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K
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s
:
C
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Hy
p
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p
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v
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Nu
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Po
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CC B
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C
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Per
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Dep
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I
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titu
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,
Scie
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Hea
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So
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Kesd
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I
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C
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(
C
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co
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tetr
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u
p
war
d
tr
en
d
o
v
er
th
e
p
ast
th
r
ee
d
ec
a
d
es
[
1
]
-
[
3
]
.
Glo
b
al
esti
m
ates
in
d
icate
th
at
ce
s
ar
ea
n
s
ec
tio
n
r
ates h
av
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in
cr
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s
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f
r
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7
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1
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f
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ed
ically
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d
p
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d
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[
4
]
,
[
5
]
.
T
h
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cr
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as
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r
ep
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ted
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lo
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r
ef
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co
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b
in
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o
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clin
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in
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s
,
in
s
titu
tio
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al
p
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ac
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an
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in
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lu
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cin
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d
eliv
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d
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is
io
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s
[
1
]
,
[
6
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-
[
8
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.
Alth
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ce
s
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eliv
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ly
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th
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tex
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f
p
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an
ag
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t
[
9
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-
[1
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I
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8
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E
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terven
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in
r
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(
A
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P
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a
)
475
Po
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to
p
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p
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win
g
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s
ar
ea
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ec
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clin
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[1
2
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[1
6
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M
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[1
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1
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T
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elief
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p
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alg
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f
m
u
ltimo
d
al
an
alg
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p
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[
19
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-
[
24
]
.
W
h
ile
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eg
im
en
s
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ally
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s
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elate
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p
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d
d
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ce
[2
5
]
-
[
29
]
.
I
n
a
d
d
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,
s
u
b
s
tan
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f
m
u
ltimo
d
a
l
an
alg
esia
ac
r
o
s
s
h
ea
lth
ca
r
e
f
ac
ilit
ies,
p
ar
ticu
lar
ly
b
etwe
en
h
ig
h
-
in
c
o
m
e
a
n
d
r
eso
u
r
ce
-
lim
ited
s
ettin
g
s
,
r
esu
ltin
g
in
in
co
n
s
is
ten
t
an
al
g
esic
ef
f
ec
tiv
en
es
s
an
d
u
n
eq
u
al
ac
c
ess
to
o
p
tim
al
p
ain
co
n
tr
o
l
[3
0
]
-
[3
3
]
.
T
h
ese
lim
it
atio
n
s
h
av
e
p
r
o
m
p
ted
in
cr
ea
s
in
g
in
ter
est
in
ad
ju
n
ctiv
e,
n
o
n
-
p
h
ar
m
ac
o
lo
g
ical
s
tr
ateg
ies th
at
ca
n
co
m
p
lem
en
t stan
d
ar
d
an
alg
esic c
ar
e
with
o
u
t a
d
d
i
n
g
p
h
ar
m
ac
o
l
o
g
ical
b
u
r
d
en
.
C
o
m
p
lem
en
tar
y
n
o
n
-
p
h
a
r
m
ac
o
lo
g
ical
in
ter
v
e
n
tio
n
s
,
in
cl
u
d
i
n
g
r
elax
atio
n
tech
n
iq
u
es,
m
u
s
ic
th
er
ap
y
,
an
d
h
y
p
n
o
s
is
-
b
ased
ap
p
r
o
ac
h
es,
h
av
e
b
ee
n
ex
p
lo
r
ed
as
ad
ju
n
cts
f
o
r
p
o
s
to
p
e
r
ativ
e
p
ain
m
an
ag
em
en
t
[3
4
]
-
[3
7
].
Am
o
n
g
th
ese,
h
y
p
n
o
t
h
er
ap
y
h
as
g
ain
ed
atten
tio
n
d
u
e
t
o
its
p
r
o
p
o
s
ed
p
s
y
ch
o
p
h
y
s
io
lo
g
ical
m
ec
h
an
is
m
s
,
wh
ich
in
clu
d
e
m
o
d
u
latio
n
o
f
au
to
n
o
m
ic
n
er
v
o
u
s
s
y
s
tem
ac
tiv
ity
,
atten
tio
n
al
r
e
d
ir
ec
t
io
n
,
an
d
co
g
n
itiv
e
r
ein
ter
p
r
etatio
n
o
f
p
ai
n
p
er
ce
p
tio
n
[3
4
]
,
[
3
5
]
,
[
3
8
]
.
Neu
r
o
p
h
y
s
io
lo
g
ical
s
tu
d
ies
s
u
g
g
est
th
at
h
y
p
n
o
s
is
m
ay
in
f
lu
en
ce
p
ain
p
r
o
ce
s
s
in
g
b
y
r
ed
u
cin
g
s
y
m
p
ath
etic
ac
tiv
atio
n
,
en
h
an
ci
n
g
p
ar
asy
m
p
ath
etic
r
esp
o
n
s
es,
an
d
en
g
ag
in
g
co
r
tical
p
ath
way
s
i
n
v
o
lv
e
d
in
p
ain
m
o
d
u
latio
n
[2
1
]
,
[
2
2
]
.
T
h
ese
m
ec
h
an
is
m
s
p
r
o
v
id
e
a
p
lau
s
ib
le
th
eo
r
etica
l b
asis
f
o
r
th
e
a
p
p
lic
atio
n
o
f
h
y
p
n
o
th
e
r
a
p
y
in
p
o
s
to
p
er
ativ
e
p
ain
c
o
n
tex
ts
.
Desp
ite
th
is
th
eo
r
etica
l
r
atio
n
ale,
th
e
em
p
ir
ical
ev
i
d
en
ce
s
u
p
p
o
r
tin
g
h
y
p
n
o
th
er
a
p
y
f
o
r
p
o
s
t
-
ce
s
ar
ea
n
p
ain
r
em
ain
s
lim
ited
an
d
m
eth
o
d
o
lo
g
ically
h
eter
o
g
e
n
eo
u
s
.
E
x
is
tin
g
p
r
im
ar
y
s
tu
d
ies
ar
e
p
r
e
d
o
m
in
an
tly
s
m
all
-
s
ca
le
an
d
s
i
n
g
le
-
ce
n
ter
,
with
m
an
y
em
p
lo
y
in
g
q
u
asi
-
ex
p
er
i
m
en
tal
d
esig
n
s
lack
in
g
r
an
d
o
m
izatio
n
o
r
b
lin
d
in
g
[3
8
]
-
[4
0
]
.
E
v
e
n
r
an
d
o
m
ized
co
n
tr
o
lled
tr
ials
in
th
is
ar
ea
r
em
ain
s
ca
r
ce
an
d
o
f
ten
r
e
p
o
r
t
s
h
o
r
t
f
o
llo
w
-
u
p
p
er
io
d
s
a
n
d
lim
ited
p
r
o
to
co
l
s
tan
d
ar
d
izatio
n
[4
1
]
.
Fu
r
th
e
r
m
o
r
e,
c
o
n
s
id
er
ab
le
v
ar
iatio
n
ex
is
ts
in
th
e
d
eliv
er
y
o
f
h
y
p
n
o
th
er
ap
y
in
ter
v
en
tio
n
s
,
in
clu
d
in
g
d
if
f
e
r
en
ce
s
in
tim
in
g
(
p
r
eo
p
er
ativ
e
v
s
.
p
o
s
to
p
er
ativ
e)
,
d
u
r
atio
n
,
f
ac
ilit
ato
r
tr
ain
in
g
,
a
n
d
u
s
e
o
f
ad
ju
n
ctiv
e
tech
n
iq
u
es,
co
m
p
li
ca
tin
g
d
ir
ec
t c
o
m
p
ar
is
o
n
ac
r
o
s
s
s
t
u
d
ies.
Alth
o
u
g
h
s
ev
e
r
al
f
in
d
i
n
g
s
f
r
o
m
s
y
s
tem
atic
r
ev
iews
an
d
m
et
a
-
an
aly
s
es
h
av
e
s
h
o
w
n
th
e
e
f
f
ec
tiv
en
ess
o
f
h
y
p
n
o
s
is
in
r
ed
u
ci
n
g
ac
u
t
e
an
d
c
h
r
o
n
ic
p
ain
ac
r
o
s
s
d
i
v
er
s
e
s
u
r
g
ical
an
d
clin
ical
p
o
p
u
latio
n
s
[4
2
]
-
[4
4
]
,
th
ese
r
ev
iews
g
e
n
er
ally
i
n
clu
d
e
h
eter
o
g
en
e
o
u
s
p
atien
t
g
r
o
u
p
s
an
d
d
o
n
o
t
f
o
cu
s
s
p
ec
if
ical
ly
o
n
p
o
s
t
-
ce
s
ar
ea
n
m
o
th
er
s
.
T
h
is
is
a
cr
itical
li
m
itatio
n
,
as
p
o
s
t
-
ce
s
ar
ea
n
p
at
ien
ts
r
ep
r
esen
t
a
d
is
tin
ct
p
o
p
u
latio
n
with
u
n
iq
u
e
p
h
y
s
io
lo
g
ical,
p
s
y
c
h
o
lo
g
ical,
an
d
ca
r
eg
iv
in
g
d
em
a
n
d
s
d
u
r
in
g
th
e
p
o
s
tp
ar
tu
m
p
e
r
io
d
.
C
o
n
s
eq
u
en
tly
,
th
e
ap
p
licab
ilit
y
o
f
b
r
o
a
d
er
h
y
p
n
o
s
is
-
r
elate
d
f
in
d
in
g
s
to
p
o
s
t
-
ce
s
ar
ea
n
p
ain
m
an
ag
em
en
t r
em
ai
n
s
u
n
ce
r
tain
.
T
o
d
ate,
n
o
s
y
s
tem
atic
r
ev
i
ew
h
as
s
p
ec
if
ically
s
y
n
th
esi
ze
d
ev
id
e
n
ce
o
n
h
y
p
n
o
th
er
ap
y
as
a
co
m
p
lem
en
tar
y
in
ter
v
e
n
tio
n
f
o
r
p
o
s
t
-
ce
s
ar
ea
n
p
ain
u
s
in
g
a
tr
an
s
p
ar
en
t
an
d
s
tan
d
ar
d
ized
m
eth
o
d
o
lo
g
ical
f
r
am
ewo
r
k
s
u
ch
as
PR
I
SMA.
T
h
is
r
ep
r
esen
ts
a
clea
r
g
ap
i
n
th
e
liter
atu
r
e,
p
ar
ticu
lar
ly
in
lig
h
t
o
f
in
cr
ea
s
in
g
em
p
h
asis
o
n
o
p
io
id
-
s
p
a
r
in
g
an
d
m
u
ltimo
d
al
p
ain
m
a
n
a
g
em
en
t
s
tr
ateg
ies
in
o
b
s
t
etr
ic
ca
r
e
[3
2
]
,
[
3
3
]
.
Ad
d
r
ess
in
g
th
is
g
ap
is
ess
en
tial
to
clar
if
y
t
h
e
cu
r
r
en
t
s
tr
en
g
th
o
f
ev
id
en
ce
,
id
en
tif
y
m
eth
o
d
o
lo
g
ica
l
lim
itatio
n
s
,
an
d
in
f
o
r
m
f
u
tu
r
e
clin
ical
p
r
ac
tice
an
d
r
esear
c
h
.
C
o
n
s
eq
u
en
tly
,
th
is
s
tu
d
y
f
o
c
u
s
ed
o
n
co
n
d
u
ctin
g
a
PR
I
SMA
-
b
ased
s
y
s
tem
atic
r
ev
iew
o
f
s
tu
d
ies
p
u
b
lis
h
ed
b
etwe
en
2
0
1
5
an
d
2
0
2
4
to
ev
alu
ate
th
e
ef
f
ec
tiv
en
ess
o
f
h
y
p
n
o
th
er
a
p
y
in
r
ed
u
cin
g
p
o
s
to
p
e
r
ativ
e
p
ain
am
o
n
g
p
o
s
t
-
ce
s
ar
ea
n
s
ec
tio
n
p
atien
ts
.
T
h
e
r
ev
iew
cr
itically
ap
p
r
aised
s
tu
d
y
q
u
ality
,
in
ter
v
en
tio
n
ch
ar
ac
ter
is
tics
,
an
d
o
u
tco
m
e
m
ea
s
u
r
es
r
ep
o
r
ted
in
th
e
i
n
clu
d
ed
s
tu
d
ies.
T
h
r
o
u
g
h
th
is
ap
p
r
o
ac
h
,
th
e
p
r
esen
t
r
ev
iew
en
d
ea
v
o
r
s
to
d
eliv
er
a
s
tr
u
ctu
r
ed
an
d
ev
i
d
en
ce
-
b
ased
s
y
n
th
esis
to
s
u
p
p
o
r
t
th
e
in
f
o
r
m
ed
in
teg
r
atio
n
o
f
h
y
p
n
o
th
er
ap
y
in
to
p
o
s
t
-
ce
s
ar
e
an
p
ain
m
a
n
ag
em
e
n
t p
r
o
t
o
co
ls
wh
er
e
ap
p
r
o
p
r
iate.
2.
M
E
T
H
O
D
2
.
1
.
Desig
n o
f
t
he
s
t
ud
y
T
h
i
s
r
e
s
e
a
r
c
h
a
d
o
p
t
e
d
a
s
y
s
t
em
a
t
i
c
r
e
v
i
e
w
a
p
p
r
o
a
c
h
t
h
a
t
w
a
s
c
a
r
r
i
e
d
o
u
t
f
o
l
l
o
w
i
n
g
t
h
e
P
R
I
SM
A
r
e
p
o
r
t
i
n
g
s
t
a
n
d
a
r
d
s
.
T
h
e
p
u
r
p
o
s
e
o
f
t
h
i
s
r
e
v
i
e
w
w
as
t
o
c
o
n
s
o
li
d
a
t
e
e
m
p
i
r
i
c
a
l e
v
i
d
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n
c
e
c
o
n
c
er
n
i
n
g
h
y
p
n
o
t
h
e
r
a
p
y
e
f
f
e
c
t
i
v
e
n
es
s
a
s
a
c
o
m
p
l
e
m
e
n
t
a
r
y
i
n
t
e
r
v
e
n
t
i
o
n
f
o
r
r
e
d
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c
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n
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p
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t
o
p
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a
t
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v
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p
a
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m
o
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p
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-
c
es
a
r
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a
n
s
e
ct
i
o
n
p
a
t
i
e
n
ts
.
Al
l
m
et
h
o
d
o
l
o
g
i
c
a
l
s
t
e
p
s
i
n
c
l
u
d
i
n
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t
e
r
a
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e
a
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ch
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n
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,
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t
u
d
y
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l
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i
o
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,
el
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g
i
b
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it
y
a
s
s
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s
m
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n
t
,
d
a
t
a
e
x
t
r
a
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a
n
d
s
y
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is
w
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p
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f
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p
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r
e
p
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b
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t
y
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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20
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2
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I
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P
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M
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G
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e
d
a
s
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h
e
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i
m
a
r
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b
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m
e
d
i
c
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l
d
at
a
b
a
s
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t
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s
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r
e
i
n
c
l
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s
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o
n
o
f
s
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d
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t
h
a
t
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r
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a
n
d
i
n
d
e
x
e
d
m
e
d
i
c
a
l
l
i
t
e
r
at
u
r
e
,
w
h
i
l
e
G
o
o
g
l
e
S
c
h
o
l
a
r
a
n
d
OJ
S
w
e
r
e
u
s
e
d
t
o
c
a
p
t
u
r
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r
e
g
i
o
n
a
l
a
n
d
n
o
n
-
i
n
d
e
x
e
d
j
o
u
r
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a
l
s
t
h
at
f
r
e
q
u
e
n
t
l
y
p
u
b
l
i
s
h
n
u
r
s
i
n
g
a
n
d
c
o
m
p
l
e
m
e
n
t
a
r
y
t
h
e
r
a
p
y
s
t
u
d
i
es
r
e
l
e
v
a
n
t
t
o
t
h
e
r
e
s
e
a
r
c
h
t
o
p
ic
.
S
e
a
r
c
h
e
s
w
e
r
e
c
o
n
d
u
c
t
e
d
f
o
r
r
e
s
e
a
r
c
h
a
r
t
i
c
l
es
r
e
l
e
a
s
e
d
f
r
o
m
J
a
n
u
a
r
y
2
0
1
5
t
h
r
o
u
g
h
D
e
c
e
m
b
e
r
2
0
2
4
.
2
.
3
.
Sea
rc
h
s
t
ra
t
eg
y
A
s
y
s
te
m
a
t
i
c
s
e
a
r
c
h
s
t
r
a
t
e
g
y
w
a
s
f
o
r
m
u
l
a
t
e
d
b
y
i
n
t
e
g
r
a
t
i
n
g
M
e
d
i
c
a
l
S
u
b
je
c
t
H
e
a
d
i
n
g
s
(
Me
S
H
)
t
e
r
m
s
w
i
t
h
f
r
e
e
-
t
e
x
t
k
e
y
w
o
r
d
s
,
a
n
d
B
o
o
l
e
a
n
o
p
e
r
a
t
o
r
s
(
A
ND
,
O
R
)
w
e
r
e
a
p
p
l
i
e
d
c
o
n
s
i
s
t
e
n
t
l
y
a
cr
o
s
s
d
a
t
a
b
as
e
s
.
T
h
e
c
o
r
e
s
e
a
r
c
h
t
e
r
m
s
i
n
c
l
u
d
e
d
v
ar
i
a
t
i
o
n
s
o
f
h
y
p
n
o
t
h
e
r
a
p
y
,
c
e
s
ar
e
a
n
s
e
c
ti
o
n
,
a
n
d
p
o
s
t
o
p
e
r
a
t
i
v
e
p
a
i
n
.
T
h
e
s
e
a
r
c
h
s
t
r
a
t
e
g
y
a
p
p
l
i
e
d
i
n
P
u
b
M
e
d
w
a
s
s
t
r
u
ct
u
r
e
d
a
s
f
o
l
l
o
ws
:
(
“H
y
p
n
o
s
i
s
”
[
M
e
SH
]
OR
h
y
p
n
o
th
e
r
a
p
y
O
R
“
c
l
i
n
i
c
a
l
h
y
p
n
o
s
i
s
”
)
A
N
D
(
“C
es
a
r
e
a
n
S
e
c
t
i
o
n
”
[
Me
SH
]
O
R
c
es
a
r
e
an
O
R
c
a
e
s
a
r
e
a
n
O
R
“
c
es
a
r
ea
n
d
e
l
i
v
e
r
y
”
)
A
N
D
(
“
p
o
s
t
o
p
e
r
a
t
i
v
e
p
ai
n
”
OR
“
p
o
s
t
-
s
u
r
g
ic
a
l
p
ai
n
”
OR
p
a
i
n
)
.
F
il
t
e
r
s
a
p
p
l
i
e
d
i
n
P
u
b
M
e
d
i
n
c
l
u
d
e
d
:
i
)
p
u
b
l
i
c
at
i
o
n
y
e
a
r
:
2
0
1
5
-
2
0
2
4
,
ii
)
l
a
n
g
u
a
g
e
:
E
n
g
l
i
s
h
o
r
I
n
d
o
n
e
s
i
a
n
,
ii
i
)
s
p
ec
i
e
s
:
h
u
m
a
n
s
,
iv
)
d
o
c
u
m
e
n
t
t
y
p
e
:
J
o
u
r
n
a
l
a
r
ti
c
l
es
.
E
q
u
i
v
a
l
e
n
t
k
e
y
w
o
r
d
c
o
m
b
i
n
a
t
io
n
s
a
n
d
f
i
l
t
e
r
s
w
e
r
e
r
e
c
o
n
ci
l
e
d
f
o
r
G
o
o
g
l
e
S
c
h
o
l
a
r
a
n
d
O
J
S
.
M
a
n
u
a
l
s
c
r
ee
n
i
n
g
o
f
r
e
f
e
r
e
n
c
e
l
is
ts
f
r
o
m
s
e
le
c
t
e
d
s
tu
d
i
e
s
w
as
p
e
r
f
o
r
m
e
d
t
o
a
r
e
f
e
r
e
n
c
e
m
a
n
a
g
e
m
e
n
t
t
o
o
l
,
a
n
d
d
u
p
l
i
c
a
t
e
e
n
t
r
i
es
w
e
r
e
r
e
m
o
v
e
d
b
e
f
o
r
e
s
t
u
d
y
s
e
l
e
ct
i
o
n
.
2
.
4
.
E
lig
ibi
lity
c
rit
er
ia
T
h
e
c
r
i
t
e
r
i
a
f
o
r
s
t
u
d
y
e
l
i
g
i
b
i
l
it
y
w
e
r
e
d
e
v
e
l
o
p
e
d
f
o
l
l
o
w
i
n
g
t
h
e
P
I
C
O
a
p
p
r
o
a
c
h
:
i)
P
o
p
u
l
a
t
i
o
n
(
P
)
:
W
o
m
e
n
u
n
d
e
r
g
o
i
n
g
c
a
e
s
a
r
e
a
n
s
e
c
ti
o
n
ii)
I
n
t
e
r
v
e
n
t
i
o
n
(
I
)
:
H
y
p
n
o
t
h
e
r
a
p
y
o
r
h
y
p
n
o
s
i
s
-
b
a
s
e
d
i
n
te
r
v
e
n
t
i
o
n
s
d
e
l
i
v
e
r
e
d
p
r
e
o
p
e
r
a
ti
v
e
l
y
,
i
n
t
r
a
o
p
e
r
a
t
i
v
e
l
y
,
o
r
p
o
s
t
o
p
e
r
a
t
i
v
e
l
y
iii)
C
o
m
p
a
r
i
s
o
n
(
C
)
:
S
t
a
n
d
a
r
d
p
o
s
to
p
e
r
a
t
i
v
e
c
a
r
e
,
r
o
u
t
i
n
e
a
n
al
g
e
s
ia
,
o
r
n
o
n
-
h
y
p
n
o
s
i
s
c
o
n
t
r
o
l
i
n
t
e
r
v
e
n
t
i
o
n
s
i
v
)
O
u
t
c
o
m
e
(
O
)
:
P
o
s
t
o
p
e
r
a
t
i
v
e
p
a
i
n
i
n
t
e
n
s
it
y
m
e
a
s
u
r
e
d
u
s
i
n
g
v
a
l
i
d
a
t
e
d
m
e
as
u
r
e
m
e
n
t
i
n
s
t
r
u
m
e
n
t
s
,
i
n
c
l
u
d
i
n
g
t
h
e
V
is
u
a
l
A
n
al
o
g
S
c
a
le
(
V
AS)
o
r
N
u
m
e
r
i
c
a
l
R
a
t
i
n
g
S
c
a
l
e
(
NR
S
)
2
.
4
.
1
.
I
n
c
lu
s
i
o
n
c
ri
t
e
r
i
a
I
n
c
l
u
s
i
o
n
w
as
r
e
s
t
r
i
c
te
d
t
o
s
t
u
d
i
e
s
t
h
at
s
at
is
f
i
e
d
a
ll
o
f
t
h
e
s
p
ec
if
i
e
d
c
r
i
t
e
r
i
a:
i)
R
e
l
ea
s
e
d
f
r
o
m
2
0
1
5
t
h
r
o
u
g
h
2
0
2
4
ii)
P
e
e
r
-
r
e
v
i
e
we
d
j
o
u
r
n
a
l
a
r
t
i
cl
es
iii)
Q
u
a
n
t
i
t
at
i
v
e
o
r
m
i
x
e
d
-
m
e
t
h
o
d
s
s
t
u
d
i
es
r
e
p
o
r
t
i
n
g
q
u
a
n
t
i
t
at
i
v
e
p
o
s
t
o
p
e
r
a
t
i
v
e
p
a
i
n
o
u
t
c
o
m
es
i
v
)
C
o
n
d
u
c
t
e
d
s
p
e
ci
f
i
c
al
l
y
a
m
o
n
g
p
o
s
t
-
c
e
s
a
r
e
a
n
s
ec
t
i
o
n
p
a
t
ie
n
t
s
v)
E
v
a
l
u
a
t
e
d
h
y
p
n
o
t
h
e
r
a
p
y
o
r
h
y
p
n
o
s
i
s
-
b
as
e
d
i
n
t
e
r
v
e
n
ti
o
n
s
as
a
d
i
s
t
i
n
ct
c
o
m
p
o
n
e
n
t
v
i
)
A
v
a
i
l
a
b
l
e
i
n
f
u
l
l
-
t
e
x
t
f
o
r
m
i
n
E
n
g
l
i
s
h
o
r
I
n
d
o
n
e
s
i
a
n
2
.
4
.
2
.
E
x
c
l
us
i
o
n
c
r
i
t
e
ri
a
E
x
c
l
u
s
i
o
n
w
as
a
p
p
l
ie
d
t
o
s
t
u
d
ie
s
f
o
r
t
h
e
s
p
e
ci
f
i
c
r
e
as
o
n
s
o
u
tl
in
e
d
b
e
l
o
w
:
i)
P
o
p
u
l
a
t
i
o
n
m
is
m
a
tc
h
:
St
u
d
i
e
s
i
n
v
o
l
v
i
n
g
g
e
n
e
r
a
l
s
u
r
g
i
c
a
l
p
a
t
i
e
n
ts
,
v
a
g
i
n
a
l
d
e
l
i
v
e
r
y
,
o
r
m
i
x
e
d
o
b
s
t
e
t
r
ic
p
o
p
u
l
a
t
i
o
n
s
w
it
h
o
u
t
s
e
p
a
r
at
e
p
o
s
t
-
c
es
a
r
e
a
n
a
n
a
l
y
s
is
ii)
I
n
t
e
r
v
e
n
t
i
o
n
a
m
b
i
g
u
i
t
y
:
S
t
u
d
ies
i
n
w
h
i
c
h
h
y
p
n
o
t
h
e
r
a
p
y
w
as
c
o
m
b
i
n
e
d
w
i
t
h
o
t
h
e
r
m
i
n
d
-
b
o
d
y
i
n
t
e
r
v
e
n
t
i
o
n
s
(
e
.
g
.
,
a
c
u
p
r
e
s
s
u
r
e
,
m
u
s
i
c
t
h
e
r
ap
y
)
w
i
t
h
o
u
t
i
s
o
la
t
i
n
g
t
h
e
e
f
f
ec
t
o
f
h
y
p
n
o
t
h
e
r
a
p
y
iii)
O
u
t
c
o
m
e
i
r
r
e
l
e
v
a
n
c
e
:
A
r
t
i
c
le
s
t
h
a
t
d
i
d
n
o
t
r
e
p
o
r
t
p
o
s
t
o
p
e
r
a
t
i
v
e
p
a
i
n
o
u
t
c
o
m
e
s
o
r
u
s
e
d
n
o
n
-
v
a
l
i
d
a
t
e
d
p
a
i
n
m
e
a
s
u
r
e
s
i
v
)
D
o
c
u
m
e
n
t
t
y
p
e
:
C
as
e
r
e
p
o
r
t
s
,
q
u
a
l
i
t
a
ti
v
e
s
t
u
d
i
e
s
,
d
i
s
s
e
r
t
at
i
o
n
s
,
t
h
e
s
e
s
,
c
o
n
f
e
r
e
n
c
e
a
b
s
t
r
ac
ts
,
e
d
i
t
o
r
ia
l
s
,
o
r
r
e
v
i
e
w
a
r
t
ic
l
es
v)
M
e
t
h
o
d
o
l
o
g
i
c
a
l
i
n
c
o
m
p
l
et
e
n
e
s
s
:
St
u
d
i
e
s
la
c
k
i
n
g
f
u
l
l
-
t
e
x
t
a
cc
e
s
s
o
r
i
n
s
u
f
f
i
c
i
e
n
t
m
et
h
o
d
o
l
o
g
i
c
a
l
d
e
t
a
il
to
p
e
r
m
i
t
a
p
p
r
a
i
s
a
l
.
2
.
5
.
Study
s
elec
t
io
n
T
h
e
s
t
u
d
y
s
e
l
e
c
ti
o
n
p
r
o
c
e
s
s
wa
s
c
a
r
r
i
e
d
o
u
t
t
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8
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6
E
ffective
n
ess
o
f h
yp
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p
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a
s
co
mp
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ta
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in
terven
tio
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in
r
ed
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(
A
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y
P
erma
n
a
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477
2
.
6
.
Da
t
a
e
x
t
ra
ct
io
n
A
s
t
a
n
d
a
r
d
i
z
e
d
d
at
a
e
x
t
r
a
c
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m
w
a
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e
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t
o
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o
ll
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c
t
r
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l
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v
an
t
i
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m
a
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f
r
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m
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cl
u
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d
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y
.
E
x
t
r
a
c
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d
v
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t
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y
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p
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o
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s
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n
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a
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ts
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p
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e
.
g
.
,
a
n
x
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e
t
y
)
,
a
n
d
r
e
p
o
r
t
e
d
l
i
m
i
t
a
t
i
o
n
s
.
Da
t
a
e
x
t
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a
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t
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n
w
as
p
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f
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o
m
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m
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b
i
as
.
2.
7
.
Q
ua
lit
y
a
pp
ra
is
a
l
S
t
u
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y
q
u
a
l
i
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p
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i
g
n
s
.
T
h
e
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B
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c
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wh
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R
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0
w
a
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f
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m
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z
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d
c
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t
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d
t
r
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a
ls
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Q
u
a
li
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b
il
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.
2.
8
.
Da
t
a
s
y
nthesis
G
i
v
e
n
t
h
e
v
a
r
i
a
b
i
l
it
y
i
n
s
t
u
d
y
d
e
s
i
g
n
s
,
i
n
t
e
r
v
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n
t
i
o
n
p
r
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d
u
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s
,
a
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d
o
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t
c
o
m
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s
m
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n
t
s
,
q
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a
n
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t
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v
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m
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t
a
-
a
n
a
l
y
s
i
s
w
a
s
d
ee
m
e
d
i
n
ap
p
r
o
p
r
i
a
t
e
.
C
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s
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q
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n
tl
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a
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a
r
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t
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.
3.
RE
SU
L
T
S
T
h
e
d
ata
b
ase
s
ea
r
ch
p
r
o
ce
s
s
r
esu
lted
in
th
e
id
en
tific
atio
n
o
f
3
2
6
r
ec
o
r
d
s
,
in
clu
d
in
g
2
5
4
r
e
co
r
d
s
f
r
o
m
Go
o
g
le
Sch
o
lar
an
d
7
2
f
r
o
m
Pu
b
Me
d
.
Fo
llo
win
g
th
e
s
cr
ee
n
in
g
o
f
titl
es
an
d
ab
s
tr
ac
ts
,
5
1
r
ec
o
r
d
s
wer
e
ex
clu
d
ed
o
win
g
to
ir
r
elev
a
n
ce
to
th
e
s
tu
d
y
o
b
j
ec
tiv
e.
Ass
es
s
m
en
t
o
f
f
u
ll
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tex
t
ar
ticles
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co
n
d
u
cted
o
n
2
7
5
ar
ticles,
o
f
wh
ich
2
7
1
wer
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x
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d
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f
o
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r
ly
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in
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d
r
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aso
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s
,
in
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g
n
o
n
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t
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ar
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p
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u
latio
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s
,
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ter
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n
o
t
in
v
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in
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o
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a
p
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,
ab
s
en
ce
o
f
p
o
s
to
p
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ativ
e
p
ain
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u
tco
m
es,
an
d
d
o
cu
m
en
t
ty
p
es
s
u
ch
as
d
is
s
er
tatio
n
s
,
co
n
f
er
e
n
ce
a
b
s
tr
ac
ts
,
o
r
n
o
n
–
p
ee
r
-
r
ev
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d
p
u
b
licatio
n
s
.
As
a
r
esu
lt,
f
o
u
r
s
tu
d
ies
s
atis
f
ied
all
p
r
ed
ef
in
e
d
in
cl
u
s
io
n
cr
ite
r
ia
an
d
wer
e
in
c
o
r
p
o
r
ated
in
t
o
th
e
q
u
alitativ
e
s
y
n
th
esis
.
A
n
o
v
e
r
v
iew
o
f
th
e
s
tu
d
y
s
elec
tio
n
p
r
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ce
d
u
r
e
co
v
er
in
g
t
h
e
s
tag
es
o
f
id
en
tific
atio
n
,
s
cr
ee
n
in
g
,
elig
ib
ilit
y
as
s
ess
m
en
t,
an
d
f
in
al
in
clu
s
io
n
is
p
r
esen
ted
in
t
h
e
PR
I
SMA
2
0
2
0
f
lo
w
d
ia
g
r
am
as
s
h
o
wn
in
Fig
u
r
e
1
.
Alth
o
u
g
h
th
e
liter
atu
r
e
s
ea
r
ch
co
v
e
r
ed
s
tu
d
ies
r
elea
s
ed
f
r
o
m
2
0
1
5
th
r
o
u
g
h
2
0
2
4
,
o
n
ly
f
o
u
r
s
tu
d
ies
p
u
b
lis
h
ed
b
etwe
en
2
0
2
1
an
d
2
0
2
4
k
n
o
wn
all
p
r
ed
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in
ed
s
p
e
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ied
elig
ib
ilit
y
cr
iter
ia
an
d
w
er
e
in
clu
d
ed
in
th
e
n
ar
r
ativ
e
s
y
n
th
esis
.
Sam
p
le
s
izes
r
an
g
ed
f
r
o
m
2
4
to
8
0
p
o
s
t
-
ce
s
ar
ea
n
s
ec
tio
n
p
atien
ts
.
T
h
r
ee
s
tu
d
ies
em
p
lo
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ed
q
u
asi
-
ex
p
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im
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n
tal
d
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n
s
,
wh
ile
o
n
e
s
tu
d
y
u
s
ed
a
r
an
d
o
m
ized
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n
tr
o
lled
tr
ial
d
esig
n
.
Acr
o
s
s
all
s
tu
d
ies,
p
o
s
to
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er
ativ
e
th
e
in
ten
s
ity
o
f
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ain
was
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u
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u
s
in
g
v
alid
ated
in
s
tr
u
m
en
ts
,
p
r
ed
o
m
in
an
tly
NR
S.
Hy
p
n
o
th
e
r
ap
y
in
ter
v
en
ti
o
n
s
v
ar
ied
in
s
tr
u
ctu
r
e
an
d
d
eliv
e
r
y
,
r
an
g
i
n
g
f
r
o
m
s
tr
u
ctu
r
ed
th
er
ap
is
t
-
g
u
id
ed
v
er
b
al
s
u
g
g
esti
o
n
an
d
r
ela
x
atio
n
tec
h
n
iq
u
es
to
co
m
b
in
ed
a
p
p
r
o
ac
h
es
in
co
r
p
o
r
atin
g
s
elf
-
h
y
p
n
o
s
is
au
d
io
.
On
e
s
tu
d
y
im
p
lem
en
ted
a
h
y
p
n
o
s
is
-
b
ased
in
ter
v
en
ti
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n
alo
n
g
s
id
e
ac
u
p
r
ess
u
r
e,
wh
ich
was
ac
k
n
o
wled
g
ed
as
a
lim
itatio
n
d
u
e
to
th
e
d
if
f
icu
lty
o
f
is
o
latin
g
th
e
i
n
d
ep
e
n
d
en
t
ef
f
ec
t
o
f
h
y
p
n
o
th
er
ap
y
.
C
o
n
t
r
o
l
g
r
o
u
p
s
ac
r
o
s
s
s
tu
d
ies
r
ec
eiv
ed
s
tan
d
ar
d
p
o
s
to
p
er
ati
v
e
ca
r
e
o
r
r
o
u
tin
e
an
alg
esic
m
an
ag
em
en
t
with
o
u
t
h
y
p
n
o
s
is
-
b
ased
in
ter
v
en
tio
n
.
A
th
o
r
o
u
g
h
s
u
m
m
a
r
y
o
f
s
tu
d
y
attr
ib
u
tes
,
in
ter
v
en
tio
n
s
,
an
d
o
u
tco
m
es is
ca
r
r
ied
in
T
ab
le
1
.
Desp
ite
h
eter
o
g
en
eity
in
s
tu
d
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e
r
f
o
r
m
a
n
c
e
b
i
a
s;
u
n
c
l
e
a
r
a
l
l
o
c
a
t
i
o
n
c
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a
l
me
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t
;
n
o
l
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g
-
t
e
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f
o
l
l
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4
D
.
E
.
A
n
u
h
g
e
r
a
,
T
.
K
u
n
c
o
r
o
,
S
.
S
u
m
a
r
n
i
,
M
.
M
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o
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a
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d
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S
u
w
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[4
0
]
,
E
f
f
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c
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o
m
b
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a
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h
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p
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b
r
e
a
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f
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e
d
i
n
g
a
n
d
a
c
u
p
r
e
s
s
u
r
e
o
n
a
n
x
i
e
t
y
a
n
d
w
o
u
n
d
p
a
i
n
i
n
p
o
s
t
-
c
e
s
a
r
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m
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t
h
e
r
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8
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E
ffective
n
ess
o
f h
yp
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th
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p
y
a
s
co
mp
leme
n
ta
r
y
in
terven
tio
n
in
r
ed
u
cin
g
…
(
A
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n
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in
d
y
P
erma
n
a
)
479
4.
DIS
CU
SS
I
O
N
4
.
1
.
I
nte
rpre
t
a
t
io
n
o
f
f
ind
ing
s
T
h
e
cu
r
r
en
t
s
y
s
tem
atic
r
ev
ie
w
in
d
icate
s
th
at
h
y
p
n
o
th
er
a
p
y
,
w
h
en
a
p
p
lied
as
a
c
o
m
p
lem
en
tar
y
in
ter
v
en
tio
n
,
is
co
n
s
is
ten
tly
ass
o
ciate
d
with
r
ed
u
ce
d
p
o
s
to
p
er
ativ
e
p
ain
in
ten
s
ity
am
o
n
g
wo
m
en
u
n
d
e
r
g
o
i
n
g
ce
s
ar
ea
n
s
ec
tio
n
.
Alth
o
u
g
h
v
a
r
iatio
n
in
s
tu
d
y
d
esig
n
was
o
b
s
er
v
ed
a
m
o
n
g
th
e
in
clu
d
ed
s
tu
d
ies
,
in
ter
v
e
n
tio
n
f
o
r
m
at
a
n
d
s
ize
o
f
s
tu
d
y
p
o
p
u
latio
n
,
th
e
d
ir
ec
tio
n
o
f
e
f
f
ec
t
was
u
n
if
o
r
m
,
with
all
s
tu
d
ies
r
ep
o
r
tin
g
lo
wer
p
ain
s
co
r
es
in
h
y
p
n
o
th
er
a
p
y
g
r
o
u
p
s
co
m
p
ar
ed
to
s
tan
d
ar
d
ca
r
e
alo
n
e.
T
h
is
co
n
s
is
ten
cy
s
u
g
g
ests
th
at
h
y
p
n
o
s
is
-
b
ased
in
ter
v
en
tio
n
s
m
ay
co
n
t
r
ib
u
te
to
p
o
s
to
p
e
r
ativ
e
p
ain
m
o
d
u
latio
n
,
p
ar
ticu
lar
ly
d
u
r
in
g
th
e
ea
r
ly
r
ec
o
v
er
y
p
er
io
d
.
Ho
wev
er
,
g
iv
e
n
th
e
p
r
ed
o
m
i
n
an
ce
o
f
q
u
asi
-
ex
p
er
im
en
tal
d
esig
n
s
an
d
lim
ited
s
am
p
le
s
izes,
th
ese
f
in
d
in
g
s
s
h
o
u
ld
b
e
i
n
ter
p
r
eted
as in
d
icativ
e
r
ath
er
th
a
n
co
n
f
ir
m
ato
r
y
o
f
ca
u
s
al
ef
f
ec
tiv
e
n
ess
.
T
h
e
o
b
s
er
v
e
d
p
ain
r
ed
u
ctio
n
m
ay
r
ef
lect
th
e
in
f
lu
en
ce
o
f
h
y
p
n
o
th
e
r
ap
y
o
n
b
o
th
s
e
n
s
o
r
y
an
d
af
f
ec
tiv
e
d
im
en
s
io
n
s
o
f
p
ai
n
p
er
ce
p
tio
n
.
Sev
er
al
s
tu
d
ies
in
clu
d
ed
in
th
is
r
ev
iew
r
ep
o
r
ted
co
n
cu
r
r
e
n
t
r
ed
u
cti
o
n
s
in
an
x
iety
o
r
p
s
y
c
h
o
lo
g
ical
d
is
co
m
f
o
r
t,
s
u
p
p
o
r
tin
g
th
e
i
n
ter
p
r
etatio
n
th
at
h
y
p
n
o
th
er
ap
y
m
a
y
alter
p
ain
ex
p
er
ien
ce
t
h
r
o
u
g
h
co
g
n
itiv
e
an
d
em
o
tio
n
al
p
ath
way
s
r
ath
er
th
a
n
d
ir
ec
t
p
h
y
s
io
lo
g
ical
an
alg
esia.
Nev
er
th
eless
,
th
e
h
eter
o
g
en
eit
y
o
f
in
ter
v
en
tio
n
p
r
o
to
c
o
ls
an
d
o
u
tco
m
e
tim
in
g
p
r
e
v
en
ts
d
e
f
in
itiv
e
co
n
clu
s
io
n
s
r
eg
ar
d
in
g
o
p
tim
al
d
o
s
ag
e,
d
u
r
atio
n
,
o
r
d
eliv
er
y
m
o
d
e
o
f
h
y
p
n
o
th
er
ap
y
.
E
v
id
en
ce
s
y
n
t
h
esized
in
th
is
r
ev
iew
s
h
o
ws
th
at
b
r
o
ad
l
y
s
im
ilar
to
p
r
io
r
r
esear
ch
d
em
o
n
s
t
r
atin
g
th
e
p
o
ten
tial
r
o
le
o
f
h
y
p
n
o
s
is
in
p
o
s
to
p
er
ativ
e
an
d
p
r
o
ce
d
u
r
al
p
ain
m
an
ag
em
e
n
t.
Prio
r
s
tu
d
ies
h
av
e
r
ep
o
r
ted
th
a
t
h
y
p
n
o
s
is
-
b
ased
in
ter
v
en
tio
n
s
ca
n
r
ed
u
ce
p
er
ce
iv
ed
p
ain
in
t
en
s
ity
,
an
x
iety
,
an
d
an
alg
esic
co
n
s
u
m
p
tio
n
ac
r
o
s
s
v
ar
io
u
s
s
u
r
g
ical
co
n
tex
ts
,
s
u
p
p
o
r
tin
g
th
e
p
lau
s
ib
ilit
y
o
f
h
y
p
n
o
th
er
ap
y
as
an
ad
ju
n
ct
to
co
n
v
en
tio
n
al
p
ain
m
an
ag
em
en
t
s
tr
ateg
ies
[4
5
]
-
[4
7
]
.
T
h
e
co
n
s
is
ten
cy
o
b
s
er
v
e
d
in
p
o
s
t
-
ce
s
ar
ea
n
p
o
p
u
latio
n
s
alig
n
s
with
th
ese
b
r
o
ad
e
r
f
i
n
d
in
g
s
,
s
u
g
g
esti
n
g
t
h
at
th
e
an
alg
esic
b
en
ef
its
o
f
h
y
p
n
o
th
er
ap
y
m
a
y
e
x
ten
d
ac
r
o
s
s
d
if
f
er
en
t
s
u
r
g
ical
p
r
o
ce
d
u
r
es.
Ho
wev
er
,
c
o
m
p
ar
e
d
with
ea
r
l
ier
liter
atu
r
e,
th
e
p
r
esen
t
r
ev
i
ew
h
ig
h
lig
h
ts
p
er
s
is
ten
t
m
eth
o
d
o
lo
g
ical
lim
itatio
n
s
in
h
y
p
n
o
t
h
er
ap
y
r
e
s
ea
r
ch
with
in
o
b
s
tetr
ic
s
ettin
g
s
.
Similar
to
co
n
ce
r
n
s
r
aised
i
n
p
r
e
v
io
u
s
r
ev
iews,
m
an
y
in
clu
d
e
d
s
tu
d
ies
lack
ed
r
an
d
o
m
iza
tio
n
,
b
lin
d
in
g
,
a
n
d
p
r
o
lo
n
g
ed
f
o
llo
w
-
up
[4
8
]
.
T
h
ese
co
n
f
in
ess
e
s
r
estrict
th
e
s
tr
en
g
th
o
f
ev
id
e
n
ce
an
d
co
m
p
licate
co
m
p
ar
i
s
o
n
s
ac
r
o
s
s
s
tu
d
ies.
Mo
r
eo
v
er
,
th
e
v
ar
iatio
n
in
in
ter
v
en
tio
n
co
m
p
o
n
en
ts
s
u
c
h
as
th
er
ap
is
t
-
g
u
id
ed
h
y
p
n
o
s
is
,
s
elf
-
h
y
p
n
o
s
is
,
o
r
co
m
b
i
n
ed
co
m
p
lem
en
tar
y
tech
n
iq
u
es
r
ef
lects
o
n
g
o
i
n
g
i
n
co
n
s
is
ten
cy
in
h
o
w
h
y
p
n
o
t
h
er
ap
y
is
o
p
er
atio
n
alize
d
in
clin
ical
r
esear
ch
,
a
ch
allen
g
e
also
n
o
te
d
in
p
r
io
r
s
y
s
tem
atic
r
ev
iews
[
49
].
4.
2
.
Clini
ca
l a
nd
re
s
ea
rc
h im
pli
ca
t
io
ns
C
o
n
s
id
er
in
g
clin
ical
p
r
ac
tice,
th
e
f
in
d
in
g
s
d
em
o
n
s
tr
ate
th
at
h
y
p
n
o
th
e
r
ap
y
m
a
y
s
er
v
e
as
a
f
ea
s
ib
le
co
m
p
lem
en
tar
y
ap
p
r
o
ac
h
to
p
o
s
to
p
er
ativ
e
p
ain
m
an
a
g
em
en
t
f
o
llo
win
g
ce
s
ar
ea
n
s
ec
tio
n
,
p
a
r
ticu
lar
ly
in
s
ettin
g
s
wh
er
e
n
o
n
-
p
h
ar
m
a
co
lo
g
ical
in
ter
v
en
tio
n
s
ar
e
en
co
u
r
a
g
ed
to
r
ed
u
ce
r
el
ian
ce
o
n
an
alg
esic
m
ed
i
ca
tio
n
s
.
Hy
p
n
o
t
h
er
ap
y
in
ter
v
en
tio
n
s
d
escr
ib
ed
in
th
e
in
clu
d
ed
s
tu
d
ies
wer
e
g
en
er
ally
lo
w
-
r
is
k
an
d
co
u
l
d
b
e
in
teg
r
ated
in
to
p
er
io
p
e
r
ativ
e
ca
r
e
with
a
p
p
r
o
p
r
iate
tr
ai
n
in
g
an
d
s
tan
d
ar
d
izatio
n
.
Ho
wev
er
,
th
e
c
u
r
r
en
t
ev
id
en
ce
b
ase
d
o
es
n
o
t
s
u
p
p
o
r
t
h
y
p
n
o
t
h
er
ap
y
as
a
r
ep
lace
m
e
n
t
f
o
r
s
tan
d
ar
d
an
alg
esic
p
r
o
to
co
ls
,
b
u
t
r
ath
er
as
an
ad
ju
n
ct
t
h
at
m
ay
e
n
h
an
ce
p
atien
t c
o
m
f
o
r
t a
n
d
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
.
Fo
r
r
esear
ch
er
s
,
th
ese
f
in
d
in
g
s
u
n
d
er
s
co
r
e
th
e
n
ee
d
f
o
r
i
m
p
r
o
v
e
d
m
eth
o
d
o
lo
g
ical
r
ig
o
r
in
f
u
tu
r
e
s
tu
d
ies.
Stan
d
ar
d
ized
i
n
ter
v
en
tio
n
p
r
o
to
co
ls
,
co
n
s
is
ten
t
o
u
t
co
m
e
m
ea
s
u
r
es,
an
d
clea
r
ly
d
ef
in
ed
co
m
p
ar
ato
r
co
n
d
itio
n
s
ar
e
n
ec
ess
ar
y
to
s
tr
en
g
th
en
e
v
id
en
ce
s
y
n
t
h
esis
a
n
d
en
ab
le
m
eta
-
a
n
aly
tic
ap
p
r
o
ac
h
es.
Ad
d
r
ess
in
g
th
ese
is
s
u
es
wo
u
ld
im
p
r
o
v
e
th
e
i
n
ter
p
r
eta
b
ilit
y
an
d
cli
n
ical
ap
p
lic
ab
ilit
y
o
f
h
y
p
n
o
th
er
ap
y
r
esear
ch
in
o
b
s
tetr
ic
p
ain
m
an
a
g
em
en
t.
4
.
3
.
Dire
ct
io
ns
f
o
r
f
uture
re
s
ea
rc
h
Fu
tu
r
e
r
esear
ch
s
h
o
u
ld
p
r
io
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o
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im
en
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h
y
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o
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x
p
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ib
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in
d
iv
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co
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en
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s
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p
er
ativ
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ca
r
e
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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ase
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481
RE
F
E
R
E
NC
E
S
[
1
]
A
.
P
.
B
e
t
r
a
n
,
J.
Y
e
,
A
.
B
.
M
o
l
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r
,
J
.
P
.
S
o
u
z
a
,
a
n
d
J
.
Z
h
a
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,
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Tr
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d
p
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s,
”
B
MJ
G
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.
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[
2
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S
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P
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,
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.
[
3
]
C
.
M
.
A
n
g
o
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,
B
.
L.
M
a
x
,
J.
M
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b
a
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n
d
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.
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3
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[1
6
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[2
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[2
8
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B
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[
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sio
l
o
g
y
a
t
Bra
wijay
a
Un
iv
e
rsity
,
M
a
lan
g
,
h
e
is
c
o
m
m
it
ted
to
sa
fe
,
e
ffe
c
ti
v
e
,
a
n
d
p
a
ti
e
n
t
-
sa
fe
ty
-
o
rie
n
ted
m
e
d
ica
l
p
ra
c
ti
c
e
s.
Ap
a
rt
fro
m
b
e
in
g
a
c
ti
v
e
a
s
a
c
li
n
ica
l
p
ra
c
ti
ti
o
n
e
r,
t
h
e
a
u
t
h
o
r
is
a
lso
in
v
o
l
v
e
d
i
n
e
d
u
c
a
ti
o
n
,
re
se
a
rc
h
,
a
n
d
imp
ro
v
in
g
t
h
e
q
u
a
li
t
y
o
f
h
o
sp
i
tal
se
rv
ice
s.
Ap
a
rt
fr
o
m
th
a
t,
th
e
a
u
th
o
r
is
a
lso
a
c
ti
v
e
ly
i
n
v
o
lv
e
d
in
e
d
u
c
a
ti
o
n
a
t
IT
S
K
(In
stit
u
te
o
f
Tec
h
n
o
lo
g
y
,
S
c
ien
c
e
a
n
d
He
a
lt
h
)
,
Dr
.
S
o
e
p
ra
o
e
n
M
a
l
a
n
g
.
H
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
r
o
d
li
@
it
s
k
-
so
e
p
ra
o
e
n
.
a
c
.
id
.
S
u
r
y
a
n
to
is
a
lec
tu
re
r
a
t
I
T
S
K
RS
d
r.
S
o
e
p
ra
o
e
n
.
He
is
a
c
t
iv
e
ly
i
n
v
o
l
v
e
d
i
n
re
se
a
rc
h
a
c
ti
v
it
ies
in
th
e
h
e
a
lt
h
se
c
to
r
with
a
fo
c
u
s
o
n
d
e
v
e
lo
p
in
g
e
v
id
e
n
c
e
-
b
a
se
d
h
e
a
lt
h
sc
ien
c
e
a
n
d
p
ra
c
ti
c
e
.
His
c
o
n
tri
b
u
ti
o
n
is
re
a
li
z
e
d
th
r
o
u
g
h
re
se
a
rc
h
a
n
d
sc
ien
ti
f
ic
p
u
b
li
c
a
ti
o
n
s
th
a
t
su
p
p
o
rt
imp
ro
v
in
g
t
h
e
q
u
a
li
ty
o
f
h
e
a
lt
h
se
rv
ice
s
a
n
d
e
d
u
c
a
ti
o
n
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
su
ry
a
n
to
@
it
sk
-
so
e
p
ra
o
e
n
.
a
c
.
id
.
Re
k
o
Priy
o
n
g
g
o
is a l
e
c
tu
re
r
a
t
ITS
K
RS
d
r
.
S
o
e
p
ra
o
e
n
.
He
is ac
ti
v
e
ly
i
n
v
o
lv
e
d
in
re
se
a
rc
h
a
c
ti
v
it
ies
in
th
e
h
e
a
lt
h
se
c
to
r
with
a
fo
c
u
s
o
n
d
e
v
e
lo
p
in
g
e
v
id
e
n
c
e
-
b
a
se
d
h
e
a
lt
h
sc
ien
c
e
a
n
d
p
ra
c
ti
c
e
.
His
c
o
n
tri
b
u
ti
o
n
is
re
a
li
z
e
d
th
r
o
u
g
h
re
se
a
rc
h
a
n
d
sc
ien
ti
f
ic
p
u
b
li
c
a
ti
o
n
s
th
a
t
su
p
p
o
rt
imp
ro
v
in
g
t
h
e
q
u
a
li
ty
o
f
h
e
a
lt
h
se
rv
ice
s
a
n
d
e
d
u
c
a
ti
o
n
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
re
k
o
@
it
sk
-
so
e
p
ra
o
e
n
.
a
c
.
i
d
.
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