User Experience Design of Stroke Patient Communications Using Mobile Finger (MOFI) Communication Board With User Center Design Approach

Abstract

p class="0abstract">Stroke has become a phenomenon in Indonesia. From 2014 to mid-2015, the disease is the first cause of death in Indonesia. This is of particular concern to the Ministry of Health so that the prevention, treatment, and prevention of stroke is further enhanced. The condition of stroke patients whose movements are limited is exacerbated by the psychic condition of patients who are unable to communicate pressure will cause obstacles to the healing process of the patient. This research proposes a stroke patient communication media by applying the technology of Mobile Finger Communication Board and user center design approach (UCD). This communication board is operated using the patient's fingers so that it is comfortable for everyday activities. Mobile Finger Communication Board Design based on five planes of user experience. The result of Mobile Finger Communication Board implementation shows that application usability level seen from perception and ergonomic point of view shows satisfaction index of the user at the satisfactory level so that it can be said that the system works with the satisfactory result of the users. It is expected that with a convenient Mobile Finger Communication Board can support the healing process of stroke so that the healing rate of stroke is increasing.
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Full text

Paper—User Experience Design of Stroke Patient Communications Using Mobile Finger (MOFI)...
User Experience Design of Stroke Patient
Communications Using Mobile Finger (MOFI)
Communication Board With User Center Design
Approach
https://doi.org/10.3991/ijim.v12i2.7937
Aan Jelli Priana!!", Herman Tolle, Ismiarta Aknuranda
Faculty of Computer Science Brawijaya University Malang, Jawa Timur, Indonesia
ms.aanjp@gmail.com
Eko Arisetijono
Brawijaya University Malang, Jawa Timur, Indonesia
Abstract—Stroke has become a phenomenon in Indonesia. From 2014 to
mid-2015, the disease is the first cause of death in Indonesia. This is of particu-
lar concern to the Ministry of Health so that the prevention, treatment, and pre-
vention of stroke is further enhanced. The condition of stroke patients whose
movements are limited is exacerbated by the psychic condition of patients who
are unable to communicate pressure will cause obstacles to the healing process
of the patient. This research proposes a stroke patient communication media by
applying the technology of Mobile Finger Communication Board and user cen-
ter design approach (UCD). This communication board is operated using the
patient's fingers so that it is comfortable for everyday activities. Mobile Finger
Communication Board Design based on five planes of user experience. The re-
sult of Mobile Finger Communication Board implementation shows that appli-
cation usability level seen from perception and ergonomic point of view shows
satisfaction index of the user at the satisfactory level so that it can be said that
the system works with the satisfactory result of the users. It is expected that
with a convenient Mobile Finger Communication Board can support the healing
process of stroke so that the healing rate of stroke is increasing.
Keyword—User Experience, Stroke, Communication Board, Activity of Daily
Living, User Center Design.
1. Introduction
Stroke has become a phenomenon in Indonesia. In the 1990s, stroke was the fourth
leading cause of death. However, in 2014 until mid-2015, this disease became the first
cause of death in Indonesia. This is of particular concern to the Ministry of Health so
that the prevention, treatment, and prevention of stroke are further enhanced. [1]
Looking at the trend of stroke that occurs, it is necessary to prevent and to handle
stroke well. In general, prevention efforts are done from the diet, rest, and exercise.
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While the stroke treatment is done through treatment to hospital, polyclinic and
traditional herbal medicine. The percentage of healing stroke is dependent on the
condition of stroke. Also, perseverance, tenacity and the willingness of patients to
heal also contributed the percentage of healing stroke.
The condition of heavy stroke patients who can not speak, limited movement and
even paralysis will cause their own barriers for patients, families and outpatient
treatment processes to the hospital. The condition of stroke is exacerbated by the
psychic condition of the pressure of the patient who is unable to communicate, unable
to walk even dependent by the family member or caregiver causing the stroke
handling to belong. Therefore, it needs support to the condition of the stroke patient
so that the treatment and healing process can run smoothly so that the healing rate of
stroke is increasing.
Support for severe stroke patients who are unable to communicate, can not walk,
paralyzed and dependent on family members or caregivers can be through the
procurement of a tool to assist the communication activities of stroke patients.
Research says that communication boards have been proven to reduce frustration with
communication. Patients have specific ideas about what terms and ideograms are
useful for communication boards. A communication board is effective in reducing
frustration and in facilitating communication. More specifically some advantages of
communication boards are improving the efficiency and speed of communication,
facilitating needs, and facilitators to gain recognition of patient individuality [2].
There is a technology outside the field of health but can support health and provide
a positive influence of mobile technology. Mobile technology can support health
services beyond the scope of the hospital for chronic and degenerative diseases [3].
Mobile technology can also be used for people with disabilities where they can not
talk and use their hands to control an app. Implementation of mobile technology is
located on Head Movement Controller System (HEMOCS) [4]. HEMOCS
implements a new customized keyboard layout design based on the alphabet usage
frequency in English and Range of Motion (ROM) to observe reactions from
HEMOCS users [5].
Based on the need for stroke and stroke patients support, in this research a
communication media of stroke patients, especially patients with difficulty speaking
conditions is proposed, limbs are difficult to move and require the help of others. This
research applies human-computer interaction (HCI) technology and Mobile Finger
(MOFI).
This study was used to help non-verbal communication of stroke patients so that
patients and people around can do daily activities well. With better communication
then the information will be well received. The use of communication boards with the
help of the patient's finger swipe does not complicate the limitations of patient
movement so that it is comfortable to use for every day and the process of healing or
stroke recovery can run smoothly. Use of communication board with the help of a
patient's fingers or tap. This is because stroke patients have limited motor movement
and can only move their fingers only.
Communication board design applies the principle of user experience which
process is divided into five areas: strategy, scope, structure, skeleton, surface. Also,
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this communication board design using User Center Design (UCD) method is a user-
centered interface design concept method with the conclusion from the user
experience through efficient observation [6]. From the previous description, the
purpose of this study is to design a communication board for non-verbal
communication media of stroke patients, apply communication board usage in stroke
patients and analyze communication board performance from usability side of stroke
patients.
1 Literature Review
1.1 Communication board
A communication board is a board used to communicate, especially for patients
with certain diseases. In this communication, a board is provided features that repre-
sent some of the daily activities of the patient. One example of the communication
board shown in Figure 2 below is the Vidatak EZ Board communication board, which
was patented in the United States in 1999.
Fig. 1. Communication Board Vidatak
The illustration of the board shows the existence of four important parts, each of
which has some icons that represent the actions of a particular patient. These four
sections include the "I AM" section indicating the patient's current state, then the
"I WANT" section indicating the desired request by the patient, the "I WANT TO
SEE" section indicating the patient's desire to meet with someone, and finally is the
"KEYBOARD" section where the patient can designate a number of characters, either
alphabetically or numerically as a patient's misspelled means to be understood by
others.
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1.2 Activity daily living (ADL)
Activity Daily Living is an activity doing daily routine work. ADL is an essential
activity for self-care. ADL includes among others: toilets, eating, dressing (dressing),
bathing, and moving places [9]. Activity Daily Living are the basic skills and occupa-
tional duties that must be possessed by a person to take care of himself independently
of a person's daily work to fulfill or relate to his role as a person in the family and
society[10]. Figure 2 shows about activity daily living.
Fig. 2. Activity Daily Living
1.3 Stroke
Stroke is a condition that occurs when the blood supply to the brain is cut off due
to blockage or rupture of blood vessels, resulting in the death of cells in some areas of
the brain. Stroke is a serious health condition that requires rapid treatment [8].
Aphasia is a syndrome of the nervous system (neurological) that impairs the ability of
language. People who suffer from this disease will have difficulty in expressing the
mind and finding it difficult to understand and find words while communicating. Of
course, this will cause problems in the life of the sufferer. Therefore, communication
is one of the important things in life. Usually, this disease will occur suddenly after
you have a stroke or injury to the head. Aphasia is divided into three nonfluent
aphasia (people who experience the disease will communicate using incomplete
sentences but can understand what others are saying), fluent aphasia (people who
experience this type of aphasia can speak fluently, using long sentences, complex, and
often unreasonable and unable to comprehend the spoken language of the other
person well), global aphasia (occurs when the language network of the brain has been
severely damaged and widespread so that the sufferer will experience severe disability
in terms of understanding and expression). Based on these three types of aphasia, the
study used a patient belonging to nonfluent aphasia or motoric aphasia.
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1.4 User experience (UX) and user center design (UCD)
According to Jakob Nielsen, user experience encompasses all aspects of user inter-
action with the company, its services, and its products. User Experience (UX) is an
experience made by a product to people as its users in the real world [6]. UX is not
simply a chain of work within the product or service that is the main thing in the
product. User Experience (UX) focuses more on functions outside the product when
in direct contact or contact with the user. The design used in this study is the method
of analysis by using The Five Planes based on research [6] about user experience. The
user experience development process is all the processes that ensure the user
understands every action taken and understands the user's expectation for each action
to be performed. The user experience development process is divided into five areas
namely strategy, scope, structure, skeleton, and surface. The user experience
development process is done from the bottom up.
The user-centered design method is a user-centered, user-centered design concep-
tual method with a conclusion from the user experience through efficient observation.
The interface design process focuses more on usability objectives, user characteris-
tics, tasks, and workflows in interface design. All information obtained through anal-
ysis of habits through a survey. The analysis results are then processed so that the
design decisions obtained interface design user-friendly. [6]
According to ISO 13407, UCD Process describes a general process for human-
centered activities in the development cycle. The human-centered design process for
interactive systems. There are four processes in UCD (ISO 13407: 1999) there are
understand and define user context, determine the needs of users and organizations,
the resulting design solution, evaluation of the design of the needs of users
3 Design of Mobile Finger (MOFI) Communication Board
Mobile Finger Communication Board will generally refer to the daily needs of eve-
ryday users or Activity Daily Living which represents some daily activities that are
always done eating, bathing, wearing clothes, moving places, to the toilet and walking
the streets. In addition to referring activity daily living or daily activities, this applica-
tion also refers to the Health Communication Board created by the VIDATAK com-
pany called EZ Picture Board. In the MOFI, there is also a menu to represent the
feelings or something that complained of the user that is pain, dizziness, cold, heat,
fear and sadness. When a user selects an action he or she wants, the system will play
the sound of the selected action through the speakers on the device. In addition to
selecting the action, the user can also compose a word consisting of a certain number
of characters. If he makes a mistake in entering a character, he can delete the charac-
ter. The user can also play the sound of the word he has compiled through the speak-
ers on the device.
Respondents were selected based on Purposive sampling technique with the
qualification of the respondent test is respondent have aphasia complaint due to the
history of stroke disease; respondent has experience using a mobile device,
respondent can read picture or writing (not illiterate). From these qualifications, the
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selected test respondents are the users with aphasia complaints due to stroke diseases
both male and female, amounting to 10 people. Data collection is done through inter-
views and observation. The interview was conducted to a neurologist at a hospital, as
a source who knew about stroke as well as doctors who deal with stroke patients.
Also, interviews were also conducted to ten patients in each home, accompanied by
family members and conditioned as comfortable as possible according to the instruc-
tions of a neurologist. Observations or observations are made on stroke patients who
are implementing communication boards using a single finger touch (tap), double-tap
double touch, and swipe to the right and left. Duration of interview and observation
for each patient ± 30 - 45 minutes.
The data collected is then analyzed using a user experience process consisting of
five steps (the five planes), namely strategy analysis, scope, structure, skeleton, and
surface. Followed by the analysis using user design method which consists of under-
standing and determining the user context, determining the needs of users and organi-
zations, resulting in design solutions, design evaluation of user needs, data collection
and observation.
3.1 Functional Requirement Analysis
System functional requirements are necessities that represent what things the sys-
tem can do. The functional requirements are shown in Table 1.
Table 1. Functional Requirement
No.
Req. Code
Functional Requirement
1. SRS-MCB-01 The system provides daily life menu choices and complaints to be com-
municated by actors.
2. SRS-MCB-02 If the actor selects a particular action, the system must be able to play the
sound of the action through the device.
3. SRS-MCB-03
The system provides a keyboard to use for typing the word as the actor
wishes.
4. SRS-MCB-04
If the actor decides to play the word sound he has compiled, then the
system must be able to play the word sound through the device.
5 SRS-MCB-05 Actors can replace or delete characters that have been typed on the system
keyboard board
The identifiable system actor is the user who has the limitation in communicating
due to an illness. People who have normal physical conditions are also included in the
category of system users. While actions that actors can take against the system
include selecting the board/tap menu, hearing the sound of the selected menu, typing
words on the keyboard, playing word sounds, and deleting characters.
3.2 Non Functional Requirement Analysis
The purpose of the analysis of non-functional needs is to get a specification about
quality aspects required by the application. The result of non-functional requirement
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analysis of system development Design User Experience Media Communication of
Stroke Patients as shown in Table 1. The non-functional requirement is shown in
Table 2 below:
Table 2. Non Functional Requirement
Non Functional Requirement
Description
Usability Applications should be easy to use with a minimum usability level
satisfactory (61-80%)
3.3 Scope Design
The scope design or scope of the Mobile Finger Communication Board consists of
several content needs that must be met. The content will be the viewing menu in the
Mobile Finger Communication Board application and according to the user's needs of
basic human needs (ADL), the usual complaints submitted by the patient, the patient's
desire to meet someone, the patient's desire for entertainment / refreshment, patient
(“Yes”, “No”, “OK”, “Thank You”).
3.4 Structure Design
In the design of structures, interaction design and information architecture are
created. The structure field serves to determine the direction of navigation in an appli-
cation and relates to the content available on the pre-made scope design. The structure
design of the Mobile Finger Communication Board consists of several structures
shown in Figure 4 below:
Fig. 3. Scope Design MoFi Communication Board
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3.5 Skeleton Design
Skeleton design is more emphasis on setting the location of elements. The follow-
ing is shown in Figure 5 is one of the skeleton designs in the main menu Mobile Fin-
ger Communication Board :
Fig. 4. Skeleton Design of MoFi Communication Board Main Menu
3.6 Interface Design
One design of the Mobile Finger Communication Board interface is shown in Fig-
ure 6 below:
Fig. 5. Interface Design of Main Menu
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3.7 Control Design
The type of interaction that the user performs on the system is the type of interac-
tion that is mediated interaction (mediated interaction) is done by using gesture
movement (gesture). The action that can be done by the user against the system,
among others, select the menu with a tap, shift the cursor arrow position of the page,
choose a specific action, choose characters to compose a word, replace and delete
characters. When a user is inside a certain page, he can move to the page position
before and afterward by tapping the movements of his fingers or shifting (swipe) the
screen with the touch of a finger.
3.8 Screenflow Design
Screenflow is a term that can be used to describe the flow of interfaces that occur
within a system. There are eight screen displays which consist of MoFi.Apk Applica-
tion, main menu, "I feel" menu, "I want" menu, "want to meet" menu, "keyboard
board" menu, "confirmation" menu, and "entertainment" menu. The eighth view is a
view of the interface compiler of the system to be developed. After the main menu,
the user can select other menus as desired, then also can make a choice back to the
main menu.
4 Implementation
Implementation of the system discussed, among others, about the explanation of
the system specification, the limits in implementing the software, the application of
method and application of user interface. MoFi implementation is done using user-
centered design method. The MOFI-controlled system is implemented into several
mobile devices of different sizes: the first device (smallest size = 4 inches), proceed to
the second device (medium size = 5.3 inches) and proceed to the third device (largest
size = 7 inches). The user's fingers touch the screen of the device once in a short time
with a range of icon menu size. If the user uses a finger tap with a long touch time,
then the voice response that appears will be too late. If the user uses double finger tap
with long touch time or more than twice, then the system will be too late to respond to
the sound. The user's finger shifts the screen (swipe) of the device once with the
widest range of menu screen sizes just to slide to the right and to the left. When the
user shifts up or down the system can not respond to the action. Sound processing on
MoFi using Google Text to Speech. Figure 6, Figure 7 and Figure 8 show the view of
the MoFi menus that are implemented on mobile devices:
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Fig. 6. Interface Design of “I Feel” and “I Want” Menu
Fig. 7. Interface Design of “Want to See” and “Keyboard” Menu
Fig. 8. Interface Design of “Confirmation” and “Entertainment” Menu
Fig. 9. Implementation Mobile Finger Communication Board
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Table 3. Demography of Respondents
Respondents = 10
• Age
> 40 th = 10 and < 40 th = 0
• Gender
Female = 4 and Male = 6
• Work Farmer = 5 Entrepreneur = 1
Employe = 2 Housewife = 2
• Long Occurrence of Stroke > 1 year = 7
< 1 year = 3
• Intensity of Mobile Device Use Often ( !1x/ day) = 9
Rarely (" 1x/3-7 day) = 1
4.1 Implementation of User Center Design (UCD) Method
There are four processes in User Center Design (UCD) by ISO 13407:1999:
1. Understand and define user context. MOFI developed to help communication
between users who have difficulty communicating (Aphasia) with people around
due to stroke. This application will generally refer to Activity Daily Living (ADL).
In this application, there is also a menu to represent the feelings or something that
complained of the user that is pain, dizziness, cold, heat, fear and so on.
2. Determine the needs of users and organizations. The needs of MOFI users can
be realized in the analysis of functional requirements and content requirements
contained in Table 1.
3. The resulting design solution. MOFI application design is based on user experi-
ence design approach (UX) which consists of design strategy, scope design, struc-
ture design, skeleton design and surface design. The results of each design have
been shown in section tree.
4. Evaluation of the design of the needs of users. Evaluation of the design is done
when testing the application to the user. This evaluation was applied by trial to us-
ers (stroke patients and normal people) of 10 people and then recorded responses
and user ratings using questionnaires.
5 Evaluation
The evaluation will be discussed about functional testing and nonfunctional testing.
Functional testing is a test conducted to determine whether the system has been
implemented by functional requirements that have been defined in the beginning. The
system requirement to be used in this test comes from the functional requirements
previously written in Table 1. This functional testing method is done by using the
black box, and functional requirement will be tested using some test cases. A good
test case can represent all possible pathways that users can make to the system. From
the test cases obtained results that the whole functional testing has been valid. This
means the system has successfully done the task of switching positions, sound
management, display images, and text.
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Non-functional testing is a test conducted to determine the quality and to the
system that has been implemented. The parameters to be used in this non-functional
testing process are device control parameters and usability parameters. MoFi control
method uses fingers when choosing application menu. Based on the results of the
control tests of each device then obtained a device control analysis that amounted to
74% for the device control score 1, which is classified as a satisfaction category.
While in device 2, obtained a control score of 75% classified as a satisfaction
category, and on device 3, obtained a score of control of 81% which classified the
category is very satisfaction.
The next non-functional testing parameter is usability, which is the parameter used
in testing the level of user satisfaction regarding the use of the system that has been
developed. This test is done by testing the system that has been developed directly to
some respondents. Respondents will be asked to fill out a questionnaire containing
some statements related to the convenience and ease of use of the system. The
statements to be used in this research questionnaire come from previous research
titled “Toward Standard Usability Questionnaires For Handheld Augmented Reality”
[11] where the research discusses usability measurements on the use of mobile device
technology on android. Classification of questionnaire result consist of very
unsatisfaction (0-20%), not satisfaction (21-40%), neutral (41-60%), satisfaction (61-
80%) and very satisfaction (81-100%).
Table 4. Questionnaire
No
List of Questionnaire Statement
Related Statement of Application Usage Perception Problem
1.
I think the amount of information displayed on the mobile device screen is appropriate
2.
I think the information displayed on the device's screen is easy to read
3.
I think that the information displayed has a quick response
4. I think the words and icons displayed on the device screen are easy to read
5.
I think the information displayed on the screen is consistent
Related Statement of Application Usage Ergonomic Issues
6.
I think interacting with this app does not require much effort mentally
7.
I think interacting with this app does not require much physical effort
8.
I think the use of this application is convenient to use my finger
9.
I find it easy to input information through the application
10
I do not feel my finger tired after using this app
11
I think the operation of this application is simple and not complicated
The result of usability parameter test of each device shows that on the first device
average usability is 73,6% (satisfaction category), on second device average usability
is 75% (satisfaction category) and on third device average usability equal to 81.4%
(very satisfaction category). Of the three devices, the satisfaction index on the user
perception aspect shows the highest score in the first statement that "the amount of
information displayed on the mobile device screen is appropriate." Then the satisfac-
tion index on the aspect of ergonomics of the use of the application shows the highest
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score on the seventh statement is "about interaction with the application does not
require much physical effort." The overall test results show that the developed system
provides satisfaction results to the users.
Table 5. Experimental Result of Device 1, 2 and 3
NO
Usability
Device 1
Device 2
Device 3
1
User Perception
73,2 %
76 %
80,8 %
2
Ergonomic
74 %
74 %
81 %
Total
73,6 %
75 %
81,4 %
Level of Usability
Satisfaction
Satisfaction
Very Satisfaction
!
Fig. 10. Experimental Result of Usability
Analysis of these results indicates that more app users feel comfortable when using
a third device that is a tablet-smartphone with a larger screen size (7 inches) of the
first device (5 inches) and second (5.3 inches). The results indicate to the iterative that
the greater the device, the more satisfaction. But from the aspect of practical use, if
the device size is too large then the user will be more difficult and heavy to carry it. It
can be said that for users, especially for patients, the use of applications on mobile
devices can be tailored to the conditions, needs, and comfort of the patient. Mobile
devices should not overload and reduce patient comfort.
6 Conclusion
This research proposes a stroke patient communication media by applying Mobile
Finger Communication Board technology with user center design (UCD) approach.
This communication board is operated using the patient's fingers so that it is
comfortable for everyday activities. Mobile Finger Communication Board Design
based on five planes of user experience. The tests performed are functional testing,
control testing, device testing and non-functional testing or usability testing. The
results of the implementation and testing show that the application usability level in
the three devices viewed from the perspective of perception and ergonomics are at
satisfaction levels (devices 1 and 2) and very satisfaction (device 3) so that it can be
73,6 75
81,4
65
70
75
80
85
Device 1 Device 2 Device 3
User Satisfaction (%)
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said that the developed system gives satisfaction results to the users. For further
research to make this application more developed features and tested again using
some parameters of other users satisfaction to more respondents and use a more
varied device sizes for more optimal results.This research proposes a stroke patient
communication media by applying Mobile Finger Communication Board technology
with user center design (UCD) approach. This communication board is operated using
the patient's fingers so that it is comfortable for everyday activities. Mobile Finger
Communication Board Design based on five planes of user experience. The tests
performed are functional testing, control testing, device testing and non-functional
testing or usability testing. The results of the implementation and testing show that the
application usability level in the three devices viewed from the perspective of
perception and ergonomics are at satisfaction levels (devices 1 and 2) and very
satisfaction (device 3) so that it can be said that the developed system gives
satisfaction results to the users. For further research to make this application more
developed features and tested again using some parameters of other users satisfaction
to more respondents and use a more varied device sizes for more optimal results.
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8 Authors
Aan Jelli Priana is a master student of the Faculty of Computer Science Brawija-
ya University, Malang, which takes the multimedia, games, and mobile.
Herman Tolle is a lecturer at the Faculty of Computer Science Brawijaya
University, Malang for the field of the multimedia, games, and mobile.
Ismiarta Aknuranda is a lecturer at the Faculty of Computer Science Brawijaya
University, Malang for the field of the information systems.
Eko Arisetijono is a specialist neurologist and lecturer at the Faculty of Medicine
Brawijaya University Malang, East Java, Indonesia.
Article submitted 05 November 2017. Final acceptance 21 January 2018. Final version published as
submitted by the authors.
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