Prior to the Indian Act and the Potlatch Ban, Indigenous nations in Canada had complex and complete healthcare systems with intrinsic ties to the land and spirit-based understandings of the cosmos. Within these holistic systems, the individual, family, and community were cared for. These systems included medicinal plant use; ceremonial practices across the lifecycle; mentorship; and land-based connections. The purpose of this research program is to: a) enliven the concept of land as healer, b) reclaim ceremonial healthcare practices that were outlawed by the government for several generations, and c) articulate nation specific pathways to community wellness in contemporary contexts. Working with several nations on community identified land-based wellness projects, life-experience and traditional stories will be gathered with knowledge keepers, youth and community to answer the research question: How can we enhance intergenerational knowledge transmission to advance community wellness and the revitalization of traditional health systems? Recommendations will inform the development of nation-specific community wellness frameworks and present ways forward for Canadian healthcare systems that engage the role of traditional healing.
Program: Scholar
Molecular mechanisms and genomic consequences of transposable element hijack strategies during embryogenesis
Transposable elements (TEs) are selfish genes that self-copy and move around the genome. Robust defense mechanisms silence TEs to prevent them from causing devastating mutations that break DNA and destroy genes. Failed TE suppression is associated with myriads of disease phenotypes including tumorigenesis and sterility. But the defense is not failsafe; TEs repeatedly acquire evasion tactics, enabling them to amplify at the expense of the genome. Using the powerful model organism, the Drosophila, this proposal aims to dissect hijack strategies TEs adopt during embryonic development. The first strategy is the timely activation of TEs before silencing is fully established. The second is for TEs to concentrate their activity near cells to increase the chance of passage to the next generation. To further reveal the full mutational impacts of TEs, we will artificially induce TE activity across multiple generations. Large numbers of new TE insertions will enable us to determine the deleterious impact on epigenetic state, gene regulation, and nuclear organization. Elucidating how TEs âcheatâ and disrupt the genome will critically inform preventative and treatment plans for diseases caused by genome instability.
Towards improving pain management for children using patient-specific genetic information
In children, ongoing pain can interfere with brain development, disrupt behaviour and increase the risk of chronic pain. This can be particularly devastating in children with high burdens of pain, such as children with cancer, many of whom experience highly-distressing pain requiring opioids. Providing timely and adequate pain treatment for these children is critical, yet it remains challenging to predict who will experience pain requiring opioids and how these children will respond to prescribed opioids. This is especially difficult in young children who cannot articulate their level of pain, limiting their ability to receive appropriate relief without harm.
My research program is working to identify unique genetic signatures that predict how likely a child is to develop painful conditions, experience severe pain and respond to opioid-based pain relievers. This information will be used to develop predictive genetic tests to inform medication choices that will enhance the safety and effectiveness of pain management strategies for children. This work also has the power to combat the opioid crisis that continues to devastate British Columbians, where opioids can be restricted to patients most likely to benefit without harm.
Digital interventions for concussion: Connecting youth and their families to care
Concussions are very common among children and adolescents. While many recover without complication, a third of those who sustain a concussion will experience symptoms that last months or years after injury. Children and adolescents who experience a slower than typical recovery report lower quality of life. This means they have increased physical and mental health concerns, more family stress, and reduced participation in valued activities (e.g., school, sports). Despite the prevalence and negative impacts of concussion, treatment options are lacking and often inaccessible (e.g., expensive, only located in major city centers). My research aims to create accessible treatment options for children and adolescents who sustain concussions. I will develop and test digital health interventions that support children, adolescents, and their families with their recovery (e.g., psychoeducational websites and smart-phone app-based behavioral interventions). This research will improve the lives of the many Canadian youth and families who have been impacted by concussion. This knowledge will be shared with other researchers and healthcare providers to improve concussion care.
Optimization of cardiovascular health in postpartum women with reproductive and pregnancy-related risk factors
Heart disease is the number one killer of women worldwide and the leading cause of premature death in Canada. In recent years, heart disease related death and illness has increased in women after childbirth. Besides well-known risk factors, women after childbirth face an additional burden of pregnancy-related risk such as high blood pressure and diabetes during pregnancy, however, the risk often gets unrecognized in primary care. Though there are many risk prediction models, they are designed to predict risk in general population and do not take into account the reproductive risk factors that limits their use in women after childbirth. My program of research on Womenâs Heart Health, aims to answer the following questions: 1) What are the contribution of reproductive and pregnancy-related risk factors in predicting the heart disease risk in women after childbirth? 2) What is the feasibility and acceptability of using risk prediction tool in primary care? 3) What is the effectiveness of risk prediction tool in screening heart disease risk in women after childbirth? The proposed local research in BC will aid in solving a problem in Canada by recommending a heart disease risk assessment and risk management of women after childbirth.
The Lifetime Exposures and Asthma Outcomes Projection Model (LEAP): A Platform for Improving Asthma Prevention in Canada
Asthma is the most common chronic disease among children in Canada. It has several main causes that occur in utero and early in life. These ârisk factorsâ can be reduced through public health interventions that prevent asthma before it develops. Despite the opportunity to drastically reduce asthma in Canada, little progress has been made on asthma prevention due to a poor understanding of which interventions to invest in and when they should be applied. My objective is to provide high quality evidence to patients, providers and policy makers on how healthcare resources can best be used to prevent asthma in children. My research program will accomplish this objective using a computer simulation model of asthma (the Lifetime Exposure and Asthma Outcomes Projection [LEAP] model), which simulates the development and life trajectory of asthma. I will evaluate a series of preventative interventions that patients and knowledge users have identified as priorities, and determine their lifetime health benefits and impact on the healthcare system. I will work closely with patients, providers and policy makers to make sure the resulting policy recommendations are aligned with their values and can be implemented in healthcare systems.
Healthcare ethics and health equity: Improving access to care through equity-focused ethical reasoning and participatory ethics research with health professionals and equity-deserving groups in BC
Uncertainty about how to ethically provide healthcare services can create barriers to care, as access to care is slowed or stopped while ethical concerns are addressed. These barriers to care can affect the health of members of equity-deserving groups, such as people who use drugs and Two-Spirit, transgender, and nonbinary people. This research focuses on gaps in knowledge about unresolved ethical issues affecting equity-deserving groups in British Columbia. Ethical issues will be addressed by: designing and testing strategies to enhance ethical reasoning skills among health professionals; working with members of equity-deserving groups and health professionals to resolve ethical dilemmas; developing a new method for ethical analysis; and openly sharing resources and resolutions. It is anticipated that the ability of health professionals to respond to ethical dilemmas will be enhanced and access to care will improve for members of equity-deserving groups. Enhanced ethical reasoning and expanded access to ethical resolutions will change practice through reducing barriers to care and support evidence-based policy, while developing a participatory empirical ethical analysis method will support future research in healthcare ethics.
Bridging KT Connections: Using the social drivers of knowledge translation (KT) to improve health care service delivery
In health care, knowledge translation (KT) is the process of moving knowledge into action to improve health systems, health services and health outcomes. KT is a social process that connects people to knowledge and supports. My area of expertise, implementation science, examines the factors that influence the use of knowledge from research and lived experience. My research program focuses on the importance of connections between people and organizations that can support KT. I use theories and evidence to design strategies to improve the use of best practices by health care providers, leaders and patients. I apply this research in health care centres, research institutes, community organizations, government, rehabilitation, and other settings. Our team is identifying and then testing a range of socially based strategies to strengthen connections between researchers, health care providers and families that can help move knowledge into action. This work will confirm the best approaches to use in different health care and research settings to improve care. The impact of this research will be to improve access to the safest, most effective health care for children and their families.
Investigating the role phagocytic immune cells play in developmental programming during gestation
Microglia, the resident macrophages and phagocytic immune cells of the brain, play an important role in neurodevelopmentâyet a fundamental question is whether these same roles have evolved in other regions of the fetus. My research is targeted at addressing this question by studying the contribution of macrophages to processes that shape the development of the skull and face (i.e., craniofacial morphogenesis), and whether distinct populations of these immune cells signal locally to contribute to normal development. During pregnancy, disrupting macrophage functions results in craniofacial and dental abnormalities. To explore the developmental contribution of these immune cells to the craniofacial region, we will use our established pharmacological mouse model alongside state-of-the-art expression profiling and imaging technologies. By studying how macrophages contribute to normal development of craniofacial tissues, this research will lead to advancements in our understanding of how maternal insults like maternal periodontal infectionâa prevalent condition associated with adverse pregnancy outcomesâdisrupts developmental programs. Overall, this research will broaden our knowledge of maternal-fetal interactions to benefit Canadians.
Using systems biology to improve neonatal sepsis diagnosis and treat antimicrobial-resistant infections
Several infectious diseases are among the top causes of death worldwide, including ~7% of deaths in Canada. Bacterial infections are often treatable; however, chronic misuse of antibiotics has created a critical global health threat by increasing antimicrobial resistance (AMR). In addition, bacterial infection can lead to sepsis, which is particularly dangerous for newborns and kills three million babies per year. Avoiding further infant deaths will require (1) methods to predict and detect sepsis early, enabling treatment when the chance of survival is greatest, and (2) knowledge of how pathogens like Klebsiella pneumoniae cause disease in newborns, guiding the development of targeted treatments that overcome AMR. Using hundreds of newborn blood samples, we are using cutting-edge genomic, bioinformatic, and machine learning approaches to identify molecular changes induced by sepsis that are generalizable to infants worldwide. This research is critical for our long-term goal of developing rapid tests and precision treatments that neutralize sepsisâthe most common cause of newborn death.