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

Students exploring the Innovation Co-Lab

Category: Biomedical Engineering Page 1 of 8

Carrying on Dr. King’s Legacy: The Fight for Equity in Obesity Treatment

“Of all the forms of inequality” Dr. Martin Luther King Jr. once said in a 1966 press conference, “injustice in health is the most shocking and the most inhumane.”

In honor of King’s impact on public health, Duke’s dean of Trinity College Dr. Gary G. Bennett delivered a powerful address Jan. 12 at the Trent Semans Center. Entitled ‘You have to Keep Moving Forward: Obesity in High-Risk Populations,’ Bennett discussed America’s Obesity Epidemic, and its disproportionate effects on Black women.

“More than 40% of the American population has obesity,” Bennett began. Incidence rates among Black women are the highest and have been since the epidemic began in 1955. “These disparities have not closed, and in many cases, they’ve widened over the years,” Bennett said.

Raisi-Estabragh 2023

Type two diabetes, hypertension, and cardiovascular disease are just some of the health risks associated with obesity. Compared to other racial groups, Black women are more likely to suffer from these conditions, as well as die from their effects. Furthermore, it appears that the efficacy of treatment options is significantly lower for patients of African descent.

But why do such disparities exist in the first place? According to Bennett, they can be attributed to a range of internal and external factors. “There certainly are physiological variations that are worth noting here, which is perhaps a challenge in all of obesity research.”

Research published in the journal Nature in 2022 found that, while there are different forms of obesity, that have shared ‘genetic and biological underpinnings.’ Environmental factors are also driving disparities. Black women are “exposed to more obesogenic environments, food desserts,” Bennett explained.  With limited access to affordable and nutritious food, options for healthy eating are slim.

But perhaps most interestingly, Black women also have a range of sociocultural factors at play. “There are fewer within-group social pressures to lose weight,” Bennett maintained. Other sociocultural factors include higher body image satisfaction and higher weight misperception. “This is problematic in some ways,” he continued. While it protects against certain eating disorders and low self-esteem, “It does challenge your ability to achieve weight loss.”

For Black women, obesity is a complex public health issue that needs to be addressed.

But how? From medication to surgery, there are myriad potential treatment options. According to Bennett, however, the real key is lifestyle intervention. “It really is the foundation.” Comprised of three parts: reduced calorie diet, physical activity, and self-monitoring, lifestyle intervention is able to reach the widest range of participants.

Like other treatment options, the lifestyle intervention route shows racial disparities in its outcomes. Because of this, Dr. Bennett’s work focuses on developing methods that are designed with Black patients in mind.

At the forefront of his research is a new online intervention called iOTA, which stands for Interactive Obesity Treatment Approach. “This is a digital obesity approach that we designed specifically for high-risk populations.” The platform personalizes weight loss goals and feedback, which assist in program retention.

In addition, participants are equipped with coaching support from trained medical professionals. “This IOTA approach does a bunch of things,” Bennett said. “It promotes weight loss and prevents weight gain, improves cardiometabolics,” along with a host of other physical benefits. Results also show a reduction in depressive symptoms and increased patient engagement. Truly incredible.

Scholars like Bennett have continued the fight for public health equity- a fight advocated for by Dr. King many years ago. For more information on Bennett and his work, you can visit his website here.

Written by Skylar Hughes | Class of 2025

Sharing a Love of Electrical Engineering With Her Students

Note: Each year, we partner with Dr. Amy Sheck’s students at the North Carolina School of Science and Math to profile some unsung heroes of the Duke research community. This is the seventh of eight posts.

“As a young girl, I always knew I wanted to be a scientist,” Dr. Tania Roy shares as she sits in her Duke Engineering office located next to state-of-the-art research equipment.

Dr. Tania Roy of Duke Engineering

The path to achieving her dream took her to many places and unique research opportunities. After completing her bachelor’s in India, she found herself pursuing further studies at universities in the United States, eventually receiving her Ph.D. from Vanderbilt University. 

Throughout these years Roy was able to explore and contribute to a variety of fields within electrical engineering, including energy-efficient electronics, two-dimensional materials, and neuromorphic computing, among others. But her deepest passion and commitment is to engage upcoming generations with electrical engineering research. 

As an assistant professor of electrical and computer engineering within Duke’s Pratt School of Engineering, Tania Roy gets to do exactly that. She finds happiness in mentoring her passionate young students. They work on projects focused on various problems in fields such as Biomedical Engineering (BME) and Mechanical Engineering, but her special focus is Electrical Engineering. 

Roy walks through the facilities carefully explaining the purpose of each piece of equipment when we run into one of her students. She explains how his project involves developing hardware for artificial intelligence, and the core idea of computer vision. 

Roy in her previous lab at the University of Central Florida. (UCF photo)

Through sharing her passion for electrical engineering, Roy hopes to motivate and inspire a new generation. 

“The field of electrical engineering is expected to experience immense growth in the future, especially with the recent trends in technological development,” she says, explaining that there needs to be more interest in the field of electrical engineering for the growth to meet demand. 

The recent shortage of semiconductor chips for the industrial market is an example of this. It poses a crucial problem to the supply and demand of various products that rely on these fundamental components, Roy says. By increasing the interest of students, and therefore increasing the number of students pursuing electrical engineering, we can build a foundation for the advancement of technologies powering our society today, says Roy.

Coming with a strong background of research herself, she is well equipped for the role of advocate and mentor. She has worked with gallium nitride for high voltage breakdowns. This is when the insulation between two conductors or electrical components fails, allowing electrical current to flow through the insulation. This breakdown usually occurs when the voltage across the insulating material exceeds a certain threshold known as the breakdown voltage.

In electric vehicles, high breakdown voltage is crucial for several reasons related to the safety, performance, and efficiency of the vehicle’s electrical system, and Roy’s work directly impacts this. She has also conducted extensive research on 2D materials and their photovoltaic capabilities, and is currently working on developing brain-inspired computer architectures for machine learning algorithms. Similar to the work of her student, this research utilizes the structure of the human brain to model an architecture for AI, replicating the synapses and neural connections.

As passionate as she is about research, she shares that she used to love to go to art galleries and look at paintings, “I could do it for hours,” Roy says. Currently, if she is not actively pursuing her research, she enjoys spending time with her two young children. 

“I hope to share my dream with this new generation,” Roy concludes.

Guest post by Sutharsika Kumar, North Carolina School of Science and Mathematics, Class of 2024

Solving More Medical Device Challenges by Teaching Others How

Note: Each year, we partner with Dr. Amy Sheck’s students at the North Carolina School of Science and Math to profile some unsung heroes of the Duke research community. This is the third of eight posts.

Eric Richardson is a professor of the practice in Biomedical Engineering and founding director of Duke Design Health. His research and teaching centers around medical device design and innovation, with a focus on underserved communities. 

Eric Richardson, Ph.D.

Richardson has always had a strong desire to enhance people’s wellbeing. Growing up, he wanted to be a doctor, but during high school, he was drawn towards the creative and problem-solving aspects of engineering. After earning a bachelor’s degree in mechanical engineering, he pivoted to biomedical engineering for graduate work. While pursuing his PhD degree, he developed a profound interest in cardiac devices. 

Through technology, Richardson has been able to impact the lives of many. He first worked in industry as a Principal R&D Engineer at Medtronic, where he helped develop transcatheter heart valves that have now helped over a million patients. However, it was his love for teaching that brought him to academia. Over the past decade as a professor, his interests have shifted towards global health and helping underserved communities. 

Richardson aims to design technology to fit the needs of people, and bridge the gap of “translation” between research and product development. During his time in industry, Richardson realized that the vast majority of medical device research doesn’t go anywhere in terms of helping patients. 

“That point of translation… is really where most technology and research dies, so I really wanted to be at that end of it, trying to figure out that pipeline of getting research, getting technology, all the way into the clinic,” Richardson says. “I would argue that is probably the hardest step of the whole process is actually getting a product together, developing it, doing the clinical trials, and doing the manufacturing and regulatory steps.” 

A prototype of Richardson’s latest device.

Through his teaching, Richardson emphasizes product design, interdisciplinary approaches, and industry-academia partnerships to best meet the needs of underserved communities. One of his favorite courses to teach is the Design Health Series, a four-course sequence that he was brought to Duke to develop. In this class, interdisciplinary teams of graduate students, ranging from medicine to business, work together to design medical devices. They learn how to identify problems in medicine, develop a solution, and translate that into an actual product. 

Richardson also encourages engineers to look at the broader picture and tackle the right problems. According to Richardson, challenges in global and emerging markets often aren’t due to a particular device, but rather, a multilayered system of care, ranging from a patient’s experience within a clinic to a country’s whole healthcare system. From this vantage point, he believes it’s important for engineers to determine where to intervene in the system, where the need is greatest, and to consider any unintended consequences. 

“I think that there is so much great talent in the world, so many exciting problems to go after. I wish and hope that people will think a little more carefully and deliberately about what problems they go after, and the consequences of the problems that they solve,” he says. 

Richardson is currently working on an abdominal brace for Postural Tachycardia Syndrome (POTS) patients – people who feel lightheaded after standing up – that is currently in clinical trials. While he is always eager to tackle different projects, as an educator, he believes the most important part of academia is training the next generation of engineers. 

“I can only do a couple projects a year, but I can teach a hundred students every year that can then themselves go and do great things.”

Guest Post by Arianna Lee, North Carolina School of Science and Mathematics, Class of 2025.

Pioneering New Treatments in Deep Brain Stimulation for Parkinson’s Disease

Note: Each year, we partner with Dr. Amy Sheck’s students at the North Carolina School of Science and Math to profile some unsung heroes of the Duke research community. This is the second of eight posts.

Meet a star in the realm of academic medicine – Dr. Kyle Todd Mitchell!

A man who wears many hats – a neurologist with a passion for clinical care, an adventurous researcher, and an Assistant Professor of Neurology at Duke – Mitchell finds satisfaction in the variety of work, which keeps him “driven and up to date in all the different areas.”

Dr. Mitchell holds a deep brain stimulation device.

Dr. Mitchell’s educational journey is marked by excellence, including a fellowship at the University of California San Francisco School of Medicine, a Neurology Residency at Washington University School of Medicine, and an M.D. from the Medical College of Georgia. Beyond his professional accolades, he leads an active life, enjoying running, hiking, and family travels for rejuvenation. 

Dr. Mitchell’s fascination with neurology ignited during his exposure to the field in medical school and residency. It was a transformative moment when he witnessed a patient struggling with symptoms experience a sudden and remarkable improvement through deep brain stimulation. This therapy involves the implantation of a small electrode in the brain, offering targeted stimulation to control symptoms and bringing relief to individuals grappling with the challenges of Parkinson’s Disease.

“You don’t see that often in medicine, almost like a light switch, things get better and that really hooked me,” he said. The mystery and complexity of the brain further captivated him. “Everything comes in as a bit of a mystery, I liked the challenge of how the brain is so complex that you can never master it.” 

Dr. Mitchell’s research is on improving deep brain stimulation to alleviate the symptoms of  Parkinson’s disease, the second most prevalent neurodegenerative disorder, which entails a progressive cognitive decline with no cure. Current medications exhibit fluctuations, leading to tremors and stiffness as they wear off. Deep brain stimulation (DBS), FDA-approved for over 20 years, provides a promising alternative. 

Dr. Mitchell’s work involves creating adaptive algorithms that allow the device to activate when needed and deactivate so it is almost “like a thermostat.” He envisions a future where biomarkers recorded from stimulators could predict specific neural patterns associated with Parkinson’s symptoms, triggering the device accordingly. Dr. Mitchell is optimistic, stating that the “technology is very investigational but very promising.”

A key aspect of Dr. Mitchell’s work is its interdisciplinary nature, involving engineers, neurosurgeons, and fellow neurologists. Each member of the team brings a unique expertise to the table, contributing to the collaborative effort required for success. Dr. Mitchell emphasizes, “None of us can do this on our own.”

Acknowledging the challenges they face, especially when dealing with human subjects, Dr. Mitchell underscores the importance of ensuring research has a high potential for success. However, the most rewarding aspect, according to him, is being able to improve the quality of life for patients and their families affected by debilitating diseases.

Dr. Mitchell has a mindset of constant improvement, emphasizing the improvement of current technologies and pushing the boundaries of innovation. 

“It’s never just one clinical trial — we are always thinking how we can do this better,” he says. 

The pursuit of excellence is not without its challenges, particularly when attempting to improve on already effective technologies. Dr. Mitchell juggles his hats of being an educator, caregiver, and researcher daily. So let us tip our own hats and be inspired by Dr. Mitchell’s unwavering dedication to positively impact the lives of those affected by neurological disorders.

Guest post by Amy Lei, North Carolina School of Science and Math, Class of 2025.

Inventors, Assemble: The Newest Gadgets Coming Out of Duke

What do a smart toilet, an analog film app, and metamaterial computer chips have in common? They were all invented at Duke!

The Office for Translation & Commercialization—which supports Duke innovators bringing new technologies to market—recently hosted its fifth annual Invented at Duke celebration. With nine featured inventors and 300 attendees, it was an energetic atmosphere to network and learn.

Attendees mingle in Penn Pavilion. Credit: Brian Mullins Photography.

When event organizer Fedor Kossakovski was selecting booths, the name of the game was diversity—from medicine to art, from graduate students to faculty. “Hopefully people feel like they see themselves in these [inventors] and it’s representative of Duke overall,” he said. Indeed, as I munched through my second Oreo bar from the snack table and made the rounds, this diversity became apparent. Here are just two of the inventions on display:

Guided Medical Solutions

The first thing you’ll notice at Jacob Peloquin’s booth is a massive rubber torso.

As he replaces a punctured layer of rubber skin with a shiny new one, Peloquin beckons us over to watch. Using his OptiSETT device, he demonstrates easy insertion and placement of a chest tube.

“Currently, the method that’s used is you make an incision, and then place your fingers through, and then take the tube and place that between your fingers,” Peloquin explained. This results in a dangerously large incision that cuts through fascia and muscle; in fact, one-third of these procedures currently end in complications.

Peloquin’s device is a trocar—a thin plastic cylinder with a pointed tip at one end and tubing coming out of the other. It includes a pressure-based feedback system that tells you exactly how deep to cut, avoiding damage to the lungs or liver, and a camera to aid placement. Once the device is inserted, the outer piece can be removed so only the tubing remains.

Peloquin demonstrates his OptiSETT device. Credit: Brian Mullins Photography.

Peloquin—a mechanical engineering graduate student—was originally approached by the surgeons behind OptiSETT to assist with 3D printing. “They needed help, so I kind of helped those initial prototypes, then we realized there might be a market for this,” he said. Now, as he finishes his doctorate, he has a plethora of opportunities to continue working on OptiSETT full-time—starting a company, partnering with the Department of Defense, and integrating machine learning to interpret the camera feed.

It’s amazing how much can change in a couple years, and how much good a rubber torso can do.

GRIP Display

This invention is for my fellow molecular biology enthusiasts—for the lovers of cells, genes, and proteins!

The theme of Victoria Goldenshtein’s booth is things that stick together. It features an adorable claw machine that grabs onto its stuffed animal targets, and a lime green plastic molecule that can grab DNA. Although the molecule looks complex, Goldenshtein says its function is straightforward. “This just serves as a glue between protein and the DNA [that encodes it].”

Goldenshtein—a postdoctoral associate in biomedical engineering—uses her lime green molecular model to demonstrate GRIP’s function. Credit: Brian Mullins Photography.

Goldenshtein applies this technology to an especially relevant class of proteins—antibodies. Antibodies are produced by the immune system to bind and neutralize foreign substances like disease. They can be leveraged to create drug therapies, but first we need to know which gene corresponds to which antibody and which disease. That’s where GRIP steps in.

“You would display an antibody and you would vary the antibody—a billion different variations—and attach each one to the system. This grabs the DNA,” Goldenshtein said.

Then, you mix these billions of antibody-DNA pairs with disease cells to see which one attaches. Once you’ve found the right one, the DNA is readily available to be amplified, making an army of the same disease-battling antibody. Goldenshtein says this method of high-throughput screening can be used to find a cancer cure.

Although GRIP be but small, its applications are mighty.

Explore Other Booths

  • Coprata: a smart toilet that tracks your digestive health
  • inSoma Bio: a polymer that aids soft-tissue reconstruction
  • Spoolyard: a platform for exploring digital footage with analog film techniques
  • FaunaLabs: smart watches for our furry friends
  • G1 Optics: a tonometer to automatically detect eye pressure
  • TheraSplice: precision RNA splicing to treat cancer
  • Neurophos: metamaterial photonics for powering ultra-fast AI computation

As I finished my last Oreo bar and prepared for the trek back to East Campus, I was presented with a parting gift—a leather notebook with “Inventor” embossed on the cover. “No pressure,” said the employee who was handing them out with a wink.

I thought about the unique and diverse people I’d met that night—an undergraduate working in the Co-Lab, an ECE graduate student, and even a librarian from UNC—and smiled. As long as we each keep imagining and scribbling in our notebooks, there’s no doubt we can invent something that changes the world.

Post by Michelle Li, Class of 2027

How to be a Global Inventor

Gadgets, devices, doo-dads, oh my! The Duke Global Health Institute (DGHI)  recently hosted three of its members to lead a panel on creating medical devices for low- and middle-income countries. The event was called “Global Medical Device Innovation: Three Models for Creation and Commercialization.”

Each sought to decrease costs and increase scalability for medical procedures. In short, they are expert inventors who are doing good in the world. 

Two of the most prominent inventors of our era. Image courtesy of Disney.

We’ll go step-by-step in a moment, but to start you on your journey to being just like our panelists, here’s a short glossary:

Standard-of-care: a public health term for the way things are usually done.

IRB: institutional review board, a group of people, usually based in universities, that protect human subjects in research studies. 

Screening: when doctors look at signs your body might show to determine
whether you need to be tested for certain conditions. 

Supply-chain: the movement of materials your product goes through before, during, and after manufacturing. It is a general term for a group of different suppliers, factories, vendors, advertisers, researchers, and others that work separately. 

Regulatory pathways: supply-chain for government approvals and other paperwork you need to have before introducing your product to the public.

Step 1: Meet your Mentors

Walter Lee is Chief of Staff of the Department of Head and Neck Surgery & Communication Sciences, Co-Director of the Head and Neck Program, and an affiliate faculty member at the Duke Global Health Institute. He presented ENlyT (pronounced like en-light), a newfangled nasopharyngoscope – a camera that goes down your nose and down your throat to screen for cancer. He wants to expand with partners in Vietnam and Singapore. 

Marlee Kreiger helped found the Center for Global Women’s Health Technologies at Duke in 2007. Since then, she has led the Center in many interdisciplinary and international ventures. In fact, the Center for Global Women’s Health Technologies spans both the Pratt School of Engineering and the Trinity College of Arts and Sciences. She presented on the Callascope, a pocket-sized colposcope – a camera device for cervical cancer screening. 

Julias Mugaga will soon be a visiting scholar at Duke – until then, he heads Design Cube at Makerere University in Uganda. He presented his KeyScope, a plug-and-play surgical camera with 0.3% of the cost of standard-of-care cameras. 

Kreiger’s presentation slides

Step 2: Name your Audience

DGHI has “global” in the name, so it is no surprise that these presenters serve communities around the world. Perhaps something that inventors like Dr. Doofenshmirtz often get wrong is that new innovation should come at the benefit of underserved communities, not at the cost of them. For Lee, that focus would be in his collaborations in Vietnam; for Mugaga it was his community in Uganda; and for Kreiger, it was the many studies conducted in Zambia, Tanzania, Kenya, Costa Rica, Honduras, and India.

Each of the presenters could agree that the main strategy is simple: find partners. Community members on the ground. Organizations that can benefit from your presence.

Another prominent–albeit villainous–inventor, Dr. Doofenshmirtz. Image courtesy of Disney.

Another notable aspect of your audience will be the certification you vie for. Depending on your location, you may need different permissions to distribute your product, or even begin on the journey to secure funding from certain sources.

In the United States, the most relevant regulatory pathway is FDA clearance, which is notably less restrictive than the CE mark distributed in the European Union. Both certifications are accepted in other countries, but many of the inventors on the panel opted to secure a CE mark to potentially appeal to a wider variety of governments around the world.

ISO is an international organization that is also necessary for certification, particularly if you are looking to test a medical product. No reason to be dragged down by the paperwork, though! When asked about securing Ugandan product certification, Mugaga declared, “This is one of the most exciting journeys I have taken.” His path to clearance was even more wrought with uncertainty – without steady sources of material in the Ugandan economy, it is harder to earn FDA or CE approval, two of the most widely-acknowledged certifications in the world. 

Mugaga’s presentation slides

Step 3: Test 

Now that you have permission, you can start changing lives. Many participants in our panelists’ studies were patients in community health clinics across the globe. Their partners in these clinics also had the opportunity to save tens to hundreds of thousands of dollars in equipment. While it seems like a no-brainer, there are ethical concerns that need to be addressed first. For that, you need to fill out…. You guessed it: more paperwork. IRB approval is usually granted by educational institutions (as you should recall from my handy glossary), and is crucial to secure before any testing with humans is started. In fact, the government (and most private investors) won’t even give you a second glance if you ask them for money without IRB approval. 

One big hurdle many of the panelists noted was a distrust of the technology and institution it came from – a foreign entity testing their products on you does not always invoke fear, but it certainly does not always promote trust. Kreiger noted that the work of their community health partners does the heavy lifting on that front; not only are they known community pillars, but they have authority to promote health technology through their existing relationships. If you run into trouble identifying partners in your inventorship journey–never fear. Lee has a message for you: “Ask around. At Duke, there’s always an expert around who’s willing to lend you their time.”

Step 4: Distribute

Now that you are an expert, your invention works, and you’re saving lives, you can attempt to cement your design as standard-of-care. This may look different depending on where in the world you want to distribute, but the next step is to contract a large-scale manufacturer. Your materials have been sourced by now (FDA says they better be) — so finding someone to put them together at an industrial scale should be easy! Your cost may fluctuate at this scale with the increased labor costs, but bulk production and distribution altogether should provide you, your institution, and your clients the best possible chance at changing the world. 

Lee did not receive NIH funding until his fourth attempt at applying. Kreiger did not settle on the first manufacturer contracted. Mugaga is still in the process of securing a CE mark. And yet, all of them are success stories. You can see the ENlyT saving lives in hospitals in Vietnam; you can track the reallocation of $18,000 in savings from purchasing a Calloscope; and if you’re lucky, you’ll catch Mulgaga on campus next year as a visiting scholar at Duke!

Post by Olivia Ares, Class of 2025

Only Mostly Dead? The Evolving Ethics of Evaluating Death

I recently had the pleasure of attending Professor Janet Malek’s lecture: Only Mostly Dead? The Evolving Ethical Evaluation of Death by Neurologic Criteria, a lecture sponsored by the Trent Center for Bioethics, Humanities & History of Medicine.

Dr. Malek is an associate professor in the Duke Initiative for Science & Society, and at the Baylor College of Medicine Center for Medical Ethics and Health Policy.

Janet Malek Ph.D.

We don’t often talk about death. On the surface, it seems like it would be a straight-forward concept. You’re either dead, or you’re not dead. Right? It turns out that clinically defining death is not so simple.

Popular media has some grasp on the ambiguity of the definition of death. Remember this scene from the popular movie, The Princess Bride? Suspecting that the protagonist is dead, his friends bring him to a miracle-worker and have the following conversation. 

Miracle Max: “Whoo-hoo-hoo, look who knows so much. It just so happens that your friend here is only MOSTLY dead. There’s a big difference between mostly dead and all dead. Mostly dead is slightly alive. With all dead, well, with all dead there’s usually only one thing you can do.

Inigo Montoya: What’s that?

Miracle Max: Go through his clothes and look for loose change.

In real life, death used to be determined by cardiopulmonary criteria – when the heart and lungs stop working.  In recent decades the idea that death can be determined using neurologic criteria – when the brain stops working – has gained acceptance. As neuroscience and technology has evolved, so too have our definitions. Now that we know more about how the brain works, we know that there may be some brain activity even after a person has met the criteria for death by neurologic criteria (DNC). This leads to philosophically rich and practically relevant questions of ethics – for example, when do we stop providing life-sustaining care? In the field of bioethics and beyond, there is high demand for discussion on this topic.

There has been controversy over defining death since the 1650’s — when a woman named Anne Greene woke up after being hanged. It wasn’t until the 1980’s that a consensus definition of death was first identified. Here is a brief history:

1950s

  • Widespread availability of ventilators led to the identification of a state described as death of the neurological system.

1960s

  • Advances in organ transplantation foster discussion on the ethics of defining death.
  • A committee at Harvard Medical School examined the definition of Brain Death. They created a definition of “Irreversible Coma,” which focused on loss of neurological function.

1980s

  • The 1980 Uniform Determination of Death Act (UDDA) provided a legal basis for clinically determining death as: an individual who has sustained either 1) irreversible cessation of circulatory and respiratory functions OR 2) irreversible cessation of functions of the entire brain.
  • 1981: President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research report. Findings are centered on questions of functioning of the organism as a whole and the brain’s role in coordinating it.

1990s-2000s

  • Clinicians arrive at general agreement that a patient in a state of coma or unresponsiveness, without brainstem reflexes and who fails an apnea test is dead by neurologic criteria. Largely it is accepted that “brain death is death” but there is not complete consensus.

2010-late

  • 2013: Case of Jahi McMath. A 13-year old girl was declared “brain dead” in California, and a death certificate was issued. However, the family fought to have her maintained on life support. They moved to New Jersey, the only state which recognized objections to brain death, and the “brain dead” declaration was reversed. Jahi lived there for 4 years before passing away. This famous case caused people to reconsider the concept of brain death.

2020s:

  • Recent innovations in heart transplantation technology will likely challenge the acceptance of the Dead Donor Rule (DDR) which requires that an individual is clinically declared dead before vital organs are removed for transplantation.
  • 2021: Assembly of the Determination of Death Committee, tasked with updating the Uniform Determination of Death Act (UDDA). Duke faculty (and founding director of Science & Society) Nita Farahany, is involved with this process.

What ethical issues and practical questions challenging Death by Neurologic Criteria (DNC) today? Dr. Malek shared the following case.

Following a tragic car accident, Ms. Jones, a 20-year-old college student, was brought to the hospital, having suffered significant anoxic brain injury. The medical team determined that she met criteria for DNC. However, her family refused to allow for further testing. Several days passed. Ms. Jones was maintained on life support, during which she did not show signs of improvement. After several difficult conversations, the family consented for assessment and Ms. Jones was declared dead — using the criteria associated with DNC.

What is the proper amount of time to continue life-sustaining treatment if a physician suspects the patient will never recover?

Although this may sound like an uncommon occurrence, nearly half of neurologists have been asked to continue neurologic support for patients that may meet criteria for DNC.

Obligating life support for patients suspected of meeting DNC, either through the family’s refusal for testing or by direct request, would likely result in ethical harms such as violation of the dignity of decedent, unjustly using scarce resources, or causing moral distress in caregivers.

However, it may be permissible to maintain life support in these situations. Dr. Malek says that we do not yet have a good ethical framework for this. Reasonable accommodations that are in line with professional guidelines probably have minimal impact, and might provide some psychosocial benefits to families.

Is consent required to test for DNC? Should it be?

Legal and professional standards favor the idea that testing for DNC likely falls under the category of implied consent, which assumes that a person would want reasonable medical care in the event of unconsciousness. In fact, 80% of neurologists think that getting consent for these evaluations is unnecessary.

These are extremely difficult questions, and there is continuing controversy over what the correct answers should be. Dr. Malek advises medical experts to work with healthcare administrators to develop clear institutional policies.

Post by Victoria Wilson, 2023 MA student in Bioethics & Science Policy

What is it like to Direct a Large, Externally-Funded Research Center?

What are the trials and tribulations one can expect? And conversely, what are the highlights? To answer these questions, Duke Research & Innovation Week kicked off with a panel discussion on Monday, January 23.

The panel

Moderated by George A. Truskey, Ph.D, the Associate Vice President for Research & Innovation and a professor in the Department of Biomedical Engineering, the panelists included…

  • Claudia K. Gunsch, Ph.D., a professor in the Departments of Civil & Environmental Engineering, Biomedical Engineering, and Environmental Science & Policy. Dr. Gunsch is the director of the NSF Engineering Research Center for Microbiome Engineering (PreMiEr) and is also the Associate Dean for Duke Engineering Research & Infrastructure.
Dr. Claudia Gunsch
  • Yiran Chen, Ph.D., a professor in the Department of Electrical & Computer Engineering. Dr. Chen is the director of the NSF AI Institute for Edge Computing (Athena).
Dr. Yiran Chen
  • Stephen Craig, Ph.D., a professor in the Department of Chemistry. Dr. Craig is the director of the Center for the Chemistry of Molecularly Optimized Networks (MONET).
Dr. Stephen Craig

The centers

As the panelists joked, a catchy acronym for a research center is almost an unspoken requirement. Case in point: PreMiEr, Athena, and MONET were the centers discussed on Monday. As evidenced by the diversity of research explored by the three centers, large externally-funded centers run the gamut of academic fields.

PreMiEr, which is led by Gunsch, is looking to answer the question of microbiome acquisition. Globally, inflammatory diseases are connected to the microbiome, and studies suggest that our built environment is the problem, given that Americans spend on average less than 8% of time outdoors. It’s atypical for an Engineering Research Center (ERC) to be concentrated in one state but uniquely, PreMieR is. The center is a joint venture between Duke University, North Carolina A&T State University, North Carolina State University, the University of North Carolina – Chapel Hill and the University of North Carolina – Charlotte.

PreMiEr – not to be confused with the English Premier League

Dr. Chen’s Athena is the first funded AI institute for edge computing. Edge computing is all about improving a computer’s ability to process data faster and at greater volumes by processing data closer to where it’s being generated. AI is a relatively new branch of research, but it is growing in prevalence and in funding. In 2020, 7 institutes looking at AI were funded by the National Science Foundation (NSF), with total funding equaling 140 million. By 2021, 11 institutes were funded at 220 million – including Athena. All of these institutes span over 48 U.S states.

Athena, or the Greek goddess of wisdom, is a fitting name for a research center

MONET is innovating in polymer chemistry with Stephen Craig leading. Conceptualizing polymers as operating in a network, the center aims to connect the behaviors of a single chemical molecule in that network to the  behavior of the network as a whole. The goal of the center is to transform polymer and materials chemistry by “developing the knowledge and methods to enable molecular-level, chemical control of polymer network properties for the betterment of humankind.” The center has nine partner institutions in the U.S and one internationally.

MONET, like French painter Claude Monet

Key takeaways

Research that matters

Dr. Gunsch talked at length about how PreMiEr aspires to pursue convergent research. She describes this as identifying a large, societal challenge, then determining what individual fields can “converge” to solve the problem.

Because these centers aspire to solve large, societal problems, market research and industry involvement is common and often required in the form of an industry advisory group. At PreMiEr, the advisory group performs market analyses to assess the relevance and importance of their research. Dr. Chen also remarked that there is an advisory group at Athena, and in addition to academic institutions the center also boasts collaborators in the form of companies like Microsoft, Motorola, and AT&T.

Dr. Chen presenting on Athena’s partner institutions at Monday’s talk.

Commonalities in structure

Most research centers, like PreMiEr, Athena, and MONET, organize their work around pillars or “thrusts.” This can help to make research goals understandable to a lay audience but also clarifies the purpose of these centers to the NSF, other funding bodies, host and collaborating institutions, and the researchers themselves.

How exactly these goals are organized and presented is up to the center in question. For example, MONET conceptualizes its vision into three fronts – “fundamental chemical advances,” “conceptual advances,” and “technological advances.”

At Athena, the research is organized into four “thrusts” – “AI for Edge Computing,” “AI-Powered Computer Systems,” “AI-Powered Networking Systems,” and “AI-Enabled Services and Applications.”

Meanwhile, at PreMiEr, the three “thrusts” have a more procedural slant. The first “thrust” is “Measure,” involving the development of tracking tools and the exploration of microbial “dark matter.” Then there’s “Modify,” or the modification of target delivery methods based on measurements. Finally, “Modeling” involves predictive microbiome monitoring to generate models that can help analyze built environment microbiomes.  

A center is about the people  

“Collaborators who change what you can do are a gift. Collaborators who change how you think are a blessing.”

Dr. stephen craig

All three panelists emphasized that their centers would be nowhere without the people that make the work possible. But of course, humans complicate every equation, and when working with a team, it is important to anticipate and address tensions that may arise.

Dr. Craig spoke to the fact that successful people are also busy people, so what may be one person’s highest priority may not necessarily be another person’s priority. This makes it important to assemble a team of researchers that are united in a common vision. But, if you choose wisely, it’s worth it. As Dr. Craig quipped on one of his slides, “Collaborators who change what you can do are a gift. Collaborators who change how you think are a blessing.”

In academia, there is a loud push for diversity, and research centers are no exception. Dr. Chen spoke about Athena’s goals to continue to increase their proportions of female and underrepresented minority (URM) researchers. At PreMiEr, comprised of 42 scholars, the ratio of non-URM to URM researchers is 83-17, and the ratio of male to female researchers is approximately 50-50.

In conclusion, cutting-edge research is often equal parts thrilling and mundane, as the realities of applying for funding, organizing manpower, pushing through failures, and working out tensions with others sets in. But the opportunity to receive funding in order to start and run an externally-funded center is the chance to put together some of the brightest minds to solve some of the most pressing problems the world faces. And this imperative is summarized well by the words of Dr. Craig: “Remember: if you get it, you have to do it!”

Post by Megna Datta, Class of 2023

The Need for Title IX in STEM

The Panel:

In recognition of the 50th anniversary of Title IX, which was intended to make sex discrimination in education illegal, a panel of Duke women met on Thursday, September 29 to talk about whether Title IX could change STEM, (Science Technology, Engineering and Math). Unfortunately, the answer was not simple.

But just through the sharing of the statistics relevant to this problem, the stories, and their solutions, one could start to understand the depth of this problem. One takeaway was that all women in STEM, whether they be student, professor, or director, have faced gender discrimination.

The student panelists after a successful forum

Down to the Statistics:

Dr. Sherryl Broverman, a Duke professor of the practice in biology and global health, gave the audience an overview. Of all of Duke’s regular ranked, tenured-track faculty, only 30% are women. In contrast, women make up 60% of the non-tenure track faculty. Dr. Broverman said men are promoted in Duke at a higher frequency. This is especially seen with the associate professor title because, on average, men are associate professors for 4 to 5 years; whereas women are associate professors for up to 9 years.

To give an example, senior Nasya Bernard-Lucien, a student panelist who studied Biomedical Engineering and then Neuroscience informed me that she has had a total of two women professors in her entire STEM career. This is a common pattern here at Duke because taking a STEM class that has a woman professor is as rare as finding a non-stressed Duke student.

Dr. Kisha Daniels (left) and Dr. Whitney McCoy (right)

The Beginning of a Girl’s Career in STEM

This disproportionate demographic of women professors in STEM is not a new occurrence with Duke or the rest of the world because the disproportion of women in STEM can be seen as early as middle school. Two of the student panelists noted that during their middle school career, they were not chosen to join an honors STEM program and had to push their school’s administration when they asked to take more advanced STEM classes.

Dr. Kisha Daniels, an associate professor of the practice in education said on a faculty panel that one of her daughters was asked by her male peers, “what are you doing here?” when she attended her middle school’s honors math class. Gender discrimination in STEM begins in early childhood, and it extends its reach as long as women continue to be in a STEM field, and that is particularly evident here at Duke.

Women in STEM at Duke

Dr. Sherryl Broverman

The last panel of the Title IX @ 50 event was the student panel which consisted of undergraduate and graduate students. Even though they were all from different backgrounds, all acknowledged the gender disparity within STEM classes.

Student Bentley Choi said she was introduced to this experience of gender discrimination when she first arrived at Duke from South Korea. She noted how she was uncomfortable and how it was hard to ask for help while being one of the few women in her physics class. One would have hoped that Duke would provide a more welcoming environment to her, but that is not the case, and it is also not an isolated incident. Across the panel, all of the women have experienced discomfort in their STEM classes due to being one of the few girls in there.

The Future of Title IX

How can Title IX change these issues? Right now, Title IX and STEM are not as connected as they need to be; in fact, Title IX, in the past, has been used to attack programs created to remedy the gender disparity in STEM. So, before Title IX can change STEM, it needs to change itself.

Title IX needs to address that this problem is a systemic issue and not a standalone occurrence. However, for this change to happen, Dr. Whitney McCoy, a research scientist in Child and Family Policy, said it perfectly, “we need people of all backgrounds to voice the same opinion to create policy change.”

So, talk to your peers about this issue because the more people who understand this situation, the chances of creating a change increases. The last thing that needs to occur is that 50 years in the future, there will be similar panels like this one that talk about this very issue, and there are no panels that talk about how we, in the present, fixed it.

Post by Jakaiyah Franklin, Class of 2025

Jason Dinh Once Collected Cicadas, Now He Researches Snapping Shrimp

Jason Dinh’s research career began unintentionally with a semester at Duke’s Marine Lab. A current fourth-year PhD candidate in Duke’s Biology Department, Dinh ventured to the Marine Lab for a mental reset in the spring of his sophomore year as a Duke undergraduate. “While I was there, I realized that people can just get paid to ask questions about how the world works,” Dinh told me, “And I really didn’t know that was a thing that you could do.” Maybe this is what I want to do, he thought.

Jason Dinh, fourth-year PhD candidate in Duke Biology Department

Dinh spent his remaining undergraduate summers investigating the impacts of soundscapes on oyster and fish larvae development. Now, he studies snapping shrimp – a small oceanic species that is “one of the biggest sound producers in the ocean,” bested only by toothed whales.

Dinh first became aware of snapping shrimp during his undergraduate research. He told me that you can find snapping shrimp “basically anywhere, from the equator up to Virginia or maybe North Carolina.” While conducting research on ocean sounds and oyster and fish larvae, Dinh noticed the frequent snapping sounds of the snapping shrimp when he placed underwater microphones. “We didn’t really know what they were doing,” Dinh said.

An image of a species of snapping shrimp like Dinh works with.

The male snapping shrimp is asymmetrical with one very large claw and one that is regular-sized. The large claw has a tiny hook on the end and when the shrimp clamps down or “snaps” the claw, the top half latches into the bottom, shooting out an air bubble at sixty miles per hour that “essentially boils the water behind it,” producing the loud snapping noise in its wake. When many shrimp are snapping at once, it sounds almost like the frying grease when cooking bacon, Dinh tells me. (Click here to watch a video of the snapping shrimp in action.)

At first, researchers suspected the bubble from the snap was a means of stunning prey, but “It turns out that snapping shrimp also fight each other,” Dinh said. And when fighting, male snapping shrimp shoot the air bubbles at one another. The bigger the shrimp’s body size, the larger the snapping claw and the louder the snapping sound.

An image of two snapping shrimp facing off.

Going into his PhD, Dinh wanted to continue his undergraduate work in acoustics and figure out novel ways animals were producing sounds. His investigation of the snapping shrimp took him in new directions, however. Through his projects, Dinh has conducted work on the costs and benefits that keep the claw size as an honest indicator of shrimp size in competitions and approached a plethora of questions from the physiological and physical mechanisms of sending and assessing snaps, up to the evolutionary implications of the sexual selection for claw size.

“I don’t think I really knew I wanted to do research until right before I applied for grad school,” Dinh said at the beginning of our conversation. He remembers being a child curious about nature and bringing in “hundreds of cicadas” and “random critters into the house.” A few decades later and his research is centered on living creatures, which is both a rewarding and tricky process.

“Live animals are going to do what live animals want to do,” Dinh stated simply. “One thing my advisor always tells us is that you don’t get to tell the animal what to do, it tells you what you are going to do.” This has certainly held true for Dinh. While he has had many detailed and well-planned experimental ideas, he says he’s ultimately ended up doing what the “animals told him they were willing and happy to do in the lab.” However, along the way Dinh basks in the “joys in tiny discoveries in the process of research.”

I asked Dinh how he ended up at Duke in the first place and why he chose to stick around for his PhD. “So I ended up at Duke for undergrad because I really liked basketball, which is a really bad reason to choose a school.” But ultimately, this choice “paid off really well because my first year was the last year we won the National Championship,” Dinh said. He traveled to Indianapolis for the event which he says was the “best basketball game of [his] life.”

Dinh decided to do his PhD at Duke because of how deeply he admires his advisor, Sheila Patek (PhD), as a scientist. “I think she’s just a wonderful, passionate, passionate defender of basic science and just doing science because more knowledge is good for society,” Dinh elaborated, “Sheila’s also a staunch and fearless advocate for her students.” Though Dinh considers himself an “outlier” in the lab – primarily a behavioral ecologist in a lab of researchers investigating biomechanics – the way that Patek approaches science is the way that he wants to approach science as well.

Like Alice falling down the rabbit hole in Alice in Wonderland, Dinh compares the diving explorations of science as being a “professional rabbit holer.” Science consists of picking questions further and further apart and leaning into research findings to tunnel into topics.

“I feel like science is being a professional rabbit holer,” Dinh stated. While Dinh is on the pursuit of the weapon size and fighting strategies of snapping shrimp, he doesn’t know exactly where he wants to head next, following the completion of his PhD. Like the snapping shrimp that collect information about their opponents to make an informed decision about engaging in fights, Dinh says he is conducting a sort of Bayesian method of his own. He’s assessing his experiences as he goes and sorting out the right next step for him.

A fan of the meditative art of writing, long morning walks with his dog, and reality TV, Dinh appreciates being “on the frontier of what we know” and is sure to let his deep-rooted curiosity about the natural world continue to guide him.

By Cydney Livingston

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