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

Tag: medicine

LowCostomy: the Low-Cost Colostomy Bag for Africa

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

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

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

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

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

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

Prototype of the LowCostomy bag

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

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

Poster with details of the team’s testing and procedures

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

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

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

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

Post by Camila Cordero, Class of 2025

The COVID-19 ‘Endgame’ Depends on Where You Live

In February of 2020, no one could have fathomed that the very next month would usher in the COVID-19 pandemic – an era of global history that has (to date) resulted in 5 million deaths, 240 million cases, trillions of dollars lost, and the worsening of every inequality imaginable.

And while scientists and governments have worked together to make incredible advances in vaccine technology, access, and distribution, it goes without saying that there is more work to be done to finally put the pieces of an exhausted global society back together. On Tuesday, October 12th, the Duke Global Health Institute (DGHI) brought together three leaders in global health to discuss what those next steps should be.

The panel discussion, which was moderated by Dr. Krishna Udayakumar of the DGHI, was titled “The COVID-19 Endgame: Where are we headed, and when will we get there?” The panelists were Dr. Ann Lindstrand, who is the World Health Organization’s unit head for the Essential Program on Immunization; Dr. Ayoade Alakija, who is the co-chair of the African Vaccine Delivery Alliance and founder of the Emergency Coordination Center in Nigeria; and Alberto Valenzuela, who is the Executive Director of the Pan American and Parapan American Games Legacy Project.

Dr. Ayoade Alakija
Dr. Ann Linstrand
Alberto Valenzuela

Dr. Lindstrand began by setting the stage and highlighting what are undoubted successes on a global level. 6.5 billion doses of the vaccine have been administered around the world, and the vaccines have impressive effectiveness given the speed with which they were developed. Yet undergirding all of this is the elephant in the room that, sitting in a 1st-world country, we don’t think about: high-income countries have administered 32 times more doses per inhabitant compared to low-income countries.

Graph from Dr. Ann Lindstrand

This vaccine inequity has been exacerbated by already weak health security systems, vaccine nationalism, and lackluster political commitment. And while the WHO is slated to enormously ramp up supplies of vaccines in Q4 of 2021 and Q1 of 2022, it doesn’t mitigate the damage to the socioeconomic welfare of people that COVID-19 has already had. Dr. Lindstrand outlines the three waves of socioeconomic impact we will see, but expressed concern that “we’re already beginning to see the first wave pan out.” 

Diagram from Dr. Ann Lindstrand

Dr. Alakija took this discussion a step further, asserting that COVID-19 is poised to become the disease of low-income countries. “If you’re living in the US or EU,” she remarked, “You’re heading into the ‘Roaring 20s’. If you live in the Global South, COVID-19 is going to become your future.”

To this point, Dr. Alakija emphasized that the only reason this is the status quo is because in her eyes, the world failed to do what was right when it should have. In her home country of Nigeria, she highlighted that out of a population of 210 million people, 5.1 million people have received the vaccine – and of those 5.1 million, just 2 million — one percent — have been double-vaccinated. “It really is a case of keeping those down further down, while giving booster doses to those that have already been vaccinated,” she said. “We don’t have diagnostic data, so people are slipping underwater and the world has no idea.”

It’s worth noting that Nigeria houses some of the megacities of the world, not just in the African continent. So according to Dr. Alakija, “we don’t solve this with a medical lens, we solve this with a whole-of-society lens.” We must, she argued, because in an interconnected world, no one exists in isolation.

Alberto Valenzuela’s work is a great example of this. In 2019, his team led organizing efforts for the Pan American Games in Lima, relying on extensive partnerships between public organizations and corporations. In 2020, though, as the world shifted, the government called on the team to transition into something much different – COVID-19 relief efforts in the country.

The results are staggering. In just 5 weeks, the Pan American and Parapan American Games Legacy Project built 10 hospitals in 5 regions of the country. The implementation of 31 vaccination centers throughout the country resulted in a tripling of the number of people vaccinated per day in Lima. To him, this work “proves what’s possible when private and public sectors merge.” In other words, remarkable things happen when all of society tackles a societal issue.

Slide from Alberto Valenzuela

So where do we go from here? Perhaps the biggest thing that stood out was the need to empower low-income countries to make decisions that are best for them. In Dr. Alakija’s words, “we need to lose the charity model in favor of a partnership model.” Dr. Lindstrand pointed out that there’s a deep know-how in the Global South of how to roll out mass-vaccination efforts – but only when we “lay down our organizational hats” can we move to what Dr. Lindstrand termed “more coordination and less confusion.” Valenzuela emphasized the need to integrate many sectors, not just healthcare, to mobilize the COVID-19 response in countries. But above all, Dr. Alakija said, “there will be no endgame until we have equity, inclusion, and health justice.” 

Post by Meghna Datta, Class of 2023

The Duke Dentist and her Research: Saving Children’s Teeth, One Tooth at a Time

Walking into our small meeting room with green scrubs and a white lab coat on, our special guest set her bag down in the front and stated “I fixed 60 teeth today and haven’t sat down since this morning.” To us, it sounds like a nightmare, but to Dr. Martha Ann Keels, working in her clinic and conducting dental research is a dream come true. 

Born and raised in North Carolina, Dr. Keels has kept her roots as she studied here at Duke. As a Duke undergrad, she received her bachelor’s degree in Chemistry and a minor in Art History, later choosing to become a pediatric dentist at UNC. It wasn’t long until she returned back to Duke to volunteer at Duke’s Children Hospital, and in 1986, she became the first pediatric dentist to get privileges to practice at Duke. She continues to run her own clinical practice alongside Duke Health System to this day, working for over 30 years!

“I get to feel the satisfaction that something I used my hands for helped alleviate pain in children,” Keels said. “I also get to watch them grow as they come in over the years. It feels super rewarding.”

With her passion and dedication, not only does she help those that enter her office, but she also conducts research on the side, wanting to help dentists all over.

Dr. Keels currently has her hands dirty with a major research project she has been working on for the past nine years. According to the National Institute of Dental and Craniofacial Research, 42% of children between the ages of two to eleven years old have at least one cavity in their primary teeth, and 23% of those children are untreated. With how high these numbers are, she and a group of other researchers are trying to develop tools that allow pediatricians and pediatric dentists to be able to identify high risk factors of cavities in children and care for them before they do occur; tools like questionnaires, surveys, and ‘top 5 predictors…’.

Table of percentages of children with cavities corresponding to age, sex, race, and poverty (National Institute of Dental and Craniofacial Research)

By observing a group of 1,300 children ever since birth, they have been analyzing all aspects of each child: collecting saliva, looking at biofilm (more commonly known as plaque), physical deformities in their teeth, and even social factors like parents’ dental experience. 

Despite the children still being fairly young, Dr. Keels reveals that a surprising amount of information has been found. “No one has ever looked at tight teeth– when your teeth are closely spaced– but we are seeing that it puts a child at high risk of cavities,” Keels said. She also adds that they have also begun to identify which types of bacteria help with reducing chances of getting a cavity, as well as bacteria that bring a high risk of creating a cavity.

 This also goes hand in hand with the microbiomes in our mouths. Dentists first believed that the microbiomes of the child’s caregiver affected the child’s microbiome, in the sense that their microbiomes would be similar from the beginning. Dr. Keels’s study says otherwise. It’s being shown that a child’s microbiome starts off as its own, unique microbiome, and it is over time that it begins to become similar to their caregiver’s microbiome.

With the vast amount of information already collected, Dr. Keels and her team continue to persevere, now wanting to push the study for another five more years. They want to start working with adolescents, wanting to also analyze mental states and how that might affect their dental hygiene and risks of cavities. 

Maybe in the near future, as you speak to your dentist at your next appointment, and they bring up a list of risk factors for cavities, who knows? That list or table could be coming from the one and only Dr. Martha Ann Keels.

Post by Camila Cordero, Class of 2025

Trust-Building, Re-Visited History, and Time Pertinent to Achieve Health Equity for Black Americans

Along with being a beautiful person and leading a productive life, Henrietta Lacks is the mother of modern medicine. Her scientific child was born without Henrietta’s consent through the clinical breakthroughs and medical miracles achieved with the help of her cervical cells – HeLa cells – stolen without her knowledge when she sought healthcare. Ironically, the same treatments developed from the cells of this Black woman are inaccessible for many Black Americans contemporarily. Though Ms. Lacks passed away from cervical cancer at the premature age of 31, her unique cells have become immortal. Her story lives on as a pertinent reminder of the importance of building trust between medicine and the Black community. In honor of her birthday, expert panelists met to both celebrate Ms. Lacks and discuss the path forward in trust-building, equity, and reckoning with our history to change the narrative of healthcare for Black Americans.

The panel honored Henrietta Lacks through discussion of the path forward for biomedical research and Black communities. The panel was hosted in August in remembrance of Ms. Lacks’ birthday on August 1st.

The panel, which took place on Tuesday, August 31, began as a conversation between Nadine Barrett (Ph.D.), Robert A. Winn (M.D.) and Vanessa B. Sheppard (Ph.D.). Among their many other titles and positions, Barrett is Director, Center for Equity in Research, Dukev CTSI and Associate Director of Equity, Community and Stakeholder Strategy, Duke Cancer Institute, Dr. Winn is the Director of the Virginia Commonwealth University (VCU) Massey Cancer Center, and Sheppard is the Associate Director of Community Outreach Engagement and Health Disparities at VCU Massey Cancer Center. The trio were joined by Reuben Warren (D.D.S., M.P.H., Dr. P.H., M.DIV.), Director of Tuskegee University’s Bioethics Center, along with a handful of other contributors including Veronica Robinson – Henrietta Lacks’ great-granddaughter and a registered nurse who represents the Lacks family on the NIH panel that reviews applications to conduct research using the HeLa genome.

A screenshot of panelists who took part in Tuesday’s conversation.

Winn began by referencing the U.S. 1932 public health service study that took place in Tuskegee, Alabama. The experiment exploited Black men in Tuskegee when an effective form of treatment for syphilis was discovered 15 years into the study but withheld from participants “to track the disease’s full progression.” In 1972, 40 years after the study began, it was the associated press, not the scientific community that finally led to the experiment’s demise and the issue of an apology from the U.S. President.

As Warren pointed out, the issue with the study was less about the treatment and more about the dishonesty, the falsifying information, and lies. “Stop calling them poor, stop calling them all sharecroppers,” Warren said of the Black men who participated in the study, “They were far more than that.” “[The study] was an issue of trust, not an issue of ignorance,” he continued. Unfortunately, when talking about this story, Winn said that Black Americans “don’t always talk about the power of us standing up and saying not again.

Bioethics violations have been a continuous part of the biomedical research enterprise in the U.S., and race and racism have been part of scientific inquiry, which continues to be of great concern, Warren said. Often, rather than putting preventative protections in place, bioethics regulations have come as a reaction to extreme violations of justice. Thus, Warren laid out a central theme of the panel that “You build trust by making yourself trustworthy and that takes time.” Rather than initiating transactional research with Black communities when the scientific and medical community needs something, Warren offered that they should start when they want to help with something.

Dr. Rueben Warren presenting examples of bioethics violations in the history of biomedical research, with most examples stemming from the United States

As Sheppard said, “[Black people] have earned a mistrust” for medical communities. This is largely hinged on Barrett’s argument that the American systems from health to education to criminal justice “are working as they were designed” – to ensure that the very inequalities that exist today came to be. Using the analogy of a marathon, Barrett said while white men in the U.S. started the race 450 years ago, Black men and women only began running this race hundreds of years later. “Those who start the race are going to…ensure that they thrive,” Barrett said. This has led to Black people dying disproportionately from often treatable diseases, Sheppard said, continuing to add that these sorts of disparities were front and center for the world to see during the COVID-19 pandemic.

In the creation of our structural inequalities, the system created “two bookends: Black and white.” But there has to be a narrative that keeps this story alive. “In order to create the change, we have got to do the work to change the narrative,” said Barrett.

Nadine Barrett (Ph.D.), Director of Health Equity and Disparities at Duke Cancer Institute

Robinson pointed to the importance of history, paralleling Warren’s comments that in focusing on health equities we are fully focusing on the future in a way that ignores the past and does not deal with “what really brought us into health disparities” in the first place. Robinson said that we “can no longer sweep [conversations on the historical injustices of medical racism] under the rug.” She continued to say that the reason why Tuesday’s conversation and the ongoing dialogue that is sure to follow is so powerful is because “we are no longer victims in our own legacies” by taking over conversations at the table rather than being the topics of discussion at the table.

Mistrust in the Black community for systems of medicine and healthcare are based on hundreds of years of action. Hesitancy – from Covid-19 vaccinations to participation in clinical trials for cancer research – amongst Black Americans “aren’t us saying no,” said Robinson, “We’re saying something happened.” Sharon Ribera Sanchez, Founder-Director of Saving Pennies 4 A Cure, is a cancer survivor and advocate for people of color to engage in clinical trials because of the difference they can make in medical developments that draw on more diverse and robust data.

But there is a bigger conversation than just having more Black folks take place in research and clinical trials, Winn said. “How are you going to look at my biology without looking at my history?” he asked, referencing the genetic implications of environmental conditions and stressors from socially constructed race that impact DNA.

An image of HeLa cells

The dialogue, which was opened and closed with a prayer, also spoke to the importance of establishing regular, ongoing, transparent relationships between the Black faith community and the medical community. This should happen, not just in times of crisis, because “mass hysteria is prime for miscommunication,” Ralph Hodge, pastor of the Second Baptist Church in South Richmond, Virginia, said.

“Today was a big way of us looking back at the past, looking at where we are at now, and moving forward to the solutions,” said Barrett. This comes by letting communities know that we care, said Winn, along with “doing things with our communities, not through them.”

A key factor in deconstructing this issue and achieving health equity is time. Time to reflect on the past in order to avoid reliving it; time to generate innovative solutions to the problems at hand; and time to invest in Black communities – to learn from them, support them, and earn their trust not because they can offer science something, but because science has something to offer them.

Post by Cydney Livingston

The Diversity Problem in Science

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.

Gowthami Arepally, M.D. 

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.

Chart of pipeline programs at Duke

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

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