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c
r
itical
p
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d
n
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ca
r
e
[
3
]
.
L
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w
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s
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f
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f
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4
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.
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ess
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I
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Hea
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Sci
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Vo
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15
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No
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3
,
Sep
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20
26
:
7
3
7
-
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44
738
I
n
I
n
d
o
n
esia,
h
ig
h
r
ates
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f
m
ater
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tality
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T
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v
ices
[
5
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,
[
6
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.
I
n
r
eg
io
n
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lik
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Ku
p
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g
C
ity
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ac
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e
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a
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e
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er
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is
r
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p
tio
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was
p
o
ten
tially
m
o
r
e
s
ev
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r
e
[
7
]
.
Prim
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lth
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/
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as
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e
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le,
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d
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af
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ca
r
e
alter
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ativ
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[
9
]
.
A
lack
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tim
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o
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ater
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estrictio
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th
e
r
is
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in
m
o
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tality
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d
m
o
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id
ity
[
1
0
]
.
Vir
tu
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ater
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(
VM
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p
o
ten
tially
ef
f
ec
tiv
e
s
tate
o
f
th
e
ar
t
s
o
lu
tio
n
to
m
itig
ate
th
ese
d
an
g
er
s
d
u
r
in
g
th
e
p
an
d
em
ic
[
3
]
.
VM
C
s
o
f
f
er
ed
ess
en
tial
ed
u
ca
tio
n
,
wh
ile
V
HVs
allo
wed
h
ea
lth
ca
r
e
p
r
o
v
id
er
s
to
r
em
o
tely
m
o
n
ito
r
m
a
ter
n
al
an
d
n
eo
n
atal
h
ea
lth
in
d
icato
r
s
,
p
r
o
v
id
e
b
r
ea
s
tf
ee
d
in
g
s
u
p
p
o
r
t,
an
d
f
o
s
ter
p
atien
t
-
p
r
o
v
i
d
er
r
ap
p
o
r
t
[
1
1
]
.
T
h
e
u
r
g
e
n
cy
o
f
t
h
is
r
esear
ch
lay
in
th
e
im
m
e
d
ia
te
n
ee
d
to
v
alid
ate
t
h
e
E
f
f
icac
y
o
f
th
is
v
ir
tu
al
ca
r
e
m
o
d
el
V
MCs
co
m
b
in
ed
with
VHVs
s
p
ec
if
ically
in
th
e
ch
allen
g
in
g
,
r
eso
u
r
ce
-
c
o
n
s
tr
ain
ed
,
an
d
h
ig
h
-
r
is
k
co
n
tex
t
o
f
K
u
p
a
n
g
C
ity
d
u
r
in
g
th
e
h
eig
h
t o
f
th
e
C
OVI
D
-
1
9
cr
is
is
.
T
h
e
p
o
s
tp
ar
tu
m
m
o
th
er
s
'
clas
s
is
p
ar
t
o
f
th
e
p
r
o
m
o
tiv
e
an
d
p
r
ev
en
ti
v
e
ef
f
o
r
ts
in
m
ater
n
al
h
ea
lth
s
er
v
ices
r
ec
o
m
m
en
d
ed
b
y
th
e
I
n
d
o
n
esian
Min
is
tr
y
o
f
Hea
lth
as
a
co
n
tin
u
atio
n
o
f
an
t
en
atal
an
d
d
eliv
er
y
s
er
v
ices.
T
h
is
p
r
o
g
r
am
aim
s
to
im
p
r
o
v
e
m
o
th
er
s
'
k
n
o
wl
ed
g
e
an
d
s
k
ills
d
u
r
in
g
th
e
p
o
s
tp
ar
tu
m
p
er
io
d
,
in
clu
d
in
g
m
ater
n
al
a
n
d
n
ewb
o
r
n
ca
r
e,
b
r
ea
s
tf
ee
d
in
g
,
r
ec
o
g
n
izin
g
d
an
g
e
r
s
ig
n
s
,
a
n
d
u
t
ilizin
g
ap
p
r
o
p
r
iate
h
ea
lth
s
er
v
ices.
I
n
lin
e
with
th
e
p
o
licy
o
f
h
ea
lth
s
er
v
ice
tr
an
s
f
o
r
m
atio
n
an
d
d
ig
italizatio
n
,
th
e
im
p
lem
en
tati
o
n
o
f
th
e
p
o
s
tp
ar
tu
m
m
o
th
er
s
'
class
h
as
b
eg
u
n
to
b
e
d
e
v
elo
p
ed
in
th
e
f
o
r
m
o
f
a
v
ir
t
u
al
class
to
ex
p
a
n
d
ac
ce
s
s
to
m
ater
n
al
h
ea
lth
ed
u
ca
tio
n
,
es
p
ec
ially
in
ar
ea
s
with
g
eo
g
r
a
p
h
ical
lim
itatio
n
s
an
d
lim
ited
ac
ce
s
s
to
h
ea
lth
s
er
v
ices
.
Glo
b
ally
an
d
n
atio
n
ally
,
v
a
r
io
u
s
s
tu
d
ies
h
av
e
s
h
o
wn
th
at
d
ig
ital
-
b
ased
p
o
s
tp
ar
tu
m
h
ea
lth
ed
u
ca
tio
n
,
s
u
ch
as
o
n
lin
e
class
es,
m
o
b
ile
ap
p
licatio
n
s
,
an
d
in
ter
ac
ti
v
e
m
ed
ia,
is
ef
f
ec
tiv
e
in
im
p
r
o
v
in
g
p
o
s
tp
ar
t
u
m
m
o
th
er
s
'
k
n
o
wled
g
e
an
d
attitu
d
es
.
Acc
o
r
d
in
g
to
[
1
2
]
,
[
1
3
]
i
n
I
n
d
o
n
esia,
s
ev
er
a
l
s
tu
d
ies
h
av
e
r
ep
o
r
te
d
th
at
d
ig
ital
ed
u
ca
tio
n
b
y
h
ea
lth
wo
r
k
er
s
ca
n
im
p
r
o
v
e
m
o
t
h
er
s
'
u
n
d
er
s
tan
d
in
g
o
f
p
o
s
tp
ar
tu
m
ca
r
e
an
d
c
o
m
p
licatio
n
p
r
ev
en
tio
n
.
I
n
[
1
4
]
,
h
o
wev
er
,
m
o
s
t
o
f
th
ese
s
tu
d
ies
s
till
f
o
cu
s
o
n
im
p
r
o
v
in
g
k
n
o
wled
g
e
an
d
ar
e
d
escr
ip
tiv
e
o
r
b
ased
o
n
s
h
o
r
t
-
ter
m
in
te
r
v
en
ti
o
n
s
.
Gap
an
aly
s
is
s
h
o
ws
th
at
em
p
ir
ical
ev
id
en
ce
r
eg
a
r
d
in
g
th
e
ef
f
ec
tiv
en
ess
o
f
v
ir
tu
al
p
o
s
tp
ar
tu
m
m
o
th
er
class
es
h
ea
lth
ca
r
e
s
ee
k
in
g
b
e
h
av
io
r
r
esear
ch
is
s
till
lim
ited
,
p
ar
ticu
lar
l
y
with
s
tr
u
ctu
r
ed
q
u
an
titativ
e
d
esig
n
s
co
n
d
u
cte
d
in
ea
s
t
er
n
I
n
d
o
n
esi
a.
Fu
r
th
er
m
o
r
e,
th
er
e
a
r
e
s
till
f
ew
s
tu
d
ies
ev
alu
atin
g
v
ir
t
u
a
l
p
o
s
tp
ar
tu
m
class
in
ter
v
en
tio
n
s
co
n
d
u
cte
d
p
er
i
o
d
ically
o
v
e
r
a
s
p
ec
if
ic
p
e
r
i
o
d
.
T
h
e
r
ef
o
r
e,
th
is
s
tu
d
y
ai
m
s
to
ev
alu
ate
th
e
ef
f
ec
tiv
en
ess
o
f
th
e
v
ir
tu
al
p
o
s
tp
ar
tu
m
m
o
th
er
class
to
war
d
s
im
p
r
o
v
in
g
m
ater
n
al
k
n
o
wled
g
e
an
d
h
ea
lth
s
er
v
ice
s
ee
k
in
g
b
eh
av
io
r
in
Ku
p
an
g
C
ity
th
r
o
u
g
h
a
p
r
e
-
p
o
s
t
s
tu
d
y
d
esig
n
.
T
h
is
m
an
u
s
cr
ip
t
aim
ed
to
f
ill
a
cr
itical
g
ap
in
ev
id
en
ce
b
y
r
ig
o
r
o
u
s
ly
ass
ess
in
g
th
e
ef
f
icac
y
o
f
th
e
in
teg
r
ated
v
ir
tu
al
ca
r
e
m
o
d
el
(
VM
C
s
an
d
V
HVs
)
in
a
g
eo
g
r
a
p
h
ically
s
p
ec
if
ic,
h
ig
h
-
n
ee
d
co
n
tex
t
d
u
r
in
g
an
u
n
p
r
ec
ed
en
te
d
p
u
b
lic
h
ea
lth
em
er
g
e
n
c
y
[
1
2
]
.
T
h
e
f
in
d
in
g
s
wer
e
ex
p
e
cted
to
p
r
o
v
id
e
r
o
b
u
s
t,
lo
ca
lized
ev
id
en
ce
o
f
a
v
iab
le,
p
a
n
d
em
ic
-
r
esp
o
n
s
iv
e
s
tr
ateg
y
f
o
r
p
o
s
tn
atal
an
d
n
e
o
n
atal
ca
r
e
[
7
]
.
T
h
e
s
u
cc
ess
f
u
l
d
em
o
n
s
tr
atio
n
o
f
th
is
v
ir
t
u
al
m
o
d
el'
s
ef
f
icac
y
o
f
f
er
ed
a
c
r
u
cial
I
m
p
licatio
n
f
o
r
p
o
licy
m
ak
e
r
s
an
d
h
ea
lth
ca
r
e
m
an
ag
e
r
s
:
it
v
alid
ated
a
s
u
s
tain
ab
le,
r
e
p
licab
le,
an
d
lo
w
-
c
o
s
t
m
o
d
el
f
o
r
d
eliv
er
in
g
ess
en
tial
m
ater
n
al
a
n
d
n
eo
n
atal
s
er
v
ices
in
r
em
o
te
o
r
r
eso
u
r
ce
-
lim
ited
s
ettin
g
s
,
b
o
th
d
u
r
in
g
f
u
tu
r
e
c
r
i
s
es a
n
d
as a
p
er
m
an
e
n
t a
u
g
m
e
n
tatio
n
to
tr
ad
itio
n
al
in
-
p
e
r
s
o
n
ca
r
e
[
1
3
]
.
Po
s
tp
ar
tu
m
ed
u
ca
tio
n
is
a
k
ey
co
m
p
o
n
en
t
o
f
m
ater
n
al
h
ea
lth
s
er
v
ices
in
I
n
d
o
n
es
ia
an
d
is
r
ec
o
m
m
en
d
ed
b
y
th
e
Min
is
tr
y
o
f
Hea
lth
as
a
co
n
tin
u
atio
n
o
f
an
ten
atal
an
d
ch
ild
b
ir
th
ca
r
e
[
1
5
]
.
I
n
lin
e
with
n
atio
n
al
h
ea
lth
s
y
s
tem
tr
an
s
f
o
r
m
atio
n
an
d
th
e
e
x
p
an
s
io
n
o
f
d
ig
ital
h
ea
lth
s
er
v
ices,
p
o
s
tp
a
r
tu
m
ed
u
ca
ti
o
n
h
as
in
cr
ea
s
in
g
ly
b
ee
n
d
eliv
e
r
ed
th
r
o
u
g
h
v
ir
tu
al
p
o
s
tp
ar
tu
m
class
es
to
im
p
r
o
v
e
ac
c
ess
,
p
ar
ticu
lar
ly
in
g
eo
g
r
a
p
h
ically
co
n
s
tr
ain
e
d
a
r
ea
s
[1
6
]
.
R
ec
en
t
s
tu
d
ies
in
d
icate
th
at
d
ig
ital
p
o
s
tp
ar
t
u
m
ed
u
ca
tio
n
ca
n
ef
f
ec
tiv
ely
im
p
r
o
v
e
m
ater
n
al
k
n
o
wled
g
e
an
d
attitu
d
es
to
war
d
p
o
s
tp
ar
tu
m
an
d
n
ewb
o
r
n
ca
r
e.
Ho
wev
er
,
ex
is
tin
g
ev
id
en
ce
in
I
n
d
o
n
esia
r
em
ain
s
lim
ited
,
as
m
o
s
t
s
tu
d
ies
f
o
cu
s
p
r
im
ar
ily
o
n
k
n
o
wled
g
e
o
u
tc
o
m
es,
ap
p
ly
s
h
o
r
t
-
ter
m
o
r
d
escr
ip
t
iv
e
d
esig
n
s
,
an
d
r
a
r
ely
ass
ess
h
ea
lth
-
s
ee
k
in
g
b
e
h
av
io
r
a
s
a
k
ey
o
u
tco
m
e
.
Mo
r
eo
v
er
,
em
p
ir
ical
e
v
id
en
ce
f
r
o
m
ea
s
ter
n
I
n
d
o
n
esia,
in
clu
d
in
g
Ku
p
an
g
C
ity
,
is
s
ca
r
ce
.
T
h
is
s
tu
d
y
ad
d
r
ess
es
th
ese
g
ap
s
b
y
ev
alu
atin
g
th
e
e
f
f
ec
ti
v
en
ess
o
f
a
s
tr
u
ctu
r
ed
v
ir
tu
al
p
o
s
tp
ar
tu
m
e
d
u
ca
tio
n
class
.
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
E
ffective
n
ess
o
f v
ir
tu
a
l p
o
s
tp
a
r
tu
m
ed
u
ca
tio
n
cla
s
s
es o
n
ma
t
ern
a
l k
n
o
w
led
g
e
…
(
I
g
n
a
s
en
s
ia
Du
a
Mir
o
n
g
)
739
2.
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n
T
h
is
s
tu
d
y
em
p
lo
y
s
a
q
u
an
tita
tiv
e
r
esear
ch
m
eth
o
d
o
l
o
g
y
.
T
h
e
em
p
lo
y
e
d
r
esear
ch
m
eth
o
d
o
lo
g
y
is
a
q
u
asi
-
ex
p
er
im
e
n
tal
d
esig
n
f
ea
tu
r
in
g
a
p
r
etest
-
p
o
s
ttes
t
f
o
r
m
at
with
o
u
t
a
c
o
n
tr
o
l
g
r
o
u
p
.
T
h
is
r
esear
ch
d
esig
n
lack
s
a
co
m
p
ar
is
o
n
g
r
o
u
p
co
n
tr
o
l,
y
et
th
e
in
itial
ass
ess
m
e
n
t
p
r
e
-
test
en
ab
les
th
e
r
esear
ch
er
to
ev
alu
ate
th
e
ch
an
g
es
th
at
o
cc
u
r
p
o
s
t
-
tr
ea
t
m
en
t.
R
esear
ch
er
s
ar
e
em
p
l
o
y
in
g
v
ir
tu
al
i
n
ter
v
en
tio
n
s
,
wh
er
eb
y
all
p
o
s
tp
ar
t
u
m
mo
th
er
s
will
p
ar
ticip
ate
i
n
v
ir
tu
al
p
o
s
tp
ar
tu
m
class
es,
an
d
th
eir
e
f
f
icac
y
will
b
e
ass
ess
ed
b
y
ev
al
u
atin
g
en
h
an
ce
m
e
n
ts
in
k
n
o
wled
g
e
,
ea
r
ly
d
etec
tio
n
o
f
co
m
p
li
ca
tio
n
s
,
an
d
th
e
p
u
r
s
u
it
o
f
tr
ea
tm
en
t
f
o
r
an
y
co
m
p
licatio
n
s
en
co
u
n
ter
ed
[
1
4
]
.
2
.
2
.
P
o
pu
la
t
io
n a
nd
s
a
m
ple
T
h
e
s
tu
d
y
p
o
p
u
latio
n
co
m
p
r
is
ed
all
p
o
s
tp
ar
tu
m
m
o
th
e
r
s
at
th
r
ee
PONE
D
h
ea
lth
ce
n
ter
s
i
n
Ku
p
an
g
C
ity
o
v
er
th
e
f
in
al
th
r
ee
m
o
n
th
s
o
f
th
e
s
tu
d
y
p
er
io
d
,
t
o
talin
g
7
2
in
d
iv
id
u
als.
T
h
e
s
am
p
lin
g
tech
n
iq
u
e
em
p
lo
y
ed
was
p
u
r
p
o
s
iv
e
s
am
p
lin
g
,
tar
g
etin
g
p
o
s
tp
ar
tu
m
m
o
th
er
s
at
th
e
th
r
ee
PONE
D
h
ea
lth
ce
n
ter
s
ac
r
o
s
s
Ku
p
an
g
C
ity
.
T
h
e
s
am
p
le
s
e
lectio
n
ad
h
er
e
d
to
s
p
ec
if
ic
i
n
clu
s
io
n
cr
iter
ia:
p
o
s
tp
ar
tu
m
p
er
io
d
3
–
4
2
d
a
y
s
,
r
esid
en
cy
in
t
h
e
lo
ca
l
ar
ea
,
o
wn
er
s
h
ip
o
f
an
A
n
d
r
o
id
s
m
ar
tp
h
o
n
e,
an
d
p
r
io
r
in
ter
ac
tio
n
with
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als.
E
x
clu
s
io
n
cr
ite
r
ia
en
co
m
p
ass
ed
p
o
s
tp
ar
tu
m
m
o
th
er
s
with
a
h
is
to
r
y
o
f
co
m
o
r
b
id
o
r
ch
r
o
n
ic
co
n
d
itio
n
s
,
as
well
as
th
o
s
e
wh
o
d
ec
lin
ed
p
ar
ticip
atio
n
in
th
e
s
am
p
le.
Su
b
s
eq
u
en
t
to
t
h
e
s
tu
d
y
,
on
ly
3
2
p
o
s
tp
ar
tu
m
m
o
th
er
s
co
n
s
en
ted
to
en
g
a
g
e
in
th
e
v
ir
tu
al
p
o
s
tp
ar
tu
m
class
ac
tiv
ities
.
2
.
3
.
Da
t
a
c
o
llect
io
n
T
h
e
in
ter
v
e
n
tio
n
p
r
o
v
id
ed
in
t
h
is
s
tu
d
y
was
a
v
ir
t
u
al
p
o
s
tp
ar
tu
m
class
f
o
r
m
o
th
e
r
s
u
s
in
g
t
h
e
Z
o
o
m
p
latf
o
r
m
f
o
r
th
r
ee
m
o
n
th
s
.
T
h
e
class
p
r
esen
ter
s
wer
e
lectu
r
er
s
in
th
e
m
id
wif
er
y
d
e
p
ar
t
m
en
t
o
f
th
e
Ku
p
an
g
Min
is
tr
y
o
f
Hea
lth
Po
ly
tech
n
ic.
T
h
e
p
o
s
tp
ar
tu
m
class
w
as
h
eld
twice
a
m
o
n
th
,
r
esu
ltin
g
in
s
ix
v
ir
tu
al
p
o
s
tp
ar
tu
m
class
s
es
s
io
n
s
.
E
v
alu
atio
n
s
wer
e
co
n
d
u
cted
b
ef
o
r
e
an
d
a
f
ter
th
e
in
ter
v
e
n
tio
n
p
r
e
-
an
d
p
o
s
t
-
in
ter
v
en
tio
n
.
T
h
is
s
tu
d
y
em
p
l
o
y
ed
q
u
esti
o
n
n
air
es
as
th
e
d
at
a
co
llectio
n
to
o
ls
an
d
m
eth
o
d
s
.
T
h
e
q
u
esti
o
n
n
a
ir
e
co
m
p
r
is
ed
s
ev
e
r
al
s
ec
tio
n
s
.
T
h
is
q
u
esti
o
n
n
air
e
was
ad
m
in
is
ter
ed
o
n
lin
e
t
o
3
0
p
o
s
tp
ar
tu
m
m
o
th
er
s
in
th
e
Pas
ir
Pan
jan
g
Pu
b
lic
Hea
lth
C
en
ter
r
eg
io
n
.
T
h
e
r
eliab
ilit
y
test
y
ield
ed
a
C
r
o
n
b
ac
h
'
s
alp
h
a
s
co
r
e
o
f
0
.
7
1
,
wh
ile
th
e
v
alid
ity
test
in
d
icate
d
th
at
th
e
co
m
p
u
ted
R
v
alu
es
f
o
r
ea
c
h
q
u
esti
o
n
ex
ce
e
d
ed
th
e
R
tab
le
v
alu
e
o
f
0
.
3
6
1
,
th
er
eb
y
c
o
n
f
ir
m
in
g
t
h
e
v
ali
d
ity
o
f
th
ese
s
tatem
en
ts
.
Up
o
n
c
o
m
p
letio
n
o
f
all
q
u
est
io
n
n
air
e
item
s
,
th
e
in
s
tr
u
m
en
t
was
ev
alu
ated
an
d
d
ee
m
e
d
v
alid
an
d
r
eliab
le.
T
h
e
q
u
esti
o
n
n
air
e
will
s
er
v
e
as
a
m
ea
s
u
r
em
e
n
t
in
s
tr
u
m
en
t f
o
r
p
r
e
-
an
d
p
o
s
t
-
te
s
ts
in
th
is
s
tu
d
y
.
2
.
4
.
E
t
hica
l
clea
ra
nce
E
th
ical
ap
p
r
o
v
al
f
o
r
th
is
s
tu
d
y
was
g
r
an
te
d
b
y
th
e
R
esear
ch
E
th
ics
C
o
m
m
is
s
io
n
o
f
t
h
e
Ku
p
an
g
Min
is
tr
y
o
f
Hea
lth
Po
ly
tech
n
ic,
r
ef
er
e
n
ce
n
u
m
b
er
:
L
B
.
0
2
.
0
3
/1
/0
1
2
0
/2
0
2
1
,
d
ated
Dec
e
m
b
er
1
7
,
2
0
2
1
.
All
p
ar
ticip
an
ts
in
th
e
s
tu
d
y
r
ec
eiv
ed
a
p
r
io
r
ex
p
lan
ati
o
n
b
ef
o
r
e
th
eir
co
n
s
en
t
was
s
o
licited
f
o
r
in
v
o
lv
em
e
n
t
i
n
th
is
r
esear
ch
.
Par
ticip
an
ts
we
r
e
n
o
t
co
er
ce
d
to
c
o
n
tin
u
e
th
eir
in
v
o
lv
em
en
t
in
th
e
s
tu
d
y
an
d
r
ec
eiv
ed
d
at
a
cr
ed
it o
f
R
p
.
5
0
,
0
0
0
as a
to
k
en
o
f
ap
p
r
ec
iatio
n
f
o
r
th
eir
p
ar
ti
cip
atio
n
.
2
.
5
.
Da
t
a
a
na
ly
s
is
T
h
e
d
ata
an
aly
s
is
in
th
is
s
tu
d
y
u
tili
ze
d
SP
S
S
s
o
f
twar
e
v
er
s
io
n
1
6
,
en
c
o
m
p
ass
in
g
u
n
iv
a
r
iate
an
aly
s
is
th
r
o
u
g
h
f
r
eq
u
en
cy
d
is
tr
ib
u
tio
n
tab
les
an
d
th
e
ca
lcu
latio
n
o
f
th
e
m
ea
n
,
m
o
d
e,
a
n
d
m
ed
ia
n
o
f
th
e
m
ea
s
u
r
e
d
v
ar
iab
les.
T
h
e
Sh
ap
ir
o
-
W
ilk
test
was
em
p
lo
y
ed
f
o
r
n
o
r
m
ali
ty
ass
es
s
m
en
t
d
u
e
to
th
e
s
am
p
le
s
ize
b
ein
g
u
n
d
er
5
0
,
with
a
s
ig
n
if
ican
ce
th
r
esh
o
ld
o
f
<0
.
0
5
f
o
r
all
v
ar
iab
les,
s
ig
n
if
y
in
g
n
o
n
-
n
o
r
m
al
d
is
tr
ib
u
tio
n
o
f
th
e
d
ata.
T
h
e
b
iv
ar
iate
an
aly
s
is
em
p
lo
y
ed
is
th
e
W
i
lco
x
o
n
s
ig
n
ed
r
an
k
test
f
o
r
o
r
d
in
al
d
ata,
p
r
o
ce
s
s
ed
u
s
in
g
th
e
SP
SS
s
o
f
twar
e
v
er
s
io
n
1
5
,
with
a
s
ig
n
if
ican
ce
lev
el
o
f
α
=
0
.
0
5
.
I
f
α
<
0
.
0
5
,
th
e
n
H1
is
ac
ce
p
ted
,
in
d
icatin
g
an
ef
f
ec
t
o
f
th
e
v
ir
tu
al
p
o
s
tp
ar
tu
m
m
o
th
er
class
o
n
th
e
k
n
o
wled
g
e,
s
k
ills
,
an
d
tr
ea
tm
en
t
-
s
ee
k
in
g
b
eh
a
v
io
r
o
f
p
o
s
tp
ar
tu
m
m
o
th
er
s
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
Resul
t
s
3
.
1
.
1
.
Cha
ra
ct
er
is
t
ics
o
f
re
s
po
nd
ent
s
A
to
tal
o
f
3
2
r
esp
o
n
d
en
ts
p
ar
t
icip
ated
in
th
is
s
tu
d
y
.
T
h
eir
d
em
o
g
r
ap
h
ic
ch
ar
ac
te
r
is
tics
ar
e
p
r
esen
ted
in
T
ab
le
1
.
M
o
s
t
p
ar
ticip
an
ts
wer
e
ag
ed
2
6
–
3
0
y
ea
r
s
(
3
1
.
3
%),
h
ad
c
o
m
p
leted
h
ig
h
s
ch
o
o
l
as
th
eir
h
ig
h
est
lev
el
o
f
ed
u
ca
tio
n
(
5
9
.
4
%),
an
d
h
ad
a
p
ar
ity
o
f
two
(
3
7
.
5
%).
3
.
1
.
2
.
E
ng
a
g
em
ent
o
f
po
s
t
pa
rt
um
mo
t
hers in t
he
v
irt
ua
l po
s
t
pa
rt
um
m
o
t
her's cla
s
s
T
h
is
will
o
u
tlin
e
th
e
en
g
ag
em
en
t
o
f
p
o
s
tp
ar
tu
m
m
o
th
er
s
i
n
th
e
v
ir
tu
al
p
o
s
tp
ar
tu
m
a
n
d
in
f
an
t
ca
r
e
class
es.
T
h
e
v
ir
tu
al
p
o
s
tp
ar
tu
m
m
ater
n
al
class
es
o
cc
u
r
r
e
d
f
o
u
r
tim
es.
Po
s
tp
ar
t
u
m
m
o
th
e
r
s
ar
e
class
if
ied
as
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.
15
,
No
.
3
,
Sep
tem
b
er
20
26
:
7
3
7
-
7
44
740
in
ac
tiv
e
if
t
h
ey
a
tten
d
o
n
ly
o
n
e
s
ess
io
n
o
f
t
h
e
m
o
th
er
class
ac
tiv
ities
,
less
ac
tiv
e
if
th
ey
a
tten
d
two
s
ess
io
n
s
,
an
d
ac
tiv
e
if
th
ey
atten
d
th
r
e
e
to
f
o
u
r
s
ess
io
n
s
,
as
s
h
o
wn
in
T
ab
le
2
.
T
ab
le
2
in
d
icate
s
th
at
a
m
ajo
r
ity
o
f
p
o
s
tp
ar
tu
m
m
o
th
er
s
(
5
3
.
1
%
)
p
ar
ticip
ate
ac
tiv
ely
in
v
ir
tu
al
p
o
s
tp
ar
tu
m
m
o
th
er
class
ac
tiv
itie
s
.
3
.
1
.
3
.
Dif
f
er
ence
s
in po
s
t
pa
rt
um
m
o
t
hers' k
no
wledg
e
re
g
a
rding
po
s
t
pa
rt
um
ca
re
a
nd
ea
rly
det
ec
t
io
n o
f
co
m
pli
ca
t
io
ns
a
f
t
er
a
t
t
endin
g
v
irt
ua
l po
s
t
pa
rt
um
cl
a
s
s
es
T
h
e
k
n
o
w
l
e
d
g
e
v
a
r
i
a
b
l
e
m
e
as
u
r
e
s
t
h
e
m
o
t
h
e
r
'
s
k
n
o
w
l
e
d
g
e
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e
f
o
r
e
a
n
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a
f
t
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r
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t
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e
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d
i
n
g
t
h
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r
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u
a
l
p
o
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p
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u
m
m
o
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'
s
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.
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e
r
e
s
u
l
t
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as
s
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o
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n
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T
a
b
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3
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e
d
a
t
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t
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7
2
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w
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t
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t
h
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W
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n
k
t
e
s
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l
d
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g
α
=
0
.
0
0
0
,
s
ig
n
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f
y
i
n
g
a
n
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m
p
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t
o
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t
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a
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T
ab
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2
.
E
n
g
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em
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t o
f
p
o
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ar
tu
m
m
o
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e
r
s
in
th
e
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r
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al
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l
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0
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ab
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3
.
C
h
an
g
es in
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s
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m
m
ater
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al
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wled
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ef
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d
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ter
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ir
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tu
m
cl
ass
es
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ssessme
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t
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n
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1
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4
.
Dif
f
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ence
s
in po
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o
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hers' a
bil
it
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o
det
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la
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h
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v
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f
p
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tu
m
m
o
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er
s
'
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to
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g
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ize
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eir
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m
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licatio
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ch
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o
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th
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ew
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at
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illed
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t
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s
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i
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f
o
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at.
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h
e
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teg
o
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n
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id
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ab
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m
o
th
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r
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illed
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k
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t step
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ased
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e
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en
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th
at
f
o
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m
at.
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e
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lts
o
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th
e
m
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r
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ize
p
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tu
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ased
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4
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ce
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h
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v
ir
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al
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te
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atal
class
.
3
.
1
.
5
.
Dif
f
er
ence
s
in t
he
t
re
a
t
m
ent
-
s
ee
k
ing
beha
v
io
r
f
o
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po
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t
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rt
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t
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es
B
ased
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n
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5
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3
8
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ield
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p
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af
ter
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g
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h
e
v
ir
tu
al
an
te
n
atal
class
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2252
-
8
8
0
6
E
ffective
n
ess
o
f v
ir
tu
a
l p
o
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tp
a
r
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m
ed
u
ca
tio
n
cla
s
s
es o
n
ma
t
ern
a
l k
n
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…
(
I
g
n
a
s
en
s
ia
Du
a
Mir
o
n
g
)
741
T
ab
le
4
.
Dif
f
e
r
en
ce
s
in
p
o
s
tp
ar
tu
m
m
o
th
e
r
s
'
ab
ilit
y
to
d
etec
t p
o
s
tp
ar
tu
m
c
o
m
p
licatio
n
s
af
te
r
atten
d
in
g
v
ir
tu
al
an
ten
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class
es
A
ssessme
n
t
N
M
e
a
n
M
i
n
M
a
x
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t
a
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r
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8
24
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4
4
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ab
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5
.
Dif
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e
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e
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t
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k
in
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b
e
h
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io
r
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o
r
p
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ar
tu
m
co
m
p
licatio
n
s
af
ter
atten
d
in
g
v
ir
t
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al
an
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class
es
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n
t
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e
a
n
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i
n
M
a
x
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d
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a
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g
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e
d
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2
.
Dis
cus
s
io
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T
h
e
f
in
d
i
n
g
s
o
f
th
is
s
tu
d
y
d
e
m
o
n
s
tr
ate
th
at
p
a
r
ticip
atio
n
in
s
tr
u
ctu
r
ed
v
ir
tu
al
p
o
s
tp
ar
tu
m
ed
u
ca
tio
n
class
es
was
a
s
s
o
ciate
d
n
o
t
o
n
ly
with
im
p
r
o
v
e
d
m
ater
n
al
k
n
o
wled
g
e
b
u
t
also
with
p
o
s
itiv
e
ch
an
g
es
in
h
ea
lth
-
s
ee
k
in
g
b
e
h
av
io
r
d
u
r
in
g
th
e
p
o
s
tp
ar
tu
m
p
er
io
d
.
T
h
e
o
b
s
er
v
ed
in
c
r
ea
s
e
in
k
n
o
wled
g
e
ap
p
ea
r
s
to
h
av
e
tr
an
s
lated
in
to
g
r
e
ater
m
ater
n
al
awa
r
en
ess
o
f
p
o
s
tp
ar
t
u
m
d
an
g
er
s
ig
n
s
,
a
p
p
r
o
p
r
iate
tim
in
g
o
f
p
o
s
tn
atal
ca
r
e
v
is
its
,
an
d
u
tili
za
tio
n
o
f
a
v
ailab
le
h
ea
lth
s
er
v
ices.
T
h
is
s
u
g
g
ests
th
at
im
p
r
o
v
ed
ac
ce
s
s
to
tim
ely
,
s
tr
u
ctu
r
ed
,
an
d
in
ter
ac
tiv
e
p
o
s
tp
ar
tu
m
e
d
u
ca
tio
n
th
r
o
u
g
h
v
ir
tu
al
p
latf
o
r
m
s
ca
n
f
ac
ilit
ate
b
eh
av
io
r
al
c
h
an
g
e
b
y
en
h
an
cin
g
m
o
th
er
s
’
u
n
d
er
s
tan
d
in
g
,
co
n
f
i
d
en
ce
,
an
d
p
er
ce
i
v
ed
b
e
n
ef
its
o
f
s
ee
k
in
g
p
r
o
f
ess
io
n
al
h
e
alth
ca
r
e.
B
ased
o
n
a
b
e
h
av
io
r
al
p
er
s
p
ec
tiv
e,
th
e
in
ter
v
en
tio
n
lik
ely
in
f
lu
en
ce
d
k
e
y
d
eter
m
in
an
ts
o
f
h
ea
lth
b
eh
av
io
r
,
in
clu
d
in
g
k
n
o
wled
g
e,
p
er
ce
iv
e
d
s
u
s
ce
p
tib
ilit
y
,
an
d
s
elf
-
ef
f
icac
y
,
wh
ich
a
r
e
ess
en
tial
f
o
r
tr
a
n
s
latin
g
in
f
o
r
m
atio
n
in
to
ac
tio
n
.
T
h
e
b
iwee
k
ly
d
eliv
er
y
m
o
d
el
o
v
e
r
th
r
ee
m
o
n
th
s
p
r
o
v
i
d
ed
r
e
p
e
a
ted
ex
p
o
s
u
r
e
an
d
r
ein
f
o
r
ce
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e
n
t
o
f
k
e
y
m
ess
ag
es,
s
u
p
p
o
r
tin
g
s
u
s
tain
ed
b
eh
av
io
r
c
h
an
g
e
r
ath
er
th
an
s
h
o
r
t
-
ter
m
k
n
o
wled
g
e
g
ain
s
alo
n
e.
T
h
ese
f
in
d
in
g
s
in
d
icate
th
at
v
ir
tu
al
p
o
s
tp
ar
tu
m
ed
u
ca
tio
n
h
as
th
e
p
o
te
n
tial
to
f
u
n
ctio
n
as
an
ef
f
ec
tiv
e
b
e
h
av
io
r
ch
a
n
g
e
in
t
er
v
en
tio
n
,
p
ar
ticu
la
r
ly
in
s
ettin
g
s
with
lim
ited
ac
ce
s
s
to
f
a
ce
-
to
-
f
ac
e
s
er
v
ices,
an
d
u
n
d
er
s
co
r
e
its
r
elev
a
n
ce
f
o
r
s
tr
en
g
th
e
n
in
g
p
o
s
tp
ar
tu
m
c
ar
e
u
tili
za
tio
n
in
ea
s
ter
n
I
n
d
o
n
esia.
3
.
2
.
1
.
K
no
wledg
e
T
h
e
r
esear
ch
f
in
d
i
n
g
s
d
em
o
n
s
tr
ate
a
s
u
b
s
tan
tial
en
h
a
n
ce
m
e
n
t
in
p
o
s
tp
ar
tu
m
m
o
th
e
r
s
'
u
n
d
er
s
tan
d
in
g
o
f
ea
r
l
y
co
m
p
licatio
n
d
etec
tio
n
a
n
d
p
o
s
tp
ar
tu
m
ca
r
e
f
o
llo
win
g
p
ar
ticip
atio
n
in
f
o
u
r
s
ess
io
n
s
o
f
th
e
v
ir
t
u
al
an
ten
atal
class
(
p
-
v
alu
e:
0
.
0
0
)
.
T
h
e
m
ea
n
k
n
o
wled
g
e
o
f
p
o
s
t
p
ar
tu
m
m
o
t
h
er
s
r
o
s
e
b
y
0
.
7
2
p
o
in
ts
.
T
h
e
r
esear
ch
f
in
d
in
g
s
i
n
d
icate
a
0
.
7
2
-
p
o
in
t
en
h
an
ce
m
e
n
t
in
p
o
s
tp
ar
tu
m
m
o
th
er
s
'
u
n
d
e
r
s
tan
d
i
n
g
o
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ated
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1
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3
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1
9
p
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.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
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I
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t J Pu
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Hea
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Sci
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15
,
No
.
3
,
Sep
tem
b
er
20
26
:
7
3
7
-
7
44
742
R
esear
ch
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p
r
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f
r
ien
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ly
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cr
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cr
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m
at
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at
was
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to
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m
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tr
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is
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ated
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ir
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m
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ater
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p
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m
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'
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t
p
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n
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ig
n
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d
co
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n
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tu
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e
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g
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m
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er
s
k
n
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a
b
o
u
t p
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t
u
m
an
d
n
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o
r
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c
o
m
p
licatio
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s
.
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h
e
r
esear
ch
r
esu
lts
s
h
o
w
a
s
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n
if
ican
t
d
if
f
er
e
n
ce
in
p
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s
tp
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tu
m
m
o
t
h
er
s
'
ab
ilit
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to
r
ec
o
g
n
iz
e
p
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s
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tu
m
co
m
p
licatio
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s
an
d
lo
w
b
ir
th
weig
h
t
in
f
an
ts
af
ter
atten
d
in
g
v
ir
tu
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p
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s
tp
ar
t
u
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class
es
(
p
-
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e
0
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,
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an
in
cr
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th
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cr
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3
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p
o
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ts
.
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ev
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ec
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ize
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d
th
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b
a
b
ies'
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ea
lth
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lem
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F
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d
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2
1
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3
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s
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Evaluation Warning : The document was created with Spire.PDF for Python.