Strokes are caused by the interruption of blood flow or the rupture of blood vessels to the brain. This sudden loss of brain function can damage the brain centers that sense or move parts our body, profoundly impacting both physical and mental functions. As a result, stroke is the number one cause of acquired disability in adults around the world. Some stroke survivors are able to recover more quickly and more completely than others. Although recovery is influenced by the location of damage in the brain and the extent of the damage, recovery is also influenced by the brain's innate ability to initiate repair and re-wire damaged blood vessels and neuronal circuits in surviving regions. At the present time, we do not yet know why this re-wiring takes place in some patients but not others, nor do we know how to manipulate this process. What we do know is that this repair process can vary between patients and that some patients, such as diabetics, have a poorer prognosis following stroke.
Dr. Craig Brown's lab will use advanced imaging technologies to assess brain structure and function to understand how the brain is able to repair itself following a stroke and to understand why this is such a variable process between different patients. His research program is focused on three distinct yet complimentary lines of research, including: 1) understanding the impact of diabetes on recovery from stroke; 2) using electrical nerve stimulation to improve stroke recovery; and 3) elucidating the cellular/molecular mechanisms of learning or experience-based brain "plasticity".
As a result of this innovative research, Dr. Brown hopes to better understand the brain's plasticity associated with normal (learning/memory) and pathological (diabetes/stroke) brain states. His intent is that this work will stimulate new therapies for improving brain function both in normal situations and after stroke, particularly in patients who have previously had a poor prognosis.
Motor vehicle crashes cause 15,000 serious injuries and over 2,000 deaths in Canada annually. The contribution of drug-impaired driving to these tragedies is unknown, but suspected to be significant. This lack of knowledge hinders the development of effective traffic safety policies to prevent drug-impaired driving.
The research of Dr. Jeffrey Brubacher aims to prevent injuries and fatalities resulting from motor vehicle crashes. His research program consists of three inter-related themes:
- Cannabis and motor vehicle crashes. This five- year study will examine 3,000 injured drivers from five BC trauma centres to determine whether there was recent marijuana use before their crashes and whether or not the driver caused the crash. The study will provide important information about the role played by marijuana in causing car crashes.
- Prescription medications and motor vehicle crashes. This project will involve combining BC prescription data with BC driver records, including traffic accident reports, to determine whether or not drivers are more likely to be involved in a crash when they are taking prescription medications such as sleeping pills or pain medications.
- The Injured Driver Platform. This study will provide information on the motor vehicle crash risk associated with recreational drug use. Over an initial three-year period, medical data will be collected and interviews will be conducted with injured drivers at five BC trauma centres, and drivers will then be followed for two years after their original crash to determine how often they are responsible in other accidents or drive while impaired.
This project will help to identify risk factors for impaired driving which may be used to develop targeted interventions to prevent this risky behaviour. Dr. Brubacher's research will contribute to an international effort to understand the role played by prescription medications, marijuana, and other illegal drugs in causing motor vehicle accidents. He will present his findings to government officials so they are better able to develop effective road safety policy and public education campaigns targeting impaired drivers and, by doing so, to improve safety on our roads.
Chronic obstructive pulmonary disease (COPD) is a lung condition that affects more than 75,000 British Columbians. People with COPD have a shortness of breath, chronic cough, and can experience difficulties with the activities of daily life, such as showering, walking, and social activities. Many people with COPD have regular flare-ups, or exacerbations, of their lung condition. These exacerbations result in a severe shortness of breath and overall weakness and fatigue and sometimes lead to long hospital stays. These flare-ups and long hospital stays can cause severe problems with activity tolerance, which then further increases the risk of future flare-ups.
The objective of Dr. Pat Camp's research program is to investigate how physical activity can improve the health outcomes of people who are hospitalized with a COPD flare-up. This research program will include a systematic literature review to summarize the current state of knowledge, validating tools to measure activity in hospitalized COPD patients, and determining if exercise programs for hospitalized patients can improve their quality of life and health outcomes. In addition, Dr. Camp's research program will include projects that incorporate patient input about what activities are important to them, which will indicate the level and type of activity that is necessary in order for these patients to be discharged safely from the hospital.
By developing a thorough understanding of how exercise leads to increased health in COPD patients, this research program aims to improve the quality of life and overall health of patients hospitalized with acute COPD flare-ups. Future work will extend these innovations to other chronic lung disease populations, such as patients with lung transplants or interstitial lung disease.
In reaction to air pollutants, asthmatics may experience an “”asthma exacerbation”” characterized by the narrowing of their airways. This may lead to a shortness of breath that may require urgent medical attention. One source of air pollution associated with asthma exacerbations is diesel exhaust. How and why diesel exhaust causes exacerbations is unclear, but one hypothesis is that it causes “”oxidative stress””, which is damage to cells and body tissues due to certain chemical characteristics. Ongoing exposure to traffic-related air pollution can also result in new asthma in previously healthy individuals. Dr. Christopher Carlsten is working to understand how different air pollutants, particularly diesel exhaust, influence asthma. He is trying to determine whether diesel exhaust creates oxidative stress, and, if so, if that stress is responsible for airway narrowing in human asthmatics. In his laboratory, diesel exhaust is generated in concentrations typically found in mining operations or in busy bus terminals. Volunteer subjects inhale the exhaust for two hours – a short exposure time has no permanent effects but does produce mild, temporary changes – and changes in oxidative stress and airway narrowing are measured. In some subjects, other typical environmental allergens such as tree and grass pollen are added to see if they worsen the effect of diesel exhaust. In addition to this work, Dr. Carlsten and colleagues are following a group of more than 20,000 children from birth to see how their exposure to such pollution may lead to new asthma. Dr. Carlsten’s research will lead to a better understanding of diesel exhaust-related airways disease and will lead to measures to protect Canadians exposed to traffic-related pollution. This research aims to inform recommendations for or against changes in fuel composition and/or personal measures to bolster anti-oxidant levels. Dr. Carlsten’s work to understand the effects of air pollution on asthma development should inform interventions regarding pollutant exposure in children.
Borderline personality disorder (BPD) is among the most complex, misunderstood, and stigmatized mental health problems. It is a serious psychiatric condition characterized by instability in relationships, emotions, identity, and behaviour that often induces intense emotional suffering and places affected individuals at high risk of suicide and self-injury. Approximately 10% of individuals affected by BPD die by suicide, 75% have attempted suicide, and 70-80% self-injure. BPD is also a significant concern for the public health-care system. Patients affected by BPD represent up to 20% of psychiatric inpatients and heavily utilize outpatient and hospital emergency services. In fact, the estimated costs to the health-care system per year for each BPD patient range from US$12,000–$30,000. Self-injury and other problems in BPD appear to be related to problems in the management of emotions, or emotion regulation problems.
Dr. Alexander Chapman’s research aims to better understand and treat BPD and related problems, such as self-injury and suicidal behaviour, by examining the role of emotions in BPD and self-injury. Research in his lab, the Personality and Emotion Research Laboratory, includes a variety of studies aimed at better understanding what causes and maintains BPD and self-injury, as well as studies designed to help us understand how to effectively treat BPD. He is also conducting studies on the risks and protective factors for self-injury.
Dr. Chapman’s short-term goal is to continue to develop his research on BPD in two key areas: (1) the role of emotion regulation in BPD and self-injury, and (2) effective treatments for BPD and NSSI. He has several grants for studies in these areas and hopes to expand this research over the next five years. In the long-term, Dr. Chapman would like to develop an interdisciplinary research, treatment, and education centre focused on BPD, self-injury, and related health problems. Such a centre would be unique in Canada and would have the potential to significantly improve our understanding and treatment of BPD as well as the education and training of junior researchers and professionals.
Organ transplantation is a life-saving procedure for many individuals. Unfortunately, the long-term success of this procedure is compromised by the rejection of the transplanted organ(s) by the recipient's immune system. T cells are specialized cells of the immune system that protect against infections but that recognize and damage transplanted organs. Understanding how T cell responses are controlled will help to develop new methods to increase the long-term and specific acceptance of transplanted organs.
Dr. Jonathan Choy's research is focused on understanding how T cell survival and persistence is regulated and how these processes contribute to organ transplant rejection. By understanding this, Dr. Choy intends to find new ways of controlling the immune response against transplanted organs. Preventing rejection will improve outcomes for the approximately 2,000 Canadians who receive solid organ transplants each year, as well as for the many Canadians who are already living with transplants.
The number of individuals suffering from chronic obstructive pulmonary disease, or COPD is on the rise in Canada and around the world. COPD, is an inflammatory disease primarily associated with lung inflammation. Inflammation also extends beyond the lungs, and the presence of inflammatory factors in the blood causes blood vessel and heart disease, increasing a COPD patient’s risk of heart attack and stroke. Exercise training is known to have anti-inflammatory effects that are beneficial in the treatment and prevention of a number of chronic conditions. However, the effects of exercise on inflammation in the airways and blood of COPD patients is not well understood. It is also unknown whether exercise training can reverse some of the detrimental effects of inflammation in the blood vessels and brains of patients with COPD and reduce their risk of having a heart attack or stroke. To answer these important questions, Dr. Neil Eves will be conducting two studies. His first study will investigate how exercise training affects the airway and blood inflammation of patients with COPD. His second study will investigate how exercise training improves blood vessel function in patients with COPD and whether these improvements are related to changes in inflammation. Reducing inflammation with exercise in patients with COPD could greatly improve the health of these patients and reduce secondary morbidities associated with the disease.
The impact of cancer on our society is enormous. According to the Canadian Cancer Society, an estimated 9,300 people will die of cancer in British Columbia in 2011, with 22,100 new cases being diagnosed. Despite the many different treatment options that have been developed in the past several decades, the high death rate demonstrates that new and better therapeutic approaches are necessary. Cancer is often caused by the disruption of cellular control and regulatory mechanisms. One such regulatory mechanism known as “”autoinhibition”” allows proteins in the cell to switch their own function on or off. Genetic mutations or viral infections can result in the disruption of this autoinhibitory function, which can lead to a continuous activation of these autoinhibitory proteins. This can result in cell changes and can ultimately lead to cancer. Dr. Joerg Gsponer is taking a new approach to understanding how cancer develops and, ultimately, how it may be controlled. His research group is is aiming to improve our understanding of the mechanisms of autoinhibition with the help of computational methods. His team will develop new computational algorithms that will help identifying proteins in the cell that are regulated by autoinhibition and reveal how the autoinhibition works and how it is disrupted in the disease case. Ultimately, this will further our understanding of how cancer develops and will hopefully help to identify new drug targets for cancer therapy.
Early delivery (delivery before spontaneous labour by induced labour or caesarean birth) is often considered for high-risk pregnancies to prevent stillbirths and protect the mother from developing pregnancy complications. However, the optimal time for early delivery is often unclear. Although birth between 37 and 41 weeks of pregnancy was once considered ideal, babies delivered early at 37 to 38 weeks are more likely to have breathing complications than babies delivered later. Deciding when a higher-risk pregnancy should be delivered therefore involves balancing the risks to the baby from delivering too early against the risks to the mother and fetus from delaying delivery too long.
Dr. Jennifer Hutcheon's research focuses on better understanding the risks and benefits associated with early delivery and how they change on a week-by-week basis. She is studying the optimal timing of delivery for repeat caesarean surgeries (a caesarean scheduled after the caesarean delivery of a previous child). Delivery before 39 weeks is not recommended because it will increase the risk of breathing complications in the infant at birth. However, planning the surgery for a later week of pregnancy makes it more likely that the mother will go into spontaneous labour before her scheduled surgery. Early work has found that despite the risks to the baby, 62% of repeat caesarean births in British Columbia happen before 39 weeks.
Dr. Hutcheon will review the medical records from all pregnancies in BC between 2001 and 2010 stored in the BC Perinatal Database Registry to better understand the factors causing the high rate of early-term delivery in women having repeat caesareans and the potential risks associated with delaying delivery until 39 weeks or later. Using large population and clinical databases, she will also examine the week-by-week risks of delivery and delaying delivery in other higher-risk populations, such as twin pregnancies and older mothers.
Dr. Hutcheon will use the information she obtains to calculate the week-by-week risks for mother and infant associated with delivery and with delaying delivery, in order to highlight the time in pregnancy at which both risks are lowest. She anticipates that her work will help inform best practice in the province and will ultimately have a positive influence on the health of babies born in BC.
Cardiovascular disease is a leading cause of death and disability worldwide. Long-term disease management approaches are effective at reducing the risk of death and disability in patients with cardiovascular disease. Canadians of South Asian and Chinese ancestry are more likely to die from heart disease or stroke than other Canadians and there is emerging evidence that these groups may have poor chronic disease management. Optimal chronic heart disease management may be significantly impaired by language barriers, a limited understanding of health determinants, and potentially differing cultural views of heart disease and treatments. The goal of Dr. Nadia Khan’s research program is to improve chronic cardiovascular care for Canadians of South Asian and Chinese ancestry. She is currently undergoing a very large study of 600 South Asian, 600 Chinese, and 600 Caucasian patients discharged with acute heart attack or unstable angina from hospitals in Vancouver, Toronto, and Calgary. The objectives of her research program include: (1) determining differences in chronic cardiovascular disease management between South Asian, Chinese, and Caucasian patients; (2) identifying the underlying patient barriers associated with poor care for each of these groups; and (3) using this information to develop targeted and culturally sensitive interventions in chronic cardiovascular disease management. Working alongside health care workers, ethnic community members, and decision makers, Dr. Khan will be developing and testing the new strategies to ensure that they are acceptable and practical for each ethnic group. This is the first program to systematically evaluate how different ethnic groups manage coronary artery disease and to identify the cultural factors that may be linked with poor care. The evidence obtained from this study will be used to plan culturally sensitive care programs for those with heart disease who are from South Asian or Chinese ancestry. This program of research will partner with community members, health care workers, and decision makers to ensure that the interventions are relevant to policy and practice.
