Counteracting the “Jumping to Conclusion” bias in schizophrenia with a combination of neuromodulation and metacognitive training

In Canada around 1% of the population is diagnosed with schizophrenia, roughly corresponding to 40 000 people in British Columbia. One typical feature of Schizophrenia is making hasty decisions without weighing evidence; this is known as the “Jumping to Conclusion” (JTC) bias. The bias can be understood as a tendency of quickly committing a final decision based only on the first available evidence. One of the most successful forms of treating the bias in schizophrenia is Metacognitive Training. During this therapy, patients try to question the logic of their own decisions. The goal of this project is to enhance the beneficial effect of this treatment and establish methods for objective monitoring of successful therapy. The previous research of Prof. Woodward lab showed that is possible to track neural connections of brain regions involved in the JTC bias. Here, we plan to identify these networks in each of our patients. Next, using a new technology for safe electric modulation of neural connectivity, we will strengthen connections in the network. Through multiple testing sessions we will monitor changes in the brains of patients and thus the progress of therapy. This project can help us improve the treatment of schizophrenia.

Biomarkers and interventions for mild traumatic brain injury and intimate partner violence

Mild traumatic brain injury (mTBI; e.g. concussion) results in a range of symptoms that disrupt daily life, and many mTBI patients go on to suffer persistent post-concussion symptoms (PPCS) that last for months to years. There are no reliable biomarkers for mTBI and PPCS, or interventions known to improve recovery.

This project will therefore assess the use of blood biomarkers as diagnostic and prognostic methods for mTBI and PPCS, and also investigate whether exercise intervention early after mTBI improves recovery. This project will also examine a grossly understudied cause of brain injury — intimate partner violence (IPV). Despite evidence of mTBI in approximately 90 percent of IPV survivors, the nature of this brain damage and how it contributes to their lived experience is poorly understood. Therefore, another goal of this project is to investigate the neurological health and a range biomarkers reflective of brain injury in women with a history of IPV.

In partnership with knowledge users (e.g. clinicians, nurses, patients, scientists), the findings from this project will facilitate the development of evidence-based interventions, education programs, and changes in practice and policy that improve the care of those who have suffered mTBIs.

Couples’ perinatal sexual health and well-being

Over 380,000 Canadian couples become pregnant each year. Of these, 20-68 percent of mothers and 22-45 percent of partners will experience distressing sexual health problems (e.g. low sexual desire, pain) that begin in pregnancy and that may continue up to 12-months postpartum. In turn, poor sexual health has many known consequences for overall health and well-being and is linked with increased use of health services. Yet, most new parents receive no information about sexual health during this period, in part, due to limited knowledge about who is most at risk and a lack of evidence-based interventions to address perinatal sexual health problems. Using a variety of research methods we will:

  1. Identify factors associated with who is most likely to experience perinatal sexual health problems.
  2. Use these factors to pilot a novel couples-based psychological intervention to improve sexual health.

In addition to benefits for couples’ sexual health, this research will also enhance couples’ general well-being, by reducing the psychological and relational burdens during an already vulnerable period. This knowledge will be shared with perinatal healthcare providers in order to improve perinatal healthcare practices.

Physical activity and the clinical management of chronic diseases in children who reside in rural and remote communities in BC’s Interior

Physical activity is a cornerstone of health and wellbeing for all children. This includes children who live with chronic conditions such as congenital heart disease and diabetes. Oftentimes, these children and their families have unanswered questions regarding the safety and importance of physical activity participation. This is partly because physical activity is not regularly discussed during clinical appointments with specialist doctors, as other clinical topics take priority.

In my research, I will work with children who live with chronic conditions, and their families, to better understand their physical activity behaviours and reasons for them. I will also work with clinical care providers to learn about their current practices and attitudes around physical activity promotion. I will then bring everybody together to develop and implement new approaches that can help children with chronic conditions to lead more active lives.

SCI pharmacovigilance: A drug safety platform to improve neurologic outcomes in spinal cord injury

Individuals with spinal cord injury experience various secondary complications including pain and muscle spasms. These complications are treated simultaneously with various medications resulting in “polypharmacy.”

The goal of my MSFHR work is to apply advanced analytical techniques to understand the neurologic effects of commonly used medications. This work challenges longstanding assumptions regarding the acute pharmacological management of spinal cord injury. Ultimately, this will yield new insights into neurologic drug safety, which in turn will optimize recovery from spinal cord injury. This will also lay the foundation for a pharmacovigilance (drug safety) platform in spinal cord injury — the first of its kind in the field.

Defining and detecting traumatic events and symptoms in autism

One in every 58 children in British Columbia meet criteria for autism spectrum disorder (ASD) — an increasingly common developmental disorder characterized by notable social and communication difficulties. Co-occurring mental and physical health conditions are the rule, rather than the exception for those on the spectrum and associated with poorer outcomes as well as more complex and costly healthcare needs for affected families. Childhood trauma is a major risk factor for physical and mental illness that has been understudied in ASD and for which there are few evidence-based guidelines. Clinical research and practice have been limited by a lack of assessment tools designed to account for the different ways in which youth with ASD may experience and express psychological trauma.

The goal of this proposal is to address this measurement gap and therein enable the applicant to develop a unique research program focused on improving the recognition, characterization, prevention and treatment of traumatic events and symptoms in autistic youth and young adults. Stakeholder engagement and knowledge translation activities will be used throughout to guide the development of measures and to inform future research, practice, and policy.

Implementation of a Canadian willingness to cross program: A strategy to increase access to kidney transplantation for highly sensitized patients

More than 20 percent of candidates on the kidney transplant waitlist are considered difficult-to-match for the already scarce resource of kidne y organs. This is because their immune system has previously been activated through pregnancy, blood transfusion, or prior organ transplants to produce a broad range of antibodies that limit their chances of finding compatible donors. These “highly sensitized” patients (HSP) face prolonged wait-times, reduced access to transplant, and an increased risk of death on the waitlist.

The main objective of this research is to implement a first-of-its-kind Willing to Cross (WTC) program. Under this national initiative, patients will be able to be transplanted across known antibodies against donors that are deemed to be at low risk of causing rejection. This strategy is anticipated to improve the chances of receiving a transplant while maintaining good patient outcomes. In addition, the study will follow patients with two cutting-edge immune assays that have been shown to detect rejection before kidney injury occurs. Recognizing that we serve a diverse patient community with different values and beliefs, we will also evaluate patient perception and readiness to adopt this new kidney allocation system.

Smart discharges to improve post-discharge survival in young infants following admission for infection

In many resource-limited countries, children who suffer from severe illness are at a high risk of dying in the six months after leaving the hospital. Most caregivers are unaware of this, although simple strategies like follow-up visits and healthy practices at home can improve survival. Our team has developed a tool that allows healthcare workers to identify children who are most at risk of dying after leaving the hospital. Healthcare workers can use this tool to identify the highest-risk children and plan follow-up visits, reducing the burden on families and the health system. The caregivers of all discharged children receive education on healthy practices and on the signs that their child needs follow-up care. In Uganda, our approach has saved the lives of children aged six months to five years old.

Here, we will confirm that this same approach can be used in a wider population. We will talk to families and healthcare workers to determine how best use this approach in different age groups and locations. We will work closely with our Ugandan partners to ensure improvements are long-lasting. Ultimately, we plan to work with our local partners to apply our approach and improve child health in remote communities across BC.

Preventing Osteoarthritis after a Sport-related Knee Injury

By 2040, 25% of Canadians will have osteoarthritis (OA), a disabling joint disease. This number will be as high as 50% for those who hurt their knee playing youth sport. Currently, the treatment of youth sport knee injuries focuses on return to sport. Few seek care beyond their injury, and little effort is made to prevent OA. Stop OsteoARthritis (SOAR) is a new physiotherapy program to reduce the risk of OA after a youth sport knee injury.

Designed with a team of patients, clinicians and researchers, SOAR teaches active youth how to manage their OA risk, and improve knee muscle strength and physical activity levels after injury. SOAR consists of a knee camp, personalized exercises, wrist-worn activity-tracker and weekly counselling.

This research will assess what youth with a sport knee injury think about SOAR and how well SOAR works to reduce muscle weakness and inactivity – proven risk factors for knee OA. We will also explore new ways to monitor knee health after injury.

The SOAR team will continue to include patient and clinician partners to make sure that SOAR is practical, and relevant. It is expected that SOAR will improve the health of young British Columbians who have a sport knee injury and reduce their risk for OA.

Early dysphagia detection in critically ill patients following prolonged mechanical ventilation

Acutely ill patients often require life-saving measures including breathing tubes and breathing machines (mechanical ventilation; MV).  As our population ages and more people have chronic, complex health conditions, MV is becoming a more common, necessary practice.

Despite medical advances, about 2 out of every 3 adult patients experience swallowing problems (dysphagia) following prolonged MV (>48 hours). Untreated dysphagia decreases quality of life, prolongs hospital stays, and leads to complications such as pneumonia and even death. Early dysphagia identification is key to avoid negative outcomes and high healthcare costs. There is currently no scientifically confirmed way to screen for dysphagia in this population.

To address this gap, my research program will study swallowing in patients following prolonged MV using modern methods, such as airway imaging and tests of breathing, tongue strength and saliva. The results will be combined with patient priorities and other evidence to develop better dysphagia detection methods and personalized treatment approaches.

Ultimately, this will lead to the first scientifically supported screening tool for this population resulting in better health outcomes and reduced care costs.