How do people with chronic low back pain perceive specific and general exercise? A mixed methods survey.

PURPOSE: Exercise prescriptions for chronic low back pain (CLBP) often utilize reductionistic, trunk-focused exercise aimed at addressing proposed pain mechanisms. It is unknown if the use of these trunk-focused exercises imply beliefs to people with CLBP about the rationale for their use (e.g., etiology), even without concurrent biomedical narratives. This study aimed to explore people's perceptions of specific and general exercise without an accompanying narrative when experiencing CLBP. METHODS: An anonymous online survey was distributed. Mixed methods were utilized for analysis. Six-point Likert scales categorized people's beliefs about individual exercises. Open-ended questions were used to gather further beliefs which were then coded into themes. RESULTS: People with CLBP perceived specific exercise as more beneficial than general exercise. Eight themes and five subthemes were defined. A high volume of positive beliefs were centered around strengthening the low back and abdominal musculature, emphasizing the importance of correct technique. Negative beliefs were held against spinal flexion and external load. Both positive and negative beliefs were underpinned by spinal/pelvic stability being important as well as certain exercises being achievable or not. CONCLUSION: This study demonstrated that people with CLBP consider specific exercises to be more beneficial than general exercises for CLBP. Specific exercises irrespective of an accompanying narrative can imply meaning about the intent of an exercise. Understanding this requires practitioners to be mindful when prescribing and communicating exercise.

Divergent host preferences of above- and below-ground Culex pipiens mosquitoes and their hybrid offspring.

Culex pipiens form pipiens and Cx. pipiens form molestus (Diptera: Culicidae) belong to a cosmopolitan taxonomic group known as the Pipiens Assemblage. Hybridization between these forms is thought to contribute to human transmission of West Nile virus (WNV) in North America. Complementary choice and no-choice landing assays were developed to examine host acceptance by North American Cx. pipiens in the laboratory. Populations collected from above- and below-ground sites in suburban Chicago were identified as forms pipiens and molestus using a polymerase chain reaction-based assay. Avian and human host acceptance was then quantified for the two populations, as well as for their hybrid and backcross offspring. No-choice tests were used to demonstrate that both the pipiens and molestus forms were capable of feeding on human and avian hosts. Choice tests were used to demonstrate that form pipiens females were strongly avian-seeking; an individual's probability of accepting the chick host was 85%. Form molestus females were more likely to accept the human host (87%). Rates of host acceptance by F1 and backcross progeny were intermediate to those of their parents. The results suggest that host preferences in Cx. pipiens are genetically determined, and that ongoing hybridization between above- and below-ground populations is an important contributor to epizootic transmission of WNV in North America.

Pyrethroid resistance in Anopheles gambiae s.s. and Anopheles arabiensis in western Kenya: phenotypic, metabolic and target site characterizations of three populations.

Field and laboratory investigations revealed phenotypic, target site and metabolic resistance to permethrin in an Anopheles gambiae s.s. (Diptera: Culicidae) population in Bungoma District, a region in western Kenya in which malaria is endemic and rates of ownership of insecticide-treated bednets are high. The sensitivity of individual An. gambiae s.l. females as indicated in assays using World Health Organization (WHO) test kits demonstrated reduced mortality in response to permethrin, deltamethrin and bendiocarb. Estimated time to knock-down of 50% (KDT50 ) of the test population in Centers for Disease Control (CDC) bottle bioassays was significantly lengthened for the three insecticides compared with that in a susceptible control strain. Anopheles arabiensis from all three sites showed higher mortality to all three insecticides in the WHO susceptibility assays compared with the CDC bottle assays, in which they showed less sensitivity and longer KDT50 than the reference strain for permethrin and deltamethrin. Microplate assays revealed elevated activity of ß-esterases and oxidases, but not glutathione-S-transferase, in An. gambiae s.s. survivors exposed to permethrin in bottle bioassays compared with knocked down and unexposed individuals. No An. arabiensis showed elevated enzyme activity. The 1014S kdr allele was fixed in the Bungoma An. gambiae s.s. population and absent from An. arabiensis, whereas the 1014F kdr allele was absent from all samples of both species. Insecticide resistance could compromise vector control in Bungoma and could spread to other areas as coverage with longlasting insecticide-treated bednets increases.

Application of a reverse dot blot DNA-DNA hydridization method to quantify host-feeding tendencies of two sibling species in the Anopheles gambiae complex.

A DNA-DNA hybridization method, reverse dot blot analysis (RDBA), was used to identify Anopheles gambiae s.s. and Anopheles arabiensis (Diptera: Culicidae) hosts. Of 299 blood-fed and semi-gravid An. gambiae s.l. collected from Kisian, Kenya, 244 individuals were identifiable to species; of these, 69.5% were An. arabiensis and 29.5% were An. gambiae s.s. Host identifications with RDBA were comparable with those of conventional polymerase chain reaction (PCR) followed by direct sequencing of amplicons of the vertebrate mitochondrial cytochrome b gene. Of the 174 amplicon-producing samples used to compare these two methods, 147 were identifiable by direct sequencing and 139 of these were identifiable by RDBA. Anopheles arabiensis bloodmeals were mostly (94.6%) bovine in origin, whereas An. gambiae s.s. fed upon humans more than 91.8% of the time. Tests by RDBA detected that two of 112 An. arabiensis contained blood from more than one host species, whereas PCR and direct sequencing did not. Recent use of insecticide-treated bednets in Kisian is likely to have caused the shift in the dominant vector species from An. gambiae s.s. to An. arabiensis. Reverse dot blot analysis provides an opportunity to study changes in host-feeding by members of the An. gambiae complex in response to the broadening distribution of vector control measures targeting host-selection behaviours.

Senescent leaf exudate increases mosquito survival and microbial activity.

We conducted experiments to evaluate the effects of soluble components in senescent leaf material on the growth and development of the eastern tree hole mosquito, Aedes triseriatus (Say). Oak leaves that were either leached for three days to remove the labile nutrient fraction, or were not leached, served as basal nutrient inputs in each experiment.Mosquito performance in microcosms containing leachate only was significantly worse compared with microcosms containing leaf material in combination with either leachate or water, indicating the importance of leaf substrates to mosquito production.Adult mosquito biomass, emergence, and development time were significantly higher in microcosms containing unleached leaves compared with leached leaf material. Additions of leachate to leached leaf treatments enhanced adult production, but not to the level observed in unleached leaf treatments.Filtered and unfiltered leachate added substantial nitrogen and phosphorus to microcosms and significantly affected mosquito growth responses. Bacterial productivity and abundance were also significantly affected by leachate additions and filtering.Taken together, these results suggest that while leaves decline with respect to nutritional value during decomposition, they remain important components of the habitat as substrates for microbial growth and mosquito feeding, particularly when nutrients (here, leachate) enter the system. Our results also illustrate the importance of soluble leaf material, which enhances mosquito production through effects on microbial community dynamics.

An acute trophic cascade among microorganisms in the tree hole ecosystem following removal of omnivorous mosquito larvae.

Results of two field experiments showed that selective removal of omnivorous mosquito larvae (Aedes triseriatus (Say)) functioning as top predators in the food web of a temperate, tree hole ecosystem resulted rapidly in increased abundance of flagellate and then ciliate populations. Flagellate density increased from <1 per ml to >103 per ml within 4 days of omnivore removal, followed shortly thereafter by an increase in ciliate density from <1 per ml to >102 per ml, after which flagellate density declined, and flagellate and ciliate densities stabilized. Rod-shaped bacteria increased slightly in density after removal of larval mosquitoes, then declined as protist density increased. Cocciform bacteria did not vary in density with these changes, thus the trophic cascade dampened at the remotest trophic level. Concomitant with the increase in protist densities, some bacteria formed elongated filaments >10 µm in length, likely an anti-predation, morphological response stimulated by suddenly intensified grazing as protozoan density rose. Results suggest that feeding by omnivorous mosquito larvae exhibited strong top-down effects on flagellate and ciliate populations, depressing them to below their equilibrium densities and nearly to extinction in tree hole ecosystems.

Research ethics. Managing risks of arthropod vector research.

Field research with vectors is an essential aspect of vector biology research and vector-borne disease prevention and control. This type of research, which brings experimental vector manipulations into endemic areas, can present risks to human populations. This paper seeks to stimulate a full discussion within the medical entomology community of the risks associated with vector field research. Such discussions will promote development of a consensus, among investigators, sponsoring agencies and the communities within which the work is done, so that appropriate steps can be taken to minimize and manage the risks, and adequate oversight can be maintained.

A supervised land cover classification of a western Kenya lowland endemic for human malaria: associations of land cover with larval Anopheles habitats.

BACKGROUND: A supervised land cover classification was developed from very high resolution IKONOS satellite data and extensive ground truth sampling of a ca. 10 sq km malaria-endemic lowland in western Kenya. The classification was then applied to an investigation of distribution of larval Anopheles habitats. The hypothesis was that the distribution and abundance of aquatic habitats of larvae of various species of mosquitoes in the genus Anopheles is associated with identifiable landscape features. RESULTS AND DISCUSSION: The classification resulted in 7 distinguishable land cover types, each with a distinguishable vegetation pattern, was highly accurate (89%, Kappa statistic = 0.86), and had a low rate of omission and commission errors. A total of 1,198 habitats and 19,776 Anopheles larvae of 9 species were quantified in samples from a rainy season, and 184 habitats and 582 larvae from a dry season. Anopheles gambiae s.l. was the dominant species complex (51% of total) and A. arabiensis the dominant species. Agricultural land covers (mature maize fields, newly cultivated fields, and pastured grasslands) were positively associated with presence of larval habitats, and were located relatively close to stream channels; whilst nonagricultural land covers (short shrubs, medium shrubs, tall shrubs, and bare soil around residences) were negatively associated with presence of larval habitats and were more distant from stream channels. Number of larval habitats declined exponentially with distance from streams. IKONOS imagery was not useful in direct detection of larval habitats because they were small and turbid (resembling bare soil), but was useful in localization of them through statistical associations with specific land covers. CONCLUSION: A supervised classification of land cover types in rural, lowland, western Kenya revealed a largely human-modified and fragmented landscape consisting of agricultural and domestic land uses. Within it, larval habitats of Anopheles vectors of human malaria were associated with certain land cover types, of largely agricultural origin, and close to streams. Knowledge of these associations can inform malaria control to gather information on potential larval habitats more efficiently than by field survey and can do so over large areas.

Toxicity of bloodmeals from ivermectin-treated cattle to Anopheles gambiae s.l.

Two anthelmintic drugs used as cattle dewormers, ivermectin and moxidectin, were tested for their lethal and sublethal effects on the malarial vectors Anopheles gambiae s.s. and An. arabiensis. In the laboratory, direct addition of ivermectin to bovine blood reduced the survivorship and fecundity of mosquitoes fed on the blood. The median lethal concentration (LC(50)) of ivermectin in the bloodmeal, for the laboratory populations of An. gambiae s.l., was 19.8 ppb. In the field, commercially available formulations containing ivermectin or moxidectin were injected into cattle at three times the recommended dose. Most (90%) of the An. gambiae s.s. that fed on the ivermectin-treated cattle within 2 weeks of treatment failed to survive more than 10 days post-bloodmeal. No eggs were deposited by An. gambiae s.s. that fed on ivermectin-treated cattle within 10 days of treatment. In contrast, the survivorship and egg production of the mosquitoes that fed on the moxidectin-treated cattle were no different from those feeding on untreated cattle. These results indicate that treatment of cattle with ivermectin could be used, as part of an integrated control programme, to reduce the zoophilic vector populations that contribute to the transmission of the parasites responsible for human malaria.

Designation of chemicals in terms of the locomotor responses they elicit from insects: an update of Dethier et al. (1960).

A scheme updating that of Dethier et al. (1960) (J. Econ. Entomol. 53: 134-136) for chemicals influencing insect locomotor behavior is introduced. Attractant, repellent, and arrestant retain their previous definitions. However, attractants or repellents are now recognized to operate both by kinetic and tactic mechanisms. Locomotor initiator is a new term for stimuli that activate normal levels of kinetic locomotion. Locomotor stimulant is reserved for activation of abnormally high kinetic locomotion, like that arising upon sublethal exposure to certain insecticides. The new terms engagent and disengagent apply to chemicals that, by their effects on locomotion, increase or decrease interaction with the source of stimulation, respectively. With these clarifications, insect behavioral terms unique to medical entomology but contradicting Dethier et al.'s classical scheme can be reconciled with the vocabulary of formal behavioral science.

Bacterial community structure in tree hole habitats of Ochlerotatus triseriatus: influences of larval feeding.

We investigated the bacterial community composition of tree holes in relation to the presence and absence of larvae of the mosquito Ochlerotatus triseriatus. Larvae were eliminated from a subset of natural tree holes with Bacillus thuringiensis serovar israelensis, and total bacterial numbers, slow- and fast-growing colony-forming units on minimal media, and 16S rRNA gene sequence data from water column and leaf material were obtained. Total bacterial counts did not change significantly with treatment; however, the number of slow-growing cultivable bacteria significantly increased in the absence of larvae. Sequence classifications and comparisons of sequence libraries using LIBSHUFF indicated that the elimination of larvae significantly altered bacterial community composition. Major groups apparently affected by larvae were Flavobacteriaceae, Rhodobacteraceae, Comamonadaceae, and Sphingomonadaceae. A clear dominance of Flavobacteriaceae in the water column after larval removal suggests members of this group are a major bacterial food source.

Conditioning of Leaf Detritus Modulates Density-Dependent Growth of Aedes triseriatus Larvae (Diptera: Culicidae).

Ration of food per capita of larval population is widely thought to limit mosquito production from container habitats, directly reflecting resource limitation. In this study, the importance of density-dependent resource limitation on larval Aedes triseriatus (Say) (Diptera: Culicidae) depended on the degree of microbial conditioning of senescent leaf detritus in surrogate tree holes. Density and ration strongly affected emergence, total female mass, and mean female mass of populations grown on leaves that had conditioned for 3 d, but had less impact when larval populations were grown on leaves that had conditioned for 1 mo. Ration per capita was a stronger predictor (50-94% of the variance) of all growth parameters measured for populations grown on leaves conditioned for 3 d compared with 1 mo (2-66% of variance), with the exception of development time. Larvae grew faster and to a larger body size on leaves conditioned for 3 d at low densities of larvae and a higher ration per capita. However, populations grown on leaves conditioned for 1 mo produced equal or more total mass and individuals of higher average mass than when grown on leaves conditioned for 3 d in treatments with low ration per capita. Well-conditioned detritus, representing the degree of microbial colonization of the organic material, must reflect the typical condition in tree holes with unconditioned leaves atypical. Therefore, results of this study suggest that experiments using well-conditioned leaves better estimate growth responses, including moderated density dependence and less importance of ration per capita, than experiments using unconditioned detritus.

Predicting West Nile Virus Infection Risk From the Synergistic Effects of Rainfall and Temperature.

Mosquito-based surveillance is a practical way to estimate the risk of transmission of West Nile virus (WNV) to people. Variations in temperature and precipitation play a role in driving mosquito infection rates and transmission of WNV, motivating efforts to predict infection rates based on prior weather conditions. Weather conditions and sequential patterns of meteorological events can have particularly important, but regionally distinctive, consequences for WNV transmission, with high temperatures and low precipitation often increasing WNV mosquito infection. Predictive models that incorporate weather can thus be used to provide early indications of the risk of WNV infection. The purpose of this study was first, to assess the ability of a previously published model of WNV mosquito infection to predict infection for an area within the region for which it was developed, and second, to improve the predictive ability of this model by incorporating new weather factors that may affect mosquito development. The legacy model captured the primary trends in mosquito infection, but it was improved considerably when calibrated with local mosquito infection rates. The use of interaction terms between precipitation and temperature improved model performance. Specifically, temperature had a stronger influence than rainfall, so that lower than average temperature greatly reduced the effect of low rainfall on increased infection rates. When rainfall was lower, high temperature had an even stronger positive impact on infection rates. The final model is practical, stable, and operationally valid for predicting West Nile virus infection rates in future weeks when calibrated with local data.

Canine surveillance system for Lyme borreliosis in Wisconsin and northern Illinois: geographic distribution and risk factor analysis.

A seroprevalence survey for Borrelia burgdorferi was conducted among the healthy canine pet population in selected counties of Wisconsin and northern Illinois to determine the distribution of Lyme disease and associated risk factors. Information obtained for each dog included place of residence, Lyme disease vaccination status, history of travel and tick exposure, signalment, and medical history. Serum samples were screened by enzyme-linked immunosorbent assay and confirmed by an immunoblot procedure. Seroprevalence by county ranged 0-40%, with the highest estimates from west-central Wisconsin. The spatial pattern was significantly correlated with human incidence of Lyme disease and with abundance of the tick vector, Ixodes scapularis. A geographic information system (GIS) was used to integrate environmental data with the location of the residences of the dogs to determine environmental risk factors. Seropositivity among dogs was positively associated with increased tick exposure and time spent outdoors and negatively associated with vaccination against Lyme disease. Seropositivity was also associated with living in forested and urban areas, and on sandy, fertile soils. A canine surveillance system is a useful method for assessing the geographic distribution of Lyme disease, and in combination with a GIS, it can be effective in determining environmental factors associated with I. scapularis endemicity.

Probable autochthonous Plasmodium vivax malaria transmission in Michigan: case report and epidemiological investigation.

In September 1995, a Michigan resident with no history of international travel was diagnosed with Plasmodium vivax infection, and local mosquito-borne transmission was suspected. An epidemiological investigation did not identify additional cases of local transmission, and there was no apparent link to the 12 imported malaria cases detected in the region. Potential sites of nighttime outdoor exposure included a campground in a swampy area, close to a racetrack frequented by international travelers, some of whom were known to come from countries with malaria transmission. Entomological investigation identified Anopheles spp. larvae and adults near the campsite. Summer temperatures 4.2 degrees C above average would have contributed to shortened maturation time of P. vivax within the insect vector, increasing the likelihood of infectivity. These investigations indicated that this patient probably acquired P. vivax infection through the bite of a locally infected Anopheles spp. mosquito. Physicians need to consider malaria as a possible cause of unexplained febrile illness, even in the absence of international travel, particularly during the summer months.

Highland malaria in Uganda: prospective analysis of an epidemic associated with El Niño.

Malaria epidemics in African highlands cause serious morbidity and mortality and are being reported more frequently. Weather is likely to play an important role in initiating epidemics but limited analysis of the association between weather conditions and epidemic transmission parameters has been undertaken. We measured entomological variables before and during an epidemic of malaria (which began in February 1998) in a highland region of south-western Uganda and analysed temporal variation in weather data against malaria incidence (estimated from clinic records), mosquito density and entomological inoculation rates (EIR). Indoor resting density of Anopheles gambiae s.l. was positively correlated with malaria incidence (r = 0.68, P < 0.05) despite extremely low vector densities. EIR totalled only 0.41 infectious bites per person during the entire 8-month study period. Rainfall during and following the El Niño event in 1997 was much higher than normal, and rainfall anomaly (difference from the mean) was positively correlated with vector density 1 month later (r = 0.55, P < 0.05). Heavier than normal rainfall associated with El Niño may have initiated the epidemic; the relationship between temperature and transmission parameters remains to be defined. The results from this study indicate that, in this highland population, epidemic malaria may occur at extremely low inoculation rates.

Bacterial enrichment in the surface microlayer of an Anopheles quadrimaculatus (diptera: culicidae) larval habitat.

Sampling of the surface microlayer of water in a marsh habitat of Anopheles quadrimaculatus Say in Michigan revealed it to be enriched with bacteria compared with subsurface water samples. Concentrations of total numbers of bacteria ranged from 18.8 x 10(6)/ml to 65.4 x 10(6)/ml (mean, 35.9 x 10(6)/ml; n = 13) in surface microlayer samples, and from 3.8 x 10(6)/ml to 14.3 x 10(6)/ml, (mean, 7.8 x 10(6)/ml; n = 13) in subsurface samples. Specifically, the surface microlayer had higher concentrations of three morphotypes of bacteria (cocci, rods, and rods attached to detritus particles). Given that bacteria are an important food of mosquito larvae, we suggest that the interfacial feeding behavior of An. quadrimaculatus larvae allows them to exploit the surface microlayer, a food-rich zone.

Behavior of larval Aedes triseriatus (Diptera: Culicidae).

The behavior of Aedes triseriatus (Say) fourth instars was studied in laboratory microcosms. A list of 14 larval behaviors was developed from observations of 108 larvae performing 1,836 different acts, and a time budget was developed from 88 larvae by recording the proportion of time each larva spent in the different behavioral states. Larval behavior was organized into clusters of surface and subsurface activities, linked by "dive" and "rise" behaviors. Eight behaviors formed the major activity pattern for larvae and dominated the time budget. Feeding behavior consisted of suspension feeding, feeding at the air-water interface, brushing container and leaf surfaces, and chewing leaf veins. Most (90.8%) of the time budget was devoted to feeding, and larvae spent 52.5% of their time feeding at or near the surface of the water and 37.5% brushing while submerged. When feeding at the air-water interface, larvae rotated about the axis formed by the respiratory siphon in alternating clockwise and counterclockwise directions, possibly to rest the muscles used to twist the larval body into the U-shaped posture characterizing this feeding behavior. Our studies showed that Ae. triseriatus larvae were not exclusively brushers nor bottom feeders as has been assumed for many Aedes larvae but showed great flexibility in feeding, where nearly the entire habitat was the "feeding zone."

Aedes triseriatus (Diptera: Culicidae) and La Crosse virus. IV. Nutritional deprivation of larvae affects the adult barriers to infection and transmission.

Groups of Aedes triseriatus (Say) were reared either as nutritionally deprived (two regimens) or well fed (one regimen) throughout larval development, and the vector competence of resulting small, normal, and large females was assessed for La Crosse virus. When fed a high dose of virus (4.6 log10/0.025 ml in Vero cell culture), 90% of small Ae. triseriatus females transmitted La Crosse virus to suckling mice compared with 70% of normal and 42% of large females. Among small females, 100% had disseminated infections as did 86% of normal females, whereas only 69% of large females had disseminated infections. All females had infected mesenterons (midguts). When fed a low dose of virus (2.2 log10/0.025 ml in Vero cell culture) in a second experiment, 15% of small females transmitted compared with 0% of large females; 50% of small females developed disseminated infections compared with 16% of large females. mesenteronal infection occurred in 70% of small but only 32% of large females. Electron microscopy of mesenteronal tissues from large and small females revealed physical differences in the basement membranes (basal laminae). The mesenterons of small females had 3-6 laminae (mean thickness of the basement membrane = 0.14 microns) compared with 9-16 laminae (mean thickness of the basement membrane = 0.24 microns) in large females. These morphological differences indicated that the mesenteronal escape barrier, which accounted for the difference in the percentage of small and large females with disseminated infections, may be, in part, a physical barrier that was modified by nutritional deprivation in the larval instars.

Early warning of malaria epidemics in African highlands using Anopheles (Diptera: Culicidae) indoor resting density.

Several highland regions of Africa recently have suffered malaria epidemics. Because malaria transmission is unstable and the population has little or no immunity, these highlands are prone to explosive outbreaks when densities of Anopheles exceed critical levels and conditions favor transmission. If an incipient epidemic can be detected early enough, control efforts may reduce morbidity, mortality, and transmission. Here we present three methods (direct, minimum sample size, and sequential sampling approaches) that could be used to determine whether the household indoor resting density of Anopheles gambiae s.I. has exceeded critical levels associated with epidemic transmission. Data on Anopheles density before, during, and after a malaria epidemic (December 1997-July 1998) in the highlands of southwestern Uganda were evaluated to demonstrate the application of these three approaches. During this epidemic, a density of 0.25 Anopheles mosquitoes per house was associated with epidemic transmission, whereas 0.05 mosquitoes per house was chosen as a normal level expected during nonepidemic months. The direct approach to calculating mean Anopheles density with an allowable error of 20-50% of the mean would require the sampling of 102-16 houses, respectively. In contrast, with only seven houses, the minimum sample size approach could be used to determine whether Anopheles density had exceeded the critical level. This method, however, would result in an overestimation of the risk of an epidemic at low Anopheles density. Finally, a sequential sampling plan could require as many as 50 houses to conclude that risk of an epidemic existed, but this disadvantage is offset by the ability to preset the probabilities of concluding that risk of an epidemic exists at both the critical and normal Anopheles densities. Our study illustrated that it is feasible, and probably expedient, to include monitoring of Anopheles density in highland malaria epidemic early warning systems.