Hopkins History: Renaissance (math)man

Engineering: Better design could lessen disasters

Education: Phonics alone is not enough

Nutrition: Teens need vitamin D

Ethics: Are pain-free animals ethical?

Medicine: Genome spurs new curriculum

Sports: Springtime of champions

Medicine: A chain for more transplants

University: Obama taps provost

Anthropology: Why are Indian women burning?

Peabody: The conductor at age 15

Renaissance (math)man

Clifford A. Truesdell III was eminent enough for a fellow mathematician to comment that his peers owed him "a deep debt of gratitude... for finding the tool to cleave the fog that once obscured the science of thermodynamics." He was also a man who named his house Il Palazzetto — the little palace — and liked to entertain guests while wearing Renaissance attire-complete with frilly collars and cuffs and elaborate jackets and leggings.

Truesdell, who taught at Johns Hopkins for 28 years, amassed a large collection of Renaissance-era European artwork, furniture, and sculpture before he died in 2000. Ornate bronze statuary, gilded baroque furniture, exquisite silverware, and a heavy concentration of extravagant Italian objets d'art made up a collection notable for its breadth and depth. In January, Christie's auction house began a months-long sale of the collection, and the proceeds as of early May totaled more than $1,578,000. The Truesdells' bed alone — a 1740s English mahogany and silk four-poster George II behemoth from the Brympton d'Evercy House — fetched more than $188,000.

Born in Los Angeles in 1919, Truesdell (who once aspired to be a poet) made his first art purchase at age 9, according to his son, Clifford Truesdell IV, an attorney in Cambridge, Massachusetts. Truesdell III, says Truesdell IV, liked performing in front of an audience — which might explain his penchant for hosting parties dressed in costume — and was one of the few mathematicians of his era who could extract a sum from a university, society, or academy for the privilege of having him give a lecture, present a paper, or just make an appearance.

Jean-Pierre Meyer, Hopkins professor emeritus of mathematics and a contemporary of Truesdell's, recalls, "Both he and his wife had a great interest in Italy because it's the place where the Renaissance occurred. It colored their entire lives. And they decided to live the life of Renaissance aristocracy." Soon after arriving at Homewood in 1961, Truesdell and his wife, Charlotte, purchased a brick and stone mansion on Greenway in the city's Guilford neighborhood. (It's currently for sale, asking price: $1.8 million.) Truesdell felt the house was not sufficiently Renaissance, so he engineered and oversaw a variety of changes to create a more Italian feel. The reworked Il Palazzetto soon began to fill with the couple's collection of art, furniture, and statuary. When the Truesdells entertained, they often hired musicians to play Renaissance works on period instruments in the home's massive front hall.

Truesdell's research focused on elasticity, the changing mathematical properties of moving bodies. That research helped advance modern engineering, and his later work investigating rational mechanics had great impact on a variety of fields, including thermodynamics. He held membership in 12 international academies of science and honorary degrees from five universities; he was twice awarded the Euler medal of the U.S.S.R. Academy of Sciences; and he had a grand collection of other awards from American and European scientific bodies.

"If he were asked what was his profession, he would not say 'mathematician,'" Meyer recalls. "He would probably call himself a scientist." Meyer also remembers that whatever he called himself, in the 28 years Truesdell spent in Maryland Hall his brusque personality and ego made him unpopular with colleagues. He was infamous for being vocally critical of other faculty members.

In 1984, Truesdell wrote an essay titled "The Computer: Ruin of Science and Threat to Mankind." He kept a study in the home devoid of electricity, where he worked by candlelight, writing with a goose feather and Renaissance inkwell. "My father didn't like anything invented after the 18th century," his son says. "He felt that the one improvement made in the 19th century was the invention of the flush toilet."
— Geoff Brown, A&S '91

Real leaders know they're fallible

"The former leader must always maintain a balanced view. He must be able to acknowledge mistakes he made during his own tenure. If he can't do that, then he's not a person of real leadership. Strong leaders are vulnerable enough to recognize that they're fallible. When they have that kind of perspective, then they know better than to lash out publicly at their successors."
— Yash Gupta, dean of the Carey Business School, commenting on public criticism of the Obama administration by former vice president Dick Cheney. From a May 12 post to the washingtonpost.com blog "On Leadership," where Gupta is a regular contributor.

Better design could lessen disasters

In 2005, Hurricane Katrina ravaged the Gulf Coast, toppling power lines and oil platforms, shattering windows, inundating homes and businesses, and killing more than 1,800 people. Experts estimate the damage surpassed $80 billion, making Katrina the costliest hurricane in United States history. Hurricane damage can't be avoided, but it can be reduced through better planning. What's needed, says Seth Guikema, are updated building codes, plus a new approach to infrastructure design. In an opinion piece aimed at policymakers, builders, and designers in the March 6 issue of Science, Guikema, an associate professor in the Whiting School of Engineering, wrote that developers need to accurately weigh up-front construction expenses against the potential costs of repair or replacement, plus the indirect costs of environmental and local economic damage, if the structure fails in a disaster. Moreover, he argues, they should consider the effects of natural buffers like wetlands or barrier islands. "We need to think beyond just meeting the minimum design codes," says Guikema.

Developers are under tremendous pressure to keep costs down, Guikema says, so they rarely do more than meet minimum standards. That means constructing buildings projected to withstand the strongest winds or highest water that could be expected, say, every 50 years. This one-size-fits-all approach doesn't work, Guikema says, because one building might house offices, while another built to the same standard holds hazardous chemicals. The higher cost of failure in the latter needs to be considered when the building is designed.

Guikema also argues that designers should take into account a structure's surroundings. "There may be some benefit in beefing up the natural protection that's there," he says. Had the wetlands off the coast of Louisiana been healthier, they might have lessened Katrina's impact on the Gulf Coast. Yet ecological restoration is rarely used as a way to reduce the risk of damage caused by natural hazards. Guikema would like to see a new system, where standards could be met through design modifications or through environmental improvements. He is working to develop models that will help them weigh the costs and benefits of activities such as rebuilding barrier islands. The idea is to establish a sound scientific basis for making tough design decisions.

Kurt Gurley, a civil engineer at the University of Florida, believes some of what Guikema advocates exists now. He points out that codes already take into account a building's end use. "A hospital and a storage shed will not be designed to the same standards," he says, "because the hospital is assigned a higher importance factor, which increases the wind loads it must be designed to resist." But importance factors only work if builders know what a structure's end use will be, Guikema says. For industrial buildings, they may not.

In the coming years, hundreds of billions of dollars will go toward building and repairing the country's roads, bridges, and buildings. The stimulus bill alone, signed into law in February, sets aside $150 billion for infrastructure. Furthermore, some scientists predict that, as the seas warm in response to climate change, hurricanes will become more intense. Guikema is working with the U.S. Department of Energy to develop models that incorporate climate change in estimates of the impact hurricanes will have on the country's power system over the next century or two. Such models shed light on "where the power outages are going to be, how bad they're going to be, how long they're going to last, how much damage there will be," he says. Utility companies that foresee their risk of outage increasing in the coming decades may want to start reinforcing their infrastructures now.
—Cassandra Willyard, A&S '07 (MA)

Phonics alone not enough

Proponents of phonics — the teaching of reading through teaching letter sounds and sound strategies to build up words — have regarded the technique as a panacea for illiteracy. Phonics was the centerpiece of the Reading First program, which was created by the No Child Left Behind Act of 2001. But a recent Johns Hopkins study indicates children can't succeed on phonics alone. A comprehensive review by the School of Education's Center for Research and Reform in Education found that the best results were produced by programs that used a combination of extensive professional development for reading teachers, cooperative learning among the students, and innovative phonetic materials.

"What was consistent with all the successful programs was that teachers were changing their methods when necessary," Slavin says. "It's not enough to just introduce a new book. What made the difference was professional development for teachers: giving them specific instructional strategies and methods that could be applied to their particular groups of students."

The two most successful reading programs, according to the survey, were the PALS (Peer Assisted Learning Strategies) method, developed by researchers at Vanderbilt University, in which children are taught simple strategies while working in pairs, and Success for All, a comprehensive reading approach for pre-K through sixth grade, designed in 1987 by a partnership of Baltimore City Public Schools and Johns Hopkins. Success for All, now used by 1,300 schools in 46 states, stresses early intervention to respond to and solve any child's learning problems. Ten thousand schools currently use PALS for reading and math.

National data show that educators are struggling to boost beginning reading skills and that reading proficiency for too many students falls below grade level. With Reading First now being phased out, Slavin says, in the current political climate of accountability school leaders need to ensure they put in its place programs that work: "Beginning reading is hugely important, one of the most important things to get right."
—Greg Rienzi

Teens need Vitamin D

Reis used data gathered from 2001 to 2004 by the Centers for Disease Control and Prevention. The data came from examinations of adolescents carried out in mobile CDC health stations operated nationwide. Reis found that a majority of the 3,600 teens aged 12 to 19 tested during routine physicals were not getting enough vitamin D. Those whose blood contained the lowest levels were more than twice as likely to have hypertension and higher-than-normal levels of sugar in their blood. What's more, they were four times as likely to have metabolic syndrome, a condition tied to obesity that can include a combination of cardiovascular risk factors, including high cholesterol.

Several things contribute to unhealthy levels of the vitamin. Poor diet, darker skin tone, lack of time outdoors, and where children live can all lead to deficiency. People don't ingest much vitamin D from sources like oily fish, including salmon, and fortified foods, including milk. "Ninety percent of what we get comes from the sun," Reis says, adding that 15 minutes of sunlight a few days each week should be enough to raise the amount of the vitamin in the blood to healthy levels. People in New England and other points far from the equator may need to spend more time in the sun or take supplements to get enough of the vitamin, which is also vital to bone health. African Americans, because of their skin color, also might need additional vitamin D because their skin doesn't absorb it from sunlight as readily as fair skin. Also, the widespread use of sunscreen, which blocks ultraviolet rays, protects people from skin cancer but may be keeping them from making the vitamin D they need to stave off other diseases, Reis says.

Although the minimum daily requirement of vitamin D recommended for teens by the federal government was recently raised to 400 international units — about the amount found in two pints of milk-"there has been a lot of talk among experts that that is too low," he adds. "We've looked at vitamin D levels in the past through the prism of bone health. Lower levels might make for healthier bones but may not be enough to get the full benefit of the vitamin throughout the body."
—Michael Anft

Are pain-free animals ethical?

A few years ago, a 10-year-old Pakistani street performer made headlines because of a rare disorder: He was unable to feel physical pain. The boy — who walked on hot coals and pierced his arms with knives for a living — had a mutation in the gene SCN9A. His powers were a fluke of nature, but scientists have been working on bioengineering animals with the same bizarre disability. They've already succeeded in increasing pain thresholds in mice and theoretically could create an animal that feels no physical pain at all. Researchers, bioethicists, and medical historians at Johns Hopkins have been pondering the implications of this potential, particularly as it relates to lab animals. If scientists created an animal that could not sense pain, would its use in the laboratory be acceptable?

"Our major conclusion from the survey was that people care about animals," says Goldberg. "And they feel that it is not pain alone, but the intrinsic value of the animal that matters."

Hopkins bioethics professor Hilary Bok, who helped lead a recent seminar on the ethics of using pain-free animals in the lab, says that the medical benefits of animal testing have to be weighed against more than just infliction of pain. "Just making animals so they can't feel pain would only satisfy you if you think the only bad thing we do to animals is make them feel physical pain," she says. "What about all the other bad feelings: frustration, loneliness, fear, anxiety, sorrow?" Pain-free animals might also be oblivious to wounds or injuries, making it more difficult for keepers to detect health problems and more likely that animals would hurt themselves, says Bok. "It's a world in which you put your hand on the [hot] stove over and over again."

A more interesting, if unlikely, scenario, she says, would be if researchers could bioengineer an animal that experienced no negative feelings at all. It would be harder to argue that using such an animal in the lab would be bad for the animal, but public opinion would surely still be against it, she says. "What's unnerving, I think, is the idea that it would be better for these animals if we destroyed their capacity to live a normal life. If they'd be better off without their entire emotional lives, that forces us to acknowledge some things about the way we treat animals."
—Andrea Appleton

Genome spurs new curriculum

It took one monumental achievement — the mapping of the human genome — to inspire a quantum change in how medical students at Johns Hopkins learn to treat patients. Starting next year, the 120 students entering the School of Medicine will tackle a course load completely retooled to teach medicine through the prism of the genome. The new program, called Genes to Society, has been designed by Hopkins faculty to revolutionize students' perspectives on how patients get sick and how medicine can better help them recover.

While past models centered on diagnosing individual diseases and treating them, the Genes to Society curriculum reflects a shift toward treating patients more holistically. By learning to examine an individual's entire biology, as well as the effects environment, family life, and genetic inheritance have on his or her health, students will ostensibly be better prepared to treat them. That includes patients who suffer from a condition or multiple conditions that develop over time, such as diabetes, hypertension, and obesity — chronic afflictions that make up the bulk of medical cases in the United States and whose incidence increases each year.

"The idea is for students to move away from the ill or not-ill mode of diagnostics and to instead place a patient on a spectrum," Nichols says. "On one end of it is the time before a patient presents with a disease, and on the other is when they are critically ill. [Students will] be taught how to view that patient and his health at all points along that spectrum and over a longer period of time."

Since deciding six years ago to radically change how they teach people to become doctors, School of Medicine educators have performed major surgery on its requirements. Out from the old curriculum are courses in pathology, pathophysiology, and pharmacology. In is a new emphasis on systems biology that will use patients' case studies as subjects in a variety of courses, so students can learn about a wide range of factors that lead to disease, says Nichols.

During their first six months in med school, students will take "foundation courses" based on clinical studies, public health, and scientific knowledge. Then, they will apply what they learn to the cases of several people suffering from disease, or who soon might be. A patient with, say, a nervous disorder might become the subject of several classes, instead of merely being included in a neurology course, as has traditionally been done. Cases of patients who have recovered from a disease will be compared with stories of patients who have died from it. Students will be asked to determine which factors — including economics, family and genetic histories, and medical treatments — may account for the different outcomes. Starting in the second semester, students will take a yearlong Genes to Society class that will focus on the role inheritance plays in disease. A course that spans all four years of medical school, called Patient, Physician, and Society, will teach the roles behavior and society play in a person's health.

The new curriculum includes a heightened emphasis on communications and medical teamwork. The program will also demand that students gain more practical experience. For example, from the second year on it will require several clerkships in such fields as emergency medicine, pediatrics, and surgery. Students will join a physician practice outside of campus for one year, during which they will track patients as part of a group of providers.

Hopkins is part of a nationwide trend toward preparing students in a more holistic way for the cases they will see once they graduate, with a goal of creating doctors capable of delivering personalized medicine. "There's a realization that medical students need to know about all kinds of systems — genetic information, organ systems, the family, society, molecular systems — so they can be effective physicians," says Carol Aschenbrener, executive vice president and chief strategy officer at the American Association of Medical Colleges.

"We're hoping this will be an exciting way to learn medicine," Nichols adds. "The issue is, how do you teach people to do individualized medicine? It's tough to get there. We've put out a pretty strong first draft on how you do that. We see it as a scaffolding for future thinking."
—MA

Springtime of champions

Men's and women's tennis both won their third straight Centennial Conference championships, qualifying for the NCAA national championship tournament and reaching the Sweet 16. In addition, junior David Maldow and sophomore Andrew Wang had been invited to compete in the NCAA singles and doubles national championships. For Maldow, this marks the third straight year that he has earned a spot in the 32-player tournament. He compiled a 17-4 record and at press time was ranked 10th in the nation. Wang won 20 matches against only two losses, becoming the first player in Johns Hopkins history to have back-to-back 20-win seasons.

Baseball won its third straight Centennial Conference championship, to qualify for the NCAA tournament. Last year, the Jays advanced to the national championship game.

Finally, men's lacrosse rode a six-game winning streak into the NCAA national championships. At press time, the Jays had advanced to the quarterfinals by defeating Brown University in an overtime thriller, 12-11.
—Dale Keiger

A chain for more transplants

Of the 80,000 people who need kidney transplants each year, more than 4,000 die while on waiting lists. Frustrated by the slow pace in reducing the suffering of people with end-stage kidney disease, a Johns Hopkins surgeon has helped come up with a way to turn one kidney transplant into a string of 10 or more. A so-called daisy-chain transplant begins when an altruistic donor provides an organ for a transplant patient whom he or she does not know. If a friend or relative of the recipient was willing to donate a kidney but could not because of incompatible blood or tissue type, doctors pair that person with another recipient who is compatible, creating another donation. Surgeons at various hospitals around the country extend the chain as long as they can.

About 16,000 people receive transplants each year, but only 6,000 kidneys come from living donors. Those organs are preferable because they are less prone to rejection or infection. Also, a kidney from a deceased donor must be held in suspended animation until surgery can be arranged; a transplant from a living donor can occur soon after the organ is removed. All this improves a patient's chance of long-term survival. Compared to the recent multiple-organ swaps that have brought together pairs of compatible donors and recipients, a daisy chain of altruistic donors creates a larger pool of blood and tissue types, says Montgomery.

Kidney donations in general have remained flat, but the proportion of donors who have no friendly or family ties to recipients has increased substantially in the last six years, largely because would-be donors have answered patients' online pleas for help. Their generosity is key to chain transplants. A second key, Montgomery says, is that unlike a multiple-kidney swap, not all of the surgeries in a chain have to be performed simultaneously in the same hospital. They can be sequential, which makes them much easier to coordinate. "There are fewer logistical hoops to jump through," Montgomery says. It's possible, he adds, that such chains could reach a dozen, or possibly dozens, of people. Montgomery, senior author of an article about the new technique in the March 12 edition of The New England Journal of Medicine, outlined one chain that started in Arizona and ended at Johns Hopkins one year later. In all, 10 people received kidneys at five hospitals.

Montgomery admits that the daisy-chain concept is not without flaws. Some people pledge to make donations, then later back out, which breaks the chain. And the method carries at least a shred of controversy. "Ethicists will be heard from who question whether it's right to hold on to a kidney to start a chain instead of getting it to someone at the top of the list for donations from [cadavers]," says Montgomery. "We'll be very interested to hear what they have to say."
—MA

Obama taps provost

The Obama administration dipped into Johns Hopkins' wellspring of talent last March and nominated provost Kristina M. Johnson for undersecretary of the Department of Energy. In that position, Johnson will lead administration initiatives for development of green energy technology such as solar and wind power, geothermal energy, and cleaner-running automobiles. At press time, Johnson's appointment had not yet been confirmed by the Senate.

Johnson came to Hopkins in 2007 from Duke University, where she was dean of the Pratt School of Engineering. At Hopkins, she restructured the provost's office and contributed to the creation of the new School of Education and Carey Business School. She also led the 18-month Framework for the Future strategic study that produced recommendations to strengthen both university research and education. In 2008, she won the John Fritz Medal, the nation's highest award in engineering.

In a written statement, university President Ron Daniels said of Johnson, "Although we will miss Kristina's energy and imagination, it is a singular source of pride for Johns Hopkins that she has been called upon to serve the country at such a critical juncture."

The university announced that Scott L. Zeger, vice provost for research and a professor of biostatistics in the Bloomberg School, would serve as interim provost and senior vice president for academic affairs during a national search for Johnson's successor.
—DK

Why are Indian women burning?

Five months after 19-year-old Anwari Begum's wedding, her body was found charred beside two empty kerosene cans near her home in South Delhi, India. Years later, a court found Begum's husband and mother-in-law guilty of her murder. Their motive: The young bride had not paid a large enough dowry.

Fire accounts for 2 percent of all deaths in India, according to a report published recently in The Lancet by Veena Das, chair of the Krieger School's Department of Anthropology, and colleagues from Harvard University. Women, most between the ages of 15 and 34, account for nearly two-thirds of those deaths, the study found. Indian women usually cook family meals, leaving them more vulnerable to kitchen accidents. But experts attribute most of the gender skew in fire deaths to dowry disputes and other forms of domestic violence. Although outlawed in 1961, demanding a dowry — even several years into a marriage — remains common practice throughout India. Some Indian women also practice hypergamy, or "marrying up" to a higher caste, which may breed resentment from the groom's family and result in demands for a heftier dowry.

Sorting out how many fire fatalities are homicides, suicides, or accidents is tremendously difficult in a country so large and decentralized. Large urban hospitals keep records on cause of death, as do some police departments and a few cremation grounds. But in rural areas, many of which don't even have police departments or hospitals, few records exist. "Increasingly there's a greater push in India to systematize the statistics on cause of death. But the institutional frameworks for doing so are completely missing," Das says. "Our suspicion was that [fire deaths] are vastly underreported in police data, and even when they're reported, it's quite likely that the death would be declared accidental."

The study estimated more than 163,000 fire-related deaths in India in 2001 — six times the number reported in national police statistics. The majority of the deaths occurred in low-income rural areas. "Dowry death is an endemic problem in Indian society," says Virendra Kumar, head of forensic medicine at the Meenakshi Medical College and Research Institute in Chennai, India. The study's number is probably an underestimate of the true number of fire deaths, he says, because many of the available datasets are woefully incomplete.

Better forensic evidence is key to finding more accurate numbers, says Das, which is the first step to making useful policy changes. Only about 15 percent of all deaths in India are medically certified, according to Das. To get better estimates for the study, she and her colleagues tapped many government, medical, and community sources. They combined government statistics with individual hospital reports and "verbal autopsies" — in which local investigators question the victim's family members or neighbors about the circumstances of death — from rural communities.

"So much [government] planning is done on the basis of what are presented as 'real' numbers. Not only for fire deaths, but even for things like disease ecologies," she says. "Estimating how reliable these numbers are is an absolutely urgent thing."
— Virginia Hughes, A&S '06 (MA)

The conductor at age 15

Rivas is the fourth generation in his family to take up the baton. His great-grandfather was a band leader, his grandfather a choral conductor, and his father, Alejandro, has led orchestras and taught in Venezuela and the United States. Currently on the faculty at Metropolitan State College of Denver, the elder Rivas recalls that his son memorized Mozart's Symphony No. 40 when he was 7 years old, conducting the piece while listening to a recording.

His father recalls, "He always asked me to take him to rehearsals, and there, instead of falling asleep as you would expect from a 6-year-old during a long rehearsal, he would sneak himself among the musicians on the stage, sit with different families of instruments, and ask them questions."

Gustav Meier, director of Peabody's graduate conducting program, says, "When I watched him auditioning for the Baltimore Symphony I was just blown away. I have never seen a 15- or 16-year-old with that amount of talent. Fabulous memory, wonderful musician, and great hands. He still needs guidance, and Peabody is exactly the place for him."

In August, Rivas will make his professional debut when he conducts Tchaikovsky, Verdi, and Mendelssohn with the Atlanta Symphony Orchestra.
—DK

Return to June 2009 Table of Contents