Elevated Leg Research Articles

The Effect of Revascularization on Lower Limb Circulation Parameters in Symptomatic Peripheral Arterial Disease.

Background: The prevalence of peripheral arterial disease and the number of revascularization procedures performed in symptomatic patients are steadily increasing. However, uncertainties remain regarding hemodynamic monitoring after revascularization and the prediction of clinical outcomes. This study aimed to investigate hemodynamic parameters with a focus on the microvasculature. Methods: This prospective, single-center study included 29 patients (15 with intermittent claudication [IC] and 14 with chronic limb-threatening ischemia [CLTI]). Before and after the revascularization procedure, in addition to the ankle-brachial index (ABI), microperfusion parameters, including microvascular blood flow, capillary oxygen saturation (SO2), and relative hemoglobin content (rHb), were assessed with lightguide spectrophotometry combined with laser Doppler flowmetry using an oxygen-to-see (O2C) device in the horizontal and elevated leg positions. Results: At baseline, SO2 in the elevated leg position was significantly lower in patients with CLTI than in those with IC (p = 0.0189), whereas the other microcirculatory parameters and ABI values were not significantly different. Patients with diabetes mellitus had a higher flow rate than those without in the horizontal leg position (p = 0.0162) but not in the elevated leg position. After successful revascularization, the flow increased immediately and significantly in both positions, whereas SO2, rHb, and the ABI did not. Conclusions: Elevated leg SO2 was significantly lower in CLTI than in clinically compensated peripheral arterial disease, whereas microvascular flow was a suitable surrogate parameter indicating successful revascularization. In studies using surgical or interventional revascularization procedures, noninvasive hemodynamic monitoring of the microcirculation at the foot level might be beneficial.

Design of energy-absorbing bionic workstation table for trains and research on occupant collision injury

Secondary impact is a significant contributor to occupant injuries in train crashes. To mitigate collision injuries, a workbench with energy-absorbing properties was developed, drawing inspiration from leaf-vein and honeycomb structures. A local collision model of a dummy compartment was established to evaluate the impact of different sandwich thicknesses on occupant injuries. By optimizing the wall thickness of the energy-absorbing sandwich, the optimal gradient parameters were determined. The assessment of occupant collision injury from the workstation table with a graded wall thickness sandwich was conducted using the LSTC Hybrid III 50th seating dummy. The results demonstrate that the workstation table influences the occupant's movement posture during a collision, preventing head impact with the tabletop. Apart from slightly elevated leg injuries in the dummy, which remained within permissible values, the head, neck, and chest injuries were reduced by 98.45%, 48.17%, and 81.18%, respectively.

Pressure in the Operating Room: A Potential Contributor to Hospital Acquired Pressure Injuries (HAPIs).

Burn patients are at risk for hospital acquired pressure injuries (HAPIs). An unexamined factor that may contribute to HAPI development is the effect of pressure from the operating table during surgery. The purpose of this study was to measure pressure on the buttocks and sacral area during burn surgery under general anesthesia (GA). Prospective study of consecutive adult burn patients admitted to an ABA- verified burn center who required surgery under GA between 06/01/22 and 08/12/22. We studied only cases that were supine, including those with both legs down (LD), one leg suspended (1LU) or both legs suspended (2LU). Interface pressures on the buttocks and sacral area were measured using a commercial sensor mat. Thousands of individual pressure measurements were integrated to show average and peak pressures over repetitive 10-minute intervals during the entire operation. Recordings were completed in 41 procedures among 28 patients (48.3 ± 16.9 yrs, % TBSA burn 19.2 ± 17.1, weight 80.2 ± 19.7kg, BMI 26.7 ± 6.2). Both average pressure (Pave) and peak pressure (Ppeak) increased significantly with greater number of elevated legs (p<0.001). During 2LU periods, Ppeak exceeded 100 mmHg for almost half the operative duration. Pave crept steadily upwards over time and had a positive relationship with weight, regardless of leg elevation. Prolonged moderate to high pressures are exerted on the sacral and buttock areas, especially with one or both legs suspended, during burn surgery. These novel observations suggest that pressure from the operating table could contribute to HAPI development.

Assessment of Dynamic Balancing Performance of Synchronized Ice Skaters With Sudden Provocation Test via Principal Component Analysis

Background: Balancing performance can be affected by regular and high-level athletic training, which has not been fully explored in synchronized ice skaters. This study aimed to analyze the dynamic balancing performance by assessing the principal and compensatory movements performed during the sudden provocation tests and evaluating the parameters that characterize the platform’s motion. Method: Twelve young female synchronized ice skaters and 12 female age-matched controls participated. Sudden provocation tests were completed three times in bipedal stance and in single-leg stances, and sport-specific fatigue session was inserted between the repetitions. Results: Significantly more time was necessary to recover balance for both groups after the fatiguing sessions (p &lt; .05). Interestingly, skaters performed less effectively in the simplest condition (bipedal stance) than the control group (p &lt; .05). The principal component analysis showed that the first principal movement was the same for both groups. The skater group used the upper body and arms more often to compensate, while the control group’s recovery strategy consisted mainly of abduction of the elevated leg. The damping ratio and the relative variance of the first principal movement showed a negative correlation (p &lt; .05), suggesting that those with superior balancing effectiveness recruited more compensatory movements.

7763 Hysteroscopic Morcellation (with Bigatti Shaver) Under Laparoscopic Guidance: A Novel Approach to Management of Caesarean Scar Pregnancy

<h3>Study Objective</h3> To present our experience in treating cases with caesarean scar pregnancy by hysteroscopic morcellation using Bigatti Shaver over a period of 1 year. <h3>Design</h3> Longitudinal prospective study for 1 year & follow up done till beta HCG level comes to normal. <h3>Setting</h3> Patients positioning in the OT table: Lithotomy position, 45-degree angle between OT table & patients elevated legs. 2 Endomat Select: one for irrigation & other for suction, RPM-2100, Irrigation: 200-250 ml/min, Pressure: 150mm of Hg <h3>Patients or Participants</h3> 10 women between age 22-35years presented to us in the OPD with caesarean scar pregnancy confirmed on their dating ultrasound. <h3>Interventions</h3> Pre operative investigations were done prior to surgery and under laparoscopy they were posted for surgical intervention - removal of scar pregnancy by Bigatti Shaver. <h3>Measurements and Main Results</h3> • No fertility desired by the patient further, so patient should be tubectomised • It should be done till 7 weeks of period of gestation • Myometrial thickness should be between 2 to 4 mm <h3>Results</h3> 1. None had any intra or post operative complications. 2. Average duration of procedure: less than half an hour & blood loss less than 100ml. 3. Serial Beta HCG from the day of discharge and weekly therefore done, which returned to non-pregnant levels by end of 4 weeks. <h3>Conclusion</h3> Hysteroscopic morcellation is a convenient and effective mode of management of caesarean scar pregnancy with excellent safety profile and patient satisfaction rates.

The predictive value of microperfusion assessments for the follow-up of tibial bypass grafts

ObjectiveWe conducted a prospective evaluation of microperfusion parameters after tibial bypass surgery was performed. Differences between grafts with occlusions during follow-up and patent grafts were analyzed in relation to the pedal arch quality. MethodsPatients receiving tibial bypass grafts for chronic limb-threatening ischemia from 2019 to 2020 were included. Assessment of microcirculation (parameters: hemoglobin oxygen saturation [sO2] and flow) was done by laser Doppler flowmetry and white light spectrometry (oxygen-to-see), supine and in elevation, whereas the macrocirculation was evaluated by the ankle-brachial index and duplex ultrasound examination. The quality of run-off was graded for each patient. Measurements were performed preoperatively, 1 day postoperatively, and after 6 months. Patients with graft occlusions during follow-up (OCCLUDED) and patients without occlusions (OPEN) were compared. ResultsWe included 42 patients (13 women, 29 men; mean age, 76.1 years; range, 60-89 years) were included. The patency of all grafts 1 day after the operation was confirmed by ultrasound examination. The overall analysis of the microcirculation showed significant changes in both the supine and elevated leg position between measurements taken preoperatively, 1 day after the operation, and after 6 months for the parameters sO2 and FLOW (sO2 supine, P = .001; sO2 elevated, P < .001; FLOW supine, P < .001; FLOW elevated, P < .001). The comparison of the values 1 day after the operation yielded significantly decreased microperfusion parameters (both O2 and FLOW) in the group that developed bypass occlusion in the later follow-up period (sO2 supine: OCCLUDED, 35.7% [7.3-65.0] and OPEN, 48.7% [25.0-72.3] P = .011; FLOW supine: OCCLUDED, 27.7 A.U. [12.7-52.7] and OPEN, 57.3 A.U. [16.0-106.7], P = .008). No significant differences in the severity of the arch impairment was found between the OPEN and OCCLUDED groups (P = .651). Absolute values of the parameters sO2 and flow showed no correlation with the pedal arch classification. ConclusionsSignificantly poorer microperfusion was detected postoperatively in patients with later occurrence of graft occlusions despite patent grafts on the first postoperative day. Microperfusion measurements might be a possible tool for the prediction of graft failure.

Venous capacitance and venous return in young adults with typical vasovagal syncope: a cross-sectional study

Vasovagal syncope (VVS) has a high prevalence in the general population and is associated with potential complications. There is limited information on the possible association between venous capacitance (VC) and...

Safety of medical compression stockings in patients with diabetes mellitus or peripheral arterial disease

IntroductionCompression therapy is highly effective in the treatment of many venous diseases, including leg edema. However, its relevance in patients with peripheral arterial disease (PAD) or diabetes mellitus is critically...

1261 The Long Term Exhaustion of a Viral Infection

Abstract Introduction Narcolepsy is a rare condition affecting only 0.02% to 0.18% of United States and Euro-pean populations. Throughout the years, hypersomnolence in the form of narcolepsy or idiopathic hypersomnia has been identified as a post infectious syndrome in rare instances. In this case, we observe a child with excessive daytime sleepiness after an infectious rash. Report of Case A 4 year old male presented to clinic for evaluation of excessive daytime sleepiness for the past 10 months. At that time, he developed a full body rash that lasted for about 1 week, and was treated with diphenhydramine and prednisone. No imminent cause was identified. For the preced-ing weeks, he was taking frequent and longer naps, and complained of difficulty with keeping his head up and his eyes open. He was evaluated for possible seizures via EEG with no seizure activity seen. Blood work was unremarkable, and a lumbar puncture showed highly elevated IgG for EBV, and low IgM for EBV, indicating a prior infection. His excessive somnolence persistent, and he was referred to undergo actigraphy, poly-somnography (PSG), and a multiple sleep latency test (MSLT). Actigraphy demonstrated disrupt-ed nocturnal sleep, PSG showed an elevated periodic leg movement index of 8.6/hr, and MSLT showed reduced sleep onset latency and sleep onset REM on 2 of 4 naps. During his physical exam, he had drooping eyelids and tongue protrusion, concerning for cataplectic facies, highly suspicious for Narcolepsy Type 1. Further confirmatory testing is pend-ing, including HLA subtype testing and hypocretin levels in CSF. Conclusion This case shows a strong association with a subacute EBV infection and the development of nar-colepsy. There are multiple cases involving the development of hypersomnolence conditions as a consequence of viral infections. Further cases would be beneficial to form additional associations.

Comorbidities in children with elevated periodic leg movement index

Comorbidities in children with elevated periodic leg movement index

Does proactive cyclic usage of a footrest prevent the development of standing induced low back pain?

Various interventions, such as standing intermittently with one leg on a footrest, have been suggested to prevent low back pain (LBP) development during prolonged standing. To assess this standing intervention twelve participants stood for 80 min while cycling through three minute periods of level-ground standing divided by one minute periods with either the right or left leg elevated onto a platform. All participants had previously participated in a prolonged level standing protocol and were classified as pain (PD) or non-pain developers (NPD). Out of the six known PDs, only one PD developed LBP by the end of the standing intervention. The intervals of elevated leg standing resulted in increased lumbar spine flexion in comparison to level standing. In addition, over time there was an increase in lumbar spine flexion during the level standing intervals. This change in lumbar spine posture in standing pain developers likely contributed to the reduced LBP development during this prolonged standing intervention

Temporal changes in stored-product insect populations associated with boot, pit, and load-out areas of grain elevators and feed mills

Commercial grain elevator and feed mill facilities can quickly become infested with stored-product insect pests, compromising the protection of the stored raw and processed cereal products. Elevators and feed mills were sampled monthly for adult stored-product insects in grain residues from the boot-pit areas and in bulk load-out samples from 2009 to 2010. The grain samples collected from the boot, pit, and load-out areas consisted of corn, soybeans, or a mixture of the two grains. Low insect densities were found in the boot-pit area during the cool winter months. Insect numbers increased in the spring and peaked during the warm summer months, prior to declining in the fall following a pattern of higher insect densities during higher ambient temperatures. The rice weevil, Sitophilus oryzae (L.), was the most prevalent species collected in all of the sampled grain residues, representing 69.2 and 35.8% of total insects collected in feed mills and elevators, respectively, during 2009 and was also commonly collected in 2010. Other commonly collected insect species included, the red flour beetle, Tribolium castaneum (Herbst); rusty grain beetle, Cryptolestes ferrugineus (Stephens); and sawtoothed grain beetle, Oryzaephilus surinamensis (Linnaeus). Our results showed that failing to clean out boot residual grain and a lack of sanitation of the pit area resulted in high numbers of insects that were transferred through the elevator leg to other locations within a facility. We conclude that the lack of sanitation at elevator and feed mill facilities allowed high numbers of insects to develop.

FEATURES OF SURGICAL TACTICS FOR PATIENTS WITH COXO-VERTEBRAL SYNDROME

Purpose of the study – to design the algorithm of selection for rational surgical tactics for treatment of patients with coxo-vertebral syndrome.Material and methods. 175 patients with coxo-vertebral syndrome were included into the study who underwent total hip replacement in the period from 2009 till 2016. The authors analyzed outcomes of treatment of 134 patients at midterm follow up of 9 months (range from 8 to 10 months) after the surgery. Mean age of patients was 54,4±12,7 y.o. Patients were subdivided into a test group (94 patients) and control group (81 patients). Standard THR approaches were used in the control group by restoring anatomical center of rotation and lower leg length. The suggested algorithm of the optimal procedure selection was applied in the test group. Clinical and functional data was evaluated by Harris Hip Score and Oswestry score. Radiographic evaluation was performed based on x-rays of vertebral-pelvic complex in standing position, by functional x-rays, CT and MRI. Evaluation of differences significance between the groups was performed by MannWhitney U-test and McNemar test.Results. Application of proposed surgical approaches allowed to increase the number of patients with good clinical and functional outcomes (test group – 82,4%, control group – 26,7%) and achieve better function of hip joint and patients’ life quality in short-term postoperative period. Excellent outcomes by Harris hip score were observed in 53,2% of patients, in control group – in 9,7%. Share of the patients complaining of lumber pain, limping and need for a walking stick after THR in the test group was less than in control group. Share of patients demonstrating pain at palpation of spinous processes, with positive test of elevated extended leg and radicular syndrome was also significantly less in test group as compared to control group.Conclusion. Practical application of proposed algorithm for selection of a rational tactics of surgical treatment for patients with combined degenerative and distrophic pathology of the hip joint and spine allows in short-term after THR to statistically significantly improve treatment outcomes in comparison with patients that underwent conventional preoperative planning and THR.

Maternal care bundle: The effect of a multimodal approach on the prevention of maternal hypotension following spinal anesthesia in parturients undergoing elective or urgent cesarean section

Background and AimMany techniques to prevent spinal induced hypotension in cesarean section have been advocated; but no one technique proved to be totally effective. The aim of this cohort interventional study was to investigate the efficacy of application of multimodal approach to decrease the incidence of hypotension (defined as mean arterial blood pressure ⩽60 mmHg) following spinal anesthesia in parturients undergoing elective or urgent cesarean section.Patients and MethodsIn this prospective cohort interventional study, 159 American Society of Anesthesiologists (ASA) classification I–II parturients undergoing elective or urgent cesarean section were enrolled. All patients received maternal care bundle which consisted of; fixed low dose of bupivacaine (7.5 mg + fentanyl 25 μg), coloading with 15 ml/kg lactated Ringer’s, placement of the patient in the supine wedged position, administration of 9 mg ephedrine sulphate IV after intrathecal injection and placement of graduated compression stockings (GCS) in the elevated leg position >45° and maintaining leg elevation at 20° following application of GCS. Demographic data, spinal anesthetic technique variables, fluid intake and urine output were documented. Mean arterial blood pressure, heart rate and oxygen saturation were recorded at baseline T0 (before spinal anesthesia administration), T1 (5 min following intrathecal injection of local anesthetics), T2 (15 min), T3 (30 min) and at T4 (end of procedure prior to PACU transfer). Total dose of ephedrine and any complication was documented.ResultsIncidence of hypotension after 5 min (T1) was 17.6%, at 15 min (T2) was 3.8% and at 30 min (T3) was 5%.ConclusionsThe application of a maternal care bundle had significantly decreased the incidence of spinal induced hypotension in parturient undergoing elective or urgent Cesarean delivery.

Well Leg Compartment Syndrome After Abdominal Surgery.

Well leg compartment syndrome (WLCS) is a complication to abdominal surgery. We aimed to identify risk factors for and outcome of WLCS in Denmark and literature. Prospectively collected claims to the Danish Patient Compensation Association (DPCA) concerning WLCS after abdominal operations 1996-2013 and cases in literature 1970-2013 were evaluated. Cases of fasciotomy within 2weeks after abdominal surgery 1999-2008 were extracted from the Danish National Patient Register (DNPR). There were 40 cases in DPCA and 124 in literature. In 68% legs were supported under the knees during surgery. Symptoms of WLCS presented within 2h after surgery in 56% and in only 3 cases after 24h. Obesity was not confirmed as risk factor for WLCS. The mean diagnostic delay was 10h. One-third of fasciotomies were insufficient. The diagnostic delay increased with duration of the abdominal surgery (p=0.04). Duration of the abdominal surgery was 4 times as important as the diagnostic delay for severity of the final outcome. DNPR recorded 4 new cases/year, and half were reported to DPCA. The first 24h following abdominal surgery of >4h' duration with elevated legs observation for WLCS should be standard. Pain in the calf is indicative of WLCS, and elevated serum CK can support the diagnosis. Mannitol infusion and acute four-compartment fasciotomy of the lower leg is the treatment. The risk of severe outcome of WLCS increases with duration of the primary operation. A broad support and change of legs' position during surgery are suggested preventative initiatives.

Development and validation of educational technology for venous ulcer care.

To develop and validate an educational technology venous ulcers care. Methodological study conducted in five steps: Situational diagnosis; literature review; development of texts, illustrations and layout; apparent and content validity by the Content Validity Index, assessment of Flesch Readability Index; and pilot testing. The developed technology was a type of booklet entitled Booklet for Venous Ulcers Care, consisting of seven topics: Diet and food intake, walking and light exercise, resting with elevated leg, bandage care, compression therapy, family support, and keeping healthy habits. The apparent validity revealed minimal agreement of 85.7% in the clarity and comprehensibility. The total content validity index was 0.97, the Flesch Readability Index was 75%, corresponding to the reading "fairly easy". The pilot test showed that 100% of people with venous ulcers evaluated the text and the illustrations as understandable, as appropriate. The educational technology proved to be valid for the appearance and content with potential for use in clinical practice. Construir e validar uma tecnologia educativa para cuidados com úlcera venosa. Estudo metodológico realizado em cinco fases: diagnóstico situacional; revisão da literatura; desenvolvimento de textos, ilustrações e diagramação; validade de aparência e de conteúdo pelo Índice de Validade de Conteúdo, avaliação do Índice de Legibilidade de Flesch; e teste piloto. A tecnologia desenvolvida foi do tipo cartilha intitulada Cartilha para cuidados com úlcera venosa, constituída de sete tópicos: Alimentação, Caminhadas e exercícios leves, Repouso com a perna elevada, Cuidados com o curativo, Terapia compressiva, Apoio familiar, e manter hábitos saudáveis. A validade aparente revelou concordância mínima de 85,7% na clareza e compreensibilidade. O Índice de Validade de Conteúdo total foi de 0,97, o Índice de legibilidade de Flesch foi de 75%, o que correspondeu à leitura "razoavelmente fácil". O teste piloto revelou que 100% das pessoas com úlcera venosa avaliaram o texto como compreensivo e as ilustrações, como adequadas. A tecnologia educativa mostrou-se válida quanto à aparência e ao conteúdo, com potencial de utilização na prática clínica.

Economic Analysis for Commingling Effects of Insect Activity in the Elevator Boot Area.

Boot areas in commercial grain elevators and feed mills contribute to commingling of insects with grain that moves through the elevator leg. A partial budget and stochastic dominance model were developed to improve pest management decision-making and risk analysis assessment from commingling effects of insect activity in the boot area. Modified pilot-scale bucket elevator legs, containing residual wheat or corn, were infested with varying insect pest densities prior to clean grain transfers. Appropriate grain discounts were applied to grain samples obtained from clean grain transfers over either: 1) insect-free and untreated boots, 2) infested and untreated boots, or 3) infested and chemical-treated (β-cyfluthrin) boots. The insect-free boots simulated performing clean-out of the boot area. Partial budget analysis and stochastic dominance modeling indicated that boot sanitation (cleanout) about every 30 d, avoiding costly grain discounts from insect commingling, is the preferred choice. Although chemical spray treatments of the empty boot may reduce insect populations of some boot residual grains, boot cleanout always had lower and usually zero insect pest populations in the boot residual grain, providing higher facility operational net income without the use of chemicals.

Abstract 289: Effect of Elevated Legs on Hemodynamic Performance During Cardiopulmonary Resuscitation in a Porcine Model of Cardiac Arrest

Purpose of the study: During advanced life support (ALS) end-tidal carbon dioxide (EtCO 2 ) reflects cardiac output (CO). A recent clinical study found an association between passive leg raising (PLR) and increased EtCO 2 during ALS. This may reflect a transient increase in pulmonary blood flow and CO, but might cause a detrimental decrease in coronary perfusion pressure (CPP). We evaluated the effect of PLR during experimental ALS in a randomized, factorial design. Materials and methods: In nine anesthetized domestic pigs (30±1.8 kg) ventricular fibrillation was induced electrically. After 3 minutes of no-flow, mechanical chest compressions (5cm @ 100 min -1 ) were started. During four 5-minute segments of CPR we measured CO, EtCO 2 , perfusion pressures, carotid and cerebral cortical microcirculatory blood flow (MBF) and CPP (the average of the positive pressure difference between decompression aortic pressure (AP) and right atrial pressure (RAP)) at minute 2 and 4. Interventions were provided in a randomized sequence with PLR vs supine position, with or without epinephrine (0.5mg iv). Values are given as mean±standard deviation. Results: PLR did not increase EtCO2 compared to supine position (3.1±0.7 vs 3.0±0.8 kPa), but CO was minimally increased from 1.1±0.3 to 1.2±0.3 Lmin -1 ,(p=0.003). PLR did not significantly increase AP (57±15 vs. 48±18 mmHg, p=0.3), but RAP was higher (43±10 vs. 31±7, p=0.003). However, no difference was found in CPP due to marked variation in both groups (median(range): PLR 20 (9,43) and supine 17(9,58)). The effect of epinephrine during this experimental setup was minimal. Conclusion: We did not find a positive effect of PLR during experimental ALS, but there were no obviously detrimental effects either.

Hip extension strength: Description and validity of a new procedure applied to older women

OBJECTIVE: We sought to: 1) describe a new procedure for measuring hip extension strength and 2) examine the convergent and known-groups validity of measurements obtained using the procedure. METHOD: Forty women (72–98 years) volunteered for this cross-sectional, observational study of muscle strength and mobility. Hip extension strength as well as hip flexion and knee extension and flexion strengths were measured using a hand-held dynamometer (HHD). Hip extension strength was measured while participants were supine and the HHD was positioned under their slightly elevated distal leg. Participants were dichotomized as independent or dependent in sit-to-stand and walking. RESULTS: Hip extension strength was measured without difficulty or untoward effects. Relative to other ipsilateral measures of hip and knee strength, hip extension strength was found to correlate significantly (r = 0.345–0.584), to be internally consistent (alpha = 0.785 and 0.751), and to load strongly (0.733 and 0.705) on a common construct-lower limb strength. Hip extension strength (left+ right/body weight) discriminated (albeit weakly) between known groups, that is, participants who were dependent versus independent in sit-to-stand and walking. CONCLUSION: Based on these findings we recommend this procedure for measuring hip extension strength in older adults.

Stored-grain insect population commingling densities in wheat and corn from pilot-scale bucket elevator boots

Grain elevator boot and pit areas facilitate the commingling of insects with the grain moving through the elevator leg. A removable boot was developed to facilitate residual grain removal and preservation in the boot and to quantify the commingling magnitude as a function of stored-product insect density. This study included two species that develop inside kernels, Rhyzopertha dominica and Sitophilus oryzae, and three species that develop outside kernels, Tribolium castaneum, Oryzaephilus surinamensis and Cryptolestes ferrugineus. The removable boots were loaded with infested residual grain and remained undisturbed for 0, 8, 16, or 24 weeks (wk). After each time point, uninfested grain was transferred through the infested boot. The adult beetles that commingled with the clean grain were sifted and counted. Further, the commingled lots were examined after 8 wk for adult progeny. The insect densities in the infested bucket elevator leg boots affected the insect densities transferred through the elevator leg to other locations. The insect density in clean wheat or corn transferred over infested boots was 1 insect/kg immediately after transfer, but this density doubled in 8 wk. More internally developing insects were collected by the elevator buckets when the clean grain flowed over the infested grain compared with the externally developing insects. β-Cyfluthrin application as a residual insecticide reduced the insect densities in the elevator boot, which consequently reduced the insect transfer to clean grain. Cleaning the bucket elevator boot area and applying residual insecticide monthly should minimize clean grain contamination.