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C
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Ser
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h
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ca
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less
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n
d
v
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VR
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[
1
]
.
E
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id
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in
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tec
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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:
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52
In
d
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n
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J
E
lec
E
n
g
&
C
o
m
p
Sci
,
Vo
l.
3
8
,
No
.
2
,
May
20
2
5
:
9
7
5
-
9
8
7
976
d
if
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team
s
[
2
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.
T
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An
o
u
td
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i
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f
o
r
m
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tech
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lo
g
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IT
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in
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r
astr
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Hea
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[
3
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E
x
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t
ar
e
am
o
n
g
th
e
m
ajo
r
s
tak
eh
o
ld
er
s
in
th
e
v
a
lu
e
ch
ain
th
at
h
av
e
alr
ea
d
y
b
eg
u
n
d
r
i
v
in
g
ac
tiv
itie
s
ce
n
ter
ed
o
n
ad
o
p
ti
n
g
th
e
m
etav
er
s
e.
I
n
to
d
ay
’
s
wo
r
ld
,
m
ed
ical
p
ictu
r
es
ar
e
v
is
u
alize
d
o
n
two
-
d
im
e
n
s
io
n
a
l
s
cr
ee
n
s
s
lice
b
y
s
lice
d
u
r
in
g
th
e
d
iag
n
o
s
tic
p
r
o
ce
s
s
o
f
r
a
d
io
lo
g
y
.
Pro
v
id
in
g
b
etter
v
is
u
aliza
tio
n
in
m
ed
ical
im
ag
in
g
h
as
th
e
p
o
ten
tial
to
i
n
cr
ea
s
e
th
e
v
alu
e
o
f
th
e
s
tu
d
y
o
f
d
is
ea
s
es
an
d
th
e
p
lan
n
in
g
o
f
s
u
r
g
ical
p
r
o
ce
d
u
r
es.
A
m
o
r
e
p
ar
ticip
ato
r
y
an
d
r
ea
lis
tic
ex
p
er
ien
ce
in
m
ed
ici
n
e
m
a
y
b
e
p
o
s
s
ib
le
b
ec
au
s
e
o
f
th
e
ca
p
ab
ilit
ies
o
f
th
e
m
eta
v
er
s
e,
wh
ich
in
clu
d
e
v
is
u
aliza
tio
n
a
n
d
im
m
er
s
io
n
.
T
h
e
ca
p
ac
ity
o
f
hos
p
itals
to
p
r
o
v
id
e
tr
ea
tm
en
t
f
o
r
p
atien
ts
is
b
ein
g
p
u
t
in
je
o
p
ar
d
y
d
u
e
to
a
n
ee
d
f
o
r
m
o
r
e
n
u
r
s
in
g
ass
is
tan
t
s
,
lab
o
r
ato
r
y
tech
n
ician
s
,
an
d
te
ch
n
ician
s
.
Usi
n
g
ex
ten
d
ed
r
e
ality
(
XR
)
ca
p
ab
ilit
ies,
th
e
m
etav
er
s
e
p
r
esen
ts
a
p
o
ten
tial
an
s
wer
f
o
r
teleh
ea
lt
h
[
4
]
.
Hea
lth
wo
r
k
er
s
’
s
er
v
ic
es
co
u
ld
b
e
p
r
o
v
id
e
d
f
r
o
m
a
d
is
tan
ce
u
s
in
g
AR
h
ea
d
s
ets an
d
wea
r
ab
le
d
e
v
ices f
o
r
d
ia
g
n
o
s
is
,
tr
ea
tm
en
t,
m
o
n
i
to
r
in
g
,
a
n
d
ca
r
e
[
5
]
.
I
m
m
er
s
iv
e
th
er
ap
ies r
ef
er
to
th
e
u
s
e
o
f
AR
,
VR
,
o
r
m
ix
ed
r
ea
lity
to
tr
ea
t,
m
an
ag
e,
o
r
p
r
ev
en
t
an
y
m
ed
ical
co
n
d
itio
n
.
C
o
g
n
itiv
e
th
er
ap
y
,
s
u
p
p
o
r
t
g
r
o
u
p
s
,
p
s
y
ch
iatr
ic
e
x
am
i
n
atio
n
s
,
an
d
r
eh
a
b
ilit
atio
n
ar
e
s
o
m
e
o
f
t
h
e
ap
p
licati
o
n
s
f
ea
s
ib
le
in
th
e
m
etav
er
s
e.
W
ith
th
e
ass
is
tan
ce
o
f
h
ap
tic
s
en
s
o
r
s
,
p
h
y
s
ic
al
tr
ea
tm
en
t
will
also
p
r
o
m
o
te
th
e
m
etav
er
s
e
’
s
d
ev
elo
p
m
e
n
t
[
6
]
,
[
7
]
.
A
d
ig
ital
u
p
h
ea
v
al
is
n
o
w
a
p
leasin
g
h
a
b
itatio
n
in
h
ea
lth
c
ar
e
p
r
o
d
u
cti
o
n
,
wh
ich
is
p
r
es
en
t
in
th
e
o
v
er
v
iew
o
f
I
n
d
u
s
tr
y
4
.
0
.
T
h
is
co
n
v
e
r
s
io
n
is
a
ca
p
tiv
at
in
g
p
lace
d
u
e
t
o
em
b
r
ac
in
g
tech
n
o
lo
g
y
-
b
ase
d
in
n
o
v
atio
n
s
to
r
ep
lace
tr
ad
iti
o
n
al
h
ea
lth
ca
r
e
p
r
o
d
u
cts.
Du
r
i
n
g
th
e
C
OVI
D
-
1
9
p
er
io
d
,
th
e
h
ea
lth
ca
r
e
s
y
s
tem
h
as
ad
v
an
ce
d
th
e
e
d
g
es
o
f
it
s
s
y
s
tem
s
an
d
h
as
f
ac
ed
a
f
ew
p
r
o
b
lem
s
th
at
h
av
e
n
ev
e
r
b
ee
n
s
ee
n
b
ef
o
r
e.
T
h
er
e
is
a
s
ig
n
if
ican
t
v
a
r
iatio
n
in
th
e
n
ee
d
f
o
r
tr
o
u
b
leso
m
e
tech
n
o
l
o
g
ies
s
u
ch
as
telem
ed
icin
e
an
d
o
t
h
er
h
ea
lth
u
n
its
b
y
o
r
g
a
n
izatio
n
s
[
8
]
.
Du
r
in
g
C
OVI
D
-
1
9
,
tech
n
o
lo
g
ical
ad
v
an
ce
m
en
ts
h
av
e
tak
en
s
o
all
n
ee
d
s
ca
n
b
e
f
u
lf
illed
b
y
u
s
in
g
m
eta
-
v
er
s
e.
T
h
e
wo
r
d
m
eta
v
er
s
e
was
co
in
ed
with
th
e
ad
d
itio
n
o
f
v
a
r
io
u
s
tech
n
o
lo
g
ies
lik
e
ar
tific
ial
in
tellig
en
ce
(
AI
)
an
d
XR
,
wh
ich
p
r
o
v
id
e
d
a
s
ig
n
if
ican
t
b
o
o
n
t
o
th
e
v
ir
t
u
al
en
v
ir
o
n
m
en
t
o
f
th
e
tr
ea
tm
en
t a
n
d
s
er
v
ices.
T
h
ese
m
et
-
av
er
s
e
tech
n
o
l
o
g
ies p
r
o
v
i
d
e
d
ig
ital c
h
an
g
e
in
th
e
h
ea
lth
in
d
u
s
tr
y
[
1
]
.
Sev
er
al
cu
ttin
g
-
e
d
g
e
tech
n
o
l
o
g
ies,
wh
ich
h
av
e
t
h
e
p
o
ten
tia
l
to
ch
a
n
g
e
d
ig
ital
h
ea
lth
ca
r
e
p
r
ac
tices
an
d
im
p
r
o
v
e
th
e
q
u
ality
o
f
v
i
r
tu
al
h
ea
lth
ca
r
e
s
er
v
ices,
ar
e
p
r
in
cip
ally
r
esp
o
n
s
ib
le
f
o
r
th
is
.
T
h
ese
tech
n
o
lo
g
ies
h
av
e
b
ee
n
in
clu
d
e
d
in
th
e
s
y
s
tem
.
A
d
ec
r
ea
s
e
in
h
u
m
an
en
g
ag
em
en
t
a
n
d
o
n
lin
e
co
m
m
u
n
i
ca
tio
n
h
as
o
cc
u
r
r
ed
d
u
e
to
th
e
e
x
p
an
s
io
n
o
f
th
e
m
etav
er
s
e.
Var
io
u
s
n
ew
tr
e
n
d
s
an
d
tech
n
o
lo
g
ies
h
av
e
em
er
g
ed
d
ail
y
,
in
cl
u
d
in
g
th
e
m
etav
er
s
e.
R
Q1
:
w
h
at
is
th
e
r
esear
ch
tr
en
d
an
d
c
o
n
tex
t
o
f
p
ast s
tu
d
ies?
Ah
m
ad
et
a
l.
[
9
]
an
al
y
ze
d
th
at
th
e
co
n
v
er
g
e
n
ce
o
f
em
er
g
i
n
g
tech
n
o
l
o
g
ies
will
af
f
ec
t
h
ea
lth
ca
r
e
s
y
s
tem
s
.
On
e
o
f
th
e
s
ec
to
r
s
m
o
s
t
s
u
s
ce
p
tib
le
to
tech
n
o
lo
g
ical
ch
a
n
g
e
is
th
e
h
ea
lth
ca
r
e
s
ec
to
r
.
T
h
e
liter
atu
r
e
r
e
v
iew
th
o
r
o
u
g
h
ly
an
aly
s
es
h
o
w
b
ig
d
ata
an
aly
tics
an
d
h
ea
lt
h
ca
r
e
s
y
s
tem
s
h
av
e
em
p
lo
y
ed
XR
an
d
6
G
tech
n
o
lo
g
ies
to
en
ab
le
ef
f
icien
t a
n
d
e
x
p
an
d
ab
le
d
eliv
er
y
o
f
h
ea
lth
ca
r
e
s
er
v
ices.
R
Q2
:
w
h
at
ch
an
g
es
ca
n
b
e
witn
ess
ed
in
th
e
h
ea
lth
ca
r
e
s
ec
to
r
d
u
e
to
th
e
f
u
s
io
n
o
f
em
er
g
in
g
tech
n
o
lo
g
ies?
R
o
b
o
ts
co
m
b
in
ed
with
AI
,
VR
,
AR
,
W
eb
3
.
0
,
in
tellig
en
t c
lo
u
d
s
,
ed
g
e
co
m
p
u
tin
g
,
an
d
q
u
a
n
tu
m
co
m
p
u
tin
g
-
al
l
p
o
s
s
ib
le
with
m
etav
er
s
e
-
ca
n
tr
an
s
f
o
r
m
th
e
h
ea
l
th
ca
r
e
i
n
d
u
s
tr
y
s
u
b
s
tan
tially
.
B
lo
ck
ch
ain
,
telep
r
esen
ce
,
an
d
d
ig
ital
twin
n
in
g
ar
e
th
r
ee
s
ig
n
if
ican
t
tech
n
ical
ad
v
a
n
ce
m
en
ts
m
er
g
in
g
i
n
th
e
m
etav
e
r
s
e.
VR
h
elp
s
d
o
cto
r
s
teac
h
o
th
er
d
o
cto
r
s
h
o
w
to
im
p
r
o
v
e
p
atien
t
o
u
tc
o
m
es.
Fo
u
r
th
in
d
u
s
tr
ial
r
ev
o
l
u
tio
n
(
4
I
R
)
t
ec
h
n
o
lo
g
ies,
wh
ich
h
elp
r
e
m
o
v
e
f
u
n
d
am
en
t
al
b
ar
r
ier
s
to
eq
u
al
d
ig
ital h
ea
l
th
ca
r
e
ac
ce
s
s
,
ad
v
an
ce
th
e
m
et
av
er
s
e
[
1
0
]
.
R
Q3
:
h
o
w
will tec
h
n
o
lo
g
ical
d
ev
elo
p
m
e
n
ts
h
elp
cu
r
b
th
e
b
a
r
r
ier
s
to
d
ig
ital
h
ea
lth
ca
r
e?
I
t
p
r
o
v
id
es
ad
v
an
ce
d
tr
ain
in
g
to
m
ed
ical
p
r
ac
titi
o
n
er
s
u
s
in
g
m
etav
er
s
e
tech
n
o
lo
g
ies,
an
d
s
u
r
g
ical
s
im
u
latio
n
s
co
u
ld
b
e
d
o
n
e
with
a
n
u
p
-
to
-
d
ate
v
e
r
s
io
n
o
f
t
h
e
latest
m
ed
ical
ad
v
a
n
ce
m
en
ts
.
T
h
ese
also
in
tr
o
d
u
ce
n
ew
co
n
ce
p
ts
o
f
th
er
ap
y
f
o
r
p
atien
ts
,
s
u
ch
as
tr
ea
tin
g
an
x
iety
o
r
p
h
o
b
ias
with
VR
th
er
ap
y
[
1
1
]
.
B
esid
es,
it
o
f
f
er
s
m
etav
er
s
e
h
ea
lth
ca
r
e
to
r
esear
ch
er
s
wo
r
ld
wid
e,
c
o
llab
o
r
a
tiv
e
r
esear
ch
in
v
ir
t
u
al
lab
s
o
n
d
r
u
g
d
is
co
v
er
y
,
m
ed
ical
s
tu
d
ies,
o
r
o
th
er
in
n
o
v
ativ
e
h
ea
lth
ca
r
e
s
o
lu
tio
n
s
.
I
n
m
ed
icin
e,
o
n
e
o
f
th
e
m
o
s
t
r
em
ar
k
ab
le
ap
p
licatio
n
s
o
f
th
e
m
etav
er
s
e
is
f
o
u
n
d
in
s
u
r
g
e
r
y
.
W
h
en
s
u
r
g
eo
n
s
p
e
r
f
o
r
m
in
t
r
icate
s
u
r
g
e
r
ies
an
y
wh
er
e
in
t
h
e
wo
r
ld
,
th
e
y
m
a
y
n
o
w
r
ec
ei
v
e
r
ea
l
-
tim
e
ass
is
tan
ce
,
wh
ich
h
as
allo
wed
th
em
to
s
h
a
r
e
th
eir
ex
p
er
tis
e
ac
r
o
s
s
in
ter
n
atio
n
al
b
o
r
d
er
s
.
E
d
u
ca
tio
n
in
m
ed
icin
e
h
as
n
ev
e
r
b
ee
n
m
o
r
e
f
ascin
atin
g
th
a
n
n
o
w,
th
an
k
s
to
th
e
v
ir
tu
al
m
ed
ical
s
im
u
latio
n
s
th
at
th
e
m
etav
er
s
e
ca
n
s
h
o
wca
s
e.
Su
ch
s
im
u
latio
n
s
o
f
f
er
th
e
tr
ain
in
g
o
f
r
ea
lis
tic
s
c
e
n
a
r
i
o
s
w
it
h
o
u
t
j
e
o
p
a
r
d
i
z
i
n
g
p
a
t
i
e
n
t
s
a
f
e
t
y
a
m
o
n
g
s
t
u
d
e
n
t
s
an
d
o
t
h
e
r
p
r
o
f
e
s
s
i
o
n
a
ls
i
n
t
h
e
m
e
d
i
c
a
l
f
i
el
d
[
1
2
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
d
o
n
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J
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&
C
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2
5
0
2
-
4
7
52
Th
e
in
teg
r
a
tio
n
o
f m
eta
ve
r
s
e
tech
n
o
lo
g
y
in
h
e
a
lth
ca
r
e:
a
c
o
mp
r
eh
en
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ive
…
(
R
ita
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977
T
h
e
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cien
tific
p
r
o
ce
d
u
r
es a
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d
r
atio
n
ales f
o
r
s
y
s
tem
atic
liter
a
tu
r
e
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ev
iews
(
SP
AR
-
4
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SLR)
m
eth
o
d
h
as
b
ee
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u
s
ed
in
th
is
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tu
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y
to
r
ev
iew
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elev
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p
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T
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r
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in
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lth
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will
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e
x
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g
liter
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r
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T
h
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id
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tif
y
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ch
tr
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y
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p
ly
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o
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tex
t,
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ter
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tio
n
,
m
ec
h
an
is
m
,
an
d
o
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tco
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e
(
C
I
MO
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lo
g
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c.
I
t
u
s
es
th
e
th
eo
r
y
-
co
n
tex
t
-
ch
a
r
ac
ter
is
tics
-
m
eth
o
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o
lo
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y
(
T
C
C
M
)
f
r
am
ewo
r
k
t
o
id
en
tify
r
esear
ch
g
ap
s
in
th
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ex
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p
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p
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o
r
f
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t
u
r
e
r
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r
ch
.
A
liter
atu
r
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r
ev
iew
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f
m
etav
er
s
e
in
th
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h
ea
lth
ca
r
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ec
to
r
was
ess
en
tial
to
u
n
d
er
s
tan
d
th
e
r
esear
ch
wo
r
k
u
n
d
er
ta
k
en
in
th
e
p
ast
to
ac
h
iev
e
th
e
s
tu
d
y
’
s
o
b
jectiv
e.
Als
o
,
f
u
tu
r
e
r
esear
c
h
p
r
o
p
o
s
itio
n
s
wi
ll b
e
p
r
o
v
id
ed
t
o
th
e
r
esear
ch
e
r
s
,
wh
ich
will h
elp
ad
v
an
ce
th
e
cu
r
r
en
t r
esear
ch
d
o
m
ai
n
.
2.
L
I
T
E
R
AT
U
RE
R
E
VI
E
W
T
h
e
r
esear
ch
o
f
[
1
]
s
h
o
wed
th
at
VR
ad
m
in
is
ter
ed
th
r
o
u
g
h
th
e
m
etav
e
r
s
e
s
ee
m
ed
s
af
e.
Up
o
n
co
llectio
n
o
f
d
ata
u
s
in
g
v
ar
i
o
u
s
m
ea
s
u
r
es,
it
was
f
o
u
n
d
th
at
n
ec
k
p
ain
d
is
o
r
d
er
s
(
NPD)
r
esu
lted
in
a
s
u
b
s
tan
tial
r
ed
u
ctio
n
in
d
is
ab
ilit
y
o
f
2
3
.
2
%.
I
n
c
o
n
tr
ast,
n
o
n
-
s
p
ec
if
ic
lo
w
b
ac
k
p
ain
(
NS
-
L
B
P)
ca
u
s
ed
a
s
ig
n
if
ican
t
d
ec
r
ea
s
e
o
f
1
7
.
8
%.
L
etaf
ati
an
d
Oto
u
m
[
1
3
]
in
v
e
s
tig
ated
th
e
p
r
i
v
ac
y
an
d
s
ec
u
r
ity
o
f
h
ea
lth
ca
r
e
in
th
e
m
etav
er
s
e
f
r
o
m
s
ev
er
al
p
e
r
s
p
ec
tiv
es.
T
h
e
au
th
o
r
s
co
n
ce
n
tr
ated
th
eir
e
f
f
o
r
ts
o
n
en
s
u
r
i
n
g
th
e
s
af
ety
o
f
d
ata
g
ath
er
in
g
an
d
co
m
m
u
n
ica
tio
n
in
s
id
e
th
e
ac
ce
s
s
lay
er
o
f
th
e
m
etav
er
s
e.
A
d
is
cu
s
s
io
n
is
h
eld
o
n
th
e
p
r
iv
ac
y
an
d
s
ec
u
r
ity
is
s
u
es
in
v
o
lv
e
d
with
u
s
in
g
clin
ical
m
ac
h
in
e
l
ea
r
n
in
g
f
o
r
in
tellig
en
t
e
-
h
ea
lt
h
an
d
th
e
o
b
s
tacle
s
lin
k
ed
with
p
r
i
v
ac
y
an
d
s
ec
u
r
i
ty
in
s
id
e
th
e
m
etav
er
s
e.
Gan
d
i
et
a
l.
[
1
4
]
l
o
o
k
e
d
th
r
o
u
g
h
th
e
m
eta
v
er
s
e
s
er
v
ices
an
d
ap
p
licatio
n
s
to
s
ee
wh
ich
o
n
e
s
co
u
ld
b
e
m
o
s
t
u
s
ef
u
lly
d
ev
elo
p
ed
f
o
r
t
h
e
u
r
o
lo
g
y
ar
ea
.
T
h
e
m
etav
e
r
s
e
’
s
co
n
v
er
g
en
ce
a
n
d
in
teg
r
at
io
n
o
f
tech
n
o
lo
g
ies
will
co
n
tr
ib
u
te
to
r
eim
ag
in
in
g
lab
o
r
ato
r
y
m
ed
ical
s
er
v
ices
th
r
o
u
g
h
en
h
a
n
ce
d
o
f
f
er
i
n
g
s
,
im
p
r
o
v
e
d
u
s
er
ex
p
er
ien
ce
s
,
in
cr
ea
s
ed
e
f
f
icie
n
cy
,
an
d
cu
s
to
m
ized
ca
r
e
[
1
5
]
.
Mu
s
am
ih
et
a
l.
[
1
6
]
d
is
cu
s
s
e
d
th
e
ap
p
licatio
n
o
f
n
o
n
f
u
n
g
ib
le
t
o
k
en
s
(
NFTs)
in
h
ea
lth
ca
r
e
a
n
d
o
u
tlin
ed
th
e
ess
en
tial
elem
en
ts
o
f
NFTs,
th
eir
s
alien
t
ch
ar
ac
ter
is
tics
,
th
eir
ad
v
an
tag
es,
an
d
th
e
p
o
ten
tial
b
en
ef
its
o
f
NFTs
in
m
an
y
h
ea
lth
ca
r
e
f
ield
s
,
in
clu
d
in
g
s
u
p
p
ly
ch
ai
n
(
SC
)
m
an
a
g
em
e
n
t,
p
atien
t
-
ce
n
tr
ic
d
ata
m
an
ag
em
en
t,
d
ig
ital
twin
s
,
clin
ical
tr
ial
m
an
ag
em
e
n
t,
an
d
g
e
n
o
m
ics.
T
elem
en
to
r
in
g
s
u
r
g
er
y
an
d
im
p
alp
ab
le
tu
m
o
r
ar
e
two
in
s
tan
ce
s
th
at
co
u
ld
s
u
cc
ee
d
i
f
im
p
r
o
v
em
en
ts
in
d
ata
tr
an
s
f
o
r
m
atio
n
a
n
d
in
f
r
astru
ctu
r
e
ca
n
o
v
e
r
co
m
e
th
e
cu
r
r
e
n
t
o
b
s
tacle
s
an
d
l
im
its
[
1
7
]
.
A
f
ew
ch
allen
g
es
th
at
m
u
s
t
b
e
co
n
s
id
er
ed
wh
e
n
im
p
lem
en
tin
g
th
is
p
o
licy
a
r
e
cy
b
er
s
ec
u
r
ity
b
r
ea
c
h
es,
p
r
iv
ac
y
is
s
u
es,
eth
ical
co
n
ce
r
n
s
,
an
d
t
h
e
e
x
ac
er
b
atio
n
o
f
h
ea
lth
ca
r
e
d
i
s
p
ar
ities
.
Neu
r
o
Ver
s
e
h
o
ld
s
g
r
ea
t
p
r
o
m
is
e
f
o
r
im
p
r
o
v
in
g
n
e
u
r
o
s
u
r
g
ical
an
d
i
n
ter
v
en
tio
n
al
p
r
o
ce
d
u
r
es wh
il
e
ad
v
an
cin
g
n
e
u
r
o
lo
g
y
[
1
8
]
.
Dig
ital
twin
n
in
g
is
a
r
ap
id
,
s
im
p
le,
an
d
s
u
itab
le
s
o
lu
tio
n
f
o
r
d
o
cto
r
s
an
d
o
th
er
m
e
d
ic
al
ex
p
er
ts
b
ec
au
s
e
o
f
its
lo
w
laten
cy
a
n
d
p
r
o
ce
s
s
in
g
ex
p
en
s
es.
Ad
d
itio
n
a
lly
,
it
m
ak
es
th
e
m
o
v
e
to
th
e
in
ter
n
et
o
f
m
ed
ical
th
in
g
s
(
I
o
MT
)
ea
s
ier
.
T
h
e
r
ea
l
-
tim
e
m
ea
s
u
r
em
e
n
t
s
tr
ateg
y
o
f
d
ee
p
lear
n
in
g
(
DL
)
-
b
ased
co
m
p
u
ter
v
is
io
n
,
wh
ich
d
o
es
awa
y
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h
th
e
r
e
q
u
ir
em
e
n
t
f
o
r
ad
d
itio
n
al
s
en
s
o
r
s
in
th
e
s
u
g
g
ested
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ig
ital
twin
,
is
o
n
e
cr
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cia
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ad
v
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n
ce
.
A
co
m
p
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eh
en
s
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co
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ce
p
tu
al
f
r
am
ewo
r
k
f
o
r
cr
ea
tin
g
d
ig
ital
twin
s
o
f
ce
r
v
ical
v
er
teb
r
al
m
atu
r
atio
n
(
C
VM
)
with
in
a
b
lo
ck
ch
ain
en
v
ir
o
n
m
en
t
h
as
b
ee
n
estab
lis
h
ed
an
d
im
p
lem
en
te
d
.
T
h
is
f
r
am
ewo
r
k
is
b
ased
o
n
Mo
b
ileNetV2
.
T
h
is
r
esear
ch
p
r
esen
ts
a
m
u
lti
-
s
er
v
er
attr
ib
u
te
-
b
ased
en
cr
y
p
tio
n
(
AB
E
)
m
etav
e
r
s
e
h
ea
lth
ca
r
e
d
ata
-
s
h
ar
in
g
s
tr
ateg
y
th
at
m
ain
tain
s
co
n
s
tan
t
en
cr
y
p
tio
n
c
o
m
p
u
tatio
n
o
v
e
r
h
ea
d
.
Fu
r
th
er
m
o
r
e,
th
is
s
tu
d
y
in
clu
d
es
a
m
u
ltit
u
d
e
o
f
f
ea
tu
r
es.
T
h
is
s
o
lu
tio
n
also
p
r
o
v
id
es
eq
u
iv
alen
ce
d
etec
tio
n
an
d
en
cr
y
p
ted
tex
t
v
alid
ity
f
o
r
m
eta
v
er
s
e
h
ea
lth
c
ar
e.
T
h
is
tec
h
n
o
lo
g
y
aim
s
to
a
cc
o
m
p
lis
h
s
af
e
d
ed
u
p
licatio
n
wh
ile
lo
wer
in
g
th
e
n
u
m
b
er
o
f
in
co
r
r
ec
t
cip
h
er
tex
ts
.
Af
ter
d
ed
u
p
licatio
n
is
f
in
is
h
ed
,
it
is
ad
v
is
ed
th
at
an
en
tire
ly
n
ew
attr
ib
u
te
-
b
ased
r
e
-
en
cr
y
p
tio
n
b
e
p
u
t
in
to
p
lace
to
f
ac
ilit
ate
au
th
o
r
ity
d
eleg
atio
n
.
Ultim
ately
,
th
e
PB
C
lib
r
ar
y
s
im
u
latio
n
ex
p
er
im
en
t sh
o
ws th
at
th
e
s
u
g
g
ested
m
eth
o
d
w
o
r
k
s
ef
f
ec
tiv
e
ly
[
1
9
]
.
T
h
e
o
ld
er
ad
u
lts
wh
o
h
ad
u
tili
ze
d
th
e
v
ir
tu
al
s
o
cial
ce
n
tr
e
h
ad
m
u
ch
im
p
r
o
v
ed
m
en
tal
h
ea
lth
co
m
p
ar
ed
to
th
o
s
e
wh
o
h
a
d
n
o
t.
T
h
er
ef
o
r
e
,
o
ld
er
p
er
s
o
n
s
’
f
ee
lin
g
s
o
f
lo
n
elin
ess
an
d
s
ad
n
ess
wer
e
less
en
ed
b
y
v
ir
tu
al
s
o
cial
ce
n
ter
s
.
W
h
en
th
e
w
o
r
ld
wid
e
ep
id
e
m
ic
s
u
b
s
id
es
an
d
th
e
p
o
p
u
latio
n
a
g
es,
v
ir
tu
al
s
o
cial
ce
n
ter
s
ca
n
ass
i
s
t
th
e
eld
er
ly
i
n
o
v
er
co
m
i
n
g
lo
n
elin
ess
an
d
s
ad
n
ess
[
2
0
]
.
So
laim
an
[
2
1
]
ex
am
in
ed
th
e
eth
ical
an
d
leg
al
is
s
u
es
s
u
r
r
o
u
n
d
in
g
h
ea
lth
ca
r
e
d
eliv
er
y
in
th
e
m
etav
er
s
e.
I
t
s
u
g
g
ests
th
at
th
e
m
et
av
er
s
e
p
r
o
b
lem
s
ar
e
m
o
r
e
c
o
m
p
licated
t
h
an
t
h
o
s
e
in
th
e
teleh
ea
lth
an
d
v
ir
t
u
al
h
ea
lth
s
ec
to
r
s
.
I
t
m
a
k
es
th
e
c
ase
th
at
in
ter
n
atio
n
al
co
o
p
er
atio
n
b
etwe
en
leg
is
lato
r
s
,
r
esear
ch
er
s
,
an
d
p
o
licy
m
a
k
er
s
is
n
ec
ess
ar
y
to
co
n
tr
o
l
th
is
ar
ea
an
d
p
r
o
m
o
te
m
eta
-
m
ed
icin
e
’
s
s
ec
u
r
e
an
d
ef
f
icien
t
a
d
v
an
ce
m
en
t.
W
h
en
it
c
o
m
es
to
p
r
o
tectin
g
th
e
p
r
iv
ac
y
an
d
co
n
f
id
en
tiality
o
f
h
ea
lth
ca
r
e
d
ata,
s
war
m
lear
n
in
g
is
a
s
o
lu
tio
n
th
at
h
as
b
ee
n
p
r
o
p
o
s
ed
af
ter
in
teg
r
atin
g
d
is
tr
ib
u
ted
m
ac
h
in
e
lear
n
in
g
with
b
lo
ck
ch
ain
tech
n
o
l
o
g
y
.
On
th
e
o
th
er
h
an
d
,
th
e
cu
r
r
e
n
t
s
war
m
lear
n
in
g
ar
c
h
itectu
r
e
m
ay
f
ac
e
n
ew
s
ec
u
r
ity
is
s
u
es
d
u
e
to
m
u
ltip
le
an
o
n
y
m
o
u
s
av
atar
s
a
n
d
an
u
n
eq
u
al
d
is
tr
ib
u
tio
n
o
f
d
ata
q
u
ality
.
Swar
m
lear
n
in
g
in
th
e
m
etav
e
r
s
e
ca
n
f
ac
ilit
ate
th
e
in
teg
r
atio
n
o
f
p
a
r
tial
m
o
d
el
p
ar
am
eter
s
with
th
e
g
lo
b
al
m
o
d
el
f
o
r
p
r
iv
ac
y
p
r
o
tectio
n
.
I
n
lig
h
t
o
f
th
e
d
is
p
ar
ity
in
h
ea
lth
ca
r
e
r
eso
u
r
ce
d
ata,
t
h
e
d
ec
e
n
tr
alize
d
au
to
n
o
m
o
u
s
o
r
g
an
izatio
n
b
l
o
c
k
ch
ain
n
etwo
r
k
h
as
b
ee
n
s
u
g
g
ested
to
g
u
ar
a
n
tee
th
e
eq
u
ity
o
f
m
o
d
el
-
s
h
ar
in
g
p
r
o
f
its
f
u
r
th
er
[
2
2
]
.
T
h
is
s
tu
d
y
also
f
o
cu
s
ed
o
n
t
h
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
5
0
2
-
4
7
52
In
d
o
n
esian
J
E
lec
E
n
g
&
C
o
m
p
Sci
,
Vo
l.
3
8
,
No
.
2
,
May
20
2
5
:
9
7
5
-
9
8
7
978
co
m
p
o
n
en
ts
o
f
t
h
e
s
elf
-
d
eter
m
in
atio
n
th
eo
r
y
f
o
r
t
h
e
m
eta
v
er
s
e
in
Un
ited
Ar
a
b
E
m
ir
at
es
d
iag
n
o
s
tics
an
d
h
ea
lth
ca
r
e.
T
wo
c
r
it
ical
f
ac
t
o
r
s
im
p
ac
tin
g
th
e
v
ir
tu
al
s
im
u
latio
n
a
n
d
p
er
ce
iv
e
d
u
s
ef
u
ln
ess
o
f
m
etav
er
s
e
tech
n
o
lo
g
y
f
o
r
m
ed
ical
p
u
r
p
o
s
es
ar
e
au
to
n
o
m
y
an
d
r
elate
d
n
ess
[
2
3
]
.
VR
h
as
th
e
p
o
te
n
tial
to
b
e
a
h
a
n
d
y
to
o
l
f
o
r
p
ain
r
e
lief
an
d
r
e
h
ab
ilit
atio
n
,
as
well
as
f
o
r
r
ed
u
ci
n
g
s
tr
ess
an
d
an
x
iety
an
d
b
o
o
s
tin
g
th
er
ap
e
u
tic
co
m
p
lian
ce
.
Vir
tu
al
co
n
s
u
ltatio
n
s
ca
n
lo
wer
c
o
s
ts
an
d
in
c
r
e
ase
ac
ce
s
s
to
ca
r
e
wh
ile
m
in
i
m
izin
g
tr
av
el
tim
e.
Me
tav
er
s
e
h
as
th
e
m
o
s
t
p
o
ten
tial
in
u
r
o
lo
g
ic
s
u
r
g
er
y
b
e
c
au
s
e
o
f
its
ca
p
ac
ity
to
tr
an
s
f
o
r
m
AI
,
AR
,
an
d
o
p
er
atio
n
p
lan
n
i
n
g
t
h
r
o
u
g
h
3
D
m
o
d
ellin
g
an
d
v
ir
tu
al
p
r
o
c
ed
u
r
es.
T
h
e
v
ir
tu
al
wo
r
ld
m
a
d
e
th
e
d
is
tan
ce
an
d
co
s
t
o
f
th
e
in
d
iv
id
u
al
’
s
th
er
a
p
y
p
o
s
s
ib
le.
T
h
ese
tr
an
s
f
o
r
m
AR
,
AI
,
an
d
3
D
m
o
d
ellin
g
f
o
r
v
ar
i
o
u
s
s
u
r
g
ical
p
r
o
ce
d
u
r
es,
in
clu
d
in
g
u
r
o
lo
g
y
.
Ad
v
an
ce
d
tech
n
o
lo
g
ies,
s
u
ch
as
m
etav
er
s
e
lear
n
in
g
,
ar
e
u
s
ed
to
estab
lis
h
s
ev
er
al
h
ea
lth
ca
r
e
s
ch
o
o
ls
th
at
o
f
f
er
lectu
r
es.
I
n
d
i
v
id
u
al
c
an
u
s
e
th
e
v
e
r
s
io
n
f
o
r
s
tu
d
y
in
th
eir
p
lace
[
1
8
]
.
On
e
o
f
co
m
m
u
n
ity
s
tr
en
g
t
h
’
s
m
o
s
t
ex
citin
g
d
if
f
icu
lties
is
s
er
u
m
h
esit
an
cy
,
wh
ich
ca
n
b
e
d
is
cu
s
s
ed
wo
r
ld
wid
e
u
s
in
g
t
h
e
m
etav
e
r
s
e.
T
h
is
ar
ea
in
itiates
th
e
im
p
r
o
v
em
en
t
o
f
th
e
in
ter
d
is
cip
lin
a
r
y
h
ea
lth
ca
r
e
s
ec
to
r
in
a
r
eso
u
r
ce
f
u
l
way
to
in
cr
ea
s
e
th
e
tech
n
ical
asp
ec
t
o
f
th
e
d
ig
ital
wo
r
ld
.
T
h
is
wo
r
k
tr
i
es
to
m
ak
e
th
e
m
etav
er
s
e
th
at
v
ir
tu
ally
p
r
o
v
i
d
es
a
h
elp
f
u
l
h
ea
lth
ca
r
e
co
m
m
u
n
ity
,
teac
h
es
ab
o
u
t
th
e
v
ac
cin
e
p
r
in
cip
les
an
d
b
o
o
s
ts
v
ac
cin
atio
n
[
1
9
]
.
T
h
e
AR
/VR
tech
n
o
lo
g
y
o
f
f
e
r
ed
b
y
m
etav
er
s
e
ca
n
h
elp
p
atien
ts
an
d
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
b
y
en
ab
lin
g
r
em
o
te
m
ed
ical
co
n
s
u
ltatio
n
s
an
d
tr
ain
in
g
.
T
o
b
ett
er
m
an
ag
e
th
eir
h
ea
lth
an
d
m
ak
e
m
o
r
e
in
f
o
r
m
e
d
d
ec
is
io
n
s
,
p
eo
p
le
ca
n
also
u
s
e
h
ea
lth
-
r
elate
d
tec
h
n
o
lo
g
ies
an
d
in
f
o
r
m
atio
n
[
1
2
]
.
Gu
p
ta
et
a
l
.
[
2
4
]
ass
ess
ed
th
e
p
atien
t
’
s
b
eh
av
io
r
ab
o
u
t
th
e
p
o
s
s
ib
le
m
etav
er
s
e
ap
p
licatio
n
in
th
e
h
ea
lth
ca
r
e
in
d
u
s
tr
y
.
Of
f
er
in
g
p
atien
ts
in
d
iv
id
u
alize
d
m
ed
ical
tr
ea
t
m
en
ts
th
r
o
u
g
h
t
h
e
m
etav
e
r
s
e
ca
n
b
e
a
s
u
b
s
tan
tial
alter
n
ativ
e.
AI
-
p
o
wer
e
d
m
ed
icin
e
ca
n
b
e
d
ev
elo
p
ed
,
p
r
o
to
ty
p
e
d
,
ev
alu
ate
d
,
r
eg
u
lated
,
tr
an
s
lated
,
an
d
im
p
r
o
v
ed
u
s
in
g
a
m
etav
er
s
e
o
f
m
ed
ical
tech
n
o
lo
g
y
a
n
d
AI
[
2
5
]
.
3.
M
E
T
H
O
D
Sy
s
tem
atic
liter
atu
r
e
r
ev
iews
ar
e
a
m
et
h
o
d
o
f
co
n
d
u
ctin
g
s
ec
o
n
d
ar
y
r
esear
ch
th
at
is
b
o
th
s
cien
tific
an
d
r
ig
o
r
o
u
s
,
an
d
t
h
ey
ar
e
f
r
eq
u
en
tly
em
p
lo
y
e
d
in
m
a
n
ag
em
en
t.
T
o
p
r
o
d
u
ce
r
esu
lts
th
at
ar
e
ac
cu
r
ate
a
n
d
v
alid
,
s
y
s
tem
atic
r
ev
iews
u
s
e
a
m
eth
o
d
ical
ap
p
r
o
ac
h
th
at
h
as
b
ee
n
p
r
ed
eter
m
in
e
d
an
d
a
s
tr
in
g
en
t
m
eth
o
d
o
l
o
g
y
.
T
h
e
m
eth
o
d
k
n
o
wn
as
SP
AR
-
4
-
SLR,
wh
ich
is
d
ep
icted
in
Fig
u
r
e
1
,
is
u
tili
ze
d
in
th
is
s
y
s
tem
atic
liter
atu
r
e
r
ev
iew
o
f
th
e
lo
w
ca
r
b
o
n
o
r
ca
r
b
o
n
n
e
u
tr
ality
f
o
r
in
cr
ea
s
in
g
f
ir
m
/
o
r
g
an
izatio
n
al
an
d
SC
p
er
f
o
r
m
an
ce
.
T
h
is
m
eth
o
d
was
d
ev
elo
p
ed
b
y
[
2
6
]
an
d
h
as
b
ee
n
u
tili
ze
d
in
n
u
m
e
r
o
u
s
r
e
v
iew
s
tu
d
ies
[
2
7
]
–
[
3
6
]
.
I
n
Fig
u
r
e
1
,
t
h
e
tec
h
n
iq
u
e
f
o
r
s
elec
tin
g
ar
ticles
is
d
ep
icted
.
T
h
e
m
an
y
s
tep
s
ar
e
b
r
o
k
e
n
d
o
wn
i
n
to
th
e
f
o
llo
win
g
ca
te
g
o
r
ies:
Fig
u
r
e
1
.
SP
AR
-
4
-
SLR f
r
am
e
wo
r
k
[
2
6
]
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
d
o
n
esian
J
E
lec
E
n
g
&
C
o
m
p
Sci
I
SS
N:
2
5
0
2
-
4
7
52
Th
e
in
teg
r
a
tio
n
o
f m
eta
ve
r
s
e
tech
n
o
lo
g
y
in
h
e
a
lth
ca
r
e:
a
c
o
mp
r
eh
en
s
ive
…
(
R
ita
R
o
y
)
979
3
.
1
.
Ass
em
bli
ng
T
o
co
m
p
lete
th
e
SP
AR
-
4
-
SLR
p
r
o
ce
s
s
,
it
i
s
n
ec
es
s
ar
y
to
lo
ca
te
an
d
co
llect
ar
ticles
f
o
r
ev
alu
atio
n
.
R
eg
ar
d
in
g
id
e
n
tific
atio
n
,
t
h
e
ev
alu
atio
n
is
p
r
im
ar
ily
c
o
n
ce
r
n
ed
with
l
o
w
ca
r
b
o
n
o
r
ca
r
b
o
n
n
e
u
tr
ality
as
its
p
r
im
ar
y
f
o
c
u
s
.
R
Q1
,
R
Q2
,
an
d
R
Q3
ar
e
f
o
cu
s
ed
with
th
e
q
u
esti
o
n
o
f
“
wh
at
”
c
o
n
s
titu
tes
th
e
SLR
f
o
r
l
o
w
-
ca
r
b
o
n
o
r
ca
r
b
o
n
-
n
e
u
tr
ality
in
o
r
d
er
to
im
p
r
o
v
e
th
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p
e
r
f
o
r
m
an
ce
o
f
f
ir
m
s
an
d
o
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g
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izatio
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as
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C
.
B
ec
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s
e
co
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p
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a
n
d
em
p
ir
ical
“
p
ap
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s
”
p
u
b
lis
h
ed
i
n
“
jo
u
r
n
als
”
ar
e
th
e
o
n
ly
s
o
u
r
ce
s
o
f
ac
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ic
liter
atu
r
e
th
at
h
av
e
b
ee
n
s
u
b
j
ec
ted
to
r
ig
o
r
o
u
s
p
ee
r
r
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,
th
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a
r
e
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e
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ly
f
o
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m
s
o
f
“
p
ap
er
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”
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at
th
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jo
u
r
n
als
p
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b
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h
.
T
h
e
Sco
p
u
s
d
atab
ase
was
u
tili
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d
a
s
b
o
th
th
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r
ch
en
g
in
e
an
d
th
e
m
eth
o
d
f
o
r
o
b
tain
in
g
th
e
co
n
te
n
t
b
ec
a
u
s
e
it
is
ca
p
ab
le
o
f
d
el
iv
er
in
g
th
e
n
ec
ess
ar
y
in
f
o
r
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atio
n
.
T
h
e
s
ea
r
ch
was
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ar
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ied
o
u
t
b
etwe
en
2
0
1
2
a
n
d
2
0
2
3
.
(
1
0
y
ea
r
s
)
.
I
n
Sco
p
u
s
,
th
e
“
ar
ticle
titl
e,
ab
s
tr
ac
t,
o
r
k
ey
wo
r
d
s
”
cr
iter
io
n
,
“
m
etav
er
s
e
”
OR
“
m
u
ltiv
er
s
e
”
AND
“
h
ea
lth
ca
r
e
”
OR
“
h
o
s
p
ital
”
wer
e
th
e
s
ea
r
ch
ter
m
s
.
I
n
to
tal,
1
8
0
ar
ticle
s
ap
p
ea
r
ed
f
r
o
m
th
e
in
itial sear
ch
.
3
.
2
.
Arr
a
ng
ing
Usi
n
g
th
e
co
d
e,
SP
AR
-
4
-
SLR
ca
n
o
r
g
an
ize
an
d
tid
y
u
p
s
ea
r
ch
r
esu
lts
.
Sco
p
u
s
’
s
ca
teg
o
r
y
to
o
l
was
u
tili
ze
d
in
th
is
s
tu
d
y
to
class
if
y
th
e
1
8
0
p
ap
e
r
s
th
at
wer
e
r
e
ce
iv
ed
th
r
o
u
g
h
o
u
t
th
e
d
esig
n
a
ted
ass
em
b
ly
tim
e.
T
h
e
to
tal
n
u
m
b
e
r
o
f
ar
ticles
a
n
d
r
e
v
iew
p
a
p
er
s
th
at
wer
e
r
e
v
iewe
d
was
r
ed
u
ce
d
f
r
o
m
1
8
0
to
1
6
2
.
E
n
g
lis
h
was
s
elec
ted
b
ec
au
s
e
th
e
in
v
esti
g
atio
n
was
wr
itten
in
E
n
g
li
s
h
,
wh
ich
r
esu
lted
in
1
5
9
ar
ticles
b
ein
g
lef
t.
B
y
its
r
esear
ch
q
u
esti
o
n
s
an
d
o
b
jectiv
es,
th
is
s
tu
d
y
ex
am
in
e
d
a
to
tal
o
f
4
4
a
r
ticles.
3
.
3
.
Ass
ess
ing
A
s
tu
d
y
o
f
th
e
ar
ticle
a
n
d
a
r
e
p
o
r
t
o
n
its
s
tr
en
g
th
s
,
s
h
o
r
tco
m
in
g
s
,
an
d
s
u
p
p
o
r
t
ar
e
p
r
esen
te
d
af
t
er
th
e
co
n
clu
s
io
n
o
f
th
e
SP
AR
-
4
-
SLR
tech
n
iq
u
e.
T
h
e
y
a
r
e
p
r
esen
t
ed
af
ter
th
e
co
n
cl
u
s
io
n
o
f
th
e
p
r
o
ce
d
u
r
e.
T
h
e
y
ea
r
o
f
p
u
b
licatio
n
,
th
e
to
p
ten
p
u
b
licatio
n
s
th
at
wer
e
cited
,
t
h
e
to
p
ten
j
o
u
r
n
als
th
at
co
n
tr
ib
u
ted
,
th
e
n
atio
n
s
,
th
e
ty
p
e
o
f
s
tu
d
y
,
an
d
th
e
m
eth
o
d
s
th
at
wer
e
u
s
ed
to
co
llect
d
ata
wer
e
all
f
ac
to
r
s
t
h
at
wer
e
tak
en
in
to
co
n
s
id
er
atio
n
th
r
o
u
g
h
o
u
t
th
e
ev
alu
atio
n
.
T
h
is
d
o
cu
m
en
t
co
n
tain
s
a
f
u
r
th
er
ex
am
in
atio
n
o
f
th
e
to
p
ic
m
atter
an
d
s
u
g
g
esti
o
n
s
f
o
r
ad
d
itio
n
al
r
esear
ch
.
T
o
p
r
esen
t
th
e
f
in
d
in
g
s
o
f
th
e
r
e
v
ie
w,
a
co
m
b
i
n
at
io
n
o
f
illu
s
tr
atio
n
s
,
tab
les,
an
d
tex
t
is
u
tili
ze
d
.
T
o
war
d
s
th
e
en
d
o
f
th
e
ess
ay
,
b
o
th
th
e
lim
itatio
n
s
o
f
th
e
ar
ticle
an
d
th
e
s
o
u
r
ce
s
o
f
f
in
an
cin
g
a
r
e
d
is
cu
s
s
ed
.
B
ec
au
s
e
th
e
r
ev
iew
m
ad
e
u
s
e
o
f
s
ec
o
n
d
ar
y
d
ata
th
at
was
av
aila
b
le
to
th
e
g
e
n
er
al
p
u
b
lic,
th
er
e
was n
o
n
ee
d
f
o
r
eth
ical
ap
p
r
o
v
al.
4.
F
I
NDING
S AN
D
F
UT
URE
RE
S
E
ARCH
D
I
RE
CT
I
O
NS
4
.
1
.
T
hem
a
t
ic
a
na
ly
s
is
T
h
e
s
tu
d
y
’
s
th
em
atic
an
aly
s
is
,
wh
ich
co
n
s
id
er
s
ac
ce
p
tan
ce
,
d
if
f
icu
lties
,
an
d
tar
g
et
au
d
ien
ce
s
wh
er
e
m
etav
er
s
e
r
esear
ch
h
as
b
ee
n
c
o
n
d
u
cte
d
in
r
e
ce
n
t
y
ea
r
s
,
is
p
r
esen
ted
in
T
ab
le
1
.
AI
,
m
ix
e
d
r
ea
lity
(
MR),
AR
,
VR
,
an
d
o
th
er
elem
en
ts
in
f
lu
en
ce
d
h
o
w
cu
s
to
m
er
s
ad
o
p
te
d
n
ew
tech
n
o
lo
g
y
.
Ou
r
an
aly
s
is
o
f
p
ee
r
-
r
ev
iewe
d
ac
ad
em
ic
p
a
p
er
s
o
n
m
etav
er
s
e
r
esear
ch
s
h
o
wed
t
h
at
th
e
wr
iter
s
n
ee
d
ed
h
elp
co
n
d
u
ctin
g
th
ei
r
s
tu
d
ies.
T
h
is
s
tu
d
y
was
u
n
d
er
tak
en
with
th
e
p
a
r
ticip
atio
n
o
f
b
o
th
h
e
alth
ca
r
e
p
r
o
f
ess
io
n
als
an
d
p
atien
ts
.
R
esear
ch
er
s
ar
e
g
r
a
d
u
ally
u
n
d
e
r
tak
in
g
v
ar
io
u
s
r
esear
ch
p
r
o
jects
in
s
ev
e
r
al
s
ec
to
r
s
to
g
en
er
ate
n
ew
r
e
s
ea
r
ch
f
in
d
i
n
g
s
an
d
o
p
p
o
r
tu
n
ities
f
o
r
f
u
r
th
e
r
s
tu
d
y
.
T
ab
le
1
.
T
h
em
atic
a
n
aly
s
is
Th
e
m
e
s
S
u
b
-
t
h
e
mes
D
i
scu
ssi
o
n
R
e
f
e
r
e
n
c
e
A
d
o
p
t
i
o
n
F
a
c
t
o
r
s:
[
3
7
]
VR
H
e
a
l
t
h
c
a
r
e
w
o
r
k
e
r
s
a
n
d
p
a
t
i
e
n
t
s
c
a
n
u
s
e
V
R
t
e
c
h
n
o
l
o
g
i
e
s
t
o
i
n
t
e
r
a
c
t
w
i
t
h
s
i
m
u
l
a
t
e
d
s
u
r
r
o
u
n
d
i
n
g
s
.
AR
3
D
mo
d
e
l
l
i
n
g
a
n
d
v
i
s
u
a
l
i
z
a
t
i
o
n
a
r
e
u
t
i
l
i
z
e
d
t
o
d
i
a
g
n
o
se
p
a
t
i
e
n
t
s
y
mp
t
o
ms,
me
d
i
c
a
l
i
m
a
g
i
n
g
,
a
n
d
v
i
t
a
l
si
g
n
s
.
MR
H
e
a
l
t
h
c
a
r
e
p
r
o
v
i
d
e
r
s
c
a
n
m
o
r
e
e
a
si
l
y
si
m
p
l
i
f
y
m
e
d
i
c
a
l
p
r
o
c
e
d
u
r
e
s
b
y
u
t
i
l
i
z
i
n
g
M
R
t
e
c
h
n
o
l
o
g
y
.
AI
A
I
c
a
n
i
mp
r
o
v
e
p
a
t
i
e
n
t
o
u
t
c
o
mes
,
e
n
h
a
n
c
e
q
u
a
l
i
t
y
o
f
l
i
f
e
a
n
d
p
r
e
v
e
n
t
i
v
e
c
a
r
e
,
a
n
d
g
e
n
e
r
a
t
e
m
o
r
e
a
c
c
u
r
a
t
e
d
i
a
g
n
o
s
i
s
a
n
d
t
r
e
a
t
me
n
t
p
l
a
n
s.
C
h
a
l
l
e
n
g
e
s
M
e
t
a
v
e
r
se
a
d
o
p
t
i
o
n
i
n
t
h
e
h
e
a
l
t
h
c
a
r
e
sec
t
o
r
i
s f
a
c
i
n
g
man
y
c
h
a
l
l
e
n
g
e
s
Th
e
me
d
i
c
a
l
m
e
t
a
v
e
r
s
e
f
a
c
e
s
t
h
e
f
o
l
l
o
w
i
n
g
c
h
a
l
l
e
n
g
e
s
−
D
a
t
a
p
r
i
v
a
c
y
i
ss
u
e
s
−
D
a
t
a
v
o
l
u
me
p
r
o
b
l
e
m
−
I
n
t
e
r
a
c
t
i
o
n
d
e
v
i
c
e
i
s
su
e
s
−
Te
c
h
n
o
l
o
g
y
c
o
st
i
ss
u
e
s
[
3
8
]
Ta
r
g
e
t
a
u
d
i
e
n
c
e
P
a
t
i
e
n
t
s
I
mp
r
o
v
i
n
g
p
a
t
i
e
n
t
s
’
w
e
l
l
-
b
e
i
n
g
b
y
p
r
o
v
i
d
i
n
g
t
i
me
l
y
a
n
d
e
f
f
i
c
i
e
n
t
m
e
d
i
c
a
l
c
a
r
e
[
3
9
]
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
5
0
2
-
4
7
52
In
d
o
n
esian
J
E
lec
E
n
g
&
C
o
m
p
Sci
,
Vo
l.
3
8
,
No
.
2
,
May
20
2
5
:
9
7
5
-
9
8
7
980
4
.
2
.
F
uture
re
s
ea
rc
h direc
t
i
o
ns
us
i
ng
T
CC
M
f
ra
m
e
wo
r
k
T
h
is
s
tu
d
y
em
p
lo
y
ed
th
e
SP
AR
-
4
-
SLR ap
p
r
o
ac
h
d
ev
el
o
p
ed
b
y
[
2
6
]
.
Utilizin
g
th
e
T
C
C
M
f
r
am
ewo
r
k
cr
af
ted
b
y
an
d
u
s
ed
b
y
[
3
5
]
,
f
u
r
th
er
r
esear
ch
a
v
en
u
es
ar
e
s
u
g
g
ested
b
ased
o
n
th
is
s
y
n
th
esis
.
I
ts
p
o
p
u
lar
ity
ca
n
b
e
attr
ib
u
t
ed
to
its
ab
ilit
y
to
ass
i
s
t
r
es
ea
r
ch
er
s
in
class
if
y
in
g
th
eir
f
in
d
in
g
s
in
to
f
o
u
r
ca
teg
o
r
ies,
allo
win
g
t
h
em
t
o
id
en
tify
o
v
e
r
lap
a
r
ea
s
an
d
p
o
s
s
ib
le
f
u
t
u
r
e
r
esear
c
h
d
ir
ec
tio
n
s
.
I
n
itially
,
th
e
th
eo
r
etica
l
f
r
am
ewo
r
k
s
th
at
wer
e
em
p
l
o
y
ed
in
liter
a
r
y
wo
r
k
s
.
Nex
t,
th
e
p
r
ev
io
u
s
ly
c
o
v
er
ed
co
n
te
x
t
an
d
th
o
s
e
th
at
h
av
e
n
o
t
b
ee
n
ex
a
m
in
ed
well.
T
h
e
liter
atu
r
e
is
ca
teg
o
r
ized
th
ir
d
ly
b
ased
o
n
th
e
f
ea
tu
r
es
o
f
th
e
m
ajo
r
is
s
u
es
ex
p
l
o
r
ed
an
d
f
o
u
r
th
ly
o
n
th
e
ap
p
r
o
ac
h
es
d
is
cu
s
s
ed
.
T
o
b
etter
u
n
d
er
s
tan
d
th
e
cu
r
r
en
t
tr
en
d
s
an
d
p
o
s
s
ib
le
f
u
tu
r
e
r
esear
ch
d
ir
ec
t
io
n
s
,
th
e
au
th
o
r
s
o
f
th
is
s
tu
d
y
u
s
ed
th
e
T
C
C
M
f
r
am
ewo
r
k
to
h
elp
th
em
id
en
tify
th
e
r
esear
ch
g
ap
s
in
t
h
e
b
o
d
y
o
f
ex
is
tin
g
liter
atu
r
e
ac
r
o
s
s
th
e
f
o
u
r
ca
teg
o
r
ies
[
3
9
]
.
T
a
b
le
2
s
h
o
ws
th
e
f
u
tu
r
e
r
esear
ch
q
u
esti
o
n
s
f
o
r
m
etav
e
r
s
e
in
h
ea
lth
ca
r
e.
T
ab
le
2
.
Po
ten
tial f
u
tu
r
e
r
esea
r
ch
ar
ea
s
an
d
q
u
esti
o
n
s
in
m
et
av
er
s
e
Th
e
m
e
s
R
e
se
a
r
c
h
g
a
p
i
d
e
n
t
i
f
i
e
d
F
u
t
u
r
e
r
e
sea
r
c
h
q
u
e
s
t
i
o
n
s
F
u
t
u
r
e
d
i
r
e
c
t
i
o
n
–
t
h
e
o
r
y
Th
e
o
r
y
–
d
r
i
v
e
n
r
e
s
e
a
r
c
h
R
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en
s
en
et
a
l.
[
4
2
]
,
in
s
titu
tio
n
al
th
eo
r
y
ca
n
also
s
er
v
e
as
a
f
o
u
n
d
atio
n
f
o
r
in
v
esti
g
atin
g
th
e
d
ec
is
io
n
to
ad
o
p
t
m
etav
er
s
e
tech
n
o
lo
g
y
an
d
th
e
ex
p
an
s
io
n
o
f
in
n
o
v
atio
n
s
in
th
e
m
ed
ical
f
ield
.
4
.
2
.
2
.
F
uture
direct
io
ns
-
co
nte
x
t
Mo
s
t
m
etav
er
s
e
r
esear
ch
o
v
er
th
e
p
ast
ten
y
ea
r
s
h
as
b
ee
n
u
n
d
er
tak
en
in
C
h
in
a
(
2
1
.
4
3
%),
f
o
llo
wed
b
y
I
n
d
ia
(
1
4
.
2
8
%),
ac
co
r
d
i
n
g
to
th
e
m
o
s
t
r
ec
en
t
SP
A
R
-
4
-
SLR
d
ata.
R
eg
ar
d
in
g
r
esear
ch
o
u
tp
u
t,
th
e
f
o
llo
win
g
two
co
u
n
tr
ies
ar
e
th
e
Un
ited
Ar
ab
E
m
ir
ates
an
d
I
taly
(
1
1
.
9
0
%
ea
ch
)
.
T
h
e
Un
ited
States
o
f
Am
er
ica
an
d
Ko
r
ea
ea
ch
co
n
tr
i
b
u
ted
7
.
1
4
%
to
th
e
s
tu
d
y
p
r
o
ject,
wh
ile
th
e
C
ze
ch
R
ep
u
b
lic
m
ad
e
u
p
ju
s
t
4
.
7
6
%
o
f
th
e
t
o
tal
r
esear
ch
in
itiativ
e.
No
tab
ly
,
7
8
.
5
7
%
o
f
m
etav
er
s
e
r
esear
ch
p
ap
er
s
u
s
ed
d
ata
f
r
o
m
s
ev
en
d
is
tin
ct
co
u
n
tr
ies:
C
h
in
a,
I
n
d
ia,
I
taly
,
th
e
Un
ited
Ar
ab
E
m
ir
ates,
Ko
r
ea
,
th
e
Un
ited
States
o
f
Am
er
ica,
an
d
t
h
e
C
ze
ch
R
ep
u
b
lic.
As
a
r
esu
lt,
th
e
r
esu
lts
’
g
en
er
a
lizab
ilit
y
will
n
o
t
b
e
d
is
cu
s
s
ed
.
T
h
u
s
,
ad
d
itio
n
al
s
tu
d
ies
s
h
o
u
ld
b
e
c
o
n
d
u
cted
in
d
if
f
er
en
t c
o
u
n
tr
ies.
T
h
e
au
th
o
r
s
d
id
a
co
n
tex
t
u
al
an
aly
s
is
to
d
eter
m
in
e
th
e
cu
r
r
en
t
liter
atu
r
e
’
s
d
is
cip
lin
ar
y
,
r
eg
io
n
al,
an
d
in
d
u
s
tr
y
f
o
ci.
Or
th
o
p
ed
ic
is
th
e
p
r
im
a
r
y
s
u
b
ject
m
atter
i
n
ac
ad
e
m
ic
p
u
b
licatio
n
s
.
T
h
e
au
th
o
r
s
th
u
s
u
r
g
e
f
u
r
th
er
r
esear
ch
in
less
-
s
tu
d
ied
ar
ea
s
s
u
ch
as
d
en
tis
tr
y
im
p
lan
ts
,
v
eter
in
ar
y
m
ed
icin
e,
o
p
h
th
alm
o
lo
g
y
,
g
astro
en
ter
o
lo
g
y
,
a
n
d
p
u
lm
o
n
o
lo
g
y
.
Acc
o
r
d
in
g
to
th
e
f
in
d
i
n
g
s
,
r
esear
ch
in
d
ev
elo
p
in
g
a
n
d
u
n
d
er
d
e
v
elo
p
e
d
ec
o
n
o
m
ies
also
s
h
o
wed
a
n
ee
d
.
Dwiv
ed
i
et
a
l.
[
4
3
]
,
th
is
co
u
ld
r
esu
lt
f
r
o
m
th
e
g
o
v
er
n
m
en
t
’
s
lack
o
f
in
v
o
lv
em
e
n
t
in
en
co
u
r
ag
in
g
th
e
ad
o
p
tio
n
o
f
in
n
o
v
ativ
e
tec
h
n
o
lo
g
y
.
Fu
tu
r
e
s
tu
d
ies
m
ay
e
x
am
in
e
th
is
to
lear
n
m
o
r
e
ab
o
u
t
h
o
w
g
o
v
er
n
m
e
n
t
in
ter
v
en
tio
n
v
a
r
ies
in
d
ev
elo
p
in
g
ec
o
n
o
m
ies
co
m
p
ar
ed
to
i
n
d
u
s
tr
ialized
o
n
es.
I
t
was
also
n
o
ted
t
h
at
th
er
e
wa
s
n
o
t
m
u
ch
m
u
ltid
is
cip
lin
ar
y
a
n
d
m
u
ltin
atio
n
al
r
esear
ch
.
A
r
o
b
u
s
t
co
m
p
ar
ativ
e
ex
am
in
atio
n
o
f
th
e
s
u
b
ject
m
a
y
b
e
p
o
s
s
ib
le
with
th
e
aid
o
f
t
h
ese
s
tu
d
ies.
4.
2
.
3
.
F
uture
direct
io
ns
-
c
ha
ra
ct
er
is
t
ics
T
h
is
s
ec
tio
n
s
u
g
g
ests
d
ir
ec
tio
n
s
f
o
r
f
u
r
th
er
r
esear
ch
o
n
ad
o
p
tin
g
m
etav
er
s
e
in
h
ea
lth
ca
r
e
,
co
n
s
id
er
in
g
d
if
f
er
e
n
t
asp
ec
ts
.
Nu
m
er
o
u
s
g
ap
s
in
t
h
e
th
em
es
an
d
f
ea
tu
r
es
o
f
t
h
ese
s
tu
d
ies
wer
e
also
f
o
u
n
d
af
ter
th
o
r
o
u
g
h
ly
ex
am
i
n
in
g
th
e
b
o
d
y
o
f
ex
tan
t
r
esear
c
h
.
T
h
e
eth
ical
an
d
leg
al
is
s
u
es
o
f
m
etav
er
s
e
ap
p
licatio
n
s
in
th
is
s
ec
to
r
ar
e
b
r
o
ad
.
T
h
o
u
g
h
s
o
m
e
r
esear
c
h
h
as
ad
d
r
ess
ed
th
ese
is
s
u
es,
th
e
f
o
cu
s
o
f
th
e
s
e
s
tu
d
ies
h
as
b
ee
n
p
r
im
ar
ily
co
n
ce
p
tu
al.
New
p
er
s
p
ec
tiv
es
o
n
th
e
s
u
b
ject
m
ig
h
t
em
er
g
e
v
ia
a
m
o
r
e
in
-
d
ep
th
in
v
esti
g
atio
n
an
d
s
tak
eh
o
ld
e
r
in
ter
v
iews.
I
t
is
also
u
n
k
n
o
wn
h
o
w
m
u
ch
r
is
k
an
d
u
n
ce
r
tain
ty
th
e
h
ea
lth
c
ar
e
in
d
u
s
tr
y
will f
ac
e
d
u
e
to
th
e
m
etav
er
s
e.
An
o
th
er
a
r
ea
o
f
f
u
r
th
er
r
esear
ch
is
h
o
w
SC
co
n
f
ig
u
r
atio
n
,
s
tak
eh
o
ld
e
r
co
llab
o
r
atio
n
,
an
d
m
etav
er
s
e
ad
o
p
tio
n
ar
e
af
f
ec
te
d
.
M
u
lti
-
cr
iter
ia
d
ec
is
io
n
-
m
a
k
in
g
(
MCDM)
m
eth
o
d
o
lo
g
ie
s
ca
n
b
e
u
s
ed
to
in
v
esti
g
ate
th
e
f
ac
to
r
s
th
at
p
r
o
m
o
te
o
r
in
h
ib
it
th
e
ad
o
p
tio
n
o
f
m
etav
e
r
s
e.
T
h
e
SC
is
s
u
e
s
r
elate
d
to
th
e
in
d
u
s
tr
y
’
s
ad
o
p
tio
n
o
f
th
e
m
etav
er
s
e
ca
n
also
b
e
an
aly
ze
d
u
s
in
g
MCDM.
T
h
er
e
is
a
ls
o
a
n
ee
d
f
o
r
m
o
r
e
liter
atu
r
e
o
n
d
e
v
elo
p
in
g
cu
s
t
o
m
ized
m
ed
icatio
n
s
in
th
e
m
etav
er
s
e.
Patien
ts
m
ay
b
en
ef
i
t
s
ig
n
if
ican
tly
f
r
o
m
th
ese; m
o
r
e
r
es
ea
r
ch
is
n
ee
d
ed
to
d
eter
m
in
e
t
h
is
.
4.
2
.
4
.
F
uture
direct
io
ns
-
m
et
ho
do
lo
g
y
R
esear
ch
em
p
lo
y
in
g
m
ix
e
d
m
eth
o
d
s
m
ay
h
elp
in
v
esti
g
ate
t
h
e
o
b
s
tacle
s
to
a
d
o
p
tio
n
en
c
o
u
n
ter
ed
b
y
in
d
u
s
tr
y
p
ar
ticip
an
ts
.
I
t
ca
n
a
ls
o
b
e
u
s
ed
to
d
eter
m
in
e
h
o
w
s
im
p
le
o
r
co
m
p
lex
p
r
e
-
o
p
e
r
at
iv
e
p
lan
n
in
g
an
d
m
ed
ical
in
ter
v
en
tio
n
will
b
e.
An
o
th
er
o
p
tio
n
is
ex
am
in
in
g
a
lo
n
g
-
ter
m
s
tu
d
y
th
at
u
s
es
3
D
m
ed
ical
m
o
d
els
to
d
escr
ib
e
m
ed
ical
s
tu
d
e
n
ts
’
le
ar
n
in
g
cu
r
v
es.
T
h
e
g
r
o
u
n
d
e
d
th
eo
r
y
tech
n
iq
u
e
ca
n
b
e
a
p
p
l
ied
to
c
o
m
p
r
e
h
en
d
s
tak
eh
o
ld
er
s
’
ad
o
p
tio
n
b
eh
a
v
i
or
an
d
in
ten
tio
n
s
in
v
a
r
io
u
s
h
ea
lth
ca
r
e
d
o
m
ai
n
s
.
Pro
s
p
ec
tiv
e
in
v
esti
g
ato
r
s
m
ay
also
u
tili
ze
tar
g
eted
f
o
cu
s
g
r
o
u
p
s
,
Delp
h
i,
an
d
f
u
zz
y
Delp
h
i
tech
n
iq
u
es
to
g
ath
e
r
d
ata
f
r
o
m
s
u
b
jects
en
tire
ly
m
is
s
in
g
f
r
o
m
ex
is
tin
g
s
tu
d
ies.
T
h
er
e
is
also
a
lack
o
f
an
in
ter
v
iew
-
b
ased
s
tu
d
y
in
th
e
liter
atu
r
e
to
co
m
p
r
eh
en
d
th
e
b
ar
r
ier
s
to
m
etav
er
s
e
ad
o
p
tio
n
in
th
e
f
ield
.
4
.
3
.
Abili
t
ies o
f
m
e
t
a
v
er
s
e
b
a
s
ed
o
n CIM
O
lo
g
ic
Den
y
er
et
a
l.
[
4
4
]
im
p
lem
e
n
t
ed
d
esig
n
s
cien
ce
ap
p
r
o
ac
h
a
n
d
C
I
MO
as
s
h
o
wn
in
F
ig
u
r
e
2
lo
g
ic
to
co
m
p
r
eh
e
n
d
th
e
a
d
v
an
ta
g
es
o
f
th
e
m
etav
er
s
e
to
th
e
h
ea
lth
ca
r
e
in
d
u
s
tr
y
.
I
n
ter
v
en
tio
n
(
I
)
is
u
s
ed
in
th
is
ca
s
e
to
attain
th
e
o
u
tco
m
e
(
O)
in
co
n
tex
t
(
C
)
.
[
4
5
]
s
tate
th
at
m
ec
h
an
is
m
(
M)
p
r
o
d
u
ce
s
th
e
d
esire
d
r
esu
lt
w
h
en
an
in
ter
v
en
tio
n
is
u
s
ed
.
T
h
is
r
e
v
iew
u
s
es
th
e
C
I
MO
lo
g
ic
to
p
r
o
v
id
e
in
f
o
r
m
atio
n
ab
o
u
t
en
lig
h
ten
in
g
th
e
ex
ce
llen
ce
o
f
h
ea
lth
ca
r
e
s
er
v
i
ce
s
p
r
o
v
id
ed
to
p
atien
ts
(
co
n
t
ex
t)
th
r
o
u
g
h
in
ter
v
en
tio
n
.
T
h
e
s
tu
d
y
also
co
v
er
s
s
u
cc
ess
f
u
lly
ad
o
p
tin
g
a
n
d
im
p
lem
en
tin
g
m
etav
e
r
s
e
(
m
ec
h
an
i
s
m
)
to
ac
h
iev
e
th
e
in
ten
d
e
d
r
e
s
u
lt.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
5
0
2
-
4
7
52
In
d
o
n
esian
J
E
lec
E
n
g
&
C
o
m
p
Sci
,
Vo
l.
3
8
,
No
.
2
,
May
20
2
5
:
9
7
5
-
9
8
7
982
Fig
u
r
e
2
.
Ab
ilit
ies o
f
m
etav
e
r
s
e
b
ased
o
n
C
I
MO
lo
g
ic
4
.
3
.
1
.
Co
nte
x
t
C
o
licch
ia
an
d
Stro
zz
i
[
4
6
]
,
th
e
s
tu
d
y
s
u
b
jects
m
a
y
in
cl
u
d
e
p
eo
p
le,
r
elatio
n
s
h
i
p
s
,
in
s
titu
tio
n
al
co
n
tex
ts
,
o
r
lar
g
er
s
y
s
tem
s
.
Giv
in
g
p
atien
ts
ac
ce
s
s
to
h
ig
h
er
-
q
u
ality
,
tim
ely
,
a
n
d
i
n
d
iv
id
u
alize
d
h
ea
lth
ca
r
e
tr
ea
tm
en
ts
aim
s
to
en
h
an
ce
th
eir
q
u
ality
o
f
life
.
T
h
is
s
tu
d
y
will
s
et
th
e
co
n
tex
t
f
o
r
f
u
t
u
r
e
r
esear
ch
in
th
e
d
o
m
ain
o
f
m
etav
e
r
s
e
in
h
ea
lth
ca
r
e.
Als
o
,
th
is
r
esear
ch
wil
l
s
et
th
e
co
n
tex
t
f
o
r
th
e
h
ea
lt
h
ca
r
e
in
d
u
s
tr
ies
to
ad
o
p
t th
e
m
etav
er
s
e.
4
.
3
.
2
.
I
nte
rv
ent
io
n
C
o
licch
ia
an
d
Stro
zz
i
[
4
6
]
ex
am
in
ed
th
e
o
cc
u
r
r
e
n
ce
s
o
r
b
e
h
av
io
r
s
th
at
h
a
v
e
an
im
p
ac
t.
Me
tav
er
s
e
in
ter
v
en
tio
n
ca
n
b
e
u
s
ed
t
o
a
ch
iev
e
th
e
g
o
al
o
r
co
n
tex
t.
R
ea
ch
in
g
th
is
g
o
al
is
m
ad
e
m
o
r
e
ac
ce
s
s
ib
le
b
y
th
e
m
etav
er
s
e
’
s
d
is
tin
ct
ch
ar
ac
te
r
is
tics
.
Yad
av
et
a
l.
[
4
7
]
,
lay
er
-
on
-
lay
er
lin
k
in
g
r
ed
u
ce
s
m
ater
ial
waste
an
d
en
er
g
y
u
s
ag
e.
Priy
ad
ar
s
h
in
i
e
t
a
l.
[
4
8
]
,
[
4
9
]
s
tate
th
at
d
ig
it
al
d
esig
n
s
f
ac
ilit
ate
th
e
p
r
o
d
u
ctio
n
o
f
n
u
m
er
o
u
s
p
r
o
d
u
ct
iter
atio
n
s
with
o
u
t
p
h
y
s
ical
p
r
in
tin
g
,
h
en
ce
im
p
r
o
v
in
g
m
a
r
k
et
r
esp
o
n
s
e.
Hu
an
g
et
a
l.
[
5
0
]
,
th
e
im
p
lem
en
tatio
n
o
f
a
d
is
tr
ib
u
ted
m
an
u
f
ac
tu
r
in
g
s
y
s
tem
r
esu
lts
in
a
r
ed
u
ctio
n
o
f
lo
g
is
tics
r
eq
u
ir
em
en
ts
,
an
in
cr
ea
s
e
in
cu
s
to
m
e
r
in
v
o
lv
em
en
t,
an
d
th
e
ab
ilit
y
to
f
ac
ilit
ate
m
ass
cu
s
to
m
izatio
n
.
4
.
3
.
3
.
M
ec
ha
nis
m
T
h
e
m
ec
h
a
n
is
m
is
h
o
w
an
i
n
ter
v
en
tio
n
p
r
o
d
u
ce
s
a
p
ar
ti
cu
lar
ef
f
ec
t
[
4
7
]
.
On
ly
th
e
s
u
cc
ess
f
u
l
im
p
lem
en
tatio
n
o
f
m
etav
e
r
s
e
will
m
ak
e
it
v
alu
ab
le
in
th
e
h
ea
lth
ca
r
e
s
ec
to
r
.
First,
m
o
r
e
f
ield
r
esear
ch
an
d
d
ev
elo
p
m
e
n
t
ar
e
n
ee
d
ed
to
m
ax
im
ize
th
e
en
v
ir
o
n
m
e
n
tal
b
e
n
ef
its
[
4
8
]
,
ec
o
n
o
m
ic
[
5
1
]
,
an
d
s
o
cial
b
en
ef
its
o
f
th
e
tech
n
o
lo
g
y
[
5
2
]
.
Nex
t,
m
o
r
e
in
v
o
lv
em
en
t
f
r
o
m
s
tak
eh
o
l
d
er
s
is
r
eq
u
ir
ed
.
T
h
is
i
n
clu
d
es
tr
ain
ed
an
d
s
k
illed
wo
r
k
er
s
[
5
3
]
an
d
p
r
o
ac
tiv
e
t
o
p
m
an
ag
em
e
n
t
[
5
4
]
.
All
o
f
th
ese
g
r
o
u
p
s
n
ee
d
t
o
b
e
m
o
tiv
a
ted
b
y
in
n
o
v
atio
n
.
T
h
e
ef
f
ec
tiv
en
ess
o
f
th
e
p
r
o
c
ess
d
ep
en
d
s
o
n
s
tak
eh
o
ld
er
c
o
llab
o
r
atio
n
[
5
5
]
.
B
ased
o
n
th
e
d
is
cu
s
s
io
n
ab
o
v
e,
th
e
f
o
llo
win
g
r
esear
ch
p
r
o
p
o
s
al
ca
n
b
e
p
r
o
v
id
e
d
f
o
r
u
p
co
m
i
n
g
in
v
esti
g
atio
n
s
.
Pro
p
o
s
itio
n
1
:
t
h
e
m
etav
er
s
e
ad
o
p
tio
n
r
ate
p
o
s
itiv
ely
co
r
r
elate
s
with
in
cr
ea
s
ed
g
o
v
er
n
m
e
n
t
p
ar
ticip
atio
n
in
th
e
r
eg
u
lat
o
r
y
n
ee
d
s
o
f
m
e
d
ical
d
ev
i
ce
s
,
b
io
-
p
r
in
ted
tis
s
u
es,
an
d
ad
d
itiv
el
y
m
ad
e
p
h
ar
m
ac
eu
ticals.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
d
o
n
esian
J
E
lec
E
n
g
&
C
o
m
p
Sci
I
SS
N:
2
5
0
2
-
4
7
52
Th
e
in
teg
r
a
tio
n
o
f m
eta
ve
r
s
e
tech
n
o
lo
g
y
in
h
e
a
lth
ca
r
e:
a
c
o
mp
r
eh
en
s
ive
…
(
R
ita
R
o
y
)
983
4
.
3
.
4
.
O
utc
o
m
e
T
h
e
ter
m
“
o
u
tco
m
e
”
r
ef
er
s
t
o
th
e
r
esu
lts
o
r
c
o
n
s
eq
u
e
n
ce
s
t
h
at
ar
e
b
r
o
u
g
h
t
ab
o
u
t
b
y
an
i
n
ter
v
en
tio
n
th
at
is
ca
r
r
ied
o
u
t
v
ia
th
e
u
tili
za
tio
n
o
f
a
m
ec
h
an
is
m
[
4
7
]
.
I
t
is
p
o
s
s
ib
le
to
ac
h
iev
e
th
e
aim
b
y
co
n
q
u
er
in
g
th
e
ch
allen
g
es
th
e
m
etav
er
s
e
p
r
e
s
en
ts
.
T
h
ese
r
esu
lts
s
y
m
b
o
liz
e
th
e
p
o
ten
tial
o
f
th
e
m
etav
e
r
s
e,
wh
ich
m
ay
b
e
u
tili
ze
d
to
its
f
u
lles
t
ex
ten
t
af
ter
it
h
as
b
ee
n
im
p
lem
en
te
d
.
Per
s
o
n
alize
d
m
ed
icatio
n
s
m
a
y
b
e
ac
q
u
ir
ed
u
s
in
g
th
e
m
etav
er
s
e
to
d
ef
i
n
e
a
p
atien
t
’
s
b
io
lo
g
ical,
p
h
y
s
io
lo
g
ica
l,
s
o
cial,
an
d
ec
o
n
o
m
ic
u
n
iq
u
en
ess
.
T
h
is
allo
ws
f
o
r
cu
s
to
m
izin
g
th
e
p
atien
t
’
s
s
ize,
d
o
s
e,
p
r
esen
tatio
n
,
an
d
th
e
p
ac
e
at
wh
ich
th
ey
ar
e
ad
m
in
is
ter
ed
[
5
6
]
.
No
ël
et
a
l.
[
5
7
]
,
th
ese
ad
v
a
n
tag
es
co
n
tr
i
b
u
te
t
o
b
etter
p
atie
n
t
ca
r
e
at
a
r
e
d
u
ce
d
ex
p
en
s
e.
Aq
u
in
o
et
a
l.
[
5
8
]
s
u
g
g
est th
at
a
p
atien
t
’
s
d
is
tin
c
t g
en
etic
p
r
o
f
ile,
p
h
y
s
io
lo
g
y
,
a
n
d
m
etab
o
lis
m
m
ay
en
ab
le
th
e
ac
cu
r
ate
s
elec
tio
n
o
f
a
m
ed
icatio
n
an
d
its
d
o
s
ag
e
,
r
ed
u
cin
g
ad
v
e
r
s
e
d
r
u
g
r
esp
o
n
s
es
an
d
waste.
T
h
e
f
o
llo
win
g
s
tu
d
y
p
r
o
p
o
s
al
ca
n
b
e
p
r
o
v
id
ed
f
o
r
u
p
co
m
in
g
in
v
esti
g
atio
n
s
b
ased
o
n
th
e
d
is
cu
s
s
io
n
ab
o
v
e.
Pro
p
o
s
itio
n
2
: u
s
in
g
m
eta
v
er
s
e
to
d
eli
v
er
tim
ely
,
i
n
d
iv
id
u
alize
d
h
ea
lth
ca
r
e
s
er
v
ices
at
a
r
e
d
u
ce
d
c
o
s
t
im
p
r
o
v
es p
atien
ts
’
q
u
ality
o
f
life
.
Ma
g
n
etic
r
eso
n
an
ce
im
a
g
in
g
(
MRI)
an
d
co
m
p
u
ted
t
o
m
o
g
r
ap
h
y
(
C
T
)
d
ata
ca
n
b
e
el
ec
tr
o
n
ically
s
to
r
ed
,
allo
win
g
f
o
r
r
a
p
id
a
n
d
af
f
o
r
d
ab
le
m
an
u
f
ac
tu
r
in
g
.
T
ac
h
er
et
a
l.
[
5
9
]
,
th
is
wo
u
ld
allo
w
f
o
r
lo
n
g
-
ter
m
u
s
e
an
d
r
ed
u
ce
th
e
n
u
m
b
er
o
f
an
im
als
n
ee
d
ed
f
o
r
tr
ain
i
n
g
.
Gib
b
s
et
a
l.
[
6
0
]
,
p
r
in
ted
tis
s
u
e,
s
u
ch
as
b
o
n
e,
will
lik
ely
r
ep
lace
s
o
m
e
an
im
al
r
esear
ch
in
th
e
p
h
ar
m
ac
e
u
tical
in
d
u
s
tr
y
.
Sin
g
h
a
n
d
J
o
n
n
alag
ad
d
a
[
6
1
]
,
3
D
-
p
r
in
ted
o
r
g
an
s
an
d
m
o
d
els
m
ay
ev
e
n
tu
ally
tak
e
th
e
r
o
le
o
f
a
n
im
al
test
in
g
in
s
cien
tific
r
ese
ar
ch
.
B
ased
o
n
th
e
d
is
cu
s
s
io
n
ab
o
v
e,
th
e
f
o
llo
win
g
s
tu
d
y
p
r
o
p
o
s
al
ca
n
b
e
p
r
o
v
i
d
ed
f
o
r
u
p
c
o
m
in
g
in
v
esti
g
atio
n
s
.
Pro
p
o
s
itio
n
3
:
l
ar
g
e
-
s
ca
le
ad
o
p
tio
n
o
f
t
h
e
m
etav
er
s
e
r
ed
u
ce
s
th
e
f
r
eq
u
e
n
cy
o
f
a
n
im
al
d
r
u
g
test
in
g
b
y
u
n
iv
er
s
ity
lab
s
an
d
p
h
a
r
m
ac
eu
tical
b
u
s
in
ess
es.
I
n
ad
d
itio
n
to
c
r
ea
tin
g
lo
ca
l
j
o
b
s
an
d
p
r
o
v
id
in
g
s
o
cial
s
ec
u
r
ity
,
th
e
m
etav
er
s
e
ca
n
f
o
s
ter
s
o
cial
in
clu
s
io
n
b
y
p
r
o
v
id
i
n
g
v
a
r
io
u
s
b
en
e
f
its
to
in
d
iv
id
u
als
with
p
h
y
s
ical
d
is
ab
ilit
ies
[
6
2
]
.
T
h
e
p
r
o
ce
s
s
b
ec
o
m
es
au
to
n
o
m
o
u
s
,
th
e
eq
u
ip
m
e
n
t
b
ec
o
m
es
n
o
is
eless
,
an
d
th
e
m
etav
er
s
e
ca
n
r
ed
u
ce
th
e
r
eq
u
i
r
em
en
t
f
o
r
co
n
tin
u
al
h
u
m
an
-
m
ac
h
in
e
in
ter
ac
tio
n
,
all
o
f
w
h
ich
ca
n
r
e
d
u
ce
th
e
lik
elih
o
o
d
o
f
ac
cid
e
n
ts
.
C
o
m
m
u
n
ity
m
em
b
er
s
ca
n
b
en
ef
it
f
r
o
m
ad
d
itio
n
al
p
r
o
d
u
ct
c
u
s
to
m
izatio
n
d
ep
e
n
d
in
g
o
n
lo
c
al
n
ee
d
s
.
B
ased
o
n
th
e
d
is
c
u
s
s
io
n
ab
o
v
e,
t
h
e
f
o
llo
win
g
s
tu
d
y
id
ea
ca
n
b
e
s
u
g
g
ested
f
o
r
u
p
c
o
m
in
g
i
n
v
esti
g
atio
n
s
.
Pro
p
o
s
itio
n
4
:
a
d
o
p
tin
g
th
e
m
etav
er
s
e
im
p
r
o
v
es
life
a
b
ilit
y
,
h
ea
lth
,
an
d
s
o
cial
well
-
b
ein
g
b
y
en
ab
lin
g
th
e
s
o
cial
in
clu
s
io
n
o
f
th
o
s
e
with
d
is
ab
ilit
ies.
A
th
o
r
o
u
g
h
r
e
v
iew
o
f
th
e
h
ea
l
th
ca
r
e
in
d
u
s
tr
y
’
s
m
etav
er
s
e
liter
atu
r
e
led
to
t
h
e
f
r
am
ew
o
r
k
d
ev
elo
p
m
en
t
s
h
o
wn
in
Fig
u
r
e
2
.
T
h
e
ad
v
an
tag
es
h
av
e
b
ee
n
d
is
cu
s
s
ed
.
T
h
e
o
b
s
ta
cles
an
d
th
e
s
tep
s
n
ee
d
ed
t
o
o
v
er
co
m
e
t
h
em
h
av
e
b
ee
n
th
o
r
o
u
g
h
ly
e
x
p
lain
ed
.
Se
v
er
al
ad
v
a
n
tag
eo
u
s
r
esu
lts
th
at
ca
n
b
e
attain
ed
with
m
etav
er
s
e
’
s
ass
i
s
tan
ce
ar
e
also
m
en
tio
n
e
d
in
th
e
f
r
a
m
ewo
r
k
.
T
h
e
r
esear
ch
co
m
m
u
n
ity
h
as,
h
o
wev
er
,
g
iv
en
less
co
n
s
id
er
atio
n
to
a
f
ew
cr
u
cial
f
ea
tu
r
es
o
f
th
e
f
r
am
e
wo
r
k
.
T
h
er
e
f
o
r
e,
th
ese
f
r
am
e
wo
r
k
co
m
p
o
n
en
ts
h
av
e
b
ee
n
p
u
t
f
o
r
th
as
p
o
ten
tial
ar
ea
s
f
o
r
f
u
r
th
er
i
n
v
esti
g
atio
n
.
5.
DIS
CU
SS
I
O
N
AND
I
M
P
L
I
CATI
O
N
O
F
T
H
E
RE
SE
A
RCH
I
n
th
is
s
ce
n
ar
io
,
me
tav
er
s
e
co
u
ld
p
r
o
v
e
t
o
b
e
a
g
am
e
ch
an
g
er
.
I
t
in
clu
d
es
th
e
in
te
g
r
atio
n
o
f
cu
ttin
g
-
ed
g
e
tech
n
o
lo
g
ies,
s
u
ch
as
AR
,
VR
,
AI
,
b
lo
ck
ch
ain
,
q
u
an
tu
m
c
o
m
p
u
tin
g
,
r
o
b
o
tics
,
i
n
ter
n
et
o
f
m
e
d
ical
d
ev
ices,
an
d
m
an
y
o
th
e
r
s
.
Op
en
in
g
d
o
o
r
s
t
o
m
an
y
ex
citin
g
ar
ea
s
o
f
ex
p
lo
r
atio
n
in
i
n
n
o
v
a
tiv
e
s
o
lu
tio
n
s
with
s
u
p
er
io
r
q
u
ality
tr
ea
tm
e
n
ts
an
d
h
ea
lth
ca
r
e
s
er
v
i
ce
s
,
b
ein
g
lev
er
ag
ea
b
le
with
th
ese
ad
v
an
ce
d
tech
n
o
l
o
g
ies
u
n
f
o
ld
s
f
u
r
th
e
r
.
Pro
v
id
in
g
lif
e
-
lik
e
ex
p
e
r
ien
ce
s
to
p
atien
t
s
an
d
h
ea
lth
ca
r
e
p
r
o
v
i
d
er
s
,
t
h
e
m
etav
er
s
e
will
u
n
lo
ck
n
ew
o
p
p
o
r
tu
n
ities
f
o
r
b
etter
h
ea
lth
ca
r
e
o
u
tco
m
es
.
T
h
e
s
tu
d
y
c
o
m
p
r
e
h
en
s
iv
el
y
r
ev
iews
al
l
th
e
ac
ad
em
ic
d
is
cu
s
s
io
n
s
an
d
r
esear
ch
co
n
ce
r
n
in
g
th
e
m
etav
er
s
e
,
th
e
h
ea
lth
ca
r
e
i
n
d
u
s
tr
y
,
an
d
ass
o
ciate
d
em
er
g
in
g
tech
n
o
lo
g
ies.
Oth
e
r
th
an
th
at,
th
e
C
OVI
D
-
1
9
p
a
n
d
em
ic
h
as
b
ee
n
a
s
ig
n
if
ica
n
t
l
ea
d
in
g
ca
u
s
e
o
f
th
e
cu
r
r
en
t
d
is
o
r
d
er
.
T
h
is
h
as
b
ee
n
b
eh
i
n
d
th
e
a
c
ce
ler
atin
g
r
ap
i
d
ch
a
n
g
e
ac
r
o
s
s
th
e
h
ea
lth
ca
r
e
ec
o
s
y
s
tem
,
f
o
r
cin
g
all
s
tak
eh
o
ld
er
s
to
r
eth
in
k
th
eir
ap
p
r
o
ac
h
to
war
d
th
is
i
n
d
u
s
tr
y
an
d
co
m
p
ellin
g
ev
er
y
o
n
e
t
o
th
e
u
n
a
v
o
id
ab
le
ad
o
p
tio
n
o
f
tech
n
o
lo
g
ies
in
o
r
d
er
to
co
p
e
with
th
e
c
h
an
g
es.
T
h
is
p
ap
er
lo
o
k
s
at
h
o
w
t
h
e
m
etav
er
s
e
m
ig
h
t b
e
a
g
am
e
-
ch
an
g
er
f
o
r
h
ea
lth
ca
r
e
i
n
th
e
f
u
tu
r
e
.
I
t
lay
s
th
e
g
r
o
u
n
d
wo
r
k
b
y
g
o
i
n
g
o
v
er
th
e
b
asics
o
f
th
e
m
etav
er
s
e
an
d
its
p
o
ten
tial
ap
p
licatio
n
s
ac
r
o
s
s
v
ar
io
u
s
m
ed
ical
f
ield
s
.
T
h
ese
en
co
m
p
ass
b
r
o
ad
-
s
ca
l
e
ch
an
g
es
s
u
ch
as
im
p
r
o
v
e
d
m
ed
ical
ed
u
ca
tio
n
a
n
d
tr
ain
in
g
,
th
r
o
u
g
h
to
p
r
o
v
id
in
g
im
m
er
s
iv
e
clin
ical
ca
r
e,
p
er
f
o
r
m
in
g
s
u
r
g
ical
p
r
o
ce
d
u
r
es,
ass
is
tin
g
in
o
b
s
te
tr
ics,
an
d
m
u
c
h
m
o
r
e.
I
n
ess
en
ce
,
th
is
s
tu
d
y
p
r
esen
ts
f
o
u
r
p
r
o
p
o
s
itio
n
s
o
n
th
e
f
u
tu
r
e
u
s
in
g
t
h
e
C
I
MO
f
r
am
e
wo
r
k
.
T
h
e
f
ir
s
t
p
r
o
p
o
s
itio
n
r
el
ates
to
th
e
f
ac
t
th
at
th
e
ad
o
p
ti
o
n
r
ate
o
f
m
etav
er
s
e
will
in
cr
ea
s
e
if
th
e
g
o
v
er
n
m
e
n
t
in
ter
v
en
es.
T
h
e
g
o
v
e
r
n
m
en
t
co
u
ld
ass
is
t
h
o
s
p
itals
with
r
esp
ec
t
to
n
ec
ess
ar
y
tech
n
o
lo
g
y
tr
an
s
f
er
an
d
f
u
n
d
in
g
.
T
h
e
g
o
v
er
n
m
en
t
co
u
ld
a
ctiv
ely
b
ec
o
m
e
in
v
o
lv
ed
in
awa
r
en
ess
c
r
ea
tio
n
ab
o
u
t
th
e
m
etav
e
r
s
e
in
th
e
h
ea
lth
ca
r
e
d
o
m
ain
.
T
h
e
s
ec
o
n
d
p
r
o
p
o
s
itio
n
in
v
o
lv
es
th
e
d
e
liv
er
y
o
f
h
ea
lth
ca
r
e
s
er
v
ices
th
r
o
u
g
h
th
e
m
eta
v
er
s
e.
T
h
e
y
co
n
s
id
er
t
h
at,
in
f
ac
t,
th
e
q
u
ality
o
f
th
e
p
atien
ts
will
in
cr
ea
s
e
d
u
e
to
a
less
er
ex
p
en
s
e,
an
d
t
h
er
e
w
ill
b
e
b
etter
tr
ea
tm
en
t
f
ac
ilit
ies
f
o
r
th
e
p
atien
ts
as
well
as
h
ig
h
er
p
atien
t
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
5
0
2
-
4
7
52
In
d
o
n
esian
J
E
lec
E
n
g
&
C
o
m
p
Sci
,
Vo
l.
3
8
,
No
.
2
,
May
20
2
5
:
9
7
5
-
9
8
7
984
s
atis
f
ac
tio
n
.
T
h
ir
d
,
th
e
p
r
o
p
o
s
itio
n
is
th
at
th
er
e
will
b
e
h
ig
h
-
q
u
ality
d
r
u
g
test
in
g
s
u
ch
as
m
etav
er
s
e.
I
t
will
also
aid
th
e
u
n
iv
er
s
ities
an
d
lab
s
.
L
astl
y
,
it
p
r
o
p
o
s
es
t
h
e
im
p
r
o
v
em
e
n
t
in
s
o
cial
life
o
f
d
is
ab
led
p
eo
p
le.
T
h
at
r
ef
lecte
d
a
s
h
if
t
in
attitu
d
e,
illu
s
tr
ated
b
y
in
cr
ea
s
ed
e
m
b
r
ac
in
g
o
f
teleh
ea
lth
an
d
th
e
p
lace
th
at
g
am
in
g
o
cc
u
p
ies in
th
e
y
o
u
n
g
er
p
o
p
u
l
atio
n
,
to
war
d
i
n
cr
ea
s
in
g
ly
o
p
e
n
em
b
r
ac
es o
f
tech
n
o
lo
g
y
in
h
ea
lth
ca
r
e.
Similar
to
VR
,
b
lo
c
k
ch
ain
,
a
n
d
d
ig
ital
twin
s
,
o
th
e
r
n
ew
te
ch
n
o
lo
g
ies
m
o
v
in
g
at
b
r
ea
k
n
ec
k
s
p
ee
d
s
to
war
d
p
r
o
ac
tiv
e
h
ea
lth
ca
r
e
tr
an
s
f
o
r
m
t
h
e
v
er
y
id
ea
o
f
h
ea
l
th
ca
r
e
its
elf
at
its
co
r
e.
E
v
en
if
th
e
m
etav
er
s
e
is
u
n
d
o
u
b
ted
ly
a
tech
n
o
lo
g
y
th
at
h
as
tr
em
en
d
o
u
s
p
o
te
n
tial
f
o
r
im
p
r
o
v
in
g
h
ea
lth
ca
r
e,
its
p
r
o
p
er
i
n
teg
r
atio
n
s
h
o
u
ld
n
o
t o
n
ly
b
e
m
ad
e
k
ee
p
i
n
g
in
co
n
s
id
er
atio
n
th
e
q
u
ality
o
f
ca
r
e
b
u
t a
ls
o
th
e
p
atien
ts
’
s
af
ety
ad
d
itio
n
ally
,
th
e
im
p
ac
t
o
n
th
e
h
u
m
a
n
d
im
en
s
io
n
.
Me
an
w
h
ile,
th
ese
is
s
u
es
o
f
in
cl
u
d
in
g
tech
n
o
lo
g
y
n
e
ed
to
b
e
r
ec
o
g
n
ized
b
u
t
s
u
p
p
r
ess
ed
.
An
y
f
u
n
ctio
n
a
l
s
y
s
tem
s
o
f
m
etav
er
s
e
ca
ll
f
o
r
a
s
tr
ik
in
g
b
alan
ce
b
etwe
en
e
th
ical
an
d
p
r
ac
tical
co
n
ce
r
n
s
co
n
ce
r
n
i
n
g
d
ata
s
ec
u
r
ity
an
d
p
r
iv
ac
y
,
in
ter
o
p
er
a
b
ilit
y
co
n
ce
r
n
s
,
an
d
leg
al
co
n
ce
r
n
s
ab
o
u
t
o
w
n
er
s
h
ip
an
d
d
is
tr
ib
u
tio
n
o
f
d
ata.
T
a
k
in
g
p
r
o
ac
tiv
e
ac
tio
n
s
to
war
d
s
m
ee
tin
g
th
ese
ch
allen
g
es,
we
will
en
s
u
r
e
th
at
s
y
s
tem
s
o
f
m
etav
er
s
e
alig
n
wi
th
th
e
p
r
in
cip
les
o
f
q
u
ality
ca
r
e
an
d
s
af
ety
in
th
eir
im
p
lem
en
tatio
n
.
As
m
u
ch
as
we
wo
u
ld
tak
e
th
e
ad
v
an
tag
e
o
f
m
etav
er
s
e
with
th
e
b
en
ef
it
in
th
e
h
ea
lth
ca
r
e
ar
en
a
th
r
o
u
g
h
ap
p
ly
in
g
th
e
p
atien
t
-
ce
n
tr
ic
a
p
p
r
o
ac
h
an
d
t
ak
in
g
a
n
o
v
er
v
iew
o
f
p
o
s
s
ib
le
r
is
k
s
an
d
b
e
n
ef
its
,
ca
r
e
an
d
th
o
u
g
h
t
h
a
v
e
to
b
e
im
p
lem
en
ted
wh
er
e
tech
n
o
lo
g
y
ac
ts
m
o
r
e
lik
e
an
en
ab
le
r
th
an
a
d
is
r
u
p
to
r
.
I
t
is
in
th
is
way
th
at
b
en
ef
its
a
b
o
u
t
b
etter
h
ea
lth
ca
r
e
o
u
tco
m
es
f
r
o
m
th
e
m
etav
er
s
e
ca
n
b
e
m
ax
im
ized
wh
ile
at
th
e
s
am
e
tim
e
tak
in
g
ca
r
e
o
f
t
h
e
welf
ar
e
an
d
in
ter
ests
o
f
p
atien
ts
.
C
u
r
r
en
t
tr
e
n
d
s
in
tech
n
o
lo
g
y
with
in
th
e
h
ea
lth
ca
r
e
in
d
u
s
tr
y
h
a
v
e
e
f
f
icien
tly
an
d
ef
f
ec
ti
v
ely
ad
o
p
ted
r
em
o
te
p
atien
t
m
o
n
ito
r
in
g
to
e
n
s
u
r
e
th
e
b
est
s
er
v
ice
to
p
ati
en
ts
with
m
o
d
er
n
telem
ed
icin
e
tech
n
iq
u
es.
Me
tav
er
s
e
is
th
e
latest
b
u
zz
wo
r
d
o
f
to
d
a
y
,
wh
ic
h
e
x
p
ec
ts
tr
an
s
f
o
r
m
ativ
e
ch
an
g
es
in
m
an
y
s
tr
ata
o
f
life
.
B
u
t
with
th
e
in
tr
o
d
u
ctio
n
o
f
th
e
m
etav
er
s
e
,
h
ea
lth
ca
r
e
will
also
ex
p
er
ien
ce
ch
an
g
e
in
th
e
n
ea
r
f
u
tu
r
e
th
r
o
u
g
h
u
p
g
r
ad
in
g
th
e
cu
r
r
e
n
t ser
v
ice
o
f
m
o
n
ito
r
i
n
g
p
atien
t h
ea
lth
,
ch
an
g
i
n
g
th
e
way
p
e
o
p
le
in
ter
ac
t
with
th
e
h
ea
lth
ca
r
e
s
y
s
tem
b
y
ad
d
in
g
m
o
r
e
in
ter
ac
ti
v
e
f
ea
tu
r
es
in
a
v
ir
tu
al
wo
r
ld
with
tech
n
o
l
o
g
ies
s
u
ch
as
VR
f
o
r
m
ed
ical
tr
ain
in
g
an
d
AR
in
s
u
r
g
ical
p
r
o
ce
d
u
r
es.
I
t
elab
o
r
ate
s
q
u
i
te
clea
r
ly
o
n
th
e
p
o
ten
tial
ap
p
licatio
n
s
o
f
th
e
Me
tav
er
s
e
in
h
ea
lth
ca
r
e.
Mo
r
e
p
r
ec
is
ely
,
it
em
p
h
asizes
th
e
p
o
s
s
ib
ilit
ies
o
f
im
p
le
m
en
tatio
n
o
f
th
e
m
etav
er
s
e
in
m
ed
ical
d
iag
n
o
s
is
,
m
o
n
ito
r
in
g
o
f
p
atien
ts
,
h
ea
lth
ca
r
e
tr
ain
i
n
g
,
s
u
r
g
er
ies,
an
d
m
e
d
ical
th
er
ap
e
u
t
ics
an
d
th
er
a
g
n
o
s
tic
.
I
n
ad
d
itio
n
,
s
o
m
e
o
f
th
e
r
ec
e
n
t
an
d
u
p
co
m
in
g
p
r
o
jects
r
e
g
ar
d
in
g
t
h
e
m
etav
e
r
s
e
in
th
e
c
o
n
tex
t
o
f
h
ea
lth
ca
r
e,
in
clu
d
in
g
b
lo
ck
c
h
ain
,
d
ig
ital
t
win
s
,
an
d
telem
ed
icin
e,
ar
e
id
en
tifie
d
.
I
t
c
r
itically
an
aly
s
es
th
e
ch
allen
g
es
an
d
o
p
en
is
s
u
es
if
m
etav
er
s
e
is
to
r
ea
lize
its
f
u
ll
p
o
ten
tial
f
o
r
h
ea
lth
ca
r
e
an
d
f
u
r
th
er
r
ec
o
m
m
e
n
d
s
r
elev
an
t
f
u
tu
r
e
s
co
p
e
d
ir
ec
tio
n
s
wh
ich
w
o
u
ld
en
ab
le
co
n
f
id
en
t im
p
le
m
en
tatio
n
o
f
th
e
m
etav
e
r
s
e
in
h
ea
lth
c
ar
e.
6.
CO
NCLU
SI
O
N
T
h
e
h
ea
lth
ca
r
e
in
d
u
s
tr
y
was
th
e
f
o
cu
s
o
f
th
is
s
tu
d
y
,
wh
ich
u
tili
ze
d
in
n
o
v
ativ
e
m
etav
er
s
e
r
esear
ch
ap
p
r
o
ac
h
es.
T
h
e
s
tu
d
y
aim
s
t
o
d
eter
m
in
e
h
o
w
im
p
lem
en
tin
g
m
etav
er
s
e
tech
n
o
lo
g
y
will
b
e
n
ef
it
th
e
h
ea
lth
ca
r
e
in
d
u
s
tr
y
.
T
o
s
ea
r
ch
th
e
Sco
p
u
s
d
atab
ase
f
o
r
p
er
tin
en
t
p
ap
e
r
s
o
n
m
etav
e
r
s
e
,
we
u
tili
ze
d
k
e
y
wo
r
d
s
.
W
ith
i
n
th
e
s
co
p
e
o
f
th
is
in
v
esti
g
atio
n
,
th
e
SP
AR
-
4
-
SLR
ap
p
r
o
ac
h
w
as
em
p
lo
y
ed
to
s
elec
t,
s
cr
ee
n
,
an
d
r
ev
iew
th
e
p
u
b
licatio
n
s
.
T
h
is
r
esear
ch
s
tu
d
y
in
clu
d
es
th
e
m
o
s
t
p
r
o
m
in
en
t
au
th
o
r
s
,
wo
r
k
s
,
p
u
b
l
icatio
n
s
,
co
u
n
tr
ies,
th
eo
r
ies,
an
d
a
p
p
r
o
ac
h
es
in
th
is
p
ar
ticu
lar
to
p
ic.
As
ca
n
b
e
o
b
s
er
v
ed
f
r
o
m
t
h
e
p
u
b
lis
h
ed
d
ata
o
n
m
etav
e
r
s
e
r
esear
ch
,
th
e
h
ea
lth
ca
r
e
r
ese
ar
ch
f
ield
h
as
u
n
d
er
g
o
n
e
s
i
g
n
if
ican
t
d
ev
elo
p
m
en
t
o
v
er
th
e
p
ast
ten
y
ea
r
s
.
I
n
ad
d
itio
n
,
th
is
s
tu
d
y
in
clu
d
e
d
a
lis
tin
g
o
f
th
e
to
p
ten
jo
u
r
n
als
in
ter
m
s
o
f
th
e
n
u
m
b
er
o
f
p
ap
er
s
p
u
b
lis
h
ed
in
th
o
s
e
jo
u
r
n
als.
B
ased
o
n
th
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
,
wh
ich
ex
am
in
ed
th
e
co
u
n
tr
ies
th
at
h
av
e
co
n
tr
ib
u
ted
to
m
etav
er
s
e
r
esear
ch
d
u
r
i
n
g
th
e
p
ast
ten
y
ea
r
s
,
it
was
d
is
co
v
er
ed
th
at
C
h
in
a
h
a
s
m
ad
e
th
e
m
o
s
t
s
ig
n
if
ican
t
co
n
tr
ib
u
tio
n
.
Desp
ite
th
is
,
th
e
r
esear
ch
er
s
en
co
u
n
ter
ed
a
f
ew
ch
alle
n
g
es
d
u
r
in
g
th
ei
r
ea
r
lier
s
cien
tific
in
v
esti
g
atio
n
s
.
Hig
h
-
q
u
ality
r
esear
ch
th
at
is
ca
r
r
ied
o
u
t
u
s
in
g
e
f
f
ec
tiv
e
m
et
h
o
d
s
is
r
eq
u
ir
e
d
in
d
ev
elo
p
in
g
c
o
u
n
tr
ies.
T
h
e
lim
itatio
n
o
f
th
e
s
tu
d
y
is
th
at
th
e
au
th
o
r
s
u
s
ed
o
n
l
y
o
n
e
p
ee
r
r
ev
iewe
d
d
atab
ase
,
n
am
ely
,
SC
OPUS,
s
o
in
t
h
e
f
u
t
u
r
e,
o
th
er
d
atab
ases
will
b
e
in
clu
d
ed
,
lik
e
W
e
b
o
f
Scien
ce
a
n
d
Go
o
g
le
Sch
o
lar
.
RE
F
E
R
E
NC
E
S
[
1
]
E.
O
r
r
e
t
a
l
.
,
“
V
i
r
t
u
a
l
r
e
a
l
i
t
y
i
n
t
h
e
man
a
g
e
me
n
t
o
f
p
a
t
i
e
n
t
s
w
i
t
h
l
o
w
b
a
c
k
a
n
d
n
e
c
k
p
a
i
n
:
a
r
e
t
r
o
sp
e
c
t
i
v
e
a
n
a
l
y
s
i
s
o
f
8
2
p
e
o
p
l
e
t
r
e
a
t
e
d
s
o
l
e
l
y
i
n
t
h
e
met
a
v
e
r
se,
”
Arc
h
i
v
e
s
o
f
P
h
y
s
i
o
t
h
e
ra
p
y
,
v
o
l
.
1
3
,
n
o
.
1
,
M
a
y
2
0
2
3
,
d
o
i
:
1
0
.
1
1
8
6
/
s
4
0
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4
5
-
0
2
3
-
0
0
1
6
3
-
8.
[
2
]
H
.
A
sr
i
,
H
.
M
o
u
s
a
n
n
i
f
,
H
.
A
l
M
o
a
t
a
s
si
me,
a
n
d
T
.
N
o
e
l
,
“
B
i
g
d
a
t
a
i
n
h
e
a
l
t
h
c
a
r
e
:
c
h
a
l
l
e
n
g
e
s
a
n
d
o
p
p
o
r
t
u
n
i
t
i
e
s,
”
i
n
Pr
o
c
e
e
d
i
n
g
s
o
f
2
0
1
5
I
n
t
e
rn
a
t
i
o
n
a
l
C
o
n
f
e
re
n
c
e
o
n
C
l
o
u
d
C
o
m
p
u
t
i
n
g
T
e
c
h
n
o
l
o
g
i
e
s
a
n
d
Ap
p
l
i
c
a
t
i
o
n
s
,
C
l
o
u
d
T
e
c
h
2
0
1
5
,
Ju
n
.
2
0
1
5
,
p
p
.
1
–
7
,
d
o
i
:
1
0
.
1
1
0
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/
C
l
o
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d
Te
c
h
.
2
0
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5
.
7
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3
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0
2
0
.
[
3
]
R
.
C
h
e
n
g
o
d
e
n
e
t
a
l
.
,
“
M
e
t
a
v
e
r
se
f
o
r
h
e
a
l
t
h
c
a
r
e
:
a
s
u
r
v
e
y
o
n
p
o
t
e
n
t
i
a
l
a
p
p
l
i
c
a
t
i
o
n
s,
c
h
a
l
l
e
n
g
e
s
a
n
d
f
u
t
u
r
e
d
i
r
e
c
t
i
o
n
s,
”
I
EEE
A
c
c
e
ss
,
v
o
l
.
1
1
,
p
p
.
1
2
7
6
4
–
1
2
7
9
4
,
2
0
2
3
,
d
o
i
:
1
0
.
1
1
0
9
/
A
C
C
ESS
.
2
0
2
3
.
3
2
4
1
6
2
8
.
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