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Introduction
The COVID-19 pandemic has introduced the world to a standstill. In keeping with a 2021 report1 as of March 7 2022, the COVID-19 pandemic precipitated the dying of over 6 million people. Undoubtedly, COVID-19ʹs infectious potential and its means to trigger severe illness and dying raised a formidable problem for the complete world group. Like with different infectious ailments, growth of vaccine was being thought-about as the last word game-changer and therefore a number of analysis groups put in devoted efforts prior to now two years to develop protected and efficient vaccines in a file time.2–4 Sooner or later of time the vaccines for COVID-19 have proved to be efficacious in stopping transmission of an infection in addition to severe sickness. Nonetheless, the protection of the vaccine stays under par in some international locations in inhabitants owing partially to a common lack of acceptability of the vaccine.5–7
Saudi Arabia is among the international locations providing vaccination to its populations in a phased method. Traditionally, vaccinations particularly these meant for kids have met with resistance in virtually all components of the world. The willingness of populations to get vaccinated may very well be an important consider deciding the success of the COVID-19 vaccination program. The angle in direction of vaccination might be formed by varied components. Attitudes within the context of well being conduct might be defined as a product of beliefs by which the individual concludes if a conduct results in optimistic or unfavorable outcomes in addition to subsequent analysis of the outcomes.2 Vaccination attitudes could also be described both as an expression of assist or vaccine hesitancy among the many public.3
Scientists are of the view that the SARS-CoV-2, the causative agent of COVID-19 is right here to remain for a very long time.4 Among the newer strains of the virus have been discovered to be extra extra infective and lethal resulting in a surge in infections, illness and dying. Vaccination has been acknowledged as a most essential issue which may contribute to countering the COVID-19 pandemic.8 Adverse attitudes in direction of vaccines manifesting as unwillingness/ hesitancy to go for vaccinations are a significant barrier to controlling the COVID-19 pandemic. Any myths, misinformation or rumors can simply propagate through social media9 and might be instrumental in creating a unfavorable angle amongst the goal inhabitants. This will result in vaccine hesitancy which is known as a deferral or denial to go for the vaccine regardless of the identical being out there.10 Generally, a number of components have been recognized to trigger vaccine hesitancy.11 It’s essential to determine the components that influences the angle of the folks in direction of COVID −19 vaccination or these which could be a explanation for hesitancy to attain the specified degree of vaccine acceptance. Vaccine hesitancy associated to the earlier vaccines has been a significant problem in some international locations.11,12
Therefore, understanding the angle of the folks might be helpful in overcoming vaccine hesitancy which may assist within the design of well being training and social advertising and marketing efforts to take away the gaps in information, and overcome misconceptions. Growth of a scale for measuring the angle might be efficient in managing the general public angle13,14 and successfully handle the vaccination program.15–17
Restricted research have been undertaken to gauge the attitudes and perceptions in direction of COVID vaccination. Few current research have labored on figuring out the limitations, beliefs in direction of vaccination and many others.18,19 Nonetheless, there may be dearth of a validated scale to evaluate the mass angle for the vaccination. The current research has performed in Kingdom of Saudi Arabia by which we have now used Well being Perception Mannequin (HBM) as a theoretical framework to develop the Covid–Vaccination Angle Scale (C-VAS). This scale will assist in understanding and measuring the important thing components that form the angle of individuals in direction of COVID-19 vaccination. It will contribute in direction of creating methods to strengthen the COVID-19 vaccination packages particularly in resistant populations. Additional, the findings of this research can be utilized by healthcare businesses in numerous international locations to re-align their grownup vaccination packages and to extend its acceptability and outreach.
Theoretical Background and Assessment of Literature
A number of theories have been employed to elucidate the person well being conduct. Amongst these, a number of the broadly used are – Theories of Deliberate Habits,20 Well being Perception Mannequin,21 Social Studying Idea.22 The HBM and Social Studying idea are grounded on the expectancy-value framework.23 The HBM idea posits that the chance that a person will undertake a selected well being conduct is predicted by the assumption about menace of sickness or illness, coupled with a perception within the effectiveness of the really helpful well being conduct.21 The constructs of the HBM are: perceived susceptibility (perceptions of the chance of 1 experiencing the end result), perceived severity (perceptions of how severe the end result goes to be), perceived advantages (perceived potential advantages of participating within the well being conduct of curiosity) and perceived limitations (perceived limitations or impediments to participating within the well being conduct). The fifth assemble within the HBM is cues to motion that are alerts or components that act as a stimulus in direction of participating within the fascinating well being conduct. These might vary from experiencing signs that set off the necessity for adopting a specific well being conduct to receiving alerts from the media, household and buddies, or a well being care supplier that affect the adoption of the conduct.2 Cues although thought-about essential in motivating and initiating any well being conduct, are one of many least studied constructs in HBM. When the specter of an motion is lower than the specter of the well being deficit, well being motivation is fashioned. The Well being Perception Mannequin (HBM) is ceaselessly utilized in understanding and designing an intervention for health-protective behaviors.24 HBM has been successfully employed throughout completely different cultural settings to check the well being beliefs.25–27 Not too long ago a number of research employed the TPB and HBM to check the intention of the folks in direction of COVID-19 vaccination.28–31
Researchers similar to Sullivan32 prolonged the well being perception mannequin by including subjective norm and self-efficacy. The position of constructs similar to self-efficacy and subjective norm are extra related the place the topic require to switch behavior of consuming, consuming, smoking, exercising and many others. Overcoming these habits is essential particularly whereas coping with persistent situations and are comparatively harder than taking the vaccination pictures. A number of researches have studied the phenomena utilizing the well being perception mannequin. These might be utilized in understanding vaccine-related behaviors on the inhabitants and to develop efficient interventions.33,34 One other well-established social cognition idea is Safety Motivation Idea (PMT).35 This idea states that a person motivation to takes safety measure are primarily based on two evaluation components specifically menace appraisal and coping appraisal. Menace appraisal evaluates the perceived severity of a threatening occasion and the perceived or vulnerability. Coping appraisal consists of perceived response efficacy, or a person’s expectation that finishing up the really helpful motion will take away the menace, and perceived self-efficacy or the assumption in a single’s means to execute the really helpful programs of motion efficiently. Among the latest causal research primarily based on the PMT investigating the intention to take COVID-19 vaccines have been primarily based on PMT idea.36,37
Vaccine hesitancy is outlined as a delay in vaccine uptake or a refusal to obtain immunization regardless of vaccination companies being out there.38 Vaccine hesitancy often arises because of a priority or doubt in regards to the worth or security of vaccination. Primarily, it happens due to info deficit that is available in the best way of growth of belief with the intervention. Despite the fact that there have been speedy developments in vaccine growth expertise, resulting in enhanced security, many latest research have reported a lower within the belief of the general public and a resultant enhance in vaccine hesitancy.39–41 Vaccine hesitancy is a significant obstacle to the success of a vaccination program. For instance, A United States primarily based survey reported that solely 50% of the folks supposed to get the vaccine.42 Additional, one other research concluded that two-thirds of People is not going to get the COVID-19 vaccine when it’s first out there, whereas 25% report that they don’t have any intention to get vaccinated at any time.43
A number of causes might be attributed to vaccination hesitancy. These embrace inauthentic info disseminated from the web and social media platforms; lack of understanding and consciousness; doubts over the advantages of vaccines; security issues; low perceived severity of sickness and perception in various medicines, lack of belief within the pharmaceutical corporations. An evaluation of the foremost vaccination campaigns additionally reveals that purported spiritual beliefs have additionally performed a significant position in lots of situations of resistance in opposition to vaccines on the inhabitants degree.24
On the particular person degree, the components influencing vaccination embrace previous particular person expertise associated to vaccination, common well being information and consciousness, beliefs and attitudes about well being and prevention, the perceived danger and profit, social norms in regards to the vaccine as additionally belief within the healthcare system and repair suppliers. Of their research Dubé et al38 concluded that there’s a important relationship between components similar to information, belief, optimistic angle, and the mother and father’ intention to vaccinate. A latest research by Magadmi & Kamel44 on a Saudi Arabian inhabitants concluded that issues in regards to the negative effects are a barrier to vaccine acceptance.
Vaccination is seen as one of the crucial essential population-level well being interventions to fight infectious sicknesses.45 Herd immunity induced by vaccines serves as a protecting issue in opposition to the unfold of the illness in populations. A lower within the immunization protection can result in decreased herd immunity46 and consequent emergence of outbreaks, in addition to a better disease- related mortality and morbidity charges.46 Lack of belief both with medical doctors, authorities businesses or with pharmaceutical corporations can be cause for hesitancy and such angle could also be mirrored by even well- educated class.47 Magadmi & Kamel44 concluded that round 44.7% of the Saudi inhabitants is keen to get vaccinated. Additionally, a majority of those that refused will settle for the vaccine if further research confirmed the protection and effectiveness of the vaccine. One of many advantages of conducting the research after the initiation of the vaccination course of is that owing to the provision of the vaccine and elevated consciousness, most people are anticipated to have thought whether or not to get vaccinated in opposition to COVID-19 and the explanations thereof. On this regard, it’s value mentioning a few research by Maurer, Uscher-Pines & Harris48 which concluded that the speed of intention to get vaccinated uptake elevated by 20% after the vaccine was launched to the market.
Supplies and Strategies
Sampling Approach and Pattern Measurement
The respondents comprised from throughout completely different areas of Saudi Arabia. The questionnaires had been administered on-line. The info was collected from March to August 2021. The questionnaire was initially framed in English language and was subsequently translated into Arabic utilizing the worldwide tips49,50 which includes ahead and reverse translation as follows:
(1). The unique questionnaire was ahead translated from English to Arabic to generate a template that was technically and linguistically as near the unique as possible. Three language specialists individually translated the questionnaire. These specialists had been native Arabic audio system who had been additionally fluent in English. Every knowledgeable ready a ahead translation of the survey questionnaires into the Arabic language with out consulting one another. The 2 principal variations had been evaluated and in comparison with the unique questionnaire by two reviewers who’re native Arabic audio system.
(2). The questionnaire was reverse translated to English once more by a distinct translator after steady dialogue among the many native Arab specialists and the English translators. Variations and conflicts had been ironed out by consensus by conferences, and a closing model was created, appropriate for testing.
The next components, proposed by Cochran51 was used to calculate the pattern dimension for the present research:
where n is sample size, Z is the area under the normal curve. p denotes the estimated proportion of an attribute in the population, q equals 1- p, and e denotes the anticipated level of precision.
As the population is large, we choose the maximum variability ie p=0.5 with 95% confidence level and ±5% precision. The estimated sample size came out to be 385 as shown below:
The steps of the data collection process has been depicted in the Figure 1.
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Determine 1 Diagrammatical illustration of the information assortment course of. |
The ultimate questionnaire comprised of two sections: the primary sections (Half A) enquires in regards to the socio-demographic profile of the respondents, whereas the second part (Half B) consists of statements capturing the angle of the respondents.
Instrument Growth Course of
Merchandise Era
The objects of the size had been generated utilizing each the deductive and inductive strategy.52
The evaluation of extant literature was carried out to type a theoretical base for the assemble. A complete of 26 emerged from the literature evaluation. Additional as part of inductive strategy, semi-structured interview was performed with 20 people representing the completely different demographic attribute (for instance age, gender, training, marital standing, occupation) of the inhabitants. The respondents for the interview had been chosen primarily based on the Judgmental strategies. The interviews lasted for round 45 minutes. Earlier than the beginning of the interview, the respondents had been apprised in regards to the goal of the interview process. The content material evaluation approach was used to look at the transcripts. Content material evaluation is a way for drawing inferences from messages by rigorously and objectively figuring out particular attributes of messages.53 A complete of 15 statements had been derived from the inductive strategy. The objects used within the closing research have been introduced within the Table 1.
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Desk 1 Issue Extraction Outcomes |
Instrument Refinement
The ready instrument was pretested for its content material validity. This was established with the assistance of healthcare professionals comprising of physicians, a pharmacist, an immunologist, and one nurse. Two objects (statements) had been excluded as part of the pre-testing section Additional, the questionnaire’s common format was confirmed by conducting a pilot research with 25 contributors. Cronbach’s coefficient α was used to evaluate the general inner dependability of all 36 parts.54 The evaluation reported α to be 0.82, which was above the brink of 0.7.55 As well as, we calculated the adjusted item-to-total correlation whose acceptable worth was increased than or equal to 0.04.55 A corrected item-to-the-total correlation of lower than 0.4 excluded three objects. The dependability rose to 0.87 with the elimination of those three parts. Thus, 4 objects had been excluded that had a modified item-to-total correlation of decrease than 0.4. After these three parts had been eliminated, the reliability improved to 0.87. Consequently, 35 objects had been retained for EFA.
Knowledge Evaluation
Exploratory Issue Evaluation (n1= 411)
Exploratory Issue Evaluation (EFA) was used to additional refine the size. EFA was carried out on the primary pattern (n1=421), whereas the Confirmatory Issue Evaluation (CFA) was carried out on the second pattern (n2=421) (CFA). EFA was used to search out hidden components from a set of parameters within the ensuing knowledge set. Pattern adequacy assessments, similar to Bartlett’s sphericity check (approx. χ2 = 7849, diploma of freedom (df) = 378, significance = 0.000), display that the co-relation matrix is significantly distinct from the id matrix. The KMO worth of 0.905 indicated that the pattern was appropriate for issue evaluation, because it was greater than the cut-off worth of 0.6.56 Principal axis factoring was used to determine components, coupled with promax rotation. Three statements had been discovered to have communalities of under the reduce off worth, 0.5 and thus had been eliminated. Additional, as regards to issue loading, any statements exhibiting issue loading under 0.557 was eliminated/ deleted. Three statements had been reported to have issue loading under 0.5 and thus had been eliminated. Additional one merchandise was dropped because of item-to-total correlation lower than 0.4.55 The remaining 28 statements had been discovered to load on the 5 components with a complete variance description of 75% considerably increased than the minimal recommended description primarily based on the variable-factor ratio.58 Primarily based upon the cautious examination the objects constituting the components, the components had been labelled as Perceived Severity, Perceived Barrier, Well being Motivation, Perceived Advantages and Perceived Danger. The outcomes of issue evaluation are proven within the Table 1.
Confirmatory Issue Evaluation (n2=429)
CFA is predicated on the utmost chance (ML) approach grounded on the supposition that the manifest variables obey regular and steady distribution. No lacking values had been reported as all of the statements had been made obligatory to reply. Univariate knowledge normality was established with the assistance of skewness and kurtosis indices. Within the current research, absolutely the skewness was reported to be inside the vary of 0.213 to 1.586, whereas absolutely the worth of kurtosis was discovered to be within the vary of 0.01 and three. These values established the information to be usually distributed.59,60 Additional, the multivariate regular distribution was assessed utilizing the Mardia’s coefficient of multivariate skewness and kurtosis.61 That is carried out by evaluating Mardia’s coefficient to a price calculated utilizing the components p (p + 2) whereby p is the variety of manifest variables within the mannequin.62 Within the current research, the Mardia’s coefficient of worth 239.62 was discovered to be lower than the worth obtained from p (p+2), which comes out to be 840 taking p = 28. Thus, the multivariate normality was additionally established. The person assemble sensible Composite Reliability (CR) values had been found to be increased than the recommended worth of 0.763 (Table 2). Additional, the general reliability of the measurement mannequin comprising of 28 objects was discovered to be 0.901. As part of the assemble validity, convergent validity and discriminant validity was assessed.
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Desk 2 Convergent and Discriminant Validity Outcomes |
To perform the assemble validity each the convergent as properly the discriminant validity was established. Convergent validity refers back to the diploma to which a number of methods of evaluating a variable present similar findings.64 Convergent Validity was established primarily based upon the satisfaction of the next standards65
- Assemble Reliability (CR) > 0.7,
- CR > Common Variance Defined (AVE) and
- AVE > 0.5.
Discriminant validity is established when a assemble doesn’t exhibit a excessive diploma of correlation with the opposite assemble from which it’s supposed to be distinct.64 The next standards had been fulfilled that established the presence of discriminant validity.65
i) MSV < AVE and
ii) ASV < AVE
The values of convergent validity and discriminant validity for every assemble had been calculated utilizing Validity Considerations Toolkit utilizing Microsoft Excel by Gaskin66 as depicted in Table 2.
Mannequin Match Estimation: Measurement Mannequin
As really helpful by Hu & Bentler67 the really helpful reduce worth of match indices are Tucker Lewis index (TLI) > 0.9, Comparative Match Index (CFI) > 0.9; Goodness-of-Match Index (GFI) > 0.95; Adjusted Goodness-of-Match Index (AGFI) >0.80; Root Imply Sq. Error of Approximation (RMSEA) < 0.8 and Standardized Root Imply Sq. Residual (SRMR) < 0.8.
The preliminary estimates of the measurement mannequin for the 5 constructs mirrored Root Imply Sq. Error of Approximation (RMSEA) as 0.050, (TLI) (0.910) and Comparative Match Index (CFI) (0.925) values had been inside the recommended ranges which fall inside the really helpful values. However Goodness-of-Match Index (GFI) (0.803), Adjusted Goodness-of-Match Index (AGFI) (0.714) didn’t fall inside the really helpful cutoff worth as proven within the Figure 2.
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Determine 2 Preliminary measurement mannequin. |
Assessment of the modification indices indicated that the mannequin re-specification would produce a significantly higher match if the error phrases had been allowed to co-vary. Thus, three pairs of the error phrases e 22 and e 25; e25 and e28 and e 11 and e 12 had been co-varied. The ensuing mannequin generated an honest degree of match indices as indicated by the AMOS Output. The RMSEA, CFI, p-close, GFI, and AGFI all met their respective cut-off necessities for goodness-of-fitness.68 The improved mannequin is proven within the Figure 3. The values of various match indices of the present and improved measurement mannequin are introduced within the Table 3.
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Desk 3 Mannequin Match Indices Worth |
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Determine 3 Ultimate measurement mannequin. |
Frequent Technique Bias
Consistency motif and social desirability are seemingly prevalent approach bias components for the reason that knowledge was self-reported for all constructs.69 The Harman Single Issue check confirms the effectiveness of Frequent Technique Bias (CMB). Issue Evaluation in SPSS software program was used to scale back all variables to a single one. As found by the unrotated issue, the only issue attributed to solely 37% of the variation, exhibiting the dearth of Frequent Technique Bias (CMB) within the present research. This confirms the absence of within the knowledge assortment course of.
To substantiate the Harman Single Issue Take a look at, Klein, Rai & Straub70 performed a second research known as the Frequent Latent Issue (CLF) Take a look at. The measurement mannequin included a single latent element (or technique issue) whose indicators consisted of all of the constructs of the earlier measurement mannequin. The distinction of the standardized regression with and with out frequent latent issue was estimated. Their distinction was calculated. Not one of the objects reported important variations larger than 0.2.66 Therefore, the findings indicated that CMB had no impact on the findings of our research. Thus the end result re-confirmed the truth that CMB didn’t influence our research discovering.
Outcomes
The Exploratory Issue Evaluation resulted in 5 components specifically Perceived Advantages’, “Perceived Obstacles”, “Perceived Severity”, “Well being Motivation” and “Perceived Danger”. The worth of issue loading mirrored that every objects loaded properly on their corresponding components as depicted within the Table 1. These extracted components had been validated with the assistance of CFA. CFA was established with the assistance of convergent validity and discriminant validity (refer Table 2) adopted by evaluation of the mannequin match indices (refer Table 3). Additional, to make sure that there isn’t a presence of systematic bias within the knowledge assortment course of, Frequent Technique Bias (CMB) was carried out. The outcomes of Harman Single Issue Take a look at and Frequent Latent Issue (CLF) Take a look at supported the absence of CMB.
Moral Approval
This research was performed in accordance with the declaration of Helsinki. The knowledgeable consent was obtained previous to collaborating within the research. Institutional Moral approval was obtained from the Analysis Ethics Committee on the College of Hafr Al-Batin, Kingdom of Saudi Arabia (G-114-2020).
Dialogue
The devastating world influence of COVID- 19 is extreme than some other pandemic of the latest previous. Despite the fact that there are issues relating to the long-term efficacy in addition to security of the vaccines amongst some sections, mass vaccination has been hailed because the mainstay of the pandemic mitigatory efforts globally.71 To be able to obtain a better protection of the vaccines, it’s important to elicit a optimistic angle in direction of the vaccine amongst people and populations. Due to this fact, it’s crucial to determine the causes of refusal/ hesitancy and accordingly making appropriate interventions. The 5 constructs “Perceived Advantages”, “Perceived Obstacles”, “Perceived Severity”, “Well being Motivation” and “Perceived Danger” in totality supplied a excessive variance clarification (70.289) within the context of individuals attitudes in direction of COVID vaccination. Moreover, all of those components met the factors for inner consistency and reliability, as proven by their respective Cronbach’s alpha statistics, in addition to convergent validity and discriminant validity, as demonstrated by CFA findings in Table 2. Findings from the research reveal particular features associated to every dimension upon which each the federal government in addition to different healthcare businesses might act to make the vaccination program extra profitable. Within the context of limitations, it is very important be certain that genuine and dependable details about completely different features of the vaccine is disseminated to the lots. This info will make the folks conscious and likewise counter their unfavorable views in direction of the vaccination. In earlier research about childhood vaccinations, spiritual beliefs have been recognized as an essential cause for vaccine hesitancy.72 The angle in direction of COVID vaccination may also be influenced by the perceived danger of the an infection. Optimistic attitudes will probably be fashioned if the people suppose that after getting vaccinated, there will probably be a low chance of getting contaminated and that vaccination is the one resolution to manage the pandemic. There may be additionally perception amongst some people that the COVID-19 phenomenon is a hoax that may result in rejection of any vaccination efforts.73 One other essential dimension that measures the angle in direction of vaccination is the extent of perceived severity or the unfavorable penalties that an individual associates with not getting the vaccination. If an individual thinks that vaccination can cut back the severity of the illness, it could result in optimistic attitudes in direction of the vaccination. Menace notion is one other aspect as regards the angle in direction of COVID vaccination. Some folks may suppose they’re too wholesome to get affected by the COVID an infection. Others may suppose that sustaining good vitamin and taking medicinal herbs will shield them in opposition to COVID. Largely, folks will probably be extra enthusiastic about getting vaccinated in the event that they really feel it’s helpful for his or her well being. Perceptions of security and effectiveness of the vaccine in stopping COVID an infection and sickness is a crucial issue governing vaccine acceptance. Vaccination acceptance additionally is dependent upon the belief the folks have in governments and the well being system. Additionally, folks could also be extra more likely to settle for the vaccine if the federal government approves the vaccine. Different components that contribute in direction of the motivation may very well be suggestion by the physicians, entry to dependable info relating to the efficacy and security of the vaccine and many others. One essential issue affecting vaccine acceptance is the affect of shut family and friends members. Misunderstandings relating to the side-effects and efficacy of sure manufacturers of vaccines may result in selective vaccine hesitancy. The popular vaccine model may at instances be unavailable resulting in refusal of people to get vaccinated.
Limitations
Limitations of this research embrace the truth that this scale has been developed using the idea of Well being Perception Mannequin. This may be taken ahead by creating an attitude-based scale by integrating constructs from different well being motivation theories similar to Safety Motivation Idea, Self-efficacy Idea and many others. Additionally, this scale centered solely on the Saudi Arabian inhabitants and therefore the validity of this scale must be established for different geographical areas and in different languages.
Conclusion
COVID-Vaccination Acceptance Scale is predicated on Well being Perception Mannequin which has been broadly used earlier to elucidate the well being conduct of people and populations. The measurement mannequin was validated by making use of CFA to look at the reliability, accuracy and validity of the size. All of the psychometric properties of the size had been discovered to be passable. This scale might be utilized for measuring the angle and behaviors associated to COVID vaccination and thus can be utilized by public well being businesses and different stake-holders for selling COVID vaccine protection in international locations and societies which nonetheless have low vaccination charges particularly because of lack of acceptance of the vaccine. This scale additionally has the potential to assist in understanding public conduct in relation to different comparable future outbreaks and the acceptance of the vaccines to counter the identical.
Funding
The authors prolong their appreciation to the Deanship of Scientific Analysis, College of Hafr Al Batin, Kingdom of Saudi Arabia for funding this work by the analysis venture No G-114-2020.
Disclosure
The authors declare no potential conflicts of curiosity with respect to the analysis, authorship, and/or publication of this text.
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