Pharmacological interventions for self-harm in adults

Background
Self-harm (SH; intentional self-poisoning or self-injury) is common, often repeated, and strongly associated with suicide. This is an update of a broader Cochrane review on psychosocial and pharmacological treatments for deliberate SH, first published in 1998 and previously updated in 1999. We have now divided the review in to three separate reviews. This review is focused on pharmacological interventions in adults who self harm.
Objectives
To identify all randomised controlled trials of pharmacological agents or natural products for SH in adults, and to conduct meta-analyses (where possible) to compare the effects of specific treatments with comparison types of treatment (e.g., placebo/alternative pharmacological treatment) for SH patients.
Search methods
For this update the Cochrane Depression, Anxiety and Neurosis Review Group (CCDAN) Trials Search Co-ordinator searched the CCDAN Specialised Register (September 2014). Additional searches of MEDLINE, EMBASE, PsycINFO, and CENTRAL were conducted to October 2013.
Selection criteria
We included randomised controlled trials comparing pharmacological treatments or natural products with placebo/alternative pharmacological treatment in individuals with a recent (within six months) episode of SH resulting in presentation to clinical services.
Data collection and analysis
We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratios (ORs) and their 95% confidence intervals (CIs). For continuous outcomes we calculated the mean difference (MD) and 95% CI. Meta-analysis was only possible for one intervention (i.e. newer generation antidepressants) on repetition of SH at last follow-up. For this analysis, we pooled data using a random-effects model. The overall quality of evidence for the primary outcome was appraised for each intervention using the GRADE approach.
Main results
We included seven trials with a total of 546 patients. The largest trial included 167 participants. We found no significant treatment effect on repetition of SH for newer generation antidepressants (n = 243; k = 3; OR 0.76, 95% CI 0.42 to 1.36; GRADE: low quality of evidence), low-dose fluphenazine (n = 53; k = 1; OR 1.51, 95% CI 0. 50 to 4.58; GRADE: very low quality of evidence), mood stabilisers (n = 167; k = 1; OR 0.99, 95% CI 0.33 to 2.95; GRADE: low quality of evidence), or natural products (n = 49; k = 1; OR 1.33, 95% CI 0.38 to 4.62; GRADE: low quality of evidence). A significant reduction in SH repetition was found in a single trial of the antipsychotic flupenthixol (n = 30; k = 1; OR 0.09, 95% CI 0.02 to 0.50), although the quality of evidence for this trial, according to the GRADE criteria, was very low. No data on adverse effects, other than the planned outcomes relating to suicidal behaviour, were reported.
Authors’ conclusions
Given the low or very low quality of the available evidence, and the small number of trials identified, it is not possible to make firm conclusions regarding pharmacological interventions in SH patients. More and larger trials of pharmacotherapy are required. In view of an indication of positive benefit for flupenthixol in an early small trial of low quality, these might include evaluation of newer atypical antipsychotics. Further work should include evaluation of adverse effects of pharmacological agents. Other research could include evaluation of combined pharmacotherapy and psychological treatment.

Energy minimization in multi-task software-defined sensor networks

Abstract—
After a decade of extensive research on application-specific wireless sensor networks (WSNs), the recent development of information and communication technologies makes it practical to realize the software-defined sensor networks (SDSNs), which are able to adapt to various application requirements and to fully explore the resources of WSNs. A sensor node in SDSN is able to conduct multiple tasks with different sensing targets simultaneously. A given sensing task usually involves multiple sensors to achieve a certain quality-of-sensing, e.g., coverage ratio. It is significant to design an energy-efficient sensor scheduling and management strategy with guaranteed quality-of-sensing for all tasks. To this end, three issues are investigated in this paper: 1) the subset of sensor nodes that shall be activated, i.e., sensor activation, 2) the task that each sensor node shall be assigned, i.e., task mapping, and 3) the sampling rate on a sensor for a target, i.e., sensing scheduling. They are jointly considered and formulated as a mixed-integer with quadratic constraints programming (MIQP) problem, which is then reformulated into a mixed-integer linear programming (MILP) formulation with low computation complexity via linearization. To deal with dynamic events such as sensor node participation and departure, during SDSN operations, an efficient online algorithm using local optimization is developed. Simulation results show that our proposed online algorithm approaches the globally optimized network energy efficiency with much lower rescheduling time and control overhead.

Interventions for self-harm in children and adolescents

Background : Self-harm(SH; intentional self-poisoning or self-injury) is common in children and adolescents, often repeated, and strongly associated with suicide. This is an update of a broader Cochrane review on psychosocial and pharmacological treatments for deliberate SH first published in 1998 and previously updated in 1999. We have now divided the review into three separate reviews; this review is focused on psychosocial and pharmacological interventions for SH in children and adolescents.

Objectives : To identify all randomised controlled trials of psychosocial interventions, pharmacological agents, or natural products for SHin children and adolescents, and to conduct meta-analyses (where possible) to compare the effects of specific treatments with comparison types of treatment (e.g., treatment as usual (TAU), placebo, or alternative pharmacological treatment) for children and adolescents who SH.

Search methods : For this update the Cochrane Depression, Anxiety and Neurosis Group (CCDAN) Trials Search Co-ordinator searched the CCDAN Specialised Register (30 January 2015).

Selection criteria : We included randomised controlled trials comparing psychosocial or pharmacological treatments with treatment as usual, alternative treatments, or placebo or alternative pharmacological treatment in children and adolescents (up to 18 years of age) with a recent (within six months) episode of SH resulting in presentation to clinical services.

Incidence and course of adolescent deliberate self-harm in Victoria, Australia, and Washington State

PURPOSE: There have been few longitudinal studies of deliberate self-harm (DSH) in adolescents. This cross-national longitudinal study outlines risk and protective factors for DSH incidence and persistence. METHODS: Seventh and ninth grade students (average ages 13 and 15 years) were recruited as state-representative cohorts, surveyed, and then followed up 12 months later (N = 3,876), using the same methods in Washington State and Victoria, Australia. The retention rate was 99% in both states at follow-up. A range of risk and protective factors for DSH were examined using multivariate analyses. RESULTS: The prevalence of DSH in the past year was 1.53% in Grade 7 and .91% in Grade 9 for males and 4.12% and 1.34% for Grade 7 and Grade 9 females, respectively, with similar rates across states. In multivariate analyses, incident DSH was lower in Washington State (odds ratio [OR] = .67; 95% confidence interval [CI] = .45-1.00) relative to Victoria 12 months later. Risk factors for incident DSH included being female (OR = 1.93; CI = 1.35-2.76), high depressive symptoms (OR = 3.52; CI = 2.37-5.21), antisocial behavior (OR = 2.42; CI = 1.46-4.00), and lifetime (OR = 1.85; CI = 1.11-3.08) and past month (OR = 2.70; CI = 1.57-4.64) alcohol use relative to never using alcohol. CONCLUSIONS: Much self-harm in adolescents resolves over the course of 12 months. Young people who self-harm have high rates of other health risk behaviors associated with family and peer risks that may all be targets for preventive intervention.

Letters, green cards, telephone calls and postcards: systematic and meta-analytic review of brief contact interventions for reducing self-harm, suicide attempts and suicide

BACKGROUND: There is growing interest in brief contact interventions for self-harm and suicide attempt. AIMS: To synthesise the evidence regarding the effectiveness of brief contact interventions for reducing self-harm, suicide attempt and suicide. METHOD: A systematic review and random-effects meta-analyses were conducted of randomised controlled trials using brief contact interventions (telephone contacts; emergency or crisis cards; and postcard or letter contacts). Several sensitivity analyses were conducted to examine study quality and subgroup effects. RESULTS: We found 14 eligible studies overall, of which 12 were amenable to meta-analyses. For any subsequent episode of self-harm or suicide attempt, there was a non-significant reduction in the overall pooled odds ratio (OR) of 0.87 (95% CI 0.74-1.04, P = 0119) for intervention compared with control. The number of repetitions per person was significantly reduced in intervention v. control (incidence rate ratio IRR = 066, 95% CI 0.54-0.80, P<0001). There was no significant reduction in the odds of suicide in intervention compared with control (OR = 0.58, 95% CI 0.24-1.38). CONCLUSIONS: A non-significant positive effect on repeated self-harm, suicide attempt and suicide and a significant effect on the number of episodes of repeated self-harm or suicide attempts per person (based on only three studies) means that brief contact interventions cannot yet be recommended for widespread clinical implementation. We recommend further assessment of possible benefits in well-designed trials in clinical populations.

Lingo: linearized grassmannian optimization for nuclear norm minimization

As a popular heuristic to the matrix rank minimization problem, nuclear norm minimization attracts intensive research attentions. Matrix factorization based algorithms can reduce the expensive computation cost of SVD for nuclear norm minimization. However, most matrix factorization based algorithms fail to provide the theoretical guarantee for convergence caused by their non-unique factorizations. This paper proposes an efficient and accurate Linearized Grass-mannian Optimization (Lingo) algorithm, which adopts matrix factorization and Grassmann manifold structure to alternatively minimize the subproblems. More specially, linearization strategy makes the auxiliary variables unnecessary and guarantees the close-form solution for low periteration complexity. Lingo then converts linearized objective function into a nuclear norm minimization over Grass-mannian manifold, which could remedy the non-unique of solution for the low-rank matrix factorization. Extensive comparison experiments demonstrate the accuracy and efficiency of Lingo algorithm. The global convergence of Lingo is guaranteed with theoretical proof, which also verifies the effectiveness of Lingo.

First, do no harm: managing the metabolic impacts of androgen deprivation in men with advanced prostate cancer

Androgen deprivation therapy (ADT) is a standard systemic treatment for men with prostate cancer. Men on ADT may be elderly and have comorbidities that are exacerbated by ADT, such as cardiovascular disease, diabetes, obesity, sedentary lifestyle and osteoporosis. Studies on managing the impacts of ADT have focused on men with non-metastatic disease, where ADT is given for a limited duration. However, some men with advanced or metastatic prostate cancer will achieve long-term survival with palliative ADT and therefore also risk morbidity from prolonged ADT. Furthermore, ADT is continued during the use of other survival-prolonging therapies for men with advanced disease, and there is a general trend to use ADT earlier in the disease course. As survival improves, management of the metabolic effects of ADT becomes important for maintaining both quality and quantity of life. This review will outline the current data, offer perspectives for management of ADT complications in men with advanced prostate cancer and discuss avenues for further research.

Incomplete contracts and the problem of social harm

We construct a model in which a first mover decides on its location before it knows the identity of the second mover; joint location results in a negative extemality. Contracts are inherently incomplete since the first mover's initial decision cannot be specified. We analyze several kinds of rights, including damages, injunctions, and rights to exclude (arising from covenants or land ownership). There are cases in which allocating any of these basic rights to the first mover-i.e., first-party rights-is dominated by second-party rights, and cases in which the reverse is true. A Coasian result (efficiency regardless of the rights allocation) only holds under a limited set of conditions. As corollaries of a theorem ranking the basic rights regimes, a number of results emerge contradicting conventional wisdom, including the relative inefficiency of concentrated land ownership and the relevance of the generator's identity. We conclude with a mechanism and a new rights regime that each yield the first best in all cases.

Loss minimization by the predictor-corrector modified barrier approach

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

GREEN MACHINING ORIENTED TO DIMINISH DENSITY GRADIENT FOR MINIMIZATION of DISTORTION IN ADVANCED CERAMICS

After sintering advanced ceramics, there are invariably distortions, caused in large part by the heterogeneous distribution of density gradients along the compacted piece. To correct distortions, machining is generally used to manufacture pieces within dimensional and geometric tolerances. Hence, narrow material removal limit conditions are applied, which minimize the generation of damage. Another alternative is machining the compacted piece before sintering, called the green ceramic stage, which allows machining without damage to mechanical strength. Since the greatest concentration of density gradients is located in the outer-most layers of the compacted piece, this study investigated the removal of different allowance values by means of green machining. The output variables are distortion after sintering, tool wear, cutting force, and the surface roughness of the green ceramics and the sintered ones. The following results have been noted: less distortion is verified in the sintered piece after 1mm allowance removal; and the higher the tool wear the worse the surface roughness of both green and sintered pieces.

The minimization of open stacks problem: A review of some properties and their use in pre-processing operations

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A geometric interpretation for transmission real losses minimization through the optimal power flow and its influence on voltage collapse

This work presents an approach for geometric solution of an optimal power flow (OPF) problem for a two bus system (a slack and a PV busses). Additionally, the geometric relationship between the losses minimization and the increase of the reactive margin and, therefore, the maximum loading point, is shown. The algebraic equations for the calculation of the Lagrange multipliers and for the minimum losses value are obtained. These equations are used to validate the results obtained using an OPF program. (C) 2002 Elsevier B.V. B.V. All rights reserved.

Primal-dual logarithmic barrier and augmented Lagrangian function to the loss minimization in power systems

This article presents a new approach to minimize the losses in electrical power systems. This approach considers the application of the primal-dual logarithmic barrier method to voltage magnitude and tap-changing transformer variables, and the other inequality constraints are treated by augmented Lagrangian method. The Lagrangian function aggregates all the constraints. The first-order necessary conditions are reached by Newton's method, and by updating the dual variables and penalty factors. Test results are presented to show the good performance of this approach.