Despite growing interest in species' range shifts, little is known about the ecological and evolutionary factors that control geographic range boundaries. We investigated the processes that maintain the northern range limit of the mud fiddler crab (Uca pugnax) at North Scituate, Massachusetts, USA (42 degrees 14' N), located approximately 60 km north of Cape Cod. Larvae from five populations in Massachusetts were reared under controlled temperatures to test whether cooler water near the edge of this species' range inhibits planktonic development. Few larvae completed development at temperatures < 18 degrees C, a threshold that larvae would regularly encounter north of Cape Cod. Extensive salt marshes are present north of the current range boundary, and a transplant experiment using field enclosures confirmed that benthic fiddler crabs can survive severe winter conditions in this northern habitat. Taken with oceanographic data, these results suggest that the range boundary of fiddler crabs is likely maintained by the influence of cooler water temperatures on the larval phase. Analyses of mitochondrial DNA sequences from a neutral marker (COI) indicate high gene flow among U. pugnax populations in Massachusetts with little differentiation across Cape Cod. Consistent with predictions regarding the homogenizing influence of gene flow, larvae from source populations north and south of Cape Cod shared a common lower threshold for development. However, larvae produced near the range edge had faster growth rates than those from the south side of Cape Cod (typically reaching the final megalopal stage 1.0-5.5 d faster at 18 degrees C). Additional studies are needed to determine the mechanism underlying this counter-gradient variation in development time. We hypothesize that dispersal into cooler water on the north side of Cape Cod may act as a selection filter that sieves out slow developers from the larval pool by increasing planktonic duration and exposure to associated sources of mortality. Thus while high gene flow may prevent the evolution of greater cold tolerance in northern populations, recurrent selection on existing variation may lead to an unexpected concentration of favorable adaptations at the edge of the range. Such a pattern could permit edge populations to play a dominant and unrecognized role in future range extensions.

BackgroundDirectly observed therapy (DOT) remains an integral component of treatment support and adherence monitoring in tuberculosis care. In-person DOT is resource intensive and often burdensome for patients. Video DOT (vDOT) has been proposed as an alternative to increase treatment flexibility and better meet patient-specific needs.MethodsWe conducted a pragmatic, prospective pilot implementation of vDOT at 3 TB clinics in Maryland. A mixed-methods approach was implemented to assess (1) effectiveness, (2) acceptability, and (3) cost. Medication adherence on vDOT was compared with that of in-person DOT. Interviews and surveys were conducted with patients and providers before and after implementation, with framework analysis utilized to extract salient themes. Last, a cost analysis assessed the economic impacts of vDOT implementation across heterogeneous clinic structures.ResultsMedication adherence on vDOT was comparable to that of in-person DOT (94% vs 98%, P = .17), with a higher percentage of total treatment doses (inclusive of weekend/holiday self-administration) ultimately observed during the vDOT period (72% vs 66%, P = .03). Video DOT was well received by staff and patients alike, who cited increased treatment flexibility, convenience, and patient privacy. Our cost analysis estimated a savings with vDOT of $1391 per patient for a standard 6-month treatment course.ConclusionsVideo DOT is an acceptable and important option for measurement of TB treatment adherence and may allow a higher proportion of prescribed treatment doses to be observed, compared with in-person DOT. Video DOT may be cost-saving and should be considered as a component of individualized, patient-centered case management plans.

Introduction Geographic Information Systems (GIS) and spatial analysis are emerging tools for global health, but it is unclear to what extent they have been applied to HIV research in Africa. To help inform researchers and program implementers, this scoping review documents the range and depth of published HIV-related GIS and spatial analysis research studies conducted in Africa. Methods A systematic literature search for articles related to GIS and spatial analysis was conducted through PubMed, EMBASE, and Web of Science databases. Using pre-specified inclusion criteria, articles were screened and key data were abstracted. Grounded, inductive analysis was conducted to organize studies into meaningful thematic areas. Results and discussion The search returned 773 unique articles, of which 65 were included in the final review. 15 different countries were represented. Over half of the included studies were published after 2014. Articles were categorized into the following non-mutually exclusive themes: (a) HIV geography, (b) HIV risk factors, and (c) HIV service implementation. Studies demonstrated a broad range of GIS and spatial analysis applications including characterizing geographic distribution of HIV, evaluating risk factors for HIV, and assessing and improving access to HIV care services. Conclusions GIS and spatial analysis have been widely applied to HIV-related research in Africa. The current literature reveals a diversity of themes and methodologies and a relatively young, but rapidly growing, evidence base.