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The significance of using games for educational purposes is well documented in the literature. It has been argued that serious games can draw more engagement and user attention to topics when compared to conventional web or print media, including concepts around energy education. The Smarter Household project has deployed an energy indoor health monitoring system in 19 UK social housing units, utilizing internet technologies to connect the end-user through tablet devices to multiple interventions (dashboard visualization, application of gamification and serious game). The serious game aimed to help residents understand their energy consumption while stimulating energy-efficient behaviors toward managing indoor conditions via in-game decisions. This chapter presents our preliminary findings relating to the serious game as an intervention across the 19 households. The game demonstrates potential value to trial participants in terms of how to apply the lessons learned from the in-game scenarios to their everyday activities.

Smart metering of domestic energy use allows consumer feedback through in-home displays (IHDs), websites or smart phone apps. Research has illustrated the need for additional ‘sense-making’ information to help households make informed energy-related decisions. This study investigates how household members respond when energy consumption data is integrated with information on indoor environmental conditions (IECs) and coupled with advice on energy saving actions. An integrated system of energy meters and IEC sensors was trialled in 19 predominantly social housing properties in the Midlands (England). Households were provided with a tablet computer and feedback was provided via a dedicated ‘Energy Dashboard’ web-based software application (app). The app was designed in collaboration with the social housing provider to display electricity and gas consumption data as well as data on three IECs: relative humidity, carbon dioxide and temperature. This paper draws on the findings from two rounds of semi-structured interviews with participants. All respondents using the app reported that they made use of the IEC data within the sense-making process, finding temperature and humidity to be useful in linking energy consumption, activities and household conditions. Interpretation of IEC data tended to increase with time as understanding increased. However, different users ‘noticed’, ‘interpreted’ and ‘enacted’ information differently as they integrated this with other sources of information, such as feedback from household members and experiential knowledge. The findings suggest that, whilst incorporating greater contextual information, such as IECs, into feedback displays can help users make sense of domestic energy consumption, the outcomes of the sense-making process will be different for different households. Nevertheless, the provision of such information appears to support householders to make decisions about their energy management that they feel appropriate for their household’s wellbeing needs, within the bounds of their agency.

We describe here the development of a new hybrid ionization approach, matrix-enhanced nanostructure initiator mass spectrometry (ME-NIMS). It combines the strengths of two demonstrated MS ionization methods, matrix-enhanced surface-assisted laser desorption/ionization (ME-SALDI) and nanostructure initiator mass spectrometry (NIMS), and exhibits significantly improved sensitivity and better reproducibility for small molecule and peptide detection. Similarly improved performance from ME-NIMS was seen in the detection of lipids and small drug molecules during tissue imaging. At least an order of magnitude improvement in the limit of detection of pentamidine was demonstrated compared to using conventional NIMS only.

Introduction The reasons that some smokers find it harder to quit than others are unclear. Understanding how individual differences predict smoking cessation outcomes may allow the development of more successful personalized treatments for nicotine dependence. Theoretical models suggest that drug users might be characterized by increased sensitivity to drug cues and by reduced sensitivity to nondrug-related natural rewards. We hypothesized that baseline differences in brain sensitivity to natural rewards and cigarette-related cues would predict the outcome of a smoking cessation attempt. Methods Using functional magnetic resonance imaging, we recorded prequit brain responses to neutral, emotional (pleasant and unpleasant), and cigarette-related cues from 55 smokers interested in quitting. We then assessed smoking abstinence, mood, and nicotine withdrawal symptoms during the course of a smoking cessation attempt. Results Using cluster analysis, we identified 2 groups of smokers who differed in their baseline responses to pleasant cues and cigarette-related cues in the posterior visual association areas, the dorsal striatum, and the medial and dorsolateral prefrontal cortex. Smokers who showed lower prequit levels of brain reactivity to pleasant stimuli than to cigarette-related cues were less likely to be abstinent 6 months after their quit attempt, and they had higher levels of negative affect during the course of the quit attempt. Conclusions Smokers with blunted brain responses to pleasant stimuli, relative to cigarette-related stimuli, had more difficulty quitting smoking. For these individuals, the lack of alternative forms of reinforcement when nicotine deprived might be an important factor underlying relapse. Normalizing these pathological neuroadaptations may help them achieve abstinence.

Identifying neural mechanisms associated with addiction has substantially improved the overall understanding of addictive processes. Indeed, research suggests that drug-associated cues may take advantage of neural mechanisms originally intended for emotional processing of stimuli relevant to survival. In this study, we investigated cortical responses to several categories of emotional cues (erotic, romance, pleasant objects, mutilation, sadness, and unpleasant objects) as well as two types of smoking-related cues (people smoking and cigarette-related objects). We recorded ERPs from 180 smokers prior to their participation in a smoking cessation clinical trial and assessed emotional salience by measuring the amplitude of the late positive potential (LPP; 400 to 600 ms after picture onset). As expected, emotional and cigarette-related pictures prompted a significantly larger LPP than neutral pictures. The amplitude of the LPP increased as a function of picture arousal level, with high-arousing erotic and mutilation pictures showing the largest response in contrast to low-arousing pleasant and unpleasant objects, which showed the smallest response (other than neutral). Compared to females, male participants showed larger LPPs for high-arousing erotic and mutilation pictures. However, unlike emotional pictures, no difference was noted for the LPP between cigarette stimuli containing people versus those containing only objects, suggesting that in contrast to emotional objects, cigarette-related objects are highly relevant for smokers. We also compared the smokers to a small (N=40), convenience sample of never-smokers. We found that never-smokers had significantly smaller LPPs in response to erotic and cigarette stimuli containing only objects compared to smokers.

The adhesion of 100 nm thick electron-beam deposited Au and Pt and magnetron sputtered Au thin films onto poly(methyl methacrylate) (PMMA) substrates can be significantly enhanced to over 90% adhesion by either spin-casting or vapor-exposure to hydrohalocarbon solvents prior to metal deposition compared to samples that are either cleaned in isopropyl alcohol or pre-treated with a remote O2 plasma. X-ray photoelectron spectroscopy (XPS) and evolved gas Fourier transform infrared spectroscopy (EGA-FTIR) reveal the presence of residual halogenated solvent molecules at the PMMA surface which chemically activates the surface to produce a stable chemical interaction between the noble metal film and the PMMA. Density functional theory (DFT) calculations show that the halogenated solvent molecules preferentially form a Lewis acid-base adduct with the oxygen atoms in the ester group in PMMA which is consistent with the measured enthalpy of desorption of chloroform (CHCl3) on PMMA determined by EGA-FTIR to be 36 kJ mol-1. The DFT model also supports the experimentally observed change in the high resolution XPS O 1s peak at 533.77 eV after metallization attributed to a change in the local bonding environment of the bridging O in the PMMA ester group. DFT also predicts that the deposited metal atom (M)more » inserts into the C-X bond where X is the halogen atom on either CHCl3 or bromoform (CHBr3) to form a O M X interaction that is observed by a M-X bond in the high resolution XPS Cl 2p3/2 peak at 198.03 eV and Br 3p3/2 peak at 182.06 eV. A range of solvents with differing polarities for PMMA pre-treatment have been used and it is proposed that non-complexing solvents result in significant metal adhesion improvement. The Gutmann acceptor number can be used to predict the effectiveness of solvent treatment for noble metal adhesion. A model is proposed in which the bond energy of the C-X bond of the solvent must be sufficiently low so that the C-X bond can be cleaved to form the M-X bond. Supporting this model, a negative control of vapor phase exposure to fluoroform (CHF3) is shown to have no effect on noble metal adhesion due to the higher bond dissociation energy of the C-F bond compared to the C-Cl and C-Br bond energy. The surface activation of vapor-phase exposed PMMA surfaces is technologically significant for the fabrication of polymer microdevices requiring Au or Pt metallization.« less

In this study, we examined the relationship between the level of daily cigarette consumption and the startle response to affective and cigarette-related cues among treatment-seeking smokers. Before receiving any behavioral or pharmacological treatment, 136 smokers attended a baseline laboratory session, during which we recorded their reflexive eyeblink responses to acoustic startle probes while they were viewing pleasant, unpleasant, neutral, and cigarette-related pictures. We found that 1) cigarette-related and pleasant pictures similarly reduced the startle magnitude compared to neutral pictures; 2) the magnitude of startle modulation rendered by pleasant or unpleasant pictures did not differ among light, moderate, and heavy smokers; and 3) startle attenuation by cigarette-related pictures was greater in heavy smokers than in light smokers. These results suggest that similar to pleasant stimuli, cigarette-related cues are motivationally salient for smokers, and that this salience increases with nicotine dependence.

Chronic smoking is thought to cause changes in brain reward systems that result in overvaluation of cigarette-related stimuli and undervaluation of natural rewards. We tested the hypotheses that, in smokers, brain circuits involved in emotional processing: (i) would be more active during exposure to cigarette-related than neutral pictures; and (ii) would be less active to pleasant compared with cigarette-related pictures, suggesting a devaluation of intrinsically pleasant stimuli. We obtained whole-brain blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging data from 35 smokers during the presentation of pleasant (erotica and romance), unpleasant (mutilations and sad), neutral, and cigarette-related pictures. Whole-brain analyses showed significantly larger BOLD responses during presentation of cigarette-related pictures relative to neutral ones within the secondary visual areas, the cingulate gyrus, the frontal gyrus, the dorsal striatum, and the left insula. BOLD responses to erotic pictures exceeded responses to cigarette-related pictures in all clusters except the insula. Within the left insula we observed larger BOLD responses to cigarette-related pictures than to all other picture categories. By including intrinsically pleasant and unpleasant pictures in addition to neutral ones, we were able to conclude that the presentation of cigarette-related pictures activates brain areas supporting emotional processes, but we did not find evidence of overall reduced activation of the brain reward systems in the presence of intrinsically pleasant stimuli.

Identifying addicts with higher risk of relapse would provide the opportunity to implement individualized interventions and increase cessation success rates. Unfortunately, the ability to predict the long-term success of drug-cessation treatments continues to elude researchers. We tested whether brain responses to emotional and cigarette-related pictures were predictive of the ability to abstain from smoking. Smokers interested in quitting (n=180) participated in a smoking cessation clinical trial. Before the initiation of any treatment we recorded event-related potentials (ERPs) evoked by emotional (both pleasant and unpleasant), neutral, and cigarette-related images. Cluster analysis was used to assign smokers to two groups based on the amplitude of the late positive potential (LPP) to the experimental stimuli. While both groups showed enhanced responses to cigarette-related cues, one group (n=81) also showed blunted brain responses to intrinsically pleasant stimuli. Smokers in the latter group were significantly less likely to be abstinent at 10, 12, and 24 weeks after their quit date. In conclusion, using event-related potentials, a direct measure of brain activity, we found that smokers with blunted brain responses to intrinsically pleasant stimuli had lower rates of long-term smoking abstinence. This response offers a new biomarker for identifying smokers at higher risk of relapse and for testing the efficacy of new interventions aimed at normalizing brain reward systems’ responses to intrinsically pleasant stimuli.

Vaccination against the human papillomavirus (HPV) is a recent development in the UK. This paper uses an optimal control model to explore how best to target vaccination. We find that the vaccination of sexually active individuals has a greater impact on disease control than the vaccination of sexually non-active individuals. Extending the model to include male vaccination, we find that including males in a vaccination strategy is cost-effective. We compare the optimal control solution to that from a constant control model and show that the optimal control model is more efficient at forcing the system to a disease-controlled steady state.

Addiction has been described as the pathological usurpation of the neural mechanisms normally involved in emotional processing. Event-related potentials (ERPs) can provide a non-invasive index of neural responses associated with the processing of emotionally relevant stimuli and serve as a tool for examining temporal and spatial commonalities between the processing of intrinsically motivating stimuli and drug cues. Before beginning a smoking cessation program, 116 smokers participated in a laboratory session in which dense-array ERPs (129 sensors) were recorded during the presentation of pictures with emotional (pleasant and unpleasant), neutral and cigarette-related content. ERP differences among categories were analyzed with use of randomization tests on time regions of interest identified by temporal principal component analysis. Both emotional and cigarette-related pictures prompted significantly more positivity than did neutral pictures over central, parietal, and frontal sites in the 452-508 ms time window. During the 212-316 ms time window, both pleasant and cigarette-related pictures prompted less positivity than neutral images did. Cigarette-related pictures enhanced the amplitude of the P1 component (136-144 ms) above the levels measured in the emotional and neutral conditions. These results support the hypothesis that for smokers, cigarette-related cues are motivationally relevant stimuli that capture attentional resources early during visual processing and engage brain circuits normally involved in the processing of intrinsically emotional stimuli.

This article utilized a panel design to analyze the relationship between employment and drug use among low-income women over a 2-year period. Five hundred and thirty four (N = 534) female welfare recipients were recruited as part of a 5-year study designed to examine the effects of chronic drug use on the transition from welfare to work. The prototypical study participant was female, single, African American, had less than a 12th grade education, and was about 30 years of age. At intake, less than 10% of the sample was employed. By the end of year 1, more than 40% of sample participants had attained employment. By the end of year 2, nearly 50% were employed. Results indicate that a welfare recipient working more hours during year 1 was a significant predictor of decreased drug use during year 2. Results are discussed in the context of using employment as a central element in tertiary prevention methods geared toward unemployed, chronic drug-using female Temporary Assistance to Needy Family (TANF)...

BACKGROUND: Recent studies conducted in Temporary Assistance to Needy Families (TANF) populations show that TANF recipients are more likely to suffer from persistent psychiatric disorders and mental health problems than are non—TANF recipients. It has been estimated that approximately 35% of TANF recipients have psychological distress symptoms, with depression being the most commonly reported disorder. OBJECTIVE: To determine if drug use may modify the welfare-distress relationship by forming an interaction with shame, economic hardship, or both. STUDY DESIGN: A survey design consisting of 534 female recipients was used. RESULTS: Drug users demonstrated higher levels of anxiety, depression, and lower self-esteem than nonusers. Neither welfare shame nor economic hardship had direct effects on psychological distress; economic hardship significantly modified the effect of drug use. CONCLUSIONS: Contrary to previously published reports, welfare shame was not associated with the psychological distress observed in this sample of welfare recipients. J Am Psychiatr Nurses Assoc, 2007; 13(5), 275-284. DOI: 10.1177/1078390307307256

Much of the public health literature indicates that peers have a significant effect on risky health behaviors. However, these studies have not considered the role of peer endogeneity (i.e., peer selection). Thus, the purpose of this study is to ascertain the importance of considering peer endogeneity when discussing the consequences of peer behavior on individual behavior, particularly on risky sexual behavior. The results show a nonsignificant association between perceived peer support for condom use and actual individual condom use in this sample of low-income, high-risk individuals. More notably, however, the results point to the importance of considering peer endogeneity in any estimation of peer influence on risky health behaviors.

This article examines the extent to which Temporary Assistance to Needy Families (TANF) recipients file income tax returns and take advantage of the Earned Income Credit (EIC), a program specifically designed to increase the economic self-sufficiency of lower income earners by supplementing earned and other income to make working more profitable. This study consisted primarily of Black and Hispanic women (n = 317), recruited for a longitudinal study designed to examine the effects of welfare reform on drug using and non-drug using welfare recipients. At the 2-year mark, 70% of the sample reported having ever filed an income tax return, of these 76% had received an EIC. Both hours worked and earnings were positively associated with EIC receipt. In this population, EIC appears to be a successful mechanism for improving economic self-sufficiency.

Nanostructure-initiator mass spectrometry (NIMS) is an established method for sensitive detection of small molecules in complex samples. It is based on the optimal combination of a porous Si substrate and a carefully selected polymer coating to allow certain analytes of interest to be concentrated on the substrate for effective ionization with minimal background interference from conventional organic matrices. The previous chapter has detailed the history and current state of the art of the technique in small-molecule profiling and imaging applications. We describe here a simple step-by-step protocol for substrate fabrication and sample preparation that provides a starting point for the technique to be adapted and optimized for 2-D biological imaging applications.

Surface-assisted laser desorption/ionization mass spectrometry (SALDI-MS), a parallel technique to matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS), utilizes inorganic particles or porous surfaces to aid in the desorption/ionization of low-molecular-weight (MW) analytes. As a matrix-free and "soft" LDI approach, SALDI offers the benefit of reduced background noise in the low MW range, allowing for easier detection of biologically significant small MW species. Despite the inherent advantages of SALDI-MS, it has not reached comparable sensitivity levels to MALDI-MS. In relation to mass spectrometry imaging (MSI), intense efforts have been made in order to improve sensitivity and versatility of SALDI-MSI. We describe herein a detailed protocol that utilizes a hybrid LDI method, matrix-enhanced SALDI-MS (ME-SALDI MS), to detect and image low MW species in an imaging mode.

This study examined social support and its association with employment, income, and drug use in a sample of 534 low-income women. Functional support was defined as the perceived quality of one's interactions with others. Structural support was defined as the number of individuals within five particular types of networks: social, employment, drug, close, and emergency. Over the two-year study period, significant increases were observed in hours worked, income from work, income from other sources, and total income. There was also a significant decrease in welfare income. Results suggest that the perceived quality of support received is an important factor in achieving positive employment outcomes.

The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 instituted a compulsory work mandate for welfare recipients. However, recipients who experience difficulties finding employment may increase their involvement in criminal activities and their frequency of substance use as a means to deal with changes precipitated by PRWORA. This study used a four-wave panel design to analyze the criminal behaviors and substance-use frequency of 534 welfare recipients in Houston, Texas. Data were collected from the Attitudes, Behaviors, and Skills Assessment (ABSA) instrument designed specifically for this study. Results show that a minority of welfare recipients were involved in criminal activity. Furthermore, although participants were losing their welfare benefits, both criminal activity and substance use declined over time.

Nanostructure-initiator mass spectrometry (NIMS) is an established method for sensitive detection of small molecules in complex samples. It is based on the optimal combination of a porous Si substrate and a carefully selected polymer coating to allow certain analytes of interest to be concentrated on the substrate for effective ionization with minimal background interference from conventional organic matrices. The previous chapter has detailed the history and current state of the art of the technique in small-molecule profiling and imaging applications. We describe here a simple step-by-step protocol for substrate fabrication and sample preparation that provides a starting point for the technique to be adapted and optimized for 2-D biological imaging applications.

Surface-assisted laser desorption/ionization mass spectrometry (SALDI-MS), a parallel technique to matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS), utilizes inorganic particles or porous surfaces to aid in the desorption/ionization of low-molecular-weight (MW) analytes. As a matrix-free and "soft" LDI approach, SALDI offers the benefit of reduced background noise in the low MW range, allowing for easier detection of biologically significant small MW species. Despite the inherent advantages of SALDI-MS, it has not reached comparable sensitivity levels to MALDI-MS. In relation to mass spectrometry imaging (MSI), intense efforts have been made in order to improve sensitivity and versatility of SALDI-MSI. We describe herein a detailed protocol that utilizes a hybrid LDI method, matrix-enhanced SALDI-MS (ME-SALDI MS), to detect and image low MW species in an imaging mode.

In the field of small-molecule studies, vast efforts have been put forth in order to comprehensively characterize and quantify metabolites formed from complex mechanistic pathways within biochemical and biological organisms. Many technologies and methodologies have been developed to aid understanding of the inherent complexities within biological metabolomes. Specifically, mass spectroscopy imaging (MSI) has emerged as a foundational technique in gaining insight into the molecular entities within cells, tissues, and whole-body samples. In this chapter we provide a brief overview of major technical components involved in MSI, including topics such as sample preparation, analyte ionization, ion detection, and data analysis. Emerging applications are briefly summarized as well, but details will be presented in the following chapters.

DIOS is a mass spectrometry (MS)-based technique capable of identification and quantification of low-mass species in complex samples. Porous silicon (PSi) substrates play a crucial role in DIOS by serving as an effective energy mediator to promote the conversion of photon energy from an irradiation laser to thermal energy for desorption and ionization of low-mass analytes of interest. The substrates also exhibit good stability under laser ablation. This good stability leads to reduced background and renders DIOS-MS an attractive tool for high resolution MS imaging of small molecules. In this chapter we summarize recent work on DIOS-MS, in particular its applications in two-dimensional imaging of metabolites. Various improved ionization approaches based on PSi will be presented as well, all with the aims of further enhancing spatial resolution, sensitivity, and reproducibility of DIOS MSI and pushing the technology envelop for broader applications.

Current practice in education of transplant recipients includes general guidelines about return to involvement in life activities emphasizing medical precautions during wound healing and avoidance of activities that present risk of infection or rejection. This approach assumes patients gradually resume pre-transplant involvement in life activities: an assumption that has not been tested. Using the Canadian Occupational Performance Measure, this cross-sectional descriptive pilot study (n = 20) explored differences in the performance of activities of daily living, instrumental activities of daily living, leisure, and productivity at three time periods within the first year. Results showed basic daily tasks are stable by the third month but some instrumental tasks declined by the end of the first year post transplant. Results indicated that there were significant differences in the Short Form-36 mental component score of the group performing "worse than expected" suggesting that preparation of recipients is needed to enable them to set realistic expectations. Results indicate the need for a longitudinal study of the resumption patterns of life activities for realistic expectations of recovery and guidelines for the treatment team.

Introduction The presence of cigarette-related cues has been associated with smoking relapse. These cues are believed to activate brain mechanisms underlying emotion, attention, and memory. Electroencephalography (EEG) alpha desynchronization (i.e., reduction in alpha power) has been suggested to index the engagement of these mechanisms. Analyzing EEG alpha desynchronization in response to affective and smoking cues might improve our understanding of how smokers process these cues, and the potential impact of this processing on relapse. Methods Before the start of a medication-assisted cessation attempt, we recorded EEG from 179 smokers during the presentation of neutral, pleasant, unpleasant, and cigarette-related pictures. Wavelet analysis was used to extract EEG alpha oscillations (8-12 Hz) in response to these pictures. Alpha oscillations were analyzed as a function of picture valence and arousal dimensions. Results Emotional and cigarette-related stimuli induced a higher level of alpha desynchronization (i.e., less power in the alpha frequency band) than neutral stimuli. In addition, the level of alpha desynchronization induced by cigarette-related stimuli was similar to that induced by highly arousing stimuli (i.e., erotica and mutilations). Conclusions These results suggest that, for smokers, cigarette-related cues are motivationally significant stimuli that may engage emotional, attentional, and memory-related neural mechanisms at a level comparable to that seen in response to highly arousing stimuli. This finding suggests that activation of emotional, attentional, and memory-related brain mechanisms may be an important contributor to cue-induced smoking relapse.

Reactivity to smoking-related cues may be an important factor that precipitates relapse in smokers who are trying to quit. The neurobiology of smoking cue reactivity has been investigated in several fMRI studies. We combined the results of these studies using activation likelihood estimation, a meta-analytic technique for fMRI data. Results of the meta-analysis indicated that smoking cues reliably evoke larger fMRI responses than neutral cues in the extended visual system, precuneus, posterior cingulate gyrus, anterior cingulate gyrus, dorsal and medial prefrontal cortex, insula, and dorsal striatum. Subtraction meta-analyses revealed that parts of the extended visual system and dorsal prefrontal cortex are more reliably responsive to smoking cues in deprived smokers than in non-deprived smokers, and that short-duration cues presented in event-related designs produce larger responses in the extended visual system than long-duration cues presented in blocked designs. The areas that were found to be responsive to smoking cues agree with theories of the neurobiology of cue reactivity, with two exceptions. First, there was a reliable cue reactivity effect in the precuneus, which is not typically considered a brain region important to addiction. Second, we found no significant effect in the nucleus accumbens, an area that plays a critical role in addiction, but this effect may have been due to technical difficulties associated with measuring fMRI data in that region. The results of this meta-analysis suggest that the extended visual system should receive more attention in future studies of smoking cue reactivity.

Recent data (CDC, 2006) reports an overall smoking rate of 11%–12% among women during pregnancy. Low socioeconomic status (SES) and depression have been found to be independent risk factors for continued smoking during pregnancy (Solomon & Quinn, 2004) (Ludman et al., 2000; Pritchard, 1994; Solomon et al., 2006; Zhu & Valbo, 2002) as well as post-partum relapse (Solomon et al., 2007). There is evidence that depression clusters with SES and other risk factors for persistent smoking during pregnancy, and that the clustering of such factors predicts smoking in a gradient fashion (Kahn, Certain, & Whitaker, 2002). That depression co-occurs with low SES is not surprising. Children who grow up with low SES parents are at two to three times greater risk for developing major depressive disorder (MDD) than those who grow up with parents of higher SES, even when parental MDD status is controlled (Ritsher, Warner, Johnson, & Dohrenwend, 2001; Gilman, Kawachi, Fitzmaurice, & Buka, 2002). Because persistent smoking during pregnancy is increasingly concentrated among low SES women, it might be assumed that the prevalence of MDD and depressive symptoms would be high in pregnant smokers. Evidence for this prediction comes from studies utilizing both epidemiological and clinical samples. In nationally representative samples of pregnant women, rates of depressive disorders have been estimated to be 11.4% in current tobacco users without nicotine dependence and 41% in women with DSM-IV nicotine dependence (Goodwin, Keyes, & Simuro, 2007); and the percentage of women above the Centers for Epidemiological Studies Depression Scale (CES-D) cutoff for depression has been found to be 37.5% (Zhu & Valbo, 2002). In a population based sample of low-income women, 9% met criteria for MDD within the past year (Flick et al., 2006). In a sample of women being screened for participation in a low intensity smoking cessation intervention trial, 46.1% of women met criteria for MDD, dysthymia or minor depression (Blalock, Fouladi, Wetter, & Cinciripini, 2005). Very few studies have examined the impact of depression on smoking cessation in pregnant women. One study found that baseline depressive symptoms failed to predict smoking cessation during late pregnancy among pregnant women participating in a telephone counseling smoking cessation intervention trial. (Ludman et al., 2000) However, the overall severity of depressive symptoms was low in the study sample, and this may have reduced the likelihood of detecting a significant relationship. Higher levels of depressive symptoms at end of pregnancy were found to predict relapse at 6 months postpartum in one study (Solomon et al., 2007). In a sample of pregnant smokers who were participating in a low intensity (videos) smoking cessation intervention (Blalock, Robinson, Wetter, & Cinciripini, 2006), we found that women with dysthymia or minor depression at baseline were less likely to be abstinent than women without current depressive disorders, although the effect for depressive disorder was marginal (OR = 6.3, 95% CI = [.757, 52.17], p = .076). Despite the lack of data on the impact of depression on smoking outcome in pregnant smokers, it seems likely that high levels of depression may pose barriers to cessation in this population and that the relative ineffectiveness of smoking cessation interventions for pregnant smokers may be due in part to lack of attention to such symptoms. While meta-analytic reviews indicate that psychosocial interventions are more effective for smoking cessation than usual care in pregnant smokers (Fiore et al., 2008; Lumley, Oliver, & Waters, 2000), the overall prenatal abstinence rates remain low with an average of 7.6% in control conditions and 13.3% in experimental conditions. More intensive interventions (e.g., greater than 90 minutes of therapist contact::Dornelas et al., 2006) or more frequent visits (e.g., up to 8::Albrecht et al., 2006), have been associated with higher abstinence rates during pregnancy; 28% at end of pregnancy and 39% at 8-weeks post—randomization, respectively. However, abstinence rates decline during the postpartum period and in most studies, perinatal differences between experimental and control conditions are no longer significant at postpartum follow-ups (Fiore et al., 2008; Melvin & Gaffney, 2004). The current study was designed to evaluate whether adding an intensive depression-focused treatment component to standard smoking cessation counseling would improve abstinence and depression outcomes in pregnant smokers. We evaluated Cognitive Behavioral Analysis System of Psychotherapy (CBASP), which is a learning-theory based approach that specifically targets interpersonal skills and coping deficits of the chronically depressed individual (McCullough, 2000). Given its interpersonal focus, CBASP appeared especially relevant for addressing a spectrum of psychosocial concerns among pregnant smokers, particularly those with high levels of depressive symptoms. In the current study, a combined smoking cessation and CBASP intervention was compared to a time and intensity matched smoking cessation and Health and Wellness (HW) educational control. Based on previous studies indicating that depression treatment components improve abstinence outcomes among those with more severe forms of depressive disorders and/or symptoms, but not among those with less severe forms of depression and/or symptoms (Brown et al., 2001; Haas, Munoz, Humfleet, Reus, & Hall, 2004; Patten, Drews, Myers, Martin, & Wolter, 2002), we hypothesized that only those with higher levels of baseline depressive symptoms would derive more benefit from the CBASP treatment, in terms of abstinence and symptom reduction, in comparison to HW. Those without such symptoms were expected to fare equally well with CBASP or HW treatments. Treatment effectiveness irrespective of symptoms of depression was not expected to vary.

Before starting a smoking cessation treatment, 51 smokers took part in a study aimed at investigating brain mechanisms associated with attention allocation. Event-related potentials to acoustic startle probes were recorded from 129 sensors during the presentation of neutral, pleasant, unpleasant, and cigarette-related pictures. Results indicated that the amplitude of the startle probe P3 component was reduced for pleasant, unpleasant, and cigarette-related conditions relative to neutral. Surface Laplacian estimates showed that sources of electrocortical activity under frontal and parietal sensors contributed to the modulation of this effect. For smokers, cigarette-related stimuli, like intrinsically motivating ones, capture attentional resources and therefore reduce the ability to process competing stimuli. The depletion of attentional resources in the presence of cigarette-related cues may contribute to the high relapse rate observed during attempts to quit smoking.

Importance Given the actions of varenicline tartrate and bupropion hydrochloride sustained-release (SR) on neurobiological targets related to affect and reward, it is thought that the modulation of nicotine withdrawal symptoms may contribute to their effectiveness. Objective To assess the relative efficacy of varenicline and bupropion SR plus intensive counseling on smoking cessation and emotional functioning. Design and Setting Placebo-controlled randomized clinical trial at a university medical center. Participants In total, 294 community volunteers who wanted to quit smoking. Interventions Twelve weeks of varenicline, bupropion SR, or placebo plus intensive smoking cessation counseling (10 sessions, for a total of approximately 240 minutes of counseling). Main Outcome Measures Prolonged abstinence from smoking and weekly measures of depression, negative affect, and other symptoms of nicotine withdrawal. Results Significant differences were found in abstinence at the end of treatment and through the 3-month postquit follow-up visit, favoring both active medications compared with placebo. At the 6-month postquit follow-up visit, only the varenicline vs placebo comparison remained significant. Varenicline use was also associated with a generalized suppression of depression and reduced smoking reward compared with the other treatments, while both active medications improved concentration, reduced craving, and decreased negative affect and sadness compared with placebo, while having little effect (increase or decrease) on anxiety and anger. No differences were noted in self-reported rates of neuropsychiatric adverse events. Conclusions and Relevance In a community sample, varenicline exerts a robust and favorable effect on smoking cessation relative to placebo and may have a favorable (suppressive) effect on symptoms of depression and other affective measures, with no clear unfavorable effect on neuropsychiatric adverse events. Trial Registration clinicaltrials.gov Identifier: NCT00507728.

The hypothesis that non-right-handedness is associated with sudden cardiac death was tested based on evidence that sympathetic imbalance may contribute to ventricular arrhythmogenesis and evidence that left-handers may have a shorter lifespan than right-handers. The study included 26 patients with coronary artery disease (CAD), a history of ventricular tachycardia-ventricular fibrillation (VT-VF), and implanted defibrillators, and 26 patients with CAD and no history of serious arrhythmias who were matched for age, sex, and New York Heart Association functional class. Patients with any history of neurologic disorders were excluded. Left-handers either wrote with the left hand or were converted from left- to right-handedness in childhood. Non-right-handers used the left hand for writing, drawing, or throwing. Handedness rates in patients with VT-VF and case-control subjects were compared with published norms in the general population to take expected rates into account. The rates of left-handedness (6 of 26 or 23.1%) and non-right-handedness (9 of 26 or 34.6%) in patients with VT-VF were significantly higher (p < 0.003 and p < 0.0001, 2-tailed, respectively) than those of similarly aged adults in the general population (left-handedness, 5%; non-right-handedness, 10.2%). The rates of left-handedness (2 of 26 or 7.7%) and non-right-handedness (4 of 26 or 15.4%) observed in the case-control group correspond closely to the expected values for that group (left-handedness, 1.3 of 26 or 5%; non-right-handedness, 2.65 of 26 or 10.2%) derived from the general population rates and were not significantly different from them.(ABSTRACT TRUNCATED AT 250 WORDS)

The tumor suppressor gene APC was recently identified, and the cDNA was cloned from chromosome 5q21. Point mutations affecting APC are seen in the hereditary syndrome familial adenomatous polyposis, and point mutations in APC and a closely linked gene, MCC, as well as loss of heterozygosity involving chromosome 5q have been reported in sporadic colon cancer. To our knowledge, loss of heterozygosity involving APC or MCC or both has not yet been described in any other human cancer besides lung cancer. We used the polymerase chain reaction and DNA content flow cytometric nuclear sorting to examine 30 primary human esophageal cancers for loss of heterozygosity of APC or MCC or both. Loss of one allele was detected in 77% of 26 informative cases. These data suggest that loss of heterozygosity of regions on 5q including the APC and MCC genetic loci is involved in the development and/or progression of most human esophageal cancers. They imply that inactivation of APC, MCC, and/or a linked gene on chromosome 5q plays a role in the pathogenesis of some cancers of the upper gastrointestinal tract, as well as in colon cancer and familial adenomatous polyposis.