A multi-level time-series analysis for forecasting and operational planning in pharmaceutical services: A case study

PurposeThe purpose of this paper is to explore how public (i.e. culture, state, paid work) and private (i.e. household) patriarchal structures work to shape a woman’s own legitimacy judgments concerning not engaging in paid work. The authors trace the intersection and interaction of legitimacy logics at both the collective (i.e. validity) and individual (i.e. propriety) levels, thereby gaining a better contextual understanding of each woman’s perception of career opportunities and limitations.Design/methodology/approachQualitative methodology drawing from 35 semi-structured interviews with Lebanese women. A multilevel analytic framework combining the institutional structures of private and public patriarchy with the micro-processes of institutional logics is used.FindingsLegitimization of (not) engaging in paid work is often tied to patriarchal logics that favor private sphere responsibilities for women, particularly related to the relational and instrumental logics of childrearing and husband-oriented responsibilities. Women’s legitimacy judgment formation seems to be based on multilevel cues and on differential instances of evaluative vs passive judgment formation. Some appear to passively assume the legitimacy of the logics; while others more actively question these logics. The findings suggest that active questioning is often overwhelmed by the negative and harsh realities making the woman succumb to passivity and choosing not to engage in paid work.Originality/valueThis study provides: a better mapping of the individual woman’s daily cognitions concerning the legitimacy of (not) engaging in paid work; and a unique multilevel analytic framework that can serve as a useful example of contextualizing career research.

Health services are one of the important forms of public service in fulfilling the basic needs of society. Research on health service management at the Auxiliary Community Health Center (Puskesmas Pembantu) level is still relatively limited, even though this facility plays an important role in providing community health services at the local level. This study aims to analyze health service management in improving service quality at Puskesmas Pembantu Meri, Mojokerto City. The study employed a descriptive qualitative approach with data collection techniques consisting of interviews, observations, and literature review. The results showed that the service management at Puskesmas Pembantu Meri has been implemented quite well through the application of online and offline registration systems, queue management, referral systems, flexible workforce allocation, and periodic service evaluations. This study also found that the digitalization of services through the JKN Mobile application helped improve service efficiency and reduce patient queues. However, the implementation of digital-based services has not been fully optimal due to limited technological literacy among some members of the community. In addition, the high targets of health programs and digital-based reporting obligations potentially increase the administrative burden on health workers. Therefore, the quality of health services is influenced not only by the service system itself, but also by the effectiveness of human resource management, organizational coordination, and the ability to adapt to technology-based service transformation.

This study aims to analyze the effect of service quality, infrastructure, and hospital image on patient satisfaction in pharmaceutical services at the outpatient pharmacy depot of RSUD Dr. Harjono Ponorogo. The research method used is quantitative correlational research with a descriptive quantitative approach. The population consists of 200 patients who purchased medications at the Outpatient Pharmacy Depot of RSUD Dr. Harjono Ponorogo in May 2025, with total sampling technique. Data collection was conducted using questionnaires with a Likert scale. Data analysis techniques included validity and reliability tests, classical assumption tests, and multiple linear regression analysis. The results showed that service quality has a positive and significant effect on patient satisfaction (t = 7.230, sig = 0.000), infrastructure has a positive and significant effect on patient satisfaction (t = 6.846, sig = 0.000), and hospital image has a positive and significant effect on patient satisfaction (t = 9.312, sig = 0.000). Simultaneously, service quality, infrastructure, and hospital image have a significant effect on patient satisfaction (F = 187.729, sig = 0.000). The coefficient of determination (Adjusted R²) is 0.738, indicating that 73.8% of patient satisfaction variation is explained by the three independent variables. The study concludes that improving service quality, infrastructure, and hospital image is crucial for enhancing patient satisfaction in pharmaceutical services.

From a political and governance perspective Spain is a decentralized country with 17 states [comunidades autónomas] resulting in a governmental structure similar to a federal state. The various state regional health services organizational and management structures are focused on caring for acute illnesses and are dominated by hospitals and technology. In a review by the Interstate Council, a body for intercommunication and cooperation between the state health care services and national government, there is a move to improve health care through an integrative approach between specialized care and primary care at the state level. Community pharmacy does not appear to have a major role in this review. Primary health care is becoming more important and leading the change to improve the roles of the health care teams. Primary care pharmacists as the rest of public health professionals are employed by the respective states and are considered public servants. Total health care expenditure is 9.0% of its GDP with the public health sector accounting for the 71% and the private sector 29% of this expenditure. Community pharmacy contracts with each state health administration for the supply and dispensing of medicines and a very limited number of services. There are approximately 22,000 community pharmacies and 52,000 community pharmacists for a population of 47 million people. All community pharmacies are privately owned with only pharmacists owning a single pharmacy. Pharmacy chain stores are not legally permitted. Community pharmacy practice is based on dispensing of medications and dealing with consumer minor symptoms and requests for nonprescription medications although extensive philosophical deep debates on the conceptual and practical development of new clinical services have resulted in national consensually agreed classifications, definitions and protocolized services. There are a few remunerated services in Spain and these are funded at state, provincial or municipal level. There are no health services approved or funded at a national level. Although the profession promulgates a patient orientated community pharmacy it appears to be reluctant to advocate for a change in the remuneration model. The profession as a whole should reflect on the role of community pharmacy and advocate for a change to practice that is patient orientated alongside the maintenance of its stance on being a medication supplier. The future strategic position of community pharmacy in Spain as a primary health care partner with government would then be enhanced.

Thoroughfares, crossroads and cul-de-sacs: Drug testing of welfare recipients

Modern healthcare in Kazakhstan is characterized by a high dynamism of socio-demographic and epidemiological processes, a significant increase in chronic diseases, regional disparities in access to medical services, as well as limited financial and human resources. Under these conditions, traditional management methods become insufficiently effective, which threatens the sustainable functioning of the system and the achievement of national and global health goals. Considering the integration of the Sustainable Development Goals (SDGs) into the state strategy, there arises a need to develop scientifically grounded models of strategic management capable of ensuring comprehensive, long-term planning and forecasting of the sector’s development. The relevance of this study is determined by the necessity for quantitative identification of interdependencies among key healthcare indicators to form tools for evaluating and optimizing managerial decisions. This creates a foundation for enhancing system resilience and minimizing risks associated with internal and external shocks. The purpose of this study is to develop a methodological and analytical toolkit for the quantitative identification of relationships among key healthcare indicators and for the formalization of a multilevel management model for the sector based on the principles of sustainable development and the strategic orientations of the SDGs. The methodological framework is based on a system-structural approach, methods of correlation and regression analysis, as well as scenario modeling. The empirical base was formed from the official statistics of the Ministry of Health of the Republic of Kazakhstan for 2010–2024, integrated with data from the WHO and the World Bank. A multilevel analytical framework was applied to identify cause-and-effect relationships and to construct predictive models, allowing for a quantitative assessment of the system’s resilience and its adaptability to external shocks. The results reveal statistically significant relationships between demographic, epidemiological, and socio-economic indicators, which made it possible to identify the key drivers of healthcare resilience. A conceptual multilevel model of strategic management has been developed, including strategic, institutional, and operational levels, ensuring the integration of planning, resource allocation, and performance evaluation of managerial decisions. The uniqueness of the study lies in its comprehensive and interdisciplinary approach. For the first time within the national context, a quantitative analysis of inter-indicator dependencies is combined with multilevel strategic healthcare management. The developed model provides a tool for scientifically grounded forecasting and optimization of systemic processes, enhancing the adaptability and sustainability of the sector to internal and external challenges. Key words: healthcare, sustainable development, indicators of sustainable development in healthcare, ecology, social aspect.

The study focuses on the segmentation and quantitative analysis of eco-oriented Slovak influencers active on Instagram in 2024. The methodological basis is a list of the five most influential influencers who, according to Forbes magazine, have been identified as the personalities with the greatest potential to motivate their audience to behave in a more responsible and environmentally sustainable manner. The analysis is based on a multi-level analytical framework that combines quantitative indicators (number of followers, engagement rate, and total volume of interactions) with visualization techniques. This approach allows for a differentiated interpretation of influencers’ performance, reflecting not only the quantity of followers but also the quality of interactions between the audience and the content. The results point to the heterogeneity of environmentally oriented influencers in Slovakia and confirm that they represent a diverse group differing in audience size, content creation structure, and follower engagement levels. An important part of the analysis is also the content dimension, which tracks the average engagement of individual post formats (Reels, Images, Carousels). Its aim is to identify formats with the highest potential for generating interactions and to distinguish them from less effective approaches. Empirical findings confirm significant differences between formats and between influencers themselves, with dynamic and audiovisually attractive content achieving the highest effectiveness. The analysis thus provides empirically based insights that can serve as a starting point for strategic communication planning for brands, environmental organizations, and the non-profit sector. At the same time, it emphasizes the need for targeted collaboration with influencers based on their quadrant classification and preferred format specialization.

This volume offers new empirical evidence on Indian skilled migrants living in European countries, which have become important destinations in the global competition for talent, and on returnees in India. Making use of an interdisciplinary and multi-level analytical framework, which simultaneously includes diaspora interventions and return migration as its main channels of participation, the studies included in this volume offer original insights into the dynamics of skilled migration from India and its effects. The studies highlight the determining factors required to channel possible contributions towards broad-based development and they suggest policy options for the home and host countries.

In the context of increasing complexity of public governance mechanisms and the expanding involvement of non-state actors, the importance of analytical tools for assessing their contribution to the socio-economic development of territories is steadily growing. A specific place in this system is occupied by zemlyachestva (regional community associations), which represent a form of network-based civic self-organization and perform the function of transmitting regional economic interests beyond the borders of the constituent entities of the Russian Federation. Despite the growing practical significance of zemlyachestva, their activities remain insufficiently conceptualized from the perspective of managerial analysis of effectiveness and performance. The purpose of this study is to develop a managerial analytical framework for assessing the performance and efficiency of zemlyachestva as non-state actors involved in the transmission of regional economic interests within the public governance system. To achieve this goal, the article addresses the following objectives: conceptual differentiation between the categories of performance and efficiency as applied to the activities of zemlyachestva; justification of their specificity as a distinct type of network intermediary in regional development; and the development of a system of criteria and indicators for evaluating managerial outcomes. The methodological foundation of the study is based on the concepts of institutional economics and transaction cost theory, network governance and social capital theory, as well as tools derived from project and strategic management. The study applies an adapted version of the Logical Framework Approach (LogFrame) and SMART planning principles to the analysis of zemlyachestva as hybrid actors of public governance. As a result of the study, a multi-level analytical framework is proposed that enables the assessment of both the integrated performance and overall efficiency of zemlyachestva, taking into account their institutional, functional, personnel-related, and economic effects. The findings may be applied in regional governance practices and in the development of programs aimed at strengthening cooperation between public authorities and civil society institutions.

The No Child Left Behind Act of 2001 requires that every classroom be staffed with a "qualified teacher." A growing literature is focusing on what causes teachers to leave their jobs and/or the teaching occupation, rather than solely on factors influencing teacher recruitment. This article uses nationally representative data from the 1999-2000 Schools and Staffing Survey to address teacher attrition in a multilevel analytic framework, accounting for the clustering of teachers within schools within states. Drawing from a theoretical framework rooted in occupational wage theory and social identity theory, we find teachers are more likely to leave if (a) they are specialized instructors (especially foreign language); (b) they have a probationary teaching certificate; (c) they are less experienced; (d) the racial composition of the students is heavily minority; (e) the students' racial composition is less matched to their own race/ethnicity; and, for teachers of some races, (f) the teaching staff's racial composition is more matched to their own race/ethnicity.

• Figurative language styles are analyzed at lexical, syntactic, semantic, discourse-level, and pragmatic NLP levels • Discourse-level styles dominate due to sarcasm’s prevalence in social media • Arabic ranks second in dataset count, but lacks stylistic diversity coverage • Embedding-based features lead performance, especially in semantic tasks • Publicly available datasets remain scarce for pragmatic and syntactic styles Figurative language detection has emerged as a critical task in natural language processing (NLP), enabling machines to comprehend non-literal expressions such as metaphor, irony, and sarcasm. This study presents a systematic literature review with a multilevel analytical framework, examining figurative language across lexical, syntactic, semantic, discourse, and pragmatic levels. We investigate the interplay between feature engineering, model architectures, and annotation strategies across different languages, analyzing datasets, linguistic resources, and evaluation metrics. Special attention is given to morphologically rich and low-resource languages, where deep learning dominates but rule-based and hybrid approaches remain relevant. Our findings indicate that deep learning models–especially transformer-based architectures like BERT and RoBERTa–consistently outperform other approaches, particularly in semantic and discourse-level tasks, due to their ability to capture context-rich and abstract patterns. However, these models often lack interpretability, raising concerns about transparency. Additional challenges include inconsistencies in annotation practices, class imbalance between figurative and literal instances, and limited data coverage for under-resourced languages. The absence of standardized evaluation metrics further complicates cross-study comparison, especially when diverse figurative language styles are involved. By structuring our analysis through linguistic and computational dimensions, this review aims to facilitate the development of more robust, inclusive, and explainable figurative language detection systems.

BackgroundAlthough Differentiated Service Delivery (DSD) for anti-retroviral therapy (ART) has been rolled-out nationally in several countries since World Health Organization (WHO)‘s landmark 2016 guidelines, there is little research evaluating post-implementation outcomes. The objective of this study was to explore patients’ and HIV service managers’ perspectives on barriers to implementation of Differentiated ART service delivery in Uganda.MethodsWe employed a qualitative descriptive design involving 124 participants. Between April and June 2019 we conducted 76 qualitative interviews with national-level HIV program managers (n = 18), District Health Team leaders (n = 24), representatives of PEPFAR implementing organizations (11), ART clinic in-charges (23) in six purposively selected Uganda districts with a high HIV burden (Kampala, Luwero, Wakiso, Mbale, Budadiri, Bulambuli). Six focus group discussions (48 participants) were held with patients enrolled in DSD models in case-study districts. Data were analyzed by thematic approach as guided by a multi-level analytical framework: Individual-level factors; Health-system factors; Community factors; and Context.ResultsOur data shows that multiple barriers have been encountered in DSD implementation. Individual-level: Individualized stigma and a fear of detachment from health facilities by stable patients enrolled in community-based models were reported as bottlenecks. Socio-economic status was reported to have an influence on patient selection of DSD models. Health-system: Insufficient training of health workers in DSD delivery and supply chain barriers to multi-month ART dispensing were identified as constraints. Patients perceived current selection of DSD models to be provider-intensive and not sufficiently patient-centred. Community: Community-level stigma and insufficient funding to providers to fully operationalize community drug pick-up points were identified as limitations. Context: Frequent changes in physical addresses among urban clients were reported to impede the running of patient groups of rotating ART refill pick-ups.ConclusionThis is one of the first multi-stakeholder evaluations of national DSD implementation in Uganda since initial roll-out in 2017. Multi-level interventions are needed to accelerate further DSD implementation in Uganda from demand-side (addressing HIV-related stigma, community engagement) and supply-side dimensions (strengthening ART supply chain capacities, increasing funding for community models and further DSD program design to improve patient-centeredness).

Parents play a critical role in children’s emotional development and psychological well-being. Cultural values and beliefs shape parenting goals and practices regarding emotion socialization and in turn impact many aspects of emotional development. This chapter applies a multi-level analysis framework (Wang, 2018, 2023) to understanding cultural influences on parental emotion socialization and children’s emotional development at the group, dyadic, individual, situational, and temporal levels. Our analysis reveals the complex and dynamic process in which emotional socialization and development take place at the intersection of the micro-context of family and the macro-context of culture. During the process, Asian parents help children develop emotional competence in line with Asian cultural values of interdependence, social harmony, sensitivity to others’ feelings and needs, and self-restraint. Asian children further play active roles in acquiring Asian cultural knowledge and skills concerning emotion and how it should be experienced, expressed, and regulated. The multi-level analysis framework provides an important guide to understand and study parenting and child development in the cultural context.

Seismic assessment of Romanian Orthodox masonry churches in the Banat area through a multi-level analysis framework

Including pharmaceutical services, service quality improvement must be carried out appropriately, quickly, and with a sense of security. Hospital pharmacy services can be evaluated based on five criteria, namely reliability, responsiveness, assurance, dependability, and empathy. One of the pharmaceutical service factors that must meet the minimum requirements for hospital services is the waiting time for prescription filling. 1) Objective: to assess satisfaction of the duration of the outpatient prescription service wait based on sharia characteristics in RSJ. Prof. Dr. Soerojo Magelang; 2) Methods: descriptively with a cross-sectional design using accidental sampling techniques on questionnaires that were analyzed univariately and bivariately using SPSS; 3) Results: a questionnaire with a total of 30 respondents showed that the patient satisfaction category was very satisfied from the five measurement dimensions (77%, 57%, 73%, 67%, 54%) and satisfied (23%, 43%, 27%, 33% , 46%) with a prescription service wait time not more than 30 minutes for non-concoction and less than 60 minutes for concoction; 4) Conclusion: based on sharia characteristics of the five dimensions of satisfaction, the results are very satisfied and satisfied and the outpatient prescription waiting time service meets the minimum standards of hospital services.