Medicine and Health Sciences Commons^™

Pathways To Success In Anatomy And Physiology At The Community College: The Role Of Prerequisite Courses, Staci B. Forgey, Mitchell R. Williams, Shana Pribesh

Educational Leadership & Workforce Development Faculty Publications

Gatekeeper courses such as Anatomy and Physiology are often referenced in discussions regarding the national shortage of persons in allied health professions. In an attempt to bolster access to STEM professions, some community colleges are mandating prerequisite courses such as Natural Sciences and/or General Biology for STEM gatekeeping courses. In this study, we examined which of these prerequisite courses helped students to pass Anatomy and Physiology and whether the courses are an additional barrier to STEM field completion. This was the first study to evaluate whether a prerequisite course was predictive of success in Anatomy and Physiology, and it contributes …

An Exploration Of Pharmacy Education Researchers' Perceptions And Experiences Conducting Qualitative Research, Antonio A. Bush, Mauriell Amechi, Adam Persky

Educational Leadership & Workforce Development Faculty Publications

Objective. To investigate pharmacy education researchers' experiences in conducting qualitative research and their perceptions of qualitative research in pharmacy education

Methods. A phenomenological approach was used to conduct one-time, in-depth interviews with 19 participants from 12 schools and colleges of pharmacy. Interview transcripts were coded and themes were identified using a modified form of the Sort and Sift, Think and Shift method of data analysis.

Results. Faculty members were the largest subgroup in the sample, followed by graduate students, postdoctoral fellows/scholars, and residents. Pharmacy education researchers had varying levels of training in conducting qualitative research and some had none at …

Cyberbullying, Digital Citizenship, And Youth With Autism: Lis Education As A Piece In The Puzzle, Abigail Phillips, Amelia Anderson

STEMPS Faculty Publications

Librarians are beginning to address the lack of services for youth with autism spectrum disorder (ASD) by providing flexible and tailored programming and services. One important need among youth with ASD is a better understanding of how to navigate the online environment safely and responsibly. Given different engagement styles with social interaction and communication, youth with ASD may be more susceptible to cyberbullying and misinterpretations during online communications than their peers. This study investigates whether librarians can (or should) play a role in digital citizenship education for youth with ASD and provides suggestions for LIS educators preparing future librarians on …

Contextualizing Performance Of Coordinated Care Network Of Veteran Services In Virginia, Marina Saitgalina, Donta Council

School of Public Service Faculty Publications

Coordinated care network is an approach to human service delivery that is recognized to improve client outcomes at a reduced cost. However, general mixed findings on the effectiveness of coordinated care networks warrant research contextualization. This article seeks to discover factors influencing the performance of a coordinated care network delivering social services to veterans and their families. The study provides a contextual analysis of a coordinated care network launched in 2016 in southeastern Virginia for two samples of 1,512 and 375 veterans and their families. Results of the regression analyses indicate that initial progress has been made both in efficiency …

Melatonin For The Treatment Of Sepsis: The Scientific Rationale, Ruben Manuel Luciano Colunga Biancatelli, Max Berrill, Yassen H. Mohammed, Paul E. Marik

Bioelectrics Publications

Sepsis affects 30 million people worldwide, leading to 6 million deaths every year (WHO), and despite decades of research, novel initiatives are drastically needed. According to the current literature, oxidative imbalance and mitochondrial dysfunction are common features of septic patients that can cause multiorgan failure and death. Melatonin, alongside its traditionally accepted role as the master hormonal regulator of the circadian rhythm, is a promising adjunctive drug for sepsis through its anti-inflammatory, antiapoptotic and powerful antioxidant properties. Several animal models of sepsis have demonstrated that melatonin can prevent multiorgan dysfunction and improve survival through restoring mitochondrial electron transport chain (ETC) …

Diagnosing Mild Traumatic Brain Injury Using Saliva Rna Compared To Cognitive And Balance Testing, Steven D. Hicks, Cayce Onks, Raymond Y. Kim, Kevin J. Zhen, Jayson Loeffert, Andrea C. Loeffert, Robert P. Olympia, Gregory Fedochak, Samantha Devita, Aakanksha Rangnekar, John Leddy, Mohammad N. Haider, Zofia Gagnon, Callan D. Mcloughlin, Matthew Badia, Jason Randall, Miguel Madeira, Aaron M. Yengo-Kahn, Justin Wenzel, Matthew Heller, Hallie Zwibel, Aaron Roberts, Samantha Johnson, Chuck Monteith, Michael N. Dretsch, Thomas R. Campbell, Rebekah Mannix, Christopher Neville, Frank Middleton

Rehabilitation Sciences Faculty Publications

BACKGROUND: Early, accurate diagnosis of mild traumatic brain injury (mTBI) can improve clinical outcomes for patients, but mTBI remains difficult to diagnose because of reliance on subjective symptom reports. An objective biomarker could increase diagnostic accuracy and improve clinical outcomes. The aim of this study was to assess the ability of salivary noncoding RNA (ncRNA) to serve as a diagnostic adjunct to current clinical tools. We hypothesized that saliva ncRNA levels would demonstrate comparable accuracy for identifying mTBI as measures of symptom burden, neurocognition, and balance.

METHODS: This case‐control study involved 538 individuals. Participants included 251 individuals with mTBI, enrolled …

Saliva Microrna Biomarkers Of Cumulative Concussion, Steven D. Hicks, Robert P. Olympia, Cayce Onks, Raymond Y. Kim, Kevin J. Zhen, Gregory Fedorchak, Samantha Devita, Aakanksha Rangnekar, Matthew Heller, Hallie Zwibel, Chuck Monteith, Zofia Gagnon, Callan D. Mcloughlin, Jason Randall, Miguel Madeira, Thomas R. Campbell, Elise Fengler, Michael N. Dretsch, Christopher Neville, Frank A. Middleton

Rehabilitation Sciences Faculty Publications

Recurrent concussions increase risk for persistent post-concussion symptoms, and may lead to chronic neurocognitive deficits. Little is known about the molecular pathways that contribute to persistent concussion symptoms. We hypothesized that salivary measurement of microribonucleic acids (miRNAs), a class of epitranscriptional molecules implicated in concussion pathophysiology, would provide insights about the molecular cascade resulting from recurrent concussions. This hypothesis was tested in a case-control study involving 13 former professional football athletes with a history of recurrent concussion, and 18 age/sex-matched peers. Molecules of interest were further validated in a cross-sectional study of 310 younger individuals with a history of no …

Peer Review Of "Predicting Health Disparities In Regions At Risk Of Severe Illness To Inform Health Care Resource Allocation During Pandemics: Observational Study, Ross Gore

VMASC Publications

This is a peer review submitted for the paper "Predicting Health Disparities in Regions at Risk of Severe Illness to Inform Health Care Resource Allocation During Pandemics: Observational Study."

Strategies For Controlling Violence Against Healthcare Workers: Application Of Fuzzy Analytical Hierarchy Process And Fuzzy Additive Ratio Assessment, Fazel Rajabi, Mehdi Jahangiri, Farnaz Bagherifard, Sean Banaee, Payam Fahadi

Community & Environmental Health Faculty Publications

Objective: The present study aimed to identify and prioritize control measures of violence against Healthcare Workers (HWs) using the Fuzzy Analytical Hierarchy Process (FAHP) and Fuzzy Additive Ratio Assessment (F-ARAS).

Background: Occupational violence is a pervasive problem in healthcare centers. Reducing violence against staff is one of the challenges for healthcare managers.

Method: At the first stage, the most common criteria and control options for violence against HWs were identified and extracted using a review of previous studies. At the next stage, criteria for selection of control measures were prioritized using the FAHP. Finally, control measures of workplace violence were …

Association Between Participation In Annual Physical Examinations And Risk Factors For Noncommunicable Diseases In Adults With Disabilities: Evidence From Shanghai, China, Yugang Li, Qi Zhang, Xiaohong Li, Mei Sun, Jun Lu, Gang Chen

Community & Environmental Health Faculty Publications

The relationships between regular participation in annual physical examinations and the risk factors for noncommunicable diseases (NCDs) among adults with disabilities remains unclear. To address this gap, we used data from 130,899 individuals with disabilities in Shanghai (2014-2016) and evaluated four risk factors for NCDs: hypertension, hyperglycemia, hyperlipidemia, and being overweight. Overall, 4540 individuals participated in annual physical examinations across all three years and 11,388 missed examinations in 2015 (group without regular participation). Chi-squared tests and binary logistic regression were used to assess differences in patient characteristics and explore correlations between variables. Significant differences in age (χ² = 102.620, …

Survey Of Workplace Violence Perception, Prevention, Strategies, And Prevalence Of Weapons In Healthcare Facilities, James D. Blando, Marilyn Lou Ridenour, Daniel Hartley

Community & Environmental Health Faculty Publications

No abstract provided.

Who Infant And Young Child Feeding Indicators In Relation To Anthropometric Measurements, Abdullah Al-Taiar, Nawal Alqaoud, Majeda S. Hammoud, Faheema Alanezi, Nawal Aldalmani, Monica Subhakaran

Community & Environmental Health Faculty Publications

Objective: This study aimed to report the WHO infant and young child feeding (IYCF) indicators from Kuwait and to investigate the associations between these indicators and anthropometric measurements.

Design: The Kuwait Nutritional Surveillance System uses observational cross-sectional approach to collects data by face-to-face interviews with mothers or child guardians using a structured questionnaire that was developed based on the WHO IYCF indicators. The weight and height of infants and young children were measured using digital scales in a standardised manner.

Setting: Vaccination centres in all governorates (provinces) of Kuwait.

Participants: Infants and young Kuwaiti children aged 0–23 months (N 5839). …

Correlation Of Circulating Angptl5 Levels With Obesity, High Sensitivity C-Reactive Protein And Oxidized Low Density Lipoprotein In Adolescents, Maha M. Hammad, Mohamed Abu-Farha, Abdullah Al-Taiar, Nada Alam-Eldin, Reem Al-Sabah, Lemia Shaban, Fahd Al-Mulla, Jehad Abubaker, Abdur Rahman

Community & Environmental Health Faculty Publications

Angiopoietin-like proteins (ANGPTL) is a family of eight members known to play an important role in metabolic diseases. Of these, ANGPTL5 is suggested to regulate triglyceride metabolism and is increased in obesity and diabetes. However, its role in metabolic diseases in adolescents is not well-studied. In this study, we tested the hypothesis of a positive association between plasma ANGPTL5, and obesity, high sensitivity C-reactive protein (HsCRP) and oxidized low-density lipoprotein (Ox-LDL) in adolescents. Adolescents (N = 431; age 11–14 years) were randomly selected from middle schools in Kuwait. Obesity was classified by the BMI-for-age based on the WHO growth charts. …

Arsenic Exposure And Methylation Efficiency In Relation To Oxidative Stress In Semiconductor Workers, Chih-Hong Pan, Ching-Yu Lin, Ching-Huang Lai, Hueiwang Anna Jeng

Community & Environmental Health Faculty Publications

This study examined associations between oxidative stress and arsenic (As) exposure and methylation efficiency in semiconductor workers. An As-exposed group (n = 427) and a control group (n = 91) were included. The As-exposure group (n = 427) included 149 maintenance staff members and 278 production staff members representing high As exposure and low As exposure, respectively. The control group included 91 administrative staff members with no or minimal As exposure. An occupational exposure assessment was conducted to assess personal As exposure by measuring As concentrations in urine, hair, and fingernails of the subjects. Urinary As(III), As(V), monomethylarsonic (MMA), and …

Assessment Of Aloe Vera For Qualitative Fit Testing Of Particulate Respirators: A Logistic Regression Approach, Anahita Fakherpour, Mehdi Jahangiri, Saeed Yousefinejad, Mozhgan Seif, Sean Banaee

Community & Environmental Health Faculty Publications

Fit testing procedure is required for filtering facepiece respirators (FFRs) to ascertain an acceptable fit between the skin and facepiece sealing surface. The present study seeks to compare the efficacy of Aloe vera (A. vera) and commercial Bitrex^TM as challenge agents of qualitative fit testing of particulate respirators. An herbal solution consisting of A. vera at seven different concentrations was developed. Threshold Screening Tests (TSTs) of A. vera solutions were compared to Bitrex^TM. To do so, solutions were administered randomly on a total of 62 participants. A placebo was also tested to ensure the taste response being …

Structural Biology Of The Enterovirus Replication-Linked 5'-Cloverleaf Rna And Associated Virus Proteins, Steven M. Pascal, Ravindranath Garimella, Meghan S. Warden, Komala Ponniah

Chemistry & Biochemistry Faculty Publications

Although enteroviruses are associated with a wide variety of diseases and conditions, their mode of replication is well conserved. Their genome is carried as a single, positive-sense RNA strand. At the 5′ end of the strand is an approximately 90-nucleotide self-complementary region called the 5′ cloverleaf, or the oriL. This noncoding region serves as a platform upon which host and virus proteins, including the 3B, 3C, and 3D virus proteins, assemble in order to initiate replication of a negative-sense RNA strand. The negative strand in turn serves as a template for synthesis of multiple positive-sense RNA strands. Building on structural …

The Impact Of Delayed Treatment Of Uncomplicated P. Falciparum Malaria On Progression To Severe Malaria: A Systematic Review And A Pooled Multicentre Individual-Patient Meta-Analysis, Andria Mousa, Abdullah Al-Taiar, Nicholas M. Anstey, Cyril Badaut, Bridget E. Barber, Quique Bassat, Joseph D. Challenger, Aubrey J. Cunnington, Dibyadyuti Datta, Chris Drakeley, Azra C. Ghani, Victor R. Gordeuk, Matthew J. Grigg, Pierre Hugo, Chandy C. John, Alfredo Mayor, Florence Migot-Nabias, Robert O. Opoka, Geoffrey Pasvoi, Claire Rees, Hugh Reyburn, Eleanor M. Riley, Binal N. Shah, Antonio Sitoe, Colin J. Sutherland, Philip E. Thuma, Stefan A. Unger, Firmine Viwami, Michael Walther, Christopher J.M. Whitty, Timothy William, Lucy C. Okell

Community & Environmental Health Faculty Publications

BACKGROUND: Delay in receiving treatment for uncomplicated malaria (UM) is often reported to increase the risk of developing severe malaria (SM), but access to treatment remains low in most high-burden areas. Understanding the contribution of treatment delay on progression to severe disease is critical to determine how quickly patients need to receive treatment and to quantify the impact of widely implemented treatment interventions, such as 'test-and-treat' policies administered by community health workers (CHWs). We conducted a pooled individual-participant meta-analysis to estimate the association between treatment delay and presenting with SM.

METHODS AND FINDINGS: A search using Ovid MEDLINE and Embase …

A Case Study On Accessible Reading With Deaf Children, Jody H. Cripps, Samuel J. Supalla, Laura A. Blackburn

Communication Disorders & Special Education Faculty Publications

The concept of accessible reading for deaf students is new and worthy of exploration. In the face of the reading difficulties often experienced by deaf students, the lack of a specialized reading methodology that works for them must be addressed. Central to the paper is a research case study undertaken with two young deaf students, proficient in American Sign Language (ASL) and learning to read. The students participated in a tutorial with a tutor knowledgeable in a specialized reading methodology called ASL Gloss. The participating students demonstrated progress in reading skills over time. Two reading measures were adapted from English …

An Assessment Of Pet Dose Reduction With Penalized Likelihood Image Reconstruction Using A Computationally Efficient Model Observer, Howard C. Gifford, C. Ross Schmidtlein, Andrzej Krol, Yuesheng Xu

Mathematics & Statistics Faculty Publications

Developing PET reconstruction algorithms with improved low-count capabilities may provide a timely and cost- effective means of reducing radiation dose in promising clinical applications such as immuno-PET that require long-lived radiotracers. For many PET clinics, the reconstruction protocol consists of postsmoothed ordered-sets expectation-maximization (OSEM) reconstruction, but penalized likelihood methods based on total-variation (TV) regularization could substantially reduce dose. We performed a task-based comparison of postsmoothed OSEM and higher-order TV (HOTV) reconstructions using simulated images of a contrast-detail phantom. An anthropomorphic visual-search model observer read the images in a location-known receiver operating characteristic (ROC) format. Acquisition counts, target uptake, and target …

Sexual Harassment Issues Among Dental Hygienists, Amber W. Hunt, Brenda T. Bradshaw, Susan Lynn Tolle

Dental Hygiene Faculty Publications

Purpose: The "#MeToo" movement has increased awareness of sexual harassment in the workplace and its detrimental effects on the work environment. The purpose of this study was to determine the prevalence of sexual harassment in a convenience sample of dental hygienists in the state of Virginia (VA).

Methods: A cross-sectional research design was used to determine the experiences of VA dental hygienists with sexual harassment in the workplace occurring over the previous twenty-four months. The revised Sexual Experiences Questionnaire (SEQ-W) measured three constructs: gender harassment, unwanted sexual attention, and sexual coercion and was administered electronically to a convenience sample of …

The Additive Effects Of Cell Phone Use And Dental Hygiene Practice On Finger Muscle Strength: A Pilot Study, Jessica R. Suedbeck, Cortney N. Armitano-Lago, Emily A. Ludwig

Dental Hygiene Faculty Publications

Purpose: The purpose of this study was to determine strength of muscles involved with instrumentation (scaling) by dental hygienists and the additive effects of cellular (mobile) phone usage, as indicated by measurements of muscular force generation.

Methods: A convenience sample of licensed dental hygienists currently in clinical practice (n=16) and an equal number of individuals not currently using devices/tools repetitively for work (n=16), agreed to participate in this pilot study. All participants completed a modified cell phone usage questionnaire to determine their use pattern and frequency. Upon completion of the questionnaire, participants' force production in six muscle groups was measured …

Postmortem Dental Records Identification By Dental Hygiene Students: A Pilot Study, Brenda T. Bradshaw, Ann M. Bruhn, Tara L. Newcomb, Hadiza Galadima

Dental Hygiene Faculty Publications

Purpose: Dental hygienists have the potential for filling critical roles in multidisciplinary victim identification teams. The purpose of this pilot study was to evaluate the accuracy of dental hygiene students utilizing dental charting, bitewings, and skull dentitions for the purpose of making identification matches.

Methods: Thirty senior dental hygiene students (n=30) independently viewed an asynchronous online multimedia-based presentation on the procedures used for collecting and recording forensic dental evidence. Following the presentation participants attempted to chart and match three bitewing radiograph sets to three human skull dentitions by correlating matches/exclusions. Immediately following the activity, each student completed a questionnaire rating …

Application Of The Unified Theory Of Acceptance And Use Of Technology Model To Predict Dental Students' Behavioral Intention To Use Teledentistry, Jafar H. Alabdullah, Bonnie L. Van Lunen, Denise M. Claiborne, Susan J. Daniel, Cherng-Jyh Yen, Tina S. Gustin

Dental Hygiene Faculty Publications

Abstract

Teledentistry is an innovative technology that can be used to improve access to care and oral health outcomes. Dental students’ intention to use teledentistry after completing dental school has not been investigated.

Purpose

The unified theory of acceptance and use of technology (UTAUT) was used to predict intentions to use teledentistry among 4th-year U.S. dental students. Methods A cross-sectional approach was performed for a 7-week period in Spring 2019. All U.S. dental schools (N = 66) were invited to participate and 16 schools agreed to participate. An anonymous survey link was emailed to academic deans for dissemination to students. …

In Vitro And In Vivio Evaluation Of A Moisture Treatment Cream Containing Three Critical Elements Of Natural Skin Moisturization, David H. Mcdaniel, Jeffrey S. Dover, Mitchell Wortzman, Diane B. Nelson

Biological Sciences Faculty Publications

Objectives

To evaluate skin barrier and hydration effects of a new rebalancing moisture treatment (TRMT) and to assess efficacy and tolerability in subjects with photodamaged skin.

Methods

In an epidermal skin model, tissues (n = 5/group) were topically treated with 25 µL of TRMT, 25 µL of a market‐leading moisturizer (MLM), or untreated for 60 minutes. Hydration was measured at 0, 15, and 30 minutes. Tissues were harvested for gene expression analysis of markers associated with skin barrier and hydration: Claudin (CLD), Aquaporin (AQP), Hyaluronic Acid Syntheses (HAS), and Hyaluronidase (HYAL). A clinical study evaluated twice‐daily application of TRMT, assessing …

Quantifying The Varying Predictive Value Of Physical Activity Measures Obtained From Wearable Accelerometers On All-Cause Mortality Over Short To Medium Time Horizons In Nhanes 2003-2006, Lucia Tabacu, Mark Ledbetter, Andrew Leroux, Ciprian Crainiceanu, Ekaterina Smirnova

Mathematics & Statistics Faculty Publications

Physical activity measures derived from wearable accelerometers have been shown to be highly predictive of all-cause mortality. Prediction models based on traditional risk factors and accelerometry-derived physical activity measures are developed for five time horizons. The data set contains 2978 study participants between 50 and 85 years old with an average of 13.08 years of follow-up in the NHANES 2003–2004 and 2005–2006. Univariate and multivariate logistic regression models were fit separately for five datasets for one- to five-year all-cause mortality as outcome (number of events 46, 94, 155, 218, and 297, respectively). In univariate models the total activity count (TAC) …

Leader Launch: A Needs Assessment And Intervention For Effective Leadership Development In Healthcare, Candice Freeman

STEMPS Faculty Publications

This case study examines how a rural healthcare system implemented LeaderLaunch, a leadership development program specifically supporting all front-line to director-level leaders employed within the organization’s facilities. John DeJoria, the healthcare system’s Director of Organizational Development, is a seasoned instructional designer and Certified Professional in Learning and Performance (CPLP) who was charged with the opportunity of determining the system’s leadership development needs and responding with aligned performance improvement interventions, intended to build competency and capacity in current, new, and emerging leadership. This case explains how John and his team designed, conducted, and utilized a three phase needs assessment to select …

Statistical Analysis Of Fnirs Data: Consideration Of Spatial Varying Coefficient Model Of Prefrontal Cortex Activity Changes During Speech Motor Learning In Apraxia Of Speech, Rachel Johnson, Jennifer Matthews, Norou Diawara, Rachel Carroll

Communication Disorders & Special Education Faculty Publications

Apraxia of speech is an impairment in the planning and programming of speech typically accompanied by aphasia (language impairment) secondary to a left hemisphere stroke. It is unknown if the structural and functional connections to the damaged area implicate the integrity of the cognitive functions of the prefrontal cortex (PFC). The present study examines the feasibility of measuring hemodynamic activity in the PFC in response to the structure of practice and during treatment. This multiple-baseline single case-design study involving two individuals with chronic acquired apraxia of speech measured the hemodynamic changes in PFC activity during treatment across the intervention period …

Qualitative Research In Pharmacy Education: An Exploration Of Pharmacy Education Researchers' Perceptions And Experiences Conducting Qualitative Research, Antonio A. Bush, Mauriell Amechi, Adam Persky

Educational Leadership & Workforce Development Faculty Publications

Objective. To investigate pharmacy education researchers’ experiences in conducting qualitative research and their perceptions of qualitative research in pharmacy education

Methods. A phenomenological approach was used to conduct one-time, in-depth interviews with 19 participants from 12 schools and colleges of pharmacy. Interview transcripts were coded and themes were identified using a modified form of the Sort and Sift, Think and Shift method of data analysis.

Results. Faculty members were the largest subgroup in the sample, followed by graduate students, postdoctoral fellows/scholars, and residents. Pharmacy education researchers had varying levels of training in conducting qualitative research and some had none at …

Hsp90 Inhibition And Modulation Of The Proteome: Therapeutical Implications For Idiopathic Pulmonary Fibrosis (Ipf), Ruben Manuel Luciano Colunga Biancatelli, Pavel Solopov, Betsy Gregory, John D. Catravas

Bioelectrics Publications

Idiopathic Pulmonary fibrosis (IPF) is a catastrophic disease with poor outcomes and limited pharmacological approaches. Heat shock protein 90 (HSP90) has been recently involved in the wound-healing pathological response that leads to collagen deposition in patients with IPF and its inhibition represents an exciting drug target against the development of pulmonary fibrosis. Under physiological conditions, HSP90 guarantees proteostasis through the refolding of damaged proteins and the degradation of irreversibly damaged ones. Additionally, its inhibition, by specific HSP90 inhibitors (e.g., 17 AAG, 17 DAG, and AUY-922) has proven beneficial in different preclinical models of human disease. HSP90 inhibition modulates a complex …

Performance Improvement In Healthcare: Integrating Gilbert's Behavior Engineering Model Within A Just Culture, Candice Freeman, Jill Erin Stefaniak

STEMPS Faculty Publications

Healthcare leadership and department management personnel are tasked with the responsibility of ensuring safe, high-quality patient care delivered by competent and proficient staff. This responsibility often comes in the form of identification of discrepant and erroneous practices that result in subsequent employee disciplinary action process improvement discussions and implementation. This case study presents an example of a sentinel event and how Gilbert's Behavior Engineering Model (BEM) was utilized in the context of a Just Culture to ensure both processes and personnel were adequately supported to meet expected task outcomes.