Awardees announced for 2019 undergraduate research recognition awards

Salma Al-Sammary (Anthropology) and Shukri Ahmed Hassan (Public Health-Global Health), Is Female Genital Circumcision the Problem?

Women in the most underserved area of Seattle experience higher rates of pre-term birth, low birthweight rates and cesarean section surgeries. The focus of this project is to see if female genital circumcision (FGC) correlates with the cause of these issues, but also if there are other factors that have an influence on high reproductive health disparities such as, racism, access to resources, and any other barriers of the community that are driving these issues.

This project works with Somali immigrant and refugee residents in the south Seattle area because it is the most under-served, ethnically and economically diverse area. Somalia has the highest rate of women who have undergone the practice of FGM/C with a leading 98% of the female population between the ages of 15-49 years being circumcised.

Our project works collaboratively with the Mama AMAAN Project which seeks to test out a community-led, integrative services approach to improve perinatal health outcomes in this population. The goal of the project is to understand why these issues are consistently happening amongst women that come from similar backgrounds, more specific amongst East African women.

While trying to reach the goal of this project, we seek to answer the following questions; What are the ways that FGC played a part in their perinatal experience and outcomes for Mom and infant? What is their perspective on the practices of FGC in Seattle as relates to themselves, their families, their community? To accomplish the goal of our research we plan on using qualitative methods by conducting written surveys and participant-observation during child birth education sessions. This project is significant because it assesses the reason for the high rates of reproductive health disparity that we are seeing amongst the women of the Somali community and how FGC is related to those problems, if at all.

Carolyn Brager (Biology), The Future of a Malaria Vaccine: Generating a Late Liver-Stage Arresting Genetically Attenuated Plasmodium falciparum Parasite Vaccine

Malaria affects close to half of the world’s population and kills nearly 3,000 children every day. Due to the rapid rise in drug-resistant parasites and insecticide-resistant mosquitoes, we need a vaccine now more than ever before. Malaria is caused when a mosquito infected with the parasite, Plasmodium, bites and injects thousands of sporozoites that infect the liver and replicate without causing symptoms for 7-10 days. After egressing out of the liver, the parasites infect red blood cells and can get taken up by another mosquito during a bite perpetuating disease transmission. In the blood stage, the population of parasites in circulation can reach the billions, symptoms occur, and disease complications can result in death.

Our strategy is to develop a pre-erythrocytic malaria vaccine by creating a genetically attenuated parasite (GAP) strain. If infection could be stopped before the parasites break through into the proliferative blood stage, both the disease and transmission could be prevented. Our goal is to make a late-liver stage arresting Plasmodium falciparum GAP conferring a broad antigenic diversity. Based on late-liver stage transcriptomics, we identified genes that could be candidates for knockout. One of these genes is mei2 of which my team already generated a CRISPR/Cas9-mediated knockout. We conducted an analysis of invasion kinetics via a growth competition assay between wild-type and mei2- parasites to ensure the gene deletion did not reduce viability. We proceeded by exposing our human-liver chimeric mice to infectious mei2- sporozoites, tracked liver stage development, and looked for breakthrough into the blood stage as an indication of incomplete attenuation. We then built on the previously established role of mei2 as an RNA binding protein by studying the subcellular localization of Pf mei2 to better understand the effect it has on liver-stage development.

Rose Fields (Biochemistry), A Designed Self-Assembling Nanoparticle Vaccine for Parenteral Induction of Mucosal Immune Responses

Enteric diseases, or diseases of the Gastrointestinal (GI) tract, remain one of the most prevalent killers of children in sub-Saharan Africa. The most practical way to prevent such diseases is through vaccination, but antigens for enteric diseases need to be delivered directly to the GI tract to be most efficient, making vaccination difficult.

Recent studies by the von Adrian group at Harvard University have found that both T and B cells are reprogrammed to home to the GI tract when they encounter retinoic acid, a metabolite of vitamin A. The King Lab at the University of Washington is working to develop a novel vaccine candidate using recently developed self-assembling protein nanoparticles, that can simultaneously package all-trans retinoic acid (ATRA) and multivalently display enteric antigens. Previous work has suggested that two cystine mutations to Cellular Retinoic Acid Binding Protein I (CRABP-I) create a disulfide bond as a result of the conformational change that CRABP-I undergoes when it binds ATRA. This disulfide bond would essentially lock ATRA into CRABP-I, reducing its dissociation constant in vivo and maintaining the gut-homing properties of the nanoparticle post-injection.

In order to assess the efficacy of these cysteine mutations, I expressed two versions of CRABP-I, the wildtype protein with no cysteine residues, and a version with no cystine residues except for the two that create the disulfide bond. After establishing that these new CRABP-I mutants folded into the approximate shape of wildtype CRABP-I via circular dichroism, I designed and tested new assays that measured free thiol concentrations of each protein after binding ATRA, as well as free ATRA concentration overtime. This data will help us determine whether these two cystine mutations make a significant difference in the ATRA binding quality of CRABP-I, which could improve the immune response generated by our vaccine candidate.

Rebecca Fogel (Community, Environment, & Planning), Mapping Economic and Socio-Cultural Inequality in Indiana

Through mapping the complexities of spatial inequality, I examined the geographic differences in economic and socio-cultural inequality across the state of Indiana. Examining inequality in my home state provided me with a deeper understanding of the gap between rich and poor within the state, how Indiana fits into the growing wealth gap in the United States, and how income inequality further impacts access to education, housing, and healthcare.

I collected data from the U.S. Census Bureau for Indiana and Indianapolis, as well as the three richest and poorest cities in the state, St. John, Zionsville, Carmel, Gary, East Chicago and Muncie. Across the state and the seven cities studied, I measured educational attainment, employment status, health insurance coverage, housing costs and income in the past 12 months.

In Indiana, less than 25% of the population over 25 has a Bachelor’s degree. Rates of health insurance coverage vary greatly across the cities studied, but are fairly consistent across racial lines within cities. Income distribution varies drastically across the state, and by race across the seven cities in this study; however, single mothers, regardless of their race or ethnicity, are far more likely to be impoverished compared to the average in each city. In the three richest cities, populations are almost entirely white, while populations in the three poorest cities are almost entirely African American. Economic differences are not the only indicator of inequality in Indiana; socio-cultural differences also underlie many aspects of poverty and inequality. Mapping how inequality varies in terms of race, gender and location provided a stronger sense of how geography affects the distribution of wealth and resources, and who is impacted the most.

Kosuke Kume (Public Health-Global Health), Review of EMS Pre-Hospital Patient Protocols: Restraint and De-Escalation Use in Psychiatric Health Emergencies

Pre-hospital patient protocols standardize medical procedures for EMTs and increase the quality of care for patients. In Washington state, these protocols vary by county and often contain a section for psychiatric emergencies with variant restraint protocols. The immediate use of restraints in these situations can be seen as dismissive to the patient and can lead to agitation and violence. Verbal de-escalation can enhance provider-patient relations and decrease likelihood of restraints, seclusion, and hospital admissions.

The goal of this project was to explore restraint and de-escalation methods used in WA state county-level EMS pre-hospital patient protocols. To complete the project, a codebook was created with binary variables with definitions that determined whether the procedures listed in the protocol satisfied the definition. Using the codebook, each protocol was independently coded by two people and disagreements were reviewed by a third person. Finally, we created descriptive statistics from the restraint protocols and stratified based on rurality. Of the 39 counties in Washington state, 77% of counties mentioned verbal de-escalation methods in their pre-hospital patient protocol.

The de-escalation method with the highest proportion in all counties recommended reassuring the patient that the providers care for them (28%). The second highest proportion in all counties was to mention the use of de-escalation methods without explicit instructions (23%). Counties that do not have specific instructions and just mention the use of de-escalation methods can be confusing if the provider does not have de-escalation training or has not trained recently. These findings highlight the need for future research concerning the adherence of EMTs to these protocols and to see the what the outcomes are of the different protocols. More research can be done through contacting individual EMS agencies to see if internal protocols exist outside of county protocols.

Kathe Mijal (Interdisciplinary Arts & Sciences, UW Tacoma), Intersectionality and Mortality: Oppression, Health, and Black Women in the United States

My research is on the intersectionalities of racism and sexism as they apply to the healthcare of women of color, and specifically that of African-American women’s maternal mortality rate. African-American women die of after-birth complications at a rate that is three times higher than that of White women.

I am using Critical Race theory and Intersectional Feminism to analyze how racism and sexism are interconnected, and how they together implicitly bias many healthcare professionals. I am working from the viewpoint that racism is widespread throughout American society, and highly influences the way that people of color, and white people, live their lives. However, I also believe that an intersectional approach is necessary to fully understand the influences on women’s healthcare, and that examining the sexism inherent in women’s care is vital to understanding the full extent of the bias society holds against Black women.

I am creating a literature study on the history of bias in the medical system with a focus on historical methods of medicalizing racism, researching the explanation for Black women’s historical distrust for the white healthcare system, and a focus on current research on implicit bias among healthcare professionals. I am hoping to discover whether the underlining differences in Black women’s maternal mortality rate, due to their societal positionality, is being addressed by their doctors in their healthcare strategies. I am hoping to show that a healthcare system that addresses bias and the biological and psychological effects of racism and sexism rather than ignoring them and treating every woman the same is vital to ensuring every woman’s optimal health outcome.

Rita Olson (Microbiology), Optimizing Oral Swab Analysis for Tuberculosis Diagnosis

Tuberculosis (TB) remains a major international health concern and one of the top 10 causes of death worldwide, according to the World Health Organization. Previous clinical work in our lab demonstrated that oral swab analysis (OSA) can successfully diagnose tuberculosis by detecting Mycobacterium tuberculosis DNA in the mouths of infected patients.

In order to strengthen OSA against traditional but more invasive methods, such as sputum sampling, improvements to DNA extraction and swab type must be investigated. I am comparing different degrees of automation with MolBio’s Trueprep, the AudioLyse, and ThermoFisher’s KingFisher against our previously validated manual Qiagen extraction protocol—with the comparison lying in sensitivity and efficiency.

In order to increase the versatility and sensitivity of OSA, I am also investigating boil preparations and dissolvable swabs. Boil preparation of swabs is a relatively simple extraction procedure, and early results have demonstrated its comparability against the Qiagen extraction. Meanwhile, dissolvable swabs have a hypothetical 100% yield of sample material. I have successfully dissolved calcium alginate swabs from Puritan in acidic sodium citrate solutions, and Luna swabs were dissolved in chaotropic agents. DNA yields are compared to non-dissolvable, previously validated swabs.

Noush Panahpour Eslami (Chemistry, Biochemistry), Assessing a Social Determinants of Health Screening Tool in the Inpatient Setting

Social determinants of health (SDOH) are non-medical factors that contribute to a person’s health and well-being. The Centers for Medicare/Medicaid Services recently released a standardized 26-question survey designed to capture SDOH in the following 13 domains: living situation, food insecurity, transportation, utility help, personal safety, financial strain, employment, family and community support, education, physical activity, substance use, mental health and disabilities. However, there is limited study using this survey tool in a safety-net institution.

Harborview Medical Center (HMC) is the public hospital serving King County, WA and provides care to a wide variety of patients. This project was a prospective, observational study which aimed to investigate implementation of this survey tool and to measure relevant SDOH and other medical factors in this setting. My role included administering the survey to patients admitted to the HMC Hospital Medicine service from October to December, 2018. I collected data related to the duration of the survey and any challenges patients encountered responding to the survey, as well as review of patient charts for demographic information, medical system utilization, and medical history.

In total, only 24 of 90 patients (27%) completed the survey. Major challenges included patient lack of interest, language barrier, ability to consent, and competing time demands. These results have implications for the generalizability of this tool and whether it comprehensively identifies SDOH needs.

Lauryn Stafford (Economics, Public Health-Global Health), Trust, Access, and Adaptation to Needs: The Role of Community-Based Promoters in Health Insurance Delivery in Gujarat, India

The research question this study addresses is: How do community-based promoters contribute to the delivery and utilization of health insurance among marginalized populations in India? The subject of investigation for this study is the insurance delivery model of VimoSEWA, an organization based in Ahmedabad, India that provides health and other social insurance services to self-employed women with limited prior access to financial protection.

To address the research question, I investigated the successes and difficulties experienced by VimoSEWA community-based insurance promoters, called aagewans, through field visits and personal interviews in Ahmedabad and nearby rural districts in Gujarat. Both aagewans and insurance members were interviewed during this study to develop a comprehensive understanding of the importance of community-based promoters in health insurance delivery and the various factors that impact their role.

The role of VimoSEWA aagewans in promoting and delivering health insurance to self-employed women in Guarat is significant because insurance improves the financial stability of these women and their families. Furthermore, health insurance is effective in decreasing high out-of-pocket healthcare expenses and improving access to quality healthcare services. However, the findings of this study indicate that the benefits of health insurance can only be attained by marginalized populations if insurance is made accessible to these communities through proper delivery methods and sufficient social support systems. VimoSEWA aagewans perform a fundamental role in establishing trust between the community and the insurance provider, making health insurance accessible, and adapting services to the community’s needs. 

Christoph Von Strouse (Community, Environment, & Planning), Aligning University Sustainability Planning with Global Development Goals

Universities are increasingly expected to integrate sustainability practices throughout their mission, strategic planning, operations and academics. Achieving institutional sustainability requires a comprehensive strategic plan which coordinates the efforts and resources of administration, facilities, faculty and students by making progress toward measurable goals. How can universities use sustainability benchmarking standards to develop a comprehensive strategic plan that achieves institutional goals, while making progress toward global sustainability reporting standards?

This project outlines a model for universities to develop a strategic sustainability plan utilizing the Sustainability Tracking Assessment and Rating System (STARS) as a foundation, to align institutional planning with the Global Reporting Initiative (GRI) and the UN Sustainable Development Goals (UN SDGs). The plan is comprised of seventeen sections or modules that aligns the categories of STARS, the GRI and the UN SDGs into a framework for benchmarking data of key performance indicators (KPIs). The data is visualized using Tableau software to create a campus sustainability map and data dashboard to track annual progress on the KPIs. The goal of this project is the creation of a generalizable and replicable model for aligning a university’s strategic sustainability planning with global sustainability metrics. This model facilitates more efficient data driven decision making and resource allocation, while supporting globally focused sustainability research and funding.

Samir Yhann (Physics), Statistical De-Identification of Medical Notes

Electronic health records (EHRs) are often used by clinical and data researchers in numerous ways for various scientific investigations. When sharing patient information, certain precautions must be followed as to prevent the risk of a malicious actor being able to extract sensitive information. This study examines an experimental method of removing potentially identifiable information from free text medical notes by finding and removing phrases which are statistically uncommon. Furthermore, this study assesses if this method reduces risk of identification while also maintaining the utility of the data.

The method involves analyzing a free-text dataset by first breaking all text up into fixed length phrases. The frequencies of these phrases are then tracked across the entire dataset on a per-patient, per-note, and dataset-wide basis. To benchmark the method, notes are de-identified using the method and privacy and utility are tested under different conditions. The results from using this method on real clinical notes are expected to produce text that will not only be more secure but will also retain information useful for applications such as machine learning, natural language processing, and data analysis.

If this method proves to be successful, it could lead to institutions being able to share medical notes with researchers more easily. This in turn would eliminate a major obstacle which medical researchers face, as it would give them access to more data. Finally, when data are shared between institutions for research, the risk of identification can be represented as an objective and quantifiable metric.