Up to 23,000 preventable deaths are estimated to occur each year in Canadian hospitals. Nurses who provide care at the bedside are well positioned to promote patient safety, because a critical component of their role is to notice and gauge potential risks. Although research suggests that nursesâ workload, training and experience influence patient mortality, little is known about the actual processes that nurses use to prevent or reduce error. Kim Shearer is applying the model of âSituational Awarenessâ (SA) to study pediatric nurses performing resuscitation of children in hospital. SA â defined as knowing what is going on in your environment â has been proposed as the primary basis for decision-making and performance in complex, dynamic systems, helping researchers understand how threats within the environment are gauged and safety is facilitated. Kimâs study will identify factors that promote or impede nursesâ ability to gauge the work environment and make decisions, generating the basic knowledge needed to create computer simulations for teaching and testing SA in pediatric resuscitation. Findings of this research will help to prevent or minimize error and enable development of novel health education interventions to improve SA and hence the safety of children in dynamic and complex acute care environments.
Research Location: Children's & Women's Health Centre of British Columbia
Pharmacogenetics of Mycophenolate in Thoracic Transplant Recipients: Role of UDP-Glucuronosyltransferase Genetic Polymorphisms
Thoracic (heart and/or lung) transplantation is an effective but aggressive measure for treatment of end-stage heart and lung diseases. However, rejection of the transplanted organ remains a major problem and frequently leads to organ loss and death. All transplant recipients take immunosuppressants (drugs that prevent rejection), yet over-immunosuppression exposes them to undesirable infections and other side effects. Mycophenolic acid (MPA) is an effective immunosuppressant commonly used in transplantation. However, tailoring MPA therapy is challenging due to the wide variability and unpredictability in treatment responsiveness and side effects among patients. Genetic makeup and metabolism of MPA have a significant bearing on drug responsiveness. While many studies provide better understanding of MPA in kidney transplant recipients, information on the thoracic transplant population is scarce. Lillian Tingâs research is exploring the role of genetics in determining treatment responses. The ultimate goal is to individualize regimens, even before treatment begins, for each patient in order to obtain optimal treatment response and minimal toxicity. The results from Lillianâs study will add valuable knowledge to transplantation management. It will be directly incorporated into patient care, improving patient survival and quality of life after transplantation.
The exploration of genetic conditions affecting the health of aboriginal people
Canadian aboriginal people have shorter life spans and an increased burden of disease compared to their non-native Canadian counterparts. As in all populations, complex disease—both genetically and environmentally determined—plays a significant role. For example, among the Inuit of Baffin Island, the prevalence of one type of congenital heart defect is four times as high as in other populations.
Dr. Laura Arbour is exploring the genetic and environmental determinants of heart defects among the Inuit of Baffin Island. She will determine the contributing factors of genetics, intake of nutrients that are important in heart development (such as folate and vitamin A) and environmental exposures during pregnancy. She will also assess whether current public health efforts to reduce birth defects by fortifying flour with folic acid are sufficient for people in a northern environment. The goal of her research is to inform public health efforts aimed at prevention, early recognition of symptoms and timely treatment.
Informed Decision Making: The Interaction Between Sustainable Maternity Care Services and Community Sustainability
To examine the role of maternity care in the sustainability of rural and remote communities, with the goal of assisting decision-makers in understanding the implications for the community and to provide them with a framework for making challenging decisions involving changes to the provision of these and other health services.
Substance-Using Women and Experiences of Primary Health Care
To analyze the social, political, and economic determinants that influence health status and access to health services among women who use injection drugs and live in Vancouver’s Downtown Eastside.
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Unclogging the Pediatric Emergency Room: Impact of Rapid Viral Diagnostics
To determine if use of a new program to support rapid diagnosis of viral respiratory infections in children will improve patient management and resource use in the Emergency Department by reducing wait time, improving decision making regarding diagnosis and decreasing antibiotic prescriptions.
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Creation and function of neighborhoods in eukaryotic chromosomes: regulation by SWR1-Com, a desposition complex for histone variant H2A.Z
Chromatin is the complex of DNA and protein material that make up chromosomes, home to the genetic code. The basic unit of chromatin is the nucleosome, a fundamental building block consisting of DNA wrapped around an octamer of histone proteins. A large number of proteins involved in cancer development and the genetic susceptibility to devastating diseases such as Ataxia Telangiectasia (a progressive immunological and neurological disorder) act through modification of chromatin structures and interfere with normal chromatin function. Differences in chromatin structures between adjacent regions specify the properties of larger macrodomains called neighbourhoods. The shape and structure of these neighbourhoods influence chromosome behavior, while complex regulatory mechanisms that ultimately involve chromatin ensure that each cell expresses only the appropriate genes, duplicates its genome with high fidelity, divides only when required, all while combating constant assaults on its DNA. Failure in any of the mechanisms regulating these events can lead to disease. These chromatin structures themselves can also be inherited, creating an additional complex set of influences that are crucial for the identity and activity of the cell. The molecular biology of chromatin structures and their role in chromosome biology and genome function in health and disease is the focus of Michael Koborâs research. Specifically, he is studying a unique chromosomal neighbourhood containing a specialized histone variant known as H2A.Z, which is deposited into chromatin by a large protein complex. Using innovative genome-wide approaches, Dr. Koborâs team aims to uncover the rules and principles of histone variant function.
The identification of susceptibility genes and phenotypic subgroups for autism spectrum disorders
Autism Spectrum Disorders (ASDs) are characterized by impairments in social interaction and communication, as well as restrictive behaviours and interests. These life-long disabilities affect more than 1 in 250 individuals. It has been shown that early diagnosis is essential for children with ASD: the earlier intervention is initiated, the better the outcome. However, affected children are commonly not definitively diagnosed until they are three years of age or older. Sibling, twin and family studies have shown that ASDs are largely genetic in origin and certain chromosomal regions harbouring possible ASD susceptibility genes have been identified. Recent studies suggest that between 5 and 48% of individuals with autism exhibit chromosomal anomalies. This suggests that small chromosomal anomalies, such as microdeletions and microduplications, may be relatively common and clinically important markers for identifying underlying causes of, and susceptible gene regions for, ASDs. Dr. Suzanne Lewis is researching the genetic susceptibilities of ASD, using a novel method for the analysis of regional changes in DNA called microarray-based comparative genomic hybridization (array-CGH). Using this method she is identifying and characterizing chromosomal abnormalities in 100 subjects with ASD. In parallel, Dr. Lewis is also researching ASD phenotypes – genetic influences in combination with respective behavioural, physical, medical, environmental and family findings. Dr. Lewis aims to build a research pathway that identifies genetically distinct subgroups of ASD that also share unique clinical phenotypes. Through researching this genotype/phenotype correlation Dr. Lewis ultimately hopes her research will contribute to a better understanding of the genetic causes and consequences of autism and help in developing methods for the very early identification of infants and families at risk for autism.
An Integrated Approach to the Hypertensive Disorders of Pregnancy
To institute a standardized protocol for the assessment, surveillance and management of women admitted with a hypertensive disorder of pregnancy and to monitor the effect of the protocol on health outcomes, resource utilization, place of care, and family/social disruption.
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Palmitoylation of ABCA1 and its effect on localization and function
Atherosclerosis is a slow, progressive disease caused by the buildup of plaque (fatty substances, cholesterol, cellular waste products, calcium and other substances) in the inner lining of the arteries. This plaque buildup can lead to heart attack, stroke or gangrene. Research has shown that high-density lipoproteins (HDL) remove excess cholesterol from plaque by transporting cholesterol away from the arteries and back to the liver, thus slowing the buildup. Higher levels of HDL seem to be protective against coronary artery disease, and thus HDL is sometimes referred to as “”good”” cholesterol. Dr. Roshni Singaraja is researching the role of the newly-discovered gene ABCA1, whose function is to to produce HDL. Specifically, she is investigating the role of the palmitoylation process (the attachment of palmitate – fatty acids – to proteins which acts as a signal for the protein to be transported) on ABCA1 and its function. In addition, Roshni will examine the function of ABCA1 in the brain and the impact of palmitoylation on these functions. Roshniâs research may lead to potential strategies to increase HDL production and to accelerate or reverse cholesterol transport in order to prevent atherosclerosis.