Category: Faculty Page 2 of 17

Using Data Science for Early Detection of Autism

On March 31, 2021

In Behavior/Psychology, Computers/Technology, Data, Faculty, Medicine, Neuroscience

Autism Spectrum Disorder can be detected as early as six to twelve months old and the American Academy of Pediatrics recommends all children be screened between twelve and eighteen months of age.

But most diagnoses happen after the age of 4, and later detection makes it more difficult and expensive to treat.

One in 40 children is diagnosed with Autism Spectrum Disorder and Duke currently serves about 3,000 ASD patients per year. To improve care for patients with ASD, Duke researchers have been working to develop a data science approach to early detection.

Geraldine Dawson, the William Cleland Distinguished Professor in the Department of Psychiatry & Behavioral Sciences and Director of the Duke Center for Autism and Brain Development, and Dr. Matthew Engelhard, a Conners Fellow in Digital Health in Psychiatry & Behavioral Sciences, recently presented on the advances being made to improve ASD detection and better understand symptoms.

The earlier ASD is detected, the easier and less expensive it is to treat. Children with ASD face challenges in learning and social environments.

ASD differs widely from case to case, however. For most people, ASD makes it difficult to navigate the social world, and those with the diagnosis often struggle to understand facial expressions, maintain eye contact, and develop strong peer relations.

However, ASD also has many positive traits associated with it and autistic children often show unique skills and talents. Receiving a diagnosis is important for those with ASD so that they can receive learning accommodations and ensure that their environment helps promote growth.

Because early detection is so helpful researchers began to ask:

“Can digital behavioral assessments improve our ability to screen for neurodevelopmental disorders and monitor treatment outcomes?”
Dr. geraldine DawsoN

The current approach for ASD detection is questionnaires given to parents. However, there are many issues in this method of detection such as literacy and language barriers as well as requiring caregivers to have some knowledge of child development. Recent studies have demonstrated that digital assessments could potentially address these challenges by allowing for direct observation of the child’s behavior as well as the ability to capture the dynamic nature of behavior, and collect more data surrounding autism.

“Our goal is to reduce disparities in access to screening and enable earlier detection of ASD by developing digital behavioral screening tools that are scalable, feasible, and more accurate than current paper-and-pencil questionnaires that are standard of care.”
Dr. Geraldine Dawson

Guillermo Sapiro, a James B. Duke Distinguished Professor of Electrical and Computer Engineering, and his team have developed an app to do just this.

On the app, videos are shown to the child on an iPad or iPhone that prompt the child’s reaction through various stimuli. These are the same games and stimuli typically used in ASD diagnostic evaluations in the clinic. As they watch and interact, the child’s behavior is measured with the iPhone/iPad’s selfie camera. Some behavioral symptoms can be detected as early as six months of age are, such as: not paying as much attention to people, reduced affective expression, early motor differences, and failure to orient to name.

In the proof-of-concept study, computers were programmed to detect a child’s response to hearing their name called. The child’s name was called out by the examiner three times while movies were shown. Toddlers with ASD demonstrated about a second of latency in their responses.

Another study used gaze monitoring on an iPhone. Nearly a thousand toddlers were presented with a split screen where a person was on one side of the screen and toys were on the other. Typical toddlers shifted their gaze between the person and toy, whereas the autistic toddlers focused more on the toys. Forty of the toddlers involved in the study received an ASD diagnosis. Using eye gaze, researchers were also able to look at how toddlers responded to speech sounds as well as to observe early motor differences because toddlers with ASD frequently show postural sway (a type of head movement).

“The idea behind the app is to begin to combine all of these behaviors to develop a much more robust ASD algorithm. We do believe no one feature will allow us to detect ASD in developing children because there is so much variation”
DR. GERALDINE DAWSON

The app has multiple features and will allow ASD detection to be done in the home. Duke researchers are now one step away from launching an at-home study. Other benefits of this method include the ability to observe over time with parents collecting data once a month. In the future, this could be used in a treatment study to see if symptoms are improving.

Duke’s ASD researchers are also working to integrate information from the app with electronic health records (EHR) to see if information collected from routine medical care before age 1 can help with detection.

The SolarWinds Attack and the Future of Cybersecurity

By Anna Gotskind

On March 2, 2021

In Business/Economics, Computers/Technology, Data, Faculty, News Release, Policy, Science Communication & Education

Cybersecurity is the protection of computer systems and networks in order to prevent theft of or damage to their hardware, software, or electronic data. While cybersecurity has been around since the 1970s, its importance and relevance in mainstream media as well as politics is growing as an increased amount of information is stored electronically. In 1986, approximately 1% of the world’s information was stored in a digital format; by 2006, just twenty years later, this had increased to 94%.

Cyber Hacking has also become more prominent with the advent of the Digital Revolution and the start of the Information Era which began in the 1980s and rapidly grew in the early 2000s. It became an effective political form of attack to acquire confidential information from foreign countries.

In mid-December of 2020, it was revealed that several U.S. companies and even government agencies were victims of a cyberattack that began in September of 2019.

The Sanford School of Public Policy hosted a leading cybersecurity reporter Sean Lyngaas to lead a discussion on the national security implications of the SolarWinds hack with Sanford Professor David Hoffman as well as Visiting Scholar and Journalist Bob Sullivan. Lyngaas graduated from Duke in 2007 and majored in Public Policy at the Sanford School.

Lyngaas did not have a direct route into cybersecurity journalism. After completing his Masters in International Relations from The Fletcher School of Law and Diplomacy at Tufts University he moved to Washington D.C. to pursue a career as a policy analyst. However, at night when he was not applying for jobs he began pitching stories to trade journals. Despite not being a “super technical guy” Lyngaas ended up becoming passionate about cybersecurity and reporting on the increasing amounts of news surrounding the growing topic. Since 2012 Lyngaas has done extensive reporting on cybersecurity breaches and recently has published several detailed reports on the SolarWinds incident.

The SolarWinds attack is considered one of the most impactful cybersecurity events in history as a result of its intricacy and the number of government and private sector victims. Lyngaas explained that most people had not heard of SolarWinds until recently, but the company nevertheless, provides software to a multitude of fortune 500 companies and government agencies. One of the software products they sell is Orion, an IT performance monitoring platform that helps businesses manage and optimize their IT infrastructure. The Hackers infiltrated Orion’s update software and over several months sent out malicious updates to 18,000 companies and government agencies. Among the victims of this espionage campaign were the U.S. Justice Department and Microsoft. As a result of the campaign, countless email accounts were infiltrated and hacked.

“A perfect example of someone robbing a bank by knocking out the security guard and putting on his outfit to have access.”
Bob Sullivan

Sullivan added that this hack is particularly concerning because the target was personal information whereas previous large-scale hacks have been centered around breaching data. Additionally, SolarWind’s core business is not cybersecurity, however, they work with and provide software to many cybersecurity companies. The attack was revealed by FireEye, a cybersecurity company that announced they had been breached.

“FireEye got breached and they are the ones usually investigating the breaches”
Sean lyngaas

This situation has prompted both those involved in the cybersecurity industry as well as the public to reconsider the scope of cyberhacking and what can be done to prevent it.

“Computer spying by nation states has been going on for decades but we talk about it more openly now.” Lyngass stated.

Lyngaas added that the public is now expecting more transparency especially if there are threats to their information. He feels we need to have better standards for companies involved in cyber security. Solarwinds arguably was not using cybersecurity best practices and had recently made price cuts which may have contributed to their vulnerability. Hoffman explained that SolarWinds had been using an easy-to-guess password to their internal systems which allowed hackers access to the software update as well as the ability to sign a digital signature.

“We are not going to prevent these breaches; we are not going to prevent the Russians from cyber espionage.” Lyngaas stated

However, he believes by using best practices we can uncover these breaches earlier and react in a timely manner to reduce damage. Additionally, he thinks there needs to be a shift in government spending in terms of the balance between cyber defense and offense. Historically, there has been a lack of transparency in government cyber spending, however, it is known that there has been more spent on offense in the last several years.

Changes are starting to be made in the cybersecurity landscape that hopefully should aid in reducing attacks or at least the severity of their impacts. California recently created a law centered around publicizing breaches which will increase transparency. The panelists added that the increasing amount of news and information available to the public about cybersecurity is aiding efforts to understand and prevent it. President Biden was openly speaking about cybersecurity in relation to protecting the election from hackers and continues to consider it an urgent issue as it is crucial in order to protect confidential U.S. information.

As Lyngaas explained, it is practically impossible to completely prevent cyber attacks, however, through increasing transparency and using best practices, incidents like the SolarWinds hack will hopefully not have effects of the same scale again.

Post by Anna Gotskind

Her Research Path Winds Through a Plant’s Growth

By Guest Post

On January 4, 2021

In Biology, Faculty, Guest Post

The beauty of research is that it allows you to take control of your own path.

“We are very lucky to be in the position to decide what we love to do and do it,” says Tai-ping Sun, a Duke biology professor studying the plant hormone GA. Researchers get to take control of their own path, she said. Every day is an opportunity to learn something new, design and analyze experiments and decide what direction to take.

Tai-ping Sun is a professor of Biology at Duke

Sun studies the GA signaling pathway because it regulates plant growth and development. She got interested in GA when she was a post-doctoral fellow at Harvard University in 1988. At the time, a lot of tools needed to be developed. As she was developing new tools to clone plant genes, she came across a GA mutant that was different. Her research is very important to understanding how the mutations in the GA signaling pathways can control the height of a plant. In fact, she says, GA mutations were one of the reasons for the success of the “Green Revolution” in the 1960s.

Sun’s current research revolves around identifying the mechanisms of the cell that make GA hormones and identifying how GA mutations have affected this pathway. Her team has identified important facets of the pathway, such as the structure and function of the nuclear receptors that allow for transcription that drives the GA response. Her team has also identified transcription factors that control the rate of the signaling pathway such as the DELLA proteins that act as master growth repressors to inhibit GA response. In fact one of her favorite discoveries is that GA triggers destruction of the DELLA proteins to activate the GA signaling pathway.

A figure from a 2004 paper by Sun on plant growth.
All three of the mutants grew less well than wild type plants.

“As a scientist, the most exciting thing is to discuss experimental data, and then trying to deduce hypothesis or modify models and then come up with new experiments for testing,” she said.

But research is not without its challenges, Sun says “not everything that you do works out the first time.” That’s why she says that as a researcher the most important thing is to have an interest in your field as well as perseverance.

Guest post by Anika Jain, Class of 2021, NC School of Science and Math

Quantifying the effects of structural racism on health

By Victoria Priester

On December 22, 2020

In Data, Faculty, Lecture, Statistics

America is getting both older and Blacker. The proportion of non-white older adults is increasing, and by 2050 the majority of elderly people will be racial minorities. In his Langford Lecture “Who gets sick and why? How racial inequality gets under the skin” on November 10, Professor Tyson H. Brown discussed the importance of studying older minorities when learning about human health. His current project aims to address gaps in research by quantifying effects of structural racism on health.

Health disparities result in unnecessary fatalities. Dr. Brown estimates that if we took away racial disparities in health, we could avoid 229 premature deaths per day. Health disparities also have substantial economic costs that add up to about 200 billion dollars annually. Dr. Brown explained that the effects of structural racism are so deadly because it is complex and not the same as the overt, intentional, interpersonal racism that most people think of. Thus, it is easier to ignore or to halt attempts to fix structural racism. Dr. Brown’s study posits that structural racism has five key tenets: it is multifaceted, interconnected, an institutionalized system, involves relational subordination and manifests in racial inequalities in life chances.

A motivator for Brown’s research was that less than 1% of studies of the effects of race on health have focused on structural racism, even though macro level structural racism has deleterious effects on health of Black people. When thinking about inequalities, the traditional mode of thinking is the group that dominates (in this case, white people) receives all benefits and the subordinates (in Dr. Brown’s study, Black people) receive all of the negative effects of racism. In this mode of thinking, whites actively benefit from social inequality. However, Dr. Brown discussed another theory: that structural racism and its effects on health undermines the fabric of our entire society and has negative impacts on both whites and Blacks. It is possible for whites to be harmed by structural racism, but not to the same extent as Black people.

Dr. Brown identified states as “important institutional actors that affect population health.” As a part of his research, he made a state level index of structural racism based off of data from 2010. The index was composed of nine indicators of structural racism, which combine to make an overall index of structural racism in states. In mapping out structural racism across the domains, the results were not what most people might expect. According to Dr. Brown’s study, structural racism tends to be highest in the midwest of the United States, rather than the south. These higher levels of structural racism were associated with worse self-rated health: one standard deviation increase in level of structural racism correlated with the equivalent of two standard deviation increases in age. In other words, a person who is affected by structural racism has similar self-rated health to people two age categories above them who do not experience negative effects of structural racism.

As the structural racism index increases, the Black-white difference in COVID-19 related deaths also increases. Overall, Dr. Brown found that structural racism is a key driver of inequalities in COVID-19 deaths between whites and Blacks. Looking forward, Dr. Brown is interested in learning more about how contemporary forms of racism contribute to inequality—such as searching racial slurs on Google and implicit bias, both of which are high in the southern United States.

After his discussion, colleagues raised questions about what can be done to eliminate negative effects of structural racism. Dr. Brown listed options such as rent protection, COVID-19 test sites in lower income communities and another stimulus bill. He also explained that the distribution of a COVID-19 vaccine needs to be done in an ethical manner and not exclude those who are less fortunate who really need the vaccine. We also need better data collection in general—the more we know about the effects of structural racism, the better we will be able to adapt equity practices to mitigate harm on Black communities.

By Victoria Priester

Most Highly Cited List Includes 37 from Duke

By Karl Bates

On November 18, 2020

In Behavior/Psychology, Engineering, Faculty, Immunology, Medicine

Five of the ten Duke women included in the most highly-cited list this year. Their scholarly publications are viewed as important and influential by their peers. (Clockwise from upper left: Costello, Curtis, Dawson, Bernhardt, Moffitt)

Duke’s leading scholars are once again prominently featured on the annual list of “Most Highly Cited Researchers.”

Thirty-seven Duke faculty were named to the list this year, based on the number of highly cited papers they produced over an 11-year period from January 2009 to December 2019. Citation rate, as tracked by Clarivate’s Web of Science, is an approximate measure of a study’s influence and importance.

Two Duke researchers appear in two categories: Human Vaccine Institute Director Barton Haynes, and Michael Pencina, vice dean of data science and information technology in the School of Medicine.

And two of the Duke names listed are new faculty, recruited as part of the Science & Technology initiative: Edward Miao in Immunology and Sheng Yang He in Biology.

This year, 6,127 researchers from 60 countries are being recognized by the listing. The United States still dominates, with 41 percent of the names on the list, but China continues to grow its influence, with 12 percent of the names.

Clinical Medicine:

Robert M. Califf, Lesley H. Curtis, Pamela S. Douglas, Christopher Bull Granger, Adrian F. Hernandez, L. Kristen Newby, Erik Magnus Ohman, Manesh R. Patel, Michael J. Pencina, Eric D. Peterson.

Environment and Ecology:

Emily S. Bernhardt, Stuart L. Pimm, Mark R. Weisner.

Geosciences:

Drew T. Shindell

Immunology:

Barton F. Haynes, Edward A. Miao

Microbiology:

Barton F. Haynes

Plant and Animal Science:

Sheng Yang He

Psychiatry and Psychology:

Avshalom Caspi, E. Jane Costello, Renate M. Houts, Terrie E. Moffitt

Social Sciences:

Michael J. Pencina

Cross-Field:

Dan Ariely, Geraldine Dawson, Xinnian Dong, Charles A. Gersbach, Ru-Rong Ji, Robert J. Lefkowitz, Sarah H. Lisanby, Jie Liu, Jason W. Locasale, David B. Mitzi, Christopher B. Newgard, Ram Oren, David R. Smith, Avner Vengosh.

The evolutionary advantage of being friendly

By Victoria Priester

On October 19, 2020

In Animals, Behavior/Psychology, Biology, Faculty, Science Communication & Education

We’ve all heard the term “survival of the fittest,” which scientist Charles Darwin famously coined to explain how organisms with heritable traits that give them an advantage — such as avoiding predators or beating out others for the chance to mate — are able to survive and pass on these advantageous traits to their offspring.

In his talk with ClubEvMed last Tuesday, Brian Hare of Duke Evolutionary Anthropology explained key points from his new book that he co-authored with his wife and research partner, Vanessa Woods, entitled Survival of the Friendliest: Understanding Our Origins and Rediscovering Our Common Humanity.

The term “fittest” is often associated with animals who are physically stronger or of more value than others, but being “fit” can also include an organism’s ability to communicate well with others in its group, which can provide an evolutionary advantage. For example, more social animals can form alliances with each other and protect each others’ young, so the whole population stays stronger in terms of number.

Hare cited a comparison between chimpanzees and bonobos, both of which have the potential for infanticide by aggressive males in a group. However, bonobos have zero cases of infanticide because female bonobos are able to communicate well and form alliances to protect each others’ young from aggressive males. Since the high cost of aggression for males outweighs the benefit, the males are friendlier, and the young bonobos survive. While this is a specific case with wild animals, other species have adopted social skills as a method of survival through domestication or self-domestication.

Hare referred to dogs as “exhibit A” of survival of the friendliest via domestication, because humans have bred dogs that are more playful, approachable and patient for centuries. Dogs are exceptionally good at understanding, responding to and communicating with humans as a result of domestication. Hare also explained one Russian study in which they began selecting foxes based on their friendliness towards people. They bred the most friendly foxes together and then compared the friendliness of their offspring to the offspring of randomly bred foxes. The results showed that friendlier foxes differed in physiology in addition to behavior, and were better at cooperating and communicating with humans. This is an example of self-domestication, which changes development patterns and has increased fitness via friendliness. Friendliness in this case means skill in cooperating and communication.

Survival of the Friendliest argues that humans today are the friendliest species of human, which may be why we have lasted so long evolutionarily. However, with the new type of friendliness also comes a new type of aggression. Mother bears are kind and nurturing to their cubs, but also have the most potential for aggression when they feel their cubs are threatened. Similarly in humans, when we feel people who share our identity are threatened, we want to protect those individuals.

Hare and Woods reason that this desire to protect also reduces our ability to cooperate or communicate with those who we feel threaten us or threaten our “group”— whether this be our family, our race or another trait. When our ability to communicate is reduced, we begin to dehumanize those who we feel threaten the people who share our identity. This then becomes a cycle, where people dehumanize those who they believe are dehumanizing them.

In order to stop this cycle, Hare and Woods argue that humans will need to alter their view of who they believe “belongs” to their group to include more people. We need to communicate openly and build a desire to protect other humans, rather than dehumanize them.

By Victoria Priester

Scholars Examine Duke’s History of Unequal Medical Care for Black People

By Cydney Livingston

On September 29, 2020

In Faculty, Medicine, Policy, Responsible Conduct, Science Communication & Education

Conversations on and actions toward making American medicine less racist continue to grow. At Duke, that includes looking at our own history as a hospital and medical center serving a diverse community.

In a Sept. 22 virtual conversation, Duke physicians Damon Tweedy M.D., Associate Professor of Psychiatry and Behavioral Sciences, and Jeffrey Baker M.D., Ph.D., Director of the Trent Center for Bioethics, Humanities, and History of Medicine, spoke about the history of Duke’s legacies of race and memory. (Watch the presentation here.)

The career of Dr. Baker, who is a professor of both pediatrics and history, has taken him around the globe, right back to his hometown of Durham –where he said he has found the most interesting story of all.

After becoming Director for the Trent Center in 2016, he was approached with “hunger” by Durham natives to know their hometown’s story. Through oral and archival sources, Dr. Baker has broached Duke hospital’s history with humility in hopes of uncovering and contextualizing the historical roles of race in Duke medicine and Durham.

Dr. Tweedy, author of Black Man in a White Coat, attended Duke for medical school in the 1990s. He was warned that it was a plantation and an institution built on tobacco and slave money.

Though Dr. Baker proposed that in many ways the hospital structure often reflects plantation hierarchies in which there is racialization of who holds what jobs and power, he said Duke’s endowment money actually came from technological progress within tobacco production rather than slavery or plantations directly.

The Duke family’s vision for the hospital was quite different from actual outcomes in practice, Dr. Baker said. The Dukes were considered racial progressives in their time and the endowment they provided to launch the Duke Medical School and Hospital in 1930 was meant to improve health and education in North Carolina and train primary care doctors for the state.

“However,” Dr. Baker said, “there were two realities: Jim Crow and the Great Depression.”

During the era of Jim Crow segregation, Duke’s primary care doctors were all white, and nearly all male. Though the hospital cared for both Black and white patients, they were segregated by race. Black patients had separate wards, and waiting areas for pediatric care were separated racially by days of the week. Waiting areas for adult patients functioned without appointments, but only white people were seen before noon. It’s likely that the care granted to white people in the first half of the day was superior to that of Black people receiving care at 4 pm or told to return the next day, he said.

Original floor plans for the Duke Hospital.

The Great Depression also generated a diversion from plans in the 1940s. When the Duke Hospital came close to bankruptcy, it chose to open private clinics on the side for revenue – which had an unintended consequence. The clinics brought a lot of money into Duke, Dr. Baker said, but it also reinforced distinctions between those who could pay for treatment and those who couldn’t. Over time, the disparities expanded with shifts towards hospital beds for insured and private patients.

In one terrible example, Maltheus “Sunny” Avery, a North Carolina A & T graduate who got into a car wreck in Burlington, NC in 1950, was diagnosed with an epidermal hematoma — a clot near his brain — and sent to Duke for emergency brain surgery. But he was refused treatment due to inadequate room in the “colored” ward.

Avery was redirected to Lincoln Hospital, Durham’s Black hospital, where he died shortly after admission. Though Dr. Baker said this story quickly faded from white memory, it is something that has retained severe importance in the popular memory of Black Durhamites. This narrative is also often conflated with a similar story about Dr. Charles Drew, the Black inventor of blood banking, who died despite attempts at rescue at a white hospital in Alamance, NC. He is often misremembered as having died from the refusal of care in a racially divided South, even though he was not.

Duke’s first Black medical student, Delano “Dale” Meriwether, arrived the same year the hospital began desegregation, 1963, and he was the first Black M.D. in 1967. Meriwether was the only Black medical student for four years before other brave pioneers joined the school.

Dr. Tweedy reflected on his own medical school experiences at Duke during clinical rotations just a little more than 20 years ago.

“I was asked to help suture a deep gash on a Black patient’s forehead,” he said, “The patient asked if we were experimenting on him since I was still a student.” In the private clinics, he once “couldn’t go anywhere near” a white patent with a minor lesion on their arm, let alone suture that patient.

Dr. Baker said there are two narratives surrounding Duke Hospital’s desegregation. One assumes that desegregation was quick and easy and uneventful, while the other proposes that systems of racial segregation were simply transformed rather than eradicated. The latter narrative better applies to the public and private clinics that had become nearly completely racialized over time, Baker said.

Even though segregation was no longer legal, Black patients received care from less experienced medical residents in the public clinics, while white patients received care from attending physicians in the nicer, private environments.

Dr. Baker said that Duke has a complicated relationship with the community of Durham. He said the merger of Durham Regional Hospital with Duke Health in the late 1990s tapped into some long-term tensions and distrust between Duke and other medical facilities of Durham.

Public clinics versus private clinics in the hospital.

Dr. Tweedy pointed out that Duke researchers always have trouble recruiting Black patients for clinical studies, despite the fact that Durham County is about half Black and Hispanic. There is some distrust to overcome, but a diverse patient population is essential to creating robust study data that ensures that treatments will work for everyone, he said.

Medical professionals “need more than just science,” Baker concluded. He said that being trained as scientists often inclines doctors to think that they are above the larger contexts and histories they exist within, and that they can somehow remain objective.

“We have come out of specific stories and backgrounds,” Dr. Baker said. “[When we treat patients], we have to think about what story we are walking into.”

“We all carry our bags of ‘stuff'” that complicate patient prognosis and care, Dr. Tweedy concurred.

As Ann Brown (M.D., M.H.S), Vice Dean for Faculty, stated at the beginning of the conversation, “In order to move forward, we must understand where we come from.”

This is true of our nation as a whole, and Duke is certainly no exception.

Post by Cydney Livingston

We Are Not All Living The COVID Moment Equally

By Cydney Livingston

On September 15, 2020

In Behavior/Psychology, Biology, Faculty, Global Health, Medicine, Science Communication & Education

We are all living within the Covid moment, but we are not living within the Covid moment equally. The pandemic has exposed a recurrent rift in the United States’ healthcare system: Black Americans and other people of color (POC) are both disproportionately impacted by health issues and disproportionately lack access to care.

In a recent study on North Carolina conditions, Duke researchers found that the “odds of testing positive for [Covid] were higher for both Black and Hispanic individuals as well as within neighborhoods with a higher proportion of Black or Hispanic residents – confirming that Black and Hispanic communities are disproportionately affected.”

In a Coronavirus Conversation sponsored last week by the Science & Society Initiative, Thomas Williams J.D. discussed this and related issues with Duke scholars Keisha L. Bentley-Edwards, Ph.D. of medicine and Jay A. Pearson, M.P.H., Ph.D of public policy.

Panelists Keisha Bentley-Edwards (Ph.D.) and Jay Pearson (Ph.D.), moderated by Thomas Williams (J.D.)

Williams opened the panel by emphasizing the relevance of this moment: Current Covid impacts are directly informed by historical inequities and intricately span into the future. This is but one system of plaguing racism.

To speak about the intimate intersection of race and healthcare in America, Pearson offered grounding insight to systemic and structural racism. The United States is a country filled with patterns that produce and reproduce systematic advantages for those who are white while simultaneously disadvantaging people of color, most often Black and indigenous populations. Racism in America greatly transcends personal acts of racialized discrimination and harassment, he said. Racism in America is multiplex, foundational, and rooted within our society’s core.

“The U.S. national identity is tied to structural racism. …This is who we are, this is who we’ve been since the beginning of this country,” Pearson said, “The racialized inequities of Covid are simply the latest [manifestations]. We shouldn’t be surprised.”

A recently circulating figure states that 96% of people with severe outcomes or death from Covid had comorbidities, the presence of health conditions in addition to Covid. But Bentley-Edwards cautioned against misuse of this claim: “Many of these people would be alive if not for Covid.”

Though many who have died from the virus had underlying conditions, it is ultimately the virus that killed them. Communities of color often have disproportionate prevalence of underlying conditions, making them more susceptible to complications from Covid. But even when the prevalence of underlying conditions is the same among white and non-white populations, people of color are more likely to be more negatively affected by them.

For example, cardiovascular disease is similarly distributed between white and Black people, yet Black people are more likely to die of it, and at a younger age, compared to white people. Similarly, Black and other POC populations who contract Covid are more likely to die despite similar rates of contracting the virus in certain regions of the country.

Dr. Bentley-Edwards speaking during Friday’s virtual Coronavirus Conversation

Pearson and Bentley-Edwards also offered their insights on who is seen as essential and who is seen as dispensable in the United States.

Those who have been on the front lines with the most exposure and risks have been laborers who are most often under-valued Black and Brown peoples, Bentley-Edwards said. Though Covid terminology has come to dub them essential, it is undeniable that our society continues to see these types of workers as dispensable or replacable, and thus does not protect the people responsible for protecting us. Because many people of color live in multi-generational households as a culturally protective factor, increased chance of contracting Covid has led to uncertainties on the safety of returning home to young and elderly family members, she said. Further, the disproportionate unemployment rate of 13% for Black Americans compared to the 8.4% national rate is a staggering one. Since insurance is tied to employment, Black and Brown communities often avoid treatments due to the financial burden of unaffordable and inaccessible care.

Within the pandemic, we have seen the ever-present epidemiological impacts of police brutality and murder in the U.S with fresh eyes, the panelists said. In many ways, Black peoples’ experiences with healthcare mirrors that of their experiences with police – likely because both systems are anchored by an unjust nucleus.

“[Covid and police brutality] are slightly different manifestations of the same phenomenon,” Pearson said. We are able to easily identify the murders of individuals such as Breonna Taylor, George Floyd, and Ahmaud Arbery as stolen lives due to racist actions, however the slow burn of a racist health care system is less easily conceptualized or reconciled with, he said. Either way, the cause is one and the same.

Racism within systems that are meant to protect have generated a deep mistrust from Black and Brown people. Williams brought up the issue of a potential Covid vaccination amongst communities of color. “You have to know the history and why they would hesitate,” Bentley-Edwards said, bringing up the Tuskegee experiments and the work of J. Marion Sims. These accounts offer grim revelation of a heinous, racist history of exploiting vulnerable people for scientific and medical explorations.

Bentley-Edwards said that governments and healthcare institutions must address the rightful apprehensions of Black and Brown people in order to decrease vaccine hesitancy and serve at-risk communities. “What are they going to do differently?”

Williams also proposed the notion of data collection as a source of bias: In what ways are the data informatics that are collected reflections of an inequitable system? Bentley-Edwards and Pearson both suggest that to understand the current moment, as well as the healthcare system more largely, there needs to be collection and analysis of racial data. Additionally, there simply needs to be measurements for indicators beyond conventional ones which do not properly account for impacts on communities of color.

The push for new and different kind of data is supported by a growing evidence for the manifestations of inequality within biological bodies. For example, Pearson spoke about his own research on telomeres, a protective structure on the ends of chromosomes that protect DNA from degradation. Telomeres are telling both of stress and aging. Pearson’s work found that the average Black American woman is six to seven biological years older than a white American woman of the same age by evaluating telomere lengths, controlling for income, education, and other important socioeconomic factors. This indicates physiological affects linked to the stresses and disproportionalities of race down to the cellular level. Through genetics, mental health, and other physical degradations, the impacts of racism and racist healthcare quite literally last a lifetime and are even intergenerational.

Diagram of telomere from a study conducted by Dr. Pearson

Pearson closed the panel by urging attendees to take action where they find themselves. Though the need for animated policy which reflects recent discussions and protests is dire, the local spaces we find ourselves in need to be reshaped as well – including our universities.

In this moment, our responsibilities to one another have become more obvious than ever before. We must become more adept in thinking about and taking action for the communities in which we live and are connected to, whether they are comprised of people who look like us or not.

Post by Cydney Livingston

Covid Tested the Resilience of Duke’s Research

By Cydney Livingston

On September 8, 2020

In Faculty, Responsible Conduct

Like nearly all other aspects of life, the normal routines of Duke research labs came to a grinding halt due to COVID-19. Duke researchers shared their reflections on the struggles and insights the process of research shutdown and reboot has had within their labs during a Virtual Research Town Hall on Thursday, September 3rd.

The Town Hall, titled “The Impact of COVID 19 on Research at Duke, Overcoming Challenges and Pressures” was moderated by Duke Vice President for Research, Larry Carin (Ph.D.). Dr. Carin mentioned that discussion of shutting down the research enterprise began in February, and at that point in time it seemed nearly hysterical. However, by mid-March shut-down plans were fully in progress, leaving labs out of commission until mid-June. To get research at Duke back underway, labs were forced to significantly reduce the density of people in facilities and no undergraduate students were allowed to participate.

Though most of the basic science labs are back in operation now, human subjects research trials have had a slower return. In no way is it business as usual. Detailed planning and scheduling, a focus on social distancing, and daily health surveys are all part of the new normal. “There is almost a Big Brother feel to this,” Dr. Carin said, comparing the moderated tracking of who enters facilities through their DukeCard swipes to George Orwell’s 1984 dystopian society.

Associate Professor Debra Silver Ph.D. spoke about her neurodevelopmental lab in molecular genetics and microbiology (MGM). In the three-month shutdown, lab members focused on writing reviews, grants, manuscripts, and took online classes to improve skills. Since re-opening, Silver’s lab has implemented lab shifts, pre-scheduled experiments, and coordinated use of shared equipment. Some of the biggest issues are the trainees missing out on critical networking and undergraduates forced to transition to nearly exclusively online work. Silver also voiced serious concern for the mental and physical health of lab members, logistical coordination of childcare and homeschooling, challenges faced by international trainees, and the need for flexibility. However, there were some silver linings as well. The Silver Lab engaged with lots of seminars, had joint lab meetings, and the mutual support for one another grew immensely under the unique circumstances.

Dr. West points out the enduring emotional impacts of COVID.

Both Silver’s lab and the West Lab, led by professor Anne West Ph.D. in neurobiology, are heavily reliant on mice for wet lab work. The mandates to reduce their mouse colonies by more than 50% was a large task and now that the labs are up and running, re-expanding the colonies has been a primary focus. West said that, similar to the Silver Lab members, half of her team picked up writing or a computational project while the other half attended online classes or meetings during shutdown. Undergraduates read and presented research papers – which turned out to be a very fruitful training experience.

One major roadblock for the West Lab’s reopening were the murders of George Floyd, Breonna Taylor, and Ahmoud Arbery. The civic unrest surrounding these deaths and the revivalism of the Black Lives Matter movement became a frequent point of discussion in lab meetings. Some members of the West Lab were unable to work during this time. West emphasized the importance of lowered expectations. She asked everyone to focus on one core experiment and to try to come into the lab for at least a few hours a day, a few days a week. The lab has been gaining traction with new data and research papers nearing completion. Like other panelists, West discussed prevailing issues including anxiety and depression, continued societal uncertainties, and the questionable financial future for research.

Assistant professor of anesthesiology Jamie R. Privratsky MD, Ph.D. highlighted COVID’s impact on clinical and critical care research. Among the positive impacts are the Society of Critical Care Medicine’s COVID-19 registry database, the abilities to do observational and database research work, and research opportunities for working with COVID patients. However, the rest of critical care research has been completely sidelined, clinician-scientists have been moved to mostly clinical duties, and there have been lots of administrative hurdles for conducting COVID related research.

A slide from Dr. Pivratsky’s presentation.

Many colleagues share Dr. Privratsky’s mixed thoughts on the gains and losses during the halt of critical care research. For those who were able to conduct some research, the risks to personal health also posed looming anxiety and danger. Dr. Privratsky chose to do what he could being physically away from his lab and worked to update protocols, maintain electronic lab notebooks, write methods sections of papers, and care for his mouse colony. He also submitted three grant proposals and said that he left the shutdown with a clearer vision and direction for his research.

The School of Medicine’s Vice Dean for Basic Science, Colin S. Duckett Ph.D. closed the town hall with encouraging reflections. Out of 17,000 Duke administered COVID tests, there have been very few positives. Duckett emphasized how seriously the Duke community and its recently returned students are taking the continued threat of Coronavirus. Though communications persist as a challenge and many argue that life right now just doesn’t feel right, Duckett called attendees’ attention to the fact that the research enterprise was successfully ramped down, ramped back up, and lab activities have made a nearly completely return. This was and continues to be no small feat and is possible due to highly collaborative efforts, he said.

Good news from Dr. Duckett about the state of Duke’s research enterprise.

Further, there were large insights gleaned from this collective experience; those of researchers’ resiliency, the importance of community, and the need to look beyond work and check in on each other as human beings. Research and the people who make it possible do not exist in a vacuum away from society. Their work and their well-being are subject to the pandemic just like everyone else. Yet, similar to the broader global public, researchers and their research are emerging stronger than before in the face of COVID-19.

Post by Cydney Livingston

COVID-19, and the Costs of Big Data

By Jeremy Jacobs

On September 2, 2020

In Computers/Technology, Data, Faculty, Global Health, Medicine

TikTok’s illicit collection of user data recently drew fire from US officials. But TikTok’s base—largely young adults under 25—was unfazed. In viral videos posted in July and August, users expressed little concern about their digital privacy.

“If china wants to know how obsessed i am with hockey,” wrote one user, “then just let them its not a secret.” “#Takemydata,” captioned another, in a video racking up 6,000 likes and over 42,000 views.

As digital technologies become ever more pervasive – or even invasive – concerns for privacy should be a concern, a pair of experts said in a Duke Science & Society webinar earlier this month.

TikTok and digital marketing aside, data collection can have real, tangible benefits. Case in point: COVID-19. Researchers at Duke and elsewhere are using peoples’ fitness trackers and smart watches to try to understand and predict the pandemic’s spread by monitoring a variety of health metrics, producing real-time snapshots of heart rate, blood pressure, sleep quality, and more. Webinar speaker Jessilyn Dunn of Duke biomedical engineering and her team have tapped into this data for CovIdentify, a Duke-funded effort to predict COVID infections using data collected by smartphones and wearable devices.

Health data from smartphones and fitness trackers may help predict and identify disease.

For several years, Dunn’s lab has researched digital biomarkers of disease—that is, how health data collected by tech we carry every day can predict anything from heart disease to cognitive decline.

It’s a potential goldmine: One recent poll suggests that 40 million Americans own some kind of smartwatch or fitness tracker. And the wearables market is rapidly expanding—by 2022, it may be worth upwards of 25 billion dollars.

As coronavirus cases began to rise in the US, Dunn’s lab quickly pivoted to develop COVID-specific biomarkers. “We have these devices … that perform physiologic monitoring,” Dunn said, “This is a method of taking vitals continuously to try to monitor what’s going on with people.”

Say you’re a participant in Dr. Dunn’s study. You download the CovIdentify app, which analyzes health data collected by your phone or smartwatch. Short daily surveys then assess your exposure to COVID-19 and whether you’ve developed any symptoms. Dunn and her team hope to find a link, some specific change in vitals that corresponds to COVID-19 infection.

There are some challenges. CovIdentify must account for variability between devices—data collected from a Fitbit, for example, might differ dramatically from an Apple Watch. And because COVID-19 manifests in unique ways across populations, a truly universal biomarker may not exist.

However, panelist Marielle Gross—a bioethicist at the University of Pittsburgh—said projects like Dunn’s raise questions of digital privacy. Gross emphasized how easily our health data can be abused.

Left: Jessilyn Dunn, PhD, a professor at Duke University and CovIdentify Researcher
Right: Marielle Gross, MD, MBE, a bioethicist and professor at the University of Pittsburgh

“Digital specimen is the digital representation of the human body,” she said. “Disrespecting it disrespects the body it represents.”

Dr. Gross cited South Korea’s efforts to curb COVID-19 as a cautionary tale. As part of the government’s response, which quickly minimized cases early in the pandemic, exposed or infected South Koreans were expected to stay home and isolate, tracked using GPS-enabled devices.

But many South Koreans chose to leave their devices at home, rather than be tracked by their government. In response, the government required its citizens to carry their devices, 24/7. In a pandemic, desperate measures may be called for. But, Gross suggests, it isn’t hard to imagine a grimmer future—where the government requires all citizens to share their location, all the time.

Gross argues that we must fundamentally shift how we think about our personal data. “There’s this broad assumption that we have to give up privacy to reap the benefits of collective data.” Gross noted. “And that’s false.”

Most ‘digital natives’ aren’t naive. They’re well aware that internet companies collect, analyze, and sell their data, sometimes to malicious effect. But many view data collection as a necessary tradeoff for an intuitive and tailored web experience.

So where do we go from here? Dr. Gross points to new developments like zero knowledge proofs, which use complex algorithms to verify data without actually seeing it. This technique promises anonymity without compromising the value of collective data. And as computing power increases, it may also be possible to perform real-time analysis without ever transmitting or storing collected health data.

And for future tech? In Dr. Gross’s opinion, ethical implications must be considered from day one. “Those sorts of considerations are not the kind of thing that you can tack on later. They have to be built into devices…at the ground floor.”

Post by Jeremy Jacobs