Category: Global Health Page 1 of 12

The massive Keeler Oak, a white oak (*Quercus alba*) in New Jersey.

An April symposium at Grainger Hall, People and Nature, brought a diverse set of speakers, both from Duke and other U.S. institutions, to examine the relationship between human culture and land and to discuss pressing issues such as environmental justice. The session was organized by PhD students Nicholas School of the Environment and the biology department.

Professor Paul Manos of Duke Biology told us how oaks, ubiquitous tree species in temperate regions, can make people think about nature. A walk in the woods looking at the different oaks can result in a fascinating journey of natural history. For those who are curious enough, an inquiry into the lives of oaks will take them deep into topics such as evolutionary history, leaky species boundaries, plant-animal interactions, among others, Manos said. Keeping true to the theme of the symposium, Manos explored some hypotheses about the first time that humans had contact with oaks, and how this relationship unfolded ever since.

Associate Professor Orou G. Gaoue of the University of Tennessee, Knoxville, took us through a detailed case study of human and plant interactions with long-term data from the country of Benin, in Africa. He showed how the harvest of the African mahogany (Khaya senegalensis) affects human demography and even the marriage dynamics of the Fulani people, with many other insights into the intertwined relationship of the locals and their harvest.

Central to the morning sessions were the rights of nature and the granting of personhood to non-humans, which is common in the cosmology of many indigenous cultures. For instance, Andrew Curley, assistant professor at the University of Arizona, mentioned in his talk that the O’odham people in the Sonoran Desert confer the Saguaro cactus personhood status. His talk exposed how colonial dynamics have created climate catastrophes and drought around the Colorado River, how indigenous peoples have to navigate these foreign systems, and how they understand their relationship with the land and water.

Michelle Carter, a first-year Masters of Environmental Management (MEM) student at Duke, examined the feasibility of the rights of nature in the US legal system. These rights allow certain natural features (e.g. rivers) to stand as a sole party in litigation and recover damages on their behalf. However, effective application and the enforcement of policy have been lacking.

The second part of the symposium focused on environmental justice. Duke Ph.D. student Maggie Swift presented a land acknowledgement which was divided into three parts: recognition of the violent history of the past; an understanding of the present with a celebration of the lives and achievements of current indigenous peoples; and a call to action so that participants were encouraged to financially support native-led organizations. Links for donations and more information can be found on the symposium website. The land acknowledgement was followed by a brief presentation on the project Unearthing Duke Forest that explores the human history surrounding Duke Forest.

Why is it important to jointly consider people and nature in your work? What insights do you gain in your work by taking this approach?
People & NAture

Christine Folch of Duke Cultural Anthropology

Assistant professor Christine Folch, from Duke’s Department of Cultural Anthropology provided an analysis of the discourse around climate change. At the center was the question “do you believe in climate change?” which has ingrained the element of doubt and the ability of the speaker to say “no, I don’t.”

Associate professor Louie Rivers III, from NC State University, gave a talk on perceived environmental risks and their influence on social justice. He pointed out that these questions could be dismissed by certain groups such as black farmers, who are concerned and disproportionally affected by environmental issues but might not relate to how the question is addressed.

Sherri White-Williamson, Environmental Justice Policy director at NC Conservation Network, explained the concept of environmental justice and provided concrete examples of how certain policies (e.g. federal housing/lending policies or interstate highway systems) can create inequalities that leave communities of color to bear the exposure of environmental degradation. She also made us aware that this year is the 40^th anniversary of the birth of the US environmental justice movement that started when an African-American community in Warren County, North Carolina organized to fight a hazardous waste landfill.

No exploration of people and nature would be complete without including the seas. A team of three students at the Duke University Marine Lab, undergrad Maddie Paris, second-year MEM Claire Huang, and Ph.D. student Rebecca Horan, presented two case studies of social and ecological outcomes linked to education and outreach interventions conducted in tropical marine environments.

Their first case study was on turtle education in Grenada, West Indies. Here a 10-week summer program for local children ages 9-12 created an improved understanding of marine turtle biology and its connection to the health of the ocean and their communities. The second case study was a 4-week training course for fisher people and fisheries officers in Mtwara, Tanzania. These participants increased their skills in monitoring the local reefs and were better equipped to educate their communities on marine environmental issues.

The symposium ended with two open questions for the audience, which should be considerations for anyone doing environmental research: Why is it important to jointly consider people and nature in your work? What insights do you gain in your work by taking this approach?

Guest post by Rubén Darío Palacio, Ph.D. 2022 in Conservation Biology from the Nicholas School of the Environment, and science director of conservation non-profit Fundacion Ecotonos in Colombia.

Kinsie Huggins: the Future Doctor Who Could Shot-Put

By Camila Cordero

On March 29, 2022

In Biology, Cardiology, Data, Field Research, Genetics/Genomics, Global Health, Medicine, Policy, Students

From shot-putting, to helping conduct two research studies, to being selected for a cardiology conference, meet: Kinsie Huggins. She is from Houston, Texas, currently majoring in Biology and minoring in Psychology with a Pre-Med track here at Duke. With such a simple description, one can already see how bright her future is!

“I want to be a pediatrician and work with kids,” Huggins says. “When I was younger, I lived in Kansas, and in my area, there were no black pediatricians. My mother decided to go far to find one and I really bonded with my pediatrician. One day, I made a pact with her in that I would become a pediatrician too so that I can also inspire other little girls like me of my color and other minority groups.”

Having such a passion to let African-American and minority voices be heard, Huggins is also part of the United Black Athletes, using her shot-put platform to make sure these voices are heard in the athletics department.

And while she may be a top-notch sportswoman, she is also just as impressive when it comes to her studies and research. One of her projects focuses on the field of nephrology – the study of kidneys and kidney disease. She and a pediatric nephrologist are currently working on studying rare kidney diseases and the differences in DNA correlating to these diseases.

Kinsie is also a researcher at GRID (Genomics Race Identity Difference), which studies the sickle cell trait in the NCAA. With the sudden deaths of college athletes from periods of over-exhaustion during conditioning, there has been a rise in attention of sickle cell trait and its impact on athletes. At first, the NCAA implemented a policy that made it mandatory for college athletes to get tested for sickle cell in 2010, but some were wary about the lack of scientific validity in such claims. Now, the NCAA has funded GRID to conduct such research.

_{The difference of Normal red blood cell and sickle cell (CDC).}

“We are analyzing the policy (athletes need to be tested for sickle cell), interviewing athletes in check-ups, and looking at data to see if the policy is working out for athletes and their performance/health,” Huggins explains.

With such an impressive profile, it doesn’t go without saying that Huggins didn’t go unnoticed. The American College of Cardiology (ACC) select high school and college students interested in the field of medicine and have them attend a conference in Washington D.C. to hear about research presentations, groundbreaking results of late-breaking clinical trials, and lectures in the field. Having worked hard, Huggins was selected to be part of the Youth Scholars program from the ACC and was invited to the conference on April 2-4.

Let’s wish Kinsie the best of luck at the conference and on her future research!

Post by Camila Cordero, Class of 2025

Measuring What Climate Change Does, Not Just Whether It’s Happening

By Nhu Bui

On February 16, 2022

In Climate/Global Change, Environment/Sustainability, Field Research, Global Health, Policy

Duke has a goal of being a “climate university,” Nicholas School of Environment Dean Toddi Steelman said in introducing a panel discussion on Climate Change Science during Research Week. She said it’s a vision in which the university’s focus on climate informs every aspect of its mission, from education and operations to community partnerships – and, of course, research.

Five Duke climate scientists spoke on the Feb. 1 panel, all remotely. (View the Discussion.)

Jim Clark, professor of statistical science at the Nicholas School, described our planet’s climate as a “moving target” when it comes to understanding its impact on biodiversity. Complex connections exist between species, like a “system of interactions” between each other, that responds to climate change.

Our understanding of this system is limited by population data collection like the Breeding Bird Survey and the USDA Forest Inventory & Analysis — projects that lack “co-located monitoring of multiple species groups,” Clark said. Such measures fail to capture the relationships between species.

Instead, Clark advocates moving away from static models like these population measurements and towards the question of “How does change in the whole community respond to the environment and other species?” In order to understand our dynamic climate, we need an equally dynamic conception of biodiversity, he argued.

Marc Jeuland, associate professor of public policy and global health, and leader of the Sustainable Energy Researchers Initiative (SETI), talked about the “deep inequities” in energy access across rural parts of developing regions and the prospect of accomplishing “a just and sustainable energy transition” of their energy sources.

He thinks the transition can be accomplished with existing sustainable energy technologies like wind and solar.

The problem has two main parts, he said. First is the lack of clean cooking energy, with 2.6 billion humans dependent on solid fuels (wood and charcoal) and polluting stoves. The second is the lack of electricity and electrical services, with 760 million people going without and millions more lacking reliable service, he said.

Jeuland said there is an urgent need to reallocate resources to spread climate solution technologies in these parts of the world.

Jeuland and his SETI team tirelessly investigate how to overcome energy poverty and the populations they affect most – primarily in Africa and Southern Asia – to understand the feasibility and tradeoffs with the adoption of increased access to alternative fuels.

Emily Bernhardt, the James B. Duke distinguished professor of biogeochemistry in the Nicholas School and chair of Duke Biology, addressed the question of how climate change and sea level rise will impact coastal communities and ecosystems.

She said we don’t really have to wait to see what will happen: predominantly low-income communities along the coast are already suffering the consequences of sea water and extreme weather events. But she said the regions’ struggles remain unsolved and underrepresented because they lack the economic and political power to affect change.

Whenever an event like a hurricane occurs, coastal plain communities are susceptible to storm surges that introduce salt into freshwater environment – leading to sometimes catastrophic, often long-lasting impacts on existing ecosystems, Bernhardt said.

Bernhardt and hundreds of other scientists along the United States coast are working together on something she called “convergence research” that seeks solutions for coastal and other vulnerable communities. It’s called the Saltwater Intrusion and Sea Level Rise (SWISLR) Research Coordinating Network.

Betsy Albright, associate professor of environmental science and policy, and Brian McAdoo, associate professor of earth and climate science, shared their zoom-hosting duties.

They talked about social justice and social science in mitigating the impact of climate change. Their work examines the role of local communities and governments in disaster recovery and how they can work to create systems to manage aid and other resources as extreme weather events become more common.

As with most climate issues, marginalized communities are disproportionately impacted by these events, they said. Albright and McAdoo are searching for ways to help these regions create the capacity to respond and become more resilient to future events.

The climate crisis is arguably the greatest challenge of this generation, but this esteemed panel brought much-needed attention to the obstacles facing every aspect of the world of climate science research and how their research is working to overcome them.

Post by Nhu Bui, Class of 2024

Medicine Under a Microscope

By Olivia Ares

On February 15, 2022

In Biology, Genetics/Genomics, Global Health, Immunology, Lecture, Science Communication & Education

Duke Research Week 2022 featured a range of speakers from across all disciplines. The Lefkowitz Distinguished Lecture on January 31st highlighted some of our favorite things here at Duke Research Blog: ingenuity and perspective.

Dr. Huda Yahya Zoghbi’s career spans decades; her Wikipedia page sports an “Awards and Honors” section that takes up my entire computer screen. She is a geneticist, neuroscientist, pediatric neurologist, pharmaceutical executive, and literature lover. Her presentation kicked off 2022 Research Week with a discussion of her work on Rett Syndrome. (View the session)

Rett Syndrome is a rare genetic disorder. The gene that researchers identified as the driver of the syndrome is MeCP2, which is especially active in brain cells. Certain mutations of this one gene can be responsible for a loss of speech, development issues, and persistent fidgeting.

This image has an empty alt attribute; its file name is _Sk5Y-Q39YYuBd_Ntz_77pXwX8uwtEhTnl4yokbul2AdWHu0xpP_mTKi8mQQHlG7GjmP32Nc4xb1oq-InXReJVfbBai5DF8Enf6LvkuPNZlPou9rc5RCjjjc6B_fRj1oCaVMGWCS — The MeCP2 protein. Image: Wikipedia Commons

Children with Rett Syndrome faced chronic misdiagnosis, and even with proper care were limited by a lack of research.

Duke’s Dr. Robert Lefkowitz introduced Zoghbi at the beginning of the seminar and explained how she came to become the leading expert on this relatively unknown disorder. After completing medical school in Beirut in the midst of the ravaging Lebanese Civil War, she came to Texas Children’s Hospital, where she was able to observe and diagnose her first case of the syndrome, a process spurred by a simple interest in a newly-published journal article.

Holistic knowledge of Rett Syndrome is completely dependent on genetic research. A mutation on the MeCP2 gene causes errors in transcription, the reading out of DNA in your cells which leads to the production of proteins.

The mutated gene’s MeCP2 protein is then lacking the ability to do its job, which is helping other genes be expressed, or actively transcribed.

It’s a vicious cycle; like when you go to sleep late one night, so you sleep in the next day, then go to sleep late the next night, then sleep in the next day, and so forth.

In order to simulate and measure the effect of different kind of mutations on the MeCP2 gene, Zoghbi and her team studied genetically modified mice. While Rett Syndrome is caused by a lack of MeCP2 function, an overactive MeCP2 gene causes MeCP2 duplication syndrome. Varying degrees of gene efficiency then produce varying degrees of severity in the syndrome’s traits, with fatality at either end of the curve.

Zoghbi’s talk focused mainly on the mechanics of the disorder on a genetic level, familiar territory to both Nobel Laureate Lefkowitz and Duke Medicine Dean Mary Klotman, who shared some discussion with Zoghbi.

This medicine on a microscale is applicable to treating genetic disorders, not just identifying them. Zoghbi has been able to experimentally correct MeCP2 duplication disorder in mice by modifying receptors in a way that reverses the effects of the disorder.

The symptoms of Rett Syndrome are physical; they present themselves as distinct phenotypes of a subtle difference in genotype that’s too small to see. The field of genetics in medicine is responsible for making that connection.

Post by Olivia Ares, Class 2025

This image has an empty alt attribute; its file name is ARES_Olivia.jpg

C is For Cookie (and for Circles of Care)

By Rebecca Williamson

On January 24, 2022

In Behavior/Psychology, Global Health, Science Communication & Education

Anyone remember the Sesame Street episode where Big Bird tackles the opioid crisis?

Me neither. However, that isn’t to say that Sesame Street isn’t doing its part to help parents and children alike to cope with this, among other pressing issues that plague our society.

Jeanette Betancourt, Ed. D. is Senior Vice President for U.S. Social Impact at Sesame Workshop, a division of the Sesame Street organization striving to positively impact children’s early learning, health, and well-being. Betancourt is deeply involved in the Sesame Street in Communities initiative (ssic.org), which she came to discuss with the Sanford School of Public Policy on January 18^th.

Sesame Street in Communities aims to bring public awareness to prominent societal issues in what Betancourt labels a “non-stigmatizing way.” Their efforts are specifically targeted to impact children coping with traumatic experiences and their families – resources on the Sesame Street in Communities website span from Elmo’s Special-Special Comfort video for children who have fallen victim to violence, to Abby’s Expressing Feelings video for children divided between divorced parents.

Not all the videos are as heavy as one might think: some of the content promotes behavioral routines, such as tooth-brushing or schedule-making, designed to build children a more stable foundation that they can use to tackle trauma, should it arise.

Some of the most recent resources posted to the *Sesame Street in Communities* website.

Betancourt says that their strategy hinges heavily upon leveling, or presenting the same messaging in a variety of mediums (videos, storybooks, live-action films), for more complete comprehension. This is reflected heavily on their website: their Autism series alone includes multiple workshops, printables, articles, videos, interactives, and storybooks. The content and learning strategies promoted by Sesame Street in Communities are all founded upon clinical research, developmental psychology, and other forms of testing to ensure that they have a measurable impact on young children and their families.

Sesame Street' Introduces 2 New Black Muppets To Teach Kids About Racial Literacy | CafeMom.com — Wes and Elijah Walker, the faces of the *Coming Together: Racial Justice* project.

One of the most recent initiatives described by Betancourt is the Coming Together: Racial Justice project. In this series of content (found on ssic.org), the viewer is introduced to the Wes and Elijah Walker, two humanoid Muppets that, according to Betancourt, are intended to represent the Black experience.

In the video, five-year old Wes and his father Elijah are sitting in the park when they are approached by Elmo, who wants to know about the pigmentation of their skin. Elijah explains to Elmo that all humans have different amounts of melanin in their skin, hence why some individuals have lighter or darker skin. Elijah also tells Elmo that, even though their skin may look different, “we’re all part of the human race.”

To make this concept easier for children to understand, Elijah connects this to the color of the changing leaves in the park, telling Elmo that leaves of different colors all came from the same tree.

If you know a child or a family that could benefit from such materials, more information can be found on ssic.org.

Post by Rebecca Williamson, Class of 2022

LowCostomy: the Low-Cost Colostomy Bag for Africa

By Camila Cordero

On January 11, 2022

In Biology, Biomedical Engineering, Cancer, Engineering, Environment/Sustainability, Global Health, Medicine, Students

It’s common for a Pratt engineering student like me to be surrounded by incredible individuals who work hard on their revolutionary projects. I am always in awe when I speak to my peers about their designs and processes.

So, I couldn’t help but talk to sophomore Joanna Peng about her project: LowCostomy.

Rising from the EGR101 class during her freshman year, the project is about building a low-cost colostomy bag — a device that collects excrement outside the patient after they’ve had their colon removed in surgery. Her device is intended for use in under-resourced Sub-Saharan Africa.

“The rates in colorectal cancer are rising in Africa, making this a global health issue,” Peng says. “This is a project to promote health care equality.”

The solution? Multiple plastic bags with recycled cloth and water bottles attached, and a beeswax buffer.

“We had to meet two criteria: it had to be low cost; our max being five cents. And the second criteria was that it had to be environmentally friendly. We decided to make this bag out of recycled materials,” Peng says.

For now, the team’s device has succeeded in all of their testing phases. From using their professor’s dog feces for odor testing, to running around Duke with the device wrapped around them for stability testing, the team now look forward to improving their device and testing procedures.

“We are now looking into clinical testing with the beeswax buffer to see whether or not it truly is comfortable and doesn’t cause other health problems,” Peng explains.

_{Poster with details of the team’s testing and procedures}

Peng’s group have worked long hours on their design, which didn’t go unnoticed by the National Institutes of Health (NIH). Out of the five prizes they give to university students to continue their research, the NIH awarded Peng and her peers a $15,000 prize for cancer device building. She is planning to use the money on clinical testing to take a step closer to their goal of bringing their device to Africa.

Peng shows an example of the beeswax port buffer (above). The design team of Amy Guan, Alanna Manfredini, Joanna Peng, and Darienne Rogers (L-R).

“All of us are still fiercely passionate about this project, so I’m excited,” Peng says. “There have been very few teams that have gotten this far, so we are in this no-man’s land where we are on our own.”

She and her team continue with their research in their EGR102 class, working diligently so that their ideas can become a reality and help those in need.

Post by Camila Cordero, Class of 2025

The Most Important 26 Hours of My First Term at Duke

By Vibhav Nandagiri

On December 20, 2021

In Cancer, Global Health, Medicine, Policy, Students

As any first-year will tell you, the scramble for joining new clubs can be a daunting one. As the dust settled from the Involvement Fair, I looked at the fistful of flyers overflowing from my desk. One of these flyers stood out to me in particular: Student Collaborative on Health Policy (SCOHP). The program, backed by the Duke Margolis Center for Health Policy, seeks to educate, serve, and research within the Duke and Durham community regarding the social, economic, and political determinants of health care.

Intrigued, I ventured to the Social Sciences building the following Sunday afternoon for their inaugural GBM. The event was lively, filled with a dizzying number of avenues for involvement. One such avenue that was the SCOHP-organized Health Policy Case Competition, advertised as a two-day team sprint to develop and pitch solutions to a pressing health care problem. The prizes were handsome: $1,000 for 1st place, $500 for 2nd place, and $250 for 3rd place, courtesy of the Margolis Center and RTI International. Furthermore, participants would be given access to mentors and industry leaders with vast experience in the area of public health.

Six teams, each consisting of three to five members, participated in the case-writing festivities. On Friday, September 10 at 5:00 PM, the case document was released. Our task: to develop a five-year plan aimed at increasing the screening for human papillomavirus (HPV) in either Malawi, South Africa, or Eswatini via a novel imaging technology known as microbeads. A considerably complex task given the vast number of social, institutional, and political barriers lying between the new technology and the women who needed it the most, not to mention the potential for HPV developing into cervical cancer if left undetected and untreated.

Our team, Team J, assumed the role of a local NGO partnering with the Eswatini government. The preliminary hours of the competition were spent sifting through a sea of research. We read reviews of tissue imaging technology, feasibility studies on drug distribution networks, and mathematical projections of healthcare costs. At once invigorating and ceaselessly frustrating, the process of developing a comprehensive solution required significant mental and physical rearrangement. The nine hours following the release of the case were spent in a variety of popular campus study spots, from Bostock to Rubenstein Library, The Coffeehouse to dorm common rooms. In the early morning hours, our plan had finally begun to take shape.

A meager five hours of rest separated Day One of the competition from Day Two. After a night of brainstorming and research, we were left with three hours to finalize our five-minute proposals before a hard 12:00 PM deadline. As the deadline approached, we changed into our best attire from the clavicle up (the marvels of Zoom) and sat down. For the next hour and change, ideas flowed thickly and quickly; eager and persuasive tones emanating from our screens, tense silence as the judges moved into breakout rooms for deliberation.

The top three teams, Team J included, were selected for a final presentation round. The guidelines for this round: strengthen the argument, lengthen the presentation. We were in the final stretch. What followed was two hours of remarkably focused work, the likes of which I had never experienced in a team setting. As we sat down for the deciding presentation of the competition, I felt an immense sense of pride, not only in our solution, but also in our twenty-six hour transformations from perplexed receivers to confident presenters. This confidence and breadth of knowledge was visible in all three teams over the course of their fifteen-minute presentations and subsequent five-minute Q&A’s.

Team J’s Final Round Presentation Over Zoom

As the clock struck 7:00 PM on Saturday, September 11, the judges had submitted their verdict, at which point the teams turned towards the screen with rapt attention. The SCOHP organizers began reading the final standings. In what was described as an extremely close decision for the judges, Team J ended up winning first place. Battling the equally powerful forces of disbelief and sleep deprivation, we let out a collective breath. It was all over.

At the time of the competition, I had yet to complete a month at Duke. I didn’t know it then, but those twenty-six hours would end up being some of the most impactful in my first semester. The competition offered an entirely different approach to learning, one that was grounded in interdisciplinary inquiry and effective collaboration. And to think–it all started with a flyer buried underneath many other flyers.

Post by Vibhav Nandagiri, Class of 2025

Nobel Laureate Dr. Jennifer Doudna and Groundbreaking Applications of CRISPR

By Anna Gotskind

On November 29, 2021

In Biology, Biomedical Engineering, Chemistry, Genetics/Genomics, Global Health, Lecture, Medicine

In 2011, Dr. Jennifer Doudna began studying an enzyme called Cas9. Little did she know, in 2020 she would go on to win the Nobel Prize in Chemistry along with Emmanuelle Charpentier for discovering the powerful gene-editing tool, CRISPR-Cas9. Today, Doudna is a decorated researcher, the Li Ka Shing Chancellors Chair, a Professor in the Department of Chemistry and Molecular as well as Cell Biology at the University of California Berkeley, and the founder of the Innovative Genomics Institute.

Doudna was also this year’s speaker for the MEDx Distinguished Lecture in October where she delivered presented on “CRISPR: Rewriting DNA and the Future of Humanity.”

“CRISPR is a system that originated in bacteria as an adaptive immune system” Doudna explained.

Dr. Jennifer Doudna holding the Nobel Prize in Chemistry

When bacterial cells are infected by viruses those viruses inject their genetic material into the cell. This discovery, a couple decades ago, was the first indication that there may be ways to apply bacteria’s ability to acquire genetic information from viruses.

CRISPR itself was discovered in 1987 and stands for “Clustered Regularly Interspaced Short Palindromic Repeats.” Doudna was initially studying RNA when she discovered Cas-9, a bacterial RNA-guided endonuclease and one of the enzymes produced by the CRISPR system. In 2012, Doudna and her colleagues found that Cas9 used base pairing to locate and splice target DNAs when combined with a guide RNA.

Essentially, they designed guide RNA to target specific cells. If those cells had a CRISPR system encoded in their genome, the cell is able to make an RNA copy of the CRISPR locus. Those RNA molecules are then processed into units that each include a sequence derived from a virus and then assemble with proteins. This RNA protein then looks for DNA sequences that match the sequence in the RNA guide. Once a match occurs, Cas9 is able to bind to and cut the DNA, leading to the destruction of the viral genome. The cutting of DNA then triggers DNA repair allowing gene editing to occur.

“This system has been harnessed as a technology for genome editing because of the ability of these proteins, these CRISPR Cas-p proteins, to be programmed by RNA molecules to cut any desired DNA sequence,” Doudna said.

Jennifer Doudna holding a Model of CRISPR-cas9

While continuing to conduct research, Doudna has also been focused on applying CRISPR in agriculture and medicine. For agriculture, researchers are looking to make changes to the genomes of plants in order to improve drought resistance and crop protection.

CRISPR-cas9 is also being applied in many clinical settings. In fact, when the COVID-19 pandemic hit, Doudna along with several colleagues organized a five-lab consortium including the labs of Dan Fletcher, Patrick Hsu, Melanie Ott, and David Savage. The focus was on developing the Cas13 system to detect COVID-19. Cas13 is a class of proteins, that are RNA guided, RNA targeting, CRISPR enzymes. This research was initially done by one of Doudna’s former graduate students, Alexandra East-Seletsky. They discovered that if the reporter RNA is is paired with enzymes that have a quenched fluorophore pair on the ends, when the target is activated, the reporter is cleaved and a fluorescent signal is released.

One study out of the Melanie Ott group demonstrated that Cas13 can be used to detect viral RNA. They are hoping to apply this as a point-of-care diagnostic by using a detector as well as a microfluidic chip which would allow for the conduction of these chemical reactions in much smaller volumes that can then be read out by a laser. Currently, the detection limit is similar to what one can get with a PCR reaction however it is significantly easier to run.

Graphical Abstract of Cas13 Research by the Melanie Ott lab

“And this is again, not fantasy, we’ve actually had just fabricated devices that will be sitting on a benchtop, and are able to use fabricated chips that will allow us to run the Cas13 chemistry with either nasal swab samples or saliva samples for detection of the virus,” Doudna added.

Another exciting development is the use of genome editing in somatic cells. This involves making changes in the cells of an individual as opposed to the germline. One example is sickle cell disease which is caused by a single base pair defect in a gene. Soon, clinicians will be able to target and correct this defect at the source of the mutation alleviating people from this devastating illness. Currently, there are multiple ongoing clinical trials including one at the Innovative Genomics Institute run by Doudna. In fact, one patient, Victoria Gray, has already been treated for her sickle cell disease using CRISPR.

Victoria Gray being treated for Sickle Cell Anemia
*Meredith Rizzo/NPR*

“The results of these trials are incredibly exciting and encouraging to all of us in the field, with the knowledge that this technology is being deployed to have a positive impact on patient’s lives,” Doudna said.

Another important advancement was made last summer involving the use of CRISPR-based therapy to treat ATR, a rare genetic disease that primarily affects the liver. This is also the first time CRISPR molecules will be delivered in vivo.

In just 10 years CRISPR-cas9 has gone from an exciting discovery to being applied in several medical and agricultural settings.

“This powerful technology enables scientists to change DNA with precision only dreamed of a few years ago,” said MEDx director Geoffrey Ginsburg, a Professor of Medicine at Duke. “Labs worldwide have redirected the course of research programs to incorporate this new tool, creating a CRISPR revolution with huge implications across biology and medicine.”

Examples of further CRISPR-Cas9 research can also be found in the Charles Gersbach lab here at Duke.

How is Universal Healthcare Like the Waterboarding Debate?

By Olivia Ares

On November 10, 2021

In Behavior/Psychology, Global Health, Lecture, Medicine, Policy, Science Communication & Education

The Duke Medical Ethics Journal (DMEJ) is an undergraduate publication started in Spring of 2020 that examines conversations around universal patient-doctor responsibility. In other words, they’re training the next generation of healthcare providers to ask big questions and make informed decisions. So, we owe them a huge thank-you in advance.

On Sunday, October 24th, DMEJ hosted Dr. Gopal Sreenivasan to speak with current members. The event was open to the public as part of the club’s mission to promote ethical practices across all fields. Dr. Sreenivasan is a moral philosopher, but he is also a professor of medicine at Duke Medical School. His position as the “Crown Professor of Ethics at the Trent Center for Bioethics, Humanities & History of Medicine,” is part of an initiative to connect societal arts and sciences aspects of Duke University to the Medical School.

“Today, I want to talk to you all about the human right to health,” he opened.

Sreenivasan’s talk was focused on the question of how individual countries can provide healthcare or insure health. “One division within the human right to health is the division between health and healthcare,” he clarified. “Another is the difference between a regular right and a human right.”

As a philosopher, Sreenivasan took the issue of access to health and placed it on a universal scale. He addressed the social determinants of health (callback time!) as part of the solution, alongside more direct-but-still-indirect healthcare actions like vaccinations. His conclusion? We are ultimately moving away from the narrative that we have a right to healthcare and towards the narrative that we have a human right to health.

“You have a right to health, but that does not necessarily mean you are going to be healthy. There are still factors that affect this which are under no one’s control. It doesn’t mean that if you don’t live to be 80 or 85 that your right has been violated. But you’re still entitled to a broader range of things than just health.”

To help illustrate this for my fellow visual learners, I’ve made a fun little visual aid.

Sreenivasan laid out a verbal map to demonstrate the confusion policy makers face about addressing the wellbeing of their constituents. If you believe healthcare is a right, you believe the government has a different role to play than if you believe health is a right. You may expect less of them in terms of handling indirect factors like social determinants and vaccines. If you believe healthcare is a human right, you expect all governments to provide healthcare access universally. This is different from Sreenivasan’s preferred view: health is a human right. All people are entitled to all aspects of their health being addressed all the time in every way in every place.

The word human in “human right” indicates universality the same way removing the care from “healthcare” does; they both broaden the scope.

After that lovely philosophical grammatical discussion (Do colorless green ideas sleep furiously?) as our foundation, Sreenivasan moved on to a challenging analogy: waterboarding.

“It does not belong to the nature of a right that everyone has to have it. But it does seem to belong to the nature of a human right that everyone has to have it. Take the human right to not be tortured, for example.”

Your moral view may differ on whether or not it is a human right not to be tortured. You may think the right should apply to all people, or no people, or only some people. But you also may think that the right should apply to only certain aspects of torture; maybe you think that specifically waterboarding doesn’t count.

(The debate around whether or not waterboarding counts as torture and whether or not it is prohibited under human rights legislation is one that has been around for a long time. Torture has been banned by multiple American presidents in multiple environments, but the language around waterboarding in particular is highly controversial. You can read more about the debate here.)

“It’s not that some people have a human right not to be tortured which protects them from waterboarding, and other people have a human right not to be tortured but it is somehow lesser and does not protect them from waterboarding. You can’t pick and choose the content based on the person for whom the right belongs.”

So, how is the waterboarding debate like universal healthcare?

For one, it’s a matter of exclusion. It’s a matter of moral philosophy. It’s a matter of definition.

The question of whether there should be universal healthcare goes far beyond the question of whether healthcare is a right.

How do we improve access? Who is at fault for rising drug prices? How is America’s healthcare system different than other countries? These questions must start with questions of definition. Who is our target audience? Who is included? Who is excluded? What is included? What is excluded?

“It seems intuitive that human rights are all or nothing.” Sreenivasan explained. “Either everyone has them or no one has them. But then you must say that their content also has to be the same.”

Post by Olivia Ares, Class 2025

Integrating Pediatric Care in NC: Behavioral Health Perspectives

By Vibhav Nandagiri

On October 29, 2021

In Faculty, Global Health, Medicine, Policy, Students

In healthcare, developing a new treatment is often half of the battle. The other half lies in delivering these treatments to those communities who need them the most. Coordinating care delivery is the goal of NC Integrated Care for Kids (InCK), an integrated pediatric service delivery and payment platform looking to serve 100,000 kids within five counties — Alamance, Orange, Durham, Granville, and Vance — in central North Carolina. The project is a collaborative effort between Duke, UNC, and the NC Department of Health and Human Services (DHHS) funded by a federal grant from the Centers for Medicare and Medicaid Services (CMS). The program’s executive director is Dr. Charlene Wong (MD, MSPH), a Duke researcher, physician, and professor who leads an interdisciplinary team of researchers and policy experts as they explore ways to reduce costs via integrating care for North Carolina youth enrolled in Medicaid and Children’s Health Insurance Program (CHIP).

The five counties that are part of NC InCK

I recently had the opportunity to speak with two of InCK’s service partners: Dr. Gary Maslow (MD, MPH) and Chris Lea (Duke ’18). Both work within the Behavioral Health group of InCK, which seeks to use behavioral health expertise through collaborative care and training providers to help support pediatric care. Maslow, a professor at the Duke Medical School, has focused heavily on child and developmental psychiatry throughout his career. Having entered medical school with a desire to work in pediatric hematology, Maslow recalls how a conversation with a mentor steered him in the direction of behavioral health. At the time, Maslow was part of the Rural Health Scholars program at Dartmouth College; while discussing his aspirations, one of his professors asked him to consider conditions outside of cancer, leading Maslow to consider chronic illness and eventually child psychiatry. “Kids have other problems,” Maslow’s professor told him.

When looking at healthcare networks, especially those in rural areas in North Carolina, Maslow noticed a disaggregated service and payment network where primary care providers were not getting the necessary education to support the behavioral health needs of children. His work with Lea, a third-year medical student at Duke, has centered around looking at Medicaid data to understand provider distribution, medication prescription, and access to therapy based one’s area of residence. Lea’s path to NC InCK began as an undergraduate at Duke, where he obtained a B.S. in psychology in 2018. As he explains, mental health has been a vested interest of his for years, a passion reinforced by coursework, research at the Durham VA Medical Center, and NC InCK. He discussed the important of appropriate crisis response, specifically how to prepare families and providers in the event of pediatric behavioral health crises such as aggression or suicidality, as critical in improving behavioral health integration. These safety plans are critical both before a potential crisis and after an actual crisis occurs.

Two main goals of Maslow and Lea’s work are to increase the implementation of safety plans for at-risk youth and expand follow-up frequency in primary care settings. The focus on primary care physicians is especially critical considering the severe shortage of mental health professionals around North Carolina.

The behavioral health group is but one subset of the larger NC InCK framework. The team is led by Chelsea Swanson (MPH). Other collaborators include Dr. Richard Chung (MD), Dan Kimberg, and Ashley Saunders. NC InCK is currently in a two-year planning period, with the program’s launch date slated for 2022.

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