Accrediting and regulatory agencies make specific mention of blood transfusion in a number of core functions essential to quality medical care. For example, the need for transfusion is considered one of the key parameters for determining the appropriateness of an operative procedure. An acute hemolytic transfusion reaction due to ABO incompatibility is specifically identified as a reviewable sentinel event for which a comprehensive analysis of cause, corrective action, preventive action and reporting are required. Blood transfusion is acknowledged to be a therapy that involves risks, so that the organization’s performance monitoring and improvement program must address the use of blood and blood components. Furthermore, a cross functional group of medical and support staff is charged with the responsibility to take the leadership role in improving transfusion practice when indicated.
Successful performance of these functions requires that the medical staff agree to some set of practice guidelines for ordering blood transfusion. Ideally, practice guidelines would be grounded in well designed clinical trials that clearly establish efficacy and quantify risk, in at least the most common settings in which this therapy is applied. The current literature does provide guidelines for some of the more commonly encountered clinical situations. However, variability in transfusion practice often reflects expert opinion, tradition, community practice, or personal experience.
A prerequisite for the development of a viable capital market is a well functioning transactions infrastructure. The settlement of securities transactions is an important component of this infrastructure, as it determines the legal transfer of the securities that are traded. This infrastructure must operate in a seamless and integrated manner, in order to minimize the costs and risks for the end users in the market and to facilitate the allocation of capital. Hence, securities settlement systems (SSSs) are crucial to the financial system and are often supported by the central bank as lender of last resort.
Disruptions in the settlement infrastructure can lead to increased transaction costs and to a possible erosion of market liquidity which, if serious enough, may undermine financial stability. An extreme example of the potential severity of settlement failures was provided by the September 11 attacks. Settlement failures in the U.S. Treasury market jumped from $1.7 billion per day in the week ending September 5 to $190 billion per day in the week ending September 19 (see Fleming and Garbade, 2002). Failures rose initially because of the destruction of communication facilities, but remained high because the lending and borrowing program was ill-suited to absorb the massive shock.
Contingent convertibles made a very modest entry in the financial landscape in December 2009 when the Lloyds banking group offered the holders of some of its hybrid debt the possibility to swap their bonds into a new bond which carried a possible conversion into shares. Early February 2011 Credit Suisse did it more spectacular. This bank managed to attract easily $2 bn in new capital using this brand new asset class. Where Lloyds was initially struggling, Credit Suisse succeeded: investors gave this new issue a warm welcome which resulted in a massive oversubscription [28].
