An assessment of differences in pediatric dental services provided for a Medicaid population when compared to a federally subsidized (military) clinic

Reimbursement for dental services performed for children receiving Medicaid is reimbursed per service while dental treatment for military dependents provided at a military installation is neither directly reimbursable to those providing the care nor billed to those receiving the care. The purpose of this study was to compare pediatric dental services provided for a Medicaid population to a federally subsidized military facility to compare treatment choices and subsequent costs of care. It was hypothesized that differences in dental procedures for Medicaid and military dependent children would exist based upon treatment philosophy and payment method. A total of 240 records were reviewed for this study, consisting of 120 Medicaid patients at the University of Texas Health Science Center at San Antonio (UTHSCSA) and 120 military dependents at Wilford Hall Medical Center (WHMC), Lackland Air Force Base, San Antonio. Demographic data and treatment information were abstracted for children receiving dental treatment under general anesthesia between 2002 and 2006. Data was analyzed using the Wilcoxon rank sum test, Kruskal-Wallis test, and Fisher's exact test. The Medicaid recipients treated at UTHSCSA were younger than patients at WHMC (40.2 vs. 49.8 months, p<.001). The university also treated significantly more Hispanic children than WHMC (78.3% vs. 30.0%, p<.001). Children at UTHSCSA had a mean of 9.5 decayed teeth and were treated with 2.3 composite fillings, 0 amalgam fillings, 5.6 stainless steel crowns, 1.1 pulp therapies, 1.6 extractions, and 1.0 sealant. Children at WHMC had a mean of 8.7 decayed teeth and were treated with 1.4 composite fillings, 0.9 amalgam fillings, 5.6 stainless steel crowns, 1.7 pulp therapies, 0.9 extractions, and 2.1 sealants. The means of decayed teeth, total fillings, and stainless steel crowns were not statistically different. UTHSCSA provided more composite fillings (p<.001), fewer amalgam fillings (p<.001), fewer pulp therapies (p <.001), more extractions (p=.01), and fewer sealants (p<.001) when compared to WHMC. Age and gender did not effect decay rates, but those of Hispanic ethnicity did experience more decay than non-Hispanics (9.5 vs. 8.6, p=.02). Based upon Texas Medicaid reimbursement rates from 2006, the cost for dental treatment at both sites was approximately $650 per child. The results of this study do not support the hypothesis that Medicaid providers provide less conservative therapies, which would be more costly, care when compared to a military treatment center. ^

The identification and prevalence of veterinary clinical events in U.S. military working dogs deployed to Iraq between March 20, 2003, and December 31, 2007

Objective. The purpose of this study was to identify the medical issues experienced by Military Working Dogs during their period of deployment in Iraq.^ Design. This study was a retrospective cross-sectional survey based on database and medical record abstraction.^ Population. Military Working Dogs (MWDs) that were deployed to Iraq at any time between 20 March 2003 and 31 December 2007 were the inclusive population of interest. Seven hundred ninety-five (795) MWDs were identified as having been deployed to Iraq during the inclusive dates. Four hundred ninety-six (496) MWDs were identified that had medical events during the deployment period. ^ Procedures. Eligible MWDs were identified through several sources, to include database query, medical record abstraction questionnaire, and medical record abstraction. Demographic information collected for each MWD included tattoo, name, age, gender, breed, Branch of Service, and duty certification. Information on each veterinary/medical clinical event (VCE) was collected. This information was coded, and data entered into a database for organization. Frequency and prevalence information were determined for each category of VCE.^ Results. The top four VCEs experienced by MWDs while deployed in Iraq were gastrohepatic, dermatologic, traumatic injury, and appendicular musculoskeletal issues.^ Conclusions. Training, equipment, and supplies for veterinary personnel who care for the deployed MWDs should be tailored accordingly to suit the identified medical needs of the MWDs. ^

Smokeless tobacco use in 2005 US Military population

U.S. Military personnel are more likely to use smokeless tobacco than civilians. The purpose of this study was to describe the relationship between smokeless tobacco use and sociodemographic, behavioral, and occupational variables, using data from the 2005 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel. The DoD survey was comprised of representative active duty U.S. military members (N=16,146). In adjusted multivariate logistic regression models, this study found smokeless tobacco use to be more prevalent in younger age, males, whites, and enlisted-rank members. By service, higher rates were reported among members of the Army and Marine Corps than among the Air Force and Navy members. Smokeless tobacco use among those who also smoke or drink heavily was also much higher than among those who did not report smoking or heavy alcohol use. Results also showed increased prevalence of smokeless tobacco use among those who reported moderate or high impulsive behavior and among those who recently deployed. These findings contribute to improving the understanding of factors related to smokeless tobacco use in the military and may help design strategies to reduce the use of this potentially toxic substance and improve health for military members.^

The effects of binge drinking on military readiness: The inability to deploy

The negative outcomes from alcohol misuse have been chronicled for decades in epidemiological studies. Recent research has focused on patterns of drinking. Binge and heavy drinking have been associated with multiple negative outcomes, to include surrogate outcomes designed to measure decrements to military readiness. This study is perhaps the first to examine whether binge or heavy drinking patterns are associated with the U.S. military’s overall inability to deploy rate or the individual reasons unable to deploy. ^ The prevalence of binge and heavy drinking and the inability to deploy rates were assessed from responses to the 2005 Department of Defense Survey of Health Related Behaviors Among Military Personnel. A secondary analysis of extant data resulted in a final sample size of 13,619 respondents who represented 847,253 active-duty military personnel. Multivariate models were fitted to examine the association between patterns of drinking and individual reasons for the inability to deploy. ^ Logistic regression showed no association of binge or heavy drinking to greater inability to deploy. Interestingly, individual reasons for the inability to deploy did show an association to include: Training, Dental Issue, No HIV Test, and Family Situation. There was no association noted for the individual reasons: Injury, Illness, Leave/Temporary Duty, or Other. Binge and heavy drinkers appear to be more susceptible to the psychosocial determinants than physical determinants as reasons for the inability to deploy. ^

Deployed military women: A second look at gender-specific infections

This descriptive, cross-sectional study addressed the relationship between variables of deployed military women and prevalence of gender-specific infections. The analysis of secondary data will look at the last deployment experience of 880 randomly selected U.S. military women who completed a mailed questionnaire (Deployed Female Health Practice Questionnaire (FHPQ)) in June 1998. The questionnaire contained 191 items with 80 data elements and one page for the subject's written comments. The broad categories of the questionnaire included: health practices, health promotion, disease prevention and treatment, reproduction, lifestyle management, military characteristics and demographics. The research questions are: (1) What is the prevalence of sexually transmitted diseases (STD), urinary tract infections (UTI) and vaginal infections (VI) related to demographic data, military characteristics, behavioral risk factors and health practices of military women during their last deployment? and (2) What are the differences between STD, UTI and VI related to the demographic data, military characteristics, behavioral risk factors and health practices of military women during their last deployment. The results showed that (1) STDs were found to be significantly associated with age and rank but not location of deployment or military branch; (2) UTI were found to be significantly associated with intrauterine device (IUD) use, prior UTI and type of items used for menses management, but not education or age; and (3) VI were significantly associated with age, rank and deployment location but not ethnicity or education. Although quantitative research exploring hygiene needs of deployed women continues, qualitative studies may uncover further “hidden” issues of importance. It cannot be said that the military has not made proactive changes for women, however, continued efforts to hone these changes are still encouraged. Mandatory debriefings of “seasoned” deployed women soldiers and their experiences would benefit leadership and newly deployed female soldiers with valuable “lessons learned.” Tailored hygiene education material, prevention education classes, easy access website with self-care algorithms, pre-deployment physicals, revision of military protocols for health care providers related to screening, diagnosing and treatment of gender-specific infections and process changes in military supply network of hygiene items for women are offered as recommendations. ^

The association between mental health and cigarette smoking in active duty military members

Previous research has shown an association between mental health status and cigarette smoking. This study examined four specific mental health predictors and the outcome variable any smoking, defined as smoking one or more cigarettes in the past 30 days. The population included active duty military members serving in the United States Army, Air Force, Navy and Marine Corps. The data was collected during the 2005 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel, a component of the Defense Lifestyle Assessment Program. The sample size included 13,603 subjects. This cross sectional prevalence study consisted of descriptive statistics, univariate analysis, and multivariate logistic regression analysis of the four mental health predictors and the any smoking outcome variable. Multivariate adjustment showed an association between the four mental health predictors and any smoking. This association is consistent with previous literature and can help guide public health officials in the development of smoking prevention and cessation programs.^

PRETERM BIRTH AND OCCUPATIONAL PHYSICAL ACTIVITY: A CASE-CONTROL STUDY OF THE RELATIONSHIP BETWEEN LENGTH OF GESTATION AND THE PHYSICAL DEMAND OF U.S. ARMY MILITARY OCCUPATIONAL SPECIALTIES (UNITED STATES)

A case-control study has been conducted examining the relationship between preterm birth and occupational physical activity among U.S. Army enlisted gravidas from 1981 to 1984. The study includes 604 cases (37 or less weeks gestation) and 6,070 controls (greater than 37 weeks gestation) treated at U.S. Army medical treatment facilities worldwide. Occupational physical activity was measured using existing physical demand ratings of military occupational specialties.^ A statistically significant trend of preterm birth with increasing physical demand level was found (p = 0.0056). The relative risk point estimates for the two highest physical demand categories were statistically significant, RR's = 1.69 (p = 0.02) and 1.75 (p = 0.01), respectively. Six of eleven additional variables were also statistically significant predictors of preterm birth: age (less than 20), race (non-white), marital status (single, never married), paygrade (E1 - E3), length of military service (less than 2 years), and aptitude score (less than 100).^ Multivariate analyses using the logistic model resulted in three statistically significant risk factors for preterm birth: occupational physical demand; lower paygrade; and non-white race. Controlling for race and paygrade, the two highest physical demand categories were again statistically significant with relative risk point estimates of 1.56 and 1.70, respectively. The population attributable risk for military occupational physical demand was 26%, adjusted for paygrade and race; 17.5% of the preterm births were attributable to the two highest physical demand categories. ^

Risk and resiliency: The untold story of youth in military families

Background: Risky sexual behaviors have been shown to increase the risk of unintended pregnancy and sexually transmitted infections (STIs) among youth. Youth in military families may be especially at risk for engaging in risky sexual behaviors because they are exposed to factors that are unique to the military culture, such as multiple relocations and parental deployment. However, data on sexual behaviors among military-dependent youth are limited and few studies have examined how these factors influence the sexual behaviors among youth. Purpose: The purpose of this dissertation was to estimate the prevalence of risky sexual behaviors among military-dependent youth and to describe how military factors may influence their sexual behaviors. Methods: Youth, aged 15–19 years, who attended a military health facility in the southern United States between June 2011 and September 2011 were recruited to complete a short, paper-based survey (N= 208, males and females) and to participate in an in-depth interview (N = 25, females). For quantitative data, prevalence estimates were computed and chi-square analyses were conducted. Logistic regression analyses were also conducted, adjusting for age, gender, and parents' duty status. For qualitative data, thematic coding of transcribed interviews was performed. Common and unique themes were examined across participants' experiences. Results: Over half of the youth was sexually experienced (53.7%). Parental deployment and number of relocations were significantly associated with having had sex in the past 3 months; however no significant associations were found between these military factors and other sexual behaviors. Although some youth felt that being a military-dependent had negatively impacted their sexual decisions, most believed the military experience had little influence on their sexual decisions. Most youth in military families also perceived having higher parental expectations to avoid risky behaviors, in general, than youth in civilian families. Conclusions: The majority of military-dependent youth are sexually experienced; however, individual and parental factors may have a greater role in sexual initiation among youth than military stressors do. The findings highlight the need for implementation of evidence-based strategies to prevent teen pregnancy and STIs at military installations. Future studies with larger sample sizes are needed to further explore how youth may cope with these military factors and the impact of parental factors on the sexual behaviors of youth.^

Post-1988 civil-military relations in Myanmar

This paper explores the development of civil–military relations in Myanmar since 1988. After the Tatmadaw (Myanmar Armed Forces) took over the state by means of a coup d’état in 1988, the top generals ruled the country without recourse to significant formal political institutions such as a constitution, elections and parliament. A unique authoritarian regime, where political power was predominantly under the military’s influence, lasted for more than 20 years in the country. It seemed to many observers that the military regime was highly durable and that its dictator, General Than Shwe, had no intention of altering the highly repressive character of the political system. However, a new leader, President Thein Sein, who came to power in March 2011, has decided to implement some political and economic reforms that could undermine the Tatmadaw’s dominant role in politics and the economy. This paper examines the background to this sudden political change in Myanmar, focusing on the relationship between its dictator, the military and the state. This paper’s main argument is that Than Shwe has carefully prepared the transition of 2011 as a generational change in the Tatmadaw and in state leadership. The argument is also made that the challenges created by Thein Sein can be understood as a result of his redefinition of national security and balancing of security-centralism with state-led developmentalism.

First steps in the discovery of patterns in the academic results of telecommunication engineering students in the subjects Analysis of Circuits and Mathematics

In this paper, the results of six years of research in engineering education, in the application of the European Higher Education Area (EHEA) to improve the performance of the students in the subject Analysis of Circuits of Telecommunication Engineering, are analysed taking into consideration the fact that there would be hidden variables that both separate students into subgroups and show the connection among several basic subjects such as Analysis of Circuits (AC) and Mathematics (Math). The discovery of these variables would help us to explain the characteristics of the students through the teaching and learning methodology, and would show that there are some characteristics that instructors do not take into account but that are of paramount importance

Quantum optical signals in telecommunication networks

Introducción a una red óptica metropolitana cuántica donde señales cuánticas y convencionales son multiplexadas en longitud de onda utilizando bandas separadas del espectro óptico. El enrutado se realiza con componentes pasivos para no perturbar los qubits. Se estudian dos redes: red de acceso WDM-PON y red metropolitana completa con backbone DWDM y redes de acceso WDM-PON.

Integrating QKD in telecommunication networks.

Discusión y experimentos sobre la integración de QKD en dos tipos de red de telecomunicaciones típicas en área metropolitana: red de backbone y red de acceso GPON.

Competence assessment of final year projects for undergraduate telecommunication students

The value of project-based learning has lead to the inclusion of project development activities in engineering courses, being the Final Year Project (FYP) the most remarkable one. Several approaches have been proposed for assessing and grading FYPs but, among them, rubrics are becoming a standard for such type of assessment. However, due to the different characteristics and orientations of the projects (some are more practically oriented, some more theoretically), and the high amount of different competences to be evaluated (knowledge, working capability, communication skills, etc.), the definition of one unique rubric suitable for the evaluation of all FYPs presented in different degree programs, is a big challenge. In a former work, the educational outcomes expected from the FYP were defined and resulted in a proposal for their assessment. Afterwards, the proposal has been tested during one year within an educational innovation-project at the Universidad Politécnica de Madrid which involved the follow-up of 8 undergraduate telecommunication students elaborating their FYPs. In this publication, our experience will be described, based on the emerging work taking place through the formalisation of the process which consisted in the following steps: i) establishment of a schedule for the whole process (publication of FYPs topics, selection of applying students and their enrolment, assignation of a jury to each FYP, elaboration and follow-up of FYPs, final report submission, oral presentation, etc.); ii) design of rubrics for each of three assessment parts: working process, final report and oral presentation; and iii) follow-up and evaluation of the involved FYPs. Finally, problems that appeared during this experience (e.g. administrative aspects, criticisms and suggestions from the students, tutors and juries involved) are discussed and some modifications in the assessment system will be proposed in order to solve or minimize these problems.

Lexical phrases in telecommunication blogs: a genre analysis

The study presented in this paper aims to provide a description of telecommunication blogs as a genre. Lexical phrases are analysed in order to reach conclusions regarding the nature of the language in these texts and the extent to which the results obtained are comparable with other written or conversational discourse types. Although the departing hypothesis is that the articles in blogs are basically transactional and their main objective is to transfer information, the conclusions point to interaction as a distinctive characteristic of this type of discourse and also to a more careful organization in the comments to the blogs entries than originally expected. RESUMEN. Este trabajo presenta una descripción de los blogs de Telecomunicación como género. A través del análisis de frases léxicas se llega a conclusiones sobre algunas de las características que definen la lengua que se usa en este tipo de textos y se comparan los resultados obtenidos con otros previos sobre el discurso escrito y el conversacional. Aunque la hipótesis de partida es que los artículos de los blogs son básicamente transaccionales, donde el principal objetivo es transmitir información, los resultados llevan a conclusiones sobre la importancia de la interacción en este tipo de discurso y también apuntan a una mayor organización de la esperable en las entradas de los comentarios al artículo principal del blog.

Application of Agent Technology for Fault Diagnosis of Telecommunication Networks

La presente tesis doctoral contribuye al problema del diagnóstico autonómico de fallos en redes de telecomunicación. En las redes de telecomunicación actuales, las operadoras realizan tareas de diagnóstico de forma manual. Dichas operaciones deben ser llevadas a cabo por ingenieros altamente cualificados que cada vez tienen más dificultades a la hora de gestionar debidamente el crecimiento exponencial de la red tanto en tamaño, complejidad y heterogeneidad. Además, el advenimiento del Internet del Futuro hace que la demanda de sistemas que simplifiquen y automaticen la gestión de las redes de telecomunicación se haya incrementado en los últimos años. Para extraer el conocimiento necesario para desarrollar las soluciones propuestas y facilitar su adopción por los operadores de red, se propone una metodología de pruebas de aceptación para sistemas multi-agente enfocada en simplificar la comunicación entre los diferentes grupos de trabajo involucrados en todo proyecto de desarrollo software: clientes y desarrolladores. Para contribuir a la solución del problema del diagnóstico autonómico de fallos, se propone una arquitectura de agente capaz de diagnosticar fallos en redes de telecomunicación de manera autónoma. Dicha arquitectura extiende el modelo de agente Belief-Desire- Intention (BDI) con diferentes modelos de diagnóstico que gestionan las diferentes sub-tareas del proceso. La arquitectura propuesta combina diferentes técnicas de razonamiento para alcanzar su propósito gracias a un modelo estructural de la red, que usa razonamiento basado en ontologías, y un modelo causal de fallos, que usa razonamiento Bayesiano para gestionar debidamente la incertidumbre del proceso de diagnóstico. Para asegurar la adecuación de la arquitectura propuesta en situaciones de gran complejidad y heterogeneidad, se propone un marco de argumentación que permite diagnosticar a agentes que estén ejecutando en dominios federados. Para la aplicación de este marco en un sistema multi-agente, se propone un protocolo de coordinación en el que los agentes dialogan hasta alcanzar una conclusión para un caso de diagnóstico concreto. Como trabajos futuros, se consideran la extensión de la arquitectura para abordar otros problemas de gestión como el auto-descubrimiento o la auto-optimización, el uso de técnicas de reputación dentro del marco de argumentación para mejorar la extensibilidad del sistema de diagnóstico en entornos federados y la aplicación de las arquitecturas propuestas en las arquitecturas de red emergentes, como SDN, que ofrecen mayor capacidad de interacción con la red. ABSTRACT This PhD thesis contributes to the problem of autonomic fault diagnosis of telecommunication networks. Nowadays, in telecommunication networks, operators perform manual diagnosis tasks. Those operations must be carried out by high skilled network engineers which have increasing difficulties to properly manage the growing of those networks, both in size, complexity and heterogeneity. Moreover, the advent of the Future Internet makes the demand of solutions which simplifies and automates the telecommunication network management has been increased in recent years. To collect the domain knowledge required to developed the proposed solutions and to simplify its adoption by the operators, an agile testing methodology is defined for multiagent systems. This methodology is focused on the communication gap between the different work groups involved in any software development project, stakeholders and developers. To contribute to overcoming the problem of autonomic fault diagnosis, an agent architecture for fault diagnosis of telecommunication networks is defined. That architecture extends the Belief-Desire-Intention (BDI) agent model with different diagnostic models which handle the different subtasks of the process. The proposed architecture combines different reasoning techniques to achieve its objective using a structural model of the network, which uses ontology-based reasoning, and a causal model, which uses Bayesian reasoning to properly handle the uncertainty of the diagnosis process. To ensure the suitability of the proposed architecture in complex and heterogeneous environments, an argumentation framework is defined. This framework allows agents to perform fault diagnosis in federated domains. To apply this framework in a multi-agent system, a coordination protocol is defined. This protocol is used by agents to dialogue until a reliable conclusion for a specific diagnosis case is reached. Future work comprises the further extension of the agent architecture to approach other managements problems, such as self-discovery or self-optimisation; the application of reputation techniques in the argumentation framework to improve the extensibility of the diagnostic system in federated domains; and the application of the proposed agent architecture in emergent networking architectures, such as SDN, which offers new capabilities of control for the network.