University of British Columbia – Page 4

Building partnerships for improving chronic pelvic pain care in gynecology: A needs assessment of health professionals-in-training

Chronic pelvic pain affects ~15 percent of women and an unknown number of gender diverse people. Despite its common and devastating effects, chronic pelvic pain is too often dismissed or mismanaged, which is in part due to physicians’ lack of education on the topic. This study will identify knowledge needs about chronic pelvic pain of BC health professionals-in-training, which will guide the development of a future online resource. To do this, we will 1) Convene a group of experts interested in improving education and care for people with chronic pelvic pain; 2) Assess the knowledge level and attitudes towards chronic pelvic pain in gynecology using a baseline survey completed by medical and nurse practitioner students; and 3) Collaborate with experts to review the needs assessment and co-create a plan for a future resource. We aim to improve the understanding of chronic pelvic pain in health professionals-in-training and ultimately improve care for people with this complex condition by addressing the specific knowledge needs and identifying meaningful information to be included in a future resource to address gaps in medical education.

Team members: Natasha Orr (UBC – School of Nursing); Paul Yong (UBC – Faculty of Medicine); Leanne Currie (UBC – School of Nursing); Karim Qayumi (UBC – Faculty of Medicine); Margaret Carlyle (UBC – Okanagan; Faculty of Arts & Social Sciences, Department of History and Sociology); Rachel Langer (UBC – Endometriosis and Pelvic Pain Laboratory); Lan Randhawa (UBC – Endometriosis and Pelvic Pain Laboratory); Helena Daudt (Pain BC); Jennifer Krist (UBC – School of Nursing).

Remission Possible: A knowledge translation project to inform British Columbians with Type 2 diabetes that remission is possible

Type 2 diabetes (T2D) is traditionally viewed as a chronic, progressive condition that someone has for life. Our research, and that of others, now shows it is possible to drive T2D into remission through specific diet and lifestyle changes. T2D remission means that blood sugars are back in the normal range with no medications needed; it represents a new way of viewing T2D which provides hope for those affected. Research shows T2D remission is achievable, but now we need a public outreach program to alert as many British Columbians as possible to this news and connect them with helpful resources. We will implement a KT initiative including: 1) Video and graphic media products that we create; 2) Earned mainstream media coverage; and 3) A social media campaign, which amplifies the first two elements and drives viewers to a web platform, RemissionPossible.ca, which will connect them with T2D remission resources. Given how broadly T2D affects British Columbians and what a “feel good” story this is, we anticipate significant interest with mainstream and social media. By carefully tracking results (impressions and web traffic), we will improve our reach and learn valuable lessons to inform future KT initiatives.

Team members: Damien Gillis; Barbara Oliveira (UBC Okanagan); Tom Elliot (UBC); Sean McKelvey (Institute for Personalized Therapeutic Nutrition, not-for-profit); Marc Pelletier (Institute for Health Systems Transformation and Sustainability, not-for-profit); Deanne Taylor (Interior Health); Kathleen Martin Ginis (UBC Okanagan and Centre for Chronic Disease Prevention and Management); Krista Lamb; JJ Belanger; Chris Xi.

Knowledge translation and mobilization to support exercise recommendations for people with bone metastases

The objective is to develop a knowledge translation and mobilization plan for exercise recommendations for people with bone metastases. In advanced cancer, cancer can spread to bone, called ‘bone metastases’. This makes bones weaker and more likely to break, leading to pain and disability. Physical activity can help people living with bone metastases to maintain their independence and engage in more activities they enjoy. However, health care professionals, exercise professionals and people living with bone metastases (user groups) are uncertain about how to safely engage in physical activity. In 2022, expert recommendations were published on physical activity specifically for people with bone metastases. Without specific tools for user groups and communication plans, it could take years for these recommendations to be taken up into practice. We will bring together people who are part of the intended user groups across British Columbia to “co-design” the best way to get information about the recommendations to people who need it, in the most useful way possible. This project aims to raise awareness about the recommendations and start the process to increase use of the recommendations for people living in British Columbia.

Team members: Christine Simmons (BC Cancer Agency); Alan Bates (BC Cancer); Cathy Clelland (BC Cancer); Sian Shuel (BC Cancer); Leah Lambert (BC Cancer); Sarah Budding Smith (BC Cancer); Chiara Singh (Fraser Health & Physiotherapy Association of British Columbia); Hardip Jhaj (British Columbia Association of Kinesiologists); Rebecca Tunnacliffe (BC Recreation and Parks Association); Tracy Torchetti (Canadian Cancer Society); Sarah Weller (BC Cancer); Stephanie Skourtes (Women’s Health Research Institute); Kirstin Lane (Exercise Science, Physical & Health Education University of Victoria); Sarah Neil-Sztramko (National Collaborating Centre for Methods and Tools); David Langelier (University of Toronto and Princess Margaret Cancer Centre); Michelle Nadler (Princess Margaret Cancer Centre); Samantha Myers (UBC – Rehabilitation Sciences).

End of Award Update – December 2024

Results

This grant supported the initial work of the Bone Metastases and Exercise Knowledge Mobilization team. This initial work was leverage to receive additional funding from another source (Canadian Cancer Society) to complete the full planned scope of the work. The result is the Bone Metasttases and Exercise (BME) Hub. The BME HUB is the result of an experience co-design process to develop knowledge mobilization products (KMP) to support people living with cancer who have bone metastases to participate in physical activity and exercise as safely as possible.

The KMP are: 1. Webinar; 2) Patient Education Handout; 3) Health Information Form; 4) Patient Video; and 5) Exercise Professional directory. We worked with experts in website design and patient education to design and launch the BME Hub website on May 27, 2024 to coincide with the Annual Meeting of the American College of Sports Medicine, the largest international clinical exercise professional organization. The BME HUB is located at https://bit.ly/BMEHub.

Impact

The KMP have been share widely with by professional associations for physiotherapy, exercise professional and kinesiology, as well as patient advocacy organizations (i.e., Re-Think), non-profit organizations (i.e., Canadian Cancer Society) associations across locally and across Canada. It has also been shared by oncology digital creators and organizations, both nationally and internationally. This widespread dissemination has enabled healthcare professionals, exercise professionals and individuals living with bone metastases to easily access new information and resources related to exercise and bone metastases, facilitating informed discussions and practices in various healthcare settings.

We presented the BME Hub at 3 local, 3 National and 7 international conferences, and have received over 8000 views by over 6000 unique users.

Based on the success of leverage of expertise and time for development of knowledge product, we have been able to support a process to translate the BME Hub Materials into different languages. We now have five languages completed and available on the website (Swedish, Spanish, German, Dutch and Japanese) with nine more in process.

Potential Influence

Looking ahead, our translation efforts are just the beginning. We are developing a Professional Development course that will be available for free on the BME Hub. This course is designed to enhance the knowledge of exercise professionals (EPs) and physiotherapists (PTs) in exercise oncology and bone metastases. We have conducted surveys to assess the needs of these professionals, which will inform the course content. By equipping healthcare professionals with this knowledge, we anticipate a positive impact on the treatment and management of individuals with bone metastases.

The BME Hub aims to improvement standard of supportive care for cancer locally, regionally, nationally and internationally, specifically support rehabilitation and physical activity promotion care delivery across a variety of clinical settings.

Next Steps

Our dissemination efforts are ongoing, with new networking opportunities arising regularly. We are also conducting thorough research on our web traffic using Google Analytics (GA4), focusing on key metrics such as views, user engagement rates, and bounce rates. Additionally, we are assessing the effectiveness of our various dissemination strategies through tracking tags embedded in our Bitly links and QR codes, allowing us to refine our outreach efforts continually.

We have undertaken an update to the original literature search for the Exercise Recommendations for People with Bone Metastases (Campbell et al. JCO Oncology Pract 2022) supported by the National Collaborating Centre for Methods and Tools (NCCMT). We are hosting a series of three virtual meetings November 25, Dec 11 and Dec 12, 2024 to accommodate various time zones. The goal of the meetings is to discuss the findings of the updated literature review with the original members of the International Bone Metastases and Exercise Working Group and the current members of the Bone Metastases and Exercise Knowledge Mobilization team, and to determine if these findings warrant any updates to the BME Hub.

The outstanding knowledge product that is in process is the Professional Development Course. We have received the majority of the content from the expert content creators, including case studies (due from contributors by December 15, 2024). The initial course design has been initiated by Department of Physical Therapy Educational Technology & Materials Manager, who has extensive training and experience in designing educational content and course design for adult learners.

Multimodal characterization and classification of bio-signals to predict cardiac arrest

Sudden cardiac arrest (SCA), due to abrupt disruption of cardiac function, is a major health problem globally. SCA can happen to anyone at any age who may or may not have been diagnosed with heart disease. SCA has a poor survival rate of about 10 percent, with an estimated 35,000 deaths in Canada annually. With an increasing rate of cases (16 percent from 2017 to 2020), SCA remains a major public health issue in British Columbia. The most effective strategy to improve survival is to achieve rapid SCA recognition, given that for every minute without cardiopulmonary resuscitation (CPR) survival rates drop by 10 percent. Wearable devices may play a major role in decreasing SCA mortality, providing real-time cardiac information for early SCA detection. My aim is to develop a wearable SCA device with embedded sensors, and use their real-time physiological data combined with artificial intelligence algorithms, to make an accurate SCA detection system. This SCA detection system will be designed to identify SCA and alert Emergency Medical Services with the individual’s location (via GPS), enabling them to provide life-saving interventions in a timely manner.

Mitotic bookmarking by transcription factors as a mechanism of transcriptional memory

Cells that are the building blocks of the organism come in different forms and functions. Stem cells are a unique type of cells, because of their ability to change (differentiate) or maintain their state. Because of this ability to differentiate into any type of cell, stem cells are on the frontiers of regenerative medicine, which is aimed to restore damaged cells, tissues or organs. The cell division (mitosis) poses a challenge for cell identity. During mitosis, the DNA is condensed into characteristic mitotic chromosomes, the nuclear membrane, separating DNA from rest of the cell, is fragmented, and the gene expression ceases. How then cells memorized which genes were expressed, to continue their expression after mitosis? The mitotic memory has been proposed as a mechanism for the maintenance of cell identity after mitosis. One arm of this mechanism, called bookmarking, is the binding of transcription factors (proteins regulating gene expression), to mitotic DNA. This project aims to establish the molecular mechanisms of mitotic bookmarking in mouse embryonic stem cells. Using methods, such as gene editing, genomics, and imaging, I will solve how stem cells maintain their identity after countless number of cell division.

The role of Baf53b in regulating neuronal gene expression and autism behaviours across development

Autism spectrum disorder (ASD) is characterized by impairments in social communication and restricted interests. Several genes have been implicated in ASD, but a group of genes in the neuronal nBAF complex have emerged as promising candidates. The nBAF complex changes the structure of DNA to influence the way several genes are expressed in a cell. To date, no research has been conducted on the role of nBAF within neuron subtypes. I will investigate the loss of the nBAF complex specifically in parvalbumin (PV) neurons in mice. PV neurons are the most abundant type of inhibitory neuron in the brain and are frequently impaired in ASD. I hypothesize that loss of the nBAF complex will alter gene expression that is necessary for proper neuron function and resulting in ASD-like behaviours. Mice lacking the nBAF complex will undergo behavioural tests that can be used as a proxy to study ASD. Next generation sequencing will be employed to investigate alterations in gene expression. This work will be the first to test how loss of the nBAF complex specifically in PV neurons might lead to behavioural changes relevant to ASDs, providing the foundation for potential treatments.

Proteome-wide mechanisms of hyperinsulinemia and sucrose-induced, tissue-specific insulin resistance

During the development of Type 2 diabetes, the body often makes more of the blood sugar-lowering hormone insulin than normal. Recent research suggests excess insulin may cause weight gain and insensitivity to insulin. Studies from our lab showed that preventing this increase of insulin can reduce weight gain and extends lifespan in mice. Too much sugar consumption also contributes to obesity and diabetes, but how this happens is still unclear. Therefore, we aim to find out whether reducing insulin can prevent the detrimental effects of high sucrose and identify the underlying causes of obesity and diabetes. So far, our experiments with mice who were given sucrose drink in place of water, have revealed that mice given that have been genetically modified to produce less insulin are protected from higher body weight and blood sugar levels. With funding from Health Research BC, we will analyze the liver, muscle, and fat of these mice using powerful techniques that can profile thousands of genes and proteins in these tissues, rather than just a few at a time. These analyses will reveal the detailed changes in the cells in response to sucrose and insulin, which will tell us how they cause obesity and diabetes and help us develop strategies for preventing diabetes.

Exploration through movement variability: How does the presence of pain affect the movement variability-adaptation process of walking?

When we walk, our bodies take each step slightly differently. This variability is how the brain explores movements so we can adapt to changing environments (e.g. bump in the sidewalk) or new challenges (e.g. painful motion). Pain from injuries or disease can lower this natural exploration because our brain avoids painful movements, ultimately limiting our ability to adapt. My study aims to understand how pain affects this variability-adaptation process in walking. In these studies, we will use electrical stimulation to create artificial knee pain, since naturally occurring pain fluctuates and is difficult to control. By synchronizing the painful stimulation with walking motions, we can precisely control the timing and severity of pain so we can measure the variability-adaptation process in real-time. First, we will test how knee pain changes movement variability. Then, we will measure how adaptation is affected by lower variability created by the pain. To conduct these projects, we will develop new wearable technology that combines electrical stimulation and motion tracking devices to perform this work in places outside the lab. The results will inform how movement variability can affect rehabilitation of painful conditions.

A novel stem cell model for human islet development and cytoarchitecture

The cultivation of stem cells to insulin-producing beta cells offers an unlimited source of transplantable material for diabetes treatment. However, currently manufactured beta cells do not function precisely like the healthy ones in our bodies. Human islets are cell clusters mainly comprised of a mix of endocrine cell types, and interactions among them are critical in controlling insulin secretion. However, this point has been overlooked by current manufacturing methods that typically attempt to make clusters enriched only for beta cells. The absence of other islet cell types may therefore be a leading cause of the failure to obtain properly regulated insulin production. We recently developed a method to coax stem cells into islet clusters that are enriched for major endocrine cell types. Interestingly, these islets formed through an essential but unidentified “budding process” and self-organized into distinct cellular arrangements over time. Our goal is to elucidate the mechanisms that regulate islet formation, including the ways in which the cells assemble and impact islet function. Success could facilitate methods to manufacture islet cells with more robust insulin production and guide cell replacement strategies for diabetes.

Pain and healthcare experiences of sex and gender minority citizens living with chronic pain in Canada

One in four people in Canada live with chronic pain. These individuals experience poorer health outcomes, higher healthcare services use, and lower quality of life. Studies show males and females experience pain differently, for example differences in pain sensitivity and pain control. But little is known about pain experiences in people who identify as a sex and gender minority, meaning a person’s sexual orientation or gender identity differs from traditional societal views. Sex and gender minority persons report higher pain and experience unique life stressors (e.g. discrimination), which may lead to worsening of their pain. We aim to study 1) pain experiences and 2) strategies to improve healthcare experiences for individuals who identify as sex and gender minority living with chronic pain by collaborating with patient and public stakeholders to answer these questions. Involving persons who identify as sex and gender minority with chronic pain in research studies is important because it provides them with a voice to offer personal stories and perspectives. Community engagement will help researchers ask the “right questions” and guide research priorities to improve the lives of people who face similar health challenges.