學術海報內容架構

12/4要到高雄參加台灣職能治療學會第30次學術研討會，這次是以海報型式發表"五字數值測驗於中風患者之練習效應。
其實製作學術海報的經驗和概念都不足。
所以查詢國內外海報的範本及加入老師給的建議，統整一張海報應該要有的內容包括如下：
1. 標題
2. 作者及所屬單位
3. 背景及目的
4. 方法
5. 結果：需以圖表示
6. 討論
7. 限制
8. 結論
8. 致謝：當有研究資金補助時，需謝謝補助機構
9. 參考資料

陳志成醫師於哈佛大學進修之手札

偶然發現一位醫師(陳志成醫師)到哈佛大學進修一年的部落格，他今年9月到哈佛大學，在部落格中記錄所學、所看、和所思，其中有幾篇文章還滿不錯，與寫作相關，與大家分享："論文審稿者"、"論文寫作"、"榮譽和相責任"、"論文評論"。

在"論文審稿者"的分享中提及，回覆審稿者之意見再加上修改論文，真的是比重寫一篇還累。此句話真的是心有戚戚焉，原本以為投稿後就能鬆一口氣，但看到審稿者意見後，覺得困難重重，剛開始時，都不知要如何下筆(回覆)，現在較願意勇於面對，漸漸覺得心理壓力沒那麼大，且能由衷感謝審稿者讓我再去思考一些我仍不清楚之處。

看完陳醫師的部落格，也期待未來自己也能夠到哈佛大學進修。

陳醫師的部落格連結如下
http://drsolomon.blogspot.com/2011/11/reviewers.html

11/28~12/2 預定進度

任務	預定完成日
1. 修改FDT論文
(1) 修改討論	12/2
2. 12/1心理計量課程-論文寫作
(1) 澄清及討論之1-2個問題	12/1
(2) 張貼心理計量中英文解釋名詞	12/1
(3) 撰寫課程討論之事項	12/2
3. 博士班論文海報修改
(1) 比較dual-task(or multi-task)與single task之優缺點	12/9
(2) 思考如何避免所測量之ADL題目為受測者可能熟悉的活動	12/9
4. 復習多變量課程	11/29
5. 準備台灣職能治療學會第30次學術研討會之海報	11/30
6. 修改SF-36論文審稿者意見	12/9
7. 準備多變量之作業三	12/14
8. 製作12/19職能治療系演講(余孟霖博士)之公告	12/5

自我勉勵

以下為老師的教悔，必須時時提醒自己
1. 積極澄清，不要有駝鳥心態
2. 要釐清(照亮)自己的"灰色地帶"，甚至"黑色地帶"，否則進展緩慢
3. 保持運動習慣，腦袋才會清醒
4. 沒做好(想不好的答案)。就思考/確認問題何在，多察看相關文獻，及找高手討論
5. 找到自己的瓶頸，好好努力

功能導向執行功能評估工具(11/27)

已發展之功能導向執行功能評估工具

Instrument	Index	Item
Executive Function Performance Test (EFPT)	1. Total score (0-100): executive functions1 2. EF component score2   (1) Initiation (0-20)   (2) Organization (0-20)   (3) Sequencing (0-20)   (4) Judgment (0-20)   (5) Completion (0-20)	4 IADL tasks2: simple cooling*, telephone use, medication management, and bill payment
Behavioural Assessment of the Dysexecutive Syndrome (BADS)-不完全是功能導向工具	Total score (0-24): executive functions3	1. Six test: 0-4 for each test4   (1) Rule shift cards**   (2) Action program**   (3) Key search   (4) Temporal Judgment   (5) Zoo map   (6) Modified six elements 2. Two questions: self rating and proxy  rating of Dysexecutive questionnaire
Dysexecutive Questionnaire (DEX)	Total score (0-80): executive functions5, a higher score reflects greated deficits in executive functions	Two versions (self rating and proxy  rating), 20 items (score 0-4 for each item)6 ： 1. abstract thinking problems 2. impulsivity 3. confabulation 4. planning problems 5. euphoria 6. temporal sequencing deficits 7. lack of insight and social awareness 8. apathy and lack of drive 9. disinhibition 10. variable motivation 11. shallowing of affective responses 12. aggression 13. lack of concern 14. perseveration 15. restlessness-hyperkinesis 16. inability to inhibit responses 17. knowing-doing dissociation 18. distractibility 19. poor decision-making ability 20. no concern for social rules
Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A) (screening tool)	1. Total score (Global executive composite, GEC)7 2. Behavioral regulation index (BRI)- 4 scales, i.c., inhibit, shift, emotional control, and self-monitor7 3. Metacognitive index (MI): 5 scales. i.c., initiate, working memory, plan/organize, task monitor, and organization of materials7	Two versions (self rating and proxy  rating), 75 items, 9 scales7: 1. inhibit 2. self-monitor 3. plan/organize 4. shift 5. initiate 6. task monitor 7. emotional control 8. working memory 9. organization of materials
Multiple Errands Test	1. inefficiencies8 (0-9)9 2. rule breaks8 (0-9)9 3. interpretation failure8 4. task failure8 (0-12)9 5. total errors8 (0-30)9 (尚無明確的index，是否total errors可算是index of executive functions，仍不確定)	Do a task in the shopping mall; 4 sets of simple tasks. (community-based, hospital-based versions, and virtual MET) Procedures 1. purchase 6 items 2. locate and record 4 items of information 3. meet the assessor at a designated point (20 minutes) 4. tell the assessor when he/she had finished
Profile of the Executive Control System (PRO-EX)	找不到相關資料	1. observational assessment (1) naturalistic setting: multi-step tasks at home, e.g., balancing checkbook (2) simulated setting: route-finding task in hospital Observational assessment consists of 7 scales: (a) goal selection; (b) planning/sequencing; (c) initiation; (d) execution; (e) timesense; (f) awareness of deficits; and (g) self-monitoring 2. interview: ask caregiver scale-specific questions
Executive Function Route Finding Task (EFRT)	A final score is calculated as a mean of the six parameters: testing executive functions10	Ask the patient to start at a designated point and to locate an office on campus (not familiar to patients). The EFRT followed a number of potential routes involving at least 5 choice points and one change in floor level. Score on the parameters: (1) task understanding; (2) information seeking; (3) retaining directions; (4) error detection; (5) error correction; and (6) on-task behavior. (score 1-4 for each parameter)
Brock Adaptive Functioning Questionnaire (BAFQ)	Index of awareness: difference between self rating and proxy rating11 (是否total errors可算是index of executive functions，仍不確定)	68 questions, divided into12 subscales12: (1) planning; (2) initiation; (3) flexibility; (4) excess caution; (5) attention; (6) memory; (7) arousal level; (8) emotionality; (9) impulsivity; (10) aggressiveness; (11) social monitoring; and (12) empathy Assessing 5 domains11: (1) planning; (2) initiation; (3) attention/memory; (4) arousal/inhibition; and (5) social monitoring Score11, 12: hardly ever (0), rarely (1), sometimes (2), often (3), almost always (4) Self rating and proxy rating, two versions
Cognitive Performance Test	Cognitive-functional profiles: 5.5- executive function intact 5.0- beginning deficits in working memory/executive function 4.5- significant deficits in working memory/executive function 4.0- rely on procedural memory/limited self awareness of disability 3.5- objects stimulate actions/guided familiar tasks	Test 6 ADL tasks: dress, shop, toast, phone, wash, and travel; CPT update: add a subtask, medbox. Total score (7-39) from the 7 tasks and then divided by 7 to determine functional level and mode; score for each task: Medbox (1-6), shop (1-6), phone (1-6), toast (1-5), wash (1-5), dress (1-5), and travel (1-6) Administration of the CPT is based on occupational therapy principles of task analysis and adaptation. The test involves the sequential elimination or inclusion of sensory cues as difficulty with performance is observed. For example, in administering the PHONE task, if difficulty is observed with locating a phone number (use of symbolic cues), the phone book is removed and the number is given. If difficulty initiating dialing follows (use of visual cues), the number is removed and non-specific dialing is demonstrated (inclusion of manual cues) for imitation. The therapist must be able to determine whether or not the difficulties are due to information processing deficits or other factors such as low education, cultural bias, or physical impairment. CPT requires working memory to orchestrate complex cognitive resources (i.e., attention, perception, language, memory) to achieve stated and implied task goals while inhibiting distracter props. The test imposes multiple sub-goal and contextual task requirements that reveal patterns of functional cognition.
Naturalistic Action Test	Total score (0-18): test attention, working memory, goal formulation and execution, object recognition, or related cognitive functions. (not really test a certain cognitive function) Higher score states better performance.	1.Making toast and coffee 2. Wrapping pa resent 3. Preparing lunchbox and schoolbag

EF: Executive functions

*需二手操作

**非功能導向

1.         Wolf TJ, Stift S, Connor LT, et al. Feasibility of using the EFPT to dectect executive function deficits at the acute stage of stroke. Work 2010;36:405-412.

2.         Baum CM,Morrison T. Test Protocol Booklet- Executive  Function Performance Test. St. Louis, MO: Program in Occupational Therapy, School of Medicine, Washington University, 2007.

3.         Armentano CGC, Porto CS, Brucki SMD, et al. Study on the Behavioural Assessment of the Dysexecutive Syndrome (BADS) performance in healthy individuals, Mild Cognitive Impair,emt and Alzheimer's disease. Dementia & Neuropsychologia 2009;3:101-107.

4.        Wilson AB, Alderman N, Burgess PW, et al. Behavioural Assessment of the Dysexecutive Syndome (BADS). Journal of Occupational Psychology, Employment and Disability 2003;5.

5.         Simblett SK,Bateman A. Dimensions of the Dysexecutive Questionnaire (DEX) examined using Rasch analysis. Neuropsychological Rehabilitation 2011;21:1-25.

6.         Burgess PW, Alderman N, Evans J, et al. The ecological validity of tests of executive function. Journal of the International Neuropsychological Society 1998;4:547-558.

7.         Rabin LA, Roth RM, Isquith PK, et al. Self- and informant reports of executive function on the BRIEF-A in MCI and older adults with cognitive compliants. Arch Clin Neuropsychol 2006;31:721-732.

8.         Alderman N, Burgess PW, Knight C, et al. Ecological validity of a simplified version of the multiple errands shopping test. J Int Neuropsychol Soc. 2003;9:31-44.

9.         Maeir A, Krauss S, Katz N. Ecological validity of the Multiple Errands Test (MET) on discharge from neurorehabilitation hospital. OTJR: Occupation, Participation and Health 2011;31:S38-S46.

10.       Kizony R, Demayo-Dayan T, Sinoff G, et al. Validation of the Executive Function Route-finding Task (EFRT) in people with mild cognitive impairment. OTJR: Occupation, Participation and Health 2011;31:S47-S52.

11.       Sohlberg MM,Matter CA. Cognitive Rehabilitation. New York: The Guilford Press, 2001.

12.       Chaytor N, Schmitter-Edgecombe M, Burr R. Improving the ecological validity of executive functioning assessment. Arch Clin Neuropsychol 2006;21:217-227.

11/25與老師討論事項記錄

11/23張貼之博士班研究架構
1. 評估功能導向之執行功能工具和評估日常生活之工具有何不同。
2. 多重任務和單一任務於實質上之差異
    (1) 概念上：為什麼多重任務比較好?多重任務價值之理由
    (2) 語義上之矛盾：多重任務太困難，導致受測者無法完成
3. 操作之ADL題目為個案熟悉的活動，容易高估個案能力，需找出避免所測量題目為個案可能熟悉的活動，此為避免功能導向執行功能工具之缺點，非為特點。
4. 明確指出現有工具施測時間約是多少，才能與欲發展工具所需施測的時間比較。施測快速，所指大約應該花費10分鐘以內的時間。
5. Lezak model之意志、計畫二面向，較為抽象，較不容易看到表現；另二個面向(目的性行動、表現效能)較為具體，可看到具體表現。
6. 工具的設計若為checklist
    (1) 評分者需要仔細觀察以明確知道是否個案有此表現，會造成評分者很忙碌
    (2) 評分者評分較為主觀
    (3) 信度可能會偏低
7. 最後一段之"驗證工具之實用功能....."，和第三段之內容沒有指出如何呼應
8. 具有執行功能指標分數非為特點
9. 給予評估工具一個名字
10. 寫作上之缺點
   (1) 矛盾：特色為多重任務，但內文中提及"任務過多，太困難導致受測者無法完成"；3個任務不算多嗎?
   (2) 語義不清：圖二之第一個框框之內容描述不清楚
11. 要設計dual task的工具，是要具有同時性，還是時序性(有先後順序)

Comments in the writing course (11/24)

回覆審查者意見
1. 澄清不一致之處及詞彙，說明讓審查者了解
2. 博士班學生的層級：what à how à why。要說明為何要如此寫的理由。
3. 了解item mean為何要相等之理由。

原先之寫作

Reviewer's comments: In terms of scaling assumptions, is it appropriate for the mean of subscale to be equivalent? If the scale is administered to certain diagnostic group which the subjects may present better score on certain aspect of QOL, will you still expect to see equivalent mean for each scale? How this can be applied to the results of your study?

Reply:

Under traditional summated rating (Likert) scaling criteria, item means should be equivalent within a scale. The item means compare within its own scale, not with other scales. The SF-36 has 8 scales, such as the PF, RP, BP, GH, VT, SF, RE, and MH scales. Each scale has its own items. For example, the RP scale has 4 items, and these 4 items should have equivalent means.

Yes, it is appropriate for the equivalent of item means, because the design of the SF-36 was under traditional summated rating (Likert) scaling criteria.

If the scale was administered to a certain diagnostic group, the subjects may present better score on certain aspects of QOL. We would expect to see the equivalent of item means within its scale, not the equivalent means between the scales.

In our study, we found that the item means within its scale were approximately equivalent for the PF, RP, GH, RE scales in heroin abusers. The item means of the BP and SF scales were different within their scales.

修改後之寫作

Reply:

In our study, we use the terms ” scale and item”, not “scale and subscale”. The SF-36 has 8 scales and each scale has its own items.

Under summated rating (Likert) scaling criteria, item means and standard deviations should be roughly equivalent within its scale. The equivalent of item means and standard deviations indicates that the distributions of the items are the same. The same item distributions mean that these items reflect the same construct. Because reflecting the same construct, it is meaningful for summating the items. For example, the 4 items of the RP scale has similar item means and standard deviations, so it is meaningful for summating the scores of the 4 items to reflect the RP construct.

Yes, it is appropriate to examine the equivalent of item means and standard deviations, because the design of the SF-36 was under summated rating (Likert) scaling criteria.

If the scale was administered to a certain diagnostic group, the subjects may present better score on certain aspects of QOL. We would expect to see the equivalent of item means and standard deviations within its scale.

Based on assumption of the equivalent of item means and standard deviations, we find the roughly equivalent of item means and standard deviations within its scale, such as the PF, RP, GH, RE scales. Therefore, we may state that the items reflect the same construct for its scale. We have revised the content: “The item means and standard deviations were roughly equivalent with its scale, except those of the BP and SF scales. In practice, a possible reason for item means and standard deviations not being equivalent is heterogeneity of item content. ”

Thanksgiving

今年的11/24是美國的感恩節，現在在美國應該是吃完火雞大餐，可能在看football，或和家人分享今年想感恩的事，或正在討論要去哪個大賣場買便宜的東西.......
今年想感恩的事.....
謝謝老師的督促和管教
今年有朋友問我：「妳在和誰說話?是男朋友嗎?」
「不是!」
「是父母嗎」?
「不是!我是和老師說話」

謝謝同儕的協助和切磋
有時會看看自己部落格的被觀看的流量統計資料和流量來源，Jenny的部落格常是我的部落格的主要轉介網址。由此可見，她可能常看我的部落格，不然就是別人藉由她的部落格而看到我的部落格，因為在她的部落格上有立即更新每個人張貼內容的資訊。謝謝啦!幫我推廣我的部落格。

Summated rating method

Likert scale (李克式量表)由Rensis Likert於1932年所發展。
Likert scale之分數計算與運用有一個基本的假設，即數字與數字之間的距離是相等，在此假設的成立的前提下，不同題目可以加總得到一個量表的總分。換句話說，假設量尺分數之間為等距，同一個構面(construct)的項目(item)可以用加總方式計分。
因此，Likert scale又稱為總加量表法或總加法(summated rating method)。

假如一個量表底下的每個項目有相同的平均值和標準差，代表每個項目的分佈相同，所以每個項目為測量同一個母體(同一個構念)，如此這些項目分數的加總，所代表之構念具有意義。例如：測量國文的題目可以相加以表示國文程度，而測量國文和測量數學的題目不應該放在一起或相加成為一個分數，因為其分數不具意義。

博士班研究架構 (11/23)

Dual-task paradigm

近期搜索有關dual-task的文獻，看到的結果為有許多文獻做motor-cognitive dual task方面的研究，特別是邊走路邊做認知方面之任務，例如：邊走路(motor)、邊說話(cognition)。(思考：走路此動作測驗，對中風病患來說適合度較低)。

Coppin, A. K., et. al. (2006)所發表之文獻"Association of executive function and performance of dual-task physical testrs among older adults: analyses from the InChianti study"，研究中測試走路的雙重任務，例如：walking/talking、walking/picking-up an object、walking/carrying a large package、walking over obstacles、walking with a weighted vest等。發現執行功能較差，走路表現能力要較差，特別是增加走路之困難程度。

Baddeley, A., et. al.(1996)所發表之文獻"Dual-task performance in dysexecutive and nondysexecutive patients with a frontal lesion"中有提出，執行功能缺損之受測者比未有執行功能問題之受測者在表現雙重任務時，有顯著的能力差異。

在閱讀一些文獻後，看到Baddekey's dual-task paradigm，是指同時做二個任務的表現(例如：邊背頌詩、邊騎腳踏車)，和只做單一任務時的表現不同。假設此二個任務會互相影響，且大腦處理過程中，二個任務在會互相競爭，以決定要先處理哪一個任務。

在現行的執行功能評估工具中，有找到二個工具為同時測驗多重任務，包括：Multiple Errands Test和Naturalistic Action Test。此二個測量都是告訴受測者要處理2個以上的任務，例如：烤麵包和煮咖啡。
雖然不是要求受測者同時執行任務(例如：邊烤麵包、邊煮咖啡)，受測者可以先執行某個任務後，再執行另一個任務(例如：先烤麵包，然後再煮咖啡)。但我想法是，多個任務要執行時，必須決定先做哪個目標任務，在大腦決定過程時，此二個任務應該會互相競爭，且互相影響，例如：必須決定要先烤麵包，還是先煮咖啡；在烤麵包時，必須要考慮烤麵包的步驟、必須同時記得要煮咖啡。
雖非同時執行多重任務，但被指派多重任務，也需同時在大腦中處理這些任務。

11/21~11/25 預定進度

任務	預定完成日
1. 修改FDT論文
(1) 修改結果	11/25
(2) 修改討論	12/2
2. 11/24心理計量課程-論文寫作
(1) 澄清及討論之1-2個問題	11/24
(2) 張貼心理計量中英文解釋名詞	11/24
(3) 撰寫課程討論之事項	11/25
3. 博士班論文海報修改	11/30
(1) 整理功能導向執行功能評估工具：工具名稱、指標、工具項目	11/25
(2) 閱讀使用ADL測量dual-task之研究	11/27
4. 復習多變量課程	11/22
5. 修改SF-36論文審稿者意見	11/30
6. 準備台灣職能治療學會第30次學術研討會之海報	11/30

11/19與老師討論事項記錄

1. 發展dual-task項目之執行功能評估工具
    (1) 對此概念的了解和解釋尚不完整，需有清楚之架構，再找老師討論
    (2) 考慮是否適合中風病患 (適合性)
2. 依照自己所設定的plateau pattern標準，於現在的FDT研究中，沒有一個index可達到標準。
    (1) 以標準訂定完整為主
    (2) 必須清楚自己所設定的標準是否合理，雖在FDT論文中不需刻意說明設定標準的理由，但必須要清楚知道如何講出理由
3. SF-36論文審查者意見回覆
    (1) 針對第一位審查者之問題2
          a. 要寫出結論(ending)
          b. SF-36適合海洛因患者之理由
              (a) SF-36是generic量表可跨領域比較
              (b) 說明海洛因患者之主要問題，SF-36之8個domains都可以測量到海洛因患者之主要問題
          c. QOL在mental illness, drug abuser, heroin abuser, or multidrug abuser中之差異
              (a) 先說明 in general有什麼差異
              (b) 再解釋此議題已經超過本研究主題，所以文章內容沒有探討此議題
              (c) 看看文章內是否有寫什麼，而導致審查者有此意見
    (2) 針對第一位審查者之問題6
         a. 只要比較BP, SF於其它國家是否一致
         b. 針對culture difference，population不一致，且此議題已經超出本研究議題，無法有肯定結果
         c. 文章內容是否需要修改以回答審稿者之意見
         d. 最後要寫出結論 (summary)
    (3) 針對第一位審查者之問題9
         a. 先定義scaling assumptions，再回答問題
         b. 看看文章內容是否有解釋不清楚之處，以致審稿者誤解，思考哪裡需要做修改
         c. 確定SF-36針對mean equivalent 和 mean order的假設和設計
    (4) 問主編為何第一位審查者之問題，沒有問題7和問題8
    (5) 針對第二位審查者之問題results (1)
         a. inter-scale correlation 分析之目的為何?
         b. 針對inter-scale correlation所做的結論不完整

4. 個人需改進之處
    (1) 概念有漏洞，學習成效不高
    (2) 個人原則模糊不清

Comments in the writing course (11/17)

1. 寫出如何驗證practice effect之定義
2. ANOVA會受樣本數影響，ANOVA為顯著但練習效應之size小，要如何解釋?
3. 先寫出主要架構，然後再寫細節
4. Table的標題太簡略

Outline of the results
1. Descriptive interpretation
2. Practice effect
    (1) Cohen's d
    (2) Patterns of the practice effect
    (3) RCIp
3. Test-retest reliability

原先之寫作

Data analysis

    The practice effects across 4 sessions (i.e., Time 0-1, Time 1-2, Time 2-3) was examined using repeated measures ANOVA. The size of the practice effect was calculated by Cohen’s d. The Cohen’s criteria are: 0.20-0.49, small effect size; 0.50-0.79, moderate effect size; and ≧ 0.80, large effect size¹.

    A cumulative pattern was defined that the mean of the posttest was lower than the pretest and follow this pattern over several sessions, until reaching a plateau. The criteria of a plateau pattern were: (1) consecutive two times of the values of Cohen’s d were lower than previous value (e.g., Cohen’s d of Time 1-2 < Cohen’s d of Time 0-1 and Cohen’s d of Time 2-3 < Cohen’s d of Time 1-2); and (2) two paired t-tests were not significant, one time-point comparing to the two following time-points respectively (e.g., Time 1-Time 2 and Time 1-Time 3).

Results

    Repeated measures ANOVA across the 4 sessions in the FDT revealed significant practice effects on three indices, selective attention, alternating attention, and basic attention and processing speed (Table 2). Table 3 presents the results of Cohen’s d. The Cohen’s d of 5 indices of the FDT ranged from 0.03 to 0.26. The practice effects of 5 indices all showed cumulative patterns across the 4 sessions. Only one index, “basic attention and processing speed” had reached a plateau after the 2^nd assessment.

修改後之寫作

Data analysis

    Effect sizes (Cohen’s d) were calculated for estimating the magnitudes of the practice effects across three comparisons at 4 time-points (i.e., Time 0-1, Time 1-2, and Time 2-3). The Cohen’s criteria are: 0.20-0.49, small effect size; 0.50-0.79, moderate effect size; and ≧ 0.80, large effect size³³.

    A cumulative pattern of the practice effect was revealed when the means of the posttests were lower than the means of the pretests in the 4 serial assessments. The decreasing means of the score (i.e., reduction in reaction time) indicate that the performance gets improvement (fast speed). The criteria of reaching a plateau pattern of the practice effect in order were: (1) two comparisons of Cohen’s d, consecutive two values of Cohen’s d were lower than its previous value (e.g., d of Time 1-2 < d of Time 0-1, and d of Time 2-3 < d of Time 1-2); and (2) two paired t-tests were not significant, one time-point comparing to the two following time-points respectively (e.g., Time 1 versus Time 2, and Time 1 versus Time 3).

Results

    Table 2 presents the magnitudes of the practice effects (Cohen’s d) of 5 indices of the FDT. The small practice effects were shown at Time 2-3 of the index of alternating attention (d = 0.23), Time 1-2 of the index of ability of inhibition (d = 0.26), and Time 2-3 of index of ability of flexibility (d = 0.26). Others’ Cohen’s d were lower than 0.16.

    The comparisons of means between pretest and posttest at the 5 indices in the 4 serial assessments were decreasing (Table 3). It indicated the practice effects of 5 indices all showed cumulative patterns. The two comparisons of the values of Cohen’s d were not lower than its previous value in the 5 indices. Thus, all 5 indices did not reach a plateau pattern (Table 2).