Research Blog

Nathan Thrall’s “A Day in the Life of Abed Salama”

On October 30, 2024

Nathan Thrall, the 2024 Pulitzer Prize Winner for General Nonfiction, sat with Rebecca Stein, discussing his book, “A Day in the Life of Abed Salama: Anatomy of a Jerusalem Tragedy.” Published October 3, 2023 by Metropolitan Books, Thrall’s book tells the story of the people whose lives became intertwined by a tragic bus accident near Jerusalem 12 years ago, serving as a spotlight that identifies the corrupt powers that Israel has over Palestine.

Author Nathan Thrall and his book “A Day in the Life of Abed Salama.” (Judy Heiblum)

Beginning with a synopsis of the book, Thrall shared the history of the West Bank enclave. Annexed and neglected, 130,000 people live between 26-foot tall concrete walls with only two exits. Within the enclave are no play areas, no sidewalks, and often trash burnings in the middle of the night; on the other side of the wall are rich images of middle-upper class housing and Hebrew University (the most prestigious university in Israel).

An Isreal wall separating Palestine and Jerusalem *The Irish Times* (Atef Safadi/EPA)

Students at a school within the enclave, in hopes of finding an area to play, walked with their teacher along the wall (along the apartheid road) and were devastatingly hit by a quarry semi-trailer. The truck proceeded to flip over and catch fire. The road where the accident took place, though used entirely by Palestinians, is under Israeli control, and therefore Palestinian authority is prohibited. Passerbys stopped and tried to help however they could, but the flames were too big. In the end, it took 30 minutes for Israeli fire trucks to show up to the burning semi-truck. Six children and one teacher died.

The book focuses on Abed Salama, the father of a boy who was involved in the accident, who after hearing about the accident, spent the next 24 hours trying to work his way through the restrictions placed on him as a Palestinian in order to find his son and make sure he was safe and alive. Abed went into the burning bus and rescued children, was rejected at many checkpoints in between hospitals where he thought his son may be–all of which are just a few of the many incommensurably heartwrenching tragedies he went through.

Abed Salama *The New Yok Review* (Ihab Jadallah)

After giving us the synopsis, Thrall then began to read a passage from his book, making it clear why he won a Pulitzer Prize. His writing, not only transformed a world of non-fiction into a very digestible piece of literature, but his ability to extract such emotion through his voice is truly inspiring. Looking around, I could see everyone leaning forward in their chairs–the room, was silent enough for the turning on and off of the air conditioning to turn my head.

I knew walking into this talk, that this book’s meaning in the world and civil discourse would have more of an impact given the increasingly dire situations in Palestine over the past 12 months. While beginning her questions, Rebecca Stein did not shy away from this topic either.

“It’s a very ordinary event, it’s not like the kind of events that we see splashed across, you know, our television screens or our phones on social media, where we’re looking at tragedies at a much bigger scale…” “…why did you take this intimate incident as a way to try to tell this much bigger story?” she asked.

While I first was a bit taken aback at this question, I realized Rebecca was right. What makes the news is usually what will grab the most attention and the most emotion. And so rarely do we see the “smaller tragedies” (smaller as in fewer casualties).

Thrall answered very calmly, and very methodically.

“I wrote this book out of a sense of, uh, despair,” replied Thrall. “…what I was really aiming to do with this book was to draw, uh, our attention to the situation for Palestinians in their ordinary lives.”

And as Thrall continued to explain why he chose to write about the bus accident, he continued to show us his brilliance as both an author and speaker. For he was able to tell a story that shows readers how something so (unfortunately) common as a car accident, can lead to such heavy consequences when the systems in place are corrupt.

“…the best way to make a systemic critique, I think, is to show the everyday, um, because otherwise, if you choose something exceptional, something that a journalist might be drawn to, it’s easier to dismiss and say, this was the action of one, uh, bad commander.”

I was moved by how open the room was. Everyone was captured by the moment of Thrall spilling truths–some of which we were familiar with and some of which we had never heard before. I could see the weight of the subject, heavy in people’s faces and postures, and yet everyone remained, and many asked more questions. Some asked where Abed Salama is now. Thrall told us how the book was published on October 3rd, four days before the Hamas-led attack on Israel; Abed and Thrall had plans to travel together and tour the book, but after the war began, Abed had to miss many of their destinations. Thrall said that Abed, though he was able to attend some of the destinations for the book tour, is mostly at home mourning for and supporting his community.

There was a sort of ambiguity as the night came to a conclusion. Thrall’s book is living as a teacher and voice for those who don’t get the opportunity to tell their stories in Palestine. Thrall doesn’t know what is next, only that tragedies will continue to be treated as accidents, and systems, unjust as they are, are much easier continued, than broken.

From Immune Responses to Private Equity, New Series Offers “Research On Tap”

By Crystal Han

On October 28, 2024

In Biology, Business/Economics, Entrepreneurship, Global Health, Immunology

On every third Thursday of the month, Devil’s Krafthouse is host to Research on Tap: a series that gives Duke researchers, from undergraduates to postdoctoral fellows, the opportunity to present their work in a casual setting. It may seem odd for the procedures of academia to make their way into a space for socialization and entertainment, but this situation allows individuals to practice speaking publicly to a general audience under a short time limit–good conditions for developing their “research elevator pitch.” These were the pitches on October 17:

*As it’s name suggests, Cv is a bacterium violet in color. Photo courtesy of Dr. Edward Miao and Dr. Carissa Harvest.*

Jacqueline Trujillo, a Ph.D. student in the Department of Molecular Genetics and Microbiology, who is part of Dr. Edward Miao’s lab, presented her research on immune cell response to the bacterium Chromobacterium violaceum (Cv). Being an environmental pathogen, Cv usually resides in the soil of tropical and subtropical areas. While disease in humans is rare, the mortality rate is high in immunocompromised individuals.

“The Miao Lab was initially studying pyroptosis, a form of cell death that occurs during infection, when they discovered Cv-induced granulomas,” Trujillo said. Granulomas are specialized structures that are formed to contain and eradicate pathogens, but they can range in the arrangement and type of cells they consist of; one induced by tuberculosis infection, for example, would include adaptive immune cells like T and B cells. However, when the pathogen inducing them is Cv, only innate immune cells are present: neutrophils in the inner cluster and inflammatory macrophages in the outer cluster. When Cv is detected, neutrophils are the first to flock to the site of infection in a “toxic swarm.” The neutrophils themselves are typically able to effectively kill microbes even before granuloma formation. “These are one of the most toxic defending cell types in the immune system,” Trujillo said.

Despite this, the lab observed something unusual: these neutrophils failed to kill off the Cv bacteria, which continued to replicate despite the swarm. The lab ultimately saw Cv eliminated by the innate granulomas within about 21 days, but the ability to survive the neutrophils is what Trujillo now aims to understand. Such a feat from an environmental bacterium comes as a surprise, being “something more characteristic of the causative agent [Yersinia] of the bubonic plague,” Trujillo said. A comparison between the proteins CopH and YopH, virulence effectors in Cv and Yersinia respectively, reveals lots of similarities between the two. Trujillo hypothesizes that CopH is part of the secret to how Cv disarms the immune system’s defenses.

The role of virulence effectors is generally “aid[ing] in survival, invasion, and suppressing immune responses.” Through needle-like structures, bacteria inject these proteins into a host cell. A cell responds to this in two main ways. It dies–initiating pyroptosis to prevent the pathogen from replicating inside the cell. Second, it signals for help by making chemical messengers called inflammatory cytokines. Investigating the first response is what led the Miao Lab to Cv-induced granulomas.

Now, the lab is interested in understanding the regulatory signals that form the granuloma–and the role that inflammatory cytokines might play, if any. In addition to testing her hypothesis on CopH, Trujillo intends to determine if neutrophils respond to Cv’s initial survival by producing the cytokine IL-18, thus recruiting immune cells to the infection site. This would help the Miao Lab confirm their idea that the neutrophils’ failure to clear Cv is what prompts the process of granuloma formation.

With much still unknown in the area of granuloma biology, Cv provides an “excellent model for studying immune cell biology and characterizing bacterial virulence effectors,” Trujillo said.

Though it happens that many Research On Tap speakers are in the sciences, the program isn’t discipline-specific. Our second researcher of the evening, Sungil Kim, studies a far different field from Jacqueline.

As a Ph.D. student in Finance at the Fuqua School of Business, Kim is looking at the effects of a growing trend in recent years: private equity (PE) firms acquiring healthcare companies. His focus is on what’s known as the “buy-and-build”, as this business strategy is often used by such firms entering the healthcare sector. The scenario typically looks like this: a private equity firm first acquires a large existing company, called the platform company or “first deal.” They’ll then acquire several smaller companies, or “add-on deals,” in order to expand the platform company’s operations.

Since private equity firms buy businesses with the eventual goal of selling them at a profit, their primary focus is increasing efficiency to reduce costs. On one hand, these buyouts might be seen as beneficial for languishing businesses in need of operation enhancements. But within the healthcare sector, many worry the resultant cost-cutting will lead to declining standards of care for patients.

Kim set out to investigate if operational improvements are sustainable across multiple acquisitions within the buy-and-build framework. The simple answer? No.

Kim confirmed that, on average, private equity firms improve the operational performance of hospitals without hurting quality, “a finding that agrees with some of the previous literature.” Yet, one only needs to take a closer look into the sequence of deals to uncover a different, more complicated story.

To arrive at his answer, Kim considered three main factors–operational efficiency, profitability and quality–in both the platform company and add-on companies. Platforms, or first acquisitions, did see success in performance, but this came with what appears to be a trade-off, as the first two factors increased while quality went down. As in, quality of healthcare. From one of Kim’s graphs, it was apparent that occurrences of four of the six health outcomes measured, including mortality and remission of heart failure, increased in such first deal situations.

Meanwhile, results for the add-ons changed little before and after the buyout, meaning that the initial success from the platform didn’t carry over to later acquisitions, even as reduced costs did. A potential reason for this inability to replicate success, Kim explained, is that these cost savings may come from reducing the number of patients and services, instead of truly improving the efficiency of operations.

In contrast to academic journals that display research that’s been in the works for years, Research on Tap brings us closer to working papers in their ongoing, exploratory stages. While it’s difficult to draw wider conclusions from Kim’s findings just yet, and important to remember the specific first deal context of this study, research like his helps us further understand the issues facing improvement of our healthcare system and where private equity plays a role.

If you’re interested in learning something new and free Krafthouse bites, swing by and attend a session–the next one occurs on November 21, 2024 at 5 p.m. The program welcomes prospective speakers to place themselves on the waitlist for a spot.

“Communicating at the Speed of Science”: Can preprints make science more accessible?

By Sophie Cox

On October 23, 2024

In Artificial Intelligence, Biology, Medicine, Responsible Conduct, Science Communication & Education

Richard Sever, Assistant Director of Cold Spring Harbor Laboratory Press in New York and Executive Editor for the Cold Spring Harbor Perspectives journals. Sever spoke at Duke about the benefits of sharing preprints of scientific papers.
Photo courtesy of Sever.

Quality is of utmost importance in the world of scientific publishing, but speed can be crucial, too. Early in the COVID-19 pandemic, for instance, researchers needed to share updates quickly with other scientists. One solution is disseminating preprints of studies that have not yet been peer reviewed or published in a traditional academic journal. Richard Sever, Assistant Director of Cold Spring Harbor Laboratory Press in New York and Executive Editor for the Cold Spring Harbor Perspectives journals, recently visited Duke to discuss his work as the co-founder of bioRxiv and medRxiv, two of a number of servers that post preprints of scientific papers.

In traditional publishing, Sever says, “When you submit a paper to a good journal… most of the time it’s immediately rejected.” Of the papers that are considered by the journal, about half will ultimately be rejected by editors. Even for successful papers, the entire process can take months or years and often ends with the paper being placed behind a paywall.

Posting preprints on servers like bioRxiv, according to Sever, doesn’t preclude the studies from eventually being published in journals. It just “means the information is public much more quickly.”

In 2013, Cold Spring Harbor Laboratory released bioRxiv. In the time since, there has been a “proliferation of discipline-specific servers” like chemRxiv, socarXiv, NutriXiv, and SportRxiv.

How do these preprint servers work? Scientists submit a study to an Rxiv server, and then after a brief screening process the paper is made visible to everyone within hours to days. A frequent concern about these servers is that they could be used to disseminate poor-quality science or false information. Since the priority is to share information rapidly, the staff and volunteers in charge of screening cannot perform extensive peer review of every submission. Instead, the screening process focuses on a few key criteria. Is the information plagiarized? Is it actual research? Is it science or non-science? And most importantly, could it be dangerous?

In 2019, Sever and his colleagues at Cold Spring Harbor collaborated with Yale and the BMJ Group to launch medRxiv, a server that focuses on health research. Since the consequences of posting misleading clinical information could be more severe, it uses enhanced screening for the papers that are submitted.

Papers can also be revised after being uploaded to a server like bioRxiv. A scientific journal, on the other hand, may occasionally publish a correction for a published article but not a completely new version.

What are the benefits of preprint servers? Releasing preprints allows scientists to transmit study results more quickly. It can also increase visibility, especially for scientists early in their careers who don’t have extensive publishing records. Grant or hiring committees can look at preprints months before a paper would be published in a journal. This emphasis on speed also accelerates communication and discovery, and the lack of paywalls could make science more accessible. Additionally, preprint servers can give researchers an opportunity to get broader feedback on their work before they submit to journals.

So why submit to scientific journals at all? Traditional publishing is slower, but it aims to assess scientific rigor and quality and, critically, the importance of the work. “The currency of academic career progression,” Sever says, “is journal articles.” Another attendee of Sever’s lecture brought up the value of curation, using the example of movie reviews on Rotten Tomatoes. Sever believes that the sort of curation performed by journals is different. Movie reviewers give their opinions later in the process; they don’t stop production of a movie halfway through, saying “I want a happy ending.” Sever believes preprint servers allow science to be shared more widely without putting the final decision in the hands of editors.

What are the concerns regarding preprint servers? One concern scientists may have is being “scooped,” or sharing information only for another researcher to claim it as their own. Sever does not find the scooping argument to be very persuasive. “How can you be scooped if you’re using an anti-scooping device?” He believes that Rxiv servers, since they allow rapid dissemination of results, actually provide a safeguard against people passing ideas off as their own because the preprint author is in control of the timing. Another concern occasionally expressed is that having a paper on an Rxiv server may make it harder to get it accepted by a journal. Sever is unconvinced, pointing out that most papers are rejected by journals anyway.

A more pressing concern may be the potential for preprint servers to disseminate bad science, though Sever notes that there are “a lot of not-very-good papers in traditional publishing” as well. Besides, academics’ careers depend on producing high-quality work, which should be an incentive not to share bad work, whether on preprint servers or in scientific journals.

Nonetheless, people do sometimes submit pseudoscience to preprint servers. “We have been sent HIV denialism, we have been sent anti-vaxx things,” Sever says. Some people, unfortunately, are motivated to share false information disguised as legitimate science. That is why bioRxiv screens submissions—less for accuracy and more for outright misinformation.

A more recent concern is the potential for AI-generated “papers.” But like journal articles, all papers posted on bioRxiv are kept there permanently, so even a fake paper that makes it through the screening process could be caught later. Anyone doing this risks future exposure. A more insidious form of this problem, Sever says, is “citation spam,” where someone generates papers under another person’s name but cites themselves in the references to improve their own citation record.

“Like anything,” Sever says, “we’ll have to accept that there’s some garbage in there, there’s some noise.” The vessel, he says, is no guarantee of accuracy, and “at some point you have to trust people.”

Sever believes preprint servers play an important role by “decoupling dissemination from certification.” He hopes they can open the door to “stimulating evolution of publishing.”

Post by Sophie Cox, Class of 2025

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

By Stone Yan

On October 21, 2024

In Global Health, Immunology, Medicine

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.

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

By Monona Zhou and Nicolas Zepeda

On October 18, 2024

In Biomedical Engineering, Engineering, Medicine, Science Communication & Education, Uncategorized

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.

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.

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

By Robin Smith

On October 15, 2024

In Artificial Intelligence, Biomedical Engineering, Engineering, Entrepreneurship, Medicine

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.

Riots and Reconciliations: Revisiting ‘The Kerner Report’

By Sarah Pusser

On October 14, 2024

In Anthropology, History, Political science

When we think of some of the most important milestones in America’s civil rights movement, rarely do people talk about “The Kerner Report.”

“U.S. Riot Commission Report. REPORT OF THE NATIONAL ADVISORY COMMISSION ON CIVIL DISORDERS” from *Center for Lost Objects*

In a conference room in the John Hope Franklin Center, I sat amidst a gathering of curious people, and at the front of the room was Rick Loessberg, the author of “Two Societies: The Rioting of 1967 and the Writing of the Kerner Report.” If you couldn’t tell from Loessberg’s contagious smile, you could certainly tell from his extensive knowledge that he was excited to be introducing us to this report, which looks at the causes of the 1967 civil rights riots.

Giving us some background history, Loessberg first acknowledged the importance of the very building we were all in. The John Hope Franklin Center, where Dr. John Hope Franklin held an office and worked until he died in 2009, was built in 2001 to create a space for everything Dr. Franklin believed in–a welcoming environment that encouraged considerate debate and discussion. Dr. Franklin was also known for writing the 5th chapter of “The Kerner Report,” which connected African American’s history in the United States and their riots in 1967. As I sat in the conference room, I couldn’t help but feel the weight and proximity of the building’s history emphasizing the importance of Loessberg’s discussion.

Loessberg then began to explain the catalyst for creating “The Kerner Report,” enumerating the tragedies of the riots in 1967. On July 23, 1967, Detroit Police raided an after-hours nightclub. The raid quickly turned violent, and the civilians in the city did not let this go unnoticed. The following five days were marked by extreme violence, with 43 people killed, over 7200 arrests, and 600 fires started. It wasn’t until 5,000 elite paratroopers came into Detroit that the riots finally stopped.

“Burning Buildings in Detroit after Riots” from *Getty Images*

In response to this, Lyndon B. Johnson created a commission of 11 members, which examined FBI reports, studied the attitudes of 13,000 people who had been arrested, and looked at U.S. Census data to discover why the riots were happening. The Census concluded that the rioting was not the fault of what the majority of Americans believed–the rioters were “losers,” “communists,” you get the point–but instead, the riots were a reaction to the years of discrimination and racism that Black people had been facing throughout their lives (which though not surprising to many today, was an incredibly progressive conclusion for the 1960s).

“Chair of the National Advisory Commission on Civil Disorders, Otto Kerner with President Lyndon Johnson” from *LBJ Presidential Library*

Additionally, “The Kerner Report” found that most of the people rioting had gone to school, had jobs, and did not have arrest records–findings that went against the stereotypes white people assigned to the rioters. The bravery of these successful people willing to risk everything in order to riot against what they knew was wrong stood out to me (however, not to say that violence should ever be encouraged). I also found it quite surprising how successful “The Kerner Report” was, given the lack of knowledge on it today, with over 1 million copies being sold in the first week.

Here are five key points “The Kerner Report” can teach us if implemented in today’s time, Loessberg said:

Be courteous: During the creation of “The Kerner Report,” the commission always made sure to have appropriate discussions, never name-calling or blaming, similar to what we see in politics today.
Focus on what everyone has in common: The commission worked hard to make sure that everyone’s voice was heard. They addressed everyone’s concerns, and even if they couldn’t explicitly “fix” their concern, by holding a space where people could voice their upset, the commission was more successful at creating a report most approved of.
Know how to read the room and when to temporarily regroup: The commission was very aware of when they would get stuck in arguments rather than discussions, and because of this, they were able to acknowledge that they needed to regroup and try to tackle the issue again.
You don’t have to win every argument: Being successful alone doesn’t make a group or society successful. The Kerner Commission knew this and always kept this in mind when researching and writing the report. Because of that, not one person was in charge of the narrative, allowing for the narrative to be a collection of ideas.
“The Kerner Report” can apply to all work settings and relationships: By observing how to tackle systemic issues and address the country about such things, we can learn about how to approach this issue today, both at large and in smaller settings. Every relationship needs respect and a facilitation of conversation to be successful.

Moving forward, Loessberg said that we must have proper education about the impacts of systemic racism on the Black community. Additionally, and something I found quite interesting because I have never heard before, Loessberg said that there is a need for a wider variety of terms that mean racist–arguing that the fact that KKK members in white sheets are called racists just as the white cashier who has inherently racist actions is racist does not allow for a deeper understanding of systematic racism.

As I looked around during the final Q&A, I saw people from all different backgrounds facilitating respectful discourse–something I can’t say I see often. When I asked if Loessberg believed this text should be taught in schools if allowed, he answered, agreeing that (absolutely) “The Kerner Report” should be in schools today, but unfortunately “…it would be accepted as critical race theory,” meaning it would not be allowed in schools today. As others asked questions, I began to put into words what I had been observing throughout this entire presentation and discussion; even when opposing opinions were shared, everyone could eventually come together to agree on one thing–How the United States is today is in need of fixing, and “The Kerner Report” can provide insightful and guiding information if implemented correctly.

When He’s Not in Class, Here’s Where You Can Find New Blogger Nico Zepeda

By Nicolás Zepeda

On October 11, 2024

In Students

When I visited college campuses last year, there were two must-see destinations at each: the libraries and the forests (gardens would suffice at those unfortunate institutions which, by the whims of geography, lacked a sylvan space). Those two places also happen to be where I am most liable to be found when classes and tasks allow. An intriguing volume, a maze of shelves, a mossy glen, or a stand of oak or pine, and I am in my element.

Homeschooled from kindergarten onwards, I was just about never more than a few feet from a book. I believe some significant portion of the public library’s collections was usually in one corner of the living room, my parents’ books lined the walls, a burgeoning collection began to fill – then overfill – my bedroom shelf, all of which impelled me to grow up on books like bacterial colonies on agarose. I learned from books, recreated with books, and began to gain an appreciation for learning for its own sake.

Despite this apparent bibliophilia, it is love and awe for the natural world that have primarily driven my interests since at least age five, when I turned my innocent quest for encyclopedic knowledge from dinosaurs to extant animals (giving my mom a much-needed break from being Mrs. Protoceratops). I obsessively read about cassowaries or tardigrades with my best friend and began to amass the collection of exotic stuffed animals that would later form a self-governing republic and conduct mass experiments in electoral systems. Now, I explore the outdoors whenever possible, whether by foot, bicycle, kayak, or cross-country ski, yearning for the freedom of a snow-covered woodland or a bog ablaze with fall color.

Recently, I’ve begun to see commonalities between Nico the bookworm and Nico of the forest frolic. I would like to think that I can attribute those connections to exposure to the realm of research. Since beginning work in a botany lab the summer before 11^th grade, I have seen those all-important forests with new eyes, trying my best to understand the mechanisms that drive their function, no hike too minor an occasion to be infused with the spirit of inquiry. What is the taxonomy of this striking fern? What evolutionary processes transformed lycophytes from pillars of the Carboniferous swamp-forests to humble, fuzzy Christmas-tree lookalikes crawling along the boreal forest floor? With the tools of modern science, the contents of ecosystems can be read almost like those of libraries, their eDNA forming a catalog, community ecology supplying the collection structure, and each organism’s biology holding a wealth of information.

Books, conversely, come alive under the investigative eye. Through classes focused on the methods of historical scholarship, I’ve learned how texts must be examined through their context; each author, work, or moment in time is deeply interconnected with many others. The flow of ideas through societal systems may not be too dissimilar from the flow of energy through natural ones. Most of all, libraries and forests share a sense of timelessness, that moment when the vastness of evolutionary deep-time catches you in a pensive mood, or when you begin to wonder, after spending too long browsing labyrinthine stacks or inscrutable pages, whether Borges may not have been right, after all, that the universe is composed of a library infinite in space and time, of which the center is undefined and the perimeter inaccessible.

I am Nico Zepeda, a freshman from Madison, Wisconsin. I plan to major in biology, with a whole host of other fields like history, philosophy, environmental science, and architecture that I hope to explore in parallel. I am thrilled to be in an environment like Duke, where fascinating, interdisciplinary research is around every corner, and I am even more excited to interact directly with Duke’s dynamic researchers and share their work through the Research Blog!

New Blogger Monona Zhou: Turning the Old into Anew

By Monona Zhou

On October 7, 2024

In Students

Every day is a surprise. As a freshman, I never imagined taking a class where I would be reading physical copies of books that have existed centuries before us. I hold in my hands a 1522 edition of “Vitruvii De architectura libri decem“ by Vitruvius Pollio. Five hundred and two years of history since the book was published, with thousands more found within its very pages. I trace my fingertips across the book, barely larger than my palm, and its aged pages that are stained with dirt, oil, and dust.

Title page of “Virtuvii De Architectura libri decem,” currently in the Rubenstein Library

Despite being in a language incomprehensible to my modern-English mind, the book seems to whisper stories and secrets that are embedded within its pages. Parallel to the research we conduct on these literatures, we also learn how the greats have done so for centuries before us. Leonardo da Vinci once studied this same book (albeit a different literal copy of the book) and applied Vitruvius’ theories of proportion to studying the human body. His meticulous investigations led him to produce “The Vitruvian Man,” blending both art and science to investigate the natural world.

So, just like how Leonardo studied the world before and around him, we find ourselves in modern day doing the same. We study history, of the curiosity, thinking, and discoveries that make up the pinnacles of human pursuit, and we explore life, of the emotions, nature, technology, and behaviors that guide and shift our every day.

As part of the team at the Duke Research Blog, I wish to share ongoing research that is relevant and connected to you, the reader. I ask myself what information can I share to make the reader better informed about the choices, actions, people, and objects that surround their lives. From the community initiatives to the groundbreaking research to the hidden stories waiting to be uncovered, there’s always something new to learn and share. I want to shine a light on these unique stories and bring awareness to the causes and impacts that define our community.

My favorite piece from the VMFA is “Landscape with Wing” by Anselm Kiefer.

To begin this journey, I want to first share my story. I come from Richmond, Virginia, where I lived for 16 years. My perfect day would consist of spending time at the Virginia Museum of Fine Arts (VMFA) and my local 2nd & Charles bookstore. While I am keeping my options open for my major, I am orienting my interests toward pursuing health and bioethics policy. Specifically, I hope to improve how we understand and define “sickness”—whether of the body or the mind. I believe that the current medical system fails to treat patients for their best wellness, often promoting treatments that produce more harm than good.

Just as I aim to help patients understand their options in healthcare, I wish to help people better understand the research that impacts their lives. Through my work, I hope to share beneficial and informative insights about the up-and-coming research happening around us. I can’t wait to see what the future holds, and I look forward to what we uncover together!

Understanding the Shifting and Complex Views of Muslim American Voters

By Noor Nazir

On October 7, 2024

In Policy, Political science

“We are techies in Silicon Valley, but we are also laborers in rural areas.”

That’s how the head of one of the nation’s largest Muslim voter-mobilization groups described the diverse socio-economic backgrounds of Muslim voters during a Sept. 30 talk held as part of the Provost’s Initiative on the Middle East.

Wa’el Alzayat is a first-generation Arab and Muslim American who serves as the CEO of Emgage, an organization that educates and mobilizes Muslim American voters in support of policies that enable our communities to thrive and democracy to flourish.

At his talk at the Sanford School of Public Policy, he showed the predominantly South Asian and Arab audience the political trajectory Muslims are undertaking this election; highlighting important turning points for the community – specifically, the events of October 7, 2023, and September 11, 2001.

Who Are Muslim American Voters?

“They are the most diverse religious group in America, consisting of Black Muslims, South Asians, Arabs, Hispanics, and others,” said Alzayat. This diversity meant that when we talk about Muslim voters, we’re not looking at a homogenous group but rather one with a wide range of perspectives, backgrounds, and priorities.

This is a community not confined to one particular industry or region but spread across the economic and social spectrum, contributing to the U.S. in a wide variety of ways.

But, just because Muslims make up 1-2% of the electorate doesn’t mean their vote doesn’t matter.

After all, in the 2000 presidential election, the deciding factor was the state of Florida, where Bush won by just 537 votes after a contentious recount process. This is 0.0034% of the population, so it’s fair to assume that the Muslim American voting bloc — more than three and a half million people — matters.

Post 9/11 and the War on Terror

Before 9/11, many Muslims supported the Republican Party. George W. Bush and Dick Cheney earned significant support from the Muslim community due to their positions on Palestine and their alignment with conservative values, including opposition to same-sex marriage.

However, the post-9/11 landscape changed everything. Alzayat shared data showing how Muslim Americans, once allied with the GOP, shifted toward the Democratic Party in response to policies like the Patriot Act, increased Islamophobia, and the Iraq War. These events alienated many Muslims, who felt targeted by the government. Since then, the Democratic Party has made strides in embracing Muslim Americans, especially during Obama’s presidency, when over 92% of Muslims supported him.

Post-October 7: The War in Gaza

Alzayat also addressed the current moment, particularly in light of the events in Gaza that began on October 7. He noted that foreign policy has always been central to Muslim voting behavior, especially regarding Palestine, Syria, Kashmir, and other Muslim-majority regions. The Gaza conflict has reignited these foreign policy concerns, driving more political engagement but also creating new divisions within the community.

Post 9/11, Muslims shifted to the Democrats. In the wake of October 7, Muslims are once again, conflicted. Since, according to Alzayat, most of the people in the community are issue voters – the Gaza war serves as one of the most colossal issues.

But neither party, Republican or Democrats, seem to side with defunding the Israeli military.

To no one’s surprise, Alzayat’s data shows a growing number of Muslims leaning toward third-party candidates, a significant shift from the 75% who voted for Biden in 2020.

Other Issues and Where Muslims Stand

As the research from Emgage illustrates, the Muslim community is not monolithic in its political beliefs. While some support progressive causes, such as gay marriage, others align more closely with traditional conservative values. This generational divide is becoming more pronounced, with younger Muslims more open to progressive social policies while older generations hold onto more conservative positions.

Issues like abortion are far from settled within the community, with different sects interpreting Islamic law differently. Alzayat pointed out that this diversity of opinion adds another layer of complexity to understanding Muslim American political behavior.

The Road to 2024: Green Party, Trump or Harris?

Alzayat went on to explain how there is no third party alternative, it’s just Trump or Harris, and Emgage has decided to endorse Harris. While he didn’t delve into this deeply, it’s reasonable to assume his stance is rooted in the historical impact of third-party votes. In key battleground states like Michigan, Wisconsin, and Pennsylvania, Jill Stein’s votes in the 2016 election arguably swung the result. Clinton lost these states by less than a percentage point and merely half of Stein’s votes could have reversed her losses.

Alzayat explained why he endorsed Harris, and not Trump.

According to him, there is no black-or-white answer and his organization could be wrong. It could be business as usual when Harris is elected, but with Trump the “could” will be a “will.”

With Trump’s presidency comes a threat of white supremacy, “We believe there is a dual threat of white supremacy and anti-Palestinians should Trump win based on what he said he will do. Jared Kushner wants to build condos in Gaza and he has been given 100 millions by funders who want to annex the West Bank,” he said.

“That fight has an option to continue if Trump isn’t an option,” he said.