Digital Commons Network^™

Associations Between Parenting Stress, Feeding Practices, And Child Eating Behaviors During The Covid-19 Pandemic, Maria G. Gonzalez

Master's Theses

The COVID-19 pandemic provides an important opportunity to understand how parenting stress during social crisis may predict child feeding practices and perceptions of child mealtime behaviors. The objective of the present study was to explore whether parents’ perceived increases in and overall levels of parenting stress during the pandemic were associated with controlling feeding practices and perceptions of child eating behaviors. Parents (n = 284) of 4–6-year-old children completed a cross-sectional online survey between March and April 2020. The survey assessed parents’ perceived change in parenting stress during the onset of the pandemic and levels of parenting stress during …

Will The Covid-19 Pandemic Finally Fuel Drug Repurposing Efforts?, Anna Chen, Shivangi Patel, Matthew Alcusky, Vittorio Maio

College of Population Health Faculty Papers

No abstract provided.

Exploring Parent Perception Of Adverse Childhood Experiences Screening In Pediatric Primary Care: A Clinical Inquiry Project, Kathryn Stevens

The Eleanor Mann School of Nursing DNP Capstone Projects

This manuscript explores the incidence and implications of Adverse Childhood Experiences (ACEs) and outlines a project assessing parental perception of their own ACEs screening during their child’s wellness visit. ACEs are adversarial events occurring during childhood, which may be chronic or singular. Abuse, neglect, and household dysfunction result in negative outcomes, including compromised neurological development and cognitive behaviors, developmental delays, poor lifestyle choices, and reduced mental and physical health. Additionally, a growing body of literature supports the impaired parenting skills in those with a history of ACEs. This can perpetuate intergenerational trauma, deprived opportunities, and poor familial health. Despite the …

Assisted Reproductive Technologies And Health-Related Issues Among Women And Children: A Research Review, Laura Maria Corradi

Dignity: A Journal of Analysis of Exploitation and Violence

From their first use in the late 1970s until the mid-1990s, Assisted Reproductive Technologies (ART) gave rise to serious concerns by feminists internationally. Their questions ranged from asking about health risks to ethical and political problems inherent in these technologies. However, over the last 25 years, interest in women’s health which used to be central to feminist theory and politics, progressively decreased and with it concerns about ART. Today, while the medical literature about health risks in ART is increasing, the topic of women’s health in relation to reproductive technologies remains marginal in feminist discourse, social sciences, and the mainstream …

On The Application, Reporting, And Sharing Of In Silico Simulations For Genetic Studies, Kaleigh Riggs, Huann-Sheng Chen, Melissa Rotunno, Bing Li, Naoko I Simonds, Leah E Mechanic, Bo Peng

Faculty, Staff and Students Publications

In silico simulations play an indispensable role in the development and application of statistical models and methods for genetic studies. Simulation tools allow for the evaluation of methods and investigation of models in a controlled manner. With the growing popularity of evolutionary models and simulation-based statistical methods, genetic simulations have been applied to a wide variety of research disciplines such as population genetics, evolutionary genetics, genetic epidemiology, ecology, and conservation biology. In this review, we surveyed 1409 articles from five journals that publish on major application areas of genetic simulations. We identified 432 papers in which genetic simulations were used …

Is Covid-19-Induced Platelet Activation A Cause Of Concern For Patients With Cancer?, Lenard M Lichtenberger, K Vinod Vijayan

Faculty, Staff and Students Publications

Patients with cancer are more susceptible to be infected by SARS-CoV-2 and develop severe outcomes including ICU admittance, mechanical ventilator support, and a high rate of mortality. Like mid-to late-stage cancer, SARS-CoV-2 infection is associated with platelet hyperactivity, systemic inflammation, thrombotic complications, and coagulopathy. Platelets also promote cancer cell growth, survival in circulation, and angiogenesis at sites of metastases. In this article, we will discuss the potential for platelets in the development of systemic inflammation and thrombosis in SARS-CoV-2-infected patients with cancer, with the concern that the platelet-induced pathogenic events are likely magnified in cancer patients with COVID-19.

Racial And Geographic Disparities In Influenza Vaccination In The Us Among Individuals With Atherosclerotic Cardiovascular Disease: Renewed Importance In The Setting Of Covid-19, Mahmoud Al Rifai, Umair Khalid, Arunima Misra, Jing Liu, Khurram Nasir, Miguel Cainzos-Achirica, Dhruv Mahtta, Christie M Ballantyne, Laura A Petersen, Salim S Virani

Faculty, Staff and Students Publications

INTRODUCTION: The importance of receiving an annual influenza vaccine among patients with atherosclerotic cardiovascular disease (ASCVD) is well established. With the rapid community spread and the possibility of another wave of COVID-19 infections in the fall, receiving an influenza vaccine is of particular importance to mitigate the risk associated with overlapping influenza and COVID-19 infections.

METHODS: We utilized cross-sectional data from the 2016 to 2019 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative U.S. telephone-based survey of adults 18 years or older. Race/ethnicity was our exposure of interest. We assessed the relative difference in influenza vaccination by race/ethnicity for …

Race And Ethnicity, Gender, And Age On Perceived Threats And Fear Of Covid-19: Evidence From Two National Data Sources, Michael D. Niño, Casey Harris, Grant Drawve, Kevin M. Fitzpatrick

Sociology and Criminology Faculty Publications and Presentations

Previous studies find preventative behaviors designed to reduce the number of infections during emerging disease outbreaks are associated with perceived risk of disease susceptibility. Few studies have attempted to identify underlying factors that explain differences in perceptions of risk during an infectious disease outbreak. Drawing from two early waves of American Trends Panel (n=7,441), as well as a National Science Foundation funded, Qualtrics national panel survey from the early stages of the pandemic (n=10,368), we test whether race and ethnicity, gender, and age were associated with six perceived threat and fear outcomes related to COVID-19. Results …

Predictive Modeling And Estimation Of The Doubling Time Of Confirmed Cases Of Covid-19 In Niger, Ibrahim Sidi Zakari, Hadiza Galadima

Community & Environmental Health Faculty Publications

Modeling is increasingly used to assess scenarios and make projections on the future course of new coronavirus disease. This allows for better planning of care as well as a relaxation or tightening of the restrictive measures decreed by the government and the health authorities. The data analyzed in this study covers the period from March 19 to June 05, 2020 and allowed predictions of new cases of COVID-19 based on a growth model with a growth rate that changes linearly over time. In addition, we calculated and predicted the doubling time of the number of positive cases in each region …

Association Between Preterm-Birth Phenotypes And Differential Morbidity, Growth, And Neurodevelopment At Age 2 Years: Results From The Interbio-21st Newborn Study, Jose Villar, María C. Restrepo-Méndez, Rose Mcgready, Fernando C. Barros, Cesar G. Victora, Shama Munim, Aris T. Papageorghiou, Roseline Ochieng, Rachel Craik, Zulfiqar Ahmed Bhutta

Department of Obstetrics & Gynaecology

Importance: The etiologic complexities of preterm birth remain inadequately understood, which may impede the development of better preventative and treatment measures.
Objective: To examine the association between specific preterm-birth phenotypes and clinical, growth, and neurodevelopmental differences among preterm newborns compared with term newborns up to age 2 years.
Design, setting, and participants: The INTERBIO-21st study included a cohort of preterm and term newborn singletons enrolled between March 2012 and June 2018 from maternity hospitals in 6 countries worldwide who were followed up from birth to age 2 years. All pregnancies were dated by ultrasonography. Data were analyzed from November 2019 …

Detection Of Mutations Associated With Variants Of Concern Via High Throughput 2 Sequencing Of Sars-Cov-2 Isolated From Nyc Wastewater, Davida S. Smyth, Monica Trujillo, Kristen Cheung, Anna Gao, Irene Hoxie, Sherin Kannoly, Nanami Kubota, Michelle Markman, Kaung Myat San, Geena Sompanya, John J. Dennehy

Publications and Research

Monitoring SARS-CoV-2 genetic diversity is strongly indicated because diversifying selection may lead to the emergence of novel variants resistant to naturally acquired or vaccine-induced immunity. To date, most data on SARS-CoV-2 genetic diversity has come from the sequencing of clinical samples, but such studies may suffer limitations due to costs and throughput. Wastewater-based epidemiology may provide an alternative and complementary approach for monitoring communities for novel variants. Given that SARS-CoV-2 can infect the cells of the human gut and is found in high concentrations in feces, wastewater may be a valuable source of SARS-CoV-2 RNA, which can be deep sequenced …

Elaborating The Science Of Food Choice For Rapidly Changing Food Systems In Low-And Middle-Income Countries, Christine E. Blake Ph.D., Rd, Edward A. Frongillo Jr. Ph.D., Andrea M. Warren, Shilpa V. Constantinides, Krystal K. Rampalli, Shiva Bhandari

Faculty Publications

The world’s food systems and environments have been changing dramatically, concomitant with changes in overand undernutrition. We elaborate the science of food choice to better understand, analyze, and respond to relationships between changing food environments and food choice. The science of food choice is concerned with generating knowledge about causal drivers of food choice decision making processes and behavior within immediate food and social environments. Three fundamental and interconnected questions undergird this science; 1) what do people eat from the options available and accessible?; 2) how do people interact with food environments?; and 3) why do people decide to acquire, …

Utility Of Multi-Theory Model (Mtm) To Explain The Intention For Pap Adherence In Newly Diagnosed Sleep Apnea Patients, Manoj Sharma, Anuj Chandra, Ryan Toth, Vinayak K. Nahar

School of Public Health Faculty Research

Purpose: The objective of this study was to assess the utility of a fourth-generation multi-theory model (MTM) in explaining the intention for initiation and sustenance of PAP adherence among newly diagnosed sleep apnea patients.
/="/">Patients and Methods: For this cross-sectional study, data were collected at a private sleep center located in the Southeastern United States. A total of 138 newly diagnosed patients with sleep apnea who had been prescribed PAP therapy completed a valid and reliable 41-item MTM instrument. Stepwise multiple regression modeling was conducted to assess MTM based explanatory variables of PAP adherence in this study sample.
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Analyzing Student Experience On Group Work With The Application Of Different Group Allocation Approaches, An Yee Tan

Management and HR

Working as a group can be as challenging as working by oneself. Common issues like ineffective group work, unequal work contribution, and poor communication are believed to be the reasons why many students preferred to work individually. The purpose of this study is to understand if there is a disparity in student experience on group work by implementing different methods of group formation, which are, intentional group formation and random assignment. Topics around team well-being, team communication, and team effectiveness are the main focus of this study. The second emphasis of this study is students’ opinions on whether or not …

Incidence And Pathophysiology Of Diabetes In South Asian Adults Living In India And Pakistan Compared With Us Blacks And Whites, K M Venkat Naraya, Dimple Kondal, Natalie Daya, Unjali P. Gujral, Deepa Mohan, Shivani A. Patel, Roopa Shivashankar, Ranjit Mohan Anjana, Lisa R. Staimez, Muhammad Masood Kadir

Community Health Sciences

Introduction: We compared diabetes incidence in South Asians aged ≥45 years in urban India (Chennai and Delhi) and Pakistan (Karachi), two low-income and middle-income countries undergoing rapid transition, with blacks and whites in the US, a high-income country.
Research design and methods: We computed age-specific, sex-specific and body mass index (BMI)-specific diabetes incidence from the prospective Center for Cardiometabolic Risk Reduction in South Asia Study (n=3136) and the Atherosclerosis Risk in Communities Study (blacks, n=3059; whites, n=9924). We assessed factors associated with incident diabetes using Cox proportional hazards regression.
Results: South Asians have lower BMI and waist circumference than blacks …

Hubungan Kontaminasi Escherichia Coli Pada Makanan Dengan Kejadian Diare Pada Murid Di Sekolah Menengah Atas (Sma) Di Kecamatan Bogor Barat Tahun 2019, Inneza Rahmelia, Ema Hermawati

Jurnal Nasional Kesehatan Lingkungan Global

Background. One of the contamination food in school is Escherichia coli bacteria which can cause diarrhea. Diarrhea is associated with inadequate environmental conditions and unhealthy behavior. The case of diarrhea in Bogor Barat District 2016 was 5700 cases. Prevalence of diarrhea for 15-24 years of age group is 7,2%. Senior high school students in Indonesia are required to attend a full day school. Those schools have canteens which serves food to the students and are supposed to ensure afood safety. The purpose of this study was to determine the association between Escherichia coli contamination in food and diarrhea among students …

Hubungan Higiene Dan Sanitasi Dengan Kontaminasi E.Coli Pada Makanan Di Tempat Pengelolaan Makanan (Tpm) Universitas X, Muhammad Iqbal, I Made Djaja

Jurnal Nasional Kesehatan Lingkungan Global

Background. This research was conducted at the University of X, West Java where researchers used secondary data from the University of X “Programs Sertifikasi Laik Higiene Sanitasi Kantin 2016-2018”. The purpose of this study was to determine the relationship between hygiene and sanitation with E. coli contamination in food at Food Establishment (TPM) at University X. Methods. The subjects used in this study amounted to 71 TPM. Results. The results showed no association between E. coli contamination and all TPM hygiene and sanitation variables. Conclusions. However, the researchers suggested that the TPM management always educate and train food handlers to …

Gambaran Higiene Sanitasi Dan Haccp (Hazard Analysis Critical Control Point) Pada Pegelolaan Makanan Terpusat Di Pesantren X, Depok, Tahun 2019, Diah Ayu Puspitarini, Ririn Arminsih Wulandari

Jurnal Nasional Kesehatan Lingkungan Global

Background. Catering that isn’t in comply with the principles of hygiene and sanitation and the HACCP system has the potential to cause foodborne diseases which lead to health and economic losses. Throughout 2018 to 2019, foodborne diseases occur in 614 Islamic boarding schools’ (IBS) students after eating foods produced by catering. IBS X catering is a special type of catering which is far from being supervised by the Ministry of Health and BPOM. Methods. This descriptive research aims to identify the physical requirements for sanitation hygiene compliance, the application of sanitation hygiene principles and HACCP in centralized food provision, and …

Studi Pendahuluan Faktor Risiko Sindrom Down (Studi Kasus Kota Dan Kabupaten Tangerang) Tahun 2019, Oscar Oleta Palit, Budi Hartono

Jurnal Nasional Kesehatan Lingkungan Global

Background. This study aims to find out the risk factors that cause Down syndrome that exist in the elderly around the City Industrial District and Tangerang District in 2019. The risk factors studied in this study include intrinsic and extrinsic characteristics. Methods. This study uses a case-control study with retrospective data. Case and control subjects were obtained at Special Needs Schools in Tangerang District. Case subjects were students who were classified as Down syndrome, while the control subjects were non-Down syndrome mentally disabled students. Results. Based on the bivariate test, the characteristics that influence the incidence of Down syndrome are …

Junk Food Consumption And Symptoms Of Mental Health Problems: A Meta-Analysis For Public Health Awareness, Muhammad Hafizurrachman, Risky Kusuma Hartono

Kesmas

Junk food consumption increases the risk of having symptoms of mental health problems. This study aimed to conduct a meta-analysis to assess the association between junk food and symptoms of mental health problems. Six researchers, two primary researchers, and four assistant researchers, from October to December 2020 conducted a systematic literature review. The data sources were selected from Pubmed and Science Direct articles published from 2010 to 2020. Those websites were check-marked for text availability for original articles, using keywords for junk foods and mental health. This study had inclusion criteria for selecting and organizing articles using the Preferred Reporting …

Patterns And Determinants Of Open Defecation Among Urban People, Vera Yulyani, Christin Angelina Febriani, Shaharuddin Ms, Dessy Hermawan

Kesmas

At the present time, an estimated of 673 million people defecate in the open space, not in private. Indonesia is a densely populated country with a lot of open defecation (OD) both in urban (37%) and rural areas (43%). Tanjung Karang Pusat Subdistrict is an area in Bandar Lampung City with the highest percentage of OD practice (45%). This study aimed to explore and explain the patterns and determinants of OD among urban people in the Tanjung Karang Pusat Subdistrict in- volving 377 respondents for quantitative analysis. Quantitative data were analyzed using the chi square and regression analysis. After controlling …

Association Between Height And Hypertension Among Us Adults: Analyses Of National Health And Nutrition Examination Survey 2007-18, Rajat Das Gupta, Maxwell Akonde, Ibrahim Hossain Sajal, Gulam Muhammed Al Kibria

Publications

Background

Previous studies that investigated association of height with prevalence and control of hypertension found mixed results. This cross-sectional study explored these associations among US adults (≥20 years).

Methods

The National Health and Nutrition Examination Survey (NHANES) 2007–18 data was analyzed. Height was measured in meters and was converted into centimeters (cm) and was further divided into quartiles: Q1 (135.3–159.2 cm), Q2 (159.3–166.2 cm), Q3 (166.3–173.6 cm), Q4 (173.7–204.5 cm). Hypertension definition of the ‘2017 American College of Cardiology/American Heart Association Guideline’ was used. Logistic regression analyses were conducted to find out the association between the dependent variable and the …

Oxytocin, Cortisol, And Cognitive Control During Acute And Naturalistic Stress, Shari Young Kuchenbecker, Sarah D. Pressman, Jared Celniker, Karen M. Grewen, Ken D. Sumida, Naveen Jonathan, Brendan Everett, George M. Slavich

Health Sciences and Kinesiology Faculty Articles

Although stress is a strong risk factor for poor health, especially for women, it remains unclear how stress affects the key neurohormones cortisol and oxytocin, which influence stress-related risk and resilience. Whereas cortisol mediates energy mobilization during stress, oxytocin has anti-inflammatory, anxiolytic, and analgesic effects that support social connection and survival across the lifespan. However, how these neurohormones interrelate and are associated with cognitive control of emotional information during stress remains unclear. To address these issues, we recruited 37 college-aged women (M_age = 19.19, SD = 1.58) and randomly assigned each to a one-hour experimental session consisting of …

Drinking Behavior Among College Students: Interventions To Increase Mindfulness And Social Capital, Jenna C. Anderson, Antonio J. Gardner, Barry Hunt

Journal of Social, Behavioral, and Health Sciences

The impacts of drinking behaviors are far-reaching, with college student drinking contributing to over 1,500 deaths and an estimated 696,000 assaults on college campuses each year (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2019). There are a variety of explanations to explain why college students engage in risky drinking behaviors. However, there is evidence to suggest that drinking and other substance use may be a result of complex psychological origins, including adverse childhood experiences (ACEs). This paper reviews the literature available on ACEs among college students, how these experiences impact alcohol use among this population, and potential areas for …

A Prospective Surveillance Study On The Kinetics Of The Humoral Immune Response To The Respiratory Syncytial Virus Fusion Protein In Adults In Houston, Texas, Brittani N Blunck, Letisha Aideyan, Xunyan Ye, Vasanthi Avadhanula, Laura Ferlic-Stark, Lynn Zechiedrich, Brian E Gilbert, Pedro A Piedra

Faculty, Staff and Students Publications

Respiratory syncytial virus (RSV)-specific serum antibody has been correlated to protection of infection and reduction of severe disease, but reinfection is still frequent. In this study, we evaluated RSV-specific serum antibody activity following natural RSV re-infection to examine the longevity of the humoral immune response in adults. Nineteen healthy adult volunteers under sixty-five years of age were enrolled during the 2018-2019 RSV season in Houston, TX. Blood was collected at three study visits. The kinetics of RSV-neutralizing, RSV F site-specific competitive, and RSV-binding antibodies in serum samples were measured by microneutralization and enzyme-linked immunosorbent assays. Three distinct profiles of RSV-specific …

Maternal Dietary Quality, Inflammatory Potential And Childhood Adiposity: An Individual Participant Data Pooled Analysis Of Seven European Cohorts In The Alphabet Consortium, Ling-Wei Chen, Adrien M. Aubert, Nitin Shivappa, Jonathan Y. Bernard, Sara M. Mensink-Bout, Aisling A. Geraghty, John Mehegan, Matthew Suderman, Kinga Polanska, Wojciech Hanke, Agnieszka Jankowska, Caroline L. Relton, Sarah R. Crozier, Nicholas C. Harvey, Cyrus Cooper, Mark Hanson, Keith M. Godfrey, Romy Gaillard, Liesbeth Duijts, Barbara Heude, James Hébert Scd, Fionnuala M. Mcauliffe, Cecily Kelleher, Catherine M. Phillips

Faculty Publications

Background

Mounting evidence suggests that maternal diet influences pregnancy and birth outcomes, but its contribution to the global epidemic of childhood obesity has not as yet been definitively characterized. We investigated whether maternal whole diet quality and inflammatory potential influence childhood adiposity.

Methods

We harmonized and pooled individual participant data from 16,295 mother-child pairs in seven European birth cohorts. Maternal pre-, early-, late-, and whole-pregnancy (any time during pregnancy) dietary quality and inflammatory potential assessed with the Dietary Approaches to Stop Hypertension (DASH) score and the energy-adjusted Dietary Inflammatory Index (E-DII™) score, respectively. Primary outcome was childhood overweight and obesity …

Whole-Exome Sequencing And Hipsc Cardiomyocyte Models Identify Myrip, Trappc11, And Slc27a6 Of Potential Importance To Left Ventricular Hypertrophy In An African Ancestry Population, Marguerite R. Irvin, Praful Aggarwal, Steven A. Claas, Lisa De Las Fuentes, Anh N. Do, C. Charles Gu, Andrea Matter, Benjamin S. Olson, Amit Patki, Karen Schwander, Joshua D. Smith, Vinodh Srinivasasainagendra, Hemant K. Tiwari, Amy J. Turner, Deborah A. Nickerson, Dabeeru C. Rao, Ulrich Broeckel, Donna K. Arnett

Epidemiology and Environmental Health Faculty Publications

Background: Indices of left ventricular (LV) structure and geometry represent useful intermediate phenotypes related to LV hypertrophy (LVH), a predictor of cardiovascular (CV) disease (CVD) outcomes.

Methods and Results: We conducted an exome-wide association study of LV mass (LVM) adjusted to height^2.7, LV internal diastolic dimension (LVIDD), and relative wall thickness (RWT) among 1,364 participants of African ancestry (AAs) in the Hypertension Genetic Epidemiology Network (HyperGEN). Both single-variant and gene-based sequence kernel association tests were performed to examine whether common and rare coding variants contribute to variation in echocardiographic traits in AAs. We then used a data-driven …

Greater Pain Severity Is Associated With Higher Glucocorticoid Levels In Hair Among A Cohort Of People Living With Hiv, Quan Zhang, Xiaoming Li Ph.D., Shan Qiao Ph.D., Shuaifeng Liu, Zhiyong Shen, Yuejiao Zhou

Faculty Publications

Background: Pain is a common occurrence and persistent symptom, which has an adverse impact on individual well-being and quality of life among people living with HIV (PLHIV). Alteration in the activity of the Hypothalamic-Pituitary-Adrenal (HPA) axis resulting in abnormal glucocorticoid levels had been proposed to play important roles in those associations. Purpose: This study aimed to investigate whether pain severity was associated with hair glucocorticoid levels, a novel method of measuring long-term glucocorticoid exposure, among a large cohort of Chinese PLHIV. Methods: A measure of pain severity and hair samples were collected from 431 adults PLHIV in Guangxi, China. Glucocorticoid …

Sars-Cov-2 Early Infection Signature Identified Potential Key Infection Mechanisms And Drug Targets, Yue Li, Ashley Duche, Michael R. Sayer, Don Roosan, Farid G. Khalafalla, Rennolds S. Ostrom, Jennifer Totonchy, Moom Roosan

Pharmacy Faculty Articles and Research

Background

The ongoing COVID-19 outbreak has caused devastating mortality and posed a significant threat to public health worldwide. Despite the severity of this illness and 2.3 million worldwide deaths, the disease mechanism is mostly unknown. Previous studies that characterized differential gene expression due to SARS-CoV-2 infection lacked robust validation. Although vaccines are now available, effective treatment options are still out of reach.

Results

To characterize the transcriptional activity of SARS-CoV-2 infection, a gene signature consisting of 25 genes was generated using a publicly available RNA-Sequencing (RNA-Seq) dataset of cultured cells infected with SARS-CoV-2. The signature estimated infection level accurately in …

Neuro-Anatomical Changes Of Carbon Monoxide Poisoning On Advanced Imaging: A Literature Review, James M. Mckivigan, Gregory Gilmour

Touro Scholarly Works

Carbon monoxide (CO) poisoning is a major public health issue in the United States that accounts for approximately 50% of poisoning cases in the nation each year and around 50,000 emergency room visits. In most instances of CO poisoning, the culprit is a malfunctioning or poorly tended heating system within the home or, occasionally, commercial building, which causes the system to leak this hazardous gas. One of the more insidious aspects of CO poisoning is that the gas is odorless and colorless, and victims of CO poisoning often do not realize that there is a problem until they begin to …