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3
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I
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I
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J
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15
,
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.
4
,
Au
g
u
s
t
20
26
:
3
2
7
9
-
3
2
9
1
3280
T
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ev
els
o
f
s
tr
ess
an
d
c
o
g
n
itiv
e
lo
ad
[
1
1
]
,
[
1
2
]
.
C
o
n
s
eq
u
e
n
tly
,
E
R
is
cr
itical
f
o
r
PS
T
s
to
s
u
cc
ee
d
b
o
th
ac
ad
em
i
ca
lly
an
d
p
r
o
f
ess
io
n
ally
.
E
R
ca
n
b
e
th
eo
r
etica
lly
g
r
o
u
n
d
ed
in
estab
lis
h
ed
p
s
y
c
h
o
lo
g
ical
f
r
am
ewo
r
k
s
,
p
ar
ticu
lar
l
y
r
esil
ien
ce
th
eo
r
y
a
n
d
s
elf
-
r
eg
u
latio
n
th
eo
r
y
.
R
esil
ien
ce
t
h
eo
r
y
co
n
c
ep
tu
alize
s
r
esil
ien
ce
as
a
d
y
n
am
ic
an
d
co
n
tex
t
-
d
ep
en
d
e
n
t
p
r
o
ce
s
s
r
ath
er
th
an
a
s
tab
le
tr
ait,
em
p
h
asizin
g
in
d
iv
id
u
als’
ca
p
ac
ity
t
o
ad
ap
t,
r
ec
o
v
er
,
an
d
ex
p
er
ien
ce
g
r
o
wth
wh
en
co
n
f
r
o
n
ted
with
ad
v
e
r
s
ity
.
I
n
ed
u
ca
tio
n
al
co
n
tex
ts
,
th
is
p
er
s
p
ec
tiv
e
h
ig
h
lig
h
ts
th
e
r
o
le
o
f
s
tr
u
ct
u
r
ed
e
x
p
o
s
u
r
e
to
ch
allen
g
es
co
m
b
in
ed
wit
h
s
u
p
p
o
r
tiv
e
co
n
d
itio
n
s
th
at
f
ac
ilit
ate
ad
ap
tiv
e
f
u
n
ctio
n
in
g
an
d
lo
n
g
-
ter
m
p
s
y
ch
o
lo
g
ical
d
ev
el
o
p
m
en
t.
C
o
m
p
lem
en
tar
ily
,
s
elf
-
r
eg
u
latio
n
t
h
eo
r
y
ex
p
lain
s
h
o
w
in
d
iv
id
u
als
m
o
n
ito
r
,
ev
alu
ate,
an
d
ad
ju
s
t
th
eir
co
g
n
itiv
e,
e
m
o
tio
n
al,
a
n
d
b
eh
a
v
io
r
al
s
tat
es
in
p
u
r
s
u
it
o
f
g
o
al
attain
m
en
t.
W
ith
in
th
is
f
r
a
m
ewo
r
k
,
E
R
ca
n
b
e
u
n
d
er
s
to
o
d
as
an
em
er
g
e
n
t
o
u
tc
o
m
e
o
f
ef
f
ec
tiv
e
s
elf
-
r
eg
u
lato
r
y
f
u
n
ctio
n
in
g
,
in
clu
d
in
g
em
o
tio
n
al
awa
r
en
ess
,
r
ef
lectiv
e
p
r
o
ce
s
s
in
g
,
a
n
d
a
d
a
p
tiv
e
s
tr
ateg
y
u
s
e.
I
n
DL
en
v
ir
o
n
m
en
ts
,
th
ese
co
n
d
itio
n
s
in
ten
s
if
y
d
em
an
d
s
o
n
lear
n
er
s
’
s
elf
-
r
e
g
u
lato
r
y
ca
p
a
city
d
u
e
to
in
cr
ea
s
ed
au
to
n
o
m
y
,
r
ed
u
ce
d
im
m
ed
iate
in
s
tr
u
cto
r
s
u
p
p
o
r
t,
an
d
h
eig
h
ten
e
d
tech
n
o
lo
g
ical
an
d
c
o
g
n
itiv
e
lo
ad
.
Su
ch
lear
n
in
g
c
o
n
tex
ts
r
eq
u
ir
e
co
n
tin
u
o
u
s
m
o
n
ito
r
i
n
g
an
d
ad
ju
s
tm
en
t
o
f
em
o
tio
n
al
an
d
co
g
n
itiv
e
s
tates
to
m
ain
tain
task
en
g
ag
em
e
n
t
an
d
p
er
f
o
r
m
an
ce
q
u
ality
,
p
o
s
iti
o
n
in
g
s
elf
-
r
e
g
u
latio
n
as
a
ce
n
tr
al
m
ec
h
an
is
m
o
f
ef
f
ec
tiv
e
lear
n
in
g
i
n
d
ig
ital
s
ettin
g
s
.
B
u
ild
in
g
o
n
th
is
th
eo
r
etica
l
f
o
u
n
d
atio
n
,
th
e
p
r
o
p
o
s
ed
m
ec
h
an
is
m
s
u
g
g
ests
th
at
s
tr
u
ctu
r
ed
DL
c
h
allen
g
es
f
ir
s
t
ac
tiv
ate
co
g
n
itiv
e
an
d
em
o
tio
n
al
a
p
p
r
aisal
p
r
o
ce
s
s
es,
th
r
o
u
g
h
wh
ich
PS
T
s
ev
alu
ate
task
d
e
m
an
d
s
as
eith
er
m
an
ag
ea
b
le
o
r
s
tr
ess
f
u
l.
T
h
ese
ap
p
r
aisals
s
u
b
s
eq
u
en
tly
tr
ig
g
er
s
elf
-
r
eg
u
lato
r
y
r
esp
o
n
s
es,
in
clu
d
in
g
g
o
al
ad
ju
s
tm
en
t,
e
m
o
tio
n
al
m
o
d
u
latio
n
,
s
tr
ate
g
ic
ad
ap
tatio
n
,
an
d
r
ef
lectiv
e
ev
alu
atio
n
.
R
ep
ea
t
ed
en
g
a
g
em
en
t
in
th
is
c
y
clica
l
p
r
o
ce
s
s
f
o
s
ter
s
th
e
g
r
a
d
u
al
d
ev
elo
p
m
en
t
o
f
ad
ap
tiv
e
co
p
i
n
g
s
tr
ateg
ies,
th
er
eb
y
c
o
n
tr
ib
u
ti
n
g
to
th
e
s
tr
en
g
th
en
i
n
g
o
f
ER
o
v
er
tim
e.
Acc
o
r
d
in
g
l
y
,
th
e
p
r
o
p
o
s
ed
m
o
d
el
ca
n
b
e
s
u
m
m
ar
ized
as:
d
ig
ital
ch
allen
g
e
→
co
g
n
itiv
e
-
e
m
o
tio
n
al
a
p
p
r
aisal
→
s
elf
-
r
eg
u
latio
n
→
ER
d
ev
elo
p
m
en
t.
T
h
is
f
r
a
m
ewo
r
k
clar
if
ies
th
e
d
e
v
elo
p
m
en
tal
m
ec
h
an
is
m
u
n
d
er
p
i
n
n
in
g
th
e
in
ter
v
en
tio
n
b
y
lin
k
in
g
en
v
ir
o
n
m
en
tal
d
em
an
d
s
with
in
ter
n
al
r
eg
u
l
ato
r
y
p
r
o
ce
s
s
es
an
d
r
esil
ien
ce
o
u
tco
m
es.
T
h
e
co
n
ce
p
tu
al
f
r
am
ewo
r
k
is
s
h
o
wn
in
Fig
u
r
e
1
.
Fig
u
r
e
1
.
C
o
n
ce
p
tu
al
f
r
a
m
ewo
r
k
o
f
E
R
d
ev
elo
p
m
en
t in
DL
e
n
v
ir
o
n
m
en
ts
R
esear
ch
co
n
s
is
ten
tly
h
ig
h
li
g
h
ts
th
e
im
p
o
r
tan
ce
o
f
E
R
in
teac
h
er
ef
f
ec
tiv
e
n
ess
an
d
well
-
b
ein
g
[
1
3
]
,
[
1
4
]
.
R
esil
ien
t
teac
h
er
s
d
em
o
n
s
tr
ate
h
ig
h
er
ad
a
p
tab
ilit
y
an
d
p
r
o
f
ess
io
n
al
s
tab
ilit
y
,
m
an
ag
e
class
r
o
o
m
ch
allen
g
es
m
o
r
e
ef
f
ec
tiv
el
y
,
a
n
d
ex
h
ib
it
s
tr
o
n
g
er
s
elf
-
ef
f
ica
cy
.
DL
e
n
v
ir
o
n
m
en
ts
p
r
esen
t
b
o
th
r
is
k
s
,
s
u
c
h
as
tech
n
o
s
tr
ess
an
d
em
o
tio
n
al
f
atig
u
e,
an
d
o
p
p
o
r
tu
n
ities
f
o
r
g
r
o
wth
,
o
f
f
er
in
g
f
lex
ib
le,
r
eso
u
r
ce
-
r
ic
h
co
n
te
x
ts
th
at
ca
n
f
o
s
ter
s
elf
-
r
e
g
u
latio
n
an
d
r
ef
lectiv
e
p
r
ac
tice.
Prio
r
s
tu
d
ies
h
av
e
s
h
o
wn
th
a
t
E
R
is
a
d
ev
elo
p
ab
le
ca
p
ac
i
ty
r
ath
er
th
an
a
f
i
x
ed
tr
ait
[
1
5
]
,
[
1
6
]
.
Day
[
1
7
]
d
em
o
n
s
tr
ated
th
at
r
e
s
ilien
ce
s
u
p
p
o
r
ts
teac
h
er
s
’
lo
n
g
-
ter
m
co
m
m
itm
en
t
an
d
ad
ap
t
ab
ilit
y
in
ch
an
g
in
g
ed
u
ca
tio
n
al
c
o
n
tex
ts
,
w
h
ile
D
u
an
et
a
l.
[
1
8
]
em
p
h
asized
t
h
e
in
ter
p
lay
o
f
p
e
r
s
o
n
al
a
n
d
c
o
n
tex
tu
al
f
ac
to
r
s
in
s
u
s
tain
in
g
teac
h
er
r
esil
ien
ce
,
p
ar
ticu
lar
ly
d
u
r
i
n
g
ea
r
ly
c
ar
ee
r
s
tag
es.
L
i
[
1
9
]
f
u
r
th
e
r
h
ig
h
lig
h
ted
th
at
em
o
tio
n
al
d
e
m
an
d
s
a
r
e
ce
n
tr
al
to
teac
h
in
g
an
d
d
i
r
ec
tly
a
f
f
ec
t
p
r
o
f
ess
io
n
al
p
er
f
o
r
m
a
n
c
e,
with
h
ig
h
er
E
R
ass
o
ciate
d
with
lo
wer
b
u
r
n
o
u
t
an
d
g
r
ea
ter
s
elf
-
ef
f
icac
y
.
H
o
wev
er
,
th
e
m
ajo
r
ity
o
f
th
es
e
s
tu
d
ies
f
o
cu
s
o
n
in
-
s
er
v
ice
teac
h
er
s
,
leav
in
g
PS
T
s
in
E
C
E
co
n
tex
ts
u
n
d
e
r
ex
a
m
in
ed
[
2
0
]
.
T
h
e
r
o
le
o
f
DL
en
v
ir
o
n
m
en
ts
in
teac
h
er
d
e
v
elo
p
m
e
n
t
h
as
r
ec
eiv
ed
in
cr
ea
s
in
g
atten
t
io
n
,
with
r
esear
ch
ex
am
in
in
g
d
ig
ital c
o
m
p
eten
ce
,
tech
n
o
s
tr
ess
,
an
d
o
n
lin
e
ad
ap
tatio
n
[
2
1
]
.
W
h
ile
DL
en
v
ir
o
n
m
en
ts
ca
n
ch
allen
g
e
teac
h
er
s
b
y
im
p
o
s
in
g
co
g
n
itiv
e
an
d
em
o
tio
n
al
d
em
an
d
s
,
th
e
y
also
p
r
o
v
id
e
o
p
p
o
r
tu
n
ities
f
o
r
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
J
E
v
al
&
R
es E
d
u
c
I
SS
N:
2252
-
8
8
2
2
E
n
h
a
n
ci
n
g
emo
tio
n
a
l res
ilien
ce
in
p
r
e
-
s
ervice
ea
r
ly
ch
ild
h
o
o
d
ed
u
c
a
to
r
s
th
r
o
u
g
h
…
(
Gu
lmir
a
Mo
mb
iyev
a
)
3281
ex
p
er
im
en
tatio
n
,
r
ef
lectio
n
,
a
n
d
co
llab
o
r
ativ
e
p
r
o
b
lem
-
s
o
lv
in
g
.
Desp
ite
th
e
g
r
o
win
g
b
o
d
y
o
f
r
esear
ch
o
n
DL
in
teac
h
er
ed
u
ca
ti
o
n
,
im
p
o
r
t
an
t
g
ap
s
r
em
ain
.
First,
ex
is
tin
g
s
tu
d
ies
p
r
ed
o
m
i
n
an
tly
f
o
cu
s
o
n
tech
n
ical
co
m
p
eten
cies,
d
ig
ital
a
d
ap
tati
o
n
,
an
d
tech
n
o
s
tr
ess
,
wh
ile
E
R
is
ty
p
ically
tr
ea
ted
as
a
s
ec
o
n
d
ar
y
o
r
co
n
te
x
tu
al
v
ar
iab
le
r
ath
e
r
th
an
a
p
r
im
a
r
y
o
u
tco
m
e.
Seco
n
d
,
th
e
m
aj
o
r
ity
o
f
r
esil
ien
ce
r
esear
ch
h
as
b
e
en
co
n
d
u
cted
wit
h
in
-
s
er
v
ice
teac
h
er
s
,
with
lim
ited
atten
tio
n
to
PS
T
s
in
E
C
E
c
o
n
tex
ts
,
wh
er
e
em
o
tio
n
al
d
em
an
d
s
ar
e
esp
ec
ially
p
r
o
n
o
u
n
ce
d
[
2
2
]
,
[
2
3
]
.
Mo
r
eo
v
er
,
th
er
e
is
a
lack
o
f
em
p
ir
ically
test
ed
in
ter
v
en
ti
o
n
-
b
ased
s
tu
d
ies
th
at
ex
am
in
e
wh
eth
er
s
tr
u
ctu
r
ed
DL
ex
p
er
ien
ce
s
c
an
ac
tiv
ely
f
o
s
ter
E
R
,
r
ath
e
r
th
an
m
er
el
y
d
escr
ib
e
its
l
ev
els.
T
h
is
cr
ea
tes
a
p
o
ten
tial
co
n
ce
p
tu
al
ten
s
io
n
:
wh
ile
DL
en
v
ir
o
n
m
en
ts
ar
e
o
f
ten
ass
o
ciate
d
with
in
cr
ea
s
ed
s
tr
ess
an
d
co
g
n
itiv
e
lo
ad
,
th
ey
ar
e
s
im
u
l
tan
eo
u
s
ly
ass
u
m
ed
to
s
u
p
p
o
r
t
r
ef
lectiv
e
p
r
ac
tice
an
d
s
elf
-
r
e
g
u
latio
n
,
wh
ich
a
r
e
k
ey
m
ec
h
an
is
m
s
o
f
r
esil
ien
ce
d
ev
elo
p
m
e
n
t.
Ho
wev
er
,
th
e
c
o
n
d
itio
n
s
u
n
d
er
wh
ich
DL
en
v
ir
o
n
m
e
n
ts
f
u
n
ctio
n
as
eith
er
a
r
is
k
o
r
a
d
ev
elo
p
m
en
tal
r
eso
u
r
ce
f
o
r
E
R
r
em
ain
in
s
u
f
f
icien
tly
u
n
d
er
s
t
o
o
d
.
Giv
en
th
ese
co
n
s
id
er
atio
n
s
,
f
o
s
ter
in
g
E
R
am
o
n
g
p
r
e
-
s
er
v
ice
teac
h
er
s
c
an
b
e
co
n
s
id
er
ed
a
cr
itical
p
r
io
r
ity
b
o
th
g
lo
b
ally
an
d
with
in
Kaz
ak
h
s
tan
.
Glo
b
a
lly
,
in
cr
ea
s
in
g
ed
u
ca
tio
n
al
co
m
p
lex
ity
,
r
ap
id
d
ig
italizatio
n
,
an
d
r
is
in
g
lev
els
o
f
teac
h
er
s
tr
ess
an
d
b
u
r
n
o
u
t
h
av
e
in
ten
s
if
ied
th
e
n
ee
d
f
o
r
s
o
cio
-
em
o
tio
n
al
co
m
p
ete
n
cies
th
at
s
u
p
p
o
r
t
ad
ap
tab
ilit
y
an
d
well
-
b
ein
g
.
I
n
th
is
co
n
tex
t,
E
R
is
n
o
t
m
er
ely
a
d
esira
b
le
attr
ib
u
te
b
u
t
a
f
o
u
n
d
atio
n
al
co
m
p
o
n
en
t o
f
s
u
s
tain
ab
le
teac
h
in
g
p
r
ac
tice.
I
n
Kaz
ak
h
s
tan
,
th
is
p
r
io
r
ity
is
f
u
r
t
h
er
am
p
lifie
d
b
y
th
e
o
n
g
o
in
g
t
r
an
s
f
o
r
m
ati
o
n
o
f
h
ig
h
er
ed
u
ca
tio
n
an
d
th
e
r
ap
id
in
teg
r
atio
n
o
f
DL
en
v
ir
o
n
m
e
n
ts
,
wh
ich
p
lace
ad
d
itio
n
al
co
g
n
itiv
e
an
d
em
o
tio
n
al
d
em
an
d
s
o
n
p
r
e
-
s
er
v
ice
teac
h
er
s
.
Desp
ite
th
ese
ch
allen
g
es,
th
e
d
e
v
elo
p
m
en
t
o
f
E
R
h
as
n
o
t
y
et
b
ee
n
s
y
s
tem
atica
lly
em
b
ed
d
e
d
in
teac
h
er
p
r
ep
a
r
atio
n
p
r
o
g
r
am
s
,
n
o
r
s
u
f
f
icien
tly
ex
am
in
ed
i
n
em
p
ir
ical
r
esear
c
h
.
Ad
d
r
ess
in
g
th
is
g
ap
is
ess
en
tial
to
en
s
u
r
e
th
at
f
u
tu
r
e
ea
r
ly
ch
ild
h
o
o
d
e
d
u
c
ato
r
s
ar
e
eq
u
ip
p
ed
n
o
t
o
n
l
y
with
tech
n
ical
an
d
p
ed
ag
o
g
ical
s
k
ills
,
b
u
t
also
with
th
e
em
o
tio
n
al
ca
p
ac
ities
n
ec
ess
ar
y
to
f
u
n
ctio
n
ef
f
e
ctiv
ely
in
ev
o
l
v
in
g
ed
u
ca
tio
n
al
co
n
tex
ts
.
T
h
ese
g
ap
s
ar
e
p
ar
ticu
lar
ly
ev
id
en
t
in
th
e
co
n
tex
t
o
f
C
en
tr
al
Asi
a,
wh
er
e
r
esear
ch
o
n
teac
h
er
r
esil
ien
ce
in
d
ig
ital
en
v
ir
o
n
m
en
ts
is
s
till
em
er
g
in
g
[
2
4
]
–
[
2
6
]
.
I
n
Kaz
ak
h
s
tan
,
th
e
r
ap
id
ex
p
an
s
io
n
o
f
DL
i
n
h
ig
h
er
e
d
u
ca
tio
n
h
as c
r
ea
ted
n
ew
ch
allen
g
es a
n
d
o
p
p
o
r
tu
n
iti
es f
o
r
teac
h
er
p
r
ep
ar
atio
n
,
y
et
em
p
ir
ical
ev
id
en
ce
o
n
its
im
p
ac
t
o
n
PS
T
s
’
em
o
t
io
n
al
d
ev
elo
p
m
en
t
r
em
ain
s
li
m
ited
[
2
7
]
,
[
2
8
]
.
T
h
is
f
o
c
u
s
alig
n
s
with
cu
r
r
en
t
n
atio
n
al
ed
u
ca
tio
n
p
o
licies
in
Kaz
ak
h
s
tan
,
wh
ich
p
r
io
r
itize
th
e
d
ig
italizatio
n
o
f
e
d
u
ca
tio
n
a
n
d
th
e
d
ev
elo
p
m
e
n
t
o
f
teac
h
er
s
’
d
i
g
ital
co
m
p
eten
cies
as
k
ey
co
m
p
o
n
en
ts
o
f
ed
u
ca
tio
n
al
r
e
f
o
r
m
.
Fo
r
ex
a
m
p
le,
n
atio
n
al
f
r
am
ew
o
r
k
s
em
p
h
asize
th
e
in
teg
r
atio
n
o
f
d
ig
ital
tech
n
o
lo
g
ies
in
to
teac
h
in
g
an
d
th
e
c
o
n
tin
u
o
u
s
p
r
o
f
ess
io
n
al
d
e
v
elo
p
m
e
n
t
o
f
ed
u
ca
to
r
s
,
y
et
th
ey
p
r
im
ar
ily
f
o
cu
s
o
n
tech
n
ical
a
n
d
in
s
tr
u
ctio
n
al
s
k
ills
,
with
lim
ited
atten
tio
n
to
s
o
cio
-
em
o
tio
n
al
co
m
p
eten
cies
s
u
ch
as
ER
.
T
h
er
ef
o
r
e,
th
er
e
is
a
n
ee
d
f
o
r
s
y
s
tem
atic
em
p
ir
ical
in
v
esti
g
atio
n
th
at
e
x
am
in
es
n
o
t
o
n
ly
le
v
els
o
f
E
R
b
u
t
also
th
e
ex
ten
t
to
wh
ich
s
tr
u
ctu
r
ed
DL
in
ter
v
en
tio
n
s
ca
n
co
n
tr
ib
u
te
to
its
d
ev
elo
p
m
en
t
[
2
9
]
–
[
3
2
]
.
B
ey
o
n
d
ad
d
r
ess
in
g
th
e
o
r
etica
l
g
ap
s
,
th
e
p
r
o
p
o
s
ed
in
te
r
v
en
tio
n
h
as
im
p
o
r
tan
t
im
p
lic
atio
n
s
f
o
r
teac
h
er
ed
u
ca
tio
n
p
r
ac
tice.
B
y
em
b
ed
d
in
g
s
tr
u
ctu
r
ed
E
R
d
ev
elo
p
m
en
t
with
in
DL
en
v
ir
o
n
m
en
ts
,
th
is
s
tu
d
y
d
em
o
n
s
tr
ates
h
o
w
em
o
tio
n
al
co
m
p
ete
n
cies
ca
n
b
e
s
y
s
te
m
atica
lly
in
teg
r
ated
in
to
d
ig
ital
teac
h
er
tr
ain
i
n
g
m
o
d
u
les
r
ath
e
r
th
a
n
tr
ea
ted
as
im
p
licit
o
r
s
ec
o
n
d
ar
y
o
u
tco
m
es.
Su
ch
an
ap
p
r
o
ac
h
co
n
tr
i
b
u
tes
to
b
r
id
g
in
g
t
h
e
p
er
s
is
ten
t
d
iv
id
e
b
etwe
en
tec
h
n
ical
d
ig
ital
s
k
ill
d
ev
elo
p
m
en
t
an
d
s
o
cio
-
em
o
tio
n
al
p
r
e
p
ar
atio
n
in
teac
h
er
ed
u
ca
tio
n
p
r
o
g
r
am
s
.
T
h
e
b
r
o
ad
e
r
im
p
ac
t
o
f
f
o
s
ter
i
n
g
E
R
am
o
n
g
p
r
e
-
s
er
v
ice
ea
r
ly
ch
ild
h
o
o
d
ed
u
ca
to
r
s
ex
ten
d
s
b
ey
o
n
d
in
d
iv
id
u
al
c
o
m
p
eten
ce
.
Pre
p
a
r
in
g
r
esil
ien
t
teac
h
er
s
m
ay
e
n
h
an
ce
th
e
o
v
er
all
q
u
ality
o
f
E
C
E
b
y
im
p
r
o
v
in
g
class
r
o
o
m
m
an
ag
em
e
n
t,
teac
h
er
–
ch
ild
i
n
ter
ac
tio
n
s
,
an
d
in
s
tr
u
ctio
n
al
s
tab
ilit
y
.
I
n
ad
d
itio
n
,
s
tr
o
n
g
er
E
R
is
ass
o
ciate
d
with
r
ed
u
ce
d
r
is
k
o
f
b
u
r
n
o
u
t,
g
r
ea
ter
p
r
o
f
e
s
s
io
n
al
lo
n
g
ev
ity
,
an
d
im
p
r
o
v
ed
m
en
tal
h
ea
lth
o
u
tco
m
es.
C
o
n
s
eq
u
en
tly
,
in
te
g
r
atin
g
E
R
-
f
o
cu
s
ed
in
ter
v
e
n
tio
n
s
in
to
d
ig
ital
teac
h
er
ed
u
ca
t
io
n
m
a
y
s
u
p
p
o
r
t
n
o
t
o
n
ly
in
d
iv
id
u
al
teac
h
er
d
ev
el
o
p
m
en
t
b
u
t
also
th
e
s
u
s
tain
a
b
ilit
y
an
d
ef
f
ec
tiv
e
n
ess
o
f
th
e
ed
u
ca
tio
n
s
y
s
tem
m
o
r
e
b
r
o
ad
ly
.
I
m
p
o
r
ta
n
tly
,
th
e
p
r
o
p
o
s
ed
a
p
p
r
o
ac
h
also
d
em
o
n
s
tr
ates
s
tr
o
n
g
p
o
ten
tial
f
o
r
s
ca
lab
ilit
y
an
d
p
o
licy
in
teg
r
atio
n
.
B
ec
au
s
e
th
e
i
n
ter
v
en
tio
n
is
em
b
e
d
d
ed
with
in
DL
e
n
v
ir
o
n
m
en
ts
,
it
ca
n
b
e
ad
ap
ted
an
d
im
p
lem
en
ted
ac
r
o
s
s
teac
h
er
e
d
u
ca
tio
n
in
s
titu
tio
n
s
with
r
elativ
ely
lo
w
s
tr
u
ctu
r
al
co
n
s
tr
ain
t
s
.
At
a
p
o
licy
lev
el,
th
e
f
in
d
in
g
s
m
ay
in
f
o
r
m
th
e
d
ev
elo
p
m
e
n
t
o
f
n
atio
n
al
t
ea
ch
er
ed
u
ca
tio
n
s
tan
d
a
r
d
s
b
y
h
ig
h
lig
h
tin
g
th
e
im
p
o
r
tan
ce
o
f
ex
p
licitly
in
teg
r
atin
g
E
R
in
to
d
ig
ital a
n
d
p
ed
a
g
o
g
ical
tr
ain
in
g
f
r
am
ewo
r
k
s
.
I
n
th
is
s
tu
d
y
,
E
R
is
o
p
er
atio
n
a
lized
as
s
co
r
es
o
n
th
e
C
o
n
n
o
r
-
Dav
id
s
o
n
R
esil
ien
ce
Sca
le
(
C
D
-
R
I
SC
)
.
T
h
e
aim
o
f
th
is
s
tu
d
y
is
to
e
x
am
in
e
th
e
ef
f
ec
t
o
f
a
s
tr
u
ctu
r
ed
DL
in
ter
v
en
tio
n
o
n
th
e
d
ev
elo
p
m
e
n
t
o
f
E
R
am
o
n
g
PS
T
s
in
E
C
E
co
n
tex
ts
in
Kaz
ak
h
s
tan
.
Acc
o
r
d
in
g
ly
,
th
e
s
tu
d
y
ad
d
r
ess
es
th
e
f
o
llo
win
g
r
esear
c
h
q
u
esti
o
n
:
h
o
w
d
o
es
a
s
tr
u
ctu
r
ed
DL
in
ter
v
e
n
tio
n
i
n
f
lu
en
ce
th
e
d
ev
elo
p
m
en
t
o
f
E
R
am
o
n
g
PS
T
s
?
B
ased
o
n
th
e
th
eo
r
etica
l
f
r
am
ewo
r
k
an
d
p
r
io
r
em
p
ir
ical
f
in
d
in
g
s
,
th
e
f
o
llo
win
g
h
y
p
o
th
esis
(
H1
)
was
f
o
r
m
u
lated
:
PS
T
s
wh
o
p
ar
ticip
ate
in
a
s
tr
u
ctu
r
ed
DL
in
ter
v
en
tio
n
e
x
p
er
im
e
n
tal
g
r
o
u
p
(
E
G)
will
d
em
o
n
s
tr
ate
s
ig
n
if
ican
tly
h
ig
h
er
p
o
s
ttes
t CD
-
R
I
S
C
s
co
r
es c
o
m
p
ar
ed
t
o
th
o
s
e
in
th
e
co
n
tr
o
l g
r
o
u
p
(
C
G)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
2
2
I
n
t
J
E
v
al
&
R
es E
d
u
c
,
Vo
l
.
15
,
No
.
4
,
Au
g
u
s
t
20
26
:
3
2
7
9
-
3
2
9
1
3282
2.
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n
T
h
is
s
tu
d
y
em
p
lo
y
e
d
a
q
u
a
n
titativ
e
q
u
asi
-
ex
p
e
r
im
en
tal
p
r
et
est
-
p
o
s
ttes
t
d
esig
n
with
n
o
n
-
e
q
u
iv
alen
t
g
r
o
u
p
s
[
3
3
]
to
ex
am
in
e
E
R
a
m
o
n
g
PS
T
s
with
in
DL
en
v
i
r
o
n
m
en
ts
in
Kaz
ak
h
s
tan
.
Qu
asi
-
ex
p
er
im
en
tal
d
esig
n
s
ar
e
p
ar
ticu
lar
l
y
s
u
itab
le
in
e
d
u
ca
tio
n
al
c
o
n
tex
ts
wh
er
e
r
a
n
d
o
m
ass
ig
n
m
en
t
is
n
o
t
f
ea
s
ib
le,
s
u
ch
as
wh
e
n
p
ar
ticip
an
ts
ar
e
o
r
g
an
ized
in
t
o
p
r
e
-
e
x
is
tin
g
ac
ad
em
ic
co
h
o
r
ts
.
I
n
th
is
s
tu
d
y
,
p
a
r
ticip
an
ts
wer
e
ass
ig
n
ed
to
g
r
o
u
p
s
b
ased
o
n
th
ese
co
h
o
r
ts
,
r
esu
ltin
g
in
n
o
n
-
r
an
d
o
m
ized
allo
ca
tio
n
,
w
h
ich
is
ty
p
ical
f
o
r
q
u
asi
-
ex
p
er
im
en
tal
r
esear
c
h
.
Pre
test
an
d
p
o
s
ttes
t
as
s
es
s
m
e
n
ts
wer
e
co
n
d
u
cted
to
e
v
alu
at
e
b
aselin
e
eq
u
iv
alen
ce
b
etwe
en
th
e
E
G
an
d
th
e
C
G,
an
d
to
m
ea
s
u
r
e
ch
an
g
es
in
E
R
f
o
llo
win
g
th
e
s
tr
u
ctu
r
ed
DL
in
ter
v
en
tio
n
s
h
o
wn
in
Fig
u
r
e
2
.
T
h
is
d
esig
n
allo
ws
f
o
r
th
e
an
aly
s
is
o
f
b
o
th
with
in
-
g
r
o
u
p
c
h
a
n
g
es
o
v
er
tim
e
an
d
b
etwe
en
-
g
r
o
u
p
d
if
f
er
en
ce
s
,
p
r
o
v
id
i
n
g
r
o
b
u
s
t
ev
id
e
n
ce
r
eg
ar
d
in
g
th
e
in
ter
v
en
tio
n
’
s
ef
f
ec
ts
wh
ile
m
ain
tain
in
g
ec
o
lo
g
ical
v
alid
ity
in
p
ar
ticip
an
ts
’
n
atu
r
al
ed
u
ca
tio
n
al
s
ettin
g
.
B
y
co
m
b
in
in
g
m
eth
o
d
o
lo
g
ical
r
ig
o
r
with
p
r
ac
tical
f
ea
s
ib
ilit
y
,
th
is
ap
p
r
o
ac
h
o
f
f
e
r
s
a
s
y
s
tem
atic
f
r
am
ewo
r
k
f
o
r
u
n
d
er
s
tan
d
in
g
h
o
w
s
tr
u
ctu
r
ed
DL
ex
p
e
r
ien
c
es
co
n
tr
ib
u
te
to
th
e
d
ev
elo
p
m
e
n
t o
f
E
R
am
o
n
g
PS
T
s
in
au
th
en
tic
teac
h
er
ed
u
ca
ti
o
n
co
n
te
x
ts
.
Fig
u
r
e
2
.
Flo
wch
ar
t
o
f
th
e
s
tu
d
y
d
esig
n
2
.
2
.
Sa
m
pli
ng
T
h
e
s
tu
d
y
in
clu
d
ed
1
6
5
PS
T
s
f
r
o
m
So
u
t
h
Kaz
ak
h
s
tan
R
esear
ch
Un
iv
er
s
ity
n
am
e
d
af
ter
M
.
Au
ez
o
v
,
r
ec
r
u
ited
f
r
o
m
th
e
3
r
d
an
d
4
th
y
ea
r
co
h
o
r
ts
o
f
t
h
e
Pre
s
ch
o
o
l
E
d
u
ca
tio
n
an
d
T
r
ain
i
n
g
p
r
o
g
r
am
u
s
in
g
a
co
n
v
e
n
ien
ce
s
am
p
lin
g
ap
p
r
o
ac
h
.
Par
ticip
an
ts
wer
e
all
o
c
ated
to
g
r
o
u
p
s
b
ased
o
n
th
eir
ex
is
tin
g
ac
ad
em
ic
co
h
o
r
ts
,
r
esu
ltin
g
in
C
G
(
n
=8
4
)
an
d
E
G
(
n
=8
1
)
.
T
h
is
allo
ca
tio
n
m
eth
o
d
r
e
f
lects th
e
n
o
n
-
r
a
n
d
o
m
ized
n
at
u
r
e
o
f
q
u
asi
-
ex
p
er
im
e
n
tal
d
esig
n
s
.
All
p
ar
ticip
an
ts
wer
e
f
em
al
e,
r
ef
lectin
g
th
e
g
en
d
e
r
d
is
tr
ib
u
tio
n
ty
p
ical
o
f
p
r
esch
o
o
l
ed
u
ca
ti
o
n
p
r
o
g
r
am
s
in
Kaz
ak
h
s
tan
.
T
h
is
h
o
m
o
g
en
eity
s
h
o
u
ld
b
e
c
o
n
s
id
er
ed
wh
en
g
en
er
alizin
g
f
in
d
in
g
s
to
m
ale
PS
T
s
.
B
o
th
g
r
o
u
p
s
wer
e
co
m
p
ar
ab
le
in
ter
m
s
o
f
ag
e
an
d
ac
ad
e
m
ic
y
ea
r
,
as
v
er
if
ied
b
y
d
escr
ip
tiv
e
s
tatis
tics
.
All
p
ar
ticip
an
ts
p
r
o
v
id
ed
wr
itten
in
f
o
r
m
ed
co
n
s
en
t,
an
d
p
ar
ticip
a
tio
n
was
v
o
l
u
n
tar
y
.
I
n
clu
s
io
n
cr
iter
ia
wer
e
en
r
o
llm
en
t
in
th
e
Pre
s
ch
o
o
l
E
d
u
ca
tio
n
an
d
T
r
ain
in
g
p
r
o
g
r
a
m
,
b
ei
n
g
a
3
r
d
o
r
4
th
y
ea
r
s
tu
d
en
t,
an
d
h
av
i
n
g
n
o
p
r
io
r
p
r
o
f
ess
io
n
al
teac
h
in
g
ex
p
e
r
ien
ce
in
p
r
esch
o
o
l
s
ettin
g
s
.
E
x
clu
s
io
n
c
r
iter
ia
in
clu
d
ed
a
n
y
p
r
ev
io
u
s
f
o
r
m
al
teac
h
in
g
ex
p
er
ien
ce
in
p
r
esch
o
o
l
in
s
titu
tio
n
s
an
d
i
n
co
m
p
let
e
s
u
r
v
ey
r
esp
o
n
s
es.
T
h
e
d
em
o
g
r
ap
h
ic
an
d
ac
ad
em
ic
ch
ar
ac
ter
is
tics
o
f
p
ar
ticip
an
ts
ar
e
s
u
m
m
ar
ized
in
T
a
b
le
1
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
J
E
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&
R
es E
d
u
c
I
SS
N:
2252
-
8
8
2
2
E
n
h
a
n
ci
n
g
emo
tio
n
a
l res
ilien
ce
in
p
r
e
-
s
ervice
ea
r
ly
ch
ild
h
o
o
d
ed
u
c
a
to
r
s
th
r
o
u
g
h
…
(
Gu
lmir
a
Mo
mb
iyev
a
)
3283
T
ab
le
1
.
C
h
ar
ac
ter
is
tics
o
f
s
tu
d
y
p
ar
ticip
a
n
ts
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
C
G
(
n
=
8
4
)
EG
(
n
=
8
1
)
To
t
a
l
(
N
=
1
6
5
)
A
g
e
(
y
e
a
r
s,
M
±
S
D
)
2
0
.
8
±
1
.
1
2
1
.
0
±
1
.
2
2
0
.
9
±
1
.
1
5
G
e
n
d
e
r
F
e
mal
e
:
8
4
(
1
0
0
%)
F
e
mal
e
:
8
1
(
1
0
0
%)
1
6
5
(
1
0
0
%)
A
c
a
d
e
mi
c
y
e
a
r
3
r
d
y
e
a
r
4
2
(
5
0
%)
4
0
(
4
9
%)
8
2
(
5
0
%)
4
t
h
y
e
a
r
4
2
(
5
0
%)
4
1
(
5
1
%)
8
3
(
5
0
%)
2
.
3
.
P
r
o
ce
du
re
T
h
e
s
tu
d
y
was
co
n
d
u
cted
d
u
r
in
g
th
e
2
0
2
5
s
p
r
in
g
s
em
ester
in
ac
co
r
d
a
n
ce
with
estab
lis
h
ed
eth
ical
s
tan
d
ar
d
s
f
o
r
r
esear
ch
i
n
v
o
lv
i
n
g
h
u
m
an
p
ar
ticip
an
ts
.
E
th
ica
l
ap
p
r
o
v
al
was
o
b
tain
e
d
f
r
o
m
th
e
R
esear
ch
E
th
ics
C
o
m
m
ittee
o
f
So
u
th
Kaz
a
k
h
s
tan
R
esear
ch
Un
iv
e
r
s
ity
n
am
e
d
af
ter
M.
Au
ez
o
v
,
an
d
all
p
a
r
ticip
an
ts
p
r
o
v
id
ed
wr
itten
in
f
o
r
m
ed
c
o
n
s
en
t,
w
ith
ass
u
r
an
ce
s
o
f
co
n
f
id
en
ti
ality
an
d
v
o
lu
n
ta
r
y
p
ar
ticip
a
tio
n
.
T
h
e
r
esear
ch
f
o
llo
wed
a
s
tr
u
ctu
r
ed
p
r
etest
–
p
o
s
ttes
t d
esig
n
.
At
b
aselin
e,
all
p
ar
ticip
an
ts
in
b
o
th
th
e
E
G
an
d
th
e
C
G
co
m
p
leted
th
e
E
R
ass
e
s
s
m
en
t
u
n
d
er
s
tan
d
ar
d
ized
co
n
d
itio
n
s
,
i
n
clu
d
in
g
id
e
n
tical
in
s
tr
u
ctio
n
s
,
eq
u
al
tim
e
allo
ca
tio
n
(
5
0
m
in
u
t
es),
an
d
c
o
n
s
is
ten
t
s
u
p
er
v
is
io
n
.
C
o
m
p
leted
p
r
ete
s
t
r
esp
o
n
s
es
wer
e
co
llected
im
m
ed
iately
an
d
s
ec
u
r
ely
s
to
r
ed
to
en
s
u
r
e
d
ata
in
teg
r
ity
.
An
y
in
c
o
m
p
lete
o
r
i
n
co
n
s
is
ten
t r
esp
o
n
s
es we
r
e
ex
clu
d
ed
f
r
o
m
an
aly
s
is
b
ased
o
n
p
r
ed
ef
in
e
d
cr
iter
ia.
T
h
ese
p
r
o
ce
d
u
r
es
p
r
o
v
i
d
ed
a
r
eliab
le
m
ea
s
u
r
e
o
f
b
aselin
e
E
R
,
en
ab
lin
g
ev
alu
atio
n
o
f
ch
an
g
es
a
f
ter
th
e
in
ter
v
en
tio
n
.
B
aselin
e
eq
u
iv
alen
ce
b
etwe
en
g
r
o
u
p
s
was
ex
am
in
ed
u
s
in
g
in
d
e
p
en
d
e
n
t
-
s
am
p
les
t
-
test
s
,
in
d
icatin
g
n
o
s
tatis
tically
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
s
b
etwe
en
g
r
o
u
p
s
in
p
r
etest
E
R
s
co
r
es.
I
n
ad
d
itio
n
,
p
r
etest
s
co
r
es
wer
e
in
clu
d
ed
as
a
co
v
ar
iate
in
s
u
b
s
eq
u
en
t
an
aly
s
es
,
an
aly
s
is
o
f
co
v
ar
ian
ce
(
ANCOVA)
to
co
n
tr
o
l
f
o
r
in
itial d
if
f
er
en
ce
s
b
etwe
en
g
r
o
u
p
s
.
Fo
llo
win
g
th
e
p
r
etest,
t
h
e
E
G
p
ar
ticip
ated
in
a
s
ix
-
wee
k
s
tr
u
ctu
r
ed
DL
in
te
r
v
en
tio
n
in
te
g
r
ated
in
to
th
eir
s
tan
d
ar
d
co
u
r
s
ewo
r
k
,
w
h
ile
th
e
C
G
co
n
tin
u
ed
r
eg
u
lar
ac
ad
em
ic
ac
tiv
ities
with
o
u
t
a
d
d
itio
n
al
s
tr
u
ctu
r
ed
elem
en
ts
.
No
alter
n
ativ
e
in
ter
v
en
tio
n
was
p
r
o
v
id
ed
to
t
h
e
C
G,
h
elp
in
g
to
attr
ib
u
te
o
b
s
er
v
e
d
d
if
f
er
e
n
ce
s
to
th
e
s
tr
u
ctu
r
ed
DL
in
ter
v
e
n
tio
n
,
w
h
ile
ac
k
n
o
wled
g
in
g
th
e
n
o
n
-
r
an
d
o
m
ized
d
esig
n
.
T
h
e
in
ter
v
en
tio
n
c
o
n
s
is
ted
o
f
s
tr
u
ctu
r
ed
d
ig
ital
task
s
,
r
e
f
lec
tiv
e
ex
er
cises
,
an
d
f
ee
d
b
ac
k
/d
is
cu
s
s
io
n
s
ess
io
n
s
,
with
ac
tiv
ities
p
r
o
g
r
ess
iv
ely
in
cr
ea
s
in
g
in
co
m
p
lex
ity
to
s
ca
f
f
o
ld
th
e
d
ev
elo
p
m
en
t
o
f
E
R
.
Par
ticip
an
ts
en
g
ag
ed
in
b
o
th
in
d
ep
en
d
en
t
an
d
g
u
id
ed
task
s
,
r
ec
eiv
ed
f
o
r
m
ati
v
e
f
ee
d
b
ac
k
,
an
d
r
e
f
lecte
d
o
n
th
eir
em
o
tio
n
al
r
esp
o
n
s
es
an
d
co
p
in
g
s
tr
ateg
ies
th
r
o
u
g
h
o
u
t
th
e
in
ter
v
en
tio
n
.
T
h
e
d
esig
n
o
f
th
e
in
ter
v
e
n
tio
n
was
in
f
o
r
m
ed
b
y
r
esil
ien
ce
th
eo
r
y
an
d
s
elf
-
r
eg
u
latio
n
th
eo
r
y
,
e
n
s
u
r
in
g
th
at
ch
allen
g
es,
r
ef
lect
io
n
,
a
n
d
f
ee
d
b
ac
k
m
ec
h
an
i
s
m
s
tar
g
eted
th
e
d
ev
elo
p
m
e
n
t o
f
E
R
.
Up
o
n
co
m
p
letio
n
o
f
th
e
s
ix
-
wee
k
in
ter
v
en
tio
n
,
a
p
o
s
ttes
t
E
R
ass
e
s
s
m
en
t
wa
s
ad
m
in
is
te
r
ed
to
b
o
t
h
g
r
o
u
p
s
u
n
d
er
th
e
s
am
e
s
tan
d
ar
d
ized
co
n
d
itio
n
s
as
th
e
p
r
etest.
Par
ticip
an
ts
wer
e
p
r
o
v
id
ed
with
clea
r
in
s
tr
u
ctio
n
s
an
d
s
u
f
f
icien
t
tim
e
to
co
m
p
lete
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ass
e
s
s
m
en
t.
All
r
esp
o
n
s
es
wer
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co
ll
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ted
im
m
ed
iately
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s
cr
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ed
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o
r
co
m
p
leten
ess
an
d
co
n
s
is
ten
cy
,
an
d
o
n
ly
v
alid
r
e
s
p
o
n
s
es we
r
e
in
clu
d
ed
in
th
e
f
in
al
d
ataset.
2
.
4
.
I
nte
rv
ent
io
n
T
h
e
E
G
p
ar
ticip
ated
in
a
s
ix
-
wee
k
s
tr
u
ctu
r
ed
DL
in
ter
v
en
tio
n
in
teg
r
ated
in
to
th
eir
s
tan
d
ar
d
co
u
r
s
ewo
r
k
.
T
h
e
in
ter
v
en
tio
n
aim
ed
to
p
r
o
v
id
e
PS
T
s
with
s
ca
f
f
o
ld
ed
o
p
p
o
r
tu
n
ities
to
ex
p
er
ien
ce
,
r
ef
lect
o
n
,
an
d
s
tr
en
g
th
en
th
eir
E
R
i
n
r
esp
o
n
s
e
to
p
r
o
f
ess
io
n
ally
r
el
ev
an
t
d
i
g
ital
ch
allen
g
es.
T
h
e
in
ter
v
en
ti
o
n
was
d
eliv
er
ed
v
ia
M
o
o
d
le,
th
e
p
r
o
g
r
am
’
s
lear
n
in
g
m
a
n
ag
em
en
t
s
y
s
tem
(
L
MS)
,
th
r
o
u
g
h
wee
k
ly
5
0
-
m
in
u
te
in
s
tr
u
cto
r
-
led
o
n
lin
e
s
ess
io
n
s
,
co
n
s
is
ten
t
with
s
tan
d
ar
d
u
n
i
v
er
s
ity
class
d
u
r
atio
n
s
i
n
Ka
za
k
h
s
tan
,
en
s
u
r
in
g
ec
o
lo
g
ical
v
alid
ity
.
All
s
ess
i
o
n
s
wer
e
in
s
tr
u
cto
r
-
led
b
y
t
h
e
s
am
e
in
s
tr
u
cto
r
an
d
f
o
llo
wed
a
s
tan
d
ar
d
ize
d
s
ess
io
n
s
tr
u
ctu
r
e,
en
s
u
r
in
g
c
o
n
s
is
ten
t
in
s
tr
u
ctio
n
s
,
tim
e
allo
ca
tio
n
,
an
d
v
ir
t
u
al
class
r
o
o
m
co
n
d
itio
n
s
ac
r
o
s
s
p
ar
ticip
an
ts
.
T
h
e
in
ter
v
e
n
tio
n
c
o
m
p
r
is
ed
th
r
ee
co
r
e
co
m
p
o
n
e
n
ts
:
i
)
s
tr
u
ctu
r
ed
d
i
g
ital
task
s
;
ii
)
g
u
id
e
d
r
ef
lectiv
e
ex
er
cises
;
an
d
iii
)
in
s
tr
u
cto
r
-
le
d
f
ee
d
b
ac
k
an
d
d
is
cu
s
s
io
n
s
ess
io
n
s
.
Fo
r
ex
am
p
le,
in
ea
r
ly
s
e
s
s
io
n
s
,
p
ar
ticip
an
ts
wer
e
ask
ed
to
d
esig
n
a
s
h
o
r
t
d
ig
ital
less
o
n
f
o
r
a
v
ir
t
u
al
p
r
es
ch
o
o
l
s
ettin
g
u
s
in
g
M
o
o
d
le
t
o
o
ls
(
e.
g
.
,
u
p
l
o
ad
in
g
in
s
tr
u
ctio
n
al
m
ater
ials
a
n
d
c
r
ea
tin
g
in
te
r
ac
tiv
e
ac
tiv
ities
)
.
A
s
am
p
le
r
ef
lectio
n
p
r
o
m
p
t
in
clu
d
ed
:
“
W
h
at
ch
allen
g
es
d
id
y
o
u
e
x
p
er
ien
ce
wh
ile
d
esig
n
in
g
th
is
less
o
n
,
an
d
h
o
w
d
id
y
o
u
m
an
a
g
e
y
o
u
r
em
o
tio
n
al
r
esp
o
n
s
e?
”
I
n
later
s
ess
io
n
s
,
p
ar
ticip
an
ts
co
m
p
leted
m
o
r
e
co
m
p
lex
task
s
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s
u
ch
as
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d
ap
t
in
g
less
o
n
p
lan
s
to
u
n
ex
p
ec
te
d
s
ce
n
ar
io
s
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g
.
,
lim
ited
s
tu
d
en
t
en
g
ag
em
en
t
o
r
tech
n
ical
is
s
u
es).
C
o
r
r
esp
o
n
d
in
g
r
ef
lectio
n
p
r
o
m
p
ts
in
clu
d
ed
:
“
Ho
w
d
id
y
o
u
r
esp
o
n
d
to
u
n
ex
p
ec
ted
d
if
f
icu
lties
,
an
d
wh
at
s
tr
ateg
ies
h
elp
ed
y
o
u
m
ain
tain
f
o
cu
s
an
d
c
o
n
tin
u
e
th
e
task
?
”
Par
ticip
an
ts
en
g
ag
ed
in
s
tr
u
ctu
r
ed
d
ig
ital
task
s
,
in
clu
d
in
g
d
ig
ital
less
o
n
p
lan
n
in
g
,
c
r
ea
tio
n
o
f
in
s
tr
u
ctio
n
al
m
ater
ials
,
an
d
a
d
ap
tatio
n
o
f
less
o
n
s
f
o
r
v
ir
tu
al
p
r
esch
o
o
l
c
o
n
tex
ts
,
with
t
ask
s
p
r
o
g
r
ess
iv
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in
cr
ea
s
in
g
in
co
m
p
lex
ity
o
v
er
th
e
s
ix
wee
k
s
,
f
r
o
m
b
asic
ac
ti
v
ities
to
in
teg
r
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less
o
n
s
im
u
latio
n
s
.
Fo
llo
win
g
ea
ch
task
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th
e
y
co
m
p
leted
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u
i
d
ed
r
e
f
lectiv
e
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to
e
v
a
lu
ate
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em
o
tio
n
al
r
esp
o
n
s
e
s
,
co
p
in
g
s
tr
ateg
ies,
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W
ee
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in
ter
v
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W
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p
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t
D
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scri
p
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v
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t
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e
s
1
D
i
g
i
t
a
l
t
a
s
k
s
+
i
n
i
t
i
a
l
r
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t
i
o
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I
n
t
r
o
d
u
c
t
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o
n
t
o
M
o
o
d
l
e
p
l
a
t
f
o
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m
a
n
d
DL
t
o
o
l
s;
c
o
m
p
l
e
t
i
o
n
o
f
b
a
s
i
c
o
n
l
i
n
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a
c
h
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n
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t
a
sk
s
;
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r
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v
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h
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l
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s.
2
R
e
f
l
e
c
t
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n
+
i
n
st
r
u
c
t
o
r
f
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d
b
a
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S
t
r
u
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u
r
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d
r
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f
l
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c
t
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o
n
o
n
W
e
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k
1
t
a
s
k
s
u
si
n
g
r
e
f
l
e
c
t
i
o
n
j
o
u
r
n
a
l
s;
i
d
e
n
t
i
f
i
c
a
t
i
o
n
o
f
e
mo
t
i
o
n
a
l
r
e
s
p
o
n
ses
;
i
n
s
t
r
u
c
t
o
r
f
e
e
d
b
a
c
k
o
n
c
h
a
l
l
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n
g
e
s a
n
d
c
o
p
i
n
g
st
r
a
t
e
g
i
e
s.
3
D
i
g
i
t
a
l
t
a
s
k
s (i
n
c
r
e
a
s
e
d
c
o
mp
l
e
x
i
t
y
)
+
r
e
f
l
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c
t
i
o
n
D
e
v
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l
o
p
m
e
n
t
a
n
d
a
d
a
p
t
a
t
i
o
n
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f
i
n
st
r
u
c
t
i
o
n
a
l
ma
t
e
r
i
a
l
s
f
o
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v
i
r
t
u
a
l
p
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e
sc
h
o
o
l
l
e
ss
o
n
s;
a
p
p
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a
t
i
o
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f
d
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g
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t
a
l
t
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.
4
F
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d
b
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i
d
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d
d
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sc
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o
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st
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-
l
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l
i
n
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sessi
o
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(
5
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m
i
n
)
r
e
v
i
e
w
i
n
g
p
r
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o
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t
a
s
k
s;
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c
h
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m
man
a
g
e
me
n
t
sc
e
n
a
r
i
o
s;
g
u
i
d
e
d
r
e
f
l
e
c
t
i
o
n
o
n
e
m
o
t
i
o
n
a
l
r
e
s
p
o
n
ses
a
n
d
p
r
o
b
l
e
m
-
so
l
v
i
n
g
a
p
p
r
o
a
c
h
e
s;
f
o
r
ma
t
i
v
e
i
n
st
r
u
c
t
o
r
f
e
e
d
b
a
c
k
.
6
R
e
f
l
e
c
t
i
o
n
+
su
mm
a
t
i
v
e
d
i
sc
u
ssi
o
n
F
i
n
a
l
r
e
f
l
e
c
t
i
o
n
a
n
d
g
r
o
u
p
d
i
s
c
u
s
s
i
o
n
;
e
v
a
l
u
a
t
i
o
n
o
f
a
c
c
u
m
u
l
a
t
e
d
e
x
p
e
r
i
e
n
c
e
s
;
c
o
n
s
o
l
i
d
a
t
i
o
n
o
f
a
d
a
p
t
i
v
e
c
o
p
i
n
g
st
r
a
t
e
g
i
e
s;
s
y
n
t
h
e
si
s
o
f
l
e
a
r
n
i
n
g
o
u
t
c
o
mes
r
e
l
a
t
e
d
t
o
E
R
.
2
.
4
.
1
.
T
ea
cher
educa
t
io
n c
o
nte
x
t
T
h
e
teac
h
er
ed
u
ca
tio
n
p
r
o
g
r
am
in
teg
r
ates
DL
co
m
p
o
n
en
t
s
th
r
o
u
g
h
o
u
t
th
e
c
u
r
r
icu
l
u
m
,
in
clu
d
in
g
en
g
ag
em
e
n
t
with
Mo
o
d
le,
e
d
u
ca
tio
n
al
s
o
f
twar
e,
an
d
b
len
d
ed
lear
n
in
g
ac
tiv
ities
s
im
u
latin
g
p
r
o
f
ess
io
n
al
teac
h
in
g
s
ce
n
ar
io
s
.
T
h
ese
ac
tiv
ities
s
u
p
p
o
r
t
th
e
d
ev
el
o
p
m
en
t
o
f
in
s
tr
u
ctio
n
al
p
l
an
n
in
g
,
class
r
o
o
m
m
an
ag
em
en
t,
an
d
r
ef
lectiv
e
p
r
ac
tice
in
tech
n
o
lo
g
y
-
m
ed
iate
d
co
n
tex
ts
.
W
ith
in
th
is
ed
u
ca
t
io
n
al
s
ettin
g
,
E
R
is
em
p
h
asized
as
an
im
p
o
r
tan
t
co
m
p
eten
ce
f
o
r
p
r
o
f
ess
io
n
al
r
ea
d
in
ess
.
T
h
e
cu
r
r
icu
lu
m
p
r
o
m
o
tes
r
ef
lectiv
e
p
r
ac
tice,
ad
ap
tiv
e
p
r
o
b
lem
-
s
o
lv
in
g
,
an
d
co
p
in
g
s
tr
ateg
ies,
wh
ich
ar
e
ess
en
tial
f
o
r
m
a
n
a
g
in
g
ch
allen
g
es
in
b
o
th
f
ac
e
-
to
-
f
ac
e
an
d
DL
en
v
ir
o
n
m
en
ts
.
T
h
e
s
tr
u
ctu
r
e
d
d
ig
it
al
task
s
an
d
r
ef
lectiv
e
ex
er
cises
im
p
lem
en
ted
in
th
e
EG
wer
e
d
esig
n
ed
to
alig
n
with
th
ese
cu
r
r
icu
lar
o
b
jectiv
es,
p
r
o
v
id
in
g
o
p
p
o
r
tu
n
ities
f
o
r
PS
T
s
to
en
g
ag
e
in
em
o
tio
n
ally
an
d
co
g
n
itiv
ely
d
em
an
d
i
n
g
s
itu
atio
n
s
.
T
h
is
alig
n
m
en
t
e
n
s
u
r
ed
th
at
th
e
in
ter
v
en
tio
n
was
co
n
s
is
ten
t
with
th
e
ex
is
tin
g
p
r
o
g
r
am
s
tr
u
ct
u
r
e
wh
ile
in
tr
o
d
u
cin
g
a
m
o
r
e
s
y
s
tem
atic
an
d
e
x
p
licit
f
o
cu
s
o
n
ER
d
ev
elo
p
m
e
n
t.
B
y
s
itu
atin
g
th
e
s
tu
d
y
with
in
a
n
atio
n
al
teac
h
er
ed
u
ca
tio
n
p
r
o
g
r
a
m
in
Kaz
ak
h
s
tan
,
th
e
r
esear
ch
s
u
p
p
o
r
ts
th
e
ec
o
lo
g
ical
v
alid
it
y
o
f
th
e
s
tu
d
y
c
o
n
tex
t
a
n
d
e
n
ab
les
ex
am
in
atio
n
o
f
h
o
w
PS
T
s
d
em
o
n
s
tr
ate
E
R
u
n
d
er
a
u
th
en
tic
DL
c
o
n
d
itio
n
s
.
2.
5
.
I
ns
t
rum
ent
E
R
was
ass
ess
e
d
u
s
i
n
g
t
h
e
C
D
-
R
I
SC
-
2
5
[
3
4
]
,
a
wi
d
e
ly
v
al
id
a
te
d
s
e
lf
-
r
e
p
o
r
t
i
n
s
t
r
u
m
e
n
t
d
esig
n
ed
to
m
ea
s
u
r
e
r
esil
ie
n
c
e
as
t
h
e
a
b
i
li
ty
to
c
o
p
e
wi
th
s
t
r
ess
,
ad
ap
t
t
o
ch
a
n
g
e,
a
n
d
m
ai
n
t
ai
n
p
s
y
c
h
o
l
o
g
ic
al
f
u
n
cti
o
n
i
n
g
u
n
d
er
a
d
v
er
s
it
y
.
T
h
e
C
D
-
R
I
S
C
-
2
5
is
a
s
t
an
d
a
r
d
i
ze
d
m
ea
s
u
r
e
an
d
w
as
u
s
e
d
i
n
its
a
d
a
p
t
e
d
Ka
za
k
h
-
la
n
g
u
a
g
e
v
e
r
s
i
o
n
f
o
r
t
h
e
p
r
ese
n
t
s
t
u
d
y
.
T
h
e
ad
ap
tat
io
n
p
r
o
ce
s
s
f
o
ll
o
w
ed
est
ab
lis
h
e
d
g
u
id
eli
n
es
f
o
r
c
r
o
s
s
-
c
u
l
t
u
r
al
ad
ap
tat
io
n
o
f
p
s
y
c
h
o
l
o
g
ic
al
i
n
s
tr
u
m
en
ts
.
F
ir
s
t,
t
h
e
o
r
i
g
i
n
a
l
E
n
g
l
is
h
v
e
r
s
i
o
n
w
as
i
n
d
e
p
e
n
d
en
t
ly
tr
a
n
s
la
te
d
i
n
t
o
Kaz
ak
h
b
y
tw
o
b
il
in
g
u
a
l
e
x
p
er
ts
f
l
u
en
t
i
n
b
o
th
la
n
g
u
a
g
es
.
T
h
e
t
r
a
n
s
l
ati
o
n
s
w
er
e
s
y
n
t
h
e
s
ize
d
i
n
t
o
a
s
i
n
g
le
v
e
r
s
i
o
n
t
h
r
o
u
g
h
c
o
n
s
e
n
s
u
s
d
is
cu
s
s
io
n
.
S
u
b
s
e
q
u
e
n
tl
y
,
a
p
an
el
o
f
f
i
v
e
ex
p
er
ts
i
n
E
C
E
a
n
d
e
d
u
c
ati
o
n
a
l
p
s
y
c
h
o
lo
g
y
ev
al
u
a
te
d
t
h
e
t
r
a
n
s
late
d
ite
m
s
f
o
r
s
e
m
a
n
t
ic
eq
u
i
v
al
e
n
ce
,
c
u
lt
u
r
al
r
ele
v
an
ce
,
a
n
d
co
n
c
e
p
t
u
al
cl
ar
it
y
.
I
te
m
s
we
r
e
r
e
v
is
e
d
b
ase
d
o
n
e
x
p
e
r
t
f
ee
d
b
ac
k
,
an
d
c
o
n
te
n
t
v
a
lid
it
y
w
as
e
n
s
u
r
e
d
t
h
r
o
u
g
h
it
e
r
ati
v
e
r
e
v
iew
.
A
b
ac
k
-
tr
an
s
latio
n
p
r
o
ce
d
u
r
e
was
th
en
co
n
d
u
cte
d
b
y
a
n
in
d
ep
en
d
en
t
b
ilin
g
u
al
ex
p
er
t
wh
o
was
b
lin
d
to
th
e
o
r
ig
in
al
in
s
tr
u
m
en
t.
T
h
e
b
ac
k
-
t
r
an
s
lated
E
n
g
lis
h
v
er
s
i
o
n
was
co
m
p
ar
e
d
with
t
h
e
o
r
i
g
in
al
C
D
-
R
I
SC
-
2
5
,
an
d
d
is
cr
ep
an
cies
wer
e
d
is
cu
s
s
ed
an
d
r
eso
lv
ed
b
y
t
h
e
r
esear
ch
team
to
en
s
u
r
e
c
o
n
ce
p
tu
al
eq
u
iv
alen
ce
.
T
h
e
p
r
e
-
f
in
al
Kaz
a
k
h
v
er
s
io
n
wa
s
p
ilo
t
-
test
ed
with
a
s
am
p
le
o
f
p
r
e
-
s
er
v
ice
teac
h
e
r
s
(
PS
T
s
;
n
=2
0
)
to
ass
ess
clar
ity
,
co
m
p
r
e
h
en
s
ib
ilit
y
,
an
d
cu
ltu
r
al
ap
p
r
o
p
r
iaten
ess
.
Min
o
r
wo
r
d
in
g
ad
ju
s
tm
en
ts
wer
e
m
ad
e
b
ased
o
n
p
ar
ticip
an
t f
ee
d
b
ac
k
.
T
h
e
p
ilo
t
s
am
p
le
was n
o
t in
clu
d
e
d
in
th
e
m
ain
an
aly
s
is
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
J
E
v
al
&
R
es E
d
u
c
I
SS
N:
2252
-
8
8
2
2
E
n
h
a
n
ci
n
g
emo
tio
n
a
l res
ilien
ce
in
p
r
e
-
s
ervice
ea
r
ly
ch
ild
h
o
o
d
ed
u
c
a
to
r
s
th
r
o
u
g
h
…
(
Gu
lmir
a
Mo
mb
iyev
a
)
3285
Ps
y
ch
o
m
etr
ic
p
r
o
p
er
ties
o
f
th
e
ad
ap
ted
s
ca
le
wer
e
ev
alu
ate
d
u
s
in
g
th
e
m
ain
s
tu
d
y
s
am
p
l
e.
I
n
ter
n
al
co
n
s
is
ten
cy
r
eliab
ilit
y
was
e
x
ce
llen
t,
with
C
r
o
n
b
ac
h
’
s
alp
h
a
o
f
α
=0
.
9
1
.
C
o
n
s
tr
u
ct
v
al
id
ity
was
ex
am
in
e
d
u
s
in
g
co
n
f
ir
m
ato
r
y
f
ac
to
r
an
aly
s
is
(
C
FA)
,
wh
ich
s
u
p
p
o
r
te
d
an
ac
ce
p
ta
b
le
m
o
d
el
f
it
f
o
r
a
u
n
i
d
im
en
s
io
n
al
s
tr
u
ctu
r
e
o
f
r
esil
ien
ce
in
th
is
s
am
p
le
(
co
m
p
ar
ativ
e
f
it
in
d
ex
(
C
FI
)
=0
.
9
3
,
r
o
o
t
m
ea
n
s
q
u
ar
e
er
r
o
r
o
f
ap
p
r
o
x
im
atio
n
(
R
MSE
A
)
=0
.
0
6
,
s
tan
d
ar
d
ized
r
o
o
t
m
ea
n
s
q
u
ar
e
r
esid
u
al
(
SR
MR
)
=0
.
0
5
)
.
Alth
o
u
g
h
th
e
o
r
ig
in
al
C
D
-
R
I
SC
-
2
5
h
as
b
e
en
co
n
ce
p
tu
alize
d
as
a
m
u
ltid
im
en
s
io
n
al
in
s
tr
u
m
e
n
t,
a
u
n
id
im
en
s
io
n
al
m
o
d
el
was
test
ed
in
th
e
p
r
esen
t
s
tu
d
y
to
r
ep
r
esen
t
o
v
er
all
r
esil
ien
ce
as
a
g
lo
b
al
co
n
s
tr
u
ct.
Alter
n
ativ
e
m
u
ltid
im
en
s
io
n
al
s
tr
u
ctu
r
es
wer
e
co
n
s
id
er
ed
;
h
o
wev
e
r
,
t
h
ey
d
id
n
o
t
d
em
o
n
s
tr
ate
s
u
p
er
io
r
m
o
d
el
f
it
o
r
im
p
r
o
v
e
d
s
u
b
s
tan
tiv
e
in
ter
p
r
etab
ilit
y
in
th
is
s
am
p
le
an
d
wer
e
th
er
ef
o
r
e
n
o
t
r
etain
ed
f
o
r
f
u
r
th
er
an
al
y
s
es.
T
h
eo
r
etica
lly
,
th
e
p
r
esen
t
s
tu
d
y
co
n
ce
p
tu
alize
s
E
R
as
an
o
v
er
ar
ch
in
g
ad
a
p
tiv
e
ca
p
ac
ity
r
ath
er
th
an
d
is
tin
ct
s
u
b
co
m
p
o
n
en
ts
,
p
ar
ticu
lar
ly
in
th
e
co
n
tex
t
o
f
PS
T
s
d
ev
elo
p
m
en
t
in
DL
en
v
ir
o
n
m
en
ts
.
E
m
p
ir
ically
,
th
e
u
n
id
im
en
s
io
n
al
s
tr
u
ctu
r
e
d
em
o
n
s
tr
ated
s
atis
f
ac
to
r
y
m
o
d
el
f
it
in
d
ices
in
th
is
s
am
p
le,
s
u
p
p
o
r
tin
g
th
e
ad
eq
u
ac
y
o
f
a
g
lo
b
al
r
esil
ien
ce
s
co
r
e
f
o
r
s
u
b
s
eq
u
en
t a
n
aly
s
es.
E
ac
h
item
is
r
ated
o
n
a
5
-
p
o
i
n
t
L
ik
er
t
s
ca
le
r
an
g
in
g
f
r
o
m
0
(
n
o
t
tr
u
e
at
all)
to
4
(
tr
u
e
n
e
a
r
ly
all
th
e
tim
e)
,
y
ield
in
g
a
to
tal
s
co
r
e
r
an
g
e
o
f
0
to
1
0
0
,
with
h
ig
h
er
s
co
r
es
in
d
icatin
g
g
r
ea
ter
r
esil
ien
ce
.
Fo
r
th
e
p
u
r
p
o
s
es
o
f
th
is
s
tu
d
y
,
o
n
ly
t
h
e
to
tal
C
D
-
R
I
SC
s
co
r
e
was
u
s
ed
as
a
co
n
tin
u
o
u
s
v
ar
ia
b
le;
n
o
s
u
b
s
ca
le
s
co
r
es
wer
e
ca
lcu
lated
.
C
h
an
g
es
in
E
R
wer
e
an
aly
ze
d
b
y
c
o
m
p
ar
in
g
p
r
e
-
test
an
d
p
o
s
t
-
test
s
co
r
es
b
etwe
en
th
e
ex
p
er
im
en
tal
an
d
C
Gs
u
s
in
g
a
p
p
r
o
p
r
iate
in
f
er
e
n
tial statis
tica
l m
eth
o
d
s
.
2.
6
.
Da
t
a
a
na
ly
s
is
All
d
ata
wer
e
co
d
ed
an
d
an
aly
ze
d
u
s
in
g
I
B
M
SP
S
S
Sta
tis
tics
v
er
s
io
n
2
8
.
Prio
r
to
in
f
er
en
tial
an
aly
s
es,
d
escr
ip
tiv
e
s
tatis
tics
wer
e
co
m
p
u
ted
f
o
r
t
h
e
C
D
-
R
I
SC
to
tal
s
co
r
e,
in
clu
d
in
g
m
ea
n
,
s
tan
d
ar
d
d
ev
iatio
n
,
m
i
n
im
u
m
,
m
ax
im
u
m
,
s
k
ewn
ess
,
an
d
k
u
r
to
s
is
to
a
s
s
es
s
d
ata
d
is
tr
ib
u
tio
n
ch
ar
ac
t
er
is
tics
with
in
ea
ch
g
r
o
u
p
.
B
aselin
e
eq
u
iv
alen
ce
b
etwe
en
th
e
E
G
an
d
C
G
was
ex
am
in
ed
u
s
in
g
in
d
e
p
en
d
e
n
t
-
s
am
p
les
t
-
test
s
o
n
p
r
etest
C
D
-
R
I
S
C
s
co
r
es.
T
h
e
ef
f
ec
t
o
f
th
e
in
te
r
v
en
tio
n
o
n
ER
was
ev
alu
ated
u
s
in
g
ANC
OVA,
with
p
o
s
ttes
t
CD
-
R
I
S
C
s
co
r
es
a
s
th
e
d
ep
en
d
en
t
v
ar
iab
le,
g
r
o
u
p
(
E
G
v
s
.
C
G)
as
th
e
f
ix
ed
f
ac
to
r
,
an
d
p
r
etest
s
co
r
es
as
th
e
co
v
ar
iate.
T
h
is
m
eth
o
d
was
em
p
lo
y
ed
to
ad
j
u
s
t
f
o
r
p
o
ten
tial
b
aselin
e
d
if
f
er
en
ce
s
a
n
d
to
p
r
o
v
id
e
a
m
o
r
e
ac
cu
r
ate
esti
m
atio
n
o
f
th
e
in
ter
v
en
tio
n
ef
f
ec
t.
Prio
r
to
co
n
d
u
ctin
g
ANCOVA,
its
as
s
u
m
p
tio
n
s
wer
e
test
ed
.
T
h
e
h
o
m
o
g
e
n
eity
o
f
r
eg
r
ess
io
n
s
lo
p
es
ass
u
m
p
tio
n
was
co
n
f
ir
m
ed
b
y
a
n
o
n
-
s
ig
n
if
ican
t
in
ter
ac
tio
n
b
etwe
en
g
r
o
u
p
an
d
p
r
etest
s
co
r
es,
F(
1
,
1
6
2
)
=
0
.
8
7
,
p
=.
3
5
.
T
h
e
ass
u
m
p
tio
n
o
f
h
o
m
o
g
en
eity
o
f
v
ar
ia
n
ce
s
was
s
u
p
p
o
r
ted
b
y
L
ev
en
e
’
s
test
,
F(1
,
1
6
3
)
=
1
.
1
2
,
p
=
.
2
9
.
No
r
m
ality
o
f
r
es
id
u
als
was
v
er
if
ied
u
s
in
g
th
e
Sh
ap
ir
o
–
W
ilk
test
,
W
=0
.
9
8
,
p
=.
0
8
.
I
n
ad
d
itio
n
,
th
e
lin
ea
r
r
elatio
n
s
h
ip
b
etwe
en
th
e
co
v
a
r
iate
an
d
t
h
e
d
ep
e
n
d
en
t
v
a
r
iab
le
was
v
er
if
ied
.
E
f
f
ec
t
s
ize
was
r
ep
o
r
ted
u
s
in
g
p
ar
tial
eta
s
q
u
ar
ed
(
η
²ₚ
)
to
q
u
an
tif
y
th
e
p
r
o
p
o
r
tio
n
o
f
v
ar
ian
ce
ex
p
lain
ed
b
y
g
r
o
u
p
m
em
b
er
s
h
ip
.
Fo
r
ad
d
itio
n
al
i
n
ter
p
r
eta
b
ilit
y
,
C
o
h
en
’
s
d
was
ca
lcu
la
ted
b
ased
o
n
g
r
o
u
p
d
if
f
er
en
ce
s
in
a
d
ju
s
ted
p
o
s
tte
s
t
m
ea
n
s
u
s
in
g
s
tan
d
ar
d
co
n
v
en
tio
n
s
f
o
r
in
te
r
p
r
etatio
n
.
Statis
tical
s
ig
n
if
ican
ce
was
s
et
at
p
<0
.
0
5
(
two
-
tailed
)
.
I
t
s
h
o
u
ld
b
e
n
o
ted
th
at
ad
d
itio
n
al
co
v
a
r
iates
s
u
ch
as
p
r
io
r
d
ig
ital
co
m
p
eten
ce
,
ac
ad
em
ic
ac
h
iev
e
m
en
t
(
GPA)
,
an
d
b
aselin
e
s
tr
ess
lev
els
w
er
e
n
o
t
in
clu
d
ed
i
n
th
e
p
r
ese
n
t
an
aly
s
is
,
as
th
e
s
tu
d
y
d
esig
n
f
o
cu
s
ed
o
n
q
u
asi
-
EG
co
m
p
ar
is
o
n
with
p
r
etest
ad
ju
s
tm
en
t
as
th
e
p
r
im
ar
y
m
et
h
o
d
f
o
r
co
n
tr
o
llin
g
in
itial g
r
o
u
p
d
if
f
er
e
n
ce
s
in
ER
.
3.
RE
SU
L
T
S
Descr
ip
tiv
e
s
tatis
tic
s
f
o
r
to
t
al
E
R
,
m
ea
s
u
r
ed
u
s
in
g
th
e
C
D
-
R
I
SC
,
ar
e
p
r
esen
ted
i
n
T
ab
le
3
.
At
p
r
etest,
b
o
th
th
e
C
G
an
d
th
e
E
G
s
h
o
wed
co
m
p
a
r
ab
le
b
as
elin
e
E
R
s
co
r
es,
co
n
f
ir
m
in
g
b
aselin
e
eq
u
iv
alen
ce
p
r
io
r
t
o
th
e
i
n
ter
v
en
tio
n
.
Po
s
t
-
in
ter
v
en
tio
n
,
th
e
E
G
d
em
o
n
s
tr
ated
a
h
ig
h
er
m
ea
n
s
co
r
e
co
m
p
ar
ed
t
o
th
e
C
G,
in
d
icatin
g
an
o
v
er
all
im
p
r
o
v
em
en
t
in
ER
.
T
h
e
C
G
s
h
o
wed
m
in
im
al
ch
an
g
e
b
etwe
en
p
r
etest
an
d
p
o
s
ttes
t
s
co
r
es.
T
h
ese
r
esu
lts
s
u
g
g
est
th
at
p
ar
ticip
atio
n
in
th
e
s
tr
u
ctu
r
ed
DL
in
ter
v
en
tio
n
m
a
y
en
h
an
ce
o
v
e
r
all
E
R
am
o
n
g
PS
T
s
.
T
ab
le
3
.
Descr
ip
tiv
e
s
tatis
tics
o
f
E
R
G
r
o
u
p
N
P
r
e
t
e
s
t
M
P
r
e
t
e
s
t
S
D
P
o
st
t
e
s
t
M
P
o
st
t
e
s
t
S
D
M
i
n
M
a
x
CG
84
7
8
.
4
1
0
.
1
7
8
.
6
1
0
.
2
55
1
0
2
EG
81
7
8
.
7
1
0
.
3
8
4
.
0
9
.
4
60
1
0
8
T
o
v
is
u
ally
illu
s
tr
ate
d
if
f
er
en
ce
s
in
p
o
s
t
-
in
ter
v
en
tio
n
ER
b
etwe
en
g
r
o
u
p
s
,
a
b
o
x
p
lo
t
o
f
C
D
-
R
I
S
C
s
co
r
es
f
o
r
th
e
C
G
an
d
t
h
e
E
G
is
p
r
esen
ted
in
Fig
u
r
e
3
.
T
h
e
p
lo
t
s
h
o
ws
th
at
th
e
E
G
h
as
a
h
ig
h
er
m
ed
ian
s
co
r
e
co
m
p
ar
ed
to
th
e
C
G,
with
a
r
e
lativ
ely
s
im
ilar
d
is
tr
ib
u
tio
n
o
f
s
co
r
es.
T
h
is
v
is
u
al
p
atter
n
is
co
n
s
is
ten
t
with
th
e
r
esu
lts
o
f
th
e
ANCOVA
an
aly
s
is
.
Ov
er
all,
th
ese
f
in
d
in
g
s
s
u
g
g
est
th
at
th
e
s
tr
u
ctu
r
e
d
D
L
in
ter
v
en
tio
n
was
ass
o
ciate
d
with
h
ig
h
er
ER
s
co
r
es in
th
e
E
G.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
2
2
I
n
t
J
E
v
al
&
R
es E
d
u
c
,
Vo
l
.
15
,
No
.
4
,
Au
g
u
s
t
20
26
:
3
2
7
9
-
3
2
9
1
3286
T
o
ass
ess
th
e
ef
f
ec
t
o
f
th
e
in
ter
v
en
tio
n
wh
ile
co
n
tr
o
llin
g
f
o
r
b
aselin
e
d
if
f
er
en
ce
s
,
an
ANCOVA
was
co
n
d
u
cte
d
with
p
o
s
ttes
t
C
D
-
R
I
SC
s
co
r
es
as
th
e
d
ep
e
n
d
en
t
v
ar
iab
le,
g
r
o
u
p
(
E
G
v
s
.
C
G)
as
th
e
i
n
d
ep
e
n
d
en
t
v
ar
iab
le,
an
d
p
r
etest
s
co
r
es
as
a
co
v
ar
iate.
T
h
e
an
al
y
s
is
r
ev
ea
led
a
s
tatis
tically
s
ig
n
if
ic
an
t
b
etwe
en
-
g
r
o
u
p
ef
f
ec
t
o
n
p
o
s
ttes
t
s
co
r
es,
F(1
,
1
6
2
)
=
1
8
.
7
6
,
p
<
0
.
0
0
1
,
η
²ₚ=
0
.
1
0
.
T
ab
le
4
p
r
esen
ts
th
e
AN
C
OVA
r
e
s
u
lts
f
o
r
p
o
s
ttes
t CD
-
R
I
SC
s
co
r
es.
T
h
ese
r
esu
lts
in
d
icate
th
at
P
STs
in
th
e
E
G
d
e
m
o
n
s
tr
ated
s
ig
n
if
ican
tly
h
ig
h
er
p
o
s
t
-
in
t
er
v
en
tio
n
CD
-
R
I
S
C
s
co
r
es
co
m
p
ar
ed
to
th
o
s
e
in
th
e
C
G,
af
ter
c
o
n
tr
o
llin
g
f
o
r
b
aselin
e
d
if
f
er
e
n
ce
s
.
T
h
is
s
u
g
g
ests
th
at
p
ar
ticip
atio
n
in
th
e
s
tr
u
ct
u
r
e
d
DL
in
ter
v
en
tio
n
was
ass
o
ciate
d
with
im
p
r
o
v
ed
ER
.
O
v
er
all,
th
e
f
in
d
in
g
s
p
r
o
v
id
e
em
p
ir
ical
s
u
p
p
o
r
t f
o
r
t
h
e
p
o
ten
tial o
f
s
tr
u
ctu
r
e
d
DL
en
v
ir
o
n
m
en
ts
to
en
h
an
ce
ER
a
m
o
n
g
PS
T
s
.
Fig
u
r
e
3
.
Po
s
ttes
t E
R
b
y
g
r
o
u
p
T
ab
le
4
.
ANCOVA
f
o
r
p
o
s
ttes
t CD
-
R
I
S
C
V
a
r
i
a
b
l
e
F
df
p
P
a
r
t
i
a
l
η²ₚ
I
n
t
e
r
p
r
e
t
a
t
i
o
n
G
r
o
u
p
(
EG
v
s.
C
G
)
1
8
.
7
6
(
1
,
1
6
2
)
<
0
.
0
0
1
0
.
1
0
M
e
d
i
u
m
e
f
f
e
c
t
4.
DIS
CU
SS
I
O
N
T
h
e
p
r
esen
t
s
tu
d
y
in
v
esti
g
ated
th
e
d
ev
elo
p
m
en
t
o
f
E
R
am
o
n
g
PS
T
s
with
in
DL
en
v
ir
o
n
m
en
ts
in
Kaz
ak
h
s
tan
.
T
h
e
f
in
d
in
g
s
i
n
d
icate
th
at
p
ar
ticip
atio
n
in
a
s
tr
u
ctu
r
ed
DL
-
b
ased
in
ter
v
e
n
tio
n
was
ass
o
ciate
d
with
a
s
ig
n
if
ican
t
in
cr
ea
s
e
i
n
E
R
,
as
ev
id
en
ce
d
b
y
h
ig
h
er
p
o
s
t
-
in
ter
v
en
tio
n
C
D
-
R
I
S
C
s
co
r
es
in
th
e
EG
co
m
p
ar
ed
to
th
e
CG
.
T
h
ese
r
esu
lts
alig
n
wi
th
p
r
ev
io
u
s
r
esear
ch
s
u
g
g
esti
n
g
th
at
r
esil
ien
ce
ca
n
b
e
en
h
an
ce
d
th
r
o
u
g
h
s
tr
u
ctu
r
e
d
ed
u
ca
tio
n
al
ex
p
er
ien
ce
s
th
at
in
v
o
lv
e
c
h
allen
g
e,
r
e
f
lectio
n
,
an
d
f
ee
d
b
ac
k
[
3
5
]
–
[
3
7
]
.
Fro
m
a
th
eo
r
etica
l
p
er
s
p
ec
ti
v
e,
th
e
f
in
d
in
g
s
s
u
p
p
o
r
t
th
e
v
iew
th
at
r
esil
ien
ce
is
a
d
y
n
am
ic
an
d
d
ev
elo
p
a
b
le
ca
p
ac
ity
r
ath
er
th
an
a
s
tab
le
tr
ait.
T
h
e
f
in
d
in
g
s
s
u
g
g
est
th
at
DL
en
v
ir
o
n
m
e
n
ts
ca
n
s
er
v
e
n
o
t
o
n
l
y
as
in
s
tr
u
ctio
n
al
s
p
ac
es
b
u
t
also
as
d
ev
elo
p
m
en
tal
co
n
tex
ts
th
at
s
u
p
p
o
r
t
p
s
y
ch
o
l
o
g
ical
ad
ap
tatio
n
.
T
h
e
o
b
s
er
v
ed
ef
f
ec
t m
ay
b
e
p
ar
tly
ex
p
lain
ed
b
y
th
e
d
esig
n
o
f
th
e
in
ter
v
en
tio
n
,
wh
ich
in
te
g
r
ated
p
r
o
g
r
ess
iv
ely
ch
allen
g
in
g
d
ig
ital
task
s
with
g
u
id
e
d
r
ef
lectio
n
an
d
in
s
tr
u
c
to
r
f
ee
d
b
ac
k
.
Su
ch
d
esig
n
f
ea
tu
r
es
lik
ely
cr
ea
ted
s
u
s
tain
ed
o
p
p
o
r
t
u
n
ities
f
o
r
PS
T
s
to
r
eg
u
late
em
o
tio
n
al
r
es
p
o
n
s
es
an
d
en
g
a
g
e
in
ad
a
p
tiv
e
co
p
in
g
s
tr
ateg
ies
d
u
r
in
g
task
co
m
p
letio
n
.
T
h
is
alig
n
s
with
p
r
ev
io
u
s
r
esear
ch
s
u
g
g
esti
n
g
th
at
r
esil
ien
ce
is
a
d
y
n
am
ic
a
n
d
d
ev
elo
p
a
b
le
ca
p
ac
ity
r
at
h
er
th
an
a
s
tab
le
tr
ait
[
3
8
]
–
[
4
1
]
.
Ho
wev
er
,
th
e
o
b
s
er
v
e
d
im
p
r
o
v
em
en
ts
in
E
R
m
ay
n
o
t
b
e
attr
ib
u
ted
s
o
lely
to
r
ef
lectiv
e
p
r
o
ce
s
s
es.
An
alter
n
ativ
e
ex
p
lan
atio
n
is
th
at
in
cr
ea
s
ed
f
am
iliar
ity
an
d
co
m
p
eten
ce
in
u
s
in
g
d
ig
ital
to
o
ls
o
v
er
tim
e
m
ay
h
av
e
r
ed
u
ce
d
task
-
r
elate
d
u
n
ce
r
tain
ty
a
n
d
co
g
n
itiv
e
lo
a
d
,
th
e
r
eb
y
in
d
ir
ec
tly
co
n
tr
ib
u
tin
g
to
im
p
r
o
v
e
d
em
o
tio
n
al
o
u
tco
m
es.
As
PS
T
s
b
ec
am
e
m
o
r
e
co
n
f
i
d
en
t
in
n
av
ig
atin
g
d
ig
ital
en
v
ir
o
n
m
e
n
ts
,
p
er
ce
iv
ed
task
d
if
f
icu
lty
m
a
y
h
a
v
e
d
ec
r
ea
s
ed
,
wh
ich
co
u
ld
h
av
e
p
o
s
itiv
ely
in
f
lu
en
ce
d
s
elf
-
r
ep
o
r
ted
r
esil
i
en
ce
.
Fu
tu
r
e
s
tu
d
ies
s
h
o
u
ld
co
n
s
id
er
in
clu
d
in
g
m
e
asu
r
es
o
f
d
ig
ital
co
m
p
eten
ce
an
d
p
er
ce
iv
ed
task
d
if
f
icu
lty
t
o
d
is
en
tan
g
le
th
es
e
ef
f
ec
ts
.
T
h
e
r
esu
lts
ar
e
co
n
s
is
ten
t
with
p
r
io
r
s
tu
d
ies
d
em
o
n
s
tr
atin
g
th
at
ex
p
er
ien
tial
an
d
r
ef
lecti
v
e
lear
n
in
g
ap
p
r
o
ac
h
es
ca
n
en
h
an
ce
ad
a
p
tiv
e
co
p
in
g
s
k
ills
in
p
r
e
-
s
er
v
ice
teac
h
er
s
[
4
2
]
–
[
4
5
]
.
I
n
th
is
s
t
u
d
y
,
th
e
in
teg
r
atio
n
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
J
E
v
al
&
R
es E
d
u
c
I
SS
N:
2252
-
8
8
2
2
E
n
h
a
n
ci
n
g
emo
tio
n
a
l res
ilien
ce
in
p
r
e
-
s
ervice
ea
r
ly
ch
ild
h
o
o
d
ed
u
c
a
to
r
s
th
r
o
u
g
h
…
(
Gu
lmir
a
Mo
mb
iyev
a
)
3287
o
f
s
tr
u
ctu
r
ed
task
s
,
r
ef
lectio
n
,
an
d
f
ee
d
b
ac
k
lik
ely
cr
ea
ted
r
ep
ea
ted
o
p
p
o
r
tu
n
ities
f
o
r
PS
T
s
to
en
g
ag
e
with
ac
ad
em
ic
ch
allen
g
es
i
n
a
s
u
p
p
o
r
ted
e
n
v
ir
o
n
m
en
t.
Ov
er
all,
th
e
f
in
d
in
g
s
in
d
icate
t
h
at
ca
r
e
f
u
lly
d
esig
n
e
d
DL
en
v
ir
o
n
m
en
ts
ca
n
f
ac
ilit
ate
p
s
y
ch
o
lo
g
ical
ad
ap
tatio
n
b
y
s
tr
u
ctu
r
in
g
m
ea
n
in
g
f
u
l
en
g
a
g
e
m
en
t
with
ac
ad
em
ic
d
em
an
d
s
an
d
s
u
p
p
o
r
tin
g
t
h
e
d
ev
elo
p
m
en
t
o
f
E
R
o
v
e
r
tim
e.
4
.
1
.
I
m
pli
ca
t
i
o
ns
f
o
r
t
ea
cher
educa
t
io
n
T
h
e
f
in
d
in
g
s
s
u
g
g
est
th
at
s
tr
u
ctu
r
ed
DL
in
ter
v
e
n
tio
n
s
in
teg
r
atin
g
s
ca
f
f
o
ld
ed
task
s
,
g
u
i
d
ed
r
ef
lectio
n
,
an
d
f
ee
d
b
ac
k
ca
n
s
u
p
p
o
r
t
th
e
d
ev
elo
p
m
e
n
t
o
f
E
R
in
PS
T
s
.
B
y
en
g
ag
in
g
in
p
r
o
g
r
ess
iv
ely
ch
allen
g
in
g
d
ig
ital
ac
tiv
ities
,
PS
T
s
d
ev
elo
p
ad
a
p
tiv
e
co
p
in
g
an
d
s
elf
-
r
eg
u
lat
io
n
s
k
ills
ess
en
tial
f
o
r
teac
h
in
g
p
r
ac
tice.
Su
ch
ac
tiv
ities
m
ay
in
clu
d
e
s
ce
n
a
r
io
-
b
ased
s
im
u
latio
n
s
o
f
class
r
o
o
m
d
is
r
u
p
tio
n
s
,
d
ig
ital
m
ic
r
o
t
ea
ch
in
g
task
s
with
p
ee
r
r
ev
iew,
a
n
d
p
r
o
b
lem
-
b
as
ed
ca
s
es r
eq
u
ir
in
g
em
o
tio
n
al
d
ec
is
io
n
-
m
ak
in
g
i
n
class
r
o
o
m
c
o
n
tex
ts
.
At
th
e
in
s
tr
u
ctio
n
al
lev
el,
teac
h
er
ed
u
ca
to
r
s
s
h
o
u
ld
em
b
ed
s
tr
u
ctu
r
ed
o
p
p
o
r
t
u
n
ities
f
o
r
ch
allen
g
e,
r
ef
lectio
n
,
an
d
f
o
r
m
ativ
e
f
ee
d
b
ac
k
in
to
c
o
u
r
s
e
d
esig
n
.
R
ef
lectio
n
ca
n
b
e
o
p
er
atio
n
alize
d
t
h
r
o
u
g
h
s
h
o
r
t
d
ig
ital
r
ef
lectio
n
jo
u
r
n
als,
p
o
s
t
-
task
em
o
tio
n
l
o
g
s
,
a
n
d
g
u
id
e
d
p
r
o
m
p
ts
f
o
cu
s
ed
o
n
em
o
tio
n
al
tr
ig
g
er
s
an
d
co
p
in
g
s
tr
ateg
ies.
Feed
b
ac
k
m
ay
b
e
d
eliv
er
ed
v
ia
r
u
b
r
ics,
p
ee
r
-
ass
ess
m
en
t
p
r
o
to
co
ls
,
an
d
b
r
ief
in
s
tr
u
cto
r
co
n
f
er
e
n
cin
g
a
f
ter
d
ig
ital
ac
tiv
ities
.
T
h
is
in
teg
r
atio
n
s
tr
en
g
th
en
s
b
o
th
co
g
n
itiv
e
en
g
ag
e
m
en
t
an
d
em
o
tio
n
al
r
ea
d
in
ess
f
o
r
p
r
ac
tice
in
d
ig
ita
l a
n
d
p
h
y
s
ical
class
r
o
o
m
s
.
At
th
e
in
s
titu
tio
n
al
lev
el,
DL
-
b
ased
in
ter
v
en
tio
n
s
m
ay
b
e
in
teg
r
ated
in
to
co
m
p
eten
cy
-
b
ased
teac
h
er
ed
u
ca
tio
n
p
r
o
g
r
am
s
to
s
y
s
tem
atica
lly
d
ev
elo
p
s
o
cio
-
em
o
t
io
n
al
co
m
p
eten
cies
alo
n
g
s
id
e
p
ed
ag
o
g
ical
s
k
ills
.
Ass
es
s
m
en
t
s
tr
ateg
ies
m
ay
in
clu
d
e
lo
n
g
itu
d
i
n
al
r
esil
ien
ce
p
o
r
tf
o
lio
s
,
s
ce
n
ar
io
-
b
ased
p
e
r
f
o
r
m
an
ce
task
s
,
an
d
cu
m
u
lativ
e
r
ef
lectio
n
r
ec
o
r
d
s
d
o
cu
m
e
n
tin
g
em
o
tio
n
al
r
esp
o
n
s
es
o
v
er
tim
e
.
At
th
e
p
o
licy
l
ev
el,
E
R
s
h
o
u
ld
b
e
ex
p
licitly
em
b
ed
d
ed
with
in
n
atio
n
al
teac
h
er
ed
u
ca
tio
n
s
t
an
d
ar
d
s
,
p
ar
ticu
lar
l
y
in
d
ig
ital
co
m
p
eten
ce
an
d
p
r
o
f
ess
io
n
al
r
ea
d
i
n
ess
f
r
am
ewo
r
k
s
.
4
.
2
.
L
im
it
a
t
io
ns
Sev
er
al
lim
itatio
n
s
o
f
th
is
s
tu
d
y
s
h
o
u
ld
b
e
ac
k
n
o
wled
g
ed
.
First,
alth
o
u
g
h
a
p
r
ete
s
t
–
p
o
s
ttes
t
q
u
asi
-
ex
p
er
im
e
n
tal
d
esig
n
w
as
em
p
lo
y
ed
,
th
e
u
s
e
o
f
n
o
n
-
eq
u
iv
alen
t
g
r
o
u
p
s
lim
its
th
e
s
tr
en
g
th
o
f
ca
u
s
al
in
f
er
en
ce
,
as
r
esid
u
al
b
aselin
e
d
if
f
er
e
n
ce
s
in
E
R
m
a
y
n
o
t
b
e
f
u
lly
elim
in
ate
d
.
T
o
m
itig
ate
th
is
is
s
u
e,
b
aselin
e
eq
u
iv
alen
ce
was
ass
ess
ed
u
s
i
n
g
p
r
etest
s
co
r
es,
an
d
ANCOVA
was
ap
p
lied
to
s
tatis
t
icall
y
ad
ju
s
t
f
o
r
in
itial
g
r
o
u
p
d
if
f
er
e
n
ce
s
.
Ho
wev
er
,
d
esp
ite
th
is
s
tati
s
tical
co
n
tr
o
l,
th
e
ab
s
en
ce
o
f
r
an
d
o
m
ass
ig
n
m
en
t
r
em
ain
s
a
k
ey
co
n
s
tr
ain
t o
n
ca
u
s
al
in
ter
p
r
eta
tio
n
.
In
ad
d
itio
n
,
s
ev
er
al
in
ter
n
al
v
alid
ity
th
r
ea
ts
co
m
m
o
n
ly
ass
o
ciate
d
with
q
u
asi
-
ex
p
er
im
e
n
tal
d
esig
n
s
s
h
o
u
ld
b
e
co
n
s
id
er
e
d
.
Ma
tu
r
at
io
n
ef
f
ec
ts
m
ay
h
av
e
in
f
lu
e
n
c
ed
th
e
r
esu
lts
,
as p
ar
ticip
an
ts
c
o
u
ld
h
av
e
n
at
u
r
ally
d
ev
elo
p
e
d
co
p
in
g
o
r
s
elf
-
r
eg
u
l
atio
n
s
k
ills
o
v
er
t
h
e
s
ix
-
wee
k
in
ter
v
en
tio
n
p
er
io
d
in
d
ep
en
d
e
n
t
o
f
th
e
tr
ea
tm
e
n
t.
T
esti
n
g
ef
f
ec
ts
ar
e
also
p
o
s
s
ib
le
d
u
e
to
r
ep
ea
ted
ad
m
in
is
tr
at
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n
o
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th
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C
D
-
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wh
ich
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ay
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itized
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ticip
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n
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r
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d
.
Fu
r
th
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r
m
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,
in
s
tr
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r
elate
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th
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eliv
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b
y
a
s
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g
le
in
s
tr
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;
t
h
u
s
,
v
ar
iatio
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in
in
s
tr
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ty
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ay
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co
n
t
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ib
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s
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Alth
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g
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f
o
r
ts
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ad
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a
r
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CO
NCLU
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ter
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ter
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p
ac
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p
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ev
elo
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m
en
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f
k
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esil
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ce
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r
elate
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s
k
ills
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lts
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ig
h
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th
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te
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tial
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ts
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o
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l
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m
s
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t
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v
ir
o
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m
en
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at
ac
tiv
ely
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ltiv
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p
in
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tr
ateg
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p
r
o
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y
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n
d
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lectiv
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f
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h
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Su
ch
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r
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lar
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n
b
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p
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ep
ar
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tr
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s
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[
1
]
M
.
A
l
e
n
e
z
i
,
“
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[
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X
.
Y
.
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E.
A
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M
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L.
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Evaluation Warning : The document was created with Spire.PDF for Python.