Cognitive behavioral therapy for depressive disorders: Outcomes from a multi-state, multi-site primary care practice.

BACKGROUND: Individuals with depressive disorders often present to and seek treatment in primary care. Integrated behavioral health services within this setting can improve access to evidence-based cognitive behavioral therapy (CBT). However, limited information exists on the effectiveness of CBT for depression in primary care. METHODS: Of the 1,302 participants with a primary depressive disorder referred by their primary care provider, 435 endorsed moderate to severe depression at baseline and engaged in at least one CBT session. A psychotherapy tracking database was used to collect relevant data, which included demographics, clinical characteristics, treatment outcomes, and CBT intervention use. RESULTS: Participants with moderate to severe depression who participated in CBT reported a significant decrease in depression and anxiety symptoms at the end of treatment (p ≤ .001, d = 0.52-0.78). Rates of reliable change, response, and remission and types of CBT interventions used differed between major and persistent depressive disorders. LIMITATIONS: Multiple limitations must be noted, which are related to the naturalistic study design, inclusion and exclusion criteria, sample operationalization, symptomatic measurement, time-limited and focused assessment, data collection strategies, and psychological services. Together, these temper the conclusions that can be drawn. CONCLUSION: Significant reductions in depression and anxiety symptoms were reported by participants with depressive disorders who engaged in short-term CBT within primary care. This study indicates that CBT can be implemented within primary care and suggests that primary care patients with depression can benefit from integrated psychological services, supporting population-based models of care.

Cognitive Behavioral Therapy for Anxiety Disorders: Outcomes From a Multi-State, Multi-Site Primary Care Practice.

BACKGROUND: Anxiety disorders are among the most common mental health conditions. Individuals with anxiety typically seek services in primary, rather than specialty, care. While there is significant evidence supporting the efficacy and effectiveness of cognitive behavioral therapy (CBT) for anxiety disorders, there have been no naturalistic studies reporting anxiety-specific treatment outcomes in primary care. METHODS: Participants (N = 1,589) were recruited from a multi-state, multi-site primary care practice, with 491 participants endorsing moderate to severe anxiety at baseline and engaging in at least one CBT session. Data was drawn from a psychotherapy tracking database. RESULTS: Among participants with moderate to severe anxiety who engaged in CBT, a significant decrease in anxiety and depression symptoms was observed over the course of psychotherapy (p< .001, d = 0.57-0.95). Rates of reliable change, response, and remission varied across diagnostic categories. The use of CBT interventions also varied across diagnoses in line with evidence-based treatment recommendations. DISCUSSION: Short-term CBT delivered in primary care is associated with significant improvements in anxiety and depression symptoms among participants with anxiety disorders. These findings support the use of a population-based approach to anxiety disorders treatment and suggest that evidence-based CBT can be implemented in the real-world setting.

Evidence for non-steady-state carbon emissions from snow-scoured alpine tundra.

High-latitude warming is capable of accelerating permafrost degradation and the decomposition of previously frozen carbon. The existence of an analogous high-altitude feedback, however, has yet to be directly evaluated. We address this knowledge gap by coupling a radiocarbon-based model to 7 years (2008-2014) of continuous eddy covariance data from a snow-scoured alpine tundra meadow in Colorado, USA, where solifluction lobes are associated with discontinuous permafrost. On average, the ecosystem was a net annual source of 232 ± 54 g C m-2 (mean ± 1 standard deviation) to the atmosphere, and respiration of relatively radiocarbon-depleted (i.e., older) substrate contributes to carbon emissions during the winter. Given that alpine soils with permafrost occupy 3.6 × 106 km2 land area and are estimated to contain 66.3 Pg of soil organic carbon (4.5% of the global pool), this scenario has global implications for the mountain carbon balance and corresponding resource allocation to lower elevations.

Initial outcomes of a real-world multi-site primary care psychotherapy program.

OBJECTIVE: Although anxiety, mood, and adjustment disorders are commonly treated in primary care, little evidence exists regarding psychotherapy outcomes within this setting. The primary objective of this study was to describe outcomes of a large-scale primary care psychotherapy program. METHODS: Patients (N = 2772) participated in cognitive behavioral therapy (CBT) as part of a multi-site primary care program. A tracking system was utilized to collect data on demographics, diagnoses, course of care, anxiety and depressive symptoms, and frequencies of psychotherapy principles used over the course of primary care CBT. RESULTS: Anxiety disorders were most frequent, often comorbid with depression. Over two-thirds of the sample participated in at least one CBT session. Case formulation, cognitive interventions, exposure, and behavioral activation were frequently utilized approaches. Significant improvements on the GAD-7 and PHQ-9 occurred for all groups, yielding medium effect sizes (d = 0.50-0.68). Rates of reliable change (48-80%), response (35-53%), and remission (21-36%) were noted for those scoring in the moderate range of severity. CONCLUSION: Patients suffering from anxiety, depression, and adjustment disorders can be effectively treated in primary care with CBT. Future efforts are needed to match patient characteristics with the types and timing of therapy interventions to improve clinical and functional outcomes.

Water soluble organic aerosols in the Colorado Rocky Mountains, USA: composition, sources and optical properties.

Atmospheric aerosols have been shown to be an important input of organic carbon and nutrients to alpine watersheds and influence biogeochemical processes in these remote settings. For many remote, high elevation watersheds, direct evidence of the sources of water soluble organic aerosols and their chemical and optical characteristics is lacking. Here, we show that the concentration of water soluble organic carbon (WSOC) in the total suspended particulate (TSP) load at a high elevation site in the Colorado Rocky Mountains was strongly correlated with UV absorbance at 254 nm (Abs254, r = 0.88 p < 0.01) and organic carbon (OC, r = 0.95 p < 0.01), accounting for >90% of OC on average. According to source apportionment analysis, biomass burning had the highest contribution (50.3%) to average WSOC concentration; SOA formation and motor vehicle emissions dominated the contribution to WSOC in the summer. The source apportionment and backward trajectory analysis results supported the notion that both wildfire and Colorado Front Range pollution sources contribute to the summertime OC peaks observed in wet deposition at high elevation sites in the Colorado Rocky Mountains. These findings have important implications for water quality in remote, high-elevation, mountain catchments considered to be our pristine reference sites.

Changing forest water yields in response to climate warming: results from long-term experimental watershed sites across North America.

Climate warming is projected to affect forest water yields but the effects are expected to vary. We investigated how forest type and age affect water yield resilience to climate warming. To answer this question, we examined the variability in historical water yields at long-term experimental catchments across Canada and the United States over 5-year cool and warm periods. Using the theoretical framework of the Budyko curve, we calculated the effects of climate warming on the annual partitioning of precipitation (P) into evapotranspiration (ET) and water yield. Deviation (d) was defined as a catchment's change in actual ET divided by P [AET/P; evaporative index (EI)] coincident with a shift from a cool to a warm period - a positive d indicates an upward shift in EI and smaller than expected water yields, and a negative d indicates a downward shift in EI and larger than expected water yields. Elasticity was defined as the ratio of interannual variation in potential ET divided by P (PET/P; dryness index) to interannual variation in the EI - high elasticity indicates low d despite large range in drying index (i.e., resilient water yields), low elasticity indicates high d despite small range in drying index (i.e., nonresilient water yields). Although the data needed to fully evaluate ecosystems based on these metrics are limited, we were able to identify some characteristics of response among forest types. Alpine sites showed the greatest sensitivity to climate warming with any warming leading to increased water yields. Conifer forests included catchments with lowest elasticity and stable to larger water yields. Deciduous forests included catchments with intermediate elasticity and stable to smaller water yields. Mixed coniferous/deciduous forests included catchments with highest elasticity and stable water yields. Forest type appeared to influence the resilience of catchment water yields to climate warming, with conifer and deciduous catchments more susceptible to climate warming than the more diverse mixed forest catchments.

Changes in assembly processes in soil bacterial communities following a wildfire disturbance.

Although recent work has shown that both deterministic and stochastic processes are important in structuring microbial communities, the factors that affect the relative contributions of niche and neutral processes are poorly understood. The macrobiological literature indicates that ecological disturbances can influence assembly processes. Thus, we sampled bacterial communities at 4 and 16 weeks following a wildfire and used null deviation analysis to examine the role that time since disturbance has in community assembly. Fire dramatically altered bacterial community structure and diversity as well as soil chemistry for both time-points. Community structure shifted between 4 and 16 weeks for both burned and unburned communities. Community assembly in burned sites 4 weeks after fire was significantly more stochastic than in unburned sites. After 16 weeks, however, burned communities were significantly less stochastic than unburned communities. Thus, we propose a three-phase model featuring shifts in the relative importance of niche and neutral processes as a function of time since disturbance. Because neutral processes are characterized by a decoupling between environmental parameters and community structure, we hypothesize that a better understanding of community assembly may be important in determining where and when detailed studies of community composition are valuable for predicting ecosystem function.

Evaluating regional patterns in nitrate sources to watersheds in National Parks of the Rocky Mountains using nitrate isotopes.

In the Rocky Mountains, there is uncertainty about the source areas and emission types that contribute to nitrate (NO3) deposition, which can adversely affect sensitive aquatic habitats of high-elevation watersheds. Regional patterns in NO3 deposition sources were evaluated using NO3 isotopes in five National Parks, including 37 lakes and 7 precipitation sites. Results indicate that lake NO3 ranged from detection limit to 38 microeq/L, delta18O (NO3) ranged from -5.7 to +21.3% per thousand, and delta15N (NO3) ranged from -6.6 to +4.6 per thousand. delta18O (NO3) in precipitation ranged from +71 to +78% per thousand. delta15N (NO3) in precipitation and lakes overlap; however, delta15N (NO3) in precipitation is more depleted than delta15N (NO3) in lakes, ranging from -5.5 to -2.0 per thousand. delta15N (NO3) values are significantly related (p < 0.05) to wet deposition of inorganic N, sulfate, and acidity, suggesting that spatial variability of delta15N (NO3) over the Rocky Mountains may be related to source areas of these solutes. Regional patterns show that NO3 and delta15N (NO3) are more enriched in lakes and precipitation from the southern Rockies and at higher elevations compared to the northern Rockies. The correspondence of high NO3 and enriched delta15N (NO3) in precipitation with high NO3 and enriched delta15N (NO3) in lakes, suggests that deposition of inorganic N in wetfall may affect the amount of NO3 in lakes through a combination of direct and indirect processes such as enhanced nitrification.

Optical Remote Sensing of Glacier Characteristics: A Review with Focus on the Himalaya.

The increased availability of remote sensing platforms with appropriate spatial and temporal resolution, global coverage and low financial costs allows for fast, semi-automated, and cost-effective estimates of changes in glacier parameters over large areas. Remote sensing approaches allow for regular monitoring of the properties of alpine glaciers such as ice extent, terminus position, volume and surface elevation, from which glacier mass balance can be inferred. Such methods are particularly useful in remote areas with limited field-based glaciological measurements. This paper reviews advances in the use of visible and infrared remote sensing combined with field methods for estimating glacier parameters, with emphasis on volume/area changes and glacier mass balance. The focus is on the Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) sensor and its applicability for monitoring Himalayan glaciers. The methods reviewed are: volumetric changes inferred from digital elevation models (DEMs), glacier delineation algorithms from multi-spectral analysis, changes in glacier area at decadal time scales, and AAR/ELA methods used to calculate yearly mass balances. The current limitations and on-going challenges in using remote sensing for mapping characteristics of mountain glaciers also discussed, specifically in the context of the Himalaya.

Hyporheic exchange and fulvic acid redox reactions in an Alpine stream/wetland ecosystem, Colorado Front Range.

The influence of hyporheic zone interactions on the redox state of fulvic acids and other redox active species was investigated in an alpine stream and adjacent wetland, which is a more reducing environment. A tracer injection experiment using bromide (Br-) was conducted in the stream system. Simulations with a transport model showed that rates of exchange between the stream and hyporheic zone were rapid (alpha approximately 10(-3) s(-1)). Parallel factor analysis of fluorescence spectra was used to quantifythe redox state of dissolved fulvic acids. The rate coefficient for oxidation of reduced fulvic acids (lambda = 6.5 x 10(-3) s(-1)) in the stream indicates that electron-transfer reactions occur over short time scales. The rate coefficients for decay of ammonium (lambda = 1.2 x 10(-3) s(-1)) and production of nitrate (lambda = -1.0 x 10(-3) s(-1)) were opposite in sign but almost equal in magnitude. Our results suggest that fulvic acids are involved in rapid electron-transfer processes in and near the stream channel and may be important in determining ecological energy flow at the catchment scale.

Winter forest soil respiration controlled by climate and microbial community composition.

Most terrestrial carbon sequestration at mid-latitudes in the Northern Hemisphere occurs in seasonal, montane forest ecosystems. Winter respiratory carbon dioxide losses from these ecosystems are high, and over half of the carbon assimilated by photosynthesis in the summer can be lost the following winter. The amount of winter carbon dioxide loss is potentially susceptible to changes in the depth of the snowpack; a shallower snowpack has less insulation potential, causing colder soil temperatures and potentially lower soil respiration rates. Recent climate analyses have shown widespread declines in the winter snowpack of mountain ecosystems in the western USA and Europe that are coupled to positive temperature anomalies. Here we study the effect of changes in snow cover on soil carbon cycling within the context of natural climate variation. We use a six-year record of net ecosystem carbon dioxide exchange in a subalpine forest to show that years with a reduced winter snowpack are accompanied by significantly lower rates of soil respiration. Furthermore, we show that the cause of the high sensitivity of soil respiration rate to changes in snow depth is a unique soil microbial community that exhibits exponential growth and high rates of substrate utilization at the cold temperatures that exist beneath the snow. Our observations suggest that a warmer climate may change soil carbon sequestration rates in forest ecosystems owing to changes in the depth of the insulating snow cover.

Winter production of CO2 and N2O from alpine tundra: environmental controls and relationship to inter-system C and N fluxes.

Fluxes of CO2 and N2O were measured from both natural and experimentally augmented snowpacks during the winters of 1993 and 1994 on Niwot Ridge in the Colorado Front Range. Consistent snow cover insulated the soil surface from extreme air temperatures and allowed heterotrophic activity to continue through much of the winter. In contrast, soil remained frozen at sites with inconsistent snow cover and production did not begin until snowmelt. Fluxes were measured when soil temperatures under the snow ranged from -5°C to 0°C, but there was no significant relationship between flux for either gas and temperature within this range. While early developing snowpacks resulted in warmer minimum soil temperatures allowing production to continue for most of the winter, the highest CO2 fluxes were recorded at sites which experienced a hard freeze before a consistent snowpack developed. Consequently, the seasonal flux of CO2 -C from snow covered soils was related both to the severity of freeze and the duration of snow cover. Over-winter CO2 -C loss ranged from 0.3 g C m-2 season-1 at sites characterized by inconsistent snow cover to 25.7 g C m-2 season-1 at sites that experienced a hard freeze followed by an extended period of snow cover. In contrast to the pattern observed with C loss, a hard freeze early in the winter did not result in greater N2O-N loss. Both mean daily N2O fluxes and the total over-winter N2O-N loss were related to the length of time soils were covered by a consistent snowpack. Over-winter N2O-N loss ranged from less 0.23 mg N m-2 from the latest developing, short duration snowpacks to 16.90 mg N m-2 from sites with early snow cover. These data suggest that over-winter heterotrophic activity in snow-covered soil has the potential to mineralize from less than 1% to greater than 25% of the carbon fixed in ANPP, while over-winter N2O fluxes range from less than half to an order of magnitude higher than growing season fluxes. The variability in these fluxes suggests that small changes in climate which affect the timing of seasonal snow cover may have a large effect on C and N cycling in these environments.