Duke Research Blog

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

Author: Anne Littlewood Page 1 of 2

The Power of Bass Connections Teamwork

Does yoga improve emotional regulation? Why don’t youth vote in elections? Can regular exercise combat anxiety and depression? How do we encourage girls to pursue careers in STEM fields? These are some of the questions explored by Bass Connections teams at Duke this year. After a year of hard work, several teams presented their answers in 5-minute flash talks at the EHDx event on April 9, and their audience was very impressed by their research.

Karina Heaton and Caleb Cooke present on their Bass Connections project, Wired for Learning

Bass Connections is a program at Duke that allows students to engage with real world problems, and apply their classroom knowledge to solve problems in society. Accepted students spend a year or more working with an interdisciplinary team of faculty, undergraduates, and graduate students on a project within the five theme areas of Bass Connections: Brain & Society, Information, Society & Culture, Global Health, Education & Human Development, and Energy & Environment.

The eleven teams that presented at EHDx were part of the Education and Human Development theme, so they spent the year exploring questions related to advancing educational systems, or exploring other areas in support of positive life outcomes for youth. Each team selected representatives to speak for five minutes on the work they have accomplished this year, and the event became a competition when the moderators announced the audience would vote for the best talk at the end.

The winning talk was presented by Bruny Kenou, a Duke undergraduate

The winner of this competition was Bruny Kenou, presenting on behalf of the Virtual Avatar Coaches project. The goal of this team was to create a peer to peer coaching program to support college students struggling with mental health. This project aims to fight stigma with a platform that allows students to send an anonymous text and receive immediate help from a peer. Peer coaches will take a semester-long course to prepare for their role in the program, and the hope is for this to eventually improve the lives of many students suffering from a fear of stigmas and labels.

The talks were followed by a reception and poster session. The team that took the blue ribbon this time was Mindfulness in Human Development. The objective of this team is to improve the lives of middle school students in Durham with a yoga and mindfulness intervention during the school day. The team has found that taking a break for yoga in the middle of the day has had positive effects on empathy, emotional regulation, and body image on the young students. Did someone say namaste?

The winner of the poster contest was the Mindfulness in Human Development Team

Honestly, I didn’t vote — I couldn’t pick a favorite! From designing a new and inclusive curriculum for elementary schools and helping kids learn computer science to investigating educational policy in Brazil and promoting awareness of female philosophers throughout history, each presentation was so impressive. It was easy to see that all of these teams have all been hard at work to affect positive change in society. If they can do this much in under a year, who knows what these talented undergraduates will accomplish in a lifetime!

Post by Anne Littlewood, Trinity ’21

The Adolescent Brain Isn’t so Bad, Really

Adriana Galván, PHD (Photo from the Duke Center for Cognitive Neuroscience Colloquium Series, DIBS)

More often than not, teenagers are portrayed in the media as troublesome, emotionally reactive, and difficult to deal with. They are widely considered to be risk-takers, and prone to making poor choices.

But is taking risks necessarily a bad thing? Should adolescents be seen as bad people? Adriana Galván, PHD, doesn’t think so.

Galván is a neuroscientist and professor at UCLA, where she studies sleep, emotion, learning, stress, and decision-making in the adolescent brain. She came to Duke on Friday, April 5 as part of the DIBS Center for Cognitive Neuroscience’s Colloquium Series.

Humans have an extended period of adolescence, because our brains take a very long time to complete development, Galván said. Adolescence is currently defined as the period between the onset of puberty and the end of developmental plasticity. During this time, teen brains are constantly changing, and these physical changes are linked to socioemotional changes in behavior.

The Brain’s Reward System: meso-limbic pathway shown in green (Photo from WikiCommons: Oscar Arias-Carrión1, Maria Stamelou, Eric Murillo-Rodríguez, Manuel Menéndez-González and Ernst Pöppel)

One of the most prominent differences between adolescent and adult brains can be found in the brain’s reward system. Research has shown that adolescents have higher levels of activation in the mesolimbic system and ventral striatum regions of the brain, areas that are very important in reward processing.

Galván believes that this greater reward system excitability in teenagers may explain why they engage in more risky behavior than adults.

A study done by Galván and her former student, Emily Barkley-Levenson, investigated the stereotype of risk-taking in adolescents. Sure enough, when tested against adults in a gambling game, adolescents were more likely to take risks. However, a closer look at the data suggests that this might not be such a bad thing.

For disadvantageous and neutral gambles, adolescents didn’t differ from adults at all. But when it came to advantageous gambles, adolescents were far more likely than adults to accept the risk. This suggests that risk-taking behavior in teens might actually be adaptive, and put young people at an advantage when it comes to making the choices that lead to innovation and discovery.

Adolescents were also shown to exhibit better learning from outcomes than adults. Adolescence is a period of time where young people are constantly receiving feedback from their environment, and learning about the world around them from social interactions and relationships.

Another of Galván’s students, Kaitlyn Breiner, found that adolescents experienced high levels of emotional distress when their expectations of social feedback were violated. This was true regardless of whether the participants were receiving positive or negative unexpected feedback; they were just as distressed by an unexpected compliment as they were by an unexpected insult. Galván hypothesizes this is because relief is a very powerful emotion, and adolescent participants were looking to find comfort in a validation of their beliefs about their social relationships. It’s comforting to feel like your interpretation of the social world is correct, especially during the shifting world of adolescence.

Adolescents learn about their world through social interactions with friends (Photo from Wikimedia Commons: Glenn Waters)

Galván and her team have also investigated the role of mesolimbic activation in mediating distress.

Following the 2016 US Presidential election, participants in Los Angeles were asked if they felt personally affected by the election. The research team then measured the activation in their nucleus accumbens (a region of the mesolimbic system that plays a role in reward) and looked for symptoms of depression. Of those who reported feeling affected by the outcome of the election, Galván found that people with high activation in their nucleus accumbens had less depressive symptoms than those with low activation in this area. This suggests that high activation of the reward system plays a role in mediating depression. If adolescent brains experience these higher levels of reward system activation, might this protect them from depression?

The bottom line is, adolescents are not bad people, and they aren’t stupid either. In some ways, they may even be smarter than adults. Teens are better at learning from outcomes, more likely to take advantageous risks, and they experience higher levels of activation in their reward system, which could have important implications for resilience. The research shows that teenagers are far more capable – and smarter – than the world believes. Let’s give them a little more credit.

Post by Anne Littlewood, Trinity ’21

Building a Mangrove Map

“Gap maps” are the latest technology when it comes to organizing data. Although they aren’t like traditional maps, they can help people navigate through dense resources of information and show scientists the unexplored areas of research.

A ‘gap map’ comparing conservation interventions and outcomes in tropical mangrove habitats around the world turns out to be a beautiful thing.

At Duke’s 2019 Master’s Projects Spring Symposium, Willa Brooks, Amy Manz, and Colyer Woolston presented the results of their year-long Masters Project to create this map.

You’d never know by looking at the simple, polished grid of information that it took 29 Ph.D. students, master’s students and undergraduates nearly a full year to create it. As a member of the Bass Connections team that has been helping to support this research, I can testify that gap maps take a lot of time and effort — but they’re worth it.

Amy Manz, Willa Brooks, and Colyer Woolston present their evidence map (or gap map) at the 2019 Master’s Projects Spring Symposium

When designing a research question, it’s important to recognize what is already known, so that you can clearly visualize and target the gaps in the knowledge.

But sifting through thousands of papers on tropical mangroves to find the one study you are looking for can be incredible overwhelming and time-intensive. This is purpose of a gap map: to neatly organize existing research into a comprehensive grid, effectively shining a light on the areas where research is lacking, and highlighting patterns in areas where the research exists.

In partnership with World Wildlife Fund, Willa, Amy, and Colyer’s team has been working under the direction of Nicholas School of the Environment professors Lisa Campbell and Brian Silliman to screen the abstracts of over 10,000 articles, 779 of which ended up being singled out for a second round of full-text screening. In the first round, we were looking for very specific inclusion criteria, and in the second, we were extracting data from each study to identify the outcomes of conservation interventions in tropical mangrove, seagrass, and coral reef habitats around the world.

Coastal Mangroves (Photo from WikiCommons: US National Oceanic and Atmospheric Administration)

While the overall project looked at all three habitats, Willa, Amy, and Colyer’s Master’s Project focused specifically on mangroves, which are salt-tolerant shrubs that grow along the coast in tropical and subtropical regions. These shrubs provide a rich nursery habitat to a diverse group of birds and aquatic species, and promote the stability of coastlines by trapping sediment runoff in their roots. However, mangrove forests are in dramatic decline.

According to World Wildlife Fund, 35 percent of mangrove ecosystems in the world are already gone. Those that remain are facing intense pressure from threats like forest clearing, overharvesting, overfishing, pollution, climate change, and human destruction of coral reefs. Now more than ever, it is so important to study the conservation of these habitats, and implement solutions that will save these coastal forests and all the life they support. The hope is that our gap map will help point future researchers towards these solutions, and aid in the fight to save the mangroves.

This year’s team built a gap map that successfully mapped linkages between interventions and outcomes, indicating which areas are lacking in research. However, the gap map is limited because it does not show the strength or nature of these relationships. Next year, another Bass Connections team will tackle this challenge of analyzing the results, and further explore the realm of tropical conservation research.

Post by Anne Littlewood, Trinity ’21

Dolphin Smarts

Imagine you are blindfolded and placed into a pool of water with a dolphin. The dolphin performs a movement, such as spinning in a circle, or swimming in a zig-zag pattern, and your task is to imitate this movement, without having seen it. Ready, go. 

Sound impossible? While it may not be possible for a human to do this with any accuracy, a dolphin would have no problem at all. When cognitive psychologist and marine mammal scientist Kelly Jaakkola gave this task to the dolphins at the Dolphin Research Center in Florida, they had no problem at all copying a human’s behavior. So how did they do it? Jaakkola thinks they used a combination of active listening and echolocation.

How smart are dolphins? (Photo from Wikimedia Commons: Stuart Burns)

Humans love to claim the title of “smartest” living animal. But what does this mean? How do we define intelligence? With a person’s GPA? Or SAT score? By assigning a person a number that places him or her somewhere on the scale from zero to Einstein? 

Honestly, this is problematic. There are many different types of intelligence that we forget to consider. For example, Do you know that five is less than seven? Can you remember the location of an object when you can’t see it? Can you mimic a behavior after watching it? Are you capable of cooperating to solve problems? Can you communicate effectively? All of these demonstrate different intelligent skills, many of which are observed in dolphins.

Needless to say, dolphins and humans are entirely different creatures. We have different body plans, different ways of interacting with the world, and different brains. It has been 90 million years since we shared a common ancestor, which is why the things we do have in common are so fascinating to researchers. 

Like us, dolphins understand ordinality. When presented with two novel boards with different numbers of dots, dolphins at the Dolphin Research Center chose the smaller number 83 percent of the time. But unlike us, they weren’t counting to solve this problem. When they were shown boards that represented consecutive numbers, the dolphins struggled, and often failed the task.

Similar to humans, dolphins understand that when objects are hidden from view, they still exist. At the Dolphin Research Center, they could easily remember the location of toy when a trainer hid it inside a bucket. However, unlike humans, dolphins couldn’t infer the movement of hidden objects. If the bucket was moved, the dolphins didn’t understand that the toy had moved with it.

Dr. Jaakkola presents to a packed room of Duke students

While they may not be physicists, Jaakkola has shown that dolphins are stellar cooperators, and amazing at synchronous tasks. When asked to press an underwater button at the same time as a partner, the dolphins pushed their buttons within 0.37 milliseconds of each other, even when they started at different times. As the earlier example shows, dolphins can also imitate incredibly well, and this skill is not limited to mimicking members of their own species. Even though humans have an entirely different body plan, dolphins can flexibly use their flipper in place of a hand, or their tail in place of legs, and copy human movements.

It is believed that dolphins evolved their smarts so that they could navigate the complex social world that they live in. As the researchers at the Dolphin Research Center have shown, they possess a wide array of intelligent abilities, some similar to humans and others entirely different from our own. “Dolphins are not sea people,” Jaakkola warned her audience, but that’s not to discount the fact that they are brilliant in their own way. 

Meet the Researcher Who Changed How We Care for Rape Survivors

One of the first things I was told during freshman orientation was that two out of every five young women at Duke experience some form of sexual assault during their four years as an undergraduate. Shortly after that, I was informed that as a Duke student, I was not allowed to protect myself with pepper spray, because it is banned by university policy.

At the 2019 Harriet Cook Carter Lecture, Ann Burgess, a professor of psychiatric mental health nursing at Boston College, reported that 25 to 30 percent of women and 10 percent of men will be sexually assaulted in their lifetimes, statistics that make our campus standard of 40 percent seem strikingly high in comparison. Burgess has devoted her life to the support of sexual assault survivors, and pioneered treatments for victims of such abuse. For the past fifty years, she has studied the traumatic effects of rape and violence on patients of all ages, and worked closely with the FBI Academy to research the underlying causes of such crimes. Her work at the FBI was so impactful, Netflix decided to write a TV series about her, a crime drama called “Mindhunter.” Talk about a powerful woman.

Ann Wolbert Burgess, DSNc, APRN, BC, FAAN (Photo from Duke University School of Nursing)

When she began her work with rape survivors in the 1970s, the world was a very different place. Public attitudes towards sexual assault were unsupportive and disapproving of victims. Rape thrived on prudery, silence, and misunderstanding. There were very few reported cases, low conviction rates of criminals, and plenty of victim blaming. “We just didn’t talk about these kinds of things,” Burgess recalled. “There was no public recognition.”

So have we advanced? Yes, absolutely. Throughout the years, Burgess says she has seen a crucial shift towards more support for survivors. She has helped the FBI develop better systems for criminal profiling, and testified countless times in court to ensure justice for survivors of all ages. Burgess has witnessed these court cases changing policies, and affecting the genesis of laws that will better protect citizens against rape and other violent crimes. She has studied lasting trauma in survivors, and used this research to implement new culturally and developmentally appropriate services for victims. She believes that, as a society, we are doing a much better job today to reduce stigma and support survivors, but that the work is not even close to finished.

Sexual assault is still an intensely pervasive issue in society. Rape can happen anywhere, to anyone, and Burgess thinks it all boils down to the cultural emphasis on aggression. “We’ve all become complacent to the violence in the world that we live in,” as panelist Lynden Harris put it. As a society, we perpetuate aggressive masculinity, often without even realizing it. And especially in communities like the military, where women and men alike are highly regulated and taught to avoid showing weakness at all costs, the stigma surrounding sexual assault is intense. Commander Alana Burden-Huber, director of public health services at the Cherry Point Naval Health Clinic, shared her perspective that it can be very difficult to come forward in such a world of conformity. She also mentioned that female jurors in sexual assault cases tend to be much harsher on female survivors than male jurors, and attributes this to the fact that female members of the military are constantly trying to be harder and more stoic, so as to parallel military men.

Mindy Oshrain and Ann Burgess listen intently to the contributions of other panelists

Panelist Mindy Oshrain, a consulting associate in the Duke Department of Psychiatry, quieted the crowd by sharing a moving quote from Maya Angelou: “There is no greater agony than bearing an untold story inside of you.” She reminded us that it is so important to listen to patients, and slow down enough to ask someone multiple times if they are doing okay. It is easy to forget this at a place like Duke, where we are all constantly moving 100 miles a minute, checking boxes as we rush from one activity to the next, but it can make all the difference to stop, and take the time to ask again- How are you really doing? What can I do to support you? Empathy has the power to change the world.

As a sophomore, I now live in a building full of young women on the edge of Central Campus, on a street that is only serviced by Duke transportation in one direction. Just a few months ago, I woke up to a Duke Alert message on my phone, which informed me that a violent rape crime had occurred in the night, just fifty yards from my apartment. While we may have come a long way since the 1970s, the unavoidable fact remains that as young women living in this world, we are not safe. Let’s change that.

Post by Anne Littlewood, Trinity ’21

Using Genetic Clues to Reform Cardiac Care

Experiencing cardiac arrest can be compared to being in a hot air balloon in a room that is rapidly filling with water. You are trapped, desperately aware of the danger you are in, and running out of time.

Andrew Landstrom, PHD, MD, shared this metaphor with his audience in the Duke Medicine Pavilion last Thursday, and a wave of empathy flooded through his listeners. He works as an Assistant Professor of Pediatrics in Duke University’s School of Medicine, and devotes his time and energy to studying the genetic and molecular causes of sudden cardiac death in the young.

Andrew Landstrom, PHD, MD (Photo from Duke Center for Applied Genomics and Precision Medicine)

For families of children who have died suddenly and unexpectedly, the worst thing of all is hearing their doctors say, “we have no idea why.” A third of sudden death cases in children have negative autopsies, which means these children die with no explanation.

When faced with an inconclusive autopsy, everyone wants answers. Why did these children die? How do we know it’s a problem with the heart? What can be done about it? What does it mean for the siblings of the child who died?

It has since been discovered that many of these unexplained deaths are actually the result of cardiac channelopathies, which are DNA mutations that cause ion channel defects in heart cell proteins. These mutations can mess up the electrical activity of the heart and cause a heart to beat in an irregular rhythm, which can have fatal consequences. Since this is a molecular problem, and not a structural one, it cannot be identified with a conventional autopsy, and requires a deeper level of genetic and molecular analysis.

One type of channelopathy is a condition known as CPVT, which is short for catecholaminergic polymorphic ventricular tachycardia. This potentially life-threatening genetic disorder is the result of a point mutation in the genome, which means that one tiny nucleotide being changed in the DNA can lead to the single most fatal arrhythmia (irregular heart rhythm) known.

Sixty percent of children suffering from CPVT have a mutation in their RYR2 gene. This gene encodes for a protein that is found in cardiac muscle, and is a key player in how calcium is processed in heart cells. The mutated version of this gene results in proteins that let way too much calcium flood the cell, which can cause fatal changes in heart rhythm.

Dr. Landstrom has been using genome research to identify and explain sudden cardiac death in children, but the human genome doesn’t always provide straightforward answers. The problem is, a mutation in the RYR2 gene doesn’t always mean a person will have CPVT, and having an incidental RYR2 gene is much more common than being diagnosed with CPVT. Dr. Landstrom is studying this gene to try to figure out which variants are pathologic, and which are physiological.

“The human genome is a lot more confusing than I think I gave it credit for, and we’re just learning to deal with that confusion now,” he admitted to his audience Feb. 14.

The Components of the Human Genome (photo from NHS National Genetics and Genomics Education Centre)

If a variant is falsely identified as pathologic, a patient will be given incorrect therapies, and suffer through unnecessary procedures. However, if a variant is falsely identified as physiological, and the patient isn’t given the necessary treatment, there will be no mitigation of the patient’s life threatening disease. Neither of these are good outcomes, so it’s very important to get it right. The current models for predicting pathogenicity are poor, and Dr. Landstrom is looking to design new model that will be able to avoid the personal, subjective opinions of human doctors and determine if a variant is pathologic or not.

Could serotonin levels be used to predict an infant’s vulnerability to SIDS? (photo from Elmedir, Wikimedia Commons)

Another area that is of interest to Dr. Landstrom is the problem of Sudden Infant Death Syndrome (SIDS), which affects about six in every 10,000 infants, and cannot be diagnosed before death. He is on the search for a biomarker that would be able to predict an infant’s vulnerability to SIDS, and thinks that these deaths may be related to elevated levels of serotonin. Finding a marker like this would allow doctors to save many healthy infants from unexplained death. Dr. Landstrom knows its not easy research and admitted “we have to fail — we are meant to fail,” on the path to success. He is very aware of both the ethical complexity and the exciting implications of genome research at Duke, and committed to converting his research into patient care.

Post by Anne Littlewood

The Importance of Moms

Emily Bray, Ph.D., might have the best job ever. Since earning her bachelor’s at Duke in 2012, she has been researching cognitive development in puppies, which basically means she’s spent the last seven years playing with dogs. If that’s not success, I don’t know what is.

Last Friday marked the 10th birthday of Duke’s Canine Cognition Center, and the 210th birthday of Charles Darwin. To celebrate, Brian Hare, Ph.D., invited former student Bray back to campus to share her latest research with a new generation of Duke undergraduates. The room was riveted — both by her compelling findings and by the darling photos of labs and golden retrievers that accompanied each slide.

Dr. Emily Bray shows photos of her study participants

During her Ph.D. program at the University of Pennsylvania, Bray worked with Robert Seyfarth, Dorothy Cheney, and James Serpell to investigate the effects of mothering on puppy development. For her dissertation, she studied a population of dog moms and their puppies at The Seeing Eye, Inc. The Seeing Eye is one of the oldest and largest guide dog schools in the U.S. They have been successfully raising and training service dogs for the blind since 1929, but like most things, it is still an imperfect science. Approximately half of the puppies bred at The Seeing Eye fail out of program. A dog that completes service training at The Seeing Eye represents two years of intensive training and care, and investing so much time and money into a dog that might eventually fail is problematic. Being able to predict the outcomes of puppies would save a lot of wasted time and energy, and Emily Bray has been doing just this.

What makes a good dog mom? (Photo from Dirk Vorderstraße, from Wikimedia Commons)

Through her work at The Seeing Eye, Bray found that, similar to humans, dogs have several types of mothering styles. She discovered that dog moms tend to fall somewhere on the spectrum from low to high maternal involvement. Some of the moms were very involved with their puppies, and seldom left their side. These hovering moms had high levels of cortisol, and became quite stressed when separated briefly from a puppy. They coddled their children, and often nursed from a laying down position, doing everything they could to make life easy for their babies. On the other side of the spectrum, Bray also observed moms that displayed much more relaxed mothering. They often took personal time, and let their puppies fend for themselves. They were more likely to nurse while sitting or standing up, which made their children work harder to feed. They were less stressed when separated from a puppy, and also just had generally lower levels of cortisol. Sound like bad parenting? Believe it or not, this tough love actually resulted in more successful puppies.

Duke’s very own assistance dogs in training!

As the puppies matured, Bray conducted a series of cognitive and temperament tests to determine if maternal style was associated with a certain way of thinking in the puppies. Turns out, dogs who experienced high maternal care actually performed much worse on the tests than dogs who were shown tough love when they were young. At The Seeing Eye graduation, it was also determined that high maternal care and ventral nursing was associated with failure. Puppies that were over-mothered were more likely to fail as service dogs.

Her theory is that tough love raises more resilient puppies. When mom is always around, the puppies don’t get the chance to experience small stressors and learn how to deal with challenge. The more relaxed moms actually did their kids a favor by not being so overbearing, and allowed for much more independent development.

Bray is now doing post-doctoral research at the University of Arizona, where she is working with Canine Companions for Independence (CCI) to determine if maternal style has similar effects on the outcomes of dogs that will be trained to assist people with a wide range of disabilities. She is also now doing cognition and temperament tests on moms pre-pregnancy to determine if maternal behavior can be predicted before the dogs have puppies. Knowing this could be a game changer, as this information could be used for selective breeding of better moms.

Me snuggling Ashton, one of the Puppy Kindergarten dogs

If you got the chance to hang out with puppies Ashton, Aiden, or Dune last semester, you have an idea of how awesome Bray’s day-to-day work is. These pups were bred at CCI, and sent to Duke to be enrolled in Duke Puppy Kindergarten, a new program on campus run through Duke’s Canine Cognition Center. Which of these three will make it to graduation? I’ve got money on Ashton, but I guess we’ll have to wait and see.

The bottom line according to Bray? “Mothering matters, but in moderation.”

HIV Can Be Treated, But Stigma Kills

Three decades ago, receiving an HIV diagnosis was comparable to being handed a death sentence. But today, this is no longer the case.

Advances in HIV research have led to treatments that can make the virus undetectable and untransmittable in less than six months, a fact that goes overlooked by many. Treatments today can make HIV entirely manageable for individuals.

However, thousands of Americans are still dying of HIV-related causes each year, regardless of the fact that HIV treatments are accessible and effective. So where is the disconnect coming from?

On the 30th anniversary of World AIDS Day, The Center for Sexual and Gender Diversity at Duke University hosted a series of events surrounding around this year’s international theme: “Know Your Status.”

One of these events was a panel discussion featuring three prominent HIV/AIDS treatment advocates on campus, Dr. Mehri McKellar, Dr. Carolyn McAllaster, and Dr. Kent Weinhold, who answered questions regarding local policy and current research at Duke.

From left to right: Kent Weinhold, Carolyn McAllaster, Mehri McKellar and moderator Jesse Mangold in Duke’s Center for Sexual and Gender Diversity

The reason HIV continues to spread and kill, Dr. McKellar explained, is less about accessibility, and more about stigma. Research has shown that stigma shame leads to poor health outcomes in HIV patients, and unfortunately, stigma shame is a huge problem in communities across the US.

Especially in the South, she said, there is very little funding for initiatives to reduce stigma surrounding HIV/AIDS, and people are suffering as a result.

In 2016, the CDC reported that the South was responsible for 52 percent of all new HIV diagnoses and 47 percent of all HIV-related deaths in the US.

If people living with HIV don’t feel supported by their community and comfortable in their environment, it makes it very difficult for them to obtain proper treatment. Dr. McKellar’s patients have told her that they don’t feel comfortable getting their medications locally because they know the local pharmacist, and they’re ashamed to be picking up HIV medications from a familiar face.

 

HIV/AIDS Diagnoses and Deaths in the US 1981-2007 (photo from the CDC)

In North Carolina, the law previously required HIV-positive individuals to disclose their status and use a condom with sexual partners, even if they had received treatment and could no longer transmit the virus. Violating this law resulted in prosecution and a prison sentence for many individuals, which only enforced the negative stigma surrounding HIV. Earlier this year, Dr. McAllaster helped efforts to create and pass a new version of the law, which will make life a lot easier for people living with HIV in North Carolina.

So what is Duke doing to help the cause? Well, In 2005, Duke opened the Center for AIDS Research (also known as CFAR), which is now directed by Dr. Kent Weinhold. In the last decade, they have focused their efforts mainly on improving the efficacy of the HIV vaccine. The search for a successful vaccine has been long and frustrating for CFAR and the Duke Human Vaccine Institute, but Dr. Weinhold is optimistic that they will be able to reach the realistic goal of 60 percent effectiveness in the future, although he shied away from predicting any sort of timeline for this outcome.

Pre-exposure prophylaxis or PrEP (photo from NIAID)

Duke also opened a PrEP Clinic in 2016 to provide preventative treatment for individuals who might be at risk of getting HIV. PrEP stands for pre-exposure prophylaxis, and it is a medication that is taken before exposure to HIV to prevent transmission of the virus. Put into widespread use, this treatment is another way to reduce negative HIV stigma.

The problem persists, however, that the people who most need PrEP aren’t getting it. The group that has the highest incidence of HIV is males who are young, black and gay. But the group most commonly receiving PrEP is older, white, gay men. Primary care doctors, especially in the South, often won’t prescribe PrEP either. Not because they can’t, but because they don’t support it, or don’t know enough about it.

And herein lies the problem, the panelists said: Discrimination and bias are often the results of inadequate education. The more educated people are about the truth of living with HIV, and the effectiveness of current treatments, the more empathetic they will be towards HIV-positive individuals.

There’s no reason for the toxic shame that exists nationwide, and attitudes need to change. It’s important for us to realize that in today’s world, HIV can be treated, but stigma kills.

Post by Anne Littlewood

Math on the Basketball Court

Boston Celtics data analyst David Sparks, Ph.D, really knew his audience Thursday, November 8, when he gave a presentation centered around the two most important themes at Duke: basketball and academics. He gave the crowd hope that you don’t have to be a Marvin Bagley III to make a career out of basketball — in fact, you don’t have to be an athlete at all; you can be a mathematician.

David Sparks (photo from Duke Political Science)

Sparks loves basketball, and he spends every day watching games and practices for his job. What career fits this description, you might ask? After graduating from Duke in 2012 with a Ph.D. in Political Science, Sparks went to work for the Boston Celtics, as the Director of Basketball Analytics. His job entails analyzing basketball data and building statistical models to ensure that the team will win.

The most important statistic when looking at basketball data is offensive / defensive efficiency, Sparks told the audience gathered for the “Data Dialogue” series hosted by the Information Initiative at Duke. Offensive efficiency translates to the number of points per possession while defensive efficiency measures how poorly the team forced the other offense to perform. These are measured with four factors: effective field goal percentage (shots made/ shots taken), turnover rate, successful rebound percentage, and foul rate. By looking at these four factors for both offensive and defensive efficiency, Sparks can figure out which of these areas are lacking, and share with the coach where there is room for improvement. “We all agree that we want to win, and the way you win is through efficiency,” Sparks said.

Since there is not a lot of room for improvement in the short windows between games during the regular season, a large component of Sparks’ job involves informing the draft and how the team should run practices during preseason.

David Sparks wins over his audience by showing Duke basketball clips to illustrate a point. Sparks spoke as part of the “Data Dialogue” series hosted by the Information Initiative at Duke.

Data collection these days is done by computer software. Synergy Sports Technology, the dominant data provider in professional basketball, has installed cameras in all 29 NBA arenas. These cameras are constantly watching and coding plays during games, tracking the locations of each player and the movements of the ball. They can analyze the amount of times the ball was touched and determine how long it was possessed each time, or recognize screens and calculate the height at which rebounds are grabbed. This software has revolutionized basketball analytics, because the implication of computer coding is that data scientists like Sparks can go back and look for new things later.

The room leaned in eagerly as Sparks finished his presentation, intrigued by the profession that is interdisciplinary at its core — an unlikely combination of sports and applied math. If math explains basketball, maybe we can all find a way to connect our random passions in the professional sphere.

The Importance of Evidence in Environmental Conservation

What counts as good evidence?

In medical research, a professional might answer this question as you would expect: evidence can be trusted if it is the result of a randomized, controlled, double-blind experiment, meaning the evidence is only as strong as the experiment design. And in medicine, it’s possible (and important) to procure this kind of strong evidence.

But when it comes to conservation, it’s a whole different story.

Dr. David Gill (photo from The Nicholas School)

The natural world is complicated, and far beyond our control. When studying the implications of conservation, it’s not so easy to design the kind of experiment that will produce “good” evidence.

David Gill, a professor in Duke’s Nicholas School for the Environment, recently led a study featured in the journal Nature that needed to  define what constitutes good evidence in the realm of marine conservation. Last Wednesday, he made a guest appearance in my Bass Connections meeting to share his work and a perspective on the importance of quality evidence.

Gill’s research has been centered around evaluating the effectiveness of Marine Protected Areas (or MPAs) as a way of protecting marine life. Seven percent of the world’s oceans are currently designated as MPAs, and by 2020, the goal is to increase this number to 10 percent. MPAs arguably have massive effects on ecosystem health and coastal community functioning, but where is the evidence for this claim?

Although past investigations have provided support for creating MPAs,  Gill and his team were concerned with the quality of this evidence, and the link between how MPAs are managed and how well they work. There have historically been acute gaps in study design when researching the effects of MPAs. Few experiments have included pre-MPA conditions or an attempt to control for other factors. Most of these studies have been done in hindsight, and have looked only at the ecological effects within the boundaries of MPAs, without any useful baseline data or control sites to compare them to.

As a result of these limitations, the evidence base is weak. Generating good evidence is a massive undertaking when you are attempting to validate a claim by counting several thousand moving fish.

Gill’s measure of ecosystem health includes counting fish. (Photo from Avoini)

So is there no way to understand the impacts of MPAs? Should conservation scientists just give up? The answer is no, absolutely not.

To produce better evidence, Gill and his team needed to design a study that would isolate the effects of MPAs. To do this, they needed to account for location biases and other confounding variables such as the biophysical conditions of the environment, the population density of nearby human communities, and the national regulations in each place.

The solution they came up with was to compare observations of current conditions within MPAs to “counterfactual” evidence, which is defined as what would have happened had the MPA not been there. Using statistical matching of MPAs to nearby non-MPA and pre-MPA sites, they were able to obtain high-quality results.

A happy sea turtle pictured in a marine protected area (photo from English Foreign and Commonwealth Office.)

The research showed that across 16,000 sampled sites, MPAs had positive ecological impacts on fish biomass in 71 percent of sites. They also discovered that MPAs with adequate staffing had far greater ecological impacts than those without, which is a pretty interesting piece of feedback when it comes to future development. It’s probably not worth it to create MPAs before there is sufficient funding in place to maintain them.

Gill doesn’t claim that his evidence is flawless; he fully admits to the shortcomings in this study, such as the fact that there is very little data on temperate, coldwater regions — mostly because there are few MPAs in these regions.

The field is ripe for improvement, and he suggests that future research look into the social impacts of MPAs and the implications of these interventions for different species. As the evidence continues to improve, it will be increasingly possible to maximize the win-wins when designing MPAs.

Conservation science isn’t perfect, but neither is medicine. We’ll get there.

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