Ariel - Volume 6 Number 3

Editors Mark Dembert J.D. Kanofsky Frank Chervenak John Lammie Curt Cummings Staff Ken Jaffe Bob Sklaroff Halley Faust Jim Burke Nancy Redfern Hans Weltin Photographer Larry Glazerman Overseas Editor Mike Sinason Humorist Jim McCan

Assessing First Visits By Physicians To Medicare Patients Discharged To Skilled Nursing Facilities

In this study of postacute care, more than 10% of Medicare skilled nursing facility (SNF) stays included no visit from a physician or advanced practitioner. Of stays with visits, about half of initial assessments occurred within a day of admission, and nearly 80% occurred within four days. Patients who did not receive a visit from a physician or advanced practitioner were nearly twice as likely to be readmitted to a hospital (28%) or to die (14%) within 30 days of SNF admission than patients who had an initial visit

Services within a busy period of an M/M/1 queue and Dyck paths

We analyze the service times of customers in a stable M/M/1 queue in equilibrium depending on their position in a busy period. We give the law of the service of a customer at the beginning, at the end, or in the middle of the busy period. It enables as a by-product to prove that the process of instants of beginning of services is not Poisson. We then proceed to a more precise analysis. We consider a family of polynomial generating series associated with Dyck paths of length 2n and we show that they provide the correlation function of the successive services in a busy period with (n+1) customers

Developing Special Education Advocates: What Changes during an Advocacy Training Program?

Background: Special education advocacy trainings, such as the Volunteer Advocacy Project (VAP), have the goal of training advocates who can eventually support families in accessing needed services for students with disabilities. In addition to the training goal of increasing participants\u27 special education knowledge and advocacy comfort, it is unknown if the VAP improves other participant outcomes related to later advocacy. Specific Aims: In this study, we asked: (1) Do VAP participants improve from pre‐ to post‐test on knowledge and advocacy comfort, as well as on role identity, involvement in the disability community, and empowerment?; (2) Do participants\u27 roles and levels of education moderate improvements in these outcomes?; and (3) Do participants who are differentially higher or lower on any of these variables at the pre‐test show greater improvement from pre‐ to post‐test on one or all other variables? Method: Participants included 70 graduates of the VAP from 2014 to 2016. These participants completed pre‐test and post‐test assessments with measures on: special education knowledge, advocacy comfort, role identity, involvement, and empowerment. Findings: Results showed significant change in knowledge, comfort, involvement, and empowerment from pre‐test to post‐test. Only level of education significantly moderated the change in role identity from pre‐test to post‐test, with those with high school education increasing their role identity compared to those with a college degree or more. Empowerment was closely related to pre‐test levels and to change scores for all other variables. Discussion: Implications for future research and practice are discussed, including the need to better understand moderators of treatment effect and mechanisms of change for advocacy trainings

Ariel - Volume 7 Number 1

Editors Mark Dembert Frank Chervanek John Lammie Jim Burke Nancy Redfern Business Alf Levy Photographer Larry Glazerman Staff Hal Faust Curt Cummings Bob Levin tOO mUCH (University Medical College Hospital - London

Mobilisation of arsenic from bauxite residue (red mud) affected soils: effect of pH and redox conditions

The tailings dam breach at the Ajka alumina plant, western Hungary in 2010 introduced ~1 million m3 of red mud suspension into the surrounding area. Red mud (fine fraction bauxite residue) has a characteristically alkaline pH and contains several potentially toxic elements, including arsenic. Aerobic and anaerobic batch experiments were prepared using soils from near Ajka in order to investigate the effects of red mud addition on soil biogeochemistry and arsenic mobility in soil–water experiments representative of land affected by the red mud spill. XAS analysis showed that As was present in the red mud as As(V) in the form of arsenate. The remobilisation of red mud associated arsenate was highly pH dependent and the addition of phosphate to red mud suspensions greatly enhanced As release to solution. In aerobic batch experiments, where red mud was mixed with soils, As release to solution was highly dependent on pH. Carbonation of these alkaline solutions by dissolution of atmospheric CO2 reduced pH, which resulted in a decrease of aqueous As concentrations over time. However, this did not result in complete removal of aqueous As in any of the experiments. Carbonation did not occur in anaerobic experiments and pH remained high. Aqueous As concentrations initially increased in all the anaerobic red mud amended experiments, and then remained relatively constant as the systems became more reducing, both XANES and HPLC–ICP-MS showed that no As reduction processes occurred and that only As(V) species were present. These experiments show that there is the potential for increased As mobility in soil–water systems affected by red mud addition under both aerobic and anaerobic conditions