MSc (Med), Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand / Objectives: To evaluate differences in virologic outcomes between adolescents and pre-adolescents initiated on HAART and to determine the patient baseline variables associated with virologic suppression. Design: Retrospective cohort study using routinely collected clinic and outcome data. Setting: Public sector HIV paediatric facility at Harriet Shezi Children’s Clinic (Chris Hani Baragwanath Hospital) Soweto, South Africa. Patients: HIV infected pre-adolescents (5 to < 11 years) and adolescents (11 to <18 years) initiating HAART between 1 April 2004 and 31 December 2008. Main outcomes and measures: Primary: virologic suppression (HIV viral load ≤ 400 copies/ml) and viral rebound (single HIV viral load ≥ 400 copies/ml after initial suppression) at 24, 48, 72 and 96 week follow up intervals. Secondary: determination of baseline variables associated with virologic suppression. Survival analysis was performed using the Kaplan Meier method and modelling was based on Cox proportional hazards. Results: Both groups exhibited similar incidence rates of virologic suppression by the 24th week from HAART initiation. Adolescents had a slightly lower incidence rate of early virologic suppression in comparison to pre-adolescents (197/100 person years vs. 203/100 person years). However, the observed difference was not statistically significant at 5% significance level (IRR: 0.97, 95%CI: 0.81 - 1.15). In a sub-group of children who had not virologically suppressed by the 24th week (168 days) of follow up, adolescents were 42% less likely to achieve virologic suppression after this time point than pre-adolescents ([IRR: 0.58, 95%CI: 0.35, 0.93). In the sub-group of all female participants, lower hazards of virologic suppression by the 24th week (aHR 0.76, 95%CI 0.59-0.99) and 96th week (aHR 0.70, 0.55-0.90) of follow up were observed among female adolescents when compared with female pre-adolescents. Additionally, clinically advanced disease was observed as a risk factor for non-virologic suppression by the 96th week of follow up among participants of all ages (aHR 0.75, 95%CI 0.64 -0.87). After 60 weeks from the initial virologic suppression, adolescents were twice more likely to experience rebound after this point than pre-adolescents (IRR: 2.33, 95%CI: 1.00 - 5.13). Conclusion: Given the potential for resistant strains of the HIV virus and the public health threat this presents, health care teams face complicated dilemmas regarding initiation of HAART to adolescents, particularly female adolescent patients who are likely to be non-adherent. Findings from the study advocate for intensified adherence and treatment support for all adolescents initiated on HAART to achieve virologic suppression within the first 6 months of treatment, a time after which they have been shown to exhibit inferior virologic suppression rates. Once virologic suppression has been attained, adolescents require prolonged treatment support to maintain long term virologic suppression at levels observed among pre-adolescents. We recommend further research into the comparison of virologic outcomes between pre-adolescents and adolescents on HAART, through prospective study designs. Qualitative study designs are also important to bridge the knowledge gaps on the barriers to HAART encountered by female adolescents.

Thesis advisor: Karen D. Arnold / As students increasingly incur high amounts of debt for their undergraduate education, there is heightened concern about the long-term implications of loans on borrowers, especially borrowers from low socioeconomic backgrounds. Drawing upon the concepts of cultural capital and habitus (Bourdieu & Passeron, 1977) and the human capital framework (Becker, 1993), this research explores how student debt and social class intersect and affect individuals' trajectory into adulthood. A total of 50 interviews were conducted with young adults who had incurred $30,000 to $180,000 in undergraduate debt and who were from varying social classes. The findings explore how four categories of students -<italic>Insiders, Entrepreneurs, Pioneers, and New Moneys</italic>- varied along dimensions of economic and cultural wealth, and experienced their college search, college education, and transition to the workforce differently. The findings point to the immense role that habitus (Bourdieu, 1986) plays in shaping borrowers' educational experiences and post-graduation outcomes: Individuals' embodied cultural capital shaped their educational experiences and interactions with institutions and the labor market. Those who had high levels of cultural resources tended to have a more rigorous college search, stronger academic orientation, and greater student involvement during college. Compared to other students, they were more likely to transition to high-paying, high-status professional positions after graduation and attend graduate school. In contrast, individuals with low cultural resources tended to have a more casual college search, were more prone to encountering errors with their financial aid, spent a great deal of time working during college, and later faced underemployment in the labor market. They were less likely to report benefiting from a social network and their credential in the labor market and more likely to express regret about their debt and college education. The findings illustrate the inequitable payoff that college and debt have for borrowers with varying levels of cultural resources, and suggest that loans can serve as a form of social reproduction. A conceptual model outlines the factors associated with incurring high levels of debt and illustrates how they relate to borrowers' college experiences and lives post-graduation. In highlighting how debt exacerbates social inequities and the risks it can pose to students, especially students with low income and cultural resources, the findings call for higher education institutions to conduct a comprehensive review of their practices and services from the time students apply to college to after they graduate. Enhanced supports at high schools and community organizations can also assist families, particularly in encouraging participation in early savings plans and strengthening their financial literacy. Additionally, increased governmental scrutiny of borrowing can help protect students from over-indebtedness. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Lynch School of Education. / Discipline: Educational Leadership and Higher Education.

Thesis advisor: Mary E. Walsh / Childhood obesity is a pervasive health issue in the United States. Research has demonstrated that various correlates are associated with the onset and maintenance of overweight status, including physical health conditions, psychological well-being, interpersonal relationships, family functioning, and educational attainment. Policymakers and educators have agreed that elementary and secondary schools are crucial settings for the promotion of healthy development and ameliorating obesity. Therefore, comprehensive school-based interventions that collaborate with community agencies are being implemented to improve the achievement and well-being of at-risk students. The present study focused on City Connects, an optimized student support intervention grounded in relational developmental systems theory that functions in predominantly high-poverty urban locations. City Connects recognizes students as possessing unique constellations of protective and risk factors (i.e., strengths and needs), and an integral aspect of the intervention is that it connects students to tailored services to enhance strengths and address needs. The endeavor of the present study was to examine K-5 students that City Connects identified as manifesting with overweight issues via a holistic, collaborative assessment process, and how these students differed from peers not designated as overweight. Findings indicated statistically significant differences across the groups, in terms of demographic characteristics, overall level of perceived risk, strengths and needs recognized, school-related academic and thriving outcomes, and the influence of specific psychosocial and familial strengths and needs on those school outcomes. Specifically, students presenting with overweight concerns were more likely to be from lower socioeconomic backgrounds; have a high association with special education service needs; represent a more intensive overall risk level; manifest a diverse array of strengths and needs across academic, social-emotional/behavioral, family, and health/medical domains; and mostly exhibit poorer school performance. The effects of certain strengths and needs moderated school performance differences in several instances. Implications for theory, policy, and practice are discussed, with recommendations for future research. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

Thesis advisor: Jacqueline Lerner / Previous research has found higher levels of school engagement to be related to various positive outcomes such as higher academic achievement, higher levels of competence, lower depression, and better personal adjustment. Overall, there is strong evidence to suggest a broad positive association between school engagement and a variety of academic, social, and emotional outcomes. However, existing work has certain limitations and some important questions remain to be addressed. In an effort to address the limitations of previous research, this study aimed to establish the within and across time relationships between family and contextual variables and school engagement. The sample for this longitudinal study included 596 students who were part of the 4-H Study of Positive Youth Development. These students were first surveyed in the fifth grade and completed subsequent questionnaires in the 6th and 7th grade (44% male; 56% female). In addition to the CES-D, several scales were constructed from the broad array of measures used in the 4-H study. The goals of this research were to identify the within and across time family and contextual predictors of school engagement, the predictors of the emotional and cognitive outcomes that result when adolescents are engaged in school, and to determine whether school engagement acts as a mediator between the variables of school climate, teacher support and parental involvement and the outcomes of grades, perceived academic competence, depression, educational aspirations, and educational expectations. The effects of gender, SES, and race were also examined. Statistical tools including regression analysis and tests of mediation were used. The findings indicated that the predictors of school engagement varied for 5th, 6th, and 7th graders in this sample. The changing predictors of school engagement and thus, the ways in which school engagement mediated the relationships between family and contextual variables and developmental outcomes demonstrated the fluidity of the adolescent and their changing needs and influences. These findings also illustrated the value of the longitudinal design of this study. / Thesis (PhD) — Boston College, 2008. / Submitted to: Boston College. Lynch School of Education. / Discipline: Applied Developmental and Educational Psychology.

Thesis advisor: Marilyn Cochran-Smith / Preparing students to participate in a democratic society means cultivating citizens who are capable of making informed, rational decisions about complex issues related to the common good. In order to do this, teachers need to provide students learning opportunities that promote critical thinking and involve in-depth examination of meaningful content. Drawing on Gutmann's (1987) theory of democratic education, this dissertation examines how beginning teachers who were prepared in a teacher education program that emphasized social justice and democratic practices think about and engage their students in this type of work. Specifically, using Newmann's (1996) framework of "authentic intellectual work" as an indicator of knowledge consistent with democratic education, this dissertation examines the extent to which the learning opportunities teachers create and the work that students produce demonstrate authentic intellectual work and examines the degree to which teachers' understandings of student learning align with authentic intellectual work. This qualitatively-oriented mixed methods study (Creswell, Plano Clark, Gutmann, & Hanson, 2003; Morse & Niehaus, 2009) used quantitative and qualitative methods concurrently to examine 11 beginning teachers' experiences during the preservice period and first two years of teaching. Using the Teacher Assessment/Pupil Learning protocol, this study draws upon quantitative methods to evaluate teachers' assessments/assignments (n=53) and students' work (n=481) on these assignments and qualitative methods to analyze interviews (n=54). Findings suggest that these beginning teachers and their students engaged in "moderate" levels of authentic intellectual work, although this varied widely. The quality of assessments was positively correlated to the quality of student learning. The degree to which teachers fostered authentic learning opportunities is complicated by teachers' beliefs about assessment and student learning and particular contextual factors such as time, accountability frameworks, classroom management, student ability, and content area. Teachers whose goals for learning aligned with authentic intellectual work were more likely to construct more authentic learning opportunities. This dissertation argues that evaluations of teacher performance and student learning must account for the quality of learning and utilize multiple measures of evaluation. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Lynch School of Education. / Discipline: Teacher Education, Special Education, Curriculum and Instruction.

The European Commission has been negotiating Economic Partnership Agreements (EPAs) with Regional Economic Communities of African, Caribbean and Pacific Group of States since 2002. The outcomes have been mixed. The negotiations with the Caribbean Forum (CARIFORUM) concluded rather more quickly than was initially envisaged, whereas negotiations with West African Economic Community (ECOWAS) and the remaining ACP regions have been dragging on for several years. This research consequently addresses the key question of what accounts for the variations in the EPA negotiation outcomes, making use of a comparative research approach. It evaluates the explanatory power of three research variables in accounting for the variation in the EPA negotiations outcomes – namely, Best Alternative to the Negotiated Agreement (BATNA); negotiation strategies; and the issues linkage approach – which are deduced from negotiation theory. Principally, the study finds that, the outcomes of the EPA negotiations predominantly depended on the presence or otherwise of a “Best Alternative” to the proposed EPA; that is then complemented by the negotiation strategies pursued by the parties, and the joint application of issues linkage mechanism which facilitated a sense of mutual benefit from the agreements.

The purpose of this study was to contribute to the literature on the educational outcomes and protective factors (i.e., support systems) in the lives of Latino immigrant youth, with a special emphasis on how these experiences relate to and are impacted by their migration experiences. Using the cultural-ecological theoretical framework and the Stages of Migration framework, this study utilized an existing data set to explore the relationships between migration stress, psychological distress, experiences of discrimination, and awareness of discrimination in relation to educational outcomes in a sample of 281 Latino immigrant youth. These relationships were then examined to see if they differed as a function of perceived support, gender, and school type (i.e., middle school versus high school). Structural equation modeling was utilized to test the hypothesized model that included migration stress, psychological distress, and education outcomes. The structural model showed very good fit. Results suggest that migration stress has a significant direct effect on psychological distress and on educational outcomes among Latino immigrant youth. Participants reporting high migration stress reported greater psychological distress and had poorer educational outcomes with respect to academic grades, educational aspirations, and educational expectations. Moderation testing indicated the structural model did not vary as a function of perceived support, gender, or school. Implications for research and practice are discussed.

This research uses a mixed methods approach to explore the both the preparation for and perceptions of graduate consultant writing center work. A review of literature shows a gap in both the knowledge surrounding graduate writing consultant education and the long-term outcomes or transfer of writing center training and work to post-graduate careers. The survey instruments in this study draw from two established studies, the Peer Writing Tutor Alumni Research Project and the National Census of Writing, while a request for curricular artifacts draws on case study research conducted by Jackson et al. Findings indicate that graduate consultants are being prepared for their work in writing centers, but that directors are not intentionally including discussions of how that work may transfer into academic careers, particularly those in writing center leadership. Despite this, current and alumni graduate consults report both immediate and long-term transfer of writing center experiences, skills, and knowledge into their occupations. The transfer of learning is perceived as being most profound for those who have remained in the academy as either professors or administrators. This research has implications for graduate students, directors, and institutions, and I conclude with an analysis of how directors can be more intentional in their work with graduate consultants in order to better prepare a new generation of writing center administrators who are aware of the academic, political, and scholarly opportunities that are possible through writing center careers.

The first chapter assesses the impact of the cohort size on labour market outcomes. Using exogenous variation and micro-level data for France, the UK and the US, we study the effect of supply shocks measured at different ages on unemployment rates and wages during a cohort's life cycle. The results from an IV estimation show that the largest magnitude of the effects is found when the cohort size is measured at age 25. The impact of both wages and unemployment rates are temporary, however, both decreasing with time. The second chapter analyses the effects of large inflows of foreign students on English undergraduates. Our results confirm previous findings that there is no overall effect, but we identify changes in the distribution of natives. We find that top performing English students are crowded in by foreign students. It is also mainly English-born males, natives who do not have English as their mother tongue and those of Asian ethnic origins that are crowded in by foreign students. In chapter three, we aim to understand the short-term effects of changes in the level of the tuition fees charged by English universities on students' geographic mobility. Our results suggest that the increase in tuition fees in 2006/07 charged by English universities led students to enrol into universities that are closer to home, with a larger effect experienced by men and White students. Moreover, we find that students are less likely to move to universities located in rich areas.

An extensive body of literature supports the clinical utility and feasibility of client-centric goal-setting techniques in neurorehabilitation. However, such techniques are seldom used and difficult to adopt in mainstream clinical practice. Two primary barriers that limit uptake and adoption of individualized goal-setting techniques into routine practice include: (1) lack of an operationalized framework susceptible to variations in the characteristics of the user and constraints of a medical setting and (2) limited knowledge on the part of clinicians and clients to confidently engage in goal-setting conversations. The eGAS app was designed to address the need for a semi-structured client-centric goal-setting framework for clinicians engaged in neurorehabilitation. This study used a single-subject design to investigate the effects of using eGAS in an outpatient hospital setting on clinician behavior and client responsiveness. A nonconcurrent, multiple-baseline design was used across three clinicians to determine if use of eGAS would result in functional changes in collaborative interviewing behaviors, validity of generated goal scales, and reliability of the process. Results revealed that using eGAS had strong functional effects on collaborative interviewing behaviors and validity of goal scales, and a weak effect on reliability. Another noteworthy finding was that eGAS could be implemented with relatively high fidelity within the constraints of a clinical context despite variations in the characteristics of the end-user, i.e. clients and clinicians. I discuss support for ecological validity of eGAS in terms of implementation barriers and facilitators that affected outcomes, methodological limitations, and future steps to improve design validity and implementation integrity.