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

Author: Cydney Livingston Page 1 of 3

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

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

Duke Junior Mixes Memory Research with Criminal Justice Reform

What do you get when you mix double majors in Philosophy and Psychology with a certificate in Philosophy, Politics, and Economics? You get someone like Kelis Johnson, a junior from Lithonia, Georgia in suburban Atlanta, who works in not one research lab at Duke, but two.

Kelis is a member of The Marsh Lab studying learning and memory in Psychology and Neuroscience, and The Wilson Center for Science and Justice at Duke Law, using legal and scientific research to advance criminal justice reform.

Kelis Johnson, member of the Marsh Lab and the Wilson Center for Science and Justice

“Managing two research assistant positions while working as an embedded writing consultant with the Thompson Writing Studio, on top of my academics, can definitely be a challenge,” Kelis says. But, she said, “The way that I have been able to manage these positions along with the rest of my busy schedule is cohesion: Although working in a lab provides a different context than the material from my classes, I think my lab work and classwork supplement one another in a profound way.”

After taking a class with Elizabeth Marsh, the lab’s Principal Investigator, Kelis found herself “interested in deepening [her] knowledge of and experience with memory research,” so she reached out to get involved in the summer of 2020. The lab has provided her a means to explore her interests in the “intersections between memory and personal identity, education and the law.”

Simultaneously, in the midst of the (first) Covid-19 summer, Kelis worked with the Microworlds Lab. She conducted historical research that profiled Black female activists. “I felt like my interests and passions began to converge on activism and bringing about change while also exploring empirical research,” she said, “This passion aligned with the work being done at the Wilson Center who use research to advance civil rights.” She joined her second lab in the fall of 2020.

Dr. Elizabeth Marsh surrounded by research assistants of the Marsh Lab

In both positions, Kelis meets weekly with her fellow colleagues to discuss an overview of the labs work or the current research in the field. She finds this fulfilling, knowing that the work she and fellow research assistants have contributed to is providing “concrete advancements … in the labs and the world more broadly.” Kelis’ work consists mostly of coding or scoring data. This means reading study participants’ responses and using a codebook (like a grading rubric) to determine how each response compares to the standard established in the experimental protocol. Kelis also participates in literature reviews and stimuli creation, where she generates relevant material such as questions, statements, or images that will be used in experiments to test research questions.

This work has enabled Kelis to meet fellow undergraduates, along with graduate students and faculty mentors, who have similar interests to her own. She has learned more about grant writing, research ethics, and statistical tools. Along with providing her invaluable research experience, strengthening her passions for criminal justice reform, and reinforcing her plans to go to law school following graduation from Duke, through her work with the Wilson Center, Kelis has been able to learn more about Durham and North Carolina. This prompted her to think deeper about her role in the larger communities around her.

Image of Duke Law School, where the Wilson Center is located.

Kelis’ research is valuable outside of the lab. “Memory research is essential to how we learn, how we structure our life and personal identity, and how we form relationships with others,” Kelis said. She also stated that, “Learning about and reforming our criminal justice system is something we must all care about. In order to attack the systematic oppression of marginalized groups, we have to understand it.”

Unfortunately, due to Covid-19, Kelis has been unable to participate in person with either of her labs. This is something she is emphatically looking forward to. However, the virtual realm has enabled other forms of meaningful interactions and experiences through digital platforms. Kelis says she really appreciates “the events hosted by the [Wilson Center] Lab that often feature exonerated individuals who speak about their experience within the criminal justice system.”

Kelis’ contributions to projects from memory difference in older and younger adults to autobiographical memory are surely only the first steps in a planned lifetime of standing at the intersection between memory, identity, and the structures of our society.

Post by Cydney Livingston

Centering Patients and Expanding Access in the Opioid Epidemic

We are still in the midst of an opioid epidemic. In 2019, an average of six North Carolinians died each day from unintentional medication or drug overdose. A striking 79% of drug overdose deaths in NC in 2018 involved opioids. This has garnered attention from many organizations and institutions in the state and prompted new concerns relating to patient-centered care.

A Duke Global Health discussion on March 17 concluded that the social response can be aided by a refined focus on mental health, as well as the use of telehealth – the delivery of health care and education remotely through various technologies.

Moderated by Brandon Knettel (Ph.D.), the Duke Global Health Institute panel considered treatment, community engagement, and public policy in addressing the opioid epidemic with panelists Nidhi Sachdeva (MPH), Padma Gulur (M.D.) Hilary Campbell (PharmD, J.D.), and Theresa Coles (Ph.D.)

Sachdeva is a Senior Research Program Leader with the Department of Population Health Sciences at Duke Medical School. Dr. Gulur is a Professor of Anesthesiology and Population Health with Duke Medical School and Executive Vice Chair of the Pain Management and Opioid Surveillance with Duke University Health System. Campbell is director of Sheps Health Workforce Health Professions Data System at UNC-Chapel Hill. Coles is Assistant Professor in Population Health Sciences with Duke Medical School.

Sachdeva opened the panel with a discussion of the Duke Opioid Collaboratory. The Collaboratory currently houses 25 different projects relating to improving data surveillance, health system quality, and public health in the realm of research on opioids.

“We’re losing more and more folks every day,” said Sachdeva. Duke’s projects represent a systems approach to the opioid epidemic, meaning there is lots of valuable overlap and connectivity between projects, and external partnerships that have provided a unique opportunity for academic and community collaboration.

Dr. Gulur stated that Duke Health has seen improvements in opioid use and prescription over the last five to six years: the ambulatory prescribing rate has gone down, fewer patients are requiring high-dose opioids overall, and there has been significant increase in availability to offer medication-assisted treatment for opioid use disorder. Like Sachdeva, Gulur’s work with Duke’s Pain Management and Opioid Surveillance exists within a larger network of organizations dedicated to the opioid issue.

“We have a very committed and collaborative infrastructure with [other] initiatives in the state,” said Gulur, who added that she is dedicated to making “sure we have all the voices at the table.”

A collective display of the Duke Opioid Collaboratory projects

Simply decreasing opioid prescriptions “doesn’t necessarily work” and solving this issue will not be a quick fix. Campbell said that her own research found that at the same time the “supply side” of opioids was shrinking, the state was “seeing the crisis getting worse.”

Enter telehealth and the need for expanded support to mental health resources. Coles explained their pertinence through discussion of her work with Granville-Vance Public Health. Coles has been working on an expanding project that assesses training, operational challenges, patient centered goals, and success from the patient’s perspective within Granville-Vance’s opioid program.

Coles found that inconsistent funding lead to lapses in access to mental health support and the “dropout of someone there to help [with behavioral health] was challenging for patients.” Telehealth bridges the gaps of inconsistent access. Further, in the case of Coles’ study, it also played a large role in increased access for patients who experienced transportation issues since the investigation took place in conjunction to Covid-19, which lowered patients’ abilities to physically attend the program in-person.

Because “no one person experiences opioid abuse … in a vacuum,” as Sachdeva said, it is important to get a comprehensive “assessment of what a person’s life looks like and their priorities for treatment” before jumping into treatment.

This map displays the concentration of unintentional medication and drug overdose death rates across the 100 counties of North Carolina.

Though the last year living under the Covid-19 pandemic has been difficult for the entire globe, the increased need for access to resources through the internet and various technologies has been positively reinforced. With new understandings of relationships to others and limited physical access to in-person healthcare, telehealth has emerged as a means to resolve decreased access. It can also serve as a way to expand access for populations who have historically suffered from inadequate access to healthcare resources, like rural populations.

Opioids “have and will continue to play a role in pain management,” Dr. Gulur said. However, better efforts to involve patients and their families in decision making around opioids, as well as more fully informed understandings of the potential risks and side effects, is necessary for centering patient priorities in care management.

Sachdeva emphasized a “nothing about us without us” philosophy for approaching the opioid epidemic. This means that the systems of care being changed to address opioid crises must depend directly on people who use opioids. It is important to center “lived experience through the whole thing.” Because each community is different, it is inadequate to make assumptions about “what a community is, what it might need, or what its story is.”

The self-described objectives of the Duke Opioid Collaboratory, which overlaps largely with other initiatives discussed during the panel.

Underlying this work is a question from Dr. Gulur, “What are you trying to treat?”

To treat the opioid epidemic, we need to treat people as complex, multi-dimensional people living complicated lives. Opioid use is only one facet of this narrative, making it pertinent to understand the rest of the story to adequately tackle this problem our nation faces. Mental health and access to care are central to this collective narrative more largely.

Post by Cydney Livingston

Increasing Access to Care with the Help of Big Data

Artificial intelligence (AI) and data science have the potential to revolutionize global health. But what exactly is AI and what hurdles stand in the way of more widespread integration of big data in global health? Duke’s Global Health Institute (DGHI) hosted a Think Global webinar Wednesday, February 17th to dive into these questions and more.  

The webinar’s panelists were Andy Tatem (Ph.D), Joao Vissoci (Ph.D.), and Eric Laber (Ph.D.), moderated by DGHI’s Director of Research Design and Analysis Core, Liz Turner (Ph.D.).  Tatem is a professor of spatial demography and epidemiology at the University of South Hampton and director of WorldPop. Vissoci is an assistant professor of surgery and global health at Duke University. Laber is a professor of statistical science and bioinformatics at Duke.

Panelist moderator, Lisa Turner

Tatem, Vissoci, and Laber all use data science to address issues in the global health realm. Tatem’s work largely utilizes geospatial data sets to help inform global health decisions like vaccine distribution within a certain geographic area. Vissoci, who works with the GEMINI Lab at Duke (Global Emergency Medicine Innovation and Implementation Research), tries to leverage secondary data from health systems in order to understand issues of access to and distribution of care, as well as care delivery. Laber is interested in improving decision-making processes in healthcare spaces, attempting to help health professionals synthesize very complex data via AI.

All of their work is vital to modern biomedicine and healthcare, but, Turner said, “AI means a lot of different things to a lot of different people.” Laber defined AI in healthcare simply as using data to make healthcare better. “From a data science perspective,” Vissoci said, “[it is] synthesizing data … an automated way to give us back information.” This returned info is digestible trends and understandings derived from very big, very complex data sets. Tatem stated that AI has already “revolutionized what we can do” and said it is “powerful if it is directed in the right way.”

A screenshot from worldpop.org

We often get sucked into a science-fiction version of AI, Laber said, but in actuality it is not some dystopian future but a set of tools that maximizes what can be derived from data.

However, as Tatem stated, “[AI] is not a magic, press a button” scenario where you get automatic results. A huge part of work for researchers like Tatem, Vissoci, and Laber is the “harmonization” of working with data producers, understanding data quality, integrating data sets, cleaning data, and other “back-end” processes.

This comes with many caveats.

“Bias is a huge problem,” said Laber. Vissoci reinforced this, stating that the models built from AI and data science are going to represent what data sources they are able to access – bias included. “We need better work in getting better data,” Vissoci said.

Further, there must be more up-front listening to and communication with “end-users from the very start” of projects, Tatem outlined. By taking a step back and listening, tools created through AI and data science may be better met with actual uptake and less skepticism or distrust. Vissoci said that “direct engagement with the people on the ground” transforms data into meaningful information.

Better structures for meandering privacy issues must also be developed. “A major overhaul is still needed,” said Laber. This includes things like better consent processes for patients’ to understand how their data is being used, although Tatem said this becomes “very complex” when integrating data.

Nonetheless the future looks promising and each panelist feels confident that the benefits will outweigh the difficulties that are yet to come in introducing big data to global health. One cool example Vissoci gave of an ongoing project deals with the influence of environmental change through deforestation in the Brazilian Amazon on the impacts of Indigenous populations. Through work with “heavy multidimensional data,” Vissoci and his team also have been able to optimize scarcely distributed Covid vaccine resource “to use in areas where they can have the most impact.”

Laber envisions a world with reduced or even no clinical trials if “randomization and experimentation” are integrated directly into healthcare systems. Tatem noted how he has seen extreme growth in the field in just the last 10 to 15 years, which seems only to be accelerating.

A lot of this work has to do with making better decisions about allocating resources, as Turner stated in the beginning of the panel. In an age of reassessment about equity and access, AI and data science could serve to bring both to the field of global health.

Post by Cydney Livingston

Student Team Quantifies Housing Discrimination in Durham

Home values and race have an intimate connection in Durham, NC. From 1940 to 2020, if mean home values in Black-majority Census tracts had appreciated at rates equal to those in white Census tracts, the mean home value for homes in Black tracts would be $94,642 higher than it is.

That’s the disappointing, but perhaps not shocking, finding of a Duke Data+ team.

Because housing accounts for the biggest portion of wealth for families that fall outside of the top 10% of wealth in the U.S., this figure on home values represents a pervasive racial divide in wealth.

What started as a Data+ project in the summer of 2020 has expanded into an ongoing exploration of the connection between persistent wealth disparities across racial lines through housing. Omer Ali (Ph.D.), a postdoctoral associate with The Samuel Dubois Cook Center on Social Equity, is leading undergraduates Nicholas Datto and Pei Yi Zhuo in the continuation of their initial work. The trio presented an in-depth analysis of their work and methods Friday, February 5th during a Data Dialogue.

The team used a multitude of data to conduct their analyses, including the 1940 Census, Durham County records, CoreLogic data for home sales and NC voter registrations. Aside from the nearly $100,000 difference between mean home values between Black census tracts (defined as >50% Black homeowners from 1940-2020) and white census tracts (defined as >50% white homeowners from 1940-2020), Ali, Datto, and Zhou also found that over the last 10 years, home values have risen in Black neighborhoods as they have been losing Black residents. Within Census tracts, the team said that Black home-buyers in Durham occupy the least valuable homes.

Home Owners Loan Corporation data

Datto introduced the concept of redlining — systemic housing discrimination — and explained how this historic issue persists. From 1930-1940, the Home Owners’ Loan Corporation (HOLC) and Federal Housing Administration (FHA) designated certain neighborhoods unsuitable for mortgage lending. Neighborhoods were given a desirability grade from A to D, with D being the lowest.

In 1940, no neighborhoods with Black residents were designated as either A or B districts. That meant areas with non-white residents were considered more risky and thus less likely to receive FHA-guaranteed mortgages.

Datto explained that these historic classifications persist because the team found significant differences in the amount of accumulated home value over time by neighborhood rating. We are “seeing long-lasting effects of these redlined maps on homeowners in Durham, “ said Datto, with even “significant differences between white [and non-white] homeowners, even in C and D neighborhoods.”

Zhou explained the significance of tracking the changes of each Census tract – Black, white, or integrated – over the last 50 years. The “white-black disparity [in home value] has grown by 287%” in this time period, he said. Homes of comparable structural design and apparent worth are much less valuable for simply existing in Black neighborhoods and being owned by Black people. And the problem has only expanded.

Along with differences in home value, both Black and white neighborhoods have seen a decline in Black homeowners in the 21st Century, pointing to a larger issue at hand. Though the work done so far merely documents these trends, rather than looking for correlation that may get at the underlying causes of the home-value disparity, the trends pair closely with other regions across the country being impacted by gentrification.

“Home values are going up in Black neighborhoods, but the number of Black people in those neighborhoods is going down,” said Datto.

Ali pointed out that there are evaluation practices that include evaluation of the neighborhood “as opposed to the structural properties of the home.” When a house is being evaluated, he said a home of similar structure owned by white homeowners would never be chosen as a comparator for a Latinx- or Black-owned home. This perpetuates historical disparities, as “minority neighborhoods have been historically undervalued” it is a compounding, systemic cycle.

The team hopes to export their methodology to a much larger scale. Thus far, this has presented some back-end issues with data and computer science, however “there is nothing in the analysis itself that couldn’t be [applied to other geographical locations,” they said.

Large socioeconomic racial disparities prevail in the U.S., from gaps in unemployment to infant mortality to incarceration rates to life expectancy itself. Though it should come as no surprise that home-values represent another area of inequity, work like Ali, Datto, and Zhou are conducting needs more traction, support, and expansion.

Post by Cydney Livingston

Invisible No More, the Cervix

How many people have seen their cervix? Obscured from view and stigmatized socially, the cervix is critical to women’s, transgender-men’s, and non-binary folks’ health — and potential reproductive health issues. A team formed through Duke’s Center for Global Women’s Health Technologies (GWHT) has created a device that not only holds immense medical potential but the potential to empower people with cervixes across the globe: It makes visible a previously invisible organ. 

Nimmi Ramanujam (Ph.D.), founder of GWHT and Professor of Engineering at Duke University, heads the team. Mercy Asiedu (Ph.D.), Gita Suneja (M.D.) Wesley Hogan (Ph.D.), and Andrea Kim have all been integral members of the interdisciplinary collaboration. Dr. Suneja is Associate Professor of Radiation Oncology at the University of Utah School of Medicine and a clinical researcher. Asiedu, former PhD student with Dr. Ramanujam and current postdoc at MIT, was integral to the development of Callascope.

The Callascope allows women and others who have cervixes, along with health professionals, to perform cervical exams without use of traditional examination tools that are larger, cannot be used for self-examinations, and often scary-looking.

When Wesley Hogan, director of Duke’s Center for Documentary Studies and research professor, heard about the idea “she was hooked.” Andrea Kim graduated from Duke University in 2018. Her senior thesis was a 12 minute documentary focused on the Callascope and its potential uses. Following graduation, over the last two years, she expanded the film to a 50-minute piece titled  “The (In)visible Organ” that was screened January 14, 2021. Kim moderated a panel with Ramanujam, Asiedu, Suneja and Hogan January 28th, 2021. 

Callascope: A handheld device that can be used to conduct cervical screenings. All that’s needed is a smart phone.

The Callascope addresses a dire global health need for better women’s reproductive health. Further, it empowers women as self-advocates of their own gynecological and reproductive health through reinvention of gynecological examination. Cervical cells have an “orderly progression,” says Suneja, we have a “great idea” of how cells become cancerous over time, “with multiple places to intervene.” Cervical examinations, however, are necessary for assessing cervical health and potential disease progression.

Originally from Ghana, Dr. Asiedu was interested in using her engineering skills to develop technology to “improve health outcomes,” particularly in countries like her own, which may lack adequate access to preventative healthcare and could benefit most from Callascope. Many women in underserved countries, as well as underserved areas of the United States, suffer disproportionately from cervical cancer — a preventable disease. 

Dr. Ramanujam, who served as a voluntary test-subject for Asiedu’s Callascope prototypes, says that it’s a really important tool “in actually changing [the cervix’s] narrative in a positive way” — it is an organ “that is indeed invisible.”

The hope is that with more awareness about and use of Callascope, cervical screenings, and vaginal health, cervixes may become more de-stigmatized and cultural norms surrounding them may shift to become more positive and open. Dr. Hogan stated that when Ramanujam pitched her the Callascope idea they were in a public restaurant. Hearing Ramanujam say words like “vagina” and “cervix” loud enough for others to hear made Hogan recognize her own embarrassment surrounding the topic and underscored the importance of the project. 

The project and the team serve as a wonderful example of intersectional work that bridges the sciences and humanities in effective, inspiring ways. One example was the Spring 2019 art exhibit, developed in conjunction with the team’s work, presented at the Nasher Museum which exposed the cervix through various mediums of art.

Multidisciplinary Bass Connections research teams contributed to this work and other interdisciplinary projects focused on the Callascope. Dr. Asiedu believes documentaries like Kim’s are “really powerful ways to communicate global health issues.” Kim who directed and produced “The (In)visble Organ” hopes to continue exploring how “we can create more cultures of inclusion …when it comes to reproductive health.” 

A piece of artwork from the (In)visible Organ art exhibit at Duke’s Nasher Museum in the spring of 2019.

Ramanujam emphasized the need to shift biomedical engineering focus to create technologies that center on “the stakeholders for whom [they] really [matter].” It is multi-dimensional thinkers like Ramanujam, Asiedu, Hogan, and Kim who are providing integrative and inventive ways to address health disparities of the 21st century — both the obvious and the invisible. 

Post by Cydney Livingston

Widespread Vaccination Will Depend on Faith in Science

Two Covid vaccines have been approved via Emergency Use Authorizations. But, many scientists, health professionals, and regulatory members alike are left wondering how to best ensure the American and global public opt-in to getting vaccinated.

During Friday, December 18th Coronavirus Conversation hosted by the Duke Initiative for Science & Society, honored guests Anthony Fauci (M.D.) and Alan Alda discussed the restoration of faith in public science agencies, moderated by Hank Greely (J.D.). You can view the entire program here (40 min.)

Dr. Fauci has become a household name this year as a member of the White House Coronavirus Task Force but is more widely regarded as one of the most trusted U.S. medical figures and has been director of the National Institute of Allergy and Infectious Disease since 1984.

Mr. Alda, though popularized through his acting career, has been a life-long advocate for science. He hosted PBS show “Scientific American Frontiers,” founded the Alan Alda Center for Communicating Science at SUNY Stony Brook, and recently released a podcast titled “Soldiers of Science.” At Stanford, Mr. Greely is director for the Center for Law and Biosciences and the Program in Neuroscience and Society, as well as a Professor of Law.

Greely asked about the public’s current level of trust for science and what must be done to get it “where it should be.” Alda said that there “seems to be this awful fall off of trust in science … at the worst possible time.” But Dr. Fauci pointed out that we have seen the evolution of lack of trust in science over the previous couple of years. The pandemic fell in the middle of extreme American divisiveness, he said, leading to individuals “developing their own set of facts instead of interpreting [actual] data that exists.”

Alda and Fauci both emphasized the need for transparent and clear scientific communication as a main tactic for increasing public faith in science. This includes use of the words “I don’t know,” particularly in response to the question of vaccine longevity, a question Dr. Fauci said will be answered “in due time.”

Alda said scientific communicators should “communicate with audience[s] with respect … with personal contact where trust builds up more quickly.” He pointed out that this means communicators must become more familiar with their audiences, what terms would be best to use, and what their audiences are “ready to hear.” Dr. Fauci added that when someone is “speaking science” to any group, the objective should not be to “impress the [audience] as to how smart [they] are.” The two major objectives laid out by Fauci: 1) Know the audience and 2) know your message, avoiding granularity and inaccessible language.

Greely interjected that the though all three panelists agree on trust in science, they were three white guys “of mature years.” He continued to say that, “One of the saddest ironies [is that] people getting hammered hardest by [Covid] tend to be people from racial and ethnic minorities … those are also [the same] groups of people that have understandable historic reasons to have less trust [in scientific agencies].” How do we reach these groups?

To do this, Dr. Fauci proposed that we need to get messengers for vaccination to “to look like and understand to whom [we] we are delivering the message.” Leaning into an idea by Alda – that we should get celebrities and widely-respected and admired individuals to get vaccinated on television – Fauci described how Surgeon General Jerome Adams got publicly vaccinated Friday morning.

Adams also delivered a message to his “Black and Brown sisters and brothers” in support of vaccination. Dr. Fauci believes more positive messaging like this will be effective. Alda reinforced that “we can’t guess about the people we’re trying to talk to.” We have to know about their biases and cause for hesitancy in order to meet them where they are, as well as address their concerns in genuine, non-condescending ways.

Alda also proposed that individuals snap a quick shot of themselves getting vaccinated and post it to social media as a #vaccie – a play on the #selfie sensation – which Greely said was “brilliant.”

Alda and Fauci concurred that the most powerful proponents of restoring faith in science may lie in the impact of individual civilians who share their trust in and compliance with vaccination amongst family and friends. Fauci said individuals should not “underestimate the impact that they have in their own immediate environment.”

Sandra Lindsay, an Intensive Care Unit nurse in New York, was one of the first people in the U.S. to receive the Pfizer Covid vaccine.

This impact could be either positive or negative, though, as Alda pointed out the problem with social media algorithms. While working on “Soldiers of Science,” he learned that social media sites are designed to “keep your eyeballs on the screen” as long as possible. This means that social media sites keep “showing you what you want to see,” which is your own bias and affirmation that your ideas are correct. If #vaccie starts trending, this might provide necessary momentum for widescale vaccine uptake.

However, because we have become “addicted to [our] bias” and convinced “over and over again that only our view is right,” according to Alda, we must work intentionally to see commonalities across seemingly alienating lines. Reflecting on his work with AIDS, Dr. Fauci suggested that we take what scientific communicators and regulatory bodies learned during that time. “What do we all want?” Fauci said, ”And how do we get there in a way that is synergistic [instead of] opposing?”

In his parting thoughts, Alda stated simply that “science will save us.” It has and will continue to allow us to “counterattack the attacks we get from our mother nature.” Dr. Fauci said that in dealing with the current pandemic, “biomedical research and science has given us something that just a decade ago would have seemed unimaginable.”

“When this is over, and it’s going to be over,” Fauci said, “We’re [going to] look back and say, ‘It was science that got us out of this, pure science.’”

Greely said we have learned a lot about science communication this year – invaluable information that we must carry forward with us.

I, like so many others around the world, can’t wait for my turn to get the Covid vaccine and to kiss 2020 and the pandemic goodbye.

Post by Cydney Livingston

Contact Tracing Is a Call for Ingenuity and Innovation

The sudden need for contact-tracing technologies to address the Covid-19 pandemic is inspiring some miraculous human ingenuity.

Wednesday, December 16th, Rodney Jenkins, Praudman Jain, and Kartik Nayak discussed Covid-19 contact tracing and the role of new technologies in a forum organized by the Duke Mobile App Gateway team.

Jenkins is the Health Director of Durham County’s Department of Public Health, Jain is CEO and founder of Vibrent Health. And Nayak is an Assistant Professor in Duke’s Computer Science department. The panel was hosted by Leatrice Martin (M.B.A.), Senior Program Coordinator for Duke’s Mobile App Gateway with Duke’s Clinical and Translational Science Institute.

Contact tracing is critical to slowing the spread of Covid, and Jenkins says it’s not going away anytime soon. Jenkins, who only began his position with Durham County Public Health in January 2020, said Durham County’s contact tracing has been… interesting. As the virus approached Durham, “Durham County suffered a severe malware attack that really rendered platforms…useless.”

Eventually, though, the department developed its own method of tracing through trial and error. North Carolina’s Department of Health and Human Services (NC HHS), like many other health departments across the nation in March, was scrambling to adjust. NC HHS was not able to provide support for Durham’s contact tracing until July, when Jenkins identified a serious need for reinforcement due to disproportionate Covid cases amongst Latinx community members. In the meantime, Durham county received help from Duke’s Physician Assistant students and the Blue Cross Blue Shield Foundation. They expanded their team of five to 95 individuals investigating and tracing Durham County’s positive cases.

Rodney Jenkins MPH is the health director of the Durham County Public Health Department.

Jenkins proclaimed contact tracing as “sacred to public health” and a necessary element to “boxing in” Covid-19 – along with widespread testing.

Durham’s tracing tool is conducted through a HIPPA-compliant, secure online portal. Data about individuals is loaded into the system, transmitted to the contact tracing team, and then the team calls close contacts to enable a quick quarantine response. The department had to “make a huge jump very quickly,” said Jenkins. It was this speedy development and integration of new technology that has helped Durham County Public Health better manage the pandemic.

Jain, along with colleague Rachele Peterson, spoke about his company, Vibrent Health.  Vibrent, which was recently awarded a five-year grant from the National Institutes of Health’s ‘ll of Us Research Program, is focused on creating and dispersing digital and mobile platforms for public health.

Naturally, this includes a new focus on Covid. With renewed interest in and dependency on contact tracing, Jain says there is a need for different tools to help various stakeholders – from researchers to citizens to government.  He believes technology can “become the underlying infrastructure for accelerating science.”

Vibrent identified needs for a national tracing model, including the labor intensity of manual processes, disparate tools, and lack of automation.

Peterson said that as we “are all painfully aware,” the U.S. was not prepared for Covid, resulting in no national tracing solution. She offered that the success of tracing has been mostly due to efforts of “local heroes” like Jenkins. Through their five-year award, Vibrent is developing a next-generation tracing solution that they hope will better target infectious spread, optimize response time, reduce labor burden in managing spread, and increase public trust.

Along with an online digital interface, the company is partnering with Virginia Commonwealth University to work on a statistical modeling system. Peterson likened their idea to the Waze navigation app, which relies on users to add important, real-time data. They hope to offer a visualization tool to identify individuals in close contact with infected or high-risk persons and identify places or routes where users are at higher risk.

Nayak closed the panel by discussing his work on a project complementary to contact tracing, dubbed Poirot. Poirot will use aggregated private contact summary data. Because physical distancing is key to preventing Covid spread, Nayak said it is both important and difficult to measure physical interactions through contact events due to privacy concerns over sensitive data. Using Duke as the case study, Poirot will help decision makers answer questions about which buildings have the most contact events or which populations – faculty versus students – are at higher risk. The technology can also help individuals identify how many daily contacts they have or the safest time of day to visit a particular building.

Nayak said users will only be able to learn about their own contact events, as well as aggregate stats, while decision makers can only access aggregate statistics and have no ability to link data to individuals.

Users will log into a Duke server and then privately upload their data using a technology called blinded tokens. Contact events will be discovered with the help of continuously changing, random identifiers with data summation at intermittent intervals. Data processing will use multiparty computation and differential privacy to ensure information is delinked from individuals. The tool is expected for release in the spring.

Screenshot of Duke’s Mobile App Gateway site.

Although we are just starting vaccination, the need for nationwide resources “will be ongoing,” Martin said.

We should continue to embrace contact tracing because widespread vaccination will take time, Jenkins said.

Jenkins, Jain, and Nayak are but a few who have stepped up to respond innovatively to Covid. It becomes increasingly apparent that we will continue to need individuals like them, as well as their technological tools, to ease the burden of an overworked and unprepared health system as the pandemic prevails in America.

Post by Cydney Livingston

Phase 3 Trials: What We Know About a Covid Vaccine

As multiple drug companies in the United States speed towards Phase 3 trials for Covid-19 vaccinations, there remain many unanswered questions about these vaccines. 

Moderated by Professor of Law and Philosophy, Nita Farahany (J.D., Ph.D), principal investigators Cynthia Gay (M.D., M.P.H) and Emmanuel (Chip) Walter (M.D.) explored these lingering anxieties in a Science and Society hosted Coronavirus Conversation Thursday, November 6th. Dr. Gay is an Associate Professor of Medicine at the University of North Carolia Chapel Hill (UNC) and Medical Director of the UNC HIV Cure Center. Dr. Walter is a professor of Pediatrics with Duke’s Global Health Institute, as well as a member in the Duke Clinical Research Institute and Duke Human Vaccine Institute. Both Gay and Walter are currently overseeing trials for SARS-COV-2 vaccines. 

Farahany began the conversation by pointing out that though the previous ideal of a vaccine by the US presidential election did not come to fruition, Phizer and Moderna just reached full enrollment for their Phase 3 trials. “[The timeline question] is a million-dollar question,” said Dr. Gay, who is overseeing the Moderna trials at UNC. She said that soon statisticians who have no conflicts of interest with the trials will have a look at the unblinded trial data to see if there are any differences between those who received placebo injections and those who received vaccines. Gay believes this first “peek” may be too early to see a significant signal indicating success of the vaccines. Dr. Walter weighed in, saying that though he hopes “we’ll see something,” he concurs that Dr. Gay’s estimate that no significant signal will be present until January is an accurate one. 

As Gay and Walter explained, probed for clarification from Farahany, drug companies undertaking vaccine development enrolled portions of the population at higher risk for contracting Covid — typically on the basis of their form of employment. For example, someone working in healthcare statistically has a higher likelihood of contracting Covid because of increased exposure to environments where Covid-infected persons may be. Vaccine trial groups were either assigned to a placebo or to a vaccine. The drug companies will be able to test the success of the vaccines by evaluating whether those who received the vaccine contract Covid at some statistically significant lower amount than those who received the placebo. 

But as Farahany pointed out, a drug company could receive an Emergency Use Authorization (EUA) for their vaccine before trials are complete, prompting the question: Will Phase 3 trial placebo participants receive the vaccine if their company receives an EUA? Dr. Walter offered that this could be problematic because there would be a lack of long-term data on vaccines and Dr. Gay suggested that because blinding is the best sort of study design, there is tension around this question. However, Walter and Gay both agreed that study participants should be honored for the role they stepped into for these trials. Thus, the timing for the EUA may be the biggest determinant on whether or not placebo-receiving Phase 3 participants will receive the vaccines as soon as they are available or not.

Other concerns focus on the overall safety of the vaccines. All of the current Covid vaccines in development are mRNA vaccines, which have never before been approved for use in humans. Dr. Walter offered that before Covid, some companies were actually poised to start an mRNA vaccine in children for other respiratory pathogens and that mRNA vaccines are “pretty well studied.” Dr. Gay reinforced these notions by stating that she doesn’t have concerns about the vaccine safety, but rather whether or not the vaccines will actually work for the particular strand of virus and “produce enough effective antibodies to have an impact.” If Covid vaccines are successful, they may actually change the direction of vaccinology in a promising way.

Walter and Gay also addressed the concerns of side effects and generally conceded that most of the side effects seen, such as low-grade fevers and injection-site tenderness, are merely side effects seen with any sort of vaccine. As Farahany pointed out, these sorts of symptoms are actually often just a signal that the immune system is working and responding to the vaccine. Dr. Gay said that a lot of the concerns over vaccine side-effects can be thought about as cost-benefit analysis. She says we make these sorts of analyses all day, every day — whether we realize it or not. For Gay, one day of muscle soreness and a slight fever is highly preferential to weeks of potential immobilization from contracting Coronavirus. 

The concluding question: How do we ensure trials are met with public trust? “We have to remember we’re in the middle of a pandemic where things really have to move quickly,” Dr. Walter said. He also offered that though this has been the fastest vaccine development he’s ever seen – aside from H1N1 – all of the safety mechanisms in place have provided safety comparable to that we would normally see. 

“This is a global tragedy we’re dealing with,” Dr. Gay said. “There is a time to step back and think, ‘Isn’t it amazing that all these [amazing, talented, expert] people are working day and night’ …They’re making it happen to try to get us an answer and some effective vaccines.” 

Post by Cydney Livingston

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