2024 SUMMER STUDENT POSTER DAY
Welcome to the 2024 Summer Student Research Program Poster Day!
Every year, this event highlights the unique and innovative research conducted by undergraduate, medical, and graduate students on the Oak Street campus during the summer.
The research community at BC Children’s Hospital offers students a genuine ‘bench to bedside’ research experience. Since the early 1990s, the Summer Student Research Program has provided over 1,000 students with opportunities to engage in projects focused on children’s and women’s health.
The breadth of research conducted here is impressive, encompassing foundational science, clinical studies and population health research. Poster Day serves as a fantastic preview of the interdisciplinary work our students will pursue as they advance in their careers as scientific and clinical investigators.
We take great pride in our students and are delighted to support them in becoming leaders in their respective fields.
Since 1987, the Summer Student Research Program has provided 1,500+ students with the opportunity to participate in projects related to child and family health under the supervision of researchers on the Oak Street Campus.
- Brigham Young University
- Claremont McKenna College
- McGill University
- McMaster University
- Queen’s University
- Royal College of Surgeons in Ireland
$180,000 + Registered Summer Students
Hours of professional development
BCCHR & Partnered Summer Studentship funding awards
130 research projects pursuing new discoveries and innovations to transform the lives of families in BC and beyond
- Simon Fraser University
- University of Hong Kong
- University College Dublin
- University of British Columbia
- University of Galway
- University of Guelph
- University of Hong Kong
- University of Limerick
- University of Ottawa
- University of Toronto
- University of Victoria
- University of Waterloo
- University of Western Ontario
- Western University
Schedule:
9:00 am –10:30 am 11:00 am –12:30 pm 2:00 pm –3:30 pm 4:00 pm
Thursday, July 25, 2024
POSTER SESSIONS
Watch Virtually: www.bcchr.ca/posterday
Session #1: Clinical & Population Health
Watch In-Person: Chieng Family Atrium, BCCHR
Session #2: Clinical & Population Health | Foundational Science
Session #3: Clinical & Population Health
Session #4: Foundational Science
Watch In-Person: Chieng Family Atrium, BCCHR
Session #5: Foundational Science
Session #6: Clinical & Population Health
Session #7: Clinical & Population Health
Session #8: Clinical & Population Health | Foundational Science
Watch In-Person: Chieng Family Atrium, BCCHR
Session #9: Clinical & Population Health
Session #10: Clinical & Population Health
Session #11: Clinical & Population Health
Session #12: Clinical & Population Health
AWARDS CEREMONY
Watch In-Person: Chan Auditorium, BCCHR OR Watch Virtually: www.bcchr.ca/posterday
Join us as we celebrate the accomplishments of our colleagues and the positive impact of research taking place in our community. The awards ceremony will feature the best poster presentation awards.
Showingcasing excellence in our talented research community!
2024 Poster Participants
Participant Research Team
Caitlin Adams Haji Research Team
Jodi Anderson Barr Research Team
Dorsa Arman Voss Research Team
Sue Rim Baek Arneja Research Team
Alexa Bailey Verchere Research Team
Sara Blais Salhi Research Team
Wongel Bogale Siden Research Team
Benjamin Brakel Tamber Research Team
Annika Burrows Maxwell Research Team
Serena Chan Blydt-Hansen Research Team
Maria Cheema Avinashi Research Team
Irene Chen Blydt-Hansen Research Team
Josie Chrenek Dell Research Team
Abstract Title
Mapping surgical, anesthesia, and obstetric training programs in sub-Saharan Africa: A narrative review
Prevalence, Practices, Attitudes, and Product Analysis of Medicinal Cannabis Use in Pediatrics
Cognitive skills in children and adolescents with Type 1 Diabetes: A scoping review
Quality of Life after Mustardé Otoplasty for Prominent Ears: Preliminary Results
Amyloid Detection In-Vitro Using the QM-FN-SO3 Aggregate-Induced-Emission Probe
Pediatric fingertip injuries: a retrospective study comparing treatment outcomes
Developing a Protocol and Chart Review Form for Investigating the Life Expectancy of Neonates with Severe Hypoxic–Ischemic Encephalopathy after Cessation of Intensive Care
To Stave or not to Stave? The Impact of Barrel-Stave Osteotomy on Cephalometric Measurements in Patients Who Have Undergone Endoscopic Repair of Sagittal Craniosynostosis
Investigating the Role of BRCA1 on Mammary Alveologenesis and Binucleation
Clinical Utility of Routine MAG-3 Scan for Surveillance of Kidney Allograft Injury at 48h Post-Kidney Transplant
Development of a Pediatric Constipation Resource Guide and Action Plan for Children: A Quality Improvement Initiative
Social media as a tool to explore mental health in children living with a solid organ transplant and their families
Effects of race-neutral reference equations on the interpretation of pediatric pulmonary function tests
Session #
Session #11: 2:00 - 3:30 pm In-Person
Session #2: 9:00 - 10:30 am In-Person
Session #12: 2:00 - 3:30 pm In-Person
Session #2: 9:00 - 10:30 am In-Person
Session #8: 11:00 - 12:30 pm In-Person
Session #6: 11:00 - 12:30 pm In-Person
Session #2: 9:00 - 10:30 am In-Person
Session #1: 9:00 - 10:30 am Virtual
Session #5: 11:00 - 12:30 pm In-Person
Session #11: 2:00 - 3:30 pm In-Person
Session #9: 2:00 - 3:30 pm In-Person
Session #6: 11:00 - 12:30 pm In-Person
Session #1: 9:00 - 10:30 am Virtual
Participant Research Team Abstract Title
April Christiansen Zwicker Research Team
Grace Clarke Horvath Research Team
Clare Cunningham Guzman Research Team
Rena Daniel Loucks Research Team
Ciana DawydiukClozza Bhatnagar Research Team
Arjun Dhaliwal Pike Research Team
Angeleet Dhanda Loucks Research Team
Arshvir Singh Dhari Correll Research Team
Gurvir Dhutt Wiens Research Team
Alisha Dostie Babul Research Team
Retrospective Review of Children’s Diagnostic Assessments for Autism Spectrum Disorder in BC: Are We Identifying Co-occurring Motor Deficits?
Characterizing Patient Outcomes for Status Dystonicus in the BC Children’s Hospital Pediatric Intensive Care Unit (PICU): A Retrospective Chart Review
Trajectories of Physical Function in Children with Juvenile Idiopathic Arthritis: Results from the CAPRI Registry
Identifying Genetic Predictors of Morphine Ineffectiveness in Children with Cancer
The Relationship Between Verbal Directions and Landing Strategy During a Drop Jump. Indicator of Secondary Anterior Cruciate Ligament (ACL) Injury Risk
Safe Play for All: Identifying Injuries and Injury Prevention Strategies for Pediatric Athletes Participating in Adaptive Sports
Safety and Efficacy of Opioid Use in Infants: A Scoping Review
Critical events in anesthetized kids undergoing tracheal intubation: a prospective multi-centre observational study
Exposure to household air pollution and pediatric post-discharge health outcomes in Uganda
Risk factors and Intervention Strategies for Cycling-Related Injuries Among Children and Youth
Session #1: 9:00 - 10:30 am Virtual
Session #8: 11:00 - 12:30 pm In-Person
Session #7: 11:00 - 12:30 pm In-Person
Session #1: 9:00 - 10:30 am Virtual
Session #7: 11:00 - 12:30 pm
Session #2: 9:00 - 10:30 am In-Person
Session #1: 9:00 - 10:30 am Virtual
Session #12: 2:00 - 3:30 pm In-Person
Session #2: 9:00 - 10:30 am In-Person
Session #10: 2:00 - 3:30 pm In-Person
Participant Research Team
Josh Dyce Cooper Research Team
Mahnoor Faisal Siden Research Team
Sally Gaherty Bush Research Team
Beatrice Gonzales Bhatnagar Research Team
Sanya Grover Loock Research Team
Rishi Gupta Salh Research Team
Ali Hawkins Bhatnager Research Team
Orli Hellerstein Woodward Research Team
Aishwarya Heran Boerner Research Team
Gabrielle Herzenberg Deyell Research Team
Abstract Title
Artificial Intelligence-Driven Information Extraction and Documentation from DoctorPatient Dialogue: A proof of concept study
Prevalence and Practices of Pediatric Medicinal Cannabis Use at BC Children’s Hospital
Evaluating the Tumor Immune Microenvironment in Primary and Metastatic Osteosarcoma
Measurement of Change in Plantar Pressure using Pedobarography Following myoActivation® Therapy
Assessing the Social Determinants of Health and Positive Childhood Experiences in Youth Patients Transitioning to Adult Care: A Cross-Sectional Survey
How do the Neurocognitive Profiles of FASD and Complex Trauma Compare in the Pediatric Population: A Scoping Review Protocol
Relationship between Hindfoot Pressure and Heel Marker Height During Static Calibration of Motion Capture
Delusion-like Beliefs Explored through Evidence Integration in Pediatric Patients with ObsessiveCompulsive Disorder and Anorexia Nervosa
Systematic review of autistic representation in the treatment literature for pediatric chronic pain
Generation of real-world evidence for children with relapsed or refractory high-risk neuroblastoma and Canadian approach to management
Session #9: 2:00 - 3:30 pm In-Person
Session #7: 11:00 - 12:30 pm In-Person
Session #3: 9:00 - 10:30 am In-Person
Session #11: 2:00 - 3:30 pm In-Person
Session #2: 9:00 - 10:30 am In-Person
Session #6: 11:00 - 12:30 pm In-Person
Session #10: 2:00 - 3:30 pm In-Person
Session #9: 2:00 - 3:30 pm In-Person
Session #10: 2:00 - 3:30 pm In-Person
Session #12: 2:00 - 3:30 pm In-Person
Participant Research Team
Elaine Huang Devlin Research Team
Hanna Huguet Siden Research Team
Rashmi Hundal Lynn Research Team
Bonnie Huynh Maxwell Research Team
Armaan Jaffer Carwana Research Team
Lujia Jian Woodward Research Team
Ellie Kalutycz Wright Research Team
Lavisha Katyal Sanatani Research Team
Chanjoo Kim Siden Research Team
Katarina Krivokapic Datta Research Team
Alysha Lee Demos Research Team
Angela Onyu Lee Brussoni Research Team
Michael Li Mishaal Research Team
Abstract
Investigating the effect of high folic acid levels on folate receptor expression in MIN6 insulinoma cells
Implementing the Pain and Irritability of Unknown Origin (PIUO) Pathway in Community Pediatric Practices: An Integrated Knowledge Mobilization Plan
Vascularizing stem cell-derived islets with stem cell-derived blood vessel organoids
Investigating the spatiotemporal role of HMMR Δexon4 splice isoform in cell division
Understanding Pediatrician Knowledge and Perspectives on Barriers and Facilitators to Social Prescribing: An Exploratory Study
The Pattern-Based Anatomy and Cognitive Mode Associated with the Auditory-Attention-forResponse (AAR) Network in fMRI
Use of ventilator-assisted maximal inspiration chest physiotherapy for children and youth with neuromuscular disorders: a pilot study
Presentation of Pediatric Syncope in the Emergency Department
Life expectancy of children with severe HIE after cessation of intensive care (a pilot study)
Long-Term Follow-Up of Patients with Developmental Epileptic Encephalopathy with Spike Wave Activation in Sleep
Equity of Access to Diagnostic Genomic Testing for Pediatric Epilepsy Patients
Evaluating Physical Infrastructure and Outdoor Play Environments in Early Learning and Child Care Centres across Canada
Increased Oral Baclofen Dose as a Preoperative Adjunct for Children with Cerebral Palsy
Norman Li Ip Research Team Improving Care Quality at Sunny Hill Outpatient Clinics: Designing and Implementing an Exit Survey
Sirui Li Lavoie Research Team
Neonatal Screening Blood Spot Cards to Monitor RSV Population Immunity in British Columbia
Session #2: 9:00 - 10:30 am In-Person
Session #10: 2:00 - 3:30 pm In-Person
Session #5: 11:00 - 12:30 pm In-Person
Session #4: 9:00 - 10:30 am In-Person
Session #3: 9:00 - 10:30 am In-Person
Session #5: 11:00 - 12:30 pm In-Person
Session #8: 11:00 - 12:30 pm In-Person
Session #9: 2:00 - 3:30 pm In-Person
Session #11: 2:00 - 3:30 pm In-Person
Session #3: 9:00 - 10:30 am In-Person
Session #6: 11:00 - 12:30 pm In-Person
Session #7: 11:00 - 12:30 pm In-Person
Session #6: 11:00 - 12:30 pm In-Person
Session #10: 2:00 - 3:30 pm In-Person
Session #4: 9:00 - 10:30 am In-Person
Participant Research Team
Vanesse Li Hawkes Research Team
Ying Jie Li Tobia Research Team
Xinyan (Betty) Lin Beasley Research Team
Lisa Liu Verchere Research Team
Reece Long Rayment Research Team
Insha Majeed Steiner Research Team
Mia Majstorovic Bettinger Research Team
Peter Malik Joharifard Research Team
Gabrielle Martinez Brussoni Research Team
Bhairvi Tara Mathur Arneja Research Team
Aralia Mills Vanderwal Research Team
Hayal Muslu Tomfohr-Madsen Research Team
Samantha Nalliah Connolly Research Team
Abstract Title
Soluble tumour necrosis factor receptor 1 predicts hospitalization in children and young adults with dengue virus infection in the Philippines
Why Not a Cochlear Implant?: Demographic, clinical, and psychosocial parameters that influence decision to decline cochlear implant in eligible candidates
Comparative Analysis of NF-κB Rel A Protein Levels in Prefrontal Cortex in Human Schizophrenia and Rats Treated with Antipsychotics
Targeting Pro-inflammatory Islet Macrophages to Treat Type 1 Diabetes
Pulmonary implications of major aortopulmonary collateral arteries in patients (MAPCAs) with severe Tetralogy of Fallot
Examining the effect of Tr1 cell therapy via IL-10 mediated suppression of inflammatory macrophages in murine IBD
Parents’ HPV vaccine perceptions in Canada, Australia and the UK: A scoping review
Validation of the Pediatric Open and Laparoscopic Integrated Surgical simulator for inguinal Hernia Repair (POLISHeR)
“It’s nice and mucky”: Centering Children’s Voices to Promote Risky Play in Child Care Centers
Predictors of poor speech outcomes following primary palatoplasty
The effects of music-listening on heart rate variability in adolescents with and without psychiatric disorders: A pilot study
Building Emotional Awareness and Mental Health (BEAM) During Pregnancy: Rationale for Adapting an App-Based Program for the Perinatal Period
Comparison of Vagus Nerve Stimulation and Corpus Callosotomy in the Treatment of Medically Intractable Epilepsy in Children: A Long-Term Single Site Study
Session #5: 11:00 - 12:30 pm In-Person
Session #6: 11:00 - 12:30 pm In-Person
Session #5: 11:00 - 12:30 pm In-Person
Session #5: 11:00 - 12:30 pm In-Person
Session #1: 9:00 - 10:30 am Virtual
Session #5: 11:00 - 12:30 pm In-Person
Session #3: 9:00 - 10:30 am In-Person
Session #12: 2:00 - 3:30 pm In-Person
Session #10: 2:00 - 3:30 pm In-Person
Session #12: 2:00 - 3:30 pm In-Person
Session #11: 2:00 - 3:30 pm In-Person
Session #10: 2:00 - 3:30 pm In-Person
Session #1: 9:00 - 10:30 am Virtual
Participant Research Team
Tracy Ngo Schultz Research Team
Melissa Olana Ip Research Team
Jack Pirie Verchere Research Team
Victoria Porter Görges Research Team
Ariel Qi Jassemi Research Team
Abstract Title
Clinical Determinants That Impact Regulatory Natural Killer Cell Frequency in Healthy Donor
Peripheral Blood
Building Clinical Skills in Neuroaffirming Care Through Simulation
Investigating the Effects of Gut-specific Deletion of the Prohormone Convertase PC1/3 in Mice
Effects of End-Tidal Carbon Dioxide Concentration on Depth of Anesthesia in Children
Undergoing Total Intravenous Anesthesia
Finding Safety in the Psychosocial History: Perspectives from General Pediatrics and Adolescent Medicine
Session #4: 9:00 - 10:30 am In-Person
Session #11: 2:00 - 3:30 pm In-Person
Session #5: 11:00 - 12:30 pm In-Person
Session #6: 11:00 - 12:30 pm In-Person
Session #12: 2:00 - 3:30 pm In-Person
BC Children’s Hospital Foundation Canucks for Kids Fund
The BC Children’s Hospital research community would like to acknowledge the following organizations for supporting training opportunities on the Oak Street Campus:
Childhood Diabetes Laboratories
Community Child Health Endowment Sunny Hill Health Centre Research Group
BCCHR Research Themes: Brain, Behaviour & Development
Childhood Diseases
Healthy Starts
Evidence to Innovation
Participant Research Team
Parveen (Priya) Rai Sly Research Team
Kiana Rashidi Wasserman Research Team
Solana Redway-Ziola Woodward Research Team
Daniel Roozbeh Brown Research Team
Charuta Sahasrabudhe Lee & Wright Research Teams
Raj Saini Hawkes Research Team
Raman Sangha Voss Research Team
Anton Santos Glegg Research Team
Setareh Setayesh Richardson Research Team
Akilesh Shankar Verchere Research Team
Abstract
Evaluating the Therapeutic Potential of Glycoconjugated Steroid for Targeted Delivery in T Cell Transfer Model of Colitis
Predicting genetic variant coverage upon expansion of a population database
The Pattern-Based Anatomy and Cognitive Mode associated with the Re-Evaluation (RE-EV) Network in fMRI
Whole blood transcriptome analysis of putative pathways driving medium vessel vasculitis
Identifying and addressing barriers to treatment compliance in pediatric users of home non-invasive respiratory support
Multidimensional household poverty is associated with mortality, disease severity, and catastrophic health expenditure among Ugandan children hospitalized with pneumonia
Exploring adolescent and parent experiences of pediatric diabetes distress in the BC Interior
Mapping Knowledge Translation Connections in Canada’s Child Development and Rehabilitation Network
Towards New Knowledge Co-Creation in Medicine: Exploring Graphic Arts-Based Thematic Analysis
Evaluating Mast Cell Transcription Heterogeneity in Human Pancreatic Islets
Session #4: 9:00 - 10:30 am In-Person
Session #9: 2:00 - 3:30 pm In-Person
Session #3: 9:00 - 10:30 am In-Person
Session #4: 9:00 - 10:30 am In-Person
Session #6: 11:00 - 12:30 pm In-Person
Session #11: 2:00 - 3:30 pm In-Person
Session #1: 9:00 - 10:30 am Virtual
Session #1: 9:00 - 10:30 am Virtual
Session #9: 2:00 - 3:30 pm In-Person
Session #4: 9:00 - 10:30 am In-Person
Participant Research Team
Noah Shew Smile Research Team
Lana Tarik Moodley Research Team
Nina Thomson Cheng Research Team
Sophie Tran Money Research Team
Samveer Uppal Cohen-Eilig Research Team
Riya Virdi Leveille Research Team
Keshvi Vithlani Horvath Research Team
Miku Wake Gan Research Team
Nicholas Wall Voss Research Team
Arshdeep Waring Mishaal Research Team
Rhonwyn Waterson Stockler Research Team
Caroline (Callie) Wolsey Ghag Research Team
James Wu Taubert Research Team
Abstract Title
Environment Scan of Food Insecurity Screening Practices at BC Children’s Hospital: a Quality Improvement Project Session #7: 11:00 - 12:30 pm In-Person
The Effects of Maternal Physical and Mental Health on Neonatal Outcomes of Congenital Heart Disease: A Pilot Study
A multi-institutional retrospective study of the treatment and clinical outcomes of pediatric craniopharyngioma: a report from the Canadian Pediatric Craniopharyngioma (CanPedsCranio) Registry
An Evaluation of COVID-19 Vaccine Reactogenicity and Pregnancy Outcomes, With and Without Influenza Vaccine Coadministration, during Pregnancy in Canada
Horizons of Hope: a narrative review assessing how adaptive strategies shape and facilitate the parental navigation of cerebral palsy diagnosis
Assessing the Impact of the Introduction of a Rapid Access Acute Knee Clinic on Time to Diagnosis and Management of Adolescent Anterior Cruciate Ligament (ACL) Injuries
Characterizing Patient Outcomes for Status Dystonicus in the BC Children’s Hospital Pediatric Intensive Care Unit (PICU): A Retrospective Chart Review
Modification of automated cardiac function prediction algorithms from non-expert echocardiographers in pediatric patients
Associations and gender-differences between physical activity and glycemic control in children and youth with type one diabetes
Impact of Early Screening Programs on Cerebral Palsy Diagnosis and Care: A Review
Finding treatments for creatine transporter deficiency: a drug repurposing timeline
Adolescent Idiopathic Scoliosis and Mental Health – Effects of Covid-19 Pandemic
Characterizing Partners of C. elegans Nuclear Hormone Receptor NHR-49 in Stress Response
Session #10: 2:00 - 3:30 pm In-Person
#2: 9:00 - 10:30 am
Session #8: 11:00 - 12:30 pm In-Person
#9: 2:00 - 3:30 pm
Session #12: 2:00 - 3:30 pm In-Person
Session #8: 11:00 - 12:30 pm In-Person
Session #3: 9:00 - 10:30 am In-Person
Session #12: 2:00 - 3:30 pm In-Person
Session #12: 2:00 - 3:30 pm In-Person
Session #8: 11:00 - 12:30 pm In-Person
Session #3: 9:00 - 10:30 am In-Person
Session #5: 11:00 - 12:30 pm In-Person
Participant Research Team
Bradley Xiang Sadarangani Research Team
Angela Yang Lynn Research Team
Jiayi (Joy) Yang Hawkes Research Team
Hayley Yau Stewart Research Team
Christopher Yu Blydt Hansen Research Team
Christina Zeng Siden Research Team
Yuchang (Janice) Zhan Taubert Research Team
Rosalie Zhou Beasley Research Team
Abstract Title Session #
A Proteome Quest: Proteomic Analysis of Klebsiella pneumoniae in Varying Growth Conditions
Studying MED15 as a Potential Therapeutic Target in Stem Cells to Treat Dysfunctional Alpha Cells in Diabetes
Soluble triggering receptor expressed on myeloid cells 1 in children and young adults with dengue virus infection in the Philippines
Examining sleep disturbance in pediatric autism spectrum disorder, obsessive-compulsive disorder and their comorbidity versus psychiatric controls
Assessing quality of life of pediatric solid organ transplant patients through social media engagement on Reddit and Facebook
A scoping review on health inequities in children living with health complexity: Incorporating an intersectional lens
Investigating functions of efk-1/eEF2K in C. elegans hypoxia survival
Comparing the Effects of First- and SecondGeneration Antipsychotics on Oligodendrocyte Proteins in White and Gray Matter
Session #8: 11:00 - 12:30 pm In-Person
Session #4: 9:00 - 10:30 am In-Person
Session #7: 11:00 - 12:30 pm In-Person
Session #7: 11:00 - 12:30 pm In-Person
Session #3: 9:00 - 10:30 am In-Person
Session #9: 2:00 - 3:30 pm In-Person
Session #8: 11:00 - 12:30 pm In-Person
Session #4: 9:00 - 10:30 am In-Person
In-Person Presentations: Chieng Family Atrium
Finding a Poster
Session #2, 6 & 9
Session #5 & 12
Session #3, 7 & 10
Session #4, 8 & 11
Refreshments
Chan Centre for Family Health Education
Poster Presentations: 9:00 - 10:30 am
Session #2 | Posters – #12 – 19
Session #3 | Posters – #20 – 27
Session #4 | Posters – #28 – 35
Poster Presentations: 11:00 - 12:30 pm
Session #5 | Posters – #36 – 44
Session #6 | Posters – #45 – 52
Session #7 | Posters – #53 – 60
Session #8 | Posters – #61 – 68
Poster Presentations: 2:00 - 3:30 pm
Session #9 | Posters – #69 – 76
Session #10 | Posters – #77 – 84
Session #11 | Posters – #85 – 92
Session #12 | Posters – #93 – 101
*This drawing is intended for visual reference only and is not to
Session #1
Participants:
Anton Santos
Benjamin Brakel
Josie Chrenek
April Christiansen
Rena Daniel
Angeleet Dhanda
Reece Long
Samantha Nalliah
Raman Sangha
Moderator:
Becci Venema
Watch Online
Thursday, July 25 | 9:00 – 10:30 am
www.bcchr.ca/posterday
July 25, 2024
9:00 - 10:30 am
www.bcchr.ca/posterday
Anton Santos
Undergraduate Student, University of British Columbia Supervisor - Dr. Stephanie Glegg
Mapping Knowledge Translation Connections in Canada’s Child Development and Rehabilitation Network
Anton Santos, Sophia Sidi, Jeremy Layco, Carrie Costello, Kristy Wittmeier, Stephanie Glegg
Background & Objectives: Knowledge translation (KT) (moving knowledge into action to improve health care) is impacted by the connections between individuals and organizations. Social network analysis (SNA) research methodologies are being used increasingly to examine KT processes. This study used SNA to examine KT connections among researchers, healthcare providers, families and KT support personnel in the field of child development and rehabilitation (CD&R) in Canada. The objectives were to quantify and map the CD&R network and the usefulness of CD&R-related information sources.
Methods: Using a cross-sectional survey design, a national online survey was administered to collect data about respondents’ top five KT connections and experiences with CD&R knowledge exchange. Participants from each group were recruited through professional networks, blogs, webinars, emails, and newsletters. Quantitative data were analyzed using descriptive statistics (counts, proportions). Relational data were entered into adjacency matrices and imported into UCINet software to derive network properties. NetDraw software was used for visualization.
Results: Of the forty-one family partners, 127 healthcare providers, 45 researchers, and 23 KT support personnel, 52 (11.8%) identified as racialized, 75 (17.0%) as having a disability, and 374 (85.0%) as women. Average connectedness (number of ties) was 0.97, ranging from zero to 13. Provincial/territorial network maps illustrate connections within and between provinces. Highest-rated information sources were research findings, experiences shared by families with CD&R needs, and healthcare providers. The least useful sources were information from family/close friends and from people/groups in the community.
Conclusion: This work offers insights into which regions in Canada may benefit most from increased KT network development efforts, and identifies preferred evidence sources for different knowledge users. Findings suggest relatively low connectivity nationally, though the small sample limits interpretability. Results will inform next steps, which include purposeful sampling to select interview participants based on their relative degree of connectivity and intersectionality, and presenting network maps to further clarify participant connections and factors influencing KT. A Delphi consensus process will follow to inform recommendations for enhancing KT capacity in Canada’s CD&R network.
Congratulations to Anton on receiving a CHILD-BRIGHT Summer Studentship
Poster 2
Session #1
July 25, 2024 9:00 - 10:30 am www.bcchr.ca/posterday
Benjamin Brakel
Medical Student, University of British Columbia Supervisor - Dr. Mandeep Tamber
To Stave or not to Stave? The Impact of Barrel-Stave Osteotomy on Cephalometric Measurements in Patients Who Have Undergone Endoscopic Repair of Sagittal Craniosynostosis
Benjamin Brakel, Annika Weir, Isabella Watson, Hana Miller, Mandeep Tamber, Ash Singhal, Faizal Haji
Background: Treatment of sagittal craniosynostosis typically involves endoscopic suturectomy (ES) to allow skull expansion followed by postoperative helmet orthosis, with improvement in cranial deformity assessed using the cephalic index (CI). The impact of variations in surgical technique on long-term CI outcomes is not well understood, and there is controversy regarding whether adding barrel-stave osteotomy (BSO) to standard ES results in greater improvement in CI postoperatively. This approach is thought to improve cranial shape and overall clinical outcomes but may increase operative burden.
Objective: The aim of this study was to investigate the impact of BSO during ES on operative outcomes and postoperative cranial deformity in patients undergoing surgical correction of sagittal craniosynostosis.
Methods: We conducted a retrospective chart review of children treated at BC Children’s Hospital for sagittal craniosynostosis with ES between 2010 and 2021. Demographics, operative outcomes, and postoperative longitudinal CI measurements were collected and compared between patients who underwent ES with or without BSO. Operative outcomes related to anesthetic and surgical time, blood loss, and length of stay were analyzed, as well as changes in CI at various follow-up times. A mixed effects model was used to compare longitudinal CI measurements between treatment groups, controlling for age and helmeting duration.
Results: A total of 86 patients were included (68 ES+BSO, 18 ES). Operative outcomes, including length of hospital stay, operative time, time under anesthesia, and blood loss, were similar between treatment groups (p > 0.05). The median follow-up time for CI measurements was 1705 days. While preoperative CI was similar for both groups (mean CI 67.34 for ES+BSO, 66.76 for ES; p=0.54), CI increased significantly more in the ES+BSO group at immediate post-op (p = 0.0046), 6-month follow-up (p = 0.0234), 2-year follow-up (p = 0.0146), and final follow-up (p = 0.0145). A mixed effects model revealed that the addition of BSO significantly increased CI measurements independent of age and helmeting duration (estimated effect size -3.7143, p = 0.0001).
Conclusions: The addition of BSO to ES significantly improves immediate and long-term cranial deformity in patients with sagittal craniosynostosis, without increasing operative burden.
Congratulations to Benjamin on receiving a BC Children’s Hospital Summer Studentship
July 25, 2024
9:00 - 10:30 am
www.bcchr.ca/posterday
Josie Chrenek
Medical Student, University of British Columbia Supervisor - Dr. Sharon Dell
Effects of race-neutral reference equations on the interpretation of pediatric pulmonary function tests
Josie Chrenek, Jasneet Dhillon, David Wensley, Sharon Dell
Background: Pulmonary function tests (PFTs) are crucial in the diagnosis and management of respiratory conditions. The American Thoracic Society (ATS) and European Respiratory Society (ERS) previously endorsed the use of Global Lung Function Initiative (GLI) reference equations that predict pulmonary function based on age, height, sex, and race. However, the derivation of these equations was based predominantly on data from White populations with inadequate representation from certain other groups. Additionally, attributing differences in lung function to race may overlook other predicating factors, such as premature births and exposures to respiratory hazards. Thus, updated 2023 ATS-ERS guidelines advocate for the use of new race-neutral GLI Global equations. Analyses have shown that Black populations tend to have improved PFT interpretations with the race-specific equations compared to the race-neutral approach, while the inverse trend is seen for White populations. However, the effects of the race-neutral equations on children and non-Black people of colour have been understudied.
Objective: To evaluate the difference in percentage and severity of lung function impairments identified using the race-specific compared to race-neutral GLI reference equations for pediatric PFT interpretation.
Methods: Retrospective spirometry data, lung volume measurements, and self-identified ethnicity will be collected for children aged 6-18 who attended the BC Children’s Hospital (BCCH) PFT lab between August 2022 and June 2024. Using R statistical software, the lower limits of normal of the FEV1, FVC, FEV1/FVC, and TLC will be computed using both the race-specific and race-neutral GLI equations to classify the PFT results as obstructive, restrictive, mixed, non-specific, or normal. Changes in lung impairment severity will be assessed using FEV1 z-scores from both sets of reference equations.
Significance: PFTs inform many clinical decisions, including eligibility assessments for treatments, lung transplants, insurance, and research participation. Thus, using race-based reference equations may disproportionately affect the diagnosis and care options for children of certain racial groups. This study aims to address existing knowledge gaps on the impacts of the race-neutral GLI Global equations in pediatric populations to help inform equitable decision-making in relation to PFT interpretation.
Congratulations to Josie on receiving a BC Children’s Hospital Summer Studentship
July 25, 2024
9:00 - 10:30 am
www.bcchr.ca/posterday
April Christiansen
Medical Student, University of Toronto Supervisor - Dr. Jill Zwicker
Retrospective Review of Children’s Diagnostic Assessments for Autism Spectrum Disorder in BC: Are We Identifying Co-occurring Motor Deficits?
April Christiansen, Sarah Hutchison, Elizabeth Mickelson, Jill Zwicker
Background: Motor impairments are highly prevalent in children with Autism Spectrum Disorder (ASD). Current data suggest that 50–88% of children with ASD experience difficulties in performing gross- and fine-motor skills, with motor performance that is usually slower, less accurate, and more variable than that of typically developing children (Kangarani-Farahani et al., 2023). These motor challenges can have a negative cascading effect on a child’s quality of life, limiting their ability to interact with peers and participate in social and physical environments (e.g., school, playground, and community). Interestingly, the nature of motor impairments in ASD often meets the criteria for Developmental Coordination Disorder (DCD), a distinct neuromotor disability marked by significant difficulty in learning and performing motor skills at an age-appropriate level. However, less than 15.1% of children with ASD receive a dual diagnosis of DCD (Bhat, 2020). Given the considerable impact motor coordination difficulties have on a child’s occupational performance, especially when co-existing with other developmental challenges such as ASD, the lack of detection in practice is concerning for children and their families. Delayed diagnosis of motor challenges or DCD can limit opportunities for early, targeted interventions and inhibit timely referral to holistic support services.
Objectives: The current study aims to: (1) determine the prevalence of motor problems in children diagnosed with ASD; and (2) determine how many of these children received a co-occurring diagnosis of DCD.
Methods: We have permission from Sunny Hill Health Centre to access databases for children who have been assessed for ASD in British Columbia from 2010–2019. We will determine the prevalence of fine and/or gross motor difficulties that were reported as part of the ASD assessment and determine the number of children who were also diagnosed with DCD.
Results: In progress.
Congratulations to April on receiving a Sunny Hill Health Centre Research Summer Studentship
July 25, 2024
9:00 - 10:30 am
www.bcchr.ca/posterday
Rena Daniel
Pharmacy Student, University of British Columbia Supervisor - Dr. Catrina Loucks
Identifying Genetic Predictors of Morphine Ineffectiveness in Children with Cancer
Rena M. Daniel, Erika N. Scott, Graeme Ernest-Hoar, Jia He Zhang, Jessica M. Lovnicki, Colin J.D. Ross, Bruce C. Carleton, S. Rod Rassekh, Ruth E. Grunau, Catrina M. Loucks
Background: While opioids are generally effective for treating serious pain in children, some individuals carry genetic variants that limit the ability of opioids to provide pain relief. Inadequate pain relief is a significant problem among childhood cancer patients. Paediatric oncology patients often experience painful adverse reactions due to chemotherapy and require opioid analgesia for relief. However, many patients lack relief after receiving analgesia and therefore must stop chemotherapy to recover. Morphine is a commonly used analgesic for these adverse reactions in paediatric oncology. Morphine response in individual patients may depend on genetic variants found in enzymes/receptors associated with opioid signalling, such as COMT, which is involved in metabolizing neurotransmitters that play roles in opioid-based pain relief. Notably, COMT variants have been found to have significant associations with opioid sensitivity and response in paediatric oncology patients. In an in-house cohort of 85 pediatric oncology patients treated with morphine for methotrexateinduced mucositis pain, COMT rs4680 A allele and rs740603 A allele were correlated with better pain relief while rs6269 G allele and rs4818 G allele were correlated with less pain relief.
Objectives: To replicate the associations between COMT variants and morphine response found in methotrexate-induced mucositis in three other chemotherapy-related adverse reactions, including vincristineinduced neuropathy, corticosteroid-induced avascular necrosis and L-asparaginase-induced pancreatitis.
Methods: Paediatric oncology patients are being recruited and classified into cases and controls based on morphine response for the three adverse reactions. Controls are defined as those with relief from morphine and cases are considered to have inadequate relief from morphine. Case-control analyses for COMT variants will be conducted using logistic regression through PLINK while adjusting for demographic/clinical factors as well as genetic ancestry.
Results: Recruited patients so far: 93 controls and 15 cases for vincristine-induced neuropathy, 9 controls and 6 cases for corticosteroid-induced avascular necrosis and 31 controls and 13 cases for L-asparaginaseinduced pancreatitis. Regression analyses are ongoing and results will be presented.
Conclusions: Replication of COMT variants in morphine response for these adverse reactions would facilitate the development of genetic screening to identify genetic markers of morphine response in patients and thus optimize pain management in paediatric oncology patients.
Congratulations to Rena on receiving a BC Children’s Hospital Summer Studentship
July 25, 2024
9:00 - 10:30 am
www.bcchr.ca/posterday
Angeleet Dhanda
Medical Student, University of British Columbia Supervisor - Dr. Catrina Loucks
Safety and Efficacy of Opioid Use in Infants: A Scoping Review
Angie Dhanda, Erika N. Scott, Catrina M. Loucks
Background: While many infants born each day do not require painful interventions, those admitted into the neonatal intensive care unit (NICU) are routinely exposed to procedures that may elicit a painful response. These procedures increase the likelihood of survival but begin right at birth and continue throughout hospitalization. When non-pharmacological options are deemed inappropriate or inadequate for pain management, opioids tend to be the mainstay therapy for pain management. Although studies have been conducted to investigate both safety and efficacy of opioids for various indications, many questions remain unanswered. Without clear guidelines in place, the use of opioids in clinical practice can vary greatly by country, region or even between hospitals within the same area for infants.
Study Objectives: The purpose of this paper will be to review the current literature regarding approaches used to assess opioid safety and effectiveness in opioid-naive infants across all indications.
Method: A scoping review is being conducted following the PRISMA-ScR methodology. Databases searched included MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials with no limitations for publication dates. Two reviewers will select articles individually, and any discrepancies will be discussed among both reviewers and an additional reviewer. Descriptive information from each article will be collected by two independent reviewers. Data will include population data (gestational age, post-menstrual age), opioid used, dose used, adjunct therapies, efficacy data, and safety data. A total of 344 articles resulted from the literature search. Of those, 163 have been selected for full-text review.
Significance: Understanding infant-specific determinants of opioid-related outcomes - relating to both safety and effectiveness, and how such outcomes can be identified or monitored, has the power to increase prescriber comfort with opioids so that adequate pain relief can be provided without harm for each infant.
July 25, 2024
9:00 - 10:30 am
www.bcchr.ca/posterday
Reece Long
Medical Student, University of British Columbia Supervisor - Dr. Jonathan Rayment
Pulmonary implications of major aortopulmonary collateral arteries in patients (MAPCAs) with severe Tetralogy of Fallot
Reece Long, Sabine Laguë, Rachel Eddy, Karen Lyons, Kevin Harris, Jonathan Rayment
Background: Congenital heart defects (CHDs) are present in approximately 1% of all live births. Tetralogy of Fallot (ToF) is the most common form of cyanotic CHD and has a spectrum of severity. ToF is characterized by 4 cardiac abnormalities: a ventricular septal defect (VSD), an aorta overriding the VSD, pulmonary valve stenosis, and right ventricular hypertrophy. Among the most severe presentations of ToF is the presence of pulmonary atresia, which prevents blood flow from the heart to the lungs via typical pulmonary circulation. To compensate, the affected fetus can develop major aortopulmonary collateral arteries (MAPCAs), which supply the lungs with blood via the systemic circulation rather than the heart. Each patient’s MAPCA anatomy is unique. Through recent advances in pediatric cardiac surgery, there has been a significant increase in the long-term survival of children with a CHD, such as ToF. However, there has been a greater prevalence of long term, extra-cardiac complications of these conditions coinciding with this increased lifespan. Despite the interconnectedness of pulmonary and cardiac physiology, the structural and physiologic pulmonary complications of many CHD conditions are not well characterised.
Objectives: The overall objective of this study is to determine if there are differences in pulmonary pathophysiology of patients with ToF compared to those with ToF+MAPCAs.
Methods: This is a retrospective case control study. Patients with a diagnosis of ToF were identified from the BCCH radiology and echocardiographic databases via keyword search. Inclusion criteria are 1) children with a diagnosis of either ToF or ToF+MAPCAs who have had some component of their care at BC Children’s Hospital between the dates of January 1, 2012 to December 31, 2023 and 2) at least one CT completed at BCCH. There are no specific exclusion criteria otherwise. Thoracic CT images are being quantitatively analysed for lung density and pulmonary vessel volume using commercial software (Vida Diagnostics, Coralville, IA, USA).
Significance: Overall, this work will act to greatly deepen our understanding of the pulmonary implications of ToF with MAPCAs. This knowledge will have the potential to allow for better long-term care and management of patients with this particular CHD.
Congratulations to Reece on receiving a BC Children’s Hospital Summer Studentship
July 25, 2024
9:00 - 10:30 am www.bcchr.ca/posterday
Samantha Nalliah
Medical Student, University of Galway Supervisor - Dr. Mary Connolly
Comparison of Vagus Nerve Stimulation and Corpus Callosotomy in the Treatment of Medically Intractable Epilepsy in Children: A Long-Term Single Site Study
Madeline W. Elder, Samantha Nalliah, Annika Weir, Faizal Haji, Mandeep S. Tamber, Paul Steinbok, Mary Connolly, Ash Singhal
Background: Despite significant advances in the treatment of pediatric epilepsy, nearly 20% of children with epilepsy have disease that is refractory to medical management. Medically intractable epilepsy (MIE) is associated with a significant burden of disease due to developmental, neurological, and cognitive impairment, as well as a persistently high risk of personal injury from seizures and resultant falls.
Vagus nerve stimulation (VNS) and corpus callosotomy (CC) are the most common palliative surgical methods used for treatment of MIE in children. VNS is a minimally-invasive approach which involves the implantation of a pacemaker-like device which intermittently stimulates the left vagus nerve, leading to stimulation of sensory and motor fibres. Adverse effects typically result from the latter and are mild, including hoarseness and voice changes. Conversely, a CC is a major intracranial surgery that involves severing a portion of the corpus callosum, which is the largest commissural pathway in the brain, allowing for transfer of neuronal impulses between the cerebral hemispheres. The major complication is disconnection syndromes, which can potentially pose a significant threat to post-operative functioning and quality of life. Despite these risks, CC has been shown to be significantly more effective in treating MIE than VNS.
The Comprehensive Epilepsy Surgery Program (CESP) at BC Children’s Hospital (BCCH) has operated on over 250 children with intractable epilepsy. In recent years CESP has transitioned from using VNS to CC given the evidence for improved outcomes. However, we have yet to assess the impact of this transition on patient outcomes.
Aims: To determine whether the management of children with medically intractable epilepsy with CC results in a greater reduction in clinically significant parameters such as seizure frequency relative to treatment with VNS.
Methods: This is a retrospective chart review of patients with MIE treated with VNS or CC at BCCH since 2000. Data is analyzed using univariate, multivariate and logistic regression analyses. Normally-distributed data is analyzed using parametric tests, and statistically significant non-normal data is analyzed using non-parametric tests.
Significance: This project aims to contribute to improved clinical practices, enhanced quality of life, and informed decision-making for families facing the challenges of MIE.
Session #1
July 25, 2024
9:00 - 10:30 am
www.bcchr.ca/posterday
Raman Sangha
Undergraduate Student, University of Victoria Supervisor - Dr. Christine Voss
Exploring adolescent and parent experiences of pediatric diabetes distress in the BC Interior
Raman Sangha, Natalie Grieve, Kyra Braaten, Simran Gill, Titilola Yakubu, Tom Warshawski, Tricia Tang, Trent Smith, Mary Jung, Christine Voss
Background: Type 1 diabetes (T1D) is one of the most common chronic conditions in children and youth, with over 2,200 children and youth living with diabetes in BC. Management of T1D includes life-long insulin therapy, frequent monitoring of glycemic control and major lifestyle changes. Adolescents with T1D are prone to experience diabetes distress - the negative emotional burden of living with diabetes - which is associated with poorer glycemic control. In the BC Interior, the prevalence of diabetes distress is unknown and resources to address it are limited.
Objective: To gain insight into adolescent and parent/guardian experiences regarding living with T1D in relation to diabetes distress in the BC Interior.
Methods: An exploratory sequential mixed methods design was used. Eligibility included adolescents aged 13-19 yrs or parents/guardians of adolescents aged 13-19 yrs with T1D living in the BC Interior. Participants completed an electronic survey including a diabetes distress screening questionnaire (Problem Areas in Diabetes-Teen (PAID-T) and Parent (P-PAID-T) Versions). Separate focus groups were conducted for adolescents and parents/guardians to identify common concerns of living with T1D, types of mental and emotional supports accessed and supports they would like to have access to. Descriptive statistics from survey data were calculated in R. Qualitative data analysis utilized an interpretive description approach and collaborative analysis techniques using NVivo.
Results: The survey was completed by n=5 adolescents (age 18±1yrs, 80% girls) and n=6 parents of adolescents with T1D (age 51±4yrs, 100% women). Most parents experienced low levels of distress (83%) (P-PAID-T score 48±18, cut-off ≥54). All adolescents experienced high levels of diabetes distress (PAID-T score 72±14, cut-off ≥44). Two parent focus groups (n=5), and one adolescent focus group (n=6) was conducted. Five themes were identified in both adolescent and parent focus groups: Psychological Experience of Living with T1D, Interruptions to Daily Living, Feelings Towards Support and Belonging, T1D Awareness and Perceptions, and Financial Considerations. The parent focus group also included an additional theme: Responsibilities Associated with T1D.
Conclusion: Improving the psychological experience of a T1D diagnosis and reducing interruptions to daily living for adolescents and parents may aide in addressing diabetes distress.
Congratulations to Raman on receiving a Faculty of Medicine Summer Studentship and the Centre for Chronic Disease Prevention and Management (CCDPM) Clinical Research & QI Incubator Award
Session #2
Participants:
Jodi Anderson
Sue Rim Baek
Wongel Bogale
Arjun Dhaliwal
Gurvir Dhutt
Sanya Grover
Elaine Huang
Nina Thomson
Moderator: Camille Laroche
Watch In-Person
Thursday, July 25 | 9:00 – 10:30 am
Chieng Family Atrium, BCCHR
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Jodi Anderson
Master’s Student, University of British Columbia Supervisor - Dr. Alasdair Barr
Prevalence, Practices, Attitudes, and Product Analysis of Medicinal Cannabis Use in Pediatrics
Anderson, J., Gibbard, M., Andrews, G., Barr, A., Siden, H., Rassekh, R.
Background: It is becoming more prevalent for parents to choose to administer cannabis to their children for medicinal purposes. However, there is little efficacy or outcomes data of cannabis use in pediatric research.
Objective: This project surveys the attitudes and experiences of families regarding pediatric medicinal cannabis at the BC Children’s Hospital and Sunny Hill Health Centre. The aims of this larger study are to characterize:
1. The prevalence of, and reasoning for use of cannabis
2. The practices of, and sources of information for parents/caregivers
3. Parent/caregiver attitudes and opinions
4. Challenges for families
This abstract focuses on the pharmacological and clinical aspects of use.
Methods: Participants of this study are parents or caregivers with children suffering from a chronic condition, who may or may not use cannabis to treat symptoms and/or side effects of other treatments. The survey was completed anonymously by participants on an iPad or their own device while waiting in a clinic for their child’s medical appointment.
Interim Results: The prevalence of medicinal cannabis use was 6% (n=17, N=298). The ages of users ranged from five to 21, with a median of 13 years old. The clinics with the highest use rate were oncology (n=8, 50%) and neurology (n=4, 25%), and the highest reported conditions of users were cancer and neurologic disorders. Over half of parents reported that cannabis is helping their child for the targeted symptom(s) (n=11, 68.8%), but many stopped using due to no perceived improvement in condition (n=4, 25%). Multiple parents of children using cannabis noted not having all the information they need for drug safety (n=8, 50%) or dosing information (n=7, 43.8%). No participants were more concerned about the side effects of cannabis relative to other medications, and all recommend the use for other children with similar conditions (n=16, 100%).
Significance and Future Directions: While only a small number of parents indicated that their child uses or has used cannabis, the product appears to show mixed therapeutic effectiveness. In the future, we plan to quantify the composition of the cannabis products children are using and further explore patterns of use.
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Sue Rim Baek
Medical Student, University of British Columbia Supervisor - Dr. Jugpal Arneja
Quality of Life after Mustardé Otoplasty for Prominent Ears: Preliminary Results
Sue Rim Baek, Rebecca Courtemanche, Sophia Shayan, Matthew Boroditsky, Jugpal Arneja
Background: Prominent ears can negatively impact a patient’s psychosocial well-being. Otoplasty, surgical intervention for prominent ears, has shown to significantly improve patients’ quality of life (QoL). However, to date, research has yet to correlate QoL outcomes with patient-reported indications for surgery and which indications affect QoL. Furthermore, research has yet to focus on the patients’ satisfaction with ear appearance with QoL, lacking information on how QoL interacts with ear appearance. The purpose of this study is to assess how the Mustardé otoplasty impacts QoL while examining patient indications for surgery and satisfaction with ear appearance post-operatively.
Methods: Patients were recruited from the senior author’s (JA) clinical practice at BC Children’s Hospital. Patients who had undergone otoplasty for prominent ears between July 2009 and April 2023 were eligible for inclusion. Eligible participants were invited to participate in the study via post mail and telephone call. Patients agreeing to participate completed the EAR-Q Ear Appearance scale with the Glasgow Benefit Inventory (GBI) or Glasgow Children’s Benefit Inventory (GCBI), either over the phone or through a Qualtrics link. Raw scores were totaled and converted into Rasch transformed scores (0 to 100 for the EAR-Q, -/+ 100 for the GBI/ GCBI) and were averaged. Chart review was also performed to collect demographic factors, pre-operative, operative, and post-operative information.
Results: Of the 76 patients invited to participate in the study, 39 (52%) completed the questionnaire. At the time of the survey completion, the average age of participants was 18.9 years old. Median score on the ear appearance scale was 64 (IQR, 53.8-73.8). The median score on the GBI was 30 (IQR, 16.7-41.7) and GCBI was 34.4 (IQR, 25.5-48.4). The average time from surgery to completion was 8.9 years. Patients who reported self-consciousness pre-operatively had higher EAR-Q and GBI scores on average (+16.6 points) than patients who did not.
Conclusions: Our study shows that most patients who went under the Mustardé otoplasty report an increase in QoL and are satisfied with their ear appearance. The results of this study may play an important role in better understanding indications for surgical intervention and patient perspectives after intervention.
Congratulations to Sue Rim Baek on receiving a Faculty of Medicine Summer Studentship
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Wongel Bogale
Medical Student, University of British Columbia Supervisor - Dr. Hal Siden
Developing a Protocol and Chart Review Form for Investigating the Life Expectancy of Neonates with Severe Hypoxic–Ischemic Encephalopathy after Cessation of Intensive Care
Wongel Bogale, Katherine Boone, Emily Kieran, Harold Siden
Background: Hypoxic–ischemic encephalopathy (HIE) is a complex condition involving brain injury due to oxygen deprivation during the neonatal period. Neonates with severe HIE commonly receive medical interventions such as artificial nutrition, hydration, and ventilation. These interventions, however, may not be of benefit to some neonates or may induce suffering that cannot be justified. When the withdrawal of intensive care occurs, it is challenging for clinicians to anticipate outcomes, with reports suggesting the unpredictability of the exact point of death being the most difficult challenge parents face during the process. Understanding the factors that impact survival after withdrawal of artificial nutrition, hydration, and ventilation (WANHV) will allow for more informed clinical decision making and provide a degree of clarity for clinicians and parents facing these rare and difficult clinical scenarios.
Objective: To develop a protocol and chart review form to investigate the life expectancy of neonates with severe HIE following the withdrawal of artificial nutrition, hydration, and ventilation.
Method: The goal of this project is a retrospective chart review of medical charts from BC Women and Children’s Hospital and Canuck Place Children’s Hospice for neonates with severe HIE who have undergone WANHV. After reviewing the available research and the inclusion and exclusion criteria, the proposed variables to be collected for the study were cross-matched against the published literature. Variables that may influence life expectancy following WANHV include the type of support withdrawn, vasopressor use, and comorbidities. The analysis will involve a survival time analysis following withdrawal of intensive care and a regression analysis involving variables that may affect survival time.
Significance: Exploring the factors that influence survival time may allow for improved anticipatory guidance for parents facing the uncertainty of their infant’s trajectory, as the unpredictability of the exact point of end-of-life is one of the most difficult challenges parents face during WANHV.
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Arjun Dhaliwal
Medical Student, Royal College of Surgeons in Ireland Supervisor - Dr. Ian Pike
Safe Play for All: Identifying Injuries and Injury Prevention Strategies for Pediatric Athletes Participating in Adaptive Sports
Arjun Dhaliwal, Kate Turcotte, Ian Pike
Background: Adaptive sports are sports designed to accommodate the specific needs of athletes with physical or cognitive disabilities. As popularity for adaptive sports increases, the need for specific injury prevention information around pediatric athletes also grows. A large gap in literature around injuries and injury prevention in pediatric adaptive sport has been identified. Knowledge around common injuries and high-risk activities in young athletes with disabilities, and how to prevent or mitigate them, can improve participation rates in adaptive sports and keep the youth active and healthy, supporting their physical, mental, and social development.
Objectives: To identify the most prevalent injuries, high-risk activities, and overall risk factors for injury in youth athletes participating in adaptive sport. To identify injury prevention strategies in the existing literature or in practice by adaptive sport organizations.
Methods: A scoping review was conducted across four databases: Embase, PubMed, Google Scholar, and SportDiscus. Using Covidence, studies were screened and quality assessed. An environmental scan was conducted, with informal interviews with adaptive sport leaders in the community to learn about injuries in their youth athletes and the improvements they desire.
Results: In total, 331 publications were identified from all databases. After removing duplicates, completing screening, and assessing full-text studies, 30 studies were included in the scoping review. Shoulder pain was the most prevalent injury observed in several adaptive sports, primarily due to overuse of the shoulder. For example, shoulder injuries are very common in sledge hockey, along with concussions and pressure ulcers. Injury prevention strategies described are non-specific and often directed toward able-bodied athletes, including strength training, stretching, posture adjustments, or custom equipment such as an accommodating bucket seat.
Implications/Future Research: Specific injury prevention strategies are needed to provide useful evidencebased information in consideration of an athlete’s particular disability and sport. In the future, information and strategies specific to adaptive sport will be implemented on Active and Safe Central, an extensive injury prevention resource developed and maintained by the BC Injury Research and Prevention Unit, containing injury prevention information on over 50 different sports and recreational activities.
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Exposure
Gurvir Dhutt
Medical Student, University of British Columbia Supervisor - Dr. Matthew Wiens
to household air pollution and pediatric post-discharge health outcomes in Uganda
Gurvir S. Dhutt, Cherri Zhang, Peter Moschovis, Matthew O. Wiens
Background: One-third of the global population uses open fires or inefficient stoves which cause harmful household air pollution (HAP). This is concentrated in low- and middle-income countries (LMIC). Particulate matter from HAP adversely affects a child’s health and has been linked to almost half of all lower respiratory infection deaths among children under 5 years of age. In many LMICs, including Uganda, as many children hospitalized for severe infectious illnesses die in the 6-months post-discharge as in-hospital. However, it is unclear how HAP impacts a child’s health as they recover from a severe infection from any cause. We investigated the association between HAP exposure and post-discharge mortality among children under 5 years of age treated for severe infection in Uganda.
Methods: We conducted a secondary analysis of data from observational cohort studies, conducted between December 2017 to December 2020, among 6,955 children 0 to 5 years admitted to one of 6 Ugandan hospitals for a severe infectious illness. Clinical signs and symptoms, sociodemographic variables, and mortality up to 6-months post-discharge was collected for all participants, and follow-up rates were >95%. HAP variables included type of cooking fuel used, location of cooking (e.g. indoors, outdoors), and primary source of household lighting. We assessed post-discharge mortality using simple and multivariate logistic regression.
Results: Preliminary analysis suggests that post-discharge mortality is associated with severe (unadjusted OR = 1.62, 95%CI 1.18, 2.22) and moderate (unadjusted OR = 1.22, 95%CI 0.94, 1.59) HAP exposure when compared to minimal exposure. Adjusting for age, sex, distance to hospital, maternal education, and maternal HIV status, the adjusted ORs for severe and moderate HAP exposure become 1.32 (95%CI 0.95, 1.83] and 1.08 (95%CI 0.83, 1.41), respectively. There was no significant interaction between exposure and age, sex, maternal education, or anemia status. Surprisingly, among those with pneumonia, post-discharge mortality decreased with increasing levels of HAP. This suggests a protective impact of pneumonia among those in the severe HAP category (p = 0.01).
Discussion: Understanding the relationship between HAP and post-discharge outcomes may help address global inequities in child health by helping to inform recommendations for improved discharge and post-discharge care.
Congratulations to Gurvir on receiving a Healthy Starts Summer Studentship
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Sanya Grover
Medical Student, University of British Columbia Supervisor - Dr. Christine Loock
Assessing the Social Determinants of Health and Positive Childhood Experiences in Youth Patients Transitioning to Adult Care: A Cross-Sectional Survey
Sanya Grover, Will Lau, Rebecca Courtemanche, Amy Mcatavey, Eva Moore, Douglas Courtemanche, Emily Fisher, Alison Faber, Sara Jassemi, Matthew Carwana, Christine Loock
Background: Children and youth with complex healthcare needs often receive specialized care in tertiary care hospitals or multidisciplinary pediatric clinics. In Canada, the mandate transfer of pediatric care to adult services varies by province/territory and type of care, often between 16 to 19 years of age (Toulany et al., 2022). While many resources exist to support youth in this transition, few integrate social determinants of health (SDoH) in this process. Recent literature has shown that positive childhood experiences (PCEs) have an inverse, dose-response relationship with adult mental health and mitigate against adverse childhood experiences (ACEs) (Bethel et al., 2019). By promoting these PCEs and enhancing resilience, we may be able to support youth better in this transition process.
Objectives: 1) To assess SDoH and PCEs of youth transitioning into adult care; 2) To assess transition readiness.
Methods: We adapted our previously existing cross-sectional survey exploring prevalence of SDoH and PCEs to include additional questions regarding transition readiness (from BCCH ON TRAC). Youth patients (>13 years of age) in the BC Children’s Hospital Cleft Palate Craniofacial program were invited to complete the paper survey during their clinic appointments. Responses were tabulated using Microsoft Excel.
Preliminary Results: From June 4th to July 9th, 2024, a total of 14 out of 16 eligible youth completed the survey, for a response rate of 88%. 11 out of 13 participants (85%) responded that they “always” identify with >4 of the 7 PCEs that were asked. Of these, 5 participants (45%) felt supported in their transition to adult care and 6 participants (55%) did not answer. For the 2 participants that did not “always” identify with >4 PCEs, 1 felt “sort of” supported with transition and1 did not know. Overall, most youth (64%) provided feedback that the survey was important in having their voice heard and for their health provider to know.
Discussion: Recognizing and promoting PCEs can be a powerful, strengths-based tool that enhances resilience in youth, especially during times of transition to adult care. Our findings will inform the further improvement of our clinic and other hospital programs for transition resources and future planning.
Congratulations to Sanya on receiving a Sunny Hill Health Centre Research Summer Studentship
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Elaine Huang
Graduate Student, University of Toronto Supervisor - Dr. Angela Devlin
Investigating the effect of high folic acid levels on folate receptor expression in MIN6 insulinoma cells
Elaine Huang, Mayu Kajino, Zoe Lofft, Angela M Devlin
Introduction: Folate is a water-soluble B vitamin crucial for DNA synthesis and methylation reactions. Folic acid (synthetic folate) supplementation is recommended for the prevention of neural tube birth defects (NTDs), which occur in the first trimester of pregnancy. The food supply in Canada is fortified with folic acid for further prevention of NTDs. Many pregnant individuals in Canada exceed the recommended folic acid supplement dose (0.4mg/day). Mixed evidence exists on high folate intake and adverse maternal and offspring metabolic health outcomes. Previous in vitro studies have shown that chronic folic acid over-supplementation significantly downregulated renal and intestinal folate uptake and the expression of folate transporters/carriers. Findings in our lab have shown a U-shaped relationship between folic acid exposure and glucose-stimulated insulin secretion in MIN6 murine insulinoma cells. It unknown if this phenotype can be attributed to changes in folate receptor expression, and if high folic acid affects folate receptors in the endocrine pancreas.
Objective: To determine the effect of acute high folic acid treatment on the expression of folate receptors (reduced-folate carrier, folate receptor-1, and proton-coupled folate transporter) in MIN6 cells.
Methods: MIN6 cells were treated with folic acid at 5x, 40x, or 120x above the control concentrations (0.16µM) for 24 hours. Cells were harvested, and total protein was determined using a bicinchoninic acid assay. Protein expression is being quantified by western blotting. Currently, antibodies against reduced folate carrier (anti-SLC19A1, 1:1000, 25958-1AP) and folate receptor-1 (anti-FBP, 1:5000, ab221543) are being run. ImageJ will be used to quantify the relative target protein expression to the internal control, heat shock protein 90 (anti-HSP90, 1:1000, ab13492).
Significance: This preliminary work provides insight into the mechanisms underlying how high folic acid levels affect the endocrine pancreas.
Congratulations to Elaine on receiving an NSERC Undergraduate Student Research Award
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Nina Thomson
Medical Student, University of British Columbia Supervisor - Dr. Sylvia Cheng
A multi-institutional retrospective study of the treatment and clinical outcomes of pediatric craniopharyngioma: A report from the Canadian Pediatric Craniopharyngioma (CanPedsCranio) Registry
Nina Thomson, Arad Keshvadi, Arthurine Yu, Sylvia Cheng, Chantel Cacciotti, Ute Bartels, Julie Bennett
Background: Craniopharyngioma (CP) are hypothalamic-pituitary axis tumors that account for 1-5% of brain tumors in children. Although benign, CPs are locally invasive, impacting adjacent anatomical structures. Standard treatment is surgery and radiation. Overall survival (OS) is generally favorable but the tumor and treatment cause significant morbidity. There is a need to better understand how these children are treated and develop novel approaches.
Objectives: To describe the treatment patterns and outcomes for pediatric CP across Canada.
Methods: We created a central repository for pediatric CP data in Canada (CanPedsCranio Registry). Data was collected from patients’ medical records. Eligible patients were 0-18 years old with a diagnosis of CP. Analysis was performed by descriptive statistics.
Results: Data collection and analysis is ongoing. Thirty patients diagnosed between 2001-2023 are included to date from SickKids Hospital (n=8), BC Children’s Hospital (n=7) and London Health Sciences Centre (n=15). Thirteen patients were biologically male (43%). The most common symptoms at presentation were headache (n=13; 43%), nausea/vomiting (n=13; 43%), and pituitary deficits (n=12; 40%). Ten patients received insertion of an intracystic catheter (33%) and eight patients received gross total resection (27%) as the first-line surgical procedure. The median number of surgeries per patient was two. Fourteen patients (43%) received radiation therapy at a median of 169 days from diagnosis. Medical therapies were delivered in six patients (20%), primarily intracystic Interferon (n=4; 13%) and intracystic Bleomycin (n=2; 7%). Two patients succumbed to complications of their disease (7%), one endocrine-related and one from cardiac failure post-surgery. Based on imaging, 18 patients (64%) had tumor progression, and the average time to progression was 117 days. Panhypopituitarism was found in 19 patients (63%), eight of which developed this after surgery (27%). The median time to development of panhypopituitarism was 82 days. Visual impairments were present in 26 patients (87%), 19 of which were present at diagnosis.
Conclusion: Only 8/30 children received upfront gross total resection in our cohort despite this being the gold standard for CP treatment. Further analysis of our national cohort will continue to provide insights into the treatment and clinical outcomes for CP patients long-term.
Congratulations to Nina on receiving a BC Children’s Hospital Summer Studentship
Session #3
Participants:
Sally Gaherty
Armaan Jaffer
Katarina Krivokapic
Mia Majstorovic
Solana Redway-Ziola
Miku Wake
Caroline (Callie) Wolsey
Christopher Yu
Moderator: Sharon Hou
Watch In-Person
Thursday, July 25 | 9:00 – 10:30 am
Chieng Family Atrium, BCCHR
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Sally Gaherty
Undergraduate Student, University of Western Ontario Supervisor - Dr. Jonathan Bush
Evaluating the Tumor Immune Microenvironment in Primary and Metastatic Osteosarcoma
Sally Gaherty, Jonathan Bush
Background: Osteosarcoma (OS) is the most common primary childhood bone tumor, accounting for approximately 2% of all childhood cancers. OS incidence exhibits a bimodal pattern, with incidence peaking in children and again at a lower level in seniors. Histologically, conventional OS (COS) most commonly presents as spindle cell tumours that produce malignant osteoid. COS has variants including chondroblastic, fibroblastic, osteoblastic, and telangiectatic, distinguished by the predominant matrix produced.
In pediatric cases, primary tumors are most frequently found in the metaphysis of long bones, where the growth plate is located. Metastasis of OS occurs in up to 20% of patients, with a notable tendency for spreading to the lungs. OS patients with metastases have significantly diminished survival rates, dropping from approximately 70% with localized disease to below 40% with metastasis. OS survival rates have vastly improved since the 1970s due to new chemotherapy protocols but plateaued for the last 20 years. When the standard protocol fails, there are very few reliable treatment alternatives. The complex interactions between OS and the immune system are a promising target for future therapies. Recent studies investigating new OS therapeutics have highlighted the role of tumor-infiltrating lymphocytes in the OS tumor microenvironment. Higher levels of immune cells have shown correlations with improved survival outcomes in OS patients, suggesting both prognostic and therapeutic implications.
Objectives:
- To explore the presence of immunohistochemical (IHC) markers in primary osteosarcoma tumor samples.
- To investigate CD8, CD68 and CD163 as potential markers to predict prognostic information such as recurrence, metastasis, event-free survival, and successful tumor necrosis (>90%).
Methods: Clinical information was collected from pediatric patients born between 1987 and 2006 diagnosed with osteosarcoma. Fifty-eight patients with formalin fixed, paraffin embedded tissue from a primary biopsy were selected. Two tissue micro arrays were created using tumor samples from those 58 patients. The TMAs were stained with IHC markers to determine CD8, CD68 and CD163 positive cells.
Significance: Understanding the connection between immune cells and the tumor environment opens avenues for developing immunotherapeutic strategies aimed at increasing treatment effectiveness and improving patient outcomes in OS.
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Armaan Jaffer
Undergraduate Student, Queen’s University Supervisor - Dr. Matthew Carwana
Understanding Pediatrician Knowledge and Perspectives on Barriers and Facilitators to Social Prescribing: An Exploratory Study
Armaan Jaffer, 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 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. A large provider know-do gap exists between the praxis and practice of SP.
Objectives:
1. Conduct a current state analysis (environmental scan) of existing programs, services and benefits that exist that may be used as SP tools by providers;
2. Explore barriers and facilitators to SP guided by the Theoretical Domains Framework through qualitative interviews with pediatric physicians.
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. An environmental scan will be conducted to identify existing SP interventions in the British Columbia context.
Future: Participant recruitment and interviews are currently ongoing.
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. The environmental scan will be clustered into relevant themes based on the SP interventions identified.
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 co-workers 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.
Congratulations to Armaan on receiving a Community Child Health Endowment Summer Studentship
Session #3
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Katarina Krivokapic
Undergraduate Student, Queen’s University Supervisor - Dr. Anita Datta
Long-Term Follow-Up of Electroclinical Features in Patients with Developmental Epileptic Encephalopathy With Spike-Wave Activation in Sleep
Katarina Krivokapic, Anita Datta
Background: Self-limited epilepsy with centro-temporal spikes (SeLECTS) is the most common pediatric focal epilepsy syndrome, generally associated with favourable neurological and cognitive outcomes. However, in rare cases, SeLECTS can evolve into a developmental epileptic encephalopathy with spike wave activation in sleep (DEE-SWAS), leading to cognitive regression. While patients with SeLECTS and SeLECTS + DEE-SWAS are typically expected to outgrow the epilepsy, more information is needed regarding the long-term cognitive impact on children with DEE-SWAS.
Objective: This study aims to compare the clinical features, EEG characteristics, and long-term cognitive and seizure outcomes between patients with typical SeLECTS and those with SeLECTS and DEE-SWAS. By doing so, we seek to identify electro-clinical predictors for developing DEE-SWAS.
Methodology: Patients with a history of SeLECTS and DEE-SWAS who underwent EEGs at BC Children’s Hospital between January 1, 1992, and March 15, 2020, will be identified, along with a control group of 200 SeLECTS patients from the same period. A retrospective review of electro-clinical features will be conducted for both groups, examining initial EEG features, long-term development, academic performance, psychiatric comorbidities, and seizure frequency.
All data will be de-identified prior to analysis. Statistical analysis will be performed using Fisher ’s exact test and the Kruskal-Wallis analysis of variance, with a significance level set at 0.05.
Anticipated Results: Patients with SeLECTS + DEE-SWAS are expected to achieve good seizure control and show EEG improvements at follow-up. However, they may experience more significant long-term cognitive and behavioral issues compared to those with typical SeLECTS. These cognitive and behavioral impacts may be related to the prolonged effects of frequent epileptiform discharges during sleep.
Implications: The results of this study may identify EEG and clinical features that will predict which SeLECTS patients are at risk of developing DEE-SWAS. This information may help clinicians counsel families of children with DEE-SWAS about the long-term prognosis of the condition, as well as strategies to optimize treatment and neurodevelopment.
Congratulations to Katarina on receiving funding from the UBC Department of Pediatrics
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Mia Majstorovic
Undergraduate Student, University of British Columbia Supervisor - Dr. Julie Bettinger
Parents’ HPV vaccine perceptions in Canada, Australia and the UK: A scoping review
Mia Majstorovic, Prubjot Gill, Julie Bettinger
Background: Human papillomavirus (HPV) is a commonly transmitted infection in sexually active individuals associated with several late-occurring cancers. While often benign in youth, HPV symptoms like genital warts are known to cause shame and affect sexual relations and self-esteem. In published literature, delivering HPV vaccines through publicly funded school-based vaccination programs is described as a superior strategy for protecting youth against HPV. School-based immunization clinics ensure convenient and equitable access to HPV vaccines, particularly for marginalized youth.
Canada, Australia and the UK have funded school-based HPV vaccination programs with high, yet ameliorable, uptake in youth aged 9-14. Many parents refuse consent for childhood HPV vaccinations despite their availability at school, leaving youth unimmunized. Importantly, studies on parents’ HPV vaccine attitudes in these countries have not been recently summarized. As youth often rely on parents to make vaccine decisions for them (even where self-consent options exist), these parental attitudes influence youth’s HPV immunization rates.
Objectives:
1.) To characterize the literature describing parents’ HPV vaccine perceptions and decision-making in Canada, Australia and the UK through a mixed methods scoping review.
2.) To explore parents’ persisting concerns towards childhood HPV vaccinations in a context where funded school-based vaccination programs exist for youth.
Methodology: Systematic searches were constructed in Medline, Embase, CINAHL and PsycINFO to retrieve relevant studies and grey literature. Texts considered for inclusion in the review were in English, published after 2006 (following global introduction of the HPV vaccine) and analyzed parents’ HPV vaccine perceptions within the three countries of focus.
Results: 1437 results were found by database searching, of which 209 were chosen for full-text analysis after title and abstract screening by one reviewer. Full-text review of collected quantitative literature has begun and recording of pertinent results. Reviewed studies suggest parents’ HPV vaccine safety concerns and education needs may often remain unaddressed amid promotion of school vaccination programs.
Implications: This review will summarize reasons for families’ HPV vaccine hesitancy in three countries where vaccination is convenient and accessible for school-going youth. The project may also inform add-on HPV vaccine promotion strategies (targeting parents) that will best complement free school vaccination programs.
Congratulations to Mia on receiving a Healthy Starts Summer Studentship
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Solana Redway-Ziola
Undergraduate Student, University of Waterloo Supervisor - Dr. Todd Woodward
The Pattern-Based Anatomy and Cognitive Mode associated with the Re-Evaluation (RE-EV) Network in fMRI
Solana Redway, Leonardo Arreaza, John Shahki, Erica Zeng, Todd S. Woodward
Functional magnetic resonance imaging (fMRI) reliably detects a network-level configuration of blood-oxygenlevel-dependent (BOLD) signal activated when checking/re-evaluating mental states, referred to as the re-evaluation (RE-EV) network. The BOLD signal that forms the RE- EV network is modulated by a range of cognitive tasks. Here we present the results of six task- based fMRI analyses which retrieved the RE-EV network, report specific pattern-based anatomical details essential for distinguishing the RE-EV network from other BOLD networks, and evidence for a cognitive mode associated with this anatomical configuration, based on how the RE-EV network was modulated by a range of task conditions. In order to facilitate recognition, we playfully nick-named the anatomical patterns specific to RE-EV network as follows: (1) Bilateral Eyeball Sitters, (2) Bilateral Space Invader Shooters, (3) Above the Line, (4) Sad Face Antennae and Flushed Cheeks, and (5) X Marks the Spot. The cognitive tasks for which we observed the RE-EV network were evidence integration × 2, task switching, Raven’s matrices, emotion regulation, and social re-evaluation. A review of these taskinduced BOLD changes associated with the RE-EV network configuration converged on a cognitive mode involving re-evaluating, re-considering, or regulating mental states.
Congratulations to Solana on receiving an NSERC Undergraduate Student Research Award
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Miku Wake
Undergraduate Student, University of British Columbia Supervisor - Dr. Heng Gan
Modification of automated cardiac function prediction algorithms from non-expert echocardiographers in pediatric patients
Miku Wake, Brendan Smith, Matthias Görges, Katherine Taylor, Simon Whyte, Heng Gan
Introduction: Echocardiography (ECHO) can be used to assess various cardiac functions, playing a significant role in the clinical care of patients. One of these functions is cardiac output (CO), a measure of blood volume pumped by the heart each minute. This value is critical to monitor during surgery and helps inform a physician’s decision-making for fluid and drug administration, as inadequate CO can lead to adverse health outcomes. Physicians use ECHOs to monitor CO changes during surgical procedures, but the ECHO images can be difficult to obtain and interpret by non-experts, especially in pediatric patients. Therefore, SickKids and the University of Toronto have developed a deep-learning algorithm to overcome the challenges of interpreting ECHOs. This algorithm has been trained on ECHO images obtained by expert echocardiographers in adult and pediatric populations. Yet, its use by non-expert echocardiographers in pediatric patients has not been verified. We are working collaboratively with SickKids to expand the use of this algorithm by non-experts for the pediatric population.
Objectives: The primary objectives of this study are to (1) test the current algorithm using transthoracic echocardiogram (TTE) images taken from pediatric subjects by non-expert physicians; (2) identify and address any errors in the current algorithm; and (3) iteratively refine the algorithm using deep machine learning to improve model performance.
Methods: Physician participants with none or minimal knowledge of ECHOs are being recruited for this study. The physician participants will undergo a one-hour training session with an expert in ECHOs to familiarize themselves with ECHO machines. After induction of anesthesia, non-expert physicians will take a TTE image of the patient’s heart. The algorithm will use these images to calculate an estimate for CO, which will be compared to the CO value obtained from the same images by an expert echographer.
Results: Data collection is ongoing.
Significance: Producing a machine algorithm that can reliably and quickly interpret CO from ECHOs taken by non-experts will make this monitoring modality more accessible, enhancing clinical care and safety and allowing physicians to assess fluctuations in CO levels quickly and effectively.
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Caroline (Callie) Wolsey
Undergraduate Student, Brigham Young University Supervisor - Dr. Arvindera Ghag
Adolescent Idiopathic Scoliosis and Mental Health –Effects of Covid-19 Pandemic
Caroline Wolsey, Arvindera Ghag
The COVID-19 pandemic has impacted the quality of life (QoL) and mental health outcomes of adolescents and youth, amplifying pre-existing disparities and creating new challenges. Children and youth affected by Adolescent Idiopathic Scoliosis (AIS) have been shown to be living with these pre-existing disparities such as anxiety, depression, body image issues, and decreased self-esteem. AIS is a complex spinal deformity, characterized by abnormal three-dimensional curvature of the spine. Despite the current research suggesting mental health needs in AIS, little work has been done exploring how COVID-19 has affected this vulnerable population. Our retrospective study explores the effect the pandemic has had on mental health and QoL in AIS patients between 2017 and 2023. Patient data was prospectively collected using the SRS-22 questionnaires as part of a multicenter registry. We will use this data to analyze mental health outcomes pre-pandemic and post-pandemic using statistical software. We hypothesize that the COVID-19 pandemic has worsened the mental health and QoL scores in AIS patients. Understanding the changes in mental health scores over time among AIS patients is essential for healthcare providers to develop intervention and support strategies to address the unique needs of AIS patients. Adolescent idiopathic scoliosis is not merely a physical condition but also has significant effects on mental health and well-being. Previous studies suggest that mental health scores in AIS patients may vary over time, generally declining. This is influenced by various clinical, demographic, and psychosocial factors. Further research is needed to analyze the underlying factors driving these trajectories and to develop effective interventions to support the mental health needs of individuals with AIS.
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Christopher Yu
Undergraduate Student, University of Western Ontario Supervisor - Dr. Tom Blydt-Hansen
Assessing quality of life of pediatric solid organ transplant patients through social media engagement on Reddit and Facebook
Christopher Yu, Irene Chen, Tom Blydt-Hansen, Julie Robillard
Background: Following traumatic transplant surgery, pediatric solid organ transplant (SOT) patients face lengthy recovery processes and lifelong risks of medical complications. Although many factors may affect the prognosis, recent studies suggest that quality of life is an important determinant for medication adherence, which is crucial for organ functioning. However, little is known regarding the post-transplant experience of pediatric SOT recipients.
Objective: As social media use among pediatric patients to share experiences and give advice continues to increase, we seek to uncover the strengths and weaknesses in pediatric post-transplant care that are shared on Reddit and Facebook.
Methods: In a mixed methods qualitative approach, this study exported text-based anonymous data from the “r/transplant” subreddit and 18 Facebook Groups. Manually filtering for pediatric experiences in the last 10 years resulted in 455 posts and 8956 associated comments from Reddit. Sentiment analysis was performed with the AFINN and National Research Council Canada Emotion lexicons in Tidytext, a text mining software in R. Inductive coding, where codes are derived from the dataset, was performed with NVivo 14.
Preliminary Results: With the AFINN sentiment analysis package, which contains a dictionary of words rated between -5 (negative) and +5 (positive), approximately 57%, 7%, and 36% of posts and 68%, 5%, and 27% of comments had positive (> 0), neutral (= 0), and negative sentiments (< 0), respectively. Further, a codebook with codes and definitions is being developed as we code towards reaching a 0.75 intercoder reliability kappa score which represents excellent agreement. Five themes have emerged: transplant characteristics, support, personal experiences, and giving and seeking advice or information. Another 500 child codes were documented under the general themes. After coding for 95 posts to reach intercoder reliability, 17 references from 6 posts mentioned their family situation while 27 references from 4 posts discussed challenges with transitioning to adult care.
Significance: By revealing gaps in transplant care, we can advocate for the improved quality and availability of resources both online and in the clinic to enhance care, improve the quality and outlook of life, and better address the daily life challenges for this patient population.
Session #4
Participants:
Bonnie Huynh
Sirui Li
Tracy Ngo
Parveen (Priya) Rai
Daniel Roozbeh
Akilesh Shankar
Angela Yang
Rosalie Zhou
Moderator: Kaitlin Winter
Watch In-Person
Thursday, July 25 | 9:00 – 10:30 am
Chieng Family Atrium, BCCHR
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Bonnie Huynh
Undergraduate Student, University of British Columbia Supervisor - Dr. Christopher Maxwell
Investigating the spatiotemporal role of HMMR Δexon4 splice isoform in cell division
Bonnie Huynh, Jenna Rever, Christopher Maxwell
In a dividing cell, the positioning of the mitotic spindle is tightly regulated and critical in establishing the orientation of cell division, which contributes to defining cell fate. Hyalyronan mediated motility receptor (HMMR) is a microtubule-associated mitotic spindle assembly factor whose regulation of key mitotic kinases, motor proteins, and various spindle assembly factors during mitosis is critical for spindle assembly, stability, and proper orientation during cell division. HMMR expression is cell cycle-regulated, with peak expression occurring between late G2 phase and early mitosis. Structurally, it consists of an N-terminal microtubule binding domain, a coiled-coil stalk, and a conserved C-terminal bZIP motif that confers centrosome localisation. Overexpression or silencing of HMMR leads to spindle abnormalities, causing misregulation of the cell division axis and progenitor cell fate. HMMR has a human-specific splice isoform which lacks exon 4, termed HMMR Δexon4, and its upregulation has been associated with increased disease progression and decreased survival in a variety of cancers. Despite its role in cancer progression, HMMR Δexon4 is poorly characterised. Therefore, this study aims to investigate the role of HMMR Δexon4 splice isoform in regulating cell division. Using MCF10A breast epithelial cell-derived CRISPR-edited clones with HMMR exon4 deleted, I evaluated changes to HMMR abundance and localisation using qPCR, western blotting, and immunofluorescence. Results show that the CRISPR-edited Δexon4 cell lines exclusively express HMMR Δexon4 isoform, with no full-length HMMR isoform present, and that loss of HMMR exon 4 reduces HMMR localisation to mitotic spindle. By gaining insight into the role of HMMR Δexon4, this investigation will further our understanding of mitotic spindle regulation and mitotic exit, as well as how HMMR Δexon4 misregulation contributes to cancer progression.
Congratulations to Bonnie on receiving an NSERC Undergraduate Student Research Award
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Sirui Li
Undergraduate Student, University of British Columbia Supervisor - Dr. Pascal Lavoie
Neonatal Screening Blood Spot Cards to Monitor RSV Population Immunity in British Columbia
Sirui Li, Jacob Shew, Blandine Dang, Marina P. Vineta, Allison W. Watts, Rujun Kang, Eva Jensen, Liam Golding, Pascal M. Lavoie
Background: Respiratory syncytial virus (RSV) is the most common virus causing seasonal cold-like symptoms in young children, and a leading cause of pediatric respiratory hospitalization worldwide.
Mathematical models used to predict seasonal RSV epidemics and hospitalization needs lack information on how long RSV-specific immune protection lasts within populations. To address this issue, our lab has developed and validated methods to measure Immunoglobulin G (IgG) from adult Dried Blood Spot (DBS) cards, allowing us to analyze RSV-specific immunity (IgG) with trace amounts of sample. This offers the possibility of validating the use of routinely collected neonatal screening DBS to monitor RSV-specific immunity in large, pediatric populations.
Objectives: To determine whether RSV-specific IgG levels and trends over time can be measured from neonatal DBS cards.
Hypothesis: The expected RSV-specific IgG levels from neonatal DBS will be low but detectable. The expected trend in IgG levels will be a decrease post-RSV seasonal peak.
Methods: This project is a retrospective longitudinal serosurvey using routinely collected neonatal screening DBS cards stored at BC Children’s Hospital, from newborns residing in the Vancouver metropolitan area (to limit geographical variations in RSV epidemics).
To test for a signal and for short-term trends (to determine antibody stability on DBS cards), 20 samples will be collected from each month between January 2023 to July 2023 (post-RSV peak). To test for long-term antibody stability, 20 samples will be collected between January 15 to January 31 (post-RSV peak) for all years between 2017 to 2023.
Samples will be eluted and assayed for RSV-specific IgG titres against the viral F and G protein, using a novel assay under development in the Lavoie Lab. Currently, recombinant F and G proteins have been extracted from transfected HEK293F cells and are being purified for multiplex ELISA development.
Significance: The data from this pilot study could lay the ground for a larger RSV study, providing a key missing component of predictive models of RSV epidemiology. More accurate predictions could help inform the timing of maternal vaccination and neonatal RSV immunoprophylaxis programs in BC, and improve RSV-based pediatric care.
Congratulations to Sirui on receiving a BC Children’s Hospital Summer Studentship
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Tracy Ngo
Undergraduate Student, University of British Columbia Supervisor - Dr. Kirk Schultz
Clinical Determinants That Impact Regulatory Natural Killer Cell Frequency in Healthy Donor Peripheral Blood
Tracy Ngo, Madeline P. Lauener, Sayeh Abdossamadi, Teesha Baker, Elena Ostroumov, Kirk R. Schultz
Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the infusion of a donor’s stem cells into a recipient, to regenerate a healthy immune system. Unfortunately, in roughly one-third of pediatric and two-thirds of adult cases, donor immune cells attack the recipient’s tissues. This results in chronic graft-versus-host disease (cGvHD), the leading non-relapse cause of diminished quality of life and has a 10-25% mortality rate.
Our lab identified that regulatory natural killer (NKreg) cells are strongly associated with the absence of cGvHD. Thus, large NKreg populations may prevent cGvHD. One approach to increase NKreg numbers is to adoptively transfer NKreg cells after transplantation, an approach that has already worked for Treg cells.
Objective: To evaluate for clinical associations (age and sex) of [1] recipient and donor NKreg cells on development of cGvHD, and [2] NKreg cell frequency in healthy donor peripheral blood, to identify optimal donors for clinical treatment.
Methods: Retrospective data was extracted from our ABLE study cohort. Blood samples collected 100 days post-transplant (117 pediatric patients) were analyzed for NKreg and cytotoxic NK (NKcyt) cells, and correlated with donor sex and recipient age (pre- and post-puberty).
NKregs and NKcyts are isolated from 20 buffy coat samples, from the Canadian Blood Services. Peripheral blood mononuclear cell, NK cell, and NKreg and NKcyt cell counts were recorded. NKregs and NKcyts were sorted using FACS.
T-tests/Mann-Whitney U tests were used for statistical analyses.
Results:
Retrospective Analysis: NKreg and NKcyt proportions and mean NKreg:NKcyt ratios were compared for the impact of recipient puberty and sex as well as the impact of donor sex. Comparisons between the GvHD and no GvHD groups showed significant difference (p < 0.05), except for the GvHD males to no GvHD males.
Prospective Analysis: Comparisons between males > 35 (n=4), males < 35 (n=4), females > 35 (n=4), and females < 35 (n=8) showed no significant differences.
Conclusion: Donor age and sex does not significantly impact NKreg frequency, suggesting that these factors do not restrict donor selection. Future studies should explore genetic correlations such as polymorphisms (SNPs) to further explore NKreg variability found in healthy donors.
Congratulations to Tracy on receiving a UBC Faculty of Medicine Summer Studentship and the Albert B and Mary Steiner Summer Research Award
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Parveen (Priya) Rai
Undergraduate Student, McMaster University Supervisor - Dr. Laura Sly
Evaluating the Therapeutic Potential of Glycoconjugated Steroid for Targeted Delivery in T Cell Transfer Model of Colitis
Parveen Rai, Wei Jen Ma, Susan Menzies, Chang Qing Wang, Harry Brumer, Laura Sly
Inflammatory bowel disease (IBD) is characterized by chronic inflammation in the gastrointestinal tract, causing symptoms, such as abdominal pain, rectal bleeding, diarrhea, weight loss, and fatigue. IBD includes two main forms that vary by the location of the inflammation: Crohn’s disease (CD) and Ulcerative Colitis (UC). Despite the increasing prevalence of IBD, there is still yet to be a cure. Corticosteroids have long been used to induce clinical remission. However, prolonged use or repeated courses of corticosteroids can pose significant side effects including growth stunting, hyperglycemia, skin and mood changes, increased infection risk, and reduced bone density. These adverse effects present many challenges to a patient’s quality of life, and it is clear that a change is needed in treatment.
Glycoconjugated steroids aim to mitigate these systemic side effects by creating a targeted approach to therapy and minimizing the required dose for effective treatment. Dexamethasone, a potent anti-inflammatory corticosteroid, will be the first drug examined. We have previously found that “GlycoCaging” dexamethasone significantly enhances its oral efficacy and reduces systemic side effects compared to the free form, in the SHIP-/- mouse model of Crohn’s Disease-like ileitis. These findings will be further explored through a T-cell transfer model of colitis. This model was set up by intraperitoneally injecting CD4+CD25-CD45RBhigh T cells isolated from wild-type CD45.1 C57BL/6 mice by fluorescence-activated cell sorting into age- and sex-matched immunodeficient Rag-/- mice. After three weeks, once the inflammation has been established, the mice will be orally gavaged with dexamethasone from 3mg/kg/d and molar equivalent caged dexamethasone. Then, the treatment efficacy will be evaluated through LEGENDplex mouse inflammation panel, ELISAs and histological scoring.
Evaluating GlycoCaged corticosteroids in two preclinical IBD mouse models will lay the groundwork for clinical studies, potentially revealing a novel framework for targeted drug delivery. This could then improve the therapeutic potential of a wide range of drugs used to treat IBD, and ultimately improve the quality of life of patients.
Congratulations to Parveen on receiving a Childhood Diseases Summer Studentship
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Daniel Roozbeh
Undergraduate Student, Western University Supervisor - Dr. Kelly Brown
Whole blood transcriptome analysis of putative pathways driving medium vessel vasculitis
Daniel Roozbeh, Simranpreet K. Mann, Kristen M. Gibson, Travis M. Blimke, Reza Falsafi, Robert E.W. Hancock, David A. Cabral, Kimberly A. Morishita, Kelly L. Brown on behalf of the PedVas Investigator Network
Objectives: Vasculitis is a rare, polygenic and multifactorial disease caused by systemic inflammation and damage to small, medium, and/or large-sized blood vessels in major organs of the body. In 2014, the first monogenic form of vasculitis, called Deficiency of Adenosine Deaminase 2 (DADA2), was discovered in two cohorts of children with a medium sized vessel vasculitis known as Polyarteritis Nodosa (PAN). Although it is known that DADA2 patients harbour loss-of-function mutations in a gene called ADA2, the role(s) of the encoded ADA2 protein in maintaining normal blood vessel integrity are not known. This study aims to elucidate the etiology of medium sized vessel vasculitis by comparing cellular and molecular immune pathways in peripheral blood cells from DADA2 and PAN patients. The primary hypothesis is that medium sized vessel vasculitis, which is a hallmark of the phenotypically indistinguishable, yet genetically distinct PAN and DADA2, is rooted in the dysregulation of a common immune/inflammatory pathway
Methods and Preliminary Results: This project will analyze retrospective RNA sequencing data from children under 18 diagnosed with DADA2 (n = 5), PAN without pathogenic ADA2 variants (n = 12), and healthy adults (n = 11). Unsupervised hierarchical clustering (DESeq2 and R Statistical Language) will be used to identify genes that show similar expression patterns in DADA2 and PAN compared to controls, suggesting commonly disrupted pathways, as well as pathways which differ between DADA2 and PAN patients, thus providing insight into the root cause(s) of DADA2-specific disease manifestations. Preliminary findings indicate differential regulation of genes related to the Type I Interferon pathway (e.g., ISG15, IFIT3, IFIT1) and the HIF1a/hypoxia signaling pathway (e.g., VHL, HSPB1) between the two DADA2 and PAN patients. These findings will be further validated through RT-qPCR on cDNA from a larger sample size, including DADA2 (n = 5), PAN (n = 10-15), and pediatric controls (n = 15) acquired from the BCCH Biobank.
Conclusions: This project has the unique opportunity to provide key insights into the immune processes, and specifically the role(s) of ADA2 that govern blood vessel integrity and, when disrupted, lead to medium sized vessel vasculitis.
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Akilesh Shankar
Undergraduate Student, University of British Columbia Supervisors - Dr. Bruce Verchere & Dr. Jane Velghe
Evaluating Mast Cell Transcription Heterogeneity in Human Pancreatic Islets
Akilesh Shankar, Jane Velghe, C. Bruce Verchere
Type 2 diabetes (T2D) is a chronic condition characterized by the body’s inability to produce sufficient insulin, resulting in elevated sugar levels. In the human pancreas, beta-cells reside amongst other hormone-producing endocrine cells such as alpha and delta cells in sub-organ clusters called ‘islets’ where they work together to regulate blood sugar levels through insulin production. Pancreatic islets also contain other cell populations including innate immune cells which are present in connective tissues that initiate and mediate the body’s inflammatory and allergic processes.
Islet immune cells have not been well-characterized in the human pancreas due to their scarcity and challenges obtaining sufficient human tissue. Human mast cells are broadly classified based on the proteases they secrete upon degranulation: tryptase positive, chymase positive, and tryptase-chymase double positive, and appear in increasing numbers in pancreatic islets from donors with amyloidosis, which is increased in both type 1 diabetes (T1D) and T2D. Recent in-house single-cell RNA sequencing data from immune cell-enriched islet cell populations have shown high proportions of mast cells in islets present in greater numbers than macrophages, which previous studies had described. We are investigating the role of mast cell transcriptomic heterogeneity and the differences in islet mast cells from donors with and without T2D. Preliminary results of unbiased clustering of mast cell populations showed 3 distinct cluster populations. Subsequent efforts aiming to immunophenotype these 3 mast cell clusters using Gene Ontology and Pathway Analysis are underway. We propose that differential gene expression data will show mRNA expression differences between islet mast cells from lean, non-diabetic donors and donors with T2D. These efforts will improve our knowledge of the inflammatory processes underlying diabetes, including the potential role of mast cells, and uncover more complex cell interactions in the pancreatic islet microenvironment.
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Angela Yang
Undergraduate Student, University of British Columbia Supervisor - Dr. Francis Lynn
Studying MED15 as a Potential Therapeutic Target in Stem Cells to Treat Dysfunctional Alpha Cells in Diabetes
Angela Yang, Samantha Mar, Cuilan Nian, Francis Lynn
Background: Blood sugar levels are regulated by various hormones secreted by pancreatic endocrine cells. When blood sugar drops, pancreatic alpha cells secrete glucagon that triggers glucose synthesis in the liver to raise blood sugar levels. Diabetes is characterized by chronic high blood sugar that can lead to diabetesrelated complications. In type 1 and 2 diabetes, glucagon secretion is dysregulated, further exacerbating this disease. However, the transcriptional mechanism behind this dysregulation is poorly understood.
Objective: My project aims to study the role of MED15 in human embryonic stem cell (hESC)-derived alpha cells (SC-α). I hypothesize that MED15 is required for human alpha cell function and maintenance.
Methods: MED15 knockdown in SC-α will be achieved using the degradation tag (dTAG) system. Specifically, an FKBP12-mutant expression cassette will be knocked onto the endogenous MED15 locus in the insulin and glucagon dual fluorescent reporter H1 hESC line, developed by the Lynn lab, using CRISPR-Cas9. A 3xHA expression cassette is included as positive selection marker. Selected CRISPR-edited hESC clones will be differentiated into mature pancreatic alpha cells and administered with dTAGV1 to induce MED15 knockdown. The effects of MED15 knockdown on alpha cell gene expression will be characterized using qPCR and immunofluorescence imaging.
Preliminary Results: So far, a successful CRISPR-edited hESC clone was identified from the transfected population. Genotyping and sequencing confirmed the expression cassette is inserted into the endogenous MED15 locus. Immunofluorescence imaging further validated the expression of the positive selection marker 3xHA in the CRISPR-edited clone. These results show a promising first step towards generating a successful MED15 knockdown model. Next steps include 1) check for chromosomal abnormalities using qPCR, and 2) perform initial dTAGV1 treatments to validate the dTAG system using immunofluorescence imaging and western blot.
Significance: Preliminary data indicate that there are very few alpha cells in mouse pancreatic islets, which limits our ability to study potential Med15-dependent mechanisms in mouse models. By generating this stem cell model, it will allow us to study the role of Med15 in transcriptional mechanisms involved in alpha cell function and maintenance, leading to new druggable targets that regulate glucagon secretion, used to treat diabetes.
Congratulations to Angela on receiving a Canucks for Kids Fund
Childhood Diabetes Laboratories Summer Studentship
July 25, 2024
9:00 - 10:30 am
Chieng Family Atrium
Rosalie Zhou
Undergraduate Student, University of British Columbia Supervisor - Dr. Clare Beasley
Comparing the Effects of First- and Second-Generation Antipsychotics on Oligodendrocyte Proteins in White and Gray Matter
Rosalie Zhou, Li Shao, Clare Beasley
Background: Schizophrenia (SCZ) is a severe mental illness characterized by positive (perceptions or behaviors not normally present) and negative (behaviors missing from what is normally present) symptoms, and treated with antipsychotics. Although the etiology of SCZ is not well understood, it has been proposed that the disorder may result from dysfunctional oligodendrocytes. Oligodendrocytes are brain cells that produce the myelin sheath that encompasses neuronal axons, thereby providing more efficient communication between neurons.
Antipsychotic medications (first- and second-generation) are prescribed to treat SCZ, including in children and adolescents. Both typical antipsychotics (first-generation) and atypical antipsychotics (second-generation) can be used to treat positive symptoms of SCZ, however these medications produce motor (first-generation) or metabolic (second-generation) side effects. The effects of first- and second-generation antipsychotics on the expression of proteins required for normal oligodendrocyte function have not yet been fully characterized. Olig2 is a transcription factor that plays a critical role in the differentiation of oligodendrocyte lineage cells into mature oligodendrocytes, and is important for maintenance of myelin and myelin repair.
Purpose: To determine if first- and second-generation antipsychotics alter levels of Olig2 protein in white and gray matter in rats.
Methods: Adult male Sprague–Dawley rats were administered the first-generation antipsychotic haloperidol (1 mg/kg), the second-generation antipsychotic clozapine (20 mg/kg) or vehicle daily for 28 days by i.p. injection. After 28 days, brains were quickly removed, and gray and white matter regions dissected, with tissue rapidly frozen on dry ice and stored at −70 °C until use. Tissue samples were homogenized and proteins were separated using gel electrophoresis. Olig2 protein levels were quantified in frontal gray and white matter by Western blotting.
Expected Results: The Western blotting results will be analyzed using ANOVA to see if Olig2 differs significantly between haloperidol, clozapine and vehicle groups.
Significance: Antipsychotics are imperative in treating the symptoms of SCZ. Greater understanding of the biological effects of antipsychotics on oligodendrocyte function could lead to new or improved medications, as such directly improving the lives of people with SCZ.
Congratulations to Rosalie on receiving a BC Children’s Hospital Summer Studentship
Session #5
Participants:
Annika Burrows
Rashmi Hundal
Lujia Jian
Vanesse Li
Xinyan (Betty) Lin
Lisa Liu
Insha Majeed
Jack Pirie
James Wu
Moderator:
Punit Chhajed
Watch In-Person
Thursday, July 25 | 11:00 am – 12:30 pm
Chieng Family Atrium, BCCHR
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Annika Burrows
Undergraduate Student, University of British Columbia Supervisor - Dr. Christopher Maxwell
Investigating the Role of BRCA1 on Mammary Alveologenesis and Binucleation
Annika Burrows, Ryan Ghorayeb, Christopher Maxwell
Introduction: Women with inherited mutations in the Breast Cancer 1 (BRCA1) gene are at high risk of developing aggressive, triple negative breast cancer at young ages. Additionally, women with BRCA1 mutations are 100 times more likely to be diagnosed with breast cancer during pregnancy or up to 1-year post-partum, termed a pregnancy associated breast cancer. During pregnancy, mammary epithelial cells undergo proliferation and differentiate into milk-producing alveolar cells. During late pregnancy and lactation, alveolar cells become binucleated via cytokinetic bypass, akin to what occurs in Drosophila male accessory gland cells, where binucleation occurs via cytokinetic bypass during an oriented cell division. In the mammary gland, BRCA1 regulates proliferation and differentiation, and is required to correctly orient the cell division axis, which affects the fate of the two daughter cells produced from a cell division. Mice with BRCA1 mutations also undergo abnormal alveologenesis; however, it is not yet known how loss of BRCA1 affects binucleation during pregnancy and lactation.
Objective: Investigate how loss of BRCA1 impacts proliferation and binucleation of mammary epithelial cells during pregnancy and lactation.
Hypothesis: As BRCA1 is required for oriented cell division and control of cell proliferation, alveologenesis is abnormal in BRCA1-mutant tissue. Loss of BRCA1 will induce proliferation but reduce binucleation during pregnancy and lactation.
Methods: We used the transgenic Blg-Cre Brca122-24f/f; Trp53+/- Mouse Model (BP mice), in which a truncating BRCA1 mutation occurs in secretory mammary epithelial cells. We conducted immunofluorescence imaging on mammary gland sections from BP and control mice during pregnancy and lactation to assess proliferation and binucleation.
Results: We found that BP mice have increased epithelial proliferation during both pregnancy and lactation, but that binucleation was reduced during lactation. Further, we found a decrease in parallel nuclei orientation in binucleate cells in both pregnancy and lactation. Finally, we identified a rare population of proliferative binucleate cells that were more abundant in BP mice.
Future Direction: We will analyze the division axis of epithelial cells during late pregnancy and lactation in BP mice. Additionally, we will utilize an organoid model of alveologenesis to determine if oriented cell divisions give rise to binucleate cells.
Congratulations
to Annika on receiving a Childhood Diseases Summer Studentship
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Rashmi Hundal
Undergraduate Student, University of British Columbia Supervisor - Dr. Francis Lynn
Vascularizing stem cell-derived islets with stem cell-derived blood vessel organoids
Rashmi Hundal, Ekaterina Filatov, Francis C. Lynn
Background: Type 1 diabetes (T1D) is an autoimmune disease where the insulin-producing pancreatic β-cells are destroyed, and hyperglycemia occurs. A therapy for T1D includes transplanting cadaveric or stem cell-derived islets (sc-islets) to replace the destroyed β-cells. However, grafted cells poorly revascularize upon transplantation, which increases the risk of graft failure. Including vasculature fragments with islets has shown to improve engraftment, but vasculature can be difficult to source or not be appropriate for the islet niche. We hypothesize that pre-vascularizing sc-islets with sc-blood vessel organoids (sc-BVOs) would enable the graft to receive blood supply quicker and allow for accelerated graft function.
Objective: To develop a protocol for pre-vascularizing sc-islets with sc-BVOs in preparation for transplantation.
Methods: Using human embryonic stem cells that were genetically modified to express GFP under the insulin promoter, we generate sc-BVOs and sc-islets, separately. Sc-BVOs consisting of endothelial cells and pericytes are combined with sc-islets as endocrine progenitors (sc-EPs) or of later stages of maturation, testing various ratios of sc-islets to sc-BVOs embedded in a collagen-matrigel matrix (CMM). To evaluate sc-islet development during coculture in CMM with sc-BVOs, GFP fluorescence is compared to control sc-islets that remain in 3D-suspension. Once sc-islets have reached the stage of early maturation, sc-isletBVOs are collected for whole-mount staining to analyze blood vessel integration into islets by immunostaining for PECAM, insulin and glucagon. Additionally, using qPCR, we will evaluate how different amounts of sc-BVOs to sc-islets influences sc-BVO (Pecam1, Pdgfra and Col4a) and sc-islet (Ins, Gcg, Sst, Pdx1 and Iapp) gene expression profiles.
Preliminary Results: Combining sc-islets with sc-BVOs in CMM while feeding with sc-islet media promotes blood vessel sprouting from sc-BVOs towards sc-islets.
Significance: Developing a protocol to pre-vascularize sc-islets with sc-BVOs that are generated from the same cell source, may lead to more readily functional sc-islets with improved survival following transplantation into animal models of T1D. If successful, this protocol may be used to make more suitable cells for islet replacement therapy for individuals with T1D.
Congratulations to Rashmi on receiving an NSERC Undergraduate Student Research Award
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Lujia Jian
Undergraduate Student, University of Hong Kong Supervisor - Dr. Todd Woodward
The Pattern-Based Anatomy and Cognitive Mode Associated with the Auditory-Attention-for-Response (AAR) Network in fMRI
Lujia Jian, Solana Redway, Jenn Huo
Our laboratory has previously identified 12 task-based brain networks that each carry out a specific functional role in a wide range of cognitive tasks. As one of the 12, the Auditory Attention for Response (AAR) Network is thought to be activated when an individual allocates attention toward an auditory input prior to performing a motor response. Its signature patterns show activity in the following regions: bilateral superior temporal gyrus, left precentral gyrus, left supplementary motor area, the cerebellum, bilateral middle frontal gyrus, bilateral lingual gyrus, and bilateral supramarginal gyrus. Here, using constrained principal component analysis for fMRI (fMRI-CPCA), we re-analyzed a series of task-based fMRI data collected in our laboratory and others from both published and unpublished studies. Then, we proposed a preliminary cognitive mode associated with the AAR network by inspecting the temporal profiles of its activation in an auditory oddball task, a probabilistic reasoning task, a semantic association task, a problem-solving task, and a lexical decision task. It was found that the AAR network is activated while planning and performing a task-required motor response following the presentation of an auditory stimulus, or suppressed when intensive visual attention is required for the task at hand due to a higher cognitive load. Besides assigning the network a cognitive mode, we also classified its pattern-based anatomy and playfully nicknamed the patterns to facilitate network identification.
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Vanesse Li
Undergraduate Student, University of British Columbia Supervisor - Dr. Michael Hawkes
Soluble tumour necrosis factor receptor 1 predicts hospitalization in children and young adults with dengue virus infection in the Philippines
Vanesse Li,
Hridesh
Mishra,
Michelle
Ngai, Valerie M. Crowley, Vanessa Tran, Maria Salome
Siose
Painaga, James Yared Gaite, Patrick Hamilton, Kevin C. Kain, Michael T. Hawkes
Background: Dengue virus (DENV) infection, transmitted by Aedes mosquitoes, is a re-emerging disease that affects millions yearly. Pathogenic features include systemic inflammation, vascular leak, and thrombocytopenia, which may be life-threatening.
Objectives: To examine the clinical utility of the cardinal pro-inflammatory cytokine tumour necrosis factor (TNF) and circulating levels of its receptor, soluble TNF receptor-1 (sTNFR1) as predictive markers of DENV progression and the need for hospitalization.
Methods: In an outpatient clinic in the Philippines, we collected clinical data and assayed TNF and sTNFR1 levels by ELISA among confirmed DENV-infected patients. Over a follow-up period of 14-21 days, clinical events including hospitalization were prospectively monitored.
Results: A total of 244 patients between the ages of 1 and 26 were enrolled. At clinic presentation, the median sTNFR1 plasma concentration was 2987 pg/mL (IQR 2382-3722) and decreased significantly after recovery. TNF levels did not differ significantly according to disease severity. However, sTNFR1 levels were statistically significantly higher in patients with WHO warning signs than in patients with uncomplicated dengue (p = 0.039).
Thrombocytopenia and plasma leakage are pathologic features of DENV disease. In our cohort, 27 patients (11%) developed hemoconcentration and 95 patients (39%) developed thrombocytopenia. sTNFR1 levels were higher in patients with hemoconcentration and thrombocytopenia.
161 (81%) patients required hospitalization. The average length of stay among hospitalized patients was 4 days (IQR 3-6). sTNFR1 levels at presentation were associated with subsequent hospitalization and with length of stay. Using the receiver operator characteristic (ROC) curve to compare test performance, sTNFR1 was superior to TNF and WHO classification as a predictor of hospitalization. When combined with WHO classification, sTNFR1 improved the AUROC significantly from 0.65 to 0.77 (p<0.0001).
Conclusion: sTNFR1 is a clinically informative marker of DENV progression, predictive of hospitalization and length of stay.
Congratulations to Vanesse on receiving a BC Children’s Hospital Summer Studentship
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Xinyan (Betty) Lin
Undergraduate Student, University of British Columbia Supervisor - Dr. Clare Beasley
Comparative Analysis of NF-κB Rel A Protein Levels in Prefrontal Cortex in Human Schizophrenia and Rats Treated with Antipsychotics
Xinyan Lin, Shao Li, Clare Beasley
Introduction: Schizophrenia (SCZ) is a severe mental disorder that affects around 1% of the population. Antipsychotic medications are prescribed to treat SCZ, however, their use is marred by a lack of efficacy and serious side effects.
While the pathophysiology of SCZ is unknown, it has been suggested that the immune system may play a role. Rel A, a subunit of the NF-κB transcription factor, plays a crucial role in regulating immune and inflammatory responses in the brain. Dysregulation of NF-κB signaling has been implicated in the pathophysiology of SCZ, with increased Rel A mRNA expression previously reported in the brain in this disorder. However, it is unclear whether Rel A protein levels are similarly increased, and whether Rel A levels are altered by antipsychotic medications.
Methods: Western blotting of human grey matter from patients with SCZ and bipolar disorder, and controls was performed to quantify Rel A levels. Statistical methods will be used to compare Rel A band patterns across different patient groups and treatment types. To further understand these findings, we will conduct Western blotting of Rel A in rat grey matter samples treated with the antipsychotics clozapine, haloperidol, or a vehicle.
Results: In progress.
Conclusions: These findings aim to enhance the understanding of neuroinflammatory processes in psychiatric conditions and improve therapeutic strategies.
Congratulations to Xinyan on receiving a BC Mental Health and Substance Use Service (BCMHSUS)
Research Summer Studentship
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Lisa Liu
Undergraduate Student, University of Toronto Supervisor - Dr. Bruce Verchere
Targeting Pro-inflammatory Islet Macrophages to Treat Type 1 Diabetes
Lisa Liu, Courtney Ostromecki, Lindsay Pallo, Heather Denroche, Bruce Verchere
Background: Type 1 diabetes mellitus (T1D) is an autoimmune disease that affects ~9 million people worldwide and is usually diagnosed during childhood. T1D arises due to the destruction of insulin producing β-cells in the pancreas, leading to insulin dependence and the potential of associated complications. Islet macrophages perpetuate autoimmunity in T1D and directly cause β-cell death by releasing pro-inflammatory cytokines like IL-1β and TNFα. Macrophages can be induced to switch from a pro-inflammatory to a pro-regenerative phenotype, higher proportions of which have been shown to prevent T1D in mice. The Verchere lab has partnered with industry to engineer lipid nanoparticles (LNPs) to deliver anti-inflammatory pro-drugs to innate immune cells.
Objective: To determine whether LNP delivery of Tipe2 mRNA (known to skew macrophages towards a pro-regenerative phenotype) can delay T1D onset in NOD mice.
Methods: LNP formulations were prepared with either Tipe2 mRNA or PBS control. 5-week-old female and male NOD mice (N=15/group) were administered control or 5 µg of LNP. Mice were monitored for the onset of diabetes (2X blood glucose >15 mM) by weekly measurement of blood glucose and body weight up to 30 weeks of age. Upon diabetes onset or at 30 weeks of age, pancreases will be harvested for histology for assessment insulitis, beta-cell mass, presence of T regulatory cells, and gene expression in sorted islet macrophages to characterize their phenotype. Flow cytometry of pancreatic islets and lymph nodes will be performed to quantify autoreactive T cells and assess the frequency and activation state of CD4+ and CD8+ T cells.
Significance: This project could provide proof-of-principle of a novel immunomodulatory nanomedicine in a mouse model of T1D and enhance current understanding of T1D pathogenesis. This work could potentially be translated to humans in the future given the safety and efficacy of current LNP therapies, expanding the therapeutic landscape of T1D treatment.
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Insha Majeed
Undergraduate Student, University of British Columbia Supervisor - Dr. Ted Steiner
Examining the effect of Tr1 cell therapy via IL-10 mediated suppression of inflammatory macrophages in murine IBD
Insha Majeed, Sarah Lim, Chad Poloni, Ted Steiner
Inflammatory Bowel Disease (IBD) is a chronic disease involving recurrent gastrointestinal inflammation, leading to abdominal pain, diarrhea, and fibrosis. A prospective targeted approach to address gut inflammation without compromising overall immune function utilizes Type 1 regulatory T cells (Tr1 cells), which are known for their ability to produce large amounts of interleukin-10, an anti-inflammatory cytokine, and aid in reducing inflammatory related damage. Furthermore, Tr1 cells play a key role in modulating the production of interleukin-1beta (IL-1β), a proinflammatory cytokine in IBD development. This modulating mechanism occurs via IL-10-dependent inhibition of both pro-IL-1β production and its caspase 1-dependent cleavage into mature IL-1β.
Over a 12-week duration, our study aims to investigate the impact of Tr1 cells on inflammation using IBD mice models, focusing on Tr1-mediated suppression of inflammatory macrophages and the elucidation of the underlying mechanism. Bone marrow-derived macrophages from IBD mouse models will be grown and stimulated with or without Tr1 cells. The evaluation of suppressive activity includes culturing macrophages in varying Tr1 supernatant ratios and co-culturing them with Tr1 cells, with subsequent measurement of changes in IL-1β production via ELISA. Characterization of these macrophages using flow cytometry will help assess effects on cell viability after exposure to Tr1 supernatant. Following the analysis of in vitro data, a comparison will be made between the gut tissue of mice that received Tr1 cells and those that did not, providing in vivo insights.
Anticipated results include a dose-dependent decrease in IL-1β levels in inflammatory macrophages when exposed to different concentrations of Tr1-conditioned media or Tr1 cells. The presence of anti-IL-10 antibodies should negate the Tr1-mediated suppressive effect, indicating IL-10 dependency.
This research, with its focus on Tr1-mediated suppression of inflammatory macrophages in a mouse IBD model, holds the potential to lay the groundwork for the development of a novel Tr1-mediated therapy for IBD. Beyond its immediate implications, the study also promises to contribute valuable insights into the intricate immunoregulatory mechanisms at play, offering a foundational platform for devising more effective therapeutic strategies not only for IBD but also for a spectrum of autoimmune conditions.
Congratulations to Insha on receiving a UBC Faculty of Medicine Summer Student Research Award
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Jack Pirie
Undergraduate Student, University of British Columbia Supervisor - Dr. Bruce Verchere
Investigating the Effects of Gut-specific Deletion of the Prohormone Convertase PC1/3 in Mice
Jack Pirie, Austin Taylor, Galina Soukhatcheva, David Datzkiw, Bruce Verchere
Background: Prohormone convertase 1/3 (PC1/3) is a serine protease that plays an important role in many endocrine tissues, including in the pancreas and the gut. PC1/3 functions within the secretory pathway by cleaving immature prohormones into intermediate or active forms in a tissue-specific manner. Within the gut, PC1/3 is expressed by enteroendocrine cells that release distinct peptide hormones for maintaining metabolic health. In K and L cells of the small intestine, PC1/3 carries out prohormone processing of the incretin factors glucose-dependant insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1), respectively. PC1/3 is encoded by the PCSK1 gene, mutations in which have been shown to have significant health implications in mice and humans. Deficiency in PC1/3 in humans leads to malabsorptive diarrhea in infants, followed by obesity in aging.
Objectives: We aim to define the consequences of PCSK1 gene mutations on gut function by examining how gastrointestinal histology changes following enteroendocrine cell-specific deletion of Pcsk1.
Methods: Blood glucose concentration and body weight were measured weekly in Pcsk1-flox/flox:Villin-Cre mice until euthanization. Cross-sections of gut tissue were stained, to confirm the absence of PC1/3, and to investigate gut hormone expression in the major intestinal regions, including: duodenum, jejunum, ileum, and colon. Each section was co-stained for PC1/3 and GLP-1. Immunofluorescent imaging was performed using an epifluorescent microscope.
Results: Body weight and blood glucose tracking of the Pcsk1-flox/flox:Villin-Cre mice is ongoing. Mutant mice demonstrate a trend of mild hypoglycemia and mild overcompensation in glucose disposal. Female mutants demonstrate slower initial growth curves. Mice with enteroendocrine cell deletion of Pcsk1 show early indications of intestinal dysfunction, including watery stools and rectal inflammation. The Pcsk1-flox/flox:VillinCre mice are also being validated to ensure PC1/3 is absent from enteroendocrine cells. PC1/3 and GLP-1 co-expression is discernible in the pancreatic islets and intestinal L cells of control mice, demonstrating cell specific staining with our antibody panel.
Summary: Enteroendocrine cell deletion of Pcsk1 in mice leads to signs of intestinal dysfunction that resembles that seen in PCSK1 null infants. This suggests that symptoms seen in PCSK1-deficient humans may be due to loss of PC1/3 in enteroendocrine cells and impaired gut hormone processing.
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
James Wu
Undergraduate Student, University of British Columbia Supervisor - Dr. Stefan Taubert
Characterizing Partners of
C. elegans
Nuclear Hormone Receptor NHR-49 in Stress Response
James Wu, Glafira Ermakova, Kelsie Doering, Stefan Taubert
Background: Pediatric cancer cells experience cellular stress, and activating cellular stress responses allows them to survive these stresses, becoming more aggressive and resistant to treatment. Uncovering the mechanism behind stress response activation can thus reveal new cancer drug targets. Our lab uses the model organism Caenorhabditis elegans, a roundworm, to study evolutionarily conserved stress resistance pathways. Mammalian peroxisome proliferator-activated receptor alpha (PPARα) is a transcription factor implicated in oxidative stress response during tumorigenesis. Our lab showed that the C. elegans PPARα homolog, Nuclear Hormone Receptor NHR-49, is required for resistance to multiple stresses that occur in pediatric cancers, including hypoxia and oxidative stress. However, the pathway through which NHR-49 confers stress resistance is still poorly characterized. Our lab recently conducted a reverse genetic screen which identified several genes that may act with NHR-49/PPARα to regulate stress resistance. This study aims to test whether three promising genes from the screen — HMG-11, NHR-174, and MADF-5 — are required in partnership with NHR-49 for survival under hypoxic conditions and/or oxidative stress.
Methods: Mutant worms were exposed to tert-butyl hydroperoxide (tBOOH), an exogenous source of oxidative stress, and measured for survival over time to determine whether each gene is required for survival in oxidative stress. To determine whether a gene is required for hypoxia survival, mutant worms were exposed to hypoxic (0.5% O2) conditions as eggs, then returned to normal oxygen (21% O2) and assessed for the proportion of worms that developed into adults. Double mutants (crossed with NHR-49) were also assessed to determine whether each gene acts in the same pathway as NHR-49 in each stress.
Results: HMG-11, NHR-174, and MADF-5 act in the same pathway as NHR-49 to confer resistance to oxidative stress. MADF-5 acts in the same pathway as NHR-49 to confer resilience in hypoxia, while HMG-11 and NHR-174 are dispensable for survival in hypoxia.
Significance: The findings from this study contribute to our understanding of the genetic pathways through which NHR-49/PPARα confer stress resilience. Future experiments on whether human homologs of the genes in this pathway play a role in stress resistance in pediatric cancer cells will help identify targets for cancer treatments.
Congratulations to James on receiving a UBC Healthy Aging Summer Student Research Award
Session #6
Participants:
Sara Blais
Irene Chen
Rishi Gupta
Alysha Lee
Michael Li
Ying Jie Li
Victoria Porter
Charuta Sahasrabudhe
Moderator:
Sajine Sathiaselan
Watch In-Person
Thursday, July 25 | 11:00 am – 12:30 pm
Chieng Family Atrium, BCCHR
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Sara Blais
Medical Student, University of British Columbia Supervisor - Dr. Saoussen Salhi
Pediatric fingertip injuries: a retrospective study comparing treatment outcomes
Sara Blais, Saoussen Salhi
Introduction: Fingertip injuries, often involving nail bed damage, are the most common hand injuries presented by pediatric patients in emergency departments. Distal phalangeal (DP) fractures, which account for 50% of all hand fractures, frequently occur with nail bed injuries. Treatment approaches for these injuries involve different degrees of fracture stabilization such as nail bed repair (NB) with or without nail plate replacement and fixation (NP), with or without splinting or casting. However, it remains unknown if the degree of fracture immobilization affects the rate of DP fracture nonunion. Given challenges in immobilizing young children’s fingers effectively, exploring less restrictive treatments could streamline care, reduce risks like impaired blood flow, and minimize recovery disruption. This study aims to estimate the association between the degree of immobilization in the treatment approach and the occurrence of fracture nonunion.
Methods: A retrospective chart review of children with DP tuft fractures associated with a nail bed injury. Eligible study patients were identified by screening the clinical databases of pediatric plastic surgeons at BC Children’s Hospital (BCCH) and were included if they were seen at the BCCH Plastic Surgery Clinic between 2014 and 2023. Demographics, treatment type, and complication details were collected from medical charts. Treatment approaches were categorized as having lower degrees of immobilization (dressing alone, nail bed repair (NB), and nail plate replacement and fixation (NP)) or higher degrees of immobilization (splinting or casting). Occurrences of nonunion or complications were analyzed by treatment approach(es).
Results: To date, 35 patients (mean age = 6.2 years; 75% right hand dominant; 49% female) met eligibility criteria. Most injuries resulted from crush mechanisms (86%). Primary treatments by immobilization degree were: dressing alone (n=5), NB (12), NP (4), NB+NP (5), NB+splint (3), NP+splint (1), NB+NP+splint (1), and splinting/casting alone (4). Four patients (11.4%) experienced one or more complications following their injury. These complications included: need for revision surgery; improperly reduced fractures; fever, rash, and infection; reduced active flexion of the DIP joint; and delayed union. Of note, one patient experienced challenges with their splinting and casting treatment. No instances of nonunion occurred, with comparable healing rates across treatment approaches.
Conclusion: Preliminary results suggest no association with immobilization degree for treatment and occurrence of nonunion. This suggests that less restrictive methods like NB may be as effective as more extensive immobilization like splinting or casting in young patients, with patients unlikely to experience nonunion. Future research should validate these findings with larger cohorts and a prospective methodology
Congratulations to Sara on receiving a BC Children’s Hospital Summer Studentship
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Irene Chen
Master’s Student, University of British Columbia Supervisor - Dr. Tom Blydt-Hansen
Social
media as a tool to explore mental health in children living with a solid organ transplant and their families
Irene Chen, Christopher Yu, Julie Robillard, Tom Blydt-Hansen
Background: Solid-organ transplantation (SOT) can save a child from organ failure, but it comes with many challenges. Recent studies show higher rates of anxiety, depression, chronic stress and post-traumatic stress symptoms in pediatric organ recipients, and their families.
Although social media is an important resource for children and adolescents with chronic health conditions, we know very little about how children with a SOT and their families share and access information on social media. The objective of this project is to determine how the SOT patient community uses social media to engage about mental health.
Methods: A comprehensive search of relevant posts was performed on Reddit (n=2 subreddits) and Facebook (n=22 groups). Publicly available posts containing a self-disclosure as someone or the family member of someone that has received a SOT during 0-24 years of age were retrieved for analysis using inductive content and thematic analysis. We will further code posts using a mental health-specific coding guide. Descriptive statistics will be used to describe the sample.
Results: Preliminary content analysis of n=70 Reddit posts identified primary codes, including personal experiences pre- and post-transplant, and seeking or providing advice, information, or support. Mental health discussions primarily centred on experiences with medical trauma or depression, as well as attitudes toward death and mental health services in transplant care. Users frequently sought advice on how to cope with mental health or emotional challenges, and group members often offered support in the form of well-wishes, providing reassurance, or validating experiences.
Conclusions: This study will contribute new evidence and actionable findings on the mental health challenges shared by pediatric transplant patients and their families on social media. By understanding how this community uses social media, we can advocate for the improved quality and availability of mental health resources both online and offline.
Congratulations to Irene on receiving a CIHR Master’s Award
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Rishi Gupta
Medical Student, University of British Columbia Supervisor - Dr. Gurpreet Salh
How do the Neurocognitive Profiles of FASD and Complex Trauma Compare in the Pediatric Population: A Scoping Review Protocol
Rishi Gupta, Colleen Pawliuk, Denise Somuah-Asamoah, Gurpreet K. Salh
Background: Prenatal alcohol exposure associated with neurocognitive deficits is often diagnosed as Fetal Alcohol Spectrum Disorder (FASD). As of 2019, the prevalence of FASD in Canada amongst the pediatric population is 1 in 1000. On the contrary, complex trauma exposure, in the form of adverse childhood experiences (ACE’s) is associated with similar neurocognitive deficits through a different pathway. Recent evidence suggests ACE exposures to be higher in individuals with FASD as compared to non-FASD controls which warrants a better understanding of how the neurocognitive deficits associated with FASD and complex trauma overlap.
Objective: The aim of the scoping review is to compare the neurocognitve profiles of children and youth diagnosed with FASD to those of children and youth presenting with complex trauma.
Methods: The scoping review will assess various studies that evaluate the neurocognitive profiles of FASD and complex trauma amongst the pediatric population (aged 0-18). The inclusion criteria will follow the PCC (population, concept, complex) framework. The databases to be searched include MEDLINE (Ovid), Embase (Ovid), PsycINFO (EBSCO), Scopus and Google Scholar. The grey literature will also be searched and backwards citation searching will be conducted of all included sources and all relevant systematic and scoping reviews. Title and abstract screening and full-text review will be performed by at least two independent reviewers. Data extraction will be performed using a tool developed for this review. The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a PRISMA flow diagram. The results of the scoping review will further be presented in a narrative and tabular format.
Significance: The review aims to bridge the current literature gap between FASD and complex trauma. A more robust understanding comparing the neurocognitive profiles of FASD and complex trauma can guide assessment, diagnosis, and interventions to support the long-term management of youth with cognitive impairments.
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Alysha Lee
Medical Student, Royal College of Surgeons in Ireland Supervisor - Dr. Michelle Demos
Equity of Access to Diagnostic Genomic Testing for Pediatric Epilepsy Patients
Alysha Lee, Kimia Ameri, Kira Burke, Cyrus Boelman, Scott Ramsay, Shelin Adam, Michelle Demos
Introduction: Epilepsy is a disorder of the brain characterized by an ongoing predisposition to epileptic seizures, and 30% of pediatric epilepsies have a genetic etiology which can be diagnosed by whole exome sequencing (WES). A diagnosis can provide information in terms of prognosis and treatment. While BC Children’s Hospital (BCCH) is the referral centre for all children with epilepsy in BC and the Yukon, clinicians have noticed a possible lack of diversity in families accessing WES. The objective of this study is to identify if WES used in epilepsy patients is equitability distributed.
Methods: In Phase I of this retrospective study, data was collected on all 59 children who received WES in 2021-2022 and were patients of two neurologists. Demographic variables collected from electronic medical records included patients’ age, sex, ethnicity, city of residence, country of birth, and language spoken by parents. The BC Rural Retention was used to find geographic residence and the BC Municipality Health Profiles were used to identify income and education.
Results: Results show 95% of parents spoke English; other primary languages were Punjabi, Chinese, and Tigrinya. Of the 25 countries of birth recorded in the physicians’ notes, 20 patients were born in Canada and 5 were born in India, Sudan, South Korea, Nigeria, or Iran. Ethnicity was recorded for 31 patients–14 (45%) Caucasians, 5 Indigenous, 4 Indians, 3 Chinese, 2 Filipinos, 1 South Korean, 1 Japanese, and 1 Persian. Fifteen families (25%) came from rural areas.
Conclusion: Our current data indicates most families were able to converse in English, despite having a range of ethnicities and backgrounds. However, due to our small numbers, we are unable to draw conclusions on whether our population is reflective of the BC population. In phase 2 of the study, we will include patients of other BCCH Pediatric Neurologists, and then compare the demographic characteristics of our families to BC and Statistics Canada population data. By identifying the social determinants of health in our population, we can determine if there is equity of access to WES and thus improve the diagnosis and treatment of epilepsy for all patients.
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Michael Li
Medical Student, University of British Columbia Supervisor - Dr. Ram Mishaal
Increased Oral Baclofen Dose as a Preoperative Adjunct for Children with Cerebral Palsy
Michael Li, Naama Rozen, Ram Mishaal
Background: Cerebral palsy (CP) refers to a group of nonprogessive movement and posture disorders and is a leading cause of childhood disability. Children with CP frequently experience increased muscle tone, which may lead to complications, such as hip displacement, that necessitate surgical intervention. Botulinum toxin A (BoNT-A), a muscle relaxant, is often perioperatively injected to improve surgical outcomes and reduce postoperative pain and muscle tone. However, several studies have reported long-term adverse effects of BoNT-A injections, including significant reductions in bone size and density, muscle atrophy, and fibrosis, including in remote muscles that have not been injected. Oral baclofen is another drug that has been used to relieve hypertonia in children with CP. We assume that increasing baclofen dose before surgery may be an effective adjunct that could improve outcomes, with potentially less long-term adverse effects. This narrative review examines the available evidence on the effectiveness and safety of increased oral baclofen dose as a preoperative adjunct for children with CP.
Methods: Conducted a narrative literature review using PubMed and Ovid Medline databases using terms like “children with cerebral palsy,” “oral baclofen,” and “surgery.”
Results: Oral baclofen as a preoperative adjunct remains unexplored. Despite its clinical utility, a limited number of studies report conflicting evidence regarding baclofen’s effectiveness in reducing muscle tone and improving motor function and activities of daily living. There have been no reports of long-term adverse effects, while acute adverse effects are often non-severe, reversible, and dose-dependent. Increasing baclofen dose should be done gradually over time to prevent toxicity.
Significance: This review addresses the current literature gap on the effectiveness and safety of increased oral baclofen dose as an adjunct for children with CP, and provides a rationale for a future comparative interventional study on surgical outcomes using BoNT-A versus increased baclofen.
Congratulations to Michael on receiving a UBC Faculty of Medicine Summer Student Research Award
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Ying Jie Li
Medical Student, University of British Columbia Supervisor - Dr. Amjad Tobia
Why Not a Cochlear Implant?: Demographic, clinical, and psychosocial parameters that influence decision to decline cochlear implant in eligible candidates
Ying Jie Li, Jayant Seth, Fainess Mwakisimba, Amjad Tobia
Background: Each year, around 2000 Canadian children are born with clinically significant hearing impairment. These deficits can interfere with a child’s ability to attain normal developmental milestones in language acquisition, cognitive development, and social behavior. Previous studies have shown relationships between impaired hearing to higher rates of grade failure in the pediatric population, leading to increased mental illness, isolation, and unemployment in adult life. Cochlear implants (CI) enable hearing to be restored in this patient population, with early implantation showing restoration of normal language development and academic achievement. However, with the recent expansion of CI candidacy to include single sided deafness (SSD), there appears to be an increasing number of CI candidates declining the intervention.
Objectives: The aim of this study is to investigate clinical, demographic, and psychosocial parameters associated with the increased rate of Cochlear Implant refusal in eligible pediatric candidates.
Methods: Participants will be identified from referrals to the Cochlear Implant team between April 2015 to March 2024. Patients who presented with unilateral or bilateral deafness and were candidates for CI will be selected for chart review. Data from these charts including age, gender, ethnicity, distance of residence address from BC Children’s Hospital, duration and compliance of hearing aid use, etiology of hearing loss, degree and laterality of hearing impairment, other medical conditions, and psychosocial parameters including parents’ jobs, education, family support and structure, hearing status of parents, and association with deaf culture will be extracted. Regression analysis will be performed to assess the association of these independent variables with rates of CI refusal. Data extraction is ongoing at the time of abstract submission.
Significance: Due to the recency of SSD inclusion in CI candidacy, there is insufficient data looking at the interplay between socioeconomic and sociocultural factors contributing the denial of CI in the pediatric population. The results of this study will help to elucidate avenues to support cochlear implant candidates facing barriers to accessing or accepting the intervention.
Congratulations to Ying Jie on receiving a UBC Faculty of Medicine Summer Student Research Award
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Victoria Porter
Medical Student, University of British Columbia Supervisor - Dr. Matthias Görges
Effects of End-Tidal Carbon Dioxide Concentration on Depth of Anesthesia in Children Undergoing Total Intravenous Anesthesia
Victoria Porter, Victoria Buswell, Matthias Görges, Teresa Skelton, Chris Chin
Background: Carbon dioxide (CO2), an end-product of metabolism, can be manipulated via controlled ventilation during general anesthesia. Elevated CO2 levels (hypercapnia) are associated with sedation, reduced consciousness, and selective pain suppression; it may also reduce wound infection rates, postoperative nausea and vomiting, and emergence times from volatile anesthetics. Conversely, lowered CO2 levels (hypocapnia) are associated with cerebral vasoconstriction, lightheadedness, altered consciousness and paresthesia. Total intravenous anesthesia (TIVA) is a commonly used anesthetic technique for its many benefits. However, the impact of CO2 on TIVA requirements has yet to be well-studied. TIVA can be guided by an electroencephalography-based depth of anesthesia monitor such as the Bispectral Index (BIS). This study aims to determine the effect of end-tidal CO2 concentration (etCO2) on the depth of anesthesia in children, as measured by BIS.
Methods: Patients aged 3-11 undergoing minimally stimulating procedures with an anticipated surgical time of over 90 minutes were recruited. Participants received a standardized TIVA anesthetic using a fixed manual propofol titration scheme, resulting in a blood concentration of approximately three mcg/ml of propofol. BIS was recorded continuously during three 15-minute steady etCO2 levels: 30, 40, and 50mmHg, assigned in random order to each participant. Time-series plots of BIS and etCO2 for each participant were made, and the effects of varying etCO2 levels on serial BIS measurements were analyzed using generalized estimating equations.
Results: Data from five initial participants, including four females, with a median age of 9.3 years, were available for analysis. Median BIS values and etCO2 levels are inversely related. For each 10 mmHg increase in etCO2, BIS values decreased by 0.35 points.
Significance: Data collection is ongoing. Discovering a correlation between etCO2 and BIS could significantly change anesthetic practice, as optimized etCO2 levels could enable lower amounts of anesthetic drug administration. This would benefit patients by exposing them to less medication and fewer associated side effects and contribute to planetary health by reducing drug wastage and disposables.
Congratulations to Victoria on receiving a UBC Faculty of Medicine Summer Student Research Award
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Charuta Sahasrabudhe
Medical Student, University of British Columbia Supervisors - Dr. James Lee & Dr. Marie Wright
Identifying and addressing barriers to treatment compliance in pediatric users of home non-invasive respiratory support
Charuta Sahasrabudhe, James Lee, Marie Wright
Introduction: A growing number of pediatric patients are being treated with home non-invasive respiratory support (CPAP or BiPAP) for management of a range of pulmonary, airway, and neuromuscular disorders. To achieve maximal benefit from this treatment, it must be used regularly and as prescribed. At BC Children’s Hospital (BCCH), the Home Tracheostomy and Ventilation (HTV) clinic supports approximately 130 children and youth aged 0-18 years who use home CPAP/BiPAP for a range of indications. Our institutional experience is that suboptimal compliance with therapy is common, particularly in the initial period of CPAP/BiPAP introduction, and may disproportionately affect certain patient groups.
Aim: Our project aims to identify the prevalence of suboptimal compliance with NIV support in the pediatric population of BC and characterize barriers versus predictors of adherence.
Methods: A literature review was conducted to identify barriers and protective factors to NIV adherence and this information was used to guide the creation of a REDcap data collection tool. This tool was then used to conduct a 5-year retrospective chart review of patterns of treatment compliance (defined as usage for >4 hours per night for >70% of nights) amongst pediatric patients aged 6-18 years who are prescribed home noninvasive respiratory support for any indication. Patient characteristics, family composition/community supports, and reasons for treatment discontinuation (including treatment failure due to non-compliance) were recorded. Characteristics of patients who achieve optimal versus suboptimal treatment compliance will be compared using appropriate statistical tests. Findings from this review will be used to put our Quality Improvement charter into action and develop tools to help increase NIV compliance.
Significance/Implications: Although suboptimal compliance with home respiratory support is a recognized risk factor for treatment failure and adverse health outcomes, our understanding of the contributory factors is incomplete, and the ideal care model for optimization of pediatric CPAP/BiPAP compliance is not known. Given the growing use of home non-invasive respiratory support in children, it is becoming increasingly important that best-practice approaches for effective delivery of therapy are identified. We anticipate that this project will add to the existing evidence base around this subject.
Congratulations to Charuta on receiving a BC Children’s Hospital Summer Studentship
Session #7
Participants:
Clare Cunningham
Ciana Dawydiuk-Clozza
Mahnoor Faisal
Angela Onyu Lee
Noah Shew
Jiayi (Joy) Yang
Hayley Yau
Moderator:
Shruti Muralidharan
Watch In-Person
Thursday, July 25 | 11:00 am – 12:30 pm
Chieng Family Atrium, BCCHR
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Clare Cunningham
Undergraduate Student, University of British Columbia Supervisor - Dr. Jaime Guzman
Trajectories of Physical Function in Children with Juvenile Idiopathic Arthritis: Results from the CAPRI Registry
Clare Cunningham, Roberta Berard, Matthew Berkowitz, Brian Feldman, Nicole Johnson, Lillian Lim, Thomas Loughin, Meghan McPherson, Paivi Miettunen, Jean-Philippe Proulx-Gauthier, Dax Rumsey, Heinrike Schmeling, Lori Tucker, Kristin Houghton, Jaime Guzman
Background: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood. Contrary to historical cohorts, it is hoped that with contemporary treatments most children with JIA will quickly improve in physical function. However, little is known about the long-term trajectories of function across JIA categories, and the factors that may influence them.
Objective: To describe the trajectories of physical function across JIA categories during the first three years following diagnosis and assess the impact of age, sex, and number of active joints.
Methods: We included children enrolled in the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry between February 2017 and April 2024. Physical function was assessed using the Kids Disability Screen (KDS); the mean of numerical answers (from 0 to 10) to two questions: “Does your child usually need help from you or another person because of arthritis?” and “Is it hard for your child to run and play because of arthritis?” Data was detailed with descriptive statistics and mean trajectories were charted using LOWESS.
Results: This study included 940 patients. Most children had oligoarthritis (45.3%), the median age at diagnosis was 9.1 years, and 63.2% were female. Trajectories varied across JIA categories. Polyarthritis RF+ had the highest mean KDS score upon diagnosis, and psoriatic arthritis the lowest. At three years follow up, patients with ERA and systemic JIA seemed to have higher mean KDS scores than the other categories. Although LOWESS indicated that KDS scores decreased for all categories over time, no category reached a mean of zero. Higher active joint counts at diagnosis and female sex appeared to be associated with higher mean KDS scores until weeks 80 and 140 respectively. Age at diagnosis did not seem to have a consistent relationship with mean KDS scores.
Conclusion/Implications: JIA categories that start at different levels of functional impairment all show improvement over time, but a subset of children continue to report functional deficits well into their disease course. On average, females, and patients with higher active joint count at baseline report higher levels of disability. We highlight the need for further research to better describe the population of those with persisting functional deficits in order to provide targeted intervention to those who need it most.
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Ciana Dawydiuk-Clozza
Undergraduate Student, University of British Columbia Supervisor - Dr. Tim Bhatnagar
The Relationship Between Verbal Directions and Landing Strategy During a Drop Jump. Indicator of Secondary Anterior Cruciate Ligament (ACL) Injury Risk
Ciana Dawydiuk-Clozza, Tim Bhatnagar
Introduction: The goal of the anterior cruciate ligament (ACL) return to sport (RTS) assessment in The Motion Lab at BC Children’s Hospital is to identify potential ACL injury risk factors and assess movement quality before a patient is cleared to return to their activities. Motion capture technology is used to collect kinematic and kinetic data during RTS assessments. These assessments involve a series of functional movement activities, such as the drop jump.
For the drop jump, literature has identified a “stiff” landing technique as a risk factor for ACL injury. Associated variables include reduced knee flexion, increased knee extension moments, and increased ground reaction forces. Despite widespread use, the verbal instructions provided prior to performing a drop jump vary substantially between different institutions. To our knowledge, few studies have looked at the effect of verbal instructions on the strategy used when performing the drop jump.
Objective: This study aims to assess the effect of different verbal prompts on drop jump biomechanics in healthy adult participants.
Methodology: Standard drop jump protocol consists of jumping forward off of a box, landing a half-height distance away with one foot on each force plate, and immediately performing a vertical jump. Two different prompts were given for the vertical jump after the initial landing: (1) to jump as high as they could and (2) jump off of the ground as fast as possible, as if the floor was hot. Three trials were collected for each.
Significance: We hypothesize that participants will present with ”stiff” landing characteristics when prompted to reduce contact time with the ground. Conversely, we expect to see “soft” landing characteristics (increased knee flexion) when directed to jump as high as possible. Current literature suggests that the tendency to perform stiff landings is problematic as it is reflective of the mode of injury seen for most non-contact ACL tears. However, the ability to perform stiff landings is desired as it represents an individual’s capability to absorb and recycle force. This study hopes to provide preliminary insight into whether verbal directions can help indicate a patient’s tendency versus ability to perform a “stiff” landing.
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Mahnoor Faisal
Undergraduate Student, University of British Columbia Supervisor - Dr. Hal Siden
Prevalence and Practices of Pediatric Medicinal Cannabis Use at BC Children’s Hospital
Mahnoor
Faisal, Hal Siden
Background: As scientific research in alternative medicine grows, more caregivers are seeking medicinal cannabis for pediatric patients despite limited evidence and guidelines. This study investigates the medicinal use of cannabinoids among pediatric patients visiting BC Children’s Hospital (BCCH) and Sunny Hill Health Centre (SHHC).
Objective: This study aims to learn about medicinal cannabis practices, understand caregiver attitudes and sources of information, and identify challenges faced by families. My focus is on family attitudes and experiences with medicinal cannabis use in pediatric care.
Methodology: The study is divided into three phases exploring family experiences and practices of pediatric medicinal cannabis use. Phase 1 involved pilot interviews in the BCCH Oncology Clinic and Phase 2 piloted an online survey at the BCCH Oncology Clinic. We are currently in Phase 3, where participants are asked to complete an online survey during BCCH and SHHC clinic visits to explore their experiences with pediatric medicinal cannabis. Data and themes were extracted from multiple choice and open-text questions.
Preliminary Results: Of the respondents, most were from a white ethnic group and cancer was the most common reported condition. Only 17 out of 281 respondents indicated their child had used cannabis products for medicinal purposes. Content from the open-text questions revealed that parents who chose not to pursue medicinal cannabis cited a lack of sufficient evidence or no perceived need. Users mainly obtained information from their healthcare providers at 69% compared to only 39% of non-users, while 45% of non-users reported having no information at all about the topic. Roughly half of both groups reported trusting their healthcare provider for information on medicinal cannabis. However, users reported more supportive provider attitudes towards pediatric medicinal cannabis use at 69% compared to only 23% of non-users. Users also reported less uncertainty about their providers’ attitudes.
Future Directions: We plan to continue recruiting in clinics across BCCH, SHHC, and expanding to a pediatric hospice. We are addressing barriers such as the lack of virtual recruiting options, language barriers, and lack of response from some clinics. The study will also expand to testing the contents of cannabis used by pediatric patients.
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Angela Onyu Lee
Undergraduate Student, University of British Columbia Supervisor - Dr. Mariana Brussoni
Evaluating Physical Infrastructure and Outdoor Play Environments in Early Learning and Child Care Centres across Canada
Angela Onyu Lee, Rachel Ramsden, Hebah Hussaina, Mariana Brussoni
Research Objectives: Quality outdoor play opportunities are crucial for children’s physical, cognitive, social and emotional development. Integrating and prioritizing outdoor experiences in early learning and child care (ELCC) settings is essential for enhancing children’s overall health and well-being. Despite these recognized benefits, there is currently limited information on the current state of outdoor play in ELCC programs across Canada. Each province and territory regulates the design, standards, and delivery of child care services independently, leading to significant diversity in outdoor play environments and protocols. The aim of the present study is to collect data on the available physical infrastructure of ELCCs across provinces, comparing and contrasting the outdoor play environments and facilities to identify potential factors that hinder equitable access to high-quality child care.
Methods: As part of a pan-national survey, the research team requested the submission of photos (approximately 500) that feature the outdoor spaces from regulated, centre-based ELCC programs that provide full-day child care. The current analysis considered six Canadian provinces – British Columbia, Manitoba, Alberta, Ontario, Nunavut Yukon and Newfoundland – as the analysis of other provinces/territories is still ongoing. The submitted photos were analyzed using a structured environmental codebook, developed internally by the research team. The categories within the codebook were determined based on the survey questions regarding the outdoor play environment and facilities, which were derived from a comprehensive review of literature on outdoor play provision. These categories include the eleven major elements of outdoor spaces: fixed play structure, play equipment, foliage, storage, surfacing, loose parts, seating, table, fence, covered elements, and wheeled toys, with some subcategories reflecting material types. The descriptive coding of the submitted photographs was conducted using the qualitative data analysis program NVivo.
Future Directions: Future studies should investigate the factors that cause the discrepancy between provinces regarding the physical infrastructure in outdoor play space, such as funding allocations, policy differences, and regional economic conditions. In addition, triangulating data from quantitative surveys, open-text qualitative feedback and photos can provide a comprehensive understanding of the barriers to equitable access and help inform targeted strategies to enhance outdoor place spaces across all provinces.
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Environment
Noah Shew
Undergraduate Student, University of Guelph Supervisor - Dr. Sharon Smile
Scan of Food Insecurity Screening Practices at BC Children’s Hospital: a Quality Improvement Project
Noah Shew, Sharon Smile
Background: Food insecurity (FI) is a lack of sufficient access to safe and nutritious food for an active and healthy life. As food becomes more unaffordable and individuals are financially constrained, food insecurity is a prevalent health concern across families in Canada. Unfortunately, in 2023, over 1 in 4 children (28.8%) under eighteen lives in a food-insecure household in British Columbia. FI is associated with parental stress and depression, nutritional deficiencies, emotional and behavioural dysfunction, cognitive development issues, higher frequency of illness, and slower recoveries from illness. Pediatric professional associations and experts recommend screening for FI using validated tools such as the 2-item Hunger Vital Sign and connecting families to community-based resources.
Objective: To determine the proportion of clinics at BC Children’s Hospital (BCCH) that routinely screen for FI and identify potential barriers to FI screening.
Methods: We created a database of medical clinics at BCCH using internet searches, the BCCH hospital directory and speaking with program directors within each program. We developed and refined a survey by piloting it with a physician, psychologist, and social worker. The survey was modified to include items regarding perceived barriers to FI screening. The Research Electronic Data Capture platform (REDCap) was used to build the survey and to support data collection and management. We will survey two clinicians, a lead physician or nurse practitioner, and a social worker from each clinical program across BCCH regarding their FI screening practices.
Preliminary Results: We identified 48 clinics to survey at BCCH. To date, five clinicians have completed the survey, of which n=4 (80%) were indirectly screening for FI based on the clinical presentation (by asking about household finances). No respondent used a formal screening tool, nor was screening for FI routinely done. Data collection is ongoing at the time of submission of the abstract.
Significance: The harmful impact of FI on a child, youth and/or their caregiver’s health is longstanding and impairing, negatively influencing cognitive skills to mental health. Without early identification and intervention, FI’s deleterious effect is a silent driver of ill health.
Congratulations to Noah on receiving a Sunny Hill Summer Student Award
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Jiayi (Joy) Yang
Undergraduate Student, University of British Columbia Supervisors - Dr. Michael Hawkes & Dr. Ashley Roberts
Soluble triggering receptor expressed on myeloid cells 1 in children and young adults with dengue virus infection in the Philippines
Jiayi Yang, Hridesh Mishra, Michelle Ngai, Valerie M. Crowley, Vanessa Tran, Maria Salome Siose Painaga, James Yared Gaite, Patrick Hamilton, Kevin C. Kain, Michael T. Hawkes
Background: Soluble triggering receptor expressed on myeloid cell 1 (sTREM1) concentration is commonly increased in dengue patients and recognised as an important regulator in immunopathogenesis of dengue. However, its prognostic significance and role in adaptive immunity are not well studied. We hypothesize that sTREM-1 acts as a marker and amplifier of neutrophil activation in the innate immune response, contributing to immune dysregulation in the adaptive response following secondary infection, potentially promoting vascular leakage and adverse clinical outcomes.
Objectives:
1) Investigate the relationship between sTREM1 levels and key immune responses, including cytokine and hematologic parameters
2) Assess sTREM1 in predicting key pathological processes and clinical outcomes to explore its potential utility in dengue prognosis and management
Method: In this prospective cohort study, we collected blood samples from children and young adults with confirmed dengue infection admitted to Lebumfacil-Santa Ana Medical Centre, Philippines. Plasma sTREM-1 and cytokine levels were measured and analyzed using a multiplex Luminex® assay. Complications (hemoconcentration, thrombocytopenia, hospitalization, intravenous fluid) were recorded.
Results: We enrolled 244 patients (median age 9, 40% female). The median sTREM-1 plasma concentration at clinic presentation was 54.10 pg/mL (IQR: 42.00-144.72 pg/mL). Elevated sTREM1 levels were associated with high absolute neutrophil count (95%CI -6.7x10-1 — -5.6x10-1, p=0.0019) and tumour necrosis factor concentrations (95%CI -1.0x10-1 — -5.2 x 10-6, p<0.0001). Patients with higher sTREM1 at presentation were more likely to develop hemoconcentration (RR=2.33, p=0.045). Hemoconcentration, in turn, was associated with subsequent hospitalization (RR=1.24, p=0.05) and greater IV fluid demand (95%CI -2.5 — -2.1x 10-5, p=0.017). Higher sTREM-1 concentrations in IgG+ patients were associated with abnormal cytokine and hematologic profiles, including elevated TNF and IL-10 levels and higher incidence of thrombocytopenia.
Conclusion: sTREM1 may be involved in neutrophil activation and vascular damage during innate immune response. We also provided the first clinical evidence of sTREM1’s role in adaptive immunity during dengue reinfection. IgG+ patients have higher sTREM1 along with abnormal cytokine and hematologic profiles. sTREM1 shows promise as a prognostic biomarker for predicting disease severity and clinical outcomes in dengue.
Congratulations to Jiayi on receiving a Healthy Starts Summer Studentship
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Examining
sleep
Hayley Yau
Undergraduate Student, University of British Columbia Supervisor - Dr. Evelyn Stewart
disturbance in pediatric autism spectrum disorder, obsessive-compulsive disorder and their comorbidity versus psychiatric controls
Hayley Yau, Anna MacLellan, Boyee Lin, Cynthia Lu, John R. Best, S. Evelyn Stewart
Introduction: It is often claimed that sleep quality is worse in individuals with pediatric autism spectrum disorder (ASD) or pediatric obsessive-compulsive disorder (OCD) when compared to individuals without ASD or OCD. However, the characteristics that impact sleep quality in pediatric ASD and OCD have not been examined together. Thus, the aim of this research is to examine specific traits in ASD and OCD that impact sleep disturbance in children and youth.
Objectives:
1) To compare sleep disturbance in a) pediatric ASD; b) pediatric OCD; c) pediatric comorbid ASD and OCD; and d) unselected psychiatric controls.
2) To investigate the correlation between symptom severity and sleep quality in: a) pediatric ASD; b) pediatric OCD; c) pediatric comorbid ASD and OCD.
Methods: Existing data will be extracted from the Sleep Disturbances Scale for Children (SDSC) and various symptom severity questionnaires stored in the Family Input Tool, a concurrent database that collects patient-reported clinical and demographic data from patients attending a mental health clinic at BC Children’s. Individuals with pediatric ASD (n = 90), OCD (n = 89), comorbid ASD and OCD (n = 18) and other unselected psychiatric controls (n = 435) will be analyzed using ANCOVA and multiple linear regression to compare sleep disturbances and examine correlations between symptom severity and sleep quality respectively.
Expected Outcomes: While analyses have yet to be completed, we predict clinically significant sleep disturbance will be identified in pediatric OCD and ASD populations, with differences in disturbance types. In addition, individuals with comorbid pediatric ASD and OCD will experience higher levels of sleep disturbance compared to those with separate diagnosis, as well as unselected psychiatric controls. Lastly, it is predicted that symptom severity will be negatively correlated with sleep quality in individuals with pediatric ASD and/or OCD.
Conclusion: This study investigates the differences in sleep disturbance between pediatric ASD, OCD, comorbid ASD and OCD, and unselected psychiatric controls to boost accuracy in diagnosing and differentiating the disorders. Additionally, this study provides important clinical implications to highlight the importance of personalized treatment approaches targeting sleep disturbances, to ensure this population receives individualized care for better therapeutic outcomes.
Congratulations to Hayley on receiving a UBC Faculty of Medicine Summer Student Research Award
Session #8
Participants:
Alexa Bailey
Ellie Kalutycz
Sophie Tran
Rhonwyn Waterson
Bradley Xiang
Yuchang (Janice) Zhan
Keshvi Vithlani & Grace Clarke
Moderator:
Sharon Hou
Watch In-Person
Thursday, July 25 | 11:00 am – 12:30 pm
Chieng Family Atrium, BCCHR
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Alexa Bailey
Undergraduate Student, McGill University Supervisor - Dr. Bruce Verchere
Amyloid Detection In-Vitro Using the QM-FN-SO3 Aggregate-Induced-Emission Probe
Alexa Bailey, Saumadritaa Kar, Bruce Verchere
Approximately 30,000 Canadian children are affected by type 1 diabetes (T1D), an autoimmune condition that attacks insulin-producing pancreatic β-cells, resulting in lifelong insulin dependency. While human islet transplants offer promising treatment for T1D, use is limited by donor availability. Consequently, stem cell-derived β-cells present a potential alternative.
Islet amyloid polypeptide (IAPP) is a 37-amino acid peptide hormone co-secreted with insulin from β-cells, playing a critical role in β-cell dysfunction in type 2 diabetes (T2D) and islet transplants. Increased insulin production, a response to insulin resistance and obesity in T2D, results in higher IAPP levels, which can aggregate into amyloid fibrils. Islet amyloid contributes to β-cell dysfunction and loss, exacerbating insulin deficiency and impairing glucose regulation. Rapid amyloid formation also occurs in pancreatic islet transplants in T1D, potentially contributing to graft failure. Thus, accurate detection of islet amyloid is crucial for advancing therapeutic strategies for diabetes.
This study investigates the novel aggregate-induced-emission probe, QM-FN-SO3 (quinoline-malononitrilethiophene-(dimethylamino)phenylsulfonate), developed for use with ß-amyloid in Alzheimer’s disease, for the detection of islet amyloid, which is implicated in islet dysfunction and diabetes. QM-FN-SO3, with its high binding sensitivity and specificity, is designed to distinguish between monomers and amyloid fibrils. Furthermore, it has high membrane penetrability allowing for both intracellular and extracellular measurements.
QM-FN-SO3 was validated by generating a standard curve using a fluorescence spectrophotometer with excitation and emission wavelengths at 488 and 680 nm, respectively. Our preliminary data suggest that QM-FN-SO3 exhibits a linear relationship between fluorescence intensity and amyloid concentration, offering a potential tool for accurately quantifying islet amyloid in vitro. Future studies will apply the QM-FN-SO3 probe to assess amyloid formation in vivo, in transplants of human stem cell-derived insulin-producing cells in diabetic mice.
By validating the QM-FN-SO3 probe, we aim to enhance the accuracy and efficiency of islet amyloid detection. Improved detection methods are critical for advancing stem cell therapies in T1D and for preserving β-cell function in patients with T2D.
Congratulations to Alexa on receiving a Canucks for Kids Fund Childhood Diabetes Laboratories Summer Studentship
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Ellie Kalutycz
Medical Student, University of British Columbia Supervisor - Dr. Marie Wright
Use of ventilator-assisted maximal inspiration chest physiotherapy for children and youth with neuromuscular disorders: a pilot study
Ellie Kalutycz, Marie Wright, Hilda Perry, Niamh Cushen, Megan Bruschetta
Background: Impaired airway clearance is a major contributor to respiratory morbidity in patients with neuromuscular disorders (NMD). Airway clearance techniques (ACT) are used by NMD patients to maintain lung health and reduce respiratory symptoms. A new type of ACT, “ventilator assisted maximal inspiration” (VAMI), is used to support children with NMD in the Home Tracheostomy and Ventilation (HTV) clinic at BCCH. Positive clinical outcomes have been observed and VAMI appears to be well-tolerated by patients; however, there has been no research investigating the clinical or quality of life outcomes of this treatment.
Objective: This project aims to obtain pilot data that will inform the design of a future clinical trial comparing VAMI to conventional forms of ACT in children and young adults with NMD.
Methodology: We conducted a 5-year retrospective chart review of patients with NMD currently or previously using VAMI, within the HTV clinic at BCCH. Patients acted as their own controls by comparing their clinical outcomes before and after the introduction of VAMI. A data collection tool was designed in REDCap, and several variables relating to lung health and function were be collected. Statistical analyses were used to assess the differences before and after treatment with VAMI, and to identify whether the impact of VAMI varies according to key patient characteristics.
Significance: The use of ACT is important in the management of patients with NMD. Despite this, there is an overall lack of clinical trials investigating the clinical impacts of ACT and its effects on patient/caregiver quality of life. There are even fewer studies looking at pediatric NMD patients. This project is an opportunity to help grow this limited academic literature. It will also be an important step in ensuring that NMD patients are receiving the best evidence-based care.
Congratulations to Ellie on receiving a UBC Faculty of Medicine Summer Student Research Award
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Sophie Tran
Medical Student, University of British Columbia Supervisor - Dr. Deborah Money
An Evaluation of COVID-19 Vaccine Reactogenicity and Pregnancy Outcomes, With and Without Influenza Vaccine Coadministration, during Pregnancy in Canada
Sophie Tran, Elisabeth McClymont, Jon Barrett, Tali Bogler, Isabelle Boucoiran, Eliana Castillo, Rohan D’Souza, Darine El-Chaâr, Safaa Fadel, Deshayne B Fell, Verena Kuret, Gina Ogilvie, Vanessa Poliquin, Manish Sadarangani, Heather Scott, John W Snelgrove, Modupe Tunde-Byass, Deborah Money for The COVERED Team
Background: COVID-19 vaccination in pregnancy has been shown to provide effective protection against the incidence and severity of SARS-CoV-2 infection, while also being safe for both pregnant persons and their infants. The evolving mutations of dominant variants of SARS-CoV-2, in addition to the waning protection of vaccines over time, have called for supplementary dosing (booster doses) and the development of updated vaccine formulations.
In addition to the COVID-19 vaccines, influenza vaccinations are recommended during pregnancy. However, there are currently very little data published on the impact of coadministration of COVID-19 vaccines with other vaccinations in the pregnant population. Continued monitoring of the reactogenicity and adverse events specific to obstetric and neonatal populations is necessary to track the impact of COVID-19 vaccines administered during pregnancy in a fulsome manner.
Methods: The Canadian COVID-19 Vaccine Registry for Pregnant Individuals (COVERED) was a national prospective cohort study that investigated the reactogenicity and pregnancy outcomes post-COVID-19 vaccination in pregnancy. Eligible participants were pregnant in 2023, at least 19 years of age, and residing in Canada. Pregnant participants could be vaccinated or unvaccinated. Study enrollment and data collection ran from September 1, 2023 to March 31, 2024. Online surveys, using REDCap, were delivered at multiple time points. Additional surveys were offered regarding vaccine outcomes, the development of new health events, and pregnancy outcomes, when applicable.
Preliminary Results: Of the 1137 participants who e-consented to the study, 845 have completed the baseline demographic survey. 438 follow-up surveys have been completed. We have collected 345 surveys on vaccine outcomes, 454 on pregnancy outcomes, and 34 on health events. Data analysis is currently in progress at the time of abstract submission.
Significance: The findings of this study are expected to add strength to the current evidence that COVID-19 vaccinations are safe to be administered in pregnancy. We expect that, similar to the general population, coadministration of the influenza and COVID-19 vaccines in pregnancy may cause increased reactogenicity when compared to single administration but will not increase the risk of adverse maternal or neonatal outcomes.
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Rhonwyn Waterson
Medical Student, University College Dublin Supervisor - Dr. Sylvia Stockler
Finding treatments for creatine transporter deficiency: a drug repurposing timeline
Rhonwyn Waterson, Aamina Shah, Roger Dyer, Peter Axerio-Cilies, Sylvia Stockler-Ipsiroglu
Introduction: The SLC6A8 gene on the X chromosome encodes for a creatine transporter (CRT-1) in the brain, heart, and muscle. Creatine Transporter Deficiency (CTD) is one of the most common causes of X-linked intellectual disability and causes inadequate uptake of creatine into cells in the brain. CTD patients experience frequent seizures, intellectual developmental disabilities, and autism-like behaviours. However, there is currently no effective treatment available for CTD.
Previous Work: In silico drug screening using a library of FDA approved drugs to identify drugs that would bind to the 3D structure of CRT-1. In vitro testing of candidate drugs for their ability to rescue mutant CRT-1 activity using electrophysiological patch clamp technique in CRT-1 variant transfected HEK293 cells.
Objectives:
Long term: Find one FDA approved drug that can rescue the function of this transporter. Short term: Quantify the amount of creatine uptake in Wild Type (WT) (“normal”) and SLC6A8 variant (“mutated”) Phe408del fibroblast cell lines.
Methods: Cellular uptake of D3 labelled creatine (D3-creatine) and its intracellular conversion to D3-Phosphocreatine and D3-Creatinine were compared between the two cell lines. Guanidino-propionate (GPA), a competitive inhibitor of the creatine transporter, was used to confirm specificity of the measured uptake rates for the CRT-1 transporter.
Results: We have created data for time and dose dependent D3-creatine uptake in wild type and Phe408del fibroblasts informing experimental protocols for further drug testing.
Discussion: Using patient fibroblasts, we are validating the results of creatine uptake in WT and Phe408del variant cells. We were able to show that creatine uptake in fibroblasts is dose dependent, and that D3-Creatine is further metabolized into D3-Phosphocreatine and D3-Creatinine. Creatine uptake in WT cells is CRT-1 specific as shown by use of GPA inhibition of the transporter. While there is some uptake of creatine seen at higher concentrations in Phe408del variant fibroblasts, more experiments using GPA are needed to prove if this uptake is specific to the CRT-1 transporter.
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
A
Bradley Xiang
Undergraduate Student, University of British Columbia Supervisor - Dr. Manish Sadarangani
Proteome Quest: Proteomic Analysis of Klebsiella pneumoniae in Varying Growth Conditions
Bradley Xiang, Liam Mullins, Emily Mason, Kaitlin Winter, Kristen Tien, Manish Sadarangani
Background: Klebsiella pneumoniae (Kp) is a Gram-negative bacterium that causes a wide range of infections and is listed as a World Health Organization priority pathogen due to risk of antimicrobial resistance (AMR). As AMR infections rise globally, vaccination is an important strategy for infection prevention. Thus far, vaccine attempts have been unsuccessful due to the high diversity of proposed vaccine antigens across Kp strains. Alternatively, some surface-expressed outer membrane proteins (OMPs) are immunogenic and highly conserved, making them ideal antigens for vaccination. Previously, our lab developed a bioinformatics pipeline to identify conserved OMP-encoding genes by analysis of >1000 Kp genomes. However, gene presence alone does not indicate protein expression levels. Ideal OMP candidate vaccine antigens should be widely expressed across diverse strains.
Objectives:
1. Identify highly conserved proteins expressed by Kp grown in nutrient-rich Brain-Heart Infusion (BHI) and nutrient-limited M9 minimal salts media.
2. Compare selected protein candidates with the OMP-encoding genes previously identified using the bioinformatics pipeline.
Methods: Based on sequence type, infection source, capsule and lipopolysaccharide type, and AMR, we selected 17 clinical isolates of Kp from a panel of 100. Additionally, we selected 3 Kp clinical isolates previously obtained from BC Children’s Hospital. Strains were grown in both BHI and M9, imitating nutrient-rich and nutrient-limited growth conditions. Samples underwent liquid chromatography tandem mass spectrometry and were compared to a well annotated reference strain proteome (NTUH-K2044). After filtering the normalized protein intensities and obtaining the Kp proteome, bioinformatic tools including PSORTb and UniProt will be utilized to determine the subcellular location of the proteins, with only outer membrane proteins being kept. The remaining proteins will then be filtered for homology to human proteins and compared to our existing core genome data.
Conclusion/Significance: This project will characterize the protein expression of globally representative strains of Kp in growth conditions that replicate nutrient conditions within typical infections. Findings will guide decisions in the design of Kp vaccine candidates for future pre-clinical studies. Ultimately, this work will contribute to our long-term goal of developing a broadly protective vaccine that targets OMPs that are conserved across a broad range of Kp strains.
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Yuchang (Janice) Zhan
Undergraduate Student, University of British Columbia Supervisor - Dr. Stefen Taubert
Investigating functions of efk-1/eEF2K in C. elegans hypoxia survival
Yuchang (Janice) Zhan, Judith Yan, Stefan Taubert
Introduction: Organisms often experience stresses like starvation and hypoxia, and they mount a conserved cellular response to adapt and survive. A vital component in the responses to starvation and hypoxia is eukaryotic elongation factor-2/eEF2 kinase (eEF2K). In starvation, mammalian eEF2K inhibits translation by phosphorylating eEF2, thus conserving energy for survival. However, how eEF2K promotes hypoxia survival is less clear. eEF2K is conserved in the nematode C. elegans as efk-1, also phosphorylates EEF-2 (worm eEF2), and is also vital for starvation and hypoxia survival. Interestingly, we found that unlike mammalian eEF2K, worm EFK-1 promotes starvation survival via a noncanonical, kinase-independent mechanism.
Objective: The purpose of this project is to examine if EFK-1 kinase activity is vital for hypoxia survival. We hypothesize that EFK-1 also promotes hypoxia survival via a kinase-independent mechanism.
Methods: Strains of wildtype (negative control), efk-1 null (positive control), and efk-1 kinase-dead (efk-1kd) mutants were put in hypoxia (0.5% O2) and room air, followed by quantification of their survival rate. If kinase activity is required, efk-1kd mutants should have reduced hypoxia survival, like null mutants.
Results: All strains showed a nearly 100% survival rate in room air, while efk-1 null mutants and efk-1 kinasedead mutants showed a similar and lower survival rate compared to wildtype strains under hypoxic stress.
Conclusions: The experimental data suggest that in C. elegans, EFK-1 promotes hypoxia survival dependent on its kinase activity.
Future Directions: Western blot will be used to test if hypoxia induces EEF-2 phosphorylation in wildtype worms (positive controls: efk-1 null, efk-1kd). The data will elucidate the mechanism of C. elegans efk-1 in hypoxia survival, revealing the evolutionary divergence of eEF2K-mediated stress responses.
Congratulations to Janice on receiving a UBC Faculty of Medicine Summer Student Research Award & an NSERC Undergraduate Student Research Award
July 25, 2024
11:00 am - 12:30 pm
Chieng Family Atrium
Keshvi Vithlani & Grace Clarke
Undergraduate Students, Queen’s University & University of British Columbia Supervisor - Dr. Gabriella Horvath
Characterizing Patient Outcomes for Status Dystonicus in the BC Children’s Hospital Pediatric Intensive Care Unit (PICU): A Retrospective Chart Review
Keshvi Vithlani & Grace Clarke (co-authors), Gabriella Ana Horvath, Dakota Peacock
Background: Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions leading to repetitive twisting movements, abnormal postures, or both. Status dystonicus (SD) is a severe form of dystonia with significant morbidity and mortality. Etiologies of dystonia are diverse, and worsening dystonia is difficult to recognize and treat. Clinicians are therefore challenged to manage SD in emergency settings.
Methods: PICU admissions for patients experiencing SD from 2014-2024 were identified via keyword search from the PICU database. Charts of included patients were manually queried for additional admissions meeting eligibility. Patient demographics, background clinical information, treatment methods, and outcomes were extracted. Dystonia was graded as 3 (cannot tolerate lying, sleep disturbed), 4 (as in 3 but with metabolic disturbance), or 5 (as in 4, but with full metabolic decompensation or organ failure).
Results: Seventy-eight admissions from 22 patients were reviewed, 17 children (9 males, 8 females) from 38 admissions met inclusion criteria. The average age was 6.9 ± 4.1 years (males 5.77 ± 3.78 years old, females 9.81 ± 3.46 years old). 44.7% of admissions had grade 3, 44% were grade 4 and 11% had grade 5. Average PICU stay was 10.9 ± 10.2 days. Infection was the most common trigger of SD (39.5%). Common underlying neurological diagnoses were genetic disorders (n=8), cerebral palsy (n=4), and idiopathic dystonia (n=3). Common anti-dystonia drugs used were clonidine, midazolam (oral and infusions), clonazepam, lorazepam, and baclofen. Clonidine, midazolam, and lorazepam were often highlighted as effective.
Discussion: This study defines the typical child with SD admitted to PICU in BC and their management. This is not an exhaustive list of SD in BC as our keyword search has limited sensitivity, and some cases had insufficient data to be included. Patient demographics are mostly consistent with previous literature with similar average ages and common triggers. Medication usage was consistent with previous studies but benzodiazepines were more commonly used and highlighted as effective in this study. Other centers have also implemented baclofen pumps which was not a significantly attempted treatment during our timeframe.
Congratulations to Keshvi on receiving a BC Children’s Hospital Summer Studentship
Session #9
Participants:
Maria Cheema
Josh Dyce
Orli Hellerstein
Lavisha Katyal
Kiana Rashidi
Setareh Setayesh
Samveer Uppal
Christina Zeng
Moderator:
Thais Rangel Bousquet Carrilho
Watch In-Person
Thursday, July 25 | 2:00 – 3:30 pm
Chieng Family Atrium, BCCHR
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Maria Cheema
Undergraduate Student, University of British Columbia Supervisor - Dr. Vishal Avinashi
Development of a Pediatric Constipation Resource Guide and Action Plan for Children: A Quality Improvement Initiative
Maria Cheema, Aruna Sethuraman, Vishal Avinashi
Background: Functional constipation accounts for 3-16% of pediatrician visits, and up to 30% of pediatric gastroenterology appointments. BC Children’s Hospital is the only exclusive children’s hospital providing gastroenterology services for the province. Constipation comprises one-third of the least urgent referrals faced by BC Children’s Hospital’s gastroenterology department, resulting in long waiting lists. Variabilities can be seen in the treatment of functional constipation and the plans for optimization before referral to gastroenterologists. Functional constipation is challenging to manage in clinics and at home, causing patients to progress to chronic symptoms, thereby lowering health-related quality of life.
Objective: To develop a pediatric constipation resource guide and action plan, providing information regarding pharmacological and non-pharmacological management options to families in the form of patient-friendly information.
Methods: Information necessary to include in the resource guide was collected from previous treatment plans, research articles outlining management options, and consulting pediatric gastroenterologists. We reviewed literature, guidelines, and standards regarding the development of patient-friendly materials. Literature regarding the use of action plans for other chronic pediatric conditions was examined. The resources created will be assessed primarily by members of the Pediatric Gastroenterology Division of BC Children’s Hospital. The action plan will be presented to a group of children and parents to seek their opinion on the comprehension, ease of use and actionability of the guide.
Anticipated Results: We expect that the implementation of the constipation resource guide and action plan will assist in creating a care pathway for physicians to use before referrals to pediatric gastroenterologists are needed, decreasing the number of referrals to the Pediatric Gastroenterology Department at BC Children’s Hospital.
Significance: The development of a constipation resource guide and action plan will encourage the creation of additional patient-friendly resources for chronic pediatric problems. These resources will increase caregiver and patient confidence regarding home management of health-related issues, leading to improved outcomes and quality of life for patients. The feedback submitted by patients and caregivers will help with the design of future resource guides, ensuring their suitability.
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Josh Dyce
Undergraduate Student, University of British Columbia Supervisor - Dr. Anthony Cooper
Artificial Intelligence-Driven Information Extraction and Documentation from Doctor-Patient Dialogue: A proof of concept study
Josh Dyce, Taqdir Ali, Harpreet Chhina, Anthony Cooper
Background: When patients have clinical visits, the encounter is documented as part of the patient’s electronic health record. This documentation is a critical resource for healthcare providers to access patients’ medical histories and track the progress of their medical conditions. Although important, this documentation process is time consuming and sometimes results in missed information.
Recent advancements in Artificial Intelligence (AI) have impacted the medical field by offering new tools to enhance healthcare quality. By leveraging machine learning and data analytics, AI applications are now capable of improving information extraction and documentation, streamlining treatment plans, and optimizing patient care. These technological advancements are transforming healthcare workflows, making them more efficient and precise, and are setting the stage for the future of medical innovation.
Objective: Use AI models to create orthopaedic clinic notes based on conversations between healthcare providers and patients.
Methods: A data pipeline was built that transcribes conversations using a pre-trained, open-source voice-totext machine learning model (Whisper from OpenAI) and converts the transcript into a clinical note using a pre-trained large language model (GPT-4 from OpenAI). A user-friendly software was developed to allow providers to easily use the program.
Three test scenarios will be designed to test the efficacy of the program. For each scenario, a healthcare provider will be shown the test scenario and asked to write a clinic note from scratch. Next, the provider will be asked to complete the clinic note with the help of the program. The amount of time taken to complete the clinic note in both situations will be compared.
Results: Data collection is ongoing at the time of abstract submission.
Significance: This project has the potential to reduce healthcare provider workload and improve clinical note accuracy and efficiency. On a larger scale, by combining this project with other AI projects ongoing in the orthopaedic department, including those to read and interpret X-rays, this project is a step forward in creating a comprehensive AI healthcare program.
Congratulations to Josh on receiving a BC Children’s Hospital Summer Studentship
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Orli Hellerstein
Undergraduate Student, University of British Columbia Supervisor - Dr. Todd Woodward
Delusion-like Beliefs Explored through Evidence Integration in Pediatric Patients with Obsessive-Compulsive Disorder and Anorexia Nervosa
Orli S. Hellerstein, Todd S. Woodward
Delusions—fixed false beliefs held with great conviction in the face of counter-evidence—are symptoms well known to psychologists for their presence in patients with schizophrenia (Luk et al., 2018). Discussions have arisen around the similarities between the delusions common in schizophrenia in adults and beliefs with delusional intensity held by pediatric patients with Anorexia Nervosa (AN) and Obsessive-Compulsive Disorder (OCD). Understanding of these beliefs is critical, as AN and OCD patients who hold beliefs with delusional intensity report poorer health outcomes than AN and OCD patients without these beliefs (Hartmann et al., 2013; Konstantakopoulos et al., 2012; Bellino et al., 2005; Vogel et al., 2006). The following study examines differences between (1) adolescents with anorexia in an intensive outpatient program (n = 26), (2) youth with OCD in an intensive outpatient program (n = 29), (3) siblings of youth with OCD (n = 17), and (4) healthy controls (n = 25) in performance on a version of the bias against disconfirmatory evidence (BADE) bias task adapted for youth. This cognitive task is traditionally used to examine the BADE cognitive bias present in schizophrenic patients with delusions. The BADE-Youth (BADE-Y) was developed for the purposes of the study to function in a youth sample. Participants completed 14 trials of the BADE-Y task and group differences were analyzed using multi-level analysis of variance (ANoVA). No significant differences in performance on the BADE were found between any participant groups. While results do not provide further insight on the original study aims, the BADE-Y showed validity related to the adult version in all groups. Future research should seek out patients with psychosis with strong delusions to test whether the BADE-Y is as sensitive to severity of delusions as the adult version.
Congratulations to Orli on receiving a Brain, Behaviour & Development Summer Studentship
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Lavisha Katyal
Undergraduate Student, Simon Fraser University Supervisor - Dr. Shubhayan Sanatani
Presentation of Pediatric Syncope in the Emergency Department
Lavisha Katyal, Erin L. Williams, Samantha Wong, Abhay Katyal, Sonia Franciosi, Shubhayan Sanatani, Victoria E. Claydon
Background: Syncope (fainting) is a common complaint in children presenting to the Emergency Department (ED). Information regarding the circumstance and prodrome for syncope is crucial in achieving a correct diagnosis, managing recurrent episodes, and reducing injury risk. The prodrome is poorly described in the pediatric population.
Aim and Methods: We aimed to characterize pediatric patients aged 6-18 years who presented to the ED at a tertiary care centre daily between 10:00-22:00 with syncope of non-cardiac origin that was not associated with traumatic head injury, seizure, or hypoglycemia. Patients completed a questionnaire regarding syncopal presentation, circumstance of their event, and their syncopal history. Patient medical records were accessed for demographics, diagnosis, and other relevant information.
Results: Over a 22-month period, 187 presenting patients met inclusion criteria, of whom 100 patients (67 female; aged 13.3±0.4 years; median Tanner stage 3 [range 1-5]; 48 females reached menarche) completed our survey. Most patients (n=84) were given a discharge diagnosis of confirmed or likely vasovagal syncope. At ED presentation, (n=45) patients had experienced at least one prior event (range 1- 14), with a mean age of first syncope onset of 11.5±0.4 years. Predisposing factors included postural stress (n=46), activity (n=31), blood-injection-injury (n=14), menstruation (n=23), emotional provocation (n=12), warm environment (n=6), or micturition/defecation (n=14). All patients reported a prodrome (median 4 symptoms, range 0-10); symptoms included light-headedness (n=87), auditory/visual changes (n=63), perceived temperature irregularities (n=54), abdominal discomfort (n=39), confusion (n=24), palpitations (n=7), chest pain (n=8), shortness of breath (n=24) or weakness (n=7). Observable signs were skin discolouration (n=60), confusion (n=33), involuntary movement (n=24) and loss of bladder/bowel control (n=3). Syncope was accompanied by a fall in 46 cases, 12 of which resulted in head impact.
Conclusion: Pediatric syncope presented with a memorable prodrome and was often associated with a fall. Further investigation should evaluate long-term prognosis and recurrence, and explore differences in presentation with sex, pubertal stage, and syncope diagnosis. These data will provide an evidence base for clinical recommendations in pediatric syncope, through which we can improve diagnostic and management practices.
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Kiana Rashidi
Undergraduate Student, University of British Columbia Supervisor - Dr. Wyeth Wasserman
Predicting genetic variant coverage upon expansion of a population database
Kiana
Rashidi, Wyeth Wasserman
It is estimated that 1 in every 12 people in Canada is affected by a rare disorder. Most of these disorders are caused by differences in DNA (deoxyribonucleic acid), the genetic material in our cells. The differences in our DNA are called variants, and can be benign or damaging.
Background variant libraries are databases of variants found in healthy groups of people. They are used to narrow down candidate variants and find ones that might be disease-causing. If a variant is common in healthy individuals, it is unlikely to be the cause of a rare disease. However, no database currently provides such information for Indigenous populations in Canada.
The Silent Genomes project at the BCCHR aims to create a database of population variants for Indigenous populations. The project started in 2017 and established Indigenous governance and oversight through extensive interactions with communities and partners. The Silent Genomes Indigenous Rare Disease Diagnosis (SGIRDD) committee has met more than 30 times to develop the processes and policies required before technical steps would be undertaken. In the past year, an initial set of DNA sequence data has been generated and processed from 596 individuals from 4 First Nations populations that have approved participation.
With the initial database created, we are studying how well this data enables the goal of aiding rare disease diagnosis. To do so, we are using statistical models to estimate how the number of individuals contributing to a population database relates to the portion of common variants in a population observed in the database. Simply put, we study methods to infer the number of common variants in a population based on data from a subset of the population.
Additionally, we want to extend our models to help determine the number of samples required from a new First Nations population considering participation in the Silent Genomes project.
Due to the sensitivity of the Silent Genomes data, we are working on developing these models using open-source data that is not from Indigenous peoples. Applying these methods to Indigenous data would only happen with appropriate engagement and approvals from the SGIRDD governance committee.
Congratulations to Kiana on receiving an Evidence to Innovation Summer Studentship
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Setareh Setayesh
Undergraduate Student, McGill University Supervisor - Dr. Anamaria Richardson
Towards New Knowledge Co-Creation in Medicine: Exploring Graphic Arts-Based
Thematic Analysis
Setareh Setayesh, Elizabeth Nijdam, Keerti Gupta, Anamaria Richardson
Background: Traditional methods for deriving conclusions from scientific data, or knowledge creation, possess several limitations given that they are typically based on written language, ignore complex narratives, and resist the extraction of unconventional themes from data. Consequently, these methods exclude neurodivergent, limited literacy, and other marginalized groups from the knowledge co-creation processes. Knowledge co-creation refers to when stakeholders in the research outcomes, such as civil society and industries, participate in the knowledge creation process. Graphic art has the potential to overcome the limitations of traditional methods given the hybrid word-image format and its capacity for communicating complex ideas. The current project aims to explore how graphic art can be used as an alternative methodology for thematic analysis. We plan to examine graphic artwork of semi-structured interviews with parents of neurodiverse children who undergo Exams Under Anesthesia (EUA), which are medical procedures facilitated by patient sedation. Specifically, we ask what additional themes can be extracted from the use of this alternative methodology compared to traditional methods.
Methods: Nine graphic artists were recruited to create a nine- to ten-page comic based on one of nine recorded and transcribed semi-structured interviews from a previous study. The finished comics were displayed at BC Children’s Hospital during Grand Rounds as well as posted online for public access. Individuals in the community are being asked to observe the artworks and provide responses via an online Qualtrics survey regarding the themes that they observe across the works. The data will be analyzed via qualitative thematic analysis to identify the most salient and commonly reported themes.
Anticipated Outcomes: The project is exploratory, but we anticipate that we will extract new themes from the data and gain knowledge about how alternative methodologies can be useful in knowledge co-creation.
Implications: Exposing alternative methodologies for knowledge co-creation can allow us to better extract information from data, particularly in order to amplify the voices of marginalized and fringe groups who often have a limited platform to communicate needs and issues.
Congratulations
to Setareh on receiving a Brain, Behaviour & Development Summer Studentship
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Samveer Uppal
Undergraduate Student, University of British Columbia Supervisor - Dr. Mor Cohen-Eilig
Horizons of Hope: a narrative review assessing how adaptive strategies shape and facilitate the parental navigation of cerebral palsy diagnosis
Samveer Uppal, Amanda Cama, Mor Cohen-Eilig
Background: Cerebral palsy (CP) is a group of permanent movement disorders that appear in early childhood and is characterized by poor coordination, stiff and weak muscles, and tremors. The complex nature of CP means that its diagnosis in a child presents significant and diverse challenges to parents. The adaptation of the parent to diagnosis is critical for their own wellbeing, the development and well-being of the affected child, and the maintenance of healthy relationship dynamics with other family members and healthcare professionals involved in the care of the child. Despite this, adaptation to diagnosis remains poorly defined or operationalized too narrowly in the existing literature set in this context.
Aims and Methods: Through a narrative synthesis of 19 studies collected by a literature search of the Ovid and PsycInfo databases, this study aimed to:
1. Identify the effects of prevalent adaptive strategies employed by parents. These include three main types – parenting attitudes, formal interventions, and self-employed coping mechanisms.
2. Classify the strategies based on the effect measured using four expansive outcomes – overcoming anticipatory grief, reducing functional stress, maintaining social networks, and building hope.
Results: Studies on formal intervention strategies are largely oriented around forms of cognitive behavioral therapy (CBT). These have yielded beneficial results in reducing functional stress, however there is little evidence of the long-term efficacy of CBT in reducing stress as a standalone therapy. Across all literature, no coping mechanisms were consistently associated with improved adaptation except for seeking of emotional social support, which yielded benefits across all outcomes. The use of this mechanism was also negatively correlated with the use of maladaptive coping mechanisms and attitudes such as overprotectiveness, behavioral disengagement, and fatalism.
Implications: There is a need for a comprehensive psychosocial intervention program that incorporates elements of psychoeducation alongside peer-support in order to adequately target all outcomes of parental adaptation to CP diagnosis. Subsequent research protocols should involve such a blend of adaptive strategies and educational content to assess the impact of fostering adaptation holistically.
Congratulations to Samveer on receiving a Sunny Hill Health Centre Research Summer Studentship
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Christina Zeng
Undergraduate Student, University of British Columbia Supervisor - Dr. Hal Siden
A scoping review on health inequities in children living with health complexity: Incorporating an intersectional lens
Christina Zeng, Sharon Hou, Colleen Pawliuk, Laesa Kim, Stephanie Glegg, Hal Siden
Background: Children living with health complexity (CLHC) have multiple or complex chronic conditions and/or functional limitations, and are amongst the highest users of healthcare services. In addition to having extensive healthcare needs, CLHC that come from underrepresented and underserved populations face health disparities related to social and cultural determinants of health. Some CLHC may navigate multiple social determinants, which intersect to uniquely impact their access to healthcare. There is a need to understand existing literature surrounding health inequities for CLHC and their families with consideration of the intersectionality of social determinants of health.
Objective: To conduct a scoping review to summarize what is known and what are the gaps regarding health inequities in CLHC with consideration of the intersectionality of social determinants of health.
Methods: We searched the databases MEDLINE, Embase, Scopus, Google Scholar, Ethnic Diversity Source, LGBTQ+ Source, and the Native Health Database. Our search strategy focused on CLHC, equity, and social determinants of health (e.g., age, sex at birth, gender, racialized/Indigenous, education, migration status, geographic location, disability status). Two reviewers are independently completing title and abstract screening, full-text screening, and data extraction. We included original, empirical research studies published in English.
Results: Our search yielded 1019 articles. Title and abstract screening resulted in 719 articles for full-text screening. Full-text screening is in progress.
Discussion: Findings from this review will offer insights to existing research on health inequities experienced by CLHC from underrepresented and underserved populations. Knowledge gathered on the experiences of CLHC facing multiple and intersecting social determinants of health will shed light on the healthcare experiences and outcomes of CLHC and their families. This information will inform development and/or refinement of interventions and policies that in turn addresses healthcare inequities faced by CLHC and their families from diverse backgrounds.
Session #10
Participants:
Alisha Dostie
Ali Hawkins
Aishwarya Heran
Hanna Huguet
Norman Li
Gabrielle Martinez
Hayal Muslu
Lana Tarik
Moderator: Catherine Demers
Watch In-Person
Thursday, July 25 | 2:00 – 3:30 pm
Chieng Family Atrium, BCCHR
Session #10
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Alisha Dostie
Undergraduate Student, University of British Columbia Supervisor - Dr. Shelina Babul
Risk factors and Intervention Strategies for Cycling-Related Injuries Among Children and Youth
Alisha Dostie, Brendan Smith, Kate Turcotte, Shelina Babul
Introduction: Cycling is a popular eco-friendly activity for children and youth that lowers the risk of chronic disease, boosts confidence, encourages independence, and helps with the development of social skills. However, it is not without risk. Cycling injuries are a main type of unintentional injury, the leading cause of death for Canadian youth <20 years-of-age. While recent prevention efforts include changes to both the built and social environments, there is a gap in up-to-date research syntheses.
Objectives: To summarize trends in emergency department visits to BC Children’s Hospital for cycling injuries between 2013 and 2022; To conduct a rapid review of the last decade of cycling-related injury prevention research regarding risk factors and intervention strategies for children and youth.
Methods: All cycling-related injury cases captured by the Canadian Hospitals Injury Reporting and Prevention Program dataset for BC Children’s Hospital (BCCH) from 2013-2022 were extracted for analysis. Keywords were developed and the Web of Science database was searched. A single reviewer conducted the screening, quality assessment, and data abstraction process using the Covidence tool. Cycling studies were included if they addressed youth <20 years-of-age and investigated either risk factors for injury or the efficacy of an intervention.
Results: Most cycling injuries seen at BCCH were open wounds of the face, and the most commonly injured groups were males, and ages 10-14. Most incidents occurred during July and August, and in 2020 and 2021. Children who rode e-bikes, were not wearing a helmet, male, over 8 years of age, or were hit by a motor vehicle were at greater risk of severe injury. Risk factors were age dependent. The research on helmet legislation is mixed, while education and safety campaigns have been largely effective.
Conclusion: The observed trends in child cycling-related injuries are similar to previous years. Educational programs and safety campaigns are promising prevention strategies and should be targeted to specific age groups. While helmet legislation may not be sufficient to protect children in case of an incident, there is a need for more research that directly investigates the efficacy of interventions at preventing pediatric cycling incidents and injuries.
Congratulations to Alisha on receiving a Community Child Health Endowment Summer Studentship
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Ali Hawkins
Undergraduate Student, University of British Columbia Supervisor - Dr. Tim Bhatnager
Relationship between Hindfoot Pressure and Heel Marker Height During Static Calibration of Motion Capture
Ali Hawkins, Beatrice Gonzales, Tim Bhatnagar
Background: The effects of equinus on a static model for motion capture at The Motion Lab at Sunny Hill Health Centre is currently unknown. Children with cerebral palsy whose heels visibly do not touch the ground use a wedge to get heel-floor contact, but there is no augmentation for children who appear to get heel contact without sufficient loading. Heel loading is required in traditional marker-based motion capture because of the compressible nature of the fatty tissue and thick elastic muscle fibers in the heel pad.
Objective: To analyze the relationship between hindfoot pressure and heel marker position. To determine whether a significant plantar flexion bias exists in the gait analysis foot model for children with equinus.
Methods: Reflective markers were placed on the feet of six healthy adults (mean age = 20.2 ± 1). They were asked to stand on a pedobarographic mat and three trials were taken: 1) weighting their feet normally 2) weighting their forefoot heavily while maintaining heel contact with the mat 3) weighting their hindfoot heavily in a mid-squat position. A vector was created from the heel marker to the toe marker for each trial. The difference between these vectors were used to calculate any changes in the plantar flexion angle between trials. Hindfoot pressures were normalized to body weight using Novel and the pressure differences between trials were calculated. The average plantar flexion angle and pressure differences were plotted to determine an initial correlation.
Significance: A planter flexion bias greater than 5 degrees would be clinically significant as it is greater than The Motion Lab’s error. If the results are clinically significant, further analysis would need to be conducted to understand its effects on kinematic gait analysis. This bias would need to be considered when interpreting kinematic gait graphs as it may change clinical recommendations.
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Aishwarya Heran
Undergraduate Student, McGill University Supervisor - Dr. Katelynn Boerner
Systematic review of autistic representation in the treatment literature for pediatric chronic pain
Aishwarya Heran, Colleen Pawliuk, Bethany Donaghy, David Moore, Kai Leong, Hemakumar Devan, Tim Oberlander, Katelynn Boerner
Chronic pain disproportionately affects autistic children and young people (CYP), yet they are underrepresented in pain research. Research on the use of psychological, physical, and pharmacological therapies in autistic CYP suggests that modifications are required to ensure treatment accessibility and efficacy. However, no such evidence base has been synthesized in pediatric pain. The aim of the present review was to (1) review existing “gold-standard” treatment literature for pediatric chronic pain to determine the representation of autistic CYP, and (2) review literature on treatment of chronic pain specifically in autistic CYP to describe the current evidence landscape and identify next directions for research. 16.7% (12/72) of randomized controlled trials (RCTs) included in Cochrane reviews of interventions for pediatric chronic pain explicitly excluded youth with a developmental delay/disability, of which only 8.3% specifically named autism. However, 68.1% of Cochrane-included RCTs had criteria or protocols which may have disproportionately impacted participation from autistic CYP, such as excluding intellectual disability, psychiatric conditions, medical conditions, and/or requiring participants to communicate verbally. Twenty-nine studies of treating chronic pain in autistic CYP were identified, of which the majority were case reports (k = 27, 93%). Studies were relatively homogeneous with respect to sex, ethnicity, and location, but heterogeneous in terms of pain condition, intervention applied, and outcomes measured. Given the high prevalence of chronic pain in autistic CYP, clear attention is needed to increase their inclusion and accessibility to participate in chronic pain research.
Congratulations to Aishwarya on receiving a Brain, Behaviour & Development Summer Studentship
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Hanna Huguet
Undergraduate Student, University of British Columbia Supervisors - Dr. Hal Siden & Dr. Sharon Hou
Implementing the Pain and Irritability of Unknown Origin (PIUO) Pathway in Community Pediatric Practices: An Integrated Knowledge Mobilization Plan
Hanna Huguet, Sharon Hou, Stephanie Glegg, Gail Andrews, Tim Oberlander, Caroline Sanders, Laesa Kim, Anne-Mette Hermansen, Hal Siden
Background: The Pain and Irritability of Unknown Origin (PIUO) Pathway was developed to manage unexplained pain and irritability in children with severe neurological impairments (SNI). However, this pathway has only been accessible to children seeing expert clinicians within a research context in a tertiary care setting.
Objective: The overarching objective of the PIUO Phase 2 Study is to implement and evaluate the use of the PIUO Pathway by community pediatricians in pediatric practices across British Columbia (BC). An emphasis of the implementation and evaluation plan is to embed an integrated knowledge mobilization (KM) plan over the course of the research process.
Methods: We are conducting a hybrid implementation-effectiveness studying using a pre-post, quasiexperimental design. This study adheres to a patient-oriented research framework and includes an integrated knowledge mobilization plan. Our integrated KM plan will be co-developed iteratively with our clinician and parent partners, to share on-going learnings and reflections from the implementation process.
Results: To enhance the accessibility of our research objectives and plan, we have created a visual summary of the research activities anticipated over the course of the implementation plan. In addition, we have created a glossary of the key terminology used in the study protocol to ensure that the language we use is understandable and accessible in lay language.
Conclusion: Phase 2 holds the potential to provide front-line community pediatricians with the capacity, motivation, and opportunity to sustain the adoption of the PIUO Pathway in community pediatric practices. Likewise, our key KM goal is to sustain partnerships with children with SNI and their families, clinicians, academic researchers, and implementation scientists, and to ensure they have current knowledge of the study’s progress, outcomes, and key learnings, and to inform future research.
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Norman Li
Undergraduate Student, University of British Columbia Supervisor - Dr. Angie Ip
Improving Care Quality at Sunny Hill Outpatient Clinics: Designing and Implementing an Exit Survey
Norman Li, Claire Chadwick, Denise Somuah Asamoah, Kimberly Szeto, Cynthia Vallance, Angie Ip
Background: Patient exit surveys can be defined as questionnaires that are filled out during the patients’ exit from a clinical consultation or healthcare facility. With the increasing importance of capturing patient feedback on the healthcare services received, exit surveys have become one of the most common tools used to assess patient satisfaction and the quality of care. These surveys are flexible and can be efficiently implemented in healthcare settings. Feedback gathered by exit surveys can help administrators identify areas in need of change and develop effective quality improvement projects and strategies to improve clinical care and patient experiences.
Objectives: The goal of this quality improvement project is to implement a consistent feedback system that will assess the care families are receiving in two outpatient clinics at Sunny Hill Health Centre: the BC Autism Assessment Network (BCAAN), and the Complex Developmental Behavioural Conditions Clinic (CDBC).
Methods: Our clinical, administrative, and family and patient engagement team have partnered to create an online exit survey for families to complete after their assessments at the BCAAN and CDBC outpatient clinics. Families will report responses on a 5-point Likert scale, followed by open-ended prompts, and optional demographics questions. We intend on piloting the survey with 10 families and following up with the families for feedback on the survey questions and user interface.
Significance: As the current feedback systems in place at Sunny Hill Health Centre yield low response rates, gather feedback that does not capture all families, and require a large team effort to operate, implementing a consistent feedback system will help us to better identify problems within the BCAAN and CDBC outpatient clinics. The collected feedback will help inform needed changes to improve the quality of care that all future families receive and can pave the way for future feedback systems to be effectively implemented.
Congratulations to Norman on receiving a Sunny Hill Summer Student Award
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Gabrielle Martinez
Undergraduate Student, University of British Columbia Supervisor - Dr. Mariana Brussoni
“It’s nice and mucky”: Centering
Children’s Voices to Promote Risky Play in Child Care Centers
Gabrielle Martinez, Mariana Brussoni
There is extensive evidence supporting the benefits of risky play on children’s cognitive, emotional, and physical development. Risky play is often experienced outdoors and is defined as thrilling or exciting play with a potential risk of injury. The 6 types of risky play include: play with great heights, play with high speed, play with dangerous tools, play near dangerous elements, play with the chance of getting lost, and roughand-tumble play. Children spend a substantial amount of time in child care centers, which makes them key environments for risky play opportunities. Current literature focuses on parents and educators perspectives of risky play, and strategies to support it. However, there is limited understanding of children’s perspectives on risky play. Qualitative interviews with 56 children aged 3-5 years in two childcare centers across British Columbia, Canada, were analyzed using thematic analysis. Preliminary findings indicate that children seek risky play opportunities and suggest elements they want in their childcare environments to facilitate risky play. Children identified barriers to risky play, including individual emotional and physical tolerances and educator allowances. The implementation of facilitators, such as, creating children-centered outdoor spaces, allowing them to play without instruction, and the opportunity for individual risk management, is needed to address the barriers children face. The inclusion of children’s perspectives on risky play is critical in understanding what children want when it comes to their play and the necessary steps required to increase children’s opportunities for risky play in child care.
Congratulations to Gabrielle on receiving a UBC Faculty of Medicine Summer Student Research Award
Session #10
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Hayal Muslu
Undergraduate Student, University of British Columbia Supervisor - Dr. Lianne Tomfohr-Madsen
Building Emotional Awareness and Mental Health (BEAM) During Pregnancy: Rationale for Adapting an App-Based Program for the Perinatal Period
Hayal Muslu, Makayla Freeman, Lianne Tomfohr-Madsen, Leslie Roos
Abstract coming soon.
Session #10
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Lana Tarik
Undergraduate Student, University of British Columbia Supervisor - Dr. Shreya Moodley
The Effects of Maternal Physical and Mental Health on Neonatal Outcomes of Congenital Heart Disease: A Pilot Study
Francesca de
la
Cruz, Lana Tarik, Lisa Guo, Winnie Chung, Astrid de Souza, Chantal Mayer, Shreya Moodley
Background: Pregnancies involving a prenatal diagnosis of fetal congenital heart disease (CHD) can significantly stress expectant mothers, leading to an increased risk of clinical depression, anxiety, and post-traumatic stress disorder. These conditions may compromise obstetrical outcomes, disrupt maternal-infant bonding, and adversely affect neonatal health. Research suggests that physical activity during pregnancy can mitigate psychological stress and improve maternal and neonatal health, however evidence specific to mothers of neonates with CHD remains limited.
Objectives: This study aims to determine (1) the relationship between physical activity and mental health in expectant mothers with a fetal diagnosis of CHD and (2) the impact of maternal mental health and physical activity on neonatal outcomes in infants born with CHD.
Methods: Participants are recruited from BC Women’s Hospital and include two groups: healthy women carrying fetuses with normal cardiac findings (n=50) and women carrying fetuses with CHD (n=50). Maternal mental health and physical activity levels are assessed using the General Anxiety Disorder-7, Patient Health Questionnaire-9, Perceived Stress Questionnaires, and the Pregnancy Physical Activity Questionnaire. Surveys are completed on REDCap upon study enrollment, in the third trimester of pregnancy, and one month after delivery. Additionally, neonatal data will be obtained from patient charts, including the manner of delivery, neonatal birth weight, Apgar score, and neonatal cardiac condition, if applicable.
Data Analysis/Results: Data analysis will involve comparing neonatal outcomes using t-tests or Wilcoxon Rank Sum tests, depending on data distribution. Physical activity scores will be categorized and analyzed using ANOVA to assess differences among groups. Correlational analysis will then be conducted to explore relationships between survey scores and neonatal health, with logistic regression identifying predictors of neonatal outcomes. The study is ongoing at the time of submission.
Significance: This study aims to elucidate the relationship between maternal psychological and physical health on neonatal outcomes in CHD-affected pregnancies. By establishing correlations between maternal mental health, physical activity, and neonatal health, study findings may provide evidence that supports prenatal interventions tailored for this high-risk population, potentially improving health outcomes and prognosis.
Session #11
Participants:
Caitlin Adams
Serena Chan
Beatrice Gonzales
Chanjoo Kim
Aralia Mills
Melissa Olana
Raj Saini
Moderator:
Mahdis Monajemi
Watch In-Person
Thursday, July 25 | 2:00 – 3:30 pm
Chieng Family Atrium, BCCHR
Session #11
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Caitlin Adams
Undergraduate Student, University of Toronto Supervisor - Dr. Faizal Haji
Mapping surgical, anesthesia, and obstetric training programs in sub-Saharan Africa: A narrative review
Caitlin Adams, Kawami Cao, Steven Chen, Helen Hsiao, Faizal Haji, Emile Joos, Shahrzad Joharifard
Background: Many countries in sub-Saharan Africa (SSA) have among the lowest surgical, anesthesia, and obstetric (SAO) workforce densities in the world. The field of global surgery takes two approaches to building SAO workforce capacity in SSA. The first approach is forming regional SAO colleges, which offer residency curricula at teaching hospitals in member countries. The second is implementing task-sharing programs, which equip non-surgical practitioners (NSPs) with essential surgical skills in an expedited time frame. Although some information about these programs is available online, there is a lack of consolidated data on their geographical distribution, trainee capacity, surgical specialties, and graduate workforce distribution. This project seeks to fill this gap by creating a geographical map of SSA SAO training programs.
Objectives: To map SAO college-accredited residency programs and task-sharing programs in member countries the West African College of Surgeons (WACS) and the East, Central, and Southern African (ECSA) health community.
Methods: Nationally representative data were compiled for all countries in SSA through email contact with the World Bank, World Health Organization country offices, Ministries of Health, regional surgical colleges, and non profit organizations. Grey literature reviews were conducted to compile information about surgical training program locations, curricula, and program graduate workforce distribution. A digital map was generated using Looker Pro to visualize population-based densities of accredited SAO residency training programs and task-sharing programs.
Discussion: While we are still in preliminary analysis, our grey literature review suggests an uneven distribution of SAO residency programs and task-sharing training programs in SSA. Next steps involve finalizing the digital maps and consolidating data on trainee capacity, surgical specialties, and graduate workforce distribution from residency and task-sharing training programs.
Congratulations to Caitlin on receiving an Office of Pediatric Surgery Evaluation and Innovation (OPSEI) Summer Studentship
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Serena Chan
Undergraduate Student, University of British Columbia Supervisor - Dr. Tom Blydt-Hansen
Clinical Utility of Routine MAG-3 Scan for Surveillance of Kidney Allograft Injury at 48h Post-Kidney Transplant
Serena Chan, Monica Ho, Sharon Gershony, Tom Blydt-Hansen
Background: The continued utility of routine surveillance mercaptoacetyltriglycine-3 (MAG-3) renal scan within 48 hours post-kidney transplant in all patients for detecting early acute kidney injury and prognosticating time to recovery needs to be evaluated.
Methods: In this retrospective analysis, a prognostic regression model, each including clinical and MAG-3 covariates, was built for each graft outcome measures: time to creatinine nadir (TTN) for timeliness of recovery, and donor to recipient unfiltered glomerular filtration rate ratio at 12-months post-transplant (uGFRR/D 12mo) for extent of recovery.
Results: 67 patients (58% male, aged 13 (IQR 7, 16) years at transplant) were included. Clinical factors associated with TTN included donor age (p<.001), type (p=.0031), cold ischemic time (p=.02), and serum creatinine 24h/0h ratio (Cr 24h/0h) (p<.001). Clinical factors correlated with uGFRR/D 12mo included recipient age (p<.001) and body surface area (BSA) (p<.001), donor BSA (p=.078), cold ischemic time (p=.044), primary diagnosis (p=.098), and Cr 24h/0h (p=.006). All four analyzed MAG-3 metrics correlated with both outcome variables, except between time to peak activity and uGFRR/D 12mo. Preliminary results show that the inclusion of MAG-3 results improves the regression model for both graft outcome variables. For TTN, the optimal Cox regression model included donor type, primary diagnosis, Cr 24h/0h, MAG-3 peak to half peak time and MAG-3 30 min/peak ratio (R2=0.30, AIC=343, p=.001), and was better-fitted compared to the model including only clinical factors (R2=0.25, AIC=414, p<.001). The best-fitted linear regression model for uGFRR/D 12mo included donor and recipient BSA, MAG-3 peak to half peak time and MAG-3 30 min/peak ratio (adjusted R2=0.50, AIC=-16.7, p<.001), and is better-fitted than the model consisting solely of clinical factors (adjusted R2=0.36, AIC=11.4, p<.001).
Significance: Post-operative MAG-3 scans provide important additional prognostic information about recovery time and extent of graft functional recovery. This data supports continued use in post-transplant monitoring.
Congratulations to Serena on receiving a UBC Faculty of Medicine Summer Student Research Award
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Beatrice Gonzales
Undergraduate Student, University of British Columbia Supervisor - Dr. Tim Bhatnagar
Measurement of Change in Plantar Pressure using Pedobarography Following myoActivation® Therapy
Beatrice Gonzales, Farah Azim, Karen Davies, Diane Wickenheiser, Mona Behrouzian, Gail Jahren, Nicholas West, Lise Leveille, Gillian Lauder, Tim Bhatnagar
Myofascial dysfunction can cause uneven weight distribution (plantar pressure) between the feet. myoActivation is a specialized technique targeting soft tissues such as scars, fascial tension, and muscles in sustained contraction to alleviate chronic pain and mobility impairments. The myoActivation assessment includes patient self-reports on weight distribution, guiding clinicians to identify affected muscles. Treatment employs a needling technique to activate muscles, release fascial restrictions, and address scar tissue. The goal is for patients to experience more balanced weight distribution between their feet. Immediately after treatment, clinical changes in this balance are noted, though these effects have not been objectively measured before. In this non-randomized, longitudinal pilot study, five consecutive patients from the Complex Pain Service were recruited for myoActivation as part of their clinical care. Patients underwent a set of eleven movement tests before and after each treatment, including a static balance test on a pedobarography plate. In the balance test, patients stood on the plate for three seconds while plantar pressure data were collected. This data was analyzed to assess center of pressure (CoP) sway area and force distribution within the foot, comparing left vs. right foot, medial vs. lateral aspects, and forefoot vs. hindfoot. CoP sway area was quantified using a convex hull method, and force distribution was analyzed with Novel pedobarography software, yielding values indicating bias towards specific foot sections. The initial (‘Pre’) and final (‘Post’) plantar pressure metrics were compared. Due to variability in myofascial dysfunction and pain and the number and locations of soft tissue releases being individualized, each patient served as their own control. CoP sway area decreased in 4 of 5 patients from Pre to Post, and force distribution bias varied among patients, with no clear reduction in bias observed in the Post data. Pedobarographic data provided objective measurements of changes in perceived weight distribution following myoActivation. These insights are valuable for myoActivation clinicians, enhancing understanding of how specific soft tissue releases impact plantar pressure metrics. This quantitative data will be used to inform a larger clinical trial in the future.
Congratulations to Beatrice on receiving a Biotalent Canada Award
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Chanjoo Kim
Undergraduate Student, University of Victoria Supervisor - Dr. Hal Siden
Life expectancy of children with severe HIE after cessation of intensive care (a pilot study)
Chanjoo Kim, Katherine Boone, Emily Kieran, Harold Siden
Introduction: Hypoxic-ischemic encephalopathy (HIE) is a birth injury caused by oxygen deprivation to the brain of a neonate, and in severe cases, may not be compatible with life. Babies born with HIE often require intensive care, including artificial nutrition, hydration and ventilation. In severe cases, artificial ventilation and other painful medical interventions can be ethically withdrawn with the goal of improving comfort for the baby; however, life expectancy after withdrawal is uncertain and not well-reported in the literature. That lack of knowledge undermines the ability of clinicians to provide accurate information to families. This pilot study aims to profile the clinical characteristics of neonates with severe HIE who underwent withdrawal of intensive care and describe the trajectory after the withdrawal.
Method: This pilot study employed a structured, retrospective medical record review. We reviewed all late preterm and term neonatal deaths related to HIE at Canuck Place Children’s Hospice between 2018 and 2023. The population consisted of neonates who died of severe HIE following withdrawal of intensive care, including artificial nutrition, hydration and ventilation.
Results: We identified 11 neonates (5 male, 6 female) with a mean gestational age of 39 weeks + 1 day, and a mean birthweight of 3275g. Most newborns with severe HIE were treated with conventional mechanical ventilation and therapeutic hypothermia. Ten babies received invasive ventilation with an endotracheal tube and their mean survival time after extubation was 4.1 days (median 0.7 days, range 0.01-15.8). Among the 11 neonates, 10 babies underwent withdrawal of artificial nutrition and hydration, and their mean survival time after withdrawal was 4.2 days (median 0.5, range 0.01-17.6). The median age at death was 7 days old (mean 11.2, range 2-23).
Conclusion: All deaths in our sample occurred after withdrawal of ventilation, but the length of survival after withdrawal varied widely across individuals. These results offer valuable information regarding the natural history following the withdrawal of intensive care in neonates with severe HIE.
Congratulations to Chanjoo on receiving a BC Children’s Hospital Summer Studentship
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Aralia Mills
Undergraduate Student, McGill University Supervisor - Dr. Tamara Vanderwal
The effects of music-listening on heart rate variability in adolescents with and without psychiatric disorders: A pilot study
Aralia Mills, Tara Gaertner, Tamara Vanderwal
Background: Heart Rate Variability (HRV) is the variation in time between heartbeat intervals. HRV is a known marker of cardiovascular health that is closely interrelated with mental health. For example, the brain regions that control HRV and emotion regulation are overlapping, and individuals with depression have lower HRV. One promising approach to “naturalistically” modulate HRV is music-listening, which has been shown to increase HRV in healthy adults, but no studies yet exist in youth.
Objective: The aim of this study is to compare HRV during music-listening in youth with and without psychiatric conditions.
Methods: Before enrolling youth, we will collect data from three pilot adult subjects. Electrocardiogram, respiration rate and skin conductance data will be recorded using a Biopac system during a 5-minute silent baseline followed by two 5-minute musical excerpts that vary in emotional valence and arousal (“relaxing” and “energizing”). HRV will be calculated from ECG data per condition, after artifacts and ectopic beats have been removed. The primary outcome measure will be the high frequency spectral component of HRV (HF-HRV: 0.15 – 0.40 Hz; a marker of parasympathetic activity). Respiration rate and skin conductance will be used to control for arousal differences. Data will be analyzed using ARTiiFACT software.
Anticipated Results: We hypothesize that music listening will increase HRV relative to baseline for all test subjects, and the largest increase will occur during the “energizing” condition.
Conclusion: Music listening is an accessible, developmentally relevant, condition to use to study (and potentially modulate) HRV in adolescents with psychiatric conditions.
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Melissa Olana
Undergraduate Student, University of British Columbia Supervisor - Dr. Angie Ip
Building Clinical Skills in Neuroaffirming Care Through Simulation
Melissa Olana, Anne Kawamura, Claire Chadwick, Colleen Pawliuk, Katelynn Boerner, Kimberly Szeto, Angie Ip
Background: Currently in BC, the number of clinicians that provide publicly funded autism assessments cannot meet the demand for children and youth requiring an assessment, resulting in wait times up to 1 to 2 years. The British Columbia Autism Assessment Network is creating a new pathway for community pediatricians and pediatric nurse practitioners to assess and diagnosis children with less complex cases of autism. This training process incorporates simulation-based learning where standardized patients (trained actors) role-play a planned scenario, allowing participating clinicians to practice the skills they have learned and build new skills through experience.
Objectives:
- Enhance community pediatric clinicians’ clinical skills in providing neuroaffirming care - Evaluate the effectiveness of simulation as a learning tool for experienced clinicians
Methods: Implement a simulation-based learning model to create a scenario where the participating clinicians will provide parents (standardized patients) with an autism diagnosis for their 2.5-year-old child. We will be collaborating with autistic youth and family members of individuals on the spectrum to help identify gaps in clinical care that we can focus learning on when building the scenario further. Feedback will be provided to participants during and after the simulation by fellow clinicians, mentors, standardized patients, and observing family collaborators. Transcripts and recordings of the simulation sessions will be analyzed for themes and learnings to improve quality of care and the use of simulation in clinician training and education.
Significance: Previous literature documenting simulation-based learning to improve quality of care for autistic patients has focused on resident clinicians or those new to their respective fields. This study focuses on experienced clinicians and how simulation can help build and improve skills in providing care that is reflective of our current understanding of autism and neuroaffirming care. The design of this project reflects the importance for clinicians to practice communicating with families in a way that is attentive to their specific needs including the impact of culture, language, and the lived experience of the families they are working with.
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Raj Saini
Undergraduate Student, Simon Fraser University Supervisor - Dr. Michael Hawkes
Multidimensional household poverty is associated with mortality, disease severity, and catastrophic health expenditure among Ugandan children hospitalized with pneumonia
Saravraj Saini, Robert O. Opoka, Andrea L. Conroy, Olaro Charles, Jackson Amone, Juliet Nabwire, John Kanyonyozi, Sophie Namasopo, Michael T. Hawkes
Background: Pneumonia is the leading cause of under-5 mortality, with 725,557 deaths in 2021. Pneumonia severity, quantified by the Respiratory Index of Severity in Children (RISC) score is a reliable predictor of mortality in resource-limited settings. However, the association between the social determinants of health and pneumonia severity among children in low- and middle-income countries is unexplored.
Objectives: To examine the association between multidimensional poverty, disease severity, and mortality among Ugandan children under-5 hospitalized for pneumonia.
Methods: This secondary analysis study used data from a 20-site stepped wedge cluster randomised controlled trial of childhood pneumonia in Uganda. The parent/guardian completed a verbal questionnaire by the study nurse that included items related to the multidimensional poverty index (MPI) and catastrophic health expenditure (CHE). Disease severity was quantified using the RISC.
Results: We included 1699 children hospitalized with hypoxemia (median age 13 months, 43% female, 2.8% case fatality rate). Using the MPI as a quantitative marker of household deprivation, 967 households (57%) were classified as MPI poor. The MPI was associated with mortality (p=0.015) and was correlated with the RISC (Kendall’s tau-b 0.11, p<0.0001).
Caregivers estimated that out-of-pocket payments for the illness amounted to median Ugandan shillings (UGX) of 50,000 (IQR 30,000 to 130,000) or USD$14 (IQR $8.1 to $35). OOP payments represented a median of 5.0% (IQR 2.5% to 10%) of the total annual household income. In 130 cases (7.7%), OOP payments exceeded 25% of the annual household income, representing CHE. Households classified as MPI poor were 1.7-fold (95%CI 1.2-2.4) more likely to experience CHE (p=0.0050).
To pay for medical expenses for the current illness, 794 participants (47%) reported borrowing money from family or friends, and 696 (41%) reported selling belongings. Cases classified as CHE were more likely to have borrowed money (RR 1.6, 95%CI 1.4-1.8, p<0.0001) or sold belongings (RR 1.8, 95%CI 1.6-2.1, p<0.0001).
Conclusion: Multidimensional poverty was associated with mortality and elevated RISC scores, with households more likely to experience CHE. The ongoing results of this study will present meaningful insights into socioeconomic inequities and their relationship to communicable diseases like pneumonia in LMICs.
Session #12
Participants:
Dorsa Arman
Arshvir Singh Dhari
Gabrielle Herzenberg
Peter Malik
Bhairvi Tara Mathur
Ariel Qi
Riya Virdi
Nicholas Wall
Arshdeep Waring
Moderator:
Jadine Knight
Watch In-Person
Thursday, July 25 | 2:00 – 3:30 pm
Chieng Family Atrium, BCCHR
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Dorsa Arman
Master’s Student, University of British Columbia Supervisor - Dr. Christine Voss
Cognitive skills in children and adolescents with Type 1 Diabetes: A scoping review
Dorsa
Arman, Luc van Heerden, Ty Sideroff, Jane Jun, Christine Voss
Background: Type 1 Diabetes (T1D) is an autoimmune disease characterized by the destruction of insulin-producing beta cells in the pancreas, necessitating reliance on exogenous insulin. In British Columbia, T1D affects over 2,000 children aged under 19 years of age. Insufficient insulin delays glucose uptake, leading to fat and protein catabolism, increasing ketone bodies, and potentially leading to diabetic ketoacidosis (DKA), a life-threatening condition that can mostly be prevented with management. However, other acute complications such as hypoglycemia and hyperglycemia are inevitable. These complications can trigger oxidative stress, inflammation and depriving neurons of energy. This causes altered brain growth and neuronal dysfunction, reducing gray matter volume and compromising white matter integrity, which may impair brain function. However, studies have shown conflicting results regarding the relationship between T1D and cognitive skills in children with T1D.
Objective: This scoping review explores the association between T1D and cognitive skills in children and adolescents.
Method: We conducted a comprehensive literature search across several databases including Medline (Ovid), Web of Science, Cochrane Library, EMBASE, and PsycINFO. From an initial pool of 3,399 studies, approximately 160 met the inclusion criteria for data extraction. Exclusion criteria were set to omit participants with potential confounding co-morbid conditions such as preterm birth, low birth weight, intellectual or learning disabilities, prior inpatient psychiatric treatment, or unrelated neurologic diseases. We included various study designs focusing on pediatric participants diagnosed with T1D. The review extracted data on study characteristics, sample demographics, age at T1D diagnosis, duration of T1D, brain MRI data, and details on the cognitive skills assessment methods and outcomes. The findings indicate that while results vary, children with T1D often exhibit, brain structural change and cognitive deficits in memory, attention, and executive functions, influenced by onset age, glycemic control, and DKA severity.
Implications: This review will illustrate the various methodologies used to measure cognitive skills and explore the relationship between T1D and cognitive skills in pediatric populations with T1D. Understanding these relationships is crucial considering the conflicting result for developing targeted interventions and policies to support more equitable and inclusive educational practices for children with T1D to thrive.
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Arshvir Singh Dhari
Medical Student, University of British Columbia Supervisor - Dr. Lynnie Correll
Critical events in anesthetized kids undergoing tracheal intubation: a prospective multi-centre observational study
Arshvir Singh Dhari, Simrin Dhillon, Steffanie Fisher, Martina Bordini, Clyde Matava, Thomas Riva, Lynnie Correll
Background: Tracheal intubation is an airway management maneuver commonly performed on patients receiving general anesthesia for surgical and diagnostic procedures. A flexible tube is inserted into the trachea to facilitate delivery of oxygen and anesthetic gases to the lungs. However, critical events—such as respiratory and cardiovascular complications—can occur during intubation and even result in death if not resolved quickly. Since these are rare, studies in large cohorts of pediatric patients are needed to better appreciate the incidence of critical events and their risk factors.
Objectives: To determine the incidence of critical events during intubation in children, potential risk factors, and possible measures to improve patient safety.
Methods: This is an international prospective multi-centre observational study of more than 105,000 intubations from over 200 children’s hospitals. To be eligible for inclusion, patients must be between 0 to 16 years old and receive intubation by the anesthesia team for procedures requiring general anesthesia. Data will be collected for 3 months. At BC Children’s Hospital, this will occur from June to August 2024. Patient and provider characteristics, airway management techniques used, outcomes, and details surrounding any critical events will be recorded on REDCap by anesthesiologists. Statistical analysis will be performed to identify the incidence of critical events and associated risk factors.
Progress: In the first 5 weeks of the study, data from 419 out of 421 eligible intubations (99.5%) was captured on REDCap. Data from 376 intubations (89.7%) was captured contemporaneously, on the same day as the procedure. Data from the remaining 43 intubations (10.3%) was captured retrospectively, after sending reminders to anesthesiologists. On average, there were 84 eligible intubations per week, which was less than the 100 eligible intubations per week predicted initially.
Significance: The study’s findings may be used to implement targeted interventions to reduce the incidence of critical events. This includes the development of new or improved screening tools to proactively identify children who are at high risk for intubation-related complications. The findings may also be used to improve intubation techniques, guidelines, and training for anesthesia providers, potentially leading to safer airway management practices for pediatric patients worldwide.
Congratulations to Arshvir on receiving a UBC Faculty of Medicine Summer Student Research Award
Session #12
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Gabrielle Herzenberg
Medical Student, University of British Columbia Supervisor - Dr. Rebecca Deyell
Generation of real-world evidence for children with relapsed or refractory high-risk neuroblastoma and Canadian approach to management
Gabrielle Herzenberg, Daniel Morgenstern, Rebecca J. Deyell
Background: High-risk neuroblastoma is the most common extracranial solid tumor of infancy, and despite intensified therapy, survival outcomes remain poor, especially in children with relapsed or refractory disease. Targeted anti-GD2 immunotherapy was incorporated into upfront maintenance therapy for high-risk neuroblastoma patients in 2010, and chemoimmunotherapy now has an established role in patients with relapsed or refractory disease. Various other strategies are utilized for relapsed or refractory neuroblastoma, including conventional chemotherapy regimens, targeted radiotherapy with high-dose 131 I-MIBG, and novel molecularly targeted therapies. Clinical trial access is limited, and patients may undergo multiple salvage strategies without systematic outcome data collection. Therefore, contemporary management and outcome data are needed for these patients.
Objectives: We aimed to identify, enroll, and abstract data for patients in British Columbia (BC) with relapsed/ refractory high-risk neuroblastoma diagnosed since 2010 to a newly initiated national central data repository— the Canadian Relapse/Refractory High-Risk Neuroblastoma (CANOE) registry. Additionally, we aimed to understand the current standard of care that pediatric oncologists across Canada utilize for managing these patients.
Methods: Following Ethics Board approval, all children with relapsed or refractory neuroblastoma diagnosed since 2010 and treated at BC Children’s Hospital were identified from a clinical database. Informed consent/ assent was obtained either in person or through RedCap e-consent, and data on enrolled patients were collected from medical records. To understand current approaches standard of care, we surveyed pediatric oncologists from all 16 Canadian pediatric oncology sites.
Results: 24 patients were identified as potentially eligible, 23 were approached (n=1 awaiting >6 mos from date of death) and 14 patients have been enrolled in CANOE to date (61%). Among these, 50% were male, the median age at diagnosis was 3.9 years (range 1.0–12.6), and 79% are now deceased. Additionally, 30 pediatric oncologists (of 39 approached, 77% participation) from all 16 Canadian sites responded to our survey on management standards of care. Survey results indicate that the standard of care varies across treatment sites. Among surveyed oncologists, 90% would use chemo-immunotherapy as a preferred initial salvage regimen, only 2/30 (both in Ontario) have had difficulty with dinutuximab access, and the number of chemoimmunotherapy cycles offered varies, with a median of 3 cycles (range 2 to 17) without and 16 cycles (range 5 to 18) with evidence of objective response.
Conclusion: The CANOE registry will provide a central database to improve our understanding of the best management practices for relapsed/refractory high-risk neuroblastoma patients based on real-world evidence. The variation in standards of care across treatment sites was shared at an inaugral national neuroblastoma provider meeting and supports the need for shared guidelines and communication among Canadian treatment centers.
Congratulations to Gabrielle on receiving a BC Children’s Hospital Summer Studentship
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Peter Malik
Medical Student, McGill University Supervisor - Dr. Shahrzad Joharifard
Validation of the Pediatric Open and Laparoscopic Integrated Surgical simulator for inguinal Hernia Repair (POLISHeR)
Peter R. A. Malik, Kayoung Heo, Julia Hael, Catherine Binda, Lukas Shum-Tim, Andreas Lindner, Daniel G. Rosenbaum, Oliver Muensterer, Shahrzad Joharifard
Objective: To validate a 3D-printed low-cost, high-fidelity simulator to train novice surgeons on how to perform open and laparoscopic pediatric inguinal hernia (PIH) repair.
Background: PIH is a congenital anomaly that forms from the failure of the processus vaginalis to close, which can cause herniation of abdominal contents into the inguinal region. Incidence rates of PIH range between 0.8 and 4.4% annually, making inguinal hernia repair one of the most frequently performed procedures in this population. The use of simulation for mastering both techniques has been shown to improve surgical outcomes by reducing peritoneal tears, conversion, postoperative complications, and the need for overnight stay. In collaboration with the British Columbia Children’s Hospital Digital Lab, we developed the Pediatric Open and Laparoscopic Integrated Simulator for Inguinal Hernia Repair (POLISHeR) to help teach PIH. Components of the simulator can be printed with low-cost materials and constructed with open-access instructions.
Methods: We will recruit participants using a convenience sample of attendees from national and international conferences, such as the Canadian Association of Pediatric Surgeons. Baseline characteristics (demographic data, previous laparoscopic and open experience, years of training, etc.) will be collected. Participants will be timed and evaluated using validated procedure-specific and error checklists. A post-study questionnaire will also be administered to evaluate various aspects of the simulator, including anatomy representation, instrument handling, procedural content, perceived realism, confidence, and comfort level. The Mann-Whitney U test will compare mean procedure-specific and error checklist scores for novice and experienced surgeons. Concurrent validity will be assessed using self-assessment scores, the number of previous hernia repairs, and simulator performance using Spearman’s correlation coefficient.
Discussion: Despite advances in surgical techniques available to treat and manage PIH, open and laparoscopic approaches to inguinal hernia repair pose technical challenges. While this work is ongoing, we hope that the validation of POLISHeR will allow its use in a variety of settings to teach PIH to medical learners. Training with the simulator has the potential to safeguard patient safety and increase the provision of this key surgical procedure.
Congratulations to Peter on receiving an
Office of Pediatric Surgery Evaluation and Innovation (OPSEI) Summer Studentship
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Bhairvi Tara Mathur
Medical Student, University of British Columbia Supervisor - Dr. Jugpal Arneja
Predictors of poor speech outcomes following primary palatoplasty
T. Mathur, F. Scheepers, S. Palm, T. Gordon, J. Arneja
Background: Cleft palates are one of the most common congenital abnormalities, and an intact palate is important for the development of speech. Sex assigned at birth, age at palate repair, ethnicity, income, and geographical location may play a role in a child’s speech following primary palatoplasty. For example, since BC Children’s Hospital (BCCH) is the only pediatric, tertiary care center in the province, patients living further away may find it challenging to attend follow-up appointments.
Objective: This study aims to describe how demographic, socioeconomic, and surgical factors may influence speech outcomes post-palatoplasty.
Methods: A retrospective chart review of non-syndromic patients who had their cleft palates repaired at BCCH between 2005 - 2015. Data collection included patient demographics, palatoplasty and secondary speech surgery details, complications, speech therapy information, and speech assessment factors including diagnosis of velopharyngeal insufficiency (VPI). Results were summarized and factors associated with VPI were statistically analyzed in R.
Preliminary Results: 209 patients (43% female) were included of which 80 (38%) had a VPI diagnosis. The median age at primary palatoplasty for all patients was 10 months (8 months – 6.6 years), and 63% of patients had a complete cleft palate. The median driving distance for patients to reach the hospital was 50 km (3 – 2684 km), median income based on postal code was $51,866, and 11% of patients were Indigenous. Patients with complete cleft palates had a higher rate of VPI compared to incomplete cleft palates (47% vs. 24%, p = 0.0014). Longer driving distances to the hospital were associated with higher rates of VPI (a median of 88 km vs. 42 km, p = 0.023). Indigenous patients had a higher rate of VPI compared to non-Indigenous patients (65% vs. 35%, p = 0.0048).
Conclusion: Upon preliminary analysis, we can see that a patient’s cleft palate type, driving distance to the hospital, and Indigenous identity are factors that increase the risk of developing VPI, which is a negative speech outcome following primary palatoplasty. With this study, we hope clinicians and researchers will be more prepared to address the social determinants of health to better speech outcomes for their patients.
Congratulations to Tara on receiving an Office of Pediatric Surgery Evaluation and Innovation (OPSEI) Summer Studentship
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Ariel Qi
Medical Student, Queen’s University Supervisor - Dr. Sara Jassemi
Finding Safety in the Psychosocial History: Perspectives from General Pediatrics and Adolescent Medicine
Ariel Qi, Vivek Gill, Erin Peebles, Brett Schrewe, Sara Jassemi
Background: The psychosocial history is a powerful tool in pediatric medicine, offering critical insights into a patient’s household, mental health, social supports, and other factors affecting their behavior and health. It is increasingly recognised as an essential skill in pediatric training, requiring sensitive communication to minimise harm from personal inquiries. Despite its importance, research is limited on pediatric trainees’ experiences with psychosocial history-taking. Our study compares General Pediatric residents with Adolescent Medicine fellows and early-career specialists to assess their learning experiences. Adolescent Medicine, a subspecialty following General Pediatrics training, focuses on medical, developmental, and psychosocial complexities in adolescence. We hypothesise that advanced approaches taught in Adolescent Medicine could enhance psychosocial history competency in the General Pediatric residency curriculum.
Aims:
- Compare the experiences of Canadian General Pediatric residents and Adolescent Medicine fellows/ early-career specialists in learning the psychosocial history.
- Evaluate the perceived epistemological and clinical roles of the psychosocial history among these trainees and pediatricians.
- Describe the strengths and weaknesses in the current psychosocial history-taking curriculum.
Methods: This qualitative study involves semi-structured interviews with Canadian General Pediatric residents and Adolescent Medicine fellows with at least six months of training, and early-career Adolescent Medicine specialists within five years into practice. Participants are recruited through emails from the Canadian Pediatric Program Directors Research Group and fellowship program directors/administrators. Interviews are conducted by two research assistants, and conceptual depth is expected to be achieved with 15-20 interviews. Data will be analysed using Braun & Clarke’s thematic analysis method, with two reviewers creating a codebook and identifying themes. Findings will be verified through member checks. The study is approved by the UBC Research Ethics Board.
Significance: Our study will provide insights into the current curriculum and culture of psychosocial history-teaching through the lens of formal, informal, and hidden curricula in medical education. The results will inform an instructional approach that improves learners’ comfort with challenging conversations and emphasises direct mentorship from staff physicians. It is hoped that this study can inform a psychosocial history teaching framework that is equity-focused, anti-oppressive, and supports patients in addressing psychosocial adversities while preventing (re-)traumatization and unnecessary harm.
Congratulations to Ariel on receiving a Brain, Behaviour & Development Summer Studentship
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Riya Virdi
Medical Student, University of British Columbia Supervisor - Dr. Lise Leveille
Assessing the Impact of the Introduction of a Rapid Access Acute Knee Clinic on Time to Diagnosis and Management of Adolescent Anterior Cruciate Ligament (ACL) Injuries
Riya Virdi, Joyce He, Nicole Krysa, Lise Leveille, Christopher Reilly
Background: The anterior cruciate ligament (ACL) is a connective tissue in the knee that prevents the tibia from translating anteriorly relative to the femur. Frequency of ACL ruptures are increasing amongst physically active adolescents, and delaying ACL reconstruction can lead to higher incidence of meniscus tears and cartilage damage, which can contribute to degenerative changes in the joint over time. A recent study conducted by our research group identified a linear relationship between patient household income and time from injury to referral to orthopaedic consult. Since then, a novel Rapid Access Acute Knee Clinic has been implemented at BC Children’s Hospital.
Objectives: To determine whether the introduction of the clinic has served to: (1) decrease the discrepancy in access to care associated with socioeconomic status, (2) decrease the delay in referral to an orthopaedic surgeon on average for all adolescent patients in the Greater Vancouver Area presenting with ACL rupture, and (3) decrease the frequency of meniscus repairs.
Methods: A retrospective chart review of prospectively collected data from the Knee Outcomes Database was conducted. Relevant data from patients who met the inclusion criteria were extracted to a secure data collection sheet. A multivariate linear regression model will be used to identify the association between time to ACL reconstruction, and the patient’s age, sex, and mean household income. Federal census data were used to estimate patients’ socioeconomic status. Four time points were followed and will be compared to the previous study: injury to surgery, injury to referral, referral to consult, and consult to surgery. A logistic regression model will be used to determine whether delayed reconstructive surgery leads to higher rates of intra-articular pathology.
Preliminary Results: 139 (72 males and 67 females) met the inclusion criteria with a mean age of 17. 95 patients had intra-articular pathology identified. 57 patients had medial meniscal tears, 56 patients had lateral meniscal tears, and 44 patients had cartilage damage.
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Nicholas Wall
Medical Student, University College Dublin Supervisor - Dr. Christine Voss
Associations and gender-differences between physical activity and glycemic control in children and youth with type one diabetes
Nicholas Wall, Ty Sideroff, Jeffrey Bone, Simran Gill, Trent Smith, Christine Voss
Background: More than 125,000 individuals under the age of 20 are diagnosed with Type One Diabetes (T1D) every year. Despite physical activity (PA) levels being shown to be related to better glycemic control (GC) in children and youth with T1D, research suggests that they are insufficiently active, which may in part be due to fear over PA-induced hypoglycemia.
Objectives: To investigate the association between PA and GC in children and youth with T1D, and to explore if any such associations differ by gender.
Methods: Children and youth (5-19yrs) in the Interior of British Columbia, Canada, wore a Fitbit Charge 5 continuously for 28-days to assess physical activity (steps/d). Intraday min-by-min Fitbit data was extracted to REDCap by a custom-written application programming interface. Median steps/d per person were calculated for days with >600 min wear time with a 14-day minimum. Participants provided a data file (5 min epoch) of their continuous glucose monitor (CGM) data for the same period. Percent ‘time in range’ (TIR) was calculated using clinical glucose targets of 3.9-10.0mmol/L. Statistical analyses were performed in R (p<0.05).
Results: Twenty-nine participants were included in analyses (45% Girls; age 12.8±3.9yrs; 86% on insulin pump; 4.6±3.5yrs since diagnosis). Median steps/d were 10,674 (IQR: 7,125-14,350) with 31% of the sample achieving 12,500steps/d. Mean TIR was 55±32%, with 14% of the sample achieving the clinical target of >70% TIR. Steps/d was positively related to greater coefficients of variability in GC (p<0.001, ß=0.34) and increases in ‘time below range’ (TBR) (p<0.001, ß=0.21). Boys were significantly more active than girls (13,087 vs 8,970 steps/d, p<0.001), while girls spent significantly more TIR (52% vs 58%, p<0.001). Generalized additive models estimated boys’ steps/d to be linearly associated with greater TIR. Conversely, models suggest girls participating in more PA did not have linear increases in TIR and had greater variation in their GC with PA.
Conclusion: Children and youth in our sample were relatively active, and greater PA was related to more TIR as well as more TBR. Gender was a significant factor in both PA participation as well as in (GC) related to PA.
July 25, 2024
2:00 - 3:30 pm
Chieng Family Atrium
Arshdeep Waring
Medical Student, University of British Columbia Supervisor - Dr. Ram Mishaal
Impact of Early Screening Programs on Cerebral Palsy Diagnosis and Care: A Review
Arshdeep Waring, Mor Cohen-Eilig, Ram Mishaal
Cerebral palsy (CP), characterized by permanent movement and postural disorders, is one of the most common childhood disabilities. Recent advancements have found that earlier diagnosis is possible using recommended screening tools such as the General Movements Assessment (GMA). The Early Motor Screening Program (EMSP) at the Sunny Hill Health Centre, BC Children’s Hospital provides GMAs to high-risk infants in BC using a virtual platform. As a new program, there is limited information available on whether it is achieving its objectives. This narrative literature review aims to explore existing literature on similar early CP programs around the world to understand whether they facilitate increased and earlier rates of diagnosis, enhance equity in access and support improved care for infants with risk factors for CP.
A literature search was performed using Medline and PubMed databases using combinations of the following search terms: “cerebral palsy,” “early diagnosis,” “early screening,” “early detection,” “GMA,” “equity,” and “virtual care.” Previous literature demonstrates that implementing early diagnosis recommendations in clinics effectively decreased the mean age of diagnosis of CP, making diagnoses prior to 12 months of corrected age possible. Additionally, it has been found that parents generally rate these clinics to be highly acceptable, and prefer receiving earlier diagnoses for their child as it could provide clarity and increase access to early interventions. Multiple studies have illustrated the significance of early CP interventions in preventing complications and maximizing functional outcomes, as well as improving parental emotional and mental health. However, literature regarding equity in access to CP services remains limited. Utilizing virtual care in other areas of healthcare has been associated with reduced burdens of travel, cost, and time for some families. Studies have indicated that virtual care may not be a suitable substitute for all families, highlighting the importance of optional in-person appointments and alternative arrangements for early CP services.
Findings from this review suggest that programs similar to the EMSP contribute to earlier diagnosis of CP, increase equity and ultimately support improved care and outcomes for these infants. Future studies may address the identified gaps in literature and analyze data from the EMSP
Congratulations to Arshdeep on receiving a Sunny Hill Summer Student Award
Session #1 | Poster #4
Martina Knappett, Master’s Student, University of Victoria Supervisor: Matthew Wiens, Healthy Starts
Pediatric Discharges in Uganda: Health Worker and Caregiver Perspectives
Martina Knappett, Clare Komugisha, Jessica Trawin, Savio Mwaka, Ezrah Bamwesigye, Collins Agaba, Jesca Nsungwa-Sabiiti, Peter Waiswa, J. Mark Ansermino, Niranjan Kissoon, Nathan Kenya Mugisha, Matthew O. Wiens
Background: Under-five mortality rates are disproportionately high in low- and middle-income countries (LMICs). One important, yet neglected, aspect of this disparity is the post-discharge period. Post-discharge mortality rates often exceed in-hospital mortality rates for children living in LMICs; however, much remains to be explored in terms of the specific barriers to improving standards of discharge care. Assessing health worker and caregiver insights will afford a better understanding of the current challenges to improving the health facility discharge process, identify priority areas for improvement in quality of care, and ultimately decrease pediatric post-discharge mortality.
Objective: The objective of this study was to determine health worker and caregiver perceptions of the pediatric discharge process in Uganda.
Methods: 180 health workers and 180 patient-caregivers from 36 nationally representative health facilities in Uganda underwent structured interviews based on the Pediatric Sepsis CoLab Environmental Scan to elicit their satisfaction and experiences with the discharge process.
Results: Training in discharge guidelines was reported by 18(10%) health workers. Eighty-six(48%) health workers perceived the caregiver discharge education provided at their facility as inadequate, and 145(81%) had never contacted a lower-level health facility or community health worker on a patient expected to return for follow-up care. To improve the education process, health workers recommended establishing counselling protocols and providing take-home materials. Among caregivers, 145(81%) stated that they were informed of their child’s diagnosis during hospitalization. A total of 105(58%) caregivers perceived time spent by health workers preparing them for discharge as adequate, while 147(82%) considered the timing of discharge suitable. For those who felt the timing was poor, the most common concern was having insufficient time to travel home. At the time of discharge, fewer than half (42%) reported having been informed of their child’s vulnerability post-discharge. To improve discharge care, caregivers recommended allowing more time for questions and earlier patient notification of discharge.
Conclusion: There are deficiencies and differing perceptions concerning the adequacy of preparation for discharge at health facilities in Uganda. Implementation of, and training for, standardized discharge protocols may improve both practices and satisfaction with peri-discharge care.