Duke Research Blog

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

Category: Global Health (Page 2 of 9)

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

Diabetes — and Privacy — Meet ‘Big Data’

“Click here to consent forever.”

If consent to participate in medical research were that simple, Joanna Radin of Yale University would have to find a new focus for her research, and I would never have found the Trent Center for Bioethics, Humanities & History of Medicine.

Luckily for us both, this is not the case. Medical consent is a very complex issue that can, as Radin’s research attests, traverse generations.

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Joanna Radin’s reserach focuses on the intersection of medical history, anthropology and ethics at Yale University. Source: Yale School of Medicine

Radin is an Associate Professor of Medical History at Yale, the perfect fit for the Humanities in Medicine Lecture Series taking place this month at the Trent Center. Her research nails the narrow intersection of medical history, anthropology, bioethics and data analytics. In fact, Radin’s appeal is so broad that her visit to Duke was sponsored by no less than six Duke departments, including the Departments of Computer Science, History, Electrical and Computer Engineering, Cultural Anthropology and Statistical Science.

Radin’s lecture honed in on a well-known case in the realm of bioethics and medical history: the Pima Native American tribe in Arizona, which is known for unusually high rates of diabetes and obesity. The Pima were the first Native American tribe to be granted a reservation in Arizona—30,000 acres—at the beginning of the California Gold Rush. In 1963, following nearly half a century of mass famine among the Pima, the National Institute of Health (NIH) conducted a survey for rheumatoid arthritis in the Pima tribe, instead discovering a frighteningly high frequency of diabetes.

In 1965, the NIH initiated a long-term observational study of the Pima that continued for about 40 years, though it was meant to last no more than 10. The goal of the study was to learn about diabetes in the “natural laboratory” of sorts that the Pima reservation unwittingly provided. The data collected in this study came to be known as the Pima Indian Diabetes Data set (PIDD).

Machine learning enters the story around 1987, when David Aha and colleagues at the University of California, Irvine (UCI) created the UCI Machine Learning Repository, an archive containing thousands of data sets, databases and data generators. The repository is still active today, virtually a gold mine for researchers in machine learning to test their algorithms. The PIDD is one of the oldest data sets on file in the UCI archive, “a standard for testing data mining algorithms for accuracy in predicting diabetes,” according to Radin.

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A Pima farmer in Pima, Arizona, circa 1900. Source: Wikimedia Commons

Generations’ worth of data on the Pima tribe have been publicly accessible in the UCI archive for over two decades, creating ethical controversy around the accessibility of information as personal as blood pressure, body mass index (BMI) and number of pregnancies of Pima Native Americans. Though the PIDD can help refine machine learning algorithms that could accurately predict—and prevent—diabetes, the privacy issues provoked by the publicness of the data are impossible to ignore.

This is where “eternal” medical consent enters the equation: no researcher can realistically inform a study participant of what their medical data will be used for 40 years in the future.

These are the interdisciplinary questions that Radin brought forth in her lecture, weaving together seemingly opposite fields of study in an engaging, thought-provoking presentation. No one who left that room will look at the Apple Terms & Conditions the same way again.

 

Post by Maya Iskandarani iskandarani_maya_100hed

Economics and Health: The Biases Behind Our Decisions

Eric Finkelstein of the the Duke Graduate Medical School in Singapore studies how economic principles might be used to improve individual healthcare.

At a talk last Friday, Finkelstein, who was selected by Thomson Reuters as one of the world’s most influential scientific minds of 2015, argued that the same biases that affect our economic decisions could also influence our healthcare choices, and that understanding these biases could help motivate individuals to live healthy active lives.

In theory, people should be able to make healthy choices, Finkelstein said. Under the utility maximization model, individuals have the ability to rationalize and recognize the benefits of taking particular actions for themselves. But often we are not rational beings, he said, and there are several “deviations” that steer us away from maximizing our utility.

One of these deviations is the “present bias” preference, which leads us to make decisions in the present that our future self will regret. He discussed a particular experiment in which people are asked to choose what they will eat in one week’s time: a candy bar or an apple. Most choose the apple, but after a week, when they were given the opportunity to reevaluate their choice and change it, most switch to the candy bar.

This experiment shows not only the dynamic, unpredictable nature of our decisions, but also highlights our tendency to overestimate the will power of our “future selves.”

Another interesting bias that prevents us from being rational is our probabilistic assessment bias, which describes our tendency to overestimate the probability of very unlikely events, while underestimating the probability of those that are likely. This bias directly relates to health and our tendency to ignore the possibility of suffering a detrimental health problem like a heart attack, when in reality it’s quite commonplace.

Eric Finkelstein’s research, which focuses on the intersection between economics and global health, has gained him renowned success nationally and abroad. Source: Duke NUS Medical School.

To understand how these biases might influence individuals suddenly diagnosed with a terminal illness, Finkelstein and his medical team in Singapore conducted their own study on healthcare choices. In the experiment, both healthy and sick individuals were asked to identify what treatments they would prioritize if diagnosed with terminal cancer: level of pain, hours of care required, potential to extend life, cost of treatment and location of death.

Most healthy individuals said they would want whatever treatment was cheapest, but showed very little interest in investing in extending their life or selecting where they died. When sick patients were asked the same questions, on the other hand, they valued place of death (home was preferred) and survival time above everything else. Such information indicates just how difficult it is for us to predict where to invest in healthcare for cancer patients.

From this study and several others, Finkelstein concludes that we are not rational beings, but are instead irrational ones that feed off of biases and change our opinions constantly. But, he suggests that through the use of incentives, we can mediate these irrational biases and ultimately improve health outcomes.

 

Post by Lola Sanchez-Carrion

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Fostering a Collaborative Research Environment in Peru

We are told time and time again that Duke is a global university, one that transcends borders and takes interdisciplinary education to the next level.

On Monday, I was able to experience this international mindset firsthand at the Peru Health Symposium, a conference that celebrated a decade of culminating research efforts by Duke in Peru.

The symposium was organized by Dr. William Pan, a professor of Global Environmental Health at Duke who has worked on many research projects in Peru ranging from reproductive health to tuberculosis. In his opening remarks, Pan said the trademark interdisciplinary nature of Duke has allowed it to succeed as a research institution in Peru, along with its affiliation to pioneers in Peruvian health/environmental research, like John Terborgh.

“We are standing on the shoulders of giants,” said Pan. During the first panel, several research projects were presented.

Field Work in Peru

Helena Frischtak conducting research with Peruvian children in the field.

Helena Frischtak, a 4th year medical student at UVA and former Doris Duke Fellow spent a year studying the neurological effects of mercury exposure on children. She performed basic neurological exams, along with cognitive tests amongst 5-11 year-old children, and preliminary data suggests potential impacts of mercury exposure on cognitive development.

Marlee Krieger of the Center for Global Women’s Health Technologies presented a cervical cancer treatment that brings colposcopy into the primary care setting. When one is screened for cervical cancer, a pap smear is first conducted and if abnormalities are detected, a colposcopy is performed and tissue is biopsied from the cervix. This multiple-step process is tedious, and the number of patients that return for the colposcopy often declines. By combining the steps into one visit and performing it with a simpler and cheaper device, testing efficiency has increased.

Maria Lazo Porras of Cayetano Heredia University (Lima’s prominent medical university) presented findings on the effects of migration from rural to urban regions on chronic disease. Her findings suggest a correlation between urbanization and obesity, but provided surprising results that indicate higher rates of hypertension and diabetes in rural communities.

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Illegal mining scars the Amazon’s lush forests and flushes mercury runoff into streams.

Students doing research in the Amazon presented posters of their findings to faculty members of the Nicolas School and DGHI.

The main theme resonating throughout the conference was the need for collaboration not only to address public/environmental health concerns, but to organize symposiums like this one. The culmination of efforts by the Center for Latin American and Caribbean Studies (CLACS), DGHI, and the Nicholas School have fueled the Peru project’s palpable success.

Below is the link to the documentary shown at the symposium:

http://www.daughterofthelake.pe/ – “Hija de la Laguna” (Daughter of the Lake), 2015. The documentary tells the story of how a Peruvian woman used her powers to stop illegal mining from destroying the lake in her community; a lake that to her, represents her mother’s spirit.

lola_sanchez_carrion_100hedPost by Lola Sanchez-Carrion

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