Instructional Videomodeling to Teach Mothers of Children with Autism to Implement Discrete Trials: A Systematic Replication

Abstract

Abstract The high number of Autism Spectrum Disorder’s (ASD) cases determines a great need for specialized service for this population. This is particularly critical, considering the intensity required according to the specialized literature. Parental training may be an affordable alternative to provide this intervention with a high integrity and less costs, and tools such as videomodeling may facilitate the efficiency of such training procedures. This work aimed to evaluate, with strict experimental control, the efficiency of instructional videomodeling while training parents of children with ASD to implement Discrete Trial Instruction. Three mother-child dyads participated: Beatriz (27 years) and Luan (3 years); Eliana (30 years old) and Igor (2 years old); Vanessa (40 years old) and Daniel (4 years old). The results showed an increase in the performance accuracy of all mothers in the application of discrete trials, with an average duration of 4 hours. It is possible that this type of instructional tool has an effect on motivation and broadly promotes access to training contingencies, unlike the limitations of face-to-face training. However, it is important to emphasize that this tool only reaches its full function if it is inserted within a broader training program.

Full text

Trends in Psychology / Temas em Psicologia DOI: 10.9788/TP2019.3-14
ISSN 2358-1883 (online edition)
Article
Trends Psychol., Ribeirão Preto, vol. 27, nº 3, p. 795-804 - September/2019
–––––––––––––––––––––––––––––––––––––––––––
* Mailing address: Rua Augusto Corrêa, s.n., Laboratório de Psicologia Experimental, sala 02, Guamá, Belém -
PA, Brazil 6600000. Phone: (82) 9 9959-3350. E-mail: adrianobarboza1@gmail.com
Este trabalho foi realizado com o apoio do Conselho Nacional de Ciência de Tecnologia - CNPq (Processo
#141921/2015-3) e da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES (Processo
PDSE #88881.132322/2016-01) para o primeiro autor. O trabalho é parte do programa de pesquisas do Instituto
Nacional de Ciência e Tecnologia sobre Comportamento, Cognição e Ensino (INCT/ECCE), fi nanciado pelo
CNPq (Processos #573972/2008-7 e #465686/2014-1) e pela Fundação de Amparo à Pesquisa do Estado de
São Paulo - FAPESP (Processos # 08/57705-8 e #2014/50909-8).
Instructional Videomodeling to Teach Mothers
of Children with Autism to Implement Discrete Trials:
A Systematic Replication
Adriano Alves Barboza*, 1, 2
Orcid.org/0000-0003-3042-1677
Lidiene Camila Barbosa Costa1, 2
Orcid.org/0000-0002-7390-3476
Romariz da Silva Barros1, 2
Orcid.org/0000-0002-1306-384X
––––––––––––––––––––––––––––––––––––––––
1Universidade Federal do Pará, Belém, PA, Brasil
2Instituto Nacional de Ciência e Tecnologia sobre Comportamento, Cognição e Ensino,
São Carlos, SP, Brasil
Abstract
The high number of Autism Spectrum Disorder’s (ASD) cases determines a great need for specialized
service for this population. This is particularly critical, considering the intensity required according to
the specialized literature. Parental training may be an aff ordable alternative to provide this intervention
with a high integrity and less costs, and tools such as videomodeling may facilitate the effi ciency of
such training procedures. This work aimed to evaluate, with strict experimental control, the effi ciency
of instructional videomodeling while training parents of children with ASD to implement Discrete Trial
Instruction. Three mother-child dyads participated: Beatriz (27 years) and Luan (3 years); Eliana (30
years old) and Igor (2 years old); Vanessa (40 years old) and Daniel (4 years old). The results showed
an increase in the performance accuracy of all mothers in the application of discrete trials, with an
average duration of 4 hours. It is possible that this type of instructional tool has an eff ect on motivation
and broadly promotes access to training contingencies, unlike the limitations of face-to-face training.
However, it is important to emphasize that this tool only reaches its full function if it is inserted within
a broader training program.
Keywords: Parental training, discrete trial instruction, instructional video modeling, Autism Spectrum
Disorder.

Barboza, A. A., Costa, L. C. B., Barros, R. S.
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Utilizando Videomodelação Instrucional para Ensinar Mães
de Crianças Diagnosticadas com Autismo a Implementar
Tentativas Discretas: Uma Replicação Sistemática
Resumo
O elevado número de casos de Transtorno do Espectro do Autismo (TEA) determina uma grande
necessidade de atendimento adequado a essa população. Isso é particularmente crítico, considerando
a intensidade necessária recomendada na literatura especializada. A intervenção parental pode ser uma
alternativa para proporcionar acesso a uma intervenção de qualidade e economicamente acessível, e
recursos como a videomodelação podem auxiliar a efi ciência deste tipo de treinamento. Este trabalho
teve como objetivo avaliar, através de rigoroso controle experimental, a efi ciência da videomodelação
instrucional no treinamento parental para implementar ensino por tentativas discretas. Participaram
deste estudo três díades mãe-criança: Beatriz (27 anos) e Luan (3 anos); Eliana (30 anos) e Igor (2 anos);
Vanessa (40 anos) e Daniel (4 anos). Os resultados mostraram aumento na precisão de desempenho de
todas as mães na aplicação de tentativas discretas, com duração média de carga horária de treinamento
em torno de 4 horas. É possível que esse tipo de ferramenta tenha efeito sobre a motivação e promova
amplamente o acesso a contingências de treinamento, diferentemente das limitações de treinamentos
presenciais. Porém é importante enfatizar que essa ferramenta só atinge sua plena função se estiver
inserida dentro de um programa mais amplo de treinamento.
Palavras-chave: Treinamento parental, ensino por tentativas discretas, videomodelação instrucional,
Transtorno do Espectro do Autismo.
Videomodelado Instruccional para Enseñar a Madres de Niños
Diagnosticados con TEA la Implementación de Ensayos Discretos:
Una Replicación Sistemática
Resumen
El alto número de casos de Trastorno del Espectro Autista (TEA) determina una gran necesidad de
servicios especializados para esta población. Esto es particularmente crítico, considerando la intensidad
requerida según la literatura especializada. Entrenamiento de genitores puede ser una alternativa
económica para proporcionar este tipo de intervención con alta integridad y a un menor costo, y
procedimientos tales como videomodelado instruccional pueden facilitar sua efi ciencia. El presente
trabajo tiene como objetivo evaluar, a través de un riguroso control experimental, la efi ciencia del
videomodelado instruccional en genitores de niños diagnosticados con TEA para la implementacion
de aprendizaje por ensayos discretos. Participaron tres díadas entre madres y niños: Beatriz (27 años)
y Luan (3 años); Eliana (30 años) y Igor (2 años); Vanessa (40 años) y Daniel (4 años). Los resultados
mostraron un aumento en la precisión del rendimiento de todas las madres en la aplicación de ensayos
discretos, teniendo en cuenta que el entrenamiento dado duro un total de 4 horas en promedio. Es posible
que este tipo de herramienta de instrucción tenga un efecto sobre la motivación de genitores y promueva
su acceso a este modelo, en contraste con las limitaciones de un entrenamiento presencial. Sin embargo,
es importante enfatizar que esta herramienta solo alcanza su función completa si se inserta dentro de un
programa de capacitación más amplio.
Palabras clave: Entrenamiento parental, instrucción de ensayos discretos, videomodelación
instrucional, Trastorno del Espectro Autista.

Instructional Videomodeling to Teach Mothers of Children with Autism to Implement
Discrete Trials: A Systematic Replication.
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Based on data from the Centers for Disease
Control and Prevention, Autism Spectrum
Disorder (ASD) is one of the most prevalent
development disorders worldwide, aff ecting 1 of
59 children aged 8 years old (Baio et al., 2016).
Specialized treatment is urgently needed for this
population. Applied Behavior Analysis (ABA)
is the scientifi c basis for treatments that are the
most eff ective (National Autism Center, 2009).
The eff ectiveness of behavioral interventions
is widely recognized (National Autism Center,
2009). Particularly in cases with more severe
impairment, the success of intervention relies
on several core characteristics: intensity of
intervention (between 30 and 40 hours per
week), onset of intervention (beginning at
~2 years old), duration of intervention (~2
years), and comprehensiveness of intervention
(multiple environments and multiple teaching
targets; Lovaas, 1987; Sallows & Graupner,
2005). However, the prescribed intensity and
costs that are associated with these types of
interventions often make it inaccessible for
a large proportion of the aff ected population,
particularly in developing countries that have
little governmental support, such as Brazil
(Barboza, Silva, Barros, & Higbee, 2015).
Parent- and caregiver-implemented
interventions (O’Dell, 1974) may play an
important role in applying ABA to a wider
proportion of the population. The number
of well-trained professionals is currently
insuffi cient to fully implement such interventions
with the prescribed intensity and duration.
The participation of well-trained parents
and caregivers in interventions may increase
effi ciency, thus allowing behavior analysts to
provide services to a larger number of cases that
focus on assessing the child’s repertoire, building
teaching programs, and assessing progress,
including the assessment of both the children’s
performance and implementation integrity.
Experimental research on the eff ectiveness
of caregiver- and parent-implemented
interventions is only incipient in Brazil
(Barboza et al., 2015; Borba, 2014; Faggiani,
2014; Ferreira, Silva, & Barros, 2016). Parents
and caregivers have been taught to implement
teaching programs, with the primary goal of
improving intervention outcomes by increasing
intensity and generalization to new environments
and people. Such studies have explored the
potential of caregivers as intervention agents,
based on the fact that they have access to the
children for more hours than any professional, as
a way to increase intervention intensity without
increasing fi nancial cost.
Therefore, the continual development
of training procedures that allow parents
and caregivers to profi ciently implement
interventions is a fundamental goal. Systematic
research on the effi ciency of diff erent training
procedures to increase parents’ and caregivers’
implementation accuracy is needed. Research
also needs to focus on the eff ects of these
interventions on children’s behavior. The present
study was an extension of previous studies in
our laboratory that focused on the eff ects of
teaching procedures on parents’ and caregivers’
implementation accuracy.
Borba (2014) previously showed the
eff ectiveness of a parent-implemented
intervention for children with developmental
delays in Brazil. Although eff ective, the
intervention that was implemented by parents
required many hours of training, particularly
at the beginning of the process. Focusing
on this issue, Faggiani (2014) designed and
implemented an online tutorial to teach
undergraduate students (Study 1) and a man who
completed high school (Study 2) how to conduct
a discrete-trials procedure. The tutorial included
theoretical training, video modeling, the
observation of correction procedures, and error
checking. Eight of nine participants reached
the implementation accuracy criterion. Other
researchers have also proposed teaching tools to
optimize training effi ciency (e.g., Fazzio, 2007;
Marcus & Wilder, 2009; Nelson-Head, Hill, &
Flores, 2012; Nielsen, Sigurdsson, & Austin,
2009; Plavnick & Ferreri, 2011; Pollard, Higbee,
Akers, & Broadhead, 2014; Vladescu, Carroll,
Paden, & Kodak, 2012).
Among the various training tools,
video modeling has been widely used as an
intervention tool (Catania, Almeida, Liu-

Barboza, A. A., Costa, L. C. B., Barros, R. S.
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Constant, & DiGennaro-Reed, 2009; Horrocks,
2010; Nielsen et al., 2009; Pollard et al., 2014;
Vladescu et al., 2012). Such tools have shown
promise in reducing the necessity of the presence
of a behavior analyst during initial training
and reducing the cost of parent-implemented
interventions.
Barboza et al. (2015) reported success in
training caregivers to conduct a discrete-trials
procedure using instructional video modeling.
Three parents participated in the study. After
watching the training videos, all of the parents
reached at least 80% accuracy in implementing
the discrete-trials program. The necessary
workload to reach such an outcome was 5 hours,
including video modeling and the presence of
the behavior analyst. The instructional video
modeling procedure was demonstrated to be
eff ective and effi cient in training parents of
children with ASD.
These studies (e.g., Barboza et al., 2015)
must be replicated with the goal of verifying
external and internal validity of the fi ndings.
For example, the experimental design was
an imperfect implementation of the multiple-
baseline design. The participants were given a
similar number of baseline sessions (four or fi ve)
before the independent variable was manipulated,
thus making the experimental design closer to an
AB design. Replicating the fi ndings of Barboza
et al. (2015) with a more rigorous experimental
design will increase internal and external
validity of the fi ndings. More empirical evidence
of the effi ciency of video modeling technology
is needed.
The present study continued the line
of investigation of Barboza et al. (2015) by
evaluating the effi ciency of instructional video
modeling as a tool for parental training. We
employed rigorous experimental controls
to evaluate the eff ects of instructional video
modeling on the implementation accuracy of a
discrete-trials procedure by parents of children
who were diagnosed with ASD. For ethical
reasons, when instructional video modeling was
insuffi cient for producing high implementation
integrity, feedback was introduced as a
remediation procedure. We assessed the time
that was necessary to achieve the training goals
as a way to measure training effi ciency.
Method
Participants
Three mother-child dyads participated in the
study: Beatriz (27 years old) and her son Luan (3
years old), Vanessa (40 years old) and her son
Daniel (4 years old), and Eliana (30 years old) and
her son Igor (2 years old). To maintain anonymity,
these are not the participants’ real names.
Beatriz and Eliana completed undergraduate
education, and Vanessa completed high school.
All of the children were diagnosed with ASD by
professionals in the Brazilian public healthcare
system. Participation was conditional on explicit
agreement by signing an informed consent
form. This research was approved by the Health
Sciences Institute Research Ethics Committee at
the Federal University of Pará (technical report
no. 175.303, December 14, 2012).
Facilities
The research was conducted in a 12.5 m2
room (2.5 m x 5.0 m) at the APRENDE Project,
located at the Nucleus of Theory and Research
on Behavior, at the Federal University of
Pará, Brazil. The room was divided in half by
a wall with a unidirectional mirror so that the
participants could be observed without seeing
the experimenter. One table and two chairs were
positioned in the room so that the mother and
child could sit down facing each other. There
was also one side chair for the experimenter.
Apparatus
The sessions were recorded using a
14-megapixel Sony Handycam camera. Data
sheets, a clipboard, blank paper, a pen, and
paper sheets with written instructions were used.
During the sessions, fi ve edibles and fi ve toys
were used as potential reinforcers.
The Verbal Behavior Milestones Assess-
ment and Placement Program (Sundberg, 2014)
was used to determine which teaching programs
would be implemented with the children in

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the generalization phase (the only moment at
which the parents implemented the intervention
with their children). The programs that were
implemented in the baseline and treatment
phases included Motor Imitation (Program 1)
and Intraverbal Using Personal Information
(Program 2).
Experimental Design
A nonconcurrent multiple baseline across
participants design (Watson & Workman, 1981)
was used to assess the eff ects of the independent
variable (instructional video modeling) on the
dependent variable (implementation accuracy of
discrete-trials procedure by parents).
Procedure
This study was divided into the following
fi ve phases:
Phase 1: Baseline. In each session, the
participants were provided (1) a paper with
instructions about the program to be imple-
mented (i.e., general teaching goal, response
required [vocal or motor], and how to record
independent, prompted, and incorrect responses),
(2) data sheet, (3) pen, (4) fi ve toys, and (5)
fi ve edibles. The participants were asked to
implement, the best possible way, fi ve discrete
trials for each teaching program. At this moment
of the baseline phase, none of the participants’
questions were answered by the researcher. The
teaching programs were then implemented with
a confederate (i.e., an experimenter who played
the role of a child with atypical development,
presenting correct and incorrect responses
according to a predetermined list) to avoid
inaccurate implementation with the children.
According to the multiple-baseline design, each
participant was given a diff erent number of
baseline sessions.
Phase 2: Intervention. The independent
variable was implemented in diff erent scheduled
sessions for each participant according to
the experimental design and considering
performance stability. The participants in the
intervention phase were individually taken to
a separate room to watch three instructional
videos. The videos were the same as those
used by Barboza et al. (2015) which combined
instructions, visual demonstrations, highlights,
and instructional subtitles. The videos focused
on skills that were necessary to implement the
discrete-trials teaching programs, including (1)
how to conduct discrete trials (a general view of
the procedure), (2) how to conduct prompting
procedures (ways of prompting a student
while conducting discrete trials), and (3) how
to implement correction procedures (how to
perform error correction). Before watching the
videos, the participants were instructed on how
to use the computer. They were also provided
a blank paper so they could take notes. The
participants watched the videos as many times
as they thought necessary. No feedback was
provided in the intervention phase.
Phase 3: Post-video modeling. After
watching the videos, the same materials as
in Phase 1 were provided, as well as the same
instructions. If implementation accuracy was less
than 80%, then the participants underwent one
more video modeling session. If performance
still did not reach the accuracy criterion (80%)
after three video modeling sessions, then the
participant was provided Level 1 feedback
(i.e., verbal instructions on how to implement
the procedural steps that the participant was
not implementing correctly). If the participant
still did not reach the accuracy criterion after
three sessions of Level 1 feedback, then Level
2 feedback (i.e., role-playing with immediate
feedback) was provided.
Phase 4: Generalization. When the 80%
performance criterion was reached in two
consecutive sessions or when the participant
performed at 100% accuracy in one session, a
generalization session was conducted. In this
session, the participant implemented discrete
trials of a new program with her child. The
teaching program was selected from the pool of
programs that were defi ned for that child based
on clinical priorities. In this phase, performance
generalization was assessed in the context of
implementing a new teaching program, which
was not part of the formal training.

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Phase 5: Follow-up. One month after
the last generalization session, a follow-up
session was conducted to check performance
maintenance.
Data Analysis
All of the experimental sessions were
analyzed daily using a discrete-trials perfor-
mance verifi cation form. This form presented
all of the necessary steps to implement the
procedure (e.g., obtaining the child’s attention,
presenting an instruction, waiting for a
response, implementing correction or prompting
procedures, recording data, and initiating the
intertrial interval). The correct implementation
of a given step produced one point on the
verifi cation form. Depending on the learning
unit, some of the steps were not applicable (e.g.,
implementing correction steps was not applicable
when a correct response was performed by the
child). The level of implementation accuracy
was determined by dividing the total number
of correct implementations by the total number
of implementations (correct and incorrect) and
multiplying the quotient by 100.
Interobserver Agreement
Thirty percent of the data that were
recorded for each participant were checked by
an independent observer who watched videos of
the sessions and performed the implementation
accuracy measurement. The level of interobserver
agreement was determined by dividing the
number of agreements by the total number of
agreements and disagreements and multiplying
the quotient by 100. The overall interobserver
agreement for this study was 98.3%.
Results
All of the participants presented highly
accurate implementation of the discrete-trials
procedure after completing the present study.
Beatriz underwent 15 data sessions. Eliana
underwent 14 sessions. Vanessa underwent
10 sessions. Figure 1 shows the participants’
performance accuracy while implementing the
three teaching programs.
All of the participants presented stability
during the baseline phase and increasing
performance accuracy after introduction of the
independent variable (video modeling). This
pattern of data suggests that the intervention
infl uenced the performance of all of the
participants. The average performance accuracy
after treatment (93.5% for Vanessa, 100% for
Eliana, and 100% for Beatriz) was higher than the
average baseline accuracy (54.5% for Vanessa,
45.5% for Eliana, and 65.5% for Beatriz). An
upward trend in accuracy was observed after
introducing the experimental treatment. This
eff ect was immediate for Vanessa and Eliana
and gradual for Beatriz.
Vanessa’s performance increased from 0%
in the fi rst baseline session to 98% in the last
postintervention session for Program 1 (Motor
Imitation). For Program 2 (Intraverbal Using
Personal Information), performance accuracy in
the fi rst baseline session was 62% and 97% in
the last post-intervention session. In the gene-
ralization session, Vanessa presented 100%
performance accuracy while implementing the
“Sitting” program, which was assigned to Daniel.
In the follow-up session, Vanessa presented 97%
implementation accuracy (Figure 1).
Eliana presented 22% accuracy at the
beginning of baseline for Program 1, and she
reached 100% accuracy in the last post-inter-
vention session. For Program 2, her performance
accuracy increased from 0% to 100% in the last
post-intervention session. In the generalization
phase, her performance accuracy was 100%,
which was partially maintained (93%) after 1
month during the follow-up session.
Beatriz presented 57% accuracy in the
fi rst baseline session of Program 1 (Motor
Imitation). Her accuracy increased to 100% in
the last post-intervention session. For Program
2 (Personal Information Intraverbal), her
performance accuracy increased from 68%
in the last baseline session to 100% in the last
post-intervention session. In the generalization
phase, Beatriz presented 100% accuracy while

Instructional Videomodeling to Teach Mothers of Children with Autism to Implement
Discrete Trials: A Systematic Replication.
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Trends Psychol., Ribeirão Preto, vol. 27, nº 3, p. 795-804 - September/2019
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Figure 1. Performance accuracy of the participants Vanessa, Eliana, and Beatriz at baseline,
post-intervention, generalization (GEN), and follow-up.

Barboza, A. A., Costa, L. C. B., Barros, R. S.
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Trends Psychol., Ribeirão Preto, vol. 27, nº 3, p. 795-804 - September/2019
implementing the “Tact of actions” program,
which was assigned to Luan. In the last follow-
up session, her performance was maintained at
100% (Figure 1).
Figure 2 shows the workload for each
participant during training. An average 3-hour
workload was necessary for the participants to
complete the intervention. Beatriz was given 88
minutes of baseline measurement, 104 minutes
of video modeling, and 18 minutes of feedback.
Vanessa was given 96 minutes of baseline
measurement, 84 minutes of video modeling,
and 5 minutes of feedback. Eliana was given
169 minutes of baseline measurement, 150
minutes of video modeling, and 19 minutes of
feedback.
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Figure 2. Workload required for each participant at baseline (Blue), instructional video
modeling (Red), and feedback (Green) sessions.
The present data generally show that the
independent variable (i.e., instructional video
modeling) had a clear and signifi cant positive
impact on implementation accuracy for all of the
participants. Beatriz’s accuracy increased from
62.5% in the fi rst baseline session to 100% in the
last post-intervention session. Eliana’s accuracy
increased from 11% to 100%. Vanessa’s
accuracy increased from 31% to 93.5%. Figure
2 shows that the workload that was necessary
to conduct this procedure (an average of 3
hours) was even less than the workload that was
reported by Barboza et al. (2015), which was an
average of 5 hours.
Discussion
The present study confi rmed fi ndings on
the effi cacy and effi ciency of instructional
video modeling procedures to teach discrete-
trials procedures to parents or caregivers (e.g.,
Barboza et al., 2015). Such training technolo-
gy is an alternative way to advance behavior-
analytic interventions for ASD under cost-
limited con-ditions. The limitations of the
experimental control that were highlighted
by Barboza et al. (2015) were successfully
overcome in the present study, in which we
conducted a progressively greater number of
baseline sessions across participants to adhere to
a multiple-baseline design.
Performance accuracy increased specifi -
cally after instructional video modeling and
before any feedback was given, thus en-
couraging the use of such a procedure to
teach parents of children who are diagnosed
with ASD how to implement discrete-trial
procedures and showing that little additional
support or feedback is needed to achieve training
goals. These data demonstrate an eff ective way
to promote interventions. Such effi ciency that is
conferred by parents consequently reduces the

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Discrete Trials: A Systematic Replication.
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time that a behavior analyst needs to dedicate
to implementation so that the behavior analyst
can focus more time on assessing the child’s
repertoire, designing teaching programs, and
monitoring the child’s progress and imple-
mentation accuracy.
More importantly, this kind of teaching
tool can reach its full potential only when it is
part of a wider training program that involves
behavior analyst presence-based interactions in
a comprehensive intervention approach. Parental
training that uses instructional video modeling
is among other tools that can be utilized by
behavior analysts to increase the potential of
interventions to produce necessary behavioral
changes, particularly when hiring technical
personnel is not an option.
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Received: 12/04/2018
1st revision: 30/10/2018
2nd revision: 24/11/2018
Accepted: 02/12/2018
__________________________________________________________________________________________
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