External Monitors Research Articles

Monitoring experience of World Health Organization external monitor for Intensified Mission Indradhanush 5.0 vaccine drive in rural Cuddalore, Tamil Nadu

The Intensified Mission Indradhanush 5.0 (IMI 5.0) aimed to extend routine immunization services across India, with a focus on children up to 5 years old. Key objectives included boosting measles and rubella vaccination coverage. By September 30, 2023, over 34.6 million children and 6.5 million pregnant women had received vaccine doses nationally. The Surveillance Medical Officer (SMO) from WHO designated external monitors to oversee session sites and perform house-to-house monitoring. Monitoring took place from October 12-14, 2023, in three health blocks of Cuddalore District. Activities included observing two session sites per day (six total) and surveying 40 households per day (120 total). Separate checklists were provided for session site monitoring and house-to-house monitoring, as per WHO guidelines. All session sites adhered to the scheduled times and locations, with proper logistics. However, some lacked IEC materials for public awareness. House-to-house monitoring confirmed full vaccination coverage for under-five children, with no missed vaccinations identified. Recommendations were made to ANMs to have IEC material to enhance community participation. Monitoring of IMI 5.0 in Cuddalore District demonstrated strong adherence to guidelines and effective vaccination session implementation. House-to-house monitoring confirmed appropriate vaccination of under-five children, indicating successful outreach. Overall, this experience provided valuable insights into operational challenges and opportunities for improvement in future immunization campaigns.

Effectiveness, utilisation and cost associated with implantable loop recorders versus external monitors after ischaemic or cryptogenic stroke

ObjectiveImplantable loop recorders (ILRs) are increasingly used for long-term rhythm monitoring after ischaemic and cryptogenic stroke, with the goal of detecting atrial fibrillation (AF) and subsequent initiation of oral anticoagulation...

The Diminished Role of Larger Auditors as External Monitors in de-SPAC Transactions

The Diminished Role of Larger Auditors as External Monitors in de-SPAC Transactions

Abstract 15925: Comparative Mortality, Safety, and Cost Among Stroke Patients Who Received Implantable Loop Records Compared to Continuous External Cardiac Monitors

Background: Implantable loop recorders (ILR) are increasingly used to screen for atrial fibrillation (AF) among patients with stroke, but real-world outcomes are lacking. Goal: To determine comparative effectiveness, safety, and costs of ILR compared with continuous external monitors (CEM) and Holter monitors in a real-world setting of patients with stroke. Methods: This retrospective cohort analysis used the Optum Labs Data Warehouse, which contains longitudinal, de-identified administrative claims. The cohort included patients with recent stroke who received cardiac monitoring from 1/1/2016 - 6/30/2021, comparing those with ILR to those with CEM (>48 hours to 30 days) or Holter (≤48 hours). Eligibility criteria included: ischemic stroke during 6 month baseline; continuous enrollment with medical and pharmacy coverage; no evidence of pacemaker, implantable cardioverter-defibrillator, AF, left atrial appendage ablation, or oral anticoagulants. The primary outcome was 12-month all-cause mortality, secondary outcomes included new diagnosis of AF + initiation of anticoagulants, hemorrhagic stroke, and total and device-related costs. Final analyses were adjusted for CHA 2 DS 2 -VASc score. Results: Among 48,801 individuals, 18.9% received ILR, 59.5% CEM, and 21.6% Holter. Groups had similar demographics and comorbidities (Table). Compared to those with CEM, the ILR group had higher odds of a new diagnosis of AF plus initiation of anticoagulants (OR 2.27; (95% CI 2.09, 2.48)), and hemorrhagic stroke (OR of 1.60 (95% CI 1.34, 1.93)). There was no difference in mortality. Unadjusted direct medical cost of monitoring was substantially higher in the ILR group ($13,975) compared to CEM ($449) and Holter ($149). Conclusions: Although the use of ILRs was associated with increased detection and treatment for AF, there was no impact on all-cause mortality. ILR was associated with increased hemorrhagic stroke and higher costs.

CE-452772-3 SELF-PULSE EXAM FOR ATRIAL FIBRILLATION SCREENING: A RANDOMIZED CONTROLLED TRIAL

Atrial fibrillation (AF), the most commonly treated cardiac arrhythmia, is associated with significant morbidity including the potential for stroke. Because AF is often asymptomatic, there is growing interest in AF screening. Trials of AF screening using external monitors, smartwatches, or other personal electronic devices have shown that screening increases detection of AF. Due to the cost and low yield of screening with insufficient evidence of clinical benefit, the US Preventative Services Task Force has not recommended comprehensive screening for AF at the current time. However, no study has evaluated whether teaching patients to detect irregularity on self-pulse exam is a feasible and effective screening tool for AF. To conduct a randomized controlled trial of self-pulse exam for detection of AF in patients who would be at high risk for stroke. We recruited 524 patients with no history of AF or atrial flutter (AFL) who would be at high risk for stroke (CHADS2VASC score ≥ 2 in men or ≥3 in women) for participation in a study of self-pulse exam for detection of AF. Participants were recruited from local primary care and cardiology clinics and randomized to either usual care or to viewing a 5-minute educational video designed to teach patients to self-detect pulse irregularity. Participants were asked to self-check twice daily for 14 days. Those detecting an abnormal pulse were then offered a confirmatory 14-day external cardiac monitor. The primary endpoint was time to detection of AF or AFL and patients were followed for one year. The one-year rate of AF or AFL detection was increased (5.5% vs. 2.4%, p=0.07), while time to AF/AFL diagnosis (121.8 days vs. 140.6 days, p=0.07, Figure) and time to anticoagulation initiation (127.8 days vs. 239.0 p=0.3) were decreased in the intervention vs. control groups, respectively. Multivariate analysis demonstrated a significant independent association of the intervention with rate of detection of AF/AFL (OR 3.04, p=0.04) and decreased time to detection of AF/AFL (HR 9.75, p=0.01), after adjusting for potential confounders. Patients can be taught a self-pulse exam via a simple educational video. This easily implemented screening tool is independently associated with a greater than three-fold increased rate of detection of AF/AFL, as well as significantly decreased time to AF/AFL diagnosis.

Under Pressure: External Monitor, Managerial Attention and Organizational Learning from Major Errors

Research on organizational learning from serious errors has uncovered several influences related to a firm’s own experiences and those of its peers. While the learning literature therefore acknowledges that the external environment affects organizational learning, research has largely overlooked the possibility that organizations other than competitors might also shape learning by the focal firm. We explore this proposition by studying the collective influence of an essential monitor (financial analysts) on repeat incidences of a serious organizational error (major oil spills). Specifically, we theorize that monitors apply pressure by setting expectations in the immediate aftermath of an error (encouraging learning from that error by directing managerial attention toward safety), but that these effects are counteracted by subsequent pressure to meet a different expectation (encouraging forgetting by diverting managerial attention away from safety and toward profit). We also theorize that analysts further shape organizational learning from errors by conditioning what we know about both experiential and vicarious learning. We test this theory by studying the effects of evolving analyst pressures on major oil spills in the U.S. by firms in the oil and gas industry, from 1980 to 2016. By showing that analysts apply differential pressures to firms following a serious error (immediately and, then, subsequently), this study highlights the role of external monitors in encouraging both organizational learning and forgetting due to socially set expectations that shift the attention of managers among competing foci in ways that affect the likelihood of repeat serious errors.

The Relation Between Private Equity Fund Reporting Quality and External Monitors, Third-party Service Providers, and Fund Attributes

The Relation Between Private Equity Fund Reporting Quality and External Monitors, Third-party Service Providers, and Fund Attributes

Accruals mispricing versus risk: Analyzing the influence of external monitoring in Brazil

AbstractIn this paper, we examine the role of external monitoring as an alternative mechanism of corporate governance pertaining to the risk and mispricing of accruals in the Brazilian market. The results provide evidence of the accruals anomaly for companies with low external monitoring and evidence that is stronger when evaluating the discretionary component of accruals. Our analysis does not support the conclusion that total and discretionary accruals represent price risk factors, which suggests that the evidence of anomaly results from mispricing. Our evidence contributes to the growing literature on accruals pricing in emerging markets, by adding elements such as the influence of external monitoring and the level of investor sophistication, hereby represented by market analysts and institutional investors. Our study provides additional evidence that the presence of these intermediary agents creates an external layer of control capable of contributing positively to the process of disclosure and pricing of financial information. Thus, the role of such intermediaries as external monitors in emerging markets can be potentially significant for correctly pricing accruals. While Brazil has its own unique institutional characteristics, our findings confirm the evidence obtained for other countries.

Jintide: Utilizing Low-Cost Reconfigurable External Monitors to Substantially Enhance Hardware Security of Large-Scale CPU Clusters

Nowadays, hardware security has become a serious concern for modern CPUs. State-of-the-art detection approaches rely heavily on trustworthy and intimate internal states, incurring significant design/operation overheads and additional risks to security and intellectual property. This article proposes an architecture called Jintide, which utilizes trusted external monitors to validate an untrusted CPU chip at runtime. This architecture records, replays, and analyzes the CPU’s IO and memory behavior with the architectural states. The Jintide simultaneously verifies whether the records are correctly replayed with the instruction set architecture and whether the records involve malicious behavior. Consequently, not only architectural but also micro-architectural threats can be detected. The Jintide adopts the states from the untrusted source because it has a built-in function to detect spurious states. The monitors comprise three types of chips (with 28-/40-nm TSMC technology): a tracer chip to record the behavior of IO ports, multiple tracer chips to record the behavior of DDR4 DIMMs, and a reconfigurable chip to verify these records with software states. As runtime external monitors, the Jintide would be especially suitable to constitute distributed large-scale clusters, which can amortize operation overheads. This scheme is effective in detecting pervasive hardware security issues, including vulnerabilities, backdoors, and hardware Trojans. The measured results show that a system composed of 300 000 Jintide CPUs containing Intel Xeon Skylake processors can detect over 99.8% of recognizable attacks at the cost of 0.98% performance loss. Hence, the Jintide is an extensible, low-cost, and effective solution to improve the hardware security of large-scale CPU clusters.

External monitoring and returns to hedge fund activist campaigns

AbstractFirms targeted by hedge fund activists experience significantly higher returns when there are fewer external monitors in place at the target firm. Using analyst coverage and institutional ownership as measures of external monitoring presence, we find that low‐monitored activist targets experience abnormal returns 17.52% above that of high‐monitored targets in the 2‐year period following the initial campaign start date. The significant effect of external monitoring remains after controlling for target firm and activist characteristics. We also document improved operating performance and an increased monitoring presence at low‐monitored target firms across the same 2‐year period, consistent with the observed market performance.

IRS Tax Enforcement and the Cost of Syndicated Loans in the United States

We show that tax enforcement benefits US firms that borrow from banks. Using data on syndicated loans over the 1993-2017 period, we find that higher IRS audit probabilities exert a negative and significant effect on the cost of loans. The baseline estimates show that a one standard deviation increase in the IRS audit probability decreases the cost of bank credit by around 9 basis points (or $1.55 million interest for the average loan). In further analysis we find that the negative effect of IRS tax enforcement on the cost of syndicated loans is more evident when the presence of external monitors, other than the IRS, is weaker and for loans issued by lead banks that are less reputed and less experienced with borrowing firms and their sector or region. IRS tax enforcement decreases also the probability that loans will contain covenants. The results are robust to several tests that address endogeneity and other concerns. These findings indicate that banks perceive the IRS as a useful external monitoring mechanism that alleviates information asymmetry in the syndicated loan market. This study informs the public policy debate about the IRS by showing that it exerts a positive spillover to the US economy in the form of lower costs of corporate financing through the banking system.

External Monitors and Score Manipulation in Italian Schools: Symptomatic Treatment or Cure?

We use the repeated random assignment of external examiners to school institutes in Italy to investigate whether the effect of external monitoring on test score manipulation persists over time. We find that this effect is still present in the tests taken one year after exposure to the examiners, and is stronger for open-ended questions, for small school institutes, and for institutes located in the northern and central regions of the country. In the second year after exposure, however, this effect disappears, suggesting that monitoring is a symptomatic treatment rather than a cure of score manipulation. We discuss learning, reputational concerns, peer pressure and teacher preferences as potential mechanisms behind our findings, and present some evidence on the role played by social capital and high stakes.

Are earnings strings restrained after SOX?

Purpose This paper aims to examine whether external monitors (auditors and analysts) constrain earnings strings, an indicator of earnings management, and whether this monitoring is more effective after the implementation of the Sarbanes-Oxley Act of 2002 (SOX), given the emphasis of SOX on improving auditing, financial reporting and the information environment. Design/methodology/approach Agency theory establishes the premise between external monitoring and earnings strings. Auditor tenure and number of analysts following provide measures for external monitoring quality. Using prior research, empirical models explaining the presence of an earnings strings and earnings strings trend are developed to test the hypotheses. Findings Pre-SOX, extreme auditor tenure, indicating lower quality external monitoring, is associated with greater earnings strings trend, and analyst coverage is associated with increased likelihood of earnings strings and greater earnings strings trend consistent with analyst pressure on management. More effective auditor and analyst monitoring occurs post-SOX in terms of reduced likelihood of earnings strings and earnings strings trend. Originality/value The authors provide evidence on how elements of external monitoring are associated with increased earnings strings pre-SOX. Further, they contribute to the debate on the impact of SOX on external firm monitoring and the overall financial information environment. By focusing on earnings strings, the outcome of earnings management, the authors provide a unique understanding of external monitoring that also provides insight on the overvaluation of equity and ultimate destruction of firm value. The evidence demonstrates how regulation has contributed to an improved financial reporting environment and external monitoring.

External Monitoring and Returns to Hedge Fund Activist Campaigns

Firms targeted by hedge fund activists experience significantly higher returns when there are fewer external monitors in place at the target firm. Using analyst coverage and institutional ownership as measures of external monitoring presence, we find that low-monitored activist targets experience abnormal returns 17.52% above that of high-monitored targets in the two-year period following the initial campaign start date. The significant effect of external monitoring remains after controlling for target firm and activist characteristics. We also document improved operating performance and an increased monitoring presence at low-monitored target firms across the same two-year period, consistent with the observed market performance.

Earnings Strings in the Post-SOX Era

We investigate whether or not the impact of external firm monitoring on earnings strings is associated with the implementation of the Sarbanes-Oxley Act of 2002 (SOX). Researchers have argued that earnings strings are likely a product of earnings management as earnings strings occur much more often than by chance. External monitors, such as auditors and analysts, may constrain this behavior. We measure the quality of the external monitoring using auditor tenure and number of analysts following the firm. We then examine whether or not this monitoring is more effective post-SOX, given the emphasis of SOX on improving auditing and financial reporting. We find that short and long auditor tenure, indicating lower quality external monitoring, is associated with reduced likelihood and length of earnings strings post-SOX, but the role of analysts as external monitors in relation to earnings strings is only partially affected by SOX. Our results are consistent with stronger auditing and an improved information environment post-SOX.

The influence of security analysts on CEO pay cuts

This study investigates the role of external monitors, in the form of analyst recommendations, on CEO pay cuts. We use the theories of signaling and optimism to arrive at propositions that predict the relationship between analyst recommendations as external monitors, and CEO pay cuts. CEO pay cuts – which constitute a strong incentive for CEO behavior – have received only limited attention in extant research. Analysis of data for US public firms from 1998 to 2013 suggest that firms with strong external monitoring mechanisms, such as public analyst recommendations, are more likely to implement pay cuts. Our findings reveal that analyst recommendations serve as important and objective external signals and a monitoring mechanism for determining CEO pay cuts. Specifically, low-performing firms and firms with high CEO pay before analyst recommendations are more likely to integrate the analyst downgrades in their decision process regarding CEO compensation. From our analysis, practitioners could learn that – even though they might find it difficult to implement CEO pay cuts – such pay cuts are not only effective but also could be implemented based on external signals from analysts. A takeaway for external analysts is the powerful effect that their negative signals have on CEO pay cuts, thus questioning the optimism bias that is so prevalent in the industry. In order to serve as truly ‘objective’ external monitors, analysts should use ratings judiciously as signaling mechanisms.

Does a Salary Cap Really Work?

Limiting executive compensation through a salary cap has emerged as one of the latest global governance initiatives. We investigate the effectiveness of a form of an executive salary cap system and find that only firms with a high level of effective external monitors set their salary cap significantly sensitive to firm performance (cap-performance sensitivity). The difference between the salary cap and actual pay (the gap) varies by the level of monitoring. Therefore, the existence of an efficient external monitoring system may be critical for a salary cap system to be successful. We also find evidence suggesting that incentive structures created by a salary cap may properly work only in the presence of an effective external monitoring system by improving better pay-performance sensitivity. Since it is almost impossible to determine an optimal level for a salary cap, we conclude that improving firm-level governance may be more important to thwart highly excessive compensation than legalizing the upper limit.

Do Bad Boards Allow Bad Acquisitions?

A large proportion of acquisitions results in shareholder wealth destruction. This study examines who is responsible for allowing bad acquisitions. Using a sample of 349 tax-free, stock-for-stock, pooling acquisitions over 1993-2001, the announcement period abnormal returns of acquirers are found to be negatively associated with weak corporate governance, e.g., staggered boards, infrequent board meetings and a single person serving as both the CEO and chairman. The presence of external stakeholders also influences announcement returns, which are positively associated with larger debt and stock ownership by trust funds. The presence of external monitors continues to be associated with superior performance in the long run, whereas the role of the board appears to diminish. Overall, the results indicate that active boards, stronger governance structures and external monitors are associated with value-enhancing acquisitions. In contrast, weak boards, dominant management and the absence of external monitoring appear to allow bad acquisitions to occur.

The Effects of External Monitors on Firm Performance and Corporate Governance Disclosure Level: Malaysian Evidence

The Effects of External Monitors on Firm Performance and Corporate Governance Disclosure Level: Malaysian Evidence

Automated Online Monitoring of Distributed Applications through External Monitors

It is a challenge to provide detection facilities for large-scale distributed systems running legacy code on hosts that may not allow fault tolerant functions to execute on them. It is tempting to structure the detection in an observer system that is kept separate from the observed system of protocol entities, with the former only having access to the latter's external message exchanges. In this paper, we propose an autonomous self-checking monitor system, which is used to provide fast detection to underlying network protocols. The monitor architecture is application neutral and, therefore, lends itself to deployment for different protocols, with the rulebase against which the observed interactions are matched, making it specific to a protocol. To make the detection infrastructure scalable and dependable, we extend it to a hierarchical monitor structure. The Monitor structure is made dynamic and reconfigurable by designing different interactions to cope with failures, load changes, or mobility. The latency of the monitor system is evaluated under fault free conditions, while its coverage is evaluated under simulated error injections