The 2012 London Summit on Family Planning set ambitious goals to enable 120 million more women and adolescent girls to use modern contraceptives by 2020. The Urban Reproductive Health Initiative (URHI) was a Bill & Melinda Gates Foundation funded program designed to help contribute to these goals in urban areas in India, Kenya, Nigeria, and Senegal. URHI implemented a range of country-specific demand and supply side interventions, with supply interventions generally focused on improved service quality, provider training, outreach to patients, and commodity stock management. This study uses data collected by the Measurement, Learning & Evaluation (MLE) Project to examine the effectiveness of these supply-side interventions by considering URHI’s influence on the number of family planning clients at health facilities over a four-year period in Kenya, Nigeria, and Senegal.The analysis used facility audits and provider surveys. Principal-components analysis was used to create country-specific program exposure variables for health facilities. Fixed-effects regression was used to determine whether family planning uptake increased at facilities with higher exposure. Outcomes of interest were the number of new family planning acceptors and the total number of family planning clients per reproductive health care provider in the last year.Higher program component scores were associated with an increase in new family planning acceptors per provider in Kenya , Nigeria , and Senegal . Higher scores were also associated with more family planning clients per provider in Kenya  and Nigeria , but not in Senegal.Supply-side interventions have increased the number of new family planning acceptors at facilities in urban Nigeria, Kenya, and Senegal and the overall number of clients in urban Nigeria and Kenya. While tailoring to the local environment, programs seeking to increase family planning use should include components to improve availability and quality of family planning services, which are part of a rights-based approach to family planning programming. The 2012 London Summit on Family Planning, now known as the FP2020 Initiative, called for a range of global commitments to enable 120 million more women and adolescent girls to use modern contraceptives by 2020 . RecentlTo date, there has been a lack of comprehensive, longitudinal data to adequately examine the role that improved supply-side programming has on actual increases in family planning use . What lip = 0.053) [For example, Bolam and colleagues 1998) found a significant increase in contraceptive uptake at 6 months post-partum associated with women exposed to facility-based post-partum FP health education, but their study was limited to one facility in Kathmandu, Nepal . In Peru found a = 0.053) . Among t= 0.053) .The purpose of this study is to examine the role that contraceptive availability and facility quality play in contraceptive uptake in urban areas in Nigeria, Kenya, and Senegal. We consider interventions undertaken by the Urban Reproductive Health Initiative (URHI), which sought to increase demand for FP, improve family planning service quality, and increase contraceptive availability in urban settings. Funded by the Bill & Melinda Gates Foundation (BMGF), the goal of the URHI was to significantly increase modern contraceptive use, particularly among the urban poor, in Uttar Pradesh, India, Nigeria, Kenya, and Senegal. The Measurement, Learning & Evaluation (MLE) project was the evaluation component of the URHI and was also funded by BMGF .Other MLE studies demonstrate the impact of URHI demand generation and access to URHI supply-side programming on women’s reported contraceptive use in India and Nigeria , 14. In This study uses baseline and endline data collected by MLE during facility audits and individual provider interviews at facilities providing reproductive health and/or maternal and child health services in targeted cities in Nigeria, Kenya, and Senegal. Since the programs covered the entire cities with demand creation programming and interventions were undertaken in high-volume and targeted facilities, it was not possible to have a comparison group in this study. In all included facilities, facility audits recorded general facility characteristics, quality assurance procedures, and physical infrastructure and equipment. Provider interviews asked about FP training, knowledge of FP, and integration of FP with other services. At larger facilities, four providers offering relevant RH services were selected at random for provider interview. All providers were interviewed at facilities with four or fewer providers offering FP services.In Senegal, baseline and endline surveys were conducted at all public and private facilities offering at least one reproductive health and/or maternal and child health service in the six program cities , and included any new facilities at endline . In NigeWe used facility audit questions to create dependent variables for this analysis. For the first dependent variable, we used the total reported number of new FP acceptors at a facility. For the second dependent variable, we used the total reported number of clients who received FP services at a facility. Kenya and Nigeria reported the number of new acceptors or total FP clients over the last 12 months. Senegal reported the number of new acceptors or total FP clients over the last 6 months, so we multiplied the number of clients by 2 to estimate the number of new acceptors or FP clients over the last 12 months. Since larger facilities are likely to have more FP clients, we controlled for facility size and a facility’s investment in family planning by dividing the number of new acceptors or total FP clients by the number of permanent reproductive health (RH) staff at a facility, as identified in the full staff roster in the facility audit. This created our two dependent variables: the number of new FP acceptors per RH provider in the last 12 months and the number of FP clients per RH provider in the last 12 months.We used both facility audit and provider interview responses to identify URHI program elements in each country. In all three countries, the program had the same objectives related to the supply side: a) integrate family planning into maternal, newborn, child, and HIV services; and b) improve the quality of services in high volume facilities. Each country implemented these activities somewhat differently depending on their contex; however, all included some form of provider training, information and outreach to patients, and ensuring stock availability. Below, as we describe the measurement methods in each country, we provide greater depth on these distinctions. We ran individual fixed effects models for each program component and each dependent variable separately as descriptive statistics. The program typically implemented multiple improvements at a given facility simultaneously, which made it difficult to identify separate effects for each improvement. We therefore used principal components analysis to generate a score based on the country-specific program components. Principal component analysis can reduce the number of variables by creating a series of uncorrelated linear combinations of variables . We usedIn Kenya, the program components score was created using seven program elements, drawing from the three main URHI implementation areas mentioned above. Provider training included: whole site FP training led by URHI ; and staff receiving URHI training on FP commodity management. Information and outreach included: having URHI supported community health workers at the facility; the number of informational/educational materials observed during the facility audit; and implementing URHI supported outreach programs. Ensuring method availability included: participation in contraceptive method redistribution (where FP methods were redistributed between facilities to ensure method availability); and URHI supported visits by clinical teams to provide long acting or permanent methods.In Nigeria, the program components score was created using six program components. The provider training components included: any interviewed provider at a facility receiving in-service training from URHI at any time; any interviewed provider receiving a URHI monitoring visit ; and any interviewed provider was a member of the URHI FP Provider Network (FPPN). Information and outreach components captured the number of FP informational/educational materials observed at the facility audit. Ensuring stock availability was measured based on whether there were any stock-outs of contraceptive methods in the last month, however, no specific intervention activity was undertaken in Nigeria to reduce stock-outs. Unique to Nigeria, URHI-sponsored facility renovation was also included.In Senegal, the program components score was created using six program elements. The provider training components were the percentage of interviewed providers at a facility who received in-service FP training; and the percentage of interviewed providers who received training on the program-modified Systematic Screening of Client Needs tool that supported client referral. The information and outreach components included the facility undertaking URHI FP education programs at the facility; the number of informational/educational materials observed at the facility audit; and whether there was a URHI sponsored midwife at a facility. Ensuring stock availability included facility participation in the URHI Informed Push Model, a program unique to Senegal that seeks to improve the flow and availability of contraceptives..Across all countries, greater than 88% of facilities interviewed at baseline were successfully interviewed at endline as well. Not all facilities provided answers to questions about program components and the number of new acceptors and FP users at both time points. For the number of new acceptors variable, missing data resulted in a loss of 39.9% of observations in Kenya, 46.2% of observations in Nigeria, and 52.0% of observations in Senegal. For the number of family planning users variable, missing data resulted in a loss of 41.5% of observations in Kenya, 42.2% of observations in Nigeria, and 50.7% of observations in Senegal. Most of this loss was due to low response to the questions about the number of new acceptors and FP users in all three countries at baseline; this may be a result of unavailability of records to answer the questions. Facilities for which full data were not available for both time periods were excluded from further analyses. Based on a logistic regression of which facilities were excluded, we found that facilities excluded from the model were significantly more likely to have been added at endline in all three countries; significantly more likely to be a private facility in Nigeria and Kenya; and were significantly likely to have a larger staff in Kenya. URHI-specific program components were set to 0 at baseline as the program did not yet exist. Table We used fixed effects regression analysis to determine whether the total number of FP users or new acceptors per provider increased more at facilities with higher URHI program scores. Facility improvements were targeted to underserved areas, so standard regression methods might have resulted in a downward bias in the impact of the improvements. Fixed effects regression corrects for this source of bias and approximates the pre-test/post-test design in experimental setting by allowing each facility’s baseline score to serve as the reference point for its endline score, rather than using baseline scores from other better resourced facilities . We usedDescriptive statistics for program components and program outcomes are presented in Tables Table We therefore used unweighted principal components analysis to create a dose score for each country. In all three countries, the mean dose score was 0.00, with a standard deviation of 1.67 in Kenya, 1.84 in Nigeria, and 1.64 in Senegal. Facilities with more program components have higher dose scores. The number of new acceptors increased significantly at facilities with higher program scores in all three countries. The mean number of new acceptors per provider in the last 12 months increased by 18 (95% CI: 7–29) in Kenya, 14 (95% CI: 8–20) in Nigeria, and 7 (95% CI: 3–12) in Senegal with a 1-point increase in program score. For the mean number of FP users per provider, significant increases were found only in Kenya and Nigeria. In particular, with a one-point increase in program score, the mean number of FP users per provider in the last 12 months increased by 31 (95% CI: 7–56) in Kenya and 26 (95% CI: 15–38) in Nigeria . Although we were unable to disentangle the role of individual interventions, separate models by program activity Table  suggest In addition, while use of panel data better allows us to draw causal inference about URHI programming and facility-level uptake and use of FP methods, we are unable to rule out confounding by other time-varying factors that may be associated with both contraceptive uptake and service improvements. Further, a number of facilities were excluded from the analysis because of missing data at one or more time points. This increases the risk of selection bias, although the use of fixed effects models corrects somewhat for this bias. Most of the exclusions were due to missing data about the number of new FP acceptors or FP users at private facilities or at baseline. This limits our ability to draw inferences about facilities that were added to the study, and about private facilities. The response rate improved somewhat at endline, however, indicating that future surveys might reduce this problem by investing in interviewer training on how to ascertain the number of clients based on medical records and by quality control to ensure that these questions are answered fully despite the effort involved in answering them. Further, this analysis used the number of RH staff members to control for facility size in considering the number of new FP acceptors or users per facility. While the number of RH staff is an imperfect proxy for facility size, we believe that it better captures a facility’s investment in RH services, regardless of size. A final limitation of this study is that the Urban Reproductive Health Initiative also sought to increase demand for FP. While the demand side is considered in other studies, this analysis focused only on the supply environment, and may therefore underestimate the program’s effect on contraceptive uptake in the three countries.The findings from this study help fill a gap in the existing literature about the effectiveness of various supply-side interventions on contraceptive uptake and use in urban African settings, where many of the FP2020 focus countries are located. These findings can be used to inform future programs seeking to contribute to the ambitious goals set by FP2020 for these countries. While tailoring to the local environment, programs seeking to increase the number of new and continuing FP users should ensure that their programs include components to improve availability and quality of FP services including training providers, commodity security, integrated services, method availability, outreach activities, and information and education materials.Care should be taken to guarantee that these components are executed well, and in a manner that helps clients exercise their right to make their own decisions about FP uptake and use. In addition, programs should consider strategies to address client agency and autonomy as well as discrimination towards clients. These may be key elements that could lead to greater increases in family planning method use and support attainment of FP2020 goals. Finally, improving supply of services should go hand-in-hand with creating a demand for FP services and building agency to use these services; this will ensure that improved services are used to meet users’ needs and desires. Undertaking multi-component supply- and demand-side programming as done by the URHI program should help to lead to increased FP use and support attainment of FP2020 goals.


Culex pipiens adults. Some individual monoterpenes were also evaluated by residual toxicity technique. Citronella oil as a reference was also loaded separately or in combination with monoterpenes on paper discs and wax. The ketone monoterpenes mixture  on paper discs was the most active (KT50 = 17.20 min) followed by ketone monoterpenes with citronella oil (KT50 = 20.79 min) and citronella oil alone (KT50 = 28.72 min). Wax formulations proved that the ketone and alcohol  monoterpenes gave the most activity as knockdown . Alcohol monoterpenes formulation recorded KT50 = 43.39 min. Residual activity of tested individual monoterpenes reported that the menthol was more toxic than camphor and camphene. Generally, this study suggests that the monoterpenes have the properties, which make them used as eco-friendly compounds in the control programs of Cx. pipiens adult. The use of paper discs is more applicable than wax in the adulticidal formulations.Different mixtures of monoterpenes  were loaded on paper discs and wax and their knockdown activities were evaluated against Culex, Aedes, and Anopheles, which transmit several infectious diseases to human; for example, filariasis, Japanese encephalitis, dengue and yellow fever viruses, and malaria [Man has suffered from the activities of mosquitoes since time immemorial and it is ranked as man's most important insect pest. The genera of mosquito have been incriminated as the main vectors: malaria , 2 are m malaria . Cx. pipiens molestus (Forsk) has been recorded in all governorates without any exception [In Egypt, the widespread house mosquitoxception  causing xception . It is txception , Rift vaxception , 8. Cx. pipiens [ Ae. aegypti were also described [ Cx. pipiens [ Ae. aegypti and their structure-activity relationships were investigated [ Cx. pipiens [Mosquito control represents an important strategy for prevention of diseases transmission and epidemic outbreaks. Synthetic pesticides have been commonly used for adult mosquito control such as organophosphates  and synthetic pyrethroids . Adulticides were applied as ultra-low volume (ULV) sprays either by aircraft or on the ground employing truck-mounted sprayers. ULV sprayers dispense very fine aerosol droplets that stay aloft and kill flying mosquitoes on contact. ULV applications involve small quantities of pesticide active ingredient in relation to the size of the area treated, which minimizes exposure and risks to people and the environment , 10. How pipiens . The larescribed . Zahran  pipiens . Knockdostigated . Michael pipiens .50 values and was discussed in detail.Therefore, the main goal of this study was to determine the efficiency of mixtures of some monoterpenes that have already toxic potential effect against mosquitoes. The study was conducted by two methods including residual and fumigant activity assays. The compounds were formulated in two types including impregnating them into paper discs and wax. The toxicity assessment was investigated as knockdown with calculation of the KTR)-camphor (98%), (L)-menthone (97%), (S)-fenchone (98%), (R)-carvone (98%), geraniol (98%), thymol (98%), -menthol (98%), (S)-limonene (96%), and camphene (95%) which were purchased from Sigma-Aldrich . Citronella oil was supplied from El Gomhoria Co. . Chemical structures of these monoterpenes and citronella oil are shown in Figures Monoterpenes include (l (98%), R, 2S, 5R Cx. pipiens were obtained from Research Institute of Medical Entomology, Ministry of Health, Dokki, Giza, Egypt, and reared under laboratory conditions. About 400–600 larvae were transferred to white enameled and shallow trays about 30 cm in diameter containing 2-3 L of dechlorinated water. These trays were always covered with mesh screen to prevent oviposition by escaping adult mosquitoes and were maintained at a room temperature (26 ± 2°C) and RH (70 ± 5%) with a 14 : 10 (L : D) photo-period and water was replaced every two days. Larvae were daily fed on biscuits and yeast powder (3 : 1 ratio) until pupation. The pupae were transferred from the trays to plastic cups containing dechlorinated water into cages with netting cover wood frames (30 × 30 × 30 cm) until adults emerged. Adults were provided with 30% sucrose solution and females were fed on pigeon blood for four times a week [Third instar larvae ofs a week . The egg2. A weight of 100 mg of each monoterpene was dissolved in 10 mL acetone to obtain 10000 mg/L of each compound in final mixture solution. The paper discs (15 discs per replicate per each mixture) were dipped for one minute in this blend solution, then removed, and left to vaporize the acetone under ambient conditions. The discs were sealed in plastic bag (50). According to the class of monoterpenes, the paper discs divided into seven groups as PD1–PD7 (PD: paper discs) as follows:immobilization of blend of ketone monoterpenes  on paper discs.immobilization of blend of alcohol monoterpenes  on paper discs.immobilization of blend of alkene monoterpenes (limonene and camphene) on paper discs.PD1 + citronella oil on paper discs.PD2 + citronella oil on paper discs.PD3 + citronella oil on paper discs.immobilization of citronella oil on paper discs.The method used was according to Kawada and his coauthors , 25 withstic bag . Seven fimmobilization of blend of ketone monoterpenes  on paper discs.immobilization of blend of alcohol monoterpenes  on paper discs.immobilization of blend of alkene monoterpenes (limonene and camphene) on paper discs.PD1 + citronella oil on paper discs.PD2 + citronella oil on paper discs.PD3 + citronella oil on paper discs.immobilization of citronella oil on paper discs.After solidification, the formulated products were used in bioassay to calculate KT50 against adult mosquitoes.The sustained release of biologically active monoterpenes from wax was evaluated. The method of preparation was as follows: raw wax (50 g) was weighted and melted at 120°C. Blend of different tested monoterpenes dissolved in acetone was mixed with the melted wax to obtain 1000 ppm of each compound in final formulation. The solution was then poured into alumina cups with fuse . Accordi Cx. pipiens female adult to different monoterpenes was assayed in two different formulationsSusceptibility of Cx. pipiens  of monoterpenes were prepared in acetone. Glass bottles 30 mL were coated with selected monoterpenes to form residual layer according to the Centre for Disease Control and Prevention (CDC) protocol [2) was tested as a reference. The number of knocked-down mosquitoes was counted at 5 min intervals for 60 minutes. Experiments were run in three replicates. KT50 values were calculated by the probit method [The monoterpenes  were selected from each tested group previously. Four concentrations  list of minimum risk pesticides. Besides, it is considered one of the most essential oils extensively used in the markets as a repellent of mosquitoes. The properties of these paper discs are shown in  Cx. pipiens is shown in 50) which was calculated as 17.2 min followed by mixture of ketone monoterpenes and citronella oil (PD4) which was calculated as 20.8 min. The mixture of alkene monoterpenes (PD3) recorded knockdown median time at 27.4 min, followed by the paper disc impregnated with citronella oil alone (PD7) at 28.7 min and the mixture of alkene monoterpenes with citronella oil together (PD6) at 33.2 min. The lowest median time recorded with paper discs impregnated with alcohol monoterpenes (PD2) was calculated as 35.9 min, followed by mixture of alcohol monoterpenes and citronella oil together (PD5) at 37.3 min. From these results the mixture of ketone monoterpenes showed the highest larvicidal effect, followed by alkene monoterpenes and then alcohol monoterpenes. The result showed that the knockdown time decreased with increased concentration in citronella oil. Mixing the citronella oil with any previous group decreased its adulticidal activity. The citronella oil alone showed medium effect. This result is in agreement with results obtained previously by Ramar and Paulraj who studied mosquito knockdown and adulticidal activities of essential oils by vaporizer, impregnated filter paper, and aerosol methods [ Cx. quinquefasciatus and recorded KT50 of 11.4 min as determined by filter paper assay. In addition, Kawada et al. (2004) evaluated multilayer paper strip impregnated with metofluthrin against mosquitoes. They found that the use of metofluthrin reduced mosquito collection by > 80% during the 1st 4 weeks [ Cx. pipiens [50 values of 0.26, 0.28, and 0.34 mg/L air, respectively. In addition, Choi et al. determined the repellent activities of five monoterpenes to Cx. pipiens. They reported that terpinene had a potent repellent activity with a protection rate of 97% at a concentration of 0.05% topical treatment. Additionally, carvacrol and thymol showed an equivalent level of repellency. A spray-type solution containing 2% a-terpinene was tested for its repellent activity against Cx. pipiens. This solution showed stronger repellent activity than the currently used repellent, N,N-diethyl-z-methyl benzamide [Knockdown activity of a mixture of monoterpenes impregnated paper discs against the female adult of methods . They pr 4 weeks . Fumigan pipiens . They reenzamide .50 = 31.79) followed, in the descending order, by W2 (KT50 = 43.39) and then W7 (KT50 = 85.45). However, formulations of W3, W4, W5, and W6 showed neglected knockdown effect (KT50 > 120 min) (d = 1.45 g/cm3) and less vapor pressure (VP) (VP = 0.15 mm Hg at 25°C) compared to the tested compounds .The results of the fumigant bioassay revealed that W1 showed the high knockdown effect (KT120 min) . These rt-test, P < 0.01) when positioned at short distances from a volunteer  [Revay and his coauthors evaluated the tabletop mosquito repellent with another six commercially spatial repellents or mosquito traps under field conditions. They proved that, under minimal air-movement, three spatial repellent based products  significantly reduced the biting-pressure ( 10 ft.) . Cx. pipiens as determined by residual assay at different concentrations  for 1 h exposure period. The results proved that, at 5 mg/cm2, all tested monoterpenes showed knockdown effect after more than one hour  with KT50 of 25.49 and 49.84 min, respectively. Deltamethrin was tested as a reference mosquitocide  was comparable with that of deltamethrin . It can be noted that deltamethrin is still the most active against adult compared to the tested monoterpenes. However, this product (synthetic pyrethroid) does not meet the environment requirement and safety. Although a hundred times higher dosage than deltamethrin is required for monoterpenes to achieve the same effect as deltamethrin, the results give an insight into the potential use of monoterpenes compounds as safe and effective household insecticides for mosquito control, for the insecticides derived from plant sources have a much lower level of risk to the environment than synthetic pesticides [ d-allethrin (30 mg/mat).Three single monoterpenes from different groups  were evaluated against the adults ofone hour . Among tuitocide . It showsticides . Howeversticides  who repo Cx. pipiens. Single or mixed monoterpenes showed high activity against Cx. pipiens adult. Activity of monoterpenes differed depending on the method of application. The selection of natural products reduces the environmental harmful impacts of pesticides and the phenomenon of resistance in adult mosquitoes. Finally such products can be used as ecofriendly alternative to chemical insecticides in vector-borne diseases control program.The current study proved that the use of paper discs was better than the wax to formulate the monoterpene and produce ecofriendly formulations in the controlling of


This can be observed in terms of what has been called polarised research, where some researchers continuously publish positive results while others publish negative results on the same issue – even when based on the same data. In order to identify and address this challenge, the objective of this study is to investigate how polarised research produce “polarised facts.” Mammography screening for breast cancer is applied as an example.Fake news and alternative facts have become commonplace in these so-called “post-factual times.” What about medical research - are scientific facts fake as well? Many recent disclosures have fueled the claim that scientific facts are suspect and that science is in crisis. Scientists appear to engage in R = 0.9).The main benefit with mammography screening is the reduced breast cancer mortality, while the main harm is overdiagnosis and subsequent overtreatment. Accordingly, the Overdiagnosis to Mortality Reduction Ratio (OMRR) is an estimate of the risk-benefit-ratio for mammography screening. As there are intense interests involved as well as strong opinions in debates on mammography screening, one could expect polarisation in published results on OMRR. A literature search identifies 8 studies publishing results for OMRR and reveals that OMRR varies 25-fold, from 0.4 to 10. Two experts in polarised research were asked to rank the attitudes of the corresponding authors to mammography screening of the identified publications. The results show a strong correlation between the OMRR and the authors’ attitudes to screening  contains supplementary material, which is available to authorized users. Science is built of facts the way a house is built of bricks: but an accumulation of facts is no more science than a pile of bricks is a house” (Henri Poincaré).“Fake news and alternative facts have become commonplace in these so-called “post-factual times.” What about medical research? Are scientific facts fake as well? A wide range of scientific results have been shown to be false [be false . Even mube false –7. Initibe false . Scientibe false  and by rbe false . Spoof rbe false , and scibe false , 13. Allbe false .facting interests instead of revealing interesting facts.One source of crisis in science is when facts are based on confirmative empirical testing  or that polarised facts can be investigated. In this field there are two main points of disagreement: a) What is the benefit of mammography screening, e.g., in terms of reduced breast cancer mortality, and b) what is the harm of this type of screening, e.g., in terms of overdiagnosis? Some researchers tend to claim that the mortality reduction is high, while the overdiagnosis rate is low [How then are we to identify and address such “polarised facts?” One approach is to reveal polarised research fields and to put polarisation on par with other forms of conflicts of interests in scientific publishing. Let me use mammography screening as an example to illustrate how e is low , while oe is low . What ise is low . MortaliAccordingly, the research questions of this brief study are: What is the OMRR in publicly funded mammography screening programs of women aged 50–69 years old? How is this related to the corresponding authors’ attitudes towards screening? A straight forward literature search identifies 8 studies who have addressed the first question. The studies and their results are shown in Table In order to assess the researchers’ attitudes to screening specific questions suggested to identify “polarised conflict of interest.” were adapted to this particular case and were sent to the corresponding authors of the identified publications. However, the corresponding authors found it difficult to answer the questions. As expected, “researchers within a polarised group in a polarised field may not themselves be able to identify the field as polarised or see themselves as belonging to a polarised group”. In order to overcome this problem, two experts on polarised conflict of interest were asked to classify the corresponding authors of the identified publications. Inclusion criteria for these experts were that they were experts on science ethics in general and polarised research in particular, and exclusion criteria were if they had been involved in mammography screening programs or their primary evaluations. The research question and the included articles were not revealed. For a description of the literature search, the questions to the authors, and the questions to the experts, and a discussion of the applied methods, see Additional file R = 0.9). The scatter plot is shown in Fig. The correlation between the OMRR and the authors’ attitudes to screening as assessed by experts in polarised research was strong . However, it may also result from self-interest , intelledisinterestedness in science [While philosophers of science and sociologists long have revealed the challenges of value-laden facts and underscored the constitutive value of  science , it is hfacting interests as much as in revealing interesting facts. Published research on mammography screening for breast cancer illustrates the problem of science being directed by strong professional interests, where some researchers continuously publish positive results while others publish negative results on the same issue – even when based on the same data. Analysing this as polarised research may provide a way to address an important issue threatening to undermine trust in scientific results and medical researchers. Hence editors should a) make researchers state their “polarised conflict of interest” when submitting manuscripts, b) make reviewers explicitly assess polarisation, and c) apply external experts to assess polarisation when reviewers (and/or editors) are too ingrained in the research to be able to make the assessment.Scientists appear to engage in How exactly to assess polarised conflict of interest may need more elaboration and collaborate work. However, Table


Scholarly concentration programs have become a common method to promote student inquiry and independent research in medical schools. Given the high resource requirements of scholarly concentration program implementation, it is important to examine program efficacy. This systematic review examined the impact of scholarly concentration programs on student research productivity.The authors carried out a literature search to find articles related to scholarly concentration program research productivity outcomes. The inclusion criterion was a method of rigorously evaluating program scholarly productivity. Study rigour was evaluated with the Medical Education Research Study Quality Instrument.The initial search disclosed 2467 unique records: 78 were considered based on titles and abstracts; eight were considered by scanning references. Eleven papers met the inclusion criteria: all were descriptive; none had a priori hypotheses that examined predictors of medical student research productivity in scholarly concentration programs or prospectively evaluated program impact on student scholarly output.While few in number and often lacking in rigour, the studies included herein suggest that adequate administrative support, strong mentorship and tailored program characteristics are essential in facilitating student research productivity in scholarly concentration programs. Given the challenges inherent in medical education research, a conceptual framework based on United Way’s approach may help program planners and educators address this gap in the evaluation of scholarly concentration programs.Electronic supplementary material The online version of this article (doi: 10.1007/s40037-017-0328-2) contains supplementary material, which is available to authorized users. Over the last few decades, scholarly concentration programs have become a common method to promote student inquiry and independent research in medical schools. This systematic review examines the impact of scholarly concentration programs on student research productivity. It underscores the importance of adequate administrative support, strong mentorship and tailored program characteristics in facilitating scholarly output. The review also highlights the potential utility of the United Way model as a conceptual framework for program planners to conduct rigorous scholarly concentration program evaluations.Medical schools have traditionally utilized a standard approach to medical education, with limited opportunity for scholarship outside the conventional medical curriculum. However, over the past few decades a number of medical schools have implemented scholarly concentration programs to promote student inquiry and independent research .The diverse nature of scholarly concentration programs and the variability in scholarly concentration program descriptors has made it challenging to determine the prevalence of these programs in the United States (US) or elsewhere –6. HowevA number of factors have prompted schools to implement scholarly concentration programs in recent years. Research experience may confer numerous benefits, including heightened analytical skills, enhanced self-directed learning and knowledge acquisition, improved oral and written communication skills, and the ability to apply new knowledge to patient care , 5. In aA number of articles have provided detailed descriptions of scholarly concentration programs at various medical schools. Boninger et al. compared the implementation of scholarly concentration programs at two institutions – the University of Pittsburgh School of Medicine, which required participation in a scholarly concentration program, and the Warren Alpert Medical School of Brown University, which offered an elective scholarly concentration program . Though Medical student participation in scholarly research has grown in conjunction with the implementation of scholarly concentration programs , 9. The any type of student research activity, including non-scholarly concentration program research initiatives such as summer assistantships and year-out programs [However, few studies have comprehensively examined the scholarly output of scholarly concentration programs. Chang et al. assessed the benefits of both structured  and unstructured medical student research activities , and found that the majority of students authored at least one article . Howeverprograms . The disprograms  warrant programs .In keeping with an evidence-based approach to assessing outcomes in medical education , 12, we Given the variability in scholarly concentration program descriptors, we defined scholarly concentration programs as (a) providing an in-depth scholarly experience beyond the conventional curriculum, (b) requiring the completion of a scholarly project, (c) extending for longer than a single summer and (d) occurring primarily at a single institution. We excluded dual-degree tracks  from our criteria for scholarly concentration programs, as these programs attract students pre-selected for a research career and offer more research opportunities than those available to students in a traditional MD curriculum . In addiAcademic Medicine, Teaching and Learning in Medicine, and Medical Education, from inception through March 2016, to find articles related to scholarly concentration program research productivity. A health sciences librarian was consulted to formulate search strategies. We searched PubMed using the Medical Subject Headings (MeSH) of ‘students, medical’, ‘schools, medical’, ‘education, medical’, and ‘education, medical, undergraduate’, and keywords including ‘scholarly concentration’, ‘scholarly experience’, ‘scholarly activity’, ‘scholarly program’, ‘research activity’, ‘research experience’, and ‘research product’. We used similar terms to search Embase and Web of Science. Given the variability in database indexing and search platforms, we also searched the journals Academic Medicine, Teaching and Learning in Medicine, and Medical Education to identify additional articles that our database queries may have missed. See Supplementary file 1 for a full list of search strategies.We carried out a literature search using the databases PubMed, Embase, and Web of Science, and the journals Our strategy for article selection is outlined in Fig. icc package in STATA 14 . Thresholds set forth by Landis and Koch were used to classify inter-rater reliability  [Three independent reviewers  who were otherwise uninvolved in the project evaluated the rigour of the studies using the Medical Education Research Study Quality Instrument . We seleperfect) .Our initial search disclosed 2467 unique records; 78 were considered based on titles and abstracts and eight were considered by scanning cited references Fig. . Eleven Two studies found a statistically significant difference in publications between students enrolled in an elective scholarly concentration program versus students who were not enrolled , 25: AreThree studies surveyed scholarly concentration program participants: Elwood et al. reported that publications and presentations increased from 13 to 53% ; SolomonThe average Medical Education Research Study Quality Instrument scores for each of the six domains of study quality were as follows: study design (1.5), sampling (1.6), data type 2.8), study validity (1.2), data analysis (2.5), and outcome (1.5)  are resources dedicated to or consumed by the program that are used to achieve program goals; activities are what the program does with inputs to fulfil its mission ; outputs are the direct products of program activities and are measured in terms of the volume of work accomplished ; and outcomes are benefits or changes for individuals or populations during or after participation in program activities [For similar programs that are implemented in vastly different settings, credibility is improved and impact is more readily identified when a common outcome system is used . Given ttivities .inputs. Depending on the structure of the scholarly concentration program, evaluators may choose to assign different weights to each of these variables, or may include additional variables in order to more accurately characterize program resources. Activities in our model include student in-depth study outside the conventional curriculum, meetings among students, mentors, and concentration directors, and evaluations by program administrators to monitor student progress and program success. Outputs include number of participants and projects, and hours spent pursuing scholarly activities. Outcomes are either directly or indirectly impacted by inputs, activities, and outputs, and include new knowledge, increased skills, greater scholarly activity, modified behaviour and attitudes, and ultimately advancement of scientific knowledge and better patient outcomes. Each variable should be evaluated to determine the effects on other variables, and relationships among inputs, activities, outputs, and outcomes should be identified to more clearly understand the nature and function of individual programs. Importantly, a single conceptual framework is inherently limited in that only certain variables and their interrelatedness can be emphasized [basis for evaluating scholarly concentration program characteristics and outcomes. Program planners and educators should ultimately develop multiple conceptual frameworks in order to view their program ‘through a succession of lenses’ [Drawing on the components outlined in the United Way model as well as common program measures included in papers from our review, we offer a logic model Fig.  as a basphasized ; thus, iphasized , we advo lenses’ .Fig. 2ScOur study has several limitations. Though each rater received the same instructions and information on the Medical Education Research Study Quality Instrument scoring system, inter-rater reliability was less than ‘almost perfect’ for some of the domains. In addition, productivity in terms of student publications and presentations is only one measure of medical student scholarly activity and scholarly concentration program success. Other measures of scholarly concentration program success such as improved critical-thinking and analytical skills, career preparation, and student-faculty relationships are less tangible, albeit important indicators of scholarly concentration program efficacy. Furthermore, research productivity may not manifest as publications or presentations until several years after graduation, which may have led to the exclusion of certain articles from our study. Though no studies to date have examined whether students are more motivated by smaller-scale, shorter-term projects, we believe scholarly concentration programs should encourage students to complete research projects that yield tangible outcomes during their undergraduate medical education. Setting realistic goals and successfully achieving them are crucial to the ongoing motivation of medical students ; thus, sIn summary, despite challenges inherent in medical education research, more rigorous, evidence-based studies that utilize conceptual frameworks are needed to determine how scholarly concentration programs and specific characteristics of scholarly concentration programs facilitate medical student research productivity. Comparative effectiveness research , 38 woulSupplementary file 1: Search strategiesSupplementary file 2: Data extraction worksheet for program outcome model


In concerts of western classical music the provision of a program note is a widespread practice dating back to the 18th century and still commonly in use. Program notes tend to inform listeners and performers about historical context, composer biographical details, and compositional thinking. However, the scant program note research conducted to date reveals that program notes may not foster understanding or enhance listener enjoyment as previously assumed. In the case of canonic works, performers and listeners may already be familiar with much of the program note information. This is not so in the case of newly composed works, which formed the basis of the exploratory study reported here. This article reports the views of 17 living contemporary composers on their writing of program notes for their own works. In particular, the study sought to understand the intended recipient, role and the content of composer-written program notes. Participating composers identified three main roles for their program notes: to shape a performer’s interpretation of the work; to guide, engage or direct the listener and/or performer; and as collaborative mode of communication between the composer, performer, and listener. For some composers, this collaboration was intended to result in “performative listening” in which listeners were actively engaged in bringing each composition to life. This was also described as a form of empathy that results in the co-construction of the musical experience. Overall, composers avoided giving too much personal information and they provided performers with more structural information. However, composers did not agree on whether the same information should be provided to both performers and listeners. Composers’ responses problematize the view of a program note as a simple statement from writer to recipient, indicating instead a more complex set of relations at play between composer, performer, listener, and the work itself. These relations are illustrated in a model. There are implications for program note writers and readers, and for educators. Future research might seek to enhance understanding of program notes, including whether the written program note is the most effective format for communications about music. The written program note for music heard in concerts of Western classical music has served as a guide to listeners since at least the 18th century . The proThree factors guided the focus of this exploratory study into composers’ intentions when writing a program note about their own music. The first of these relates to the authorship of program notes; while program notes are often written by professional program note writers, performers and concert organizers, composers of contemporary classical music tend to be asked to write a note about their own works. The second guiding factor concerns the extant literature, which has focused on program notes in relation to canonic works and has, to this point, ignored contemporary classical music. Finally, the three researchers are actively engaged in contemporary classical music as practitioners—composers, performers, and artist educators—and as such we were uniquely positioned to undertake the study from the multiple perspectives of practitioner and researcher .In particular, the study sought to understand, in a more systematic way, the intended recipient, role and the content of composer-written program notes. Seventeen contemporary composers, all of whom had written musical works for one of our three contemporary classical music projects, were asked to respond to a series of questions about their thinking on program note writing. Recognizing several gaps in the literature, we sought information on the composer as program note writer about their own newly composed works; the role the composer would like the program note to play; and the type of information required to achieve this role. Three research questions were posed:(1)For whom does a contemporary classical composer write a program note?(2)What is the intended role of the program note?(3)What information does the composer want to communicate about their newly composed works?per se, we sourced a wide range of writings around the topic. This included studies on composer intentions, program notes for the music of composers who are no longer living, and listeners or audiences and the concert experience. We also consulted educational writing for higher education performers on how to write program notes. Finally, we considered articles on the thinking of composers and other people involved with new music festivals. These articles included written reflections from one professional program note writer, and in one instance we drew on a team member’s personal experience as a composer.Because of the lack of extant research into program notes being there of the composer” (p. 357). On this basis, while it may not be possible to know a composer’s intention, “it is necessary to understand a work within the perspective of the world in which it was written” (p. 357).Our study responded to Poème électronique by Edgard Varèse, Ferrara considered what listeners hear when exposed to multiple renditions of a work. He concluded that listeners first observe only the syntactical meanings of the work: they consider sounds in relation to their individual and connecting phonemic qualities. At the next level, listeners make semantic meanings by interpreting sounds and making sound relationships, from possible references to complex understandings of the sounds within a work. The most complex listening involves listeners who are able to make ontological meaning of the music through socially constructed relationships between the music and their own life world contexts.In The ontological meaning, then, takes into account the work in its entirety, which “in some works presents a glimpse of the historically based [onto-historical] world of the composer” , p. 357.In the only previous study on the program note, (1)Dramatic notes are those that use emotive, often pictorial language to describe a scene or sensation: for example, a storm at sea with rolling waves, violent winds and crashes of thunder; and(2)Structural notes describe compositional aspects of the work, which may include the form, structure, or striking timbral qualities.Kumari. For Blom, it was structural information that provided the key to understanding the work and allowed a deeper rehearsal process to be undertaken; for Viney, it was ontological information.Contrary to Margulis’s hypothesis, listeners’ enjoyment of the music was not heightened by text descriptions provided in advance of their listening. Moreover, she found that listeners’ enjoyment was less when they received dramatic program notes than when they received notes that were structural. Although Margulis’s research concerned listeners rather than performers and composers, the positive and negative impact of programs notes has been echoed in research that examines the experiences of performers and their relationship with program notes. For example, in their search to understand a stylistically unusual and conceptually challenging work by Australian composer Ross Edwards, pianists In another performance-based study, The program note in written form arose from the migration in music performances from the private salon to the public concert hall, at which time listeners expressed an interest in “printed explanations and instructions” , p. 1. VThe technicalities to which Burkat refers are consistent with Margulis’s “structural” comments. At odds with Margulis, Burkat advocated that listener enjoyment would be rated more highly when dramatic, rather than structural notes, were provided. This may of course differ according to the particular demands of hearing atonal and/or complex new music, but it might also expose the belief, noted earlier, that a dramatic program note enhances the listening experience. A negative view of structural information appeared in a letter to the editor of a composers’ association newsletter in which spectromorphology as tools for describing and analyzing the electroacoustic listening experience, acknowledged that composer communications are not always beneficial to the listener:Composer What the composer has to say  is not unimportant, and it undoubtedly influences (both helping and impeding) the listener’s appreciation of music and musical ideas, but it is not always perceptually informative or relevant. (p. 107)Also writing of the electroacoustic listening experience, Festival attendee and writing mentor Matthew The final source of information about the nature and function of program notes is that of guides written for higher education students who are required to create program notes for their performances. Concerned about dense or lengthy program notes that divide the attention of the listener and frustrate their enjoyment of a work, Pianist-educator Like Scaife’s examples of structural and syntactical information include some semantic statements, and in his two examples of best practice (for works by Janáček and Duparc), Scaife provided a balance of ontological, dramatic, semantic, and structural information. Of interest, Scaife’s examples were written in the third person and did not include the personal voice of the performer; nor do the guides refer to writing notes for the works of living composers. However, there is a common call for accurate information, balance of content, a warning about too much structural information, and advice against including personal opinion.per se. Why this is so is beyond the scope of this study but the assumptions and traditions of program notes, mentioned earlier, have perhaps presumed that the listener, composer, performer, and concert organizer are all happy with the status quo. The diverse literature reviewed above indicates that is not always so. However, with only one exception the program note is positioned, for both canonic and contemporary classical music, as an informative and positive inclusion, with differing advice on content style and acknowledgment of the program note writer as the professional, the student, the performer, and the composer. Our study aimed to narrow the writer to the contemporary classical composer and investigate further the issue of content style and issues of what this communicates.There is a lack of extant research into program notes 1. Antarctica resulted in works for one or two instruments played by one pianist/performer; Australia East and West sought works for viola and piano; and Playing with Fire engaged composers with electroacoustics  and live acoustic piano. The first project included composers from Australia, New Zealand, Italy, Portugal, and Spain, and composers involved in the other projects lived in Australia. Twelve composers were male and five were female; they were all professional composers and ranged from early careerists to established careerists. All participating composers had written at least one program note for the works contributed to our projects; however, the study focused more broadly on the program notes composers had written for their works in general. Once ethical consent was obtained from the lead university, composer participants across the three projects were invited to complete a questionnaire on their program note writing; this was distributed by email once each composer had submitted their composition. Participants signed a consent form and they were assured of their anonymity. The first 12 composers responded to questions one and two about their written program notes, and initial analysis revealed that they were also disclosing facets of their program note process and content. To learn more about this, we posed two additional questions (questions 3 and 4). The final five composers answered all four questions.The participants, 17 composers, had written new works for one of three new music projects. The projects were embedded in research-based practice and each resulted in one or more public performances and academic articles, and a commercial recording Please answer the following questions in relation to your recent experience composing for the project (one of the three projects named above):(1)What role should a program note play for the performer and the listener?(2)Should different information be given to the performer and the listener?(a)If different, what sort of information should be given to each?(3)How do you go about writing a program note?(4)What do you include, and why?We employed a “naturalistic” coding process that started with reading each response without applying codes. Following Throughout the analytical process, two primary coders were used to reduce error and bias in coding the responses . There wFinally, data were displayed in a way that is conceptually pure, making distinctions that are meaningful and which provide interesting content. This included detailed discussion of multiple themes complete with subthemes, illustrations, quotations and multiple perspectives from different respondents.We note that one performer (P1), a pianist, chose to respond to the composer questions when copied in to the questionnaire email. Her responses, while not included in the composer data, are included in the findings where relevant as they give a complementary performer’s perspective. The composers are identified here using a code based on gender, project  and respondent number: for example, M1A is male, he wrote for Antarctica and he was the first male composer to respond.We structure the results and discussion according to the three emergent themes. The first of these concerns the intended audience for the program note, including the lines of communication between composer, performer and listeners. Next, we turn to the intended role of the program note and highlight its role in relation to interpretation, understanding and collaboration. Finally, we address the content of the program note, discussing what the composers wished to communicate.function for each cohort explained that “the languages are so different” (M2A) for performers and listeners. M4A agreed that program notes are useful for both listener and performer, but he drew a distinction between the types of writing for listeners and performers. This idea was expanded by three composers  who noted the need for separate technical detail that would be relevant only for the performer and would therefore be included as performance instructions in the score.Fourteen of the 17 composers felt that program notes were most often useful for both listeners and performers. Three composers  asserted that the same type of program note information could serve both performer and listener. For both groups, “the program note helps the communication between the performer and the listener” (F2A). The performer (P1) agreed that the program note could help to generate a shared understanding and that this is “crucial when the audience faces contemporary art music.” Composers who felt that program notes serve a different Composer F1A felt that a program note is not relevant to the performer, advocating the need for “another kind of communication.” M7EW indicated that in his experience, the most useful communication between composer and performer is verbal dialog. M3A suggested that while information on “programmatic” (dramatic) elements of a composition might be beneficial for both performer and listener, “in the case of completely abstract music program notes can be difficult … in terms of misleading an audience” by imposing “an external framework on a work which was conceived without one.” M10P noted a similar contrast with respect to musical works that relate to extra-musical concerns such as environmental advocacy. Programmatic elements need to be shared with performers and listeners so that they can share in “larger artistic concerns that may evoke such things as landscape, literature, narrative and scientific principles … that may come to bear on the music” (M6A), thereby “allowing additional insight and a greater depth of understanding” (M7EW). Here, the program note might help the performer and listener in “navigating the piece”.Finally, composer M8EW positioned the program note as something that might attract a performer to play the piece. He also suggested that a program note may be important in the evaluation of a work by critics or by those assessing the works for concert programming or other evaluative purposes: these cohorts often value written program notes for their insights. Associated with this were comments about the need to translate works for multiple audiences; in addition to listeners, many composers need to describe their work to external stakeholders such as funding bodies and higher education research panels. M8EW somewhat cynically suggested program notes can make a work “sound more complex/intellectual than it is [in order to] … influence their assessments favorably.”Figure 1, the model illustrates that while the score and the program note serve two distinct and commonly understood functions , the program note carries the composer’s intentions to both the listener and the performer, developing empathy with the work. As such, it has the potential to assist performers in their interpretation (dotted line). When empathy arises, it results in co-construction of the musical experience between the composer, performer, and the listener.To summarize this range of views, we devised an initial diagrammatic model of communication from the composer through both program note and score. Shown as In the background and facilitating this experience are the ideas of the composer or other writer, as expressed in the program note. We contend that the program note cannot be understood with a simple model of communication or transmission because the listening experience and the interpretive work of the performer are necessarily more complex than this. Indeed, these interactions offer the scope for both listener and performer to bring their own perspectives to bear on the musical experience. We explore this complexity in the next section.Participants noted several intended roles in relation to program notes. These were grouped into three themes pertaining to the program note’s influence on the listener and performer, shaping performer interpretation, and the program note as a collaborative tool.guide and direction. Each mode is expressed below using the composer’s voice.In line with guide, highlights the composer’s desire to retain some “ambiguity or lack of meaning” (F3EW); this mode “should inspire the listener to be absorbed into listening to the music” (M9P). Reminiscent of The first mode, By giving “sufficient [information] to listen in a better way” (M5A), the program note in this mode offers “a subtle track … leaving some mystery in the air” and leaving the listener “ready to listen freely and without prejudices” (F1A). M3A took this further by deliberately restricting the information given to listeners so as not “to limit them in the way they might experience the work.” This view relates to the experience of composer Jean-Claude Risset, mentioned earlier, who “was excited by the variety of [listener] reactions … happy to discover occasional symbolic or even mythical evocations which I found valid and suggestive” , p. 29. Alongside this, composers wrote of the program note adding “a dimension to the work which can enable the performer and audience to become more engaged or involved in the piece” (M3A). This might communicate ontological information such as “the poetic and aesthetic suggestions of the piece” (M5A), “personal experiences of the composer … [or] other pieces of music, and/or works of art from other disciplines that informed the piece” (M7EW). Program notes might also direct “emotional/aesthetic connections and meaning and understanding of a piece for the performer” (F4EW).direction, similarly situates the program note as a “track for interpretation which has to be as generic as possible … not limiting the performer, as well as listener, on his [sic] personal interpretation of the ‘open’ meanings of musical composition” (M1A). In this mode, however, the program note is also a deliberate, two- or three-way communication tool that directs communication or generates “dialog between performer, listener, but also the composer” (M2A). This can create what the performer (P1) termed a process of empathizing with the composer’s intention.The second mode, In this mode, the program note is described as a tool that might help listeners’ and performers’ navigation of a work by communicating an ontological “sense of advocacy” (M10P). Writing of program notes as a resource, M11PS wanted to give “confidence to performers and audience alike in their exploration, interpretation and enjoyment of the music” (M11PS). Composer M11P inferred a greater level of control in order to create what he termed “ideal” performers and listeners. Similarly, within the collaborative mode M5A described an intent that was far more prescriptive, defining “all the musical details … to prevent modalities … not in accordance with the composer’s intentions.” More prescriptive composers intended the program note to direct “the way [performers] interpret the musical notes and instructions” (F5EW).Five composers intended their program notes to help shape performer interpretation and enhance performers’ understanding of their intentions. As with listeners, composers wrote of helping with a performer’s “first comprehension” of the work whilst not being “exhaustive” in relation to interpretation (M5A). For these living composers, program notes often worked alongside direct interaction “as a reminder for the performers of [contextual] elements discussed during the preparation of the pieces” (M7EW). Program notes also helped to “clarify the aesthetic approach and inspire some imaginative play” (M9P), for which purpose they included structural “information about the techniques and material of the work [to] aid in interpretation” and performance (M8EW). The performer (P1) reflected that her responsibility “is to do my best in conveying the composer’s idea. This is possible only through a close collaboration.”Another common theme was that of “not providing too much information in the program note” (F3EW). Composers were keen to avoid a note that “explains the piece in itself” (F1A). F1A commented that his compositions were “part of my intimacy and part of my private world as creator.” F3EW’s intention was for both listener and performer to assign their own interpretations to the piece. The composer wrote of ambiguity as “one of the main attractions of music as opposed to the other art forms.” Noting the risk that listeners’ individual interpretations might be threatened, M7EW described program notes as a “double-edged sword.”M3A acknowledged that performers and listeners might choose not to read the program notes at all. The careful balance between too little and too much information was the subject of M9P’s comments, in which he expressed the desire to “inspire the listener … often by not explaining too much, but allowing for some surprise.” Three composers asserted that, “musical works should not require a program to be effective” . The latter of these believed… that the idea of reductive listening is very important … [with] many listening situations [able to] focus entirely on the sound itself, removed from any anecdotal, referential preconceptions about a piece that may be provided via program notes.For several composers, the program note represented a form of collaboration between themselves, performers and/or listeners. Mentioned above, M7EW wrote of a “recurrent and meaningful dialog with performers”. M9P emphasized co-creative freedom in this relationship: “the performer should understand what the composer is wanting to convey … but room should be left for their creative collaborative contribution.”For F2A, listeners were initially recipients of the collaboration between composer and performer. As such, the program note “communicates some intentions from the composer that will be interpreted through the performer to finally reach the listener.” And yet this composer later extended the collaboration to include the listener: the performer “plays/acts the piece and the listener actively participates … while listening to the piece.” M9P agreed, noting listeners’ “creative contribution” to the works they hear. We term this “performative listening” in that composers, listeners and performers can be positioned as active components of the process that brings each composition to life. Their “different participation” in the process necessitates different information for each, and F2A was concerned to highlight that communication is multi-directional. Thus, the program note can be an important element in activating the listener’s participation.The issue of collaboration was also noted in relation to the differences between information provided to the performer and the listener. F1A preferred to relay information to performers “in the process of working the piece with him or her.” M7EW agreed that some information would not be “of use or interest” to listeners. This might relate particularly to contemporary music for which performers often need explanations for new forms of notation/musical effects: “more information about techniques used in the composition” (F5EW).Even so, F5EW’s practice was to provide a common program note for listeners and performers, as did several other composers. F3EW was adamant that performers and listeners should receive the same information, and M11P agreed: “In most cases the program note can function equally for performers and audience to illuminate their experience of the work.” Of interest, and hinting at another collaborative theme, he also noted that listeners should sometimes be kept in the dark: “if the intention of the composer is to make the performer complicit in some kind of trick on the audience, then the two will have different needs.”Composers were asked what information they wanted to communicate in the program notes about their works. Their responses were analysed using the Margulis and Ferrara descriptors and are discussed below, starting with the communication with listeners.When asked about communication with the listening audience, 12 composers responded that they include ontological  or dramatic (descriptive) information, and seven composers included both. Most composers intended this as a framework for engagement that would not “tell the audience what to hear” (M4A). Four composers suggested that semantic information was helpful and only one composer highlighted purely structural information.Noted earlier, M3A wrote of the danger, particularly with abstract music, of creating a program note for a work conceived without an external framework. In contrast, M6A noted that program notes provide listeners of difficult or abstract music with “vital information.” Similarly, he recorded the need to communicate the “extra musical influence[s]” of programmatic music. M7EW agreed, although he felt that “ultimately the piece should work without the support of a program note.” M10P gave the specific example of electroacoustic works that essentially have no program: they “focus entirely on the sound itself, removed from any anecdotal, referential preconceptions … that may be provided via program notes.” This relates to the composer’s belief in reductive listening. However, the same composer noted the importance of communicating to performers and listeners external  influences.When asked about communication with performers, two of the composers were adamant that a program note is simply not enough. In a widely varied set of responses about communicating with performers, 11 composers included structural information, 10 emphasized syntactical information, eight focused on ontological information, four introduced dramatic information, and two focused on semantic information. M11P reiterated “a range of technical information which a performer needs and which an audience other than fellow specialists does not need.” Others highlighted structural information related to “the layers of the piece” (M1A) and/or to the compositional process: “why I adopted a certain structure or what certain articulation markings have developed from” (M4A). In terms of technical notes, M10P explained that “it is important for the performer to understand the work intimately, so this does involve a more detailed/complete comprehension of the music.” M6A provided the same note to performers and listeners, but in line with MP11 he added technical information to the performance score as required. Interpretational information was rarely prescriptive, seeking rather to:•Inspire some imaginative play or stimulus (M9P);•Provide a track for interpretation that doesn’t limit the performer or listener (M1A);•Help inform interpretation [with] … a more detailed analytical approach and explanation of the compositional elements (M4A);•Help direct emotional/aesthetic connections and meaning and understanding (F4EW);•Inform performers’ interpretation of musical notes and instructions (F5EW);•Aid in the interpretation of the work (M8EW); and•Give the performer a sense of what the piece aims to express (F5EW).Figure 2, composer-written programs variously sought to engage and guide and, to an extent, to direct, both listener and performer. This was achieved through different styles of program note content engaging with collaboration through performative listening.Overall, the responses suggest that composers intend performers to receive more structural information than listeners, and that for both performers and listeners too much personal information is to be avoided. Shown at A major strength of this exploratory study is that we formed relationships of trust with each composer, working with them from the point of commission, through the preparation process, and to the point of performance and recording. As a result, we were able to elicit frank and honest responses. Although, the study has made a contribution to understanding a very under-researched aspect of music, we must also acknowledge its limitations. First, this was a small sample of composers and we do not seek to make generalizations. We also note that this area of research is new. We uncovered many possible avenues for further research, and we hope that the model advanced in the following section will help others to continue this work.The literature confirmed that program notes are written for the concert audience, the audio or audio-visual listener, the performer, the examiner, and for Internet readers. Professional program writers, students and performers are commonly the program note writers, and they are advised to give neither too much information nor too many words. Composers, too, write program notes, and these were described as variously clear and insightful, or confounding and full of technical jargon. The literature revealed syntactical, semantic and ontological ways of listening upon repeated hearings, and it suggested that listeners may not necessarily want to receive a dramatic (descriptive) meaning that influences or even overrides their personal interpretations. Despite Margulis’s finding that dramatic notes might not increase listeners’ enjoyment, they dominate contemporary program notes and they remain an aspect recommended by educators.Program note content typically provides a balance of historical, descriptive and structural information, and the literature exposes differing views on the inclusion of each. If the program note is situated as a form of analysis for a given work, readers can expect notes written by a work’s composer to communicate meanings that intersect between the present, and the time and world of the composer when writing the work in question.The study reveals that composers’ intentions for their program notes vary. In this study, 14 of the 17 composers wrote their program notes for both listeners and performers. Three composers considered the same information to be relevant to both, and six felt that it should be different. Performers were often given further  information that was not considered relevant or interesting for the listener. Composers identified three main roles for the program note: to guide or direct the listener or performer; to shape the performer’s interpretation; and as a tool for collaboration between the composer, performer, and listener.Eight of the 17 composers asserted that the program note should guide but not limit interpretation or the listening experience. Four of these aimed for collaboration between composer, performer, and listener intended to result in “performative listening” in which listeners were actively engaged in bringing each composition to life. Another four also encouraged a more active interpretive role for the listener resulting in the co-construction of the musical experience.We return here to Figure 3 summarizes the attitudes of the composers in this study in terms of target recipient, and the role and content of the program notes. It also draws in composers’ preferences for their listeners and illustrates that the role and impact of program notes is both complex and nuanced.The implications of this study include the need for program note writers to carefully consider the range of possibilities and intended impact of program notes, and perhaps to gauge this by seeking feedback. Similarly, the production and format of program notes for listeners merits attention. In higher education settings, commentary that recommends descriptive notes is perhaps misleading. Indeed, performers, composers and other program note writers might benefit from asking themselves when, where, how, and in what form each work is best communicated to different stakeholders. It is hoped that the range of perspectives revealed in this article will provide useful information to assist in these considerations.Future research on composers’ thinking about the intent and content of program notes might focus on whether musical works are considered to require a program note, and why. This might include triangulation of data from the composer, program note content and listener. Analysis of program notes themselves, written for and by different people – composers, performers, and professional program note writers – might add further perspectives to the Goldilocks-style balance between the amount and different types of information each writer wants to communicate. Further analysis of program notes for different media or contexts might reveal whether a program note is, or should be, a different text for each reader: concert goer, CD or web listener, student performer, professional performer and so on.Researchers might also ask under what circumstances program note information is written. If a music publisher required a note for the published version of a score, for example, would composers include information for every possible reader? If not, where might the other “versions” be kept? Similarly, if a concert promoter requested a program note, the composer would know something of the expected concert audience, whereas a CD note would have to cater for many different listening contexts. Further, do listeners want to read program notes before, during or after a performance? And finally, although this study focused on living composers, researchers might ask what happens to this knowledge—particularly that shared through collaboration—when the composer is dead? As educators and performers, we wonder whether consideration of this might prompt composers to record the information they wish to communicate in different ways. With these considerations in mind, perhaps the written program note is only one of the many communication forms we will see in the future.The three authors confirmed that they were involved in all four authorship criteria as laid out below. Authors made substantial contributions to the conception or design of the work and the acquisition, analysis, and interpretation of data for the work; drafted the work and revised it critically for important intellectual content; approved the final version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.