I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h Science
(
I
J
P
H
S)
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
2
0
2
5
,
p
p
.
1
5
61
~
1
56
8
I
SS
N:
2
2
5
2
-
8
8
0
6
,
DOI
: 1
0
.
1
1
5
9
1
/ijp
h
s
.
v
1
4
i3
.
2
5
9
8
1
1561
J
o
ur
na
l ho
m
ep
a
g
e
:
h
ttp
:
//
ijp
h
s
.
ia
esco
r
e.
co
m
K
n
o
w
l
e
d
g
e
,
a
t
t
i
t
u
d
e
s
,
a
n
d
p
r
a
c
t
i
c
e
s
o
f
n
u
r
s
e
s
c
a
r
i
n
g
f
o
r
s
u
r
g
i
c
a
l
c
e
r
e
b
r
a
l
a
n
e
u
r
y
s
m
p
a
t
i
e
n
t
s
i
n
a
T
h
a
i
T
e
r
t
i
a
r
y
H
o
s
p
i
t
a
l
P
a
la
ma
So
bu
t
1
,
B
o
o
ny
a
da
Wo
ng
pim
o
ln
1
,
Su
pa
t
t
ra
P
lea
y
no
ng
k
ha
e
2
,
K
it
i
y
a
ra
t
H
a
nl
ue
2
,
Sa
t
t
a
wa
s
Udo
ns
a
t
1
1
D
i
v
i
si
o
n
o
f
A
d
u
l
t
a
n
d
G
e
r
o
n
t
o
l
o
g
i
c
a
l
N
u
r
si
n
g
,
F
a
c
u
l
t
y
o
f
N
u
r
si
n
g
,
R
o
i
E
t
R
a
j
a
b
h
a
t
U
n
i
v
e
r
s
i
t
y
,
R
o
i
Et
,
T
h
a
i
l
a
n
d
2
N
e
u
r
o
su
r
g
e
r
y
I
n
t
e
n
si
v
e
C
a
r
e
U
n
i
t
,
R
o
i
Et
H
o
s
p
i
t
a
l
,
R
o
i
Et
,
T
h
a
i
l
a
n
d
Art
icle
I
nfo
AB
S
T
RAC
T
A
r
ticle
his
to
r
y:
R
ec
eiv
ed
Sep
3
0
,
2
0
2
4
R
ev
is
ed
Dec
2
3
,
2
0
2
4
Acc
ep
ted
Ma
r
6
,
2
0
2
5
Ru
p
t
u
re
d
c
e
re
b
ra
l
a
n
e
u
ry
sm
a
f
ter
su
rg
e
ry
is
a
c
rit
ica
l
c
o
n
d
i
ti
o
n
th
a
t
n
e
c
e
ss
it
a
tes
v
ig
il
a
n
t
m
o
n
i
to
ri
n
g
a
n
d
e
a
rly
d
e
tec
ti
o
n
o
f
c
o
m
p
li
c
a
ti
o
n
s
b
y
sta
ff
n
u
rse
s
.
Th
e
re
fo
re
,
a
n
a
p
p
r
o
p
riate
lev
e
l
o
f
sk
il
l
a
n
d
k
n
o
wle
d
g
e
re
l
a
ted
to
t
h
e
m
a
n
a
g
e
m
e
n
t
o
f
p
a
ti
e
n
ts
u
n
d
e
rg
o
i
n
g
s
u
rg
e
ry
is
c
r
u
c
ial
fo
r
n
u
rse
s
t
o
su
p
p
o
rt
th
e
se
p
a
ti
e
n
ts
.
T
h
e
c
u
rre
n
t
re
s
e
a
rc
h
a
ime
d
to
e
x
a
m
in
e
KA
P
in
d
ica
to
rs
(k
n
o
wle
d
g
e
,
a
tt
it
u
d
e
,
a
n
d
p
ra
c
ti
c
e
)
a
m
o
n
g
n
u
rse
s
i
n
th
is
c
o
n
tex
t,
m
a
k
in
g
u
se
o
f
a
c
ro
ss
-
se
c
ti
o
n
a
l
stu
d
y
d
e
sig
n
in
v
o
l
v
in
g
th
e
p
a
rti
c
i
p
a
ti
o
n
o
f
1
1
1
sta
ff
n
u
rse
s
se
lec
ted
ra
n
d
o
m
ly
fr
o
m
o
n
e
tertiary
h
o
sp
it
a
l
l
o
c
a
ted
in
th
e
n
o
rt
h
e
a
st
o
f
T
h
a
il
a
n
d
.
T
h
e
stu
d
y
wa
s
c
a
rried
o
u
t
d
u
rin
g
F
e
b
ru
a
ry
–
Ju
n
e
2
0
2
4
,
m
a
k
i
n
g
u
se
o
f
a
su
rv
e
y
t
o
a
c
q
u
ire
d
e
m
o
g
ra
p
h
ic
d
a
ta
a
lo
n
g
with
a
q
u
e
sti
o
n
n
a
ire
to
m
e
a
su
re
th
e
KA
P
in
d
ica
to
rs.
Da
ta
we
re
a
n
a
ly
z
e
d
u
sin
g
t
h
e
S
p
e
a
rm
a
n
c
o
rre
latio
n
c
o
e
fficie
n
t
a
n
d
P
e
a
rso
n
c
o
rre
latio
n
c
o
e
fficie
n
t
.
Th
e
fin
d
i
n
g
re
v
e
a
led
th
a
t
th
e
o
v
e
ra
ll
KA
P
sc
o
re
o
n
c
a
rin
g
p
a
ti
e
n
ts
with
r
u
p
tu
re
d
c
e
re
b
ra
l
a
n
e
u
ry
sm
u
n
d
e
rg
o
in
g
su
rg
e
ry
w
a
s
h
ig
h
.
Ho
we
v
e
r,
t
h
e
c
o
rre
latio
n
o
b
se
rv
e
d
b
e
twe
e
n
k
n
o
wle
d
g
e
/
a
tt
it
u
d
e
/
a
g
e
/
d
u
ra
ti
o
n
o
f
e
x
p
e
rien
c
e
fo
r
c
a
rin
g
p
a
ti
e
n
ts
with
ru
p
tu
re
d
c
e
re
b
ra
l
a
n
e
u
r
y
sm
u
n
d
e
r
g
o
i
n
g
s
u
rg
e
ry
a
n
d
p
ra
c
ti
c
e
wa
s sh
o
wn
to
b
e
b
o
th
p
o
sit
iv
e
a
n
d
si
g
n
if
ica
n
t
(
p
<
0
.
0
5
)
.
T
h
e
re
fo
re
,
n
u
rse
a
d
m
in
istrato
rs
sh
o
u
l
d
imp
lem
e
n
t
a
c
o
m
p
re
h
e
n
siv
e
k
n
o
wle
d
g
e
train
i
n
g
s
y
ste
m
,
e
n
h
a
n
c
e
sp
e
c
ialize
d
train
i
n
g
,
a
n
d
im
p
ro
v
e
n
u
rsi
n
g
p
ra
c
ti
c
e
s
fo
r
t
h
e
se
p
a
ti
e
n
ts
.
T
h
is
will
h
e
lp
to
e
n
su
re
t
h
a
t
sta
ff
n
u
rs
e
s
a
c
h
iev
e
a
h
ig
h
lev
e
l
o
f
KA
P
in
p
ro
v
id
in
g
o
p
ti
m
a
l
c
a
re
fo
r
t
h
e
se
p
a
ti
e
n
ts
.
K
ey
w
o
r
d
s
:
Attitu
d
e
Kn
o
wled
g
e
Pra
ctice
R
u
p
tu
r
ed
ce
r
e
b
r
al
an
e
u
r
y
s
m
Staf
f
n
u
r
s
es
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
:
Sattawas U
d
o
n
s
at
Div
is
io
n
o
f
Ad
u
lt a
n
d
Ger
o
n
to
lo
g
ical
Nu
r
s
in
g
,
Facu
lty
o
f
Nu
r
s
in
g
,
R
o
i E
t Rajab
h
at
Un
iv
er
s
ity
R
o
i E
t,
T
h
ailan
d
E
m
ail
:
s
attawa
s
9
@
g
m
ail.
co
m
,
s
attawa
s
.
u
@
r
er
u
.
ac
.
th
1.
I
NT
RO
D
UCT
I
O
N
R
u
p
tu
r
ed
ce
r
eb
r
al
a
n
eu
r
y
s
m
s
ar
e
a
m
ajo
r
h
ea
lth
co
n
ce
r
n
,
with
ap
p
r
o
x
im
ately
3
.
2
%
o
f
th
e
g
lo
b
a
l
p
o
p
u
latio
n
r
ec
eiv
i
n
g
tr
ea
tm
e
n
t
ea
ch
y
ea
r
[
1
]
.
T
h
e
r
u
p
tu
r
e
r
a
te
o
f
ce
r
eb
r
al
a
n
eu
r
y
s
m
s
,
lead
i
n
g
to
s
u
b
ar
ac
h
n
o
id
h
em
o
r
r
h
ag
e
(
SAH
)
,
is
ab
o
u
t
9
p
er
1
0
0
,
0
0
0
p
eo
p
le
.
An
eu
r
y
s
m
al
SAH
ac
co
u
n
ts
f
o
r
0
.
4
%
t
o
0
.
6
%
o
f
all
d
ea
t
h
s
,
with
an
esti
m
ated
2
0
%
m
o
r
tality
r
ate
an
d
3
0
%
to
4
0
%
o
f
s
u
r
v
iv
o
r
s
ex
p
er
ie
n
cin
g
lo
n
g
-
ter
m
co
m
p
licatio
n
s
[
2
]
.
A
liter
atu
r
e
r
ev
iew
id
en
tifie
s
s
ev
er
al
r
is
k
f
ac
to
r
s
f
o
r
d
ev
e
lo
p
in
g
ce
r
eb
r
al
an
eu
r
y
s
m
s
as
;
Firstl
y
,
p
er
s
o
n
al
f
ac
to
r
s
s
u
ch
as
ad
v
an
ce
d
ag
e
[
3
]
,
f
am
ily
h
is
to
r
y
o
f
ce
r
eb
r
al
an
eu
r
y
s
m
[
4
]
,
h
y
p
e
r
ten
s
io
n
,
[
3
]
,
[
5
]
,
[
6
]
,
f
em
ale
g
en
d
er
[
6
]
-
[
8
]
,
an
d
h
is
to
r
y
o
f
tr
au
m
atic
b
r
ain
i
n
ju
r
ies
.
Seco
n
d
ly
,
h
ea
lth
b
eh
a
v
io
r
al
f
ac
to
r
s
s
u
ch
as
s
u
b
s
tan
ce
ab
u
s
e
(
alco
h
o
l,
m
eth
am
p
h
eta
m
in
e,
an
d
co
ca
in
e
)
[
9
]
,
[1
0
]
,
an
d
s
m
o
k
in
g
[
5
]
,
[
9
]
,
[1
1
]
.
L
astl
y
,
g
en
etic
co
n
d
itio
n
s
s
u
ch
as
ar
ter
io
v
e
n
o
u
s
m
alf
o
r
m
atio
n
s
(
AVM
)
[
1
2
]
,
[
1
3
]
.
E
s
s
en
tially
,
h
ea
lt
h
b
eh
a
v
io
r
s
ar
e
a
n
im
p
o
r
tan
t
f
ac
to
r
in
m
an
ag
i
n
g
b
lo
o
d
p
r
ess
u
r
e
an
d
m
ain
tain
i
n
g
v
ascu
lar
h
ea
lth
,
p
ar
ticu
lar
l
y
f
o
r
p
atien
ts
wh
o
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
5
61
-
1
56
8
1562
h
av
e
u
n
d
er
g
o
n
e
ce
r
eb
r
o
v
ascu
lar
s
u
r
g
er
y
.
R
ec
en
t
s
tu
d
ies
in
d
icate
th
at
h
ig
h
lev
els
o
f
s
u
b
s
tan
ce
ab
u
s
e
an
d
h
ea
v
y
s
m
o
k
i
n
g
ar
e
ass
o
ciate
d
with
in
cr
ea
s
ed
r
is
k
.
T
h
u
s
,
im
p
r
o
v
in
g
life
s
ty
le
ch
o
ices
co
u
ld
s
ig
n
if
ican
tl
y
r
ed
u
ce
th
e
r
is
k
o
f
d
ev
elo
p
in
g
r
u
p
tu
r
ed
ce
r
eb
r
al
a
n
eu
r
y
s
m
s
[
9
]
,
[1
1
]
,
[1
4
].
A
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
is
a
cr
itical
em
er
g
en
cy
th
at
d
em
an
d
s
im
m
ed
iate
m
an
a
g
em
en
t
to
p
r
ev
en
t
s
ev
er
e
n
eu
r
o
lo
g
ical
d
am
ag
e
o
r
d
ea
th
[
15
]
.
I
m
p
o
r
tan
tly
,
a
s
u
b
s
et
o
f
s
tr
o
k
e
ch
ar
ac
ter
ized
b
y
h
ig
h
f
atality
an
d
m
o
r
b
id
ity
,
o
cc
u
r
r
in
g
at
a
y
o
u
n
g
er
ag
e
th
an
o
th
er
s
tr
o
k
e
ty
p
es
[
16
]
.
Acc
o
r
d
in
g
ly
,
it
is
cr
u
cial
to
m
ak
e
an
d
iag
n
o
s
is
at
an
ea
r
ly
s
tag
e
in
o
r
d
er
to
p
er
f
o
r
m
an
eu
r
y
s
m
o
cc
lu
s
io
n
.
On
e
o
f
th
e
tr
ea
tm
en
t
o
p
tio
n
s
was su
r
g
ical
clip
p
in
g
o
f
th
e
an
eu
r
y
s
m
v
ia
cr
an
io
to
m
y
[
17
]
.
T
h
e
p
o
s
to
p
er
ativ
e
cr
itical
p
er
io
d
f
o
r
p
atien
ts
with
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
s
is
f
r
au
g
h
t
with
d
an
g
er
,
as
in
itial
h
em
o
r
r
h
ag
e,
ea
r
ly
r
ec
u
r
r
en
t
b
leed
in
g
,
ce
r
eb
r
al
v
aso
s
p
asm
,
s
eizu
r
es,
ce
r
eb
r
al
ed
em
a,
an
d
d
elay
ed
ce
r
eb
r
al
is
ch
em
ia
(
DC
I
)
ar
e
all
f
ac
to
r
s
wh
ich
ca
n
lead
to
ex
ce
s
s
iv
e
lev
els
o
f
b
o
th
m
o
r
tality
an
d
m
o
r
b
id
ity
[
18
]
.
Ab
s
o
lu
tely
,
p
o
s
to
p
er
ativ
e
n
u
r
s
in
g
ca
r
e
is
im
p
o
r
tan
t
f
o
r
p
r
ev
en
tin
g
co
m
p
licatio
n
s
an
d
en
s
u
r
in
g
a
s
m
o
o
th
r
ec
o
v
er
y
f
o
r
p
atien
ts
u
n
d
er
g
o
in
g
ce
r
eb
r
o
v
ascu
lar
s
u
r
g
er
y
[
1
9
]
.
T
h
eir
co
m
m
itm
en
t
to
co
n
tin
u
o
u
s
m
o
n
ito
r
in
g
an
d
ea
r
ly
d
etec
tio
n
o
f
co
m
p
licatio
n
s
is
cr
u
cial
in
p
r
ev
en
tin
g
co
m
p
licatio
n
s
an
d
en
s
u
r
in
g
o
p
tim
al
o
u
tco
m
es
.
Fu
r
th
er
m
o
r
e,
a
lack
o
f
k
n
o
wled
g
e
am
o
n
g
s
taf
f
n
u
r
s
es
in
ca
r
in
g
f
o
r
th
ese
p
atien
ts
ca
n
g
r
ea
tly
elev
ate
th
e
r
is
k
o
f
co
m
p
licatio
n
s
[
20
]
.
C
o
n
s
eq
u
en
tly
,
s
taf
f
n
u
r
s
es
m
u
s
t
p
o
s
s
ess
a
s
o
lid
f
o
u
n
d
atio
n
o
f
k
n
o
wled
g
e
to
ef
f
ec
tiv
ely
p
r
ev
en
t
co
m
p
licatio
n
s
f
o
llo
win
g
s
u
r
g
er
y
[
21
]
.
T
h
is
p
r
o
ce
s
s
b
eg
in
s
with
a
th
o
r
o
u
g
h
r
is
k
ass
ess
m
en
t
an
d
in
itial
ev
alu
atio
n
f
o
r
s
u
r
g
ical
p
atien
ts
,
f
o
llo
wed
b
y
ef
f
ec
tiv
e
m
an
ag
em
en
t
s
tr
ateg
ies
f
o
r
an
y
id
en
tifie
d
r
is
k
s
,
p
r
ev
en
tin
g
r
ec
u
r
r
en
t
b
leed
in
g
[2
2
]
,
d
elay
ed
ce
r
eb
r
al
is
ch
em
ia,
c
er
eb
r
al
v
aso
s
p
asm
,
in
cr
ea
s
ed
in
tr
ac
r
an
ial
p
r
ess
u
r
e
(
I
I
C
P
)
,
ce
r
eb
r
al
ed
em
a
[
22
]
,
[
23
]
,
an
d
s
eizu
r
e
[
24
]
,
[
25
]
.
Mo
r
eo
v
er
,
a
n
eg
ativ
e
attitu
d
e
am
o
n
g
s
taf
f
n
u
r
s
es
ca
n
p
r
o
f
o
u
n
d
ly
af
f
ec
t
p
atien
t
ca
r
e,
p
o
ten
tially
r
esu
ltin
g
in
ad
v
er
s
e
o
u
tco
m
es
[
26
].
R
o
i
E
t
Ho
s
p
ital,
lo
ca
ted
in
R
o
i
E
t
p
r
o
v
in
ce
in
n
o
r
th
ea
s
ter
n
T
h
ailan
d
,
s
er
v
es
as
a
k
ey
h
ea
lth
ca
r
e
f
ac
ilit
y
f
o
r
th
e
lo
ca
l
p
o
p
u
latio
n
.
I
t
o
f
f
er
s
a
v
ar
iety
o
f
h
ea
lth
ca
r
e
s
er
v
ices,
am
o
n
g
wh
ich
ar
e
th
e
em
er
g
en
cy
d
ep
ar
tm
en
t,
alo
n
g
with
b
o
th
in
p
atien
t
an
d
o
u
tp
atien
t
ca
r
e
s
er
v
ices
.
T
h
e
h
o
s
p
ital
is
k
n
o
wn
f
o
r
its
ef
f
o
r
ts
to
im
p
r
o
v
e
h
ea
lth
ca
r
e
ac
ce
s
s
in
th
e
r
eg
io
n
,
f
o
cu
s
in
g
o
n
b
o
th
g
en
er
al
m
ed
icin
e
an
d
s
p
ec
ialized
tr
ea
tm
en
ts
.
R
o
i
E
t
p
r
o
v
in
ce
its
elf
is
k
n
o
wn
f
o
r
its
ag
r
icu
ltu
r
al
co
m
m
u
n
ity
an
d
cu
ltu
r
al
h
er
itag
e,
an
d
th
e
h
o
s
p
ita
l
is
v
ital
f
o
r
th
e
h
ea
lth
ca
r
e
s
er
v
ices
it
p
r
o
v
id
es
f
o
r
lo
ca
l
r
esid
en
ts
.
I
n
ad
d
itio
n
to
m
ed
ical
s
er
v
ices,
R
o
i
E
t
Ho
s
p
ital
is
a
ter
tiar
y
h
o
s
p
ital
th
at
ca
n
n
o
t
r
ef
u
s
e
to
ac
ce
p
t
p
atien
ts
an
d
m
u
s
t
tak
e
r
ef
er
r
als
f
o
r
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
ca
s
es
th
at
r
eq
u
ir
e
s
u
r
g
er
y
f
r
o
m
all
h
o
s
p
itals
in
th
e
p
r
o
v
in
ce
,
in
clu
d
in
g
th
o
s
e
in
n
ea
r
b
y
p
r
o
v
in
ce
s
lik
e
Ma
h
asar
ak
h
am
an
d
Kala
s
in
.
Pre
v
io
u
s
s
tu
d
ies
o
n
th
e
in
cid
en
ce
o
f
s
tr
o
k
e
in
T
h
ailan
d
h
av
e
r
ep
o
r
ted
r
ates
o
f
4
.
0
%,
3
.
8
%,
an
d
3
.
9
%,
r
esp
ec
tiv
ely
,
in
d
icatin
g
a
co
n
s
is
ten
t
u
p
war
d
tr
en
d
[
2
7
]
.
T
h
is
in
cr
ea
s
in
g
in
cid
en
ce
o
f
s
tr
o
k
e
h
as
co
n
s
eq
u
en
tly
led
to
a
g
r
o
win
g
d
em
an
d
f
o
r
cr
itical
ca
r
e
u
n
it
b
ed
s
to
ac
co
m
m
o
d
ate
p
atien
ts
r
eq
u
ir
in
g
in
ten
s
iv
e
m
ed
ical
atten
tio
n
.
Ad
d
itio
n
ally
,
g
iv
en
th
at
th
e
in
ten
s
iv
e
ca
r
e
u
n
it
(
I
C
U)
h
as
lim
ited
b
ed
s
,
no
t
ev
er
y
ca
s
e
m
ay
b
e
ac
co
m
m
o
d
ated
in
th
e
I
C
U,
an
d
p
atien
ts
m
ay
n
ee
d
to
b
e
p
lace
d
in
g
en
er
al
war
d
s
.
T
h
er
ef
o
r
e,
s
taf
f
n
u
r
s
es
m
u
s
t
p
o
s
s
ess
th
e
k
n
o
wled
g
e,
attitu
d
es,
an
d
p
r
ac
tice
(
KAP)
n
ec
ess
ar
y
to
ca
r
e
f
o
r
th
is
p
atien
t
g
r
o
u
p
ef
f
ec
tiv
ely
.
Ad
d
itio
n
ally
,
g
iv
en
th
at
th
e
in
ten
s
iv
e
ca
r
e
u
n
it
(
I
C
U
)
h
as
lim
ited
b
ed
s
,
n
o
t
ev
er
y
ca
s
e
m
ay
b
e
ac
co
m
m
o
d
ated
in
th
e
I
C
U,
an
d
p
atien
ts
m
ay
n
ee
d
to
b
e
p
lace
d
in
g
en
er
al
war
d
s
.
T
h
er
ef
o
r
e,
s
taf
f
n
u
r
s
es m
u
s
t p
o
s
s
ess
th
e
KAP
n
ec
ess
ar
y
to
ca
r
e
f
o
r
th
is
p
atien
t g
r
o
u
p
ef
f
ec
tiv
ely
.
C
u
r
r
e
n
t
l
y
,
t
h
e
r
e
i
s
a
l
i
m
i
te
d
n
u
m
b
e
r
o
f
s
t
u
d
i
es
o
n
t
h
e
K
AP
o
f
s
t
a
f
f
n
u
r
s
es
c
a
r
i
n
g
f
o
r
p
o
s
t
o
p
e
r
a
t
i
v
e
r
u
p
t
u
r
e
d
c
e
r
e
b
r
a
l
a
n
e
u
r
y
s
m
p
a
t
i
e
n
ts
i
n
T
h
a
i
l
a
n
d
.
H
u
m
a
n
b
e
h
a
v
i
o
r
c
a
n
b
e
e
x
p
l
a
i
n
e
d
t
h
r
o
u
g
h
t
h
e
t
h
r
e
e
c
o
n
t
i
n
u
o
u
s
p
r
o
c
e
s
s
e
s
w
h
i
c
h
ar
e
d
e
s
c
r
i
b
e
d
i
n
t
h
e
KA
P
m
o
d
e
l
[
28
].
S
i
m
i
l
a
r
l
y
,
t
h
e
q
u
a
l
it
y
o
f
n
u
r
s
i
n
g
c
a
r
e
i
s
c
l
o
s
e
l
y
li
n
k
e
d
t
o
n
u
r
s
e
s
'
k
n
o
w
l
e
d
g
e
,
a
t
ti
t
u
d
e
s
,
a
n
d
p
r
a
c
ti
ce
s
,
a
s
t
h
e
s
e
el
e
m
e
n
ts
a
r
e
es
s
e
n
t
i
a
l
f
o
r
d
e
l
i
v
e
r
i
n
g
e
v
i
d
e
n
c
e
-
b
a
s
e
d
c
a
r
e
t
o
p
a
t
i
e
n
ts
[
29
]
.
I
m
p
o
r
t
a
n
t
l
y
,
s
t
a
f
f
n
u
r
s
e
s
e
q
u
i
p
p
e
d
w
i
t
h
t
h
e
e
s
s
e
n
t
i
al
K
A
P
a
r
e
v
i
t
al
i
n
p
r
e
v
e
n
t
i
n
g
c
o
m
p
l
i
c
a
t
i
o
n
s
d
u
r
in
g
b
o
t
h
p
r
e
o
p
e
r
a
t
i
v
e
a
n
d
p
o
s
t
o
p
e
r
a
t
i
v
e
c
a
r
e
[
30
]
,
[
31
].
E
s
s
e
n
t
i
a
l
l
y
,
h
e
a
lt
h
c
a
r
e
p
r
o
v
i
d
e
r
s
p
l
a
y
a
k
e
y
r
o
l
e
i
n
o
f
f
e
r
i
n
g
i
n
f
o
r
m
a
t
i
o
n
t
h
a
t
s
u
p
p
o
r
t
s
d
e
c
i
s
i
o
n
-
m
a
k
i
n
g
a
m
o
n
g
r
e
l
a
t
i
v
e
s
a
n
d
t
h
o
s
e
a
f
f
e
c
t
e
d
b
y
c
e
r
e
b
r
a
l
a
n
e
u
r
y
s
m
s
[
32
]
.
As
a
l
i
f
e
-
t
h
r
e
at
e
n
i
n
g
c
o
n
d
i
t
i
o
n
,
r
e
l
a
t
e
d
n
u
r
s
i
n
g
c
a
r
e
i
n
v
o
l
v
e
s
t
h
e
KA
P
o
f
n
u
r
s
i
n
g
s
t
a
f
f
w
h
i
c
h
w
i
ll
h
a
v
e
an
i
n
f
l
u
e
n
c
e
u
p
o
n
t
h
e
s
u
b
s
e
q
u
en
t
d
i
s
e
as
e
p
r
o
g
r
e
s
s
i
o
n
a
n
d
p
r
o
g
n
o
s
i
s
.
A
cc
o
r
d
i
n
g
l
y
,
t
h
i
s
r
e
s
e
a
r
c
h
s
o
u
g
h
t
t
o
es
t
a
b
li
s
h
t
h
e
c
u
r
r
e
n
t
l
e
v
e
ls
o
f
k
n
o
wl
ed
g
e
,
a
t
t
it
u
d
e
,
a
n
d
p
r
a
c
ti
c
e
o
f
n
u
r
s
i
n
g
p
r
o
f
e
s
s
i
o
n
a
ls
d
e
l
i
v
e
r
i
n
g
c
a
r
e
t
o
p
a
t
i
e
n
t
s
w
i
th
r
u
p
t
u
r
e
d
c
e
r
e
b
r
a
l
a
n
e
u
r
y
s
m
u
n
d
e
r
g
o
i
n
g
s
u
r
g
e
r
y
i
n
t
h
e
c
r
i
tic
a
l
p
e
r
i
o
d
,
s
i
n
c
e
a
n
u
n
d
e
r
s
t
a
n
d
i
n
g
o
f
t
h
e
s
e
KA
P
f
ac
t
o
r
s
c
a
n
s
u
p
p
o
r
t
t
h
e
p
r
o
v
is
i
o
n
o
f
t
a
r
g
e
t
e
d
i
m
p
r
o
v
e
m
e
n
t
s
a
n
d
s
e
r
v
e
a
s
g
u
i
d
el
i
n
e
s
f
o
r
t
h
e
p
r
o
v
i
s
i
o
n
o
f
t
r
a
i
n
i
n
g
p
r
o
g
r
a
m
s
t
o
e
n
h
a
n
c
e
s
t
a
n
d
a
r
d
s
i
n
c
l
i
n
i
c
al
n
u
r
s
i
n
g
p
r
a
c
t
ic
e
i
n
t
h
is
a
r
e
a
.
2.
M
E
T
H
O
D
T
h
is
s
tu
d
y
m
ad
e
u
s
e
o
f
a
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
with
in
s
tr
u
m
en
ts
co
m
p
r
is
in
g
b
o
th
s
tr
u
ctu
r
ed
s
u
r
v
ey
s
an
d
f
ac
e
-
to
-
f
ac
e
in
ter
v
i
ews.
T
h
e
r
eq
u
ir
ed
s
am
p
le
s
ize
was
d
eter
m
in
ed
v
ia
th
e
G*
p
o
wer
3
.
1
.
9
.
2
[
33
]
co
r
r
elatio
n
f
o
r
a
b
iv
ar
iate
n
o
r
m
al
m
o
d
el
with
a
p
o
wer
test
o
f
9
0
an
d
ef
f
ec
t
s
ize
o
f
0
.
3
[
34
]
.
Usi
n
g
a
s
tatis
tical
s
ig
n
if
ican
ce
lev
el
o
f
.
0
5
,
th
e
s
am
p
le
s
ize
was
f
o
u
n
d
to
b
e
9
2
.
T
h
is
v
alu
e
was
in
cr
ea
s
ed
b
y
1
0
%
to
allo
w
f
o
r
in
co
m
p
lete
q
u
esti
o
n
n
air
e
s
u
r
v
ey
d
ata,
r
esu
ltin
g
in
a
f
in
al
s
am
p
le
s
ize
o
f
1
1
1
p
ar
ticip
an
ts
.
A
p
r
o
b
ab
ilit
y
-
b
ased
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
0
6
K
n
o
w
led
g
e,
a
ttit
u
d
e,
a
n
d
p
r
a
ctice
o
f sta
ff n
u
r
s
es o
n
ca
r
in
g
f
o
r
p
a
tien
ts
w
ith
…
(
P
a
la
ma
S
o
b
u
t
)
1563
r
an
d
o
m
s
am
p
lin
g
p
r
o
ce
s
s
was
u
s
ed
to
s
elec
t
p
ar
ticip
an
ts
,
with
o
u
t
th
e
u
s
e
o
f
s
u
b
s
titu
tio
n
.
Staf
f
n
u
r
s
es
wh
o
h
ad
ex
p
er
ien
ce
o
f
at
least
3
m
o
n
th
s
wo
r
k
in
g
o
n
ca
r
in
g
f
o
r
p
atien
ts
u
n
d
er
g
o
in
g
s
u
r
g
er
y
f
o
r
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
s
d
u
r
in
g
a
cr
itical
p
er
io
d
in
a
ter
tiar
y
h
o
s
p
ital
in
R
o
i
E
t,
in
th
e
n
o
r
th
ea
s
t
o
f
T
h
ailan
d
,
wer
e
co
n
s
id
er
ed
elig
ib
le
f
o
r
in
clu
s
io
n
in
th
e
s
tu
d
y
,
o
n
th
e
co
n
d
itio
n
th
at
th
ey
wer
e
r
ea
d
y
an
d
willin
g
to
p
ar
ticip
ate.
T
h
e
d
ata
wer
e
g
ath
er
ed
v
ia
a
s
tr
u
ctu
r
ed
q
u
esti
o
n
n
air
e
s
u
r
v
ey
ad
m
in
is
ter
ed
v
ia
f
ac
e
-
to
-
f
ac
e
in
ter
v
iews.
T
h
e
q
u
esti
o
n
n
air
e
was
d
ev
elo
p
ed
b
y
th
e
r
esear
ch
er
to
co
v
er
th
e
KAP
f
ac
to
r
s
o
n
th
e
b
asis
o
f
th
e
liter
atu
r
e
r
ev
iew.
T
h
e
q
u
esti
o
n
n
air
e
s
ec
tio
n
co
n
ce
r
n
in
g
k
n
o
wled
g
e
co
n
tain
s
2
4
item
s
in
wh
ich
p
ar
ticip
an
ts
wer
e
ask
ed
to
r
ate
ea
ch
item
as
co
r
r
ec
t
o
r
in
co
r
r
ec
t
o
n
k
n
o
wled
g
e
ab
o
u
t
ca
r
in
g
f
o
r
p
atien
t
with
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
u
n
d
er
g
o
in
g
s
u
r
g
er
y
.
T
h
e
q
u
esti
o
n
n
air
e
h
ad
b
o
th
p
o
s
itiv
e
an
d
n
eg
ativ
e
item
q
u
esti
o
n
s
,
with
n
eg
ativ
e
item
s
co
r
e
r
ev
er
s
ed
.
T
h
e
q
u
esti
o
n
n
air
e
p
r
esen
ts
eig
h
t
d
im
en
s
io
n
s
in
clu
d
in
g
p
r
eo
p
er
ativ
e
ca
r
e
ass
ess
m
en
t
in
th
e
cr
itical
p
er
io
d
,
p
o
s
to
p
er
ativ
e
ca
r
e
to
p
r
ev
en
t
r
ec
u
r
r
en
t
b
leed
in
g
,
p
o
s
to
p
er
ativ
e
ca
r
e
to
p
r
ev
en
t c
er
eb
r
al
v
aso
s
p
asm
,
p
o
s
to
p
er
ativ
e
ca
r
e
to
s
u
p
p
o
r
t
in
d
iv
id
u
als
with
h
y
d
r
o
ce
p
h
alu
s
,
p
o
s
to
p
er
ativ
e
ca
r
e
to
p
r
ev
en
t
s
eizu
r
es,
p
o
s
to
p
er
ativ
e
ca
r
e
to
s
u
p
p
o
r
t
in
d
iv
id
u
als
with
ce
r
eb
r
al
ed
em
a,
p
o
s
to
p
er
ativ
e
ca
r
e
to
p
r
ev
e
n
t
I
I
C
P,
an
d
p
o
s
to
p
er
ativ
e
ca
r
e
to
p
r
ev
en
t
co
m
p
licatio
n
s
in
v
ar
io
u
s
b
o
d
y
s
y
s
tem
s
.
T
h
e
s
co
r
e
f
o
r
all
item
s
wer
e
class
if
ied
in
to
th
r
ee
lev
el
as
:
lo
w
(
0
-
8
.
0
0
s
co
r
e
)
,
f
air
(
8
.
01
-
16
.
0
0
s
co
r
e
)
,
h
ig
h
(
16
.
01
-
24
.
00
)
.
Seco
n
d
ly
,
th
e
attitu
d
e
q
u
esti
o
n
n
air
e
.
A
1
0
-
item
s
tr
u
ctu
r
ed
q
u
esti
o
n
n
air
e
was
u
s
ed
to
ass
ess
th
e
lev
el
o
f
attitu
d
e,
ea
ch
r
ated
o
n
a
4
-
p
o
in
t
L
ik
er
t
s
ca
le,
f
o
r
wh
ich
th
e
r
esp
o
n
s
es
in
d
icate
d
s
tr
o
n
g
ag
r
ee
m
en
t,
ag
r
ee
m
en
t,
n
eith
er
ag
r
ee
m
en
t
n
o
r
d
is
ag
r
ee
m
en
t,
an
d
f
in
ally
d
is
ag
r
ee
m
en
t.
T
h
is
q
u
esti
o
n
n
air
e
h
ad
b
o
th
p
o
s
itiv
e
an
d
n
eg
ativ
e
item
q
u
esti
o
n
s
,
with
n
eg
ativ
e
item
s
co
r
es
r
ev
er
s
ed
.
All
item
s
co
r
es
wer
e
ca
teg
o
r
ized
at
th
r
ee
d
if
f
er
en
t
lev
els as in
d
icate
d
: p
o
o
r
(
10
.
00
-
20
.
00
)
,
f
air
(
20
.
01
-
30
.
00
)
,
an
d
h
ig
h
(
30
.
01
-
40
.
00
)
.
L
astl
y
,
a
20
-
item
s
tr
u
ctu
r
ed
q
u
esti
o
n
n
air
e
ass
ess
ed
th
e
p
ar
ticip
an
ts
’
lev
el
o
f
p
r
ac
tice
u
s
in
g
a
4
-
p
o
in
t
L
ik
er
t
s
ca
le,
with
p
ar
ticip
an
ts
b
ein
g
ask
ed
to
id
en
tify
wh
eth
er
th
ey
p
r
ac
ticed
alwa
y
s
(
7
d
ay
s
/
week
)
,
m
o
s
tly
(
4
-
6
d
ay
s
/
week
)
,
s
o
m
etim
es
(
1
-
3
d
ay
s
/
week
)
,
o
r
n
ev
er
.
T
h
e
q
u
esti
o
n
n
air
e
p
r
esen
ts
eig
h
t d
im
en
s
io
n
s
in
clu
d
es p
r
eo
p
er
ativ
e
ca
r
e
ass
ess
m
en
t
in
th
e
cr
itical
p
er
io
d
,
p
o
s
to
p
er
ativ
e
ca
r
e
to
p
r
ev
en
t
r
ec
u
r
r
en
t
b
leed
in
g
,
p
o
s
to
p
er
ativ
e
ca
r
e
to
p
r
ev
en
t c
er
eb
r
al
v
aso
s
p
asm
,
p
o
s
to
p
er
ativ
e
ca
r
e
to
s
u
p
p
o
r
t
in
d
iv
id
u
als
with
h
y
d
r
o
ce
p
h
alu
s
,
p
o
s
to
p
er
ativ
e
ca
r
e
to
p
r
ev
en
t
p
r
ev
en
tin
g
s
eizu
r
es,
p
o
s
to
p
er
ativ
e
ca
r
e
to
s
u
p
p
o
r
t
in
d
iv
id
u
als
with
ce
r
eb
r
al
ed
em
a,
p
o
s
to
p
er
ativ
e
ca
r
e
to
p
r
ev
en
t
I
I
C
P,
an
d
p
o
s
to
p
er
ativ
e
ca
r
e
to
p
r
ev
en
t c
o
m
p
licatio
n
s
in
v
ar
io
u
s
b
o
d
y
s
y
s
tem
s
.
T
h
e
s
co
r
es f
o
r
all
item
s
wer
e
class
if
ied
in
to
th
r
ee
lev
els
as
:
0
-
2
0
.
0
0
as
p
o
o
r
,
2
0
.
0
1
-
4
0
.
0
0
as
av
er
ag
e,
an
d
4
0
.
0
1
-
6
0
.
0
0
as
h
ig
h
.
All in
s
tr
u
m
en
ts
wer
e
d
ev
elo
p
ed
b
y
th
e
r
esear
ch
er
s
.
An
ev
alu
atio
n
o
f
th
e
v
alid
ity
an
d
r
eliab
ilit
y
o
f
ea
ch
o
f
th
e
q
u
esti
o
n
n
air
e
item
s
was
co
n
d
u
cted
.
T
wo
n
eu
r
o
s
u
r
g
eo
n
s
an
d
o
n
e
ad
u
lt
an
d
g
er
o
n
to
lo
g
y
n
u
r
s
in
g
lectu
r
er
ass
ess
ed
co
n
ten
t
v
alid
ity
.
T
h
e
co
n
ten
t
v
alid
ity
in
d
ex
(
C
VI
)
of
KAP
wer
e
0
.
9
0
,
0
.
9
2
,
an
d
0
.
95
r
esp
ec
tiv
ely
.
T
o
test
th
e
r
eliab
ilit
y
,
3
0
in
d
iv
id
u
als wh
o
d
id
n
o
t
p
ar
ticip
ate
in
th
e
s
tu
d
y
b
u
t
m
et
th
e
id
en
tical
in
clu
s
io
n
cr
iter
ia
wer
e
u
s
ed
f
o
r
th
e
in
v
esti
g
atio
n
.
I
n
th
is
s
tu
d
y
,
T
h
e
Ku
d
er
-
R
ich
ar
d
s
o
n
2
0
(
KR
-
20
)
o
f
th
e
k
n
o
wled
g
e
q
u
esti
o
n
n
air
e
was
0
.
89,
wh
ile
th
e
C
r
o
n
b
ac
h
’
s
alp
h
a
v
alu
es f
o
r
th
e
q
u
esti
o
n
n
air
e
s
ec
tio
n
s
o
n
attitu
d
e
an
d
p
r
ac
tice
wer
e
r
esp
ec
t
iv
ely
0
.
8
3
an
d
0
.
8
7
.
Descr
ip
tiv
e
an
aly
s
is
was
p
er
f
o
r
m
ed
to
ass
ess
th
e
d
ata
g
ath
er
ed
in
th
e
s
tu
d
y
u
s
in
g
SP
SS
s
o
f
twar
e
v
er
s
io
n
2
0
,
d
ev
elo
p
ed
b
y
I
B
M.
Descr
ip
tiv
e
s
tatis
tic
was
u
s
ed
to
r
ep
o
r
t
f
r
eq
u
en
cy
,
p
er
ce
n
tag
es,
m
ea
n
,
an
d
s
tan
d
ar
d
d
ev
iatio
n
.
Fu
r
th
er
,
co
r
r
e
latio
n
u
s
in
g
Pear
s
o
n
co
r
r
elatio
n
co
ef
f
icien
t
an
d
Sp
ea
r
m
an
co
r
r
elatio
n
co
ef
f
icien
t,
wer
e
u
s
ed
to
d
eter
m
in
e
s
ig
n
if
ican
t
d
if
f
er
en
ce
s
b
etwe
en
th
e
v
ar
iab
les
at
a
s
ig
n
if
ican
ce
lev
el
o
f
p
<0
.
05
.
E
th
ical
ap
p
r
o
v
al
f
o
r
th
is
r
esear
ch
was
g
r
an
ted
b
y
th
e
R
o
i
E
t
Ho
s
p
ital
R
esear
ch
E
th
ics
C
o
m
m
ittee
(
Ap
p
r
o
v
al
n
u
m
b
er
0
8
2
/
2567
).
W
h
o
h
as
wr
itten
in
f
o
r
m
ed
co
n
s
en
t
was
s
ec
u
r
ed
f
r
o
m
p
ar
ticip
an
ts
with
an
ass
u
r
an
ce
o
f
co
n
f
id
en
tiality
.
I
n
ad
d
itio
n
,
p
r
io
r
to
co
m
m
en
ce
m
en
t
o
f
th
e
d
ata
g
ath
er
in
g
p
r
o
ce
s
s
,
th
e
p
ar
ticip
an
ts
wer
e
in
f
o
r
m
ed
o
f
th
e
p
u
r
p
o
s
es
an
d
p
r
o
ce
d
u
r
es
o
f
th
e
r
esear
ch
an
d
g
r
an
ted
th
eir
wr
itten
co
n
s
en
t
o
n
th
is
b
asis
.
I
n
ter
v
iews
wer
e
th
en
ca
r
r
ied
o
u
t
to
estab
lis
h
a
d
etailed
ca
s
e
h
is
to
r
y
f
r
o
m
ea
ch
p
ar
ticip
an
t,
wh
er
eu
p
o
n
th
e
q
u
esti
o
n
n
air
e
s
u
r
v
ey
was
s
u
b
s
eq
u
en
tly
ad
m
in
is
ter
ed
.
Par
ticip
an
ts
wh
o
lack
ed
s
u
f
f
icien
t
ed
u
ca
tio
n
to
co
m
p
lete
th
e
q
u
esti
o
n
n
air
e
wer
e
p
r
o
v
id
ed
with
ass
is
tan
ce
.
No
lim
itatio
n
was
p
lace
d
u
p
o
n
th
e
tim
e
tak
en
to
f
in
is
h
th
e
q
u
esti
o
n
n
air
e
s
u
r
v
ey
.
T
h
is
r
esear
ch
was c
ar
r
ied
o
u
t in
Feb
r
u
ar
y
–
J
u
n
e
2
0
2
4
.
3.
RE
SUL
T
S
AND
DIS
CUSSI
O
N
T
ab
le
1
p
r
esen
ts
th
e
v
ar
io
u
s
d
em
o
g
r
ap
h
ic
ch
ar
ac
ter
is
tics
o
f
th
e
1
1
1
s
tu
d
y
p
ar
ticip
an
ts
,
ex
p
r
ess
in
g
d
ata
f
o
r
ea
ch
v
ar
iab
le
in
ter
m
s
o
f
f
r
eq
u
en
cy
an
d
p
er
ce
n
tag
e
.
A
h
ig
h
p
r
o
p
o
r
tio
n
o
f
th
e
s
tu
d
y
p
ar
ticip
an
ts
wer
e
f
em
ale,
at
9
8
.
2
%
,
an
d
th
e
ag
e
g
r
o
u
p
s
h
o
win
g
th
e
h
ig
h
est
f
r
eq
u
en
cy
was
2
8
-
3
4
y
ea
r
s
,
at
4
4
.
20
%
.
Me
an
wh
ile,
65
.
80
%
h
ad
m
ar
r
ied
s
tatu
s
,
an
d
9
3
.
3
%
h
eld
a
B
ac
h
elo
r
d
eg
r
ee
.
Mo
r
e
th
an
h
af
t
o
f
p
ar
ticip
an
ts
h
ad
o
v
er
5
y
ea
r
s
o
f
ex
p
er
ien
ce
f
o
r
ca
r
in
g
p
atien
ts
with
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
u
n
d
er
g
o
in
g
s
u
r
g
er
y
(
60
.
4
%
)
.
Mo
s
t
p
ar
ticip
an
ts
wo
r
k
ed
in
Neu
r
o
s
u
r
g
er
y
in
ten
s
iv
e
ca
r
e
u
n
it
(
1
9
.
0
0
%),
an
d
h
ad
p
ar
ticip
ated
a
4
-
m
o
n
th
tr
ain
in
g
co
u
r
s
e
in
n
u
r
s
in
g
s
p
ec
ialty
f
o
r
p
atien
ts
with
s
tr
o
k
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
5
61
-
1
56
8
1564
T
ab
le
1
.
Gen
e
r
al
ch
ar
ac
ter
is
tics
am
o
n
g
p
a
r
ticip
an
ts
(
n
=
1
1
1
)
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
F
r
e
q
u
e
n
c
y
P
e
r
c
e
n
t
a
g
e
(
%)
G
e
n
d
e
r
M
a
l
e
2
1
.
8
F
e
mal
e
1
0
9
98
.
2
A
g
e
(
y
e
a
r
s
)
21
-
27
46
41
.
40
28
-
34
49
44
.
20
35
-
41
10
9
.
00
42
-
48
6
5
.
40
M
e
a
n
±
S
D
,
M
a
x
-
M
i
n
29
.
2
3
±
5
.
21
45
-
22
M
a
r
i
t
a
l
s
t
a
t
u
s
M
a
r
r
i
e
d
38
65
.
80
U
n
marr
i
e
d
73
34
.
20
Ed
u
c
a
t
i
o
n
l
e
v
e
l
B
a
c
h
e
l
o
r
d
e
g
r
e
e
1
0
8
97
.
3
M
a
s
t
e
r
d
e
g
r
e
e
2
1
.
8
D
o
c
t
o
r
a
l
d
e
g
r
e
e
1
.
9
D
u
r
a
t
i
o
n
o
f
e
x
p
e
r
i
e
n
c
e
f
o
r
c
a
r
i
n
g
p
a
t
i
e
n
t
s
w
i
t
h
r
u
p
t
u
r
e
d
c
e
r
e
b
r
a
l
a
n
e
u
r
y
sm
u
n
d
e
r
g
o
i
n
g
su
r
g
e
r
y
<
1
y
e
a
r
11
9
.
9
1
-
5
y
e
a
r
s
33
29
.
7
>
5
y
e
a
r
s
67
60
.
4
W
o
r
k
i
n
g
d
e
p
a
r
t
men
t
S
u
r
g
i
c
a
l
i
n
t
e
n
si
v
e
c
a
r
e
u
n
i
t
17
15
.
30
A
c
u
t
e
c
a
r
e
u
n
i
t
17
15
.
30
N
e
u
r
o
s
u
r
g
e
r
y
i
n
t
e
n
si
v
e
c
a
r
e
u
n
i
t
21
19
.
00
Tr
a
u
m
a
i
n
t
e
n
si
v
e
c
a
r
e
u
n
i
t
19
17
.
10
N
e
u
r
o
s
u
r
g
e
r
y
u
n
i
t
18
16
.
20
Tr
a
u
m
a
u
n
i
t
19
17
.
10
Tr
a
i
n
i
n
g
c
o
u
r
ses
f
o
r
n
u
r
si
n
g
sp
e
c
i
a
l
t
y
i
n
n
u
r
si
n
g
f
o
r
p
a
t
i
e
n
t
s wit
h
st
r
o
k
e
(
4
mo
n
t
h
s
)
Y
e
s
78
70
.
3
No
33
29
.
7
I
n
T
ab
le
2
,
th
e
o
b
tain
ed
KAP
s
co
r
es
wer
e
ca
teg
o
r
ized
in
h
ig
h
lev
el
.
T
h
e
m
ea
n
k
n
o
wled
g
e
s
co
r
e
19
.
11
(
SD
=
2
.
46
)
,
m
ea
n
attitu
d
e
s
co
r
e
3
5
.
44
(
SD
=
4
.
10
)
,
an
d
m
ea
n
p
r
ac
tice
s
co
r
e
4
7
.
27
(
SD
=
7
.
26
)
.
I
n
T
ab
le
3
,
k
n
o
wled
g
e,
attitu
d
e,
ag
e,
an
d
d
u
r
atio
n
o
f
ex
p
er
ien
ce
f
o
r
ca
r
in
g
p
atien
ts
with
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
u
n
d
er
g
o
in
g
s
u
r
g
er
y
wer
e
s
h
o
wn
to
b
e
s
ig
n
if
ican
tly
p
o
s
itiv
ely
co
r
r
elate
d
with
p
r
ac
tice
(
r
=.
6
0
7
,
.
5
2
6
,
.
2
1
3
,
an
d
.
8
0
6
r
esp
ec
tiv
ely
)
.
Ho
wev
er
,
n
o
co
r
r
elatio
n
was
f
o
u
n
d
b
etwe
en
ed
u
ca
tio
n
lev
el
an
d
p
r
ac
tice
(
p
=
.
453
).
I
n
T
ab
le
4
,
th
e
o
v
er
all
m
ea
n
p
r
ac
tice
s
co
r
e
was
2
.
33
(
SD
=
0
.
35
)
.
T
h
e
lo
west
m
ea
n
s
co
r
e
was
r
ec
o
r
d
ed
f
o
r
p
o
s
to
p
er
ativ
e
ca
r
e
in
p
r
ev
en
tin
g
s
eizu
r
es,
wh
ich
was
1
.
59
(
SD
=
1
.
21
)
.
C
o
n
v
er
s
ely
,
th
e
h
ig
h
est
m
ea
n
s
co
r
e
was f
o
r
p
o
s
to
p
er
ativ
e
ca
r
e
in
p
r
ev
en
tin
g
v
aso
s
p
asm
,
with
a
s
co
r
e
o
f
2
.
71
(
SD
=
0
.
49
).
T
ab
le
2
.
Dif
f
e
r
en
t le
v
els o
f
v
a
r
iab
les
with
p
r
ac
tice
to
war
d
ca
r
in
g
f
o
r
p
atien
ts
with
r
u
p
tu
r
e
d
ce
r
eb
r
al
an
eu
r
y
s
m
u
n
d
er
g
o
in
g
s
u
r
g
er
y
in
cr
itical
p
er
io
d
(
n
=
1
1
1
)
V
a
r
i
a
b
l
e
s
M
e
a
n
SD
Le
v
e
l
s
K
n
o
w
l
e
d
g
e
19
.
11
2
.
46
H
i
g
h
A
t
t
i
t
u
d
e
35
.
44
4
.
10
H
i
g
h
P
r
a
c
t
i
c
e
47
.
27
7
.
26
H
i
g
h
T
ab
le
3
.
Facto
r
s
co
r
r
elatio
n
w
ith
p
r
ac
tice
to
war
d
ca
r
in
g
f
o
r
p
atien
ts
with
r
u
p
tu
r
e
d
ce
r
eb
r
al
an
eu
r
y
s
m
u
n
d
er
g
o
in
g
s
u
r
g
er
y
in
cr
itical
p
er
io
d
(
n
=
1
1
1
)
V
a
r
i
a
b
l
e
s
C
o
r
r
e
l
a
t
i
o
n
c
o
e
f
f
i
c
i
e
n
t
p
-
v
a
l
u
e
K
n
o
w
l
e
d
g
e
.
6
0
7
(
p
)
.
0
0
0
**
A
t
t
i
t
u
d
e
.
5
2
6
(
p
)
.
05
*
A
g
e
(
y
e
a
r
s
)
.
2
1
3
(
p
)
.
05
*
Ed
u
c
a
t
i
o
n
a
l
l
e
v
e
l
-
.
0
7
2
(
s
)
.
4
5
3
D
u
r
a
t
i
o
n
o
f
e
x
p
e
r
i
e
n
c
e
f
o
r
c
a
r
i
n
g
p
a
t
i
e
n
t
s wi
t
h
r
u
p
t
u
r
e
d
c
e
r
e
b
r
a
l
a
n
e
u
r
y
sm
u
n
d
e
r
g
o
i
n
g
su
r
g
e
r
y
.
8
0
6
(
s
)
0
0
0
**
r
p
P
e
a
r
s
o
n
c
o
r
r
e
l
a
t
i
o
n
c
o
e
f
f
i
c
i
e
n
t
;
r
s
S
p
e
a
r
m
a
n
c
o
r
r
e
l
a
t
i
o
n
c
o
e
f
f
i
c
i
e
n
t
T
ab
le
4
.
Me
an
an
d
s
tan
d
a
r
d
d
ev
iatio
n
o
f
p
ar
ticip
an
ts
’
s
co
r
e
s
on
p
r
ac
tice
to
war
d
ca
r
in
g
f
o
r
p
atien
ts
with
r
u
p
tu
r
e
d
ce
r
eb
r
al
an
eu
r
y
s
m
u
n
d
er
g
o
in
g
s
u
r
g
e
r
y
in
c
r
itical
p
e
r
io
d
(
n
=
111
)
I
t
e
ms
M
e
a
n
SD
1
.
P
r
e
o
p
e
r
a
t
i
v
e
c
a
r
e
a
ssessm
e
n
t
i
n
c
r
i
t
i
c
a
l
p
e
r
i
o
d
2
.
17
.
83
2
.
P
o
st
o
p
e
r
a
t
i
v
e
c
a
r
e
t
o
p
r
e
v
e
n
t
r
e
c
u
r
r
e
n
t
b
l
e
e
d
i
n
g
2
.
66
.
48
3
.
P
o
st
o
p
e
r
a
t
i
v
e
c
a
r
e
t
o
p
r
e
v
e
n
t
c
e
r
e
b
r
a
l
v
a
s
o
s
p
a
sm
2
.
71
.
49
4
.
P
o
st
o
p
e
r
a
t
i
v
e
c
a
r
e
t
o
su
p
p
o
r
t
i
n
d
i
v
i
d
u
a
l
s
w
i
t
h
h
y
d
r
o
c
e
p
h
a
l
u
s
2
.
54
.
48
5
.
P
o
st
o
p
e
r
a
t
i
v
e
c
a
r
e
t
o
p
r
e
v
e
n
t
se
i
z
u
r
e
1
.
59
1
.
21
6
.
P
o
st
o
p
e
r
a
t
i
v
e
c
a
r
e
t
o
su
p
p
o
r
t
i
n
d
i
v
i
d
u
a
l
s
w
i
t
h
c
e
r
e
b
r
a
l
e
d
e
ma
2
.
28
.
71
7
.
P
o
st
o
p
e
r
a
t
i
v
e
c
a
r
e
t
o
p
r
e
v
e
n
t
i
n
c
r
e
a
sed
i
n
t
r
a
c
r
a
n
i
a
l
p
r
e
ss
u
r
e
(
I
I
C
P
)
2
.
55
.
53
8
.
P
o
st
o
p
e
r
a
t
i
v
e
c
a
r
e
f
o
r
p
r
e
v
e
n
t
i
n
g
c
o
mp
l
i
c
a
t
i
o
n
s i
n
v
a
r
i
o
u
s
b
o
d
y
s
y
s
t
e
m
2
.
16
.
41
O
v
e
r
a
l
l
n
u
r
si
n
g
p
r
a
c
t
i
c
e
2
.
33
.
35
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
0
6
K
n
o
w
led
g
e,
a
ttit
u
d
e,
a
n
d
p
r
a
ctice
o
f sta
ff n
u
r
s
es o
n
ca
r
in
g
f
o
r
p
a
tien
ts
w
ith
…
(
P
a
la
ma
S
o
b
u
t
)
1565
T
h
e
r
esu
lts
co
n
f
ir
m
ed
a
h
ig
h
lev
el
o
f
k
n
o
wled
g
e
f
o
r
a
m
ajo
r
ity
o
f
r
esp
o
n
d
en
ts
,
p
ar
ticu
lar
ly
th
o
s
e
with
m
o
r
e
th
an
f
iv
e
y
ea
r
s
o
f
ex
p
er
ien
ce
,
as
th
ey
wer
e
m
o
r
e
lik
ely
to
ex
h
ib
it
s
tr
o
n
g
p
r
ac
tices
in
ca
r
in
g
f
o
r
p
atien
ts
with
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
s
.
Mo
r
eo
v
er
,
it
was
o
b
s
er
v
ed
th
at
m
an
y
p
ar
ticip
an
ts
h
ad
p
r
ev
io
u
s
ly
atten
d
ed
s
p
ec
ialized
tr
ain
in
g
co
u
r
s
es
in
s
tr
o
k
e
ca
r
e,
f
u
r
th
er
en
h
an
cin
g
th
eir
ex
p
er
tis
e
.
Similar
ly
,
n
u
r
s
es
’
ex
p
er
ien
ce
an
d
th
e
co
r
r
elatio
n
b
etwe
en
k
n
o
wled
g
e,
attitu
d
e,
an
d
p
r
ac
tice
[
35
]
.
As
a
r
esu
lt,
it
is
ess
en
tial
f
o
r
s
taf
f
n
u
r
s
es
to
p
o
s
s
ess
a
d
ee
p
u
n
d
er
s
tan
d
in
g
o
f
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
s
to
ef
f
ec
tiv
ely
p
r
ev
en
t
co
m
p
licatio
n
s
,
s
u
ch
as
r
ec
u
r
r
en
t
b
leed
in
g
[
22
]
,
v
aso
s
p
asm
,
d
elay
ed
ce
r
eb
r
al
is
ch
em
ia,
I
I
C
P,
ce
r
eb
r
al
ed
em
a
[
22
]
-
[
24
]
,
an
d
s
eizu
r
e
[
24
]
,
[
25
]
.
T
h
eir
r
o
le
in
co
n
tin
u
o
u
s
m
o
n
ito
r
in
g
an
d
ea
r
ly
d
etec
tio
n
o
f
co
m
p
licatio
n
s
is
v
ital
to
p
r
ev
en
tin
g
f
u
r
th
er
is
s
u
es
an
d
en
s
u
r
in
g
o
p
tim
al
o
u
tco
m
es
f
o
r
th
ese
p
atien
ts
.
I
n
d
ee
d
,
o
n
g
o
in
g
lear
n
in
g
is
m
o
s
t
ef
f
ec
tiv
ely
r
ein
f
o
r
ce
d
th
r
o
u
g
h
th
e
co
n
s
is
ten
t
p
r
ac
tice
o
f
p
r
o
ce
d
u
r
es
[
3
6
]
.
B
esid
es,
k
n
o
wled
g
e
is
o
n
e
o
f
th
e
ess
en
tial
ch
ar
ac
ter
is
tics
f
o
r
s
taf
f
n
u
r
s
es
b
ec
au
s
e
it
s
h
ap
es
th
eir
p
er
ce
p
tio
n
an
d
ap
p
r
o
ac
h
to
ca
r
e
.
T
h
e
g
r
ea
ter
th
eir
k
n
o
wled
g
e,
th
e
s
tr
o
n
g
er
th
eir
d
r
iv
e
to
ap
p
ly
th
eir
s
k
ills
an
d
ex
p
er
tis
e
in
p
er
f
o
r
m
in
g
task
s
with
p
r
o
f
ess
io
n
alis
m
an
d
ex
ce
llen
ce
[
3
7
]
.
As
a
r
esu
lt,
s
taf
f
n
u
r
s
es
with
a
h
ig
h
lev
el
o
f
k
n
o
wled
g
e
in
th
is
r
esear
ch
d
em
o
n
s
tr
ate
a
p
o
s
itiv
e
im
p
ac
t o
n
th
e
q
u
ality
o
f
n
u
r
s
in
g
p
r
ac
tice
s
k
ills
.
Fu
r
th
er
m
o
r
e,
th
e
m
ajo
r
ity
o
f
p
ar
ticip
an
ts
d
em
o
n
s
tr
ated
a
h
ig
h
ly
p
o
s
itiv
e
attitu
d
e,
p
ar
ticu
lar
ly
th
o
s
e
with
o
v
er
f
iv
e
y
ea
r
s
o
f
ex
p
er
ien
ce
in
ca
r
in
g
f
o
r
p
atien
ts
with
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
u
n
d
er
g
o
in
g
s
u
r
g
er
y
.
T
h
eir
f
r
eq
u
en
t
en
co
u
n
ter
s
with
p
atien
t
ch
an
g
es
co
n
tr
ib
u
ted
s
ig
n
if
ican
tly
to
s
h
ap
in
g
th
ese
attitu
d
es
.
As
a
r
esu
lt,
th
e
ir
p
er
s
p
ec
tiv
es
wer
e
m
o
ld
ed
th
r
o
u
g
h
ex
p
er
ien
ce
an
d
th
e
co
n
tin
u
o
u
s
lear
n
in
g
p
r
o
ce
s
s
.
A
s
im
ilar
p
r
ev
io
u
s
s
tu
d
y
f
o
u
n
d
th
at
m
o
r
e
wo
r
k
in
g
ex
p
er
ien
ce
p
o
s
itiv
ely
co
r
r
elate
s
with
b
etter
k
n
o
wled
g
e
an
d
attitu
d
es
[
3
8
]
.
T
h
er
ef
o
r
e,
s
taf
f
n
u
r
s
es
wh
o
ex
p
er
ien
ce
d
a
p
o
s
it
iv
e
ch
an
g
e
in
th
eir
k
n
o
wled
g
e
an
d
attitu
d
es
m
ay
in
f
lu
en
ce
th
e
q
u
ality
o
f
ca
r
e
[
39
].
Alth
o
u
g
h
s
taf
f
n
u
r
s
es’
p
r
ac
tice
in
ca
r
in
g
with
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
h
as h
ig
h
ca
teg
o
r
y
b
ec
au
s
e
s
taf
f
n
u
r
s
es
wh
o
h
ad
k
n
o
wled
g
e
s
co
r
es we
r
e
ca
teg
o
r
ized
in
h
ig
h
lev
el
.
In
ad
d
itio
n
,
th
is
m
ay
b
e
d
u
e
to
th
e
f
ac
t
th
at
m
o
s
t
s
taf
f
n
u
r
s
es
p
o
s
s
ess
h
ig
h
k
n
o
wled
g
e
lev
els,
wh
ich
co
u
ld
lead
to
h
ig
h
s
k
ill
lev
els
in
ca
r
in
g
f
o
r
p
atien
ts
af
ter
ce
r
eb
r
al
an
eu
r
y
s
m
s
u
r
g
er
y
.
Ab
s
o
lu
tely
,
if
in
d
iv
id
u
als
h
av
e
k
n
o
wled
g
e
an
d
a
p
o
s
itiv
e
attitu
d
e,
it
lead
s
to
im
p
r
o
v
ed
s
k
ills
in
ca
r
in
g
f
o
r
th
ese
p
atien
t
[
36
].
B
esid
es,
th
is
s
tu
d
y
f
o
u
n
d
th
at
th
e
h
ig
h
est
s
co
r
es
f
o
r
p
r
ac
tice
in
ca
r
in
g
f
o
r
th
ese
p
atien
ts
wer
e
p
o
s
to
p
er
ativ
e
ca
r
e
f
o
r
p
r
ev
en
tin
g
v
aso
s
p
asm
,
f
o
llo
wed
b
y
p
o
s
to
p
er
ativ
e
ca
r
e
f
o
r
p
r
ev
en
tin
g
r
ec
u
r
r
en
t b
leed
in
g
.
Fu
r
th
er
m
o
r
e,
th
is
s
tu
d
y
was
s
ig
n
if
ican
t
p
o
s
itiv
e
co
r
r
elatio
n
b
etwe
en
th
e
s
taf
f
n
u
r
s
es
’
KAP
to
war
d
ca
r
in
g
o
f
p
atien
ts
with
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
u
n
d
er
g
o
in
g
s
u
r
g
er
y
in
cr
itical
p
er
io
d
with
p
-
v
alu
e<
0
.
05
.
L
ik
ewise,
n
u
r
s
es'
k
n
o
wled
g
e
an
d
attitu
d
e
s
h
o
w
a
p
o
s
itiv
e
co
r
r
elatio
n
with
th
eir
p
r
ac
tice
[
40
].
KAP
T
h
is
m
ay
b
e
attr
ib
u
ted
to
th
e
f
ac
t
th
at
s
taf
f
n
u
r
s
es
with
ex
ten
s
iv
e
k
n
o
wled
g
e
ten
d
to
d
ev
elo
p
m
o
r
e
p
o
s
itiv
e
attitu
d
es,
wh
ich
in
tu
r
n
en
h
an
ce
s
th
eir
p
r
ac
tice
in
ca
r
in
g
f
o
r
p
o
s
t
o
p
er
ativ
e
p
atien
ts
[
3
5
]
.
Ad
d
itio
n
ally
,
th
is
s
tu
d
y
f
o
u
n
d
a
s
ig
n
if
ican
t
p
o
s
itiv
e
co
r
r
elatio
n
b
etwe
en
s
taf
f
n
u
r
s
es'
ag
e,
d
u
r
atio
n
o
f
ex
p
er
ien
ce
with
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
s
,
an
d
th
eir
p
r
ac
tices
in
ca
r
in
g
f
o
r
th
ese
p
atien
ts
d
u
r
in
g
cr
itical
p
er
io
d
s
,
with
a
p
-
v
alu
e
<0
.
0
5
.
C
o
n
s
eq
u
en
tly
,
o
ld
er
s
taf
f
n
u
r
s
es with
th
eir
ex
ten
s
iv
e
ex
p
er
ien
ce
ten
d
to
p
r
o
v
id
e
ex
ce
p
tio
n
al
p
o
s
to
p
er
ativ
e
ca
r
e
wh
ich
en
s
u
r
es th
e
h
ig
h
est q
u
ality
o
f
ca
r
e
[
38
].
4.
CO
NCLUS
I
O
N
T
h
e
KAP
o
f
s
taf
f
n
u
r
s
es
p
lay
an
im
p
o
r
tan
t
ca
r
in
g
in
p
o
s
to
p
er
ativ
e
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
p
atien
ts
.
T
h
e
s
tu
d
y
s
u
g
g
ests
th
at
r
eg
u
lar
s
u
p
er
v
is
io
n
s
h
o
u
ld
b
e
p
r
o
v
id
ed
to
n
ewly
r
ec
r
u
ited
n
u
r
s
es
o
r
th
o
s
e
wo
r
k
in
g
in
u
n
its
th
at
ca
r
e
f
o
r
th
ese
p
atien
ts
.
Acc
o
r
d
in
g
to
th
is
r
esear
ch
,
we
r
ec
o
m
m
en
d
im
p
lem
en
tin
g
s
tr
u
ct
u
r
ed
tr
ain
in
g
p
r
o
g
r
am
s
f
o
cu
s
ed
o
n
p
r
ev
en
tin
g
co
m
p
licatio
n
s
af
ter
p
o
s
to
p
er
ativ
e
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
s
u
r
g
er
y
,
alo
n
g
s
id
e
o
n
g
o
in
g
p
r
o
f
ess
io
n
al
d
ev
elo
p
m
en
t
to
en
s
u
r
e
th
at
s
taf
f
n
u
r
s
es r
em
ain
u
p
d
ated
o
n
th
e
latest
k
n
o
wled
g
e
an
d
r
esear
ch
ad
v
an
ce
m
en
ts
.
T
h
is
will
en
h
an
ce
th
e
p
r
ev
en
tio
n
o
f
co
m
p
licatio
n
s
f
o
llo
win
g
p
o
s
to
p
er
ativ
e
r
u
p
tu
r
ed
ce
r
eb
r
al
an
eu
r
y
s
m
s
u
r
g
er
y
,
u
ltima
tely
lead
in
g
to
m
o
r
e
ef
f
ec
tiv
e
n
u
r
s
in
g
ca
r
e
.
ACK
NO
WL
E
DG
E
M
E
NT
S
T
h
e
au
th
o
r
s
wo
u
ld
lik
e
to
th
an
k
s
th
e
n
u
r
s
in
g
s
taf
f
s
wh
o
p
ar
ticip
ate
in
th
is
s
tu
d
y
,
as
well
as
th
e
n
u
r
s
e
ad
m
in
is
tr
ato
r
s
o
f
R
o
i E
t
H
o
s
p
ital
f
o
r
th
eir
k
in
d
ly
s
u
p
p
o
r
t
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
T
h
is
r
esear
ch
h
as n
o
f
u
n
d
in
g
i
n
v
o
lv
e
d
.
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
5
61
-
1
56
8
1566
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
O
E
Vi
Su
P
Fu
Palam
a
So
b
u
t
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
B
o
o
n
y
ad
a
W
o
n
g
p
im
o
ln
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Su
p
attr
a
Pleay
n
o
n
g
k
h
ae
✓
✓
✓
✓
✓
✓
Kitiy
ar
at
Han
lu
e
✓
✓
✓
✓
✓
Sattawas U
d
o
n
s
at
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
C
:
C
o
n
c
e
p
t
u
a
l
i
z
a
t
i
o
n
M
:
M
e
t
h
o
d
o
l
o
g
y
So
:
So
f
t
w
a
r
e
Va
:
Va
l
i
d
a
t
i
o
n
Fo
:
Fo
r
mal
a
n
a
l
y
s
i
s
I
:
I
n
v
e
s
t
i
g
a
t
i
o
n
R
:
R
e
so
u
r
c
e
s
D
:
D
a
t
a
C
u
r
a
t
i
o
n
O
:
W
r
i
t
i
n
g
-
O
r
i
g
i
n
a
l
D
r
a
f
t
E
:
W
r
i
t
i
n
g
-
R
e
v
i
e
w
&
E
d
i
t
i
n
g
Vi
:
Vi
su
a
l
i
z
a
t
i
o
n
Su
:
Su
p
e
r
v
i
s
i
o
n
P
:
P
r
o
j
e
c
t
a
d
mi
n
i
st
r
a
t
i
o
n
Fu
:
Fu
n
d
i
n
g
a
c
q
u
i
si
t
i
o
n
CO
NF
L
I
C
T
O
F
I
N
T
E
R
E
S
T
ST
A
T
E
M
E
NT
T
h
is
r
esear
ch
h
as
n
o
co
n
f
lict o
f
in
ter
est
.
DATA AV
AI
L
AB
I
L
I
T
Y
T
h
e
d
ata
th
at
s
u
p
p
o
r
t
th
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
ar
e
av
aila
b
le
o
n
r
eq
u
est
f
r
o
m
th
e
co
r
r
esp
o
n
d
in
g
au
th
o
r
,
[
SU
]
.
T
h
e
d
ata,
wh
ich
co
n
tain
in
f
o
r
m
atio
n
th
a
t
co
u
ld
co
m
p
r
o
m
is
e
th
e
p
r
iv
ac
y
o
f
r
esear
ch
p
ar
ticip
an
ts
,
ar
e
n
o
t p
u
b
licly
a
v
ailab
le
d
u
e
to
ce
r
tain
r
estrictio
n
s
.
RE
F
E
R
E
NC
E
S
[
1
]
R
.
G
.
T
a
w
k
,
T.
F
.
H
a
s
a
n
,
C
.
E.
D
’
S
o
u
z
a
,
J
.
B
.
P
e
e
l
,
a
n
d
W
.
D
.
F
r
e
e
ma
n
,
“
D
i
a
g
n
o
s
i
s
a
n
d
t
r
e
a
t
m
e
n
t
o
f
u
n
r
u
p
t
u
r
e
d
i
n
t
r
a
c
r
a
n
i
a
l
a
n
e
u
r
y
sms
a
n
d
a
n
e
u
r
y
sma
l
su
b
a
r
a
c
h
n
o
i
d
h
e
m
o
r
r
h
a
g
e
,
”
Ma
y
o
C
l
i
n
i
c
Pr
o
c
e
e
d
i
n
g
s
,
v
o
l
.
9
6
,
n
o
.
7
,
p
p
.
1
9
7
0
–
2
0
0
0
,
2
0
2
1
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
ma
y
o
c
p
.
2
0
2
1
.
0
1
.
0
0
5
.
[
2
]
M
.
M
e
g
l
i
o
,
“
C
l
a
z
o
s
e
n
t
a
n
f
a
i
l
s
t
o
m
e
e
t
p
r
i
m
a
r
y
e
n
d
p
o
i
n
t
i
n
p
h
a
se
3
R
E
A
C
T
st
u
d
y
o
f
a
n
e
u
r
y
sm
a
l
su
b
a
r
a
c
h
n
o
i
d
h
e
m
o
r
r
h
a
g
e
,
”
N
e
u
ro
l
o
g
y
T
i
m
e
s
,
p
.
N
A
-
N
A
,
2
0
2
3
.
[
3
]
X
.
W
a
n
g
a
n
d
X
.
H
u
a
n
g
,
“
R
i
s
k
f
a
c
t
o
r
s
a
n
d
p
r
e
d
i
c
t
i
v
e
i
n
d
i
c
a
t
o
r
s
o
f
r
u
p
t
u
r
e
i
n
c
e
r
e
b
r
a
l
a
n
e
u
r
y
sms
,
”
Fro
n
t
i
e
rs
i
n
P
h
y
s
i
o
l
o
g
y
,
v
o
l
.
1
5
,
p
p
.
1
–
1
8
,
S
e
p
.
2
0
2
4
,
d
o
i
:
1
0
.
3
3
8
9
/
f
p
h
y
s.
2
0
2
4
.
1
4
5
4
0
1
6
.
[
4
]
A
.
L
.
H
u
g
u
e
n
a
r
d
,
V
.
P
.
G
u
p
t
a
,
A
.
C
.
B
r
a
v
e
r
m
a
n
,
a
n
d
R
.
G
.
D
a
c
e
y
,
“
G
e
n
e
t
i
c
a
n
d
h
e
r
i
t
a
b
l
e
c
o
n
s
i
d
e
r
a
t
i
o
n
s
i
n
p
a
t
i
e
n
t
s
o
r
f
a
m
i
l
i
e
s
w
i
t
h
b
o
t
h
i
n
t
r
a
c
r
a
n
i
a
l
a
n
d
e
x
t
r
a
c
r
a
n
i
a
l
a
n
e
u
r
y
s
m
s,
”
J
o
u
rn
a
l
o
f
N
e
u
ro
su
rg
e
ry
,
v
o
l
.
1
3
4
,
n
o
.
6
,
p
p
.
1
9
9
9
–
2
0
0
6
,
2
0
2
1
,
d
o
i
:
1
0
.
3
1
7
1
/
2
0
2
0
.
8
.
J
N
S
2
0
3
2
3
4
.
[
5
]
V
.
K
a
r
h
u
n
e
n
,
M
.
K
.
B
a
k
k
e
r
,
Y
.
M
.
R
u
i
g
r
o
k
,
D
.
G
i
l
l
,
a
n
d
S
.
C
.
La
r
ss
o
n
,
“
M
o
d
i
f
i
a
b
l
e
r
i
s
k
f
a
c
t
o
r
s
f
o
r
i
n
t
r
a
c
r
a
n
i
a
l
a
n
e
u
r
y
sm
a
n
d
a
n
e
u
r
y
sma
l
s
u
b
a
r
a
c
h
n
o
i
d
h
e
mo
r
r
h
a
g
e
:
a
me
n
d
e
l
i
a
n
r
a
n
d
o
mi
z
a
t
i
o
n
s
t
u
d
y
,
”
J
o
u
r
n
a
l
o
f
t
h
e
Am
e
r
i
c
a
n
H
e
a
r
t
As
s
o
c
i
a
t
i
o
n
,
v
o
l
.
1
0
,
n
o
.
2
2
,
N
o
v
.
2
0
2
1
,
d
o
i
:
1
0
.
1
1
6
1
/
JA
H
A
.
1
2
1
.
0
2
2
2
7
7
.
[
6
]
B
.
L
.
H
o
h
e
t
a
l
.
,
“
2
0
2
3
g
u
i
d
e
l
i
n
e
f
o
r
t
h
e
m
a
n
a
g
e
m
e
n
t
o
f
p
a
t
i
e
n
t
s
w
i
t
h
a
n
e
u
r
y
s
m
a
l
s
u
b
a
r
a
c
h
n
o
i
d
h
e
m
o
r
r
h
a
g
e
:
A
g
u
i
d
e
l
i
n
e
f
r
o
m
t
h
e
A
m
e
r
i
c
a
n
H
e
a
r
t
A
s
s
o
c
i
a
t
i
o
n
/
A
m
e
r
i
c
a
n
S
t
r
o
k
e
A
s
s
o
c
i
a
t
i
o
n
,
”
S
t
r
o
k
e
,
v
o
l
.
5
4
,
n
o
.
7
,
J
u
l
.
2
0
2
3
,
d
o
i
:
1
0
.
1
1
6
1
/
S
T
R
.
0
0
0
0
0
0
0
0
0
0
0
0
0
4
3
6
.
[
7
]
R
.
M
.
K
r
z
y
ż
e
w
sk
i
e
t
a
l
.
,
“
I
n
t
r
a
c
r
a
n
i
a
l
a
n
e
u
r
y
sm
d
i
s
t
r
i
b
u
t
i
o
n
a
n
d
c
h
a
r
a
c
t
e
r
i
s
t
i
c
s
a
c
c
o
r
d
i
n
g
t
o
g
e
n
d
e
r
,
”
Br
i
t
i
s
h
J
o
u
rn
a
l
o
f
N
e
u
ro
s
u
r
g
e
r
y
,
v
o
l
.
3
2
,
n
o
.
5
,
p
p
.
5
4
1
–
5
4
3
,
S
e
p
.
2
0
1
8
,
d
o
i
:
1
0
.
1
0
8
0
/
0
2
6
8
8
6
9
7
.
2
0
1
8
.
1
5
1
8
5
1
4
.
[
8
]
M
.
F
r
é
n
e
a
u
,
C
.
B
a
r
o
n
-
M
e
n
g
u
y
,
A
.
-
C
.
V
i
o
n
,
a
n
d
G
.
L
o
i
r
a
n
d
,
“
W
h
y
a
r
e
w
o
men
p
r
e
d
i
s
p
o
s
e
d
t
o
i
n
t
r
a
c
r
a
n
i
a
l
a
n
e
u
r
y
sm?
,
”
Fr
o
n
t
i
e
rs
i
n
C
a
rd
i
o
v
a
sc
u
l
a
r
Me
d
i
c
i
n
e
,
v
o
l
.
9
,
F
e
b
.
2
0
2
2
,
d
o
i
:
1
0
.
3
3
8
9
/
f
c
v
m
.
2
0
2
2
.
8
1
5
6
6
8
.
[
9
]
Y
.
W
.
H
a
d
d
a
d
,
E
.
K
o
r
c
a
r
i
,
G
.
N
.
P
o
l
s
i
n
e
l
l
i
,
a
n
d
D
.
Y
u
c
h
u
a
n
,
“
T
h
e
e
f
f
e
c
t
o
f
c
o
c
a
i
n
e
a
n
d
m
e
t
h
a
m
p
h
e
t
a
m
i
n
e
o
n
s
a
c
c
u
l
a
r
a
n
e
u
r
y
s
m
f
o
r
m
a
t
i
o
n
a
n
d
r
u
p
t
u
r
e
:
A
l
i
t
e
r
a
t
u
r
e
r
e
v
i
e
w
,
”
B
r
a
i
n
H
e
m
o
r
r
h
a
g
e
s
,
v
o
l
.
2
,
n
o
.
3
,
S
e
p
.
2
0
2
1
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
h
e
s
t
.
2
0
2
0
.
1
1
.
0
0
2
.
[
1
0
]
J.
R
.
V
i
t
t
e
t
a
l
.
,
“
Th
e
c
l
i
n
i
c
a
l
i
m
p
a
c
t
o
f
r
e
c
e
n
t
m
e
t
h
a
mp
h
e
t
a
m
i
n
e
e
x
p
o
su
r
e
i
n
a
n
e
u
r
y
sma
l
su
b
a
r
a
c
h
n
o
i
d
p
a
t
i
e
n
t
s
,
”
Re
s
e
a
rc
h
S
q
u
a
re
(
Pre
p
ri
n
t
)
,
M
a
r
.
3
1
,
2
0
2
3
.
d
o
i
:
1
0
.
2
1
2
0
3
/
r
s.
3
.
r
s
-
2
6
9
4
4
2
4
/
v
1
.
[
1
1
]
P
.
B
e
n
n
e
t
t
,
G
.
B
.
d
e
A
g
u
i
a
r
,
a
n
d
R
.
C
.
d
a
S
i
l
v
a
,
“
T
h
e
r
e
l
a
t
i
o
n
s
h
i
p
b
e
t
w
e
e
n
smo
k
i
n
g
a
n
d
b
r
a
i
n
a
n
e
u
r
y
sms
:
f
r
o
m
f
o
r
ma
t
i
o
n
t
o
r
u
p
t
u
r
e
,
”
Re
v
i
s
t
a
d
a
Asso
c
i
a
ç
ã
o
M
é
d
i
c
a
Bra
s
i
l
e
i
r
a
,
v
o
l
.
6
7
,
n
o
.
6
,
p
p
.
8
9
5
–
8
9
9
,
Ju
n
.
2
0
2
1
,
d
o
i
:
1
0
.
1
5
9
0
/
1
8
0
6
-
9
2
8
2
.
2
0
2
1
0
2
9
3
.
[
1
2
]
B
.
L
e
e
,
J.
W
.
Le
e
,
K
.
Y
.
P
a
r
k
,
D
.
J
.
K
i
m,
B
.
M
.
K
i
m
,
a
n
d
J.
C
h
u
n
g
,
“
E
n
d
o
v
a
sc
u
l
a
r
t
r
e
a
t
m
e
n
t
o
f
i
n
t
r
a
c
r
a
n
i
a
l
a
n
e
u
r
y
sms
a
sso
c
i
a
t
e
d
w
i
t
h
b
r
a
i
n
a
r
t
e
r
i
o
v
e
n
o
u
s
mal
f
o
r
ma
t
i
o
n
s
,
”
J
o
u
r
n
a
l
o
f
N
e
u
r
o
i
n
t
e
n
si
v
e
C
a
r
e
,
v
o
l
.
2
,
n
o
.
2
,
p
p
.
4
5
–
5
1
,
O
c
t
.
2
0
1
9
,
d
o
i
:
1
0
.
3
2
5
8
7
/
j
n
i
c
.
2
0
1
9
.
0
0
1
7
1
.
[
1
3
]
M
.
E.
El
-
A
b
t
a
h
,
J.
C
.
P
e
t
i
t
t
,
A
.
K
a
s
h
k
o
u
s
h
,
R
.
A
c
h
e
y
,
M
.
D
.
B
a
i
n
,
a
n
d
N
.
Z
.
M
o
o
r
e
,
“
E
n
d
o
v
a
sc
u
l
a
r
ma
n
a
g
e
me
n
t
o
f
a
r
t
e
r
i
o
v
e
n
o
u
s
mal
f
o
r
m
a
t
i
o
n
–
a
ss
o
c
i
a
t
e
d
i
n
t
r
a
c
r
a
n
i
a
l
a
n
e
u
r
y
sms
:
a
s
y
st
e
ma
t
i
c
l
i
t
e
r
a
t
u
r
e
r
e
v
i
e
w
,
”
W
o
rl
d
N
e
u
r
o
su
r
g
e
r
y
,
v
o
l
.
1
6
4
,
p
p
.
2
5
7
–
2
6
9
,
A
u
g
.
2
0
2
2
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
w
n
e
u
.
2
0
2
2
.
0
5
.
0
5
1
.
[
1
4
]
X
.
F
e
n
g
e
t
a
l
.
,
“
N
u
m
b
e
r
o
f
c
i
g
a
r
e
t
t
e
s
smo
k
e
d
p
e
r
d
a
y
,
sm
o
k
i
n
g
i
n
d
e
x
,
a
n
d
i
n
t
r
a
c
r
a
n
i
a
l
a
n
e
u
r
y
s
m
r
u
p
t
u
r
e
:
a
c
a
se
–
c
o
n
t
r
o
l
s
t
u
d
y
,
”
Fro
n
t
i
e
rs
i
n
N
e
u
ro
l
o
g
y
,
v
o
l
.
9
,
p
.
3
8
0
,
M
a
y
2
0
1
8
,
d
o
i
:
1
0
.
3
3
8
9
/
f
n
e
u
r
.
2
0
1
8
.
0
0
3
8
0
.
[
1
5
]
L.
Tr
a
k
o
l
i
s
a
n
d
A
.
K
.
P
e
t
r
i
d
i
s
,
“
C
l
i
n
i
c
a
l
m
a
n
a
g
e
me
n
t
o
f
a
r
u
p
t
u
r
e
d
i
n
t
r
a
c
r
a
n
i
a
l
a
n
e
u
r
y
sm,
”
Fro
n
t
i
e
rs
i
n
S
t
r
o
k
e
,
v
o
l
.
3
,
S
e
p
.
2
0
2
4
,
d
o
i
:
1
0
.
3
3
8
9
/
f
s
t
r
o
.
2
0
2
4
.
1
4
5
0
6
5
0
.
[
1
6
]
R
.
C
h
e
n
,
S
.
Zh
a
n
g
,
A
.
X
i
a
o
,
R
.
G
u
o
,
a
n
d
J.
M
a
,
“
R
i
s
k
f
a
c
t
o
r
s
f
o
r
i
n
t
r
a
c
r
a
n
i
a
l
a
n
e
u
r
y
sm
r
u
p
t
u
r
e
i
n
p
e
d
i
a
t
r
i
c
p
a
t
i
e
n
t
s,”
Ac
t
a
N
e
u
ro
c
h
i
r
u
rg
i
c
a
,
v
o
l
.
1
6
4
,
n
o
.
4
,
p
p
.
1
1
4
5
–
1
1
5
2
,
A
p
r
.
2
0
2
2
,
d
o
i
:
1
0
.
1
0
0
7
/
s
0
0
7
0
1
-
0
2
1
-
0
4
9
5
7
-
2.
[
1
7
]
A
.
S
.
D
e
sh
m
u
k
h
e
t
a
l
.
,
“
Th
e
m
a
n
a
g
e
m
e
n
t
o
f
i
n
t
r
a
c
r
a
n
i
a
l
a
n
e
u
r
y
sm
s:
c
u
r
r
e
n
t
t
r
e
n
d
s
a
n
d
f
u
t
u
r
e
d
i
r
e
c
t
i
o
n
s,
”
N
e
u
ro
l
o
g
y
I
n
t
e
r
n
a
t
i
o
n
a
l
,
v
o
l
.
1
6
,
n
o
.
1
,
p
p
.
7
4
–
9
4
,
J
a
n
.
2
0
2
4
,
d
o
i
:
1
0
.
3
3
9
0
/
n
e
u
r
o
l
i
n
t
1
6
0
1
0
0
0
5
.
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
0
6
K
n
o
w
led
g
e,
a
ttit
u
d
e,
a
n
d
p
r
a
ctice
o
f sta
ff n
u
r
s
es o
n
ca
r
in
g
f
o
r
p
a
tien
ts
w
ith
…
(
P
a
la
ma
S
o
b
u
t
)
1567
[
1
8
]
M
.
L.
G
a
sa,
“
C
u
r
r
e
n
t
c
o
n
c
e
p
t
s
i
n
a
n
a
e
st
h
e
s
i
a
f
o
r
a
n
e
u
r
y
sma
l
s
u
b
a
r
a
c
h
n
o
i
d
h
a
e
mo
r
r
h
a
g
e
,
”
J
o
u
r
n
a
l
o
f
U
n
i
v
e
rsi
t
y
o
f
K
w
a
z
u
l
u
-
N
a
t
a
l
,
v
o
l
.
1
9
,
n
o
.
1
2
,
p
p
.
e
1
–
e
2
0
,
2
0
1
9
.
[
1
9
]
W.
-
S
.
C
h
o
e
t
a
l
.
,
“
K
o
r
e
a
n
c
l
i
n
i
c
a
l
p
r
a
c
t
i
c
e
g
u
i
d
e
l
i
n
e
s
f
o
r
a
n
e
u
r
y
sm
a
l
s
u
b
a
r
a
c
h
n
o
i
d
h
e
m
o
r
r
h
a
g
e
,
”
J
o
u
r
n
a
l
o
f
K
o
re
a
n
N
e
u
ro
s
u
r
g
i
c
a
l
S
o
c
i
e
t
y
,
v
o
l
.
6
1
,
n
o
.
2
,
p
p
.
1
2
7
–
1
6
6
,
M
a
r
.
2
0
1
8
,
d
o
i
:
1
0
.
3
3
4
0
/
j
k
n
s
.
2
0
1
7
.
0
4
0
4
.
0
0
5
.
[
2
0
]
T.
H
a
u
ss
a
l
o
,
“
P
o
st
o
p
e
r
a
t
i
v
e
n
u
r
si
n
g
c
a
r
e
o
f
a
d
u
l
t
n
e
u
r
o
su
r
g
i
c
a
l
p
a
t
i
e
n
t
s
i
n
t
e
r
v
e
n
t
i
o
n
s
a
n
d
c
o
n
si
d
e
r
a
t
i
o
n
s
a
c
c
o
r
d
i
n
g
t
o
l
i
t
e
r
a
t
u
r
e
,
”
J
y
v
ä
sk
y
l
ä
n
A
m
m
a
t
t
i
k
o
rk
e
a
k
o
u
l
u
(
J
AM
K
)
,
2
0
2
1
,
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s
:
/
/
w
w
w
.
t
h
e
s
e
u
s
.
f
i
/
b
i
t
s
t
r
e
a
m
/
h
a
n
d
l
e
/
1
0
0
2
4
/
5
1
1
5
5
4
/
T
h
e
si
s_
H
a
u
ss
a
l
o
_
Ti
i
n
a
.
p
d
f
?
s
e
q
u
e
n
c
e
=
2
(
A
c
c
e
ss
e
d
:
J
a
n
1
0
,
2
0
2
4
)
[
2
1
]
Y
.
H
u
a
n
g
,
X
.
W
a
n
g
,
J.
Li
,
Q
.
H
e
,
a
n
d
R
.
W
a
n
g
,
“
K
n
o
w
l
e
d
g
e
,
a
t
t
i
t
u
d
e
,
a
n
d
p
r
a
c
t
i
c
e
t
o
w
a
r
d
s
e
n
h
a
n
c
e
d
r
e
c
o
v
e
r
y
a
f
t
e
r
su
r
g
e
r
y
a
mo
n
g
p
a
t
i
e
n
t
s
u
n
d
e
r
w
e
n
t
t
h
o
r
a
c
o
s
c
o
p
y
s
u
r
g
e
r
y
,
”
PLO
S
O
N
E
,
v
o
l
.
1
9
,
n
o
.
9
,
p
.
e
0
3
0
9
8
2
1
,
S
e
p
.
2
0
2
4
,
d
o
i
:
1
0
.
1
3
7
1
/
j
o
u
r
n
a
l
.
p
o
n
e
.
0
3
0
9
8
2
1
.
[
2
2
]
P
.
D
u
a
n
g
t
h
o
n
g
p
h
o
n
,
B
.
S
o
u
w
o
n
g
,
W
.
M
u
n
k
o
n
g
,
a
n
d
A
.
K
i
t
k
h
u
a
n
d
e
e
,
“
R
e
s
u
l
t
s
o
f
a
p
r
e
v
e
n
t
i
v
e
r
e
b
l
e
e
d
i
n
g
p
r
o
t
o
c
o
l
i
n
p
a
t
i
e
n
t
s
w
i
t
h
r
u
p
t
u
r
e
d
c
e
r
e
b
r
a
l
a
n
e
u
r
y
sm
:
A
r
e
t
r
o
s
p
e
c
t
i
v
e
c
o
h
o
r
t
s
t
u
d
y
,
”
Asi
a
n
J
o
u
rn
a
l
o
f
N
e
u
r
o
s
u
rg
e
ry
,
v
o
l
.
1
4
,
n
o
.
3
,
p
p
.
7
4
8
–
7
5
3
,
S
e
p
.
2
0
1
9
,
d
o
i
:
1
0
.
4
1
0
3
/
a
j
n
s
.
A
JN
S
_
3
2
_
1
9
.
[
2
3
]
K
.
Li
e
t
a
l
.
,
“
A
r
e
v
i
e
w
o
f
t
h
e
m
a
n
a
g
e
me
n
t
o
f
c
e
r
e
b
r
a
l
v
a
s
o
sp
a
sm
a
f
t
e
r
a
n
e
u
r
y
sm
a
l
su
b
a
r
a
c
h
n
o
i
d
h
e
m
o
r
r
h
a
g
e
,
”
W
o
rl
d
N
e
u
ro
s
u
r
g
e
r
y
,
v
o
l
.
1
2
6
,
p
p
.
5
1
3
–
5
2
7
,
Ju
n
.
2
0
1
9
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
w
n
e
u
.
2
0
1
9
.
0
3
.
0
8
3
.
[
2
4
]
G
.
F
u
s
h
i
h
a
r
a
e
t
a
l
.
,
“
F
a
c
t
o
r
s
a
s
so
c
i
a
t
e
d
w
i
t
h
e
a
r
l
y
s
e
i
z
u
r
e
s
a
f
t
e
r
su
r
g
e
r
y
o
f
u
n
r
u
p
t
u
r
e
d
i
n
t
r
a
c
r
a
n
i
a
l
a
n
e
u
r
y
sms
,
”
C
l
i
n
i
c
a
l
N
e
u
ro
l
o
g
y
a
n
d
N
e
u
r
o
su
r
g
e
r
y
,
v
o
l
.
1
7
8
,
p
p
.
9
3
–
9
6
,
M
a
r
.
2
0
1
9
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
c
l
i
n
e
u
r
o
.
2
0
1
9
.
0
2
.
0
0
7
.
[
2
5
]
B
.
J.
D
a
o
u
e
t
a
l
.
,
“
S
e
i
z
u
r
e
p
r
o
p
h
y
l
a
x
i
s
i
n
u
n
r
u
p
t
u
r
e
d
a
n
e
u
r
y
sm
r
e
p
a
i
r
:
a
r
a
n
d
o
m
i
z
e
d
c
o
n
t
r
o
l
l
e
d
t
r
i
a
l
,
”
J
o
u
rn
a
l
o
f
S
t
ro
k
e
a
n
d
C
e
re
b
r
o
v
a
sc
u
l
a
r
D
i
se
a
ses
,
v
o
l
.
2
9
,
n
o
.
1
0
,
p
.
1
0
5
1
7
1
,
O
c
t
.
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
j
st
r
o
k
e
c
e
r
e
b
r
o
v
a
s
d
i
s
.
2
0
2
0
.
1
0
5
1
7
1
.
[
2
6
]
A
.
M
.
B
a
z
e
z
e
w
,
N
.
N
u
r
u
,
T.
G
.
D
e
m
ssi
e
,
a
n
d
D
.
G
.
A
y
e
l
e
,
“
K
n
o
w
l
e
d
g
e
,
p
r
a
c
t
i
c
e
,
a
n
d
a
ss
o
c
i
a
t
e
d
f
a
c
t
o
r
s
o
f
p
r
e
o
p
e
r
a
t
i
v
e
p
a
t
i
e
n
t
t
e
a
c
h
i
n
g
a
mo
n
g
s
u
r
g
i
c
a
l
u
n
i
t
n
u
r
s
e
s,
a
t
N
o
r
t
h
w
e
s
t
A
m
h
a
r
a
C
o
m
p
r
e
h
e
n
si
v
e
S
p
e
c
i
a
l
i
z
e
d
R
e
f
e
r
r
a
l
H
o
sp
i
t
a
l
s
,
N
o
r
t
h
w
e
s
t
Et
h
i
o
p
i
a
,
2
0
2
2
,
”
BM
C
N
u
rsi
n
g
,
v
o
l
.
2
2
,
n
o
.
2
0
,
Jan
.
2
0
2
3
,
d
o
i
:
1
0
.
1
1
8
6
/
s1
2
9
1
2
-
023
-
0
1
1
7
5
-
2.
[
2
7
]
W
.
C
h
a
n
t
k
r
a
n
,
J.
C
h
a
i
s
a
k
u
l
,
R
.
R
a
n
g
si
n
,
M
.
M
u
n
g
t
h
i
n
,
B
.
S
a
k
b
o
o
n
y
a
r
a
t
,
“
P
r
e
v
a
l
e
n
c
e
o
f
a
n
d
f
a
c
t
o
r
s
a
ss
o
c
i
a
t
e
d
w
i
t
h
st
r
o
k
e
i
n
h
y
p
e
r
t
e
n
si
v
e
p
a
t
i
e
n
t
s
i
n
T
h
a
i
l
a
n
d
f
r
o
m
2
0
1
4
t
o
2
0
1
8
:
A
n
a
t
i
o
n
w
i
d
e
c
r
o
s
s
-
sec
t
i
o
n
a
l
st
u
d
y
,
”
S
c
i
e
n
t
i
f
i
c
R
e
p
o
r
t
s
,
v
o
l
.
1
1
,
n
o
.
1
,
p
p
.
1
7
6
1
4
,
S
e
p
.
2
0
2
1
,
d
o
i
:
1
0
.
1
0
3
8
/
s4
1
5
9
8
-
0
21
-
9
6
8
7
8
-
4.
[
2
8
]
Z.
Q
i
q
u
a
n
a
n
d
W
.
H
u
a
,
“
Th
e
K
A
P
t
h
e
o
r
y
,
”
T
h
e
L
o
g
i
c
o
f
C
h
i
n
a
’
s
N
e
w
S
c
h
o
o
l
R
e
f
o
rm
s
,
p
p
.
3
8
–
5
0
,
2
0
2
1
,
d
o
i
:
1
0
.
1
1
6
3
/
9
7
8
9
0
0
4
4
7
3
3
0
0
_
0
0
4
.
[
2
9
]
F
.
Li
n
e
t
a
l
.
,
“
P
r
e
v
e
n
t
i
n
g
s
u
r
g
i
c
a
l
s
i
t
e
i
n
f
e
c
t
i
o
n
s
:
F
a
c
i
l
i
t
a
t
o
r
s
a
n
d
b
a
r
r
i
e
r
s
t
o
n
u
r
ses’
a
d
h
e
r
e
n
c
e
t
o
c
l
i
n
i
c
a
l
p
r
a
c
t
i
c
e
g
u
i
d
e
l
i
n
e
s
—
A
q
u
a
l
i
t
a
t
i
v
e
st
u
d
y
,
”
J
o
u
r
n
a
l
o
f
C
l
i
n
i
c
a
l
N
u
rsi
n
g
,
v
o
l
.
2
8
,
n
o
.
9
–
1
0
,
p
p
.
1
6
4
3
–
1
6
5
2
,
M
a
y
2
0
1
9
,
d
o
i
:
1
0
.
1
1
1
1
/
j
o
c
n
.
1
4
7
6
6
.
[
3
0
]
H
.
Y
o
u
,
J
.
L
i
,
X
.
W
a
n
g
,
G
.
Z
h
a
n
g
,
a
n
d
J.
Y
a
n
g
,
“
A
n
a
l
y
s
i
s
o
n
c
h
a
r
a
c
t
e
r
i
st
i
c
s
a
n
d
n
u
r
si
n
g
p
o
i
n
t
s
o
f
s
u
r
g
i
c
a
l
a
n
d
i
n
t
e
r
v
e
n
t
i
o
n
a
l
t
r
e
a
t
me
n
t
f
o
r
e
l
d
e
r
l
y
c
e
r
e
b
r
a
l
a
n
e
u
r
y
s
m,”
O
n
c
o
l
o
g
i
e
,
v
o
l
.
2
2
,
n
o
.
4
,
p
p
.
2
3
5
–
2
4
4
,
2
0
2
0
,
d
o
i
:
1
0
.
3
2
6
0
4
/
o
n
c
o
l
o
g
i
e
.
2
0
2
0
.
0
1
4
1
2
3
.
[
3
1
]
A
.
A
y
y
a
d
,
N
.
A
.
B
a
k
e
r
,
I
.
O
w
e
i
d
a
t
,
K
.
A
l
-
M
u
g
h
e
e
d
,
S
.
A
.
A
l
s
e
n
a
n
y
,
a
n
d
S
.
M
.
F
.
A
b
d
e
l
a
l
i
e
m
,
“
K
n
o
w
l
e
d
g
e
,
a
t
t
i
t
u
d
e
s,
a
n
d
p
r
a
c
t
i
c
e
s
t
o
w
a
r
d
p
a
t
i
e
n
t
saf
e
t
y
a
m
o
n
g
n
u
r
ses
i
n
h
e
a
l
t
h
c
e
n
t
e
r
s,
”
B
MC
N
u
rs
i
n
g
,
v
o
l
.
2
3
,
n
o
.
1
,
p
.
1
7
1
,
M
a
r
.
2
0
2
4
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
2
9
1
2
-
0
2
4
-
0
1
8
3
1
-
1.
[
3
2
]
B
.
G
ö
c
k
i
n
g
,
N
.
B
i
l
l
e
r
-
A
n
d
o
r
n
o
,
G
.
B
r
a
n
d
i
,
S
.
G
l
o
e
c
k
l
e
r
,
a
n
d
A
.
G
l
ä
ssel
,
“
A
n
e
u
r
y
sma
l
su
b
a
r
a
c
h
n
o
i
d
h
e
m
o
r
r
h
a
g
e
a
n
d
c
l
i
n
i
c
a
l
d
e
c
i
si
o
n
-
ma
k
i
n
g
:
A
q
u
a
l
i
t
a
t
i
v
e
p
i
l
o
t
st
u
d
y
e
x
p
l
o
r
i
n
g
p
e
r
sp
e
c
t
i
v
e
s
o
f
t
h
o
se
d
i
r
e
c
t
l
y
a
f
f
e
c
t
e
d
,
t
h
e
i
r
n
e
x
t
o
f
k
i
n
,
a
n
d
t
r
e
a
t
i
n
g
c
l
i
n
i
c
i
a
n
s,”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
rn
a
l
o
f
E
n
v
i
ro
n
m
e
n
t
a
l
R
e
se
a
rc
h
a
n
d
Pu
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
2
0
,
n
o
.
4
,
p
.
3
1
8
7
,
F
e
b
.
2
0
2
3
,
d
o
i
:
1
0
.
3
3
9
0
/
i
j
e
r
p
h
2
0
0
4
3
1
8
7
.
[
3
3
]
F
.
F
a
u
l
,
E
.
E
r
d
f
e
l
d
e
r
,
A
.
-
G
.
L
a
n
g
,
a
n
d
A
.
B
u
c
h
n
e
r
,
“
G
*
P
o
w
e
r
3
:
A
f
l
e
x
i
b
l
e
s
t
a
t
i
s
t
i
c
a
l
p
o
w
e
r
a
n
a
l
y
s
i
s
p
r
o
g
r
a
m
f
o
r
t
h
e
s
o
c
i
a
l
,
b
e
h
a
v
i
o
r
a
l
,
a
n
d
b
i
o
m
e
d
i
c
a
l
s
c
i
e
n
c
e
s
,
”
B
e
h
a
v
i
o
r
R
e
s
e
a
r
c
h
M
e
t
h
o
d
s
,
v
o
l
.
3
9
,
n
o
.
2
,
M
a
y
2
0
0
7
,
d
o
i
:
1
0
.
3
7
5
8
/
B
F
0
3
1
9
3
1
4
6
.
[
3
4
]
J.
C
o
h
e
n
,
S
t
a
t
i
s
t
i
c
a
l
p
o
w
e
r
a
n
a
l
y
si
s
f
o
r t
h
e
b
e
h
a
v
i
o
r
a
l
sc
i
e
n
c
e
s
.
N
e
w
Y
o
r
k
:
R
o
u
t
l
e
d
g
e
,
1
9
8
8
.
d
o
i
:
1
0
.
4
3
2
4
/
9
7
8
0
2
0
3
7
7
1
5
8
7
.
[
3
5
]
S
.
Zh
a
n
g
,
Y
.
L
i
,
M
.
T
o
n
g
,
Z.
W
e
n
,
a
n
d
Y
.
X
u
e
,
“
K
n
o
w
l
e
d
g
e
,
a
t
t
i
t
u
d
e
s a
n
d
p
r
a
c
t
i
c
e
t
o
w
a
r
d
s
p
o
s
t
o
p
e
r
a
t
i
v
e
n
u
r
si
n
g
o
f
p
a
t
i
e
n
t
s wit
h
d
i
g
i
t
r
e
p
l
a
n
t
a
t
i
o
n
a
n
d
sk
i
n
f
l
a
p
t
r
a
n
s
p
l
a
n
t
a
t
i
o
n
a
mo
n
g
n
e
w
n
u
r
ses
i
n
B
e
i
j
i
n
g
:
a
c
r
o
s
s
-
sec
t
i
o
n
a
l
s
u
r
v
e
y
,
”
BM
J
O
p
e
n
,
v
o
l
.
1
4
,
n
o
.
4
,
p
.
e
0
8
0
7
3
4
,
A
p
r
.
2
0
2
4
,
d
o
i
:
1
0
.
1
1
3
6
/
b
mj
o
p
e
n
-
2
0
2
3
-
0
8
0
7
3
4
.
[
3
6
]
D
.
R
.
K
r
a
t
h
w
o
h
l
,
B
.
S
.
B
l
o
o
m,
a
n
d
B
.
B
.
M
a
si
a
,
T
a
x
o
n
o
m
y
o
f
e
d
u
c
a
t
i
o
n
a
l
o
b
j
e
c
t
i
v
e
s,
h
a
n
d
b
o
o
k
I
I
:
a
f
f
e
c
t
i
v
e
d
o
m
a
i
n
(
t
h
e
c
l
a
ssi
f
i
c
a
t
i
o
n
o
f
e
d
u
c
a
t
i
o
n
a
l
g
o
a
l
s)
.
1
9
5
6
.
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
:
/
/
w
w
w
.
a
maz
o
n
.
c
o
m
/
Ta
x
o
n
o
m
y
-
Ed
u
c
a
t
i
o
n
a
l
-
O
b
j
e
c
t
i
v
e
s
-
H
a
n
d
b
o
o
k
-
C
l
a
ssi
f
i
c
a
t
i
o
n
/
d
p
/
B
0
0
0
B
Y
2
O
V
I
[
3
7
]
T.
L
.
P
.
A
g
u
s
t
i
,
N
.
A
r
k
h
a
e
si
,
A
.
R
i
a
n
sari
,
a
n
d
R
.
H
a
p
sar
i
,
“
K
n
o
w
l
e
d
g
e
,
a
t
t
i
t
u
d
e
s,
a
n
d
p
r
a
c
t
i
c
e
s
o
f
I
n
d
o
n
e
si
a
n
med
i
c
a
l
a
n
d
n
o
n
-
med
i
c
a
l
u
n
d
e
r
g
r
a
d
u
a
t
e
st
u
d
e
n
t
s
t
o
w
a
r
d
C
O
V
I
D
-
1
9
,
”
I
n
t
e
rn
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
P
u
b
l
i
c
H
e
a
l
t
h
S
c
i
e
n
c
e
(
I
J
PH
S
)
,
v
o
l
.
1
1
,
n
o
.
1
,
p
p
.
1
8
5
–
1
9
4
,
M
a
r
.
2
0
2
2
,
d
o
i
:
1
0
.
1
1
5
9
1
/
i
j
p
h
s
.
v
1
1
i
1
.
2
0
7
8
4
.
[
3
8
]
X
.
W
e
n
,
F
.
W
a
n
g
,
X
.
L
i
,
a
n
d
H
.
G
u
,
“
S
t
u
d
y
o
n
t
h
e
k
n
o
w
l
e
d
g
e
,
a
t
t
i
t
u
d
e
,
a
n
d
p
r
a
c
t
i
c
e
(
K
A
P
)
o
f
n
u
r
si
n
g
s
t
a
f
f
a
n
d
i
n
f
l
u
e
n
c
i
n
g
f
a
c
t
o
r
s
o
n
C
O
V
I
D
-
1
9
,
”
Fr
o
n
t
i
e
rs
i
n
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
8
,
p
p
.
1
–
6
,
Ja
n
.
2
0
2
1
,
d
o
i
:
1
0
.
3
3
8
9
/
f
p
u
b
h
.
2
0
2
0
.
5
6
0
6
0
6
.
[
3
9
]
N
.
S
h
o
q
i
r
a
t
,
D
.
M
a
h
a
s
n
e
h
,
O
.
A
l
-
K
h
a
w
a
l
d
e
h
,
a
n
d
L.
A
l
H
a
d
i
d
,
“
N
u
r
ses’
k
n
o
w
l
e
d
g
e
,
a
t
t
i
t
u
d
e
s,
a
n
d
b
a
r
r
i
e
r
s
t
o
w
a
r
d
p
a
i
n
man
a
g
e
me
n
t
a
m
o
n
g
p
o
st
o
p
e
r
a
t
i
v
e
p
a
t
i
e
n
t
s i
n
Jo
r
d
a
n
,
”
J
o
u
r
n
a
l
o
f
Pe
ri
A
n
e
s
t
h
e
s
i
a
N
u
rsi
n
g
,
v
o
l
.
3
4
,
n
o
.
2
,
p
p
.
3
5
9
–
3
6
7
,
A
p
r
.
2
0
1
9
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
j
o
p
a
n
.
2
0
1
8
.
0
5
.
0
1
2
.
[
4
0
]
K
.
Li
u
,
M
.
Lv
,
X
.
L
i
u
,
H
.
W
a
n
g
,
Z.
C
h
e
n
,
a
n
d
H
.
X
u
,
“
K
n
o
w
l
e
d
g
e
,
a
t
t
i
t
u
d
e
s
a
n
d
p
r
a
c
t
i
c
e
s
o
f
e
n
h
a
n
c
e
d
r
e
c
o
v
e
r
y
a
f
t
e
r
su
r
g
e
r
y
a
mo
n
g
p
a
e
d
i
a
t
r
i
c
s
u
r
g
i
c
a
l
n
u
r
ses
i
n
C
h
i
n
a
:
A
c
r
o
ss‐
se
c
t
i
o
n
a
l
s
t
u
d
y
,
”
N
u
r
si
n
g
O
p
e
n
,
v
o
l
.
1
0
,
n
o
.
3
,
p
p
.
1
8
3
0
–
1
8
3
9
,
M
a
r
.
2
0
2
3
,
d
o
i
:
1
0
.
1
0
0
2
/
n
o
p
2
.
1
4
4
3
.
B
I
O
G
RAP
H
I
E
S O
F
AUTH
O
RS
Pa
la
m
a
S
o
b
u
t
is
a
n
u
rsi
n
g
in
stru
c
t
o
r
a
t
d
iv
isi
o
n
o
f
Ad
u
lt
a
n
d
G
e
ro
n
t
o
lo
g
ica
l
Nu
rsin
g
,
F
a
c
u
lt
y
o
f
Nu
rsin
g
,
R
o
i
Et
Ra
jab
h
a
t
Un
iv
e
rsit
y
,
T
h
a
il
a
n
d
.
S
h
e
re
c
e
iv
e
d
h
e
r
M
.
N
.
S
.
i
n
Ad
u
lt
N
u
rsin
g
a
t
Kh
o
n
k
a
e
n
Un
i
v
e
rsity
.
He
r
re
se
a
rc
h
in
tere
sts
a
re
m
a
in
ly
fo
c
u
se
d
o
n
a
d
u
lt
a
n
d
g
e
ro
n
t
o
l
o
g
ica
l
n
u
rsi
n
g
.
Sh
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
p
a
lam
a
.
z
o
rs
o
2
0
0
5
@
g
m
a
il
.
c
o
m
.
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
5
61
-
1
56
8
1568
Bo
o
n
y
a
d
a
W
o
n
g
p
i
m
o
ln
is
a
n
As
sista
n
t
P
r
o
fe
ss
o
r
a
t
Di
v
is
io
n
o
f
A
d
u
lt
a
n
d
G
e
ro
n
to
lo
g
ica
l
Nu
rsin
g
,
F
a
c
u
lt
y
o
f
N
u
rsin
g
,
R
o
i
Et
Ra
jab
h
a
t
Un
iv
e
rsity
,
T
h
a
il
a
n
d
.
S
h
e
re
c
e
iv
e
d
h
e
r
M
.
N
.
S
.
i
n
N
u
rsin
g
Ad
m
in
istrati
o
n
a
t
C
h
u
lal
o
n
g
k
o
r
n
Un
iv
e
rsity
.
He
r
re
se
a
rc
h
in
tere
sts
a
re
m
a
in
ly
f
o
c
u
se
d
o
n
a
d
u
lt
a
n
d
g
e
ro
n
to
lo
g
ica
l
n
u
rsin
g
a
n
d
n
u
rsi
n
g
m
a
n
a
g
e
m
e
n
t
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
bo
o
n
y
a
d
a
@re
ru
.
ac
.
th
.
S
u
p
a
ttr
a
Pl
e
a
y
n
o
n
g
k
h
a
e
wo
r
k
s
a
t
t
h
e
Ne
u
ro
s
u
rg
e
ry
In
te
n
siv
e
Ca
re
Un
it
,
R
o
i
Et
Ho
sp
it
a
l,
R
o
i
E
t,
T
h
a
il
a
n
d
.
S
h
e
re
c
e
iv
e
d
h
e
r
Ba
c
h
e
lo
r
d
e
g
re
e
in
Nu
rsin
g
a
t
Bo
r
o
m
a
ra
jo
n
a
n
i
Co
ll
e
g
e
o
f
Nu
rsi
n
g
,
C
h
o
n
b
u
ri
,
Th
a
il
a
n
d
.
He
r
re
se
a
rc
h
fo
c
u
se
s
o
n
h
o
sp
it
a
ls,
h
e
a
lt
h
,
a
n
d
trau
m
a
ti
c
b
ra
in
in
ju
r
y
,
e
sp
e
c
ially
n
e
u
r
o
l
o
g
y
p
r
o
b
lem
s
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
su
p
a
tt
ra
4
7
8
6
@g
m
a
il
.
c
o
m
.
K
iti
y
a
r
a
t
H
a
n
lu
e
wo
rk
s
a
t
th
e
Ne
u
r
o
su
rg
e
r
y
In
te
n
siv
e
C
a
re
Un
it
,
Ro
i
Et
Ho
sp
it
a
l,
Ro
i
Et
,
Th
a
il
a
n
d
.
S
h
e
r
e
c
e
iv
e
d
h
e
r
Ba
c
h
e
lo
r
d
e
g
re
e
in
Nu
rsin
g
a
t
S
r
ima
h
a
sa
ra
k
h
a
m
Co
ll
e
g
e
o
f
Nu
rsi
n
g
,
M
a
h
a
sa
ra
k
h
a
m
,
Th
a
il
a
n
d
.
He
r
re
se
a
rc
h
fo
c
u
s
e
s
o
n
h
o
sp
it
a
ls,
h
e
a
lt
h
,
a
n
d
trau
m
a
ti
c
b
ra
in
in
ju
r
y
,
e
sp
e
c
ially
n
e
u
r
o
l
o
g
y
p
r
o
b
lem
s
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
wh
it
m
a
tt
e
r@win
d
o
ws
li
v
e
.
c
o
m
.
S
a
tta
w
a
s
Ud
o
n
sa
t
is
a
n
u
rsi
n
g
i
n
stru
c
t
o
r
a
t
D
i
v
isio
n
o
f
Ad
u
lt
a
n
d
G
e
ro
n
t
o
lo
g
ica
l
Nu
rsin
g
,
F
a
c
u
lt
y
o
f
Nu
rsi
n
g
,
Ro
i
Et
Ra
jab
h
a
t
Un
i
v
e
rsity
,
Th
a
il
a
n
d
.
He
re
c
e
iv
e
d
h
is
M
.
N
.
S
.
i
n
G
e
ro
n
to
lo
g
ica
l
Nu
rsi
n
g
a
t
B
u
ra
p
h
a
Un
i
v
e
rsity
.
His
re
se
a
rc
h
in
ter
e
sts
a
re
m
a
in
ly
fo
c
u
se
d
o
n
a
d
u
lt
a
n
d
g
e
ro
n
t
o
lo
g
ica
l
n
u
rsin
g
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
sa
tt
a
wa
s
9
@g
m
a
il
.
c
o
m
o
r
s
a
tt
a
wa
s.u
@re
ru
.
a
c
.
th
.
Evaluation Warning : The document was created with Spire.PDF for Python.