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1.
Oecologia ; 195(2): 513-524, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33415421

RESUMO

Anthropogenic nitrogen (N) deposition is significantly altering both community structure and ecosystem processes in terrestrial ecosystems across the globe. However, our understanding of the consequences of N deposition in dryland systems remains relatively poor, despite evidence that drylands may be particularly vulnerable to increasing N inputs. In this study, we investigated the influence of 7 years of multiple levels of simulated N deposition (0, 2, 5, and 8 kg N ha-1 year-1) on plant community structure and biological soil crust (biocrust) cover at three semi-arid grassland sites spanning a soil texture gradient. Biocrusts are a surface community of mosses, lichens, cyanobacteria, and/or algae, and have been shown to be sensitive to N inputs. We hypothesized that N additions would decrease plant diversity, increase abundance of the invasive annual grass Bromus tectorum, and decrease biocrust cover. Contrary to our expectations, we found that N additions did not affect plant diversity or B. tectorum abundance. In partial support of our hypotheses, N additions negatively affected biocrust cover in some years, perhaps driven in part by inter-annual differences in precipitation. Soil inorganic N concentrations showed rapid but ephemeral responses to N additions and plant foliar N concentrations showed no response, indicating that the magnitude of plant and biocrust responses to N fertilization may be buffered by endogenous N cycling. More work is needed to determine N critical load thresholds for plant community and biocrust dynamics in semi-arid systems and the factors that determine the fate of N inputs.


Assuntos
Briófitas , Ecossistema , Colorado , Nitrogênio , Solo
2.
Emerg Infect Dis ; 27(2): 385-395, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33496225

RESUMO

To improve recognition of coronavirus disease (COVID-19) and inform clinical and public health guidance, we randomly selected 600 COVID-19 case-patients in Colorado. A telephone questionnaire captured symptoms experienced, when symptoms occurred, and how long each lasted. Among 128 hospitalized patients, commonly reported symptoms included fever (84%), fatigue (83%), cough (73%), and dyspnea (72%). Among 236 nonhospitalized patients, commonly reported symptoms included fatigue (90%), fever (83%), cough (83%), and myalgia (74%). The most commonly reported initial symptoms were cough (21%-25%) and fever (20%-25%). In multivariable analysis, vomiting, dyspnea, altered mental status, dehydration, and wheezing were significantly associated with hospitalization, whereas rhinorrhea, headache, sore throat, and anosmia or ageusia were significantly associated with nonhospitalization. General symptoms and upper respiratory symptoms occurred earlier in disease, and anosmia, ageusia, lower respiratory symptoms, and gastrointestinal symptoms occurred later. Symptoms should be considered alongside other epidemiologic factors in clinical and public health decisions regarding potential COVID-19 cases.


Assuntos
/complicações , Pacientes Internados/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Colorado/epidemiologia , Tosse/epidemiologia , Tosse/virologia , Progressão da Doença , Dispneia/epidemiologia , Dispneia/virologia , Fadiga/epidemiologia , Fadiga/virologia , Feminino , Febre/epidemiologia , Febre/virologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Mialgia/epidemiologia , Mialgia/virologia , Avaliação de Sintomas , Adulto Jovem
3.
J Environ Manage ; 278(Pt 2): 111559, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33137686

RESUMO

Given rapid environmental change, the development of new, data-driven, interdisciplinary approaches is essential for improving assessment and management of river systems, especially with respect to flooding. In the world's extensive drylands, difficulties in obtaining field observations of major hydrological events mean that remote sensing techniques are commonly used to map river floods and assess flood impacts. Such techniques, however, are dependent on available cloud-free imagery during or immediately after peak discharge, and single images may omit important flood-related hydrogeomorphological events. Here, we combine multiple Landsat images from Google Earth Engine (GEE) with precipitation datasets and high-resolution (<0.65 m) satellite imagery to visualise flooding and assess the associated channel-floodplain dynamics along a 25 km reach of the unvegetated, ephemeral Río Colorado, Bolivia. After cloud and shadow removal, Landsat surface reflectance data were used to calculate the Modified Normalized Difference Water Index (MNDWI) and map flood extents and patterns. From 2004 through 2016, annual flooding area along the narrow (<30 m), shallow (<1.7 m), fine-grained (dominantly silt/clay) channels was positively correlated (R2 = 0.83) with 2-day maximum precipitation totals. Rapid meander bend migration, bank erosion, and frequent overbank flooding was associated with formation of crevasse channels, splays, and headward-eroding channels, and with avulsion (shifting of flow from one channel to another). These processes demonstrate ongoing, widespread channel-floodplain dynamics despite low stream powers and cohesive sediments. Application of our study approaches to other dryland rivers will help generate comparative data on the controls, rates, patterns and timescales of channel-floodplain dynamics under scenarios of climate change and direct human impacts, with potential implications for improved river management.


Assuntos
Inundações , Rios , Agricultura , Colorado , Humanos , Hidrologia
4.
Sci Total Environ ; 748: 142236, 2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33039138

RESUMO

The rise of hydraulic fracturing and unconventional oil and gas (UOG) exploration in the United States has increased public concerns for water contamination induced from hydraulic fracturing fluids and associated wastewater spills. Herein, we collected surface and groundwater samples across Garfield County, Colorado, a drilling-dense region, and measured endocrine bioactivities, geochemical tracers of UOG wastewater, UOG-related organic contaminants in surface water, and evaluated UOG drilling production (weighted well scores, nearby well count, reported spills) surrounding sites. Elevated antagonist activities for the estrogen, androgen, progesterone, and glucocorticoid receptors were detected in surface water and associated with nearby shale gas well counts and density. The elevated endocrine activities were observed in surface water associated with medium and high UOG production (weighted UOG well score-based groups). These bioactivities were generally not associated with reported spills nearby, and often did not exhibit geochemical profiles associated with UOG wastewater from this region. Our results suggest the potential for releases of low-saline hydraulic fracturing fluids or chemicals used in other aspects of UOG production, similar to the chemistry of the local water, and dissimilar from defined spills of post-injection wastewater. Notably, water collected from certain medium and high UOG production sites exhibited bioactivities well above the levels known to impact the health of aquatic organisms, suggesting that further research to assess potential endocrine activities of UOG operations is warranted.


Assuntos
Água Subterrânea , Fraturamento Hidráulico , Poluentes Químicos da Água , Colorado , Gás Natural , Campos de Petróleo e Gás , Estados Unidos , Águas Residuárias , Poluentes Químicos da Água/análise , Recursos Hídricos
5.
J Environ Manage ; 276: 111271, 2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33007712

RESUMO

Achieving conservation outcomes requires concerted engagement from many people across diverse societies. However, many conservation practitioners struggle to engage new audiences. Research suggests one effective strategy to reach nonengaged individuals is to encourage interested conservation actors to share information, provide resources and assistance, and organize local events to recruit others; we call these "diffusion behaviors." Previous studies suggest few conservation actors who engage in personal-sphere PEB also engage in diffusion PEB, potentially because these behaviors have unique barriers which have yet to be identified. We investigated if there are different psychosocial drivers of diffusion and personal-sphere PEB by surveying residents in Colorado, USA about their personal-sphere wildscape behaviors (e.g. planting native plants) and diffusion wildscape behaviors (e.g. helping a friend plant native plants). Including diffusion-specific psychosocial variables led to better predictions of both personal-sphere and diffusion PEB. Diffusion-specific self-efficacy, social and environmental response efficacy, and reputational concerns about perceived competence were significant predictors of diffusion behavior. Diffusion-specific environmental response efficacy and injunctive norms enforced through sanctioning significantly predicted personal-sphere behavior. Personal-sphere self-efficacy and dynamic norm beliefs predicted both behavior types. Our findings suggest that research should consider personal-sphere and diffusion PEB as distinct domains and should investigate the power of diffusion-specific perceptions. Conservation outreach programs seeking to encourage diffusion of PEB may benefit from designing programming to try to change these perceptions.


Assuntos
Jardinagem , Comportamento Social , Colorado , Humanos , Autoeficácia , Inquéritos e Questionários
6.
J Environ Qual ; 49(3): 569-581, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-33016400

RESUMO

Urbanization alters the delivery of water and sediment to receiving streams, often leading to channel erosion and enlargement, which increases loading of sediment and nutrients, degrades habitat, and harms sensitive biota. Stormwater control measures (SCMs) are constructed in an attempt to mitigate some of these effects. In addition, stream restoration practices such as bank stabilization are increasingly promoted as a means of improving water quality by reducing downstream sediment and pollutant loading. Each unique combination of SCMs and stream restoration practices results in a novel hydrologic regime and set of geomorphic characteristics that interact to determine stream condition, but in practice, implementation is rarely coordinated due to funding and other constraints. In this study, we examine links between watershed-scale implementation of SCMs and stream restoration in Big Dry Creek, a suburban watershed in the Front Range of northern Colorado. We combine continuous hydrologic model simulations of watershed-scale response to SCM design scenarios with channel evolution modeling to examine interactions between stormwater management and stream restoration strategies for reducing loading of sediment and adsorbed phosphorus from channel erosion. Modeling results indicate that integrated design of SCMs and stream restoration interventions can result in synergistic reductions in pollutant loading. Not only do piecemeal and disunited approaches to stormwater management and stream restoration miss these synergistic benefits, they make restoration projects more prone to failure, wasting valuable resources for pollutant reduction. We conclude with a set of recommendations for integrated planning of SCMs and stream restoration to simultaneously achieve water quality and channel protection goals.


Assuntos
Conservação dos Recursos Naturais , Qualidade da Água , Colorado , Ecossistema , Chuva
7.
Fam Syst Health ; 38(3): 323-326, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32955287

RESUMO

This commentary discusses the journey to integrated behavioral health and primary care in the state of Colorado. The authors discuss integrated care, and the lessons learned by early adopters can help those just getting started. They argue integration is possible in practice settings of all types despite the barriers that exist - but these barriers must continue to be broken down for further scaling and long-term sustainability. While adequate payment, workforce, and data-sharing infrastructure and policy are necessary for scaling and sustainability, they are not sufficient: practice transformation support is crucial for a change this fundamental. Finally, scaling and sustaining integration takes a village; diverse stakeholders across sectors, including payers, clinicians, patients, public health, philanthropy, and policymakers, all have a role to play. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Prestação Integrada de Cuidados de Saúde , Psiquiatria , Colorado , Humanos , Atenção Primária à Saúde
8.
AJR Am J Roentgenol ; 215(3): 673-678, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755165

RESUMO

OBJECTIVE. The purpose of this study is to evaluate the experience of radiologists who include contact information in radiology reports in an era of open access to reports via patient portals. SUBJECTS AND METHODS. A prospective nonrandomized survey of all 61 radiologists in a single private practice group was conducted between July and August 2019. The survey, which consisted of 21 questions, was administered via a secure online survey software platform and distributed by e-mail. Participation was voluntary and anonymous. Data were analyzed using statistical analysis software. RESULTS. A total of 87% (53 of 61) of the radiologists completed the survey. Of these radiologists, 78% (41 of 52) indicated that they include their telephone number in radiology reports 75% or more of the time, with one radiologist not providing a response. Thirty-six percent of the radiologists are contacted once a year by patients, and 27% are contacted once a month. Of the 41 radiologists who include contact information 75% of the time or more, most (56% [23 of 41]) reported an increase in the frequency of patient contact. The reasons why radiologists had a patient contact them were to better understand the radiology report (95% of radiologists), to seek follow-up recommendations (39%), to express gratitude (34%), and to point out mistakes in the report (27%). Moreover, 98% (40 of 41) of radiologists reported never receiving complaints from a referring physician. Only 2% of radiologists stated that patient interaction was detrimental to workflow. Most radiologists found that interacting with patients was a satisfying experience and indicated that they would welcome more patient interaction. CONCLUSION. Including radiologist contact information in radiology reports increases patient-radiologist interaction. Despite this increased patient interaction, most radiologists indicated that they would welcome more interaction and found the communication satisfying.


Assuntos
Portais do Paciente , Padrões de Prática Médica/estatística & dados numéricos , Radiologistas , Telefone , Colorado , Humanos , Relações Médico-Paciente , Estudos Prospectivos , Inquéritos e Questionários
9.
J Environ Manage ; 271: 111037, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32778317

RESUMO

Riparian ecosystems are shaped by interactions among streamflow, plants, and physical processes. Sustaining functioning riparian ecosystems in the face of climate change, growing human demands for water, and increasing water scarcity requires improved understanding of the sensitivity of riparian ecosystems to shifts in flow regimes and associated adaptive management strategies. We applied projected future flow regimes to an ecogeomorphic model of riparian and channel response to evaluate these interactions. We tested the hypothesis that components of the riparian ecosystem vary in their vulnerabilities to shifts in flow attributes and that changes in the representation of functional groups of plants result from interactions between ecological and physical drivers. Using the Yampa and Green Rivers in northwestern Colorado as our test system, we investigated ecogeomorphic response to (1) synthetic flow regimes representing continuous changes from baseline flows; and (2) future flow scenarios that incorporate changing climate, demand, and water-resource projects. For this region, we showed that riparian plant presence, composition, and cover are highly sensitive to the high flows that occur early in the growing season, but that shifts to low flows are also important, especially for determining the functional diversity of a riparian community. Future flow regimes are likely to induce vegetation encroachment on lower channel surfaces and to increase plant cover, which will be dominated by fewer functional groups. In particular, we predict a decrease in some mesic plants (shrubs and tall herbs) and an increase in presence and cover of late-seral, xeric shrubs, most of which are non-native species. Managing for high flows that occur early in the growing season must complement maintenance of adequate baseflows to maintain ecosystem functioning in the face of hydrologic alterations induced by climate change and human water demand.


Assuntos
Ecossistema , Rios , Mudança Climática , Colorado , Hidrologia
10.
J Environ Radioact ; 222: 106340, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32763727

RESUMO

As the number of nuclear power plants (NPPs) being decommissioned increases internationally, many issues are being raised. One such issue is related to site soil analyses for the determination of residual risk for license termination. In a typical site-cleanup analysis, the majority of soil samples at the site are at or below the detection limit (BDL). Conventional approaches to managing BDL data are to simply ignore or substitute the data with a value of zero or the detection limit itself. However, these approaches are statistically biased, limiting their usefulness. Within the environmental science community, the issue of how to treat BDL data has been examined by a number of investigators. This study reviewed the issue of BDL data in nuclear decommissioning using the analytical methods suggested by studies in the environmental science, including the Kaplan-Meier method, robust regression on order statistics, and maximum likelihood estimation. The use of these methods to handle BDL data was examined using a case study with respect to its potential impact on dose/risk assessment, the soil volume removal estimate, and the associated costs. The case study was based on the Colorado School of Mines Research Institute's site soil data. Our analysis included the consideration of the uncertainties associated with residual dose/risk, waste soil volume estimation, and costs. An uncertainty analysis was conducted using a Latin hypercube sampling approach. Results showed that using BDL data can have a large impact on the estimation of dose/risk, waste volume, and waste disposal cost of a NPP decommissioning project.


Assuntos
Centrais Nucleares , Monitoramento de Radiação , Poluentes Radioativos do Solo , Colorado , Limite de Detecção , Medição de Risco , Poluentes Radioativos do Solo/análise
11.
Public Health Rep ; 135(5): 621-630, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32791022

RESUMO

OBJECTIVE: Electronic health records (EHRs) hold promise as a public health surveillance tool, but questions remain about how EHR patients compare with populations in health and demographic surveys. We compared population characteristics from a regional distributed data network (DDN), which securely and confidentially aggregates EHR data from multiple health care organizations in the same geographic region, with population characteristics from health and demographic surveys. METHODS: Ten health care organizations participating in a Colorado DDN contributed data for coverage estimation. We aggregated demographic and geographic data from 2017 for patients aged ≥18 residing in 7 counties. We used a cross-sectional design to compare DDN population size, by county, with the following survey-estimated populations: the county population, estimated by the American Community Survey (ACS); residents seeking any health care, estimated by the Colorado Health Access Survey; and residents seeking routine (eg, primary) health care, estimated by the Behavioral Risk Factor Surveillance System. We also compared data on the DDN and survey populations by sex, age group, race/ethnicity, and poverty level to assess surveillance system representativeness. RESULTS: The DDN population included 609 840 people in 7 counties, corresponding to 25% coverage of the general adult population. Population coverage ranged from 15% to 35% across counties. Demographic distributions generated by DDN and surveys were similar for many groups. Overall, the DDN and surveys assessing care-seeking populations had a higher proportion of women and older adults than the ACS population. The DDN included higher proportions of Hispanic people and people living in high-poverty neighborhoods compared with the surveys. CONCLUSION: The DDN population is not a random sample of the regional adult population; it is influenced by health care use patterns and organizations participating in the DDN. Strengths and limitations of DDNs complement those of survey-based approaches. The regional DDN is a promising public health surveillance tool.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Geografia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vigilância em Saúde Pública/métodos , Fatores Socioeconômicos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Colorado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
12.
Curr Biol ; 30(14): R797-R798, 2020 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-32693068

RESUMO

Sleep health has multiple dimensions including duration, regularity, timing, and quality [1-4]. The Coronavirus 2019 (COVID-19) outbreak led to Stay-at-Home orders and Social Distancing Requirements in countries throughout the world to limit the spread of COVID-19. We investigated sleep behaviors prior to and during Stay-at-Home orders in 139 university students (aged 22.2 ± 1.7 years old [±SD]) while respectively taking the same classes in-person and remotely. During Stay-at-Home, nightly time in bed devoted to sleep (TIB, a proxy for sleep duration with regard to public health recommendations [5]) increased by ∼30 min during weekdays and by ∼24 mins on weekends and regularity of sleep timing improved by ∼12 min. Sleep timing became later by ∼50 min during weekdays and ∼25 min on weekends, and thus the difference between weekend and weekday sleep timing decreased - hence reducing the amount of social jetlag [6,7]. Further, we find individual differences in the change of TIB devoted to sleep such that students with shorter TIB at baseline before the first COVID-19 cases emerged locally had larger increases in weekday and weekend TIB during Stay-at-Home. The percentage of participants that reported 7 h or more sleep per night, the minimum recommended sleep duration for adults to maintain health [5] - including immune health - increased from 84% to 92% for weekdays during Stay-at-Home versus baseline. Understanding the factors underlying such changes in sleep health behaviors could help inform public health recommendations with the goal of improving sleep health during and following the Stay-at-Home orders of the COVID-19 pandemic.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Sono , Estudantes , Transtornos Cronobiológicos/fisiopatologia , Ritmo Circadiano , Colorado/epidemiologia , Humanos , Pandemias , Universidades
13.
Oecologia ; 193(4): 811-825, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32728948

RESUMO

Differentiation in physiological activity is a critical component of resource partitioning in resource-limited environments. For example, it is crucial to understand how plant physiological performance varies through time for different functional groups to forecast how terrestrial ecosystems will respond to change. Here, we tracked the seasonal progress of 13 plant species representing C3 shrub, perennial C3 and C4 grass, and annual forb functional groups of the Colorado Plateau, USA. We tested for differences in carbon assimilation strategies and how photosynthetic rates related to recent, seasonal, and annual precipitation and temperature variables. Despite seasonal shifts in species presence and activity, we found small differences in seasonally weighted annual photosynthetic rates among groups. However, differences in the timing of maximum assimilation (Anet) were strongly functional group-dependent. C3 shrubs employed a relatively consistent, low carbon capture strategy and maintained activity year-round but switched to a rapid growth strategy in response to recent climate conditions. In contrast, grasses maintained higher carbon capture during spring months when all perennials had maximum photosynthetic rates, but grasses were dormant during months when shrubs remained active. Perennial grass Anet rates were explained in part by precipitation accumulated during the preceding year and average maximum temperatures during the past 48 h, a result opposite to shrubs. These results lend insight into diverse physiological strategies and their connections to climate, and also point to the potential for shrubs to increase in abundance in response to increased climatic variability in drylands, given shrubs' ability to respond rapidly to changing conditions.


Assuntos
Carbono , Ecossistema , Colorado , Poaceae , Estações do Ano
14.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32661191

RESUMO

Most US states have now legalized medical marijuana (MMJ) use, giving new hope to families dealing with chronic illness, despite only limited data showing efficacy. Access to MMJ has presented several challenges for patients and families, providers, and pediatric hospitals, including the discrepancy between state and federal law, potential patient safety issues, and drug interaction concerns. Colorado was one of the first states to legalize MMJ and has remained at the forefront in addressing these challenges. Children's Hospital Colorado has created and evolved its MMJ inpatient use policy and has developed a unique consultative service consisting of a clinical pharmacist and social worker. This service supports patients and families and primary clinical services in situations in which MMJ is actively being used or considered by a pediatric patient. The first 50 patients seen by this consultative service are reported. Eighty percent of patients seen had an oncologic diagnosis. Symptoms to be ameliorated by active or potential MMJ use included nausea and vomiting, appetite stimulation, seizures, and pain. In 64% of patients, MMJ use was determined to be potentially unsafe, most often because of potential drug-drug interactions. In 68% of patients, a recommendation was made to either avoid MMJ use or adjust its administration schedule. As pediatric hospitals address the topic of MMJ use in their patients, development of institutional policy and clinical support services with specific expertise in MMJ is a recommended step to support patient and families and hospital team members.


Assuntos
Comitês Consultivos , Hospitais Pediátricos , Maconha Medicinal/uso terapêutico , Política Organizacional , Adolescente , Criança , Pré-Escolar , Colorado , Governo Federal , Feminino , Humanos , Lactente , Legislação de Medicamentos , Masculino , Encaminhamento e Consulta , Governo Estadual , Adulto Jovem
15.
MMWR Morb Mortal Wkly Rep ; 69(26): 847-849, 2020 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-32614809

RESUMO

On March 26, 2020, Colorado instituted stay-at-home orders to reduce community transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). To inform public health messaging and measures that could be used after reopening, persons with laboratory-confirmed COVID-19 during March 9-26 from nine Colorado counties comprising approximately 80% of the state's population† (Adams, Arapahoe, Boulder, Denver, Douglas, El Paso, Jefferson, Larimer, and Weld) were asked about possible exposures to SARS-CoV-2 before implementation of stay-at-home orders. Among 1,738 persons meeting the inclusion criteria§ in the Colorado Electronic Disease Surveillance System, 600 were randomly selected and interviewed using a standardized questionnaire by telephone. Data collection during April 10-30 included information about demographic characteristics, occupations, and selected activities in the 2 weeks preceding symptom onset. During the period examined, SARS-CoV-2 molecular testing was widely available in Colorado; community transmission was documented before implementation of the stay-at-home order. At least three attempts were made to contact all selected patients or their proxy (for deceased patients, minors, and persons unable to be interviewed [e.g., those with dementia]) on at least 2 separate days, at different times of day. Data were entered into a Research Electronic Data Capture (version 9.5.13; Vanderbilt University) database, and descriptive analyses used R statistical software (version 3.6.3; The R Foundation).


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Exposição Ambiental/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Saúde Pública/legislação & jurisprudência , Adulto , Colorado/epidemiologia , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Laboratórios , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Isolamento Social
16.
Ann Biomed Eng ; 48(9): 2281-2284, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32710248

RESUMO

The global COVID-19 pandemic disrupted supply chains across the world, resulting in a critical shortage of personal protective equipment (PPE) for frontline healthcare workers. To preserve PPE for healthcare providers treating COVID-19 positive patients and to reduce asymptomatic transmission, the Department of Bioengineering at the University of Colorado, Denver | Anschutz Medical Campus collaborated with National Jewish Health to design and test patterns for cloth face coverings. A public campaign to sew and donate the final pattern was launched and over 2500 face coverings have been donated as a result. Now that nearly three million cases of COVID-19 have been confirmed in the United States, many state and local governments are requiring cloth face coverings be worn in public. Here, we present the collaborative design and testing process, as well as the final pattern for non-patient facing hospital workers and community members alike.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Máscaras/provisão & distribução , Pandemias/prevenção & controle , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/prevenção & controle , Engenharia Biomédica , Colorado/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Pessoal de Saúde , Hospitais , Humanos , Colaboração Intersetorial , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Têxteis , Estados Unidos/epidemiologia , Design Universal
18.
J Environ Manage ; 268: 110704, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32510439

RESUMO

Land managers often need to predict watershed-scale erosion rates after disturbance or other land cover changes. This study compared commonly used hillslope erosion models to simulate post-fire sediment yields (SY) at both hillslope and watershed scales within the High Park Fire, Colorado, U.S.A. At hillslope scale, simulated SY from four models- RUSLE, AGWA/KINEROS2, WEPP, and a site-specific regression model-were compared to observed SY at 29 hillslopes. At the watershed scale, RUSLE, AGWA/KINEROS2, and WEPP were applied to simulate spatial patterns of SY for two 14-16 km2 watersheds using different scales (0.5-25 ha) of hillslope discretization. Simulated spatial patterns were compared between models and to densities of channel heads across the watersheds. Three additional erosion algorithms were implemented within a land surface model to evaluate effects of parameter uncertainty. At the hillslope scale, SY was only significantly correlated to observed SY for the empirical model, but at the watershed scale, sediment loads were significantly correlated to observed channel head densities for all models. Watershed sediment load increased with the size of the hillslope sub-units due to the nonlinear effects of hillslope length on simulated erosion. SY's were closest in magnitude to expected watershed-scale SY when models were divided into the smallest hillslopes. These findings demonstrate that current erosion models are fairly consistent at identifying areas with low and high erosion potential, but the wide range of predicted SY and poor fit to observed SY highlight the need for better field observations and model calibration to obtain more accurate simulations.


Assuntos
Fogo , Sedimentos Geológicos , Colorado , Monitoramento Ambiental , Modelos Teóricos , Solo
19.
J Pediatr Orthop ; 40(6): e460-e465, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501916

RESUMO

BACKGROUND: Brachial plexus birth injury (BPBI) is a condition in which the brachial plexus is thought to be damaged during the birth process. Studies have cited a varying incidence rate ranging from 0.5 to 4.0 per 1000 live births. The purpose of this study is to evaluate birth claims data over a 15-year period to identify risk and protective factors for BPBI in the state of Colorado. METHODS: A data request was made to the state hospital association for birth claims data. We requested all birth claims from the years 2000 to 2014. ICD9 codes for variables of interest included: BPBI, shoulder dystocia, heavy-for-dates, macrosomia, breech delivery, instrumented birth, birth hypoxia, and gestational diabetes. A multivariable logistic regression model quantified both risk and protective factors for the development of BPBI as odds ratios (ORs) with 95% confidence intervals (CI). RESULTS: There were 966,447 birth records received from State Hospital Association. The BPBI incidence was 0.63/1000 live births. The mean (SD) birth weight was 3187 (572) g for the total population and 3808 (643) g for the BPBI births. Later admission year indicated a decrease in BPBI births (OR, 0.94; 95% CI: 0.92, 0.96/y). Asian, black, and Hispanic infants were more likely to have a BPBI than white infants. Shoulder dystocia (OR, 60.37; 95% CI: 47.90, 76.13) was the highest risk factor for BPBI followed by instrumented forceps birth (OR, 21.04; 95% CI: 12.22, 36.21), breech delivery (OR, 15.38; 95% CI: 5.60, 42.25), and gestational diabetes (OR, 4.46; 95% CI: 3.29, 6.57). Cesarean single births had the lowest risk for BPBI (0.27; 95% CI: 0.20, 0.37), whereas cesarean multiple births (2.33; 95% CI: 1.10, 4.94) and natural multiple births (3.20; 95% CI: 1.36, 7.55) were at higher risk when compared with natural single births and all were statistically significant at P<0.027. Colorado births had a decreased risk of BPBI compared with the United States each year from 2000 (0.82/1000 births vs. 1.6/1000 live births, P<0.001) to 2012 (0.56/1000 live births vs. 0.9/1000 live births, P=0.003). CONCLUSIONS: BPBI has decreased from 2000 to 2014. Historically Colorado has had a lower BPBI incidence than the United States. Shoulder dystocia, instrumented forceps birth, gestational diabetes, and breech delivery are the biggest predictors for BPBI. Increased awareness of shoulder dystocia and instrumented birth are hypothesized to have reduced these incidences. Nonwhites and Medicaid patients seem to be at higher risk for BPBI. LEVEL OF EVIDENCE: Level II-Prognostic.


Assuntos
Traumatismos do Nascimento/epidemiologia , Peso ao Nascer , Plexo Braquial/lesões , Cesárea/estatística & dados numéricos , Colorado/epidemiologia , Diabetes Gestacional/epidemiologia , Feminino , Hospitalização , Humanos , Incidência , Recém-Nascido , Modelos Logísticos , Razão de Chances , Gravidez , Fatores de Risco , Distocia do Ombro/epidemiologia , Estados Unidos
20.
Public Health ; 185: 8-14, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32505041

RESUMO

OBJECTIVES: Opioid overdose death rates have continued to spike exponentially from the start of the 21st century, creating what is known to be one of the worst public health crises in the United States. Simultaneously, as more states began passing medical cannabis laws (MCLs), the idea that marijuana was the solution to the opioid crisis began to spread nationwide. As some states have maintained strict medical marijuana policies, others-such as Colorado-have expanded their statutes to allow recreational marijuana sales within their state. Researchers have been able to provide sense of the public health implications resulting from MCLs, but little is known about the effects of this marijuana policy expansion. This preliminary study will focus on exploring the statewide effects of Colorado's recreational marijuana policy on the state's opioid overdose death rates. STUDY DESIGN: Because Colorado has existing panel data for opioid overdose death rates, we can use statistical software to define and create an optimal control group to adequately resemble Colorado's outcome variable of interest. This process known as the synthetic control method can provide a valid counterfactual for Colorado's opioid overdose outcomes in the absence of this policy-a Colorado that did not expand marijuana policy to the point recreational dispensaries were established. METHODS: Opioid overdose death rate data from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (WONDER) will be used to construct a synthetic control unit composed of a donor pool of states resembling Colorado's regulatory environment pertaining to marijuana before legalization. The synthetic control unit allows for a comparative observation of overdose rate trends in Colorado and its synthetic counterpart for the years 1999-2017, all while including a set of predictor variables for robustness checks. A difference-in-difference estimate will then help us observe the effects of the treatment given to Colorado. Inference tests will be conducted to evaluate the method's predictive power and significance of the results. RESULTS: The results of the synthetic control model and its outcomes showed that the estimated negative 5% drop in overdose death rates was deemed insignificant on conducting a placebo in-space analysis, meaning there is not enough evidence to prove that opening recreational dispensaries as a result of recreational marijuana legislation was instrumental in reducing Colorado's ongoing opioid crisis depicted through opioid overdose deaths. CONCLUSION: Owing to the lack of additional post-treatment data and captured lagged effects, it is too soon to dismiss this policy as inadequate in combating the opioid epidemic. Once additional post-treatment data become available, the study can be reproduced to obtain more robust results and achieve a clearer understanding of the policy implications shown.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/epidemiologia , Uso da Maconha/epidemiologia , Uso da Maconha/legislação & jurisprudência , Adulto , Cannabis , Centers for Disease Control and Prevention, U.S. , Colorado/epidemiologia , Humanos , Legislação de Medicamentos , Maconha Medicinal , Pessoa de Meia-Idade , Epidemia de Opioides , Saúde Pública , Política Pública , Análise Espacial , Estados Unidos
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