
e
n
t
w
i
t
h
t
h
o
s
e
w
h
o
h
a
s
m
o
r
e
c
o
m
p
l
i
c
a
t
e
d
d
i
s
e
a
s
e
l
i
k
e
DM
&HT
.
On
c
e
HT
c
o
e
xi
s
t
e
n
t
w
i
t
h
D
M
,
b
o
t
h
B
P
a
n
d
B
GL
a
r
e
n
o
t
s
i
g
ni
f
i
c
a
n
t
l
y
d
if
f
e
r
e
n
t
w
i
t
h
t
h
o
s
e
wh
o
ha
v
e
a
s
i
ng
l
e
d
i
s
e
a
s
e
o
nly
,
a
n
d
vi
c
e
v
e
r
s
a
.
AC
K
NOWL
E
DGE
M
E
NT
S
T
hi
s
s
t
ud
y
wa
s
f
u
n
de
d
by
W
i
d
y
a
M
a
n
da
l
a
C
a
t
h
o
l
i
c
U
ni
ve
r
s
i
t
y
S
ur
a
b
a
ya
(
Gr
a
n
t
n
u
m
be
r
:
183a
/WM
01.
5/N/2017)
a
n
d
S
a
i
n
t
L
o
ui
s
C
o
l
l
e
ge
,
B
a
n
gko
k
,
T
h
a
i
l
a
n
d.
T
hi
s
pu
bli
c
a
t
i
o
n
i
s
s
uppo
r
t
e
d
by
F
a
c
u
l
t
y
o
f
Nur
s
i
ng,
W
i
d
y
a
M
a
n
d
a
l
a
C
a
t
h
o
l
i
c
U
ni
ve
r
s
i
t
y
S
ur
a
b
a
y
a
.
RE
F
E
R
E
NC
E
S
[1
]
Pad
i
l
a,
“
N
u
rs
i
n
g
Car
e
P
l
an
fo
r
In
t
e
r
n
al
D
i
s
e
as
e
(i
n
Bah
a
s
a
I
n
d
o
n
e
s
i
a),
”
2
0
1
3
.
Y
o
g
y
ak
art
a:
N
u
h
a
M
ed
i
k
a.
[2
]
W
o
rl
d
H
e
a
l
t
h
O
rg
an
i
zat
o
n
(W
H
O
),
“
D
e
fi
n
i
t
i
o
n
o
f
a
n
O
l
d
e
r
o
r
O
l
d
e
r
P
e
o
p
l
e
P
e
rs
o
n
,
”
2
0
1
3
.
Re
t
ri
ev
e
d
fr
o
m:
h
t
t
p
:
/
/
w
w
w
.
w
h
o
.
i
n
t
/
h
e
a
l
t
h
i
n
fo
/
s
u
rv
ey
/
a
g
e
i
n
g
d
e
fn
o
l
d
e
r/
en
/
[3
]
W
o
rl
d
H
e
al
t
h
O
rg
a
n
i
zat
i
o
n
(
W
H
O
),
“
N
o
n
-
C
o
mm
u
n
i
cab
l
e
D
i
s
e
as
e
s
Pro
g
r
e
s
s
Mo
n
i
t
o
r
2
0
1
5
(Se
p
t
e
m
b
e
r
2
0
1
5
),
”
2
0
1
5
.
G
e
n
ev
a:
W
H
O
.
[4
]
Mi
n
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a
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a,
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u
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8
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.
1
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.
Evaluation Warning : The document was created with Spire.PDF for Python.
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(
N
i
P
utu
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ur
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253
[8
]
T
h
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G
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0
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4
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5
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6
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7
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m
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8
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.
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9
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A
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.
L
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,
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D
ag
o
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ack
,
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Co
m
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d
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d
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y
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d
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arg
et
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rg
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t
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1
1
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0
]
T
O
D
A
Y
St
u
d
y
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ro
u
p
,
“
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1
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A
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.
Co
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.
Pal
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.
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Prev
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1
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[2
2
]
Ram
o
n
-
A
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Mart
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-
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