Well Connected

(From Summer 2014 Duke Nursing magazine)

By Angela Spivey

How does a nursing professor with a PhD in family and child development start a collaboration with a neuroscientist? For Leigh Ann Simmons, PhD, MFT, it all began in yoga class. Simmons, an associate professor of nursing, had just received review comments on her application for a federal research grant. She wanted to investigate whether levels of a particular amino acid (branched chain amino acids, or BCAAs) are elevated in women who experience postpartum depression. BCAAs are abundant in high-protein diets, and they have been associated with obesity, insulin resistance, and depression. So Simmons thought, maybe BCAAs could be used as a biomarker to identify women at risk for postpartum depression. Then health care professionals could intervene before depression develops, perhaps with a special diet.

The grant-application reviewers loved Simmons’ idea. But they wanted to see some preliminary data in pregnant animals before they’d consider funding her proposed human study. Previous studies had linked these amino acids to depressive behavior in rats, but only in males.

The thought of conducting an animal study herself was new to Simmons. She had never even worked with mice before.

With all this on her mind, Simmons went to yoga class as usual. Her friend and colleague, Staci Bilbo, PhD, an assistant professor of psychology and neuroscience, happened to be in class too. Afterward, Simmons asked her if she had ever manipulated diet in her mouse studies. It turns out she had. That conversation led to a collaboration.

While the connection came via yoga class, the funding to conduct the research is courtesy of Bass Connections, a university-wide initiative that aims to engage faculty and students in teams working to tackle complex issues, and to expose students to inquiry across disciplines. Bass Connections was launched in 2013 with a $50 million gift from Anne and Robert Bass. Just as Simmons’ project crosses the lines between nursing and neuroscience, other Duke University School of Nursing researchers are leading Bass Connections projects that span the globe, from Asia to Africa, as well as Duke’s campus, from computer science to economics.

MASK ON MOM

It’s fitting that Simmons connected with Bilbo during yoga class; Simmons has long focused on helping women live healthy lives and is an integrative health coach and yoga teacher herself. While Bilbo is primarily interested in how diet and other events during pregnancy affect the health and behavior of offspring, Simmons is interested in the mothers. “You know when you’re on a plane, and the pilot will say, ‘If we have to drop the oxygen masks, make sure you put on your mask before you take care of your child?’ My research has always been about mask-on-mom,” Simmons says. “When we help mom, then we’re de facto helping the kids.”

The team is examining levels of BCAAs and incidence of depression in females who have just given birth—both mice and humans. Though BCAAs are important for building muscle, they are found at higher levels in the average Western diet (what Simmons calls “the McDonald’s diet”). In addition, BCAAs are naturally produced at higher levels during pregnancy, as the mom’s body builds a baby. “If you’re eating a diet that actually enhances branched chain amino acids, and then you’re pregnant, and that is also increasing their production, maybe some women reach a threshold that pushes them over the edge, contributing to postpartum depression,” Simmons says.

Students working on the project are gaining experience in both animal research and human behavioral research. For instance, one PhD nursing student is administering a questionnaire that the human moms take right after giving birth, regarding their diets and their behavior. An ABSN student is measuring maternal care and other behavior of mice that are fed diets with different levels of fat and branched-chain amino acids. The students are also getting experience in metabolomics, which uses advanced technology such as mass spectrometers to analyze the presence of metabolites in blood and other tissues, as a way of understanding how diet and other factors affect the body. The students will be able to compare metabolomics results, including signatures left behind by BCAAs, in blood samples from both mice and women, and find out how they correlate with behavior.

Simmons herself is spending time learning to conduct animal research in Bilbo’s lab, such as behavioral tests and laboratory assays. “I want to be able to talk with authority about all aspects of the research. I can’t do that unless I’ve done it myself,” Simmons says. “I also like it because in that aspect, the students are teaching me.”

PREPARING FOR THE GLOBAL DEMENTIA PANDEMIC

Baomu. Loosely defined, the word means caregiver. While the term is unfamiliar in the United States, it’s commonplace to many families in China caring for an aging family member with dementia. The word denotes the informal system in which largely untrained rural people in need of work travel to more affluent, urban areas of the country to live with and care for people with dementia, much like an au pair might live full time with a family to care for a child.

Dementia has been called the next global pandemic; it’s estimated that worldwide the number of people with dementia will triple by 2050, according to Alzheimer’s Disease International. Bei Wu, PhD, professor and director of international research at Duke University School of Nursing, is documenting how people across the globe care for their family members with the disease. Wu has long conducted research on aging in China, where her 101-year-old grandmother still resides. One of her latest projects, funded by Bass Connections to begin in July 2014, will document how caregiving for people with dementia gets accomplished in China and Sri Lanka, and it will reveal opportunities and needs for training programs.

In the United States, families affected by dementia are likely to get help from a trained home health aide or a certified nursing assistant. But just because the United States has a more formal system of caregiver training doesn’t mean that the West has the issue all figured out, Wu says. “Our goal is to find out how we can facilitate collaboration between the two developing regions, as well as share our experiences and learn from theirs,” she says.

Collaborator Kirsten Corazzini, PhD, an associate professor of nursing, points out that both the baomu system and the Western system have their drawbacks. “There are big issues around what happens when a caregiver is residing with the family 24-7, including human resource issues such as developing skills, and ensuring caregiver and care recipient quality of life,” Corazzini says. On the other hand, studies have pointed out that the United States suffers from the opposite problem—lack of consistency in an ever-changing cast of caregivers. No one country has the complete answer, and that’s why it’s important to conduct qualitative interviews before forming any hypotheses, Wu says.

Improving care for people with dementia is a challenge that must be tackled systematically and globally, says Eleanor McConnell, PhD, MSN, GCNS, BC, an associate professor of nursing. “Moving forward, if we are a global society, it’s really not acceptable for affluent countries to import people to solve their workforce problems,” she says. “We need to think about, how do we collectively develop a work force? And, how do we pay for this?”

To that end, the project involves faculty and students from not only nursing, but also computer science and economics.

IMPROVING ANESTHESIA CARE IN THE DEVELOPING WORLD

If you’re an experienced health care professional in a developing country where your skills are desperately needed, do you take time away from serving patients to get the validation of a college degree? Or do you stay on the job and watch people with less experience move ahead of you in the ranks?

Nurse anesthetists in Ghana, Africa, won’t have to make that choice if Brett Morgan, DNP, CRNA, assistant professor of nursing, has his way. As part of his long-term interest in improving anesthesia care in developing countries, Morgan is adapting a traditional curriculum for nurse anesthetists into a distance learning program. “The goal is that these nurse anesthetists can stay working in their communities while reaching the objectives that are necessary to get their baccalaureate degree,” Morgan says.

In the United States, there is about one anesthesia provider for every 4,000 people. In some developing countries, the ratio is as low as one in a million. “Surgeons are giving their own anesthesia, or finding laypeople to do it, or else there simply is no access to surgical care because there is no one to administer anesthesia,” Morgan says.

Nurse anesthetists in Ghana have traditionally been trained in a hospital-based diploma program and are considered of a lower rank than general nurses. To increase the number of providers and the quality of care, Morgan had previously helped establish a baccalaureate degree program for nurse anesthetists at Ghana’s University for Development Studies. Now he’s adding this executive-education-style distance program. “The current system in Ghana isn’t perpetuating the profession of nurse anesthetist very well,” Morgan says. “We hope this distance-learning program will be another part of the solution.”

Morgan is collaborating with faculty in the Duke Global Health Institute and the Department of Computer Science. The first step is designing a tablet-based platform to be used to teach the bulk of the courses. Later, Duke faculty, students in the nursing master’s program, and medical residents and fellows in the anesthesia residency program will travel to Ghana to implement the tablet platform, train faculty and students there, and conduct a survey of health care systems and communities.

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