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In
d
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K
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s
:
Air
tr
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co
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An
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Pro
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m
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cle
r
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Ps
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ch
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f
atig
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Qu
ality
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f
life
T
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s
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CC B
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C
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A
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Ma
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I
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d
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lu
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as.a
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id
1.
I
NT
RO
D
UCT
I
O
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Pro
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r
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m
u
s
cle
r
elax
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(
PMR
)
h
as
b
ee
n
d
em
o
n
s
tr
ated
to
b
e
an
ef
f
icac
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u
s
tec
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iq
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in
d
im
in
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h
in
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s
tr
ess
lev
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an
d
en
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g
m
e
n
tal
well
-
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.
T
h
is
r
elax
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v
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y
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f
icien
t
b
ec
au
s
e
it
p
o
s
itiv
ely
af
f
ec
ts
p
h
y
s
ical
an
d
m
en
tal
h
ea
lth
[
1
]
–
[
3
]
o
n
l
y
wit
h
s
af
e
m
o
v
em
e
n
ts
,
s
h
o
r
t
tim
e,
an
d
n
o
c
o
s
t o
r
ju
s
t
d
o
s
h
o
r
t
s
tr
etch
es
b
etwe
en
wo
r
k
ac
tiv
ities
with
o
u
t
n
ee
d
to
p
u
r
ch
ase
s
p
ec
ial
eq
u
ip
m
en
t
[
4
]
,
[
5
]
.
Mo
r
eo
v
er
,
PMR
h
as
b
ee
n
d
is
co
v
er
ed
t
o
n
o
tab
ly
d
im
in
is
h
p
ain
am
o
n
g
th
e
eld
er
ly
[
3
]
.
O
v
er
elev
e
n
d
e
ca
d
es
ag
o
,
p
io
n
ee
r
p
h
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s
ician
,
E
d
m
u
n
d
J
ac
o
b
s
o
n
d
is
co
v
er
ed
PMR
an
d
p
r
o
v
ed
its
ef
f
ec
tiv
en
ess
as
a
th
er
ap
y
in
th
e
m
ed
ical
s
ec
to
r
,
s
u
ch
as b
ein
g
b
en
ef
icial
in
co
n
tr
o
llin
g
b
lo
o
d
p
r
ess
u
r
e
[
6
]
,
n
eg
ativ
e
em
o
tio
n
al
(
s
tr
ess
,
an
x
i
ety
,
an
d
d
ep
r
ess
io
n
)
[
3
]
,
[
7
]
,
[
8
]
,
i
n
cr
ea
s
e
s
elf
-
esteem
an
d
s
elf
-
ef
f
icac
y
[
4
]
,
r
ed
u
ce
ch
em
o
t
h
er
ap
y
s
id
e
ef
f
ec
ts
[
9
]
,
a
n
d
as
a
m
ea
s
u
r
e
o
f
p
ain
[
5
]
.
I
t
was
r
ep
o
r
ted
th
at
it
r
ed
u
ce
s
an
x
iety
,
im
p
r
o
v
e
s
s
leep
q
u
ality
,
an
d
en
h
an
ce
s
th
e
q
u
ality
o
f
life
am
o
n
g
C
OVI
D
-
1
9
s
u
f
f
er
er
s
[
1
0
]
–
[
1
2
]
.
C
o
n
s
id
er
in
g
th
e
b
en
e
f
its
o
f
PMR
in
th
e
m
ed
ical
f
ield
a
s
a
n
o
n
-
p
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a
r
m
ac
o
lo
g
ical
th
er
ap
y
,
th
e
d
ev
elo
p
m
e
n
t
o
f
r
elax
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n
i
n
ter
v
en
tio
n
s
to
im
p
r
o
v
e
air
tr
af
f
ic
co
n
tr
o
ller
(
AT
C
)
.
Per
f
o
r
m
a
n
ce
in
I
n
d
o
n
esia
is
co
n
s
id
er
ed
h
ig
h
l
y
im
p
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tan
t
g
i
v
en
th
e
h
ig
h
s
ca
le
o
f
m
en
tal
w
o
r
k
lo
ad
[
1
3
]
,
[
1
4
]
.
I
n
wh
ich
ai
r
tr
af
f
ic
co
n
t
r
o
ller
s
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
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Sci
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N:
2252
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8
8
0
6
Th
e
effec
tiven
ess
o
f p
r
o
g
r
ess
i
ve
mu
s
cle
r
ela
xa
tio
n
fo
r
a
ir
tr
a
ffic c
o
n
tr
o
ller
…
(
La
lu
Mu
h
a
mma
d
S
a
leh
)
201
ar
e
r
esp
o
n
s
ib
le
f
o
r
q
u
alitativ
e
wo
r
k
lo
ad
[
1
5
]
o
f
s
af
ely
d
i
r
ec
tin
g
air
cr
a
f
t,
en
s
u
r
i
n
g
s
u
f
f
icien
t
s
ep
ar
atio
n
b
etwe
en
air
cr
af
t
in
clu
d
in
g
b
y
p
r
o
v
i
d
in
g
in
s
tr
u
ctio
n
s
to
p
ilo
ts
,
as
well
a
s
m
an
ag
in
g
em
e
r
g
en
c
y
s
itu
atio
n
s
[
1
4
]
,
[
1
6
]
.
T
h
is
ca
n
ca
u
s
e
m
o
r
b
id
ities
s
u
ch
as
d
ep
r
ess
io
n
,
an
x
iety
,
s
tr
ess
,
an
d
o
th
e
r
s
[
1
7
]
,
[
1
8
]
.
Sev
er
al
s
tu
d
ies
also
r
ep
o
r
ted
th
at
th
e
AT
C
wo
r
k
lo
ad
was
s
i
g
n
if
ican
tly
h
ea
v
y
an
d
a
f
f
ec
ted
th
em
p
s
y
ch
o
lo
g
ically
[
1
3
]
,
[
1
4
]
,
as
well
as
h
ad
an
im
p
ac
t o
n
wo
r
k
p
e
r
f
o
r
m
an
ce
[
1
9
]
.
I
n
v
esti
g
atio
n
s
in
th
e
last
f
ew
y
ea
r
s
th
at
r
ev
iew
t
h
e
ef
f
ec
tiv
e
n
ess
o
f
PMR
in
ac
tiv
e
wo
r
k
e
r
s
ar
e
v
er
y
lim
ited
an
d
ar
e
s
till
in
th
e
m
e
d
ical
s
co
p
e,
s
u
ch
as
th
e
ef
f
ec
t
iv
en
ess
in
n
u
r
s
es
[
2
0
]
.
T
h
is
em
p
ir
ical
ev
id
en
ce
o
f
PMR
ef
f
icac
y
ca
n
p
r
o
m
o
te
th
e
im
p
lem
en
tatio
n
to
im
p
r
o
v
e
th
e
h
ea
lth
s
tatu
s
o
f
wo
r
k
er
s
b
o
th
in
g
o
v
er
n
m
e
n
t
ag
en
cies
an
d
p
r
iv
ate
in
s
titu
tio
n
s
.
T
h
e
av
iatio
n
in
d
u
s
tr
y
’
s
s
co
p
e
en
co
m
p
ass
es
s
tr
in
g
en
t
r
eg
u
latio
n
s
u
n
d
er
s
co
r
in
g
th
e
s
ig
n
if
ican
ce
o
f
b
o
th
p
h
y
s
ical
an
d
m
en
tal
f
itn
ess
.
Fo
r
in
s
tan
ce
,
as
o
u
tlin
ed
in
r
e
g
u
latio
n
No
.
6
9
/2
0
1
7
b
y
th
e
Min
is
ter
o
f
T
r
an
s
p
o
r
tatio
n
,
R
ep
u
b
lic
o
f
I
n
d
o
n
esia
co
n
ce
r
n
in
g
Av
iatio
n
Saf
ety
R
eg
u
latio
n
s
Su
b
p
ar
t
C
Me
d
ical
R
eq
u
ir
em
en
ts
6
7
,
2
0
3
,
a
p
er
s
o
n
m
u
s
t n
o
t
s
u
f
f
er
f
r
o
m
d
is
ea
s
es
o
r
d
is
ab
ilit
ies
th
at
ca
n
in
ter
f
er
e
with
th
e
s
m
o
o
t
h
wo
r
k
p
r
o
ce
s
s
.
Ad
d
itio
n
ally
,
th
e
p
s
y
ch
o
lo
g
ical
d
is
o
r
d
er
f
ac
to
r
is
o
n
e
o
f
t
h
e
co
n
d
itio
n
s
f
o
r
n
o
t b
ein
g
allo
wed
to
r
ec
eiv
e
a
p
er
s
o
n
n
el
h
ea
lth
licen
s
e.
T
h
e
co
n
ce
p
t
o
f
s
tr
ess
h
as
ev
o
l
v
ed
a
n
d
is
s
ee
n
as
a
n
o
n
g
o
in
g
ad
ap
tiv
e
p
r
o
ce
s
s
[
2
1
]
.
Star
tin
g
f
r
o
m
s
tr
ess
ca
n
h
a
v
e
a
s
er
io
u
s
im
p
ac
t
o
n
a
p
er
s
o
n
'
s
m
en
tal
an
d
p
h
y
s
ical
h
ea
lth
,
to
th
e
b
o
d
y
’
s
r
esp
o
n
s
e
to
s
tr
ess
b
y
r
elea
s
in
g
ch
em
icals
in
th
e
b
lo
o
d
wh
ic
h
ca
n
ca
u
s
e
ch
r
o
n
ic
h
ea
lth
co
n
d
itio
n
s
s
u
ch
as
h
y
p
er
ten
s
io
n
an
d
co
r
o
n
ar
y
h
ea
r
t
d
is
ea
s
e,
r
eq
u
ir
in
g
in
ter
n
al
tr
ea
tm
en
t
[
2
1
]
–
[
2
3
]
.
T
h
is
ca
n
b
e
i
llu
s
tr
ated
th
r
o
u
g
h
th
e
air
tr
af
f
i
c
co
n
tr
o
ller
,
wh
er
e
th
er
e
ar
e
v
er
y
h
ig
h
wo
r
k
lo
ad
d
em
an
d
s
wh
ich
r
esu
lt
in
co
n
d
itio
n
s
o
f
f
atig
u
e
a
n
d
m
u
s
cle
ten
s
io
n
as
a
r
ef
lex
r
esp
o
n
s
e
to
s
tr
ess
,
wh
ich
ca
n
d
ev
elo
p
in
to
a
s
er
io
u
s
illn
ess
.
T
h
e
I
n
ter
n
atio
n
al
C
iv
il
Av
i
atio
n
Or
g
an
izatio
n
(
I
C
AO)
s
tates
th
at
th
e
a
b
s
en
ce
o
f
ac
cid
e
n
ts
is
n
o
t
a
s
ig
n
o
f
q
u
ality
n
eg
lect,
it
r
eq
u
ir
es
co
n
tin
u
o
u
s
im
p
r
o
v
em
e
n
t,
esp
ec
ially
in
q
u
ality
an
d
s
af
ety
-
o
r
ien
ted
h
u
m
an
r
eso
u
r
ce
s
.
I
n
lig
h
t
o
f
th
e
f
o
r
e
g
o
in
g
,
a
r
en
ewe
d
f
o
cu
s
o
n
co
n
tin
u
o
u
s
im
p
r
o
v
em
en
t
with
in
h
u
m
an
r
eso
u
r
ce
s
,
p
a
r
ticu
lar
ly
with
r
eg
ar
d
t
o
q
u
ality
a
n
d
s
af
ety
in
itiativ
es,
is
d
ee
m
ed
ess
en
tial.
2.
M
E
T
H
O
D
T
h
is
s
tu
d
y
u
tili
ze
d
a
q
u
asi
-
e
x
p
er
im
en
tal
p
r
e
-
test
p
o
s
t
-
test
co
n
tr
o
l
g
r
o
u
p
d
esig
n
,
r
esp
o
n
d
en
ts
wer
e
allo
ca
ted
to
in
ter
v
en
tio
n
an
d
c
o
n
tr
o
l
g
r
o
u
p
s
b
ased
o
n
th
eir
w
illi
n
g
n
ess
to
p
ar
ticip
ate
in
in
ter
v
en
tio
n
tr
ain
i
n
g
at
th
e
o
u
ts
et
o
f
t
h
e
s
tu
d
y
,
f
ac
ili
tated
b
y
th
e
s
u
p
p
o
r
t
o
f
s
h
if
t
co
o
r
d
in
at
o
r
s
in
ea
ch
Air
Nav
b
r
an
ch
.
Stru
ctu
r
e
d
q
u
esti
o
n
n
air
e
in
te
r
v
iews
wer
e
ca
r
r
ied
o
u
t
to
ass
ess
in
ter
v
en
tio
n
o
u
tco
m
es
at
th
e
c
o
m
m
en
ce
m
en
t
an
d
co
n
clu
s
io
n
o
f
th
e
in
ter
v
en
tio
n
p
er
io
d
.
T
h
e
in
ter
v
en
tio
n
s
wer
e
ev
alu
ate
d
at
two
ju
n
ctu
r
es:
at
th
e
o
u
ts
et
an
d
f
o
llo
win
g
th
e
in
ter
v
en
tio
n
.
E
t
h
ical
cle
ar
an
c
e
was
s
ec
u
r
ed
f
r
o
m
th
e
E
th
i
cs
C
o
m
m
is
s
io
n
o
f
th
e
Facu
lty
o
f
Pu
b
lic
Hea
lth
,
Hasan
u
d
d
in
Un
iv
e
r
s
ity
,
u
n
d
er
p
r
o
to
co
l
n
u
m
b
er
:
1
4
2
2
2
1
0
5
0
0
2
.
T
h
e
s
a
m
p
l
e
s
i
z
es
i
n
e
a
c
h
s
u
b
g
r
o
u
p
,
e
n
c
o
m
p
a
s
s
i
n
g
b
o
t
h
i
n
t
e
r
v
e
n
t
i
o
n
a
n
d
c
o
n
t
r
o
l
g
r
o
u
p
s
,
w
e
r
e
a
d
j
u
s
t
e
d
t
o
m
a
t
c
h
t
h
e
c
o
u
n
t
o
f
A
i
r
N
a
v
m
e
m
b
e
r
s
i
n
t
h
e
s
i
x
c
h
o
s
e
n
r
e
s
e
a
r
c
h
a
r
e
a
s
.
T
h
is
a
g
r
e
e
m
e
n
t
wa
s
r
e
a
c
h
e
d
t
h
r
o
u
g
h
a
f
o
c
u
s
g
r
o
u
p
d
i
s
c
u
s
s
i
o
n
i
n
v
o
lv
i
n
g
t
h
e
r
e
s
e
a
r
c
h
t
e
a
m
,
A
i
r
N
a
v
I
n
d
o
n
e
s
i
a
P
e
r
s
o
n
n
e
l
C
o
n
t
r
o
l
a
n
d
E
v
a
l
u
a
t
i
o
n
M
a
n
a
g
e
r
,
s
e
v
e
r
al
A
i
r
Na
v
g
e
n
er
a
l
m
a
n
a
g
e
r
s
,
a
n
d
I
n
t
e
r
n
a
ti
o
n
a
l A
i
r
T
r
a
f
f
i
c
C
o
n
t
r
o
l
l
e
r
A
s
s
o
c
i
at
i
o
n
(
I
A
T
C
A
)
c
h
a
i
r
a
n
d
m
e
m
b
e
r
s
.
A
s
a
m
p
l
e
s
t
r
at
i
f
i
c
a
t
i
o
n
m
e
t
h
o
d
w
as
a
p
p
l
i
e
d
a
c
r
o
s
s
t
h
e
s
i
x
s
el
e
c
te
d
A
i
r
N
a
v
s
t
r
a
t
a
,
b
e
g
i
n
n
i
n
g
w
i
t
h
t
h
e
m
a
i
n
,
i
n
t
e
r
m
e
d
i
at
e
,
a
n
d
p
r
i
m
a
r
y
b
r
a
n
c
h
e
s
,
e
n
s
u
r
i
n
g
a
b
a
l
a
n
c
e
d
r
e
p
r
e
s
e
n
t
a
ti
o
n
f
o
r
a
n
a
l
y
s
is
.
L
i
m
i
te
d
s
a
m
p
le
s
i
z
es
i
n
s
o
m
e
r
es
e
a
r
c
h
a
r
e
as
we
r
e
d
u
e
t
o
r
e
s
o
u
r
c
e
c
o
n
s
t
r
a
i
n
ts
a
n
d
t
h
e
b
u
s
y
s
c
h
e
d
u
l
e
s
o
f
A
T
C
s
,
i
m
p
a
c
t
i
n
g
c
o
n
t
r
o
l
a
n
d
o
t
h
e
r
w
o
r
k
-
r
e
l
a
t
e
d
a
c
t
i
v
i
t
i
e
s
.
D
es
p
it
e
e
f
f
o
r
t
s
t
o
o
p
t
i
m
i
z
e
a
v
a
i
l
a
b
l
e
s
a
m
p
l
es
,
t
h
i
s
lim
i
t
a
t
i
o
n
p
e
r
s
i
s
te
d
,
d
i
s
c
u
s
s
i
o
n
s
w
it
h
c
o
n
t
r
o
l
l
e
r
c
o
o
r
d
i
n
a
t
o
r
s
w
e
r
e
h
el
d
t
o
a
d
a
p
t
t
o
t
h
e
s
e
c
o
n
d
i
ti
o
n
s
a
n
d
w
o
r
k
a
c
tiv
i
t
i
es
.
T
h
e
s
am
p
le
s
ize
em
p
lo
y
ed
in
th
is
r
esear
ch
ad
h
er
ed
to
th
e
s
tan
d
ar
d
s
o
u
tlin
e
d
in
Kr
ejcie
an
d
Mo
r
g
an
’
s
1
9
7
0
s
em
in
al
ar
ticle
o
n
d
eter
m
in
in
g
s
am
p
le
s
ize
f
o
r
r
esear
ch
ac
tiv
ities
[
2
4
]
,
a
lth
o
u
g
h
Kr
ejcie
an
d
Mo
r
g
an
’
s
r
ef
er
en
ce
is
d
ate
d
,
it
p
r
o
v
i
d
es
a
r
o
b
u
s
t
f
o
u
n
d
atio
n
,
m
eth
o
d
o
l
o
g
ical
cr
ed
ib
ilit
y
,
an
d
en
ab
les
b
etter
co
m
p
a
r
ab
ilit
y
an
d
r
ep
r
o
d
u
cib
ilit
y
with
in
th
e
r
esear
ch
co
m
m
u
n
ity
wh
e
n
d
eter
m
in
in
g
s
am
p
le
s
ize
f
o
r
s
tu
d
ies.
T
h
e
s
tu
d
y
p
o
p
u
latio
n
in
itially
co
m
p
r
is
ed
3
4
0
in
d
iv
i
d
u
als,
with
1
8
1
r
e
s
p
o
n
s
es
o
b
tain
ed
.
Fo
llo
win
g
ad
ju
s
tm
en
ts
f
o
r
th
e
n
u
m
b
er
o
f
r
esp
o
n
d
e
n
ts
f
r
o
m
s
e
lecte
d
r
esear
ch
ar
ea
s
,
t
h
e
f
in
al
p
ar
ticip
an
t
c
o
u
n
t
was
b
ased
o
n
elig
ib
ilit
y
cr
iter
ia.
T
h
is
r
esu
lted
in
a
to
tal
o
f
1
8
4
r
esp
o
n
d
en
ts
,
with
a
1
:1
r
atio
m
ain
tain
ed
b
etwe
en
th
e
in
ter
v
en
tio
n
a
n
d
c
o
n
tr
o
l
g
r
o
u
p
s
as
s
h
o
wn
in
Fig
u
r
e
1
.
All
r
esp
o
n
d
en
ts
u
n
d
er
wen
t
t
h
e
s
am
e
in
itial
s
tag
es,
wh
ich
in
v
o
lv
ed
co
m
p
letin
g
a
p
r
e
-
test
q
u
esti
o
n
n
ai
r
e.
Ad
d
itio
n
ally
,
th
e
in
ter
v
e
n
tio
n
g
r
o
u
p
r
ec
eiv
ed
s
p
ec
if
ic
tr
ain
in
g
o
n
th
e
im
p
lem
en
tatio
n
tech
n
iq
u
es
o
f
PMR
.
T
h
is
tr
ain
in
g
was
f
ac
ilit
ated
b
y
th
e
r
e
s
ea
r
ch
team
,
co
m
p
r
is
ed
o
f
cli
n
ical
p
s
y
ch
o
lo
g
is
ts
.
T
h
e
r
elax
atio
n
tr
ai
n
in
g
was
c
o
n
d
u
cte
d
f
o
r
t
h
e
in
ter
v
e
n
tio
n
g
r
o
u
p
r
esp
o
n
d
en
ts
,
wh
o
wer
e
g
ath
er
ed
in
a
s
in
g
le
m
ee
tin
g
r
o
o
m
an
d
in
s
tr
u
cte
d
o
n
th
e
ap
p
r
o
p
r
iate
PMR
s
tag
es.
Su
b
s
eq
u
en
tly
,
th
e
in
ter
v
en
tio
n
g
r
o
u
p
im
p
lem
en
ted
t
h
e
r
esu
lts
o
f
t
h
e
r
elax
atio
n
tr
ain
in
g
b
ef
o
r
e
an
d
af
ter
t
h
eir
air
c
r
af
t
c
o
n
tr
o
l
d
u
ties
,
with
th
e
aim
o
f
p
r
o
m
o
tin
g
r
elax
atio
n
o
r
r
ed
u
cin
g
m
u
s
cle
ten
s
io
n
.
T
h
is
ac
tiv
ity
was
co
n
d
u
cted
o
v
er
an
eig
h
t
-
wee
k
o
b
s
er
v
atio
n
p
er
i
o
d
with
o
u
t
s
p
ec
if
ic
tim
e
lim
its
f
o
r
o
b
s
er
v
atio
n
,
en
co
m
p
ass
in
g
m
o
r
n
in
g
,
af
ter
n
o
o
n
,
an
d
ev
e
n
in
g
s
ess
io
n
s
to
alig
n
with
th
e
f
lu
ctu
atin
g
s
h
if
t
s
ch
ed
u
les
o
f
r
esp
o
n
d
en
ts
wh
o
ar
e
AT
C
.
E
ac
h
r
elax
atio
n
s
e
s
s
i
o
n
was
d
ir
ec
tly
s
u
p
er
v
is
ed
b
y
th
e
en
u
m
er
ato
r
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
1
,
Ma
r
ch
20
25
:
2
0
0
-
210
202
team
to
en
s
u
r
e
p
r
ec
is
io
n
in
r
elax
atio
n
m
o
v
em
e
n
ts
an
d
to
v
er
i
f
y
th
at
all
n
ec
ess
ar
y
s
tep
s
wer
e
ex
ec
u
ted
co
r
r
ec
tly
an
d
n
o
t
o
v
er
lo
o
k
ed
.
E
n
u
m
e
r
ato
r
s
u
n
d
er
we
n
t
tr
ain
in
g
o
n
p
r
o
g
r
ess
iv
e
m
u
s
cle
r
elax
atio
n
tec
h
n
iq
u
es
,
t
h
e
1
4
co
r
e
s
tag
es,
p
er
f
o
r
m
ed
twice
d
u
r
i
n
g
ea
ch
s
ess
io
n
,
alo
n
g
with
two
s
p
ec
ial
o
p
en
in
g
s
tep
s
(
p
r
ay
i
n
g
an
d
co
n
clu
d
in
g
with
th
an
k
s
g
iv
in
g
)
,
wer
e
m
eti
cu
lo
u
s
ly
d
etailed
as
:
−
B
ef
o
r
e
r
elax
in
g
,
AT
C
p
r
ay
s
f
i
r
s
t a
cc
o
r
d
in
g
t
o
th
eir
r
esp
ec
tiv
e
b
elief
s
.
−
W
r
in
k
le
y
o
u
r
f
o
r
e
h
ea
d
an
d
e
y
eb
r
o
ws u
n
til th
ey
wr
in
k
le,
th
e
n
r
elax
th
em
ag
ain
s
lo
wly
f
o
r
1
0
s
ec
o
n
d
s
.
T
h
e
m
o
v
em
en
t i
n
th
e
f
ac
ial
ar
ea
aim
s
to
r
elax
th
e
f
ac
ial
m
u
s
cles.
−
C
lo
s
e
y
o
u
r
ey
es a
s
h
ar
d
as p
o
s
s
ib
le
u
n
til th
e
m
u
s
cles in
th
e
e
y
e
ar
ea
f
ee
l te
n
s
e
f
o
r
1
0
s
ec
o
n
d
s
.
−
C
lo
s
e
y
o
u
r
m
o
u
t
h
wh
ile
p
r
ess
in
g
y
o
u
r
teeth
as
h
ar
d
as
p
o
s
s
ib
le
f
o
r
1
0
s
ec
o
n
d
s
,
to
r
elax
m
u
s
cle
ten
s
io
n
in
th
e
jaw.
−
Ma
k
e
th
e
letter
O
o
n
th
e
lip
s
,
th
en
p
u
ll
as
h
a
r
d
as
p
o
s
s
ib
le
f
o
r
wa
r
d
f
o
r
1
0
s
ec
o
n
d
s
,
aim
i
n
g
to
r
ela
x
th
e
m
u
s
cles in
th
e
m
o
u
th
ar
ea
.
−
Pre
s
s
y
o
u
r
h
ea
d
to
war
d
s
y
o
u
r
b
ac
k
u
n
til
y
o
u
f
ee
l
ten
s
io
n
in
y
o
u
r
n
ec
k
m
u
s
cles
f
o
r
1
0
s
ec
o
n
d
s
.
T
h
e
m
o
v
em
en
t i
n
th
is
ar
ea
is
in
ten
d
ed
to
r
ela
x
th
e
n
ec
k
m
u
s
cles
to
r
elea
s
e
ten
s
io
n
.
−
B
en
d
an
d
lo
wer
y
o
u
r
ch
in
u
n
ti
l it
to
u
ch
es y
o
u
r
ch
est f
o
r
1
0
s
ec
o
n
d
s
.
−
Gr
asp
y
o
u
r
h
an
d
s
wh
ile
m
ak
in
g
a
f
is
t f
o
r
1
0
s
ec
o
n
d
s
,
aim
ed
at
tr
ain
in
g
y
o
u
r
h
an
d
m
u
s
cles
.
−
B
en
d
b
o
th
wr
is
ts
b
ac
k
s
lo
wly
f
o
r
1
0
s
ec
o
n
d
s
.
−
G
r
a
s
p
b
o
t
h
h
a
n
d
s
a
n
d
b
r
i
n
g
t
h
e
f
i
s
t
s
t
o
t
h
e
s
h
o
u
l
d
e
r
s
f
o
r
1
0
s
e
c
o
n
d
s
,
a
i
m
i
n
g
t
o
t
r
a
i
n
t
h
e
h
a
n
d
m
u
s
c
l
e
s
a
t
t
h
e
b
a
c
k
.
−
R
aise
b
o
th
s
h
o
u
ld
er
s
to
war
d
s
y
o
u
r
ea
r
s
as
h
ig
h
as
p
o
s
s
ib
le
f
o
r
1
0
s
ec
o
n
d
s
.
T
h
is
m
o
v
e
m
en
t
is
in
ten
d
ed
to
r
elax
th
e
s
h
o
u
ld
er
m
u
s
cles
.
−
L
if
t
y
o
u
r
b
o
d
y
f
r
o
m
t
h
e
b
ac
k
o
f
th
e
ch
air
,
th
e
n
s
tick
o
u
t
y
o
u
r
ch
est
f
o
r
1
0
s
ec
o
n
d
s
,
aim
i
n
g
to
tr
ain
y
o
u
r
b
ac
k
m
u
s
cles
.
−
Pu
ll in
y
o
u
r
s
to
m
ac
h
as h
ar
d
a
s
y
o
u
ca
n
u
n
til it f
ee
ls
ten
s
e
f
o
r
1
0
s
ec
o
n
d
s
,
to
r
elax
y
o
u
r
ch
e
s
t m
u
s
cles
.
−
Pu
ll in
y
o
u
r
s
to
m
ac
h
as h
ar
d
a
s
p
o
s
s
ib
le
f
o
r
1
0
s
ec
o
n
d
s
,
to
tr
ain
y
o
u
r
s
to
m
ac
h
m
u
s
cles
.
−
Stra
ig
h
ten
th
e
s
o
les o
f
y
o
u
r
f
e
et
f
o
r
1
0
s
ec
o
n
d
s
,
to
r
elax
th
e
leg
m
u
s
cles
.
−
Af
ter
r
elax
in
g
,
s
ay
g
r
atitu
d
e
.
F
i
g
u
r
e
1
.
F
l
o
wc
h
a
r
t
o
f
s
t
u
d
y
p
a
r
t
i
c
i
p
a
n
ts
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Th
e
effec
tiven
ess
o
f p
r
o
g
r
ess
i
ve
mu
s
cle
r
ela
xa
tio
n
fo
r
a
ir
tr
a
ffic c
o
n
tr
o
ller
…
(
La
lu
Mu
h
a
mma
d
S
a
leh
)
203
Data
wer
e
g
ath
er
ed
v
ia
in
t
er
v
iews
with
AT
C
in
d
if
f
er
en
t
r
eg
io
n
s
em
p
l
o
y
in
g
s
ta
n
d
ar
d
ized
q
u
esti
o
n
n
air
es.
Desp
ite
u
tili
zi
n
g
a
s
tan
d
ar
d
ized
q
u
esti
o
n
n
air
e,
as
elab
o
r
ate
d
b
el
o
w,
th
e
q
u
e
s
tio
n
n
air
e
’
s
v
alid
ity
an
d
r
eliab
ilit
y
wer
e
s
till
ass
es
s
ed
o
n
AT
C
s
n
o
t
in
v
o
lv
ed
in
th
is
s
tu
d
y
to
ascer
tain
its
ap
p
r
o
p
r
iaten
ess
f
o
r
th
is
s
tu
d
y
’
s
co
n
tex
t,
an
d
all
q
u
esti
o
n
n
air
e
item
s
wer
e
d
ee
m
ed
v
ali
d
an
d
r
eliab
le.
T
h
e
d
ep
r
ess
io
n
,
an
x
iety
,
an
d
s
tr
ess
(
DASS)
q
u
esti
o
n
n
air
e
,
d
esig
n
ed
b
y
L
o
v
ib
o
n
d
in
1
9
9
5
[
2
5
]
we
u
tili
ze
th
is
r
ef
er
en
ce
b
ec
au
s
e
th
e
DASS
q
u
esti
o
n
n
air
e
p
r
o
v
id
es
d
etaile
d
m
ea
s
u
r
em
en
ts
o
f
d
ep
r
ess
io
n
,
an
x
iety
,
an
d
s
tr
ess
lev
els,
all
o
win
g
r
esear
ch
er
s
an
d
p
r
ac
titi
o
n
er
s
to
g
ai
n
a
c
o
m
p
r
eh
e
n
s
iv
e
u
n
d
er
s
tan
d
in
g
o
f
an
i
n
d
iv
id
u
al
’
s
p
s
y
ch
o
l
o
g
i
ca
l
co
n
d
itio
n
.
T
h
e
Sety
awa
ti
q
u
esti
o
n
n
air
e
d
esig
n
ed
in
1
9
9
4
[
2
6
]
wer
e
u
s
ed
to
m
ea
s
u
r
e
f
ee
lin
g
s
o
f
wo
r
k
f
atig
u
e,
th
e
Sety
awa
ti
q
u
esti
o
n
n
air
e
r
em
ain
s
im
p
o
r
t
an
t
f
o
r
u
s
e
to
d
a
y
d
u
e
t
o
its
v
alid
ity
,
f
o
c
u
s
o
n
wo
r
k
f
at
ig
u
e,
r
elev
an
ce
to
co
n
tem
p
o
r
ar
y
wo
r
k
p
lace
d
em
an
d
s
,
an
d
its
ab
ilit
y
to
p
r
o
v
id
e
co
n
s
is
ten
cy
an
d
co
n
tin
u
ity
in
r
e
s
ea
r
ch
o
n
t
h
e
p
h
en
o
m
en
o
n
o
f
w
o
r
k
f
atig
u
e.
Fo
llo
win
g
th
e
h
ea
lth
m
ea
s
u
r
e
m
en
ts
wer
e
tak
en
:
o
x
y
g
en
s
atu
r
atio
n
,
p
u
ls
e
r
ate,
an
d
b
lo
o
d
p
r
ess
u
r
e.
Ox
y
g
en
s
atu
r
atio
n
a
n
d
p
u
ls
e
r
ate
wer
e
m
ea
s
u
r
ed
u
s
in
g
an
o
x
im
eter
,
an
d
wh
ile
b
lo
o
d
p
r
ess
u
r
e
was
m
ea
s
u
r
ed
with
a
m
an
u
al
s
p
h
y
g
m
o
m
an
o
m
eter
.
B
lo
o
d
p
r
ess
u
r
e
an
d
p
u
l
s
e
r
ate
m
ea
s
u
r
em
en
ts
wer
e
ca
teg
o
r
ized
ac
co
r
d
in
g
to
th
e
Am
er
ican
Hea
r
t
Ass
o
ciatio
n
g
u
id
elin
es,
a
n
d
o
x
y
g
en
s
atu
r
atio
n
was
ass
ess
ed
i
n
ac
co
r
d
a
n
ce
with
s
tan
d
ar
d
s
s
et
b
y
th
e
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
(
W
HO)
.
Qu
ality
o
f
life
d
ata
was
ass
ess
ed
b
ased
o
n
th
e
ev
alu
ati
o
n
o
f
th
e
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
’
s
q
u
ality
o
f
lif
e
ass
e
s
s
m
en
t
[
2
7
]
we
r
ef
er
to
th
e
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
q
u
ality
o
f
life
q
u
esti
o
n
n
air
e
to
ev
alu
ate
th
e
q
u
ality
o
f
life
o
f
AT
C
s
b
ec
au
s
e
th
is
q
u
esti
o
n
n
air
e
en
s
u
r
es
alig
n
m
e
n
t
with
i
n
ter
n
atio
n
al
s
tan
d
ar
d
s
,
h
ig
h
v
ali
d
ity
an
d
r
eliab
ilit
y
,
an
d
its
a
b
ilit
y
to
p
r
o
v
id
e
a
co
m
p
r
eh
e
n
s
iv
e
o
v
e
r
v
iew
an
d
u
s
ef
u
l c
o
m
p
a
r
ativ
e
d
ata
f
o
r
r
e
s
ea
r
ch
an
d
clin
ical
p
r
ac
tice.
W
e
r
ec
o
g
n
ized
th
at
t
h
e
p
r
im
ar
y
co
n
f
o
u
n
d
in
g
f
ac
to
r
in
th
is
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Evaluation Warning : The document was created with Spire.PDF for Python.
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8
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6
Th
e
effec
tiven
ess
o
f p
r
o
g
r
ess
i
ve
mu
s
cle
r
ela
xa
tio
n
fo
r
a
ir
tr
a
ffic c
o
n
tr
o
ller
…
(
La
lu
Mu
h
a
mma
d
S
a
leh
)
207
o
f
in
d
iv
id
u
als
a
n
d
i
n
a
v
ar
iety
o
f
co
n
tex
ts
o
r
s
itu
atio
n
s
[
3
2
]
–
[
3
4
]
.
T
h
ese
f
in
d
i
n
g
s
u
n
d
er
s
c
o
r
e
th
e
p
o
te
n
tial
o
f
PMR
tech
n
iq
u
es
to
aid
in
d
iv
i
d
u
als,
in
clu
d
in
g
wo
r
k
er
s
,
in
m
an
ag
in
g
s
tr
ess
,
an
x
iety
,
an
d
en
h
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g
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h
y
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ical
f
lex
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ilit
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.
T
h
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in
d
in
g
s
h
ig
h
lig
h
t
th
e
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o
ten
tial
o
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tech
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iq
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ass
is
t
in
d
iv
id
u
als,
p
ar
ticu
lar
ly
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p
lo
y
ee
s
lik
e
AT
C
s
,
in
m
an
ag
in
g
p
s
y
ch
o
lo
g
ical
f
atig
u
e
a
n
d
im
p
r
o
v
in
g
m
en
tal
h
ea
lth
.
T
h
e
p
r
ac
tical
i
m
p
licatio
n
s
s
u
g
g
est
th
e
im
p
o
r
tan
ce
o
f
p
r
io
r
itis
in
g
AT
C
s
’
p
s
y
ch
o
lo
g
ical
well
-
b
ei
n
g
wh
e
n
d
esig
n
in
g
wo
r
k
p
lace
s
tr
ess
m
an
ag
em
en
t
s
tr
ateg
ies
.
T
h
es
e
s
t
r
at
e
g
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o
u
l
d
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n
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o
r
p
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t
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n
t
e
r
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o
n
d
i
t
i
o
n
i
n
g
t
e
c
h
n
i
q
u
es
,
s
u
c
h
as
P
MR
.
Fu
t
u
r
e
,
b
r
o
a
d
e
r
,
a
n
d
in
-
d
e
p
t
h
s
t
u
d
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es
a
r
e
w
a
r
r
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n
te
d
t
o
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a
i
n
a
d
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p
e
r
u
n
d
e
r
s
t
a
n
d
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g
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MR
’
s
r
o
l
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n
e
n
h
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n
c
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h
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a
n
d
m
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t
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l
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lt
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n
t
h
e
w
o
r
k
i
n
g
p
o
p
u
l
a
t
i
o
n
.
T
h
i
s
i
s
p
a
r
t
i
c
u
l
a
r
l
y
r
el
e
v
a
n
t
c
o
n
s
i
d
e
r
in
g
t
h
e
h
i
g
h
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p
r
e
s
s
u
r
e
e
n
v
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o
n
m
e
n
t
a
n
d
e
l
e
v
a
t
e
d
r
is
k
o
f
p
s
y
c
h
o
l
o
g
i
c
a
l
d
is
o
r
d
e
r
s
f
a
c
ed
b
y
A
T
C
.
T
h
e
s
tu
d
y
en
c
o
u
n
ter
e
d
im
p
le
m
en
tatio
n
lim
itatio
n
s
,
p
ar
ticu
l
ar
ly
d
u
r
i
n
g
th
e
h
ei
g
h
t
o
f
th
e
C
OVI
D
-
19
p
an
d
em
ic
with
th
e
Delta
v
ar
ia
n
t
’
s
h
ig
h
m
o
r
b
id
ity
r
ate.
T
h
is
r
estricte
d
d
aily
v
is
its
to
th
e
r
e
s
ea
r
ch
s
ite.
W
h
ile
th
e
s
tu
d
y
b
en
ef
its
f
r
o
m
a
s
a
m
p
le
d
r
awn
ac
r
o
s
s
s
ix
Air
Nav
r
eg
io
n
s
(
m
ain
,
m
id
d
le,
an
d
Pra
tam
a
B
r
an
ch
es),
p
o
ten
tial
lim
itatio
n
s
ex
is
t
d
u
e
to
u
n
ev
e
n
r
esp
o
n
d
e
n
t
d
i
s
tr
ib
u
tio
n
ac
r
o
s
s
s
o
m
e
b
r
a
n
ch
es.
Allo
ca
tio
n
o
f
p
ar
ticip
an
ts
in
to
in
ter
v
e
n
tio
n
an
d
co
n
tr
o
l
g
r
o
u
p
s
was
d
et
er
m
in
ed
b
y
av
ailab
ilit
y
r
atio
s
.
Fu
r
th
er
m
o
r
e,
t
h
e
ass
es
s
m
en
t
s
o
lely
f
o
cu
s
ed
o
n
t
h
e
s
h
o
r
t
-
ter
m
im
p
ac
t
o
f
th
e
i
n
ter
v
en
tio
n
.
C
o
n
s
eq
u
en
tly
,
t
h
ese
r
esu
lts
ca
n
ac
t
as
a
ca
taly
s
t f
o
r
f
u
t
u
r
e
in
v
esti
g
ati
o
n
s
.
4.
CO
NCLU
SI
O
N
Acc
o
r
d
in
g
to
t
h
e
f
in
d
in
g
s
,
h
ea
l
th
s
tatu
s
an
d
q
u
ality
o
f
life
,
as
ass
es
s
ed
b
y
v
ar
io
u
s
i
n
d
icato
r
s
,
ex
h
ib
ited
g
r
ea
ter
im
p
r
o
v
em
e
n
t
in
th
e
in
ter
v
en
tio
n
g
r
o
u
p
co
m
p
ar
ed
to
th
e
co
n
tr
o
l.
T
h
is
s
u
g
g
ests
th
at
in
teg
r
atin
g
PMR
in
to
r
o
u
tin
e
p
r
ac
tices
ca
n
ef
f
ec
tiv
ely
allev
iate
m
u
s
cle
ten
s
io
n
.
I
t
is
r
ec
o
m
m
en
d
ed
th
at
f
u
tu
r
e
r
esear
ch
er
s
co
n
d
u
ct
ex
p
e
r
im
en
ts
,
esp
ec
ial
ly
in
t
h
e
f
ield
o
f
p
h
ar
m
ac
o
l
o
g
y
,
in
im
p
r
o
v
in
g
th
e
h
ea
lth
s
tatu
s
o
f
AT
C
s
s
o
th
at
th
ey
ca
n
co
m
p
ar
e
t
h
e
ef
f
ec
tiv
en
ess
o
f
p
h
ar
m
ac
o
l
o
g
ical
a
n
d
n
o
n
-
p
h
a
r
m
ac
o
lo
g
ical
s
tu
d
ies.
T
h
is
s
tu
d
y
f
u
r
th
er
h
ig
h
lig
h
ts
th
e
v
alu
e
o
f
estab
lis
h
in
g
a
s
tr
ess
m
an
ag
em
en
t
team
with
in
an
in
d
u
s
tr
y
.
T
h
is
team
wo
u
ld
b
e
r
esp
o
n
s
ib
le
f
o
r
i
d
en
tify
in
g
s
o
u
r
ce
s
o
f
s
tr
ess
an
d
d
esig
n
i
n
g
in
te
r
v
en
tio
n
s
tr
ateg
ies
to
ass
is
t
em
p
lo
y
ee
s
in
m
an
ag
in
g
th
eir
well
-
b
ein
g
.
ACK
NO
WL
E
DG
E
M
E
NT
S
T
h
e
au
th
o
r
s
ar
e
g
r
atef
u
l
to
th
e
I
n
d
o
n
esia
E
n
d
o
wm
en
t
Fu
n
d
f
o
r
E
d
u
ca
tio
n
(
L
PDP)
f
o
r
s
p
o
n
s
o
r
in
g
th
is
r
esear
ch
,
Hasan
u
d
d
in
U
n
iv
er
s
ity
,
R
esear
ch
in
s
titu
tio
n
s
an
d
co
m
m
u
n
ity
s
er
v
ice
(
L
PP
M)
,
an
d
o
u
r
Facu
lty
o
f
Pu
b
lic
Hea
lth
,
Occ
u
p
atio
n
al
Hea
lth
an
d
Saf
ety
De
p
ar
tm
en
t
f
o
r
c
o
n
tr
ib
u
tin
g
to
th
e
s
u
cc
es
s
o
f
th
is
s
tu
d
y
.
T
h
e
au
th
o
r
s
also
ac
k
n
o
wled
g
e
I
n
t
er
n
atio
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al
Air
T
r
af
f
ic
C
o
n
tr
o
ller
Ass
o
ciatio
n
(
I
AT
C
A)
an
d
Air
Nav
f
o
r
th
eir
s
u
p
p
o
r
ts
.
I
n
d
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ca
tio
n
(
L
PDP)
,
n
u
m
b
er
PR
J
.
4
7
/LPDP/2
0
1
9
RE
F
E
R
E
NC
E
S
[
1
]
S
.
B
o
s
t
a
n
i
,
M
.
R
a
m
b
o
d
,
P
.
S
.
I
r
a
n
i
,
a
n
d
C
.
T
o
r
a
b
i
z
a
d
e
h
,
“
C
o
m
p
a
r
i
n
g
t
h
e
e
f
f
e
c
t
o
f
p
r
o
g
r
e
ssi
v
e
m
u
sc
l
e
r
e
l
a
x
a
t
i
o
n
e
x
e
r
c
i
se
a
n
d
su
p
p
o
r
t
g
r
o
u
p
t
h
e
r
a
p
y
o
n
t
h
e
h
a
p
p
i
n
e
ss
o
f
n
u
r
s
i
n
g
s
t
u
d
e
n
t
s:
A
r
a
n
d
o
m
i
z
e
d
c
l
i
n
i
c
a
l
t
r
i
a
l
s
t
u
d
y
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
rn
a
l
o
f
A
f
ri
c
a
N
u
rs
i
n
g
S
c
i
e
n
c
e
s
,
v
o
l
.
1
3
,
n
o
.
9
,
p
.
1
0
0
2
1
8
,
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
i
j
a
n
s.
2
0
2
0
.
1
0
0
2
1
8
.
[
2
]
S
.
R
i
c
h
e
s
,
L
.
A
z
e
v
e
d
o
,
L
.
B
i
r
d
,
S
.
P
i
s
a
n
i
,
a
n
d
L
.
V
a
l
m
a
g
g
i
a
,
“
V
i
r
t
u
a
l
r
e
a
l
i
t
y
r
e
l
a
x
a
t
i
o
n
f
o
r
t
h
e
g
e
n
e
r
a
l
p
o
p
u
l
a
t
i
o
n
:
a
s
y
s
t
e
m
a
t
i
c
r
e
v
i
e
w
,
”
S
o
c
i
a
l
P
s
y
c
h
i
a
t
r
y
a
n
d
P
s
y
c
h
i
a
t
r
i
c
E
p
i
d
e
m
i
o
l
o
g
y
,
v
o
l
.
5
6
,
n
o
.
1
0
,
p
p
.
1
7
0
7
–
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2
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,
2
0
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d
o
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.
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s
0
0
1
2
7
-
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1
-
0
2
1
1
0
-
z.
[
3
]
N
.
A
.
L.
A
t
i
,
S
.
F
.
Z
a
h
r
o
,
Y
.
P
u
s
p
a
r
i
n
i
,
S
.
A
.
W
i
d
o
w
a
t
i
,
a
n
d
S
.
N
.
R
o
f
i
’
a
h
,
“
Ef
f
e
c
t
o
f
G
r
o
u
p
A
c
t
i
v
i
t
y
Th
e
r
a
p
y
(
T
A
K
)
P
r
o
g
r
e
ssi
v
e
M
u
s
c
l
e
R
e
l
a
x
a
t
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o
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