A surge in eating disorders during the COVID-19 pandemic has contributed to a workforce crisis. Our teamâs research shows that one-third of Canadian eating disorder clinicians are considering leaving their job. Currently, eating disorder services are primarily based in limited specialized programs. However, an innovative early intervention model in general mental health settings is being developed for the Canadian context. In this model, integrated youth services play a core role in rapid response. This capacity building model has significant promise, yet it is unknown how to best support clinicians working with this model.
The project will bring together researchers and research users for a full-day interactive event, to co-develop a research strategy for eating disorder early intervention in BC. The research agenda will focus on two key questions: (i) what are the barriers and facilitators to implementation of early intervention across BC service settings; and (ii) how can we best evaluate early intervention outcomes, and the impact of this service model on clinicians who provide care for eating disorders.
The project outcomes will be integrated into a pan-Canadian strategy for eating disorders early intervention research.
Research Location: BC Children's Hospital Research Institute
Developing Educational Tools for Neonatal Intensive Care Staff Regarding Rapid Genome-wide Sequencing
The Neonatal Intensive Care Units (NICUs) at BC Womenâs Hospital and Victoria General Hospital care for >2000 critically ill babies each year. Many of these babies are sick because they have genetic conditions which can be very difficult to diagnose (the disorders are rare and many of these babies are premature). There is a new test called genomic sequencing (GS) that looks at a babyâs entire genetic code and can detect a change that may be responsible for the babyâs medical problems. This test has revolutionized the ability to diagnose babies with genetic disorders and is ordered for many babies in the NICU. The results can be difficult to interpret for the doctors who order the test (often it is not clearcut as to whether the change is causing the disorder and sometimes medical problems can be discovered that are not part of the babyâs condition (e.g., risk for cancer). The NICU team is composed of doctors, nurses and other healthcare workers (but not genetic counsellors). We conducted a study of the NICU staff that showed they are not comfortable ordering GS, interpreting the results and want more education about GS. In this project, we will develop educational tools to help the NICU staff look after babies who have had GS.
Developing novel strategies to enhance CAR Treg manufacture and testing in transplantation
After organ transplantation, patients must take immunosuppressive drugs to prevent rejection of the organ by their immune system. However, these drugs have severe side-effects. In contrast, regulatory T cell (Treg) therapy, which uses naturally suppressive immune cells to produce immunosuppression, can avoid these side-effects. Tregs for therapy can be isolated from patients, genetically modified in the lab, and infused back into patients to block unwanted immune responses without broader effects. However, improvements are still needed to this therapy. This project takes two strategies to enhance Treg therapy. Firstly, I will test the effect of supplementing lactic acid during cell growth in order to identify an optimal media composition that promotes function. Secondly, I will develop a human organ-in-a-dish system to model complicated transplantation immune responses in a lab without using mouse models, which often donât replicate events in humans. Overall, this work will produce Tregs that function and survive better when administered to patients and develop a new way to test and model Treg function in a complex human system.
Consequences of preconception bariatric surgery for fetal size and pathological growth restriction: a linked population registry study.
In Canada, 20-30% of reproductive-aged women suffer from obesity, which increases the chances that they will experience pregnancy complications. Preconception treatment of obesity with bariatric surgery reduces the risks of most pregnancy complications, but it increases the risk of having a baby measured in the smallest 10% (small-for-gestational-age, SGA). However, SGA is a poor indicator of fetal growth restriction (FGR), a condition where growth is impeded by a disease process. This distinction is important as FGR is associated with increased risks of neonatal complications, while most SGA infants are healthy. Whether preconception treatment with bariatric surgery is associated with increased odds of FGR is still unclear.
In this study, we will use a population database to evaluate the association between preconception bariatric surgery and the risk of FGR. Results of this study will be important to examine the balance between risks and benefits of preconception bariatric surgery in clinical care. Results will be diffused through scientific publications and presentations. Educational material, including infographic summaries and courses, will be created to disseminate findings to clinicians and patients.
Use of CAR Tregs to induce transplantation tolerance
Organ transplantation, the primary treatment for organ failure, necessitates lifelong immunosuppressive therapy. Traditional immunosuppressants like steroids pose risks of severe infections and cancer due to their non-specific action. To address this, we’ve developed engineered Tregs, which migrate specifically to transplanted organs and prevent rejection. Initial studies in mice demonstrate promising delay in skin graft rejection. However, the effectiveness of Tregs combined with various immunosuppressive drugs used in transplantation remains unclear. My research aims to bridge this gap by investigating how engineered Tregs interact with common drugs to identify optimal combination therapies for transplant tolerance induction. I will also explore the underlying mechanisms of immune suppression. Ultimately, this work will inform the design of clinical trials, optimizing drug-Treg combinations as a therapeutic approach to combat transplant rejection.
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.
EQUITY-PIC-BC: Epidemiology and Quality of Pediatric Intensive Care in British Columbia: a health equity perspective
Children with life-threatening illness need urgent, high-quality, hospital care. In BC, regions with the highest rates of child death are the furthest from specialized pediatric hospitals. Healthcare providers in local community hospitals initiate treatment for sick children. Children who need specialized care are transported to one of two pediatric intensive care units (PICU) in BC, in Vancouver and Victoria. Canadian research suggests needing transport to access PICU care could increase a sick childâs risk of dying. Inequitable access to care may lead to inequitable outcomes for children in our province. I propose to 1) Describe geographic differences in rates of life-threatening illness among children in BC, 2) Describe what happens to children with life-threatening illness in the hospital and after they go home, and 3) partner with patients, families, communities, and healthcare providers to evaluate health equity stratifiers that may be associated with a childâs risk of developing life-threatening illness or their outcome due to systemic inequity. Our research will improve understanding of the healthcare needs of sick children in BC and inform initiatives to ensure that all children have the best care and chance of recovery.
Rising Up: Collaborating with Chinese Families and Communities to Promote Mental Health Literacy
Many Chinese families living in BC struggle in silence to support their childâs mental health. Most resources are available only in English and were developed without cultural knowledge about mental health or related considerations of stigma. In this project, we begin to address this gap by partnering with Chinese families and community agencies to co-design resources that are culturally-meaningful, engaging, and effective. To start, we will work with a committee of Chinese caregivers and community providers of children aged 3-13y to promote mental health awareness early on in childhood.
We will co-host workshops with 2 activities to gain information and feedback about (i) existing resources, and (ii) what mental health information is needed and how they wish to receive it. The workshops will be offered both in-person and online, across daytime, evening and weekend hours, so people from different locations and schedules can attend. We will make special efforts to include a balance of mothers, fathers and grandparents. We will identify key themes and top priorities from the discussions to guide future steps towards co-developing culturally appropriate mental health resources for Chinese families.
Partnering to improve early identification and early intervention for children with developmental coordination disorder
Developmental Coordination Disorder (DCD) is a common condition that significantly interferes with a childâs ability to learn motor skills. Without treatment, these motor challenges can persist into adulthood and limit job opportunities, affect physical and mental health, and impact quality of life. Early identification and intervention are crucial to change this negative trajectory.
More than 50,000 children in BC may have DCD, but most of these children are unlikely to have a diagnosis or receive therapy. Our survey of BC parents of children with DCD showed that they first identified concerns about their childâs motor skills at age 3 years, but did not receive a diagnosis until age 8, missing a critical window for early intervention. Parents also identified significant barriers to accessing therapy for their child.
In this project, we will bring together a diverse group of parents, researchers, health organizations, and clinicians to determine how to streamline early identification and improve access to early intervention. We will hold a series of meetings with these key partners to identify research objectives and co-develop a grant application to implement and evaluate early interventions for children with DCD.
Drawing Attention to an Invisible Injury: Increasing Awareness and Reducing the Burden of Concussion among Workers and Workplaces in British Columbia
Concussion, or mild traumatic brain injury, is the most common form of brain injury, causing physical, emotional, and mental health symptoms, with the potential for long term impacts, particularly if not managed properly. Concussion can happen to anyone, anywhere, and is a top five cause of workplace time-loss. In BC, from 2017-2021, concussion accounted for 4.8% of all time-loss claims and 8% of claims by retail salespersons, mostly among young workers. The aim of this project is to increase concussion awareness and education within the retail industry by highlighting key messages from the evidence-based online resource, the Concussion Awareness Training Tool for Workers and Workplaces. By leveraging existing partnerships, we will engage a large retailer to promote concussion education within their workforce. Information sessions will be delivered on concussion prevention, recognition, recovery, management, and Return-to-Work. We will create a concussion infographic and recruit a worker to share their personal story via video for wide dissemination. Not only will this initiative create awareness and change attitudes about concussion at work, but the safety messages will be applicable to workersâ lives beyond the workplace.