Research Blog

Following the people and events that make up the research community at Duke

Child Protective Services Do Work, But They Are Unevenly Distributed

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Roughly one in seven  New York City children suffer confirmed mistreatment at home and many are placed in foster care. But relatively few children are permanently separated from their parents by the termination of parental rights, according to new research from Duke University and Rutgers University-Newark.

The data points to a relative success story in the world of child welfare, said Chris Wildeman, a Duke University sociologist and co-author of the research. In New York City, child welfare specialists intervene often in abuse and neglect cases but are often able to avoid terminating parental rights, even when they do remove the child from the home, Wildeman added.

Wildeman’s co-authors are Kieran Healy, a Duke sociologist, and Frank Edwards and Sara Wakefield from the School of Criminal Justice at Rutgers University – Newark.

In New York City, roughly two in five children will be involved in an investigation by their local child protective services office; one in seven will experience confirmed maltreatment, one in 35 will be placed in foster care. (Dallas Clemons)

“I think the core takeaway there is that New York is the prime example of taking maltreatment seriously and intervening as a system,” Wildeman said. “But also taking seriously the idea that permanent termination of parental rights totally closes off any chance for family reunification, so only doing it in the most extreme circumstances.”

The peer-reviewed study, appearing the week of July 19 in the Proceedings of the National Academy of Sciences, derives from an analysis of child welfare data from the nation’s 20 most populous counties. (The New York data is from all five boroughs because the entire city’s child welfare system is under a single governing umbrella)

The study looked at how often children were the subject of a child services investigation; suffered confirmed mistreatment, were placed in foster care, and removed permanently from their homes through the termination of parental rights.

Nationally, roughly one in three children will be involved in an investigation by their local child protective services office; one in eight will experience maltreatment, one in 17 will be placed in foster care and one in 100 will have parental rights terminated, according to the study.

In New York City, roughly two in five children will be involved in an investigation by their local child protective services office; one in seven will experience confirmed maltreatment, one in 35 will be placed in foster care and one in 600 will have parental rights terminated, according to the study.

Nationally, one in 100 parents will have their rights terminated, while in New York that figure is one in 600. (Dallas Clemons)

“The system is functioning more the way many child welfare advocates would like it to function,” Wildeman said. “Make sure you identify maltreatment, but attempt to use services rather than foster care treatment, at least initially, and then only terminating parental rights in only the most extreme circumstances. And trying to be aware of racial disparities in those processes.”

CITATION:  “Contact with Child Protective Services is Pervasive but Unequally Distributed by Race and Ethnicity in Large US Counties,” PNAS, July 19, 2021. DOI: 10.1073/pnas.2106272118

Post by Eric Ferreri , Duke University Communications

In the World Capital of Vanilla Production, Nearly Three out of Four Farmers Say They Don’t Have Enough to Eat

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A new study investigates why and what they can do about it

Madagascar, famous for its lemurs, is home to almost 26 million people. Despite the cultural and natural riches, Madagascar is one of the poorest countries in the world. Over 70% of Malagasy people are farmers, and food security is a constant challenge. Rice is the most important food crop, but lately an internationally-prized crop has taken center stage: vanilla. Most of the world’s best quality vanilla comes from Madagascar. While most Malagasy farmers live on less than $2 per day, selling vanilla can make some farmers rich beyond their dreams, though these profits come with a price, and a new study illustrates it is not enough to overcome food insecurity.

In a paper published June 25, 2021 in the journal Food Security, a team of scientists collaborating between Duke University and in Madagascar set out to investigate the links between natural resource use, farming practices, socioeconomics, and food security. Their recently published article in the journal Food Security details intricate interactions between household demographics, farming productivity, and the likelihood of experiencing food shortages.

Vanilla beans, Wikimedia Commons

The team interviewed almost 400 people in three remote rural villages in an area known as the SAVA region, an acronym for the four main towns in the region: Sambava, Andapa, Vohemar, and Antalaha. The Duke University Lemur Center has been operating conservation and research activities in the SAVA region for 10 years. By partnering with local scientists, the team was able to fine-tune the way they captured data on farming practices and food security. Both of the Malagasy partners are preparing graduate degrees and expanding their research to lead the next generation of local scientists.

Farmers harvesting the rice fields in Madagascar. Credit: Wikimedia Commons.

The international research team found that a significant proportion of respondents (up to 76%) reported that they experienced times during which did not have adequate access to food during the previous three years. The most common cause that they reported was small land size; most respondents estimated they owned less than 4 hectares of land (<10 acres), and traditional farming practices including the use of fire to clear the land are reducing yields and leading to widespread erosion. The positive side is that the more productive the farm, especially in terms of rice and vanilla harvests, the lower the probability of food insecurity. There was an interaction between rice and vanilla harvests, such that those farmers that produced the most rice had the lowest probability of food insecurity, even when compared to farmers who grew more vanilla but less rice. Though vanilla can bring in a higher price than rice, there are several factors that make vanilla an unpredictable crop.

The vanilla market is subject to extreme volatility, with prices varying by an order of magnitude from year to year. Vanilla is also a labor- and time-intensive crop; it requires specific growing conditions of soil, humidity, and shade, it takes at least 3 years from planting to the first crop. Without the natural pollinators in its home range of Mexico, Malagasy vanilla requires hand pollination by the farmers, and whole crops can be devastated by natural disasters like disease outbreaks and cyclones. Further, the high price of vanilla brings with it ‘hot spending,’ resulting in cycles of boom and bust for impoverished farmers. Because of the high price, vanilla is often stolen, which leads farmers to spend weeks in their fields guarding the vanilla from thieves before harvesting. It also leads to early harvests, before the vanilla beans have completely ripened, which degrades the quality of the final products and can exacerbate price volatility.

In addition to the effects of farming productivity on the probability of food insecurity, the research revealed that household demographics, specifically the number of people living in the household, had an interactive effect with land size. Those farmers that had larger household sizes (up to 10 in this sample) had a higher probability of experiencing food insecurity than smaller households, but only if they had small landholdings. Those larger families that had larger landholdings had the lowest food insecurity. These trends have been documented in many similar settings, in which larger landholdings require more labor, and family labor is crucial to achieving food sovereignty.

The results have important implications for sustainable development in this system.  The team found that greater rice and vanilla productivity can significantly reduce food insecurity. Therefore, a greater emphasis on training in sustainable, and regenerative, practices is necessary. There is momentum in this direction, with new national-level initiatives to improve rice production and increase farmers’ resilience to climate change. Further, many international aid organizations and NGOs operating in Madagascar are already training farmers in new, regenerative agriculture techniques. The Duke Lemur Center is partnering with the local university in the SAVA region to develop extension services in regenerative agriculture techniques that can increase food production while also preserving and even increasing biodiversity. With a grant from the General Mills, the Duke Lemur Center is developing training modules and conducting workshops with over 200 farmers to increase the adoption of regenerative agriculture techniques.

Further, at government levels, improved land tenure and infrastructure for securing land rights is needed because farmers perceive that the greatest cause of food insecurity is their small landholdings. Due to the current land tenure infrastructure, securing deeds and titles to land is largely inaccessible to rural farmers. This can lead to conflicts over land rights, feelings of insecurity, and little motivation to invest in more long-term sustainable farming strategies (e.g., agroforestry). By improving the ability of farmers to secure titles to their land, as well as access agricultural extension services, farmers may be able to increase food security and productivity, as well as increased legal recognition and protection.

To move forward as a global society, we must seek to achieve the United Nation (UN) Sustainable Development Goals (SDGs). One of the SDGs is Goal #2, Zero Hunger. There are almost one billion people in the world who do not have adequate access to enough safe and nutritious food. This must change if we expect to develop sustainably in the future. Focusing on some of the hardest cases, Madagascar stands out as a country with high rates of childhood malnutrition, prevalence of anemia, and poverty. This year, more than one million people are negatively impacted by a three-year drought that has resulted in mass famine and a serious need for external aid. Sadly, these tragedies occur in one of the most biodiverse places on earth, where 80-90% of the species are found no where else on earth. This paradox results in a clash between natural resource conservation and human wellbeing.

Achieving the UN’s SDGs will not be easy; in fact, we are falling far short of our targets after the first decade. The next ten years will determine if we meet these goals or not, and our collective actions as a global society will dictate whether we transform our society for a sustainable future or continue with the self-destructive path we have been following. Further research and interventions are still needed to conserve biodiversity and improve human livelihoods.

Learning Something Surprising About “SuperLearners”

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The discovery of a signaling pathway in the brain that could make mice into ‘superlearners’ understandably touched off a lot of excitement a few years back.

But new work led by Duke neurologist and neuroscientist Nicole Calakos MD PhD suggests there’s more to the story of the superlearner chemical pathway than anybody realized.

A genetically-enhanced ‘smart mouse’ doing some important work. (Boston University)

In a study led by postdoctoral researchers Ashley Helseth and Ricardo Hernandez-Martinez,  the Calakos lab developed a new tool to visualize activity of this Integrated Stress Response (ISR) signaling pathway because it contributes to synaptic plasticity – the brain’s ability to rewire circuits – as well as to learning and memory.

What they didn’t expect to see is that a population of cells called cholinergic interneurons, which comprise only 1 or 2 percent of the whole basal ganglia structure, seem to have the ISR pathway working all the time. The basal ganglia, which is the focus of much of Calakos’ work, plays a role in Parkinson’s and Huntington’s diseases, Tourette’s syndrome, obsessive compulsive disorder and more.

Nicole Calakos, the Lincoln Financial Group distinguished professor of Neurobiology and Neurology. (Alex Boerner)

“This totally changes how you think about the pathway,” Calakos said. “Everybody thought this pathway used an on-demand response type of mechanism, but what if some cells needed it for their everyday activities?”

To answer this, they blocked the ISR in just those rare interneurons in mice and it actually reproduced the enhanced performance on learned tasks that the earlier studies had shown when the pathway was blocked universally throughout the brain. This finding focuses attention on this select subset of brain cells, the cholinergic interneurons that release the chemical signal acetylcholine, as being responsible for at least some of the ‘superlearner’ behavior.

Since the integrated stress response pathway and its potential to enhance learning and memory was identified, drugs for dementia and traumatic brain injury are being designed to manipulate it and help the brain recover. But there may be more to the story than anyone realized, Calakos said.

“Our results show that the ISR plays a major role in acetylcholine-releasing cells, and our current best dementia drugs boost acetylcholine,” she said.

With their new tool, SPOTlight, the team were able to highlight the presence of cholinergic interneurons (red) which are only 1 to 2 percent of the cell population in the ganglia. (Helseth et al)

Acetylcholine, the chemical that these rare cholinergic interneurons use to signal in the brain, is well known for its powerful effects on influencing brain states for attention and learning. This finding suggests that at least some of the ‘superlearner’ properties of inhibiting the ISR occur by influencing brain state, rather than acting directly in the cells that are being rewired during learning.

In addition to the full research article, Science published on April 23 an article summary by Helseth and Calakos and a perspective piece by a pair of University of Minnesota neuroscientists highlighting the finding’s importance.

More work is required to sort out what ISR is and is not doing, but it’s possible that these new findings can help to develop “more precise, more nuanced Alzheimer’s drugs,” Calakos said.

Post by Karl Leif Bates

Survival of the… Friendliest?

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Chances are, you’ve heard about survival of the fittest. But what about survival of the friendliest? While we often think that the strongest, meanest, and most powerful organisms often prevail as the most fit, it seems that friendship bears the real evolutionary winners.

Brian Hare (Ph.D.) and Vanessa Woods (M.SciComm) are the researcher and co-author duo responsible for shaping this idea in their latest book, Survival of the Friendliest. On top of this extensive collaboration, the pair also happen to be married. The two discussed their work at an event series hosted by Duke Alumni Forever Learning Institute Wednesday, April 21st and Thursday, April 22nd.  Hare is a Professor of Evolutionary Anthropology, Psychology, and Neuroscience at Duke and a core member of the Center for Cognitive Neuroscience. Woods is the Director of the Duke Puppy Kindergarten, as well as a writer and journalist.

Vanessa Woods, Taz, and Brian Hare

In the history of evolution, friendliness often proceeds unusual evolutionary success, meaning that friendly species prevail over time. Hare and Woods are uncovering critical factors for why this pattern emerges in their research. For the context of their work, Woods defined friendliness as anything that is mutually beneficial between organisms. Their questions and investigation were first centered around dogs.

“Where did dogs come from?” Hare said. This poses a really “fascinating evolutionary problem.” Prior research shows that dogs first originated 15,000-25,000 years ago, delineated from wolves. But why? Dogs have become one of the “top two or three most successful animals,” while wolves have nearly gone extinct.

The answer to their evolution and their success is found in friendliness. “Dogs have remarkable social genius,” Hare said, they are able to understand communicative gestures and in return communicate with humans in a way that not even one of our closet genetic relatives, the Bonobo, can.  This evolutionary selection for friendliness drove the stark contrasts seen between dogs and wolves today, fundamentally changing dogs’ physical shapes and forms along with their psychology. The same pattern of genetic inheritance encoding for inclination to cooperate also changes much of a species morphology in signature ways.

Vanessa and Brian co-authored the 2020 book, Survival of the Friendliest.

Hare and Woods ventured to Siberia to analyze the findings of an experiment pertaining to fox behavior that has been ongoing since it was first set up by a Russian geneticist in 1959. One group of foxes has experienced randomly selected mating, while the other group of foxes has been artificially shaped by manmade selection for the friendliest foxes.

When they compared the long-term results of decades separate population changes, Hare and Woods found the friendlier foxes had shorter faces, different colorations, curlier tails, and smaller canines. These are the same factors used by archaeologists to distinguish dogs from wolves. The morphological and physiological changes for niceness are synonymous across the two species.

A fox from the friendly group, pictured center, has evolved different physical characteristics according to the manmade selection for friendliness in a long-running genetic experiment in Siberia.

They have also found a similar pattern in humans. Our species as not alone on the planet when it first evolved, said Hare: We shared the planet with approximately four other Hominids who also had big brains, cultural artifacts, and linguistic abilities like we do. “There had to be something in addition to those traits that allowed our species to survive while others went extinct.” He proposes survival of the friendliness and the development of different physical characteristics.

In a study comparing modern humans to archaic ones, Hare and Woods found that modern humans have traits like much smaller brow ridges and narrower, shorter faces – what you would expect to see, based on the fox model from their work in Siberia that also helped explain the evolution of dogs. Our white sclera – the white part of your eye – acts as our “curly tail.” The white tissue likely has been selected for with the development of our other friendly features, as we are the only primate whose sclera is light, which makes communication by glance easier.

Reconstructions of archaic hominid groups. The image on the far right is the reconstruction of a Homo sapiens.

If we are the friendliest, Woods asked, then why are we capable of such cruelty and malice? Even though we are extremely friendly to in-group strangers, when our in-group is threatened, we are prepared to defend them against out-group strangers.

“We are all capable of dehumanization when we feel that the group that we love … is threatened,” Woods said. This is a model they are referring to as the mother bear hypothesis: A mother bear is most patient when she is dealing with her cubs, but most angry when another organism threatens her offspring.

The number one predictor of dehumanization is the feeling that your own group or identity is being dehumanized, and in those moments, the same part of the brain that enables cooperative communication shuts down and is dampened.  

The duo cited cross-group friendships, democracy, and our perception of other animals as important factors for offsetting dehumanization in the human species. Cross-group friendships provide a bridge of empathy, democracy contributes to collective group identity and decisions, and our perceptions of other animals limit dehumanization when we have an ecological view of our relation to other species rather than a top-down, human-centric approach.

Darwin was also a fan of friendliness in nature!

“You have to understand what was wrong about the past but not blind yourself to what you do find,” Woods said when asked about the dark history of morphology-based pseudo-sciences that prompted racial persecutions. This is something that the pair reckons with for a whole chapter in their book.

“You can see in our faces the faces of friendliness,” Hare said.

May we all lean into this niceness after encountering Hare and Woods work. It’s gotten us this far, and it seems particularly vital for our collective future.

Post by Cydney Livingston

A Virtual Stroll through the 2021 Bass Connections Showcase

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Posters, presentations, and formalwear: despite the challenge of a virtual environment, this year’s annual Fortin Foundation Bass Connections Showcase still represented the same exciting scholarship and collegiality as it has in years past.

While individuals could no longer walk around to see each of this year’s 70+ teams present in person, they were instead able to navigate a virtual hall with “floors” designated for certain teams. With labels on each virtual table, it almost mimicked the freedom of leisurely strolls down a hall lined with posters, stopping at what catches your eye. Three sessions were held over Thursday, April 15 and Friday, April 16.

The beginning of each session featured five-minute “lightning” presentations by a diverse set of teams, representing the range of research that students and faculty participated in.  One such presentation was lead by Juhi Dattani ’22 (NCSU) and Annie Roberts ’21, who covered research generated by their team, “Regenerative Grazing to Mitigate Climate Change.” The team was an inter-institutional project bringing together UNC, NCCU, NCSU, and Duke. And as they aptly summarized, “It’s not the cow, but how.” Cows can help fight instead of contribute to the climate crisis, through utilizing regenerative grazing – which is an indigenous practice that has been around for hundreds of years – to improve soil health and boost plant growth.

The team during the 2019-2020 year, pre-COVID, on the Triangle Land Conservancy’s Williamson Preserve.

Research is not just relegated to the physical sciences. Brittany Forniotis, a PhD candidate ’26, and Emma Rand ’22 represented the team “Mapping History: Seeing Premodern Cartography through GIS and Gaming.” Their team was as interdisciplinary as it gets, drawing from the skills of individuals in everything from art history to geography to computer science. They posited that mapmakers use features of map to argue how people should see the world, not necessarily how they saw the world. To defend this hypothesis, they annotated maps to record and categorize data and even converted maps to 3D to make them virtual, explorable worlds. The work of this team enabled the launch of Sandcastle, which aims to “enable researchers to visualize non-cartesian, premodern images of places in a comparative environment that resembles the gestural, malleable one used by medieval and early modern cartographers and artists.”

The work of the team added to a project launch of Sandcastle.

Sophie Hurewitz (T ’22) and Elizabeth Jones (MPP ’22) presented on behalf of the “North Carolina Early Childhood Action Plan: Evidence-based Policy Solutions”, Their recommendations for alleviating childhood food insecurity in North Carolina as outlined by the North Carolina Early Childhood Action Plan will provide a roadmap for NC Integrated Care for Kids (NC InCK) to consider certain policy changes.

One of the most remarkable parts of Bass Connections is how it opens doors for students to pursue avenues and opportunities that they may have never been exposed to otherwise. Hurewitz said that “Being a part of this team led me and a team member to apply for the 2021 Bass Connections Student Research Award, which we were ultimately awarded to study the barriers and facilitators to early childhood diagnosis of Autism Spectrum Disorder (ASD) among Black and Latinx children in North Carolina.” In addition to the award, Hurewitz and fellow team member Ainsley Buck were able to present their team’s research at the APA Region IV Annual Meeting.

The 2019-2020 team, pre-COVID.

From gene therapy for Alzheimer’s disease to power grids on the African continent, this year’s teams represented a wide range of research and collaboration. Erica Langan ’22, a member of the team “REGAIN: Roadmap for Evaluating Goals in Advanced Illness Navigation”, said that “For me, Bass Connections has been an extraordinary way to dive into interdisciplinary research. It’s an environment where I can bring my existing skills and knowledge to the table and also learn and grow in new ways.” This interdisciplinary thinking is a hallmark of not just Bass Connections, but Duke as a research institution, and it’s clear that this spirit is alive and well, even virtually.

Post by Meghna Datta

A New Algorithm for “In-Betweening” images applied to Covid, Aging and Continental Drift

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Collaborating with a colleague in Shanghai, we recently published an article that explains the mathematical concept of ‘in-betweening,’in images – calculating intermediate stages of changes in appearance from one image to the next.

Our equilibrium-driven deformation algorithm (EDDA) was used to demonstrate three difficult tasks of ‘in-betweening’ images: Facial aging, coronavirus spread in the lungs, and continental drift.

Part I. Understanding Pneumonia Invasion and Retreat in COVID-19

The pandemic has influenced the entire world and taken away nearly 3 million lives to date. If a person were unlucky enough to contract the virus and COVID-19, one way to diagnose them is to carry out CT scans of their lungs to visualize the damage caused by pneumonia.

However, it is impossible to monitor the patient all the time using CT scans. Thus, the invading process is usually invisible for doctors and researchers.

To solve this difficulty, we developed a mathematical algorithm which relies on only two CT scans to simulate the pneumonia invasion process caused by COVID-19.

We compared a series of CT scans of a Chinese patient taken at different times. This patient had severe pneumonia caused by COVID-19 but recovered after a successful treatment. Our simulation clearly revealed the pneumonia invasion process in the patient’s lungs and the fading away process after the treatment.

Our simulation results also identify several significant areas in which the patient’s lungs are more vulnerable to the virus and other areas in which the lungs have better response to the treatment. Those areas were perfectly consistent with the medical analysis based on this patient’s actual, real-time CT scan images. The consistency of our results indicates the value of the method.

The COVID-19 pneumonia invading (upper panel) and fading away (lower panel) process from the data-driven simulations. Red circles indicate four significant areas in which the patient’s lungs were more vulnerable to the pneumonia and blue circles indicate two significant areas in which the patient’s lungs had better response to the treatment. (Image credit: Gao et al., 2021)
We also applied this algorithm to simulate human facial changes over time, in which the aging processes for different parts of a woman’s face were automatically created by the algorithm with high resolution. (Image credit: Gao et al., 2021. Video)

Part II. Solving the Puzzle of Continental Drift

It has always been mysterious how the continents we know evolved and formed from the ancient single supercontinent, Pangaea. But then German polar researcher Alfred Wegener proposed the continental drift hypothesis in the early 20th century. Although many geologists argued about his hypothesis initially, more sound evidence such as continental structures, fossils and the magnetic polarity of rocks has supported Wegener’s proposition.

Our data-driven algorithm has been applied to simulate the possible evolution process of continents from Pangaea period.

The underlying forces driving continental drift were determined by the equilibrium status of the continents on the current planet. In order to describe the edges that divide the land to create oceans, we proposed a delicate thresholding scheme.

The formation and deformation for different continents is clearly revealed in our simulation. For example, the ‘drift’ of the Antarctic continent from Africa can be seen happening. This exciting simulation presents a quick and obvious way for geologists to establish more possible lines of inquiry about how continents can drift from one status to another, just based on the initial and equilibrium continental status. Combined with other technological advances, this data-driven method may provide a path to solve Wegener’s puzzle of continental drift.

The theory of continental drift reconciled similar fossil plants and animals now found on widely separated continents. The southern part after Pangaea breaks (Gondwana) is shown here evidence of Wegener’s theory. (Image credit: United States Geological Survey)
The continental drift process of the data-driven simulations. Black arrow indicates the formation of the Antarctic. (Image credit: Gao et al., 2021)

The study was supported by the Department of Mathematics and Physics, Duke University.

CITATION: “Inbetweening auto-animation via Fokker-Planck dynamics and thresholding,” Yuan Gao, Guangzhen Jin & Jian-Guo Liu. Inverse Problems and Imaging, February, 2021, DOI: 10.3934/ipi.2021016. Online: http://www.aimsciences.org/article/doi/10.3934/ipi.2021016

Yuan Gao

Yuan Gao is the William W. Elliot Assistant Research Professor in the department of mathematics, Trinity College of Arts & Sciences.

Jian-Guo Liu is a Professor in the departments of mathematics and physics, Trinity College of Arts & Sciences.

Jian-Guo Liu

Are You Funnier Than a Duke Postdoc?

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Odds are, probably not.

On Saturday, April 10th, Duke Postdoc Comedy Club hosted Are We There Yet?, a virtual comedy showcase featuring Triangle-based comedians. The show was moderated by Bo Ma and featured six comics: Tori Grace Nichols, Amy Mora, Josh Rosenstein, Nat Davis, Yutian Feng, and headliner Isatu Kamara (in order of appearance). 

The virtual comedy club was sponsored by the Duke Office of Research, The Graduate School, and the Division of Student Affairs, who collectively scraped together a whopping $15 to pay each of the up-and-coming comedians, giving the audience their first laugh of the night. Let’s see $8 billion endowment… subtract the product of 15 times 6… carry the one… wait, how many zeroes is that again? Good one, Duke. 

Given that the show was free, I definitely felt like I got a lot more than I paid for.

I was shocked at how many of the performers had prior comedy experience in the community; almost all of the comics had extensive performance resumes both in Durham and outside of the Triangle area. Prevalent themes of the night included jokes related to gender and racial identity, COVID-induced weight gains (dubbed by Amy Mora as the “quarantine fifteen”), and the less than prolific employment prospects currently awaiting postdoctoral students.

Yutian Feng’s setup for Are We There Yet?. Tropical paradise or kitchen island? Guess we’ll never know…

One of the highlights of the show was radiology postdoc Yutian Feng’s set. A self-described PhD, which he clarified stood for “permanent head damage,” his hobbies included identifying as a straight white male “because it’s the only way to get elected in this country,” and conversing with Siri on his Apple Watch, which he has programmed to congratulate him with a salty profanity every time he finishes exercising. After watching his set, all I can think to say is congratulations (salty profanity) — being that funny must’ve been quite the workout! 

Isatu Kamara and Jimmy Carter (vaguely visible on her left).

The show’s headliner was Isatu Kamara, an up-and-coming Durham-based comedian who tuned in alongside her cat, Jimmy Carter.

Kamara’s set revolved around her identities, particularly as a “stay-at-home daughter” and non-rich person, lamenting about the recent invasion of “gentrification scooters” and the sunroom epidemic in Durham.

Future plans? Kamara hopes to upgrade from the shopping cart that they have at the grocery store specifically for single people. You know, the one that’s “half of the size of the Happy Family™ shopping cart” and only has room for “a pack of White Claws, a bottle of wine, and some cat food?” A very ambitious goal but, hey, we’re rooting for you, Isatu. 

Though the fruits of their research careers remain unknown, the comedic future seems promising for the Postdoc Comedy Club’s self-described “two to three” members. After all, as Yutian aptly pointed out during his set, they all have the opportunity to move “from the most underpaid job to the second most underpaid job” — a drop in the bucket when compared to their masses of student debt and cure their similarly high degrees of self-loathing, but hey, at least they got fifteen bucks?

Post by Rebecca Williamson

A Patient’s and Doctor’s Perspective on Narrative Medicine

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When asked about the process of writing her memoir, Dana Lorene Creighton paused in thought.

“It’s like spilling your guts to a lined composition notebook,” she said.

On Tuesday, March 30th, Creighton was joined by Dr. Sneha Mantri, her neurologist at Duke and director of the Trent Center’s Program in Medical Humanities, for Narrative Medicine: A Patient’s Perspective – a conversation about the impact of narrative medicine and the journey to her memoir, A Family Disease: A Memoir of Multigenerational Ataxia.

Creighton, who has an MS in exercise physiology and has spent her career involved in clinical research and community health at both UNC-Chapel Hill and Duke, has spinocerebellar ataxia, a hereditary neurodegenerative condition characterized by a lack of muscle coordination. The illness is commonly visible through slurred speech, stumbling, falling, and incoordination due to damage to the cerebellum – the part of the brain that controls muscle coordination.

As Creighton described, prior to writing her book in her late forties, she hadn’t successfully communicated to anyone the impact of ataxia on her life. And so, her memoir was organically born, but as Creighton says, “it was hard for me to type as fast as I was thinking, and that lasted for several months.”

It took Creighton a couple of years just to write the foundation of the book, which draws on neuroplasticity research, personal memories, and medical records to highlight the importance of storytelling in deriving meaning from illness. She spent the next two years after that re-shaping the arc, drawing on a wealth of her own experiences as well as decades of journaling that had left her with a meticulous set of notes.

As both Creighton and Dr. Mantri emphasized, writing is a deeply cathartic exercise as well as a way to share significant personal narratives. This is especially true in a field such as medicine, where people are so often treated as an illness or statistic rather than a human being.

Narrative medicine was coined as a term by Dr. Rita Charon in her book Narrative Medicine: Honoring the Stories of Illness, to refer to “medicine practiced with the narrative skills of recognizing, absorbing, interpreting, and being moved by the stories of illness . . . . Along with their scientific expertise, doctors need the expertise to listen to their patients, to understand as best they can the ordeals of illness, to honor the meanings of their patients’ narratives of illness, and to be moved by what they behold so that they can act on their patients’ behalf.”

While the recognition of patient and doctor narratives has been around for many years, it was not until fairly recently that narrative medicine emerged as a field of knowledge that doctors could educate themselves in.

Dr. Mantri is familiar with the benefits of narrative medicine from a clinical perspective, holding an M.S in Narrative Medicine from Columbia University and being a leader of various narrative medicine initiatives at Duke, both with doctors and medical students.

According to Dr. Mantri, elucidating these narratives is crucial to understanding that at the end of the day, doctors and patients work to navigate challenges of illnesses with different perspectives. It’s necessary to hear the story of a patient as well as understand the story of a clinician. Only then can doctors work to find moments of alignment between these two perspectives, resulting in care that is more patient-centered.

From the patient perspective, Creighton remarks that a chapter in her book delves into narrative medicine, even though at the time she had no idea what it was. As she learned more about the field, though, it became clear just how integral narrative medicine was to her experience processing and coming to terms with her ataxia. Prior to taking a class on narrative medicine, she assumed that it wouldn’t be a positive experience. But years later, she credits the process of writing her memoir with allowing her to move on, in many ways, from the hold her illness had on her.

Creighton also pointed out that as humans, “we want the same things – to feel heard and to make meaningful connections with others who can potentially help us navigate whatever condition we’re going through.”

To that end, Dr. Mantri and Creighton both referred to several resources that can help people with illnesses find communities of other individuals with the same illness, in order to find the type of solidarity and understanding promoted by sharing experiences. One such resource is PatientsLikeMe, where individuals can ask questions and exchange tips on their specific illness with others going through similar struggles.

PatientsLikeMe

Finally, Creighton was asked about the things she’d like clinicians to know from her perspective as a patient. She described the disconnect that she had often felt, not only with doctors but with therapists and counselors, stemming from a feeling that the help she was offered often did not meet her where she was. In brainstorming ways to mitigate this gap, both Dr. Mantri and Creighton pointed to a need for doctors to focus on a patients’ needs and desires, and a need for patients to advocate for themselves.

As the conversation concluded, Creighton emphasized the importance of being seen as a human rather than a victim of a disease. Spinocerebellar ataxia is neurodegenerative, meaning that symptoms progressively get worse. But as Creighton remarked: “Losing my abilities is going to happen. Losing my abilities doesn’t change the human that I am.”

Post by Meghna Datta

Using Data Science for Early Detection of Autism

Sticky post

Autism Spectrum Disorder can be detected as early as six to twelve months old and the American Academy of Pediatrics recommends all children be screened between twelve and eighteen months of age.

But most diagnoses happen after the age of 4, and later detection makes it more difficult and expensive to treat.

One in 40 children is diagnosed with Autism Spectrum Disorder and Duke currently serves about 3,000 ASD patients per year. To improve care for patients with ASD, Duke researchers have been working to develop a data science approach to early detection.

Geraldine Dawson, the William Cleland Distinguished Professor in the Department of Psychiatry & Behavioral Sciences and Director of the Duke Center for Autism and Brain Development, and Dr. Matthew Engelhard, a Conners Fellow in Digital Health in Psychiatry & Behavioral Sciences, recently presented on the advances being made to improve ASD detection and better understand symptoms.

The earlier ASD is detected, the easier and less expensive it is to treat. Children with ASD face challenges in learning and social environments.

ASD differs widely from case to case, however. For most people, ASD makes it difficult to navigate the social world, and those with the diagnosis often struggle to understand facial expressions, maintain eye contact, and develop strong peer relations.

However, ASD also has many positive traits associated with it and autistic children often show unique skills and talents. Receiving a diagnosis is important for those with ASD so that they can receive learning accommodations and ensure that their environment helps promote growth. 

Because early detection is so helpful researchers began to ask:

“Can digital behavioral assessments improve our ability to screen for neurodevelopmental disorders and monitor treatment outcomes?”

Dr. geraldine DawsoN

The current approach for ASD detection is questionnaires given to parents. However, there are many issues in this method of detection such as literacy and language barriers as well as requiring caregivers to have some knowledge of child development. Recent studies have demonstrated that digital assessments could potentially address these challenges by allowing for direct observation of the child’s behavior as well as the ability to capture the dynamic nature of behavior, and collect more data surrounding autism.

“Our goal is to reduce disparities in access to screening and enable earlier detection of ASD by developing digital behavioral screening tools that are scalable, feasible, and more accurate than current paper-and-pencil questionnaires that are standard of care.”

Dr. Geraldine Dawson

Guillermo Sapiro, a James B. Duke Distinguished Professor of Electrical and Computer Engineering, and his team have developed an app to do just this.

On the app, videos are shown to the child on an iPad or iPhone that prompt the child’s reaction through various stimuli. These are the same games and stimuli typically used in ASD diagnostic evaluations in the clinic. As they watch and interact, the child’s behavior is measured with the iPhone/iPad’s selfie camera. Some behavioral symptoms can be detected as early as six months of age are, such as: not paying as much attention to people, reduced affective expression, early motor differences, and failure to orient to name.

In the proof-of-concept study, computers were programmed to detect a child’s response to hearing their name called. The child’s name was called out by the examiner three times while movies were shown. Toddlers with ASD demonstrated about a second of latency in their responses. 

Another study used gaze monitoring on an iPhone. Nearly a thousand toddlers were presented with a split screen where a person was on one side of the screen and toys were on the other. Typical toddlers shifted their gaze between the person and toy, whereas the autistic toddlers focused more on the toys. Forty of the toddlers involved in the study received an ASD diagnosis. Using eye gaze, researchers were also able to look at how toddlers responded to speech sounds as well as to observe early motor differences because toddlers with ASD frequently show postural sway (a type of head movement).

“The idea behind the app is to begin to combine all of these behaviors to develop a much more robust ASD algorithm. We do believe no one feature will allow us to detect ASD in developing children because there is so much variation”

DR. GERALDINE DAWSON

The app has multiple features and will allow ASD detection to be done in the home. Duke researchers are now one step away from launching an at-home study. Other benefits of this method include the ability to observe over time with parents collecting data once a month. In the future, this could be used in a treatment study to see if symptoms are improving.

Duke’s ASD researchers are also working to integrate information from the app with electronic health records (EHR) to see if information collected from routine medical care before age 1 can help with detection.

Post by Anna Gotskind

In Drawers of Old Bones, New Clues to the Genomes of Lost Giants

DNA extracted from a 1,475-year-old jawbone reveals genetic blueprint for one of the largest lemurs ever.

By teasing trace amounts of DNA from this partially fossilized jawbone, nearly 1,500 years after the creature’s death, scientists have managed to reconstruct the first giant lemur genome. Credit: University of Antananarivo and George Perry, Penn State

If you’ve been to the Duke Lemur Center, perhaps you’ve seen these cute mouse- to cat-sized primates leaping through the trees. Now imagine a lemur as big as a gorilla, lumbering its way through the forest as it munches on leaves.

It may sound like a scene from a science fiction thriller, but from skeletal remains we know that at least 17 supersized lemurs once roamed the African island of Madagascar. All of them were two to 20 times heftier than the average lemur living today, some weighing up to 350 pounds.

Then, sometime after humans arrived on the island, these creatures started disappearing.

The reasons for their extinction remain a mystery, but by 500 years ago all of them had vanished.

Coaxing molecular clues to their lives from the bones and teeth they left behind has proved a struggle, because after all this time their DNA is so degraded.

But now, thanks to advances in our ability to read ancient DNA, a giant lemur that may have fallen into a cave or sinkhole near the island’s southern coast nearly 1,500 years ago has had much of its DNA pieced together again. Researchers believe it was a slow-moving 200-pound vegetarian with a pig-like snout, long arms, and powerful grasping feet for hanging upside down from branches.

A single jawbone, stored at Madagascar’s University of Antananarivo, was all the researchers had. But that contained enough traces of DNA for a team led by George Perry and Stephanie Marciniak at Penn State to reconstruct the nuclear genome for one of the largest giant lemurs, Megaladapis edwardsi, a koala lemur from Madagascar.

Ancient DNA can tell stories about species that have long since vanished, such as how they lived and what they were related to. But sequencing DNA from partially fossilized remains is no small feat, because DNA breaks down over time. And because the DNA is no longer intact, researchers have to take these fragments and figure out their correct order, like the pieces of a mystery jigsaw puzzle with no image on the box.

Bones like these are all that’s left of Madagascar’s giant lemurs, the largest of which weighed in at 350 pounds — 20 times heftier than lemurs living today. Credit: Matt Borths, Curator of the Division of Fossil Primates at the Duke Lemur Center

Hard-won history lessons

The first genetic study of M. edwardsi, published in 2005 by Duke’s Anne Yoder, was based on DNA stored not in the nucleus — which houses most of our genes — but in another cellular compartment called the mitochondria that has its own genetic material. Mitochondria are plentiful in animal cells, which makes it easier to find their DNA.

At the time, ancient DNA researchers considered themselves lucky to get just a few hundred letters of an extinct animal’s genetic code. In the latest study they managed to tease out and reconstruct some one million of them.

“I never even dreamed that the day would come that we could produce whole genomes,” said Yoder, who has been studying ancient DNA in extinct lemurs for over 20 years and is a co-author of the current paper.

For the latest study, the researchers tried to extract DNA from hundreds of giant lemur specimens, but only one yielded enough useful material to reconstitute the whole genome.

Once the creature’s genome was sequenced, the team was able to compare it to the genomes of 47 other living vertebrate species, including five modern lemurs, to identify its closest living relatives. Its genetic similarities with other herbivores suggest it was well adapted for grazing on leaves.

Despite their nickname, koala lemurs weren’t even remotely related to koalas. Their DNA confirms that they belonged to the same evolutionary lineage as lemurs living today.

To Yoder it’s another piece of evidence that the ancestors of today’s lemurs colonized Madagascar in a single wave.

Since the first ancient DNA studies were published, in the 1980s, scientists have unveiled complete nuclear genomes for other long-lost species, including the woolly mammoth, the passenger pigeon, and even extinct human relatives such as Neanderthals.

Most of these species lived in cooler, drier climates where ancient DNA is better preserved. But this study extends the possibilities of ancient DNA research for our distant primate relatives that lived in the tropics, where exposure to heat, sunlight and humidity can cause DNA to break down faster.

“Tropical conditions are death to DNA,” Yoder said. “It’s so exciting to get a deeper glimpse into what these animals were doing and have that validated and verified.”

See them for yourself

Assembled in drawers and cabinets cases in the Duke Lemur Center’s Division of Fossil Primates on Broad St. are the remains of at least eight species of giant lemurs that you can no longer find in the wild. If you live in Durham, you may drive by them every day and have no idea. It’s the world’s largest collection.

In one case are partially fossilized bits of jaws, skulls and leg bones from Madagascar’s extinct koala lemurs. Nearby are the remains of the monkey-like Archaeolemur edwardsi, which was once widespread across the island. There’s even a complete skeleton of a sloth lemur that would have weighed in at nearly 80 pounds, Palaeopropithecus kelyus, hanging upside down from a branch.

Most of these specimens were collected over 25 years between 1983 and 2008, when Duke Lemur Center teams went to Madagascar to collect fossils from caves and ancient swamps across the island.

“What is really exciting about getting better and better genetic data from the subfossils, is we may discover more genetically distinct species than only the fossil record can reveal,” said Duke paleontologist Matt Borths, who curates the collection. “That in turn may help us better understand how many species were lost in the recent past.”

They plan to return in 2022. “Hopefully there is more Megaladapis to discover,” Borths said.

A fossil site in Madagascar. Courtesy of Matt Borths, Duke Lemur Center Division of Fossil Primates

CITATION: “Evolutionary and Phylogenetic Insights From a Nuclear Genome Sequence of the Extinct, Giant, ‘Subfossil’ Koala Lemur Megaladapis Edwardsi,” Stephanie Marciniak, Mehreen R. Mughal, Laurie R. Godfrey, Richard J. Bankoff, Heritiana Randrianatoandro, Brooke E. Crowley, Christina M. Bergey, Kathleen M. Muldoon, Jeannot Randrianasy, Brigitte M. Raharivololona, Stephan C. Schuster, Ripan S. Malhi, Anne D. Yoder, Edward E. Louis Jr, Logan Kistler, and George H. Perry. PNAS, June 29, 2021. DOI: 10.1073/pnas.2022117118.

Black Americans’ Vaccine Hesitancy is Grounded in More Than Mistrust

Covid-19 is considered a “general pandemic,” but its impacts have been disproportionate along the lines of race and ethnicity. Though vaccines may serve as our best chance to put an end to Covid, the problem of vaccine hesitancy amongst Black people in the U.S. is particularly pervasive and grounded by more than simple mistrust.

Gary Bennett (Ph.D.) discussed the issue of complex determinants of vaccine hesitancy among Black Americans Monday, April 5. Bennett is a Professor of Psychology, Neuroscience, Global Health, and Medicine at Duke, as well as director of Duke Digital Health and Vice Provost for Undergraduate Education.

Gary Bennett, Ph.D.

“At the end of the day, we are dealing with an issue that demands pragmatic attention,” Bennett said, “How do we get shots in arms?” It turns out, the answer is quite complex and historically confounded.

While Black people have experienced much higher burdens from Covid-19 despite contracting the disease at a similar rate to whites, they have been disproportionately vaccinated at lower rates than white people.

“Access matters and it matters a lot,” Bennett said. One clear example of decreased access for Black Americans is that fewer vaccination sites are located in areas with high concentrations of Black people.

However, Bennett said, access does not simply equal place. “How much friction are you creating in this process?” he prompted, pointing to examples of complicated registration systems, inadequate public transportation to vaccine sites, or overall distance from a location. All of these factors already limit who is able to access vaccinations without the added influences of reduced vaccine uptake due to vaccine hesitancy.

A slide from Dr. Bennett’s presentation which outlines the plethora of impactors on access.

Vaccine hesitancy was listed by the World Health Organization as a top 10 global threat in 2019, when vaccines were preventing 2-3 million deaths per year in the pre-Covid era. Though Bennett said that vaccine hesitancy “has been with us for a long time,” there “are real consequences” to continued reluctance and refusal to get vaccinated with heightened risks due to the nature of the pandemic.

Bennett said that many claims around hesitancy blame communities for their inability to access vaccines, but this fails to consider or to change the underlying behaviors that drive hesitancy. Bennett outlined these underlying drivers as 1) mistrust, 2) social norms, and 3) understandable uncertainties.

A slide from Dr. Bennett’s presentation showing the unequal distribution of vaccination sites in Atlanta GA in predominantly white areas.

“It’s not just mistrust of the medical system, it’s mistrust of institutions,” Bennett said, “There’s a lot of reasons for [Black people] to mistrust institutions.” The murder of George Floyd stands as one poignant contemporary example, but “Tuskegee [still] looms large in the minds of Black Americans.” The Tuskegee experiment exploited 600 Black men working as sharecroppers who had syphilis by knowingly withholding treatment and simply seeing what happened to their bodies as a result of the disease for over 40 years.

This experiment was not the first of its kind: Whole body radiation was tested on Black people. Fistula surgery was developed on enslaved Black women by the “father of modern gynecology.” The immortal cells of Henrietta Lacks, a Black woman, have been used far and wide to advance science after a sample of her cancerous cervix was unknowingly stolen from her. Modern studies have also shown how different implicit biases of Black patients shape their treatment outcomes due to skewed physician perceptions.

The capital riot, the murder of George Floyd, and the Jim Crow Era all exemplify the pervasive institutionalized racism that erodes Black trust in U.S. institutions of all kinds.

Our social networks are also vitally important to influencing our feelings about receiving the Covid vaccine. In Black communities, Bennett said, fewer people in their networks have gotten vaccinations and those who have received vaccines are less vocal about it leading to a collective lack of interest in receiving vaccinations.

These two factors, paired with understandable uncertainties about the side effects of the vaccine or potentially getting Covid itself, generate the need to change our approaches to vaccine hesitancy and increased uptake amongst Black communities in the U.S.

White people have been disproportionately vaccinated over all other racial/ethnic categories in the U.S.

To do this we need to lead with empathy and appreciate the fact that changing attitudes towards vaccines is a process. “Shaming people is bad,” Bennett said. “Stigmatizing people will actually lead to the converse of what we expect.”

Over time, we can work to correct misconceptions, contextualized uncertainties, and share stories rather than statistics to push people further from vaccine refusal and closer to vaccine demand.

And when more Black Americans are ready, “vaccination should be an easy choice.” By implementing opt-out policies, rather than opt-in and by taking more direct actions like making vaccination appointments for people, Covid vaccines may indeed be the key to ending the pandemic – in an equitable and proportionate way.

Post by Cydney Livingston

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