Scholar Award

Decision makers need to decide how to best allocate limited societal and healthcare resources to fund different healthcare services. Health economic evaluation is a tool commonly used to inform these types of funding decisions; however, which costs to consider in economic evaluation can have a significant impact on the resulting funding decision. A societal perspective considers costs within the formal healthcare sector (e.g., physician, hospital and drug costs) as well as costs outside the healthcare sector (e.g., work productivity costs of patients and their family caregivers).

Mild traumatic brain injury (mTBI), commonly known as concussion, is a major public health concern. Around 42 million of the world's population sustain mTBIs annually. In Canada, ice hockey has the highest sports concussion rates in children and youth. In British Columbia, 2.4 million dollars were spent on hospitalization for mTBI in 2010. Furthermore, recent studies have linked multiple mTBIs from sports with heightened risk of long term brain changes.

My research aims to answer two questions: when and under what circumstances do some young people intentionally physically harm themselves, and how can we improve our clinical tools to reduce these behaviours? Intentional self-harm is alarmingly prevalent in young British Columbians: around 5-7% of BC youth have attempted to end their own lives, 10-15% have experienced serious suicidal thoughts, and 15-18% have engaged in non-suicidal self-injury. These behaviours can have devastating impacts on youth, their families, and their communities.

Gut health is closely connected to our microbiota, a unique, constantly evolving, group of trillions of bacteria that live in our bodies. Gut microbes produce compounds that are absorbed into our blood, providing nourishment and also affecting the gut environment. The digestive tract is composed of many different local areas, called habitats, in which physical and chemical properties such as water availability, salt concentration, acidity or temperature are tightly controlled by human-microbe interactions.

Regenerative medicine such as stem cell based therapy holds great promise towards addressing many diseases that afflict millions of Canadians, including many forms of cancer, muscular and neurological degenerative disorders, diabetes, and arthritis. However, this promise has yet to be fully realized. Despite the many advances in stem cell biology, little is known on the mechanisms governing stem cell identity and on how this identity can be effectively changed and applied towards its target function.

Endometrial cancer (EC), or cancer of the uterus, is the most common gynecological cancer in Canada, with new cases and deaths increasing annually, due to an increase in the rate of common risk factors, like obesity. In British Columbia, the number of new EC cases is projected to increase by 50% and mortality to double by 2031. We must investigate economically feasible prevention strategies to control the rate of this cancer.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people face judgment and discrimination on the basis of their sexualities and genders. This leads many LGBTQ people to avoid seeking treatment from the healthcare system, to hide aspects of their sexuality/gender when seeking care, or to selectively visit LGBTQ-affirming providers.

The goal of this research program is to develop a comprehensive understanding of healthcare access patterns among LGBTQ people in BC.

Objectives:

Cancer is a complex disease with many factors which determine how rapidly cancer cells can grow and spread throughout the body. Significant differences exist within the cancer cell population of a patient. These differences shape the interaction of cancer cells with the surrounding healthy tissue, with dramatic variation between patients. This so called cancer heterogeneity has profound implication for patient prognosis, and is one of the primary challenges to developing effective cancer treatments.

Depression has recently become the leading cause of disability, worldwide. It affects one out of every 20 Canadians, causing significant suffering to patients and their families and costing the economy CAD$32.3 billion each year. Previous efforts to address the burden of disease caused by depression have mostly been focused on expanding access to mental health services.

Up to 73% of people who are able to walk post-stroke suffer a fall, commonly within the first few months after discharge home. Optimizing the approach to rehabilitation of walking balance remains vital to long-term outcomes post-stroke.  A fall poses a significant risk of injury and erodes confidence. The loss in confidence alone can lead to decreased activity levels, loss of independence and social isolation that affect quality of life and overall health, even hastening death.

A defining characteristic of cancer cells is their ability to grow and replicate in an uncontrolled manner. Cancer cells have altered signaling pathways that allow them to bypass checkpoints that would normally prevent their rapid growth. STAT3 protein is a master regulator of cancer cell signaling and is found to be overactive in 70 % of cancers. While healthy cells can survive without STAT3, cancer cells become addicted to overactive STAT3 and are sensitive to disruptions in this pathway.

The healthcare system is undergoing a paradigm shift toward person- and family-centred care. While this is a critical priority, it will be challenging to put into practice. One strategy to implement this change is shared decision-making (SDM), a process that supports patients and providers to discuss the risks and benefits of options, clarify preferences, and make choices based on their informed values. Knowledge translation and implementation science (KT/IS) are key approaches for accelerating this system change.

Primary care includes the day-to-day services provided by family doctors, nurse practitioners, and other health care providers. High quality primary care that follows patients over time and coordinates specialist and hospital care is key to an effective and efficient health care system. Unfortunately, many Canadians struggle to get primary care where and when they need it, despite there being more family doctors per person than ever before.

My research program seeks to answer the following questions:

Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer related deaths mostly due to the absence of symptoms as the cancer develops. This leads to diagnosis after the tumor has already become widely invasive and cannot be surgically removed. Unfortunately, surgical removal of early stage tumors is the most effective treatment option and other treatments, such as chemotherapy, are woefully ineffective.

Thus, there are two major fronts where research could improve the outcomes of pancreatic cancer patients:

Personal identity--one's psychological sense of personal continuity--is an important aspect of mental health, informing one's motivations, behaviours, and social relations. Disruptions in identity can contribute to prevalent conditions such as personality disorders. Indeed, distorted identity is a core aspect of personality dysfunction and disorder, contributing to considerable negative health and social outcomes--and a prominent challenge for health care providers and systems.