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Two UT faculty members honored by American Chemical Society

Dr. Amanda Bryant-Friedrich and Dr. Paul Erhardt were recognized at the American Chemical Society’s fall national meeting last month in Boston.

Bryant-Friedrich, interim dean of the College of Pharmacy and Pharmaceutical Sciences, was named a Fellow of the American Chemical Society, and Erhardt, Distinguished University Professor of Medicinal Chemistry, was inducted into the American Chemical Society Medicinal Chemistry Division Hall of Fame.

Dr. Amanda Bryant-Friedrich, center, posed for a photo with Gurdat Premnauth, UT alumnus who received a master of science degree in chemistry in 2016, left, and Immaculate Sappy, a PhD candidate in the UT Department of Medicinal Chemistry, at the American Chemical Society’s fall national meeting last month in Boston. Bryant-Friedrich was named a Fellow of the American Chemical Society.

The American Chemical Society Fellow designation is awarded to a member who has made exceptional contributions to the science or profession and has provided excellent volunteer service to the community.

Bryant-Friedrich joined the University in 2007 as an associate professor in medicinal and biological chemistry in the College of Pharmacy and Pharmaceutical Sciences. In 2016, she was appointed dean of the College of Graduate Studies, and on Sept. 1, she was named interim dean of the College of Pharmacy. She is vice provost for graduate affairs, professor of medicinal and biological chemistry, and director of the University’s Shimazdu Laboratory for Pharmaceutical Research Excellence.

She received a bachelor of science degree in chemistry at North Carolina Central University, a master’s degree in chemistry from Duke University, and a doctorate in pharmaceutical chemistry from Ruprecht-Karls Universität in Germany. In addition, she conducted postdoctoral studies at the University of Basel in Switzerland.

“After spending several years at an undergraduate-serving institution, I decided that having a larger research focus would allow me to offer more students opportunities,” Bryant-Friedrich said. “The University of Toledo has a research and teaching mission aligned with my interest as well as a globally diverse student body. When offered the opportunity to join this community, I couldn’t say no.”

Her research interests include modified nucleic acids; biomarkers; DNA and RNA damage; photochemistry; mass spectrometry; ionizing radiation; and women in science.

“It is important to me to remain active as a researcher to continue to provide training and research opportunities for students from around the world and right here in northwest Ohio,” said Bryant-Friedrich, one of 12 women named a Fellow this year. “So many questions still remain about the origins of disease, and I hope to continue to contribute to our understanding of the root of diseases such as cancer and Alzheimer’s while searching for new treatments for viral infection.”

Dr. Paul Erhardt, right, received a plaque from Dr. Paul Ornstein, chair of the American Chemical Society Medicinal Chemistry Division, during the Hall of Fame induction ceremony last month in Boston.

Erhardt has been a member of the UT faculty for 25 years. He is director of the Center for Drug Design and Development, which promotes health-related interdisciplinary research programs and facilitates collaborations between the academic and private sectors so useful technologies can be matured and delivered to the marketplace to benefit the public.

He has been a member of the American Chemical Society for nearly 50 years. His early career began in the private sector, first at American Critical Care Labs and then at Berlex Laboratories, where he rose to the rank of assistant director of research and global development. After 20 years, he transitioned to academia and joined The University of Toledo with a desire to share his knowledge and research skills with students.

The American Chemical Society Division of Medical Chemistry Hall of Fame inducts those who have made outstanding contributions to medicinal chemistry through research, teaching and/or division service.

“With regard to the hall of fame award, I am enormously proud as this is the highest acknowledgement that can be bestowed within my chosen field of endeavor,” Erhardt said.

He received a bachelor of arts degree in chemistry and doctorate in medicinal chemistry from the University of Minnesota. He did postdoctoral studies in drug metabolism while at the University of Texas at Austin.

Erhardt is well-known for the pioneering discovery and development of esmolol, a soft drug used in emergency settings that continues to save numerous lives on a daily basis around the globe. He has written more than 125 publications and received more than 50 U.S. patents.

He has been an active member of the International Union of Pure and Applied Chemistry, where he served as president of Division VII Chemistry and Human Health.

“I plan to retire and assume an emeritus position where I can continue to pursue research,” Erhardt said. “One hobby project that I have never had time for is to establish a human drug metabolism database on the internet akin to the protein database that can be used by all investigators across the globe who are interested in such a topic.”

Breakthrough research at UT shows promise in treating drug-resistant form of deadly breast cancer

A University of Toledo cancer researcher has received nearly $450,000 in grant funding from Susan G. Komen Northwest Ohio to continue his research into triple negative breast cancer, an aggressive form of the disease that frequently develops resistance to existing chemotherapies.

Dr. Amit K. Tiwari, an assistant professor in UT’s College of Pharmacy and Pharmaceutical Sciences who specializes in investigating multidrug resistant cancers, recently identified a new chemotherapy drug that is showing promise in curing triple negative breast cancer, even in cases where patients have developed resistance to conventional chemotherapy.


“Poor prognosis in most triple negative breast cancer cases is due to development of drug resistance. Once patients develop resistance to one chemotherapy, they stop responding to any other chemotherapy. Resistant triple negative breast cancer results in metastasis, diminishing patient survival time to less than a year,” Tiwari said. “These new drugs are unique. Not only are they showing promise in destroying triple negative breast cancer cells, but even if the disease gets to the stage of drug resistance, it is reversing the resistance and making it more sensitive to traditional chemotherapy.”

Triple negative breast cancer accounts for between 15 percent to 20 percent of all breast cancer cases. Treatment is difficult because the cancer does not respond to hormonal therapies or therapies that target HER2 receptors — common methods of treating other breast cancers.

But what makes the disease especially deadly is that the patient often develops resistance to currently available chemotherapy drugs.

“The goal of my research has been to understand why these patients end up getting drug resistance and how we can stop it,” Tiwari said.

His research led him to targeting the cancer cells in a nonconventional way, which has proven both successful in treating the disease and in reversing drug resistance. The new treatment, which has been lab-tested on human breast cancer models, has been provisionally patented by UT.

With the three-year grant from Susan G. Komen Northwest Ohio, Tiwari and his team of researchers at The University of Toledo will be able to continue development and research of the new drugs and move their work closer to clinical trials.

“We are so thankful for the friends, family and neighbors that fight alongside us, helping to reduce the number of breast cancer deaths in Ohio, both on the ground and through research,” said Mary Westphal, executive director of Susan G. Komen Northwest Ohio. “As we celebrate 25 years of impact in northwest Ohio, we are so pleased to be able to award this grant to our partners at The University of Toledo.”

“The University of Toledo is a long-standing partner of Komen Northwest Ohio, receiving funding to support community health programming and advance scientific research for a number of years,” UT Vice President for Research Frank Calzonetti said. “Dr. Tiwari’s efforts to develop new treatments for the most aggressive form of breast cancer is the latest example of how our talented faculty experts are advancing knowledge that impacts our community.”

Triple negative breast cancer patients currently have a poor five-year survival prognosis; however, Tiwari said those who do make it to the five-year mark have a good long-term prognosis. If the new treatment is proven to be as promising as the initial research suggests, Tiwari said it could be a major breakthrough toward curing triple negative breast cancer.

“This actually brings a lot of hope,” Tiwari said.

UT research award dollars reach five-year high

The University of Toledo researchers brought in $27.1 million in new grants to fund research during the 2018 fiscal year, contributing to a five-year high in external research funding.

When combining the 39.5 percent increase in new awards compared to 2017 with renewal grants awarded to continue progress on previously funded projects, the total amount of grants awarded to UT in 2018 climbed to $46.6 million, an increase of 21 percent compared to the previous year.

“Our research portfolio is growing,” UT President Sharon L. Gaber said. “The University’s faculty members are leaders in their academic disciplines who are making important advancements in their field of study and helping UT achieve national research prominence.”

The number of grants jumped 15 percent in fiscal year 2018, from 282 in 2017 to 326. Of those, the number of new awards increased 11 percent, from 163 to 182.

“My office has seen grant awards increase across the entire campus in a wide range of disciplines, showing a strong faculty response in supporting the University’s commitment to building research,” Vice President for Research Frank Calzonetti said. “I am particularly impressed by the number of new awards, compared to awards to continue previously funded projects. These new awards are mostly for projects that have met agency merit review criteria and have a higher probability of future funding.”

Federal awards in 2018 include:

• $2.4 million from the U.S. Department of Energy to Dr. Sridhar Viamajala, professor in the UT Department of Chemical Engineering, for a project titled “A Comprehensive Strategy for Stable, High Productivity Cultivation of Microalgae With Controllable Biomass Composition”;

• $1.8 million from the Air Force Research Laboratory to Dr. Randy Ellingson, professor in the Department of Physics and Astronomy, for a project titled “Ultra-High Efficiency and Lightweight Thin-Film Photovoltaic Electricity for Portable, On-Demand Power for Defense Applications”; and

• $438,172 from the National Institutes of Health to Dr. Heather Conti, assistant professor in the UT Department of Biological Sciences, for a project titled “Novel Role for B-Defensin 3 in the Regulation of Innate Lymphocytes and Oral Mucosal Immune Responses.”

For more information about UT’s research enterprise, visit utoledo.edu/research.

UT faculty awarded $1.3 million in federal grants for medical research, education, technology

Faculty members at The University of Toledo were awarded $1.3 million in federal grants for projects related to opioid abuse, mental health, cancer and antimicrobial technology.

“The University of Toledo continues to advance its strong research base, this time in the two critical areas of innovative drug targets for cancer risk and also to public health and opioid crisis education,” said Congresswoman Marcy Kaptur. “The University of Toledo’s leadership in pioneering treatments and therapies for everything from heart disease to detecting a substance-use relapse has earned it the attention of granting agencies. Securing competitive federal awards is no easy task. Congratulations to UT for identifying and competing in very competitive space.”

Dr. Cheryl McCullumsmith, professor and chair of the UT Department of Psychiatry, was awarded a three-year, $449,076 grant from the Center for Substance Abuse Treatment to expand education about opioid use disorder across all disciplines within UT’s College of Medicine and Life Sciences.

“The College of Medicine and Life Sciences will equip all medical students with the knowledge and the skills they need to appropriately manage opioid treatment and confidently identify opioid use disorders, regardless of their planned specialty. We are training a generation of family medicine doctors, surgeons and internists to actively prevent and treat opioid use disorders,” McCullumsmith said.

Dr. Linda Lewandowski, dean of the UT College of Nursing and co-chair of the UT Opioid Task Force, was awarded a three-year, $371,723 grant from the Substance Abuse and Mental Health Services Administration for an interdisciplinary public health project that will provide evidenced-based mental health awareness training to UT students, faculty and staff, as well as the wider northwest Ohio community.

The training includes appropriate responses, materials on available community resources, and information about the unique mental health needs of active-duty military and veterans. The program is built with a specific emphasis on issues related to the opioid epidemic.

“With one in five Americans experiencing mental health problems in a given year, it is more likely that an individual will come across someone having an emotional or mental health crisis than someone having a heart attack. By providing ‘mental health first aid,’ we will empower our students, faculty and community to recognize mental health and substance abuse problems and respond appropriately. This type of training is especially important during this time of the pervasive opioid crisis affecting our state and the nation,” Lewandowski said.

Dr. Maria Diakonova, professor in the UT Department of Biological Sciences, was awarded a three-year, $449,667 grant from the National Institute of General Medical Sciences to focus on a protein called JAK2 as she works to identify new drug targets to reduce the risk of cancer.

“Our goal is to explain the JAK2-mediated intracellular pathways and have a better understanding of the mechanisms involved in cell proliferation, or cell division, which could provide insight into future therapeutic approaches to cancer,” Diakonova said.

Dr. Terry Bigioni, professor in the UT Department of Chemistry and Biochemistry, was awarded a $50,000 grant from the National Science Foundation to research broad-spectrum antimicrobial coatings for garments and textiles. Antimicrobial treatments are already used in medicine as anti-infective treatments and in garments and textiles for odor control. This technology could bring odor control to a wider range of products and reduce the need to launder many garments, improving garment lifespan and reducing their environmental impacts.

“We think our antimicrobial technology could bring a lot of added value to the garment and medical industries and create new manufacturing jobs right here in northwestern Ohio,” Bigioni said.

UT scientists awarded nearly $1 million in federal grants to examine cell behaviors

The U.S. Department of Health and Human Services awarded nearly $1 million in federal grants to two scientists at The University of Toledo for research projects examining cell behaviors that can lead to the development of better medicines to treat cancer, cardiovascular disease and autoimmune disease.

“Once again one of our top-level Ohio universities proves that they are on the cutting edge of medical research and innovation,” said Congresswoman Marcy Kaptur. “Northern Ohio is a leader in medical research, and these funds build on that foundation of excellence. These researchers are pushing boundaries and working to develop treatments and therapies to help those suffering from chronic illness. The University of Toledo distinguishes itself by competing and winning competitive grant opportunities such as the one announced [Sept. 11]. I am pleased to be able to support their efforts to access federal research resources.”

Dr. Ajith Karunarathne, assistant professor in the UT Department of Chemistry and Biochemistry, received $441,323 from the National Institute of General Medical Sciences to examine the regulation of a crucial group of signaling pathways named G-protein and GPCRs that help the body control functions, including heart rate, and are involved in pathological processes such as cancer and heart disease.

“Knowledge from our experiments will help develop tissue- and organ-specific therapeutics for a variety of diseases, including cancer, that are less harmful to bodily functions,” Karunarathne said.

Dr. James Slama, professor in the UT Department of Medicinal and Biological Chemistry, received $461,898 from the National Institute of General Medical Sciences to identify the elusive receptor for nicotinic acid adenine dinucleotide phosphate, or NAADP, which could lead to the development of inhibitors that may be useful as anti-tumor drugs.

“This project is part of an effort to discover how cells in an organism control their behaviors, and how they can respond to changing outside conditions,” Slama said. “Calcium inside of the cell is an important controller, and a second chemical, named NAADP, is one of several substances that triggers internal calcium release. Our goal is to understand how NAADP causes this calcium release and to identify the individual steps in the process in both normal and in diseased states.”

UT chemists awarded $2.1 million to develop new antibiotic to treat TB

The National Institutes of Health awarded a team of chemists at The University of Toledo a five-year, $2.1 million grant to create a new, more effective drug to treat tuberculosis, the most common cause of death from an infectious disease worldwide.

The grant renews funding through 2023 for the project that combats drug resistance to current antibiotics.

Dr. Donald Ronning, left, and Dr. Steve Sucheck are using a five-year, $2.1 million grant from the National Institutes of Health to develop a better drug to treat tuberculosis.

Dr. Donald Ronning and Dr. Steve Sucheck, professors in the UT Department of Chemistry and Biochemistry, will build on their progress made in the fight against Mycobacterium tuberculosis, which can be spread through coughing, sneezing or laughing, and kills more people each year than HIV, malaria and the flu. It takes at least six months to clear the infection with the drugs currently available.

“Antibiotics discovered 60 years ago are becoming obsolete as bacteria naturally evolve to outsmart drug therapies,” Sucheck said. “Mycobacterium tuberculosis, which kills 1.5 million people a year, is one of a number of bacteria that have become increasingly drug-resistant.”

“We’re designing an antibiotic to shorten the time it takes to clear the infection,” Ronning said. “Instead of six to 24 months, we’re aiming for a therapy of two weeks, like treating strep throat or an ear infection, as well as reducing the side effects.”

The team has published several papers about breakthroughs in their ongoing research in journals, including Nature Communications, Scientific Reports and the Journal of Biological Chemistry, as well as the American Chemical Society’s journals Biochemistry and Infectious Diseases.

“We’ve used X-rays to structurally characterize two targets and are making progress in understanding how to better hit those targets to make a molecule that is going to be much more potent against the bacterium that causes tuberculosis,” Ronning said.

The research centers around inhibiting two essential classes of enzymes found in Mycobacterium tuberculosis. One is called the antigen 85 Complex that the researchers learned changes shape as it performs its job in the cell, making the protein more vulnerable to some of the compounds the lab has been testing. The second enzyme class synthesizes long polymers of sugar. Inhibiting this enzyme promotes an accumulation of compounds toxic to the bacterium and leads to rapid killing.

“There is a tremendous need to identify new drugs and new drug targets that can be used to treat this increasingly drug-resistant bacteria,” Sucheck said. “We are creating something that has never been made. The work is urgent because many cases of TB are almost impossible to treat.”

Art and science set to collide at Toledo CellulART Sept. 14

Toledo CellulART, a regional meeting that brings together the art and scientific communities, will take place Friday, Sept. 14, in the UT Center for the Visual Arts on the Toledo Museum of Art Campus.

CellulART celebrates the link between art and science while promoting collaboration, interaction and discussion between cytoskeletal researchers.

This year the keynote talk will be given by Dr. Kenneth Yamada, National Institutes of Health Distinguished Investigator in the Cell Biology Division at the National Institute of Dental and Craniofacial Research in Bethesda, Md. He will speak at 1 p.m.

The meeting also will feature a scientist/artist talk by Dr. Edna Cukierman, co-leader of the Pancreas Research Interest Group at the Fox Chase Cancer Center in Philadelphia. She will talk at 5:30 p.m.

Throughout the daylong event, there will be oral and poster presentations by faculty members, researchers, and undergraduate and graduate students.

The meeting is sponsored by the American Society for Cell Biology; Cytoskeleton Inc.; Fisher Scientific International Inc.; and by the UT offices of the President and the Provost; the UT College of Natural Sciences and Mathematics; and the UT Department of Biological Sciences.

For more information regarding registration, abstract submission or the image competition, click here.

Professor receives $2.6 million research grant to further examine link between gut bacteria and high blood pressure

A University of Toledo researcher recently received a $2.64 million grant from the National Heart, Lung and Blood Institute to continue her groundbreaking study into how the unique colonies of tiny microorganisms living in our gut can regulate blood pressure — or lead to hypertension.

High blood pressure is one of the most common ailments among American adults. According to figures from the U.S. Centers of Disease Control and Prevention, one in three adults has hypertension. And only about half of those have their condition under control.

Dr. Bina Joe has received a $2.64 million grant from the National Heart, Lung and Blood Institute for her research on hypertension and gut bacteria.

But even those who are actively controlling their hypertension are frequently just masking the problem.

“Blood pressure medicines are not curing the cause. They are attacking it after its onset,” said Dr. Bina Joe, Distinguished University Professor and chair of UT’s Department of Physiology and Pharmacology, and director of the Center for Hypertension and Precision Medicine. “If we know that there are some bacteria that shouldn’t be there and we can correct it early on, will that lead to better health as a preventative measure?”

The hope is that the grant-funded research could ultimately lead to breakthroughs that would give clinicians a way to treat or even prevent high blood pressure by manipulating those microorganisms, also known as microbiota.

Researchers have long known that our genes can predispose us to high blood pressure. But only more recently — thanks in large part to the research by Joe’s team at The University of Toledo — has the medical community begun to realize how the microorganisms living in our bodies play a role in that equation.

“A human is an ecosystem,” Joe said. “We have one host and so many microbiota. Together they influence several traits for normal health.”

The four-year grant will allow Joe’s lab and co-investigators from her department, Drs. Matam Vijay-Kumar and Ritu Chakravarti, to dig deeper into that connection in three ways:

• First, researchers will look into how an individual’s genome determines which microorganisms flourish in their guts.

• Second, researchers will look at the effects of high salt consumption on the animals’ microbiota. Salt can kill bacteria, and it’s possible, Joe said, that high salt intake can disturb the microbiota that are beneficial to maintenance of normal blood pressure.

• Third, researchers will look at epigenetics — essentially how gene function can be altered by environmental factors and diet.

Though the work is still early, Joe and her graduate student, Saroj Chakraborty, have already been granted a patent. Researchers isolated a certain chemical called beta hydroxybutyrate that increases with exercise, but decreases with salt consumption. Joe said it’s possible that exercise benefits hypertension in part because of the higher concentration of that compound.

The lab fed hypertensive rats a precursor of that molecule to see if their blood pressure decreased.

“Sure enough, it did,” Joe said. “Our idea is if there are people who cannot exercise but they’re salt-sensitive hypertensives, here could be a magic pill. You could take a bit of this chemical so you don’t have to keep running but you can control your blood pressure. That’s unpublished data coming from this work, currently in peer review.”

Some of Joe’s earlier work on microbiota and hypertension also is getting attention for its intersection with the growing worry that overuse of antibiotics is leading to an increase in drug-resistant superbugs.

Research led by her lab found that common antibiotics could lead to a spike in blood pressure for certain individuals, while other antibiotics may actually reduce blood pressure in hypertensive patients.

The reason for that discrepancy appears to be tied to how the antibiotics interact with an individual’s microbiota.

The findings, which were recently published in the journal Physiological Genomics, could lead to additional studies that hone a more individualized approach for physicians to consider when using antibiotics to treat infection.

“I think this study is hugely important for the future of prescribing antibiotics. They’re prescribed so often to hypertensive individuals, and this study shows that can have a really negative affect on their blood pressures,” said Sarah Galla, an MD/PhD candidate, who worked with Joe on the study.

“This highlights the importance of more studies that need to be done to further the field of personalized medicine, rather than just prescribing the same antibiotic to every patient.”

UT engineer awarded nearly $400,000 to make 2D materials using high-pressure gases

Two-dimensional, or 2D, layered materials are expected to be next-generation building blocks for electronics and batteries, as well as aerospace, automotive and health-care equipment.

The National Science Foundation awarded an engineer at The University of Toledo a three-year, nearly $400,000 grant to refine his newly developed method to continuously and rapidly produce 2D-layered materials using high-pressure gases, into a means for mass production with the potential to transform U.S. manufacturing.

Dr. Reza Rizvi, assistant professor of mechanical, industrial and manufacturing engineering, looked at a dispersion of graphene that was produced using his rapid and scalable exfoliation process. This new process can enable low-cost, flexible and printable electronic devices.

One example of a two-dimensional material is graphene, a flat form of carbon that is strong, lightweight, and electrically and thermally conductive with a high surface area. The material is about 50,000 times thinner than a human hair.

Dr. Reza Rizvi, assistant professor in the Department of Mechanical, Industrial and Manufacturing Engineering and the project’s principal investigator, said the main challenge is the high cost of production.

“Our process called compressible flow exfoliation is capable of continuously producing quality 2D-layered nanomaterials using a supersonic flow of high-pressure gases in just a fraction of a second. Comparable processes take minutes, hours or even days,” Rizvi said. “Using this grant, we will investigate the fundamental mechanisms and process issues, and we will devise strategies for scaling the process to industrial production so that we can take this process out of the lab and into the factory.”

According to the NSF grant, “The results of this work advances the nation’s prosperity and security by boosting competitiveness of U.S. manufacturing efforts on the international stage and promoting broader adoption of two-dimensional materials into next-generation nanotechnology-enabled products.”

Rizvi’s research was recently published in the scientific journal Advanced Materials.

UT psychologist wins Fulbright grant to study child abuse prevention in Netherlands

About 540 children are identified as victims of abuse or neglect each year in Lucas County.

“For every substantiated case of physical child abuse in the U.S., approximately 40 more exist that go undetected. It’s heartbreaking,” said Dr. Michele Knox, University of Toledo professor of psychology, who has dedicated her life to protecting children and educating parents with alternative methods of discipline.


She recently was awarded her second Fulbright award to visit the Netherlands to find innovative and effective ways to improve child abuse prevention in the United States.

“I am honored to receive this award. It is an opportunity to bring home new ideas and approaches because the Netherlands is among the nations with the lowest rates of child maltreatment deaths,” Knox said. “I will be learning from the people there and benefiting from their expertise, knowledge and success.”

Starting in spring 2019, Knox will spend nearly three weeks at the University of Utrecht, the largest university in the Netherlands.

“This is a big change from my last Fulbright specialist project, which was in northern Portugal,” Knox said. “I was teaching the Portuguese how to use evidence-based parenting group programs to prevent child abuse.”

The United States, Mexico and Portugal have “exceptionally” high rates of child maltreatment deaths, according to the UNICEF Innocenti Research Centre.

For 16 years, Knox has been a master trainer for the American Psychological Association’s Adults and Children Together (ACT) Raising Safe Kids Program, which trains parents and caregivers in nonviolent discipline, child development, anger management and social problem-solving skills.

While in the Netherlands, Knox plans to teach college students and professionals about the ACT program and other topics related to child abuse and well-being.

Knox teaches medical students and residents at UT. She also is a clinical psychologist who specializes in children, adolescents and trauma; child abuse prevention; and parenting.

“Spanking is often the first step in the cycle of child abuse, and it can result in aggressive behavior and delinquency in kids,” Knox said. “I teach alternative methods of discipline for positive parenting solutions, such as the use of timeouts, removal of privileges, and positive reinforcement to reward the child’s good behavior.”

Her current research addresses factors related to harsh and abusive parenting, outcomes of child maltreatment prevention programs, and the efficacy of the Child Advocacy Studies training program for medical students.