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8
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[
5
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,
[
6
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.
Ho
w
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th
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f
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[
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[
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Fu
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[
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2.
M
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2
.
1
.
De
s
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T
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ch
d
e
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in
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q
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p
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–
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t
d
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g
n
w
ith
a
co
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tr
o
l
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v
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ti
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d
co
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t
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ag
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5
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2
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2
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co
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in
wo
m
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m
en
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p
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s
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,
to
ta
lin
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1
2
1
.
U
s
in
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Slo
v
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m
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a
s
am
p
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f
9
3
r
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as
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o
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m
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2
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3
.
Sa
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p
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u
ch
a
s
a
g
e
an
d
h
ea
l
th
s
ta
tu
s
,
wh
i
ch
ca
n
in
f
l
u
en
c
e
in
co
n
t
in
e
n
ce
.
Sec
o
n
d
,
th
e
Af
ig
e
l
t
h
er
a
p
y
s
t
an
d
ar
d
o
p
er
a
t
in
g
p
r
o
c
ed
u
r
e
s
(
S
O
P
)
o
u
t
lin
ed
th
e
A
f
ig
el
ad
m
in
i
s
tr
at
io
n
p
r
o
ce
d
u
r
e,
in
clu
d
in
g
d
o
s
ag
e
an
d
tr
ea
tm
e
n
t
t
im
e,
en
s
u
r
in
g
co
n
s
i
s
ten
cy
in
t
h
er
ap
y
ap
p
l
ic
at
io
n
.
T
h
ir
d
,
t
h
e
o
b
s
e
r
v
at
io
n
s
h
e
et
w
as
u
s
ed
to
r
ec
o
r
d
o
b
s
er
v
at
io
n
s
r
e
la
ted
to
A
f
ig
el
u
s
e
b
y
r
es
p
o
n
d
en
t
s
in
th
e
in
t
er
v
en
t
i
o
n
g
r
o
u
p
,
em
p
h
a
s
iz
in
g
ad
h
e
r
en
ce
to
p
r
o
c
ed
u
r
e
s
an
d
p
o
t
en
t
ia
l
s
id
e
ef
f
ec
t
s
.
Fin
al
ly
,
th
e
q
u
e
s
t
io
n
n
a
ir
e
f
o
r
u
r
in
ar
y
in
co
n
t
in
en
ce
d
iag
n
o
s
i
s
(
QUI
D)
wa
s
u
s
ed
to
ev
alu
at
e
th
e
s
ev
er
ity
an
d
f
r
eq
u
en
cy
o
f
u
r
in
ar
y
in
co
n
tin
en
ce
.
T
h
i
s
q
u
e
s
tio
n
n
a
ir
e
h
a
s
b
ee
n
t
es
te
d
f
o
r
v
al
id
ity
an
d
r
el
iab
il
ity
,
m
ak
in
g
i
t
an
ap
p
r
o
p
r
i
at
e
to
o
l
f
o
r
th
is
r
e
s
ea
r
ch
co
n
tex
t.
2
.
5
.
Re
s
e
a
rc
h
p
ro
ce
d
ur
e
s
T
h
i
s
s
tu
d
y
wa
s
d
e
s
ig
n
ed
to
e
v
alu
at
e
th
e
e
f
f
e
ct
iv
en
e
s
s
o
f
A
f
ig
e
l
in
t
r
ea
t
in
g
u
r
in
ar
y
in
co
n
tin
en
c
e
in
r
es
p
o
n
d
en
t
s
.
T
h
e
f
i
r
s
t
p
h
as
e
wa
s
p
r
e
p
ar
at
io
n
,
in
wh
ich
s
tu
d
y
s
taf
f
wer
e
t
r
a
in
ed
in
th
e
u
s
e
o
f
Af
ig
e
l
an
d
th
e
ad
m
in
i
s
t
r
a
tio
n
o
f
th
e
QUI
D
q
u
es
t
io
n
n
a
ir
e
.
Nex
t,
in
th
e
p
r
e
-
te
s
t
p
h
a
s
e,
a
ll
r
e
s
p
o
n
d
en
t
s
f
r
o
m
b
o
th
in
t
er
v
en
t
io
n
an
d
c
o
n
tr
o
l
g
r
o
u
p
s
u
n
d
er
wen
t
a
b
a
s
e
lin
e
a
s
s
e
s
s
m
en
t
u
s
in
g
th
e
Q
UI
D
q
u
es
t
io
n
n
a
ir
e
to
d
ete
r
m
i
n
e
th
e
ir
b
a
s
e
lin
e
l
ev
e
l
o
f
in
co
n
t
in
en
ce
.
Du
r
i
n
g
th
e
in
t
er
v
e
n
t
io
n
p
h
as
e,
t
h
e
tr
e
at
m
en
t
g
r
o
u
p
w
il
l
c
o
n
s
u
m
e
Af
ig
el
ac
co
r
d
in
g
to
es
tab
li
s
h
ed
SO
P
s
.
T
h
e
s
tu
d
y
r
eq
u
ir
es
r
e
s
p
o
n
d
en
t
s
t
o
r
ec
o
r
d
th
e
ir
Af
ig
el
u
s
e
an
d
an
y
c
h
an
g
es
th
ey
ex
p
er
ien
ce
o
v
er
a
s
p
e
cif
ic
p
er
io
d
.
F
in
a
ll
y
,
d
u
r
in
g
th
e
p
o
s
t
-
te
s
t,
b
o
th
g
r
o
u
p
s
wi
ll
b
e
r
ea
s
s
e
s
s
ed
u
s
in
g
th
e
QUI
D
q
u
e
s
t
io
n
n
a
ir
e
to
m
ea
s
u
r
e
ch
an
g
e
s
af
t
er
th
e
in
ter
v
en
tio
n
,
th
u
s
p
r
o
v
id
in
g
in
s
ig
h
t
in
to
Af
ig
e
l
's
ef
f
ec
tiv
e
n
es
s
in
a
d
d
r
e
s
s
i
n
g
th
e
r
e
s
e
ar
ch
p
r
o
b
l
em
.
2
.
6
.
I
nte
rv
e
nt
io
n
d
u
ra
t
io
n
T
h
e
Af
ig
e
l
in
ter
v
en
t
io
n
w
a
s
a
d
m
in
is
te
r
ed
o
v
er
s
ix
m
o
n
th
s
(
Ap
r
i
l
to
Oc
to
b
er
2
0
2
5
)
.
P
ar
t
i
cip
a
n
t
s
in
th
e
in
t
er
v
en
ti
o
n
g
r
o
u
p
(
n
=
3
1
)
co
n
s
u
m
ed
Af
ig
e
l
d
a
il
y
ac
co
r
d
in
g
to
e
s
t
ab
li
s
h
e
d
s
t
an
d
a
r
d
o
p
er
at
in
g
p
r
o
ce
d
u
r
e
s
.
T
h
e
d
o
s
a
g
e
an
d
ad
m
in
is
tr
at
io
n
t
im
e
w
er
e
s
t
an
d
a
r
d
i
ze
d
a
cr
o
s
s
a
l
l
p
ar
t
i
cip
a
n
t
s
to
en
s
u
r
e
tr
e
atm
en
t
co
n
s
i
s
t
en
cy
.
2
.
7
.
F
o
l
lo
w
-
up
Fo
l
lo
w
-
u
p
as
s
es
s
m
en
ts
w
er
e
co
n
d
u
c
ted
at
t
wo
t
im
e
p
o
in
t
s
:
b
as
el
in
e
(
p
r
e
-
te
s
t)
an
d
p
o
s
t
-
in
ter
v
en
t
io
n
(
p
o
s
t
-
te
s
t
)
.
T
h
e
Q
UI
D
q
u
e
s
t
i
o
n
n
air
e
wa
s
ad
m
in
i
s
t
er
ed
a
t
b
o
th
t
im
e
p
o
in
t
s
to
e
v
al
u
a
te
ch
an
g
e
s
in
u
r
in
ar
y
in
co
n
tin
en
c
e
s
ev
er
i
ty
an
d
f
r
eq
u
en
cy
.
B
o
th
th
e
in
t
er
v
e
n
tio
n
an
d
co
n
t
r
o
l
g
r
o
u
p
s
u
n
d
er
w
en
t
id
en
t
ic
al
as
s
es
s
m
en
t p
r
o
to
co
l
s
to
m
ain
t
ain
m
e
th
o
d
o
l
o
g
i
ca
l r
ig
o
r
.
2
.
8
.
P
a
rt
ic
ip
a
n
t
a
dh
er
en
ce
Ad
h
er
en
c
e
m
o
n
ito
r
in
g
wa
s
i
m
p
le
m
en
ted
th
r
o
u
g
h
p
ar
t
ic
ip
an
t
s
e
lf
-
r
ep
o
r
tin
g
u
s
in
g
an
o
b
s
e
r
v
a
tio
n
s
h
e
et
,
in
wh
ich
r
es
p
o
n
d
en
t
s
d
o
cu
m
en
ted
th
eir
d
ai
ly
Af
ig
el
co
n
s
u
m
p
t
io
n
an
d
an
y
ch
a
n
g
es
o
r
s
id
e
ef
f
ec
t
s
ex
p
er
ien
ce
d
.
T
h
is
ap
p
r
o
ac
h
al
ig
n
s
wi
th
es
tab
l
is
h
ed
m
e
th
o
d
s
f
o
r
m
o
n
ito
r
in
g
m
ed
ic
at
io
n
ad
h
er
en
ce
in
b
eh
av
io
r
a
l
in
ter
v
en
tio
n
s
.
Ad
h
er
en
ce
r
a
te
s
wer
e
ca
lcu
la
t
ed
a
s
th
e
p
er
c
en
t
ag
e
o
f
th
e
p
r
e
s
cr
ib
ed
d
o
s
e
co
n
s
u
m
ed
r
e
la
tiv
e
to
th
e
to
ta
l
ex
p
e
ct
ed
d
o
s
e
d
u
r
in
g
th
e
in
t
er
v
en
tio
n
p
e
r
io
d
.
Par
ti
cip
an
ts
wh
o
d
em
o
n
s
tr
a
te
d
ad
h
er
en
ce
l
e
s
s
th
an
8
0
%
w
er
e
r
ec
o
r
d
ed
f
o
r
s
en
s
it
iv
ity
an
al
y
s
i
s
to
a
s
s
e
s
s
th
e
i
m
p
ac
t
o
f
ad
h
er
en
c
e
o
n
tr
e
atm
en
t
o
u
t
co
m
es
.
2
.
9
.
Da
t
a
a
na
ly
s
i
s
Da
ta
an
a
ly
s
i
s
wa
s
p
er
f
o
r
m
ed
u
s
in
g
d
ep
en
d
en
t
an
d
in
d
ep
e
n
d
en
t
t
-
te
s
ts
.
T
h
e
d
e
p
en
d
en
t
t
-
t
e
s
t
wa
s
u
s
ed
to
co
m
p
ar
e
d
if
f
er
en
ce
s
in
s
tr
e
s
s
in
co
n
t
in
en
ce
l
ev
el
s
b
e
f
o
r
e
an
d
af
t
er
Af
ig
el
tr
e
at
m
en
t
in
th
e
in
t
er
v
en
t
io
n
g
r
o
u
p
.
On
th
e
o
th
er
h
an
d
,
th
e
in
d
ep
en
d
en
t
t
-
te
s
t
wa
s
u
s
ed
to
co
m
p
ar
e
u
r
i
n
ar
y
in
co
n
t
in
e
n
ce
lev
e
l
s
b
et
we
en
th
e
in
ter
v
en
t
io
n
an
d
co
n
t
r
o
l
g
r
o
u
p
s
af
t
er
tr
e
atm
en
t
.
T
h
e
d
a
ta
o
b
ta
in
ed
w
il
l
b
e
an
aly
ze
d
u
s
in
g
ap
p
r
o
p
r
ia
te
s
ta
ti
s
ti
ca
l
s
o
f
tw
ar
e
to
o
b
t
ain
v
a
lid
r
e
s
u
lt
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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lth
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2252
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8
8
0
6
E
ffective
n
ess
o
f A
fig
el
th
era
p
y
in
r
ed
u
cin
g
u
r
in
a
r
y
in
co
n
tin
e
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ce
a
mo
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g
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r
eme
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o
p
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s
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l
…
(
S
iti F
a
to
n
a
h
)
461
3.
RE
SU
L
T
S
T
ab
le
1
s
h
o
ws th
at
th
e
av
er
a
g
e
ag
e
o
f
r
esp
o
n
d
e
n
ts
was 4
7
.
1
0
y
ea
r
s
,
with
a
m
in
im
u
m
v
alu
e
o
f
4
1
an
d
a
m
ax
im
u
m
o
f
5
3
y
ea
r
s
,
in
d
icatin
g
a
m
id
d
le
-
ag
e
d
g
r
o
u
p
.
T
h
e
f
r
eq
u
e
n
cy
o
f
ch
ild
b
ir
th
s
h
o
wed
an
av
er
a
g
e
o
f
3
.
4
0
,
in
d
icatin
g
a
f
air
l
y
d
iv
e
r
s
e
b
ir
th
ex
p
er
ien
ce
am
o
n
g
r
e
s
p
o
n
d
en
ts
.
I
n
th
e
an
aly
s
is
o
f
th
e
d
is
tr
ib
u
tio
n
o
f
in
co
n
tin
en
ce
,
th
e
co
n
tr
o
l
g
r
o
u
p
s
h
o
wed
a
n
in
c
o
n
tin
en
c
e
r
ate
b
e
f
o
r
e
Af
ig
el
o
f
6
.
1
8
,
af
ter
wh
ich
th
e
in
co
n
tin
en
ce
r
ate
in
cr
ea
s
ed
t
o
6
.
3
0
,
wh
ile
in
th
e
in
ter
v
e
n
tio
n
g
r
o
u
p
,
th
er
e
was
a
s
ig
n
if
ican
t
d
ec
r
ea
s
e
f
r
o
m
1
.
5
3
b
ef
o
r
e
Af
ig
el.
Fin
ally
,
t
h
e
d
is
tr
ib
u
tio
n
o
f
in
co
n
tin
en
c
e
ty
p
es
s
h
o
wed
th
at
u
r
g
e
i
n
c
o
n
tin
en
ce
was
th
e
m
o
s
t
co
m
m
o
n
,
o
cc
u
r
r
i
n
g
in
4
7
%
o
f
r
esp
o
n
d
e
n
ts
.
T
h
ese
d
at
a
ca
n
b
e
u
s
ed
t
o
b
etter
u
n
d
er
s
tan
d
th
e
r
elatio
n
s
h
i
p
b
etwe
en
th
e
Af
ig
el
in
ter
v
en
tio
n
an
d
t
h
e
im
p
r
o
v
em
en
t
o
f
em
e
r
g
en
cy
i
n
co
n
tin
e
n
ce
co
n
d
itio
n
s
.
T
ab
l
e
2
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at
co
n
s
i
s
t
en
t
p
e
lv
ic
f
lo
o
r
ex
er
c
i
s
e
s
lead
t
o
s
ig
n
if
ic
an
t
r
ed
u
c
tio
n
s
in
u
r
in
ar
y
le
ak
ag
e
a
n
d
ca
n
ef
f
ec
ti
v
e
ly
en
h
an
ce
p
e
lv
i
c
m
u
s
cl
e
s
tr
en
g
th
,
wh
i
ch
i
s
cr
u
cia
l
f
o
r
m
an
ag
in
g
in
co
n
t
in
en
ce
[
1
5
]
,
[
1
8
]
.
T
h
e
ef
f
e
ct
iv
e
n
e
s
s
o
f
A
f
ig
el
ca
n
al
s
o
b
e
co
m
p
ar
e
d
to
es
ta
b
li
s
h
ed
th
er
ap
eu
ti
c
ap
p
r
o
ac
h
es
s
u
ch
a
s
ele
ct
r
o
m
y
o
g
r
ap
h
i
c
b
i
o
f
e
ed
b
a
ck
,
wh
ich
h
a
s
s
h
o
wn
s
ig
n
if
i
c
an
t
im
p
r
o
v
em
en
t
in
p
e
lv
i
c
f
l
o
o
r
m
u
s
cl
e
s
tr
en
g
th
an
d
p
at
ie
n
t
-
r
ep
o
r
ted
o
u
tco
m
e
s
r
e
la
ted
to
th
e
s
ev
er
it
y
o
f
u
r
in
ar
y
in
co
n
t
in
en
ce
[
1
7
]
,
[
1
9
]
.
T
h
e
s
e
th
er
ap
i
e
s
f
o
cu
s
o
n
en
h
an
c
in
g
th
e
p
h
y
s
io
lo
g
ic
al
m
ec
h
an
i
s
m
s
in
v
o
lv
ed
in
u
r
in
ar
y
co
n
tr
o
l
.
T
h
e
f
i
n
d
in
g
s
p
r
e
s
en
t
ed
in
th
i
s
s
tu
d
y
s
u
g
g
e
s
t
th
a
t
Af
ig
el
m
ay
s
h
ar
e
m
ec
h
a
n
i
s
m
s
s
im
i
l
ar
to
th
o
s
e
s
ee
n
w
ith
P
FM
T
a
n
d
b
io
f
ee
d
b
ac
k
,
a
s
b
o
th
aim
to
s
tr
en
g
th
en
th
e
p
elv
ic
f
lo
o
r
an
d
r
eh
ab
i
l
ita
te
m
u
s
cl
e
f
u
n
ct
io
n
,
l
ea
d
in
g
to
im
p
r
o
v
ed
b
lad
d
er
|
co
n
tr
o
l
[
1
7
]
,
[
2
0
]
.
Mo
r
eo
v
er
,
co
n
s
id
er
in
g
th
e
i
m
p
li
ca
ti
o
n
s
o
f
l
if
e
s
ty
l
e
f
ac
to
r
s
s
u
ch
a
s
o
b
e
s
i
ty
an
d
p
h
y
s
i
ca
l
a
ct
iv
i
ty
,
wh
i
ch
ar
e
r
e
co
g
n
iz
ed
as
c
o
n
tr
ib
u
t
in
g
e
lem
en
t
s
to
u
r
in
ar
y
in
co
n
t
in
en
ce
,
Af
ig
el
ad
m
in
i
s
tr
a
tio
n
s
h
o
u
ld
id
e
al
ly
b
e
p
air
ed
w
ith
lif
e
s
ty
le
m
o
d
if
i
ca
tio
n
s
f
o
r
o
p
ti
m
a
l
o
u
tco
m
es
[
1
4
]
.
E
n
g
a
g
in
g
i
n
we
ig
h
t
m
an
a
g
em
en
t
an
d
p
h
y
s
ica
l
ex
er
ci
s
e
s
h
a
s
b
e
en
s
h
o
wn
to
p
r
o
v
id
e
ad
d
it
io
n
a
l
b
en
ef
it
s
,
s
u
p
p
o
r
t
in
g
b
lad
d
er
h
e
al
th
an
d
im
p
r
o
v
in
g
o
v
er
a
ll
we
lln
es
s
[
2
1
]
,
[
2
2
]
.
T
h
i
s
m
u
l
tif
ac
et
ed
ap
p
r
o
ac
h
co
u
ld
s
ig
n
if
ican
t
ly
en
h
an
ce
th
e
ef
f
ica
cy
o
f
tr
e
atm
en
t
s
l
ik
e
Af
ig
e
l.
Acc
o
r
d
in
g
to
th
e
d
at
a
p
r
e
s
en
ted
,
th
e
co
n
tr
o
l
g
r
o
u
p
ex
h
ib
it
ed
m
in
i
m
a
l
ch
a
n
g
e
in
u
r
i
n
ar
y
in
co
n
tin
en
c
e
s
co
r
e
s
,
wi
th
a
m
ea
n
s
co
r
e
d
e
cr
e
as
e
f
r
o
m
6
.
3
0
(
SD
=
1
.
7
4
)
to
6
.
1
8
(
S
D
=
1
.
6
6
)
p
o
s
t
-
in
t
er
v
en
t
io
n
,
l
ea
d
in
g
to
a
p
-
v
alu
e
o
f
0
.
2
1
,
in
d
ica
t
in
g
th
at
th
e
r
e
s
u
l
t
s
wer
e
n
o
t
s
t
at
i
s
t
ic
al
ly
s
ig
n
if
ican
t.
C
o
n
v
er
s
e
ly
,
th
e
i
n
t
er
v
en
ti
o
n
g
r
o
u
p
d
e
m
o
n
s
tr
at
ed
a
s
u
b
s
t
an
ti
al
r
ed
u
ct
io
n
in
u
r
in
ar
y
in
co
n
t
i
n
en
ce
,
wi
th
s
co
r
e
s
d
ec
r
e
a
s
in
g
f
r
o
m
6
.
3
0
(
S
D
=
1
.
5
3
)
t
o
1
.
5
3
(
S
D
=
1
.
8
7
)
,
d
e
m
o
n
s
tr
a
t
in
g
a
s
ig
n
if
i
ca
n
t
p
-
v
alu
e
o
f
0
.
0
0
0
.
T
h
i
s
s
t
ar
k
co
n
t
r
a
s
t
s
u
g
g
e
s
t
s
th
at
Af
ig
e
l h
a
s
a
p
r
o
f
o
u
n
d
ef
f
e
ct
o
n
al
lev
ia
tin
g
u
r
i
n
ar
y
in
c
o
n
t
in
en
ce
s
y
m
p
to
m
s
.
T
h
e
f
in
d
i
n
g
s
a
li
g
n
wit
h
e
x
is
t
in
g
l
ite
r
a
tu
r
e
t
h
at
s
u
p
p
o
r
ts
v
a
r
i
o
u
s
in
te
r
v
e
n
ti
o
n
s
,
in
c
lu
d
i
n
g
p
h
a
r
m
ac
o
l
o
g
ic
al
tr
ea
t
m
e
n
ts
a
n
d
p
e
lv
ic
f
l
o
o
r
m
u
s
cl
e
t
r
a
in
in
g
,
in
a
d
d
r
ess
i
n
g
u
r
i
n
a
r
y
i
n
c
o
n
ti
n
en
ce
.
F
o
r
e
x
am
p
l
e,
s
tu
d
ies
h
a
v
e
s
h
o
w
n
t
h
at
p
el
v
i
c
f
l
o
o
r
m
u
s
cl
e
e
x
e
r
cis
e
ca
n
l
ea
d
t
o
s
i
g
n
if
i
ca
n
t
i
m
p
r
o
v
e
m
e
n
ts
in
i
n
c
o
n
ti
n
en
ce
co
n
d
iti
o
n
s
a
m
o
n
g
w
o
m
e
n
[
1
]
,
[
1
7
]
,
[
2
3
]
.
T
h
e
r
es
u
lts
f
r
o
m
t
h
is
s
t
u
d
y
in
d
i
ca
t
e
t
h
at
Af
ig
el
m
a
y
s
e
r
v
e
a
s
i
m
i
la
r
r
o
le
,
p
o
te
n
t
ial
ly
f
u
n
cti
o
n
i
n
g
as
a
n
ec
ess
a
r
y
a
d
j
u
n
c
t
o
r
alt
er
n
a
t
iv
e
t
o
c
u
r
r
en
t t
h
er
ap
e
u
ti
c
s
t
r
a
te
g
ies
.
T
h
e
r
e
s
u
lt
s
f
r
o
m
T
ab
le
3
f
u
r
t
h
er
co
r
r
o
b
o
r
a
te
th
e
s
ig
n
if
ican
t
im
p
ac
t
Af
ig
e
l
h
ad
o
n
r
ed
u
ci
n
g
u
r
in
ar
y
in
co
n
tin
en
c
e
wh
en
co
m
p
ar
e
d
to
th
e
co
n
tr
o
l
g
r
o
u
p
.
W
i
th
a
m
ea
n
s
co
r
e
o
f
1
.
5
3
(
S
D
=
1
.
8
7
)
p
o
s
t
-
tr
e
at
m
en
t
in
th
e
in
t
er
v
en
t
io
n
g
r
o
u
p
v
e
r
s
u
s
a
m
e
an
s
co
r
e
o
f
6
.
1
8
(
S
D
=
1
.
6
6
)
in
th
e
co
n
tr
o
l
g
r
o
u
p
,
th
e
s
t
at
i
s
t
ic
al
s
i
g
n
if
ic
an
c
e
(
p
-
v
alu
e
=
0
.
0
0
0
)
d
em
o
n
s
tr
a
te
s
a
lev
e
l
o
f
ef
f
ec
tiv
en
e
s
s
th
a
t
w
ar
r
an
t
s
cl
in
ica
l
co
n
s
id
er
a
tio
n
.
Su
ch
d
at
a
r
ef
le
ct
an
es
s
en
t
ia
l
cr
i
ter
io
n
f
o
r
e
v
a
lu
a
tin
g
tr
e
atm
en
t
ef
f
i
ca
cy
in
c
lin
ic
al
s
e
tt
in
g
s
,
e
m
p
h
a
s
iz
in
g
th
e
n
ee
d
f
o
r
m
o
r
e
in
t
eg
r
a
t
iv
e
ap
p
r
o
ac
h
es
in
m
an
ag
in
g
u
r
in
ar
y
i
n
co
n
t
in
en
ce
[
2
4
]
,
[
2
5
]
.
Fu
r
th
er
m
o
r
e
,
m
u
ltip
le
s
tu
d
ies
ex
p
lo
r
e
t
h
e
ef
f
icac
y
o
f
co
n
s
er
v
ativ
e
tr
ea
tm
e
n
ts
,
s
u
ch
as
PF
MT
an
d
b
io
f
ee
d
b
ac
k
s
y
s
tem
s
.
Fo
r
in
s
tan
ce
,
L
i
et
a
l
.
[
2
6
]
p
er
f
o
r
m
ed
a
s
y
s
tem
atic
r
ev
iew
an
d
m
eta
-
an
aly
s
is
,
in
d
icatin
g
v
ar
y
in
g
r
esu
lts
f
o
r
d
if
f
er
en
t
c
o
n
s
er
v
ativ
e
in
ter
v
e
n
tio
n
s
an
d
f
o
u
n
d
elec
tr
ical
s
tim
u
latio
n
to
b
e
o
n
e
o
f
th
e
m
o
r
e
ef
f
ec
tiv
e
tr
ea
tm
en
ts
f
o
r
im
p
r
o
v
in
g
u
r
in
ar
y
i
n
co
n
tin
e
n
ce
s
co
r
es.
W
an
g
et
a
l
.
[
2
7
]
also
u
n
d
er
s
co
r
e
th
at
wh
ile
PF
MT
is
r
ec
o
m
m
en
d
ed
as
a
f
ir
s
t
-
lin
e
tr
ea
tm
en
t,
f
u
r
th
er
ev
i
d
en
ce
is
n
ee
d
ed
co
n
ce
r
n
in
g
ad
ju
n
ctiv
e
m
eth
o
d
s
,
in
d
icatin
g
t
h
at
th
e
in
teg
r
atio
n
o
f
tech
n
o
lo
g
ies
lik
e
b
io
f
e
ed
b
ac
k
m
ay
n
o
t
u
n
iv
er
s
ally
en
h
an
ce
o
u
tco
m
es.
L
astl
y
,
wh
ile
ad
v
an
ce
m
en
ts
in
d
ig
ital h
ea
lth
tech
n
o
lo
g
ies co
m
b
in
in
g
PF
MT
with
m
o
tio
n
-
b
ased
th
er
ap
ies m
ay
s
u
g
g
est
im
p
r
o
v
e
d
s
y
m
p
to
m
r
elief
an
d
q
u
ality
o
f
life
,
t
h
e
s
p
ec
if
ic
claim
s
ab
o
u
t
th
e
o
u
tco
m
es
o
f
n
o
v
el
m
u
ltifa
ce
ted
s
tr
ateg
ies n
ee
d
s
u
b
s
tan
tiatio
n
th
at
alig
n
s
with
r
ig
o
r
o
u
s
clin
ical
r
esear
ch
[
2
8
]
.
Mo
r
eo
v
er
,
th
e
im
p
l
ic
at
io
n
s
o
f
th
is
s
tu
d
y
ar
e
p
er
tin
en
t
co
n
s
i
d
er
in
g
th
e
r
i
s
in
g
p
r
ev
a
len
ce
o
f
u
r
in
ar
y
in
co
n
tin
en
c
e,
wh
i
ch
is
in
f
lu
e
n
ce
d
b
y
n
u
m
er
o
u
s
f
ac
to
r
s
in
clu
d
in
g
ag
e,
o
b
e
s
i
ty
,
an
d
ch
i
ld
b
ir
th
[
1
4
]
,
[
2
9
]
,
[
3
0
]
.
T
h
e
p
r
o
n
o
u
n
c
ed
i
m
p
r
o
v
em
en
t
n
o
ted
in
th
e
in
t
er
v
en
ti
o
n
g
r
o
u
p
in
d
i
ca
te
s
a
p
o
te
n
t
ia
l
to
i
m
p
r
o
v
e
q
u
a
li
ty
o
f
l
if
e
f
o
r
in
d
i
v
id
u
al
s
s
u
f
f
er
in
g
f
r
o
m
th
i
s
co
n
d
it
io
n
,
s
u
p
p
o
r
t
in
g
f
u
r
th
e
r
r
e
s
ea
r
ch
in
th
i
s
d
o
m
ain
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J Pu
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Sci
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N:
2252
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8
8
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6
E
ffective
n
ess
o
f A
fig
el
th
era
p
y
in
r
ed
u
cin
g
u
r
in
a
r
y
in
co
n
tin
e
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ce
a
mo
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g
p
r
eme
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o
p
a
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…
(
S
iti F
a
to
n
a
h
)
463
T
h
e
s
ig
n
if
i
ca
n
t
f
in
d
in
g
s
f
r
o
m
th
i
s
s
tu
d
y
s
u
g
g
e
s
t
th
at
A
f
ig
e
l
m
ay
b
e
an
ef
f
e
ct
iv
e
tr
e
atm
e
n
t
o
p
t
io
n
f
o
r
u
r
in
ar
y
in
co
n
tin
en
ce
,
p
ar
ti
cu
la
r
ly
f
o
r
in
d
iv
id
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a
ls
wh
o
h
a
v
e
n
o
t
f
o
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n
d
r
el
ie
f
th
r
o
u
g
h
tr
a
d
it
io
n
a
l
th
er
a
p
i
es
.
Fu
t
u
r
e
s
tu
d
ie
s
s
h
o
u
ld
co
n
s
id
e
r
lo
n
g
er
f
o
l
lo
w
-
u
p
p
er
io
d
s
to
as
s
es
s
th
e
s
u
s
ta
in
ab
il
i
ty
o
f
Af
ig
e
l
's
ef
f
ec
ts
wh
i
le
al
s
o
ex
p
lo
r
in
g
i
t
s
ef
f
ec
tiv
en
e
s
s
ac
r
o
s
s
d
if
f
er
en
t
d
em
o
g
r
ap
h
ic
g
r
o
u
p
s
an
d
ty
p
e
s
o
f
in
co
n
tin
en
c
e
[
3
1
]
,
[
3
2
]
.
T
h
e
in
clu
s
io
n
o
f
lar
g
er
s
am
p
le
s
i
ze
s
an
d
v
ar
ied
m
eth
o
d
o
lo
g
i
e
s
m
ay
al
s
o
en
h
an
c
e
t
h
e
r
o
b
u
s
tn
e
s
s
an
d
g
en
er
al
iz
ab
i
li
ty
o
f
th
e
f
in
d
in
g
s
.
A
s
y
s
te
m
a
ti
c
r
ev
ie
w
i
n
d
i
ca
te
s
t
h
a
t
v
ar
io
u
s
t
r
ea
tm
en
t
m
o
d
al
it
ie
s
,
in
c
lu
d
in
g
co
n
s
er
v
a
ti
v
e
m
e
th
o
d
s
s
u
ch
a
s
p
elv
ic
f
lo
o
r
m
u
s
cl
e
tr
ain
in
g
an
d
a
cu
p
u
n
ctu
r
e,
h
av
e
s
h
o
wn
ef
f
ic
ac
y
a
cr
o
s
s
d
em
o
g
r
ap
h
i
c
g
r
o
u
p
s
[
3
3
]
.
No
t
ab
ly
,
ex
t
en
d
ed
f
o
l
lo
w
-
u
p
p
er
io
d
s
ar
e
cr
u
c
ia
l
f
o
r
ev
al
u
at
in
g
th
e
s
u
s
ta
in
ab
il
it
y
o
f
u
r
in
ar
y
in
co
n
t
in
en
ce
tr
e
atm
en
t
s
,
a
s
ex
i
s
tin
g
li
te
r
a
t
u
r
e
h
ig
h
lig
h
t
s
th
e
n
ec
e
s
s
i
ty
o
f
lo
n
g
-
ter
m
as
s
e
s
s
m
en
t
r
eg
ar
d
in
g
th
e
ir
ef
f
ec
t
s
[
3
4
]
,
[
3
5
]
.
Fu
r
th
er
m
o
r
e,
ex
p
a
n
d
in
g
s
a
m
p
l
e
s
i
ze
s
an
d
e
m
p
l
o
y
in
g
d
iv
er
s
e
m
eth
o
d
o
lo
g
ie
s
wo
u
ld
s
ig
n
if
ican
t
ly
en
h
an
c
e
th
e
r
e
li
ab
i
li
ty
an
d
ap
p
li
ca
b
il
it
y
o
f
f
in
d
in
g
s
in
u
r
in
a
r
y
in
co
n
t
in
en
ce
r
e
s
e
ar
ch
[
3
6
]
.
T
h
e
s
in
g
le
-
s
it
e
d
e
s
ig
n
co
n
d
u
cted
ex
c
lu
s
iv
el
y
in
B
a
g
e
len
Vi
ll
ag
e,
P
es
aw
ar
an
R
eg
en
cy
,
lim
it
s
th
e
g
en
er
al
iz
ab
i
li
ty
o
f
f
in
d
i
n
g
s
to
b
r
o
ad
er
I
n
d
o
n
e
s
i
an
p
o
p
u
la
tio
n
s
o
r
o
th
er
lo
w
-
r
e
s
o
u
r
ce
s
e
tt
i
n
g
s
.
De
s
p
it
e
th
es
e
lim
i
ta
tio
n
s
,
th
e
f
in
d
in
g
s
ca
r
r
y
s
ig
n
if
ic
an
t
p
r
ac
ti
ca
l
im
p
l
ic
at
io
n
s
f
o
r
u
r
in
ar
y
in
co
n
t
in
en
ce
m
an
ag
e
m
en
t
in
r
es
o
u
r
c
e
-
l
im
it
ed
s
et
t
in
g
s
.
T
h
e
s
u
b
s
t
an
t
ia
l
r
ed
u
c
tio
n
in
Q
UI
D
s
co
r
e
s
(
f
r
o
m
6
.
3
0
to
1
.
5
3
)
in
th
e
in
ter
v
en
t
io
n
g
r
o
u
p
s
u
g
g
e
s
t
s
Af
i
g
e
l
m
ay
s
e
r
v
e
a
s
an
ac
ce
s
s
ib
l
e
a
l
ter
n
at
iv
e
w
h
er
e
s
p
e
ci
al
iz
ed
p
elv
ic
f
lo
o
r
m
u
s
c
le
tr
ain
in
g
p
r
o
g
r
am
s
ar
e
u
n
av
a
i
lab
le.
T
h
i
s
is
p
ar
ti
cu
l
ar
ly
r
e
lev
an
t
g
iv
e
n
th
a
t
co
n
s
er
v
a
t
iv
e
tr
e
at
m
en
t
s
lik
e
PF
MT
r
eq
u
ir
e
tr
a
in
ed
h
ea
lth
ca
r
e
p
r
o
v
id
er
s
,
wh
o
ar
e
s
ca
r
ce
in
r
u
r
al
I
n
d
o
n
es
ian
co
n
t
ex
t
s
.
T
h
e
in
ter
v
en
t
i
o
n
'
s
ap
p
li
ca
b
il
ity
to
p
r
em
en
o
p
au
s
a
l
wo
m
en
ad
d
r
es
s
es
an
u
n
d
e
r
s
tu
d
ied
p
o
p
u
la
tio
n
,
a
s
m
o
s
t
ex
i
s
t
in
g
r
e
s
ea
r
ch
f
o
cu
s
e
s
o
n
p
o
s
tm
en
o
p
au
s
a
l
wo
m
e
n
.
5.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
d
em
o
n
s
tr
ated
t
h
a
t
Af
ig
el
ef
f
ec
tiv
ely
r
ed
u
ce
d
u
r
in
ar
y
i
n
co
n
tin
e
n
ce
s
y
m
p
to
m
s
in
th
e
in
ter
v
en
tio
n
g
r
o
u
p
co
m
p
ar
ed
to
th
e
c
o
n
tr
o
l
g
r
o
u
p
,
wh
ich
s
h
o
wed
m
i
n
im
al
ch
a
n
g
es.
T
h
e
h
ig
h
ly
s
tatis
tically
s
ig
n
if
ican
t
d
if
f
er
en
ce
b
etwe
en
th
e
two
g
r
o
u
p
s
co
n
f
ir
m
e
d
Af
ig
el'
s
ef
f
ec
tiv
en
ess
as
a
th
er
ap
eu
tic
in
ter
v
en
tio
n
.
T
h
e
d
em
o
g
r
a
p
h
ic
p
r
o
f
ile
o
f
th
e
r
esp
o
n
d
en
ts
,
p
r
ed
o
m
in
an
tly
m
id
d
le
-
a
g
ed
w
o
m
en
with
v
ar
io
u
s
ty
p
es
o
f
in
co
n
tin
en
ce
(
SUI
,
UUI
,
an
d
m
ix
ed
)
,
co
n
f
ir
m
s
th
e
clin
ical
r
elev
an
ce
o
f
th
is
in
ter
v
en
tio
n
in
im
p
r
o
v
in
g
th
e
q
u
ality
o
f
life
o
f
p
eo
p
le
wit
h
u
r
in
ar
y
in
co
n
tin
e
n
ce
.
T
h
es
e
f
in
d
in
g
s
alig
n
with
th
e
liter
atu
r
e
s
h
o
win
g
th
at
p
elv
ic
f
lo
o
r
m
u
s
cle
s
tr
en
g
th
en
in
g
tech
n
iq
u
es a
n
d
s
im
ilar
in
te
r
v
en
tio
n
s
ca
n
p
r
o
d
u
ce
s
ig
n
if
ic
an
t im
p
r
o
v
em
en
ts
.
Fu
tu
r
e
r
esear
ch
r
ec
o
m
m
e
n
d
s
lo
n
g
er
-
ter
m
f
o
llo
w
-
u
p
an
d
co
m
p
ar
is
o
n
s
ac
r
o
s
s
p
o
p
u
lat
io
n
s
an
d
ty
p
es
o
f
in
co
n
tin
en
ce
t
o
en
s
u
r
e
t
h
e
s
u
s
tain
ab
ilit
y
an
d
g
en
er
aliza
b
ilit
y
o
f
Af
ig
el'
s
ef
f
ec
ts
to
a
b
r
o
ad
e
r
p
o
p
u
latio
n
.
ACK
NO
WL
E
DG
M
E
N
T
S
W
e
wo
u
ld
lik
e
to
th
an
k
th
e
Dir
ec
to
r
o
f
th
e
T
an
j
u
n
g
k
ar
an
g
Hea
lth
Po
ly
tech
n
ic
an
d
th
e
C
en
ter
f
o
r
R
esear
ch
an
d
C
o
m
m
u
n
ity
Ser
v
ice
f
o
r
p
r
o
v
id
in
g
r
esear
ch
f
u
n
d
in
g
.
W
e
wo
u
ld
also
lik
e
to
th
an
k
th
e
Hea
d
o
f
B
ag
elen
Pes
awa
r
an
Villag
e
a
n
d
h
is
s
taf
f
f
o
r
th
eir
p
er
m
is
s
io
n
to
u
s
e
th
eir
v
illag
e
as
a
r
esear
ch
lo
ca
tio
n
.
W
e
wo
u
ld
also
lik
e
to
th
an
k
th
e
p
r
em
en
o
p
a
u
s
al
wo
m
en
in
th
e
B
ag
elen
Pes
awa
r
an
v
illag
e
ar
ea
wh
o
p
ar
ticip
ated
as r
esear
ch
r
esp
o
n
d
e
n
ts
an
d
a
g
r
ee
d
to
u
n
d
e
r
g
o
th
e
Af
ig
el
th
er
ap
y
s
er
ies f
r
o
m
s
tar
t to
f
in
is
h
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
T
h
is
r
esear
ch
was
f
u
n
d
e
d
b
y
t
h
e
Min
is
tr
y
o
f
Hea
lth
,
th
r
o
u
g
h
th
e
DI
PA
f
u
n
d
s
o
f
th
e
T
an
j
u
n
g
Ka
r
an
g
Min
is
tr
y
o
f
Hea
lth
Po
ly
tech
n
ic
with
th
e
n
u
m
b
er
HK.
1
1
2
.
3
.
0
2
/DI
PA/2
0
2
5
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
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M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Na
m
e
o
f
Aut
ho
r
C
M
So
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Vi
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Fu
Sit
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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
.
2
,
J
u
n
e
20
26
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