Program Performance Research Articles

Abstract WMP33: Translating Evidence Into Practice: Early Supported Discharge in Intracerebral Hemorrhage

Background: The 2022 guidelines from the American Heart Association/American Stroke Association underscore the significance of coordinated multidisciplinary care and early discharge planning for spontaneous intracerebral hemorrhage (ICH) patients. Early Supported Discharge (ESD) programs have been found to curtail hospital stays for ICH patients. Purpose: This Quality Improvement initiative aimed to optimize our ESD program, originally designed for acute ischemic stroke patients, by expanding eligibility to encompass mild to moderate spontaneous ICH patients. The primary objectives were to evaluate the effects on the hospital length of stay and discharge-to-home rates. Methods: In 2020, a collaboration between our acute care hospital and homecare organization led to the development of an ESD program, Homeward Stroke Recovery, for ischemic stroke survivors in local catchment areas. Eligibility criteria were broadened to include ICH patients in July 2022. Descriptive statistics were used to track the program's performance, specifically discharge-to-home rates and hospital length of stay for ICH survivors discharged with Homeward Stroke Recovery. Results: Following the expansion of Homeward Stroke Recovery Program eligibility, the discharge-to-home rate for ICH patients at the site increased by 14.2% (27.5% to 41.7%). Additionally, the median length of stay decreased by 2 days (6 days to 4 days). Conclusions: In conclusion, our Quality Improvement project has successfully enhanced the Homeward Stroke Recovery program. This was achieved by aligning eligibility criteria with evidence-based recommendations for patients with mild to moderate spontaneous ICH, leading to a substantial positive impact on patient outcomes. The outcomes of this initiative not only affirm the efficacy of broadening eligibility for ESD programs but serves as a beacon and blueprint to widen scope through evidence-guided improvements.

Resilience of Social Transfer Programs to Large Unexpected Shocks

Large, unexpected shocks are becoming more frequent, making the design of robust social transfer programs more vital than ever. We evaluate the performance of the Food Friendly Program (FFP), the largest in-kind social transfer program in Bangladesh, before and during the nation-wide COVID-19 lockdown. Using two-rounds of nationally representative household surveys combined with administrative data, we document that high leakages and large welfare losses are related to corruption. This contrasts with the performance of the pre-lockdown FFP, when leakage was low and coverage high. We then compare the performance of the FFP with two initiatives launched following the pandemic: an in-kind and cash transfer program, respectively. These programs have markedly higher levels of leakage than the FFP. Our findings are relevant to other large shocks, such as those caused by climate change, and have important policy implications for the design and delivery of transfer programs in developing countries characterized by institutional weaknesses.

Lifetime maximization of wireless sensor networks while ensuring intruder detection

Wireless sensor networks (WSN) have a wide variety of application areas and one of these areas is border crossing security. Unauthorized crossing of border areas, unauthorized arms and drug trafficking can be avoided at a lower cost and easier than conventional methods by monitoring the borders with the help of a WSN. In this study, we offer a mathematical model that guarantees the detection of possible intruders by scheduling the activities of the sensors whatever the route the intruder follows throughout the border zone or whatever the time the intruder enters to the route. To achieve the highest possible WSN management efficiency, we integrate coverage, routing, data routing, and sensor scheduling WSN design issues into the mathematical model. We first demonstrate the effectiveness of scheduling the sensors by the help of the offered mathematical model by comparing it against a random activity schedule of the sensors with respect to network lifetime and intruder detection ratio performance measures. We also develop a Lagrangean heuristic strategy to solve realistic sized instances of the proposed problem. We produce several random border zone instances with varying sizes and test the proposed solution strategy to illustrate the effectiveness of the offered solution strategy by comparing its performance against the performance of a commercial mixed-integer linear programming (MILP) solver.

Monitoring Behaviour Change of Farmers to Support Ecologically Friendly Agricultural Management Program in Peatland Ecosystems

Conserving peatland areas requires the commitment and the capacities of all stakeholders, including farmers living within the areas. Two business models, agro-silvo-fishery and Trigona apiculture, have been established in a demonstration plot in the peatland ecosystem of Baru Village, Banyuasin, South Sumatra, as new options for farmers to improve livelihoods while also managing peatland sustainably. Trainings on sustainable production, post-harvest, and markets were provided to the rice-based farmers to help them manage new livelihood options. Monitoring the behavioural transformation of farmers engaged in the two business model pilots is a crucial aspect of the program. This is accomplished using the ADKAR approach, which posits that attaining long-term behavioural change involves progressing through stages of Awareness, Desire, Knowledge, Ability, and Reinforcement. A survey instrument was created to monitor farmers behaviour changes in (i) collective action, and (ii) managing agroecosystems sustainably, reflecting collaborative effort required to conserve peatland. Prior to the intervention program, a baseline survey (n=43) was conducted to record farmers’ current knowledge. The findings revealed that most farmers (60%) never joined a group but motivated to actively participate, whereas 25% of farmers had actively participated in groups and were eager to urge other farmers to join. Most farmers (52%) acknowledge the significance of safeguarding peatland areas but lack the knowledge to do so, whereas 25% have implemented ecologically friendly agricultural management in peatland areas. When the program began, none of the farmers were involved in agro-silvo-fishery or Trigona apiculture. According to a mid-program assessment aimed at recording the performance of the business models, 3 farmers have adopted apiculture with a total of 101 beehives. While none of the farmers adopt agro-silvo-fishery individually, 5 farmers produced organic fertilizer individually using the training program’s new competence. However, producing organic fertilizer as collective action was halted, suggesting farmers partiality to work individually rather than collectively. A final survey to assess behavioural changes is planned towards the end of the program next year. The ADKAR approach for monitoring farmers’ behavior change is useful for evaluating the performance of intervention programs and seek solutions to ensure it is aligned with the landscape level NRM goals.

Characterization of program and erase speed of memory capacitors with nanolaminated HfO2/Al2O3 stacks for application in non-volatile memories

The programming and erase performance of atomic layer deposited HfO2/Al2O3 memory stacks is investigated depending on the thickness of the tunnel oxide and the annealing of the structures. The as-grown stacks require applying of voltage pulses with duration of about 10-3 s for a measurable electron trapping (programming). The time dependence of the electron trapping process is quite sharp initially - the increase of the charging time from 4×10-4 s to 4×10-3 s provides more than 80% of the saturation value of the trapped charge obtained at durations above 1 s. The annealing increases the time needed for the onset of the electron trapping. For the chosen voltage amplitudes the programming characteristics does not depend on the tunnel oxide thickness. The electron detrapping (erase) is observed even at durations of ~10-7 s, but with a low efficiency. The erase characteristics is more gradual then the program one, and shows some dependence on tunnel oxide and annealing. The complete erase is achieved for times comparable to those for programming the cell. Erase pulses with duration > 10-2 s results to accumulation of positive charge in the capacitors.

Colorectal Cancer Screening Programs in Latin America

Colorectal cancer (CRC) is a leading cause of cancer-related mortality globally, with increasing incidence and mortality in Latin America. CRC screening programs can reduce disease burden, but information on screening programs in Latin America is limited. To describe characteristics (eg, type of program, uptake, neoplastic yield) of CRC screening programs in Latin America. PubMed, Ovid MEDLINE, EMBASE, Cochrane, PsycINFO, Web of Science Core Collection, LILACS, and SciELO were searched from inception to February 2023. Relevant references from bibliographies, conference proceedings, and gray literature were considered. The search strategy included English, Spanish, and Portuguese terms. Included were studies of CRC screening programs in Latin America using fecal immunochemical test (FIT) or colonoscopy as the primary screening method. Four reviewers independently assessed study eligibility based on titles, with review of abstracts and full texts as needed. Guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed for data abstraction and quality assessment. Descriptive information was extracted, and data were pooled using a random-effects model. Program performance indicators included rates of participation and FIT positivity, adenoma detection rate (ADR), advanced adenoma detection rate (AADR), CRC detection rate, and colonoscopy quality indicators. There were 17 studies included from upper middle-income and high-income countries in Latin America with a total of 123 929 participants. Thirteen studies used FIT as the initial screening method, whereas 4 used screening colonoscopy. The participation rate in FIT-based programs was 85.8% (95% CI, 78.5%-91.4%). FIT positivity rates were 15.2% (95% CI, 9.6%-21.8%) for the 50-ng/mL threshold and 9.7% (95% CI, 6.8%-13.0%) for the 100-ng/mL threshold. For FIT-based studies, the pooled ADR was 39.0% (95% CI, 29.3%-49.2%) and CRC detection rate was 4.9% (95% CI, 2.6%-7.9%); for screening colonoscopy-based studies, the pooled ADR was 19.9% (95% CI, 15.5%-24.8%) and CRC detection rate was 0.4% (95% CI, 0.1%-0.8%). This systematic review and meta-analysis suggests that CRC screening in upper middle-income countries in Latin America is feasible, detecting rates of neoplasia comparable with those of high-income regions. Population-based screening programs should be developed or enhanced in these settings. There is a knowledge gap regarding feasibility and yield of screening programs in lower middle-income countries.

EFL students’ motivational currents during Extensive Reading Programs: A retrodictive qualitative modelling

Motivation to read, the driving force to achieve one’s reading goals, plays a significant role in language learning as it relates to reading engagement and achievement. Its presence is prominently necessary for a longer learning period. This article explores the features of nine pre-service students’ motivational currents and how their motivation changes throughout the task performance in Extensive Reading Programs (henceforth ERPs). Data were collected from diaries, and a retrodictive qualitative model was applied to recount the experiences of the student participants’ motivational currents following Dörnyei’s Directed Motivational Currents (DMC). Themes of diaries and interviews were generated following the Interpretative Phenomenological Analysis. The findings show that the features of DMC are salient and functioning throughout the student’s learning experiences and facilitate the construction of their future identity as readers. Four patterns of motivational currents during the students’ learning were a steady wave, slight wave, moderate wave, and great wave patterns. The variability and stability of task performance motivation indicate that students’ motivational trajectories are unique, conditional, and context-bound. Identifications of the sources of motivators and demotivators provide hints for designing more engaging classroom activities, enriching the task features, and sustaining students’ motivation. This study concludes with possible directions for future motivation research.

디지털 교육 체제 전환을 위한 교사단의 양성연수 성과 분석

This study is to conduct a survey to check the performance of the teacher training program of the Digital Leadership School. As a result, the pre and post surveys of the teachers of digital leading schools showed significantly improvements in their ability to utilize AI courseware in all areas. Therefore, the educational effectiveness of the teachers of digital leading schools is high enough. Second, differentiated training courses are needed according to trainees' capabilities. Rather than compulsorily organizing the teacher corps of digital leading schools by school, we should seek a selection method centered on teachers who want to participate among teachers with basic competencies. Finally, in addition to AI courseware, teachers will need a platform where they can share experiences on practical applications of digital education.

The Relationship between Characteristics, Attitudes and Community Participation on CSR Program Performance

Corporate Social Responsibility (CSR) is a company's commitment to behaving ethically and contributing to sustainable development. CSR is implemented through collaboration with company stakeholders to improve people's lives. CSR prioritizes balancing the company's financial, social and environmental aspects. This research aims to determine the relationship between attitudes, participation and community characteristics on the performance of the CSR program by PT Pertamina Patra Niaga Fuel Terminal Samarinda. This study uses a quantitative approach. The total number of respondents who will be included in this research is 90 people who are members of the community who participate in the Bank Ramli CSR program by PT Pertamina Patra Niaga Fuel Terminal Samarinda. The Spearman Rank correlation test will be used to measure the relationship between variables such as characteristics, attitudes and community participation on CSR program performance. This research found that community characteristics such as community income and level of knowledge have a significant correlation with CSR program performance, while other characteristics such as gender, age, education, number of family dependents, and employment do not have a significant influence on CSR program performance. Community attitudes in the affective aspect have a significant positive correlation with the company's responsibility towards society. Apart from that, community participation in the aspect of enjoying the program also has a very significant correlation to company profits and the company's responsibility towards the community.

Predictors of standardized in-service examination performance and residency outcomes in a graduate periodontics program.

The objectives of this study were to assess the influence of learner- and education-related factors on standardized in-service examination performance and determine whether in-service examination scores predict residency outcomes. American Academy of Periodontology (AAP) In-service Examination (AIE) scores from 10 periodontics residency classes at a single center were recorded and compared against a panel of learner- and education-related variables using multiple linear regression models. Defined residency outcome measures were analyzed against AIE scores using binomial logistic regression. No evaluated learner- or education-related variable was a statistically significant predictor of AIE score in this study sample. Likewise, AIE score was not a statistically significant predictor of any assessed residency outcome. The AAP has performed a tremendous service to periodontics residents and programs by marshaling the leadership and expertise necessary to offer a professionally constructed assessment instrument. However, in the current study, no relationship could be identified between AIE score and any outcome, including first-attempt board certification. The AAP In-service Committee appears well situated to provide additional leadership focusing on exam implementation, which may enhance AIE value in competency decision making.

Entrepreneurship Mentoring Programme and Market Performance: Evidence from SIDO Supported Micro and Small Enterprises in Arusha, Tanzania

The overall market performance of Micro and Small Enterprises in Tanzania has been observed to be poor because entrepreneurs are unable to compete, identify opportunity, identify the needs of customers and produce what is needed and failure to retain and satisfy their customers. As a result, the graduating rate of micro to small, medium and large enterprises in Tanzania is absolutely very low. This high failure rate is mainly caused by lack competent entrepreneurs who can compete, explore market environment, identify and exploit business opportunities. The purpose of this study was to establish the association between entrepreneurship mentoring programme and Small Industrial Development Organization (SIDO) supported Micro Small Enterprises’ (MSEs) market performance in Arusha Municipality. The study used cross-sectional research design. Data were collected using survey questionnaire on 230 sampled Small Industrial Development Organization (SIDO) supported MSEs and analysed by using Structural equation model (SEM). The results revealed that there was positive relationship between entrepreneurship mentoring programme and SIDO supported MSEs market performance. The study contributes in providing empirical evidence to body of knowledge and provides an insight to policy makers on the role of entrepreneurship mentoring programme in supporting or facilitating performance of MSEs in the market. The study concluded that overall entrepreneurship mentoring programme has strong positive association with MSEs market performance. The study recommended that SIDO and other institutions offering entrepreneurship training programmes to establish incubation Centres that will incubate MSEs after graduating from entrepreneurship trainings so that they can be well mentored and monitored.

Output Performance of Collaborative Governance: Examining Collaborative Conditions for Achieving Output Performance of the Dutch Flood Protection Program

Despite abundant research on collaborative governance, relatively little attention has been paid to explaining its performance. When are collaborations performing and what conditions are required to achieve high performance? This study fills this gap by building on the performance matrix for assessing collaborative governance regimes by Emerson and Nabatchi. Drawing on survey data, we use a fuzzy set qualitative comparative analysis (fsQCA) to explore the performance of 26 collaborative flood risk governance projects in the Netherlands. We analyze how conditions of engagement, shared motivation, external expertise, connective leadership and resource availability shape the output performance of these collaboratives. The results reveal four “success” configurations. Success stems, in particular, from “connective leadership” and resources for collaboration working in tandem, or with one of these conditions combined with respectively “external expertise” and “shared motivation.” Failure, in contrast, stems from the absence of multiple conditions. Consequently, we draw lessons about the spectrum of different concrete recipes of collaboration fostering output performance.

Fostering Literacy Culture through 5-Minute Reading Habit: A Community Service Initiative at Elementary School 034816 Jambu Mbellang

This community service aims to develop a culture of literacy at SD Negeri 034816 Jambu Mbellang through the habit of reading for 5 minutes. Involving instructors, students and parents, this program focuses on producing positive changes in reading behavior among participants. By carrying out preparatory analysis and planning, we explain the literacy situation in schools and propose relevant strategies. The results of implementing this program show a major change in children's enthusiasm for reading, as well as growth in literacy skills. Ongoing reviews and regular monitoring can identify supporting factors and barriers to program performance. Outreach to parents and their involvement in children's literacy instruction is critical in establishing a supportive atmosphere at home. Workshops and additional training for teachers and parents provide insight and practical solutions to improve literacy learning. The success of this program is not only seen in improving students' reading abilities, but also in changes in attitudes, active participation of parents, and growth in teacher skills. These results suggest that bringing the entire school community together can foster a positive and sustainable literacy culture. It is hoped that this success will provide inspiration and input for similar efforts to improve literacy in other schools.

Assessment of ChatGPT-3.5's Knowledge in Oncology: Comparative Study with ASCO-SEP Benchmarks.

ChatGPT (Open AI) is a state-of-the-art large language model that uses artificial intelligence (AI) to address questions across diverse topics. The American Society of Clinical Oncology Self-Evaluation Program (ASCO-SEP) created a comprehensive educational program to help physicians keep up to date with the many rapid advances in the field. The question bank consists of multiple choice questions addressing the many facets of cancer care, including diagnosis, treatment, and supportive care. As ChatGPT applications rapidly expand, it becomes vital to ascertain if the knowledge of ChatGPT-3.5 matches the established standards that oncologists are recommended to follow. This study aims to evaluate whether ChatGPT-3.5's knowledge aligns with the established benchmarks that oncologists are expected to adhere to. This will furnish us with a deeper understanding of the potential applications of this tool as a support for clinical decision-making. We conducted a systematic assessment of the performance of ChatGPT-3.5 on the ASCO-SEP, the leading educational and assessment tool for medical oncologists in training and practice. Over 1000 multiple choice questions covering the spectrum of cancer care were extracted. Questions were categorized by cancer type or discipline, with subcategorization as treatment, diagnosis, or other. Answers were scored as correct if ChatGPT-3.5 selected the answer as defined by ASCO-SEP. Overall, ChatGPT-3.5 achieved a score of 56.1% (583/1040) for the correct answers provided. The program demonstrated varying levels of accuracy across cancer types or disciplines. The highest accuracy was observed in questions related to developmental therapeutics (8/10; 80% correct), while the lowest accuracy was observed in questions related to gastrointestinal cancer (102/209; 48.8% correct). There was no significant difference in the program's performance across the predefined subcategories of diagnosis, treatment, and other (P=.16, which is greater than .05). This study evaluated ChatGPT-3.5's oncology knowledge using the ASCO-SEP, aiming to address uncertainties regarding AI tools like ChatGPT in clinical decision-making. Our findings suggest that while ChatGPT-3.5 offers a hopeful outlook for AI in oncology, its present performance in ASCO-SEP tests necessitates further refinement to reach the requisite competency levels. Future assessments could explore ChatGPT's clinical decision support capabilities with real-world clinical scenarios, its ease of integration into medical workflows, and its potential to foster interdisciplinary collaboration and patient engagement in health care settings.

Routine image-enhanced endoscopic surveillance for metachronous esophageal squamous cell neoplasms in head and neck cancer patients.

Esophageal squamous cell neoplasms (ESCNs) are common second primary tumors in patients with head and neck cancer. Image-enhanced endoscopy (IEE) with Lugol chromoendoscopy or magnifying narrow-band imaging both increase the detection of early ESCNs. No evidence-based ESCN surveillance program for head and neck cancer patients without a history of synchronous ESCNs exists. We aimed to evaluate the performance of an IEE surveillance program with magnifying narrow-band imaging endoscopy and Lugol chromoendoscopy. From April 2016, we routinely used IEE with magnifying narrow-band imaging and Lugol chromoendoscopy to evaluate patients with head and neck cancer history. All patients who were negative for ESCNs at the first surveillance endoscopy and received at least 2 IEEs through December 2019 were included. Demographic profiles, clinical data, cancer characteristics, IEE results and pathology reports were analyzed. A total of 178 patients were included. Only 4 patients (2.2%) developed metachronous ESCNs during follow-up, all of whom received curative resection treatment. The interval for the development of metachronous ESCNs was 477 to 717 days. In multivariate Firth logistic regression and Kaplan‒Meier survival curve analysis, Lugol's voiding lesion type C had an increased risk of esophageal cancer development (adjusted odds ratio = 15.71; 95% confidence interval, 1.33-185.87, p = 0.029). Eight patients died during the study period, and none of them had metachronous ESCNs. IEE with magnifying narrow-band imaging and Lugol chromoendoscopy is an effective surveillance program in head and neck cancer patients without a history of ESCNs. Annual surveillance can timely detect early ESCNs with low ESCN-related mortality.

Using multimodal learning analytics to understand effects of block‐based and text‐based modalities on computer programming

AbstractBackgroundWith the development of computational literacy, there has been a surge in both research and practice application of text‐based and block‐based modalities within the field of computer programming education. Despite this trend, little work has actually examined how learners engaging in programming process when utilizing these two major programming modalities, especially in the context of secondary education settings.ObjectivesTo further compare programming effects between and within text‐based and block‐based modalities, this research conducted a quasi‐experimental research in China's secondary school.MethodsAn online programming platform, Code4all, was developed to allow learners to program in text‐based and block‐based modalities. This research collected multimodal data sources, including programming platform data, process data, and performance data. This research further utilized multiple learning analytics approaches (i.e., clustering analysis, click stream analysis, lag‐sequential analysis and statistics) to compare learners' programming features, behavioural patterns and knowledge gains under two modalities.Results and ConclusionsThe results indicated that learners in text‐based modality tended to write longer lines of code, encountered more syntactical errors, and took longer to attempt debugging. In contrast, learners in block‐based modality spent more time operating blocks and attempt debugging, achieving better programming knowledge performances compared to their counterparts. Further analysis of five clusters from the two modalities revealed discrepancies in programming behavioural patterns.ImplicationsThree major pedagogical implications were proposed based on empirical research results. Furthermore, this research contributed to the learning analytics literature by integrating process‐oriented and summative analysis to reveal learners' programming learning quality.

Preliminary Development of a Program ABSITE Dashboard (PAD) to Guide Curriculum Innovation

Medical Knowledge for general surgery residents' is assessed by the American Board of Surgery In- Training Examination (ABSITE). ASBITE score reports contain many metrics residency directors can utilize to assess resident progress and perform program evaluation. The purpose of this study was to develop a framework to evaluate program effectiveness in teaching specific subtest and subtopic areas of the ABSITE, using ABSITE score reports as an indicator. The aim is to demonstrate the identification of topic areas of weakness in program-wide performance on the ABSITE to guide proposed modification of the general surgery residency program curriculum, and to initiate development of a data visualizing dashboard to communicate these metrics. A single institution retrospective study was performed utilizing ABSITE score reports from general surgery residents at a large academic training program from 2017 to 2020. ABSITE performance metrics from 320 unique records were entered into a database; statistical analysis for linear trends and variance were conducted for standard scores, subtest standard scores, and incorrect subtest topics. Deviation from national average scores were calculated by subtracting the national average score from each subtest score for each trainee. Data were displayed as medians or proportions and are displayed to optimize visualization as a proof-of-concept for the development of a program dashboard. Trends and variance in general surgery program and cohort performance on various elements of the ABSITE were visualized using figures and tables that represent a prototype for a program dashboard. Figure A1 demonstrates one example, in which a heatmap displays the median deviation from national average scores for each subtest by program year. Boxplots show the distribution of the deviation from national average, range for national average scores, and the recorded scores for each subtest by program year. Trends in median deviation from the national average scores are displayed for each program year paneled by subtest or for each exam year paneled by cohort. Median change in overall test scores from one program year to another in a cohort is visualized as a table. Bar graphs show the most often missed topics across all program years and heatmaps were generated showing the proportion of times each topic was missed for each subtest and exam year. We demonstrate use of ABSITE reports to identify specific thematic areas of opportunities for curriculum modification and innovation as an element of program evaluation. In this study we demonstrate, through data analysis and visualization, feasibility for the creation of a Program ABSITE Dashboard (PAD) that enhances the use of ABSITE reports for formative program evaluation and can guide modifications to surgery program curriculum and educational practices.

PENGANGGARAN BERBASIS KINERJA DAN AKUNTABILITAS KINERJA PADA LEMBAGA PEMERINTAH

The aim of this research is to investigate the relationship between performance-based budgeting and performance accountability of government institutions. Government performance accountability is measured by indicators of program smoothness, budget implementation, performance indicators, financial analysis, evaluation reporting, and program duration. Performance-based budgeting uses measures of accountability and transparency, budget fairness, efficiency, and effectiveness as independent variables. Decisions are made by individuals who have power in the best interests. This research involved 39 department employees, secretaries, section heads, sub-division heads, and work subunits from the Regional Work Unit (SKPD) of the Environment and Forestry Service of Bengkulu Province who helped prepare the government budget. Data was collected through a questionnaire method, and respondents were given one. To analyze the data, the Spearman Rank test and hypothesis testing were used. The results of this research show that the three independent variables-implementation of performance-based budgeting with metrics of budget accountability and transparency, budget discipline, budget fairness, budget efficiency, and budget effectiveness-influence the performance accountability of government institutions

Disentanglement with Futures, State, and Interaction

Recent work has proposed a memory property for parallel programs, called disentanglement, and showed that it is pervasive in a variety of programs, written in different languages, ranging from C/C++ to Parallel ML, and showed that it can be exploited to improve the performance of parallel functional programs. All existing work on disentanglement, however, considers the "fork/join" model for parallelism and does not apply to "futures", the more powerful approach to parallelism. This is not surprising: fork/join parallel programs exhibit a reasonably strict dependency structure (e.g., series-parallel DAGs), which disentanglement exploits. In contrast, with futures, parallel computations become first-class values of the language, and thus can be created, and passed between functions calls or stored in memory, just like other ordinary values, resulting in complex dependency structures, especially in the presence of mutable state. For example, parallel programs with futures can have deadlocks, which is impossible with fork-join parallelism. In this paper, we are interested in the theoretical question of whether disentanglement may be extended beyond fork/join parallelism, and specifically to futures. We consider a functional language with futures, Input/Output (I/O), and mutable state (references) and show that a broad range of programs written in this language are disentangled. We start by formalizing disentanglement for futures and proving that purely functional programs written in this language are disentangled. We then generalize this result in three directions. First, we consider state (effects) and prove that stateful programs are disentangled if they are race free. Second, we show that race freedom is sufficient but not a necessary condition and non-deterministic programs, e.g. those that use atomic read-modify-operations and some non-deterministic combinators, may also be disentangled. Third, we prove that disentangled task-parallel programs written with futures are free of deadlocks, which arise due to interactions between state and the rich dependencies that can be expressed with futures. Taken together, these results show that disentanglement generalizes to parallel programs with futures and, thus, the benefits of disentanglement may go well beyond fork-join parallelism.

Towards contextualized complex systems approaches to scaling-up hepatitis B birth-dose vaccination in the African region: a qualitative systematic review.

Despite the longstanding implementation of universal hepatitis B infant vaccination programs, the World Health Organization African region (WHO AFRO) maintains the highest prevalence (2.5%) of chronic hepatitis B virus (HBV) infection among children ≤5 years of age. Scaling-up hepatitis B birth-dose (HepB BD) vaccination could avert mother-to-child transmission of HBV infection and advance regional progress towards eliminating viral hepatitis. To describe whether - and how - complexities within the health system or intervention influence the performance of HepB BD vaccination programs in the WHO AFRO. Using a complexity perspective, we conducted a qualitative systematic review of literature published between 2009-2022. A Boolean search strategy retrieved relevant literature indexed in PubMed, EBSCOhost databases, Scopus, and Web of Science, with supplementary searches conducted to identify any missed articles. No language restrictions were applied. Data extraction, synthesis and analysis were guided by a systems-based logic model tailored to systematic reviews of complex interventions. Our search yielded 672 published records. Of these, 28 (26 English, 2 French) were eligible for inclusion. Among the 12 WHO AFRO member states represented, the origin of evidence weighted highest in Nigeria (n = 12) and Senegal (n = 5). The performance of HepB BD vaccination programs across member states are influenced by underlying complexities across eight cross-cutting themes: (i) availability and interpretation of HepB BD vaccination policies, (ii) capacity of vaccine supply and cold chain systems, (iii) availability of equitable and sustainable financing, (iv) capacity and capability of health care workers (HCWs), (v) immunization monitoring systems and impaired feedback loops, (vi) influence of context vs system design on the timeliness of vaccination, (vii) maternal knowledge and socio-economic factors, and (viii) wider contextual factors (geography, climate, cultural practices). Countries looking to introduce, or scale-up HepB BD vaccination programs will benefit from careful consideration of components of the intervention design that are dependent on the end-user's context and capabilities in accessing the vaccine; the adherence and interpretation of essential components of the policy; the provision of adequate support of stakeholders specifically HCWs and government ministries; and the need for innovative approaches to underlying complexities. Lessons offered by these African experiences provide pragmatic approaches to successfully implementing HepB BD vaccination programs in the region.