Isometric Hamming embeddings of weighted graphs.

A mapping α:V(G)→V(H) from the vertex set of one graph G to another graph H is an isometric embedding if the shortest path distance between any two vertices in G equals the distance between their images in H. Here, we consider isometric embeddings of a weighted graph G into unweighted Hamming graphs, called Hamming embeddings, when G satisfies the property that every edge is a shortest path between its endpoints. Using a Cartesian product decomposition of G called its canonical isometric representation, we show that every Hamming embedding of G may be partitioned into a canonical partition, whose parts provide Hamming embeddings for each factor of the canonical isometric representation of G. This implies that G permits a Hamming embedding if and only if each factor of its canonical isometric representation is Hamming embeddable. This result extends prior work on unweighted graphs that showed that an unweighted graph permits a Hamming embedding if and only if each factor is a complete graph. When a graph G has nontrivial isometric representation, determining whether G has a Hamming embedding can be simplified to checking embeddability of two or more smaller graphs.

Factorization and pseudofactorization of weighted graphs.

For unweighted graphs, finding isometric embeddings of a graph G is closely related to decompositions of G into Cartesian products of smaller graphs. When G is isomorphic to a Cartesian graph product, we call the factors of this product a factorization of G. When G is isomorphic to an isometric subgraph of a Cartesian graph product, we call those factors a pseudofactorization of G. Prior work has shown that an unweighted graph's pseudofactorization can be used to generate a canonical isometric embedding into a product of the smallest possible pseudofactors. However, for arbitrary weighted graphs, which represent a richer variety of metric spaces, methods for finding isometric embeddings or determining their existence remain elusive, and indeed pseudofactorization and factorization have not previously been extended to this context. In this work, we address the problem of finding the factorization and pseudofactorization of a weighted graph G, where G satisfies the property that every edge constitutes a shortest path between its endpoints. We term such graphs minimal graphs, noting that every graph can be made minimal by removing edges not affecting its path metric. We generalize pseudofactorization and factorization to minimal graphs and develop new proof techniques that extend the previously proposed algorithms due to Graham and Winkler [Graham and Winkler, '85] and Feder [Feder, '92] for pseudofactorization and factorization of unweighted graphs. We show that any n-vertex, m-edge graph with positive integer edge weights can be factored in O(m2) time, plus the time to find all pairs shortest paths (APSP) distances in a weighted graph, resulting in an overall running time of O(m2+n2 log log n) time. We also show that a pseudofactorization for such a graph can be computed in O(mn) time, plus the time to solve APSP, resulting in an O(mn+n2 log log n) running time.

Barriers, facilitators and interventions to support help-seeking amongst young people living in families impacted by parental mental illness: A systematized review.

AIM: Children living in families impacted by parental mental illness are at increased risk of adverse mental and physical health outcomes compared with children living in families unaffected by mental illness. Considered to be a hard-to reach group, it is likely that there are unique barriers for these young people in seeking help for their difficulties. This systematized review synthesizes what is currently known about help-seeking barriers, facilitators and interventions for young people affected by parental mental illness. METHODS: Three databases were searched, yielding 2556 results and three studies were identified through other sources. Studies were screened on title and abstract review and were excluded if they were published before 2005 or if they did not include the perspectives of young people. At a second stage, full-text articles were screened based on the inclusion criteria. Eleven studies were included for data extraction and quality appraisal. RESULTS: Qualitative and quantitative data synthesis revealed three significant barriers (i) stigma, (ii) family communication and (iii) lack of belonging and shared experience, three key facilitators (i) individual characteristics, (ii) group identification and (iii) anonymity and three primary components of therapeutic interventions (i) psychoeducation, (ii) connection with peers and (iii) accessibility. CONCLUSIONS: It was found that stigma towards mental illness is highly salient amongst young people impacted by parental mental illness and has unique effects on their patterns of help-seeking. Help-seeking research amongst this group is still emerging, with a need for greater clarity in operationalisation of help-seeking constructs and more robust methodological designs.

Aiding diagnosis of childhood attention-deficit/hyperactivity disorder of the inattentive presentation: Discriminant function analysis of multi-domain measures including EEG.

INTRODUCTION: We developed a neurocognitive assessment tool (NCAT) in consultation with mental health professionals working with children with AD/HD as a diagnostic aid and screening tool. This study examines the predictive utility of NCAT in the classification of children with AD/HD Inattentive presentation. METHOD: Fifty three children with AD/HD Inattentive presentation and 161 typically-developing children completed an NCAT assessment. Discriminant function analyses examined group membership prediction for separate components of NCAT and for the components combined. RESULTS: The combined model correctly classified 93.4 % of participants, with 91.4 % sensitivity and 93.9 % specificity. Contributions to classification were from SNAP-IV, psychological needs satisfaction, self-regulation, executive function performance, and EEG. The combined model resulted in a 9.3 % increase in specificity and 5.9 % increase in sensitivity compared to SNAP-IV alone. CONCLUSIONS: NCAT provides good discrimination between children with and without AD/HD of the Inattentive presentation, and further investigation including other subtypes and comorbidities is warranted.

Stress management in the workplace for employees with hypertension: a randomized controlled trial.

While behavioral interventions can improve blood pressure (BP) in individuals with hypertension, getting such services to people who could benefit remains difficult. Workplace programs have potential as dissemination vehicles. The objective is to evaluate the effectiveness of a standardized stress management program delivered in groups at the workplace for reducing BP compared with enhanced usual care. This randomized controlled trial studied 92 urban medical center employees with hypertension randomized into two groups. The intervention was a 10-week group workshop on cognitive-behavioral coping skills. Enhanced usual care included self-help materials for BP reduction and physician referral. Intervention group participants' systolic BP (SBP) decreased 7.5 mm Hg over controls between baseline and follow-up, from 149.1 (95% CI: 146.0-152.1) to 140.0 (95% CI: 134.7-145.2), p < .001. The differential change between intervention and enhanced usual care groups (Group × Time interaction) was 7.5 mm Hg (t = -2.05; p = .04). Diastolic BP reductions were not significantly different. Scores on measures of emotional exhaustion and depressive rumination showed significant improvements and correlated with reductions in SBP. There was no significant change in the usual care group. A standardized worksite group intervention produced clinically meaningful reductions in SBP in participants with hypertension.

A 2-Year Holistic Health and Stress Intervention: Results of an RCT in Clergy.

INTRODUCTION: This study sought to determine the effect of a 2-year, multicomponent health intervention (Spirited Life) targeting metabolic syndrome and stress simultaneously. DESIGN: An RCT using a three-cohort multiple baseline design was conducted in 2010-2014. SETTING/PARTICIPANTS: Participants were United Methodist clergy in North Carolina, U.S., in 2010, invited based on occupational status. Of invited 1,745 clergy, 1,114 consented, provided baseline data, and were randomly assigned to immediate intervention (n=395), 1-year waitlist (n=283), or 2-year waitlist (n=436) cohorts for a 48-month trial duration. INTERVENTION: The 2-year intervention consisted of personal goal setting and encouragement to engage in monthly health coaching, an online weight loss intervention, a small grant, and three workshops delivering stress management and theological content supporting healthy behaviors. Participants were not blinded to intervention. MAIN OUTCOME MEASURES: Trial outcomes were metabolic syndrome (primary) and self-reported stress and depressive symptoms (secondary). Intervention effects were estimated in 2016 in an intention-to-treat framework using generalized estimating equations with adjustment for baseline level of the outcome and follow-up time points. Log-link Poisson generalized estimating equations with robust SEs was used to estimate prevalence ratios (PRs) for binary outcomes; mean differences were used for continuous/score outcomes. RESULTS: Baseline prevalence of metabolic syndrome was 50.9% and depression was 11.4%. The 12-month intervention effect showed a benefit for metabolic syndrome (PR=0.86, 95% CI=0.79, 0.94, p<0.001). This benefit was sustained at 24 months of intervention (PR=0.88; 95% CI=0.78, 1.00, p=0.04). There was no significant effect on depression or stress scores. CONCLUSIONS: The Spirited Life intervention improved metabolic syndrome prevalence in a population of U.S. Christian clergy and sustained improvements during 24 months of intervention. These findings offer support for long-duration behavior change interventions and population-level interventions that allow participants to set their own health goals. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01564719.

A cluster-randomised controlled trial of values-based training to promote autonomously held recovery values in mental health workers.

BACKGROUND: The implementation and use of evidence-based practices is a key priority for recovery-oriented mental health service provision. Training and development programmes for employees continue to be a key method of knowledge and skill development, despite acknowledged difficulties with uptake and maintenance of behaviour change. Self-determination theory suggests that autonomy, or a sense that behaviour is self-generated, is a key motivator to sustained behaviour change, in this case practices in mental health services. This study examined the utility of values-focused staff intervention as a specific, reproducible method of autonomy support. METHODS: Mental health workers (n = 146) were assigned via cluster randomisation to either a values clarification condition or an active problem-solving control condition. RESULTS: Results demonstrated that a structured values clarification exercise was useful in promoting integrated motivation for the changed practice and resulted in increased implementation planning. CONCLUSIONS: Structured values clarification intervention demonstrates utility as a reproducible means of autonomy support within the workplace. We discuss future directions for the study of autonomous motivation in the field of implementation science. TRIAL REGISTRATION: ACTRN12613000353796.

Value motivations predict burnout and intentions to leave among mental health professionals.

BACKGROUND: Values guide and potentially motivate people in their lives. Aligning personal values with organisational values has the potential to improve job satisfaction, reduce burnout and lower Intentions To Leave (ITL). AIMS: To determine whether changes in Value Motivation (VM) predict burnout and ITL following training. METHOD: Participants were staff from a Mental Health (MH) organisation in Australia. They participated in the Collaborative Recovery Training Programme (CRTP) and completed pre- and post-measures of values, general health, burnout and ITL. RESULTS: Increasingly holding work values due to guilt and shame predicted higher burnout after training. Increases in intrinsically held values predicted less ITL after training. CONCLUSIONS: Attending to and clarifying VM's has the potential to decrease burnout and ITL. Training programmes should focus on understanding the importance of values in reducing burnout and turnover rates among MH professionals.

A comparison of two coaching approaches to enhance implementation of a recovery-oriented service model.

Moving to recovery-oriented service provision in mental health may entail retraining existing staff, as well as training new staff. This represents a substantial burden on organisations, particularly since transfer of training into practice is often poor. Follow-up supervision and/or coaching have been found to improve the implementation and sustainment of new approaches. We compared the effect of two coaching conditions, skills-based and transformational coaching, on the implementation of a recovery-oriented model following training. Training followed by coaching led to significant sustained improvements in the quality of care planning in accordance with the new model over the 12-month study period. No interaction effect was observed between the two conditions. However, post hoc analyses suggest that transformational coaching warrants further exploration. The results support the provision of supervision in the form of coaching in the implementation of a recovery-oriented service model, and suggest the need to better elucidate the mechanisms within different coaching approaches that might contribute to improved care.

Updating medical school psychiatry curricula to meet projected mental health needs.

OBJECTIVE: In view of the growing disease burden of mental disorders, we consider the pressing need to update medical school psychiatry education to better equip doctors to recognise and treat these conditions. Key challenges to the delivery of medical school mental health curricula, and possible directions for reform, are reviewed with the aims of stimulating collaboration and enhancing the efficiency across schools. CONCLUSIONS: In Australia, medical school expansion provides opportunities to prepare many training doctors to meet growing mental health care needs. Despite this, published reviews of practice and curriculum models are notably lacking. Australia, unlike other countries, has yet to agree on a core curriculum in medical school psychiatry, with practices varying widely between schools. Curricula should equip doctors to better recognise and treat common mental disorders during early stages, as well as preparing some for specialist psychiatry training. High-quality, multidisciplinary teaching in varied clinical settings may boost teaching resources. Additionally, medical education provides opportunities to better equip doctors to take care of their own mental health. Key challenges are to achieve a consensus on core curricula across Australian medical schools, and an appropriate proportion of medical school curriculum time for mental disorders, relative to their complexity and large disease burden.

Improving implementation of evidence-based practice in mental health service delivery: protocol for a cluster randomised quasi-experimental investigation of staff-focused values interventions.

BACKGROUND: There is growing acceptance that optimal service provision for individuals with severe and recurrent mental illness requires a complementary focus on medical recovery (i.e., symptom management and general functioning) and personal recovery (i.e., having a 'life worth living'). Despite significant research attention and policy-level support, the translation of this vision of healthcare into changed workplace practice continues to elude. Over the past decade, evidence-based training interventions that seek to enhance the knowledge, attitudes, and skills of staff working in the mental health field have been implemented as a primary redress strategy. However, a large body of multi-disciplinary research indicates disappointing rates of training transfer. There is an absence of empirical research that investigates the importance of worker-motivation in the uptake of desired workplace change initiatives. 'Autonomy' is acknowledged as important to human effectiveness and as a correlate of workplace variables like productivity, and wellbeing. To our knowledge, there have been no studies that investigate purposeful and structured use of values-based interventions to facilitate increased autonomy as a means of promoting enhanced implementation of workplace change. METHODS: This study involves 200 mental health workers across 22 worksites within five community-managed organisations in three Australian states. It involves cluster-randomisation of participants within organisation, by work site, to the experimental (values) condition, or the control (implementation). Both conditions receive two days of training focusing on an evidence-based framework of mental health service delivery. The experimental group receives a third day of values-focused intervention and 12 months of values-focused coaching. Well-validated self-report measures are used to explore variables related to values concordance, autonomy, and self-reported implementation success. Audits of work files and staff work samples are reviewed for each condition to determine the impact of implementation. Self-determination theory and theories of organisational change are used to interpret the data. DISCUSSION: The research adds to the current knowledge base related to worker motivation and uptake of workplace practice. It describes a structured protocol that aims to enhance worker autonomy for imposed workplace practices. The research will inform how best to measure and conceptualise transfer. These findings will apply particularly to contexts where individuals are not 'volunteers' in requisite change processes. TRIAL REGISTRATION ACTRN: ACTRN12613000353796.

Use of a randomized multiple baseline design: rationale and design of the spirited life holistic health intervention study.

Clergy suffer from high rates of obesity, chronic disease, and depression, and simultaneously underestimate the toll these take on their daily functioning. Health interventions are needed for clergy and may be tailored to their occupational context and theological beliefs. Few studies have sought to improve clergy health. No prior studies have utilized a randomized design. Spirited Life is a randomized, multiple baseline study that offered enrollment to nearly all United Methodist Church clergy in North Carolina in fall 2010. A total of 1114 clergy (response rate = 64%) enrolled. Using a multiple baseline design, we randomized participants to three cohorts. Each cohort began the health intervention in one of three consecutive years. The third cohort served as a randomized waitlist control cohort, allowing comparisons between the first and third cohorts. The two-year Spirited Life intervention consists of: 1) a theological underpinning for health stewardship based on incarnation, grace, and response and delivered during workshops; 2) the stress management program Williams LifeSkills; 3) Naturally Slim, an online weight loss program; 4) phone contact with a Wellness Advocate; and 5) $500 small grants for health goals. Metabolic syndrome is the primary endpoint. Stress and depressive severity are secondary endpoints. We measured each construct before, twice during, and at the end of the two-year intervention. Study outcomes, to be published after follow-up data are gathered, will provide evidence of the effectiveness of the combined intervention components of Spirited Life. If successful, the intervention may be considered for use with other clergy and faith populations.

IMPACT OF WILLIAMS LIFESKILLS® TRAINING ON ANGER, ANXIETY AND AMBULATORY BLOOD PRESSURE IN ADOLESCENTS.

BACKGROUND: The Williams LifeSkills® (WLS) anger and stress management workshop provides training in strategies to cope with stressful situations and build supportive relationships. PURPOSE: The purpose of this study was to determine the impact of school-based Williams LifeSkills training on anger, anxiety and blood pressure in adolescents. METHODS: 159 adolescents (mean age±SD=15.7±1.4 years) were randomized to WLS (n=86) or control (CTL, n=73) groups. The WLS group engaged in twelve 50-min WLS training sessions conducted by teachers at school. RESULTS: Anger-in and anxiety scores decreased and anger control scores increased in the WLS group across the six-month follow-up period compared to the CTL group (group x visit, ps<0.05). Daytime diastolic BP was lower across the follow-up in the WLS group (p=0.08). DBP was significantly lower across the follow-up period in the WLS group among those with higher SBP at baseline (p=0.04). CONCLUSION: These findings demonstrate beneficial impact of WLS upon self-reported anger-in, anger-control, anxiety levels and ambulatory DBP in the natural environment in healthy normotensive youth.

Expression and characterization of Cryptococcus neoformans recombinant App1.

We characterized Cryptococcus neoformans recombinant antiphagocytic protein 1 (rApp1) by SDS-PAGE, gel filtration chromatography, circular dichroism, and fluorescence spectroscopy. rApp1 produced by C. neoformans var. grubii contains an odd number of cysteines; therefore, it has the ability to form intermolecular disulfide bridges which can lead to the formation of amyloid fibrils in the absence of ß-mercaptoethanol or DTT in vitro. Alternate approaches to over-expression of rApp1 in the Lepidopteran High Five(™) Insect cell line using pIZ/V5-His and in lentivirus were explored and are described. Finally, localization of App1 in vivo was examined in the presence and absence of the capsule.

SEER coding standards result in underestimation of positive surgical margin incidence at radical prostatectomy: results of a systematic audit.

PURPOSE: SEER (Surveillance, Epidemiology and End Results) is the leading source of population level data on prostate cancer, including the positive surgical margin incidence at radical prostatectomy. Recently studies showed wide ranges in positive surgical margin rates among individual registries, which we hypothesized was the result of coding inaccuracies. Thus, we systematically audited SEER prostate cancer data. MATERIALS AND METHODS: The New Mexico Tumor Registry, a SEER core registry, was queried for incident prostate cancer cases in 2007 that met certain criteria, including 1) adenocarcinoma histology, 2) malignant behavior and 3) radical prostatectomy as the first course of therapy. Pathological stage codes were audited by examining original radical prostatectomy pathology reports in accordance with SEER coding guidelines. The incidence and sites of positive surgical margins were critically analyzed. RESULTS: Of the 305 cases that met all study inclusion criteria with complete source documents available 92 (30%) were coded incorrectly. The most common error was failure to properly account for surgical margin status (46 of 92 cases or 50%). The incidence of positive surgical margins in organ confined disease cases was 13% by SEER coding rules but 28% by a more clinical definition of positive surgical margins (p<0.001). In organ confined cases positive surgical margins occurred principally at the apex but in nonorgan confined cases most were multifocal. CONCLUSIONS: In this SEER registry 30% of radical prostatectomy cases in 2007 were coded inaccurately. SEER coding guidelines result in underestimating the positive surgical margin incidence. Clinicians and investigators should recognize the limitations of tumor registry data on positive surgical margins.

Role of glucose in the expression of Cryptococcus neoformans antiphagocytic protein 1, App1.

The cryptococcus-specific protein antiphagocytic protein 1 (App1) regulates Cryptococcus neoformans virulence by controlling macrophage-driven fungal phagocytosis. This is accomplished through complement receptors (CR), specifically CR3. When inhaled, C. neoformans can cause a life-threatening meningoencephalitis in immunocompromised patients. Because glucose starvation can significantly change the gene expression and virulence of C. neoformans and because App1 is critical for phagocytosis in the lung-a low-glucose environment-we investigated the role of glucose in App1 expression. We found that App1 was upregulated dramatically under low-glucose conditions, and it was upregulated when C. neoformans cells were incubated in bronchoalveolar lavage (BAL) fluid, serum, and cerebrospinal fluid, which are low-glucose environments. Characterization of App1's regulation based on mammalian lung physiology revealed that App1 is upregulated via both increases in transcription and increases in mRNA stability. Our data provide new insights regarding C. neoformans adaptations to low-glucose environments.

Adaptation and implementation of an evidence-based behavioral medicine program in diverse global settings: The Williams LifeSkills experience.

Epidemiological research has documented the health-damaging effects of psychosocial factors like hostility, depression, anxiety, job stress, social isolation and low socioeconomic status. Several studies suggest that behavioral interventions can reduce levels of these psychosocial factors. Herein we describe the translational process whereby the Williams LifeSkills® (WLS(®)) program and products for reducing psychosocial risk factors have been developed and tested in clinical trials in the U.S. and Canada and then adapted for other cultures and tested in clinical trials in other countries around the world. Evidence from published controlled and observational trials of WLS(®) products in the U.S. and elsewhere shows that persons receiving coping skills training using WLS(®) products have consistently reported reduced levels of psychosocial risk factors. In two controlled trials, one for caregivers of a relative with Alzheimer's Disease in the U.S. and one for coronary bypass surgery patients in Singapore, WLS(®) training also produced clinically significant blood pressure reductions. In conclusion, WLS(®) products have been shown in controlled and observational trials to produce reduced levels of both psychosocial and cardiovascular stress indices. Ongoing research has the potential to show that WLS(®) products can be an effective vehicle for the delivery of stress reduction and mental health services in developing countries.

Evaluation of a pharmacist-managed lipid clinic that uses point-of-care lipid testing.

BACKGROUND: Hyperlipidemia is a significant, modifiable risk factor for developing coronary heart disease. Low-density lipoprotein cholesterol (LDL-C) goal achievement has improved overall, but many high-risk patients remain above the desired LDL-C goals. Published data have demonstrated the ability of pharmacist-managed lipid clinics to improve lipid management in a variety of clinical settings. OBJECTIVE: This observational analysis aimed to report the impact of a newly developed hospital-based, outpatient lipid clinic by the use of point-of-care testing on LDL-C goal attainment. METHODS: A retrospective, observational analysis was conducted from February 2007 to December 2008. The primary outcome measure was the change in the proportion of patients who achieved their LDL-C goal at the end of the observation period compared with baseline. RESULTS: A total of 81 patients met study inclusion criteria. Mean duration of follow-up was 9.0 ± 4.9 (SD) months. At the end of the observation period, 82.9% of patients achieved their LDL-C goal compared with 55.3% at baseline (P < .0001). The mean LDL-C decreased from 103 ± 45 mg/dL at baseline to 82 ± 28 mg/dL at the end of the observation period (P < .0001). CONCLUSION: An outpatient hospital-based, pharmacist-managed lipid clinic improved LDL-C goal attainment. Our results are unique in that pharmacists used point-of-care testing to obtain lipid results for making therapy adjustments during the face-to-face visit.

Video-based coping skills to reduce health risk and improve psychological and physical well-being in Alzheimer's disease family caregivers.

OBJECTIVE: To determine whether video-based coping skills (VCS) training with telephone coaching reduces psychosocial and biological markers of distress in primary caregivers of a relative with Alzheimer's disease or related dementia (ADRD). METHODS: A controlled clinical trial was conducted with 116 ADRD caregivers who were assigned, alternately as they qualified for the study, to a Wait List control condition or the VCS training arm in which they viewed two modules/week of a version of the Williams LifeSkills Video adapted for ADRD family care contexts, did the exercises and homework for each module presented in an accompanying Workbook, and received one telephone coaching call per week for 5 weeks on each week's two modules. Questionnaire-assessed depressive symptoms, state and trait anger and anxiety, perceived stress, hostility, caregiver self-efficacy, salivary cortisol across the day and before and after a stress protocol, and blood pressure and heart rate during a stress protocol were assessed before VCS training, 7 weeks after training was completed, and at 3 months' and 6 months' follow-up. RESULTS: Compared with controls, participants who received VCS training plus telephone coaching showed significantly greater improvements in depressive symptoms, trait anxiety, perceived stress, and average systolic and diastolic blood pressures that were maintained over the 6-month follow-up period. CONCLUSIONS: VCS training augmented by telephone coaching reduced psychosocial and biological indicators of distress in ADRD caregivers. Future studies should determine the long-term benefits to mental and physical health from this intervention. TRIAL REGISTRATION: http://www.clinicaltrials.gov; #NCT00396825.