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James Rilling, PhD                                     Charles M. Epstein, MD
ECAS: Anthropology                                  SOM: Neurology: Epilepsy
Functional basis of precuneus expansion in human evolution

Despite being of similar size, the human skull is more globularized than the Neanderthal skull, due primarily to bulging of the parietal lobes in humans. There is evidence to suggest that human globularity resulted from expansion of a medial brain structure known as the precuneus. The precuneus is involved in multiple functions, but the anterior dorsal precuneus, where human expansion is most pronounced, is most strongly implicated in visuospatial integration and self-centered mental imagery. It has been suggested that Neanderthals were hunting prey up close, based on their high frequency of broken bones, the thickness of their spears and lack of evidence for spear-throwers. On the other hand, there is evidence for habitual throwing of long range projectiles in anatomically modern humans. Thus, selection for the ability to throw projectiles accurately from a distance may have led to precuneus expansion and enhanced visuospatial abilities in humans. This project will evaluate whether the precuneus is involved in accurate throwing, thereby informing speculation on the selection pressure that drove precuneus expansion. Transcranial Magnetic Stimulation (TMS) will be used to examine the effects of temporarily inactivating the upper precuneus on throwing accuracy. Subjects will throw at a target before and after receiving either TMS or a sham treatment. As a control, subjects will also perform a non-throwing movement before and after TMS or sham treatment. Throwing accuracy will be compared before and after TMS and sham treatments to determine if inactivating the upper precuneus impacts throwing accuracy more than it impacts performance on the control task.

Eri Saikawa, PhD                                         Carla Roncoli, PhD
ECAS: Environmental Science                     ECAS: Anthropology
Climate-smart agriculture in US-China- Ethiopia using living mulch systems

Capital-intensive, fertilizer-dependent agriculture significantly contributes to climate change by emitting greenhouse gases (GHGs) into the atmosphere. At the same time, agriculture is highly vulnerable to climate change, particularly in Africa, where most rural households derive their livelihood from rain fed farming. To address these challenges, a new paradigm in agricultural risk management has emerged in the last decade, known as climate-smart agriculture (CSA). CSA aims to achieve the triple-win of climate change mitigation, adaptation, and increased productivity. We propose an interdisciplinary pilot project to test an innovative, integrative approach combining environmental science and anthropology to assess the climate change mitigation and adaptation potential of CSA practices with that of fertilizer-based systems in three agro-ecological contexts. We will do so by measuring soil GHG emissions from fields managed under select practices, while also working with local farmers to identify barriers to adoption of promising CSA practices. Emission measurements will be conducted in three countries that have different agricultural systems. Two are the world largest economies (US and China), which jointly contribute to 22% of all GHG emissions from agriculture. The other is Ethiopia, where fertilizer use is still limited but growing at the fastest rate in the continent. China and Ethiopia are priority countries for Emory University’s global engagement strategy, and the project capitalizes on Emory’s existing and emerging institutional partnership in these countries. The project will provide further stimulus to work with the Carter Center to leverage major funding for a research program on climate change mitigation and adaptation.

Kristin Wall, PhD                                          Lisa Haddad, MD
SPH: Epidemiology                                       SOM: GYN OB
Development of an intervention to improve postpartum IUD/implant services in Rwanda

The World Health Organization endorses postpartum family planning services as safe, effective, and cost-effective for the prevention of unintended pregnancy, and abortion and the optimization of birth spacing, maternal and newborn health. However, postpartum family services remain underutilized. Like many sub-Saharan African countries, Rwanda is committed to reducing unmet need for family planning, particularly among postpartum women. However, despite capacity building and interest, current provision of postpartum family planning services in Rwanda remains extremely low. This low utilization is hypothesized to be due to lack of hospital `champions’ promoting the service, low provider motivation, lack of demand-creation strategies informed by clients’ needs and preferences, lack of male involvement, and lack of optimized operational procedures (i.e., timing of consent). To address these issues, we recently received a Gates Grand Challenge Award to develop and pilot test an intervention to improve postpartum intrauterine device (IUD) service supply and demand coordination. Meetings with the Rwandan Ministry of Health revealed that while our focus on the IUD is important, a broader focus on postpartum use of other long-acting reversible family planning methods, especially the implant, is urgently needed. In this application, we propose to leverage our currently funded work to improve postpartum implant services and demand, in addition to the IUD, in Rwanda. In Aim 1, we will evaluate knowledge, attitudes, and practices related to postpartum implant at the systems-level and the client-level (Months 1-6). We hypothesize that facilitators and barriers to postpartum implant service delivery will correlate with: demand and therefore ability to practice and achieve comfort with the skill; champion identification; training of community health workers to discuss the postpartum implant with couples as well as individuals; and development systematic workflows and consenting procedures. We hypothesize that facilitators and barriers to postpartum implant uptake will correlate with: contraception preferences and needs, fertility intentions, previous contraception experiences, perceived risk of unintended pregnancy, sociocultural and traditional norms, myths/misconceptions about the postpartum implant, concerns about the health impact/side-effects of the postpartum implant, HIV status, male involvement, and systems-level factors such as consent timing. In Aim 2, we will evaluate current infrastructure and procedures for postpartum implant services (Months 1-6) via direct observation of practices and analysis of operational workflows within four hospitals, two high-volume hospitals in Kigali and two hospitals in rural areas. We hypothesize that optimized, systematic workflows and procedures, such as those for consenting clients, in antenatal care and maternity services will not be in place, and that stocks of implants for postpartum use will be low (due to low demand), but that hospitals will have the infrastructure to support functional implementation procedures. In Aim 3, we will develop the combination postpartum IUD/implant intervention (Months 6-12). We hypothesize that the intervention may include: postpartum IUD/implant insertion (refresher) training, workflow/consenting procedure development, champion identification, and community health worker training based on couple/client identified contextual preferences and needs. This is, to our knowledge, the first use of a comprehensive framework to rigorously develop an intervention for improving postpartum IUD/implant services. Future directions include pilot testing the intervention which will lay the groundwork for a large, randomized controlled trial.

Canhua Xiao, PhD                                        Rebecca Gary, RN/PhD
SON: Academic Advancement                    SON: Academic Advancement
Does personalized home-based aerobic and resistance exercise reduce fatigue and inflammation in patients with head and neck cancer receiving IMRT: a pilot study

Fatigue is one of the most frequently reported symptoms in patients with cancer and can profoundly affect a cancer patient’s quality of life, treatment adherence, and health care utilization. Both pre- and post-treatment fatigue is also prognostic for pathologic tumor response and poor survival. Patients with head and neck cancer (HNC), who typically receive radiotherapy (RT), have high rates of fatigue, compared to patients with other types of cancer. This fatigue can persist or worsen up to one-year post-treatment. Recent research on Intensity-modulated RT (IMRT), a new radiotherapy that targets tumors with higher doses of radiation while avoiding normal structures, has shown that HNC patients receiving IMRT experience even higher fatigue compared to conventional-RT. Patients receiving immunotherapy, the newest and most exciting biological treatment for cancer, also experience high levels of fatigue. Physical activity/exercise has been recommended by the National Comprehensive Cancer Network (NCCN) as a non-pharmacological intervention to manage fatigue, as no Food and Drug Administration-approved pharmacological agent effectively prevents or treats fatigue. However, exercises effects in fatigue for HNC patients has not been well-documented and the underlying biological mechanisms of exercise on fatigue and eventually cancer prognosis and survival are not well-established. Preliminary and inconclusive findings suggest inflammation as a potential mechanism linking exercise and fatigue, as well as cancer survival. Our study confirmed a positive association between fatigue and inflammation in HNC patients, and our pilot data further supported that this association might be regulated by inflammation-related epigenetic changes (e.g. DNA methylation). Although a large body of evidence has shown the importance of DNA methylation changes, a well-studied epigenetic modification, in various diseases and processes including cancer, psychiatric symptoms, and inflammation, the evidence for exercise-related inflammation changes secondary to DNA methylation modifications is sparse, and none of these changes have been directly connected to cancer-related fatigue yet. Thus, we propose a randomized clinical trial to test a 12-week home-based exercise intervention (a combined aerobic and resistance exercise vs. aerobic exercise alone from pre-IMRT to 6-week post-IMRT) for HNC patients receiving IMRT. The interventions have been well-received by our studies on heart failure patients. The overall purpose of this pilot study is to examine the feasibility and limited efficacy of the exercise interventions on fatigue and inflammation in HNC patients undergoing IMRT. The findings are anticipated to shed light on future large randomized clinical trials (R01) to fully examine exercises effect on fatigue and inflammation, and eventually on cancer prognosis and survival.

Melissa Young, PhD                                        Barry Ryan, PhD
SPH: Global Health                                          SPH: Environmental Health
Environmental Exposures during Lactation: Are Mycotoxin and Pesticide exposures associated with an inflammatory breastmilk profile and impaired infant intestinal permeability in Haryana, India?

High levels of child malnutrition in India the first 6 months of life represents a critical public health challenge. Nutrition is an established factor contributing to early growth faltering, but a major unanswered question is the role of environmental exposures in causing growth failure. Mycotoxins/pesticides may contribute to environmental enteric dysfunction, a sub-clinical inflammatory condition that results in a leaky gut, malabsorption of essential nutrients and child malnutrition. Limited existing data suggests that mycotoxin and pesticide exposure may lead to elevated levels of oxidative stress and inflammatory markers and increased gut permeability. However, human data is scarce and many questions remain. We are in a unique position to be able to answer this critical question by using existing breastmilk and serum samples collected as part of a NIH R21 grant in Haryana, India This interdisciplinary proposal combines the expertise of researchers in nutrition and environmental health to explore pathways of mycotoxin and pesticides as environmental exposure during lactation and the potential impact on breastmilk composition and infant gut health. SPECIFIC AIMS 1) To evaluate mycotoxin and pesticide exposure in 100 mother-infant pairs in rural Haryana, India Hypothesis 1: Environmental exposure to mycotoxin and pesticides among lactating women will result in breastmilk concentrations of mycotoxins and pesticides beyond acceptable upper limits of exposure. 2) To explore potential pathways of environmental exposure on breastmilk inflammation and infant gut integrity among 100 mother-infant pairs. Hypothesis 2: Breastmilk mycotoxin and pesticide concentrations are associated with an inflammatory breastmilk profile and impaired infant intestinal permeability.