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Rohit Pradhan,1 Bradley Beauvais,1 Zo Ramamonjiarivelo,1 Diane Dolezel,2 Dan Wood,3 Ramalingam Shanmugam1 1School of Health Administration, Texas State University, San Marcos, TX, 78666, USA; 2Department of Health Informatics and Information Management, Texas State University, Round Rock, TX, 78665, USA; 3Army-Baylor University MHA/MBA Program, U.S. Army Medical Center of Excellence, San Antonio, TX, 78234, USACorrespondence: Rohit Pradhan, ENC 264, School of Health Administration, Texas State University, 601 University Dr, San Marcos, TX, 78666, USA, Tel +1 (512) 245-6529, Email pradhan@txstate.eduIntroduction: Staffing is critical to hospital performance. However, in recent years, hospitals have struggled with severe staffing shortages, forcing them to rely on expensive agency staff to meet urgent patient care needs. This substitution of agency staff for permanent employees has raised concerns over its potential impact on financial stability. This study investigated the association of agency labor with hospital financial performance.Methods: Utilizing tenets from agency theory and transaction cost theory, data for the calendar year 2022 for active short-term acute care hospitals (n=2771) in the United States were analyzed using multivariable linear regression analysis. Hospital financial performance was assessed using three variables: net patient revenue, operating revenue per bed, and operating expense per bed. The independent variable was agency labor cost, representing the total expenditure on agency labor. Additionally, organizational and market-level control variables that may independently affect hospital financial performance were included.Results: Our regression findings indicated that agency labor cost was significantly associated with all three dependent variables: net patient revenue (β = 0.224, p < 0.001), operating revenue per bed (β = 0.042, p < 0.001), and operating expense per bed (β = 0.032, p < 0.001).Discussion: The results indicated that increased agency labor was associated with higher revenues, but it also corresponded with increased expenses. Therefore, hospitals should strategically use agency staffing to meet immediate operational needs while remaining cognizant of its financial implications. The judicious use of agency labor can help hospitals balance the benefits of increased revenue against higher costs, while ensuring that they still meet immediate patient needs.Keywords: agency staff, contract labor, hospital financial performance, healthcare staffing

Bradley Beauvais, Rohit Pradhan, Zo Ramamonjiarivelo, Michael Mileski, Ramalingam Shanmugam School of Health Administration, Texas State University, San Marcos, TX, USACorrespondence: Rohit Pradhan, Email pradhan@txstate.eduIntroduction: Staffing is critical to hospital quality, but recent years have seen hospitals grappling with severe shortages, forcing them to rely on contract or agency staff for urgent patient care needs. This shift in staffing mix has raised questions about its impact on quality. Consequently, this study investigated whether the increased use of agency staff has affected healthcare quality in hospitals. Given the limited recent research on this topic, practitioners remain uncertain about the effectiveness of their staffing strategies and their potential impact on quality.Methods: Drawing from agency theory, data were obtained from Definitive Healthcare which consolidates information from numerous public access databases pertaining to hospitals such as the American Hospital Association Annual Survey (hospital profile) and the Hospital Value-Based Purchasing Program (quality data). We conducted a cross-sectional study using a multivariable linear regression model (2021– 2022) with appropriate organizational and market- level control variables. Quality was measured across eight variables while the independent variable of interest was agency labor cost ratio operationalized as the percentage of net patient revenue consumed by agency labor expense.Results: Our results suggested that the employment of agency staff was significantly and negatively associated with six of eight quality measures tested, including the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) star rating, Hospital Compare rating, the hospital Total Performance Score (TPS), and three of the four sub-domains that comprise the TPS: clinical domain score, person and community engagement domain score, and the efficiency and cost reduction score.Discussion: Our results indicated that the increased use of agency labor may have a significant negative influence on quality outcomes at the hospital level. Our findings support the premise that interventions that promote full-time staffing may be more supportive of the quality of care delivered as well as patients’ perceptions of care.Keywords: hospital, quality, patient safety, contract staffing, agency staffing

Bradley Beauvais, Michael Mileski, Zo Ramamonjiarivelo, Kimberly Ann Lee, Clemens Scott Kruse, Jose Betancourt, Rohit Pradhan, Ramalingam Shanmugam School of Health Administration, Texas State University, San Marcos, TX, USACorrespondence: Bradley Beauvais, School of Health Administration, Texas State University, San Marcos, TX, USA, Tel +1 (210)627-1078, Email bmb230@txstate.eduBackground: Although hospitals have been the traditional setting for interventional and rehabilitative care, skilled nursing facilities (SNFs) can offer a high-quality and less costly alternative than hospitals. Unfortunately, the financial health of SNFs is often a matter of concern. To partially address these issues, SNF leaders have increased engagement in a number of affiliations to assist in improving quality and reducing operational costs, including Accountable Care Organizations (ACOs), Health Information Exchanges (HIEs), and participation in Bundled Payment for Care Improvement (BPCI) programs. What is not well understood is what impact these affiliations have on the financial viability of the host organizations. Given these factors, this study aims to identify what association, if any, exists between SNF affiliations and revenue generation.Methods: Data from calendar year 2022 for n=13,447 SNFs in the US were assessed using multivariate regression analysis. We evaluated two separate dependent measures of revenue generation capacity: net patient revenue per bed and net patient revenue per discharge and considered three unique facility affiliations including (1) ACOs, (2) HIEs, and (3) BPCI participants.Results: Six multivariable linear regressions revealed that ACO affiliation is negatively associated with revenue generation on both dependent measures, while HIE affiliation and BPCI participation reflected mixed results.Conclusion: A better understanding of the financial impact of SNFs’ affiliations may prove insightful. By carefully considering the value of each affiliation, and how each is applicable to any given market, policymakers, funding agencies, and facility leaders may be able to better position SNFs for more sustainable financial performance in a challenging economic environment.Keywords: skilled nursing facilities, accountable care organizations, health information exchanges, bundled payment for care improvement, revenue, discharges

Abstract The fine particles generated by the foundry industry are present in the atmosphere; they have an impact on the climate because of their influence on atmospheric radioactive phenomena. As a result of this scenario, there is a rising amount of legislation restricting the emission of pollutants from foundry industries and related businesses. In response to this situation, many researchers have concentrated on end-of-pipe technologies, one of which is the wet scrubber, which is a device that is primarily used in foundries to control pollution and is one of the devices that has been incorporated. The disadvantage of using this wet scrubber, on the other hand, is that it contributes to secondary pollution when it is used. In order to combat secondary pollution, a model of an enhanced wet scrubber system that incorporates a multi-sand filtering technology was developed. The performance of this redesigned wet scrubber system was evaluated with the use of computational fluid dynamics (CFD) software. In CFD, the Reynolds stress model was applied for simulation. The pressure magnitudes and velocity magnitudes are obtained by this simulation. The volume fraction of the dust was evaluated through the DPM approach. Because of the introduction of the filtration tank's computation, it was discovered that successful filtration was accomplished using sand filters, meaning that environmental chemicals and particles were totally filtered from 0.17 kg at the entrance to zero kg of particles at the outflow.

Ramalingam Shanmugam,1 Gerald Ledlow,2 Karan P Singh3 1School of Health Administration, Texas State University, San Marcos, TX, 78666, USA; 2Department of Healthcare Policy, Economics and Management, School of Community and Rural Health, The University of Texas at Tyler Health Science Center, Tyler, TX, 11937, USA; 3Department of Epidemiology and Biostatistics, The University of Texas at Tyler Health Science Center, Tyler, TX, 11937, USACorrespondence: Karan P Singh Email karan.singh@uthct.eduAbstract: This article provides a thorough explanation of methods and theoretical concepts to detect infectivity of COVID-19. The concept of heterogeneity is discussed and its impacts on COVID-19 pandemics are explored. Observable heterogeneity is distinguished from non-observable heterogeneity. The data support the concepts of heterogeneity and the methods to extract and interpret the data evidence for the conclusions in this paper. Heterogeneity among the vulnerable to COVID-19 is a significant factor in the contagion of COVID-19, as demonstrated with incidence rates using data of a Diamond Princess cruise ship. Given the nature of the pandemic, its heterogeneity with different social norms, pre- and post-voyage quick testing procedures ought to become the new standard for cruise ship passengers and crew. With quick testing, identification of those infected and thus, not allowing to embark on a cruise or quarantine those disembarking, and other mitigation strategies, the popular cruise adventure could become norm for safe voyage. The novel method used in this article adds valuable insight in the modeling of disease and specifically, the COVID-19 virus.Keywords: observed heterogeneity, non-observed heterogeneity, over dispersion, under dispersion, Poisson distribution, binomial distribution, Tango’s test statistics

Ramalingam Shanmugam,1 Karan P Singh2 1School of Health Administration, Texas State University, San Marcos, TX, 78666, USA; 2Department of Epidemiology and Biostatistics, School of Community and Rural Health, The University of Texas Health Sciences Center at Tyler, Tyler, TX, 75708, USACorrespondence: Karan P SinghDepartment of Epidemiology and Biostatistics, School of Community and Rural Health, The University of Texas Health Sciences Center at Tyler, Tyler, TX, 75708, USAEmail karan.singh@uthct.eduBackground: Challenges to manage, mitigate, or prevent the COVID-19’s pandemics are felt by medical, healthcare professionals and governing agencies. Health researchers conduct survey among the citizens to capture their opinion on COVID-19. In such surveys like in Hanafiah and Wan (2020), structural-zero (different from sampling zero) category occurs as they question about perception, knowledge, and communication regarding COVID-19.Materials: The data were collected in a survey conducted among Malaysians by Hanafiah and Wan regarding COVID-19. The survey focused on people’s response about the public communication, knowledge, and perception.Methods: One of the four question categories in the survey is mutually exclusive with the other three questions. Consequently, there will be no entry in that category. Such group is called structurally zero category in the literature. The literature never probed the migrative split to other categories of the unknown proportion belonging to the structural zero category. In this article, the probability-based new and innovative method configures what proportion in that mutually exclusive category and it is the essence of our method.Results: The mutually exclusive nature of subquestions manufactured structural zero in their data. A careful analysis of the data has created so far unknown probability concepts in the literature, which we named as “Exodus probabilities” in this article. Its discovery and utility are illustrated and elaborated with application in COVID-19. This methodology is also useful in applications in engineering, epidemiology, marketing, communication networking, etc.Conclusion: What is quite novel about the discovery of the exodus probability in this article is the evolution of the concepts from the structural-zero category. In such situation, when a category is eliminated, the proportions of the sample might have uncommunicatively transited to other viable categories and our research question is all about configuring their proportions. This is an innovative approach.Keywords: public knowledge, perception, communication, sample space, dependent probabilities, Venn layout, odds, odds ratio, survey outcomes

Titanium dioxide (TiO2) nanoparticles were prepared through Rosmarinus-officinalis leaf extracts at 90 and 200°C. In this research, the degradations of methylene blues by using TiO2 nanoparticles Sun light radiations were studied. The synthesized materials were characterized using XRDs, UV-Vis, PL, SEM, TEM, EDS and XPS. The results displayed that bio-synthesis temperatures intrude the shapes and sizes of TiO2 nanoparticles. For TiO2-90, micrographs show separable crystalline with irregular morphologies and agglomerate cubic particles. For the other TiO2-200 sample, SEM and TEM micro-imaging shows crumbly agglomerated cubic structures. The XRD shows that the intense peaks observed at angles of 25.37°, 37.19°, 47.81° and 53.89° confirming a highly crystalline oriented as (004), (200), and (105) planes respectively. The optical properties of TiO2 nanoparticles synthesized were conveyed by PL and UV-Vis. The energy band gap calculated was 3.0 eV for both samples; that indicates heating temperature didn't influence the band gap of the samples. The elemental composition Ti and O2 is shown by EDS and XPS. Photo-catalytic experiments discovered that TiO2-90 nanoparticles were well-organized in photo-degradations of MB, likened to TiO2-200. The great activities of TiO2-90 were because of better physicochemical characteristics associated with TiO2-200 effectively degrading MB under photo-light. Photo-degradations of dye under sunlight as plentifully obtainable energy sources by TiO2, synthesized by simpler techniques, can be hopeful to grow an eco-friendly and economical process. [ABSTRACT FROM AUTHOR]

Right from the olden days, many products have been made according to foundry practices in order to generate prosperity in the societies in which they operate while reaping these types of benefits through the operation of foundries. It is alarming that the emissions released by foundries affect human health. Therefore, foundries installed Pollution Control devices (PCDs), in accordance with this development; researchers examined the effectiveness of these PCDs in controlling emissions from foundries in different parts of the world. The emission control obtained by installing these PCDs is explained in this article based on the data gathered from the survey. The cartridge filter equipped with an induction furnace reduced the concentration of SPM to less than 20 mg/Nm3. This result of the investigation indicates that the cartridge filter built into the induction furnace achieves the best efficiency in controlling contaminants from iron foundries. Interestingly, the operation of the cartridge filter has yet to be documented. Therefore, the construction operation, the performance of the cartridge filter, and its efficiency in achieving contaminations control in foundries are described. This will provide useful information on the use of cartridge filters in an induction furnace to reduce Iron foundry emissions.