Public Health Commons^™

Emerging Clostridioides Difficile Ribotypes Have Divergent Metabolic Phenotypes, Firas S Midani, Heather A Danhof, Nathanael Mathew, Colleen K Ardis, Kevin W Garey, Jennifer K Spinler, Robert A Britton

Faculty, Staff and Students Publications

Clostridioides difficile is a gram-positive spore-forming pathogen that commonly causes diarrheal infections in the developed world. Although C. difficile is a genetically diverse species, certain ribotypes are overrepresented in human infections, and it is unclear if metabolic adaptations are essential for the emergence of these epidemic ribotypes. To identify ribotype-specific metabolic differences, we therefore tested carbon substrate utilization by 88 C. difficile isolates and looked for differences in growth between 22 ribotypes. As expected, C. difficile was capable of growing on a variety of carbon substrates. Further, C. difficile strains clustered by phylogenetic relationship and displayed ribotype-specific and clade-specific …

Exploring Profiles Of Fathers Integrating Food And Physical Activity Parenting Practices, John A Jimenez-Garcia, Louise C Mâsse, Robert L Newton, Salma M Musaad, Alicia Beltran, Teresia M O'Connor

Children’s Nutrition Research Center Staff Publications

Objective: This study aims to identify fathers' profiles integrating food parenting practices (FPP) and physical activity parenting practices (PAPP).

Design: We analysed cross-sectional data. The fathers completed the reduced FPP and PAPP item banks and socio-demographic and family dynamics (co-parenting and household responsibility) questionnaires. We identified fathers' profiles via latent profile analysis. We explored the influence of social determinants, child characteristics and family dynamics on fathers' profiles using multinomial logistic regression.

Setting: Online survey in the USA.

Participants: Fathers of 5-11-year-old children.

Results: We analysed data from 606 fathers (age = 38 ± 8·0; Hispanic = 37·5 %). Most fathers …

Construct Validity, Test-Retest Reliability, And Inter-Rater Objectivity Of The Swimming Competence Assessment Scale (Scas), Jon Sundan, Håvard Lorås, Monika Haga

International Journal of Aquatic Research and Education

This study aimed to investigate the construct validity, test-retest reliability, and inter-rater reliability of a newly developed and comprehensive instrument for assessment of children’s swimming competence. The Swimming Competence Assessment Scale (SCAS) consists of six consecutive test items (entry, swim on front, surface dive, float, swim on back and exit) that aligns with the Norwegian curricular standard of swimming competence. The exploratory factor analysis retained a unidimensional model, supporting one underlaying statistical dimension with acceptable internal consistency (α = 0.79). Intraclass correlation coefficients (ICCs) between test and retest ranged from .84 to .98, and .97 for the total score. Strong …

"Feel For The Water": What Is It, Really?, Robert Keig Stallman, Kristine De Martelaer

International Journal of Aquatic Research and Education

The phrase, 'feel for the water,' is commonly used. But what does it really mean? The traditional idea of this 'feel' focuses on the sensation of touch and use of the hands to produce propulsion. But what about water resistance? Mastering a feel for how to reduce resistance is equally important as the unique relationship between aquatic propulsion and resistance is of great importance. While being in the water, the effects of gravity and buoyancy also need to be perceived by the learner and taught by the instructor. Reflection on the effects on propulsion-resistance and gravity-buoyancy requires relevant exercises to …

Water Orientation Skills And Basic Safety And Swimming Skills Of Children With Autism Spectrum Disorder, Kelle L. Murphy, Min Liu

International Journal of Aquatic Research and Education

Drowning is the leading cause of death among individuals with autism spectrum disorder (ASD). The current study examined water orientation (i.e., comfort level), water safety, and beginning swimming skills of individuals with ASD of ages ranging from 3 to 13 years using the Aquatic Orientation Checklist (AOC) (Kilian et al., 1984). Data were collected during consecutive Fall and Spring semesters. A total of 23 children (n = 15 boys; n = 8 girls) volunteered for the study. Lessons were conducted twice a week for 10 weeks continuously and each lesson was 45 minutes in length. Overall, the swimming program had …

Fighting Instinct: The Brain, Emotions And Decision-Making In The Water, Jill Nash, Sam Hills

International Journal of Aquatic Research and Education

This conceptual paper explores the complex interplay among the human brain, emotions, and decision-making processes, particularly in aquatic environments. Integrating insights from neuroscience, psychology, and behavioural economics, we investigate how instinctual responses and emotional states influence our decisions during water-related activities. By analysing both biological and psychological factors, the paper aims to illuminate the intricacies of human behaviour in various aquatic settings and highlights significant gaps in the research on emotional decision-making that warrant further investigation. Additionally, the paper suggests interventions, including plausible communication strategies, to mitigate the impact of instinctual responses and improve safety and decision-making efficiency.

Goggles And Water Competence: An Addendum, Marek Rejman, Robert Keig Stallman Ph.D.

International Journal of Aquatic Research and Education

We offer this short addendum to the 2017 article that appeared in IJARE, ‘’From swimming skill to water competence: Towards a more inclusive drowning prevention future’’ (Stallman et al., 2017), as an editorial to argue that the essential water competencies ought to be mastered “without goggles.” The focus is on the potential negative effect of goggle use during beginning swimming instruction along with their likely absence during unintended and unexpected immersions in natural bodies of water that often lead to drowning. Rejman and Stallman (2024) demonstrated the development of dependence on goggles among young adults and described its negative effect …

In This Issue 14:4, Stephen J. Langendorfer Ph.D.

International Journal of Aquatic Research and Education

In This Issue 14:4

The Perceived Benefits Of And Barriers To Open-Water Swimming: A Mixed-Methods Examination, David Elliott Ph.D, Mark A. Christie Ph.D

International Journal of Aquatic Research and Education

This study set out to determine the perceived benefits of, and barriers to, open-water swimming (OWS). Adopting a mixed-methods approach, six hundred and sixty-five open-water swimmers responded to an online survey consisting of the Exercise Benefits and Barriers Scale (EBBS) and a series of open-ended questions. Data from the EBBS revealed the strongest perceived benefits to be ‘Psychological Outlook’ and ‘Life Enhancement.’ In terms of barriers, those presented in the EBBS received low ratings with only ‘Physical Exertion’ considered as being somewhat problematic. Content analysis performed on the open-ended responses showed social aspects, mental well-being, and connection to nature as …

Evaluation Of Online Information On The Cold Shock Response To Accidental Immersion In Cold Water, Adam Wilson, Heather Massey, Clare M. Eglin

International Journal of Aquatic Research and Education

Many of the UK open water accidental deaths have been attributed to the initial responses to cold water immersion (CWI) collectively known as the cold shock response (CSR). The aim of this study was to analyse the publicly available internet information on CWI and CSR for accuracy and quality compared to the ‘gold standard’ published, peer-reviewed research. Seventy-eight webpages which provided information in English on unexpected CWI and CSR were evaluated. Webpages were accessible, widely available, and had appropriate readability scores. Webpage accuracy was suboptimal including only presenting on average 10 (range 3-16) CSR components out of 19. Quality of …

A Preventionist Framework For Reducing Drowning: A Case For Parenting Interventions, Miriam G. Clark, Linda Quan, Patricia Chamberlain

International Journal of Aquatic Research and Education

Drowning is preventable but still claims the lives of over 300,000 people worldwide every year. The purpose of this theoretical review paper is threefold: 1) discuss the theoretical framework for a multi-faceted system of prevention; 2) discuss the importance of parenting, a crucial area where current drowning prevention research is falling short in this multi-faceted approach; and 3) discuss how evidence-based practices from psychosocial parenting research could be used to create drowning prevention interventions that support parents to implement water safety practices in their families. Practical ideas for integrating psychosocial parent interventions with drowning prevention knowledge are discussed. Such interventions …

Precision Phenotyping For Curating Research Cohorts Of Patients With Unexplained Post-Acute Sequelae Of Covid-19, Alaleh Azhir, Jonas Hügel, Jiazi Tian, Jingya Cheng, Ingrid V Bassett, Douglas S Bell, Elmer V Bernstam, Maha R Farhat, Darren W Henderson, Emily S Lau, Michele Morris, Yevgeniy R Semenov, Virginia A Triant, Shyam Visweswaran, Zachary H Strasser, Jeffrey G Klann, Shawn N Murphy, Hossein Estiri

Faculty, Staff and Student Publications

BACKGROUND: Scalable identification of patients with post-acute sequelae of COVID-19 (PASC) is challenging due to a lack of reproducible precision phenotyping algorithms, which has led to suboptimal accuracy, demographic biases, and underestimation of the PASC.

METHODS: In a retrospective case-control study, we developed a precision phenotyping algorithm for identifying cohorts of patients with PASC. We used longitudinal electronic health records data from over 295,000 patients from 14 hospitals and 20 community health centers in Massachusetts. The algorithm employs an attention mechanism to simultaneously exclude sequelae that prior conditions can explain and include infection-associated chronic conditions. We performed independent chart reviews …

Control Of Clostridioides Difficile Virulence And Physiology By The Flagellin Homeostasis Checkpoint Flic-Fliw-Csra In The Absence Of Motility, Duolong Zhu, Katherine J Wozniak, Firas Midani, Shaohui Wang, Xingmin Sun, Robert A Britton

Faculty, Staff and Students Publications

Mutations affecting Clostridioides difficile flagellin (FliC) have been shown to be hypervirulent in animal models and display increased toxin production and alterations in central metabolism. The regulation of flagellin levels in bacteria is governed by a tripartite regulatory network involving fliC, fliW, and csrA, which creates a feedback system to regulate flagella production. Through genomic analysis of C. difficile clade 5 strains (non-motile), we identified they have jettisoned many of the genes required for flagellum biosynthesis yet retain the major flagellin gene fliC and regulatory gene fliW. We therefore investigated the roles of fliC, fliW …

Michelle Obama: Moving Towards Childhood Obesity Solutions, Ian Gallagher

Osmosis Magazine

Throughout the Obamas' time in office, approval ratings made it clear the most popular Obama was not the man in the Oval Office. First Lady Michelle Obama consistently received higher approval ratings than her husband during his time in office. This could be attributed to her strong devotion to her family and her appearance as a genuinely good and caring person. During her time in office she drew the attention of the public by shedding light on one of the worst health epidemics currently afflicting the country: childhood obesity.

The Role Of Chemistry In The Prevention And Containment Of The Zika Virus, Joe Ortolani

Osmosis Magazine

Similar to West Nile and yellow fever, Zika is a mosquito-born e dis ease th at has gained quite a bit of attention since its recent arrival in Latin America for its possible link to a string of fetal brain defects. The Zika virus was first identified in Uganda in 1947, but for much of the late 20th century, very little was known about the virus.

Associations Among Shopping Methods, Diet Adherence, And Nutrition Knowledge Of Employed Primary Grocery Shoppers In Households With Children, Baylee Schneider

Master's Theses

Obesity is a prominent risk factor for chronic disease, which is the leading cause of death in the United States. Obesity and chronic disease rates continue to rise, requiring a need for prevention and intervention efforts. The future role of dietetics is to provide treatment and prevention through holistic approaches, by understanding individuals’ habits that contribute to the onset of disease, specifically their food choices, grocery shopping methods, and influences that waver these selections. The purpose of this study is to evaluate the relationship between grocery shopping methods (online or in-store), Mediterranean diet adherence, nutrition knowledge, and food purchase patterns …

The Swahili Version Of The Cd-Risc 10 Resilience Scale: Psychometric Properties And Factors Associated With Resilience Among Healthcare Workers In Tanzania, Kevinson Mwangi, Sabina Odero, Gideon Mbithi, Rachel Odhiambo, Rosemary Stephen, Tumbwene Mwansisya, Eunice Pallangyo, Eunice Ndirangu, Amina Abubakar

Institute for Human Development, East Africa

Background: Despite the central role of resilience in promoting mental well-being, little is known about the resilience process among healthcare workers in East Africa, partly due to the lack of adequately standardised and psychometrically sound assessment tools for our context. This study provides the first psychometric evaluation of the Swahili version of the Connor-Davidson Resilience Scale 10 (CD-RISC 10) among nurses/midwives and community health volunteers (CHVs) in Tanzania, potentially informing the accuracy of measuring resilience in this setting. Additionally, we examine factors associated with self-reported resilience as measured by the CD-RISC 10 scale.

Methods We used cross-sectional data on nurses/midwives …

Contraceptive Hormone Influences On The Role Of Primary Reinforcement And Reinforcer-Enhancement In Nicotine Self-Administration, Kathleen Robin Mcnealy

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

Hormonal contraceptives contain a synthetic estrogen (e.g., ethinyl estradiol/EE) and/or a synthetic progestin (e.g., levonorgestrel/LEVO) and can exacerbate nicotine intake. However, whether altered intake reflects changes in nicotine reinforcement or enhancement by nicotine of co-occurring reinforcers is unknown. This reinforcer-enhancement effect is evidenced in rats when nicotine self-administration is increased by the presence of a visual stimulus (VS) reinforcer. This dissertation examined the effects of EE and LEVO on nicotine reinforcement and reinforcer-enhancement in ovary-intact female Sprague-Dawley rats. Rats were implanted with a jugular catheter and assigned to receive daily injections of EE (Vehicle, 0.125 [Low], or 0.18 [High] μg/day; …

Antiseizure Medications And Their Differing Effects On Cardiovascular Risk, Aleena Abbasi, Bassil Abbasi, Scott Mintzer, Carla Lopinto-Khoury

Department of Neurology Faculty Papers

This review discusses the differing effects of enzyme-inducing and non-inducing antiseizure medications on cardiovascular risk and their implications for the management strategies of epilepsy patients. Traditional risk markers, including low density lipoprotein, high density lipoprotein and triglycerides, can be altered by both enzyme induction and inhibition. Other markers of vascular risk, including c-reactive protein, non-high-density lipoprotein and homocysteine, are affected by antiseizure medications, although adults and children may have different responses. The overall atherosclerotic risk picture is more complex due to indirect effects such as neuroendocrine function and the metabolic syndrome. Large scale data shows an evolving understanding of cardiovascular …

Multiscale 3d Spatial Analysis Of The Tumor Microenvironment Using Whole-Tissue Digital Histopathology, Daniel Shafiee Kermany, Ju Young Ahn, Matthew Vasquez, Weijie Zhang, Lin Wang, Kai Liu, Zhan Xu, Min Soon Cho, Wendolyn Carlos-Alcalde, Hani Lee, Raksha Raghunathan, Jianting Sheng, Xiaoxin Hao, Hong Zhao, Vahid Afshar-Kharghan, Xiang Hong-Fei Zhang, Stephen Tin Chi Wong

Faculty, Staff and Students Publications

No abstract provided.

Pharmacodynamics Of Aspirin Through Gestation: Predictors Of Aspirin Response And Association With Pregnancy Outcome, A Prospective Cohort Study, Rupsa C. Boelig, Emily Foecke Munden, Tingting Zhan, Steven E. Mckenzie, Walter K. Kraft

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

Low-dose aspirin is recommended for prevention of hypertensive disorders of pregnancy (HDP) and preterm birth (PTB) in high-risk pregnancies. There is limited data on factors impacting aspirin response in pregnancy. We aimed to evaluate predictors of aspirin response and association with pregnancy outcome with a prospective study of high-risk pregnancies taking 81 mg aspirin daily. Aspirin response was evaluated with Platelet Function Assay-100 (PFA-100) epinephrine closure time at baseline (< 16 weeks' gestation), follow-up 1 (2-4 weeks after aspirin initiation), and follow-up 2 (28-32 weeks gestation). Multivariable regression was used to identify factors associated with PFA-100 at each visit, and results presented with beta coefficient (B) and confidence interval. The median difference (MD) in PFA-100 in those with and without HDP or PTB was compared. Results included 108 who completed follow-up 1 and 96 who completed both visits with > 75% adherence. PFA-100 was increased from baseline at follow-ups 1 and 2 (MD 37 (27-49); MD 26 (15.5-38.5) respectively). At follow-up 1, obesity (B = -30 (-53 to -7) seconds), …

Altered Thermal Preference By Preoptic Estrogen Receptor Alpha Neurons In Postpartum Females, Nan Zhang, Meng Yu, Qianru Zhao, Bing Feng, Yue Deng, Jonathan C Bean, Qingzhuo Liu, Benjamin P Eappen, Yang He, Kristine M Conde, Hailan Liu, Yongjie Yang, Longlong Tu, Mengjie Wang, Yongxiang Li, Na Yin, Hesong Liu, Junying Han, Darah Ave Threat, Nathan Xu, Taylor Smiley, Pingwen Xu, Lulu Chen, Tianshu Zeng, Yanlin He, Chunmei Wang

Faculty, Staff and Students Publications

OBJECTIVE: This study aims to investigate how reproductive experience (RE) alters thermal preference and thermoregulation in female mice, with a focus on estrogen receptor alpha (ERα)-expressing neurons in the preoptic area (POA).

METHODS: Thermal preference and body temperature were measured in female mice with and without RE, and virgin female mice with selective deletion of ERα from the POA (ERα

RESULTS: We showed that female mice prefer a cooler environment starting from late pregnancy and persisting long term postpartum. Female mice with RE (>4 weeks post-weaning) displayed lower body temperature and a lower thermal preferred temperature, and lost preference …

An Automated Treatment Planning Portfolio For Whole Breast Radiotherapy, Hana Baroudi, Leonard Che Fru, Deborah Schofield, Dominique L Roniger, Callistus Nguyen, Donald Hancock, Christine Chung, Beth M Beadle, Kent A Gifford, Tucker Netherton, Joshua S Niedzielski, Adam Melancon, Manickam Muruganandham, Meena Khan, Simona F Shaitelman, Sanjay Shete, Patricia Murina, Daniel Venencia, Sheeba Thengumpallil, Conny Vrieling, Joy Zhang, Melissa P Mitchell, Laurence E Court

Faculty, Staff and Student Publications

Background: Automation in radiotherapy presents a promising solution to the increasing cancer burden and workforce shortages. However, existing automated methods for breast radiotherapy lack a comprehensive, end-to-end solution that meets varying standards of care.

Purpose: This study aims to develop a complete portfolio of automated radiotherapy treatment planning for intact breasts, tailored to individual patient factors, clinical approaches, and available resources.

Methods: We developed five automated conventional treatment approaches and utilized an established RapidPlan model for volumetric arc therapy. These approaches include conventional tangents for whole breast treatment, two variants for supraclavicular nodes (SCLV) treatment with/without axillary nodes, and two …

American Association Of Physicists In Medicine (Aapm) Chapter Climate Check: Mixed Methods Analysis Of Survey Responses, Ashley J Cetnar, Ghada Aldosary, Meghan C Koo, Holly Lincoln, Angélica Pérez-Andújar, Surendra Prajapati, Samantha J Simiele, Kristi R G Hendrickson

Faculty, Staff and Student Publications

Introduction: The American Association of Physicists in Medicine (AAPM) recently shared results and recommendations from its first Equity, Diversity, and Inclusion (EDI) Climate Survey, which was designed to assess the climate at the workplace, the AAPM organization, and the AAPM regional chapter level. This work further explores the status of EDI at the regional chapter level.

Methods: AAPM's EDI Survey was distributed to 5500 members and had a response rate of 25%. In the survey, three open-ended comment boxes were provided for feedback, including one for regional AAPM members. Sixty-four percent of respondents indicated they were part of a regional …

Clinical Use Of Gafchromic Ebt4 Film For In Vivo Dosimetry For Total Body Irradiation, Emily Draeger, Fada Guan, Min-Young Lee, Dae Yup Han, William Donahue, Zhe Jay Chen

Faculty, Staff and Student Publications

Purpose: In vivo dosimetry is a common requirement to validate dose accuracy/uniformity in total body irradiation (TBI). Several detectors can be used for in vivo dosimetry, including thermoluminescent dosimeters (TLDs), diodes, ion chambers, optically stimulated luminescent dosimeters (OSLDs), and film. TLDs are well established for use in vivo but required expertise and clinical system availability may make them impractical for multifractionated TBI. OSLDs offer quick readout, but recalls have restricted their use. The purpose of this work was to validate the newly available Gafchromic EBT4 film for TBI in vivo dosimetry.

Methods: Film calibration curves were created under standard conditions …

Robust Automated Method Of Spatial Resolution Measurement In Radiotherapy Ct Simulation Images, Pavel Govyadinov, Rick R Layman, Tucker Netherton, Raymond Mumme, Aaron K Jones, Laurence E Court, Moiz Ahmad

Faculty, Staff and Student Publications

Background: Variation in imaging protocol, patient positioning, and the presence of artifacts can vary image quality in CT images used for radiotherapy planning. Automated methods for spatial resolution (SR) estimation exist but require further investigation and validation for wider adoption.

Purpose: To validated previously existing algorithm for SR estimation and introduce improvements that make it robust to patient positioning, CT protocol, site, and artifacts.

Method: A reference algorithm based on the previous gold standard was recreated and modified to improve robustness. The algorithms were tested on three different datasets: (1) a cylindrical ACR CT QC phantom scanned using a Siemens …

Bevacizumab Beyond Progression: Impact Of Subsequent Bevacizumab Re-Treatment In Patients With Ovarian, Fallopian Tube, And Peritoneal Cancer After Progression, Amma Asare, Rebecca Ann Previs, Daniel Spinosa, Bryan Fellman, Amelia L Scott, Isabelle Mulder, May Mahmoud, Ahmed Enbaya, Jean Hansen Siedel, Lauren Cobb, Pamela T Soliman, Anil K Sood, Robert L Coleman, Angeles Alvarez Secord, Shannon N Westin

Faculty, Staff and Student Publications

Background: This study evaluated whether patients with epithelial ovarian, fallopian tube, and primary peritoneal carcinoma (OC) who are immediately re-treated with bevacizumab derive benefit after disease progression on a bevacizumab-containing regimen.

Methods: This multi-institutional, retrospective study compared patients with high grade non-mucinous epithelial OC who received bevacizumab followed directly by another bevacizumab-containing treatment regimen to patients who received bevacizumab followed by a regimen that did not contain bevacizumab (or received no further treatment). Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan Meier product-limit estimator and modeled via Cox proportional hazards regression.

Results: Among 226 patients with OC …

Canonical And Non-Canonical Functions Of The Non-Coding Rna Component (Terc) Of Telomerase Complex, Chongwen Cao, Weiyi Gong, Yuanlong Shuai, Sara Rasouli, Qianyun Ge, Anam Khan, Aleksandra Dakic, Nagireddy Putluri, Gennady Shvets, Yun-Ling Zheng, Danyal Daneshdoust, Rani Mahyoob, Jenny Li, Xuefeng Liu

Faculty, Staff and Students Publications

The telomerase complex consists of a protein component (TERT), which has reverse transcriptase activity, and an RNA component (TERC), which serves as a template for telomere synthesis. Evidence is rapidly accumulating regarding the non-canonical functions of these components in both normal or diseased cells. An oligonucleotide-based drug, the first telomerase inhibitor, secured FDA approval in June 2024. We recently summarized the non-canonical functions of TERT in viral infections and cancer. In this review, we expand on these non-canonical functions of TERC beyond telomere maintenance. Specifically, we explore TERC's roles in cellular aging and senescence, immune regulation, genetic diseases, human cancer, …

Associations Of Parental Perceived Health With Child Movement Behaviors Within Two-Parent Households, You Fu, Hayley Almes, Nora Constantino, Doria Schmidt, Ryan D. Burns

International Journal of Physical Activity and Health

This study aimed to examine how perceived parental mental and physical health status was associated with child physical activity, screen time, and sleep. Participants were 6- to 17-year-old minors (N = 20,156; 47.9% female) from the 2022 US National Survey of Children’s Health. Dependent variables were children’s physical activity frequency, screen time, and sleep. Independent variables were parents’ physical and mental health status. Using the Actor-Partner Interdependence Model, two adjusted path models were constructed. One for parent mental health associating with parental physical health, another for parent physical health associating with parental mental health–both further associating with child movement behaviors. …

Survey Of Mosquito Larval Habitats At The Ksu Field Station, Rose Sofia, Eli Lovvorn, Aspen Hartman, Andrew Haddow

Symposium of Student Scholars

The greater Atlanta metropolitan area hosts numerous mosquito species that are nuisance biters and can transmit arthropod-borne diseases to humans. We surveyed the Kennesaw State University (KSU) Field Station – an incredibly biodiverse location – where student, staff, and faculty-led groups engage in outdoor research and teaching activities. The KSU Field Station located in Cobb County, GA is a heavily trafficked 25-acre property that may attract various mosquito species capable of transmitting pathogens to humans and animals alike. On August 27th, 2024, our team investigated the KSU Field Station to quantify and record potential water-holding containers that serve as mosquito …