Internal and external rotation of the shoulder is often challenging to quantify in the clinic. Existing technologies, such as motion capture, can be expensive or require significant time to setup, collect data, and process and analyze the data. Other methods may rely on surveys or analog tools, which are subject to interpretation. The current study evaluates a novel, engineered, wearable sensor system for improved internal and external shoulder rotation monitoring, and applies it in healthy individuals. Using the design principles of the Japanese art of kirigami (folding and cutting of paper to design 3D shapes), the sensor platform conforms to the shape of the shoulder with four on-board strain gauges to measure movement. Our objective was to examine how well this kirigami-inspired shoulder patch could identify differences in shoulder kinematics between internal and external rotation as individuals moved their humerus through movement patterns defined by Codman’s paradox. Seventeen participants donned the sensor while the strain gauges measured skin deformation patterns during the participants’ movement. One-dimensional statistical parametric mapping explored differences in strain voltage between the rotations. The sensor detected distinct differences between the internal and external shoulder rotation movements. Three of the four strain gauges detected significant temporal differences between internal and external rotation (all p < .047), particularly for the strain gauges placed distal or posterior to the acromion. These results are clinically significant, as they suggest a new class of wearable sensors conforming to the shoulder can measure differences in skin surface deformation corresponding to the underlying humerus rotation.

Background: In spring 2021, the infection prevention and control department at a pediatric academic medical center identified 3 oncology patients with concern for invasive Rhizopus spp infections. An in-depth investigation was conducted, but a common source of the fungus was not identified. In August 2021, an additional oncology patient with concern for invasive Rhizopus spp was identified, resulting in an extended investigation for possible sources of fungus. Methods: A multidisciplinary work group was assembled. The CDC Targeted Environmental Investigation Checklist for Outbreaks of Invasive Infections Caused by Environmental Fungi was used as a framework for conducting the investigation. Stakeholders were engaged throughout the process, including the hematology–oncology service, hospital leadership, environmental services, patient safety and quality, and facilities and engineering. The investigation included hospital incident command system (HICS) activation; visual inspection of patient rooms and common spaces; heating, ventilation, and air conditioning (HVAC) review; environmental sampling (surfaces, linen, and air); chart review; and process mapping. Results: By early October 2021, 2 environmental samples grew isolates (each at 1 CFU/m3) of the same species of Rhizopus as one of the affected patients. One sample was from a patient room, and the other from an outdoor garden space. No source of indoor amplification of Rhizopus was identified. The investigation revealed several opportunities for improvement: annual room maintenance schedules, use of gardens and outdoor spaces by at-risk patients, linen storage, construction and/or infection control risk assessment (ICRA) processes, and appliances used by families (eg, washing machines and refrigerators). Work streams were established to address each of these areas. Conclusions: No definite source was identified for the 4 invasive Rhizopus spp infections. This extensive investigation highlighted multiple opportunities for improvement; the changes implemented may prevent future invasive fungal infections in high-risk pediatric patients.

Funding: None

Disclosures: None

Brain metastases (BM) are the most common intracranial neoplasm and represent a major clinical challenge across many medical disciplines. The incidence of BM is increasing, largely due to improvements in primary disease therapeutics conferring greater systemic control, and advancements in neuroimaging techniques and availability leading to earlier diagnosis. In recent years, the landscape of BM treatment has changed significantly with the advent of personalized targeted chemotherapies and immunotherapy, the adoption of focal radiotherapy (RT) for higher intracranial disease burden, and the implementation of new surgical strategies. The increasing permutations of options available for the treatment of patients diagnosed with BM necessitate coordinated care by a multidisciplinary team. This review discusses the current treatment regimens for BM as well as examines the salient features of a modern multidisciplinary approach.

We present Phantom, a fast, parallel, modular, and low-memory smoothed particle hydrodynamics and magnetohydrodynamics code developed over the last decade for astrophysical applications in three dimensions. The code has been developed with a focus on stellar, galactic, planetary, and high energy astrophysics, and has already been used widely for studies of accretion discs and turbulence, from the birth of planets to how black holes accrete. Here we describe and test the core algorithms as well as modules for magnetohydrodynamics, self-gravity, sink particles, dust–gas mixtures, H2 chemistry, physical viscosity, external forces including numerous galactic potentials, Lense–Thirring precession, Poynting–Robertson drag, and stochastic turbulent driving. Phantom is hereby made publicly available.

Purpose: We identified key clinicopathologic features of brain metastasis (BM) patients who are long-term survivors (LTS). Methods: We screened a prospective database of 1892 patients (treated 2006-2017), identified 92 (5%) who lived > 3 years following BM diagnosis, and performed per patient analyses. Results: Median age at diagnosis of BM was 57 years (range 19-77), 77% were women. The most common tumors were lung (50%), breast (26%), thyroid (7%) and skin (5%). 42% had tumors with drug-targetable oncoproteins (e.g. EGFR mutant) and 15% expressed hormonal receptors. ECOG was <2 in 70%. 47% had stage IV disease at diagnosis (75% with brain as the first site). 55% had controlled extracranial disease at the time of BM diagnosis. Median BM diameter was 1.5 cm (range 0.2-7) and 62% had a single lesion. Treatment was with surgery, radiosurgery, whole brain radiation (WBRT), or systemic therapy alone in 38%, 62%, 52%, and 4%, respectively. 53% received targeted- or immuno-therapy. Median follow up was 63 months (range 36-113). 61% failed intracranially at a median 24 months (range 1-99). 5 and 10- year survival (from BM diagnosis) was 82%, and 34%, respectively. Neither upfront WBRT nor other variables tested correlated with improved survival. In patients who died, an MRI was available within 3 months from death in 57%; of those 55% had no active intracranial disease, suggesting that the majority of deaths were non-neurologic. Conclusion: In general, LTS of BM had a limited number of BM, inactive extracranial disease, and drug targetable mutations.

OBJECTIVES/SPECIFIC AIMS: High-sensitivity diagnostics for early infant diagnosis (EID) of HIV at the point of care (POC) are not widely available. Lateral flow immunoassays (LFA) can detect HIV-p24, but are not sensitive enough in practice. With improvements, LFA are a compelling platform for POC in EID. We used functionalized magnetic beads and immunocomplex dissociation to improve sensitivity of HIV-p24 LFA. Here, we evaluate the utility for LFA to quantitatively report HIV-p24 concentration and estimate HIV viral load. Using purified p24 protein and virion constructs, we determined the limits of detection for HIV-p24 using LFA rapid tests. Using measurements from HIV-p24 ELISA, laboratory-developed RT-qPCR, droplet digital PCR, and gold standard clinical viral load, we further characterized the relationship between HIV-p24 concentration, HIV genomic RNA, and LFA test line signal. METHODS/STUDY POPULATION: We measured HIV-p24 concentration by ELISA (R&D Systems) and LFA (Alere Determine HIV-1/2 Ab/Ag Combo). An LFA reader instrument was used to image test lines and measure test line signal on the LFA. HIV viral loads were measured using RT-qPCR and droplet digital RT-PCR protocols adapted in our lab. We obtained gold standard viral load measurements using the Roche Cobas TaqMan system at Vanderbilt University Medical Center. Data analysis was performed using Prism 7 and Stata 14. RESULTS/ANTICIPATED RESULTS: LFA test line signal increases in a predictable, dose-dependent manner and correlates with concentration of purified HIV-p24 with a linear range between 50 and 1000 pg/mL (Spearman r=1; p=0.0004). We compared p24 concentration (ELISA). We evaluated the utility of LFA to quantify HIV-p24 from virions suspended in human plasma, which increased the limit of detection for HIV-p24 to 100 pg/mL and shifted the linear range 100–10,000 pg/mL (Spearman r=0.77; p<0.001). To evaluate the relationship between HIV-p24 concentration and concentration of HIV RNA, we employed 3 molecular techniques. The LFA is capable of detecting HIV-p24 concentrations that correspond to a range of viral loads between 653,000 and 1655 copies of viral RNA/mL. DISCUSSION/SIGNIFICANCE OF IMPACT: Our preliminary results are very promising, indicating that commercially available LFA can quantitatively measure HIV-p24 concentration to low levels. When coupled with our analysis of the relationship between HIV-p24 concentration and HIV RNA concentration, LFA may be a potential platform allowing us to estimate HIV viral burden at clinically relevant levels. Our next steps will be to evaluate this relationship in primary, clinical specimens in collaboration with the Tennessee Center for AIDS Research. We will incorporate technologies to improve the sensitivity of these LFA and evaluate their performance in field settings in Zambia. Our findings are broadly applicable for use in HIV care and treatment programs and early infant diagnosis programs around the world.

There has been an effective movement afoot in the Republic of Guinea to improve the climate of study and research for local and foreign scholars alike. The most obvious physical evidence of this is the dramatically improved archival facility in Conakry. In April 1991 Les Archives Nationales du Guinée began moving into an entirely new, specially constructed building next to the Ministère de la Jeunesse, des Arts, de la Culture et des Sports. By the summer of 1992, the lengthy process of settling into the building's 1600 square meters appeared to be complete.

This is a modern, well-equipped facility, organized and administered by trained Guinean archivists who are appropriately concerned with preservation of resources. A tour of some of the main archival storage areas revealed a large collection of bound, well-preserved documents. According to the Associate Director, Seydouba Cissé, there are five such climate-controlled rooms, containing a total of 5,000 meters of metal shelving. According to the personnel list there are two conservators on the staff. At their disposal is a studio for restoration and a room for cleaning books and documents. There is also a microfilm room (I did not have time to examine this collection), and a microfilm reading machine. In the summer of 1992 photocopying was readily available at a reasonable price per page. The card catalog in the air-conditioned reading room was in fairly good order, though some student mémoires (see below) were filed under categories inconsistent with their titles.

Some scholars interested in ancient Ghana and Mali dare to sift relevant oral traditions of the Western Sudan in search of historical evidence, while others express doubts that these sources can contain any information of value to historians. A period markedly affected by this question is that which saw the disintegration of Ghana and the rise of Mali in the twelfth and thirteenth centuries. Despite historians' general acknowledgement of the pitfalls accompanying the use of oral tradition as a source of information, much of what we know, or would like to think we know about this era, has been drawn from the legend of Wagadu and from the Sunjata epic.

Clearly a large part of the material in these oral traditions is composed of the stuff of myth and folktale, and on the face of it the prospect of trying to glean historical information from them is not an encouraging one. But woven into the patchwork fabric of these narratives are infrequent threads bearing diminishing echoes of people and events of the distant past. Vague, inaccurate, and potentially misleading as they must be, these archaic fragments nevertheless merit whatever attention is necessary to interpret their significance, in the hope that they might yield some useful historical insights.

Any pretensions to historicity in the Wagadu tradition and in the Sunjata epic may be open to question because there is so little that can be verified. While the mythical quality of some elements in the texts is obvious, there are others that could have a historical basis but cannot be independently confirmed. The material consulted here is approached with the attitude that, given the rarity of firmly documented sources, historians cannot afford to ignore the possibility that there is some information worth distilling from the oral accounts of ancient Mali and the related Soninke era that preceded it.

“An only son must never die in war until the end of the world.”

(Seydou Camara, “Bilali of Faransekila,” 1:396)

Discussing the significance of Kande Kamara's oral history of West African experiences in the First World War, Joe Harris Lunn observes that, although historians have begun to examine the effects of that war on west Africa, their studies are mostly based on written sources, “and therefore shed little light on the lived reality of the war for the African masses whose perceptions of their experiences were never recorded.” Of particular value then, is the oral history provided by the Guinean veteran Kande Kamara, offering as it does an opportunity for assessing the European war's impact on west Africans. Lunn finds, however, that west African soldiers who served in France during the First World War have left very few records of either their wartime experiences or its effects on their later lives. The text by the late Malian hunters' singer Seydou Camara that is presented here helps to redress this lamentable deficiency because, although it is a step or two removed from the sort of firsthand eyewitness account offered by Kande Kamara, it provides valuable support for and confirmation of certain elements of Kande Kamara's testimony. Composed and sung by Seydou Camara, “Bilali of Faransekila” provides us with an oral traditional counterpart to Kande Kamara's firsthand account.

We first conceived of this study several years ago, when our respective lines of research seemed to some extent to converge on the period of the decline of ancient Ghana. It has proved a more complex matter than we imagined, or than the deceptively simple title above might suggest--partly because it is often more difficult to prove that something did not happen than that it did. We have had to divide our analysis into two parts. First we examine the external written sources for the Almoravid conquest of Ghana. Our work in this respect has been immensely facilitated by the appearance in 1975 of Cuoq's Recueil des sources arabes, which in some sense provides the infrastructure for our argument. We have also had the invaluable privilege of seeing in proof Hopkins' and Levtzion's Corpus of early Arabic sources. In the second half of our study, it will be the turn of internal sources, mainly oral traditions. We use the terms external and internal advisedly, since the simple distinction between written sources and oral traditions is too artificial: an oral tradition was an oral tradition, whether written down in Arabic in the Middle Ages or in French in this century, and a great deal of the information in both parts of our article must have started as oral tradition.

Putting it very bluntly, we have discovered no sources, whether external or internal, which unambiguously point to such a conquest. A handful of sources suggest some link between the rise of the Almoravids and the decline of Ghana, but with a puzzling vagueness--a vagueness which decreases as the number of centuries between the alleged event, and the report of it increases.

That is why, regarding the time between the death of one great king and the rise of another king made famous by God, If you ask whether in that intervening period there were other kings, Of course there were, But their names are not known.

Some scholars search for historical evidence in the ancient traditions preserved by bards of the Western Sudan, while other writers express doubts that these sources can contain any information of value to historians. A period markedly affected by this question is the early thirteenth century, because it was then that the Mali empire was established, and because most of the evidence for this is derived from the Sunjata tradition, which is an essential part of the repertoire of many Mande bards (also known as “griots” or, in the Mande language, jeliw). A limited amount of information on thirteenth-century Mali is available from Arabic sources, but these were written a century to a century and a half after the reign of Sunjata, and although Ibn Khaldun confirms the existence of the famous mansa and reports that he subdued the Soso (Susu, Sosso), the external writings provide no biographical details about the purported empire-builder. Conversely, some episodes in the internal oral accounts are specifically addressed to the life and times of Sunjata, with elements from other time periods—some of which are identifiable and others not—regularly creeping in and out of the narratives. Some themes are obviously mythical, while others could have a historical basis but cannot be independently confirmed. Thus, any historian addressing thirteenth-century Mali must either accept the severe limitations of the external written sources and say very little indeed about that period, or face the difficulties involved in supplementing these with references to the oral sources.

Before departing for Mali, researchers should write a formal request for permit to conduct research to: Ministre de l'Enseignement Supérieur et de la Recherche Scientifique, Bamako. A second letter should be sent to M. Mamadou Sarr, Chef de la Division de Recherche Scientifique, B.P. 159, Bamako, advising him that the first letter has been written and stating both the research topic and the anticipated duration of the research trip.

Once in Bamako (if permission is granted), the “Autorisation de Recherche” can be obtained from M. Sarr, whose office is in the Ministry of Education Building on the Place de la Liberté. If this can be done within the first few days after arrival and before expiration of the temporary visa, the research authorization can simplify the visa renewal process at the Direction des Services de Sécurité. Authorization for access to the Archives Nationales du Mali requires a separate application, which also is issued by M. Sarr and can be applied for at the same time as the general authorization.

Every researcher is required to work under the aegis of the Institut des Sciences Humaines, of which M. Sarr is director. Those intending to do field work are assigned an I.S.H.M. “technician” who may have some background in the subject and can also be helpful in contacting informants. In principle, the technician is supposed to accompany the investigator on all field trips, and the investigator is expected to pay the technician's transportation costs, food, and lodging, as well as 2,000 Malien francs (about $5.00) per diem.

In Part I of this paper we examined the external written sources and found no unambiguous evidence that an Almoravid conquest of ancient Ghana ever occurred. The local oral evidence reviewed in this part of our study supports our earlier hypothesis, in that we find nothing in the traditions to indicate any conquest of the eleventh-century sahelian state known to Arab geographers as “Ghana.” Instead, the oral traditions emphasize drought as having had much to do with the eventual disintegration of the Soninke state known locally as “Wagadu.”

An immediate problem involved in sifting the oral sources for evidence of an Almoravid conquest is that a positive identification between the Wagadu of oral tradition and the Ghana of written sources has never been established. Early observers like Tautain (1887) entertained no doubts in this regard, and recently Meillassoux seems to have accepted a connection, if not an identification, between Ghana and Wagadu when he notes that “les Wago, dont le nom a donné Wagadu, sont les plus clairement associés à l'histoire du Ghana.” However, much continues to be written on the subject, and the question remains a thorny one. On the lips of griots (traditional bards) and other local informants, Wagadu is a timeless concept, so a reliable temporal connection between people and events in the oral sources on one hand and Ghana at the time of the Almoravids on the other, is particularly elusive. Indeed, any link between the traditions discussed here and a specific date like 1076 must be regarded as very tenuous, as must any association of legendary events with Islamic dates. In western Sudanic tradition influenced by Islam, the hijra (A.D. 622) is both prestigious and convenient, a date with which virtually any event in the remote past can be associated, though such a claim may have nothing to do with any useful time scale.

The basic purpose here is to offer an archival report about historical and ethnographic material collected partly in Mali but mostly in Guinea, when such efforts in the latter country were contrary to official government policy and in some cases could be hazardous to undertake. Owing to the risks involved in some intellectual activities in Guinea between 1958 and 1984, as well as the importance of the material recorded on reel-to-reel tapes in this archive, the research accomplished by Djibril Tamsir Niane in the 1960s that culminated in the 1969-1971 expeditions to Baga villages, was itself historically significant. Moreover, the fact that once the research had been done the recorded information survived ensuing decades of potentially destructive climatic conditions and political events is remarkable. Therefore, as a prologue to introducing the archival material in the process of preservation at the time of this writing, it seems appropriate to begin this report with a description of the circumstances under which the recordings were made and how they survived to the present day.

Abstract. Theories of radicalization make implicit predictions about variation among attitudes in the communities from which radicals are drawn. This article subjects some popular theories to empirical testing. The precise process by which individuals come to sympathize with, provide material support for or actually engage in political violence is fully comprehensible only by longitudinal analysis, but much existing work tries to reconstruct the process by looking only at one part of its outcomes: those who have become radicalized. The result is a large number of theories and mechanisms, with little compelling empirical support. A cross-sectional snapshot of an at-risk community cannot definitively support a particular theory of radicalization, but it can rule out those whose predictions about attitudes are at variance with the empirical observations. We designed a survey instrument to measure attitudes to issues widely believed to be relevant to radicalization and deployed it among Muslim communities in Ottawa. The results are remarkably inconsistent with patterns of variation in attitudes predicted by popular theories of radicalization. Instead, they show variation of attitudes along three independent dimensions: social/economic/political satisfaction/dissatisfaction, moral/religious satisfacton/dissatisfaction, and a dimension that appears to be associated with radicalization. This suggests that governments may have less policy leverage to mitigate radicalization than generally supposed.

Résumé. Les théories de la radicalisation font des prévisions implicites quant à la variation parmi les attitudes au sein des communautés dont les radicaux sont issus. Cet article soumet quelques unes des théories populaires à une vérification empirique. Le processus précis par lequel des individus sympathisent avec, appuient ou s'engagent dans la violence politique ne peut être complètement saisi que par une analyse longitudinale, bien qu'une bonne partie de la recherche à date essaie de reconstruire le processus en regardant seulement une partie de ces résultats : ceux qui sont devenus radicalisés. En conséquence, un grand nombre de théories et de mécanismes sont soutenus par peu de preuve empirique. Un aperçu transversal d'une communauté à risque ne peut pas confirmer une théorie particulière de radicalisation, mais il peut éliminer celles dont les prévisions ne se conforment pas aux observations empiriques. Nous avons conçu un instrument de sondage pour mesurer des attitudes envers des enjeux qui sont largement perçus comme se rapportant à la radicalisation et nous l'avons administré au sein de communautés musulmanes à Ottawa. Le désaccord entre les résultats et les variations des attitudes postulées par les théories de la radicalisation est remarquable. Les résultats manifestent davantage une variation des attitudes autour de trois dimensions indépendantes : l'in/satisfaction sociale/économique/politique, l'in/satisfaction morale/religieuse ainsi qu'une dimension qui semble être liée à la radicalisation. Il s'ensuit que les politiques publiques risquent d'être moins utiles aux gouvernements pour atténuer la radicalisation que ce qui est généralement supposé.