Role induction, perseverance in therapy and psychotherapy outcome

Therapists and researchers alike consider premature termination to be problematic to assessing true outcomes in psychotherapy. Some feel that it is the number one problem facing both researchers and clinicians today. The role induction (RI) procedure, or educating clients about the purpose and process of therapy, is one method that has been found to lower premature termination rates as well as increase positive outcomes in psychotherapy. The current study was designed to investigate the effects of a RI onpremature termination rates, outcome, and measures of therapeutic alliance. The mechanism of RI as a medium in which to influence clients to remain in therapy was also investigated. Sixty-eight clients and their therapists participated in the current research. Each client and the therapist completed outcome and alliance measures at specified points in the therapy. Half (n = 34) of the clients received a role induction and the other half acted as a control group. The role induction was in the form of a 13-minute videotape entitled What to Expect in Psychotherapy

Role induction, perseverance in therapy and psychotherapy outcome

Therapists and researchers alike consider premature termination to be problematic to assessing true outcomes in psychotherapy. Some feel that it is the number one problem facing both researchers and clinicians today. The role induction (RI) procedure, or educating clients about the purpose and process of therapy, is one method that has been found to lower premature termination rates as well as increase positive outcomes in psychotherapy. The current study was designed to investigate the effects of a RI onpremature termination rates, outcome, and measures of therapeutic alliance. The mechanism of RI as a medium in which to influence clients to remain in therapy was also investigated. Sixty-eight clients and their therapists participated in the current research. Each client and the therapist completed outcome and alliance measures at specified points in the therapy. Half (n = 34) of the clients received a role induction and the other half acted as a control group. The role induction was in the form of a 13-minute videotape entitled What to Expect in Psychotherapy

Workplace Wellness Programs: Empirical Doubt, Legal Ambiguity, and Conceptual Confusion

Federal laws that protect workers from insurance discrimination and infringement of health privacy include exceptions for wellness programs that are “voluntary” and “reasonably designed” to improve health. Initially, these exceptions were intended to give employers the flexibility to create innovative wellness programs that would appeal to workers, increase productivity, and protect the workforce from preventable health conditions. Yet a detailed look at the scientific literature reveals that wellness program efficacy is quite disputed, and even highly touted examples of program success have been shown to be unreliable. Meanwhile, the latest administrative regulations on wellness programs were vacated by a district court in January 2019, leaving the legal scope of wellness programs in flux. The U.S. District Court of Connecticut now has a case before it that could start a national overhaul of these programs. In this Article, we give a scientific and legal overview of wellness programs and explain why wellness programs are a source of ethical controversy. Given the unsteady evidence on wellness programs’ benefits and their real potential risks, we argue that more should be done to regulate their scope and design. A robust interpretation of the relevant statutes would help protect workers in the face of indecisive evidence. To this end, we conclude with an attempt to resolve the widespread disagreement over the terms “voluntary” and “reasonable design” with the goal of providing courts and regulators with a more workable framework to apply

Prisons and Pandemics

This Article focuses on how to balance public health, public safety, and incarcerated people’s legal rights when implementing a program for early release from confinement. Ethical, epidemiological, and legal arguments all point to a need for an immediate reduction in the incarcerated population. However, this leaves open several points of reasonable disagreement about how to manage early release. These include how to set priorities for processing and releasing individuals across the country. For example, officials could prioritize screening individuals who are housed in facilities that have been hit hard by infection; or by screening individuals who have a safe place to quarantine post-release; or individuals who are being held for violations of parole, lower level and nonviolent crimes, or prior to their trials; or individuals who are most vulnerable to coronavirus; or individuals who have already served most of their sentences; and so on. This Article discusses how to set priorities for safely and quickly returning incarcerated individuals to their communities during a life-threatening outbreak. In Part II, we establish why incarcerated people are especially vulnerable during a public health emergency. For a variety of reasons, incarcerated people are more likely than the general public to acquire and to experience negative outcomes from infectious diseases, putting their health and the health of surrounding communities at risk. In Part III, we discuss the pandemic response taken by federal and state prisons and local jails and explain why it has had little success. For the most part, releases have been slow and discretionary, meaning that whether an individual is released is “like the luck of the draw” because there are “wardens in certain prisons that will get right on it, and some that won’t release a soul.” We also outline some of the recommendations proposed by bodies like the ACLU and members of Congress. Careful consideration of these different plans for releasing incarcerated people from confinement is important in order to prepare for COVID-19 in the coming months and to look toward future pandemics. In Part IV, we summarize the moral, practical, and legal arguments for making the health of incarcerated people a priority during a pandemic. These arguments rely on the ethical principle that we are morally required to protect individuals who have been deprived of the liberty to protect themselves; empirical evidence indicating that high infection rates within correctional facilities have serious public health consequences for surrounding communities; and legal precedent that suggests that incarcerated people have a right to protection from infectious diseases. Taking these arguments together, it is reasonable to support a substantial reduction in jail and prison populations, irrespective of one’s general views about the ethics and purpose of mass incarceration. In Part V, we delve into the details of how to release incarcerated people. There have been several general recommendations outlining broad guidelines for doing so. However, the ethical priorities that underlie these different recommendations have not been made explicit and have not been considered together. In this Part, we identify the various ethical considerations relevant to early release, and we argue that five factors should be given special priority. These are (1) risk of recidivism for a violent offense, (2) presumption of innocence for the accused, (3) risk of mortality from coronavirus, (4) proportion of sentence served, and (5) responsibilities to third parties

Properly Learning Decision Trees with Queries Is NP-Hard

We prove that it is NP-hard to properly PAC learn decision trees with queries, resolving a longstanding open problem in learning theory (Bshouty 1993; Guijarro-Lavin-Raghavan 1999; Mehta-Raghavan 2002; Feldman 2016). While there has been a long line of work, dating back to (Pitt-Valiant 1988), establishing the hardness of properly learning decision trees from random examples, the more challenging setting of query learners necessitates different techniques and there were no previous lower bounds. En route to our main result, we simplify and strengthen the best known lower bounds for a different problem of Decision Tree Minimization (Zantema-Bodlaender 2000; Sieling 2003). On a technical level, we introduce the notion of hardness distillation, which we study for decision tree complexity but can be considered for any complexity measure: for a function that requires large decision trees, we give a general method for identifying a small set of inputs that is responsible for its complexity. Our technique even rules out query learners that are allowed constant error. This contrasts with existing lower bounds for the setting of random examples which only hold for inverse-polynomial error. Our result, taken together with a recent almost-polynomial time query algorithm for properly learning decision trees under the uniform distribution (Blanc-Lange-Qiao-Tan 2022), demonstrates the dramatic impact of distributional assumptions on the problem.Comment: 41 pages, 10 figures, FOCS 202

A Strong Composition Theorem for Junta Complexity and the Boosting of Property Testers

We prove a strong composition theorem for junta complexity and show how such theorems can be used to generically boost the performance of property testers. The $\varepsilon$-approximate junta complexity of a function $f$ is the smallest integer $r$ such that $f$ is $\varepsilon$-close to a function that depends only on $r$ variables. A strong composition theorem states that if $f$ has large $\varepsilon$-approximate junta complexity, then $g \circ f$ has even larger $\varepsilon'$-approximate junta complexity, even for $\varepsilon' \gg \varepsilon$. We develop a fairly complete understanding of this behavior, proving that the junta complexity of $g \circ f$ is characterized by that of $f$ along with the multivariate noise sensitivity of $g$. For the important case of symmetric functions $g$, we relate their multivariate noise sensitivity to the simpler and well-studied case of univariate noise sensitivity. We then show how strong composition theorems yield boosting algorithms for property testers: with a strong composition theorem for any class of functions, a large-distance tester for that class is immediately upgraded into one for small distances. Combining our contributions yields a booster for junta testers, and with it new implications for junta testing. This is the first boosting-type result in property testing, and we hope that the connection to composition theorems adds compelling motivation to the study of both topics.Comment: 44 pages, 1 figure, FOCS 202

INCIDENCE AND RISK FACTORS FOR NON-DEVICE ASSOCIATED HEALTHCARE ASSOCIATED INFECTIONS

Due to current targeted surveillance programs of healthcare associated infections (HAIs), there is a paucity of research on non-device associated urinary tract infections (ND-UTIs), non-device associated pneumonia (ND-pneumonia), and non-device associated bloodstream infections (ND-BSIs). However, limited data that do exist suggest that the proportion of all HAIs that were non-device associated have increased over the last decade. Thus, the purpose of this study was to update current estimates of ND-HAI rates and their frequency relative to device associated infections, assess temporal trends, and identify potential risk factors for ND-HAIs among adult patients hospitalized at the University of North Carolina (UNC) Hospitals between 2013 – 2017. Between 2013 and 2017, the rates of ND-UTIs and ND-pneumonia remained relatively stable, and the rate of ND-BSIs increased. Additionally, ND-UTIs and ND-pneumonia cases represent the majority of infections, with almost 3 in 4 UTIs and pneumonia cases being non-device associated in 2017. One in three BSIs are non-device associated at UNC Hospitals. Females, older adults, peptic ulcer disease, paralysis, immunosuppression, opioid use, TPN, and trauma patients all had a higher risk of ND-UTI. Urinary retention, suprapubic catheters and nephrostomy tubes may also increase patient risk of ND-UTI, although estimates were imprecise. Risk factors for ND-pneumonia included male sex, older age, ICU admission, and chronic bronchitis/emphysema, congestive heart failure, paralysis, and immunosuppression. Finally, risk factors for ND-BSIs included male sex, peptic ulcer disease, paralysis, general anesthesia, opioids, and peripheral venous catheters; higher Morse Fall Risk score, beta-blockers, and UTIs (device or non-device associated) also appeared to increase patient risk. These results all suggest that specific patient and clinical characteristics may increase the risk for certain ND-HAIs, and future studies should explore targeting modifiable risk factors for potential prevention strategies.Doctor of Philosoph