Assessment of Rates of Suicide Risk Screening and Prevalence of Positive Screening Results Among US Veterans After Implementation of the Veterans Affairs Suicide Risk Identification Strategy.

Importance: In 2018, the Veterans Health Administration (VHA) implemented the Veterans Affairs (VA) Suicide Risk Identification Strategy to improve the identification and management of suicide risk among veterans receiving VHA care. Objectives: To examine the prevalence of positive suicide screening results among veterans in ambulatory care and emergency departments (EDs) or urgent care clinics (UCCs) and to compare acuity of suicide risk among patients screened in these settings. Design, Setting, and Participants: This cross-sectional study used data from the VA's Corporate Data Warehouse (CDW) to assess veterans with at least 1 ambulatory care visit (n = 4 101 685) or ED or UCC visit (n = 1 044 056) at 140 VHA medical centers from October 1, 2018, through September 30, 2019. Exposures: Standardized suicide risk screening and evaluation tools. Main Outcomes and Measures: One-year rate of suicide risk screening and evaluation, prevalence of positive primary and secondary suicide risk screening results, and levels of acute and chronic risk based on the VHA's Comprehensive Suicide Risk Evaluation. Results: A total of 4 101 685 veterans in ambulatory care settings (mean [SD] age, 62.3 [16.4] years; 3 771 379 [91.9%] male; 2 996 974 [73.1%] White) and 1 044 056 veterans in ED or UCC settings (mean [SD] age, 59.2 [16.2] years; 932 319 [89.3%] male; 688 559 [66.0%] White) received the primary suicide screening. The prevalence of positive suicide screening results was 3.5% for primary screening and 0.4% for secondary screening in ambulatory care and 3.6% for primary screening and 2.1% in secondary screening for ED and UCC settings. Compared with veterans screened in ambulatory care, those screened in the ED or UCC were more likely to endorse suicidal ideation with intent (odds ratio [OR], 4.55; 95% CI, 4.37-4.74; P < .001), specific plan (OR, 3.16; 95% CI, 3.04-3.29; P < .001), and recent suicidal behavior (OR, 1.95; 95% CI, 1.87-2.03; P < .001) during secondary screening. Among the patients who received a Comprehensive Suicide Risk Evaluation, those in ED or UCC settings were more likely than those in ambulatory care settings to be at high acute risk (34.1% vs 8.5%; P < .001). Conclusions and Relevance: In this cross-sectional study, population-based suicide risk screening and evaluation in VHA ambulatory care and ED or UCC settings may help identify risk among patients who may not be receiving mental health treatment. Higher acuity of risk among veterans in ED or UCC settings compared with those in ambulatory care settings highlights the importance of scaling up implementation of brief evidence-based interventions in the ED or UCC to reduce suicidal behavior.

Clinical inquiry. Chronic urticaria: what diagnostic evaluation is best?

Chronic urticaria affects 1% of the general population and is usually defined as the presence of hives (with or without angioedema) for at least 6 weeks.¹

The keys to a successful security project.

Poor planning of a security project can result in cost overruns and, sometimes, an unsuccessful project, the authors report. Based on their experience in dealing with vendors, contractors, and management, they present in this article the planning steps that should be taken to insure successful completion of the project from its beginning to its integration.

Redox speciation of copper in rainwater: temporal variability and atmospheric deposition.

Copper speciation was determined in 68 rainwater samples collected in Wilmington, NC, from August 25, 2000, to September 24, 2002. Volume-weighted average concentrations of Cu(total), dissolved Cu(II), and dissolved Cu(I) were 5.3, 3.2, and 1.4 nM, respectively, with a significantly higher ratio of Cu(II)/Cu(I) in summer relative to winter events. The concentrations of all Cu species were higher in storms of continental origin relative to marine-dominated events, suggesting anthropogenic and/or terrestrial sources are important contributors of Cu in precipitation. Concentrations of strong Cu-complexing ligands were consistently lower than dissolved Cu concentrations, indicating a significant portion, but not all, of the dissolved Cu in rainwater is strongly complexed. A portion of these ligands, in addition to the sulfite and chloride in precipitation, may be Cu(I)-complexing ligands, which may explain the resistance of Cu(I) against oxidation in rainwater. Using our rainwater concentration data along with other published rainwater Cu concentrations and an estimate for total global annual rain, the total global flux of Cu removed from the atmosphere via wet deposition is 150 x 106 kg yr(-1). This represents complete removal of the estimated Cu input into the troposphere and indicates essentially all Cu released into the global atmosphere is removed by rain.