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40 Years in Global Health – an Interview With Dr. John Bartlett

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Dr. John Bartlett, Professor of Medicine and Global Health Researcher

In your retirement, would you ever hold four Zoom calls every week with colleagues?  

To be fair, Dr. John Bartlett is not technically retired. He is employed by Duke at the 20% level and continues to serve as a Professor of Medicine. However, his busy schedule, which also includes 2-3 months in Tanzania every year and writing grants to support research education efforts, in no way resembles the glorified picture of retirement many of us imagine! 

Fellow freshmen, we may be in for the long haul. 

Before I dive into my interview with Dr. Bartlett, I must acknowledge the incredible enthusiasm he showed in response to my invitation to an interview. Even as cable lines are down in western North Carolina, where he resides, due to the impact of Hurricane Helene, he still offered to keep our original interview time and made himself fully accessible to my questions. I extend my sincere gratitude to Dr. Bartlett for his time, and it is only just for me to relay his thoughts to our readers at large. 

For students unfamiliar with Dr. Bartlett’s background or professional experiences, he has been a Duke faculty member since the 1980s, serving as both a physician in infectious diseases and internal medicine and a professor. His lengthy career traversed continents, having become deeply involved in international HIV/AIDS research and treatment since the 2000 World AIDS conference held in Durban, South Africa. 

“As I traveled to South Africa, I witnessed the profound disparities between clinical outcomes for patients in the U.S., who were thriving, and [those in] the continent most severely impacted by HIV, where no treatment was available,” said Dr. Bartlett, recalling his transition to international work. “We reckoned that [the] concept of research with service could be applicable with an African partner,” he added, which led him to spend two-thirds of the next decade in Tanzania, focusing on this new partnership.  

Picture of the Kilimanjaro Christian Medical Centre, where Dr. Bartlett conducted most of his research and education efforts in Tanzania

Captivated by Dr. Bartlett’s unique experiences, I inquired why he became involved in Tanzania, a country halfway across the globe. To my surprise, it turned out that in the early 2000s, faculty and students at Duke held a strong inclination towards advancing global health research. At the same time, researchers also sought to expand the scope of their activities overseas. Dr. Bartlett shared what was perhaps the most important reason last: “I have to credit my wife, a social worker, who was also quite committed to international work.”  

I learned much about global health throughout the interview. When Dr. Bartlett shared statistics showing 100% effectiveness of certain HIV/AIDS treatments currently offered in lower-income countries, I was stunned. From no access to treatment a few decades ago to successful management of the disease today, there has been remarkable and swift progress that is saving millions of lives. Of course, there are still barriers to treatment including cultural norms, “ubiquitous” stigma, lack of testing resources, and cost. However, the global health field is advancing every day, with newfound knowledge regarding protective factors against HIV transmission helping to further lower mortality rates.  

Discussing Duke’s global health efforts at large, Dr. Barlett was quick to point out the diversity of current projects around the world. “I would refer you to the website for the latest list of countries because I can’t keep up with the continuing growth!” Upon a quick search, this sentiment makes sense: Duke works in more than 40 countries and there are more than 100 active projects. “I am especially proud to see that [the institute’s work] is not limited to a single geographic region or a single topic”, Dr. Bartlett added, reflecting how projects “run the gammit from infectious diseases to non-communicable diseases to cancer to mental health to health systems strengthening.”  

By this point in the article, maybe some engineer readers are yearning for a message pertaining to their academic interests. Don’t worry, Dr. Bartlett talked about your importance in global health work during the conversation too! “There are quite a few BME professors who work with students to develop practical, low-cost solutions to common global health problems,” he said. From rapid diagnostic tests to laparoscopes, the BME department has played a crucial role in the Global Health Institute’s efforts. And these engineering projects are still active: for students desiring to involve themselves in this work, Dr. Bartlett recommends reaching out to Dr. Ann Saterbak, a Biomedical Engineering professor who coordinates many opportunities.  

Before I conclude, I would like to share a quote from Dr. Kathy Andolsek, professor of family medicine, discussing the character, expertise, and work of Dr. Bartlett: 

“He was a dedicated researcher and clinician and an early pioneer in HIV/AIDS. [As a] primary doc, I [worked] with him to get my patients into his clinical trials… so we ‘shared’ many patients. He was inspirational to students and a great listener.” 

Thank you, Dr. Bartlett, for your tireless work on HIV/AIDS treatment around the world. As an educator, researcher, and clinician, you have contributed much to the betterment of health outcomes for patients. Your commitment towards this noble cause and desire to help Tanzanian counterparts become independent in their research encourage all of us, medical students and non-medical students alike, to persistently pursue goals we believe in.  

Stone Yan, class of 2028

Sticking to Sweat: The Future of Biosensors and Tracking Our Health

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Bandaids and pimple patches are the first things we consider when discussing adhesives in medicine. But what if there is more to the story? What if adhesives could not only cover and protect but also diagnose and communicate? It turns out Dr. Wei Gao, assistant professor of medical engineering at the California Institute of Technology, is asking these exact questions. In the field of biomedical adhesives, Gao’s research is revolutionizing our understanding of precision medicine and medical testing accessibility. He visited Duke on Oct. 9 to present his work as part of the MEMS (Mechanical Engineering and Material Science) Seminar Series. 

Wei Gao presenting at Duke University

Gao’s research team focuses on material, device, and system innovations that apply molecular research and principles to clinical settings and improve health. Gao focused his talk on the invaluable characteristics and uses of sweat. Sweat can offer doctors a broad spectrum of information, including nutrients, biomarkers, pH levels, electrolytes/salts, and hormones. He leverages this fundamental characteristic of human physiology to design wearable biosensors that can provide early warnings of health issues or diseases. Gao focuses on making biomarker detection more efficient than current methods, such as blood samples, which require hospital testing, involve highly invasive techniques, and lack continuous monitoring. 

The first milestone in his research came in 2016 when he introduced a fully printed, wearable, real-time monitoring sensor device. The device allowed them to continuously collect sweat and wirelessly communicate data about these sweat samples from patients onto digital devices. The initial 2016 device focused on resolving four fundamental challenges: since most chemical sensors are not stable over long periods of time, the device had to be (1) low-cost and (2) disposable without sacrificing performance. In addition, the device had to (3) be mass-producible to be accessible to the public and (4) integrate multiple signals that could be real-time transmitted to a digital interface.  

Schematic of the sensor array for multiplexed perspiration analysis in Dr. Gao’s 2016 biosensor design

To address the first two of those challenges, Gao and his group turned to printing techniques.  The circuit substrate was a thin piece of flexible PET (a plastic), upon which they layered the circuit components.  The flexible sensor array was constructed in a similar pattern, with a layer of PET patterned with gold to produce the electrodes, covered with parylene, and then each electrode was tuned to receive a specific chemical stimulus: potassium and sodium ion sensors, with a polyvinyl butyrate reference electrode, and oxidase-based glucose and lactate sensors paired with a silver/silver chloride reference electrode.  This design allows the simultaneous monitoring of multiple biomarkers.  To transmit the data wirelessly, the circuit board included a Bluetooth transceiver.

The next major step was to devise a way to monitor sweat without relying upon heat or vigorous exercise, neither of which may be feasible in the case of clinically ill patients. In a 2023 paper, Gao and colleagues published a biosensor that could induce localized sweating using an electric circuit. Called iontophoresis, the technique delivers a drug (a cholinergic agonist) that stimulates the sweat glands on demand and only in the area of the sensor. 

Another important question was how to power the devices sustainably.  Gao’s lab has devised two primary responses to this question: In a 2020 paper, his team powered a similar multiplexed wireless sensor entirely using electricity generated from compounds in sweat. This entailed using lactate biofuel cells to harness the oxidation of lactate to pyruvate (coupled with the reduction of oxygen to water) to provide a stable current. In a 2023 paper, they employed a flexible perovskite solar cell onboard the device to power the monitoring of a suite of biomarkers.

Dr. Gao’s recent publication in February 2024 highlighted a Consolidated AI-Reinforced Electronic Skin (CARES) for stress response monitoring

With these technical hurdles overcome, Gao and his lab have been able to develop sensors targeted to several important medical applications. The work can be directly applied to the monitoring of conditions like cystic fibrosis and gout. More broadly, wearable biosensors can be used to track levels of medically relevant compounds like cortisol (for stress monitoring), C reactive protein (inflammation), and reproductive hormones. The lab has also branched into other kinds of devices that use similar microfluidics approaches, including smart bandages for wound monitoring and smart masks to detect biomarkers in breath.

Through eight years of dedicated investigation, Gao serves as a pioneer in the field of bioelectronic interfaces. Gao continues to widen the possibilities of biosensors not only within the medical sphere but also for the general public. For example, his lab is collaborating with NASA and the U.S. Navy to support the performance and health of astronauts and our military, which is vital as they work in extreme environments. By pushing forward ground-breaking devices such as sweat biosensors, our healthcare systems can pursue preventative care, reducing the need for treatments or health resources by catching these issues early on. Following Gao’s footsteps, we can now build toward a healthier future as we improve the precision of our healthcare approaches and technological advancements.

By Monona Zhou and Nicolás Zepeda

Duke experts discuss the potential of AI to help prevent, detect and treat disease

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Sure, A.I. chatbots can write emails, summarize an article, or come up with a grocery list. But ChatGPT-style artificial intelligence and other machine learning techniques have been making their way into another realm: healthcare.

Imagine using AI to detect early changes in our health before we get sick, or understand what happens in our brains when we feel anxious or depressed — even design new ways to fight hard-to-treat diseases.

These were just a few of the research themes discussed at the Duke Summit on AI for Health Innovation, held October 9 – 11.

Duke assistant professor Pranam Chatterjee is the co-founder of Gameto, Inc. and UbiquiTx, Inc. Credit: Brian Strickland

For assistant professor of biomedical engineering Pranam Chatterjee, the real opportunity for the large language models behind tools like ChatGPT lies not in the language of words, but in the language of biology.

Just like ChatGPT predicts the order of words in a sentence, the language models his lab works on can generate strings of molecules that make up proteins.

His team has trained language models to design new proteins that could one day fight diseases such as Huntington’s or cancer, even grow human eggs from stem cells to help people struggling with infertility.

“We don’t just make any proteins,” Chatterjee said. “We make proteins that can edit any DNA sequence, or proteins that can modify other disease-causing proteins, as well as proteins that can make new cells and tissues from scratch.”

Duke assistant professor Monica Agrawal is the co-founder of Layer Health. Credit: Brian Strickland

New faculty member Monica Agrawal said algorithms that leverage the power of large language models could help with another healthcare challenge: mining the ever-expanding trove of data in a patient’s medical chart.

To choose the best medication for a certain patient, for example, a doctor might first need to know things like: How has their disease progressed over time? What interventions have already been tried? What symptoms and side effects did they have? Do they have other conditions that need to be considered?

“The challenge is, most of these variables are not found cleanly in the electronic health record,” said Agrawal, who joined the departments of computer science and biostatistics and bioinformatics this fall.

Instead, most of the data that could answer these questions is trapped in doctors’ notes. The observations doctors type into a patient’s electronic medical record during a visit, they’re often chock-full of jargon and abbreviations.

The shorthand saves time during patient visits, but it can also lead to confusion among patients and other providers. What’s more, reviewing these records to understand a patient’s healthcare history is time-intensive and costly.

Agrawal is building algorithms that could make these records easier to maintain and analyze, with help from AI.

“Language is really embedded across medicine, from notes to literature to patient communications to trials,” Agrawal said. “And it affects many stakeholders, from clinicians to researchers to patients. The goal of my new lab is to make clinical language work for everyone.”

Duke assistant professor Jessilyn Dunn leads Duke’s BIG IDEAs Lab. Credit: Brian Strickland

Jessilyn Dunn, an assistant professor of biomedical engineering and biostatistics and bioinformatics at Duke, is looking at whether data from smartwatches and other wearable devices could help detect early signs of illness or infection before people start to have symptoms and realize they’re sick.

Using AI and machine learning to analyze data from these devices, she and her team at Duke’s Big Ideas Lab say their research could help people who are at risk of developing diabetes take action to reverse it, or even detect when someone is likely to have RSV, COVID-19 or the flu before they have a chance to spread the infection.

“The benefit of wearables is that we can gather information about a person’s health over time, continuously and at a very low cost,” Dunn said. “Ultimately, the goal is to provide patient empowerment, precision therapies, just-in-time intervention and improve access to care.”

Duke associate professor David Carlson. Credit: Brian Strickland

David Carlson, an associate professor of civil and environmental engineering and biostatistics and bioinformatics, is developing AI techniques that can make sense of brain wave data to better understand different emotions and behaviors.

Using machine learning to analyze the electrical activity of different brain regions in mice, he and his colleagues have been able to track how aggressive a mouse is feeling, and even block the aggression signals to make them more friendly to other mice.

“This might sound like science fiction,” Carlson said. But Carlson said the work will help researchers better understand what happens in the brains of people who struggle with social situations, such as those with autism or social anxiety disorder, and could even lead to new ways to manage and treat psychiatric disorders such as anxiety and depression.

Credit: Brian Strickland.
Robin Smith
By Robin Smith

Post-COVID: The New Normal in the Health Care System

The COVID-19 pandemic sometimes feels like a problem we mostly dealt with yesterday, not one we’re still facing today. However, Duke medical anthropologist Harris Solomon had a different story to tell in the Trent Humanities in Medicine Lecture on April 9.

The transformations within Intensive Care Units (ICUs) across the globe, initially sparked by necessity, have morphed into what might be our “next normal,” Solomon said.

Harris Solomon. Associate Professor in the Department of Cultural Anthropology at Duke University

During the height of the pandemic, hospitals morphed into war zones where the frontlines became the ICU rooms. Like never before, these rooms became a no-man’s-land that few others would cross. A separation was born.

This separation, however, was beyond a physical space; it was a delineation of roles and responsibilities. Nurses often found themselves acting as intermediaries between the patient and the external healthcare team, prompting a sense of isolation and moral burden. They wrestled with their fears in solitary confinement, while colleagues relayed instructions over walkie-talkies—a stark contrast to the collaborative nature of pre-pandemic medicine. Protocols that were once straightforward now needed a touch of ‘MacGyvering,’ with clinicians making do with what was available.

The rigidity of clinical trials also faced challenges; the blinding of studies was questioned as lifesaving drugs teetered on the edge of accessibility. Solomon gave an example of what this change looked like in real life. A patient was due to be treated, and they said that they didn’t care about the details. Even if it was a placebo, they were fine with it. While he didn’t go into the specifics of what had happened, he used this story to accentuate the disparity between evidence and treatment. People don’t care about the treatment as much as they used to.

“We make decisions like we never did before. We summon the need to accept uncertainty”, Solomon said.

As the crisis was evolving, and the world was recovering from the aftermath of COVID, the fabric of healthcare work found itself to be changed forever. Processes and practices that were once considered to be stable, are now brought under a microscope in a post-pandemic world.

The pandemic has indeed been a catalyst for change, but is this change good? While there is no black-and-white answer, I left the room feeling a bit uncomfortable. Although the pandemic has prompted a reevaluation of the health care system, have we innovated, or have we just found shortcuts?

 

The HIV/AIDS Epidemic: Revisiting the Early Days of a Global Health Crisis

On June 5, 1981, the Centers for Disease Control and Prevention reported the first cases of a mysterious disease afflicting young, otherwise healthy men in a tiny suburb of Los Angeles, California. The disease, now known as AIDS, would go on to infect 85.6 million people around the world, sparking an epidemic that persists to this day.

On February 6, 2024, Duke’s Global Health Institute hosted a conversation with Dr. James Curran and Dr. Kevin M. De Cock, both former leaders at the CDC, about their experiences on the frontlines of the AIDS crisis in the earliest days of this epidemic. The conversation was moderated by Dr. Chris Beyrer and Dr. Nwora Lance Okeke, two Duke researchers in infectious disease.

Pictured from left to right: Dr. James Curran and Dr. Kevin M. De Cock

The Origin of the Epidemic

The first cases of AIDS were reported by Dr. Michael Gottlieb, a young immunologist from UCLA. His groundbreaking findings, published in the CDC’s Morbidity and Mortality Weekly Report, described “previously healthy gay men from Los Angeles, San Francisco, and New York, who presented with rare opportunistic infections,” said De Cock. These infections, known as PCP (Pneumocystis carinii pneumonia) and KS (Kaposi’s sarcoma), were extremely rare. Upon observation, Gottlieb identified a startling commonality among the cases: they were all sexually active gay men.

Michael Gottlieb: The Rutgers Alumnus Who First Identified the Deadly  Disease We Now Call AIDS | New Brunswick, NJ Patch

These findings “didn’t fit into any organizational unit at the CDC,” so a multispecialty task force was formed. Led by Curran, it recruited experts in STIs, parasitology, virology, cancer, and more.

Tracking the Epidemic

At the start of the epidemic, cases were phoned into the CDC by individual doctors. But this quickly became inadequate. The epidemic was growing fast, and CDC phone lines could not keep up. “The CDC, therefore, developed a surveillance case definition for the syndrome,” De Cock explained. “Cases meeting this definition were reported through health departments to the CDC.”

“I think we were able with the case definition for surveillance, to take advantage of the fact that all of these conditions were very serious and so unusual that the physician would say ‘I’ve never seen anything like it,’…,” Curran said. “The other conditions were far less specific and far less useful for tracking the disease.”

In October 1981, these tracking protocols helped identify AIDS as a sexually transmitted disease. A national case-control study found that sexual activity was a leading risk factor, and a cluster of cases in 10 US cities linked via sexual contact was discovered. “People just didn’t want to believe it,” Curran said. “They wanted to believe that it wasn’t something transmissible.” 

Expanding Epidemic

Over the next year, the epidemic expanded to include injection drug users, heterosexual partners of bisexual men, people of Haitian descent, and infants. But perhaps most surprising was the transmission occurring through blood transfusion. In December 1982, a case of AIDS-like illness was reported in a 20-month-old infant after receiving blood from a donor who later developed the virus.

“Until that December report of the infant, the mainstream media had actually paid very little attention to AIDS. But that suddenly changed,” said De Cock. “While AIDS was seen as a problem of marginalized groups… it was easy to ignore. But anyone might need a blood transfusion.”

In the following years, rumors surrounding transmission and contact sparked nationwide panic. Fear of contracting the disease caused AIDS patients to lose their jobs and housing. Although the CDC provided up-to-date information on the nature of the virus, quelling public fear was extremely difficult. “AIDS proved that you can’t separate prevention and treatment,” Curran explained.

Modern AIDS Era

As we get close… to 100 million HIV infections since the epidemic began- have we done as well as we should have?”

Dr. Kevin M. De Cock

In 1991, researchers successfully identified HIV (Human immunodeficiency virus) as the underlying cause of AIDS. Since then, scientific understanding of the disease has greatly improved. “Our success has made AIDS more normal, which has robbed the disease of some of its mystique,” De Cock expressed. However, there is still no known cure for AIDS. The disease is a lifelong battle that wreaks havoc on the people it infects.

HIV / AIDS - Our World in Data
Source: Our World in Data

De Cock and Curran’s contributions to the AIDS epidemic fundamentally shaped our understanding of the virus. Their work shines a light on the importance of frontline research and support. Their book, entitled ‘Dispatches from the AIDS Pandemic: A Public Health Story,’ is available to read here.

Written by Skylar Hughes, Class of 2025

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

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

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

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

Raisi-Estabragh 2023

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

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

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

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

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

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

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

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

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

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

Written by Skylar Hughes | Class of 2025

International Experience Shaped Epidemiologist’s Career Path

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

In the complex world of scientific exploration, definitive answers often prove elusive, and each discovery brings with it a nuanced understanding that propels us forward. Dr. Dana Kristine Pasquale’s journey in public health serves as a testament to the intricate combination of exploration and redirection that have shaped her into the seasoned scientist she is today.

Pasquale said her scientific path has been  “…a nonlinear journey, that’s been a series of over-corrections. As I’ve gone from one thing to another, that hasn’t turned out to be what I expected.”

Dana Pasquale Ph.D.

Anchored in her formative years in a study abroad experience in Angola, Africa during undergraduate studies, Pasquale’s exposure to clinical challenges left an indelible mark. She keenly observed the cyclic nature of treating infections by shadowing a local physician. 

“We would treat the same people from month to month for the same kinds of infections,” she recalled. 

Things like economic and social barriers weren’t as stark there – everyone was at the same level, and there was no true impact that she could make investigating them. This realization sparked a profound understanding that perhaps a structural, community-focused intervention could holistically address healthcare needs – water, sanitation, etc. It set the course for her future research endeavors.

Upon returning to the U.S., she orchestrated a deliberate shift in her academic trajectory, choosing to immerse herself in medical anthropology at the University of North Carolina-Chapel Hill. Her mission was clear: to unravel how local communities conceptualize health. Engaging with mothers and child health interventionists, she delved into health behavior, yet found herself grappling with persistent frustrations. 

“I found [health behavior] frustrating because there were still a lot of structural issues that made things impossible,” she says. “And even when you think you’re removing some of the barriers, you’re not removing the most important ones.”

 Rather than being a roadblock, this frustration became a catalyst for Pasquale, propelling her toward the realms of epidemiology and sociology. Here, the exploration of macro and structural factors aligned seamlessly with her vision for sustainable public health, providing the missing pieces to the intricate puzzle she was trying to solve. She didn’t expect to end up here until her mentor suggested going back to school for it.

As principal investigator of Duke’s RDS2 COVID-19 Research and Data Services project during the early months of the pandemic, Pasquale navigated the challenges associated with transitioning contact-tracing efforts online. Despite hurdles in data collection due to the project’s reliance on human interaction and testing, the outcome was an innovative online platform, minimizing interaction and invasiveness. This accomplishment beautifully intertwines with her ongoing work on scalable strategies to enhance efficiency in public health activities during epidemics. 

“We had a lot of younger people say that they would prefer to enter their contacts online rather than talk to someone… something that could be a companion to public health, not subverting contact-tracing, which is an essential public health activity.”

Pasquale’s expansive portfolio extends to an HIV Network Analysis for contact tracing and intelligent testing allocation. Presently, she is immersed in a project addressing bacterial hospital infections among patients and hospital personnel, a testament to her unwavering commitment to tackling critical health challenges from various angles.

When queried about her approach to mentoring and teaching, Pasquale imparts a valuable piece of wisdom from her mentor: “If you’re not completely embarrassed by the first work you ever presented at a conference, then you haven’t come far enough.” 

Her belief in the transformative power of mistakes and the non-linear trajectory in science resonates in her guidance to students, encouraging them to not only accept but embrace the inherent twists and turns in their scientific journeys. As they navigate their scientific journeys, she advocates for the importance of learning and growing from each experience, fostering resilience and adaptability in the ever-evolving landscape of scientific exploration.

Guest Post by Ashika Kamjula, North Carolina School of Math and Science, Class of 2024

Scientific Passion and the Aspirations of a Young Scientist

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

Meet Dr. Oyindamola Adefisayo – Oyinda to her friends – a Postdoctoral Research Fellow at Duke. She’s exploring bacterial factors in host-pathogen interactions using mice. 

During our interview, parallels in our journeys became clear. Even as a high school senior, I could strongly identify with Dr. Adefisayo’s work and share similar passions. I envisioned myself evolving into an inspiring scientist just like her and felt a strong connection with my aspirations as a high school senior.

Originally from Lagos, Nigeria, Dr. Adefisayo came to the U.S. via the African Leadership Academy in Johannesburg. Like me, she left home at 16 for a two-year residential program for teenagers. It was filled with passionate and driven students like I’m with at NCSSM. Oyinda earned her B.A. in Biology at Clark University, specializing in the genetic basis of wing and eye development in the fruitfly Drosophila melanogaster.

Her Ph.D. at Memorial Sloan Kettering in New York City focused on Immunology and Microbial Pathogenesis.  She studied mycobacteria, examining DNA damage response pathways, antibiotic resistance, and mutagenesis. The work connected with her knowledge of Nigeria’s high tuberculosis burden as she sought practical applications. She found that a delay in the machinery of DNA copying itself triggered a damage repair pathway called PafBC. 

Beyond the lab, Oyinda’s passion for ballroom dancing reflects her belief that science is an art, since there’s so much creativity and artistic sense that goes into being a scientist. This resonated with me too. I use painting as an outlet during my research on environmental stressors and antibiotics at NCSSM.

I was inspired by Dr. Adefisayo’s beliefs and passions. She continues her scientific career by delving deeper into protocol development, data analysis, and global knowledge-sharing. Her goal is to learn from bacterial and host genetics and contribute to  simplifying and expediting life science research for professionals worldwide.

Guest post by Emily Alam, North Carolina School of Math and Science, Class of 2024.

Solving More Medical Device Challenges by Teaching Others How

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

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

Eric Richardson, Ph.D.

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

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

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

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

A prototype of Richardson’s latest device.

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

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

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

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

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

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

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

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

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

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

Dr. Mitchell holds a deep brain stimulation device.

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

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

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

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

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

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

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

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

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

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

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

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