Bass Connections and GHANDI – Understanding Disability from a Global Perspective

Duke prides itself on being a research institution that is not only intellectually curious, but also extremely interdisciplinary. Through Duke’s Bass Connections initiative, students and faculty come together in project teams that tackle complex issues using multiple disciplines and approaches. The program held its annual fair last week to showcase its work and to get new students connected with these exciting projects.

How does it work?

Graduate students, undergraduates, and faculty members apply for a research project in any of these five areas: Brain and Society, Information Society & Culture, Global Health, Education & Development, and Energy. Once accepted, group members work on a year-long research project, that often includes a field work component. One project in particular that combines many disciplines and interests to address an issue of global importance GANDHI, a Global Health project that studies disability from multiple cultural perspectives.

What is GANDHI?

GANDHI team members meet with Dr. Rune Simeonsson at UNC to discuss the WHO ICF-CY (International Classification of Functioning – Children and Youth), a document he helped co-write that provides a framework for diagnosing and addressing disability.

The Global Alliance on Disease and Health Innovation (GANDHI) was created in 2016 to support disabled individuals by providing them with the community reintegration tools necessary to live a healthy, comfortable life. Yukhai Lin, a Duke undergrad and GANDHI team member, shared that many hospital systems are not good at helping those the disabled reintegrate themselves in their community, and often forget about their patients after they are released. The research team recognized this flaw, and began a thorough data collection process to understand the reason for this lack of care. In the fall of 2016, team members took a seminar course, “Living with Disability Around the Globe”, in which they were paired with global partners in ten different countries to examine disability from a more specific context. In this interdisciplinary class, team members not only strengthened their knowledge of disability and its implications on global societies, but they were also able to develop strong research skills, for they ultimately synthesized their findings by creating a thorough comparison of disability in each of the countries studied.

The team also attended a conference in New Orleans to network with organizations that were conducting similar research. Lin said she interviewed doctors from The Netherlands, as well as leaders of influential health organizations to holistically understand the issues that come with helping the disabled. The team hopes to present their findings at a forum this spring, and, like many other Bass Connection projects, will continue throughout the 2017-2018 academic year. They encourage all to apply, and hope to broaden the scope of their research by adding countries in Southeast Asia and creating new opportunities for fieldwork. Some eager students have already showed interest in going to China to interview families with disabled members, says Lin.

Other Bass Connections projects at the fair spread across all disciplines, ranging from the development of effective chemotherapy drugs to the study of urban development in cities across the globe. But, what all projects share in common is a strong emphasis on research that is hands-on, collaborative, and relevant to society.

 

Post by Lola Sanchez-Carrion

Posted in Global Health, Medicine, Students | Comments Off on Bass Connections and GHANDI – Understanding Disability from a Global Perspective

Using the Statistics of Disorder to Unravel Real-World Chaos

What do election polls, hospital records, and the Syrian conflict have in common? How can a hospital use a patient’s vital signs to calculate their risk of cardiac arrest in real time?

Duke statistical science professor Rebecca Steorts

Duke statistical science professor Rebecca Steorts

Statistician Rebecca Steorts is developing advanced data analysis methods to answer these questions and other pressing real-world problems. Her research has taken her from computer science to biostatistics and hospital care to human rights.

One major focus of Steorts’ research has been estimating death counts in the Syrian civil war. She is working with her research group at Duke and the Human Rights Data Analysis Group (https://hrdag.org/) on combining databases of death records into a single master list of deaths in the conflict, a task known as record linkage.

“The key problem of record linkage is this: you have this duplicated information, how do you remove it?” explained Steorts. For example, journalists from different organizations might independently record the same death in their databases. Those duplicates have to be removed before an accurate death toll can be determined.

At first glance, this might seem like an easy task. But typographic errors, missing information, and inconsistent record-keeping make hunting for duplicates a complex and time consuming problem; a simple algorithm would require days to sort through all the records. So Steorts and her collaborators designed software to sift through the different databases using powerful machine learning techniques. In 2015, she was named one of MIT Technology Review’s 35 Innovators Under 35 for her work on the Syrian conflict. She credits a number of colleagues and students for their contributions to the project, including Anshumali Shrivastava (Rice University), Megan Price (HRDAG), Brenda Betancourt and Abbas Zaid (Duke University), Jeff Miller (Harvard Biostatistics, formerly Duke University), Hanna Wallach (Microsoft Research), and Giacomo Zanella (University of Bocconi and Visitor of Duke University in 2016).

Steorts’ work towards estimating death counts in the Syrian conflict is still ongoing, but human rights isn’t the only field that she plans to study. “I think of my work as very interdisciplinary,” she said. “For me, it’s all about the applications.”

Recently, Steorts, colleague Ben Goldstein, and students Reuben McCreanor and Angie Shen have been applying statistical methods to medical data from the Duke healthcare system. Her ultimate goal is to find techniques that can be used for many different applications and data sets.

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Guest post by Angela Deng, North Carolina School of Science and Math, Class of 2017

José Jerónimo – Innovations in Cervical Cancer Screening

José Jerónimo and his team are transforming the face of cervical cancer screening. Jerónimo is a physician and senior advisor for the women’s cancers branch of PATH, an international nonprofit organization that uses innovative technologies to improve health outcomes in developing countries. Jerónimo, who’s work at PATH has facilitated the prevention and treatment of cervical cancer for thousands in the developing world, spoke at the Duke Institute for Global Health on Dec. 2.

Cervical cancer testing has been a point of conflict in the medical community for quite some time now, for the pap smear — for many years, the only test available to detect cervical cancer — is not very sensitive to abnormal tissue. Since skepticism with the pap smear arose a few decades ago, doctors like Jerónimo have been working tirelessly to find more effective screening strategies.

José Gerónimo, Peruvian physician and public health advocate, received his specialty training in gynecologic oncology at the National Cancer Institute in Peru.

José Jerónimo, Peruvian physician and public health advocate, received his specialty training in gynecologic oncology at the National Cancer Institute in Peru.

Cervical cancer can be acquired through the presence of HPV (human papilloma virus). Chronic infections of HPV have been proven to increase the likelihood of contracting cervical cancer, so developing primary prevention initiatives to avoid developing HPV to begin with are essential to decrease the prevalence of cervical cancer. HPV testing, unlike the pap smear, can be self-collected and does not require the complex, expensive machinery that the pap smear does. Initial self-sampling studies in India, Uganda, and Nicaragua indicated a willingness by the female community to self-test, so long as sanitary and private conditions were provided.

Studies in the Jujuy province of Argentina indicated that community health workers played a key role in facilitating the self-sampling process. When the health workers differed locals to clinics or sent them to facilities for testing, only 20 percent actually went. But, when they brought the self-sampling tests to locals’ homes directly, testing was above 80 percent. The easy accessibility of self-sampling, along with encouragement by local health volunteers, clearly showed that self-sampling was much more effective.

A group of female community health workers in Lima, Peru, educating the community about HPV testing.

Jerónimo’s current work focuses on strengthening government screening systems for HPV that are already in place. By helping ministries introduce and scale up the testing, he and others at PATH hope to decrease HPV and cervical cancer rates.

But, it goes beyond testing. Jerónimo emphasizes the need for evaluation and follow-up mechanisms after testing positive. Although testing efforts have improved significantly, the treatment provided after for those who have tested positive is still lagging. Jerónimo claims that much of this is due to minimal efforts by the local governments to really follow through beyond the testing phase.

PATH is looking for innovative ways to treat HPV that are inexpensive and effective. They recently developed their own version of the thermal coagulator, a probe that treats infected tissue using heat. Their design runs on a battery, rather than needing constant electricity, and uses a progressive heating mechanism that is only activated upon touching the cervix. There is still progress to be made, in both testing and treatment of HPV and cervical cancer, but through efforts by both local and international communities, Jerónimo shows us that is possible.

lola_sanchez_carrion_100hedPost by Lola Sanchez-Carrion

I Know What You Did Last Summer…

From June to August 2016, four Duke students: Emma Heneine, Casey MacDermod, Maria Perez, and Noor Tasnim, packed their bags and traveled to Guatemala. They were participants in the Student Research Training (SRT) Program, studying “indoor air quality, cooking, and bathing habits in Indigenous Mayan households in six villages surrounding Lake Atitlan in Guatemala.”

The poster they presented on their project recently won first place in the Global Health Undergraduate Research Fair.

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Maria Perez (left) and Casey MacDermod (right)

The Duke Research Blog caught up with student researchers Maria Perez and Casey MacDermod after the conference. Maria Perez is a senior majoring in International Comparative Studies (ICS) and Global Health; she had research experience prior to traveling to Guatemala. Casey MacDermod is a junior majoring in Cultural Anthropology; she had no research experience in high school or at Duke prior to this experience. MacDermod knew what type of research she was interested in, so she looked through faculty members who did that type, found Dr. David Boyd, met with him, and learned about his SRT team.

Boyd told the students what the focus of the research should be, and the students, “as a team… came up with the questions and how [to] do the research…” Perez said. In order to monitor indoor air pollution, the team measured the small and large particulate matter with an instrument known as Dylos and the carbon monoxide levels with a carbon monoxide monitor.

From January until June, the team conducted background research on air pollution in Durham. At the beginning of June, they traveled to Guatemala and “had about a week of orientation,” said Perez. During this time, they met with on-site assistants who taught them on how to give questionnaires and conduct interviews.

Mostly, the team was self-directed; that was part of the challenge. MacDermod said that, although Boyd was with them “about the first three or four days…” and there were translators (Micaela and Carolina) that “gave us all the information we needed and were with us every step of the way throughout the research,” the student researchers needed to be flexible and able to think on their feet.

Every day, the team of four would split up into two groups with one translator each, then go to a village and do research. They would meet up for lunch and then either head back to their living site or go back into the villages to conduct more research. Based on her observations, MacDermod infers that using wood-burning stoves and temescales, or sweatlodges, caused the particulate matter to be “off the charts.”

The SRT program is part of the Duke Global Health Institute and the students were under the guidance and support of Dr. Boyd, Dr. Craig Sinkinson, Mayan Medical Aid, the primary schools in the municipalities and Bass Connections.

Although their winning poster included some graphs, Perez and MacDermod emphasized that these charts were produced automatically by the apparatus used to monitor air pollution. Further analysis of their data will occur next term.

meg_shieh_100hedPost and photo by Meg Shieh

Starting Your Own Business in Social Entrepreneurship? Lessons from Four Founders

Interested in starting your own jazz festival? Or creating hydrogen-rich water to boost your circulation and improve muscle recovery?

These are the accomplishments of Cicely Mitchell and Gail Levy, who were among four inspiring leaders at the evening panel discussion in the Fuqua School of Business this past Wednesday. Excited students and faculty gathered in the Kirby Reading room to learn about the leaders’ unique perspectives as founders of non-profit and for-profit solutions to various social impact and sustainability issues.

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Students and faculty gathered for dinner and networking before the panel discussion.

Organized by the Duke Innovation & Entrepreneurship Initiative and the Center for the Advancement of Social Entrepreneurship (CASE), the panel served to enlighten the audience about the challenges the women have faced and the lessons they learned in starting and scaling their social ventures. Panel moderator Erin Worsham, the Executive Director of CASE, opened the discussion with a few statistics.

In the non-profit sector, women make up 75% of the workforce, but in leadership positions, this ratio drops to 45%. As of 2013 in the for-profit sector, only 2.7% of venture capital investments went to fund companies with a female CEO. While black women own 1.5 million businesses in the U.S., they receive only 0.2% of venture funding. Undoubtedly, Worsham concluded, there is a lot of work to do in terms of women getting funded and represented as leaders.

Erin Worsham opened up the panel with statistics about women in the workforce. Worsham is the Executive Director of the award-winning CASE based at Duke University’s Fuqua School of Business

To commence the discussion, Worsham asked the panelists to speak about the gender discrimination they faced while starting their own companies. Gail Levy, founder of H Factor Water, a health-focused company producing hydrogen-infused water in environmentally friendly packaging, answered with a time she was challenged to a drinking match in order to close a deal. “The lesson I learned is to not go and drink your way into making a deal,” Levy joked. “But more importantly, you need to have grit and tenacity. Let our presence be known, because eventually we will be heard.”

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Gail Levy was the founder of the White House Millennium Green Committee under the Clinton Administration in 1999. She is passionate about advocating for women worldwide and is also the founder of H Factor Water.

Founder of The Art of Cool, a Durham nonprofit promoting music education to Durham-area youth, Cecily Mitchell remarked that she would be charged significantly more money than a male counterpart to work with the same artist.

Cicely Mitchell is co-founder of The Art of Cool, a Durham nonprofit promoting music education to Durham-area youth

Cicely Mitchell is co-founder of The Art of Cool, a Durham nonprofit promoting music education to Durham-area youth

Rebecca Ballard, lawyer and founder of Maven Women, a sustainability-focused fashion company dedicated to making professional wear for women, noted that “we live in a visual world, but we need to start looking at a person’s character rather than solely focusing on how they look.” Based on her experience with her medical real estate development company ACCESS Medical Development, angel investor Stephanie Wilson expanded on the comment, adding that the best thing to do about the prejudice against women is to know that it’s there and fight for it.

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Rebecca Ballard told the audience, “The most challenging thing about being a working woman is that appearance is considered ‘relevant.’” She started her career as a public interest lawyer and was previously the Executive Director of Social Impact 360.

I asked the founders to share their experiences in building a successful customer base. Wilson noted that to institute her company, she “determined who was the top real estate agent in our area and sought them out. I discussed my idea with them and asked for their advice on segueing into the market.” She suggested sending handwritten thank you notes to build relationships with your customers.

Stephanie Wilson founded ACCESS Medical Development and is also the co-founder of MillennialsMovingMillions.org.

Stephanie Wilson founded ACCESS Medical Development and is also the co-founder of MillennialsMovingMillions.org.

Mitchell added that The Art of Cool held the first few concerts for relatives and friends, and later partnered up with other small entrepreneurs. “Make sure what you do connects with people enough that they want to go and tell other people about what you’re doing,” she advised.

Cecily Mitchell talked about her experience with The Art of Cool. She handles the booking, contracts, networking, pitching for sponsorships and assisting in writing grants for the company.

Maven Woman founder Rebecca Ballard commented on the importance getting support from women in other sustainable industries, since “you are all driven by the same mission in the social entrepreneurship space.”

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Rebecca Ballard is the founder of Maven Women, a sustainability-focused fashion company dedicated on making professional wear for women.

Worsham’s final question for the panel asked for any last pieces of advice. Ballard concluded the conversation with a reason why she started her company: “Social entrepreneurship exists because the status quo is not okay. There are externalities happening and people being treated badly; the status quo doesn’t have to be the way it is.”

From left to right:

Posing with the panelists! From left to right: Anika Radiya-Dixit (author), Gail Levy, Cecily Mitchell, Rebecca Ballard, and Stephanie Wilson.

By Anika Radiya-Dixit

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An Expert’s Perspective on Mental Health

In honor of Mental Health Awareness Week and Depression Awareness Month, I interviewed Rae Jean Proeschold-Bell,  an associate research professor of Global Health in the Duke Global Health Institute whose research focuses on positive mental health, clergy health, and the integration of care within health systems.

In 2007, Proeschold-Bell founded the Clergy Health Initiative, a program developed to improve health outcomes among the clergy of North Carolina. In their first study, they performed a longitudinal survey of nine Methodist churches in North Carolina to determine the clergy’s health status. It was found that the clergy had a far higher obesity rate (41%) than the rest of North Carolina (29%). High rates of chronic disease associated with overweight/obese individuals were also present. The most interesting find, though, was that depression rates were double that of the regional average. Why?

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Proeschold-Bell has conducted research in Kenya, Tanzania, Peru, India, and the U.S.

“Being the leader of an organization is difficult, says Proeschold-Bell. Churches are extremely underfunded and are constantly pressed for time. Pastors are expected to do all of the spiritual work that being a pastor entails, and also act as business managers for the church. But, thanks to donations from the Duke Endowment, Proeschold-Bell was able to develop three interventions to improve clergy health. Since then, she’s retrieved ten years of data that has allowed for further improvements in holistic health for the clergy of North Carolina.

When asked about depression specifically, Proeschold-Bell said that “the current model in place to treat depression does not work.” We focus strictly on treating the issue by mitigating its symptoms through an antidepressant, instead of pulling at the issue from multiple roots.

She says our efforts should be focused on increasing positive mental health. Positive mental health refers to the presence of positive emotions and good functioning (in both individual and social environments). Work being done by Corey Keyes at Emory has shown that individuals with high positive mental health are less likely to develop depression and chronic disease. By focusing our efforts towards improving one’s overall mental wellbeing, we can get individuals “ahead of the curve” and prevent them from even being depressed in the first place, says Proeschold-Bell.

Further research focusing on positive emotions has been conducted by Barbara Fredrickson at UNC, who suggests that positive emotions have been scientifically proven to increase people’s open-mindedness. Those with more positive emotions have been more willing to try new things and open up to other people, says Proeschold-Bell. These positive emotions connect greatly to one’s ability to be resilient, and there is research to be done in the overlap between possessing these emotions and being able to recover from situations of trauma and conflict that can be mentally straining.

To tackle mental health issues, we must look at them holistically and extensively. Not only do these issues need to be covered from all angles, but interventions need to be culturally competent and context-specific. Keeping these values in mind, will help improve global mental health outcomes.

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Post by: Lola Sanchez-Carrion