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Background Lithium has long been recognised as an effective treatment for bipolar disorder. Its relative efficacy has been measured with a diverse range of clinical outcomes, resulting in differences in efficacy reporting that have not been systematically reviewed. Aims We aimed to identify and compare the various measures of lithium efficacy employed in interventional studies for people with bipolar disorder. Method Database (PubMed, Web of Science) and hand searches were performed to identify studies that assessed a clinical response in patients with bipolar disorder who received lithium, up to the end of 2021. We included primary human interventional studies without excluding specific study designs, bipolar disorder subtypes, duration or dosage of lithium treatment. Continuous outcome effects were meta-analysed; binary outcomes were synthesised visually and narratively. The Cochrane risk-of-bias tool was used to assess study-level risk of bias. Results Seventy-one studies were included (N = 30 542). Approximately two-thirds of participants attained a clinically significant improvement in manic or depressive symptoms, and over 50% achieved remission. About a third required hospital admission (study length 2–12 years) and around 50% needed further treatment to stay well or had recurrence of symptoms; the latter two outcomes tended to be assessed over long-term maintenance periods. Conclusions An abundance of measurements have been used to assess lithium's clinical effects, across several study designs. Despite the resultant high heterogeneity, an overall picture of lithium's effects emerges that supports previous literature; between half and two-thirds of patients respond well to lithium across varying outcome measures, baseline mood states, study durations and bipolar disorder subtypes.

Strontium isotopes (Sr-87/Sr-86) provide valuable information to help reconstruct past mobility. For the analysis of archaeological tooth enamel to provide a direct assessment of mobility, a comparison to the baseline Sr-87/Sr-86 in a region is required. In this study, a large-scale Sr-87/Sr-86 baseline of Portugal is created based on 151 paired plant and soil leachate samples combined with previously published data (20 additional plant and 33 additional soil leachate sites). Spatial patterns of Sr-87/Sr-86 are evident, following Portugal's geology and terrain, with higher Sr-87/Sr-86 in the granite dominated north and further inland. Influences from sea spray are observed along the coastal regions of the country. The bioavailable strontium range for Portugal is 0.70575-0.73487, and paired plant-soil leachate site measurements show a strong positive relationship. Empirical Bayesian Kriging (EBK) alongside mean Sr-87/Sr-86 per geological unit are used to provide predictive surfaces for bioavailable Sr-87/Sr-86. We find that the addition of archaeological site-specific measurements is required in archaeological mobility studies to ensure local-scale Sr-87/Sr-86 variation is captured, illustrated in this study using the Late Middle Neolithic to Early Bronze Age site of Perdigoes. The bioavailable strontium isoscape for Portugal provides a baseline map for future archaeological and palaeoecological studies in this region and contributes to the global efforts to map strontium isotope variability. ARC Discovery Project DP160100811 Grant agreement number 948913 info:eu-repo/semantics/publishedVersion

Objectives The early pathogenesis and precursors of Bipolar Disorder (BD) are poorly understood. There is some cross-sectional and retrospective evidence of affective lability as a predictor of BD, but this is subject to recall biases. The present review synthesises the prospective evidence examining affective lability and the subsequent development of BD at follow-up. Methods The authors performed a systematic search of PubMed, PsycInfo and Embase (1960–June 2020) and conducted hand searches to identify studies assessing affective lability (according to a conceptually-inclusive definition) at baseline assessment in individuals without a BD diagnosis, and a longitudinal follow-up assessment of bipolar (spectrum) disorders. Results are reported according to the PRISMA guidelines, and the synthesis without meta-analysis (SWiM) reporting guidelines were used to strengthen the narrative synthesis. The Newcastle–Ottawa Scale was used to assess risk of bias (ROB). Results 11 articles describing 10 studies were included. Being identified as having affective lability at baseline was associated with an increased rate of bipolar diagnoses at follow-up; this association was statistically significant in six of eight studies assessing BD type I/II at follow-up and in all four studies assessing for bipolar spectrum disorder (BSD) criteria. Most studies received a ‘fair’ or ‘poor’ ROB grade. Conclusions Despite a paucity of studies, an overall association between prospectively-identified affective lability and a later diagnosis of BD or BSD is apparent with relative consistency between studies. This association and further longitudinal studies could inform future clinical screening of those who may be at risk of BD, with the potential to improve diagnostic accuracy and facilitate early intervention.

The creation of bioavailable strontium baseline maps are critical for interpreting bioarchaeological data. With the increasing production of local archaeological site-specific, regional or national maps, devising an approach for combining these datasets to create larger or higher density isoscapes is crucial. Using Portugal as a case study, this presentation will discuss how combining different archives and scales of strontium isotope data can provide a robust baseline for archaeological mobility studies. The presentation will introduce the first country-wide bioavailable strontium baseline for Portugal, created using paired plant and soil leachate measurements from 151 sampling sites. Our dataset will be used as a foundation, with additional data from published archaeological site baselines (using modern plant, human bones and faunal remains), our recently collected regional plant samples, and published European and global datasets (on agricultural soils and mineral waters) compared. Plant samples provide the majority of strontium data in Portugal, and are a solid base for archaeological studies. This approach provides an opportunity to compare different archives to this plant base to highlight the variability in the archives used for strontium mapping and to highlight inadequacies in our current sampling strategies. Comparing datasets also allows for an evaluation of isotopic variation on varying scales; wide-scale sampling highlights how the diverse geological, geographical, and climatic regions of Portugal lead to an interesting spatial distribution of 87Sr/86Sr across the country. Furthermore, regional and site-specific sampling allows for the assessment of residential mobility and the range of landscapes used by past human populations. Reconstructing palaeomobility patterns requires a full picture of isotopic diversity at both the local, regional and broader level, combining datasets of varying scales moves us one step closer to creating the robust baselines required.