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Continued vigilance - development of an online evaluation tool for assessing preparedness of medical facilities for biological events.

Front Public Health · 2014 · PMC3995059 · PMID 24783192

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a positive trendno p-value reported
Considering the complexity, needed resources and efforts that must be invested in each activity designed to increase preparedness, integration of less than four levels of performance may cause inability to witness a positive trend of correcting gaps.

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Quoted from the open-access full text in Europe PMC under the licence the publisher applied. The sentence is reproduced exactly as published; the emphasis is ours.