Characterizing Groundwater Flow Across the Barrier Island-High Marsh Interface

The freshwater resources of barrier islands are influenced by a variety of hydrogeologic factors, which create unique regions of groundwater composition. Factors including evapotranspiration, geologic constraints, tidal forcing, and meteoric inputs influence subterranean flow creating a groundwater salinity gradient throughout the island-marsh setting which directly influences the spatial distribution of dominant vegetation on the island. Rising sea levels and variation in local climate may alter the hydrologic balance on barrier islands, potentially shifting salinity gradients and ecological baselines on short timescales. The intrusion of saltwater into the barrier island freshwater system could result in the shifting of ecotones and potential destabilization of barrier sediments. Over three years, multiple methods were adopted to characterize the groundwaters of Waties Island, a barrier island located in northeastern South Carolina. Three study transects located on the sound side of the island encompassed the ecological shift between maritime forest and salt marsh. Shallow groundwater monitoring wells were installed along the transects to observe mixing between fresh island-derived groundwaters and more saline groundwaters from the estuary. Water table elevation, temperature, and salinity measurements were recorded at 20-minute intervals over an 11-month period (n = 24,332). Modal analysis of the data revealed tidal and meteorological drivers of groundwater level across the transect. Twenty-nine time-series electrical resistivity (ER) surveys along the transition from forest to marsh revealed horizontal mixing of groundwater within highly permeable sediment layers. Geologic analyses of sediments along the transition elucidated a geologic framework with distinct zones of permeability bounded by impermeable muddy sediment layers. The primary movement and transport of porewaters from the island into the marsh platform was determined to be horizontal with sandy overwash and erosional fans serving as conduits. No tidal signal influence was observed within the surficial aquifer in the maritime forest, however at the forest-high marsh boundary, precipitation was the principal driver of subterranean flow with spring and storm tides periodically raising the water table and reversing flow towards the island. Within the low marsh, groundwater elevation and flow direction was directly linked to the tidal stage of Dunn Sound. The results presented here highlight the dynamic nature of shallow hydrogeologic interactions between barrier islands and back-barrier environments with implications for shifting ecological baselines, understanding the subterranean estuary of biogeochemical reactions, and determining barrier island stability in an uncertain climatic future

Influence of childhood trauma on the treatment outcomes of pharmacological and/or psychological interventions for adolescents and adults with bipolar disorder: protocol for a systematic review and meta-analysis

Despite available pharmacological and psychological treatments, remission rates for bipolar disorder remain relatively low. Current research implicates the experience of childhood trauma as a potential moderator of poor treatment outcomes among individuals with bipolar disorder. To date, the evidence reporting the influence of childhood trauma on the treatment outcomes of pharmacological and/or psychological interventions for adolescents and adults with bipolar disorder has not been systematically reviewed. MEDLINE Complete, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials will be searched to identify randomised and nonrandomised studies of pharmacological and/or psychological interventions for bipolar disorder, which also assessed childhood trauma. To be eligible for inclusion, studies must have been conducted with adolescents or adults (≥10 years). Data will be screened and extracted by two independent reviewers. The methodological quality of the included studies will be assessed with the Cochrane Collaboration’s Risk of Bias tool and the Newcastle-Ottawa Scale. If deemed viable, a meta-analysis will be conducted using a random effects model. Heterogeneity of evidence will be estimated with the I² statistics. This systematic review will use only previously published data. Therefore, ethical approval is not required. The results will be written in concordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, published in peer-reviewed journals and presented at relevant conferences. CRD42020201891

Influence of childhood trauma on the treatment outcomes of pharmacological and/or psychological interventions for adolescents and adults with bipolar disorder: protocol for a systematic review and meta-analysis

IntroductionDespite available pharmacological and psychological treatments, remission rates for bipolar disorder remain relatively low. Current research implicates the experience of childhood trauma as a potential moderator of poor treatment outcomes among individuals with bipolar disorder. To date, the evidence reporting the influence of childhood trauma on the treatment outcomes of pharmacological and/or psychological interventions for adolescents and adults with bipolar disorder has not been systematically reviewed.Method and analysisMEDLINE Complete, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials will be searched to identify randomised and nonrandomised studies of pharmacological and/or psychological interventions for bipolar disorder, which also assessed childhood trauma. To be eligible for inclusion, studies must have been conducted with adolescents or adults (≥10 years). Data will be screened and extracted by two independent reviewers. The methodological quality of the included studies will be assessed with the Cochrane Collaboration’s Risk of Bias tool and the Newcastle-Ottawa Scale. If deemed viable, a meta-analysis will be conducted using a random effects model. Heterogeneity of evidence will be estimated with the I² statistics.Ethics and disseminationThis systematic review will use only previously published data. Therefore, ethical approval is not required. The results will be written in concordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, published in peer-reviewed journals and presented at relevant conferences.PROSPERO registration numberCRD42020201891.</jats:sec

The impact of post-traumatic stress disorder in pharmacological intervention outcomes for adults with bipolar disorder: a protocol for a systematic review and meta-analysis

AbstractBackgroundRecent data indicates high prevalence of post-traumatic stress disorder (PTSD) in bipolar disorder (BD). PTSD may play a role in poor treatment outcomes and quality of life for people with BD. Despite this, few studies have examined the pharmacological treatment interventions and outcomes for this comorbidity. This systematic review will bring together currently available evidence regarding the impact of comorbid PTSD on pharmacological treatment outcomes in adults with BD.MethodsA systematic search of Embase, MEDLINE Complete, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL) will be conducted to identify randomised and non-randomised studies of pharmacological interventions for adults with diagnosed bipolar disorder and PTSD. Data will be screened and extracted by two independent reviewers. Literature will be searched from the creation of the databases until April 1 2021. Risk of bias will be assessed using the Newcastle-Ottawa Scale and the Cochrane Collaborations Risk of Bias tool. A meta-analysis will be conducted if sufficient evidence is identified in the systematic review. The meta-analysis will employ a random-effects model and be evaluated using the I2 statistic.DiscussionThis review and meta-analysis will be the first to systematically explore and integrate the available evidence on the impact of PTSD on pharmacological treatments and outcome in those with BD. The results and outcomes of this systematic review will provide directions for future research and be published in relevant scientific journals and presented at research conferences.Systematic review registrationThe protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020182540).</jats:sec

The influence of childhood trauma on the treatment outcomes of pharmacological and/or psychological interventions for adolescents and adults with bipolar disorder: A systematic review and meta-analysis

[Objective] The influence of childhood trauma on the treatment outcomes of pharmacological and/or psychological interventions for adolescents and adults with bipolar disorder was systematically reviewed.[Methods] Randomised and non-randomised studies of interventions for bipolar disorder that included an assessment of childhood trauma were eligible. MEDLINE Complete, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched. Two independent reviewers completed the screening and extraction process. Two independent reviewers assessed the risk of bias in the included studies using the Cochrane Collaboration's Risk of Bias tool and the Newcastle-Ottawa Scale. Alongside a narrative synthesis, random-effects meta-analyses were performed.[Results] Twelve studies (1175 participants) were included. The narrative review highlighted differential treatment outcomes among individuals with a history of childhood trauma. The meta-analyses suggested that childhood trauma was unrelated to treatment response (five studies, 426 participants; odds ratio 0.58, 95% CI 0.27–1.25, p = .164) but may be associated with greater improvement in global functioning (three studies, 210 participants; Hedge's g 0.65, 95% CI 0.04–1.26, p = .037).[Limitations] The impact of childhood trauma on the effectiveness of specific pharmacological/psychological interventions could not be explored due to the small body of research identified.[Conclusion] The overall quality of the extant evidence is low, which precludes definitive comment on the role of childhood trauma in the treatment of bipolar disorder. Additional research that uses large and representative samples is required to ascertain whether a history of childhood trauma affects the treatment outcomes of interventions for individuals with bipolar disorder.ALW is supported by a Deakin University Centre of Research Excellence in Psychiatric Treatment Postgraduate Research Scholarship. AJ is supported by a Deakin University Research Training Program Scholarship. SER is supported by an Australian Government Research Training Program Scholarship. WM is currently funded by an Alfred Deakin Postdoctoral Research Fellowship and a Multiple Sclerosis Research Australia early-career fellowship. OMD is supported by a NHMRC R.D. Wright Biomedical Career Development Fellowship (APP1145634). SMC is supported by a NHMRC Senior Research Fellowship (APP1136344). MB is supported by a NHMRC Senior Principal Research Fellowship (APP1156072).Peer reviewe

Mixed methods thematic analysis of a randomised controlled trial of adjunctive mitochondrial agents for bipolar depression

Objective: There is often a shortfall in recovery following treatment for an episode of bipolar disorder (BD). Exploration of participant’s experience provides vital information to enhance statistical outcomes for novel therapy trials. This study used mixed-methods to explore participants’ experience of a trial testing N-acetyl cysteine (NAC) and mitochondrially active nutraceuticals for BD depression. Methods: Case report forms from a randomised controlled trial (RCT) of BD depression (n = 148) were analysed using a pragmatic adaption of grounded theory and thematic analysis. Results: Thematic analysis of 148 study participants indicated numerous changes in participant experience over time. For example, perceived environmental stressors reported by participants decreased over the trial in both treatment groups. Quantitative analysis of the themes revealed more positive theme reports in the combination treatment arm compared to the placebo arm and there were more negative themes identified in the placebo arm, compared to the NAC arm. Conclusion: This approach revealed additional results not elucidated in the primary quantitative analysis. This emphasises the value of mixed-methods research in capturing participants’ experiences in RCTs and detecting possible latent benefits and risks. Such methods can detect latent target signals in novel therapy trials conducted in BD and generate novel hypotheses

Childhood trauma and depressive symptoms in bipolar disorder: A network analysis

BackgroundChildhood trauma is related to an increased number of depressive episodes and more severe depressive symptoms in bipolar disorder. The evaluation of the networks of depressive symptoms—or the patterns of relationships between individual symptoms—among people with bipolar disorder with and without a history of childhood trauma may assist in further clarifying this complex relationship.MethodsData from over 500 participants from the Heinz C. Prechter Longitudinal Study of Bipolar Disorder were used to construct a series of regularised Gaussian Graphical Models. The networks of individual depressive symptoms—self-reported (Patient Health Questionnaire—9; n = 543) and clinician-rated (Hamilton Depression Rating Scale—17; n = 529)—among participants with bipolar disorder with and without a history of childhood trauma (Childhood Trauma Questionnaire) were characterised and compared.ResultsAcross the sets of networks, depressed mood consistently emerged as a central symptom (as indicated by strength centrality and expected influence); regardless of participants’ history of childhood trauma. Additionally, feelings of worthlessness emerged as a key symptom in the network of self-reported depressive symptoms among participants with—but not without—a history of childhood trauma.ConclusionThe present analyses—although exploratory—provide nuanced insights into the impact of childhood trauma on the presentation of depressive symptoms in bipolar disorder, which have the potential to aid detection and inform targeted intervention development.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/175954/1/acps13528_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/175954/2/acps13528.pd

Attachment insecurity partially mediates the relationship between childhood trauma and depression severity in bipolar disorder

BackgroundChildhood trauma is associated with greater depression severity among individuals with bipolar disorder. However, the mechanisms that explain the link between childhood trauma and depression severity in bipolar disorder remain poorly understood. The mediational role of attachment insecurity in childhood and adulthood was assessed in the current study.MethodsParticipants with bipolar disorder (N = 143) completed measures of childhood trauma (Childhood Trauma Questionnaire), attachment insecurity (Experiences in Close Relationships Scale) and depression severity (Hamilton Depression Rating Scale) as part of the Prechter Longitudinal Study of Bipolar Disorder. A sequential mediation model was tested using path analysis: the direct and indirect effects of childhood trauma on depression severity with attachment insecurity (attachment anxiety and avoidance) in childhood (mother and father) and adulthood (partner) as mediators were estimated.ResultsThe final path model demonstrated an excellent fit to the data (comparative fit index = 0.996; root mean square error of approximation = 0.021 [90% confidence interval = 0.000–0.073]). Supporting the hypothesised sequential mediation model, maternal attachment anxiety in childhood and romantic attachment avoidance in adulthood partially mediated the relationship between childhood trauma and depression severity; this effect accounted for 12% of the total effect of childhood trauma on depression severity.ConclusionAttachment insecurity in childhood and adulthood form part of the complex mechanism informing why people with bipolar disorder who have a history of childhood trauma experience greater depression severity. Addressing attachment insecurity represents a valuable psychotherapeutic treatment target for bipolar disorder.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/172784/1/acps13419.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172784/2/acps13419_am.pd