I
nte
rna
t
io
na
l J
o
urna
l o
f
Adv
a
nces in Applie
d Science
s
(
I
J
AAS)
Vo
l.
14
,
No
.
2
,
J
u
n
e
2
0
2
5
,
p
p
.
523
~
5
3
2
I
SS
N:
2252
-
8
8
1
4
,
DOI
:
1
0
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1
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5
9
1
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.
v14.
i
2
.
pp
523
-
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3
2
523
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R
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ed
No
v
2
5
,
2
0
2
4
R
ev
is
ed
Ap
r
1
7
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2
0
2
5
Acc
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ted
Ma
y
1
0
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2
0
2
5
S
u
rg
ica
l
site
i
n
fe
c
ti
o
n
s
(S
S
I)
c
o
n
ti
n
u
e
t
o
b
e
a
p
ro
b
lem
fo
r
su
r
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o
n
s,
a
n
d
u
n
f
o
rtu
n
a
tely
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S
S
I
in
f
o
rm
a
ti
o
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sy
ste
m
s
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re
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n
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e
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ti
li
z
ed
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h
is
stu
d
y
a
n
a
ly
z
ed
th
e
u
se
r
a
c
c
e
p
tan
c
e
o
f
th
e
SSI
in
f
o
rm
a
ti
o
n
s
y
ste
m
b
a
se
d
o
n
t
h
e
e
x
ten
d
e
d
tec
h
n
o
lo
g
y
a
c
c
e
p
tan
c
e
m
o
d
e
l
(TAM
2
).
A
c
r
o
ss
-
se
c
ti
o
n
a
l
q
u
e
stio
n
n
a
ire
-
b
a
se
d
st
u
d
y
.
T
h
e
v
a
riab
les
stu
d
ied
i
n
ten
ti
o
n
to
u
se
(IU),
p
e
rc
e
iv
e
d
e
a
se
o
f
u
se
(
P
EOU),
d
e
m
o
g
ra
p
h
ic
fa
c
to
rs
(F
D),
su
b
jec
t
iv
e
n
o
rm
(S
N),
Im
a
g
e
(
I),
jo
b
re
lev
a
n
c
e
(JR),
o
u
tp
u
t
q
u
a
l
i
ty
(O
Q),
re
su
lt
d
e
m
o
n
stra
b
il
it
y
(RD),
p
e
rc
e
iv
e
d
u
se
fu
ln
e
ss
(P
U).
Da
ta
we
re
c
o
ll
e
c
ted
b
y
fil
li
n
g
o
u
t
q
u
e
stio
n
n
a
ires
a
n
d
th
e
n
a
n
a
l
y
z
e
d
u
sin
g
sm
a
rt
-
p
a
rti
a
l
lea
st
sq
u
a
re
s
(
P
LS
)
.
I
n
t
o
tal,
6
1
n
u
rse
s
we
re
i
n
c
lu
d
e
d
.
M
o
st
re
sp
o
n
d
e
n
ts
a
re
a
g
e
d
3
1
-
35
(2
6
.
2
3
%
),
a
n
d
m
o
st
wo
r
k
i
n
g
p
e
rio
d
s
a
re
b
e
twe
e
n
1
1
-
1
5
y
e
a
rs
(2
7
.
8
7
%
).
Th
e
re
we
re
sig
n
ifi
c
a
n
t
p
o
siti
v
e
e
f
fe
c
ts
o
n
SN
to
P
U
(β=
0
.
1
2
;
p
<
0
.
0
1
)
a
n
d
I
(β=
0
.
7
3
9
;
p
<
0
.
0
1
),
JR
t
o
P
U
(β=
0
.
0
5
8
;
p
<
0
.
0
5
)
,
RD
to
th
e
P
U
(β
=
0
.
3
6
4
;
p
<
0
.
0
1
)
,
P
U
t
o
IU
(β=
0
.
3
2
2
;
p
<
0
.
0
1
)
,
P
EOU
to
IU
(β=
0
.
5
6
5
;
p
<
0
.
0
1
)
a
n
d
P
U
(β=
0
.
4
7
6
;
p
<
0
.
0
1
),
F
D
t
o
I
U
(β=
0
.
1
0
9
;
P
<
0
.
0
1
)
a
n
d
P
U
(
β=
0
.
0
3
;
p
<
0
.
0
5
)
.
Th
e
re
latio
n
sh
i
p
b
e
twe
e
n
S
N
a
n
d
IU
(β=
-
0
.
0
5
4
;
p
<
0
.
0
5
)
a
n
d
OQ
to
P
U (β=
-
0
.
0
7
5
;
p
<
0
.
0
1
)
we
re
sig
n
ifi
c
a
n
tl
y
n
e
g
a
ti
v
e
.
Im
a
g
e
h
a
s n
o
sig
n
ifi
c
a
n
t
e
ffe
c
t
o
n
PU
(p
>
0
.
0
5
).
T
h
is
stu
d
y
c
o
n
c
lu
d
e
d
th
a
t
P
EOU
is
th
e
m
o
st
in
flu
e
n
ti
a
l
v
a
ria
b
le i
n
th
e
IU
t
h
e
SSI
in
fo
rm
a
ti
o
n
sy
ste
m
.
K
ey
w
o
r
d
s
:
I
n
f
ec
tio
n
c
o
n
tr
o
l
I
n
f
o
r
m
atio
n
s
y
s
tem
M
ed
ical
in
f
o
r
m
atics
ap
p
licatio
n
s
Su
r
g
ical
wo
u
n
d
in
f
ec
tio
n
T
ec
h
n
o
lo
g
y
tr
a
n
s
f
er
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Ma
r
ia
Ulf
a
Sch
o
o
l o
f
Me
d
icin
e,
Facu
lty
o
f
Me
d
icin
e
an
d
Hea
lth
Scien
c
es,
Un
iv
er
s
itas
Mu
h
am
m
ad
iy
a
h
Yo
g
y
a
k
ar
ta
J
l.
B
r
awijay
a,
Kasih
an
,
B
an
tu
l,
Yo
g
y
ak
a
r
ta,
5
5
1
8
3
,
I
n
d
o
n
esi
a
E
m
ail:
m
ar
iau
lf
a
@
u
m
y
.
ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
I
n
f
ec
tio
u
s
d
is
ea
s
es
co
n
tin
u
e
t
o
p
o
s
e
a
p
r
o
f
o
u
n
d
c
h
allen
g
e
t
o
g
lo
b
al
p
u
b
lic
h
ea
lth
,
esp
ec
ially
with
in
d
ev
elo
p
in
g
n
atio
n
s
s
u
ch
as
I
n
d
o
n
esia
[
1
]
.
T
h
e
p
r
ev
alen
ce
a
n
d
im
p
ac
t
o
f
th
ese
d
is
ea
s
es
h
ig
h
lig
h
t
th
e
n
ee
d
f
o
r
en
h
an
ce
d
h
ea
lth
i
n
f
r
astru
ctu
r
e,
s
u
r
v
eilla
n
ce
,
a
n
d
i
n
ter
v
en
ti
o
n
s
tr
ateg
ies
to
ef
f
ec
tiv
ely
a
d
d
r
ess
an
d
m
itig
ate
th
eir
ef
f
ec
ts
o
n
v
u
l
n
er
ab
le
p
o
p
u
latio
n
s
.
Desp
ite
a
d
v
an
ce
m
e
n
ts
in
m
e
d
ical
tech
n
o
lo
g
y
a
n
d
in
f
ec
tio
n
c
o
n
tr
o
l
p
r
o
to
co
ls
,
s
u
r
g
ical
s
ite
in
f
ec
tio
n
s
(
SS
I
s
)
co
n
tin
u
e
to
p
r
esen
t
a
s
ig
n
if
ican
t
ch
al
len
g
e
f
o
r
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als,
u
n
d
er
s
co
r
in
g
th
e
n
ee
d
f
o
r
o
n
g
o
in
g
r
esear
ch
a
n
d
im
p
r
o
v
em
en
t
in
p
r
ev
en
tiv
e
s
tr
ateg
ies
[
2
]
,
[
3
]
.
SS
I
ca
n
in
cr
ea
s
e
m
o
r
b
id
ity
,
m
o
r
tality
,
an
d
tr
ea
tm
en
t
co
s
ts
d
u
e
to
th
e
tr
ea
tm
en
t
len
g
th
an
d
o
th
er
co
m
p
licatio
n
s
[
4
]
.
Desp
ite
ad
v
an
ce
s
in
p
r
o
p
h
y
lactic
an
tib
io
tics
,
b
etter
an
esth
esia,
ad
v
an
c
ed
eq
u
ip
m
en
t,
an
d
in
cr
ea
s
ed
p
o
s
to
p
er
ativ
e
v
i
g
ilan
ce
,
SS
I
r
em
ain
s
co
m
m
o
n
[
4
]
.
Acc
o
r
d
in
g
to
W
HO,
m
o
r
e
th
a
n
o
n
e
in
ten
p
eo
p
le
in
d
ev
elo
p
in
g
c
o
u
n
tr
ies
wh
o
u
n
d
er
g
o
s
u
r
g
er
y
a
r
e
af
f
e
cte
d
b
y
SS
I
,
wh
ile
in
d
ev
elo
p
e
d
c
o
u
n
tr
ies,
it
o
cc
u
r
s
in
5
0
0
,
0
0
0
p
e
o
p
le
p
er
y
ea
r
.
R
eg
io
n
al
d
ata
u
n
d
e
r
s
co
r
e
th
e
g
r
a
v
i
ty
o
f
th
e
is
s
u
e
at
h
an
d
;
f
o
r
in
s
tan
ce
,
th
e
r
ates
o
f
SS
I
ar
e
d
o
cu
m
e
n
ted
at
ap
p
r
o
x
im
ately
1
%
in
th
e
Am
er
icas,
c
o
m
p
ar
ed
to
a
s
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n
if
ican
tly
h
ig
h
e
r
r
ate
o
f
6
.
3
%
in
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
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2
2
5
2
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8
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4
I
n
t J Ad
v
Ap
p
l Sci
,
Vo
l.
14
,
No
.
2
,
J
u
n
e
2
0
2
5
:
5
2
3
-
532
524
Mo
r
o
cc
o
[
5
]
.
I
n
I
n
d
o
n
esia,
v
a
r
io
u
s
s
tu
d
ies
h
a
v
e
i
n
d
icate
d
th
at
th
e
in
cid
en
ce
r
ates
o
f
SS
I
in
clea
n
an
d
clea
n
-
co
n
tam
in
ated
s
u
r
g
ical
p
r
o
ce
d
u
r
es
r
an
g
e
b
etwe
en
5
.
3
2
a
n
d
1
3
.
9
%
[
6
]
.
At
C
ip
to
Ma
n
g
u
n
k
u
s
u
m
o
Ho
s
p
ital,
t
h
e
p
r
ev
alen
ce
o
f
p
o
s
to
p
er
ativ
e
S
SIs
f
o
llo
win
g
ab
d
o
m
in
al
s
u
r
g
er
ies
was
7
.
2
%
f
r
o
m
2
0
0
9
to
2
0
1
1
.
I
n
c
o
n
tr
ast,
Haji
Ho
s
p
ital
in
E
ast
J
av
a
Pro
v
in
ce
r
ec
o
r
d
ed
an
SS
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in
cid
e
n
ce
o
f
0
.
3
1
%
d
u
r
in
g
th
e
f
ir
s
t
h
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o
f
2
0
2
2
.
Giv
en
th
e
o
n
g
o
in
g
ch
allen
g
es
p
o
s
ed
b
y
SS
I
s
,
th
e
im
p
lem
en
tatio
n
o
f
ef
f
ec
tiv
e
s
u
r
v
eillan
ce
an
d
m
o
n
ito
r
in
g
to
o
ls
is
ess
en
tial f
o
r
co
n
tr
o
llin
g
an
d
p
r
ev
en
tin
g
th
ese
in
f
ec
tio
n
s
.
T
h
e
ad
v
an
ce
m
en
t
o
f
h
ea
lth
i
n
f
o
r
m
atio
n
s
y
s
tem
s
h
as
s
ig
n
if
ican
tly
im
p
r
o
v
ed
th
e
m
a
n
ag
em
en
t
o
f
m
ed
ical
d
ata,
r
esu
ltin
g
in
en
h
an
ce
d
in
f
ec
tio
n
s
u
r
v
eillan
ce
[
7
]
.
A
p
r
o
m
in
en
t
ex
am
p
le
is
th
e
SS
I
in
f
o
r
m
atio
n
s
y
s
tem
im
p
lem
en
ted
at
Haji
Ho
s
p
ital
in
E
ast
J
av
a,
wh
ich
is
d
esig
n
ed
to
m
o
n
ito
r
S
SI
b
y
m
eticu
lo
u
s
ly
ca
p
tu
r
in
g
p
r
eo
p
e
r
ativ
e,
in
tr
a
o
p
e
r
ativ
e,
an
d
p
o
s
to
p
e
r
ativ
e
d
ata
f
o
r
s
y
s
tem
atic
tr
ac
k
in
g
o
f
in
f
ec
tio
n
r
ates.
Ho
wev
er
,
s
in
ce
its
in
tr
o
d
u
cti
o
n
in
2
0
1
9
,
th
e
s
y
s
tem
h
as
n
o
t
u
n
d
er
g
o
n
e
a
co
m
p
r
eh
en
s
iv
e
ev
alu
atio
n
o
r
en
h
an
ce
m
e
n
t,
a
n
d
t
h
e
tr
a
n
s
itio
n
f
r
o
m
m
an
u
al
d
o
cu
m
en
tatio
n
to
a
n
elec
tr
o
n
ic
f
o
r
m
at
h
as
p
o
s
ed
ch
allen
g
es
f
o
r
h
ea
lth
ca
r
e
p
er
s
o
n
n
el,
af
f
ec
tin
g
b
o
th
ad
o
p
tio
n
an
d
ef
f
ec
tiv
e
u
tili
z
atio
n
[
8
]
.
Var
io
u
s
th
e
o
r
etica
l
m
o
d
els
h
av
e
b
ee
n
u
tili
z
ed
in
h
ea
lth
ca
r
e
tech
n
o
lo
g
y
ac
ce
p
tan
ce
,
n
o
ta
b
ly
,
th
e
tech
n
o
lo
g
y
ac
ce
p
ta
n
ce
m
o
d
el
(
T
AM
)
d
ev
elo
p
e
d
b
y
Dav
is
,
wh
ich
elu
cid
ates
u
s
er
ac
ce
p
tan
ce
b
ased
o
n
p
er
ce
iv
e
d
u
s
ef
u
l
n
ess
(
PU)
an
d
ea
s
e
o
f
u
s
e
[
9
]
.
E
x
p
an
d
in
g
o
n
T
AM
,
in
co
r
p
o
r
atin
g
ad
d
itio
n
al
elem
en
ts
s
u
ch
as
s
u
b
jectiv
e
n
o
r
m
s
(
SN)
an
d
co
g
n
itiv
e
p
r
o
ce
s
s
es,
th
u
s
o
f
f
er
in
g
a
m
o
r
e
h
o
lis
tic
u
n
d
er
s
tan
d
in
g
o
f
tec
h
n
o
lo
g
y
ac
ce
p
tan
ce
[
1
0
]
,
[
1
1
]
.
R
esear
ch
s
u
g
g
ests
th
at
f
ac
to
r
s
lik
e
o
r
g
an
i
z
atio
n
al
s
u
p
p
o
r
t,
tr
ai
n
in
g
,
a
n
d
s
y
s
tem
u
s
ab
ilit
y
ar
e
cr
u
cial
f
o
r
th
e
ad
o
p
tio
n
o
f
elec
tr
o
n
ic
h
ea
lth
r
ec
o
r
d
s
[
1
2
]
–
[
1
4
]
.
Ho
wev
e
r
,
t
h
er
e
is
a
n
o
tab
le
lack
o
f
s
tu
d
ies
ass
ess
in
g
th
e
ac
ce
p
tan
ce
o
f
SS
I
s
u
r
v
eillan
ce
s
y
s
tem
s
,
u
n
d
er
s
co
r
in
g
a
s
ig
n
if
ica
n
t a
r
ea
th
a
t
n
ee
d
s
f
u
r
th
e
r
in
v
esti
g
atio
n
.
T
h
e
ex
am
in
atio
n
o
f
b
eh
av
i
o
r
ch
an
g
e
s
tr
ateg
ies
r
elate
d
to
te
ch
n
o
lo
g
y
ac
ce
p
ta
n
ce
lar
g
ely
r
elies
o
n
th
e
T
AM
,
a
f
r
am
ewo
r
k
t
h
at
en
a
b
l
es
u
s
to
p
r
e
d
ict
h
u
m
an
b
eh
a
v
i
o
r
b
y
an
aly
z
in
g
th
e
v
a
r
io
u
s
f
a
cto
r
s
th
at
i
n
f
lu
en
ce
th
e
ac
ce
p
tan
ce
o
f
in
f
o
r
m
ati
o
n
s
y
s
tem
s
[
9
]
,
[
1
5
]
.
B
u
ild
in
g
o
n
th
is
f
o
u
n
d
atio
n
al
m
o
d
el,
Ve
n
k
atesh
a
an
d
Da
v
is
d
ev
elo
p
e
d
T
AM
2
,
wh
ic
h
in
c
o
r
p
o
r
ates
ad
d
itio
n
al
th
e
o
r
etic
al
co
n
s
tr
u
cts
th
at
en
h
a
n
ce
o
u
r
u
n
d
e
r
s
tan
d
in
g
o
f
u
s
er
ac
ce
p
tan
ce
[
1
6
]
.
T
h
is
in
clu
d
es
th
e
d
y
n
am
ics
o
f
s
o
cial
i
n
f
lu
en
ce
as
SNs
,
v
o
lu
n
tar
in
ess
,
an
d
s
o
cial
im
ag
e
alo
n
g
s
id
e
co
g
n
itiv
e
in
s
tr
u
m
e
n
tal
p
r
o
ce
s
s
es
th
at
ass
e
s
s
th
e
r
elev
an
ce
o
f
task
s
,
q
u
ality
o
f
o
u
tp
u
ts
,
v
er
if
iab
i
lity
o
f
r
esu
lts
,
an
d
p
er
ce
iv
ed
ea
s
e
o
f
u
s
e
(
PEOU
)
o
f
th
e
tech
n
o
lo
g
y
[
1
6
]
.
T
h
is
m
u
ltifa
ce
ted
ap
p
r
o
ac
h
f
o
s
ter
s
a
d
ee
p
er
in
s
ig
h
t
in
to
h
o
w
u
s
er
s
en
g
ag
e
with
in
n
o
v
atio
n
s
.
Desp
ite
th
e
im
p
lem
en
tatio
n
o
f
th
e
SSI
in
f
o
r
m
atio
n
s
y
s
tem
at
Haji
Ho
s
p
ital
in
E
ast
J
av
a,
r
ec
en
t
r
ep
o
r
ts
in
d
icate
a
c
o
n
ce
r
n
i
n
g
tr
en
d
:
f
r
o
m
2
0
1
9
to
2
0
2
2
,
th
e
s
y
s
tem
'
s
u
tili
z
a
tio
n
h
as
co
n
s
is
ten
tly
f
allen
s
h
o
r
t
o
f
ex
p
ec
ted
tar
g
ets.
Ho
wev
er
,
th
er
e
is
a
p
au
city
o
f
r
esear
c
h
ex
am
in
in
g
th
e
ac
ce
p
ta
n
ce
o
f
SS
I
m
o
n
ito
r
in
g
s
y
s
tem
s
a
m
o
n
g
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als.
Un
lik
e
p
r
ev
io
u
s
r
esear
ch
p
r
im
ar
ily
f
o
cu
s
ed
o
n
g
e
n
er
al
elec
tr
o
n
ic
h
ea
lth
r
e
co
r
d
s
o
r
o
th
er
h
ea
lth
m
an
a
g
e
m
en
t
s
y
s
tem
s
,
th
is
s
tu
d
y
in
v
esti
g
ates
ex
p
licitly
an
SS
I
s
u
r
v
eillan
ce
ap
p
licatio
n
.
B
y
em
p
lo
y
in
g
th
e
T
AM
2
f
r
a
m
ewo
r
k
,
th
e
r
esear
ch
ev
alu
ates
th
e
in
f
l
u
en
ce
o
f
s
o
cial
f
ac
to
r
s
(
s
u
ch
as
SN
s
an
d
v
o
lu
n
tar
in
ess
)
a
n
d
c
o
g
n
itiv
e
in
s
tr
u
m
e
n
tal
p
r
o
ce
s
s
es
(
in
clu
d
in
g
p
e
r
ce
iv
ed
r
elev
an
ce
,
o
u
t
p
u
t
q
u
ality
(
OQ)
,
an
d
r
esu
lt
v
er
if
ia
b
ilit
y
)
o
n
th
e
s
y
s
tem
'
s
ac
ce
p
tan
ce
am
o
n
g
h
ea
lth
ca
r
e
wo
r
k
er
s
.
T
h
e
f
in
d
in
g
s
f
r
o
m
th
is
r
esear
ch
ar
e
an
ticip
a
ted
to
en
h
an
ce
th
e
s
y
s
tem
’
s
u
s
ab
ilit
y
an
d
ef
f
ec
tiv
en
ess
,
u
ltima
tely
f
ac
ilit
atin
g
im
p
r
o
v
em
e
n
ts
in
SS
I
m
o
n
ito
r
in
g
an
d
p
r
e
v
en
tio
n
ef
f
o
r
ts
.
Un
d
er
s
tan
d
i
n
g
th
e
f
a
cto
r
s
in
f
lu
en
cin
g
th
e
a
d
o
p
tio
n
o
f
s
u
ch
s
y
s
tem
s
is
cr
u
cial,
as
th
eir
p
r
ac
tical
im
p
lem
en
tatio
n
ca
n
lead
to
im
p
r
o
v
e
d
in
f
ec
tio
n
co
n
tr
o
l
an
d
p
atien
t
o
u
tco
m
es.
T
h
is
s
tu
d
y
aim
s
to
ad
d
r
ess
a
s
ig
n
if
ican
t
r
esear
ch
g
ap
b
y
an
al
y
z
in
g
u
s
er
ac
ce
p
tan
ce
o
f
th
e
SSI
in
f
o
r
m
atio
n
s
y
s
tem
th
r
o
u
g
h
th
e
len
s
o
f
th
e
T
AM
2
m
o
d
el.
2.
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n a
nd
s
et
t
ing
T
h
is
s
tu
d
y
was
s
y
s
tem
atica
lly
d
esig
n
ed
as
a
cr
o
s
s
-
s
ec
tio
n
al,
q
u
esti
o
n
n
air
e
-
b
ased
in
v
esti
g
atio
n
aim
ed
at
ass
ess
in
g
th
e
ad
o
p
ti
o
n
o
f
a
s
p
ec
if
ic
ap
p
licatio
n
a
m
o
n
g
m
em
b
er
s
o
f
th
e
I
n
f
ec
ti
o
n
p
r
e
v
en
tio
n
an
d
co
n
tr
o
l
li
n
k
n
u
r
s
e
(
I
PC
L
N)
T
ea
m
at
Haji
Ho
s
p
ital,
s
itu
ated
in
E
ast
J
av
a
Pro
v
in
ce
,
I
n
d
o
n
esia.
T
h
e
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
f
a
cilitated
d
ata
co
llectio
n
at
a
s
in
g
le
tim
e
p
o
i
n
t,
th
e
r
eb
y
en
ab
lin
g
a
n
ev
alu
atio
n
o
f
t
h
e
r
elatio
n
s
h
ip
s
b
etwe
en
v
ar
io
u
s
s
tu
d
y
v
ar
iab
les
[
1
7
]
,
[
1
8
]
.
T
h
is
s
tu
d
y
was
co
n
d
u
cted
f
r
o
m
J
an
u
ar
y
to
Ma
r
ch
2
0
2
3
;
th
e
r
esear
ch
to
o
k
p
lace
at
Haji
Ho
s
p
ital,
a
p
r
o
m
in
en
t
r
eg
io
n
al
r
ef
er
r
al
in
s
titu
tio
n
r
ec
o
g
n
i
z
ed
f
o
r
its
well
-
estab
lis
h
ed
in
f
ec
tio
n
p
r
ev
en
tio
n
a
n
d
co
n
tr
o
l
(
I
PC
)
p
r
o
g
r
am
.
T
h
e
s
tu
d
y
p
o
p
u
latio
n
co
m
p
r
is
ed
6
1
r
eg
is
ter
ed
n
u
r
s
es
in
teg
r
als
to
th
e
h
o
s
p
ital'
s
I
P
C
L
N
team
.
T
h
ese
n
u
r
s
es
p
lay
a
cr
itical
r
o
le
in
im
p
lem
en
tin
g
in
f
ec
tio
n
p
r
ev
en
tio
n
p
r
o
to
co
ls
an
d
en
f
o
r
cin
g
co
m
p
lian
ce
with
h
o
s
p
ital
in
f
ec
tio
n
co
n
tr
o
l
g
u
id
elin
es,
wh
ich
ar
e
ess
en
tial
f
o
r
m
ain
tain
i
n
g
p
atien
t
s
af
ety
a
n
d
en
h
a
n
cin
g
o
v
e
r
all
h
ea
lth
ca
r
e
q
u
ality
with
in
th
e
in
s
titu
tio
n
.
T
h
e
in
clu
s
io
n
cr
iter
ia
f
o
r
th
is
s
tu
d
y
co
m
p
r
is
ed
all
ac
tiv
e
m
em
b
er
s
o
f
t
h
e
I
PC
L
N
team
at
Haji
Ho
s
p
ital
in
E
ast
J
av
a
Pro
v
in
ce
wh
o
ex
p
r
ess
ed
a
willin
g
n
ess
to
p
ar
ticip
ate.
I
n
co
n
t
r
ast,
th
e
ex
clu
s
io
n
cr
iter
ia
s
tip
u
lated
th
at
n
u
r
s
e
s
with
p
r
ev
io
u
s
ex
p
er
ie
n
ce
u
s
in
g
th
e
ap
p
licatio
n
u
n
d
e
r
ex
am
in
atio
n
wo
u
ld
b
e
ex
cl
u
d
ed
to
e
n
s
u
r
e
th
at
th
e
r
esp
o
n
s
es g
ath
er
e
d
ac
cu
r
at
ely
r
ep
r
esen
ted
t
h
e
p
er
ce
p
tio
n
s
o
f
f
ir
s
t
-
tim
e
u
s
er
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Ad
v
Ap
p
l Sci
I
SS
N:
2252
-
8
8
1
4
B
r
id
g
in
g
tech
n
o
lo
g
y
a
n
d
h
ea
lt
h
ca
r
e:
u
s
er a
cc
ep
ta
n
ce
o
f a
s
u
r
g
ica
l sit
e
in
fectio
n
…
(
A
fa
n
F
a
tkh
u
r
A
kh
ma
d
)
525
Data
wer
e
co
llected
u
s
in
g
a
s
tr
u
ctu
r
ed
q
u
esti
o
n
n
air
e
ad
ap
ted
f
r
o
m
t
h
e
T
AM
as
ex
ten
d
ed
b
y
Ven
k
atesh
an
d
Dav
is
[
1
6
]
,
ad
m
in
is
ter
ed
in
b
o
th
p
a
p
er
-
b
ase
d
an
d
d
i
g
ital
f
o
r
m
a
ts
to
ac
c
o
m
m
o
d
ate
p
ar
ticip
an
t
p
r
ef
er
en
ce
s
.
T
h
e
m
eth
o
d
o
lo
g
i
es
em
p
lo
y
ed
in
th
is
s
tu
d
y
ar
e
co
n
s
is
ten
t
with
p
r
ev
io
u
s
r
esear
ch
th
at
h
as
u
tili
ze
d
th
e
T
AM
to
e
v
alu
ate
h
o
s
p
ital
in
f
o
r
m
atio
n
m
a
n
ag
em
en
t
s
y
s
tem
s
(
HI
MS)
[
1
9
]
,
[
2
0
]
.
T
h
e
q
u
esti
o
n
n
air
e
co
m
p
r
is
ed
two
m
ain
s
ec
tio
n
s
:
d
em
o
g
r
ap
h
ic
in
f
o
r
m
atio
n
,
i
n
clu
d
in
g
a
g
e
an
d
len
g
t
h
o
f
s
er
v
ice
in
y
ea
r
s
,
an
d
T
AM
co
n
s
tr
u
cts,
wh
ich
in
clu
d
ed
in
ten
tio
n
to
u
s
e
(
I
U)
,
PE
OU,
f
ac
to
r
d
em
o
g
r
ap
h
ic
(
FD)
,
S
N,
im
ag
e
(
I
)
,
jo
b
r
elev
an
ce
(
J
R
)
,
OQ,
r
esu
lt
d
em
o
n
s
tr
ab
ilit
y
(
R
D)
,
an
d
PU
[
1
6
]
.
E
ac
h
co
n
s
tr
u
ctio
n
was
ass
ess
ed
u
s
in
g
a
7
-
p
o
in
t
L
i
k
er
t
s
ca
le
(
1
=stro
n
g
ly
d
is
ag
r
ee
to
7
=
s
tr
o
n
g
ly
ag
r
ee
)
.
T
h
e
q
u
esti
o
n
n
air
e
was
d
i
s
tr
ib
u
ted
in
p
er
s
o
n
d
u
r
in
g
s
ch
ed
u
led
I
PC
L
N
team
m
ee
tin
g
s
an
d
th
r
o
u
g
h
o
n
lin
e
s
u
r
v
ey
p
latf
o
r
m
s
,
with
p
ar
ticip
an
ts
r
ec
eiv
in
g
d
etailed
in
s
tr
u
ctio
n
s
an
d
en
co
u
r
ag
em
en
t
to
s
ee
k
clar
if
icatio
n
as
n
ee
d
ed
.
All
r
esp
o
n
s
es
w
er
e
an
o
n
y
m
ized
t
o
m
ain
tain
co
n
f
id
e
n
tiality
an
d
co
m
p
leted
q
u
esti
o
n
n
ai
r
es
wer
e
s
ec
u
r
ely
s
to
r
ed
in
a
d
ig
ital
r
ep
o
s
ito
r
y
f
o
r
an
aly
s
is
.
2
.
2
.
Da
t
a
a
na
ly
s
is
I
n
th
is
s
tu
d
y
,
s
tr
u
ctu
r
al
eq
u
atio
n
m
o
d
elin
g
(
SEM
)
was
u
tili
ze
d
to
in
v
esti
g
ate
th
e
r
elatio
n
s
h
ip
s
b
etwe
en
v
ar
io
u
s
v
ar
iab
les
th
r
o
u
g
h
p
at
h
an
aly
s
is
,
in
co
r
p
o
r
atin
g
s
ev
e
r
al
cr
itical
ass
ess
m
en
ts
[
2
1
]
.
T
h
e
m
ea
s
u
r
em
en
t
m
o
d
el
was
s
cr
u
tin
ized
f
o
r
r
eliab
ilit
y
an
d
v
ali
d
ity
,
with
f
ac
to
r
lo
ad
i
n
g
s
ab
o
v
e
0
.
5
c
o
n
s
id
er
ed
ac
ce
p
tab
le
[
2
2
]
,
[
2
3
]
,
co
m
p
o
s
ite
r
eliab
ilit
y
(
C
R
)
v
alu
es
ex
c
ee
d
in
g
0
.
7
,
co
n
f
ir
m
i
n
g
in
ter
n
al
co
n
s
is
t
en
cy
,
an
d
av
er
ag
e
v
ar
ian
ce
e
x
tr
ac
ted
(
AVE
)
v
alu
es
g
r
ea
ter
t
h
an
0
.
5
,
in
d
icatin
g
co
n
v
er
g
e
n
t
v
ali
d
ity
.
Fu
r
th
er
m
o
r
e,
C
r
o
n
b
ac
h
’
s
alp
h
a
v
alu
es
ab
o
v
e
0
.
7
estab
lis
h
ed
s
ca
le
r
elia
b
ilit
y
,
wh
ile
d
is
cr
im
in
an
t
v
al
id
ity
was
ass
e
s
s
ed
u
s
in
g
th
e
Fo
r
n
ell
-
L
ar
ck
e
r
cr
iter
ia
al
o
n
g
s
id
e
cr
o
s
s
-
lo
ad
in
g
an
aly
s
is
.
T
h
e
s
tr
u
ctu
r
al
m
o
d
el
ev
alu
ated
p
ath
co
ef
f
icien
ts
to
d
eter
m
in
e
th
e
s
tr
en
g
th
an
d
s
ig
n
if
ican
ce
o
f
r
elatio
n
s
h
ip
s
,
en
s
u
r
in
g
th
at
all
v
ar
ian
ce
in
f
latio
n
f
ac
to
r
(
VI
F)
v
al
u
es
r
em
ain
e
d
b
elo
w
5
to
m
itig
ate
m
u
ltico
llin
ea
r
ity
,
with
s
tat
is
tical
s
ig
n
if
ican
ce
r
ec
o
g
n
i
ze
d
at
a
p
-
v
alu
e
t
h
r
esh
o
ld
o
f
<
0
.
0
5
[
2
2
]
,
[
2
4
]
.
Ad
d
itio
n
ally
,
b
o
t
h
d
ir
ec
t
an
d
in
d
ir
ec
t
ef
f
ec
ts
wer
e
an
aly
ze
d
,
an
d
m
o
d
el
v
alid
ity
was
af
f
ir
m
e
d
th
r
o
u
g
h
v
ar
i
o
u
s
g
o
o
d
n
ess
-
of
-
f
it
m
ea
s
u
r
es,
wh
ich
co
llectiv
ely
estab
lis
h
ed
th
e
f
in
d
in
g
s
as
r
o
b
u
s
t,
r
eliab
le,
a
n
d
r
ep
licab
le.
Ad
d
itio
n
al
d
ata
tab
les
an
d
d
etailed
m
o
d
el
o
u
tp
u
ts
ar
e
av
ailab
le
upon
r
eq
u
est.
2
.
3
.
E
t
hica
l c
lea
ra
nce
T
h
is
s
tu
d
y
was
g
r
an
ted
eth
ic
al
ap
p
r
o
v
al
b
y
t
h
e
I
n
s
titu
tio
n
al
E
th
ics
C
o
m
m
ittee
o
f
Haji
Ho
s
p
ital
in
E
ast J
av
a
Pro
v
in
ce
(
E
th
ics C
o
m
m
ittee
Fil
e
No
.
0
7
3
/3
2
/KOM
.
E
T
I
K/2
0
2
3
)
.
B
ef
o
r
e
th
e
co
m
m
en
ce
m
en
t o
f
d
ata
co
llectio
n
,
all
p
ar
tici
p
an
ts
wer
e
p
r
o
v
id
e
d
with
a
th
o
r
o
u
g
h
ex
p
lan
atio
n
o
f
th
e
s
tu
d
y
'
s
o
b
jectiv
es,
p
o
ten
tial
r
is
k
s
,
an
d
ass
o
ciate
d
b
en
ef
its
to
en
s
u
r
e
in
f
o
r
m
e
d
p
a
r
ticip
atio
n
.
W
r
itten
in
f
o
r
m
ed
co
n
s
en
t
was
o
b
tain
ed
f
r
o
m
all
in
d
iv
id
u
als,
th
er
eb
y
af
f
ir
m
in
g
th
e
v
o
l
u
n
tar
y
n
atu
r
e
o
f
th
ei
r
in
v
o
lv
em
e
n
t.
T
o
u
p
h
o
l
d
d
ata
co
n
f
id
en
tiality
,
p
ar
ticip
an
t
r
esp
o
n
s
es
wer
e
an
o
n
y
m
ized
,
an
d
all
co
llected
d
ata
wer
e
s
ec
u
r
ely
s
to
r
ed
to
p
r
ev
en
t
u
n
au
th
o
r
ized
ac
ce
s
s
.
T
h
e
s
tu
d
y
co
m
p
lied
with
th
e
et
h
ical
p
r
i
n
cip
les
d
elin
ea
ted
in
th
e
Dec
lar
atio
n
o
f
Helsin
k
i
a
n
d
I
n
d
o
n
esian
n
atio
n
al
r
esear
ch
eth
ics
g
u
id
elin
es.
B
y
ad
h
er
i
n
g
to
th
ese
r
ig
o
r
o
u
s
m
eth
o
d
o
lo
g
ical
an
d
m
o
r
al
s
tan
d
ar
d
s
,
we
en
d
ea
v
o
r
to
en
s
u
r
e
th
at
th
is
r
esear
ch
'
s
f
in
d
in
g
s
ar
e
v
alid
an
d
r
ep
r
o
d
u
cib
le
w
h
ile
m
ain
tain
in
g
a
n
u
n
wav
er
in
g
co
m
m
itm
e
n
t to
et
h
ical
in
teg
r
ity
in
r
esear
ch
p
r
ac
tices.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
De
m
o
g
r
a
ph
ic
re
s
po
nd
e
nts
T
h
e
an
al
y
s
is
p
r
esen
ted
k
ey
i
n
s
ig
h
ts
in
to
u
s
er
ac
ce
p
tan
ce
o
f
th
e
SS
I
s
y
s
tem
.
T
ab
le
1
s
h
o
ws
th
e
d
em
o
g
r
a
p
h
ic
d
ata
r
ev
ea
lin
g
t
h
at
m
o
s
t
r
esp
o
n
d
en
ts
wer
e
a
g
ed
b
etwe
en
3
1
a
n
d
3
5
(
2
6
.
2
3
%)
an
d
h
ad
1
1
to
1
5
y
ea
r
s
o
f
ex
p
er
ien
ce
in
th
e
h
o
s
p
ital
s
ettin
g
(
2
7
.
8
7
%).
T
h
is
s
u
g
g
ests
th
at
a
s
ig
n
if
ican
t
p
r
o
p
o
r
tio
n
o
f
t
h
e
s
tu
d
y
p
ar
ticip
a
n
ts
wer
e
s
ea
s
o
n
ed
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als,
wh
ich
m
ay
i
n
f
lu
en
ce
th
eir
ac
ce
p
tan
ce
o
f
th
e
SS
I
s
y
s
tem
.
T
h
e
d
escr
ip
tiv
e
s
tatis
tic
s
f
o
r
all
v
ar
iab
les
ar
e
s
y
s
tem
atica
l
ly
p
r
esen
ted
in
T
ab
le
2
.
T
h
e
to
t
a
l
s
co
r
e
f
o
r
th
e
SN
v
ar
iab
le
r
ea
ch
ed
6
4
1
,
y
ield
in
g
an
av
er
ag
e
o
f
1
0
.
5
0
8
.
T
h
ese
m
ea
s
u
r
em
en
t
r
esu
l
ts
in
d
icate
th
at
th
e
av
er
ag
e
s
co
r
e
f
o
r
SN
is
co
m
p
ar
ativ
ely
elev
ated
,
s
u
g
g
esti
n
g
th
at
r
esp
o
n
d
en
ts
p
er
ce
i
v
e
a
s
ig
n
if
ican
t
in
f
lu
en
ce
f
r
o
m
in
d
i
v
id
u
als
o
f
im
p
o
r
tan
c
e
r
eg
ar
d
in
g
th
eir
b
elief
s
ab
o
u
t
wh
eth
er
ce
r
tain
b
eh
av
i
o
r
s
s
h
o
u
ld
o
r
s
h
o
u
ld
n
o
t
b
e
en
ac
ted
.
A
s
im
ilar
tr
en
d
is
o
b
s
er
v
ed
ac
r
o
s
s
th
e
r
em
ain
in
g
v
ar
iab
les,
in
clu
d
in
g
J
R
,
OQ,
R
D,
PU,
PEOU
,
an
d
I
U,
all
o
f
wh
ic
h
also
ex
h
ib
it
h
ig
h
m
ea
n
v
alu
es.
I
n
c
o
n
tr
ast,
th
e
v
ar
ia
b
le
p
er
tain
i
n
g
to
I
g
ar
n
er
e
d
a
m
o
d
er
ate
r
atin
g
,
with
a
m
ea
n
s
co
r
e
o
f
1
4
.
9
0
2
.
T
h
e
v
ar
ia
b
les
ar
e
ca
teg
o
r
ize
d
as
f
o
llo
ws:
lo
w*
(
SN:
2
-
5
;
I
:
3
-
8
;
J
R
:
2
-
5
;
OQ:
2
-
5
;
R
D:
4
-
1
1
;
PU:
4
-
1
1
;
PEOU
:
4
-
1
1
;
I
U:
2
-
5
)
,
m
o
d
er
ate*
*
(
SN:
6
-
9
;
I
:
9
-
1
4
;
J
R
:
6
-
9
;
OQ:
6
-
9
;
R
D:
1
2
-
1
9
;
PU:
1
2
-
1
9
;
P
E
OU:
1
2
-
1
9
;
I
U:
6
-
9
)
,
an
d
h
i
g
h
*
*
*
(
SN:
1
0
-
1
4
;
I
:
1
5
-
2
1
;
J
R
:
1
0
-
1
4
;
OQ:
1
0
-
1
4
; RD: 2
0
-
2
8
; PU:
20
-
2
8
; PE
OU:
2
0
-
2
8
; I
U:
1
0
-
1
4
)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
1
4
I
n
t J Ad
v
Ap
p
l Sci
,
Vo
l.
14
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,
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:
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3
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526
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le
1
.
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o
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ic
r
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o
n
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ts
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h
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r
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c
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e
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s
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3
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4
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0
>
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2
3
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2
8
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ab
le
2
.
Descr
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tiv
e
s
tatis
tics
V
a
r
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a
b
l
e
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i
n
i
m
u
m
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a
x
i
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m
M
e
a
n
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u
m
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t
a
n
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r
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t
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.
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3
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5
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4
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5
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2
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15
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8
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2
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3
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6
14
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2
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6
6
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7
3
6
1
.
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3
2
3
.
2
.
O
ute
r
a
na
ly
s
is
Fig
u
r
e
1
e
x
p
lain
s
th
e
m
a
n
d
ato
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y
d
esig
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ter
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h
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at
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,
J
R
,
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U
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ir
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ter
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in
g
s
m
ar
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-
p
ar
tial l
ea
s
t sq
u
ar
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4
(
PLS)
s
o
f
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e.
Fig
u
r
e
1
.
Ou
ter
m
o
d
el
d
e
s
ig
n
with
s
m
ar
tPLS 4
s
o
f
twar
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Ad
v
Ap
p
l Sci
I
SS
N:
2252
-
8
8
1
4
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r
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tech
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u
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u
r
e
2
.
First m
o
d
el
l
o
ad
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g
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ac
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ec
u
tio
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r
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lts
3
.
3
.
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nn
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o
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Af
ter
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m
in
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itab
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ate
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el
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o
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e
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e
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ic
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in
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R
2
)
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d
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e
p
ath
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ef
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icien
t
m
u
s
t
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ex
am
i
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[
2
2
]
.
R
-
s
q
u
ar
e
m
ea
s
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r
es
th
e
p
r
o
p
o
r
tio
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ted
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(
en
d
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g
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at
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n
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e
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p
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y
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e
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ar
iab
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at
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cts it (
ex
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o
u
s
)
.
T
a
b
le
3
p
r
e
s
en
ts
th
e
R
-
s
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u
ar
ed
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alu
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wh
ich
elu
cid
ate
th
e
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r
o
p
o
r
tio
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f
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ar
ian
ce
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x
p
lain
e
d
b
y
v
ar
io
u
s
f
ac
to
r
s
in
th
e
s
tu
d
y
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Sp
ec
if
ically
,
it
is
r
ev
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led
th
at
5
4
.
7
%
o
f
th
e
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ar
ian
ce
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I
is
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ib
u
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le
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n
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n
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6
6
.
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t
h
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I
U
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e
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o
m
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e
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ef
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an
d
P
E
OU.
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r
th
er
m
o
r
e
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s
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b
s
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tial
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n
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te
d
f
o
r
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y
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e
in
f
lu
en
ce
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o
f
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,
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R
,
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esh
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ld
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u
s
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o
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ter
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t
h
e
R
-
s
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lu
es
ar
e
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o
llo
ws:
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R
-
s
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u
ar
ed
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alu
e
o
f
0
.
7
5
is
in
d
icati
v
e
o
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a
s
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b
s
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tial
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tr
o
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g
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ec
t,
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v
alu
e
o
f
0
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5
r
ef
lects
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m
o
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er
ate
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m
ed
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m
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2
5
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ig
n
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m
all)
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ec
t.
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r
t
h
er
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o
r
e
,
we
m
ea
s
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r
ed
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e
p
ath
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ef
f
icien
ts
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etwe
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n
s
tr
u
cts
to
s
ee
th
e
r
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n
s
h
i
p
'
s
s
ig
n
if
ican
ce
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d
s
tr
en
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.
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e
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e
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esis
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h
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ct
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s
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ip
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n
d
d
e
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en
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t v
ar
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s
as sh
o
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in
Fig
u
r
e
3
.
T
ab
le
3
.
R
-
s
q
u
ar
e
r
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lts
R
-
sq
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a
r
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R
-
sq
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a
r
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st
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I
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4
6
0
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5
4
5
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.
6
6
7
0
.
6
6
5
PU
0
.
6
8
9
0
.
6
8
7
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
1
4
I
n
t J Ad
v
Ap
p
l Sci
,
Vo
l.
14
,
No
.
2
,
J
u
n
e
2
0
2
5
:
5
2
3
-
532
528
Fig
u
r
e
3
.
T
est
r
esu
lts
o
f
s
tr
u
ct
u
r
al
m
o
d
el/
in
n
er
m
o
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el
T
h
e
r
esu
lts
o
f
th
e
p
ath
an
aly
s
is
r
ev
ea
led
s
ig
n
if
ica
n
t
r
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n
s
h
ip
s
am
o
n
g
th
e
v
a
r
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u
s
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n
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tr
u
ctio
n
s
ex
am
in
ed
in
t
h
e
s
tu
d
y
in
T
a
b
le
4
.
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tab
ly
,
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n
eg
ativ
ely
in
f
lu
en
ce
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IU
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0
.
0
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4
,
p
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0
.
0
1
)
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u
g
g
esti
n
g
t
h
at
s
o
cial
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r
ess
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r
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m
ay
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is
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u
r
ag
e
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er
s
f
r
o
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ad
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g
t
h
e
s
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tem
.
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n
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n
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ast,
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h
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ited
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s
ig
n
if
ican
t
p
o
s
itiv
e
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f
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t
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(
0
.
3
2
2
,
p
<
0
.
0
1
)
,
in
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icatin
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th
at
u
s
er
s
a
r
e
m
o
r
e
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ely
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r
ac
e
th
e
SS
I
s
y
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tem
if
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ey
r
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g
n
ize
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e
n
ef
its
f
o
r
th
ei
r
wo
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k
f
lo
w
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d
p
atien
t
ca
r
e.
PEOU
s
h
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wed
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tr
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n
g
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o
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e
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r
r
e
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n
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with
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4
7
6
,
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<
0
.
0
1
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d
IU
(
0
.
5
6
5
,
p
<
0
.
0
1
)
.
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h
is
em
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h
asizes
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e
im
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o
r
tan
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a
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f
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ly
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y
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tem
in
p
r
o
m
o
tin
g
u
s
er
a
d
o
p
tio
n
.
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d
itio
n
ally
,
RD
(
0
.
3
6
4
,
p
<
0
.
0
1
)
s
ig
n
if
ican
tly
in
f
lu
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ce
d
PU
,
h
ig
h
lig
h
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g
th
e
n
ec
ess
ity
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o
r
u
s
er
s
to
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av
e
cl
ea
r
ev
id
en
ce
o
f
th
e
s
y
s
tem
'
s
b
en
ef
its
to
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u
lly
ap
p
r
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iate
its
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alu
e.
C
o
n
v
er
s
ely
,
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ativ
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im
p
ac
ted
PU
(
-
0
.
0
7
5
,
p
<
0
.
0
1
)
,
s
u
g
g
esti
n
g
th
at
tech
n
ical
s
h
o
r
tco
m
i
n
g
s
an
d
in
ad
e
q
u
ate
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y
s
tem
p
er
f
o
r
m
an
ce
co
u
ld
h
in
d
er
u
s
e
r
ac
ce
p
tan
ce
.
Fu
r
th
e
r
m
o
r
e
,
b
o
th
JR
(
0
.
0
5
8
,
p
<
0
.
0
5
)
an
d
FD
(
0
.
1
0
9
,
p
<
0
.
0
1
)
s
ig
n
if
ican
tly
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f
ec
te
d
PU
a
n
d
IU
,
u
n
d
e
r
s
co
r
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g
th
e
im
p
o
r
tan
ce
o
f
alig
n
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n
g
s
y
s
tem
f
u
n
ctio
n
ality
with
u
s
er
s
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jo
b
r
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o
n
s
ib
ilit
ies an
d
d
e
m
o
g
r
ap
h
ic
ch
a
r
ac
ter
is
tics
.
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ab
le
4
.
R
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lts
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f
th
e
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o
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el
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tr
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ctu
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e/
in
n
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el
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R
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t
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p
P
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e
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5
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J Ad
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Ap
p
l Sci
I
SS
N:
2252
-
8
8
1
4
B
r
id
g
in
g
tech
n
o
lo
g
y
a
n
d
h
ea
lt
h
ca
r
e:
u
s
er a
cc
ep
ta
n
ce
o
f a
s
u
r
g
ica
l sit
e
in
fectio
n
…
(
A
fa
n
F
a
tkh
u
r
A
kh
ma
d
)
529
T
h
is
s
tu
d
y
in
v
esti
g
ates th
e
r
el
atio
n
s
h
ip
b
etwe
en
FD
,
p
r
ec
is
ely
ag
e,
len
g
th
o
f
s
er
v
ice,
an
d
t
ec
h
n
o
lo
g
y
ad
o
p
tio
n
.
T
h
e
f
in
d
in
g
s
d
em
o
n
s
tr
ate
th
at
d
em
o
n
s
tr
ab
ilit
y
,
JR
,
an
d
PEOU
s
ig
n
if
ican
t
ly
an
d
p
o
s
itiv
ely
in
f
lu
en
ce
PU
as
an
in
ter
v
en
i
n
g
v
ar
iab
le.
Mo
r
eo
v
er
,
SN
s
an
d
PEOU
d
i
r
ec
tly
af
f
ec
t
th
e
in
ten
tio
n
to
u
tili
ze
tech
n
o
lo
g
y
.
W
h
ile
th
ese
r
esu
lt
s
ar
e
co
n
s
is
ten
t
with
p
r
ev
io
u
s
r
esear
ch
[
2
5
]
,
[
2
6
]
,
th
ey
also
r
ev
ea
l
a
s
ig
n
if
ican
t
d
iv
er
g
en
ce
co
n
ce
r
n
in
g
th
e
r
o
le
o
f
SN
s
.
Fu
r
th
er
m
o
r
e,
th
is
s
tu
d
y
co
n
tr
ib
u
tes
to
t
h
e
ex
i
s
tin
g
liter
atu
r
e
b
y
elu
cid
atin
g
th
e
co
m
p
le
x
ities
o
f
SN
s
an
d
t
h
eir
u
n
ex
p
ec
t
ed
ly
n
eg
ati
v
e
im
p
ac
t
o
n
th
e
in
ten
tio
n
to
ad
o
p
t
tech
n
o
lo
g
y
.
T
h
is
s
u
g
g
ests
th
a
t
co
n
tex
tu
al
f
ac
to
r
s
,
s
u
ch
as
p
r
o
f
ess
io
n
al
au
to
n
o
m
y
an
d
in
d
iv
id
u
al
ju
d
g
m
en
t
,
m
ay
s
u
p
er
s
ed
e
s
o
cial
in
f
l
u
en
c
es in
d
ec
is
io
n
s
r
elate
d
to
tech
n
o
lo
g
y
a
d
o
p
tio
n
.
An
in
tr
ig
u
in
g
f
in
d
in
g
f
r
o
m
t
h
e
p
r
esen
t
s
tu
d
y
is
th
e
p
r
o
n
o
u
n
ce
d
n
eg
ativ
e
im
p
ac
t
o
f
SNs
o
n
th
e
in
ten
tio
n
to
u
tili
ze
th
e
ap
p
lica
tio
n
.
Pre
cisely
,
a
1
%
in
c
r
ea
s
e
in
SNs
co
r
r
esp
o
n
d
s
t
o
a
0
.
0
5
4
%
d
ec
r
ea
s
e
in
th
e
I
U.
T
h
is
p
h
en
o
m
e
n
o
n
in
d
icate
s
th
at
an
in
d
iv
id
u
al’
s
p
er
ce
p
ti
o
n
o
f
ex
ter
n
al
p
r
ess
u
r
es
ad
o
p
t
in
g
th
e
ap
p
licatio
n
m
ay
,
p
ar
ad
o
x
ically
,
d
eter
its
u
s
ag
e
.
Descr
ip
tiv
e
s
tatis
tics
r
ev
ea
l
elev
ated
lev
els
o
f
SNs
an
d
I
U;
h
o
wev
er
,
th
eir
in
ter
ac
tio
n
r
ev
ea
ls
th
at
p
ar
tici
p
an
ts
d
o
n
o
t
p
e
r
ce
iv
e
th
e
ap
p
licatio
n
as
b
en
ef
icial.
T
h
is
s
tan
d
s
in
s
tar
k
co
n
tr
ast
to
p
r
e
v
io
u
s
f
in
d
in
g
s
in
r
esear
ch
o
n
t
h
e
T
AM
2
,
wh
ich
g
en
er
ally
i
n
d
icate
d
eith
er
a
n
eu
tr
al
o
r
p
o
s
itiv
e
co
r
r
elatio
n
b
etwe
en
SNs
an
d
I
U
[
2
7
]
–
[
2
9
]
.
Mo
r
eo
v
e
r
,
s
tu
d
ies
ex
am
in
in
g
telec
o
m
m
u
n
icatio
n
s
er
v
ices
in
B
iu
ck
y
et
a
l.
[
2
7
]
an
d
t
h
e
ad
o
p
tio
n
o
f
au
g
m
e
n
ted
r
ea
lity
t
ec
h
n
o
lo
g
ies
[
3
0
]
h
a
v
e
r
ep
o
r
te
d
s
im
ilar
ly
p
o
s
itiv
e
ass
o
ciatio
n
s
.
T
h
e
o
b
s
er
v
e
d
d
is
cr
ep
an
cies
m
ay
b
e
attr
ib
u
ted
to
c
o
n
tex
t
-
s
p
ec
if
ic
f
ac
t
o
r
s
,
p
ar
ticu
lar
l
y
in
h
ea
lth
ca
r
e,
wh
er
e
p
r
o
f
ess
io
n
a
ls
o
f
ten
p
r
io
r
itize
p
er
s
o
n
al
e
x
p
er
ien
ce
s
an
d
p
er
ce
iv
e
d
ad
v
a
n
tag
es
o
v
er
ex
ter
n
al
in
f
lu
en
ce
s
.
E
x
is
tin
g
liter
atu
r
e
s
u
g
g
ests
th
at
m
a
n
d
ated
tech
n
o
lo
g
y
a
d
o
p
tio
n
,
p
ar
ticu
l
ar
ly
with
o
u
t
clea
r
b
en
ef
its
,
ca
n
en
g
en
d
e
r
r
esis
tan
ce
am
o
n
g
m
ed
ical
p
e
r
s
o
n
n
el
[
3
1
]
.
A
s
ig
n
if
ican
t
f
in
d
in
g
o
f
th
is
s
tu
d
y
is
th
e
d
etr
im
e
n
tal
ef
f
ec
t
o
f
OQ
o
n
PU.
W
h
ile
p
r
io
r
r
e
s
ea
r
ch
h
as
r
ep
o
r
ted
a
p
o
s
itiv
e
co
r
r
elatio
n
[
3
2
]
,
[
3
3
]
,
o
u
r
r
esu
lts
s
u
g
g
est
th
at
u
s
er
s
p
er
ce
iv
e
th
e
ap
p
licatio
n
as
in
ef
f
icien
t
,
th
u
s
d
im
in
is
h
in
g
its
p
er
ce
iv
e
d
u
tili
ty
.
Par
ticip
an
ts
ex
p
r
ess
ed
th
at
th
e
s
y
s
tem
h
am
p
er
s
th
eir
p
er
f
o
r
m
an
ce
,
d
ec
r
ea
s
in
g
p
r
o
d
u
ctiv
ity
a
n
d
in
cr
ea
s
in
g
ted
iu
m
in
th
eir
wo
r
k
p
r
o
ce
s
s
es.
T
h
is
lo
w
lev
el
o
f
en
g
ag
em
e
n
t
m
ay
b
e
attr
ib
u
ted
to
in
ad
e
q
u
ate
tr
ain
i
n
g
an
d
s
o
cializa
tio
n
c
o
n
ce
r
n
i
n
g
th
e
ap
p
licatio
n
'
s
f
u
n
ctio
n
alities
.
T
o
m
itig
ate
th
ese
n
eg
ativ
e
p
e
r
ce
p
tio
n
s
,
it
is
ess
en
tial
to
ad
d
r
ess
th
ese
is
s
u
es
th
r
o
u
g
h
s
y
s
tem
o
p
ti
m
izatio
n
s
,
u
s
ab
ilit
y
en
h
an
ce
m
e
n
ts
,
an
d
tar
g
eted
u
s
er
tr
ain
in
g
in
itiativ
es.
C
o
n
v
er
s
ely
,
th
e
d
em
o
n
s
tr
ab
ilit
y
o
f
r
e
s
u
lts
s
u
b
s
tan
tia
lly
in
f
lu
en
ce
s
PU,
u
n
d
e
r
s
co
r
in
g
th
e
im
p
o
r
ta
n
ce
o
f
o
b
s
er
v
a
b
le
b
en
ef
its
d
er
iv
ed
f
r
o
m
th
e
s
y
s
tem
[
3
4
]
.
User
s
wh
o
witn
ess
tan
g
ib
le
im
p
r
o
v
em
en
ts
,
s
u
ch
as
en
h
an
c
ed
p
atien
t
ca
r
e
o
r
r
ed
u
ce
d
s
u
r
g
ical
in
f
ec
tio
n
s
,
ar
e
m
o
r
e
in
clin
ed
to
r
e
g
ar
d
th
e
tech
n
o
lo
g
y
as
v
alu
a
b
le.
T
h
is
alig
n
s
with
p
r
io
r
s
tu
d
ies
o
n
elec
tr
o
n
ic
h
ea
lth
r
ec
o
r
d
s
,
h
ig
h
lig
h
tin
g
th
e
n
ec
ess
ity
f
o
r
in
tu
itiv
e
d
esig
n
an
d
r
o
b
u
s
t
tr
ain
in
g
p
r
o
g
r
am
s
to
f
a
cilitate
tech
n
o
lo
g
y
ad
o
p
tio
n
[
3
5
]
,
[
3
6
]
.
A
p
o
s
s
ib
le
ex
p
lan
atio
n
f
o
r
t
h
is
d
iv
e
r
g
e
n
ce
is
th
at
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
m
ay
p
r
i
o
r
itize
p
er
s
o
n
al
ex
p
e
r
ien
ce
an
d
p
er
c
eiv
ed
ad
v
an
ta
g
es
o
v
er
ex
ter
n
al
o
p
in
io
n
s
.
Pre
v
io
u
s
s
tu
d
ies
h
av
e
s
h
o
wn
th
at
m
an
d
ato
r
y
tech
n
o
lo
g
y
ad
o
p
tio
n
with
o
u
t
clea
r
b
en
ef
its
ca
n
lead
to
r
esis
tan
ce
am
o
n
g
m
ed
ical
s
taf
f
[
3
7
]
–
[
3
9
]
.
T
h
er
ef
o
r
e,
in
s
titu
tio
n
s
im
p
le
m
en
tin
g
t
h
e
SS
I
s
y
s
tem
s
h
o
u
ld
em
p
h
asize
ev
i
d
en
ce
-
b
ase
d
d
em
o
n
s
tr
atio
n
s
t
o
allev
iate
s
k
ep
ticis
m
.
T
h
e
s
ig
n
if
ican
t
im
p
ac
t
o
f
R
D
o
n
PU
u
n
d
er
s
co
r
es
th
e
cr
itic
al
n
ee
d
to
m
a
k
e
th
e
s
y
s
tem
’
s
b
en
ef
its
ap
p
ar
en
t
t
o
u
s
er
s
[
4
0
]
.
W
h
en
u
s
er
s
ca
n
witn
ess
p
o
s
itiv
e
o
u
t
co
m
es,
s
u
ch
as
d
ec
r
ea
s
ed
s
u
r
g
ical
in
f
ec
tio
n
r
ates
an
d
im
p
r
o
v
ed
p
atien
t
ca
r
e,
th
ey
ar
e
m
o
r
e
lik
ely
to
r
eg
ar
d
th
e
s
y
s
tem
as
v
alu
ab
le
an
d
in
teg
r
ate
it
in
to
th
eir
wo
r
k
f
lo
ws.
C
o
n
v
er
s
ely
,
th
e
n
eg
ativ
e
in
f
lu
e
n
ce
o
f
OQ
o
n
PU
in
d
icate
s
th
at
in
ef
f
icien
cies
-
s
u
ch
as
s
lo
w
p
r
o
ce
s
s
in
g
tim
es
o
r
tech
n
ical
g
litch
es
-
ca
n
d
is
s
u
ad
e
u
s
er
s
f
r
o
m
f
u
lly
co
m
m
itti
n
g
to
th
e
te
ch
n
o
lo
g
y
[
4
1
]
.
B
y
ad
d
r
ess
in
g
th
ese
is
s
u
es
th
r
o
u
g
h
s
y
s
tem
en
h
a
n
ce
m
en
ts
an
d
r
esp
o
n
s
iv
e
tech
n
ical
s
u
p
p
o
r
t
,
o
r
g
a
n
izatio
n
s
ca
n
b
o
ls
ter
u
s
er
p
er
ce
p
ti
o
n
an
d
e
n
g
ag
em
e
n
t.
Fu
r
th
er
m
o
r
e,
t
h
e
s
tr
o
n
g
co
r
r
elatio
n
b
etwe
en
PEOU
,
PU,
an
d
I
U
alig
n
s
with
f
in
d
in
g
s
f
r
o
m
p
r
ev
io
u
s
s
tu
d
ies
o
n
elec
tr
o
n
ic
h
ea
lth
r
ec
o
r
d
s
[
3
6
]
.
Hea
lth
ca
r
e
p
r
o
f
ess
io
n
als
ar
e
m
o
r
e
in
clin
ed
to
ac
ce
p
t
s
y
s
tem
s
th
at
r
eq
u
ir
e
m
in
im
al
tr
ain
in
g
an
d
s
ea
m
less
ly
in
teg
r
ate
in
to
th
eir
ex
is
tin
g
wo
r
k
f
lo
ws.
R
esear
c
h
in
d
icate
s
th
at
h
o
s
p
itals
th
at
in
v
est
in
in
tu
itiv
e
d
esig
n
an
d
co
m
p
r
eh
en
s
iv
e
tr
ain
in
g
p
r
o
g
r
a
m
s
ty
p
ically
e
x
p
er
ien
c
e
h
ig
h
er
ad
o
p
tio
n
r
ates
[
3
6
]
.
C
o
n
s
eq
u
en
tly
,
f
u
tu
r
e
im
p
le
m
en
tatio
n
s
s
h
o
u
l
d
p
r
io
r
itize
r
ed
u
cin
g
c
o
m
p
lex
ity
an
d
en
s
u
r
i
n
g
ad
eq
u
ate
u
s
er
s
u
p
p
o
r
t to
en
h
a
n
ce
tech
n
o
lo
g
y
a
cc
ep
tan
ce
.
T
h
e
f
in
d
in
g
s
o
f
o
u
r
s
tu
d
y
h
i
g
h
lig
h
t
im
p
o
r
tan
t
p
r
ac
tical
im
p
licatio
n
s
f
o
r
h
o
s
p
ital
m
an
ag
em
en
t
in
en
h
an
cin
g
th
e
s
u
cc
ess
f
u
l
im
p
l
em
en
tati
o
n
o
f
ap
p
licatio
n
s
o
r
t
ec
h
n
o
lo
g
y
.
I
t
is
ess
en
tial
f
o
r
h
o
s
p
itals
to
co
n
d
u
c
t
r
eg
u
lar
tr
ain
i
n
g
s
ess
io
n
s
th
at
f
am
iliar
ize
u
s
er
s
with
s
y
s
tem
f
u
n
ctio
n
alities
an
d
p
o
ten
tial
ch
an
g
es
t
o
wo
r
k
f
lo
ws.
Ad
d
itio
n
ally
,
an
e
ar
ly
co
m
m
u
n
icatio
n
s
tr
ateg
y
s
h
o
u
ld
b
e
estab
lis
h
ed
to
ef
f
ec
ti
v
ely
em
p
h
asize
th
e
ap
p
licatio
n
'
s
b
en
ef
its
an
d
allev
iate
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y
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esis
tan
ce
am
o
n
g
u
s
er
s
.
SN
s
p
lay
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cr
u
cial
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o
le,
as
th
ey
in
d
ir
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tly
in
f
lu
en
ce
PU
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d
im
ag
e
w
h
ile
d
ir
ec
tly
af
f
ec
tin
g
t
h
e
IU
ap
p
licatio
n
.
Activ
e
in
v
o
lv
e
m
en
t
o
f
m
an
ag
e
m
en
t
in
th
e
im
p
lem
en
ta
tio
n
p
r
o
ce
s
s
is
also
v
ital f
o
r
f
ac
ilit
atin
g
s
m
o
o
th
er
tech
n
o
l
o
g
ical
ad
o
p
tio
n
,
u
l
tim
ately
lead
in
g
to
im
p
r
o
v
e
d
o
u
tc
o
m
es in
h
ea
lth
c
ar
e
s
ettin
g
s
.
T
h
is
s
tu
d
y
p
r
esen
ts
s
ev
er
al
lim
itatio
n
s
.
Firstl
y
,
it
was
c
o
n
d
u
cte
d
in
a
s
in
g
le
in
s
titu
tio
n
,
Haji
Ho
s
p
ital,
wh
ich
m
a
y
r
estrict
t
h
e
g
en
er
aliza
b
ilit
y
o
f
th
e
f
in
d
in
g
s
to
o
th
er
h
ea
lth
ca
r
e
s
ettin
g
s
.
Fu
tu
r
e
r
esear
ch
s
h
o
u
ld
aim
to
in
clu
d
e
m
u
ltip
le
in
s
titu
tio
n
s
to
en
h
an
ce
e
x
ter
n
al
v
alid
ity
.
Seco
n
d
ly
,
th
e
r
elian
ce
o
n
s
elf
-
r
ep
o
r
ted
m
ea
s
u
r
es
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tr
o
d
u
ce
s
th
e
p
o
s
s
ib
ilit
y
o
f
r
esp
o
n
s
e
b
ias.
I
n
co
r
p
o
r
atin
g
o
b
jectiv
e
u
s
ag
e
d
ata
in
f
u
tu
r
e
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ies
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ee
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ig
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ates in
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ates
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ased
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AM
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e
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r
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m
e
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ical
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o
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tio
n
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T
h
e
f
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in
g
s
a
r
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lin
k
e
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to
th
e
p
r
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alu
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SS
I
in
f
o
r
m
atio
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s
tem
at
Haji
Ho
s
p
ital
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E
ast
J
av
a,
I
n
d
o
n
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Ov
er
all,
r
esp
o
n
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e
n
ts
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e
a
f
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o
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ab
le
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ce
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tio
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o
f
th
e
ap
p
licatio
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ac
r
o
s
s
m
o
s
t
in
d
icato
r
s
,
alth
o
u
g
h
its
im
ag
e
is
r
ated
as
o
n
ly
m
o
d
er
ate.
R
ec
en
t
o
b
s
er
v
atio
n
s
r
ev
ea
l
a
n
eg
ativ
e
r
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n
s
h
ip
b
etwe
en
SN
s
an
d
th
e
IU
ap
p
licatio
n
,
w
h
ich
co
n
tr
ad
icts
p
r
ev
io
u
s
ass
u
m
p
tio
n
s
in
tech
n
o
lo
g
y
a
d
o
p
tio
n
r
e
s
ea
r
ch
.
Ou
r
r
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lts
p
r
o
v
id
e
co
m
p
ellin
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i
d
en
ce
t
h
at
th
is
p
h
en
o
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en
o
n
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co
n
n
e
cted
to
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e
r
ce
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tio
n
s
o
f
th
e
ap
p
l
icatio
n
'
s
u
s
ef
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ln
ess
(
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2
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an
d
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e
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5
6
5
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,
r
ath
er
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a
n
b
ein
g
d
r
iv
e
n
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o
lely
b
y
s
o
cial
in
f
lu
en
ce
.
Fu
r
th
e
r
m
o
r
e
,
th
e
n
e
g
ativ
e
ef
f
ec
t o
f
OQ
on
PU
(
H7
: β=
-
0
.
0
7
5
,
p
<
0
.
0
1
)
s
u
g
g
ests
th
at
u
s
er
s
p
er
ce
iv
e
th
e
ap
p
licatio
n
as
in
ef
f
icien
t,
wh
ich
h
am
p
er
s
th
eir
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er
f
o
r
m
an
ce
.
T
h
is
u
n
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er
s
co
r
es
t
h
e
im
p
o
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tan
ce
o
f
im
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r
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v
e
d
tr
ain
in
g
an
d
p
r
o
ac
tiv
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co
m
m
u
n
icatio
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tr
ateg
ies to
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h
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ce
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s
er
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o
n
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id
e
n
ce
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d
f
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ilit
ate
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o
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tio
n
.
Fu
tu
r
e
r
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ch
s
h
o
u
ld
ex
p
an
d
b
ey
o
n
d
a
s
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le
h
o
s
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ital,
ex
p
l
o
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e
n
d
er
d
if
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e
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en
ce
s
in
ad
o
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tio
n
b
eh
a
v
io
r
,
an
d
in
v
esti
g
ate
th
e
r
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le
o
f
wo
r
k
p
l
ac
e
cu
ltu
r
e
an
d
lead
er
s
h
ip
in
s
h
ap
in
g
tech
n
o
l
o
g
y
ac
ce
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ta
n
c
e.
Ad
d
r
ess
in
g
th
ese
f
ac
to
r
s
will
p
r
o
m
o
te
s
m
o
o
th
e
r
tech
n
o
lo
g
y
tr
a
n
s
itio
n
s
an
d
u
ltima
tely
im
p
r
o
v
e
ef
f
icien
cy
an
d
th
e
q
u
ality
o
f
h
ea
lth
ca
r
e
s
er
v
ice
d
eliv
e
r
y
.
ACK
NO
WL
E
DG
E
M
E
NT
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T
h
is
s
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d
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th
esis
f
o
r
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ac
ad
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ic
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r
ee
in
Ma
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ter
o
f
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s
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ital
Ad
m
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is
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atio
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Po
s
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ate
Pro
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Un
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Evaluation Warning : The document was created with Spire.PDF for Python.
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