Developing a roadmap for nurse-assisted injection in BC’s supervised consumption services

Supervised consumption services are an essential part of health care and community services for people who use substances in British Columbia. These services are particularly important for people who inject substances because they offer a safer place to inject and an opportunity to access harm reduction supplies, connect with resources, and receive care if needed. Using in a supervised consumption services can make the difference between life and death in the context of the overdose crisis because staff can quickly detect an overdose, administer naloxone, and call emergency services. Therefore, it is essential to remove any barrier that may prevent people who inject substance from accessing such services. One barrier that is consistently reported is the lack of assistance for people who need help injecting. Nurses are not currently allowed to provide any assistance. This project is designed to explore this issue and find ways to improve access to supervised consumption services for people who need help injecting.

Co-developing a digital health systems research program to support cultural safety and health equity for Two-Spirit, transgender and nonbinary patients in British Columbia

Better and more inclusive care is dependent on including patient perspectives or “voice.” Yet, patient voice is rarely included in the design, modification or implementation of digital health systems (DHS) such as patient portals or electronic health records. As a result, DHS are rarely embraced by patient populations who could have the greatest benefit.

For Two-Spirit, transgender, nonbinary and other gender-diverse people (Trans+), this lack of voice is made worse by inaccurate DHS representations of gender identities. Negative healthcare experiences can discourage Trans+ patients from attending or returning for future visits.

Our collaboration includes Trans+ people, Trans Care BC, and other researchers. We will co-develop a program of research that brings patient voices into the design, modification, and implementation of DHS. The project extends our ongoing work to improve representation in DHS. This project is timely given the provincial government’s recent implementation of Health Gateway, a patient-accessed DHS allowing patients access to their health records.

HIV In My Day: Destigmatizing HIV through theatre, living history, and storytelling

Despite advancements in HIV treatment and care, HIV stigma remains a challenge today. “HIV In My Day” is a community-based research project that has collected and digitally archived 100+ interviews with long-term HIV survivors and caregivers across British Columbia. It is crucial to share these stories more widely with communities who are still disproportionately impacted by HIV/AIDS as well as healthcare providers who serve these communities in order to continue destigmatizing HIV.

In collaboration with “In My Day”, a verbatim theatre production adapted from these stories, our proposed knowledge translation activities will be part of a larger arts-based event in December 2022 at The Cultch in Vancouver, including post-show interactive audience engagement; multimedia presentations of the findings from “HIV In My Day”; intergenerational forums with “HIV In My Day” participants; storytelling workshops for people living with HIV; performances of the “Viral Monologues”.

Together these activities will benefit attendees, including community members and healthcare providers, by teaching HIV history, building storytelling skills, and fostering intergenerational dialogue around HIV within and between affected communities.

The safer washroom campaign: Disseminating best practices in the public and private sectors

For people who use substances who cannot or do not have access to a supervised consumption site, washrooms can provide a private space that feels safe. However, when people use in washrooms, they can face serious risks including the risks of overdosing alone and potentially not receiving life-saving help in time. There are ways of making washrooms safer, but it can be difficult to know how. Best practices have been developed in the past few years to provide guidance to community-based organizations, businesses, health care institution, and other settings where washrooms are publicly accessible. Despite best efforts to make these best practices known, gaps remain. This project is designed to make share this information more broadly and improve washroom safety across the province. To make this happen, we plan on conducting consultation with various groups and developing a safer washroom campaign.

Co-development of an educational toolkit to integrate palliative approaches to care for workers in inner city settings

People who are vulnerable and marginalized such as those who have substance use disorders, mental illness, or are homeless are at high risk of death. Our research shows that they could benefit from palliative approaches to care but the inner city workers who most care for them like housing and harm reduction workers do not have much support and knowledge related to palliative approaches to care. We have worked for several years with a community-based action team to integrate palliative approaches to care into their work and have developed an educational toolkit prototype with them. In this Reach project we propose to use Rearch funds to complete our user-centered design to ensure that toolkit is developed in ways that are relevant and useable for the intended audiences. Specifically, we will (a) turn the toolkit content into user friendly resources, videos and graphics, (b) engage community-based peer reviewers to provide feedback, and (c) develop and implement a dissemination plan for uptake. We anticipate with better prepared and supported inner city workers, people who are vulnerable and marginalized will have better outcomes at the end-of-life such as access to palliative care services when needed.

Strengthening Cultural Identity: Supporting urban Indigenous youth-in-care to access culture through self-determined health and wellness in lək̓ʷəŋən territory

The Strengthening Cultural Identity project will connect urban Indigenous youth in care to language learning resources and culturally centered coming of age activities in lək̓ʷəŋən territory (Victoria, British Columbia). These elements were identified by youth participants during the 2018-2021 Coming of Age Project, as a way to strengthen their Indigenous identities. Building on the partnership between Surrounded by Cedar Child and Family Services (SCCFS) and the University of Victoria, we are proposing a knowledge sharing project that will support two of SCCFS’s youth groups, the Xe’Xe’tuls’thut (leadership) group and the Youth Advisory Council, in determining how they would like to integrate language and cultural teachings into their lives.

We will do this by:

  1. Translating knowledge sharing resources into lək̓ʷəŋən’anthun (Lewungen’athun) to honour the territory where we work, and nuučaan̓uɫ (Nuu chah nulth), to recognize the diversity of the urban Indigenous youth-in-care community.
  2. Working with the youth to facilitate access to language learning (e.g. the KS tools, language resources/teachers) and cultural activities in self-determined ways
  3. Celebrating what we have learned at a community feast.

Endothelial calcium dynamics regulating cerebrovascular function and capillary stalling in the healthy and diabetic brain

The brain is a metabolically demanding organ . Mismatch between blood flow and demand (from neurons) leads to a disruption and in extreme cases injury. Because the smallest blood vessels in the brain are narrow, they are prone to becoming obstructed by circulating cells and debris. This is exacerbated in Diabetics, with “sticky” blood vessels. The cells of blood vessels, endothelial cells, are more than just “pipes”, they form large physically connected networks between themselves. An important regulator of these networks, and a signal to communicate between them, is waves of calcium flowing into cells, which can propagate between these cells. How Diabetes affects these networks of blood vessels, and in turn impact the health of the brain is unknown. Thanks to new genetic tools with state of the art microscopes, we can directly observe these calcium fluxes into endothelial cells in the living, awake, mouse brain, and especially when these blood vessels become occluded. Combined with simultaneous monitoring of blood flow and neural activity I will be able to directly measure concurrent changes in brain activity, blood flow and calcium fluxes to investigate these dynamics in the living healthy or Diabetic mammalian brain.

Honouring all our relations: Advancing health and wellness of uncounted Indigenous peoples in BC through addressing gaps in population health and wellness reporting

Reporting on population health is important to monitor trends, identify priorities, and track progress to address inequities. All Indigenous peoples have the right to be counted. Yet, over 88,000 Indigenous people in British Columbia (BC) who do not have ‘Status’ under the Indian Act or are not registered with Metis Nation BC are currently ‘uncounted’ in population health reporting.

Responsibility for reporting on health of BC residents lies with the Office of the Provincial Health Officer, including collaborative reporting on health of diverse Indigenous peoples in BC. Currently, there is no process to report on health of uncounted Indigenous peoples. Gaps include: lack of formal relationships with those representing uncounted Indigenous peoples; no way of identifying this population in BC health data; absence of research frameworks reflecting uncounted Indigenous peoples’ perspectives; and no implementation plan for province-wide surveillance involving uncounted Indigenous peoples.

This study aims to support health of uncounted Indigenous peoples in BC by addressing current gaps in population health reporting, through partnerships that uphold Indigenous self-determination, decision-making and perspectives of health and wellness.

The impact of the loss-of-function ankyrin-B p.S646F variant on cardiomyocyte and neuronal excitability: Implications for diagnosis and treatment of heart disease

The electrical rhythms underlying heart and brain function are sustained by proteins that form pores in cellular membranes that flux ions like calcium and sodium. These pores are anchored in place by a molecule called ankyrin-B (ANKB). We discovered a genetic change in the Gitxsan Nation of Norther BC that results in a version of ANKB (ANKB p.S646F) associated with heart defects at birth, arrhythmias, sudden death, seizures, and cerebral aneurysms. We showed that this version of the ANKB molecule is mishandled by immature heart cells; however, we do not fully understand how this ANKB version contributes to clinical manifestations. As a clinician-scientist and expert in microscopy-based measurement of cellular excitability, I am well-positioned to bridge this important knowledge gap. By imaging calcium and voltage changes in living cells, I will study the impact of partial loss of ANKB and expression of disease-associated ANKB p.S646F versions on heart and brain cell excitability. I will also compare heart cell excitability data with patient electrocardiograms to help understand the connections between fundamental laboratory and clinical observations.

Developing patient-specific technologies to improve functional outcomes following joint replacement

The inability of patients to perform daily tasks after joint replacement remains a significant challenge as well as a burden on health systems because these poor results often require additional treatment (e.g. rehabilitation) and re-replacement. This challenge can be addressed by surgeons using individual patient characteristics to personalize how they perform joint replacement surgery. However, many surgeons perform too few procedures to effectively personalize their plans and thus technologies are needed to provide assistance.

The goal of this research is to develop an improved understanding of how patient specific factors affect the results of joint replacement as well as to develop technologies that can collect data about each patient’s individual characteristics and use these data to assist surgeons in optimally planning each surgery. This will be achieved by a combination of computer-based biomechanical research, statistical modelling, and novel sensor development. This work will improve our understanding of personalized joint replacement, yield new clinical technologies, enable surgeons to more effectively personalize surgery, result in improved patient function, and improve the health systems in BC and beyond.