Institutional Quality Research Articles

Design of a smart medical service quality evaluation system based on a hybrid multi-criteria decision model

As medical informatization continues to progress, the sophistication of smart medicine (SM) systems has led to a marked enhancement in the caliber of medical services provided. Nevertheless, the existing body of literature is sparse when it comes to frameworks for evaluating service quality, specifically within the domain of smart medicine (SM). Drawing on a hybrid multi-criteria decision-making model that fuses the best–worst method (BWM) with the VIKOR approach, this research has crafted an innovative framework for assessing the service quality of SM. BWM was used to obtain the weights of all dimensions and indicators under each dimension. Then, the service quality of hospitals H1, H2 and H3 in Xiamen was evaluated using the VIKOR method. The results showed that smart appointments, diagnosis and treatment are three important dimensions to evaluate SM service quality in medical institutions. The stability and robustness of the model were proved through sensitivity analysis. Findings suggest that hospitals can strengthen the construction of their appointment information platforms, the quality management of internal doctors, and the information connection between self-service terminals and information platforms to improve hospital service quality in the construction of smart medicine.

Institutional Quality and Economic Growth in the Energy Transition of MENA Countries

This paper investigates the energy transition in MENA region countries, emphasizing the pivotal role of institutional quality and its impact on economic growth. It explores the interactions between institutional quality, energy transition initiatives, and economic growth, aiming to understand how strong institutions can facilitate a successful transition. The empirical analysis employs a simultaneous equations model to identify institutional factors that can either support or hinder the energy transition and its influence on economic growth. The findings provide valuable insights for policymakers and economic stakeholders, underscoring the critical importance of robust institutions in driving the energy transition process and stimulating economic growth in the MENA region from 2000 to 2022.

Role of Institutional Quality and Financial Developments in Realizing Clean Energy Legislation in Indonesia

Role of Institutional Quality and Financial Developments in Realizing Clean Energy Legislation in Indonesia

A Threshold Effect of Financial Development on Natural Resource Rents-Sustainable Human Development Nexus: Empirical Evidence from Sub-Saharan Africa

Sub-Saharan African (SSA) nations are falling behind in human development when compared to other regions globally, despite their abundant natural resources. Several Sub-Saharan African states have an underdeveloped financial structure, leading to underutilization of natural resource profits for human development. This research examines how the level of financial development impacts the relationship between natural resource rents and sustainable human development in 40 SSA countries from 2005 to 2019. This research used the dynamic panel threshold (DPT) approach, an advanced econometric methodology designed to address concerns often seen in panel data such as endogeneity, cross-sectional dependence, and heterogeneity. The cointegration findings showed a long-term association among the variables. The dynamic panel threshold analysis showed that natural resource rent had a detrimental influence on human capital development when financial development was below a certain threshold. Conversely, the outcomes were different when financial development exceeded the threshold. Financial system progress in Sub-Saharan African states considerably uses resource windfalls to improve sustainable human development. This research conducted robustness tests by using alternative estimates excluding outlier sample countries and extra proxies. The conclusions remained unchanged. Policy suggestions were introduced to enhance the financial sector and improve institutional quality in order to ensure sustainable growth in the SSA area.

An Empirical Analysis on Institutional Quality, Fiscal Policy and Debt Sustainability in Sub-Saharan Africa (SSA)

Many Sub-Saharan African (SSA) countries are finding it difficult to fulfill their massive debt repayment obligations, which bilateral financial institutions have declared to be unmanageable. Government institutions are to blame for such disparities in the budgetary components, which have been empirically confirmed to be detrimental. Part of the reason for SSA's income generation and debt management problems is related to fiscal policy components where there has been an unwarranted exaggeration of government expenditure. Accordingly, the current study used a panel Autoregressive Distributed Lag (ARDL) to examine how fiscal policy and institutional quality affected the sustainability of debt in 48 SSA nations between 2008 and 2022. The study’s findings suggested that the elements of fiscal policy (expenditure and revenue) as well as indicators of institutional quality (governance), such as control of corruption, effectiveness of government, political stability, absence of violence, regulatory quality, the rule of law, voice, and accountability, were important in explaining the long-term sustainability of public debt. The speed of adjustment to the long-run equilibrium was slow, which may be related to the unstable governance in each of the cross-sectional nations. Hence, the study concluded that the interactive effects of institutional quality and fiscal policy significantly influenced debt sustainability in the long run. The study’s conclusions can be very helpful to policymakers, particularly in those nations where major fiscal and external imbalances are being generated by low ratings for key institutional quality indices.

Effect of institute and LMS service quality on HEI Brand Equity: an empirical investigation

Purpose The purpose of this paper is to examine the education service quality factors, for online education context, that drive the brand equity of a higher education institute. In the times of emerging online education programmes by otherwise traditional institutes, assessing the service quality of educational institutions and its effect on the institute’s brand represents an extant research gap. Design/methodology/approach This study addresses the gap by empirically measuring higher education institution (HEI) service quality and explores its impact on student engagement, satisfaction and brand equity. This research analyses structured data from 250 students, through partial least squares-based structural equation modelling, to test the proposed hypotheses. Findings Within the overall service quality of an HEI, all components of institutional service quality are found to affect student engagement strongly; however, only some dimensions of learning management system service quality do. Student engagement is found to positively impact student satisfaction which, in turn, strongly affects all elements of HEI brand equity. Originality/value This study adds value to the extant research in higher education service quality by adding a layer of online platform service quality and offers actionable insights for HEI administrators.

Course of Depression and Anxiety among Refugees and Asylum Seekers: A Systematic Review and Meta-analysis of Longitudinal Studies

AbstractRefugees and asylum seekers are at a high risk of developing mental health disorders, especially depression and anxiety. The prevalence of these disorders in refugees and asylum seekers has been well-documented in cross-sectional studies, but it is impossible to track their course over time using this research design. Hence, this systematic review and meta-analysis used data from existing longitudinal studies to examine the course of depression and anxiety in refugees and asylum seekers in upper-middle and high-income countries. Longitudinal studies reporting depression and anxiety were systematically searched from seven databases (Ovid MEDLINE, Ovid EMBASE, Ovid CINAHL, Scopus, Web of Science, PsycINFO, and Google Scholar) and included studies that fulfilled the inclusion criteria and underwent Joanna Briggs Institute (JBI) quality assessment. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used to report the findings. An estimated pooled prevalence of depression and anxiety across time points was reported using a random effect model with a 95% confidence interval. Cochran’s Q and I2 statistics were conducted to assess heterogeneity among included studies, while funnel plots and Eggers tests were used to assess publication bias. Twenty longitudinal studies for depression and eight longitudinal studies for anxiety were included in the final analysis. The pooled prevalence of depression and Anxiety at baseline was 23.14% (95% CI: 16.34, 29.94) and 25.33% (95% CI: 5.10, 45.57), respectively. After the baseline data collection, the pooled prevalence of depression and anxiety increased over time. Specifically, the prevalence of depression rose from 17.55% (95% CI: 6.66, 28.45) 1 year after baseline to 34.04% (95% CI: 15.45, 52.63) 3 years after baseline. Similarly, the pooled prevalence of anxiety increased from 14.96% (95% CI: 10.59, 29.33) at 1 year after baseline to 33.09% (95% CI: 26.96, 39.21) at 3 years after baseline. The prevalence of depression more than doubled over the course of 3 years, rising from 17.55% at the 1-year mark after baseline to 34.04% at the 3-year mark after baseline. Similarly, the prevalence of anxiety exhibited a significant increase from 14.96% at the 1-year mark after baseline to 33.09% at the 3-year follow-up. These findings underscore the importance of implementing early settlement interventions and designing targeted measures to mitigate the prevalence of anxiety and depression among refugees and asylum seekers.

Ethics and Values Matter: The Role of Higher Education

Human existence is a process of learning and development aimed at achieving wisdom, and education has been regarded as the ultimate value system since the birth of culture and way of life for this reason. Education is more than only the acquisition of skills or the gathering of knowledge or news about a topic of interest from others or from other parts of the world. It is not limited to the abilities of obtaining information received and preserved via knowing, or just the exploration of existential problems and familiarization with previously acquired knowledge or data, or with a system of knowledge - but also with the goal of comprehending this cognition. Knowledge is involved with the comprehension of a collection of propositions or concepts. Knowledge can be theoretical and practical, fundamental and abstract, and it may exist in any time period: past, present, and future. However, cognition is always done in the present. Past memories and future prophecies are also remembered in the present, as the ideas flash or surface in the mind. These flashes act as an impetus for our quick determination, allowing us to decide whether or not to undertake anything. However, for the purpose of brevity, I'll lump the two, knowledge and cognition, together under the heading of knowledge. Education fosters the development of talents from all three faculties, as well as wisdom in their right application for the benefit of people and society for creating value and ethics. The goal of NEP 2020 is also having important role in higher education teaching to encourage systematic and focused discoveries and practices that benefit society. Society views higher education institutions as catalysts for the transformation of knowledge into wisdom. The quality, morals, and ethics of higher education institutions are increasingly important in integrating young people into society. A country like India has a large young population, and they are the frontiers of the Indian government's Made in India Initiative. It has been well mentioned that the actual philosophy of education is in the combination of ethics, virtues, values, and the validity of human life, thus it is vital to improve ethical values, philosophical thinking, study, research, and moral growth in the Indian education system.

Analysing the European Defence Fund’s financing distribution across EU countries: what drives national participation in defence-industrial integration projects?

The establishment of the European Defence Fund (EDF) marks a significant shift in how EU Member States approach the integration of the defence industry as it aims to systematically promote inter-European defence-industrial cooperation across national defence sectors. However, there is a lack of empirical evidence of the actual dynamics regarding EDF implementation. While there are accounts of EU countries’ varying political positions on defence integration, including its industrial aspect, it remains unclear whether Member States’ actual participation in integration projects aligns with these positions. Are national motives consistent once effective defenceindustrial integration is underway? The findings, based on Masson’s (2024) data on by-country distribution of EDF project financing (2021–2022), present a more nuanced picture of EU countries’ effective engagement with defence-industrial integration than anticipated by the political perspective. While there is a positive relationship between participation in the EDF and defence market size, strategic culture does not influence EU members’ involvement in the Fund. Furthermore, while liberal economicindustrial governance is negatively associated with national participation in EDF projects, a country’s institutional quality has a significant positive relationship with it. This article reveals more complex dynamics of EDF implementation than suggested by the political perspective on defence-industrial integration pre-EDF.

Politics and city growth in Italy: Do connections matter?

AbstractIn this paper, I assess the existence of a political connection premium for Italian municipalities during the so-called “Second Republic” (1991–2011). The early 1990s witnessed a seminal event in Italian political history with the “Mani Pulite” (“Clean Hands”) investigation following the fall of the Berlin Wall. Subsequently, major political parties dissolved, culminating in a bipolar political landscape characterized by cyclical alternation between center-right and center-left factions (extending until at least 2011). Exploiting population data on small and medium-sized Italian municipalities between 1991 and 2011, I found that “politically connected” municipalities showed a population premium of about 2.5% compared to “non-politically connected” ones. The results are robust to NUTS-3 fixed effects, to a comprehensive set of controls, and to a full set of robustness checks. The relationship is confirmed using aggregate municipal income data as an additional proxy of local economic growth. Over and above this, social capital and the quality of local institutions seem to play a pivotal role in enabling the political connection. Election-related checks suggest the connection as two-way: using municipal data from the 2013 and 2018 general elections, I found that the treated municipalities depicted a higher turnout and fewer populist votes.

Volume-outcome relationships for intra-aortic balloon pump in acute myocardial infarction

Abstract Background Acute myocardial infarction (MI) is one of the major scenarios of intra-aortic balloon pump (IABP) use, particularly when complicated by cardiogenic shock. The utilization of mechanical circulatory support devices including IABP varies widely per hospital, while whether a higher IABP volume at each hospital is translated into better outcomes in acute MI is unclear. Purpose To evaluate the relationship between the volume of IABP use and mortality at the hospital level in patients with acute MI undergoing percutaneous coronary intervention (PCI). Methods Using a Japanese nationwide administrative database, a total of 26,490 patients with acute MI undergoing primary PCI from 154 hospitals were included. The primary endpoint was the observed/predicted in-hospital mortality ratio. The predicted mortality per patient was calculated using baseline variables and was averaged for each hospital. The associations among PCI volume for acute MI, observed and predicted in-hospital mortality, and observed and predicted IABP use were assessed at the hospital level. Results Of the 26,490 patients, 2,959 (11.2%) were treated with IABP and 1,283 (4.8%) died during hospitalization. The annualized number of IABP use per hospital in acute MI was 4.5 [2.4-10.7]. In lower primary PCI volume centers, IABP was more likely to be underused than expected, and the observed/predicted in-hospital mortality ratio was higher than in higher volume centers (Figure). The observed/predicted mortality ratio seemed lowest in hospitals where the observed/predicted IABP use ratio was around one. Conclusions The present study showed that the lower annual number of IABP use was associated with an increased mortality risk at the hospital level, and suggested that standardized IABP use can be an institutional quality indicator in a setting of acute MI.

Hypothesis Test of Human Capital Investment Determinants on Institution’s Performance Using PLS-SEM Approach

Accelerating the quality of education institutions remains a priority for Malaysian Government as it forms the foundation for building a high caliber talent in the labor market. Focusing on improving the quality of universities one of the main concerns is to develop the human quality through increasing the quality and resilience of human capital as the enabler towards competitive global market. In general, this paper recognizes the findings on the role of human capital investment (HCI) determinants and their significant contribution to institution’s performance. It also emphasizes the roles of HCI in institution's success and survival in a highly competitive business environment as highlighted in The Twelfth Malaysia Plan (2021-2025) and Malaysia Education Blueprint 2015-2025. Human capital strategically contributes to the quality of academics in turn affects issues such as inefficient labor markers in achieving the greater quality of Malaysia's education system specifically. Hence, to analyze the contribution of determinants a theoretical model was constructed underlined by Human Capital Theory, Resource Based View (RBV) and Malcom Baldrige criteria. Then to obtain the feedback a survey consisting of sixty (66) items with a seven (7) Likert scale was used as the measurement instrument to gather the data from 309 lecturers in UiTM. Data then were analyzed using Structural Equation Modelling approach on the SmartPLS3 platform. The result explained coefficient of determination (R2) value of 66.9% suggested that the variance of institution performance could moderately be explained by HCI determinants where knowledge, skill and training positively influenced the performance of the institution.

Enhancing Load Capacity Factor: The Influence of Financial Accessibility, AI Innovation, and Institutional Quality in the United States

Enhancing Load Capacity Factor: The Influence of Financial Accessibility, AI Innovation, and Institutional Quality in the United States

Bilateral value chain reshaping through regional trade agreements deepening: Evidence from belt and road countries

This paper investigates the impact of Regional Trade Agreements (RTAs) on the reshaping of value chains from both domestic and regional perspectives by using national-level data from the Belt and Road countries. The findings indicate that the depth of RTAs among Belt and Road countries can not only enhance regional integration characterized by regional value chain inter-connections and promote the value chain upgrading of trading partners in the regional production system, but also facilitates the construction of domestic value chains, thus forming a new pattern of bilateral value chain reshaping. The conclusions still hold after addressing the potential endogeneity and robustness concerns. Mechanism test results show that the effects of productivity enhancement and institutional quality improvement are important channels for RTAs-deepening to promote value chain reshaping. Heterogeneity test results indicate that ‘WTO-X’ provisions of RTAs are more conducive to promoting value chain reshaping, and the promoting effect of RTAs-deepening on value chain reshaping is more significant for the manufacturing industry. These findings have important policy implications to further expand high-level opening-up, deepen RTAs provisions and actively participate in global governance.

Family Involvement and Firm Performance: A Worldwide Study Unveiling Key Mechanisms

Prior literature establishes a link between family involvement and the firm financial performance. However, the mechanisms through which family involvement in a firm affects its financial performance in different institutional settings are largely unknown. Using an unbalanced panel of 3,322 listed firms from 32 countries over a 9-year period, we find that family involvement in ownership and management on average has negative effects on financial performance. Moreover, the negative effect of family ownership is less profound in countries with good institutional quality. We further find that R&D intensity partially mediates the negative relationship between family involvement and the firm financial performance, but the mediation effect is conditional on the degree of institutional quality in a country. These findings advance the family business, innovation, and institutional literature, and offer important implications for theory and practice.

Resource nationalism: the intersection of politics and economics

Resource nationalism has a complex economic, political, and cultural history and reality. The evolution of the supply and demand structure of the global mineral metal market influences it. It is closely linked to the “economic-political” system within resource-rich countries. We analyze the ‘economic-political’ logic of resource nationalist behavior using the two-tier game theory. We examine 261 cases of resource nationalism since 1990 and test the theoretical hypotheses using quantitative techniques. The results show that rising mineral prices are the main trigger for contemporary resource nationalism. However, ideology, institutional quality, social climate, and economic dependence within resource countries play a non-negligible role. Resource wealth dependence in host countries makes it difficult for policymakers to escape national resource interventions. We argue that (1) The global economic trading system imbalance is the root of resource nationalism. (2) Resource nationalism is an endeavor by resource-rich countries to seek entitlements from mineral resource endowments. (3) Resource nationalism is not a zero-sum competition in the national economic trading system. In the face of the potential risks posed by resource nationalism to the global supply of minerals, the relevant interest groups should have sufficient strategic reserves to cope with the possible game of interests.

Economic freedom and legal gender disparity

AbstractUsing a panel dataset from 1970 to 2019, this paper theorizes and empirically demonstrates that countries with higher levels of economic freedom have fewer legal differences between men's and women's economics rights. Specifically, economic freedom promotes equal legal treatment of women to work, get paid, and be entrepreneurs. This finding is robust to controlling for income, political institutional quality, and country and period fixed effects. Furthermore, economic freedom's impact is amplified in democratic countries. The results challenge the prevailing notion that capitalism is detrimental to women, instead providing evidence that economically free countries favor less legal discrimination against women.

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist's role, part 2: Complications, postrevascularization care, and quality improvement.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the later phases of inpatient care are reviewed. Published descriptions and validation of clinical pharmacist roles specific to the acute management of STEMI are limited. This high-risk period from presentation through revascularization, stabilization, and hospital discharge involves complex pharmacotherapeutic decision points, many operational medication needs, and multiple layers of quality oversight. A companion article reviewed STEMI pharmacotherapy from emergency department presentation through revascularization. Herein we complete the pharmacotherapy review for the STEMI patient across the inpatient phases of care, including the management of peri-infarction complications with vasoactive and antiarrhythmic agents, considerations for postrevascularization antithrombotics, and assessments of supportive therapies and secondary prevention. Key guideline recommendations and literature developments are summarized from the clinical pharmacist's perspective alongside suggested pharmacist roles and responsibilities. Considerations for successful hospital discharge after STEMI and pharmacist involvement in associated institutional quality improvement efforts are also provided. We aim to support inpatient pharmacy departments in advancing clinical services for this critical patient population and call for further research delineating pharmacists' impact on patient and institutional STEMI outcomes.

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist's role, part 1: Patient presentation through revascularization.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the critical initial phases of care are reviewed. Despite established value in the emergency department (ED), cardiac care, and intensive care settings, there is currently little published literature describing or supporting clinical pharmacist roles in the acute management of STEMI. The high-risk period from hospital presentation through revascularization and stabilization involves complex pharmacotherapeutic decision points, many operational medication needs, and multiple layers of quality oversight. While rife with opportunities for pharmacists to optimize care, this timeframe appears inconsistently targeted by clinical pharmacy services, which may halt after ED evaluation and then resume upon postcatheterization cardiac unit admission. Herein we review the key pharmacotherapeutic modalities and considerations for the patient with STEMI across the critical initial phases of care. These include supportive therapies prior to revascularization, the host of antithrombotics involved in revascularization by percutaneous coronary intervention and/or fibrinolysis, and other periprocedural medications. Important practice guidelines and clinical resources are summarized from the clinical pharmacist perspective, and roles and responsibilities of the responding pharmacist are suggested. A companion article will extend the review to periprocedural adverse event management, key early decision-making regarding long-term risk reduction, and pharmacist involvement in institutional quality improvement efforts. We aim to support inpatient pharmacy departments in advancing clinical services for this critical patient population, and we call for further research delineating pharmacist impact on patient and institutional STEMI outcomes. Patients presenting with STEMI rapidly traverse multiple phases of care and receive a host of antithrombotic and supportive medications during acute management, presenting many important pharmacotherapeutic decision points and roles for pharmacists.

Exploring the Dynamic Link Between Trade Openness, External Debt, and Economic Growth in Sub-Saharan Africa: Challenges and Considerations

This study investigates the dynamic relationship between trade openness, external debt, and economic growth in Sub-Saharan Africa, focusing on the period from 1990 to 2023. The research examines how trade openness and external debt impact regional economic performance by employing Panel Autoregressive distributed lag (ARDL) techniques utilizing the pool mean group and mean group estimator’s approach. The analysis reveals that while trade openness does not stimulate economic growth, external debt similarly has significant challenges, often hindering long-term development prospects within Sub-Saharan African countries. The findings underscore the importance of managing debt sustainably and aligning trade policies with growth-enhancing strategies. Additionally, human capital and institutional quality are essential endogenous growth factors that significantly influence economic growth in Sub-Saharan Africa. The study recommends that while trade openness alone may not directly drive economic growth, its benefits can be amplified by complementary strategies such as investing in human capital, technological adoption, and industrial policy. The study concludes with policy recommendations to enhance economic resilience and foster sustainable growth, such as attracting foreign direct investment, combined with infrastructure development and sound fiscal management.