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.
Program: Scholar
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 neurodevelopment—yet 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 infection—a prevalent condition associated with adverse pregnancy outcomes—disrupts 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 sepsis—the most common cause of newborn death.
Harnessing the Gut Bacterium Akkermansia muciniphila for Probiotic Innovation and Healthy Aging
The human gut is home to trillions of microbes that play a critical role in health and disease. My laboratory investigates common beneficial bacteria that colonize the intestinal mucus layer. While these bacteria offer benefits including improved metabolic health, they can also weaken the gut’s protective mucus barrier, leading to inflammation. We are using advanced genetic techniques to engineer probiotic strains that maximize health benefits, while maintaining gut safety. A major focus of our work is to engineer these bacteria as probiotics to promote healthy aging and longevity, and as innovative new types of vaccines. We are also working on strategies to modulate mucus degrading bacteria in the gut to combat graft-versus-host disease, a serious post-transplant condition. Using a combination of genetics, animal models, and bacteria isolated from human donors, we aim to contribute to the development of safe and effective microbiome-based therapeutics.
Understanding and exploiting the role of phagocyte mechanobiology in anti-tumor immunity
Cancer is the leading cause of mortality in British Columbia. Whereas the immune system has long been recognized as an effective protection against infections, recent breakthroughs have demonstrated that the immune system also has the capacity to control cancer progression. Thus, cancer immunotherapies are being developed as a new type of treatment that acts by boosting the natural capacities of the immune system and directing it to destroy tumors. Amongst the different types of cells composing the immune system, professional phagocytes have the unique capacity to eliminate cancer cells by engulfing and digesting them. Subsequently, they are able to activate other immune cells, called lymphocytes, to mount an immune response specifically directed against the tumor. However, new evidence suggests that mechanical cues and physical constraints prevent phagocytes from using their anti-tumor potential. The goal of this project is to understand how phagocytes sense, respond and utilize mechanical forces to overcome physical constraints, with the aim to harness these mechanisms to develop more effective cancer immunotherapies.
Characterizing metabolic biomarkers of drug response and precision treatment in triple-negative breast cancer
Triple-negative breast cancer (TNBC) is the deadliest breast cancer subtype, in part due to lack of targeted therapy. Therefore, there is a need to improve methods that determine if treatment is effective and to develop targeted therapies. Cancer cells reprogram their metabolism to enable tumour growth. In doing so, they release metabolites into blood and urine that can act as signals of tumour and treatment status, known as biomarkers. Rather than assessing treatment effectiveness months after therapy, measuring metabolite biomarkers may allow clinicians to determine response to therapy in real-time and early during treatment. Moreover, metabolite biomarkers can also indicate if a tumour is susceptible to specific treatment, thereby tailoring effective therapy to the individual patient. The proposed research program will determine how tumour metabolite biomarkers can indicate effective response and susceptibility to TNBC treatment. Ultimately, this work will contribute to validating metabolite biomarkers that can be used by clinicians to make informed patient care decisions and improve TNBC treatment.
The Road to Recovery Initiative (R2RI): A Prospective Evaluation of a Novel Program for the Delivery and Coordination of Addiction Care in a Canadian Setting
The consequences of substance use have had a devastating impact on British Columbia’s (BC) healthcare system. Since the declaration of the province’s public health emergency in 2016, over 10,000 British Columbians have died from an overdose. The lack of a coordinated addiction treatment system provincially is a significant contributor to BC’s present state. To address this, Providence Health Care is implementing the Road to Recovery Initiative (R2RI), an innovate model of care to address two aspects of BC’s addiction treatment crisis through: 1) increasing access to on-demand addiction care; and 2) reorganizing existing clinical services to support patients at every phase of recovery. The proposed Program of Research seeks to evaluate key health and social outcomes associated with the implementation of R2RI. Participants of this program will be followed for 5 years with data collection focused on: substance use, illness trajectory, community engagement, health care utilization, health risk behaviours, quality of life, overdose, and death. Knowledge gained through this research will identify outcomes associated with the provision of a coordinated addiction treatment system and will inform successful scale-up of this new approach.
Quantifying navigational impairments in preclinical Alzheimer’s disease
Our brain contains a ‘cognitive map’ of the external world that helps us navigate, and encode/retrieve memories. Dementias such as Alzheimer’s Disease (AD) degenerate these regions, causing well-known memory impairments and much less well-understood navigational impairments. My research program seeks to quantify how navigation is impacted in early AD in rodents and humans.
Young and older human participants will navigate a virtual reality maze. We will quantify how their errors in positioning and navigating scale when the complexity of the task is increased. We will perform similar experiments in rats navigating a physical maze, where we can additionally record neural activity. We will then extend the task to participants diagnosed with preclinical AD, and rodent models of AD. We will characterize the behavioural and neural correlates of early progression of AD, with the goal of finding a metric that is predictive of AD-induced cognitive impairment, and its underlying neural mechanisms.
Over 60,000 British Columbians currently live with dementia. A non-invasive and affordable test such as this will allow clinicians to perform early diagnosis, and start approaches that reduce symptoms and improve quality of life.
Innovating health promotion efforts in response to youth tobacco use
Today’s tobacco use landscape has shifted since the introduction of e-cigarettes, which have become highly popular amongst youth. Nicotine addiction, subsequent smoking, and increased heart and lung disease risk are some of the major concerns brought forward within the public health community in relation to e-cigarette use, with youth disproportionately at risk for these detrimental impacts. Compounding this new landscape of tobacco use include socio-environmental factors that impact use, including rapid advances in technologies (e.g., new social media platforms; smartphone applications). As a result, the new generation of tobacco users are not the same as previous generations, and efforts to protect young people from exposure to tobacco smoke and e-cigarette vapor must similarly shift to adapt to this new landscape. I am responding to this need through my program of research, whereby responsive, youth-driven evidence is being harnessed to develop youth-friendly tobacco control resources for delivery on their preferred digital platforms. Ultimately, this research will lead to optimal solutions to curb tobacco use and reduce tobacco-related disease, situating BC as a leader in adapting to tobacco use of today.