Strong Compliance Research Articles

Understanding Characteristics that Define the Feasibility of Conservation Actions in a Common Pool Marine Resource Governance System

AbstractEffective conservation requires people to make choices about how they interact with the environment. Social characteristics influence the likelihood of establishing conservation actions with strong compliance (hereafter “feasibility”), but are rarely considered in conservation planning. Our study makes two contributions to understand feasibility. First, we explicitly test the associations between social characteristics and the presence and form of resource management. Second, we compare the ability of different types of data to elucidate feasibility. We use Ostrom's (2007) thinking on social–ecological systems and literature on resource management in Melanesia to create a context‐specific framework to identify social characteristics that influence feasibility for conservation management. We then apply this framework and test for associations between the presence and form of management on one hand and social characteristics on the other, using data collected at different resolutions. We found that conservation feasibility was associated with characteristics of the governance system, users, and the social, economic, and political setting. Villages with different forms of management were more similar to each other socially than to villages without management. Social data collected at the resolution of households accounted for over double the variation in the form and presence of management compared to data at the resolution of villages. Our methods can be adapted to conservation planning initiatives in other socioeconomic settings.

Looking up to regulations, out at peers or down at the bottom line: How institutional logics affect the prevalence of age-related HR practices

Drawing on new institutionalism theory, this study examines the influence of institutional logics, the belief systems that direct decision-makers’ attention to particular sets of issues, on human resource (HR) adaptation to demographic changes. We argue that the prevalence of age-neutral HR management and of age-related HR practices such as age assessment and older worker-targeted practices, are shaped by the strength of the strategic (business case), benchmarking (comparing one’s set of policies with peers’) and compliance (laws and regulations) logics. In a sample of 420 US organizations, a strong strategic logic was associated only with greater prevalence of age-neutral HR management. A strong benchmarking logic was associated with greater prevalence of age-neutral HR management, of age assessment practices, and of older worker-targeted practices. A strong compliance logic was associated with greater prevalence of age-assessment and older worker-targeted practices. This article contributes to research on ageing and extends work on institutional logics by (1) focusing on organizations’ differential enactment of institutional logics, reflecting the contextual embeddedness of HR practices, and (2) showing that the prevalence of age-neutral HR management and of age-related HR practices are associated with competitive as well as institutional isomorphism.

Electoral Cycles in International Reserves: Evidence from Latin America and the OECD

In Latin America there is ample evidence of exchange rate depreciations after elections. Hence, we turn to the behavior of international reserves over the 1980–2005 period to investigate if exchange rates are temporarily stabilized before elections. Using annual, quarterly, and monthly data to define the election year, we find that international reserves fall significantly before elections, which indeed suggests a policy of stabilizing exchange rates. The patterns observed in the region are not replicated in OECD countries. However, once we control for legislative checks and balances on executive discretion in countries with strong compliance with the law, the behavior of both regions becomes remarkably similar. We find that lower effective checks and balances can explain why reserves fall before elections in Latin America. The electoral cycles in reserves and exchange rates in Latin America can be interpreted in terms of the fiscal dominance of monetary policy.

Weak Compliance Undermines the Success of No-Take Zones in a Large Government-Controlled Marine Protected Area

The effectiveness of marine protected areas depends largely on whether people comply with the rules. We quantified temporal changes in benthic composition, reef fish biomass, and fishing effort among marine park zones (including no-take areas) to assess levels of compliance following the 2005 rezoning of the government-controlled Karimunjawa National Park (KNP), Indonesia. Four years after the rezoning awareness of fishing regulations was high amongst local fishers, ranging from 79.5±7.9 (SE) % for spatial restrictions to 97.7±1.2% for bans on the use of poisons. Despite this high awareness and strong compliance with gear restrictions, compliance with spatial restrictions was weak. In the four years following the rezoning reef fish biomass declined across all zones within KNP, with >50% reduction within the no-take Core and Protection Zones. These declines were primarily driven by decreases in the biomass of groups targeted by local fishers; planktivores, herbivores, piscivores, and invertivores. These declines in fish biomass were not driven by changes in habitat quality; coral cover increased in all zones, possibly as a result of a shift in fishing gears from those which can damage reefs (i.e., nets) to those which cause little direct damage (i.e., handlines and spears). Direct observations of fishing activities in 2009 revealed there was limited variation in fishing effort between zones in which fishing was allowed or prohibited. The apparent willingness of the KNP communities to comply with gear restrictions, but not spatial restrictions is difficult to explain and highlights the complexities of the social and economic dynamics that influence the ecological success of marine protected areas. Clearly the increased and high awareness of fishery restrictions following the rezoning is a positive step. The challenge now is to understand and foster the conditions that may facilitate compliance with spatial restrictions within KNP and marine parks worldwide.

Selected FINRA notices and disciplinary actions, October‐December 2011

PurposeThe purpose of this paper is to provide summaries of selected Financial Industry Regulatory Authority (FINRA) regulatory notices and disciplinary actions issued in October, November, and December 2011.Design/methodology/approachThe paper provides Regulatory Notice 11‐49, October 2011, Advertising Regulation; Regulatory Notice 11‐52, November 2011, Senior Designations; Regulatory Notice 11‐54, November 2011, Branch Office Inspections; and the description of one disciplinary action in which a firm was sanctioned and an individual fined.FindingsNotice 11‐49: to inform firms of recent developments regarding the application of rules governing communications with the public, FINRA is proving guidance to firms on communication with the public regarding exchange‐traded products, treasury inflation‐protected securities (TIPS), use of “FINRA” in firm trademarks, and identification of related prior filings when submitting new filings for review. Notice 11‐52: FINRA reminds firms of their supervisory obligations regarding the use of certifications and designations that imply expertise, certification, training or specialty in advising senior investors. Notice 11‐54: FINRA and the Securities and Exchange Commission's Office of Compliance Inspections and Examinations provide broker‐dealer firms with information on developing effective policies and procedures for branch office inspections and remind firms of supervisory requirements under FINRA's supervision rule and notes common deficiencies and strong compliance practices. Trade Reporting Notice on TRACE Reporting Issues: FINRA answers selected member firm detailed questions on reporting issues related to The Trade Reporting and Compliance Engine (TRACE), the vehicle developed by FINRA to facilitate the mandatory reporting of over the counter secondary market transactions in eligible fixed income securities. All broker/dealers who are FINRA member firms have an obligation to report transactions in corporate bonds to TRACE under an SEC approved set of rules.Originality/valueThese are direct excerpts designed to provide a useful digest for the reader and an indication of regulatory trends.

Market Procyclicality and Systemic Risk

We model the systemic risk associated with the so-called balance-sheet amplification mechanism in a system of banks with interlocked balance sheets and with positions in real-economy-related assets. Our modeling framework integrates a stochastic price dynamics with an active balance-sheet management aimed to maintain the Value-at-Risk at a target level. We find that a strong compliance with capital requirements, usually alleged to be procyclical, does not increase systemic risk unless the asset market is illiquid. Conversely, when the asset market is illiquid, even a weak compliance with capital requirements increases significantly systemic risk. Our findings have implications in terms of possible macro-prudential policies to mitigate systemic risk.

Understanding and Preventing Dysfunctional Behavior in Organizations

We review the literature on dysfunctional behavior in organizations and illuminate the potential contribution of human resource development (HRD) to manage such behavior and contribute to strong governance and compliance. The impetus for this article comes from evidence of dysfunctional behavior in banking and financial organizations in many countries in recent times. We define dysfunctional behavior at individual, organizational, and institutional levels of analysis and propose a model of HRD to address dysfunctional behavior at these levels. HRD potentially plays four key roles in the context of managing and/or preventing dysfunctional behavior: development of employee awareness and skills; effective governance of HRD practices, structures, and delivery mechanisms; development of an ethical governance culture and climate and a more far-reaching role than that of organizational governance and agency mediation that minimizes the possibility of dysfunctional organizational behavior. We conclude with a discussion of HRD research and practice implications.

Polyethylene Glycol Hydrogel Spinal Sealant (DuraSeal Spinal Sealant) as an Adjunct to Sutured Dural Repair in the Spine

A prospective, multicenter, randomized, two-arm, single-blind, investigational device exemption pivotal study. To assess the efficacy and the safety of a polyethylene glycol (PEG) hydrogel spinal sealant (DuraSeal Spinal Sealant) as an adjunct to sutured dural repair compared with standard of care methods (control) to obtain a watertight dural closure in patients undergoing an intentional durotomy during spinal surgery. If a watertight dural closure is not achieved, cerebrospinal fluid leak with associated complications may occur. The PEG hydrogel spinal sealant is an Food and Drug Administration (FDA)-approved adjunct to sutured dural repair in spine surgery. This synthetic, absorbable hydrogel sealant works in the presence of fluid, conforms to irregular surfaces, and demonstrates strong adherence and compliance to tissue, without interfering with underlying tissue visibility. A total of 158 patients were treated at 24 centers after they were randomized on the basis of an approximately 2:1 ratio (sealant:control); 102 received the PEG hydrogel spinal sealant and 56 received standard care. The primary end point was intraoperative watertight closure. Secondary end points included evaluations of postoperative cerebrospinal fluid leak, infection, and wound healing. Patients treated with the PEG hydrogel spinal sealant had a significantly higher rate of watertight closure than the control (100% vs. 64.3%, P < 0.001). No statistical differences were seen in postoperative cerebrospinal fluid leak, infection, and wound healing. No neurologic deficits were seen attributable to the sealant. The PEG hydrogel spinal sealant evaluated in this study is safe and effective for providing watertight closure when used as an adjunct to sutured dural repair during spinal surgery. This readily available tool is superior to other standard of care technologies commonly used to achieve intraoperative watertight dural closure.

Postdischarge impact of C-L psychiatry treatment in obstetrical inpatients.

Purpose. Twenty-eight women, referred to C-L Psychiatry during their obstetrical inpatient stay were interviewed six months post-discharge to determine how they experienced the consultation process, whether they recollected and adhered to treatment recommendations, and whether they developed or had a recurrence of mental health problems post-discharge. Method. Semi-structured telephone interviews were conducted by a psychologist who had not been involved with patient care. Results. There was strong congruence between reason for referral as stated in psychiatric consult notes and participants' recollections and strong congruence and compliance regarding treatment recommendations. Sixty-four percent of women had concerns regarding mood post-discharge, of whom 66% sought professional help within six months. Participants' recommendations for improving the effectiveness of the C-L service to obstetrical inpatients pertained mainly to sensitivity to patients' feelings, consistency of message and personnel, and post-discharge follow-up. Conclusions. Obstetrical patients had good recollection of their experience of C-L psychiatry, and post-discharge compliance with treatment recommendations was high. A post-discharge telephone call might further enhance treatment compliance and encourage women who are struggling with mood difficulties to seek help. Contact between C-L psychiatry and patients' primary care physician may also enhance care post-discharge.

Computer-Facilitated Assessment of Disaster Preparedness for Remote Hospitals in a Long-Distance, Virtual Tabletop Drill Model

Emergency preparedness experts generally are based at academic or governmental institutions. A mechanism for experts to remotely facilitate a distant hospital's disaster readiness is lacking. The objective of this study was to develop and examine the feasibility of an Internet-based software tool to assess disaster preparedness for remote hospitals using a long-distance, virtual, tabletop drill. An Internet-based system that remotely acquires information and analyzes disaster preparedness for hospitals at a distance in a virtual, tabletop drill model was piloted. Nine hospitals in Cape Town, South Africa designated as receiving institutions for the 2010 FIFA World Cup Games and its organizers, utilized the system over a 10-week period. At one-week intervals, the system e-mailed each hospital's leadership a description of a stadium disaster and instructed them to login to the system and answer questions relating to their hospital's state of readiness. A total of 169 questions were posed relating to operational and surge capacities, communication, equipment, major incident planning, public relations, staff safety, hospital supplies, and security in each hospital. The system was used to analyze answers and generate a real-time grid that reflected readiness as a percent for each hospital in each of the above categories. It also created individualized recommendations of how to improve preparedness for each hospital. To assess feasibility of such a system, the end users' compliance and response times were examined. Overall, compliance was excellent with an aggregate response rate of 98%. The mean response interval, defined as the time elapsed between sending a stimuli and receiving a response, was eight days (95% CI = 8-9 days). A web-based data acquisition system using a virtual, tabletop drill to remotely facilitate assessment of disaster preparedness is efficient and feasible. Weekly reinforcement for disaster preparedness resulted in strong compliance.

African Land, Up for Grabs

Sheikh Saudi and Ethiopia, Arabia, Mohammed where spends Hussein he his was time born Ali shuttling Al in a Amoudi, village between 64 a years citizen Riyadh ago. of Sheikh Saudi A abia, spends his time shuttlin between Ri adh d Ethiopia, where he was born i a village 64 ye rs ago. The son of a Yemeni father and Ethiopian mother, Al Amoudi boasts an estimated net worth of $10 billion. He is the richest Ethiopian and, according to Forbes, the 64th richest man in the world. Fortyfive years ago, he emigrated to Saudi Arabia and built his fortune in oil refineries and the booming construction industry. But Al Amoudi never lost touch with his homeland. In fact, Ethiopian real-estate has become a key part of his burgeoning portfolio. In 2009, Al Amoudi's company, Saudi Star Agricultural Development, signed long-term leases for nearly 25,000 acres in the country's northeastern regional state, Gambella, to produce

Corporate environmentalism in a small emerging economy: stakeholder perceptions and the influence of firm characteristics

AbstractThis study presents a neo‐institutional perspective of the perceptions of corporate environmentalism held by stakeholder groups relative to each other and the influence that specific firm‐level characteristics, such as size, ownership, compliance record, and location, have on these perceptions. Empirical evidence is gathered from the emerging economy context of Trinidad and Tobago and its pollution‐intensive oil, gas, and petrochemical sectors. Results indicate that non‐governmental and community‐based organizations (NGOs/CBOs) are most critical and business chains least critical of corporate environmentalism. All stakeholders perceive larger firms and those with strong compliance records as having stronger corporate environmentalism, while government stakeholders perceive foreign‐owned firms, business chain perceives urban‐based firms, and NGOs/CBOs perceive state‐owned firms as having stronger corporate environmentalism. These preliminary findings can guide corporate managers in handling stakeholder relations and can guide policy‐makers seeking to circumvent industry‐stakeholder friction in emerging economies. Copyright © 2010 John Wiley &amp; Sons, Ltd and ERP Environment.

Adherence to nutritional recommendations and subsequent cognitive performance: findings from the prospective Supplementation with Antioxidant Vitamins and Minerals 2 (SU.VI.MAX 2) study

Few studies have investigated the long-term effect of overall nutritional recommendations on cognition. In a French cohort of middle-aged adults, we evaluated the association between the French National Nutrition and Health Program (Program National Nutrition Santé) Guideline Score (PNNS-GS) assessed at baseline and cognitive performance evaluated 13 y later. The PNNS-GS was estimated at baseline (1994-1996) (maximum score: 15 points) in 2135 subjects in the SU.VI.MAX (Supplementation with Antioxidant Vitamins and Minerals) study. We assessed cognitive performance of subjects in 2007-2009 via a battery of 4 neuropsychologic tests that included phonemic and semantic fluency, the RI-48 (rappel indicé-48 item) cued-recall test, the trail-making test, and forward and backward digit spans. A principal components analysis was performed to account for correlations in test scores. Multivariate linear regression models or analyses of covariance were also performed. In a multivariate model, we observed a positive association between the PNNS-GS and the cued-recall test and semantic and phonemic fluency tasks, whereas no association was observed with digit spans. The principal components analysis revealed 2 factors interpreted as reflecting verbal memory and executive functioning. Better adherence to nutritional recommendations was significantly associated with the verbal memory factor (β = 0.41; 95% CI: 0.17, 0.64), whereas no association was shown with the executive functioning factor. Removing specific components from the PNNS-GS did not modify the findings. This study suggests that strong compliance with nutritional recommendations in midlife is associated in elderly individuals with better verbal memory, which is a cognitive domain that is particularly vulnerable to pathologic aging and Alzheimer disease. This trial was registered at clinicaltrials.gov as NCT00272428.

The Vagaries Of Public Support For Government Actions In Case Of A Pandemic

Government health measures in a pandemic are effective only with strong support and compliance from the public. A survey of 1,583 US adults early in the 2009 H1N1 (swine influenza) pandemic shows surprisingly mixed support for possible government efforts to control the spread of the disease, with strong support for more extreme measures such as closing borders and weak support for more basic, and potentially more effective, policies such as encouraging sick people to stay home from work. The results highlight challenges that public health officials and policy makers must address in formulating strategies to respond to a pandemic before a more severe outbreak occurs.

Aktuelle Herausforderungen und zeitgemäße Möglichkeiten der Gruppenanalyse in einer sich verändernden Welt am Beispiel Norwegens

Contemporary Possibilities and Challenges of Group Analysis in a Changing World Group analysis has often been considered both as a panacea - a universal treatment for various psychological problems and suffering, and as an emancipatory project for increased self understanding and self fulfillment. The increased focus today on evidence based practice and documented effect represents a great challenge to group analysis, - a challenge which has to be taken seriously and not considered irrelevant to our practice. Today the development seems to move away from universal treatments towards more specialized, designed and even manualized treatment programs of specific mental disorders. It will be focussed on what these challenges imply for group analysis and group analytic training in Norway. What changes need to be done in group analytic training if group analysis should be a viable and relevant treatment modality, not least within the public mental health services? It will also be discussed whether the group analytic identity acquired during the group analytic training contains elements of strong loyalty, conformity and compliance which become an obstacle to necessary changes.

Corporate Governance, Distress Syndrome and Nigerian Banks

This study basically beamed its searchlight on the banking sector in Nigeria. It covered the period before the bank consolidation and the issues involved in corporate governance were also considered. The role corporate governance has played in the unfolding scenario particularly during the period 1994-2003 was noted. This paper therefore examined the conceptual framework the literature review and the methodology in a nutshell while the discussions and findings were brought out as exhaustively as possible. The paper further attempted to establish the nexus between corporate governance and banking sector distress in Nigeria. The author recommended a strong compliance with the latest code of corporate governance handed over by the Central Bank of Nigeria to banks. It ultimately posited that effective corporate governance will make the directors and top management accountable for their misdeeds; it will resolve the issue of bank distress and will bring the expected sanity into the sector.

Experimental studies on dimethylsulfide (DMS) and dimethylsulfoniopropionate (DMSP) production by four marine microalgae

The production of dimethylsulfide (DMS) and dimethylsulfoniopropionate (DMSP) by marine microalgae was investigated to elucidate more on the role of marine phytoplankton in ocean-atmosphere interactions in the global biogeochemical sulfur cycle. Axenic laboratory cultures of four marine microalgae-Isochrysis galbana 8701, Pavlova viridis, Platymonas sp. and Chlorella were tested for DMSP production and conversion into DMS. Among these four microalgae, Isochrysis galbana 8701 and Pavlova viridis are two species of Haptophyta, while Chlorella and Platymonas sp. belong to Chlorophyta. The results demonstrate that the four algae can produce various amounts of DMS(P), and their DMS(P) production was species specific. With similar cell size, more DMS was released by Haptophyta than that by Chlorophyta. DMS and dissolved DMSP (DMSPd) concentrations in algal cultures varied significantly during their life cycles. The highest release of DMS appeared in the senescent period for all the four algae. Variations in DMSP concentrations were in strong compliance with variations in algal cell densities during the growing period. A highly significant correlation was observed between the DMS and DMSPd concentrations in algal cultures, and there was a time lag for the variation trend of the DMS concentrations as compared with that of the DMSPd. The consistency of variation patterns of DMS and DMSPd implies that the DMSPd produced by phytoplankton cells has a marked effect on the production of DMS. In the present study, the authors’ results specify the significant contribution of the marine phytoplankton to DMS(P) production and the importance of biological control of DMS concentrations in oceanic water.

Surgical/Pathologic Breast Cancer Indicators: Adherence by the Florida Initiative for Quality Cancer Care (FIQCC) Consortium.

Abstract Background: The FIQCC is comprised of 11 practice sites across the state that participate in a comprehensive review of quality of care specific to cancer patients across many disease sites. Quality indicators were scripted based on the accepted QOPI, NCCN, ACOS, and site-specific PI panel consensus indicators for breast cancer patients. An evaluation was done to assess adherence to performance indicators among the sites.Methods: Comprehensive chart reviews were conducted for all patients with breast cancer first seen in 2006 by a medical oncologist at one of the 11 FIQCC sites (3 academic/8 community). Quality measures included: 1) presence and completeness of the pathology report (tumor size, grade, specimen orientation, margins inked, margin status, receptor status); 2) documentation of surgery type (breast conserving vs. mastectomy); 3) documentation of sentinel lymph node biopsy (SLNB) and if SLNB positive for metastatic disease documentation of a complete axillary node dissection; 4) mammogram usage post surgery; and 5) referral to radiation. Statistical comparisons were performed using chi-square test.Results: Charts of 622 patients (99% female) with a median age of 60 years (range 22-95) were reviewed. With respect to pathologic reporting, there was strong compliance (&amp;gt;90%) for documentation of a pathology report, AJCC or TMN staging, tumor size and grade, status of margins, and receptor status. However, only 370 of 537 (69%) reports documented that the specimen was oriented and 474 of 537 (88%) stated the margins were inked. Breast conserving surgery was performed in 294 of 539 patients (55%). In clinical N0 patients, SLNB was performed in 447 of 543 (82%). Of the patients with a metastatic SLNB, 123 of 156 (79%) went on to have a complete axillary node dissection. Compliance was highly variable with obtaining a mammogram within 14 months of surgery (77%; range 26-98%). However, referral to radiation within 1 year was highly consistent (97%; range 80-100%). Significant variances across practice sites were noted for the reporting of margin orientation (p&amp;lt;0.001), inking of the margins (p&amp;lt;0.001), performance of SLNB (p&amp;lt;0.001), and obtaining a mammogram within 14 months of surgery (p&amp;lt;0.001).Discussion: The FIQCC allows for identification of the need for quality improvement in multiple aspects of breast cancer care. Findings based on 2006 cases identified a need for improvements in margin orientation and inking, use of SLNB and obtaining mammograms in follow-up after breast conserving surgery. These findings are now being used at the participating sites to guide quality improvement efforts. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1079.

A theory of contracts for strong service compliance

We investigate, in a process algebraic setting, a new notion of correctness for service compositions, which we callstrong service compliance: composed services are strong compliant if their composition is both deadlock and livelock free (this is the traditional notion of compliance), and whenever a message can be sent to invoke a service, it is guranteed to be ready to serve the invocation. We also define a new notion of refinement, calledstrong subcontract pre-order, suitable for strong compliance: given a composition of strong compliant services, we can replace any service with any other service in subcontract relation while preserving the overall strong compliance. Finally, we present a characterisation of the strong subcontract pre-order by resorting to the theory of a (should) testing pre-order.

Adherence to National Quality Forum (NQF) colorectal cancer indicators among members of the Florida Initiative for Quality Cancer Care (FIQCC) consortium

6563 Background: FIQCC is a consortium of 10 institutions participating in a comprehensive practice-based system of quality self-assessment across a number of cancer types. The NQF has endorsed several performance measures to assess the quality of care for colorectal cancer (CRC) patients. We have sought to identify adherence to NQF CRC indicators among members of FIQCC. Methods: Comprehensive chart reviews were conducted for all patients with CRC first seen in 2006 by a medical oncologist at one of the 10 FIQCC sites (2 academic/8 community). NQF quality measures included: 1) consideration or administration of chemotherapy to patients with stage III colon cancer (CC); 2) completeness of pathology reporting for CRC; 3) &gt;12 regional lymph nodes (LN) examined for resected CC. Statistical comparisons were performed using chi-squared analysis. Results: The population consisted of 475 patients (250 men and 225 women) with a median age of 65 years (range 27–92). Chemotherapy was considered/administered in 96.5% (136/141) of stage III CC patients. With respect to CRC pathologic reporting, there was strong compliance (&gt;90%) for reporting the number of LN examined and involved by tumor, proximal/distal margin status, depth of invasion, and histologic grade. However, only 225 of 295 (76.2%) reports documented lymphovascular invasion status. Radial margin status was included for 45% (27/60) of surgical rectal cancer specimens. Only 73.9% (173/234) of CC cases had &gt;12 LN examined. Of the NQF measures, significant differences across practice sites were noted for the reporting of histologic grade (p = 0.0002), proximal/distal margin status (p = 0.049), and lymphovascular invasion (p &lt; 0.0001). Conclusions: Although there was uniformly strong adherence to the application of adjuvant therapy for stage III CC across FIQCC sites, the adequacy of lymphadenectomy and LN examination for resected CC was lower and varied considerably across sites. There remains room for improvement of pathologic CRC reporting across the whole consortium as well as at individual sites. The FIQCC initiative allows for the identification of targets for global quality improvement as well as of specific measures for individual institutions. No significant financial relationships to disclose.