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Objectives. The goal of this study was to investigate and identify risk factors for suicide among all active duty members of the US military during 2005 or 2007. Methods. The study used a cross-sectional design and included the entire active duty military population. Study sample sizes were 2 064 183 for 2005 and 1 981 810 for 2007. Logistic regression models were used. Results. Suicide rates for all services increased during this period. Mental health diagnoses, mental health visits, selective serotonin reuptake inhibitors (SSRIs), sleep prescriptions, reduction in rank, enlisted rank, and separation or divorce were associated with suicides. Deployments to Operation Enduring Freedom or Operation Iraqi Freedom were also associated with elevated odds ratios for all services in the 2007 population and for the Army in 2005. Conclusions. Additional research needs to address the increasing rates of suicide in active duty personnel. This should include careful evaluation of suicide prevention programs and the possible increase in risk associated with SSRIs and other mental health drugs, as well as the possible impact of shorter deployments, age, mental health diagnoses, and relationship problems.

Mechanisms of Abnormal Cardiac Repolarization During Insulin-Induced Hypoglycemia Robert T.C.E. Robinson , Nigel D. Harris , Robert H. Ireland , Stuart Lee , Christopher Newman and Simon R. Heller From the Clinical Sciences Center, University of Sheffield, Sheffield, U.K Abstract Prolonged cardiac repolarization causes fatal cardiac arrhythmias. There is evidence that these contribute to sudden death associated with nocturnal hypoglycemia in young people with diabetes. We measured cardiac repolarization (QT interval [QTc] and QT dispersion [QTd]) during experimental hypoglycemia with and without β-blockade and potassium infusion to establish possible mechanisms. Two groups of 10 nondiabetic men (study 1 and study 2) each underwent four hyperinsulinemic clamps: two euglycemic (5 mmol/l) and two hypoglycemic (5 mmol/l and 2.5 mmol/l for 60 min each). Study 1 was performed with and without potassium infusion to maintain normal concentrations and study 2 with and without β-blockade (atenolol, 100 mg/day for 7 days). QTd was unchanged during euglycemia but increased during hypoglycemia (55 ms, P < 0.0001 vs. baseline), which was prevented by potassium (6 ms, P = 0.78). QTc increased significantly during hypoglycemia alone (67 ms, P < 0.0001) and during potassium replacement (46 ms, P = 0.02). In study 2, the increase in QTd during hypoglycemia (68 ms, P < 0.0001) was prevented by β-blockade (3 ms, P = 0.88). The increase in QTc during hypoglycemia (55 ms, P < 0.0001) was prevented by β-blockade (1 ms, P = 0.98). Our data indicate that hypoglycemia causes an acquired long QT syndrome. Sympathoadrenal stimulation is the main cause, through mechanisms that involve but are not limited to catecholamine-mediated hypokalemia. These abnormalities are prevented by selective β-blockade. Footnotes Address correspondence and reprint requests to Dr. Simon Heller, University of Sheffield, Clinical Sciences Centre, Northern General Hospital, Sheffield, S57AU, U.K. E-mail: s.heller{at}sheffield.ac.uk . Received for publication 10 November 2002 and accepted in revised form 28 February 2003. BP, blood pressure; EKG, electrocardiogram; QTc, corrected QT interval; QTd, QT dispersion; VT, ventricular tachycardia. DIABETES

Introduction This study was designed to investigate the accuracy of clinical information provided by referring general dental practitioners (GDPs) following the introduction of a standardised referral form across Wales (the All Wales Universal Orthodontic Referral Form [AWUORF]) and to see whether the information given could be reliably used to screen the referrals.Aim To evaluate whether priority cases were being readily identified and whether inappropriate referrals could be minimised, thereby potentially reducing waiting lists.Method A service evaluation involving the retrospective study of 200 consecutive referrals to a specialist practice over a three-month period. A descriptive data analysis was undertaken.Results The GDPs had successfully identified the main complaint in 156 (78%) of the referrals. Of the 44 (22%) clinically inaccurate referrals, there was no impact on the patient in terms of referral pathway in 32 (16%) cases, but in the remaining 12 (6%), 5 (2.5%) cases were prioritised unnecessarily and the remaining 7 (3.5%) would have been seen more quickly had the GDP provided the relevant clinical information. The appropriateness of referral in terms of eligibility of the patient to receive NHS-funded orthodontic treatment was high with only 18 (9%) patients failing to meet the criteria.Conclusion The AWUORF successfully guides the GDP to make appropriate referrals and enables accurate triage in the majority of cases.

To examine incidence of mental health diagnoses during initial service of U.S. active duty military members and identify associations with deployment, attrition, and suicide. A retrospective cohort of 576,502 service members (SMs) newly enlisted between 2003 and 2006 was identified. Data included medical encounter, deployment and attrition, and suicide. Multivariable logistic regression models examine the association between mental health diagnoses coded within the SMs' first 6 months of eligibility for health care benefits and deployment. Multivariable Cox proportional hazards models quantify the association between mental health diagnoses and attrition and suicide. The cumulative incidence of mental health diagnoses was approximately 9% at 6 months of service. Adjustment, depressive, and anxiety disorders were most common. Those with any mental health diagnosis during initial eligibility had increased risk of early attrition and were 77% less likely to deploy. Early mental health diagnoses were not statistically significantly associated with death by suicide. Mental health diagnoses during initial eligibility are common and associated with reduced odds of deployment and increased risk of early attrition. Policies designed to either retain or discharge SMs with a mental health diagnosis identified during initial training merit close examination in light of these findings.

In the nineteenth century, Kentucky was one of the nation's leading producers of racehorses, whiskey, tobacco -- and new counties. By 1886 the three original Kentucky counties had been carved into 119 (belated 120th was to be formed in 1912). These small divisions commanded the fierce loyalty of their citizens and for most Kentuckians formed the center of political and community life. The County in Kentucky Historyshows the bitter strife of countywide feuds and the conviviality of court day, the sporadic outbreaks of ill-feeling between town and country and the high-spirited brawls that regularly accompanied elections. Robert M. Ireland traces the structural changes in county government from the days when justices of the peace made up a self-perpetuating county court to the more democratic period when the buying of votes replaced the buying of offices. The most beneficial change that could come to local government -- consolidation into fewer units -- Ireland sees as unlikely where the tradition of county loyalties and rivalries remains as strong as it does in Kentucky.

Although an important part of local government, particularly in the South, in their early years the county courts have not been thoroughly investigated. This book offers the first comprehensive examination of the county courts during the antebellum era in one southern state Kentucky, placing them in the context of its constitutional and political structure. More administrative than judicial in function, the courts were the means of providing most services of government for the people. This range of activity is fully discussed here, from road building to tax collecting to caring for the poor. Robert M. Ireland also explores the political aspects of the courts as well as their sometimes complex relationship with the state legislature and with the growing towns and cities. The courts, however, often failed in performing their duties, and the justices, being appointed, became a self-perpetuating oligarchy who seldom consulted the wishes of the people. Elected officials and the voters themselves thus grew increasingly alienated by the working of the courts. Their resentment culminated finally in a constitutional reform that in 1850 created an elective system of county government in Kentucky.

This is the final report on the moss flora of the Bío-Bío Region (Región VIII) in south-central Chile where collections were made in 2001-2003. Reported in this paper are one species new to South America, four species new to Chile and 16 species new to the Region. With these new additions the total number of taxa in the Bío-Bío Region is 343, corresponding to 331 species and 12 infraspecific taxa. A complete checklist of the mosses for all the provinces in the Region is presented.

An n‐type pyromellitic diimide polymer composite with in situ microstructure growth of the common element compound SnCl2 reaches power factor of 50–100 μW m−1 K−2, the highest purely n‐type polymer composite power factor yet reported. The composite has a gigantic Seebeck coefficient between −4000 and −5000 μV K−1, many times higher than other polymer composites.

growth of the common element compound SnCl reaches power factor of 50-100 μW m K , the highest purely n-type polymer composite power factor yet reported. The composite has a gigantic Seebeck coefficient between -4000 and -5000 μV K , many times higher than other polymer composites.