The training and development needs of midwives in Indonesia: paper 2 of 3

BACKGROUND: There is a shortfall in midwives in Indonesia (an estimated 26 per 100 000 people), which means that the quality of antenatal, perinatal and postnatal care varies widely. One consequence of this is the high rate of maternal and perinatal mortality, which has prompted a number of health initiatives. The current study was part of a review of the existing complex system of midwifery training and the development of a coherent programme of continuing professional development, tighter accreditation regulations and clearer professional roles. Its aims were to identify the occupational profiles and development needs of the participating midwives, and to establish whether any differences existed between grades, geographical location and hospital/community midwives. METHODS: A psychometrically valid training-needs instrument was administered to 332 midwives from three provinces, covering both hospital and community staff and a range of midwifery grades. The instrument had the capacity to identify occupational roles and education/training needs of the respondents. RESULTS: The occupational roles of the midwives varied significantly by province, indicating regional service delivery distinctions, but very little difference in the roles of hospital and community midwives. The most educated midwives attributed more importance to 35 out of the 40 tasks, suggesting an implicit role distinction in terms of level of activity. All midwives reported significant training needs for all 40 tasks. The most-educated midwives recorded training needs for 24 tasks, while the less-educated had training requirements for all tasks, which suggests that new training programmes are effective. Few differences in training needs were revealed between hospital and community midwives CONCLUSION: The results from this survey suggest important regional differences in how the midwife's role is discharged and underline the importance of this sort of research, in order to ensure the suitability of basic and postbasic educational provision. The study also highlights the need for further development and training of midwives in a wide range of tasks. These results provide a systematic and reliable overview of current midwifery roles and development needs and could serve to inform future training

Advances in Driving Anger

Driving anger is the most widely studied emotion in the driving context and one of the more commonly studied topics in traffic and transportation psychology. Anger has a substantial impact on driving behaviour and is both a cause and a consequence of numerous negative driving outcomes. Over the years, what we have come to know about driving anger has developed in proportion to the increase in quality of research dedicated to this topic. The idea behind this special issue is to provide a forum in which to better understand driving anger: to highlight what has been learned about driving anger over the past quarter century and to stimulate new research for the next decade

The training and development needs of nurses in Indonesia: paper 3 of 3

BACKGROUND: Indonesia's recent economic and political history has left a legacy of widespread poverty and serious health problems, and has contributed to marked inequalities in health care. One means of responding to these challenges has been through a reconsideration of the professional roles of nurses, to enable them to deal with the range and complexity of health problems. However, there are currently a number of obstacles to achieving these aims: there is a serious shortfall in trained nurses; the majority of nurses have only limited education and preparation for the role; and there is no central registration of nurses, which means that it is impossible to regulate either the profession or the standards of care. This study aimed to establish the occupational profiles of each grade of nurse, identify their training and development needs and ascertain whether any differences existed between nurses working in different regions or within hospital or community settings. METHODS: An established and psychometrically valid questionnaire was administered to 524 nurses, covering three grades and coming from five provinces. RESULTS: Significant differences in job profile were found in nurses from different provinces, suggesting that the nature of the role is determined to some degree by the geographical location of practice. The roles of hospital and community nurses, and the different grades of nurse, were fairly similar. All nurses reported significant training needs for all 40 tasks, although these did not vary greatly between grade of nurse. The training needs of nurses from each of the provinces were quite distinct, while those of hospital nurses were greater than those of community nurses. CONCLUSION: The results suggest that the role of the nurse is not as diverse as might be expected, given the different levels of preparation and training and the diversity of their work environments. This may reflect the lack of a central registration system and quality framework, which would normally regulate clinical activities according to qualifications. The differences in training needs between subsections of the sample highlight the importance of identifying skills deficits and using this information to develop customized post-registration education programmes. Together, these results provide a rigorous and reliable approach to defining the occupational roles and continuing education needs of Indonesian nurses

A review of High Performance Computing foundations for scientists

The increase of existing computational capabilities has made simulation emerge as a third discipline of Science, lying midway between experimental and purely theoretical branches [1, 2]. Simulation enables the evaluation of quantities which otherwise would not be accessible, helps to improve experiments and provides new insights on systems which are analysed [3-6]. Knowing the fundamentals of computation can be very useful for scientists, for it can help them to improve the performance of their theoretical models and simulations. This review includes some technical essentials that can be useful to this end, and it is devised as a complement for researchers whose education is focused on scientific issues and not on technological respects. In this document we attempt to discuss the fundamentals of High Performance Computing (HPC) [7] in a way which is easy to understand without much previous background. We sketch the way standard computers and supercomputers work, as well as discuss distributed computing and discuss essential aspects to take into account when running scientific calculations in computers.Comment: 33 page

Damage areas on selected LDEF aluminum surfaces

With the U.S. about to embark on a new space age, the effects of the space environment on a spacecraft during its mission lifetime become more relevant. Included among these potential effects are degradation and erosion due to micrometeoroid and debris impacts, atomic oxygen and ultraviolet light exposure as well as material alteration from thermal cycling, and electron and proton exposure. This paper focuses on the effects caused by micrometeoroid and debris impacts on several LDEF aluminum plates from four different bay locations: C-12, C-10, C-01, and E-09. Each plate was coated with either a white, black, or gray thermal paint. Since the plates were located at different orientations on the satellite, their responses to the hypervelocity impacts varied. Crater morphologies range from a series of craters, spall zones, domes, spaces, and rings to simple craters with little or no spall zones. In addition, each of these crater morphologies is associated with varying damage areas, which appear to be related to their respective bay locations and thus exposure angles. More than 5% of the exposed surface area examined was damaged by impact cratering and its coincident effects (i.e., spallation, delamination and blow-off). Thus, results from this analysis may be significant for mission and spacecraft planners and designers

Dry Matter Intake, Milk Performance and Production Efficiency from Spring Calving Dairy Cows Offered Grass-Only, Grass-White Clover and Total Mixed Ration Diets

In pasture-based dairy production systems, dry matter intake (DMI) is one of the main factors curtailing milk production and production efficiency. The inclusion of white clover (Trifolium repens L.) in swards of perennial ryegrass (PRG; Lolium perenne L.) can increase DMI from increased sward nutritive value over a grass-only sward. Feeding a fully balanced TMR diet can enhance milk production as a result of greater DMI and through greater control of feed quality. Therefore, the objective of this study was to determine the relationship between DMI, milk production, and energy efficiencies for dairy cows consuming different diets. A farm systems experiment was conducted from 2015-2021. The three treatments were: TMR (100% confinement; grass silage, maize silage, concentrate), grass-only herbage (GR), or grass-white clover herbage (CL). Dry matter intake was estimated 17 times over the duration of the study, using the n-alkane technique for the GR and CL treatments, and an electronic roughage intake control system for the TMR treatment. Simultaneously, milk production, and production efficiencies were also measured. Significant increases (P \u3c 0.001) in milk production, DMI, and production efficiencies were observed when cows consumed the TMR diet compared with the grazing diets. Greater energy (P \u3c 0.001) was available for milk production after maintenance for the TMR treatment. All treatments had similar energy (148.64 g Unité fourragère lait; UFL) available for milk solids (MS) production after accounting for maintenance. Cows consuming the TMR diet had significantly higher (P \u3c 0.001) daily energy intake (+17%) compared to the pasture-fed cows. Cows grazing the CL swards consumed 1.03 kg greater (P \u3c 0.001) total DMI compared to the GR cows. This translated into greater daily milk (+1.2 kg) and MS (0.12 kg) compared with the GR treatment. The current study highlights the benefits of a TMR and ryegrass/white clover diet for increasing milk production, and energy efficiencies above a grass-only diet

Grazing and Animal Welfare of Dairy Cows in Europe, What do We Know?

Grazing systems are important components of the landscape in almost all European countries. Grazing is inherently close to the nature of herbivores, but no longer applied everywhere in Europe. This paper discusses the extent of dairy cow grazing in Europe and the effect of grazing on animal welfare. The study builds on results of surveys from the European Grassland Federation (EGF) Working Group “Grazing” (WGG) in the period 2010–2022 and a focus group meeting in 2022. Data on the extent of grazing of dairy cows in Europe are provided. Europe can be divided into six distinctive regions with respect to the extent of grazing. The extent of grazing is country specific and there is less grazing in the East and the South than in the North and the West of Europe. In general, the popularity of grazing in Europe is declining, but there are a few exceptions. The main positive effects of grazing on animal welfare and animal health identified are that grazing provides much more scope for natural behaviour, may reduce the risk of udder health problems and may benefit claw health. The main negative effects are that in the field cows are exposed to weather conditions, especially sun, and fluctuations in diet composition. The WGG members concluded that grazing has, in general, a positive effect on animal welfare and animal health. A changing climate and associated changing weather conditions are seen as the biggest challenges for grazing in the next decade

Financial incentives to discontinue long-term benzodiazepine use: a discrete choice experiment investigating patient preferences and willingness to participate.

OBJECTIVES: Investigate the acceptability of financial incentives for initiating a medically supervised benzodiazepine discontinuation programme among people with long-term benzodiazepine use and to identify programme features that influence willingness to participate. METHODS: We conducted a discrete choice experiment in which we presented a variety of incentive-based programs to a sample of older adults with long-term benzodiazepine use identified using the outpatient electronic health record of a university-owned health system. We studied four programme variables: incentive amount for initiating the programme, incentive amount for successful benzodiazepine discontinuation, lottery versus certain payment and whether partial payment was given for dose reduction. Respondents reported their willingness to participate in the programmes and additional information was collected on demographics, history of use and anxiety symptoms. RESULTS: The overall response rate was 28.4%. Among the 126 respondents, all four programme variables influenced stated preferences. Respondents strongly preferred guaranteed cash-based incentives as opposed to a lottery, and the dollar amount of both the starting and conditional incentives had a substantial impact on choice. Willingness to participate increased with the amount of conditional incentive. Programme participation also varied by gender, duration of use and income. CONCLUSIONS: Participation in an incentive-based benzodiazepine discontinuation programme might be relatively low, but is modifiable by programme variables including incentive amounts. These results will be helpful to inform the design of future trials of benzodiazepine discontinuation programmes. Further research is needed to assess the financial viability and potential cost-effectiveness of such economic incentives

Grazing and Animal Welfare of Dairy Cows in Europe, What do We Know?

Grazing systems are important components of the landscape in almost all European countries. Grazing is inherently close to the nature of herbivores, but no longer applied everywhere in Europe. This paper discusses the extent of dairy cow grazing in Europe and the effect of grazing on animal welfare. The study builds on results of surveys from the European Grassland Federation (EGF) Working Group “Grazing” (WGG) in the period 2010–2022 and a focus group meeting in 2022. Data on the extent of grazing of dairy cows in Europe are provided. Europe can be divided into six distinctive regions with respect to the extent of grazing. The extent of grazing is country specific and there is less grazing in the East and the South than in the North and the West of Europe. In general, the popularity of grazing in Europe is declining, but there are a few exceptions. The main positive effects of grazing on animal welfare and animal health identified are that grazing provides much more scope for natural behaviour, may reduce the risk of udder health problems and may benefit claw health. The main negative effects are that in the field cows are exposed to weather conditions, especially sun, and fluctuations in diet composition. The WGG members concluded that grazing has, in general, a positive effect on animal welfare and animal health. A changing climate and associated changing weather conditions are seen as the biggest challenges for grazing in the next decade