PERCS

Abstract: Establishing and running remote consultation services is challenging politically (interest groups may gain or lose), organizationally (remote consulting requires implementation work and new roles and workflows), economically (costs and benefits are unevenly distributed across the system), technically (excellent care needs dependable links and high-quality audio and images), relationally (interpersonal interactions are altered), and clinically (patients are unique, some examinations require contact, and clinicians have deeply-held habits, dispositions and norms). Many of these challenges have an under-examined ethical dimension. In this paper, we present a novel framework, Planning and Evaluating Remote Consultation Services (PERCS), built from a literature review and ongoing research. PERCS has 7 domains—the reason for consulting, the patient, the clinical relationship, the home and family, technologies, staff, the healthcare organization, and the wider system—and considers how these domains interact and evolve over time as a complex system. It focuses attention on the organization's digital maturity and digital inclusion efforts. We have found that both during and beyond the pandemic, policymakers envisaged an efficient, safe and accessible remote consultation service delivered through state-of-the art digital technologies and implemented via rational allocation criteria and quality standards. In contrast, our empirical data reveal that strategic decisions about establishing remote consultation services, allocation decisions for appointment type (phone, video, e-, face-to-face), and clinical decisions when consulting remotely are fraught with contradictions and tensions—for example, between demand management and patient choice—leading to both large- and small-scale ethical dilemmas for managers, support staff, and clinicians. These dilemmas cannot be resolved by standard operating procedures or algorithms. Rather, they must be managed by attending to here-and-now practicalities and emergent narratives, drawing on guiding principles applied with contextual judgement. We complement the PERCS framework with a set of principles for informing its application in practice, including education of professionals and patients.

Abstract: Not since the advent of the integrated development environment has a development tool had the impact on programmer productivity that refactoring tools have had for object-oriented developers. However, at the present time, such tools do not exist for high-performance languages such as C and Fortran; moreover, refactorings specific to high-performance and parallel computing have not yet been adequately examined. We observe that many common refactorings for object-oriented systems have clear analogs in procedural Fortran. The Fortran language itself and the introduction of object orientation in Fortran 2003 give rise to several additional refactorings. Moreover, we conjecture that many hand optimizations common in supercomputer programming can be automated by a refactoring engine but deferred until build time in order to preserve the maintainability of the original code base. Finally, we introduce Photran, an integrated development environment that will be used to implement these transformations, and discuss the impact of such a tool on legacy code reengineering.This work is being funded by IBM under the PERCS project.

Abstract: In 2001, the Defense Advanced Research Projects Agency called for the creation of commercially viable computing systems that would not only perform at very high levels but also be highly productive. The forthcoming POWER7®-IH system known as Productive, Easy-to-use, Reliable Computing System (PERCS) was IBM's response to this challenge. Compared with state-of-the-art high-performance computing systems in existence today, PERCS has very high performance and productivity goals and achieves them through tight integration of computing, networking, storage, and software. This paper describes the PERCS hardware and software, along with many of the design decisions that went into its creation.

Abstract: Background: The Program to Enhance Relational and Communication Skills (PERCS) was developed at a large hospital in the United States to enhance clinicians’ preparedness to engage in difficult conversations. Aim: To describe the implementation of PERCS in an Italian hospital and assess the program’s efficacy. Methods: The Italian PERCS program featured 4-h experiential workshops enrolling 10–15 interdisciplinary participants. The workshops were organized around the enactment and debriefing of realistic case scenarios portrayed by actors and volunteer clinicians. Before and after the workshop, participants rated their perceived preparation, communication and relational skills, confidence, and anxiety on 5-point Likert scales. Open-ended questions explored their reflections on the learning. T-tests and content analysis were used to analyze the quantitative and qualitative data, respectively. Results: 146 clinicians attended 13 workshops. Participants reported better preparation, confidence, and communication skills ( p5 0.001) after the workshops. The program had a different impact depending on the discipline. Participants valued the emphasis on group feedback, experiential and interdisciplinary learning, and the patient’s perspective, and acquired: new communication skills, self-reflective attitude, reframed perspective, and interdisciplinary teamwork. Conclusion: PERCS proved culturally adaptable to the Italian context and effective in improving participants’ sense of preparation, communication skills, and confidence.