ABSTRACT
The main sources of lead exposure for children occur in the home environment, yet no low-cost analytical methods exist to screen homes for lead hazards. Previously, an inexpensive (~$20), quantitative lead screening kit was developed in which residents collect soil, paint, and dust samples that are returned to a laboratory for lead analysis using X-ray fluorescence spectroscopy (XRF). This screening kit was initially validated in 2020; it was determined that in situ and ex situ XRF lead measurements on the same samples exhibited strong sensitivity, specificity, and accuracy. As a follow-up to the initial validation, an implementation study and further statistical analyses were conducted. Correlation analysis using the results from nearly 400 screening kits identified an overall lack of correlation between sample types, reinforcing the utility of all eight sample locations. Principal component analysis searched for underlying correlations in sample types and provided evidence that both interior and exterior paint are major sources of lead hazards for Indiana homes. The implementation study compared the results of the government-standard lead inspection and risk assessment (LIRA) and the lead screening kit in 107 Indiana homes. In the United States, the LIRA is a thorough inspection of paint, dust, and soil that is usually state mandated in response to a child's elevated blood level and is used to identify where remediation efforts should be focused. The lead screening kit and LIRA agreed on the presence of lead in 79 of the 107 homes tested (74%). Discrepancies in agreement are likely the result of differences in the sample location and number of samples collected by each method. Overall, these results suggest that the lead screening kit is an acceptable resource that could be used to expand the services health departments provide for lead prevention. Integr Environ Assess Manag 2024;00:1-10. © 2024 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).
ABSTRACT
BACKGROUND: Those who experience lower extremity weakness or paralysis following a stroke often exhibit gait deviations caused by the inability to completely lift their foot during swing. An ankle-foot orthosis (AFO) is commonly prescribed for individuals post stroke with this mobility impairment. STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To determine whether significant differences could be observed in post-stroke individuals ambulating with an experimental AFO set at three different ankle orientations. METHODS: Gait analysis was conducted for eight post-stroke individuals ambulating with an experimental AFO set in three different randomly selected ankle orientations: 5° dorsiflexion, 5° plantarflexion, and neutral alignment. Temporospatial (velocity, cadence, stride length and step length), kinematic (knee angle), kinetic (external knee moment), and plantar force (heel) data were assessed. Within-subject statistical analysis was conducted using the repeated measures ANOVA to determine whether observed differences between the three orientations were significant. RESULTS: Post-stroke individuals generally exhibited less knee flexion during loading response when their AFO was aligned at 5° plantarflexion. Six of the eight subjects demonstrated increased knee flexion moment during loading response with the plantarflexed versus dorsiflexed alignment. The plantarflexed ankle orientation also resulted in greater peak heel contact force during loading response. CONCLUSIONS: Post stroke individuals may demonstrate less knee flexion during loading response and increased knee flexion moment (with respect to a dorsiflexed orientation) when their AFO is aligned in 5° plantarflexion. The fixed plantarflexed ankle orientation consistently resulted in greater peak heel contact force during loading response. CLINICAL RELEVANCE: Plantarflexed AFOs are contraindicated for individuals with prior history of pressure sores on their heels. Post stroke individuals placed in 5° dorsiflexion may demonstrate increased knee flexion, enhanced shock absorption, decreased knee flexion moment, and decreased heel pressure (with respect to a plantarflexed orientation) during loading response.
