The role of intersectionality in identity formation of young adults

with ASD

Hannah Chang, Mor Cohen-Eilig

Background: Autism spectrum disorder (ASD) is a developmental disorder characterized by social communication impairment and repetitive behaviors. While ASD prevalence has greatly increased, the development of personal, subjective perceptions of identity among autistic individuals remains unclear. Clinicians and families often struggle deciding when and how to disclose ASD diagnosis to the individual themselves. Identity is closely linked to mental health, and especially for ASD in which masking can lead to poor mental health outcomes. Thus it is important to understand how ASD identity develops and how diagnostic pathways may affect this process. Gender dysphoria (GD) is the distress from the incongruence between gender identity and assigned sex at birth. While GD is often found comorbid with ASD, how this cross-sectionality creates unique implications for this particular population has yet been studied. In addition, external social-cultural factors may affect the development of both ASD and gender identities.

Study Purpose: The goal of this study is to investigate how ASD diagnostic pathway, intersectionality between ASD and gender identity development, and cultural influences may impact identity formation, mental health, and functionality of autistic individuals. This study will help establish guidelines on diagnosis disclosure process, and meaningful interventions to support healthy identity development.

Methodology: We will recruit 20-30 young-adults (age>16) who are diagnosed with ASD. The study will be conducted in two stages. First, quantitative data will be collected through an online survey that will include various scales to measure autistic phenotype, gender identity, mental well-being, and level of social support. In the second stage, we will create an individual “intersectionality map” for each participant and conduct a semi-structured online interview.

Future Directions: This project is in the progress of solidifying study protocol for submission to the ethics board within the next month. Participant recruitment and data collection is scheduled to begin in the fall. Expected outcome will be an in-depth understanding on the role of intersectionality in the diagnosis pathway. We predict that a comprehensive disclosure and understanding of the factors affecting identity will lead to more positive perceptions of autistic individuals and higher functionality in society.

SESSION #5 Poster #38

Mahnoor Faisal

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Undergraduate Student, University of British Columbia | Supervisor: Hal Siden

Optimizing the Management of Pain and Irritability in Children with Severe Neurological Impairment

Mahnoor

Faisal, Hal Siden, Anne-Mette Hermansen

Background: The PIUO study focuses on serving children with severe neurological impairment (SNI) who are typically non-verbal, non-mobile, and cognitively impaired. These children often experience pain and irritability daily, yet the source of their discomfort is difficult to identify because they are non-verbal. Many primary caregivers have expressed their concern regarding this matter and instead rely on behavioural observations such as grimacing or vocalizations to assess their child’s pain. New research has also demonstrated that individuals with intellectual disabilities may be more sensitive to painful stimuli, but physicians still have no standardized method for treating them.

Objective: Our team believes that the lack of a standardized approach for investigating and managing pain and irritability of unknown origin (PIUO) contributes to the persistence of pain in this population. To address this issue, this study uses a systematic approach for assessing the treatment of pain and irritability called the PIUO Pathway.

Method: This study tests children aged 6 months to 18 years with severe neurological impairment and who have PIUO. The PIUO Pathway consists of a series of tests and treatments that first look at the patient’s history and then conduct a physical exam, followed by screening tests, and then pharmacology to treat the pain.

Results: The Pathway has produced 30% of resolved or identified pain. It may streamline pain management for this population and improve the well-being of children and their families. In the cases where pain persists beyond the PIUO Pathway, we know that the participants and their families still benefit from the relationship they built with our team of nurses and doctors. The majority of caregivers welcome this holistic, patient-centred approach to their child’s treatment.

Update: This study is shifting to Phase II where we will implement our findings in community settings using the principles of implementation science. We want to produce a guideline for pediatricians that can be implemented across British Columbia. Our poster update will present the trial’s results at a glance and how they inform our overall data analysis and provide an overview of our next steps.

Watch Online:

Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Rita Jin

Undergraduate Student, University of British Columbia | Supervisor: Todd S. Woodward

Characterization of a Novel Task-Based fMRI Functional Brain Network: Auditory

Yu Xuan (Rita) Jin, Todd S. Woodward

Functional magnetic resonance imaging (fMRI) is a method for tracking blood oxygen level-dependent (BOLD) signals as they move in different network configurations around the brain. The available network configurations are currently unknown. This study includes various analyses of fMRI signals during multiple cognitive tasks, curations of anatomical configurations that repeat over tasks, and interpretations of BOLD signal changes between task conditions. The project focuses on the discovery and study of the auditory perception (AUD) network involved in linguistic processing. Through two key cognitive tasks, the Thought Generating Task and the Radio Speech Task, the activation of the novel AUD network is measured during times of auditory perception. Data from the functional brain network and its associated hemodynamic responses (HDRs) were analyzed through fMRI Constrained Principal Component Analysis (fMRI-CPCA), two-way repeated-measures ANOVA, and SPSS Analysis of Predictor Weights.

SESSION #5 Poster #40

Caroline Ruus

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Undergraduate Student, University of British Columbia | Supervisor: Rebecca Deyell

Whole Abdominal Radiotherapy in Children and Adults with Sarcoma: A CanSaRCC Study

Caroline Ruus, Sylvia Cheng, Hagit Peretz Soroka, Derek Tsang, Abha Gupta, Rebecca J Deyell

Background: The Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC) is a national registry and virtual biobank that was created in order to facilitate research and improve outcomes of sarcoma patients. Sarcoma is an aggressive form of cancer that arises from bones and soft tissues in young people, and radiotherapy often has a role in local control. Rarely, children and young adults have peritoneal dissemination of sarcoma, and although whole abdominal radiotherapy (WART) is recommended, there is limited data regarding toxicity or evidence of efficacy.

Objective: We aim to describe indications and evaluate outcomes for pediatric and young adult sarcoma patients treated with WART with a primary aim of describing time to treatment failure (i.e. recurrence within the WART field), toxicity, progression-free and overall survival.

Methods: Patients aged 0-39 years at diagnosis with sarcoma who received WART between January 1, 2000 and May 1, 2023 will be identified from CanSaRCC nationally. Data collection includes patient demographics, clinicopathologic factors including histology, age, extent of disease and therapy, radiation planning and therapy techniques, toxicities and survival outcomes. Estimated sample size is 40 patients across Canada. Descriptive statistics will be used to summarize the treatments received, and the Kaplan-Meier method will be used to analyze time to treatment failure and survival outcomes.

Progress: CanSaRCC was recently activated at BC Children’s Hospital and 45 patients have been enrolled, including five who received WART for diagnoses of rhabdomyosarcoma or desmoplastic small round cell tumor. In collaboration with pediatric and adult cancer sites nationally, we are undertaking work to systematically identify, collect data and analyze outcomes of these patients.

Conclusion: We anticipate study results to describe indications, tolerability and efficacy of WART for young patients with abdominal dissemination of sarcoma.

SESSION #5 Poster #41

Simran Gill

https://bcchr.ca/posterday

Master’s Student, University of British Columbia | Supervisor: Christine Voss

Physical activity behaviours and determinants thereof in children with type 1 diabetes in the Interior of BC: a mixed methods feasibility study

Simran

Gill, Ty Sideroff, Trent Smith, Tricia S Tang, Christine Voss

In BC, over 2,500 children live with diabetes. The fear of inadequate blood glucose control following physical activity (PA) may deter children with T1D from engaging in regular PA, despite its importance in reducing the risk of developing cardiovascular disease. A better understanding of the PA behaviours of children with T1D is necessary.

The study describes objectively measured (moderate-to-vigorous) physical activity (MVPA) levels of children with T1D aged 8-15yrs in BC’s Interior. We also explored patient- and parent-reported barriers, facilitators and experiences related to their PA.

In this sequential mixed methods study, parent-child dyads were recruited from communities across BC’s Interior. Parents completed an electronic demographics and child PA questionnaire. Participants were mailed an accelerometer (ActiGraph GT3X) to be worn around the waist for 7 consecutive days to measure MVPA. Virtual semi-structured interviews were conducted via Zoom, one with the child and one with the parent. Device-based PA data informed the initial probing questions during the interviews.

Fifteen children (9 boys and 6 girls, age 10.9±2.3 years) with T1D (average time since dx 3.5±3.4 years) participated in the study. All participants were using a continuous glucose monitor and 66% reported using an insulin pump. Mean daily MVPA was 43.6±26.4 min/day with 40% meeting PA guidelines of 60 mins/day of MVPA. Children were more active during weekdays (47.1±26.8 mins/day) compared to weekends (29.7±26.4 mins/day) p=0.002. There were no significant differences in recorded PA in boys vs girls. Interview analysis showed diabetic youth are comparatively active to their peers despite barriers to PA such as hypoglycemia.

This project provides important insight regarding the PA behaviours of children with T1D living in BC’s Interior. This information will be useful for parents and clinical care providers who support children with T1D. Furthermore, the findings from this work may guide future research endeavours that aim to promote PA participation and optimized health outcomes in this population.

Congratulations to Simran on receiving a BC Children’s Hospital Research Institute Master’s

SESSION #5 Poster #42

Chen Yu (Daisy) Sun

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Undergraduate Student, McMaster University | Supervisor: Tamara Cohen

Comparing health outcomes of children and adolescents with obesity

who attend an in-person vs. virtual multidisciplinary family-based behavioural lifestyle intervention

Chen Yu Sun, Madelaine Gierc, Tamara Cohen

Introduction: The Shapedown BC program is a provincially funded 10-week family-based behavioural lifestyle intervention designed for children and adolescents aged six to 17 years living with obesity. The program involves participation in weekly educational and interactive sessions on topics related to nutrition, physical activity, screen time, sleep, body image, self-esteem, family meals, and healthy family communication. Since 2006, the program has been implemented in-person across six clinics in BC; however, due to the COVID-19 pandemic, it was forced to adapt to a fully virtual format. It is unclear how the virtual format compares to the in-person intervention in shaping health behaviour changes and consequently body mass index (BMI) outcomes in participants. Therefore, the primary objective of this study is to compare the health outcomes of children who participated in the virtual Shapedown program to pre-COVID in-person delivery.

Methods: This retrospective chart review study of n=80 children (ages six to 17 years old) will use non-identifying data collected by the Shapedown BC multidisciplinary team. Participants from the virtual intervention (n=40; September 2021 to December 2022) will be matched with those from the in-person intervention (n=40; 2016 to 2019) based on age, sex, BMI-z, and enrollment season at baseline. Anthropometric measures (body weight and height) are assessed and recorded at three different time points: during clinical intake, pre-intervention, and post-intervention. Surveys were used to capture health outcomes, including diet quality, exercise patterns, sedentary behaviour, and family habits pre- and post-intervention. Student T-tests will be used to assess the group differences between the groups.

Results: Data is currently being retrieved from the databased and matched accordingly.

Study Impact: This study will provide insights into the effectiveness of the virtual multidisciplinary family-based behavioral lifestyle intervention in improving BMI-z and related health outcomes, compared to the conventional in-person intervention. These findings will contribute to the future design and delivery of virtual weight management programs aimed at preventing and managing childhood and adolescent obesity.

Congratulations to Daisy on receiving a BC Children’s Hospital Research Institute Summer Studentship

SESSION #5 Poster #43

Erica Zeng

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Undergraduate Student, University of Western Ontario | Supervisor: Todd Woodward

Profiling the fMRI derived Language-Based Network for pre- and postsurgical monitoring

Erica Zeng, John Shahki, Todd S. Woodward

Background: In neurosurgery, pre- and post-surgical planning and monitoring are crucial in ensuring optimal conservation and recovery of cognitive function. A key focus during this process is on the Broca’s and Wernicke’s area (BWA) because impairment of this brain area can negatively impact linguistic function and quality of life. Task-based fMRI has detected a left-lateralized network that simultaneously engages BWA. This study will assess this network’s activation over a range of cognitive fMRI tasks in order to establish a baseline hemodynamic response (HDR) profile of this network.

Methods: This study included 163 healthy controls from five different cognitive tasks. Constrained Principal Component Analysis for fMRI was employed to identify and characterize functional brain networks that emerged while undergoing tasks and their associated hemodynamic responses.

Results: The studied network was activated during each of the linguistic- and emotion-based tasks and was characterized by left-lateralized activation with simultaneous engagement of the BWA. Further, each cognitive task exhibited distinct hemodynamic response patterns specific to their conditions.

Conclusion: Activation of this network during the linguistic and emotion recognition tasks suggests that this network’s function lies in the extraction of linguistic- and emotion-based meaning. The derived task-specific HDR profiles will serve as a baseline against which a patient’s HDR profile can be compared to. This comparison will allow for the monitoring of linguistic changes in patients pre- and post-operation.

SESSION #5 Poster #44

Serena Zhang

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Undergraduate Student, University of British Columbia | Supervisor: Kevin C. Harris

READYorNotTM Feasibility Trial: Assessing the Efficacy of an App-Based Transition Intervention in Adolescents with Congenital Heart Disease

Serena

Zhang, Bianca Fukakusa, Najah Adreak, Simran Gill, Venessa Thorsen, Kevin C. Harris

Background: The growing number of children with congenital heart disease (CHD) who survive into adulthood constitute one of the fastest growing populations in adult cardiology practices. However, many children with CHD face challenges continuing regular cardiology follow-up, particularly as they graduate from pediatric to adult healthcare. This population is vulnerable to gaps in care, and we are unsure of how to best close the gap. E-Health solutions, such app-delivered transitions in care (TiC) interventions, have the potential to offer cost-effectiveness, accessibility to rural patients, and long-term support for young adults as they enter the adult healthcare system.

Objective: To compare the efficacy of the MyREADY TransitionTM CHD with a 1-on-1 nurse-led TiC intervention in improving self-management skills.

Methods: We recruited 16-17-year olds with moderate to complex CHD from the Children’s Heart Centre at BC Children’s Hospital. This is a multi-centre study with 4 sites in total. Participants are randomized to the app or nurse intervention group based on their week of appointment. Those in the app group receive a 30-minute session with a nurse and access to the app for 18 months, while participants in the nurse intervention group meet once with a nurse during a clinic appointment for one hour. Health behaviours and cognitive factors are measured in both groups using questionnaires (Transition Readiness Assessment Questionnaire, my HeartScale, General Self-Efficacy Questionnaire) at various time points before, during, and after the intervention. Optional qualitative interviews are conducted to obtain participant feedback on the intervention in both groups.

Expected Outcome: We anticipate that the app, offering repeated exposure over time, will yield superior selfmanagement skills over 18 months compared to the nurse-led intervention. We expect that app-group participants will also have a better understanding of their CHD anatomy and a higher self-efficacy compared to those in the nurse group.

Conclusion: This trial investigates the feasibility and preliminary efficacy of an intervention for effective transition intervention in children with CHD. The findings aim to inform evidence-based TiC guidelines and future studies in this population.

Athena Li

Undergraduate Student, University of British Columbia | Supervisor: Vilte Barakauskas

Review of Quality Indicators in Pediatric Lab and Future Steps Towards Better Pediatric Care

Athena Li, Vilte Barakauskas

To objectively measure and manage lab quality, labs need to define their service goals and objectives. Clinical quantitative quality requirements in the form of quality indicators (QI) are then established to meet set goals. Starting from 2008, the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) established the Working Group on ‘‘Laboratory Errors and Patient Safety’ (WG-LEPS project) to define specifications for QI’s across labs independent from the size of organization and type of activities, the complexity of processes undertaken and the different degrees of knowledge and ability of the staff. The final goal is to establish a Model of Quality Indicators (MQI) that can provide labs with a way to monitor processes, improve performance and decrease error rates. However, established MQIs so far do not generally differentiate between adult or pediatric labs. This review seeks to explore and search through any existing literature on QI’s in pediatric labs and other quality assessment methods in pediatric healthcare. Search parameters will focus on the Quality Indicators consisting of the 10 key core lab indicators recommended by the Laboratory Medicine and Pathobiology (LMP) Quality Council and population set to neonates (0-28 days) and infants (>28 days to 1 year). Then a general search for quality assessment in pediatric healthcare will be conducted to gather information about the this gap in knowledge of lab QI’s in pediatrics.

SESSION #6: BASIC SCIENCE & CLINICAL

Moderator:

Larissa Celiberto

Participants:

Mackenzie Campbell

Jessica Chan

1:30 –3:00 PM

In-Person: Chieng Family Atrium

Makenna Clement-Ranney

Beatrice Gonzales

Kaitlin Law

Jennifer Law

Abby McCluskey

Samantha Pang

Aimee Xinxo

SESSION #6 Poster #45

Mackenzie Campbell

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisor: Wendy Robinson

Reconsidering the Hardy-Weinberg equilibrium threshold in genetic data quality control

Mackenzie Campbell, Li Qing Wang, Amy Inkster, Giulia Del Gobbo, Victor Yuan, Wendy P. Robinson

Background: Methylation quantitative trait loci (mQTLs) are single nucleotide polymorphisms (SNPs) associated with changes in DNA methylation and likely to have functional significance by affecting gene expression. Most mQTL studies use a Hardy-Weinberg equilibrium (HWE) threshold as a quality control measure to exclude SNPs thought to be genotyping errors. However, deviations from HWE can occur due to population sub-structure, especially if genotypes show a deficiency of heterozygotes.

Objectives: To investigate whether SNPs excluded by the HWE threshold are not genotyping errors, but rather a consequence of population substructure, and to explore if these previously excluded SNPs have functional importance.

Methods: SNP array data from three independent, ethnically diverse, cohorts were accessed: Epigenetic studies of the Placenta In Complications of pregnancy (EPIC, n=74), the NICHD Fetal Growth Study (NICHD, n=289, dbGaP phs001717. v1.p1), and the Rhode Island Child Health Study (RICHS, n=137, dbGaP phs001586.v1.p1). SNPs failing HWE in the full cohorts were identified and tested for HWE within ethnicity/race/ancestry sub-groups (EPIC: n=16 East Asian, 47 European, 11 South Asian (clustering); NICHD: n=48 Asian/Pacific Islander, 98 Hispanic, 69 Non-Hispanic Black, 74 NonHispanic White; RICHS: n=10 African, 5 Asian, 121 Caucasian (clustering)).

Results:

1. We found that SNPs failing the HWE threshold (EPIC: 3986 SNPs, NICHD: 37541, RICHS: 3703) were mostly due to a deficiency of heterozygotes (EPIC: 98.2% deficient, NICHD: 99.6%, RICHS: 83.3%), and many of these SNPs were associated with ethnicity and/or ancestry cluster (EPIC: 63% associated, NICHD: 92%, RICHS: 44.5%).

2. Of SNPs that deviated from HWE in the full cohorts, very few also deviated within all ancestry-related groups (EPIC: 0.6%, NICHD: 0.2%, RICHS: 0.05%). Results were confirmed by testing for HWE in randomly selected small groups (ethnically diverse), to rule out sample size as a factor.

3. These SNPs were involved in 2.9% of the unique SNPs in mQTL-CpG associations.

Conclusions: Our results suggest that SNPs showing fewer heterozygotes than expected are not genotyping errors, but instead deviate from HWE due to population substructure. These results have implications for researchers working with genetic data and suggest that the HWE threshold may not be useful when applied to ethnically diverse populations.

Congratulations to Mackenzie on receiving a BC Children’s Hospital Research Institute

Healthy Starts Summer Studentship

SESSION #6 Poster #46

Jessica Chan

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisor: Bruce Verchere

Using Islet Amyloid Polypeptide (IAPP) as a Biomarker for Type 1 Diabetes

Jessica Chan, Lindsay P. Pallo, C. Bruce Verchere

Background: Type 1 Diabetes (T1D) is an autoimmune disease that affects over 300,000 Canadians. T1D emerges when insulin-secreting beta cells in pancreatic islets are destroyed by autoimmune attack, leading to chronic hyperglycemia and exogenous insulin dependence. Previous studies have determined that beta cells undergo secretory pathway stress which impairs prohormone processing, leading to the secretion of incompletely processed peptide species. Islet amyloid polypeptide (IAPP) is a hormone processed in beta cells by sequential cleavage of its precursor proIAPP1-67 into its intermediate form, proIAPP1-48, and then into mature IAPP1-37. Our lab previously found an elevated ratio of proIAPP1-48 to mature IAPP in children with T1D. However, research investigating levels of circulating proIAPP1-67 in individuals has been limited due to the lack of a sensitive and specific assay for this proIAPP species.

Objective: Establish a sandwich ELISA to measure circulating proIAPP1-67 in humans, then determine whether intact proIAPP1-67 circulates in disproportionate amounts in people with long-standing or recent-onset T1D compared to nondiabetic individuals.

Methods: We used western blot and immunohistochemistry to validate the reactivity and specificity of multiple monoclonal mouse antibodies raised against human proIAPP-derived peptides. To generate an immunoassay specific for human proIAPP1-67, we compared different antibody pairs for a sandwich ELISA using synthetic proIAPP1-67 peptide. To determine whether our ELISA could detect endogenous human proIAPP1-67, we assayed human islet lysates and plasma samples from non-diabetic and T1D donors. Upon validating the proIAPP1-67 ELISA, we will measure and compare the ratios of (pro)IAPP species across T1D and non-diabetic individuals.

Anticipated Results: In people with T1D, circulating levels of proIAPP1-67 will be significantly decreased relative to nondiabetic individuals. However, the relative level of proIAPP1-67 to mature IAPP will be elevated in T1D.

Future Directions: By comparing levels of precursor to mature forms of IAPP, we can assess beta-cell dysfunction as a measure of beta-cell prohormone processing efficiency. Once the proIAPP1-67 ELISA is validated, we aim to measure (pro) IAPP levels in larger clinical cohorts to assess how prohormone processing changes over the course of the T1D and assess the value of proIAPP biomarkers in evaluating the efficacy of immunotherapies in clinical trial.

SESSION #6 Poster #47

Makenna Clement-Ranney

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of Western Ontario | Supervisor: Angela Devlin

The impact of riboflavin deficiency and folic acid supplementation on individual and transgenerational metabolic health

Makenna

Clement-Ranney, Adam Hung, Coralie Bergeron, Taylor Ricci, Angela Devlin

Background: Folic acid, the synthetic form of folate, and riboflavin are essential micronutrients for biochemical processes such as cellular metabolism, DNA synthesis, and methylation. Both are involved in a metabolic cycle known as onecarbon metabolism. Findings from observational studies performed by our lab and others have noted a prevalence of high folate status and riboflavin deficiency among Canadian women. Individual impacts of riboflavin deficiency and excess folic acid supplementation on individual and transgenerational metabolic health have been identified. However, little is known regarding the mechanisms behind these impacts.

Aims: We aim to assess the following using a mouse model:

• To determine the effect of low-riboflavin status on adiposity.

• To conduct a confirmatory analysis of upregulated 3-hydroxyanthranilate, 3,4-dioxygenase (Haao) expression in placenta from male offspring of folic acid-supplemented dams.

• To characterize the endothelial cell population in gestational day 18.5 placenta using FACS.

Methods: Male and female C57BL/6J mice were treated with a control diet (6mg riboflavin/kg) or a riboflavin deficient diet (1 mg riboflavin/kg) for 8 weeks. Body composition was measured at 4 and 8 weeks by EchoMRI; weekly body weights were measured, and fat pads were collected and analyzed following the 8-week feeding period.

Fluorescent immunohistochemistry will be used to confirm differential expression of Haao as previously identified by our lab through Nanostring analysis performed on placenta of male offspring from dams fed a control (2 mg/kg folic acid, 10% kcal fat), control folic acid-supplemented (10 mg/kg folic acid, 10% kcal fat), western (45% kcal fat, 2 mg/kg folic acid), or western folic acid-supplemented diet (10 mg/kg folic acid, 45% kcal fat).

At gestational day 18.5, 3-5 placentas from C57BL/6J dams will be harvested and pooled. Endothelial cells will be isolated and characterized using fluorescence-activated cell sorting.

Results: Studies remain ongoing. Preliminary results reveal no effect of diet on body composition. Significant upregulation of Haao expression is present in folic acid-supplemented groups.

Significance: This project acts as an exploratory analysis to provide data that can be used in planning future studies towards understanding the combined effects of gestational riboflavin deficiency/excess folic acid supplementation on growth and development.

Congratulations to Makenna on receiving a NSERC Undergraduate Student Research Award

SESSION #6 Poster #48

Beatrice Gonzales

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisor: Tim Bhatnagar

Enhancing Muscle Activity Measurement in the Motion Laboratory

Beatrice

Gonzales, Tim Bhatnagar

Introduction: The Motion Lab (TML) performs gait analyses for children with mobility issues to quantify gait metrics and suggest interventions to improve their gait. Electromyography (EMG) is used as part of this analysis to determine how muscles are activating during gait. EMG sensors can be affected by various factors such as baseline noise, adherence to skin and skin impedance. Literature suggests a number of “best practices” for achieving the highest quality signal, however, there is little investigation into the exact effect the intervention has on the signal quality. Currently at TML, EMG sensors are placed directly on children’s skin without any skin preparation (e.g. cleaning) which could affect signal quality.

Objective: To investigate and assess the literature-defined “best practices” for collecting EMG data to ensure reliable data collection for clinical decision-making.

Methods: Five young adults ranging from 19 to 24 years were recruited as part of this quality improvement (QI) study. Eight EMG sensors were placed in established locations on the skin to measure muscle activation signals from: 1) the medial gastrocnemius, 2) the tibialis anterior, 3) the semimembranosus (hamstring), and 4) the rectus femoris, for each leg. The sensors are secured with stretchable straps that cover and wrap around the leg. For the baseline condition, participants walked for 6m with the sensors applied without any intervention. The following conditions were then tested: (i) cleaning skin with alcohol pads, (ii) cleaning skin with soap and water, (iii) shaving body hair, (iv) using abrasive gel to clean the skin, and (v) application of higher tension to the sensor straps. The participants repeated the 6m walk for eight trials under each condition. Signal-to-noise ratio scoring and signal quality analysis were conducted to quantify the effects of the interventions.

Expected Results: The observed differences in EMG signals will reveal the impact of specific interventions on signal quality. Analysis of such effects will reveal on the most effective practices for obtaining reliable EMG data.

Discussion: The findings of this study will serve to provide some clarity on best practice guidelines for collecting EMG for children coming to TML for clinical gait analysis.

SESSION #6 Poster #49

Kaitlin Law

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisor: Clare Beasley

Plasma-Derived Exosomes as a Biomarker of Traumatic Brain Injury and Predictor of Long-term Psychiatric Symptoms

Kaitlin Law, Li Shao, Clare Beasley, William Panenka

Background: Over 160,000 Canadians each year sustain at least one traumatic brain injury (TBI). The current leading diagnostic tool is a combination of subjective reports, physical exams, and cognitive tests. As such, many patients with TBI remain undiagnosed. Such injury results in increased risk of developing mood or anxiety disorders and worsening of symptoms of those diagnosed. Since the biological mechanisms causing such a risk are unknown, identifying blood biomarkers could be used as a diagnostic tool to predict mental health consequences of TBI.

Exosomes are extracellular vesicles released from cells and produced in the endosomal compartment of most eukaryotic cells. Exosomes have been implicated with the immune response and removal of unnecessary proteins among other functions. As such, difference in presence of potential biomarkers in TBI injury versus controls can predict development or worsening of psychiatric symptoms.

Purpose: To determine if exosomes can be a useful biomarker in identifying brain cell damage following TBI with the further goal of predicting long term mental health consequences.

Methods: Subjects included children and young adults between the ages of 14-24 years with mild (n=15) or moderate/ severe (n=15) TBI and orthopedic or soft-tissue trauma controls (n=15). For each subject, blood samples, and clinical CT and MRI data were obtained along with cognitive and behavioural assessments at multiple times points up to 18 months, depending on TBI severity. Blood samples were taken at <12 hours post injury.

Samples were centrifuged at 5,000g for 20 minutes to pellet platelets. Then total exosomes were extracted from 500uL of plasma using iZON columns. Total exosomes were then incubated with L1CAM-biotinylated antibody and bound to streptavidin-plus ultra-link resin to isolate neuronal derived exosomes (NDEs).

Results: Exosomes were successfully isolated from control samples using size exclusion chromatography. Nanoparticle Tracking Analysis demonstrates particle counts in NDE fraction. Potential protein biomarkers on exosomes are being analyzed.

Applications: If differences in biomarkers between control and TBI groups are identified, a blood-based test could be developed to assist in diagnosing TBI. Furthermore, if differences in neuronal biomarkers can be identified, such biomarkers can act as predictors for long term mental health consequences.

Congratulations to Kaitlin on receiving a BC Mental Health and Substance Use Services Summer Studentship

SESSION #6 Poster #50

Jennifer Law

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisor: Sylvia Cheng

Impact and Use of Patient-Reported Outcomes to measure Quality of Life in Pediatric Neuro-oncology and Hematopoietic Stem Cell Transplantation Care in British Columbia

Jennifer Law, Meera Rayar, Rebecca Deyell, Caron Strahlendorf, Hal Siden, Justin Lee, Sylvia Cheng

Background: Providing comprehensive care to pediatric oncology patients is crucial, as treatment and diagnosis often lead to adverse psychological, pain, cognitive, and mobility complications. Previous research has shown that obtaining quality of life (QOL) information can give new insight into the experience of cancer treatment. One method to obtain QOL data systematically is through patient reported outcomes (PROs). PROs are self-reported measures without input from healthcare providers (HCPs).

Objective: To determine the feasibility, acceptability, and impact of PRO implementation for pediatric neuro-oncology and Hematopoietic Stem Cell Transplantation (HSCT) patients.

Methods: Neuro-oncology and HSCT patients aged ≥ 5 years and their parents/caregivers were recruited at all stages of cancer care from the BCCH oncology program. PROs were measured using PROMIS®, a suite of evaluation tools that has been validated in previous studies involving pediatric oncology patients to measure change over time. PROs were collected every 3 months using REDCap. Reports of PRO data were returned to HCPs, accompanied by a post-review survey. Participants and HCPs will have the opportunity to participate in semi-structured interviews at the completion of this study.

Results: Pre-surveys indicated that HCPs faced barriers to obtaining PROs including time, inconsistent collection methods, and patient difficulty in comprehending surveys. Nine neuro-oncology and 8 HSCT participants have been recruited, 5 of which include dyads (parent and patient both participating). Currently, 7 of 12 participants have completed 3 time points. Amongst the dyads, parent reported measures were consistent with patient reported measures across all domains, except peer relationships. Seven post-review surveys were completed by HCPs, revealing a mean score of 8.7 on a 0-10 scale for the helpfulness of PRO data in clinical management.

Conclusion: PRO information on QOL can be helpful to clinicians. Attention will need to be paid to what factors influence ongoing participation by children and parents in providing PRO QOL information. This study can foster the development of an infrastructure for PRO collection for pediatric oncology patients, allowing for better understanding of patient perspectives and improvement of clinical care.

SESSION #6 Poster #51

Abby McCluskey

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, Queen’s Univeristy | Supervisor: Chinten James Lim

Investigating the role of integrin activation in CD47-mediated cell death in T-cell acute lymphoblastic leukemia

Abby McCluskey, Pasal Leclair, Chinten James Lim

T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive hematologic malignancy accounting for approximately 15% of pediatric ALL cases. T-ALL carries a worse 5-year prognosis than other ALL forms, with current chemotherapeutics resulting in secondary life-threatening side effects. Emerging treatments for T-ALL include targeting cell markers over-expressed on malignant cells, such as CD47. CD47 is a cell surface marker primarily known for helping cells evade immune surveillance. Overexpression of CD47 has been phenotypically observed in T-ALL.

Ligation of CD47 by certain monoclonal antibodies has been shown to facilitate “type 3” cell death characterized by exposure of phosphatidylserine (PS) on the plasma membrane’s outer leaflet, mitochondrial membrane potential disruption, and increased reactive oxygen species. This pathway of cell death is still minimally understood as the primary focus of CD47 research has been on its anti-phagocytic functions.

Previously, CD47 has been shown to have a role in integrin activation. To explore the relationship between CD47 and integrins, we investigated the effect of activating β1 integrins – the most prevalent integrin subunit in leukocytes –on CD47-mediated cell death. Cell death assays were performed with the co-incubation of integrin activator MnCl2 with anti-CD47 antibody CC2C6 in wild-type (WT) Jurkat cells. Cell death was analyzed using flow cytometry by assessing Annexin-V PS binding. These experiments showed a synergistic effect between MnCl2 and CC2C6 on CD47-mediated cell death, suggesting that integrins are involved with this pathway. To determine if this phenomenon is reliant on β1-integrins, the assay was repeated with β1-null Jurkat cells. Surprisingly, β1-nulls showed significantly higher CD47-mediated cell death induced by CC2C6 ligation, while co-incubation of CC2C6 and MnCl2 did not produce the synergistic effect on cell death observed in WT cells.

Our findings suggest that inactive β1 integrins have an inhibitory effect on CD47-mediated cell death. These results provide further insight into the mechanisms of CD47-mediated cell death and continue to cement CD47 as a potential therapeutic target for T-ALL. This project’s next steps include assessing β1-integrin activation in CC2C6-treated cells and exploring the relationship between integrins, actin, and CD47 in T-ALL models.

Congratulations to Abby on receiving a BC Children’s Hospital Research Institute Summer Studentship

SESSION #6 Poster #52

Samantha Pang

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisors: Randa Ridgway & Matthias Görges

Ambulatory adductor canal catheter program: reducing opioid requirements after anterior cruciate ligament reconstruction surgery in adolescents

Samantha Pang, Lorna Murphy, Kathleen Duddy, Nicholas West, Matthias Görges, Katherine Lanigan, Randa Ridgway

Background: Anterior cruciate ligament (ACL) reconstruction surgery typically requires an overnight hospital stay and opioid-based postoperative analgesia. The BCCH Acute Pain Service (APS) developed a program using a perineural catheter to allow continuous infusion of analgesia at home using an elastomeric pump to facilitate day-case surgery in adolescents undergoing ACL reconstruction surgery.

Objectives: This study aimed to compare the use of a perineural catheter with an elastomeric pump against different analgesic modalities to investigate its impact on opioid requirements.

Methods: This was a retrospective audit of adolescent ACL reconstruction surgery between 2018-2022. Patients were divided into three groups: intraoperatively, group A received local infiltration analgesia (LIA), group B received a single-shot adductor canal block (ACB), and group C received an ACB and a catheter, with an elastomeric pump attached in the post-anesthetic care unit, before same-day discharge. Patients in group C received a daily phone call from APS, who documented opioid requirements. A Pairwise Wilcoxon Rank-Sum Test was used to compare opioid consumption between the three groups.

Results: Data were available from 55 patients (14 males) who were median [IQR] 16 [15-17] years old, with n=20 patients in group A, n=15 in group B, and n=20 in group C. There were no significant differences between groups B and C in intraoperative opioid consumption. There was no reduction in opioid consumption in the immediate postoperative period between those who received LIA (group A) and those who received ACB (groups B and C) (MD 0.0 mg/kg, 95% CI -0.05 to 0.01, p=0.360). On postoperative day 1, rescue opioid analgesia was required by 14/19 (74%) patients in group A, 10/14 (71%) in group B, but only 4/19 (21%) in group C (p=0.002; MD compared to group A 0.05 mg/kg, 95% CI 0.0 to 0.09, p=0.033; MD compared to group B 0.06 mg/kg, 95% CI 0.0 to 0.11, p=0.067).

Implications/Future Directions: This study identified reduced opioid consumption post-ACL reconstruction surgery in adolescent patients who received an ambulatory adductor canal perineural catheter and elastomeric pump. Despite the small sample size, our results suggest potential benefit of this technique, which requires confirmation in a prospective study.

Congratulations to Samantha on receiving a BioTalent Canada Award

SESSION #6 Poster #53

Aimee Xinxo

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of Waterloo | Supervisors: Gabriella Horvath & Aamina Shah

Induced Pluripotent Stem Cells: A Versatile Tool for Disease Modelling and Drug Discovery with a Focus on Neuronal Progenitor Cell Differentiation

Aimee Xinxo, Aamina Shah, Glen Sequiera, Gabriella Horvath

Induced pluripotent stem cells (iPSC’s) offer a versatile and powerful tool for scientific research, disease modeling, and drug discovery. iPSC’s are somatic cells which have been reprogrammed back to their pluripotent state through the use of different transcription factors. Therefore their ability to be generated from patient cells, differentiate into various cell types, and replicate disease characteristics makes them a valuable resource for advancing our understanding of human biology and developing innovative therapies. In particular, iPSC’s can be differentiated into neuronal progenitor cells (NPC’s) which can then be further differentiated towards specific neural lineages. In this experiment, our goal is to differentiate the iPSC’s into forebrain cortical neurons, using a dual SMAD inhibition method which blocks BMP and TGFB pathways to rapidly differentiate iPSC’s into early neuroectoderm. However, before specific neural lineages can be made, the presence of NPC’s in a culture was confirmed through the detection of certain protein biomarkers which were used as a control.

NPC’s contain a unique mixture of intracellular molecules and proteins expressed on their cellular surface which can be detected through immunofluorescent staining. Immunofluorescent staining is a commonly used technique in molecular biology research which helps understand the localization and propagation of protein biomarkers expressed in different parts of tissue. This process involves stimulating the production of targeted antibodies that recognize specific antigenic markers. These antibodies are linked to an enzyme that, when triggered, initiates a chemical reaction that results in the production of colour at the site of the antigenic marker. Some primary antibodies which confirm the presence of NPC’s in a culture include Nestin, and Sox 2.

Once forebrain cortical neurons have been generated from NPC’s, Ca2+ imaging will then be utilized as a tool to provide insights to neuronal activity. Ca2+ ions play a critical role in neuronal signalling and can help researchers investigate how alterations in activity are linked to various neurological diseases, including Epilepsy and Parkinson’s Disease. By studying Ca2+ dynamics, researchers can better understand functioning of healthy and diseased neurons, and further our understanding of neurological disorders in hopes of finding potential therapeutic interventions.

SESSION #7: BASIC SCIENCE & CLINICAL

Moderator:

Georgina Barnabas

Participants:

Hadil Alfares

Laura Cunningham

1:30 –3:00 PM

In-Person: Chieng Family Atrium

Anya Fineman

Kevin Jeong

T. Mitchell Mazza

Hana Miller

Abigail Netanya Ngan

Rachel Wang

Jenicia Zhen

SESSION #7 Poster #54

Hadil Alfares

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisor: Kevin Harris

The SEARCH study: Study Evaluating Adolescents for Risk factors associated with Cardiovascular Health

Hadil Alfares, Bianca Fukakusa, Najah Adreak, Christine Voss, Kevin Harris

Background: According to the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) health index, fewer than 1 in 5 Canadian youth (age 12-19) are in ideal cardiovascular health. The CANHEART health index is a tool used to monitor the prevalence of modifiable cardiovascular risk factors (diet, smoking status, physical activity, and weight) in pediatric populations. Longitudinal data on cardiovascular health and the relationship with other related factors (quality of life, role of parents, environmental factors, and medical history) in pediatric populations is needed.

Objective: To describe prevalence of cardiovascular risk factors using the CANHEART index in our pediatric population at the Children’s Heart Centre over time in relation to their cardiac condition.

Method: Children and adolescents ages 8-19 years old who were seen at the Children’s Heart Centre, regardless of their reason for visit, were invited to participate in the study. Participants and their parents completed annual surveys over the duration of five years, including questionnaires regarding their own health behaviors (diet, physical activity, smoking status) and quality of life, measured through child self-report and parent-proxy report of the PedsQL (Pediatric Quality of Life Inventory). Chart reviews were performed to obtain participant’s characteristics (age, natal sex, cardiac diagnosis, height, and weight).

Results: This is a cross-sectional analysis of a longitudinal study. Recruitment began in June 2016 and is still ongoing. We recruited 695 participants at baseline, in which 49.6% were male and 50.4% were female. There were 241 participants with congenital heart disease, 133 with heart disease, 275 with a healthy heart and 34 participants with other serious/chronic conditions with a healthy heart. There were 31 (4.7%) participants who consumed 5 servings of fruit and vegetables per day. The mean self reported moderate/vigorous physical activity is 77.9 (72.2) minutes per day. There were 435 (91%) participants who reported to be non-smokers and 464 (70.6%) participants were in the normal BMI category.

Conclusion: Understanding the relationship between modifiable cardiovascular risk factors, and other related factors is critical, as it will help tailor future prevention programs and promote ideal health amongst pediatric populations.

SESSION #7 Poster #55

Laura Cunningham

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisors: Michelle Bauer & Ian Pike

Exploring emergency room doctors’ occupational experiences with patient recovery and their child safety, injury, and play perspectives

Laura Cunningham, Michelle Bauer, Ian Pike

Background: Literature suggests that the work life of an emergency room (ER) doctor is not easily balanced with family duties and child rearing. Overtime hours, shift work systems, and the risk of illness transmission to family members can intensify stress parents experience and shape parenting practices. Examinations of ER doctors’ parenting practices, involvement in patient recovery, and conceptualizations of injury and safety can help researchers understand how their occupational experiences may shape their children’s engagement in risky play and operationalizations of hazards, risks, and dangers. Conducting research with this population can provide important understanding about how experience with risk and injury is processed and translated into everyday life and their unique perspectives on injury and danger.

Objectives: We aim to illustrate the viewpoint of ER doctors who are parents on a variety of topics, including COVID-19 changes in parenting and work, views on work-life balance, involvement in children’s lives, and emotional aspects related to work and parenting. In addition, the area of risky play will receive particular focus, specifically relating to serious injury, differences between risky and dangerous play, and involvement in childhood safety and injury mitigation.

Methods: 40 participants will be recruited for this study. They must work as a medical doctor currently or within the past 2 years in an emergency care role and have at least one child between the ages of 4 and 13. Semi-structured interviews will be conducted online or in person, lasting approximately 1 hour. Interviews will be auto-recorded on passwordprotected personal recording device. Post-interview, the option of engaging in member checking will be presented to participants. We are intending to analyze data using critical discourse analysis, narrative analysis, and reflexive thematic analysis.

Direction of Study: Results from this study will help demonstrate how experiences as ER doctors influence perspectives on their children’s risky play. Findings may influence scholarly conversation surrounding gender and cultural expectations as well as work and home life balance support for ER doctors.

Congratulations to Laura on receiving a BC Injury Research and Prevention Unit Summer Student Research Award

SESSION #7 Poster #56

Anya Fineman

Undergraduate Student, Pitzer College | Supervisor: Michael Kobor

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Epithelial to Mesenchymal Transition Phenotype in a Model of Inflammatory Bowel Disease

Anya Fineman, Paula T. Littlejohn, Bruce Vallance, Michael S. Kobor

Inflammatory Bowel Disease (IBD) is a chronic disorder affecting millions of individuals annually, with steadily increasing prevalence. Fibrosis, the thickening and scarring of tissue in the gastrointestinal (GI) tract, is a common complication in IBD patients that arises from excessive activation of normal wound healing processes due to chronic inflammation. One crucial mechanism involved in fibrosis development is the epithelial-to-mesenchymal transition (EMT), wherein epithelial cells in the GI tract undergo a phenotypic change, transforming into fibrotic mesenchymal cells. EMT is regulated by a network of transcription factors (TFs), some of which have been associated with KDM1A, a histone demethylase that can repress or heighten the expression of genes through the removal of methyl groups.

In this study, we investigate the expression of KDM1A and related TFs in the gut tissues of mice with IBD compared to wild-type controls. We use quantitative polymerase chain reaction (qPCR) and Western blot analyses to assess the mRNA and protein levels, respectively. To explore these mechanisms, we utilize MUC2 knockout mice, which serve as a spontaneous model for ulcerative colitis, a subtype of IBD.

Despite the increasing prevalence of IBD, treatment options remain limited in their range and effectiveness. By gaining a deeper understanding of the key mechanisms involved in the disease process at the molecular level, we aim to identify potential targets for tailored treatments, providing new avenues for therapeutic interventions.

Congratulations to Anya on receiving a BC Children’s Hospital Research Institute Healthy Starts Summer Studentship

SESSION #7 Poster #57

Kevin Jeong

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisor: Christopher Maxwell

Analyzing the loss of binucleate cells during fluorescence activated cell sorting

Kevin Jeong, Ryan Ghorayeb, Christopher Maxwell

Young women with BRCA1 mutations are often diagnosed with aggressive, hormone receptor negative breast cancer, termed triple negative breast cancer (TNBC). In multiple mouse models with Brca1 mutations that develop TNBC, ectopic alveologenesis precedes overt tumor formation. Therefore, it is important to study alveolar cells and their potential impact on the formation of triple negative tumors. Under normal conditions, alveologenesis occurs during pregnancy and lactation, and during this process, alveolar cells become binucleate by undergoing mitosis, but not completing cytokinesis. Binucleate alveolar cells, however, are likely more fragile than mononucleated cells, and may be lost through experimental techniques such as fluorescence activated cell sorting (FACS) and/or single cell RNA-sequencing. Importantly, these challenges may lead to false conclusions or hinder the potential to make discoveries.

Here, we investigated if binucleate mammary epithelial cells are lost during FACS compared to mononucleate cells. We used the normal mouse mammary epithelial cell line (nMuMG) transduced with fluorescence ubiquitin cell cycle indicator (FUCCI) vectors to discriminate between mononucleate 4N and binucleate 2N+2N cells. We treated nMuMG FUCCI cells with dihydrocytochalasin B (DCB), a cytokinesis inhibitor, to induce binucleation. We then quantified the proportion of binucleate cells via confocal immunofluorescence, and compared this to the proportion of binucleate cells observed through FACS. We observed a decrease in the number of binucleate cells captured through FACS compared with the number of binucleate cells we quantified using confocal microscopy. This study provides evidence that binucleate mammary epithelial cells are lost during FACS, and this should be considered when working with primary human tissue samples that are expected to contain binucleate cells. Moreover, previous studies that sorted samples containing binucleate cells using FACS prior to downstream analyses should be reinterpreted.

Congratulations to Kevin on receiving a BC Children’s Hospital Research Institute Summer Studentship

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

T. Mitchell Mazza

Undergraduate Student, Syracuse University | Supervisor: Clare Beasley

The Complement System in Schizophrenia: The effect of antipsychotic drug administration on inflammatory activity in the brain

T. Mitchell Mazza, Li Shao, Clare L. Beasley

Background: Schizophrenia is a major psychiatric disorder involving a range of symptoms including hallucinations, delusions, and disorganized thinking, and it affects approximately 1% of the population in Canada. Recent studies in genetic and molecular biology have demonstrated dysregulated immune system activity in individuals with schizophrenia and other psychiatric disorders, but the exact relationship between the immune system and mental illnesses remains to be elucidated. The complement cascade is a set of proteins involved in innate immunity and first-line defense against pathogens. This system of proteins has recently received increased attention as a result of evidence suggesting elevated activity in individuals with schizophrenia.

Objective: This study aims to contribute to this field by examining the effect of antipsychotic medications on complement component 3 (C3) protein, which plays a central role in all three complement cascade pathways and may provide important insight into complement activity.

Methods: Rats (n = 30) were administered antipsychotic medications (clozapine or haloperidol) or a control (saline) for 28 days, and samples were isolated from multiple brain regions and peripheral tissues. Levels of C3 present in orbitofrontal cortex in each sample will be analyzed using Western blotting techniques.

Results: Data is currently being analyzed.

Conclusion: This study serves to contribute to experimental research examining immune system dysregulation in psychiatric disorders. It uniquely incorporates an analysis of common psychiatric medications used as treatment for schizophrenia to provide further insight into mechanistic effects of medications. As researchers begin to better understand the molecular biology of schizophrenia and other mental illnesses, more targeted and specific therapeutics may be developed in order to more effectively treat this debilitating and often treatment-resistant disorder.

Congratulations to Mitchell on receiving a Fulbright Canada Mitacs Globalink Program Studentship

SESSION #7 Poster #59

Hana Miller

Undergraduate Student, McGill University | Supervisor: Ash Singhal

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Remoteness of Residence and Pediatric Surgical Outcomes in British Columbia

Hana Miller, Ash Singhal

Background: The Canadian healthcare system strives to provide high-quality care to its residents regardless of geographic location. In British Columbia (BC), there is one pediatric tertiary care hospital serving a population of almost 5 million people over an area of 944,735 square kilometers. This requires families living in rural areas to travel long distances for necessary surgical interventions. This research project investigates the association of remoteness of residence (RoR) with pediatric surgical outcomes in BC.

Methods: All patients with surgical outcomes and address data from 2017-2022 in the BC Children’s Hospital (BCCH) National Surgical Quality Improvement Program (NSQIP) database were collected (n=3277). Patients with addresses outside BC, Yukon, and the Northwest Territories were excluded. The driving time of patients in the study (n=3254) were calculated using google maps. Patients were categorized as close (<2 hour drive; n=2415) or far (> 2 hours drive; n=839) from BCCH. Chi squared test was used to assess differences in surgical outcomes between groups.

Preliminary Results: The following outcomes were recorded and were not statistically significant (p>0.05): hospital length of stay (5.0 day average), readmission within 30 days (3.8%), surgical site infections (3.6%), adverse events (composite; 2.1%), and 30-day mortality (0.2%). There was a statistically significant difference between the need for an unplanned second surgical procedure between the close and far group (close=2.8%, far=1.4%; p=0.03).

Conclusions: Those who live close to BCCH are more likely to require an unplanned second surgical procedure. The reason for this requires further investigation. The remainder of the data suggests that the current model of a single high-resource intensive care setting is able to provide similar surgical results to all patients, regardless of a patient’s geographic location.

Congratulations to Hana on receiving a BC Children’s Hospital Research Institute Brain, Behaviour & Development Summer Studentship

SESSION #7 Poster #60

Abigail Netanya Ngan

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisor: Catherine Biggs

Newborn Screening for Severe Combined Immunodeficiency in British Columbia

Abigail Netanya Ngan, Kyla Hildebrand, Stuart Turvey, Elliot James, Victoria Cook, Scott Cameron, Audi Setiadi, Gurdip Hulait, Graham Sinclair, Catherine M Biggs

Background: Severe combined immunodeficiency (SCID) is an inborn error of immunity characterized by severely low T cell counts and predisposition to infections. Early diagnosis is essential so that infants can be urgently referred for lifesaving treatment. Newborn screening for SCID provides a method to detect SCID and other conditions associated with T cell lymphopenia (TCL), and was introduced in BC in October 2022. The purpose of this project was to assess outcomes from the first 8 months of newborn screening for SCID in BC.

Methods and Results: A chart review was conducted to investigate the geographic distribution, T cell values, diagnoses, and outcomes of infants who had a positive newborn screen for SCID. Between October 3 and June 16, 2023, 28,816 initial samples were tested, and 30 infants screened positive. Infants who screened positive had a broad geographic distribution that included the Yukon and all 5 health authorities of BC. Of the 30 infants, 13 had normal repeat testing and were discharged from the program, 2 were lost to follow up, and 15 were referred for immunologic evaluation. So far, no infant identified through the screening program has been found to have SCID, however, 10 were diagnosed with conditions associated with TCL, including: a non-SCID form of T cell immunodeficiency (1 infant), chromosomal microdeletion syndromes (3), leukemia (1), congenital infection (1), hydrops (1), extreme prematurity (1), and idiopathic TCL (2). The performance of the newborn screening test has a positive predictive value of 30%, where the 10 infants diagnosed with conditions associated with TCL were categorized as a true positive result.

Significance: Introducing the newborn screening program for SCID in BC facilitated early diagnosis and treatment of medically actionable conditions associated with TCL. Our experience highlights the broad range of causes of TCL in newborns, and the importance of this screening program for optimizing outcomes through prompt recognition.

SESSION #7 Poster #61

Rachel Wang

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisor: Laura Sly

Targeting IL-13 to treat Crohn’s disease-associated intestinal fibrosis

Rachel Wang, Kwestan Safari, Sue Menzies, Laura Sly

Background: Crohn’s Disease (CD) is a type of inflammatory bowel disease that results in patchy, transmural gastrointestinal inflammation. Due to prolonged inflammation, over 50% of people with CD develop intestinal fibrosis, a life-threatening complication characterized by increased collagen deposition and muscle thickening. Fibrosis can lead to strictures that require surgical intervention. However, since CD is chronic and recurring, many people with CD need to undergo multiple surgeries. Despite the importance of intestinal fibrosis, there are currently no drugs used to target CD-associated fibrosis.

To study CD, the Sly Lab works with a SHIP knockout mouse model that spontaneously develops intestinal inflammation and fibrosis in the distal ileum. Our laboratory found that blocking IL-13 signalling in SHIP knockout mice prevents the development of intestinal fibrosis. Thus, we wanted to find the cellular source of IL-13. Single-cell RNA (scRNA) sequencing data on people with CD reveals that mast cells are key producers of IL-13. Since the scRNA sequencing data is from humans, we want to ask whether mast cells are also the main producers of IL-13 in our SHIP knockout mouse model.

Objective: To determine whether mast cells are the main producers of IL-13 in SHIP knockout mice and evaluate their impact on intestinal fibrosis outcomes.

Methods: We will perform scRNA sequencing on the small intestine of SHIP KO mice to confirm that our model’s mast cells have IL-13 transcripts and to determine whether other cell type(s) also have IL-13 transcripts. Subsequently, immunofluorescence will be used to co-localize IL-13 and c-kit, a mast cell marker. We will also deplete mast cells from SHIP KO mice using an anti-c-kit antibody to provide evidence that mast cells produce IL-13 in our mouse model.

Implications/Significance: Since there are currently no anti-fibrotic drugs, many people with CD-associated intestinal fibrosis require surgery. By identifying specific cell types and underlying mechanisms that contribute to intestinal fibrosis, we may identify potential therapeutic targets that can be used to develop drugs to treat intestinal fibrosis and reduce the incidence of this devastating complication in people with CD.

Congratulations to Rachel on receiving a BC Children’s Hospital Research Institute

Childhood Diseases Summer Studentship Summer Studentship

SESSION #7 Poster #62

Jenicia Zhen

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisor: Bruce Verchere

Peptidylglycine alpha-amidating monooxygenase is involved in islet cilia formation and hormone secretion

Jenicia Zhen, Yi-Chun Chen, Nils Back, Richard Mains, Betty Eipper, Mitsuhiro Komba, Anna Glyon, Patrick MacDonald, C. Bruce Verchere

Introduction: Pancreatic islet cells release peptide hormones, such as insulin, to regulate blood glucose levels. In islet cells, peptide hormone precursors undergo enzymatic modification to become biologically active hormones. Peptidylglycine alpha-amidating monooxygenase (PAM) is an enzyme that catalyzes the modification of peptide precursors to amidated peptides. Carriers of Pam polymorphisms have an increased risk of developing type 2 diabetes (T2D) and show reduced insulin secretion from islets, however, the underlying cellular mechanism remains unclear. PAM is suggested to be involved in primary cilia assembly, and recent research has demonstrated a critical role of β-cell cilia in regulating pancreatic islet cell communication and hormone secretion.

Aim and Hypothesis: We aim to investigate whether PAM is involved in pancreatic islet cilia formation and hormone secretion. We hypothesize that the loss of PAM in β-cells would result in altered cilia morphology and disrupt the crossregulation of islet cells.

Methods: To test whether PAM affects islet cell cilia morphology, we performed immunostaining on islets from β-cell specific PAM knockout (βPamKO) and wild-type (Wt) mice using anti-acetylated α-tubulin antibody and used ImageJ and CiliaQ softwares to quantify cilia length and number. To examine whether PAM impacts islet hormone secretion, we incubated βPamKO and Wt islets at low (1mM) and high (11mM) glucose media and analyzed insulin, proinsulin, glucagon, and somatostatin levels in the media via ELISAs. To study whether PAM affects islet cell composition, we performed immunostaining on βPamKO and Wt mouse pancreatic sections using anti-insulin, anti-glucagon and antisomatostatin antibodies and analyzed different cell number in islet via QuPath software.

Results: Islets from βPamKO mice have reduced cilia length and density compared to control. Islets from βPamKO mice also showed reduced insulin, glucagon, and somatostatin secretion. Furthermore, islets from βPamKO mice displayed a lower percentage of insulin-positive cells.

Conclusion: Our findings suggest that PAM plays a role in mediating pancreatic islet cilia formation, islet hormone secretion, and orchestrating islet cell composition. Further research should be conducted to explore the role of PAM in autocrine and paracrine signaling via cilia and understand how the impairment of PAM in β-cell may contribute to the development of T2D.

Congratulations to Jenicia on receiving a UBC Faculty of Medicine Summer Studentship

SESSION #8: CLINICAL

Moderator:

Thais Rangel

Bousquet Carrilho

Participants:

Sabine Bonnor

1:30 –3:00 PM

In-Person: Chieng

Family Atrium

Serena Chan

Ethan Fong

Katarina Krivokapic

Sirui Li

Jessica Luo

Jessica Moh

Jenna Ramji

Laura Seyler

Thursday, July 27 | 1:30 - 3:00 pm

Sabine Bonnor

Undergraduate Student, University of British Columbia | Supervisor: Jessica Dennis

Depression and Anxiety Trajectories in Older Adult Canadians: An Analysis of Genetic and Non-Genetic Factors

Bonnor, Sabine; Singh, Karanvir; Dennis, Jessica

Getting older comes with many life changes, including transitions in occupation, social environments, and health status. Mental health too changes as individuals age, yet the factors that influence shifts in mental health are poorly understood, despite their public health relevance. According to the World Health Organization, more than 1-in-5 adults aged 60 years and older have a mental health condition such as depression or anxiety, both of which have wellestablished genetic components. However, few studies have investigated how genetics affects changes in mental health as people age. The genetic and environmental factors that affect changes in mental health could be different from those that affect mental health per se, and distinguishing these factors could help us better identify individuals who need extra support as they age. This study aims to address the gap by analyzing the impact of genetic and non-genetic factors on the mental health trajectories of older adult Canadians participating in the Canadian Longitudinal Study on Aging. The study includes over 26,000 genotyped participants aged 45-85 at baseline, who have completed detailed health, lifestyle, and behavioural questionnaires, at three separate time points, each separated by three years. Our study aims to characterize changes in anxiety and depressive symptoms over time and quantify the association between genetic risk factors and these symptoms. We will use polygenic scores to capture the genetic components of depression and anxiety in the cohort, growth curve models to illustrate the patterns in how depression and anxiety changes over time, and linear regression to enable predictive results. The findings of this analysis will provide valuable evidence to guide the development of targeted prevention and treatment strategies for older adults.

Congratulations to Sabine on receiving an Edwin S.H. Leong Centre for Healthy Aging Award

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Serena Chan

Undergraduate Student, University of British Columbia | Supervisor: Tom Blydt-Hansen

Clinical Utility of Routine MAG-3 Scan for Surveillance of Kidney Allograft Injury at 48h Post-Kidney Transplant

Serena Chan, Tom Blydt-Hansen, Sharon Gershony

Background: Currently, routine surveillance with mercaptoacetyltriglycine-3 (MAG-3) renal scan is used to evaluate the severity of acute kidney injury in the first 48 hours post-kidney transplant in all patients. This test is sensitive in identifying regional perfusion defects (e.g. infarction), ureteral leak or delayed excretion. The MAG-3 scan is, however, an expensive test with logistical challenges to coordinate on short notice, in addition to radiation exposure. Although identification of regional perfusion defects or leaks would prompt urgent intervention, it is a relatively uncommon finding; and in most cases the scan may not directly change management in the short term. Recent work in our lab has identified functional indicators of acute kidney injury caused by ischemia-reperfusion injury, but they have not been compared with MAG-3 scan in terms of prognostic utility. Thus, this project aims to evaluate the continued utility of routine surveillance MAG-3 scans for detecting early acute kidney injury and prognosticating time to recovery.

Methods: Pediatric patients who have undergone kidney transplants from 2016 to 2023 at BCCH have been included in this study. Clinical data, including donor, recipient and functional parameters related to risk of acute kidney injury and graft outcome, are extracted from the HOPESOT clinical transplant registry. Data from MAG-3 scans, including perfusion time, excretory phase and specific abnormalities, are extracted from imaging and diagnostic reports. Statistical tests will be run to compare the prognostic utility of the MAG-3 scan results with the previously identified allograft functional indicators.

Results: Data analysis is in progress at the time of abstract submission.

Significance: The findings from this project will help to guide the use of the MAG-3 scan in the immediate post-operative time period after a kidney transplant, and inform the optimal utilization of MAG-3 scans more broadly for the pediatric transplant community.

SESSION #8 Poster #65

Ethan Fong

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, Pomona College | Supervisor: Matthew Carwana

Understanding Pediatrician Knowledge and Perspectives on Barriers and Facilitators to Social Prescribing: An Exploratory Study

Ethan Fong, Britt Udall, Matthew Carwana

Background: Social prescribing (SP) is an intervention that targets social conditions through community referrals to assistance for issues such as income security, food security, mental health, and justice. Few examples of successful long-term implementation of SP have been reported in primary care settings in North America, while SP practices are well integrated into the UK’s healthcare system. While patient perspectives on the efficacy of social prescribing are numerous, few studies have examined how providers engage in SP. Likewise, there is no information on practitioner involvement in SP in BC. Overall, a large provider know-do gap exists between the praxis and practice of SP.

Objectives:

1. To determine how much pediatric primary care providers participate in social prescribing.

2. To understand the barriers and facilitators to the implementation of social prescribing practices for pediatric primary care providers in British Columbia.

3. To produce a checklist tool that providers can use to improve their ability to engage in effective social prescribing.

Methods: Semi-structured qualitative Zoom interviews will be conducted when participants have been voluntarily recruited via BC Pediatric Society newsletters and purposive sampling to ensure the involvement of various specialties of pediatricians from around the province. Interviews will be transcribed, then analyzed. Discussion questions allow pediatricians to define social prescribing and community-referral practices, discuss how they address social stressors and supports, gauge buy-in with the practice, and explore barriers, then facilitators of SP integration.

Analysis: Grounded theory analysis, across-case, and within-case strategies will be applied to identity themes and relationships, followed by an iterative thematic analysis process aided by NVIVO.

Future: Participant recruitment will begin later this summer.

Anticipated Results: While general pediatricians will be familiar with SP practices, specialized practitioners will be less proficient at describing the integration of SP into their practice. Facilitators may include the presence of social worker/ occupation therapist coworkers and SP-informed curriculum, whereas barriers may consist of visitation length and practitioner and patient knowledge of community resources.

Implications: For the first time in BC, pediatricians’ knowledge and perspectives on social prescribing will be consolidated to inform the implementation of future SP practices and policy.

SESSION #8 Poster #66

Katarina Krivokapic

Undergraduate Student, Queen’s University | Supervisor: Anita Datta

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Significance of Frontal Intermittent Rhythmic Delta Activity (FIRDA) on EEG in the Pediatric Population

Katarina Krivokapic, Anita Datta, Inderpal Gill

Introduction: Frontal intermittent rhythmic delta activity (FIRDA) is an electroencephalogram (EEG) pattern that primarily occurs in adults. Characterized by a 2-3 Hz delta frequency activity and an amplitude of 50-100 mv that occurs predominantly in the bilateral frontal lobes, it was first described in 1945 and initially attributed to deep midline lesions and posterior fossa tumours. Subsequently, FIRDA was demonstrated to occur with hemispheric brain tumours, ischemic brain injury, and metabolic derangements. The pathophysiological significance of FIRDA is yet to be fully understood. Although FIRDA has been shown to occur in children, limited literature exists on the significance of this EEG finding in the pediatric population. A small (n = 22) study found FIRDA to be rare and a non-specific indication of brain abnormality. This study aims to investigate the significance of FIRDA in the pediatric population through the collection and analysis of electrographic and clinical data of patients with FIRDA, bifrontal slowing, and dysrhythmic background EEG findings.

Methods: For this retrospective chart review, patients from the BC Children’s Hospital (BCCH) EEG database were arranged into three groups for clinical data collection: FIRDA group, bifrontal slowing group (control), and background dysrhythmia group (control).

Preliminary Results: 21 FIRDA patients were identified from the database of 43,061 patients, comprising 0.049% of all patients referred to BCCH for an EEG. 17 of the 23 FIRDA patients (74%) had a history of seizures. 2 of the 23 FIRDA patients (8.7%) are deceased. Co-occurring conditions were diverse and included malignant neoplasms, traumatic and anoxic brain injuries, metabolic and genetic disorders, and exposure to toxins.

Conclusion: Our preliminary results suggest that FIRDA is rare and associated with a non-specific range of adverse neurological outcomes. Further comparison with control groups and statistical analysis is pending to delineate differences between FIRDA and other abnormal EEG pattern

Congratulations to Katarina on receiving a BC Children’s Hospital Research Institute

Brain, Behaviour & Development Summer Studentship

SESSION #8 Poster #67

Sirui Li

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisor: Pascal Lavoie

Post-Covid Outcomes Among Education Workers in the Vancouver, Richmond, and Delta School Districts: A Cross-Sectional Study

Sirui Li, Allison W. Watts, Louise C. Mâsse, David M. Goldfarb, Kathy O’Sullivan, Tisha Montgomery, Mark Pitblado, Liam Golding, Jacob Shew, Claire Cheung, Pascal M. Lavoie

Background: After infection with COVID-19, some patients continue to report symptoms that persist long-term beyond the acute infection period (post-COVID). There is a lack of information about the burden of post-COVID outcomes among education workers, who experienced major physical and mental effects during the pandemic due to learning disruptions. Quantifying the burden of post-COVID symptoms within this occupational group will be important to inform and adapt school-related policies.

Objective: To assess the prevalence of post-COVID symptoms among education workers of three school districts in the Vancouver metropolitan area (Vancouver, Richmond, and Delta).

Methods: A cross-sectional study of education workers who were enrolled by email (to the school districts) between January and May of 2023 from 3 school districts: Vancouver, Richmond, and Delta. Participants were invited to answer an online questionnaire and provide a blood sample for SARS-CoV-2 nucleocapsid (N) serology testing. In the questionnaire, de-identified demographic data and post-COVID symptom responses were collected. Patients who tested positive for SARS-CoV-2 by viral nucleic acid amplification (NAAT), rapid antigen testing (RAT) technology, or N serology were considered to have a prior COVID infection.

Results: 1128 participants were enrolled, 1100 answered the post-COVID symptom questionnaire and 998 provided a blood sample. The cohort had a median age of 49 (IQR: 41, 56), was 78% female sex (n=859), and 59% were teachers (n=646). 652/1128 (57.8%) staff tested positive for SARS-CoV-2. 338/1100 (30.7%) reported at least 1 postCOVID symptom. Out of 18 post-COVID symptoms, persistent fatigue was most common (n=146, 13.4%), followed by decreased energy to exercise (n=145, 13.3%), and then by difficulty concentrating (i.e. “brain fog) (n=144, 13.3%). In 240 participants, the most common symptom length was 3-6 months (n=88, 36.7%). In 238 participants, symptoms most reduced their ability to carry out daily activities ‘a little’ (n=156, 65.6%). In participants who tested positive for SARS-CoV-2, the chance of participants experiencing post-COVID symptoms was similar by age category: 20-29 (34.3%), 30-39 (32.3%), 40-49 (35.9%), 50-59 (35.8%), 60-69 (37.1%), and 70-79 (60.0%), respectively.

Implications: This data reinforced the idea that after SARS-CoV-2 infection, long-lasting symptoms may negatively impact everyday life, especially in female patients - even within a highly vaccinated group of education workers. Even in the aftermath of the pandemic, preventative measures against viral infection should continue to warrant attention.

Congratulations to Sirui on receiving a BC Children’s Hospital Research Institute

Healthy Starts Summer Studentship

SESSION #8 Poster #68

Jessica Luo

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisor: Zoë Brown

A facilitated peer discussion program for improving anesthesia resident wellness: a preliminary analysis of benefits and suggested improvements

Jessica Luo, Nicholas West, James D Taylor, Theresa Newlove, Zoë Brown

Background: Pediatric anesthesiologist trainees commonly experience a second victim response following both patient safety incidents and non-safety-related situations (such as physical and emotional stress) that occur during perioperative patient care. In a 2020 survey of anesthesia residents at a Canadian institution, over half experienced a second victim response following near-miss events during their pediatric anesthesia rotation. Additionally, a majority rated “discussion with peers” as a desirable support option following perioperative near-miss events. Although the need for resident support resources is well established, interventions for resident wellness not been well studied.

Objectives: Better REsident Wellness (BREW) rounds are an ongoing quality improvement initiative at BC Children’s Hospital (BCCH) aimed at improving second victim responses following adverse perioperative events. The BREW program was evaluated using pre- and post-intervention surveys to 1) identify the most beneficial components of BREW Rounds, and 2) understand how BREW rounds may be improved.

Methods: All R2 – R5 residents are invited to participate during their pediatric anesthesiology rotations. The weekly 1-hour, in-person, peer discussions are facilitated by a clinical psychologist. Pre- & post-intervention REDCap surveys used to evaluate the BREW program included closed Likert-style and open response questions. Free-text feedback from follow-up surveys were qualitatively analyzed in NVivo.

Results: BREW rounds began in July 2021, with evaluation from October 2021 to February 2023. Overall, 33/48 (69%) invited residents completed both pre- & post-surveys, and all respondents attended one or more BREW rounds. 32/33 (97%) respondents considered BREW “helpful,” “safe,” and “would recommend to future residents.” Within 50 follow-up, open responses, the most noted benefits included themes involving discussion of shared experiences (n=25), bonding with colleagues (n=17), having an open and/or safe space (n=12), and being validated by a proficient and trained facilitator (n=8). Common suggestions for improvement included: session availability (n=9), desire for specific discussion topics/talking points (n=5), and establishing protected time for BREW rounds (n=4).

Conclusion: BREW rounds received overwhelmingly positive feedback from residents. Prospective work may include extending BREW rounds to other BCCH/UBC programs, as well as incorporating semi-structured interviews to further understand the positive impacts and directions for program improvement.

Congratulations to Jessica on receiving a BioTalent Canada Award

SESSION #8 Poster #69

Jessica Moh

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, Simon Fraser University | Supervisor: Lori B. Tucker

Fatigue in Children and Teens with Systemic Auto-inflammatory Diseases

Jessica

Moh, Lori Tucker

Background: Systemic auto-inflammatory diseases (SAID) are rare diseases commonly presenting in childhood characterized by episodic or persistent unprovoked inflammation. Children with SAID may have fever episodes with associated symptoms, or bone inflammation called chronic recurrent multifocal osteomyelitis (CRMO). These diseases can affect children’s functioning and quality of life, but there have been few reports regarding fatigue in children with SAID.

Objective: To evaluate self-reported fatigue among children with SAID, and explore differences between children with periodic fever syndromes (PFS) and children with CRMO in disease-related fatigue.

Methods: Children and their families seen at the BC Children’s Hospital Division of Rheumatology’s Auto-inflammatory Clinic were invited to participate in the CAN-Fever Registry, a single-centre, longitudinal registry of children with SAID. Data collected includes demographics (sex, current age, diagnosis, age at diagnosis, time from symptom to diagnosis), symptoms, physician and parent global assessments. The Pediatric Quality of Life (PedsQL) Multidimensional Fatigue questionnaire was the primary outcome measure; children ages 8 and older completed self-report, and a parental form was completed for children < age 8. The PedsQL score ranges from 0-100, with higher scores indicating less fatigue. Descriptive statistics were used, and comparison of PedsQL Fatigue scores to previously published reports of children with chronic arthritis was done.

Results: 162 SAID patients completed the PedsQL questionnaire at study enrollment; 115 subjects with PFS, 47 subjects with CRMO. The mean time from symptom onset to diagnosis for PFS was 2.5 yrs, and for CRMO 0.8 yrs. Subjects with PFS reported significantly higher fatigue (median PedsQL score 58.33, IQR 47.22-69.44) than children and teens with CRMO (median PedsQL score 68.95, IQR 59.72-79.16) (p<0.0001). Active disease rated by Physician Global Assessment > 0 was associated with higher fatigue. Subjects with SAID reported significantly higher fatigue compared with published data from children with juvenile idiopathic arthritis (SAID mean PedsQL score 61.5; JIA mean 80; p<0.001).

Conclusion: Children and teens with SAID report significant fatigue associated with active disease periods, and higher compared to children with JIA. Attention to assessment of fatigue, impact on quality of life, and directed treatment are important for children with SAID.

SESSION #8 Poster #70

Jenna Ramji

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisor: Matthias Görges

Bubble Blowing as an Effective Method for Distraction during Pediatric IV Insertion: A Randomized Controlled Trial

Jenna Ramji, Matthias Görges, Nicholas West, Bianca Vizcaino, Steffanie Fisher, Christa Morrison, Lisa Daechsel, James Chen

Background: Anxious children have increased pain awareness and consequently experience greater pain. Therefore, managing pre-procedural anxiety and pain in children is essential to their care. Intravenous cannula (IV) insertion is a painful procedure that causes significant anxiety in some children. Distraction-based methods provide an inexpensive and safe option to reduce anxiety and pain perception in children. Bubble blowing was previously used in the operating room (OR) and other areas of BC Children’s Hospital during painful procedures, including IV insertion. Video watching replaced bubble blowing in the OR due to potential infection control issues. However, some anesthesiologists feel that video watching is less effective than bubble blowing, especially in younger children.

Objectives: The primary aim of this study is to determine if bubble blowing is a more effective method of reducing perceived pain than video watching during IV insertions before induction of anesthesia for medical imaging. The secondary objective is to compare pre-procedural anxiety between the bubble-blowing and video-watching groups.

Methods: This study is a randomized controlled superiority trial. One hundred and twenty children between the ages of 2 and 5 years, who need an IV for their medical imaging procedure, will be recruited. With parental consent, children will be randomly assigned to blow bubbles (experimental) or watch a video (control). Both groups will undergo standard IV insertion procedures, while using their assigned distraction method. Children will have their pain and pre-procedural anxiety scored by a trained observer, at specific timepoints before, during, and (for pain only) immediately after the IV insertion procedure. A linear regression model, controlling for age, sex, and baseline pain score, will be used to compare the differences in pain between the bubble-blowing and video-watching groups. A similar analysis will be conducted for pre-procedural anxiety scores.

(Anticipated) Results: Patient recruitment is expected to start in July 2023 and complete by Spring 2024.

(Anticipated) Conclusions: If we can demonstrate benefit of bubble distraction, we can recommend bubble blowing as an effective technique for other areas of the hospital and re-visit infection control guidelines preventing their current use in the operating room.