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In
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t
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ti
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m
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se
d
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(G
BL)
a
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ro
ss
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P
o
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e
se
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ig
h
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e
d
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c
a
ti
o
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ti
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n
s.
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to
tal
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f
2
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st
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ts
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o
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p
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ire
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ss
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g
a
tt
it
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rd
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rn
i
n
g
c
o
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ts
a
n
d
c
o
m
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ten
c
y
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e
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m
e
n
t.
Re
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e
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ll
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ti
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e
m
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a
l
lea
rn
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g
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s
v
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rsa
l
c
o
m
p
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ies
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su
c
h
a
s
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m
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c
o
m
m
u
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ic
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ti
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n
,
a
n
d
e
m
p
a
th
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tl
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ize
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a
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rc
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d
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in
c
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se
d
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li
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x
p
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s
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.
F
e
m
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n
d
th
o
se
with
p
r
io
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sti
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g
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a
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t
th
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i
n
stit
u
ti
o
n
a
l
a
n
d
p
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d
a
g
o
g
ica
l
lev
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ls.
T
h
e
se
in
si
g
h
ts
p
o
in
t
to
a
g
a
p
b
e
twe
e
n
st
u
d
e
n
ts’
e
n
th
u
si
a
sm
a
n
d
c
u
rre
n
t
e
d
u
c
a
ti
o
n
a
l
p
ra
c
ti
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e
s,
u
n
d
e
rl
in
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n
g
t
h
e
imp
o
rtan
c
e
o
f
stru
c
tu
re
d
g
u
i
d
a
n
c
e
fo
r
in
teg
ra
t
in
g
G
BL
e
ffe
c
ti
v
e
ly
.
Bu
i
ld
i
n
g
o
n
th
e
se
fin
d
in
g
s,
th
e
st
u
d
e
n
t
-
p
e
rc
e
iv
e
d
i
n
te
g
ra
ti
o
n
fo
r
n
o
v
e
l
e
d
u
c
a
ti
o
n
(S
P
INE
)
fra
m
e
wo
rk
is
p
r
o
p
o
se
d
a
s
a
d
e
c
isio
n
-
m
a
k
in
g
m
o
d
e
l
to
g
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id
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p
e
d
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g
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g
ica
ll
y
g
r
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u
n
d
e
d
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BL
in
p
h
y
sio
th
e
ra
p
y
c
u
rricu
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e
m
p
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a
siz
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v
i
d
e
n
c
e
-
in
f
o
rm
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d
,
c
o
n
tex
t
-
se
n
sit
iv
e
,
a
n
d
s
u
sta
in
a
b
le
imp
lem
e
n
tatio
n
.
K
ey
w
o
r
d
s
:
Gam
e
-
b
ased
lear
n
in
g
Ph
y
s
ical
th
er
ap
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ed
u
ca
tio
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Pro
f
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io
n
al
co
m
p
eten
ce
Stu
d
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t p
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p
tio
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Un
d
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r
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d
u
ate
s
tu
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T
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is i
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CC B
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se
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C
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A
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:
Ma
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Sch
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Hea
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L
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Po
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m
ar
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r
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p
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1.
I
NT
RO
D
UCT
I
O
N
E
d
u
c
ati
o
n
a
l
i
n
n
o
v
a
ti
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h
as
b
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co
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ess
en
tial
f
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r
h
ig
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ed
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c
atio
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to
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ap
t
to
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a
p
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a
n
s
f
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y
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t
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n
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o
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te
m
p
o
r
a
r
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s
o
cia
l
d
e
m
a
n
d
s
[
1
]
,
[
2
]
.
T
h
is
s
h
if
t
r
e
p
r
es
en
ts
a
p
ar
a
d
i
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m
c
h
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,
m
o
v
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awa
y
f
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o
m
t
r
a
d
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ti
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tio
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els
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wh
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r
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o
f
te
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p
ass
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a
n
d
lim
it
s
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m
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n
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am
ic
,
s
tu
d
en
t
-
ce
n
ter
ed
ap
p
r
o
ac
h
es
[
3
]
.
Ac
ti
v
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le
ar
n
i
n
g
s
tr
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,
i
n
clu
d
in
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team
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b
ased
lea
r
n
in
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d
th
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f
lip
p
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class
r
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m
,
h
av
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b
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en
wid
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p
ted
to
f
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d
er
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n
itiv
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p
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s
s
es su
ch
as r
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,
an
aly
s
is
,
s
y
n
th
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,
an
d
ev
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tio
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,
en
h
a
n
cin
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ac
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p
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m
an
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d
p
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b
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s
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lv
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k
ills
[
4
]
,
[
5
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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lva
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r
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W
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ter
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in
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a
n
d
m
o
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m
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[
3
]
,
[
6
]
.
Alth
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h
GB
L
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if
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to
th
e
ap
p
licatio
n
o
f
is
o
l
ated
g
am
e
d
esig
n
elem
en
ts
—
s
u
ch
as
p
o
in
ts
,
lev
els,
o
r
b
ad
g
es
—
with
in
n
o
n
-
g
a
m
e
co
n
tex
ts
to
en
h
an
ce
en
g
ag
em
en
t
an
d
m
o
tiv
atio
n
[
7
]
.
B
o
th
a
p
p
r
o
ac
h
es
h
av
e
d
e
m
o
n
s
tr
ated
th
e
im
p
r
o
v
em
en
t
o
f
s
tu
d
en
ts
’
in
tr
i
n
s
ic
m
o
tiv
atio
n
,
en
g
ag
em
e
n
t,
an
d
s
atis
f
ac
tio
n
.
T
h
ese
ap
p
r
o
ac
h
es
ar
e
p
a
r
ticu
lar
ly
r
elev
an
t
i
n
h
ea
lth
ed
u
ca
tio
n
,
wh
er
e
i
n
teg
r
atin
g
tech
n
ical
k
n
o
wled
g
e
with
tr
a
n
s
v
er
s
al
an
d
s
o
cio
e
m
o
tio
n
al
c
o
m
p
ete
n
cies
is
ess
en
tial
f
o
r
p
r
ep
a
r
in
g
c
o
m
p
eten
t
an
d
r
ef
lectiv
e
p
r
o
f
ess
io
n
als
[
8
]
,
[
9
]
.
I
n
p
h
y
s
io
th
er
a
p
y
ed
u
ca
tio
n
,
s
tu
d
en
ts
ar
e
ex
p
ec
ted
t
o
d
ev
e
lo
p
b
o
th
tech
n
ical
co
m
p
eten
cies,
s
u
ch
as
ass
ess
m
en
t,
d
iag
n
o
s
is
,
an
d
tr
ea
tm
en
t
p
lan
n
in
g
,
a
n
d
tr
an
s
v
e
r
s
al
co
m
p
eten
cies,
in
clu
d
in
g
team
wo
r
k
,
c
o
m
m
u
n
icatio
n
,
e
m
p
ath
y
,
lead
er
s
h
ip
,
an
d
d
ec
is
i
o
n
-
m
ak
i
n
g
,
wh
ich
a
r
e
cr
u
cial
f
o
r
p
atien
t
-
ce
n
ter
e
d
ca
r
e
an
d
in
ter
p
r
o
f
ess
io
n
al
co
llab
o
r
atio
n
[
1
0
]
.
E
v
id
e
n
ce
s
u
g
g
ests
th
at
co
o
p
er
ativ
e
a
n
d
g
am
if
ied
lea
r
n
in
g
s
tr
ateg
ies
en
h
an
ce
th
ese
s
k
ills
b
y
en
g
a
g
in
g
s
tu
d
e
n
ts
in
ac
tiv
e,
p
ar
ticip
ato
r
y
ed
u
ca
tio
n
a
l
ex
p
er
ien
ce
s
[
1
1
]
.
Fo
r
in
s
tan
ce
,
co
o
p
er
ativ
e
l
ea
r
n
in
g
h
as
b
ee
n
ass
o
ciate
d
with
im
p
r
o
v
ed
lea
d
er
s
h
i
p
,
m
o
tiv
atio
n
,
an
d
o
r
g
an
izatio
n
al
ab
ilit
ies,
wh
il
e
s
o
cio
-
em
o
ti
o
n
al
c
o
m
p
eten
c
ies
s
u
ch
as
em
p
ath
y
an
d
as
s
er
tiv
en
ess
ca
n
b
e
in
f
lu
en
ce
d
b
y
f
ac
to
r
s
lik
e
g
en
d
er
a
n
d
p
r
io
r
p
r
o
f
ess
io
n
al
ex
p
er
ie
n
ce
[
1
2
]
,
[
1
3
]
.
B
y
e
m
b
ed
d
in
g
g
a
m
if
ied
elem
en
ts
an
d
in
ter
ac
tiv
e
lear
n
in
g
ac
tiv
ities
,
p
h
y
s
io
th
e
r
ap
y
p
r
o
g
r
am
s
ca
n
cr
ea
te
a
u
th
en
tic
c
lin
ical
s
ce
n
ar
io
s
in
wh
ich
s
tu
d
en
ts
ap
p
ly
th
eo
r
et
ical
k
n
o
wled
g
e,
p
r
ac
tice
p
r
o
b
lem
-
s
o
lv
in
g
,
an
d
r
ec
eiv
e
i
m
m
ed
iate
f
ee
d
b
ac
k
,
r
ein
f
o
r
cin
g
b
o
th
t
ec
h
n
ical
a
n
d
tr
an
s
v
er
s
al
co
m
p
eten
cies
[
1
4
]
.
Alth
o
u
g
h
r
esear
c
h
h
as
d
em
o
n
s
tr
ated
th
e
b
en
ef
its
o
f
GB
L
in
m
ed
ical
an
d
n
u
r
s
in
g
ed
u
ca
tio
n
[
4
]
,
[
1
4
]
,
s
tu
d
ies
ex
am
in
in
g
its
ap
p
licatio
n
in
p
h
y
s
io
th
er
ap
y
r
em
ai
n
li
m
ited
,
p
ar
ticu
la
r
ly
in
Po
r
tu
g
al
.
Mo
r
eo
v
er
,
th
er
e
is
a
lack
o
f
e
v
id
en
ce
r
eg
ar
d
i
n
g
h
o
w
p
h
y
s
io
th
er
ap
y
s
tu
d
en
ts
p
er
ce
iv
e
th
e
u
tili
ty
o
f
GB
L
f
o
r
d
ev
el
o
p
in
g
b
o
th
tr
an
s
v
er
s
al
an
d
tech
n
ical
co
m
p
eten
cies
ac
r
o
s
s
d
if
f
er
en
t
ac
a
d
em
ic
s
tag
es.
Un
d
er
s
tan
d
in
g
t
h
ese
p
er
ce
p
tio
n
s
is
cr
itical,
as
lear
n
er
en
g
ag
em
e
n
t
an
d
ac
ce
p
tan
ce
ar
e
k
ey
d
eter
m
in
an
ts
o
f
s
u
cc
ess
f
u
l
im
p
lem
en
tatio
n
a
n
d
cu
r
r
icu
lu
m
d
esig
n
[
4
]
,
[
1
5
]
.
T
h
e
p
r
esen
t
m
u
lticen
ter
s
tu
d
y
ad
d
r
ess
es
th
is
g
ap
b
y
e
x
am
in
in
g
Po
r
tu
g
u
ese
p
h
y
s
io
th
er
ap
y
s
tu
d
en
ts
’
p
er
ce
p
tio
n
s
o
f
GB
L
,
with
p
ar
ticu
lar
em
p
h
asis
o
n
its
co
n
tr
ib
u
tio
n
to
tr
an
s
v
e
r
s
al
an
d
tech
n
ical
co
m
p
eten
cies.
Ad
d
itio
n
ally
,
th
e
s
tu
d
y
e
x
p
lo
r
es
p
o
ten
tial
v
ar
iatio
n
s
in
th
ese
p
er
ce
p
tio
n
s
ac
co
r
d
i
n
g
to
ac
ad
em
ic
y
ea
r
,
g
en
d
e
r
,
an
d
p
r
io
r
h
ea
lth
-
r
elate
d
e
x
p
er
i
en
ce
.
B
y
s
y
s
tem
atica
lly
i
n
v
esti
g
atin
g
s
tu
d
e
n
ts
’
p
er
s
p
ec
tiv
es,
th
is
r
esear
ch
aim
s
to
g
en
e
r
ate
em
p
ir
ical
ev
id
e
n
ce
to
s
u
p
p
o
r
t
th
e
d
ev
elo
p
m
en
t
o
f
a
co
n
ce
p
tu
al
m
o
d
el
f
o
r
i
n
teg
r
atin
g
g
am
i
f
ied
a
n
d
in
ter
ac
tiv
e
lear
n
in
g
s
tr
ateg
ies in
p
h
y
s
io
th
e
r
ap
y
e
d
u
ca
tio
n
.
2.
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n
T
h
is
was
a
cr
o
s
s
-
s
ec
tio
n
al
d
escr
ip
tiv
e
s
tu
d
y
d
esig
n
ed
t
o
in
v
esti
g
ate
p
h
y
s
io
th
er
a
p
y
s
tu
d
en
ts
’
p
er
s
p
ec
tiv
es
o
n
th
e
u
s
e
o
f
g
am
es
in
p
h
y
s
io
th
er
ap
y
c
u
r
r
icu
la.
Par
ticip
an
ts
wer
e
u
n
d
er
g
r
ad
u
a
te
s
tu
d
en
ts
en
r
o
lled
in
th
e
1
s
t
to
4
th
y
ea
r
s
o
f
p
h
y
s
io
th
er
ap
y
p
r
o
g
r
am
s
ac
r
o
s
s
s
ix
h
ig
h
er
ed
u
ca
tio
n
in
s
titu
tio
n
s
in
Po
r
tu
g
al.
Data
wer
e
co
llected
th
r
o
u
g
h
a
s
in
g
le
s
elf
-
ad
m
in
is
ter
ed
o
n
lin
e
q
u
esti
o
n
n
air
e
th
at
e
x
p
lo
r
e
d
s
tu
d
en
ts
’
p
er
ce
p
tio
n
s
o
f
th
e
ap
p
licatio
n
o
f
g
am
es
f
o
r
teac
h
in
g
–
lear
n
in
g
p
u
r
p
o
s
es,
as
well
as
th
eir
p
o
ten
tial
co
n
tr
ib
u
tio
n
to
th
e
d
ev
elo
p
m
en
t
o
f
b
o
th
tr
a
n
s
v
er
s
al
an
d
tec
h
n
ical
co
m
p
eten
cies
in
p
h
y
s
io
t
h
er
ap
y
tr
ain
in
g
.
T
h
e
q
u
esti
o
n
n
air
e
also
g
ath
e
r
ed
d
em
o
g
r
a
p
h
ic,
e
d
u
ca
tio
n
al,
an
d
o
cc
u
p
atio
n
al
b
ac
k
g
r
o
u
n
d
in
f
o
r
m
atio
n
to
ex
a
m
in
e
p
o
s
s
ib
le
ass
o
ciatio
n
s
with
s
tu
d
en
ts
’
p
er
ce
p
tio
n
s
.
T
h
e
s
tu
d
y
was
d
esig
n
ed
an
d
r
ep
o
r
ted
in
ac
co
r
d
an
ce
with
th
e
s
tr
en
g
t
h
en
in
g
th
e
r
ep
o
r
tin
g
o
f
o
b
s
er
v
atio
n
al
s
tu
d
ies
in
e
p
id
em
io
lo
g
y
(
STROB
E
)
g
u
id
elin
es
f
o
r
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
ies,
ad
ap
ted
to
th
e
co
n
tex
t
o
f
o
n
lin
e
q
u
esti
o
n
n
ai
r
e
-
b
ased
r
esear
c
h
.
Par
ticip
ati
o
n
was
v
o
l
u
n
tar
y
an
d
an
o
n
y
m
o
u
s
,
an
d
in
f
o
r
m
ed
co
n
s
en
t w
as o
b
tain
ed
elec
tr
o
n
ically
p
r
io
r
to
d
ata
co
llectio
n
.
2
.
2
.
P
a
rt
icipa
nts a
nd
re
cr
uitm
ent
Par
ticip
an
ts
wer
e
u
n
d
er
g
r
ad
u
a
te
p
h
y
s
io
th
e
r
ap
y
s
tu
d
en
ts
(
N=
2
0
8
)
r
ec
r
u
ited
f
r
o
m
s
ix
h
i
g
h
er
ed
u
ca
tio
n
in
s
titu
tio
n
s
ac
r
o
s
s
Po
r
tu
g
al.
B
etwe
en
Ma
r
ch
an
d
Ma
y
2
0
2
5
,
f
o
r
m
al
in
v
itatio
n
s
to
p
a
r
ticip
ate
wer
e
s
en
t
to
th
e
co
u
r
s
e
co
o
r
d
in
ato
r
s
o
f
eig
h
t
p
h
y
s
io
th
er
ap
y
p
r
o
g
r
am
s
,
wh
o
s
u
b
s
eq
u
en
tly
d
is
s
em
in
ated
th
e
in
v
itatio
n
in
ter
n
ally
to
th
eir
s
tu
d
en
ts
.
Six
in
s
ti
tu
tio
n
s
r
esp
o
n
d
e
d
p
o
s
itiv
ely
an
d
wer
e
in
clu
d
ed
in
th
e
s
tu
d
y
,
r
e
p
r
esen
tin
g
a
m
i
x
o
f
p
u
b
lic
an
d
p
r
iv
ate
h
ig
h
er
e
d
u
ca
tio
n
in
s
titu
tio
n
s
f
r
o
m
d
if
f
er
en
t
r
eg
io
n
s
o
f
th
e
c
o
u
n
t
r
y
.
E
lig
ib
ilit
y
cr
iter
ia
in
clu
d
ed
cu
r
r
en
t
en
r
o
lm
en
t
in
th
e
p
h
y
s
io
th
er
a
p
y
p
r
o
g
r
am
a
n
d
p
r
o
v
is
io
n
o
f
i
n
f
o
r
m
ed
co
n
s
en
t.
Stu
d
en
ts
wh
o
wer
e
n
o
t
ac
tiv
ely
en
r
o
lled
o
r
wh
o
d
ec
lin
e
d
p
a
r
ticip
atio
n
wer
e
e
x
clu
d
ed
.
All
p
ar
ticip
an
ts
co
m
p
leted
th
e
q
u
esti
o
n
n
air
e
o
n
ce
d
u
r
in
g
th
e
s
tu
d
y
p
er
io
d
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
2
2
I
n
t
J
E
v
al
&
R
es E
d
u
c
,
Vo
l
.
15
,
No
.
2
,
Ap
r
il
20
26
:
1
3
8
8
-
1
3
9
7
1390
2
.
3
.
M
ea
s
ures/
i
ns
t
rum
ent
s
Data
w
e
r
e
c
o
ll
e
c
t
e
d
t
h
r
o
u
g
h
a
s
t
r
u
c
t
u
r
e
d
q
u
e
s
t
i
o
n
n
a
i
r
e
s
p
e
c
i
f
ic
a
l
l
y
d
e
v
e
l
o
p
e
d
f
o
r
th
is
s
tu
d
y
,
co
n
s
is
tin
g
o
f
two
m
ain
p
ar
ts
.
T
h
e
f
ir
s
t
p
ar
t
ad
d
r
ess
ed
s
o
cio
d
em
o
g
r
ap
h
ic
an
d
e
d
u
ca
tio
n
al
c
h
ar
ac
ter
is
tics
(
6
item
s
)
,
in
clu
d
in
g
ag
e,
g
en
d
er
,
y
ea
r
o
f
s
tu
d
y
,
an
d
p
r
ev
io
u
s
ac
a
d
em
ic
o
r
h
ea
lth
-
r
elate
d
ex
p
er
ien
c
e.
T
h
e
s
ec
o
n
d
p
ar
t
ass
es
s
ed
s
tu
d
en
ts
’
p
er
ce
p
tio
n
s
r
eg
ar
d
in
g
th
e
u
s
e
o
f
g
am
e
s
(
GB
L
)
in
h
ig
h
e
r
ed
u
ca
tio
n
an
d
p
h
y
s
io
th
e
r
ap
y
p
r
ac
tice,
with
item
s
r
ated
o
n
a
7
-
p
o
in
t
L
ik
er
t
s
ca
le
(
1
=stro
n
g
l
y
d
is
ag
r
ee
to
7
=
s
tr
o
n
g
ly
a
g
r
ee
)
.
Per
ce
p
tio
n
item
s
wer
e
o
r
g
an
ized
i
n
to
th
r
ee
d
o
m
ain
s
:
i)
t
r
an
s
v
er
s
al
co
m
p
eten
cies
(
5
item
s
)
—
ca
p
tu
r
in
g
p
er
ce
iv
ed
im
p
ac
t
o
f
g
am
es
o
n
s
k
ills
s
u
ch
as
cr
iti
ca
l
th
in
k
in
g
,
co
m
m
u
n
icatio
n
,
team
wo
r
k
,
an
d
p
r
o
b
lem
-
s
o
lv
in
g
.
E
x
am
p
le
item
:
“
u
s
in
g
g
am
es
in
class
h
elp
s
m
e
d
ev
elo
p
m
y
p
r
o
b
lem
-
s
o
lv
i
n
g
s
k
ills
”;
ii)
t
ec
h
n
ical
co
m
p
eten
cies
(
5
item
s
)
—
ev
alu
atin
g
p
e
r
ce
iv
ed
u
s
ef
u
ln
ess
o
f
g
am
es
in
en
h
a
n
cin
g
d
is
cip
lin
e
-
s
p
ec
if
ic
k
n
o
wled
g
e
an
d
p
r
ac
tical
s
k
ills
r
elev
an
t
to
p
h
y
s
io
th
e
r
ap
y
.
E
x
am
p
le
item
:
“
g
am
es
h
el
p
m
e
b
etter
u
n
d
er
s
tan
d
p
h
y
s
i
o
th
er
a
p
y
tech
n
i
q
u
es”
;
an
d
iii)
p
r
o
f
ess
io
n
al
ap
p
licatio
n
c
o
n
tex
ts
(
1
8
item
s
)
—
ass
es
s
in
g
th
e
p
er
ce
i
v
ed
a
p
p
r
o
p
r
iaten
es
s
o
f
u
s
in
g
g
am
es
in
v
ar
io
u
s
p
h
y
s
io
th
er
ap
y
-
r
elate
d
s
ettin
g
s
,
in
clu
d
in
g
ca
s
e
d
is
cu
s
s
io
n
,
g
r
o
u
p
p
r
o
jects,
team
m
an
ag
em
en
t,
p
r
iv
ate
an
d
p
u
b
lic
p
r
ac
tice,
an
d
s
p
ec
if
ic
clin
ical
ar
e
as
s
u
c
h
as
n
eu
r
o
lo
g
y
,
p
ain
m
an
ag
e
m
e
n
t,
m
u
s
cu
l
o
s
k
eleta
l
r
eh
ab
ilit
atio
n
,
s
p
o
r
ts
,
p
alliativ
e
ca
r
e,
m
e
n
tal
h
ea
lth
,
an
d
h
ea
lth
ed
u
ca
tio
n
.
E
x
am
p
le
ite
m
:
“
u
s
in
g
g
am
es
is
r
elev
an
t f
o
r
d
esig
n
in
g
in
ter
v
e
n
tio
n
s
in
ad
u
lt
n
eu
r
o
lo
g
y
.
”
T
h
e
q
u
esti
o
n
n
ai
r
e
was
d
ev
el
o
p
ed
b
ased
o
n
co
n
s
u
ltatio
n
s
with
f
o
u
r
ex
p
er
ts
:
two
p
h
y
s
io
th
er
ap
y
ed
u
ca
to
r
s
an
d
two
s
p
ec
ialis
ts
in
GB
L
.
T
h
eir
in
p
u
t
g
u
id
ed
t
h
e
f
o
r
m
u
latio
n
an
d
r
ef
in
e
m
en
t
o
f
item
s
to
en
s
u
r
e
r
elev
an
ce
,
clar
ity
,
an
d
co
m
p
r
e
h
en
s
iv
e
co
v
e
r
ag
e
o
f
th
e
d
o
m
a
in
s
,
m
ak
in
g
t
h
e
in
s
tr
u
m
e
n
t
s
u
i
tab
le
f
o
r
t
h
e
tar
g
et
p
o
p
u
latio
n
.
T
h
e
in
s
tr
u
m
en
t
w
as
r
ev
iewe
d
b
y
f
o
u
r
ex
p
er
ts
in
lear
n
in
g
in
n
o
v
ativ
e
co
n
tex
t
s
,
wh
o
r
ea
ch
ed
f
u
ll
ag
r
ee
m
en
t
r
eg
ar
d
in
g
t
h
e
clar
it
y
,
co
h
er
en
ce
,
an
d
r
elev
a
n
ce
o
f
all
item
s
,
en
s
u
r
in
g
s
tr
o
n
g
co
n
t
en
t
v
a
lid
ity
.
A
p
ilo
t
test
was
co
n
d
u
cted
to
v
er
if
y
t
h
e
in
ter
n
al
co
n
s
is
ten
cy
o
f
th
e
s
ca
le.
T
h
e
in
ter
n
al
co
n
s
is
ten
cy
was
f
o
u
n
d
to
b
e
ac
ce
p
tab
le
(
C
r
o
n
b
ac
h
’
s
α
=0
.
7
3
o
v
er
all)
,
in
d
icatin
g
s
atis
f
ac
to
r
y
r
eliab
ilit
y
f
o
r
r
esear
c
h
p
u
r
p
o
s
es.
Fu
r
th
er
an
aly
s
is
d
em
o
n
s
tr
ated
ex
ce
lle
n
t
in
ter
n
al
co
n
s
is
ten
cy
ac
r
o
s
s
d
o
m
ain
s
,
with
C
r
o
n
b
ac
h
’
s
α
v
alu
es
o
f
0
.
9
4
f
o
r
tr
an
s
v
er
s
al
co
m
p
ete
n
cies,
0
.
9
5
f
o
r
tech
n
ical
co
m
p
eten
cies
,
an
d
0
.
9
7
f
o
r
p
r
o
f
ess
io
n
al
ap
p
licatio
n
co
n
tex
ts
,
in
d
icatin
g
s
tr
o
n
g
r
eliab
ilit
y
f
o
r
r
esear
ch
p
u
r
p
o
s
es.
2.
4
.
P
r
o
ce
du
re
/
d
a
t
a
co
llect
i
o
n
T
h
e
q
u
esti
o
n
n
ai
r
e
w
as
a
d
m
i
n
is
te
r
e
d
b
etw
ee
n
M
ar
c
h
a
n
d
Ma
y
2
0
2
5
.
C
o
u
r
s
e
c
o
o
r
d
i
n
at
o
r
s
f
r
o
m
th
e
p
a
r
ti
ci
p
at
in
g
i
n
s
ti
t
u
ti
o
n
s
w
e
r
e
co
n
t
ac
t
ed
an
d
i
n
v
it
ed
t
o
d
is
s
e
m
i
n
at
e
th
e
s
t
u
d
y
.
Af
te
r
a
g
r
ee
i
n
g
to
co
lla
b
o
r
at
e,
t
h
e
y
in
t
r
o
d
u
ce
d
th
e
p
r
o
je
ct
t
o
t
h
ei
r
s
tu
d
e
n
ts
d
u
r
i
n
g
class
es
a
n
d
c
ir
c
u
la
te
d
th
e
q
u
es
ti
o
n
n
ai
r
e
li
n
k
v
i
a
i
n
s
t
it
u
ti
o
n
al
e
m
a
il
lis
ts
.
S
tu
d
en
ts
we
r
e
ab
le
t
o
c
o
m
p
let
e
t
h
e
q
u
esti
o
n
n
ai
r
e
ele
ct
r
o
n
i
ca
ll
y
v
i
a
t
h
e
l
in
k
p
r
o
v
i
d
e
d
.
Pa
r
ti
ci
p
at
io
n
w
as
v
o
l
u
n
ta
r
y
,
r
es
p
o
n
s
es
w
er
e
a
n
o
n
y
m
o
u
s
,
an
d
in
f
o
r
m
ed
c
o
n
s
e
n
t
was
o
b
tai
n
ed
b
ef
o
r
e
c
o
m
p
l
eti
n
g
t
h
e
q
u
es
ti
o
n
n
ai
r
e
.
2.
5
.
Da
t
a
a
na
ly
s
is
Descr
ip
tiv
e
s
tatis
tic
s
(
m
ea
n
s
,
s
tan
d
ar
d
d
ev
iatio
n
s
,
an
d
f
r
e
q
u
en
cies)
wer
e
u
s
ed
to
c
h
ar
a
cter
ize
th
e
s
am
p
le.
Gr
o
u
p
co
m
p
ar
is
o
n
s
ac
r
o
s
s
y
ea
r
s
o
f
s
tu
d
y
wer
e
co
n
d
u
cted
u
s
in
g
th
e
Kr
u
s
k
al
–
W
al
lis
te
s
t.
Dif
f
er
en
ce
s
b
etwe
en
two
g
r
o
u
p
s
(
g
e
n
d
er
,
p
r
ev
io
u
s
co
u
r
s
e
atten
d
a
n
ce
,
h
ea
lth
-
r
elate
d
ex
p
er
ien
ce
)
we
r
e
ex
am
in
ed
u
s
in
g
Ma
n
n
–
W
h
itn
ey
U
test
s
.
C
o
r
r
elatio
n
s
b
etwe
en
ag
e
an
d
p
er
ce
p
tio
n
s
wer
e
an
aly
ze
d
u
s
in
g
Sp
ea
r
m
an
’
s
r
h
o
.
B
o
n
f
er
r
o
n
i c
o
r
r
ec
tio
n
s
wer
e
ap
p
lied
f
o
r
m
u
ltip
le
co
m
p
ar
is
o
n
s
in
p
o
s
t h
o
c
an
aly
s
es to
co
n
t
r
o
l f
o
r
T
y
p
e
I
e
r
r
o
r
.
All
r
ep
o
r
ted
p
-
v
alu
es
r
ef
lect
B
o
n
f
er
r
o
n
i
-
ad
ju
s
ted
s
ig
n
if
ica
n
ce
.
All
an
aly
s
es
wer
e
co
n
d
u
ct
ed
u
s
in
g
I
B
M
SP
SS
Statis
t
ics,
v
er
s
io
n
2
7
.
0
(
I
B
M
C
o
r
p
.
,
Ar
m
o
n
k
,
NY)
,
with
th
e
s
ig
n
if
ican
ce
lev
el
s
et
at
p
<0
.
0
5
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
A
to
tal
o
f
2
0
8
p
h
y
s
io
th
e
r
ap
y
s
tu
d
en
ts
wer
e
r
ec
r
u
ited
f
r
o
m
s
ix
d
if
f
er
en
t
in
s
titu
tio
n
s
ac
r
o
s
s
Po
r
tu
g
al.
T
h
e
s
am
p
le
in
clu
d
ed
2
5
s
tu
d
e
n
ts
f
r
o
m
L
eir
ia,
p
r
e
d
o
m
in
a
n
tly
in
th
e
th
ir
d
y
ea
r
(
n
=1
7
)
; 6
s
tu
d
en
ts
f
r
o
m
L
is
b
o
n
,
d
is
tr
ib
u
ted
ac
r
o
s
s
th
e
th
ir
d
an
d
f
o
u
r
th
y
e
ar
s
;
5
2
s
tu
d
e
n
ts
f
r
o
m
Gaia
,
with
3
0
in
th
e
s
ec
o
n
d
y
ea
r
an
d
2
2
in
t
h
e
f
o
u
r
th
y
ea
r
;
s
tu
d
en
ts
f
r
o
m
Po
r
to
(
n
=
43)
,
m
o
s
tly
i
n
th
e
f
o
u
r
th
y
ea
r
;
s
tu
d
en
ts
f
r
o
m
B
r
ag
a
n
ça
(
n
=
36
)
,
ev
e
n
ly
d
is
tr
ib
u
ted
ac
r
o
s
s
th
e
f
i
r
s
t,
s
ec
o
n
d
,
a
n
d
th
i
r
d
y
e
ar
s
;
an
d
s
tu
d
en
ts
f
r
o
m
Alg
ar
v
e
(
n
=
4
6
)
,
p
r
ed
o
m
in
a
n
tly
in
th
e
f
ir
s
t
y
ea
r
.
T
h
e
s
am
p
le
i
n
clu
d
ed
s
tu
d
en
ts
f
r
o
m
all
f
o
u
r
y
ea
r
s
o
f
th
e
c
o
u
r
s
e
(
1
s
t
y
ea
r
:
n
=5
8
;
2
n
d
y
ea
r
:
n
=5
2
;
3
r
d
y
ea
r
:
n
=4
4
;
4
th
y
ea
r
:
n
=5
4
)
.
T
h
e
m
ea
n
ag
e
i
n
cr
ea
s
ed
p
r
o
g
r
ess
iv
ely
ac
r
o
s
s
y
ea
r
s
,
r
an
g
in
g
f
r
o
m
1
9
.
1
7
y
ea
r
s
(
SD=3
.
5
9
)
in
th
e
1
s
t
y
ea
r
t
o
2
3
.
4
1
y
ea
r
s
(
SD=3
.
2
9
)
in
th
e
4
t
h
y
ea
r
.
Ge
n
d
er
d
is
tr
ib
u
tio
n
wa
s
u
n
b
alan
ce
d
,
with
a
p
r
ed
o
m
in
an
ce
o
f
f
e
m
ale
s
tu
d
en
ts
in
all
y
ea
r
s
.
T
h
e
p
r
o
p
o
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a
g
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g
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n
d
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mal
e
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f
e
ma
l
e
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o
t
h
e
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c
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r
ses
–
n
o
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y
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s
;
p
r
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v
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s
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x
p
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t
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s
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n
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y
e
s
3
.
1
.
G
B
L
in
ph
y
s
io
t
hera
py
educ
a
t
io
n:
v
a
lued by
s
t
ud
ent
s
bu
t
un
derut
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d in c
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Stu
d
en
ts
ex
p
r
ess
ed
g
en
er
ally
p
o
s
itiv
e
v
iews r
eg
ar
d
in
g
th
e
i
n
teg
r
atio
n
o
f
g
am
es in
to
h
ig
h
e
r
ed
u
ca
tio
n
an
d
p
h
y
s
io
th
er
ap
y
tr
ain
in
g
.
T
h
eir
r
esp
o
n
s
es
in
d
icate
d
n
e
u
tr
al
to
m
o
d
er
ately
p
o
s
itiv
e
attitu
d
es
to
war
d
th
e
p
ed
ag
o
g
ical
u
s
e
o
f
g
am
es,
with
m
ea
n
s
co
r
es
r
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g
in
g
b
e
twee
n
3
.
2
4
an
d
5
.
6
1
o
n
a
7
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p
o
in
t
L
ik
er
t
s
ca
le.
T
h
e
h
i
g
h
est
lev
els
o
f
a
g
r
ee
m
en
t
wer
e
o
b
s
er
v
e
d
f
o
r
th
e
n
ee
d
to
in
cr
ea
s
e
o
p
p
o
r
tu
n
ities
to
u
s
e
g
am
es
in
b
o
t
h
th
eo
r
etica
l
(
M=
5
.
3
2
,
SD=1
.
5
4
)
an
d
p
r
ac
tical
class
es
(
M
=5
.
3
7
,
SD=1
.
6
0
)
,
as
well
as
f
o
r
th
e
p
er
ce
iv
e
d
im
p
o
r
tan
ce
o
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g
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m
es
in
h
ea
lth
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r
elate
d
co
u
r
s
es
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5
.
0
9
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.
5
8
)
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d
with
in
th
e
p
h
y
s
io
th
er
ap
y
d
e
g
r
ee
(
M=
5
.
0
3
,
SD=1
.
6
1
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.
T
h
is
f
in
d
in
g
r
ef
lects
a
s
tr
o
n
g
awa
r
en
ess
am
o
n
g
s
tu
d
en
ts
o
f
th
e
p
o
ten
tial
o
f
g
am
es
to
en
h
an
ce
lear
n
in
g
en
g
ag
em
e
n
t,
m
o
tiv
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n
,
a
n
d
t
h
e
i
n
te
g
r
atio
n
o
f
b
o
th
c
o
g
n
itiv
e
an
d
p
r
ac
tical
s
k
ills
in
h
ea
lth
ca
r
e
co
n
te
x
ts
[
9
]
,
[
1
6
]
,
[
1
7
]
.
Fro
m
a
p
ed
a
g
o
g
ical
p
er
s
p
ec
tiv
e,
th
e
p
r
ef
e
r
en
ce
f
o
r
in
cr
e
ased
g
am
e
u
s
ag
e
in
b
o
th
t
h
eo
r
etica
l
a
n
d
p
r
ac
tical
s
ettin
g
s
u
n
d
e
r
s
co
r
es
s
tu
d
en
t
s
’
u
n
d
e
r
s
tan
d
in
g
th
at
GB
L
c
an
b
r
i
d
g
e
th
e
g
ap
b
etwe
en
ab
s
tr
ac
t k
n
o
wled
g
e
a
n
d
ap
p
lied
clin
ical
p
r
ac
tice.
Mo
r
eo
v
e
r
,
th
e
p
er
ce
iv
ed
im
p
o
r
ta
n
ce
o
f
GB
L
ac
r
o
s
s
b
o
th
t
h
eo
r
etica
l
a
n
d
p
r
ac
tical
co
m
p
o
n
en
ts
m
ay
r
ef
lect
s
tu
d
en
ts
’
ap
p
r
ec
iatio
n
f
o
r
a
h
o
l
is
tic
in
teg
r
atio
n
o
f
lear
n
in
g
m
o
d
alities
[
1
8
]
,
wh
e
r
e
in
ter
ac
tiv
e
an
d
p
ar
ticip
at
o
r
y
m
eth
o
d
s
co
m
p
lem
en
t
tr
ad
it
io
n
al
lectu
r
es
an
d
clin
ical
p
lace
m
en
ts
.
T
h
ese
r
esu
lts
alig
n
with
ev
id
en
ce
s
u
g
g
e
s
tin
g
th
at
th
e
m
ea
n
in
g
f
u
l
in
co
r
p
o
r
atio
n
o
f
g
a
m
es
in
to
cu
r
r
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la
ca
n
en
h
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ce
b
o
t
h
m
o
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n
an
d
s
elf
-
ef
f
icac
y
,
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d
in
g
to
im
p
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v
ed
en
g
a
g
em
en
t
an
d
k
n
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wled
g
e
r
eten
tio
n
in
h
ea
lth
p
r
o
f
ess
io
n
s
ed
u
ca
tio
n
[
1
6
]
,
[
1
7
]
,
[
1
9
]
.
C
o
n
v
er
s
ely
,
lo
wer
ag
r
ee
m
en
t
lev
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wer
e
r
ep
o
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ted
r
eg
ar
d
i
n
g
th
e
ad
eq
u
ac
y
o
f
cu
r
r
en
t
g
am
e
u
s
e
in
teac
h
in
g
–
lear
n
i
n
g
c
o
n
tex
ts
(
M=
3
.
5
1
,
SD=1
.
7
3
)
,
s
u
g
g
esti
n
g
th
at
s
tu
d
en
ts
co
n
s
id
er
ex
is
tin
g
o
p
p
o
r
tu
n
ities
in
s
u
f
f
icien
t.
T
h
is
f
ee
d
b
ac
k
is
i
m
p
o
r
tan
t
as
it
m
ay
r
ef
lect
t
h
e
v
ar
io
u
s
lim
itatio
n
s
ass
o
ciate
d
with
th
e
r
elativ
ely
lim
ited
ad
o
p
tio
n
o
f
GB
L
s
tr
ateg
ies
in
p
h
y
s
io
th
er
a
p
y
e
d
u
ca
ti
o
n
,
s
u
ch
as
lim
ited
e
d
u
ca
to
r
t
r
ain
in
g
,
in
s
u
f
f
icien
t
r
eso
u
r
ce
s
,
lack
o
f
alig
n
m
en
t
with
cu
r
r
icu
lar
o
b
jectiv
es,
an
d
tim
e
co
n
s
tr
ain
ts
[
2
0
]
,
[
2
1
]
.
R
ec
o
g
n
izin
g
th
ese
co
n
s
tr
ain
ts
p
r
o
v
id
es
a
v
alu
ab
l
e
o
p
p
o
r
tu
n
ity
f
o
r
e
d
u
ca
to
r
s
a
n
d
c
u
r
r
icu
lu
m
d
esig
n
e
r
s
to
r
e
f
lect
o
n
h
o
w
f
u
tu
r
e
cu
r
r
icu
la
co
u
ld
b
etter
i
n
teg
r
at
e
GB
L
ap
p
r
o
ac
h
es
an
d
f
o
s
ter
p
r
ac
tices
th
at
s
u
p
p
o
r
t
th
e
s
y
s
tem
atic
ad
o
p
tio
n
o
f
th
ese
s
tr
ateg
ies,
u
ltima
tely
en
h
an
cin
g
b
o
th
s
tu
d
en
t
en
g
ag
e
m
en
t
an
d
lear
n
i
n
g
o
u
tc
o
m
es.
As
s
u
m
m
ar
ized
in
T
ab
le
2
,
th
ese
r
esu
lts
co
llectiv
ely
h
ig
h
lig
h
t
s
tu
d
en
ts
’
r
ec
o
g
n
i
tio
n
o
f
th
e
e
d
u
ca
tio
n
al
p
o
ten
ti
al
o
f
g
am
es,
d
esp
ite
lim
ited
im
p
lem
en
tatio
n
in
cu
r
r
en
t
cu
r
r
icu
la.
N
o
s
tatis
tic
ally
s
ig
n
if
ican
t
d
if
f
er
en
ce
s
wer
e
o
b
s
er
v
ed
b
etwe
en
ac
ad
em
ic
y
ea
r
s
f
o
r
an
y
o
f
t
h
e
item
s
(
all
p
>0
.
0
5
)
.
3
.
2
.
I
nte
g
ra
t
ing
G
B
L
in
ph
y
s
io
t
h
er
a
py
:
t
ra
ns
v
er
s
a
l
s
k
ills
a
cr
o
s
s
t
he
curr
ic
ulu
m
,
t
ec
hn
ica
l
s
k
ills
t
hro
ug
h
clinica
l e
x
perience
Stu
d
en
ts
co
n
s
is
ten
tly
p
er
ce
iv
ed
GB
L
as
a
v
alu
ab
le
ap
p
r
o
ac
h
f
o
r
d
ev
elo
p
in
g
b
o
th
tr
an
s
v
er
s
al
an
d
tech
n
ical
co
m
p
ete
n
cies
in
p
h
y
s
io
th
er
ap
y
ed
u
ca
tio
n
.
Me
an
s
co
r
es
ex
ce
ed
ed
5
o
n
a
7
-
p
o
i
n
t
s
ca
le
ac
r
o
s
s
all
ac
ad
em
ic
y
ea
r
s
,
in
d
icatin
g
g
e
n
er
ally
p
o
s
itiv
e
attitu
d
es
t
o
war
d
th
e
ed
u
ca
tio
n
al
v
al
u
e
o
f
g
a
m
es.
As
d
etailed
in
T
ab
le
3
,
s
tu
d
en
ts
r
e
p
o
r
ted
h
i
g
h
a
n
d
s
tab
le
r
ec
o
g
n
itio
n
o
f
t
r
an
s
v
er
s
al
co
m
p
eten
cies
s
u
ch
as
id
ea
g
en
er
atio
n
,
lead
er
s
h
ip
,
em
p
ath
y
,
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.
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4
7
5
.
6
6
±
1
.
3
6
5
.
0
7
±
1
.
5
6
5
.
3
3
±
1
.
5
7
0
.
0
4
4
*
10
Tr
a
i
n
s
k
i
l
l
s
i
n
se
t
t
i
n
g
p
h
y
s
i
o
t
h
e
r
a
p
y
g
o
a
l
s
4
.
8
7
±
1
.
5
5
6
.
0
4
±
1
.
3
9
5
.
7
0
±
1
.
4
2
5
.
1
3
±
1
.
6
5
5
.
2
4
±
1
.
5
8
0
.
0
2
3
*
11
Tr
a
i
n
p
l
a
n
n
i
n
g
a
n
d
t
r
e
a
t
me
n
t
sk
i
l
l
s
5
.
3
6
±
1
.
2
1
6
.
0
4
±
1
.
3
9
5
.
7
0
±
1
.
4
2
5
.
1
3
±
1
.
6
5
5
.
5
4
±
1
.
4
5
0
.
0
0
0
*
*
12
Tr
a
i
n
r
e
s
e
a
r
c
h
s
k
i
l
l
s
i
n
p
h
y
s
i
o
t
h
e
r
a
p
y
4
.
6
2
±
1
.
6
2
5
.
6
3
±
1
.
5
8
5
.
2
7
±
1
.
6
2
4
.
7
9
±
1
.
9
3
5
.
0
6
±
1
.
7
3
0
.
0
0
0
*
*
13
Tr
a
i
n
d
i
a
g
n
o
st
i
c
s
k
i
l
l
s
i
n
p
h
y
si
o
t
h
e
r
a
p
y
5
.
1
2
±
1
.
5
0
5
.
8
1
±
1
.
5
2
5
.
4
5
±
1
.
5
5
4
.
6
5
±
1
.
9
0
5
.
2
4
±
1
.
6
7
0
.
0
0
5
*
*
N
o
t
e
:
*
p
<
0
.
0
5
;
*
*
p
<
0
.
0
1
T
h
ese
p
atter
n
s
s
u
g
g
est
th
at
wh
ile
th
e
ed
u
ca
tio
n
al
v
alu
e
o
f
GB
L
f
o
r
tr
an
s
v
er
s
al
s
k
ills
is
u
n
iv
er
s
ally
ac
k
n
o
wled
g
e
d
,
tech
n
ical
c
o
m
p
eten
cies
ar
e
ap
p
r
ec
iated
d
if
f
er
en
tially
ac
r
o
s
s
th
e
cu
r
r
ic
u
lu
m
,
lik
ely
r
ef
lectin
g
s
tu
d
en
ts
’
s
tag
e
-
s
p
ec
if
ic
clin
ical
ex
p
o
s
u
r
e
an
d
co
m
p
eten
ce
d
e
v
elo
p
m
en
t.
Pre
v
io
u
s
q
u
asi
-
ex
p
er
im
en
tal
r
esear
ch
with
p
h
y
s
io
th
er
ap
y
s
tu
d
e
n
ts
in
Po
r
tu
g
al
h
as
s
im
ilar
ly
h
ig
h
lig
h
ted
th
e
r
elev
an
ce
o
f
GB
L
in
f
o
s
ter
in
g
tr
an
s
v
er
s
al
co
m
p
eten
cies
s
u
ch
as
co
m
m
u
n
icatio
n
,
c
o
llab
o
r
atio
n
,
an
d
m
o
tiv
atio
n
[
2
2
]
,
[
2
3
]
.
I
t
is
also
n
atu
r
al
th
at
th
e
p
er
ce
iv
ed
im
p
ac
t
o
f
GB
L
o
n
tech
n
ical
co
m
p
eten
cies
ev
o
lv
e
s
o
v
er
th
e
co
u
r
s
e
o
f
t
r
ain
in
g
,
a
s
s
tu
d
en
ts
en
co
u
n
te
r
d
if
f
er
en
t
s
tag
es
o
f
clin
ical
p
r
ac
tice.
Fo
r
ex
am
p
le,
p
lan
n
in
g
,
tr
ea
tm
en
t,
an
d
d
iag
n
o
s
tic
s
k
ill
s
wer
e
r
ated
h
ig
h
er
am
o
n
g
s
ec
o
n
d
-
a
n
d
th
ir
d
-
y
ea
r
s
tu
d
en
ts
,
c
o
r
r
esp
o
n
d
in
g
to
th
eir
in
itial
ex
p
o
s
u
r
e
to
p
r
ac
tica
l
clin
ical
s
ettin
g
s
in
Po
r
tu
g
u
ese
h
ig
h
e
r
ed
u
ca
tio
n
in
s
titu
tio
n
s
[
2
3
]
.
T
h
is
ea
r
ly
p
r
ac
tical
ex
p
er
ien
ce
m
ay
also
h
elp
ex
p
lain
wh
y
,
in
later
y
ea
r
s
,
s
tu
d
en
ts
p
er
ce
iv
e
a
g
r
o
win
g
n
ee
d
f
o
r
in
n
o
v
ati
v
e
ap
p
r
o
ac
h
es
s
u
ch
as
GB
L
,
a
s
th
ey
in
cr
ea
s
in
g
ly
r
ec
o
g
n
ize
a
lack
o
f
a
n
ev
id
e
n
ce
-
b
ased
p
r
ac
tice
cu
ltu
r
e
i
n
clin
ical
p
lace
m
en
ts
—
a
co
n
tr
ast
th
at
ca
n
f
o
s
ter
o
p
en
n
ess
to
n
o
v
el
lea
r
n
in
g
s
tr
ateg
ies
[
2
4
]
.
C
o
llectiv
ely
,
th
ese
f
in
d
in
g
s
in
d
icate
th
at
GB
L
m
a
y
s
er
v
e
as
a
f
lex
ib
le
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
J
E
v
al
&
R
es E
d
u
c
I
SS
N:
2252
-
8
8
2
2
P
h
ysio
th
era
p
y
ed
u
c
a
tio
n
a
n
d
g
a
me
-
b
a
s
ed
le
a
r
n
in
g
:
d
ev
elo
p
in
g
th
e
… (
Dia
n
a
F
ilip
a
S
a
lva
d
o
r
B
ern
a
r
d
o
)
1393
p
ed
ag
o
g
ical
to
o
l
.
S
tu
d
en
ts
c
o
n
s
is
ten
tly
v
alu
e
its
r
o
le
in
d
e
v
elo
p
in
g
tr
an
s
v
er
s
al
c
o
m
p
ete
n
cies
th
r
o
u
g
h
o
u
t
th
e
cu
r
r
icu
lu
m
,
wh
ile
its
im
p
ac
t
o
n
tech
n
ical
s
k
ills
ev
o
lv
es
in
al
ig
n
m
en
t
with
ex
p
er
ien
tial
lear
n
in
g
o
p
p
o
r
tu
n
ities
,
em
er
g
in
g
m
o
s
t
s
tr
o
n
g
ly
in
in
t
er
m
ed
iate
s
tag
es
(
e.
g
.
,
p
lan
n
i
n
g
an
d
tr
ea
tm
en
t
s
k
ills
)
an
d
c
o
n
s
o
lid
atin
g
in
later
y
ea
r
s
(
e.
g
.
,
d
iag
n
o
s
tic
an
d
r
es
ea
r
ch
s
k
ills
)
.
3
.
3
.
I
nd
iv
id
ua
l a
nd
educa
t
io
na
l f
a
ct
o
rs sh
a
pin
g
a
cc
ept
a
nce
o
f
G
B
L
in p
hy
s
io
t
hera
py
educ
a
t
io
n
An
aly
s
is
o
f
ass
o
ciatio
n
s
b
et
wee
n
s
tu
d
en
ts
’
c
h
ar
ac
ter
is
tics
an
d
th
eir
p
er
ce
p
tio
n
s
o
f
GB
L
r
ev
ea
led
s
ev
er
al
r
elev
an
t
p
atter
n
s
.
As
s
u
m
m
ar
ized
in
T
ab
le
4
,
n
o
s
ig
n
if
ican
t
co
r
r
elatio
n
s
wer
e
f
o
u
n
d
b
etwe
en
a
g
e
an
d
s
tu
d
en
ts
’
v
iews
o
n
th
e
ap
p
licatio
n
o
f
g
am
es
in
h
ig
h
e
r
ed
u
ca
ti
o
n
o
r
p
h
y
s
io
th
er
ap
y
tr
ain
in
g
,
e
ith
er
f
o
r
tr
an
s
v
er
s
al
o
r
tech
n
ical
co
m
p
eten
cies
(
a
ll
p
>0
.
0
5
)
.
Gen
d
er
-
r
elate
d
d
if
f
er
en
ce
s
wer
e
o
b
s
er
v
ed
,
with
f
em
ale
s
tu
d
en
ts
r
ep
o
r
tin
g
s
ig
n
if
ican
tly
h
ig
h
er
ag
r
ee
m
en
t
r
eg
ar
d
in
g
th
e
ea
r
ly
in
tr
o
d
u
ctio
n
o
f
g
am
es
in
p
h
y
s
io
th
er
ap
y
tr
ai
n
in
g
(
p
=0
.
0
2
6
)
an
d
g
r
ea
ter
p
er
ce
i
v
ed
b
e
n
ef
its
f
o
r
ass
ess
m
en
t
(
p
=0
.
0
2
7
)
,
clin
ical
in
ter
v
iew
(
p
=0
.
0
2
0
)
,
r
esear
ch
(
p
=0
.
0
1
4
)
,
a
n
d
d
iag
n
o
s
tic
s
k
ill
s
(
p
=0
.
0
4
4
)
.
Sp
ec
if
ically
,
th
e
s
tu
d
y
b
y
Pad
illa
-
Me
lén
d
ez
et
a
l
.
[
2
5
]
d
em
o
n
s
tr
ated
th
at
f
em
ale
s
tu
d
en
ts
’
attitu
d
e
s
to
war
d
p
lay
f
u
l
s
tr
ateg
ies
ar
e
in
d
ep
en
d
en
t
o
f
o
th
er
f
ac
t
o
r
s
,
wh
er
ea
s
in
m
ale
s
tu
d
en
ts
,
th
e
ef
f
ec
t
o
f
p
lay
f
u
l
n
ess
is
m
ed
iated
b
y
p
er
ce
iv
ed
u
s
ef
u
ln
ess
.
Ap
p
lied
to
o
u
r
co
n
tex
t,
th
is
s
u
g
g
ests
th
at
f
em
ale
p
h
y
s
io
th
e
r
a
p
y
s
tu
d
en
ts
m
ay
m
o
r
e
r
ea
d
ily
em
b
r
ac
e
GB
L
d
u
e
to
its
in
h
e
r
e
n
t
en
g
a
g
em
en
t
an
d
in
ter
ac
tiv
ity
,
wh
ile
m
ale
s
tu
d
en
ts
m
ay
r
eq
u
ir
e
a
clea
r
er
u
n
d
er
s
tan
d
in
g
o
f
th
e
p
ed
a
g
o
g
ical
v
alu
e
an
d
u
tili
ty
to
f
u
lly
ap
p
r
ec
iate
its
b
en
ef
its
.
T
h
er
ef
o
r
e
,
to
en
s
u
r
e
eq
u
itab
le
a
cc
ep
ta
n
ce
o
f
GB
L
am
o
n
g
b
o
t
h
m
ale
an
d
f
em
ale
s
tu
d
en
ts
,
it
is
im
p
o
r
tan
t
to
ex
p
licitly
co
m
m
u
n
icate
b
o
t
h
th
e
p
r
in
cip
les
an
d
th
e
p
r
ac
tical
r
elev
an
ce
o
f
th
ese
s
tr
ateg
ies with
in
p
h
y
s
io
th
er
ap
y
cu
r
r
ic
u
la.
Stu
d
en
ts
wh
o
h
a
d
p
r
e
v
io
u
s
ly
atten
d
ed
o
th
e
r
h
ig
h
er
e
d
u
ca
ti
o
n
p
r
o
g
r
a
m
s
wer
e
less
f
av
o
r
a
b
le
to
war
d
p
er
f
o
r
m
ativ
e
o
r
r
o
le
-
p
lay
g
am
es (
p
=0
.
0
2
5
)
an
d
m
o
r
e
lik
ely
t
o
co
n
s
id
er
cu
r
r
en
t g
a
m
e
u
s
e
s
u
f
f
icien
t (
p
=
0
.
0
0
5
)
,
co
m
p
ar
ed
with
th
o
s
e
with
o
u
t s
u
ch
ex
p
e
r
ien
ce
.
I
n
ter
e
s
tin
g
ly
,
r
esear
ch
in
o
th
e
r
ar
ea
s
o
f
GB
L
,
s
u
ch
as lan
g
u
a
g
e
ed
u
ca
tio
n
,
h
as sh
o
wn
th
at
m
ale
s
tu
d
en
ts
with
h
ig
h
er
p
r
io
r
k
n
o
wled
g
e
ten
d
to
ac
h
iev
e
b
etter
o
u
tco
m
es in
GB
L
in
ter
v
en
tio
n
s
[
2
6
]
,
[
2
7
]
.
Ho
wev
er
,
r
esis
tan
ce
am
o
n
g
p
h
y
s
io
th
er
ap
y
s
tu
d
en
ts
m
ay
r
ef
l
ec
t
th
e
cu
ltu
r
al
an
d
p
r
o
f
ess
io
n
al
co
n
te
x
t
o
f
h
ea
lth
ed
u
ca
tio
n
,
wh
e
r
e
th
e
d
eliv
e
r
y
o
f
ca
r
e
is
p
er
ce
iv
e
d
as
a
h
ig
h
ly
s
er
io
u
s
d
o
m
ain
.
Ou
r
f
in
d
in
g
s
m
ir
r
o
r
a
p
a
r
ad
o
x
alr
ea
d
y
d
escr
ib
e
d
in
o
th
er
s
tu
d
ies,
wh
er
e
p
lay
an
d
th
e
s
er
io
u
s
ac
t
o
f
lear
n
in
g
co
ex
is
t,
y
et
th
eir
v
al
u
e
an
d
m
e
an
in
g
ar
e
s
tr
o
n
g
ly
c
o
n
tex
t
-
d
ep
en
d
en
t f
o
r
s
tu
d
en
ts
[
2
8
]
,
[
2
9
]
.
T
ab
le
4
.
I
n
d
iv
id
u
al
an
d
ed
u
ca
t
io
n
al
f
ac
to
r
s
ass
o
ciate
d
with
v
ar
iatio
n
s
in
s
tu
d
en
ts
’
p
er
s
p
ec
ti
v
es o
n
GB
L
I
t
e
m
G
r
o
u
p
1
(
m
e
a
n
±
S
D
)
G
r
o
u
p
2
(
m
e
a
n
±
S
D
)
p
-
v
a
l
u
e
G
e
n
d
e
r
M
a
l
e
(
n
=
7
1
)
F
e
mal
e
(
n
=
1
3
7
)
G
a
mes
s
h
o
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l
d
st
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t
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f
i
r
st
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e
a
r
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.
4
9
±
1
.
7
8
5
.
0
5
±
1
.
6
7
0
.
0
2
6
Tr
a
i
n
a
ss
e
ssm
e
n
t
s
k
i
l
l
s
5
.
2
0
±
1
.
5
4
5
.
6
4
±
1
.
4
9
0
.
0
2
7
Tr
a
i
n
c
l
i
n
i
c
a
l
i
n
t
e
r
v
i
e
w
sk
i
l
l
s
5
.
0
3
±
1
.
5
0
5
.
4
8
±
1
.
5
8
0
.
0
2
0
Tr
a
i
n
r
e
s
e
a
r
c
h
s
k
i
l
l
s
4
.
7
0
±
1
.
6
3
5
.
2
4
±
1
.
7
6
0
.
0
1
4
Tr
a
i
n
d
i
a
g
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o
st
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c
s
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4
.
9
3
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.
7
3
5
.
4
0
±
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.
6
3
0
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0
4
4
P
r
e
v
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o
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s
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g
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t
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se
Y
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=
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N
o
(
n
=
1
8
9
)
P
e
r
f
o
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mat
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v
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p
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y
g
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s s
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4
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5
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9
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5
C
u
r
r
e
n
t
u
s
e
o
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g
a
m
e
s i
s
s
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f
f
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c
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1
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7
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0
5
P
r
e
v
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s
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e
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l
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t
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t
r
a
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n
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n
g
Y
e
s (n
=
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3
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N
o
(
n
=
1
8
5
)
G
a
mes
a
r
e
i
mp
o
r
t
a
n
t
i
n
a
p
h
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s
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o
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e
5
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5
2
±
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9
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4
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9
7
±
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6
0
.
0
4
3
Ad
d
itio
n
ally
,
s
tu
d
e
n
ts
with
p
r
io
r
h
ea
lth
-
r
elate
d
t
r
ain
in
g
r
at
ed
th
e
im
p
o
r
ta
n
ce
o
f
g
am
es
with
in
th
e
p
h
y
s
io
th
er
a
p
y
cu
r
r
ic
u
lu
m
s
ig
n
if
ican
tly
h
ig
h
e
r
th
an
p
ee
r
s
with
o
u
t
s
im
ilar
b
ac
k
g
r
o
u
n
d
s
(
p
=0
.
0
4
3
)
.
T
h
ese
o
b
s
er
v
atio
n
s
s
u
g
g
est
th
at,
in
h
ea
lth
-
r
elate
d
p
r
o
g
r
am
s
,
th
e
i
n
tr
o
d
u
ctio
n
o
f
GB
L
m
ay
b
en
ef
it
f
r
o
m
ca
r
e
f
u
lly
s
elec
tin
g
g
am
e
ty
p
es
with
lo
w
er
p
lay
f
u
l
o
r
p
e
r
f
o
r
m
ativ
e
in
te
n
s
ity
,
s
u
ch
as
co
lla
b
o
r
ativ
e
o
r
co
m
p
etitiv
e
f
o
r
m
ats,
wh
ile
av
o
id
in
g
c
o
m
p
lex
r
o
l
e
-
p
la
y
o
r
s
im
u
latio
n
g
a
m
es
th
at
m
ay
n
o
t
alig
n
with
s
tu
d
en
ts
’
p
r
o
f
e
s
s
io
n
al
ex
p
ec
tatio
n
s
[
3
0
]
.
W
h
en
teac
h
in
g
h
ea
lth
co
n
ten
t
with
g
am
es,
two
o
b
jectiv
es
m
u
s
t
b
e
cle
ar
ly
co
m
m
u
n
icate
d
:
th
e
r
u
les o
r
g
a
m
ep
lay
,
w
h
ich
d
ef
in
e
h
o
w
th
e
p
lay
e
r
in
ter
ac
t
s
with
th
e
g
am
e,
an
d
t
h
e
ch
all
en
g
es,
wh
ich
r
ewa
r
d
s
u
cc
ess
f
u
l a
ctio
n
s
an
d
c
r
ea
te
o
b
s
tacle
s
th
at
p
r
ev
en
t
im
m
ed
i
at
e
s
u
cc
ess
.
Ach
iev
in
g
cla
r
ity
o
n
b
o
t
h
co
m
p
o
n
en
ts
is
p
ar
ticu
lar
ly
ch
allen
g
in
g
i
n
p
er
f
o
r
m
ativ
e
o
r
r
o
le
-
p
lay
i
n
g
g
am
es,
p
o
ten
tially
lim
itin
g
th
eir
p
er
ce
iv
e
d
ed
u
ca
tio
n
al
v
al
u
e
in
s
er
io
u
s
p
r
o
f
ess
io
n
al
tr
ain
in
g
c
o
n
tex
ts
.
T
h
is
s
tu
d
y
p
r
esen
ts
s
o
m
e
li
m
itatio
n
s
th
at
s
h
o
u
ld
b
e
co
n
s
id
er
ed
in
lig
h
t
o
f
th
eir
im
p
l
icatio
n
s
f
o
r
ed
u
ca
tio
n
al
p
r
ac
tice.
First,
its
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
d
o
e
s
n
o
t
allo
w
ca
u
s
al
in
f
er
en
ce
s
b
etwe
en
s
tu
d
en
t
ch
ar
ac
ter
is
tics
an
d
p
er
ce
p
tio
n
s
o
f
GB
L
;
h
o
wev
er
,
it
p
r
o
v
id
ed
a
v
alu
ab
le
s
n
ap
s
h
o
t
o
f
ass
o
ciatio
n
s
ac
r
o
s
s
a
b
r
o
ad
an
d
d
iv
e
r
s
e
p
h
y
s
io
th
er
a
p
y
s
tu
d
en
t
p
o
p
u
latio
n
,
o
f
f
er
i
n
g
in
s
i
g
h
ts
th
at
ca
n
in
f
o
r
m
cu
r
r
icu
lu
m
d
ev
elo
p
m
en
t
an
d
p
ed
ag
o
g
ical
p
lan
n
i
n
g
.
Seco
n
d
,
d
ata
wer
e
c
o
llected
v
ia
s
elf
-
ad
m
in
is
ter
ed
q
u
esti
o
n
n
air
es,
wh
ich
m
ay
b
e
in
f
lu
en
ce
d
b
y
s
o
cial
d
esira
b
i
lity
b
ias
o
r
v
ar
iab
le
i
n
ter
p
r
et
atio
n
s
;
n
o
n
eth
eless
,
th
is
m
eth
o
d
f
ac
ilit
ated
th
e
in
clu
s
io
n
o
f
a
lar
g
er
a
n
d
m
o
r
e
r
ep
r
esen
tativ
e
s
am
p
le
ac
r
o
s
s
m
u
ltip
le
r
eg
io
n
s
o
f
Po
r
t
u
g
al,
s
u
p
p
o
r
tin
g
th
e
id
en
tific
atio
n
o
f
tr
en
d
s
r
ele
v
a
n
t f
o
r
h
ig
h
er
ed
u
ca
tio
n
s
tr
ateg
ies.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
2
2
I
n
t
J
E
v
al
&
R
es E
d
u
c
,
Vo
l
.
15
,
No
.
2
,
Ap
r
il
20
26
:
1
3
8
8
-
1
3
9
7
1394
Fu
tu
r
e
r
esear
ch
co
u
ld
b
u
ild
o
n
th
ese
f
in
d
in
g
s
to
g
u
id
e
th
e
d
esig
n
an
d
im
p
lem
en
tatio
n
o
f
m
o
r
e
ef
f
ec
tiv
e
GB
L
s
tr
ateg
ies
in
p
h
y
s
io
th
e
r
ap
y
e
d
u
ca
tio
n
.
L
o
n
g
itu
d
in
al
o
r
m
i
x
ed
-
m
et
h
o
d
s
tu
d
ies
wo
u
ld
allo
w
f
o
r
an
u
n
d
er
s
tan
d
i
n
g
o
f
h
o
w
s
tu
d
en
t
s
’
p
er
ce
p
tio
n
s
ev
o
lv
e
th
r
o
u
g
h
o
u
t
th
eir
tr
ain
in
g
a
n
d
ea
r
ly
p
r
o
f
ess
io
n
al
p
r
ac
tice,
in
f
o
r
m
in
g
th
e
tim
in
g
an
d
s
eq
u
en
cin
g
o
f
GB
L
in
ter
v
en
tio
n
s
.
Ob
s
er
v
atio
n
al
o
r
ex
p
er
im
en
tal
s
tu
d
ies
co
u
ld
ev
alu
ate
h
o
w
GB
L
d
ir
ec
tly
i
m
p
ac
ts
th
e
d
ev
elo
p
m
en
t
o
f
tr
an
s
v
er
s
al
an
d
tech
n
ical
co
m
p
eten
cies,
in
clu
d
in
g
clin
ical
r
ea
s
o
n
in
g
a
n
d
p
atien
t
-
ce
n
ter
ed
s
k
ills
,
th
er
eb
y
p
r
o
v
id
in
g
e
v
id
en
ce
t
o
r
ef
i
n
e
cu
r
r
icu
lar
in
teg
r
atio
n
.
C
o
m
p
ar
ativ
e
s
tu
d
ies
ac
r
o
s
s
h
ea
lth
p
r
o
f
ess
io
n
s
an
d
in
ter
n
at
io
n
al
co
n
tex
ts
co
u
ld
illu
m
in
at
e
h
o
w
ed
u
ca
tio
n
al
s
tr
u
ctu
r
es
an
d
cu
ltu
r
al
f
ac
to
r
s
in
f
lu
en
ce
t
h
e
ef
f
ec
tiv
en
ess
o
f
g
am
e
-
b
ased
p
ed
ag
o
g
ies.
Fu
r
t
h
er
m
o
r
e,
q
u
alitativ
e
in
v
esti
g
atio
n
s
o
f
ed
u
ca
to
r
p
er
s
p
ec
tiv
es
an
d
im
p
lem
en
tatio
n
p
r
o
ce
s
s
es
co
u
ld
id
e
n
tify
p
r
a
ctica
l
en
ab
ler
s
an
d
b
ar
r
ier
s
,
o
f
f
e
r
in
g
ac
tio
n
a
b
le
in
s
ig
h
ts
f
o
r
s
u
s
tain
ab
le
ad
o
p
ti
o
n
an
d
o
p
tim
iz
atio
n
o
f
GB
L
ap
p
r
o
ac
h
es
in
h
ig
h
er
ed
u
ca
tio
n
c
u
r
r
icu
la.
3
.
4
.
T
he
SPIN
E
f
ra
m
ewo
r
k
:
a
s
t
ud
ent
-
info
rm
ed
m
o
del
f
o
r
in
t
eg
ra
t
ing
G
B
L
in
ph
y
s
io
t
her
a
py
educa
t
io
n
Dr
awin
g
o
n
t
h
e
em
p
ir
ical
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
,
th
e
s
tu
d
en
t
-
p
er
ce
iv
ed
in
te
g
r
atio
n
f
o
r
n
o
v
e
l
ed
u
ca
tio
n
(
SP
I
NE
)
f
r
am
ewo
r
k
is
p
r
o
p
o
s
ed
as
a
d
ec
is
io
n
-
m
ak
in
g
m
o
d
el
to
g
u
id
e
th
e
p
ed
a
g
o
g
ically
g
r
o
u
n
d
ed
a
n
d
c
o
n
tex
t
-
s
en
s
itiv
e
in
teg
r
atio
n
o
f
GB
L
with
in
p
h
y
s
io
th
er
ap
y
cu
r
r
icu
la,
as
s
h
o
wn
in
Fig
u
r
e
1
.
T
h
is
f
r
am
ewo
r
k
ac
k
n
o
wled
g
es
th
at
t
h
e
ef
f
ec
ti
v
e
im
p
lem
en
tatio
n
o
f
GB
L
d
e
p
en
d
s
n
o
t
o
n
ly
o
n
p
ed
ag
o
g
ica
l
d
esig
n
b
u
t
also
o
n
lear
n
er
p
er
ce
p
tio
n
s
,
co
n
te
x
tu
a
l
co
n
s
tr
ain
ts
,
an
d
in
s
titu
tio
n
al
r
ea
d
in
ess
.
T
h
e
m
o
d
el
is
s
tr
u
ctu
r
ed
ar
o
u
n
d
f
iv
e
in
ter
r
elate
d
d
im
en
s
io
n
s
:
−
Stu
d
en
t
n
ee
d
s
an
d
p
er
ce
p
tio
n
s
(
S)
—
s
u
p
p
o
r
ted
b
y
s
tu
d
en
ts
’
s
tr
o
n
g
ag
r
ee
m
e
n
t
o
n
t
h
e
v
al
u
e
o
f
in
cr
ea
s
in
g
GB
L
o
p
p
o
r
tu
n
ities
in
b
o
th
th
eo
r
etica
l
an
d
p
r
ac
tical
c
lass
es
(
M=
5
.
3
2
an
d
M=
5
.
3
7
,
r
esp
ec
tiv
ely
)
,
h
ig
h
lig
h
tin
g
m
o
tiv
atio
n
an
d
p
er
ce
iv
ed
r
elev
a
n
ce
as k
ey
d
r
iv
er
s
.
−
Ped
ag
o
g
ical
alig
n
m
en
t
an
d
p
lay
f
u
ln
ess
(
P)
—
in
f
o
r
m
ed
b
y
f
in
d
in
g
s
th
at
co
llab
o
r
ativ
e
a
n
d
co
m
p
etitiv
e
g
am
es
wer
e
m
o
r
e
ac
ce
p
tab
le
t
h
an
p
e
r
f
o
r
m
ativ
e
o
r
r
o
le
-
p
lay
f
o
r
m
ats,
s
u
g
g
esti
n
g
th
at
g
am
e
ty
p
o
lo
g
y
m
u
s
t
alig
n
with
p
r
o
f
ess
io
n
al
au
th
en
ticity
an
d
co
u
r
s
e
o
b
jectiv
es.
−
I
n
d
iv
id
u
al
f
ac
to
r
s
(
I
)
—
d
er
iv
e
d
f
r
o
m
g
e
n
d
er
-
r
elate
d
d
i
f
f
er
en
ce
s
an
d
p
r
io
r
ed
u
ca
tio
n
al
ex
p
er
ien
ce
;
f
o
r
in
s
tan
ce
,
f
em
ale
s
tu
d
en
ts
r
ated
GB
L
h
ig
h
er
f
o
r
ass
ess
m
en
t
an
d
d
iag
n
o
s
tic
s
k
ills
,
wh
ile
s
t
u
d
en
ts
with
p
r
io
r
h
ig
h
er
e
d
u
ca
tio
n
s
h
o
wed
less
in
ter
est in
r
o
le
-
p
la
y
g
am
es.
−
Neg
o
tiatio
n
an
d
i
ter
atio
n
(
N)
—
r
ef
lecte
d
in
s
tu
d
e
n
ts
’
n
eu
tr
al
v
iews
o
n
th
e
ad
eq
u
ac
y
o
f
cu
r
r
en
t
GB
L
u
s
e
(
M=
3
.
5
1
)
,
wh
ic
h
em
p
h
asize
t
h
e
n
ee
d
f
o
r
o
n
g
o
in
g
d
ialo
g
u
e
b
etwe
en
e
d
u
ca
to
r
s
a
n
d
lear
n
er
s
to
iter
ativ
ely
r
ef
in
e
GB
L
im
p
lem
en
tatio
n
a
n
d
en
s
u
r
e
r
esp
o
n
s
iv
en
ess
to
f
e
ed
b
ac
k
.
−
E
n
v
ir
o
n
m
en
tal
an
d
i
n
s
titu
tio
n
al
s
u
p
p
o
r
t
(
E
)
—
em
er
g
in
g
f
r
o
m
th
e
r
ec
o
g
n
itio
n
o
f
u
n
d
er
u
til
izatio
n
o
f
g
am
es
in
cu
r
r
en
t
c
u
r
r
icu
la,
p
o
in
tin
g
t
o
th
e
im
p
o
r
tan
ce
o
f
f
ac
u
lty
tr
a
in
in
g
,
i
n
f
r
astru
ctu
r
e,
a
n
d
cu
r
r
i
cu
lar
alig
n
m
en
t
f
o
r
s
u
s
tain
ab
le
in
teg
r
atio
n
.
Fig
u
r
e
1
.
C
o
n
ce
p
tu
al
r
ep
r
esen
tatio
n
o
f
th
e
SP
I
NE
f
r
am
ewo
r
k
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8
8
2
2
P
h
ysio
th
era
p
y
ed
u
c
a
tio
n
a
n
d
g
a
me
-
b
a
s
ed
le
a
r
n
in
g
:
d
ev
elo
p
in
g
th
e
… (
Dia
n
a
F
ilip
a
S
a
lva
d
o
r
B
ern
a
r
d
o
)
1395
C
o
llectiv
ely
,
th
e
SP
I
NE
f
r
a
m
ewo
r
k
p
r
o
v
id
es
a
th
eo
r
etic
ally
g
r
o
u
n
d
ed
y
et
em
p
ir
icall
y
in
f
o
r
m
e
d
s
tr
u
ctu
r
e
to
g
u
i
d
e
ed
u
ca
to
r
s
an
d
cu
r
r
icu
l
u
m
d
esig
n
er
s
in
em
b
ed
d
in
g
GB
L
in
p
h
y
s
io
th
er
ap
y
ed
u
ca
tio
n
,
f
o
s
ter
in
g
m
ea
n
in
g
f
u
l
lear
n
in
g
ex
p
er
ie
n
ce
s
th
at
in
teg
r
ate
co
g
n
iti
v
e,
af
f
ec
tiv
e,
an
d
p
r
o
f
ess
io
n
al
d
im
en
s
io
n
s
o
f
co
m
p
eten
ce
.
T
h
e
f
r
am
ew
o
r
k
i
n
Fig
u
r
e
1
is
v
is
u
ally
d
ep
icted
as
a
s
p
in
al
c
o
lu
m
n
,
wh
er
e
ea
ch
v
er
teb
r
a
r
e
p
r
esen
ts
o
n
e
o
f
th
e
f
i
v
e
in
ter
d
ep
en
d
en
t
d
im
en
s
io
n
s
:
s
tu
d
en
t
n
ee
d
s
(
S),
p
ed
ag
o
g
ical
alig
n
m
e
n
t
(
P),
i
n
d
iv
id
u
al
f
ac
t
o
r
s
(
I
)
,
n
eg
o
tiatio
n
(
N)
,
a
n
d
en
v
i
r
o
n
m
en
t
(
E
)
.
T
h
e
s
tr
u
ctu
r
e
co
n
v
ey
s
th
e
id
ea
o
f
alig
n
m
en
t,
s
u
p
p
o
r
t,
an
d
ad
ap
tiv
e
f
ee
d
b
ac
k
ess
en
tial f
o
r
s
u
s
tain
ab
le
GB
L
in
teg
r
atio
n
in
p
h
y
s
io
t
h
er
ap
y
c
u
r
r
icu
la.
4.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
co
n
f
ir
m
ed
th
at,
as
an
ticip
ated
in
th
e
in
tr
o
d
u
ctio
n
,
p
h
y
s
io
th
er
ap
y
s
tu
d
en
ts
r
ec
o
g
n
ize
th
e
ed
u
ca
tio
n
al
v
alu
e
o
f
GB
L
f
o
r
b
o
th
tr
an
s
v
er
s
al
an
d
tech
n
ical
co
m
p
eten
cies.
Stu
d
en
ts
co
n
s
is
ten
tly
v
alu
ed
GB
L
f
o
r
en
h
an
cin
g
tr
an
s
v
er
s
al
s
k
ills
ac
r
o
s
s
all
y
ea
r
s
,
wh
ile
p
er
ce
iv
ed
b
en
e
f
its
f
o
r
tech
n
ical
co
m
p
eten
cies
ev
o
lv
e
d
with
clin
ical
ex
p
o
s
u
r
e,
p
ar
ticu
lar
ly
in
i
n
ter
m
ed
iate
s
tag
es
o
f
tr
ain
in
g
.
Ge
n
d
er
an
d
p
r
io
r
ed
u
ca
tio
n
al
o
r
h
ea
lth
-
r
elate
d
ex
p
e
r
ien
ce
we
r
e
also
s
h
o
wn
t
o
in
f
l
u
en
ce
s
tu
d
en
ts
’
p
er
ce
p
tio
n
s
,
h
ig
h
lig
h
tin
g
th
e
n
ee
d
f
o
r
tailo
r
ed
s
tr
ateg
ies
to
en
s
u
r
e
eq
u
itab
le
ac
ce
p
tan
ce
an
d
ef
f
ec
tiv
e
in
t
eg
r
atio
n
.
T
h
ese
f
in
d
in
g
s
s
u
p
p
o
r
t
th
e
d
elib
er
ate
in
co
r
p
o
r
atio
n
o
f
GB
L
in
to
p
h
y
s
io
th
er
a
p
y
c
u
r
r
icu
la,
with
ca
r
ef
u
l
co
n
s
id
er
atio
n
o
f
g
a
m
e
ty
p
es,
lea
r
n
in
g
o
b
jectiv
es,
an
d
p
r
ac
tic
al
r
elev
an
ce
.
Dr
awin
g
o
n
th
ese
em
p
ir
i
ca
l
in
s
ig
h
ts
,
th
e
SP
I
NE
f
r
am
e
wo
r
k
was
d
ev
elo
p
ed
as
a
s
tu
d
en
t
-
in
f
o
r
m
e
d
m
o
d
el
t
o
g
u
id
e
th
e
p
e
d
ag
o
g
ically
g
r
o
u
n
d
ed
an
d
co
n
tex
t
-
s
en
s
itiv
e
i
n
teg
r
atio
n
o
f
GB
L
with
in
p
h
y
s
io
th
e
r
ap
y
cu
r
r
icu
l
a.
T
h
e
f
r
am
ewo
r
k
s
y
n
t
h
esizes
k
ey
f
ac
t
o
r
s
,
in
clu
d
in
g
s
tu
d
en
t
n
ee
d
s
,
p
ed
ag
o
g
ical
alig
n
m
en
t,
i
n
d
iv
id
u
al
d
if
f
er
e
n
ce
s
,
iter
ativ
e
f
ee
d
b
ac
k
,
an
d
en
v
ir
o
n
m
e
n
tal
s
u
p
p
o
r
t,
p
r
o
v
id
in
g
ac
tio
n
a
b
le
g
u
id
an
ce
f
o
r
ed
u
ca
to
r
s
an
d
cu
r
r
icu
lu
m
d
esig
n
e
r
s
.
T
h
ese
f
in
d
in
g
s
d
em
o
n
s
tr
ate
th
at
GB
L
c
an
b
e
a
f
lex
ib
le
an
d
ef
f
e
ctiv
e
p
e
d
ag
o
g
ical
to
o
l,
wit
h
th
e
SP
I
NE
f
r
am
ew
o
r
k
o
f
f
er
i
n
g
a
s
tr
u
ctu
r
e
d
a
p
p
r
o
a
ch
t
o
o
p
tim
ize
cu
r
r
ic
u
lu
m
d
esig
n
an
d
lear
n
in
g
ex
p
er
ien
c
es.
Fu
tu
r
e
r
esear
ch
s
h
o
u
ld
ex
p
lo
r
e
lo
n
g
itu
d
in
al
im
p
ac
ts
o
f
G
B
L
o
n
co
m
p
eten
ce
ac
q
u
is
itio
n
,
in
v
esti
g
ate
ed
u
ca
to
r
p
er
s
p
ec
tiv
es,
a
n
d
e
x
am
in
e
cr
o
s
s
-
cu
ltu
r
al
ap
p
licatio
n
s
to
f
u
r
th
e
r
r
ef
i
n
e
th
e
f
r
am
ewo
r
k
.
ACK
NO
WL
E
DG
M
E
N
T
S
T
h
e
au
th
o
r
s
wo
u
ld
lik
e
to
th
an
k
th
e
f
ac
u
lty
m
em
b
er
s
an
d
co
o
r
d
in
ato
r
s
o
f
th
e
p
ar
ticip
at
in
g
h
ig
h
er
ed
u
ca
tio
n
in
s
titu
tio
n
s
f
o
r
th
eir
v
alu
ab
le
s
u
p
p
o
r
t
in
d
is
s
em
in
atin
g
th
e
s
tu
d
y
an
d
f
ac
ilit
atin
g
s
tu
d
en
t
r
ec
r
u
itm
en
t.
W
e
al
s
o
ex
ten
d
o
u
r
g
r
atitu
d
e
to
all
th
e
p
h
y
s
io
th
er
ap
y
s
tu
d
e
n
ts
wh
o
v
o
lu
n
tar
ily
p
ar
ticip
at
ed
an
d
s
h
ar
ed
th
eir
p
er
s
p
ec
tiv
es
,
m
ak
in
g
th
is
r
esear
ch
p
o
s
s
ib
le.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
T
h
is
wo
r
k
was
s
u
p
p
o
r
ted
b
y
n
atio
n
al
f
u
n
d
s
f
r
o
m
FC
T
–
Fu
n
d
aç
ão
p
ar
a
a
C
iên
cia
e
a
T
ec
n
o
l
o
g
ia,
I
.
P.,
u
n
d
er
p
r
o
jects
UI
D/6
1
5
7
/2
0
2
5
an
d
UI
D/0
5
7
0
4
/2
0
2
3
,
w
h
ich
f
u
n
d
t
h
e
r
esear
ch
u
n
its
to
wh
ich
th
e
au
th
o
r
s
b
elo
n
g
.
T
h
e
f
u
n
d
er
s
h
a
d
n
o
r
o
le
in
s
tu
d
y
d
esig
n
,
d
ata
co
lle
cti
o
n
an
d
an
al
y
s
is
,
d
ec
is
io
n
to
p
u
b
lis
h
,
o
r
p
r
ep
a
r
atio
n
o
f
th
e
m
a
n
u
s
cr
ip
t.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
t
r
ib
u
to
r
R
o
les
T
a
x
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
i
d
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
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R
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Vi
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P
Fu
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a
Fil
ip
a
Salv
ad
o
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er
n
ar
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o
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Ma
n
u
el
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o
aq
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im
d
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v
a
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G
.
Paq
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ete
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Ma
r
len
e
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r
is
tin
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es
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o
s
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C
:
C
o
n
c
e
p
t
u
a
l
i
z
a
t
i
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n
M
:
M
e
t
h
o
d
o
l
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g
y
So
:
So
f
t
w
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r
e
Va
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Va
l
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d
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t
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Fo
:
Fo
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mal
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n
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1
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a
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p
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rt
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rsity
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ialist
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c
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a
m
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d
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re
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Ca
rd
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irato
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0
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d
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a
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re
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h
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rre
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re
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ll
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in
2
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a
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2
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2
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th
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field
o
f
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sc
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c
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ro
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stit
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ters
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
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m
a
il
:
d
ia
n
a
b
e
rn
a
rd
o
@ip
b
.
p
t.
Ma
n
u
e
l
J
o
a
q
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a
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il
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a
P
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G
.
Pa
q
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h
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.
c
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te i
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ra
p
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a
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th
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F
a
c
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lt
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o
f
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p
o
r
t,
Un
i
v
e
rsity
o
f
P
o
rt
o
.
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h
o
ld
s
a
m
a
ste
r’s
d
e
g
re
e
in
S
p
o
rt
S
c
ien
c
e
s
fro
m
t
h
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sa
m
e
in
stit
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ti
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n
,
a
s
we
ll
a
s
b
a
c
h
e
lo
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d
e
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re
e
s
in
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ra
p
y
a
n
d
in
M
a
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g
e
m
e
n
t,
a
n
d
t
h
e
p
ro
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ss
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n
a
l
ti
tl
e
o
f
S
p
e
c
ialist
in
P
h
y
sio
th
e
ra
p
y
.
He
is
c
u
rre
n
tl
y
a
n
a
s
sista
n
t
p
ro
fe
ss
o
r
a
n
d
d
e
p
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ty
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r
a
t
t
h
e
Esc
o
la
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u
p
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ri
o
r
d
e
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a
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a
n
P
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e
t
d
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v
a
d
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a
n
d
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n
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rc
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e
r
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th
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t
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se
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rc
h
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ter
fo
r
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l
o
g
ica
l
Hu
m
a
n
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v
e
lo
p
m
e
n
t.
His
a
c
a
d
e
m
ic
o
u
t
p
u
t
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n
c
lu
d
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s
se
v
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n
p
e
e
r
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re
v
iew
e
d
sc
ien
ti
fic
a
rti
c
les
p
u
b
li
sh
e
d
in
in
ter
n
a
ti
o
n
a
l
j
o
u
r
n
a
ls
in
d
e
x
e
d
in
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c
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p
u
s
a
n
d
Web
o
f
S
c
ien
c
e
,
a
n
d
o
n
e
b
o
o
k
c
h
a
p
ter
p
u
b
li
sh
e
d
b
y
Ed
it
o
rial
M
é
d
ica
P
a
n
a
m
e
rica
n
a
.
His
m
a
in
re
se
a
rc
h
in
tere
sts
in
c
l
u
d
e
p
h
y
sio
th
e
ra
p
y
a
ss
e
ss
m
e
n
t
a
n
d
in
ter
v
e
n
ti
o
n
,
b
a
lan
c
e
a
n
d
p
r
o
p
rio
c
e
p
ti
o
n
,
t
h
e
r
a
p
e
u
ti
c
e
x
e
rc
ise
,
a
n
d
a
c
ti
v
e
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rn
in
g
m
e
th
o
d
o
l
o
g
ies
in
h
e
a
lt
h
e
d
u
c
a
ti
o
n
.
Alo
n
g
sid
e
h
is
a
c
a
d
e
m
ic
a
c
ti
v
it
y
,
h
e
c
o
ll
a
b
o
ra
tes
with
Bwiz
e
r
Ld
a
.
,
a
c
o
m
p
a
n
y
d
e
d
ica
ted
t
o
a
d
v
a
n
c
e
d
trai
n
in
g
i
n
p
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y
sio
t
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ra
p
y
a
n
d
h
e
a
lt
h
sc
ien
c
e
s.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
m
a
n
u
e
l.
p
a
q
u
e
te@
i
p
iag
e
t.
p
t
.
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r
lene
Cr
istin
a
Ne
v
e
s
Ro
sa
o
b
tain
e
d
h
e
r
P
h
.
D
.
i
n
He
a
lt
h
S
c
ien
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e
s
a
n
d
Tec
h
n
o
l
o
g
ies
fr
o
m
th
e
Un
i
v
e
rsity
o
f
Av
e
iro
(2
0
1
5
-
F
u
n
d
e
d
b
y
th
e
P
o
rt
u
g
u
e
se
F
o
u
n
d
a
ti
o
n
fo
r
S
c
ien
c
e
a
n
d
Tec
h
n
o
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g
y
-
F
CT)
.
S
h
e
is
c
u
rre
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tl
y
a
n
a
d
ju
n
c
t
p
ro
f
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ss
o
r
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th
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ra
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ra
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m
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rs an
d
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D
.
p
ro
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ra
m
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t
th
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P
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tec
h
n
ic I
n
sti
tu
te o
f
Leiria.
He
r
a
c
a
d
e
m
ic
o
u
t
p
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t
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n
c
lu
d
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s
m
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n
1
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iew
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v
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b
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h
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ters
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c
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p
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field
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