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l J
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Vo
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Im
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5
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n
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ted
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e
a
lt
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k
f
o
rc
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fro
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iffere
n
t
p
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v
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te
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o
sp
it
a
ls
in
Ba
n
g
a
lo
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In
d
ia.
A
str
u
c
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d
q
u
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st
io
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ire
wa
s
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se
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v
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n
2
6
a
n
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t
h
o
n
3
.
1
3
we
re
u
se
d
fo
r
sta
ti
stica
l
a
n
a
ly
sis.
M
o
st
o
f
th
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p
a
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n
ts
(6
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2
%
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a
d
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g
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d
e
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v
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it
a
s
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n
ti
a
l
fo
r
p
ro
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a
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%
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u
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ty
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t
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re
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ly
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5
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c
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m
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o
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n
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th
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t
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p
it
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d
t
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m
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t
c
o
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tri
b
u
te
d
to
d
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ss
a
ti
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c
ti
o
n
.
Th
u
s,
o
rg
a
n
iza
ti
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n
s
sh
o
u
ld
d
e
v
e
lo
p
a
m
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tran
sp
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re
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t
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fa
ir,
a
n
d
e
m
p
l
o
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e
-
c
e
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tri
c
a
p
p
ra
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sy
ste
m
to
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n
h
a
n
c
e
jo
b
sa
ti
sfa
c
ti
o
n
,
wo
r
k
fo
r
c
e
sta
b
il
it
y
,
a
n
d
o
v
e
ra
ll
p
a
ti
e
n
t
c
a
re
q
u
a
li
t
y
.
K
ey
w
o
r
d
s
:
Hea
lth
wo
r
k
f
o
r
ce
Ho
s
p
ital e
n
v
ir
o
n
m
e
n
t
J
o
b
s
atis
f
ac
tio
n
L
ea
d
er
s
h
ip
ap
p
r
o
ac
h
es
Per
f
o
r
m
an
ce
a
p
p
r
aisal
Sen
tim
en
t a
n
aly
s
is
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
:
Su
b
o
d
h
S
.
Sath
ee
s
h
Dep
ar
tm
en
t o
f
Ho
s
p
ital a
n
d
H
ea
lth
Ma
n
ag
em
en
t,
I
n
s
titu
te
o
f
Hea
lth
Ma
n
ag
em
en
t Res
ea
r
c
h
E
lectr
o
n
ic
C
ity
,
Hu
lim
an
g
ala,
B
an
g
alo
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e,
Kar
n
atak
a
5
6
0
1
0
5
,
I
n
d
ia
E
m
ail:
d
r
s
u
b
o
d
h
s
ath
ee
s
h
@
g
m
ail.
co
m
1.
I
NT
RO
D
UCT
I
O
N
Op
er
atio
n
ef
f
icie
n
cy
an
d
q
u
ality
o
f
ca
r
e
p
r
o
v
id
ed
b
y
h
ea
lth
ca
r
e
s
y
s
tem
s
d
ep
en
d
a
lo
t
o
n
th
e
f
o
u
n
d
atio
n
estab
lis
h
ed
b
y
a
s
k
illed
an
d
m
o
tiv
ated
wo
r
k
f
o
r
c
e
[
1
]
.
T
h
e
lead
er
s
h
ip
s
y
s
tem
s
in
h
o
s
p
itals
ar
e
n
o
t
ju
s
t
ab
o
u
t
p
r
o
d
u
ctiv
ity
it
is
also
ab
o
u
t
d
ev
elo
p
in
g
a
cu
lt
u
r
e
o
f
co
llab
o
r
atio
n
an
d
r
esil
ien
ce
[
2
]
.
T
h
e
jo
b
s
atis
f
ac
tio
n
o
f
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als i
s
s
ig
n
if
ican
tly
im
p
a
cted
b
y
th
ese
lead
er
s
h
ip
ap
p
r
o
ac
h
es a
s
well
as th
e
p
er
f
o
r
m
an
ce
ap
p
r
aisal
s
y
s
tem
s
[
3
]
,
[
4
]
.
Ap
p
r
aisal
p
r
ac
t
ices
in
h
o
s
p
itals
ca
n
h
av
e
a
d
ir
ec
t
im
p
ac
t
o
n
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
al
-
b
ased
o
u
tco
m
es
lik
e
p
r
o
d
u
ctiv
ity
,
r
eten
tio
n
r
ate,
an
d
p
h
y
s
ical
a
n
d
em
o
tio
n
al
well
-
b
ein
g
[
5
]
.
I
n
a
h
ea
lth
ca
r
e
s
ettin
g
th
ese
o
u
tco
m
es
d
ir
e
ctly
im
p
ac
t
th
e
q
u
ality
o
f
ca
r
e
p
r
o
v
id
e
d
an
d
th
e
s
atis
f
ac
tio
n
an
d
well
-
b
ein
g
o
f
p
atien
ts
.
J
o
b
s
atis
f
ac
tio
n
ca
n
b
e
d
ef
i
n
ed
b
r
o
a
d
ly
as
a
f
u
lf
illi
n
g
wo
r
k
ex
p
er
ien
ce
f
o
r
em
p
lo
y
ee
s
.
Per
f
o
r
m
an
ce
ap
p
r
aisals
ar
e
cr
itical
to
h
u
m
an
r
eso
u
r
ce
m
an
ag
em
en
t
an
d
a
s
ig
n
if
ican
t
to
o
l
in
ef
f
ec
tiv
ely
m
an
ag
i
n
g
an
d
im
p
r
o
v
in
g
a
n
em
p
lo
y
ee
’
s
p
er
f
o
r
m
an
ce
[
6
]
.
T
h
e
y
ar
e
im
p
o
r
tan
t
in
d
ec
is
io
n
-
m
ak
in
g
p
r
o
ce
s
s
es
ass
o
ciate
d
with
p
r
o
m
o
tio
n
s
,
r
ec
o
g
n
izin
g
ac
h
iev
e
m
en
ts
,
ca
r
ee
r
d
e
v
elo
p
m
e
n
t,
a
n
d
p
ay
r
aises
.
W
h
en
alig
n
ed
with
clea
r
an
d
f
ai
r
cr
i
ter
ia
ap
p
r
aisal
s
y
s
tem
s
ca
n
en
h
an
ce
em
p
lo
y
ee
s
atis
f
ac
tio
n
an
d
m
o
tiv
atio
n
[
7
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J Pu
b
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Hea
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Sci
I
SS
N:
2252
-
8
8
0
6
I
mp
a
ct
o
f le
a
d
ers
h
ip
a
p
p
r
o
a
c
h
es a
n
d
a
p
p
r
a
is
a
l p
r
a
ctice
s
o
n
h
o
s
p
ita
l wo
r
kfo
r
ce
…
(
S
u
b
o
d
h
S
.
S
a
th
ee
s
h
)
1413
Per
f
o
r
m
an
ce
ap
p
r
aisal
is
n
o
t
j
u
s
t
ab
o
u
t
th
e
m
ea
s
u
r
em
e
n
t
o
f
em
p
lo
y
ee
p
er
f
o
r
m
a
n
ce
,
it
f
o
c
u
s
es
o
n
i
d
en
tify
in
g
an
d
n
u
r
t
u
r
in
g
th
e
s
k
ills
th
at
an
em
p
lo
y
ee
s
h
o
u
l
d
b
u
il
d
to
en
h
an
ce
th
eir
s
k
ills
[
8
]
.
A
s
tan
d
ar
d
ized
p
er
f
o
r
m
an
ce
ap
p
r
aisal
s
y
s
tem
ca
n
g
u
id
e
m
an
ag
er
s
r
eg
a
r
d
in
g
r
eq
u
i
r
em
en
ts
th
at
alig
n
with
in
d
iv
id
u
al
a
n
d
o
r
g
an
izatio
n
al
g
o
als.
L
ea
d
er
s
h
ip
s
ty
les
in
h
o
s
p
ital
s
ca
n
v
ar
y
in
d
if
f
er
en
t
s
p
an
s
o
f
s
ty
les
an
d
ca
n
b
e
tr
an
s
f
o
r
m
atio
n
al,
au
th
o
r
itar
ian
,
o
r
d
em
o
cr
atic
in
ap
p
r
o
ac
h
[
9
]
.
E
f
f
ec
tiv
e
lea
d
er
s
h
ip
p
r
ac
tices
co
n
tr
ib
u
te
h
ea
v
ily
to
a
p
o
s
itiv
e
wo
r
k
en
v
ir
o
n
m
en
t,
th
e
y
ca
n
c
o
n
tr
ib
u
te
t
o
cr
ea
tiv
ity
,
in
n
o
v
a
tio
n
,
an
d
en
h
a
n
cin
g
h
u
m
a
n
r
e
latio
n
s
h
ip
s
th
er
eb
y
im
p
r
o
v
in
g
th
e
p
o
ten
tial
o
f
th
e
em
p
lo
y
ee
[
4
]
.
Ho
s
p
ital
lead
e
r
s
with
th
e
a
b
ilit
y
to
ad
ap
t
to
th
e
ev
o
l
v
in
g
n
ee
d
s
o
f
th
eir
team
s
ar
e
cr
itical
f
o
r
a
p
r
o
d
u
ctiv
e
an
d
p
o
s
itiv
e
wo
r
k
en
v
ir
o
n
m
en
t
[
1
0
]
.
Stu
d
ies
o
v
er
th
e
y
ea
r
s
h
av
e
id
en
tifie
d
th
at
th
e
s
atis
f
ac
tio
n
o
f
s
taf
f
d
ep
en
d
s
a
lo
t
o
n
lea
d
er
s
h
ip
p
r
ac
tices
th
at
ar
e
r
ela
tio
n
al
-
f
o
cu
s
ed
a
n
d
tr
an
s
f
o
r
m
ativ
e
[
1
1
]
.
T
h
e
r
a
p
id
ev
o
lu
tio
n
o
f
h
ea
lth
ca
r
e
s
er
v
i
ce
s
o
v
er
th
e
y
ea
r
s
an
d
th
e
a
g
in
g
p
o
p
u
latio
n
h
av
e
cr
ea
ted
a
d
em
an
d
f
o
r
s
k
illed
h
ea
lth
ca
r
e
o
f
f
icials.
T
h
is
also
em
p
h
asizes
th
e
n
ee
d
f
o
r
n
u
r
t
u
r
in
g
a
s
u
p
p
o
r
tiv
e
an
d
co
n
s
id
er
ate
wo
r
k
en
v
ir
o
n
m
en
t
th
at
ca
n
en
h
a
n
ce
em
p
lo
y
ee
s
atis
f
ac
tio
n
[
1
2
]
.
Fair
p
ay
,
a
m
an
ag
ea
b
le
am
o
u
n
t
o
f
wo
r
k
,
an
d
p
r
o
s
p
ec
t
s
f
o
r
s
k
ill
en
h
an
ce
m
en
t
an
d
p
r
o
f
ess
io
n
al
g
r
o
wth
ar
e
v
ital
in
f
o
s
ter
in
g
th
e
well
-
b
ein
g
o
f
em
p
lo
y
ee
s
[
1
3
]
.
B
y
p
r
io
r
itizin
g
th
e
n
ee
d
s
o
f
th
e
em
p
lo
y
ee
s
,
o
r
g
a
n
izatio
n
s
ca
n
a
ch
iev
e
co
m
m
itm
en
t
o
f
th
eir
em
p
lo
y
ee
s
an
d
u
ltima
t
ely
p
o
s
itiv
e
o
r
g
an
izatio
n
al
cu
l
tu
r
e
an
d
p
atien
t satis
f
ac
tio
n
[
7
]
.
T
h
is
s
tu
d
y
aim
s
to
ex
p
lo
r
e
th
e
n
u
an
ce
d
im
p
ac
t
o
f
p
er
f
o
r
m
an
ce
ap
p
r
aisals
an
d
lead
er
s
h
ip
s
ty
les
o
n
th
e
o
v
er
all
jo
b
s
atis
f
ac
tio
n
o
f
em
p
lo
y
ee
s
in
h
ea
lth
ca
r
e
s
ettin
g
s
.
Per
f
o
r
m
an
ce
a
p
p
r
aisal
is
a
cr
u
cial
m
ec
h
an
is
m
f
o
r
u
n
d
er
s
tan
d
in
g
em
p
lo
y
ee
f
ee
d
b
ac
k
an
d
th
e
lead
er
s
h
ip
a
p
p
r
o
ac
h
h
as
a
s
ig
n
if
ican
t
r
o
le
in
u
n
d
er
s
tan
d
in
g
wo
r
k
p
lace
cu
ltu
r
e
an
d
a
s
en
s
e
o
f
b
elo
n
g
in
g
am
o
n
g
em
p
lo
y
e
es.
T
h
ese
elem
en
ts
wh
e
n
c
o
m
b
in
ed
ca
n
p
r
o
v
id
e
v
alu
ab
le
in
s
ig
h
ts
o
n
jo
b
s
atis
f
ac
tio
n
an
d
q
u
ality
o
f
wo
r
k
ex
p
er
ien
ce
.
2.
M
E
T
H
O
D
A
d
escr
ip
tiv
e
cr
o
s
s
-
s
ec
tio
n
al
m
eth
o
d
was
em
p
lo
y
e
d
to
co
ll
ec
t
d
ata
f
r
o
m
a
r
an
d
o
m
ly
s
a
m
p
led
2
5
8
.
h
ea
lth
wo
r
k
er
s
.
T
h
e
h
ea
lth
w
o
r
k
er
s
wh
o
h
av
e
ex
p
e
r
ien
ce
d
th
e
ap
p
r
aisal
p
r
o
ce
s
s
f
o
r
at
le
ast
two
y
ea
r
s
wer
e
in
clu
d
ed
in
t
h
e
s
tu
d
y
.
T
h
is
en
s
u
r
ed
th
at
th
e
y
h
ad
s
o
m
e
ex
p
er
ien
ce
in
th
e
ap
p
r
aisal
at
le
ast
two
tim
es.
T
h
e
h
ea
lth
wo
r
k
er
s
wh
o
wer
e
n
ew
ly
jo
in
ed
o
r
h
a
d
o
n
ly
o
n
e
-
tim
e
ex
p
er
ie
n
ce
with
a
p
p
r
aisal
w
er
e
n
o
t
in
clu
d
e
d
in
th
e
s
tu
d
y
.
W
e
b
eliev
ed
th
is
wo
u
ld
b
r
in
g
s
o
m
e
u
n
if
o
r
m
ity
i
n
h
av
in
g
s
o
m
e
b
asic
id
ea
ab
o
u
t
th
e
ap
p
r
aisal
f
o
r
th
ese
p
ar
ticip
an
ts
.
T
h
e
s
am
p
le
s
ize
was
d
eter
m
in
ed
u
s
in
g
p
o
wer
an
aly
s
is
with
m
ed
iu
m
ef
f
ec
t
(
0
.
5
0
)
a
n
d
two
-
tailed
p
-
v
al
u
e
≤
0
.
0
5
a
n
d
0
.
8
0
as
p
o
wer
[
1
4
]
.
All
h
ea
lth
wo
r
k
er
s
,
s
atis
f
y
in
g
th
e
i
n
clu
s
io
n
cr
iter
ia
wer
e
lis
ted
f
r
o
m
ea
c
h
o
f
th
e
h
o
s
p
itals
,
a
n
d
2
5
8
p
ar
ticip
an
ts
wer
e
s
el
ec
ted
u
s
in
g
t
h
e
lo
tter
y
m
eth
o
d
.
T
h
e
r
esear
ch
er
s
d
ev
elo
p
e
d
a
s
tr
u
ctu
r
ed
q
u
esti
o
n
n
air
e
as
th
e
p
r
im
ar
y
d
ata
c
o
llectio
n
in
s
tr
u
m
en
t.
Per
f
o
r
m
an
ce
ap
p
r
aisal
an
d
lead
er
s
h
ip
wer
e
t
h
e
k
e
y
o
u
tco
m
e
v
ar
iab
les
th
at
r
ef
lect
h
o
w
th
e
em
p
lo
y
ee
s
f
ee
l
v
al
u
ed
a
n
d
s
u
p
p
o
r
ted
with
in
th
e
r
o
le,
co
n
tr
ib
u
tin
g
to
th
eir
o
v
er
all
s
atis
f
ac
tio
n
with
in
th
eir
o
r
g
an
izatio
n
.
T
h
e
q
u
esti
o
n
n
air
e
in
clu
d
es
b
o
th
clo
s
ed
-
en
d
ed
an
d
o
p
en
-
en
d
ed
q
u
esti
o
n
s
.
T
h
e
clo
s
ed
-
e
n
d
ed
q
u
esti
o
n
s
m
ain
ly
f
o
cu
s
ed
o
n
th
e
ex
p
e
r
ien
ce
s
o
f
h
ea
lth
wo
r
k
e
r
s
with
th
e
ap
p
r
aisal
p
r
o
ce
s
s
an
d
also
g
ath
er
ed
in
f
o
r
m
atio
n
o
n
s
o
cio
-
d
em
o
g
r
ap
h
ic
d
ata,
a
n
d
lead
er
s
h
ip
.
Af
ter
p
r
ep
a
r
in
g
t
h
e
q
u
esti
o
n
n
air
e
,
it
was
s
h
ar
ed
with
in
d
u
s
tr
y
ex
p
e
r
ts
(
3
)
w
h
o
h
ad
m
o
r
e
th
an
5
y
ea
r
s
o
f
ex
p
er
ien
ce
in
m
an
a
g
er
ial
an
d
n
o
n
-
m
an
ag
e
r
ial
r
o
les
in
h
ea
lth
ca
r
e
in
s
titu
tio
n
s
an
d
p
u
b
lic
h
ea
lth
ex
p
er
ts
(
2
)
wh
o
h
ad
m
o
r
e
th
a
n
5
y
ea
r
s
o
f
ex
p
er
ien
ce
in
h
ea
lth
ca
r
e
m
an
ag
em
e
n
t
r
esear
ch
f
o
r
estab
lis
h
in
g
f
ac
e
v
alid
ity
.
Mo
d
if
icatio
n
s
wer
e
m
ad
e
to
th
e
f
in
al
q
u
esti
o
n
n
air
e
as p
er
th
e
s
u
g
g
esti
o
n
s
f
r
o
m
t
h
e
ex
p
er
ts
.
T
h
e
f
in
al
d
ata
co
llectio
n
to
o
l
in
clu
d
ed
m
ea
s
u
r
em
en
t
s
ca
les
l
ik
e
(
Yes/No
)
,
an
d
a
L
ik
er
t
s
ca
le
(
R
atin
g
f
r
o
m
1
-
5
o
n
s
tr
o
n
g
ly
d
is
ag
r
ee
to
s
tr
o
n
g
ly
ag
r
ee
)
.
Me
an
s
an
d
f
r
eq
u
e
n
cies
wer
e
ca
lcu
lated
an
d
th
e
d
ata
wer
e
f
u
r
t
h
er
s
u
m
m
ar
ized
to
m
ea
n
in
g
f
u
l
ca
teg
o
r
ies
o
f
h
ea
lth
wo
r
k
e
r
s
'
ex
p
er
ien
ce
with
ap
p
r
aisal.
T
h
e
d
escr
ip
tiv
e
an
aly
s
is
was
d
o
n
e
u
s
in
g
SP
SS
v
er
s
io
n
2
5
.
T
h
e
u
s
e
o
f
o
p
e
n
-
en
d
ed
q
u
esti
o
n
s
h
elp
e
d
in
co
llectin
g
tex
tu
al
r
esp
o
n
s
es
f
r
o
m
th
e
p
a
r
ticip
an
ts
o
n
d
if
f
er
en
t
asp
ec
ts
o
f
jo
b
s
atis
f
ac
tio
n
.
T
h
e
s
en
tim
en
tal
an
aly
s
is
o
f
th
ese
r
esp
o
n
s
es
was
d
o
n
e
u
s
in
g
Py
th
o
n
v
er
s
io
n
3
.
1
3
.
Sen
tim
en
t
s
co
r
es
wer
e
d
eter
m
in
e
d
b
y
ca
teg
o
r
izin
g
th
e
r
esp
o
n
s
es
in
to
p
o
s
itiv
e,
n
eg
ativ
e,
an
d
n
eu
t
r
al
s
en
tim
en
ts
b
ased
o
n
th
eir
n
atu
r
e,
a
n
d
in
s
ig
h
ts
wer
e
g
en
er
ated
.
B
ef
o
r
e
ad
m
in
is
ter
in
g
th
e
q
u
esti
o
n
n
ai
r
e,
th
e
p
u
r
p
o
s
e
o
f
th
e
s
tu
d
y
was
ex
p
lain
ed
to
th
e
p
ar
ticip
an
ts
an
d
wr
itten
co
n
s
en
t
was
o
b
tain
ed
f
r
o
m
th
e
p
ar
ticip
an
ts
.
T
h
ey
wer
e
in
f
o
r
m
ed
th
at
th
eir
p
ar
ticip
atio
n
was
v
o
lu
n
tar
y
an
d
co
u
ld
with
d
r
aw
f
r
o
m
th
e
s
tu
d
y
if
th
ey
c
h
o
s
e
to
d
o
s
o
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
Am
o
n
g
th
e
s
tu
d
y
p
a
r
ticip
an
ts
,
1
9
2
(
7
4
.
4
%)
wer
e
f
em
ale
a
n
d
6
6
(
2
5
.
6
%)
wer
e
m
ale.
A
m
o
n
g
th
e
p
ar
ticip
an
ts
,
1
4
4
(
5
5
.
8
%)
wer
e
in
th
e
ag
e
g
r
o
u
p
o
f
2
0
-
3
9
a
n
d
1
1
9
(
4
2
.
2
%)
wer
e
in
th
e
30
-
3
9
ag
e
g
r
o
u
p
as
s
h
o
wn
in
T
a
b
le
1
.
R
eg
ar
d
in
g
th
eir
e
d
u
ca
tio
n
al
q
u
alif
icat
io
n
s
,
a
m
ajo
r
ity
o
f
th
em
we
r
e
d
eg
r
ee
h
o
l
d
er
s
(
5
4
.
7
%),
f
o
llo
wed
b
y
m
aster
s
(
2
3
.
6
%)
an
d
d
ip
l
o
m
a
h
o
l
d
e
r
s
(
2
1
.
3
%).
R
eg
ar
d
in
g
th
eir
s
er
v
ice
p
r
o
f
ile,
1
0
2
(
3
9
.
6
%)
h
ad
1
-
3
y
ea
r
s
o
f
e
x
p
e
r
ien
ce
an
d
7
3
(
2
8
.
2
%)
h
ad
4
-
6
y
ea
r
s
o
f
e
x
p
er
ien
ce
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
4
1
2
-
1
4
1
8
1414
T
h
e
r
esu
lts
d
ep
icted
th
at
th
e
m
ajo
r
ity
o
f
th
e
p
ar
ticip
an
ts
(
6
2
.
2
%)
h
ad
a
p
r
o
p
er
u
n
d
er
s
tan
d
in
g
o
f
th
e
p
er
f
o
r
m
an
ce
ap
p
r
aisal
p
r
o
ce
s
s
in
th
eir
r
esp
ec
tiv
e
o
r
g
an
izat
io
n
s
,
as
s
h
o
wn
in
T
ab
le
2
.
T
h
ey
b
eliev
e
th
at
th
e
ap
p
r
aisal
p
r
o
ce
s
s
is
an
i
n
teg
r
a
l
p
ar
t
o
f
p
r
o
f
ess
io
n
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eg
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1415
R
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ar
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tim
en
t sco
r
es o
n
d
i
f
f
er
en
t a
s
p
ec
ts
o
f
p
e
r
f
o
r
m
a
n
ce
ap
p
r
aisal
3
.
1
.
Dis
cus
s
io
n o
f
t
he
f
ind
in
g
s
Per
f
o
r
m
an
ce
ap
p
r
aisals
an
d
lead
er
s
h
ip
ar
e
cr
itical
in
h
ea
lth
ca
r
e
s
ettin
g
s
to
en
s
u
r
e
em
p
lo
y
ee
s
atis
f
ac
tio
n
an
d
m
ain
tain
th
e
q
u
ality
o
f
p
atien
t
ca
r
e
in
h
ea
lth
wo
r
k
er
s
.
wh
e
n
th
e
ap
p
r
aisal
s
y
s
tem
is
tr
an
s
p
ar
en
t,
f
air
,
co
n
s
tr
u
ctiv
e
an
d
co
m
m
u
n
icate
s
clea
r
ly
,
t
h
e
em
p
l
o
y
ee
s
f
ee
l
co
n
f
id
en
t
an
d
ac
k
n
o
wled
g
ed
wh
ich
s
ig
n
if
ican
tly
co
n
tr
ib
u
te
s
to
th
eir
o
v
er
all
jo
b
s
atis
f
ac
ti
o
n
.
Ma
jo
r
ity
o
f
th
e
p
ar
ticip
a
n
t
s
f
elt
th
at
th
ey
h
ad
a
clea
r
u
n
d
er
s
tan
d
in
g
o
f
th
e
p
er
f
o
r
m
an
ce
ap
p
r
aisal
p
r
o
ce
s
s
an
d
r
ec
o
g
n
ized
th
at
it
is
an
in
teg
r
al
p
ar
t
o
f
p
r
o
f
ess
io
n
al
g
r
o
wth
an
d
d
ev
elo
p
m
en
t.
T
h
ey
also
b
eliev
e
th
at
p
er
f
o
r
m
an
ce
ap
p
r
aisals
ca
n
b
e
a
s
o
u
r
ce
o
f
m
o
tiv
atio
n
a
n
d
s
ig
n
if
ican
tly
i
m
p
r
o
v
e
p
e
r
f
o
r
m
an
ce
,
alig
n
in
g
with
o
th
er
s
tu
d
ies.
T
h
u
s
,
th
is
s
h
o
ws
a
p
o
s
itiv
e
p
er
ce
p
tio
n
to
war
d
s
th
e
a
p
p
r
a
is
al
s
y
s
tem
am
o
n
g
th
e
p
ar
tic
ip
an
ts
in
g
en
er
al.
Ho
wev
er
,
m
an
y
o
f
th
em
also
ex
p
r
ess
ed
th
eir
d
is
s
atis
f
ac
tio
n
with
th
e
ap
p
r
aisal
p
r
o
ce
s
s
in
th
eir
o
r
g
an
izatio
n
a
n
d
r
aised
co
n
ce
r
n
s
o
v
er
th
e
f
air
n
ess
an
d
ac
cu
r
ac
y
o
f
th
e
p
r
o
ce
s
s
.
T
h
is
is
attr
ib
u
ted
to
a
clea
r
lack
o
f
co
m
m
u
n
icatio
n
ab
o
u
t
th
e
ap
p
r
aisal
p
r
o
ce
s
s
,
as
m
an
y
s
tu
d
ies
h
av
e
p
o
in
ted
o
u
t
th
e
im
p
o
r
tan
ce
o
f
co
m
m
u
n
icatio
n
in
th
e
p
r
o
ce
s
s
an
d
h
o
w
th
at
ca
n
af
f
ec
t
th
e
p
er
ce
p
tio
n
a
n
d
p
er
f
o
r
m
an
ce
o
f
th
e
p
ar
ticip
an
ts
[
1
5
]
,
[
1
6
]
.
A
clea
r
co
m
m
u
n
icati
o
n
en
s
u
r
in
g
p
r
o
p
e
r
f
ee
d
b
ac
k
o
n
em
p
l
o
y
ee
p
er
f
o
r
m
an
ce
h
el
p
s
th
e
e
m
p
lo
y
ee
s
t
o
u
n
d
er
s
tan
d
th
e
e
x
p
ec
ted
s
tan
d
ar
d
s
a
n
d
clar
ity
with
th
e
ev
alu
atio
n
p
r
o
ce
s
s
ca
n
in
tu
r
n
im
p
r
o
v
e
e
m
p
lo
y
ee
p
er
f
o
r
m
a
n
ce
an
d
p
r
o
f
ess
io
n
al
g
r
o
wth
.
Par
ticip
an
ts
b
eliev
ed
th
at
u
n
f
air
p
r
ac
tices
an
d
u
n
s
atis
f
ac
to
r
y
a
p
p
r
aisal
p
r
o
ce
s
s
es
h
av
e
co
n
tr
ib
u
ted
to
e
m
p
lo
y
ee
attr
itio
n
i
n
th
eir
r
esp
ec
tiv
e
o
r
g
a
n
izatio
n
s
.
T
h
e
ab
s
en
ce
o
f
tr
an
s
p
ar
e
n
cy
in
th
e
p
r
o
ce
s
s
an
d
p
e
r
ce
iv
ed
b
iases
m
ay
co
n
tr
ib
u
te
to
t
h
e
in
s
tab
ilit
y
with
in
th
e
h
ea
lth
wo
r
k
f
o
r
ce
.
T
h
is
f
in
d
in
g
alig
n
s
with
th
e
f
in
d
in
g
s
o
f
V
ar
m
a
an
d
C
h
av
an
,
wh
ich
em
p
h
asize
th
at
a
f
air
an
d
tr
an
s
p
a
r
en
t
a
p
p
r
aisal
p
r
o
ce
s
s
is
in
teg
r
al
t
o
th
e
tu
r
n
o
v
er
in
ten
tio
n
r
ates
o
f
em
p
lo
y
ee
s
[
1
7
]
.
T
h
u
s
,
if
th
e
a
p
p
r
aisal
p
r
o
ce
s
s
is
b
iased
an
d
u
n
eth
ically
ap
p
lie
d
,
th
e
e
m
p
lo
y
ee
is
m
o
r
e
lik
ely
t
o
f
ee
l
in
s
ec
u
r
e
in
th
eir
r
o
les
wh
ich
i
n
tu
r
n
lead
s
to
h
ig
h
er
attr
itio
n
r
ates.
Ad
d
r
ess
in
g
th
ese
is
s
u
es
th
r
o
u
g
h
a
s
tr
u
ctu
r
ed
,
f
air
,
a
n
d
tr
an
s
p
ar
en
t
ap
p
r
aisal
p
r
o
ce
s
s
ca
n
ac
tu
ally
b
en
ef
it
th
e
co
m
p
an
ies
as
th
ese
ca
n
im
p
r
o
v
e
s
atis
f
ac
tio
n
lead
in
g
t
o
g
r
ea
ter
r
eten
tio
n
a
m
o
n
g
th
e
em
p
lo
y
ee
s
[
1
8
]
.
T
h
e
ef
f
ec
tiv
e
lea
d
er
s
h
ip
is
an
o
th
er
k
e
y
f
ac
to
r
,
ch
a
r
ac
ter
ized
b
y
in
d
iv
id
u
alize
d
s
u
p
p
o
r
t,
wh
ich
f
o
s
ter
s
m
o
tiv
atio
n
a
n
d
tr
u
s
t
in
am
o
n
g
th
e
em
p
lo
y
ee
s
.
T
h
e
s
p
ec
if
i
c
lead
er
s
h
ip
q
u
alities
p
lay
a
cr
itical
r
o
le
in
jo
b
s
atis
f
ac
tio
n
.
Am
o
n
g
o
u
r
p
a
r
ticip
an
ts
,
th
e
m
ajo
r
ity
b
eliev
ed
th
at
th
eir
m
an
ag
er
h
ad
an
id
e
alize
d
in
f
lu
en
ce
o
n
th
em
an
d
f
a
v
o
r
e
d
th
at
s
ty
le
o
f
lead
er
s
h
ip
as
it
was
v
ital
in
b
u
ild
in
g
tr
u
s
t
an
d
ad
m
ir
atio
n
.
T
h
is
is
co
n
s
is
ten
t
with
th
e
s
tu
d
ies,
o
n
lead
er
s
h
ip
s
ty
les,
wh
ich
also
id
en
tifie
d
th
e
in
f
lu
en
ce
o
f
m
a
n
ag
er
s
am
o
n
g
em
p
l
o
y
ee
s
an
d
p
r
ef
er
en
ce
f
o
r
id
ea
lized
in
f
lu
en
ce
[
1
1
]
,
[
1
9
]
,
[
2
0
]
.
Ho
wev
er
,
th
e
p
ar
ticip
an
ts
h
ad
m
ix
e
d
o
p
in
io
n
s
o
n
th
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
4
1
2
-
1
4
1
8
1416
lev
els
o
f
in
d
iv
id
u
al
co
n
s
id
er
a
tio
n
s
p
r
o
v
id
ed
b
y
th
eir
m
an
a
g
er
s
.
wh
ile
th
ey
d
o
r
ec
o
g
n
ize
th
e
im
p
o
r
tan
ce
o
f
u
n
d
er
s
tan
d
i
n
g
in
d
iv
id
u
al
s
tr
en
g
th
s
f
o
r
th
eir
ca
r
ee
r
ad
v
a
n
ce
m
en
t,
th
e
ex
ten
t
to
wh
ich
th
e
m
an
ag
er
s
p
r
o
v
id
ed
in
d
iv
id
u
alize
d
s
u
p
p
o
r
t
v
ar
ied
[
2
1
]
,
[
2
2
]
.
Stu
d
ies
h
ig
h
lig
h
te
d
th
e
im
p
o
r
tan
ce
o
f
s
u
p
p
o
r
t
an
d
en
c
o
u
r
a
g
em
en
t
f
r
o
m
t
h
eir
im
m
e
d
iate
m
an
a
g
er
s
an
d
h
o
w
it
im
p
r
o
v
es
p
er
f
o
r
m
an
ce
am
o
n
g
e
m
p
lo
y
ee
s
.
Desp
ite
th
is
,
m
an
y
p
ar
ticip
an
ts
f
elt
th
at
th
eir
m
an
ag
er
lack
e
d
en
th
u
s
iasm
an
d
v
is
io
n
,
an
d
f
ailed
to
b
ec
o
m
e
an
in
s
p
ir
atio
n
al
m
o
tiv
ato
r
f
o
r
th
e
m
.
Par
ticip
an
ts
f
elt
u
n
d
er
v
al
u
ed
a
n
d
u
n
d
er
a
p
p
r
ec
iated
in
th
e
ab
s
en
ce
o
f
p
r
o
p
er
g
u
id
a
n
ce
an
d
s
u
p
p
o
r
t
f
r
o
m
th
ei
r
im
m
e
d
iate
m
an
a
g
er
s
,
ec
h
o
in
g
s
im
ilar
f
in
d
i
n
g
s
r
e
p
o
r
ted
b
y
O
u
y
a
n
g
e
t
a
l.
[
2
3
]
an
d
Kr
iz
e
t
a
l.
[
2
4
]
.
T
h
e
lack
o
f
m
o
tiv
atio
n
al
lead
er
s
h
ip
an
d
g
u
id
an
ce
d
im
i
n
is
h
es
th
e
co
n
f
i
d
en
ce
an
d
lim
its
th
e
p
er
f
o
r
m
an
ce
o
f
th
ese
em
p
lo
y
ee
s
.
B
y
f
o
s
ter
in
g
a
p
o
s
itiv
e
an
d
in
s
p
ir
in
g
wo
r
k
e
n
v
ir
o
n
m
en
t
with
ef
f
ec
tiv
e
lead
er
s
h
ip
an
d
in
d
iv
i
d
u
alize
d
s
u
p
p
o
r
t
ca
n
e
n
h
an
ce
th
eir
c
o
n
n
ec
tio
n
with
th
eir
m
an
ag
er
s
an
d
ca
n
ac
t
as
a
s
o
u
r
ce
o
f
m
o
tiv
atio
n
f
o
r
t
h
e
e
m
p
lo
y
ee
.
W
h
ile
m
o
s
t
o
f
th
e
p
ar
ticip
an
ts
ag
r
ee
d
th
at
t
h
eir
m
an
a
g
er
s
h
a
v
e
p
r
o
v
id
ed
t
h
em
s
p
ac
e
to
d
is
cu
s
s
th
eir
co
n
ce
r
n
s
o
n
t
h
e
ap
p
r
aisal
p
r
o
ce
s
s
,
m
an
y
f
elt
th
ese
d
is
cu
s
s
io
n
s
r
ar
ely
led
to
an
y
s
ig
n
if
ican
t
o
u
tco
m
es
.
Par
ticip
an
ts
o
f
ten
f
elt
th
at
t
h
e
r
e
was
a
ten
d
en
c
y
am
o
n
g
th
e
m
an
ag
er
s
to
o
v
e
r
lo
o
k
th
e
im
p
o
r
tan
ce
o
f
g
iv
in
g
co
n
s
tr
u
ctiv
e
f
e
ed
b
ac
k
.
T
h
is
lack
o
f
co
n
s
tr
u
ctiv
e
f
e
ed
b
ac
k
is
a
s
ig
n
if
ican
t
is
s
u
e
n
o
ted
b
y
[
2
5
]
,
[
2
6
]
w
h
ich
h
ig
h
lig
h
ted
th
e
im
p
ac
t
o
f
th
i
s
f
ee
d
b
ac
k
o
n
m
ain
tain
in
g
p
e
r
f
o
r
m
a
n
ce
s
tan
d
ar
d
s
am
o
n
g
t
h
e
em
p
lo
y
ee
s
.
T
h
e
p
er
ce
iv
ed
b
ias
o
f
m
an
a
g
er
s
in
th
e
ap
p
r
aisal
p
r
o
ce
s
s
was
a
m
ajo
r
co
n
ce
r
n
v
o
iced
b
y
th
e
p
ar
ticip
an
ts
.
R
esear
ch
b
y
Alm
ar
o
et
a
l
.
[
2
7
]
,
B
elle
e
t
a
l
.
[
2
8
]
,
an
d
T
r
an
et
a
l
.
[
2
9
]
d
is
cu
s
s
es
th
ese
b
iases
an
d
th
ei
r
d
etr
im
e
n
tal
ef
f
e
ct
o
n
em
p
lo
y
ee
s
'
tr
u
s
t
in
o
r
g
a
n
izatio
n
al
s
tan
d
ar
d
s
an
d
tr
an
s
p
ar
en
cy
in
th
e
ap
p
r
aisal
p
r
o
ce
s
s
.
T
o
im
p
r
o
v
e
em
p
lo
y
ee
tr
u
s
t,
o
r
g
an
izatio
n
s
s
h
o
u
ld
f
o
cu
s
o
n
p
r
o
v
id
in
g
h
ig
h
-
q
u
ality
c
o
n
s
tr
u
ctiv
e
f
e
ed
b
ac
k
as
well
as
d
ev
elo
p
s
tr
ateg
ies
to
a
d
d
r
es
s
p
er
ce
iv
ed
b
iases
.
C
r
ea
tin
g
an
u
n
b
iased
ap
p
r
aisal
p
r
o
c
ess
with
clea
r
an
d
ac
tio
n
ab
le
f
ee
d
b
ac
k
ca
n
s
tr
en
g
th
en
th
e
co
n
f
id
en
ce
o
f
th
e
e
m
p
lo
y
ee
in
th
e
f
air
n
ess
o
f
th
e
ap
p
r
aisal
p
r
o
ce
s
s
an
d
th
e
in
te
g
r
ity
o
f
th
e
ap
p
r
aisal e
v
alu
atio
n
s
.
W
e
b
eliev
e
th
e
s
en
tim
en
t
a
n
aly
s
is
g
iv
es
a
clea
r
e
r
d
e
f
i
n
itio
n
o
f
p
ar
ticip
an
ts
'
f
ee
lin
g
s
o
n
th
e
p
er
f
o
r
m
an
ce
ap
p
r
aisal
p
r
o
ce
s
s
,
an
d
h
el
p
ed
u
s
to
i
n
ter
p
r
et
th
eir
f
ee
lin
g
s
o
n
jo
b
s
atis
f
ac
tio
n
.
T
h
e
p
er
f
o
r
m
a
n
c
e
ap
p
r
aisal
p
r
o
ce
s
s
an
d
co
n
ce
r
n
s
o
v
er
p
ar
tiality
h
ad
a
h
ig
h
er
p
r
o
p
o
r
tio
n
o
f
n
eg
ativ
e
o
r
n
eu
tr
al
s
en
tim
en
ts
em
er
g
e
m
ay
b
e
d
u
e
to
th
e
co
m
m
o
n
p
er
ce
p
tio
n
o
f
u
n
f
air
f
a
v
o
r
itis
m
o
r
b
ias
th
at
m
ay
af
f
ec
t
th
e
tr
u
s
t
in
th
e
p
r
o
ce
s
s
.
Ov
er
all
all
th
e
r
esp
o
n
s
es
d
r
ew
n
e
g
ativ
e
o
r
n
eu
tr
al
s
en
tim
en
t
s
u
g
g
esti
n
g
th
at
th
e
e
m
p
lo
y
ee
m
ay
h
a
v
e
a
m
is
co
n
ce
p
tio
n
r
eg
ar
d
in
g
th
e
f
air
n
ess
in
th
e
p
r
o
ce
s
s
o
r
m
a
y
b
e
d
is
ap
p
o
in
ted
r
eg
ar
d
in
g
t
h
e
o
u
tco
m
es
o
f
th
e
ap
p
r
aisal
p
r
o
ce
s
s
,
s
im
ilar
s
tu
d
ies,
also
r
ep
o
r
ted
th
at
th
e
b
ias
in
th
e
ap
p
r
aisal
p
r
o
ce
s
s
s
u
ch
as
p
ar
tiality
,
co
m
m
u
n
icatio
n
g
ap
s
,
an
d
lac
k
o
f
in
cr
em
en
ts
ca
n
u
n
d
er
m
in
e
th
e
tr
u
s
t
an
d
r
esu
lt
in
d
is
s
ati
s
f
ac
tio
n
am
o
n
g
th
e
p
ar
ticip
an
ts
[
3
0
]
–
[
3
2
]
.
T
o
g
eth
er
,
p
er
f
o
r
m
an
ce
ap
p
r
aisal
a
n
d
lead
er
s
h
ip
r
o
les
s
h
ap
e
d
th
e
p
er
ce
p
tio
n
s
o
f
o
u
r
s
tu
d
y
p
ar
ticip
an
ts
an
d
th
eir
in
ten
tio
n
to
s
tay
in
th
eir
jo
b
lead
in
g
to
s
atis
f
ac
tio
n
.
T
h
is
s
t
u
d
y
o
f
f
er
ed
a
n
o
v
el
ap
p
r
o
ac
h
to
d
if
f
er
e
n
tiatin
g
th
e
s
en
tim
en
ts
o
f
p
ar
ticip
an
ts
o
n
jo
b
s
atis
f
ac
tio
n
an
d
t
h
e
p
e
r
f
o
r
m
an
ce
ap
p
r
aisal
p
r
o
ce
s
s
.
Usi
n
g
th
is
,
th
e
r
esear
ch
er
s
wer
e
a
b
le
to
id
en
tify
th
e
s
p
ec
if
ic
ar
ea
s
th
at
ar
e
i
n
n
e
ed
o
f
im
p
r
o
v
em
e
n
t.
E
v
en
th
o
u
g
h
th
is
s
tu
d
y
p
r
o
v
id
ed
a
d
etailed
u
n
d
er
s
tan
d
in
g
o
f
v
ar
i
o
u
s
asp
ec
ts
th
at
co
n
tr
i
b
u
ted
to
th
e
o
v
er
all
s
atis
f
ac
tio
n
,
th
is
s
tu
d
y
co
llected
o
n
ly
s
am
p
les
f
r
o
m
p
r
i
v
ate
h
o
s
p
itals
in
th
e
m
etr
o
p
o
litan
city
o
f
th
e
co
u
n
tr
y
,
wh
ich
m
ay
lim
it
th
e
g
en
e
r
aliza
b
ilit
y
o
f
o
u
r
f
in
d
i
n
g
s
.
I
n
a
d
d
itio
n
to
s
en
tim
en
t
an
al
y
s
is
,
th
is
s
tu
d
y
m
ain
ly
o
f
f
er
s
a
d
escr
ip
tiv
e
an
aly
s
is
o
f
th
e
q
u
an
titativ
e
v
a
r
iab
les
to
u
n
d
er
s
tan
d
th
e
e
f
f
ec
tiv
en
e
s
s
o
f
p
er
f
o
r
m
an
ce
ap
p
r
aisals
an
d
lead
er
s
h
ip
ap
p
r
o
ac
h
es
o
n
th
e
o
v
er
all
jo
b
s
at
is
f
ac
tio
n
o
f
th
e
wo
r
k
f
o
r
ce
in
h
ea
lth
ca
r
e
s
ettin
g
s
.
Fu
tu
r
e
s
tu
d
ies
co
u
ld
ca
r
r
y
o
u
t
a
th
o
r
o
u
g
h
q
u
alitativ
e
an
aly
s
is
th
at
f
u
r
th
er
ex
p
lo
r
es
th
e
p
er
ce
p
tio
n
o
f
wo
r
k
cu
ltu
r
e
o
r
m
o
tiv
atio
n
o
r
f
u
r
th
e
r
in
v
esti
g
ates w
o
r
k
en
g
ag
em
e
n
t a
n
d
o
r
g
an
izatio
n
al
co
m
m
it
m
en
t.
4.
CO
NCLU
SI
O
N
E
n
s
u
r
in
g
s
atis
f
ac
tio
n
with
p
e
r
f
o
r
m
a
n
ce
s
tan
d
a
r
d
s
am
o
n
g
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
is
es
s
en
tial
f
o
r
f
o
s
ter
in
g
c
o
n
tin
u
o
u
s
s
k
ill
d
e
v
elo
p
m
en
t
a
n
d
en
ab
lin
g
th
e
m
t
o
ex
ce
l
in
t
h
eir
r
esp
o
n
s
ib
ilit
ies
.
I
t
is
also
a
cr
itical
p
ar
t
o
f
a
n
o
r
g
an
izatio
n
'
s
m
is
s
i
o
n
to
ac
h
iev
e
o
r
g
an
izatio
n
al
g
o
als
wh
ich
u
ltima
tely
r
esu
lts
in
en
h
a
n
ce
d
q
u
ality
o
f
p
atien
t
ca
r
e.
T
h
e
s
tu
d
y
em
p
h
asizes
th
e
s
ig
n
if
ican
ce
o
f
a
p
er
f
o
r
m
an
ce
ap
p
r
aisal
s
y
s
te
m
an
d
lead
er
s
h
ip
i
n
em
p
lo
y
ee
jo
b
s
atis
f
ac
tio
n
.
T
h
e
m
ajo
r
co
n
ce
r
n
s
ex
p
r
ess
ed
in
clu
d
e
th
e
f
air
n
ess
,
ac
cu
r
ac
y
,
a
n
d
tr
an
s
p
ar
e
n
cy
o
f
th
e
ap
p
r
aisal
p
r
o
ce
s
s
a
n
d
t
h
e
lack
o
f
in
d
iv
id
u
alize
d
s
u
p
p
o
r
t
i
n
lead
e
r
s
h
ip
.
Per
f
o
r
m
a
n
ce
f
ee
d
b
ac
k
an
d
g
u
id
an
ce
f
r
o
m
m
an
ag
e
r
s
ar
e
cr
u
cial
f
o
r
em
p
lo
y
ee
r
eten
t
io
n
a
n
d
p
er
f
o
r
m
an
ce
s
tan
d
ar
d
s
.
E
s
tab
lis
h
in
g
a
s
tr
u
ctu
r
ed
a
n
d
u
n
b
iased
ap
p
r
a
is
al
s
y
s
tem
th
at
en
s
u
r
es
tr
an
s
p
ar
en
cy
,
an
d
f
air
n
ess
,
as
well
a
s
cr
ea
tin
g
ef
f
ec
tiv
e
lead
er
s
h
ip
,
f
o
r
a
s
u
p
p
o
r
tiv
e
wo
r
k
en
v
i
r
o
n
m
e
n
t,
s
h
o
u
l
d
b
e
th
e
to
p
p
r
io
r
ities
f
o
r
th
e
h
ea
lth
o
r
g
an
izatio
n
s
.
Stra
teg
ies
th
at
f
o
cu
s
o
n
th
es
e
n
o
t
o
n
ly
p
r
o
m
o
te
jo
b
s
atis
f
ac
tio
n
b
u
t
also
en
ab
le
a
s
tead
y
an
d
co
n
f
id
en
t
wo
r
k
f
o
r
ce
,
wh
ich
e
v
en
tu
ally
,
f
u
lf
ill th
e
b
ig
g
er
g
o
al
o
f
p
r
o
v
id
in
g
h
i
g
h
-
q
u
ality
p
atien
t c
ar
e
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
N
o
f
u
n
d
i
n
g
i
n
v
o
l
v
e
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
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mp
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ct
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a
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ip
a
p
p
r
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n
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p
p
r
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is
a
l p
r
a
ctice
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o
n
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o
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p
ita
l wo
r
kfo
r
ce
…
(
S
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o
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S
.
S
a
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1417
AUTHO
R
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M
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N
T
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h
is
jo
u
r
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u
s
es
th
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C
o
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tr
ib
u
to
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o
les
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ax
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al
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d
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ho
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C
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eg
u
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s
titu
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n
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o
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in
ac
co
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th
e
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r
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n
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1
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3
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