960771

research-article2020
ISP0010.1177/0020764020960771International Journal of Social PsychiatryLo et al.

E CAMDEN SCHIZOPH

Original Article

International Journal of

Development and validation of the Social Psychiatry

1­–8
© The Author(s) 2020
Lo’s Healthy and Happy Lifestyle Scale Article reuse guidelines:
sagepub.com/journals-permissions

(LHHLS): The resilience in general DOI: 10.1177/0020764020960771

https://doi.org/10.1177/0020764020960771
journals.sagepub.com/home/isp

population facing COVID-19 in Taiwan

Angela Lo1, Kuan-Ying Hsieh2,3 , Wan-Chun Lu4, Ierna Shieh5,

Frank Huang-Chih Chou6 and Vincent Shieh7

Abstract
Background: This article explores the effectiveness of development of the Lo’s Healthy and Happy Lifestyle Scale
(LHHLS), which is an evaluative tool that monitors the resilience of the Taiwan population in times of such COVID-19
epidemic. Also, to verify factors of resilience, namely the reliability and validity of self-efficacy and positive thinking, and
establishment of a prospective norm analysis.
Method: The study mainly applied Explorative Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) to
develop LHHLS and establish the reliability and validity of the tool’s structure, verify norm analysis and the reliability of
data from each question using Cronbach’s alpha.
Results: According to statistics, LHHLS has a good factorial effectiveness and relatively high reliability, with factor
reliability analyses where Cronbach’s alpha lies between 0.83 to 0.94. The 14 questions in the LHHLS has a total variance
of 67.04%. The tool includes two sub-assessments that are theoretically and statistically appropriate: mental health/self-
efficacy and positive thinking.
Conclusion: The tool LHHLS can be applied to populations affected by COVID-19. With participants’ self-awareness
of mental health state and state of happy living, this tool is valid and reliable in assessing and evaluating the resilience of
such participants against times of COVID-19. This study can become future use for epidemic prevention communities
in monitoring residents’ healthy living and changes in their resilience. Also, can become a reference standard for
interventions to reduce the impacts populations’ happy and healthy living, in times of biological disasters.

Keywords
COVID-19, Healthy and Happy Lifestyle Scale (LHHLS), resilience norm verification, self-efficacy, positive thinking

Background
Coronavirus Disease 2019 (COVID-19) began its spread in 1
F aculty of Medicine, College of Medicine, Kaohsiung Medical
Wuhan City of China and has become a global threat. On University, Kaohsiung
30th January 2020, COVID-19 was announced as a public 2
Department of Child and Adolescent Psychiatry, Kaohsiung Municipal
health emergency that required global attention. On 11th Kai-Syuan Psychiatric Hospital, Kaohsiung
3
Graduate Institute of Medicine, College of Medicine, Kaohsiung
March, World Health Organization (WHO) announced it as
Medical University, Kaohsiung
a global epidemic. Following the rapid escalation in num- 4
Department of Adult Psychiatry, Kaohsiung Municipal Kai-Syuan
ber of confirmed cases and deaths, COVID-19 has affected Psychiatric Hospital, Kaohsiung
globally 187 countries, with a global tally of 18,282,208 5
Graduate Institute of Humanities in Medicine, Taipei Medical
number of confirmed cases and a global death toll of University, Taipei
6
Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung
693,694 people (as of 5th August). These figures are bound 7
Graduate Institute of Gender Education, National Kaohsiung Normal
to rise in the future and our global population, society, University, Kaohsiung
economy, environment have received heavy blows, with
Corresponding author:
COVID-19 becoming a globalized biological disaster.
Kuan-Ying Hsieh, Department of Child and Adolescent Psychiatry,
Taiwan placed past experiences dealing with SARS Psychiatry Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No.
onto big data analysis, new technological skills, proactive 130, Kai-Syuan 2nd Rd, Lingya District, Kaohsiung 80276.
overseas management, home quarantine, home isolation, Email: [email protected]
2 International Journal of Social Psychiatry 00(0)

community outbreak investigation and confirmed case hereditary (Caspi et al., 2003), biology (Charney, 2004;
detection and other related crisis managements, to success- Morgan et al., 2002), psychology (Campbell-Sills et al.,
fully reduce the disaster’s impacts and the harmful spread 2006; Tugade & Fredrickson, 2004), and environmental
of COVID-19 in Taiwan communities (Wang et al., 2020). factors (Haskett et al., 2006; King et al., 1998). Richardson
Taiwan’s performance in epidemic prevention and resist- and his colleagues targeted this variable and made a
ance has surprised the world. hypothesis that begins with a starting point or ‘a stable
Global countries, in the face of COVID-19, have big- state’ of biological psychology – mental stability (Jensen
scaled prevalence of impact on human’s economy and et al., 1990). Humans can allow their bodies, thoughts,
lifestyle, caused loss of resources and lives, scarce and and mental state to be adjusted according to living envi-
insufficient medical resources. A system to reduce such ronments (Richardson, 2002). However, not all adaptive
disastrous impacts on society will challenge the resilience measures are effective, but instead, cause more destruct
of humans. to the stability of biological psychological health. This
Geographically, Taiwan is in the subtropical region of novel and reintegrated journey of resilience can result in
Asia, where natural, manmade and biological disasters are one of these four outcomes below:
common occurrences even in daily life. Such disasters
include typhoons, earthquakes, floods, African swine fever, (1) Increase opportunities of growth and strengthen
Enteroviruses, dengue fever, Severe Acute Respiratory adaptability of psychological traits
Syndrome (SARS) and COVID-19. Compared to natural (2) Recover to the basic state of stability
disasters, biological viral disasters can cause an epidemic (3) Affects the need for compensation for losses
and continue causing harm to human lives for weeks or (4) Poor adaptability due to inability to overcome
even months. pressure (Connor & Davidson, 2003).
Global outbreak of the contagious COVID-19 has
caused widespread fear in many populations and panic As such, the ability of human’s recovering resilience post-
buying of resources like daily necessities, including toilet disaster is seen as the ability to successfully respond and
paper and food, across Europe and America. Normal daily overcome pressure. In other words, verified results and
activities and commercialized activities have been heavily data of a study, on the long-term monitoring of healthy,
impacted even on the regional level and is likely to con- smart-living after disasters, have shown that there is a need
tinue for a long time (Noji, 2001). to focus on, stimulate and emphasize human’s innate resil-
In Taiwan’s population study, approximately 9.2% of ience against disasters. This aids in protection of individu-
participants reported that they are increasingly pessimistic als from chronic post-traumatic stress disorders (King
about how SARS has turned their lives in an atypical crisis et al., 1998; Waysman et al., 2001).
(Peng et al., 2010). Thus, biological disasters challenged As such, this article further clarifies the foundation of
human lives, impacts humans’ psychological health, way resilience in biological – society psychological health. It
of living and self-adaptability. This is something worth is important to fully understand how humans respond to
thinking about. Also, ponder about how to prevent and stress and trauma, which helps to prevent and intervene
reduce disasters, continuously develop a healthy commu- with a healthy, content lifestyle working model. This
nity, and how to practice healthy smart living in communi- helps individuals recover from stressful events and stress-
ties for the long-term. related diseases.
In face of natural and manmade disasters all over the A study, conducted on the Hakka survivors from
world, resilience within actions and medical science is Taiwan’s 921 earthquake, reports that indicators, including
increasingly emphasized (Charney, 2004; Masten, 2001). reception, preparedness, self-reliance, spirituality, Hakka
Resilience is defined as the ability to positively adapt in spirit, resources’ obtainability, societal support, the Internet,
face of pressure or trauma (Luthar et al., 2000), and and other services, have a positive impact on post-disaster
includes expected and related results of bodily health recovery (Jang & Wang, 2012). Indigenous groups have
(Black & Ford-Gilboe, 2004; Humphreys, 2003; Monteith stated, in response to Typhoon Morakot in Taiwan, that
& Ford-Gilboe, 2002; Wagnild, 2008) and psychological they have many interactive strategies with the residents, in
health (Humphreys, 2003; Nygren et al., 2005; Rew attempts to alleviate survivors’ sufferings, promote tribal
et al., 2001). People who can withstand pressure are able culture and build a recoverable community. But these activ-
to maintain a better function after experiencing it ities have been constantly ignored in post-disaster recon-
(Bonanno, 2004). Past decades of research have shown, struction initiatives (Fan, 2015). Another study on the gas
human’s adaptability has multidimensional features and explosions suggested an assistance plan for the resilience of
produces changes according to environment, time, age, societal psychological health.
gender, cultural background, lifestyle differences (Rutter, Disaster Adaptive Cycle and risk events form a cause
1985; Seligman & Csikszentmihalyi, 2014; Werner & and effect relationship, and from the perspective of per-
Smith, 1992). Earlier research has shown, restoration and ceived risks, observe how societies resiliently adapt to
Lo et al. 3

environmental changes (Chiang et al., 2014). Also, this for standard ethics: NCKU HREC-E-109-066-2). Prior
cycle emphasizes how to learn from adaptive abilities, statistical analysis, data that served possible identification
strategize feasible systems and actively organize different purposes have been deleted from the collected data.
types of responses 30. These build a friendly attitude Therefore, research was exempted of the requirement for an
toward societal adaptability and focuses on the whole cul- informed consent form from the committee.
ture (made up of individuals and society), where collabo-
ration between traditional and scientific knowledge Lo’s Healthy and Happy Lifestyle Scale
highlights the importance of magnified risks in society
(Chiang et al., 2014) (Halfacree, 2006).
(LHHLS)
Many evaluative scales about resilience (Wagnild & Prior to formulating the LHHLS, a data analysis on publi-
Young, 1993), include various dimensions of it, including cations was carried out first. Next, the research team
tenacity (Hull et al., 1987; Kobasa, 1979) and feelings of refined the Warwick–Edinburgh Mental Well-being Scale
pressure (Cohen et al., 1983). However, these contingency (WEMWBS) (Tennant et al., 2007). Together with special-
measures lack generalizability (Carlson, 2001; Mosack, ist groups, through discussions and revisions, the cata-
2002) and have not been verified in Taiwan. logue of 14 questions was formulated. To ensure the face
Thus, this study seeks to develop an evaluative tool that validity of LHHLS, the expert meetings with Taiwan,
is convenient and contains a thoroughly verified resilience Korea, Japan and America professors were held to review
scale. Although other different scales have been devel- the translated items of questionnaires and remove irrele-
oped, they have yet to receive widespread discussion and vant contents. Each item of LHHLS was reviewed by
acceptance, and not one of these scales have been identi- experts to verify the face and content validity. The use of
fied as a priority. the 5-point Likert scale was standardized throughout the
This research team considered the importance of recon- catalogue, with responses ranging from a scale of 1 (Never)
structing lifestyles in disaster and the impacts of various to 5 (Always). To ensure the authenticity of the scale,
factors like encouraging psychological health. every content had been revised according to advice and
As such, the research team have developed the Lo’s constructive criticism from a group of psychiatrists and
Healthy and Happy Lifestyle Scale (LHHLS) after going specialists. Culturally sensitive wordings and irrelevant
through reconstruction works in Typhoon Morakot and content have been removed. Participants were asked to
Kaohsiung’s gas explosion. The LHHLS serves as an eval- rate themselves on their feelings of a happy and healthy
uative tool about the impacts of disasters on individuals lifestyle over the past 2 weeks. A high score on the LHHLS
and societies, also to monitor the post-disaster recovery of indicates a high standard of healthy and happy living.
residents. This serves as a reference to understand recov-
ery of disaster communities through validation of indica- Statistical analysis
tors of healthy and happy living from the scale (Lo &
Shieh, 2019). This tool understands from the perspective LHHLS was conducted on 1,714 research participants to
of individuals’ self-awareness, and contents are focused on ensure psychological analytical features. Through factor
a short evaluation of a healthy and happy lifestyle. This analysis, we can observe the structural effectiveness.
can be built upon healthy and happy living, and adaptabil- Concretely speaking, using the RANDBETWEEN func-
ity scale of Taiwanese population in face of COVID-19, tion in Excel, 1,714 participants were randomly split into
with the norm of each question, reliability and validity of two samples. After which, the first sample (n = 857)
the scale. underwent EFA while the second sample (n = 857) under-
went CFA. Using SPSS statistical software (compatible
with Windows IBM SPSS Statistics Ver. 24.0, NY
Methodology Armonk, NY: IBM Corp) to carry out EFA. Due to factor-
related assumptions, we used Varimax rotation to carry
Data and study population
out analysis of principal components factors, then used
Participants are gathered between 8th April 2020 to 18th Kaiser-Mayer Olkin (KMO) for sampling adequacy and
April 2020 through a survey on Google Forms, which was Bartlett’s test. KMO value >0.60, while big data statisti-
distributed in Taiwan towards the general public. A total of cal analysis from the Bartlett’s test indicates that data is
1,714 individuals responded to this online survey, making adequate in carrying out factor analysis (Tabachnick &
up the pool of research participants, of which were 564 Fidell, 2007). In consideration of variance, it shows meas-
males, 1,138 females and five transgenders. urement of feasibility of related concepts or structures
(Hardy, 2004).
Due to multivariate skewness (−0.21) and multivariate
Research ethics statement
kurtosis (−0.35), Pointing out the normal distribution of
This research has obtained approval from the research ethics the second sample placed through CFA, a maximum like-
committee in National Cheng Kung University (Certificate lihood estimation is required to ensure model statistics
4 International Journal of Social Psychiatry 00(0)

Table 1.  Sociodemographic characteristics and hospital Results

visiting of participants.
Introduced the characteristics of a social population in our
Variable n % participants. Table 1. Social population characteristics and
Gender hospital visits of participants. Table 1 lists out the statisti-
Male 564 32.9 cal features of social population in our participants.
Female 1138 66.4 Descriptive statistics along with both the EFA and
Transgender 5 0.3 CFA factor loadings of the LHHLS items are presented in
Occupation Table 2.
None 302 17.6
Police officer 24 1.4
Civil servant 133 7.8 Construct validity
Labor worker 411 24.0 Explorative Factor Analysis.  An Explorative Factor Analysis
Healthcare 187 10.9 (EFA) was conducted on a sample of 857 parents of par-
Teaching profession 301 17.6 ticipants. KMO value for sampling adequacy is 0.95, indi-
Student 108 6.3 cating that sample is adequate. Bartlett’s test of sphericity
Others 248 14.5
compares our correlation matrix to the identity matrix and
Age (years)
results have shown that they are unrelated, thus supporting
Under 20 23 1.3
the presence of factors.
20–29 173 10.1
Carrying out the principal components factor analysis
30–39 263 15.3
40–49 517 30.2
using Varimax rotation, which assumes each factor being
50–59 505 29.5 related thus rotating these factors, to confirm factors. In
60–69 206 12.0 the beginning, results confirmed the proposed 2-factor
Above 70 20 1.2 solution of all 14 items, and results supported and explained
Marital status total variance 67.04% of the 2-factor solution.
Never married 464 27.1 Table 2 lists sub-scales of items and factor load. The
Married 1101 64.2 theoretical factor for the design of evaluative tools and
Divorced 98 5.7 the 2-factor solution coincide. The first factor (α = .94)
Widowed 28 1.6 includes eight items, with a factor load of .60 to .84. The
Cohabitation 13 0.8 second subscale (α = .83) includes six items, with a factor
Religion load of .51 to .81. Each subscale scoring average to be
None 570 33.3 above the passing average calculation. Table 3 lists the
Yes 1144 66.7 Pearson’s likelihood between each dimension of the
Education LHHLS.
None 0 0
Primary 5 0.3 Confirmatory Factor Analysis.  CFA fit index is within accept-
Secondary 10 0.6 able range: CFI = 0.924, NNFI = 0.913 and SRMR = 0.048.
High school 174 10.2 Except RMSEA = 0.101, standard chi-square = 88.901
Bachelor’s degree 888 51.8 (chi-square = 8178.850, df = 92, p < .001). Otherwise,
Master’s degree/PhD 626 36.5 each factor’s factor load is as follows: Factor 1 factor
Others 3 0.001
load = 0.66–0.87, factor 2 factor load = 0.45–0.84. Overall,
current model shows that data is an acceptable fit.
should follow ETA to obtain factor structure. Using Amos
statistical software (compatible with Windows’ IBM Amos Reliability
Statistics Ver. 22.0, NY Armonk, NY: IBM Corp) to carry
out CFA. Usually, the Standardized Root Mean Square Internal consistency of LHHLS measures with a
Residual (SRMR) should fall below 0.08 (Chang et al., Cronbach’s α value of .94. From Table 2, sub-dimensions
2018; Tennant et al., 2007), root mean square error of of LHHLS, namely self-efficacy has Cronbach’s α value
approximation (RMSEA) below 0.08 (Bentler & Bonett, of .94 whereas positive thinking have Cronbach’s α value
1980; MacCallum et al., 1996; Wu et al., 2015), Comparative of .83.
Fit Index (CFI) and Non-Normed Fit Index (NNFI) above
0.9 (Bentler & Bonett, 1980; Lin et al., 2014) indicates a
Discussion
good fit. As well as a standard chi-squared (chi-square/df)
smaller than 2 (Tabachnick & Fidell, 2007) or smaller than In this research, we have developed and verified LHHLS
5 (Wheaton et al., 1977). A test for validity of the internal in measuring the recovery of resilience within population
standardized tools was carried out. samples in Taiwan. The 14 items in the final version of
Lo et al. 5

Table 2.  Means, standard deviations, Cronbach’s α, and factor loadings for the items in the LHHLS.

Items Mean (SD) (n = 1714) EFA (n = 857) CFA (n = 857)

Self-efficacy (α = .94)
2. I feel that I am a useful person. 4.08 (0.90) 0.71 0.72
5. I am full of energy in life and can overcome anything. 3.79 (0.89) 0.70 0.83
6. I can deal with problems very well. 3.92 (0.77) 0.84 0.81
7. I have a logical and clear thought process when faced with a problem. 3.98 (0.78) 0.84 0.77
8. I feel that I am a great person. 3.80 (0.93) 0.80 0.84
9. I have good relationships with others. 3.92 (0.78) 0.60 0.69
10. I am confident. 3.79 (0.91) 0.82 0.87
11. I can always efficiently use my knowledge to deal with problems. 3.91 (0.82) 0.83 0.82
Positive Thinking (α = .83)
1. I am optimistic about my future life. 3.73 (0.96) 0.51 0.59
3. I feel that life is carefree. 3.64 (0.95) 0.56 0.65
4. I am interested and curious of others. 3.44 (1.00) 0.81 0.40
12. I feel cared for and loved. 3.89 (0.87) 0.60 0.64
13. I am interested in things that are new to me. 3.92 (0.88) 0.67 0.59
14. I am always rejoicing in life. 3.62 (0.88) 0.65 0.79

Note. EFA = exploratory factor analysis; CFA = confirmatory factor analysis; SD = standard deviation.

Table 3.  Correlation among the dimensions of the LHHLS. (whether the individual believes they can complete tasks in
unknown fields with their self-efficiency), energy (extent
LHHLS dimensions Self-efficacy Positive thinking
of difficulty in lowering one’s self-efficacy) (Bandura,
Self-efficacy – 0.76** 1977). In the first subscale of LHHLS, we used eight items
Positive thinking 0.76** – to measure one’s self-efficacy. As expected, self-efficacy
and recovery ability are positively related. Individuals
Note. **p < .01.
with a lower scoring in self-efficacy are more likely to face
psychological challenges in face of COVID-19.
LHHLS has a total variance of 67.04%, including two the- In the second subscale, we used six items to measure
oretical and statistical appropriate sub-scales: self-efficacy positive thinking. In earlier studies, positive thinking is
and positive thinking. The psychological scale features defined as reflective in the overall demeanor of thoughts,
support 2 factor hypotheses, including construct validity behaviors, feelings, and speech (McGrath, 2004), and is
(using EFA and CFA), and reliability (using Cronbach’s related to pain alleviation and health outcome predic-
alpha to measure internal consistency). LHHLS abides by tions (Tugade et al., 2004; Tugade & Fredrickson, 2004).
psychological standardized measurements and have been Following 11th September 2001, a study on stress response
proven to be a simple and potentially become a standard- reported that after the terrorist attack in America, people
ized scale in the future. Its use is to measure whether with resilience are less likely to develop depression and
individuals have successfully managed the impacts of psychiatric activity does not increase as well (Fredrickson
COVID-19 on their adaptability. et al., 2003). Another meta-analysis found that having a
LHHLS is made up of two scales, scoring from a range positive mindset helps in achieving successes in work, per-
1 to 5, where a higher scoring indicates a higher adaptabil- formance, social relationships, self-awareness, problem-
ity of individuals in face of COVID-19. The two items of solving, creativity and health (Lyubomirsky et al., 2005).
recovery which they feel the most for is the ‘self-efficacy’ As expected, positive thinking and recovery ability are
sub-dimension. They are people who ‘think themselves as positively related, allowing individuals to have constructa-
useful’ and ‘have a logical and clear thought process in bility, creativity and to overcome challenges caused by
times of challenges’. The two tangible dimensions they COVID-19. In this research, resilience and self-efficacy
understand the least is ‘positive thinking’. They are people and positive thinking have a positive relationship.
who ‘are curious and interested about other people’ and The resilience of people in face of COVID-19 and its
‘always feel happy in their lives’. societal impacts can be effectively understood using the
The first weighted subscale, self-efficacy, is defined as LHHL-RS. Or in assessments of individuals’ resilience
people’s belief in successfully carrying out a task that pro- against such disastrous impacts. It is said that such evalua-
duces desirable outcomes. Where in many dimensions tions into individuals’ psychological health and resilience
exists differences, including amplitude (whether the indi- have a value and it is a reliable tool. At the same time, it
vidual believes to accomplish tasks alone), universality provides us with a goal towards encouraging interventions
6 International Journal of Social Psychiatry 00(0)

in crucial reconstruction of psychological health after a Author contributions

disaster (Lo & Shieh, 2019). This research sets the founda- Conceptualization, H.W.L. and F.H.C.; methodology, K.Y.H.;
tion for future research into education, family science and software, W.C.L.; validation, K.Y.H. and W.C.L; formal analy-
technological science through multidimensional factors of sis, K.Y.H. and W.C.L investigation, K.Y.H. and W.C.L.;
resilience evaluation of the participants from the normal resources, H.W.L. and F.H.C.; data curation, H.W.L. and F.H.C;
population. writing—original draft preparation, K.Y.H; writing, review and
Because of the global threat of the biological disaster, editing, W.C.L, H.W.L. and F.H.C.; supervision, H.W.L. and
COVID-19, it has caused tremendous consequences in F.H.C.; project administration, H.W.L. and F.H.C.; funding
our daily lives. Therefore, in times of biological virus out- acquisition, H.W.L. and F.H.C.
break in the future, we must be constantly equipped with
healthy mental energy and consider self-efficacy and pos- Declaration of conflicting interests
itive thinking into our healthy and happy lives. As such, to The author(s) declared no potential conflicts of interest with respect
elevate our own resilience against disasters, strengthen to the research, authorship, and/or publication of this article.
disaster prevention and reduction and build an actionable
plan to educate about healthy living. Funding
In times of COVID-19, LHHLS conceptualizes and The author(s) disclosed receipt of the following financial sup-
measures individuals’ adaptability in self-efficacy and port for the research, authorship, and/or publication of this arti-
positive thinking. However, this research has limitations. cle: This integrated study is supported by funding from Ministry
First, the study data were exclusively self-reported and of Science and Technology of Taiwan. V.S. have led the MOST
may have therefore suered from shared-method variance. 3 years integrated project, included three subprojects (MOST
Second, the participants in this study were recruited from 104~106-2625-M-017-001), A.L. has led an ongoing project,
included four subprojects (MOST 107~110-2625-M-037-
whom responded to the recruitment advertisement.
001), F.C. is the primary investigator of this MOST study
Therefore, the results of this study might not be general- (MOST 107~110-2625-M-280-001), V.S. and A.L. are also
ized to college students who did not participate in this supported by the Ministry of Health and Welfare is gratefully
study. acknowledged.
We did not investigate the validity of the LHHLS with
related standards. Despite that, further research must be Ethical approval
conducted, to use the validity of other related standards
This research has obtained approval from the research ethics
and adaptability scales to prove our findings. Despite this committee in National Cheng Kung University (Certificate for
limitation, our overall finding states that LHHLS is relia- standard ethics: NCKU HREC-E-109-066-2).
ble and valid. Also, LHHLS can also serve to devise other
tools for disaster prevention and treatment plans in normal ORCID iDs
populations.
Kuan-Ying Hsieh https://orcid.org/0000-0002-6728-0807
Frank Huang-Chih Chou https://orcid.org/0000-0001-7802
Conclusion -3489

The LHHLS tool’s verification results present that LHHLS References

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