Local Supervisors Research Articles

Community health care workers in pursuit of TB: Discourses and dilemmas

Community-led tuberculosis (TB) active case finding is widely promoted, heavily funded, but many efforts fail to meet expectations. The underlying reasons why TB symptom screening programs underperform are poorly understood. This study examines Nigerian stakeholders’ insights to characterize the mechanisms, enabling structures and influences that lead programs to succeed or fail.Eight focus group discussions were held with Community Health Workers (CWs) from four models of community-based TB screening and referral. In-depth interviews were conducted with 2 State TB program managers, 8 Community based organizations (CBOs), and 6 state TB and Leprosy Local Government supervisors. Transcripts were coded using Framework Analysis to assess how divergent understandings of CWs’ roles, expectations, as well as design, political and structural factors contributed to the observed underperformance.Altruism, religious faith, passion, and commitment to the health and well-being of their communities were reasons CWs gave for starting TB symptom screening and referral. Yet politicized or donor-driven CWs' selection processes at times yielded implementers without a firm grounding in TB or the social, cultural, and physical terrain. CWs encountered suspicion, stigma, and hostility in both health facilities and communities. As the interface between the TB program and communities, CWs often bore the brunt of frustrations with inadequate TB services and CBO/iNGO collaboration. Some CWs expended their own social and financial capital to cover gaps in the active case finding (ACF) programs and public health services or curtailed their screening activities.Effective community-led TB active case finding is challenging to design, implement and sustain. Contrary to conventional wisdom, CWs did not experience it as inherently empowering. Sustainable, supportive models that combine meaningful engagement for communities with effective program stewardship and governance are needed. Crucially effective and successful implementation of community-based TB screening and referral requires a functional public health system to which to refer.

Permissive Supervisor Synthesis for Markov Decision Processes Through Learning

This paper considers the permissive supervisor synthesis for probabilistic systems modeled as Markov Decision Processes (MDP). Such systems are prevalent in power grids, transportation networks, communication networks, and robotics. We propose a novel supervisor synthesis framework using automata learning and compositional model checking to generate the permissive local supervisors in a distributed manner. With the recent advances in assume-guarantee reasoning verification for MDPs, constructing the composed system can be avoided to alleviate the state space explosion. Our framework learns the supervisors iteratively using counterexamples from the verification and is guaranteed to terminate in finite steps and to be correct.

The influence of quality of work life on motivation and retention of local government tuberculosis control programme supervisors in South-eastern Nigeria.

IntroductionSignificant gap exists in knowledge about employee-centred human resources practices that address motivation and retention of local government tuberculosis control programme supervisors (LGTBS) in Nigeria. The study examined the role of quality of worklife (QWL) in motivating and retaining LGTBS.Materials and methodsThe study was conducted in south-eastern region of Nigeria comprising five states and 95 local government areas. The design was mixed-methods. We used cross-sectional survey to collect quantitative data on socio-demographic factors, QWL, motivation and retention from a total sample of LGTBS. The qualitative component involved focus group discussions (n = 3) with 26 LGTBS. Quantitative data were analysed using exploratory factor analysis, descriptive statistics, Spearman correlation, Mann-Whitney test, Kruskal-Wallis test and multiple linear regression. Qualitative data were analysed using a thematic framework approach.ResultsThe final 40-item QWL scale was found to be valid and reliable. The LGTBS had high QWL (M = 5.15, SD = 0.88) and motivation (M = 5.92, SD = 1.08), but low intention to leave their jobs (M = 2.68, SD = 1.59). Education significantly predicted satisfaction with overall QWL, work-family balance and work design; but tenure predicted satisfaction with work context. Work design and work-family balance significantly predicted motivation of LGTBS. Motivation mediated the relationship between QWL and intention to leave and accounted for 29% variance in intention to leave. Whereas LGTBS were motivated by responsibility, learning opportunities, achievement and recognition; they were dissatisfied with lack of flexible work schedules, involvement in non-TB tasks, long hours at work, limited opportunities for vacation, resource inadequacy, work-related stigma, lack of promotional opportunities, and pay disparity and delay.ConclusionAddressing work design, work-family balance and working conditions may increase the motivation and retention of LGTBS and improve human resources for TB at the district level and performance of the TB control programme.

Supervisory Control of Communicating Timed Discrete Event Systems for State Avoidance Problem

We study the supervisory control of timed discrete event systems (TDESs) communicating via unbounded FIFO channels. We model a local TDES by a finite-state automaton with a special event of the global clock. A local supervisor observes the events generated by the corresponding local TDES, and estimates the current state of the other local TDESs based on the synchronized global clock and the received events. We study the state avoidance problem, and propose a distributed control algorithm for the local supervisors to collectively control the global system not to reach a given set of undesirable states.

Nursing care and management of patients' sleep during hospitalisation: A cross-sectional study.

To explore and describe how patients' sleep is addressed at acute-care hospitals in Sweden with regard to nursing care, management and the development of knowledge in this area. Sleep is a basic human need and thus important for health and health maintenance. Patients describe sleeping in hospital as a stressor, and research shows that nurses tend to underestimate patients' perceived problems with sleep during hospitalisation. How do nursing staff at acute hospitals address patients' sleep and the development of knowledge in this area? A cross-sectional descriptive study was conducted based on data collected through a web survey. Head nurses, registered nurses, nursing care developers and local training supervisors at 36 randomised acute-care hospitals in Sweden were invited to participate. This study was executed and reported in accordance with SQUIRE 2.0. The results of the survey (53 responses from 19 wards at 15 acute-care hospitals) showed that no policy documents exist and no current training addresses sleep during hospital stay. All participants agreed that sleep should be considered a nursing topic and that it is important for hospitalised patients. Patients' sleep during hospitalisation is undermanaged at acute-care hospitals. Nurses, health care managers and organisations face challenges if they are to achieve better outcomes. This study shows that nurses do consider patients' sleep important and addressing sleep as part of nursing care. Future studies in the area should focus on what kinds of support and education are needed in the clinical context.

KOMUNIKASI PENGAWAS DALAM MENINGKATKAN KINERJA GURU SEKOLAH DASAR DI KECAMATAN SOMBA OPU KABUPATEN GOWA

The supervision process carried out by the Supervisor and Principal aims to improve the performance of the teachers. The teacher's performance includes the ability to prepare teaching materials, choose media learning, carry out learning and evaluate learning activities. For this reason supervisors in carrying out supervision activities must adopt a communication strategy that includes interpersonal communication, group communication and mass communication. However, in the implementation of supervision, supervisors experienced various obstacles including: Clarity of roles and tasks, Policy Structure, Communication Ability of Local and National Leader Support Supervisors.

Verification of Delay Co-Observability for Discrete Event Systems

In this paper, we investigate how to verify delay co-observability for a given discrete event system and its specification language. Delay co-observability is introduced to solve the decentralized nonblocking networked control problem for discrete event systems under nondeterministic communication delays in our previous paper. We first define a set of indistinguishable string collections and transform the verification problem of delay co-observability to the problem of checking if all of the indistinguishable string collections are valid or not. We then construct a set of verifiers to track all of these string collections. Checking if all of the indistinguishable string collections are valid or not can be done by checking if the states in these verifiers are “good” or “bad”. The specification language is delay co-observable if and only if there are no “bad” states in all verifiers. The computational complexity of the proposed algorithm is polynomial with respect to the number of states and events of the system and exponential with respect to the number of local supervisors and the upper bounds on the delays.

Optimal Supervisory Architecture and Financial Integration in a Banking Union*

Both in the USA and in the Euro area, bank supervision is the joint responsibility of local and central supervisors. I study a model in which local supervisors do not internalize as many externalities as a central supervisor. Local supervisors are more lenient, but banks also have weaker incentives to hide information from them. These two forces can make a joint supervisory architecture optimal, with more weight put on centralized supervision when cross-border externalities are larger. Conversely, more centralized supervision endogenously encourages banks to integrate more cross-border. Due to this complementarity, the economy can be trapped in a suboptimal equilibrium with either too little or too much central supervision, when a superior equilibrium would be achievable.

How selfish individuals achieve unselfish goals: majority-based progressive control of discrete event systems

ABSTRACT We present majority-based progressive control in which local supervisors have not only their own private specifications as primary goals, but an additional global specification representing a desirable behavior of the overall system. The control policy follows the majority rule, and the ultimate goal is to achieve a progressive closed-loop behavior whereby the number of local supervisors meeting private specifications increases as the controlled system evolves. For this purpose, we present the notion of majority-controllability of a global specification, and show that it is a crucial condition for the existence of local supervisors achieving a progressive global specification. Using the presented control theory, we analyze how the federal estate tax in the Unites States was repealed in 2010.

A Multi-Traffic Inter-Cell Interference Coordination Scheme in Dense Cellular Networks

This paper proposes a novel semi-distributed and practical ICIC scheme based on the Almost Blank SubFrame (ABSF) approach specified by 3GPP. We define two mathematical programming problems for the cases of guaranteed and best-effort traffic, and use game theory to study the properties of the derived ICIC distributed schemes, which are compared in detail against unaffordable centralized schemes. Based on the analysis of the proposed models, we define Distributed Multi-traffic Scheduling (DMS), a unified distributed framework for adaptive interference-aware scheduling of base stations in future cellular networks which accounts for both guaranteed and best-effort traffic. DMS follows a two-tier approach, consisting of local ABSF schedulers, which perform the resource distribution between guaranteed and best effort traffic, and a lightweight local supervisor, which coordinates ABSF local decisions. As a result of such a two-tier design, DMS requires very light signaling to drive the local schedulers to globally efficient operating points. As shown by means of numerical results, DMS allows to (i) maximize radio resources reuse, (ii) provide requested quality for guaranteed traffic, (iii) minimize the time dedicated to guaranteed traffic to leave room for best-effort traffic, and (iv) maximize resource utilization efficiency for best-effort traffic.

Saberes locais sobre formação de jovens em vulnerabilidade social na região de M’Boi Mirim e proximidades

Resumo Esta pesquisa toma a educação como eixo privilegiado para o enfrentamento da vulnerabilidade social juvenil na região de M’Boi Mirim e proximidades. Por meio de entrevistas qualitativas, foram ouvidos educadores, diretores e gestores locais, de escolas (15 e um EJA) e equipamentos de formação complementar (3 centros de juventude). As escolas investigadas mostram dificuldade no enfrentamento dos desafios lá vividos: sobrecarregadas na função social assumida, vivem problemas de diversos tipos, desde restrições financeiras, inconstância do corpo docente, evasão escolar, violência dentro e fora do meio escolar, e dificuldade de tornar a escola um lugar inclusivo e plural. Há, porém, escolas, centros de juventude e educadores locais que têm desenvolvido estratégias fecundas para o enfrentamento da vulnerabilidade social juvenil, criando dispositivos de não discriminação, espaços de diálogo e de respeito compartilhado e abrindo seus portões para o convívio regular e cotidiano com o entorno, entre outras ações.

Training and experiences in ultrasound and focused echo among post graduate trainees in anaesthesia, critical care and emergency medicine

Introduction: Use of ultrasound scans (USS) has rapidly expanded and it is being used by many non-radiology specialists in fields such as anaesthesia, critical care and emergency medicine. There are well established guidelines on the use of USS in these specialities. Training in USS should be appropriately supervised and should lead to an accreditation to ensure the quality and to minimize mistakes. Study objectives: We evaluated the training, experience, and confidence in USS/Focused ECHO among anaesthesia, critical care and emergency medicine trainees. Methods: An online survey was sent to the post-graduate trainees in anaesthesia, critical care and emergency medicine who wereundergoing local training in Sri Lanka during August-September 2017. No ethical approval was required, and participation was entirely voluntary with responses kept anonymised. Results: Out of 69 responders, only 25 (36.2%) had a dedicated training programme in USS/F-ECHO. Trainees gained their knowledge mainly from their seniors (52.1%), workshops (46.3%) and local educational supervisor (37.6%). Only 9 (13.1%) maintained a log book. Majority were always or often confident in performing vascular USS. However, trainees were least confident in F-ECHO. Conclusions: There should be a dedicated USS and focused ECHO programme and a curriculum for the trainees in anaesthesia, critical care and emergency medicine and they should be encouraged to maintain a log book of their training experiences.

Exploiting Distinguishers in Local Modular Control of Discrete-Event Systems

Local modular control (LMC) is an approach to the supervisory control theory (SCT) of discrete-event systems that exploits the modularity of plant and specifications. Recently, distinguishers and approximations have been associated with SCT to simplify modeling and reduce synthesis effort. This paper shows how advantages from LMC, distinguishers, and approximations can be combined. Sufficient conditions are presented to guarantee that local supervisors computed by our approach lead to the same global closed-loop behavior as the solution obtained with the original LMC, in which the modeling is entirely handled without distinguishers. A further contribution presents a modular way to design distinguishers and a straightforward way to construct approximations to be used in local synthesis. An example of manufacturing system illustrates our approach. Note to Practitioners — Distinguishers and approximations are alternatives to simplify modeling and reduce synthesis cost in SCT, grounded on the idea of event-refinements. However, this approach may entangle the modular structure of a plant, so that LMC does not keep the same efficiency. This paper shows how distinguishers and approximations can be locally combined such that synthesis cost is reduced and LMC advantages are preserved.

A Supervisory Control Theoretic Approach to the Analysis of Democratic Progress

In this paper, we show that supervisory control theory of discrete event systems can serve as a methodology to analyze the principle of democratic progress. For this purpose, we address a new supervisory control problem in which each local supervisor is designed with its own private specification, and an additional progressive specification is given as a global objective for a system to follow. We present the controllability and power-observability as the main conditions for a controlled system to meet a progressive specification in the sense that the number of local supervisors meeting private specifications increases as the controlled system evolves. We then demonstrate that the developed theory can be used to analyze the principle of democratic progress in a systematical way through a case study of labor unions in the Unites States.

To what extent are midwives adapting antenatal information for pregnant women with intellectual disabilities? A survey of NHS trusts in England

ObjectivesTo identify the existing antenatal information provision practices for pregnant women with intellectual disabilities in England. To identify how practices between and within local supervising authorities differed, and if midwives were adapting standard antenatal information for pregnant women with intellectual disabilities, including examples of accessible information being used. Study designCross-sectional survey. MethodsAll contact supervisors of midwives from acute trusts with maternity services were accessed via the local supervisor of midwives officers' databases and sent a questionnaire. Quantitative data were collated. Associations between trust size, geographical location, antenatal provision and National Institute for Health and Care Excellence guidelines alongside National policy were examined using Fischer's exact test of association. ResultsContact supervisors of midwives returned a questionnaire on behalf of their trust (74, 53%). The majority worked in maternity units with more than 4000 births a year (50, 66%). Few trusts had a specialist or lead midwife in post for pregnant women with intellectual disabilities (17, 22.9%) but over half (39, 52.7%) reported that their trust had a specialist learning disability nurse in post. Only 28.3% reported availability of post registration training and even fewer (8, 10.8%) had access to written protocols. Less than half reported extra time being offered at the booking (29, 39.1%) or routine antenatal appointments (30, 40.5%). Less than a quarter (17, 22.9%) reported that their trust had routine antenatal written information available in accessible formats. ConclusionReasonable adjustments to standard antenatal information for pregnant women with intellectual disabilities were not common practice. Most trusts did not have local guidelines in place or offer midwives post registration education to help support them in this requirement.

Evaluation of the leprosy control programme surveillance system in Kwara State, Nigeria, 2010 - 2014

Objective: Leprosy is a chronic, infectious disease complicated with blindness and loss of fingers/toes in some cases. Though the disease is targeted for eradication in Nigeria, the country had the 6th highest prevalence globally in 2013. This study was conducted to evaluate the leprosy surveillance system in Kwara State, assessing its operations, attributes and determining its usefulness. Method: The 2001 updated guidelines for evaluating public health systems of Centers for Disease Control and Prevention was used. Key informant interviews were done with the State Tuberculosis and Leprosy (TBL) Control Officer, and the State Epidemiologists to assess the importance of the public health, purpose and operation of the surveillance system, resources used to operate it as well as the attributes of the system. Questionnaires were administered to Local Government Area TBL supervisors to assess the attributes of the surveillance system. Surveillance data from 2010 to 2014 was analyzed and data quality determined. Results: Incidence of leprosy over the five year period 2010 – 2014 was 62.0%, 59.0%, 54.0%, 67.0%, and 42.0% respectively, with occurrence of the multi-bacillary type in 83.1% to 90.7% newly detected cases. The system was found to be 51.0% sensitive(most hospitals do not have treatment forms for health workers use, community awareness programmes was done in 53.0% of local government areas in last 3 months, contact tracing was however always done), 90.0% simple, 93.0% acceptable and 95.0% timely. Data system was both paper and electronics, based on collection, collation, analysis and reporting done quarterly in a year. The surveillance system is donor-driven and fully integrated with that of tuberculosis and buruli ulcer. Annual surveillance expenditure was about $2 500. Conclusion: Kwara State Leprosy Surveillance System has a low sensitivity with delayed case detection. Training of health workers on early case detection, provision of treatment forms and more community awareness will improve the surveillance system’s sensitivity.

Optimal Supervisory Architecture and Financial Integration in a Banking Union

Both in the United States and in the Euro area, bank supervision is the joint responsibility of local and central/federal supervisors. I study how such a system can optimally balance the lower inspection costs of local supervisors with the ability of the central level to internalize cross-border or interstate externalities. The model predicts that centralised supervision endogenously increases market integration and cross-border externalities, further strengthening the need for centralised supervision. This complementarity implies that, for some parameterizations of the model, the economy can be trapped in a local supervision equilibrium with low supervision and integration. In such a case, the forward-looking introduction of a centralized supervisory architecture achieves a superior equilibrium. JEL Classification: D53, G21, G28, G33, G38, L51

Decentralized Supervision and Coordination of Concurrent Discrete Event Systems under LTL Constraints

In this paper, we consider a control problem of a concurrent discrete event system modeled by a Mealy automaton, where several subsystems are partially synchronized via shared events. We impose to the system local and global constraints described by linear temporal logic formulas. We propose hierarchical control architecture consisting of local supervisors and a coordinator. By a game-based approach, we synthesize a controller that guarantees the specifications of both levels.

Hierarchical bank supervision

This paper presents a model in which a central and a local supervisor contribute their efforts to obtain information on the solvency of a local bank, which is then used by the central supervisor to decide on its early liquidation. This hierarchical model is contrasted with the alternatives of decentralized and centralized supervision, where only the local or the central supervisor collects information and decides on liquidation. The local supervisor has a higher bias against liquidation (supervisory capture) and a lower cost of getting local information (proximity). Hierarchical supervision is the optimal institutional design when the bias of the local supervisor is high but not too high and the costs of getting local information from the center are low but not too low. With low (high) bias and high (low) cost it is better to concentrate all responsibilities in the local (central) supervisor.

Hub-and-Spoke Regulation and Bank Leverage

Hub-and-spoke regulation, where a central regulator with legal power over firms delegates monitoring to local supervisors, can improve information collection, but can also lead to agency problems and capture. We document that following the closure of a US bank regulator’s field offices, the banks they previously supervised distribute cash, increase leverage, and increase their risk of failure, more than similar banks in the same time and place. The opposite occurs for openings. Our findings suggest that field level interaction is an important part of regulation, and that distancing supervisors from banks to prevent regulatory capture can increase bank risk.