I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h Science
(
I
J
P
H
S)
Vo
l.
15
,
No
.
1
,
M
a
r
ch
20
26
,
p
p
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I
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N:
2
2
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8
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1
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9
1
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h
s
.
v
15
i
1
.
2
6
9
1
4
208
J
o
ur
na
l ho
m
ep
a
g
e
:
h
ttp
:
//
ijp
h
s
.
ia
esco
r
e.
co
m
Acute
and chro
ni
c lead e
x
po
sure a
nd inte
l
lig
ence q
u
o
tient
a
mo
ng
Indo
nesian
a
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lescents:
a
c
ro
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section
a
l stu
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No
v
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Dew
i,
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nd
a
h T
ri
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ticle
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to
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y:
R
ec
eiv
ed
No
v
2
5
,
2
0
2
5
R
ev
is
ed
Feb
1
1
,
2
0
2
6
Acc
ep
ted
Feb
1
6
,
2
0
2
6
Lea
d
e
x
p
o
s
u
re
is
a
p
e
rsiste
n
t
e
n
v
iro
n
m
e
n
tal
h
e
a
lt
h
c
o
n
c
e
rn
t
h
a
t
c
a
n
imp
a
ir
c
o
g
n
i
ti
v
e
fu
n
c
ti
o
n
i
n
a
d
o
les
c
e
n
ts.
Th
e
re
fo
re
,
th
is
st
u
d
y
a
ims
t
o
e
x
a
m
in
e
th
e
a
ss
o
c
iatio
n
b
e
twe
e
n
a
c
u
te
a
n
d
c
h
ro
n
ic
lea
d
e
x
p
o
su
re
a
n
d
i
n
telli
g
e
n
c
e
q
u
o
ti
e
n
t
(IQ)
sc
o
re
s
a
m
o
n
g
I
n
d
o
n
e
sia
n
a
d
o
les
c
e
n
ts.
A
c
ro
ss
-
se
c
ti
o
n
a
l
stu
d
y
wa
s
c
a
rried
o
u
t
i
n
v
o
l
v
in
g
3
9
a
d
o
les
c
e
n
ts
wh
o
we
re
c
h
o
se
n
t
h
ro
u
g
h
p
u
r
p
o
siv
e
sa
m
p
li
n
g
.
Ac
u
te
e
x
p
o
su
re
wa
s
a
ss
e
ss
e
d
u
sin
g
b
lo
o
d
l
e
a
d
lev
e
ls
(n
=
1
5
)
,
w
h
il
e
c
h
ro
n
ic
e
x
p
o
s
u
re
wa
s
e
v
a
lu
a
ted
wit
h
h
a
ir
lea
d
lev
e
ls
(n
=
2
4
)
.
IQ
wa
s
m
e
a
su
re
d
u
sin
g
WAIS
a
d
m
i
n
istere
d
b
y
a
li
c
e
n
se
d
p
sy
c
h
o
lo
g
ist,
w
h
il
e
a
ss
o
c
iatio
n
s
b
e
twe
e
n
th
e
v
a
riab
les
we
re
e
x
a
m
in
e
d
u
ti
li
z
i
n
g
th
e
Ch
i
-
s
q
u
a
re
tes
t.
T
h
e
re
su
lt
s
re
v
e
a
led
th
a
t
c
h
ro
n
ic
lea
d
e
x
p
o
su
re
wa
s
sig
n
ifi
c
a
n
t
ly
li
n
k
e
d
t
o
b
e
lo
w
-
a
v
e
ra
g
e
IQ
(OR
=
1
.
9
0
;
9
5
%
CI:
1
.
0
7
–
3
.
3
6
),
wh
i
le
a
c
u
te
e
x
p
o
su
re
h
a
d
a
we
a
k
e
r
re
latio
n
sh
ip
(OR
=
0
.
3
5
;
9
5
%
CI:
0
.
1
3
–
0
.
8
9
;
p
=
0
.
0
2
2
).
T
h
e
se
re
su
lt
s
i
n
d
ica
ted
th
e
imp
o
rtan
c
e
o
f
lo
n
g
-
term
e
n
v
iro
n
m
e
n
tal
e
x
p
o
s
u
re
c
o
n
tr
o
l
.
K
ey
w
o
r
d
s
:
Acu
te
B
o
r
d
er
lin
e
C
h
r
o
n
ic
I
n
tellig
en
ce
q
u
o
tien
t
L
ea
d
ex
p
o
s
u
r
e
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
No
v
ian
a
Dew
i
Me
d
ical
L
ab
o
r
ato
r
y
T
ec
h
n
o
lo
g
y
,
Sek
o
lah
T
in
g
g
i I
lm
u
Kese
h
atan
Nasio
n
al
Su
r
a
k
ar
ta,
I
n
d
o
n
esia
E
m
ail: n
o
v
ian
ad
ewi@
s
tik
esn
a
s
.
ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
T
h
e
r
esu
lts
o
f
th
e
2
0
2
3
PISA
ar
e
s
u
p
p
o
r
ted
b
y
t
h
e
W
o
r
ld
Po
p
u
latio
n
R
ev
iew
r
ep
o
r
t
p
u
b
lis
h
ed
in
2
0
2
4
,
s
h
o
win
g
th
at
th
e
av
er
ag
e
i
n
tellig
en
ce
q
u
o
tien
t
(
I
Q)
o
f
I
n
d
o
n
esian
s
is
7
8
.
4
9
.
T
h
is
f
ig
u
r
e
p
lace
s
I
n
d
o
n
esia
in
1
2
9
th
p
lace
o
u
t
o
f
1
9
7
co
u
n
tr
ies
test
ed
[
1
]
.
Var
io
u
s
f
ac
to
r
s
ca
n
in
f
lu
en
ce
th
e
lo
w
av
er
ag
e
I
Q
f
o
u
n
d
in
th
e
co
u
n
tr
y
,
s
u
ch
as
en
v
ir
o
n
m
en
tal
p
o
llu
tio
n
r
esu
ltin
g
f
r
o
m
in
d
u
s
tr
ializatio
n
a
n
d
m
o
d
er
n
h
u
m
an
ac
tiv
ities
.
E
x
p
o
s
u
r
e
to
h
ea
v
y
m
etals,
s
u
ch
as
lead
,
h
as
b
ee
n
ass
o
ciate
d
with
r
ed
u
ce
d
I
Q.
Stu
d
ies
o
n
th
e
im
p
ac
ts
o
f
lead
d
is
clo
s
u
r
e
o
n
ad
o
lescen
ts
'
m
en
tal
h
ea
lth
f
o
u
n
d
t
h
at
co
n
ce
n
tr
atio
n
s
a
b
o
v
e
5
m
ic
r
o
g
r
a
m
s
/d
L
lo
wer
ed
I
Q
s
co
r
es
b
y
u
p
to
4
.
9
p
o
in
ts
.
T
h
e
r
esu
lts
ar
e
p
lau
s
ib
le,
p
ar
ticu
lar
ly
c
o
n
s
id
er
in
g
t
h
at
en
v
ir
o
n
m
en
tal
p
o
llu
tio
n
is
am
o
n
g
th
e
f
ac
to
r
s
ca
u
s
in
g
d
am
ag
e
t
o
th
e
ce
n
tr
al
n
er
v
o
u
s
s
y
s
tem
(
C
NS)
.
T
h
is
f
o
r
m
o
f
p
o
llu
tio
n
is
u
s
u
ally
ca
u
s
ed
b
y
d
if
f
er
e
n
t
f
ac
to
r
s
,
in
clu
d
in
g
co
n
tam
i
n
a
n
ts
f
r
o
m
m
o
t
o
r
v
e
h
icle
ex
h
au
s
t.
C
o
n
s
eq
u
en
tly
,
s
ch
o
o
ls
lo
ca
ted
r
elativ
ely
clo
s
e
to
h
ig
h
way
s
ar
e
m
o
r
e
v
u
ln
e
r
ab
le,
with
s
tu
d
e
n
ts
b
ein
g
at
r
i
s
k
o
f
h
av
in
g
lo
wer
I
Q
s
co
r
es
[
2
]
.
L
ea
d
af
f
ec
ts
th
e
b
o
d
y
'
s
in
ter
n
al
o
r
g
an
s
y
s
tem
s
,
in
clu
d
in
g
th
e
n
er
v
o
u
s
s
y
s
tem
[
3
]
.
T
h
e
m
etal's
ca
p
ac
ity
to
tr
av
er
s
e
th
e
b
lo
o
d
-
b
r
ain
b
ar
r
ie
r
(
B
B
B
)
v
ia
ac
ti
v
e
tr
an
s
p
o
r
t
m
ec
h
an
is
m
s
m
o
d
er
ated
b
y
d
iv
alen
t
m
etal
tr
an
s
p
o
r
ter
1
(
DM
T
1
)
an
d
Z
I
P
p
r
o
tein
s
s
u
g
g
ests
its
p
o
ten
tial
to
co
llect
in
th
e
ce
n
tr
al
n
er
v
o
u
s
s
y
s
tem
(
C
NS)
[
4
]
,
[
5
]
.
Fu
r
th
er
m
o
r
e,
f
etu
s
es
an
d
y
o
u
n
g
ch
ild
r
en
ar
e
s
p
ec
if
ically
s
u
s
ce
p
tib
le
to
th
e
n
eu
r
o
lo
g
ica
l
ef
f
ec
ts
o
f
lead
b
ec
au
s
e
th
eir
d
ev
elo
p
in
g
n
er
v
o
u
s
s
y
s
tem
s
ab
s
o
r
b
a
lar
g
er
p
r
o
p
o
r
tio
n
.
A
p
r
ev
io
u
s
s
tu
d
y
s
u
p
p
o
r
ts
th
is
,
in
d
icatin
g
th
at
a
d
o
lescen
ts
h
av
e
a
s
ig
n
if
ican
tl
y
h
ig
h
er
b
alan
ce
o
f
ci
r
cu
latin
g
lead
r
ea
ch
in
g
th
e
b
r
ain
co
m
p
ar
ed
to
ad
u
lts
[
6
]
.
Ad
o
lescen
ts
h
av
e
b
ee
n
s
h
o
w
n
to
p
o
ten
tially
b
ec
o
m
e
in
atten
tiv
e,
h
y
p
e
r
ac
tiv
e,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
A
cu
te
a
n
d
ch
r
o
n
ic
lea
d
ex
p
o
s
u
r
e
a
n
d
in
tellig
en
ce
q
u
o
tien
t a
mo
n
g
I
n
d
o
n
esia
n
…
(
N
o
via
n
a
Dewi)
209
an
d
ir
r
itab
le
with
lo
w
lead
ex
p
o
s
u
r
e.
T
h
is
d
e
m
o
g
r
ap
h
ic,
wh
en
ex
p
o
s
ed
to
h
ig
h
er
lead
lev
els,
m
ay
e
x
p
er
ien
ce
d
ef
er
r
ed
g
r
o
wth
,
r
ed
u
ce
d
in
te
llig
en
ce
,
s
h
o
r
t
-
ter
m
m
em
o
r
y
l
o
s
s
,
an
d
h
ea
r
in
g
lo
s
s
.
At
h
ig
h
er
co
n
ce
n
tr
atio
n
s
,
th
is
to
x
ic
m
etal
ca
n
lead
to
ir
r
ev
er
s
ib
le
b
r
ain
d
am
ag
e
a
n
d
p
o
ten
tially
d
ea
th
[
7
]
.
Acc
o
r
d
in
g
to
p
r
ev
io
u
s
s
tu
d
ies,
lo
w
-
lev
el
lead
ex
p
o
s
u
r
e
ca
n
s
u
b
s
tan
tially
im
p
ac
t
I
Q,
as
well
as
th
e
b
eh
av
io
r
,
co
n
ce
n
tr
atio
n
,
an
d
atten
tio
n
s
p
an
o
f
ad
o
lescen
ts
,
lead
in
g
to
p
er
ip
h
e
r
al
n
eu
r
o
p
ath
y
.
T
h
e
m
etal
ca
n
also
lead
to
d
ec
r
ea
s
ed
m
o
to
r
ac
tiv
ity
b
ec
au
s
e
it
ca
u
s
es
th
e
lo
s
s
o
f
th
e
m
y
elin
s
h
ea
th
th
at
in
s
u
lates
n
er
v
es.
T
h
is
s
ig
n
if
ican
tly
im
p
air
s
th
e
tr
an
s
m
is
s
io
n
o
f
n
er
v
e
im
p
u
ls
es,
lead
in
g
to
m
u
s
cle
f
au
lts
,
esp
ec
ially
in
th
e
o
u
te
r
m
u
s
cles,
f
atig
u
e,
an
d
p
o
o
r
co
o
r
d
in
atio
n
[
8
]
.
A
p
r
ev
io
u
s
s
tu
d
y
r
ev
ea
led
t
h
at
b
ee
f
an
d
ch
ic
k
en
s
o
ld
in
o
p
e
n
-
air
m
ar
k
ets alo
n
g
h
ea
v
ily
tr
a
f
f
ick
ed
r
o
ad
s
ca
n
h
ar
b
o
r
lea
d
co
n
ta
m
in
atio
n
in
th
e
air
[
9
]
.
I
n
d
u
s
tr
ializatio
n
h
as
b
ee
n
s
h
o
wn
to
in
c
r
ea
s
e
th
e
r
is
k
o
f
s
o
il
an
d
wate
r
p
o
ll
u
tio
n
,
wh
ich
ar
e
s
u
s
ce
p
tib
le
to
lead
ex
p
o
s
u
r
e.
T
y
p
ically
,
th
is
to
x
icity
is
ca
u
s
ed
b
y
th
e
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tile
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y
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u
el
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itio
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o
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em
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esti
cid
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in
ag
r
icu
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e
(
p
esti
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[
1
0
]
,
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1
1
]
.
T
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e
en
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ir
o
n
m
en
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at
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er
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lem
atic
b
eh
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h
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u
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d
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o
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Ho
wev
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er
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ich
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s
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v
y
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to
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r
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lea
d
[
1
2
]
.
Desp
ite
ex
ten
s
iv
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ev
id
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k
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g
lead
ex
p
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ies
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ec
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n
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M
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O
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d
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h
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s
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r
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d
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e
s
tu
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p
ar
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ts
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id
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n
to
two
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r
o
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p
s
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ac
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te
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n
d
a
ch
r
o
n
ic
g
r
o
u
p
ex
p
o
s
ed
to
lead
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as
s
h
o
wn
in
T
ab
le
1
.
E
th
ical
ap
p
r
o
v
al
co
n
f
ir
m
e
d
th
at
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s
tu
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y
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r
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t
o
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et
all
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s
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al
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d
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ter
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atio
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al
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ical
s
tan
d
ar
d
s
.
T
h
e
s
m
al
l
s
am
p
le
s
ize
m
ay
d
ec
r
ea
s
e
s
tatis
tica
l
p
o
wer
an
d
lim
it
g
en
er
aliza
b
ilit
y
.
C
o
n
f
o
u
n
d
in
g
v
ar
iab
les in
th
is
s
tu
d
y
in
clu
d
e
d
life
s
ty
le
an
d
o
c
cu
p
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n
.
T
ab
le
1
.
Sam
p
lin
g
p
r
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d
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r
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G
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p
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l
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t
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p
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t
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
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I
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15
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1
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M
ar
ch
20
26
:
2
0
8
-
215
210
Data
an
aly
s
is
was
ac
h
iev
ed
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s
in
g
SP
SS
v
er
s
io
n
2
3
.
B
o
t
h
d
escr
ip
tiv
e
an
d
in
f
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en
tial
s
tatis
tica
l
m
eth
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d
s
wer
e
ap
p
lied
to
in
ter
p
r
et
th
e
co
llected
d
ata.
Descr
ip
tiv
e
s
tatis
t
ics
wer
e
u
s
ed
to
p
r
esen
t
th
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d
is
tr
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tio
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f
p
ar
ticip
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ts
.
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h
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esu
lts
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e
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r
esen
te
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as
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ea
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s
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d
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r
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C
h
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-
s
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Q
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ican
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esh
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ld
was e
s
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lis
h
ed
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0
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,
with
a
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5
% c
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id
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ce
i
n
ter
v
al.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
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N
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h
e
r
esu
lts
s
h
o
wed
th
at
lead
lev
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e
s
till
with
in
n
o
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m
al
lim
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d
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DC
s
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d
ar
d
s
.
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DC
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o
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en
d
s
s
af
e
b
lo
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d
lead
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f
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ad
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lts
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d
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th
an
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f
o
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ts
.
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h
is
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ec
o
m
m
en
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ased
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n
a
p
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s
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y
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ch
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en
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to
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y
ea
r
s
f
r
o
m
th
e
NHAN
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S
I
I
I
d
ataset,
wh
ich
d
em
o
n
s
tr
ated
a
s
ig
n
if
ica
n
t
lin
k
b
etwe
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/
d
L
an
d
p
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o
r
ac
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e
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f
o
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m
an
ce
[
1
3
]
,
[
1
4
]
.
C
h
r
o
n
ic
ex
am
i
n
atio
n
p
a
r
am
eter
s
u
s
in
g
h
ai
r
,
lea
d
lev
els
wer
e
s
aid
t
o
b
e
in
n
o
r
m
al
th
r
esh
o
l
d
s
wh
en
th
e
lev
el
in
th
e
h
air
s
am
p
le
was
<4
.
0
μ
g
/g
[
1
5
]
.
W
h
en
as
s
ess
ed
b
y
ac
u
te
an
d
ch
r
o
n
ic
lead
le
v
els,
th
ese
r
e
m
ain
ed
with
in
n
o
r
m
al
lim
its
.
H
o
wev
er
,
w
h
en
ass
ess
ed
b
y
I
Q
s
co
r
es,
th
e
a
v
er
ag
e
f
o
r
ch
r
o
n
ic
e
x
p
o
s
u
r
e
was lo
wer
th
an
th
at
o
f
ac
u
te
e
x
p
o
s
u
r
e,
as sh
o
wn
in
Fig
u
r
e
1
.
Fig
u
r
e
1
.
I
Q
ca
te
g
o
r
y
g
r
a
p
h
b
ased
o
n
ty
p
e
o
f
e
x
p
o
s
u
r
e
(
ac
u
t
e
an
d
ch
r
o
n
ic
)
Acu
te
ex
p
o
s
u
r
e
r
eq
u
ir
ed
a
lo
n
g
er
r
ea
cti
o
n
tim
e
th
a
n
ch
r
o
n
ic
ex
p
o
s
u
r
e,
an
d
th
o
s
e
in
2
y
e
ar
s
d
id
n
o
t
ca
u
s
e
s
ig
n
if
ican
t
co
g
n
itiv
e
d
e
clin
e.
T
h
e
ef
f
ec
ts
o
f
lead
e
x
p
o
s
u
r
e
o
n
co
g
n
itiv
e
p
a
r
am
eter
s
h
av
e
b
ee
n
wid
ely
d
o
cu
m
e
n
ted
in
c
h
r
o
n
ic
ex
p
o
s
u
r
e
s
tu
d
ies,
p
ar
ticu
lar
l
y
with
r
esp
ec
t
to
m
em
o
r
y
a
n
d
lear
n
in
g
.
L
ea
d
r
ep
lace
d
ca
lciu
m
in
v
ar
io
u
s
r
eg
u
lato
r
y
ev
en
ts
in
v
o
lv
in
g
ca
lm
o
d
u
l
in
,
d
is
r
u
p
tin
g
en
e
r
g
y
m
etab
o
lis
m
an
d
ca
lciu
m
r
elea
s
e
f
r
o
m
m
ito
ch
o
n
d
r
ia,
w
h
ich
lead
s
t
o
th
e
p
r
im
in
g
o
f
p
r
o
g
r
am
m
ed
ce
ll
d
ea
th
.
T
h
ese
n
eu
r
o
p
h
y
s
io
lo
g
ical
ch
an
g
es
d
is
r
u
p
te
d
s
y
n
ap
tic
c
o
n
n
ec
tiv
ity
a
n
d
n
e
u
r
o
g
en
esis
,
b
o
th
o
f
wh
ich
p
lay
ess
en
tial
r
o
les
in
n
eu
r
al
p
last
icity
.
L
ea
d
ex
p
o
s
u
r
e
p
lay
ed
a
s
ig
n
if
ican
t
r
o
le
in
s
y
n
ap
tic
n
eu
r
o
to
x
icity
,
with
th
e
r
elate
d
co
g
n
itiv
e
ch
an
g
es
lin
k
ed
t
o
its
b
u
ild
u
p
in
astro
g
lia
a
n
d
m
icr
o
g
lia.
Ast
r
o
cy
tes
f
o
r
m
t
h
e
B
B
B
an
d
p
er
f
o
r
m
h
o
m
eo
s
tatic
r
eg
u
lato
r
y
f
u
n
ctio
n
s
th
at
s
u
p
p
o
r
t
lo
n
g
-
ter
m
p
o
ten
tiatio
n
,
wh
ich
is
im
p
o
r
tan
t
f
o
r
s
y
n
ap
tic
p
last
icity
,
lear
n
in
g
,
an
d
m
em
o
r
y
[
1
6
]
-
[
1
8
]
.
C
h
i
-
s
q
u
ar
e
test
r
esu
lts
in
d
icat
ed
a
p
-
v
alu
e
o
f
0
.
0
2
2
(
0
.
0
5
)
,
in
d
icatin
g
th
at
b
o
t
h
ac
u
te
an
d
ch
r
o
n
ic
ex
p
o
s
u
r
e
h
a
d
a
s
tatis
t
ically
s
i
g
n
if
ican
t
im
p
ac
t
o
n
I
Q
d
ec
li
n
e.
Acu
te
lead
ex
p
o
s
u
r
e
(
OR
:
0
.
3
4
5
,
9
5
%
C
I
=
0
.
1
3
3
-
0
.
8
9
9
)
s
h
o
wed
a
n
eg
ati
v
e
ef
f
ec
t
o
n
I
Q,
b
u
t
it
was
m
ild
er
th
a
n
ch
r
o
n
ic
ex
p
o
s
u
r
e
(
OR
:
1
.
9
0
0
,
9
5
%
C
I
=
1
.
0
7
3
-
3
.
3
6
3
)
.
T
h
is
s
tu
d
y
o
b
s
er
v
ed
th
at
ch
r
o
n
ic
lead
ex
p
o
s
u
r
e,
ass
es
s
ed
th
r
o
u
g
h
h
air
s
am
p
les,
was
m
o
r
e
s
tr
o
n
g
ly
ass
o
ciate
d
with
r
ed
u
ce
d
I
Q
th
an
ac
u
te
ex
p
o
s
u
r
e
m
ea
s
u
r
ed
b
y
b
lo
o
d
lea
d
lev
el
s
.
B
ased
o
n
p
r
ev
io
u
s
o
b
s
er
v
atio
n
s
,
en
v
ir
o
n
m
e
n
tal
ex
p
o
s
u
r
e
to
lead
ca
u
s
ed
n
eu
r
o
to
x
ic
ef
f
ec
ts
,
w
h
ich
m
an
if
e
s
ted
as
ch
an
g
es
in
n
er
v
o
u
s
s
y
s
tem
f
u
n
ctio
n
,
s
u
ch
as
co
g
n
itiv
e
im
p
air
m
en
t,
m
en
tal
h
ea
lth
o
r
m
o
o
d
d
is
o
r
d
er
s
,
an
d
n
eu
r
o
m
o
to
r
d
y
s
f
u
n
ctio
n
[
1
9
]
.
I
n
th
e
c
o
n
tex
t
o
f
t
h
is
ex
p
lo
r
ati
o
n
,
T
a
b
le
2
s
h
o
wed
th
at
th
e
g
r
o
u
p
with
ch
r
o
n
ic
lead
ex
p
o
s
u
r
e
r
esu
lted
in
6
6
.
7
%
o
f
ad
o
lescen
ts
h
av
in
g
b
elo
w
-
av
e
r
ag
e
I
Qs.
Me
an
w
h
ile,
ac
u
te
ex
p
o
s
u
r
e
s
h
o
wed
th
at
3
3
.
3
%
also
h
a
d
b
elo
w
-
av
er
a
g
e
I
Qs.
L
ea
d
p
o
is
o
n
in
g
in
ad
o
lescen
ts
co
u
ld
r
ed
u
ce
in
tellig
en
ce
.
B
ased
o
n
o
b
s
er
v
atio
n
s
,
wh
en
lead
lev
els
f
o
u
n
d
in
th
e
b
lo
o
d
o
f
ad
o
lescen
ts
wer
e
3
tim
e
s
th
e
n
o
r
m
al
lim
it
(
n
o
r
m
al
in
tak
e
is
ar
o
u
n
d
0
.
3
m
illi
g
r
am
s
p
er
d
ay
)
,
th
er
e
wa
s
a
d
ec
r
ea
s
e
in
I
Q
b
elo
w
8
0
.
T
h
is
f
o
r
m
o
f
b
r
ain
d
y
s
f
u
n
ctio
n
ty
p
ically
o
cc
u
r
r
ed
b
ec
au
s
e
lead
co
m
p
etitiv
ely
r
e
p
lace
d
k
e
y
m
i
n
er
als
s
u
ch
as
zin
c,
co
p
p
er
,
an
d
ir
o
n
,
w
h
ich
wer
e
ess
en
tial
f
o
r
r
eg
u
latin
g
C
NS f
u
n
ctio
n
.
T
h
is
r
ed
u
ce
d
an
ad
o
lescen
t’
s
ch
an
ce
s
o
f
s
u
cc
ess
in
s
ch
o
o
l
[
2
0
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
A
cu
te
a
n
d
ch
r
o
n
ic
lea
d
ex
p
o
s
u
r
e
a
n
d
in
tellig
en
ce
q
u
o
tien
t a
mo
n
g
I
n
d
o
n
esia
n
…
(
N
o
via
n
a
Dewi)
211
Ad
o
lescen
t
s
tu
d
en
ts
with
I
Q
d
ec
lin
e
ex
p
er
ien
ce
d
d
if
f
icu
lties
in
d
ev
elo
p
in
g
a
d
ap
tiv
e
b
eh
av
io
r
,
wh
ich
d
ir
ec
tly
im
p
ac
te
d
th
ei
r
d
ail
y
liv
es.
C
o
m
m
o
n
p
r
o
b
lem
s
f
ac
ed
b
y
th
is
d
em
o
g
r
ap
h
ic
in
clu
d
e
d
lear
n
in
g
d
if
f
icu
lties
,
ad
ju
s
tm
en
t
d
if
f
ic
u
lties
,
an
d
p
er
s
o
n
ality
is
s
u
es
[
2
1
]
.
L
ea
r
n
in
g
ac
tiv
ities
wer
e
d
ir
ec
tly
r
elate
d
to
in
tellectu
al
ab
ilit
ies.
T
h
is
was
ev
id
en
ce
d
b
y
th
e
f
ac
t th
at
lear
n
in
g
r
e
q
u
ir
ed
at
least th
e
ab
ilit
y
to
r
em
em
b
er
an
d
u
n
d
er
s
tan
d
,
as
well
as
th
e
ca
p
ab
ilit
y
to
id
en
tify
ca
u
s
e
-
an
d
-
ef
f
ec
t
r
elatio
n
s
h
ip
s
.
Ad
o
lesce
n
t
s
tu
d
en
ts
with
I
Q
d
ec
lin
e
ex
h
ib
ited
d
if
f
icu
lty
th
i
n
k
in
g
a
b
s
tr
ac
tly
.
Fo
r
th
is
g
r
o
u
p
o
f
in
d
iv
id
u
als,
an
y
lear
n
in
g
ex
p
er
ien
ce
m
u
s
t b
e
r
elate
d
to
co
n
cr
ete
o
b
jects.
T
h
is
co
n
d
itio
n
was
ass
o
ciate
d
wi
th
wea
k
s
h
o
r
t
-
ter
m
m
em
o
r
y
,
p
o
o
r
r
ea
s
o
n
i
n
g
,
an
d
d
if
f
icu
lty
in
d
ev
elo
p
in
g
id
ea
s
[
2
2
]
.
A
p
r
ev
io
u
s
s
tu
d
y
r
ep
o
r
ted
th
at
ad
o
lescen
t
s
tu
d
en
ts
with
I
Q
d
ec
lin
e
ex
p
er
ien
ce
d
co
g
n
itiv
e
d
ef
icits
,
r
ef
lecte
d
in
co
g
n
itiv
e
p
r
o
ce
s
s
es
lik
e
p
er
ce
p
tio
n
,
m
em
o
r
y
,
id
e
a
d
ev
elo
p
m
en
t,
ev
alu
atio
n
,
a
n
d
r
ea
s
o
n
i
n
g
.
W
h
en
en
g
ag
in
g
th
is
d
em
o
g
r
a
p
h
ic
in
lear
n
in
g
ac
tiv
ities
,
it
was
ex
p
ec
ted
th
at
th
e
u
s
e
o
f
co
m
p
le
x
lan
g
u
a
g
e
co
u
ld
b
e
co
m
p
letely
av
o
id
ed
.
T
h
e
la
n
g
u
ag
e
u
s
ed
m
u
s
t
b
e
i
n
th
e
f
o
r
m
o
f
s
h
o
r
t,
c
o
n
cr
ete,
s
in
g
le
s
en
ten
ce
s
in
o
r
d
er
t
o
f
o
s
ter
ea
s
y
u
n
d
e
r
s
tan
d
in
g
am
o
n
g
ad
o
lescen
ts
with
I
Q
d
ec
lin
e
[
2
3
]
.
T
h
is
was
s
u
p
p
o
r
ted
b
y
th
e
C
h
i
-
s
q
u
ar
e
test
r
esu
lts
(
T
ab
le
3
)
,
wh
ich
in
d
icate
d
a
p
-
v
al
u
e
o
f
0
.
0
2
2
(
0
.
0
5
)
,
in
d
icatin
g
th
at
b
o
t
h
ac
u
te
an
d
ch
r
o
n
ic
ex
p
o
s
u
r
e
h
a
d
a
s
tati
s
tically
s
ig
n
if
ican
t
im
p
ac
t
o
n
I
Q
r
ed
u
ctio
n
.
Ad
o
lescen
ts
with
h
ig
h
er
lev
els
o
f
lead
wer
e
af
f
ec
ted
b
y
d
elay
ed
g
r
o
wth
,
d
ec
r
ea
s
ed
in
tellig
en
ce
,
m
em
o
r
y
co
m
p
licatio
n
s
(
s
h
o
r
t
-
te
r
m
m
e
m
o
r
y
)
,
an
d
h
ea
r
in
g
im
p
air
m
e
n
t
at
a
h
ig
h
er
lev
el
o
f
s
ev
e
r
ity
.
Fu
r
th
er
m
o
r
e,
lea
d
ca
u
s
ed
ir
r
ev
e
r
s
ib
le
b
r
ai
n
d
a
m
ag
e
an
d
e
v
en
d
ea
th
[
6
]
.
Me
m
o
r
y
co
m
p
o
n
en
ts
wer
e
p
r
o
v
e
n
to
in
f
lu
e
n
ce
ac
ad
em
ic
ac
h
iev
em
e
n
t
in
a
d
d
itio
n
to
p
s
y
c
h
o
m
etr
ic
in
tellig
en
ce
.
Sp
ec
if
ically
,
wo
r
k
in
g
m
em
o
r
y
(
W
M)
,
th
e
ab
ilit
y
to
p
r
o
ce
s
s
a
n
d
r
etain
in
f
o
r
m
atio
n
,
was
ass
o
ciate
d
wit
h
p
e
r
f
o
r
m
an
ce
o
n
v
a
r
io
u
s
c
o
g
n
itiv
e
task
s
,
s
u
ch
as
r
ea
s
o
n
in
g
an
d
v
er
b
al
co
m
p
r
e
h
en
s
io
n
.
As
r
ep
o
r
ted
b
y
p
r
e
v
io
u
s
ex
p
lo
r
atio
n
s
,
a
r
elatio
n
s
h
ip
ex
is
ted
b
etwe
en
W
M
an
d
in
tellig
en
ce
,
as we
ll a
s
b
etwe
en
s
h
o
r
t
-
ter
m
m
e
m
o
r
y
,
W
M,
an
d
I
Q
[
2
4
]
.
T
o
x
ic
m
etals
lik
e
lead
,
m
er
cu
r
y
,
an
d
ca
d
m
i
u
m
h
av
e
ad
v
er
s
e
ef
f
ec
ts
,
lead
in
g
to
n
eu
r
o
d
e
v
elo
p
m
en
tal
d
is
o
r
d
er
s
,
n
e
u
r
o
d
eg
en
e
r
ativ
e
d
is
ea
s
es,
an
d
g
r
o
wth
d
elay
s
i
n
ad
o
lescen
ts
[
2
5
]
.
Mo
r
eo
v
er
,
th
e
u
s
e
o
f
lead
i
n
in
d
u
s
tr
y
h
a
d
r
esu
lted
in
wid
es
p
r
ea
d
en
v
ir
o
n
m
en
tal
co
n
tam
in
atio
n
an
d
s
ev
er
e
to
x
icity
,
in
c
lu
d
in
g
n
eu
r
o
l
o
g
ical
d
is
ea
s
es,
d
ev
elo
p
m
en
tal
p
r
o
b
lem
s
in
ad
o
lescen
ts
,
a
n
d
c
h
r
o
n
ic
d
is
ea
s
es
[
2
6
]
.
Glo
b
ally
,
t
h
e
u
s
ag
e
o
f
tetr
ae
th
y
l
lead
in
g
aso
lin
e
was
a
s
ig
n
if
ic
an
t
co
n
t
r
ib
u
to
r
to
air
p
o
llu
tio
n
an
d
lead
ex
p
o
s
u
r
e.
T
h
e
o
n
g
o
i
n
g
g
r
o
wth
in
b
lo
o
d
lead
lev
els
af
ter
th
e
b
an
o
n
lea
d
ed
g
aso
lin
e
was
s
u
p
p
o
s
ed
t
o
r
esu
lt
f
r
o
m
en
v
ir
o
n
m
en
tal
e
x
p
o
s
u
r
e,
p
ar
ticu
lar
ly
g
iv
en
th
e
p
r
o
x
im
ity
o
f
r
esid
en
tial a
r
ea
s
to
in
d
u
s
tr
ies p
r
o
n
e
to
lead
co
n
tam
in
atio
n
.
L
ea
d
was
u
b
i
q
u
ito
u
s
a
n
d
n
eu
r
o
to
x
ic,
p
ar
ticu
lar
ly
h
ar
m
f
u
l
t
o
ad
o
lescen
ts
,
wh
o
wer
e
m
o
r
e
v
u
ln
er
ab
le
th
an
ad
u
lts
to
its
to
x
ic
ef
f
ec
ts
.
T
h
e
p
r
ev
alen
ce
o
f
lead
p
o
is
o
n
in
g
an
d
ir
o
n
d
e
f
icien
cy
h
a
d
b
ee
n
o
b
s
er
v
e
d
to
b
e
h
ig
h
in
s
o
cio
ec
o
n
o
m
ically
v
u
ln
er
ab
le
p
o
p
u
latio
n
s
,
n
eg
ati
v
ely
im
p
ac
tin
g
n
eu
r
o
c
o
g
n
iti
v
e
d
ev
elo
p
m
en
t
in
ad
o
lescen
ts
.
Ob
s
er
v
atio
n
s
in
d
icate
th
at
o
v
er
h
alf
o
f
th
e
U
S
p
eo
p
le
was
ex
p
o
s
ed
t
o
h
a
r
m
f
u
l
lead
lev
els
in
ch
ild
h
o
o
d
,
s
tem
m
in
g
f
r
o
m
th
e
h
is
to
r
ical
u
s
e
o
f
lead
e
d
g
as
o
lin
e
.
Alth
o
u
g
h
th
e
o
v
er
all
i
m
p
ac
t
o
f
c
h
ild
h
o
o
d
lead
ex
p
o
s
u
r
e
o
n
m
en
tal
h
e
alth
an
d
ch
a
r
ac
ter
tr
aits
in
th
e
US
p
o
p
u
latio
n
h
as
n
o
t
y
et
b
ee
n
ev
alu
ate
d
.
A
s
ig
n
if
ican
t
p
o
r
tio
n
o
f
m
en
t
al
illn
ess
s
y
m
p
to
m
s
an
d
a
d
v
e
r
s
e
p
er
s
o
n
ality
tr
aits
in
US
a
d
o
lescen
ts
o
v
er
th
e
p
ast
7
5
y
ea
r
s
co
u
ld
b
e
lin
k
ed
to
lead
ex
p
o
s
u
r
e.
T
h
e
p
o
ten
tial
h
ar
m
f
u
l
im
p
ac
t
o
f
t
h
is
to
x
ic
m
etal
o
n
p
s
y
ch
iatr
y
,
m
e
d
icin
e,
an
d
ad
o
lescen
t h
ea
lth
m
ig
h
t b
e
m
o
r
e
s
ig
n
if
ican
t th
an
p
r
e
v
io
u
s
ly
esti
m
ated
[
2
7
]
.
On
ce
in
s
id
e
th
e
C
NS,
lead
d
is
r
u
p
ts
n
eu
r
al
h
o
m
eo
s
tasi
s
b
y
in
h
ib
itin
g
n
eu
r
o
tr
an
s
m
itter
s
y
s
tem
s
,
in
cr
ea
s
in
g
o
x
id
ativ
e
s
tr
ess
,
an
d
ac
tiv
atin
g
m
icr
o
g
lial
ce
lls
.
T
h
is
led
to
n
eu
r
o
in
f
lam
m
atio
n
an
d
n
er
v
e
d
a
m
ag
e
[
2
8
]
.
Oth
er
s
tu
d
ies
h
av
e
s
h
o
wn
th
at
lead
was
p
r
o
v
e
n
to
i
n
h
ib
it
th
e
f
u
n
ctio
n
o
f
NM
DA
r
ec
ep
to
r
s
,
th
er
eb
y
d
is
r
u
p
tin
g
s
y
n
ap
tic
p
last
icity
an
d
lear
n
in
g
p
r
o
ce
s
s
es
[
2
9
]
.
Sev
er
al
s
tu
d
ies
co
n
s
is
ten
tly
h
ig
h
lig
h
t
th
e
n
eg
ativ
e
im
p
ac
t
o
f
lead
e
x
p
o
s
u
r
e
o
n
c
h
ild
r
en
'
s
m
en
tal
an
d
b
eh
a
v
io
r
al
d
ev
elo
p
m
en
t.
Pre
v
io
u
s
s
tu
d
y
s
h
o
wed
a
s
tr
o
n
g
n
eg
ativ
e
r
elatio
n
s
h
i
p
b
etwe
en
lead
lev
els
an
d
v
is
u
al
-
p
er
ce
p
tu
al
p
r
o
g
r
ess
in
ch
ild
r
e
n
with
lear
n
in
g
p
r
o
b
lem
s
,
as
m
ea
s
u
r
ed
b
y
th
e
B
en
d
er
Vis
u
al
-
Mo
to
r
Gestalt
T
e
s
t.
T
h
e
s
tu
d
y
d
em
o
n
s
tr
ated
th
at
e
v
en
m
in
im
al
lead
ex
p
o
s
u
r
e
c
o
u
ld
h
a
r
m
v
is
u
al
-
m
o
to
r
s
k
ills
[
8
]
.
Oth
er
s
tu
d
ie
s
s
h
o
wed
th
at
ex
p
o
s
u
r
e
to
le
ad
s
ev
er
ely
af
f
ec
ted
lear
n
in
g
an
d
m
em
o
r
y
,
as we
ll a
s
I
Q
o
f
ch
ild
r
e
n
,
f
o
u
n
d
to
b
e
in
v
er
s
ely
p
r
o
p
o
r
ti
o
n
al
to
b
lo
o
d
lead
lev
els
[3
0
].
L
ea
d
was
r
ef
er
r
ed
to
as
a
h
ea
v
y
m
etal,
alo
n
g
with
m
er
cu
r
y
,
ch
r
o
m
iu
m
,
ca
d
m
iu
m
,
an
d
a
r
s
en
ic.
T
h
is
m
etal
g
en
er
ally
en
ter
s
th
e
h
u
m
an
b
o
d
y
th
r
o
u
g
h
th
e
d
ig
e
s
tiv
e
s
y
s
tem
,
r
esp
ir
ato
r
y
s
y
s
tem
,
an
d
s
k
in
[3
1
]
.
L
ea
d
'
s
to
x
ico
lo
g
y
was
d
an
g
e
r
o
u
s
b
ec
au
s
e
its
io
n
ic
m
ec
h
a
n
is
m
en
ab
led
it
to
s
u
b
s
titu
te
f
o
r
o
th
e
r
b
iv
alen
t
ca
tio
n
s
lik
e
C
a
2+
,
Mg
2+
,
Fe
2+
,
as
well
a
s
m
o
n
o
v
alen
t
ca
tio
n
s
s
u
ch
as
Na+
.
As
s
tated
in
a
p
r
ev
io
u
s
ex
p
lo
r
atio
n
,
th
e
m
etal
co
u
ld
in
v
a
r
iab
ly
af
f
ec
t
f
u
n
d
am
e
n
tal
b
io
lo
g
ical
p
r
o
ce
s
s
es
in
th
e
h
u
m
an
b
o
d
y
[3
2
]
.
C
o
n
tin
u
o
u
s
lead
ac
cu
m
u
latio
n
in
t
h
e
b
o
d
y
s
ig
n
if
ican
tly
af
f
ec
ted
v
ar
io
u
s
p
r
o
ce
s
s
es,
in
clu
d
in
g
d
is
r
u
p
tin
g
in
te
r
ce
llu
lar
s
ig
n
alin
g
,
ce
ll
ad
h
esio
n
,
p
r
o
t
ein
f
o
ld
in
g
a
n
d
m
atu
r
atio
n
,
i
o
n
ic
tr
an
s
p
o
r
t,
a
p
o
p
to
s
is
,
en
z
y
m
e
r
eg
u
latio
n
,
an
d
n
eu
r
o
tr
a
n
s
m
itter
r
elea
s
e
[3
3
]
.
L
ea
d
f
u
r
th
er
in
f
lu
en
ce
d
s
o
d
i
u
m
io
n
co
n
ce
n
tr
atio
n
,
wh
ic
h
is
cr
u
cial
f
o
r
v
ital
b
io
lo
g
ical
f
u
n
ctio
n
s
s
u
ch
as
r
esp
o
n
d
in
g
to
s
tim
u
li
in
ex
ci
tato
r
y
n
etwo
r
k
s
f
o
r
ce
ll
-
to
-
ce
ll
co
m
m
u
n
icatio
n
,
n
eu
r
o
tr
a
n
s
m
itter
u
p
tak
e
(
in
cl
u
d
in
g
d
o
p
am
in
e,
c
h
o
lin
e,
an
d
GABA),
an
d
m
an
ag
in
g
ca
lciu
m
u
tili
za
tio
n
an
d
r
eten
tio
n
b
y
s
y
n
ap
to
s
o
m
es.
T
h
e
in
ter
ac
tio
n
b
etwe
en
lead
a
n
d
s
o
d
iu
m
also
in
ter
f
e
r
ed
with
s
o
d
iu
m
'
s
n
o
r
m
al
f
u
n
ctio
n
[
3
4
]
,
[
3
5
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
1
,
M
ar
ch
20
26
:
2
0
8
-
215
212
T
h
e
im
p
ac
t
o
f
b
o
th
ch
r
o
n
ic
a
n
d
ac
u
te
lead
ex
p
o
s
u
r
e
o
n
I
Q
s
co
r
es,
wh
en
n
o
t
a
d
d
r
ess
ed
s
er
io
u
s
l
y
th
r
o
u
g
h
p
o
licy
an
d
p
u
b
lic
ed
u
ca
tio
n
,
co
u
ld
in
cr
ea
s
e
th
e
r
is
k
o
f
ad
o
lescen
t
s
tu
d
en
ts
with
I
Q
d
ec
lin
e,
m
ak
in
g
th
e
d
em
o
g
r
a
p
h
ic
less
s
u
ited
f
o
r
ex
ec
u
tiv
e
-
le
v
el
jo
b
s
wh
er
e
d
ec
is
io
n
-
m
ak
in
g
was
co
n
s
id
er
ed
co
r
e.
Acc
o
r
d
i
n
g
to
[
3
0
]
,
lead
ex
p
o
s
u
r
e
at
lev
els
o
f
1
0
-
3
0
μ
g
/
d
L
was
lin
k
ed
to
a
2
to
3
-
p
o
in
t
d
r
o
p
in
I
Q
s
co
r
es
d
u
r
in
g
th
e
s
tu
d
y
.
Fu
r
t
h
er
m
o
r
e,
a
1
μ
g
/
d
L
in
cr
ea
s
e
in
b
lo
o
d
lead
le
v
el
w
as
lin
k
ed
t
o
a
0
.
5
-
p
o
i
n
t
d
ec
r
ea
s
e
in
I
Q
test
s
co
r
es
f
o
r
b
o
th
ar
ith
m
etic
a
n
d
r
ea
d
in
g
s
k
ills
.
T
h
e
ed
u
ca
tio
n
al
ch
allen
g
es
ad
o
lescen
t
s
tu
d
en
ts
with
I
Q
d
ec
lin
e
o
f
ten
f
ac
e
m
ad
e
th
e
g
r
o
u
p
v
u
ln
er
ab
le
to
em
p
lo
y
m
e
n
t
-
r
el
ated
is
s
u
es,
p
ar
ticu
lar
ly
d
u
e
to
lo
w
wo
r
k
s
k
ills
an
d
r
ed
u
ce
d
p
r
o
d
u
ctiv
ity
.
T
h
is
d
im
in
is
h
ed
p
r
o
d
u
ctiv
ity
was
o
b
s
er
v
ed
to
b
e
clo
s
ely
r
elate
d
to
ch
r
o
n
ic
n
u
tr
itio
n
al
p
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ia
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e
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r
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tly
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icien
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Q
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ates
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ter
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m
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r
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x
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s
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ld
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p
air
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g
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itiv
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f
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n
ctio
n
a
n
d
l
o
wer
in
tellig
en
c
e
s
co
r
es
[
37
]
,
[
38
]
.
Ov
er
tim
e,
b
o
th
c
h
r
o
n
ic
an
d
a
cu
te
lead
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x
p
o
s
u
r
e
lo
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ed
n
o
t
o
n
ly
i
n
tellig
en
ce
b
u
t
also
im
m
u
n
ity
lev
els
[
2
1
]
.
C
o
n
s
id
er
in
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th
is
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was
ess
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ex
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m
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ate
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h
ea
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cr
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m
o
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ito
r
r
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p
air
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n
u
tr
ie
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t
ab
s
o
r
p
tio
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em
ia,
a
n
d
v
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D
d
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icien
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y
.
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e
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ts
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en
tifie
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b
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k
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ia
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d
v
itam
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D
d
ef
ici
en
cy
m
u
s
t
also
b
e
p
r
o
v
id
e
d
with
tar
g
eted
in
ter
v
en
tio
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s
,
in
clu
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in
g
s
u
p
p
lem
en
tatio
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an
d
a
n
u
tr
itio
u
s
d
iet
tailo
r
ed
to
s
p
ec
if
ic
n
u
tr
itio
n
al
n
ee
d
s
.
Pre
v
io
u
s
in
v
esti
g
atio
n
s
r
ep
o
r
ted
th
at
ad
o
lescen
ts
ex
p
o
s
ed
to
lead
f
r
e
q
u
en
tly
h
a
d
lo
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v
itam
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D
lev
els
an
d
h
i
g
h
er
in
f
lam
m
ato
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y
m
ar
k
er
s
.
L
ea
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in
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u
ce
d
ch
r
o
n
ic
in
f
la
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m
atio
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c
o
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ld
im
p
air
v
itam
in
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ab
s
o
r
p
tio
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in
ad
o
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,
wh
ich
in
tu
r
n
m
ay
p
r
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m
o
te
th
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d
ev
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p
m
en
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o
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im
m
u
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iated
d
is
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es.
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h
is
co
n
s
is
ten
tly
h
ig
h
lig
h
te
d
th
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i
m
p
o
r
tan
ce
o
f
i
n
ter
v
en
tio
n
s
to
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x
p
o
s
u
r
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an
d
s
af
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ar
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ad
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lescen
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f
r
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m
im
m
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l
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ical
d
is
ea
s
es a
n
d
n
e
g
ativ
e
h
ea
lth
e
f
f
ec
ts
[
39
]
.
L
ea
d
ex
p
o
s
u
r
e
r
em
ain
ed
a
v
er
y
s
ig
n
if
ican
t
p
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lic
h
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lth
co
n
ce
r
n
,
c
o
n
tr
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u
tin
g
to
an
esti
m
ated
0
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9
m
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o
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d
ea
th
s
a
n
d
2
1
.
7
m
illi
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n
d
is
ab
ilit
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ea
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lo
s
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b
ally
d
u
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t
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p
r
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lo
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g
ed
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p
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W
HO
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ap
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ately
3
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8
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6
A
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tellig
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…
(
N
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via
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a
Dewi)
213
in
v
esti
g
atio
n
s
to
i
d
en
tify
p
o
ten
tial
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ce
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f
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tam
in
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wer
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an
d
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ciate
d
r
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s
[
2
7
]
,
[
4
0
].
T
h
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tu
d
y
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a
d
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ly
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Fig
u
r
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2
.
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o
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4.
CO
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[
22
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