Category: Responsible Conduct

For 223 years — ever since Britain established its first Australian colony in 1788 — indigenous Australians have exercised resistance to colonial plundering and exploitation. One thing colonizers have plundered and exploited is water — water that is “cultural, spiritual; water for our people, water for our country,” according to Tati Tati Elder Brendan Kennedy.

As part of the Fall 2021 Global Environmental Justice Speaker Series — part of a student-led Environmental Justice course here at Duke — on October 6th, Dr. Bruce Lindsay, the Senior Lawyer at Environmental Justice Australia (EJA), discussed indigenous water rights in Australia.

Because the Australian constitution is “silent on key issues” of land and water use, throughout the 19th and 20th centuries, water use was regulated according to English riparian rights in conjunction with English common law. Under this colonial law, whoever owned the land on which water flowed had the right to that water.

Dr. Lindsay argued that Australian law was designed according to the “gross fantasy of the empty continent.” Upon the premise that Aboriginals simply did not exist, colonizers proceeded accordingly — buying and selling land that was already occupied and under aboriginal custodianship. Because Aboriginals didn’t own land in a way recognized by the law, they were “marginalized and excluded” from decisions about water infrastructure and allocation “while degradation [went] on around them.”

Dr. Lindsay and the EJA work primarily with aboriginal communities and organizations in the Murray Darling Basin. The Murray Darling Basin is the largest river Basin in Australia, hosting 90% of the population, 70% of irrigated land, and providing 40% of agricultural production. A precious resource amidst Australia’s hot, semi-arid climate, the Basin has been the site of major conflicts over water since the early 19th century.

The Murray Darling faces a problem called “over allocation,” which means that more entitlements for water use have been issued than can be sustained at their full value. By the 1990s and 2000s, over-extraction had led to drought and unprecedented water shortages, and the ecosystems supported by the Murray Darling Basin were “on the verge of ecological collapse.” The Australian government passed the Water Act of 2007 and the Basin Plan of 2012 to bring the Basin to a “healthier level” and “ensure that the Basin is managed in the national interest” as they saw fit.

To highlight the tension between the Australian legal view and the Aboriginal view, Dr. Lindsay read the Aboriginal anthropologist Deborah Bird Rose’s definition of country. According to Australia’s indigenous people, country “gives and receives life… is lived in and lived with… is a proper noun… is a living entity with a yesterday, today and tomorrow with a consciousness, and a will toward life.” For Aboriginals, the flow of water should support this notion of cultural wellbeing and “genuine coexistence.” But according to Dr. Lindsay, Australian law (being a “pillar of the settler state”) does not currently provide for “life, ecosystem health, and spirit except for where it intersects with the utilitarian purpose.” Thus, Dr. Lindsay believes that the law needs a massive upheaval in order to be reconciled with the indigenous vision.

The EJA is currently working with Aboriginal communities on one such upheaval: the “cultural flows” concept of water management. Cultural flows necessitates reallocation and redistribution of water rights by the Australian government in order to increase Aboriginal control and authority over water. To restore life to country, reverse environmental catastrophe, and revitalize their economic health and culture, Aboriginals hold that there must be a change from the current model where water is understood as something to be continually exploited. Such a change is not without historical precedent: in New Zealand in 2017, the government granted the Whanganui River legal status as a living entity, so that New Zealand law now views harming the Whanganui tribe and harming the river as equivalent.

Ultimately, the EJA hopes to implement the cultural flows framework across the Basin. They’re starting by working with the Tati Tati First Nations community to implement cultural flows in the Margooya Lagoon. Because this requires the Victorian government to deliver the rights to manage water there, the EJA must work with both Australian law and the Aboriginal view. Dr. Lindsay claimed that they don’t have to be mutually exclusive. The EJA seeks to find the intersection where water as a public good to be managed in the public interest can also be water managed for the good of country and the health of the community. Thus, the EJA aims to advocate for policy that enables that mutually beneficial outcome.

Dr. Lindsay ended by recalling his earlier point of reconciling Australian law with indigenous vision. He stated that a “broader set of changes” need to occur in order to really bring justice to Aboriginal communities. Although the Australian High Court’s passing of the Native Title Act of 1993 ostensibly ended riparian rights by recognizing “native title” (the aboriginal traditional ownership of land “according to their own laws and customs”), native title is a “limited device” as far as water rights. Indigenous Australians have native title rights over 30% of the Australian continent, but own only 0.01% of water entitlements. Because state governments have a large role in reallocation, cultural flows projects would have to proceed on a case-by-case basis.

What Dr. Lindsay really hopes to see is a legal mechanism other than native title that will grant legitimacy to aboriginal traditional ownership. He recalled the Uluru Statement from the Heart. It states:

“[Our] sovereignty… has never been ceded or extinguished. How could it be otherwise? That peoples possessed a land for sixty millennia and this sacred link disappears from world history in merely the last two hundred years?”
Uluru Statement from the heart

How could it be? Sadly, the fact that only 0.01% of water entitlements are owned by indigenous Australians indicates that the sacred link of traditional ownership has disappeared — at least in the legal sense. So this is the ultimate goal of Dr. Lindsay and the EJA’s work with indigenous communities: to restore this sacred link.

Post by Zella Hanson

Cemetery, Community, Classroom: Collaborating to Honor the Dead

By Zella Hanson

On September 21, 2021

In Art, Business/Economics, Environment/Sustainability, Faculty, Policy, Responsible Conduct, Students

The institutional neglect and indignity faced by many African Americans during and after the Jim Crow era in the South didn’t end when their lives did. In a panel hosted by the Duke Office of Durham & Community Affairs on Sept. 10, a community leader, Duke professor, and undergraduate student discussed some of the work they are doing to combat the marginalization of Durham’s deceased in Geer Cemetery, two miles from Duke’s campus.

Debra Taylor Gonzalez-Garcia, President, Friends of Geer Cemetery

Founded on land purchased from Frederick and Polly Geer by John O’Daniel, Nelson Mitchell, and Willie Moore in 1877, Geer Cemetery is the final resting place for over 3000 of Durham’s African American citizens. As Maplewood Cemetery was segregated, from 1877 until the opening of Beechwood cemetery in 1924 Geer served as the only cemetery for the African American dead. Lacking public funding and under fire from the health department for overcrowding, Geer Cemetery closed in the 1930s and, in the absence of a plan for its continued upkeep, fell into a state of disrepair.

President of Friends of Geer Cemetery Debra Taylor Gonzalez-Garcia provided a brief history of Geer Cemetery.

The nonprofit Friends of Geer Cemetery was formed in 2003 by “concerned citizens and neighbors” and has worked to “restore the cemetery’s grounds and research its histories” under their mission statement “restore, reclaim, respect.” According to Gonzalez-Garcia, work consists of maintaining the cemetery grounds, repairing headstones, writing life stories, and advocating for recognition.

Friends of Geer Cemetery has accomplished a lot in terms of restoration: in 2004 the cemetery was unrecognizable, with broken headstones, overgrowth, and sunken burials. Today, with the help of Keep Durham Beautiful, Preservation Durham, and other volunteers, the entire cemetery can now be easily viewed.

The organization also continues to work tirelessly toward their other objectives, reclamation and respect. By mining local records, research volunteers have created a database which includes approximately 1,651 burials, but efforts are ongoing.

Gonzalez-Garcia expressed excitement about the organization receiving grant funding for an archaeological survey. “[The survey] will help us to map out burials, because currently, there is no map,” Gonzalez-Garcia said. “We aren’t sure where people are buried.”

The community leader discussed how efforts to reclaim Geer Cemetery bring about questions that reckon with white supremacy in general. “We’re not told stories of the African Americans who built Durham,” Gonzalez-Garcia said. “Why do we know so much about Washington Duke, and nothing of Augustus Shepard? Why should Maplewood still exist and not Geer Cemetery?”

Associate Professor of the Practice in International Comparative Studies Adam Rosenblatt expressed his interest in how care for the dead is “bound up with human rights and social justice.” This interest is personal: he has his own graveless ancestors who disappeared in the Holocaust. He expressed his passion for educating others about “places of mourning in our midst” through “community-engaged” scholarship.

Along with Gonzalez-Garcia, Rosenblatt sponsored a Story+ program at Duke entitled Geer Cemetery: Labor, Dignity, and Practices of Freedom in an African American Burial Ground. With the help of sponsors and a graduate mentor, Duke undergraduates Nyrobi Manuel, Kerry Rork, and Huiyin Zhou researched the cemetery closely in order to “uncover the stories of ordinary citizens and add these stories back into the historic narrative about Geer.” The researchers produced three unique, interactive digital projects which will contribute to the Friends of Geer Cemetery’s online platform for education and outreach.

Rosenblatt discussed one challenge the Story+ engaged with: What really constitutes a human subject? The IRB’s definition doesn’t include the dead; there’s no IRB protocols for researching the dead and their stories. Many archives disappear entirely, or are fragmented.

Nyrobi Manuel, a Duke undergraduate, was one of Rosenblatt and Golzalez-Garcia’s mentees. Manuel took Rosenblatt’s course “Death, Burial, and Justice in the Americas” and says the course inspired her to dig deeper into African American death practices. Through the Story+, Manuel researched John C. Scarborough, who established the fifth-oldest Black-owned funeral home in the country. She produced a project entitled “Scarborough and Hargett Funeral Home: Dignified Death and Compassion in the Black Community.”

Manuel discussed her findings. Many funeral directors became important figures in their community, and John C. Scarborough was no different. A philanthropist and important community member, he helped to establish Scarborough Nursery School, North Carolina’s oldest licensed nursery school.

What’s always drawn Gonzalez-Garcia to Geer Cemetery is its “quiet beauty” and sense of connection. Though her ancestors are buried in Virginia, where she’s from, Geer Cemetery seeks to tell stories of African Americans through “emancipation and reconstruction: throughout history.” Geer is special because it seeks to tell the story of her “blood relatives” while also celebrating the history of Durham, which, she said fondly, is “my community now.”

The Diversity Problem in Science

By Meghna Datta

On February 1, 2021

In Medicine, Policy, Responsible Conduct

With COVID-19 being a fixture of our lives for nearly a year now, science has been a staple in the news. Along with science, though, a long-overdue conversation about the state of race relations in America has taken center stage, which makes diversity in science a critical topic to delve into. COVID-19 has highlighted not only a national crisis in healthcare response, but also longstanding health disparities across racial and socioeconomic groups that have only been exacerbated by the pandemic.

On Wednesday, January 27, Dr. Gowthami “Gow” Arepally, known for her work as Professor of Hematology at the Duke School of Medicine, led a talk called “The Diversity Problem in Science” that aimed to highlight not only the obvious problems in research but the urgency with which everyone, from the individual to the collective level, should aim to address the problem within their spheres of influence. Dr. Arepally is not only known for her work in the medical school but also as a valuable mentor for colleagues, undergraduates, and high school students — a point that was highlighted as an important way non-URM (under-represented minority) scientists can make a difference.

Underrepresentation in science starts early, Arepally says. For example, while discrepancies in graduation rates between Black/Hispanic students and their white/Asian peers are not bad in high school, they get progressively worse through college and beyond. In 2016, 18% of degrees nationally were awarded overall in STEM fields — but this number drops to 12% for Black students and 15% for Hispanic students. As of 2015, Black applicants have lower medical school acceptance rates than peer applicants – 34% versus 44% for their white counterparts. And the numbers get worse further into medical school; Black students and Hispanic students each represent less than 6% of medical school graduates, while a staggering 80% of graduates are either white or Asian.

This perpetuates a cycle going into the workforce that discourages young underrepresented minority (URM) students from entering STEM, seeing a lack of role models that look like them. As of 2016, only 39% of full-time faculty at medical schools were female, and a mere 4% of faculty were Black. This results in barriers to NIH research that further hold URM scientists back. Between 1999 and 2012, 72% of NIH awards were given to white scientists and 24% were given to Asian scientists, but only 2.4% of these awards were given to Black scientists.

This is a story that is shocking when told through statistics but is all too familiar, as an experience, for minority students and researchers interested in pursuing careers in the sciences. However, there are concrete ways to counter the problem. As Dr. Arepally pointed out, NIH Diversity Supplements for existing NIH grants can be obtained from the high school to faculty level as an added source of support for URM researchers. Medical societies themselves can be sources of diversity initiatives, such as Dr. Arepally’s society, the American Society of Hematology, which boasts one of the most aggressive minority recruitment initiatives. Within Duke, many pipeline programs exist for researchers to support URM students and new researchers and faculty.

Most importantly, it’s important for individuals to enact change on a personal level. Whether it means educating oneself on underrepresentation, advocating for the advancement of other URM trainees and colleagues, or committing to the success of URM students through pipeline programs, individual steps can add up.

And as Dr. Arepally highlighted, these steps, however small, are important to prioritize. Increasing diversity in medicine, for example, can help address existing health disparities. URM physicians are more likely to address the care of minority populations, while minority patients are more likely to choose URM populations. And the existence of more URM physicians improves the cultural competency of all trainees. Sex diversity, too, has a positive effect on the quality of science in collaborative groups. The impacts of diversity extend to role-modeling for younger students, who may be at a crossroads in terms of determining a future career. In this way, current measures to increase diversity can foster a cycle of more diverse students entering STEM and being supported there, for generations to come.

Diversity in science is not only good for science and scientists, Arepally says, but for all of us. Science should reflect the society it serves, and with more diversity in science, breakthroughs will be applicable and accessible to every person — not just the majority.

Post by Meghna Datta

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

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

World Bank takes on big data for development

By Irene Park

On March 5, 2020

In Business/Economics, Climate/Global Change, Responsible Conduct, Statistics, Visualization

Apparently, data is the new oil.

Like oil, data might be considered a productive asset capable of generating innovation and profit. It also needs to be refined to be useful. And according to Haishan Fu, Director of the World Bank’s Development Data Group, data is, much like oil, a development issue. She was the keynote speaker for a Feb. 25 program at Duke, “Rethinking Development: Big Data for Development.”

Haishan Fu, Director of the World Bank Development Data Group

While big data is… well, big, Fu explains that it has a more focused quality as well. “When you go deeper, you can see something really personal,” she says. Numbers don’t have to be quite so intimidating in their largesse and clutter: everything is integrated in some way. All of the numbers address the same questions: who, what, when, where?

That’s why the World Bank and countless other organizations and individuals across the globe have begun moving toward big data for the purpose of social and economic development studies. It helps tackle the who–what-when-where of real and complex global issues with increased precision, greater efficiency, and a fresh perspective.

For example, the World Bank’s 2019 Tanzania Poverty Assessment integrated household survey results and geospatial data to estimate poverty within a small region of Tanzania. Despite lacking exact data for that area, using big data to make this estimation was still extremely powerful. In fact, its precision increase was equivalent to doubling the survey’s sample size.

A bit further northwest in Africa, the World Bank has also been using big data in Cote d’Ivoire to predict population density based on cellphone subscriber data.

In Cote d’Ivoire, making predictions from big data (figure on right) has actually allowed for more precision than predictions from census data (left).

In Yemen, integrated data from multiple sources is being used to determine road networks and physical accessibility of hospitals. The World Bank can estimate this kind of information without actually having any ground contact, improving both time- and money-efficiency. Studies have made it evident that less road access is linked to poverty, so they’re hoping to improve road networks as well as update population estimates and further other local developments.

And Brazil has served as a case study in “how social media can provide economic insight,” Fu explains. There, the World Bank has been using Twitter to detect early variations in labor market activities, searching for key words and hashtags in tweets and determining if users’ later employment statuses future have any sort of relationship to the content of their earlier tweets. Interestingly, the Twitter index and unemployment rates in Brazil display similar trends.

These examples are just a few of many big data initiatives the World Bank has been working toward. And though they have proven valuable for lower-income countries across the world, the lack of data in certain areas still poses a huge problem. The data deficit has been contributing to global inequalities, with higher-income countries being able to provide and have access to more data and thus also new improvement technologies. Ending poverty requires eradicating data deprivation, Fu says.

Image result for world bank twin goals — The World Bank’s twin goals: (1) end poverty, (2) promoted shared prosperity.
Image from the World Bank

Eradicating data deprivation is a collaborative effort between the public and private sectors, which is also an issue of its own. On the one hand, there’s a major under-investment in public sector data. On the other, today’s winner-take-most economics and the dominance of select superstar firms have led some private companies to avoid sharing data and favored only those companies able to produce the biggest of datasets.

Fu says working toward data partnerships is a learning process for everyone involved; it’s still a work in progress and probably will be for a while. The potential of big data is already there—it’s just waiting to be totally harnessed. “We will collectively have this platform to increase efficiency, promote responsible use, and come up with sustainable initiatives,” Fu says of the future.

In other words, the World Bank is just getting started.

On ‘Things We Already Know,’ Checklists and Mindfulness

By Lawrence Carin

On October 25, 2019

In Behavior/Psychology, OVPR, Responsible Conduct

I recently spoke to the Academic Council about my new role overseeing Duke’s entire research enterprise – medical and campus – and I reiterated for them the messages in my first blog post: that all of us should take part in the quality and rigor of Duke’s research efforts and that everyone should participate in activities like Responsible Conduct of Research (RCR) training and other activities that will help us to improve.

Not all the faculty are persuaded, I soon learned.

“I read your recent blog post about quality. Clearly that was not meant for me,” one senior faculty member said to me. He suggested that my reminding the community of such matters was beneath him, and probably beneath many other faculty. “Of course we treat people with respect! Of course we always do research the right way!”

In response, let me share with you an important lesson from a book I read recently, “The Checklist Manifesto,” by Atul Gawande. He’s a general and endocrine surgeon at Brigham and Women’s Hospital in Boston who advocates the use of checklists for surgeons, just as pilots and space programs have used.

Checklists impose structure, they force us to think more slowly and carefully, and to systematically address specific questions of relevance to the mission, even if it’s a procedure we’ve done countless times before. Pilots and astronauts aren’t insulted by them.

At the end of his book, Gawande writes about his personal use of checklists in his surgical practice and a very important lesson he learned by using them.

When he first started thinking about checklists, Gawande thought it was an interesting subject, and that it was highly relevant to the average surgeon. However, with respect to himself, a top-flight surgeon, a former Rhodes Scholar and a MacArthur Fellow, he felt the exercise was probably redundant.

But since he had written and spoken so much about checklists, Gawande always went through the motions, just to avoid looking like a hypocrite. That is, until a particular surgery humbled and changed his perspective on checklists forever.

Gawande was about to perform a surgery, and the head nurse was going down the list of items needed for this particular procedure. All items checked off as expected until they came to the need for a substantial supply of blood in case of a rare complication that could cause severe bleeding.

This item surely was added after a prior disaster and a root-cause analysis that refined the checklist for this type of surgery. But as they went down the checklist, the extra blood was absent. So the team quickly got the blood, and the surgery commenced.

To Gawande’s horror, this particular surgery triggered that rare complication. But because they had the substantial supply of extra blood on hand, the surgical team was able – with great effort — to save the patient’s life.

Gawande says he was chastened by this experience. Without attention to the checklist, this patient would have died on the table.

But academic research isn’t anything like flying a plane or opening an abdomen, or is it? I think the stakes for university research are very high. Duke just settled a case related to research misconduct that cost the university more than $100 million, and damaged our reputation. It might have been prevented.

Pilots routinely use checklists before and during flight.

We have a responsibility to be good stewards of the more than $1 billion in annual funding that allows us to do this important work. The organizations that entrust us with those resources (often the federal government) are counting on us to use those resources well, and to engage in research of the highest quality. The stakes are high, and so should be our responsibilities.

While they aren’t a perfect analogue to things like RCR training, safety checklists address predictable human fallibility, which is often a result of thinking instinctually rather than carefully. RCR training, conflict of interest forms, institutional review boards and other research controls seek to address issues in the same way, by identifying problems that have come up in the past at Duke or other institutions and trying to prevent these lessons from having to be learned again (analogous to the need for extra blood).

I also think it’s important that another key component of checklists is cultural: Anyone on the surgical team is allowed to question anything before or during the surgery. This means that a junior nurse on the team can challenge the lead surgeon if they see something that is in conflict with best practice or the checklist. If you see something, say something.

Anyone at Duke who sees behavior that challenges the values connected to the principles of our checklists – conflict of interest, institutional review board, responsible conduct of research — has the right, and the responsibility, to say something.

Inviting faculty, trainees and staff to engage with training does not mean we feel our people are unaware of these issues. It does not mean we feel that Duke researchers lack integrity. It is just that we are all very busy and focused on many things, and we are human.

I’m asking all of us to slow down for a moment, and to remind ourselves of our responsibility to ourselves, to the broader Duke community, and to our research sponsors. We want to set a tone and a culture that will help all of us push the Duke research enterprise to even higher levels of excellence.

Post by Larry Carin, Vice President for Research

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