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h
t
a
ls
o
g
e
t
in
f
e
c
te
d
s
o
th
e
ac
tu
a
l
n
u
m
b
e
r
o
f
n
u
r
s
es
w
h
o
d
i
e
d
o
f
th
is
v
i
r
u
s
m
ig
h
t
b
e
h
ig
h
e
r
th
an
t
h
e
o
f
f
i
c
ia
l
r
e
c
o
r
d
.
T
h
u
s
,
r
e
p
o
r
ts
o
f
n
u
r
s
e
s
’
m
o
r
t
a
l
ity
b
a
s
e
d
o
n
p
u
b
li
s
h
e
d
r
e
p
o
r
ts
a
r
e
u
r
g
en
tly
r
e
q
u
i
r
e
d
t
o
o
v
e
r
c
o
m
e
th
e
c
h
a
l
l
en
g
e
s
f
ac
e
d
b
y
n
u
r
s
e
s
[
5
]
.
I
n
a
n
o
u
t
b
r
e
ak
r
e
s
p
o
n
s
e
,
n
u
r
s
e
s
a
r
e
o
f
t
en
a
t
t
h
e
f
o
r
ef
r
o
n
t
.
I
n
d
e
e
d
,
t
h
ey
h
av
e
s
ev
e
r
a
l
r
o
l
e
s
in
t
h
e
m
an
ag
em
en
t
o
f
a
p
an
d
em
i
c
.
Nu
r
s
e
s
f
a
c
e
v
a
r
i
o
u
s
ch
a
l
l
en
g
es
in
th
e
m
an
ag
em
en
t
o
f
em
e
r
g
in
g
in
f
e
c
ti
o
u
s
d
is
e
a
s
e
(
E
I
D
)
r
e
l
a
t
e
d
t
o
th
e
r
ai
s
e
d
b
u
t
u
n
p
r
e
d
i
c
ta
b
l
e
r
is
k
o
f
in
f
ec
t
io
n
.
Nu
r
s
es
ex
p
e
r
i
en
ce
s
o
m
e
ch
an
g
e
s
w
i
th
in
t
h
e
i
r
w
o
r
k
en
v
i
r
o
n
m
en
t
an
d
an
u
n
c
er
t
a
in
ty
th
a
t
b
e
c
o
m
e
m
ain
b
a
r
r
i
er
s
an
d
b
e
i
n
g
a
c
h
a
l
l
en
g
e
i
n
n
u
r
s
in
g
p
r
a
c
t
i
ce
[
6
]
.
Nu
r
s
es
e
x
p
er
ien
ce
a
h
i
g
h
e
m
o
tio
n
al
s
tr
e
s
s
w
it
h
i
n
th
eir
w
o
r
k
.
Nu
r
s
e
s
d
escr
ib
e
th
e
p
h
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s
ical
ex
h
a
u
s
tio
n
an
d
m
e
n
tal
d
is
tr
es
s
r
elate
d
to
t
h
e
s
tr
ai
n
o
f
tr
ia
g
e
d
ec
is
io
n
s
,
t
h
e
i
n
f
ec
tio
n
r
is
k
,
an
d
also
th
e
p
ain
o
f
lo
s
in
g
co
lleag
u
es
a
n
d
th
eir
p
atien
t
s
,
b
r
in
g
n
u
r
s
e
s
i
n
to
v
u
l
n
er
ab
le
s
itu
a
tio
n
[
7
]
.
On
e
p
r
io
r
s
tu
d
y
s
tated
t
h
at
n
u
r
s
es
ta
k
i
n
g
ca
r
e
f
o
r
p
atien
t
s
w
it
h
i
n
f
ec
tio
u
s
d
is
ea
s
es,
s
u
ch
as
s
e
v
er
e
a
cu
te
r
esp
ir
ato
r
y
s
y
n
d
r
o
m
e
(
S
AR
S)
an
d
C
OVI
D
-
1
9
,
e
x
p
er
ien
ce
d
m
e
n
tal
an
d
p
s
y
c
h
o
l
o
g
ical
d
is
tr
ess
[
8
]
–
[
1
0
]
.
I
n
Sau
d
i
A
r
ab
ia,
9
1
.
8
%
o
f
h
ea
lt
h
ca
r
e
w
o
r
k
er
s
,
m
o
s
t
o
f
th
e
m
w
er
e
n
u
r
s
e
s
,
h
ad
a
n
eg
ati
v
e
attit
u
d
e
in
tr
ea
tin
g
p
atien
t
s
w
it
h
eit
h
er
s
u
s
p
ec
ted
o
r
co
n
f
ir
m
ed
m
id
d
l
e
e
ast
r
esp
ir
ato
r
y
s
y
n
d
r
o
m
e
(
ME
R
S)
[
9
]
,
[
1
1
]
.
Nu
r
s
es
'
a
n
x
iet
y
a
n
d
s
tr
es
s
lev
els
i
n
cr
ea
s
ed
as
th
e
r
ep
o
r
ts
o
f
C
OVI
D
-
19
-
r
elate
d
d
ea
th
s
.
T
h
is
is
esp
ec
iall
y
t
h
e
ca
s
e
w
it
h
f
o
r
ce
d
d
ep
lo
y
m
e
n
ts
a
n
d
d
eliv
er
ies
to
o
th
er
f
r
o
n
tli
n
e
ar
ea
s
d
u
e
to
lab
o
r
s
h
o
r
tag
es.
I
n
ad
d
itio
n
,
if
a
h
ea
lth
w
o
r
k
er
i
n
v
o
l
v
ed
in
h
a
n
d
lin
g
a
ca
s
e
is
in
f
ec
ted
o
r
d
ies,
it
is
m
o
r
e
lik
el
y
t
h
at
th
e
o
f
f
i
ce
r
w
il
l
a
v
o
id
th
e
s
u
s
p
ec
ted
ca
s
e
o
r
r
ef
u
s
e
to
tr
ea
t
t
h
e
p
atie
n
t
[
9
]
,
[
1
2
]
.
T
h
e
s
t
u
d
y
ab
o
u
t
t
h
e
o
u
tb
r
ea
k
o
f
S
AR
S
r
esu
lted
t
h
at
t
h
e
n
u
r
s
es
w
er
e
d
esire
to
leav
e
t
h
eir
j
o
b
s
d
u
r
in
g
th
e
o
u
tb
r
ea
k
d
u
e
to
th
e
p
er
ce
iv
ed
r
is
k
o
f
w
o
r
k
s
tr
ess
r
elate
d
to
tan
u
r
e,
s
o
cial
r
el
atio
n
,
an
d
f
atalit
y
as
w
ell
[
9
]
.
A
n
o
th
er
r
esear
ch
h
as
f
o
u
n
d
th
at
th
e
n
e
g
ati
v
e
s
id
e
o
f
w
o
r
k
e
n
v
ir
o
n
m
e
n
t
ar
e
r
elate
d
to
in
cr
ea
s
in
g
t
h
e
r
is
k
o
f
m
alicio
u
s
co
n
s
eq
u
en
ce
s
,
s
p
ec
if
icall
y
b
u
r
n
o
u
t
an
d
th
e
i
m
p
ac
t
to
w
ar
d
th
e
l
o
w
-
q
u
alit
y
o
f
ca
r
e
[
1
3
]
.
B
u
r
n
o
u
t
s
y
n
d
r
o
m
es
in
d
icate
a
s
et
o
f
s
y
m
p
to
m
s
o
f
ex
h
a
u
s
tio
n
,
ex
p
r
es
s
ed
b
y
a
la
ck
o
f
p
h
y
s
ical
d
ep
er
s
o
n
aliza
t
io
n
(D
P
)
an
d
s
elf
-
d
ev
al
u
atio
n
r
ed
u
ce
d
p
er
s
o
n
al
ac
co
m
p
li
s
h
m
e
n
t
(
R
P
A
)
.
T
h
e
i
m
p
ac
ts
o
f
b
u
r
n
o
u
t
s
y
n
d
r
o
m
e
a
m
o
n
g
n
u
r
s
e
s
m
a
k
e
d
etr
i
m
e
n
tal
e
f
f
ec
t
s
to
b
o
th
in
d
iv
id
u
als
an
d
o
r
g
a
n
izat
io
n
s
b
ec
au
s
e
a
d
ec
li
n
e
i
n
o
n
e’
s
b
io
p
s
y
ch
o
s
o
cial
h
ea
lth
lead
s
to
wo
r
k
d
is
s
ati
s
f
ac
tio
n
,
ab
s
e
n
ce
an
d
p
r
esen
ce
,
a
n
d
ea
r
l
y
r
etir
e
m
e
n
t,
w
h
ich
i
s
t
u
r
n
h
a
r
m
th
e
s
a
f
et
y
o
f
p
atie
n
ts
[
1
4
]
,
[
1
5
]
.
Nu
r
s
es
as
h
ea
lt
h
p
r
o
f
es
s
io
n
al
s
ar
e
v
u
l
n
er
ab
le
to
ex
p
er
ien
c
in
g
b
u
r
n
o
u
t
t
h
e
c
h
ar
ac
ter
is
tic
s
o
f
t
h
eir
w
o
r
k
ar
e
p
r
o
lo
n
g
ed
co
n
tact
w
it
h
t
h
e
p
atien
ts
,
ex
p
o
s
e
to
a
h
ig
h
w
o
r
k
lo
ad
,
ter
m
i
n
ated
il
l
p
atien
ts
t
h
at
t
h
e
y
tr
ea
ted
,
an
d
in
ap
p
r
o
p
r
iate
tr
ain
in
g
f
o
r
w
o
r
k
p
lace
u
r
g
e
n
c
y
,
an
d
e
m
o
tio
n
al
e
x
h
a
u
s
tio
n
[
1
4
]
,
[
1
5
]
.
T
h
e
2
4
h
o
u
r
s
r
esp
o
n
s
ib
ilit
y
i
n
ca
r
in
g
f
o
r
th
e
ir
p
atien
ts
m
a
y
e
x
p
o
s
e
n
u
r
s
es
to
s
tr
ess
.
I
t
ca
u
s
e
s
b
u
r
n
o
u
t
i
n
th
e
lo
n
g
ter
m
c
ar
e
an
d
in
ter
r
u
p
t
s
th
e
q
u
al
it
y
o
f
ca
r
e
an
d
th
eir
p
r
o
f
ess
io
n
al
d
ev
elo
p
m
e
n
t
[
1
4
]
,
[
1
6
]
.
A
w
o
r
ld
w
id
e
C
OVI
D
-
1
9
p
an
d
e
m
ic
i
s
an
u
n
k
n
o
w
n
tr
au
m
atic
ca
s
e
f
o
r
n
u
r
s
e
s
,
s
o
t
h
er
e
h
as b
ee
n
litt
le
r
esear
c
h
i
n
s
p
ec
tin
g
b
u
r
n
o
u
t r
elate
d
to
C
OVI
D
-
1
9
.
I
n
d
ee
d
,
id
en
tify
in
g
t
h
e
v
ar
iab
les
w
h
ich
ar
e
r
elate
d
to
b
u
r
n
o
u
t
s
y
n
d
r
o
m
e
i
s
ef
f
ec
tiv
e
to
p
r
ev
en
t
th
is
s
y
n
d
r
o
m
e
[
1
4
]
.
Giv
en
th
i
s
co
n
s
id
er
atio
n
,
t
h
is
s
tu
d
y
a
i
m
ed
to
id
en
tify
n
u
r
s
e
s
’
b
u
r
n
o
u
t
lev
e
ls
d
u
r
i
n
g
t
h
e
C
OVI
D
-
1
9
p
an
d
em
ic
a
n
d
to
d
escr
ib
e
th
e
s
o
cio
-
d
em
o
g
r
ap
h
ic
an
d
w
o
r
k
en
v
ir
o
n
m
e
n
t
-
r
elate
d
f
ac
to
r
s
to
d
is
s
e
m
in
ate
b
as
ic
in
f
o
r
m
atio
n
to
lo
w
er
an
d
p
r
ev
en
t t
h
e
b
u
r
n
o
u
t a
m
o
n
g
n
u
r
s
es.
2.
RE
S
E
ARCH
M
E
T
H
O
D
2
.
1
.
Respo
nd
e
nt
T
h
is
w
a
s
a
cr
o
s
s
-
s
ec
tio
n
a
l
s
t
u
d
y
w
i
th
o
n
li
n
e
q
u
es
tio
n
n
a
ir
e
s
u
r
v
e
y
u
n
d
er
to
o
k
f
r
o
m
Ma
y
1
to
J
u
n
e
1
5
,
2
0
2
0
.
T
h
e
co
n
v
e
n
ie
n
t
s
a
m
p
l
e
w
as
r
ec
r
u
ited
t
h
r
o
u
g
h
a
p
u
b
lic
a
n
n
o
u
n
ce
m
e
n
t
an
d
p
er
s
o
n
al
n
et
w
o
r
k
t
h
at
co
n
tain
s
a
n
i
n
v
itatio
n
o
f
p
ar
t
icip
atin
g
i
n
t
h
e
b
u
r
n
o
u
t
s
y
n
d
r
o
m
e
s
u
r
v
e
y
.
T
h
e
s
u
r
v
e
y
w
a
s
co
m
p
o
s
ed
o
f
1
8
4
n
u
r
s
es
f
r
o
m
s
o
m
e
h
o
s
p
ital
s
an
d
p
u
b
lic
h
ea
lth
ce
n
ter
s
in
Se
m
ar
an
g
C
it
y
,
I
n
d
o
n
esia
.
Fo
r
in
clu
s
io
n
,
th
e
r
esp
o
n
d
en
ts
h
ad
to
b
e
n
u
r
s
es
an
d
p
r
o
v
id
in
g
d
ir
ec
t
ca
r
e
to
p
atien
ts
d
u
r
in
g
t
h
e
C
OVI
D
-
1
9
p
an
d
em
ic
in
a
h
o
s
p
ital,
p
u
b
lic
h
ea
lt
h
ce
n
ter
,
o
r
o
th
er
h
ea
lth
ca
r
e
s
er
v
ice
s
in
Se
m
ar
a
n
g
C
it
y
.
T
h
o
s
e
w
h
o
w
er
e
o
n
leav
e
d
u
r
in
g
th
e
p
an
d
e
m
ic
f
o
r
an
y
r
ea
s
o
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I
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1
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.
T
he
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t
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n t
he
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rno
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m
e
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d t
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ar
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8806
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p
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117
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[
1
7
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,
[
1
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.
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,
[
1
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.
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[
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–
[
2
1
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.
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[
2
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2
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Oth
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1
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[
2
3
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T
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v
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s
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ti
ll
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ial.
T
h
e
Evaluation Warning : The document was created with Spire.PDF for Python.
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11
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1
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20
22
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1
13
-
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118
h
ig
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g
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ee
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ca
tio
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[
2
4
]
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[
2
5
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A
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p
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(
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is
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y
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o
ciate
d
w
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v
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[
2
6
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H
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[
2
7
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[
2
8
]
.
T
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lf
-
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a
m
o
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g
n
u
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s
es.
Yet,
lo
w
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u
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n
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al
s
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ex
p
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ce
b
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s
.
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t
th
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ac
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n
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s
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ass
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task
s
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n
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s
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w
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k
lo
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n
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s
e
s
.
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o
,
th
e
f
ac
to
r
o
f
e
m
o
tio
n
al
n
u
r
s
es
i
n
r
u
n
n
i
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g
n
u
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s
in
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s
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v
ices
ca
n
af
f
ec
t
p
er
f
o
r
m
a
n
ce
in
n
u
r
s
i
n
g
s
er
v
ice
[
2
9
]
,
[
3
0
]
.
B
esid
es,
E
E
s
ee
m
ed
to
in
cr
e
ase
in
n
u
r
s
e
s
w
it
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p
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f
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s
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n
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ex
p
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less
th
a
n
f
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v
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y
ea
r
s
[
1
5
]
.
W
o
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k
ex
p
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m
a
y
d
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r
ea
s
e
b
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t
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m
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e
x
p
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ce
th
e
y
h
a
v
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th
e
m
o
r
e
c
o
n
f
id
e
n
ce
t
h
e
y
ar
e
[
2
4
]
.
Nu
r
s
es
w
h
o
h
a
v
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m
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e
ex
p
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ce
s
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etter
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o
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m
s
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v
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g
ab
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eg
ar
d
in
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w
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p
lace
w
ith
h
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a
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ce
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tain
t
y
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T
h
ey
al
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h
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v
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d
ev
elo
p
ed
a
p
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t
r
elatio
n
s
h
ip
s
at
wo
r
k
[
2
4
]
.
Oth
er
s
tu
d
ie
s
also
f
o
u
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d
t
h
at
w
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m
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ar
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at
h
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g
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k
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a
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d
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to
t
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k
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f
D
P
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e
b
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w
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e.
W
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m
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e
also
p
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d
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b
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r
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le
as
m
o
t
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d
n
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r
s
e
[
1
5
]
,
[
3
1
]
.
Oth
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th
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DP
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R
P
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a
n
f
e
m
ale
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s
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s
an
d
h
ad
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ar
r
ied
(
2
3
.
4
%).
Mo
s
t
o
f
th
e
m
w
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h
i
g
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s
co
r
e
o
f
DP
m
o
r
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th
a
n
5
0
y
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s
a
g
ed
(
3
3
.
3
%)
an
d
m
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e
th
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y
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s
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f
p
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f
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s
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n
al
ex
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ce
(
2
4
.
7
%).
Ma
le
n
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r
s
es
o
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e
t
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h
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ter
ten
d
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to
p
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o
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th
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e
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g
with
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m
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th
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w
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k
p
lace
[
1
5
]
.
So
m
e
s
t
u
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ie
s
s
tated
t
h
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t
h
e
f
a
m
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y
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t th
at
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ev
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h
e
m
f
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m
th
o
s
e
n
e
g
ati
v
e
b
eh
a
v
io
r
s
[
1
5
]
,
[
3
2
]
.
T
h
e
w
o
r
k
e
n
v
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o
n
m
en
t
-
r
elate
d
f
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r
s
,
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n
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n
g
t
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n
it
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f
w
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k
,
C
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D
-
19
-
r
elate
d
p
atien
ts
in
ch
ar
g
e,
p
er
s
o
n
a
l
p
r
o
tectiv
e
eq
u
ip
m
e
n
t
(
P
P
E
)
u
s
ag
e,
an
d
r
ed
u
ce
d
an
x
iet
y
-
r
elate
d
P
P
E
u
s
ag
e
,
ar
e
also
i
m
p
o
r
tan
t
to
b
e
co
n
s
id
er
ed
.
Fu
r
t
h
er
m
o
r
e,
th
e
ce
r
tain
ch
a
r
ac
ter
is
tics
o
f
th
e
w
o
r
k
p
lace
also
co
n
tr
ib
u
te
in
d
ev
elo
p
in
g
b
u
r
n
o
u
t a
m
o
n
g
n
u
r
s
es.
T
h
er
ef
o
r
e,
th
e
ch
ar
ac
te
r
i
s
tic
o
f
p
atie
n
t,
th
e
w
o
r
k
lo
ad
at
th
e
w
o
r
k
p
lace
,
an
d
n
u
r
s
es
’
f
a
m
il
y
ar
e
co
n
tr
ib
u
te
to
th
e
ap
p
ea
r
an
ce
o
f
b
u
r
n
o
u
t
[
2
1
]
.
T
h
e
b
u
r
n
o
u
t
s
y
n
d
r
o
m
e
o
f
n
u
r
s
e
s
ca
n
b
e
tr
ig
g
er
ed
b
y
a
p
o
o
r
m
a
n
ag
e
m
en
t
o
f
h
u
m
an
r
eso
u
r
ce
s
an
d
s
u
p
p
lies
to
p
r
o
v
id
e
q
u
ality
o
f
ca
r
e
to
p
atien
ts
.
I
t
r
esu
lt
s
in
t
h
e
p
o
o
r
d
eliv
er
y
p
er
f
o
r
m
a
n
ce
o
f
ca
r
e
[
2
2
]
.
R
eg
ar
d
in
g
t
h
e
w
o
r
k
e
n
v
ir
o
n
m
en
t
-
r
elate
d
f
ac
to
r
s
,
an
o
th
er
s
tu
d
y
d
escr
ib
ed
f
o
u
r
co
m
p
o
n
en
ts
co
n
s
is
t
o
f
au
to
n
o
m
y
,
co
n
tr
o
l
o
v
er
th
e
en
v
ir
o
n
m
e
n
t,
p
h
y
s
ic
ian
–
n
u
r
s
e
r
elatio
n
s
h
ip
,
an
d
o
r
g
an
izatio
n
al
s
u
p
p
o
r
t.
I
n
d
ee
d
,
in
d
iv
id
u
al
v
u
l
n
er
ab
ilit
y
a
n
d
th
e
p
r
o
f
ess
io
n
al
e
n
v
ir
o
n
m
e
n
t,
i
n
clu
d
in
g
t
h
e
d
ail
y
w
o
r
k
p
lace
a
n
d
th
e
co
m
m
u
n
it
y
,
i
m
p
ac
t
t
h
e
b
u
r
n
o
u
t
a
m
o
n
g
n
u
r
s
es.
B
u
r
n
o
u
t
i
s
a
ls
o
p
ar
tic
u
la
r
l
y
d
eter
m
in
ed
b
y
t
h
e
p
o
o
r
o
r
g
an
iza
tio
n
o
f
w
o
r
k
th
at
ca
u
s
es
w
o
r
k
o
v
er
lo
ad
,
lack
o
f
au
to
n
o
m
y
,
an
d
lac
k
o
f
s
u
p
p
o
r
t f
o
r
n
u
r
s
es’
d
u
ties
[
1
3
]
.
T
h
e
p
r
esen
t
s
tu
d
y
id
e
n
ti
f
ies
th
e
w
o
r
k
en
v
ir
o
n
m
en
t
-
r
elat
ed
f
ac
to
r
s
in
cl
u
d
in
g
w
it
h
C
OVI
D
-
1
9
in
f
ec
ted
p
atien
ts
’
co
n
d
itio
n
a
n
d
r
ed
u
ce
d
a
n
x
iet
y
w
it
h
P
P
E
u
s
ag
e
w
er
e
n
o
t
s
ig
n
i
f
ica
n
tl
y
co
r
r
elate
d
w
it
h
t
h
e
P
A
d
o
m
ain
s
o
f
b
u
r
n
o
u
t.
T
h
e
u
n
i
t
o
f
w
o
r
k
s
is
t
h
e
o
n
l
y
o
n
e
w
o
r
k
e
n
v
ir
o
n
m
en
t
-
r
elate
d
f
ac
t
o
r
th
at
s
ig
n
i
f
ica
n
tl
y
co
r
r
elat
ed
w
it
h
DP
d
o
m
ai
n
(
p
<0
.
0
5
)
w
it
h
a
v
er
y
w
ea
k
co
r
r
e
latio
n
(
co
r
r
elatio
n
co
ef
f
ic
ien
t
=
0
.
1
9
0
)
.
T
h
e
o
th
er
s
tu
d
y
also
s
h
o
w
ed
th
at
tas
k
o
v
er
lo
ad
r
elate
d
to
th
e
u
n
it
o
f
w
o
r
k
w
a
s
p
o
s
iti
v
el
y
a
s
s
o
c
iated
w
ith
b
u
r
n
o
u
t.
B
u
r
n
o
u
t
a
m
o
n
g
n
u
r
s
e
s
co
r
r
elate
s
w
it
h
th
e
p
r
o
b
lem
s
o
f
w
o
r
k
en
v
ir
o
n
m
e
n
t
o
f
n
u
r
s
in
g
p
r
ac
tice.
T
h
ese
r
es
u
lts
ca
n
n
o
t
b
e
th
e
f
r
a
m
e
w
o
r
k
i
n
b
u
r
n
o
u
t
p
r
ev
en
tio
n
a
m
o
n
g
n
u
r
s
es
d
u
e
to
m
an
y
o
th
er
v
ar
iab
l
es
th
at
m
a
y
co
n
tr
o
l
o
v
er
th
e
e
n
v
ir
o
n
m
en
t t
h
at
co
r
r
elate
d
w
i
th
th
e
b
u
r
n
o
u
t d
o
m
ai
n
s
[
1
3
]
.
T
h
e
p
o
o
r
w
o
r
k
e
n
v
ir
o
n
m
e
n
t
is
co
r
r
elate
d
to
th
e
r
is
k
o
f
b
u
r
n
o
u
t
a
m
o
n
g
n
u
r
s
es
an
d
ca
u
s
es
t
h
e
lo
w
-
q
u
alit
y
o
f
n
u
r
s
i
n
g
ca
r
e
[
1
3
]
.
R
eg
ar
d
in
g
n
u
r
s
es
w
h
o
ca
r
e
f
o
r
C
OVI
D
-
1
9
p
atien
t
s
,
6
3
.
6
% o
f
t
h
e
m
e
x
p
er
ien
ce
a
h
ig
h
le
v
el
o
f
E
E
an
d
m
o
s
t o
f
t
h
e
m
ar
e
p
u
b
lic
h
ea
lt
h
n
u
r
s
es
(
2
0
.
8
%),
5
6
.
3
%
o
f
th
em
ex
p
er
ie
n
ce
a
h
i
g
h
le
v
el
o
f
DP
an
d
m
o
s
t
o
f
th
e
m
ar
e
s
u
r
g
ical
w
ar
d
n
u
r
s
e
(
4
0
%),
w
h
ile
4
6
.
7
% o
f
th
e
m
e
x
p
er
ien
ce
a
h
i
g
h
lev
el
o
f
P
A
a
n
d
m
o
s
t o
f
th
e
m
ar
e
d
ial
y
s
is
n
u
r
s
es (
5
0
%).
Nu
r
s
es
w
o
r
k
i
n
g
i
n
a
n
e
m
er
g
in
g
s
i
tu
at
io
n
v
u
ln
er
ab
l
y
e
x
p
er
ien
ce
b
u
r
n
o
u
t.
T
h
e
h
i
g
h
s
co
r
e
o
f
E
E
in
d
icate
s
t
h
e
a
n
x
ie
t
y
a
n
d
s
tr
e
s
s
ex
p
er
ie
n
ce
d
b
y
n
u
r
s
es.
U
n
d
esira
b
le
w
o
r
k
co
n
d
itio
n
s
w
i
th
li
m
ited
ti
m
e
i
n
p
er
f
o
r
m
in
g
n
u
r
s
i
n
g
ca
r
e
an
d
a
n
o
v
er
lo
ad
o
f
task
s
m
a
y
co
n
tr
i
b
u
te
to
th
e
h
ig
h
EE
s
co
r
es.
C
OVI
D
-
1
9
as
a
n
e
w
ca
s
e
g
i
v
es
n
u
r
s
es
n
e
w
co
n
d
it
io
n
s
.
L
ac
k
o
f
e
x
p
er
ien
ce
f
o
r
n
u
r
s
es
i
n
ca
r
in
g
C
O
VI
D
1
9
r
elate
d
p
atien
ts
ca
n
ag
g
r
a
v
ate
t
h
e
h
i
g
h
s
co
r
e
o
f
E
E
.
T
h
e
h
ig
h
le
v
el
o
f
E
E
id
e
n
tif
ied
a
m
o
n
g
p
u
b
lic
h
ea
lth
n
u
r
s
es
r
elate
d
to
t
h
e
d
if
f
ic
u
lt
o
f
p
atien
ts
t
h
at
t
h
e
y
ca
r
e
.
P
u
b
lic
h
ea
lth
ce
n
ter
s
p
r
o
v
id
e
th
eir
s
er
v
ices
i
n
t
h
eir
o
w
n
co
m
m
u
n
it
y
a
n
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
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B
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u
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s
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o
r
kin
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in
C
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p
a
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(
Tr
i
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to
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119
a
r
e
h
eld
i
n
a
p
r
o
lo
n
g
ed
p
er
i
o
d
[
3
3
]
,
[
3
4
]
.
T
h
e
i
m
p
o
r
tan
ce
of
p
r
i
m
ar
y
ca
r
e
i
n
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ea
lt
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er
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a
n
d
t
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in
cr
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a
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f
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p
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h
ea
lt
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er
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ice
s
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e
s
n
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s
to
f
ac
e
t
h
e
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e
w
ch
a
llen
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es
a
n
d
i
n
cr
ea
s
i
n
g
m
o
r
e
s
tr
ess
o
r
to
th
e
w
o
r
k
.
T
h
er
ef
o
r
e
,
w
e
m
u
s
t
d
eter
m
i
n
e
s
o
m
e
f
a
cto
r
s
th
at
co
n
tr
ib
u
te
to
E
E
am
o
n
g
n
u
r
s
e
s
in
th
eir
w
o
r
k
p
lace
s
u
ch
as
d
eliv
er
i
n
g
n
u
r
s
in
g
ca
r
e
i
n
t
h
eir
p
atie
n
ts
’
h
o
m
e
s
,
t
h
e
o
v
er
lo
ad
o
f
t
h
eir
t
ask
s
,
o
r
t
h
e
lac
k
o
f
co
n
tr
o
l o
v
er
th
eir
o
w
n
w
o
r
k
p
l
ac
e.
W
o
r
k
in
g
co
n
d
itio
n
s
al
s
o
i
n
cr
e
ase
t
h
e
DP
s
co
r
es
,
s
p
ec
i
f
icall
y
in
d
ial
y
s
is
n
u
r
s
e
s
w
h
o
r
o
u
ti
n
el
y
m
ee
t
a
ch
r
o
n
ic
i
ll
n
e
s
s
s
u
c
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as
e
n
d
-
s
t
ag
e
k
id
n
e
y
d
is
ea
s
e
th
at
n
ee
d
lo
n
g
-
ter
m
ca
r
e
.
T
h
is
o
cc
u
r
s
u
s
u
all
y
i
n
a
g
r
o
w
in
g
p
o
o
r
p
r
o
g
n
o
s
is
eld
er
l
y
w
h
o
o
f
ten
r
eq
u
ir
e
h
ea
v
y
p
h
y
s
ical
ef
f
o
r
t
s
;
e
v
en
t
h
e
h
i
g
h
r
is
k
o
f
d
ea
th
in
t
h
e
u
n
it.
D
ial
y
s
is
n
u
r
s
e
s
ar
e
e
x
p
er
ien
ce
d
to
h
i
g
h
le
v
els
o
f
b
u
r
d
en
an
d
s
tr
es
s
[
2
0
]
,
[
3
4
]
.
T
h
e
u
n
i
t
w
h
e
r
e
th
e
n
u
r
s
es
w
er
e
o
n
d
u
t
y
w
as
s
i
g
n
if
ica
n
tl
y
co
r
r
elate
d
w
it
h
t
h
e
DP
d
o
m
a
in
(
p
<0
.
0
5
)
w
i
th
a
v
er
y
w
ea
k
co
r
r
elatio
n
.
P
r
o
f
ess
io
n
al
ac
tiv
itie
s
s
h
o
u
ld
attai
n
a
s
atis
f
ac
t
io
n
eit
h
er
in
ec
o
n
o
m
ic
o
r
p
r
o
f
ess
io
n
al.
T
h
e
p
r
o
f
ess
io
n
al
tas
k
s
h
o
u
l
d
e
m
p
h
a
s
ize
th
e
m
ai
n
r
o
le
o
f
n
u
r
s
es
i
n
co
m
m
u
n
i
t
y
.
Ho
w
e
v
er
,
d
if
f
er
en
t
le
v
el
s
o
f
j
o
b
s
tr
ess
alo
n
g
t
h
e
d
ail
y
p
r
ac
tice,
m
a
y
lead
to
t
h
e
i
n
cr
e
asin
g
le
v
el
o
f
b
u
r
n
o
u
t
[
1
3
]
.
Nu
r
s
es
m
a
y
e
x
p
er
ien
ce
b
u
r
n
o
u
t,
h
a
v
e
t
h
e
r
esi
lien
ce
to
s
ta
y
i
n
th
eir
w
o
r
k
d
u
e
to
t
h
e
ir
o
p
tim
i
s
m
[
2
5
]
,
[
3
5
]
.
P
er
s
o
n
al
ch
ar
ac
ter
is
tics
f
ac
to
r
s
co
u
ld
b
e
m
o
r
e
ass
o
ciate
d
w
it
h
b
u
r
n
o
u
t
a
m
o
n
g
n
u
r
s
es
d
u
r
i
n
g
th
e
p
an
d
e
m
ic
t
h
an
a
n
y
w
o
r
k
en
v
i
r
o
n
m
e
n
t
f
ac
to
r
s
.
A
p
er
s
o
n
's
c
h
ar
ac
ter
is
tic
s
af
f
ec
t
o
n
e
's
ab
ili
t
y
to
o
v
er
co
m
e
t
h
e
w
o
r
k
lo
ad
e
v
en
in
t
h
e
p
an
d
e
m
ic.
Or
g
an
iza
tio
n
al
ef
f
o
r
ts
p
la
y
a
n
i
m
p
o
r
tan
t
r
o
le
i
n
s
tr
e
n
g
t
h
e
n
i
n
g
n
u
r
s
e
s
to
p
r
ev
en
t
b
u
r
n
o
u
t.
Nu
r
s
e
s
n
ee
d
to
g
et
m
a
x
i
m
u
m
s
u
p
p
o
r
t
to
c
ar
r
y
o
u
t
t
h
eir
w
o
r
k
w
i
th
h
ig
h
s
elf
-
e
f
f
icac
y
a
n
d
a
f
ee
li
n
g
o
f
s
ec
u
r
it
y
[
2
2
]
.
4.
CO
NCLU
SI
O
N
T
h
e
f
ac
to
r
s
o
f
d
e
m
o
g
r
ap
h
ic
a
n
d
w
o
r
k
e
n
v
ir
o
n
m
en
t
ar
e
n
o
t
th
e
o
n
l
y
v
ar
iab
les
t
h
at
i
m
p
a
ct
b
u
r
n
o
u
t
a
m
o
n
g
n
u
r
s
es
in
t
h
e
p
a
n
d
e
m
i
c.
T
h
e
o
th
er
f
ac
to
r
m
a
y
co
n
tr
ib
u
te
t
h
e
b
u
r
n
o
u
t
a
n
d
ch
a
llen
g
ed
n
u
r
s
e
s
.
N
u
r
s
e
s
m
a
y
n
e
g
l
ec
t
t
h
eir
p
er
s
o
n
al
an
d
th
eir
d
u
t
y
i
n
ef
f
o
r
t
to
o
v
er
co
m
e
t
h
e
n
eg
at
iv
e
co
n
s
eq
u
e
n
c
es
o
f
th
i
s
s
y
n
d
r
o
m
e,
in
cr
ea
s
i
n
g
t
h
e
n
e
g
ati
v
e
attit
u
d
es
to
w
ar
d
s
t
h
eir
w
o
r
k
.
As
s
tat
ed
ab
o
v
e,
th
e
p
an
d
em
ic
h
as
a
s
p
ec
if
ic
b
u
r
d
en
t
h
at
d
is
tin
g
u
is
h
es
i
t
f
r
o
m
all
o
t
h
er
s
,
w
h
et
h
er
t
h
e
b
u
r
n
o
u
t
c
h
ar
ac
t
er
is
tic
t
h
e
s
a
m
e
as
t
h
e
n
o
r
m
al
s
itu
a
tio
n
.
I
t
m
ea
n
s
p
r
o
f
ess
io
n
ali
s
m
in
n
u
r
s
i
n
g
i
s
r
eq
u
ir
ed
to
d
ea
l w
i
th
t
h
e
C
O
VI
D
-
1
9
p
an
d
e
m
ic.
T
h
e
s
e
r
esu
l
ts
im
p
ly
th
at
n
u
r
s
es’
m
an
ag
e
r
s
s
h
o
u
l
d
d
e
t
e
r
m
in
e
s
ev
e
r
a
l
f
a
c
t
o
r
s
in
n
u
r
s
e
s
th
a
t
m
o
r
e
p
r
o
n
e
t
o
b
u
r
n
o
u
t
.
I
n
t
e
r
v
en
ti
o
n
s
t
o
p
r
e
v
en
t
an
d
t
r
e
a
t
b
u
r
n
o
u
t
a
r
e
n
ec
e
s
s
a
r
y
f
o
r
n
u
r
s
es
a
n
d
o
th
e
r
h
e
a
l
th
p
r
o
f
es
s
i
o
n
a
l
to
p
r
o
m
o
t
e
b
e
t
t
e
r
w
o
r
k
p
l
a
c
e
w
el
lb
e
i
n
g
.
T
h
e
r
e
l
a
t
e
d
o
r
g
a
n
i
z
a
ti
o
n
s
h
o
u
l
d
a
s
s
e
s
s
th
e
r
e
q
u
i
r
e
d
p
r
o
g
r
am
s
t
o
in
c
r
e
as
e
t
h
e
q
u
al
i
ty
o
f
c
a
r
e
.
N
u
r
s
in
g
p
r
o
f
e
s
s
i
o
n
a
ls
s
h
o
u
l
d
u
n
d
e
r
s
ta
n
d
t
h
e
p
h
y
s
i
c
al
an
d
em
o
t
i
o
n
a
l
r
e
q
u
i
r
em
en
t
,
in
an
i
n
s
t
an
t
,
s
u
p
p
o
r
t
t
h
r
o
u
g
h
th
e
s
e
l
f
-
h
el
p
g
r
o
u
p
s
t
o
s
h
a
r
e
th
e
i
r
f
e
e
lin
g
o
r
t
o
r
e
q
u
e
s
t
th
e
b
u
r
n
o
u
t
in
t
e
r
v
en
ti
o
n
.
N
u
r
s
in
g
m
an
ag
em
en
t
s
h
o
u
l
d
as
s
ess
th
e
f
u
tu
r
e
s
tu
d
y
t
o
f
in
d
th
e
e
f
f
ec
t
iv
e
in
t
e
r
v
en
t
i
o
n
s
in
p
r
ev
en
t
in
g
th
e
b
u
r
n
o
u
t
am
o
n
g
n
u
r
s
es
,
s
p
e
c
if
i
c
a
l
ly
d
u
r
i
n
g
t
h
e
p
an
d
em
i
c
.
H
an
d
l
in
g
b
u
r
n
o
u
t
p
r
o
b
l
em
s
is
s
e
en
as
b
e
in
g
a
b
l
e
t
o
im
p
r
o
v
e
t
h
e
q
u
a
li
ty
o
f
p
a
t
i
en
t
c
a
r
e
.
I
n
t
er
v
en
t
i
o
n
s
th
a
t
in
c
r
e
a
s
e
s
e
lf
-
s
u
p
p
o
r
t
t
o
d
e
a
l
w
i
th
th
e
w
o
r
k
en
v
ir
o
n
m
en
t
a
r
e
n
e
e
d
e
d
t
o
h
e
l
p
c
o
n
t
r
o
l
th
is
s
y
n
d
r
o
m
e
.
H
o
w
ev
e
r
,
in
t
e
r
v
en
t
i
o
n
s
a
r
e
m
o
r
e
s
u
g
g
es
t
e
d
a
t
th
e
r
e
a
d
in
ess
o
n
d
u
ty
in
a
r
o
u
t
in
e
w
o
r
k
p
l
a
ce
,
th
e
s
t
r
u
c
tu
r
e
,
an
d
th
e
f
u
n
c
t
i
o
n
s
th
a
t
m
an
ag
e
i
t
th
an
in
th
e
o
th
e
r
f
ac
t
o
r
r
e
l
at
e
d
t
o
b
u
r
n
o
u
t
.
ACK
NO
WL
E
D
G
M
E
NT
S
T
h
is
r
esear
ch
w
a
s
s
el
f
-
f
u
n
d
ed
.
Ou
r
ap
p
r
ec
iatio
n
g
o
es
to
all
n
u
r
s
es
t
h
at
p
ar
ticip
ated
in
th
i
s
s
tu
d
y
an
d
ou
r
d
ee
p
est
ap
p
r
ec
iatio
n
g
o
es
to
all
n
u
r
s
e
s
f
ac
i
n
g
th
e
C
OVI
D
-
1
9
p
an
d
e
m
ic.
T
h
e
au
t
h
o
r
s
h
av
e
n
o
co
n
f
licts
o
f
in
ter
est a
s
s
o
ciate
d
w
it
h
th
i
s
s
t
u
d
y
.
RE
F
E
R
E
NC
E
S
[
1
]
S
a
t
g
a
s
P
e
n
a
n
g
a
n
a
n
C
O
V
I
D
-
1
9
,
“
D
e
c
r
e
e
o
f
t
h
e
M
i
n
i
s
t
e
r
o
f
H
e
a
l
t
h
o
f
t
h
e
R
e
p
u
b
l
i
c
o
f
I
n
d
o
n
e
si
a
N
u
m
b
e
r
H
k
.
0
1
.
0
7
/
M
e
n
k
e
s/
3
2
8
/
2
0
2
0
c
o
n
c
e
r
n
i
n
g
G
u
i
d
e
l
i
n
e
s
f
o
r
p
r
e
v
e
n
t
i
o
n
a
n
d
c
o
n
t
r
o
l
o
f
c
o
r
o
n
a
v
i
r
u
s
d
i
se
a
se
2
0
1
9
(
C
O
V
I
D
-
19
)
i
n
t
h
e
w
o
r
k
p
l
a
c
e
,
(
I
n
I
n
d
o
n
e
si
a
:
K
e
p
u
t
u
s
a
n
M
e
n
t
e
r
i
K
e
se
h
a
t
a
n
R
e
p
u
b
l
i
k
I
n
d
o
n
e
s
i
a
N
o
m
o
r
H
k
.
0
1
.
0
7
/
Me
n
k
e
s/
3
2
8
/
2
0
2
0
T
e
n
t
a
n
g
Pa
n
d
u
a
n
Pe
n
c
e
g
a
h
a
n
D
a
n
P
e
n
g
e
n
d
a
l
i
a
n
c
o
r
o
n
a
v
i
ru
s
d
i
s
e
a
s
e
2
0
1
9
(
C
O
VI
D
-
19
)
d
i
t
e
m
p
a
t
k
e
r
j
a
,
”
M
e
n
t
e
r
i
K
e
se
h
a
t
.
R
e
p
u
b
l
i
k
I
n
d
o
n
e
s.
,
v
o
l
.
2
0
1
9
,
p
p
.
1
–
2
0
7
,
2
0
2
0
.
[
2
]
S
.
P
a
y
b
a
st
,
F
.
B
a
g
h
a
l
h
a
,
A
.
Emam
i
,
a
n
d
M
.
K
o
o
sh
a
,
“
T
h
e
a
n
x
i
e
t
y
d
i
so
r
d
e
r
a
mo
n
g
t
h
e
h
e
a
l
t
h
c
a
r
e
p
r
o
v
i
d
e
r
s
d
u
r
i
n
g
t
h
e
c
o
v
i
d
-
19
i
n
f
e
c
t
i
o
n
p
a
n
d
e
mi
c
:
a
s
y
st
e
mat
i
c
r
e
v
i
e
w
,”
I
n
t
e
rn
a
t
i
o
n
a
l
C
l
i
n
i
c
a
l
N
e
u
r
o
s
c
i
e
n
c
e
J
o
u
rn
a
l
,
v
o
l
.
7
,
n
o
.
3
,
p
p
.
1
1
5
–
1
2
1
,
2
0
2
0
,
d
o
i
:
1
0
.
3
4
1
7
2
/
i
c
n
j
.
2
0
2
0
.
1
1
.
[
3
]
K
.
C
.
R
o
b
b
i
n
s,
“
N
N
J
J
o
u
r
n
a
l
c
l
u
b
-
su
p
p
o
r
t
f
o
r
n
u
r
se
s
d
u
r
i
n
g
t
h
e
G
l
o
b
a
l
C
O
V
I
D
-
19
p
a
n
d
e
mi
c
,
”
N
e
p
h
r
o
l
o
g
y
N
u
rs
i
n
g
J
o
u
r
n
a
l
,
v
o
l
.
4
7
,
n
o
.
3
,
p
.
2
7
1
,
2
0
2
0
,
d
o
i
:
1
0
.
3
7
5
2
6
/
1
5
2
6
-
7
4
4
x
.
2
0
2
0
.
4
7
.
3
.
2
7
1
.
[
4
]
A
.
N
a
se
e
r
,
M
.
S
h
a
k
o
o
r
,
F
.
V
o
h
r
a
,
T
.
A
b
d
u
l
j
a
b
b
a
r
,
Q
.
M
a
r
i
a
m,
a
n
d
M
.
A
.
R
e
h
ma
n
,
“
K
n
o
w
l
e
d
g
e
,
a
w
a
r
e
n
e
ss
a
n
d
p
r
a
c
t
i
c
e
o
f
h
e
a
l
t
h
c
a
r
e
p
r
o
f
e
ssi
o
n
a
l
s
a
mi
d
S
A
R
S
-
C
o
V
-
2
,
c
o
r
o
n
a
v
i
r
u
s
d
i
se
a
se
o
u
t
b
r
e
a
k
,
”
P
a
k
i
st
a
n
J
o
u
r
n
a
l
o
f
M
e
d
i
c
a
l
S
c
i
e
n
c
e
s
,
v
o
l
.
3
6
,
n
o
.
S
4
,
M
a
y
2
0
2
0
.
[
5
]
A
.
A
.
P
a
r
i
k
e
si
t
,
N
.
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