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I
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ex
p
l
ain
c
o
n
ce
p
ts
at
an
ap
p
r
o
p
r
iate
lev
el,
an
d
“
s
o
cial
co
n
g
r
u
e
n
ce
”
b
ec
au
s
e
o
f
th
e
ir
s
i
m
ilar
s
o
cial
r
o
les
s
o
th
e
y
f
ee
l
m
o
r
e
at
ea
s
e
w
it
h
a
p
ee
r
-
o
r
n
ea
r
-
p
ee
r
teac
h
er
th
an
w
it
h
a
s
en
io
r
clin
icia
n
[
5
]
.
P
A
L
w
a
s
in
it
iated
to
s
u
p
p
o
r
t
t
h
e
f
ir
s
t
-
y
ea
r
s
tu
d
e
n
ts
.
I
n
m
ed
ical
f
a
cu
lt
y
,
f
ir
s
t
-
y
ea
r
s
t
u
d
en
t
s
o
f
ten
f
in
d
s
tar
tin
g
n
e
w
ac
ad
e
m
ic
li
f
e
ch
allen
g
in
g
[
6
]
.
P
A
L
p
r
o
g
r
am
,
s
u
c
h
as
p
ee
r
m
e
n
to
r
in
g
,
en
ab
l
es
th
e
m
to
ad
ap
t
to
th
e
n
e
w
ac
ad
e
m
ic
e
n
v
ir
o
n
m
e
n
t
a
n
d
lear
n
i
n
g
m
et
h
o
d
[
7
]
.
T
h
e
y
ar
e
u
r
g
ed
to
ac
co
m
p
li
s
h
p
r
ec
lin
ical
ac
ad
e
m
ic
r
eq
u
ir
e
m
en
ts
.
R
ep
o
r
ts
o
n
P
AL
p
r
o
g
r
a
m
s
i
m
p
le
m
en
ted
in
m
ed
ical
f
ac
u
lt
y
g
e
n
er
all
y
f
o
cu
s
ed
o
n
th
e
m
e
n
tee
s
’
p
o
s
itiv
e
i
m
p
ac
t.
Yet,
th
e
i
m
p
ac
t
o
f
th
e
p
ee
r
m
e
n
to
r
s
’
a
s
p
ec
t
is
n
o
t
w
id
el
y
e
x
p
lo
r
ed
.
T
h
er
ef
o
r
e,
w
e
ai
m
t
o
r
ev
ie
w
s
tu
d
ies
th
a
t
r
ep
o
r
ted
th
e
i
m
p
ac
t
o
f
P
AL
p
r
o
g
r
a
m
s
o
n
p
ee
r
m
en
to
r
s
in
m
ed
ical
f
ac
u
lt
y
,
p
ar
ticu
lar
l
y
o
n
th
eir
ac
ad
e
m
ic
li
f
e
a
n
d
co
m
m
u
n
ica
tio
n
s
k
il
l.
2.
RE
S
E
ARCH
M
E
T
H
O
D
T
h
is
s
y
s
te
m
atic
r
e
v
ie
w
a
n
d
n
ar
r
ativ
e
s
y
n
t
h
esi
s
o
f
s
t
u
d
ies
ass
es
s
i
n
g
th
e
i
m
p
ac
t
o
f
P
AL
o
n
th
e
ac
ad
em
ic
li
f
e
a
n
d
co
m
m
u
n
ica
tio
n
s
k
ill
s
o
f
m
en
t
o
r
s
w
as
p
er
f
o
r
m
ed
ac
co
r
d
in
g
to
p
r
ef
er
r
ed
r
ep
o
r
tin
g
ite
m
s
f
o
r
s
y
s
te
m
a
tic
r
ev
ie
w
s
a
n
d
m
et
a
-
an
a
l
y
s
is
(
P
R
I
SM
A
)
g
u
id
eli
n
es
[
8
]
.
T
h
e
d
ir
ec
to
r
y
o
f
o
p
en
ac
ce
s
s
j
o
u
r
n
al
(
DOA
J
)
,
P
u
b
Me
d
C
en
tr
al,
s
cien
ti
f
ic
elec
tr
o
n
ic
lib
r
ar
y
o
n
li
n
e
(
SciEL
O)
,
an
d
Scien
c
eDir
ec
t
d
atab
ases
ad
v
an
ce
d
s
ea
r
ch
u
s
ed
to
p
er
f
o
r
m
a
l
iter
atu
r
e
s
ea
r
c
h
i
n
g
.
W
e
u
s
ed
‘
p
ee
r
m
en
to
r
in
g
’
AN
D
‘
m
ed
ical
s
t
u
d
en
t
’
A
N
D
‘
ac
ad
e
m
ic’
AND
‘
co
m
m
u
n
icat
io
n
’
k
e
y
w
o
r
d
s
.
T
h
e
s
ea
r
ch
f
ilter
ed
b
y
t
h
e
p
u
b
licatio
n
y
ea
r
: 2
0
1
4
-
2019.
Af
ter
eli
m
i
n
atio
n
o
f
d
u
p
licate
s
,
a
p
r
eli
m
i
n
ar
y
s
e
lectio
n
o
n
titl
es
a
n
d
ab
s
tr
ac
ts
w
as
co
n
d
u
cted
.
T
h
e
n
ex
t
s
tep
i
s
as
s
es
s
ed
f
u
ll
te
x
t
s
ar
ticles
f
o
r
eli
g
ib
ilit
y
Fi
g
u
r
e
1
.
Scr
ee
n
in
g
o
f
t
h
e
ar
ticles
w
er
e
d
o
n
e
b
ased
o
n
th
ese
in
cl
u
s
io
n
cr
iter
ia:
i
)
p
o
p
u
latio
n
w
a
s
m
ed
ical
s
tu
d
e
n
t
f
r
o
m
d
e
v
elo
p
ed
o
r
d
ev
elo
p
in
g
co
u
n
tr
y
;
ii
)
ex
p
o
s
u
r
e
o
f
i
n
ter
est
w
as
P
AL
p
r
o
g
r
a
m
;
ii
i
)
o
u
tco
m
e
w
a
s
r
elate
d
to
th
e
i
m
p
ac
t
o
f
P
AL
p
r
o
g
r
a
m
o
n
p
ee
r
m
en
to
r
s
in
m
ed
ical
f
ac
u
l
t
y
;
iv
)
t
y
p
es
o
f
s
t
u
d
y
w
er
e
q
u
a
n
titativ
e
a
n
d
q
u
alita
tiv
e.
J
o
an
n
a
B
r
ig
g
s
I
n
s
tit
u
te
(
J
B
I
)
’
s
cr
itical
ap
p
r
aisal
to
o
ls
u
s
ed
to
cr
iticall
y
ap
p
r
aise
th
e
in
clu
d
ed
ar
ticles.
T
h
e
d
ata
f
r
o
m
t
h
e
in
cl
u
d
ed
ar
ticles
w
er
e
ex
tr
ac
ted
an
d
s
y
n
th
e
s
ized
as d
escr
ip
tiv
e
.
3.
RE
SU
L
T
S
A
ND
D
I
SCU
SS
I
O
N
3
.
1
.
Study
identif
ica
t
io
n a
nd
s
ele
ct
io
n
T
h
e
d
atab
ase
ad
v
an
ce
d
s
ea
r
ch
id
en
ti
f
ied
1
,
101
ar
ticles.
Ar
ticles
g
ai
n
ed
w
er
e
9
7
8
f
r
o
m
P
u
b
Me
d
C
en
tr
al,
9
9
ar
ticles
f
r
o
m
Sci
en
ce
Dir
ec
t,
2
2
f
r
o
m
DO
A
J
,
an
d
t
w
o
f
r
o
m
SciE
L
O.
D
u
p
licate
ar
ticles
w
er
e
r
e
m
o
v
ed
.
T
h
er
e
ar
e
1
,
0
6
4
n
o
t
r
elev
a
n
t
ar
ticle
s
r
e
m
o
v
ed
.
T
w
e
n
t
y
-
f
i
v
e
ar
tic
les
e
x
cl
u
d
ed
ex
p
o
s
u
r
e
o
f
i
n
ter
est
w
a
s
n
o
t
P
A
L
p
r
o
g
r
a
m
an
d
p
o
p
u
latio
n
w
as
n
o
t
f
r
o
m
m
ed
ica
l
s
t
u
d
en
t
s
.
F
iv
e
eli
g
ib
le
ar
ticle
s
w
er
e
f
r
o
m
s
t
u
d
ies
co
n
d
u
cted
f
o
r
m
ed
ical
f
ac
u
lt
y
s
t
u
d
en
ts
i
n
I
n
d
ia,
Au
s
tr
alia,
I
s
r
ae
l,
Un
i
ted
State
s
o
f
Am
er
ic
a
(
US
A
)
,
an
d
I
r
an
.
T
h
e
P
R
I
SMA
f
lo
w
c
h
ar
t is s
h
o
w
n
in
F
ig
u
r
e
1
.
T
a
b
le
1
h
ig
h
l
ig
h
ts
t
h
e
s
u
m
m
ar
y
o
f
t
h
e
f
i
v
e
elig
ib
le
ar
ticles.
3
.
2
.
F
ind
ing
s
Stu
d
y
b
y
S
in
g
h
et
a
l.
ev
alu
ated
th
e
p
ar
ticip
an
ts
o
f
th
e
2
0
1
0
Me
n
to
r
in
g
P
r
o
g
r
a
m
in
Un
iv
er
s
it
y
C
o
lleg
e
o
f
Scie
n
ce
s
,
Del
h
i.
Alo
n
g
s
id
e
5
2
f
ac
u
lt
y
m
en
to
r
s
,
5
7
n
ea
r
-
p
ee
r
s
w
er
e
ass
i
g
n
ed
t
o
m
e
n
to
r
1
4
8
f
ir
s
t
y
ea
r
m
ed
ical
s
tu
d
e
n
ts
i
n
th
e
m
en
to
r
in
g
p
r
o
g
r
am
.
Feed
-
b
ac
k
q
u
esti
o
n
n
air
e
w
as
g
iv
e
n
to
th
e
f
ac
u
lt
y
m
e
n
to
r
s
,
n
ea
r
-
p
ee
r
m
en
to
r
s
,
a
n
d
m
en
te
e
at
th
e
en
d
o
f
t
h
e
y
ea
r
.
T
h
e
f
ee
d
-
b
ac
k
f
r
o
m
t
h
e
n
ea
r
-
p
ee
r
m
en
to
r
s
w
as
m
ad
e
i
n
th
e
f
o
r
m
o
f
q
u
a
n
ti
tat
iv
e
a
n
d
q
u
alitati
v
e
a
n
al
y
s
es
[
9
]
.
Sciclu
n
a
et
a
l.
s
tu
d
ied
th
e
U
n
iv
er
s
it
y
o
f
Ne
w
So
u
th
W
ales
’
m
ed
ical
f
ac
u
lt
y
s
t
u
d
en
ts
w
h
o
en
g
a
g
ed
th
e
2
0
1
2
p
ee
r
lear
n
in
g
p
r
o
g
r
a
m
.
T
h
e
s
tu
d
e
n
ts
f
r
o
m
y
ea
r
o
n
e
an
d
t
w
o
w
h
o
co
m
p
leted
co
u
r
s
es
i
n
th
e
f
ir
s
t
s
e
m
e
s
ter
.
T
h
e
s
tu
d
en
t
s
w
er
e
th
en
co
m
b
i
n
ed
as
o
n
e
co
h
o
r
t
t
o
co
m
p
lete
co
u
r
s
es
in
t
h
e
s
ec
o
n
d
s
e
m
ester
.
T
h
e
y
f
o
r
m
ed
s
tu
d
y
g
r
o
u
p
s
w
h
er
e
t
h
e
s
en
io
r
b
ec
am
e
th
e
m
en
to
r
s
.
Qu
est
io
n
n
air
e
f
o
r
P
ee
r
L
ea
r
n
i
n
g
w
as
g
iv
e
n
o
n
li
n
e
to
y
ea
r
1
-
6
s
tu
d
e
n
ts
.
T
h
e
q
u
e
s
tio
n
n
air
e
co
n
s
is
ted
o
f
2
6
f
ix
ed
-
r
esp
o
n
s
e
i
te
m
s
w
i
th
f
o
u
r
p
o
in
ts
L
ic
k
er
t
s
ca
le
(
s
tr
o
n
g
l
y
a
g
r
ee
-
s
tr
o
n
g
l
y
d
is
a
g
r
ee
)
an
d
t
w
o
o
p
en
-
e
n
d
ed
ite
m
s
.
T
h
e
1
-
1
2
f
ix
ed
-
r
e
s
p
o
n
s
e
ite
m
s
a
n
d
t
w
o
o
p
en
-
en
d
ed
ite
m
s
w
er
e
a
n
s
w
er
ed
b
y
all
s
t
u
d
en
ts
.
T
h
e
r
es
t
o
f
t
h
e
ite
m
s
w
er
e
tar
g
eted
ac
co
r
d
in
g
to
ac
ad
e
m
ic
y
ea
r
an
d
p
ee
r
teac
h
in
g
ex
p
er
ien
ce
[
1
0
]
.
Dick
m
an
et
a
l.
r
ep
o
r
ted
a
s
tu
d
y
o
n
n
ea
r
-
p
ee
r
teac
h
er
s
o
f
B
ar
I
lan
U
n
i
v
er
s
it
y
,
Sa
f
ed
,
I
s
r
ae
l.
T
h
e
n
ea
r
-
p
ee
r
teac
h
er
s
w
er
e
th
e
f
ir
s
t
-
y
ea
r
s
tu
d
en
t
s
o
f
th
e
Fac
u
lt
y
o
f
Me
d
icin
e
w
h
o
h
ad
co
m
p
leted
A
n
ato
m
y
co
u
r
s
e
w
it
h
g
r
ad
e
at
least
8
5
o
u
t
o
f
1
0
0
.
T
h
e
y
w
er
e
tr
ain
ed
i
n
T
h
e
n
ea
r
-
p
ee
r
in
s
tr
u
cto
r
s
(
NP
I
)
p
r
o
g
r
am
.
T
h
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
I
SS
N:
2
2
5
2
-
8806
Th
e
imp
a
ct
o
f p
ee
r
a
s
s
is
ted
lea
r
n
in
g
o
n
men
to
r
s
’
a
ca
d
emic
life
…
(
S
a
b
r
in
a
I
n
ta
n
Zo
r
a
y
a
)
403
Dep
ar
t
m
en
t
o
f
Me
d
ical
E
d
u
ca
tio
n
an
d
t
h
e
An
ato
m
y
p
r
o
g
r
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[
1
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A
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ased
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m
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n
d
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e
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m
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ad
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ac
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s
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t
h
e
m
en
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r
s
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ad
s
o
m
e
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in
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m
t
h
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m
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h
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ati
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m
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f
f
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a
s
w
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p
ar
ticip
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in
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n
ter
-
m
en
to
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e
s
s
io
n
s
i
m
p
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v
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m
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to
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ab
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cr
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d
p
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ac
k
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T
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k
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[
1
3
]
.
Stu
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k
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p
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3
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2
.
1
.
G
o
o
d
Co
m
m
u
nica
t
io
n
S
k
ills
B
ased
o
n
th
e
r
e
s
u
l
ts
a
n
d
d
is
c
u
s
s
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s
o
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ev
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s
tu
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ie
s
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t
h
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s
s
t
u
d
y
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a
v
e
f
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n
d
th
a
t Si
n
g
h
,
Scicl
u
n
a,
an
d
A
b
d
o
lalizad
eh
all
h
ad
s
tr
o
n
g
l
y
i
m
p
l
ied
th
e
b
en
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f
it
o
f
p
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r
m
e
n
to
r
in
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p
r
o
g
r
a
m
i
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d
ev
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p
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g
s
t
u
d
en
t
s
’
co
m
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k
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s
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u
p
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ted
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w
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s
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m
ilar
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es
u
lt
[
1
4
]
-
[
1
7
]
,
Sin
g
h
et
a
l.
f
o
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n
d
i
n
t
h
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s
tu
d
ie
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t
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at
m
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to
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ev
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il
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a
s
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lt
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f
m
e
n
to
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ac
tiv
i
ties
,
a
s
th
e
p
r
ev
io
u
s
s
tu
d
y
[
9
]
.
Sciclu
n
a
et
a
l.
f
o
u
n
d
th
at
teac
h
i
n
g
th
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j
u
n
io
r
s
i
m
p
r
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v
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m
en
to
r
s
’
co
m
m
u
n
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n
s
k
il
ls
.
T
h
e
p
ee
r
-
m
e
n
to
r
in
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p
r
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r
am
h
elp
ed
p
ee
r
-
m
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to
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in
m
ai
n
tai
n
in
g
i
n
ter
ac
tio
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w
it
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j
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n
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.
C
o
n
ti
n
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o
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s
in
ter
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n
s
lead
to
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m
p
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m
e
n
t
o
f
th
e
ir
o
v
er
all
co
m
m
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n
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s
k
ill
s
.
S
o
m
e
c
i
r
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m
s
t
a
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s
f
o
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d
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v
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e
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t
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w
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n
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s
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s
p
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c
i
a
l
l
y
t
h
o
s
e
w
h
o
a
r
e
s
h
y
[
1
0
]
.
A
b
d
o
lalizad
eh
et
a
l.
s
u
p
p
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r
ts
th
ese
f
i
n
d
in
g
s
b
y
s
tati
n
g
th
a
t
m
en
to
r
s
h
ad
a
p
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ce
p
tio
n
t
h
at
th
e
y
i
m
p
r
o
v
ed
t
h
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s
o
cial
s
k
ills
,
p
ar
tic
u
lar
l
y
co
m
m
u
n
icat
io
n
s
k
i
ll
s
a
n
d
e
m
p
ath
y
.
Me
n
to
r
s
al
s
o
h
ad
s
o
m
e
o
p
p
o
r
tu
n
itie
s
to
in
f
o
r
m
th
e
m
ed
ical
s
c
h
o
o
l
ad
m
in
is
tr
ativ
e
au
t
h
o
r
ities
ab
o
u
t
p
r
o
b
lem
s
a
n
d
co
n
ce
r
n
s
o
f
t
h
e
n
e
w
l
y
e
n
ter
ed
s
tu
d
e
n
ts
,
w
h
ic
h
r
esu
lted
in
d
ev
e
lo
p
in
g
an
ef
f
ec
ti
v
e
r
elatio
n
s
h
ip
w
it
h
th
e
m
.
C
o
m
m
u
n
ica
tin
g
w
it
h
s
ch
o
o
l
o
f
f
icials
a
s
w
ell
a
s
p
ar
ticip
atin
g
i
n
in
ter
-
m
en
to
r
s
ess
io
n
s
i
m
p
r
o
v
ed
th
e
m
en
to
r
s
’
ab
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y
to
cr
iticize
a
n
d
p
r
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v
id
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f
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d
b
ac
k
to
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th
er
s
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an
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ec
ti
v
e
m
a
n
n
er
.
T
h
ey
also
d
ec
lar
ed
th
at
p
ar
ticip
atin
g
i
n
th
e
m
e
n
to
r
in
g
p
r
o
g
r
am
i
m
p
r
o
v
ed
th
eir
tea
m
-
w
o
r
k
in
g
s
k
i
ll
s
[
1
3
]
.
Dick
m
an
et
a
l.
an
d
An
d
r
e
et
a
l
.
m
er
el
y
d
i
s
cu
s
s
ed
o
r
g
r
ac
e
d
th
e
to
p
ic
o
f
co
m
m
u
n
icatio
n
at
a
g
la
n
ce
in
th
eir
s
t
u
d
ies.
B
o
th
s
tu
d
ie
s
o
n
l
y
m
e
n
tio
n
ed
th
e
i
m
p
o
r
tan
ce
an
d
b
en
ef
i
ts
o
f
co
m
m
u
n
icatio
n
in
lear
n
i
n
g
th
r
o
u
g
h
teac
h
in
g
ex
p
er
ie
n
ce
w
it
h
o
u
t
r
ea
ll
y
ac
k
n
o
w
led
g
i
n
g
th
e
ch
an
g
es
i
n
co
m
m
u
n
icatio
n
s
k
ills
t
h
at
m
e
n
to
r
s
h
av
e
t
h
r
o
u
g
h
o
u
t t
h
eir
ex
p
er
ie
n
ce
as a
m
e
n
to
r
[
1
1
]
,
[
1
2
]
.
Ox
f
o
r
d
E
n
g
l
is
h
Dict
io
n
ar
y
s
ta
tes
t
h
at
“
co
m
m
u
n
icatio
n
is
i
m
p
ar
tin
g
,
co
n
v
e
y
i
n
g
,
o
r
e
x
ch
a
n
g
in
g
id
ea
s
an
d
k
n
o
w
led
g
e”
[
1
8
]
.
T
h
is
d
ef
i
n
itio
n
d
escr
ib
es
a
g
en
er
al
c
h
ar
ac
ter
is
tic
o
n
th
e
w
o
r
d
co
m
m
u
n
ica
tio
n
,
w
h
ich
is
“
a
p
r
o
ce
s
s
o
f
s
h
ar
in
g
,
co
n
v
e
y
in
g
id
ea
s
,
a
n
d
k
n
o
w
led
g
e
t
h
r
o
u
g
h
a
s
y
s
te
m
o
r
ce
r
tai
n
m
e
ch
an
i
s
m
i
n
v
o
lv
i
n
g
s
y
m
b
o
ls
,
s
i
g
n
s
a
n
d
b
eh
av
io
r
”.
I
n
ev
er
y
d
a
y
m
ed
ici
n
e
p
r
ac
ti
ce
,
co
m
m
u
n
icatio
n
i
s
t
h
e
c
en
t
er
,
if
n
o
t
t
h
e
h
ea
r
t
an
d
s
o
u
l
o
f
t
h
e
w
h
o
le
tr
ea
tm
en
t
r
eg
i
m
e
n
.
T
h
e
p
r
o
ce
s
s
o
f
i
m
p
ar
ti
n
g
a
n
d
ex
c
h
an
g
i
n
g
in
f
o
r
m
at
io
n
a
n
d
k
n
o
w
led
g
e
i
n
m
ed
icin
e
is
to
b
e
ap
p
lied
as
a
m
et
h
o
d
ical
m
ec
h
an
i
s
m
to
e
x
tr
ac
t
i
n
f
o
r
m
ati
o
n
th
a
t
t
h
e
d
o
cto
r
s
n
ee
d
f
r
o
m
p
a
tie
n
ts
-
b
e
it
f
r
o
m
an
a
m
n
es
is
a
n
d
/o
r
p
h
y
s
ica
l
ex
a
m
in
at
io
n
,
to
ar
r
iv
e
at
a
ce
r
t
ain
c
o
n
cl
u
s
io
n
an
d
f
o
r
m
a
d
iag
n
o
s
i
s
.
I
f
th
ese
s
er
i
es
o
f
in
f
o
r
m
atio
n
ex
tr
ac
tio
n
m
ec
h
a
n
i
s
m
i
s
f
la
w
ed
o
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e
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t
h
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en
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s
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ac
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p
r
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p
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ly
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t
h
e
w
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g
o
r
in
ap
p
r
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p
r
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w
a
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to
co
m
m
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icate
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o
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ea
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m
e
n
t
s
h
o
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o
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ld
lead
th
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p
atie
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t
to
in
ter
p
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et
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‘
d
o
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d
i
f
f
er
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tl
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leav
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)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
I
SS
N:
2
2
5
2
-
8806
Th
e
imp
a
ct
o
f p
ee
r
a
s
s
is
ted
lea
r
n
in
g
o
n
men
to
r
s
’
a
ca
d
emic
life
…
(
S
a
b
r
in
a
I
n
ta
n
Zo
r
a
y
a
)
407
B
etter
ca
r
e
an
d
h
i
g
h
-
q
u
a
lit
y
m
ed
icin
e
f
o
r
p
atien
t
s
s
tar
t
s
w
it
h
g
o
o
d
co
m
m
u
n
icatio
n
[
1
9
]
.
Do
cto
r
s
w
it
h
g
o
o
d
co
m
m
u
n
icatio
n
s
k
i
lls
ar
e
m
o
r
e
lik
el
y
to
m
a
k
e
a
n
ac
cu
r
ate,
co
m
p
r
eh
e
n
s
i
v
e
d
iag
n
o
s
is
an
d
d
etec
t
e
m
o
tio
n
al
d
is
tr
es
s
i
n
p
atie
n
ts
an
d
r
esp
o
n
d
to
t
h
e
m
ap
p
r
o
p
r
i
atel
y
;
a
m
o
n
g
o
th
er
s
.
Go
o
d
co
m
m
u
n
icatio
n
w
i
th
p
atien
ts
w
o
u
ld
en
s
u
r
e
p
atien
ts
’
s
ati
s
f
ac
tio
n
o
n
t
h
e
ca
r
e
th
e
y
h
av
e
r
ec
ei
v
ed
an
d
les
s
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x
i
o
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s
ab
o
u
t th
e
p
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o
b
le
m
in
v
o
l
v
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n
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th
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s
ick
n
e
s
s
.
Go
o
d
co
m
m
u
n
ica
tio
n
co
n
tr
ib
u
tes
to
p
atien
ts
a
g
r
ee
in
g
w
it
h
a
n
d
f
o
ll
o
w
i
n
g
ad
v
ic
e
g
iv
e
n
b
y
d
o
cto
r
s
.
T
h
is
g
iv
e
s
a
h
in
t
o
n
th
e
i
m
p
o
r
tan
ce
o
f
e
m
p
a
th
y
i
n
co
m
m
u
n
icatio
n
.
N
o
t
o
n
l
y
d
o
es
g
o
o
d
co
m
m
u
n
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n
p
av
es
a
p
ath
t
o
w
ar
d
s
a
b
etter
tr
ea
t
m
en
t,
b
u
t
also
g
i
v
es
a
p
o
s
iti
v
e
i
m
p
ac
t
o
n
p
atien
ts
’
p
h
y
s
ical
co
n
d
itio
n
[
2
0
]
.
3
.
2
.
2
.
E
m
pa
t
hy
E
m
p
ath
y
h
as
b
ee
n
d
ef
i
n
ed
as
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a
v
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i
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n
d
f
ee
li
n
g
s
o
f
an
o
t
h
er
h
u
m
a
n
b
ei
n
g
.
As
a
co
n
s
eq
u
en
ce
,
e
m
p
at
h
y
ca
n
d
e
s
c
r
i
b
e
a
w
i
d
e
r
an
g
e
o
f
s
o
c
i
al
p
h
en
o
m
en
a
,
s
u
c
h
as
f
e
e
l
in
g
c
o
n
c
e
r
n
f
o
r
an
o
t
h
e
r
p
e
r
s
o
n
’
s
s
i
tu
at
i
o
n
,
in
t
e
r
n
a
li
z
in
g
th
e
p
e
r
c
ei
v
e
d
em
o
ti
o
n
s
o
f
o
th
e
r
p
e
o
p
l
e
[
2
1
]
,
d
is
ce
r
n
in
g
a
n
d
ac
ce
p
ti
n
g
o
th
er
p
eo
p
le’
s
m
o
ti
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es
o
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in
te
n
t
io
n
s
,
o
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ad
o
p
tin
g
w
h
a
t
o
th
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s
ar
e
p
er
ce
iv
e
d
to
b
eliev
e
o
r
to
b
e
th
in
k
i
n
g
.
Su
ch
e
m
p
at
h
et
ic
r
e
s
p
o
n
s
es
ar
e
th
o
u
g
h
t
to
in
cr
ea
s
e
w
h
e
n
e
v
er
a
p
er
s
o
n
h
as
h
ad
a
r
elate
d
p
r
ev
io
u
s
ex
p
er
ien
ce
,
p
er
ce
iv
es
a
s
i
m
ilar
it
y
b
et
w
ee
n
h
i
m
s
elf
o
r
h
er
s
el
f
a
n
d
an
o
t
h
er
p
er
s
o
n
,
r
ec
eiv
es
ex
p
licit o
r
i
m
p
licit
e
m
p
ath
y
tr
ain
i
n
g
,
a
n
d
w
i
th
t
h
e
s
tr
e
n
g
th
o
r
s
alien
ce
of
a
p
er
s
o
n
al
as
s
o
ci
atio
n
[
2
2
]
.
T
h
e
ca
p
ac
ity
to
ta
k
e
t
h
e
p
er
s
p
ec
tiv
e
o
f
o
t
h
er
s
,
to
b
e
s
e
n
s
it
iv
e
to
th
eir
in
n
er
e
x
p
er
ien
ce
an
d
to
en
g
a
g
e
w
it
h
t
h
e
m
co
m
p
a
s
s
io
n
atel
y
,
r
ath
er
th
a
n
s
i
m
p
l
y
s
h
ar
i
n
g
t
h
ei
r
em
o
tio
n
s
(
s
y
m
p
at
h
y
)
i
s
o
n
e
o
f
th
e
d
ef
i
n
itio
n
an
d
k
e
y
w
o
r
d
ex
a
m
p
les
o
f
e
m
p
at
h
y
.
I
n
t
h
e
m
ed
ical
co
n
te
x
t,
e
m
p
ath
y
ca
n
b
e
d
ef
i
n
ed
as
“a
p
p
r
ec
iatio
n
o
f
th
e
p
atien
t
’
s
e
m
o
tio
n
s
an
d
ex
p
r
es
s
io
n
o
f
th
a
t
a
w
ar
e
n
es
s
to
th
e
p
atien
t”.
E
m
p
ath
y
w
as
al
s
o
as
a
co
g
n
itiv
e
ab
ilit
y
in
p
r
o
v
id
in
g
ca
r
e,
u
n
d
er
s
ta
n
d
in
g
a
n
d
p
atien
t
’
s
p
er
s
p
ec
tiv
e,
an
d
r
elate
s
to
co
m
m
u
n
icatio
n
s
k
ill
i
n
m
ed
ical
f
ield
s
[
2
3
]
.
R
esear
ch
e
s
h
av
e
s
h
o
w
n
t
h
e
p
o
s
iti
v
e
o
u
tco
m
es
ass
o
ciate
d
w
i
th
th
e
q
u
alit
y
o
f
d
o
cto
r
-
p
atie
n
t
r
elatio
n
s
h
ip
an
d
d
o
cto
r
-
p
atie
n
t
co
m
m
u
n
icatio
n
,
a
n
d
t
h
at
e
m
p
a
th
y
e
n
h
a
n
ce
s
b
o
th
.
Mo
r
e
e
m
p
ath
ic
s
t
u
d
en
t
s
r
ec
eiv
e
h
ig
h
er
r
ati
n
g
s
o
f
cli
n
ical
co
m
p
e
ten
ce
a
n
d
p
er
f
o
r
m
ed
b
ette
r
o
n
h
i
s
to
r
y
-
ta
k
in
g
an
d
s
tan
d
ar
d
ized
p
h
y
s
ical
ex
a
m
i
n
atio
n
s
.
Mo
r
e
e
m
p
ath
ic
m
ed
ical
s
tu
d
e
n
ts
an
d
d
o
cto
r
s
r
ec
eiv
ed
h
ig
h
er
p
atien
t
s
at
is
f
ac
tio
n
r
atin
g
s
.
E
m
p
at
h
y
ca
n
i
n
f
l
u
e
n
ce
th
e
p
atien
t
to
b
e
ab
le
to
in
cr
ea
s
e
p
atien
t
s
ati
s
f
ac
tio
n
a
n
d
co
m
p
lia
n
ce
i
n
th
e
tr
ea
t
m
e
n
t
p
r
o
ce
s
s
[
2
4
]
-
[
2
6
]
.
P
atien
ts
j
u
d
g
e
e
m
p
at
h
y
to
b
e
v
er
y
i
m
p
o
r
tan
t
in
co
n
s
u
ltat
io
n
s
,
a
n
d
s
h
o
w
b
etter
tr
ea
t
m
e
n
t a
d
h
er
en
ce
a
n
d
g
r
ea
t
er
en
ab
le
m
e
n
t
w
it
h
m
o
r
e
e
m
p
ath
ic
d
o
cto
r
s
[
2
7
]
-
[
3
2
]
.
Do
cto
r
s
an
d
m
ed
ical
ca
r
e
g
i
v
er
s
ar
e
a
m
o
n
g
s
t
th
o
s
e
in
d
i
v
id
u
als
w
h
o
ar
e
p
o
s
it
io
n
ed
b
y
s
o
ciet
y
a
s
p
eo
p
le
w
h
o
tr
ea
t
ill
n
ess
a
n
d
c
o
m
f
o
r
ts
t
h
o
s
e
w
h
o
ar
e
in
t
h
eir
ca
r
e.
I
t
is
n
o
t
o
u
t
o
f
lo
g
ic
th
a
t
th
ese
i
n
d
i
v
id
u
al
s
ar
e
ex
p
ec
ted
to
h
av
e
a
h
i
g
h
d
e
g
r
ee
o
f
e
m
p
at
h
y
to
w
ar
d
s
t
h
eir
f
ello
w
m
e
n
,
g
iv
e
n
t
h
eir
s
tat
u
s
.
I
t
is
,
h
o
w
e
v
er
n
o
t
al
w
a
y
s
th
e
c
ase.
E
t
h
ical
er
o
s
io
n
,
a
p
h
e
n
o
m
en
o
n
w
h
er
e
em
p
a
th
y
a
n
d
s
y
m
p
at
h
y
d
ec
li
n
es
w
it
h
i
n
cr
ea
s
i
n
g
clin
ical
e
x
p
er
ien
ce
s
h
a
s
b
ee
n
d
escr
ib
ed
in
US
m
ed
ical
s
t
u
d
en
t
s
tr
an
s
itio
n
in
g
f
r
o
m
p
r
e
-
cli
n
ical
to
cli
n
ical
tr
ain
i
n
g
,
an
d
o
n
w
ar
d
s
in
to
s
p
e
cialis
m
a
n
d
in
d
ep
en
d
en
t
p
r
ac
t
ice
[
3
3
]
-
[
3
9
]
.
W
o
r
k
p
lace
s
tr
es
s
h
as
b
ee
n
cited
as
a
ca
u
s
e
o
f
et
h
ical
er
o
s
io
n
a
m
o
n
g
s
t
d
o
cto
r
s
,
an
d
in
cr
ea
s
i
n
g
lev
e
ls
o
f
cli
n
ical
r
esp
o
n
s
ib
ilit
y
a
n
d
f
ati
g
u
e
s
ec
o
n
d
ar
y
to
w
o
r
k
lo
ad
ar
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p
o
s
s
ib
le
d
r
iv
er
s
o
f
e
m
p
ath
y
d
ec
li
n
e
[
3
3
]
,
[
34
]
,
[
37
]
,
[
39
]
-
[
4
2
]
Hav
i
n
g
a
s
tr
o
n
g
an
d
w
ell
d
e
v
elo
p
ed
s
en
s
e
o
f
e
m
p
ath
y
in
a
m
ed
ical
s
tu
d
e
n
t
’
s
c
h
ar
ac
ter
tr
aits
m
i
g
h
t
h
elp
i
n
g
iv
i
n
g
a
n
e
v
en
b
ette
r
f
o
u
n
d
atio
n
f
o
r
a
m
o
r
e
r
esil
ien
t
s
en
s
e
o
f
e
m
p
at
h
y
i
n
f
u
t
u
r
e
d
o
cto
r
s
.
A
n
d
m
en
to
r
i
n
g
j
u
n
io
r
s
o
r
p
ee
r
s
m
i
g
h
t
b
e
o
n
e
o
f
th
e
w
a
y
s
to
d
ev
elo
p
it i
n
ea
r
l
y
y
ea
r
s
o
f
m
ed
ical
ed
u
ca
tio
n
.
B
ased
o
n
th
e
m
en
to
r
s
’
p
er
ce
p
tio
n
,
co
m
m
u
n
icati
n
g
w
it
h
t
h
e
m
e
n
tees
i
m
p
r
o
v
ed
th
eir
s
o
cial
s
k
ill
s
,
p
ar
ticu
lar
l
y
t
h
eir
co
m
m
u
n
ic
atio
n
s
k
ills
a
n
d
s
en
s
e
o
f
e
m
p
a
th
y
.
Me
n
to
r
s
h
ad
to
r
ef
lect
o
n
t
h
eir
o
w
n
ex
p
er
ien
ce
s
a
n
d
c
h
o
o
s
e
s
u
cc
e
s
s
f
u
l
o
n
es
to
s
o
lv
e
s
i
m
ilar
p
r
o
b
le
m
s
o
f
t
h
eir
m
e
n
tee
s
i
n
o
r
d
er
to
h
elp
th
e
m
.
T
h
is
in
t
u
r
n
i
m
p
r
o
v
ed
t
h
eir
o
w
n
s
e
lf
-
r
ef
lect
io
n
ab
ilit
y
.
Me
n
to
r
s
f
ee
l
e
m
o
tio
n
a
ll
y
co
n
te
n
t
a
n
d
s
atis
f
ied
to
s
ee
t
h
eir
m
en
tees
p
as
s
ed
[
1
3
]
.
T
h
is
f
i
n
d
in
g
b
y
A
b
d
o
lalizad
eh
et
a
l.
i
s
also
d
o
cu
m
en
ted
b
y
Si
n
g
h
e
t
a
l.
w
h
er
e
m
en
to
r
s
f
elt
th
a
t
th
eir
s
el
f
-
r
ef
lect
in
g
th
in
k
in
g
in
cr
ea
s
ed
w
h
ile
an
d
af
t
er
teac
h
in
g
th
eir
m
e
n
tee
s
d
u
e
to
th
e
f
ac
t
th
at
t
h
e
y
w
er
e
r
e
m
in
d
ed
b
y
t
h
e
p
ast
ti
m
e
o
f
w
h
at
t
h
e
y
s
h
o
u
ld
n
o
t
d
o
an
d
ad
v
is
ed
th
eir
j
u
n
io
r
n
o
t
to
m
ak
e
t
h
e
s
a
m
e
m
is
tak
e
[
9
]
.
3
.
2
.
3
.
T
ea
ching
s
k
ill
s
“
To
tea
ch
is
to
lea
r
n
t
w
ice
.
”
(
J
o
s
ep
h
J
o
u
b
er
t)
[
4
3
]
.
T
h
e
q
u
o
te
ab
o
v
e
h
as
a
s
tr
o
n
g
r
elata
b
le
ess
e
n
ce
w
it
h
t
h
e
t
h
e
m
e
d
is
c
u
s
s
ed
in
th
is
r
e
v
ie
w
.
Fi
n
d
in
g
s
i
n
t
h
e
j
o
u
r
n
als
w
e
h
a
v
e
r
ev
ie
w
e
d
h
ig
h
li
g
h
ted
t
h
e
ex
p
er
i
en
ce
o
f
teac
h
i
n
g
f
r
o
m
t
h
e
m
e
n
to
r
s
’
-
b
e
it
p
ee
r
s
o
r
n
ea
r
p
ee
r
s
,
p
er
s
p
ec
tiv
e.
No
t
o
n
l
y
d
o
m
e
n
to
r
s
h
ad
t
h
e
ex
p
er
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ce
to
lear
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h
o
w
to
teac
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,
th
e
y
h
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to
lear
n
t
w
ice
in
o
r
d
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to
teac
h
th
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m
e
n
tees
w
ell.
A
s
id
e
ef
f
ec
t
f
r
o
m
t
h
at
is
h
a
v
i
n
g
b
etter
u
n
d
er
s
tan
d
in
g
o
n
th
e
s
u
b
j
ec
ts
th
e
y
w
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e
a
s
s
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n
e
d
t
o
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e
a
c
h
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m
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t
o
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a
v
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a
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d
a
b
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r
w
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x
p
l
a
i
n
i
n
g
-
i
m
p
a
r
t
i
n
g
k
n
o
w
l
e
d
g
e
t
o
t
h
e
i
r
m
e
n
t
e
e
s
.
As
h
as
b
ee
n
ad
d
r
ess
ed
b
y
Sci
clu
n
a
et
a
l.
i
n
t
h
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s
tu
d
ie
s
,
m
en
to
r
s
f
o
u
n
d
th
at
teac
h
in
g
t
h
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j
u
n
io
r
s
p
r
o
m
o
ted
th
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d
ee
p
lear
n
i
n
g
.
T
h
ey
f
elt
th
at
th
eir
u
n
d
er
s
ta
n
d
in
g
an
d
k
n
o
w
led
g
e
o
f
a
to
p
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er
e
a
u
g
m
e
n
ted
b
y
b
ein
g
n
ea
r
-
p
ee
r
teac
h
er
[
1
0
]
,
[
4
4
]
.
T
h
is
p
h
en
o
m
en
o
n
h
as
b
ee
n
s
t
u
d
ied
i
n
q
u
i
te
a
n
u
m
b
er
o
f
s
t
u
d
ies.
Am
o
n
g
o
th
er
s
r
ev
ie
w
s
b
y
Fio
r
ella
an
d
Ma
y
er
,
b
y
D
u
r
an
,
an
d
b
y
An
n
ette
B
u
r
g
e
s
s
.
T
h
e
s
tu
d
en
t
tu
to
r
s
elf
-
p
er
ce
iv
ed
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
2
5
2
-
8
8
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6
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
,
Vo
l.
1
0
,
No
.
2
,
J
u
n
e
20
21
:
4
01
–
4
10
408
b
en
ef
it
s
s
u
ch
a
s
t
u
to
r
s
ar
e
d
r
iv
en
to
en
g
ag
e,
a
n
al
y
s
e
a
n
d
v
er
b
alis
e
w
h
at
t
h
e
y
k
n
o
w
,
an
d
to
r
ea
lis
e
an
d
ad
d
r
ess
th
eir
o
w
n
k
n
o
w
led
g
e
g
ap
s
[
4
4
]
.
C
o
m
p
ar
ed
to
th
e
s
tu
d
en
ts
wh
o
o
n
l
y
s
t
u
d
y
,
t
h
e
s
t
u
d
en
ts
w
h
o
teac
h
th
eir
p
ee
r
s
d
ev
elo
p
r
elativ
el
y
m
o
r
e
co
m
p
r
eh
en
s
iv
e
u
n
d
er
s
tan
d
i
n
g
o
f
a
s
u
b
j
ec
t.
T
h
is
is
co
n
f
ir
m
ed
b
y
s
tu
d
y
f
i
n
d
i
n
g
s
b
y
Fio
r
ella
an
d
Ma
y
er
.
T
h
e
y
f
u
r
t
h
er
s
tate
t
h
at
t
h
e
s
t
u
d
en
ts
w
h
o
p
r
ep
a
r
e
an
d
ac
tu
all
y
teac
h
h
av
e
m
o
r
e
en
d
u
r
in
g
co
m
p
r
e
h
en
s
io
n
t
h
at
w
as
m
ea
s
u
r
ed
th
r
o
u
g
h
lo
n
g
-
ter
m
as
s
es
s
m
en
t
th
a
n
th
o
s
e
w
h
o
o
n
l
y
p
r
e
p
ar
e
to
teac
h
[
4
5
]
.
Du
r
an
d
i
s
cu
s
s
es
in
h
i
s
r
ev
ie
w
w
h
et
h
er
teac
h
in
g
is
a
n
e
f
f
ec
ti
v
e
w
a
y
to
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n
.
T
h
e
p
r
o
ce
s
s
o
f
teac
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i
n
g
co
m
p
r
is
e
s
p
r
ep
ar
atio
n
,
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p
lan
atio
n
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d
f
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d
b
ac
k
.
W
h
e
n
ex
p
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to
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ch
,
th
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d
e
n
ts
p
r
ep
ar
es
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ater
ial
to
b
e
p
r
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ted
.
T
h
e
s
tu
d
e
n
ts
ca
n
tr
an
s
f
er
t
h
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k
n
o
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g
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b
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x
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ial
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b
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led
g
e
a
n
d
ad
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r
ess
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g
t
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r
r
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r
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r
t
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.
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d
b
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it
t
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d
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t
m
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to
r
s
/t
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to
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h
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iz
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f
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f
ee
d
b
ac
k
b
ased
o
n
in
-
d
ep
th
th
in
k
i
n
g
r
e
f
lecti
n
g
to
th
eir
o
w
n
u
n
d
er
s
tan
d
i
n
g
an
d
li
m
i
tatio
n
[
4
6
]
.
3
.
2
.
4
.
L
ea
dersh
ip
Sin
g
h
et
a
l.
i
n
t
h
eir
f
in
d
i
n
g
s
f
o
u
n
d
th
a
t
m
en
to
r
s
d
e
v
el
o
p
ed
b
etter
lead
er
s
h
ip
s
k
ill
s
.
T
h
es
e
m
e
n
to
r
s
also
d
ev
elo
p
ed
a
s
en
s
e
o
f
co
n
ce
r
n
an
d
g
o
al.
Mo
s
t
n
ea
r
-
p
ee
r
m
e
n
to
r
s
t
h
o
u
g
h
t
t
h
at
t
h
e
s
t
u
d
en
t
m
en
to
r
p
r
o
g
r
a
m
in
Me
n
to
r
in
g
2
0
1
0
ea
r
n
th
em
ad
v
a
n
ta
g
es
i
n
d
u
al
m
en
to
r
in
g
,
p
r
o
b
le
m
s
o
l
v
i
n
g
,
r
esp
o
n
s
ib
ilit
y
,
i
n
ter
ac
tio
n
,
co
n
f
id
e
n
ce
,
co
u
n
s
eli
n
g
,
b
u
ild
i
n
g
r
ela
tio
n
s
,
a
n
d
s
el
f
-
a
n
al
y
s
is
o
f
m
is
ta
k
es.
So
m
e
g
ai
n
ed
co
n
f
id
en
c
e
a
n
d
s
e
l
f
-
s
a
t
i
s
f
a
c
t
i
o
n
w
h
e
n
t
h
e
y
f
o
u
n
d
o
u
t
t
h
a
t
t
h
e
m
e
n
t
e
e
t
h
e
y
t
a
u
g
h
t
c
o
u
l
d
p
a
s
s
w
e
l
l
.
O
n
t
h
e
o
t
h
e
r
h
a
n
d
,
S
c
i
c
l
u
n
a
et
a
l.
f
o
u
n
d
th
at
n
ea
r
-
p
ee
r
teac
h
er
s
b
eli
ev
ed
th
at
teac
h
in
g
th
e
ir
j
u
n
io
r
s
aid
ed
th
e
m
i
n
ac
h
ie
v
i
n
g
m
o
r
e
co
n
f
id
en
ce
.
96.
3
%
o
f
th
e
m
f
el
t
en
co
u
r
ag
e
d
to
s
u
p
p
o
r
t
th
eir
j
u
n
io
r
s
.
An
d
r
e
et
a
l.
also
em
p
h
asized
t
h
e
b
en
ef
it
s
ea
r
n
ed
b
y
m
en
to
r
s
ar
e
lead
er
s
h
ip
s
k
ill
s
.
T
h
ey
f
o
u
n
d
t
h
at
8
1
%
s
tr
o
n
g
l
y
a
g
r
ee
d
th
at,
o
n
an
i
n
d
iv
id
u
al
b
asis
,
th
e
y
w
er
e
p
r
ep
ar
e
d
to
m
en
to
r
th
eir
j
u
n
i
o
r
s
.
T
h
e
y
b
eliev
ed
th
at
MiM
elec
tiv
e
co
u
ld
in
cr
ea
s
e
th
e
ir
MiM
ex
p
er
ien
ce
(
7
7
%),
m
en
to
r
in
g
s
k
ill (
8
3
%),
an
d
lead
er
s
h
ip
(
8
0
%)
[9
]
,
[
10
]
,
[
1
2
]
.
R
o
y
al
C
o
lleg
e
o
f
P
h
y
s
ic
ian
s
i
n
2
0
1
0
s
tated
th
at
“
Ou
r
clea
r
view
i
s
th
a
t
d
o
cto
r
s
h
a
ve
fo
r
2
5
ye
a
r
s
,
p
erh
a
p
s
lo
n
g
er,
b
ee
n
fa
ilin
g
t
o
g
ive
th
e
lea
d
ers
h
ip
o
f
w
h
ic
h
th
ey
a
r
e
emin
en
tly
c
a
p
a
b
le,
a
n
d
w
h
ich
s
o
ciety
r
ig
h
tly
ex
p
ec
ts
o
f
th
em
.
”
T
h
e
Gen
er
al
Me
d
ical
C
o
u
n
cil
i
n
th
e
2
0
0
9
v
er
s
io
n
o
f
T
o
m
o
r
r
o
w
’
s
Do
cto
r
s
s
tated
:
“
Med
ica
l
s
tu
d
en
ts
a
r
e
to
mo
r
r
o
w
’
s
d
o
cto
r
s
.
I
n
a
cc
o
r
d
a
n
ce
w
ith
Go
o
d
Med
ica
l
P
r
a
ctice
,
g
r
a
d
u
a
tes
w
ill
ma
ke
th
e
ca
r
e
o
f
th
eir
p
a
tien
ts
th
ei
r
fir
s
t
co
n
ce
r
n
,
a
p
p
lyin
g
th
eir
kn
o
w
led
g
e
a
n
d
s
kills
i
n
a
c
o
m
p
e
t
e
n
t
a
n
d
e
t
h
i
c
a
l
m
a
n
n
e
r
a
n
d
u
s
i
n
g
t
h
e
i
r
a
b
i
l
i
t
y
t
o
p
r
o
v
i
d
e
l
e
a
d
e
r
s
h
i
p
a
n
d
a
n
a
l
y
s
e
c
o
m
p
l
e
x
a
n
d
u
n
c
e
r
t
a
i
n
s
i
t
u
a
t
i
o
n
s
”
[
4
7
].
“
Th
ere
i
s
n
o
th
in
g
in
a
p
h
ysicia
n
’
s
ed
u
c
a
tio
n
a
n
d
tr
a
in
in
g
th
a
t
q
u
a
lifi
es
h
im
to
b
ec
o
me
a
lea
d
er
.
”
(
Ma
th
is
,
“
Th
e
Ma
th
is
ma
xim
s
:
less
o
n
s
in
lea
d
ers
h
ip
”)
[
4
8
]
.
T
h
is
lin
e
f
r
o
m
Ma
t
h
is
co
u
ld
n
o
t
b
e
f
ar
f
r
o
m
th
e
tr
u
th
.
Me
d
ical
k
n
o
w
led
g
e
alo
n
e
is
i
n
s
u
f
f
ic
ien
t
to
p
r
o
v
id
e
ex
ce
llen
t
m
ed
ical
ca
r
e.
T
h
e
r
o
le
o
f
a
p
h
y
s
ician
g
o
es
b
ey
o
n
d
s
i
m
p
l
y
p
r
o
v
id
in
g
cli
n
i
ca
l c
ar
e
an
d
en
co
m
p
as
s
es a
le
ad
er
s
h
ip
r
o
le
w
it
h
i
n
th
e
h
ea
lt
h
ca
r
e
team
,
m
ed
ical
ce
n
tr
e,
p
r
o
f
ess
io
n
,
a
n
d
co
m
m
u
n
i
t
y
.
C
l
in
ic
ian
s
m
u
s
t
m
aster
th
e
n
ec
es
s
ar
y
s
k
ill
s
to
co
o
p
er
ate
an
d
co
llab
o
r
at
e
w
it
h
o
th
er
h
ea
lt
h
ca
r
e
p
r
o
f
ess
i
o
n
als
an
d
e
f
f
ec
t
iv
el
y
lead
a
tea
m
in
t
h
e
p
atien
t
-
ca
r
e
en
v
ir
o
n
m
en
t
an
d
th
e
lar
g
er
co
n
tex
t,
o
f
h
ea
lt
h
ca
r
e
s
y
s
te
m
s
[4
9
]
.
T
o
b
e
co
m
p
eten
t
p
h
y
s
icia
n
s
,
ta
k
i
n
g
o
n
p
ee
r
m
en
to
r
in
g
lead
er
s
h
ip
r
esp
o
n
s
ib
ilit
y
ca
n
f
u
r
th
er
d
ev
elo
p
th
e
s
k
ills
n
ee
d
ed
s
u
c
h
as
en
h
a
n
ce
t
h
eir
co
m
m
u
n
ica
tio
n
,
in
ter
p
er
s
o
n
al,
an
d
lead
er
s
h
ip
s
k
ills
[
50
]
-
[
5
2
]
.
Stu
d
ies
ca
r
r
ied
o
u
t
i
n
th
e
Un
i
te
d
States
f
o
r
lead
er
s
h
ip
d
ev
elo
p
m
e
n
t
w
e
r
e
i
m
p
lici
t
r
ath
er
th
an
e
x
p
licit
an
d
th
at
l
ea
d
er
s
h
ip
d
ev
elo
p
m
en
t
w
a
s
r
ar
el
y
th
e
m
a
in
p
u
r
p
o
s
e
o
f
th
e
ac
tiv
it
y
(
O
’
C
o
n
n
e
ll
an
d
P
asco
e,
2
0
0
4
)
[4
7
].
E
ac
h
s
t
u
d
y
,
r
e
s
ea
r
ch
,
a
n
d
r
ev
i
e
w
al
w
a
y
s
h
as
l
i
m
itatio
n
s
a
n
d
th
i
s
r
ev
ie
w
is
n
o
e
x
ce
p
tio
n
.
Ou
r
s
t
u
d
y
f
o
cu
s
ed
o
n
m
e
n
to
r
s
'
p
o
in
t
o
f
v
ie
w
,
a
n
d
i
m
p
ac
ts
o
n
m
en
to
r
s
’
li
f
e
i
n
t
h
e
ac
ad
e
m
ic
e
n
v
ir
o
n
m
en
t.
W
h
ile
o
n
e
o
f
w
h
ic
h
th
e
li
m
itat
io
n
is
t
h
at
w
e
co
u
ld
o
n
l
y
o
b
tai
n
f
r
ee
f
u
ll
-
te
x
t
j
o
u
r
n
al
p
u
b
licatio
n
s
.
T
h
e
o
th
er
is
o
f
th
e
lan
g
u
a
g
e
b
ar
r
ier
,
w
h
er
e
w
e
o
n
l
y
s
e
lecte
d
E
n
g
l
is
h
b
ased
a
r
ticles.
T
h
is
m
ea
n
s
t
h
at
o
u
r
s
co
p
e
o
f
r
ev
ie
w
i
s
r
elativ
el
y
n
ar
r
o
w
.
4.
CO
NCLU
SI
O
N
P
ee
r
A
s
s
i
s
ted
L
ea
r
n
in
g
P
r
o
g
r
a
m
s
al
m
o
s
t
co
n
s
i
s
te
n
tl
y
g
iv
e
b
en
e
f
its
to
w
ar
d
s
m
en
tee
o
r
j
u
n
io
r
s
tu
d
e
n
ts
.
T
h
e
b
en
e
f
its
i
n
clu
d
e
b
etter
ac
ad
e
m
ic
ac
h
ie
v
e
m
en
t
s
in
th
e
ir
m
ed
ical
s
t
u
d
ies.
St
u
d
ies co
n
ce
r
n
in
g
th
e
i
m
p
ac
t
o
f
P
ee
r
Ass
i
s
ted
L
ea
r
n
in
g
P
r
o
g
r
a
m
,
b
e
it
p
ee
r
-
m
e
n
to
r
in
g
o
r
n
ea
r
-
p
ee
r
m
en
to
r
in
g
ar
e
r
ar
el
y
d
is
c
u
s
s
ed
.
Stu
d
e
n
ts
w
h
o
ar
e
m
en
to
r
s
f
elt
th
at
th
e
y
w
er
e
n
o
t
m
er
el
y
b
ei
n
g
a
s
t
u
d
en
t,
b
u
t
also
li
v
in
g
t
h
eir
lif
e
a
n
d
h
a
v
in
g
d
ev
e
lo
p
ed
im
p
r
o
v
e
m
en
t
s
in
t
h
eir
ac
ad
e
m
ic
lif
e
as
a
w
h
o
le.
Me
n
to
r
s
h
av
e
b
ee
n
f
o
u
n
d
to
h
av
e
a
b
etter
ac
ad
em
ic
li
f
e
in
ter
m
s
o
f
s
o
c
ial
s
k
ill
s
.
Am
o
n
g
th
e
m
ar
e
c
o
m
m
u
n
icatio
n
s
s
k
ills
,
e
m
p
at
h
y
,
lead
er
s
h
ip
,
an
d
teac
h
i
n
g
s
k
ill
s
.
T
h
ese
s
k
ills
t
h
at
w
o
u
ld
b
e
t
h
e
f
o
u
n
d
ati
o
n
a
n
d
i
m
p
o
r
ta
n
t
m
o
d
alities
th
at
w
o
u
ld
s
u
r
el
y
b
en
e
f
it
th
e
m
in
t
h
eir
li
f
e
as a
d
o
cto
r
,
b
e
it a
s
a
p
r
ac
titi
o
n
er
,
o
r
as a
n
ed
u
ca
to
r
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
I
SS
N:
2
2
5
2
-
8806
Th
e
imp
a
ct
o
f p
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r
a
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is
ted
lea
r
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in
g
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life
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(
S
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409
RE
F
E
R
E
NC
E
S
[1
]
T
o
p
p
in
g
K
.
J
,
“
T
h
e
e
ff
e
c
ti
v
e
n
e
ss
o
f
p
e
e
r
tu
to
rin
g
in
f
u
rth
e
r
a
n
d
h
ig
h
e
r
e
d
u
c
a
ti
o
n
:
A
t
y
p
o
lo
g
y
a
n
d
re
v
ie
w
o
f
th
e
li
tera
tu
re
,
”
Hig
h
e
r
Ed
u
c
a
ti
o
n
,
v
o
l
.
3
2
,
n
o
.
3
,
p
p
.
3
2
1
-
3
45
,
1
9
9
6
.
[2
]
He
rr
m
a
n
n
-
W
e
rn
e
r,
A
e
t
a
l.
,
“
P
e
e
r
-
a
ss
isted
lea
rn
in
g
(P
A
L
)
in
u
n
d
e
rg
ra
d
u
a
te
m
e
d
ica
l
e
d
u
c
a
ti
o
n
:
A
n
o
v
e
r
v
ie
w
,
”
Z
e
it
sc
h
rift
f
ü
r E
v
id
e
n
z,
Fo
rt
b
il
d
u
n
g
u
n
d
Qu
a
li
t
ä
t
im
Ge
su
n
d
h
e
it
sw
e
se
n
,
v
o
l.
1
2
1
,
p
p
.
74
-
81
,
2
0
1
7
.
[3
]
Irv
in
e
,
S
,
W
il
li
a
m
s,
B
,
a
n
d
M
c
Ke
n
n
a
,
L
,
“
Ho
w
a
re
we
a
ss
e
s
sin
g
n
e
a
r
-
p
e
e
r
tea
c
h
in
g
in
u
n
d
e
rg
ra
d
u
a
te
h
e
a
lt
h
p
ro
f
e
ss
io
n
a
l
e
d
u
c
a
ti
o
n
?
A
s
y
ste
m
a
ti
c
re
v
ie
w
,
”
Nu
rs
e
Ed
u
c
a
ti
o
n
t
o
d
a
y
,
v
o
l.
5
0
,
p
p
.
42
-
50
,
2
0
1
7
.
[4
]
Ola
u
ss
e
n
A
,
Re
d
d
y
P
,
Irv
in
e
S
,
a
n
d
W
il
l
iam
s
B,
“
P
e
e
r
-
a
ss
isted
lea
rn
in
g
:
T
im
e
f
o
r
n
o
m
e
n
c
latu
re
c
la
rif
ic
a
ti
o
n
,
”
M
e
d
ica
l
Ed
u
c
a
ti
o
n
O
n
li
n
e
,
v
o
l.
2
1
,
n
o
.
1
,
p
p
.
1
-
8
,
2
0
1
6
.
[5
]
Yu
,
T
.
C,
W
il
so
n
,
N.
C,
S
in
g
h
,
P
.
P
,
L
e
m
a
n
u
,
D.
P
,
Ha
wk
e
n
,
S
.
J
,
a
n
d
Hill
,
A
.
G
,
“
M
e
d
ica
l
stu
d
e
n
t
s
-
as
-
tea
c
h
e
rs:
a
s
y
ste
m
a
ti
c
re
v
ie
w
o
f
p
e
e
r
-
a
ss
ist
e
d
tea
c
h
in
g
d
u
rin
g
m
e
d
ica
l
sc
h
o
o
l
,
”
Ad
v
a
n
c
e
s
in
me
d
ica
l
e
d
u
c
a
ti
o
n
a
n
d
p
ra
c
ti
c
e
,
v
o
l.
2
,
p
p
.
1
5
7
-
1
72
,
2
0
1
1
.
[6
]
B
ro
o
k
e
r
A
,
Bro
o
k
e
r
S
,
a
n
d
L
a
w
r
e
n
c
e
J
,
“
F
irst
y
e
a
r
stu
d
e
n
ts’
p
e
rc
e
p
ti
o
n
s
o
f
th
e
ir
d
if
f
icu
lt
ies
,
”
S
tu
d
e
n
t
S
u
c
c
e
ss
,
v
o
l.
8
,
n
o
.
1
,
p
p
.
49
-
62
,
2
0
1
7
.
[7
]
Bh
u
iy
a
n
P
,
S
u
p
e
A
,
a
n
d
Re
g
e
N
,
“
T
h
e
A
rt
o
f
Tea
c
h
in
g
M
e
d
ica
l
S
tu
d
e
n
ts,
”
3
rd
e
d
.
I
n
d
ia
:
Ree
d
El
se
v
ier
In
d
ia
,
2
0
1
5
.
[8
]
M
o
h
e
r
D
e
t
a
l
.
,
“
P
r
e
f
e
r
r
e
d
re
p
o
r
t
i
n
g
i
t
e
m
s
f
o
r
sy
s
tem
a
t
i
c
re
v
iew
s
a
n
d
m
e
ta
-
a
n
a
ly
s
e
s
:
T
h
e
P
R
I
S
M
A
st
a
t
e
m
e
n
t
,
”
P
L
o
S
M
e
d
i
c
i
n
e
,
v
o
l
.
8
,
n
o
.
7
7
1
6
,
p
p
.
3
3
6
-
3
4
1
,
2
0
0
9
.
[9
]
S
in
g
h
S
,
S
in
g
h
N,
a
n
d
Dh
a
li
w
a
l
U
,
“
Ne
a
r
-
p
e
e
r
m
e
n
to
rin
g
t
o
c
o
m
p
lem
e
n
t
f
a
c
u
lt
y
m
e
n
to
rin
g
o
f
f
irs
t
-
y
e
a
r
m
e
d
ica
l
stu
d
e
n
ts
in
I
n
d
ia,”
J
o
u
rn
a
l
o
f
Ed
u
c
a
ti
o
n
a
l
Eva
l
u
a
ti
o
n
f
o
r
He
a
lt
h
Pro
f
e
ss
io
n
s
,
v
o
l.
1
1
,
n
o
.
12
,
2
0
1
4
.
[1
0
]
S
c
iclu
n
a
H
.
A
,
O’S
u
ll
iv
a
n
A
.
J,
Bo
y
le
P
,
Jo
n
e
s
P
.
D,
a
n
d
M
c
Ne
i
l
H
.
P
,
“
P
e
e
r
lea
rn
in
g
i
n
t
h
e
UN
S
W
M
e
d
icin
e
p
ro
g
ra
m
As
se
ss
m
e
n
t
a
n
d
e
v
a
lu
a
ti
o
n
o
f
a
d
m
issio
n
s,
k
n
o
w
led
g
e
,
sk
i
ll
s
a
n
d
a
tt
it
u
d
e
s,”
BM
C
me
d
ica
l
e
d
u
c
a
ti
o
n
,
v
o
l.
1
5
,
n
o
.
1
,
p
p
.
1
6
7
.
1
-
1
6
7
.
9
,
2
0
1
5
.
[1
1
]
Dic
k
m
a
n
N,
Ba
ra
sh
A
,
Re
is
S
,
a
n
d
Ka
ra
sik
D
,
“
S
tu
d
e
n
ts
a
s
a
n
a
to
m
y
n
e
a
r
-
p
e
e
r
tea
c
h
e
rs:
A
d
o
u
b
le
-
e
d
g
e
d
sw
o
rd
f
o
r
a
n
a
n
c
ien
t
sk
il
l,
”
BM
C
M
e
d
ica
l
E
d
u
c
a
t
io
n
,
v
o
l.
1
7
,
n
o
.
1
56
,
p
p
.
1
-
5
,
2
0
1
7
.
[1
2
]
A
n
d
re
C,
De
e
rin
J
,
a
n
d
L
e
y
k
u
m
L
,
“
S
tu
d
e
n
ts
h
e
l
p
in
g
st
u
d
e
n
ts:
v
e
rti
c
a
l
p
e
e
r
m
e
n
to
rin
g
to
e
n
h
a
n
c
e
th
e
m
e
d
ica
l
sc
h
o
o
l
e
x
p
e
rien
c
e
,
”
BM
C
Res
e
a
rc
h
No
tes
,
v
o
l
.
1
0
,
n
o
.
1
76
,
p
p
.
1
-
7
,
2
0
1
7
.
[1
3
]
A
b
d
o
laliza
d
e
h
P
,
P
o
u
r
h
a
ss
a
n
S
,
G
a
n
d
o
m
k
a
r
R,
He
id
a
ri
F
,
a
n
d
S
o
h
ra
b
p
o
u
r
A
.
A
,
“
Du
a
l
p
e
e
r
m
e
n
to
rin
g
p
r
o
g
ra
m
f
o
r
u
n
d
e
rg
ra
d
u
a
te
m
e
d
ica
l
stu
d
e
n
ts:
Ex
p
lo
ri
n
g
t
h
e
p
e
rc
e
p
ti
o
n
s
o
f
m
e
n
to
rs
a
n
d
m
e
n
tee
s,”
M
e
d
ica
l
J
o
u
rn
a
l
o
f
th
e
Isla
m
ic
Rep
u
b
li
c
o
f
Ira
n
,
v
o
l
.
3
1
,
n
o
.
1
,
p
p
.
2
-
6
,
2
0
1
7
.
[1
4
]
Us
m
a
n
,
R
,
a
n
d
Ja
m
il
,
B
,
“
P
e
rc
e
p
ti
o
n
s
o
f
u
n
d
e
rg
ra
d
u
a
te
m
e
d
ic
a
l
stu
d
e
n
ts
a
b
o
u
t
p
e
e
r
a
ss
isted
lea
rn
in
g
,
”
T
h
e
Pro
f
e
ss
io
n
a
l
M
e
d
ica
l
J
o
u
r
n
a
l
,
v
o
l.
2
6
,
n
o
.
0
8
,
p
p
.
1
2
8
3
-
1
2
8
8
,
2
0
1
9
.
[1
5
]
Bu
g
a
j,
T
.
J
e
t
a
l.
,
“
P
e
e
r
-
a
ss
iste
d
lea
rn
in
g
(
P
A
L
):
sk
il
ls
lab
tu
t
o
rs’
e
x
p
e
rien
c
e
s
a
n
d
m
o
ti
v
a
ti
o
n
,
”
BM
C
me
d
ica
l
e
d
u
c
a
ti
o
n
,
v
o
l.
1
9
,
n
o
.
1
,
p
.
3
5
3
,
2
0
1
9
.
[1
6
]
S
o
rian
o
-
M
o
re
n
o
,
A
.
N
,
De
lg
a
d
o
-
Ra
y
g
a
d
a
,
J
.
E
,
P
e
ra
lt
a
,
C.
I
,
S
e
rr
a
n
o
-
Día
z
,
E.
S
,
Ca
n
a
z
a
-
A
p
a
z
a
,
J.
M
,
a
n
d
T
o
r
o
-
Hu
a
m
a
n
c
h
u
m
o
,
C.
J
,
“
P
e
rc
e
p
ti
o
n
o
f
m
e
d
ica
l
stu
d
e
n
ts
a
b
o
u
t
c
o
u
rse
s
b
a
se
d
o
n
p
e
e
r
-
a
ss
isted
lea
rn
in
g
in
f
iv
e
P
e
r
u
v
ian
u
n
iv
e
rs
it
ies
,
”
BM
C
re
se
a
rc
h
n
o
tes
,
v
o
l.
1
3
,
n
o
.
1
,
p
p
.
1
-
6
,
2
0
2
0
.
[1
7
]
W
il
li
a
m
s,
B
,
W
a
ll
is,
J
,
a
n
d
M
c
Ke
n
n
a
,
L
, “
Ho
w
is
p
e
e
r
-
te
a
c
h
in
g
p
e
rc
e
iv
e
d
b
y
f
irst
y
e
a
r
p
a
ra
m
e
d
ic stu
d
e
n
ts?
Re
su
lt
s
f
ro
m
th
re
e
y
e
a
rs,”
J
o
u
rn
a
l
o
f
Nu
r
sin
g
E
d
u
c
a
ti
o
n
a
n
d
Pra
c
ti
c
e
,
v
o
l
.
4
,
n
o
.
1
1
,
p
p
.
8
-
15
,
2
0
1
4
.
[1
8
]
“
Ox
f
o
rd
Co
m
m
u
n
ica
ti
o
n
,
”
2
0
2
0
[On
li
n
e
]
.
A
v
a
il
a
b
le:
h
tt
p
s://
o
x
f
o
rd
c
o
m
m
u
n
ica
ti
o
n
s.co
m
/
.
[1
9
]
L
ö
ff
ler
-
S
tas
t
k
a
,
H
,
S
e
i
tz,
T
,
Bil
l
e
th
,
S
,
P
a
stn
e
r,
B
,
P
re
u
sc
h
e
,
I
,
a
n
d
S
e
id
m
a
n
,
C
,
“
S
ig
n
if
ica
n
c
e
o
f
g
e
n
d
e
r
in
th
e
a
tt
it
u
d
e
to
w
a
rd
s
d
o
c
to
r
-
p
a
ti
e
n
t
c
o
m
m
u
n
ica
ti
o
n
in
m
e
d
ica
l
stu
d
e
n
ts
a
n
d
p
h
y
sic
ian
s,”
W
i
e
n
e
r
k
li
n
i
sc
h
e
W
o
c
h
e
n
sc
h
rift
,
v
o
l
.
1
2
8
,
n
o
.
1
7
-
18
,
p
p
.
6
6
3
-
6
6
8
,
2
0
1
6
.
[2
0
]
L
lo
y
d
M
a
n
d
Bo
r
R
,
“
Co
m
m
u
n
ica
ti
o
n
S
k
il
ls
f
o
r
M
e
d
icin
e
,
”
3
rd
e
d
.
Ch
u
rc
h
il
l
L
ivin
g
sto
n
e
,
2
0
0
9
.
[2
1
]
Ba
tso
n
C
.
D.
,
“
T
h
e
se
th
in
g
s ca
ll
e
d
e
m
p
a
th
y
:
e
ig
h
t
re
late
d
b
u
t
d
ist
i
n
c
t
p
h
e
n
o
m
e
n
a
,
”
T
h
e
M
IT
Pre
ss
,
p
p.
3
-
16
,
2
0
0
9
.
[2
2
]
V
a
len
te
F
,
“
Em
p
a
th
y
a
n
d
Co
m
m
u
n
ica
ti
o
n
:
A
M
o
d
e
l
o
f
Em
p
a
th
y
De
v
e
lo
p
m
e
n
t,
”
J
o
u
rn
a
l
o
f
Ne
w
M
e
d
ia
a
n
d
M
a
ss
Co
mm
u
n
ica
ti
o
n
,
v
o
l
.
3
,
n
o
.
1
,
p
p
.
1
-
24
,
2
0
1
6
.
[2
3
]
De
rk
se
n
,
F
,
Be
n
sin
g
,
J
,
a
n
d
L
a
g
ro
-
Ja
n
ss
e
n
,
A
,
“
Ef
fe
c
ti
v
e
n
e
ss
o
f
e
m
p
a
th
y
in
g
e
n
e
ra
l
p
ra
c
ti
c
e
:
a
sy
st
e
m
a
ti
c
re
v
ie
w
,
”
Brit
ish
J
o
u
rn
a
l
o
f
Ge
n
e
ra
l
Pra
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5
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6
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Ka
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[2
7
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sla
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Hu
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8
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[2
9
]
Erd
m
a
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.
B
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,
“
E
m
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[3
0
]
Co
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.
A
,
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il
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S,
a
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[3
1
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M
e
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r
S
.
W
,
M
c
Co
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n
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ie
A
,
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a
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.
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.
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Re
lev
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Co
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Emp
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(C
A
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[3
2
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M
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.
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tt
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.
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,
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las
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.
[3
3
]
S
tratta E
.
C
,
Rid
in
g
DM
a
n
d
Ba
k
e
r
P
,
“
Et
h
ica
l
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ro
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q
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7
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.
[3
4
]
Ne
w
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B
.
W
,
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rb
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L
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J,
Clev
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lan
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E
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ll
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n
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,
“
Is
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-
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9
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[3
5
]
Ch
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D
.
C
.
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Kirsh
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D
.
S
,
Ya
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se
lt
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.
H
,
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a
ra
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teriz
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h
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ro
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T
e
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3
4
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o
.
4
,
p
p
.
3
0
5
-
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11
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2
0
1
2
.
[3
6
]
Ne
u
m
a
n
n
M
e
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a
l.
,
“
Em
p
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th
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e
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li
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n
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so
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s:
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s
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a
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o
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stu
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ies
w
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m
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ica
l
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d
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n
ts
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sid
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n
ts,
”
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mic
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8
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p
.
9
9
6
-
1
0
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9
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2
0
1
1
.
[3
7
]
W
e
st
C
.
P
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t
a
l
.
,
“
A
p
ro
sp
e
c
ti
v
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d
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re
latio
n
s
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ip
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e
tw
e
e
n
m
e
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ica
l
k
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o
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led
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e
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n
d
p
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o
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a
li
sm
a
m
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tern
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e
re
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e
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ts,
”
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l.
8
2
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.
6
,
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p
.
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8
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.
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8
]
W
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k
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,
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ra
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y
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P
.
H,
a
n
d
T
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m
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W
.
,
“
A
tt
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l
s
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h
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l:
A
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o
rt
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d
y
,
”
M
e
d
ica
l
Ed
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ti
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n
,
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l
.
3
8
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o
.
5
,
p
p
.
5
2
2
-
5
34
,
2
0
0
4
.
[3
9
]
D
y
rb
y
e
L
.
N,
T
h
o
m
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s
M
.
R,
a
n
d
S
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a
n
a
f
e
lt
T
.
D
,
“
M
e
d
ica
l
st
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d
e
n
t
d
istres
s:
Ca
u
se
s,
c
o
n
se
q
u
e
n
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e
s,
a
n
d
p
r
o
p
o
se
d
so
lu
ti
o
n
s,”
M
a
y
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Cli
n
ic
Pro
c
e
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n
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s
,
v
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l
.
8
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.
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p
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1
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,
2
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0
5
.
[4
0
]
G
ri
ff
it
h
C
.
H
a
n
d
W
il
so
n
J
.
F
,
“
Th
e
lo
ss
o
f
id
e
a
li
s
m
th
ro
u
g
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o
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t
i
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e
rn
sh
ip
,
”
Eva
l
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Pro
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s
,
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l.
2
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.
4
,
p
p
.
4
1
5
-
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26
,
2
0
0
3
.
[4
1
]
L
o
o
i
J
.
C
.
L
,
“
Em
p
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th
y
a
n
d
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o
m
p
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ten
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e
,
”
T
h
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M
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o
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rn
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stra
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l
.
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8
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.
7
,
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.
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4
-
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0
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.
[4
2
]
T
h
iri
o
u
x
B,
Birau
lt
F
,
a
n
d
Ja
a
fa
ri
N
,
“
Em
p
a
th
y
is
a
p
ro
tec
ti
v
e
f
a
c
to
r
o
f
b
u
rn
o
u
t
i
n
p
h
y
sic
ian
s:
Ne
w
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e
u
ro
-
p
h
e
n
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m
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n
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lo
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ica
l
h
y
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th
e
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s
re
g
a
rd
in
g
e
m
p
a
th
y
a
n
d
s
y
m
p
a
th
y
in
c
a
re
re
latio
n
sh
i
p
,
”
Fro
n
t
ier
s
in
Psy
c
h
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g
y
,
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o
l.
7
,
p
p
.
7
6
3
-
7
7
4
,
2
0
1
6
.
[4
3
]
M
a
se
h
e
la
,
L
.
M
a
n
d
M
a
b
ik
a
,
M
,
“
A
n
a
s
se
ss
m
e
n
t
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m
p
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o
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th
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M
e
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to
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P
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ra
m
m
e
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stu
d
e
n
t
p
e
rf
o
r
m
a
n
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e
,
”
J
o
u
rn
a
l
o
f
S
tu
d
e
n
t
Af
fa
irs
i
n
Af
ric
a
,
v
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l.
5
,
n
o
.
2
,
p
p
.
1
6
3
-
1
8
2
,
2
0
1
7
.
[4
4
]
Bu
rg
e
ss
,
A
,
M
c
G
re
g
o
r,
D
,
a
n
d
M
e
ll
is,
C
,
“
M
e
d
ica
l
stu
d
e
n
ts
a
s
p
e
e
r
tu
to
rs:
a
sy
ste
m
a
ti
c
re
v
i
e
w
,
”
BM
C
me
d
ica
l
e
d
u
c
a
ti
o
n
,
v
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l.
1
4
,
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o
.
1
,
p
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8
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1
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2
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Erl
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4
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