Novel treatment approaches for children and adolescents with obsessive-compulsive disorder

Background: Obsessive-compulsive disorder (OCD) is a prevalent and disabling condition with typical onset during childhood. The recommended treatment is cognitive behavioral therapy (CBT), but it is seldom available to young people. Previous research has indicated that internet- delivered CBT (ICBT) is an efficacious treatment for adolescents with OCD, but little is known about its feasibility for children and if the treatment is transferrable to other contexts. Further, ICBT has been proposed as a possible first intervention in a stepped care model, but knowledge is lacking about the efficacy and cost-effectiveness of such a model. Aims: The overall aim of this thesis was to develop and evaluate novel approaches to deliver and scale up the treatment for children and adolescents with OCD. More specifically, the aims were to evaluate (1) the feasibility of ICBT for children 7-11 years with OCD, (2) if the ICBT program is transferrable to clinical units in different countries, and (3) if ICBT in a stepped care model has comparable effects as, and using less resources than, face-to-face CBT for children and adolescents with OCD. Methods: Study I was an open pilot study where 11 children and their parents received 12 weeks of therapist-guided ICBT (aim 1). In Study II, ICBT was provided to 31 families at three different clinical units located in Gothenburg, London, and Brisbane, to investigate if the treatment is transferrable to other contexts outside the clinic in Stockholm where it was originally developed (aim 2). Study III was a two-site randomized non-inferiority trial where 152 children and adolescents with OCD either received ICBT in a stepped care approach (ICBT for 16 weeks and non-responders were offered face-to-face CBT between the 3-month and 6-month follow-up), or standard face-to-face CBT (16 weeks of face-to-face CBT and non-responders were offered additional face-to-face CBT between the 3-month and 6-month follow-up). The non-inferiority was evaluated at the 6-month follow-up using the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) as the main outcome and the trial incorporated a full economic evaluation (aim 3). Results: In Study I, the treatment completion was high and both children and their parents were overall very satisfied with the treatment. The results showed a large reduction of OCD symptom severity and improvements on secondary outcomes (e.g., general functioning and family accommodation) after treatment, which were maintained during the follow-up period of three months. In Study II, the number of treatment completers and therapist time differed somewhat between the sites. Overall, results indicated large reductions of OCD symptoms, with additional improvements up to the 3-month follow-up. Further, the therapists reported both advantages and challenges with the online format. In Study III, we could demonstrate that the stepped care treatment was as efficacious as the face-to-face treatment with an estimated mean difference of 0.91 points on the CY-BOCS (95% CI, -1.46 to 3.28, p = .45; 68% responders in both groups), but to a lower cost for the health care provider (average cost saving of -$2104 [95% CI, -3006 to -1202] per participant in the stepped care treatment compared with the face-to-face treatment). Results remained largely the same also when broadening the economic evaluation to the health care organization perspective and the societal perspective. Conclusions: Therapist-guided ICBT is a feasible intervention for both children and adolescents with OCD, also when delivered in other settings and countries than the clinic in Stockholm (Sweden). ICBT can be provided as a first treatment step where patients who do not respond sufficiently subsequently receive face-to-face CBT. This stepped care approach provides equal treatment effect as standard face-to-face CBT while at the same time being cost-saving for the health care provider. Though most importantly, ICBT could greatly increase access to evidence- based treatment so more children and adolescents with OCD can get the help they need and deserve

A lower bound on CNF encodings of the at-most-one constraint

Constraint "at most one" is a basic cardinality constraint which requires that at most one of its $n$ boolean inputs is set to $1$. This constraint is widely used when translating a problem into a conjunctive normal form (CNF) and we investigate its CNF encodings suitable for this purpose. An encoding differs from a CNF representation of a function in that it can use auxiliary variables. We are especially interested in propagation complete encodings which have the property that unit propagation is strong enough to enforce consistency on input variables. We show a lower bound on the number of clauses in any propagation complete encoding of the "at most one" constraint. The lower bound almost matches the size of the best known encodings. We also study an important case of 2-CNF encodings where we show a slightly better lower bound. The lower bound holds also for a related "exactly one" constraint.Comment: 38 pages, version 3 is significantly reorganized in order to improve readabilit

On Structural Parameterizations of Hitting Set: Hitting Paths in Graphs Using 2-SAT

Hitting Set is a classic problem in combinatorial optimization. Its input consists of a set system F over a finite universe U and an integer t; the question is whether there is a set of t elements that intersects every set in F. The Hitting Set problem parameterized by the size of the solution is a well-known W[2]-complete problem in parameterized complexity theory. In this paper we investigate the complexity of Hitting Set under various structural parameterizations of the input. Our starting point is the folklore result that Hitting Set is polynomial-time solvable if there is a tree T on vertex set U such that the sets in F induce connected subtrees of T. We consider the case that there is a treelike graph with vertex set U such that the sets in F induce connected subgraphs; the parameter of the problem is a measure of how treelike the graph is. Our main positive result is an algorithm that, given a graph G with cyclomatic number k, a collection P of simple paths in G, and an integer t, determines in time 2^{5k} (|G| +|P|)^O(1) whether there is a vertex set of size t that hits all paths in P. It is based on a connection to the 2-SAT problem in multiple valued logic. For other parameterizations we derive W[1]-hardness and para-NP-completeness results.Comment: Presented at the 41st International Workshop on Graph-Theoretic Concepts in Computer Science, WG 2015. (The statement of Lemma 4 was corrected in this update.

Computing NodeTrix Representations of Clustered Graphs

NodeTrix representations are a popular way to visualize clustered graphs; they represent clusters as adjacency matrices and inter-cluster edges as curves connecting the matrix boundaries. We study the complexity of constructing NodeTrix representations focusing on planarity testing problems, and we show several NP-completeness results and some polynomial-time algorithms. Building on such algorithms we develop a JavaScript library for NodeTrix representations aimed at reducing the crossings between edges incident to the same matrix.Comment: Appears in the Proceedings of the 24th International Symposium on Graph Drawing and Network Visualization (GD 2016

Variations on Instant Insanity

In one of the first papers about the complexity of puzzles, Robertson and Munro [14] proved that a generalized form of the then-popular Instant Insanity puzzle is NP-complete. Here we study several variations of this puzzle, exploring how the complexity depends on the piece shapes and the allowable orientations of those shapes

Approximating Multilinear Monomial Coefficients and Maximum Multilinear Monomials in Multivariate Polynomials

This paper is our third step towards developing a theory of testing monomials in multivariate polynomials and concentrates on two problems: (1) How to compute the coefficients of multilinear monomials; and (2) how to find a maximum multilinear monomial when the input is a $\Pi\Sigma\Pi$ polynomial. We first prove that the first problem is \#P-hard and then devise a $O^*(3^ns(n))$ upper bound for this problem for any polynomial represented by an arithmetic circuit of size $s(n)$. Later, this upper bound is improved to $O^*(2^n)$ for $\Pi\Sigma\Pi$ polynomials. We then design fully polynomial-time randomized approximation schemes for this problem for $\Pi\Sigma$ polynomials. On the negative side, we prove that, even for $\Pi\Sigma\Pi$ polynomials with terms of degree $\le 2$, the first problem cannot be approximated at all for any approximation factor $\ge 1$, nor {\em "weakly approximated"} in a much relaxed setting, unless P=NP. For the second problem, we first give a polynomial time $\lambda$-approximation algorithm for $\Pi\Sigma\Pi$ polynomials with terms of degrees no more a constant $\lambda \ge 2$. On the inapproximability side, we give a $n^{(1-\epsilon)/2}$ lower bound, for any $\epsilon >0,$ on the approximation factor for $\Pi\Sigma\Pi$ polynomials. When terms in these polynomials are constrained to degrees $\le 2$, we prove a $1.0476$ lower bound, assuming $P\not=NP$; and a higher $1.0604$ lower bound, assuming the Unique Games Conjecture

Tree decompositions with small cost

The f-cost of a tree decomposition ({Xi | i e I}, T = (I;F)) for a function f : N -> R+ is defined as EieI f(|Xi|). This measure associates with the running time or memory use of some algorithms that use the tree decomposition. In this paper we investigate the problem to find tree decompositions of minimum f-cost. A function f : N -> R+ is fast, if for every i e N: f(i+1) => 2*f(i). We show that for fast functions f, every graph G has a tree decomposition of minimum f-cost that corresponds to a minimal triangulation of G; if f is not fast, this does not hold. We give polynomial time algorithms for the problem, assuming f is a fast function, for graphs that has a polynomial number of minimal separators, for graphs of treewidth at most two, and for cographs, and show that the problem is NP-hard for bipartite graphs and for cobipartite graphs. We also discuss results for a weighted variant of the problem derived of an application from probabilistic networks

Simplest random K-satisfiability problem

We study a simple and exactly solvable model for the generation of random satisfiability problems. These consist of $\gamma N$ random boolean constraints which are to be satisfied simultaneously by $N$ logical variables. In statistical-mechanics language, the considered model can be seen as a diluted p-spin model at zero temperature. While such problems become extraordinarily hard to solve by local search methods in a large region of the parameter space, still at least one solution may be superimposed by construction. The statistical properties of the model can be studied exactly by the replica method and each single instance can be analyzed in polynomial time by a simple global solution method. The geometrical/topological structures responsible for dynamic and static phase transitions as well as for the onset of computational complexity in local search method are thoroughly analyzed. Numerical analysis on very large samples allows for a precise characterization of the critical scaling behaviour.Comment: 14 pages, 5 figures, to appear in Phys. Rev. E (Feb 2001). v2: minor errors and references correcte

The Scaling Window of the 2-SAT Transition

We consider the random 2-satisfiability problem, in which each instance is a formula that is the conjunction of m clauses of the form (x or y), chosen uniformly at random from among all 2-clauses on n Boolean variables and their negations. As m and n tend to infinity in the ratio m/n --> alpha, the problem is known to have a phase transition at alpha_c = 1, below which the probability that the formula is satisfiable tends to one and above which it tends to zero. We determine the finite-size scaling about this transition, namely the scaling of the maximal window W(n,delta) = (alpha_-(n,delta),alpha_+(n,delta)) such that the probability of satisfiability is greater than 1-delta for alpha < alpha_- and is less than delta for alpha > alpha_+. We show that W(n,delta)=(1-Theta(n^{-1/3}),1+Theta(n^{-1/3})), where the constants implicit in Theta depend on delta. We also determine the rates at which the probability of satisfiability approaches one and zero at the boundaries of the window. Namely, for m=(1+epsilon)n, where epsilon may depend on n as long as |epsilon| is sufficiently small and |epsilon|*n^(1/3) is sufficiently large, we show that the probability of satisfiability decays like exp(-Theta(n*epsilon^3)) above the window, and goes to one like 1-Theta(1/(n*|epsilon|^3)) below the window. We prove these results by defining an order parameter for the transition and establishing its scaling behavior in n both inside and outside the window. Using this order parameter, we prove that the 2-SAT phase transition is continuous with an order parameter critical exponent of 1. We also determine the values of two other critical exponents, showing that the exponents of 2-SAT are identical to those of the random graph.Comment: 57 pages. This version updates some reference

On Embeddability of Buses in Point Sets

Set membership of points in the plane can be visualized by connecting corresponding points via graphical features, like paths, trees, polygons, ellipses. In this paper we study the \emph{bus embeddability problem} (BEP): given a set of colored points we ask whether there exists a planar realization with one horizontal straight-line segment per color, called bus, such that all points with the same color are connected with vertical line segments to their bus. We present an ILP and an FPT algorithm for the general problem. For restricted versions of this problem, such as when the relative order of buses is predefined, or when a bus must be placed above all its points, we provide efficient algorithms. We show that another restricted version of the problem can be solved using 2-stack pushall sorting. On the negative side we prove the NP-completeness of a special case of BEP.Comment: 19 pages, 9 figures, conference version at GD 201