Real-world Programs Research Articles

Abstract TMP106: Use of Net Promoter Score to Quantify the Participant Experience With a Telehealth Lifestyle Management and Cardiovascular Risk Reduction Coaching Program

Introduction: Improving the patient experience of care is 1 of the 3 dimensions of healthcare’s “Triple Aim.” The net promoter score (NPS) measures willingness to recommend a company’s services and is widely used by Fortune 500 companies as an indicator of customer loyalty/satisfaction. The NPS is increasingly being used to assess patients’ healthcare experience. We sought to quantify the experience of participants in the same telehealth lifestyle management and CVD risk reduction coaching program used in multiple NIH/PCORI-funded stroke-related multi-center RCTs (namely, SAMMPRIS, CREST-2, CAPTIVA and TEAMS-BP) by measuring the NPS in real-world (i.e., non-RCT) program participants. Methods: Participants in the coaching program typically have an opportunity to complete a voluntary satisfaction survey after 12 weeks and 1 year of participation and annually thereafter. The survey is conducted online or via telephone. For this analysis the NPS was calculated, from 17,929 consecutive surveys completed by non-RCT program participants, using responses on an 11-point scale (10 = "strongly agree"; 0 = "strongly disagree") to this item: “I would recommend the program to others.” Scores can range from -100 (worst) to +100 (best). In industry, a positive NPS is well regarded, and scores ≥50 are thought to highlight an excellent experience. Results: Three categories of responders were identified and classified as ‘promoters’ (rating = 9 or 10; i.e., those who would likely recommend the program = 78% of responses), ‘passives’ (rating = 7 or 8; i.e., those who are satisfied but would probably not actively promote the program = 16% of responses) and ‘detractors’ (rating = ≤6; i.e., those who might actively discourage participation = 6% of responses). The NPS (calculated from the % of promoters minus the % of detractors) was +72, a score comparable to that achieved by the most popular/successful commercial organizations in other industries. Conclusion: This is the first study to utilize the NPS to evaluate the participant experience with a telehealth coaching program that has been/is currently being successfully deployed in multiple stroke-related multi-center RCTs. The data show that real-world program participants have an NPS indicative of very high satisfaction.

Towards a better understanding of real-world home-visiting programs: a large-scale effectiveness study of parenting mechanisms in Brazil

BackgroundThe scale-up of parenting programmes to support early childhood development (ECD) is poorly understood. Little is known about how and when early interventions are most effective. Sustainability of ECD programming...

Passive acoustic monitoring and automated detection of the American bullfrog

AbstractBiological invasions pose significant threats to biodiversity and ecosystem functioning. Removal of introduced species is most successful when detected early. We evaluate the effectiveness of passive acoustics combined with automated recognition in detecting the invasive American bullfrog (Lithobates catesbeianus). We applied this technique to two real-world monitoring programs aimed at determining the optimal time of day for monitoring the species in Europe, for which we recorded the species in Belgium and Italy; and for evaluating the effectiveness of BirdNET (a free and user-friendly automated recognizer) in analyzing a large dataset collected in Spain. BirdNET was highly effective in automatically detecting the bullfrog presence, with a detection rate (compared to visual inspection of sonograms) of 89.5% using default settings (85 of 95 recordings with known presence), and 95.8% with user-specific settings (91 of 95 recordings detected). The system showed remarkable precision, correctly identifying 99.7% (612 out of 614) of the verified predictions, and with only one mislabelled recording (predicted to be present when it was absent). The species’ vocal activity in Belgium and Italy was higher during the night compared to crepuscular periods. Recording analyses and output verification of the dataset collected in Spain was carried out in 3.8% of the recorded time, and resulted in significantly reduced effort compared to visual inspection. Our study highlights the effectiveness of this technique for remotely surveying the American bullfrog, making it a significantly potential tool for informing management decisions, particularly for the early detection of the species’ arrival in new areas.

INTERCEPT Program of circulating tumor DNA (ctDNA) testing for minimal residual disease (MRD) in colorectal cancer (CRC): Results from a prospective clinical cohort.

27 Background: Minimal residual disease, defined by ctDNA+ in the absence of macroscopic of disease, represents a new and clinically poorly defined subset of patients (pts). While observational cohorts have been reported on the prognosis of MRD, there is little information on the impact of returning and acting on ctDNA results on the subsequent ability to detect radiographic disease. Here we provide real-world evidence form a large prospective cohort where ctDNA testing was routinely performed and returned to pts and providers, providing opportunities to understand the prognostic performance of ctDNA in practice, including the rate of false negatives defined as radiographic recurrence without detectable ctDNA. Methods: The INTERCEPT program enrolled pts undergoing curative intent surgery for stages II-IV CRC at MD Anderson Cancer Center. A tumor-informed MRD assay (Signatera) was drawn post-operatively and every 3 months as per established reimbursement guidelines. Pts enrolled between Jan-Dec 2022 were included with follow up through Aug, 2023. Post-op timepoint was defined as any test within 6.5 months of surgery to include adjuvant therapy. A false negative result was defined as a negative test but with radiographic detection of recurrence within the subsequent 4 months. Results: A total of 1,140 pts were included, with 44.7% female and 39% with advanced disease. At least one ctDNA+ result was obtained in 338 patients (29.6%). When limited to pts with a post-operative/post-adjuvant timepoint (n= 520) and a median follow up of 10.4m, the 12m DFS was 94.2% for ctDNA-, and 54.3% for pts with at least 1 ctDNA+ test (median DFS of 14.9m); HR 17.67 (95% CI: 10.08 – 30.99), p<0.0001. When segregated by stage, ctDNA remained the most important predictor of outcomes [Table], such that pts with stage IV ctDNA- had better prognosis than pts with stage II ctDNA+ (38.9% vs 87.7% 12mDFS, p=.002). For 15 pts, we detected a false negative ctDNA, representing a rate of 1.3% (15/1140) corresponding to a negative predictive value (NPV) of 98.1%. Conclusions: In this first prospective real-world ctDNA program, MRD testing had a high NPV (98.1%) with very few false negative cases. The prognostic importance of ctDNA was confirmed and exceeded the risk prediction of stage alone, underlying and supporting the importance of introducing the test in practice and the need to investigate interventional studies, as are ongoing in the INTERCEPT program (crcmrd.org). [Table: see text]

Liquid biopsies for faster diagnosis of suspected advanced pancreatic and biliary tract cancers: ACCESS, a UK innovation programme.

614 Background: Tissue diagnosis in biliary tract (BTC) and pancreatic (PC) cancer is challenging due to anatomical location and patient (pt) factors (frailty, sepsis); approximately 25% of invasive biopsies are nondiagnostic, requiring repeat procedure. Most BTC and PC pts present with advanced disease. In stage III and IV solid tumours, Guardant 360 (G360) 74 gene panel liquid biopsy (LB) detects ctDNA in 80%/85% of BTC/PC. ACCESS is a real-world innovation programme evaluating the impact of adding G360 to the current invasive diagnostic pathway for suspected BTC/PC in 6 hospitals in West London; (n=240). Methods: This is a pre-planned interim analysis of the first sequential 65 pts with G360 in ACCESS. Patients were age>18 years, ECOG ≤ 2 with high radiographic suspicion of stage III/IV BTC or PC without histological diagnosis at registration or other malignancies within 3 years. Positive LBs were reviewed at molecular tumour board with 4 pre-specified levels of diagnostic certainty: diagnostic/consistent/possibly/not consistent. Tumour board review followed. Endpoints include repeat biopsy rate, change in time to diagnosis, quality of life, health economic assessment and patient satisfaction. Results: 64 patients were analysed (1 excluded). 50% female, median age 73 years (43-94), suspected cancer sites 14%/77%/9% BTC/PC/either BTC or PC. Suspected stage III/IV disease 38%/62%. ctDNA detection rate was 80%/100%/82% in overall cohort/BTC/PC. Most commonly detected LB alterations in suspected BTC/PC were TP53, APC, ATM, CDK/TP53, KRAS, CDKN2A, ARID1A. In BTC and PC, diagnostic method was liquid biopsy alone/liquid and tissue biopsy/tissue alone in 16%/49%/33%. 17% had repeat biopsy. Sensitivity/specificity of cancer diagnosis (all-comers) using liquid biopsy was 86% (95% CI 73.3-94.2)/38.5% (95% CI 13.9-68.4). Conclusions: There is a high ctDNA detection rate with high level diagnostic certainty, promising for future genomic transformation of BTC/PC diagnostic pathways, potentially reducing repeat invasive biopsies, speeding up diagnosis, facilitating precision therapy, with ACCESS defining a blueprint for molecular integration of liquid biopsies. Full recruitment is planned to complete in March 2024.

HyperPUT: generating synthetic faulty programs to challenge bug-finding tools

As research in automatically detecting bugs grows and produces new techniques, having suitable collections of programs with known bugs becomes crucial to reliably and meaningfully compare the effectiveness of these techniques. Most of the existing approaches rely on benchmarks collecting manually curated real-world bugs, or synthetic bugs seeded into real-world programs. Using real-world programs entails that extending the existing benchmarks or creating new ones remains a complex time-consuming task. In this paper, we propose a complementary approach that automatically generates programs with seeded bugs. Our technique, called HyperPUT, builds C programs from a “seed” bug by incrementally applying program transformations (introducing programming constructs such as conditionals, loops, etc.) until a program of the desired size is generated. In our experimental evaluation, we demonstrate how HyperPUT can generate buggy programs that can challenge in different ways the capabilities of modern bug-finding tools, and some of whose characteristics are comparable to those of bugs in existing benchmarks. These results suggest that HyperPUT can be a useful tool to support further research in bug-finding techniques—in particular their empirical evaluation.

Sustaining health obesity prevention programs: Lessons from real-world population settings

Current understanding of what sustains public health programs is derived primarily from evaluations of programs delivered for only a few years. To improve program planning and knowledge on program sustainment, we examined real-world population programs that have been delivered for >2 years. Our focus was physical activity and nutrition programs for obesity prevention. We identified programs through published literature and searched through publicly available information on the theoretical factors determining sustainment. We reviewed 90 programs and explored intervention characteristics, provider, delivery and process level factors, and the outer environment influences.Programs were sustained on average 15 years and more frequently characterised as behavioural change skills programs targeting children, funded by non-government organisations and delivered by community organisations. Most programs had undergone some modification (n = 55). Differences between programs were observed across key factors: Programs sustained 15+ years were mainly behaviour skills programs (n = 21); and characterised by interactive designs (i.e., face-to-face or digital) over static innovations (i.e., print material) compared with those sustained <15 years (p = 0.024). While government funding supported many of the programs (n = 45;), those sustained 15+ years were more likely to have been commercially funded (p = 0.044); and were less likely to have current community involvement (p = 0.013). Differences in ownership and funding were also observed across countries. While multiple factors may influence program sustainment, longer delivered programs where distinguished by their program characteristics and outer contextual factors, suggesting such factors may have an important role in sustaining programs in the longer-term.

Flexible control flow graph alignment for delivering data-driven feedback to novice programming learners

Supporting learners in introductory programming assignments at scale is a necessity. This support includes automated feedback on what learners did incorrectly. Existing approaches cast the problem as automatically repairing learners’ incorrect programs extrapolating the data from an existing correct program from other learners. However, such approaches are limited because they only compare programs with similar control flow and order of statements. A potentially valuable set of repair feedback from flexible comparisons is thus missing. In this paper, we present several modifications to CLARA, a data-driven automated repair approach that is open source, to deal with real-world introductory programs. We extend CLARA’s abstract syntax tree processor to handle common introductory programming constructs. Additionally, we propose a flexible alignment algorithm over control flow graphs where we enrich nodes with semantic annotations extracted from programs using operations and calls. Using this alignment, we modify an incorrect program’s control flow graph to match correct programs to apply CLARA’s original repair process. We evaluate our approach against a baseline on the twenty most popular programming problems in Codeforces. Our results indicate that flexible alignment has a significantly higher percentage of successful repairs at 46% compared to 5% for baseline CLARA. Our implementation is available at https://github.com/towhidabsar/clara.

Multiple Targets Directed Greybox Fuzzing

Directed greybox fuzzing (DGF) can quickly discover or reproduce bugs in programs by seeking to reach a program location or explore some locations in order. However, due to their static stage division and coarse-grained energy scheduling, prior DGF tools perform poorly when facing multiple target locations (targets for short). In this paper, we present multiple targets directed greybox fuzzing which aims to reach multiple programs locations in a fuzzing campaign. Specifically, we propose a novel strategy to adaptively coordinate exploration and exploitation stages, and a novel energy scheduling strategy by considering more relations between seeds and target locations. We implement our approaches in a tool called LeoFuzz and evaluate it on crash reproduction, true positives verification, and vulnerability exposure in real-world programs. Experimental results show that LeoFuzz outperforms six state-of-the-art fuzzers, <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">i.e.</i> QYSM, AFLGo, Lolly, Berry, Beacon and WindRanger in terms of effectiveness and efficiency. Moreover, LeoFuzz has detected 23 new vulnerabilities in real-world programs, and 12 of them have been assigned CVE IDs.

Grammar-aware test case trimming for efficient hybrid fuzzing

In recent years, hybrid fuzzing has garnered significant attention by combining the benefits of both fuzzing and concolic execution. However, existing hybrid fuzzing techniques face problems such as the performance overhead of concolic execution and low code coverage in real-world programs. In this study, we observed that concolic execution often falls into repetitive loop structures when analyzing inputs generated by fuzzing, leading to the construction of redundant constraint expressions, which severely impacts its efficiency. Based on this observation, we design a test case trimming approach to remove input fields related to repetitive loop structures. We propose a lightweight taint analysis technique to infer input’s grammatical structure and construct a hierarchical grammar tree. Then, through delta debugging, we identify nodes that do not affect the code coverage and remove the corresponding input fields. We implement a prototype ScissorFuzz. Experimental results show that our approach brings an average of 8.2% improvement in code coverage and triggers 115 more crashes compared to the state-of-the-art hybrid fuzzing technique QSYM. By eliminating redundant fields, our approach reduces the resource and time overhead associated with concolic execution during input processing, thereby enhancing the efficiency of hybrid fuzzing.

Mirrored dynamics of a wild mosquito population suppression model with Ricker-type survival probability and time delay.

Here, we formulated a delayed mosquito population suppression model including two switching sub-equations, in which we assumed that the growth of the wild mosquito population obeys the Ricker-type density-dependent survival function and the release period of sterile males equals the maturation period of wild mosquitoes. For the time-switched delay model, to tackle with the difficulties brought by the non-monotonicity of its growth term to its dynamical analysis, we employed an essential transformation, derived an auxiliary function and obtained some expected analytical results. Finally, we proved that under certain conditions, the number of periodic solutions and their global attractivities for the delay model mirror that of the corresponding delay-free model. The findings can boost a better understanding of the impact of the time delay on the creation/suppression of oscillations harbored by the mosquito population dynamics and enhance the success of real-world mosquito control programs.

The Road to Reintegration: Evaluating the Effectiveness of VA Healthcare in Vocational Rehabilitation and Employment Retention for Veterans with Mental Health and Substance Use Disorders.

Veterans diagnosed with mental health and/or substance use disorders (SUD) often face significant barriers to employment and reintegration into civilian society. In the current study, we investigated whether how the VA healthcare system for mental health and/or SUD treatment predicted program enrollment into vocational rehabilitation, simultaneous mental health and/or SUD treatment while enrolled in vocational rehabilitation predicted employment at discharge, and mental health and/or SUD treatment continues and employment remain 60-days-post-vocational-rehabilitation discharge. An outcome-based, summative program evaluation design to measure quality assurance of vocational rehabilitation services provided to 402 veteran patients enrolled in a VA healthcare located within the Great Lakes Health Care System - Veterans Integrated Services Network. Multivariable logistic regression analyses showed psychological empowerment (confidence in one's ability to work or find work) is a significant factor determining whether a veteran is enrolled in the vocational rehabilitation program, prior mental health treatment (yes/no) and frequency of mental health treatment did not predict program enrollment, and frequency of SUD VA system treatment 60 days prior did not predict program enrollment. Other findings showed that simultaneous mental health and/or SUD treatment while enrolled in vocational rehabilitation did not predict employment at discharge, and employment at discharge did not predict continued mental health and/or SUD treatment post-discharge from vocational rehabilitation. However, veterans with both SUD and mental health and continued mental health treatment were less likely to be employed. Utilization of real-world program evaluation data from an actual VHA vocational rehabilitation program enhances the study's ecological validity, offering practical implications for policymakers and practitioners in the field. The findings support the importance of veterans enrolling in mental health and/or SUD treatment simultaneously while enrolled in vocational rehabilitation services, as integrating vocational rehabilitation with mental health and SUD treatment services can lead to improved vocational and health outcomes for veterans (eg, development of targeted interventions to support veterans' successful reintegration into the workforce and society).

On the definition of pesticide-free crop production systems

Pesticide-free but non-organic production systems have been recently introduced in public and private programs in Europe. However, a key challenge is to define what ‘pesticide-free’ comprises and means. This paper aims to give insights in and critical reflections on the definition and regulation of pesticide-free crop production systems in real-world programs. To this end, we review four examples of public and private pesticide-free production programs in European crop production (i.e. from France, Germany and Switzerland). Our analysis reveals several semantic and regulatory inconsistencies and potential confusion that exists around the term pesticide-free crop production, i.e. we find that it is far from clear-cut what pesticide-free production systems are. For example, programs differ with respect to which part of the crop management cycle is regulated. Moreover, all programs offer various exceptions for pesticide use. Definitions and regulations differ widely across case studies. For example, to participate in governmental programs on pesticide-free production farmers in one country have different requirements than in another. Moreover, governmental regulations not match with those in private programs and vice versa. Pesticide-free production programs can be a useful and viable addition to European agricultural and food systems. However, based on the here presented insights, we formulate eight recommendations for policy and industry how to clarify, align and harmonize pesticide-free crop production.

Assessing Feasibility and Barriers to Implementing a Family-Based Intervention in Opioid Treatment Programs.

Families Facing the Future (FFF) is an intervention designed specifically for families with a parent in methadone treatment. FFF is unique because it addresses prevention for children and recovery for parents in a single intervention. The primary goals of the program are to prevent parents' relapse, help them cope with relapse if it occurs, and teach parenting skills in order to reduce the likelihood of substance use among their children. FFF has been implemented as an adjunct to treatment in several Opioid Treatment Programs, but has not been widely adopted due to various implementation barriers. The aims of this study, therefore, were to (1) assess the perceived feasibility of implementing FFF and (2) identify/describe barriers to implementing FFF. An online survey was used to assess implementation feasibility, while individual qualitative interviews were conducted to explore specific barriers to implementation. Data collection from a total of 40 participants (20 patients and 20 providers) was conducted from August 2022 to October 2022 at two Opioid Treatment Programs in Florida. Analyses revealed high feasibility scores, indicating that FFF was viewed by both patients and providers as a practical intervention to implement. Despite strong perceived feasibility of the intervention, qualitative findings identified several implementation barriers with respect to difficulty attending parent training sessions, aversion to in-home visits, and lack of funding (inability to provide patient incentives/bill insurance). This study provides evidence that while patients and providers view FFF as having high feasibility, significant implementation barriers exist. This paper fills a void in the literature by informing if and which modifications might be necessary to facilitate wider adoption of FFF in real-world Opioid Treatment Program settings.

Impact of San Francisco's New Street crisis response Team on Service use among people experiencing homelessness with mental and substance use disorders: A mixed methods study protocol.

Mobile crisis services for people experiencing distress related to mental health or substance use are expanding rapidly across the US, yet there is little evidence to support these specific models of care. These new programs present a unique opportunity to expand the literature by utilizing implementation science methods to inform the future design of crisis systems. This mixed methods study will examine the effectiveness and acceptability of the Street Crisis Response Team (SCRT), a new 911-dispatched multidisciplinary mobile crisis intervention piloted in San Francisco, California. First, using quantitative data from electronic health records, we will conduct an interrupted time series analysis to quantitatively examine the impacts of the SCRT on people experiencing homelessness who utilized public behavioral health crisis services in San Francisco between November 2019 and August 2022, across four main outcomes within 30 days of the crisis episode: routine care utilization, crisis care reutilization, assessment for housing services, and jail entry. Second, to understand its impact on health equity, we will analyze racial and ethnic disparities in these outcomes prior to and after implementation of the SCRT. For the qualitative component, we will conduct semi-structured interviews with recipients of the SCRT's services to understand their experiences of the intervention and to identify how the SCRT influenced their health-related trajectories after the crisis encounter. Once complete, the quantitative and qualitative findings will be further analyzed in tandem to assist with more nuanced understanding of the effectiveness of the SCRT program. This evaluation of a novel mobile crisis response program will advance the field, while also providing a model for how real-world program implementation can be achieved in crisis service settings.

Til o‘rganishda grammatikaning ahamiyati

This article deals that a strong understanding of grammar is essential for effective communication, as it enables learners to convey subtle nuances in meaning and to comprehend spoken and written language. Whether through online courses, textbooks, or real-world language exchange programs, investing time and effort into improving grammar skills is a vital part of the language learning process.

Real-world evaluation of an acceptance and commitment therapy–based group programme for breast cancer survivors with fear of cancer recurrence

PurposeTo evaluate the effectiveness and acceptability of a 6-week acceptance and commitment therapy (ACT)–based group programme on participants’ fear of cancer recurrence (FCR), quality of life (QoL), psychological distress and psychological flexibility at the end of the programme and 12-week follow-up.MethodsA one-group, post-test service evaluation of a real-world psychological programme was carried out to evaluate collected outcome measures and attendance for a total of 21 groups facilitated between 2017 and 2019. Participants were breast cancer survivors who attended a 6-week group programme led by NHS clinicians. Descriptive statistics and repeated measures ANOVA analyses were carried out for each outcome measure. Attendance levels were examined to assess acceptability.ResultsA total of 97 group participants who had completed curative treatment for breast cancer took part. Of whom, 89% completed at least 4 of the 6 weekly group sessions and 76% attended the 12-week follow-up session. Eighty-four (87%) participants returned outcome measures at all three time points relative to group participation (T1 = pre, T2 = post T3 = 12-week follow-up). Group participants were female, mean age 51.9 years. FCR was highest at T1 (mean 25.2, SD 4.7), reduced T2 (mean 21.2, SD 5.4) and further lowered T3 (mean 19.5, SD 6.2). This difference was statistically significant (p < 0.001). QoL was lowest at T1 (mean 62.4, SD 15.7), increased T2 (mean 71.7, SD 18.1) and further increased at T3 (mean 75.9, SD 17.5). This difference was statistically significant (p < 0.001). Psychological distress measures were shown to reduce, and psychological flexibility increased.ConclusionsThis real-world evaluation of an ACT-based group programme led to improvements in FCR, QoL, psychological distress and psychological flexibility in this population. This evaluation provides basis for further investigation to determine if these results can be replicated by controlled research design across diverse populations.

Impact on physical function of the +AGIL Barcelona program in community-dwelling older adults with cognitive impairment: an interventional cohort study

BackgroundOlder adults with cognitive impairment (CI) have higher multimorbidity and frailty prevalence, lower functional status and an increased likelihood to develop dementia, non-cognitive deficits, and adverse health-related events. +AGIL, a real-world program for frail older adults in a primary care area of Barcelona, is a pragmatic, multi-component and integrated intervention implemented since 2016. It includes physical activity, nutrition, sleep hygiene, revision and adequacy of pharmacological treatment, detection of undesired loneliness and screening for CI; to improve physical function in community-dwelling older adults. We aimed to assess the + AGIL longitudinal impact on physical function among community-dwelling frail older persons with CI.MethodsAn interventional cohort study included data from all the + AGIL consecutive participants from July 2016 until March 2020. Based on the comprehensive geriatric assessment, participants were offered a tailored multi-component community intervention, including a 10-week physical activity program led by an expert physical therapist. Physical performance was measured at baseline, three and six months follow-up. The pre-post impact on physical function was assessed by paired sample t-test for repeated samples. Linear mixed models were applied to analyze the + AGIL longitudinal impact. P-values < 0.05 were considered statistically significant.Results194 participants were included (82 with CI, based on previous diagnosis or the Mini-COG screening tool), 68% women, mean age 81.6 (SD = 5.8) yo. Participants were mostly independent in Activities of Daily Living (mean Barthel = 92.4, SD = 11.1). The physical activity program showed high adherence (87.6% attended ≥ 75% sessions). At three months, there was a clinically and statistically significant improvement in the Short Physical Performance Battery (SPPB) and its subcomponents in the whole sample and after stratification for CI [CI group improvements: SPPB = 1.1 (SD = 1.8) points, gait speed (GS) = 0.05 (SD = 0.13) m/s, Chair stand test (CST)=-2.6 (SD = 11.4) s. Non-CI group improvements: SPPB = 1.6 (SD = 1.8) points, GS = 0.08 (SD = 0.13) m/s, CST=-6.4 (SD = 12.1) seg]. SPPB and gait speed remained stable at six months in the study sample and subgroups. CI had no significant impact on SPPB or GS improvements.ConclusionOur results suggest that older adults with CI can benefit from a multidisciplinary integrated and comprehensive geriatric intervention to improve physical function, a component of frailty.

Valkyrie: Improving fuzzing performance through deterministic techniques

Greybox fuzzing has received much attention from developers and researchers due to its success in discovering bugs within many programs. However, randomized algorithms have limited fuzzers’ effectiveness. First, branch coverage feedback that is based on random edge ID can lead to branch collision. Besides, state-of-the-art fuzzers heavily rely on randomized methods to reach new coverage. Finally, some state-of-the-art fuzzers only employ heuristics-based bug exploitation methods, which are not effective in triggering those that require non-trivial triggering conditions.We believe deterministic techniques deliver consistent and reproducible results. We propose Valkyrie, a greybox fuzzer whose performance is boosted primarily by deterministic techniques. Valkyrie combines collision-free branch coverage with context sensitivity to maintain accuracy while introducing an instrumentation removal algorithm to reduce overhead. It also pioneers a new mutation method, compensated step, allowing fuzzers that use solvers to adapt to real-world fuzzing scenarios without randomness. Additionally, Valkyrie proactively identifies possible exploit points in target programs and utilizes solvers to trigger actual bugs. We implement and evaluate Valkyrie’s effectiveness on the standard benchmark Magma, and a wide variety of real-world programs. Valkyrie triggered 21 unique integer and memory errors, 10.5% and 50% more than AFL++ and Angora, respectively. Valkyrie reached 8.2% and 12.4% more branches in real-world programs, compared with AFL++ and Angora, respectively. We also verify that our branch counting and mutation method is better than the state-of-the-art, which shows that deterministic techniques trump random techniques in consistency, reproducibility, and performance.

Gluu Essentials Digital Skills Training for Middle-Aged and Older Adults That Makes Skills Stick: Results of a Pre-Post Intervention Study.

A number of real-world digital literacy training programs exist to support engagement with mobile devices, but these have been understudied. The purpose of this study was to examine the effectiveness and program acceptability of a digital skills training program among middle-aged and older adults (aged ≥50 years) and to gather participants' recommendations for lifelong digital skills promotion. The Gluu Essentials digital skills training program includes learning resources to support tablet use. Through pre-post surveys, this study assessed mobile device proficiency, confidence in going online and in avoiding frauds and scams, the frequency of engaging in online activities, program engagement, acceptability, and suggestions for continued support. A total of 270 middle-aged and older adults completed baseline surveys. Of these 270 participants, 145 (53.7%) completed follow-up surveys. Our findings indicate that mobile device proficiency increased (P<.001), whereas confidence was unchanged. Participants also reported going online more frequently to shop (P=.01) and access government services (P=.02) at follow-up. Program engagement varied considerably, but program acceptability was high. Participants' recommendations included the need for providing ongoing programs for support and training because technology constantly changes, reducing costs for technology and internet access, and keeping learning resources simple and easy to access. The Gluu Essentials digital skills training program increased mobile device proficiency and frequency of web-based activities (shopping and accessing government services) among middle-aged and older adults.