Social Skill Development in Teenagers with Autism Who Are Homeschooled in Rural Southwest: A Phenomenological Study of the Lived Experience of Caregivers

The purpose of this hermeneutic phenomenological study was to describe the caregiver\u27s lived experience of social skill development in their teenage or young adult students who have autism. Vygotsky\u27s social constructivism theory frames the structure of social development within the student\u27s family, community, and local culture. The central research question guiding this study was, what were the caregivers\u27 lived experiences of social interactions with their homeschooled teenager or young adult diagnosed with autism? All participants were caregivers of teenage or young adult students diagnosed with autism who received all or part of their schooling through homeschooling, micro-schooling, or habilitation services in their home in the rural Southwest United States. Data was collected in person and via electronic means (e.g., video conferencing) through journal writing, individual interviews, and focus groups. Journals, individual interviews, and focus groups were analyzed to triangulate the data to improve the reliability and validity of the data collected. Themes within the caregiver\u27s lived experience were compared with themes that emerged across each caregiver\u27s lived experience to identify effective practices for developing social skills among teenage and young adult students with autism. Themes developed from the data were caregiver resources and challenges, intervention services and planning for the future, and social maturation. By keeping their true natural environment constant during their formative years, teenagers and young adults may have better success at learning functional communication and self-regulation skills, which are foundational to learning social skills. Social skills, in turn, are foundational to successful integration into communities and workplaces and may help alleviate comorbidities of depression and mental illnesses

Cost accounting for public utilities

Cost accounting for public utilities is much broader in its scope and more intricate than cost accounting for a manufacturing concern, in that public utilities sell service instead of a manufactured product, and in rendering this service are regulated, or, in a sense, governed by Federal and state regulations imposed upon them. These regulations often limit and restrict the utility from collecting a fair return for the service rendered. In many instances utilities do not have an adequate system of accounting installed to show the true cost of rendering service, and it is difficult for them to defend what they consider fair rates before the Commission under whose jurisdiction they operate. When accounting systems do not reflect the true separate capital and operating costs, it becomes necessary to re-write many of the book accounts and to appraise the property in order to determine the cost or value of the property and cost of operations for rate making purposes. This article will be confined specifically to three classes of utilities, to wit: (a) Electric Utilities, (b) Water Utilities, (c) Railroad Utilities

The impact of live supervision on the family therapist\u27s level of immediacy, anxiety, responsiveness, and genuineness

The effects of live supervision via telephone on therapists was explored. Three supervisors experienced in live supervision were each asked to supervise live, two family therapists until they had each made a minimum of three phone interventions per therapist. The therapists\u27 behavior two minutes immediately before the interventions and two minutes immediately after the phone interventions were then rated by judges using nonverbal and scale measures. Therapists\u27 behavior were rated on the following factors: anxiety, responsiveness, immediacy, and genuineness. The results did not indicate any significant differences between therapist\u27s behavior before and after phone interventions, and only modest differences in behaviors between therapists using different supervisors. The findings are supportive of live supervision as there was no evidence the live interventions affect the therapists negatively on the above dimensions. The findings are discussed with implications for the field of supervision

Does the inclusion of the cost and burden of adverse drug reactions associated with drug-resistant TB treatment affect the incremental cost-effectiveness of new treatment regimens? A case study from the introduction of bedaquiline in South Africa National TB Programme

South Africa has one of the world’s highest burdens of TB, HIV/TB co-infection, and drug-resistant TB. Second-line TB treatment is less effective, more expensive, and more toxic than treatment for drug-sensitive TB. Nearly 1 in every 5 persons who starts treatment for drug-resistant TB in South Africa will die; 1 in every 3 persons who survives treatments experiences permanent, profound hearing loss. For decades there was little progress in TB research, however, and so treatment with old regimens continued despite safety concerns. In 2012 the US and European regulatory authorities approved a new drug, bedaquiline, but only for treatment in cases with no other options. In 2015, the South African Medicines Control Council approved bedaquiline for drug-resistant TB, but only a limited number of doses were approved in the 2016/2017 annual budget and the focus, again, was only for the patients who had no other options. In order to inform policy makers in planning and budgeting for drug-resistant TB treatment, the aim of this thesis was to determine whether the simple calculation that bedaquiline was too expensive relative to standard regimens using kanamycin was too simple. Particularly, given the high burden of adverse drug reactions (ADR) associated with kanamycin, would the inclusion of the cost and burden of ADR affect the incremental cost effectiveness ratio of a new treatment regimen where bedaquiline replaces kanamycin? Analysis of the national drug-resistant TB case register showed that mortality during second-line treatment was early, primarily in the first 6 months of treatment, even when patients do not have extensive drug resistance. HIV-positive patients not on anti-retroviral therapy (ART) at initiation of drug-resistant TB treatment have the highest risk of mortality. The high early mortality is a real risk that clinicians have to balance when deciding to initiate ART and effective second-line TB treatment both as quickly as possible. Daily injections coupled with taking more than 10 pills each day are a heavy burden for patient compliance, but also pose concerns in terms of overlapping and compounding toxicities; this burden was confirmed through a meta-analysis of the pooled frequency of adverse events among cohorts with at least 25% of the patients HIV-positive. A competing risk analysis of a cohort of drug-resistant TB patients from Johannesburg – addressing the reality that patients may not have experienced an ADR because they died rather than because they were at lower risk – indicated that HIV-infected patients who are not yet stable on ART and second-line TB treatment are at the highest risk of ADR. A Markov model built and parameterized using the data from the South African national TB programme indicates that bedaquiline for all drug-resistant TB led to a small gain in effectiveness at a cost that was under the costs of the drug itself, due to savings from daily injection visits. While cost-effective, it was not clear that South African policy makers needed to move beyond the offer of bedaquiline for patients with extensive drug resistance. However, the calculation, and the decision point, were different once the costs and disability associated with ADRs was included in the analysis. Bedaquiline-based regimens offer a cost-saving and more effective alternative to an injection-based regimen for drug-resistant TB patients treated in the public sector in South Africa

ASPEN simulation of the SNG production process in an indirect coal-liquefaction plant

The synthetic natural gas (SNG) production process (methanation, CO-shift, and hydrogen removal) in an indirect coal-liquefaction plant was simulated using the Advanced System for Process Engineering (ASPEN). The simulation of the methanation unit agreed to within 12% of Fluor's design for converting carbon monoxide and carbon dioxide. A parametric study examined the effect of four important operating parameters on product composition, process thermal efficiency, and outlet temperature from the second methanation reactor. The molar split of gas feed to the CO-shift unit before methanation was varied from 0.2 to 0.6; variations of molar recycle ratio (0.01 - 0.67), molar steam-to-feed ratio (0.04 - 0.19), and feed temperature (478 - 533 K, 400-500/sup 0/F) to the first methanation reactor were also studied. A 50%-lower split improved thermal efficiency by 6%, but the mole % hydrogen and carbon monoxide in the product SNG required to meet pipeline-quality standards and temperature constraints were not met. Increasing the steam-to-feed ratio from 0.04 to 0.19 improved product quality but decreased thermal efficiency by 8%. By decreasing the feed temperature from 533 to 477 K (500 to 400/sup 0/F), product specifications and temperature constraints were met with no effect on thermal efficiency. However, it may be impractical to operate the reactor at 477 K (400/sup 0/F) because the kinetics are too slow. Increasing the recycle ratio from 0.4 to 0.67 had no effect on thermal efficiency, and temperature constraints and product specifications were met. The SNG production process should be optimized at recycle ratios above 0.67

Electric Sector Policy, Technological Change, and U.S. Emissions Reductions Goals: Results from the EMF 32 Model Intercomparison Project

The Energy Modeling Forum (EMF) 32 study compares a range of coordinated scenarios to explore implications of U.S. climate policy options and technological change on the electric power sector. Harmonized policy scenarios (including mass-based emissions limits and various power-sector-only carbon tax trajectories) across 16 models provide comparative assessments of potential impacts on electric sector investment and generation outcomes, emissions reductions, and economic implications. This paper compares results across these policy alternatives, including a variety of technological and natural gas price assumptions, and summarizes robust findings and areas of disagreement across participating models. Under a wide range of policy, technology, and market assumptions, model results suggest that future coal generation will decline relative to current levels while generation from natural gas, wind, and solar will increase, though the pace and extent of these changes vary by policy scenario, technological assumptions, region, and model. Climate policies can amplify trends already under way and make them less susceptible to future market changes. The model results provide useful insights to a range of stakeholders, but future research focused on intersectoral linkages in emission reductions (e.g., the role of electrification), effects of energy storage, and better coverage of bioenergy with carbon capture and storage (BECCS) can improve insights even further

Electric sector policy, technological change, and U.S. emissions reductions goals: Results from the EMF 32 model intercomparison project

The Energy Modeling Forum (EMF) 32 study compares a range of coordinated scenarios to explore implications of U.S. climate policy options and technological change on the electric power sector. Harmonized policy scenarios (including mass-based emissions limits and various power-sector-only carbon tax trajectories) across 16 models provide comparative assessments of potential impacts on electric sector investment and generation outcomes, emissions reductions, and economic implications. This paper compares results across these policy alternatives, including a variety of technological and natural gas price assumptions, and summarizes robust findings and areas of disagreement across participating models. Under a wide range of policy, technology, and market assumptions, model results suggest that future coal generation will decline relative to current levels while generation from natural gas, wind, and solar will increase, though the pace and extent of these changes vary by policy scenario, technological assumptions, region, and model. Climate policies can amplify trends already under way and make them less susceptible to future market changes. The model results provide useful insights to a range of stakeholders, but future research focused on intersectoral linkages in emission reductions (e.g., the role of electrification), effects of energy storage, and better coverage of bioenergy with carbon capture and storage (BECCS) can improve insights even further