Monday, July 22, 2019

Government of Canada Invests in Innovative Health Research at Dalhousie & Nova Scotia Health Authority

*Note: this post is also published on Dal News and is co-authored with Michele Charlton from Dalhousie. 

Four medical scientists from Dalhousie University are the recipients of $2.6 million in funding from the Government of Canada for their groundbreaking health research.
Four clinician scientists affiliated with the Nova Scotia Health Authority (NSHA) and the IWK Health Centre also received funding, bringing the total in new health research funding to $4 million.
The funding, which is provided by the Canadian Institutes of Health Research (CIHR) project grants, will help researchers from Dalhousie and NSHA gather the kind of information they need to make real improvements to clinical practice, health service delivery, and public health policy.
The Project Grant competition is one of CIHR’s flagship funding programs. They are multi-year grants that are designed to support researchers at various stages in their careers as they conduct health research and knowledge translation projects that cover the full range of health research topics. Project grant recipients are leaders in their fields and their projects tackle pressing health issues that matter to Canadians, such as cancer, autism, heart disease, and dementia.

Highlights of successfully funded researchers

Martin Alda
Psychiatry Researcher, NSHA
Project title: Clinical and genetic factors in response to treatment of bipolar disorder

This study seeks to cut down the time it takes to find an effective treatment for bipolar disorder. Traditionally a trial-and-error approach to finding an effective treatment is used but this project seeks to better inform the process using genetic data.

Support for this project is not only local but also on an international scale. Local researchers are part of an international consortium, ConLiGen and this project has also received funding from the European group ERA PerMed Cofund.

Jason Berman
Division of Hematology/Oncology, IWK Health Centre
Project title: Using the Zebrafish as a model for chemoprevention for TP53 mutation carriers

Patients with Li Fraumeni syndrome (LFS) have a mutation in a gene called TP53 in every cell in their bodies, which puts them at much greater risk for developing cancers early in life and throughout their lifetime. While surveillance programs that include MRIs and other imaging tests have helped identify these tumours earlier so that they are more easily treated, these patients still require intensive therapy to cure their cancers. Patients who survive their first tumour are likely to have second, third and more tumours that will all need treatment. What types of cancer and when these tumours will develop is hard to predict.

The zebrafish shares similar genetics to humans, fertilizes externally producing large numbers of offspring, which are transparent and easily studied. Dr. Berman and his team have already genetically engineering zebrafish to contain the most common TP53 mutations found in LFS, and these fish develop cancers by 8-10 months of age. These fish can be screened early in development for signs that their TP53 gene is not functional and introduce additional mutations found in LFS patient tumours. The young fish can then be used to screen for drugs that restore normal TP53 and observe if cancers are prevented. By demonstrating that these responses in zebrafish are conserved in patient samples, we aim to improve the outcome for these children.

Zhenyu Cheng
Assistant Professor, Faculty of Medicine
Project title: Pseudomonas aeruginosa protease promotes chronic inflammation and immune evasion

Pseudomonas aeruginosa is a bacterial pathogen that inhabits soil and water as well as plant and animal tissues. It can be an opportunistic human pathogen, causing infections when normal immune defenses are disrupted.

Respiratory P. aeruginosa infection is the leading reason for morbidity in cystic fibrosis patients. The infections normally persist in the lungs of cystic fibrosis patients because of the formations of bacterial biofilms, and can lead to inflammation in the lung.

The goal of Dr. Cheng’s research is to characterize how a P. aeruginosa-secreted protease modulates inflammation in the context of chronic infection in CF lungs. His findings may lead to the development of new strategies for alleviating the terrible inflammation in the lungs of these patients that eventually creates the need for lung transplants.

Melanie Kelly
Professor, Faculty of Medicine
Project Title: The Serine Hydrolases: Positioned at the Axis of Endocannabinoid-Elcosanoid Signaling

The endocannabinoid system (ECS) is an important physiological regulatory system, and drugs that target this system have effects on a number of critical biological systems including synaptic transmission and immune response. The ECS is also the target for cannabinoid constituents from the cannabis plant including behaviorally active tetrahydrocannabinal (THC) that interacts with cannabinoid 1 and cannabinoid 2 receptors.

There is a tremendous interest in targeting the ECS to treat disease, particularly using indirect agonists such as enzyme inhibitors, which block the metabolism of endocannabinoids. Although there has been significant promise in pre-clinical studies, clinical trials of enzyme inhibitors have been halted due to either a lack of efficacy or toxicity.

Dr. Kelly’s research will address these important areas by:

1) providing fundamental knowledge about the manipulation of endocannabinoid signaling in the central nervous system (CNS)
2) Identifying the risks or benefits of using drugs that indirectly enhance endocannabinoid levels for therapeutic targeting of the ECS in CNS disease

Emily Gard Marshall

Associate Professor, Faculty of Medicine
Project title: The CUP Study - Comparative analysis of centralized waitlist effectiveness, policies, and innovations for Connecting Unattached Patients to primary care providers

How well do waitlists to find a family practice work and what could we do to help them work better

People who have access to a regular primary care provider (family doctor or nurse practitioner) receive better and more appropriate care and have better health outcomes than those who do not. Across Canada, 15% of people do not have a regular provider, and are referred to as “unattached patients.”

Seven Canadian provinces, including Nova Scotia, have centralized waitlists that coordinate matching unattached patients to a primary care provider. These centralized waitlists all work differently, but no one has studied how well they work.

Dr. Marshall will compare centralized waitlists in Nova Scotia, Quebec, and Ontario to see how effective they are at connecting unattached patients to primary care providers. The findings from this study will be shared with stakeholders from all the provinces.

Natalie O. Rosen
Associate Professor, Faculty of Science
Project title: A multi-method study of self-expansion in couples coping with Female Sexual Interest/Arousal Disorder

Sexual health is a fundamental aspect of quality of life; a satisfying sexual relationship is associated with better physical, psychological, and relationship health and well-being. Problems with sexual function are extremely common, especially for women. A persistent difficulty with sexual desire and/or arousal that is personally upsetting (Female Sexual Interest/Arousal Disorder or FSIAD) affects 7-23% of the general population.

Sexual desire—the key component in FSIAD—is thought to be embedded in, and influenced by, interpersonal factors, with FSIAD being coined the most ‘relational’ of sexual dysfunctions. One highly relevant interpersonal factor that has been associated with greater sexual desire and satisfaction in community couples is self-expansion. Self-expansion in relationships represents the extent to which partners  facilitate the attainment of new perspectives and provide opportunities for novel and exciting experiences. For example, a couple might engage in self-expanding activities together such as learning how to cook a new type of cuisine or taking a trip to a new city to explore interesting sights.

The goal of Dr. Rosen’s study is to examine how self-expansion in relationships influences sexual desire and associated impairments in couples coping with FSIAD. The results have the potential to improve the health of couples coping with FSIAD by providing novel targets for couple interventions.

Sudeep Shivakumar
Hematology Researcher, NSHA
Project title: EPCAT III - Extended Venous Thromboembolism Prophylaxis Comparing Rivaroxaban and Aspirin to Aspirin Alone Following Total Hip and Knee Arthroplasty

The EPCAT III study is a continuation of the comparison of aspirin and blood thinners when preventing blood clots after hip and knee replacement surgery. Previous studies have shown that aspirin is just as effective and safe as a more expensive blood thinner. This results in significant cost savings to the health care system.

Blood clots are common complications following these types of surgeries and traditionally, blood thinners are given to prevent them. However, blood thinners are expensive and can lead to bleeding.

This study continues the work of the team who were previously published in the New England Journal of Medicine.

Rudolf Uher & Stan Matwin
Psychiatry Researchers, NSHA
Project title: Automated analysis of natural speech in personalized treatment for major depressive disorder

Can artificial intelligence (AI) improve on clinical intuition when treating depression? Researchers will test whether treatment selection for depression by AI (based on analyzed speech patterns) can improve upon clinical intuition during assessments and follow up visits.

Speech rhythms reflect the speaker’s mood in the moment and reflect their thought processes and motivations. Listening to speech is a key part of clinical assessment which informs treatment selection such as psychotherapy, brain stimulation or medication. Choosing which treatment will be effective is hard to predict.

Wednesday, April 24, 2019

ACOA Invests $2million in Orthpaedic Innovation

Andy Fillmore, Member of Parliament for Halifax, on behalf of the Atlantic Canada Opportunities Agency (ACOA) announced a $2 million investment for a NSHA orthopaedic project on Wednesday April 17th. 

Left to right: Dr. Travis McDonough (CEO & Founder Kinduct), Barbara Campbell (CEO OrthoMX), MP Andy Fillmore (MP for Halifax), Dr. Alex Fuentes (Chief Scientific & Technology Officer, Emovi), Dr. Michael Dunbar (Principal Investigator & Orthopaedic Surgeon), Dr. Gail Tomblin Murphy (VP Research & Innovation, NSHA)

Dr. Michael Dunbar and the orthopaedic research team, in conjunction with partners Kinduct, Emovi and OrthoMX, are seeking to advance the standard of care, increase treatment options and improve orthopaedic wait times.

NSHA puts a priority on translating research into clinical practice and this project will provide medical staff with enhanced information such that they can make more timely and precise decisions.

Once again, we are drawing a straight line from research and innovation to improved patient outcomes. Nova Scotia Health Authority places a high priority on research and this particular project will advance the standard for patients who need orthopaedic care. We are very pleased to collaborate with industry partners to improve care for Nova Scotians.”
      - Janet Knox, President and CEO, Nova Scotia Health Authority

The technology involved is a three part partnership between Kinduct, Emovi and OrthoMX. Kinduct developed a platform for remote patient monitoring where patients can access information about their care and interact with their healthcare team. Emovi's KneeKG system is a wearable knee assessment device that assesses knee joint functions dynamically. OrthoMX uses the InStride app to track walking patterns. These three parts together will shape the new Mobility Assessment Clinic at the QEII Health Sciences Centre. 

Today we see that meaningful collaboration fosters innovation. With the support of ACOA, our NSHA collaborative research partnership with Kinduct, Emovi and OrthoMX is bringing transformative innovations to patients across Nova Scotia.”
    - Dr. Michael Dunbar, Orthopaedic Surgeon, Endowed Chair of Arthroplasty Outcomes, Queen Elizabeth II Health Sciences Centre

Congratulations to Dr. Dunbar and the orthopaedic team!

Monday, April 15, 2019

Welcome Jordan Warford

Welcome to our new Research Ethics Board Manager- Jordan Warford! 

Jordan joined Research in late March 2019 after Ken Jenkins' retirement. 
REB Manager Jordan Warford

Jordan is a neuroscientist focusing on understanding brain inflammation including MS. He holds extensive policy experience including holding seats on provincial post-secondary program evaluation committees, patient advocacy groups, and Dalhousie University’s animal ethics committee.

Jordan's role as the Manager of the REB is to manage the review of research protocols for research being conducted within the Nova Scotia Health Authority before that research begins.
Jordan enjoys being outside with his family (fur and human), running the roads on his bike and if you haven’t met him yet, drop by the Research Ethics office to check out his socks!

Please welcome us in joining Jordan to NSHA.

Wednesday, March 13, 2019

Researchers point to diet and lifestyle as a way we can avoid premature death and disability in Canada

Samiah Alam & Dr. Leah Cahill
A national initiative led by researchers at the Nova Scotia Health Authority (NSHA) and Dalhousie University studied the burden of diseases and injuries attributable to risk factors in Canada and their paper was recently published in CMAJ Open

Nutrition researchers Dr. Leah Cahill(1) and Samiah Alam set out to quantify the determinants of healthy life expectancy in Canada from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD). The GBD study is "an international scientific effort to systematically quantify the comparative magnitude of global health loss resulting from disease, injuries and risk factors to inform evidence-based policy-making." While burden estimates have been presented for individual countries such as the United States, Germany and the UK to help with national policies and prioritizing, Canada had not yet been summarized. 

The top 3 risk factors identified in Canada from the study were (1) tobacco, (2) diet and (3) high body mass index, followed by (4) high fasting plasma glucose, (5) high systolic blood pressure, (6) alcohol and drug use, (7) occupational risks, (8) high total cholesterol, (9) impaired kidney function and (10) air pollution. Cahill hopes the study will inform national health policy by prioritizing these risk factors in Canada. "An understanding of Canada’s foremost health problems, their risk factors, and how both are changing over time is crucial to inform national health policy and programs, health authority planning and scientific research priorities...actionable preventive strategies can lead to improved health outcomes." 

Cahill used three well-established metrics to summarize health loss including
disability-adjusted life years (DALYs), total deaths and years lived with disability . "One DALY is equivalent to 1 year of healthy life (free of disease, injury or disability) lost. Because DALYs quantify both mortality and morbidity, total DALYs are considered to represent the burden of diseases and injuries for a country, indicating the gap between the country’s current health status and an ideal health situation in which the country’s entire population lives to an advanced age, free of disease and disability." 

The trend for Canada from 1990 to 2016 hasn't changed at the top. Tobacco exposure has continued to be the leading risk factor followed by diet, but high BMI and high fasting plasma glucose have both increased, beating out high blood pressure and high cholesterol both of which dropped in rankings over time. 

The good news is that factors proving to be the highest risk, tobacco and diet, are modifiable- change your ways, lower your own risks and reduce Canada's health burden.

1- Leah Cahill, PhD, Affiliated Scientist, QEII Health Sciences Centre, Nova Scotia Health Authority, Howard Webster Department of Medicine Research Chair and Assistant Professor, Dalhousie University, Visiting Scientist, Department of Nutrition, Harvard T. H. Chan School of Public Health