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I
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R
esp
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CC B
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C
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e
s
p
o
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ing
A
uth
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r
:
C
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Yac
tay
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-
Ar
ias
Dep
ar
tam
en
to
d
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s
tu
d
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s
Ge
n
er
ales,
Un
iv
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a
,
Per
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m
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ed
u
.
p
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1.
I
NT
RO
D
UCT
I
O
N
R
esp
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ato
r
y
d
is
ea
s
es
ar
e
a
m
ajo
r
p
u
b
lic
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ea
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p
r
o
b
lem
a
f
f
ec
tin
g
m
illi
o
n
s
wo
r
ld
wid
e
[
1
]
.
T
h
ese
co
n
d
itio
n
s
alter
lu
n
g
f
u
n
ctio
n
,
m
ak
e
b
r
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th
in
g
d
if
f
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lt,
an
d
m
an
i
f
est
th
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s
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v
ar
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r
o
at,
an
d
d
if
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lty
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g
[
2
]
.
I
n
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itio
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to
th
eir
im
p
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t
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n
q
u
ality
o
f
life
,
th
ese
d
is
ea
s
es
ar
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a
s
ig
n
if
ic
an
t
ec
o
n
o
m
ic
b
u
r
d
en
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h
ea
lth
ca
r
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co
s
ts
an
d
lo
s
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p
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u
ctiv
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.
Am
o
n
g
th
e
m
o
s
t
co
m
m
o
n
an
d
d
eb
ilit
atin
g
r
esp
ir
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r
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d
is
ea
s
es
ar
e
in
f
lu
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p
n
e
u
m
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n
ia,
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d
asth
m
a,
all
o
f
wh
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h
av
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s
ig
n
if
ican
t
co
n
s
eq
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en
ce
s
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I
n
th
is
s
en
s
e,
tim
ely
an
d
ac
cu
r
ate
m
ed
ical
ca
r
e
is
ess
en
tial
f
o
r
th
e
ef
f
ec
tiv
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m
an
ag
em
en
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f
r
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at
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cu
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s
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N
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ca
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ch
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ex
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er
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s
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tem
s
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T
h
ese
ar
e
tech
n
o
lo
g
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d
esig
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ed
to
h
elp
b
o
th
h
ea
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ca
r
e
p
r
o
f
ess
io
n
als
an
d
in
d
i
v
id
u
als
id
en
tify
r
esp
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r
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d
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r
ex
am
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y
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tem
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v
elo
p
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[
3
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is
a
n
ex
p
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s
y
s
tem
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ab
le
o
f
d
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Fu
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Po
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[
4
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ev
alu
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it
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m
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On
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[
5
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d
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elo
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in
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ield
wh
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r
esp
ir
ato
r
y
d
is
ea
s
es.
Pre
v
io
u
s
s
tu
d
i
es
h
av
e
d
ev
elo
p
e
d
s
y
s
tem
s
ca
p
ab
le
o
f
d
iag
n
o
s
in
g
o
n
ly
a
lim
ited
s
et
o
f
d
is
ea
s
es,
m
ak
in
g
it
d
if
f
icu
lt
t
o
o
p
tim
ally
im
p
lem
e
n
t
th
em
to
id
en
tif
y
m
u
ltip
le
s
im
ilar
c
o
n
d
itio
n
s
,
s
u
ch
as
in
f
lu
en
za
,
p
n
e
u
m
o
n
ia,
an
d
asth
m
a,
in
a
s
in
g
le
d
ia
g
n
o
s
tic
s
y
s
tem
.
T
h
is
f
r
ag
m
en
tatio
n
i
n
d
etec
tin
g
s
im
ilar
d
is
ea
s
es with
d
if
f
er
en
t sy
s
tem
s
r
esu
lts
in
th
e
in
ef
f
icien
t u
s
e
o
f
r
eso
u
r
ce
s
.
T
o
f
ill
th
is
g
ap
,
th
is
s
tu
d
y
d
e
v
elo
p
s
a
web
-
b
ased
ex
p
er
t
s
y
s
tem
ad
ap
tab
le
to
m
o
b
ile
d
e
v
i
ce
s
f
o
r
th
e
p
r
elim
in
ar
y
d
iag
n
o
s
is
o
f
r
esp
i
r
ato
r
y
d
is
ea
s
es
s
u
ch
as
in
f
lu
en
za
,
p
n
eu
m
o
n
ia,
an
d
asth
m
a.
T
h
is
s
y
s
tem
is
b
a
s
ed
o
n
th
e
d
ec
is
io
n
tr
ee
m
et
h
o
d
,
a
tech
n
iq
u
e
th
at
u
s
es
a
h
ier
ar
ch
ical
s
tr
u
ctu
r
e
o
f
d
ec
is
io
n
s
to
co
n
cl
u
d
e.
Ad
ap
tab
ilit
y
to
m
o
b
ile
d
ev
ice
s
will
allo
w
u
s
er
s
to
ac
ce
s
s
th
e
d
iag
n
o
s
tic
s
y
s
tem
an
y
tim
e,
an
y
wh
er
e,
m
a
k
in
g
it
ea
s
ier
to
g
et
q
u
ick
an
d
ac
cu
r
a
te
m
ed
ical
h
elp
wh
en
n
ee
d
ed
[
6
]
.
I
n
ad
d
itio
n
,
th
e
u
s
e
o
f
a
d
ec
is
io
n
tr
ee
in
th
e
d
iag
n
o
s
tic
p
r
o
ce
s
s
en
s
u
r
es
a
s
y
s
tem
atic
an
d
s
tr
u
ctu
r
ed
ev
al
u
atio
n
o
f
s
y
m
p
to
m
s
,
im
p
r
o
v
i
n
g
th
e
a
cc
u
r
ac
y
an
d
ef
f
ec
tiv
en
ess
o
f
r
esp
ir
ato
r
y
d
i
s
ea
s
e
d
iag
n
o
s
is
.
T
h
e
m
ai
n
o
b
jec
ti
v
e
o
f
t
h
is
s
tu
d
y
is
t
o
d
e
v
el
o
p
a
n
d
e
v
a
lu
ate
a
we
b
-
b
ase
d
e
x
p
e
r
t
s
y
s
t
e
m
f
o
r
t
h
e
d
ia
g
n
o
s
is
o
f
r
es
p
i
r
at
o
r
y
d
is
e
as
es.
T
h
is
s
y
s
t
em
will
b
e
d
es
ig
n
ed
t
o
a
cc
u
r
at
el
y
a
n
d
ef
f
i
cie
n
t
l
y
i
d
en
tif
y
c
o
n
d
i
ti
o
n
s
s
u
c
h
as
i
n
f
l
u
e
n
z
a,
p
n
eu
m
o
n
ia
,
an
d
ast
h
m
a.
T
h
e
e
v
al
u
ati
o
n
wi
ll f
o
cu
s
o
n
t
h
e
u
s
a
b
ilit
y
a
n
d
d
i
ag
n
o
s
ti
c
e
f
f
ic
ie
n
c
y
o
f
t
h
e
s
y
s
te
m
,
i
n
cl
u
d
in
g
p
a
r
a
m
ete
r
s
s
u
ch
as
p
r
ec
is
io
n
,
ac
cu
r
a
cy
,
s
en
s
iti
v
i
ty
,
a
n
d
s
p
e
cif
ici
ty
.
On
th
e
o
th
er
h
an
d
,
th
e
im
p
o
r
t
an
ce
o
f
im
p
lem
en
tin
g
th
is
ex
p
er
t
s
y
s
tem
lies
in
its
ab
ilit
y
t
o
im
p
r
o
v
e
ac
ce
s
s
to
h
ea
lth
ca
r
e,
f
ac
ilit
ate
ac
cu
r
ate
an
d
tim
ely
p
r
ed
ia
g
n
o
s
is
,
an
d
r
ed
u
ce
th
e
b
u
r
d
e
n
o
n
h
ea
lth
ca
r
e
s
y
s
tem
s
b
y
p
r
e
v
en
tin
g
s
er
io
u
s
an
d
c
o
s
tly
co
m
p
licatio
n
s
ass
o
ciate
d
with
r
esp
ir
ato
r
y
d
is
ea
s
es.
E
x
p
er
t
s
y
s
tem
s
in
m
ed
icin
e
p
la
y
a
cr
itical
r
o
le
in
p
r
o
v
id
in
g
im
m
e
d
iate
ac
ce
s
s
to
k
n
o
wled
g
e
f
o
r
p
h
y
s
ician
s
an
d
p
atien
ts
.
Usi
n
g
alg
o
r
ith
m
s
s
u
ch
as
d
ec
is
io
n
tr
ee
s
,
an
d
ex
p
er
t
s
y
s
tem
s
im
p
r
o
v
e
th
e
q
u
ality
an
d
s
af
ety
o
f
h
ea
lth
ca
r
e.
T
h
ey
d
o
th
is
b
y
p
r
o
v
id
in
g
co
m
p
u
ter
ize
d
clin
ical
d
ec
is
io
n
s
u
p
p
o
r
t
n
o
t
o
n
ly
to
clin
ician
s
b
u
t
also
to
p
atien
ts
an
d
o
t
h
er
s
tak
eh
o
ld
er
s
,
en
s
u
r
in
g
th
at
t
h
ey
h
a
v
e
ac
ce
s
s
to
r
elev
an
t
in
f
o
r
m
atio
n
an
d
ex
p
e
r
tis
e
[
7
]
.
T
h
is
ca
p
a
b
ilit
y
f
ac
ilit
ates
m
o
r
e
in
f
o
r
m
ed
d
e
cisi
o
n
-
m
ak
in
g
,
lead
i
n
g
to
m
o
r
e
ac
cu
r
ate
p
r
esu
m
p
tiv
e
d
i
ag
n
o
s
es
an
d
b
etter
p
atien
t
o
u
tco
m
es.
I
t
also
p
r
o
m
o
tes
p
u
b
lic
ed
u
ca
tio
n
ab
o
u
t
r
esp
ir
ato
r
y
h
ea
lth
an
d
en
c
o
u
r
ag
es
h
ea
lth
s
elf
-
m
an
ag
em
en
t,
em
p
o
wer
i
n
g
in
d
iv
id
u
als to
m
ak
e
in
f
o
r
m
e
d
d
ec
is
io
n
s
ab
o
u
t th
eir
well
-
b
ein
g
.
2.
L
I
T
E
R
AT
U
RE
R
E
VI
E
W
2
.
1
.
B
re
a
k
do
wn o
f
re
s
pira
t
o
ry
di
s
ea
s
es
T
h
is
s
ec
tio
n
p
r
esen
ts
a
d
et
ailed
an
aly
s
is
o
f
s
ev
er
al
r
esp
ir
ato
r
y
d
is
ea
s
es,
s
u
ch
as
in
f
lu
en
za
,
p
n
eu
m
o
n
ia,
an
d
asth
m
a.
T
h
e
d
ef
in
itio
n
s
o
f
ea
ch
o
f
th
ese
d
is
ea
s
es
h
av
e
b
ee
n
ex
am
in
ed
,
as
well
a
s
th
e
ch
ar
ac
ter
is
tic
s
y
m
p
to
m
s
ass
o
ciate
d
with
ea
ch
.
T
h
is
b
r
ea
k
d
o
wn
allo
ws
f
o
r
a
d
ee
p
er
u
n
d
er
s
tan
d
in
g
o
f
th
ese
r
esp
ir
ato
r
y
d
is
ea
s
es,
th
eir
clin
ical
m
an
if
estatio
n
s
,
an
d
th
eir
im
p
licatio
n
s
f
o
r
d
iag
n
o
s
is
an
d
tr
ea
tm
en
t.
2
.
1
.
1
.
I
nfluenza
I
n
f
lu
en
za
is
a
r
ap
id
-
o
n
s
et
v
ir
al
r
esp
ir
ato
r
y
d
is
ea
s
e
r
esp
o
n
s
ib
le
f
o
r
s
ig
n
if
ican
t
lev
els
o
f
i
lln
ess
an
d
d
ea
th
wo
r
ld
wid
e
[
8
]
.
I
t
ca
u
s
e
s
an
n
u
al
win
ter
ep
id
em
ics
an
d
,
s
o
m
etim
es,
wid
esp
r
ea
d
p
an
d
em
ics.
Alth
o
u
g
h
it
is
u
s
u
ally
m
ild
an
d
s
elf
-
lim
itin
g
,
it
ca
n
p
o
s
e
s
ig
n
if
ican
t
h
ea
lth
r
is
k
s
,
p
ar
ticu
lar
ly
to
t
h
e
el
d
er
ly
o
r
th
o
s
e
with
u
n
d
er
ly
i
n
g
ch
r
o
n
ic
h
ea
lth
co
n
d
itio
n
s
,
p
o
te
n
tially
lead
in
g
t
o
s
er
io
u
s
illn
ess
o
r
ev
en
d
ea
th
[
9
]
.
I
n
ad
d
itio
n
,
y
o
u
n
g
ch
ild
r
e
n
ar
e
p
a
r
ticu
lar
l
y
s
u
s
ce
p
tib
le
to
s
ev
er
e
in
f
lu
e
n
za
v
ir
u
s
in
f
ec
tio
n
s
an
d
ass
o
ciate
d
co
m
p
licatio
n
s
[
1
0
]
.
T
y
p
ical
s
y
m
p
t
o
m
s
o
f
i
n
f
lu
en
za
in
clu
d
e
f
e
v
er
,
m
ala
is
e,
co
u
g
h
,
a
n
d
b
o
d
y
ac
h
es
[
1
1
]
.
I
n
ad
d
itio
n
,
ac
co
r
d
in
g
to
th
e
W
o
r
ld
Hea
lt
h
Or
g
an
izatio
n
(
W
HO)
[
1
2
]
,
o
th
er
s
y
m
p
to
m
s
m
ay
in
clu
d
e
co
u
g
h
i
n
g
(
u
s
u
ally
d
r
y
)
,
h
ea
d
ac
h
es,
m
u
s
cle
an
d
j
o
in
t a
ch
es,
s
ev
er
e
g
e
n
er
al
m
al
aise,
a
s
o
r
e
th
r
o
at,
a
n
d
a
r
u
n
n
y
n
o
s
e.
2
.
1
.
2
.
P
neum
o
nia
Pn
eu
m
o
n
ia
is
a
co
m
m
o
n
an
d
life
-
th
r
ea
ten
in
g
d
is
ea
s
e
th
at
r
eq
u
ir
es
ea
r
ly
d
etec
tio
n
to
p
r
ev
en
t
f
u
r
th
er
d
am
ag
e
t
o
th
e
p
atien
t
an
d
p
o
t
en
tially
s
av
e
th
e
p
atien
t'
s
life
[
1
3
]
–
[
1
5
]
.
I
t
is
also
th
e
lead
in
g
in
f
ec
tio
u
s
ca
u
s
e
o
f
d
ea
th
in
ch
ild
r
e
n
u
n
d
e
r
f
i
v
e
y
ea
r
s
o
f
ag
e
wo
r
ld
wid
e
[
1
6
]
,
[
1
7
]
.
Alth
o
u
g
h
it
is
p
o
s
s
ib
le
to
d
etec
t
an
d
tr
ea
t
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
0
8
8
-
8
7
0
8
I
n
t J E
lec
&
C
o
m
p
E
n
g
,
Vo
l.
14
,
No
.
6
,
Dec
em
b
e
r
20
24
:
6
6
0
0
-
6
6
1
1
6602
p
n
eu
m
o
n
ia
with
s
im
p
le
to
o
ls
an
d
d
r
u
g
s
,
d
etec
tio
n
r
em
ain
s
a
m
ajo
r
ch
allen
g
e
in
d
ev
elo
p
i
n
g
c
o
u
n
tr
ies
[
1
8
]
,
[
1
9
]
.
T
h
is
d
is
ea
s
e
p
r
esen
ts
s
y
m
p
to
m
s
s
u
ch
as
co
u
g
h
,
d
if
f
ic
u
lty
b
r
ea
th
in
g
,
in
cr
ea
s
ed
r
esp
i
r
ato
r
y
r
ate,
s
p
u
t
u
m
p
r
o
d
u
ctio
n
,
an
d
ch
est
p
ain
.
I
t
ca
n
also
ca
u
s
e
g
en
er
al
s
y
m
p
to
m
s
s
u
ch
as
f
ev
er
,
f
atig
u
e,
m
u
s
cle
ac
h
es,
an
d
lo
s
s
o
f
ap
p
etite
[
2
0
]
.
2
.
1
.
3
.
Asthm
a
Ast
h
m
a
is
a
ch
r
o
n
ic
r
esp
ir
ato
r
y
d
is
ea
s
e
th
at
af
f
ec
ts
a
lar
g
e
n
u
m
b
er
o
f
p
eo
p
le
wo
r
l
d
wid
e
[
2
1
]
.
Alth
o
u
g
h
t
h
er
e
is
n
o
cu
r
e
f
o
r
asth
m
a,
it
ca
n
b
e
co
n
tr
o
lled
with
in
h
aler
s
an
d
p
r
e
v
en
tiv
e
m
ea
s
u
r
es
to
av
o
i
d
tr
ig
g
er
s
.
Ho
wev
e
r
,
ac
c
u
r
ate
d
iag
n
o
s
is
o
f
asth
m
a
in
ad
u
lts
r
em
ain
s
a
c
h
allen
g
e
i
n
c
u
r
r
e
n
t
clin
ical
p
r
ac
tice
[
2
2
]
.
I
n
ad
d
itio
n
,
d
iag
n
o
s
is
in
ch
ild
r
e
n
is
a
s
ig
n
if
ican
t
cl
in
ical
ch
allen
g
e
[
2
3
]
.
T
h
e
f
o
u
r
m
o
s
t
co
m
m
o
n
p
r
esen
tin
g
s
y
m
p
to
m
s
ar
e
c
o
u
g
h
,
wh
ee
zi
n
g
,
s
h
o
r
tn
ess
o
f
b
r
ea
th
,
an
d
ch
est
tig
h
tn
ess
[
2
4
]
,
[
2
5
]
.
Acc
o
r
d
in
g
to
th
e
W
HO
[
2
6
]
,
s
o
m
e
p
eo
p
le
m
ay
ex
p
er
ien
ce
wo
r
s
en
in
g
s
y
m
p
to
m
s
d
u
r
in
g
co
ld
s
p
ells
o
r
t
em
p
er
atu
r
e
ch
an
g
es.
Oth
er
tr
ig
g
er
s
m
a
y
in
clu
d
e
e
x
p
o
s
u
r
e
t
o
d
u
s
t,
s
m
o
k
e,
ce
r
ta
in
f
u
m
es,
g
r
ass
an
d
tr
ee
p
o
lle
n
,
an
d
co
n
tact
with
an
im
al
h
id
es a
n
d
f
ea
th
er
s
,
h
a
r
s
h
s
o
ap
s
,
an
d
p
e
r
f
u
m
es.
2
.
2
.
Rela
t
ed
wo
rk
s
Acc
o
r
d
in
g
to
C
an
ar
i
et
a
l.
[
3
]
r
esp
ir
ato
r
y
d
is
ea
s
es
h
av
e
ca
u
s
ed
h
ig
h
m
o
r
tality
r
ates
wo
r
ld
wid
e
o
v
er
th
e
y
ea
r
s
,
a
s
itu
atio
n
t
h
at
was
h
ig
h
lig
h
ted
ag
ain
d
u
r
in
g
th
e
c
o
r
o
n
a
v
ir
u
s
d
is
ea
s
e
2
0
1
9
(
C
OVI
D
-
19
)
p
an
d
em
ic.
Peo
p
le
liv
in
g
in
e
x
tr
em
e
p
o
v
er
ty
ar
e
th
e
m
o
s
t
v
u
ln
er
ab
le
to
th
ese
d
is
ea
s
es.
T
o
f
ac
ilit
ate
th
e
d
iag
n
o
s
is
o
f
r
esp
ir
ato
r
y
d
is
ea
s
es,
a
m
o
b
ile
h
ea
lth
ap
p
licatio
n
was
d
esig
n
ed
,
allo
win
g
p
atien
ts
to
r
e
g
is
ter
an
d
o
b
tain
a
d
iag
n
o
s
is
f
r
o
m
th
e
co
m
f
o
r
t
o
f
th
eir
h
o
m
es.
T
h
e
v
alid
atio
n
o
f
th
e
d
esig
n
,
b
ased
o
n
f
u
n
ctio
n
ality
,
ef
f
icien
cy
,
ef
f
ec
tiv
en
ess
,
an
d
s
atis
f
ac
tio
n
,
s
h
o
wed
h
i
g
h
ac
ce
p
tan
ce
a
m
o
n
g
u
s
er
s
d
u
e
t
o
its
ab
ilit
y
to
r
ed
u
ce
th
e
tim
e
n
ee
d
ed
to
o
b
tain
a
d
iag
n
o
s
is
.
I
n
th
e
s
am
e
v
ein
,
Ar
an
i
et
a
l.
[
2
7
]
d
ev
elo
p
e
d
a
f
u
zz
y
ex
p
er
t
s
y
s
tem
f
r
am
ewo
r
k
to
d
iag
n
o
s
e
p
n
eu
m
o
n
ia
an
d
d
is
tin
g
u
is
h
it
f
r
o
m
o
th
e
r
r
esp
ir
ato
r
y
d
is
ea
s
es
s
u
ch
as
ch
r
o
n
ic
b
r
o
n
c
h
itis
,
tu
b
er
cu
lo
s
is
,
asth
m
a,
s
tr
o
k
e,
an
d
lu
n
g
ca
n
ce
r
.
T
h
e
m
ain
g
o
al
was
to
p
r
o
v
i
d
e
a
d
ec
is
io
n
-
s
u
p
p
o
r
t
t
o
o
l
f
o
r
b
o
th
g
en
er
al
p
r
ac
titi
o
n
er
s
an
d
p
atien
ts
,
esp
ec
ially
in
th
e
d
iag
n
o
s
is
o
f
p
n
eu
m
o
n
ia,
a
d
is
ea
s
e
with
clin
ical
s
ig
n
s
t
h
at
ar
e
d
if
f
icu
lt
to
d
is
tin
g
u
is
h
f
r
o
m
o
th
e
r
r
esp
i
r
ato
r
y
d
is
ea
s
es.
T
o
d
ev
elo
p
th
e
s
y
s
tem
,
th
ey
u
s
ed
a
f
u
zz
y
ex
p
er
t
s
y
s
tem
m
eth
o
d
o
l
o
g
y
,
wh
ic
h
was
d
iv
id
ed
in
to
f
o
u
r
p
h
ases
ac
co
r
d
i
n
g
to
th
e
p
r
o
to
t
y
p
e
life
cy
cle
m
eth
o
d
o
l
o
g
y
.
T
h
e
r
esu
lts
o
b
tain
ed
s
h
o
wed
th
at
t
h
e
s
y
s
tem
h
ad
a
s
en
s
i
tiv
ity
o
f
9
7
%,
a
s
p
ec
if
icity
o
f
8
5
%,
a
n
d
an
ac
cu
r
ac
y
o
f
9
3
%
in
d
iag
n
o
s
in
g
t
h
e
d
is
ea
s
e.
T
h
is
in
d
icate
s
th
at
th
e
d
e
v
e
lo
p
ed
f
u
zz
y
ex
p
er
t
s
y
s
tem
h
a
s
h
ig
h
p
er
f
o
r
m
an
ce
in
d
etec
tin
g
p
n
eu
m
o
n
ia
an
d
d
i
f
f
er
en
tiatin
g
it f
r
o
m
o
th
er
r
esp
ir
ato
r
y
d
is
ea
s
es.
Similar
ly
,
Po
r
ter
et
a
l.
[
4
]
d
e
v
elo
p
ed
an
d
ev
alu
ate
d
th
e
p
r
e
cisi
o
n
o
f
a
s
m
ar
tp
h
o
n
e
-
b
ased
d
iag
n
o
s
tic
alg
o
r
ith
m
f
o
r
d
etec
tin
g
asth
m
a.
T
o
d
e
v
elo
p
th
e
alg
o
r
ith
m
,
th
ey
co
n
d
u
cted
a
p
r
o
s
p
e
ctiv
e,
d
o
u
b
le
-
b
lin
d
d
iag
n
o
s
tic
ac
cu
r
ac
y
s
tu
d
y
an
d
co
m
p
ar
e
d
th
e
p
er
f
o
r
m
a
n
ce
o
f
th
e
alg
o
r
ith
m
with
ex
p
er
t
clin
ical
ass
e
s
s
m
en
t
an
d
f
o
r
m
al
p
u
lm
o
n
a
r
y
f
u
n
ctio
n
test
in
g
.
I
n
d
iv
id
u
als
with
p
h
y
s
ician
-
d
iag
n
o
s
ed
asth
m
a
wer
e
d
iv
id
ed
in
to
two
ca
teg
o
r
ies:
th
o
s
e
with
co
n
f
ir
m
ed
ex
ac
er
b
atio
n
s
an
d
th
o
s
e
with
co
n
tr
o
lled
asth
m
a
.
T
h
e
alg
o
r
ith
m
'
s
p
er
f
o
r
m
an
ce
was
th
e
n
ev
alu
ated
in
r
elatio
n
to
clin
ical
d
iag
n
o
s
is
an
d
p
atien
t
-
r
ep
o
r
ted
wh
ee
ze
d
etec
tio
n
.
R
esu
lts
s
h
o
wed
th
at
th
e
alg
o
r
ith
m
h
ad
a
p
o
s
itiv
e
p
er
ce
n
tag
e
ag
r
ee
m
en
t
(
PP
A)
o
f
8
9
%
with
ex
p
er
t
clin
ical
d
iag
n
o
s
is
o
f
asth
m
a
ex
ac
er
b
a
tio
n
s
.
I
n
ad
d
itio
n
,
th
e
n
eg
ativ
e
p
er
ce
n
tag
e
ag
r
ee
m
e
n
t
(
NPA)
was
8
4
%.
I
t
a
ls
o
o
u
tp
er
f
o
r
m
ed
as
a
d
etec
to
r
o
f
p
atien
t
-
r
ep
o
r
te
d
wh
ee
ze
with
a
s
en
s
itiv
ity
o
f
6
3
.
7
%,
s
u
g
g
esti
n
g
its
ef
f
ec
tiv
en
ess
in
r
ap
id
ly
id
e
n
tify
in
g
asth
m
a
ex
ac
er
b
atio
n
s
with
o
u
t
th
e
n
ee
d
f
o
r
clin
ic
al
ex
am
in
atio
n
o
r
p
u
lm
o
n
a
r
y
f
u
n
ctio
n
test
in
g
.
L
ik
ewise,
Gu
r
b
eta
et
a
l.
[
2
8
]
d
ev
elo
p
e
d
an
d
test
ed
a
r
ea
l
-
tim
e
au
to
m
ated
telem
ed
icin
e
s
y
s
tem
with
ex
p
er
t
d
ia
g
n
o
s
is
f
o
r
asth
m
a
an
d
c
h
r
o
n
ic
o
b
s
tr
u
ctiv
e
p
u
lm
o
n
ar
y
d
is
ea
s
e
(
C
OPD)
.
T
h
is
s
y
s
tem
,
wh
ich
in
teg
r
ates
a
s
p
ir
o
m
eter
,
a
m
o
b
ile
ap
p
licatio
n
,
a
n
d
a
n
ex
p
e
r
t
d
iag
n
o
s
is
s
y
s
tem
,
is
b
ased
o
n
tech
n
o
l
o
g
ies
s
u
ch
as
An
d
r
o
id
,
J
av
a,
MA
T
L
AB
,
an
d
h
y
p
er
tex
t
p
r
ep
r
o
ce
s
s
o
r
(
PHP).
T
h
e
p
r
im
ar
y
o
b
jectiv
e
was
to
p
r
o
v
i
d
e
ac
cu
r
ate
d
iag
n
o
s
is
an
d
ex
p
er
t
ad
v
ice
to
p
atien
ts
in
r
em
o
te,
r
u
r
al,
an
d
is
o
lated
ar
ea
s
,
as
well
as
th
o
s
e
with
lim
ited
p
h
y
s
ical
m
o
b
ilit
y
.
A
p
r
o
s
p
ec
tiv
e
s
tu
d
y
was
co
n
d
u
cted
in
th
r
ee
r
em
o
te
p
r
im
a
r
y
h
ea
lth
ca
r
e
f
ac
ilit
ies
an
d
o
n
e
h
o
s
p
ital
in
B
o
s
n
ia
a
n
d
Her
ze
g
o
v
in
a.
O
v
er
s
ix
m
o
n
th
s
,
7
8
0
p
atien
ts
wer
e
ass
ess
ed
an
d
d
iag
n
o
s
ed
u
s
in
g
th
e
d
e
v
elo
p
e
d
s
y
s
tem
,
f
o
r
wh
ich
tec
h
n
o
lo
g
ies
s
u
ch
as
An
d
r
o
i
d
,
J
av
a,
MA
T
L
AB
,
an
d
PHP
wer
e
u
s
ed
to
b
u
ild
th
e
n
ec
ess
ar
y
tech
n
o
l
o
g
ical
in
f
r
astru
ctu
r
e
.
T
h
e
r
esu
lts
o
f
th
e
s
tu
d
y
s
h
o
wed
a
n
ac
c
u
r
ac
y
o
f
9
7
.
3
2
%
in
d
iag
n
o
s
in
g
asth
m
a
an
d
C
OPD
in
th
e
ev
alu
ated
p
atien
ts
.
I
n
ad
d
itio
n
to
im
p
r
o
v
in
g
th
e
q
u
ality
o
f
ca
r
e,
th
e
s
y
s
tem
p
r
o
v
id
e
d
s
ig
n
if
ican
t
b
en
ef
its
in
ter
m
s
o
f
ac
ce
s
s
to
ca
r
e
f
o
r
p
atien
ts
in
r
e
m
o
te
ar
e
as
an
d
with
lim
ited
p
h
y
s
ical
m
o
b
ilit
y
.
Similar
ly
,
B
u
r
n
ash
ev
et
a
l.
[
5
]
d
ev
elo
p
e
d
a
f
u
zz
y
ex
p
er
t
s
y
s
tem
u
s
in
g
f
u
zz
y
lo
g
ic
to
ass
es
s
th
e
s
ev
er
ity
o
f
p
n
eu
m
o
n
ia,
ta
k
in
g
ad
v
a
n
tag
e
o
f
th
e
in
h
er
en
t
u
n
ce
r
tain
ty
i
n
m
ed
ical
d
iag
n
o
s
is
.
T
h
e
k
n
o
wled
g
e
b
ase
was
b
u
ilt
in
SW
I
-
Pro
lo
g
to
im
p
r
o
v
e
m
ed
ical
d
ec
is
io
n
-
m
ak
in
g
an
d
to
c
o
n
tr
ib
u
te
to
t
h
e
d
e
v
elo
p
m
e
n
t
o
f
m
ed
ical
s
o
f
twar
e
p
r
o
d
u
cts.
T
h
ey
u
s
ed
f
u
zz
y
lo
g
ic
to
d
ea
l
with
u
n
ce
r
tain
ty
an
d
d
e
v
elo
p
ed
a
clien
t
-
s
er
v
er
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I
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&
C
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N:
2088
-
8
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0
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g
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o
s
is
o
f res
p
ir
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to
r
y
d
is
ea
s
es:
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n
in
n
o
v
a
tive
a
p
p
r
o
a
c
h
…
(
La
b
eria
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o
A
n
d
r
a
d
e
-
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r
en
a
s
)
6603
s
y
s
tem
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s
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Py
th
o
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d
Pro
l
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T
h
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s
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Djan
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Q1
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y
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e
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Q4
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t
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m
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Q
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3
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3
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th
e
s
elec
ted
s
y
m
p
to
m
s
,
a
v
ar
iety
o
f
s
o
u
r
ce
s
wer
e
co
n
s
u
lted
,
in
clu
d
i
n
g
s
cien
tific
a
r
ticles.
Sp
ec
if
ically
,
s
y
m
p
to
m
s
ass
o
ciate
d
with
in
f
lu
en
za
wer
e
tak
en
f
r
o
m
[
9
]
,
[
1
0
]
,
s
y
m
p
t
o
m
s
ch
ar
ac
ter
is
tic
o
f
p
n
eu
m
o
n
ia
wer
e
tak
en
f
r
o
m
[
1
8
]
,
a
n
d
s
y
m
p
to
m
s
ass
o
ciate
d
with
asth
m
a
wer
e
id
en
tifie
d
f
r
o
m
[
2
2
]
–
[
2
4
]
.
On
ce
th
e
co
llectio
n
o
f
th
ese
r
elev
an
t
s
y
m
p
to
m
s
was
co
m
p
lete,
we
m
o
v
ed
o
n
to
t
h
e
n
ex
t
s
tag
e
o
f
th
e
p
r
o
ce
s
s
,
wh
ich
was
th
e
co
n
s
tr
u
ctio
n
o
f
th
e
d
ec
is
io
n
tr
ee
.
T
h
is
d
ec
is
io
n
tr
ee
was
co
n
s
tr
u
cted
as
a
v
is
u
al
r
ep
r
esen
tatio
n
o
f
th
e
d
if
f
er
e
n
t
d
iag
n
o
s
tic
p
ath
way
s
th
at
th
e
ex
p
er
t
s
y
s
tem
wo
u
ld
f
o
llo
w
d
ep
en
d
in
g
o
n
th
e
s
y
m
p
to
m
s
p
r
esen
ted
b
y
th
e
p
atien
t.
E
ac
h
n
o
d
e
in
th
e
tr
ee
r
ep
r
esen
ted
a
p
ar
ticu
lar
s
y
m
p
to
m
,
wh
ile
th
e
b
r
an
ch
es
i
n
d
icate
d
p
o
s
s
ib
le
m
ed
ical
co
n
d
itio
n
s
ass
o
ciate
d
with
th
o
s
e
s
y
m
p
to
m
s
.
T
h
is
h
ier
ar
ch
ical
s
tr
u
ctu
r
e
allo
wed
th
e
ex
p
er
t
s
y
s
tem
to
m
ak
e
d
if
f
er
e
n
tiated
an
d
p
r
ec
is
e
d
iag
n
o
s
es,
ad
ap
ted
t
o
th
e
s
p
ec
if
ic
s
y
m
p
to
m
s
o
f
ea
ch
p
atien
t.
3
.
4
.
Co
nfusi
o
n m
a
t
rix
a
nd
p
er
f
o
rma
nce
m
et
rics
T
h
e
co
n
f
u
s
io
n
m
atr
i
x
s
er
v
es
as
a
v
alu
ab
le
to
o
l
to
ef
f
icien
tly
illu
s
tr
ate
th
e
p
er
f
o
r
m
a
n
ce
o
f
t
h
e
class
if
ier
,
with
th
e
ad
v
an
tag
e
o
f
d
ir
ec
t
in
ter
p
r
etatio
n
o
f
th
e
r
esu
lts
.
I
ts
s
im
p
licity
allo
ws
e
f
f
ec
tiv
e
ev
alu
atio
n
o
f
m
u
ltip
le
m
o
d
els
o
r
al
g
o
r
it
h
m
s
[
3
4
]
,
m
a
k
in
g
it
a
v
er
s
at
ile
to
o
l
f
o
r
ev
alu
atin
g
p
er
f
o
r
m
an
ce
in
d
if
f
er
e
n
t
co
n
tex
ts
an
d
a
p
p
licatio
n
s
.
A
s
s
h
o
wn
in
Fig
u
r
e
2
,
th
e
f
o
u
r
p
r
im
ar
y
co
m
p
o
n
en
ts
o
f
th
e
co
n
f
u
s
io
n
m
atr
ix
co
n
s
is
t o
f
tr
u
e
p
o
s
itiv
es (
T
P),
f
alse p
o
s
itiv
es (
FP
)
,
tr
u
e
n
eg
at
iv
es (
T
N)
,
an
d
f
alse n
eg
ativ
es
(
FN)
.
Fig
u
r
e
2
.
R
ep
r
esen
tatio
n
o
f
th
e
co
n
f
u
s
io
n
m
atr
ix
On
ce
th
e
co
n
f
u
s
io
n
m
atr
ix
is
co
n
s
tr
u
cted
,
th
e
m
atr
ix
v
al
u
es
ca
n
b
e
u
s
ed
t
o
ca
lcu
late
v
ar
i
o
u
s
m
o
d
el
ev
alu
atio
n
m
et
r
ics,
s
u
ch
as
p
r
ec
is
io
n
,
ac
cu
r
ac
y
,
s
en
s
itiv
ity
,
an
d
s
p
ec
if
icity
.
T
h
ese
m
et
r
ics
p
r
o
v
id
e
a
m
o
r
e
d
etailed
u
n
d
er
s
tan
d
in
g
o
f
th
e
p
er
f
o
r
m
an
ce
o
f
th
e
m
o
d
el
in
ter
m
s
o
f
its
ab
ilit
y
to
c
o
r
r
ec
tl
y
class
if
y
s
am
p
les
in
to
d
if
f
er
e
n
t c
lass
es.
T
h
e
m
etr
ics ar
e
d
escr
ib
ed
in
d
etail
b
el
o
w.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J E
lec
&
C
o
m
p
E
n
g
I
SS
N:
2088
-
8
7
0
8
P
r
elimin
a
r
y
d
ia
g
n
o
s
is
o
f res
p
ir
a
to
r
y
d
is
ea
s
es:
a
n
in
n
o
v
a
tive
a
p
p
r
o
a
c
h
…
(
La
b
eria
n
o
A
n
d
r
a
d
e
-
A
r
en
a
s
)
6605
Pre
cisi
o
n
,
a
v
ital
m
ea
s
u
r
e
o
f
a
m
o
d
el'
s
ef
f
icac
y
in
co
r
r
ec
tly
id
en
tify
in
g
p
o
s
itiv
e
ca
s
es,
g
ain
s
p
ar
ticu
lar
r
ele
v
an
ce
i
n
s
itu
at
io
n
s
wh
er
e
t
h
e
co
s
ts
ass
o
ciate
d
with
f
alse
p
o
s
itiv
es
ar
e
s
u
b
s
tan
tial.
I
t
is
ca
lcu
lated
as
th
e
r
atio
o
f
tr
u
e
p
o
s
itiv
e
p
r
ed
ictio
n
s
to
th
e
to
ta
l
n
u
m
b
e
r
o
f
p
o
s
itiv
e
p
r
ed
ictio
n
s
g
en
er
ated
b
y
th
e
m
o
d
el
[
3
5
]
.
I
t c
an
b
e
ca
lcu
late
d
u
s
in
g
(
1
)
.
=
+
(
1
)
Acc
u
r
ac
y
,
d
ef
in
e
d
as
th
e
r
atio
o
f
c
o
r
r
ec
tly
p
r
e
d
icted
ca
s
es
to
th
e
to
tal
n
u
m
b
er
o
f
ca
s
es
in
th
e
d
ataset,
is
an
ess
en
tial
m
etr
ic
f
o
r
e
v
alu
atin
g
a
m
o
d
el'
s
p
er
f
o
r
m
an
ce
in
class
if
icatio
n
o
r
p
r
e
d
ictio
n
[
3
5
]
.
T
h
is
f
u
n
d
am
e
n
tal
m
ea
s
u
r
e
p
r
o
v
id
e
s
a
clea
r
v
iew
o
f
th
e
m
o
d
el'
s
ab
ilit
y
to
class
if
y
ac
cu
r
ately
.
Acc
u
r
ac
y
,
wh
ic
h
co
n
s
id
er
s
b
o
t
h
co
r
r
ec
t
a
n
d
i
n
co
r
r
ec
t
p
r
ed
ictio
n
s
,
p
r
o
v
id
es
a
co
m
p
r
eh
en
s
iv
e
v
iew
o
f
th
e
m
o
d
el'
s
p
r
ed
ictiv
e
ab
ilit
y
.
I
t c
an
b
e
ca
lcu
lated
u
s
i
n
g
(
2
)
.
=
+
+
+
+
(
2
)
T
h
e
s
en
s
itiv
ity
o
f
a
d
iag
n
o
s
tic
test
r
ep
r
esen
ts
it
s
ab
ilit
y
to
ad
eq
u
ately
d
etec
t p
o
s
itiv
e
ca
s
es with
in
th
e
to
tal
n
u
m
b
e
r
o
f
tr
u
e
p
o
s
itiv
e
c
ases
.
A
h
ig
h
s
en
s
itiv
ity
in
d
icate
s
th
at
th
e
test
h
as
a
l
o
wer
te
n
d
en
cy
to
g
en
er
ate
f
alse
n
eg
ativ
es,
th
u
s
in
cr
ea
s
in
g
its
r
eliab
ilit
y
.
Sen
s
itiv
ity
,
b
y
f
o
cu
s
in
g
o
n
th
e
d
etec
tio
n
o
f
tr
u
e
p
o
s
itiv
e
ca
s
es,
is
cr
itical
in
ev
alu
atin
g
th
e
ef
f
ec
tiv
en
ess
o
f
a
m
o
d
el.
I
t c
an
b
e
ca
lcu
lated
u
s
in
g
(
3
)
.
=
+
(
3
)
T
h
e
Sp
ec
if
icity
o
f
a
d
iag
n
o
s
tic
test
r
ep
r
esen
ts
i
ts
ab
ili
ty
to
ad
eq
u
ately
d
etec
t
n
eg
ativ
e
ca
s
es
wi
th
in
th
e
to
tal
n
u
m
b
e
r
o
f
tr
u
e
n
e
g
ativ
e
ca
s
es.
Hig
h
s
p
ec
if
icity
s
u
g
g
ests
th
at
th
e
test
h
as
a
l
o
wer
p
r
o
p
en
s
ity
to
g
en
er
ate
f
alse
p
o
s
itiv
es,
th
at
is
,
to
m
i
s
clas
s
if
y
n
eg
ativ
e
ca
s
es
a
s
p
o
s
itiv
e.
B
y
f
o
cu
s
in
g
o
n
th
e
ac
cu
r
ate
id
en
tific
atio
n
o
f
n
eg
ativ
e
ca
s
es,
s
p
ec
if
icity
p
lay
s
a
cr
itical
r
o
le
in
ev
alu
atin
g
th
e
r
eliab
ilit
y
o
f
a
m
o
d
el.
I
t
ca
n
b
e
ca
lcu
lated
u
s
in
g
(
4
)
.
=
+
(
4
)
4.
RE
SU
L
T
S
4
.
1
.
Dev
elo
ped we
b e
x
pert
s
y
s
t
em
Fig
u
r
es
3
a
n
d
4
d
e
m
o
n
s
tr
ate
t
h
e
ad
ap
ta
b
ilit
y
o
f
th
e
d
ev
elo
p
ed
web
-
b
ased
ex
p
er
t
s
y
s
tem
f
o
r
m
o
b
ile
d
ev
ices,
d
esig
n
ed
to
d
iag
n
o
s
e
th
r
ee
s
p
ec
if
ic
r
esp
ir
ato
r
y
d
is
ea
s
es:
in
f
lu
en
za
,
asth
m
a,
an
d
p
n
e
u
m
o
n
ia.
Fig
u
r
e
3
(
a
)
s
h
o
ws
th
e
in
itial
in
ter
f
ac
e
o
f
th
e
s
y
s
tem
,
welc
o
m
in
g
th
e
u
s
er
a
n
d
p
r
o
v
id
in
g
a
b
r
ief
d
escr
ip
tio
n
o
f
th
e
ex
p
er
t
s
y
s
tem
'
s
f
u
n
ctio
n
ality
.
I
t
also
f
ea
tu
r
es
a
b
u
tto
n
th
at
lets
th
e
u
s
er
s
tar
t
th
e
d
iag
n
o
s
tic
p
r
o
ce
s
s
,
m
ak
in
g
it
ea
s
y
to
ass
es
s
th
eir
h
ea
lth
s
tatu
s
.
Fig
u
r
e
3
(
b
)
s
h
o
ws
th
e
d
iag
n
o
s
tic
q
u
er
y
p
r
o
ce
s
s
in
d
etail.
E
ac
h
q
u
esti
o
n
h
as
two
r
esp
o
n
s
e
o
p
tio
n
s
:
"Ye
s
"
an
d
"No
.
"
User
s
s
h
o
u
ld
s
elec
t
"y
es"
if
th
ey
ar
e
ex
p
er
ien
cin
g
th
e
s
y
m
p
to
m
m
e
n
tio
n
ed
i
n
th
e
q
u
esti
o
n
an
d
"n
o
"
o
th
er
wis
e.
I
t
is
im
p
o
r
tan
t
t
o
n
o
te
th
at
th
e
q
u
esti
o
n
s
ar
e
p
r
esen
ted
a
u
to
m
atica
lly
as
th
e
u
s
er
an
s
wer
s
o
r
s
elec
ts
an
o
p
tio
n
.
T
h
is
i
n
ter
ac
tiv
e
a
p
p
r
o
ac
h
allo
ws
f
o
r
a
f
lu
i
d
an
d
d
y
n
am
ic
u
s
er
ex
p
er
ien
c
e.
As
th
e
u
s
er
p
r
o
g
r
ess
es
b
y
an
s
wer
in
g
t
h
e
q
u
esti
o
n
s
,
th
e
s
y
s
tem
m
ak
es
in
f
er
en
ce
s
b
ased
o
n
th
e
a
n
s
wer
s
p
r
o
v
i
d
ed
a
n
d
f
in
ally
d
is
p
lay
s
th
e
f
in
al
d
iag
n
o
s
is
r
esu
lt.
T
h
is
web
-
e
x
p
er
t
s
y
s
tem
-
b
ased
ap
p
r
o
ac
h
n
o
t
o
n
ly
f
ac
ilit
ates
th
e
d
iag
n
o
s
is
p
r
o
ce
s
s
f
o
r
th
e
u
s
er
b
u
t
also
p
r
o
v
id
es
a
n
ef
f
ec
tiv
e
to
o
l f
o
r
ea
r
ly
d
etec
tio
n
an
d
m
an
ag
em
en
t
o
f
r
esp
ir
ato
r
y
d
is
e
ases
.
Fig
u
r
e
4
(
a
)
s
h
o
ws
th
e
r
esu
lt
o
f
th
e
d
iag
n
o
s
is
,
wh
ich
is
d
eter
m
in
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ter
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licatio
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ef
f
ec
ti
v
ely
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On
th
e
o
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er
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an
d
,
Fig
u
r
e
4
(
b
)
s
h
o
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wh
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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I
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Mo
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in
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en
tifie
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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&
C
o
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p
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I
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8
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p
ir
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to
r
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s
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tive
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A
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6607
4
.
2
.
Usa
bil
it
y
ev
a
lua
t
io
n
A
to
tal
o
f
1
5
u
s
er
s
p
ar
ticip
ate
d
in
t
h
e
u
s
ab
ilit
y
e
v
alu
atio
n
s
tu
d
y
.
T
h
e
s
elec
tio
n
o
f
th
ese
p
ar
ticip
an
ts
was
d
o
n
e
th
r
o
u
g
h
co
n
v
en
ie
n
c
e
s
am
p
lin
g
,
wh
ic
h
m
ea
n
s
t
h
at
th
o
s
e
in
d
iv
i
d
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als
wh
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r
e
e
asil
y
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d
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g
to
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th
e
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ased
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s
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d
av
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iter
ia.
T
h
e
u
s
er
s
ev
alu
ated
th
e
u
s
ab
ilit
y
o
f
th
e
s
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s
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th
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g
h
a
s
p
ec
ially
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li
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wh
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n
s
is
ted
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f
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0
SUS q
u
esti
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n
s
,
as sh
o
wn
in
T
ab
le
1
.
T
ab
le
2
s
h
o
ws
th
e
r
esu
lts
o
b
tain
ed
u
s
in
g
th
e
SUS
m
eth
o
d
.
T
h
ese
r
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lts
p
r
o
v
id
e
an
in
s
ig
h
t
in
to
th
e
u
s
er
ex
p
er
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ce
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en
in
ter
ac
t
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g
with
th
is
d
ig
ital
to
o
l.
T
h
e
s
co
r
es
o
b
tain
ed
,
wh
ich
r
an
g
e
f
r
o
m
7
7
.
5
to
8
7
.
5
,
r
ef
lect
a
g
en
er
ally
p
o
s
itiv
e
tr
en
d
in
th
e
ea
s
e
o
f
u
s
e
p
er
ce
iv
ed
b
y
th
e
u
s
er
s
.
T
h
is
co
n
s
is
ten
cy
in
th
e
s
co
r
es
s
u
g
g
ests
a
co
n
s
is
ten
cy
in
t
h
e
p
er
ce
p
tio
n
o
f
th
e
u
s
ef
u
l
n
ess
an
d
e
f
f
ec
tiv
en
ess
o
f
th
e
s
y
s
tem
,
in
d
icatin
g
a
s
o
lid
an
d
f
u
n
ctio
n
al
d
esig
n
.
I
t
is
also
im
p
o
r
tan
t
t
o
n
o
te
th
at
th
e
a
v
er
ag
e
SUS
s
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e
o
b
tai
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ed
w
as
8
2
.
Acc
o
r
d
in
g
to
th
e
cu
r
v
ed
g
r
ad
in
g
s
ca
le
f
o
r
th
e
SUS
[
3
6
]
,
th
is
av
er
ag
e
s
co
r
e
p
lace
s
th
e
s
y
s
tem
in
Gr
ad
e
A,
with
in
th
e
9
0
% to
9
5
% p
er
ce
n
tile r
an
g
e.
T
h
is
r
esu
lt f
u
r
th
er
co
n
f
ir
m
s
th
e
h
ig
h
u
s
ab
ilit
y
p
er
ce
iv
ed
b
y
u
s
er
s
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d
p
lace
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th
e
s
y
s
tem
in
a
ca
teg
o
r
y
o
f
ex
ce
llen
ce
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ter
m
s
o
f
ea
s
e
o
f
u
s
e.
L
ik
ewi
s
e,
th
is
en
co
u
r
ag
in
g
r
esu
lt
n
o
t
o
n
ly
v
alid
ates
th
e
ef
f
ec
tiv
en
ess
o
f
th
e
cu
r
r
e
n
t
s
y
s
tem
b
u
t
also
s
er
v
es
as
a
f
u
n
d
am
en
tal
s
tar
tin
g
p
o
in
t
f
o
r
f
u
tu
r
e
iter
ativ
e
im
p
r
o
v
em
e
n
ts
.
I
t
also
h
i
g
h
lig
h
ts
th
e
im
p
o
r
tan
ce
o
f
a
co
n
tin
u
o
u
s
f
ee
d
b
ac
k
a
n
d
d
esig
n
r
ef
in
em
en
t
s
tr
ateg
y
f
o
cu
s
ed
o
n
en
s
u
r
i
n
g
a
n
o
p
ti
m
al
an
d
s
atis
f
y
in
g
u
s
er
ex
p
e
r
ien
ce
at
all
s
tag
es
o
f
in
ter
ac
tio
n
with
th
e
ex
p
er
t
s
y
s
tem
,
wh
ich
is
cr
u
cial
f
o
r
its
co
n
tin
u
e
d
s
u
cc
ess
an
d
ab
ilit
y
to
ef
f
ec
tiv
ely
m
ee
t
u
s
er
n
ee
d
s
.
T
ab
le
2
.
R
esu
lt o
f
th
e
u
s
ab
ilit
y
ev
alu
atio
n
with
th
e
SUS
U
ser
Q1
Q2
Q3
Q4
Q5
Q6
Q7
Q8
Q9
Q
1
0
S
U
S
S
c
o
r
e
U
ser 1
3
2
4
1
4
2
4
1
4
1
80
U
ser 2
4
1
4
2
4
2
5
2
4
2
80
U
ser 3
4
2
4
1
4
2
4
2
4
2
7
7
.
5
U
ser 4
4
1
5
1
4
2
4
1
4
1
8
7
.
5
U
ser 5
4
2
4
2
4
1
4
2
4
1
80
U
ser 6
4
2
5
2
4
2
4
2
4
2
7
7
.
5
U
ser 7
4
2
4
1
4
2
5
2
4
1
8
2
.
5
U
ser 8
4
1
4
2
4
2
4
1
4
1
8
2
.
5
U
ser 9
4
2
5
2
4
1
4
2
4
2
80
U
ser 1
0
3
1
4
1
4
2
5
1
4
1
85
U
ser 1
1
4
1
4
1
4
2
4
1
4
1
85
U
ser 1
2
3
1
5
1
4
2
4
1
4
1
85
U
ser 1
3
4
2
4
1
4
2
4
1
4
1
8
2
.
5
U
ser 1
4
4
2
5
1
4
2
5
1
4
1
8
7
.
5
U
ser 1
5
4
1
4
2
4
2
4
1
4
2
80
4
.
3
.
Sy
s
t
e
m
perf
o
r
m
a
nce
ev
a
lua
t
io
n
Fig
u
r
e
5
(
a
)
s
h
o
ws
th
e
v
ar
ia
b
le
ab
ilit
y
o
f
th
e
s
y
s
tem
to
d
is
cr
im
in
ate
b
etwe
en
p
o
s
itiv
e
an
d
n
eg
ativ
e
ca
s
es
th
r
o
u
g
h
an
ev
alu
atio
n
with
a
s
et
o
f
2
1
ca
r
ef
u
lly
d
esig
n
ed
s
im
u
lated
ca
s
es
(
1
5
p
o
s
itiv
e
an
d
6
n
e
g
ativ
e)
,
co
r
r
ec
tly
id
e
n
tify
in
g
1
2
p
o
s
iti
v
e
an
d
4
n
eg
ativ
e
ca
s
es.
T
h
is
r
esu
lt
s
u
g
g
ests
a
p
r
o
m
is
in
g
a
b
ilit
y
f
o
r
th
e
ea
r
ly
d
etec
tio
n
o
f
r
esp
ir
ato
r
y
d
is
ea
s
es
s
u
ch
as
in
f
lu
e
n
za
,
asth
m
a,
an
d
p
n
eu
m
o
n
ia,
wh
ich
co
u
ld
h
a
v
e
s
ig
n
if
ican
t
im
p
licatio
n
s
f
o
r
clin
ical
m
an
ag
em
en
t
an
d
tr
ea
tm
e
n
t.
Ho
w
ev
er
,
th
e
p
r
esen
ce
o
f
2
ca
s
e
s
m
is
class
if
ied
as
p
o
s
itiv
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3
ca
s
es
m
is
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if
ied
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n
eg
ativ
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in
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icate
s
th
e
ex
is
ten
ce
o
f
ch
allen
g
es
in
th
e
s
p
ec
if
icity
an
d
s
en
s
itiv
ity
o
f
th
e
s
y
s
tem
.
Fu
r
th
er
m
o
r
e
,
th
e
a
n
aly
s
is
o
f
t
h
e
s
y
s
tem
p
er
f
o
r
m
an
ce
p
ar
am
eter
s
p
r
o
v
id
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a
co
m
p
lete
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ictu
r
e
o
f
its
ef
f
ec
tiv
en
ess
an
d
ac
cu
r
ac
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n
id
en
tify
in
g
p
o
s
itiv
e
an
d
n
eg
ativ
e
ca
s
es.
As
Fig
u
r
e
5
(
b
)
d
em
o
n
s
tr
ates,
th
e
p
r
ec
is
io
n
o
f
8
6
%
r
ep
r
esen
ts
th
e
f
r
ac
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o
f
p
o
s
itiv
e
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es
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r
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tly
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d
en
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b
y
th
e
s
y
s
tem
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in
d
icatin
g
a
r
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ar
k
ab
le
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to
m
in
im
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alse
p
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d
,
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r
e,
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ea
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ce
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e
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es
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s
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e
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.
T
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ac
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6
%
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b
r
o
a
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ce
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h
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d
th
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s
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lects
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r
r
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tly
class
if
y
th
e
m
ajo
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ity
o
f
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en
s
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f
8
0
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ig
h
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ts
th
e
s
y
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'
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to
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etec
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th
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p
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esen
ce
o
f
r
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th
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o
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u
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u
g
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f
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ess
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id
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tify
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o
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s
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On
th
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h
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d
,
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e
s
p
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icity
o
f
6
7
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th
e
p
r
o
p
o
r
tio
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o
f
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ativ
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es
co
r
r
ec
tly
class
if
ied
b
y
th
e
s
y
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tem
,
in
d
icatin
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ce
r
tain
ten
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en
c
y
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al
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e
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o
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T
h
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lts
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o
b
tain
ed
th
r
o
u
g
h
a
r
i
g
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r
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s
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aly
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is
o
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th
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n
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u
s
io
n
m
atr
ix
,
p
r
o
v
id
e
a
d
etaile
d
ev
alu
atio
n
o
f
th
e
p
er
f
o
r
m
an
ce
o
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th
e
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y
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tem
an
d
p
r
o
v
id
e
g
u
id
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ce
f
o
r
f
u
tu
r
e
im
p
r
o
v
em
e
n
ts
an
d
ad
a
p
tatio
n
s
th
at
co
u
ld
in
c
r
ea
s
e
its
clin
ical
u
tili
ty
an
d
im
p
ac
t o
n
m
ed
ical
p
r
ac
tice.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
0
8
8
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8
I
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t J E
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C
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p
E
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g
,
Vo
l.
14
,
No
.
6
,
Dec
em
b
e
r
20
24
:
6
6
0
0
-
6
6
1
1
6608
(
a)
(
b
)
Fig
u
r
e
5
.
R
esu
lt o
f
p
e
r
f
o
r
m
an
ce
p
ar
am
eter
s
o
f
th
e
ex
p
er
t sy
s
tem
in
th
e
p
r
elim
in
ar
y
d
iag
n
o
s
is
o
f
r
esp
ir
ato
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(
a)
co
n
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u
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io
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m
atr
i
x
o
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e
2
1
ca
s
es e
v
alu
ated
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d
(
b
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p
er
f
o
r
m
an
ce
m
etr
ics
5.
DIS
CU
SS
I
O
N
T
h
e
ex
p
er
t
s
y
s
tem
p
r
esen
ted
in
th
is
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tu
d
y
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d
esig
n
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f
o
r
t
h
e
p
r
elim
in
a
r
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iag
n
o
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is
o
f
r
esp
ir
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d
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s
u
ch
as
in
f
lu
en
za
,
asth
m
a,
an
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p
n
eu
m
o
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ia,
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em
o
n
s
tr
ates
a
g
o
o
d
ab
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class
if
y
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o
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itiv
e
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d
n
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ativ
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ca
s
es,
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h
ig
h
lev
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o
f
ac
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r
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as
ev
id
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ce
d
in
Fig
u
r
e
5
.
Fu
r
th
er
m
o
r
e,
Fig
u
r
es
3
an
d
4
s
h
o
w
a
m
o
b
ile
-
f
r
ien
d
ly
d
esig
n
th
at
im
p
r
o
v
es
ac
ce
s
s
ib
ilit
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f
o
r
u
s
er
s
.
T
h
ese
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en
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h
ig
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lig
h
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f
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o
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r
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ile
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ly
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p
latf
o
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m
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r
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m
o
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e
,
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e
u
s
ab
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ev
a
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s
in
g
th
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SUS
m
eth
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d
y
ield
ed
an
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e
s
co
r
e
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f
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2
,
s
u
g
g
esti
n
g
t
h
at
th
e
s
y
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tem
is
p
er
ce
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ed
as in
tu
itiv
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an
d
ea
s
y
to
u
s
e,
in
cr
ea
s
in
g
its
p
o
ten
tial c
lin
ical
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tili
ty
.
W
h
en
co
m
p
ar
in
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o
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r
r
esu
lts
with
th
o
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e
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f
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tu
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ies,
s
ig
n
if
ican
t
d
if
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er
en
ce
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ar
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er
v
ed
.
Fo
r
ex
am
p
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t
h
e
f
u
zz
y
ex
p
e
r
t
s
y
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tem
o
f
Ar
an
i
et
a
l.
[
2
7
]
s
h
o
w
ed
a
s
en
s
itiv
ity
o
f
9
7
%,
a
s
p
e
cif
icity
o
f
8
5
%,
an
d
an
ac
cu
r
ac
y
o
f
9
3
%
in
th
e
d
ia
g
n
o
s
is
o
f
p
n
eu
m
o
n
ia.
Alth
o
u
g
h
th
ese
r
esu
lts
ar
e
s
u
p
e
r
io
r
to
o
u
r
s
,
it
is
im
p
o
r
tan
t
to
em
p
h
asize
th
at
o
u
r
s
y
s
tem
d
em
o
n
s
tr
ates
co
m
p
etitiv
e
p
r
ec
is
io
n
,
co
v
er
s
a
b
r
o
a
d
er
s
p
e
ctr
u
m
o
f
r
esp
ir
ato
r
y
d
is
ea
s
es,
an
d
is
ch
ar
ac
ter
ized
b
y
its
ab
ilit
y
to
ad
ap
t
to
m
o
b
ile
d
ev
ices,
wh
ich
im
p
r
o
v
es
its
ac
ce
s
s
ib
ilit
y
an
d
p
r
ac
tical
u
tili
ty
.
Fu
r
th
er
m
o
r
e,
th
e
s
m
ar
tp
h
o
n
e
-
b
ased
d
iag
n
o
s
tic
alg
o
r
ith
m
d
ev
elo
p
e
d
b
y
Po
r
ter
et
a
l.
[
4
]
s
h
o
wed
a
s
en
s
itiv
ity
o
f
6
3
.
7
%
in
th
e
id
en
tific
atio
n
o
f
asth
m
a
ex
ac
er
b
atio
n
s
,
h
ig
h
lig
h
tin
g
t
h
e
ef
f
ec
tiv
en
ess
o
f
tech
n
o
lo
g
ical
ap
p
r
o
ac
h
es
f
o
r
th
e
r
ap
id
d
etec
tio
n
o
f
s
p
ec
i
f
ic
co
n
d
itio
n
s
.
I
n
th
e
s
am
e
v
ein
,
th
e
au
to
m
ate
d
telem
ed
icin
e
s
y
s
tem
b
y
Gu
r
b
eta
et
a
l.
[
2
8
]
ac
h
iev
ed
an
ac
cu
r
ac
y
o
f
9
7
.
3
2
%
in
th
e
d
iag
n
o
s
is
o
f
asth
m
a
an
d
C
OPD,
h
ig
h
lig
h
tin
g
th
e
im
p
o
r
tan
ce
o
f
tec
h
n
o
lo
g
ical
s
o
lu
tio
n
s
to
im
p
r
o
v
e
ac
ce
s
s
to
h
ea
lth
ca
r
e.
Ho
wev
e
r
,
th
e
n
o
v
elty
o
f
o
u
r
s
y
s
tem
lies
in
its
co
m
p
r
eh
en
s
iv
e
a
p
p
r
o
ac
h
an
d
ad
a
p
tab
ilit
y
.
Un
lik
e
p
r
ev
io
u
s
s
tu
d
ies
th
at
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J E
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&
C
o
m
p
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g
I
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N:
2088
-
8
7
0
8
P
r
elimin
a
r
y
d
ia
g
n
o
s
is
o
f res
p
ir
a
to
r
y
d
is
ea
s
es:
a
n
in
n
o
v
a
tive
a
p
p
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a
c
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…
(
La
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eria
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o
A
n
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A
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en
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6609
f
o
cu
s
ed
o
n
o
n
e
o
r
two
s
p
ec
if
ic
d
is
ea
s
es,
o
u
r
s
y
s
tem
co
v
er
s
th
r
ee
r
esp
ir
ato
r
y
d
is
ea
s
es.
No
n
eth
eless
,
a
s
ig
n
if
ican
t
lim
itatio
n
o
f
o
u
r
s
tu
d
y
lies
in
t
h
e
u
tili
za
tio
n
o
f
s
im
u
lated
ca
s
es
r
ath
e
r
th
a
n
r
ea
l
clin
ical
d
ata,
p
o
ten
tially
im
p
ac
tin
g
t
h
e
g
e
n
er
aliza
b
ilit
y
o
f
th
e
f
i
n
d
in
g
s
to
r
ea
l
-
wo
r
ld
clin
ical
s
ce
n
a
r
io
s
.
Ho
wev
er
,
th
e
s
y
s
tem
d
ev
elo
p
e
d
with
a
d
ec
is
io
n
tr
ee
a
p
p
r
o
ac
h
a
n
d
its
a
d
ap
tab
ilit
y
to
m
o
b
ile
d
e
v
ices
co
u
ld
b
r
o
ad
e
n
th
e
to
o
l'
s
s
co
p
e
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d
ac
ce
s
s
ib
ilit
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f
o
r
p
r
elim
in
ar
y
d
iag
n
o
s
is
,
p
ar
ticu
lar
ly
in
p
o
p
u
latio
n
s
f
ac
i
n
g
g
eo
g
r
ap
h
ical
o
r
in
f
r
astru
ctu
r
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co
n
s
tr
ain
ts
.
T
h
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
co
n
tr
ib
u
te
to
th
e
ex
is
tin
g
k
n
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wl
ed
g
e
b
y
d
em
o
n
s
tr
atin
g
th
at
a
web
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ased
ex
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t sy
s
tem
ca
n
b
e
ef
f
ec
tiv
e
f
o
r
th
e
p
r
elim
i
n
ar
y
d
ia
g
n
o
s
is
o
f
r
esp
ir
ato
r
y
d
is
ea
s
es,
with
a
g
o
o
d
p
er
ce
p
tio
n
o
f
u
s
ab
ilit
y
b
y
u
s
er
s
.
T
h
is
ex
te
n
d
s
p
r
e
v
io
u
s
k
n
o
wled
g
e
b
y
i
n
clu
d
in
g
th
e
a
b
ilit
y
to
a
d
ap
t
to
m
o
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ile
d
e
v
ices,
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ich
n
o
t
o
n
ly
im
p
r
o
v
es
ac
ce
s
s
ib
ilit
y
b
u
t
also
co
n
v
en
ien
ce
f
o
r
en
d
-
u
s
er
s
.
Alth
o
u
g
h
o
u
r
r
esu
lts
d
o
n
o
t
r
ea
c
h
th
e
ac
cu
r
ac
y
an
d
s
en
s
itiv
ity
f
ig
u
r
es
o
f
s
o
m
e
p
r
ev
io
u
s
s
tu
d
ies,
th
e
ac
cu
r
ac
y
o
f
th
e
d
e
v
elo
p
ed
s
y
s
tem
is
s
ig
n
if
ican
t.
Fu
r
th
er
m
o
r
e,
th
e
in
clu
s
io
n
o
f
a
wid
er
r
an
g
e
o
f
d
is
ea
s
es
an
d
th
e
ad
ap
tab
ilit
y
to
d
if
f
er
en
t
p
latf
o
r
m
s
ar
e
im
p
o
r
tan
t
a
d
v
an
tag
es.
T
h
is
s
tu
d
y
h
i
g
h
lig
h
ts
th
e
im
p
o
r
tan
ce
o
f
tech
n
o
l
o
g
ical
s
o
lu
tio
n
s
in
m
e
d
ical
d
iag
n
o
s
is
an
d
th
eir
p
o
ten
tial t
o
im
p
r
o
v
e
ac
ce
s
s
to
an
d
q
u
alit
y
o
f
h
ea
lth
ca
r
e.
T
h
e
m
ain
p
u
r
p
o
s
e
o
f
th
is
s
tu
d
y
was
to
d
ev
elo
p
an
d
ev
alu
ate
a
web
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b
ased
ex
p
er
t
s
y
s
tem
f
o
r
th
e
p
r
elim
in
ar
y
d
iag
n
o
s
is
o
f
r
esp
ir
ato
r
y
d
is
ea
s
es,
with
a
f
o
cu
s
o
n
ad
ap
tab
ilit
y
to
m
o
b
ile
d
ev
ices
to
im
p
r
o
v
e
ac
ce
s
s
ib
ilit
y
.
T
h
e
r
esu
lts
ar
e
p
r
o
m
is
in
g
an
d
s
u
g
g
est
th
at
th
e
s
y
s
tem
co
u
ld
b
e
a
u
s
ef
u
l
to
o
l
in
clin
ical
p
r
ac
tice.
Nev
er
th
eless
,
f
u
r
th
er
r
esear
ch
u
s
in
g
r
ea
l
clin
ical
d
ata
is
cr
u
cial
to
v
alid
ate
its
p
er
f
o
r
m
an
c
e
in
clin
ical
s
ettin
g
s
an
d
im
p
r
o
v
e
its
d
iag
n
o
s
tic
ca
p
ab
ilit
ies.
Un
an
s
wer
ed
q
u
esti
o
n
s
ab
o
u
t
its
ef
f
ec
tiv
en
ess
u
n
d
er
r
ea
l
-
wo
r
ld
co
n
d
itio
n
s
s
h
o
u
ld
b
e
ad
d
r
ess
ed
in
f
u
t
u
r
e
s
tu
d
ies
to
e
n
s
u
r
e
th
e
r
eliab
ilit
y
an
d
ac
c
u
r
ac
y
o
f
th
e
s
y
s
tem
in
ev
er
y
d
a
y
clin
ical
p
r
ac
tice.
E
v
alu
atin
g
th
ese
f
ac
to
r
s
will
n
o
t
o
n
ly
allo
w
th
e
to
o
l
to
b
e
im
p
r
o
v
ed
b
u
t
will
also
co
n
tr
ib
u
te
to
th
e
ef
f
e
ctiv
e
in
te
g
r
atio
n
o
f
n
ew
tech
n
o
lo
g
ies in
to
r
o
u
tin
e
h
ea
lth
ca
r
e.
6.
CO
NCLU
SI
O
N
T
h
e
p
r
esen
t
s
tu
d
y
s
u
cc
ee
d
ed
i
n
d
ev
elo
p
i
n
g
a
web
-
b
ased
e
x
p
er
t
s
y
s
tem
ad
ap
tab
le
to
m
o
b
i
le
d
ev
ices
f
o
r
th
e
p
r
elim
in
ar
y
d
ia
g
n
o
s
is
o
f
r
esp
ir
ato
r
y
d
is
ea
s
es
s
u
ch
as
in
f
lu
en
za
,
asth
m
a,
an
d
p
n
e
u
m
o
n
ia,
ev
alu
atin
g
its
u
s
ab
ilit
y
an
d
d
iag
n
o
s
tic
ef
f
ici
en
cy
.
Usi
n
g
a
m
eth
o
d
o
l
o
g
ical
ap
p
r
o
ac
h
th
at
co
m
b
in
ed
th
e
d
ev
elo
p
m
e
n
t
o
f
th
e
s
y
s
tem
u
s
in
g
th
e
R
AD
m
o
d
el,
a
d
ec
is
io
n
t
r
ee
,
an
d
its
ev
alu
atio
n
th
r
o
u
g
h
a
SUS
q
u
esti
o
n
n
air
e
an
d
s
im
u
lated
ca
s
es,
we
o
b
tain
ed
s
ig
n
if
ican
t r
esu
lts
th
at
h
ig
h
lig
h
t th
e
ca
p
ac
ity
an
d
p
o
ten
tial o
f
th
is
to
o
l.
T
h
e
s
y
s
tem
s
h
o
wed
s
ig
n
if
ican
t
ac
cu
r
ac
y
,
in
d
icati
n
g
a
co
n
s
id
er
ab
le
a
b
ilit
y
to
d
iag
n
o
s
e
a
n
d
d
if
f
e
r
en
tiate
b
e
twee
n
th
e
a
n
aly
ze
d
r
esp
ir
ato
r
y
d
is
ea
s
es.
T
h
e
u
s
ab
ilit
y
ev
alu
atio
n
,
with
an
a
v
er
a
g
e
s
co
r
e
o
f
8
2
in
th
e
SUS
m
e
th
o
d
,
s
u
g
g
ests
th
at
u
s
er
s
p
er
ce
iv
e
th
e
s
y
s
tem
as
i
n
tu
itiv
e
an
d
ea
s
y
to
u
s
e.
T
h
es
e
r
esu
lts
ar
e
im
p
o
r
tan
t
b
ec
au
s
e
th
ey
h
ig
h
lig
h
t
th
e
p
o
ten
tial
o
f
th
e
s
y
s
tem
as
a
v
iab
le
o
p
tio
n
f
o
r
th
e
p
r
elim
in
ar
y
d
iag
n
o
s
is
o
f
r
esp
ir
ato
r
y
d
is
e
ases
in
clin
ical
an
d
co
m
m
u
n
ity
s
ettin
g
s
.
Fu
r
th
e
r
m
o
r
e,
t
h
e
r
esu
lts
o
f
t
h
e
s
tu
d
y
p
r
o
v
id
e
ev
id
e
n
ce
t
h
at
web
-
b
ased
an
d
m
o
b
ile
-
ad
ap
tiv
e
ex
p
e
r
t
s
y
s
tem
s
ca
n
b
e
ef
f
ec
tiv
e
f
o
r
th
e
p
r
elim
i
n
a
r
y
d
iag
n
o
s
is
o
f
r
esp
ir
ato
r
y
d
i
s
ea
s
es,
wh
ich
co
u
ld
tr
an
s
f
o
r
m
clin
ical
p
r
ac
tice
b
y
p
r
o
v
id
in
g
ac
ce
s
s
ib
le
a
n
d
ea
s
y
-
to
-
u
s
e
to
o
ls
f
o
r
h
ea
lth
c
ar
e
p
r
o
f
ess
io
n
als,
esp
ec
ially
p
atien
ts
.
T
h
is
a
d
v
a
n
ce
m
en
t
n
o
t
o
n
ly
im
p
r
o
v
es
a
cc
ess
to
ac
cu
r
ate
p
r
elim
in
ar
y
d
iag
n
o
s
es
b
u
t
also
h
as
th
e
p
o
ten
tial
to
o
p
tim
ize
h
ea
lth
ca
r
e
r
eso
u
r
ce
s
b
y
f
ac
ilit
atin
g
ea
r
ly
an
d
tim
ely
d
etec
tio
n
o
f
th
ese
d
is
ea
s
es.
T
o
ex
p
a
n
d
th
e
im
p
ac
t
o
f
o
u
r
f
in
d
in
g
s
,
it
is
ess
en
tial
to
co
n
d
u
ct
ad
d
itio
n
al
s
tu
d
ies
th
at
v
a
lid
ate
th
e
s
y
s
tem
's
p
er
f
o
r
m
an
ce
in
r
ea
l
-
wo
r
ld
cli
n
ical
s
ettin
g
s
u
s
in
g
r
ea
l
clin
ical
d
ata.
T
h
e
in
teg
r
atio
n
o
f
a
d
v
an
ce
d
d
iag
n
o
s
tic
tech
n
iq
u
es,
s
u
c
h
as
m
ac
h
in
e
lear
n
in
g
an
d
ar
tific
ial
i
n
tellig
en
ce
,
c
o
u
ld
f
u
r
th
er
im
p
r
o
v
e
th
e
ac
c
u
r
ac
y
an
d
r
eliab
ilit
y
o
f
th
e
s
y
s
tem
.
Fu
r
th
er
m
o
r
e
,
alth
o
u
g
h
o
u
r
r
esu
lts
ar
e
p
r
o
m
is
in
g
,
q
u
esti
o
n
s
r
em
ain
ab
o
u
t
th
e
s
y
s
tem
'
s
ef
f
ec
tiv
en
ess
in
r
ea
l
-
wo
r
ld
c
o
n
d
itio
n
s
,
s
u
ch
as
its
b
eh
av
io
r
in
th
e
f
ac
e
o
f
t
h
e
v
a
r
iab
ilit
y
an
d
co
m
p
lex
ity
o
f
r
ea
l
clin
ical
ca
s
es
an
d
its
im
p
ac
t
o
n
clin
ica
l
d
ec
is
io
n
-
m
ak
in
g
an
d
p
atien
t
h
ea
lth
o
u
tco
m
es.
Ad
d
r
ess
in
g
th
ese
q
u
esti
o
n
s
w
ill
r
eq
u
ir
e
f
u
t
u
r
e
r
esear
ch
to
ass
es
s
th
e
im
p
ac
t
o
f
th
e
s
y
s
te
m
in
d
aily
clin
ical
p
r
ac
tice.
RE
F
E
R
E
NC
E
S
[
1
]
M
.
A
,
N
.
K
.
V
,
a
n
d
P
.
S
.
Y
,
“
R
e
s
p
i
r
a
t
o
r
y
d
i
s
e
a
s
e
s
d
e
t
e
c
t
i
o
n
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s
i
n
g
d
e
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p
l
e
a
r
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i
n
g
me
t
h
o
d
s,
”
i
n
2
0
2
3
S
e
c
o
n
d
I
n
t
e
r
n
a
t
i
o
n
a
l
C
o
n
f
e
re
n
c
e
o
n
T
re
n
d
s
i
n
E
l
e
c
t
ri
c
a
l
,
E
l
e
c
t
r
o
n
i
c
s,
a
n
d
C
o
m
p
u
t
e
r
E
n
g
i
n
e
e
ri
n
g
(
T
EE
C
C
O
N
)
,
A
u
g
.
2
0
2
3
,
p
p
.
1
1
7
–
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2
1
,
d
o
i
:
1
0
.
1
1
0
9
/
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EC
C
O
N
5
9
2
3
4
.
2
0
2
3
.
1
0
3
3
5
8
8
7
.
[
2
]
R
.
R
a
c
h
m
a
n
,
S
.
A
r
may
a
n
t
i
,
a
n
d
T
.
K
u
sn
a
n
d
a
r
,
“
W
e
b
-
b
a
s
e
d
e
x
p
e
r
t
s
y
s
t
e
m
f
o
r
r
e
s
p
i
r
a
t
o
r
y
d
i
so
r
d
e
r
s
i
n
h
u
m
a
n
u
si
n
g
b
a
c
k
w
a
r
d
c
h
a
i
n
i
n
g
me
t
h
o
d
,
”
I
n
f
o
rm
a
t
i
c
s
M
a
n
a
g
e
m
e
n
t
,
E
n
g
i
n
e
e
r
i
n
g
a
n
d
I
n
f
o
rm
a
t
i
o
n
S
y
st
e
m
J
o
u
r
n
a
l
,
v
o
l
.
1
,
n
o
.
1
,
p
p
.
3
5
–
3
8
,
Ju
l
.
2
0
2
3
,
d
o
i
:
1
0
.
5
6
4
4
7
/
i
me
i
sj
.
v
1
i
1
.
2
1
4
.
[
3
]
D
.
C
.
C
.
C
a
n
a
r
i
,
A
.
V
.
G
.
O
b
i
s
p
o
,
J.
L
.
H
.
S
a
l
a
z
a
r
,
L
.
A
n
d
r
a
d
e
-
A
r
e
n
a
s
,
a
n
d
M
.
C
a
b
a
n
i
l
l
a
s
-
C
a
r
b
o
n
e
l
l
,
“
M
o
b
i
l
e
a
p
p
d
e
si
g
n
:
l
o
g
g
i
n
g
a
n
d
d
i
a
g
n
o
st
i
c
s
o
f
r
e
s
p
i
r
a
t
o
r
y
d
i
se
a
s
e
s,”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
rn
a
l
o
f
Ad
v
a
n
c
e
d
C
o
m
p
u
t
e
r
S
c
i
e
n
c
e
a
n
d
A
p
p
l
i
c
a
t
i
o
n
s
,
v
o
l
.
1
3
,
n
o
.
8
,
p
p
.
4
5
1
–
4
5
9
,
F
e
b
.
2
0
2
2
,
d
o
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:
1
0
.
1
4
5
6
9
/
I
JA
C
S
A
.
2
0
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2
.
0
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3
0
8
9
0
.
[
4
]
P
.
P
o
r
t
e
r
,
J.
B
r
i
sb
a
n
e
,
U
.
A
b
e
y
r
a
t
n
e
,
N
.
B
e
a
r
,
a
n
d
S
.
C
l
a
x
t
o
n
,
“
A
s
mart
p
h
o
n
e
-
b
a
s
e
d
a
l
g
o
r
i
t
h
m
c
o
mp
r
i
si
n
g
c
o
u
g
h
a
n
a
l
y
s
i
s
a
n
d
p
a
t
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e
n
t
-
r
e
p
o
r
t
e
d
s
y
m
p
t
o
ms
i
d
e
n
t
i
f
i
e
s
a
c
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t
e
e
x
a
c
e
r
b
a
t
i
o
n
s
o
f
a
s
t
h
m
a
:
a
p
r
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sp
e
c
t
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v
e
,
d
o
u
b
l
e
b
l
i
n
d
,
d
i
a
g
n
o
st
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c
a
c
c
u
r
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c
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s
t
u
d
y
,
”
J
o
u
rn
a
l
o
f
Ast
h
m
a
,
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.
6
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.
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.
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