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

Author: Meghna Datta Page 1 of 2

Junior Alec Morlote Pursues a Love for Biology Via Fruit Flies

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As Alec Morlote emphasizes, he’s a Biology major because “I’m really interested in it. I’d definitely be a Biology major whether I was pre-med or not.”

Morlote, a Trinity junior from northern New Jersey, works in the lab of Dr. Pelin Volkan studying the neurobiology of fruit flies. Why fruit flies, of all things? Well, Morlote initially signed up for a research fellowship program during the summer following his freshman year.

Of course, in March of that year, COVID-19 happened, so Morlote ended up postponing his work to this past summer. He got paired with the Volkan lab because he didn’t want to work in an area of research that was very familiar to him.

“I wanted to use research as an opportunity to learn something completely new,” he said. The neurobiology of fruit flies hit the nail on the head.

Alec Morlote

The Volkan Lab is a cell biology and neurobiology lab that studies how social behavior, specifically courting, is affected by stimuli, using fruit flies as a model organism. Morlote’s specific project has to do with olfactory stimuli – the things flies smell. In flies, as he explained, one gene is responsible for courtship behavior in male flies. If you take out the olfactory receptor of the fly, however, that gene won’t be active.

Morlote is interested in seeing how the olfactory receptor is critical to the expression of this gene.

To do this, he has been working on imaging the antennae of flies – work he describes as “cool, but tedious.” It’s incredibly detailed work to pick apart the antenna off of such a tiny creature.  Once isolated, neurotransmitters in the antenna that have been tagged with green fluorescent protein (GFP) light up, thus showing the expression pattern of all cells expressing the neurotransmitter.

Humans clearly don’t have as simplistic a courtship behavior as fruit flies, but the simplicity of the fruit fly makes it an incredibly valuable organism for studying neurobiology. All discoveries in humans initially started with some sort of watered-down version of the human anatomy, whether mice or in this case, fruit flies. Discoveries into the neurobiology and neuroplasticity of fruit flies just might yield significant discoveries into the neurobiology and neuroplasticity of the human brain.

When asked about his favorite and least favorite parts about his research, Morlote laughed.

“I don’t like doing work for three months and getting no results at all,” he remarked in reference to the initial work he started on this summer – but alas, such is the nature of scientific research. But he adds that the best part of research is getting results, any at all. And even no results can mean something.

Morlote’s poster from his summer research

Research was a way for Morlote to narrow his post-graduation plans. He knows now that he wants to pursue an MD, or possibly an MD/PhD. But initially, research was a way for him to see whether this was the path for him at all. When asked why he chose to be pre-med, Morlote said that “it just seemed like the most practical way to apply a love for science.” Biology is the science that he loves the most, and so being pre-med seemed like a no-brainer.

It’s also a family business. Both of Morlote’s parents are doctors, so medicine “is not unfamiliar territory to me.” Being Latin American, both his parents have worked extensively with Latin communities in New Jersey, which is work he hopes to emulate in the future.

Whether or not benchwork stays a part of his life, Morlote knows that he wants his career to involve research somehow. The way he sees it, “you’re doing the bare minimum if you’re just a doctor but you’re not trying to better medicine in some way.” 

Contributing to research just might become his way.

Post by Meghna Datta, Class of 2023

Undergraduate Researchers William He and Annie Wang Dig Deeper into Hypergraphs

Like most things during the height of the pandemic, research that could be conducted virtually was conducted virtually. And that’s why, although juniors William He and Annie Wang have been working together on a research project since last September, they’ve never actually met in person.

He, a Math major from Houston, and Wang, a Computer Science and Math double-major from Raleigh, both work in the lab of Professor Debmalya Panigrahi, where the focus is on research in theoretical computer science, particularly graph algorithms. Wang and He did work on hypergraphs, and, after I asked them to explain what hypergraphs were in the most elementary terms (I am not a Math major), they went back and forth on how exactly to relay hypergraphs to a lay audience.

Annie Wang

Here is what they landed on: hypergraphs are essentially generalizations of normal graphs. In a normal graph, there are edges –each edge connects two points. There are also vertices – each point is a vertex. But in a hypergraph, each edge connects multiple points.

He and Wang were looking at a generalization of graph reliability – if all edges disconnect at a certain probability, what is the probability that the graph itself will break down because crucial edges are disconnecting?

William He

Their research adds to existing research on maximum flow problems, which Wikipedia tells us “entail finding a feasible flow through a flow network to obtain the maximum possible flow rate.” In a landmark paper written by T.E. Harris and F.S. Ross in 1955, the two researchers formulated the maximum flow problem using an example of the Soviet railroad and considering what cuts in the railroad would disconnect the nation entirely – and what cuts could be made with little impact to railway traffic flow. 

Maximum flow problems are a core tenet of optimization theory, used widely in disciplines from math to computer science to engineering. You may not know what mathematical optimization is, but you’ve seen it in action before: in electronic circuitry, in economics, or unsurprisingly, used by civil engineers in traffic management.

It’s expected to be incredibly difficult to exactly calculate the target value of He and Wang’s question. They landed on an approximation that they know is far from the exact calculation, but still brings them closer to understanding hypergraph connectivity more fully.

The process

So what draws them to research? For He, it’s like an itch. He describes that “sometimes I’ll be watching a movie, and then thirty minutes in I’m thinking about a possible solution to a math problem and then I can’t focus on the movie anymore.” You can’t get on with things until you scratch the itch, but the best part to him is when things finally start to make sense. For Wang, research is just plain fun. She enjoys learning about algorithms and theorems, and she loves the opportunity to work with professors who are at the forefront of their field.

After Duke, He wants to pursue a PhD, likely in theoretical computer science, while Wang is still weighing her options – whether she wants to go into academia or industry. While He came into Duke as a prospective Economics major, in quarantine especially he realized just how much he enjoyed math for the sake of itself.

Wang, similarly, thought she would want to pursue software engineering, but she’s slowly realizing that she likes “solving the problems within the field – problems that I need a PhD to solve.” The magic of research, for her, is that “you’re solving problems that no one has answers to yet.” And wherever the future takes both of them, she says that in doing research, even at the undergraduate level, “you feel like you’re pushing the boundary a tiny bit, and that’s a cool feeling.”

Post by Meghna Datta, Class of 2023

For Undergraduate Student Tiffany Yen, Sustainability is More Than Just a Buzzword

Tiffany Yen, a Duke junior majoring in chemistry, grew up in the sunny suburbs of Los Angeles, never too far from the coastline. She’s always loved being outside, especially in California where there is no shortage of trails to hike and beaches to go to. Friends know her as a Patagonia aficionado, going so far as to buy her a book profiling the company’s business model for her birthday. In fact, from Yen, I learned that every Patagonia store gives out city-specific stickers, so if you feel so inclined, you can collect them (as Yen obviously does). All this is to say: Tiffany Yen has always been interested in sustainability.

“I never understood why what we do has to come at the cost of the planet,” Yen said, in discussing how her years in school learning about climate change fueled her passion for sustainable science. “The environment is so important. Without it, we wouldn’t be here.”

Tiffany Yen

Unsure of what she wanted to study at Duke and where she wanted to go post-graduation, she decided to take her two interests – sustainability and chemistry, particularly polymer chemistry – and see what she could do to combine them. She knew coming into college that she wanted to do research, so that landed her at the Becker Lab for Functional Materials.

The Becker Lab is a multidisciplinary organic materials lab focused on biomedical applications – specifically, things like adhesives and drug delivery. Yen works on improvements to intercranial pressure sensors. Traditionally, after head trauma, doctors need to measure the intercranial space to see if the brain is damaged. The sensor that is used is wired and tends to be a very invasive procedure – the probe is connected to a machine outside, and there’s a high risk of infection.

Collaborators at Northwestern developed a biodegradable wireless device that, after implantation, doesn’t require a secondary procedure to take out. The problem is that it degrades a little too fast – and so measurements can’t be taken. Yen, with her mentor, is working on building a film encapsulation to make it possible for the device to take good measurements.

Right now, they’re trying out azelaic acid instead of succinic acid. Azelaic acid has favorable anti-inflammatory properties and is commonly used in acne medications. It could also potentially increase the bioresorbability of the polymer. Their hope is that the film not only helps the body metabolize more of the polymer, but actually helps in healing.

Snapshots from Yen’s life at the lab

So why medical research? Yen explains that while her work may not seem obviously linked to sustainability, the push for finding materials that can degrade is extremely relevant. And while she’s not all that interested in medicine specifically, she likes things that are practical and applicable.

“When I did research in the past,” Yen said, “there wasn’t always an application. It sometimes was about synthesizing something, just for the sake of science.” And while there’s certainly value in strengthening science fundamentals, she admits that research in that vein doesn’t really appeal to her. “I want to work on things that I directly see adding value to society.”

After college, Yen sees herself going to graduate school and working towards a PhD in “some physical science related to chemistry.”  Ultimately, her goal is to work at the interface of venture capital and scientific research, using her science background to find and fund promising innovations in sustainability. “There are so many incredible things being researched out there,” Yen says, “but the biggest problem in research is funding and commercializing.” She continues, “I think there are other people out there who can do better research than I can, so I want to go out there, find the stuff, and fund it.”

Yen has come to believe that just because she dedicated her time at Duke to science, it doesn’t mean she needs to stay in science forever. There’s value in scientific knowledge no matter where you go. And as businesses realize that public interest in sustainability is growing, she’s crossing her fingers that her skillset will poise her to be a valuable asset in seeking out new innovations. 

Snapshots from Yen’s life at the lab

She said that when she came into college, she felt a pressure to pursue a more traditional path, like being pre-med. “I value stability, and I’m very risk-averse,” she laughs.

But when she asked herself what she’d be happiest doing, she knew it would be trying to save the planet in some way. But she clarifies: “At this point, I can’t save the planet. I think that’s a very far-fetched thing for one person to do.” Instead, “I’d rather try and maybe fail than not try at all.”

Post by Meghna Datta, Class of 2023

The COVID-19 ‘Endgame’ Depends on Where You Live

In February of 2020, no one could have fathomed that the very next month would usher in the COVID-19 pandemic – an era of global history that has (to date) resulted in 5 million deaths, 240 million cases, trillions of dollars lost, and the worsening of every inequality imaginable.

And while scientists and governments have worked together to make incredible advances in vaccine technology, access, and distribution, it goes without saying that there is more work to be done to finally put the pieces of an exhausted global society back together. On Tuesday, October 12th, the Duke Global Health Institute (DGHI) brought together three leaders in global health to discuss what those next steps should be.

The panel discussion, which was moderated by Dr. Krishna Udayakumar of the DGHI, was titled “The COVID-19 Endgame: Where are we headed, and when will we get there?” The panelists were Dr. Ann Lindstrand, who is the World Health Organization’s unit head for the Essential Program on Immunization; Dr. Ayoade Alakija, who is the co-chair of the African Vaccine Delivery Alliance and founder of the Emergency Coordination Center in Nigeria; and Alberto Valenzuela, who is the Executive Director of the Pan American and Parapan American Games Legacy Project.

Dr. Ayoade Alakija
Dr. Ann Linstrand
Alberto Valenzuela

Dr. Lindstrand began by setting the stage and highlighting what are undoubted successes on a global level. 6.5 billion doses of the vaccine have been administered around the world, and the vaccines have impressive effectiveness given the speed with which they were developed. Yet undergirding all of this is the elephant in the room that, sitting in a 1st-world country, we don’t think about: high-income countries have administered 32 times more doses per inhabitant compared to low-income countries.

Graph from Dr. Ann Lindstrand

This vaccine inequity has been exacerbated by already weak health security systems, vaccine nationalism, and lackluster political commitment. And while the WHO is slated to enormously ramp up supplies of vaccines in Q4 of 2021 and Q1 of 2022, it doesn’t mitigate the damage to the socioeconomic welfare of people that COVID-19 has already had. Dr. Lindstrand outlines the three waves of socioeconomic impact we will see, but expressed concern that “we’re already beginning to see the first wave pan out.” 

Diagram from Dr. Ann Lindstrand

Dr. Alakija took this discussion a step further, asserting that COVID-19 is poised to become the disease of low-income countries. “If you’re living in the US or EU,” she remarked, “You’re heading into the ‘Roaring 20s’. If you live in the Global South, COVID-19 is going to become your future.”

To this point, Dr. Alakija emphasized that the only reason this is the status quo is because in her eyes, the world failed to do what was right when it should have. In her home country of Nigeria, she highlighted that out of a population of 210 million people, 5.1 million people have received the vaccine – and of those 5.1 million, just 2 million — one percent — have been double-vaccinated. “It really is a case of keeping those down further down, while giving booster doses to those that have already been vaccinated,” she said. “We don’t have diagnostic data, so people are slipping underwater and the world has no idea.”

It’s worth noting that Nigeria houses some of the megacities of the world, not just in the African continent. So according to Dr. Alakija, “we don’t solve this with a medical lens, we solve this with a whole-of-society lens.” We must, she argued, because in an interconnected world, no one exists in isolation.

Alberto Valenzuela’s work is a great example of this. In 2019, his team led organizing efforts for the Pan American Games in Lima, relying on extensive partnerships between public organizations and corporations. In 2020, though, as the world shifted, the government called on the team to transition into something much different – COVID-19 relief efforts in the country.

The results are staggering. In just 5 weeks, the Pan American and Parapan American Games Legacy Project built 10 hospitals in 5 regions of the country. The implementation of 31 vaccination centers throughout the country resulted in a tripling of the number of people vaccinated per day in Lima. To him, this work “proves what’s possible when private and public sectors merge.” In other words, remarkable things happen when all of society tackles a societal issue.

Slide from Alberto Valenzuela

So where do we go from here? Perhaps the biggest thing that stood out was the need to empower low-income countries to make decisions that are best for them. In Dr. Alakija’s words, “we need to lose the charity model in favor of a partnership model.” Dr. Lindstrand pointed out that there’s a deep know-how in the Global South of how to roll out mass-vaccination efforts – but only when we “lay down our organizational hats” can we move to what Dr. Lindstrand termed “more coordination and less confusion.” Valenzuela emphasized the need to integrate many sectors, not just healthcare, to mobilize the COVID-19 response in countries. But above all, Dr. Alakija said, “there will be no endgame until we have equity, inclusion, and health justice.” 

Post by Meghna Datta, Class of 2023

The Major Player in Global Infrastructure Investment – And What That Means for the Climate

Perhaps no singular economy in the world has grown and expanded as rapidly as China’s. “Made in China” labels prove just how far of a reach China has globally – from clothes to technology to automotive parts. But there’s another facet of this expansion that is poised to become more and more important.

Developing countries across the world face infrastructure challenges that hinder their growth and prosperity, and these challenges have only been exacerbated by COVID-19. China, along with other key economic players, is sensing this sore lack, and competing to invest in global infrastructure projects. There are many questions to be asked about the ethics and impact of global infrastructure investment, but one thought in particular rises to the top: what does infrastructure investment mean for the climate?

To prod at this question, the Duke University Center for International and Global Studies hosted a conversation with Dr. Jackson Ewing on September 29 entitled “The Great Infrastructure Game: Why Asia, Europe, and America are Competing to Build in the Developing World and What It Means for the Global Climate”. Ewing, who holds a joint appointment as a senior fellow at Duke University’s Nicholas Institute of Environmental Policy as well as adjunct associate professor at the Sanford School of Public Policy, unpacked the “game” by taking a specific deep dive into China’s investment sources, standards, and approaches.

Dr. Jackson Ewing

A couple of key things stood out from the conversation. The first is that to understand China’s infrastructure investment impact, it’s important to understand the Belt and Road Initiative (BRI). The BRI is arguably the most important “umbrella mechanism” for China’s infrastructure investment, associated with projects such as ports, railways, airports, and power plants. Launched in 2013, its name comes from the concept of the Silk Road, an ancient network of trade routes connecting China to the Mediterranean, that was established during the Han Dynasty 2,000 years ago. This modern-day Silk Road connects Asia with Africa and Europe via land and maritime networks. The initiative defines its five major priorities to be “policy coordination, infrastructure connectivity, unimpeded trade, financial integration, and connecting people.”

Mapping the Belt-and-Road Initiative

The BRI has led to what Ewing called “meteoric investment growth.” What does that investment look like? Ewing made note of several key characteristics. One is that Chinese lending has shifted significantly, from lending to sovereign banks to lending to companies and organizations in destination countries. This type of investment makes up nearly 70% of China’s portfolio. Another characteristic of this investment is that a chunk of the BRI project portfolio – 35%, to be exact – has encountered massive criticism on the grounds of corruption and environmental issues.

Slide from the presentation by Dr. Ewing

Previously, energy investment along the BRI looked mostly like coal. Between 2007 and 2015, China led all nations in financing nearly 25 billion dollars of outbound coal creation, with India, Indonesia, Mongolia, Turkey, and Vietnam being its biggest recipients.

Slide from the presentation by Dr. Ewing

Ewing noted that while China arguably does have a coal overcapacity problem, “it still compares significantly in outbound renewables.” The diagram below gives a breakdown of BRI energy investments – while the orange chunk of coal is still the biggest chunk of investment, the green renewable chunks don’t lag far behind. This increased interest in the renewable space is largely fueled by capacity problems, as well as domestic and environmental challenges. There has been a plateauing of coal consumption in the country – but is that something to get excited about?

 There have been cross-ministerial efforts to promote a Green BRI in response to criticism, but as Ewing put it, “They’ve led to debatably meaningful practices to undergird existing initiatives.” While coal investment has slowed down as hydro investment has picked up the pace, China’s annual energy finance from policy banks has taken a hit and is slowing down. So what can we conclude?

Slide from the presentation by Dr. Ewing
Slide from the presentation by Dr. Ewing

Well, it’s safe to conclude two things. The first is that this Chinese shift away from coal does matter – but whether this will lead to a change in Chinese investment philosophy that will mark the next decade remains to be seen. The second thing to conclude is that as China dips more into the renewable space, other countries will follow. In fact, the U.S and EU have been prioritizing renewable investments for a while. This competition may very well mean that we see a growing number of renewable projects, which is undoubtedly good news for the climate.

Post by Meghna Datta, Class of 2023

Student Photographer Josephine Vonk Marvels at Life Through her Camera

For Josephine Vonk, the best part about photography is the people. “I couldn’t care less about the technical aspects,” she laughs. “That part is just a means to an end.”

Vonk, a junior from Houston and a Psychology major with a certificate in Documentary Studies and a certificate in Innovation and Entrepreneurship, had no interest in photography prior to Duke. As a first-year, she stumbled into a Documentary Studies class she was required to take as part of the FOCUS program and only later realized it was taught by Professor Susie Post Rust – a former photographer for National Geographic. Reminiscing on her first year at Duke, she recalled how “halfway through the semester, Susie sat me down and basically told me I was bombing the class – I needed to step it up.”

Josephine Vonk (T ’23)

Rather than forcing her into a loathsome relationship with the craft, however, the challenge piqued her interest and pushed her to learn her way around a camera – if only to prove to herself that she could. After her first semester, she decided she wanted to take another photography class -DOCST 230, or Small Town USA. A couple of years later, she’s now decidedly more comfortable around a camera. Now in her second year as a Service Learning Assistant (SLA) for Post Rust’s class, she also recently joined the team at the 9th Street Journal as a photographer and continues to take photography classes.

For Vonk, the magic of photography is the excuse it gives her to marvel at the way humans behave.  It allows her to step outside the confines of what normal people do to gain access into another person’s life. She’s no longer hindered by small talk – she can walk around a person as they’re talking for the optimal angle, or look back on pictures that so clearly capture emotional reactions. “Photography is very much a form of visual research,” she explains. While the connection between photography and traditional forms of academic research is not often drawn, the classic adage is classic for a reason: a picture really is worth a thousand words.

Matt of Matthew’s Chocolates in Hillsborough, photographed by Josephine Vonk

A pivotal moment for her occurred spring semester of her first year, when she shot a project centered around Matthew’s Chocolates in Hillsborough. As she went in week after week and built a rapport with the owner of the shop, she began to realize the importance of relationships in photography – “the emotional access and content you gain is a lot better.”

Matt of Matthew’s Chocolates in Hillsborough, photographed by Josephine Vonk

But perhaps her favorite project, she says, was a series she shot for DOCST 119S centered around femininity and the beauty of the female body. Aiming to reframe how the media views females by utilizing the female gaze, she ran into a lot of ethical issues such as consent and what she could and couldn’t shoot. In the process, though, she realized the power she held as a photographer: she set the groundwork, and she established the nature of the project. “The camera is invasive,” she reflected. Through her Canon, she can portray people in ways that they don’t even see themselves. But it was ultimately rewarding; the purpose of her project was to highlight the unique beauty of each of her subjects. And therein lies the power of photography:it serves as a third eye, an alternate way of seeing the world that causes us to pause and think.

Photographed by Josephine Vonk

Vonk described herself as a “freaky Psych major” – intensely passionate about the ways that humans function and interact with each other and themselves. For her, photography is just “another tool in my belt to ask questions and gain access.” And true to that sentiment, the diversity of her projects show that photography has allowed her to ask and answer questions about life, through a camera lens.  

Photographed by Josephine Vonk

A Virtual Stroll through the 2021 Bass Connections Showcase

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

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

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

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

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

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

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

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

The 2019-2020 team, pre-COVID.

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

Post by Meghna Datta

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

PatientsLikeMe

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

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

Post by Meghna Datta

Bass Connections Teams Tackling COVID-19 Problems, from Food Security to Voting-by-Mail

Most people at Duke are familiar with Bass Connections, the powerhouse interdisciplinary research program that brings together students and faculty from a wide variety of backgrounds to tackle complex problems.

Like most people, when the country went on COVID-19 pandemic lockdown, team leaders and members within Bass Connections needed to adapt their approach.

Instead of merely adapting, though, some Bass Connections teams saw a problem-solving opportunity. They pivoted to address some of the most pressing problems that the pandemic has created or exacerbated. On Tuesday, March 2nd, eight teams gathered to present their research at the first Bass Connections Works in Progress Symposium.

Equity and Efficiency of Using Wearables Data for COVID-19 Monitoring was one team that presented at the Symposium.

These teams tackled issues ranging from the ethics of contact tracing to the availability and access to contraception.

One team focused on the issue of food security amongst Latinx populations in Durham. Their presentation was lead by Elaijah Lapay, Faraan Rahim, and Karina Moreno Bueno. The team aimed to tackle three major goals: “How is the pandemic affecting the food security of Latinx residents, and how do environmental public health factors contribute to this population’s risk for COVID-19 infection? How does the incorporation of fresh, local foods mitigate these effects? How is the pandemic affecting the food assistance services locally, nationally, and internationally for the Latinx community?”

Of the Hispanic/Latinx respondents to the 2019 Durham Community Health Survey, 20.9% said they sometimes skipped or limited their meals. Combining that with the fact that 36% of the total number of COVID-19 cases in Durham have been within the Hispanic population, it’s fairly clear that there is a link between food security and health outcomes.

To this end, the Bass Connections team partnered with Root Causes to help advance their project goals through Root Cause’s Fresh Produce Program. Root Causes is an organization started by Duke Medical School students prior to the pandemic that previously provided fresh produce to food-insecure patients at the Duke Outpatient Clinic. But in order to adapt to contactless delivery and new needs due to COVID-19, Root Causes and the Bass team partnered to expand its reach to nearly 150 households in Durham.

Pipeline for Fresh Produce Program, taken from the symposium presentation of Improving Food Security to Increase Resiliency to COVID-19 for Latinx Populations

This expansion was aided immensely by the Duke Campus Farm, which despite the pandemic mobilized to change the produce it grew to be more culturally relevant to the households they were supporting.

In the future, the team hopes to continue to expand their survey data in the Triangle and continue to assess the impact of the Fresh Produce Program.  

Another Bass Connections team broadly addressed the challenges COVID-19 posed to the election process, through three sub-projects focusing on absentee balloting, organizing, and overall voter participation. The symposium presentation for the absentee balloting research was lead by Chase Johnson, Emma Shokeir, and Kathryn Thomas.

To hear more about the work of this Bass Connections team, watch the presentation above.

The 2020 election saw more people than ever relying on absentee voting, either by the one-stop process or by voting through mail. However, this team aimed to address the many voters that are disenfranchised because their votes are rejected due to errors in their ballot. While NC courts ruled that voters are required to be notified if their ballot needs curing, the difficulty of curing one’s ballot often dissuades people from even starting the process, leading to those votes not being counted.

The team utilized the app BallotTrax, a company that the North Carolina State Board of Elections hired to track these ballots. The team then focused on phone banking to increase BallotTrax usage, and then analyzed voter outcomes.

In the future, they hope to analyze the effect that BallotTrax outreach had on voting success, the efficacy of BallotTrax for voters in North Carolina, and the efficiency of North Carolina’s vote-by-mail system compared to other states.

A goal of this symposium for many teams was to ask audience members for suggestions on ways to direct their research further. The beauty of seeing research midway through the process is that it opens the door for collaborative thinking, out-of-the-box ideas, and being open about obstacles and mistakes.

This virtual Symposium is a testament not just to Duke’s collaborative research spirit, which is alive and well despite the pandemic, but to the adaptability of Duke student researchers and faculty. There’s no doubt that these eight Bass Connections Teams, among the many other teams part of the program this year, have been generating relevant and impactful knowledge and will continue to do so.

Post by Meghna Datta

The Diversity Problem in Science

With COVID-19 being a fixture of our lives for nearly a year now, science has been a staple in the news. Along with science, though, a long-overdue conversation about the state of race relations in America has taken center stage, which makes diversity in science a critical topic to delve into. COVID-19 has highlighted not only a national crisis in healthcare response, but also longstanding health disparities across racial and socioeconomic groups that have only been exacerbated by the pandemic.

 On Wednesday, January 27, Dr. Gowthami “Gow” Arepally, known for her work as Professor of Hematology at the Duke School of Medicine, led a talk called “The Diversity Problem in Science” that aimed to highlight not only the obvious problems in research but the urgency with which everyone, from the individual to the collective level, should aim to address the problem within their spheres of influence. Dr. Arepally is not only known for her work in the medical school but also as a valuable mentor for colleagues, undergraduates, and high school students — a point that was highlighted as an important way non-URM (under-represented minority) scientists can make a difference.

Gowthami Arepally, M.D. 

Underrepresentation in science starts early, Arepally says. For example, while discrepancies in graduation rates between Black/Hispanic students and their white/Asian peers are not bad in high school, they get progressively worse through college and beyond. In 2016, 18% of degrees nationally were awarded overall in STEM fields — but this number drops to 12% for Black students and 15% for Hispanic students. As of 2015, Black applicants have lower medical school acceptance rates than peer applicants – 34% versus 44% for their white counterparts. And the numbers get worse further into medical school; Black students and Hispanic students each represent less than 6% of medical school graduates, while a staggering 80% of graduates are either white or Asian.

This perpetuates a cycle going into the workforce that discourages young underrepresented minority (URM) students from entering STEM, seeing a lack of role models that look like them. As of 2016, only 39% of full-time faculty at medical schools were female, and a mere 4% of faculty were Black. This results in barriers to NIH research that further hold URM scientists back. Between 1999 and 2012, 72% of NIH awards were given to white scientists and 24% were given to Asian scientists, but only 2.4% of these awards were given to Black scientists.

This is a story that is shocking when told through statistics but is all too familiar, as an experience, for minority students and researchers interested in pursuing careers in the sciences. However, there are concrete ways to counter the problem. As Dr. Arepally pointed out, NIH Diversity Supplements for existing NIH grants can be obtained from the high school to faculty level as an added source of support for URM researchers. Medical societies themselves can be sources of diversity initiatives, such as Dr. Arepally’s society, the American Society of Hematology, which boasts one of the most aggressive minority recruitment initiatives. Within Duke, many pipeline programs exist for researchers to support URM students and new researchers and faculty.

Chart of pipeline programs at Duke

Most importantly, it’s important for individuals to enact change on a personal level. Whether it means educating oneself on underrepresentation, advocating for the advancement of other URM trainees and colleagues, or committing to the success of URM students through pipeline programs, individual steps can add up.

And as Dr. Arepally highlighted, these steps, however small, are important to prioritize. Increasing diversity in medicine, for example, can help address existing health disparities. URM physicians are more likely to address the care of minority populations, while minority patients are more likely to choose URM populations. And the existence of more URM physicians improves the cultural competency of all trainees. Sex diversity, too, has a positive effect on the quality of science in collaborative groups. The impacts of diversity extend to role-modeling for younger students, who may be at a crossroads in terms of determining a future career. In this way, current measures to increase diversity can foster a cycle of more diverse students entering STEM and being supported there, for generations to come.

Diversity in science is not only good for science and scientists, Arepally says, but for all of us. Science should reflect the society it serves, and with more diversity in science, breakthroughs will be applicable and accessible to every person —  not just the majority.

Post by Meghna Datta

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