common quality issues with revised birth certificate data david justice data acquisition and evaluation branch divis

1. Common Quality Issues with Revised Birth Certificate Data David Justice Data Acquisition and Evaluation Branch Division of Vital Statistics, NCHS Good morning, I plan to address a number of issues related to the implementation of the revised birth certificates. If some things look familiar, it is because some portions of my presentation are updates of a similar presentation by Kryn Krautheim at last year�s VSCP Meeting in Washington. There won�t be a significant level of detail presented. Instead, we thought it would be best to expose as many issues as possible to give you an idea of problems you may want to follow up on in your area or be prepared for when you implement the new birth data set. I will also address some general procedural issues and available tools that we like to formally remind you of each year.Good morning, I plan to address a number of issues related to the implementation of the revised birth certificates. If some things look familiar, it is because some portions of my presentation are updates of a similar presentation by Kryn Krautheim at last year�s VSCP Meeting in Washington. There won�t be a significant level of detail presented. Instead, we thought it would be best to expose as many issues as possible to give you an idea of problems you may want to follow up on in your area or be prepared for when you implement the new birth data set. I will also address some general procedural issues and available tools that we like to formally remind you of each year.

2. To begin, just a few slides to show you the coverage across the US of the revised birth certificate. This slide shows the 20 states in GRAY that implemented the new certificate by the end of 2006.To begin, just a few slides to show you the coverage across the US of the revised birth certificate. This slide shows the 20 states in GRAY that implemented the new certificate by the end of 2006.

3. And this slide reflects in BLUE the 7 additional areas that plan to implement the revised birth certificate by the end of 2007. I say by the end of 2007 because we again have some areas that are tentatively planning to implement the revised data set sometime during the year. Of course, NCHS continues to discourage any area from implementing during a year if it can possibly be avoided. NOTE: 2 deaths split in 2007; 4 births split in 2007And this slide reflects in BLUE the 7 additional areas that plan to implement the revised birth certificate by the end of 2007. I say by the end of 2007 because we again have some areas that are tentatively planning to implement the revised data set sometime during the year. Of course, NCHS continues to discourage any area from implementing during a year if it can possibly be avoided. NOTE: 2 deaths split in 2007; 4 births split in 2007

4. Finally, based on information received prior to our individual meetings with you yesterday, we expect the 18 additional areas in BLUE to implement the revised birth certificate in 2008 which would mean a cumulative total of 45 birth revisers by the end of 2008. 18 for 2008: AR, AZ, DC, GU, LA, MA, ME, MO, MT, NC, NJ, NV, OK, OR, UT, VA, WV, YCFinally, based on information received prior to our individual meetings with you yesterday, we expect the 18 additional areas in BLUE to implement the revised birth certificate in 2008 which would mean a cumulative total of 45 birth revisers by the end of 2008. 18 for 2008: AR, AZ, DC, GU, LA, MA, ME, MO, MT, NC, NJ, NV, OK, OR, UT, VA, WV, YC

5. 2007: The Scales Tipped Moving beyond the raw number of states to have implemented the revised certificates, this slide shows that we had slightly less than � of all U.S. birth records filed using the new format in 2006. In 2007, which is the 5th year of revised data for some states, we should reach the point where there will be more revised birth records than non-revised. If all goes as planned, only about 17% of all birth records will still be non-revised in 2008. Of course, after we process the updates to revision dates that you provided yesterday the number of non-revised records for 2008 will certainly increase.Moving beyond the raw number of states to have implemented the revised certificates, this slide shows that we had slightly less than � of all U.S. birth records filed using the new format in 2006. In 2007, which is the 5th year of revised data for some states, we should reach the point where there will be more revised birth records than non-revised. If all goes as planned, only about 17% of all birth records will still be non-revised in 2008. Of course, after we process the updates to revision dates that you provided yesterday the number of non-revised records for 2008 will certainly increase.

6. Median Reporting Lag So, how long is it taking for the revised birth data to be submitted to NCHS? Well, for 2006, you can see that the lag time for the revisers, shown in YELLOW has settled right around or actually below the lag time for the non-revisers, shown in GREEN. And both the reviser lag of 27 days and the non-reviser lag of 28 days for 2006 are both right on the VSCP contract goal of 30 days after the end of each 2 week reporting period. NOTES:2005 revised = 27, 2005 non-revised = 29 2006 revised = 27, 2006 non-revised = 28 So, how long is it taking for the revised birth data to be submitted to NCHS? Well, for 2006, you can see that the lag time for the revisers, shown in YELLOW has settled right around or actually below the lag time for the non-revisers, shown in GREEN. And both the reviser lag of 27 days and the non-reviser lag of 28 days for 2006 are both right on the VSCP contract goal of 30 days after the end of each 2 week reporting period. NOTES:2005 revised = 27, 2005 non-revised = 29 2006 revised = 27, 2006 non-revised = 28

7. Infant Death Underreporting New item �Infant Alive at Time of Report� If response is �NO� then a matching infant death record should be identified March 2006 � Article in DVS newsletter July 2006 � Presentation at VSCP Meeting Now I will shift the focus to quality issues related to the revised birth data. The first issue also includes information from the death file. In recent years, there have been several presentations and communications alluding to the apparent underreporting of infant deaths based on infant mortality rates for infants weighing less than 500 grams. Today I will just recap what has been done in the last year in terms of working to help registration areas address this issue. (CLICK) As you know, the revised birth record includes the item �Infant Alive at Time of Report� which is a straightforward mechanism that can be used to follow up for infant deaths when the reported response is �NO.� (CLICK) In March of 2006, DVS included a short report in its electronic newsletter addressing the reporting of this new item and the success of matching these records with the appropriate infant deaths. (CLICK) Then, at last year�s VSCP meeting, DVS presented additional information about the underreporting of infant deaths. After that meeting, we decided that DVS should be more proactive in identifying states with suspected reporting problems and implement reports to assist states in finding potentially unreported infant deaths.Now I will shift the focus to quality issues related to the revised birth data. The first issue also includes information from the death file. In recent years, there have been several presentations and communications alluding to the apparent underreporting of infant deaths based on infant mortality rates for infants weighing less than 500 grams. Today I will just recap what has been done in the last year in terms of working to help registration areas address this issue. (CLICK) As you know, the revised birth record includes the item �Infant Alive at Time of Report� which is a straightforward mechanism that can be used to follow up for infant deaths when the reported response is �NO.� (CLICK) In March of 2006, DVS included a short report in its electronic newsletter addressing the reporting of this new item and the success of matching these records with the appropriate infant deaths. (CLICK) Then, at last year�s VSCP meeting, DVS presented additional information about the underreporting of infant deaths. After that meeting, we decided that DVS should be more proactive in identifying states with suspected reporting problems and implement reports to assist states in finding potentially unreported infant deaths.

8. Infant Death Underreporting January 2007 � DAEB sent �Infant Alive� reports to 2005 birth revisers March 2007 � DAEB sent �Infant Alive� reports to all 2006 revisers April 2007 � Article sent by Charlie Rothwell May 2007 � DAEB sent < 500g reports to non-revisers So, in January of this year, we sent reports to all 2005 birth revisers showing records where �NO� was reported for infant alive with no matching infant death identified on death files received by NCHS. (CLICK) In March, we followed up with the same reports to all 2006 birth revisers. Since the 2006 files are still in progress for most states we expect that corrections based on the use of the reports will be evident by the time the 2006 files are closed. We plan to send out updated reports most likely on a quarterly basis. (CLICK) In April, Charlie Rothwell distributed a more detailed report about the underreporting of infant deaths and how DVS was proceeding to interact with states to assist in addressing the problem. (CLICK) Finally, since the underreporting is no less of a problem with non-revisers, we developed a report identifying < 500 gram infants that had not been matched to an infant death. That report was sent to all 2006 non-revisers in May.So, in January of this year, we sent reports to all 2005 birth revisers showing records where �NO� was reported for infant alive with no matching infant death identified on death files received by NCHS. (CLICK) In March, we followed up with the same reports to all 2006 birth revisers. Since the 2006 files are still in progress for most states we expect that corrections based on the use of the reports will be evident by the time the 2006 files are closed. We plan to send out updated reports most likely on a quarterly basis. (CLICK) In April, Charlie Rothwell distributed a more detailed report about the underreporting of infant deaths and how DVS was proceeding to interact with states to assist in addressing the problem. (CLICK) Finally, since the underreporting is no less of a problem with non-revisers, we developed a report identifying < 500 gram infants that had not been matched to an infant death. That report was sent to all 2006 non-revisers in May.

9. Infant Death Underreporting Positive response to reports from DAEB Identify infant deaths that have not been reported or linked Identify birth records where �Infant Alive� is reported incorrectly Identify birth records that should have been reported as a fetal death So far, we have received positive responses to our reports and we have been encouraged to send them routinely. (CLICK) In addition to assisting in the identification of unreported and unlinked infant deaths, states report that they have also found birth records where the infant alive item has been reported incorrectly and also birth records that should have been reported as fetal deaths. We will continue to modify all of these reports as we get input from you.So far, we have received positive responses to our reports and we have been encouraged to send them routinely. (CLICK) In addition to assisting in the identification of unreported and unlinked infant deaths, states report that they have also found birth records where the infant alive item has been reported incorrectly and also birth records that should have been reported as fetal deaths. We will continue to modify all of these reports as we get input from you.

10. Data Quality Issues Out of range values and inconsistencies State system not adhering to specs State specs different from NCHS specs NCHS specs not detailed enough Some problems not identifiable on an individual record basis In just a minute, I am going to cover some examples of common quality issues we have seen on the revised birth files. Most of these issues are with out of range values and/or inconsistencies between items that are usually encountered at NCHS for one of four reasons: (CLICK) The State system is not adhering to the specifications that the state provided to the system developer, The State specifications are different from the recommended NCHS edit specifications, The NCHS edit specifications are not detailed enough to identify values or combinations of values that we now recognize as potential problems, and/or (4) Some problems are not identifiable on an individual record basis.In just a minute, I am going to cover some examples of common quality issues we have seen on the revised birth files. Most of these issues are with out of range values and/or inconsistencies between items that are usually encountered at NCHS for one of four reasons: (CLICK) The State system is not adhering to the specifications that the state provided to the system developer, The State specifications are different from the recommended NCHS edit specifications, The NCHS edit specifications are not detailed enough to identify values or combinations of values that we now recognize as potential problems, and/or (4) Some problems are not identifiable on an individual record basis.

11. Data Quality Issues 1 APGAR SCORE AT 10 MINUTES Depends on Apgar at 5 Minutes Only if Apgar at 5 Minutes is < 6 Code �88� is used when Apgar at 5 minutes is 06 - 10 The first issue is a repeat issue from last year�s presentation�..as a reminder we are only looking for a 10 minute APGAR score when the 5 minute APGAR score is less than 6. Otherwise, 88 should be reported for 10 minute APGAR to indicate not applicable. (NOTE: APGAR 10 should also be reported if APGAR 5 = 99.) The first issue is a repeat issue from last year�s presentation�..as a reminder we are only looking for a 10 minute APGAR score when the 5 minute APGAR score is less than 6. Otherwise, 88 should be reported for 10 minute APGAR to indicate not applicable. (NOTE: APGAR 10 should also be reported if APGAR 5 = 99.)

12. Data Quality Issues HISPANIC ORIGIN OF FATHER Unknown level inconsistent with other father�s information (race, education, dob) Defaulting to �NNNN� when unmarried instead of �UUUU� An interesting problem we have identified is with the father�s Hispanic origin. Generally, the unknown levels for the father�s variables are consistent within a State��maybe 15% each for race, Hispanic origin, education and date of birth. When we encountered a state with almost no unknowns for Hispanic origin of father compared to about 15% for the other father�s variables, we knew there was a problem. (CLICK) The state traced the issue to the fact that in the absence of father�s information for unmarried mothers the Hispanic fields were defaulting to a string of N�s, indicating non-Hispanic, rather than a string of U�s to indicate unknown. Subsequently, we noticed the same problem in several other states and we were able to communicate the source of the problem to each state. NOTE: At least 9 states = KS, DE, WY, TX, SC, NH, NH, IN, COAn interesting problem we have identified is with the father�s Hispanic origin. Generally, the unknown levels for the father�s variables are consistent within a State��maybe 15% each for race, Hispanic origin, education and date of birth. When we encountered a state with almost no unknowns for Hispanic origin of father compared to about 15% for the other father�s variables, we knew there was a problem. (CLICK) The state traced the issue to the fact that in the absence of father�s information for unmarried mothers the Hispanic fields were defaulting to a string of N�s, indicating non-Hispanic, rather than a string of U�s to indicate unknown. Subsequently, we noticed the same problem in several other states and we were able to communicate the source of the problem to each state. NOTE: At least 9 states = KS, DE, WY, TX, SC, NH, NH, IN, CO

13. Data Quality Issues 3 INVALID FIPS CODES Blanks are invalid Use ZZ for country or state Use 999 for county Use 99999 for place Another repeat problem from last year deals with the FIPS geographic coding. The most common problem with the FIPS coding is the reporting of blanks in one or more of the geographic fields. (CLICK) If a component of the geographic code is not classifiable then a string of Z�s should be reported for country or state or a string of 9�s should be reported for county or place. Records with invalid FIPS codes are listed on the routine validation reports that are transmitted to you. NOTE: FIPS GOING AWAY�..BUT PLAN TO CONTINUE UNTIL AFTER 2010 CENSUSAnother repeat problem from last year deals with the FIPS geographic coding. The most common problem with the FIPS coding is the reporting of blanks in one or more of the geographic fields. (CLICK) If a component of the geographic code is not classifiable then a string of Z�s should be reported for country or state or a string of 9�s should be reported for county or place. Records with invalid FIPS codes are listed on the routine validation reports that are transmitted to you. NOTE: FIPS GOING AWAY�..BUT PLAN TO CONTINUE UNTIL AFTER 2010 CENSUS

14. Data Quality Issues METHOD OF DELIVERY � Attempted Forceps, Vacuum Vs. Final Route and Method of Delivery = Forceps, Vacuum Forceps/Vacuum should be reported in only one place For method of delivery, if forceps is reported on the final route and method of delivery question then the response for the separate attempted forceps question should be NO. However, we have encountered records where the attempted forceps response is YES and forceps is also reported as the final route of delivery. (CLICK) The point is that forceps should only be reported in at most one place. Of course, the same logic applies to the vacuum category.For method of delivery, if forceps is reported on the final route and method of delivery question then the response for the separate attempted forceps question should be NO. However, we have encountered records where the attempted forceps response is YES and forceps is also reported as the final route of delivery. (CLICK) The point is that forceps should only be reported in at most one place. Of course, the same logic applies to the vacuum category.

15. Data Quality Issues RISK FACTOR � Previous C-Section Bad combinations with # of C-sections: Yes, 00 No, 99 or reported number Unknown, 00 or reported number Later in this session, Joyce is going to discuss the analysis of the c-section rates resulting from the revised birth data. (CLICK) However, I want to mention some combinations of values that are not logical: We have found records with the previous c-section box checked and 00 reported for the number of previous c-sections. Clearly, if the c-section box is checked then the number should be 1 or more or unknown. (CLICK) We have also found records where NO is reported for the previous c-section box but a reported value or unknown is reported for the number. If the box is reported as NO then 00 should be reported for the number. (CLICK) Finally, there are situations where the previous c-section box is reported as unknown yet there is a number reported for the number of previous c-sections. If the box is reported as unknown, then we would expect the number to also be unknown.Later in this session, Joyce is going to discuss the analysis of the c-section rates resulting from the revised birth data. (CLICK) However, I want to mention some combinations of values that are not logical: We have found records with the previous c-section box checked and 00 reported for the number of previous c-sections. Clearly, if the c-section box is checked then the number should be 1 or more or unknown. (CLICK) We have also found records where NO is reported for the previous c-section box but a reported value or unknown is reported for the number. If the box is reported as NO then 00 should be reported for the number. (CLICK) Finally, there are situations where the previous c-section box is reported as unknown yet there is a number reported for the number of previous c-sections. If the box is reported as unknown, then we would expect the number to also be unknown.

16. Data Quality Issues 6 RISK FACTOR � Infertility Treatment Subcategories added end of 2003 If infertility treatment = Y then report Y, N or U for subcategories Otherwise, subcategories X or U One result of the HHS clearance process for the revised certificates was the addition of two subcategories to the Infertility Treatment risk factor box. Of course, this created the possibility for inconsistencies between the reporting of the infertility box and the 2 subcategories. (CLICK) If risk factor infertility treatment is YES then the infertility drug subcategory should be Y, N or U and the assisted reproductive technology category should also be Y, N or U. (CLICK) When risk factor infertility treatment is NO then both subcategories should be coded to X to indicate NOT APPLICABLE. However, we are seeing many states reporting NO for the subcategories when NOT APPLICABLE should be reported. If risk factors infertility treatment = UNKNOWN then we would expect both subcategories to be U (Unknown).One result of the HHS clearance process for the revised certificates was the addition of two subcategories to the Infertility Treatment risk factor box. Of course, this created the possibility for inconsistencies between the reporting of the infertility box and the 2 subcategories. (CLICK) If risk factor infertility treatment is YES then the infertility drug subcategory should be Y, N or U and the assisted reproductive technology category should also be Y, N or U. (CLICK) When risk factor infertility treatment is NO then both subcategories should be coded to X to indicate NOT APPLICABLE. However, we are seeing many states reporting NO for the subcategories when NOT APPLICABLE should be reported. If risk factors infertility treatment = UNKNOWN then we would expect both subcategories to be U (Unknown).

17. Data Quality Issues 7 MONTH DEFAULTS ON DATES Other Pregnancy Outcome Last Live Birth First Prenatal Care Visit Month reported as 01 instead of 99 when unknown month The next issue is one that is not able to be monitored on an individual record basis. (CLICK) When we look at the frequencies for month of last pregnancy outcome (and also last live birth and first prenatal care visit) we notice that the level reported for January is routinely higher than the other months. (CLICK) Our suspicion which has been confirmed by a couple of states so far is that when only the year is reported the month is being recorded as 01 rather than 99. If the information is truly unknown, then we want the information reported as unknown. We will continue to monitor this issue and work with you to identify the facilities that are the causing the most problems.The next issue is one that is not able to be monitored on an individual record basis. (CLICK) When we look at the frequencies for month of last pregnancy outcome (and also last live birth and first prenatal care visit) we notice that the level reported for January is routinely higher than the other months. (CLICK) Our suspicion which has been confirmed by a couple of states so far is that when only the year is reported the month is being recorded as 01 rather than 99. If the information is truly unknown, then we want the information reported as unknown. We will continue to monitor this issue and work with you to identify the facilities that are the causing the most problems.

18. Data Quality Issues OUTLYING VALID VALUES Mother�s Height in Feet (1,2,7,8) Plurality (>6) In hindsight, there are some variables for which the NCHS acceptable ranges and edit specifications probably could have been handled differently. (CLICK) We are seeing values of 1, 2, 7, and 8 reported for mother�s height in feet in more records than we would expect. However, per the NCHS edit specifications, all of these values are allowed upon verification. (CLICK) Similarly, we have noticed some records with plurality reported greater than 6 which were determined to be incorrectly reported. The NCHS specifications only recommend an edit on plurality greater than 9. For both the height and plurality variables we will be reevaluating our edits as our internal systems are reengineered.In hindsight, there are some variables for which the NCHS acceptable ranges and edit specifications probably could have been handled differently. (CLICK) We are seeing values of 1, 2, 7, and 8 reported for mother�s height in feet in more records than we would expect. However, per the NCHS edit specifications, all of these values are allowed upon verification. (CLICK) Similarly, we have noticed some records with plurality reported greater than 6 which were determined to be incorrectly reported. The NCHS specifications only recommend an edit on plurality greater than 9. For both the height and plurality variables we will be reevaluating our edits as our internal systems are reengineered.

19. Not Classifiable Levels Contract Standards Reviser Levels are being monitored Available on VSCP Website 2007 levels have been added Some items with 0 unknowns? This is the first of 4 slides that are just reminders to you�.. As we have mentioned previously, the VSCP Contract Standards for the unknown tolerance levels do NOT currently apply to Revisers. (CLICK) However, the Reviser Levels are being monitored and are available on our VSCP Website. We have just recently incremented the tables to include 2007 data and encourage you to regularly check your unknown levels against the recommended tolerance levels and against other states. (CLICK) Also, please note that there are some states with items such as medical risk factors that have absolutely no unknowns. This will prompt us to ask you if your system allows for unknown reporting or if there is a default to None when an item is allowed to be skipped or left blank.This is the first of 4 slides that are just reminders to you�.. As we have mentioned previously, the VSCP Contract Standards for the unknown tolerance levels do NOT currently apply to Revisers. (CLICK) However, the Reviser Levels are being monitored and are available on our VSCP Website. We have just recently incremented the tables to include 2007 data and encourage you to regularly check your unknown levels against the recommended tolerance levels and against other states. (CLICK) Also, please note that there are some states with items such as medical risk factors that have absolutely no unknowns. This will prompt us to ask you if your system allows for unknown reporting or if there is a default to None when an item is allowed to be skipped or left blank.

20. Facility Reports All states are submitting facility codes on the revised file 2005 Joint presentation by NCHS and N.Y. State NCHS can produce reports by facility for any values, particularly unknowns As those that have already revised know, there is a field on the NCHS file layout that accommodates a facility code. The good news is that all revisers to date are submitting these codes to NCHS for quality control use. (CLICK) You may recall a joint presentation in 2005 by New York State and NCHS staff showing how useful the facility information can be in tracking potential quality issues. (CLICK) The point here is just to remind you that we have mechanisms in place to produce facility reports for you at any time even if you suspect a problem that we have not communicated to you. NOTE: WY was 0000 in 2006 but 2007 looks okay As those that have already revised know, there is a field on the NCHS file layout that accommodates a facility code. The good news is that all revisers to date are submitting these codes to NCHS for quality control use. (CLICK) You may recall a joint presentation in 2005 by New York State and NCHS staff showing how useful the facility information can be in tracking potential quality issues. (CLICK) The point here is just to remind you that we have mechanisms in place to produce facility reports for you at any time even if you suspect a problem that we have not communicated to you. NOTE: WY was 0000 in 2006 but 2007 looks okay

21. Void Flags Void Lists not required if void flag used properly Not used by all revised states Annual Final Void List still required Those that have already revised also know there is a void flag on the NCHS file layout that allows states to identify voided records. This flag can be used rather than having to send void lists by emails, transmittals or other documentation separate from the actual data file. (CLICK) Unfortunately, the void flag is not presently being used by all revisers so we will to continue working with those of you that have not yet implemented the flag. At the end of each data year, we will continue to request a single final cumulative list of voids as an independent check against the records that are flagged on your file.Those that have already revised also know there is a void flag on the NCHS file layout that allows states to identify voided records. This flag can be used rather than having to send void lists by emails, transmittals or other documentation separate from the actual data file. (CLICK) Unfortunately, the void flag is not presently being used by all revisers so we will to continue working with those of you that have not yet implemented the flag. At the end of each data year, we will continue to request a single final cumulative list of voids as an independent check against the records that are flagged on your file.

22. 2008 Documentation Deliverable each Fall � plan to request a full set from all States in 2008 Include certificates, worksheets, and system documentation � useful for 1st time revisers NCHS would like to review drafts in advance As a final reminder, the VSCP contracts include an annual deliverable of documentation. As we communicated to you in the individual state meetings yesterday, we plan to request a full set of documentation from all areas for 2008 since it has been several years since we have done so. (CLICK) At a minimum, it is helpful to have copies of certificates, worksheets, and system documentation for any data conversion that takes place to create the NCHS extract file. NCHS would appreciate the opportunity to review draft certificates to provide comments on the comparability with US Standard. Of course, this is only helpful to you if we receive the copies far enough in advance for you to incorporate changes that we suggest and that you agree to make. As a final reminder, the VSCP contracts include an annual deliverable of documentation. As we communicated to you in the individual state meetings yesterday, we plan to request a full set of documentation from all areas for 2008 since it has been several years since we have done so. (CLICK) At a minimum, it is helpful to have copies of certificates, worksheets, and system documentation for any data conversion that takes place to create the NCHS extract file. NCHS would appreciate the opportunity to review draft certificates to provide comments on the comparability with US Standard. Of course, this is only helpful to you if we receive the copies far enough in advance for you to incorporate changes that we suggest and that you agree to make.

23. Questions or Concerns? DAEB Statistician or Vital Statistics Specialist David Justice DVS/DAEB Research Triangle Park, NC djustice@cdc.gov 919 541 0589 We certainly value your input regarding any reports we send to you and as described earlier this week, DVS is in the process of reengineering its internal processing systems. This process will force us to reevaluate our edit specifications and our error reporting mechanisms in order to be more efficient and to provide better information to you. (CLICK) So, we encourage you to let us know if you have any questions about the quality issues I have presented, questions about the deliverables we are requesting of you, or questions about the reports that are available to you. Thank you very much for the time. I will now move aside so we can proceed with the remaining presentations.We certainly value your input regarding any reports we send to you and as described earlier this week, DVS is in the process of reengineering its internal processing systems. This process will force us to reevaluate our edit specifications and our error reporting mechanisms in order to be more efficient and to provide better information to you. (CLICK) So, we encourage you to let us know if you have any questions about the quality issues I have presented, questions about the deliverables we are requesting of you, or questions about the reports that are available to you. Thank you very much for the time. I will now move aside so we can proceed with the remaining presentations.