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The Impact of Emotional Intelligence on Career Decision-Making Difficulties and Generalized Self-Efficacy Among University Students in China

Authors Ran Z, Zeb S, Nisar F, Yasmin F , Poulova P , Haider SA 

Received 23 January 2022

Accepted for publication 24 March 2022

Published 8 April 2022 Volume 2022:15 Pages 865—874

DOI https://doi.org/10.2147/PRBM.S358742

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Igor Elman



ZOU Ran,1 Sadaf Zeb,2 Faiza Nisar,2 Fakhra Yasmin,3 Petra Poulova,4 Syed Arslan Haider5

1Faculty of Education, Segi University, Petaling Jaya, Malaysia; 2Department of Professional Psychology, Bahria University, Islamabad, Pakistan; 3School of Education, South China Normal University, Guangzhou, 510631, People’s Republic of China; 4Department of Informatics and Quantitative Methods, Faculty of Informatics and Management, University of Hradec, Kralove, 500 03, Czech Republic; 5Department of Management, Sunway University Business School (SUBS), Sunway University, No 5, Jalan Universiti, Bandar Sunway, 47500, Selangor Darul Ehsan, Malaysia

Correspondence: Fakhra Yasmin, School of Education, South China Normal University, Guangzhou, 510631, People’s Republic of China, Tel +86 13802400964, Email [email protected]

Purpose: University life is a critical time when students start thinking about their careers in the future. Emotions and confidence are important factors in the career decision-making process. This process of choosing a specific direction towards a career often opens students to many uncertain situations, leading them to stress and anxiety. Emotional intelligence and generalized self-efficacy facilitate students in effective career decision-making by coping with difficulties during academia. The present study aimed to find the impact of emotional intelligence (EI) on career decision-making (CDM) and generalized self-efficacy (GSE) among university students in China.
Patients and Methods: The study included 310 undergraduate students from different universities of China. A cross-sectional research design was used and a convenient sampling technique was utilized. For the present study, Wong and Law emotional intelligence, generalized self-efficacy, and career decision-making difficulties scales were utilized.
Results: Findings of the study show that there is a significant relationship between EI, GSE, and career decision-making difficulties. Results revealed a significant positive relationship of GSE with emotional intelligence. GSE has a significant negative relationship with career decision-making difficulties. Moreover, EI has a significant negative relationship with career decision-making difficulties.
Conclusion: The study will help students to utilize emotional intelligence skills during academic and vocational life. For future research, qualitative studies would be conducted to better explore the underlying causes behind career decision-making difficulties.

Keywords: emotional intelligence, generalized self-efficacy, career decision-making difficulties, university students, China

Introduction

University life is an important entrepreneurship period for students, and they have many concerns regarding their career choices and academic success.1 In building a career, self-awareness is compulsory, that is what the person actually wants to achieve in their lives and then accordingly making plans and working to achieve them.2 As per Di Fabio and Kenny,3 university time requires major decisions to continue the education based upon the plan of joining a particular workforce where students have high expectations for themselves, ie, about careers, etc., and they are directly influencing the social progress, sustainability, and resilience of their communities and nations. For many students, the career decision-making process is a major life task and, obviously, it can raise uncertainties that may lead to delays in making career decisions. Such delays are often the result of specific difficulties associated with negative emotional states including frustration, depression, anxiety, and stress. Moreover, the problems are often linked with the use of maladaptive coping strategies, which can further intensify depression, anxiety, and stress. These emotional states may be additional causes for avoiding the decision-making process, thus further hindering the decision-making process.4 According to World’s Youth (2013), building the basis of the world’s future students is influential to the demanding social values, norms, and monetary and social development. The shift from student to employee plays a substantial change in their lives and may be a source of confusion, which is why it’s among the most important and most troublesome choices for students in selecting a profession.5 This process of choosing a specific direction towards a career often opens students to many uncertain situations, which further lead students to stress and anxiety. This indecisiveness might affect a person’s self-belief about his/her capacities to perform certain tasks within a career, which is often predicted by previous experiences of success and failure. Previous research has not investigated these variables among university students. Therefore, the present study tested the effect of emotional intelligence on career decision-making and generalized self-efficacy among university students.

Emotional intelligence plays a vital role to facilitate students in effective career decision-making by helping them to cope with difficulties during academia. Emotional intelligence (EI) refers to an assemblage of non-cognitive skills, potentials, and expertise that influence a person’s capability to cope with environmental conditions and pressures.6 According to Asian culture, the individual must continue the personal heritage and reach the desires of the elderly generation.7 Because of this, it’s arguable that Asians’ vocation options might not be a manifestation of the real profession preference but, instead, a manifestation of family interests.8 Parental participation and cautiousness will be the contributing factors once the people are involved with the process of determining a suitable career. Previously affecting factors such as early childhood experiences play a significant part in the career decision-making (CDM) procedure and quite a powerful influence is sensed and maintained, then potential outcomes are usually based on this experience.9 Regular concern and a healthy involvement of parents with their children builds confidence in them to choose the best of the many professions that appeal to them.10 Appropriate counseling regarding professions by parents also has an effective role since the advisers have to fulfill the choice of a career regarding the individual’s skills and interests.11

According to Bandura12 Self Efficacy (SE) is described as the individual’s judgment of the skills to bring together and implement courses of actions essential to accomplish chosen kinds of performances. Ren et al13 proposed that generalized self-efficacy (GSE) might have substantial impacts on the behaviors or activities between the individual, the effort spent, and somebody’s thoughts and mental reactions. The overall SE is described as the decisions that each student has about their abilities to organize and perform the actions required by different specific circumstances in the university context.14 Hackett and Betz15 further extended Bandura’s self-efficacy theory, suggested the role of SE expectations CDM, and found that career choices and decisions are restricted due to the low self-efficacy expectations. This results in anxiety and avoidance of career pursuits. Therefore, for career counseling, increasing SE expectations in career decision-making is one of the useful focuses.15 Regarding decision-making tasks as compared with high SE, past literature revealed that individuals with reduced SE expectations for CDM experience greater stress or prevention. Furthermore, it was found that those individuals who progress without the benefits of consideration are far less likely to have effective DM and occupation execution outcomes than those who have contributed in exploratory behavior, as suggested by empirical evidence considering career exploration and CDM behaviors.16,17 Furlong et al18 established classifications of problems in CDM deviations from perfect career decisions leads to difficulties in the CDM process. According to this model, an ideal career decision-maker is the individual who has awareness regarding how to make a career choice, willingness regarding decision-making, and the ability to make the decision appropriately. The two possible ways in which decision problems occurred because of deviation are: by preventing one from making a career choice or by leading to a less optimal career decision (CD). Sidiropoulou-Dimakakou et al19 proposed the model comprised of three main kinds of difficulty: lack of readiness to engage in the CDM procedure, lack of information, and inconsistent information. Current findings by Lee20 showed that a substantial percentage of university students are doubtful about career decisions and various cognitive factors are related to the career indecision, including CDM, SE,21 dysfunctional career thoughts,22 lack of information,23 internal–external conflicts,24 self-knowledge,25 and experience of past jobs.26

Previous studies demonstrated the effect of self-efficacy perceptions in CDM as well as the articulated choices.27 People with greater SE amounts have satisfaction of the vocational functions, exhibit greater interest for specific choices, and have higher persistence regarding their career goals.28 On the other hand, individuals having a very low awareness of self-efficacy in career decisions face problems in engaging in potential career options.29 The action theory of career development by Yousefi et al30 suggested that professions are preferred through daily activities, like the usage of speech in interaction with other people. In this theory, emotions are a person’s inner processes and are connected to the demands, aims, strategies, tasks, and commitments. Additionally, Yousefi et al30 further explain the importance of three reasons that highlight the role of emotions in building careers, like how emotions stimulate and strengthen actions, regulate and govern activities, and ease obtaining and developing narratives about professions. The idea of Emotional Intelligence (EI) was introduced by the investigators to study the career-related problems and also to advance the knowledge about the effects of emotions on career decisions.31,32 Based on Ran et al,33 EI refers to a person’s capability to assess, comprehend, and differentiate a person’s own emotions and those of others. This emotional information is utilized by people to guide actions and thinking. EI is one of the vital factors in explaining career choices and success over the past decade.3,34 Chesnut and Cullen35 demonstrated that those people who determine their interests and openly express them well throughout the vocation counseling procedure have greater EI. They also said that those people who are proficient at handling their emotions incline to be better accommodated to CDM, because they are better able to forecast the psychological aftermath of vocation choices. This lets them prevent professions with disagreeable tasks and responsibilities while pursuing vocations that can cause better life and job fulfilment. Thus, improving EI capacities can encourage career options by boosting SE in making real-life decisions. By keeping in mind the targeted goal, high emotional intelligence individuals are prone to more satisfaction in relations of their support from the social system to expand their surroundings. As mentioned by Schutte and Loi,36 highly EI persons tend to think and shift their paradigms regarding the goals they have selected.

The significance of the study was to comprehend the effect of EI on CDM issues and GSE among university students in China. Among the most essential issues, people are facing throughout their life would be to choose their career and, when appropriate, advice or counseling is not given it results in distress, negative feelings, frustration, and trouble to deal with. Additionally, the absence of appropriate advice, uncertainty concerning occupation, parental participation, differences in personality, vocational interests, demographic status, historical job experiences, and cultural obstacles would be the contributing factors in career decision-making difficulties. Some pupils may experience substantial stress, occasionally depression with surrounding vague conditions. These pupils may fall into the indecisive category and might require one’s career and counseling.37 Therefore, EI significantly predicts CDM as the EI trait is quite beneficial for an individual accountable for the success of a specific aim.

Materials and Methods

Objectives

  1. To see the relationship between EI, CDMD, and GSE among university Students.
  2. To find out the effect of EI on career decision-making and generalized self-efficacy among university students.

Hypotheses

  1. There would be a significant relationship between emotional intelligence and career decision-making difficulties among university students.
  2. There would be a significant relationship between emotional intelligence and generalized self-efficacy among university students.
  3. There would be a significant relationship between generalized self-efficacy and career decision-making difficulties among university students.
  4. There would be a significant effect of emotional intelligence and generalized self-efficacy on career decision-making difficulties among university students.

Research Design

In the current study, a cross-sectional correlation design study was used.

Subjects

In the current study, undergraduate students aged between 18 and 26 years (Female/Male) belong to the Nuclear/Joint family System participated via online surveys. Their credentials related to gender, marital status, semester number, and university were also acquired. Data was collected through a convenient sampling technique (accessible through online medium). Sample size is calculated by G-power, ie, 310 (M=1.43, SD=0.50) and was taken from different universities of China.

Instruments

Demographic Sheet

The demographic information sheet includes age, gender, family system (joint and nuclear), marital status, semester, and university.

Emotional Intelligence Scale (Wong and Law, 2002)

Wong and Law,38 were the developers of the emotional intelligence scale. It is used to find the level of EI. The scale is comprised of 16 items and four subscales, with four items each including self-emotions appraisal, regulation of emotions, use of emotions, and others emotion appraisal. The responses of the Wong and Law38 emotional intelligence scale (WLEIS) are marked on a 7-point Likert scale (0=disagree to 6=agree). To give a total score, all the scores for each of 16 items are summed up. Overall, the reliability of the scale is 0.88. The alpha reliability for the sample subscales is 0.79, 0.76, 0.83, and 0.86, respectively.

Career Decision-Making Difficulties (Gati and Saka, 2001)

Gati and Saka25 designed the career decision-making difficulties scale. The objective of the scale is to assess the difficulties in the CDM procedure. The revised abbreviated version comprises 34 items, using a 9-point reaction scale (1=does not describe me personally to 9=explains me well), containing two validity items. Each item represents among those 10 difficulty categories and the three major clusters. The entire score of this career decision-making difficulties questionnaire (CDDQ) provides information concerning the person’s overall level of career indecision. The three major clusters’ scores offer information concerning someone’s issues involving lack of readiness, lack of information, and Inconsistent information. Reliability of the entire scale is 0.95. The alpha reliability for this sample subscales is 0.72, 0.95, and 0.93, respectively.

General Self-Efficacy Scale (Schwarzer and Jerusalem, 2010)

Schwarzer and Jerusalem39 were the developers of general self-efficacy scale. This scale was used to assess SE. It consists of 10-items and is marked on a 4-choice response from “Not at all true,” which scores 1, to “Exactly true.” The total scores are given by summing up all the scores for each of the ten items. Overall, Cronbach’s alpha for scale is 0.88. The alpha reliability for this sample is 0.82.

Procedure

In order to collect data for the present study the online survey has been made and advertised on different social media platforms (Instagram, Facebook, WhatsApp, and through email). Only the participants who have internet facilities and mobile phones were requested to contribute in the present research. The applicants were informed about the objectives and procedure of the task beforehand. They were given the right to walk away from the research at any time. They were also educated regarding confidentiality rights and asked for their consent before beginning with the procedure. Once all agreed, they were requested to fill out the Wong and Law38 emotional intelligence (EI), generalized self-efficacy (GSE), and career decision-making difficulties questionnaires. The present study includes the students who are currently enrolled in the Bachelor’s program of different universities of China and to whom the English language is understandable. Moreover, those students who are physically (any physical disability) or mentally challenged would be excluded.

Ethical Considerations

Care was taken to ensure participant safety and confidentiality. Scales utilized in the study were obtained with the author’s knowledge and permission. Scale guidelines given by the authors were also thoroughly followed. Every participant’s informed consent was obtained, with the right to withdraw from the study when they want and their names and other confidential details protected. No risk or harm was brought on the sample.

Data Analysis

SPSS (version 25) was utilized in the present research to examine the results. Pearson Bivariate correlation and regression were used to test the hypothesis.

Results

Frequencies and percentages of the study participants are presented in Table 1. The age range of the participants was 18–26 years. The sample comprised of 310 participants. Participants with age range 18–20 comprised of 157 (50.6%) participants, 21–23 comprised of 129 (41.5%), and 24–26 comprised of 24 (7.8%) participants. In total, 177 (57.1%) were male and 133 (42.9%) were female; 185 (59.7%) participants belonged to a nuclear family system and 125 (40.3%) belonged to a joint family system; 287 (92.6%) were single participants, nine (2.9%) were married, and 14 (4.5%) were engaged participants.

Table 1 Frequencies and Percentages of the Demographic Characteristics of the Sample

Basic descriptive statistics of the study are presented in Table 2. For the present study descriptive, mean, standard deviation, and reliabilities of study variables were estimated. Bivariate correlation and regression analysis were used to examine the study variables. The self-emotion appraisal subscale mean is 5.48 (SD=1.19). The mean for regulation of emotion subscale is 5.68 (SD=0.96). Use of emotion subscale mean is 5.47 (SD=1.19) and other emotion appraisal subscale mean is 4.82 (SD=1.43). Mean of readiness subscale is 5.25 (SD=1.36), lack of information subscale mean is 4.51 (SD=1.89), and inconsistent information subscale mean is 4.7 (SD=1.96). The mean of generalized self-efficacy is 31.03 (SD=4.8). The alpha reliability emotional intelligence subscales, career decision-making difficulties questionnaire subscales, and generalized self-efficacy are 0.79, 0.76, 0.83, 0.86, 0.72, 0.95, 0.93, and 0.82, respectively.

Table 2 Pearson Product Moment Correlation among Generalized Self-Efficacy, Emotional Intelligence, and Career Decision-Making Subscales among University Students (N=310)

Table 2 shows the findings of correlation among generalized self-efficacy, emotional intelligence, and career decision-making. It indicates that there is a significant positive association between the EI subscales with GSE scale. This means those having higher emotional intelligence were having more GSE. GSE has a significant negative connection with lack of information and inconsistent information subscales of CDM difficulties scale. SEA subscale of emotional intelligence has a significant negative relationship with readiness, lack of information, and inconsistent information subscales of career decision-making difficulties questionnaire. UOE subscale of EI has a significant negative relationship with readiness, lack of information, and inconsistent information subscales of CDM questionnaire. OEA subscale of EI also has a significant negative relationship with lack of information.

Table 3 shows the regression model of emotional intelligence and generalized self-efficacy predicting career decision-making difficulties among university students. It suggests that this model accounts for a 3% change in the variance of the readiness subscale of the career decision-making difficulties. The findings also indicate that with every one-unit change in self-emotions appraisal, the lack of information will decrease by 0.24 units. This suggests that this model accounts for an 8% change in the variance of the lack of information subscale of the career decision-making difficulties. Moreover, the results show that, with every one-unit change in self-emotions appraisal, the inconsistent information will decrease by 0.32 units. This suggests that this model accounts for a 6% change in the variance of inconsistent information subscale of the CDM questionnaire.

Table 3 Regression Model of Emotional Intelligence and Generalized Self-Efficacy Predicting Career Decision-Making Difficulties among University Students

Discussion

For young adults, university life is an important entrepreneurship period, and they have many concerns regarding their career choices and academic success.1 In building a career, self-awareness is compulsory, that what the person actually wants to achieve in their lives and then accordingly making plans and working on them to achieve them.2 The significance of this study was to understand the role of emotional intelligence and generalized self-efficacy on career decision-making difficulties among university students. The study goal was to see the impact of emotional intelligence on career decision-making difficulties, and GSE among university students in China. It was based on assessing career decision-making difficulties, generalized self-efficacy, and emotional intelligence of the university students in the phase of their career decision-making, ie, university time before they selected a particular career. Three scales were used in the present study, including the emotional intelligence Wong and Law38 scale, career decision-making difficulties, and the generalized self-efficacy scale.

We had three major hypotheses to explore. The first hypothesis aimed to investigate the connection between EI and career decision-making problems among university students. Correlation analysis revealed that emotional intelligence has a substantial negative relationship with lack of readiness, lack of information, and inconsistent information subscales of career decision-making difficulties. Consistent with the previous literature as per the conceptualization of EI by Wong and Law,38 Lam and Santos40 found that those people high in self-emotion appraisal have a better understanding of their preference and abilities, which ultimately results in theability of a more precise and focused search for information. This consequently results in more reduced difficulties relevant to CDM. They also found that, as self-efficacy is an impressionable construct, interventions that are much focused on increasing self-efficacy relevant to career decision-making can also decrease indecision levels related to career life. Inconsistent information like opposing evidence, and inner (eg, conflicting private career standards) and outside battles (eg, conflicts between personal interests and preferences of others)also impact career options. Likewise, readiness continues to be identified as a variable impacting CDM; lacking readiness might function as an inhibition to the CDM procedure. Lack of readiness is distinguished by an insufficient drive to participate in CDM, overall indecisiveness about all kinds of CDM, and dysfunctional opinions about CDM.41

The second hypothesis was aimed at exploring a relationship between EI and GSE among university students. Correlation analysis showed positive relations between the emotional intelligence subscales with the GSE scale. It means those having higher emotional intelligence were having more generalized self-efficacy. The positive relations between the emotional intelligence subscales with the generalized self-efficacy scale support previous findings of Schutte et al,36 as people having high EI are more likely to be fulfilled with their social structures and feel motivated to modify the environments to achieve goals. Especially concerning their career, they are also more inclined to be self-aware, know what they want, and then make an effort to achieve their plans. Moreover, the findings of a study by Santos et al42 implied that those who have high EI have enhanced understanding of their feelings and have an augmented ability and skills in making decisions regarding their careers in the coming future.

The third hypothesis aimed at investigating the connection between GSE and CDMD among university students. Correlation analysis revealed that GSE has a substantial negative association with lack of information and inconsistent information subscales of CDM problems. It correlates with previous literature because the study conducted by Jaensch et al43 found that career decision-related SE is an important predictor of indecision related to career options. The meta-analysis of Choi et al44 explored the association between CD-related SE and some variables including race, self-esteem, gender, career obstacles, career indecision, occupational identity, vocational outcome expectations, and peer support. Career-related difficulties and career indecision have an established negative relation with career decision-related SE. Also, the findings about the negative connection between the CDMD and GSE provide significant confirmation that self-efficacy (either career-related or generalized) was significant in career decision-making. It confirms that negative self-evaluation in terms of personal abilities leads to career decision-making issues.45 Research suggests that people who have low career decision-making SE have a tendency to restrict their career choices and targets since they recognize poor chances for attaining particular career ambitions.27,29 This description could also apply to the senses of doubtful college students. Moreover, regarding the fourth hypothesis that EI predicts CDMD among university students, Sulejmanov and Seitl45 have shown that, expectedly, those individuals who are high in emotional intelligence displayed less difficulties in their career decision-making. According to previous research, this study also showed that most individuals show the association between EI and career decision-making problems. A study examined the alterations in the understanding stressors related to academia and psychophysiological responses of anxiety centered on unique profiles of emotional regulation. Learners with greater degrees of approval and control over their feelings felt the ailments along with the academic environment as less threatening, and so suffered lower levels of mental strain.46 Previous study evidence also demonstrated the effect of EI on the SE of experts with respect to decision-making.47

Conclusion

The study aimed to see the impact of EI on CDMD and generalized self-efficacy among university students in China. Outcomes supported the hypothesis. Results show the findings of correlation among GSE, EI, and career decision-making. Results reveal that there is a significant positive connection between the EI subscales with generalized self-efficacy scale. It means those having higher emotional intelligence were having more GSE. GSE has a significant negative connection with lack of information and inconsistent information subscales of CDM difficulties scale. It shows that higher generalized self-efficacy lessens career decision-making difficulties. Moreover, higher emotional intelligence in individuals leads to less career decision-making difficulties. Thus, it may be concluded that career counseling programs at the institutional level, awareness seminars, and workshops for pupils and parents could be effective for greater future career choices. The purpose of the study was to shed light on the role of emotional intelligence and generalized self-efficacy on career decision-making difficulties among university students. Nowadays the role of emotional intelligence significantly increases. Emotional intelligence refers to diagnose, recognize, control, and understand our own emotions and others. Those individuals who have better understanding of their own feelings and emotions do not let them sabotage the way they make decisions which can lead to a better chance in managing situations more effectively and proactively. University life is basically a transition period and students are facing difficulties while making career decisions. Moreover, in China, few educational psychologists and career counselors are providing services in educational institutions due to which more problems occurred related to careers. Therefore, government and higher authorities should take steps for the betterment of career development policies.

Implications

This study’s implications contributed to highlighting the importance of emotional intelligence and generalized self-efficacy in career decision-making among students. The findings of this study will be accommodating for both students and parents, with a healthy involvement of parents in career decision-making which plays an important role because, based on their experiences, they give a better direction to their children. It will be helpful for students in utilizing emotional intelligence skills during academic and vocational life. China is a country where job opportunities are limited and also people face problems in finding jobs according to their interests. Therefore, counseling sessions will be arranged for the students at the initial level to prepare them for the challenges of the future. As career decision-making plays a significant role for both working and non-working students, therefore, it is vital that different universities should design adequate career assessment tools before and after graduation. Seminars, workshops, and awareness sessions regarding career decisions will be conducted for both parents and students to educate them. Furthermore, career counselors will help the students to identify their characteristics, interests, and preferences at the earlier stage for making better future career decisions. More emphasis should be given to students by providing them better coaching and career education in the last semesters especially. Likewise, knowledge regarding career decision-making will help students in the long-term, including efficiency, satisfaction with their job, etc. Lastly, the current results are inspiring for career and employment counseling.

Limitations of the Study

Firstly, the data cannot be generalized to the university students of other cities across the country. Additionally, because this was a sample of students it is difficult to generalize the findings to other groups unless additional evidence is supplied. It would be helpful for future research to examine individuals SE expectations in vocation development and construction by drawing distinct samples which have attracted less practical attention. Another limitation was that this study did not contribute to practical guidance for the universities’ career counseling services and how the intervention plans could be devised to cater to such career-related issues. As the study contained the self-report questionnaire so students might respond in which they appear socially desirable, so the sample can be biased. Culture and gender differences are significant factors in the decision-making process. Thus, career counselors should be aware and provide appropriate interventions to lessen career decision-making difficulties among undergraduates.

Suggestions for Future Research

Future study must incorporate the framework of career interventions that universities may include in their curriculum and ensure career services are provided to students. Future researchers might validate the findings by utilizing samples from diverse populations or cultures and even different universities within China. Future research should proceed by looking into the demographic’s variables, including gender differences, etc. Also keepin mind that the instruments can influence findings greatly, hence, future studies should look into more appropriate scales to explore further in depth. Moreover, for future research, qualitative studies should be conducted to better explore the underlying causes behind career decision-making difficulties among university students.

Ethics Statement

The Institutional Review Board (IRB) of the Department of Professional Psychology, Bahria University, Islamabad approved the study. The consent obtained prior to the study commencement from the study participants was “informed consent” and the guidelines outlined in the Declaration of Helsinki were followed.

Funding

The open access of this research is supported by the SPEV project 2021 at the Faculty of Informatics and Management, University of Hradec Kralove, Czech Republic.

Disclosure

The authors report no conflicts of interest in this work.

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