Digital Commons Network^™

Measuring The Impact Of A Delay In Care On Pediatric Otolaryngologic Surgery Completion, Geethanjeli N Mahendran, Ching Siong Tey, Mary Frances Musso, Grace Shebha Anand, Jeffrey Larson, Mitesh Mehta, Lara Reichert, Kara Prickett, Nikhila Pinnapureddy Raol

Faculty, Staff and Students Publications

Objective: To determine if postponement of elective pediatric otorhinolaryngology surgeries results in a change in overall healthcare utilization and if there is any commensurate impact on disease progression.

Methods: We identified patients ≤18 years of age whose surgeries were postponed at the onset of the COVID-19 pandemic-related shutdown. We then tracked patients' rate of and patterns of rescheduling surgery. Surveys were also sent to caregivers to better characterize his/her decision regarding moving forward with his/her child's surgery during COVID-19.

Results: A total of 1915 pediatric patients had elective surgeries canceled, of which 992 (51.8%) were rescheduled within 4 months. No …

Nerve-To-Cancer Transfer Of Mitochondria During Cancer Metastasis, Gregory Hoover, Shila Gilbert, Olivia Curley, Clémence Obellianne, Mike T Lin, William Hixson, Terry W Pierce, Joel F Andrews, Mikhail F Alexeyev, Yi Ding, Ping Bu, Fariba Behbod, Daniel Medina, Jeffrey T Chang, Gustavo Ayala, Simon Grelet

Faculty, Staff and Students Publications

The nervous system has a pivotal role in cancer biology, and pathological investigations have linked intratumoural nerve density to metastasis1. However, the precise impact of cancer-associated neurons and the communication channels at the nerve–cancer interface remain poorly understood. Previous cancer denervation models in rodents and humans have highlighted robust cancer dependency on nerves, but the underlying mechanisms that drive nerve-mediated cancer aggressivity remain unknown2,3. Here we show that cancer-associated neurons enhance cancer metabolic plasticity by transferring mitochondria to cancer cells. Breast cancer denervation and nerve–cancer coculture models confirmed that neurons significantly improve tumour energetics. …

Reentry For Formerly Incarcerated Individuals: A Focus On Workforce Reentry And Recidivism In Appalachia, Margaret E. Francisco

Electronic Theses and Dissertations

Formerly incarcerated individuals face challenges to successful reentry, a critical component of reducing recidivism and improving public health outcomes. These challenges are particularly acute in rural Appalachia, where structural disadvantages such as limited economic opportunities, healthcare access, and public transportation intersect with stigma and systemic barriers related to prior incarceration. This dissertation addresses these gaps through a mixed-methods examination of reentry and recidivism, grounded in public health frameworks and focused on the unique context of rural Appalachia.

This work includes three studies. First, a PRISMA-guided systematic review synthesized qualitative research on barriers and facilitators to employment following incarceration. Findings highlighted …

The Resilience Of The Human Lungs: Evolution, Smoke, And Disease, Joan B Soriano, Francesca Polverino

Faculty, Staff and Students Publications

No abstract provided.

Stool-Based Molecular Tuberculosis Treatment Monitoring: A Faster Means For Detecting Persistent Mycobacteria Compared To Phenotypic Culture, Clement Gascua Adu Gyamfi, Abigail Seeger, Durbbin Mulengwa, Anca Vasiliu, Lucia Carratala-Castro, Bariki Mtafya, Nontobeko Maphalala, Shilzia Munguambe, Belen Saavedra, Tara Ness, Gugu Maphalala, Sozinho Acacio, Edson Mambuque, Joanna Ehrlich, Rojelio Mejia, Mangaliso Ziyane, H Lester Kirchner, Christoph Lange, Alexander Kay, Alberto L Garcia-Basteiro, Anna Mandalakas, Andrew R Dinardo

Faculty, Staff and Students Publications

Background: Tuberculosis (TB) treatment monitoring is hindered by the lack of a rapidly measured biomarker that accurately predicts clinically relevant outcomes. Symptom screening poorly correlates with bacillary burden. Although culture is a direct measure of viable bacillary burden, the long turnaround time makes it clinically irrelevant.

Methods: The TB treatment monitoring potential of stool-based, quantitative polymerase chain reaction (qPCR) was prospectively assessed among 231 participants of all ages from Eswatini, Tanzania, and Mozambique with microbiologically confirmed TB. Stool qPCR results were compared to sputum culture, persistent symptoms, drug resistance, and World Health Organization TB outcomes.

Results: Quantitative bacillary burden measured …

Effect Of Social Drivers Of Health On Screening For Type 2 Diabetes In Individuals With Gestational Diabetes During Delivery Hospitalization And 4-12 Weeks Postpartum, Ingmar N Bastian, Manisha Gandhi, Mark A Turrentine

Faculty, Staff and Students Publications

Objective: To prospectively evaluate postpartum diabetes screening rates among individuals with gestational diabetes mellitus (GDM) offered testing during the delivery hospitalization or at 4-12 weeks postpartum compared with historic outpatient-only screening and to assess the role of social and structural drivers of health.

Methods: This retrospective study compared patients with GDM who delivered between January 1 and December 31, 2023 (retrospective cohort), and underwent outpatient screening at 4-12 weeks postpartum with a 75-g 2-hour oral glucose tolerance test (OGTT) with a prospective cohort (June 24-November 5, 2024) of the first 100 patients who underwent screening in the immediate postpartum delivery …

The Impact Of Mindfulness Therapy To Reduce Disruptive Behavior In High School, Wendy Nell Peters

Electronic Theses and Dissertations

The aim of this project was to determine the impact and effectiveness of Gina Biegel’s mindfulness techniques for stressed teens method on adolescent anxiety and the disruptive symptoms that lead to high school adolescents being assigned to detention. This project described a quantitative correlational design research project that investigated a small adolescent sample size, with a goal of decreasing the number of local high school adolescent students who are repeat detention offenders, by implementing Gina Biegel’s mindfulness techniques for stressed teens method on those high school adolescents who were assigned to detention. This was achieved by collecting demographic data from …

Developing Culturally Centered Outreach Materials For Rural Native Veterans, Alexandra B Caloudas, Kelley Arredondo, Gail Beauchamp, Sharon Anastas, Kathy Marchant-Miros, Kristen Frosio, Giselle Day, Katherine Bay, Stephanie Day, Jan Lindsay, Jay Shore

Faculty, Staff and Students Publications

Native Americans serve in the U.S. military at the highest rate per capita of any ethnoracial group and have elevated rates of mental health (MH) difficulties compared to other ethnoracial groups, including posttraumatic stress disorder, alcohol use disorders, and suicide. Almost half of Native Veterans live in rural areas; rurality is associated with significant barriers to MH services. Engaging in outreach with Native Veterans is an important pathway for connecting them with MH care, but the outreach process and educational materials must be culturally aligned to be more effective. We collaborated with partners at a rural Department of Veterans Affairs …

Low-Dose Metformin Requires Brain Rap1 For Its Antidiabetic Action, Hsiao-Yun Lin, Weisheng Lu, Yanlin He, Yukiko Fu, Kentaro Kaneko, Peimeng Huang, Ana B De La Puente-Gomez, Chunmei Wang, Yongjie Yang, Feng Li, Yong Xu, Makoto Fukuda

Faculty, Staff and Students Publications

Metformin is the most commonly prescribed antidiabetes drug, yet its precise mechanism of action remains controversial. Previous studies have suggested that metformin acts peripherally by reducing hepatic glucose output and altering gut functions. Here, we report a neural mechanism via the small guanosine triphosphatase Ras-related protein 1 (Rap1). Mice with forebrain-specific Rap1 knockout exhibited resistance to the antidiabetic effects of low-dose metformin while remaining sensitive to other antidiabetic agents. Centrally administered metformin inhibited brain Rap1 and reduced hyperglycemia. Conversely, forced activation of brain Rap1 increased glycemia and abolished the glycemic effect of metformin. Metformin activated a specific subset of neurons …

Predictors Of Healthcare Providers' Readiness For Health System Transformation In Saudi Arabia, Ahmed Ali Alasiri

Health Services Research Dissertations

The healthcare system in Saudi Arabia is undergoing significant health reform to warrant sustainable welfare provision. Privatization or public-private partnerships (PPPs) were introduced in 2021 and outlined the vision for the health system for 2023. The planned initiatives aim to be comprehensive and effectively reach individuals and society, including citizens, noncitizens, and visitors. This dissertation seeks to study and explore privatization, the role of healthcare providers, and their capacity to adapt to the transformation of the healthcare system. To achieve this ambitious goal, several interrelated projects have been undertaken. The first project was a systematic review aimed at studying the …

Incidence Of And Risk Factors For Hospital-Acquired Bleeding In People With Cancer: A Systematic Review, Mansour Gergi, Jinah Kim, Amalia Dolan, Laura Haines, Ang Li, Neil A Zakai

Faculty, Staff and Students Publications

Background: Hospital-acquired (HA) bleeding (bleeding occurring during hospitalization) in cancer patients is poorly characterized, potentially increasing morbidity and mortality due to under- or overprescription of low-dose anticoagulation for venous thromboembolism prevention.

Objectives: To perform a systematic review and meta-analysis (as appropriate) to identify the incidence of and risk factors for HA bleeding in people with cancer.

Methods: A systematic English-language search was conducted using Ovid MEDLINE, Ovid EMBASE, Google Scholar, and Cochrane Library. Keywords and controlled vocabulary related to bleeding risk in hospitalized cancer patients were iteratively refined. Studies assessing HA bleeding as a primary or coprimary endpoint were included, …

Molecular Maestro In The Lung: The Sphingolipid Rheostat, Joselyn Rojas-Quintero, Francesca Polverino

Faculty, Staff and Students Publications

No abstract provided.

“Medication Is Only 10% Of Recovery”: A Mixed-Method Analysis Of Facilitators And Barriers To The Equitable Implementation Of Medications For Opioid Use Disorder Treatment, Alexandra Hernandez-Vallant

Psychology ETDs

Medications for opioid use disorder (MOUD), the gold standard treatment for OUD, are underutilized. Yet, research on MOUD clinical encounters is limited. Attention to social determinants of health (SDOH) can help improve engagement and retention in MOUD treatment. This dissertation project describes development of a clinical vignette-based survey using a two phase exploratory sequential design to examine the extent to which SDOH influence clinical decision-making among MOUD providers. Study 1 included interviews with 23 providers to learn their perspectives on facilitators/barriers to MOUD treatment and the clinical and social determinants most influential to their clinical decision-making. Study 2 involved development …

Sustaining Digital Health Interventions For Long-Term Cardiovascular Disease Prevention In The Energy Industry, Yul Isnadi, L. Meily Kurniawidjaja, Doni Hikmat Ramdhan

Kesmas

Cardiovascular disease (CVD) is a major health concern for energy industry workers due to occupational risks. Digital health interventions (DHIs) offer innovative strategies for CVD prevention in this high-risk group. This study aimed to explore the effectiveness and sustainability of DHI by incorporating behavior change theories, behavior change techniques, and principles of persuasive system design. A literature review was performed using PubMed, Scopus, Web of Science, and CINAHL databases to collect relevant information on interventions for CVD prevention among energy sector workers. The results indicated that while DHI could improve physical activity, dietary habits, and medication adherence in the short …

Angioedema: Is Icu Admission Warranted? A Single Institution Assessment, Madeleine Brill-Edwards, W. Chase Hamilton, Erika J. Yoo, Jennifer Costello, George J. Koenig, Murray J. Cohen, Joshua A. Marks

Department of Surgery Faculty Papers

INTRODUCTION: Angioedema has potential for rapid airway decompensation requiring intervention. Patients are often admitted to an ICU for "airway watch." There is a lack of evidence to support which patients require this.

AIM: We aimed to characterize admission patterns and outcomes of angioedema patients at our institution to assess resource utilization and necessity of ICU use. We hypothesized that patients not requiring intubation upon presentation are safe to manage outside the ICU.

MATERIALS AND METHODS: Retrospective chart review of patients admitted to our urban academic quaternary referral institution with angioedema ICD-10 codes between 2017 and 2020. Charts reviewed for demographics, …

Role And Use Of Race In Artificial Intelligence And Machine Learning Models Related To Health, Martin C Were, Ang Li, Bradley A Malin, Zhijun Yin, Joseph R Coco, Benjamin X Collins, Ellen Wright Clayton, Laurie L Novak, Rachele Hendricks-Sturrup, Abiodun O Oluyomi, Shilo Anders, Chao Yan

Faculty, Staff and Students Publications

The role and use of race within health-related artificial intelligence (AI) and machine learning (ML) models have sparked increasing attention and controversy. Despite the complexity and breadth of related issues, a robust and holistic framework to guide stakeholders in their examination and resolution remains lacking. This perspective provides a broad-based, systematic, and crosscutting landscape analysis of race-related challenges, structured around the AI and ML life cycle and framed through "points to consider" to support inquiry and decision-making.

Single-Cell Transcriptomics Reveals Biomarker Heterogeneity Linked To Cdk4/6 Inhibitor Resistance In Breast Cancer Cell Lines, Ilenia Migliaccio, Martina Bonechi, Dario Romagnoli, Giulia Boccalini, Francesca Galardi, Cristina Guarducci, Agostina Nardone, Rachel Schiff, Laura Biganzoli, Luca Malorni, Matteo Benelli

Faculty, Staff and Students Publications

Cyclin dependent kinases 4 and 6 inhibitors have brought great improvements in the treatment of luminal breast cancer, but resistance is a major clinical hurdle. Multiple biomarkers of resistance have been proposed, but none is currently utilized in clinical practice. By performing single-cell RNA sequencing of seven palbociclib-naïve luminal breast cancer cell lines and palbociclib-resistant derivatives, we show that established biomarkers and pathways related to CDK4/6i resistance present marked intra- and inter- cell-line heterogeneity. Transcriptional features of resistance could be already observed in naïve cells correlating with levels of sensitivity (IC50) to palbociclib. Resistant derivatives showed transcriptional clusters that significantly …

Global, Regional, And National Time Trends In Falls And Their Predictions: An Age-Period-Cohort Analysis Of The Global Burden Of Disease Study 2021, Huan Jiang, Ning Sun, Huiqi Yang, Ye Li, Lihong Jiang, Huicui Zhao, Yi Zeng, Chengyang Sun, Chun Xu, Yongqiang Lai, Jia Meng

Health & Biomedical Sciences Faculty Publications

Background: Falls are a global public health issue with a heavy disease and socioeconomic burden, with an increasing number of risky people. The aim of this study is to explore the global disease burden of falls and to provide a scientific basis for the prevention and management of falls.

Methods: This study used data from the Global Burden of Disease Study 2021 (GBD 2021) to analyse global, regional, and national temporal trends in falls. An age-period-cohort (APC) model was applied to analyse data from 1990 to 2021, with global predictions made through 2046.

Findings: Although the falls mortality of all …

The Effectiveness Of Remote Patient Monitoring In Reducing The Risk Of Rehospitalizations In Covid-19 Patients: A Meta-Analysis, Dela Riadi, Indang Trihandini, Dewi Nirmala Sari, Fikri Wijaya

Kesmas

An integrated analysis of various Remote Patient Monitoring (RPM) studies is needed to evaluate the reduction rate of the risk of rehospitalization in COVID-19 patients. This meta-analysis aimed to provide an overview of the effectiveness of RPM. A literature search through online databases (PubMed, Science Direct, Scopus, ProQuest, and Embase) was conducted from 2019 to 2022. After using the Cochrane Collaboration's risk of bias tool, five studies on COVID-19 were selected. Based on the data collected from 2,685 participants (intervention = 1,060, control = 1,625), the use of RPM was found to reduce rehospitalization by 0.56 times compared to not …

Cross-Cultural Adaptation And Validation Of Ranas-Based Instrument For Measuring Latrine Use Behavior In Indonesia, Vera Yulyani, Fatwa Sari Tetra Dewi, Iswanto Iswanto

Kesmas

Using toilets is a simple way to prevent diarrhea, yet no validated tool exists to measure this habit. This study aimed to develop and validate instruments for measuring latrine use consistency. This questionnaire was adapted from the risk, attitude, norm, ability, and self-regulation (RANAS) framework developed in India and modified for Indonesia. It was evaluated by three experts using the content validity index (CVI). The face validity index (FVI) was pilot-tested on 40 community respondents. Variables measured included behavior, habits, intentions to use toilets, knowledge, attitudes, norms, abilities, and self-regulation. Question items with relevance and clarity scores of item CVI …

In Pursuit Of A Better Hospital Quality Metric For Medicare, Brad Wright Ph.D.

Faculty Publications

No abstract provided.

Integrating Circulating Tumor Dna Into Clinical Management Of Colorectal Cancer: Practical Implications And Therapeutic Challenges, Nikhil Vojjala, Viktoriya Gibatova, Raj N Shah, Sakshi Singal, Rishab Prabhu, Geetha Krishnamoorthy, Karen Riggins, Nagaishwarya Moka

Faculty, Staff and Students Publications

The American Cancer Society estimates that over 152,000 new cases of colorectal cancer (CRC) were diagnosed in 2024, with more than 105,000 cases affecting the colon and 46,000 involving the rectum. CRC remains the second leading cause of cancer-related deaths in the United States, with an estimated 53,010 deaths in 2024. In the era of precision medicine, which incorporates molecular and environmental information into clinical decision-making, identifying patients harboring a deficiency in Deoxyribonucleic acid (DNA) repair allowed for targeted immunotherapies and significantly reduced CRC-related mortality. A significant advancement in this domain is the application of liquid biopsy, which has emerged …

Resilience Mediates The Association Between Discrimination And Psychological Distress Among Rural, Black Women In South Carolina: A Structural Equation Model, Camryn Garrett, Abhisheak Aggrawal, Huiyi Xia, Cheuk Chi Tam, Bankole Olatosi Ph.D., Sarah Wilcox Phd, Xiaoming Li Ph.D., Shan Qiao Ph.D.

Faculty Publications

Introduction

The marginalization of intersecting racial, gender, and rural identities compounds the structural vulnerabilities (e.g., discrimination, stigma, health disparities) experienced by Black women in South Carolina’s rural areas. Discriminatory experiences can deteriorate mental health; however, resilience can potentially reduce the ill effects of discrimination by decreasing associated psychological distress. This study examines the mediating role of resilience in the association between discrimination and psychological distress among rural, Black women in South Carolina in the post-pandemic era.

Methods

Black women (n = 300, mean age = 48.6) living in rural South Carolina were recruited from January to February 2024 using …

Refinement Of Hyams Grading Criteria For Olfactory Neuroblastoma In An Endoscopic Sinus Surgery Predominant Cohort With Extended Follow-Up: Worth The Effort?, Stacey Gargano, Vincent Cracolici, Carl Snyderman, Eric Wang, Garret Choby, Aron Pollack, Paul Gardner, Diana Bell, Raja Seethala

Computational Medicine Center Faculty Papers

BACKGROUND: Hyams grading is considered prognostic in olfactory neuroblastoma (ONB), but grading criteria are subjective and predate modern classification and surgical approach. We evaluate the application of granular grading criteria to an endoscopic surgery predominant cohort with extended follow-up.

METHODS: 78 ONB patients were identified (1994-2019) with original diagnoses dating to 1979. Original Hyams grade, Modified Hyams grade incorporating more detailed criteria and other histologic features (i.e. divergent differentiation, clear cell/oncocytic change, and spindling) were assessed if feasible, evaluated for distribution by grade and correlated with outcomes.

RESULTS: Original Hyams grade (n = 43) distribution was: I: 4 (9%), II: …

Inequality And Covid Risk At School: Racial Disparities In Indoor Density, Vaccination Rates, And Consequences For Absenteeism, Michael C. Quinn, Michah W. Rothbart, Amy Ellen Schwartz, Brian Elbel

Center for Policy Research

During the COVID pandemic, schools were widely believed to be a venue that facilitated disease transmission. While some worried Black and Hispanic students would disproportionately face greater risk of COVID exposure at school (school COVID risk) – given well-documented racially disparate school environments and resources – little empirical evidence exists documenting or refuting potential disparities in school COVID risk. This paper begins to fill this gap by examining racial disparities in the school environments that contribute to COVID risk at school—specifically, vaccination rates and classroom space per pupil (indoor density) - in New York City elementary schools. We then document …

Association Between Sociocultural Factors, Obesity, And Depression In The Hispanic/Latino Population, Maia Junco

Walden Dissertations and Doctoral Studies

The increasing prevalence of obesity and mental health disparities among Hispanic/Latino populations in the United States underscores the need to understand how sociocultural factors shape physical and psychological health. The purpose of this study was to examine how acculturation, diet quality, and fiber intake affect BMI and depressive symptoms over time. The study was guided by acculturation theory and the biopsychosocial model. The study used longitudinal secondary data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) with a sample of N=8,816, including adults who completed examination visits, 1 (2008–2011) and 2 (2014–2017). Path analysis was conducted to assess direct …

Phosphoglycerate Mutase Regulates Treg Differentiation Through Control Of Serine Synthesis And One-Carbon Metabolism, Wesley H Godfrey, Judy J Lee, Shruthi Shanmukha, Kaho Cho, Xiaojing Deng, Chandra Shekar R Ambati, Vasanta Putluri, Abu Hena Mostafa Kamal, Paul M Kim, Nagireddy Putluri, Michael D Kornberg

Faculty, Staff and Students Publications

The differentiation and suppressive functions of regulatory CD4 T cells (Tregs) are supported by a broad array of metabolic changes, providing potential therapeutic targets for immune modulation. In this study, we focused on the regulatory role of glycolytic enzymes in Tregs and identified phosphoglycerate mutase (PGAM) as being differentially overexpressed in Tregs and associated with a highly suppressive phenotype. Pharmacologic or genetic inhibition of PGAM reduced Treg differentiation and suppressive function while reciprocally inducing markers of a pro-inflammatory, T helper 17 (Th17)-like state. The regulatory role of PGAM was dependent on the contribution of 3-phosphoglycerate (3 PG), the PGAM substrate, …

Dietary Lipids Induce Ppard And Bcl6 To Repress Macrophage Il-23 Induction After Intestinal Injury And Lps Exposure, Ashleigh M Gil, Daniel F Zegarra-Ruiz, Wan-Jung Wu, Kendra Norwood, Adrien Assie, Buck S Samuel, Angela M Major, Gretchen E Diehl, Andrea A Hill Mcalester

Faculty, Staff and Students Publications

Unresolved tissue damage is a common feature of Inflammatory Bowel Disease (IBD) that facilitates disease progression. Here, we showed that high animal fat diets (HFD), an environmental risk factor associated with IBD pathogenesis, suppress intestinal macrophage production of critical tissue repair responses after damage. This includes reduced IL-23 production, which drives downstream production of IL-22, which is needed for barrier repair. Indicating that dietary lipids interfere with responses to microbial molecules needed to induce barrier protective functions, we found oleic acid could directly suppress macrophage Il23a induction after lipopolysaccharide (LPS) treatment. Deleting the lipid transporter CD36 on macrophages restored the …

Demystifying The Nuances Of The Lipid Patient: A Guide For Primary Care Providers, Merle Myerson, Kyle Gillett, James O'Hara, Richard Potter, Neil Skolnik

Abington Jefferson Health Papers

Atherosclerosis, a major cause of mortality and morbidity in the United States (US), is driven by complex factors, including the cumulative burden of low-density lipoprotein cholesterol (LDL-C) and other atherogenic lipids and lipoproteins. Lipid management in US primary care aims to prevent atherosclerotic cardiovascular disease (ASCVD) events through screening and LDL-C lowering to risk-based goals. However, lipid screening and ASCVD treatment is often inadequate, with few patients meeting LDL-C goals in clinical practice. Primary care providers have a vital role in identifying patients most at risk of ASCVD to prevent ASCVD events and improve patient outcomes. There are multiple different …

Rna Sequencing Reveals Inflammatory And Metabolic Changes In The Lung And Brain After Carbon Black And Naphthalene Whole Body Inhalation Exposure In A Rodent Model Of Military Burn Pit Exposures, Allison M. Haaning, Brian J. Sandri, Henry L. Wyneken, William T. Goldsmith, Joshua P. Nixon, Timothy R. Nurkiewicz, Chris H. Wendt, Paul Barach, Janeen H. Trembley, Tammy A. Butterick

College of Population Health Faculty Papers

Military personnel deployed to Iraq and Afghanistan were exposed to emissions from open-air burn pits, where plastics, metals, and medical waste were incinerated. These exposures have been linked to deployment-related respiratory diseases (DRRD) and may also impact neurological health via the lung-brain axis. To investigate molecular mechanisms, adult male rats were exposed to filtered air, naphthalene (a representative volatile organic compound), or a combination of naphthalene and carbon black (surrogate for particulate matter; CBN) via whole-body inhalation (six hours/day, three consecutive days). Lung, brain, and plasma samples were collected 24 h after the final exposure. Pro-inflammatory biomarkers were assessed using …