Discoveries for life

The faces of health research 2023

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Predicting neurodegenerative diseases and cognitive decline in seniors

“Alzheimer's research has tended to focus on detecting disease processes to make a diagnosis. What I am interested in is whether these measurements could predict the loss of specific memory components. I am also trying to understand whether this memory loss is a result of the disease itself or due to the degeneration of the hippocampus, a key area of the brain for memory.”

Étienne Aumont
Doctoral candidate in psychology, Université du Québec à Montréal

Alzheimer’s is a disease that is defined by the damage it does to the brain, rather than by its symptoms. It is suspected that the brain starts breaking down many years before a person with Alzheimer's begins to lose their cognitive functions. This means that cognitive decline could be predicted by detecting Alzheimer's and measuring the progression of the neurodegenerative disease associated with it.

Vanier Scholar Étienne Aumont from Université du Québec à Montréal is working to confirm this hypothesis by using neuroimaging to measure different regions of the hippocampus. Étienne will use annual monitoring data collected on 300 seniors in the TRIAD (Translational Biomarkers in Aging and Dementia) cohort to understand whether markers of Alzheimer’s can predict neurodegenerative disease, and if the disease can lead to memory loss.

In addition to Étienne’s research work, he also founded Sciences 101, an organization that encourages students to acquire science communication skills in 2019. Through this organization, he also founded the science outreach magazine la FIBRE, organized a science outreach competition, and developed a great number of training workshops for the student community.

Further reading

A precision approach to mechanical ventilation might improve the health outcomes of respiratory failure patients

“CAVIARDS is testing the hypothesis that a personalized delivery of mechanical ventilation based on measurements at the bedside can improve the survival and overall experience of ventilation in cases of respiratory failure.”

Dr. Laurent Brochard

Acute respiratory failure affects tens of thousands of Canadians every year, with its most severe form being Acute Respiratory Distress Syndrome (ARDS), which is a very frequent cause of admission to intensive care units. ARDS has a mortality rate of 30 to 40%, so it is imperative that researchers improve the disease’s prognosis.

That’s where Dr. Laurent Brochard of Unity Health Toronto comes in, with his Clinical Trials Fund-supported CAVIARDS—Careful Ventilation in Acute Respiratory Distress Syndrome—trial. Brochard’s lab will test the hypothesis that a personalized delivery of mechanical ventilation based on patient’s measurements at the bedside can improve survival and reduce the duration of mechanical ventilation. If this hypothesis is correct, personalized delivery of mechanical ventilation will increase survival rates and mitigate other long-term effects of ventilation, such as lung and brain damage.

Critical care medicine seeks to improve the survival rate and the quality of life for patients staying in ICUs. The international CAVIARDS trial aims to do the same, helping more patients recover faster from respiratory failure. And although clinical trials are designed to primarily benefit future patients, many are associated with excellent quality of care for the patients in the trial. For people with respiratory failure, the benefits of better mechanical ventilation might start before the trial even concludes.

Further reading

Expanding our knowledge of treating bloodstream infections to improve health outcomes

“Even though there are hundreds of thousands of cases of Staphylococcus aureus bloodstream infections every year worldwide, there is so much we do not know about optimizing health outcomes for those affected with this serious bacterial infection. When the opportunity to contribute to this international endeavour arose, it was imperative for me that Canada would be well represented.”

Dr. Todd C. Lee
Scientist
Research Institute of the McGill University Health Centre

Each year, more than 10,000 Canadians become infected with a Staphylococcus aureus bloodstream infection. This disease can result in severe sepsis, spread infection to other parts of the body, and even result in death – and unfortunately, it’s one of the most common serious bacterial infections in the world. While antibiotic treatments are available, infectious disease doctors are frequently faced with challenging cases involving this type of infection and many questions remain on how to treat them most effectively.

The S. aureus Network Adaptive Platform (SNAP) is an international trial that is evaluating multiple treatment strategies to improve health outcomes for patients with this disease. Dr. Todd C. Lee and the SNAP team are now taking this network’s objective one step further. Through a new clinical trial project called “Expanding the Staphylococcus Aureus Network Adaptive Platform,” he is examining new approaches to treating this type of infection. First, Dr. Lee’s team is evaluating if a combination of cefazolin and ertapenem is effective against methicillin-sensitive infections, the most common type of Staphylococcus aureus bloodstream infection. Second, the researchers are comparing the benefits of two other antibiotics currently used to treat methicillin-resistant strains. Finally, the team is evaluating how an old tuberculosis drug, rifampin, may or may not be necessary to treat infections involving prosthetic heart valves.

Researchers from Australia, Canada, Israel, New Zealand, Singapore, and the UK are involved in this new project. Dr. Lee’s new trial represents an addition to the largest international collaborative effort in better understanding the treatment of this lethal disease. Dr. Lee is hopeful that, over the next decade, it will lead to numerous innovations in patient care and generate actionable evidence to inform future care and treatments.

Further reading

Small steps for big changes

Implementing an evidence-based diabetes prevention program in diverse urban communities

“This research offers an innovative, cost-saving, and sustainable solution for the prevention of type two diabetes in traditionally underserved, at-risk populations by partnering with communities.”

Dr. Mary Jung
Associate Professor
School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus

Dr. Mary Jung is an Associate Professor in the School of Health and Exercise Sciences at the University of British Columbia (UBC), Okanagan Campus. Dr. Jung aims to develop evidence-based diabetes prevention interventions designed for community implementation and sustainability while improving equity, diversity, and inclusivity in all research endeavours. She was named a Michael Smith Foundation for Health Research Scholar in 2015, and Killam Accelerator Research Fellow in 2023.

Dr. Jung leads the Diabetes Prevention Research Group, is the founder of the diabetes prevention program “Small Steps for Big Changes” and is director of UBC’s Centre for Health Behaviour Change.

Dr. Jung is the Nominated Principal Investigator for a CIHR Healthy Cities Implementation Science Team Grant titled: Small Steps for Big Changes: Implementing an Evidence-Based Diabetes Prevention Program into Diverse Urban Communities. This research will test the implementation, effectiveness, and sustainability of a diabetes prevention program in urban communities in Canada and Australia where rates of type two diabetes are high and diabetes prevention programs remain inaccessible.

Further reading

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Training Canada’s next generation of clinical research professionals

Photo credit: Tony Felgueras

“The CANTRAIN training platform is addressing the critical need for training and mentoring of clinical research professionals and investigators to fill existing gaps across our public institutions and biotechnology industries. Having qualified professionals to develop, implement, and operate timely and effective clinical trials also means better health outcomes for everyone in Canada.”

Dr. Jean Bourbeau
Senior Scientist, Research Institute of the McGill University Health Centre
Professor, Department of Medicine, Faculty of Medicine and Health Sciences, McGill University
Department of Medicine, Division of Respiratory Medicine, McGill University Health Centre

The COVID-19 pandemic has exposed critical gaps across our public institutions and in our pharmaceutical and biotechnology industries. It has become clear that Canada requires a well-coordinated training, skills development, and mentorship program to improve the design and implementation of clinical trials. The CANadian consortium of clinical trial TRAINing platform (CANTRAIN) may be the answer to building capacity in our clinical trials ecosystem.

CANTRAIN is a national clinical trial training platform led by Dr. Jean Bourbeau, Senior Scientist with the Centre for Outcomes Research and Evaluation at the Research Institute of the McGill University Health Centre. The CANTRAIN team comprises 95 researchers from 14 institutions across 9 provinces, who are collaborating with public and private partners. How will the rollout of CANTRAIN training platform help attract and develop highly qualified clinical researchers and scientists in Canada?

Dr. Bourbeau’s team has identified solutions to advance the professional development of clinical research professionals across Canada. Some of the e-learning solutions available through the platform include competency-based training with certification, mentoring, experiential learning, internships, and networking programs. The CANTRAIN platform will offer several training streams such as trial operations, design and analysis, and partnership development. It will also ensure Canada remains competitive with high standard clinical research. But that’s not the only impact of this national training platform. Having highly qualified personnel to run clinical trials more effectively also means better health outcomes for everyone in Canada.

CANTRAIN is one of seven training platforms supported by the Clinical Trials Fund. These collaborative initiatives will train the next generation of clinical research professionals in such specialties as biostatistics, stroke research, behavioural change, and the general practice of clinical research.

Further reading

An arthritis treatment may bring health benefits to people with mucopolysaccharidoses

“Understanding the cause of the symptoms that patients experience helps us develop new therapies that may make a difference for them. The most rewarding part my work is seeing advances in treatment that lead to better health outcomes even if these changes are small.”

Dr. John James Mitchell
Pediatric biochemical geneticist and clinical researcher,
Montreal Children’s Hospital and Child Health and Human Development

Mucopolysaccharidoses are a group of rare diseases estimated to affect one in 25,000 births. People with these rare diseases are born without an enzyme responsible for breaking down complex carbohydrates called glycosaminoglycans. Over time, glycosaminoglycans build up in the body causing inflammation, joint pain and stiffness, skeletal abnormalities and, in some cases, cognitive disabilities. Current treatments have improved life expectancy for people with mucopolysaccharidoses.

As a pediatric biochemical geneticist, Dr. John James Mitchell has worked with children with rare genetic diseases for over 20 years. He has always been amazed by the resilience of the patients and their families in the face of challenges that diseases such as mucopolysaccharidoses can bring. Dr. Mitchell is now looking for additional therapies that can continue supporting their journey. One promising therapy may be a medication called adalimumab. Results from a clinical trial in the United States show that the treatment reduces pain and inflammation in patients with arthritis. Early studies and anecdotal information suggest that adalimumab may offer similar benefits to people with mucopolysaccharidoses.

Dr. Mitchell’s randomized clinical trial titled “The Safety and Efficacy of Adalimumab for Pain Reduction in Individuals with Mucopolysaccharidoses” will provide answers about the safety and benefits of adalimumab as a potential treatment for mucopolysaccharidoses types I, II, IVA and VI. His team is evaluating how the drug impacts patient experience with pain, life quality, joint range of motion, and other variables. Dr. Mitchell is hopeful that adalimumab treatment will reduce pain and inflammation and, as a result, improve the quality of life of those living with mucopolysaccharidoses. A Canada-based clinical trial will also ensure that Canadians have access to the treatment after approval.

Further reading

New targeted therapy offers hopes for treatment of arrhythmogenic right ventricular cardiomyopathy, a genetic heart condition

“It can be a helpless feeling to carry a gene for arrhythmogenic right ventricular cardiomyopathy and know that, no matter how you live your life, you may someday develop a deadly form of heart disease. The goal of our research is to develop a therapy to prevent the onset of arrhythmogenic right ventricular cardiomyopathy and, for those that have already developed the condition, to effectively treat them.”

Dr. Jason Roberts
Scientist and Associate Professor,
Population Health Research Institute,
McMaster University

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a genetic heart disorder that often shows no symptoms before sudden cardiac arrest, even in young and otherwise healthy patients. Reports of young athletes’ sudden deaths on the playing field or rink are often caused by ARVC, and there is a subtype so common in Newfoundland that it is called the “Newfoundland curse.” Currently, there are no effective medical therapies for ARVC. The only reliable intervention to prevent sudden death is the insertion of an implantable cardioverter-defibrillator; however, shocks from the device can be painful and traumatic. Furthermore, this device means limitations on the patient’s lifestyle, such as avoiding physical activity that accelerates the progression of the disease.

But a new study, the TaRGET trial, led by Dr. Jason Robert, a scientist at McMaster University’s Population Health Research Institute and a genetic arrythmia specialist, is evaluating a promising new therapy for this genetic heart condition, the small-molecule drug tideglusib.

Dr. Roberts and his team of collaborators have found that tideglusib is able to prevent the development of ARVC in mice and can also partially reverse the disease. With the backing of the Clinical Trials Fund, Dr. Roberts and his team are now exploring tideglusib’s potential in clinical trials. A treatment that reduces the need for insertion of defibrillators and enables affected individuals to live without lifestyle restrictions and device-related complications could be game changing for ARVC patients.

In Canada, there is already a national network—the Hearts in Rhythm Organization— whose goal is to improve the care of ARVC patients. The network and its collaborators across the country will be involved in the TaRGET trial. Equally important, TaRGET will be conducted through the Population Health Research Institute at McMaster University and Hamilton Health Sciences, which has previously conducted pivotal clinical trials for medicines in cardiology.

Dr. Roberts is hopeful that advances in therapy will dramatically improve the lives of patients with genetic cardiac disorders.

Further reading

Adapting the Attachment and Child Health (ATTACH™) approach for broader availability

An App to Promote Healthy Parent-Child Relationships and Children’s Mental Health and Development

Dr. Nicole Letourneau & ATTACH™ Team
Professor
University of Calgary

ATTACH™ is an evidence-based, psychoeducational parenting program designed to help parents affected by adversity, such as family violence, depression and low-income, promote the mental health and development of their preschool-aged children. The Harvard Center on the Developing Child named ATTACH™ a prestigious Frontiers of Innovation project. ATTACH™ was singled out for its ground-breaking impacts on children’s mental health and development by building parents’ reflective function (i.e. insight into their own and their children’s thoughts and feelings). ATTACH™ also improves children’s attachment security and children’s immune cell gene expression linked to inflammation. Following a successful pilot test, we propose to test, scale, and spread the ATTACH™ Online App across Alberta with 10 agencies, including eight women’s shelters serving mothers and children affected by family violence, an agency serving parents and children affected by mental health problems, and an agency serving low-income teen mothers and their infants.

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Breaking the Cycle: Evaluating and Implementing an Early Intervention Program for Children Exposed to Adversity

A program to support mother-child relationships for mothers who use substances

Dr. Nicole Racine
Assistant Professor, CHEO Chair in Child and Youth Mental Health
School of Psychology, University of Ottawa

One in three Canadian children is exposed to adverse childhood experiences (ACEs), including abuse, neglect, and family violence. During early childhood, when the foundation for lifelong mental health is established, exposure to ACEs is particularly harmful.

Breaking the Cycle (BTC) is an award-winning program that serves substance-using mothers and their young children who are at risk for exposure to ACEs. BTC is a one-of-a-kind program in Canada for substance-using mothers that specifically targets the mental health of young children and the mother-child relationship.

Co-led by Dr. Debra Pepler and Margaret Leslie, this team grant aims to understand whether the BTC program enhances mental health outcomes for young children, and whether it is associated with long-term cost savings. The team will also identify strategies for scaling and implementing the Breaking the Cycle program in other communities. This project will position Canada as an international leader in infant mental health and improve mental health outcomes for children exposed to ACEs.

Further reading

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It takes a village to raise a child

Capacity-building to improve mental health outcomes in Canada’s youngest children

Dr. James N. Reynolds
Professor
Queen’s University

Canada lacks a systematic approach to supporting the mental health needs of young children and their families. Healthcare practitioners often fail to recognize vulnerability in young children because they do not know what to look for, and families struggle to access early mental health support for their children. Consequently, early developmental risks that go unidentified can solidify into behavioural challenges and adverse mental health outcomes in later years that will require significantly more effort from the child, their family and available community services to address.

Decades of work led by Infant and Early Mental Health Promotion (IEMHP) and its partners have engaged organizations from multiple sectors along with community leaders and families in building the capacity to better address Infant and Early Mental Health (IEMH) concerns. Our proposed research will leverage a community intervention called the Infant and Early Mental Health Care Pathways Intervention. IEMHP has developed a community-led, capacity-building model for embedding IEMH into current health, education and social services. This proposal will test the hypothesis that implementing this model and its associated assessment tools will enhance, create and even expand IEMH promotion, prevention and treatment services within communities.

Further reading

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Promoting dual-generation mental health through a hybrid eHealth & community-based intervention

Implementing the BEAM (Building Emotional Awareness and Mental Well-Being) App-based Program with a network of community agencies to treat parent mental illness, build social supports, and prevent child mental health and developmental challenges.

Dr. Leslie E. Roos
Assistant Professor
University of Manitoba

Untreated mental illness in a parent can impact young children by exposing them to stressful events including violence or relationship disruptions. Dr. Roos and her team have created an app-based program called BEAM (Building Emotional Awareness and Mental Well-Being) to support family mental health by providing educational videos, group checks-in, support forums, and mental-health symptom tracking. BEAM is designed to improve the well-being of a generation of children born during a global pandemic to highly stressed parents. Research so far shows that BEAM has great promise in helping parents overcome challenges and improve parent-child relationships. We expect that BEAM will be able to prevent child mental health problems and developmental impairments when rolled -out in the community. This will be tested in a pragmatic clinical trial in which BEAM will be co-delivered by Family Dynamics, a large community organization based in Winnipeg. Dr. Roos and her team will track program roll-out and measure BEAM’s success at preventing harsh parenting and improving child health, development, and school-readiness. This partnership model establishes a strategy for wide-scale delivery of BEAM across Canada in a way that is accessible to those that need it most. Dr. Roos is excited to help children and families thrive in the recovery from the pandemic and beyond.

Further reading

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Developing Culturally Grounded Methods for Understanding Indigenous Children's Mental Health

Dr. Melissa Tremblay
Assistant Professor
University of Alberta

For Indigenous (i.e., First Nations, Metis, and Inuit) children in Canada, the need for early childhood investment is pronounced. Nurturing the healthy development of Indigenous children is complex, requiring the weaving together of community-led innovation and scientific research, as well as the fundamental recognition that Indigenous peoples and communities have the knowledge that is needed to improve the health status of their own children. Moreover, successful implementation of early childhood programming requires assessment, screening, and evaluation tools that are grounded in community and cultural understandings of mental health. This project builds on a partnership between the Early Years Program and academic researchers. Early Years Programming has been co-created by the Martin Family Initiative alongside Indigenous communities across Canada with the intent of unleashing the potential that all children are born with. Working in partnership with Early Years programming in Alberta, the Yukon, and Nunavut, the objectives of this project are twofold: (1) to examine factors associated with successful implementation of Early Years programming in Indigenous communities, to help lay the foundation for early childhood mental health; and (2) to co-create tools to evaluate early childhood program implementation in ways that centralize Indigenous community priorities related to early childhood mental health.

Further reading

Promoting the Mental Health of our Youngest Canadians

Knowledge Development and Exchange Hub for Mental Health in the Early Years

Dr. Alice Schmidt Hanbidge
Dr. Alice Schmidt Hanbidge is a Scientific Co-Director at the KDE Hub, in addition to Associate Professor in the School of Social Work, and Adjunct Professor with the Faculty of Health at the University of Waterloo.

Dr. Colleen McMillian
Dr. Colleen McMillan is a Scientific Co-Director at the KDE HUB as well as Associate Professor in the School of Social Work, Adjunct with Faculty of Health and cross appointed at the School of Pharmacy at the University of Waterloo. She is a Clinical Adjunct Professor at the Department of Family Medicine, McMaster University.

Researchers continue to learn how critical the first five years of life are to positive mental health throughout the life span. Mental health can be improved over the long-term by working with families, communities, and governments to ensure the best possible conditions in the early years. More research is needed, however, in areas such as how to support children from various cultures, geographic locations and contexts. CIHR is funding implementation science research across Canada through the Mental Health in the Early Years (MHITEY) program. The Knowledge Development and Exchange Hub (KDE Hub) exists to support mental health promotion and mental illness prevention projects. The KDE Hub will work with MHITEY researchers to share new learnings with families, communities, caregivers, program providers, fellow researchers and government. The Hub will support the MHITEY research teams to learn together and connect them with others who share their interests, generating new learning across research teams. Through the Hub’s support, we can amplify the work of the MHITEY research projects and make a difference in the mental health of our youngest Canadians, both now and in the future.

Further reading

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Dr. Hawkes takes the first step towards a Strep A vaccine to prevent serious illness in children

“The ultimate goal is a safe and effective vaccine that can be widely used as a public health tool to prevent Strep A disease.”

Dr. Michael Hawkes

Strep throat is not a rare ailment in children, but it can quickly become severe enough to require hospitalization. Dr. Michael Hawkes at the University of Alberta is a pediatric infectious disease physician who has seen many cases of life-threatening Streptococcus A (Streptococcus pyogenes).

Dr. Hawkes and his team are launching a phase 1 study in healthy volunteers testing the safety and immune response of two new Strep A vaccines, based on peptides (small proteins) that generate antibodies to fight Strep A.

Without proper treatment—and there is currently no available vaccine to prevent the illness—Strep A can turn into rheumatic fever, bloodstream infections, and flesh-eating disease. Evidently, a Strep A vaccine could avert serious disease in Canadian children; and around the globe, rheumatic fever is a major cause of heart disability, meaning that prevention is an important public health goal that reaches beyond Canada’s borders.

The first phase of this trial will involve 30 healthy volunteers. Once safety and usefulness are established, future studies will follow. Dr. Hawkes’s ultimate goal is a vaccine that can be widely used to prevent Strep A in children.

Further reading

Can we avoid esophagectomy in patients with esophageal squamous cell carcinoma?

Improving quality of life following treatment for esophageal cancer

"My hope is that the NEEDS trial positively impacts the quality of life of esophageal cancer patients.”

Dr. Jelena Lukovic
Radiation Oncologist, Princess Margaret Cancer Centre, University Health Network
Assistant Professor, University of Toronto

The esophagus is the hollow, muscular tube that carries food and liquids from the throat to the stomach. Like other tissues, organs, or structures in the body, the esophagus is a site where cancer can develop. In fact, esophageal cancer is the 7th most common cancer and 6th most common cause of cancer death.

Esophageal squamous cell carcinoma represents 90% of cases globally. Curative intent treatment where cancer specialists aim to get rid of the cancer for good is controversial. Patients are usually treated with a combination of chemotherapy and radiotherapy followed by an esophagectomy, a surgical procedure in which all or part of the esophagus is removed. Esophagectomy has a negative impact on quality of life and existing scientific evidence has not resolved whether it is truly necessary.

Dr. Jelena Lukovic is a radiation oncologist at the University Health Network’s Princess Margaret Cancer Centre and Assistant Professor at University of Toronto. Dr. Lukovic is a member of the team leading the NEEDS trial, an international randomized trial that seeks to compare outcomes after chemotherapy and radiotherapy followed by surgery with definitive chemotherapy and radiotherapy with surveillance and, if necessary, surgery to remove the remaining parts of a tumour, known as “salvage esophagectomy”. The trial also aims to determine if health-related quality of life is superior by avoiding esophagectomy in a proportion of patients. Dr. Lukovic and her colleagues anticipate that the results will be highly cited and form the basis of national and international treatment guidelines for esophageal squamous cell carcinoma.

Further reading

Can we better treat acute pain in children?

Clinical researcher at McMaster University conducts clinical trial to determine whether a non-opioid medication can reduce pain as effectively as morphine with fewer side effects in children with appendicitis

"As a clinical practitioner, I’ve noticed that acute pain is responsible for approximately 70% of all visits among patients in emergency medicine. Unfortunately, it is quite common that we use painkillers without sufficient evidence of their effectiveness or safety. This can potentially lead to harmful side effects. Because of the devastating impact of the opioid crisis and the need to find effective alternatives, I’m currently investigating a non-opioid to treat severe abdominal pain. By exploring new avenues for pain management, my goal is to provide safe and effective care for patients overall."

Dr. Mohamed Eltorki
Assistant Professor of Pediatrics and Pediatric Emergency Medicine, McMaster University

Appendicitis is a common condition among Canadian children that often leads to emergency surgery. Children with appendicitis can experience severe abdominal pain, which makes pain management crucial. Opioids such as morphine are often prescribed but taking them carries serious risks and side effects.

Dr. Mohamed Eltorki, an Assistant Professor of Pediatrics and Pediatric Emergency Medicine at McMaster University, and his colleagues are studying whether a non-opioid medication called ketorolac is as effective as morphine in treating children with appendicitis. Ketorolac is known to help decrease inflammation and pain with fewer side effects. The team is conducting a multi-centre randomized controlled trial that will involve 600 patients from hospitals across Canada. Study participants will receive either a single dose of morphine or ketorolac based on the flip of a coin.

Dr. Eltorki hopes this study will provide evidence for families and practitioners to guide their use of effective pain medicines in children.

Further reading

Precision medicine for the other ovarian cancers

Molecular features of endometriosis-associated cancer can be used to re-classify ovarian cancers and direct management

"We are on the verge of seeing cancer by how they evolved rather than where they appear. This new understanding can drive more efficient prevention and management strategies. Our work is part of this new paradigm. By recognizing parallels between rare ovarian cancers and more common uterine cancers, we will ultimately bring more options for patients and better co-operation between researchers across fields."

Dr. Michael Anglesio
Assistant Professor, University of British Columbia

The best way to understand endometriosis-associated cancers is to better understand their origins from endometriosis and cells in the endometrium. This is a unique group of cancers that does not follow the same evolution, responses to treatment, or hereditary risk factors as more common high-grade serous ovarian cancers.

Dr. Michael Anglesio, an Assistant Professor at the University of British Columbia, and his team work closely with endometriosis clinicians to learn more about how endometriosis develops and progresses as a chronic disease with malignant potential. His group is one of a few groups to study endometriosis at a genetic level and the first to describe cancer-like mutations in this condition – even when it doesn’t turn into cancer.

Dr. Anglesio is a leader in a global team working together to build a resource of endometriosis-associated ovarian carcinoma samples that will help to understand how these cancers evolve. His team has already defined four subtypes that are nearly identical to cancers in the endometrium. This discovery may soon change treatment for endometriosis-associated cancers, including reducing toxic chemotherapies for many of them.

While endometriosis-associated cancers are considered rare, endometriosis is not. Almost 10% of individuals with a uterus may be affected by endometriosis and are at elevated risk for these cancers. By looking at both cancer and pre-cancers, Dr. Anglesio hopes to bring benefits to both individuals affected by endometriosis and those affected by related malignancies.

Further reading

Yes, doctors keep your surgery wounds clean. But the best solution—iodine or saline—is a hotly debated question.

“Irrigating surgical site infections may improve patient outcomes and reduce the burden to our healthcare system. Uncertainty remains, but we are hopeful that the CLEAN Wound trial will resolve that uncertainty.”

Dr. Paul Karanicolas

You might think that washing out a surgical incision is obvious, but there is some variability within Canada—and even within institutions—about when and how you should wash wounds, and with what fluid.

Dr. Paul Karanicolas’ trial will examine whether irrigating (washing) surgical incisions can reduce the chances of a surgical site infection. These infections are a burden on patients and the healthcare system, resulting in additional health problems and longer hospital stays, but this simple and inexpensive intervention will likely improve patient outcomes.

Called the CLEAN Wound trial, Dr. Karanicolas will compare a povidone-iodine solution (an antiseptic) and a saline solution with no wound irrigation, and measure the results after 30 days. With this new funding from the Clinical Trials Fund, the CLEAN Wound trial will be rolled out in eight community and academic centres across Ontario.

Dr. Karanicolas is hopeful that his trial will resolve the uncertainty around irrigating surgical site infections, thus leading to a better standard of care for all patients in Canada and worldwide.

We can’t fix what we don’t understand

University of Toronto researcher aims to understand how structure-selective DNA endonucleases recognize and cleave DNA as a potential therapeutic target for cancer

“Cancer cells are highly complex, constantly evolving and adapting to their environment. They have a variety of genetic mutations and alterations that allow them to grow and spread uncontrollably. Every step forward in cancer research takes us one step closer to a world without this terrible disease. My role in the fight against cancer is to break new ground in our mechanistic understanding of enzymes that have critical roles in DNA repair and genome stability, two processes that are often compromised in cancer cells.”

Dr. Haley Wyatt
Assistant Professor, Department of Biochemistry, Temerty Faculty of Medicine, University of Toronto

The Achilles heel of cancer cells lies in identifying a characteristic weakness or vulnerability that these abnormal cells possess, which can be targeted and exploited for the purpose of treating cancer. One such characteristic is uncontrolled cell proliferation and growth, which leads to an increased amount of DNA damage due to errors during replication, exposure to harmful compounds, and oxidative stress. While normal cells can repair or remove damaged DNA, cancer cells often acquire mutations in genes that regulate this process, leading to an accumulation of DNA damage, abnormal DNA structures, and genomic instability.

With the support of a CIHR Project Grant, Dr. Haley Wyatt at the University of Toronto is studying how structure-selective endonucleases recognize and cleave aberrant DNA structures to safeguard genome integrity. Her experimental approaches are highly complementary and include biochemistry, structural biology, and molecular biology. Dr. Wyatt’s fundamental research may ultimately identify regions of structure-selective endonucleases that are amenable to therapeutic intervention.

Further reading

Building on mutual support!

A Vanier Scholar at Laval University has partnered with a community organization to explore how the community and people living in supervised apartments can mutually support one another

“I am interested in the creation of autonomy- and inclusion-friendly environments in the community of autistic people with intellectual or physical disabilities. I am motivated to work in partnership with those affected by the focus of my research, with a view to generating sound scientific data that can also be used by actors on the ground. Working with a community organization as part of my Ph.D. is extremely stimulating!”

Justine Marcotte
Vanier Scholar and Doctoral Student in Community Health, Laval University

An increasing number of organizations are establishing supervised apartments to better meet the housing needs of autistic people with intellectual and/or physical disabilities. However, the organizations are grappling with a number of questions: How to create an environment that adequately supports tenants’ independence? And how to foster tenants’ participation in their own community? Unfortunately, the scientific literature lacks the information needed to answer these important questions.

The community partner organization in this project shares these concerns. Through meetings with those involved in this organization, we came up with the idea of developing a mutual support network between the tenants who will live in the supervised apartments, as well as between the tenants and other community members. To identify the key elements that need to be brought together to ensure that the mutual support network meets the needs of the various actors involved and is sustainable over time, community members and tenants are invited to share their ideas in a community forum and one on-one interviews.

In addition to contributing to advancing knowledge, this research will inform the partner organization and others developing similar residential projects about the development of sustainable mutual support networks between autistic tenants with intellectual or physical disabilities and the other community members. The project will thus help with the creation of residential and community environments where these people can maximize their potential.

Further reading

Breathing machines are uncomfortable for patients. Can a sedative already used in intubation help make breathing machines tolerable for more patients?

“I enjoy research because it allows me to have a wider impact, helping not only the patient that is directly in front of me, but potentially improving care for critically ill patients throughout the world for years to come.”

Dr. Kim Lewis

Before patients with respiratory failure are intubated or connected to a mechanical ventilator, most are connected to a breathing machine called non-invasive ventilation (NIV). This form of ventilation (similar to a machine for sleep apnea but stronger) means that the patient does not have to have a breathing tube inserted and be placed into a medically induced coma to allow the lungs to recover. It is less invasive, reduces the length of intensive care stays, and reduces the risk of pneumonia.

But while NIV is preferable to mechanical ventilation, it is not all sunshine. Non-invasive ventilation can be quite uncomfortable— the mask is very tight-fitting, and the machine delivers a high pressure of air. Some patients simply cannot tolerate NIV, meaning they must be moved on to a mechanical ventilator.

But Dr. Kim Lewis, a critical care physician at McMaster University, may have a solution: a medication called dexmedetomidine, already used in intubation, can calm the patient down, provide pain relief, and treat underlying delirium. Dr. Lewis is hoping that her blinded randomized clinical trial will demonstrate that the sedative dexmedetomidine, compared to a placebo, will help patients tolerate NIV, and therefore help to prevent the need for intubation and mechanical ventilation.

This trial came out of the COVID-19 pandemic when Dr. Lewis was intubating many patients with respiratory failure. She knew she had to find a solution. If dexmedetomidine is found to help patients, it will keep more people off mechanical ventilators, making hospital stays shorter and more agreeable.

Further reading

Stopping the spread of lung cancer

Vanier Scholar at the University of Manitoba focuses on how cells recycle their mitochondria as a novel approach to preventing metastasis in lung cancer

“I lost my father and grandfather to cancer and that ignited my interest to conduct research on cancer, keeping me motivated to this day. The best part of my research is the sense of fulfillment I get from my research, helping me go to the lab every morning. It’s very rewarding to feel I’m a small part of ongoing collective efforts to combat lung cancer. My research could help develop novel treatments to slow down the spread of lung cancer cells to other organs in lung cancer patients.”

Javad Alizadeh
Vanier Scholar and PhD candidate
University of Manitoba

Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death in Canada. In fact, more Canadians die of lung cancer than colorectal, pancreatic and breast cancers combined. Metastasis, or the spread of the cancer to other parts of the body, is the major cause of death among lung cancer patients.

Javad Alizadeh, a Vanier Scholar and PhD candidate at the University of Manitoba, is focused on finding ways to prevent metastasis of lung cancer cells to other tissues. His research so far has shown that a specific protein located on mitochondria appears to play a crucial role in the migration and metastasis of lung cancer cells to other organs. These findings could hopefully contribute to the development of new approaches to decrease the metastasis of lung cancer, thereby significantly increasing the life expectancy of Canadian patients diagnosed with lung cancer.

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From H1N1 to COVID-19, this collaborative critical care network shows how to run trials during a pandemic

“In playing a role in the global response to COVID-19, we are both improving the lives of those most severely affected, and pointing to a powerful approach to improve health care for critically ill Canadians in the future.”

Dr. John Marshall

Dr. John Marshall has been running trials in pandemic preparedness since the H1N1 outbreak in 2009, under the umbrella of the Randomized Embedded Multifactorial Adaptive Platform trial in Community-Acquired Pneumonia (REMAP-CAP). Once COVID-19 was declared an outbreak, Dr. Marshall’s multinational trial shifted its focus to evaluating treatments for severe COVID-19.

Dr. Marshall has long been an advocate for collaborative, multi-institute clinical research. He chaired the Canadian Critical Care Trials Group from 2005 to 2012, which gave him a greater appreciation for collaborative research. In 2008, similar trial networks from around the world formed a loose alliance, the Forum for Acute Care Trialists. These existing networks were instrumental in dealing with the COVID-19 pandemic, and H1N1 before it.

REMAP-CAP is a platform for global collaborative research. To date, the trial has recruited over 10,000 patients with COVID-19, and the trial has established the benefits of treatment using corticosteroids, IL-6 receptor antagonists, and antiplatelet agents, as well as the harms of hydroxychloroquine. The results from these trials have been incorporated into WHO guidelines and changed the way that clinicians manage severe COVID-19.

REMAP-CAP’s renewed funding comes from the Centre for Research on Pandemic Preparedness and Health Emergencies. This funding is as much financial assistance moving forward as it is a recognition of the accomplishments that Dr. Marshall’s team has already achieved in pandemic preparedness.

Further reading

Leveraging biological sex and genetics for beta cell-directed precision medicine in type 1 diabetes

"Our work will identify targets in beta cells that improve their ability to survive and maintain insulin production in each sex. This is a critical first step toward developing sex-informed therapeutics to improve beta cell function in people living with or at risk for T1D."

Dr. Elizabeth J. Rideout
Assistant Professor, Cellular & Physiological Sciences – University of British Columbia

Dr. Rideout is an Associate Professor in the Department of Cellular and Physiological Sciences at The University of British Columbia. She currently holds a CIHR Sex and Gender Science Chair in Genetics, and was named a Michael Smith Foundation for Health Research Scholar in 2017. Dr. Rideout’s research program is focused on identifying metabolic genes and pathways that contribute to sex differences in metabolism and metabolic disease. One major area of research in Dr. Rideout’s lab concerns sex differences in insulin production under normal conditions and during stress using fly, rodent and human models.

Dr. Rideout is the Nominated Principal Investigator for a CIHR – Juvenile Diabetes Research Foundation (JDRF) team grant competition entitled ‘Type 1 Diabetes and Precision Medicine’. Using human islets and mice, Dr. Rideout’s lab works with the labs of Drs. James Johnson, Bruce Verchere, Peter Thompson and Dan Luciani to define how sex and genetics influence insulin throughout all stages of its production and release in the context of type 1 diabetes (T1D) pathogenesis. This team will determine how insulin synthesis, processing and quality-control mechanisms are disrupted in each sex in people living with T1D. The team will also test how modulating key steps of insulin’s production affects beta cell function and diabetes progression in the gold standard mouse model of T1D. These studies will allow the team to determine which steps are disrupted in T1D, and whether these changes can identify individuals at a high risk of developing diabetes. This knowledge will help the team test whether these steps can be therapeutically targeted to prevent and treat T1D. Because the team’s studies will use sex-based analysis for all their data, their studies will take an important step forward in developing sex-informed prevention and treatment strategies for type 1 diabetes.

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Empowering diverse youth with diabetes through precision medicine, ‘EVERYONE’

“The reality is that we have much to learn about precision medicine and how it can be successfully used and equitably implemented. The EVERYONE study will contribute to a greater understanding of the physiologic and social factors underlying heterogeneity in diabetes outcomes, and the opportunity to evaluate precision medicine-based approaches to optimize diabetes care.”

Dr. Farid Mahmud
Associate Professor, Faculty of Medicine – University of Toronto; Staff Physician, Division of Endocrinology – Sickkids

Farid Mahmud is an Endocrinologist and Associate Professor at the University of Toronto and Associate Scientist at The Hospital for Sick Children Research Institute. Dr. Mahmud's overall research focus is diabetes clinical research, relating to the early evaluation and prevention of diabetes-related complications and the impact of the social determinants of health on diabetes outcomes. He serves as lead investigator for multiple clinical trials including the Adolescent Diabetes Cardio-Renal Intervention Trial in Canada and the ATTEMPT (Adolescent Type 1 diabetes treatment with SGLT2i for hyperglycemia & hyperfiltration trial) innovative clinical trial funded as part of the CIHR Strategies for Patient Oriented Research. He also serves as a Global Editor for the 2022 International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines that provide evidence-based recommendations for the assessment and treatment of children, adolescents, and young adults with diabetes worldwide.

Dr. Mahmud is the Nominated Principal Investigator for the CIHR-JDRF Type 1 Diabetes and Precision Medicine team grant for his project entitled, “Empowering diverse youth with diabetes through precision medicine, ‘EVERYONE’.” The goal of this study is to create new knowledge on how differences in genes, environment, and social factors contribute to differences in type 1 diabetes management and develop ways to improve outcomes for all youth with type 1 diabetes. This research project will use a personalized approach to diabetes care at the Hospital for Sick Children and other regional practices.

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Spatio-temporal dynamics of immune and non-immune islet injury in Type 1 Diabetes

“Our work will furnish exciting new insights into the two-way dialogue between the autoimmune process and the beta cells and how this influences the variability in the timing and severity of T1D between people. We are confident that what we learn from these studies will lay a foundation for new treatments for patients at different stages of T1D, ultimately supporting the goal of precision-guided medicine.”

Dr. Peter Thompson
Assistant Professor, Department of Physiology & Pathophysiology – University of Manitoba

Dr. Thompson is an Assistant Professor in the Department of Physiology & Pathophysiology at The University of Manitoba and a Principal Investigator at the Children’s Hospital Research Institute of Manitoba. His recently established research program is focused on understanding Type 1 Diabetes (T1D) from the perspective of the insulin-producing beta cells and their complex interactions with the immune system. The long-term goal of his work is to develop new therapies that will protect beta cells for the prevention and cure of T1D.

Dr. Thompson is the Nominated Principal Investigator for a CIHR – Juvenile Diabetes Research Foundation (JDRF) team grant competition entitled ‘Type 1 Diabetes and Precision Medicine’. His team, including Dr. Guy Rutter at Université de Montréal, Dr. Herbert Gaisano at University of Toronto and Dr. Pere Santamaria at University of Calgary and Diabetes Action Canada patient partners will investigate an intriguing theory to explain how and why T1D varies so much between people. The team will visualize how the autoimmune process develops and whether in it may exhibit selectivity for destroying key beta cell populations that act as master regulators of insulin output. This will be achieved by the application of an array of state-of-the-art genetic tools combined with prospective imaging in T1D mouse models and human T1D pancreas specimens to study the heterogeneity of the autoimmune process and its impacts on beta cells in real-time. They will also study how targeting beta cell stress programs reciprocally shapes the evolution of autoimmunity in T1D. Together, these studies are expected to support the development of new precision-guided treatments for T1D.

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Decline, refuse, resist?

Nurses’ understandings of dementia and the provision of unwanted personal hygiene care in acute care facilities

“My experiences as a Registered Nurse in residential dementia care inspires my research. I am interested in how nurses understand clients with dementia and particularly their right to refuse assistance with personal hygiene care. Memories of the many clients who firmly declined my offers of assistance with their care compelled me to explore how nurses hear the declinations of people with dementia (as declinations? As refusals? As acts of resistance?) and the discourses that shape their understandings of how they ought to best respond. I am deeply committed to research that will help frontline nurses support and prioritize the capacities of people living with dementia to decide what is best for their lives and bodies.”

Patricia Morris
Registered Nurse, Vanier Scholar and PhD candidate, University of New Brunswick

For many of us with class, neurotypical, and able-body privilege, the bath has been an important site of relaxation and body modification; an experience marked by low lighting or aggressive callous rasping (or perhaps both) that sits at the intersection of pleasure and hygiene. But this is certainly not the experience of all who bathe. Clinicians and researchers have long recognized that bathing is one of the most challenging activities of daily living for people living with dementia. Challenges with executive functioning, motor processing and sensory changes contribute to the propensity of some people with dementia to self-neglect as their disease processes worsen and lead to the development of behavioral and psychological symptoms of dementia.

As a Registered Nurse, Patricia Morris has experienced the incredible challenge of assisting clients with with unwanted bathing in providing residential dementia care. As a Vanier Scholar and PhD candidate at the University of New Brunswick, Patricia is carrying out research that explores nurses’ understandings of what they ought to do when a client’s body, clothing, or immediate environment are soiled but the person declines their assistance. Through focus group discussions stimulated by shared immersion in a virtual simulation, she is delving into the ways that nurses describe clients and their declinations of care. She is particularly interested in examining how acute care nurses navigate the complex task of providing (or declining to provide) personal hygiene care amidst a global pandemic that necessitates a hyper-fixation on cleanliness and infection prevention for the safety of other clients.

Further reading

Naturally killing the deadliest ovarian cancers

Redirecting our immune system's natural killer cells to treat high-grade serous cancer

“Ovarian cancer has been steadily and silently killing for the past 30 years. Unfortunately, the few patients that survive carry lifelong scars from the current standard of care. I plan to take every opportunity to change this story for people with ovaries. I believe natural killer cells present a unique therapeutic opportunity.”

Sarah Nersesian (she/her)
Vanier Scholar and PhD Candidate, Dalhousie University

An ovarian cancer diagnosis shouldn't mean battling side effects for the rest of life or receiving a death sentence. But unfortunately for those diagnosed with high-grade serous cancer (HGSC), it often is.

Sarah Nersesian is a Vanier Scholar, PhD candidate, and science communicator at Dalhousie University. She has dedicated her life to finding new therapies that effectively eliminate both HGSC and the harsh side effects of current treatments. Among new treatments, the most effective are proving to be immunotherapies, which enhance the immune system's response to cancer and lead to far fewer side effects than classical chemotherapies. Natural killer (NK) cells are a promising new candidate for immunotherapy. Appropriately named, NK cells are highly efficient killers; however, cancer is good at shutting their response down.

To figure out how to best equip them to resist cancer suppression, Sarah is investigating the relationship between NK cells and HGSC. Working under the leadership of Dr. Jeanette Boudreau, Sarah and her labmates have so far have discovered that specific NK cells are better at predicting outcomes for HGSC patients than others. In the future, her research will inform the kinds of immunotherapy that scientists develop and hopefully will result in a new therapeutic option for HGSC patients in Canada.

Further reading

Sexualized drug use among HIV-positive gay men

Exploring the impact of HIV status, mental health, and substance use on sexualized drug use practices

“As a practicing nurse for over 12 years, I have witnessed some of the challenges faced by gay men living with HIV related to their serostatus, mental health, and substance use. As rates of sexualized drug use continue to increase among gay men, my hope is to better understand their experiences to help combat stigma and improve nursing care for this group.”

Lauren Orser
Vanier Scholar and PhD Candidate, University of Ottawa, School of Nursing

Lauren Orser is a Vanier Scholar and PhD candidate in the School of Nursing at the University of Ottawa. Her research focuses on HIV-positive gay, bisexual, and other men who have sex with men (gbMSM) who engage in chemical sex, or chemsex, using amphetamine-class drugs (e.g., crystal methamphetamine) to facilitate sexual activity. Specifically, this research will examine the intersecting factors of HIV-related stress, mental health, substance use, and addiction. It will aim at understanding the factors related to engagement in chemsex and its effects on physical health, mental well-being, and risk-taking practices among HIV-positive gbMSM. The findings will expand current understandings about chemsex and will help researchers and clinicians address the complex and interrelated health effects of this sexual and substance using practice.

Further reading

Mapping the reproductive health needs and priorities of women living with HIV

A Canadian study with global impact

“The academic tradition of the West is not community-based. So I have had to learn to leave the traditions of the space where I study to better align with community-based approaches.”

Lashanda Skerritt
Vanier Scholar and MD/PhD Candidate, McGill University

People are living longer, healthier lives with HIV compared to the early years of the epidemic. These advances have led to a shift in the reproductive health needs of people living with HIV, particularly women, who make up nearly a quarter of the people living with HIV in Canada and over half of the people living with HIV around the world.

Lashanda Skerritt is a Vanier Scholar and MD/PhD candidate at McGill University. She is a member of the research team leading the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS). By engaging patients and communities living with HIV, Lashanda and the CHIWOS research team have found that women living with HIV in Canada have diverse and dynamic reproductive goals. However, only about a third of these women were comfortable discussing their reproductive goals with their health care providers.

Using a visual concept mapping approach, Lashanda has mapped the health care priorities of a sample of women living with HIV in Canada. Her work has revealed that feeling safe and supported was the most central consideration in the satisfaction of women with their HIV care. It suggests that if we create environments where women living with HIV feel safe and comfortable discussing their reproductive goals, we can help ensure that care aligns with their goals and priorities.

Further reading

A ground-breaking gene therapy to improve health outcomes for patients with acute lymphoblastic leukemia

"As a hematologist, I work with patients with blood cancers such as myeloma, leukemia, and lymphoma. Every day, I see the devastating effects cancer has on people’s lives. It truly is these people who inspire me to do research that makes better cancer therapies a reality. Our team has a mandate to develop made-in-Canada, life-saving cell-based therapies."

Dr. Kevin Hay
Clinical Scientist and Hematologist, The Leukemia/Bone Marrow Transplant Program of BC, BC Cancer

Chimeric antigen receptor (CAR-T) cell therapy is a treatment in which a patient’s T cells, a specific type of immune system cell, are isolated and modified to recognize and attack cancerous cells. This ground-breaking gene therapy is manufactured in a laboratory and then given to a patient by infusion. One of the CAR-T cell therapies currently available targets CD19, a protein found on the surface of B cell cancer. CD19 CAR-T cell therapies have promising results in the treatment of some types of leukemia and lymphoma.

Despite this, only 30-50% of patients with acute lymphoblastic leukemia have a durable remission or cure after receiving CAR-T cell infusion. Dr. Kevin Hay believes that the key to improving the clinical outcomes of CAR-T cell therapies for these patients may lie in CAR-T cells designed to target a protein called CD22. Dr. Hay is co-leading the first Canadian research teams with the expertise and capability to test, manufacture, and distribute CD22 CAR-T cells right here in Canada.

For now, thanks to research collaborations with lab facilities based at BC Canada, the Ottawa Hospital Research Institute, and the National Research Council’s Human Health Therapeutics Research Centre, Dr. Hay’s phase 1 clinical trial will evaluate the benefits of this novel therapy to determine a safe dose to treat children and adults with acute lymphoblastic leukemia, including those who have relapsed after receiving CD19 CAR-T cell therapy. The team is also looking at tumour and blood samples hoping to identify other proteins that can increase the benefits of CAR-T cells therapies against other types of cancer. Results from Dr. Hay’s study will provide the foundations for other trials and set the standards to approve CD22 CAR-T cell therapy in Canada, with the potential to make this ground-breaking gene therapy available to a larger number of cancer patients in the future.

Further reading

Seizing opportunities to prevent legal system involvement in mental health care trajectories
A doctoral researcher and Vanier Scholar is looking for ways to better equip mental health care services to prevent situations leading to a not criminally responsible verdict

"Research that involves preventing legal system involvement for people living with severe mental disorders is too often done in isolation. Yet, as this a fundamentally interdisciplinary matter, any proposed solutions must necessarily be intersectoral. My research combines psychosocial, systemic and organizational perspectives to better equip the health care and social services system so that we can meet the complex needs of these people and reduce disparities in access to quality services."

Marichelle Leclair
Doctoral researcher and Vanier Scholar, University of Montreal

Vanier Scholar Marichelle Leclair is a doctoral candidate in both the Department of Psychology and the School of Public Health at the University of Montreal. She works to improve the organization of mental health care and services available to people involved in the criminal justice system. Based on the National Trajectory Project on criminal responsibility, she models administrative data on health from a cohort of over 1,000 individuals declared not criminally responsible, as well as from interviews with service users, informal caregivers and professionals.

Her work has demonstrated that, for the majority of these individuals, the system is aware of their mental health disorders, but few of them benefit from any real follow-up. She also showed that, unlike in traditional models of access to care, families may contribute to service disruptions by acting as makeshift providers for services that replace those perceived as ineffective and stigmatizing. Her work points towards the targeted and sustained action required to make specialized services available to prevent involvement with the legal system before an offence is committed, fostering integration and alignment strategies between services and empowering general practitioners and psychiatrists to be involved in prevention.

Marichelle is preparing to lead international evaluative research, starting in 2023, on legal models of psychiatric care, which will provide a basis for establishing organizational principles for services and standards of care in the field—ultimately improving service user recovery, loved ones' experiences and everyone's safety.

Further reading

Transforming type 1 diabetes treatment
Vanier Scholar at McGill University aims improve the delivery of pancreatic cell therapy for the treatment of T1D patients

"With the recent clinical successes in cell therapy and regenerative medicine, the translational potential of bioengineering research is more real than ever. I hope that the development of our biomedical devices will bring us one step closer to a cure for type 1 diabetes."

Jonathan Brassard
Vanier Scholar and PhD candidate, McGill University

Type 1 diabetes affects more than 300,000 Canadians and its impact continues to rise in Canada and the world. Transplantation of pancreatic islets, the tissue regulating insulin and blood sugar, is a promising strategy to treat diabetic patients because it can eliminate their dependence on external insulin sources. One problem of this approach is graft rejection, a process where your own immune system attacks the newly transplanted tissue and destroys it. To protect the islets, scientists are encapsulating them in biocompatible materials that create a physical barrier to prevent the immune cells to reach the graft while allowing nutrients to go through. Unfortunately, the large quantity of islets needed makes it difficult to have enough nutrients for all the graft, leading to significant cell death and failure of the therapy.

To address these issues, Vanier Scholar and PhD candidate Jonathan Brassard is working as part of a team at McGill University which is fabricating a small device that can encapsulate several hundred thousand islets and protect them from immune destruction. To optimize survival of the graft, this device contains many blood vessel-like channels that can be directly irrigated by the patient's own blood after transplantation. This strategy will allow patients with type 1 diabetes to be treated by islet transplantation without suffering from the difficult complications related to immunosuppression or insulin management.

Further reading

How can we best promote healthy growth among children?
Vanier Scholar and PhD candidate at the University of Calgary is focused on improving the assessment and communication of child growth data

"Children grow and flourish in many ways. However, there are many misconceptions and myths surrounding how children should grow. My research focuses on understanding how to best help children grow to their potential and achieve optimal development. I collaborate with parents, children, and health care providers to engage in research that can positively impact parental expectations and care practices and promote healthy growth among children. My training to date has fueled my passion for the role that evidence-based knowledge and effective knowledge communication can play in the improvement of health and given me even greater desire to continue to excel in my research."

Seham Elmrayed
Vanier Scholar and PhD Candidate (Epidemiology), University of Calgary

Childhood obesity is a major public health concern in Canada. Recent estimates indicate that 30% of Canadian children were overweight or obese.

Vanier Scholar Seham Elmrayed is a PhD candidate in pediatric epidemiology at the University of Calgary. Building on research findings from the United States and Canada indicating that most parents do not understand growth charts information and that most parents fail to recognize their child's risk of obesity, Seham works with healthcare providers and parents to identify opportunities to improve the assessment and communication of child growth information.

This work is allowing Seham to further develop her understanding of how we can not only best identify children at risk of suboptimal growth but also how to effectively communicate that risk, when it is there, to parents who play a key role in determining their children's health outcomes.

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Citizen-driven solutions to population health problems
Researcher brings local solutions to global problems to advance population health equitably

"The social, economic, and ecological conditions which shape health influence population groups in different ways. We cannot address disparities in health outcomes without remedying the root causes of health inequities. My research and life experience have shown that people are not powerless. Citizens' voices matter. Citizens and communities are the experts in their own health and social well-being. We must amplify citizens' voices to address the population health challenges we currently face."

Dr. Jasmin Bhawra
Assistant Professor, Toronto Metropolitan University
Director, CHANGE Research Lab

The primary focus of my interdisciplinary research program is to ethically apply digital innovations in partnership with communities for health systems transformation. The global health issues we currently face are complex and require reimagining solutions that are scalable across multiple systems (e.g. health, environment, food, social services, justice). Climate change, the COVID-19 pandemic, and the burden of non-communicable disease epidemics disproportionately impact racialized, Indigenous, and lower-income communities.

When viewed through a systems science lens, these health and social issues are deeply interconnected. Building on her Banting Postdoctoral Fellowship work at the University of Saskatchewan, Dr. Jasmin Bhawra developed the CHANGE Research Lab, which is based at Toronto Metropolitan University where she is an Assistant Professor with the School of Occupational and Public Health. The CHANGE Research Lab works with citizens to improve community health. Many of the prominent chronic health issues globally cannot be untangled from social and economic circumstance, so taking a holistic approach for population health is important for sustainable change.

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Contributing to Hepatitis C Elimination
Banting postdoctoral researcher at the Ottawa Hospital Research Institute uses implementation science to improve access to community-based hepatitis C care for people who inject drugs

"Ensuring equitable access to effective and appropriate health care services for all is the driving force behind my research. Because of my clinical training as a nurse and experience in working in a wide range of settings, I firmly believe that community organizations should play a larger role in improving access to health care for equity-deserving populations. Through my postdoctoral research program, I have been pursuing this vision by working in close collaboration with community organizations to examine how they can improve access to hepatitis C care for people who inject drugs. Working with community leaders and members is the best part of my research; the multidirectional exchange of information and learning is extremely valuable and truly eye-opening."

Dr. Guillaume Fontaine
Banting Postdoctoral Researcher, Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute

As an implementation scientist and health services researcher, Dr. Guillaume Fontaine works across disciplines and settings to improve access to high-quality care for different populations and solve challenges within the health care system. His research draws on implementation science – the scientific study of methods and strategies that facilitate the uptake of evidence-based practices, programs and policies into regular use by practitioners and policymakers. Dr. Fontaine examines what drives human behaviour, how and why things work, as well as the processes, mechanisms of change and contextual factors influencing implementation. His research these last few years, supported by a Vanier Canada Graduate Scholarship, a Banting Postdoctoral Fellowship and a Canadian Network on Hepatitis C Postdoctoral Fellowship, has been centered on preventing disease and promoting health in equity-deserving populations.

Currently, Dr. Fontaine's research is focused on using implementation science to improve access to high-quality hepatitis C care for people who inject drugs. Hepatitis C is one of Canada's most burdensome infectious illnesses, and up to 85% of new infections in Canada occur in people who inject drugs. New and highly effective treatments, known as direct-acting antivirals, provide the prospect of an actual cure for individuals and the potential for eradicating hepatitis C in Canada. However, multiple factors, such as stigmatization and disconnected health services, impede access to hepatitis C testing and treatment for people who inject drugs. Improving access to community-based hepatitis C care for people who inject drugs is a key step for hepatitis C eradication in Canada and across the globe.

Dr. Fontaine's postdoctoral research program investigates how best to implement high-quality hepatitis C care in harm reduction organizations serving people who inject drugs, such as needle syringe programs and supervised injection sites. Ultimately, his research seeks to give a voice to people who inject drugs and improve their access to hepatitis C testing, treatment and prevention services, contributing to hepatitis C eradication in Canada.

In August 2023, Dr. Fontaine will join McGill University as Assistant Professor of Implementation Science in the Ingram School of Nursing, Faculty of Medicine and Health Sciences. His program of research will focus on the advancement of methodological and theoretical approaches in implementation science to support the adoption of evidence-based practices, policies, and digital health innovations to improve population health, with an emphasis on chronic disease prevention.

Further reading

The role of sleep for the aging brain
Banting postdoctoral researcher studies sleep and circadian disturbances in the presymptomatic stage of Alzheimer's disease

"Alzheimer's disease is a huge burden on people's lives and society as a whole. Since we can modify sleep and circadian patterns with behavioral therapies, my hope is that a better understanding of the involvement of sleep and circadian disturbances in the development of Alzheimer's disease has the potential to delay or even prevent the occurrence of this disease in some people."

Dr. Andrée-Ann Baril
Banting Postdoctoral Researcher, Douglas Mental Health University Institute and McGill University

Our brains are hard-wired to sleep everyday, highlighting the importance of sleep and circadian rhythms to the functioning of our bodies and brains. Recent evidence is showing changes in sleep and circadian rhythms before the onset of clinical symptoms of Alzheimer's disease. These changes may be a cause or a consequence of the disease.

Dr. Andrée-Ann Baril is a Banting postdoctoral researcher at the Douglas Mental Health University Institute and the Department of Psychiatry at McGill University. Her work is focused on elucidating how sleep and circadian disturbances are linked to the development of Alzheimer's disease, using genetics and biomarkers derived from blood and cerebrospinal fluid samples. Her research will provide evidence to understand which key sleep components are involved in Alzheimer's disease pathology and through which biological pathways. Ultimately, Dr. Baril aims to uncover whether certain sleep patterns and biomarkers can predict future Alzheimer's disease cases and develop therapies to potentially contribute to preventing this disease.

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Improving sedation methods and accelerating brain recovery for critically ill children

“We are moved by the possibilities of making real tangible change at the bedside and offering new solutions to numerous patients and families who are affected by the many problems associated with traditional sedatives. This project is the seed of building a larger trial that will study the effect of inhaled anesthetics on brain function.”

Dr. Angela Jerath
Sunnybrook Research Institute
Cardiac anesthesiologist, Sunnybrook Health Sciences Centre

Many children admitted to pediatric intensive care units need sedation to support lifesaving therapies like mechanical ventilation. Unfortunately, these intravenous sedatives can cause delirium in more than half these children. Delirium is a brain disorder that presents as poor concentration, memory, and attention, and it can have devastating consequences such as longer hospital stays, reduced survival, and possible longer-term cognitive changes for the child. For families, visiting their child with delirium can be crushing as children may be too agitated to interact with the family or may not even recognize close family members.

Thanks to a pilot clinical trial, Dr. Angela Jerath at the Sunnybrook Research Institute is exploring and testing alternative sedation methods. Her pilot project, called Advancing Brain Outcomes in pediatric critically ill patients sedated with Volatile AnEsthestic Agents, or ABOVE, is studying the safety and feasibility of inhalation-based sedation. Unlike intravenous sedatives, inhaled ones do not accumulate in the body and are rapidly eliminated through the lungs. Researchers believe that inhaled anesthetics may help get the child off mechanical ventilators sooner. This means reduced delirium and accelerated brain recovery. In addition, inhaled sedatives are more accessible since they are used safely every day in operating rooms. They are also cheap and widely available.

Dr. Jerath has been working in sedation research for many years and, along with her research team, was motivated to put this project together after seeing how challenging it can be for critically ill children and their parents. The team comprises of leading experts in neurointensive care and pediatrics working in multiple intensive care units in Canada. They bring in the expertise and capacity needed to continue following children who were treated with inhaled sedatives for one year and to study the neurocognitive outcomes. The team is hopeful that inhaled sedation will provide clinicians and families with new drug options that offer better quality of sleep for these child patients with fewer neurocognitive side effects.

Further reading

Re-evaluating current treatment for bleeding complications in intensive care

“As the largest individual patient-randomized trial evaluating pantoprazole in critically ill patients, strong international collaboration means that REVISE will more than double the database on this topic and may influence intensive care practice worldwide.”

Dr. Deborah Cook
Distinguished Professor of Medicine, Clinical Epidemiology & Biostatistics at McMaster University

The development of stomach ulcers is a rare complication faced by critically ill patients on life support in the Intensive Care Unit (ICU), especially by those who require breathing machines. To prevent gastrointestinal bleeding from these ulcers, ICU doctors often administer pantoprazole, a drug that reduces acid production in the stomach. However, this treatment may lead to an increased risk of lung and bowel infection which raises a critical point—do the benefits of using pantoprazole outweigh the risks?

This is one of the questions motivating Dr. Deborah Cook, Distinguished Professor of Medicine, Clinical Epidemiology & Biostatistics at McMaster University. She is driving the largest individual patient Canadian-led ICU trial in the world. The Re-Evaluating the Inhibition of Stress Erosions trial (REVISE) is reassessing these current practices for treating critically ill patients. The factors that researchers are re-evaluating include whether acid suppression using pantoprazole decreases the risk of bleeding, whether it does more harm than good, and whether the treatment is worth the cost.

Since co-founding the first collaborative national research consortium in 1990 focused on improving outcomes in the ICU, Dr. Cook has conducted many trials to inform and improve the daily care of the sickest hospitalized patients in Canada and globally. She is motivated by the ethical imperative to constantly re-evaluate established practices as the epidemiology of critical illness and critical care interventions evolve over time.

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An understudied type of cancer receives new attention, with the potential to treat tumours that have spread to other parts of the body

“I hope this trial will help to provide a new and potentially better option for patients with gastroesophageal cancers and HER-2 positive disease in Canada.”

Dr. Elena Elimova

Gastroesophageal cancer has not had much research attention and despite recent advances, does not have many treatment options. One potential option centres on those patients who have tested positive for a protein called human epidermal growth factor receptor 2 (HER2). With this trial, those with HER2-positive gastroesophageal cancer have access to a novel second-line therapy that targets the cancer-expressing HER2 protein.

Dr. Elena Elimova is a gastrointestinal oncologist at the Princess Margaret Cancer Centre in Toronto who will lead this study testing a new targeted treatment. This trial is building on an earlier study that tested the efficacy of zanidatamab, a HER2-specific antibody, with the potential to better treat patients with gastroesophageal cancers and HER2-positive diseases in Canada.

HER2 is a protein that causes cancer cells, anywhere in the body, to grow quickly, and as such, this study of the antibody zanidatamab has the potential to stop or slow down tumour growth.

A large number of patients will be able to take part in this trial, since it is operating through the Canadian Cancer Trials Group, the largest national cancer research network.

Because research in gastroesophageal cancers has lagged behind other cancers, it can be especially deadly, even when diagnosed early. Dr. Elimova hopes through her research to make a difference in the lives of patients diagnosed with this cancer throughout the world.

Further reading

Better policies needed to prevent superbugs

Trying to prevent the spread of superbugs across the agricultural, health and environmental sectors

“Antibiotic resistance poses risks to public health because one in four human infections no longer respond to initial treatment by antibiotics. My research efforts with the CIHR-funded Global 1 Health Network address this problem across public health, agricultural, environmental and pharmaceutical policy sectors at national and international levels so that collaborative policies can be developed. It is imperative that measures to address the silent pandemic of antimicrobial resistance are featured in the Pandemic Treaty.”

Dr. Mary Wiktorowicz
Professor, York University

Because the rate of superbugs has elevated due to misuse of antibiotics, structural changes need to be made in the agricultural sector and in the overall medical treatment of humans and animals. Through the Global 1 Health Network, Dr. Wiktorowicz and her team are evaluating how antibiotics are used in low-, middle- and high-income countries around the world so that better regulatory measures can be developed and put in place for health care, agriculture, the environment and drug manufacturing.

To do this, Dr. Wiktorowicz is identifying the most effective governance and policy strategies regarding antibiotic use in five countries (Senegal, the Philippines, Hungary, the Netherlands, and Canada). Particularly, she is examining how tensions and trade-offs between agricultural trade and human health policy can be managed by governments. This will help her provide decision makers and stakeholders with findings that will lead to the development of collaborative solutions.

Further reading

Improving care for youth with spinal muscular atrophy through play

“Together with youth, families, and health care providers, we designed a video game to promote physical activity in children and adolescents with spinal muscular atrophy in order to give them access to recreation that is both rehabilitative and fun.”

Dr. Maryam Oskoui
Research Institute of the McGill Health Centre

Everyone agrees that an active lifestyle helps improve children’s health and quality of life. Physical activities are even more important to youth with spinal muscular atrophy, a rare genetic disorder that causes muscle weakness and associated complications that range from mild to severe. New drug treatments can help patients get stronger and live longer. But youth with spinal muscular atrophy may have limited opportunities and less motivation to exercise and stretch their muscles regularly. What if existing rehabilitative therapies could be redesigned to provide more fun exercises for youth with spinal muscular atrophy?

Working directly with youth, families, and health care providers, Dr. Maryam Oskoui realized that the key to developing a more stimulating exercise program for children and adolescents with spinal muscular atrophy is—literally—through play. Dr. Oskoui collaborated with these groups to develop an “exergame,” a type of video game designed to encourage users to stay active from the convenience of their home. Dr. Oskoui’s exergame uses a low-cost sensor that tracks users’ body movements and measures their progress.

Dr. Oskoui and her research team are now testing if the exergame is effective in providing accessible rehabilitation for children and youth with spinal muscular atrophy. She also hopes to identify better ways to measure the benefits of rehabilitative treatments for youth with this rare genetic disease. Her findings will help ensure care decisions support youth’s individual health needs and promote their independence.

Dr. Oskoui is part of INFORM RARE, a Canadian research network that evaluates therapies and makes recommendations to improve care for children with rare treatable genetic diseases.

Further reading

Unanswered questions around antibiotic use are harming patients

Dr. Daneman's BALANCE research program hopes to create a better evidence base for antibiotic treatments

“My research program is sparked by the unanswered questions I encounter in the process of caring for these vulnerable patients. Many of the fundamental decisions we make lack an evidence base. The ultimate goal for the BALANCE platform trial is to learn how to maximize the benefits and minimize the harms of antibiotics.”

Dr. Nick Daneman

Bloodstream infections are a leading cause of death in Canada, but there are still questions about the preciseness of antibiotic treatments. Antibiotics are a useful way of curing blood infections, but excess antibiotics run the risk of causing antimicrobial resistance, a major danger inside and outside of hospitals.

Dr. Nick Daneman is trying to strike a balance between curing infections and minimizing antibiotic harms. In his appropriately named BALANCE, or the Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness, trial, he is comparing the efficacy and side effects of seven days versus fourteen days of antibiotic treatment for bloodstream infections. If this trial confirms that shorter duration treatment is effective, it could lead to large global reductions in unnecessary antibiotic use.

After BALANCE is complete, many questions will remain. The newly funded BALANCE+ trial will follow from BALANCE to provide an evidence base for other aspects of antibiotic treatment plans, including whether or not to ‘de-escalate' broad-spectrum antibiotics to narrower spectrum drugs, whether oral antibiotics are as effective as intravenous antibiotics, which oral antibiotics to choose, and how to deal with infections caused by intravenous catheters.

BALANCE is the largest trial ever conducted among patients with bloodstream infections, and the study already counts 3400 patients across 73 hospitals. To Dr. Daneman, that is a lot of patients who will have improved care, while the general risk of antimicrobial resistance is decreased.

Further reading

Matter that Matters

Examining how white matter damage in the brain is related to cognitive impairment in neurodegenerative diseases

“Aging affects all of us - but in different ways. I hope that large-scale studies of neurodegenerative diseases, such as the Ontario Neurodegenerative Disease Research Initiative, will give us insight into the mechanics of dementia so that clinicians can better prevent, diagnose, and treat cognitive impairment. That way, more of us will age well.”

Dana Broberg
PhD student, Western University

White matter is brain tissue that connects various regions for communication purposes. If it is damaged by neurodegenerative disease, it can lead to cognitive impairment.

Dana Broberg is a PhD student at Western University. The primary goal of her research is to understand how damage in white matter identified with structural imaging compares to potential early-stage damage in white matter that appears normal. Dana hopes to determine whether early-stage damage to white matter in the brain detected through diffusion imaging is related to cognitive impairment in neurodegeneration. She also wants to validate a novel speech biomarker of cognition that clinicians can use to both interpret and provide early detection of cognitive impairment.

Dana is the recipient of the 2022 CIHR-IA Anne Martin-Matthews Prize of Excellence in Research on Aging. Her research is part of the Ontario Neurodegenerative Disease Research Initiative (ONDRI), which aims to characterize five diseases leading to dementia: Alzheimer's disease, Parkinson's disease, frontotemporal dementia, amyotrophic lateral sclerosis, and cerebrovascular disease.

Further reading

Improving care for the sickest patients around the world

“We still know so very little about what the best strategy is to treat patients with severe infections in hospitals. COVID-19 exposed several gaps in our knowledge about these infections and how they impact patients. We have a lot of work to do to fill those gaps, but we're also hoping to use these experiences to be better prepared for the next outbreak or pandemic.”

Dr. Srinivas Murthy

Dr. Srinivas Murthy is a Clinical Associate Professor in the Department of Pediatrics at the University of British Columbia's Faculty of Medicine. Improving how patients do is the main reason why he has been conducting research on emerging infections and outbreaks even before the COVID-19 pandemic. After the H1N1 pandemic in 2009, his team designed a platform clinical trial that has become one of the leading platforms during the COVID-19 pandemic.

Now Dr. Murthy's team is using the Randomized Embedded Multifactorial Adaptive Platform Trial of Community Acquired Pneumonia to search for ways to improve care for influenza patients who have been hospitalized. Influenza is a common respiratory illness affecting millions of Canadians each year. It is also one of the primary causes of pneumonia leading to hospitalization. Dr. Murthy's clinical trial will identify what combination of therapies – antivirals, steroids, and immunomodulators – work best to improve these patients' health and get them home earlier. The team is also looking for the most patient-centered way of receiving consent from people in a clinical trial.

Further reading

Rapid, cheap, and effective detection of superbugs

New genetic markers of antimicrobial resistance should help all researchers rapidly detect and treat bacterial infections

“I think we should ensure that new diagnostic innovation tests to detect superbugs are both cheap and effective. That way they can be accessed by collaborators in countries that have limited resources. Their challenges broaden my understanding of the worldview and give me insight into why we're lucky to practice research in Canada.”

Dr. Dylan Pillai
Professor, University of Calgary

Dr. Dylan Pillai is leading a multinational group of researchers who are trying to eliminate ‘superbugs' through use of practical interventions that will reduce the prevalence of antibiotic resistance infections in humans and animals that are located close to Laguna Lake, Philippines. To achieve this, his team will first start a multi-pronged approach of surveillance and detection of antibiotic resistance in hospitals. Through use of an application-supported antibiotic stewardship program, physicians will have access to the Philippines National Antibiotic Guidelines and a rapid, point-of-care, nucleic acid amplification-based diagnostic test to detect community-acquired antibiotic resistant infections that are present among patients in ERs and ICUs.

Dr. Pillai's group will conduct a genomic surveillance of highly antibiotic resistant organisms so that overuse of antibiotics can be lowered. Their point-of-care test will also lead to the development of rapid, affordable, and portable diagnostic tests that can detect numerous types of pathogens (such as SARS-CoV-2 or malaria in resource-limited Ethiopia and Sri Lanka).

Further reading

How does income inequality affect adolescent health?

It may be associated with deaths attributed to drug overdose among Canadian youth

"Growing income equality is not only unjust; it is a public health concern that will ultimately negatively impact Canada's social and economic conditions, which in turn may impact adolescent mental health. Addressing these conditions will benefit the health of Canadian youth and may prevent premature mortality."

Dr. Roman Pabayo
Associate Professor, University of Alberta, School of Public Health
Canada Research Chair in Social and Health Inequities

Dr. Roman Pabayo is an Associate Professor in the University of Alberta’s School of Public Health and a Canada Research Chair in Social and Health Inequities. Dr. Pabayo leads the Emerge Research Lab where he supervises a team of researchers and students who are investigating the adverse relationship between income inequality and population health outcomes, particularly among Canadian youth.

In one population-based study, PhD candidate Claire Benny identified a harmful, significant association between income inequality within residential areas and an increased risk for all-cause mortality and deaths attributed to drug overdose among Canada's youth. These findings highlight the need to decrease inequities, which have a detrimental effect on the health of the youth population in Canada. They also present opportunities to target those at risk and to mitigate the harmful effects of income inequality, which include higher depressive and anxiety symptoms among adolescents as well as substance abuse.

Further reading

Is weight loss during pregnancy safe for women with obesity?

Over 52,000 Ontario women with pre-pregnancy obesity will help to guide weight management during pregnancy

"At the OMNI Research Group, we are committed to generating practice-changing research that will improve patient experience, quality of care, and clinical outcomes for pregnant women and their infants. Understanding the impact of gestational weight loss on adverse perinatal outcomes among women with obesity is important. Up to 15% of women with extreme obesity reported intentional weight loss during pregnancy while no clear guidelines are available for gestational weight management by severity of obesity."

Yanfang (Mary) Guo, PhD
Adjunct Professor and Affiliate OMNI Investigator
Clinical Epidemiology Program, Ottawa Hospital Research Institute
BORN Ontario

Daniel Corsi, PhD
Scientist and Assistant Professor
Clinical Epidemiology Program, Ottawa Hospital Research Institute
School of Epidemiology and Public Health and Department of Obstetrics and Gynecology, University of Ottawa
CHEO Research Institute
BORN Ontario

Darine El-Chaâr, MD, MSc
Maternal-Fetal Medicine Specialist/Associate Professor and Associate Scientist
Clinical Epidemiology Program, Ottawa Hospital Research Institute
Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital
Department of Obstetrics and Gynecology, University of Ottawa

Almost 20% of Canadian women enter pregnancy with an elevated body mass index (BMI). Appropriate gestational weight gain helps to improve maternal and fetal outcomes for individuals living with obesity. Due to limited and controversial findings of current studies, weight gain recommendations during pregnancy are not tailored for individuals with increasing BMI categories. The 2009 Institute of Medicine (IOM) guidelines for gestational weight gain recommend that individuals living with obesity should gain between 5 and 9 kg during pregnancy regardless of their obesity class.

Although weight loss during pregnancy is not indicated, it has been shown that 5-8% of women with obesity, and up to 15% of women with extreme obesity, reported intentional weight loss during pregnancy. Given that a clinical trial of gestational weight loss is not feasible, a high-quality observational study was greatly needed to explore potential harms of intentional weight loss during pregnancy.

Drs. Guo, Corsi and El-Chaâr and their team at the OMNI Research Group, based at the Ottawa Hospital Research Institute, are using data from BORN Ontario to study the impact of weight loss during pregnancy on a wide range of adverse maternal and infant outcomes for individuals with obesity.

As the largest and most robust provincial perinatal dataset, BORN Ontario captures all hospital births in the province, accounting for 40% of births across Canada. Using data from more than 52,000 charts, the team has already identified that intentional weight loss during pregnancy is associated with small-for-gestational-age babies for all obesity classes. This study overcomes limitations of previous research and fills gaps by investigating dose-response effects of gestational weight loss on perinatal outcomes.

Further reading

A new trial for immune deficiency will grow the capacity for gene editing therapy in Canada

“I have the great privilege to watch many of my patients grow from infants into these amazing, vibrant young adults. One of my most rewarding images is watching my son face off in hockey against a patient who had been successfully treated for SCID.”

Dr. Nicola Wright
Barb Ibbotson Chair in Pediatric Hematology, University of Calgary

Gene editing is a novel therapy in Canada, and University of Calgary hematologist Nicola Wright is positioning herself at the forefront of it with a pilot project aiming to build the infrastructure and expertise required for the therapy in Canada.

Dr. Wright's lab, in collaboration with Dr. Donald Kohn of the University of California, Los Angeles, developed a base editing gene therapy strategy for CD3δ severe combined immune deficiency (SCID), a genetic disorder where infants are born with no immune system, making almost any common illness fatal.

This study is a multi-centre Canadian clinical trial to test base editing in patients with CD3δ SCID, in which Dr. Wright and her team collect patient bone marrow cells, fix the incorrect CD3δ nucleotide with the correct one, then reinfuse the cells back into the patient with long term follow up for clinical outcomes and immune reconstitution. With that mistake in the DNA fixed, patients can produce their own T-cells to fight infection.

Gene therapy within Canada is rare, and patients with immune disorders must typically travel to other countries for treatment, where the only commercialized therapy costs upwards of $2 million. Using the CD3δ SCID trial as a pilot, this project is expected to pave the way for more advanced therapies for other rare genetic disorders, allowing patients access to treatment closer to home.

Living with SCID is complicated, but Wright's research shows a path forward for immunocompromised children to lead normal, healthy lives. This might be the first gene editing therapy trial for immune disorders in Canada, but it will not be the last.

Further reading

Overcoming adversity

University of Manitoba researcher aims to identify protective factors to reduce substance use, build resilience and improve health outcomes among adolescents who have experienced adversity in childhood

"Studying childhood adversity is difficult, but I do it to produce evidence that can hopefully help to reduce violence so that fewer kids have these traumatic experiences. Our work aims to identify protective factors that may be effective in reducing substance use and fostering resilience among adolescents."

Tracie O. Afifi, PhD
Professor, Department of Community Health Sciences, University of Manitoba
Canada Research Chair in Childhood Adversity and Resilience

When children and adolescents experience adverse childhood experiences, they are more likely to use substances and have poor mental and physical health across the lifespan.

Dr. Tracie Afifi at the University of Manitoba studies child maltreatment and mental health with a focus on resilience, intervention, and prevention. Dr. Afifi and her team are conducting research and analyzing data to understand what factors might be protective and reduce the likelihood of substance use, including the use of alcohol, nicotine, and cannabis among adolescents who have experienced adversity. They also want to know how sexual or gender identity influences the relationship between substance use and mental health in these young people. The results of their first studies have shown that the likelihood of substance use becomes significantly greater if adolescents with a history of adverse childhood experiences also experiences peer victimization.

This work will help develop strategies and interventions that build resilience in adolescents and young adults and decrease substance use, mental health problems, and physical health conditions.

Further reading

From cell to society - an equitable approach to research

UBC Vanier Scholar collaborates with community members to study clinical and social implications of HIV on women

"Women's health is severely neglected and under-researched, especially in the area of HIV. That is why our team is trying to find creative ways to share our research results with the community of women who live with this disease so that we can advance knowledge exchange, equity, inclusion, accessibility, and justice together."

Shayda Swann
MD/PhD student and Vanier Scholar, University of British Columbia

Thanks to the discovery of effective treatments, there's a unique opportunity to understand how HIV can affect healthy aging. Vanier Scholar Shayda Swann is interested in studying how the virus impacts women's reproductive health and hormones, like estrogen and progesterone, and then leads to other issues such as heart disease, osteoporosis, and liver damage. She is also examining how social circumstances impact the gender and racial discrimination, substance use, poverty, and stress that women experience with these health outcomes.

That's why Ms. Swann wants to demonstrate how sharing research results directly with women who live with HIV through YouTube videos, research tea-parties, and art-based knowledge translation and exchange events will lead to valuable scientific research conducted hand-in-hand with community members.

Ms. Swann is a member of the BC Carma Chiwos Collaboration (BCC3) Women's Healthy Aging Research team composed of women living with HIV, clinicians, academics, and community members based in British Columbia. They are seeking to better understand healthy aging in women living with HIV.

Further reading

Advances in corticosteroid use could greatly improve health outcomes for respiratory failure patients

“If the use of early corticosteroids in patients with non-COVID respiratory failure or extending corticosteroid treatment in patients with respiratory failure who are aren't improving proves beneficial, rolling it out will directly improve the health outcomes of the over 30,000 Canadians a year admitted to hospital with respiratory failure.”

Dr. Bram Rochwerg

Bram Rochwerg is an ICU doctor and researcher in Hamilton who looks after critically ill patients, many of whom are admitted with acute respiratory failure requiring support for their breathing. Respiratory failure can be due to a number of causes including COVID but also pneumonia, lung inflammation, sepsis, aspiration and others. Dr. Rochwerg's front-line experience has informed a new trial, funded by the Clinical Trials Fund, that seeks to answer pressing questions about the role of corticosteroids, a well-known anti-inflammatory drug, in patients with acute respiratory failure.

The Corticosteroid Early and Extended (CORT-E2) Trial will test the efficacy and safety of early corticosteroid use in ICU patients with non-COVID respiratory failure and extending corticosteroid use in ICU patients with persistent respiratory failure, whether due to COVID or another cause.

Corticosteroids are already commonly used in medicine. The trial will build on this previous expertise to determine some of the finer details of corticosteroid use, including whether non-COVID patients will benefit the same way that COVID patients do, and the optimal duration of therapy, especially in those that aren't getting better with traditional supportive care.

According to Dr. Rochwerg, if early or extended corticosteroid treatment proves beneficial, rolling it out will be straightforward given this is a low-cost intervention (corticosteroids are generic and relatively inexpensive) and easy to administer (can easily be given orally or intravenously) and will directly improve the outcomes of the over 30,000 Canadians each year who are hospitalized with respiratory failure due to any cause.

CORT-E2 is part of the larger Canadian-led PRACTICAL (Platform of the Randomized Clinical Trials in Critical Illness) platform trial. Platform trails are designed to maximize research efficiency by providing an opportunity to study multiple interventions within the same clinical trial infrastructure. As such, Dr. Rochwerg and the CORT-E2 and PRACTICAL teams are engaged with a wide variety of fellow researchers, clinicians, patients and partners to make a real difference in improving the outcomes of critically ill patients across Canada and worldwide.

Further reading

Can our own microbiomes help treat and prevent antimicrobial resistant organisms?

“Many of the patients I see have infections caused by antimicrobial resistant organisms, and I have seen the negative impact of such infections on patients, hospitals and communities. We know we need to develop and test new therapeutics to fight antimicrobial resistant organisms. Our hope is that this new line of research leads to therapeutic interventions that can be widely and cheaply available to people in Canada and from around the globe.”

Dr. Bryan Coburn
Clinician-Scientist and Infectious Diseases Specialist at the University Health Network

According to a 2022 Public Health Agency surveillance report, antimicrobial resistance is one of the top 10 global public health issues. Most approaches to treat infections rely on antibiotics. But antibiotic drugs are becoming less effective as drug-resistant pathogens emerge, and we need to develop and test new therapeutics to fight antimicrobial resistant organisms.

Dr. Bryan Coburn, a clinician-scientist and infectious diseases specialist at the University Health Network, is pursuing the development of novel treatments for antimicrobial resistance using microbial consortia, or simply put, a mixture of live cultured bacteria in a clinical trial called Microbial Ecosystem Therapeutic-2 (MET-2). Dr. Ashley Rooney, a postdoctoral fellow who defended her doctoral thesis under Dr. Coburn's supervision in 2022, suggested that microbial consortia may decrease infections caused by antimicrobial resistant organisms.

To better understand the potential benefits of microbial consortia, Dr. Coburn and his team are working on a pilot clinical trial called the Antimicrobial Resistant Organism Decolonization After Microbiome Perturbation. The study will evaluate if a consortium of bacteria given in pill form can help decrease or eradicate antimicrobial resistant organisms, improve patients' microbiomes, and complement antibiotics for treatment and prevention of infection. The researchers will determine if they can safely recruit people into the trial. They also hope their preliminary findings will lead to a larger clinical trial of MET-2 in the future.

Further reading

A futuristic cure for blood cancer is within our reach, and Dr. Kekre believes Canada should get on board

“Every time I see a patient with cancer who can receive CAR-T cells because of our clinical trials, someone who would have lost hope and had no other options, I know that I am doing something worthwhile.”

Dr. Natasha Kekre

Natasha Kekre is a hematologist at The Ottawa Hospital and associate professor at the University of Ottawa devoted to a ground-breaking therapy for leukemia. After seeing many of her patients succumb to their cancer, despite aggressive chemotherapy, Dr. Kekre is now turning her expertise to CAR-T therapy, a personalized therapy that uses the patient's own genetically modified immune cells to fight leukemia.

CAR-T cells are made by isolating a patient's immune cells from their blood, genetically modifying and activating the cells in the lab, and then re-administering them to the same patient, allowing for a patient's immune cells to be targeted against their cancer. However, this personalized treatment requires expertise and infrastructure that is rare in Canada. Dr. Kekre thinks that her trial should provide the necessary information to approach Health Canada for clinical approval and bring this Canadian manufactured product to standard-of-care for Canadian cancer patients.

Dr. Kekre and her team are hoping to show that Canadian-made CAR-T cells that target a specific tumour protein called CD19 can improve the lifespan of patients with lymphoblastic leukemia. It will also support her goal of demonstrating to Health Canada that these modified cells can be made in Canada.

The most rewarding aspect of her work is, of course, the hope that she brings to cancer patients. Canadian-made CAR-T cells offer hope against a very aggressive form of cancer. According to Dr. Kekre, this trial focuses on bringing a new therapy to Canada so that Canadians can benefit as the trail unfolds. If she can demonstrate that CAR-T cells are effective and safe, Canadians will have access to a new therapy against leukemia.

Further reading

Precision medicine offers a way to make mechanical ventilation safer for patients with lung failure

“I see the joy patients experience as they journey back toward life as they knew it. Nothing could be more rewarding than to integrate a deep technical understanding of lung physiology and mechanical ventilation with cutting edge clinical trial design to help more patients with acute lung failure get back to their lives and their loved ones.”

Dr. Ewan Goligher

When patients develop acute lung failure and can no longer breathe on their own, mechanical ventilation is used to sustain life by breathing for the patient. While this is a life-saving intervention, it can cause injury to the lungs by over-stretching them, leading to worsened organ failure and death.

But a clinical trial by Ewan Goligher at the University Health Network will test a new strategy for mechanical ventilation that he believes will be safer and more effective, minimizing the risk of lung injury while still keeping the patient breathing.

Dr. Goligher is exploring what happens when the ventilator is set to avoid high pressures rather than high volumes. This allows more precision in care, as high volumes are likely only harmful to patients with high lung pressure, and in fact, should not be avoided for patients with low pressure.

Acute lung failure has a high mortality rate, upwards of 40%, and while mechanical ventilation is necessary to keep the patient breathing, it's not without its own risks of lung damage. The research of Dr. Goligher might lead to more precise ventilation, where settings are tailored to each patient instead of a one-size-fits-all approach. This represents a move towards a “precision medicine paradigm for ventilation,” says Dr. Goligher.

Issues of lung failure were only exacerbated by the COVID-19 pandemic, giving even stronger support for change. If Dr. Goligher's findings are convincing, an already life-saving procedure—mechanical ventilation—is going to become more precise, and safer as a result.

Further reading

Accelerating Clinical Trials (ACT) Pan-Canadian Consortium

New pan-Canadian Clinical Trials Consortium promises to establish stronger links between clinical trial stakeholders and bolster Canada's research networks

"We all benefit from effective therapies that have been established through prior randomized control trials, which are the gold standard for determining the effects of drugs and other interventions. Through support of clinical trials, Canadians can help find ways to improve health."

Dr. P. J. Devereaux

Timely clinical trials are critical to protecting and improving human health. Unfortunately, many barriers exist to conducting clinical trials in Canada, which is where the Accelerating Clinical Trials (ACT) Consortium steps in.

The ACT Consortium is a large network of clinical trial researchers, patients, government and industry from across Canada , headed by a 12-person Operations Committee and two co-chairs, Dr. P. J. Devereaux of McMaster University and Dr. Guy Rouleau at the McGill University Health Centre. The purpose of the ACT Consortium is to facilitate national clinical trials, Canadian participation in international trials, and implement their results on a large scale. The Consortium is one arm of Canada's much larger Biomanufacturing and Life Sciences Strategy.

Clinical trials, particularly randomized control trials, are essential to the healthcare industry, providing hard evidence on the effectiveness of new drugs and therapies. But undertaking clinical trials and facilitating important discussions among stakeholders can sometimes be difficult , which is why the ACT Consortium is working on expanding and supporting existing clinical trial units and networks and developing new networks in priority areas.

But the ACT Consortium's ambitions go beyond networking and represent a major shift in how clinical trials are done in Canada. The 250-person team is planning to improve the national ethics approval process , simplify randomized control trial contracts, create efficient data sources, and explore novel trial designs. All in all, the ACT Consortium should have the intended effect of democratizing clinical trials and aiding in equitable access, participation, and information-sharing.

But as Nominated Principal Applicant Dr. Devereaux says, the most rewarding part of the ACT Consortium for him is getting to work with passionate individuals from across Canada who are focused on improving health through the advancement of clinical trials in Canada.

The co-chairs of the ACT Consortium are Dr. P.J. Devereaux and Dr. Guy Rouleau. The pan-Canadian members of the Operations Committee are Dr. Wayne Clark, Dr. Dean Fergusson, Dr. Amit Garg, Dr. Jeremy Grimshaw, Dr. Valerie Harvey, Dr. Corinne Hohl, Dr. Catherine Joyes, Dr. Susan Marlin, Dr. Emily McDonald, Dr. Louise Pilote, Dr. Stuart Nicholls, and Dr. Lawrence Richer.

Further reading

Working toward Inuit food sovereignty in Arviat, Nunavut

"Climate change and food insecurity are not new to Inuit people. Our project is directed at rebuilding the capacity and knowledge to harvest locally and to share food abundance through planning for sustainable food product development.”

Shirley Tagalik and Dr. Gita Ljubicic

The incidence of food insecurity in Nunavut is the highest in Canada, and four times the national average. Shirley Tagalik, Dr. Gita Ljubicic, and their research team based at McMaster University are investigating a coordinated community harvest of geese as a potential path to enhancing food sovereignty in Arviat, Nunavut.

Shirley is the Director of the Aqqiumavvik Society, an organization working to address food insecurity and other community challenges in Arviat, Nunavut, and a partner in the Nunavut Network Environment on Indigenous Health Research. She researches areas of education, child and language development, youth engagement and suicide prevention, determinants of health, healing, cultural revitalization, climate change, and food security. Working with Inuit elders over 30 years, Shirley documents Inuit cultural knowledge and works to rebuild the strengths of cultural concepts into community programs. She was recently awarded a Governor General Innovation Award for her work on Arctic Corridors and Northern Voices Research.

Dr. Gita Ljubicic is an Associate Professor in the School of Earth, Environment and Society at McMaster University, and is a Canada Research Chair in Community-Engaged Research for Northern Sustainability. She works at the intersection of cultural and environmental geography, driven by a deep commitment to respecting and learning from Indigenous knowledge alongside science in order to address complex socio-ecological issues. Over the past 20 years, she has worked with Inuit community members and organizations across Inuit Nunangat (homelands) in Canada on projects that aim to address community-identified priorities.

Shirley, Gita, and their team aim to ultimately improve research practice, contribute to decision-making, and support Inuit self-determination in research.

Further reading

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Inuit knowledge to support climate change adaptation

"In the face of the climate crisis, the power and significance of meaningful community partnerships in research is crucial. Bringing local voices, experiences, and priorities into international decision-making about climate change is increasingly urgent and necessary."

Dr. Sherilee Harper

Sherilee Harper, MSc, PhD, is a Canada Research Chair in Climate Change and Health and an Associate Professor in the School of Public Health at the University of Alberta. Her research investigates weather, environment, and health in the context of climate change in Canada, Uganda, and Peru. She collaborates with government and community partners to prioritise climate-related health actions, planning, interventions, and research. She is a Lead Author on the Intergovernmental Panel on Climate Change (IPCC) Special Report on the Ocean and Cryosphere in a Changing Climate; Lead Author on the IPCC's Sixth Assessment Report; serves on IPCC's Gender Task Group; and serves on the Editorial Board of Epidemiology and Infection.

Dr. Harper is the lead Principal Investigator for the Niqivut Silalu Asijjipalliajuq ("Our Food and Climate Change") research program. This research program will promote adaptive capacity among Inuit by enhancing local capacity to detect and respond to food-related climate-health outcomes; and evaluate opportunities for food-related climate change adaptation polices, programs, and actions. The program has 2 research themes: (1) strengthen Inuit food sovereignty for climate change adaptation, and (2) share Inuit knowledge to support climate change adaptation. It will also address the important themes of Inuit knowledge (IK) in research, Inuit health, nutrition, and wellness, climate change adaptation, and gender.

This Nunavummiut-led research approach will offer best practice guidance for other initiatives; will create leaders with expertise in climate change, country food, and Inuit health; and demonstrate the importance of Inuit knowledge and Inuit Qaujimajatuqangit for adaptation, enabling communities to manage the food-related health effects of climate change.

Further reading

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Enhancing food security in the Northwest Territories

"Climate change can impact the ability to harvest country foods in northern and remote communities, which increases food insecurity and leads to further challenges for health and wellbeing. Our team works collaboratively with northern and Indigenous communities, organizations, partners, and governments to build on existing food system activities and policies to strengthen pathways for the inclusion of country food into different spaces, like schools and community programs."

Dr. Kelly Skinner

Kelly Skinner is an Associate Professor in the School of Public Health Sciences at the University of Waterloo. In 2022, the Canadian Institutes of Health Research and the Public Health Agency of Canada awarded Dr. Skinner the Applied Public Health Chair in healthy environments for climate change and food security in northern Canada. This Chair aims to better understand the intersections between food security, climate change, and Indigenous communities in the Northwest Territories (NWT), northern regions in Canada, and globally, the circumpolar north, with an emphasis on community action, self-determination, and knowledge sharing.

Dr. Skinner's research engages with northern communities, partners, and governments on interdisciplinary, community-based, and collaborative health and social projects related to food, nutrition, food security, health and risk communication, and the broader context of northern and Indigenous food systems and environments. This work has involved dietary assessment with youth, program evaluation, and community development and has moved towards social justice and social policy for improving food security and advocacy for food sovereignty.

Dr. Skinner is the Nominated Principal Investigator for a project aiming to learn from and enhance community capacity to address place-based priorities to inform climate change and food security action locally, regionally, and territorially. The approach includes cross-cutting themes of traditional knowledge, governance, youth, and sex and gender, and is grounded in participatory action research. Her multidisciplinary team works closely with partners in six communities across four regions in the NWT to understand the potential of local actions, and to scale-out and scale-up learning. This research promotes community action and self-determination of local food systems in communities in the NWT and ultimately improves health outcomes. The knowledge gathered, and shared across multiples levels (locally, regionally, territorially, government decision-makers/ knowledge users) will help facilitate development of more effective programs and policies to address food security and climate change in the NWT.

Further reading

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