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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. 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. 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. 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.

Abstract Background Directly 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. Methods We 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. Results Medication 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. Conclusions Video 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.

Contrary to the prevalent assumption that stringed instruments were absent from Phrygian music, tortoise-shell lyres excavated at Gordion show that such instruments were played in Phrygia during its heyday. Since the shells—or carapaces—are early and potentially the first from outside the Greek world, their identification is based on cautious analysis of worked edges, scrape marks, and a symmetrical pattern of drill holes that reveal details of the lyres’ construction and zoomorphic aesthetic. Two well-preserved examples from an abandonment deposit in the cellar of an extramural house on Gordion’s Northeast Ridge beneath Tumulus E can be dated stratigraphically to the first quarter of the seventh century B.C.E. This context of instruments and domestic artifacts preserves string music as the accompaniment to weaving, dining, and the worship of Matar (Cybele) in a prosperous household. These lyres clarify the musical culture of Anatolia, which is otherwise heavily abstracted in Greek myths and theoretical writings. Those instruments that Phrygia was best known for, the aulos and cymbals, are also materially and pictorially attested at Gordion, but the lyres expand the Phrygian soundscape to include a largely unknown polyphony. Additional figures can be found under this article’s abstract on AJA Online.

Although chronic pain (CP) is highly prevalent, current modalities are not sufficient to address the needs of people living with this condition. Pharmacological treatments for CP can have severe side effects and increased likelihood of patients overdosing or developing addiction. Behavioral treatments are often indicated for the treatment of CP, but barriers to treatment are common. Virtual reality (VR)-based interventions have shown promise as an effective and potentially accessible form of treatment for CP. However, previous research on VR interventions for people living with CP has not often included diverse populations, including racial and ethnic minority groups and people with low socioeconomic status. This study aimed to gauge the interest of patients with CP in participating in a hypothetical study of at-home VR for CP and to identify predictors of interest. Patients were recruited from a low socioeconomic and racially and ethnically diverse community. A total of 48 participants living with CP were recruited from an electronic medical record database, a research participant database, and a pain clinic, and they completed surveys about demographics, pain levels, technology use, and knowledge of VR. Bivariate testing was used to determine which, if any, of the aforementioned variables were associated with interest in a hypothetical study of at-home VR for CP. Stepwise logistic regression models predicting interest were built based on bivariate testing. Finally, we used a thematic analysis framework to analyze an additional open-ended question about reasons for interest in participating in a VR intervention for CP. Despite low technology use and little knowledge and experience with VR, results showed high interest (42/48, 88%) among patients in participating in a hypothetical study of at-home VR for CP. More frequent email use and using Facebook demonstrated nonsignificant trends toward interest in participating in a VR clinical trial for pain (P=.06 for email use and P=.06 for Facebook use). In stepwise multivariate models controlling for pain score, Facebook use was predictive of being somewhat or very interested in participating in a VR clinical trial for pain (P=.047). Open-ended responses tended to cite the novelty of VR and desperation for pain relief as reasons for participants' interest. We found high interest in participating in a clinical trial of VR despite low use of technology and low knowledge of VR. Future fully powered studies should seek to confirm the effectiveness of VR treatments for people with CP, especially people from lower socioeconomic, and racially and ethnically diverse backgrounds.

Reactivation of herpes zoster leading to disseminated and visceral organ involvement is an uncommon phenomenon and almost always associated with immunocompromised patients. Visceral herpes zoster is a challenging diagnosis to make as patients typically present with severe abdominal pain which precedes the typical rash of herpes zoster. We describe the case of a 68-year-old female who presented to the emergency department with abdominal pain and was subsequently diagnosed with disseminated herpes zoster and found to have underlying monoclonal gammopathy.

India accounts for nearly one-quarter of the global tuberculosis (TB) burden. Directly observed treatment (DOT) through in-person observation is recommended in India, although implementation has been heterogeneous due largely to resource limitations. Video DOT (vDOT) is a novel, smartphone-based approach that allows for remote treatment monitoring through patient-recorded videos. Prior studies in high-income, low disease burden settings, such as the United States, have shown vDOT to be feasible, although little is known about the role it may play in resource-limited, high-burden settings. The goal of the research was to assess the feasibility and acceptability of vDOT for adherence monitoring within a resource-limited, high TB burden setting of India. We conducted a prospective, single-arm, pilot implementation of vDOT in Pune, India. Outcome measures included adherence (proportion of prescribed doses observed by video) and verifiable fraction (proportion of prescribed doses observed by video or verbally confirmed with the patient following an incomplete/unverifiable video submission). vDOT acceptability among patients was assessed using a posttreatment survey. A total of 25 patients enrolled. The median number of weeks on vDOT was 13 (interquartile range [IQR] 11-16). Median adherence was 74% (IQR 62%-84%), and median verifiable fraction was 86% (IQR 74%-98%). More than 90% of patients reported recording and uploading videos without difficulty. We have demonstrated that vDOT may be a feasible and acceptable approach to TB treatment monitoring in India. Our work expands the evidence base around vDOT by being one of the first efforts to evaluate vDOT within a resource-limited, high TB burden setting. To our knowledge, this is the first reported use of vDOT in India.

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°14′ N), located ∼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°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°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.

A fire at Gordion ca. 800 B.C. preserved an ornate woven textile folded up in Megaron 3. A new visual reconstruction of this artifact from the Early Phrygian destruction level shows a complex composition combining slit-tapestry weaving and soumak wrapping. A unique find from Early Iron Age Anatolia, the textile shares geometric motifs and design elements with many other types of Phrygian artifacts, such as painted pottery, inlaid furniture, and a pebble mosaic, and shows weaving to have been part of the koine of geometric design of the era.