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Journal of Autism and Developmental Disorders

https://doi.org/10.1007/s10803-020-04571-8

BRIEF REPORT

Brief Report: Improving Employment Interview Self‑efficacy Among


Adults with Autism and Other Developmental Disabilities Using Virtual
Interactive Training Agents (ViTA)
Shanna L. Burke1   · Tan Li2 · Adrienne Grudzien1 · Stephanie Garcia2

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract
This study evaluated the measurable impact of the use of virtual interactive training agents (ViTA) as a way to practice inter-
viewing and gain confidence in responding to questions asked during job interviews. Of the total participants (n = 153), the
majority were male (72.55%) with an average age of 21.71 years old (SD = 3.14 years). Autism spectrum disorders (ASDs;
64.71%) and intellectual disability (40%) were the most frequently reported diagnoses. Using a within-subjects repeated
measures design, the repeated measures linear regression analysis found that the average self-efficacy score increased by 0.31
(p = 0.002), and statistically significant increases were found in all three subscales. Further development of virtual reality
interventions like ViTA, that improve outcomes for adults with ASDs and other developmental disabilities, is warranted.

Keywords  Autism spectrum disorders · Employment · Intellectual disabilities · Interviewing · Virtual interactive training
agents · Self-efficacy

Individuals with autism spectrum disorder (ASD) and other and social motivation, areas in which adults with ASD and
developmental disabilities are profoundly underrepresented other developmental disorders may need additional support
in the workforce (Baldwin et al. 2014). The U.S. Bureau of to master.
Labor Statistics (2019) reports that only 20% of Americans Research on job interviewing has highlighted that inter-
with a disability were employed in 2018 compared to nearly view-specific anxiety is common in the general population
70% of non-disabled adults aged 16 and older. Approxi- and as a construct, is different from other forms of anxiety
mately 50,000 youth with ASD turn 18 each year, and even and includes communication, appearance, performative,
among those considered ‘high functioning,’ low level, poor behavioral (e.g. physiological response), and social anxiety
paying jobs are typical (Chen et al. 2015). Communication components that interact to influence interview performance
deficits are a prominent symptom of ASD and impact suc- (McCarthy and Goffin 2004). Previous interview experi-
cess in accessing and maintaining appropriate employment ences may affect future job interviews through diminished
(Hendricks 2010). Using data from the National Longitudi- self-efficacy (Tross and Maurer 2008). Thus, for those
nal Transition Study (n = 830), Chiang et al. (2013) found struggling with social and communication-based obstacles,
that stronger social skills predicted later employment. Effec- interviewing skills interventions support the development of
tively engaging potential employers through the interview competencies that reduce barriers to obtaining a job. Previ-
process requires communication and social awareness skills ous research has indicated that social skills and vocational
training reduced rates of anxiety and depression among
* Shanna L. Burke young adults with ASD (Hillier et al. 2011) and employ-
sburke@fiu.edu ment has been associated with increased financial independ-
1
ence across time (Howlin et al. 2005). In turn, an increasing
School of Social Work, Robert Stempel College of Public number of adults with ASD and other developmental dis-
Health and Social Work, Florida International University,
11200 S.W. 8th Street, AHC5 585, Miami, FL 33199, USA abilities are turning to vocational rehabilitation services for
2 assistance (Taylor and Seltzer 2012).
Department of Biostatistics, Robert Stempel College
of Public Health and Social Work, Florida International Advances in technology in recent decades have allowed
University, 11200 S.W. 8th Street, Miami, FL 33199, USA researchers to develop computer software and internet-based

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Journal of Autism and Developmental Disorders

behavioral interventions for accomplishing various social (Bradley and Newbutt 2018; Cheng et al. 2015) to create vir-
and clinical goals. The American Academy of Social Work tual learning environments. Researchers have distinguished
and Social Welfare includes as one of its 12 Grand Chal- between immersive and non-immersive VR (Cheng et al.
lenges, a mandate to Harness Technology for Social Good 2015) based on whether the intervention included the use
(Trahan et al. 2019). Virtual reality (VR) technology has of a head-mounted display (HMD). Thus far, HMDs have
been successfully integrated into the treatment of phobias been integrated into a small number of virtual interventions
(Parsons and Rizzo 2008) and post-traumatic stress disorder developed to increase the social skills (e.g. attention and ges-
(PTSD; Rizzo et al. 2015) as well as substance use, eating turing) of adults with ASD, but their use remains in an early
disorders, and schizophrenia (Freeman et al. 2017). Tech- stage of development and requires additional evaluation to
nology-based interventions have already been used to assist understand how or if the degree of immersion influences the
children (Magrini et al. 2019) and adolescents (Bellini and development of specific skills (Miller and Bugnariu 2016).
Akullian 2007) with ASD to develop skills and behaviors Other technology-based interview skills projects have
that increase communication and functional capacities. In produced trending positive results. The European Union
their review of technology-aided instruction and interven- (EU) funded BRAINTRAIN program used a single-player
tion for ASD youth, Odom et al. (2015) note that adolescents gaming format to increase “adaptive social decision making”
with ASD often “prefer to access and use technology relative (de Heer et al. 2019, p. 368) among high functioning adults
to other social and leisure activities” (p. 3807). Given the with ASD. The game presented participants with increas-
population’s affinity for technology and existing evidence ingly abstract interview questions in the context of greater
for its use in behavioral interventions, studies examining levels of environmental stimuli to enhance executive func-
the potential of VR to support the development of inter- tioning. Evaluation has been limited, however. A user study
view skills among adults with ASD have recently begun to with Dutch adults (n = 42) indicated that the game experi-
emerge. ence was associated with changes in social responsiveness
The JobTIPs program, which was enhanced to include in a quarter to nearly one third of participants with ASD
interview-specific content for job seekers with ASD, was but pre and post-test results were not significant (de Heer
evaluated by Strickland et al. (2013) as a randomized con- et al. 2019). Alternately, Kumazaki et al. (2020) developed
trolled trial (RCT). Participants accessed multi-media inter- a non-immersive program that used a female robot to allow
view skills content from their home computer and afterward participants (n = 8) to practice taking the role of interviewer
completed a simulated online interview with a live clini- and interviewee during interview simulations. Both studies
cian in avatar form, during which participants were pro- sought to improve interview skills and to increase participant
vided detailed feedback about their performance. Pre and motivation to engage others socially (de Heer et al. 2019)
post simulated interviews for a store clerk position were or to understand that others have viewpoints different from
used to evaluate the effectiveness of the intervention. Smith their own, referred to as a ‘theory of mind’—which is com-
et al. (2014, 2015) evaluated a virtual reality job interview monly impaired in those living with ASD (Kumazaki et al.
training program delivered via computer (n = 26) for young 2020).
adults with an ASD diagnosis. Ten hours of VR training Technology-based activities are often preferred by indi-
was provided to participants through five sessions which viduals with ASDs (Odom et  al., 2015) and promising
were individualized based on participant job interest and preliminarily results from early VR-based interview skills
allowed for increasing difficulty. The intervention sought to interventions, combined with a professional mandate to
enhance participants’ ability to communicate their depend- investigate the application of technology to address behav-
ability, capacity to engage in teamwork, honesty, eagerness ioral and social concerns of vulnerable and marginalized
(for the position), and professionalism in an interview set- groups, suggest that further development of VR interven-
ting and provided ongoing feedback for most intervention tions that improve outcomes for adults with ASD and other
components. Sessions also allowed participants to practice developmental disabilities is warranted. This study incorpo-
establishing rapport and communicating in a “positive way.” rates and builds on data from a preliminary study examining
Like Strickland et al. (2013), Smith et al. (2014) documented the use of the virtual interactive training agent (ViTA), a
considerable, significant effect size increases in performance VR job interview practice system, to increase performance
between pre and post mock interviews. Recent research by during job interviews (Burke et al. 2018). Using a consider-
Arter et al. (2018) with a small group of high school stu- ably larger sample size compared to our original pilot and
dents (n = 8) with low reading and comprehension scores others’ studies (Arter et al. 2018; Smith et al. 2014; Strick-
contributed to this positive trend—six students improved land et al. 2013), we aimed to (1) evaluate the measurable
their performance and five were able to advance to a more impact of ViTA software on participants’ interviewing skills,
challenging interview level. Each of these VR job interview (2) evaluate the measurable impact of ViTA software on
training interventions used non-immersive technology participants’ perceived self-efficacy, and, (3) evaluate the

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Journal of Autism and Developmental Disorders

relationship between curriculum/intervention program par- 10 to 12 interview questions, which expand to 144 differ-
ticipation and the participants’ Marino Interview Assess- ent scenarios. Seven different interchangeable backgrounds
ment Scale (MIAS) score. (i.e., hotel lobby, business office, and warehouse breakroom)
set situational contexts that closely align with participants’
specific employment interests (ViTA is described in fur-
Data Collection and Program ther detail in Burke et al. 2018). The ViTA training stimuli
Implementation and order of presentation were determined by the program
implementation team. The system provides a wide variety
The ViTA Curriculum of distinct training opportunities for a range of job inter-
view interactions that can progress in difficulty level and be
The ViTA program consists of the use of the ViTA system adjusted to the specific needs of the user. The list of stand-
(intervention) accompanied by a curriculum of instructional ard job interview questions was derived from the agency’s
strategies to teach students ways of responding to questions experience with vocational job interviews and by searching
asked during job interviews, including interview etiquette, for predictable interview questions on the internet. In the
such as greetings, acceptable small talk, and closing or current study, the average length of time from the pre-test
thanking the interviewer. Job interviews generally take on and the post-test, and therefore the length of the curricu-
a predictable structure, or an “arc,” which informs the vir- lum itself, was approximately 22 weeks. A visualization of
tual human’s (VH’s) script. This interview structure, or arc, a participant interacting with the ViTA system is provided
informed the development of the curriculum and was later in Fig. 1.
used to create the VH’s script used during all interviews.
This arc consists of 10 to 12 standard job interview questions
that (1) have participants demonstrate introductory state- Sample
ments and consistency with social norms; (2) accentuate
the strengths and self-advocacy skills of the participant; (3) Availability or convenience sampling was used as par-
highlights ones’ abilities through self-promotion; (4) allow ticipants were students in secondary and postsecondary
for a situational or behavioral example; (5) focus on day-to- programs that were selected based on collaborative agree-
day practicalities of the job, such as hours, availability, and ments and proximity. To be included in this study, par-
transportation; and, (6) signal that the interview is ending. ticipants had to have a disability diagnosis, be enrolled
The importance of good first impressions, clear and concise in secondary or postsecondary education, and report a
responses, active listening and showing interest through ver- willingness and consent to use ViTA, engage in the cur-
bal and non-verbal cues, self-promotion through highlight- riculum, and for the data to be collected. The participant
ing strengths and experience, providing clear and concise provided assent if they were under 18, and consent if they
responses, and self-promoting by identifying individual were over 18 years of age. A parent or guardian provided
strengths are all emphasized in the curriculum. consent if the participant was under 18 or under guardi-
anship, if the participants was over 18 years of age. The
ViTA System and Intervention research and evaluation team did not know nor interact

The ViTA system is available to organizations and licenses


are granted on a 12-month subscription basis at an annual
cost to the organization of $999. This fee covers the cost of
curriculum development, training, research/product devel-
opment, and technical support but does not cover the cost
of equipment. The minimum equipment necessary to prop-
erly run the ViTA DMF Software includes a laptop (rec-
ommended) or another computer, 24″ HD LCD monitor or
larger, HDMI Cable or VGA, 3.5 mm multimedia speakers,
3.5 mm lapel microphone, wireless mouse, and a wireless
keyboard to allow for the remote operation of the Interview
Scenario feature.
To produce a variety of experiences, three male and three
female VHs of varying ages and ethnic backgrounds were
created. Each VH can exhibit soft-touch, neutral, and hostile
behavioral dispositions and is capable of asking an initial Fig. 1  A participant interacting with the ViTA system

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Journal of Autism and Developmental Disorders

with the participants. Consent was obtained by the pro- Statistical Analyses
gram implementation team, who interacted with the par-
ticipants and teachers, and administered the curriculum, We performed descriptive analyses to calculate the mean
and implemented ViTA. The evaluation team received de- and standard deviation for continuous variables, and the fre-
identified data, which informs this paper. quency distribution and percent for categorical variables. We
Of the total participants (n = 153), the majority were employed repeated measures linear regression analysis to
male (72.55%) and not Hispanic or Latino (60.13%), with estimate the unadjusted and adjusted treatment effect on the
an average age of 21.71 years old (SD = 3.14 years). The self-efficacy scale as well as the three subscales (strengths,
participants reported several different types of disabilities, career decisions, general), and the MIAS instrument, respec-
including autism (64.71%), intellectual disability (40%), tively. The average score of each scale was used as the
attention deficit hyperactivity disorder (ADHD) or attention dependent variable in the regression analysis. The number
deficit disorder (ADHD; 16.34%), cerebral palsy (4.58%), of disabilities was used as the control variable since some
Down syndrome (0.65%), Prader-Willi syndrome (0.65%), participants had multiple disabilities. Other control variables
and other non-specific types (24.18%). The majority of the included age, sex, and ethnicity. All the analyses were con-
participants had one disability (70.59%), 1.93% reported no ducted in SAS 9.4. A power analysis found that a sample size
disability, and other participants had multiple disabilities. of 153 participants provided at least 80% power to detect a
The highest number of disabilities was five in a single par- minimum effect size f of 0.11 in the repeated measure analy-
ticipant (0.65%). ses for continuous dependent variables with 0.05 level of
significance. This calculation was done in G*Power 3.1.9.4
(Faul et al. 2009).
Measures

The Marino Interview Assessment Scale (MIAS) was Results


designed to measure the degree to which the participant
utilized certain skills in an interview setting. Participants The mean number of days between the ViTA self-efficacy
scored a 1 if they did not use a strategy that was called for pre-test and post-test was 159.09 days (SD = 73.29 days).
in the context of a specific question. A score of 2 indicated The mean number of days between the MIAS pre-test and
that skill was still in the beginning stages of implementation the post-test was 151.41 days (SD = 62.68 days). Table 1
while 3 indicated that the skill was developing. A score of displays the demographic composition of the sample, as well
4 indicated that the interviewee adequately used the skill or as the self-efficacy mean and standard deviation scores (total
strategy. The highest score, 5, indicated that the participant and subsample). The mean of the average scores for ViTA
was accomplished at the strategy. self-efficacy, including all three subscales of strength, career
Self-efficacy was measured using the VITA-DMF Self- decisions, and general, were higher after the treatment than
Efficacy scale. This scale was scored by adding all individual before. Among the three subscales, the general subscale had
questions within an individual scale and then dividing this the highest mean both before (3.93, SD = 0.88) and after the
sum by the number of completed items for that scale. There treatment (4.22, SD = 0.76), and the strengths subscale had
are 16 items for the strengths subscale, 25 for the career the greatest increase from baseline to post-treatment. The
subscale, and eight items in the general subscale. MIAS scale scores were also higher after the treatment.
The MIAS and VITA-DMF Self-Efficacy scale were The results for the repeated measures linear regres-
administered using a within-subjects repeated measures sion analysis (Table  2) showed that the average score
(pretest-post-test) design, in which each participant serves increased by 0.31 (SE = 0.10, 95% CI 0.101–0.502,
as his/her own control. Students participated in four ViTA p = 0.003) for self-efficacy, 0.32 (SE = 0.10, 95% CI
interview sessions, one initial face-to-face interview, and 0.119–0.524, p = 0.002) for strengths, 0.28 (SE = 0.10,
one final face-to-face interview at completion of sessions, 95% CI 0.075–0.481, p = 0.008) for career decisions, and
over approximately 22 weeks. Instruments were distributed 0.30 (SE = 0.11, 95% CI 0.09–0.51, p = 0.006) for gen-
to students through web links. Students clicked on these eral. All the increases were still statistically significant
links, entered a student code (assigned by the classroom but slightly smaller after controlling for age, the number
teacher using instructions provided by the program imple- of disabilities, sex, and ethnicity. The adjusted increase
mentation team), and answered the questions. The informa- for self-efficacy was 0.27 (SE = 0.10, 95% CI 0.07–0.47,
tion was stored in a secure Research Electronic Data Capture p = 0.009). The adjusted results were 0.28 (SE = 0.10, 95%
(REDCap; (Harris et al. 2009, 2019) system at Floirda Inter- CI 0.07–0.5, p = 0.006) for strengths, 0.26 (SE = 0.10,
national University. The study was approved by the Florida 95% CI 0.05–0.5, p = 0.015) for career decisions, and
International University IRB #18-0080. 0.25 (SE = 0.11, 95% CI 0.04–0.5, p = 0.028) for general.

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Journal of Autism and Developmental Disorders

Table 1  Descriptive statistics
Variable Mean SD

Age 21.73 3.17


Sex
 Male 110 73.33
 Female 40 26.67
Ethnicity
 Hispanic or Latino 61 40.67
 Not Hispanic or Latino 89 59.33
Disability ­typea
 Autism 99 66.00
 Down syndrome 1 0.67
 ADHD/ADD 25 16.67
 Intellectual disability 40 26.67
 Cerebral palsy 7 4.67
 Prader-Willi syndrome 1 0.67
 Other 37 24.67
Number of disabilities
 1 108 72.00
 2 29 19.33
 3 9 6.00
 4 3 2.00
 5 1 0.67
N %
Variable Pre Post
Mean SD Mean SD

Self-efficacy 3.66 0.78 3.97 0.74


 Strengths 3.67 0.79 3.99 0.76
 Career decisions 3.61 0.77 3.89 0.79
 General 3.94 0.85 4.24 0.76
MIAS 1.47 0.71 2.56 0.82
a
 Some participants had multiple disabilities

Table 2  Unadjusted and adjusted treatment effect (post vs. pre,  n = 150)


Outcomes Unadjusted effect Adjusted ­effecta
Estimate SE 95% CI p value Estimate SE 95% CI p value

Self-efficacy 0.306 0.099 (0.101, 0.502) 0.003 0.267 0.100 (0.068, 0.465) 0.009
 Strength 0.321 0.102 (0.119, 0.524) 0.002 0.275 0.103 (0.070, 0.480) 0.009
 Career decisions 0.278 0.102 (0.075, 0.481) 0.008 0.254 0.104 (0.047, 0.461) 0.017
 General 0.301 0.107 (0.088, 0.513) 0.006 0.253 0.108 (0.039, 0.467) 0.021
MIAS 1.092 0.095 (0.905, 1.280) < 0.0001 1.089 0.094 (0.902, 1.276) < 0.0001
a
 Adjusted by age, number of disabilities, sex, and ethnicity

Among all three subscales of self-efficacy, strength had and 1.09 (SE = 0.09, 95% CI 0.9–1.28, p < 0.0001), both
the greatest increases both unadjusted and adjusted by with and without controlling for age, number of disabili-
age, number of disabilities, sex, and ethnicity. The MIAS ties, sex and ethnicity, respectively.
increased by 1.09 (SE = 0.09, 95% CI 0.9–1.3, p < 0.0001)

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Journal of Autism and Developmental Disorders

Discussion living with developmental disabilities. ViTA’s developers


report that it was initially designed for high-anxiety popu-
Findings from this study suggest that ViTA may be an lations, including those with developmental disabilities
effective tool to enhance interview skills and self-efficacy because the use of “intelligent virtual agents” removes
among adults with ASD and other developmental disor- the risk of human bias and thus reduces participant anxi-
ders. Interview assessment means measured by the MIAS ety making it a more effective intervention tool (Hartholt
were more than one point higher, as scores increased et al. 2019a, b). The most recent iteration of ViTA (devel-
from 1.47 to 2.56 pre- to post-interview, indicating not oped after the present study began and not included in
only statistically significant results but likely clinically the current study) integrated software that allows the
significant results. This study replicated positive results system to track and provide feedback on non-verbal com-
from our earlier pilot study (Burke et al. 2018), but saw a munication skills including response delay, voice volume,
greater increase between pre- and post scores (0.45 com- blink rate, eye gaze, and head orientation (Hartholt et al.
pared to 1.09). Thus, participants demonstrated increased 2019a, b). JobTIPS, using a notably different model from
skill at making appropriate introductory and closing ViTA, reported limited success in improving non-verbal
statements, communicating personal and professional skills (“delivery”). Additional evaluation of ViTA with its
strengths, identifying examples of previous situations or updated functionality is merited given the importance of
behaviors related to the position applied for, and demon- non-verbal communication in social skills, something that
strating an understanding of day-to-day practicalities of factors heavily into employers’ hiring practices (Walker
life on the job. This study also included a measurement et al. 2019).
of multiple self-efficacy domains, which saw improve- One of the strengths of this study was the diversity of the
ment. Average mean scores for general and sub-domain sample, which represented multiple developmental disabili-
self-efficacy (strengths and career decisions) were higher ties, including ASD, ADHD/ADD, intellectual disability,
at similar rates among participants after the intervention. and cerebral palsy among others; 29% of the participants had
Results from this study are in line with the limited number multiple disabilities. Nearly 40% of participants reported
of existing intervention evaluations that have sought to Hispanic ethnicity, unlike other studies that did not include
implement VR programs to enhance interview skills but Hispanic participants (Smith et al. 2014; Strickland et al.
our considerably larger sample size, which includes our 2013) thus filling a gap in the literature. Despite the strengths
pilot study participant results (n = 153), allows for greater of this study, certain limitations exist. The research design
confidence in the results. was quasi-experimental with pre and posttest measures,
Several small RCTs have evaluated VR-based interview rather than a randomized controlled trial. One of those meas-
skills interventions. Assessment of the JobTIPS program ures, the MIAS, was developed for the ViTA pilot study and
(n = 22, all males aged 16 to 19) produced significant and as a new, unpublished instrument, does not have test–retest
positive increases on content items, but the impact on par- scores available. It is unclear, therefore, what effect its pre
ticipant delivery, while positive, was minimal (Strickland and post-test application had on outcomes. Additionally, this
et al. 2013). Similarly, Smith et al.’s study (2014) pro- study did not have a follow up so it is unknown whether
duced large or medium effect sizes for most individual participants’ interview skill improvements are maintained
items among treatment group participants in pre and post- across time. In addition, the true clinical significance of the
interview simulations. Large effect sizes for role-playing statistically significant improvements is unknown, including
total scores (group-by-time) were observed among those whether they translate to higher employment rates. Future
who completed the intervention. No such effect was research in this area may choose to include generalization
observed in the treatment-as-usual control group. Unlike probes, social validity measures, and include distinct follow-
other studies (Arter et al. 2018; Strickland et al. 2013), fol- up data collection. Simply, collecting data on how partici-
low up was completed at six months and those who com- pants’ positive behavior changes in the study generalized
pleted the intervention had a higher likelihood of being across people, settings, times, and situations outside of the
employed than those who did not (OR 7.82, p < 0.05) academic setting would be insightful.
(Smith et al. 2015). ViTA performed better than the EU- VR interventions offer a range of other benefits to con-
funded BRAINTRAIN program, which was evaluated with sumers and researchers. As it is computer-based, VR tech-
a pretest/posttest design and did not produce statistically nology allows for greater accuracy and ease in data col-
significant results (de Heer et al. 2019). lection due to its capacity for “precise control of complex,
This study, which documents ViTA’s effectiveness, con- multisensory, [and] dynamic 3D stimulus presentations” so
tributes to the growing evidence for moderately immersive that “sophisticated behavioral interaction is possible and
VR technology’s potential to improve the lives of those such physical activity can be precisely tracked, recorded,
and analyzed to study human performance and behavior”

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Journal of Autism and Developmental Disorders

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Author Contributions  SLB conceptualized the study, partnered with education, and learning sciences (pp. 367–376). Berlin: Springer.
the Dan Marino Foundation to evaluate their implementation of ViTA, Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statisti-
and contributed to all aspects of the research, analysis, and writing the cal power analyses using G*Power 3.1: Tests for correlation and
manuscript. AG contributed to the writing of this manuscript. TL con- regression analyses. Behavior Research Methods, 41(4), 1149–
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Funding  This research was funded by the Dan Marino Foundation, a cine, 47(14), 2393–2400. https​://doi.org/10.1017/S0033​29171​
Google Impact Challenge Grant, and FIU Embrace. 70004​0X.
Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M.,
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