Assurance Function Research Articles

Sakkyndige psykologers refleksjoner om Barnesakkyndig kommisjons kvalitetssikrende funksjon

The future of many vulnerable children depends on the quality of child welfare decisions, where reports from independent child welfare experts may carry considerable weight. Before these reports are used in child welfare decision-making processes, they are quality-assessed by the Expert Commission on Children. In the present study, 12 psychologists working as independent child welfare experts were interviewed about their experiences of the Expert Commission on Children’s quality assurance function. Based on qualitative thematic analyses, the informants’ statements were sorted into two main themes. The first main theme circled around experiences that the Commission enhances the quality of the experts’ work by having a ‘Sharpening support function’, contributing to a more unified and consistent practice. Under the second main theme, ‘What type of quality?’, concerns were raised that the Commission, due to lack of access to the factual basis of the reports, cannot accurately evaluate their professional or substantial quality. The informants suggested alternative quality assurance methods, such as feedback loops between the Commission and the experts, and that the Commission should instead undertake an in-depth examination of a smaller sample of reports. The findings are discussed in the context of the broader debate surrounding quality indicators for child welfare work. Keywords: independent expert, assessment, child welfare, quality assurance, Commission for child welfare experts

The Function of the Regional Development Work Plan in the Planning and Budgeting Process of Bekasi City

Based on the Bekas City RPJPD 2005 – 2025 and 2020 – 2024 RPJMD, the Bekas City Government has prepared the 2023 Bekas City RKPD based on the Regulation of the Minister of Home Affairs of the Republic of Indonesia Number 17 of 2021 concerning Guidelines for Preparing Regional Government Work Plans for 2022 because it has not been implemented. There is a new Minister of Home Affairs Regulation regarding Guidelines for Preparing Regional Government Work Plans for 2023.In this research, the author used a descriptive qualitative approach. The Regional Development Work Plan (RKPD) is a very important tool in the planning and budgeting process, as a description of annual programs and activities as the basis for General Budget Policy and Temporary Budget Ceiling Priorities. The RKPD must be reviewed by the Bekasi Inspectorate, to ensure quality there is harmony between the RPJMD and RKPD, so that the development stages per year are in accordance with those that have been determined. The review issues recommendations as a quality assurance function that must be followed up, and after the review is carried out, a Mayor's Regulation regarding RKPD is stipulated. In discussing the RAPBD, it must be based on the RKPD, and adjustments can be made to the budget ceiling for each program and activity.

Security testing as part of a digital assurance toolkit

The role of IT audit and other digital assurance functions is to provide comfort to stakeholders regarding risks and the controls that have been implemented by management to safeguard an organisation. This paper discusses the misalignment between digital assurance activities and security testing. When performing security testing from an assurance perspective, it is common for the discussion with management to focus on the number of findings, not necessarily the impact. From a security testing perspective, a single finding could result in a business compromise, or multiple low findings could be chained together to result in a more significant business impact. Citing example findings across multiple sectors and geographic locations, the paper details what security testing results often look like, related challenges in an assurance context, the difference between security testing and other assurance activities, how to get management buy-in, and key recommendations on how best to use security testing as part of a digital assurance toolkit, with the caveat that scarce specialist skills are required.

Selfing in epiphytic bromeliads compensates for the limited pollination services provided by nectarivorous bats in a neotropical montane forest.

Abstract. Plants with specialized pollination systems frequently exhibit adaptations for self-pollination, and this contradictory situation has been explained in terms of the reproductive assurance function of selfing. In the neotropics, several plant lineages rely on specialized vertebrate pollinators for sexual reproduction, including the highly diverse Bromeliaceae family, which also displays a propensity for selfing. Thus far, the scarce evidence on the role of selfing in bromeliads and in other neotropical plant groups is inconclusive. To provide insights into the evolution and persistence of self-fertilization in the breeding systems of Bromeliaceae, we studied four sympatric epiphytic species from the genus Werauhia (Tillandsioideae) in Costa Rica. We documented their floral biology, pollination ecology and breeding systems. We estimated the contribution of selfing by comparing the reproductive success between emasculated flowers requiring pollinator visits and un-manipulated flowers capable of selfing and exposed to open pollination across two flowering seasons. The studied species displayed specialized pollination by nectar-feeding bats as well as a high selfing ability (auto-fertility index values > 0.53), which was attained by a delayed selfing mechanism. Fruit set from natural cross-pollination was low (<26% in both years) and suggested limited pollinator visitation. In line with this, we found a very low bat visitation to flowers using video-camera recording, from 0 to 0.24 visits per plant per night. On the contrary, the contribution of selfing was comparatively significant since 54-80% of the fruit set from un-manipulated flowers can be attributed to autonomous self-pollination. We concluded that inadequate cross-pollination services diminished the reproductive success of the studied Werauhia, which was compensated for by a delayed selfing mechanism. The low negative effects of inbreeding on seed set and germination likely reinforce the persistence of selfing in this bromeliad group. These results suggest that selfing in bat-pollinated bromeliads may have evolved as a response to pollinator limitation.

Standardized corporate social responsibility disclosure, assurance, and real earnings management: evidence from developing countries

Research aims: This study aims to present empirical evidence on the effect of social responsibility disclosure on real earnings management and the role of assurance in this relationship. This is based on a paradox, i.e., companies that publish standardized corporate social responsibility disclosures to project ethical business practices are also associated with accounting and financial scandals.Design/Methodology/Approach: This study was conducted on non-financial sector companies in developing countries that are members of ASEAN-4, namely Indonesia, Malaysia, Thailand, and the Philippines, which issued GRI-based social responsibility disclosures in the period 2013-2019, amounting to 285 companies with a total of 859 observations.Research findings: The results demonstrated that companies with standardized social responsibility disclosures tend to reduce their real earnings management practices. However, the assurance variable mitigates the negative effect of corporate social responsibility on real earnings management, implying that assurance provides false credibility. In an additional analysis, the samples were grouped based on board structure. The findings of this study are consistent with two-tier board structures, suggesting that a one-tier system provides better information quality.Theoretical contribution/Originality: The originality of this study lies in a comprehensive measurement of social responsibility disclosure variables using an index that gauges a combination of accountability and performance aspects. Furthermore, this study takes into account assurance as a variable representing the credibility of information, which surprisingly moderates the negative effect of social responsibility disclosure on real earnings management.Practitioner/Policy implication: The findings of this study underscore the importance of standardized social responsibility disclosure in mitigating managerial opportunistic behavior. The findings also highlight the need to enhance the assurance function to prevent its use as an opportunistic management tactic.

Entity recognition method for airborne products metrological traceability knowledge graph construction

The airborne system, as one of the complex and extensive subsystems of an aircraft, primarily performs critical flight assurance functions. The quality of its components has a direct impact on the aircraft's safety and reliability. Metrology documents comprehensively document the performance parameters throughout the entire product life cycle. The Metrological Traceability Knowledge Graph (MTKG) for airborne products offers decision support to engineers engaged in metrological tasks, ensuring the continuous high quality of the products. This paper introduces an entity recognition method for airborne product metrological traceability knowledge graph construction. First, the ontology for MTKG is developed. Next, a fine-tuned multi-network model is proposed. Named entities in the field of metrology are recognized through three stages: word vector representation, sentence feature extraction, and optimal label assignment. Meanwhile, active learning methods are incorporated to reduce the expense of data annotation. The proposed model is validated using an actual metrology corpus, and the experimental results demonstrate its superior performance compared to the other four baseline methods. Finally, the MTKG is developed using this approach, offering engineers intelligent applications, including metrological traceability analysis and traceability path reasoning within the process of product metrology. This enhances the metrology capabilities of airborne products and demonstrates the extensive potential of knowledge graphs in metrology.

Drivers for the maturity of integrated governance in organizations—An empirical investigation

This paper sheds light on the factors driving the maturity levels of integrated governance by analysing survey responses from 148 companies that reported on their efforts to coordinate and align their separated assurance functions. When an organization's assurance functions lack coordination, it can lead to challenges like isolated risk functions, incomplete risk coverage and redundant controls. Integrated governance aims to incorporate and optimize on organization's assurance functions to support an effective risk control environment and the integrity of information used by management and the governing bodies. Despite this goal, research indicates that no organization has achieved a mature level of integrated governance yet. To address this research gap, we identify key drivers for integrated governance maturity such as the awareness of integrated governance within the organization, the implementation of the Three Lines (of Defense) Model and the maturity levels of subsystems, that is, the risk management function and the internal control system.

Playing the Business Angel: The Impact of Well-Known Business Angels on Venture Performance

People well known to the general public are increasingly acting as business angels (BAs) for young and innovative ventures worldwide. These BAs are less known for their venture evaluation skills and often do not have a professional reputation as investors. The signaling function of these well-known investors could therefore be less relevant for founders because of a limited quality assurance function. Nonetheless, a venture’s affiliation with a well-known BA may still positively alter the quality perceptions of various stakeholders because the BAs can put their reputation in other areas of life at risk, provide an easy-to-interpret and fluent cue to the general public, and improve the observability of the signal. Using a sample of more than 2,900 early-stage ventures that made a venture pitch during the Canadian, German, U.K., and U.S. versions of the reality TV show Dragons’ Den, we find that BAs’ degree of being known has a positive impact on target firm survival, web traffic, and sales. The impact of BAs’ general degree of being known is particularly strong if the congruency between the investors and the target ventures is high. These effects exist over and above potential selection effects, the professional reputation of the BA, and the greater financial resources of a funded venture. The empirical findings indicate that well-known BAs can have a positive effect on venture performance and that founders should consider not only the professional reputation of BAs but also the degree to which they are known to a general audience.

Використання можливостей внутрішнього аудиту при оцінюванні якості трудових відносин та процесів формування і розвитку кадрового потенціалу суб’єктів господарювання

The purpose of this study is to specify the specifics of internal audit in the field of labor relations and human resources, taking into account the current requirements of the International Standards for the Professional Practice of Internal Auditing, and to substantiate the main types of engagements to be performed by internal auditors. It is substantiated that the engagements performed by internal audit are actually represented by two large groups: assurance engagements and consulting services. These trends correspond to the development of the content of the audit (transition to a broad interpretation and transformation into an assurance engagement) and a fundamental change in the role of the audit - a combination of the advisory and assurance functions. The author proposes to define internal audit in the field of labor relations in order to be fully in line with international standards, which is proposed to be considered as an independent, objective activity to provide assurance on the compliance of labor processes (human resources, personnel management) with the established evaluation criteria and advisory services that should benefit the organization, increase its value and improve its performance. The purposes that can be set for the internal audit service in the field of labor relations and human resources are highlighted and possible evaluation criteria and their limitations are identified. The distribution of functions and responsibilities in the performance of assurance engagements by the internal audit service is specified. The presented developments should form the basis of such a document as the internal audit charter, since the Atributes Standards of the International Standards for the Professional Practice of Internal Auditing (Section 1000 – Purpose, Authority, and Responsibility) stipulate that the purpose, authority, and responsibility of the internal audit function should be formally defined in the internal audit charter. It is substantiated that the development of such a document detailing the types of engagements to be performed by the internal audit service in the field of labor relations and human resources potentially possible for a particular enterprise is an important area for further research.

Використання можливостей внутрішнього аудиту при оцінюванні якості трудових відносин та процесів формування і розвитку кадрового потенціалу суб’єктів господарювання

The purpose of this study is to specify the specifics of internal audit in the field of labor relations and human resources, taking into account the current requirements of the International Standards for the Professional Practice of Internal Auditing, and to substantiate the main types of engagements to be performed by internal auditors. It is substantiated that the engagements performed by internal audit are actually represented by two large groups: assurance engagements and consulting services. These trends correspond to the development of the content of the audit (transition to a broad interpretation and transformation into an assurance engagement) and a fundamental change in the role of the audit - a combination of the advisory and assurance functions. The author proposes to define internal audit in the field of labor relations in order to be fully in line with international standards, which is proposed to be considered as an independent, objective activity to provide assurance on the compliance of labor processes (human resources, personnel management) with the established evaluation criteria and advisory services that should benefit the organization, increase its value and improve its performance. The purposes that can be set for the internal audit service in the field of labor relations and human resources are highlighted and possible evaluation criteria and their limitations are identified. The distribution of functions and responsibilities in the performance of assurance engagements by the internal audit service is specified. The presented developments should form the basis of such a document as the internal audit charter, since the Atributes Standards of the International Standards for the Professional Practice of Internal Auditing (Section 1000 – Purpose, Authority, and Responsibility) stipulate that the purpose, authority, and responsibility of the internal audit function should be formally defined in the internal audit charter. It is substantiated that the development of such a document detailing the types of engagements to be performed by the internal audit service in the field of labor relations and human resources potentially possible for a particular enterprise is an important area for further research.

Economic and Political Analysis of Initial Teacher Education from Consensus and Conflict Perspectives in Documents of International Institutions

This study aims to reveal the economic and political issues underlying the remarks related to initial teacher education (ITE) in the documents published by international institutions, European Union (EU), Organization for Economic Co-operation and Development (OECD), and United Nations (UN), and to examine these issues from the perspective of consensus and conflict approaches to education. The study is designed as a systematic review. ITE-related 67 documents published by UN, EU, and OECD were analyzed following several coding steps. According to the results, international institutions promote entrepreneurship, life-long learning, and information and communication technologies as economic issues in ITE. As political issues, they put forward social themes including preparing for diversity, quality in ITE including accountability and standards, and structure of ITE including flexibility and autonomy. Although the documents are mainly parallel with the consensus approach, economic and political issues revealed in the study were discussed from perspectives of both approaches. One perspective considers promoting the economic issues in ITE the economic efficiency and growth which is beneficial for all. The other reminds that division of this benefit may include class-based inequalities. Also, different perspectives emphasize different social themes and they bring different explanations for how the quality assurance functions.

Re-engineering Quality Assurance Functions to Support Implementation of CBC in Secondary Schools Lessons for Tanzania: A Literature Review

The significance of quality assurance (QA) function in supporting CBC implementation should not be underestimated. Major functions of QAs are to supervise the implementation of the curriculum, organize in-service courses for curriculum implementers, and conduct research on the best practices on QA of the delivery of education. Regardless of the aforementioned QAs functions, a review of literature indicates that QA officers in many African countries do not visit secondary schools as it is required, instead they prefer visiting primary schools to execute their QA activities. This casts doubt on their capacity to carry out their responsibilities in the setting of CBC in secondary schools. Therefore, the purpose of this desktop paper was to find out how QA functions should be re-engineered to match with CBC principles to enable QA officers to supervise implementation of CBC in secondary schools. The specific objectives of this study were to identify the challenges that hinder the execution of QAs functions, recommend strategies for QA officers to enhance their performance and find out lessons which Tanzania can learn from other countries in order to improve QA operations in secondary schools. To find answers to these questions, the study reviewed literature and found that the QA departments were understaffed. Tanzania’s QA department, for example, has 1185 officers, with 218 officers assigned to Secondary and Teachers’ Colleges. Furthermore, review of literature revealed that lack of in-service training among QAs officers has hampered their ability to carry out QA activities in compliance with CBC principles. Based on the findings, the study recommends that there should be adequate staffing of QA department and capacity building for QAs Staff to enable them to execute their roles effectively in the context of CBC.

Visual Inspection for Industries

The system is an AI-ML image recognition-based application that gives Quality Control and Quality Assurance functionality at the same time to the small-scale industries. The system continuously scans the product for any defects, anomalies, imperfections, damages, foreign substances, or any other non-standard qualities on the product. The system basically is a governing/supervising authority that keeps that fact in check that the standard procedures and standard quality has been maintained throughout the production. This system works automatically and there is little to no human input required. It is fully automatic and requires no human input. There are no chances of error that are very plausible in a human-assisted or human-moderated system. The system only requires regular maintenance from a well-trained technician and no further human input. The system is smart and gives warnings, can halt production when needed for the QA.

Determination of commissioning criteria for multileaf-collimator, stereotactic radiosurgery treatments on Varian TrueBeam and Edge machines using a novel anthropomorphic phantom.

An anthropomorphic phantom has been developed by Varian Medical Systems for commissioning multileaf‐collimator (MLC), stereotactic radiosurgery (SRS) treatments on Varian TrueBeam and Edge linear accelerators. Northwest Medical Physics Center (NMPC) has collected end‐to‐end data on these machines, at six independent clinical sites, to establish baseline dosimetric and geometric commissioning criteria for SRS measurements with this phantom. The Varian phantom is designed to accommodate four interchangeable target cassettes, each designed for a specific quality assurance function. End‐to‐end measurements utilized the phantom to verify the coincidence of treatment isocenter with a hidden target in a Winston‐Lutz cassette after localization using cone‐beam computed tomography (CBCT). Dose delivery to single target (2 cm) and single‐isocenter, multitarget (2 and 1 cm) geometries was verified using ionization chamber and EBT3 film cassettes. A nominal dose of 16 Gy was prescribed for each plan using a site's standard beam geometry for SRS cases. Measurements were performed with three Millennium and three high‐definition MLC machines at beam energies of 6‐MV and 10‐MV flattening‐filter‐free energies. Each clinical site followed a standardized procedure for phantom simulation, treatment planning, quality assurance, and treatment delivery. All treatment planning and delivery was performed using ARIA oncology information system and Eclipse treatment planning software. The isocenter measurements and irradiated film were analyzed using DoseLab quality assurance software; gamma criteria of 3%/1 mm, 3%/0.5 mm, and 2%/1 mm were applied for film analysis. Based on the data acquired in this work, the recommended commissioning criteria for end‐to‐end SRS measurements with the Varian phantom are as follows: coincidence of treatment isocenter and CBCT‐aligned hidden target < 1 mm, agreement of measured chamber dose with calculated dose ≤ 5%, and film gamma passing > 90% for gamma criteria of 3%/1 mm after DoseLab auto‐registration shifts ≤ 1 mm in any direction.

Supply Chain Resilience in VUCA World: Towards a Holistic Approach of Quality Assurance and Risk Management

Supply chain management is often associated with disruptions and chaos. This paper intends to explore the factors causing supply chain disruptions and develop a framework for supply chain resilience, thereby highlighting the significance of integrating quality assurance and risk management. With the help of in-depth interviews of management officials involved in the pharmaceutical supply chains in Pakistan, the study finds that a holistic approach towards quality assurance function is indispensable in the supply chain of pharmaceuticals. Drawing on the theoretical framework of chaos theory and complexity theory, the results of this study show that supply chain resilience can be achieved effectively by implementing a proper risk management system identifying the possibilities, and quantifying and mitigating the risks before they emerge. The study also highlights the differences between the supply chain resilience capability of large and small-scale pharmaceutical firms in Pakistan

4 - Institutional Constraints Affecting Quality Assurance Processes in Tanzania’s Private Universities

The purpose of this study is to identify the institutional constraints of quality assurance processes in Tanzania’s private universities and colleges. The descriptive survey design combines qualitative and quantitative research approaches. Purposive, stratified, and random sampling procedures are used to select a sample of 486 participants in the study who comprised 191 academic staff, 291 students, and 4 quality assurance officials from four private universities. Questionnaires and interviews are used for data collection. The findings indicate that inadequate financing, lack of capacity in terms of adequate, qualified and experienced human resources to undertake quality assurance functions, lack of clear and viable quality assurance policies, lack of awareness on quality assurance issues, and lack of academic leadership were the identified major institutional constraints to quality assurance processes in Tanzania’s private universities. The theoretical and policy implications of these findings are also discussed.

Does external assurance on CSR reporting contribute to its higher quality? Empirical evidence from China

This paper examines the difference that the assurance brings to the quality of CSR reports in the Chinese institutional setting, in particular, the difference in quality (proxy – RKS ranking) of assured and unassured CSR reports, as well as whether the high ownership concentration and corresponding to it “entrenchment effect” obstruct the positive impact the assurance exerts on the quality of CSR reports. The paper examines CSR reports on 2,292 firm-year observations of large Chinese companies over three years (2015–2018). The hypothesis development process predicates on the signaling and stakeholder theories, whilst this study applies regression analysis to test the hypotheses. Consistent with the predictions of signaling and stakeholder theories, the paper finds that assurance contributes to the higher quality of CSR reports. Moreover, the study finds that assured CSR reports have higher sub-scores in all four aspects of RKS ranking. However, as ownership concentration exceeds 50 per cent and reaches the majority, it thwarts the advancement in the quality of CSR reports through its assurance. The paper provides an initial empirical account of the role of assurance in the emerging CSR reporting practice in China. The paper contributes to the modest body of empirical research on the function of external assurance in the CSR area by explicating the role played both by the accounting (external assurance) and corporate governance (ownership concentration) infrastructure to ensure high quality of CSR reporting. The paper briefs local, international regulatory authorities and the business community about the importance of external assurance for the CSR reporting quality.

Optimizing the Performance of the Quality Assurance Committee in the Implementation of Education and Training BPSDM Papua Province

The purpose of this study is to find out and analyze the role of the Quality Assurance Committee in the implementation of education and training at BPSDM Papua Province. 2) to find out and analyze the Performance Optimization of the Quality Assurance Committee in the implementation of Education and Training at BPSDM Papua Province. The research method used is descriptive analysis research, which is to provide data that is as accurate as possible about humans, circumstances or other symptoms, especially to reinforce hypotheses so that they can assist in strengthening old theories or within the framework of developing new theories. The results of this study are the role of the Papua Province BPSDM Quality Assurance Committee plays an important role in the education and training implementation process because the role of KPM can help make standard standards in conducting education and training starting from the planning, evaluation and quality quality stages, besides that KPM can make post-training instruments and implement so that BPSDM Papua Province as the organizer of the education and training has data related to the quality of graduates who have attended the training. So it can be concluded that the role of the Papua Province BPSDM Quality Assurance Committee plays an important role in providing education, training and implementing it so that the Papua Province BPSDM as the education and training provider has data related to the quality of graduates participating in the training. Optimizing the performance of KPM BPSDM Papua Province can be done through several environmental aspects, namely, the social environment, the political and legal environment, the labor environment and the technical environment. KPM BPSDM Papua Province as a team that carries out quality control and assurance functions must carry out its duties and responsibilities as well as possible and professionally so that BPSDM Papua Province can feel the existence of KPM.

Retraction Note: Development of an abnormal ocean circulation and Japanese visualization teaching system based on the Internet of Things

Today, China’s communications industry is developing rapidly, and Internet of Things (IoT) technology is also widely used in various industries. In view of the rapid growth of Internet of Things users and the ever-increasing demand for intelligence and IT, operators’ customer awareness and the follow-up business assurance function of network application services are facing major challenges. It also observes and studies ocean anomalous circulations at different times, as well as key areas where anomalies occur and evolve. The ocean observation network established by the Institute of Oceanology of the Chinese Academy of Sciences (IOCAS) has deployed more than 20 sets of deep-sea diving markers in the junction area of the Yap–Mariana trenches at 130°E, 140°E, and 142°E. This observation network provides the evolution of sea temperature, salinity, and ocean currents related to recent ENSO events and effectively supplements the shortcomings of on-site observation of ENSO events. With the development of science and technology and the development of computer networks, distance learning has gradually shown its potential advantages. It makes Japanese teaching easier. Due to the popularity of Japanese and the continuous enrichment of Japanese teaching content, it can also continuously update and improve its functions, which can effectively solve the problem of overload. The visualization system is the product of time progress and educational renewal, and it helps to improve the teaching effect of Japanese lessons. It includes new teaching methods and diversified educational resources. With the support of modern educational technology, it is easily recognized by teachers and students.

The relationship of large city out-of-hospital cardiac arrests and the prevalence of COVID-19.

BackgroundThough variable, many major metropolitan cities reported profound and unprecedented increases in out-of-hospital cardiac arrest (OHCA) in early 2020. This study examined the relative magnitude of those increases and their relationship to COVID-19 prevalence.MethodsEMS (9-1-1 system) medical directors for 50 of the largest U.S. cities agreed to provide the aggregate, de-identified, pre-existing monthly tallies of OHCA among adults (age >18 years) occurring between January and June 2020 within their respective jurisdictions. Identical comparison data were also provided for corresponding time periods in 2018 and 2019. Equivalent data were obtained from the largest cities in Italy, United Kingdom and France, as well as Perth, Australia and Auckland, New Zealand.FindingsSignificant OHCA escalations generally paralleled local prevalence of COVID-19. During April, most U.S. cities (34/50) had >20% increases in OHCA versus 2018–2019 which reflected high local COVID-19 prevalence. Thirteen observed 1·5-fold increases in OHCA and three COVID-19 epicenters had >100% increases (2·5-fold in New York City). Conversely, cities with lesser COVID-19 impact observed unchanged (or even diminished) OHCA numbers. Altogether (n = 50), on average, OHCA cases/city rose 59% during April (p = 0·03). By June, however, after mitigating COVID-19 spread, cities with the highest OHCA escalations returned to (or approached) pre-COVID OHCA numbers while cities minimally affected by COVID-19 during April (and not experiencing OHCA increases), then had marked OHCA escalations when COVID-19 began to surge locally. European, Australian, and New Zealand cities mirrored the U.S. experience.InterpretationMost metropolitan cities experienced profound escalations of OHCA generally paralleling local prevalence of COVID-19. Most of these patients were pronounced dead without COVID-19 testing.FundingNo funding was involved. Cities provided de-identified aggregate data collected routinely for standard quality assurance functions.