A pilot randomized clinical trial of tDCS for increasing exercise engagement in individuals with elevated depressive symptoms: Rationale, design, and baseline characteristics.

Regular exercise protects against overweight/obesity as well as numerous chronic diseases. Yet, less than half of Americans exercise sufficiently. Elevated levels of depressive symptoms have been identified as an important correlate of physical inactivity as well as poor adherence to exercise programs. Individuals with depression are less sensitive to rewards and demonstrate an attentional bias toward negative stimuli. These, and other features of depression, may place them at increased risk for effectively managing the affective experience of exercise. Lower baseline levels of activation of the left (vs right) frontal cortex, an area implicated in affect regulation, have also been found in depression, potentially pointing to this region as a potential target for intervening on affect regulation during exercise. Transcranial direct current stimulation (tDCS) has shown promise in impacting a variety of cognitive and affective processes in a large number of individuals, including people with depression. Some findings have suggested that tDCS targeting the left dorsolateral prefrontal cortex (DLPFC), specifically, may improve emotion regulation. Transcranial direct current stimulation could theoretically be a novel and potentially promising approach to improving the affective experience of exercise, thereby increasing exercise adherence among individuals with depressive symptoms. Here we present the rationale, design, and baseline characteristics of a pilot randomized controlled trial of tDCS versus sham delivered 3x/week for 8 weeks in the context of supervised aerobic exercise (AE) program among 51 low-active individuals with elevated depressive symptoms (86.3% female; mean age = 49.5). Follow-up assessments were conducted at end of treatment, and three and six months after enrollment to examine changes in levels of objectively-measured moderate-to-vigorous physical activity (MVPA). If effective, this approach could have high public health impact on preventing obesity and chronic diseases among these at-risk individuals.

A developmental-based motivational intervention to reduce alcohol and marijuana use among non-treatment-seeking young adults: a randomized controlled trial.

AIMS: To test the hypothesis that among non-treatment-seeking emerging adults (EA) who both use marijuana and have alcohol binges, a brief, longitudinally delivered, developmentally based motivational intervention would show greater reductions in the use of these two substances compared with a health education control condition. DESIGN: Parallel, two-group, randomized controlled trial with follow-up interventions conducted at 1, 3, 6 and 9 months and final assessments at 12 and 15 months. SETTING: Hospital-based research unit in the United States. PARTICIPANTS: Community-based 18-25-year-olds who reported at least monthly binge drinking and at least weekly marijuana use. INTERVENTION: Motivational intervention (EA-MI) focused primarily on themes of emerging adulthood (identity exploration, instability, self-focus, feeling in-between, a sense of possibilities) and the subjects' relationship to substance use (n = 110) compared with an attention-matched health education control condition (n = 116). MEASUREMENTS: The primary outcomes were days of binge alcohol, marijuana and dual use day as measured using the timeline follow-back method analysing the treatment by time interaction to determine relative differences in the rate of change between intervention arms. FINDINGS: At baseline, the mean rate (days/30) of binge drinking was 5.23 (± 4.31) of marijuana use was 19.4 (± 10.0) and of dual (same day) use was 4.11 (± 4.13). Relative to baseline, there were reductions in the rate of binge alcohol use, marijuana use and days of combined binge alcohol and marijuana use (P < 0.001) at all follow-up assessments. However, the treatment × time interaction was not statistically significant for alcohol (P = 0.37), for marijuana (P = 0.07) or for dual use (P = 0.55). Averaged over all follow-ups, mean reductions in binge, marijuana and dual use days were 1.16, 1.45 and 1.08, respectively, in the health education arm, and 1.06, 1.69 and 0.96 in EA-MI. Bayes factors were < 0.01 for frequency of binge alcohol use and frequency of dual binge alcohol and marijuana and 0.016 for marijuana use. CONCLUSIONS: A brief, longitudinally delivered, developmentally based motivational intervention for young adults did not produce reductions in binge alcohol, marijuana use or dual use days relative to a control condition.

An Open Trial of Electronic Cigarettes for Smoking Cessation Among Methadone-Maintained Smokers.

INTRODUCTION: Smoking cessation pharmacotherapies tested in persons with opioid use disorder have produced low quit rates. Electronic cigarettes (e-cigarettes) have been used by many methadone-maintained (MMT) smokers, but controlled trials evaluating cessation and reduction outcomes have not been performed in this population with deleterious tobacco-related health consequences. METHODS: In this open trial of NJOY e-cigarettes, MMT smokers received 6 weeks of treatment and were instructed to use only e-cigarettes. Outcomes included carbon monoxide confirmed 7-day point smoking cessation prevalence at week 7 (end of treatment) and self-reported change in mean cigarettes per day (CPD) at each 2-week assessment. The final assessment was 2 weeks after treatment ended (week 9). RESULTS: The 12 participants averaged 46 years old and 50% were male. On average, participants reported smoking 17.8 (±5.3) CPD. One person had a biochemically confirmed quit at week 7. Participants tended to report marked reductions in mean CPD between quit day (week 1) and the week 3 assessment. Relative to baseline, statistically significant reductions in mean CPD were observed at all follow-up assessments. Mean reductions in CPD were -12.4 (95% confidence interval [CI]: -15.0, -9.9; P < .001), -14.8 (95% CI: -17.4, -12.2; P < .001), -13.9 (95% CI: -16.6, -11.2), and -10.8 (95% CI: -13.4, -8.2; P < .01) at the 3-, 5-, 7-, and 9-week assessments, respectively. Adherence to e-cigarettes was 89.1% during the 6 treatment weeks. CONCLUSIONS: E-cigarettes were associated with reductions in cigarette use. Smoking cessation rates in MMT smokers are low and whether long-term smoking reductions can persist and produce health benefits should be studied. IMPLICATIONS: E-cigarettes were associated with reduced tobacco use in MMT smokers. Adherence to e-cigarettes is high among methadone smokers. Week-7 smoking quit rates are similar to pharmacotherapies tested in this population.

E-cigarette knowledge, attitudes, and use in opioid dependent smokers.

Individuals in treatment for opioid dependence have smoking rates 3-5 times greater than the U.S. prevalence rate. Traditional smoking cessation strategies have been ineffective in this population. Novel approaches are needed as well as harm reduction avenues. E-cigarettes (e-cigs) may provide such a novel harm reduction and cessation opportunity, but little is known about the knowledge of, attitudes about, and usage of e-cigs in opioid dependent smokers. The current study enrolled 315 opioid dependent smokers (164 methadone, 151 buprenorphine), treated in the same health system in Fall River, Massachusetts. The sample was 49.7% male and 85.1% non-Latino White. Overall 98.7% had heard of e-cigs, 73.0% had ever tried e-cigs, and 33.8% had used e-cigs in the past 30 days. The most common reasons for use were curiosity (41.4%) and to quit all nicotine (26.0%). The proportion of opioid dependent smokers that had ever tried e-cigs and used them in the past month was substantially greater than that found in recent general population surveys. While e-cigs have been used to quit smoking, how to optimize their utility as a cessation tool remains undefined. E-cigs should be a part of smoking cessation discussions with this vulnerable, difficult-to-treat population.

Project Impact: a pharmacotherapy pilot trial investigating the abstinence and treatment adherence of Latino light smokers.

Light smoking is particularly prevalent among Latino smokers. Nicotine replacement (NRT) and varenicline are effective medications for smoking cessation for moderate-heavy smokers but have not been tested in light smokers, and thus, there are no treatment guidelines for use with light smokers. This pilot trial tested the efficacy of NRT and varenicline in increasing smoking abstinence among Latino light smokers. A 3-group (NRT, varenicline, and varenicline-placebo) randomized design was used, and Latino light smokers (≤10 cigarettes per day) received 12 weeks of treatment, which included a culturally informed behavioral health session and ongoing medication management visits. At follow-up, there were no abstinent participants in the placebo and NRT groups. However, 30% of participants in the varenicline group were abstinent at the 3-, 4-, and 6-month follow-up. This study represents the only investigation that specifically targets Latino light smokers using these treatments and characterizing their treatment adherence.

Lead exposure and poisoning of songbirds using the Coeur d'Alene River Basin, Idaho, USA.

Previous studies have found widespread Pb poisoning of waterfowl in the Coeur d'Alene River Basin in northern Idaho, USA, which has been contaminated by mining and smelting activities. We studied the exposure of ground-feeding songbirds to Pb, sampling 204 American robins (Turdus migratorius), song sparrows (Melospiza melodia), and Swainson's thrushes (Catharus ustulatus) throughout the basin. These songbirds had mean blood Pb concentrations (mg/kg, dry weight) of less than 0.19 at a reference area (25 mg Pb/kg soil), 1.09 at moderately contaminated sites (170 to 1300 mg Pb/kg soil), and 2.06 at highly contaminated sites (2000 to 5000 mg Pb/kg soil). Based on guidelines for evaluating blood Pb in birds, 6% of robins from the highly contaminated sites had background concentrations, 24% were subclinically poisoned, 52% were clinically poisoned, and 18% were severely clinically poisoned with Pb. Blood Pb concentrations were lower in song sparrows than in robins and lowest in Swainson's thrushes. More than half of the robins and song sparrows from all contaminated sites and more than half of the Swainson's thrushes from highly contaminated sites showed at least 50% inhibition of the activity of the enzyme δ-aminolevulinic acid dehydratase (ALAD), commonly used as a measure of exposure to Pb. The highest hepatic Pb concentration of 61 mg/kg (dry weight) was detected in a song sparrow. Using Al as a marker for soil in songbird ingesta, we estimated average soil ingestion rates as 20% in robins, 17% in song sparrows, and 0.7% in Swainson's thrushes. Soil Pb in ingesta accounted for almost all of the songbirds' exposure to Pb. Based on these results, it is recommended that ecological risk assessments of ground-feeding songbirds at contaminated sites include soil ingestion as a pathway of exposure to Pb.

Relating the ability of mallards to ingest high levels of sediment to potential contaminant exposure in waterfowl.

When waterfowl feed from the bottom of bodies of water, they sometimes ingest sediments along with their food, and this sediment can be a major source of contaminants. Learning how much sediment waterfowl can consume in their diet and still maintain their health would be helpful in assessing potential threats from contaminants in sediment. In a controlled laboratory study the maximum tolerated percentage of sediment in the diet of mallards (Anas platyrhynchos) was measured. When fed a well-balanced commercial avian diet, 50, 60, or 70% sediment in the diet on a dry-weight basis did not cause weight loss over a two-week period. Ducks fed this same commercial diet, but containing 80 or 90% sediment, lost 8.6 and 15.6% of their body weight, respectively, in the first week on those diets. After factoring in the ability of the mallards to sieve out some of the sediment from their diet before swallowing it, we concluded that the mallards could maintain their health even when approximately half of what they swallowed, on a dry-weight basis, was sediment.

Blood lead concentrations in waterfowl utilizing Lake Coeur d'Alene, Idaho.

The Coeur d'Alene River Basin, Lake Coeur d'Alene, and the Spokane River contain elevated heavy metal concentrations in sediment and water from historical mining and ore processing operations in the Coeur d'Alene Basin. Lead poisoning has been identified as the cause of death in hundreds of waterfowl utilizing wetlands in the floodplain of the Coeur d'Alene River, but little was known about hazards to waterfowl from heavy metal contamination in shallow bays and wetlands of Lake Coeur d'Alene. We examined lake sediment and blood lead concentrations in waterfowl utilizing Lake Coeur d'Alene, Idaho, to evaluate potential lead contamination of waterfowl utilizing the lake. We collected 56 palustrine and 102 lacustrine sediment samples and 61 mallard and 8 wood duck blood samples. Mean lead concentrations from palustrine and lacustrine sediment samples ranged from 14 to 3508 mg/kg dry weight (dw) and from 19 to 5009 mg/kg (dw), respectively. Lead concentrations in palustrine and lacustrine sediment from several Lake Coeur d'Alene bays were higher than those in lake reference areas and were higher than Bunker Hill Superfund Site target cleanup levels and suggested site-specific toxicity thresholds for swans. Mean blood lead from mallard and wood ducks sampled from Lake Coeur d'Alene bays were within lead toxicity ranges for waterfowl associated with clinical and severe clinical lead poisoning. We also collected 19 Canada goose and 3 mallard fecal samples to evaluate exposure through sediment ingestion. Waterfowl using Lake Coeur d'Alene appear to be exposed to lead by ingesting contaminated lake sediment. Our model predicts a sediment lead effects range of 147-944 mg/kg (dw) and mortality effects level of 1652 mg/kg (dw) for mallards utilizing Lake Coeur d'Alene. The locations of Harrison Slough, Powderhorn Bay, and Cottonwood Bay at the mouth of the Coeur d'Alene River and Blackwell Island and Cougar Bay near the Spokane River outflow of Lake Coeur d'Alene were the areas of greatest concern for waterfowl exposure to lead contaminated sediment.

Phosphorus amendment reduces hepatic and renal oxidative stress in mallards ingesting lead-contaminated sediments.

Lead poisoning of waterfowl has been reported for decades in the Coeur d'Alene River Basin (CDARB) in Idaho as a result of the ingestion of lead-contaminated sediments. This study was conducted to determine whether the addition of phosphoric acid to CDARB sediments would reduce the bioavailability and toxicity of lead to the liver and kidney of mallards (Anas platyrhynchos). Mallards received diets containing 12% clean sediment (controls) or 12% sediment from three different CDARB sites containing 4520, 5390, or 6990 microg/g lead (dry weight) with or without phosphoric acid amendment. Liver and kidney lead concentrations were significantly higher in all CDARB treatment groups and ranged from geometric mean values of 18.2 (liver) and 28.7 (kidney) for the first 2 sites to 22.5 (liver) and 45.6 (kidney) microg/g (wet weight) for the third site. With amendments all liver lead concentrations were reduced 36 to 55%, and all kidney lead concentrations were lowered 54 to 73%. Unamended CDARB sediment from the third site resulted in the following hepatic effects: over 1.6-fold elevation of liver glutathione (reduced form; GSH) concentration, higher GSH S-transferase and oxidized glutathione (GSSG) reductase activities, and lower protein-bound thiols (PBSH) concentration. Renal effects included higher kidney GSH concentrations for all CDARB sites, with over 2.1-fold higher for the third site. Resulting kidney GSSG to GSH ratios were lower at two sites. At the third site, gamma-glutamyl transferase (GGT) activity was elevated, and lipid peroxidation as thiobarbituric acid-reactive substances (TBARS) was 1.7-fold greater. Amendment restored all hepatic variables as well as the renal variables TBARS and GGT so they did not differ from controls. Although amendments of phosphorus substantially reduced the bioavailability of lead and some of the adverse effects, lead concentrations in the tissues of mallards fed the amended sediments were still above those considered to be harmful to waterfowl under the present conditions.

Phosphorus amendment reduces hematological effects of lead in mallards ingesting contaminated sediments.

Lead poisoning of waterfowl has been reported for decades in the Coeur d'Alene River Basin (CDARB) in Idaho as a result of the ingestion of lead-contaminated sediments. This study was conducted to determine whether the addition of phosphoric acid to sediments would reduce the bioavailability and toxicity of lead to mallards (Anas platyrhynchos) as related to adverse hematological effects and altered plasma chemistries. Mallards received diets containing 12% clean sediment (controls) or 12% sediment from three different CDARB sites containing 4520, 5390, or 6990 microg/g lead (dw) with or without phosphoric acid amendment. Blood lead concentrations were significantly higher in all CDARB treatment groups and ranged from geometric mean values of 5.0 microg/g for the first two sites to 6.2 microg/g for the third site. With amendments, all blood lead concentrations became 41% to 64% lower. Red blood cell ALAD activity was depressed by 90% or more with lead-contaminated sediment from all sites and did not differ with amended diets. Free erythrocyte protoporphyrin (FEP) concentrations were elevated by contaminated sediment from all sites. Amendment decreased the elevations in FEP by as much as 80%. Hematocrit values and hemoglobin concentrations were lower for all lead site sediments by as much as 30% for site 3. Plasma enzyme activities for ALT, CK, and LDH-L were elevated by as much as 2.2-fold, and plasma creatinine concentration was 1.7-fold higher for site 3 sediment. Amendments restored hematocrit, hemoglobin, and plasma enzyme activities so that they did not differ from controls. Although amendments of phosphorus substantially reduced the bioavailability of lead and alleviated many of the adverse hematological effects, lead concentrations in the blood of mallards fed the amended sediments were still above those believed to be harmful to waterfowl under the present conditions.

Phosphorus amendment reduces bioavailability of lead to mallards ingesting contaminated sediments.

Lead poisoning of waterfowl has been reported for decades in the Coeur d'Alene River Basin in Idaho as a result of the ingestion of lead-contaminated sediments. We conducted a study to determine whether the addition of phosphoric acid to sediments would reduce the bioavailability of lead to mallards (Anas platyrhynchos). When sediments were amended with 1% phosphorus under laboratory conditions, and diets containing 12% amended sediment were fed to mallards, reductions in tissue lead were 43% in blood, 41% in liver, and 59% in kidney with sediment containing about 4,520 microg/g lead on a dry-weight basis and 41, 30, and 57% with sediment containing about 6,990 microg/g lead. When sediments were treated with phosphorus and left to age for about 5 months in the field, reductions in lead were 56% in blood, 54% in liver, and 66% in kidney at one site with about 5,390 microg/g lead and 64, 57, and 77% at a second site with about 6,990 microg/g lead. In the field, the inability to mix the phosphoric acid uniformly and deeply enough into the sediment may have resulted in more than 1% phosphorus being added to the sediment. Although both lab and field amendments of phosphorus substantially reduced the bioavailability of lead, lead concentrations in the tissues of mallards fed the amended sediments were still above those believed to be harmful to waterfowl. Based on earlier studies of sediment toxicity to waterfowl in the Coeur d'Alene River Basin, combined with the results of our amendment study, the addition of phosphoric acid as we used it might only significantly benefit waterfowl where sediments or soils contain less than 1,000-2,000 microg/g lead.