M akingbetteraccesstohealthcareservices
I n t e r n a t i o n a l
Te l e c o m m u n i c a t i o n
U n i o n
Maki
ngbet
t
eracces
st
oheal
t
hcar
es
er
vi
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I
TUD St
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Re
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n141/2
Printed in Switzerland
Geneva, 2006
International
Te l e c o m m u n i c a t i o n
Union
Ky
o
d
oBunkas
haCo,Lt
d
International Telecommunication Union
Making better access
to healthcare services
Disclaimer
This report has been prepared by many volunteers from different administrations and
organizations. The mention of specific companies or products does not imply any endorsement
or recommendation by ITU. Opinions expressed are those of the authors and do not engage ITU
in any way.
October 2005
E dited by the National Ins titute of Information and C ommunic ations T ec hnology
Nukui-K itamac hi, 4 c home, K oganei-s hi, T okyo, 184-8795 J apan
Publis hed by K yodo B unkas ha c o, Ltd
5 91, Higas hi 5, K ita 3, C huo-ku, S apporo, Hokkaido
063 0033 J apan
http: www.iword.c o.jp kyodobunkas ha
c opyright Ⓒ 2005.11.2
IS B N4 87739 120 7 C 3082
© ITU/BDT and NICT 2005
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3 St
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z
at
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vi
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s………………………………………………………………
4.
3
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he
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l
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hs
t
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l
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me
di
c
i
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4
.
3.
2 I
TU s
t
anda
…………………………………………
4.
3.
3 TELEMEDI
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CS
4.
3.
4 Me
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z
at
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…………………………………………………………………
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t
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bl
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68
7
1
7
1
8
3
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0
90
9
6
9
9
104
1
0
8
112
PART 2:CASE REPORT ………………………………………………………………………
1 Bangl
ade
s
h ……………………………………………………………………………………
2 Bhut
an…………………………………………………………………………………………
3 Bul
gar
i
a ………………………………………………………………………………………
4 Cambodi
a ……………………………………………………………………………………
5 Et
hi
opi
a ………………………………………………………………………………………
…………………………………………………………………………………………
6 Ge
or
gi
a
1
22
1
22
1
3
1
1
39
1
4
8
1
5
2
1
5
6
9
11
1
1
1
2
1
3
1
6
19
23
2
5
28
2
8
2
8
3
3
4
0
5
0
5
0
5
2
5
6
6
4
7 Gr
e
e
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e:
Mat
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r
ni
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me
di
c
i
neSe
r
v
i
c
e
si
nt
heAe
g
e
anI
s
l
a
nds………………………
8 I
ndi
a……………………………………………………………………………………………
9 I
ndone
s
i
a………………………………………………………………………………………
10 J
apan…………………………………………………………………………………………
11 Ke
nya…………………………………………………………………………………………
12 Kos
ova ………………………………………………………………………………………
vi
a…………………………………………………………………………………………
13 Lat
14 Li
t
huani
a ……………………………………………………………………………………
15 Ma
l
i …………………………………………………………………………………………
16 Ma
l
t
a…………………………………………………………………………………………
17 Moz
ambi
que…………………………………………………………………………………
18 Ne
pal…………………………………………………………………………………………
19 ThePac
i
f
i
cOpe
nLe
ar
ni
ngHe
a
l
t
hNe
t …………………………………………………
20 Paki
s
t
an………………………………………………………………………………………
21 PapuaNe
w Gui
ne
a…………………………………………………………………………
22 Pe
r
u……………………………………………………………………………………………
23 Rus
s
i
anf
e
de
r
at
i
on …………………………………………………………………………
24 Tanz
ani
a ……………………………………………………………………………………
25 Tur
ke
y ………………………………………………………………………………………
26 Ukr
ai
ne………………………………………………………………………………………
27 Zambi
a ………………………………………………………………………………………
ANNEX 1:
RESOLUTI
ON 41OF WTDC,I
STANBUL,20
02
10
1
5
9
1
6
4
1
81
1
88
1
9
9
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8
21
2
21
8
2
25
2
2
9
2
31
23
6
2
40
2
4
7
2
5
6
2
6
5
2
69
2
7
2
28
0
2
8
4
PART 1
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e
aofa
boutonemi
l
l
i
ons
qua
r
eki
l
ome
t
r
e
sa
nda
popul
at
i
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ppr
oxi
mat
e
l
y61
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l
l
i
on,ofwhi
c
hmor
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han5
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l
l
i
on(
85
.
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i
vei
nr
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a
l
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e
a
s
. Thehe
al
t
hc
ar
es
ys
t
e
mi
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r
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ve
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bl
et
opr
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al
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hs
e
r
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c
e
st
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a
t
i
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r
ei
sal
a
c
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t
or
sandhe
al
t
hc
a
r
ei
nf
r
a
s
t
r
uc
t
ur
e
. The
f
e
w me
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c
a
ls
pe
c
i
al
i
s
t
swor
ki
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nt
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ount
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at
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andot
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i
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s
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her
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a
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a
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s
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ar
ede
l
i
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r
ys
ys
t
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ds
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ount
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i
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t
ht
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rl
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e
dme
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ale
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pe
r
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s
our
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e
s
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e
l
e
me
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pr
ovi
deas
ol
ut
i
ont
os
omeoft
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obl
e
msme
nt
i
one
dabov
e
. Tr
adi
t
i
ona
l
l
y,onedi
f
f
i
c
ul
t
yi
n
a
c
hi
e
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e
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al
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hc
ar
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t
ora
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t
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ntmus
tbe
phy
s
i
c
al
l
ypr
e
s
e
nti
nt
hes
a
mepl
ac
e
. Re
c
e
nta
dv
a
nc
e
si
ni
nf
or
ma
t
i
onandt
e
l
e
c
ommuni
c
a
t
i
on
t
e
c
hnol
ogi
e
s
,howe
ve
r
,havec
r
e
at
e
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e
de
nt
e
doppor
t
uni
t
i
e
sf
orove
r
c
omi
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hi
sby
i
nc
r
e
as
i
ngt
henumbe
rofway
st
hathe
al
t
hc
ar
ec
anbede
l
i
ve
r
e
d. Tha
nkst
o
t
e
l
e
c
ommuni
c
at
i
ons
,t
e
l
e
me
di
c
i
neof
f
e
r
ss
ol
ut
i
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orl
ong
di
s
t
anc
ec
ons
ul
t
a
t
i
on,e
me
r
g
e
nc
y
me
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c
a
la
s
s
i
s
t
anc
e
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ni
s
t
r
at
i
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s
t
i
c
s
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upe
r
vi
s
i
ona
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l
i
t
yas
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ur
a
nc
e
,a
nd
e
duc
at
i
onandt
r
ai
ni
ngf
orhe
al
t
hc
ar
es
t
a
f
f
.
Wi
t
hi
nt
hel
i
mi
t
soft
heavai
l
abl
ef
i
nanc
i
a
lr
e
s
our
c
e
s
,i
twa
sr
e
c
omme
nde
di
nEt
hi
opi
at
os
t
ar
t
t
hei
nt
r
oduc
t
i
onoft
e
l
e
me
di
c
i
neappl
i
c
a
t
i
onswi
t
hde
r
mat
ol
og
yduet
ot
hes
hor
t
a
geof
s
pe
c
i
al
i
s
t
si
nt
hi
sme
di
c
aldi
s
c
i
pl
i
neandal
s
obe
c
aus
es
ki
ndi
s
e
as
e
sa
r
eve
r
yc
ommoni
nt
he
c
ount
r
y. Twe
l
vehos
pi
t
al
swe
r
es
e
l
e
c
t
e
dt
obec
onne
c
t
e
dt
oge
t
he
rv
i
at
heI
nt
e
r
ne
ti
nt
ot
he
t
e
l
e
me
di
c
i
nei
nf
or
ma
t
i
onne
t
wor
k. Fol
l
owi
ngt
e
l
e
de
r
mat
ol
og
y
,ot
he
rt
e
l
e
me
di
c
i
nea
ppl
i
c
a
t
i
ons
c
oul
dbeadde
dl
at
e
r
,s
uc
hast
e
l
e
r
a
di
ol
ogy,t
e
l
e
c
ar
di
ol
og
y
,t
e
l
e
pa
t
hol
ogye
t
c
. Ofc
our
s
e
,
t
e
l
e
me
di
c
i
nec
annoti
nc
r
e
as
et
henumbe
rofdoc
t
or
si
nt
hec
ount
r
ybuti
the
l
pst
ous
eavai
l
a
bl
e
r
e
s
our
c
e
smor
ee
f
f
i
c
i
e
nt
l
y.
I
twa
spos
s
i
bl
et
oe
xt
e
ndt
het
e
l
e
me
di
c
i
nei
nf
or
mat
i
onne
t
wor
ki
nEt
hi
opi
at
ot
hev
i
l
l
a
g
el
e
v
e
l
(
pr
i
mar
yhe
al
t
hc
ar
euni
t
s
)us
i
ngI
nt
e
r
ne
tt
r
a
ns
mi
s
s
i
onpl
at
f
or
ms
. He
a
l
t
hc
ar
eatt
hev
i
l
l
ag
e
l
e
v
e
li
sr
e
l
at
i
ve
l
ys
i
mpl
e:i
tc
e
nt
r
e
sonpe
r
f
or
mi
ngvac
c
i
nat
i
ons
,di
s
pe
ns
i
ngc
ommonme
di
c
i
ne
s
/c
andpr
ovi
di
ngma
t
e
r
nal
hi
l
dhe
a
l
t
hadvi
c
e
,i
nc
l
udi
ngf
ami
l
ypl
anni
ng
. The
s
es
e
r
v
i
c
e
sdonot
r
e
qui
r
et
heus
eofs
ophi
s
t
i
c
a
t
e
df
or
msoft
e
l
e
me
di
c
i
nee
qui
pme
nt
. Ac
omput
e
randmode
m
woul
dal
l
ow t
hee
x
c
hangeofe
l
e
c
t
r
oni
cme
s
s
a
ge
s(
e
ma
i
l
)andi
twoul
dal
s
ope
r
mi
tdi
s
t
a
nc
e
e
duc
a
t
i
on.
Thi
se
xa
mpl
es
howe
dc
l
e
ar
l
yt
hatde
ve
l
opi
ngc
ount
r
i
e
sc
anbe
ne
f
i
tf
r
om t
hei
nt
r
oduc
t
i
onof
t
e
l
e
me
di
c
i
nes
e
r
vi
c
e
s
,andt
hati
ti
sus
e
f
ulf
ort
he
i
rhe
al
t
hc
ar
es
ys
t
e
m. I
tc
oul
dbean
e
c
onomi
c
alme
ansofa
c
hi
e
vi
ngnat
i
ona
lhe
a
l
t
hpol
i
c
yobj
e
c
t
i
ve
swi
t
hr
e
ga
r
dt
ot
he
/
i
mpr
ove
me
nta
nd ore
xt
e
ns
i
onofme
di
c
alandhe
al
t
hc
a
r
e
. Te
l
e
me
di
c
i
neal
s
opr
omi
s
e
st
o
1
4
e
nhanc
et
hec
ont
i
nue
dme
di
c
ale
duc
at
i
onofdoc
t
or
s
,nur
s
e
sa
ndot
he
rhe
al
t
hc
ar
epr
ac
t
i
t
i
one
r
s
i
nr
ur
ala
r
e
as
. Thi
si
sawi
dear
e
aofa
ppl
i
c
at
i
on,andonet
ha
ti
se
x
t
r
e
me
l
yus
e
f
ulf
ora
l
l
de
ve
l
opi
ngc
ount
r
i
e
s
.
Whatar
et
hecommonandmos
tur
g
entp
r
ob
l
emsi
nde
ve
l
op
i
ngco
unt
r
i
eswhi
c
hc
o
ul
dbe
al
l
evi
at
edbyus
i
ngt
e
l
emedi
ci
ne
?
Thes
ecount
r
i
ess
uf
f
e
rf
r
o
m as
ever
es
ho
r
t
ag
eofheal
t
hcar
epr
of
e
s
s
i
o
nal
s
. Compe
t
e
nt
me
di
c
als
pe
c
i
al
i
s
t
sus
i
ngs
t
at
e
of
t
he
ar
tme
di
c
alt
e
c
hnol
ogys
uc
hass
c
anne
r
sa
ndot
he
r
s
ophi
s
t
i
c
a
t
e
ddi
a
gnos
t
i
ce
qui
pme
nta
r
eve
r
yr
a
r
e
,ge
ne
r
al
l
ywor
ki
ngi
nt
heuni
v
e
r
s
i
t
yhos
pi
t
al
s
ofl
ar
gec
i
t
i
e
s
. Thel
ac
kofme
di
c
als
pe
c
i
a
l
i
s
t
s
,andt
hel
i
mi
t
e
doppor
t
uni
t
i
e
sf
orc
ons
ul
t
a
t
i
ons
be
t
we
e
ndoc
t
or
si
nr
e
gi
ona
la
ndr
e
mot
es
mal
lhos
pi
t
al
swi
t
ht
he
i
rc
ol
l
e
a
g
ue
si
nt
her
e
f
e
r
r
a
l
hos
pi
t
al
sr
e
s
ul
t
si
nal
ar
genumbe
rofunne
c
e
s
s
a
r
yr
e
f
e
r
r
al
s
. Te
l
e
me
di
c
i
nel
i
nksbe
t
we
e
n
ho
s
p
i
t
al
sand o
t
he
rme
di
c
ali
ns
t
i
t
ut
i
onsc
o
ul
dl
e
ad t
oano
v
e
r
al
li
mpr
ov
e
me
ntof he
al
t
hc
ar
e
s
e
r
v
i
c
e
st
hr
ought
hec
e
nt
r
al
i
z
at
i
o
nand c
o
o
r
di
nat
i
o
no
fr
e
s
our
c
e
s(
s
pe
c
i
al
i
s
t
s
,har
dwar
eand
s
o
f
t
war
epac
kag
e
s
)
.
Thepopul
at
i
onl
i
vi
ngi
nr
ur
alandr
emo
t
ear
eass
uf
f
er
sf
r
o
ml
acko
rev
enab
s
e
nceo
fhe
al
t
h
car
e.
Asaf
i
r
s
tpr
i
or
i
t
y,t
he
r
ei
sane
e
dt
oi
mpr
ov
ema
t
e
r
na
la
ndc
hi
l
dc
a
r
e
,i
npar
t
i
c
ul
arwhe
ni
t
c
ome
st
oe
ar
l
yde
t
e
c
t
i
onofhi
ghr
i
s
kpr
e
g
na
nc
i
e
s
. Thede
p
l
o
yme
ntof f
i
xe
do
rmobi
l
e
t
e
l
e
c
ommuni
c
at
i
ont
e
l
e
c
e
nt
r
e
s
,whi
c
har
enow c
ons
i
de
r
e
dt
ob
eoneof t
hep
os
s
i
bl
eway
sof
br
i
ngi
ngt
e
l
e
c
ommuni
c
at
i
ons
e
r
v
i
c
e
st
or
ur
alar
e
as
,c
oul
db
eus
e
f
ulf
ort
e
l
e
me
di
c
i
neaswe
l
l
.
As
mal
lbuswi
t
happr
op
r
i
at
eme
di
c
aldi
agnos
t
i
ce
qui
pme
ntand adoc
t
o
rv
i
s
i
t
i
ngr
ur
alar
e
as
onar
e
gul
arbas
i
s
,c
o
ul
db
eagood s
ol
ut
i
o
n. Thebuss
houl
d hav
eamo
b
i
l
es
at
e
l
l
i
t
ep
ho
ne
f
o
rc
ons
ul
t
at
i
onwi
t
ht
hehos
pi
t
al
. Thi
smo
b
i
l
eme
di
c
als
e
r
v
i
c
ec
oul
d al
s
opl
ayav
e
r
y
i
mpo
r
t
antr
ol
ei
ndi
s
e
as
epr
e
v
e
nt
i
onand he
al
t
hp
r
omo
t
i
o
n. I
tc
oul
d al
s
ob
eus
e
f
ult
op
r
ov
i
de
ac
onne
c
t
i
onv
i
aI
nt
e
r
ne
tbe
t
we
e
nahe
al
t
hc
e
nt
r
es
t
af
f
e
db
yanur
s
e(
whe
r
eav
ai
l
abl
e
)and
t
hene
ar
e
s
thos
pi
t
al
. Nur
s
epr
ac
t
i
t
i
o
ne
r
sc
anp
r
ov
i
dep
r
i
mar
yc
ar
eb
utt
he
yf
r
e
q
ue
nt
l
yne
e
d
c
o
ns
ul
t
at
i
o
nand adv
i
c
ef
r
om doc
t
or
s
. Thel
e
v
e
lo
f ne
e
dv
ar
i
e
sf
r
o
mr
e
as
s
ur
anc
east
ot
he
c
o
r
r
e
c
t
ne
s
sof adi
ag
nos
i
st
ounc
e
r
t
ai
nl
yaboutadi
agnos
i
sand ap
l
anf
o
rmanage
me
nt
,
par
t
i
c
ul
ar
l
yme
di
c
ale
v
ac
uat
i
on.
Hi
ghmat
er
nalandpr
enat
almor
t
al
i
t
yr
at
e. Oneoft
hemaj
orf
ac
t
or
sc
ont
r
i
but
i
ngt
ot
hi
s
s
i
t
uat
i
oni
st
hei
nade
quac
yoft
r
ai
ne
ds
t
a
f
fandt
heve
r
yl
at
ei
de
nt
i
f
i
c
a
t
i
onofpat
hol
og
i
c
a
l
pr
e
gnanc
i
e
s
. Loc
almat
e
r
ni
t
yuni
t
sc
o
ul
db
ec
onne
c
t
e
db
yt
e
l
e
me
di
c
i
nel
i
nk t
ot
hemat
e
r
ni
t
y
s
e
r
v
i
c
ei
nar
e
g
i
o
nalo
rr
e
f
e
r
r
alhos
pi
t
al
. Thi
swi
l
lal
l
o
wr
e
mot
emoni
t
o
r
i
ngof t
hehe
al
t
ho
f
pr
e
gnantwome
n,e
s
pe
c
i
al
l
yt
hos
ewi
t
hp
at
ho
l
o
gi
c
alpr
o
bl
e
ms
.
Ve
r
yf
ew doct
or
s(
par
t
i
cul
ar
l
yi
nr
ur
alandr
e
mot
ear
eas
)haveacc
es
st
ome
d
i
calj
our
nal
s
af
t
ergr
aduat
i
o
n. Asar
e
s
ul
t
,t
he
yar
euna
bl
et
oke
e
pt
he
i
rpr
of
e
s
s
i
onals
ki
l
l
supt
odat
e
.
The
r
ei
sane
e
dt
omakec
ont
i
nue
dme
di
c
a
le
duc
at
i
ona
c
c
e
s
s
i
bl
et
oasmanyhe
a
l
t
h
pr
of
e
s
s
i
onal
saspos
s
i
bl
e
. Emai
land I
nt
e
r
ne
tac
c
e
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uale
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at
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al
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ount
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s
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our
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t
e
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ai
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nel
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ur
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ng
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e
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i
l
yont
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ur
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hc
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e
f
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om t
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or
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m be
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oor
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ti
nt
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ayadualr
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et
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s
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l
s
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ne
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a
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sa
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r
sa
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t
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t
or
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nde
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ount
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ve
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pe
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s
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at
e
. Thi
spr
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t
t
i
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m upwi
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l
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me
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nec
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t
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l
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at
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oni
nf
r
a
s
t
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mt
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nti
nf
or
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oni
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t
or
sa
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swi
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i
mme
di
at
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nt
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msofs
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meandi
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e
a
t
me
nt
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swi
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at
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nt
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ome
t
hi
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ha
ti
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antat
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hi
se
ar
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a
ge
.
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pi
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nf
or
mat
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ms(
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r
ebe
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omi
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t
a
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f
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ys
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e
m. AnHI
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t
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or
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ort
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e
me
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i
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e
.
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l
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e
w de
ve
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ount
r
i
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or
dt
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l
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nf
or
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e
r
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r
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t
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f
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c
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nc
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soft
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hc
ar
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t
ora
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.
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l
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ft
el
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Ther
ol
eoft
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ommuni
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at
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l
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t
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e
sc
a
nnotbeov
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r
e
s
t
i
ma
t
e
d. The
yf
or
mt
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at
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or
mf
or
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al
t
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c
a
t
i
on. Mos
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at
i
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or
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ont
e
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e
s
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nt
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ve
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t
or
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ort
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ve
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nt
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e
c
t
or
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toft
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t
r
ac
t
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l
t
hs
e
r
v
i
c
e
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st
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tt
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yc
a
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e
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yt
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t
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i
mpl
et
e
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e
c
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at
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i
l
i
t
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e
s
. Fore
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o
t
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ans
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t
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r
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e
s
s
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sgr
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t
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r
ans
mi
s
s
i
ont
e
c
hnol
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e
s
.
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xi
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t
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ans
mi
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s
i
ont
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e
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t
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ode
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ve
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me
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or
mat
i
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ongast
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ns
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ss
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c
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e
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ort
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e
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e
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e
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t
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ans
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e
r
r
e
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f
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e
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ang
i
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om a
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t
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ul
l
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i
nkt
os
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i
l
li
mage
s
. Opt
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c
a
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i
br
el
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ar
ea
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de
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di
um f
orbr
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ons
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t
e
l
l
i
t
et
e
c
hnol
og
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sus
e
f
ulf
or
r
e
ac
hi
ngr
e
mot
el
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at
i
onsa
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ur
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e
as
. Thewi
de
s
pr
e
a
dus
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l
ec
ommuni
c
at
i
onsha
s
madet
hi
st
e
c
hnol
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c
e
s
s
i
bl
ef
ore
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al
t
haswe
l
l
.
TheI
nt
e
r
ne
ti
sbe
c
omi
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art
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l
l
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ngdoc
t
or
st
or
e
a
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i
ni
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t
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t
or
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or
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t
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e
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ma
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li
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t
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hi
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ve
ni
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ve
l
ope
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ount
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s
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et
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t
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r
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t
h
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s
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t
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om c
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r
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t
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t
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at
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or
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nt
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nt
r
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c
e
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t
anti
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ve
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ope
dc
ount
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i
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s
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ni
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e
l
e
c
ommuni
c
a
t
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onope
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or
si
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c
ommuni
c
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t
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ons
e
r
v
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c
ef
ort
he
mi
ni
s
t
r
yofhe
al
t
handane
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e
ve
nues
t
r
e
am;
r
a
t
he
r
,i
ti
st
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ont
r
i
but
i
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t
e
l
e
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ommuni
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at
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onc
ompani
e
st
ot
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l
lbe
i
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at
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on,byhe
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pi
ngt
oi
mpr
ovea
nd
e
xt
e
ndac
c
e
s
st
ome
di
c
als
e
r
v
i
c
e
s
. Fort
hi
sr
e
a
s
on,a
sf
ara
st
hei
nt
r
oduc
t
i
onoft
e
l
e
me
di
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i
ne
appl
i
c
at
i
onsi
sc
onc
e
r
ne
d,t
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l
e
c
ommuni
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t
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onope
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or
si
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v
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l
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ngc
ount
r
i
e
sa
r
et
hena
t
ur
a
l
par
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ne
r
sofdoc
t
or
s
.
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r
ei
sane
e
dt
obr
i
dget
hegapbe
t
we
e
nt
het
e
l
e
c
ommuni
c
at
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ona
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a
l
t
hc
a
r
ec
ommuni
t
i
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s
a
ta
l
ll
e
v
e
l
s
. Nat
i
onalmi
ni
s
t
r
i
e
sofhe
a
l
t
ha
ndoft
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l
e
c
ommuni
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at
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onsa
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s
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owor
k
t
oge
t
he
rt
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r
oduc
eat
e
l
e
me
di
c
i
nepol
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c
yandpr
ov
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deuni
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r
s
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ls
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r
vi
c
ewhe
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me
r
g
e
nc
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r
vi
c
e
s
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al
t
hands
oc
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ali
nf
or
ma
t
i
ons
ys
t
e
msa
r
ec
onc
e
r
ne
d.
Theme
di
c
alpr
of
e
s
s
i
ons
houl
dt
aket
hel
e
adi
nde
t
e
r
mi
ni
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tt
hene
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dsa
r
ea
ndhow
t
e
l
e
c
ommuni
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at
i
onandbus
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ne
s
smi
ghthe
l
p. Ofc
our
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e
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hei
mpl
e
me
nt
a
t
i
onofs
uc
han
ambi
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ouspr
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am s
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e
v
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g
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s
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c
or
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hea
va
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l
a
bl
er
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s
our
c
e
s
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f
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r
s
ts
t
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p,par
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c
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ar
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bor
a
t
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s
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onand
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r
s
t
andi
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obl
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m. Thi
swi
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bl
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oopt
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mi
z
et
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mi
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our
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e
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ar
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a
t
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onofe
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f
or
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ti
sc
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art
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tt
hei
nt
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oduc
t
i
onoft
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l
e
me
di
c
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nehast
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dont
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ng
t
e
l
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c
ommuni
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a
t
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oni
nf
r
as
t
r
uc
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ur
e
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ve
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t
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l
e
s
s
,f
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v
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l
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t
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ot
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nor
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c
t
i
vec
ount
r
i
e
s
.
Re
f
er
ence
［1］ Ehe
a
l
t
h:
I
TU Te
l
e
me
di
c
i
neEx
pe
r
tTr
a
i
ni
ngCour
s
e
TokaiUni
v
e
r
s
i
t
yofJ
apanl
e
adst
hewa
y, I
TU Ne
ws,
2
6
No.
4
,Ma
y20
02
,pp.
1
2.
［2］ E//
he
a
l
t
hExpe
r
tTr
a
i
ni
ngCour
s
eHos
t
e
da
tToka
iUni
ve
r
s
i
t
y, WTDC 0
2i
nf
or
ma
t
i
ondoc
ume
nt
,s
e
e:
ht
t
p:
/
/
/
/i
/
www.
i
t
u.
i
nt
I
TUD/
c
onf
e
r
e
nc
e
s
wt
dc
20
0
2/
doc
nf
odoc
s
i
nde
x
.
ht
ml
2
7
9
2 Co
mmo
ne
he
al
t
hap
p
l
i
c
at
i
o
ns
2
.
1 Whyi
st
el
emedi
ci
neexpandi
ngatt
hi
st
i
me?
Att
hebe
gi
nni
ngoft
hene
w mi
l
l
e
nni
um a
l
lc
ount
r
i
e
sf
ac
et
wos
e
r
i
ouspr
obl
e
ms:
1)t
hene
e
dt
oi
nc
r
e
as
et
hequal
i
t
yande
f
f
i
c
i
e
nc
yoft
hehe
a
l
t
hc
a
r
es
y
s
t
e
m,pr
ov
i
di
ngopt
i
mal
he
al
t
hs
e
r
vi
c
ef
ort
hee
nt
i
r
epopul
at
i
oni
nde
pe
nde
nt
l
yoft
i
mea
ndpl
a
c
e
,and
2)t
hene
e
dt
ot
r
i
m he
al
t
hc
ar
ebudge
t
s
.
Thec
ombi
nat
i
onoft
he
s
ene
w ne
e
dsandt
her
api
dde
ve
l
opme
ntofa
ne
l
e
c
t
r
oni
c
sa
nd
t
e
l
e
c
ommuni
c
at
i
oni
nf
r
a
s
t
r
uc
t
ur
ec
apabl
eofme
e
t
i
ngt
he
s
ene
e
dshasc
r
e
a
t
e
dt
her
i
g
ht
c
ondi
t
i
onsf
ort
hede
s
i
gnandde
ve
l
opme
ntoft
e
l
e
me
di
c
i
net
oe
x
t
e
ndt
oa
l
lpar
t
sofc
l
as
s
i
c
a
l
me
di
c
i
ne
.
Cur
r
e
nt
l
yt
he
r
ear
et
womai
ndi
r
e
c
t
i
onsi
nt
hede
ve
l
opme
ntoft
e
l
e
me
di
c
i
ne
.
・Te
pe
c
i
a
l
i
z
at
i
on,l
e
a
di
ngt
ot
he
l
e
me
di
c
i
nei
si
nc
or
por
at
e
di
nal
la
r
e
asofme
di
c
als
de
ve
l
opme
ntofne
w br
anc
he
sora
r
e
asofs
pe
c
i
al
i
z
a
t
i
ons
uc
hast
e
l
e
c
ar
di
ol
og
y,t
e
l
e
pa
t
hol
og
y,
t
e
l
e
de
r
ma
t
ol
og
ye
t
c
. Thi
si
st
her
e
s
ul
tofne
t
wor
ki
ng,wi
t
hs
pe
c
i
al
i
s
t
si
ndi
f
f
e
r
e
nta
r
e
a
sof
me
di
c
alpr
ac
t
i
c
ebe
i
ngc
onne
c
t
e
dandc
oope
r
at
i
ng.
・Home
c
ar
easawayt
ode
l
i
ve
re
he
al
t
hs
e
r
vi
c
e
sa
tt
hea
c
t
ualpoi
ntofne
e
d.
2.
2 De
vel
opment
si
nt
el
emedi
ci
ne
Thef
ol
l
owi
ngpar
agr
aphspr
ovi
deanout
l
i
neoft
hedi
r
e
c
t
i
ont
ha
tt
e
l
e
me
di
c
i
nede
ve
l
opme
nt
s
ar
et
aki
ng,asi
l
l
us
t
r
at
e
di
nt
hepr
oj
e
c
t
spr
e
s
e
nt
e
di
nPa
r
t2oft
hi
sr
e
por
t
. Be
f
or
ee
x
ami
ni
ng
e
a
c
har
e
aofme
di
c
als
pe
c
i
al
i
z
a
t
i
oni
nde
t
ai
l
,i
ti
si
mpor
t
antt
oe
mpha
s
i
z
ewhatt
he
ya
l
lha
v
ei
n
c
ommon.
1)Al
lt
e
l
e
me
di
c
i
nea
ppl
i
c
at
i
onsus
et
hes
a
meba
s
i
cc
ompone
nt
s
,i
.
e
.
a)ame
anst
oc
apt
ur
et
hene
c
e
s
s
ar
yi
nf
or
ma
t
i
on
b)ame
anst
oc
ommuni
c
at
et
hei
nf
or
mat
i
onr
e
mot
e
l
y
c
)ame
anst
odi
s
pl
ayt
hi
si
nf
or
mat
i
on
d)ame
anst
or
e
c
e
i
v
ef
e
e
dbac
k.
2)The
yc
anbepr
ac
t
i
c
e
danypl
ac
et
hene
c
e
s
s
a
r
ye
qui
pme
nti
sa
v
a
i
l
a
bl
e
. Cont
r
a
r
yt
opopul
ar
be
l
i
e
f
,t
e
l
e
me
di
c
i
nedoe
snotr
e
l
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t
e
l
l
i
t
ec
ommuni
c
a
t
i
ons
,de
s
pi
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et
hel
at
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e
rsus
e
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ul
ne
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s
i
npr
ovi
di
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c
e
s
st
ot
hemor
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mot
er
e
gi
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r
t
h. Ehe
al
t
hs
e
r
v
i
c
e
sa
r
ec
ommonl
y
pr
ovi
de
dus
i
ngor
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l
e
phonel
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ne
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,i
nt
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g
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at
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e
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vi
c
e
sdi
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alne
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wor
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SDN)
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oc
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l
ar
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ane
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wor
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LANs
)
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r
e
l
e
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oc
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la
r
e
ane
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wor
ks(
WLANs
)
,mobi
l
ec
ommuni
c
a
t
i
ons
s
ys
t
e
ms(
GSM)
,opt
i
c
alf
i
br
ec
abl
e
s
,t
heI
nt
e
r
ne
ta
ndi
nt
r
a
ne
t
s
.
3)The
r
ear
et
woc
ommuni
c
at
i
onmode
s― onl
i
nea
ndof
f
l
i
ne
.
4
)Theai
mi
ne
ac
hc
as
ei
st
oi
mpr
ov
et
hequal
i
t
yofe
he
al
t
hs
e
r
vi
c
e
swi
t
h:
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as
t
e
rdi
agnos
i
s
・i
mpr
ove
dt
r
e
at
me
nta
ndr
e
duc
e
dde
l
a
y
si
na
dmi
ni
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t
e
r
i
ngme
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c
at
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r
f
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mi
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s
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he
dul
e
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at
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nt
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ove
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ul
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bg
2
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e
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t
a
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e
duc
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t
s
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e
duc
t
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onofs
t
r
e
s
sa
ndt
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mepr
e
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ur
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ove
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nt
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a
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a
f
f
.
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mpor
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t
i
vei
st
oac
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e
vee
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onomi
e
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os
t
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orhe
al
t
hs
e
r
vi
c
e
s
. Some
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pi
t
alc
os
t
sa
r
ec
ove
r
e
dbyhe
al
t
hi
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ur
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es
c
he
me
s
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oc
os
ts
av
i
ngsf
r
om t
he
a
ppl
i
c
at
i
onoft
e
l
e
me
di
c
i
nei
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f
f
e
r
e
nta
r
e
asofme
di
c
als
pe
c
i
a
l
i
z
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t
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ont
r
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a
t
et
os
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ngs
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ors
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yasawhol
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ort
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ye
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s
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t
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t
t
e
nda
ntf
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nc
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a
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i
a
lbe
ne
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i
t
s
.
Pot
e
nt
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al
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f
e
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e
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l
dsofme
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a
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ne
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i
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om e
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t
h. Gi
ve
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d
t
ol
i
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opeoft
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e
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e
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e
por
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e
w oft
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e
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ti
nt
e
r
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s
tt
hatde
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opi
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c
ount
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e
shaves
howni
nt
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mpl
e
me
nt
a
t
i
ona
ndde
ve
l
opme
ntoft
e
l
e
pat
hol
og
yand
t
e
l
e
de
r
mat
ol
ogy,t
he
s
et
wof
i
e
l
dshavebe
e
ns
e
l
e
c
t
e
df
ore
x
ami
na
t
i
oni
ng
r
e
a
t
e
rde
t
ai
li
n
s
e
par
at
es
e
c
t
i
onsf
ur
t
he
rbe
l
ow.
Tel
ecar
di
ol
ogy
Thi
si
st
hepr
ac
t
i
c
eofc
ar
di
ol
og
yus
i
ngs
t
at
e
of
t
he
a
r
ti
nf
or
ma
t
i
onandc
ommuni
c
a
t
i
on
t
e
c
hnol
ogi
e
s(
Be
ol
c
hi2
003)
. Theai
mi
st
opr
ov
i
dec
hr
oni
c
al
l
yi
l
lpa
t
i
e
nt
swi
t
ha
c
c
e
s
st
o
s
pe
c
i
al
i
z
e
de
he
al
t
hs
e
r
vi
c
e
sa
ndi
nc
r
e
a
s
et
he
i
rqual
i
t
yofl
i
f
ebyr
e
duc
i
ngt
hec
os
toft
r
e
a
t
me
nt
andmi
ni
mi
z
i
ngt
hei
nc
onve
ni
e
nc
ec
aus
e
dbyt
hene
e
dt
ot
r
av
e
la
ndbypr
ol
ong
e
da
bs
e
nc
e
s
f
r
om homeandt
hewor
ki
nge
nv
i
r
onme
nt
.
Te
l
e
c
ar
di
ol
og
yor
i
gi
nat
e
dal
mos
t3
5ye
ar
sa
g
oi
nr
e
s
pons
et
ot
hene
e
dt
omoni
t
ort
he
c
ar
di
ovas
c
ul
a
rpar
ame
t
e
r
soft
hef
i
r
s
tpa
t
i
e
nt
sf
i
t
t
e
dwi
t
hi
mpl
ant
e
dpac
e
ma
ke
r
s
. Thi
sl
e
dt
o
t
hede
ve
l
opme
ntofe
ar
l
ys
i
ngl
e
l
e
adt
r
a
ns
t
e
l
e
phoni
ce
l
e
c
t
r
oc
ar
di
og
r
ams
. Cur
r
e
nt
l
y
,
i
ndi
vi
dual
swi
t
hpa
c
e
make
r
sf
or
mt
hel
a
r
g
e
s
tgr
oupofpat
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e
nt
sr
e
c
e
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vi
ngt
e
l
e
c
a
r
di
ol
og
i
c
a
l
c
ons
ul
t
at
i
onandc
ont
i
nuousmoni
t
or
i
ng
.
Fur
t
he
rde
ve
l
opme
nt
si
nal
la
s
pe
c
t
soft
e
l
e
c
a
r
di
ol
ogy
,a
ndi
t
swor
l
dwi
dedi
s
s
e
mi
nat
i
on,a
r
ei
n
pr
og
r
e
s
s
. Thi
si
sbe
c
aus
et
hemai
nbe
ne
f
i
c
i
a
r
i
e
soft
e
l
e
c
a
r
di
ol
og
yar
epat
i
e
nt
swi
t
h
c
a
r
di
ovas
c
ul
ardi
s
e
a
s
e
s(
CVD)
,al
t
houghi
ti
sal
s
ous
e
di
nc
a
s
e
sofki
dne
ydi
s
e
a
s
e
s
,pul
mona
r
y
di
s
e
as
e
s
,abnor
malpr
e
gnanc
i
e
se
t
c
. CVD a
f
f
l
i
c
t
smor
et
han60mi
l
l
i
onpe
opl
ei
nEur
opea
nd
al
mos
tt
hes
amenumbe
ri
nt
heUSA. CVDsa
r
et
hema
i
nc
aus
eofde
at
hi
nEur
opea
nd
Nor
t
hAme
r
i
c
a. CVDsa
r
enotonl
yt
hemos
tc
ommonc
hr
oni
cdi
s
e
a
s
e
s
,butt
he
yar
et
hemos
t
e
xpe
ns
i
vedi
s
e
as
e
sf
ore
he
al
t
hpr
ovi
de
r
s
.
Tel
eder
mat
ol
ogy
Thi
si
soneoft
hemos
tus
e
f
ula
ndr
e
wa
r
di
ngt
e
l
e
me
di
c
i
neappl
i
c
a
t
i
ons
,ass
ki
ndi
s
e
as
e
sar
e
e
xt
r
e
me
l
yc
ommon. Onequar
t
e
rofal
lpa
t
i
e
nt
ss
e
e
ki
ngme
di
c
alhe
l
pi
sdoi
ngt
hi
sbe
c
aus
eof
s
ki
ndi
s
e
as
e
. Whati
smor
e
,al
mos
ta
l
ls
ki
npr
obl
e
msa
r
eas
s
oc
i
at
e
dwi
t
hahi
g
hde
gr
e
eof
ps
yc
hol
ogi
c
aldi
s
c
omf
or
t
.
Te
l
e
de
r
mat
ol
ogyi
nvol
ve
sr
e
mot
ede
r
mat
ol
ogi
s
tc
ons
ul
t
a
t
i
onf
orpa
t
i
e
nt
sa
nd/ort
he
i
rpr
i
ma
r
y
he
a
l
t
hpr
ovi
de
r
s
,f
orpur
pos
e
sofdi
a
gnos
i
sa
ndmanag
e
me
ntadv
i
c
e(
Woot
t
on,Oa
kl
e
y,20
02
)
.
Ani
mpor
t
antpa
r
toft
e
l
e
de
r
ma
t
ol
ogyi
st
het
r
ans
f
e
rofi
ma
ge
s
. Thi
si
snotune
x
pe
c
t
e
d,a
s
de
r
ma
t
ol
ogi
s
t
shav
er
e
l
i
e
doni
mage
sa
sdi
ag
nos
t
i
ct
ool
sf
orde
c
a
de
s
.
I
nge
ne
r
alde
r
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udet
hef
a
c
t
t
hatpat
hol
og
yi
ma
gequa
l
i
t
yi
saf
unc
t
i
onofma
nypr
oc
e
s
s
e
s
,s
uc
haspr
oc
e
s
s
i
ngoft
i
s
s
ue
,
c
ut
t
i
ngands
t
a
i
ni
ngoft
hes
l
i
de
,abi
l
i
t
yoft
hemi
c
r
os
c
opet
of
or
m ac
l
e
a
r
,i
nf
oc
usi
mag
e
s
ui
t
abl
ef
orc
apt
ur
i
nge
t
c
. The
s
ea
ndot
he
rc
ha
l
l
e
ng
e
shav
el
i
mi
t
e
dt
heut
i
l
i
t
yandus
eof
pat
hol
ogyi
magi
ngandt
e
l
e
pa
t
hol
ogy. Fur
t
he
r
mor
e
,t
hedi
ve
r
s
i
t
y
,c
ompl
e
x
i
t
ya
nds
c
opeof
pa
t
hol
og
ya
ndme
di
c
a
lmi
c
r
os
c
opyhav
ema
dei
tdi
f
f
i
c
ul
tf
oror
g
a
ni
z
at
i
onst
oagr
e
eon
s
t
anda
r
dsf
orpat
hol
og
yi
magi
ng
. Ther
e
a
s
onsf
ort
hedi
f
f
i
c
ul
t
i
e
si
ns
t
anda
r
di
z
i
nggui
de
l
i
ne
s
ands
t
andar
dsi
npat
hol
ogyi
magi
ngar
ede
s
c
r
i
be
dbe
l
ow. The
n,me
t
hodsa
r
epr
opos
e
df
or
be
gi
nni
ngt
omovef
or
war
dons
t
andar
di
z
a
t
i
on. Thi
spr
oc
e
s
swi
l
lbec
ompl
i
c
a
t
e
dandwi
l
lnot
bec
ompl
e
t
e
danyt
i
mes
oon;none
t
he
l
e
s
s
,i
tne
e
dst
obes
t
ar
t
e
d.
Thepat
hol
o
gyenvi
r
onment
Thos
ewhowoul
da
t
t
e
mptt
ode
f
i
nes
t
a
ndar
dsorgui
de
l
i
ne
sf
orpa
t
hol
og
yi
mag
i
ngne
e
dt
o
haveac
l
e
arunde
r
s
t
andi
ngoft
hewi
des
c
opeofi
ma
ge qual
i
t
y or r
e
s
ol
ut
i
on ne
c
e
s
s
a
r
yf
or
i
mag
i
ngt
obeus
e
f
uli
npat
hol
ogy. Oneoft
hebe
s
twa
ysofde
s
c
r
i
bi
ngt
he
s
er
e
qui
r
e
me
nt
si
st
o
/
e
x
ami
net
hewayat
ypi
c
als
ur
gi
c
alpat
hol
ogi
s
tus
e
shi
she
rmi
c
r
os
c
ope
.I
ne
xa
mi
ni
ngs
ome
c
as
e
s
,t
hepat
hol
ogi
s
twi
l
lnotus
et
hemi
c
r
os
c
opeata
l
l
,ma
ki
ngadi
ag
nos
i
si
ns
t
e
adont
he
gr
os
sv
i
s
uale
xami
na
t
i
on. I
not
he
rc
as
e
s
,t
hepat
hol
ogi
s
twi
l
lus
ea4xobj
e
c
t
i
vel
e
ns(
wi
t
han
opt
i
c
a
lr
e
s
ol
ut
i
onof∼5mi
c
r
ons
)
,whi
l
ei
not
he
rc
as
e
sa2
0xl
e
ns(
opt
i
c
a
lr
e
s
ol
ut
i
onof∼1
mi
c
r
on)or4
0
xl
e
ns(
opt
i
c
alr
e
s
ol
ut
i
onof∼0
.
5mi
c
r
on)i
sus
e
d. Asaf
ur
t
he
ropt
i
on,t
he
r
e
ar
eve
r
ypowe
r
f
uloi
l
i
mme
r
s
i
onl
e
ns
e
sa
nd,be
y
ondt
ha
t
,e
l
e
c
t
r
onmi
c
r
os
c
opy. Thec
hoi
c
eof
opt
i
c
si
supt
ot
hepat
hol
ogi
s
t
,andhi
sorhe
rj
udgme
nta
st
owhati
sr
e
qui
r
e
df
ort
hec
as
eat
ha
nd. Thes
a
mear
g
ume
ntc
anbeappl
i
e
dt
oot
he
rf
a
c
t
or
st
ha
tha
v
eane
f
f
e
c
toni
mage
qua
l
i
t
y
,s
uc
hasc
ont
r
a
s
t
,t
i
s
s
ues
t
ai
ni
ngandt
i
s
s
uepr
oc
e
s
s
i
ng
.I
mag
i
ngg
ui
de
l
i
ne
si
n
pat
hol
ogyne
e
dt
ot
akei
nt
oac
c
ountt
hef
a
c
tt
hati
ti
supt
ot
hepa
t
hol
ogi
s
tt
ode
t
e
r
mi
nei
ft
he
s
pe
c
i
me
nori
magei
sofs
uf
f
i
c
i
e
ntqual
i
t
yt
or
e
nde
radi
ag
nos
i
s
.
Mi
cr
os
cop
yi
magi
ng
Thedi
f
f
i
c
ul
t
yofi
ma
ges
t
andar
di
z
at
i
oni
nt
e
l
e
pa
t
hol
ogyi
st
ha
ts
oma
nyf
a
c
t
or
sc
ani
nf
l
ue
nc
e
i
magequal
i
t
y
. Thef
ol
l
owi
ngs
ys
t
e
mc
ompone
nt
sar
er
e
qui
r
e
df
orage
ne
r
a
lpa
t
hol
ogy
i
ma
gi
ngs
t
at
i
on. 1)Mi
c
r
os
c
ope:t
he
s
ev
ar
ywi
de
l
yac
c
or
di
ngt
ot
ypeofmi
c
r
os
c
ope
,
ma
gni
f
i
c
a
t
i
on,t
ypeofobj
e
c
t
i
vel
e
ns
,c
onde
ns
e
r
,ape
r
t
ur
e
,f
i
l
t
e
r
sa
ndl
i
g
htvol
t
ag
e
. Eac
hus
e
r
/
c
anc
hang
eorc
hos
ee
ac
hi
t
e
me
v
e
r
yt
i
mehe
s
heus
e
si
t
.2
)Opt
i
c
alc
oupl
e
r:
t
hi
sc
onne
c
t
st
he
1
0
Yuka
koYa
g
i
,J
ohnR.Gi
l
be
r
t
s
on,MD,Uni
v
e
r
s
i
t
yofPi
t
t
s
bur
g
hMe
di
c
alCe
nt
r
e
,Pi
t
t
s
bur
g
h,PA,USA,UPMC
-28
＠i
Canc
e
rPav
i
l
i
on,Pi
t
t
s
bur
gh,USA,Te
l:
4
12
64
7
666
4,Fa
x:4
12
62
3
1
4,e
ma
i
l:y
a
gi
ma
p.
pi
t
t
.
e
du
3
3
a
b
c
d
e
Fi
g
.
1
mi
c
r
os
c
opeandc
ame
r
a,andi
ti
sa
nar
tt
oc
hoos
et
her
i
ghtone
.3
)Came
r
a:
t
he
r
ear
eana
l
og
anddi
gi
t
alt
y
pe
s
,wi
t
havar
i
e
t
yofpar
ame
t
e
r
ss
uc
hasCCD s
i
z
e
,s
ampl
i
ngi
nt
e
r
v
al
,dyna
mi
c
r
ange
,andc
ol
ourc
har
ac
t
e
r
i
s
t
i
c
s
. 4)Comput
e
rands
of
t
wa
r
e:
s
i
z
e
sofRAM andVRAM a
nd
CPU s
pe
e
dc
hanget
hes
pe
e
dofc
ont
r
ol
l
i
ngt
he
s
ehugei
mag
e
sa
ndt
henumbe
rofc
ol
our
st
o
di
s
pl
a
y. I
mag
ea
c
qui
s
i
t
i
ona
ndma
ni
pul
at
i
ons
of
t
wa
r
edi
r
e
c
t
l
yi
nf
l
ue
nc
ei
mag
equal
i
t
y
. 5)
Di
s
pl
ay:
Eac
hdi
s
pl
a
yha
sdi
f
f
e
r
e
ntc
ha
r
ac
t
e
r
i
s
t
i
c
s(
e
.
g.s
pat
i
a
lr
e
s
ol
ut
i
on,max
i
mum l
umi
na
nc
e
)
andt
heus
e
rc
anc
hanget
hebr
i
ght
ne
s
sa
ndc
ont
r
as
t
,af
f
e
c
t
i
ngpe
r
c
e
i
ve
di
ma
gequal
i
t
y. I
ti
s
a
l
s
oi
mpor
t
antt
opr
ope
r
l
yc
al
i
br
a
t
et
hedi
s
pl
a
ys
.6
)Compr
e
s
s
i
on/i
ma
gef
or
ma
t:
s
i
nc
et
he
i
mag
e
sa
r
es
ol
a
r
g
e
,i
ti
sof
t
e
nne
c
e
s
s
ar
yt
oc
ompr
e
s
st
hei
ma
g
e
s
. Wi
t
hr
e
s
pe
c
tt
oi
mage
qual
i
t
yanddi
ag
nos
t
i
cac
c
ur
ac
y,i
s
s
ue
ss
uc
ha
sa
c
c
e
pt
a
bl
ec
ompr
e
s
s
i
onr
at
i
oandwhe
t
he
rt
he
c
ompr
e
s
s
i
ons
houl
dbel
os
s
l
e
s
sorl
os
s
yar
ei
mpor
t
a
nt
.
Compr
e
s
s
i
on/
i
magef
or
mat:s
i
nc
et
hei
ma
ge
sar
es
ol
a
r
g
e
,i
ti
sof
t
e
nne
c
e
s
s
a
r
yt
oc
ompr
e
s
st
he
i
mage
s
. Wi
t
hr
e
s
pe
c
tt
oi
ma
gequa
l
i
t
yanddi
a
gnos
t
i
ca
c
c
ur
ac
y,i
s
s
ue
ss
uc
ha
sa
c
c
e
pt
abl
e
c
ompr
e
s
s
i
onr
a
t
i
oandwhe
t
he
rt
hec
ompr
e
s
s
i
ons
houl
dbel
os
s
l
e
s
sorl
os
s
yar
ei
mpor
t
ant
.
The
r
ear
es
omanypa
t
hol
ogyi
magi
ngs
y
s
t
e
mst
hatc
a
nbebui
l
twi
t
hmanypos
s
i
bl
e
c
ombi
nat
i
onsbe
c
aus
et
he
r
ear
emanyc
hoi
c
e
sf
ore
a
c
hc
ompone
ntoft
hes
ys
t
e
m. Ea
c
h
c
ompone
ntpr
e
s
e
nt
savar
i
e
t
yofopt
i
onst
ot
heus
e
r;
a
nde
a
c
hus
e
rc
anpi
c
kanyve
r
s
i
onof
e
ac
hc
ompone
nt
. Fur
t
he
r
mor
e
,t
hes
a
mes
ys
t
e
m wi
t
ht
hes
a
mec
ompone
nt
s
,whe
nope
r
at
e
dby
us
e
r
sofdi
f
f
e
r
e
ntl
e
ve
l
sofs
ki
l
la
ndknowl
e
dg
e
,c
a
nr
e
s
ul
ti
ndi
f
f
e
r
e
nti
mag
equal
i
t
yl
e
ve
l
s
.
Col
ourdi
f
f
e
r
e
nt
i
at
i
onsbe
t
we
e
ns
y
s
t
e
msa
r
es
howni
nFi
g
ur
e1.
Li
mi
t
at
i
onsofc
ur
r
entt
e
l
epat
hol
ogy
Te
l
e
pat
hol
ogyi
saus
e
f
ult
oolf
orr
e
mot
edi
a
gnos
i
si
npat
hol
og
y
,f
ore
duc
a
t
i
ona
ndf
or
obt
ai
ni
ngas
e
c
ondopi
ni
on. I
ti
se
s
pe
c
i
a
l
l
yus
e
f
uli
nt
hes
uppor
tofi
s
ol
a
t
e
dpat
hol
og
i
s
t
sa
nd
nons
pe
c
i
al
t
ypat
hol
ogi
s
t
s
. Howe
ve
r
,t
e
l
e
pa
t
hol
ogy,i
ng
e
ne
r
al
,hass
e
e
nl
i
mi
t
e
dus
ef
ort
he
f
ol
l
owi
ngr
e
as
ons
.
1)I
ti
sa
ne
xpe
ns
i
veandt
i
mec
ons
umi
ngpr
oc
e
s
s
.
2)Thel
i
mi
t
e
df
i
e
l
dofvi
e
w oft
e
l
e
pa
t
hol
og
yi
ma
g
e
s
,unl
i
kegl
as
ss
l
i
de
sdi
r
e
c
t
l
yvi
e
we
dona
mi
c
r
os
c
ope
,of
t
e
nmake
spat
hol
og
i
s
t
sf
e
e
lunc
omf
or
t
a
bl
e
.
3
4
Fi
g.
2
3
)The
r
ei
snowi
de
l
yac
c
e
pt
e
dme
t
hodt
ome
a
s
ur
et
hei
ma
gequa
l
i
t
yandac
c
ur
a
c
yofi
mag
e
par
ame
t
e
r
ss
uc
hasc
ol
our
.
I
nge
ne
r
al
,t
heus
e
soft
e
l
e
pat
hol
ogyar
ef
or1)pr
i
mar
ydi
a
gnos
i
s
,2)s
e
c
ondopi
ni
on,
3
)
e
duc
at
i
on/QA.Eac
hmayr
e
qui
r
eauni
quet
e
l
e
pa
t
hol
ogys
y
s
t
e
m de
s
i
g
n.
The
r
ear
es
e
ve
r
alge
ne
r
alt
y
pe
soft
e
l
e
pat
hol
ogys
ys
t
e
ms
.
1)I
ns
t
at
i
cmode(
s
t
or
eandf
or
wa
r
dorl
i
v
e
)
,i
ma
g
e
s(
t
y
pi
c
al
l
yonl
yaf
e
w)ar
ec
a
pt
ur
e
dand
t
r
ans
mi
t
t
e
df
ors
e
que
nt
i
alvi
e
wi
ng.
2)I
ndynami
cmo
de,l
i
vev
i
de
oi
mage
sa
r
et
r
ans
mi
t
t
e
da
ndvi
e
we
ddyna
mi
c
a
l
l
yi
nr
e
a
lt
i
me
.
3)Dy
nami
cs
ys
t
emswi
t
har
obot
i
cmi
c
r
o
s
co
pea
l
l
ow t
her
e
mot
ev
i
e
we
rt
oc
ont
r
olt
he
mi
c
r
os
c
opeatt
heor
i
gi
na
t
i
ngs
i
t
ef
oramor
ei
nt
e
r
ac
t
i
vee
xpe
r
i
e
nc
e
.
4)Co
mbi
ni
ngs
t
at
i
canddy
nami
cs
ys
t
e
mspr
oduc
ehybr
i
ds
y
s
t
e
mswi
t
he
v
e
nmor
ef
l
e
xi
bi
l
i
t
y
.
5
)Whol
es
l
i
dei
magi
ng(
vi
r
t
uals
l
i
dei
mag
i
ng)i
st
hene
we
s
tde
ve
l
opme
nti
nwhi
c
ht
hee
nt
i
r
e
s
l
i
dei
sdi
g
i
t
i
z
e
d,obv
i
at
i
ngt
hene
e
dt
os
e
l
e
c
ti
ndi
v
i
dua
lors
e
que
nt
i
a
li
mag
e
sf
orv
i
e
wi
ng
.
De
pe
ndi
ngont
her
e
qui
r
e
me
nt
sa
ndbudge
t
,di
f
f
e
r
e
ntt
ype
soft
e
l
e
pa
t
hol
ogys
y
s
t
e
ms― wi
t
h
di
f
f
e
r
e
ntl
e
ve
l
sofi
magequal
i
t
y― c
anbeus
e
d. Fur
t
he
r
mor
e
,asi
nt
hemor
eg
e
ne
r
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og
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ai
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os
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e
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ogys
ys
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e
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ve
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ompl
e
xt
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eands
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e
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a
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ai
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ants
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our
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ai
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e
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s
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e
r
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e
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ai
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ur
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gur
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ual
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ypat
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t
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rown
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our
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e
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i
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i
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e
a
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us
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ogi
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t
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e
s
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onv
e
nt
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at
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e
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anbee
ve
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t
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l
e
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og
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.
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e
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yt
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magi
ngs
ys
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e
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t
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t
a
t
i
ons
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at
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e
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e
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og
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or
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t
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at
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cs
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e
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i
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t
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ss
pe
c
i
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t
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ort
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ant
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e
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ywant
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mt
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i
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he
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e
l
e
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ogys
ys
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e
m,s
t
at
i
ci
ma
get
e
l
e
pa
t
hol
ogywor
ksve
r
ywe
l
l
. Howe
ve
r
,whe
nt
her
e
f
e
r
r
i
ng
/
pat
hol
ogi
s
tdoe
snothavee
noughc
onf
i
de
nc
ei
nhi
she
rowndi
a
g
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i
sorne
e
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i
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r
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i
st
ober
e
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r
e
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hes
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at
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ci
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et
e
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e
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t
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ogys
ys
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e
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a
nber
i
s
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a
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et
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ons
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og
i
s
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a
g
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i
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s
e
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nt
i
r
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l
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ans
mi
t
t
e
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mage
s
,whi
c
h
we
r
ec
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e
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her
e
f
e
r
r
i
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l
i
ni
c
i
an. Thei
ma
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l
i
t
yofs
t
a
t
i
ci
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e
sde
pe
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he
pe
r
s
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apt
ur
e
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he
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e
nt
i
al
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yl
i
mi
t
i
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l
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t
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ons
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t
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or
e
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c
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ur
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i
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c
i
s
i
on. I
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si
mpor
t
a
ntt
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r
s
t
andt
hata hi
g
hr
e
s
ol
ut
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on i
mage
i
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c
e
s
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ar
i
l
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t
yi
mage
,e
s
pe
c
i
al
l
yi
ft
heopt
i
c
a
li
mag
ef
r
om t
hemi
c
r
os
c
opei
s
outoff
oc
usorot
he
r
wi
s
ei
mpe
r
f
e
c
t
. Mos
ti
mage
sc
a
pt
ur
e
dbype
opl
ewhoar
enote
xpe
r
i
e
nc
e
d
i
nt
e
l
e
pat
hol
ogyordi
g
i
t
a
li
ma
gi
ngs
how pr
obl
e
mst
hata
r
er
e
l
at
e
dt
ot
heus
eoft
he
mi
c
r
os
c
ope
,s
uc
haspr
obl
e
mswi
t
hf
oc
usandc
ol
ourf
i
de
l
i
t
y
.
Dy
nami
ci
mag
et
e
l
ep
at
hol
ogyi
sl
i
mi
t
e
dbymanyoft
hef
a
c
t
or
sa
l
r
e
a
dyl
i
s
t
e
df
ors
t
at
i
c
t
e
l
e
pat
hol
ogy,i
naddi
t
i
ont
ot
hef
ac
tt
ha
tt
hedy
na
mi
ci
ma
gequal
i
t
yatt
her
e
c
e
i
ve
rs
i
t
e
de
pe
ndsont
heba
ndwi
dt
hofne
t
wor
kus
e
d(
a
ndt
heamountofc
ompr
e
s
s
i
onr
e
qui
r
e
d)
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n
pr
a
c
t
i
c
e
,mos
ts
ys
t
e
msus
i
ngH323orH3
2
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ordy
na
mi
ci
ma
ge
sc
annotpr
ov
i
dei
mag
equa
l
i
t
y
asg
oodass
t
at
i
cs
ys
t
e
ms
. Fort
hi
sr
e
a
s
on,oneof
t
e
nus
e
sbot
hs
t
a
t
i
ci
mag
eanddynami
c
i
ma
gi
ngi
nones
ys
t
e
m. Thi
swor
kswe
l
l
. Howe
v
e
r
,whe
nr
obot
i
cmi
c
r
os
c
ope
sa
r
eus
e
d,wi
t
h
mot
or
i
z
e
ds
t
ag
e
sf
orr
e
mot
ec
ont
r
ol
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hes
y
s
t
e
m ne
e
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pe
c
i
al
i
z
e
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qui
pme
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hati
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c
ommoni
npat
hol
ogypr
ac
t
i
c
e
s
,andi
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ami
l
i
art
opa
t
hol
ogi
s
t
s
. Cons
ul
t
i
ngpat
hol
ogi
s
t
s
c
a
nus
enonr
obot
i
cmi
c
r
os
c
ope
sf
ordyna
mi
ct
e
l
e
pa
t
hol
og
y,a
ndl
e
tt
her
e
f
e
r
r
i
ngs
i
t
ec
ont
r
ol
t
he
ms
oast
of
oc
usonar
e
asofi
nt
e
r
e
s
t
,butt
hes
a
mepr
obl
e
mswi
t
hs
t
a
t
i
ci
mag
eofa
r
e
a
s
e
l
e
c
t
i
onr
e
ma
i
n.
Anot
he
rf
ac
t
ori
nbot
hs
t
at
i
canddyna
mi
ct
e
l
e
pa
t
hol
ogys
ys
t
e
msi
st
ha
tc
ur
r
e
nts
y
s
t
e
msa
r
e
s
i
gni
f
i
c
ant
l
ys
l
owe
rt
hant
hemanualus
eofagl
a
s
ss
l
i
deonami
c
r
os
c
ope
. Nomat
t
e
rwhat
ki
ndofs
ys
t
e
m weus
e
,i
tt
ake
sl
onge
rf
ort
hepa
t
hol
og
i
s
tt
oma
keadi
ag
nos
i
sus
i
ng
t
e
l
e
pa
t
hol
ogyi
ma
ge
s
. Howe
ve
r
,i
ft
hepa
t
hol
og
i
s
tus
e
st
hes
ys
t
e
ma
spar
tofapat
hol
og
y
i
nf
or
mat
i
ons
ys
t
e
m,i
tmi
ghti
nt
hef
ut
ur
er
e
duc
et
hes
pe
c
i
a
l
i
s
tst
ot
alt
i
met
odi
ag
nos
eand
r
e
por
t
.
Aut
omat
e
dwhol
e
s
l
i
dei
ma
gi
ng(
WSI
)i
sane
wt
e
c
hnol
ogyt
hathasbr
oug
htt
hepos
s
i
bi
l
i
t
yof
s
t
a
nda
r
di
z
at
i
oni
npat
hol
ogyne
ar
e
r
. WSIi
nvol
v
e
sdi
g
i
t
i
z
i
ngofe
nt
i
r
es
l
i
de
s(
s
ot
he
r
ei
sno
i
s
s
ueofs
ubs
ampl
i
ng)
,t
hei
magi
ngpr
oc
e
s
sbe
i
ngaut
oma
t
e
d(
e
l
i
mi
nat
i
ngt
hene
e
dt
of
or
c
e
s
pe
c
i
f
i
cpar
ame
t
e
r
sande
l
i
mi
nat
i
nghuma
nf
ac
t
or
si
ni
mag
ec
apt
ur
e
)
. Howe
ve
r
,s
i
nc
et
he
t
e
c
hnol
ogyi
ss
t
i
l
lde
ve
l
opi
ng,i
twi
l
lt
a
kea
not
he
rf
e
wy
e
ar
sbe
f
or
ei
tbe
c
ome
sc
l
i
ni
c
a
l
l
y
3
6
Fi
g
.
3
a
vai
l
abl
eandaus
e
f
uls
ys
t
e
m. Fi
gur
e2s
howsani
ma
geobt
a
i
ne
dwi
t
haWSIs
y
s
t
e
m.
Met
hodsf
ors
t
andar
di
zat
i
oni
npat
hol
o
gy
Whe
nwet
hi
nkaboutme
di
c
ali
ma
ges
t
a
ndar
ds
,t
hi
sc
ommonl
yi
nc
l
ude
st
her
e
qui
r
e
di
ma
ge
r
e
s
ol
ut
i
on,t
henumbe
rofc
ol
our
s
,moni
t
orr
e
s
ol
ut
i
on,c
ompr
e
s
s
i
onr
at
i
o,f
or
mate
t
c
. As
me
nt
i
one
dabove
,pat
hol
og
yi
ma
gi
ngha
sawi
der
a
ng
eofr
e
qui
r
e
me
nt
s
,a
ndi
ss
ubj
e
c
tt
o
s
i
gni
f
i
c
a
nthuma
nf
ac
t
or
sa
ndnoni
magi
ngr
e
l
at
e
dpar
a
me
t
e
r
st
hatmakeas
i
ngl
es
t
andar
df
or
pa
t
hol
ogyi
mag
i
ngpr
obl
e
ma
t
i
c
. De
f
i
ni
ngar
e
qui
r
e
d pi
xe
lr
e
s
ol
ut
i
on i
sme
ani
ngl
e
s
si
ft
he
opt
i
c
alf
oc
usors
t
ai
ni
ngqua
l
i
t
yi
snotde
f
i
ne
d,ande
ve
ni
ft
he
s
epa
r
ame
t
e
r
sc
oul
dbede
f
i
ne
d,
t
hei
maget
ypeandqual
i
t
yr
e
qui
r
e
df
ors
omea
s
pe
c
t
sofpa
t
hol
og
yi
sr
a
di
c
al
l
ydi
f
f
e
r
e
ntf
r
om
t
ha
tr
e
qui
r
e
df
orot
he
r
s
. Onec
oul
dde
c
i
deonaf
i
l
ef
or
ma
tf
orf
i
l
et
r
ans
f
e
r
,butt
hi
swoul
d
nota
ddr
e
s
ss
omeoft
hemor
ebas
i
ci
s
s
ue
si
npat
hol
og
yi
magi
ng
.
Thei
mpor
t
antc
onc
e
pt
sf
orpat
hol
ogyi
ma
gi
ngs
t
andar
dst
oc
ons
i
de
ra
r
e:
1)Sys
t
e
mss
houl
dbeabl
et
os
har
ei
ma
g
ef
i
l
e
s
.
2
)Thes
t
andar
dss
houl
dal
l
ow t
het
r
ans
mi
s
s
i
onofi
nf
or
mat
i
ononbas
e
l
i
nec
ol
our
sa
nd
r
e
c
omme
nde
ddi
s
pl
aypar
ame
t
e
r
s
.
3)Thei
mage
ss
houl
dbeus
e
f
ult
ot
hepat
hol
ogi
s
t
,notne
c
e
s
s
ar
i
l
ybe
t
t
e
rorwor
s
et
ha
ndi
r
e
c
t
e
xami
nat
i
onofas
l
i
deunde
rt
hemi
c
r
os
c
ope
.
4)A me
c
hani
s
mt
oe
val
uat
ei
mag
equa
l
i
t
yobj
e
c
t
i
ve
l
ys
houl
dbepr
e
s
e
nt
.
5)A me
c
ha
ni
s
mt
oadj
us
ta
ndc
or
r
e
c
tmi
nore
r
r
or
soft
i
s
s
uepr
oc
e
s
s
i
ngs
houl
dbede
ve
l
ope
d.
6)A publ
i
cor
gani
z
at
i
ons
houl
ds
uppor
tpat
hol
og
i
s
t
si
nt
hede
v
e
l
opme
ntofs
t
anda
r
ds
.
Tomovepat
hol
ogyi
ma
gi
ngi
nt
oas
pac
ewhe
r
es
t
anda
r
dsc
anbee
f
f
e
c
t
i
ve
l
yappl
i
e
dt
he
r
ear
e
t
woma
i
nar
e
asofa
t
t
ac
k. Onei
nvol
ve
sf
or
ma
lt
r
ai
ni
ngofpa
t
hol
ogi
s
t
si
ni
mag
i
ngand
i
ma
ge
r
e
l
a
t
e
dac
t
i
v
i
t
i
e
s
. Thi
smayt
a
ket
hef
or
m ofawe
bbas
e
df
or
malt
r
a
i
ni
ngpr
oc
e
s
si
n
di
agnos
t
i
ci
ma
gi
ng(
e
.
g.c
ont
i
nui
nge
duc
a
t
i
onc
our
s
e
s
)
. Thes
e
c
onda
r
e
a
,mor
edi
r
e
c
t
l
y
appl
i
c
a
bl
et
ot
hi
spape
r
,i
st
hede
ve
l
opme
ntoft
e
c
hni
c
alme
c
hani
s
mst
or
e
movehuma
nf
a
c
t
or
i
s
s
ue
si
nt
hei
mag
ec
a
pt
ur
epr
oc
e
s
s
. Thegoal
sa
r
et
oc
or
r
e
c
t(
oratl
e
as
ti
de
nt
i
f
y
)di
f
f
e
r
e
nc
e
s
be
t
we
e
ns
ys
t
e
msa
ndmat
e
r
i
al
s
,t
ode
v
e
l
opt
e
c
hni
c
alpr
ot
oc
ol
sf
ore
val
ua
t
i
ngand/org
r
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di
ng
i
magequal
i
t
yobj
e
c
t
i
ve
l
y
,andf
i
nal
l
y,t
ode
pl
oyc
ol
ours
t
anda
r
di
z
at
i
ont
e
c
hnol
og
y.
3
7
Toavoi
dhumanf
ac
t
or
s
,aut
oma
t
e
d,whol
e
s
l
i
dei
mag
i
ngr
obot
sa
nd/ori
ma
gi
ngmi
c
r
os
c
ope
s
maypr
ovi
deas
ol
ut
i
on(
Fe
r
r
e
i
r
aR,e
ta
l
. 19
97;
GuJ
,Og
i
l
vi
eR i
npr
e
s
s
)
. Howe
ve
r
,t
he
s
e
s
ys
t
e
mshavenoty
e
ta
c
hi
e
ve
dc
l
i
ni
c
alpr
oduc
ts
t
at
us
,andar
el
i
mi
t
e
dt
og
r
oupst
hata
r
ea
bl
et
o
af
f
or
dt
he
m. Al
s
o,i
tt
ake
st
i
meandt
r
a
i
ni
ngf
orpat
hol
og
i
s
t
st
oi
nt
e
r
pr
e
tWSIi
nanopt
i
ma
l
wa
y. Howe
v
e
r
,i
ti
sc
l
e
art
hats
uc
hs
y
s
t
e
mswi
l
lbe
c
omemor
ewi
de
s
pr
e
a
di
nt
hene
x
ts
e
v
e
r
a
l
ye
ar
s
.I
magi
ngmi
c
r
os
c
ope
s(
r
obot
i
cmi
c
r
os
c
ope
swi
t
hbui
l
t
i
nc
a
me
r
asa
ndr
obot
i
cs
t
ag
e
s
)c
an
pot
e
nt
i
al
l
yr
e
movepr
obl
e
msr
e
l
a
t
e
dt
ot
hehumanf
a
c
t
or
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uc
hasv
ar
i
a
t
i
onsbe
t
we
e
nus
e
r
si
n
t
e
r
msofmi
c
r
os
c
opef
oc
us
,f
i
l
t
e
randbr
i
ght
ne
s
ss
e
t
t
i
ng
s
. Byha
vi
ngt
he
s
epar
ame
t
e
r
s
s
of
t
war
e
c
ont
r
ol
l
e
d,t
he
s
es
ys
t
e
msc
anhe
l
pa
c
hi
e
v
ear
e
asofi
ma
gequal
i
t
ys
t
anda
r
di
z
a
t
i
on.
Aut
omat
e
dwhol
e
s
l
i
dei
magi
ngr
obot
sc
a
pt
ur
eac
ompl
e
t
eg
l
as
ss
l
i
de(
pr
e
f
e
r
abl
yf
a
s
te
noug
ht
o
beus
e
f
ulf
orr
e
mot
edi
agnos
i
sf
orf
r
oz
e
ns
e
c
t
i
ons
)wi
t
houthumani
nt
e
r
ve
nt
i
on. Wi
t
ht
he
a
ddi
t
i
onofa
ut
omat
e
ds
l
i
del
oa
de
r
sa
ndbar
c
ode
s
,a
l
ongwi
t
hc
ont
r
ols
l
i
de
st
omoni
t
or
r
e
s
ol
ut
i
onandc
ol
ourpar
ame
t
e
r
s
,t
he
s
es
ys
t
e
msc
anaut
omat
et
hee
nt
i
r
ei
mag
epr
oc
e
s
s
.
Sys
t
e
mst
os
uppor
tt
he
s
eQA f
unc
t
i
onsa
r
ebe
i
nge
v
al
ua
t
e
da
tPi
t
t
s
bur
gh,Ar
i
z
onaa
ndot
he
r
c
e
nt
r
e
s
. Thi
ss
houl
dl
e
adt
oamaj
ori
mpr
ov
e
me
nti
nt
e
l
e
pat
hol
ogyi
mag
i
ng
,a
ndope
nt
he
doorf
ore
x
t
e
ns
i
vequal
i
t
yc
ont
r
olandi
magequa
l
i
t
ys
t
andar
di
z
at
i
ont
e
c
hni
que
s
.
I
magequal
i
t
ye
val
uat
i
oni
sa
not
he
ri
mpor
t
antf
ac
t
or
. Cur
r
e
nt
l
y
,t
heme
t
hodsus
e
dt
oe
v
a
l
ua
t
e
i
magequal
i
t
yar
eve
r
ys
ubj
e
c
t
i
veandvar
ybe
t
we
e
ni
ndi
vi
dual
sa
ndi
ns
t
i
t
ut
i
ons
. Thi
s
s
ubj
e
c
t
i
vi
t
ydoe
snotne
c
e
s
s
a
r
i
l
yaf
f
e
c
tdi
a
gnos
i
sbyt
e
l
e
pa
t
hol
og
yand/
ort
hei
ma
gi
ngs
y
s
t
e
m.
Howe
ve
r
,ast
e
l
e
pa
t
hol
ogys
ys
t
e
msbe
c
omemor
epopul
a
randmor
eubi
qui
t
ous
,i
twi
l
lbe
c
ome
ne
c
e
s
s
ar
yt
ode
ve
l
opmor
eobj
e
c
t
i
v
ei
ma
gequa
l
i
t
ya
s
s
e
s
s
me
ntme
t
hods
. Eve
ns
ome
t
hi
ngas
ne
w andunt
e
s
t
e
dast
hewhol
e
s
l
i
dei
mag
e
ri
smaki
ngr
api
di
nr
oa
dsi
nt
ot
e
l
e
pa
t
hol
og
y
,a
nd
s
e
ve
r
alc
omme
r
c
i
als
ys
t
e
msa
r
eavai
l
abl
eont
hemar
ke
t
. Eac
hs
y
s
t
e
mg
i
ve
sadi
f
f
e
r
e
ntv
i
s
ua
l
i
mpr
e
s
s
i
onoft
hei
mage
s
,anddi
f
f
e
r
e
ntmode
l
soft
hes
ames
ys
t
e
m gi
vedi
f
f
e
r
e
nti
mpr
e
s
s
i
ons
andi
mag
equal
i
t
y. Wedonotknow wha
tl
e
ve
lofqual
i
t
yofi
mag
ewer
e
a
l
l
yne
e
df
orc
l
i
ni
c
a
l
us
e
s
,f
ore
duc
a
t
i
onorf
orr
e
s
e
ar
c
hpur
pos
e
s
,c
ompl
i
c
at
i
ngt
hepr
obl
e
m ofs
t
a
ndar
di
z
at
i
on. At
t
heUni
ve
r
s
i
t
yofPi
t
t
s
bur
ghMe
di
c
alCe
nt
r
e
,weha
vej
us
ts
t
ar
t
e
di
nt
hi
sl
i
neofr
e
s
e
ar
c
h,
Fi
g.
4
3
8
de
ve
l
opi
ngas
ys
t
e
mt
oe
val
uat
ei
magequa
l
i
t
yobj
e
c
t
i
v
e
l
yandde
f
i
net
hel
e
v
e
lofqua
l
i
t
yf
or
e
a
c
hpur
pos
e
. Theappr
oac
hc
anbeappl
i
e
dt
oa
nyki
ndofi
mag
i
ngs
y
s
t
e
mf
orpa
t
hol
og
y.
Fi
gur
e4i
l
l
us
t
r
at
e
st
hepr
ot
ot
ypeappl
i
c
at
i
on.
Tel
epat
hol
o
gyf
ordevel
o
pi
ngcount
r
i
e
s
Theke
yf
unc
t
i
ona
l
i
t
yofat
e
l
e
pa
t
hol
og
ys
y
s
t
e
mi
st
hea
bi
l
i
t
yt
oal
l
ow al
oc
alphy
s
i
c
i
ant
os
e
nd
mi
c
r
os
c
opei
mage
sofat
i
s
s
ues
e
c
t
i
on,al
ongwi
t
ht
e
xtt
ode
s
c
r
i
bet
hec
l
i
ni
c
alc
ont
e
x
t
,t
ot
he
r
e
mot
epat
hol
ogye
x
pe
r
t
.I
nt
heUSA andEur
ope
,pa
t
hol
ogyi
ma
g
i
ngandt
e
l
e
pa
t
hol
ogyar
e
movi
ngt
ot
heus
eofWSI
,andpa
t
hol
og
i
s
t
sa
r
ea
bl
et
ol
ookatt
hevi
r
t
ua
ls
l
i
det
hr
ought
he
I
nt
e
r
ne
tf
r
om anywhe
r
ei
nt
hewor
l
d. Howe
ve
r
,i
nt
hec
a
s
eofde
ve
l
opi
ngnat
i
ons
,popul
a
r
t
e
l
e
pat
hol
ogyi
ss
t
i
l
lbas
e
done
mai
l(
s
e
nde
rc
a
pt
ur
e
ss
t
at
i
ci
mag
e
sa
nds
e
ndst
he
ma
se
mai
l
at
t
ac
hme
nt
s
,wi
t
habr
i
e
fc
as
ede
s
c
r
i
pt
i
on)duet
ol
i
mi
t
e
dne
t
wor
kbandwi
dt
handt
e
c
hni
c
al
s
uppor
t
.
I
ns
omec
as
e
s
,t
he
r
ei
snote
ve
nahi
s
t
ol
og
yl
a
bt
opr
ovi
dehi
s
t
ol
og
ys
l
i
de
sf
ormi
c
r
os
c
ope
e
x
ami
nat
i
onbyapat
hol
ogi
s
t
. Now,asc
ur
r
e
ntt
e
l
e
pat
hol
ogypr
a
c
t
i
c
ede
pe
ndson
s
l
i
de
mount
e
d,s
t
ai
ne
dt
i
s
s
ues
ampl
e
s
,t
hi
sa
bs
e
nc
emake
si
tdi
f
f
i
c
ul
tt
os
e
tupa
ndr
una
t
e
l
e
pat
hol
ogys
e
r
vi
c
e
. TheUni
ve
r
s
i
t
yofBa
s
e
li
nSwi
t
z
e
r
l
andha
si
ns
t
al
l
e
das
mal
lhi
s
t
ol
ogy
l
abatt
henat
i
onalr
e
f
e
r
r
alhos
pi
t
alofHoni
ar
a,Sol
omonI
s
l
ands
. Spe
c
i
me
nsa
r
enow
pr
e
pa
r
e
dl
oc
a
l
l
y
,andt
hehi
s
t
ol
ogyi
mag
e
sar
es
e
ntt
ot
hes
e
r
v
e
ri
nBa
s
e
l
,whe
r
epat
hol
ogi
s
t
s
f
r
om Eur
opeandt
heUSc
anr
e
vi
e
wt
hec
as
e
sa
ndpr
ov
i
deadi
a
g
nos
i
s
. Cur
r
e
nt
l
yt
he
r
ear
eno
pat
hol
ogi
s
t
spr
ac
t
i
c
i
ngi
nt
heSol
omons(
Br
auc
hl
iK e
tal
.2
004
)
.
Att
heUni
ve
r
s
i
t
yofPi
t
t
s
bur
g
hMe
di
c
a
lCe
nt
r
e
,awe
bbas
e
dt
e
l
e
pat
hol
og
ys
y
s
t
e
m(
s
t
or
ea
nd
f
or
wa
r
d)andane
mai
lbas
e
ds
ys
t
e
ma
r
ebe
i
ngus
e
dt
opr
ovi
deas
s
i
s
t
a
nc
et
oanumbe
rof
c
ount
r
i
e
s
,i
nc
l
udi
ngEgypta
ndI
ndi
a. Theas
s
i
s
t
anc
ec
ons
i
s
t
sofl
i
mi
t
e
dt
e
c
hni
c
a
ls
uppor
tby
he
l
pde
s
ks
t
af
fandi
magi
ngs
of
t
wa
r
et
ool
sandme
di
c
als
uppor
tbypa
t
hol
ogi
s
t
s
. Thes
c
opeof
t
hewe
bba
s
e
dt
e
l
e
pa
t
hol
og
ys
ys
t
e
m wasr
e
duc
e
dt
omaket
hes
ys
t
e
ms
i
mpl
e
r
.I
naddi
t
i
on,
a
c
c
e
s
sha
sbe
e
npr
ov
i
de
dt
ot
hewe
bs
i
t
e
sof
f
e
r
i
ngar
c
hi
ve
de
duc
at
i
onalc
onf
e
r
e
nc
ev
i
de
os
,a
nd
//
t
ot
heWSIs
i
t
ec
ont
ai
ni
nge
duc
at
i
ona
lc
as
e
s(
ht
t
p:
t
e
l
e
pat
hol
og
y
.
upmc
.
e
du)
.
I
npr
ovi
di
ngt
e
l
e
pat
hol
ogys
uppor
tt
ode
ve
l
opi
ngc
ount
r
i
e
s
,at
ot
als
e
r
vi
c
e
sa
ppr
oa
c
hs
houl
dbe
c
ons
i
de
r
e
d;
t
hi
si
nc
l
ude
ss
e
t
t
i
ngupt
hel
abor
at
or
y,t
r
ai
ni
ngl
abt
e
c
hni
c
i
a
nsa
ndpa
t
hol
og
i
s
t
s
,
pr
ovi
di
ngr
e
mot
es
y
s
t
e
ms
uppor
ta
ndt
r
a
i
ni
ng,di
ag
nos
i
s
,andc
as
ema
i
nt
e
nanc
e
. Ex
i
s
t
i
ng
i
nf
r
as
t
r
uc
t
ur
eandne
wt
e
c
hnol
ogi
e
sc
andov
e
t
ai
lt
opr
ov
i
dene
e
de
ddi
ag
nos
t
i
cs
e
r
vi
c
e
s
,wi
t
h
t
r
ai
ni
ngbe
ne
f
i
t
sf
ort
heme
di
c
alpr
of
e
s
s
i
ona
l
si
nv
ol
ve
d. I
nt
hi
swa
y
,pe
opl
ei
nde
ve
l
opi
ng
c
ount
r
i
e
swi
l
lhaveanoppor
t
uni
t
yt
obe
ne
f
i
tf
r
om t
hemor
eadva
nc
e
dt
e
c
hnol
ogi
e
snow
av
a
i
l
abl
e
.
Re
f
er
ences
［1］Br
a
uc
hl
iK e
tal
. Te
l
e
pa
t
hol
og
yont
heSol
omonI
s
l
ands
t
woy
e
a
r
se
xpe
r
i
e
nc
ewi
t
hahy
br
i
dWe
ba
nd
e
ma
i
l
ba
s
e
dt
e
l
e
pa
t
hol
og
ys
ys
t
e
m i
nJ Te
l
e
me
d Te
l
e
c
ar
e.2
0
0
4;1
0Suppl1:
1
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Re
s
pons
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r
om t
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s
t
Der
mat
ol
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ul
t
antRe
s
pons
e
Dat
e:2Apr
i
l
,2005
Dat
er
ef
er
r
alr
ecei
ved:1Apr
i
l
,2005
Tel
eder
mat
ol
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ySi
t
e:Ge
or
ge
Pat
i
entc
ode:7Out
pat
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Pr
ov
i
d
erc
o
de:
1
Co
ns
ul
t
antName:RoyCol
ve
n,MD
I
ns
t
i
t
ut
i
o
n:
UCT
4
5
NumberofI
mages:6
Tot
alf
i
l
es
i
z
e:8.
2MB
Cas
eSummar
y
XX ye
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d HI
V. St
ap
hc
ar
r
i
ag
ei
s
l
i
ke
wi
s
epr
e
v
al
e
nti
nHI
V pat
i
e
nt
s
,maki
ngs
e
c
ondar
yi
nf
e
c
t
i
onal
i
ke
l
ye
v
e
nt
. Thi
si
sno
tt
o
s
ayt
hathec
oul
dnthav
eat
opi
ce
c
z
e
ma,o
ranot
he
rs
y
s
t
e
mi
cc
aus
eo
fi
t
c
hi
ngwi
t
hs
e
c
ondar
y
l
e
s
i
onsf
r
om s
c
r
at
c
hi
ngt
hathav
ebe
c
o
mei
nf
e
c
t
e
d. Se
c
ondar
ys
yp
hi
l
i
sus
ual
l
ydo
e
s
nte
r
ode
,
and t
heoneye
arhi
s
t
or
ywoul
d maket
hi
sunl
i
ke
l
y. Eas
yt
or
ul
eo
ut
,t
ho
ugh.
Re
commendat
i
ons
Ic
ompl
e
t
e
l
yagr
e
ewi
t
hyourmanage
me
ntt
husf
ar
.I
naddi
t
i
ont
ot
hef
l
uc
l
o
xac
i
l
l
i
nand
p
he
ne
r
gan,Iwoul
d al
s
ogi
v
ehi
m at
op
i
c
als
t
e
r
o
i
dt
ohe
l
pr
e
duc
et
hes
ympt
omsf
r
om t
he
s
e
c
hr
o
ni
cl
e
s
i
ons
. Ei
t
he
rLe
nov
at
eor10% Dov
at
eo
i
nt
me
ntwo
ul
ds
uf
f
i
c
e
,whi
c
he
v
e
ryo
uc
an
g
i
v
ehi
mi
nr
e
as
onab
l
equant
i
t
y. Ul
t
i
mat
e
l
y,i
f hi
s
Pl
e
as
el
e
tmeknow t
her
e
s
ul
t
sof hi
sHI
Vt
e
s
t
.
(
Foot
not
e:HI
Vs
e
r
opos
i
t
i
ves
ubs
e
que
nt
l
y)
Feedbackf
orRe
f
er
r
i
ngPr
ovi
der
I
magequal
i
t
y:
Exc
e
l
l
e
nt
Hi
s
t
or
i
cald
at
a: Suf
f
i
c
i
e
nt
Co
mment
s:
None
Educat
i
onalval
ue:
Hi
gh
Re
vi
ew d
ur
i
ngne
xts
i
t
evi
s
i
t
?Ye
s
Re
f
er
ences
(
As
s
umi
ngt
hi
spat
i
e
nte
ndsupbe
i
ngHI
V＋)Ful
lPDF o
ft
hi
sar
t
i
c
l
ei
sat
t
ac
he
ds
e
par
at
e
l
y
.
Et
i
ol
ogyo
fp
r
ur
i
t
i
cpapul
arer
upt
i
onwi
t
hHI
Vi
nf
e
ct
i
o
ni
nUg
and
a.
Re
s
neckJSJr
,VanBeekM,Fur
mans
kiL,Oyug
iJ,LeBo
i
tPE,Kat
ab
i
r
aE,Kamb
ug
uF,
Maur
e
rT,Be
r
g
erT,Pl
et
c
herMJ,Macht
i
ngerEL.
De
par
t
me
ntofDe
r
ma
t
ol
ogyandI
ns
t
i
t
ut
ef
orHe
al
t
hPol
i
c
ySt
udi
e
s
,Uni
v
e
r
s
i
t
yofCa
l
i
f
or
ni
a
,
4
6
SanFr
anc
i
s
c
o,Sc
hoolofMe
di
c
i
ne
,CA 9
4
14
303
63
,USA.r
e
s
ne
c
k＠i
t
s
a.
uc
s
f
.
e
du
CONTEXT:A f
r
e
que
ntc
aus
eofhumani
mmunode
f
i
c
i
e
nc
yvi
r
us(
HI
V)r
e
l
a
t
e
dmor
bi
di
t
yi
n
s
ubSahar
anAf
r
i
c
ai
sac
ommonl
yoc
c
ur
r
i
ng
,i
nt
e
ns
e
l
ypr
ur
i
t
i
cs
ki
nr
as
h. Ther
e
s
ul
t
i
ngs
c
a
r
s
ar
edi
s
f
i
g
ur
i
ngands
t
i
g
mat
i
z
i
ng. De
s
pi
t
et
hes
ubs
t
a
nt
i
a
lpr
e
val
e
nc
eofpr
ur
i
t
i
cpa
pul
a
r
e
r
upt
i
on(
PPE)a
mongHI
Vi
nf
e
c
t
e
dAf
r
i
c
ans
,t
hec
aus
eha
sbe
e
ne
l
us
i
v
e
. OBJ
ECTI
VE:
To
de
t
e
r
mi
net
hee
t
i
ol
ogyofPPE oc
c
ur
r
i
ngi
nHI
Vi
nf
e
c
t
e
di
ndi
vi
dual
s
. DESI
GN,SETTI
NG,
AND PATI
ENTS:Cr
os
s
s
e
c
t
i
onals
t
udyofHI
Vi
nf
e
c
t
e
dpa
t
i
e
nt
swi
t
ha
c
t
i
vePPE f
r
om c
l
i
ni
c
s
i
nUg
andac
onduc
t
e
df
r
om Ma
y19t
hr
oughJ
une6,2
0
03. Enr
ol
l
me
ntoc
c
ur
r
e
di
nt
hemont
h
pr
e
c
e
di
ngMay19
. Eac
hpar
t
i
c
i
pantwa
sc
l
i
ni
c
a
l
l
ye
x
ami
ne
dby2de
r
ma
t
ol
og
i
s
t
s
,ha
d
l
a
bor
at
or
ys
t
udi
e
spe
r
f
or
me
d,wa
sa
dmi
ni
s
t
e
r
e
da
ne
pi
de
mi
ol
ogi
cque
s
t
i
onna
i
r
e
,andha
das
ki
n
bi
ops
yofane
wl
e
s
i
one
va
l
uat
e
dbyade
r
ma
t
opa
t
hol
ogi
s
t
. MAI
N OUTCOME MEASURES:
Hi
s
t
ol
ogi
c
alc
har
ac
t
e
r
i
s
t
i
c
sofne
w pr
ur
i
t
i
cl
e
s
i
ons
. Ot
he
ra
s
s
e
s
s
me
nt
si
nc
l
ude
dCD4c
e
l
l
c
ount
,e
os
i
nophi
lc
ount
,andphys
i
c
i
ana
s
s
e
s
s
e
dr
as
hs
e
ve
r
i
t
y
. RESULTS:Of1
09pat
i
e
nt
s
me
e
t
i
ngi
nc
l
us
i
onc
r
i
t
e
r
i
a,102(
9
3.
6%)c
ompl
e
t
e
dt
hes
t
udy
. TheCD4c
e
l
lc
ount
si
nt
hi
ss
t
udy
/
popul
at
i
onwe
r
ege
ne
r
al
l
yl
ow (
me
di
a
n,46mi
c
r
oL)a
ndi
nve
r
s
e
l
yr
e
l
a
t
e
dt
oi
nc
r
e
as
i
ngr
a
s
h
s
e
ve
r
i
t
y(
me
di
anCD4c
e
l
lc
ount
s:
122f
ormi
l
d,41f
ormode
r
at
e
,a
nd9f
ors
e
v
e
r
e;
P＜.
0
0
1f
or
t
r
e
nd)
. Ei
g
ht
ys
i
xpa
t
i
e
nt
s(
84
%;9
5%c
onf
i
de
nc
ei
nt
e
r
v
al
,7
7%91
%)ha
dbi
ops
yf
i
ndi
ng
s
c
har
ac
t
e
r
i
s
t
i
cofa
r
t
hr
opodbi
t
e
s
. Pat
i
e
nt
swi
t
har
t
hr
opodbi
t
e
sonbi
ops
yha
ds
i
g
ni
f
i
c
ant
l
y
/mi
hi
ghe
rpe
r
i
phe
r
ale
os
i
nophi
lc
ount
s(
me
di
a
n,3
3
0vs180
c
r
oL;
P＝ .
02
)a
ndhadat
r
e
nd
t
owa
r
dl
owe
rCD4c
e
l
lc
ount
s(
me
di
an,4
0vs9
9/
mi
c
r
oL;
P＝ .
0
7
)t
hant
hos
ewi
t
hout
hi
s
t
ol
ogi
c
a
le
v
i
de
nc
eofa
r
t
hr
opodbi
t
e
s
. CONCLUSI
ONS:
Pr
ur
i
t
i
cpapul
are
r
upt
i
on
oc
c
ur
r
i
ngi
nHI
Vi
nf
e
c
t
e
di
ndi
vi
dual
sma
ybear
e
a
c
t
i
ont
oa
r
t
hr
opodbi
t
e
s
. Wehypot
he
s
i
z
e
t
hatt
hi
sc
ondi
t
i
onr
e
f
l
e
c
t
sanal
t
e
r
e
da
nde
x
a
gge
r
a
t
e
di
mmuner
e
s
pons
et
oar
t
hr
opoda
nt
i
g
e
ns
i
nas
ubs
e
tofs
us
c
e
pt
i
bl
eHI
Vi
nf
e
c
t
e
dpat
i
e
nt
s
.
Thank y
ouf
o
rr
e
f
e
r
r
i
ngt
hi
spat
i
e
nt
!
I
mmedi
at
ebe
nef
i
t
s
I
mme
di
a
t
ebe
ne
f
i
t
soft
hene
t
wor
kt
husf
a
rha
v
ebe
e
ne
nhanc
e
me
ntoft
r
i
ag
e
,di
a
gnos
t
i
c
s
uppor
t
,ands
ki
ndi
s
e
as
emanage
me
ntg
ui
da
nc
ef
r
om ade
r
mat
ol
og
i
s
t
. Thet
e
l
e
de
r
mat
ol
ogi
s
ts
r
e
s
pons
ewa
s1
00%andt
i
me
l
y,us
ual
l
ywi
t
hi
n35day
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r
e
s
pons
et
i
me
sr
a
ng
ef
r
om l
e
s
st
ha
n
onehourt
os
e
ve
nday
s
)
. Ther
e
s
pons
e
,wi
t
ht
her
e
f
e
r
r
ali
mage
s
,we
r
eava
i
l
abl
et
og
oi
nt
ot
he
pa
t
i
e
ntsme
di
c
a
lr
e
c
or
df
orf
ut
ur
er
e
f
e
r
e
nc
e
. Ther
e
f
e
r
r
i
ngpr
ovi
de
ra
l
s
obe
ne
f
i
t
e
df
r
om
l
e
ar
ni
ngabouts
ki
ndi
s
e
as
emana
ge
me
ntand,whe
nr
e
f
e
r
e
nc
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swe
r
epr
ov
i
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d,mor
eg
e
ne
r
a
l
r
e
adi
ngont
her
e
f
e
r
r
e
dpa
t
i
e
ntsc
ondi
t
i
on. A f
ur
t
he
re
duc
at
i
onalbe
ne
f
i
twa
sgl
e
ane
dwhe
n
t
hePIr
e
vi
s
i
t
e
dt
hes
i
t
e
st
or
e
vi
e
wt
hec
as
e
swi
t
ht
hepr
ov
i
de
r
s
. Thi
swa
smos
ta
ppar
e
nti
n
Ge
or
ge
,W.C.
,whe
r
et
hePIr
e
vi
s
i
t
e
dt
og
i
v
eapr
of
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s
s
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lde
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e
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opme
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ort
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ne
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alpr
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i
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ndwa
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bl
et
or
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e
wc
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s
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e
c
t
l
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t
ht
her
e
f
e
r
r
i
ng
pr
ovi
de
r
s
. Thi
sv
i
s
i
ta
l
s
os
e
r
ve
di
nt
r
oubl
e
s
hoot
i
ngf
ora
nydi
f
f
i
c
ul
t
i
e
swi
t
ht
hes
y
s
t
e
m. The
PIf
ur
t
he
r
mor
ee
s
t
abl
i
s
he
dawe
e
kl
yr
e
vi
e
w oft
het
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e
de
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mat
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ogyr
e
f
e
r
r
al
swi
t
ht
hes
t
af
f
,
i
nc
l
udi
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r
ai
ne
e
s
,i
nt
hede
r
mat
ol
ogydi
v
i
s
i
ona
tUCT. Thi
swe
e
kl
yt
e
l
e
de
r
mat
ol
og
yr
e
v
i
e
w
s
e
s
s
i
onhasbe
c
omear
out
i
nepar
toft
het
r
a
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ni
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ur
r
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c
ul
um. Las
t
l
y
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hene
t
wor
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s
pr
ov
i
de
dani
nt
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c
ont
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og
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e
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l
e
ng
i
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r
ma
t
ol
og
y
c
a
s
e
sf
r
om UCT a
ndUW ha
vebe
e
ne
xc
ha
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df
ort
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a
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on. A l
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v
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ac
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l
dbe
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nt
het
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t
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e
s
.
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t
f
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s
Thes
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s
t
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m hasnotbe
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nwi
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t
f
al
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s
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mageut
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l
i
t
y
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houg
hus
ual
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yve
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ygoodt
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l
e
nt
,
c
anvar
y,i
nt
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t
yandbodys
i
t
e
. Upl
oadi
ngi
ma
ge
sa
ndhi
s
t
or
yt
a
ke
st
i
me
4
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outofabus
ypr
i
mar
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de
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c
he
dul
e
. Obt
a
i
ni
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nf
or
me
dc
ons
e
nta
ndans
we
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i
ng
que
s
t
i
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r
e
si
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i
ke
wi
s
ebur
de
ns
omef
orabus
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al
t
hc
a
r
epr
ovi
de
r
. Came
r
af
ai
l
ur
ea
tone
s
i
t
e(
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r
manus
)i
mpos
e
dade
l
ayof68we
e
ksi
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e
f
e
r
r
al
s
,andt
het
hr
e
a
toft
he
f
tofe
qui
pme
nt
i
sa
l
wa
y
spr
e
s
e
nt
. Se
c
ur
i
nge
qui
pme
ntg
e
ne
r
al
l
yc
ome
sa
tt
hee
x
pe
ns
eofe
f
f
i
c
i
e
nc
y
.
Fut
ur
eob
j
e
ct
i
v
es(
ye
art
wo)
Obj
e
c
t
i
ve
sf
ort
hes
e
c
ondye
aroft
hi
spr
oj
e
c
ti
nc
l
ude:
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a)Ext
e
ns
i
onoft
hene
t
wor
kt
oi
nc
l
udeot
he
runde
r
s
e
r
ve
dar
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a
s
a
t
i
ons
. ThePIhasha
d
di
s
c
us
s
i
onswi
t
ht
heSout
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r
i
c
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me
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ar
di
ngs
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ort
hemi
l
i
t
ar
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i
mar
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de
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s
. Si
mi
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s
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us
s
i
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ur
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e
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t
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i
di
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nt
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r
e
t
r
ov
i
r
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r
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c
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e
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e
i
ve
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ov
alt
oe
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pandt
r
ai
nt
wos
i
t
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s
s
i
ont
e
c
hni
que
s;howe
ve
r
,i
nge
ne
r
a
lt
he
yf
a
i
lt
os
a
t
i
s
f
yt
hede
mandi
ngc
ondi
t
i
onsof
e
he
al
t
h.
A maj
ori
mpr
ove
me
ntove
rt
hevoi
c
e
or
i
e
nt
e
di
nf
r
a
s
t
r
uc
t
ur
ei
st
heI
nt
e
gr
a
t
e
dSe
r
vi
c
e
sDi
g
i
t
a
l
Ne
t
wor
k,I
SDN. Asi
t
snamei
mpl
i
e
s
,I
SDNsobj
e
c
t
i
v
ei
st
opr
ov
i
devoi
c
e(
i
ndi
g
i
t
i
z
e
df
or
m)
anddat
ac
ommuni
c
a
t
i
ononas
i
ngl
ei
nf
r
a
s
t
r
uc
t
ur
e
.I
SDN pr
e
s
e
nt
sf
ul
l
dupl
e
xac
c
e
s
sonan
onde
mandba
s
i
st
hr
ought
woi
nt
e
r
f
a
c
e
s:BRI(
Ba
s
i
cRa
t
eI
nt
e
r
f
ac
e
)andPRI(
Pr
i
ma
r
yRat
e
I
nt
e
r
f
ac
e
)
.
/
BRIc
ons
i
s
t
soft
hr
e
ei
nde
pe
nde
ntc
hanne
l
s:t
woB(
be
ar
e
r
)c
hanne
l
sof6
4kbi
t
se
a
c
h,a
ndone
/sdat
/
a
D(
dat
a)c
hanne
lof1
6kbi
t
s
. TheBc
hanne
l
sc
anbea
gg
r
e
ga
t
e
dt
oas
i
ngl
e12
8kbi
t
c
ha
nne
l
. TheD c
ha
nne
li
sus
e
df
orc
ont
r
ols
i
g
nal
sa
ndc
al
lda
t
a
. PRIhas30Bc
hanne
l
s
.
I
SDN ha
sanumbe
rofa
dv
ant
a
ge
sa
s
s
oc
i
at
e
dwi
t
hi
t
sbe
i
ngane
ndt
oe
nddi
gi
t
a
ls
ys
t
e
m.
As
i
mi
l
ars
ys
t
e
m,s
har
i
ngs
omede
s
i
gnpr
i
nc
i
pl
e
swi
t
hI
SDN,i
sknowng
e
ne
r
i
c
a
l
l
yas
t
i
me
di
vi
s
i
onmul
t
i
pl
e
x
i
ng(
TDM)
. TDM s
y
s
t
e
msc
ons
t
i
t
ut
eadi
g
i
t
a
lhi
e
r
a
r
c
hybe
gi
nni
ngwi
t
h
1
2
＋9
Ta
nkutBe
y
gu,T
썥
ur
kTe
l
e
c
om De
pa
r
t
me
ntofI
nf
or
ma
t
i
c
sNe
t
wor
ks
,Te
l:
031
23
131
91
1,Fa
x:＋903
1
231
3
1
95
9,Ema
i
l:t
ankut
.
be
yg
u＠t
ur
kt
e
l
e
kom.
c
om.
t
r
5
0
/s
/
E1(
2,
048Mbi
t
);
ac
hanne
l
i
z
e
dve
r
s
i
oni
se
mpl
oye
dwi
t
hnx64kbi
t
s
.
Thoughbot
hI
SDN a
ndTDM ne
t
wor
ksa
r
ee
f
f
e
c
t
i
vea
tt
r
a
ns
mi
t
t
i
ngs
y
nc
hr
onousda
t
a
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he
yar
e
l
e
s
swe
l
ls
ui
t
e
dt
or
e
s
pondi
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ot
heva
r
y
i
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har
ac
t
e
rofmul
t
i
me
di
aappl
i
c
at
i
onsa
ndme
e
t
i
ng
t
hene
e
df
oragua
r
a
nt
e
e
dl
e
ve
lofQoSwhi
l
epr
e
s
e
r
vi
nge
c
onomyofne
t
wor
ki
ng.
As
y
nc
hr
onoust
r
ans
f
e
rmode
As
ync
hr
onoust
r
ans
f
e
rmode(
ATM)i
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nt
e
gr
at
e
ds
ol
ut
i
ont
ot
her
e
s
t
r
i
c
t
i
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hata
ppl
yt
o
anys
ync
hr
onousf
l
ow off
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xe
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e
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mes
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ot
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a
. Si
z
i
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c
ke
ts
t
r
uc
t
ur
et
oa
c
e
l
lof5
3byt
e
sa
ndaf
i
r
ms
ys
t
e
m ofs
i
g
na
l
l
i
ngt
oada
ptdyna
mi
c
a
l
l
yt
ov
a
r
i
ousc
ha
r
a
c
t
e
r
i
s
t
i
c
s
ofmul
t
i
me
di
af
l
ow,t
heATM ne
t
wor
kove
r
c
ome
st
hema
i
npr
obl
e
mst
ha
tt
het
r
a
di
t
i
ona
l
s
y
nc
hr
onousappr
oa
c
hf
ac
e
s
.
Di
gi
t
als
ubs
cr
i
berl
i
nes
Di
gi
t
als
ubs
c
r
i
be
rl
i
ne
s(
DSL)pr
e
s
e
nta
nout
s
t
andi
ngs
ol
ut
i
ons
a
t
i
s
f
y
i
ngt
hebr
oadbanda
c
c
e
s
s
ne
e
dsofs
ma
l
la
ndme
di
ums
i
z
ebus
i
ne
s
s
e
sa
ndhomeus
e
r
sa
l
i
ke
. Theunde
r
l
yi
ngi
de
ai
st
o
ma
kef
ul
lbandwi
dt
hc
a
pac
i
t
yofar
e
gul
a
rc
oppe
rpai
r(
t
e
l
e
phones
ubs
c
r
i
be
rl
i
ne
)a
v
a
i
l
abl
eby
de
pl
oyi
ngDSLAM (
Di
gi
t
alSubs
c
r
i
be
rLi
neAc
c
e
s
sMul
t
i
pl
e
xe
r
)i
nt
hec
e
nt
r
a
lof
f
i
c
eoft
he
t
e
l
e
phonyc
ompany,i
npl
ac
eoft
het
r
a
di
t
i
ona
lv
oi
c
ee
qui
pme
ntwhi
c
hus
e
sonl
yi
t
s4kHz
ba
nd. Wi
t
haDSL mode
m att
hec
us
t
ome
rpr
e
mi
s
e
s
,ahi
g
hbandwi
dt
ha
tr
e
a
s
onabl
e
di
s
t
anc
e
si
sa
c
hi
e
vabl
e
. Thebandwi
dt
hobt
ai
ne
dde
pe
ndsont
hequal
i
t
yoft
hel
i
nea
ndt
he
di
s
t
anc
ef
r
om t
hec
e
nt
r
alof
f
i
c
ehos
t
i
ngt
heDSLAM.
The
r
ei
savar
i
e
t
yofDSL t
e
c
hnol
og
i
e
s
,c
ol
l
e
c
t
i
ve
l
yknownasx
DSL. Twooft
he
m ar
e
par
t
i
c
ul
ar
l
yus
e
f
uli
ne
he
al
t
happl
i
c
at
i
ons:
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Symme
t
r
i
cDi
gi
t
alSubs
c
r
i
be
rLi
ne
)
/
SDSL pr
ov
i
de
sdat
ar
at
e
supt
o2.
3Mbi
t
si
nbot
hdi
r
e
c
t
i
onswi
t
hi
nar
ang
eof3km ov
e
ra
s
i
ngl
ec
oppe
rpai
r
. Ast
henamei
mpl
i
e
s
,t
hi
st
e
c
hnol
og
yi
ss
ui
t
a
bl
ef
ora
ppl
i
c
a
t
i
onswi
t
h
t
hedowns
t
r
e
am t
r
af
f
i
cl
oadc
l
os
et
ot
heups
t
r
e
a
m,s
uc
hast
e
l
e
c
ons
ul
t
at
i
on.
・ADSL(
As
ymme
t
r
i
cDi
gi
t
alSubs
c
r
i
be
rLi
ne
)
t
r
e
a
m. 9
ADSL i
sde
s
i
gne
dt
ome
e
tt
hene
e
df
oradowns
t
r
e
a
mr
at
egr
e
at
e
rt
hant
heups
/sdowns
/sups
Mbi
t
t
r
e
am a
nd768kbi
t
t
r
e
am i
sa
c
hi
e
va
bl
ewi
t
hi
naf
e
w hundr
e
dme
t
e
r
sf
r
om
t
hec
e
nt
r
alof
f
i
c
e
. Theope
r
at
i
ngr
angei
st
ypi
c
al
l
y5.
5km. Ast
het
r
a
ns
por
tme
t
hod,
ADSL us
e
sATM.
ADSL handl
e
sPSTN c
al
l
sc
onc
ur
r
e
nt
l
ywi
t
hda
t
ac
ommuni
c
at
i
onbyma
ki
ngus
eoft
hel
ow
f
r
e
que
nc
i
e
soft
hel
i
nes
pe
c
t
r
um f
orv
oi
c
ea
ndt
hehi
ghe
rf
r
e
que
nc
i
e
sf
ordat
a
. Howe
ve
r
,t
hi
s
addst
ot
hec
ompl
e
xi
t
yont
hec
us
t
ome
rs
i
de
,r
e
qui
r
i
ngt
hei
ns
t
a
l
l
a
t
i
onofas
i
gnals
pl
i
t
t
e
r
andami
c
r
of
i
l
t
e
ratt
heus
e
rs
i
de
.
A ve
r
s
i
onofADSL knownasG.Li
t
edi
s
pe
ns
e
swi
t
ht
hes
pl
i
t
t
e
r
,andi
sde
s
i
g
ne
dt
obemor
e
/
/
us
e
r
f
r
i
e
ndl
y. G.Li
t
epr
ovi
de
sada
t
ar
a
t
ef
r
om 1
2
8kbi
tst
o1
,
544Mbi
tsdowns
t
r
e
a
m,a
nd
/st
/sups
f
r
om 128kbi
t
o38
4kbi
t
t
r
e
am. Ot
he
rve
r
s
i
onsofADSL i
nc
l
udet
her
e
c
e
nt
l
y
de
pl
oy
e
dADSL2andADSL2＋.
Theot
he
rmaj
orDSL t
ype
sa
r
e:
・HDSL(
Hi
g
hbi
t
r
a
t
eDi
g
i
t
a
lSubs
c
r
i
be
rLi
ne
)
Ba
s
i
c
al
l
y,HDSL pr
ov
i
de
st
hes
a
mes
e
r
v
i
c
ea
sa
nE1c
onne
c
t
i
on.
・VDSL(
Ve
r
yHi
ghDat
ar
at
eDi
gi
t
a
lSubs
c
r
i
be
rLi
ne
)
/sdowns
/sups
VDSL de
l
i
ve
r
s5
2Mbi
t
t
r
e
am a
nd2
.
3Mbi
t
t
r
e
a
m atdi
s
t
anc
e
sofaf
e
w
hundr
e
dme
t
e
r
s
.
Radi
ocommuni
cat
i
on
Ce
l
l
ul
arr
adi
one
t
wor
ksa
r
emos
t
l
yf
r
e
que
nc
yorc
ode
di
vi
s
i
onmul
t
i
pl
ea
c
c
e
s
ss
ys
t
e
ms(
FDMA
5
1
orCDMA)a
ndc
ompos
e
dofc
e
l
l
s(
ge
ne
r
al
l
yofhe
x
ag
ona
ls
ha
pe
)de
f
i
ne
dbybas
es
t
at
i
onst
ha
t
e
nabl
ef
r
e
que
nc
yorc
oder
e
us
e
. Thet
e
r
mi
nal
sc
ommuni
c
at
et
hr
oug
hba
s
es
t
at
i
onsc
onne
c
t
e
d
t
oac
e
nt
r
als
wi
t
c
hi
nguni
t
.
Ce
l
l
ul
arne
t
wor
ksc
ans
uppor
tma
nyda
t
as
e
r
vi
c
e
s
,al
t
houg
hv
oi
c
ec
al
l
sands
hor
tme
s
s
agi
ng
r
e
mai
nt
hemai
ndr
i
ve
r
s
.
The
r
ei
sal
ar
genumbe
rofdi
g
i
t
alc
e
l
l
ul
a
rt
e
c
hnol
og
i
e
s:GSM,GPRS(
Ge
ne
r
a
lPa
c
ke
tRa
di
o
Se
r
vi
c
e
)
,CDMA (
CodeDi
vi
s
i
onMul
t
i
pl
eAc
c
e
s
s
)
,EDGE(
Enhanc
e
dDa
t
af
orGSM
Evol
ut
i
on)
,3GSM andDECT,t
onamebutaf
e
w.
Thebac
kboneofr
adi
oc
ommuni
c
at
i
oni
si
mpl
e
me
nt
e
dbys
a
t
e
l
l
i
t
e
s
. Sa
t
e
l
l
i
t
ec
ommuni
c
a
t
i
on
hast
womai
nadva
nt
ag
e
s:
1)ve
r
yl
ar
gebandwi
dt
h
2)i
nhe
r
e
ntpoi
nt
t
omul
t
i
poi
ntt
r
a
ns
mi
s
s
i
onove
rav
e
r
yl
ar
g
ear
e
a.
Thi
smake
si
tanat
t
r
ac
t
i
ves
ol
ut
i
oni
nt
hea
bs
e
nc
eofat
e
r
r
e
s
t
r
i
a
li
nf
r
as
t
r
uc
t
ur
e
,whe
t
he
rduet
o
t
her
e
mot
e
ne
s
sofar
e
gi
onort
oadi
s
a
s
t
e
rofs
omeki
nd.
The
r
ear
eve
r
ye
f
f
e
c
t
i
veande
f
f
i
c
i
e
ntr
adi
oc
ommuni
c
a
t
i
ont
e
c
hnol
ogi
e
st
ha
te
nabl
ebot
h
mobi
l
i
t
yandhi
ghQoS,s
uc
hasWi
Fi
. Unf
or
t
una
t
e
l
y,adi
s
c
us
s
i
onoft
hede
t
a
i
l
swoul
dgo
be
yondt
hes
c
opeoft
hi
sr
e
por
t
.
Summar
y
The
r
ei
sav
e
r
ywi
der
angeoft
e
l
e
c
ommuni
c
at
i
ont
e
c
hni
que
sr
e
a
dyt
os
e
r
vee
he
al
t
hunde
ra
ny
c
ondi
t
i
ons
. Thr
ought
hes
t
r
ongc
onne
c
t
i
onbe
t
we
e
ni
nf
or
mat
i
ona
ndc
ommuni
c
at
i
on
t
e
c
hnol
ogi
e
s
,ave
r
ypowe
r
f
ule
xampl
ei
st
heI
nt
e
r
ne
t
,ne
w pos
s
i
bi
l
i
t
i
e
sf
ore
he
a
l
t
ha
ppl
i
c
a
t
i
ons
e
me
r
gewhi
l
ebr
i
ngi
ngne
w pr
obl
e
mss
uc
ha
ss
e
c
ur
i
t
yal
ong
.
13
3
.
2 Sat
el
l
i
t
ebas
e
dt
e
l
e
me
di
ci
nepr
ac
t
i
ces
As
ucces
ss
t
or
yf
r
om I
ndi
a
Backgr
ound
I
ndi
ai
sf
ac
e
dwi
t
ht
hee
nor
moust
as
kofpr
ov
i
di
nghe
al
t
hc
a
r
et
oavas
tr
ur
a
lpopul
at
i
on,
s
pr
e
adi
ni
nac
c
e
s
s
i
bl
eandr
e
mot
ear
e
as
,i
nc
l
udi
ngdi
s
t
a
nti
s
l
and. 80
%oft
hepopul
a
t
i
onl
i
v
e
i
ns
ome62
7,
00
0vi
l
l
a
ge
s;byc
ont
r
a
s
t
,80
%oft
heme
di
c
als
pe
c
i
a
l
i
s
t
sr
e
s
i
dei
nt
hemaj
orc
i
t
i
e
s
.
Thec
ount
r
yi
ss
e
r
ve
dbyappr
oxi
ma
t
e
l
y27
,
0
00hos
pi
t
a
l
sa
ndhe
al
t
hc
e
nt
r
e
s
,br
oke
ndownas
f
ol
l
ows:
・di
s
t
r
i
c
thos
pi
t
al
s― 67
0;
・c
ommuni
t
yhe
al
t
hc
e
nt
r
e
s― 3
,
000;
・pr
―
i
mar
yhe
al
t
hc
e
nt
r
e
s 23,
00
0;
・me
di
c
alc
ol
l
e
ge
sa
nds
upe
r
s
pe
c
i
al
t
yhos
pi
t
al
s― 2
50.
I
ndi
af
ac
e
sot
he
rc
hal
l
e
nge
sa
swe
l
l
,i
nc
l
udi
ngt
hedi
f
f
i
c
ul
tt
e
r
r
ai
n,l
ongdi
s
t
anc
e
s
,poor
t
r
ans
por
t
at
i
on,poorl
i
t
e
r
a
c
y,l
ow i
nc
omeandl
i
mi
t
e
da
c
c
e
s
st
ome
di
a
. As
s
ur
i
nga
c
c
e
s
st
o
he
a
l
t
hc
a
r
eatt
hes
upe
r
s
pe
c
i
al
t
yl
e
ve
lf
ort
hee
nt
i
r
er
ur
a
lpopul
at
i
oni
sal
mos
ti
mpos
s
i
bl
e
,a
s
i
t
ua
t
i
ont
hatmi
g
htbec
har
ac
t
e
r
i
z
e
dasa he
a
l
t
hdi
v
i
de. Te
l
e
me
di
c
i
nei
st
heonl
yopt
i
on
t
hatpr
omi
s
e
st
obr
i
dg
et
hi
sdi
v
i
de
.
Aspar
toft
heut
i
l
i
z
at
i
onofs
pac
et
e
c
hnol
ogyf
ort
hede
ve
l
opme
ntoft
hec
ount
r
ysr
e
mot
e
1
3
Rav
iSa
ks
e
na
,Pr
oj
e
c
tMana
g
e
r― Te
l
e
me
di
c
i
ne
,Spa
c
eAppl
i
c
a
t
i
onsCe
nt
r
e
,I
SRO,Ahme
da
ba
d,I
ndi
a
5
2
r
e
gi
ons
,t
heI
ndi
anSpac
eRe
s
e
ar
c
hOr
ga
ni
z
at
i
on,I
SRO,ha
si
ni
t
i
at
e
danumbe
rofpr
og
r
a
mme
s
.
Oneoft
hemaj
orpr
ogr
amme
si
st
e
l
e
me
di
c
i
ne
.I
SRO ha
st
ake
nt
hei
ni
t
i
at
i
vet
opr
ov
i
de
s
at
c
ombas
e
dt
e
l
e
he
al
t
handt
e
l
e
me
di
c
i
nef
a
c
i
l
i
t
i
e
s
,i
nt
hef
r
ame
wor
kofas
oc
i
a
lpr
og
r
amme
.
Te
l
e
me
di
c
i
nepr
omi
s
e
st
oi
mpr
ovea
c
c
e
s
s
,r
e
duc
et
r
ave
lc
os
t
sf
orpat
i
e
nt
sa
ndhe
al
t
hc
ar
es
t
af
f
/e
al
i
ke
,l
owe
re
xpe
ndi
t
ur
eons
t
af
f
qui
pme
ntc
os
t
,pr
ov
i
des
uppor
tt
ope
opl
ei
nt
he
i
rown
e
nvi
r
onme
nt
,andove
r
c
omer
ur
ali
s
ol
at
i
on.
Theappl
i
c
at
i
onsoft
e
l
e
me
di
c
i
near
e:
・t
e
l
e
c
ons
ul
t
at
i
on
・t
e
l
e
di
agnos
i
s
・r
adi
ol
ogy
・pat
hol
ogy
・c
ar
di
ol
ogy
・opht
ha
l
mol
ogy
・t
e
l
e
e
duc
at
i
on
・CME(
c
ont
i
nue
dme
di
c
a
le
duc
at
i
on)
Te
l
e
me
di
c
i
nes
ys
t
e
msc
ons
i
s
te
s
s
e
nt
i
al
l
yof(
a
)apat
i
e
nt
e
ndt
e
r
mi
na
l
,(
b)as
pe
c
i
a
l
i
s
t
e
nd
t
e
r
mi
na
la
nd(
c
)as
e
r
ve
r
.
Pat
i
ent
endt
er
mi
nal
si
ncl
ude:
・A PC wi
t
ht
e
l
e
me
di
c
i
nes
of
t
war
eandi
nt
e
r
f
ac
e
sf
ordi
ag
nos
t
i
ci
ns
t
r
ume
nt
s
・A v
i
de
oc
onf
e
r
e
nc
i
ngs
ys
t
e
m
・Di
agnos
t
i
c
si
ns
t
r
ume
nt
s
・A 1
2l
e
adECG uni
t
・A hi
ghr
e
s
ol
ut
i
onXr
ays
c
anne
r
・A di
gi
t
ali
magi
ngc
apabl
emi
c
r
os
c
opef
orpa
t
hol
og
y.
Speci
al
i
s
t
endt
er
mi
nal
si
ncl
ude:
・A PC wi
l
e
me
di
c
i
nes
of
t
wa
r
e
t
ht
e
・Pr
oc
e
s
s
i
nganddi
s
pl
ayoft
hedi
agnos
t
i
cdat
a
・A vi
de
oc
onf
e
r
e
nc
i
ngs
ys
t
e
m.
l
l
i
t
ebas
edi
nf
r
as
t
r
uc
t
ur
e
Ther
at
i
onal
ef
oras
at
e
Vi
de
oc
onf
e
r
e
nc
i
ngi
soneoft
hemai
nc
ompone
nt
sofa
nyt
e
l
e
me
di
c
i
nes
ys
t
e
m. Thi
sr
e
qui
r
e
sa
/s
da
t
ae
xc
hanger
at
eofa
tl
e
a
s
t3
84kbi
t
.I
nde
ns
e
l
ypopul
at
e
da
r
e
a
s
,t
e
r
r
e
s
t
r
i
a
l
t
e
l
e
c
ommuni
c
at
i
ons
ys
t
e
ms(
I
SDN oropt
i
c
alf
i
br
e
)of
f
e
rhi
g
hc
a
pa
c
i
t
yatal
ow c
os
t;howe
v
e
r
,
t
he
yar
el
e
s
sc
os
t
e
f
f
e
c
t
i
vei
nr
e
mot
ear
e
as
,whe
r
et
hepopul
a
t
i
onde
ns
i
t
yi
sl
owe
r
.
Fur
t
he
r
mor
e
,t
hec
ons
t
r
uc
t
i
onofs
uc
ha
ni
nf
r
a
s
t
r
uc
t
ur
ei
st
i
me
i
nt
e
ns
i
ve
.
Sa
t
e
l
l
i
t
e
ba
s
e
dc
ommuni
c
at
i
oni
st
hemos
te
f
f
e
c
t
i
vewa
yofpr
ov
i
di
ngt
hene
c
e
s
s
a
r
y
c
ommuni
c
at
i
onl
i
nks
. Compar
e
dt
oat
e
r
r
e
s
t
r
i
a
ll
i
nk,i
ta
l
l
owsubi
qui
t
ousa
c
c
e
s
sa
nywhe
r
e
wi
t
hi
nt
hes
a
t
e
l
l
i
t
esf
oot
pr
i
nt
,atamuc
hl
owe
rc
os
tandwi
t
har
e
duc
e
dl
e
a
dt
i
me
.
Sa
t
c
ombas
e
dl
i
nksar
et
husmor
es
ui
t
a
bl
ef
ort
het
e
l
e
me
di
c
i
nene
t
wor
k. Thec
onf
i
g
ur
a
t
i
onof
at
ypi
c
alI
SRO t
e
l
e
me
di
c
i
nes
at
c
om ne
t
wor
ki
ss
hownonFi
g
ur
e1
. Ar
ound100t
e
r
mi
na
l
sa
r
e
/
a
l
r
e
a
dyope
r
at
i
onal
,c
onne
c
t
i
ng20s
upe
r
s
pe
c
i
al
t
yhos
pi
t
al
s
,80di
s
t
r
i
c
tr
ur
a
lhos
pi
t
al
s
,a
nd
ot
he
r
sl
oc
a
t
e
di
nr
e
mot
epl
a
c
e
sl
i
ket
heAndamanandNi
c
obari
s
l
a
nds
,Laks
hadwe
e
ps
,and
poor
l
yac
c
e
s
s
i
bl
ear
e
a
sofLa
dakhandt
henor
t
he
as
t
. Ma
nymor
ear
ei
nt
hepr
oc
e
s
sof
i
ns
t
al
l
at
i
on(
Fi
g.
2
)
.
Thr
e
et
ype
sofc
onne
c
t
i
v
i
t
yar
epr
ovi
de
d:
・Poi
nt
t
opoi
nt
5
3
・Poi
nt
t
omul
t
i
poi
nt
・Mul
t
i
poi
nt
t
omul
t
i
poi
nt
Thet
e
r
mi
nal
sus
eVSATswi
t
ha3.
8
ma
nt
e
nna.
orne
t
wor
kc
ont
r
ol
.I
t
st
e
c
hni
c
alc
ha
r
ac
t
e
r
i
s
t
i
c
sa
r
ea
s
AnI
SRO hubatBangal
or
ei
sus
e
df
/
/
f
ol
l
ows:dat
ar
at
e3
84kbi
ts
,l
i
nkonde
mand(
SCPCDAMA)
,LANTCP I
Pi
nt
e
r
f
a
c
e
.
Twot
ype
soft
e
r
mi
nal
sa
r
eus
e
d:
1
)s
t
andal
one
e
a
c
hnoder
e
qui
r
e
st
hef
ul
ls
of
t
wa
r
es
ui
t
e
2)s
e
r
ve
r
ba
s
e
dt
hef
ul
ls
of
t
wa
r
es
ui
t
er
e
s
i
de
sa
tt
hes
e
r
v
e
rnodeonl
y
,t
heot
he
rnode
sbe
i
ng
br
ows
e
r
ba
s
e
dwi
t
hmi
ni
mals
of
t
wa
r
er
e
qui
r
e
me
nt
s
Pat
i
e
nt
e
ndt
e
r
mi
nal
sar
epr
ovi
de
dwi
t
h:
・aPC wi
t
ht
e
l
e
me
di
c
i
nes
of
t
wa
r
e
・aPCbas
e
dvi
de
oc
onf
e
r
e
nc
i
ngs
ys
t
e
m
・a12l
e
adECG uni
t
・a
nA3s
i
z
eXr
ays
c
a
nne
rorXr
a
yvi
e
w boxwi
t
hdi
g
i
t
a
lc
a
me
r
aands
t
anda
ndapa
t
hol
og
y
mi
c
r
os
c
opewi
t
hdi
gi
t
alc
a
me
r
a(
a
ts
omel
oc
a
t
i
ons
)
・aVoI
Pphone
・apr
i
nt
e
r
.
Doc
t
or
e
ndt
e
r
mi
nal
shave:
・aPC wi
t
ht
e
l
e
me
di
c
i
nes
of
t
wa
r
e
・aPCbas
e
dors
t
andal
onevi
de
oc
onf
e
r
e
nc
i
ngs
ys
t
e
m wi
t
hPTZ(
pa
n,t
i
l
t
,z
oom)c
a
me
r
a
・aVoI
Pphone
・apr
i
nt
e
r
.
Fi
g
.
1
5
4
Fi
g.
2 I
SRO t
e
l
e
me
di
c
i
nene
t
wor
k
I
SRO hast
ake
nt
hel
e
adt
os
t
andar
di
z
ee
he
al
t
hdat
ai
nt
e
r
c
ha
ng
e:
・DI
COMDi
gi
t
alI
magi
ngandCommuni
c
at
i
oni
nMe
di
c
i
ne
・HL7ve
lSe
ve
n
He
al
t
hLe
・Vi
de
oc
onf
e
r
e
nc
i
ngs
t
anda
r
ds
・H.
323wi
t
hH.
261andH.
2
63vi
de
oc
odi
ng
.
r
ans
por
t
a
bl
et
e
l
e
me
di
c
i
net
e
r
mi
nal
st
ha
tc
anbe
Thes
at
c
om s
ol
ut
i
onr
e
l
i
e
sont
heus
eoft
move
df
r
om vi
l
l
aget
ovi
l
l
a
gebyvan. Thi
si
sdonet
oavoi
dt
hepr
ohi
bi
t
i
v
ec
os
t
soff
i
t
t
i
ng
t
e
r
mi
nal
si
ne
v
e
r
ys
i
ngl
evi
l
l
age
. Themobi
l
euni
t
sar
ea
s
s
i
g
ne
dt
oc
ove
rac
l
us
t
e
rofvi
l
l
a
g
e
s
,
v
i
s
i
t
i
nge
ac
hvi
l
l
ageatr
e
g
ul
ari
nt
e
r
val
sa
nda
l
s
oonc
a
l
l
,whe
nr
e
qui
r
e
d. Themobi
l
euni
t
c
ons
i
s
t
sofas
ma
l
lbusc
ha
s
s
i
swi
t
har
oof
mount
e
d1.
8m a
nt
e
nnaandVSAT e
l
e
c
t
r
oni
c
sf
or
s
at
e
l
l
i
t
ec
onne
c
t
i
v
i
t
y. Thevansa
r
es
e
l
f
c
ont
ai
ne
d;
i
na
ddi
t
i
ont
ot
heVSAT t
e
r
mi
nalt
he
y
hav
eavi
de
oc
onf
e
r
e
nc
i
ngs
y
s
t
e
m andaPCbas
e
dt
e
l
e
me
di
c
i
nes
ys
t
e
m,a
swe
l
la
sdi
ag
nos
t
i
c
i
ns
t
r
ume
nt
s
. The
yar
eal
s
of
ul
l
yai
r
c
ondi
t
i
one
d,andf
i
t
t
e
dwi
t
hanuni
nt
e
r
r
upt
i
bl
epowe
r
s
uppl
yandpe
t
r
olg
e
ne
r
at
or
.I
SRO ha
ss
uppl
i
e
dopht
ha
l
mi
ct
e
l
e
me
di
c
i
nevanst
o:
・Sanke
rNe
t
hr
al
aya,Che
nnai
・Ar
avi
ndEyeHos
pi
t
al
,Madur
ai
.
Va
nsa
r
ebe
i
nge
xt
e
ns
i
ve
l
yus
e
dbybot
ht
hehos
pi
t
a
l
st
opr
ovi
dee
y
ec
a
r
es
e
r
vi
c
e
st
ol
ar
ge
numbe
rofv
i
l
l
age
s
. Twomor
et
e
l
e
me
di
c
i
nev
ansf
org
e
ne
r
a
lme
di
c
i
near
ei
nt
hepi
pe
l
i
ne
.
Ut
i
l
i
z
at
i
o
n
A us
e
rme
e
t
i
ngwa
sor
g
ani
z
e
di
nNove
mbe
r2
00
3t
or
e
vi
e
wt
heut
i
l
i
z
a
t
i
onoft
het
e
l
e
me
di
c
i
ne
s
ys
t
e
msi
ns
t
al
l
e
dbyI
SRO. Doc
t
or
sf
r
om s
upe
r
s
pe
c
i
al
t
yhos
pi
t
al
s
,s
oc
i
a
lr
e
s
e
ar
c
hs
c
i
e
nt
i
s
t
s
5
5
a
ndt
e
l
e
me
di
c
i
nes
ys
t
e
mv
e
ndor
spar
t
i
c
i
pa
t
e
di
nt
heme
e
t
i
ng
. Soc
i
a
lr
e
s
e
ar
c
hs
c
i
e
nt
i
s
t
s
s
ol
i
c
i
t
e
df
e
e
dbac
kf
r
om doc
t
or
sa
ndpat
i
e
nt
sa
ts
omeoft
het
e
l
e
me
di
c
i
nenode
sr
e
g
a
r
di
ngt
he
ut
i
l
i
z
at
i
onandac
c
e
pt
anc
eoft
e
l
e
me
di
c
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a
t
et
r
ans
por
tme
c
hani
s
m,a
t
r
a
ns
l
a
t
ort
ha
tpr
oduc
e
st
het
e
xt
bas
e
dme
s
s
a
ge
sf
r
om pr
og
r
a
m da
t
as
t
r
uc
t
ur
e
s
,andt
hel
og
i
ct
o
ge
ne
r
at
eHL7me
s
s
age
s
.
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ntofope
ns
t
andar
di
z
e
ddi
s
t
r
i
but
e
dc
omput
i
ngi
nf
r
a
s
t
r
uc
t
ur
e
sha
snow c
r
e
a
t
e
dan
oppor
t
uni
t
yt
os
i
mpl
i
f
yt
heHL7s
pe
c
i
f
i
c
a
t
i
ona
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r
e
a
ml
i
net
hede
ve
l
opme
ntof
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ompl
i
anta
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i
c
at
i
ons
. Theappl
i
c
a
t
i
onofc
ur
r
e
ntdi
s
t
r
i
but
e
dc
omput
i
ngt
e
c
hnol
og
yt
o
t
heHL7s
pe
c
i
f
i
c
at
i
onwoul
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kei
tpos
s
i
bl
et
odi
s
pe
ns
ewi
t
ht
heHL7e
nc
odi
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ul
e
sa
nd
me
s
s
ag
epar
s
e
r
sa
ndt
r
ans
l
at
or
s
,whi
l
epr
ov
i
di
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ompr
e
he
ns
i
veope
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t
anda
r
d,
c
omme
r
c
i
al
l
ya
va
i
l
a
bl
emul
t
i
pl
a
t
f
or
mc
ommuni
c
at
i
onc
apabi
l
i
t
i
e
s
.
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xts
e
c
t
i
onspr
e
s
e
ntt
hr
e
eappr
oac
he
st
oHL7i
mpl
e
me
nt
a
t
i
on:
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at
f
or
mde
pe
nde
nta
ppr
oac
hbas
e
donAc
t
i
veX/
DCOM (
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l
e
on)
･A pl
at
f
or
mi
nde
pe
nde
nt
,l
anguag
e
de
pe
nde
nta
ppr
oa
c
hba
s
e
donJ
a
v
at
ool
ki
t(
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v
e
r
s
i
t
yof
Gi
e
s
s
e
n,Ge
r
many)
･A pl
at
f
or
mi
nde
pe
nde
ntandl
a
ng
uag
e
i
nde
pe
nde
nta
ppr
oa
c
hbas
e
donOMG CORBA
(
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nme
d/Te
l
e
me
d)
at
f
or
mdependentAct
i
veX/DCOMbas
e
dappr
o
ac
h
1.
2 Pl
Mi
c
r
os
of
ta
ndi
t
sa
l
l
i
e
shavei
mpl
e
me
nt
e
dadi
s
t
r
i
but
e
dobj
e
c
tmode
lc
a
l
l
e
dDCOM,wi
t
h
Ac
t
i
veX c
ompone
nt
sde
s
i
gne
dus
i
ngDCOM［15］
.
［2
］
Ac
t
i
v
e
Xf
ore
he
a
l
t
h i
sac
ol
l
a
bor
at
i
vepr
oj
e
c
tbyMi
c
r
os
of
t
,Andov
e
rWor
ki
ngGr
oup
［6］body
a
ndt
heHe
a
l
t
hLe
ve
lSe
ve
n(
HL7)
.I
ti
sde
s
i
g
ne
dt
opr
ov
i
dee
as
y
,i
ne
xpe
ns
i
ve
he
al
t
happl
i
c
a
t
i
onsa
nds
y
s
t
e
ms
.
i
nt
e
r
ope
r
abi
l
i
t
ybe
t
we
e
ne
Ac
t
i
veX pr
ov
i
de
saf
r
ame
wor
ki
nvol
vi
ngt
heDCOM c
ommuni
c
a
t
i
one
nv
i
r
onme
nt
,and
di
f
f
e
r
e
ntl
e
v
e
l
sofi
nf
r
as
t
r
uc
t
ur
eobj
e
c
t
sde
f
i
ne
df
ore
a
s
eofi
mpl
e
me
nt
at
i
onofadi
s
t
r
i
but
e
d
obj
e
c
t
bas
e
ds
ys
t
e
ms
. Ac
t
i
ve
Xi
st
heke
ybui
l
di
ngbl
oc
kf
ori
nt
e
r
a
c
t
i
onbe
t
we
e
na
ppl
i
c
a
t
i
ons
ands
e
r
vi
c
e
s― whe
t
he
ront
hes
amemac
hi
ne
,onal
oc
a
lne
t
wor
k,orov
e
rt
heI
nt
e
r
ne
t
.
Ac
t
i
v
e
Xc
ompone
nt
sc
anbewr
i
t
t
e
ni
na
nyl
ang
uag
eandde
pl
oye
dac
r
os
smul
t
i
pl
eope
r
a
t
i
ng
s
ys
t
e
ms
.
The
s
ef
r
e
e
l
yl
i
c
e
ns
e
dc
ompone
nt
sa
ndi
mpl
e
me
nt
at
i
ong
ui
de
l
i
ne
sa
r
ebas
e
dont
hewor
kdone
byt
heSpe
c
i
alI
nt
e
r
e
s
tGr
ouponObj
e
c
tBr
oke
r
i
ngTe
c
hnol
ogi
e
s(
SI
GBOT)ofHL7,and
s
pe
c
i
f
i
e
st
heHL7me
s
s
a
gepr
of
i
l
e
sa
ndAc
t
i
ve
Xba
s
e
dv
e
r
s
i
onoft
heme
s
s
a
gi
ngappl
i
c
a
t
i
on
［2
］
pr
ogr
ammi
ngi
nt
e
r
f
a
c
e(
API
)de
ve
l
ope
dbyt
heAndove
rWor
ki
ngGr
oup
.
TheAc
t
i
ve
Xf
ore
he
al
t
h(
AHC)me
s
s
ag
i
ngc
ompone
nt
se
nc
a
ps
ul
at
et
heHL72.
3me
s
s
agei
nt
o
obj
e
c
t
sa
ndmakei
te
as
yt
oc
onne
c
tvar
i
ouss
y
s
t
e
ms
. Appl
i
c
at
i
onss
i
mpl
yr
e
que
s
tt
he
73
［8］.
Fi
g.
1 Chame
l
e
ona
r
c
hi
t
e
c
t
ur
e
a
ppr
opr
i
at
eobj
e
c
t(
e
.
g.anadmi
s
s
i
onorame
di
c
at
i
onor
de
r
)
,addt
hea
ppr
opr
i
a
t
edat
a
e
l
e
me
nt
sa
ndt
r
ans
par
e
nt
l
ys
e
ndt
heobj
e
c
tt
oa
ppl
i
c
a
t
i
onst
ha
ta
r
ec
onf
i
gur
e
dt
or
e
c
e
i
vei
t
.A
f
l
e
xi
bl
ear
c
hi
t
e
c
t
ur
emake
spos
s
i
bl
eami
g
r
a
t
i
onpat
hf
r
om l
e
g
ac
ys
y
s
t
e
msa
ndi
nt
e
r
f
ac
ee
ng
i
ne
s
t
one
t
wor
ke
d,c
ompone
nt
bas
e
dappl
i
c
a
t
i
ons
. Appl
i
c
at
i
onsc
a
ns
e
ndme
s
s
a
g
e
sv
i
aDCOM t
o
a
not
he
rAc
t
i
ve
X appl
i
c
at
i
on,ora
c
r
os
saTCP/I
Pc
onne
c
t
i
ont
oa
ne
xi
s
t
i
ngHL7
c
ompa
t
i
bl
e
appl
i
c
at
i
on.
The
r
ear
enow HL7pr
oduc
t
sa
vai
l
abl
eont
hema
r
ke
tba
s
e
donAc
t
i
veX a
ndDCOM. HL7
Chame
l
e
oni
soneoft
hepopul
arpr
oduc
t
st
hatwe
r
ee
v
a
l
uat
e
da
spar
toft
hi
spr
oj
e
c
t
. The
f
undame
nt
aladvant
ag
eofChame
l
e
oni
st
hati
ts
e
par
at
e
st
heme
s
s
a
g
ei
nt
e
r
f
a
c
ef
r
om t
he
di
f
f
e
r
e
nti
mpl
e
me
nt
at
i
onsofHL7,a
l
l
owi
nganappl
i
c
a
t
i
onwr
i
t
t
e
nwi
t
honei
nt
e
r
f
a
c
et
o
s
uppor
tawi
denumbe
rofdi
f
f
e
r
e
ntv
e
r
s
i
onsofHL7
,ass
howni
nFi
g
ur
e1
. Cha
me
l
e
ons
de
s
i
gnde
al
swi
t
hpot
e
nt
i
alpr
obl
e
msbys
hi
e
l
di
ngt
heappl
i
c
a
t
i
onc
odef
r
om t
her
a
w HL7dat
a
s
t
r
uc
t
ur
e
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tut
i
l
i
z
e
sani
nt
e
r
me
di
at
ene
s
t
e
dda
t
as
t
r
uc
t
ur
et
ha
ti
sgr
a
phi
c
al
l
ymappe
dont
oa
［8］
numbe
rofdi
f
f
e
r
e
ntHL7me
s
s
a
get
r
e
e
s
.
Thene
xtl
e
ve
loft
hee
ngi
nei
st
heCOM (
OCX/
Ac
t
i
ve
X)wr
appe
rl
ay
e
r
. Thi
swr
a
ppe
r
e
xpos
e
st
hee
nt
i
r
eAPIoft
heme
s
s
agee
ng
i
ne
. TheGUIc
onf
i
g
ur
a
t
i
ona
ppl
i
c
a
t
i
oni
swr
i
t
t
e
ni
n
De
l
phia
ndwor
kst
hr
ought
heCOM i
nt
e
r
f
a
c
e
. TheGUIc
onf
i
g
ur
at
i
onut
i
l
i
t
yi
saf
ul
l
f
e
at
ur
e
,
mul
t
i
pl
e
doc
ume
nti
nt
e
r
f
a
c
epr
ogr
am. I
ti
sus
e
dt
ode
f
i
neme
s
s
a
g
e
sandma
ppi
ng,a
ndge
ne
r
a
t
e
s
t
ubc
odei
nt
hena
t
i
v
el
ang
uageoft
heus
e
rsa
ppl
i
c
a
t
i
on(
Vi
s
ua
lBa
s
i
c
,De
l
phi
,C,C＋＋ e
t
c
.
)
.
Thege
ne
r
at
e
dc
l
as
s
e
sf
or
mt
hei
nt
e
r
f
ac
ef
ort
heus
e
rsa
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i
c
a
t
i
onc
ode
. Ata
nys
t
ag
e
,t
heGUI
c
onf
i
gur
at
i
ont
oolma
ybeus
e
dt
or
e
c
onf
i
g
ur
et
het
ypeofHL7me
s
s
a
g
e
s
wi
t
houtr
e
c
ompi
l
i
ng
［8
］.
t
heus
e
rsa
ppl
i
c
at
i
on
Thi
si
mpl
e
me
nt
at
i
one
nvi
r
onme
ntpr
ovi
de
sagoodi
nt
e
r
ope
r
a
bi
l
i
t
yme
c
ha
ni
s
ma
mongs
t
di
f
f
e
r
e
ntve
r
s
i
onsofHL7. Si
nc
ei
ti
sbas
e
donCOM (
s
uppor
t
e
dbyMi
c
r
os
of
tWi
ndows
)
,i
ti
s
qui
t
ee
f
f
i
c
i
e
nt
. Howe
ve
r
,asi
nanydi
s
t
r
i
but
e
da
ppl
i
c
at
i
ona
ppr
oa
c
hbas
e
donope
r
at
i
ng
s
ys
t
e
ms
,t
hi
sa
ppr
oac
hhast
hepr
obl
e
m ofpl
at
f
or
mde
pe
nde
nc
e
. Al
s
o,t
hi
sappr
oac
hdoe
snot
t
akei
nt
oa
c
c
ountt
hene
w HL7ve
r
s
i
on3,whi
c
hi
sbas
e
donanobj
e
c
t
or
i
e
nt
e
dappr
oa
c
h.
1
.
3 Pl
at
f
o
r
mi
nd
ependent
,l
anguag
ede
pe
nde
ntap
pr
oach
TheJ
aval
anguag
e
,andmor
ei
mpor
t
ant
l
yt
heJ
a
vaVi
r
t
ua
lMa
c
hi
ne(
J
VM)f
r
om Sun
Mi
c
r
os
ys
t
e
msa
ndi
t
sa
l
l
i
e
s
,havepr
ovi
de
dapowe
r
f
ul
,ope
nme
t
hodol
og
yf
ort
hede
v
e
l
opme
nt
ofdi
s
t
r
i
but
e
dappl
i
c
a
t
i
ons
.I
ti
sapl
a
t
f
or
mi
nde
pe
nde
nta
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oac
hbe
c
aus
eJ
VM c
a
nc
onve
r
t
anypl
at
f
or
m(
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os
uppor
tt
hi
sa
r
c
hi
t
e
c
t
ur
e
. Howe
v
e
r
,t
heappl
i
c
a
t
i
onshavet
ous
eas
i
ngl
e
［
］
l
ang
ua
ge
,i
.
e
.J
a
va 15. Va
r
i
ousi
mpl
e
me
nt
at
i
onsa
r
enow a
va
i
l
a
bl
ef
orHL7mi
ddl
e
wa
r
e
bas
e
donJ
a
va. Wehadanoppor
t
uni
t
yt
oe
v
al
ua
t
et
heHL7t
ool
ki
tf
r
om t
heUni
v
e
r
s
i
t
yof
Gi
e
s
s
e
n,Ge
r
many.
TheHL7me
s
s
agel
i
br
ar
yf
orJ
avaf
r
om t
heUni
v
e
r
s
i
t
yHos
pi
t
a
lofGi
e
s
s
e
ni
sba
s
e
dont
he
74
［9
］
Fi
g.
2 J
av
aAppl
i
c
at
i
onc
ans
e
ndme
s
s
a
g
e
swi
t
hTCPpr
ot
oc
olov
e
rt
hene
t
.
［1
Fi
g.
3 TheOMG EHe
al
t
hDomai
nTa
s
kFor
c
et
e
c
hnol
ogymap
0］
we
l
l
knowndi
s
t
r
i
but
e
dappl
i
c
at
i
onde
ve
l
opme
ntpar
adi
g
m ba
s
e
donal
a
nguag
es
uppor
t(
J
av
a
)
.
J
avavi
r
t
ualmac
hi
ne
spr
ovi
det
hepl
at
f
or
mi
nde
pe
nde
nc
ei
nt
hi
ss
i
t
uat
i
on. I
nt
hi
sc
a
s
e
,t
he
HL7pac
kagei
sal
i
br
ar
ywr
i
t
t
e
ni
nJ
ava
,s
uppor
t
i
ngt
hepr
ogr
a
mme
rwr
i
t
i
ngJ
a
vaappl
i
c
a
t
i
ons
t
hatha
ndl
eHL7me
s
s
age
s
.
Wi
t
ht
heHL7pac
kage
,i
ti
spos
s
i
bl
et
obui
l
dar
bi
t
r
a
r
yHL7me
s
s
ag
e
s
. The
s
eme
s
s
a
ge
sc
anbe
c
onve
r
t
e
di
nt
ot
e
xta
nds
ave
di
norr
e
t
r
i
e
v
e
df
r
om f
i
l
e
s
.I
ti
sa
l
s
opos
s
i
bl
et
os
e
ndme
s
s
a
ge
s
［9
］
wi
t
hTCP/I
Ppr
ot
oc
olove
rt
hene
t
,ass
howni
nFi
g
ur
e2
.
Thi
sl
anguage
ba
s
e
d,di
s
t
r
i
but
e
dappl
i
c
a
t
i
onde
v
e
l
opme
nta
ppr
oa
c
hove
r
c
ome
st
hepr
obl
e
m of
pl
at
f
or
m de
pe
nde
nc
e
,andpr
ovi
de
saf
l
e
xi
bl
eme
c
ha
ni
s
mf
orde
v
e
l
opi
ngHL7appl
i
c
a
t
i
onsi
n
J
av
at
hatwoul
dr
unonavar
i
e
t
yofs
y
s
t
e
ms
. Howe
ve
r
,t
hi
sa
ppr
oa
c
hwi
l
lonl
ypr
ovi
de
i
nt
e
r
ope
r
abi
l
i
t
yofa
ppl
i
c
a
t
i
onswr
i
t
t
e
ni
nJ
a
va
. Ma
nyhos
pi
t
a
la
ppl
i
c
a
t
i
onshav
el
e
g
a
c
yc
ode
wr
i
t
t
e
ni
nl
anguage
sot
he
rt
hanJ
ava. He
nc
eac
ompl
e
t
es
ol
ut
i
ont
ot
hei
nt
e
r
ope
r
abi
l
i
t
y
pr
obl
e
mc
anonl
ybepr
ovi
de
dt
hr
oughac
ombi
nat
i
onofHL7andCORBA.
75
1
.
4 Pl
at
f
or
mi
ndependentandl
anguag
e
i
nd
ep
endentap
pr
oach
TheCommonObj
e
c
tRe
que
s
tBr
oke
rAr
c
hi
t
e
c
t
ur
e(
CORBA)i
st
hef
r
ame
wor
kand
s
pe
c
i
f
i
c
a
t
i
onf
oradi
s
t
r
i
but
e
dc
omput
i
ngs
y
s
t
e
m de
v
e
l
ope
dj
oi
nt
l
ybys
e
ve
r
a
lhundr
e
d
c
omput
i
ngc
ompa
ni
e
sunde
rt
hemanag
e
me
nta
us
pi
c
e
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heObj
e
c
tManag
e
me
ntGr
oup
(
OMG)
. CORBA pr
ovi
de
sas
t
andar
df
r
a
me
wor
kf
orobj
e
c
t
or
i
e
nt
e
ddi
s
t
r
i
but
e
dc
omput
i
ng
［15］.
t
ha
ti
si
nde
pe
nde
ntofpl
at
f
or
ms
TheCORBA f
r
ame
wor
ki
sbe
i
ngus
e
df
ori
nt
e
r
ope
r
abl
eappl
i
c
a
t
i
onde
v
e
l
opme
nti
nmany
a
r
e
as
,i
nc
l
udi
ngf
i
na
nc
e
,manuf
ac
t
ur
i
ng
,t
e
l
e
c
ommuni
c
at
i
onsa
nde
he
a
l
t
h. Fi
g
ur
e3s
howst
he
var
i
ousCORBAbas
e
dbui
l
di
ngbl
oc
ksde
f
i
ne
dbyt
heOMG e
he
al
t
h(
CORBAme
d)i
nt
e
r
e
s
t
gr
oupofOMG f
orus
i
ngCORBA i
nt
hee
he
a
l
t
ha
ppl
i
c
at
i
ondomai
n. TheCORBA a
ppr
oa
c
h
al
l
owsa
ppl
i
c
at
i
onst
obede
ve
l
ope
di
navar
i
e
t
yofl
ang
ua
g
e
s
,s
uc
ha
sJ
ava
,Vi
s
ualBas
i
c
,C
＋＋,Smal
［1
lTal
ke
t
c
.
0］
.
Thi
si
st
hebe
s
tappr
oa
c
ht
oi
nt
e
r
ope
r
a
bi
l
i
t
y
,be
c
a
us
ei
ti
sbot
hpl
at
f
or
mi
nde
pe
nde
nta
nd
l
anguage
i
nde
pe
nde
nt
.
I
ti
snow pos
s
i
bl
et
omapt
hedoma
i
nknowl
e
dgeande
xpe
r
i
e
nc
er
e
pr
e
s
e
nt
e
dbyt
heHL7
Ve
r
s
i
on2.
2Spe
c
i
f
i
c
a
t
i
ont
oCORBA t
opr
oduc
eapowe
r
f
ulf
r
a
me
wor
kf
ori
nt
e
r
f
ac
i
ng
di
s
t
r
i
but
e
dme
di
c
ala
ppl
i
c
at
i
ons
.I
nt
hi
smappi
ng,t
heHL7s
pe
c
i
f
i
c
at
i
onwoul
dde
f
i
newhat
t
heappl
i
c
at
i
onsc
ommuni
c
at
eabout
,whi
l
et
heCORBA s
pe
c
i
f
i
c
at
i
onwoul
dde
f
i
nehow t
he
y
［13
］. Themappi
c
ommuni
c
at
e
nge
mpha
s
i
z
e
sHL7asa
ne
he
a
l
t
hdoma
i
ns
pe
c
i
f
i
c
a
t
i
on,whi
l
e
CORBA t
e
c
hnol
ogypr
ov
i
de
st
hebas
i
sf
ora
nope
ns
t
a
nda
r
dc
ommuni
c
at
i
onpl
a
t
f
or
m. The
r
e
s
ul
t
i
ngmar
r
i
ag
e:
･s
i
mpl
i
f
i
e
st
heov
e
r
al
lHL7s
pe
c
i
f
i
c
at
i
on(
e
.
g.byobvi
a
t
i
ngt
hene
e
df
orHL7s
pe
c
i
f
i
ce
nc
odi
ng
r
ul
e
s
)
,
･r
e
duc
e
st
hec
ompl
e
x
i
t
yofde
ve
l
opi
ngHL7ba
s
e
da
ppl
i
c
at
i
ons(
e
.
g.bymaki
ngHL7pa
r
s
e
r
s
r
e
dunda
nt
)
,and
･e
e
se
he
al
t
hs
y
s
t
e
m de
ve
l
ope
r
st
oe
mpl
oyc
omme
r
c
i
al
l
yav
a
i
l
a
bl
e
,we
l
l
s
uppor
t
e
d
nabl
［1
di
s
t
r
i
but
e
dc
omput
i
ngt
e
c
hnol
ogy
3］
.
Thene
xts
e
c
t
i
onde
s
c
r
i
be
sourpr
ot
ot
ypei
mpl
e
me
nt
a
t
i
on,whi
c
hus
e
st
heCORBA a
ppr
oa
c
h
wi
t
hJ
aval
angua
gebi
ndi
ng.
2 I
mp
l
e
me
nt
i
ngdi
s
t
r
i
b
ut
e
dehe
al
t
happ
l
i
c
at
i
o
nsus
i
ngHL7andCORBA
I
nor
de
rt
opar
t
i
c
i
pat
easar
e
c
i
pi
e
ntofHL7me
s
s
ag
e
s
,a
na
ppl
i
c
at
i
onmus
tbepr
ovi
de
dwi
t
h
t
heappr
opr
i
at
et
r
ans
por
tme
c
ha
ni
s
m,apa
r
s
e
rt
ha
tma
pst
her
e
l
e
va
ntHL7me
s
s
a
ge
si
nt
o
pr
ogr
am dat
as
t
r
uc
t
ur
e
s
,andt
hel
ogi
ct
opr
oc
e
s
sHL7me
s
s
a
g
e
s
. Si
mi
l
a
r
l
y,t
oge
ne
r
a
t
eHL7
me
s
s
a
ge
s
,anappl
i
c
a
t
i
onmus
tbepr
ovi
de
dwi
t
ht
hea
ppr
opr
i
at
et
r
ans
por
tme
c
ha
ni
s
m,a
t
r
ans
l
at
ort
hatpr
oduc
e
st
het
e
xt
bas
e
dme
s
s
ag
e
sf
r
om pr
og
r
am dat
as
t
r
uc
t
ur
e
s
,andt
hel
ogi
ct
o
ge
ne
r
at
eHL7me
s
s
age
s
.
Theadve
ntofope
ns
t
andar
di
z
e
ddi
s
t
r
i
but
e
dc
omput
i
ngi
nf
r
as
t
r
uc
t
ur
e
shasnow c
r
e
a
t
e
dan
oppor
t
uni
t
yt
os
i
mpl
i
f
yt
heHL7s
pe
c
i
f
i
c
a
t
i
ona
nds
t
r
e
aml
i
net
hede
v
e
l
opme
ntof
HL7c
ompl
i
anta
ppl
i
c
at
i
ons
. Theappl
i
c
at
i
onofc
ur
r
e
ntdi
s
t
r
i
but
e
dc
omput
i
ngt
e
c
hnol
og
yt
o
t
heHL7s
pe
c
i
f
i
c
a
t
i
onwoul
dma
kei
tpos
s
i
bl
et
odi
s
pe
ns
ewi
t
ht
heHL7e
nc
odi
ngr
ul
e
sa
nd
me
s
s
a
gepa
r
s
e
r
sa
ndt
r
ans
l
a
t
or
s
,whi
l
epr
ov
i
di
ngc
ompr
e
he
ns
i
veope
n,s
t
anda
r
d,
c
omme
r
c
i
al
l
ya
va
i
l
a
bl
emul
t
i
pl
at
f
or
mc
ommuni
c
a
t
i
onc
a
pabi
l
i
t
i
e
s
.
OMG CORBA pr
ovi
de
sadi
s
t
r
i
but
e
dobj
e
c
t
or
i
e
nt
e
df
r
ame
wor
kf
orde
v
e
l
opme
nta
ppl
i
c
at
i
ons
76
［1
Fi
g
.
4 Cur
r
e
ntt
ypi
c
a
lHL7a
ppl
i
c
a
t
i
ons
t
r
uc
t
ur
e
3］
t
hata
r
ei
nde
pe
nde
ntofope
r
at
i
ngs
ys
t
e
ms(
pl
a
t
f
or
ms
)
,l
a
ng
ua
gef
ors
of
t
wa
r
ede
v
e
l
opme
nta
nd
c
ommuni
c
at
i
onpr
ot
oc
ol
s
. The
r
ei
sa
ne
xc
i
t
i
ngoppor
t
uni
t
yt
oma
pt
hec
ons
i
de
r
abl
edoma
i
n
knowl
e
dgeande
xpe
r
i
e
nc
er
e
pr
e
s
e
nt
e
dbyt
heHL7Ve
r
s
i
on2.
2s
pe
c
i
f
i
c
at
i
ont
oCORBA s
oa
s
t
opr
oduc
eapowe
r
f
ulf
r
ame
wor
kf
ori
nt
e
r
f
ac
i
ngdi
s
t
r
i
but
e
dme
di
c
a
lappl
i
c
a
t
i
ons
.
TheOpe
nEMe
d(
Te
l
e
me
d)a
ppl
i
c
at
i
onf
r
om LosAl
amosLabor
at
or
ypr
ov
i
de
st
hi
si
nt
e
g
r
at
i
on
］.
ofHL7andCORBA［11
Theaut
hor
sc
hos
et
oadopta
nappr
oac
hus
e
dbyt
heUni
ve
r
s
i
t
yHos
pi
t
a
lofGi
e
s
s
e
n,Ge
r
ma
ny
(
ass
howni
nFi
gur
e2)
,wi
t
hCORBA s
e
r
v
i
c
e
sa
dde
dt
oe
nabl
ec
onne
c
t
i
ont
oot
he
rdi
s
t
r
i
but
e
d
s
ys
t
e
msi
nt
hef
ut
ur
e
. TheUni
ve
r
s
i
t
yofGi
e
s
s
e
nHL7pac
ka
gei
sal
i
br
a
r
ywr
i
t
t
e
ni
nJ
av
a
,
s
uppor
t
i
ngpr
og
r
a
mme
r
swr
i
t
i
ngappl
i
c
at
i
onsde
a
l
i
ngwi
t
hHL7me
s
s
a
g
e
s
.
TheHL7pac
kageal
l
owsa
r
bi
t
r
ar
yHL7me
s
s
ag
e
st
obec
ons
t
r
uc
t
e
d. The
s
eme
s
s
ag
e
sc
a
nbe
c
onv
e
r
t
e
df
ors
av
i
ngandr
e
t
r
i
e
va
last
e
xtf
i
l
e
s
. Fur
t
he
r
mor
et
he
r
ei
sawayt
os
e
ndme
s
s
ag
e
s
wi
t
hTCPpr
ot
oc
olov
e
rt
hene
t
.
3 I
mp
l
e
me
nt
at
i
o
ns
t
r
at
e
g
y
Theadvant
ageofaddi
ngCORBA s
e
r
v
i
c
e
swa
st
ha
tma
ppi
ngHL7s
pe
c
i
f
i
c
at
i
ont
oCORBA
c
oul
dpr
oduc
eapowe
r
f
ulf
r
ame
wor
kf
ori
nt
e
r
f
ac
i
ngdi
s
t
r
i
but
e
dme
di
c
ala
ppl
i
c
at
i
ons
.
Fi
gur
e4s
howst
hes
c
he
me
.
CORBA he
l
psusa
c
hi
e
vet
hef
ol
l
owi
ng
.
･El
e
ss
pe
c
i
f
i
c
at
i
on
i
mi
nat
eHL7e
nc
odi
ngr
ul
･El
i
mi
nat
eHL7pa
r
s
e
r
･El
i
mi
nat
eHL7t
r
ans
l
at
or
･Re
duc
et
heamountofappl
i
c
at
i
onl
ogi
c
･St
［13］
andar
di
z
et
hec
ommuni
c
at
i
ons
e
r
vi
c
e
s
Fi
gur
e5s
howst
hear
c
hi
t
e
c
t
ur
alv
i
e
w ofaCORBAbas
e
dHL7appl
i
c
a
t
i
on. Thi
ss
e
c
t
i
on
c
us
s
i
ononappr
oac
he
st
oi
mpl
e
me
nt
i
ngHL7bas
e
dappl
i
c
at
i
onsi
nCORBA.
pr
e
s
e
nt
sadi
s
The
r
ear
emanyappr
oac
he
st
hatc
oul
dbet
a
ke
ni
nmode
l
l
i
ngt
heHL7c
onc
e
pt
sus
i
ngOMG
I
nt
e
r
f
a
c
eDe
f
i
ni
t
i
onLanguage(
I
DL)
. The
s
ei
nc
l
udet
hef
ol
l
owi
ng
.
･Us
i
ngCORBA t
os
i
mpl
yt
r
ans
mi
tASCI
Is
t
r
i
ng
st
hatha
vebe
e
ne
nc
ode
dus
i
ngt
heHL7
e
nc
odi
ngr
ul
e
s
. Thi
sa
ppr
oac
hpr
ovi
de
sas
t
a
ndar
dope
ni
nf
r
as
t
r
uc
t
ur
ef
ort
r
ans
por
t
i
ng
t
e
xt
bas
e
dme
s
s
a
ge
sbe
t
we
e
nappl
i
c
at
i
ons
. Howe
v
e
r
,t
r
a
ns
l
at
i
onf
r
om pr
og
r
a
m da
t
a
77
Fi
g
.
5 HL7Appl
i
c
a
t
i
ons
t
r
uc
t
ur
eus
i
ngCORBA［1
3］
s
t
r
uc
t
ur
e
st
ot
e
xt
bas
e
dme
s
s
age
si
ss
t
i
l
lr
e
qui
r
e
d,asi
spa
r
s
i
ngf
r
om t
e
x
t
bas
e
dme
s
s
a
ge
st
o
pr
ogr
am da
t
as
t
r
uc
t
ur
e
s
.
･De
s
c
r
i
bi
ngt
hec
ur
r
e
ntHL7f
undame
nt
a
le
nc
odi
ngc
ons
t
r
uc
t
s
,s
uc
hasme
s
s
a
g
e
s
,s
e
g
me
nt
s
,
andf
i
e
l
ds
,andus
i
ngt
he
s
ec
ons
t
r
uc
t
st
ot
r
a
ns
mi
tASCI
Is
t
r
i
ngswhi
c
hha
v
ebe
e
ne
nc
ode
d
us
i
ngt
heHL7e
nc
odi
ngr
ul
e
s
,butwi
t
hf
e
we
rme
s
s
ag
ede
l
i
mi
t
i
ngc
ha
r
ac
t
e
r
s
. Thi
sa
ppr
oa
c
h
pr
ov
i
de
samode
s
ts
t
e
pt
owa
r
dsde
f
i
ni
ngac
l
e
a
ne
ri
nt
e
r
f
a
c
et
ot
heHL7me
s
s
a
ge
s
［12］
i
nf
r
a
s
t
r
uc
t
ur
ei
nt
e
r
msofobj
e
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ope
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l
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e
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s
f
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nt
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ar
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yt
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l
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g
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om t
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sf
r
ame
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si
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l
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t
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dbe
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Somecons
i
der
at
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o
ri
nt
er
oper
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l
i
t
y
Sys
t
emsneednotb
ei
dent
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cal― butt
heymus
tbeabl
et
ot
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kwi
t
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r
meani
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l
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!
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r
e
que
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c
onc
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pt
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ope
r
abi
l
i
t
yi
st
ha
ta
dopt
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onoft
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a
met
e
c
hni
c
a
l
s
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andar
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g
ani
z
at
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als
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e
ms
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i
c
i
e
si
sapr
e
r
e
qui
s
i
t
e
. Thi
si
snott
hec
as
e―
at
eme
ani
ngf
ul
l
ywi
t
h
i
ns
t
e
ad,whati
sne
c
e
s
s
a
r
yi
st
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v
e
r
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msbea
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et
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ommuni
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e
a
c
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r
. Di
f
f
e
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e
nts
t
andar
dsma
yi
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e
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e
da
c
r
os
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e
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dt
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ow
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nt
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ompe
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rt
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e
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ve
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ywhe
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s
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abi
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t
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s
. Thus
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ti
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t
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st
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hemos
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t
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nt
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hene
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st
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t
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s
e
ha
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obes
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a
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he
r
ec
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ort
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ount
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y. (
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nt
r
a
i
ns
t
i
t
ut
i
ona
li
s
di
f
f
e
r
e
nt
.
)
Fi
g.
2 Mul
t
i
l
aye
rs
t
r
uc
t
ur
eofi
nt
e
r
ope
r
abi
l
i
t
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ore
he
a
l
t
h26
2
6
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pr
oduc
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r
mi
s
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r
om TMABr
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nt
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ope
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udyRe
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t
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epar
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nt
er
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t
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om t
hes
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ar
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ls
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o
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at
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fi
nt
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n
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aveal
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nt
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m. Onc
emi
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os
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mshav
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t
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nt
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oduc
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ort
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t
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c
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t
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t
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ra
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r
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r
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m be
c
ome
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os
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ft
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nt
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rt
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nt
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l
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t
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ome
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me
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ai
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pe
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ti
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r
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ns
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v
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nve
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t
me
nt
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e
d. Thus
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ti
sbe
s
ta
v
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c
at
i
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ha
tonl
ypur
por
t
s
t
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mme
di
at
e
l
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ovi
di
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l
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ne
f
i
t
st
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he
popul
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i
on. Ke
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pi
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e
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our
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el
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mi
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e
da
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os
t
l
ymi
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a
ke
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f
or
de
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ew t
heco
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e
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ehol
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ur
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fo
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yave
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yl
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mi
t
eddomai
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ei
ng
i
mpl
e
ment
e
d
The
r
emaybeat
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mpt
at
i
ont
oi
gnor
et
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oadhol
i
s
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ca
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c
a
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ll
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mi
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e
d
s
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ut
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onf
oras
pe
c
i
f
i
cpr
obl
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mi
sbe
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mpl
e
me
nt
e
d. The
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ei
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at
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rt
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t
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mpt
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e
me
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tofs
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ut
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la
tonc
e
. Howe
ve
r
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hi
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mi
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e
ds
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ut
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onmus
tne
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e
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l
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r
ne
dbys
t
r
i
c
ti
nt
e
r
ope
r
abi
l
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t
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s;
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et
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ra
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at
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t
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e
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e
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gni
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v
i
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obe
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datal
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e
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anc
e
ds
t
a
g
e
.
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me
mbert
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t
hi
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i
mpl
yas
eto
ft
ec
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cals
t
andar
d
s― i
ti
sab
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p
l
e
wo
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ki
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t
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nt
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oduc
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t
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t
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e
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ur
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omanyus
e
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s
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e
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or
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at
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e
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e
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e
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ns
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c
e
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y whi
c
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om t
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e
me
nt
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on.
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ys
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msar
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v
e
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nt
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ope
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l
la
st
a
i
l
or
i
ngt
r
a
i
ni
ngpr
og
r
a
msa
nd
a
ppl
i
c
at
i
onst
hata
r
es
ui
t
abl
ef
ort
hedi
f
f
e
r
e
ntr
e
qui
r
e
me
nt
s
. Thi
si
spa
r
t
i
c
ul
ar
l
yt
r
uef
or
de
ve
l
opi
ngc
ount
r
i
e
s
,buta
l
s
of
oradvanc
e
dc
ount
r
i
e
s
,whe
r
edi
f
f
e
r
e
ntg
e
ne
r
at
i
onsa
ndt
ype
sof
pe
opl
emakeupave
r
ywi
dega
mutofhe
t
e
r
oge
ne
ousne
e
ds
.
Si
mul
at
i
onandt
es
t
i
ngi
nl
i
mi
t
edbutr
eal
i
s
t
i
cenv
i
r
onment
smaybebo
r
i
ngandd
el
ayt
he
r
ealt
hi
ng ― buti
tp
aysof
fi
nt
hel
ongr
un
The
r
ear
emanyappr
oac
he
st
oi
mpl
e
me
nt
i
nge
he
al
t
hi
nar
e
g
i
onors
y
s
t
e
m.
1)Atonee
xt
r
e
mei
s(
a)i
nt
r
oduc
i
ngac
ompl
e
t
es
ys
t
e
m,c
ompr
i
s
i
nga
l
lpos
s
i
bl
ea
ppl
i
c
a
t
i
ons
f
ore
he
al
t
h,a
dmi
ni
s
t
r
at
i
one
t
c
.
,and(
b)i
mpl
e
me
nt
i
ngt
hene
wt
e
c
hnol
og
yaswi
de
l
yas
pos
s
i
bl
e
.
2)Att
heot
he
re
xt
r
e
me
,(
a)onl
yaf
e
wa
ppl
i
c
a
t
i
onsar
ei
nt
r
oduc
e
d,and(
b)t
he
s
ea
r
e
i
nt
r
oduc
e
di
nonl
yave
r
yl
i
mi
t
e
dpopul
at
i
onofus
e
r
s
.
Thef
i
r
s
ta
ppr
oac
hi
ss
ome
t
i
me
sr
e
f
e
r
r
e
dt
oa
st
hebi
g
ba
ng a
ppr
oa
c
h. I
ti
sr
a
t
he
rr
i
s
ky
.
Thi
saut
horr
e
c
omme
ndst
hes
e
c
ondappr
oac
h. I
ti
sl
e
s
sr
i
s
ky
,a
l
l
owsf
orl
e
a
r
ni
ngandl
i
mi
t
s
t
hedamageofe
r
r
or
s(
whi
c
har
ei
ne
vi
t
abl
e
)
.I
ti
sr
e
c
omme
nde
dt
oi
nt
r
oduc
ee
he
a
l
t
h
t
e
c
hnol
ogya
ndappl
i
c
at
i
onsi
ni
nde
pe
nde
nt
,buti
nt
e
r
ope
r
abl
ebl
oc
ks
. The
ymus
tbe
c
onc
e
i
v
e
dasbe
i
ngt
hebui
l
di
ngbl
oc
ksofamuc
hl
ar
ge
ra
ndc
ompl
e
t
es
y
s
t
e
mt
hatwi
l
lbe
upgr
ade
dwi
t
hc
ompl
e
xi
t
yandpopul
at
i
oni
ng
r
adua
ls
t
e
ps
,wi
t
ht
i
meaf
t
e
re
a
c
hs
t
e
pf
or
s
t
oppi
ng,l
e
ar
ni
ngandr
e
f
l
e
c
t
i
ng
. Suc
c
e
s
s
f
ul
l
yi
mpl
e
me
nt
i
ngas
ma
l
ls
e
tofa
ppl
i
c
a
t
i
onsi
na
l
i
mi
t
e
dpopul
a
t
i
onwi
l
lpr
ov
i
det
hee
xpe
r
i
e
nc
eandc
onf
i
de
nc
et
oe
x
panda
ndupg
r
a
de
.
Cr
uc
i
alt
ot
hei
nt
r
oduc
t
i
onofa
ppl
i
c
at
i
onsandt
e
c
hnol
og
i
e
si
st
ha
tt
he
ybec
onc
e
i
v
e
dt
o
ope
r
at
ewi
t
honea
not
he
ra
nd,mos
ti
mpor
t
a
nt
l
y,wi
t
ht
heus
e
r
.
Al
t
ho
ug
hs
eemi
ngl
yunr
el
at
ed,di
f
f
er
enteheal
t
hd
o
mai
nsar
ei
nt
e
r
de
pe
nde
ntandneedt
o
i
nt
er
op
er
at
ewi
t
heachot
her
Someoft
hedi
f
f
e
r
e
ntdomai
nsofe
he
al
t
hout
l
i
ne
di
nt
heabov
ei
nt
r
oduc
t
i
onma
ys
e
e
mr
a
t
he
r
unr
e
l
at
e
d. Ca
r
e
f
ulr
e
f
l
e
c
t
i
onwi
l
ls
how t
hei
nt
e
r
r
e
l
a
t
i
ons
hi
ps
. Onee
xampl
ei
ss
ur
v
e
i
l
l
a
nc
e
,
whi
c
hi
si
mpor
t
antf
orr
e
c
ogni
z
i
ngunus
uals
pr
e
a
di
ngofdi
s
e
as
e
,orf
r
e
que
ntoc
c
ur
r
e
nc
e
sof
ne
w orunus
uals
ympt
oms
. Howe
v
e
r
,goods
ur
v
e
i
l
l
anc
ei
sonl
ypos
s
i
bl
ewi
t
hg
ood
a
dmi
ni
s
t
r
at
i
onofe
he
al
t
h,andf
r
e
que
ntorc
ont
i
nuousc
ol
l
e
c
t
i
ona
ndanal
ys
i
sofe
he
al
t
hdat
a
(
e
.
g.f
r
om vi
r
t
uale
l
e
c
t
r
oni
che
al
t
hr
e
c
or
dsorEHRs
)
. Butt
hi
sc
a
nonl
ybea
c
hi
e
ve
di
ft
he
e
he
al
t
ht
e
c
hnol
ogi
e
sa
ndappl
i
c
at
i
onsf
ort
he
s
edomai
nsc
anc
ommuni
c
at
ee
a
s
i
l
yand
i
nt
e
l
l
i
gi
bl
ywi
t
he
ac
hot
he
r
,i
.
e
.i
ft
he
s
edomai
nsa
r
ei
nt
e
r
ope
r
a
bl
e
. Mor
e
ov
e
r
,e
xpa
ndi
ngon
t
hi
se
x
ampl
e
,wi
t
hi
nc
r
e
as
e
dt
r
av
e
lbe
t
we
e
nc
ount
r
i
e
s
,di
s
e
as
ec
anbec
a
r
r
i
e
dac
r
os
sv
e
r
ygr
e
at
di
s
t
anc
e
s;s
ot
hatt
heanal
ys
i
sa
ndc
ompa
r
i
s
onofda
t
aac
r
os
sve
r
ydi
s
pa
r
at
er
e
gi
onsbe
c
ome
s
―
par
amount
. Thi
si
sonl
ypos
s
i
bl
ei
fi
nt
e
r
ope
r
a
bi
l
i
t
yac
r
os
snat
i
ona
lbor
de
r
s e
ve
nac
r
os
s
c
ont
i
ne
nt
s― i
sbui
l
ti
na
tt
hede
s
i
gns
t
ag
eoft
hes
ys
t
e
ms
. Thes
a
mea
r
gume
nt
shol
dt
r
uef
or
he
al
t
he
duc
at
i
on,whe
t
he
rr
e
f
e
r
r
i
ngt
ot
hec
i
t
i
z
e
npat
i
e
nt
,ort
hec
i
t
i
z
e
nhe
a
l
t
hpr
ov
i
de
r
.
Don tb
et
oopr
oud― ber
eadyt
ol
ear
nf
r
o
mt
heexpe
r
i
e
nc
eofo
t
her
s
,i
ns
t
eadof
r
ei
nvent
i
ngt
hewheel
The
r
ei
sas
t
r
ongt
e
mpt
at
i
ont
ode
s
i
gnt
hi
ng
sa
sonewoul
dl
i
ket
he
mt
obea
ndus
e
home
gr
ownt
e
c
hnol
ogyandappl
i
c
a
t
i
onswhe
r
e
v
e
rpos
s
i
bl
e
.I
ti
si
nde
e
dt
r
uet
ha
tl
oc
al
i
ndus
t
r
ys
houl
dbes
t
i
mul
at
e
d;f
ur
t
he
r
mor
e
,di
f
f
e
r
e
ntc
ount
r
i
e
s
,e
nvi
r
onme
nt
s
,andc
ul
t
ur
e
shav
e
di
f
f
e
r
e
ntne
e
ds
. Ne
ve
r
t
he
l
e
s
s
,i
ti
spr
ude
ntt
os
t
udywhati
sa
v
a
i
l
a
bl
ee
l
s
e
whe
r
eandbui
l
don
t
hi
s
,r
at
he
rt
hanr
e
i
nve
nt
i
ngf
r
om s
c
r
at
c
h. Le
ar
ni
ngf
r
om t
hee
x
pe
r
i
e
nc
eofot
he
r
sc
ans
pa
r
e
muc
hwas
t
ea
ndpai
n. Ofc
our
s
et
hi
sr
e
qui
r
e
sahe
a
l
t
hydos
eofhumi
l
i
t
y,s
ome
t
i
me
s
89
par
t
i
c
ul
ar
l
yl
ac
ki
ngwhe
r
ei
ti
smos
tne
e
de
d.
Thi
nkandpl
ant
r
ans
nat
i
onal
l
y,noti
ni
s
ol
at
i
on― r
e
membert
hatt
e
chno
l
o
gyp
er
meat
es
bo
r
d
er
s
The
r
ear
eot
he
rg
oodr
e
as
onsf
ora
nal
ys
i
ngwha
ti
sav
a
i
l
abl
eont
hemar
ke
t
,t
oav
oi
d
unne
c
e
s
s
ar
ydupl
i
c
at
i
onofe
f
f
or
t:
i
nt
e
r
ope
r
a
bi
l
i
t
yandi
t
sa
c
c
ompany
i
ngbus
i
ne
s
sc
as
e
.
I
nt
e
r
ope
r
abi
l
i
t
yi
snotonl
yi
mpor
t
anti
nor
de
rt
oal
l
ow t
het
r
a
ns
f
e
rofhe
al
t
hda
t
aac
r
os
s
r
e
gi
onsa
ndnat
i
ons
. Car
e
f
ulandas
t
ut
ede
ve
l
opme
ntofi
nt
e
r
ope
r
abl
eappl
i
c
at
i
onsbr
oa
de
ns
t
hemar
ke
tf
ors
e
l
l
i
ngt
he
m out
s
i
det
hepr
i
mar
yr
e
g
i
onofa
ppl
i
c
a
t
i
on. Ne
v
e
r
t
he
l
e
s
s
,t
hef
oc
us
s
houl
dbeonac
hi
e
v
i
ngs
hor
t
t
e
r
m goal
si
nas
t
anda
r
ds
ba
s
e
dappr
oac
h,r
a
t
he
rt
hant
r
y
i
ngt
o
e
s
t
abl
i
s
ht
oomuc
hwhe
ni
nt
e
r
nalpr
obl
e
msar
epe
r
ha
psmor
epr
e
s
s
i
ng
.
Ke
epyours
i
ght
sont
hehi
g
hergoal― av
i
s
i
onofc
i
t
i
z
enc
ent
r
ede
he
al
t
h:
abo
utt
he
ci
t
i
z
en,f
ort
heci
t
i
z
en,andbyt
heci
t
i
z
e
n
I
nal
lt
hepl
anni
ngbe
i
ngc
ar
r
i
e
douti
nt
hei
nt
r
oduc
t
i
onofe
he
al
t
honemus
tnotf
or
ge
tt
he
ul
t
i
mat
egoal:
r
e
a
l
i
z
a
t
i
onoft
hevi
s
i
onofc
i
t
i
z
e
nc
e
nt
r
e
de
he
a
l
t
hf
ora
l
l
,wi
t
hf
as
t
e
r
,be
t
t
e
ra
nd
c
he
a
pe
re
he
al
t
hde
l
i
ve
r
yt
oal
l
,f
ac
i
l
i
t
at
e
dbye
he
al
t
hme
t
hodol
ogi
e
sandt
e
c
hnol
ogi
e
s
. The
t
e
c
hnol
ogi
e
st
he
ms
e
l
ve
sa
r
enott
hegoa
l
,butwhatt
he
yc
ana
nds
houl
de
nabl
e― abe
t
t
e
rl
i
f
e
f
ora
l
l
.
Fi
nal
l
y,c
r
e
at
et
hevi
s
i
onf
oryourc
ount
r
y,andt
he
nde
s
i
gnt
her
oa
dma
p,e
ns
ur
i
ngt
haty
ou
ke
e
pi
nt
e
r
ope
r
abi
l
i
t
yasabas
i
cc
or
er
e
qui
r
e
me
nt― youa
r
et
he
nmor
el
i
ke
l
yt
obeont
her
oa
d
t
os
uc
c
e
s
s
!
4
.
3 St
andar
di
z
at
i
o
nact
i
vi
t
i
e
s
4.
3
.
1 Cur
r
e
nts
i
t
uat
i
o
ni
ne
heal
t
hs
t
and
ar
d
i
zat
i
on27
Thegr
owi
ngde
mandf
orc
onne
c
t
i
vi
t
ybe
t
we
e
nhe
a
l
t
hr
e
l
at
e
dor
ga
ni
z
a
t
i
ons
,wi
t
ht
heai
m of
gi
vi
ngs
uppor
tt
odat
as
har
i
ngands
e
r
v
i
c
e
si
nt
e
r
ope
r
a
bi
l
i
t
y
,ha
sbe
e
na
ddr
e
s
s
e
di
ndi
f
f
e
r
e
nt
s
t
andar
di
z
at
i
oni
ni
t
i
at
i
ve
si
nt
hel
as
tde
c
a
de
.I
nt
hi
sf
i
e
l
d,t
r
a
di
t
i
ona
l
l
yc
har
a
c
t
e
r
i
z
e
dby
s
ol
ut
i
onsde
ve
l
ope
donapr
opr
i
e
t
a
r
yoradhocbas
i
s
,wi
t
hs
ubs
e
que
nti
nt
e
gr
a
t
i
onba
r
r
i
e
r
sa
nd
i
nc
ompa
t
i
bl
es
e
r
v
i
c
e
s
,ma
nys
t
andar
dsde
v
e
l
opme
ntor
g
ani
z
at
i
ons
,bot
hnat
i
onaland
i
nt
e
r
na
t
i
onal
,havebe
e
nwor
ki
ngt
og
e
t
he
ri
nor
de
rt
oha
r
moni
z
et
hehe
a
l
t
har
e
abyt
he
a
dopt
i
onofc
ommonr
ul
e
sandpr
oc
e
dur
e
s
.
Ev
e
nt
houghi
mpor
t
antr
e
s
ul
t
shavebe
e
nac
hi
e
ve
da
ndt
heus
eofs
t
a
ndar
dsi
sc
ons
i
de
r
abl
y
mor
ewi
de
s
pr
e
adt
hanatt
hebe
gi
nni
ngoft
hel
as
tde
c
a
de
,i
ns
omec
as
e
ss
t
a
nda
r
di
z
a
t
i
oni
n
e
he
al
t
hdoe
snoty
e
tme
e
tt
hee
xi
s
t
i
ngne
e
dsofus
e
r
s
. Me
di
c
ala
dvanc
e
sa
ndr
api
dl
ye
vol
vi
ng
r
e
qui
r
e
me
nt
smakeac
ont
i
nuousupgr
a
depr
oc
e
s
sne
c
e
s
s
a
r
yi
nor
de
rt
oma
i
nt
ai
nt
he
s
t
anda
r
di
z
at
i
ons
i
t
uat
i
on.
St
andar
di
z
at
i
oni
ne
he
a
l
t
hhasy
e
tt
oove
r
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. Nonc
ont
ac
ts
e
ns
or
sa
r
ee
x
pe
c
t
e
dt
oi
nc
r
e
as
ei
npopul
ar
i
t
yi
n
t
hene
arf
ut
ur
e
.I
ft
he
yar
eus
e
di
nt
hear
e
a
soft
e
l
e
home
c
ar
eandg
e
r
i
at
r
i
cc
a
r
e
,t
hema
r
ke
t
maye
x
pl
odei
na
dv
anc
e
dc
ount
r
i
e
s
.
Fi
gur
e2 TheWor
l
dMa
r
ke
tf
orBi
ome
t
r
i
c
s
Fi
gur
e3 Pe
r
c
e
nt
a
g
eofbi
ome
t
r
i
cpr
oduc
t
s
10
0
1-3 Ne
c
e
s
s
i
t
yof b
i
ome
t
r
i
c
si
nt
e
l
e
me
di
c
i
ne
Wi
t
ht
hei
nc
r
e
as
i
ngi
mpor
t
anc
eoft
hec
ompr
e
he
ns
i
vema
na
ge
me
ntofme
di
c
ali
nf
or
ma
t
i
oni
n
oura
gi
ngs
oc
i
e
t
y
,i
ndi
v
i
dua
li
de
nt
i
f
i
c
at
i
oni
se
s
s
e
nt
i
alnotonl
yf
ort
e
l
e
me
di
c
i
nebutf
or
i
nf
or
ma
t
i
onmanag
e
me
ntf
ori
ndi
vi
duali
nf
or
ma
t
i
onbr
ows
i
ngandma
ki
ngi
ns
ur
a
nc
epay
me
nt
s
.
J
apani
sf
ac
i
ngt
hepr
obl
e
m ofani
nc
r
e
as
ei
nt
henumbe
rofpe
opl
ewhodonotpayhe
a
l
t
h
i
ns
ur
anc
ef
e
e
s
. Ast
henumbe
rofpat
i
e
nt
swhoat
t
e
mptt
or
e
c
e
i
veme
di
c
a
ls
e
r
vi
c
e
si
nani
l
l
e
g
a
l
ma
nne
rt
hr
oughi
de
nt
i
f
i
c
at
i
ont
he
f
ti
se
x
pe
c
t
e
dt
og
r
ow,t
hei
mpor
t
anc
eofi
ndi
v
i
dua
l
i
de
nt
i
f
i
c
at
i
onwi
l
lbee
nhanc
e
d.
Wehavei
de
nt
i
f
i
e
dt
hef
ol
l
owi
ngne
e
dsi
nt
e
l
e
me
di
c
i
nef
ori
ndi
v
i
dua
li
de
nt
i
f
i
c
a
t
i
on:
1.He
al
t
hi
ns
ur
anc
eI
Dc
e
r
t
i
f
i
c
at
e(
orI
Dc
a
r
di
ns
omec
ount
r
i
e
s
)
2.Re
mot
ec
ons
ul
t
i
ng
3.Eme
r
ge
nc
yt
r
a
ns
por
t
4.He
al
t
hc
he
c
k(
e
x
c
e
ptf
ordi
s
e
as
e
s
)
5.Re
t
ur
nofme
di
c
alf
e
e
s
6.Pat
i
e
ntc
har
tbr
ows
i
ng(
f
ort
hepat
i
e
ntonl
y)
Theaboves
i
xappl
i
c
at
i
onsr
e
qui
r
ei
de
nt
i
f
i
c
a
t
i
onac
c
ur
a
c
yashi
ghast
hatne
e
de
df
ort
heonl
i
ne
banki
ngs
y
s
t
e
m.
2
. PROPOSAL
Wef
e
e
lt
hatt
hef
ol
l
owi
ngopt
i
c
als
e
ns
orus
i
ngt
hevi
de
ophones
y
s
t
e
mi
sapr
omi
s
i
ng
bi
ome
t
r
i
c
ss
y
s
t
e
mf
ort
e
l
e
home
c
ar
e
.
2-1 Fac
e
A Me
t
hodol
ogy:
Wel
e
ar
nt
hec
har
ac
t
e
r
i
s
t
i
c
sofe
a
c
hf
ac
eus
i
ngCCD c
a
me
r
a
sa
ndphot
osi
n
a
dva
nc
e
,pr
e
par
eadat
abas
e
,ande
xami
net
het
ar
ge
tf
ac
ebas
e
dont
hef
a
c
epat
c
ht
he
or
y(
whi
c
h
i
st
ot
al
l
ydi
f
f
e
r
e
ntf
r
om t
hene
ur
alne
t
wor
kt
he
or
yt
hatha
sa
l
r
e
a
dybe
e
ndi
s
c
us
s
e
de
x
t
e
ns
i
ve
l
y
)
.
Pr
e
l
i
mi
nar
yl
e
ar
ni
ng:Ex
t
r
ac
t
st
her
e
l
at
i
v
epos
i
t
i
onsoft
hee
y
e
s
,nos
e
,ande
ye
br
ows
,anddr
aws
ani
de
nt
i
f
i
c
at
i
onc
ur
veus
i
ngAdaboos
tI
mag
ema
t
c
hi
ng:
Ext
r
ac
t
st
hee
ye
,nos
e
,ande
y
e
br
ow
c
ha
r
ac
t
e
r
i
s
t
i
c
soft
het
ar
ge
tf
ac
e
,a
ndmat
c
he
st
he
m wi
t
hda
t
ai
nt
hedat
aba
s
e
B Advant
ag
e
s:A vi
de
ophones
ys
t
e
m us
i
ngaPCbas
e
dorde
di
c
at
e
dt
e
r
mi
na
lde
v
i
c
ei
sus
e
di
n
t
e
l
e
home
c
ar
e
. Thus
,c
ompar
e
dwi
t
hot
he
ra
ppl
i
c
at
i
ons
,i
ti
se
a
s
yt
oc
apt
ur
et
hepat
i
e
ntsf
a
c
e
i
ma
gef
r
om t
hef
r
onte
ac
ht
i
mewi
t
hal
mos
tt
hes
ames
i
z
eunde
runi
f
or
mi
l
l
umi
na
t
i
on
c
ondi
t
i
onst
ha
ta
r
ec
l
os
et
oi
de
al
. Be
c
a
us
et
hehi
ghqual
i
t
yCCD de
v
i
c
ea
l
l
owst
hedoc
t
ort
o
s
e
et
hes
ympt
omsofa
ne
mi
a,i
c
t
e
r
us
,s
pi
de
ra
ngi
oma,andne
r
vedamage
,t
hev
i
s
ua
lc
he
c
ka
nd
f
ac
ei
de
nt
i
f
i
c
at
i
onc
anbepe
r
f
or
me
ds
i
mul
t
ane
ous
l
y
.I
ti
s
,howe
v
e
r
,di
f
f
i
c
ul
tt
oma
i
nt
a
i
n
c
ons
i
s
t
e
nti
de
nt
i
f
i
c
at
i
onac
c
ur
ac
y,ast
hef
a
c
ec
ha
r
a
c
t
e
r
i
s
t
i
c
smayc
ha
ng
eove
rt
i
me
. Fa
l
s
e
i
de
nt
i
f
i
c
a
t
i
onasar
e
s
ul
tofpl
as
t
i
cs
ur
ge
r
yont
hee
ye
s
,nos
e
,a
ndj
aw ma
yal
s
obepos
s
i
bl
e
.
Thus
,i
ti
spr
e
f
e
r
a
bl
et
ous
eanot
he
ri
de
nt
i
f
i
c
at
i
ont
e
c
hni
quei
na
ddi
t
i
ont
of
ac
ei
de
nt
i
f
i
c
a
t
i
on.
2-2 I
r
i
s
A Me
t
hodol
ogy:I
ndi
vi
dual
sc
a
nbei
de
nt
i
f
i
e
dbas
e
dont
hei
r
i
spa
t
t
e
r
n,whi
c
hi
suni
quet
o
［
］
e
ac
hpe
r
s
on.2 Thei
r
i
spat
t
e
r
ni
sf
or
me
dwi
t
hi
ns
i
xmont
hsa
f
t
e
rbi
r
t
ha
nds
t
abi
l
i
z
e
swi
t
hi
n
oneye
a
ra
f
t
e
rbi
r
t
h,anddoe
snotc
hang
eunt
i
lde
at
h. Twode
vi
c
e
sc
anbeus
e
dt
ome
as
ur
e
10
1
Fi
gur
e4 Ana
l
y
s
i
soft
hei
r
i
s
Fi
g
ur
e5 Thepat
t
e
r
nofr
e
t
i
na
lbl
oodv
e
s
s
e
l
s
(
Ar
t
e
r
yandVe
i
n)
t
hei
r
i
spat
t
e
r
n,asf
ol
l
ows
.
1.I
ft
hevi
de
ophones
ys
t
e
mi
se
qui
ppe
dwi
t
haz
oomi
ngf
unc
t
i
on,i
tc
anwor
kasa
ni
r
i
s
i
de
nt
i
f
i
c
at
i
onde
vi
c
e
.
2
.A de
di
c
at
e
dl
i
g
ht
r
e
ac
t
i
onde
vi
c
ec
anme
as
ur
et
hes
pe
e
dofl
i
g
htr
e
ac
t
i
ona
nde
x
ami
net
he
i
r
i
spat
t
e
r
ns
i
mul
t
ane
ous
l
y.
I
nt
hei
de
nt
i
f
i
c
at
i
onpr
oc
e
s
s
,t
heana
l
ys
i
sz
onei
ss
e
l
e
c
t
e
df
r
om t
hei
r
i
spat
t
e
r
ns
ampl
e
dus
i
ng
t
heCCD,i
t
spr
of
i
l
ei
se
x
t
r
ac
t
e
dus
i
ngaGaborf
i
l
t
e
randt
he
nc
ode
d. Thi
sc
odei
sus
e
dt
o
s
e
l
e
c
tt
hec
l
os
e
s
ti
r
i
sc
odei
nt
heda
t
aba
s
eba
s
e
dont
heHammi
ngdi
s
t
a
nc
eval
ue
. Thee
r
r
or
−2
4
4
r
at
ei
s2
,t
hes
amepr
obabi
l
i
t
yofac
oi
nt
os
se
ndi
ngwi
t
ht
hes
amer
e
s
ul
t2
44t
i
me
si
na
r
ow.
B Advant
ag
e
s:Nonc
ont
ac
t
,e
as
yt
ous
e
,a
ndac
c
ur
at
e
.I
twoul
dbeve
r
ydi
f
f
i
c
ul
tt
of
a
kean
i
r
i
s
,e
ve
nwi
t
hadvanc
e
dpl
as
t
i
cs
ur
ge
r
yande
yeope
r
a
t
i
ont
e
c
hni
que
s
.I
nc
ombi
na
t
i
onwi
t
h
t
hel
i
g
ht
r
e
ac
t
i
onde
vi
c
e
,i
tc
anme
as
ur
et
hei
r
i
sr
e
a
c
t
i
ons
pe
e
d(
whi
c
ha
i
dsi
ndi
ag
nos
i
sof
pr
obl
e
mswi
t
ht
hebr
ai
ns
t
e
m andoc
ul
omot
orne
r
v
e
)a
ndi
de
nt
i
f
yt
hei
r
i
spa
t
t
e
r
n
s
i
mul
t
ane
ous
l
y
.
2-3 Re
t
i
na
A Pr
i
nc
i
pl
e:Thev
e
s
s
e
l
spat
t
e
r
noft
her
e
t
i
nac
anbeus
e
df
ori
de
nt
i
f
i
c
a
t
i
on. Thi
sve
s
s
e
l
s
pat
t
e
r
nr
e
mai
nsunc
hange
dunl
e
s
st
hev
e
i
nss
hr
i
nkduet
odi
abe
t
e
sorot
he
ri
l
l
ne
s
s
.I
ti
s
nor
mal
l
ydi
f
f
i
c
ul
tt
os
e
et
heve
i
npat
t
e
r
nwi
t
houte
x
pa
ndi
ngt
hei
r
i
sus
i
ngc
he
mi
c
a
l
s(
e
.
g.
,
My
dr
i
n)
.I
nr
e
c
e
ntye
a
r
s
,howe
ve
r
,ade
v
i
c
ehasbe
e
nde
v
e
l
ope
dt
ha
tc
a
ns
e
et
heve
i
npat
t
e
r
n
wi
t
houtt
heus
eofi
r
i
s
ope
ne
rc
he
mi
c
a
l
s
. Asde
di
c
a
t
e
de
qui
pme
nti
sne
c
e
s
s
ar
yi
nbot
hc
a
s
e
s
,i
t
i
snotpos
s
i
bl
et
oc
onduc
tr
e
t
i
nai
de
nt
i
f
i
c
at
i
onus
i
nganor
ma
lv
i
de
ophones
y
s
t
e
ma
l
one
.
B Adva
nt
a
ge
s:Nonc
ont
ac
tandac
c
ur
a
t
e
,butnote
a
s
yt
ous
e
. Thebi
ol
og
i
c
alor
i
g
i
noft
he
r
e
t
i
nai
st
hes
ameast
hatoft
hebr
ai
n. I
nf
a
c
t
,i
ti
spos
s
i
bl
et
oe
s
t
i
ma
t
et
hec
ondi
t
i
onoft
he
bl
oodi
nt
hebr
ai
nf
r
om t
ha
ti
nt
her
e
t
i
na
,a
ndt
hebr
ai
npr
e
s
s
ur
ef
r
om t
heopt
i
cpapi
l
l
aont
he
r
e
t
i
na. Somee
as
yt
ous
ede
vi
c
e
sa
r
ee
xpe
c
t
e
dt
obede
ve
l
ope
di
nt
hef
ut
ur
e
. Wes
houl
df
oc
us
ont
her
e
t
i
nade
vi
c
easapr
omi
s
i
ngt
e
l
e
home
c
a
r
ede
v
i
c
e
.
10
2
3
. PROSPECTS
31 Re
l
uc
t
anc
et
ous
ef
i
nge
r
pr
i
nt
s
TheU.
S.Vi
s
i
tPr
ogr
am e
mpl
oye
dbyt
hei
mmi
g
r
a
t
i
ona
ut
hor
i
t
i
e
si
n20
04,whi
c
hus
e
s
f
i
ng
e
r
pr
i
nt
sf
ori
ndi
vi
duali
de
nt
i
f
i
c
at
i
on,ha
sbe
e
npoor
l
ye
va
l
uat
e
dbyt
hos
ev
i
s
i
t
i
ngAme
r
i
c
a.
Thi
si
sduet
ot
hef
a
c
tt
hatt
hi
sFBIt
e
c
hni
que
,knowna
sAFI
S(
Aut
omat
e
dFi
ng
e
r
pr
i
nt
I
de
nt
i
f
i
c
at
i
onSys
t
e
m)
,hasbe
e
nus
e
dt
oi
de
nt
i
f
yc
r
i
mi
nal
si
nt
heUni
t
e
dSt
a
t
e
s
. Ma
nype
opl
e
maynotac
c
e
ptt
heus
eofs
uc
hac
r
i
mi
na
li
de
nt
i
f
i
c
at
i
ons
y
s
t
e
mf
ort
ot
al
l
ydi
f
f
e
r
e
ntme
di
c
a
lus
e
.
Mos
tus
e
r
sma
ypr
e
f
e
rnonc
ont
ac
t
t
ypebi
ome
t
r
i
ct
e
c
hni
que
st
hatdonotus
ef
i
ng
e
r
pr
i
nt
s
.
Di
a
gnos
i
sus
i
ngt
hevi
de
ophones
ys
t
e
m pr
ov
i
de
si
nf
or
ma
t
i
onont
hepat
i
e
ntsphy
s
i
c
al
c
har
ac
t
e
r
i
s
t
i
c
s
. Thus
,i
ti
snat
ur
a
lt
ous
es
uc
hphy
s
i
c
ali
nf
or
ma
t
i
onf
orus
e
ri
de
nt
i
f
i
c
a
t
i
on.
32 Thr
e
eac
c
ur
ac
yl
e
v
e
l
s
A numbe
rofbi
ome
t
r
i
c
sc
ompani
e
sha
vede
v
e
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om t
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t
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t
l
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t
ant
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ts
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c
tt
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t
l
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s
t
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at
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me
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oj
e
c
tdur
at
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on:
t
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t
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mat
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at
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t
ande
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t
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at
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ve
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ts
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e
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om t
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at
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.
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ac
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t
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e
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ys
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s
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e
s
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oot
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rf
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ng
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s
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si
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or
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ons
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i
t
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ur
t
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ri
nt
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oj
e
c
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al
t
e
x
t
. Thi
si
st
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e
nt
i
alc
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l
i
c
tofi
nt
e
r
e
s
t
s
.
10
8
Par
t2:
Pr
oj
ectd
es
cr
i
pt
i
on
Thi
si
st
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or
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al
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t
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t
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tha
st
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l
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c
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ound
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us
t
i
f
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c
at
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l
. Tobec
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e
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e
r
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als
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t
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r
ss
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e
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.
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uat
or
swoul
dl
i
ket
os
e
eade
s
c
r
i
pt
i
onoft
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nne
ri
nwhi
c
ht
hepr
opos
e
dpr
oj
e
c
ts
obj
e
c
t
i
ve
sc
ont
r
i
but
et
ot
hes
c
i
e
nt
i
f
i
c
,t
e
c
hni
c
al
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oc
i
ala
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i
c
yobj
e
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t
i
ve
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nt
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r
e
a
s
c
onc
e
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ne
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l
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i
c
i
pat
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dr
e
s
ul
t
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e
c
t
.
I
ti
sofa
dv
ant
a
gei
fpar
t
ne
r
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eabl
et
ode
s
c
r
i
bet
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mpa
c
toft
hepr
opos
e
dpr
oj
e
c
ti
nt
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r
e
a
c
onc
e
r
ne
d.
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mpl
ement
at
i
onpl
an
Thi
ss
e
c
t
i
onde
s
c
r
i
be
si
nde
t
a
i
lt
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anne
dt
oa
c
hi
e
vet
heobj
e
c
t
i
v
e
soft
hepr
opos
e
d
pr
oj
e
c
t
.
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nt
r
oduc
t
i
ons
houl
de
xpl
ai
nt
hes
t
r
uc
t
ur
eoft
hi
swor
kpl
a
nandhow t
hepl
anwi
l
ll
e
a
dt
he
par
t
i
c
i
pant
st
oac
hi
e
vet
heobj
e
c
t
i
ve
s
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ts
houl
dal
s
oi
de
nt
i
f
ys
i
gni
f
i
c
a
ntr
i
s
ksa
ndc
ont
i
nge
nc
y
pl
ans
. Thepl
anmus
tbebr
oke
ndownac
c
or
di
ngt
ot
ype
sofa
c
t
i
v
i
t
i
e
s
.
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t
hi
ne
a
c
hac
t
i
v
i
t
yt
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kpl
ans
houl
dbebr
oke
ndownt
ot
as
ks
,whi
c
hs
houl
df
ol
l
ow t
he
l
ogi
c
alphas
e
soft
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oj
e
c
t
,andi
nc
l
udema
na
ge
me
ntoft
hepr
oj
e
c
ta
ndas
s
e
s
s
me
ntofpr
og
r
e
s
s
andr
e
s
ul
t
s
. Thepl
a
ns
houl
di
nc
l
udeawor
ks
c
he
dul
e
,s
howi
ngt
het
i
mi
ngoft
hedi
f
f
e
r
e
nt
t
as
ksa
ndt
he
i
rc
ompone
nt
s(
Gant
tc
har
tors
i
mi
l
a
r
)
. Thi
sgr
aphi
c
alpr
e
s
e
nt
at
i
onoft
he
c
ompone
nt
shast
os
how t
hei
nt
e
r
de
pe
nde
nc
i
e
sofdi
f
f
e
r
e
ntt
as
ks
.
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roft
as
ksands
ubt
as
ksmus
tbeappr
opr
i
at
et
ot
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ompl
e
xi
t
yoft
hewor
kandt
he
ov
e
r
al
lv
al
ueoft
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e
dpr
oj
e
c
t
. Ea
c
ht
as
ks
houl
dbeamaj
ors
ubdi
vi
s
i
onoft
he
pr
opos
e
dpr
oj
e
c
ta
nds
houl
dal
s
ohaveave
r
i
f
i
a
bl
ee
ndpoi
nt
. Thepl
a
nni
ngs
houl
dbe
s
uf
f
i
c
i
e
nt
l
yde
t
ai
l
e
dt
oj
us
t
i
f
yt
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e
de
f
f
or
ta
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l
l
ow pr
og
r
e
s
smoni
t
or
i
ng.
Thi
si
sa
l
s
ot
hepl
a
c
et
oe
xpl
ai
nwhe
t
he
r(
andwhy)ne
wt
e
c
hnol
ogyorne
w pr
oc
e
s
s
e
swi
l
lbe
ut
i
l
i
z
e
d. I
fas
ummar
ypage
shasnotbe
e
npr
ov
i
de
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si
st
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ac
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oe
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a
i
nwhe
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he
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s
i
mi
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ari
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t
i
at
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ve
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e
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ve
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ope
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c
ounti
st
ake
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he
rna
t
i
onalor
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nt
e
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nat
i
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e
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ar
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odi
s
c
us
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e
l
at
e
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e
c
t
st
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l
ue
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e
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a
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oac
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ort
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oj
e
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t
.I
fne
c
e
s
s
a
r
y
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s
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r
i
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dde
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l
uet
ha
ti
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xpe
c
t
e
df
or
mc
a
r
r
y
i
ng
outt
hewor
katna
t
i
onalori
nt
e
r
nat
i
ona
ll
e
v
e
l
.
Par
t
ne
r
shavet
obeve
r
ys
pe
c
i
f
i
cast
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tt
hepr
oj
e
c
tpr
opos
a
lwi
l
lde
l
i
v
e
r
. Thene
xts
e
c
t
i
on
i
sc
l
os
e
l
yc
onne
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t
e
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t
ht
hede
l
i
ve
r
abl
e
s
. Thi
si
st
hedi
s
s
e
mi
nat
i
onpl
a
n.
10
9
Di
s
s
emi
nat
i
on
Thee
xpl
oi
t
at
i
onand/ordi
s
s
e
mi
nat
i
onpl
ansha
vet
or
e
ve
ala
nde
ns
ur
eanade
qua
t
eand
opt
i
malus
eoft
hepr
oj
e
c
tr
e
s
ul
t
s
,whe
r
epos
s
i
bl
ebe
y
ondt
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ne
f
i
c
i
a
r
yr
e
gi
on/c
ount
r
y
.
Co
s
t
Thi
ss
e
c
t
i
ongi
ve
sc
os
te
s
t
i
mat
e
sandpos
s
i
bl
es
our
c
e
soff
undi
ng
. Par
t
ne
r
shavet
os
how t
hat
t
heove
r
al
lf
i
nanc
i
a
lpl
a
nf
ort
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oj
e
c
ti
sade
quat
e
.
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heri
s
s
ues
I
ft
he
r
ear
ee
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hi
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alorg
e
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ri
s
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ue
sa
s
s
oc
i
a
t
e
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t
ht
hes
ubj
e
c
toft
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oj
e
c
tpr
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a
l
,t
he
y
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vet
obet
ake
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nt
oac
c
ount
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ti
sr
e
c
omme
nde
dt
oi
ndi
c
at
ewhi
c
hna
t
i
ona
la
nd
i
nt
e
r
nat
i
onalr
e
gul
at
i
onsar
eappl
i
c
abl
eande
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pl
a
i
nhow t
he
ywi
l
lber
e
s
pe
c
t
e
d.
Co
ns
or
t
i
um andpr
o
j
ectr
es
our
ces
Pr
opos
al
smus
tbepr
e
s
e
nt
e
dbyane
xi
s
t
i
nguni
t
,e
i
t
he
ri
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pe
nde
ntorf
unc
t
i
oni
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t
hi
na
l
oc
a
l
l
ye
s
t
abl
i
s
he
dr
e
s
e
a
r
c
hor
gani
z
at
i
on,andpr
e
f
e
r
a
bl
yha
vi
ngdi
s
t
i
nc
tor
ga
ni
z
a
t
i
ona
la
nd
admi
ni
s
t
r
at
i
veboundar
i
e
s
. Thi
spa
r
ta
i
mst
ode
mons
t
r
at
ehow t
hepr
oj
e
c
twi
l
lmobi
l
i
s
et
he
c
r
i
t
i
c
alma
s
sofr
e
s
our
c
e
s(
pe
r
s
onne
l
,e
qui
pme
nt
,f
undi
nge
t
c
.
)ne
c
e
s
s
a
r
yf
ors
uc
c
e
s
s
.
Thec
ons
or
t
i
um de
s
c
r
i
pt
i
onhast
oi
nc
l
udet
hef
ol
l
owi
ng.
―Of
f
i
c
i
alname
sofpar
t
i
c
i
pantor
gani
z
at
i
ons
,i
nc
l
udi
ngs
hor
tna
me
s
,i
fa
ny
,a
ddr
e
s
s
e
sand
c
ount
r
i
e
s
.
―I
nf
or
mat
i
ononac
t
i
vi
t
yt
y
pe(
i
ndus
t
r
i
alor
ga
ni
z
at
i
on,e
duc
at
i
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a
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ni
ngor
gani
z
a
t
i
one
t
c
.
)
ofe
ac
hpar
t
ne
r
.
―Le
gals
t
at
us(
gove
r
nme
nt
al
,i
nt
e
r
nat
i
ona
le
t
c
.
)
.
―Br
i
e
fde
s
c
r
i
pt
i
onofac
t
i
vi
t
i
e
sa
nde
xpe
r
t
i
s
e
.
I
naddi
t
i
on,de
t
ai
l
e
dde
s
c
r
i
pt
i
onsoft
her
ol
eofpa
r
t
i
c
i
pant
s
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he
i
rc
ompl
e
me
nt
a
r
i
t
i
e
s
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ndi
n
whatwa
yt
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yar
es
ui
t
e
dandc
ommi
t
t
e
dt
ot
het
as
ksa
s
s
i
g
ne
dt
ot
he
m,mus
tbei
nc
l
ude
d. Any
unus
ua
ls
t
af
f
i
ngr
e
qui
r
e
me
nt
s
,s
uc
hasc
ons
ul
t
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nt
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i
des
pe
c
i
a
l
i
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t
s
,hav
et
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de
nt
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i
e
d
he
r
e
. Pos
s
i
bl
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r
t
ne
r
sa
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l
s
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et
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de
nt
i
f
i
e
d,ac
c
ompani
e
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xpl
a
na
t
i
on
ofwhyt
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ons
or
t
i
um ne
e
dst
he
m.
Management
Thi
ss
e
c
t
i
ons
houl
di
nc
l
udeade
s
c
r
i
pt
i
onofhow t
hepr
oj
e
c
twi
l
lbes
t
r
uc
t
ur
e
da
ndma
nag
e
d,i
.
e
.←字取り
t
heor
gani
z
at
i
on,mana
ge
me
nta
ndde
c
i
s
i
onma
ki
ngs
t
r
uc
t
ur
e
soft
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oj
e
c
t
,t
hepl
a
nf
ort
he あり
mana
ge
me
ntofknowl
e
dge
,i
nt
e
l
l
e
c
t
ualpr
ope
r
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yandot
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ra
c
t
i
v
i
t
i
e
sar
i
s
i
ngi
nt
hepr
oj
e
c
t
.
De
pe
ndi
ngont
hes
i
z
eands
c
opeofapr
oj
e
c
t
,as
pe
c
i
al
l
yc
ons
t
i
t
ut
e
dmana
ge
me
ntt
e
a
m wi
t
h
de
di
c
at
e
ds
t
a
f
fc
ov
e
r
i
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a
ng
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ki
l
l
smayne
e
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obes
e
tup. Cons
or
t
i
um manag
e
me
ntma
y
i
nc
l
udec
oor
di
nat
i
onatt
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ons
or
t
i
um l
e
ve
loft
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e
c
hni
c
a
lac
t
i
vi
t
i
e
s
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e
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emana
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me
nt
andot
he
ri
nnovat
i
onr
e
l
at
e
dac
t
i
vi
t
i
e
soft
hepr
oj
e
c
t;
ov
e
r
s
e
e
i
ngs
c
i
e
nc
ea
nds
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i
e
t
yi
s
s
ue
s
r
e
l
at
e
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ot
her
e
s
e
ar
c
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t
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t
i
e
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onduc
t
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t
hi
nt
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oj
e
c
t;ove
r
al
ll
e
g
al
,c
ont
r
ac
t
ua
l
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t
hi
c
a
l
,
f
i
nanc
i
alandadmi
ni
s
t
r
at
i
vemanage
me
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hec
ons
or
t
i
um;pr
e
par
i
ng
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t
i
ngandma
na
gi
ng
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ons
or
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i
um agr
e
e
me
ntbe
t
we
e
nt
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r
t
i
c
i
pant
s
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fandwhe
nne
c
e
s
s
a
r
y;
e
t
c
.
Checkl
i
s
tf
orpr
opos
er
s
Be
f
or
ema
ki
ngyours
ubmi
s
s
i
on,yous
houl
dc
he
c
kt
hef
ol
l
owi
ng
.
―Haveyoui
nc
l
ude
dal
lma
i
nt
opi
c
sa
nds
e
c
t
i
ons
?
―Doe
se
ac
hpageoft
hepr
opos
alhaveahe
a
de
rs
howi
ngt
hepr
opos
a
lna
me
?
11
0
―Ar
eal
lpage
snumbe
r
e
d?
―I
st
hepr
opos
alpr
e
par
e
dasac
ompl
e
t
e
,s
i
ngl
e
s
i
de
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pe
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opy(
r
e
me
mbe
rt
oke
e
pa
s
e
l
f
)?
c
ompl
e
t
ec
opyf
oryour
―Hast
hec
ompl
e
t
es
e
tofpr
opos
aldoc
ume
nt
sbe
e
npa
c
ka
ge
da
ndc
or
r
e
c
t
l
yaddr
e
s
s
e
d?
―Doyouhaveal
lt
hene
c
e
s
s
ar
yaut
hor
i
z
at
i
onsf
r
om e
ac
hme
mbe
roft
hec
ons
or
t
i
um t
os
ubmi
t
t
hi
spr
opos
alont
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i
rbe
hal
f
?
11
1
/
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wt
omakeat
e
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e
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c
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he
al
t
hp
r
o
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e
c
ts
us
t
ai
nab
l
e:
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nt
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e
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t
s
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a
t
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os
＊
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e
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al
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at
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nt
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i
nTabl
eV.Al
l(
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be
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omel
a
r
ge
rt
ha
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hi
si
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rt
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t
i
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ov
e
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oj
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V. Cos
t
s
har
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ngamongpar
t
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A.Decompos
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t
i
onofWTP i
nt
oe
f
f
ect
s
Thepr
e
vi
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e
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ts
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e
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ompos
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sWTP
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nt
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ort
e
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m. The
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e
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t
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howni
nTabl
eVI
.
11
8
Tabl
eI
V Compa
r
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s
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i
t
s(
Uni
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Tabl
eV Compar
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at
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o
Bas
e
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ar
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s
,how t
heWTPde
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si
nt
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ef
ourc
ompone
nt
s
. Thepva
l
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nt
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I
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ment
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11
9
Tabl
eVI
I De
c
ompos
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t
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onofWTPi
nt
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f
f
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hiCi
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b Br
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om t
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ome
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4
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ookBangl
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emed
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ac
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ount
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ong
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ows
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at
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y
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l
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ans:
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ual
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e
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h
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c
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6
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c
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an-Popul
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at
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at
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o
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7
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［7］
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e:Co
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r
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al
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l
ebySNDP Bangl
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e
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om t
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e
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ai
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e
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e
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a
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mpr
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em:
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l
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r
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t
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l
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t
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e
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om t
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et
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i
t
yt
ha
tv
i
l
l
a
geGPwi
l
la
na
l
yz
et
heECG r
e
c
or
dus
i
ngt
heav
ai
l
abl
es
of
t
wa
r
ei
snot
/
/
e
xc
l
ude
d. I
ft
heGPi
snots
ki
l
l
e
de
noug
hori
fhe
s
hef
e
e
l
sne
c
e
s
s
i
t
yt
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ons
ul
ts
pe
c
i
a
l
i
s
t
,he
hec
hanc
evi
al
oc
a
lt
e
l
e
c
e
nt
r
e
st
ot
r
ans
f
e
rabnor
ma
lpar
t
sofECG r
e
c
or
dora
l
lECG
s
hehast
r
e
c
or
dsdi
f
f
i
c
ul
tf
ordi
ag
nos
t
i
c
st
ol
oc
alme
di
c
alc
e
nt
r
e
. Thef
e
e
dbac
khe
l
psf
orpr
ope
ra
nd
f
as
tt
r
e
at
me
nta
ndf
ol
l
owupofpat
i
e
nt
s
. Thusbot
hl
oc
a
lme
di
c
a
lpe
r
s
onne
la
ndpa
t
i
e
nta
r
e
i
nc
l
ude
di
nt
hepr
oc
e
s
soft
e
l
e
c
ons
ul
t
a
t
i
ons
,t
e
l
e
di
a
gnos
t
i
c
sa
ndt
e
l
e
t
r
e
at
me
nt
.
Se
pt
e
mvr
iEme
r
ge
nc
ys
e
r
vi
c
e
sc
e
nt
r
ene
ti
sr
e
pr
e
s
e
nt
e
di
nt
hec
e
nt
r
eoff
i
g
.
3. I
t
spa
r
t
i
c
i
pa
t
i
on
i
nt
hene
t
wor
ksi
sa
ne
xc
e
l
l
e
ntde
c
i
s
i
on,a
st
hehi
g
hqual
i
f
i
c
at
i
onofme
di
c
a
lpe
r
s
ona
lf
r
om t
hi
s
c
e
nt
r
ewi
l
lpr
ovi
dec
ont
i
nuoust
e
l
e
c
ons
ul
t
a
t
i
onsdur
i
ngt
het
i
meoft
hepr
oj
e
c
ta
nda
f
t
e
ri
t
s
e
nd. Thee
qui
pme
ntofme
di
c
alc
e
nt
r
ei
nc
l
udeamongal
lot
he
rme
di
c
a
lde
vi
c
e
saddi
t
i
ona
l
c
omput
e
r
s
,vi
de
oc
ame
r
a
sa
ndt
e
l
e
phonel
i
ne
s
,s
pe
c
i
a
l
l
yde
di
c
at
e
dt
oc
onne
c
t
i
onwi
t
ht
he
c
ommuni
t
ypubl
i
cne
t
. Te
l
e
c
ons
ul
t
at
i
onswi
l
lbeor
g
a
ni
z
e
da
ts
pe
c
i
f
i
cpr
e
ar
r
ange
dhour
s
,
whi
c
hmayva
r
yf
ordi
f
f
e
r
e
ntv
i
l
l
age
s
.
I
nor
de
rt
omakeal
lc
ons
ul
t
at
i
ons
,di
s
t
a
ntdi
a
gnos
t
i
candt
r
e
a
t
me
nte
as
ya
ndc
ont
r
ol
l
a
bl
e
,
e
l
e
c
t
r
oni
cve
r
s
i
onsofpat
i
e
nt
sr
e
c
or
dswi
l
lbeus
e
d. Oneoft
heav
a
i
l
abl
ea
tt
hemar
ke
t
e
l
e
c
t
r
oni
cdat
apac
kage
s
,appr
ove
dbyNat
i
ona
lHe
al
t
hI
ns
ur
anc
eI
ns
t
i
t
ut
i
on,wi
l
lbec
hos
e
n.
Thusa
l
ldat
amaybec
he
c
ke
dpe
r
i
odi
c
a
l
l
ya
nda
na
l
y
z
e
di
nde
t
a
i
l
sdur
i
ngpr
oj
e
c
tt
i
mea
nd
a
f
t
e
ri
t
se
nd. Whati
smor
e
,t
omaket
het
e
l
e
c
a
r
di
ol
og
ys
e
s
s
i
onsmor
ee
f
f
e
c
t
i
v
e
,c
ar
di
ol
ogi
s
t
s
,
c
ons
ul
t
ant
sf
r
om t
hee
me
r
ge
nc
yc
e
nt
r
ewi
l
lr
e
c
e
i
vet
hes
a
mebl
oodpr
e
s
s
ur
ea
ndECG s
of
t
wa
r
e
pac
kaget
hata
r
eavai
l
abl
ewi
t
hbl
oodpr
e
s
s
ur
eandECG hol
t
e
r
s
.I
nas
hor
tt
i
mea
f
t
e
r
a
na
l
yz
i
ngpat
i
e
nt
sECG r
e
c
or
dsc
ar
di
ol
ogi
s
t
swi
l
ls
e
ndv
i
ae
mai
lorv
oi
c
emai
lt
he
i
r
r
e
c
omme
nda
t
i
onsf
orf
ur
t
he
rt
r
e
a
t
me
nta
ndmoni
t
or
i
ng
.
Oneaddi
t
i
onalt
e
l
e
s
e
r
ve
ri
si
nc
l
ude
dont
her
i
ghtha
nds
i
deoff
i
g.
4
. Thi
si
st
het
e
l
e
s
e
r
ve
rat
STI
LBAS,whi
c
hi
sunde
rt
hes
upe
r
vi
s
i
onofSTI
LBASTe
l
e
me
di
c
i
neg
r
oup. Thel
a
t
t
e
rha
s
t
o:
―Se
r
veasme
t
hodol
ogi
c
a
ls
upe
r
vi
s
or
,i
.
e
.t
of
ol
l
ow a
ndhe
l
pbot
hvi
l
l
a
g
eGPsa
ndSe
pt
e
mv
r
i
me
di
c
alc
e
nt
r
es
t
af
ft
oor
gani
z
eandc
ar
r
youta
l
lt
e
l
e
me
di
c
i
nes
e
r
v
i
c
e
s;
―Fol
l
ow t
hes
t
r
i
c
tf
i
l
li
nofa
l
lpat
i
e
nt
se
l
e
c
t
r
oni
cda
t
ar
e
c
or
ds;t
hepr
e
c
i
s
eandc
or
r
e
c
tus
eof
c
ar
di
ov
as
c
ul
arde
vi
c
e
s;pr
e
c
i
s
ea
ppl
i
c
a
t
i
onofbl
oodpr
e
s
s
ur
eandECG s
of
t
wa
r
e;
―St
or
et
e
l
e
e
he
al
t
hs
e
r
vi
c
edat
af
orf
ut
ur
eana
l
ys
i
s
.
I
naddi
t
i
onTe
l
e
me
di
c
i
neg
r
ouphast
os
t
udyanda
nal
y
z
e:
―Me
di
c
ale
f
f
e
c
toft
e
l
e
me
di
c
i
nes
e
r
vi
c
ei
nt
e
r
msoft
i
meoft
r
e
at
me
nt
,t
i
mef
orr
e
c
e
i
v
i
ng
c
ons
ul
t
at
i
onse
t
c
.
;
―Fi
na
nc
i
a
le
f
f
e
c
toft
e
l
e
me
di
c
i
neappl
i
c
a
t
i
onc
ompar
e
dt
onor
ma
lf
ac
e
t
of
ac
ev
i
s
i
t
s(
r
e
duc
t
i
on
ofhe
a
l
t
hc
ar
ec
os
t
sbyr
e
duc
i
ngt
henumbe
rofvi
s
i
t
st
hatme
di
c
a
ls
t
a
f
fne
e
dst
oma
ket
o
t
he
i
rpat
i
e
nt
s;
byc
ut
t
i
ngdownonpat
i
e
nt
sj
our
ne
yst
ohe
a
l
t
hc
e
nt
r
e
sors
pe
c
i
a
l
i
s
t
s
c
ons
ul
t
at
i
ons;byr
e
duc
i
ngt
hel
e
ngt
hofs
t
a
yi
nhos
pi
t
al
sa
nde
t
c
.
)
,
―Ps
yc
hol
ogi
c
ale
f
f
e
c
toft
e
l
e
me
di
c
i
nes
e
r
v
i
c
e
,i
.
e
.as
s
e
s
s
me
ntt
hes
at
i
s
f
ac
t
i
onoft
heme
di
c
a
ls
t
a
f
f
appl
yi
ngt
e
l
e
c
ons
ul
t
at
i
ons
,ana
l
yz
i
ngt
e
l
e
e
he
al
t
hac
c
e
pt
a
nc
ef
r
om t
hepoi
ntofv
i
e
w of
pa
t
i
e
nt
sa
ndr
e
l
a
t
i
ve
se
t
c
.
BASt
e
l
e
s
e
r
ve
rmayhave3mor
eappl
i
c
a
t
i
ons:
14
2
―Toor
gani
z
e
,i
fa
ndwhe
nne
c
e
s
s
ar
y,c
ons
ul
t
at
i
onswi
t
hhi
g
hl
yqual
i
f
i
e
dme
di
c
als
pe
c
i
a
l
i
s
t
.
swi
t
ht
heme
di
c
a
ls
t
af
fofDrGr
e
e
nbe
r
gc
l
i
ni
ci
nSof
i
a
,
Ne
got
i
at
i
onsar
ei
npr
ogr
e
s
―Toor
ndnur
s
e
sf
r
om t
her
ur
a
l
gani
z
e
,t
e
l
e
e
duc
at
i
onandt
e
l
e
t
r
a
i
ni
ngf
orme
di
c
aldoc
t
or
sa
a
r
e
a,t
oor
ga
ni
z
et
e
l
e
c
onf
e
r
e
nc
e
s
,t
e
l
e
t
r
adi
ngf
ort
e
l
e
me
di
c
i
nepr
oduc
t
se
t
c
.
―Toor
z
e
,i
fa
ndwhe
nne
c
e
s
s
ar
y,t
e
l
e
ps
y
c
hol
ogi
c
alc
ons
ul
t
at
i
ons
. Thes
t
a
f
foft
he
ga
ni
I
ns
t
i
t
ut
eofPs
yc
hol
ogy(
I
P)
,BAS,wi
l
lbei
nv
ol
v
e
di
ndi
s
t
antps
yc
hol
og
i
c
alc
ons
ul
t
a
t
i
ons
.
Thi
si
smos
ta
ppr
opr
i
a
t
ede
c
i
s
i
onasI
PBASi
st
hel
a
r
ge
s
tnat
i
onalc
e
nt
r
ef
orf
undame
nt
al
ps
yc
hol
ogi
c
a
ls
t
udi
e
sandt
r
ans
f
e
rofs
c
i
e
nt
i
f
i
cac
hi
e
ve
me
nt
si
ndi
f
f
e
r
e
ntbr
anc
he
sof
ps
y
c
hol
ogyandt
e
c
hnol
og
y,
Tel
eps
ychol
og
y
Anot
he
rs
t
r
at
e
gi
cgoaloft
hepr
oj
e
c
ti
st
ode
ve
l
opa
ndof
f
e
ravi
r
t
ualhi
g
hqual
i
t
y
ps
yc
hol
ogi
c
als
e
r
vi
c
et
ope
opl
ef
r
om r
e
mot
ear
e
a
st
hatha
dnopos
s
i
bi
l
i
t
yt
oc
ons
ul
t
pr
of
e
s
s
i
onal
. Te
xt
,c
ol
ouri
mage
s
,s
hor
t
s
e
g
me
ntv
i
de
oa
ndaudi
oc
l
i
pswi
l
lbet
r
a
ns
mi
t
t
e
d
dur
i
ngt
hec
our
s
eoft
hepr
oj
e
c
t
. Thust
hepr
oj
e
c
te
mpl
oyss
t
at
e
of
t
he
a
r
tr
e
mot
ene
t
wor
ki
ng
t
e
c
hnol
ogyt
oe
nabl
ee
xpe
r
t
st
oc
ommuni
c
a
t
edi
r
e
c
t
l
ywi
t
hpat
i
e
nt
sandt
ope
r
f
or
mr
e
mot
e
c
ons
ul
t
at
i
ons
,s
upe
r
vi
s
i
on,ps
y
c
hol
ogi
c
a
le
v
al
ua
t
i
onsandc
ont
i
nuousmoni
t
or
i
ngaswe
l
la
st
o
advi
s
er
ur
alps
yc
hol
ogi
s
t
sa
nde
he
al
t
hwor
ke
r
s
.
Thr
e
ear
et
hemai
nr
e
as
onst
oi
nc
l
udet
e
l
e
ps
y
c
hol
og
yi
nt
hepr
oj
e
c
t:
―Theme
anst
oof
f
e
re
ps
yc
hol
og
i
c
alc
ons
ul
t
at
i
onsa
r
eava
i
l
abl
e
. Expe
r
i
e
nc
eofot
he
r
c
ount
r
i
e
sr
e
ve
al
e
dt
hei
mpor
t
anc
eofe
ps
y
c
hol
ogya
ndi
t
se
f
f
e
c
t
i
v
e
ne
s
s(
Ai
ns
wor
t
h2
004;
Gar
c
i
ae
tal
.2004;Lahad2004;
Wi
l
de
r
mut
h2
0
04
)
. Butf
or
e
i
g
ne
x
pe
r
t
i
s
ei
snota
ppl
i
c
abl
e
i
ft
he
r
ear
enota
c
c
ur
at
ec
ondi
t
i
onst
oi
nt
r
oduc
ei
ta
ndi
ft
hi
se
x
pe
r
t
i
s
ei
snotadj
us
t
e
dt
o
l
oc
alc
har
ac
t
e
r
i
s
t
i
c
sa
ndr
e
qui
r
e
me
nt
s
.
―I
nBul
gar
i
at
he
r
ei
sade
mandofs
uc
hs
e
r
vi
c
e
s
. Al
t
houghc
omput
e
r
sandI
nt
e
r
ne
ta
r
enot
%ofI
nt
e
r
ne
tvi
s
i
t
or
sa
r
el
ooki
ng,f
orps
yc
hol
ogi
c
a
l
avai
l
abl
ei
ne
ve
r
yhous
e
hol
d,about1
i
nf
or
mat
i
onands
uppor
t
. Whatus
e
r
sar
el
ooki
ngf
or
? Thea
ns
we
ri
ss
i
mpl
e
ma
nype
opl
e
know how t
he
ys
houl
dl
i
vehe
al
t
hi
e
r(
f
ood,we
i
ght
,e
xe
r
c
i
s
ee
t
c
.
)butar
enotabl
et
oa
dj
us
t
t
he
i
rl
i
f
et
ot
hi
sknowl
e
dge
.I
nt
e
r
ne
tus
e
r
sa
r
eve
r
ymuc
hl
ooki
ngf
ors
uc
hi
nf
or
mat
i
on. I
n
addi
t
i
on,t
he
yar
el
ooki
ngf
orps
yc
hol
ogi
c
a
la
dvi
c
ea
ndc
ouns
e
l
l
i
ngi
nl
ot
sofar
e
asc
ove
r
i
ng
l
i
f
e
s
t
yl
epr
obl
e
ms
,l
one
l
i
ne
s
s
,me
l
anc
hol
y
,j
e
a
l
ous
y,ma
r
i
t
a
lpr
obl
e
ms
,al
c
ohola
nddr
ug
de
pe
nde
nc
e
,bul
i
mi
ae
t
c
.
Al
loft
hi
sma
ybej
us
ta
par
tofe
v
e
r
y
dayl
i
f
e
,or
ma
ybes
e
r
i
ousme
nt
al
i
l
l
ne
s
s
e
s
,ora
ny
t
hi
ng
i
nbe
t
we
e
n. Eve
nl
e
s
s
s
e
r
i
ouspr
obl
e
msa
r
e
of
t
e
nac
a
us
eofmi
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e
r
y
andl
ac
kofc
a
pa
c
i
t
yf
or
pr
oduc
t
i
vewor
kand
he
al
t
hi
e
rl
i
f
e
. Se
ve
r
al
we
bs
i
t
e
sa
l
r
e
adye
xi
s
t
of
f
e
r
i
nge
xc
l
us
i
ve
l
yora
s
par
toft
he
i
rs
e
r
v
i
c
e
vi
r
t
ualps
yc
hol
ogi
c
al
Fi
g.
5 Loc
a
lv
i
r
t
ualps
y
c
hol
ogi
c
a
ls
i
t
eof
f
e
r
i
ngon-a
ndof
f
l
i
ne
c
ons
ul
t
at
i
ons(
Fi
g.
5)
.
c
ons
ul
t
at
i
ons
14
3
Somear
ef
r
e
e
,s
omer
e
qui
r
es
ma
l
lf
e
e
. The
us
e
r
sc
ont
a
c
tt
he
s
es
i
t
e
sus
ual
l
yf
r
om home
.
I
nt
hepr
oj
e
c
tst
ar
ge
tr
e
gi
onhomec
omput
e
r
s
andI
nt
e
r
ne
tac
c
e
s
sf
r
om homear
er
e
a
r
.
De
ve
l
opme
ntofl
oc
alpubl
i
cf
r
e
eofc
har
ge
t
e
l
e
c
e
nt
r
e
s
,asr
e
al
i
z
e
di
nt
hi
spr
oj
e
c
t
,i
sa
s
ol
ut
i
onof
f
e
r
i
ngabi
gge
rpr
opor
t
i
onof
popul
at
i
onac
c
e
s
st
ovi
r
t
ualps
yc
hol
og
y
c
ons
ul
t
at
i
ons
.
―I
naddi
t
i
on,t
r
a
di
t
i
onal
l
y,ps
yc
hol
ogi
c
alhe
l
p
hasbe
e
nt
r
e
at
e
dast
heCi
nde
r
e
l
l
aofhe
a
l
t
h
s
e
r
vi
c
e
sde
s
pi
t
eofi
t
si
mpor
t
anc
e
. Wor
l
d
Fi
g.
6 Wor
ki
ngpl
a
c
ef
orv
i
r
t
ua
l
He
al
t
hOr
gani
z
at
i
one
s
t
i
mat
e
st
hatnowa
da
ys
ps
y
c
hol
ogi
c
a
lc
ons
ul
t
at
i
ons
a
l
mos
t1
,
50
0mi
l
l
i
onpe
opl
es
uf
f
e
rf
r
om
ps
yc
hol
ogi
c
alpr
obl
e
msa
ndne
e
dhe
l
p.
De
s
pi
t
eoft
hi
sf
a
c
t
,ps
yc
hol
ogi
c
alc
ons
ul
t
i
ng,wi
t
hs
omee
x
c
e
pt
i
ons
,i
snotc
ove
r
e
dby
i
ns
ur
anc
ef
unds
. Eps
yc
hol
ogyof
f
e
r
sr
e
l
at
i
ve
l
yc
he
e
ps
ol
ut
i
onwhi
c
hma
ys
a
t
i
s
f
i
e
dpa
t
i
e
nt
s
andwi
l
lnotpute
nor
mousbur
de
nonhe
al
t
hc
a
r
ebudge
t
.
Ent
hus
i
as
t
i
cl
i
c
e
ns
e
dps
yc
hol
og
i
s
t
sa
r
ei
nv
ol
ve
di
nvi
r
t
ualps
y
c
hol
og
i
c
a
lc
ons
ul
t
at
i
ons
.
/
Pot
e
nt
i
alpat
i
e
ntus
e
r
shavet
ovi
s
i
tl
oc
a
lt
e
l
e
c
e
nt
r
e
swhe
r
es
pe
c
i
a
l
i
z
e
d,hi
dde
nf
r
om v
i
e
wa
nd
s
oundpr
oofpl
ac
e
sf
orps
yc
hol
ogi
c
alc
ons
ul
t
a
t
i
onsar
ee
qui
ppe
d. Thus
,i
fa
ndwhe
nne
c
e
s
s
ar
y
,
us
e
r
sr
e
l
yont
e
c
hni
c
aladvi
s
e
sa
ndont
hehe
l
poft
e
l
e
c
e
nt
r
es
t
af
f
. Thet
e
c
hni
c
a
ls
t
a
f
fwi
l
lnot
at
t
e
ndt
e
l
e
s
e
s
s
i
ons
. Di
r
e
c
tc
onne
c
t
i
oni
sor
gani
z
e
dbe
t
we
e
nl
oc
a
lt
e
l
e
c
e
nt
r
e
sa
ndas
e
r
ve
ra
t
STI
LBAS. Thel
a
t
t
e
ri
st
hewor
ki
ngpl
a
c
ef
orv
i
r
t
ua
lps
y
c
hol
ogi
c
alc
ons
ul
t
a
t
i
ons(
Fi
g.
6
)
.I
n
or
de
rt
omakee
ps
yc
hol
ogi
c
alc
ont
ac
ta
se
as
i
e
ra
spos
s
i
bl
e
,3mode
l
sofc
ont
a
c
t
sa
r
ef
or
e
s
e
e
n:
―Exc
hangeoft
e
xtme
s
s
age
s
,i
.
e
.e
ma
i
l
s;
―I
ne
tt
e
l
e
phonyand
nt
e
r
―Vi
de
oc
onne
c
t
i
on.
Bot
honl
i
neandof
f
l
i
nes
e
s
s
i
onsa
r
epl
anne
d. Of
f
l
i
nes
e
s
s
i
onsr
e
l
ye
nt
i
r
e
l
yont
e
x
tme
s
s
ag
e
s
.
Vi
s
ua
lc
ont
ac
twi
l
lbeus
e
donl
yi
nc
as
eofne
c
e
s
s
i
t
yanda
f
t
e
rpr
e
l
i
mi
nar
yag
r
e
e
me
ntbe
t
we
e
n
us
e
randps
y
c
hol
ogi
s
t
.I
ti
se
s
s
e
nt
i
a
lt
obeunde
r
l
i
ne
dt
ha
tt
hepr
oj
e
c
tdoe
snotf
oc
uson
t
r
e
at
me
ntofs
e
v
e
r
eme
nt
alc
ondi
t
i
ons
.I
ti
snotor
i
e
nt
e
dt
owar
dst
hes
e
r
i
ousi
l
l
ne
s
s
e
s
,whi
c
h
mayr
e
qui
r
ehos
pi
t
al
i
z
at
i
on. Eps
y
c
hol
og
y,a
sf
or
e
s
e
e
ni
nt
hepr
oj
e
c
t
,i
st
a
r
ge
t
e
da
tt
hos
e
ma
nype
opl
e
,f
r
om a
l
la
geg
r
oups
,whoar
es
uf
f
e
r
i
ngi
ns
i
l
e
nc
e
,whodonots
e
e
kadoc
t
oror
ps
y
c
hi
at
r
i
s
tbutwhoc
anbea
i
de
di
nac
hi
e
vi
ngabe
t
t
e
ra
ndmor
epr
oduc
t
i
v
el
i
f
eby
ps
yc
hol
ogi
c
ala
dvi
c
e
.
I
nawor
d,wepr
e
f
e
randputt
hes
t
r
e
s
sont
e
xt
me
s
s
age
sasmai
nc
ommuni
c
at
i
ons
our
c
eof
e
ps
yc
hol
ogi
c
alc
ouns
e
l
l
i
ng
. Re
as
onst
opr
e
f
e
re
ma
i
lc
ont
a
c
t
sa
r
e:
―Ema
i
l
sa
r
ee
as
yt
ous
e
,f
ami
l
i
art
oma
nypot
e
nt
i
a
lpat
i
e
nt
sandve
r
ys
i
mi
l
art
owr
i
t
i
ng
l
e
t
t
e
r
s
.I
naddi
t
i
ont
he
ypr
ovi
deanonv
i
s
ualandnona
udi
t
or
y
,pr
i
v
at
ea
ndr
e
l
i
abl
ewa
yof
c
ommuni
c
at
i
onandc
r
e
a
t
eaps
yc
hol
og
i
c
als
pac
ei
nwhi
c
hpai
rofpe
opl
ei
nt
e
r
a
c
t
s
,
―Emai
l
sc
r
e
a
t
eat
e
xtt
al
kasJ
ohnSul
e
r(
2
0
04)br
i
l
l
i
a
nt
l
ye
xpl
a
i
ns
. Fort
hos
ewhol
ov
et
o
wr
i
t
e
,e
ma
i
li
sahe
ave
n. Lot
sofpe
opl
ef
e
e
lt
ha
tt
he
yc
a
ne
x
pr
e
s
st
he
ms
e
l
ve
sbe
t
t
e
ri
nt
he
wr
i
t
t
e
nwor
ds
. As
ki
l
l
f
ulwr
i
t
ei
sa
bl
et
oc
ommuni
c
a
t
ec
ons
i
de
r
abl
ede
pt
ha
nds
ubt
l
e
t
yi
n
t
hede
c
e
pt
i
ve
l
ys
i
mpl
ewr
i
t
t
e
nwor
d. Wr
i
t
i
ngmayi
nv
ol
vedi
f
f
e
r
e
ntme
nt
a
lme
c
ha
ni
s
mst
ha
n
14
4
i
npe
r
s
ont
al
kaswr
i
t
t
e
ndi
al
oguer
e
f
l
e
c
t
sadi
s
t
i
nc
tc
og
ni
t
i
v
es
t
y
l
et
ha
te
nabl
e
ss
omepe
opl
e
t
obemor
ee
xpr
e
s
s
i
ve
,s
ubt
l
e
,or
gani
z
e
d,orc
r
e
a
t
i
vei
nhow t
he
yc
ommuni
c
a
t
e
. Thuswr
i
t
t
e
n
t
e
xtof
t
e
nr
e
ve
al
spe
r
s
onalc
har
ac
t
e
r
i
s
t
i
c
,whi
c
hi
sofs
i
gni
f
i
c
anthe
l
pdur
i
ngvi
r
t
ua
l
c
ons
ul
t
at
i
ons
.
―Ema
i
l
smaybeanonymousa
save
r
a
geI
nt
e
r
ne
tus
e
r
sa
r
enota
wa
r
ehow t
ot
r
ac
kdownt
he
or
i
g
i
nandi
de
nt
i
t
yt
heme
s
s
age
.I
fus
e
r
swa
nt
,t
he
ymayus
eps
e
udonym,notr
e
alna
me
s
.
Theonl
yr
e
qui
r
e
me
nti
st
oke
e
pt
hes
ameps
e
udonym dur
i
ngt
hee
nt
i
r
edur
a
t
i
onof
e
ps
yc
hol
ogi
c
a
lc
ont
ac
t
s
. Thi
spot
e
nt
i
a
lf
ora
nonymi
t
yandt
hel
ac
koff
ac
e
t
of
a
c
ec
ue
s
di
s
i
nhi
bi
t
ss
omepe
opl
e
,whi
c
hi
sv
e
r
yi
mpor
t
a
nti
ns
mal
lpat
r
i
ar
c
halc
ommuni
t
i
e
sa
st
hos
e
e
nga
ge
di
nt
hepr
oj
e
c
t
. Pe
opl
ef
e
e
lf
r
e
et
os
a
yt
hi
ngst
he
ywoul
dntor
di
na
r
i
l
ys
ay
,
e
nc
our
age
st
he
mt
obemor
eope
n,hone
s
t
,a
nda
f
f
e
c
t
i
ona
t
e
.
―Emai
lc
ont
ac
t
sus
ual
l
ya
r
eof
f
l
i
neanddonotoc
c
uri
nr
e
a
lt
i
me
. Thi
si
se
s
s
e
nt
i
a
lf
or
/pat
us
e
r
s
i
e
nt
sa
sg
i
ve
st
i
met
ot
hi
nk,e
va
l
uat
eandc
ompos
et
he
i
rme
s
s
a
ge
si
namos
t
appr
opr
i
at
ewa
y. Thes
amec
ountf
orl
i
c
e
ns
e
dps
y
c
hol
ogi
s
t
,whoi
snotpr
e
s
s
e
dt
or
e
s
pond
ont
he
s
pota
ndi
fne
c
e
s
s
ar
ymayt
akeadv
ant
a
geoft
hi
sandde
di
c
at
emor
et
i
meon
c
ons
i
de
r
i
nge
v
e
r
ypar
t
i
c
ul
arc
as
e
.I
naddi
t
i
on,t
heas
ync
hr
onousc
ha
r
ac
t
e
rofe
mai
l
e
xc
hangegi
v
e
sc
hanc
et
oadj
us
tt
hes
pe
e
dofv
i
r
t
ua
lc
ouns
e
l
l
i
ngac
c
or
di
ngt
ot
hene
e
dsoft
he
us
e
r
s
.I
nt
e
r
ac
t
i
vet
i
mec
anbes
hor
t
e
ne
dors
t
r
e
t
c
he
d,a
sne
e
de
d.
―Las
e
as
t
,e
mai
l
se
xc
ha
ng
ee
na
bl
e
sust
or
e
c
or
dt
hei
nt
e
r
a
c
t
i
onsbys
a
v
i
ngt
he
tbutnotl
t
ype
dt
e
xtme
s
s
age
s
.
Ofc
our
s
e
,us
a
geofe
ma
i
l
shasne
gat
i
ves
i
t
e
st
oo:
―Somepe
opl
emaynotbeat
t
r
ac
t
e
dt
oe
mai
lbe
c
a
us
ei
ti
nvol
v
e
st
ypi
ng. Ev
e
r
y
oneknows
how t
ot
al
kbutnote
ve
r
yonef
e
e
l
sc
omf
or
t
a
bl
et
ypi
ng. De
f
i
ni
t
e
l
y,t
het
ypi
ng/
wr
i
t
i
ngba
r
r
i
e
r
wi
l
lf
i
l
t
e
rs
omeus
e
r
s
.
―Emai
la
nonymi
t
yi
snotf
undame
nt
a
l
l
ya good t
hi
ng
.I
tma
yt
ur
noutt
obe ba
d as
we
l
l
.I
tc
ut
sbot
hways
.
―Spam i
sa
not
he
rne
gat
i
veas
pe
c
tofe
mai
l
i
ng
. Al
le
mai
lus
e
r
sar
es
ubj
e
c
t
e
dt
oj
unkma
i
l
s
ai
me
dt
os
e
l
ls
ome
t
hi
ng. Thi
smaybeas
e
r
i
ouspr
obl
e
m,a
spe
opl
es
ubj
e
c
t
i
v
e
l
ye
xpe
r
i
e
nc
e
e
ma
i
la
sape
r
s
onals
pa
c
e
. Re
c
e
i
v
i
ngs
pa
m maybe
a
tbac
ks
omeus
e
r
s
.
For
e
s
e
e
ns
ol
ut
i
oni
sa
va
i
l
abl
eI
nt
e
r
ne
tt
e
l
e
phonyandpr
e
s
c
he
dul
e
ds
e
s
s
i
onswi
t
hl
i
c
e
ns
e
d
ps
yc
hol
ogi
s
tf
ort
hos
ewhoar
enotwi
l
l
i
ngorr
e
a
dyt
or
e
l
yone
mai
lc
ont
ac
t
s
.
Expect
edout
come
s
―Che
apt
e
l
e
me
di
c
i
nes
e
r
vi
c
es
ui
t
abl
et
oi
mpr
ov
equal
i
t
yofhe
a
l
t
hc
a
r
eandhe
a
l
t
hmoni
t
or
i
ng
ofpat
i
e
nt
sf
r
om adi
s
t
anc
e;
―De
ve
l
opme
ntofa
dvanc
e
di
nt
e
r
a
c
t
i
vee
nvi
r
onme
ntf
orme
di
c
als
t
af
fa
ndpat
i
e
nt
s;
―Ne
w knowl
e
dgeac
qui
r
e
dc
onc
e
r
ni
ngt
hea
c
c
e
pt
a
nc
eofi
nt
e
l
l
i
ge
nte
nvi
r
onme
ntbypa
t
i
e
nt
s
andt
hei
nf
l
ue
nc
eoft
e
l
e
me
di
c
i
nes
e
r
vi
c
eonl
i
f
es
at
i
s
f
a
c
t
i
onandons
a
t
i
s
f
a
c
t
i
onf
r
om v
i
r
t
ua
l
he
al
t
hs
upe
r
vi
s
i
on;
Si
g
ni
f
i
c
antr
e
duc
t
i
onofpar
tofhe
al
t
hc
ar
ebudge
t
sde
di
c
a
t
e
dt
ohomehe
a
l
t
hvi
s
i
t
s
.
Pot
ent
i
alp
r
obl
ems
Par
t
ne
r
sa
r
ewe
l
la
wa
r
et
hatt
he
yl
lf
ac
es
i
gni
f
i
c
antpr
obl
e
msdur
i
ngt
hee
nt
i
r
edur
a
t
i
onoft
he
pr
oj
e
c
t
. Someoft
he
s
epr
obl
e
msa
r
eal
r
e
a
dyar
e
a
l
i
t
y
,ot
he
ra
r
es
t
i
l
ll
at
e
nt
. Fe
w oft
he
14
5
pr
obl
e
mst
hatwea
r
el
ooki
ngt
oove
r
c
omea
r
e:
―Ne
gat
i
veat
t
i
t
udeora
tl
e
as
ts
us
pi
c
i
ont
owa
r
dst
e
l
e
me
di
c
i
nea
ppl
i
c
at
i
onsa
nde
s
pe
c
i
al
l
yt
o
di
s
t
a
ntc
ons
ul
t
a
t
i
onsasc
ompar
e
dt
of
ac
e
t
of
a
c
es
e
r
v
i
c
e
. Thi
si
sapr
obl
e
m wehav
ea
l
r
e
a
dy
me
ta
ndt
r
y
i
ngt
obe
atdown. Bot
hme
di
c
als
t
af
fandpot
e
nt
i
a
lus
e
r
sa
r
es
us
pi
c
i
ons
. Thi
s
at
t
i
t
udei
sc
hange
dve
r
ys
l
owl
yandwi
t
hl
ot
sofe
f
f
or
t
s
.
―Thel
ac
koft
e
c
hni
c
ale
xpe
r
i
e
nc
eofbot
hl
oc
alme
di
c
a
ls
t
af
fa
ndpat
i
e
nt
s
. Fort
hemome
nt
t
woar
et
hewayst
oove
r
c
omet
hi
sobs
t
a
c
l
e:(
1
)t
r
a
i
ni
ngc
our
s
e
sf
orv
ol
unt
e
e
r
st
ous
eand
be
c
omef
ami
l
i
arwi
t
hI
nt
e
r
ne
tt
e
c
hnol
ogyand(
2)t
e
c
hni
c
als
uppor
tofus
e
r
si
nl
oc
a
l
t
e
l
e
c
e
nt
r
e
s
.
―Anot
he
rs
e
r
i
ouspr
obl
e
mi
sune
ve
nas
s
e
s
st
oI
nt
e
r
ne
t
. Thepr
of
i
l
eofI
nt
e
r
ne
tus
e
r
si
nt
he
c
ount
r
yr
e
ve
al
st
ha
t(
a)I
nt
e
r
ne
tus
a
gei
ns
mal
lv
i
l
l
ag
e
si
st
i
me
ss
ma
l
l
e
rt
ha
ni
nt
hec
a
pi
t
a
lor
bi
gc
i
t
i
e
s;(
b)The
r
ei
sas
i
gni
f
i
c
antag
eands
e
xdi
f
f
e
r
e
nc
e
si
nI
nt
e
r
ne
tus
aget
oowi
t
ht
he
i
nc
r
e
as
eofme
anaget
hepe
r
c
e
ntofI
nt
e
r
ne
tus
e
r
sdr
opsa
ndr
e
ac
he
s3
.
1%i
nt
heag
e
g
r
oup＞50yr
s
.I
naddi
t
i
on,me
nas
s
e
s
sI
nt
e
r
ne
tal
mos
tt
i
me
smor
et
hanwome
n(
ABC
De
s
i
gn& Communi
c
at
i
on200
3a& b)
. Thi
spr
obl
e
mi
snote
as
yt
oov
e
r
c
ome
. Pa
r
t
i
a
l
s
ol
ut
i
oni
sde
ve
l
opme
ntoff
r
e
ec
ommuni
t
yt
e
l
e
c
e
nt
r
e
s
,whi
c
hi
sas
t
r
a
t
e
gi
cgoaloft
he
pr
oj
e
c
t
. Adv
e
r
t
i
s
e
me
nt
sa
ndac
t
i
vei
nvol
v
e
me
ntofl
oc
ala
dmi
ni
s
t
r
a
t
i
v
eandme
di
c
al
aut
hor
i
t
i
e
sal
s
ohe
l
ps
.I
ns
omec
as
e
sge
ne
r
a
lpr
ac
t
i
t
i
one
r
sa
r
et
hos
ewhohavet
opus
ha
l
i
t
t
l
epe
opl
et
ous
ev
i
r
t
ualc
ons
ul
t
at
i
ons
.
―Fe
ar
sofl
oos
i
ngpr
of
i
t
s
. Thi
si
sas
i
gni
f
i
c
antpr
obl
e
me
s
pe
c
i
al
l
yi
nt
hec
a
s
eof
t
e
l
e
ps
yc
hol
ogyc
ouns
e
l
l
i
ngal
t
houg
hi
ti
sc
or
r
e
s
pondst
ot
e
l
e
c
ar
di
ol
ogy
,t
oo. The
s
ea
r
et
he
mai
nf
e
ar
sa
sf
ort
hemome
nta
de
quat
er
e
i
mbur
s
e
me
ntpol
i
c
ydoe
snote
x
i
s
t
s
. He
al
t
h
i
ns
ur
anc
ef
undsdonotc
ove
rv
i
r
t
ualc
ons
ul
t
at
i
ons
. Ora
g
ai
n,t
hi
si
st
hepr
obl
e
mt
os
e
par
a
t
e
c
har
i
t
yandbus
i
ne
s
s
. Butt
he
s
ef
e
ar
sa
r
enotwe
l
l
f
ounde
da
tl
e
as
ti
nt
hec
as
eofv
i
r
t
ual
ps
yc
hol
ogyhe
l
p. I
ti
sr
e
c
ogni
z
e
dt
ha
tt
r
a
di
t
i
onalps
yc
hol
og
yc
ons
ul
t
a
t
i
onss
e
r
veonl
y
f
r
ac
t
i
onoft
hepopul
at
i
onwhor
e
al
l
yne
e
di
t
. Toma
nype
opl
eI
nt
e
r
ne
ts
e
e
msmor
epr
i
v
a
t
e
,
andt
hi
spe
r
c
e
i
ve
dpr
i
vac
yhe
l
pst
he
mc
r
os
st
heba
r
r
i
e
rofs
t
i
g
mat
os
e
e
khe
l
pt
hr
oug
h
t
e
l
e
c
ouns
e
l
l
i
ng. I
nt
e
r
ne
ti
spr
ovi
di
ngabr
i
dg
eac
r
os
soneoft
heba
r
r
i
e
r
st
ha
tke
e
ppe
opl
e
f
r
om ge
t
t
i
ngt
hehe
l
pt
he
yne
e
d. Thust
e
l
e
ps
y
c
hol
ogye
xpandst
heg
r
oupofpot
e
nt
i
al
pat
i
e
nt
sa
ndr
e
a
c
he
spe
opl
et
hati
nmos
tc
a
s
e
swi
l
lne
v
e
rme
e
tps
y
c
hol
ogi
s
tf
ac
e
t
of
ac
e
.
About6
0%ofvi
r
t
ualps
yc
hol
ogypat
i
e
nt
sc
ons
ul
tl
i
c
e
ns
e
dps
y
c
hol
ogi
s
tf
ort
hef
i
r
s
tt
i
mei
n
t
he
i
rl
i
f
e
. Whati
smor
e
,ove
r65
%oft
e
l
e
ps
yc
hol
og
ypa
t
i
e
nt
sunde
r
t
aket
hene
x
ts
t
e
pt
owa
r
d
f
ac
e
t
of
ac
ec
ons
ul
t
at
i
onsa
ndt
r
e
at
me
nt(
Ai
ns
wor
t
h2
00
4)
. Thus
,s
i
mpl
ee
s
t
i
ma
t
i
ons
r
e
v
e
a
l
e
dt
ha
te
v
e
nwhe
nvi
r
t
ualps
yc
hol
og
yc
ons
ul
t
a
t
i
onsa
r
ef
r
e
eofc
ha
r
g
e
,e
v
e
nwhe
nt
he
y
a
r
eof
f
e
r
e
dasc
ha
r
i
t
y,t
her
e
s
ul
ti
sa
ni
nc
r
e
as
eofpa
i
df
ac
e
t
of
a
c
ec
ons
ul
t
at
i
ons
. Puti
n
anot
he
rwor
ds
,e
f
f
or
t
sde
di
c
a
t
e
dt
ot
e
l
e
ps
y
c
hol
ogi
c
a
lc
ha
r
i
t
yatt
hee
ndr
e
c
e
i
ve
dr
e
wor
d.
Or
,i
nt
hec
as
eofv
i
r
t
ualps
yc
hol
ogy,c
har
i
t
ye
nhanc
e
sbus
i
ne
s
s
. The
r
ei
snodoubtt
ha
tt
he
s
ames
c
he
mewi
l
la
ppl
yt
ot
e
l
e
c
ar
di
ol
ogyaswe
l
l
.
―Ens
ur
i
ngt
e
c
hni
c
als
e
c
ur
i
t
yandc
onf
i
de
nt
i
a
l
i
t
yofv
i
r
t
ua
lc
ons
ul
t
a
t
i
onsmayal
s
obea
pr
obl
e
ma
sde
s
pi
t
eofnume
r
oust
e
c
hni
c
a
ls
ol
ut
i
ons
,t
hepos
s
i
bi
l
i
t
yf
oruna
ut
hor
i
z
e
da
c
c
e
s
s
t
ovi
r
t
ua
li
nf
or
mat
i
onc
annotbet
ot
al
l
yne
g
l
e
c
t
e
d.
―Anot
he
rpr
obl
e
ma
c
c
ount
i
ngmai
nl
yt
ot
e
l
e
ps
yc
hol
og
yandt
oas
ma
l
l
e
re
xt
e
ndt
o
t
e
l
e
c
a
r
di
ol
ogyi
st
hel
ac
kofnonve
r
ba
lc
ommuni
c
a
t
i
onc
ha
nne
l
s
. Thi
si
st
hebi
g
g
e
s
t
di
s
adva
nt
ag
eofv
i
r
t
ualc
ommuni
c
at
i
ona
shuma
nf
a
c
ea
ndbodyl
ang
ua
g
ear
er
i
c
hi
n
me
ani
ngande
mot
i
ons
. The
s
eac
c
ount
sbot
hf
orps
yc
hol
og
i
s
t
sa
ndf
orpat
i
e
nt
s
. Whe
none
c
a
nnots
e
eot
he
rpe
opl
esf
ac
e
sorhe
a
rt
he
ms
pe
a
khei
sl
oos
i
ngal
ls
ubt
l
evoi
c
eandbody
l
a
ng
uagec
ue
s
. Thusa
s
s
e
s
s
i
ngt
henuanc
e
sofc
ommuni
c
at
i
ngi
sv
e
r
ydi
f
f
i
c
ul
t
. Thel
ac
kof
14
6
f
ac
e
t
of
ac
ec
ue
sma
yr
e
s
ul
ti
nambi
gui
t
y. Thi
se
nha
nc
e
st
het
e
nde
nc
yt
opr
oj
e
c
tonc
e
e
xpe
c
t
at
i
ons
,wi
s
he
s
,anxi
e
t
i
e
sandf
e
ar
si
nt
owha
tt
heot
he
rpe
r
s
onwr
ot
e
,unt
ot
hes
ome
wha
t
s
hadowyf
i
gur
es
i
t
t
i
ngatt
heot
he
re
ndoft
heI
nt
e
r
ne
t
. Ps
y
c
hot
he
r
api
s
t
sc
al
lt
hi
sa
t
r
ans
f
e
r
e
nc
er
e
a
c
t
i
on or pr
oj
e
c
t
i
on . I
ti
sunc
ons
c
i
ousa
ndc
oul
dl
e
adt
o
mi
s
unde
r
s
t
andi
ngsa
spe
opl
edonotr
e
a
l
i
z
ehow i
ti
ss
t
e
e
r
i
ngt
he
i
rbe
ha
v
i
our
. Asus
ual
,t
he
c
oi
nhast
wos
i
t
e
s
,i
.
e
.t
hepos
i
t
i
onofot
he
ra
ut
hor
si
sj
us
tt
heoppos
i
t
e
. The
yc
l
ai
mt
ha
t
e
xc
ha
ngeoft
e
xtme
s
s
age
sc
ar
r
i
e
sus pa
s
tt
hedi
s
t
r
ac
t
i
ngs
upe
r
f
i
c
i
a
la
s
pe
c
t
sofape
r
s
ons
e
xi
s
t
e
nc
eandc
onne
c
t
susmor
edi
r
e
c
t
l
yt
ot
he
i
rmi
nda
ndpe
r
s
ona
l
i
t
y. Fort
he
ms
e
e
i
ngi
s
e
qua
lt
obe
l
i
e
vi
ng. The
s
ea
r
et
headvoc
a
t
e
sofvi
de
oc
hanne
l
s
.I
nanat
t
e
mptt
omi
ni
mi
z
e
t
hi
spr
obl
e
m,t
hepr
oj
e
c
tg
i
ve
sapos
s
i
bi
l
i
t
yt
oa
ddvi
de
oc
onne
c
t
i
oni
fa
ndwhe
nne
c
e
s
s
ar
y
.
Thi
swi
l
lbedoneonl
yaf
t
e
rpr
e
l
i
mi
na
r
yagr
e
e
me
ntofus
e
r
s
. Unde
rdi
s
c
us
s
i
oni
sa
pos
s
i
bi
l
i
t
yt
o pr
oj
e
c
t aphot
oofps
y
c
hol
ogi
s
tl
e
a
di
ngvi
r
t
ualc
ons
ul
t
a
t
i
ons
. Hope
f
ul
l
yt
hi
s
hast
ode
c
r
e
as
et
het
r
ans
f
e
r
e
nc
er
e
a
c
t
i
ons
.
De
s
pi
t
eoft
heaboveme
nt
i
one
dpr
obl
e
ms
,pa
r
t
ne
r
sbe
l
i
e
v
et
hate
x
pe
c
t
e
dout
c
ome
swi
l
l
c
ompe
ns
at
ea
l
ldi
f
f
i
c
ul
t
i
e
s
. Pr
e
di
c
t
abl
er
e
s
ul
t
sa
tpr
oj
e
c
tse
ndar
e:
―I
mpr
ove
dqual
i
t
yofe
he
al
t
hs
e
r
vi
c
eduet
oe
a
s
i
l
y,c
he
a
p,f
as
t
,pr
i
v
a
t
e
,ata
nyt
i
meandf
r
om
a
ny
whe
r
ec
ont
ac
tbe
t
we
e
nme
di
c
als
t
af
fa
ndpa
t
i
e
nt
s;
―De
v
e
l
opme
ntofa
dv
anc
e
di
nt
e
r
ac
t
i
vee
nvi
r
onme
ntf
orme
di
c
als
t
af
fa
ndpa
t
i
e
nt
s;
―Ne
w knowl
e
dgeac
qui
r
e
dc
onc
e
r
ni
ngt
hea
c
c
e
pt
a
nc
eofi
nt
e
l
l
i
g
e
nte
nvi
r
onme
ntbypat
i
e
nt
s
a
ndt
hei
nf
l
ue
nc
eoft
e
l
e
me
di
c
i
nes
e
r
v
i
c
eonl
i
f
es
at
i
s
f
ac
t
i
ona
ndons
at
i
s
f
a
c
t
i
onf
r
om v
i
r
t
ua
l
he
al
t
hs
upe
r
vi
s
i
on;
―Si
gni
f
i
c
antr
e
duc
t
i
onofpa
r
tofhe
al
t
hc
ar
ebudg
e
t
sde
di
c
at
e
dt
ohomehe
al
t
hv
i
s
i
t
sa
sa
r
e
s
ul
tofa
voi
danc
eofi
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akeofTe
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l
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ame
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ore
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ompl
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eandunambi
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at
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15
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als
e
r
v
e
r,whi
c
hi
ss
i
t
ua
t
e
da
tt
he
Me
di
c
alPhys
i
c
sLabor
at
or
yoft
heUni
ve
r
s
i
t
yofAt
he
ns
. Fr
om t
heme
di
c
a
ls
e
r
v
e
r
,da
t
a
c
anal
s
ober
e
t
r
i
e
ve
dandupda
t
e
dbyt
hes
uppor
t
i
nghos
pi
t
al
. Theme
di
c
a
ls
e
r
v
e
ri
sba
s
e
d
onMi
c
r
os
of
tsSQL Se
r
ve
r
,i
ns
t
al
l
e
donI
nt
e
lsPe
nt
i
um Wor
ks
t
at
i
onr
unni
ngWi
ndowsNT
Se
r
v
e
r
.
Te
l
e
me
di
c
i
neSe
r
v
i
c
e
sa
r
ei
ni
t
i
at
e
dbypr
i
mar
yc
a
r
ephys
i
c
i
a
nsa
nd/
ormi
dwi
ve
s
,whe
nt
he
yar
e
c
onf
r
ont
e
dwi
t
hane
me
r
ge
nc
ymat
e
r
ni
t
yc
as
e
,ort
he
yar
ei
nne
e
dofe
xpe
r
ta
dvi
c
eonar
out
i
ne
f
ol
l
ow upe
xami
nat
i
onofapr
e
gnantwoma
n. Te
l
e
me
di
c
i
nes
e
s
s
i
onsa
r
ei
ni
t
i
at
e
dwi
t
hpat
i
e
nt
c
ons
e
nta
ndt
he
yt
y
pi
c
a
l
l
yi
nc
l
ude:
1
)Cr
e
at
i
on(
orupda
t
e
)oft
hepa
t
i
e
ntsEl
e
c
t
r
oni
cPat
i
e
ntRe
c
or
d(
EPR);
2
)Re
c
or
di
ngoft
hec
ar
di
ot
oc
ogr
am (
CTG)t
r
a
c
eandi
ns
e
r
t
i
oni
nt
her
e
c
or
d;
3
)Tr
ans
mi
s
s
i
onofEPR t
ot
heme
di
c
als
e
r
v
e
rhos
t
e
datt
heMe
di
c
a
lPhy
s
i
c
sLabor
a
t
or
y
(
Sc
hoolofMe
di
c
i
ne
,Uni
ve
r
s
i
t
yofAt
he
ns
);
4)Al
e
r
toft
hephys
i
c
i
ansoft
he2ndObs
t
e
t
r
i
c
sa
ndGy
na
e
c
ol
ogyDe
par
t
me
ntoft
heAr
e
t
ai
e
i
on
Uni
v
e
r
s
i
t
yHos
pi
t
ali
nAt
he
nsvi
ae
mai
l
,t
e
l
e
phoneorvi
de
oc
onf
e
r
e
nc
e;
5
)Re
v
i
e
w oft
heEPR oft
hepat
i
e
ntbye
xpe
r
tphy
s
i
c
i
ans
,r
e
c
or
di
ngoft
he
i
ropi
ni
onand
s
t
or
ageoft
headde
di
nf
or
mat
i
ont
ot
hes
e
r
ve
ra
r
c
hi
ve
s;
6
)Di
s
c
us
s
i
onoft
hec
as
ebe
t
we
e
nhos
pi
t
a
le
xpe
r
t
sandr
e
mot
ephys
i
c
i
anand/ormi
dwi
f
e
s
,v
i
a
16
1
t
e
l
e
phoneorv
i
de
oc
onf
e
r
e
nc
e(
de
pe
ndi
ngont
hec
a
s
e
)i
fne
e
dar
i
s
e
s;
7
)Handl
i
ngt
hec
a
s
eatr
e
mot
es
i
t
easa
gr
e
e
d.
Re
s
ul
t
s
Dur
i
ngt
hei
ni
t
i
ali
mpl
e
me
nt
at
i
onphas
e
,bot
ht
e
c
hni
c
ala
ndc
l
i
ni
c
a
la
s
pe
c
t
soft
hes
e
r
v
i
c
ehav
e
be
e
ne
val
uat
e
d. Eva
l
uat
i
onoft
heEl
e
c
t
r
oni
cEhe
al
t
hRe
c
or
d,vi
de
oc
onf
e
r
e
nc
i
ngandCTG
r
e
c
or
di
ngandpr
oc
e
s
s
i
ngmodul
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sf
oc
us
e
dont
he
i
rr
e
l
i
a
bi
l
i
t
y,us
e
r
f
r
i
e
ndl
i
ne
s
sa
ndav
a
i
l
abi
l
i
t
y
.
Ne
t
wor
ke
val
uat
i
onf
oc
us
e
doni
t
sr
e
l
i
a
bi
l
i
t
y
,a
va
i
l
a
bi
l
i
t
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pe
e
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x
pr
e
s
s
e
di
nt
e
r
msoft
he
t
i
mer
e
qui
r
e
dt
ope
r
f
or
m ke
yope
r
at
i
ons
. Cl
i
ni
c
ale
va
l
uat
i
onf
oc
us
e
dont
heade
qua
c
yoft
he
c
ommuni
c
at
e
di
nf
or
mat
i
onf
orr
e
ac
hi
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c
i
s
i
onwhe
ndi
s
t
a
nc
es
e
par
at
e
spat
i
e
nta
nde
x
pe
r
t
phys
i
c
i
an.
Dur
i
ngt
hepe
r
i
odbe
i
ngr
e
por
t
e
d(
Aug
us
t1
9
98― Fe
br
ua
r
y200
0
)t
hi
r
t
yTe
l
e
me
di
c
i
nes
e
s
s
i
ons
havet
ake
npl
ac
ebe
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we
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nt
heEhe
al
t
hCe
nt
r
eofMy
konosa
ndt
he2ndObs
t
e
t
r
i
c
sa
nd
Gy
na
e
c
ol
ogyCl
i
ni
c
,whi
l
et
e
ns
e
s
s
i
onswe
r
eor
i
gi
na
t
e
df
r
om t
heEhe
a
l
t
hCe
nt
r
eofNa
x
os
.
I
nal
lc
a
s
e
sas
i
ng
l
eat
t
e
mpts
uf
f
i
c
e
dt
oe
s
t
a
bl
i
s
ht
heTe
l
e
me
di
c
i
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nk. Thet
i
mer
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r
e
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o
t
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ans
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e
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ntEHCRsbe
t
we
e
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ndt
e
r
t
i
a
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ys
i
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wa
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sl
e
s
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han1
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e
c
onds
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Communi
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at
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e
mswe
r
enote
nc
ount
e
r
e
ddur
i
ngt
hee
nt
i
r
epe
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od.
Vi
de
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onf
e
r
e
nc
i
ngl
i
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r
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s
t
abl
i
s
he
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t
e
rEHCR dat
aha
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nt
r
a
ns
f
e
r
r
e
d,t
oa
l
l
ow
/
c
ommuni
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at
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t
we
e
nt
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ons
ul
t
i
ngandt
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i
ma
r
yc
a
r
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i
c
i
ansand ormi
dwi
v
e
s
r
e
que
s
t
i
ngas
s
i
s
t
anc
e
. Thel
i
nkswe
r
eag
ai
ne
a
s
i
l
ye
s
t
abl
i
s
he
d,r
e
ma
i
ne
dac
t
i
vedur
i
ngt
he
e
nt
i
r
ec
ons
ul
t
at
i
onsandwe
r
ef
oundt
obeofg
oodqua
l
i
t
yf
ort
hepur
pos
e
soft
hes
e
r
vi
c
e
.
TheEl
e
c
t
r
oni
cPa
t
i
e
ntRe
c
or
dandt
heCTG r
e
c
or
di
nga
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oc
e
s
s
i
ngmodul
e
swe
r
ef
oundt
o
ber
e
l
i
abl
e
,asnopr
obl
e
mswe
r
ee
nc
ount
e
r
e
d. The
i
ra
va
i
l
a
bi
l
i
t
ywa
se
x
pe
c
t
e
dt
obehi
g
hby
de
s
i
g
n,whi
c
hpr
ove
dt
obet
r
ue
. Thea
va
i
l
abi
l
i
t
yandr
e
l
i
abi
l
i
t
yoft
hes
e
r
v
e
ronwhi
c
ht
he
pa
t
i
e
ntEPRsar
es
t
or
e
d,att
heMe
di
c
alPhys
i
c
sLa
bor
a
t
or
y
,we
r
eal
s
of
oundt
obehi
gh.
Theus
eofa
l
lmodul
e
spr
ove
dt
obee
a
s
y
. Par
t
i
c
i
pat
i
ngme
di
c
a
lpr
of
e
s
s
i
ona
l
sf
e
l
tc
omf
or
t
a
bl
e
wi
t
ht
hes
of
t
wa
r
eaf
t
e
ras
hor
tt
r
ai
ni
ngpe
r
i
odofa
boutoneda
y. Theav
e
r
aget
i
mer
e
qui
r
e
dt
o
s
t
udyandupdat
eane
xi
s
t
i
ngpat
i
e
ntEPR wa
sa
ppr
oxi
mat
e
l
yf
i
ve(
5)mi
nut
e
s
,whi
l
et
het
i
me
r
e
qui
r
e
dt
oc
r
e
at
eane
w EPR was1
0mi
nut
e
s
. Thet
i
mer
e
qui
r
e
dt
or
e
c
or
daCTG t
r
ac
ea
nd
t
oat
t
ac
hi
tt
ot
hepa
t
i
e
ntr
e
c
or
dwasa
r
ound2
5mi
nut
e
s
. Thi
si
si
na
c
c
or
dwi
t
ht
heMa
t
e
r
ni
t
y
Gui
de
l
i
ne
,whi
c
hs
t
at
e
st
hate
a
c
hr
e
c
or
di
ngs
houl
dbeofa
tl
e
a
s
t2
0mi
nut
e
sdur
a
t
i
on. The
ov
e
r
al
lt
i
mer
e
qui
r
e
dt
or
e
c
or
dpat
i
e
ntdat
af
ort
hef
i
r
s
tt
i
mewa
s
,t
he
r
e
f
or
e
,l
e
s
st
han35
mi
nut
e
s
,whi
c
hwa
sc
ons
i
de
r
e
dac
c
e
pt
a
bl
e
.
Ma
t
e
r
ni
t
yTe
l
e
me
di
c
i
nes
e
r
vi
c
e
swe
r
eof
f
e
r
e
di
n4
0c
a
s
e
s
. Al
lc
a
s
e
s
,c
onc
e
r
ne
dpr
e
gna
nt
wome
nt
aki
ngr
out
i
nef
ol
l
owupe
xami
nat
i
ons
. Al
lc
a
s
e
sbutonewe
r
ef
oundt
obenor
ma
l
.
Onl
yoneoft
hepat
i
e
nt
spr
e
s
e
nt
e
dwi
t
hac
ompl
i
c
a
t
e
dc
l
i
ni
c
alc
ondi
t
i
on,na
me
l
yt
hatof
pr
e
ma
t
ur
el
aboura
s
s
oc
i
at
e
dwi
t
hpl
ac
e
nt
apr
ae
vi
a. Pr
i
ma
r
yc
a
r
ephys
i
c
i
a
ns
,f
ol
l
owi
ngt
he
a
dvi
c
eobt
ai
ne
dus
i
ngt
het
e
l
e
me
di
c
i
nes
y
s
t
e
m,e
v
ac
ua
t
e
dt
hepa
t
i
e
ntt
oAr
e
t
a
i
e
i
onhos
pi
t
a
l
.
Ov
e
r
al
li
nt
hi
ss
t
udy,t
hec
ont
e
nt
soft
hepat
i
e
ntEPR,i
nc
l
udi
ngt
heCTG t
r
a
c
e
,pr
ov
e
dt
obe
ade
quat
ei
nr
e
a
c
hi
ngas
af
ede
c
i
s
i
onf
ora
l
l40c
a
s
e
s
.
Ma
t
e
r
ni
t
yTe
l
e
me
di
c
i
nes
e
r
vi
c
e
swe
r
ef
oundt
obeas
i
g
ni
f
i
c
anta
i
dt
oPr
i
mar
yCa
r
eUni
t
st
ha
t
donothaveac
c
e
s
st
os
pe
c
i
al
i
z
e
dobs
t
e
t
r
i
ce
xpe
r
t
i
s
e
. Bypr
ovi
di
nge
he
al
t
he
mpl
oy
e
e
soft
hos
e
uni
t
swi
t
he
as
y,onde
mandac
c
e
s
st
oe
x
pe
r
tadv
i
c
e
,t
he
yi
mpr
ov
et
hequa
l
i
t
yoft
hes
e
r
v
i
c
e
s
pr
ovi
de
dt
opr
e
gnantl
adi
e
s;t
he
yal
l
ow a
nopt
i
mals
e
l
e
c
t
i
onofc
as
e
st
ha
ta
r
ei
nne
e
dof
e
v
ac
uat
i
ont
ot
e
r
t
i
ar
yuni
t
s
,whi
c
h,t
oge
t
he
rwi
t
hi
mpr
ovi
ngt
hequa
l
i
t
yofl
oc
a
l
l
yof
f
e
r
e
d
r
out
i
nef
ol
l
owupe
x
ami
nat
i
on,mayl
e
a
dt
oas
ubs
t
ant
i
a
lr
e
duc
t
i
onofc
os
t
sandpat
i
e
nt
16
2
s
at
i
s
f
ac
t
i
on. Asar
e
s
ul
t
,pat
i
e
ntdi
s
pl
a
c
e
me
ntc
anber
e
duc
e
dt
oami
ni
mum f
orr
out
i
ne
e
xami
nat
i
ons
. Duet
ot
hebi
gnumbe
rofpr
e
gnanc
i
e
spe
ra
nnum i
nt
het
woi
s
l
ands(
5
0on
ave
r
age
)
,t
hi
sl
e
adst
oac
ons
i
de
r
abl
er
e
duc
t
i
onofmobi
l
i
t
yc
os
t
s
. Ther
e
t
ur
nont
he
i
nve
s
t
me
ntoft
het
e
l
e
mat
i
ci
nf
r
as
t
r
uc
t
ur
eandt
heme
di
c
a
lde
vi
c
e
sc
a
nt
husbeac
hi
e
ve
di
na
l
i
t
t
l
emor
et
ha
naye
a
r
.
Di
s
cus
s
i
on
De
s
pi
t
et
hef
a
c
tt
hatt
hec
ont
e
ntofpat
i
e
ntr
e
c
or
ds
,i
nc
l
udi
ngCTGs
,we
r
ef
oundt
obe
s
uf
f
i
c
i
e
ntf
ort
r
e
at
i
ngmat
e
r
ni
t
yc
a
s
e
s
,i
twa
sge
ne
r
a
l
l
yr
e
c
og
ni
z
e
dt
ha
tamor
eg
e
ne
r
i
c
c
us
t
omi
z
at
i
onoft
heEPR s
of
t
wa
r
ewoul
di
nc
r
e
a
s
et
her
i
c
hne
s
sofi
nf
or
mat
i
oni
tc
ont
ai
nsa
nd
woul
df
a
c
i
l
i
t
at
ee
xpe
r
t
si
ngai
ni
ngabe
t
t
e
runde
r
s
t
andi
ngoft
hec
a
s
e
sbe
i
nghandl
e
d.
I
nf
or
mat
i
onpr
ov
i
de
dor
al
l
y(
e
.
g
.v
i
av
i
de
oc
onf
e
r
e
nc
e
)a
ndnots
t
or
e
di
npat
i
e
nt
sr
e
c
or
ds
i
nc
r
e
as
et
hel
e
ng
t
hofTe
l
e
me
di
c
i
nes
e
s
s
i
onsandi
nc
r
e
as
et
her
i
s
kofl
oos
i
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s
i
nt
e
r
pr
e
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nt
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nt
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heEhe
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e
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ve
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e
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at
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e
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or
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ke
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nt
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nt
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pr
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ove
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at
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ri
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ope
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nt
e
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know a
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e
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ore
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ons
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r
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um oft
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ons
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16
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ci
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s
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s
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l
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ount
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r
e
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e
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as
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ar
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e
dand
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ummar
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l
ow.
2
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ar
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t
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os
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mul
at
i
onsofTe
l
e
c
ons
ul
t
at
i
onsbe
t
we
e
nApol
l
oHos
pi
t
al
s
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de
r
a
bad,Che
nna
ia
ndDuba
i
f
orc
as
e
ss
pe
c
i
f
i
ct
oCa
r
di
ol
ogy
,Ne
ur
os
ur
g
e
r
y& Or
t
hope
di
c
swe
r
edone
.
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di
c
alConf
e
r
e
nc
e
Br
us
s
e
l
s
. Sur
gi
c
alpr
oc
e
dur
ei
nCl
e
ve
l
a
nd,USAr
e
c
e
i
v
e
di
nApol
l
o
Hos
pi
t
a
l
sDe
l
hi
,Che
nna
i
,& Hy
de
r
abadi
n1
99
7
.
Te
l
e
med
i
ci
neCent
r
e
ss
etupbyApol
l
o
Apol
l
ohass
e
tupov
e
r5
7Te
l
e
me
di
c
i
neCe
nt
r
e
sac
r
os
sdi
f
f
e
r
e
ntl
oc
a
t
i
onsi
nt
hec
ount
r
yand
abr
oadwi
t
hmanymor
ei
nt
hepi
pe
l
i
ne
. Apol
l
ohaswor
ke
dwi
t
hdi
f
f
e
r
e
ntki
ndsofe
nt
i
t
i
e
si
n
t
hee
he
a
l
t
hi
ndus
t
r
yr
angi
ngf
r
om l
ar
g
eCor
por
at
ehos
pi
t
a
l
sa
ndGove
r
nme
nthos
pi
t
a
l
st
o
s
mal
lc
l
i
ni
c
sandI
nf
or
mat
i
onCe
nt
r
e
s
. Apol
l
ohast
hee
x
pe
r
t
i
s
et
oe
xe
c
ut
edi
f
f
e
r
e
ntki
ndsof
Te
l
e
me
di
c
i
nepr
oj
e
c
t
s
.
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e:
Ar
agondaA Rur
alEheal
t
hMod
el
/l
Ar
agondai
sar
e
mot
ev
i
l
l
agei
nt
heC hi
t
t
oordi
s
t
r
i
c
tofc
l
i
ni
c
al
a
bor
a
t
or
ye
v
a
l
ua
t
i
ons
.
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aPr
ade
s
hha
vi
ngl
oc
alRe
g
i
s
t
e
r
e
dMe
di
c
alPr
ac
t
i
t
i
one
r
sandt
heMa
nda
l
a
m Pr
i
mar
y
17
1
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al
t
hCe
nt
r
e
,manne
dbyas
i
ngl
er
e
gi
s
t
e
r
e
ddoc
t
or
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l
i
ve
r
se
he
a
l
t
hs
e
r
vi
c
e
st
oa
l
lt
he
a
dj
oi
ni
ngvi
l
l
age
soft
heThavanampal
l
eMa
ndal
a
m. The
r
ewe
r
enodi
ag
nos
t
i
cf
a
c
i
l
i
t
i
e
sa
t
/
Ar
agonda. Loc
alGe
ne
r
alPr
ac
t
i
t
i
one
r
sde
pe
nde
donChi
t
t
oora
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l
l
or
ef
orc
l
i
ni
c
a
l
l
a
bor
a
t
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ye
va
l
uat
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ons
.
s
o
Ar
ag
ondawass
e
l
e
c
t
e
dt
obe
c
omeourf
i
r
s
tTe
l
e
me
di
c
i
neCe
nt
r
ebe
c
aus
eAr
ag
ondawasal
l
i
kea
nyot
he
rt
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alI
ndi
a
nv
i
l
l
agewi
t
honl
yt
heba
s
i
cme
di
c
alf
ac
i
l
i
t
i
e
s
. Thema
j
or
oc
c
upa
t
i
onoft
hepe
opl
eofAr
agondaands
ur
r
oundi
nga
r
e
a
si
sa
gr
i
c
ul
t
ur
e
. Thea
i
l
me
nt
s
we
r
es
e
as
onal;
dur
i
ngs
umme
rai
l
me
nt
swe
r
eofma
l
ar
i
a
lnat
ur
ea
nddur
i
ngmons
oons
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t
e
r
bor
nedi
s
e
as
e
swe
r
er
ampant
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tdi
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ves
uf
f
i
c
i
e
ntdoc
t
or
sa
ndme
di
c
alf
a
c
i
l
i
t
i
e
st
o
pr
ovi
des
e
c
ondar
ya
ndt
e
r
t
i
ar
yc
a
r
e
. Ke
e
pi
ngt
he
s
ef
ac
t
or
si
nv
i
e
w,Apol
l
ode
c
i
de
dt
os
t
a
r
ti
t
s
pi
l
otTe
l
e
me
di
c
i
nepr
oj
e
c
ti
nAr
a
gondabyc
onne
c
t
i
ngAr
ag
ondat
ot
heApol
l
ohos
pi
t
al
si
n
Hyde
r
abadandChe
nnaihos
pi
t
al
s
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he
r
e
bybr
i
ngi
ngt
e
r
t
i
a
r
yc
a
r
ea
tt
he
i
rdoor
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t
e
ps
.
I
nc
i
de
nt
a
l
l
y
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ag
ondai
sI
ndi
asf
i
r
s
tRur
a
lTe
l
e
me
di
c
i
neSt
at
i
on.
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0be
dde
dhos
pi
t
alwass
e
tupi
nAr
a
g
ondawi
t
hs
t
a
t
eoft
hea
r
te
qui
pme
nt
,whi
c
hi
nc
l
ude
d
CT Sc
an,Ul
t
r
as
ound,Xr
ayandanar
r
a
yofme
di
c
a
lpe
r
s
onne
lt
ogi
v
egoods
e
c
ondar
yc
a
r
e
f
ac
i
l
i
t
i
e
s
. A Te
l
e
me
di
c
i
neCe
nt
r
ewasal
s
os
e
tupt
of
a
c
i
l
i
t
a
t
eonet
oonei
nt
e
r
ac
t
i
onbe
t
we
e
n
t
hedoc
t
ora
ndt
hes
pe
c
i
al
i
s
t
sl
oc
at
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de
i
t
he
ri
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l
o,Hyde
r
a
badorChe
nnai
. Si
nc
ei
t
s
i
nc
e
pt
i
on,t
heAr
agondapr
oj
e
c
ti
sdoi
nge
x
t
r
e
me
l
ywe
l
lt
aki
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ua
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es
e
c
ondopi
ni
onvi
a
s
a
t
e
l
l
i
t
ef
r
om Che
nnaia
ndus
i
ngt
hel
andl
i
nef
r
om Hyde
r
abad.
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a
gondaTe
l
e
me
di
c
i
newa
sf
i
r
s
tv
i
e
we
dbyMrBi
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nt
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or
me
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e
s
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de
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heUni
t
e
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St
at
e
dofAme
r
i
c
ai
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c
h2000dur
i
nghi
svi
s
i
tt
oHyde
r
a
ba
d. Hevi
e
we
dal
i
v
e
t
e
l
e
c
ons
ul
t
a
t
i
onbe
t
we
e
nAr
agondaandApol
l
oHos
pi
t
a
l
s
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r
abad. MrPr
amodMa
ha
j
a
n
i
naugur
a
t
e
dt
heAr
ag
ondaTe
l
e
me
di
c
i
neCe
nt
r
ei
nApr
i
l20
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ale
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a
l
t
hpr
of
e
s
s
i
ona
l
s
whous
eTe
l
e
me
di
c
i
neatAr
agondat
oda
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e
e
ll
e
s
si
s
ol
a
t
e
df
r
om me
di
c
alc
ol
l
e
a
gue
sand
r
e
s
our
c
e
s
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nt
hi
smode
lTe
l
e
me
di
c
i
nei
ss
i
mpl
yat
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oe
xt
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ndt
hehos
pi
t
alsr
e
f
e
r
r
al
ba
s
eandi
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of
i
tme
c
hani
s
m. Cos
t
sa
ndl
i
mi
t
at
i
onsont
e
c
hnol
og
yar
ec
ons
i
de
r
abl
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r
e
duc
e
d.
Re
s
ul
t
soft
hi
sPi
l
ots
t
udyt
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oac
ons
e
ns
ust
ha
te
noug
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v
i
de
nc
ee
xi
s
t
st
oj
us
t
i
f
y
i
nc
or
por
at
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ngTe
l
e
me
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c
i
nea
sa mode
lofc
a
r
e notj
us
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ort
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ondaHos
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t
a
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ma
nymor
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l
l
a
ge
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ownst
hatl
ac
kac
c
e
s
st
ome
di
c
alc
a
r
e
.
Te
l
e
me
di
ci
neI
ni
t
i
at
i
v
esatSanj
ayGand
hiPos
t
g
r
aduat
eI
ns
t
i
t
ut
eo
fMedi
c
alSc
i
enc
es
,
7
,
8
,
9,
10
,
1
1,
12
,
1
3,
1
4
Lucknow6,
Sanj
ayGandhiPos
t
gr
aduat
eI
ns
t
i
t
ut
eofMe
di
c
a
lSc
i
e
nc
e
s(
SGPGI
MS)
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know i
sat
e
r
t
i
a
r
y
c
ar
er
e
f
e
r
r
alhos
pi
t
alandapr
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mi
e
r
ec
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nt
r
ef
ort
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ac
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i
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upe
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pe
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i
a
l
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tme
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pr
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onal
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ta
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ar
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hi
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i
or
i
t
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al
t
ha
r
e
asofna
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i
onal
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mpor
t
anc
e
. Thi
si
st
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i
r
s
tt
e
r
t
i
a
r
yc
a
r
ehos
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t
ali
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cs
e
c
t
ori
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at
oi
nt
r
oduc
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Hos
pi
t
alI
nf
or
mat
i
onSy
s
t
e
mi
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98. Thes
of
t
wa
r
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sde
ve
l
ope
di
nc
ol
l
abor
at
i
onwi
t
ht
he
Ce
nt
r
ef
orDe
ve
l
opme
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dc
omput
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ng(
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ti
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hef
i
r
s
tpubl
i
cs
e
c
t
or
hos
pi
t
ali
nt
hec
ount
r
yt
os
t
ar
tat
e
l
e
me
di
c
i
nepr
og
r
am i
n199
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onduc
t
e
dal
ar
g
enumbe
r
oft
e
l
e
me
di
c
i
nepr
oj
e
c
t
st
ot
e
s
tt
het
e
c
hnol
ogyi
ndi
f
f
e
r
e
nthe
al
t
hr
e
l
a
t
e
da
ppl
i
c
at
i
ons
.
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r
e
nt
l
y
,Or
i
s
s
aTe
l
e
me
di
c
i
nene
t
wor
kpr
oj
e
c
ti
sr
unni
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nf
ul
ls
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ng
,Ut
t
a
r
anc
ha
lne
t
wor
k
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sunde
ri
mpl
e
me
nt
at
i
onphas
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rPr
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t
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e
t
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g
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d. SGPGI
t
e
l
e
me
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i
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oma
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i
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l
e
me
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i
net
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oug
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sor
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z
at
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ona
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t
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t
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e
ss
uc
hasc
onf
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r
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nc
e
s
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e
mi
na
r
sa
ndwor
ks
hops
.
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e
tt
hec
ur
r
e
ntandf
ut
ur
ene
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al
t
ht
e
c
hnol
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ti
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nabl
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l
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hs
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ora
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at
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or
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orr
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e
ar
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he
r
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r
om di
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e
r
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r
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ve
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e
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ss
e
t
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l
e
me
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c
i
neandBi
ome
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c
a
lI
nf
or
mat
i
c
s
.
17
2
a)
b)
Fi
g
.
2 a)Te
l
e
me
di
c
i
newor
ks
t
a
t
i
oni
npr
og
r
e
s
sa
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nt
r
a
hos
pi
t
a
l
t
e
l
e
me
di
c
i
nene
t
wor
koft
heope
r
a
t
i
ont
he
a
t
r
ef
orr
e
alt
i
mei
nt
e
r
a
c
t
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v
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t
e
l
e
s
ur
gi
c
alc
onf
e
r
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nc
e
Tel
emedi
ci
neI
nf
r
as
t
r
uct
ur
eatSGPGI
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r
e
nt
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y,t
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r
as
t
r
uc
t
ur
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l
e
me
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i
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nt
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nt
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l
e
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at
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adi
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e
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e
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hol
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r
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c
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ar
r
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ans
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ra
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mot
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at
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mul
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c
at
i
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s
t
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xI
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g
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l
e
me
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t
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ne
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l
e
me
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r
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gh
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ame
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r
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c
alpr
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e
s
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nt
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mpus
t
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l
e
me
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Audi
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om di
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t
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a
a
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oad(
Fi
g.
3
)
.
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eeheal
t
h
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econs
ul
t
at
i
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r
eat
mentpl
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l
e
me
nt
or
i
ng
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MShasbe
e
nac
t
i
vei
nt
e
l
e
he
al
t
hc
a
r
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i
nc
eSe
pt
e
mbe
r200
0
. Thi
swa
sc
a
r
r
i
e
douti
n
Se
pt
e
mbe
r2
000be
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we
e
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t
hor
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s
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r
i
c
thos
pi
t
al
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ndSGPGI
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t
ar
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ade
s
h. Pi
t
hor
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oc
at
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nt
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ang
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t
a
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ade
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t
a
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7
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kmsawa
yf
r
om Luc
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de
oc
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i
ppi
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i
e
nt
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t
r
as
oundandXr
a
yi
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g
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ype
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andha
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et
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ans
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t
e
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om t
hes
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ewe
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nt
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rt
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mpura
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hos
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al
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oc
at
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di
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at
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ar2
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e
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ac
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uat
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wa
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om Luc
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ar
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t
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nt
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i
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e
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ot
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nt
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pe
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g.
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or
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l
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nt
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om s
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ai
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onne
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om Ma
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t
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a
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g
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om AI
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nt
s
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e
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e
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ur
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nt
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ans
mi
t
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e
df
r
om Luc
know t
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r
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sone
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e
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me
nt
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r
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r
t
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ur
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o
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ac
t
i
c
e:
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ul
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nf
or
mat
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w De
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or
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g
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g.
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g
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om t
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l
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at
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nt
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anc
e
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oad.
17
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t
i
at
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ay
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ce:
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t
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17
8
Tabl
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ult
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t
hatt
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me
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c
i
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r
om t
he f
a
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on pr
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me
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ui
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sne
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e
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l
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me
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ort
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ans
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l
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s
ubs
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agnos
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e
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tbes
ol
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toft
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e
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l
e
me
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dne
ve
rbef
or
c
e
dont
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at
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di
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alc
a
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00
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t
one
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e
me
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c
i
nef
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l
doc
c
ur
r
e
di
nApr
i
l20
00
,whe
nt
heme
di
c
a
lf
undi
ngs
y
s
t
e
ma
ppr
ov
e
d
t
heus
eofbi
l
l
abl
ei
ns
ur
anc
epoi
nt
sf
ort
he r
e
mot
edi
a
gnos
i
sofpa
t
hol
ogi
c
a
li
ma
g
e
sdur
i
ng
s
ur
g
e
r
y. Thi
sdat
ee
s
s
e
nt
i
al
l
ymar
kst
hec
omme
nc
e
me
ntoft
e
l
e
me
di
c
i
nei
nJ
apan.
Annex1
HPB10
75
De
c
e
mbe
r2
4,1997
To :Pr
e
f
e
c
t
ur
alGove
r
nor
s
Fr
om:TheDi
r
e
c
t
orGe
ne
r
a
l
,He
al
t
hPol
i
c
yBur
e
a
uMi
ni
s
t
r
yofHe
a
l
t
ha
ndWe
l
f
ar
e
Ti
t
e
l:
Theus
eofCommuni
c
at
i
onandI
nf
or
ma
t
i
onTe
c
hnol
ogi
e
st
oDe
l
i
v
e
rMe
di
c
a
l
Ca
r
e
Te
l
e
me
di
c
i
ne
Wi
t
hr
e
c
e
nta
dvanc
e
si
nc
ommuni
c
at
i
onandi
nf
or
mat
i
ont
e
c
hnol
ogi
e
s
,t
hepot
e
nt
i
albe
ne
f
i
t
s
oft
e
l
e
me
di
c
i
ne
,t
ha
ti
s
,us
eofc
ommuni
c
at
i
ona
ndi
nf
or
ma
t
i
ont
e
c
hnol
ogi
e
st
ode
l
i
v
e
r
me
di
c
a
lc
ar
e(
wi
l
lc
al
l
e
dt
e
l
e
me
di
c
i
nehe
r
e
af
t
e
r
)a
r
ebe
c
omi
ngwe
l
lr
e
c
og
ni
z
e
d.
Somet
e
l
e
me
di
c
i
neappl
i
c
a
t
i
ons
,i
npa
r
t
i
c
ul
art
hos
ebe
t
we
e
nhos
pi
t
a
l
sandphy
s
i
c
i
ansor
de
nt
i
s
t
s
,ha
vea
l
r
e
adyc
omei
npr
a
c
t
i
c
e
. Ex
ampl
e
si
nc
l
udet
heus
eoft
e
l
e
c
ommuni
c
a
t
i
onst
o
t
r
ans
mi
tdi
agnos
t
i
ci
mag
e
ss
uc
haspa
t
hol
ogi
c
ali
mage
sf
r
om phys
i
c
i
ansorde
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i
s
t
st
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pe
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i
a
l
i
s
t
sf
orc
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ul
t
a
t
i
on.
Fr
om now onwa
r
ds
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e
l
e
me
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i
nei
se
x
pe
c
t
e
dt
obeus
e
df
orava
r
i
e
t
yofpur
pos
e
s
.
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l
e
me
di
c
i
nemi
ghtbeus
e
d,f
ore
xampl
e
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ode
l
i
ve
rc
ar
eba
s
e
dont
e
c
hnol
ogys
uc
ha
sv
i
de
o
t
ope
opl
ei
nt
he
i
rhomei
ni
s
ol
at
e
di
s
l
a
ndsorr
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mot
er
ur
a
la
r
e
aswhe
r
ef
a
c
e
t
of
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ac
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t
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i
c
i
a
nsorde
nt
i
s
t
si
shar
dl
ya
va
i
l
a
bl
e
.
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eoft
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l
e
me
di
c
i
nebe
t
we
e
nhos
pi
t
al
sa
ndphy
s
i
c
i
a
nsorde
nt
i
s
t
swoul
dnotbec
ont
r
a
r
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oAr
t
i
c
l
e20ofMe
di
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alPr
a
c
t
i
t
i
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t
i
c
l
e20ofDe
nt
a
lPr
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whi
c
h
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e
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t
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c
l
e20ofMe
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c
a
lPr
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t
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t
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e
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e
r
)
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i
nc
ec
ar
ei
sg
i
v
e
n
f
ac
e
t
of
ac
ei
nt
hi
sc
as
e
. Thei
s
s
uear
i
s
e
si
nt
heus
eoft
e
l
e
me
di
c
i
newi
t
hr
e
s
pe
c
tt
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i
c
l
e
20ofMe
di
c
alPr
ac
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i
t
i
one
rLa
w,howe
v
e
r
,whe
nc
ar
ei
sde
l
i
v
e
r
e
dt
ot
hehome
sofpa
t
i
e
nt
s
.
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rs
uc
hc
i
r
c
ums
t
anc
e
s
,t
hepr
i
nc
i
pl
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swhi
c
ht
e
l
e
me
di
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i
nea
ppl
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c
a
t
i
onss
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dbeba
s
e
don
a
r
es
hownbe
l
ow. Li
s
t
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dal
s
oi
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ol
l
owi
ngar
ewhats
houl
dbenot
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di
nt
heus
eof
t
e
l
e
me
di
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i
newi
t
hr
e
s
pe
c
tt
oAr
t
i
c
l
e20ofMe
di
c
a
lPr
a
c
t
i
t
i
one
r
.
Thef
ol
l
owi
ngs
hal
lbenot
e
dandknownt
ot
hos
ewhoma
yc
onc
e
r
n.
19
6
Ac
opyofapubl
i
s
he
dr
e
por
tf
r
om as
t
udygr
oupont
e
l
e
me
di
c
i
ne
,f
ounde
dbyt
heMi
ni
s
t
r
y
ofHe
al
t
handWe
l
f
a
r
e
,i
si
nc
l
ude
dhe
r
e
wi
t
hf
ory
ourr
e
f
e
r
e
nc
e
.
1 Pr
i
nci
pl
es
Me
di
c
alc
ar
es
houl
dbegi
v
e
nf
ac
e
t
of
ac
ei
npr
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nc
i
pl
e
,andt
e
l
e
me
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c
i
nes
houl
dbeus
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dt
o
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ompl
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.
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r
m me
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alc
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ul
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r
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.
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l
fa
s
s
e
s
s
me
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ei
nc
l
ude
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s
ual
i
z
a
t
i
ona
l
gor
i
t
hm i
mpl
e
me
nt
e
di
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t
av
e
. Topas
st
he
dat
af
r
om t
hewe
bpaget
ot
hevi
s
ual
i
z
at
i
onmodul
eandt
or
e
t
ur
nt
her
e
s
ul
t
s
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c
r
i
pti
s
us
e
d. ThePHPs
c
r
i
ptpr
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e
s
s
e
sus
e
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t
apr
e
s
e
nt
e
da
st
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r
st
oaque
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t
i
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r
eand
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e
ndst
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mt
ot
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t
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ogr
am t
ope
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f
or
mv
i
s
ua
l
i
z
at
i
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heMul
t
i
di
me
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i
onal
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c
al
i
ngal
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i
t
hm. The
nge
ne
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at
e
dpi
c
t
ur
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e
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ot
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t
i
e
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os
how hi
ss
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at
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hr
e
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pe
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t
t
os
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at
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i
e
nt
si
nt
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wodi
me
ns
i
ona
ls
c
a
l
eofr
i
s
ks
.
We
bpag
eoft
hes
ys
t
e
mc
ont
a
i
nsl
e
a
r
ni
ngmat
e
r
i
als
uc
ha
se
t
e
x
t
books
,f
r
e
que
nt
l
yas
ke
d
que
s
t
i
ons
,r
e
c
omme
ndat
i
onsa
bouts
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e
e
pdi
s
e
as
et
r
e
at
me
nt
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i
c
i
a
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t
i
e
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al
ogv
i
ae
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l
,
i
nf
or
ma
t
i
onabouts
l
e
e
pme
di
c
i
nee
xpe
r
t
si
nLi
t
huani
a
.
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bpagedi
s
s
e
mi
nat
e
st
her
e
l
e
vanti
nf
or
mat
i
on,a
nda
i
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opl
et
os
e
l
f
a
s
s
e
s
st
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i
r
s
l
e
e
p. I
nt
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e
s
e
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pe
rmai
nat
t
e
nt
i
oni
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ot
hes
ubs
ys
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e
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e
l
f
a
s
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e
s
s
me
nt
.
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pe
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ngont
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t
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e
l
f
as
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e
s
s
me
ntt
hepa
t
i
e
nt
sa
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et
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oi
mpr
ovet
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i
rs
l
e
e
p,
a
r
eadvi
s
e
dvi
aI
nt
e
r
ne
t
,andi
nc
as
eofne
c
e
s
s
i
t
yar
ei
nvi
t
e
dt
ov
i
s
i
ta
ne
xpe
r
tphy
s
i
c
i
a
n.
Subs
ys
t
em f
ors
el
f
as
s
es
s
me
nt
Ma
nype
opl
ef
e
e
lt
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he
i
rs
l
e
e
pi
snotpe
r
f
e
c
t
. Thef
i
r
s
ts
t
e
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r
dss
l
e
e
pi
mpr
ov
e
me
nt
s
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dbel
e
ar
ni
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l
f
as
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e
s
s
me
nt
. Ac
t
i
v
i
t
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e
rl
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g
e
di
nt
hewe
bba
s
e
dt
ooli
s
i
l
l
us
t
r
at
e
di
nFi
g.
4. A us
e
rl
ogi
nst
ot
hes
ys
t
e
ma
ndhi
sge
ne
r
a
ldat
ai
ss
t
or
e
di
nt
hes
ys
t
e
m
dat
abas
e
. Theus
e
rc
anc
hoos
ee
i
t
he
rt
oma
keas
e
l
fa
s
s
e
s
s
me
ntt
e
s
t
sort
or
e
ade
t
e
xt
books
whi
c
hc
ont
ai
ni
nf
or
mat
i
onaboutva
r
i
ouss
l
e
e
pdi
s
or
de
r
s
,e
duc
a
t
i
onalma
t
e
r
i
alon
phar
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ol
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c
alornonphar
mac
ol
ogi
c
a
ls
l
e
e
pdi
s
or
de
r
st
r
e
at
me
nt
,andf
r
e
que
nt
l
yas
ke
d
que
s
t
i
ons
. Weas
s
umet
hataus
e
roft
hewe
bpag
eha
sr
e
adge
ne
r
a
li
nf
or
ma
t
i
ononba
s
i
c
f
ac
t
or
si
nf
l
ue
nc
i
ngt
hes
l
e
e
pqual
i
t
y,andha
sc
onc
l
ude
dt
hathi
ss
l
e
e
pi
mpr
ove
me
nti
sa
am.
Fi
g.
4 Us
e
ra
c
t
i
v
i
t
ydi
agr
21
4
s
uf
f
i
c
i
e
nt
l
ys
e
r
i
oushe
al
t
hpr
obl
e
m. Toa
i
dt
heus
e
rt
os
e
l
f
as
s
e
s
shi
she
al
t
hs
t
a
t
e
,hei
sa
s
ke
d
t
oans
we
raque
s
t
i
onnai
r
ec
ont
ai
ni
ng25que
s
t
i
ons
. Theda
t
ae
l
i
c
i
t
e
df
r
om ans
we
r
si
s
vi
s
ual
i
z
e
ds
howi
ngt
hepoi
ntc
or
r
e
s
pondi
ngt
ot
hedat
eoft
heus
e
ri
nt
het
wodi
me
ns
i
ona
ls
c
a
l
e
ofr
i
s
kse
xpl
ai
ne
dbe
l
ow. Theans
we
r
sa
r
epr
oc
e
s
s
e
da
l
s
obyane
xpe
r
ts
ys
t
e
m. I
ft
heus
e
r
woul
dbeas
s
e
s
s
e
dashe
al
t
hy,hewoul
dbegi
ve
ns
omea
dv
i
c
e
show t
oi
mpr
ovehi
ss
l
e
e
p. The
ans
we
r
sc
ani
mpl
yac
onc
l
us
i
onont
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ol
l
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ngpos
s
i
bl
es
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e
e
pdi
s
or
de
r
s:I
ns
omni
a,Sl
e
e
p
apne
as
yndr
ome
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s
t
l
e
s
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e
gs
y
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ome
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t
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oe
s
opha
g
e
alr
e
f
l
ux,Hy
pe
r
s
omni
aandNar
c
ol
e
ps
y
.
I
nt
hi
sc
as
et
heus
e
ri
sas
ke
dt
oans
we
rt
hemor
ee
x
t
e
ns
i
veque
s
t
i
onna
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r
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ont
ai
ni
ng175
que
s
t
i
ons
. Thea
ns
we
r
si
mpl
yas
s
e
s
s
me
ntoft
hehe
a
l
t
hs
t
at
us
. Ther
e
s
ul
t
sa
g
ai
nar
e
vi
s
ual
i
z
e
dands
hownt
ot
heus
e
ri
nt
het
wodi
me
ns
i
ona
ls
c
a
l
eofr
i
s
ks
,a
ndanadv
i
c
ei
sg
i
v
e
n,
e
.
g.t
oc
ont
a
c
tane
xpe
r
tvi
ae
mai
l
. Be
f
or
eav
i
s
i
tt
ophys
i
c
i
ant
hepat
i
e
nti
sa
dv
i
s
e
dt
o
s
e
l
f
t
e
s
thi
squal
i
t
yofs
l
e
e
p,t
hepr
e
s
e
nc
eoft
hes
ympt
omsofa
nxi
e
t
yandde
pr
e
s
s
i
on,andt
o
as
s
e
s
st
hequal
i
t
yofl
i
f
e
. Thewe
bpag
et
e
ac
he
st
hepat
i
e
ntt
ounde
r
s
t
andhi
she
a
l
t
hpr
obl
e
ms
andhe
al
t
hs
t
a
t
us
,a
swe
l
lashe
l
psaphy
s
i
c
i
a
nt
os
a
vet
het
i
meont
hedi
ag
nos
t
i
c
s
.
Sl
e
e
pqual
i
t
yc
ompl
ai
nsa
r
epar
t
i
c
ul
a
r
l
yr
e
l
e
va
ntt
ome
nt
ali
l
l
ne
s
s
. Thef
ac
t
or
sr
e
l
a
t
i
ngt
o
a
nx
i
e
t
yandde
pr
e
s
s
i
onar
eoneoft
hemos
tc
onc
omi
t
ant
sofs
l
e
e
pc
ompl
a
i
nsi
nge
ne
r
a
l
popul
at
i
on. Be
c
a
us
eoft
hatt
heHos
pi
t
a
lAnxi
e
t
yandDe
pr
e
s
s
i
onSc
a
l
e(
HADS)wa
sc
hos
e
n
［4］. Theg
f
ora
s
s
e
s
s
me
ntoft
hos
es
ympt
oms
l
oba
ls
c
or
ee
v
al
uat
e
st
hel
e
ve
lofpr
e
s
e
nc
eoft
he
s
ympt
omsofa
nx
i
e
t
y,de
pr
e
s
s
i
on,orbot
h,a
nxi
e
t
yandde
pr
e
s
s
i
on.
TheMe
di
c
a
lOut
c
ome
sSt
udy36I
t
e
m Shor
tFor
m He
a
l
t
hSur
ve
y(
SF36
)wa
sus
e
dt
oqua
nt
i
f
y
［5］
ge
ne
r
alhe
al
t
hr
e
l
at
e
dqual
i
t
yofl
i
f
e
. Themul
t
i
i
t
e
ms
c
al
e
soft
heSF3
6me
as
ur
ee
v
e
n
he
a
l
t
hr
e
l
a
t
e
dc
onc
e
pt
s:phy
s
i
c
a
lf
unc
t
i
oni
ng
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ol
el
i
mi
t
at
i
onsa
sar
e
s
ul
tofphy
s
i
c
a
lhe
al
t
h
pr
obl
e
ms
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l
ypai
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ne
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al
t
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r
c
e
pt
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ons
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i
t
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l
i
t
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i
a
lf
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t
i
oni
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ol
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i
mi
t
at
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aus
e
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ona
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al
t
hpr
obl
e
msa
ndge
ne
r
alme
nt
a
lhe
al
t
h. Al
ldi
me
ns
i
ons
r
e
f
l
e
c
tphys
i
c
alandme
nt
a
ls
umma
r
yme
a
s
ur
e
s
.
A pat
i
e
nts
ubmi
t
si
nf
or
mat
i
ononhi
she
al
t
hpr
obl
e
msa
ns
we
r
i
ngt
heque
s
t
i
onnai
r
e
sme
nt
i
one
d
above:PSQI
,HADS,SF3
6. Theus
e
rsdat
aar
epr
oc
e
s
s
e
dbyme
ansofaMul
t
i
di
me
ns
i
ona
l
Sc
a
l
i
ngal
gor
i
t
hm,a
ndt
her
e
s
ul
t
sar
epr
e
s
e
nt
e
dt
ot
heus
e
ri
nav
i
s
ual
i
s
e
df
or
m. A poi
nt
c
or
r
e
s
pondi
ngt
ot
hedat
aoft
heus
e
ri
ss
howni
nat
wodi
me
ns
i
onals
c
a
l
eofdi
f
f
e
r
e
ntr
i
s
ks
.
Anadvi
c
ei
sg
i
ve
nc
or
r
e
s
pondi
ngt
ot
her
e
s
ul
t
soft
hes
e
l
f
a
s
s
e
s
s
me
nt
. Thes
c
a
l
eofr
i
s
ksi
s
us
e
dt
omoni
t
ort
het
r
e
at
me
ntpr
og
r
e
s
s
.
Wewi
l
li
l
l
us
t
r
at
et
hevi
s
ual
i
z
a
t
i
onoft
her
e
s
ul
t
sofs
e
l
f
a
s
s
e
s
s
me
ntbyane
xampl
eof
［3］
s
e
l
f
as
s
e
s
s
me
ntofs
l
e
e
pqual
i
t
yac
c
or
di
ngt
ot
hePi
t
t
s
bur
ghSl
e
e
pQua
l
i
t
yI
nde
x
. Theba
s
i
s
f
ors
e
l
f
a
s
s
e
s
s
me
nti
st
hec
ompar
i
s
onoft
hea
ns
we
r
soft
heus
e
rwi
t
ht
hea
ns
we
r
soft
hepa
t
i
e
nt
s
i
ndat
aba
s
i
soft
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e
e
pMe
di
c
i
neCe
nt
r
eoft
heI
ns
t
i
t
ut
eofPs
y
c
hophy
s
i
ol
og
yand
Re
habi
l
i
t
at
i
on,c
ont
ai
ni
ngt
hedat
aons
l
e
e
pqual
i
t
yof3
5
0pa
t
i
e
nt
s
. Thedi
agnos
e
sofpa
t
i
e
nt
s
i
nt
hedat
abas
i
sar
eknown. Thet
wodi
me
ns
i
onals
c
al
eofr
i
s
ksi
sf
or
me
dbyme
a
nsofa
［6,7］. Thei
mul
t
i
di
me
ns
i
ona
ls
c
a
l
i
ngt
e
c
hni
que(
MDS)
ma
geobt
a
i
ne
dbyme
a
nsofMDSi
s
us
e
dt
ovi
s
ual
i
z
et
heda
t
aba
s
i
s
. Le
tusbr
i
e
f
l
yi
nt
r
oduc
et
hei
de
aofMDS. Thea
ns
we
r
sofk
＝1,
pat
i
e
nt
st
onque
s
t
i
onsofaque
s
t
i
onnai
r
ea
r
ede
not
e
dbyndi
me
ns
i
onalv
e
c
t
or
sXi,i
.
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.
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k,
＝
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n)
xi
Xi (
.
.
.
,
xi
,i
.
e
.t
hes
e
tXi,i 1,
.
.
.
,
k,c
or
r
e
s
pondst
ot
heda
t
aba
s
i
sofpa
t
i
e
nt
swhos
e
di
agnos
e
sa
r
eknown. Thei
de
aofMDSi
st
oma
pas
e
tofndi
me
ns
i
ona
lv
e
c
t
or
st
oat
wo
di
me
ns
i
onalpl
anepr
e
s
e
r
vi
ngasmuc
haspos
s
i
bl
et
hemut
ualdi
s
t
a
nc
e
sbe
t
we
e
nve
c
t
or
s
.
Ma
t
he
ma
t
i
c
a
l
l
yt
hi
spr
obl
e
mc
a
nbef
or
mul
at
e
dasmi
ni
mi
z
a
t
i
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k
k
2
∑＝1
di

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
s
t
r
e
s
s＝∑
j
i
j
i
＝1 j
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
de
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＝
j
j
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not
e
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t
hr
e
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pe
c
tt
oZ＝(
Z1,
.
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.
,
Zk)
,whe
r
edi
(
Z)
Zi−Zi
(
X)
Xi−Xi
nor
mi
nt
hendi
me
ns
i
onals
pac
eandi
nt
het
wodi
me
ns
i
onals
pa
c
ec
or
r
e
s
pondi
ngl
y. The
21
5
Fi
g.
5 Vi
s
ual
i
z
at
i
onofdat
aonps
y
c
hoe
mot
i
onals
t
at
usas
s
e
s
s
me
ntus
i
ngPi
t
t
s
bur
ghSl
e
e
p
Qua
l
i
t
yI
nde
x
. Not
et
hatt
hepoi
nt
sr
e
pr
e
s
e
nt
i
ngpat
i
e
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om t
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h
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om t
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22
7
Dur
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ngt
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ageoft
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22
8
17 Moz
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Backgr
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nt
heme
di
c
alf
i
e
l
dandhec
a
npa
s
st
hate
xpe
r
t
i
s
et
ohi
spat
i
e
nt
s
. Te
l
e
me
di
c
i
ne
hast
hepot
e
nt
i
alt
oi
mpr
ov
et
hede
l
i
ve
r
yofhe
a
l
t
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ar
ebybr
i
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ng
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e
r
vi
c
e
s
s
uc
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adi
ol
ogy,me
nt
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t
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ma
t
ol
og
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ra
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hi
l
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al
t
hpr
ot
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c
t
i
on,home
c
ar
e
e
t
c
.t
ounde
r
s
e
r
v
e
dc
ommuni
t
i
e
sandi
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v
i
dua
l
si
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hr
ur
ala
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bana
r
e
a
s
.
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palwi
t
hf
e
w doc
t
or
sa
ndme
di
c
alhe
al
t
hc
e
nt
r
e
si
npl
a
c
e
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ay
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t
a
lr
ol
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n
addr
e
s
s
i
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vi
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hene
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dsoft
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nr
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mot
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ur
a
la
r
e
aswhe
r
et
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t
e
l
e
c
ommuni
c
at
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ons
e
r
vi
c
ei
sa
v
ai
l
a
bl
e
. Thee
s
s
e
nt
i
a
lc
a
r
es
e
r
vi
c
e
sMOH ha
sr
e
c
ogni
z
e
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ni
t
s
pl
anar
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e
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t
i
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al
t
h,i
mmuni
z
at
i
on,TBa
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e
pr
os
yc
ont
r
ol
,c
ondom pr
omot
i
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s
t
r
i
but
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nt
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g
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a
t
e
dManage
me
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l
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l
l
ne
s
s(
I
MCI
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nvi
r
onme
nt
als
a
ni
t
at
i
on,
me
nt
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t
hs
e
r
vi
c
e
s
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t
t
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l
i
t
i
e
s
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s
e
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e
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l
i
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a
t
i
on,s
c
hoolhe
a
l
t
h
s
e
r
vi
c
e
se
t
c
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es
e
r
vi
c
e
sc
anbeac
hi
e
ve
dt
hr
ought
e
l
e
me
di
c
i
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e
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nt
i
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d
t
hr
e
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oac
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s
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c
hni
c
ali
nf
r
as
t
r
uc
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ur
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omm Pol
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s
oi
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t
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et
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v
a
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l
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bl
ea
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la
ppr
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a
t
e
I
nf
or
mat
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on& Communi
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at
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c
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e
s(
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ns
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tofr
ur
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lde
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opme
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nd
pove
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l
e
vi
at
i
on,dr
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ang
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i
ons― i
nc
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ore
xa
mpl
e
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adi
o,
t
e
l
e
vi
s
i
on,vi
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as
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e
t
t
er
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c
or
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r
s
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nds
t
andal
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omput
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s
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l
lasf
i
xe
da
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l
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phone
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nt
e
r
ne
t
. Fort
hepr
ovi
s
i
onofe
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al
t
hs
e
r
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c
e
s
,i
ti
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t
l
ye
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s
e
nt
i
a
lt
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de
uni
ve
r
s
ala
c
c
e
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st
ot
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e
c
ommuni
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ons
e
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v
i
c
e
st
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oug
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ount
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y
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nar
e
a
s
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t
hal
i
mi
t
e
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e
l
e
c
om i
nf
r
as
t
r
uc
t
ur
et
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nt
e
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ne
ti
spr
oba
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yt
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s
tpl
at
f
or
mt
ous
e
. The
pr
obl
e
m wi
t
ht
hei
nt
e
r
ne
twoul
dbet
hel
a
c
kofqual
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t
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e
r
v
i
c
e
,whe
r
et
her
e
qui
r
e
d
bandwi
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hmaynota
l
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ysbeavai
l
abl
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orl
i
v
ei
nt
e
r
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t
i
vec
ons
ul
t
a
t
i
ons
. Thebe
s
ts
ol
ut
i
on
f
orNe
palwoul
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t
or
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or
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r
dt
e
c
hnol
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i
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nt
e
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ne
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ai
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abl
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pe
e
d
c
onne
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t
i
ons
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uc
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ommonphonel
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ne
s
. Thec
onve
nt
i
ona
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l
e
phone
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onv
e
r
s
a
t
i
ons
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i
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i
mpl
ye
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l
lf
ort
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thasbe
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na
dopt
e
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s
of
ari
nNe
pal
. Me
di
al
i
ker
adi
oandTV c
anbehe
l
pf
uli
ndi
s
s
e
mi
nat
i
ngt
hei
nf
or
mat
i
ona
l
pr
ogr
amme
st
ot
her
e
mot
ear
e
as
. Ra
di
oNe
pa
la
ndNe
pa
lTe
l
e
v
i
s
i
onha
ve
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of
ar
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e
n
br
oa
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as
t
i
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che
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l
t
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udi
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s
at
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t
or
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e
r
s
edi
s
e
a
s
e
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obl
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msandt
he
i
rc
ar
e
. Bas
i
ct
e
l
e
me
di
c
i
ner
e
qui
r
e
me
nt
sc
a
nc
ons
i
s
tofac
a
me
r
awi
t
ha
moni
t
ora
ndt
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t
ori
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e
nt
r
all
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a
t
i
ona
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ni
s
t
e
r
i
ngt
ot
hene
e
dsoft
her
e
mot
es
i
t
e
.
Ast
hene
x
tg
e
ne
r
a
t
i
onofbr
oadbandandwi
r
e
l
e
s
st
e
c
hnol
og
yc
ome
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i
ne
,at
e
l
e
me
di
c
i
ne
a
ppl
i
c
at
i
onc
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ge
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t
ht
hats
ys
t
e
m. Thef
ut
ur
et
e
c
hnol
og
i
e
sus
e
df
ort
hi
spur
pos
ear
e
mobi
l
ede
vi
c
et
e
c
hnol
ogi
e
si
nc
l
udi
ngs
a
t
e
l
l
i
t
e
,vi
r
t
ualr
e
a
l
i
t
yt
e
c
hnol
og
i
e
s
,PDA e
t
c
. The
23
3
i
nt
e
r
ac
t
i
veTV,DAB,VOD wi
l
lbec
ommonpl
a
c
ei
nt
hene
arf
ut
ur
e
. Si
mi
l
a
r
l
y
,i
nt
e
l
l
i
ge
nt
me
di
c
almoni
t
or
i
nge
qui
pme
ntandus
eofe
l
e
c
t
r
oni
cpa
t
i
e
ntr
e
c
or
ds(
EPR)c
a
nbeut
i
l
i
z
e
d
whe
ngi
vi
ngadvi
c
et
ot
hepat
i
e
nt
se
l
e
c
t
r
oni
c
al
l
y. Di
f
f
e
r
e
nts
of
t
wa
r
ef
ordi
gi
t
ali
mag
i
ng,us
e
r
t
r
a
i
ni
ng
,pa
t
i
e
nts
uppor
ta
ndope
r
at
i
onofbi
ome
di
c
alde
v
i
c
e
swi
l
lbehe
l
pf
ult
oo. HMF of
Ne
palhasa
l
s
oe
nac
t
e
d t
hee
l
e
c
t
r
oni
ct
r
ans
ac
t
i
onsa
nddi
gi
t
als
i
g
na
t
ur
eAc
ti
n2
00
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or
maki
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f
f
e
r
e
ntt
r
ans
ac
t
i
onsandde
l
i
ve
r
yofe
l
e
c
t
r
oni
cda
t
ar
e
l
i
abl
eands
af
e
. Thi
swi
l
l
e
nabl
eane
nvi
r
onme
ntc
onduc
i
vef
ort
hepr
ov
i
s
i
onoft
e
l
e
me
di
c
i
nes
e
r
vi
c
e
swi
t
hi
nNe
paland
abr
oad.
Fac
t
or
sf
o
rgr
o
wt
ho
ft
e
l
e
me
di
c
i
neac
t
i
v
i
t
i
e
s
I
nge
ne
r
a
l
,t
hegr
owt
handi
mpl
e
me
nt
at
i
onoft
e
l
e
me
di
c
i
nepr
a
c
t
i
c
e
sa
ndt
he
i
ra
ppl
i
c
a
t
i
on
de
pe
ndsupont
hef
ol
l
owi
ngf
ac
t
or
s:
・Te
l
e
c
ommuni
c
at
i
oni
nf
r
as
t
r
uc
t
ur
e:Thought
hegr
owt
hoft
hena
t
i
onalne
t
wor
ka
ndi
t
s
pe
ne
t
r
at
i
onr
at
ehasi
nc
r
e
as
e
di
nt
hel
a
s
t10ye
a
r
si
nNe
pal;i
ti
ss
t
i
l
li
ns
uf
f
i
c
i
e
nta
ndmos
tof
t
hepopul
a
t
i
oni
nt
her
ur
a
la
ndr
e
mot
ea
r
e
asdonotha
veac
c
e
s
st
ot
heba
s
i
c
t
e
l
e
c
ommuni
c
a
t
i
ons
e
r
vi
c
e
s
. Expans
i
onofne
t
wor
kc
a
pa
c
i
t
yandi
t
se
xt
e
ns
i
oni
nt
heVDCs
hast
obec
ar
r
i
e
dwi
t
hahi
ghe
rpr
i
or
i
t
ybe
f
or
ei
nt
r
oduc
i
ngt
het
e
l
e
he
a
l
t
hs
e
r
vi
c
e
si
nt
he
s
e
ar
e
a
s
.
・Bandwi
dt
hofc
onne
c
t
i
on:Theot
he
ri
mpor
t
a
ntf
a
c
t
orf
ors
moot
hde
l
i
ve
r
yandt
r
a
ns
mi
s
s
i
on
gi
t
ali
mage
sa
ndmul
t
i
me
di
ai
nf
or
ma
t
i
oni
st
hebandwi
dt
hof
f
e
r
e
dbyt
het
e
l
e
c
omm
ofdi
l
i
ne
s
. Thought
heNe
pal
e
s
enat
i
onalt
r
unkne
t
wor
kc
ons
i
s
t
sofa14
0mbpsbr
oa
dba
nd
mi
c
r
owa
ves
ys
t
e
m,t
he l
as
tmi
l
ec
oppe
rl
i
ne
sc
a
nhi
nde
rt
hef
l
ow ofdat
a
. Fori
nt
e
r
a
c
t
i
v
e
vi
de
oc
onf
e
r
e
nc
i
ng,i
ti
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e
qui
r
e
dt
ohav
ea
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e
a
s
t3
8
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i
ne
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nor
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rt
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vegoodqua
l
i
t
y
andac
c
e
pt
abl
evi
de
oa
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c
et
r
ans
mi
s
s
i
on. Ot
he
r
wi
s
e
,as
i
gni
f
i
c
a
ntl
a
gt
i
mea
ndj
e
r
ki
ne
s
s
i
nt
hepi
c
t
ur
ebe
c
ome
squi
t
ea
nnoyi
ngt
ot
hev
i
e
we
r
.
・Saf
e
t
yands
e
c
ur
i
t
yi
s
s
ue
s:
Doi
ngt
e
l
e
me
di
c
i
neov
e
rI
Pus
i
ngt
hee
xi
s
t
i
ngne
t
wor
kandwi
t
h
pas
s
wor
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ot
e
c
t
i
onmayj
us
t
i
f
yt
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i
cr
e
qui
r
e
me
nt
s
,butt
hei
s
s
ueofs
e
c
ur
i
t
yandpe
r
s
ona
l
pr
i
vac
ys
t
i
l
lr
e
ma
i
nsde
bat
abl
e
. The
r
ei
sal
wa
yspos
s
i
bi
l
i
t
yofs
ome
oneha
c
ki
ngi
n.
/s
The
r
e
f
or
e
,e
duc
at
i
onala
ndc
l
i
ni
c
alg
ui
de
l
i
ne
sa
nds
a
f
e
t
y
e
c
ur
i
t
ys
t
a
ndar
dsne
e
dt
obe
de
ve
l
ope
dt
oe
ns
ur
et
hes
af
e
t
yande
f
f
e
c
t
i
v
e
ne
s
soft
het
e
l
e
me
di
c
i
nede
v
i
c
e
sa
l
ongwi
t
h
bl
oc
ki
ngofpi
r
ac
ywi
t
hi
nt
hec
onne
c
t
i
on.
・Li
c
e
ns
ur
e:Thel
e
galands
oc
i
oc
ul
t
ur
ali
s
s
ue
shav
et
obeov
e
r
c
omef
ort
hee
f
f
i
c
i
e
nc
yoft
he
t
e
l
e
me
di
c
i
nepol
i
c
y. Thephys
i
c
i
ansc
onduc
t
i
ngr
e
gul
a
rc
ons
ul
t
at
i
onsi
not
he
rs
t
at
e
sor
c
ount
r
i
e
ss
houl
dbel
i
c
e
ns
e
di
nt
hatt
e
r
r
i
t
or
yornotr
e
ma
i
nsi
mpor
t
ant
. Ase
a
c
hc
ount
r
yhas
i
t
sownme
di
c
alpr
ac
t
i
c
eac
tt
hatde
f
i
ne
st
hel
i
c
e
ns
i
ngandpr
ac
t
i
c
i
ngpr
oc
e
dur
eand
t
e
l
e
me
di
c
i
net
e
c
hnol
ogyknowsnobounda
r
i
e
s
,t
he
r
es
houl
dbeac
l
e
a
r
,uni
ques
t
a
nda
r
dand
l
i
c
e
ns
i
ngpr
oc
e
dur
egl
obal
l
y.
Co
ncl
us
i
ons
He
al
t
hc
ar
es
ys
t
e
msa
r
eve
r
ymuc
hapr
oduc
toft
henat
i
oni
nt
hes
a
mewa
yasi
t
sc
ul
t
ur
e
,t
he
me
di
c
alt
r
adi
t
i
ons
,t
hes
oc
i
oe
c
onomi
cs
i
t
uat
i
onandde
mogr
a
phi
cf
ac
t
or
s
. Al
t
houg
ht
he
de
ve
l
opme
nta
ndus
eoft
e
l
e
me
di
c
i
newi
l
lbeadopt
e
ddi
f
f
e
r
e
nt
l
yi
nt
hedi
f
f
e
r
e
nthe
a
l
t
hc
ar
e
s
ys
t
e
msduet
oavai
l
abi
l
i
t
yoft
e
l
e
c
ommuni
c
a
t
i
oni
nf
r
as
t
r
uc
t
ur
ea
c
r
os
st
hena
t
i
ons
,i
nt
e
r
nat
i
onal
i
nt
e
r
a
c
t
i
oni
nt
hef
i
e
l
di
se
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23
8
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l
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23
9
20 Paki
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an55
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om t
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r
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at
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otofhypeaboutt
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pos
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r
om t
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a. Thec
onf
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fi
t
ski
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t
r
at
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l
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f
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c
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at
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t
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omec
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e
c
t
s
. A br
i
e
fnot
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e
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t
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nt
i
f
i
e
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l
e
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c
i
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or
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i
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r;
1 Heal
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o
r
mat
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m(
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ti
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hwi
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eabout
t
hepr
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ma
r
yhe
a
l
t
hc
ar
es
e
c
t
ora
l
s
o. I
ti
nc
l
ude
sa
ne
l
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t
r
oni
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e
c
or
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ul
l
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nt
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oduc
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ar
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nke
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ta
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l
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ot
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r
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ma
br
e
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toft
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at
e
s
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ve
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opme
nt
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nhe
a
l
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hs
e
c
t
or
.
2 Heal
t
hI
nf
or
mat
i
onRes
our
ceCent
e
r(
HI
RC)
Thi
spr
oj
e
c
ta
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msa
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omot
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al
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e
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c
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ode
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l
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ner
e
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our
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e
nt
e
ra
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a
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l
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r
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t
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or
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ought
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t
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et
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tc
a
n
al
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ei
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s
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as
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ne
s
s
.
24
3
3 Tel
eps
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at
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Thi
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e
c
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ort
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ti
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4 Tel
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Thi
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tl
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r
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t
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mat
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nt
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ort
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t
sa
r
eatdi
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age
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t
r
y. HI
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oj
e
c
thasbe
e
n
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ni
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nt
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t
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l
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at
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l
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mat
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e
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a
ge
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C.Te
l
e
me
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ai
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f Paki
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t
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r
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abor
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s
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or
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r
om t
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e
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t
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rt
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ai
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si
nt
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ount
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our
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nt
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r
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Vi
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c
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am wi
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ami
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wa
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us
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i
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Theai
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onsoft
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ame
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t
ani
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me
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e
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r
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hr
oug
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l
e
me
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i
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pe
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i
al
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z
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l
t
hc
a
r
e
t
ot
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s
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r
ve
dar
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asofPaki
s
t
a
n. Re
ma
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ka
bl
yl
ow t
e
l
e
c
ommuni
c
a
t
i
ona
ndt
e
c
hnol
og
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c
os
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os
pe
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dupoft
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r
s
. Mos
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t
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nt
,howe
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e
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st
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r
e
al
i
z
at
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ont
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nt
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ne
tc
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lt
e
l
e
me
di
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nt
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ol
e
. Ast
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ont
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nue
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ogr
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er
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at
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omeubi
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ous
.
Fut
ur
eDi
r
ect
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ons
1 Te
l
e
me
di
c
i
ne― me
di
c
ali
nt
r
ane
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ft
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ount
r
y
Theul
t
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mat
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onne
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te
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e
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al
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ar
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ount
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oughwhi
c
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ul
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pe
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i
mes
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t
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r
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nt
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ount
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tha
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meanda
g
ai
nt
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t
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st
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peoft
e
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e
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s
i
bl
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e
a
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bl
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l
l
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ti
snotadr
e
am
24
4
a
nymor
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de
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ki
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t
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nt
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ome
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a
s
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st
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pe
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s
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t
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i
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nf
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ai
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ame
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e
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hi
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r
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om i
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ort
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at
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al
i
z
a
t
i
on.
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i
gnc
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gur
at
i
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l
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e
c
ts
e
e
st
wone
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e
r
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onne
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i
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t
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a
c
h
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he
r
. Te
l
e
Haus
l
i
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l
otne
t
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kwi
l
li
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r
c
onne
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twi
t
ht
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x
i
s
t
i
ngTe
l
i
kom Ne
t
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k. The
pi
l
otpr
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e
c
tai
mst
ode
t
e
r
mi
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as
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bi
l
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t
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oma
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t
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e
c
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onne
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r
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onne
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t
i
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t
hot
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r
ne
t
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e
r
ne
t
,PSTN,e
t
c
)i
nt
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e
. Thet
r
i
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e
c
twi
l
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e
s
t
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g
at
et
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f
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pt
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r
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onne
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t
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onne
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f
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s
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ut
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l
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a
c
i
l
i
t
i
e
s
. Ene
r
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ys
our
c
e
i
sa
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t
anta
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pe
c
tofpr
ovi
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ngr
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lc
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t
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e
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or
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s
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e
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t
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nt
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e
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ov
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r
nme
nt
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ur
et
hat
t
e
l
e
c
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at
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or
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ons
e
r
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i
c
e
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e
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her
ur
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ast
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ought
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i
rc
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t
i
c
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pa
t
i
on. PANGTEL wi
l
lpr
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hel
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de
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s
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rt
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oug
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e
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e
r
vi
c
e
si
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ur
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s
s
ue
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i
kei
nt
e
r
c
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c
t
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t
ypol
i
c
yt
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sbe
i
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e
l
ope
dbyPANGTEL andI
CCC woul
dbe
e
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age
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oac
knowl
e
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e
c
tobj
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t
i
ve
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yt
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ngl
e
ve
r
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or
ur
ala
r
e
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t
hr
ought
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i
rpr
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i
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i
t
i
e
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oma
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her
ur
a
lt
e
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e
c
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onne
t
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Thec
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e
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nt
e
rame
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ur
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at
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al
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ome
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al
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sa
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e
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ai
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s
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e
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et
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ans
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onne
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omedi
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om t
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r
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t
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ur
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at
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l
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.
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ome
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a
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oni
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ar
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ol
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e
r
.
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at
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ans
mi
s
s
i
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Thi
suni
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abl
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e
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lf
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om t
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r
e
c
t
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f
i
xe
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roft
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ri
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onne
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t
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i
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mt
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t
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nke
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la
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et
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gna
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r
di
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l
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eFi
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g
.
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Fi
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at
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c
ho
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omp
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25
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Thi
spr
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am r
e
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e
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om t
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i
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oc
e
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s
e
st
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ome
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a
ls
i
gna
l
sa
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e
s
e
nt
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mi
nt
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omput
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rdi
s
pl
ay
. Thi
s
pr
ogr
a
m wa
sde
v
e
l
ope
di
nVi
s
ua
lBas
i
c
.
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ss
pe
c
i
f
i
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pos
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am c
ont
ai
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i
onsa
r
e:
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alc
onne
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t
i
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t
ht
hee
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ort
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rpor
tCOM.
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mot
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t
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hr
ougha
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m.
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s
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i
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i
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ome
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als
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gnal
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ort
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. Se
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.
6
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bi
l
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gnal
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.
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nal
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.
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. Se
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.
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om di
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e
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ur
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l
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s
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ke
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g.
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ar
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e
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ar
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8 He
ar
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at
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26
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l
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t
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nt
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l
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t
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s
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wi
l
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l
pe
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ur
t
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rt
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ki
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l
e
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t(
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c
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i
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e
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t
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et
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oot
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us
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al
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s
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l
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at
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ount
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h
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e
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i
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c
t
.
27
4
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ki
s
hNat
i
onalTel
emedi
ci
nePr
oj
ec
t(
TNTP)
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pos
e,oper
at
i
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r
oces
s
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r
entap
pl
i
cat
i
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ur
eexp
ect
at
i
o
ns:
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ng
oa
li
st
oe
s
t
abl
i
s
haNat
i
ona
lTe
l
e
me
di
c
i
neSt
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oupunde
rt
hel
e
a
de
r
s
hi
pof
I
STEM,I
s
t
a
nbulUni
ve
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s
i
t
yCont
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ngMe
di
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a
lEduc
a
t
i
onandRe
s
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a
r
c
hCe
nt
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r
. Thi
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r
oup
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ght
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me
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ni
t
i
a
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rr
e
a
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z
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i
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e
me
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l
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i
t
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e
me
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c
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ner
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ac
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e
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yc
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roft
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ount
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y
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hes
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met
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meac
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e
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oope
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t
i
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t
hf
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z
at
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t
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c
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t
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nt
e
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t
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ona
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c
t
st
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br
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me
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c
ala
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e
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hnol
ogi
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me
nt
s
.
St
r
at
egyandc
har
t
i
ngacour
s
e:
The
r
ear
enumbe
rofpr
e
par
at
or
ys
t
udi
e
st
ha
tne
e
dt
obec
a
r
r
i
e
dout
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e
dt
or
e
s
e
a
r
c
h
s
ui
t
abi
l
i
t
yoft
e
l
e
me
di
c
i
newi
t
he
xi
s
t
i
nghe
al
t
hc
ar
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ys
t
e
mi
nTur
ke
yandde
t
e
r
mi
nei
t
sov
e
r
a
l
l
be
ne
f
i
t
sa
swe
l
las:
―t
/pr
ot
r
yt
opi
npoi
ntpos
s
i
bl
edi
f
f
i
c
ul
t
i
e
s
obl
e
m ar
e
a
sa
ndf
i
nds
ol
ut
i
ons
,
―t
ode
t
e
r
mi
net
heappr
opr
i
at
et
e
l
e
c
ommuni
c
a
t
i
ons
y
s
t
e
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t
ss
ui
t
abi
l
i
t
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t
ht
hee
x
i
s
t
i
ng
t
e
l
e
c
ommuni
c
a
t
i
oni
nf
r
as
t
r
uc
t
ur
e
,
―t
omakeal
i
s
tpos
s
i
bl
epr
i
vat
ea
ndg
ove
r
nme
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ge
nc
i
e
st
hatc
a
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ovi
der
e
s
our
c
e
sa
nd
de
t
e
r
mi
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hepr
os
pe
c
toft
he
i
rc
l
os
ec
oope
r
at
i
on.
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e
dt
ode
t
e
r
mi
nepr
obabl
ei
ns
t
i
t
ut
i
onsqual
i
f
i
e
dt
oj
oi
nt
hes
ys
t
e
ma
ndope
ndi
a
l
ogwi
t
h
t
he
i
ra
dmi
ni
s
t
r
at
i
vebodi
e
s
. Wehav
et
oi
nt
r
oduc
e
,por
t
r
a
yt
hegr
e
atbe
ne
f
i
t
sande
x
pl
ai
nt
he
me
c
hani
c
soft
e
l
e
me
di
c
i
net
ot
he
i
rgove
r
ni
ngbodi
e
s
. Wene
e
dt
oc
onf
e
rwha
tt
he
yhav
et
odo
anddi
s
c
us
st
her
e
s
pons
i
bi
l
i
t
i
e
s
. Wene
e
dt
oout
l
i
net
hee
xt
e
ntofi
nv
e
s
t
me
nti
ne
qui
pme
nta
nd
de
pl
oyme
ntoft
e
c
hni
c
als
t
af
f
.I
naddi
t
i
ont
oi
nt
e
r
nalr
e
s
our
c
e
s
,e
x
t
e
r
nalr
e
s
our
c
e
ss
houl
dbe
e
xpl
or
e
dt
ode
t
e
r
mi
nepos
s
i
bi
l
i
t
yande
x
t
e
ntofc
oope
r
at
i
ont
hatc
a
nbee
xpe
c
t
e
d.
Onc
et
he
s
ei
s
s
ue
sar
ec
ompl
e
t
e
l
yaddr
e
s
s
e
da
ndr
e
s
ol
ve
dt
hepr
oj
e
c
ts
houl
dc
omme
nc
eunde
r
t
hes
t
e
wa
r
ds
hi
pofI
STEM.
St
r
uct
ur
eofTNTP:
I
STEM (
I
s
t
anbulUni
ve
r
s
i
t
yCont
i
nui
ngMe
di
c
a
lEduc
a
t
i
ona
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s
e
ar
c
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nt
e
r
)i
s
r
e
s
pons
i
bl
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ori
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t
i
a
t
i
ng,de
ve
l
opi
nganda
dmi
ni
s
t
e
r
i
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heTur
ki
s
hNa
t
i
ona
lTe
l
e
me
di
c
i
ne
Pr
oj
e
c
t
.I
STEM,t
hedr
i
vi
ngf
or
c
eofTNTP,i
sa
na
c
a
de
mi
ci
ns
t
i
t
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i
onofI
s
t
a
nbulUni
v
e
r
s
i
t
y
.
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ni
s
t
r
at
i
ve
l
yi
ti
st
i
e
dt
oRe
c
t
or
s
hi
pofI
s
t
anbulUni
ve
r
s
i
t
y
. Admi
ni
s
t
r
at
i
v
ebodyof
I
STEM c
ons
i
s
t
sofac
ha
i
r
ma
n,avi
c
ec
hai
r
man,boa
r
dofdi
r
e
c
t
or
s
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na
dv
i
s
or
yboar
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Pe
r
ma
ne
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ni
s
t
r
at
i
v
eBodyc
ons
i
s
t
sofDi
r
e
c
t
or
,As
s
i
s
t
antDi
r
e
c
t
or
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wos
e
c
r
e
t
a
r
i
e
sa
nd
t
hr
e
et
e
c
hni
c
a
ls
t
af
fme
mbe
r
s
. Addi
t
i
ona
lpe
r
s
onne
lar
ede
pl
oye
da
sne
e
de
d,us
ual
l
ye
mpl
oy
e
d
a
sc
ons
ul
t
i
ngc
ont
r
ac
t
or
s
.I
nt
hef
ut
ur
e
,whe
ni
ti
sc
ompl
e
t
e
l
yope
r
at
i
onal
,r
e
pr
e
s
e
nt
at
i
ve
sof
ot
he
runi
v
e
r
s
i
t
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e
sandi
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t
i
t
ut
i
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l
lbei
nv
i
t
e
dt
oj
oi
nt
hea
dmi
ni
s
t
r
at
i
v
eboa
r
d.
I
STEM i
sl
oc
at
e
datt
heI
s
t
anbulUni
v
e
r
s
i
t
yMe
di
c
alFa
c
ul
t
yCapaCampus
. The
yha
v
e60
0
s
quar
eme
t
e
r
sofof
f
i
c
es
pac
ef
orDi
r
e
c
t
or
,as
s
i
s
t
a
ntdi
r
e
c
t
or;
s
e
c
r
e
t
a
r
i
als
t
af
fa
ndt
he
yhavet
he
i
r
ownpr
oduc
t
i
ona
ndpos
t
pr
oduc
t
i
ons
hop. The
r
ei
sa12
0s
e
a
ta
mphi
t
he
a
t
e
r
,t
wome
e
t
i
ng
r
ooms
onewi
t
hac
apac
i
t
yof8
0pe
r
s
onsa
ndas
ma
l
l
e
ronef
or3
0pe
r
s
ons(
Fi
g.
4
)
.
I
nf
r
as
t
r
uc
t
ur
eande
qui
pme
nt:I
STEM us
e
st
e
r
r
e
s
t
r
i
a
lc
onne
c
t
i
onsa
nds
at
e
l
l
i
t
el
i
nksf
or
t
e
l
e
c
ommuni
c
at
i
onsa
ndut
i
l
i
z
e
sI
nt
e
r
ne
t
,ADSL,Ra
di
oLi
nk,I
SDN,Sa
t
e
l
l
i
t
eandUl
akNe
t
27
5
(
Tur
ki
s
hNat
i
onalI
nt
e
rUni
ve
r
s
i
t
yAc
ade
mi
c
Ne
t
wor
k)
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nt
e
r
ne
t:Ut
i
l
i
z
e
sI
nt
e
r
ne
tc
onne
c
t
i
onpr
ov
i
de
d
byI
s
t
anbulUni
ve
r
s
i
t
yandTur
ki
s
hTe
l
e
c
om t
o
c
ommuni
c
at
ewi
t
hl
oc
al
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i
onala
nd
i
nt
e
r
nat
i
onalt
e
r
mi
nal
s
. Thes
e
r
v
i
c
epr
ov
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de
d
byTur
ki
s
hTe
l
e
c
om i
sne
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t
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rs
uf
f
i
c
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nti
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s
pe
e
dnora
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quat
ei
nc
a
pa
c
i
t
yt
os
e
r
vet
he
c
ommuni
c
at
i
onne
e
dsofI
STEM. Al
t
houg
h
s
e
r
v
i
c
es
e
e
mst
obes
at
i
s
f
ac
t
or
yf
ordat
a
t
r
ans
f
e
r
,i
ti
si
na
de
quat
ef
orqual
i
t
yi
mage
t
r
ans
f
e
r
s
. Fort
het
i
mebe
i
ng,onl
yda
t
aand
s
t
i
l
li
mage
s(
phot
os
,r
adi
ol
ogyi
mage
s
,a
nd
Fi
g
.
4 Pi
c
t
ur
ef
r
om I
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e
nt
e
r
pat
hol
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ci
ma
ge
s
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r
ebe
i
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r
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agnos
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ount
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s
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28
4
Tab
l
e1
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me
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2
8
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M akingbetteraccesstohealthcareservices
I n t e r n a t i o n a l
Te l e c o m m u n i c a t i o n
U n i o n
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Printed in Switzerland
Geneva, 2006
International
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