University of Cincinnati
Education and Research Center (ERC)
Please visit periodically to read about
Interdisciplinary student learning opportunities, and
Interdisciplinary team accomplishments in developing solutions to improve health and safety through research, research to practice (r2p) and prevention through design (PtD).
Upcoming Interdisciplinary trip:
is being scheduled - stay tuned
OTHER UPCOMING EVENTS AT: http://eh.uc.edu/ERC/Upcoming_events.asp
The biannual ERC Orientation included a special seminar by Dr. Debra Novak, RN, PhD, Senior Service Fellow from National Personal Protective Technology Laboratory (NPPTL), NIOSH, CDC. She gave an overview of the Healthcare Respiratory Protection Surveillance and Intervention Research in the NPPTL. Slides are available here.
Reported by Swarup Alex Zachariah
A group of 8 people that included students and faculty from the Occupational and Environmental Hygiene, Occupational Health Nursing and Engineering core programs travelled to the Wright-Patterson Air Force Base on 05/15/2014. The purpose of the trip was to obtain a brief overview on the various researches and its impact on the researchers and the workforce.
The day started with a brief overview of the day’s agenda by Dr. Christianson. The trip was about an hour’s ride from the university campus. Although, some of the faculty and students already knew each other, the ride to the air force base provided some rare insights into each person’s life and experiences. We were received at the base by our escorts who immediately put us at ease with some light hearted humor.
Following the exchange of a few pleasantries, the students and the faculty were escorted to the facility. The initial part of the tour focused on how the facility is able to recreate certain situations from actual flight under a highly controlled mechanized setup, for example burning of fuel. Interactions of different systems such as fuel line, pressure systems, and visualization techniques were all showcased along with a brief explanation of the same. A little further came the best part of the day, where we were taken to a fancy looking lab with a number of mirrors and a sequentially arranged set of rectangular metal boxes. The set up reminded one of the childhood days when one would play with mirrors and try to reflect light into other people’s faces in order to annoy them. The only difference being that here the equipment cost ran into millions and it was serious research that was being conducted here. Focused lasers can rake up localized temperatures to a few hundred degrees in a fraction of time, part of which was amusingly showcased with the example of a half burnt wall calendar. The interactions focused on the difficulties of setting up the equipment, knowing what is to be done, the need for such costly equipment and instruments, and how the experiments translate to knowledge and learnings.
Coming from different backgrounds, the questions the group posed were varied as well. Some were interested in the ergonomics, while others were interested in the engineering aspect of the research. Shuttling between the labs and braving the unusually cold and windy weather, the group marched on learning small things and enriching our knowledge along the way. The tour ended with a small tour of the aircraft hangar where we were left amazed at the enormity of the structure. Occasionally, one could see a few planes in the sky that looked like tiny dots, which was in stark comparison with the actual resting and rework place of these gigantic marvels of mankind. The air cleaning systems and the personal protective equipment the workers wear while repairing the planes were shown at this time.
Although, the trip lasted only half a day, the practical experience we were able to witness combined with the liberal transfer of the technical know-how of our generous hosts at the air force base made for a trip that will always be worth remembering.
Students presented their TRT and Workshop projects in the annual ERC Students Research Findings Symposium on April 15, 2014.
Swarup Zachariah: Predicting core body temperature, sweat rate, cardiac output and stroke volume using a 3D whole body model for firefighters (left)
James Dietrich: Assessing the Protection Factor of Firefighters’ Respirators against Combustion Ultrafine Particles (right)
Ali Aljaroudi: The Effect of Active Pre-Cooling on Firefighters During Live Burn Training Activities (left)
Kelley James: Impact of Heat Exposure on Postural Balance of Firefighters (right)
Janie Allen-Blue, Jennifer Leslie, Latrice Moss, Shelly Kuyat : A Collaborative, Cross-Functional Study to Determine Biological Hazards among Emergency Department Personnel (left)
Sarah Gamble, Yousef Elmashae, Shuang Gao: Title: Qualitative Assessment of Workplace Health and Safety in Low Wage Restaurant Workers (right)
Scott Everson, Ali Aljaroudi, Shannon Douglas, Jean Schechtman, James Dietrich: Hearing Conservation Knowledge and Training for Firefighters
Reported by: Yousef Elmashae and Shuang Gao
On February 28, the annual Topical Workshop was held at the Procter Hall (UC College of Nursing). This year, the topic was Respiratory Protection in Health-Care Environments.This event provided an opportunity for graduate students, healthcare professionals and personnel involved in the development, testing and implementing respiratory protection strategies to observe presentations and discuss the status of respiratory protection in healthcare environments.
Keynote Lecture by Dr. Roy McKay
Dr. Roy McKay, PhD, Associate Professor of Environmental Health, University of Cincinnati, Cincinnati, OH; Chair ANSI Z88.10 Fit Testing Methods
Dr. McKay started the workshop as the Keynote Speaker presenting an interesting topic named “Fundamentals of Respiratory Protection, Importance of Respirator Fit and Non-Wear Time”.
Dr. McKay began his presentation by emphasizing the necessity of the fit testing, due to a wide variety of facial shapes and size. Then, he talked about the purpose of the fit testing and explained the qualitative fit test and quantitative fit test, respectively. Dr. McKay explained an important point, which is “Fit Test” does not measure respirator Fit. Instead, it measures the leakage. He also talked about the respirator training and donning issues such a disconnect between respirator training, knowledge, and performance. He also showed some common mistakes of wearing respirator in workplace and common errors that may cause a poorly fitting respirator to falsely “Pass”. Other main issues he discussed in his presentation included factors affecting respirator protection, assigned protection factor, effective protection factor, reasons to remove respirator, and the effect of increasing wear-time of respirator.
Keynote Lecture by Dr. Bonnie Rogers
Bonnie Rogers, DrPH , COHN-S, LNCC, FAAN, Associate Professor of Nursing and Public Health, Director, NC OSHERC and OHN Program, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Dr. Rogers gave a talk on “Respiratory Protection for Health Care workers”. Their group conducted a research that evaluated respirator usage for respiratory infection among health care workers in a sample of North Carolina acute care hospitals. Her presentation was divided into four parts including assessment of written respirator protection program policies, survey to assess knowledge and beliefs about respiratory protection among direct health care workers and managers, use of respiratory protection among health care workers, and observations of respirator use. At the end of the presentation, she gave some recommendations to the health care workers, such as keep optimizing the respiratory protection policy, conduct evaluation frequently, and consider the respiratory protection of visitors as well as patients.
Keynote Lecture by Dr. Richard H. Koehler
Richard H. Koehler, MD, FACS, Staff Surgeon, Martha’s Vineyard Hospital, Oak Bluffs, MA & Nantucket Hospital, Nantucket, MA ; CAS, Massachusetts General Hospital, Boston, MA; CEO, Critical Fit Technologies, LLC, Tisbury, MA
Dr. Richard Koehler gave a talk on “Surgical Smoke in Operating Rooms: Considerations for Respiratory Protection”. He started his talk by presenting a picture of surgeon doctors who had very different size faces but wore the same size mask. Other surgeon doctors were wearing single elastic strap or nonfunctional lower strap. Dr. Koehler showed statistics data about the cost of surgical masks. Most hospitals pay roughly 6-11 cents per mask and a small community hospital spends about $10,000 yearly on surgical masks.
Dr. Koehler emphasized that the N95 mask provides a better seal than the surgical mask, but still does not completely contain the cough effluent. He also talked about the toxins in surgical smoke, e.g., surgical smoke has been shown to contain known carcinogens and viable biological particles. OSHA estimates that 500,000 health care workers are exposed to laser or electrosurgical smoke each year. Dr. Koehler showed many studies to support his point view about the topic. He discussed the need to develop a better face seal to accommodate the complex variables in human facial anatomy.
The presentation showed the importance of developing the surgical mask to protect health care workers from many airborne hazards.
After the presentation of three keynote speakers, the audiences were divided into three groups for in-depth discussion with the keynote speakers. At the end of the workshop, there was a discussion panel, which was moderated by Dr. Grinshpun and included three additional members: Debra A. Novak and Kevin X. He from the National Personal Protective Technology Laboratory (NPPTL) , the National Institute for Occupational Safety and Health (NIOSH) and Pam Hunter from Cincinnati Children's Hospital Medical Center (CCHMC). In this panel discussion, members talked about the recent NIOSH research on respiratory protection, workers’ response for wearing the N95 respirators, and some other related subjects.
The 10th Annual Pilot Research Project Training Program (PRP) Research Capacity Building Workshop was held on March 17-18. Nineteen PhD students and faculty members attended. Nine of these were from UC and ten were from other institutions in the PRP consortium – Bowling Green State University, Central State University, Ohio University, Western Kentucky University, and Air Force Institute of Technology. On the first day of the workshop, Lisa Kurek from BBC Entrepreneurial Training & Consulting in Ann Arbor, Michigan, served as a presenter on the “nuts and bolts” of grant writing for researchers, including topics such as an overview of NIH/CDC/NIOSH, the peer review process, hypothesis driven research, proposal development, and understanding the electronic submission process. The second day of the workshop included interactive presentations by University of Cincinnati researchers. Dr. Amit Bhattacharya, PRP Program Director, discussed faculty development, grant review, and the NIH Roadmap Initiatives. Ms. Claudia Norman, Senior Regulatory Compliance Specialist at the UC Internal Review Board (IRB), gave an overview of the ethical treatment of human subjects and the IRB approval process for human subject research. Dr. Erin Haynes discussed helpful techniques for writing research proposals. Dr. Ian Papautsky and Dr. Haynes explained the development of their collaborative research on point-of-care sensors starting from their first PRP grant to their current R01 grant. Dr. Eric Kettleson completed the presentations by discussing pilot grants and career path development for early-stage investigators. The workshop concluded with a Q & A session with Drs. Tiina Reponen, Bhattacharya, and Kettleson. The workshop participants were very appreciative of the opportunity to attend and gain knowledge on grant writing and career development.
Dr. Haynes gave helpful hints for grant writing.
Reported by: Latrice Moss, RN, BSN, Ashu Mani, Jean Schechtman, RN, BSN, Jennifer Leslie, RN, BSN, and Janie Allen-Blue, RN, BS
Students from the Occupational Health Nursing program and the Occupational Hygiene program and two professors participated in this tour to several interesting destinations in Indiana.
We had the privilege of visiting the state of the art Birck Nanotechnology Center, a research facility in Discovery Park at Purdue University. The tour was led by John Weaver, PhD, the Facility Manager, who is responsible for day to day operations but was also involved in the initial vision and design of the facility. The Birck Nanotechnology Center was designed with an interdisciplinary focus, dedicated to collaborative work among many disciplines. In our tour we were able to see this depicted in a chart showing how cross collaboration began between disciplines with just a few professionals and how it has expanded and resulted in significant research and published works. Some of these disciplines include chemistry, electrical engineering, biology, mechanical engineering and physics. In our tour we learned of the unique designs possessed by this facility that sets it apart from other like facilities. Some of these features include the largest and cleanest university cleanroom in the country. The cleanliness is measured by the amount of particles greater than a half micron in diameter per cubic foot of air. At Birck Nanotechnology Center, this measurement is 1 or less particles per cubic foot of air. This is partly achieved by precisely filtered air that is exchanged 9 ½ times a minute. The cleanroom also uses ultrapure water, free of all contaminants and minerals, making it the purest water in the world. Other features we learned of on our visit include laboratories with specific engineering to dampen vibration, control the temperature down to 0.1 degrees Celsius and to eliminate any electromagnetic interference. These features are essential when working on a nanoscale to eliminate any outside interference with conducted research. Some types of research being conducted at the Birck Nanotechnology Center include energy conversion and heat transfer, nanophotonics and optics, bionanotechnology and nanomedicine, and nanoelectronics and semiconductor devices.
ADM Agricultural Innovation Center, Purdue University
The next destination was the Research Machining Services at the Archer Daniels Midland (ADM) Agricultural Innovation Center in the Department of Agricultural and Biological Engineering. Our group met with Carol Weaver, the contact person at the ADM Agricultural Innovation Center, Purdue University.
The visiting students got a chance to see the Machining Laboratories, the central meeting/discussion room and the Farm Machinery parking garage. Dr. Weaver informed the students from UC about the numerous agricultural competitions hosted at the Purdue University. These competitions, some sponsored by industries, are held in the fields of agronomy, farm machinery, and horticulture. The ADM Agricultural Innovation Center organizes workshops for local farmers and works with them hand-in-hand to develop planting and harvesting schedules. The students were also told about the mobile air-quality monitoring lab (one of 50 such labs set up by NASA) which is not currently used; however, may be available for collaborative research should funds become available! One of the coolest equipment
While the students from UC were intrigued by a few cool equipment and a couple of undergraduate students slaving away in the machinery laboratory during spring break, the most interesting feature of the facility was the close collaboration between research, industry and the local farmers! The facility was a great example of how good science with the backing of industries can prove to be highly beneficial for the ultimate stakeholders of all the good research we do: the people!
Meadow Lake Wind Farm
Next morning we visited the Meadow Lake Wind Farm. Meadow Lake is part of EDP Renewable Energy North America LLC. EDP has been building wind farms since 1996 and has been publicly listed since 2008. EDP North America is part of a larger EDP that is based in Europe, and 63.8% of the employees are located in Europe.
The process of developing a wind farm begins with locating an area with wind, but also with the power lines to carry the energy that will be generated. White County in Indiana had such an environment, so EDP partnered with the farmers who owned the property as well as the municipalities in the area to plan a farm. The area is assessed for an extended period of time to insure that the turbines will be positioned for the greatest results. These turbines consist of three parts, the tower, the blades and the nacelle. The blades each span 120 feet and had to be carried in on flatbed trucks, and the roads needed to be modified during that time. The farm was built in 4 phases (with a 5th uncompleted at this time). Each of the phases is managed by a different company. There are 303 turbines with a capacity of 500 megawatts, which can power over 150,000 average homes.
The tour bus drove the students to one of the turbines to observe the massive blades in motion. There is a slight hum close to the turbine, but not much other noise. The fields around the turbine are plowed, and continue to be used by the farmers.
Bio Town Ag
Their Vision: Mankind has the potential to improve the way in which we produce food, fuel, and fiber.
Their Mission: To explore new frontiers in agricultural sustainability where we creatively deploy technologies to eliminate the environmental impacts of past agricultural production processes.
Bio Town Ag is a multigenerational family agribusiness with a 21st century approach to farming. Located just north of Reynolds, Indiana in White County, Bio Town Ag’s Energy Center operates a proprietary, 100% sustainable closed-loop model that completely returns to the earth everything taken from it with nothing going to waste.
The farm is anchored by a 4500-head natural beef cattle feed operation and an 800-sow pork production facility. A several-acre row-crop production component yields corn, soybeans and small grain that feed the farm’s livestock. The farm receives organic waste by-products from Midwest companies. The corporate by-product material is merged with manure from the livestock facilities to fuel a 7.2 million gallon anaerobic digester. Methane from the digester powers 5 generators that put electricity on the grid, while other equipment separates the liquids and solids to produce fertilizer for the row crops.
The idea of farming as a strictly agricultural enterprise has been revolutionized, changing the output waste to usable energy and by-products. Our tour guide and third generation family member explained that his father had the idea to build and operate an anaerobic digester capable of capturing the methane gas given off by decomposing manure, converting it to electricity, and using the by-products as fertilizer and fiber-based products.
The farm is successfully obtaining its goal. At peak output, the methane gas generators supply 3 megawatts of electricity per hour. This is enough green electricity to power 1800 homes.
More information can be found on their website: www.biotownag.com
The last stop was the Tippecanoe Laboratories of Evonik Corporation located in Lafayette, Indiana. The pharmaceutical laboratories were developed by Eli Lilly Company in 1953 and acquired by Evonik at the beginning of 2010. It is the company's second-largest site in the US. The acquisition of Tippecanoe represents an important milestone in the strategy of the Health Care Business Line.
The site totals 9.5 square kilometers or approximately 2,350 acres which include factories, farmland and a wildlife habitat. Products are active ingredients and intermediates for cancer drugs and veterinary drugs. High-potency active pharmaceutical ingredients (HPAPIs) are a growing area for pharmaceutical manufacturers and contract manufacturing organizations (CMOs). To manufacture these ingredients it takes specialized considerations in facility design, equipment, operation, and safety processes to achieve the desired level of containment of the drug substance or finished-drug product.
For drug-substance manufacturing, the HPAPI may be a small-molecule, biologic, or a hybrid of the two such as an antibody–drug conjugate, which links a cytotoxic small-molecule to a monoclonal antibody. Due to the high level of potent ingredients, safety for the protection of workers, the environment as well as the product is an essential element of the operation. Evonik uses containment systems which have multiple layers of containment technology including glove bags, contained transfer systems, clean surfaces, isolated waste and vent systems and PPE specified by industrial hygiene professionals.
The Evonik representative who led the students on tour is an industrial hygienist and the manager of the health and nutrition areas. The corporation also employs an occupational health nurse who is responsible for program development and support for OH compliance, health & wellness, worker’s compensation case management, administering and interpreting health surveillance testing and training support.
While I found everything quite interesting and was amazed at the technology involved in the production of these active pharmaceutical ingredients, I felt a high sense of urgency in terms of safety; however, contamination incidents were rare. Contamination could cause cancer, reproductive abnormalities and chromosomal changes to name a few. The safe management of chemical contamination, cross contamination, asepsis is the foundation for the success of this organization.
Additional information can be obtained from: Evonik.com and
www.osha.gov/dts/osta/otm/otm_toc.html), in particular Section VI, Chapter 2.
On Friday, February 21st, 2014, students from the Education and Research Center (ERC) visited three locations NIOSH (Columbia Parkway), River Metals Recycling, and Cincinnati Fire Museaum
Submitted by Sarah Gamble, RN, BSN and Janie Allen-Blue, RN, BS
The interdisciplinary group included students from the Occupational Health Nursing and Industrial Hygiene programs. The NIOSH location on the east side of Cincinnati is called the Division of Applied Research and Technology (DART). We learned about current research endeavors. Thomas Connor, PhD, and Barbara A. Mackenzie presented “Preventing Occupational Exposure to Hazardous Drugs in Healthcare Settings.” They focused on hazardous drugs, specifically anti-neoplastic drugs (cancer fighting drugs), and exposures in the healthcare setting.
Claire Caruso, PhD, a research scientist, focuses on the hazards in the workplace that are linked to inadequate sleep. Dr. Caruso’s research included nurses whose jobs include shift rotations, night work, and extended shifts. We also received information about the Total Worker Health program (TWH) integrating occupational safety and health protection with health promotion to prevent worker injury and illness and the advancement of health and well-being (Caruso, Robison, Charles, 2013). Workplace violence and bullying has really come to the forefront. Bullying in the workplace has been around for a long time, but we are now compelled to do something about it since realizing that bullying has stressful and psychological implications. I believe that employers have a responsibility to protect all employees from bullying and that employees should have the ability to submit a complaint without repercussions. In terms of violence in the workplace, well I believe every employer should have a NO TOLERANCE policy.
Tracy Galinsky, PhD, and Captain, U.S Public Health Service, discussed safe patient handling, associated risk factors, and preventative interventions. According to Dr. Galinsky, providing education to healthcare workers about safe patient handling is crucial to prevent work related strains and sprains. It was interesting to learn about lifting hazards for pregnant women in the workplace. While one might understand that lifting is hazardous, having an understanding of the hazards of prolonged standing, bending at the waist and squatting is important. If organizations such as the American College of Obstetricians and Gynecologists (ACOG) and the American College of Occupational and Environmental Medication (ACOEM) do not have guidance on lifting then it’s no wonder that employers and employees are uneducated in regard to the hazards for pregnant women.
Dr. Jerry Smith and Debbie Sammons provided a demonstration of their work with Rapid Methamphetamine Detection equipment. This technology is in use by law enforcement and other agencies to provide these groups the ability to rapidly detect Methamphetamines. This equipment helps to identify possible methamphetamine labs and highly toxic and flammable cooking sites. The detection equipment will help to keep workers safe.
In many industrial settings, hearing protection is vital to ensuring employees have a safe work environment. I enjoyed observing the hearing protection device labs at NIOSH. It’s amazing to see today’s technology in hearing protection. Hearing is such a sensitive sense and many of us don’t realize the things we do that jeopardize our hearing.
River Metals Recycling
Submitted by: Ryan Peck
Our second stop along the trip was at River Metals Recycling, in Newport, Kentucky. We were introduced to the facility by safety manager Brent Charlton and vice president of operations Steve Winters. The Newport facility employs nearly 40 workers, with around 25 workers on-site at any given time during operating hours. Normally the facility is in operation for 5 ½ days per week, (Monday-Friday and Saturday mornings) but can increase hours as needed during peak times. This location purchases and sells both ferrous (metal that sticks to a magnet; ex. vehicles, iron, steel) and non-ferrous (ex. aluminum, copper, brass) scrap. During normal operation, the plant is able to shred roughly 120 tons (240,000 lbs.) of material per hour. Most of the processed material is transported to purchasing clients on barges that travel along the adjacent Licking River as well as the nearby Ohio River. These barges carry an average load of around 1,300 tons (2,600,000 lbs.). River Metals goes above and beyond many similar companies by providing its clients with metallurgy reports of all recycled materials shipped out, saving the clients from performing the metallurgy testing.
The work environment at River Metals Recycling is very safety-conscious. At the time of our visit, the plant had an impressive 186 days without injury. As a result of their safety efforts, this facility was given the SHARP (Safety and Health Achievement Recognition Program) distinction by OSHA. This status is only given to companies who have shown to operate an exceptional injury and illness prevention program. River Metals is the only recycling plant in all of Kentucky with this recognition. Through the tour we were able to see the whole operation of the facility from where the materials are initially dropped off by the public to where the final recycled materials are shipped out. For a recycling plant with so many moving parts and changing environments, it operates with great precision and efficiency. It was certainly an eye opening experience to see how a well-run, safety conscious facility like this operates.
Fire Museum of Greater Cincinnati
Submitted by: Jean Schechtman, RN, BSN, COHN-S
The last stop was the Fire Museum of Greater Cincinnati. Cincinnati has played a large part in the history of firefighting. The first firefighters were citizens trying to stop the destruction of property. They designed wooden buckets that could be passed from person to person filled with water, then threw the water on the fire. Although many people assisted in putting out the fire, not much of the water reached the fire. Pumpers were designed and used in Cincinnati, by 1853 the first successful steam fire engine was invented. On April 1, 1853, Cincinnati established the first professional and fully paid fire department in the U.S. Cincinnati continued to contribute to the development of firefighting equipment, in 1913 the Ahrens-Fox fire engines were some of the most famous fire engines in the world. The museum has many examples of fire trucks, engines and pumpers. One of the pumpers was donated by the Aurora, Indiana fire department. I work with a current member of the Aurora Fire Department and I was interested in seeing this pumper. I took a photograph of the pumper to share with my co-worker. We ended the day by climbing into a fire truck with open sides. We had a group picture taken as we pretended we were firefighters in control of a fire.
System Safety Engineering & Hazard Analysis: An Introduction by Steve Mattern
Reported by Matthew Coombs, Mechanical Engineering, Occupational Safety and Health
Steve Mattern gave an interesting introduction to system safety engineering and hazard analysis, from the perspective of someone with decades of real life experience, going beyond industry regulations.
Mr Mattern’s presentation began with noting the vast array of definitions of risk, which vary by field. In order to clarify the process of system safety, Mr Mattern recommended using a consolidated set of safety-related vocabulary to define failure pathways. The motives of a system safety engineer to practice system safety Mr Mattern argued is a matter of perspective, targeted on the end goal of minimizing risk to the operator. Placing yourself in the nearest proximity to risk prioritizes system failures.
Explaining his system safety approach, Mr Mattern illustrated with two models. First, the historical model, of “fly-fix-fly” where airplanes were flown until failure, resulting in fleet redesign and retrofitting, until failure occurred again with the process repeating itself. Today’s system safety model is centered around the idea of “first time safe (but not necessarily risk free)” which is defined by identifying the mishap/hazard, determining system-level effects, categorizing hazards, performing in-depth causal analysis, mitigating or controlling hazards to acceptable levels of risk, monitoring the design to ensure implementation of safety requirements, verifying the adequacy of safety requirement implementation, and lastly performing residual risk assessments. Even still however, Mr Mattern noted that acceptable risk is still a subjective decision comparing the acceptability of a mishap to credible alternatives and potential benefits.
In summary, a system safety activity is planned, not an ad hoc activity. The system safety process must be defined with specific tasks, and its implementation produces engineering artifacts to prove you understand the safety risk of the system, and have mitigated that risk to a defined level of acceptance.
Left Photo: Audience consisted for students and faculty from all ERC Programs.
Right Photo: Discussions after the seminar; from the left: Dr. Tom Huston, Mr. Steve Mattern, Mr Matthew Coombs (OSHE PhD student) and Dr. Jay Kim).