The Voluntary Adjustment of Railroad Obligations

Automatic memory management techniques eliminate many programming errors that are both hard to find and to correct. However, these techniques are not yet used in embedded systems with hard realtime applications. The reason is that current methods for automatic memory management have a number of drawbacks. The two major ones are: (1) not being able to always guarantee short real-time deadlines and (2) using large amounts of extra memory. Memory is usually a scarce resource in embedded applications. In this paper we present a new technique, Real-Time Reference Counting (RTRC) that overcomes the current problems and makes automatic memory management attractive also for hard real-time applications. The main contribution of RTRC is that often all memory can be used to store live objects. This should be compared to a memory overhead of about 500% for garbage collectors based on copying techniques and about 50% for garbage collectors based on mark-and-sweep techniques

Exploring the feasibility of engaging Traditional Birth Attendants in a prevention of Mother to Child HIV Transmission program in Lilongwe, Malawi

ObjectiveTo investigate the willingness of Traditional Birth Attendants (TBAs) to provide single dose antiretroviral prophylaxis to infants born to mothers with HIV and the feasibility of providing the TBAs with antiretroviral medication.Design2 focus groups with a total of 17 registered TBAs.SettingLilongwe, MalawiMethodsTBAs were recruited by local health workers and participated in focus groups assessing their attitudes towards participation in a PMTCT program.ResultsTBAs were willing to participate in this prevention of mother-to-child HIV transmission (PMTCT) program and helped identify barriers to their participation.ConclusionsGiven appropriate support and training, TBAs’ participation in PMTCT programs could be an additional way to deliver medication to mothers and neonates who might otherwise miss crucial doses of medication

Detectable Viral Load in Late Pregnancy among Women in the Rwanda Option B+ PMTCT Program: Enrollment Results from the Kabeho Study.

There are limited viral load (VL) data available from programs implementing Option B+, lifelong antiretroviral treatment (ART) to all HIV-positive pregnant and postpartum women, in resource-limited settings. Extent of viral suppression from a prevention of mother-to-child transmission of HIV program in Rwanda was assessed among women enrolled in the Kigali Antiretroviral and Breastfeeding Assessment for the Elimination of HIV (Kabeho) Study. ARV drug resistance testing was conducted on women with VL\u3e2000 copies/ml. In April 2013-January 2014, 608 pregnant or early postpartum HIV-positive women were enrolled in 14 facilities. Factors associated with detectable enrollment VL (\u3e20 copies/ml) were examined using generalized estimating equations. The most common antiretroviral regimen (56.7%, 344/607) was tenofovir/lamivudine/efavirenz. Median ART duration was 13.5 months (IQR 3.0-48.8); 76.1% of women were on ART at first antenatal visit. Half of women (315/603) had undetectable RNA-PCR VL and 84.6% (510) had36 months compared to those on ART 4-36 months (72/191, 37.7% versus 56/187, 29.9%), though the difference was not significant. The odds of having detectable enrollment VL decreased significantly as duration on ART at enrollment increased (AOR = 0.99, 95% CI: 0.9857, 0.9998, p = 0.043). There was a higher likelihood of detectable VL for women with lower gravidity (AOR = 0.90, 95% CI: 0.84, 0.97, p = 0.0039), no education (AOR = 2.25, (95% CI: 1.37, 3.70, p = 0.0004), nondisclosure to partner (AOR = 1.97, 95% CI: 1.21, 3.21, p = 0.0063) and side effects (AOR = 2.63, 95% CI: 1.72, 4.03, p36 months with genotyping available. Most women were receiving ART at first antenatal visit, with relatively high viral suppression rates. Shorter ART duration was associated with higher VL, with a concerning increasing trend for higher viremia and drug resistance among women on ART for \u3e3 years

Increasing cardiovascular medication adherence:A Medical Research Council complex mHealth intervention mixed-methods feasibility study to inform global practice

AimsTo evaluate a mHealth intervention to increase medication adherence among Iranian coronary heart disease patients.DesignQuantitative-dominant mixed-methods study.Data SourceIranian coronary heart disease patients’ responses and most recent clinical documents as well as responses from Iranian cardiac nurses who participated in this study.MethodsThe study was conducted between September 2015–April 2016 drawing on the Medical Research Council's Framework. Phase one comprised of a patients’ survey and focus groups with cardiac nurses. The automated short message service reminder was piloted in phase two. We recruited 78 patients and randomized to receive either 12-week daily reminders or usual care. The primary outcome was the effect on medication adherence; secondary outcomes were self-efficacy, ejection fraction, functional capacity, readmission rate and quality of life.ResultsFeasibility was evidenced by high ownership of mobile phones and high interest in receiving reminders. Participants in the intervention group showed significantly higher medication adherence compared with the control group.ConclusionThe mHealth intervention was well accepted and feasible with early evidence of effectiveness that needs to be confirmed in a fully powered future randomized clinical trial