Medicine and Health Sciences Commons^™

Ketamine For Pain In Sickle Cell Disease Reduces Opioid Usage, Christina O Onyebuchi, Corrie E Chumpitazi, Jennifer L Placencia, Andrea N Jackson, Jennifer L Jones, Laura Torres, Venée N Tubman

Faculty, Staff and Students Publications

CONTEXT: Pain attributable to sickle cell disease (SCD) is often unpredictable, recurrent, and requires complex treatments. Subanesthetic ketamine infusion has been studied in other diseases and disorders, but there is still limited data on its efficacy in pain management for SCD.

OBJECTIVES: The primary objective is to determine if subanesthetic ketamine infusion reduces pain scores and opioid requirements in hospitalized pediatric patients with SCD.

RESULTS: Forty-six admissions among 22 patients between February 2018 and December 2019 were analyzed. We observed decrease in pain scores within 24 hours of ketamine initiation in 34 of 46 admissions (mean pain score per patient …

Risk Of Alzheimer's Disease And Related Dementias In Persons With Glaucoma: A National Cohort Study, Casey Crump, Jan Sundquist, Weiva Sieh, Kristina Sundquist

Faculty, Staff and Student Publications

PURPOSE: Glaucoma is a heterogeneous group of optic neuropathies that potentially may be associated with other cerebral neurodegenerative processes leading to dementia. However, prior studies have been inconsistent. We examined dementia risks after glaucoma diagnosis in a large population-based cohort.

DESIGN: National matched cohort study.

PARTICIPANTS: A total of 324 730 persons diagnosed with glaucoma during 1995-2017 in Sweden and 3 247 300 age- and sex-matched population-based controls without prior dementia.

METHODS: Cox regression was used to compute hazard ratios (HRs) for Alzheimer's disease (AD), vascular dementia (VaD), and all-cause dementia in persons with glaucoma compared with controls, adjusting for …

Development And Feasibility Pilot Study Of Indigenous Recovery Planning: A Community-Engaged Approach To Addressing Substance Use In A Native Community, Monica C Skewes, Vivian M Gonzalez, Julie A Gameon, Adriann Ricker, Shannon Martell, Martel Reum, Shannon Holder

Faculty, Staff and Student Publications

Although Native (American Indian and Alaska Native [AI/AN]) populations have high rates of abstinence from alcohol, health problems associated with substance use remain a pressing concern in many AI/AN communities. As part of a longstanding community-based participatory research (CBPR) project involving five years of relationship building and three preliminary studies, our team of academic and community co-researchers developed a culturally grounded intervention to facilitate recovery from substance use disorders among tribal members from a rural AI reservation. Our Indigenous Recovery Planning (IRP) intervention consists of six weekly sessions and aims to provide inroads to existing resources in the community, affirm …

Techniques In Medicine: Ipsilateral Transforaminal Epidural Steroid Injection In Bertolotti’S Syndrome, Peter D Vu, Christopher L Robinson, Omar Viswanath, Ivan Urits, Jamal Hasoon

Faculty, Staff and Student Publications

Bertolotti's syndrome, also known as lumbosacral transitional vertebrae, is a relatively rare spinal condition characterized by an anatomical variation in the lower spine. Conservative approaches such as physical therapy, anti-inflammatory medications and lifestyle modifications may be recommended for mild cases. In more severe cases or when conservative measures fail to provide relief, injections such as may be considered to alleviate pain. This case is unique in that we document a challenging technique of ipsilateral transforaminal epidural steroid injection in a patient with Bertolotti's syndrome.

Post-Mastectomy Pain Syndrome: A Review Article And Emerging Treatment Modalities, Jay D Shah, Kennedy Kirkpatrick, Krishna Shah

Faculty, Staff and Students Publications

Post-mastectomy pain syndrome (PMPS) is a syndrome broadly applied to the development of chronic pain after surgical breast intervention (i.e., lumpectomy and mastectomy). The incidence of PMPS is likely underreported, and this has contributed to a paucity of high-level evidence related to the treatment of the aforementioned condition. A drive to reduce the burden of opioid use has led to pain management physicians trialing a variety of strategies to help patients manage PMPS. This review discusses the latest evidence behind treatment options for PMPS, exploring medications as well as interventional techniques (e.g., nerve blocks, radiofrequency ablation, neuromodulation, and intrathecal drug …

Psilocybin With Acceptance And Commitment Therapy (Act) For The Treatment Of Social Anxiety Disorder (Sad), Aspen E. Allred

University Honors Theses

Social Anxiety Disorder (SAD) is a debilitating mental health condition characterized by an overwhelming fear and anxiety of social rejection that can lead to chronic patterns of social behavioral avoidance. Despite the existence of traditional efficacious treatments, a significant number of individuals either do not respond to treatment or experience a recurrence of symptoms over extended periods, spanning 10-12 years. Acceptance and Commitment Therapy (ACT), a form of acceptance-based behavioral therapy considered part of the "third wave" of cognitive behavioral therapies, has shown promising results in early studies, comparable to those of Cognitive Behavioral Therapy (CBT) that is considered the …

Association Of Plasma Ykl-40 With Mri, Csf, And Cognitive Markers Of Brain Health And Dementia, Matthew P Pase, Jayandra J Himali, Raquel Puerta, Alexa S Beiser, Mitzi M Gonzales, Claudia L Satizabal, Qiong Yang, Hugo J Aparicio, Daniel J Kojis, Charles S Decarli, Oscar L Lopez, Will Longstreth, Vilmundur Gudnason, Thomas H Mosley, Joshua C Bis, Alison Fohner, Bruce M Psaty, Mercè Boada, Pablo García-González, Sergi Valero, Marta Marquié, Russell Tracy, Lenore J Launer, Agustín Ruiz, Myriam Fornage, Sudha Seshadri

Faculty, Staff and Student Publications

BACKGROUND AND OBJECTIVES: Higher YKL-40 levels in the CSF are a known biomarker of brain inflammation. We explored the utility of plasma YKL-40 as a biomarker for accelerated brain aging and dementia risk.

METHODS: We performed cross-sectional and prospective analyses of 4 community-based cohorts in the United States or Europe: the Age, Gene/Environment Susceptibility-Reykjavik Study, Atherosclerosis Risk in the Communities study, Coronary Artery Risk Development in Young Adults study, and Framingham Heart Study (FHS). YKL-40 was measured from stored plasma by a single laboratory using Mesoscale Discovery with levels log transformed and standardized within each cohort. Outcomes included MRI total …

Growing Through Adversity: The Relation Of Early Childhood Educator Post-Traumatic Growth To Young Children’S Executive Function, Caron A. C. Clark, Holly Hatton-Bowers, Kimia Akhavein, Sarah Rasby, Gilbert R. Parra

Department of Educational Psychology: Faculty Publications

Introduction: Early childhood educators (ECEs) play a critical role in supporting the development of young children’s executive functions (EF). EF, in turn, underpins lifelong resilience and well-being. Unfortunately, many ECEs report adverse childhood experiences (ACEs) that may compound high stress levels associated with an emotionally and physically demanding profession. ACEs have well-established negative implications for adult well-being and may dampen ECEs’ capacities to engage in emotionally responsive interactions with children. However, many individuals who experience ACEs also report post-traumatic growth experiences that foster empathy, self-determination, and resilience. Such post-traumatic growth may equip teachers with skills to engage in responsive …

General Cognitive Ability In High School, Attained Education, Occupational Complexity, And Dementia Risk, Jimi Huh, Thalida Em Arpawong, Tara L. Gruenewald, Gwenith G. Fisher, Carol A. Prescott, Jennifer J. Manly, Dominika Seblova, Ellen E. Walters, Margaret Gatz

Psychology Faculty Articles and Research

INTRODUCTION

We address the extent to which adolescent cognition predicts dementia risk in later life, mediated by educational attainment and occupational complexity.

METHODS

Using data from Project Talent Aging Study (PTAS), we fitted two structural equation models to test whether adolescent cognition predicts cognitive impairment (CI) and Ascertain Dementia 8 (AD8) status simultaneously (N_{Cognitive Assessment} = 2477) and AD8 alone (N_{Questionnaire} = 6491) 60 years later, mediated by education and occupational complexity. Co-twin control analysis examined 82 discordant pairs for CI/AD8.

RESULTS

Education partially mediated the effect of adolescent cognition on CI in the cognitive assessment aample and …

Annual Research Review: The Power Of Predictability – Patterns Of Signals In Early Life Shape Neurodevelopment And Mental Health Trajectories, Elysia Poggi Davis, Laura M. Glynn

Psychology Faculty Articles and Research

The global burden of early life adversity (ELA) is profound. The World Health Organization has estimated that ELA accounts for almost 30% of all psychiatric cases. Yet, our ability to identify which individuals exposed to ELA will develop mental illness remains poor and there is a critical need to identify underlying pathways and mechanisms. This review proposes unpredictability as an understudied aspect of ELA that is tractable and presents a conceptual model that includes biologically plausible mechanistic pathways by which unpredictability impacts the developing brain. The model is supported by a synthesis of published and new data illustrating the significant …

Barriers To Mental Health Seeking Among Army Aviation Personnel: A Preliminary Report, Aric J. Raus

National Training Aircraft Symposium (NTAS)

This research explores barriers to mental health seeking, self-reported symptoms, and perspectives on self-help mental-wellness options among U.S. Army Aviation Personnel. Safe aviation operations require constant focus and mental clarity. These requirements expand when considering the implications and added stress of military operations, especially in combat scenarios. Yet, recent studies demonstrate that aviation personnel avoid seeking healthcare due to fears of losing their medical certification. This report provides preliminary results from the first known study on barriers to mental health seeking among U.S. Army aviation personnel. Utilizing an anonymous survey instrument, facilitated primarily through Social Media recruiting of current and …

Evaluating The Oral Health-Related Quality Of Life Among Dental Patients In South India - A Descriptive Study, Dheekshitha P K, Sudeep C B Dr., Sunil P M Dr., Suji M Dr.

Annual Research Symposium

This study aims to evaluate the oral health-related quality of life among dental patients in South India.

Temporal Relation Between Pubertal Development And Peer Victimization In A Prospective Sample Of Us Adolescents, Jessica A. Marino, Elysia Poggi Davis, Laura M. Glynn, Curt A. Sandman, Jennifer Hahn-Holbrook

Psychology Faculty Articles and Research

Peer victimization typically peaks in early adolescence, leading researchers to hypothesize that pubertal timing is a meaningful predictor of peer victimization. However, previous methodological approaches have limited our ability to parse out which puberty cues are associated with peer victimization because gonadal and adrenal puberty, two independent processes, have either been conflated or adrenal puberty timing has been ignored. In addition, previous research has overlooked the possibility of reverse causality—that peer victimization might drive pubertal timing, as it has been shown to do in non-human primates. To fill these gaps, we followed 265 adolescents (47% female) prospectively across three-time points …

Impact Of Equine Interaction During Psychotherapy On Anxiety And Depression For Residential Treatment Program Patients Experiencing Substance Withdrawal, Molly M. Friend, Molly C. Nicodemus, Clay Cavinder, Caleb Lemley, Pauline Prince, Katherine A. Cagle-Holtcamp, Rebecca M. Swanson

People and Animals: The International Journal of Research and Practice

As incidences of substance use disorders (SUD) increase in the wake of the COVID-19 pandemic, there is a need for more effective treatment approaches. Further, treatment approaches currently available struggle to retain patients during the period of substance withdrawal in early treatment due to patients’ withdrawal symptoms including increased feelings of anxiety and depression. Withdrawal symptoms have been linked to dysregulated cortisol concentrations present in this period. Psychotherapy incorporating equine interaction (PIE) has emerged in other populations as a treatment that decreases cortisol concentrations and improves treatment retention. The present study investigated the impact of 4 weeks of PIE on …

Investigating The Motivational Differences For Healthy Eating In Men And Women, Kylie Martin, John Adams

Journal of Applied Disciplines

The study aimed to measure the differing levels of intrinsic and extrinsic motivation for healthy eating behaviors in men and women. Through social media outreach, a sample of 57 participants (n=57), aged 18-69, living across the United States, primarily in the midwestern area, completed an online survey. The Motivation for Healthy Eating Scale (MHES) assessed different subgroups of internal and external motivation for healthy eating. Five of the six subgroups were used in the online survey sent to participants (intrinsic motivation, integrated regulation, identified regulation, introjected regulation, and external regulation). An independent samples t-test was performed to assess …

Support Systems: The Effect They Have On Domestic Violence Victims, Kimberly Diann Burton

Doctoral Dissertations and Projects

In the last five years, domestic violence has escalated in the number of episodes reported and in the severity of violence. Researchers attribute this increased frequency and severity to the COVID-19 pandemic. During the lockdown time of the pandemic, victims and their abusers could not escape from arguments, which resulted in tensions rising. This study brings attention to the fact that domestic violence is still a pervasive problem. It gives information to help the abused stay out of violent relationships and/or escape. There was conflicting research on whether support systems help victims of these violent relationships escape or stay in …

Patient And Dentist Perspectives On Collecting Patient Reported Outcomes After Painful Dental Procedures In The National Dental Pbrn, Elsbeth Kalenderian, Sayali Tungare, Urvi Mehta, Sharmeen Hamid, Rahma Mungia, Alfa-Ibrahim Yansane, David Holmes, Kim Funkhouser, Ana M Ibarra-Noriega, Janelle Urata, D Brad Rindal, Heiko Spallek, Joel White, Muhammad F Walji

Faculty, Staff and Student Publications

BACKGROUND: Dental Patient Reported Outcomes (PROs) relate to a dental patient's subjective experience of their oral health. How practitioners and patients value PROs influences their successful use in practice.

METHODS: Semi-structured interviews were conducted with 22 practitioners and 32 patients who provided feedback on using a mobile health (mHealth) platform to collect the pain experience after dental procedures. A themes analysis was conducted to identify implementation barriers and facilitators.

RESULTS: Five themes were uncovered: (1) Sense of Better Care. (2) Tailored Follow-up based on the dental procedure and patient's pain experience. (3) Effective Messaging and Alerts. (4) Usable Digital Platform. …

Proposal Of A Private Caretaker-Completed Questionnaire To Assess The Suitability Of Domestic Cats For Animal-Assisted Interventions, Alina Simona Rusu, Iulia Francesca Pop, Christine Olsen, Magdalena Nawarecka-Piątek, Michal Plewczynski, Eivind Øverli Holm, Dennis C. Turner

People and Animals: The International Journal of Research and Practice

The objective of this study was to develop a caretaker-completed questionnaire entitled “Cats’ Behavioral Suitability for Animal-Assisted Interventions” (CatSAAI), covering two categories of items associated with seven feline personality factors. These feline personality factors were previously identified and validated by Mikkola et al. (2021) on a large sample of domestic cat guardians. The aim of the CatSAAI questionnaire is to facilitate the interpretation of the behavioral suitability or unsuitability of each individual cat for inclusion in feline-assisted interventions, while considering the prevention of stress and risks in AAI settings for both people and animals. The tool was proposed by an …

A Validation Study Of The Occupational Depression Inventory In Poland And Ukraine, Krystyna Golonka, Karine O. Malysheva, Dominika Fortuna, Bożena Gulla, Leon T. De Beer, Irvin Sam Schonfeld, Renzo Bianchi

Publications and Research

This study examined the psychometric and structural properties of the Polish and Ukrainian versions of the Occupational Depression Inventory (ODI). We relied on two samples of Polish employees (NSample1 = 526, 47% female; NSample2 = 164, 64% female) and one sample of Ukrainian employees (NSample3 = 372, 73% female). In all samples, the ODI exhibited essential unidimensionality and high total-score reliability (e.g., McDonald’s omegas > 0.90). The homogeneity of the scale was strong (e.g., 0.59 ≤ scale-level Hs ≤ 0.68). The ODI’s total scores thus accurately ranked individuals on a latent occupational depression continuum. We found evidence of complete measurement invariance …

Current Practices, Perceived Barriers, And Promising Implementation Strategies For Improving Quality Of Smoking Cessation Support In Accredited Cancer Programs Of The American College Of Surgeons., Jamie S. Ostroff, Eileen M. Reilly, Jessica L. Burris, Graham W. Warren, Rachel C. Shelton, Timothy W. Mullett, Just Ask Quality Improvement Task Force

Psychology Faculty Publications

PURPOSE: Persistent smoking is associated with poor outcomes in cancer care. It is strongly recommended that oncology care providers provide cessation support; however, there is limited information about smoking cessation assessment and treatment patterns in routine oncology practice.

METHODS: Leaders of the American College of Surgeons Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (National Accredited Program for Breast Cancer) elected to participate in a national quality improvement initiative (Just ASK) focused on smoking assessment/treatment in cancer care. Online baseline survey responses were received from 762 accredited programs.

RESULTS: Most programs reported regularly asking about smoking (89.9%), …

Park Use, Urban Environmental Justice, And Place Attachment In Parks In Low-Income Neighborhoods In New York City, Javier Eduardo Otero Peña

Dissertations, Theses, and Capstone Projects

This three-article dissertation brings environmental psychology themes and questions to a large-scale public health research project about a subset of community parks and park renovations in low-income neighborhoods in New York City (NYC). What attributes and perceived aspects of the physical and social environment of parks and their neighborhoods are associated with higher park use? How do residents of gentrifying low-income neighborhoods feel about park renovations that took place in their communities? What can be learned from parks, park renovations and place attachment from exploring user-generated content in the Google Maps platform? Each of the articles presented in this dissertation …

Profiles Of Activity Engagement And Depression Trajectories As Covid-19 Restrictions Were Relaxed, Jonathan L. Chia, Andree Hartanto, William Tov

Research Collection School of Social Sciences

Given elevated depression rates since the onset of the pandemic and potential downstream implications, this research examined the association between activity engagement and depression among middle-aged and older adults postlockdown. This study aimed to (a) identify activity engagement profiles among middle-aged and older adults, (b) understand factors associated with profile memberships, and (c) compare depression trajectories across profiles as COVID-19 restrictions eased over 16 months in Singapore. This longitudinal study involved 6,568 middle-aged and older adults. Latent growth analysis was first conducted to obtain estimates of depression trajectories for each individual. Latent profile analysis was then conducted to identify different …

Infant Hedonic/Anhedonic Processing Index (Hapi-Infant): Assessing Infant Anhedonia And Its Prospective Association With Adolescent Depressive Symptoms, Jessica L. Irwin, Elysia Poggi Davis, Curt A. Sandman, Tallie Z. Baram, Hal S. Stern, Laura M. Glynn

Psychology Faculty Articles and Research

Background

Anhedonia, an impairment in the motivation for or experience of pleasure, is a well-established transdiagnostic harbinger and core symptom of mental illness. Given increasing recognition of early life origins of mental illness, we posit that anhedonia should, and could, be recognized earlier if appropriate tools were available. However, reliable diagnostic instruments prior to childhood do not currently exist.

Methods

We developed an assessment instrument for anhedonia/reward processing in infancy, the Infant Hedonic/Anhedonic Processing Index (HAPI-Infant). Exploratory factor and psychometric analyses were conducted using data from 6- and 12-month-old infants from two cohorts (N = 188, N = 212). …

Assessment Of Patient Satisfaction And Treatment Outcomes In Digital Smile Design Vs Conventional Smile Design: A Randomized Controlled Trial, Chetan Luniyal, Anuj K Shukla, Mayank Priyadarshi, Farah Ahmed, Nishu Kumari, Pinki Bankoti, Ramanpal S Makkad

Faculty, Staff and Student Publications

BACKGROUND: The esthetics of a smile holds significant importance in an individual's self-esteem and overall quality of life. In the realm of cosmetic dentistry, smile design has traditionally relied on conventional methods, but recent advances in technology have introduced digital smile design (DSD) as a promising alternative.

MATERIALS AND METHODS: In this randomized controlled trial, 150 adult patients seeking smile enhancement procedures were enrolled and randomly assigned to one of two groups: the DSD group or the conventional smile design group. The DSD group underwent smile design using digital technology, including intraoral scans, computer-aided design, and 3D simulations. Meanwhile, the …

Influence Of Zirconia/Glass Veneer Thickness And Implant Abutment Material On The Final Shade Of Implant Restorations, Nishu Kumari, Anuj K Shukla, Rohit Malviya, Aman Raj, Bhagyashree Sutaria, Lalima Kumari, Ramanpal S Makkad

Faculty, Staff and Student Publications

BACKGROUND: Achieving an optimal shade match for these restorations is crucial for aesthetic outcomes. The thickness of zirconia/glass veneer and the choice of implant abutment material play vital roles in determining the final shade of implant restorations.

MATERIALS AND METHODS: This study investigated the influence of zirconia/glass veneer thickness (0.5 mm and 1.0 mm) and implant abutment material (zirconia and titanium) on the final shade of implant restorations. A total of 60 identical implant restorations were fabricated and divided into four groups based on the combinations of veneer thickness and abutment material. The shade of each restoration was assessed using …

Investigating The Long-Term Success And Complication Rates Of Zirconia Dental Implants: A Prospective Clinical Study, Anuj Kishor Shukla, Mayank Priyadarshi, Nishu Kumari, Sonal Singh, Pallavi Goswami, Sparsh B Srivastava, Ramanpal S Makkad

Faculty, Staff and Student Publications

This study addresses the durability and complications of zirconia dental implants through a prospective clinical investigation. Zirconia implants are increasingly utilized in dental implantation, and a comprehensive understanding of their long-term performance is essential.

BACKGROUND: Zirconia dental implants have gained attention due to their biocompatibility and aesthetics. However, research on their extended success and complication rates is limited.

MATERIALS AND METHODS: A prospective clinical study involved the placement of 30 zirconia dental implants in patients requiring tooth replacement. The implants were followed up for five years. Success was defined as the implant remaining stable and functional. Complications, including peri-implant mucositis …

Racial Discrimination And Interpersonal Violence In Asian American Adolescents During The Covid-19 Pandemic, Yu Lu, Elizabeth Baumler, Leila Wood, Vi D Le, Shannon P Guillot-Wright, Jeff R Temple

Faculty, Staff and Student Publications

PURPOSE: Racial discrimination targeting Asians in the United States has increased sharply since the COVID-19 pandemic. Despite a well-established link with mental/physical health outcomes, little is known about how racial discrimination relates to interpersonal violence, particularly in adolescents. To address this gap in knowledge, we examined cross-sectional and longitudinal (1-year follow-up) associations between racial discrimination and interpersonal violence perpetration and victimization in Asian American adolescents in a large US city.

METHODS: Data from Waves 3 (2020) and 4 (2021) of a randomized clinical trial of a school-based violence prevention program were examined. We limited our sample to participants who identified …

Risk Factors For Post-Discharge Adverse Outcomes Following Hospitalization Among Older Adults Diagnosed With Elder Mistreatment, Monique R Pappadis, Leila Wood, Allen Haas, Jordan Westra, Yong-Fang Kuo, Charles P Mouton

Faculty, Staff and Student Publications

Using 100% Medicare data files, this study explored whether primary elder mistreatment (EM) diagnosis, EM type, and facility type were associated with 3-year mortality and 1-year unplanned hospital readmission among older patients diagnosed with EM with hospital discharge from 10/01/2015 through 12/31/2018 (n = 11,023). We also examined outcome differences between older patients diagnosed with EM and matched non-EM patient controls. Neglect by others was the most common EM diagnosis. Three-year mortality was 56.7% and one-year readmission rate was 53.8%. Compared to matched non-EM patient controls, older EM patients were at an increased risk of mortality and readmission. Among …

Safety And Academic Outcomes Of College Campus-Based Advocacy Services, Rachel J Voth Schrag, Elizabeth Baumler, Dixie Hairston, Cynthia Jones, Leila Wood

Faculty, Staff and Student Publications

Intimate partner violence (IPV), sexual assault, and stalking are consequential public health and safety issues with wide reaching impacts on emerging adults, including those on college campuses in the United States. In response to high rates of violence among college student populations, universities are developing campus-based advocacy (CBA) programs, which aim to support survivors of interpersonal violence through supportive connections, resource acquisition, and safety planning. However, little data exists related to their impact on key student-survivor outcomes. Thus, this study aims to understand (a) the approach CBA programs use to address safety and academic concerns of student-survivors, and (b) the …

Safety And Academic Outcomes Of College Campus-Based Advocacy Services, Rachel J Voth Schrag, Elizabeth Baumler, Dixie Hairston, Cynthia Jones, Leila Wood

Faculty, Staff and Student Publications

Intimate partner violence (IPV), sexual assault, and stalking are consequential public health and safety issues with wide reaching impacts on emerging adults, including those on college campuses in the United States. In response to high rates of violence among college student populations, universities are developing campus-based advocacy (CBA) programs, which aim to support survivors of interpersonal violence through supportive connections, resource acquisition, and safety planning. However, little data exists related to their impact on key student-survivor outcomes. Thus, this study aims to understand (a) the approach CBA programs use to address safety and academic concerns of student-survivors, and (b) the …