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K
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w
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d
s
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B
o
d
y
tem
p
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Gen
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al
an
esth
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Po
s
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an
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s
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iv
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R
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Sh
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T
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CC B
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C
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A
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R
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Priy
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Dep
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f
An
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I
n
s
titu
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f
T
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o
lo
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Scie
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an
d
Hea
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R
S d
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So
ep
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a
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Kesd
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V/B
R
W
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Ma
lan
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E
ast J
av
a,
I
n
d
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esia
E
m
ail:
r
ek
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@
its
k
-
s
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ao
en
.
a
c.
id
1.
I
NT
RO
D
UCT
I
O
N
Po
s
t
-
an
esth
etic
s
h
iv
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in
g
(
PA
S)
is
a
co
m
m
o
n
p
o
s
to
p
e
r
ativ
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co
m
p
licatio
n
t
h
at
o
cc
u
r
s
ac
r
o
s
s
a
wid
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r
an
g
e
o
f
s
u
r
g
ical
p
r
o
ce
d
u
r
es
a
n
d
a
n
esth
etic
tech
n
iq
u
es.
C
lin
ically
,
PAS
is
n
o
t
m
er
ely
a
s
o
u
r
ce
o
f
d
is
co
m
f
o
r
t
b
u
t
is
ass
o
ciate
d
with
i
n
cr
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ased
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x
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en
co
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s
u
m
p
tio
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,
elev
ated
ca
r
b
o
n
d
io
x
id
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p
r
o
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ctio
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,
m
etab
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s
is
,
an
d
h
eig
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ten
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d
c
ar
d
io
v
ascu
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wo
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k
lo
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d
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w
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ay
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m
p
r
o
m
is
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p
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s
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,
p
ar
ticu
lar
ly
in
v
u
ln
e
r
ab
le
p
at
ien
ts
[
1
]
-
[
4
]
.
As
a
r
esu
lt,
PA
S
is
in
cr
ea
s
in
g
ly
r
ec
o
g
n
ize
d
as
an
in
d
icato
r
o
f
in
ad
eq
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ate
p
er
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p
e
r
ativ
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th
er
m
al
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eg
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latio
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r
ath
er
t
h
an
a
b
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n
ig
n
p
o
s
to
p
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v
en
t.
Per
io
p
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h
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p
o
th
e
r
m
ia
r
e
m
ain
s
th
e
m
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s
t
co
n
s
is
ten
tly
r
ep
o
r
ted
tr
ig
g
er
o
f
PAS.
Hy
p
o
th
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m
ia
d
u
r
in
g
an
esth
esia
ar
is
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f
r
o
m
im
p
air
ed
th
er
m
o
r
e
g
u
lato
r
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o
n
tr
o
l,
an
esth
etic
-
in
d
u
ce
d
v
aso
d
ilatio
n
,
e
x
p
o
s
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r
e
to
co
ld
o
p
er
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r
o
o
m
en
v
ir
o
n
m
en
ts
,
an
d
h
ea
t
lo
s
s
f
r
o
m
lar
g
e
s
u
r
g
ical
f
ield
s
[
5
]
-
[
7
]
.
Desp
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ad
v
an
ce
s
in
Evaluation Warning : The document was created with Spire.PDF for Python.
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26
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512
ac
tiv
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war
m
in
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tech
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ter
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r
ep
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ted
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ates,
esp
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d
u
r
in
g
m
ajo
r
o
n
co
lo
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ic
s
u
r
g
er
ies
[
6
]
-
[
9
]
.
T
h
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f
in
d
in
g
s
s
u
g
g
est
a
p
er
s
is
t
en
t
g
ap
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etwe
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elin
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r
ec
o
m
m
en
d
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s
an
d
r
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l
-
wo
r
ld
clin
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p
r
ac
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Sev
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al
p
atien
t
-
r
elate
d
f
ac
t
o
r
s
h
av
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b
ee
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id
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tifie
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co
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tr
i
b
u
to
r
s
to
p
e
r
io
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p
o
th
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PAS.
A
r
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t
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eta
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T
a
n
et
a
l.
[
1
0
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d
em
o
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s
tr
ated
th
at
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w
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o
d
y
m
ass
in
d
ex
(
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MI
)
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ag
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,
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lo
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ed
s
u
r
g
ical
d
u
r
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ex
ten
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is
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ig
n
if
ican
tly
in
cr
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s
e
th
e
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i
s
k
o
f
p
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s
to
p
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h
y
p
o
th
er
m
ia.
Am
o
n
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ese
f
ac
to
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s
,
B
MI
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p
ar
ticu
lar
l
y
r
elev
an
t
b
ec
a
u
s
e
it
r
ef
lects
th
e
p
atien
t’
s
th
e
r
m
al
in
s
u
latio
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ca
p
ac
ity
an
d
en
er
g
y
r
eser
v
e.
Un
d
er
weig
h
t
p
atie
n
ts
p
o
s
s
ess
r
ed
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ce
d
s
u
b
cu
tan
eo
u
s
f
at,
lead
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g
t
o
ac
ce
ler
ated
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ea
t
lo
s
s
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wh
ile
ag
e
-
r
elate
d
p
h
y
s
io
lo
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ical
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h
a
n
g
es
f
u
r
th
e
r
im
p
air
t
h
er
m
o
r
e
g
u
lato
r
y
r
esp
o
n
s
es
[
1
1
]
,
[
1
2
]
.
Ho
wev
e
r
,
th
e
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elativ
e
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n
tr
ib
u
tio
n
o
f
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MI
an
d
ag
e
to
PAS
r
em
ain
s
in
co
n
s
is
te
n
tly
r
ep
o
r
ted
ac
r
o
s
s
s
tu
d
ies,
with
s
o
m
e
in
v
esti
g
ati
o
n
s
s
u
g
g
esti
n
g
a
h
ig
h
er
PAS
r
is
k
in
o
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er
weig
h
t
p
o
p
u
latio
n
s
,
h
ig
h
lig
h
tin
g
th
e
co
m
p
l
ex
ity
o
f
th
er
m
o
r
eg
u
latio
n
d
u
r
i
n
g
an
esth
esia
[
1
3
]
,
[
1
4
]
.
I
m
p
o
r
ta
n
tly
,
e
x
is
tin
g
s
tu
d
ie
s
v
ar
y
co
n
s
id
er
a
b
ly
in
t
h
e
ir
m
eth
o
d
o
lo
g
ical
ap
p
r
o
ac
h
es.
Ma
n
y
in
v
esti
g
atio
n
s
f
o
cu
s
p
r
im
ar
ily
o
n
p
o
s
to
p
er
ativ
e
tem
p
e
r
atu
r
e
m
ea
s
u
r
em
en
ts
o
r
s
in
g
le
tim
e
-
p
o
in
t
ass
ess
m
en
ts
,
lim
i
tin
g
in
s
ig
h
t
in
to
in
tr
ao
p
er
ativ
e
tem
p
er
atu
r
e
d
y
n
am
ics
[
1
5
]
,
[
1
6
]
.
Oth
er
s
e
x
am
in
e
h
et
er
o
g
en
e
o
u
s
s
u
r
g
ical
p
o
p
u
latio
n
s
,
m
ak
in
g
it
d
if
f
icu
lt
to
ex
tr
a
p
o
late
f
i
n
d
in
g
s
to
s
p
ec
if
ic
p
r
o
ce
d
u
r
es
s
u
ch
as
m
astecto
m
y
,
wh
ich
is
ch
ar
ac
ter
ized
b
y
p
r
o
lo
n
g
ed
o
p
er
ativ
e
tim
e,
e
x
ten
s
iv
e
tis
s
u
e
ex
p
o
s
u
r
e,
an
d
s
u
b
s
tan
tial
h
ea
t
lo
s
s
[
1
1
]
.
C
o
n
s
eq
u
en
tly
,
th
er
e
is
lim
ited
em
p
ir
ical
ev
id
en
ce
lin
k
i
n
g
s
tr
u
ctu
r
ed
in
tr
ao
p
er
ativ
e
tem
p
er
atu
r
e
tr
en
d
s
with
PAS in
b
r
ea
s
t c
an
ce
r
s
u
r
g
er
y
.
T
h
e
s
ca
r
city
o
f
d
ata
is
ev
en
m
o
r
e
p
r
o
n
o
u
n
ce
d
in
l
o
w
-
a
n
d
m
i
d
d
le
-
in
co
m
e
co
u
n
tr
ies,
in
clu
d
in
g
I
n
d
o
n
esia,
wh
er
e
r
eso
u
r
ce
c
o
n
s
tr
ain
ts
m
ay
lim
it
r
o
u
tin
e
u
s
e
o
f
ac
tiv
e
war
m
in
g
s
y
s
tem
s
.
Mo
s
t
p
u
b
lis
h
ed
ev
id
en
ce
o
r
ig
in
ates
f
r
o
m
h
ig
h
-
r
eso
u
r
ce
s
ettin
g
s
,
a
n
d
f
ew
s
tu
d
ies
h
av
e
ex
am
in
e
d
PAS
r
is
k
f
ac
to
r
s
with
in
I
n
d
o
n
esian
s
u
r
g
ica
l
co
n
tex
ts
,
p
ar
ticu
lar
ly
u
s
in
g
s
tr
u
ctu
r
e
d
in
tr
ao
p
e
r
ativ
e
tem
p
er
atu
r
e
m
ea
s
u
r
em
en
ts
an
d
s
tan
d
ar
d
ized
s
h
iv
e
r
in
g
ass
ess
m
en
t
to
o
ls
.
As
a
r
esu
lt,
l
o
c
al
ev
id
en
ce
to
i
n
f
o
r
m
r
is
k
-
b
ased
p
er
io
p
er
ativ
e
th
er
m
al
m
an
ag
e
m
en
t r
em
ai
n
s
in
s
u
f
f
icien
t.
T
h
er
ef
o
r
e,
t
h
is
s
tu
d
y
aim
ed
to
an
aly
ze
in
tr
ao
p
er
ativ
e
tem
p
er
atu
r
e
ch
a
n
g
es
at
d
ef
i
n
ed
in
ter
v
als
an
d
to
ev
alu
ate
th
e
ass
o
ciatio
n
b
etwe
en
b
o
d
y
m
ass
in
d
ex
,
ag
e
,
an
d
p
o
s
t
-
an
esth
etic
s
h
iv
er
in
g
am
o
n
g
m
astecto
m
y
p
atien
ts
u
n
d
er
g
o
in
g
g
en
er
al
a
n
esth
esia
in
an
I
n
d
o
n
esian
ter
tiar
y
ca
r
e
s
ettin
g
.
T
h
e
s
tu
d
y
in
teg
r
ates
p
atien
t
-
r
elate
d
r
is
k
f
ac
t
o
r
s
with
in
tr
a
o
p
er
ativ
e
t
h
er
m
al
tr
e
n
d
s
.
I
t
s
ee
k
s
to
ad
d
r
ess
an
im
p
o
r
tan
t
g
ap
in
th
e
liter
atu
r
e
an
d
to
p
r
o
v
id
e
co
n
tex
t
-
s
p
ec
i
f
ic
ev
id
en
ce
t
h
at
m
ay
s
u
p
p
o
r
t
th
e
d
ev
el
o
p
m
en
t
o
f
s
tr
u
ct
u
r
ed
p
er
io
p
e
r
ativ
e
war
m
in
g
s
tr
ateg
ies,
p
ar
ticu
lar
l
y
f
o
r
h
ig
h
-
r
is
k
p
atien
t g
r
o
u
p
s
.
2.
M
E
T
H
O
D
T
h
is
d
escr
ip
tiv
e
o
b
s
er
v
atio
n
a
l
s
tu
d
y
was
co
n
d
u
cted
at
a
m
ilit
ar
y
ter
tiar
y
h
o
s
p
ital
in
Ma
lan
g
,
E
ast
J
av
a,
I
n
d
o
n
esia,
in
v
o
lv
i
n
g
wo
m
en
u
n
d
er
g
o
in
g
r
ad
ica
l
m
astecto
m
y
u
n
d
e
r
g
en
e
r
al
an
esth
esia
with
en
d
o
tr
ac
h
ea
l
in
tu
b
atio
n
.
A
p
u
r
p
o
s
iv
e
s
am
p
lin
g
ap
p
r
o
ac
h
was
ap
p
lied
t
o
o
b
tain
a
h
o
m
o
g
en
e
o
u
s
clin
ical
p
o
p
u
latio
n
,
r
esu
ltin
g
in
3
6
elig
ib
le
p
ar
ticip
an
ts
.
I
n
clu
s
io
n
cr
iter
ia
co
m
p
r
is
ed
ASA
p
h
y
s
ica
l
s
tatu
s
I
I
I
,
s
u
r
g
ical
d
u
r
atio
n
ex
ce
ed
i
n
g
6
0
m
in
u
t
es,
ex
p
o
s
u
r
e
to
lo
w
o
p
er
atin
g
r
o
o
m
tem
p
er
atu
r
e,
a
b
s
en
ce
o
f
p
h
a
r
m
ac
o
lo
g
ical
an
ti
-
s
h
iv
er
in
g
ag
e
n
ts
,
an
d
p
r
o
v
is
io
n
o
f
wr
itten
in
f
o
r
m
ed
co
n
s
en
t.
Patien
ts
with
ASA
I
V
s
tatu
s
o
r
p
o
s
to
p
er
ativ
e
co
m
p
licatio
n
s
r
eq
u
ir
in
g
in
ten
s
iv
e
ca
r
e
a
d
m
is
s
io
n
wer
e
ex
clu
d
ed
to
m
in
im
ize
co
n
f
o
u
n
d
in
g
e
f
f
ec
ts
o
n
th
er
m
o
r
eg
u
latio
n
.
I
n
tr
ao
p
e
r
ativ
e
b
o
d
y
tem
p
er
atu
r
e
was
m
ea
s
u
r
ed
u
s
in
g
a
ca
lib
r
ated
in
f
r
ar
e
d
th
er
m
o
m
eter
at
f
ix
ed
tim
e
p
o
in
ts
,
s
p
ec
if
ically
3
0
an
d
6
0
m
in
u
tes
a
f
ter
in
d
u
ctio
n
o
f
a
n
esth
esia.
PAS
was
ass
es
s
ed
u
p
o
n
ar
r
i
v
al
in
th
e
r
ec
o
v
er
y
r
o
o
m
u
s
in
g
th
e
b
ed
s
id
e
s
h
iv
er
in
g
ass
ess
m
en
t
s
ca
le
(
B
SAS),
a
clin
ically
v
alid
at
ed
in
s
tr
u
m
e
n
t
with
estab
lis
h
ed
r
eliab
ilit
y
an
d
in
t
er
-
r
ater
c
o
n
s
is
ten
cy
in
p
o
s
to
p
er
ativ
e
s
ettin
g
s
.
B
MI
was
cla
s
s
if
ied
ac
co
r
d
in
g
to
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
cr
iter
ia
in
to
u
n
d
er
weig
h
t
(
<1
8
.
5
k
g
/m
²)
,
n
o
r
m
al
(
1
8
.
5
–
2
4
.
9
k
g
/m
²
)
,
an
d
o
v
er
weig
h
t
(
≥
2
5
k
g
/m
²)
,
wh
ile
ag
e
was
ca
teg
o
r
ized
in
to
ad
u
lt
(
2
0
–
6
0
y
ea
r
s
)
an
d
el
d
er
ly
(
>6
0
y
ea
r
s
)
.
Hy
p
o
th
er
m
ia
s
ev
e
r
ity
was d
ef
in
ed
u
s
in
g
s
tan
d
a
r
d
clin
ical
th
r
esh
o
ld
s
.
T
o
r
ed
u
ce
v
ar
ia
b
ilit
y
f
r
o
m
f
ac
to
r
s
in
f
lu
e
n
cin
g
h
y
p
o
th
er
m
ia,
all
p
atien
ts
r
ec
eiv
e
d
an
esth
esia
ac
co
r
d
in
g
to
th
e
h
o
s
p
ital’
s
s
tan
d
ar
d
ized
p
r
o
to
co
l,
an
d
n
o
ac
tiv
e
war
m
in
g
d
ev
ices
wer
e
u
s
ed
d
u
r
in
g
s
u
r
g
er
y
.
Op
er
atin
g
r
o
o
m
co
n
d
itio
n
s
an
d
in
tr
ao
p
er
ati
v
e
f
lu
id
m
a
n
ag
e
m
en
t
f
o
llo
wed
r
o
u
tin
e
in
s
titu
tio
n
al
p
r
ac
tice
f
o
r
a
ll
ca
s
es.
Descr
ip
tiv
e
s
tat
is
tic
s
w
er
e
u
s
ed
to
s
u
m
m
ar
ize
p
atien
t
ch
ar
ac
ter
is
tics
,
an
d
ass
o
ciati
o
n
s
b
etwe
en
PAS
an
d
ca
teg
o
r
ical
v
ar
ia
b
les
(
B
M
I
an
d
ag
e)
wer
e
an
aly
ze
d
u
s
in
g
C
h
i
-
s
q
u
ar
e
test
s
wi
th
a
s
ig
n
i
f
ican
ce
lev
el
s
et
at
p
<
0
.
0
5
.
E
th
ical
ap
p
r
o
v
al
was
o
b
tai
n
ed
b
ef
o
r
e
s
tu
d
y
i
n
itiatio
n
,
an
d
all
p
r
o
ce
d
u
r
es
co
m
p
lied
with
th
e
Dec
lar
atio
n
o
f
Helsin
k
i.
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
A
s
s
o
cia
tio
n
o
f b
o
d
y
m
a
s
s
in
d
ex
a
n
d
a
g
e
a
s
r
is
k
fa
cto
r
s
fo
r
p
o
s
t
-
a
n
esth
etic
… (
R
ek
o
P
r
iyo
n
g
g
o
)
513
3.
RE
SU
L
T
S
AND
D
I
SCU
SS
I
O
N
T
h
e
s
tu
d
y
co
m
p
r
is
ed
3
6
wo
m
en
u
n
d
e
r
g
o
in
g
r
ad
ical
m
as
tecto
m
y
u
n
d
e
r
g
en
er
al
a
n
esth
esia
with
en
d
o
tr
ac
h
ea
l
i
n
tu
b
atio
n
.
I
n
t
r
a
o
p
er
ativ
e
tem
p
er
atu
r
e
m
o
n
ito
r
in
g
d
em
o
n
s
tr
ated
a
p
r
o
g
r
ess
iv
e
d
ec
lin
e
d
u
r
in
g
s
u
r
g
er
y
.
At
3
0
m
in
u
tes,
1
9
p
atien
ts
(
5
2
.
8
%)
h
ad
alr
ea
d
y
d
ev
elo
p
e
d
m
o
d
e
r
ate
h
y
p
o
t
h
er
m
ia,
wh
ile
th
is
p
r
o
p
o
r
tio
n
in
c
r
ea
s
ed
to
2
6
p
a
tien
ts
(
7
2
.
2
%)
at
6
0
m
in
u
tes.
No
ca
s
es
o
f
s
ev
er
e
h
y
p
o
th
er
m
ia
(
<3
2
º
C
)
wer
e
o
b
s
er
v
ed
d
u
r
in
g
th
e
in
t
r
ao
p
er
a
tiv
e
p
er
io
d
.
T
ab
le
1
s
u
m
m
ar
izes p
atien
t c
h
ar
ac
ter
is
tics
an
d
in
tr
ao
p
er
ativ
e
tem
p
er
atu
r
e
p
r
o
f
iles
.
Mo
s
t p
ar
ticip
an
ts
wer
e
ad
u
lts
ag
ed
2
0
–
6
0
y
ea
r
s
(
7
7
.
8
%),
w
h
ile
eld
er
ly
p
atien
t
s
(
>6
0
y
ea
r
s
)
ac
co
u
n
ted
f
o
r
2
2
.
2
%
o
f
th
e
s
am
p
le.
Ne
ar
ly
h
alf
o
f
th
e
p
atien
ts
(
4
7
.
2
%)
wer
e
class
if
ied
as
u
n
d
e
r
weig
h
t
b
ased
o
n
b
o
d
y
m
ass
i
n
d
ex
(
B
MI
)
.
At
6
0
m
in
u
tes
in
tr
ao
p
e
r
ativ
ely
,
m
o
d
er
ate
h
y
p
o
th
er
m
ia
was
o
b
s
er
v
ed
in
th
e
m
ajo
r
ity
o
f
p
atien
ts
(
7
2
.
2
%),
in
d
icatin
g
s
u
b
s
tan
tial
in
tr
ao
p
er
ativ
e
h
ea
t
lo
s
s
.
PAS
was
o
b
s
er
v
e
d
in
1
1
p
atien
ts
(
3
0
.
6
%),
wh
ile
2
5
p
atien
ts
(
6
9
.
4
%)
d
id
n
o
t e
x
p
e
r
ien
ce
s
h
iv
er
in
g
.
PAS wa
s
ass
e
s
s
ed
u
s
in
g
th
e
B
SAS
u
p
o
n
ad
m
is
s
io
n
to
th
e
r
ec
o
v
e
r
y
r
o
o
m
.
T
h
e
C
h
i
-
s
q
u
ar
e
an
aly
s
is
p
r
es
en
ted
in
T
ab
le
2
d
em
o
n
s
tr
ated
s
tatis
tical
ly
s
ig
n
if
ican
t
ass
o
ciatio
n
s
b
etwe
en
PAS
an
d
B
MI
(
χ²
=
1
4
.
5
1
6
;
d
f
=
2
;
p
=
0
.
0
0
1
)
,
as
well
as
b
etwe
en
PAS
an
d
ag
e
(
χ²
=
4
.
9
4
6
;
d
f
=
1
;
p
=
0
.
0
2
6
)
.
E
ld
er
ly
p
atien
ts
a
n
d
th
o
s
e
with
lo
wer
B
MI
wer
e
m
o
r
e
lik
ely
to
d
ev
elo
p
PAS
co
m
p
a
r
ed
t
o
a
d
u
lt
an
d
n
o
r
m
al
-
weig
h
t
p
atien
ts
.
Am
o
n
g
t
h
e
1
1
p
atie
n
ts
wh
o
d
ev
elo
p
ed
PAS,
B
SAS
s
co
r
es
r
an
g
ed
f
r
o
m
1
to
3
.
Mild
s
h
iv
er
in
g
(
B
SAS
s
co
r
e
1
)
was
o
b
s
er
v
ed
in
4
p
atien
ts
(
1
1
.
1
%),
m
o
d
er
ate
s
h
iv
er
in
g
(
B
SAS
s
co
r
e
2
)
in
5
p
atien
ts
(
1
3
.
9
%),
an
d
s
ev
er
e
s
h
iv
er
in
g
(
B
SAS
s
co
r
e
3
)
in
2
p
atien
ts
(
5
.
6
%).
No
ca
s
es
o
f
g
en
er
ali
ze
d
in
ca
p
ac
itatin
g
s
h
iv
er
in
g
wer
e
r
ec
o
r
d
e
d
.
T
ab
le
1
.
Su
m
m
a
r
izes p
atien
t c
h
ar
ac
ter
is
tics
an
d
in
tr
ao
p
e
r
ativ
e
tem
p
er
atu
r
e
p
r
o
f
iles
(
n
=
3
6
)
V
a
r
i
a
b
l
e
C
a
t
e
g
o
r
y
F
r
e
q
u
e
n
c
y
(
n
)
P
e
r
c
e
n
t
a
g
e
(
%)
A
g
e
A
d
u
l
t
(
2
0
-
6
0
y
e
a
r
s)
28
77
.
8
El
d
e
r
l
y
(
>
6
0
y
e
a
r
s)
8
22
.
2
B
o
d
y
mas
s i
n
d
e
x
(
B
M
I
)
<
1
8
.
5
(
U
n
d
e
r
w
e
i
g
h
t
)
17
47
.
2
18
.
5
-
25
.
0
(
n
o
r
ma
l
)
19
52
.
8
>
2
5
.
0
(
o
v
e
r
w
e
i
g
h
t
)
4
11
.
1
I
n
t
r
a
o
p
e
r
a
t
i
v
e
t
e
m
p
e
r
a
t
u
r
e
3
0
mi
n
-
M
i
l
d
h
y
p
o
t
h
e
r
mi
a
17
47
.
2
3
0
mi
n
-
M
o
d
e
r
a
t
e
h
y
p
o
t
h
e
r
mi
a
19
52
.
8
6
0
mi
n
-
M
i
l
d
h
y
p
o
t
h
e
r
mi
a
10
27
.
8
6
0
mi
n
-
M
o
d
e
r
a
t
e
h
y
p
o
t
h
e
r
mi
a
26
72
.
2
S
e
v
e
r
e
h
y
p
o
t
h
e
r
m
i
a
(
<
3
2
°
C)
0
0
S
h
i
v
e
r
i
n
g
i
n
c
i
d
e
n
c
e
Y
e
s
11
30
.
6
No
25
69
.
4
T
ab
le
2.
C
h
i
-
s
q
u
ar
e
test
r
esu
lts
f
o
r
ag
e
a
n
d
B
MI
to
PAS
V
a
r
i
a
b
l
e
P
e
a
r
so
n
C
h
i
-
s
q
u
a
r
e
d
f
p
-
v
a
l
u
e
A
g
e
4
.
9
4
6
1
0
.
0
2
6
B
M
I
1
4
.
5
1
6
2
0
.
0
0
1
4.
DIS
CU
SS
I
O
N
T
h
is
s
tu
d
y
d
em
o
n
s
tr
ated
a
h
ig
h
in
cid
en
ce
o
f
in
tr
ao
p
e
r
ativ
e
h
y
p
o
th
er
m
ia
am
o
n
g
p
atien
ts
u
n
d
er
g
o
in
g
r
ad
ical
m
astecto
m
y
u
n
d
er
g
en
er
al
an
esth
esia,
with
m
o
r
e
th
an
two
-
th
ir
d
s
o
f
p
ar
ticip
a
n
ts
d
ev
elo
p
in
g
m
o
d
er
ate
h
y
p
o
th
er
m
ia
b
y
6
0
m
in
u
tes
in
tr
ao
p
er
ativ
el
y
.
T
h
ese
f
in
d
i
n
g
s
in
d
icate
th
at
clin
ically
r
elev
a
n
t
h
ea
t
lo
s
s
o
cc
u
r
s
ea
r
ly
d
u
r
i
n
g
s
u
r
g
e
r
y
d
esp
it
e
s
tan
d
ar
d
ized
an
esth
etic
m
an
ag
em
en
t.
Similar
p
atter
n
s
o
f
in
tr
ao
p
er
ativ
e
h
y
p
o
th
er
m
ia
h
av
e
b
ee
n
r
e
p
o
r
t
ed
in
m
ajo
r
o
n
co
lo
g
ic
p
r
o
ce
d
u
r
es,
p
a
r
ticu
lar
ly
i
n
th
e
ab
s
en
ce
o
f
r
o
u
tin
e
ac
tiv
e
war
m
in
g
s
tr
ateg
ies
[
1
7
]
,
[
1
8
]
.
Po
s
t
-
an
esth
etic
s
h
iv
er
in
g
o
c
cu
r
r
ed
in
n
ea
r
ly
o
n
e
-
th
i
r
d
o
f
p
atien
ts
,
an
d
s
tatis
tically
s
ig
n
if
ican
t
ass
o
ciatio
n
s
wer
e
id
en
tifie
d
b
etwe
en
PAS
an
d
b
o
th
ag
e
an
d
B
MI
.
E
ld
er
ly
p
atien
ts
an
d
t
h
o
s
e
with
lo
w
B
MI
wer
e
s
ig
n
if
ican
tly
m
o
r
e
lik
el
y
to
e
x
p
er
ie
n
ce
PAS,
h
ig
h
lig
h
tin
g
th
e
im
p
o
r
tan
ce
o
f
p
atie
n
t
-
r
elate
d
f
ac
t
o
r
s
in
p
o
s
to
p
er
ativ
e
th
e
r
m
o
r
e
g
u
lato
r
y
d
is
tu
r
b
an
ce
s
.
T
h
ese
f
in
d
i
n
g
s
ar
e
co
n
s
is
ten
t
with
p
r
ev
io
u
s
s
tu
d
ies
r
ep
o
r
tin
g
in
cr
ea
s
ed
PAS
s
u
s
ce
p
tib
ilit
y
a
m
o
n
g
eld
e
r
ly
p
atien
ts
d
u
e
to
a
g
e
-
r
elate
d
d
ec
lin
es
in
t
h
er
m
o
r
eg
u
lato
r
y
ca
p
ac
ity
,
in
clu
d
in
g
im
p
air
ed
v
aso
co
n
s
tr
ictio
n
an
d
r
e
d
u
ce
d
s
h
iv
er
in
g
th
r
esh
o
ld
s
[
1
3
]
,
[
1
9
]
,
[
2
0
]
T
h
e
ass
o
ciatio
n
b
etwe
en
lo
w
B
MI
an
d
PAS
o
b
s
er
v
ed
in
th
is
s
tu
d
y
s
u
p
p
o
r
ts
p
r
io
r
ev
id
en
c
e
s
u
g
g
esti
n
g
th
at
u
n
d
er
weig
h
t
p
atien
ts
h
a
v
e
lim
ited
th
er
m
al
in
s
u
latio
n
an
d
r
ed
u
ce
d
m
etab
o
lic
r
eser
v
es,
p
r
ed
is
p
o
s
in
g
th
em
t
o
h
y
p
o
th
e
r
m
ia
an
d
s
u
b
s
eq
u
e
n
t
s
h
iv
er
in
g
[
1
0
]
.
Ho
wev
er
,
c
o
n
f
lictin
g
f
in
d
in
g
s
h
a
v
e
b
ee
n
r
ep
o
r
ted
i
n
th
e
liter
atu
r
e,
with
s
o
m
e
s
tu
d
ies id
en
tify
in
g
h
ig
h
e
r
PAS
r
is
k
am
o
n
g
o
v
er
weig
h
t
p
atien
ts
[
1
3
]
.
T
h
is
d
is
cr
ep
an
cy
s
u
g
g
ests
th
at
B
MI
alo
n
e
d
o
es
n
o
t
d
eter
m
i
n
e
PAS
r
is
k
b
u
t
lik
ely
in
t
er
ac
ts
with
o
th
er
p
er
io
p
er
ativ
e
f
ac
to
r
s
.
B
ey
o
n
d
PAS
in
cid
en
ce
,
s
h
iv
er
in
g
s
ev
er
ity
ass
ess
ed
u
s
in
g
B
SAS
r
ev
ea
led
th
at
m
o
d
er
ate
-
to
-
s
ev
er
e
s
h
iv
er
in
g
(
s
co
r
es
2
-
3
)
was
m
o
r
e
f
r
e
q
u
en
tly
o
b
s
er
v
ed
am
o
n
g
el
d
er
ly
an
d
u
n
d
er
weig
h
t
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
:
5
1
1
-
5
1
7
514
p
atien
ts
.
Alth
o
u
g
h
in
f
er
en
tial
test
in
g
f
o
r
B
SAS
s
ev
er
ity
w
as
n
o
t
c
o
n
d
u
cted
d
u
e
t
o
s
am
p
le
s
ize
lim
itatio
n
s
,
th
is
d
escr
ip
tiv
e
p
atter
n
s
u
g
g
ests
th
at
v
u
ln
er
a
b
le
p
atie
n
t
g
r
o
u
p
s
m
a
y
e
x
p
er
ien
ce
n
o
t
o
n
ly
a
h
ig
h
er
o
cc
u
r
r
en
ce
b
u
t a
ls
o
g
r
ea
ter
i
n
ten
s
ity
o
f
P
AS,
in
cr
ea
s
in
g
th
e
clin
ical
b
u
r
d
en
d
u
r
in
g
p
o
s
to
p
er
ativ
e
r
ec
o
v
er
y
.
T
h
e
h
ig
h
in
cid
en
ce
o
f
m
o
d
er
ate
h
y
p
o
t
h
er
m
ia
at
6
0
m
in
u
te
s
f
u
r
th
er
em
p
h
asizes
th
e
v
u
ln
er
ab
ilit
y
o
f
m
astecto
m
y
p
atien
ts
to
in
tr
a
o
p
er
ativ
e
h
ea
t
lo
s
s
.
C
u
r
r
en
t
p
er
io
p
er
ativ
e
g
u
i
d
elin
es
r
ec
o
m
m
en
d
c
o
n
tin
u
o
u
s
tem
p
er
atu
r
e
m
o
n
ito
r
i
n
g
an
d
t
h
e
u
s
e
o
f
ac
tiv
e
war
m
in
g
s
tr
a
teg
ies,
p
ar
ticu
lar
ly
in
h
ig
h
-
r
is
k
p
o
p
u
latio
n
s
[
2
1
]
,
[
2
2
]
.
T
h
e
co
n
cu
r
r
en
t
o
cc
u
r
r
e
n
ce
o
f
h
y
p
o
th
er
m
ia
an
d
PAS
o
b
s
er
v
ed
in
th
is
s
tu
d
y
s
u
p
p
o
r
ts
th
e
clin
ical
r
elev
an
ce
o
f
ea
r
ly
th
er
m
al
in
ter
v
en
tio
n
s
s
u
ch
as
p
r
e
war
m
in
g
an
d
f
o
r
ce
d
-
air
wa
r
m
in
g
s
y
s
tem
s
,
as
d
em
o
n
s
tr
ated
in
p
r
ev
i
o
u
s
s
tu
d
ies
[
2
3
]
,
[
2
4
]
.
Sev
er
al
lim
itatio
n
s
s
h
o
u
ld
b
e
co
n
s
id
er
e
d
wh
e
n
in
ter
p
r
eti
n
g
th
ese
f
in
d
in
g
s
.
T
h
e
r
elati
v
ely
s
m
all
s
am
p
le
s
ize
lim
its
s
tati
s
tical
p
o
wer
an
d
r
estricts
m
o
r
e
ad
v
an
ce
d
m
u
ltiv
ar
iab
le
o
r
s
ev
er
i
ty
-
b
ased
an
al
y
s
es,
th
er
eb
y
lim
itin
g
ca
u
s
al
in
f
er
e
n
ce
.
Ad
d
itio
n
ally
,
th
is
s
in
g
le
-
ce
n
ter
s
tu
d
y
was
co
n
d
u
cte
d
in
a
s
p
ec
if
ic
s
u
r
g
ical
s
ettin
g
,
wh
ich
m
ay
r
e
d
u
ce
t
h
e
g
en
er
aliza
b
ilit
y
o
f
th
e
r
e
s
u
lts
to
o
th
er
in
s
titu
tio
n
s
with
d
if
f
er
e
n
t
p
atien
t
p
o
p
u
latio
n
s
o
r
p
er
io
p
er
ativ
e
p
r
ac
tices.
I
n
tr
a
o
p
er
ativ
e
tem
p
er
atu
r
e
m
ea
s
u
r
e
m
en
ts
wer
e
li
m
ited
to
two
tim
e
p
o
in
ts
(
3
0
a
n
d
6
0
m
in
u
tes),
p
o
ten
tially
o
v
er
lo
o
k
in
g
d
y
n
a
m
ic
tem
p
er
atu
r
e
f
l
u
ctu
atio
n
s
th
r
o
u
g
h
o
u
t
s
u
r
g
e
r
y
.
Mo
r
eo
v
er
,
o
th
er
k
n
o
wn
f
ac
to
r
s
in
f
lu
en
cin
g
PAS
,
s
u
ch
as
A
SA
p
h
y
s
ical
s
ta
tu
s
,
an
esth
etic
tech
n
iq
u
e,
s
u
r
g
ical
d
u
r
atio
n
,
an
d
e
n
v
ir
o
n
m
en
tal
c
o
n
d
itio
n
s
,
wer
e
n
o
t a
n
al
y
ze
d
a
n
d
m
ay
ac
t a
s
co
n
f
o
u
n
d
er
s
[
1
7
]
,
[
2
5
]
-
[
3
0
]
.
Desp
ite
th
ese
lim
itatio
n
s
,
th
e
u
s
e
o
f
s
tan
d
a
r
d
ized
tem
p
er
atu
r
e
m
o
n
ito
r
in
g
,
v
alid
ated
PAS
ass
es
s
m
en
t
to
o
ls
,
an
d
ap
p
r
o
p
r
iate
s
tatis
tic
al
an
aly
s
is
s
tr
en
g
th
en
s
th
e
in
t
er
n
al
v
alid
ity
o
f
th
is
s
tu
d
y
.
T
h
ese
m
eth
o
d
o
lo
g
ical
ap
p
r
o
ac
h
es
co
n
tr
ib
u
te
to
t
h
e
r
eliab
ilit
y
o
f
th
e
s
t
u
d
y
f
in
d
i
n
g
s
an
d
s
u
p
p
o
r
t
th
e
ac
cu
r
ac
y
o
f
t
h
e
r
esu
lts
o
b
tain
ed
.
W
h
ile
g
en
er
aliza
tio
n
s
h
o
u
ld
b
e
u
n
d
er
tak
en
ca
u
tio
u
s
ly
,
th
e
f
in
d
in
g
s
p
r
o
v
i
d
e
c
o
n
tex
t
-
s
p
ec
if
ic
ev
id
e
n
ce
s
u
p
p
o
r
tin
g
r
is
k
-
b
ased
p
er
io
p
e
r
ativ
e
war
m
in
g
s
tr
ateg
ies
an
d
s
tr
u
ctu
r
ed
tem
p
e
r
atu
r
e
m
o
n
ito
r
in
g
in
m
astecto
m
y
p
atien
ts
,
p
ar
ticu
lar
ly
with
in
s
i
m
ilar
clin
ical
s
ettin
g
s
.
5.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
d
em
o
n
s
tr
ates
a
h
ig
h
in
cid
en
ce
o
f
in
tr
ao
p
er
ativ
e
h
y
p
o
th
er
m
ia
am
o
n
g
p
atien
ts
u
n
d
er
g
o
in
g
r
ad
ical
m
astecto
m
y
u
n
d
er
g
e
n
er
al
an
esth
esia,
with
m
o
r
e
t
h
an
two
-
th
ir
d
s
o
f
p
atien
ts
d
e
v
elo
p
in
g
m
o
d
er
ate
h
y
p
o
th
er
m
ia
with
in
th
e
f
ir
s
t
6
0
m
in
u
tes
o
f
s
u
r
g
e
r
y
.
Po
s
t
-
an
esth
etic
s
h
iv
er
in
g
o
cc
u
r
r
e
d
in
n
ea
r
ly
o
n
e
-
th
ir
d
o
f
p
atien
ts
an
d
was sig
n
if
ican
tly
ass
o
ciate
d
with
ad
v
an
ce
d
ag
e
an
d
lo
w
b
o
d
y
m
ass
in
d
ex
,
in
d
i
ca
tin
g
th
at
p
a
tien
t
-
r
elate
d
f
ac
to
r
s
p
lay
a
n
im
p
o
r
ta
n
t r
o
le
in
p
o
s
to
p
er
ativ
e
th
e
r
m
o
r
eg
u
lato
r
y
d
is
tu
r
b
a
n
ce
s
.
B
ey
o
n
d
PAS in
cid
en
ce
,
th
e
d
escr
ip
tiv
e
d
is
tr
ib
u
tio
n
o
f
B
SAS
s
co
r
es
s
u
g
g
ests
th
at
u
n
d
er
weig
h
t
an
d
eld
er
ly
p
atien
ts
m
ay
ex
p
e
r
ien
ce
g
r
ea
ter
s
h
iv
er
in
g
s
ev
er
ity
,
h
i
g
h
lig
h
tin
g
a
n
in
cr
ea
s
ed
clin
ic
al
b
u
r
d
en
i
n
th
ese
v
u
ln
er
a
b
le
g
r
o
u
p
s
.
Alth
o
u
g
h
ca
u
s
al
r
elatio
n
s
h
ip
s
ca
n
n
o
t
b
e
in
f
er
r
ed
,
th
ese
f
in
d
in
g
s
u
n
d
e
r
s
co
r
e
th
e
clin
ical
r
elev
an
ce
o
f
id
en
tify
in
g
h
ig
h
-
r
is
k
p
atien
ts
p
r
io
r
to
s
u
r
g
er
y
.
Fro
m
a
clin
ical
p
er
s
p
ec
tiv
e
,
th
e
r
esu
lts
s
u
p
p
o
r
t
th
e
im
p
lem
en
tatio
n
o
f
s
tr
u
ctu
r
ed
p
e
r
io
p
er
ativ
e
tem
p
er
atu
r
e
m
o
n
ito
r
in
g
an
d
ta
r
g
eted
war
m
in
g
p
r
o
to
co
ls
,
p
ar
ticu
lar
ly
f
o
r
p
atien
ts
with
lo
w
B
MI
an
d
ad
v
an
ce
d
ag
e.
E
ar
ly
th
er
m
al
in
te
r
v
en
ti
o
n
s
,
s
u
ch
as
p
r
ewa
r
m
in
g
a
n
d
ac
tiv
e
in
tr
ao
p
er
ativ
e
war
m
in
g
,
m
ay
r
ed
u
ce
th
e
in
cid
en
ce
a
n
d
s
ev
er
ity
o
f
p
o
s
t
-
an
esth
etic
s
h
iv
er
in
g
an
d
im
p
r
o
v
e
p
o
s
to
p
er
ativ
e
co
m
f
o
r
t
an
d
s
af
ety
.
I
n
s
ettin
g
s
wh
er
e
u
n
iv
er
s
al
war
m
in
g
is
n
o
t
f
ea
s
ib
le,
r
is
k
-
b
ased
th
er
m
al
m
an
ag
em
en
t
r
e
p
r
esen
ts
a
p
r
a
g
m
atic
ap
p
r
o
ac
h
to
im
p
r
o
v
in
g
p
e
r
io
p
er
ativ
e
c
ar
e
q
u
a
lity
.
ACK
NO
WL
E
DG
M
E
N
T
S
W
e
th
an
k
t
h
e
s
u
r
g
ical
an
d
n
u
r
s
in
g
team
s
at
th
e
m
ilit
ar
y
h
o
s
p
ital
in
Ma
lan
g
f
o
r
th
eir
ex
ce
llen
t
s
u
p
p
o
r
t
d
u
r
in
g
d
ata
co
llectio
n
.
Sp
ec
ial
th
an
k
s
g
o
to
th
e
p
er
i
o
p
er
ativ
e
s
taf
f
,
wh
o
s
e
tech
n
ical
d
ilig
en
ce
en
s
u
r
e
d
ac
cu
r
ate
m
o
n
ito
r
in
g
a
n
d
a
s
s
ess
m
en
t.
T
h
is
r
esear
ch
was c
o
m
p
leted
with
o
u
t e
x
ter
n
al
f
u
n
d
in
g
o
r
g
r
an
ts
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
Au
th
o
r
s
s
tate
n
o
f
u
n
d
in
g
in
v
o
lv
ed
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
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
A
s
s
o
cia
tio
n
o
f b
o
d
y
m
a
s
s
in
d
ex
a
n
d
a
g
e
a
s
r
is
k
fa
cto
r
s
fo
r
p
o
s
t
-
a
n
esth
etic
… (
R
ek
o
P
r
iyo
n
g
g
o
)
515
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
O
E
Vi
Su
P
Fu
R
ek
o
Priy
o
n
g
g
o
✓
✓
✓
✓
Mu
h
am
m
ad
R
o
d
li
✓
✓
✓
✓
✓
Su
r
y
an
to
✓
✓
✓
An
n
es R
in
d
y
Per
m
an
a
✓
✓
✓
✓
✓
✓
W
id
ig
d
o
R
ek
s
o
Neg
o
r
o
✓
✓
✓
✓
Sin
d
u
Sin
tar
a
✓
✓
✓
✓
C
:
C
o
n
c
e
p
t
u
a
l
i
z
a
t
i
o
n
M
:
M
e
t
h
o
d
o
l
o
g
y
So
:
So
f
t
w
a
r
e
Va
:
Va
l
i
d
a
t
i
o
n
Fo
:
Fo
r
mal
a
n
a
l
y
s
i
s
I
:
I
n
v
e
s
t
i
g
a
t
i
o
n
R
:
R
e
so
u
r
c
e
s
D
:
D
a
t
a
C
u
r
a
t
i
o
n
O
:
W
r
i
t
i
n
g
-
O
r
i
g
i
n
a
l
D
r
a
f
t
E
:
W
r
i
t
i
n
g
-
R
e
v
i
e
w
&
E
d
i
t
i
n
g
Vi
:
Vi
su
a
l
i
z
a
t
i
o
n
Su
:
Su
p
e
r
v
i
s
i
o
n
P
:
P
r
o
j
e
c
t
a
d
mi
n
i
st
r
a
t
i
o
n
Fu
:
Fu
n
d
i
n
g
a
c
q
u
i
si
t
i
o
n
CO
NF
L
I
C
T
O
F
I
N
T
E
R
E
S
T
ST
A
T
E
M
E
NT
Au
th
o
r
s
s
tate
n
o
co
n
f
lict o
f
in
t
er
est.
DATA AV
AI
L
AB
I
L
I
T
Y
Du
e
to
in
s
titu
tio
n
al
co
n
f
id
en
t
iality
r
u
les,
th
e
s
tu
d
y
d
ata
ar
e
n
o
t
p
u
b
licly
av
ailab
le.
Ho
wev
er
,
th
e
d
atasets
m
ay
b
e
r
eq
u
ested
f
r
o
m
th
e
co
r
r
esp
o
n
d
in
g
au
t
h
o
r
in
wr
itin
g
an
d
will
b
e
p
r
o
v
id
ed
p
e
n
d
in
g
in
s
titu
tio
n
al
ap
p
r
o
v
al
.
RE
F
E
R
E
NC
E
S
[
1
]
T.
M
a
su
b
u
c
h
i
,
K
.
M
i
n
o
g
u
c
h
i
,
H
.
K
a
w
a
k
a
m
i
,
T
.
M
i
h
a
r
a
,
a
n
d
H
.
S
a
t
o
,
“
G
r
a
n
i
s
e
t
r
o
n
f
o
r
p
r
e
v
e
n
t
i
o
n
o
f
p
o
s
t
o
p
e
r
a
t
i
v
e
s
h
i
v
e
r
i
n
g
i
n
su
r
g
i
c
a
l
p
a
t
i
e
n
t
s
:
a
s
y
st
e
ma
t
i
c
r
e
v
i
e
w
a
n
d
met
a
-
a
n
a
l
y
s
i
s,
”
B
MC
A
n
e
st
h
e
si
o
l
o
g
y
,
2
0
2
5
,
d
o
i
:
1
0
.
1
1
8
6
/
s1
2
8
7
1
-
025
-
0
3
3
4
8
-
9.
[
2
]
F
.
X
i
a
e
t
a
l
.
,
“
D
e
v
e
l
o
p
me
n
t
,
v
a
l
i
d
a
t
i
o
n
a
n
d
v
i
su
a
l
i
z
a
t
i
o
n
o
f
r
i
sk
p
r
e
d
i
c
t
i
o
n
mo
d
e
l
f
o
r
p
o
st
o
p
e
r
a
t
i
v
e
sh
i
v
e
r
i
n
g
i
n
p
a
t
i
e
n
t
s
u
n
d
e
r
g
o
i
n
g
v
i
d
e
o
-
a
ss
i
st
e
d
t
h
o
r
a
c
o
sc
o
p
i
c
l
o
b
e
c
t
o
my
:
a
r
e
a
l
-
w
o
r
l
d
r
e
t
r
o
sp
e
c
t
i
v
e
s
t
u
d
y
,
”
S
c
i
e
n
t
i
f
i
c
R
e
p
o
r
t
s
,
p
p
.
1
–
1
5
,
2
0
2
5
.
[
3
]
S
.
R
a
u
c
h
,
C
.
M
i
l
l
e
r
,
A
.
B
r
ä
u
e
r
,
B
.
W
a
l
l
n
e
r
,
M
.
B
o
c
k
,
a
n
d
P
.
P
a
a
l
,
“
P
e
r
i
o
p
e
r
a
t
i
v
e
h
y
p
o
t
h
e
r
mi
a
—
a
n
a
r
r
a
t
i
v
e
r
e
v
i
e
w
,
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o
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u
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3
4
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p
p
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–
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,
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3
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B
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RAP
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AUTH
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RS
Re
k
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Priy
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lec
tu
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ITS
K
R
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ly
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se
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ti
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ies
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c
a
n
b
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c
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tac
ted
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m
a
il
:
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k
o
@itsk
-
s
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ra
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n
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c
.
id
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h
a
m
m
a
d
R
o
d
li
is
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n
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n
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sth
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sio
lo
g
y
sp
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c
ialist
wh
o
is
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x
p
e
ri
e
n
c
e
d
in
a
n
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sth
e
sia
se
rv
ice
s,
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ten
siv
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c
a
re
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n
d
a
c
u
te
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ic p
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m
a
n
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g
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m
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t
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rti
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n
2
0
1
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a
t
th
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T
k
.
II
d
r.
Arm
y
Ho
sp
it
a
l.
S
o
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p
ra
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n
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a
lan
g
.
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th
a
m
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d
ica
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d
u
c
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ti
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c
k
g
ro
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d
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n
d
a
sp
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in
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e
sth
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sio
lo
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t
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wijay
a
Un
i
v
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rsity
,
M
a
lan
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is
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o
m
m
it
ted
to
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fe
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ffe
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n
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th
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h
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lt
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lan
g
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e
c
a
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tac
ted
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d
li
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tsk
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ra
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c
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lt
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b
u
ti
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t
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li
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lt
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s
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d
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d
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c
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ti
o
n
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
su
ry
a
n
t
o
@itsk
-
s
o
e
p
ra
o
e
n
.
a
c
.
i
d
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
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Hea
lth
Sci
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N:
2252
-
8
8
0
6
A
s
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f b
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R
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g
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)
517
Ann
e
s
Rin
d
y
Per
m
a
n
a
is
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lec
tu
re
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ITS
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RS
d
r
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S
o
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p
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n
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is
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ti
v
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ly
in
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e
c
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ted
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n
n
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s@
it
sk
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so
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ra
o
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n
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c
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d
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ig
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k
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g
o
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lec
tu
re
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n
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p
ra
c
ti
ti
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lt
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law
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ra
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ti
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r.
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p
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rm
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n
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n
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d
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re
tary
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d
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p
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rsin
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tu
d
y
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ro
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m
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t
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d
r
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sp
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ra
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sd
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m
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lan
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ll
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d
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rsin
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law
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n
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p
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b
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lt
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n
d
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lt
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is
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rc
h
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n
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rv
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ies
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H
e
c
a
n
b
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c
o
n
tac
ted
a
t
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m
a
il
:
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i
g
d
o
.
wrn
@its
k
-
so
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p
ra
o
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n
.
a
c
.
id
.
S
in
d
u
S
in
t
a
r
a
is
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sp
e
c
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a
li
st
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n
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sth
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sio
l
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n
d
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te
n
siv
e
th
e
ra
p
y
wh
o
g
ra
d
u
a
ted
fro
m
Bra
wijay
a
Un
i
v
e
rsity
.
He
h
a
s
e
x
p
e
rien
c
e
a
s
a
n
a
n
e
sth
e
sio
l
o
g
ist
in
v
a
ri
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s
h
o
sp
i
tals
in
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n
d
o
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sia
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k
s
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P
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r.
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.
M
u
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b
d
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leh
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Ba
se
,
M
a
lan
g
Re
g
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n
c
y
.
Ap
a
rt
fro
m
c
li
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ica
l
p
ra
c
ti
c
e
,
h
e
a
c
ti
v
e
ly
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a
rti
c
ip
a
tes
in
sc
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fic
a
c
ti
v
it
ies
,
re
se
a
rc
h
,
a
n
d
c
o
m
p
e
ten
c
y
d
e
v
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lo
p
m
e
n
t
in
th
e
field
s
o
f
a
n
e
sth
e
sia
,
i
n
ten
si
v
e
c
a
re
,
a
n
d
p
a
ti
e
n
t
sa
fe
ty
.
H
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
sin
d
u
@its
k
-
so
e
p
ra
o
e
n
.
a
c
.
i
d
.
Evaluation Warning : The document was created with Spire.PDF for Python.