Thesis (M.Med.(General Surgery)--University of the Witwatersrand, Faculty of Health Sciences, 2014. / Background. Renal insufficiency is increasingly common in end-stage liver disease and allocation of livers to this category of patient has escalated. The frequency of combined liver-kidney transplantation (CLKT) has consequently increased. Indications for CLKT in children differ from those for adults and typically include rare congenital conditions; subsequently limited numbers of this procedure have been performed in paediatric patients worldwide. Scant literature exists on the subject. Methods. Subsequent to institutional approval, a retrospective chart analysis of all paediatric CLKTs performed at the Transplant Unit, Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa between January 2005 and July 2013 was conducted. Results. Defining children as younger than 18 years of age, 43 patients had received a liver transplant since 2005, of whom 8 received a CLKT. Indications included autosomal recessive polycystic kidney disease (n=3), primary hyperoxaluria type 1 (n=4) and heterozygous factor H deficiency with atypical haemolytic uraemic syndrome (n=1). Graft combinations included whole liver and one kidney (n=5), whole liver and two kidneys (n=1) and left lateral liver segment and one kidney (n=2), all from deceased donors. Patient age ranged from 4 to 17 years (median 9) and included 4 females and 4 males. Weight ranged from 13 to 42 kg (median 22.5). We describe one in-hospital mortality. The remaining 7 patients were long-term survivors with a survival range from 6 to 65 months. Conclusions. Although rarely indicated in children, CLKT is an effective treatment option, appropriately utilising a scarce resource and significantly improving quality of life in the recipient.

There is a general agreement that food habits change over time. This has been clearly shown in studies conducted in first world countries, but until recently this information has been lacking in South Africa, particularly among preschool children, although nutrition information is available on dietary intake at a particular point of time in some groups. Changing food habits may affect disease. With the rapidly changing socio-political situation in South Africa diet too must have changed and one cannot rely on previous nutritional information. New reliable information is needed to help plan future health needs of all South Africans. Dietary intake in association with dental health has been studied by numerous investigators. Regarding energy and specific nutrients, studies have thus far shown no relationship of energy to dental caries incidence; carbohydrate, particularly sugars, have shown both positive and negative relationships to caries incidence and indirectly dietary fats may be associated with low caries because fat and sugar intake are inversely proportional to each other. The role of trace elements has varied from caries promoting to cariostatic. It is clear though that because of the complex nature of the caries process, carbohydrate intake, together with other macro- and micronutrients, does not fully explain the development of this disease. This could be influenced by the fact that most of the studies conducted on diet and dental health have been cross-sectional. The Vipeholm study in Sweden, the Hopewood House study in Australia and more recently the Michigan study in the United States are the only longitudinal studies that have examined the association between diet and dental caries incidence and both the Vipeholm and Hopewood House studied only selected groups in institutions. Until now no true longitudinal study had been conducted among South African preschool children regarding the association between diet and the development of dental caries. The Birth-to-Ten study is the first such longitudinal study that selected a random sample representative of the population groups in the country and has provided unique information on the longitudinal dietary intake together with the dental health at 1- and 5- years. In addition no South African study has looked at the impact of past diet on the present dental health of the same South African children and the Birth-to-Ten study provided this opportunity.

This dissertation investigated teacher perceptions about adaptive skill training within an early childhood comprehensive development classroom for students with intellectual disabilities. The purpose of this study was to gain a better understanding about adaptive skills from a teacher's perspective. The aims of the study were to help educators understand the role of comfort level, importance of adaptive skills, planning for adaptive skills, and connecting adaptive skills to an academic outcome. A quantitative, cross-sectional design was used, and an online survey was completed by 254 special education teachers. The participants that completed the survey were 93% female and on average had 14 years of teaching experience. The survey gathered teachers' opinions about adaptive skills. It was reported that teachers felt adaptive skills were important to teach in the classroom environment. The teachers also reported that toileting was the most important adaptive skill. The survey also found that teachers explicitly teach adaptive skills on a daily basis. The survey also revealed that instruction might improve if access to a structured curriculum was more readily available and age appropriate. It was reported that there were very limited opportunities for educators to attend professional development about adaptive skills. These findings communicated that adaptive skills seem to be important to educators, and the lack of availability for structured curriculums should be addressed to further meet the needs of students with intellectual disabilities.

Thesis advisor: Rebekah Levine Coley / Research on adverse childhood experiences (ACEs) has demonstrated the high prevalence rates of such experiences, with about 60% of individuals in national U.S. samples reporting one or more types of ACEs as children (Chapman et al., 2013; Finkelhor et al., 2015). Further, research has established robust links between ACEs and a range of negative behavioral and health outcomes in adulthood (Felitti et al., 1998; Hughes et al., 2017; Kalmakis & Chandler, 2015; Wang et al., 2020; Wang & Maguire-Jack, 2018; Wolff et al., 2018). Less is known about when potential negative consequences of ACEs exposure emerge. The few studies that have examined the relationship between ACEs and early outcomes have employed inconsistent modeling strategies which has left the functional form of the relationship unclear, which could lead to either under-or over-estimating the risk associated with various levels of ACEs exposure (Crouch et al., 2019; Hughes et al., 2017; Lanier et al., 2018; Wang et al., 2019). Further, these studies have not comprehensively examined the potential moderating role of socio-ecological factors like neighborhood context. Theoretical frameworks suggest neighborhood resources might buffer children from negative consequences associated with ACEs while exposure to neighborhood-level adversities might exacerbate negative consequences. In order to address these gaps, the currently study examined the functional form of the relationship between ACEs experienced in the first four years of life and kindergarten behavioral outcomes and tested the moderating role of neighborhood resources and neighborhood adversities in a large, nationally representative sample of young children drawn from the Early Childhood Longitudinal Study - Birth Cohort (ECLS-B; N ≈ 10,700) linked with neighborhood administrative data. Using inverse probability weighting to strengthen internal validity, numerous modeling strategies supported a linear relationship between early childhood ACEs and kindergarten behavioral outcomes. Greater ACEs exposure was associated with significantly lower prosocial skills and significantly higher externalizing behavior problems, with small effect sizes of 0.075 to 0.143 standard deviation shifts in behaviors for each additional ACEs exposure. Interaction models found that ACEs were significantly associated with behavioral consequences regardless of neighborhood context. Overall, the robust modeling strategies employed provide the strongest evidence to date of the significant, linear relationship between ACEs and early behavioral consequences. / Thesis (PhD) — Boston College, 2023. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

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This mixed-methods study explores childhood trauma with a primary focus on the beliefs and attitudes of elementary school administrators in their ability to offer trauma-informed leadership and assist their teachers in trauma-informed care (TIC) and education. Participants at various stages of their careers were recruited from elementary schools across 10 U.S. states (N = 240). Employing an explanatory sequential mixed method design, Phase I assessed school administrators’ attitudes using the attitudes related to trauma-informed care scale (ARTIC-45) (see Appendix A). Phase II employed semi-structured interviews to collect qualitative data to explain further and clarify the quantitative results. Findings suggest that elementary school administrators have positive attitudes related to trauma-informed care. Findings also suggest years of administrative experience shows a negative statistically significant relationship while the number of TIC training hours shows a positive statistically significant relationship to attitudes related to trauma-informed care. Analysis also suggests no statistically significant relationship between years of teaching experience and attitudes related to trauma-informed care. A closer examination of the ARTIC – 45 subscales indicate elementary school administrators have negative personal support attitudes toward TIC implementation and negative feelings about the systemwide support they receive from colleagues, supervisors, and administration to implement TIC.

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