Abstract
This qualitative study examines the experiences of 16 Israeli high school homeroom teachers coping with the death of a student from their class. We used in-depth, semistructured, face-to-face interviews. Analysis of the findings revealed three key themes: (a) After their initial sense of shock and pain upon learning of the death of one of their students, the homeroom teachers were immediately asked to convey the bad news to their class. (b) The teachers experienced profound grief, had difficulty dealing with the student’s absence, and invested resources in preserving the student’s memory through various activities. (c) The teachers claimed that the experience affected their personal lives and stated that memories of it continued to surface long afterwards. Some found it difficult to function and even chose to leave the profession. The discussion raises the need for early assessment and planning in schools to address loss-related issues and provide support for teachers.
Introduction
Death is a natural part of the life cycle that people across the globe all must face (Case, Cheah, & Liu, 2017). Losing someone close is a painful, staggering, and difficult experience for any individual. Dealing with such a loss is a long and difficult process entailing distressing feelings of sadness, loneliness, anger, and guilt (Bușu & Luchici, 2016).
In the United States, the five leading causes of death among teenagers are accidents (unintentional injuries), homicide, suicide, cancer, and heart disease. Accidents account for nearly one half of all the teenage deaths (Blum & Qureshi, 2011). Between 2009 and 2015 in Israel, 1,056 children aged 5 to 14 and 2,551 young people aged 15 to 24 years died, with cancer and accidents among the leading causes of these deaths (Goldberger, Aborba, & Haklai, 2018).
The death of an adolescent affects classmates, school staff, and teachers who taught the student (Hart & Garza, 2013). The homeroom teacher plays a central role in her students’ adjustment and must provide the best possible response to their needs arising from the experience of loss. The homeroom teacher spends many hours with her students. Indeed, she is the adult who is closest to them, the one who has shared a variety of meaningful experiences with them. In light of this, the homeroom teacher can be the one who helps students make sense of traumatic events. Crisis situations, including those involving loss, often require an immediate response. Because the homeroom teacher plays a central role in the lives of her students, she is able to provide the needed immediate response (Dyregrov, Dyregrov, & Idsoe, 2013; Granot, 2014; Lytje, 2017).
Many studies discuss how children and adolescents cope with loss and bereavement, but empirical knowledge is lacking regarding how teachers deal with the death of a student at their school (Hagan, Ingram, & Wolchik, 2016; Lane, Rowland, & Beinart, 2014). The aim of this study is to enhance our understanding of how homeroom teachers cope when one of their students dies. The study examines the feelings elicited by the loss and how the teachers cope with these feelings. This study has the potential to increase our understanding of the needs of homeroom teachers who must deal with a loss of a student in order to best address their needs should such situations arise in the future. At the same time, the findings of the study will enable teachers to improve the support and assistance they provide to the rest of the class.
Theoretical Framework
Many approaches have been developed for understanding and researching the field of bereavement. One is based on Freud’s (1917) conceptualization, according to which bereavement is a means of breaking the relationship with the deceased and of mourning. Other approaches focus on the individual’s biological, behavioral, cognitive, and emotional responses to the traumatic state (Bowlby, 1980; Kubler-Ross, 1969; Lindemann, 1944). The two-track model of loss and bereavement (Rubin, 1981; Rubin, 1999) was developed to consolidate the theoretical, clinical, and empirical literature on response to loss overtime. According to this model, dealing with loss is similar to dealing with crises and trauma states in that it addresses the visible and latent layers of loss (Rubin, Witztum, & Malkinson, 2017). The mourning process helps bereaved mourners absorb the loss into their lives, while acceptance of the loss and readjusting to life allow individuals to regain a sense of control.
The model is based on two parallel tracks of adjustment to life without the deceased: The first track is concerned with how people function and how the emotional, interpersonal, cognitive, somatic, and psychiatric dimensions of their functioning are affected by the experience of loss. This entails mapping the symptoms that accompany the loss including anxiety, depression, somatic complaints, psychiatric symptoms, family and interpersonal relationships, self-image and self-esteem, meaning structure, response to work demands, and investment in life’s tasks. Altogether, this track reflects the individual’s ability to recreate an adaptive response in the various spheres of life.
The second track focuses on the relationship with the deceased from the object relationship perspective. This entails examining the individual’s images and memories of the deceased as well as the degree of emotional distance from the deceased, together with positive and negative feelings toward the deceased the degree to which the deceased was idolized, the conflicts with the deceased, along with the extent to which the individual deals with the loss. Together, all of these factors provide a picture of the changing and complex relationship with the deceased (Rubin, 1981; Rubin, 1999).
The tracks complement each other and provide a broader understanding of the experience of loss and bereavement. The tracks are connected, for example, in that the more difficulties in functioning experienced by the bereaved individual, the stronger the relationship with the deceased. On the other hand, each track has its own focus and character trajectory. While the first track is more prominent at the beginning of the grieving period, the second track, which focuses on the relationship with the deceased, remains the center of adjustment over the years (Rubin, 1981; Rubin, 1999; Rubin, Witztum, & Malkinson, 2017).
Coping With the Death of a Student Among Homeroom Teachers
A homeroom teacher’s job includes teaching and imparting knowledge, guiding students overtime, and maintaining an emotional connection with them. A homeroom teacher must monitor the students’ educational and social progress as well as maintain contact with their parents and their subject-area teachers. These responsibilities place the homeroom teacher as the central figure in maintaining students’ mental well-being (Granot, 2014). In the case of the death of a student, the homeroom teacher must deal both with her own personal grief and pain as well as with her obligation to help the class. Like their students, teachers may also feel guilt, fear, sadness, anger, and confusion upon being notified of the death of a student from their class (Balk, Zaengle, & Corr, 2011). A qualitative study examining the experiences of homeroom teachers in coping with the death of one of their students in a U.S. school where more than 10 students abruptly passed away for various reasons (accidents, murder, suicide, and illness) found that teachers coped mainly by expressing and releasing painful emotions. The teachers described their feelings of severe shock, confusion, and helplessness. Alongside their commitment to supporting their students in the grieving process, the teachers also sought to find peace in themselves. The study also revealed that the teachers were unable to deal with the incident directly and talked about it only indirectly. Most indicated the need for additional resources during the crisis such as counseling and psychologist support (Hart & Garza, 2013).
While teachers mourn their own lost relationship with the deceased student, they remain committed to helping the rest of their students process this traumatic experience (Case et al., 2017). A study that examined teachers’ perceptions of their role vis-à-vis students found that more than half thought that supporting these students was not their job but rather the job of counseling professionals (Dyregrov, Dyregrov, & Idsoe, 2013). Many participants stated that they refrained from discussing the topic in the classroom due to their lack of knowledge and confidence (Case et al., 2017). The administration’s expectations and their own expectations that they should provide assistance made them feel guilty that the students’ needs remain unanswered (Lowton & Higginson, 2003).
An extensive body of literature discusses the loss of a child and the effects of that loss on family members, especially parents and siblings (Davidson, 2018; Donovan, Wakefield, Russell, & Cohn, 2015; Endo, Yonemoto, & Yamada, 2015). Yet, empirical knowledge is lacking about how homeroom teachers perceive such a loss. Indeed, very few studies have focused on teachers’ perceptions of the topic of loss and bereavement in the classroom. The aim of this study is to examine how homeroom teachers cope after the death of a student in their classroom in order to help teachers improve their coping skills and provide a better response to the other students in times of crisis.
Methodology
Participants
The study used the qualitative–phenomenological approach that seeks to understand people’s behaviors and experiences through observations. The study included 16 Israeli homeroom teachers between the ages of 32 and 72 with 7 to 30 years of teaching experience. The participants all taught in high school (Grades 10–12) and all experienced the death of a student in their homeroom class. Their acquaintance with the deceased students ranged from only 3 days to approximately 3 years. The deceased students included 6 girls and 10 boys. The causes of their deaths varied. In total, seven died from cancer, four from road accidents, one from a natural disaster, one from cardiac arrest, two from medical complications, and one in a terrorist attack. Exclusion criteria were teachers whose students died as a result of suicide. The participating teachers included nine women and seven men. In addition, 12 of the participants were married with children, 2 were single and 2 were divorced.
Research Instruments
The qualitative data in this study were collected using semistructured, in-depth, face-to-face interviews. The interviews served as an instrument to help us learn about and examine the participants’ experiences. The interviews were conducted based on an interview guide that included significant key areas but was flexible enough to allow dialogue and meaningful self-expression to develop between the interviewer and interviewee (Brinkman & Kvale, 2015). Each interview lasted for an hour and was conducted in Hebrew. Data collection proceeded until theoretical saturation was reached (i.e., additional interviews yielded no new material for analysis).
The interviews were based on prewritten questions in the interview guide. Examples include: “How do you view your role as a homeroom teacher after the death of a student?”, “Who played a significant role for you during the grieving period?”, “What are the school’s procedures when a student passes away?” and “What do you think can help homeroom teachers deal with the loss of a student?”
Research Procedure
The Institutional Review Board of Oranim College of Education, Israel approved the study. The study was conducted on the basis of purposeful sampling, which aims to create a diverse sample reflecting different participants, thus providing a comprehensive picture of the topic being investigated (Patton, 2002).
The interviewees were recruited through advertisements posted on social network sites for Israeli teachers. After giving informed consent, the participants were interviewed in their homes. The interviews lasted approximately an hour; each interview was recorded and subsequently transcribed.
Data Analysis
The interviews were analyzed using content analysis to identify code central themes and patterns. In the first stage, all the interviews were read and analyzed line by line. Next, comparisons and contrasts were made to identify repeated themes across interviews. At this point, subcategories of meaning were collapsed to represent a conceptually meaningful summary of the findings. Then, the interview’s main themes were identified, along with subcategories. In the next stage, the researchers looked for related themes, and the subcategories were grouped into secondary categories. In the final stage, we identified the study’s central themes. The core themes or main categories that emerged from the data were reordered conceptually and placed back into context, enabling us to analyze and integrate large amounts of data and to generate abstractions and interpretations (Creswell & Poth, 2018).
Results
This study examines how homeroom teachers cope with the death of a student from their class during the school year. From the analysis of the interviews, three main themes emerged that embody the teachers’ struggle on different levels.
The first theme emerges from the following statement: “On a Saturday morning, someone knocked on my door.” After receiving the bitter news, the teachers had to pass it on to their students. They had to cope with receiving the news, the feelings associated with it, their initial reactions of grief and their transition from news recipient to news messenger.
The second theme focuses on how the teachers coped in the period following the loss: “I enter the classroom and her chair is empty.” This theme encompasses the ways in which the teachers dealt with the recent loss: returning to the classroom with the deceased student absent, attending the various ceremonies (funeral or shiva condolence call), commemorating the student and attempting to return to their normal schedule.
The third theme centers on the impact of the loss on the teachers’ personal lives: “I keep it together at work but fall apart at home.” Losing a student elicits feelings of guilt and grief among the teachers, especially if they failed to make a meaningful connection with the student prior to the death. Indeed, after a student dies, some teachers become so worried about the future that they leave the profession.
“On a Saturday Morning, Someone Knocked on My Door”: The Teachers Receive the Bitter News and Must Deliver It to Their Students
The homeroom teachers described receiving the news about their student’s death as a difficult and tense moment they believed would remain etched in their memory for their entire lives, thus enabling them to reconstruct it accurately. They told of receiving the bitter news under various circumstances: on their day off, during school vacation, on their way to a family event, and even at night after going to bed. Processing and internalizing such painful news take time. Regardless of how their student died, their initial reactions were of shock, panic, and attempting to deny the reality. The teachers had difficulty processing the news. In some cases, they even chose not to hear the news so as to keep the reality away as long as possible. They described the moment of receiving the news as chaotic. Even their reconstructions during the interviews were marked by considerable confusion. Their speech was sometimes disorganized, and the sequence of events was often intermittent. Upon receiving the news, they reacted with confusion, immense pain, helplessness, a feeling of loss, fear, a feeling that the sky had fallen, and sometimes even a sense of guilt. The very second they told me [that the student was killed] I said it couldn’t be, it didn’t happen, to move it away from me … I didn’t want to hear the details; I didn’t want to know exactly what happened and how it happened.
In all the interviews, the transition from news recipient to messenger appeared to be immediate, without enabling the teachers to process the terrible information they had just learned. Moreover, in order to assume the role of messenger, the teachers had to suppress their personal feelings and their desire to withdraw into their own pain. On the one hand, you have your tremendous sense of personal grief, the feeling that you’ve received a blow. On the other hand, you are a teacher, you have students you have to think about, and you don’t, I couldn’t. I just couldn’t, I couldn’t think about the students at that moment, I couldn’t. I remained inside my own head … I said to myself, ‘After this night, you must reset yourself, you must now pick yourself up because you have 35 other students waiting for you and needing your support.’ I don’t know what to do but I know I should be there for them.
“I Enter the Classroom and Her Chair Is Empty”: Coping in the Period Following the Loss
All the teachers described the emotional burden of coping on the day after the loss, when they were still in a state of emotional turmoil but also needed to support their students in the classroom. Some of the teachers felt they needed more time before confronting their students. Yet in most cases, they came to school immediately afterwards despite not knowing what to do or say. In most cases, the school offered some professional assistance.
The day after the loss, and sometimes even the same day, the teachers were instructed by the educational staff (principal, school counselor, and psychologist). Yet, some of the teachers felt these instructions were not helpful in dealing with the class or had not been adapted to them and their students. So, I come into the classroom without knowing how to get enough air to breathe … everyone is standing around and crying and screaming … total hysteria … and I have to manage all this now. What should I do?! I have no idea, I have no idea at the moment so I act according to my instincts … The counsellor is standing beside me and is even more lost than I am, and the person from the psychological service did not even bother to take a moment to go and see what’s going on in the classroom … What can you do, there are children who were there when it happened, there are children who witnessed it. After the parents’ and siblings’ eulogies … something like this is crazy, the funeral is very difficult … and I hear the mother cry and scream … And I begin reading my eulogy and shaking and my voice is shaky and unclear, everything is blurry. I don’t have any air. Every morning when I enter the classroom her chair remains empty, reminding me that she is not there and will never return … That was the hardest for me. When I call the roll, should I read her name or skip it?
The teachers indicated that both they and their students needed to find a way to commemorate the deceased students through ceremonies and memorial events. Most of the teachers stated they set up some sort of memorial in the classroom that remained throughout the year. Some schools instituted a tradition of commemorating the deceased student in the form of an annual race or soccer tournament held near the date the student passed away. The teachers attempted to memorialize the student through meaningful positive action related to the student’s life and work that would serve to bring closure to the remaining students.
“I Keep It Together at Work but Fall Apart at Home”: The Impact of the Loss on the Teachers’ Personal Lives
The teachers interviewed for the study indicated they continued dealing with the loss overtime. Indeed, for most of them, it even took a toll on their personal lives. The interviews revealed several of the teachers’ mechanisms for coping with the loss and the impact of the loss on their personal lives. All this was influenced by the nature of the relationship with the deceased student, previous losses in the teacher’s personal life and the support received at the time of the loss. Teachers who knew the student well were close to the student and had an emotional connection with the student before the death talked about the loss in terms of losing their own child. These teachers described major grief, difficulty in accepting reality, enormous pain, and difficulty in daily functioning that sometimes lasted for years. For the first two years, it was with me all the time, I couldn’t let go of it. Everything reminded me of it, everything made me think, I really couldn’t detach myself from it. It was truly like a mother mourning a child. It could be a sad song that elicited [the memories], everything brought it up.
Three of the teachers stated that following the death of their student, they decided to stop teaching because they no longer wanted the major responsibility of being a homeroom teacher and feared the loss of more students. Nevertheless, out of their commitment and love for the other students, they chose to continue their duties as homeroom teachers until the end of their original commitment. Remaining on the job took a toll on them. They described the conflict between work and home, their attempt to continue to function at school and their difficulties functioning at home with their own children.
The teachers stated that memories continue to resurface over the years. Everyone remembers the exact date the student passed away and many continue to attend to the memorial services. Others are reminded of their student at unexpected places or times, have flashbacks in which they see or hear the student, are unwilling to teach the class the student belonged to and sometimes refuse to teach the student’s brother or sister. When I get a new class list and I see her brother’s name, I say: How can you do this to me, how can you do this to him?!
Discussion and Conclusions
The aim of this study was to examine the experiences and coping mechanisms of high school homeroom teachers in dealing with the loss of a student from their class. The findings show that receiving the news of a student’s death is a difficult and shattering experience for the teachers who must immediately become the bearers of bad news even before they have a chance to deal with it themselves. The findings also show that the student’s absence affects the teachers on a daily basis and that they seek ways to preserve the student’s memory as part of the grieving process. Getting back into a routine helps the teachers cope and distracts them from the terrible pain. Finally, the student’s death also affects the personal lives of the teachers. Some want to change their profession, while others hold onto the painful memories for a long time.
The findings of this study indicate that the teachers reacted with shock, confusion, helplessness, fear, guilt, and sorrow to the news of their student’s death, even when the death was not sudden. The response to loss is different for every bereaved person and depends on different factors. Upon realizing that a loved one has died, people often respond with feelings of anxiety, anger, depression, helplessness, and guilt (Bușu & Luchici, 2016). These feelings are a response to the inability to protect oneself. They reflect the desire to feel in control of the situation, to protect loved ones who are still alive, and to recognize their weaknesses and vulnerability (S. S. Rubin et al., 2017). The confusing and upsetting moment of receiving the message is strongly etched in their memories, and they are able to repeat the events accurately even after a great deal of time has passed. Studies of family members who received the news of the death of a loved one show that the initial reactions are shock and pain (Aein & Delaram, 2014; Gilbey, 2010).
In the teachers’ view, the worst part of the death of a student was the need to become the bearer of bad news and tell their students about the death. While engulfed in grief over the deceased student and the loss of their relationship, the teachers remain committed to helping their students process this traumatic experience (Case et al., 2017). Despite their pain and their desire to focus on their own grief, they immediately had to mobilize their resources for their students, even when they did not know how to act. This finding is contrary to the study by Dyregrov et al. (2013), which found that more than half of teachers think it is not their job to take care of students who experience loss but rather the job of professionals. A large body of literature focuses on how medical and mental health professionals deliver bad news. Studer, Danuser, and Gomez (2017) reviewed physicians’ responses to delivering bad news and found high stress and anxiety levels before and after delivering the news. Being the bearer of bad news is a frightening responsibility that requires skill and knowledge, but usually those who do so have very little time to prepare (Monden, Gentry, & Cox, 2016).
This study found that the teachers found it difficult and painful to return to school and witness the student’s absence, as the obvious void made them feel confused and helpless about their role and how to deal with their class. Indeed, when a person’s daily routine is disrupted, problems with interpersonal relationships, concentration difficulties, physical problems, and more may arise (Rubin, 1999). Doka (1989) defined the concept of disenfranchised grief as the grief of a person whose loss is unrecognized and who cannot grieve publicly or gain social support while grieving. In this study, this type of grief occurs in the absence of recognition that a relationship existed between the bereaved teacher and the deceased because the student was not a family member. Teachers’ grief is often hidden and disenfranchised because neither they nor others recognize the nature of their relationship with the deceased (Doka, 1989). Thus, their grief response may be perceived as inappropriate and their difficulties in adaptation may become greater.
This study indicates that teachers have a need to attend ceremonies and commemorative events. Through these rituals and commemorations, the deceased seems to continue to exist in the inner world of the teachers who were so close to the student (Rubin et al., 2017).
The basic social stance toward death entails a lack of preparation and an unwillingness to deal with death as a part of the life cycle. The individual seeks to avoid the grief and sorrow associated with the loss despite being aware of the universality of death. Therefore, many bereaved people may feel shame and guilt about their feelings, as society urges them to recover and move on. Thus, rituals and mourning practices play an important role in legitimizing mourners’ need to mourn and express their feelings. In Rubin’s two-track model (Rubin, 1981; Rubin, 1999), the second track also examines the bereaved individual’s emotional and cognitive involvement with the deceased, along with the willingness to change that relationship. The track includes, among other things, a longing for the deceased, a desire to renew the connection as well as memories of the person. Attending memorial ceremonies and commemorations seems to enable teachers to renew this connection, to express their longing, and to be flooded by the memories associated with the deceased student.
Some of the teachers stated that the death of their student was like the death of their own child in terms of the intensity of the experience. Studies examining therapists’ responses to the death of a patient found that the therapist’s personal–emotional response is similar to his or her reactions to a loss of a significant others such as a friend or family member (Strom-Gottfried & Mowbray, 2006).
Most of the empirical research conducted on the two-track bereavement model has focused on parents’ reactions to the loss of their children. S. S. Rubin et al. (2017) found that the deceased child is never forgotten. The parents forever define themselves as bereaved and continue deal with the loss of their children. Parents who lost adolescent children exhibited feelings of shock and guilt about their failure to raise their child to adulthood (Rubin, 1981; Rubin, 1999). While a teacher’s relationships with her students are not parental relationships, they do include the aspects of protection and emotional availability. This study indicates that long-term investment and emotional involvement in a deceased student is often also at the expense of additional connections, somewhat resembling what happens in the case of a close connection between family members.
The participants in this study described being significantly affected by the loss and by the need to provide assistance to their students in its aftermath. Compassion fatigue is a mental state in which feelings of compassion and sorrow for others as well as attempts to alleviate their pain may impair one’s ability to empathize with others and to endure suffering (Figley, 1995). It reflects a situation in which care providers in various fields are cumulatively exposed to the suffering, distress, and trauma of their patients. Figley (1995) contends that caring has a “price” and that professionals who listen to stories of fear, pain, and suffering may experience similar feelings because they care. A few studies examining compassion among educators in Israel (Levkovich & Ricon, 2018, 2019) found that 24% of educators reported secondary traumatization. Symptoms of secondary trauma encompass three key areas: recurrently experiencing the traumatic event, avoidance of the memories of the event, and constant arousal (Figley, 1995).
In this study, the evidence of avoidance was found mainly among some teachers who were having difficulty returning to the classroom after the loss of their students or who decided to leave the teaching profession after the incident. Some of the teachers described feeling irritated and dysfunctional, mainly at home. The participants’ reports are supported by research examining teachers’ perceptions of the support they give their students after traumatic incidents. The current findings also painted a picture of teachers who had difficulty separating the troubling events from their personal lives and also found it difficult to balance between the response they needed to give to their students and their ability to protect themselves (Alisic, 2012). Some of the teachers in this study expressed fears of losing another student in the future or of losing a loved one, recalled memories of their favorite student or remembered the course of the tragic events. In this study, no assessments were made to examine secondary traumatic symptoms. The teachers’ responses may be normative or some of them may need further support.
Teachers experienced the loss of a student as difficult and upsetting. They are obligated to assist the other students while at the same time they must personally deal with a variety of problematic emotions. Their work with the other students is necessary for the school to function optimally, even though many times they feel pain and fatigue in doing this job. Sometimes the intensity of this pain is so great they decide to leave the teaching profession. Studies on teachers leaving the profession indicate that a large amount of stress including emotional overload, anxiety, and job demands affects this decision (Howes & Goodman-Delahunty, 2015; Skaalvik & Skaalvik, 2018). A study in Denmark among approximately 1,000 teachers who provided support to mourning students found that teachers experience stress from this type of work. Moreover, they tend to generalize the students’ grief rather than providing a dedicated response to each student depending on the type of loss (parent or sibling). The study also found that as time goes by, neither students nor teachers receive support from the school system or its care providers (Lytje, 2017). A study conducted in the United Kingdom emphasized that the responses of teachers and schools to losses were usually ad hoc, inconsistent and without teacher guidance and regulated support (Holland & McLennan, 2015). The researchers concluded that the school did not always understand the long-term consequences of loss for the students and the educational staff.
Study Limitations
This study was conducted using the phenomenological qualitative method, which allows for deeper understanding of the interviewees’ experiences. Yet, the qualitative research used only a small sample of participants from Israel, and hence its results cannot be generalized to wider population groups. In addition, all the homeroom teachers taught in high school, but the students’ causes of death varied. No participants had students who died by committing suicide. Future research should strive for homogeneity in the causes of death.
Practical Implications
The findings of the study support the need to discuss the issues of death and bereavement at school as a means of prevention even before students or teachers encounter such issues to enable them to prepare in advance to deal with the grieving process if and when needed. In addition, care providers, including psychologists and school counselors, also require thorough preparation and familiarity with the subject as they are expected to support teachers in times of crisis.
The findings of this study reinforce the need to build and implement school intervention programs in cases of student loss and to provide support to teachers overtime and not just right after the incident. Teachers need ongoing guidance and counseling regarding the ways they should act. In addition, they require a source of assistance in dealing with their feelings, pain, and difficulties in managing the classroom after such a significant loss in their own life and the lives of their students.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by The MOFET Institute (IL).
