Primary Ciliary Dyskinesia (PCD) causes microscopic hair-like projections called cilia to not function properly. Cilia sweep away germs that are breathed in but become trapped in mucous lining the airways. PCD causes frequent, severe sickness, which can require lung transplantation to prevent early death. Symptoms are seen at birth but diagnosis is frequently delayed due to problems with current tests. Electron Microscopy (EM) is one test for PCD, but only detects about 50-70% of cases. Genetic tests are more sensitive but we do not yet know all of the mutations that cause PCD, called Variants of Unknown Significance (VUSs). We recently created a new test for PCD using immunofluorescence (IF), which illuminates specific parts of cilia using a laser microscope. This test distinguished all PCD samples from healthy individuals. IF provides visual evidence that certain VUSs cause abnormal cilia. This test is also cheaper, faster and easier to interpret. Before IF can be used to diagnose PCD, we must show that it outperforms EM and genetic tests in a large group of patients from across Vancouver. This study will establish IF as a confirmatory PCD test, helping patients access personalized treatment and new gene-therapy clinical trials.
Research Pillar: Clinical Research
Validation and Implementation of a Wearable Cardiac Arrest Detection System in Clinical and Community Settings
Sudden cardiac arrest is a leading cause of death in Canada, often resulting in death within minutes if not treated. Quick recognition is crucial, but many incidents occur when no one is around to help. Our research aims to change this by using common consumer wearable devices, like smartwatches, to detect and predict cardiac arrest. Currently, smartwatches are unable to do this in a reliable way because these algorithms are not trained and tested on real cardiac arrest cases. We have collected this type of data from patients in hospices, undergoing medically assisted dying, and dying in the intensive care unit and trained highly accurate algorithms to detect cardiac arrest. In this project I will build an end to end cardiac arrest detection and alerting system which can use this algorithm to detect cardiac arrest, and complete the necessary steps to integrate it into the 9-1-1 system, building a foundation for real world community testing.
Our goal is to harness everyday wearable technology to improve the detection of cardiac arrest, enhancing survival rates and improving patient outcomes.
A multi-layer genomic analysis to understand the biological basis of corticosteroid-induced AVN in children with cancer: Toward precision health strategies.
The Problem: Avascular necrosis (AVN) is a serious complication of corticosteroid treatment in some children with cancer, causing bone damage and, in severe cases, requiring surgery. It affects quality of life and places additional burdens on families and healthcare systems. Currently, there are no reliable ways to predict or prevent severe AVN.
Overview of the Research: In a study of 972 children with cancer, I identified four genetic variants strongly linked to corticosteroid-induced AVN. This project will explore how these genetic factors influence AVN risk by validating key predictors in 718 additional patients, pinpointing causal variants, and investigating how these genes affect bone cell responses to corticosteroids.
Anticipated Outcome: Development of a genetic test to identify children at high risk for severe AVN.
Potential Impact: A genetic test for AVN risk would allow doctors to personalize treatment plans for children with cancer. Children identified as high-risk could be monitored more closely or given alternative treatments to prevent AVN from developing in the first place. This would significantly reduce the number of children experiencing this painful and debilitating side effect.
ACTIVE: Adding Life to Years in Cognitive Frailty by Preventing Falls and Promoting Cognitive Function
With age, some individuals experience physical frailty and difficulties in their thinking abilities (i.e., cognitive frailty). This increases the risk of falls and dementia, both of which negatively impact one’s ability to function and quality of life. Falls are a major reason why older adults suddenly go from independent living to long-term care. Thus, it is important to find ways to reduce falls and promote cognitive health in cognitively frail older adults.
Past research shows exercise can reduce falls and promote cognitive function in older adults. However, it is not known whether these benefits apply to those with cognitive frailty. To address this knowledge gap, we will conduct a 12-month home-based exercise program, delivered by physical therapists (PTs), in 328 community-dwelling adults aged 70-89 with cognitive frailty and a history of falls. To increase participation and follow through with the home-based exercise program, PTs will work with each older adult to set exercise goals and create action plans.
Given the immense health burden of falls in cognitively frail older adults, our study could have major health benefits and guide future strategies that positively add life to years among those with cognitive frailty.
Exercise Snacks in Adults Living with Obesity
Individuals with obesity experience chronic low-grade inflammation increasing their risk of cardiometabolic disease. Inflammation is driven by the combination of excess body fat and high blood sugar that often accompanies obesity. Exercise is a powerful tool to lower inflammation and lower blood sugar but many people with obesity are insufficiently active. Exercise “snacks” are an exciting new concept where ~1-2 min bursts of vigorous activity are repeated periodically throughout the day. The approach represents a practical and time-efficient way for individuals with obesity to become more active, improve their blood sugar, and lower inflammation. We will determine if people with obesity can perform exercise snacks in their daily lives and whether exercise snacks can improve inflammatory markers. Eighty people with obesity will be randomly assigned to an Exercise Snacks (3-4 daily “snacks” on 5 days/wk) or a Placebo (stretching/mobility exercises) group. Inflammation, blood sugar control, and fitness will be assessed before and after 12 weeks. We will be the first to determine if exercise snacks can help individuals with obesity overcome barriers to physical activity, reduce inflammation, and improve blood sugar.
Power Exercise for Stroke Recovery: A Multi-Site Pilot Randomized Controlled Trial
Loss of mobility is common after a stroke. Strength training helps build muscle strength but does not always improve mobility. This may be because many programs do not focus enough on building muscle power, which is how quickly muscles work. Power training is a special type of strength training, where you lift lighter weights quickly. It may be more effective than traditional strength training but more research is needed.
We are launching a multi-site pilot randomized trial between McMaster University and UBC–Okanagan. We will recruit 60 people with stroke, and assign them to one of two 10-week exercise programs: the POWER intervention or traditionally-prescribed strength training. Our outcomes are the feasibility of our methods (eg, recruitment), but also compare its effects on mobility, fatigue, mental health, and quality of life. Two people with lived experience of stroke are providing input into our methods.
This work will grow awareness on strength training for people with stroke in BC. The success of this study will also open the door for collaborations with other universities to establish the benefits of power training. We hope to then update the exercise guidelines to reach clinicians and improve stroke care.
Surgical, oncologic, and patient reported outcomes following breast conserving surgery versus mastectomy: a longitudinal study
Several trials have established breast conserving surgery (BCS) followed by radiation has equivalent or improved survival to mastectomy for early breast cancer, yet mastectomy rates are rising globally. It is thought patients perceive mastectomy to improve survival and reduce worry of recurrence, however recent advances in patient-centered care have measured patient reported health-related quality of life (HRQoL) among breast cancer patients, and early studies report higher HRQoL among BCS patients.
BCS rates in British Columbia are below the national average. Further clinical and HRQoL data are needed to understand factors influencing the BC mastectomy rate and inform clinical recommendations for BCS.
A patient cohort will be recruited from Providence Breast Centre and classified into BCS, mastectomy by patient preference, and mastectomy medically necessary to compare postoperative complications, oncologic outcomes, and patient reported psychosocial and HRQoL outcomes.
By linking oncologic and HRQoL outcomes, this study will provide novel information to facilitate more informed preoperative surgical counselling, and guide institutional and provincial policy for development of Canadian breast cancer surgery quality indicators.
Integrating Exercise Snacks into Type 2 Diabetes Care: feasibility and management of cardiovascular risk factors
Most people living with type 2 diabetes (T2D) do not achieve enough physical activity and miss benefiting from the powerful health benefits of exercise. “Exercise snacks” are short bursts of exercise lasting 1 minute or less, which can be done sporadically throughout the day. These snacks can be easily performed anywhere using stair-climbing or simple body weight exercises. Incorporating exercise snacks into the daily routine could help to break up sedentary time, regulate blood sugar, and improve blood pressure and fitness levels. This research program aims to explore the positive effects of exercise snacks in individuals living with T2D. Through a combination of lab-based studies and a real-world clinical trial that will deliver an exercise snacks intervention via a Smartphone “app”, we will test if exercise snacks can lower blood sugar and improve cardiovascular health in people with type 2 diabetes. In order to maximize the reach and impact of our research, we will also develop infographics and videos to help teach individuals with T2D how to incorporate exercise snacks into their day. This research aims to empower people living T2D to improve their health, one exercise snack at a time!
Caregiver-Child Sleep and Relationships in Canadian Foster and Kinship Families
Sleep is important for health, yet little is known about sleep in foster and kinship families. In my postdoctoral fellowship, I will lead research to learn about the sleep health, how best to support sleep, and the connection between sleep and caregiver-child relationships for foster/kinship families. In Study 1, we will synthesize research on children’s sleep in foster and kinship care. In Study 2, we will interview foster and kinship caregivers of children aged 0-5 years to learn about the caregiver and child’s sleep, and how sleep influences the caregiver-child relationship. In Study 3, we will compare sleep in foster and kinship families with other families in Canada. In Study 4, foster and kinship caregivers will help us design and test a sleep resource. We are creating an advisory panel to work with us to create research that is useful and interesting to the foster/kinship community, and respectful of different cultures and family dynamics. With the advisory panel, we will share the results in journal articles, at conferences, via webinars, and through foster/kinship organizations. This research will help healthcare professionals and policymakers understand, and help support, the sleep of families in foster and kinship care.
SuPA Mobility: Supporting Physical Activity for Mobility in Older Adults with Mobility Limitations
Problem
As individuals age, they have a greater risk of limited mobility, or difficulty in getting around safely in one’s environment. Limited mobility is linked to illness, disease, and decreased quality of life.
Recent research show increasing physical activity by 6-minutes per day can improve mobility and prevent future disability. Despite the positive impacts on health, many older Canadians do not perform sufficient physical activity. Health coaching, a person-centered process to change behaviors with goal-setting, action planning, and feedback, is effective at improving physical activity participation in older adults. However, none of the previous health coaching studies included older adults with limited mobility.
Research
This study aims to address this knowledge gap to evaluate if health coaching can improve mobility and increase physical activity in older adults with limited mobility. We will conduct a 6-month study comparing health coaching to health education on improving mobility in older adults aged with limited mobility.
Potential Impact
Increasing physical activity through the use of health coaching has the potential to improve mobility and decrease the negative health impacts of limited mobility in older adults.