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

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Maintaining a Healthy Sex Life While Living with Cancer

By Nonie Arora

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Dr. Kevin Weinfurt. Credit: DCRI

“In the last seven days, how much difficulty have you had with sexual activity?” Dr. Kevin Weinfurt asks his research participants. A psychologist by training who works in medical research for the the Duke Clinical Research Institute, Weinfurt studies the best ways to measure patient health using self-report.

His most recent collaborative project involved developing a self-report sexual health instrument funded by the National Cancer Institute (NCI) at the National Institutes of Health. Many cancer patients are struggling with serious sexual side effects from their cancer treatments, and we lacked a good self-report scale for sexual function, Weinfurt explained.

Weinfurt and his colleagues ask questions like, “In the past seven days (or 2 weeks, 2 months) how much difficulty have you had with X action?” They are finding that while people prefer to report long time periods and think they are more accurate, they actually can’t recall the specific details over a long period of time. It’s an open question whether people really remember what happened a month ago, Weinfurt said.

In a recent study, they had people participate in a 30-day diary of their sexual activity. Each time they engaged in an activity, they noted how well everything worked, he said. At the end of the 30 days, the researchers checked how well the average daily rating of participants matched what they remembered happening. Weinfurt agrees that asking patients to record their activity could change the activity itself or the quality of their recall, but he says that the scale should still be fairly accurate.

Sexual Health. Credit: NHS

Sexual Health. Credit: NHS

They found that the mood that the person is in when they complete the measure greatly affects what they report. Men in a positive mood recalled having excellent erectile function, even if that was not the case.

Measuring sexual function is important because it affects the quality of life for many patients, Weinfurt said. Many patients are eager to talk about sex-related issues because they feel isolated and alone with some of these struggles.

Overall, sexual health is not widely recognized as a priority by clinicians and clinical researchers and sexual ignorance is more common than we would think, so participants often require education before they can participate in studies successfully, he said.

Students Brief Senate, FDA, & Personalized Medicine Coalition

By Nonie Arora

Duke students and faculty brief Senate staffers, Pictured left to right: Allison Dorogi, Nonie Arora, Robert Cook-Deegan, Samantha Phillips, Jenny Zhao, Elisa Berson. Credit: Robert Cook-Deegan

Duke students and faculty brief Senate staffers, Pictured left to right: Allison Dorogi, Nonie Arora, Robert Cook-Deegan, Samantha Phillips, Jenny Zhao, Elisa Berson. Credit: Robert Cook-Deegan

The week of April 13, at the height of cherry blossom season, Duke students traveled to Washington, D.C. to brief senior staff members of the Senate, Food and Drug Administration (FDA), and the Personalized Medicine Coalition (PMC). Over the spring semester, five students in the Genome Sciences & Policy Capstone course (including myself) studied the regulatory framework of laboratory developed tests (LDTs).

LDTs are tests developed for use in a single laboratory. The clinical laboratories that develop LDTs are considered to be medical device manufacturers and are therefore subject to FDA jurisdiction. The FDA exercises “enforcement discretion” over LDTs, which means they choose when to regulate these tests.

Duke students in Washington, D.C. Credit: Robert Cook-Deegan

Duke students in Washington, D.C. Credit: Robert Cook-Deegan

Under the supervision of Duke professor Robert Cook-Deegan, we dove into five case studies regarding different types of LDT tests.

The case study that I focused on was the differential regulation of two tests used for breast cancer patients. The two tests, MammaPrint and Oncotype Dx are regulated differently even though both aim to help doctors understand when patients should have follow-up chemotherapy after surgery. The company that markets MammaPrint, Agendia, chose to obtain FDA clearance for their test, but the company behind Oncotype Dx, Genomic Health, chose against it. Surprisingly, this decision did not substantially increase the number of patients who receive Oncotype Dx relative to MammaPrint.

Furthermore, the two tests do not always produce the same result, according to a research study. Several key question remain, such as:

  1. Is the FDA-regulated test more accurate?
  2. Does the more accurate test get more market share? Does FDA approval make a difference?
  3. How should these tests, and ones like them, be regulated to reduce harm to patients?

The students hope that their case studies will serve as illuminating examples for stakeholders and help guide the conversation regarding federal regulation of LDTs.

 

Ben Wang: Food lover and undergraduate researcher

Ben Wang in rural Appalachia Credit: Ben Wang

Ben Wang in rural Appalachia Credit: Ben Wang

By Nonie Arora

Ben Wang, a senior Evolutionary Anthropology major from New Jersey, strongly believes we are what we eat. A foodie, scientist, and future health care practitioner, he thinks that changing food habits can improve our nation’s health.

“When we came to Duke, our summer reading book was Eating Animals,” he said.  “I felt so many emotions while I was reading the book. It really impacted the way I think about food. In fact, I became a pescetarian (a fish-eating vegetarian).”

Freshman year, Wang knew he had this interest in food, but he didn’t know how to incorporate it into his academic world.

During his second year, Wang started to find his way. “I remembered the topic when I was hunting for a research lab, and started working in Dr. Tso-Pang Yao’s metabolism lab so that I could learn more about how nutrition directly impacts health,” he said.

Wang spent time investigating proteins that increase or decrease the amount of “mitochondrial fusion” that happens in cells. Wang explained that metabolism is how our bodies process food and distribute nutrients, and these compounds help in that process.

“I really enjoyed this lab because the topic was directly related to patient care and our research had direct pharmacologic applications,” Wang said.

Farm Fresh tomatoes! Credit: Ben Wang

Farm Fresh tomatoes! Credit: Ben Wang

In the summer of 2014, he pursued a Bass Connections fellowship in rural Appalachia, in one of the most impoverished counties in the US.

He participated in a Farm-to-Table partnership between local Appalachian farms and a middle school. This partnership was part of a broader program for Appalachian girls. He coordinated the logistics and ended up doing much of the culinary work for the partnership, cooking up delicacies with ingredients like swiss chard, beets, and kale.

“I really wanted to go all the way in introducing a fresh perspective to these women,” Wang said, “I had to convince the girls that these veggies would taste good.”

Farm to Table initiative in action. Credit: Ben Wang

Farm to Table initiative in action. Credit: Ben Wang

They did not always like his creations.
He says one student told him, “I’m not going to eat this hippie food.”

But he persevered, and ultimately most of the girls were excited about what they had learned and reevaluated the way they ate.

Maintaining lasting gains will be difficult because much of the food would have been unaffordable to the girls on their own. In the town that they live in, the closest supermarket is a Walmart a half hour away. Other than that, there is a Dollar General and Hillbilly Market, neither of which stock fresh produce, according to Wang.

However, Wang thinks that showing these girls there are food options beyond those that they have experienced was valuable, and that they can choose to strive for them if they want to.

Changing eating habits, one delicious meal at a time. Credit: Ben Wang

Changing eating habits, one delicious meal at a time. Credit: Ben Wang

As for Wang, he is headed to dental school in the fall and hopes to include nutritional awareness in his future practice to help his patients achieve better systemic health.

 

 

Behind the Scenes at Duke's Student-Run Science Journal

By Nonie Arora

What do tuberculosis vaccines, water quality, and protein trafficking share in common? All may be featured in articles for the upcoming issue of Duke Science Review. I spoke with Matthew Draelos, co-editor-in-chief, and other publication team members.

Duke Science Review Publication. Credit: Nonie Arora

Duke Science Review Publication. Credit: Nonie Arora

Draelos explained that the Duke Science Review deals with broad topics with an emphasis on review articles and draws from the undergraduate, graduate, and professional school communities.

Draelos’s motivations for leading the Duke Science Review stem from his previous research experiences. Draelos worked in an undergraduate lab for four years at NC State University. There, he felt integrated into the publication process in the laboratory of Dr. Gavin Williams. At Duke, he is excited to have the opportunity to get involved in a student-run science journal and take on a leadership role.

His interest in science is focused on pharmaceutical development, particularly antibiotics. He has worked previously with enzymes called polyketide synthases, which are nature’s machinery for making antibiotics. He hopes to someday develop novel chemical solutions to unsolved medical problems.

Students learn about the publication process. Credit: Nonie Arora.

Students learn about the publication process. Credit: Nonie Arora.

“I think it’s important for students to publish their research primarily because in the current funding environment it’s publish or perish. This is increasingly true for young scientists. We must be able to write well, and the Duke Science Review establishes a risk-free forum for students to practice scientific writing,” Draelos commented.

A second reason he mentioned for enabling students to publish their work is that people spend considerable time and energy writing papers for courses, and a lot of that effort is wasted if only the professor is able to read their work. This journal is a way for people to spread their work to a larger audience and perhaps gain some additional recognition.

Lefko Charalambous, an editor for the journal, added that it is important to improve scientific communication and literacy in budding scientists. “It’s a way for us to appreciate what goes into producing a journal article and the reward from having it published at our age,” he said.

“We hope to enrich the scientific discourse, especially for freshmen and sophomores who are looking into scientific research and don’t know where to start,” Draelos said.

To submit an abstract for a potential report or article, check out their website.

Is the "Wizarding Gene" Dominant or Recessive?

By Nonie Arora

Dr. Spana explains the wizarding gene to eager students. Credit: Arnab Chatterjee

Dr. Spana explains the wizarding gene to eager students. Credit: Arnab Chatterjee

How do recessive alleles and the world of Harry Potter connect? Some students found out last week from Dr. Eric Spana, a faculty member in the Biology department.

He started off by explaining how a mutation in the MC1R (melanocortin 1 receptor) gene causes red hair in humans because of the way it affects a pigment called eumelanin. He added that MC1R is a recessive gene, and showed a pedigree of the Weasley family tree. Professor Spana pointed out that J. K. Rowling had gotten the genetics right. The Weasley clan has red hair and so does Harry’s daughter Lily. This makes sense because Harry must have a recessive allele for red hair since his mother, also Lily, had red hair. Whether this is intentional or just fortuitous casting, who can really say?

He then explained some potential retroactive genetic “crosses” that could be done to determine whether the “wizarding gene” was dominant or recessive. As a quick refresher, recessive alleles require both the mom and dad to pass on the same genetic sequence to the child for the condition to occur, while dominant alleles require only one copy.

According to Professor Spana, Step 1 was to check whether a witch and a muggle who mated ould produce a wizard. Indeed, this is possible, and the evidence is Seamus Finnigan, a half-blood wizard. Due to these results, the gene could still be dominant or recessive.

In Step 2, he explained, you mate a wizard to someone who could not have the wizarding gene. Fridwulfa, the giantess, married Mr. Hagrid, a wizard, to produce our beloved Rubeus Hagrid, who was a wizard. Since giants cannot have the wizarding gene, but Hagrid is still a wizard, the wizarding gene must be dominant!

Crowd of students ask provocative questions about squibs and recessive vs. dominant inheritance. Credit: Arnab Chatterjee

Crowd of students ask provocative questions about squibs and recessive vs. dominant inheritance. Credit: Arnab Chatterjee

You’ll have to stop by Dr. Spana’s office to ask him more about where muggle-borns and squibs come from. There’s a few different genetic explanations, and I encourage you to do some thinking and exploration.

Outside of his work on the genetics of Harry Potter, Dr. Spana also researches and teaches Genetics & Developmental Biology at Duke.

Death with Dignity: the Brittany Maynard Story

By Nonie Arora

Is it acceptable for patients to choose to die on their own terms? Can physicians assist them with their wishes? Where do we draw the line for euthanasia and end-of-life decision making? Faculty and students discussed these thorny issues at a recent Science & Society Round Table event, co-hosted by the Duke Undergraduate Bioethics Society.

Brittany Maynard, "Death with Dignity" advocate. Credit: Wikipedia

Brittany Maynard, “Death with Dignity” advocate. Credit: Wikipedia

This event was sparked by the recent events regarding Brittany Maynard. On November 1st, Maynard, a 29-year-old terminally ill cancer patient, chose to take a pill that ended her life.

During the roundtable, professor Dr. Jennifer Hawkins and paramedic Anita Swiman discussed this case as a launching point to delve into ethical issues regarding decision-making and “Death with Dignity” laws. Dr. Hawkins is a philosopher in bioethics and has studies quality of life issues and the nature of suffering. Swiman, an emergency medical technician, has insight into what it’s really like to deal with families who are making decisions about end-of-life care.

Because of her brain tumor, Maynard would have to undergo a very difficult process of death. She chose to relocate from California to Oregon to take advantage of their “Death with Dignity” statute. Previously, about 750 people – mostly elderly – had used the statute, but Maynard changed the discussion by being a young, vibrant woman talking about a decision to end her life, according to round table moderator, Michael “Buz” Waitzkin.

Dr. Hawkins described three main worries that come along with physician-assisted suicide. She said the first struggle is whether it can be in someone’s best interests to die. “Death is the enemy for most of us most of the time because we are healthy and have things we want to do,” she said. However, some people are suffering deeply. She questioned how can we distinguish between those that could be helped in what remains of their lives from those who cannot.

“Even if we can agree that sometimes it’s in a person’s best interests to die,” Dr. Hawkins explained, “We can disagree about the roles of physicians or other health care workers in this process.” Physicians generally operate by the code of doing no harm. Some people believe including physician-assisted suicide violates sacred codes of physician conduct.

Editorial Cartoon by Dan Wasserman of the Boston Globe

Editorial Cartoon by Dan Wasserman of the Boston Globe

Finally, Hawkins said that even if we can agree that sometimes it is in some people’s best interests to die, and we don’t have a problems with physicians helping them, we may still worry about the effects on society of such a policy that permits physician-assisted suicide. She said that some people are concerned about how such a policy could impact end-of-life decision making if elders feel pressured to choose this option, against their own wishes, to not feel like a burden on their families.

 “Will we be able to keep the policy restricted to the terminally ill, those who request it, and those who are able to take the prescription on their own?” Dr. Hawkins asked the group. She questioned why we restrict the application of “Death with Dignity” laws to those who can ask for a prescription. Some people who are paralyzed or cannot take prescriptions for themselves are excluded.

Paramedic Anita Swiman provided a perspective based on practice. “As a health care provider in prehospital medicine, there are clear laws that we must follow. If a patient meets certain criteria, we know what we will do. We take our personal feelings out of the discussion. We (sometimes face) assault from family members who want something different from what their family member had written in their wishes.”

Swiman said that pre-hospital providers act as counselors as well. She described that while being receptive to what family members are saying, paramedics sometime have to explain, “This is what the person wanted. This is what the law states. I would like to fix the situation for you, but there is nothing that I will be able to do for you.”

Ultimately, scholarly work that addresses the nature of suffering or examines consequences of “Death with Dignity” laws in different states could further inform the difficult ethical issue of physician-assisted suicide.

All Ears for Corn Genetics

By Nonie Arora

“Technology is progress” and “new is better” seem to be mantras in some fields of research. However, when it comes to fields of genetically modified corn, we might be wise to think otherwise.

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Dr. Mary Eubanks and Students at the Campus Farm. Credit: Nonie Arora

Duke biology professor Dr. Mary Eubanks spoke to a group of Duke students, community members, and a farmer from Togo about corn genetics in a workshop held Friday, Oct. 24 at the Duke Campus Farm. Dr. Eubanks founded her own seed genetics company (Sun Dance Genetics LLC) and is a leading advocate for changing the way we grow corn.

Dr. Eubanks became intrigued by the origins of corn while studying the origins of agriculture and the start of American civilization in an archaeology PhD program. She realized that she wouldn’t be able to answer her questions about what she considered to be this “great botanical mystery” without an understanding of genetics. To uncover this mystery, she pursued a postdoctoral program in corn genetics. Based on her experimentation, she developed the hypothesis that maize domestication involved something called intergeneric hybridization, or crossing between plants in different genera.

European Corn Borner attacks Maize. Credit: Wikimedia commons

European Corn Borner attacks Maize. Credit: Wikimedia commons

During her career, Dr. Eubanks also worked in regulatory affairs and learned about the devastating effects of chemical pesticides. She became an advocate for sustainable agriculture: finding ways to develop pest-resistant corn without genetic engineering. She has successfully transferred natural resistance to the worst insect pests of corn — corn rootworm and European corn borer.

In contrast to using natural breeding methods to create new lines of corn, genetically modifying organisms could have negative effects on human health, according to Dr. Eubanks. Dr. Eubanks believes that the inserter and promoter sequences that are used to get the genes to express the foreign proteins can lead to antibiotic resistance and intestinal issues for humans.

The group was surprised by her description of her own anaphylactic shock reaction to Bt-corn, a GMO. Her own personal history of the allergic reaction made her think of the potential reactions our bodies could be having to GMOs. Dr. Eubanks described how it was problematic that genes being introduced to the crop came from other organisms and that humans haven’t evolved a tolerance to the proteins the genes encode. This could lead to potential allergenicity in humans. According to Dr. Eubanks, it is possible that there has been horizontal gene transfer between plasmids — small molecules used to insert genes from one organism to the next — and the human gut.

When asked about the regulations regarding GMOs, Dr. Eubanks explained that the FDA is in charge of the labeling and GMOs are generally regarded as safe so long as they are substantially equivalent to the other food product. The industry is very opposed to the labeling of GMOs and 90% of the corn, cotton, and soy available has some GMO product in it, according to Dr. Eubanks. She believes that not enough is being done to regulate the industry.

We were intrigued by her discussion of food security and funding for interventions. She described that a lot of international work on food security highly promotes technology and the big industry agricultural model. Dr. Eubanks believes we need to change our paradigm from thinking that the most advanced technological options are always best to considering an ecological intensification approach. Such an approach seeks to design more productive, sustainable production systems that are well suited to their environments by better understanding how nature functions. Her current work is helping bring food security to South Sudan through corn that is pest-resistant and drought-tolerant.

 

Rationing is Not a Four-Letter Word

Wasserman Globe cartoon

Palin and “Death Panels” cartoon from the Boston Globe.

By Nonie Arora

Starting with a news clip of Sarah Palin talking about death panels on Fox News is a sure-fire way to gain the attention of your audience. That’s exactly what Dr. Phillip Rosoff did to ease into his more serious talk about the ethics of rationing health care in the United States. He spoke to a crowded audience of clinicians, ethicists, and students for the Trent Center for Bioethics, Humanities, & History of Medicine lecture series.

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Dr. Philip Rosoff. Source: pediatrics.duke.edu

Dr. Rosoff discussed both moral and economic reasons why we need to ration healthcare in the United States. For one, health care costs are bankrupting the nation and taking money from other social goods. According to Dr. Rosoff, our health care system is expensive, inefficient and has astounding disparities in access to quality care.

“Health care is not the only good. Other factors contribute to our ability to live a good life, including education and the arts,” he said.

“The key to rationing isn’t saying ‘no,’ but how it’s done,” he said.

He unveiled his vision for a better model of health care. In his eyes, a single-payer system that would eliminate the centralized profit motive – where physicians and hospitals have the perverse financial incentives to sell things – would decrease costs without compromising quality. He believes that a similar, expansive, generous benefit plan should be available to all, and those who make the rules ought to be bound by them. Problems arise when people make decisions for others without being affected by the outcomes, Dr. Rosoff explained.

He referenced the organ transplant waiting list, UNOS, as an accepted system where most patients do not complain about bias or unfairness because they realize that everyone has been given a fair shot. The same should be true of our reformed health care system: there should be no “VIPs” or “VUPS” (very unimportant people) and steps ought to be taken to ensure that everyone with a similar clinical prognosis should be bound by the same rules.

While it may seem impossible to increase coverage while lowering costs, other countries provide high quality care at a fraction of the cost, Rosoff explained. Twenty five percent of our spending in the U.S. goes towards unnecessary treatments or administrative expenses.

When asked what the rallying cry for such a major change in the health care system would be, Dr. Rosoff said that the system as it is will bankrupt us, so changes need to be made. At the same time, we need to avoid evoking the scarcity principle, drawing as little attention as possible to changes being made, he concluded.

Learn more specifics about the ethical principles underlying the rationing of healthcare in Dr. Rosoff’s latest book: Rationing is Not A Four-Letter Word: Setting Limits on Healthcare (Published by Basic Bioethics)

Why are Dogs Skinny in Costa Rica?

By: Nonie Arora

Duke student Mary Chavarria had the opportunity to learn how animals are treated in an indigenous community in Costa Rica. Chavarria is a junior from Los Angeles, California studying evolutionary anthropology. An avid traveler, she is a also a member of Round Table and on the executive broad of the Duke Undergraduate Bioethics Society.

Chavarria and her group members presenting their findings. Credit: Mary Chavarria

Chavarria and her group members presenting their findings. Credit: Mary Chavarria

Last semester, she studied abroad in Costa Rica through the Duke OTS program on tropical medicine & global health. In addition to taking classes on tropical medicine and field ethnobiology, Chavarria had the opportunity to complete a research project while in the region.

The minister of health for the region presented the students with potential topics that he believed ought to be investigated for the indigenous communities. There was a range of projects: dental health, isolated older adults, social groups and pets. Chavarria and her group chose to research how pets were perceived and the health of pets in the community.

Her group wanted to know how perceptions of animals influence their health as pets and how this would correlate with zoonosis, the transfer of disease from animals to humans. To determine perceptions of animals, they developed a survey to use in a school.

“We knew that it would be difficult to just go house to house. We would have to hike between them and there are mountains in between. We decided that the best way to access most people reliably would be to go to a school,” Chavarria explained.

They asked questions like:

  • Do you like your pet?
  • Do you play with it?
  • Why do you have a pet?
The team meets with students to ask them about pets. Credit: Mary Chavarria

The team meets with students to ask them about pets. Credit: Mary Chavarria

They surveyed 70 kids from elementary and middle school. Their response rate was almost one hundred percent since they administered the survey in classrooms.

“We found that pets were not treated as you or I may consider [treating a pet]: groomed or walked. They were utilitarian, to put it gently. The pets were skinny,” Chavarria explained.

“While the animals were skinny, people also don’t have great nutrition in this under-resourced region. People would feed them parts of what they were eating, which wasn’t supremely nutritious for humans, and [was] even less so for dogs,” Chavarria said.

Chavarria’s team also found that people in the region really didn’t know the extent to which diseases could be transmitted between humans and animals. Scabies, spread by a parasite that causes similar diseases in humans and dogs, is a problem in the region, she added.

Ultimately, Chavarria believes that better awareness of disease transmission between animals and humans and better treatment of animals has the potential to reduce human disease.

Students DiVE into the Body to Learn about Addiction

By: Nonie Arora

Dr. Schwartz-Bloom explains the mechanics of the DiVe. Credit: Nonie Arora

Dr. Schwartz-Bloom explains the mechanics of the DiVE. Credit: Nonie Arora

There are not many six-sided, immersive virtual environments in the world–but one of them is at Duke.

Students had the opportunity to dive into pharmacology visualizations with Dr. Rochelle Schwartz-Bloom last week during a tour of the Duke immersive Virtual Environment (DiVE). She explained that the 3D in the DiVE is different from the 3D of a typical movie theater: the glasses have a refresh rate that’s out of sync between the two eyes.

It’s like being inside of a video game. You use a Nintendo-like wand and press buttons to interact with the environment.

We walked through two simulations modeling different aspects of addiction. In the first, we learned why some people are more likely to become alcoholics than others. In the second, we observed the brain changes that underpin addiction to nicotine.

We dove right into the body of an avatar drinking a beer. Some people metabolize alcohol differently than others, depending on their genetic code, Schwartz-Bloom explained.

The simulation was created by a team of students working with Schwartz-Bloom: she assembled a team of students studying biology, chemistry, computer science, electrical and computer engineering and visual arts. They worked together for a year to build the simulation, which explains how alcohol gets oxidized depending on genetics and whether the changes in metabolism increase or decrease the risk for alcoholism.

Students dragging NAD into the active site of the alcohol metabolizing enzyme in the DiVE. Credit: Nonie Arora

Students dragging NAD into the active site of the alcohol metabolizing enzyme in the DiVE. Credit: Nonie Arora

Dr. Schwartz-Bloom explained the advantages of learning about this reaction with a 3D visualization. “Students made this as a game so that others could go in there to make the changes happen – they’d have to grab and move the atoms. The game gives students a real sense of why you need zinc and NAD for this chemical reaction,” Schwartz-Bloom said.

Through the second visualization, we realized why smokers who are addicted generally increase their consumption of cigarettes over time. We saw how repeated exposure to nicotine changes the brain, causing smokers to need more cigarettes over time to get the same pleasurable feelings. The tool can be used in schools to educate students how smoking actually changes the brain, Schwartz-Bloom said.

In the DiVE, I felt like I was on the Magic School Bus, jumping right into the action to learn about pharmacology principles! Free group tours are available at the DiVE between 4:30 and 5:30 on Thursdays.

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