Author Interviews, Exercise - Fitness, Mental Health Research / 20.03.2023

MedicalResearch.com Interview with: Dr Helen Keyes  PhD, AFBPsS, SFHEA Head of School  Psychology & Sport Science Anglia Ruskin University Cambridge MedicalResearch.com: What is the background for this study? What types of sporting events? Response: The data were collected as part of a large government study looking at a range of measures on health and activities across the UK population. Our study honed in on aspects of wellbeing – life satisfaction, loneliness, happiness, anxiety, a sense that life is worthwhile – as well as whether participants had attended a live sporting event in the last year. The data collected did not differentiate between different types of sport – the positive effects that we report for wellbeing are population-wide across a whole range of sports, from attending a local football match all the way up to elite sporting events. (more…)
Author Interviews, Cancer Research, Genetic Research, JAMA, Personalized Medicine, Vanderbilt / 18.03.2023

MedicalResearch.com Interview with: Jonathan Mosley, MD, PhD Associate Professor Division of Clinical Pharmacology Departments of Internal Medicine and Biomedical Informatics Vanderbilt University Medical Center MedicalResearch.com: What is the background for this study? Response: Prostate cancer is an important source of morbidity and mortality among men. Earlier detection of disease is essential to reduce these adverse outcomes. Prostate cancer is heritable, and many single nucleotide polymorphisms (SNPs) associated with disease risk have been identified. Thus, there is considerable interest in using tools such as polygenic risk scores, which measure the burden of genetic risk variants an individual carries, to identify men at elevated risk of disease. (more…)
Author Interviews, Gastrointestinal Disease / 17.03.2023

MedicalResearch.com Interview with: Richard E. Moses, D.O., J.D. Gastroenterologist, Associate Vice President, Mirikizumab Indication Lead Global Medical Affairs, Eli Lilly and Company MedicalResearch.com: What is the background for this study? Would you briefly describe how mirikizumab works in UC?  Response: First, this study specifically evaluated mirikizumab, a humanized IgG4 monoclonal antibody that selectively targets the p19 subunit of IL-23 and inhibits the IL-23 pathway. Inflammation due to over-activation of the IL-23 pathway plays a critical role in the pathogenesis of UC. Regulatory decisions for mirikizumab as a potential treatment for adults with moderately to severely active UC in the U.S., E.U and other countries around the world are expected in 2023. If approved, mirikizumab has the potential to be the only UC treatment that selectively targets the p19 subunit of IL-23. Gastroenterologists today benefit from having data from a range of endpoints, which can help them determine appropriate treatment options depending on their specific patients' needs and symptoms. In addition to clinical response and clinical remission – which are often used to determine the effectiveness of a treatment – we can also use combined endpoints like histologic-endoscopic mucosal improvement (which gauges remission and treatment effectiveness), histologic-endoscopic mucosal remission (the reduction of underlying inflammation visible endoscopically) and inflammatory biomarkers faecal calprotectin (fCal) and C-reactive protein (CRP) to inform our treatment strategies. This analysis focused on patients treated with mirikizumab from the induction study who received intravenous mirikizumab every 4 weeks until Week 12 (LUCENT-1), and patients who responded to mirikizumab during 12-week induction period who were re-randomized for the maintenance period, receiving subcutaneous mirikizumab every four weeks up to Week 40 (LUCENT-2) for 52 weeks of continuous treatment. This study explored the relationship between achieving histologic-endoscopic mucosal improvement (HEMI), histologic-endoscopic mucosal remission (HEMR) and improvement of biomarkers fCal and CRP levels at Weeks 12 and 52. (more…)
Allergies, Author Interviews, Cancer Research, Dermatology, Melanoma / 17.03.2023

MedicalResearch.com Interview with: Jenni Komulainen University of Eastern Finland | UEF MedicalResearch.com: What is the background for this study? Response: The background for this study comes from the earlier findings that the skin cancer risk and atopic status have some connection, but the results have been inconsistent. The connection between atopy and skin cancers may be related to the stimulation of protective immune response or the predisposition to carcinogenesis through chronic inflammation. The aim of this study was to investigate if atopic disorders associate with skin cancers. (more…)
Author Interviews, Cancer Research, Nature, NYU, Pancreatic / 17.03.2023

MedicalResearch.com Interview with: Aristotelis Tsirigos, Ph.D. Professor of Medicine and Pathology Co-director, Precision Medicine Director, Applied Bioinformatics LaboratoriesNew York University School of Medicine MedicalResearch.com: What is the background for this study? Response: Pancreatic cancer is one of the most lethal types of cancer with only 12% of patients surviving more than 5 years after diagnosis. One of the main reasons behind the dismal prognosis is the complexity of the tumor. Pancreatic cancer cells are very heterogenous and interact with different types of non-malignant cells in what is known as the tumor microenvironment. (more…)
Author Interviews / 10.03.2023

MedicalResearch.com Interview with: Norman Kleiman, PhD, MS Department of Environmental Health Sciences Mailman School of Public Health Columbia University, New York, NY MedicalResearch.com: What is the background for this study? Response: The 1986 Chornobyl nuclear disaster caused the evacuation of 300,000 persons from the cities and villages surrounding the nuclear power plant complex. Pets and belongings were left behind, and the Soviet authorities ordered all animals within the Chornobyl Exclusion Zone killed. Some dogs evaded destruction, and some 300+ descendants of these animals live primarily at two locations today, immediately surrounding the Nuclear Power Plant (NPP) complex and about 10 km away in Chornobyl city. What is relatively unknown to the general public is that Chornobyl is not a desolate, abandoned wasteland. Some thousands of individuals work there every day in continuing cleanup activities and at two new fuel reprocessing facilities built near the damaged reactor. These areas have been substantially remediated, and the average radiation levels are relatively modest. The dogs, which, while feral, are accustomed to human interaction, live near the workers and are not currently exposed to high radiation levels. In contrast to lower radiation levels, there is a toxic mixture of heavy metals, organics, pesticides, and unknown chemicals left over from years’ long cleanup efforts and the decay of a large former military-industrial complex at the NPP. Since 2016, the NPP authorities have brought in teams of veterinarians and volunteers to spay, neuter, and vaccinate the dogs to protect the workers and deal with a growing population. At the same time, some scientists joined the teams to obtain various kinds of biospecimens (hair, urine, feces, blood, saliva, parasites) to examine the animals’ health and learn how this toxic environment may have affected them or their offspring. Since dogs are human companion animals and live closely with us, any information we learn about health risks to the dogs may be relevant to protecting human workers and inform us about the kinds of health risks posed by ecological and environmental disasters in the future. (more…)
Aging, Author Interviews, Geriatrics, NEJM, Pulmonary Disease, Respiratory, Vaccine Studies / 09.03.2023

MedicalResearch.com Interview with: Veronica Hulstrøm MD, PhD Senior Director Clinical Project Lead for RSV Older Adults GSK     MedicalResearch.com: What is the background for this study? Response: The AReSVi-006 phase III trial is designed to investigate the efficacy and safety of GSK’s respiratory syncytial virus (RSV) vaccine candidate for adults aged 60 years and above. The phase III trial is a randomized, placebo-controlled, double-blind, international trial with 24,966 participants who received either the investigational vaccine or placebo. (more…)
Author Interviews, Breast Cancer, Cancer Research, JAMA, Race/Ethnic Diversity / 09.03.2023

MedicalResearch.com Interview with:
Hyuna Sung, PHDHyuna Sung, PHD Senior Principal Scientist, Cancer Surveillance Research American Cancer Society Kennesaw, GA 30144
  MedicalResearch.com: What is the background for this study? Response: Triple-negative breast cancer (TNBC) accounts for 10% to 20% of all breast cancer diagnoses in the US. This subtype of breast cancer tends to spread faster and has fewer treatment options. In the US, Black women are about two-fold more likely than White women to develop TNBC. (more…)
Allergies, Author Interviews, Dermatology / 09.03.2023

MedicalResearch.com Interview with: Nicholas Gulati, MD, PhD Director, Early Detection of Skin Cancer and Oncodermatology Clinic The Kimberly and Eric J. Waldman Department of Dermatology Mount Sinai Health System New York, New York MedicalResearch.com: What is the background for this study? What is dupilumab primarily used for? Response: Dupilumab is a monoclonal antibody that inhibits a specific part of the immune system known as Th2 cells, which are important in the development of various diseases including atopic dermatitis (eczema) and asthma. Therefore, dupilumab has become one of the major treatments for these conditions. Given the increasing use of this drug, it is important to understand the safety of it in terms of cancer development, as that is currently largely unknown. (more…)
Author Interviews, Heart Disease, JAMA, Statins / 09.03.2023

MedicalResearch.com Interview with: Myeong-Ki Hong, MD PhD Professor of Cardiology Yonsei University College of Medicine Severance Cardiovascular Hospital Seoul, Korea MedicalResearch.com: What is the background for this study? Response: The background of this study was to compare the long-term clinical outcomes between the two distinct strategies regarding statin intensity in patients with coronary artery disease (CAD). One is to titrate statin intensity to meet a target low-density lipoprotein cholesterol (LDL-C) level (treat-to-target strategy), the other is to maintain high-intensity statin without a target goal (high-intensity statin strategy). (more…)
Author Interviews, Cannabis, Pharmacology, Tobacco Research / 08.03.2023

MedicalResearch.com Interview with: Philip Lazarus, PhD Boeing Distinguished Professor, Pharmaceutical Sciences Professor, Dept of Pharmaceutical Sciences College of Pharmacy and Pharmaceutical Sciences Washington State University Spokane, WA 99210   MedicalResearch.com: What is the background for this study? Response: Smoking and tobacco use remains a major health issue. Smokers use cigarette over the course of the day because the levels of nicotine, the addictive agent in cigarettes and other forms of tobacco, dimmish with time in the bloodstream due to the breakdown of nicotine by enzymes in the body. By inhibiting the breakdown of nicotine in smokers, one would expect that the levels of nicotine would remain higher after smoking a single cigarette, and that these individuals may not require lighting up another cigarette so quickly, reducing the number of cigarettes smoked over the course of a day. This could have a profound effect on reducing the overall harm incurred from smoking or from using other forms of tobacco. In a single previous study, smokers who used a CBD inhaler exhibited a 40% reduction in cigarette use. In addition, while cannabis users are often smokers, previous studies have indicated that they smoke less cigarettes than non-cannabis-using cigarette smokers. In previous studies published in 2021, we found that major cannabinoids present in cannabis like THC and CBD inhibit major metabolizing enzymes in our body, including several that are important in drug metabolism. We hypothesized that CBD and its major active metabolite, 7-hydroxy (OH)-CBD, may also be inhibiting one or more of the enzymes important in the metabolism (or breakdown) of nicotine. (more…)
Author Interviews, Infections, JAMA, OBGYNE, Pediatrics / 08.03.2023

MedicalResearch.com Interview with: Anna Roca PhD MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine Fajara, The Gambia MedicalResearch.com: What is the background for this study? Response: Context specific interventions are needed to decrease the high burden of severe neonatal morbidity and mortality in sub-Saharan Africa. Severe bacterial infections are a main cause of neonatal mortality in the continent. Oral intra-partum azithromycin is a cheap intervention easily scalable. Before embarking on this trial, we conducted a proof-of-concept trial that showed the intervention reduced maternal and neonatal bacterial carriage of the most prevalent bacteria causing neonatal sepsis in the continent. (more…)
Author Interviews, COVID -19 Coronavirus, Electronic Records, Health Care Systems, Race/Ethnic Diversity / 07.03.2023

MedicalResearch.com Interview with: Dhruv Khullar, M.D., M.P.P. Director of Policy Dissemination Physicians Foundation Center for Physician Practice and Leadership Assistant Professor of Health Policy and Economics Weill Cornell Medicine, NYC   MedicalResearch.com: What is the background for this study? Response: From prior research, we know that there are racial/ethnic differences in the acute impact of COVID-19, including higher rates of hospitalization and death among Black and Hispanic individuals compared to white individuals. Less is known about whether there are differences in the rates or types of long COVID by race and ethnicity. (more…)
Author Interviews, Depression / 05.03.2023

Editor's note: This piece discusses suicide. If you have experienced suicidal thoughts or have lost someone to suicide and want to seek help, you can contact the Crisis Text Line by texting "START" to 741-741 or call the Suicide Prevention Lifeline at 800-273-8255. MedicalResearch.com Interview with: Alexia Aguilar Geisinger Commonwealth School of Medicine Scranton, PA     MedicalResearch.com: What is the background for this study? Response: Traditional antidepressants like Zoloft and Lexapro have three major drawbacks.
  • First, they have a therapeutic lag and take at least a couple weeks to begin to improve mood.
  • Second, they do not work very well for many patients with only about one-third experiencing a remission.1
  • Third, they carry a Food and Drug Administration black box warning for increasing the risk of suicide in young-adults. There is tremendous enthusiasm for the anesthetic ketamine and esketamine because they overcome all three of these limitations. The brand name of esketamine is Spravato. Spravato received conditional approval from the FDA in March of 2019 as a nasal spray for treatment resistant depression or acute suicidality.  The goal of this study was to examine prescriptions for ketamine and esketamine in 2019 and 2020.

(more…)

Author Interviews, Gender Differences, JAMA, Surgical Research / 03.03.2023

MedicalResearch.com Interview with: Mario FL Gaudino, MD, PhD, MSCE, FEBCTS, FACC, FAHA Stephen and Suzanne Weiss Professor in Cardiothoracic Surgery (II) Assistant Dean for Clinical Trials Professor of Clinical Epidemiology and Health Services Research at Weill Cornell Graduate School Director of the Joint Clinical Trials Office (JCTO) Director of Translational and Clinical Research, Department of Cardiothoracic Surgery Chair Coronary Artery Task Force, European Association for Cardio-Thoracic Surgery Weill Cornell Medicine | NewYork – Presbyterian Hospital Department of Cardiothoracic Surgery MedicalResearch.com: What is the background for this study? Response: It is well-documented that women undergoing CABG have higher mortality and morbidity when compared with men. They are referred to surgery later than men, with more cardiovascular risk factors than men, and present more frequently with heart failure or in non-elective settings. However, overall CABG outcomes have improved over time, and so we sought to evaluate national trends in outcomes specifically in women. (more…)
Alzheimer's - Dementia / 03.03.2023

Dementia is a condition that affects many older adults aged 65 years and older but is increasingly being diagnosed in much younger people. It is a tragic disease as the personality of the sufferer changes, they struggle to identify close family members, and there is a profoundly sad loss of dignity as the disease progresses. Medical researchers are very active in undertaking experiments to find better ways of early diagnosis and treating patients more effectively. We look at the more recent research in this regard.

Improved Digital Markers

Scientists have found a new method to predict dementia before its onset or while it is still mild. This allows those who are positively identified to make lifestyle changes to stay healthy for longer and to begin preparing for special care when they can no longer look after themselves. The research tests comprised a study of driving behaviors. This was a longitudinal study. It had a 96% accuracy and considered 200 driving elements. Just under 3000 test subjects participated in the study, which took place in five US states. All the participants were still driving their own vehicles as a way of retaining their independence as they entered the older age stages of life, with everyone being between 65 and 79 years of age. Eighty-five percent of this age group were found to still be driving at this stage of life. None had signs of cognitive decline. Follow-up of the participants took place three years after the testing phase. Sixty-one participants had gone on to develop Alzheimer’s disease, some cognitive decline, or other types of dementia. The researchers compared their results against two other popular methods (logistic regression and random forests) of predicting dementia and found that their test had a 6-10% greater accuracy than the rest. Two aspects of driving that were especially useful for predicting future dementia were how many times drivers braked hard with 0.4 g or greater deceleration and the ratio of right and left turns. Regarding the latter, older people found it less risky to turn right rather than left. Early warning of possible dementia later in life is essential to preparing for increasing levels of care, from overnight, to 24/7. Check out this guide if you want to know more about what is overnight care. Many dementia patients with mild impairment may start with this form of assistance. A bit of help when needed can allow the person to store their energy for greater independence in intimate activities like bathing. (more…)
Aging, Alzheimer's - Dementia, Author Interviews, Supplements / 01.03.2023

MedicalResearch.com Interview with: Christopher R. Martens PhD Assistant Professor Director, Delaware Center for Cognitive Aging Research Department of Kinesiology & Applied Physiology University of Delaware Newark, DE MedicalResearch.com: What is the background for this study? Response: One of the main issues with Alzheimer's disease is an impaired ability to make energy in the brain. NAD+ is critically involved in the creation of energy within cells and there is strong evidence that nicotinamide riboside (NR), a precursor to NAD+, can restore brain function in mice that exhibit similar characteristics as people with Alzheimer's disease. We had previously studied the effects of NR in healthy older adults and wanted to see whether it is even capable of getting into brain tissue. We used remaining blood samples from our original study and measured the amount of NAD+ within tiny "vesicles" in the blood that we are quite confident originated from the brain and other neural tissue (more…)
Author Interviews, Infections, NIH, OBGYNE / 01.03.2023

MedicalResearch.com Interview with:
William A. Petri, MD PhDWilliam A. Petri, MD PhD Wade Hampton Frost Professor of Medicine and Vice Chair for Research of the Department of Medicine Professor of Medicine, Microbiology, Immunology and Cancer Biology, and Pathology, Medicine: Infectious Diseases and International Health, Medicine: Infectious Diseases and International Health
MedicalResearch.com: What is the background for this study? MedicalResearch.com We tested if prophylactic antibiotics could prevent sepsis and death in women in the late stages of normal vaginal labor and delivery. It was previously known that antibiotic were effective for this purpose in women undergoing C-section. The study was a randomized placebo-controlled trial at 8 international sites of nearly 30,000 women. (more…)
Author Interviews, Heart Disease, Race/Ethnic Diversity / 28.02.2023

MedicalResearch.com Interview with: Dr. Muchi Ditah Chobufo MD MPH Cardiology Fellow West Virginia University MedicalResearch.com: What is the background for this study? Response: Ischemic heart diseases are a significant cause of morbidity and mortality in the USA. Also, there exists alarming ethnic disparities in mortality rates following acute myocardial infarction. To this effect, significant efforts have been deployed over the years to curb its burden and reduce extant disparities. It is in this light that we set out to analyze general and ethnic specific trends in acute myocardial infarction related age adjusted mortality rates (AAMR) in the entire USA from 1999-2020.  (more…)
Emergency Care / 28.02.2023

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Contact a qualified medical professional before engaging in any physical activity, or making any changes to your diet, medication or lifestyle, When something doesn’t feel right, a trip to the ER might be on your mind. But what happens when it is a nonemergency? Urgent care exists as an alternative to the ER when there are nonemergency related health concerns.

Warning Signs

Before you take a trip to Instacare, take a long look at common emergency warning signs. Trouble breathing, consistent chest pain, profuse bleeding or an inability to discern reality. All of these are signs that you should prioritize an ER visit. There are plenty of other warning signs to look out for, and several unique situations that will also require an ER visit. Getting wrapped up in the meaning of warning signs should not lead to unneeded stress. Do you feel comfortable driving to an urgent care, or would it be too difficult to manage? Being able to get behind the wheel is a good sign that your health-related issue can be handled by an urgent care. (more…)
Author Interviews, COVID -19 Coronavirus, Nature, OBGYNE, Pediatrics / 28.02.2023

MedicalResearch.com Interview with: Dr Jessica Miller, PhD Murdoch Children’s Researcher and Professor David Burgner, Murdoch Children’s Group Leader, Infection and Immunity Murdoch Children’s Research Institute Royal Children's Hospital Victoria Australia   MedicalResearch.com: What is the background for this study? Response: Early reports following the initial COVID-19 lockdowns showed huge variation in changes to preterm birth and stillbirth rates, deeming it difficult to understand the pattern worldwide. It was uncertain if the observed variations were due to differences in study design and methodology, immediate impacts of lockdowns or changes in health service utilization. Previous reports from single populations or facilities were unlikely to be representative of the population and could not be compared across populations. Lockdowns affected health, social and economic factors that could lead to reductions in preterm birth rates. Changes in hygiene practices and abruptions to traffic following lockdown led to alterations in non-COVID infections and air pollution, which are known to trigger inflammation and contribute to preterm birth. Given the uncertainty in the earlier reports, we aimed to conduct a rigorous, standardised analysis using high-quality, total-population data from across the world in order to summarize and compare rates across countries. Our large global study included 52 million births between 2015-2020 from 26 countries and represents one of the first large-scale analyses of birth outcomes during the early months of COVID-19. (more…)
Author Interviews, Diabetes, Karolinski Institute, Pediatrics, Weight Research / 28.02.2023

MedicalResearch.com Interview with: Yuxia Wei PhD Student Unit of Epidemiology Institute of Environmental Medicine Karolinska Institutet Stockholm | Sweden   MedicalResearch.com: What is the background for this study? Response: Diabetes is traditionally known for having two types (type 1 diabetes and type 2 diabetes). However, it is becoming increasingly clear that diabetes is much more complex than this traditional classification. Several attempts have been made to address this heterogeneity and in 2018, a  Swedish ground-breaking study proposed that there are five distinct subtypes of diabetes in adults. They have been replicated in different populations and it has been shown that there are differences between the subtypes in terms of genetics and risks of complications. Another way of elucidating the relevance of these subtypes is to investigate whether the influence of known risk factors for diabetes is different on different subtypes. Our study is one of the first attempts to address this. We used a study design known as Mendelian randomization, to investigate the influence of childhood obesity on these diabetes subtypes that typically occur after age 35. This work was a collaboration between Karolinska institutet in Stockholm, University of Bristol in the UK and Sun Yat-Sen University in China. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JACC / 26.02.2023

MedicalResearch.com Interview with: Rishi K. Wadhera, MD, MPP, MPhil Section Head, Health Policy and Equity, Richard A. and Susan F. Smith Center for Outcomes Research Associate Program Director Cardiovascular Medicine Fellowship at Beth Israel Deaconess Medical Center Assistant Professor of Medicine, Harvard Medical School @rkwadhera MedicalResearch.com: What is the background for this study? Response: High and rising prescription drug costs in the United States contribute to medication non-adherence and financial strain among adults with cardiovascular risk factors or disease. As a result, addressing prescription drug costs in patients with chronic conditions has become a national priority. In response to these growing concerns, federal policymakers passed the Inflation Reduction Act on August 16, 2022, which aims to address high out-of-pocket drug costs for adults enrolled in Medicare Part D, by placing a $2000 annual cap on out-of-pocket prescription drug costs and expanding eligibility for full low-income subsidies to individuals that reduce deductible costs and prescription copayments (among several other provisions). It is unclear how these provisions will affect Medicare beneficiaries with cardiovascular risk factors and/or conditions. (more…)
Author Interviews, Herpes Viruses, JAMA, STD, USPSTF / 23.02.2023

MedicalResearch.com Interview with: James Stevermer, M.D., M.S.P.H. Vice chair for clinical affairs Professor of family and community medicine University of Missouri Medical director of MU Health Care Family Medicine–Callaway Physicians, Dr. Stevermer joined the U.S. Preventive Service Task Force in January 2021.     MedicalResearch.com: What is the background for this study? Response: Genital herpes is a common sexually transmitted infection (STI) that unfortunately has no cure and cannot accurately be detected in people who do not have signs of the condition. The current screening tests have limitations and there is a high chance that test results will say a person has the condition when they do not. In addition, the available treatments are focused on managing symptoms and preventing the condition from reoccurring. As a result, the Task Force concluded that the harms of screening outweigh the benefits. (more…)
Author Interviews, Endocrinology, Environmental Risks / 23.02.2023

MedicalResearch.com Interview with: Jesse Goodrich PhD Assistant Professor Department of Population and Public Health Sciences Keck School of Medicine University of Southern California MedicalResearch.com: What is the background for this study? Response: Per- and poly-fluoroalkyl substances (PFAS) are a group of persistent chemicals that are known to interfere with hormones and metabolism. In our previous research, we have found that PFAS exposure is associated several specific diseases, especially in children and adolescents. These include obesity, type 2 diabetes, liver disease, and even liver cancer. However, we are still only just starting to fully understand all of the health effects of the many different PFAS in existence. Previous studies have focused primarily on one or two main PFAS. However, there are over 9,000 known PFAS, and people are exposed not just to a single PFAS but to mixtures of many PFAS. Importantly, the combination of these chemical exposures may affect us differently than single exposures alone. To address this challenge, we used an innovative approach to study design to examine how exposure to PFAS impacts biological processes which may underly the development of many different diseases in adolescents and young adults. To do this, we first measured thousands of naturally occurring chemicals, known as metabolites, in people's blood. Then, using a new biostatistical method developed by our team, we identified how exposure to a mixture of several PFAS impacted each individual chemical. Finally, we used this information to determine which biological processes are changed by PFAS exposure. (more…)