Joint Effects Research Articles

Examining the Joint Effects of Epilepsy and Mental Health Conditions on Severe Maternal Morbidity.

Background: Mental health conditions and epilepsy frequently coexist and have independently been associated with severe maternal morbidity (SMM). Since little is known about the risks of these conditions when they occur together in pregnancy, we evaluated the associations of mental health conditions, epilepsy, and SMM. Methods: We conducted a population-based study of births in California between 2007 and 2018. Antenatal epilepsy and mental health conditions (defined as depression, anxiety, posttraumatic stress disorder, and other) were identified using billing codes. We categorized individuals into the following mutually exclusive exposure groups: no epilepsy or mental health conditions (referent), mental health conditions alone, epilepsy alone, or both epilepsy and mental health conditions. Our primary outcome was SMM, defined by the 20-indicator Centers for Disease Control and Prevention Index. We conducted multivariable logistic regression models adjusted for sociodemographic and clinical confounding factors. Results: In a cohort of 5,275,994 births, SMM occurred more frequently in individuals with mental health conditions alone, epilepsy alone, and both mental health conditions and epilepsy (1.8%, 3.0%, 4.2%, respectively) compared with the referent group (0.8%). The odds of SMM were significantly increased for each exposure group: adjusted odds ratio (aOR) 2.13, 95% confidence interval (CI) 2.05-2.22 for mental health conditions; aOR 3.79, 95% CI 3.45-4.18 for epilepsy; and aOR 4.91, 95% CI 4.01-6.00 for both. Conclusion: Epilepsy and mental health conditions were independently associated with SMM, and individuals carrying both diagnoses had the highest odds of SMM. Our results highlight the need for awareness of SMM risks in this population.

C-reactive protein, genetic susceptibility, and the long-term risk of venous thromboembolism in patients with past cancer.

Several studies indicated that C-reactive protein (CRP) is associated with the risk of venous thromboembolism (VTE) in general population. But CRP appears to be unrelated to VTE events in newly diagnosed cancer patients. However, as the survival time of cancer patients increases, the effect of CRP on the long-term risk of VTE may change. We aimed to investigate the association between CRP and VTE in cancer survivors, and further assess the modification effect of genetic susceptibility. Cox proportional hazards model was used to evaluate the association between serum CRP levels and VTE risk, as well as to investigate the joint effect of CRP and genetic susceptibility. The Kaplan-Meier curve and the restricted cubic spline were used to visualize the relationship between CRP and VTE. This study included 30,145 participants with cancer diagnosis at baseline in the UK Biobank. Over a follow-up period of 344,636 person-years, a total of 1,151 VTE events were recorded. Participants were divided into four groups based on the quartiles of CRP levels. The adjusted hazard ratios (95% CIs) of Q1, Q2, Q3, and Q4 were 1.00, 1.20 (0.99-1.44), 1.25 (1.04-1.50), and 1.51 (1.25-1.82), respectively. For those with high genetic risk of VTE, high CRP had an additional increased risk for VTE. CRP can be used as a predictive biomarker for VTE risk in cancer survivors, especially for those with high genetic risk. Future research can explore whether prevention and treatment strategies for VTE can be developed based on CRP for cancer survivors.

Identifying modifiable factors and their joint effect on brain health: an exposome-wide association study.

Considerable uncertainty remains regarding the associations of multiple factors with brain health. We aimed to conduct an exposome-wide association study on neurodegenerative disease and neuropsychiatry disorders using data of participants from the UK Biobank. Multivariable Cox regression models with the least absolute shrinkage and selection operator technique as well as principal component analyses were used to evaluate the exposures in relation to common disorders of central nervous system (CNS). Restricted cubic splines were conducted to explore potential nonlinear correlations. Then, weighted standardized scores were generated based on the coefficients to calculate the joint effects of risk factors. We also estimated the potential impact of eliminating the unfavorable profiles of risk domains on CNS disorders using population attributable fraction (PAF). Finally, sensitivity analyses were performed to reduce the risk of reverse causality. The current study discovered the significantly associated exposures fell into six primary exposome categories. The joint effects of identified risk factors demonstrated higher risks for common disorders of CNS (HR = 1.278 ~ 3.743, p < 2e-16). The PAF varied by exposome categories, with lifestyle and medical history contributing to majority of disease cases. In total, we estimated that up to 3.7 ~ 64.1% of disease cases could be prevented.This study yielded modifiable variables of different categories and assessed their joint effects on common disorders of CNS. Targeting the identified exposures might help formulate effective strategies for maintaining brain health.

Sunscreen use associated with elevated prevalence of anti-nuclear antibodies in U.S. adults.

Antinuclear antibody (ANA) prevalence in the U.S. population increased from 1988 to 2012, especially in white and more educated individuals. In adults ages 20-39 years from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 and 2011-2012, ANA prevalence was previously associated with urinary concentrations of a common sunscreen ingredient, benzophenone 3, measured in winter. Spot urines may not capture relevant chronic exposures, thus we examined whether ANA was related to sunscreen use. In a cross-sectional study of adults ages 20-59 (N=416 ANA positive, 2656 ANA negative, by Hep-2 immunofluorescence, 1:80 dilution), we examined associations of ANA with reported sunscreen use when in the sun for 1h or more. Logistic regression was used to calculate covariate-adjusted prevalence odds ratios (POR) and 95% Confidence Intervals (CI), overall and stratified by demographic factors, season, and vitamin D. We explored associations and joint effects with other sun protective behaviors and sunburn in the past 12 months. The association of ANA with sunscreen differed by age (interaction p=0.004): for ages 20-39, we saw an exposure response (POR 2.61, 95% CI 1.50, 4.24 for using sunscreen always or most of the time, and POR 1.85; 1.12, 3.05 for less frequent versus never-use; trend p<0.001). These associations were more apparent in females (interaction p=0.082), non-Hispanic white and black participants (vs. other race/ethnicity, interaction p=0.023), and those with sufficient serum vitamin D (≥50 vs. <50nmol/L, interaction p=0.001). ANA was not associated with other protective behaviors and not confounded or modified by these behaviors or recent sunburn. These cross-sectional findings showed frequent sunscreen was associated with ANA in younger adults, supporting the need for replication, and longitudinal studies with detailed exposure histories.

Performance of hinge joints in hollow-core slab bridges reinforced with iron-based shape memory alloy U-bars

The mechanical behavior of hinge joints has an important influence on the hollow-core slab bridges. However, hinge joints are prone to cracking. This study proposed a new hinge joint reinforced by locally prestressed iron-based shape memory alloy (Fe-SMA) U-bars for the new hollow-core slab bridge. To verify the effectiveness of this hinge joint, six test specimens were prepared, encompassing two spans (10 m and 20 m), and three working conditions (nonactivation, activation before cracking, and repair and activation after cracking). The load transfer mechanism under flexural-shear load was investigated, and the validity was verified using a proposed simplified analytical model. The results indicated that the failure mode of the new hinge joint under flexural-shear load can be divided into three stages. The new hinge joint can effectively apply local prestressing by heating activation of the Fe-SMA U-bars, thus increasing the crack penetration load. In addition, the damaged new hinge joints can be repaired and further reinforced by pressure injection of adhesive and heating activation of the Fe-SMA U-bars. Load transfer is affected by the development of cracks, and the ultimate load of the new hinge joint is controlled by the splitting tensile strength of the concrete in the hinge joint.

Breaking the silence: The effects of online social movements on gender-based violence

This paper investigates the impact of online social movements against gender-based violence (GBV) on GBV-related crime. Using machine learning techniques, we construct a novel dataset tracking the prevalence of GBV-related social media movements on Twitter from 2014 to 2017. Matching this data with weekly FBI crime reports across U.S. states we estimate the effect of tweets related to GBV on GBV-related reported crime. Our econometric approach aims to mitigate concerns of spurious correlations arising from common trends in Twitter usage and crime. We estimate national level regressions with differential effects on GBV-related and non-GBV-related crimes within the same week, as well as regressions at the state-by-week level controlling for state and month fixed effects. Our main findings reveal that GBV-related tweets led to a small but significant short-term decrease in GBV-related crime reports. Further analysis suggests that the decrease is attributable to a reduction in actual crime rather than in reporting behavior.

Towards Context-Aware Emotion Recognition Debiasing From a Causal Demystification Perspective via De-Confounded Training.

Understanding emotions from diverse contexts has received widespread attention in computer vision communities. The core philosophy of Context-Aware Emotion Recognition (CAER) is to provide valuable semantic cues for recognizing the emotions of target persons by leveraging rich contextual information. Current approaches invariably focus on designing sophisticated structures to extract perceptually critical representations from contexts. Nevertheless, a long-neglected dilemma is that a severe context bias in existing datasets results in an unbalanced distribution of emotional states among different contexts, causing biased visual representation learning. From a causal demystification perspective, the harmful bias is identified as a confounder that misleads existing models to learn spurious correlations based on likelihood estimation, limiting the models' performance. To address the issue, we embrace causal inference to disentangle the models from the impact of such bias, and formulate the causalities among variables in the CAER task via a customized causal graph. Subsequently, we present a Contextual Causal Intervention Module (CCIM) to de-confound the confounder, which is built upon backdoor adjustment theory to facilitate seeking approximate causal effects during model training. As a plug-and-play component, CCIM can easily integrate with existing approaches and bring significant improvements. Systematic experiments on three datasets demonstrate the effectiveness of our CCIM.

Advancing Real-World Image Dehazing: Perspective, Modules, and Training.

Restoring high-quality images from degraded hazy observations is a fundamental and essential task in the field of computer vision. While deep models have achieved significant success with synthetic data, their effectiveness in real-world scenarios remains uncertain. To improve adaptability in real-world environments, we construct an entirely new computational framework by making efforts from three key aspects: imaging perspective, structural modules, and training strategies. To simulate the often-overlooked multiple degradation attributes found in real-world hazy images, we develop a new hazy imaging model that encapsulates multiple degraded factors, assisting in bridging the domain gap between synthetic and real-world image spaces. In contrast to existing approaches that primarily address the inverse imaging process, we design a new dehazing network following the "localization-and-removal" pipeline. The degradation localization module aims to assist in network capture discriminative haze-related feature information, and the degradation removal module focuses on eliminating dependencies between features by learning a weighting matrix of training samples, thereby avoiding spurious correlations of extracted features in existing deep methods. We also define a new Gaussian perceptual contrastive loss to further constrain the network to update in the direction of the natural dehazing. Regarding multiple full/no-reference image quality indicators and subjective visual effects on challenging RTTS, URHI, and Fattal real hazy datasets, the proposed method has superior performance and is better than the current state-of-the-art methods.

Concentration-dependent cellular responses of coontail (Ceratophyllum demersum) during the substitutions to perfluorooctanoic acid by its two alternatives

The substitutions of alternatives to legacy per- and polyfluoroalkyl substances (PFASs) may lead to unknown and variational joint toxicity on ecosystems. To comprehensively understand the effects of substitutions on aquatic ecosystems, the single and joint effects of perfluorooctanoic acid (PFOA) and its alternatives (perfluorobutanoic acid, PFBA; 2,3,3,3-tetrafluoro-2-(1,1,2,2,3,3,3,heptafluoropropoxy)propanoic acid, GenX) with various concentrations and compositions on a primary producer, coontail (Ceratophyllum demersum), were investigated at cellular level. Results showed that the substitutions of PFBA/GenX could alleviate the inhibition of PFOA on plant length, hydrogen peroxide accumulation, and chlorophyll b, due to the shifts of reactive oxygen species and their less toxicity to antioxidants. Significant up-regulations of superoxide dismutase, glutathione, and carotenoid implied their primary roles in defensing against PFASs (p<0.05). Catalase/peroxidase was significantly up-regulated in PFBA/GenX substitutions (p<0.05) to help alleviate stress. PFBA substitutions reduced 23.9% of PFOA in organelle and GenX reduced the subcellular concentrations of PFOA by 1.8%–17.4%. Redundancy analysis suggested that PFOA, PFBA, and GenX in cell wall and organelle, as well as GenX in soluble fractions, were responsible for the cellular responses. These findings were helpful to understand the integrated effects on aquatic ecosystems during the substitutions to legacy PFASs by alternatives.

Phage-derived polysaccharide depolymerase potentiates ceftazidime efficacy against Acinetobacter baumannii pneumonia via low-serum-dependent mechanisms

The emergence of multidrug-resistant Acinetobacter baumannii (MDR-AB), which most commonly manifests as pneumonia, has posed significant clinical challenges and called for novel treatment strategies. Phage depolymerases, which degrade bacterial surface carbohydrates, have emerged as potential antimicrobial agents. However, their preclinical application is limited to systemic infections due to their dependency on serum-mediated bacterial killing. To extend the treatment paradigm of depolymerase to low-serum lung infections, we explored the feasibility of applying phage depolymerase to potentiate antibiotic efficacy in controlling MDR-AB pneumonia. Using a model depolymerase, Dpo71, we observed that it could effectively potentiate antibiotic efficacy against MDR-AB2 bacteria in low-serum conditions mimicking lung milieu but showed no adjuvant effect in serum-free conditions. Unprecedentedly, we reported this low-serum-dependent mechanism that polysaccharide-degrading enzyme Dpo71 exposed bacteria to serum-induced membrane permeabilization and oxidative phosphorylation pathway inhibition, leading to a weakened ATP-dependent efflux pump and strengthened ROS-induced membrane permeabilization. These joint effects facilitated antibiotic (ceftazidime, CFZ) binding, ultimately exerting bactericidal effects. Resultantly, the bacterial load in the lungs of the Dpo71-CFZ combination group was significantly reduced compared with the Dpo71-alone and CFZ-alone groups. Overall, this study unravels the low-serum-dependent mechanisms by which depolymerase potentiated antibiotic efficacy, highlighting its potential as a novel strategy to enhance antibiotic activity against severe pneumonia.

Vegetation diversity in structure, species or colour: Coupling effects of the different characteristics of urban green spaces on preference and perceived restoration

The benefits of urban green spaces for human beings have become increasingly evident amid global urbanisation, which has exacerbated health issues. However, the effects of different characteristics of urban green spaces, such as vegetation structure, species and colour, on human health and well-being remain poorly understood. This study addressed this gap using a mixed design (between-subjects and within-subjects) and a 2 × 2 × 2 factorial design to combine structural diversity, species richness and colour diversity of vegetation. Participants experienced virtual scenes created on Mars to assess preference and perceived restoration. Through analysis of variance (ANOVA), beneficial features of urban green space and formulated equations using a linear regression model to explain the joint effects of these characteristics were identified. Results indicate that rich structure, species and colours of vegetation significantly enhance preferences and perceived restoration, with colour having the greatest impact ─ 2.55 times greater than structural diversity and species richness. However, the superposition of multiple features does not mean ‘the more the merrier’, as binary and ternary interactions can have synergistic and erosive roles. Therefore, medium complexity is most beneficial for improving health and well-being. Overall, urban green space construction should consider multiple dimensions for a harmonious relationship between humans and nature, promoting sustainable development.

Adequate sleep duration accentuates the effect of glucagon-like peptide-1 receptor variant on HbA1c: A gene-environment interaction study

BackgroundBoth glucagon-like peptide-1 receptor (GLP1R) agonists and lifestyle modifications are widely adopted in managing glycemia. However, the joint effects of GLP1R agonists with lifestyle on glycemic traits have not been evaluated. MethodsThis gene-environment study tested the interaction between GLP1R-rs10305492 variant, consistent with the effect of GLP1R agonist therapies, and four lifestyle factors (diet, physical activity, sleep duration, and chronotype) for glucose and glycated hemoglobin (HbA1c) levels among 263,846 UK Biobank participants. Linear regression models were conducted to evaluate the effects of the rs10305492 and lifestyle factors on glucose and HbA1c levels. ResultsGLP1R-rs10305492-AA/AG genotype combined a healthy diet, regular physical activity, adequate sleep duration, or morning chronotype were associated with lower glucose and HbA1c levels (all P for trend < 0.001). A synergistic effect was found between rs10305492 and sleep duration on HbA1c, suggesting a recommended adequate sleep duration (7–8 h/day) may amplify the HbA1c lowering effect of GLP1R agonists. Joint effects of the rs10305492 and adequate sleep were associated with a 26 % reduced risk of hyperglycemia (>7.8 mmol/L) risk and a 22 % lower of high HbA1c (>39 mmol/mol or 5.7 %). ConclusionsCombining GLP1R agonists with adequate sleep may provide additional benefits for glycemic control in clinical practice.

An Evaluation Of The Effect Of Corporate Governance And Macroeconomic Variables On Financial Performance Of Pension Schemes In Kenya

The study investigated the impact of corporate governance (CG) and macroeconomic variables on the financial performance of pension schemes in Kenya thereby addressing the key research question: What is the effect of CG and macroeconomic variables on the financial performance of pension funds in Kenya? Qualitative, quantitative and correlational research designs were used to assess the effect of these factors on financial performance of pension funds. Quantitative data on annual return of pension funds and macroeconomic variables from 2012 to 2020 as well as qualitative data on CG indicators were used in the study. Return on investments proxied pension fund performance. Primary data was collected using survey questionnaires from the pension schemes from the CG indicators to develop the CG index. The findings show that effect of CG indicators on pension performance was positive and significant. The moderating effect of macroeconomic variables was significant whereas the joint effect of CG indicators and macroeconomic factors on pension funds performance was significant. The individual contribution of both factors was nevertheless varied. The main conclusion of the study is that pension fund financial performance is influenced by both CG and macroeconomic factors implying that there is need to take into account the impact of these factors in the execution of investment plans of pension funds to ensure generation of adequate funds for retirement benefits.

Effects of lift-up building design, building setback, and urban open space on pedestrian danger under the joint effect of floodwater and wind

Urban block layouts affect both the flow patterns of floodwater and wind in urban built environments and ultimately pedestrian danger within the urban building array. Computational fluid dynamics (CFD) is used to simulate both the floodwater inundation process and the wind-blowing process within three kinds of urban block configurations under a floodwater-wind joint effect, including the lift-up building design, horizontal and vertical building setbacks, and urban open space. The obtained floodwater velocity, depth, and wind speed at the pedestrian level are adopted to quantify the level of pedestrian danger by using the instability threshold formula of a human body. A laboratory flume experiment regarding the stability/instability of a dummy that represents a pedestrian in a quasi-natural state is performed to qualitatively validate the numerical simulation results. Compared to the cuboid or triangular pillar that supports the lift-up building structure, the circular pillar yields the minimum resistance against floodwater and increases the wind speed at the pedestrian level, consequently leading to a large danger zone area. Horizontal building setbacks decrease the pedestrian danger, but vertical building setbacks intricately affect it. The existence of open space within the block decreases pedestrian danger to some extent depending on the location and area of open space. The wind plays the dominant role in triggering pedestrian instability for both the lift-up building design and the horizontal setback case. For both the lift-up building design and the open space configuration, the walking and running speeds of pedestrians decrease much more than the conventional urban block. The results of this study could be referred to by administrators and stakeholders in the design and management of urban building arrays to mitigate pedestrian risk in the content of resilient city management.

Casual inference-enabled graph neural networks for generalized fault diagnosis in industrial IoT system

Data-driven fault diagnosis plays a crucial role in diagnosing the operational status within the Industrial Internet of Things (IIoT) systems. Although Graph Neural Networks (GNNs) have recently gained traction in fault diagnosis by adeptly modeling complex dependencies present in high-dimensional sensor measurements, they still grapple with the challenges presented by varying working conditions and pervasive environmental noise, which can significantly hinder their generalization capabilities. Hence, we propose Causal Inference-Enabled Graph Neural Networks (CIE-GNN) for generalized fault diagnosis in large-scale IIoT systems. Specifically, we establish a structural causal model for the GNN-based fault diagnosis model, revealing that the non-causal factors lead to spurious correlations and act as the confounders, thus impairing the generalization performance of fault diagnosis models. To rectify this issue, we design the disentangled transformation module and the causal disentanglement regularization based on mutual information minimization strategy, facilitating the effective decoupling between the fault-causal factors and the non-causal factors in the representation level. Additionally, we propose the random pairing-based backdoor adjustment regularization to mitigate the negative effects of non-causal factors. Extensive experiments and rigorous theoretical analysis validate the generalization capabilities of CIE-GNN across diverse working environments.

Concurrent consumption of cocoa flavanols and caffeine does not acutely modulate working memory and attention

PurposeConsumption of cocoa flavanols and caffeine might acutely enhance cognition, particularly in synergy. Due to the use of multifaceted tasks in prior research, it is unclear precisely which cognitive functions are implicated. Here we aimed to assess the acute effects of the (joint) ingestion of cocoa flavanols and caffeine on temporal attention, spatial attention, and working memory.MethodsIn four separate sessions of a randomized, double-blind, placebo-controlled, crossover trial, 48 young adult participants consumed a placebo drink, a cocoa flavanols (415 mg) drink, a caffeine (215 mg) drink, and a drink containing both concurrently. In each session, after ingestion, we tested performance in three cognitive tasks. We tested temporal attention in a dual-target rapid serial visual presentation paradigm, known to elicit the attentional blink, in which the time between the targets was manipulated. We measured spatial attention in a visual search task, where we varied the number of distractors that appeared simultaneously with the target. We tested working memory in a delayed recall task, in which the number of stimuli to be remembered was manipulated.ResultsWe obtained the expected performance pattern in each task, but found no evidence for modulation of response accuracy or reaction times by the ingestion of either substance, nor of their combined ingestion, even in the most challenging task conditions.ConclusionsWe conclude that, even when jointly ingested, neither the tested amount of cocoa flavanols nor caffeine have acute effects that are robustly measurable on cognitive tasks that target attention and working memory specifically.

Triglyceride-glucose index and its additive interaction with ABCG2/SLC2A9 polygenic risk score on hyperuricemia in middle age and older adults: findings from the DLCC and BHMC study

Objective We aim to investigate the joint effect of triglyceride-glucose (TyG) index and polygenic risk scores (PRS) of urate transporter genes ABCG2 and SLC2A9 on hyperuricemia. Methods Baseline data from two prospective population-based cohort studies, including 30,453 individuals aged 50 years or older, were used to analyze the association between TyG index and hyperuricemia. A case-control study was then designed from the cohorts to investigate the interaction between genetic predisposition and TyG index on hyperuricemia among 595 matched pairs. PRS was constructed using 14 single nucleotide polymorphisms located in the ABCG2 and SLCA29 genes. Results In both sexes, higher TyG index levels were correlated with elevated serum urate (SUA) levels (p values in both sexes < 0.001). In men, per unit increase of TyG was associated with a 1.44-fold (95% confidence interval [CI]: 1.35–1.55) higher risk of hyperuricemia after adjusted for covariates. In women, this estimate was 1.69 (1.51–1.89). Demonstrated by the restrict cubic spline model, TyG index was both linearly and non-linearly associated with elevated SUA (both p values < 0.001). Association between TyG index and hyperuricemia was stronger among people with higher genetic risk, and vice versa. Compared to people with TyG < 9 and PRS < 2, the odds ratios (ORs) (95% CIs) for hyperuricemia in the TyG <9 but PRS ≥2, TyG ≥9 but PRS < 2, TyG ≥9 and PRS ≥2 groups were 3.30 (1.53–7.14), 3.16 (1.23–8.11) and 7.55 (2.76–20.65), respectively. Additive interaction was also significant, with 57.5% (30.5%–84.4%) of the excess risk attributable to the additive gene-TyG index interaction. Conclusions The impact of genetic predisposition on hyperuricemia was significantly greater among individuals with a higher TyG index. Over 50% of the increased risk can be attributed to the interaction, indicating a crucial synergy between genetic factors and TyG index when estimating hyperuricemia risk.

Menopausal characteristics and hormone replacement therapy in relation to long-term risk of cholecystectomy in women

BackgroundWomen are known to be at higher risk for gallbladder disease than men, suggesting a role of female hormones in the pathogenesis of gallbladder disease. This study aimed to assess menopausal characteristics, hormone replacement therapy (HRT) and their joint effect on long-term risk of cholecystectomy in women.MethodsA total of 184,677 women were included from the UK Biobank. Multivariable Cox regression models were used to estimate the associations of menopausal characteristics and HRT with risk of cholecystectomy. The joint influence of HRT use and the status and type of menopause on incident cholecystectomy were further evaluated.ResultsDuring a median of 12.7 years of follow-up, 4,991 incident cases of cholecystectomy were identified. Natural menopause, regardless of menopausal age, was not associated with risk of cholecystectomy, while surgical menopause at a young age was associated with a higher risk of cholecystectomy. Ever use of HRT was associated with a higher risk of cholecystectomy. In particular, women who were surgically-menopausal and started HRT before menopause had the highest risk for cholecystectomy (hazard ratio = 2.28; 95% confidence interval: 1.70–3.04), when compared with women who were naturally-menopausal and never used HRT.ConclusionsEarly surgical menopause and ever use of HRT was independently associated with the risk of cholecystectomy.

Using Digital Art and Attachment Priming in a Web-Based Serious Game to Reduce Pain and Social Disconnection in Individuals With Chronic Pain and Loneliness: Randomized Controlled Trial.

Arts engagement using virtual reality and serious games represent promising nonpharmacological self-management treatment approaches to chronic pain. This study is the first randomized controlled trial to explore the impact of a web-based serious game that simulated a visit to an art museum on pain and social disconnection among individuals living with chronic pain and loneliness. This study aimed to test the joint and separate effects of exposure to digital art and attachment figure priming on pain and social disconnection among individuals living with chronic pain and loneliness. This randomized controlled trial used a 2 (digital artwork present and absent) × 2 (secure attachment and avoidant attachment prime) repeated measures factorial web-based experimental design with a hanging control condition. Mediation and moderation analyses examined how feelings about the social world triggered by the artwork and frequency of museum visits impacted the effects of the interventions on pain and social disconnection. The results are based on 308 participants. Mean age of the participants was 42.78 (SD 13.11; range 18-76) years, and 60.2% (n=186) were women. Posttest pain was lower than pretest pain for the artwork present (P=.001) and absent (P=.001) conditions. Similarly, posttest pain was lower than pretest pain for the secure (P=.001) and avoidant (P=.001) attachment priming conditions. Relative to the control group, artwork present (P=.001) and absent (P=.01) conditions had decreased posttest pain. The secure (P=.001) and avoidant (P=.001) attachment priming conditions also had lower posttest pain scores relative to the control group. Moreover, social disconnection decreased from pre- to posttest for both the artwork present (P=.04) and the secure attachment priming (P=.002) conditions. Relative to the control group, posttest social disconnection was lower for the artwork present (P=.02) and secure attachment priming condition (P=.03). The artwork-secure attachment (P=.001) and artwork-avoidant attachment (P=.006) conditions had lower posttest pain scores compared with the control group. Social disconnection decreased from pre- to posttest for the artwork-secure attachment (P=.01) and no artwork-secure attachment (P=.05) conditions. Posttest social disconnection was lower for the artwork-secure attachment condition compared with the control group (P=.04). Positive feelings about the social world triggered by artwork exposure and frequency of museum visits in the last year played a mediating and moderating role in these effects. Positive feelings about the social world were associated with decreased pain (B=-.53) and social disconnection (B=-.25), and these effects operated on individuals exposed to digital artwork at low, medium, and high frequency of physical museum visits. Relative to a control group, visiting a web-based art museum reliably decreased pain and social disconnection among individuals living with chronic pain and loneliness. Engaging with digital artwork that triggers positive feelings about the social world may mitigate the burden of chronic pain.

Herbivory and allelopathy contribute jointly to the diversity-invasibility relationship.

Although herbivory and allelopathy play important roles in plant invasions, their roles in mediating the effect of plant diversity on invasion resistance remain unknown. In a 2-year field experiment, we constructed native plant communities with four levels of species richness (one, two, four, and eight species) and used a factorial combination of insecticide and activated carbon applications to reduce herbivory and allelopathy, respectively. We then invaded the communities with the introduced plant Solidago canadensis L. One year after the start of the experiment, there was no statistically significant net effect of species richness on biomass of the invader. However, a structural equation model showed that species richness had a positive direct effect on invader biomass that was partially balanced out by a negative indirect effect of species richness via increased light interception. In the second year, the relationship between invader biomass and species richness was negative when we analyzed the treatment combination with herbivory and allelopathy separately. Therefore, we conclude that joint effects of herbivory and allelopathy may play major roles in driving the diversity-invasibility relationship and should be considered in future studies.