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Research roundup: Recent grants and publications for Emory faculty and staff
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As an academic research institution, Emory’s faculty and staff conduct studies across every discipline, from the sciences to the humanities. Here’s a sample of recent grant awards and the work they will support, plus highlights from some published research findings.

Rollins School of Public Health

Antibiotic resistance is an ecological challenge around the world

Antibiotic resistance is a worldwide health problem usually addressed with newer drugs and controls on needless overuse of antibiotics. But a team of researchers led by Emory’s Maya Nadimpalli believes antibiotic resistance is also an environmental problem, especially in low and middle income countries where inadequate water and sanitation infrastructure can make resistant pathogens more likely to move between humans and animals. Nadimpalli, assistant professor in the Rollins School of Public Health, worked with researchers from five countries to track the spread of antibiotic resistance between humans and animals in Cambodia, a middle income country. Comparing stretches of DNA that encode antibiotic resistance genes from E-coli recovered from humans and meat, they found bacteria from both humans and animals carried a similar piece of DNA showing resistance to the same antibiotics. In places where public health infrastructure was lacking, this bacterial flow can make the rise and spread of antibiotic resistant pathogens worse. Their study, published in Frontiers in Ecology and the Environment, is important because almost 5 million deaths per year can be attributed to antibiotic resistant bacteria, and low- and middle- income countries have unique points where humans and animals interact. This contributes to the global rise of bacteria resistant to antibiotics.

Pioneer study links heavy menstrual bleeding to self-rated health and quality of life problems

Researchers at the Rollins School of Public Health recently led the first study of its kind to rigorously examine heavy menstrual bleeding and health, an under-studied topic, across multiple countries. “Menstruation is still a taboo topic, which leads people who menstruate to feel like they need to conceal their menstrual experiences,” says first author Sheela Sinharoy, PhD, assistant professor of global health at Rollins. Surveying 6,626 women across 10 cities in low- and middle-income countries in south Asia and sub-Saharan Africa including Bangladesh, Indian, Nepal, Senegal, Uganda, Kenya and Zambia, the researchers compared measures of heavy menstrual bleeding with measures of demographics and health.

The study, published in The Lancet, found that globally, across their sample, the prevalence of heavy menstrual bleeding was close to 50%, and that it negatively affects quality of life across countries. Heavy menstrual bleeding was significantly associated with feeling tired or short of breath during the menstrual period and reporting of worse self-rated physical health though not with reporting of subjective wellbeing.

The health effects of heavy menstrual bleeding are difficult to understand and measure because of their association with subjective individual experience. In addition, because menstruation is still a taboo topic, people often feel that they cannot talk about their experiences. Because of the preliminary nature of their findings, the authors believe there’s a need for research to understand determinants and identify and implement solutions to this problem.

Community collaborations needed to combat the opioid crisis among Indigenous youth

New research by a team of Rollins researchers has emphasized the need for culturally sensitive approaches to drug treatment and prevention programs for American Indian and Alaskan Native young adults. Since 2019, drug overdose deaths among teens ages 14-18 have been on the rise. The highest increase has been in American Indian and Alaska Native young adults. However, there are currently very few culturally-centered drug treatment and prevention programs for these groups.

In the study, published in the journal Population Science, lead co-author Kelli Komro, PhD, Rollins professor of behavioral, social and health education sciences, and colleagues examined two NIH-funded programs aimed at these populations. They found both projects emphasize the importance of building relationships with community partners to insure that all drug programs are culturally appropriate with tribal oversight. Insights learned through focus groups with youthful participants, parents and service providers established the role of family, social and cultural connections as protection against psychosocial problems including drug abuse.

The team found that building relationships with community members, tribal leaders and elders is an essential way to ensure that programming is culturally appropriate. Although more culturally-centered opioid intervention and treatment programs for American Indian and Alaska Native youth are still needed, the authors believe this research can serve as a model for further prevention work. 

Rollins researchers awarded grants to prevent community and firearm violence among Black youths

Two Rollins researchers were awarded a three-year grant from the CDC’s National Center for Injury Prevention and Control to evaluate prevention of gun-related violence and injuries. Briana Woods-Jaeger, PhD, associate professor of behavioral, social and health education, and research associate professor Melvin Livingston, PhD, will focus on evaluating economic security policies as primary prevention strategies for Black youth and young adults between the ages of 10-34, the population most at risk of experiencing gun violence.

“What we know is that there are racial inequities in violence and in concentrated poverty with recent studies indicating three-generation poverty is over 16 times higher among Black adults than white adults,” says Woods-Jaeger. Livingston adds, “What we don’t have a good sense of is how economic security policies are working for Black families.” 

The researchers will examine the impact of minimum wage, welfare, food stamps and Earned Income Tax Credits on preventing gun violence. They will also conduct interviews with Black young people injured by firearms and their primary caregivers to explore lived experiences with these policies.

Woods-Jaeger was also awarded a second $1.2 million, three-year grant from the CDC to evaluate the effectiveness of an arts-based youth empowerment program in reducing community violence. That program, Youth Empowered Advocating for Health (YEAH), partners with young people to better understand their experiences and improve outcomes. This research will examine if YEAH promotes youth protective factors like critical consciousness, positive racial identity, social cohesion and hope for the future and reduces the risks for violence.

Winship Cancer Institute

Improving the definition of high-risk smoldering multiple myeloma for better patient outcomes

Smoldering multiple myeloma is a precursor condition that can develop into myeloma with observable symptoms, one of the most common blood cancers in the U.S. A subset of patients with smoldering multiple myeloma are at a high risk of developing multiple myeloma, a cancer of the plasma cells, and may benefit from early intervention.

Sagar Lonial, MD, chair of Emory’s Department of Hematology and Medical Oncology and Winship Cancer Institute’s chief medical officer, is the principal investigator of a new $7 million Myeloma Accelerator Challenge grant from the nonprofit Multiple Myeloma Research Foundation to develop an improved definition of high-risk smoldering multiple myeloma to guide treatment decisions and improve patient outcomes. Lonial will lead a network of seven institutions to create and leverage a large, collaborative set of patient samples and use cutting-edge clinical and multi-omics platforms for analysis. The three-year project will define which patients are suited for early intervention, which types of interventions can have the greatest impact and which patients can be safely monitored without intervention because of their low risk of disease progression.

The Multiple Myeloma Research Foundation’s Myeloma Accelerator Challenge Program Grants aim to foster collaboration and advance compelling hypotheses that are ready for rapid testing in clinical trials.

Georgia Blood Cancer Trials Network will bring investigational therapies to underserved communities

A $2 million grant from the Leukemia & Lymphoma Society (LLS) will bring the benefits of cancer treatments and therapies to Georgians who live far from metropolitan Atlanta. The grant, awarded to Jonathon Cohen, MD, associate professor of hematology and medical oncology and co-director of the Lymphoma Program at Winship Cancer Institute, will support the newly created Georgia Blood Cancer Trials Network to make cutting edge care and therapies available to Georgia patients with blood cancer, especially in rural areas where higher poverty rates and long travel distances make it harder for people to take part in clinical trials.

The grant, along with funding from a National Cancer Institute Research Specialist Award, is part of the LLS IMPACT grant program, created to build networks of clinical trial sites in underserved areas. Although Georgia is the eighth largest state in the U.S. by population and the largest by land area east of the Mississippi River, 75% of the state’s 159 counties are classified as rural. Many have high rates of poverty and are frequently located far enough from Atlanta to make it difficult for rural Georgians from all socioeconomic backgrounds to take part in clinical trials. 

The IMPACT program will let patients with hematologic malignancies participate in important trials without leaving their communities. Winship’s program will connect with patients through existing real world outcomes projects, such as the Lymphoma Epidemiology of Outcomes project, and will leverage this resource to identify candidates for available studies. Participating sites will not only have access to hematology trials but will also provide educational opportunities, multi-disciplinary discussions of complicated cases and give patients the opportunity to confer with a Winship expert via telemedicine, to learn more about study options and ask additional questions about treatment options.

Clinical trial of Tumor Treating Fields therapy shows promise in non-small cell lung cancer

A phase 3 clinical trial reported promising results on the use of an electrical therapy called Tumor Treating Fields (TTFields) together with standard systemic treatments for patients with metastatic non-small cell lung cancer following platinum-based therapies. Results from the trial, led by Winship Cancer Institute medical oncologist Ticiana Leal, MD, were published in The Lancet Oncology.

When cancer cells divide and multiply rapidly within the non-small cell lung cancer (NSCLC) tumor, they carry different types of electrically charged elements that play a role during the cell division process. Other healthy cells in the treatment area multiply at a much slower rate, if at all. The Tumor Treating Field therapy used in the study delivers low intensity, wave-like electric fields to the location of the tumor that disrupt the growth of cancer cells.

The phase 3 trial (called LUNAR) tested a wearable TTFields device developed by the oncology biotech firm Novocure. Adding TTFields therapy to physician’s choice of immunotherapy drugs called immune checkpoint inhibitors or docetaxel, a type of chemotherapy, resulted in a statistically significant and clinically meaningful three-month improvement in median overall survival.

Notably, the data demonstrated the efficacy and safety of TTFields therapy with no additional systemic toxicities or new safety signals.

“The results of the LUNAR study are highly encouraging,” said Leal, associate professor of hematology and medical oncology. “The LUNAR trial is the first study in more than seven years to show a significant improvement in overall survival in metastatic non-small cell lung cancer post-platinum chemotherapy. I am heartened by this progress and the potential of this innovative therapy to help many metastatic lung cancer patients in need of new treatment choices following platinum therapy, without added systemic toxicity.”

Study finds movies underrepresent women in the role of physicians

U.S. movies perpetuate gender stereotypes in the medical field, according to a study co-led by Reshma Jagsi, MD, chair of Emory’s Department of Radiation Oncology and a Winship Cancer Institute researcher. The study, published in the Journal of the American Medical Association Internal Medicine, was drawn from plot summaries, keywords and casting credits of films from 1990-2020 in the movie database. The team found that representation of women physicians in movies was much lower than the growing proportion of women in medicine.

Jagsi believes movie representation of women physicians hasn’t kept pace with the increasing number of women physicians studying and practicing medicine today. Despite comprising half of U.S. medical students and one-third of practicing physicians, the study found that women make up only 18.6% of all physicians depicted in movies from 1990-2020.

“Among physician-characters in movies, even in the most recent movies we studied, the percent of women among physician characters was more reflective of the demographics of the medical profession over a quarter of a century ago,” Jagsi said. An additional finding was what Jagsi called “woeful under-representation of women and people of color in those movies rated G and PG, which is particularly disappointing since that’s the depiction being presented to some of the youngest viewers and shaping their sense of who can and should be a doctor.”

The underrepresentation of both women and people of color extended to G- and PG-rated movies geared to younger viewers. Jagsi remains hopeful that the study showed “a higher proportion of women film writers was associated with including at least one woman-character as a physician.” 

Brain Health Center

Investigating indicators of ALS disease progression and response

Jonathan Glass, MD, professor of neurology and pathology at Emory School of Medicine and the Emory ALS Center, received a $200,000 grant from the BELOCO Foundation to support new and ongoing projects to identify genetic markers and investigate blood and spinal fluid indicators of disease progression and response to treatment. Glass is widely recognized for research on the origins and prevention of amyotrophic lateral sclerosis, a neurodegenerative disease that affects nerve cells in the brain and spinal cord and presently has no known cure, as well as nerve degeneration and neurological diseases in general.

The BELOCO Foundation, rooted in the philanthropic legacy of Betty and Lovick P. Corn, was established in 1967 with a commitment to supporting the arts, education, medical research and religious organizations. 

Emory researchers discover improved diagnostic technique for immune disorders

A research team led by Shanmuganathan Chandrakasan, MD, associate professor at the School of Medicine, recently developed a better, more effective way to diagnose disorders of the immune system, especially in children. The current and most widely used existing diagnostic method is to look for activation of T cells, the specialized white blood cells that help the immune system fight disease. Key evidence is a marker called soluble interleukin-2 receptor (sIL-2R). This has been hard to analyze because sIL-2R testing is only performed in a few places in the U.S. and takes time to yield results. It can be a serious problem for patients who need immediate attention.

Searching for a better diagnostic method, the Emory-led team, including postdoctoral researcher Deepak Kumar, found two cell markers of immune disorders in the T-cells, HLA-DR and CD38-positive, that closely correlated with sIL-2R and could easily be identified in any lab equipped with flow cytometry, a widely used lab test to evaluate characteristics of cells in blood. In their paper, the investigators said their new test will be especially useful for patients with hemophagocytic lymphohistiocytosis (HLH), a rare but potentially lethal condition that usually strikes babies and children. HLH can be fatal if it isn’t caught and addressed quickly, sometimes leaving doctors only a brief opportunity to make decisions that could save a life, as the investigators discovered.

“During the course of our study,” they note, “We observed instances when direct T-cell activation aided in making timely interventions in patients who are critically ill when sIL-2R results were either delayed or did not accurately reflect T-cell activation state.” 

Emory researchers examine music’s role in clinical neurorehabilitation

A new Emory-led study published in the Annals of the New York Academy of Sciences reviews the growing body of research on music cognition and motor responses, an interdisciplinary field that blends music theory, psychology, neuroscience, anthropology and linguistics to study the multiple ways humans experience and perceive music. The study’s goals include showing how rhythmic sensory stimulation can be applied in therapeutic settings for people with Parkinson’s disease, stroke, mild cognitive impairment or other neurodegenerative diseases.

The research team was led by Madeleine Hackney, PhD, associate professor of medicine in the School of Medicine’s Division of General Medicine and Geriatrics, and Laura Emmery, PhD, associate professor of music theory in the Department of Music. Their study examined research in areas of music cognition, the psychology of rhythm, and clinical neurorehabilitation to investigate the relationship between the temporal element of music and the way this timing affects motor response under different contexts. The goal is to bridge the gap between music cognition and clinical neurorehabilitation, the multiple medical processes aimed at recovery from nervous system disabilities such as spinal injury or brain damage, to spur new research where each discipline makes a contribution. This study builds off similar research assessing how dance-based therapy can improve performance of motor and cognitive function.

Hackney and Emmery’s paper concludes that research on rhythmic auditory stimulation and music-based rehabilitative motor therapy for patients with cognitive impairment, stroke, Parkinson’s and other neurodegenerative diseases shows promising results in rehabilitation therapies. These findings should be considered when devising musically driven motor and cognitive rehabilitation programs.

Goizueta Business School

Why sluggish turnover is a bottleneck for diversity in the boardroom

Organizations are increasingly embracing diversity at their very highest echelons, but an Emory professor recently found that progress on corporate boards remains slow. Studying two decades of data, Wei Jiang, Asa Griggs Candler Professor of Finance in Emory’s Goizueta Business School, found board members can remain in place 10 years or more, much longer than the turnover among CEOs.

“Looking at the data, we see that around 25% of board directors hold on to their seats for 10 years or more; with 8.5% of them remaining in place for up to 20 years,” she says. “That translates into an average turnover rate of just 8.9% for public firms in the U.S., which compares with an annual CEO turnover of closer to 13%.” This slow turnover leaves a very narrow door for diversifying the makeup of corporate boards.

In her forthcoming paper, Jiang notes that as recently as 10 years ago, women made up less than 10% of all U.S. corporate boards. Only in 2019 did the proportion of female board members climb north of 15% for all U.S. publicly listed companies for the first time. Jiang blames what she calls “slow turnover” — a sort of inertia in the boardroom that is directly tied to the length of time that incumbent directors remain in their positions.

Interestingly, Jiang also found proxy fights by activist shareholders challenging incumbent managers tend to increase turnover of board members, raising number of women and minority board members by about 10%. She believes this unintentional diversification isn’t a substitute for increasing diversity in a purposeful and sustained way. Instead, Jiang thinks corporations should either limit board tenure or encourage voluntary turnover, a change she recognizes might be difficult.

“Most companies don’t impose limits on board directorships.” She says. “And human nature is such that simply inviting board members to nominate themselves or others to stand down voluntarily is probably a big ask psychologically.”

Serving markets: Inclusive brands stand to benefit

New research by Goizueta Business School’s Omar Rodriguez-Vila found social media marketing messages by some of the biggest consumer brands in the country don’t yet reflect the diverse demography of their customers. Rodriguez-Vila, professor in the practice of marketing, studied brand inclusivity, the concept that brands should “serve the needs of underrepresented communities in ways that enhance their perception of belonging and respect,” as he puts it. The lack of brand inclusivity exists despite a steady increase in diversity, equity and inclusionm (DEI) to the top of corporate agendas in the U.S. and elsewhere in the last few years.

By 2022, all Fortune 100 companies had clearly-defined DEI initiatives outlined on their websites. Seeking to learn whether the corporations extended the same support for diversity to their customers, Rodriguez-Vila and colleagues analyzed 11,000 social media posts from 2021 and 2022 on Facebook, Instagram and TikTok, looking for patterns of representational diversity in skin type, body type, hair type and physical ability.

Their research, scheduled in an upcoming edition of Harvard Business Review, used the Simpson’s Diversity Index, a tool originally developed to measure population diversity, but applied it in a new way to measure diversity in social media messages. While the racial diversity index measured by the U.S. Census in 2020 was 61%, Rodriguez-Vila found a social media index diversity of just 41%.

“The last time the racial diversity index was in that range was in the year 2000,” he says. The gap between social media representation and actual demographics was common across brands in almost all industries studied including airlines, fashion, consumer packaged goods, financial services, hospitality and retail.

Is AI censoring us?

A pair of researchers at the Goizueta Business School has found new examples of how artificial intelligence (AI) can introduce unexpected bias into social media, with unintended but serious consequences for sexual minorities. At a time when both governments and tech industry leaders have been developing new regulations governing AI and calling for a moratorium on AI training, Ramnath Chellappa, PhD, professor of information systems and operations management, and PhD candidate Jonathan Gomez Martinez investigated how AI-driven language moderation ended up censoring what the authors call “reclaimed language.” This includes words or phrases that might be a slur if used in some contexts but exactly the opposite if used by the people the language was originally intended to target.

“Terms like ‘queer’ are used within the community both in jest and as a marker of identity and belonging,” says Martinez. “But if used by those outside the community, this kind of language could be deemed inflammatory or offensive.”

The authors suspected AI wouldn’t be able to distinguish between these two ways of using the same words. Would this failure affect the online interactions of minority users, they wondered?

Using a proprietary Twitter program, they analyzed 1.8 million Twitter messages and 2 million replies from 2,700 users, about half of whom identified as gay or lesbian in their Twitter bios. Their study ran from January to May 2020, covering the period when Twitter switched to AI-based content moderation. This let them measure any increase in prosocial exchanges, such as in-group use of terms like “bitch” or “queer” that would have been perceived as incoherent or inappropriate to outsiders.

“We found a notable reduction in the use of terms that could be considered toxic,” Chellappa says. “When the AI moderation is in effect, you see these users’ language become more vanilla.” The authors found a 27% reduction in reclaimed language when AI did the content moderation. While that may not seem like much, they say it highlights the problems of using AI to make decisions about the precise and subtle ways people actually use language, with major implications for anyone who wants to understand the practical effect of AI on any group that might be the target of bias or exclusion.

“Wherever you have user-generated content, you are likely to find communities with their own, unique way of interacting,” Chellappa says. “We looked at LGBTQ+ Twitter users, but you could also look at the African American community, for instance.”  

Nell Hodgson Woodruff School of Nursing

Nursing faculty member awarded American Academy of Sleep Medicine Foundation grant to address sleep health disparities

The American Academy of Sleep Medicine Foundation has awarded its prestigious Community Sleep Health and Public Awareness Grant to Glenna Brewster, PhD, assistant professor at the Nell Hodgson Woodruff School of Nursing. The grant was awarded in recognition of her project, "Providing Sleep Education to Predominantly Black/African American Congregations,” which aims to address the significant under-addressed sleep health disparities that exist in African American communities.

Brewster, an expert on sleep disturbance, will partner with associate professor Fayron Epps, PhD, to determine whether a tailored sleep education program delivered to congregants of 15 predominantly African American churches can improve their sleep and increase their knowledge regarding when and how to follow-up with health care providers. Results from this project will be used as preliminary data for grant applications to further disseminate this program.

Brewster’s overall research goal is to reduce sleep health disparities within African American communities. The project will also educate congregants of the churches under study about the basic principles of sleep, teach behavioral techniques to improve sleep, discuss how prevalent sleep disorders are diagnosed, screen attendees for sleep apnea, and provide recommendations for follow-up, as needed. Results from the project may be further disseminated as needed.

The American Academy of Sleep Medicine’s Community Sleep Health and Public Awareness Grant supports a wide range of projects and initiatives dedicated to addressing sleep health needs in local, national or global communities.

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