2021 Summer Student Research Program

Watch Presentations Online: www.bcchr.ca/posterday | Poster Day Participants

Welcome to the 2021 Virtual Poster Day for the Summer Student Research Program. Each year we host this event to showcase unique and innovative research being conducted by undergraduate, medical and graduate students over the summer.

Over the past year, the COVID-19 pandemic has continued to impact all areas of research on the Oak Street Campus. As the health and safety of the research community is our first priority, we were able to work with our partner organizations to adjust all aspects of the summer program so it could be held virtually once again. Despite the challenges, we realize the important contributions our summer students make each year, and hope the research community at BC Children’s Hospital has provided students with valuable research opportunities and learning experiences.

Since the early 1990s, the Summer Student Research Program has provided students an opportunity to participate in research projects related to children’s and women’s health. It is amazing to see the activities the students are involved with, which range from basic science to clinical and population health research. Poster Day provides a wonderful preview of the interdisciplinary work our students will pursue as they progress into their own careers as scientific and clinical investigators.

We are proud of the students here and we are pleased to be able to help them become leaders in their fields.

Sincerely, Ashley Biggerstaff, Sharon Yau and Laura Christensen Research Education Team, BC Children’s Hospital Research Institute www.bcchr.ca/posterday

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Summer Student Poster Day Thursday, July 29, 2021 Watch Presentations Online - www.bcchr.ca/posterday

Morning Sessions

Showcasing the outstanding work of summer students and their contributions to research. Each participant will have 5 minutes to discuss their poster and up to 5 minutes for questions.

8:30 - 10:30 am

Session 1: Clinical, Population Health & Health Services Session 2: Clinical, Population Health & Health Services Session 3: Basic Science

11:00 am - 12:30 pm

Session 4: Basic Science, Clinical & Population Health Session 5: Clinical, Population Health & Health Services Session 6: Clinical, Population Health & Health Services

Afternoon Sessions

1:00 - 2:50 pm

Awards Ceremony

3:15 - 3:30 pm

Session 7: Clinical, Population Health & Health Services Session 8: Clinical, Population Health & Health Services Session 9: Basic Science, Clinical & Population Health

Join us in celebrating the accomplishments of our colleagues and the positive impact of research taking place in our community. The award ceremony will feature the poster presentation awards.

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Since 1987, the Summer Student Research Program has provided 1,500+ students with the opportunity to participate in projects related to child and family health under the supervision of researchers on the Oak Street Campus.

2021 Program Details

165

Registered Summer Student Research Program participants

113 Undergraduate Students 42 Medical Students 10 Alumni & Master’s Students

61

Participant Affiliations:

29 Brain, Behaviour & 31 Childhood Diseases 37 Partner Organizations Development 38 Evidence to Innovations 30 Healthy Starts

25

Represented universities

165

Offsite/remote research projects

32

$125,000+

Hours of virtual learning

BCCHR/Partnered Summer Studentship funding awarded

Research projects pursuing new discoveries and innovations to transform the lives of children and families in BC and beyond

Participant Universities 17 National Universities | 8 International Universities Concordia University Cornell University Dalhousie University Emily Carr University Harvard University McGill University McMaster University National University of Ireland Queen’s University

Quinnipiac University Royal College of Surgeons in Ireland Simon Fraser University University College Dublin University College London University of Birmingham University of British Columbia University of California

University of Guelph University of Ottawa University of Saskatchewan University of Texas University of Toronto University of Victoria University of Waterloo Western University

www.bcchr.ca/ssrp Watch Presentations Online: www.bcchr.ca/posterday | Poster Day Participants

Showingcasing excellence in our talented research community!

2021 Poster Participants Participant Chihiro Abe

Srishti Ahuja Leonardo Arreaza Dilpreet Bharaj

Maya Bird Tereza Blahova Maya Jasmine Bodnar Lindsay Booth

Noah Boroditsky Christopher Buckland Krystal Cardinal

Lauren Caswell, Lauren Jones, Alexandra Turvey Hurram Mansoor Chaudry Brooke Cheng

Research Team Bhatnagar Research Team

Abstract Title Interactive technology for rehabilitation: Engaging and partnering with patients, families, and clinicians to guide optimal clinical implementation and effectiveness Kobor mQTLHub: A database to explore mQTLs in Research Team human buccal epithelial cells Woodward Functional Assessment of the fMRI-derived Research Team Re-Evaluation Network Steiner A study to detect and measure food sensitivities Research Team in children an adolescents with Eosinophilic Esophagitis (EoE) and Food Protein Induced Enterocolitis (FPIES) Bettinger The Role of Teachers in Grade 6 School-Based Research Team Immunization Programs in an Urban Setting Horvath & Ipsiroglu The Interconnection of Sleep Disturbances in Research Teams Rett Syndrome: A Scoping Review Miyanji Motion Preservation Evaluation of the Spine Research Team in Adolescent Idiopathic Scoliosis Following Anterior Vertebral Body Tethering Felton Assessing the impact of COVID-19 precautions Research Team on classroom communication for adolescents with hearing loss: A qualitative study Loock Research Team Missing Race and Ethnicity Based Data in Pediatrics: Why and Where Culham The Ductus Arterious and Its Role in Congenital Research Team Cardiopulmonary Diseases Burns Research Team Pain management for pediatric patients undergoing appendectomies: A retrospective chart review Turvey Host and Viral Genomic Determinants of Research Team COVID-19 Eslami Research Team Srigley Research Team

Prevalence of Suicidality in Psychosis in a Pediatric Emergency Unit Becoming Hand Hygiene Heroes: A public health campaign for patient & family safety in the hospital setting

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Session #6 11:00 am - 12:30 pm Session #3 8:30 - 10:30 am Session #5 11:00 am - 12:30 pm Session #8 1:00 - 2:40 pm Session #2 8:30 - 10:30 am Session #8 1:00 - 2:40 pm Session #1 8:30 - 10:30 am Session #7 1:00 - 2:40 pm Session #2 8:30 - 10:30 am Session #1 8:30 - 10:30 am Session #6 11:00 am - 12:30 pm Session #6 11:00 am - 12:30 pm Session #2 8:30 - 10:30 am Session #9 1:00 - 2:50 pm

Watch Presentations Online: www.bcchr.ca/posterday | Poster Day Participants

Participant

Amarpreet Chera Claire Cheung Bayley Dalbec

Research Team

Synnes Research Team Lavoie Research Team Pike Research Team

Jasjot Kaur Deol

Murthy Research Team

Simrin Dhillon

Davis Research Team

Emily Dunnion

Cooper Research Team

Bianca Fukakusa

Harris Research Team

Darren Ge

Glegg Research Team

Bita Gholamian

Yong Research Team

Tara Gholamian

Cooper Research Team Sadarangani Research Team

Vivek Gill Jacob Gravelle

Chilvers Research Team

Jasleen Grewal

Pike Research Team

Adrian Haasler

Elango Research Team

Abstract Title

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Vignettes to Evaluate Parental Perception of Session #7 Severity of Disability 1:00 - 2:40 pm The mTOR inhibitor DDIT4L decreases Session #3 protein synthesis in monocytes 8:30 - 10:30 am Drowning Prevention Strategies in British Session #7 Columbia: What has been done and how 1:00 - 2:40 pm can we improve? ....................................................................

Effects of Booster Seat Legislation on Child Passenger Safety and Booster Seat Adherence VITdALIZE-KIDS: Rapid Correction of Session #9 Vitamin D Deficiency in Pediatric Critical 1:00 - 2:50 pm Illness (A Phase III Multicentre Randomized Controlled Trial) Associations between Anemia and Clinical Session #7 Outcomes among Patients with Cardiac 1:00 - 2:40 pm Amyloidosis Design and manufacturing of a custom Session #2 3D-printed foot prosthesis for children with 8:30 - 10:30 am fibular hemimelia A Feasibility Study: Physical Activity Session #4 Counselling in Children with Congenital 11:00 am - 12:30 pm Heart Disease (PACCC) Interactive Technology for Rehabilitation: Session #1 Task Analysis of a New Gaming System to 8:30 - 10:30 am Support Clinical Implementation Patient Experiences of EndometriosisSession #6 Associated Dyspareunia Self-Management 11:00 am - 12:30 pm to Inform Online Resource Development Morquio B Disease: A Case Report Session #8 1:00 - 2:40 pm The Social Distribution of COVID-19 Vaccine Session #2 Hesitancy among Parents & Young Adults in 8:30 - 10:30 am British Columbia Determining the prevalence of food Session #6 insecurity in the pediatric cystic fibrosis 11:00 am - 12:30 pm population in B.C. and the Yukon and its effects on healthcare outcomes Indigenous Driver Training; Aiming to Bridge Session #8 the Injury Gap between Indigenous and 1:00 - 2:40 pm non-Indigenous Populations in BC In-vivo assessment of energy metabolism in Session #8 metabolic myopathies: Repeatability of the 1:00 - 2:40 pm 13 C-glucose breath test

Watch Presentations Online: www.bcchr.ca/posterday | Poster Day Participants

Participant

Research Team

Julia Handra

Armstrong Research Team

Rafid Haq

Tucker Research Team Woodward Research Team

Helen Hsiao

Olivia Hill Jack Ho Catalina Ionescu Moses Jeong Nisha Johal Emily Johnston

Stockler Research Team McLaughlin Research Team Anglesio Research Team Gibson Research Team Parker Research Team Siden Research Team

Jalisa Karim

Oberlander Research Team

Pardis Kazemian

Leavitt Research Team

Abstract Title

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Prototyping an End-to-End Platform for Session #7 Genomic Care to Meet the Needs of Both 1:00 - 2:40 pm Patients and Providers The COVID-19 Pandemic and Children with Session #1 Rheumatic Diseases 8:30 - 10:30 am fMRI analysis of functional brain networks Session #9 involved in memory tasks and visual and 1:00 - 2:50 pm verbal discrimination tasks in healthy individuals Active Involvement of Children in ADHD Session #1 Randomized Control Trials Assessing Sleep 8:30 - 10:30 am Geographic variabilities in out-of-pocket Session #2 prescription drug costs for chronic pediatric 8:30 - 10:30 am conditions Somatic activating KRAS G12 mutations in Session #3 endometriosis 8:30 - 10:30 am Examination of EZH2 in Skeletal Muscles of Session #5 Differing Oxidative Capacity 11:00 am - 12:30 pm Characterizing mitochondrial alanine Session #5 transporters as novel drug targets 11:00 am - 12:30 pm Caregiver-reported nociceptive pain Session #9 responses in children with significant 1:00 - 2:50 pm neurological impairment Investigation of the effects of oxytocin for Session #9 induction and augmentation of labour on 1:00 - 2:50 pm ASD in the child Lipid nanoparticle-mediated delivery of Session #4 CRISPR knockdown of GNAO1 in brain cells 11:00 am - 12:30 pm

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Participant

Jessica Koe

Research Team

Parker Research Team

Abstract Title

Elucidating how post-translational modifications regulate SLC38A2/SNAT2 localization Kaitlyn Kwok Murthy A Scoping Analysis of Trial Sponsorship and Research Team Data Flows of Global Clinical Trials Justine Lau Kobor The effect of SUMOylation on the histone Research Team variant, H2A.Z Kelly Lau Vallance Inflammasome Activation Coordinates Early Research Team Intestinal Mucosal Defense Against the Enteric Pathogen Salmonella Tess Leavitt Hayden Investigating the Origin of Proenkephalin Research Team Present in the Blood and Cerebrospinal Fluid as a Potential Biomarker of Huntington Disease Anne Lesack Ogilvie Willingness to Self-Collect an HPV Sample: Research Team HPV FOCAL Study Exit Survey Results Melody Li Woodward Functional Assessment of the fMRI-derived Research Team Two-Handed Response Network Arielle Locke Cheng Outcomes of children treated with Research Team preoperative radiotherapy for local control in pediatric sarcoma Aidan Loh Cooper Validating Different Methods of Measuring Research Team Paediatric Leg Length Discrepancy Brody Lyons Grennan Assessing the acceptability of doxycycline Research Team (STI PrEP/PEP) in a population of men who have sex with men (MSM) Anmol Mattu Pike A synthesis of the evidence for prevention Research Team of non-contact anterior cruciate ligament injuries among youth female athletes: Implications for family physicians and general practitioners Caroline McCamus Pouladi Examining the expression of the Research Team leukodystrophy-linked Claudin-11 in Primary and Immortalized Cells Watch Presentations Online: www.bcchr.ca/posterday | Poster Day Participants

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Session #3 8:30 - 10:30 am Session #8 1:00 - 2:40 pm Session #5 11:00 am - 12:30 pm Session #5 11:00 am - 12:30 pm Session #5 11:00 am - 12:30 pm Session #4 11:00 am - 12:30 pm Session #1 8:30 - 10:30 am Session #4 11:00 am - 12:30 pm Session #1 8:30 - 10:30 am Session #6 11:00 am - 12:30 pm Session #9 1:00 - 2:50 pm

Session #4 11:00 am - 12:30 pm

Participant

Research Team

Nikita Menon

Voss Research Team

Lindy Moxham

Whyte Research Team

Tia Murdoch

Babul Research Team Baird Research Team Maxwell Research Team

Ashleigh Nazareth Phuong Nguyen Emma Nielsen

Purdy Research Team

Sara Niyyati

Klein Geltink Research Team Karakochuk Research Team

Dahlia Parolin

Humaira Patel

Babul Research Team

Devann Paterson

Verchere Research Team

Andrew D Pauls

Mulpuri Research Team

Austin Pietramala

Voss Research Team

Maia Poon

Rozmus Research Team

Abstract Title

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Exploring the journey of patients with Session #8 congenital heart disease in the context 1:00 - 2:40 pm of physical activity education: A narrative review Genetic Differences in Pharmacodynamic Session #6 Safety Endpoints with Propofol Anesthesia 11:00 am - 12:30 pm in Children Assessing Concussion Knowledge in Session #1 Rural BC 8:30 - 10:30 am External Validation of the PRESTO Pediatric Session #8 Trauma Risk Adjustment Tool 1:00 - 2:40 pm Control of the cell division axis and Session #3 daughter cell size through Hyaluronan 8:30 - 10:30 am Mediated Motility Receptor (HMMR) Bloody Blockers: Developing a model of Session #9 massive pulmonary hemorrhage to assess a 1:00 - 2:50 pm novel device for lung isolation Assessing and Improving the Metabolic Session #3 Fitness of Expanded Human CD8+ T-cells 8:30 - 10:30 am Prevalence of Iron Deficiency and the Effect Session #2 of Inflammation Adjustment on Ferritin 8:30 - 10:30 am Concentrations in Pregnant Women in Vancouver, BC Dissemination and Scale-Up of Injury Session #2 Programs and Interventions for Canadian 8:30 - 10:30 am Children and Youth Beta-cell prohormone convertase 1/3 Session #5 deficiency increases amyloid severity 11:00 am - 12:30 pm in mice Variability in Post-Operative Management Session #9 of Developmental Dysplasia of the Hip: 1:00 - 2:50 pm A Surgeon’s Survey Social, Behavioural, and Environmental Session #7 Correlates of Glycemic Control in Pediatric 1:00 - 2:40 pm Type 1 Diabetics in the BC Interior The Interpretation of Clinical Variants of Session #1 Uncertain Significance (VUS) in Pediatric 8:30 - 10:30 am Hematology and Oncology

Watch Presentations Online: www.bcchr.ca/posterday | Poster Day Participants

Participant Bethany Poon Lara Radovic Ethan Elliot Rajkumar

Research Team Lavoie Research Team Coelho Research Team Vallance Research Team

Maiya Rasheed

Blydt-Hansen Research Team

Taylor Ricci

Devlin Research Team Javer Research Team

Mohammadali Saffarzadeh

Sofia Samper

Voss Research Team

Oliver Schoales

Beasley Research Team Verchere Research Team Machan Research Team

Amardeep Singh Sekhon Amit Sharma

Arnima Singh

Sumara Stroshein Nima Toussi Erin Tanaka

Christoffersen-Deb & Prestley Stuart Research Teams R. Murphy Research Team Woodward Research Team Klein Geltink Research Team

Brianna Tsui

Voss Research Team

Alexandra Turvey, Lauren Jones, Lauren Caswell Stephanie U

Richmond Research Team

Tanisha Vallani

Ipsiroglu Research Team Stewart Research Team

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Abstract Title Development of an in vitro neonatal gut model to investigate necrotizing enterocolitis Parental Coping and Self-Efficacy in a MixedGender Sample of Youth with Eating Disorders A Closer Examination into Innate Epithelial Response Regulation by Gut Microbiota Against Enteric Bacterial Pathogens The Effect of HLA-DR/DQ Eplet Mismatch on Urinary CXCL10/Cr Expression in Children, Early Post-Kidney Transplant The Role of Riboflavin in the Regulation of Vascular Endothelial Function A Comparative Study Assessing Improvement in Cognitive Deficit Secondary to CRS in Patients Treated with Surgical Management: A Prospective Trial Adherence to Diabetes Canada: Clinical Practice Guidelines (2018) for Children with Type 1 Diabetes in Interior Health Effect of Antipsychotic Medications on Levels of Complement C4 The role of islet amyloid polypeptide in islet function and beta-cell mass Correlation of Hysterosalpingogram and Fallopian Tube Recanalization in Infertile Women Early Pregnancy Assessment Clinic (EPAC) Data Registry

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Developing a Community Food Security Indicator Framework Functional Assessment of the fMRI-derived Extraction of Meaning Network Uncovering the regulation and function of the glycolytic enzyme triosephosphate isomerase in CD8+ T cells Determinants of Daily Physical Activity in Children and Youth with Disabilities in Canada Human Genome Analysis: Harnessing the Power of Genome Sequencing to Identify Rare Genetic Diseases Sleep and Traumatic Brain Injury: A Scoping Review of Polysomnography Findings Perspectives and recommendations: Youth obsessive-compulsive disorder diagnosis disclosure in the school setting

Session #8 1:00 - 2:40 pm Session #3 8:30 - 10:30 am Session #3 8:30 - 10:30 am

Watch Presentations Online: www.bcchr.ca/posterday | Poster Day Participants

Session #7 1:00 - 2:40 pm Session #7 1:00 - 2:40 pm Session #3 8:30 - 10:30 am Session #2 8:30 - 10:30 am Session #5 11:00 am - 12:30 pm Session #9 1:00 - 2:50 pm Session #2 8:30 - 10:30 am Session #1 8:30 - 10:30 am Session #3 8:30 - 10:30 am Session #9 1:00 - 2:50 pm Session #9 1:00 - 2:50 pm

Session #4 11:00 am - 12:30 pm Session #6 11:00 am - 12:30 pm Session #8 1:00 - 2:40 pm Session #4 11:00 am - 12:30 pm

Participant

BResearch Team

Mary Rose Waniss

Lynn Research Team

Isabella Watson

Singhal Research Team

Emma Arneja Wells-Durand Research Team Rui Yang (Oscar) Xu Lavoie Research Team David Yeung Anthony Yuen

Elliott Research Team Moore & Sang Research Teams

Sahar Zandi Nia

Wiens Research Team

Alissa Zhang

Leveille Research Team Piper Research Team

Yu Wen (Jade) Zhong

The BC Children’s Hospital research community would like to acknowledge the following organizations for supporting training opportunities on the Oak Street Campus:

Abstract Title

Mutation in type 2 diabetes susceptibility gene, CDKAL1, results in dysfunctional premature phenotype in β-cell development Acetazolamide to Treat Symptomatic Ruptured Arachnoid Cysts: A Pediatric Case Series Burden of Care for Patients with Cleft Lip and Palate Decreased population immunity against respiratory syncytial virus in women and infants during the COVID-19 pandemic How do Adolescents Perceive Peers who have Genetic Conditions?

Attitudes of GBM towards methamphetamine use and relation to reducing methamphetamine use in three Canadian Cities The added value of lactate measured on admission for the prediction of mortality in children in Uganda Crossing the tibial physis in prepubescent ACL reconstructions – Is it safe?

Standardizing Vitamin D Administration to Minimize Deficiency in Children with Intestinal Failure

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Session #5 11:00 am - 12:30 pm Session #1 8:30 - 10:30 am

Session #4 8:30 - 10:30 am Session #7 1:00 - 2:40 pm Session #6 11:00 am - 12:30 pm Session #2 8:30 - 10:30 am Session #1 8:30 - 10:30 am Session #4 11:00 am - 12:30 pm Session #7 1:00 - 2:40 pm

BC Children’s Hospital Foundation Canucks for Kids Fund Childhood Diabetes Laboratories Community Child Health Endowment Research Themes: Brain, Behaviour & Development Childhood Diseases Healthy Starts Evidence to Innovation

Watch Presentations Online: www.bcchr.ca/posterday | Poster Day Participants

Session #1 CLINICAL & POPULATION HEALTH Moderator: Robert Selles Participants: Maya Jasmine Bodnar Christopher Buckland Darren Ge Rafid Haq Olivia Hill Melody Li Aidan Loh Tia Murdoch Maia Poon Oliver Schoales Isabella Watson Sahar Zandi Nia Watch Virtually Live: Each presenter will have 5 minutes to discuss their poster and 5 minutes for questions from attendees.

Thursday, July 29, 2021 | 8:30 - 10:30 am www.bcchr.ca/posterday

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Session #1 | Poster #1 Maya Jasmine Bodnar, Undergraduate Student, University of British Columbia Supervisor: Firoz Miyanji, Evidence to Innovation

Motion Preservation Evaluation of the Spine in Adolescent Idiopathic Scoliosis Following Anterior Vertebral Body Tethering Garshana Rajkumar, Sachini Jayasinghe, Maya Bodnar

Background: Adolescent idiopathic scoliosis (AIS) is commonly corrected with spinal fusion, involving the implantation of stiff rods and bone grafting. Fusion is a well-established procedure that demonstrates overall improved patient quality of life, though it compromises postoperative range of motion and may accelerate disc degeneration (Miyanji et al., 2021).

Anterior vertebral body tethering (AVBT) is becoming a reputable non-fusion alternative to correcting AIS in skeletally immature patients, whereby a flexible tether is implanted and tensioned on the convexity of the spinal curve. Unlike traditional fusion, AVBT may more effectively preserve spinal motion through correcting spinal curvature as the patient grows. Currently, no study has evaluated the degree to which spinal motion is preserved following AVBT. Objectives: To assess the effects of AVBT on: 1. Un-instrumented vertebral segment motion.

2. Instrumented intervertebral segment motion.

3. Motion preservation of the spine in patients with AIS following AVBT relative to patients with AIS that underwent posterior instrumented fusion (control).

Methods: An ongoing prospective, case-control study is being performed on patients (n = 33) that underwent surgical correction of AIS with AVBT. During their 2-5 year postoperative follow up visit, patients are consented and acquire four radiographs in addition to routine posteroanterior and lateral radiographs. Additional radiographs will include Right and Left Best Bend and Forward and Backward Bend. Motion is assessed through several radiographic measures, including calculating total range of motion from upright lateral to Forward and Backward bend lateral. Further data collection includes perioperative data, a quality-of-life outcomes assessment collected post-operatively (SRS Questionnaire), and trunk flexibility tape measurements. Data is then entered into a database and compared to a similar cohort of fusion patients.

Anticipated Results: We predict that patients with AIS that underwent AVBT will display increased motion at the intervertebral segments of both the instrumented and un-instrumented spinal segments compared to patients that received posterior instrumented fusion.

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Session #1 | Poster #2 Christopher Buckland, Undergraduate Student, University of British Columbia Supervisor: Gordon Culham

Congratulations to Christopher on receiving summer studentship project funding from the Children & Women Medical Staff Association

The Ductus Arterious and Its Role in Congenital Cardiopulmonary Diseases Christopher C. Buckland, Dr. James E. Potts, J.A. Gordon Culham

The Ductus Arteriosus (DA) is a blood vessel that has an important role in the circulation of the fetus because it allows for blood to bypass the lungs and directly enter the systemic circulation after being ejected from the right ventricle.

A few days following birth, the DA begins to close and starts transitioning into a ligamentum arteriosum. This transition ensures that systemic and pulmonary blood flow are now separate. In addition to the DA’s important purpose for fetal circulation, it is involved in a number of congenital cardiovascular and pulmonary abnormalities. A DA that fails to close at birth is called a Patent Ductus Arteriosus, which can lead to dilation of the heart due to the increase in blood volume that the heart has to pump. Over time, this could cause heart failure or damage to the pulmonary vascular tree. Another condition that pertains to a DA is a Coarctation of the Aorta (CoA). In this anomaly, the ductal tissue abnormally extends into the wall of the aorta and wraps around a segment of the upper descending aorta. During closure of the DA, the ductal tissue will contract; however, constriction of the abnormally distributed ductal tissue will pull and cause inward folding of the aortic walls producing an obstruction. The purpose of this presentation is to provide an introduction to the role of the DA in fetal circulation, to discuss the normal transition of the circulation at birth and to illustrate two of the lesions that we will be including in our full project.

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Session #1 | Poster #3 Darren Ge, Undergraduate Student, University of Waterloo Supervisor: Stephanie Glegg, Evidence to Innovation

Congratulations to Darren on receiving a BC Children’s Hospital Sunny Hill Summer Studentship

Interactive Technology for Rehabilitation: Task Analysis of a New Gaming System to Support Clinical Implementation Darren Ge, Kimberly Miller, Stephanie Glegg

Background: Interactive technology is a subset of virtual reality-based therapies where users explore simulated game environments with real-time feedback on their actions. Applied to rehabilitation, these interventions can enhance motivation and provide practice opportunities to promote motor learning. System design to meet patient and clinician needs, and resources supporting decision-making are critical for adoption. LUMOplay is an interactive gaming software that allows users to project the virtual environment to create interactive walls/floors. A team of clinicians, developers, family, and leadership is collaborating with our research team to support and study the implementation of this system for clinical use at Sunny Hill Health Centre.

Aim: To develop clinical tools to support the implementation of LUMOplay in Sunny Hill’s Acute Pediatric Rehabilitation Program.

Methods: This work encompassed part of the implementation strategy of a hybrid implementation/clinical pilot trial comprised of clinical education/training, resource development and technology co-design. Task analysis was used to inform resources targeting frequent barriers to virtual reality adoption, including lack of knowledge/skill, confidence in clinical decision-making, and system functionality for therapists. Each of the 250+ games were analyzed from a therapeutic standpoint to identify kinematic requirements (e.g., reaching, side-stepping), accessibility constraints (e.g, wheelchair/gait aid compatibility, visual/auditory clutter), and ways to change the degree of difficulty (e.g, modifying the task and/or changing up the physical environment.).

Results: The task analysis has informed game categorizations for clinical ease of use to support clinical decision-making based on cognitive demands and therapeutic goals, as well as a framework for grading the degree of challenge to meet patient needs. Patient profiles to filter games for impairments, and a clinician interface to interpret patient progress from kinematic and gameplay data will follow.

Significance: This intervention is expected to decrease barriers for clinicians using LUMOplay by helping them develop personalized, effective patient programs to optimize the games’ therapeutic value for rehabilitation.

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Session #1 | Poster #4 Rafid Haq, Undergraduate Student, University of British Columbia Supervisor: Lori B. Tucker, Childhood Diseases

Congratulations to Rafid on receiving a UBC Faculty of Medicine Summer Studentship

The COVID-19 Pandemic and Children with Rheumatic Diseases Rafid Haq, Kristin Houghton, Herman Tam, Lori Tucker

Background: The COVID-19 pandemic has had widespread impact on usual medical care, including the care of children with chronic rheumatologic diseases such as juvenile idiopathic arthritis (JIA), systemic lupus erythematosus (SLE), vasculitis, and systemic autoinflammatory disease (SAID). Changes to usual care may include having virtual medical visits, limitations of allied health care, difficulty getting routine lab screening testing done, and changes in how routine infused medications are provided. In addition, patients with rheumatic diseases and their families may have anxiety about whether they are at increased risk of COVID-19 based on their disease and its treatments, many of them being immunosuppressing.

Objective: To investigate the changes to the health care of rheumatic disease patients caused by the COVID-19 pandemic and how it has impacted the concerns of both the patient and their family.

Methods: We have designed a survey for the parents and the patients to complete, to obtain information on how they perceive the differences in managing their disease. The survey addresses several issues relating to potential impact of the pandemic on the care of children with rheumatic diseases, and possible concerns specific to these children and their treatments. Domains include how the child’s diagnosis affects family concern about COVID-19; how COVID-19 has affected the child’s treatment and disease management; child and family mental health and security impacted

by COVID-19 as well as patient demographics. The survey is being distributed to patients having their visits with the Rheumatology clinic.

Expected Results: We expect our project outcomes to show that families with children living with rheumatic diseases have significant concerns regarding the pandemic in relation to their child’s condition. A significant number of families may have experienced difficulty in fully adhering to follow-up with physicians, laboratory testing and medications due to the pandemic.

Implications: The potential benefit of this work would be to assess the problems that have developed for children living with rheumatic conditions as a result of the pandemic and begin to determine strategies to combat them, that could possibly persist past the pandemic and be used in the future.

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Session #1 | Poster #5 Olivia Hill, Undergraduate Student, University of Hawai’i at Mānoa Supervisor: Sylvia Stockler, Childhood Diseases

Active Involvement of Children in ADHD Randomized Control Trials Assessing Sleep Olivia Hill, Scout McWilliams, Ted Zhou, Sylvia Stockler, Osman Ipsiroglu

Introduction: In recent years the increase in childhood ADHD diagnoses has been closely followed by a surge in the prescription of medication for children. The active involvement of children in medical interventions and clinical trials is part of children’s rights. It is of the utmost importance that during the course of treatment, children are exercising their rights to informed consent or assent and expressing their views to ensure they are leading personally meaningful lives.

We will investigate the child’s participation in ADHD randomized control trials (RCTs) from a child’s rights perspective because the symptoms heavily affect the daytime functioning and quality of life of children. Our research questions are: 1) how was the child involved in the consenting process, and 2) was the child directly involved in any of the tools used to measure ADHD, sleep, miscellaneous outcomes, the reporting of adverse events; or was a proxy used.

Methods: We will perform a secondary analysis of a dataset provided by a previous scoping literature review (conducted

by McWilliams et al. 2020), which aimed to identify interventional ADHD RCTs that measured sleep as a primary or secondary outcome in pediatric populations.

Results: Of the 52 studies analyzed, 3 did not mention consent in any way. There were 8 studies in which only the parent participated in the consent process and had an age range of 2-12. 23 subjective sleep tools were found; 10 involved the child primarily, 38 ADHD tools; 4 involved the child, 15 miscellaneous tools; 3 involved the child, and 6 adverse event tools; 2 involved the child. The developed protocol was registered with Open Science Framework.

Conclusion: These findings suggest there has not been a consensus approach to obtaining consent/assent in pediatric ADHD RCTs. The tools used to measure outcomes sparsely involved the child. The findings from this analysis will help to determine if the child’s rights are being properly considered in ADHD RCTs and to guide future studies in the consenting procedure.

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Session #1 | Poster #6 Melody Li, Undergraduate Student, University of British Columbia Supervisor: Todd Woodward, Brain, Behaviour & Development

Congratulations to Melody on receiving a UBC Faculty of Medicine Summer Studentship

Functional Assessment of the fMRI-derived Two-Handed Response Network Melody Li, Todd Woodward

Background: The Two-Handed Response Network (2RESPN) is one of the two Response Networks—the other being the One-Handed Response Network (1RESPN)—belonging to the twelve fMRI-derived functional brain networks identified through Task-based Functional Magnetic Resonance Imaging (fMRI) and Constrained Principal Component Analysis (CPCA). Both the 2RESPN and 1RESPN are involved in motor responses and have Hemodynamic Responses (HDRs) that peak late in the trial; however, Two-Handed RESPN consisted of bilateral activation, while the One-Handed RESPN consisted of lateralized activation.

Objective: To explore the activation and deactivation of the Two-Handed Response Network in response to associative memory encoding, task-switching, and facial discrimination tasks using fMRI data of healthy controls and patients with schizophrenia.

Methods: The Two-Handed Response Networks were identified with fMRI-CPCA and network classifications. CPCA combines regression analysis and principal component analysis to derive images of functional neural networks when the analyzed blood-oxygenation-level-dependent (BOLD) is constrained to the predictable aspect of variance in the BOLD signal dependent on the stimuli presented. Estimated hemodynamic response (HDR) plots were interpreted to understand the cognitive processes underlying these networks. The BOLD fMRI technique measures the changes in inhomogeneity of the magnetic field due to changes in blood oxygenation as hemoglobin and deoxyhemoglobin are magnetically distinct. Subsequent analysis of the timing and duration of peaks on HDR plots can allow for the interpretation of cognitive processes.

Results: Schizophrenia patients demonstrated a significant decrease in post-activation suppression when compared to healthy controls in the associative memory encoding, task-switching, and facial discrimination tasks.

Significance: Identification of the differences in activation and deactivation of the 2RESPN in patients with schizophrenia and healthy controls will increase our understanding of functional connectivity in schizophrenia patients and contribute to the future use of neuromodulation as a possible treatment option for schizophrenia.

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Session #1 | Poster #7 Aidan Loh, Undergraduate Student, Western University

Supervisors: Anthony Cooper & Harpreet Chhina, Evidence to Innovation

Congratulations to Aidan on receiving a BioTalent Canada Summer Student Workplace Program Placement

Validating Different Methods of Measuring Paediatric Leg Length Discrepancy Aidan Loh, Tim Bhatnagar, Harpreet Chhina, Brittany Lim, Lise Leveille, Anthony Cooper

Background and Justification: Leg length discrepancy (LLD) or anisomelia, is a condition in which the paired lower extremity limbs show a structural deformity of unequal lengths causing deviations in one’s gait. Numerous imaging and clinical techniques have been used to measure anatomical leg length. Among the most popular methods are radiographic measurements and scanograms. However, these methods are not feasible for everyone and involve radiation exposure.

In our retrospective study, we will look at 3 methods used to measure the leg length of a child with LLD: EOS imaging system, an optical marker-based motion capture system, and clinical anatomy feature-based measurements conducted by physiotherapists. EOS will be utilized as our gold standard and all other modes of measurement will be correlated to it. If we can validate the motion capture system measurements, it will confirm that it is an accurate and safer way of measurement with no radiation dose.

Methods: The leg length of children that attended a clinical gait analysis appointment with a motion capture systemidentified LLD of at least 2cm, will have 3 different measurement methods of LLD compared: EOS imaging scan, motion capture system-based measurement, and anatomical feature-based measurement by a physiotherapist. EOS scans that have been formerly collected for routine clinical care will be used to re-measure lower limb lengths.

Analysis: We will calculate how much the gait analysis and clinical measurements deviate from the EOS assessment using the Intraclass Correlation Coefficient (ICC) and pairwise correlation coefficients, and the mean difference and 95% confidence interval.

Expected Outcomes: With the technological advancements of the motion lab, we are expecting the measurement to be statistically significant and comparable to the EOS measurement.

Significance: Safe and accurate ways of leg length measurement will be instrumental in advancing the medical field as well as clinically diagnosing and treating LLD. If the motion capture analysis method of measurement is proven to be statistically similar to the EOS scan, one will be at a lesser risk of radiation exposure. This brings a sense of urgency and importance to validate a safer way of measurement which will potentially help increase the standard of life of children all around the world.

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Session #1 | Poster #8 Tia Murdoch, Undergraduate Student, Selkirk College Supervisor: Shelina Babul, Evidence to Innovation

Congratulations to Tia on receiving a Community Child Health Endowment Summer Studentship

Assessing Concussion Knowledge in Rural BC Tia Murdoch, Shelina Babul

Background: Concussions are the result of a blow to the head or body that disrupts brain functioning resulting in sensory, emotional, cognitive, and physical symptoms. Rural areas experience a higher rate of concussions than urban-dwelling counterparts, decreased access to primary healthcare and specialists, and low utilization of tertiary healthcare services.

These factors put rural residents at risk for more difficult recoveries from concussions. By educating rural residents on identification and management of concussions, they may be more likely to seek care following a suspected concussion, resulting in a less complex recovery. The Concussion Awareness Training Tool (CATT) is one such education tool, in that it provides several eLearning modules which address recognition, diagnosis, treatment and management of concussions.

Objectives: This survey aims to measure: a) concussion knowledge of residents in a rural BC town; b) the efficacy of the CATT eLearning modules in improving this knowledge; and c) determine if participants will use the CATT eLearning modules in the future.

Methods: Participants were asked to complete a pre-intervention survey that evaluated their knowledge of the signs and symptoms of concussion, and beliefs regarding misconceptions and knowledge of concussion management and treatment. Immediately after completing the survey, participants were asked to complete a 30-minute eLearning module of their choice from the CATT website (cattonline.com). One week after the initial survey, participants were asked to complete a post-intervention survey which included the same knowledge questions from the first survey, and provide their opinion on the selected eLearning module.

Preliminary Results: This project is ongoing; however, early results are promising. To date, 89 participants have completed the initial survey and 21 have completed the post-intervention survey. Individual scores have improved between the two surveys from 70.67% correct to 77.67% correct (p < 0.05).

Implications: This research is among the first to measure the concussion knowledge within a rural population. The results will help to illustrate the need for public concussion education and guide future research into rural and remote communities. It also provides an opportunity to disseminate concussion prevention and management education to residents of a rural community.

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Session #1 | Poster #9 Maia Poon, Undergraduate Student, McMaster University Supervisor: Jacob Rozmus, Childhood Diseases

Congratulations to Maia on receiving a BC Children’s Hospital Research Institute Childhood Diseases Summer Studentship

The Interpretation of Clinical Variants of Uncertain Significance (VUS) in Pediatric Hematology and Oncology Maia Poon, Jacob Rozmus

Background: Molecular genetic testing is commonly performed to identify germline pathogenic mutations in all aspects of pediatric clinical care. When identified, pathogenic variants can inform diagnosis, prognosis, and risk assessment for patients and their family members. However, variants of unknown/uncertain significance (VUS) are reported with Sanger sequencing, gene panels, whole-exome sequencing, and whole-genome sequencing. VUS pose clinical dilemmas as it is often very difficult to incorporate these results into practice.

Hypothesis: There is no consistent approach for incorporating germline genetic VUS into patient care within pediatric hematology and oncology clinical service.

Specific Aims: 1. Determine the total number and results of clinical diagnostic gene sequencing tests performed in the Division of Pediatric Hematology, Oncology & BMT at BC Children’s Hospital over the last 10 years.

2. Determine how germline VUS were used, if at all, in clinical decision-making.

3. Identify whether physicians in our division have a consistent approach to dealing with VUS. Methods: 1. Retrospectively review all clinical diagnostic gene sequencing tests ordered in the division over the last 10 years, subdivided into three categories of results based on the American College of Medical Genetics (ACMG) five-tier classification system: 1) pathogenic or likely pathogenic variant, 2) VUS and 3) likely benign, benign or no variants identified. Patients who underwent genetic testing will be identified through internal databases. Data including the indication for testing and type of test will be collected.

2. Collect data on how physicians managed VUS including whether: 1) results were disclosed to patients and their families, 2) patients were referred to medical genetics, 3) other relatives underwent genetic testing as part of family segregation studies, 4) further diagnostic work-up was triggered by the VUS and 5) clinical management changed. Details will be collected regarding follow-up testing performed for additional evidence through retrospective chart reviews and interviews with involved physicians.

3. Create an anonymous REDCap survey in which physicians respond to case examples involving genetic test results with VUS modeled on real cases identified in our retrospective review.

By analyzing our previous experience with the interpretation of VUS and current physician perspectives on their assessment, we hope to begin to develop a standardized, consistent approach to variant assessment.

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Session #1 | Poster #10 Oliver Schoales, Undergraduate Student, McGill University Supervisor: Clare Beasley, Brain, Behaviour & Development

Effect of Antipsychotic Medications on Levels of Complement C4 Clare Bealsey, Li Shao, Oliver Schoales

Schizophrenia is a chronic psychiatric disorder that affects patients around the world. With symptoms that include delusions and hallucinations, the disorder can be quite debilitating and has been shown to lower one’s life expectancy by an average of 20 years. While treatments for the disorder do exist, much is still unknown about the etiology of schizophrenia. The complement pathway, a component of the immune system, has been identified as being potentially related to schizophrenia due to the fact that activity in this pathway seems to be elevated in individuals with the disorder. More specifically, complement C4, responsible for mediating inflammation, phagocyte recruitment, and forming classical/lectin pathway C3 convertase, has been demonstrated to correlate with schizophrenia. Results of research on the topic have demonstrated that patients with schizophrenia show a greater frequency of C4A alleles and higher C4A transcript levels in post-mortem brain tissue. As well, research on mice has shown that overexpressing C4A in mice reduces cortical synapse density, increases microglial engulfment of synapses, and alters behaviour. This suggests that increased C4-mediated synaptic elimination can result in abnormal brain circuits and behaviour. A second study on mice demonstrated the fact that overexpression of C4 in prefrontal cortex neurons leads to perturbations in dendritic spine development and hyperconnectivity. This mirrors the neuropathology found in human patients with schizophrenia.

While this research seems to, at least to an extent, elucidate the connection between the complement system and schizophrenia, there is still much room for discovery. Specifically, more research needs to be done on the potential of C4 as a target for psychopharmacological treatment. Previous research on antipsychotic medications and the complement system has been too mixed to draw any clear conclusions. For this reason, this study aims to test the hypothesis that antipsychotic medication will affect levels of complement C4 in the plasma of rats. The results of this study could prove quite valuable in the future treatment of schizophrenia and could increase the wellbeing of those who suffer from this debilitating disorder.

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Session #1 | Poster #11 Isabella Watson, Undergraduate Student, University of Toronto Supervisor: Ash Singhal, Brain, Behaviour & Development

Acetazolamide to Treat Symptomatic Ruptured Arachnoid Cysts: A Pediatric Case Series Isabella Watson, Ash Singhal, Patrick McDonald, Paul Steinbok, Brendon Graeber

Background: Arachnoid cysts are benign intracranial mass lesions that, when ruptured, may cause seizures, raised intracranial pressure, hemorrhage, and/or loss of consciousness. There is no widely agreed-upon treatment and there is debate whether a non-operative or surgical approach is the best course of action. The carbonic anhydrase inhibitor, acetazolamide, may be an effective non-operative approach in treating ruptured arachnoid cysts.

Methods: The Pediatric Neurosurgery Clinical Database at BC Children’s Hospital from 2000 to 2020 was queried and four pediatric patients who were treated with acetazolamide after presentation with a ruptured middle cranial fossa arachnoid cyst were identified.

Results: All patients showed some degree of symptom improvement. Three of the patients showed complete reabsorption of their subdural collections in the ensuing 6 months. One patient had an inadequate response to acetazolamide and went on to require surgical management.

Conclusion: Acetazolamide is a safe and reasonable primary treatment option in pediatric patients with ruptured middle cranial fossa arachnoid cysts that may avoid the need for surgery.

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Session #1 | Poster #12 Sahar Zandi Nia, Undergraduate Student, University of British Columbia Supervisor: Matthew Wiens, Healthy Starts

Congratulations to Sahar on receiving a BC Children’s Hospital Boris Kuzeljevic Summer Studentship

The added value of lactate measured on admission for the prediction of mortality in children in Uganda Sahar Zandi Nia, Ansh Kumar Sharma, Coco Liu, Jerome Kabakyenga, Nathan Kenya Mugisha, Abner Tagoola, Elias Kumbakumba, J Mark Ansermino, Niranjan Kissoon, Matthew Wiens

Background: The utility of a single lactate level at admission has been shown for diagnosing sepsis and septic shock, but has not been demonstrated to add significant value as an early warning marker in sepsis. Its potential role in settings with limited laboratory, diagnostic and treatment resources remains controversial. To determine the added value of an admission lactate to basic and routinely available clinical and sociodemographic data, we developed prognostic models both with and without lactate measurements.

Methods: This study utilized data from an ongoing cohort study of children 6-60 months of age admitted with a proven or suspected infection to 4 hospitals in Uganda. A broad set of 60 candidate predictor variables were measured at admission by trained research staff. These predictors included vital signs, signs and symptoms, comorbidities, as well as social and demographic variables. Candidate predictors were used to build elastic net prediction models with and without lactate for in-hospital mortality. The incremental value of adding lactate to the model was measured using the area under the receiver operating curve (AUROC) and net reclassification index (NRI) presented as the change in the true-positive rate (NRI+) and change in the false-positive rate (NRI-).

Results: Between June 2017 and January 2019, 3650 consecutively admitted children were enrolled. Of these, 174 (4.8%) died during hospitalization. The model with lactate (L+) had the same mean AUROC compared to the model without lactate (L-) (0.81 [0.78, 0.85] vs 0.81 [0.77, 0.85]. We found an NRI+ of -0.01 [-0.04, 0.03] and NRI- of 0.02 [0.01, 0.03].

At the 2.3% predicted probability threshold, 2 (1.1%) who died were correctly reclassified into the high-risk group by the L+ model. The L+ model correctly reclassified 142 (3.9%) who did not die as low-risk and incorrectly reclassified 160 (4.4%) who did not die as high-risk.

Conclusions: We could not demonstrate the added value of lactate in the prognostication of in-hospital mortality when combined with readily available clinical and sociodemographic data. The role of serial lactate measurements to guide treatment optimization requires additional investigation.

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Session #2 CLINICAL & POPULATION HEALTH Moderator: Anila Virani Participants: Emily Dunnion Maya Bird Noah Boroditsky Hurram Mansoor Chaudry Vivek Gill Jack Ho Michelle Kim Dahlia Parolin Humaira Patel Maiya Rasheed Sofia Samper Anthony Yuen Watch Virtually Live: Each presenter will have 5 minutes to discuss their poster and 5 minutes for questions from attendees.

Thursday, July 29, 2021 | 8:30 - 10:30 am www.bcchr.ca/posterday

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Session #2 | Poster #13 Emily Dunnion, Undergraduate Student, Queen’s University

Supervisors: Anthony Cooper & Harpreet Chhina, Evidence to Innovation

Congratulations to Emily on receiving BioTalent Canada Summer Student Workplace Program Placement

Design and manufacturing of a custom 3D-printed foot prosthesis for children with fibular hemimelia Emily Dunnion, Harpreet Chhina, Anthony Cooper

Background: Previously, amputation was seen to be the only treatment for patients diagnosed with fibular hemimelia.

Over the last three decades, huge advancements have been made, introducing limb lengthening as a suitable alternative.

However, children that undergo reconstruction rather than amputation still experience discrepancies, often having a significantly smaller foot with a reduced length, width, and height. Even with these discrepancies between feet, children are often dressed in the same size shoe as the unaffected foot. This can affect the balance, comfort, and confidence patients feel while participating in daily activities.

Purpose: The purpose of this study is to determine the needs of patients with fibular hemimelia through an in-house Needs Assessment survey and use those needs to design and 3D print a custom foot prosthesis for the patients.

The prosthesis will be made with the goal of reducing the economical burden of buying different sized shoes and increasing the patients’ balance, comfort, and confidence in their footwear.

Methods: A pilot study is being conducted where 5 patients that submitted a Needs Assessment survey were brought into the clinic to complete a motor assessment and have their feet scanned by a 3D scanner in full weight-bearing, semi weight-bearing, and non-weight-bearing positions. A 3D model of their feet was rectified using CAD software, and the prosthesis was designed such that it completes the affected foot with the external anatomy of the unaffected foot. Once the prostheses are completed, the patients will complete an in-house satisfaction survey to assess the success of the prosthesis.

Significance/Outcomes: Currently, there are no fibular hemimelia-specific prostheses to help improve the patients’ quality of life. The goal of this project is to implement the custom prosthesis into the standard of care for these patients, improving their satisfaction early in their treatment.

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Session #2 | Poster #14 Maya Bird, Undergraduate Student, University of British Columbia Supervisor: Julie Bettinger, Healthy Starts

Congratulations to Maya on receiving a UBC Faculty of Medicine Summer Studentship, Florence & George Heighway Endowment Fund

The Role of Teachers in Grade 6 School-Based Immunization Programs in an Urban Setting Maya Bird, Julie Bettinger, Hana Mitchell

Background: The human papilloma virus (HPV) vaccine is safe and effective in preventing sexually transmitted cancercausing infections and genital warts. In British Columbia (BC), the HPV vaccine is offered to students in grade 6 as a part of publicly funded school-based immunization programs (SBIPs) with the goal of providing protection before individuals become sexually active. Despite this, HPV vaccine coverage in BC (66.1% of females and 63.5% of males in grade 6) remains below the public health goal of 90% and is limiting progress in HPV prevention. Teachers have the potential to play a significant role in SBIPs. However, there is little research on what is expected of them. Our study presents the perspectives of school principals, school nurses, teachers, parents, and students from 3 schools on teacher involvement in SBIPs in an urban area of BC. Methods: Using a convergent interviewing technique, 9 adults were interviewed individually, and 37 grade 6 students were interviewed in groups. Interviews are being analyzed using a qualitative data management program (NVivo12™).

Data are being organized into patterns, categories, and basic descriptive units for interpretation through thematic content analysis using interpretive description.

Preliminary Observations: It was widely accepted that teachers should be involved in the distribution/return of consent forms, scheduling of immunization days, and connecting parents with school nurses. Adults and students noted the need to manage student anxiety and offer a more relaxed day of studies on immunization days. It was also deemed appropriate for teachers to share fact-based vaccine information in health or science classes outside of SBIPs, which is currently not routinely done in grade 6 programs. Adult stakeholders agreed that teachers’ individual opinions about vaccines should not be expressed or discussed.

Significance: Given that SBIPs are powerful measures to increase vaccination coverage rates, clarifying the scope and expectations for teachers in SBIPs will better support public health in vaccine delivery and may raise vaccine awareness among students and parents. Our preliminary findings contribute to improving SBIPs and ultimately HPV vaccine coverage.

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Session #2 | Poster #15 Noah Boroditsky, Undergraduate Student, Queen’s University Supervisor: Christine Loock, Brain, Behaviour & Development

Congratulations to Noah on receiving an OPSEI Summer Student Scholarship

Missing Race and Ethnicity Based Data in Pediatrics: Why and Where Noah Boroditsky, Christine Loock, Catherine Binda, Will Lau, Damian Duffy, Ethan Ponton

Background: Racism, the differential treatment of people based on their perceived racial or ethnic identity, causes health inequities between racial groups. An absence of race or ethnicity data (RED) in healthcare makes evaluation and awareness of health inequalities caused by systemic racism challenging. Current literature is scarce on collection methods of RED in healthcare globally.

Methods: English language references and grey literature published in MEDLINE, Embase, and relevant sources between January 1, 2000, and July 3, 2021, were identified after consultation with a research librarian. Abstracts were evaluated for inclusion and exclusion criteria. Thematic analysis and data extraction were conducted after full-body reviews.

Studies included in the final review focused on participants ≤18, were based in a healthcare facility and collected race or ethnicity data.

Results: A total of 1,193 references were collected in the initial search (296 MEDLINE, 894 Embase, 3 other). After a full-body evaluation, 28 references were retained and included in the final analysis. Articles were set in the United States (n=7), Canada (n=5), Australia (n=4), and the United Kingdom (n=1). RED was collected using Electronic Medical Records (n=8), Electronic Health Records (n=6), collaborative studies (n=2), Patient Chart Documentation (n=1), and National Emergency Services Information System (NEMSIS) data (n=1). RED was collected in Tertiary care centers (n=8), Secondary care centers (n=1), a Primary care center (n=1), and a Quaternary care center (n=1). Racial and ethnic categories discussed in the literature included: White, Hispanic, Black, Indigenous, Aboriginal, and Asian. Six articles explicitly reported a need for more RED collection.

Conclusion: Collecting RED is critical to understanding health inequities and the impacts of racism in healthcare.

Globally, there is limited information on RED collection. We strongly endorse the recommendation of the BC Office of Human Rights Commissioner on the collection of RED in all age groups, including pediatrics. Capturing RED respectfully, meaningfully, and accurately across all groups will help identify potential associations, barriers, and inequities in health outcomes, helping to mitigate and eliminate systemic racism in healthcare.

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Session #2 | Poster #16 Hurram Mansoor Chaudry, Undergraduate Student, University of Regina Supervisor: Ali Eslami, Brain, Behaviour & Development

Prevalence of Suicidality in Psychosis in a Pediatric Emergency Unit Hurram Chaudry, Ali Eslami

In schizophrenia and other psychotic disorders, it is determined that the lifetimes risk of suicide death is about 6%.

We know from prior studies that there is an increased risk of suicidality in schizophrenia (a primarily psychotic disorder) and other psychotic disorders. A plethora of prior studies have also delineated how insight is correlated with an increased risk of suicidality. Insight is defined in psychiatry as the awareness and ability to recognize one’s own illness and situation.

Our population of interest is the pediatric population admitted in the CAPE (Child & Adolescent Psychiatric Emergency) in the age range 0 to 15. Since psychotic disorders can rarely be diagnosed this, if at all, we look at cases of psychotic episodes and first episode psychosis in said population.

The purpose of this study is to see if psychosis is a shielding factor or a risk factor in suicidality and to delineate any differences in suicidality in children with psychosis versus without psychosis. We hypothesize that children admitted to the CAPE Unit with a psychotic crisis as their primary concern are less likely to be suicidal. We believe that since during a psychotic crisis, insight is highly compromised, those children, in the midst of their psychotic crisis are at a lesser risk of suicidal ideation or other suicidal behaviors.

Medical records and patient summaries of all patients admitted in the CAPE Unit with a primary concern of a psychotic episode over the last 20 years are being looked at. This study is the first of its sort, to our knowledge, in assessing this relationship between psychotic episodes and suicidality as a function of insight in a pediatric population.

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Session #2 | Poster #17 Vivek Gill, Undergraduate Student, Western University Supervisor: Manish Sadarangani, Healthy Starts

Congratulations to Vivek on receiving a BC Children’s Hospital Research Institute Healthy Starts Summer Studentship

The Social Distribution of COVID-19 Vaccine Hesitancy among Parents & Young Adults in British Columbia

Vivek Gill, Bahaa Abu Raya, Sofia Bartlett, Julie Bettinger, Adriana Cabrera, Daniel Coombs, Soren Gantt, David Goldfarb, Agatha Jassem, Mel Krajden, Muhammad Morshed, Laura Sauvé, Inna Sekirov, Sarah Silverberg, Danuta Skowronski, Hennady Shulha, Kim Marty, Manish Sadarangani Background: COVID-19 vaccines present a pathway out of the SARS-CoV-2 pandemic. In May 2021, Canada authorized the Pfizer-BioNTech COVID-19 vaccine for children 12-15, and vaccines for those under 12 may be approved by early 2022. Vaccine hesitancy poses a significant threat to the success of phased reopening and is known to be heterogeneous among the population. As such, certain groups may exhibit greater COVID-19 vaccine delay or refusal. To reach optimal population immunity, young adults and children must be targeted by COVID-19 vaccine confidence efforts according to specific socio-demographic and psychological factors.

Objectives: Assess how intention to receive a COVID-19 vaccine among British Columbian parents and young adults is determined by: 1. Socio-demographic factors 2. Scale-measured psychological constructs: general vaccine hesitancy, COVID-19 vaccine attitudes, influenza vaccination behaviours, social norms (indirect/direct), perceived behavioural control Methods: Participants (0-24 years old) completed a cross-sectional, observational survey between November 2020 and March 2021, providing socio-demographic data and completing psychological construct scales. Means were calculated for each scale and item reliability was assessed using Cronbach’s alpha. Two multivariable mixed-effects logistic regression models were created to explore which socio-demographic and scale-measured psychological constructs were associated with the primary outcome, “intention to receive a COVID-19 vaccine”. Adjusted odds ratios were calculated and case-wise deletion was used to address missing data.

Results: Of 2,381 participants, 76.1% intended to receive a COVID-19 vaccine and 7.4% did not. Respondents who intended to COVID-19 vaccinate had more favourable COVID-19 vaccine attitudes (p < 0.0001), were less likely to view vaccination as risky (p = 0.0002) and reported to be influenced by direct (p < 0.0001) and indirect social norms, including the Provincial Health Officer (p = 0.0165) and friends (p = 0.0107). No socio-demographic factors were predictive of COVID-19 vaccination intention.

Conclusions: To enhance COVID-19 vaccine uptake among children and young adults, public health messaging should focus on vaccine safety and benefits, while leveraging trusted voices including the BC Provincial Health Officer. Social norms are influential in facilitating COVID-19 vaccine acceptance, and individuals should be encouraged to discuss the benefits of vaccination with friends and others who are important to them.

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Session #2 | Poster #18 Jack Ho, Undergraduate Student, McMaster University Supervisor: Tom McLaughlin, Evidence to Innovation

Congratulations to Jack on receiving a BC Children’s Hospital Research Institute Summer Studentship

Geographic variabilities in out-of-pocket prescription drug costs for chronic pediatric conditions Jack Ho, Tom McLaughlin

Background: Prescription drugs are a major cost within the Canadian healthcare system, accounting for over 20% of total health spending. Although the federal Canada Health Act requires provincial governments to provide hospital and physician care to residents free of charge, there is no similar requirement for coverage of outpatient prescription medications. As a result, each province has developed its own public insurance program for children, and sets its own eligibility requirements (e.g. low-income families), premiums, and list of covered medications. Previous studies in adults have shown that for many drugs, coverage varies widely between provinces. There are limited studies in children, and those that do exist are many years old. It is therefore necessary to study the “postal code lottery” for costs associated with pediatric conditions.

Objectives: This paper aims to study the variability in public drug insurance coverage and out-of-pocket costs between provinces and territories for low-income Canadian families with children who require common pediatric medications.

Methods: Drug coverage plans were collected from publicly available government websites for each province and territory. Several simulation models were created for families with differing incomes and medication needs. Using the eligibilities, exceptions, coverage amounts, and drug lists from each province, out-of-pocket costs were calculated and compared.

Results: Wide variation was found when comparing out-of-pocket costs across provinces, with costs differing by more than $1500 annually for the same clinical scenario. Furthermore, type of medication was found to be a contributing factor to coverage, with ADHD medications being covered at a lower rate than drugs for other conditions.

Conclusions: Canadians receive differing amounts of drug coverage based on where they live and what type of drugs they need. Considering that many depend on drug coverage for their prescription costs, Canada should strive for a more equitable system.

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Session #2 | Poster #19 Michelle Kim, Undergraduate Student, McMaster University Supervisor: Matthew Carwana, Evidence to Innovation

Seeing the unseen: a retrospective review of the RICHER Social Pediatrics clinical programs, 2018-2021

Michelle Kim, Sunny Sun, Judy So, Gwyn McIntosh, Clea Bland, Kristina Pikksalu, Tanjot Singh, Christine Loock, Matthew Carwana Background: Since its establishment in 2006, the RICHER initiative (Responsive, Interdisciplinary, Intersectional Child and Community Health Education Research) has been providing community based medical and outreach programs for socially vulnerable families in the inner-city communities in Vancouver. As new immigrants, Indigenous families, or families with complex needs, many continue to face barriers in accessing care or adherence to mainstream care options. In collaboration with various clinical branches and community partnerships, RICHER is committed to providing clinical care with a priority consideration for social determinants of health including gender, race, and ethnicity. This retrospective project will contribute to a better understanding of the population that the RICHER clinical program serves and aims to improve health equity for children in the Vancouver communities.

Objective: This project aims to describe the patient demographics of the RICHER clinical outreach program, successes and shortcomings of RICHER, and barriers to accessing care.

Methods: The study will conduct a retrospective chart review of all patients seen under the RICHER primary care program. Demographic information, diagnosis, and other relevant data on the social determinants of health of RICHER patients between 2018 – 2021 will be collected and analyzed.

Results/Future Directions: This study is currently ongoing. Once the data has been analyzed, it is hoped that the results will ultimately aid in identifying potential gaps in the clinical outreach program, barriers to accessing healthcare, and inform and direct future prospective research programs at RICHER and other social pediatrics programs.

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Session #2 | Poster #20 Dahlia Parolin, Undergraduate Student, University of British Columbia Supervisor: Crystal Karakochuk, Healthy Starts

Prevalence of Iron Deficiency and the Effect of Inflammation Adjustment on Ferritin Concentrations in Pregnant Women in Vancouver, BC Dahlia Parolin, Kelsey Cochrane, Crystal Karakochuk

Objective: Adequate iron stores during pregnancy are essential for healthy development, as low iron status is associated with adverse outcomes for both mother and child. Serum ferritin is the preferred diagnostic test for iron deficiency in Canada. However, ferritin is an acute phase reactant and concentrations increase in the presence of inflammation independent of iron status, confounding the interpretation. Regression corrections are recommended to adjust ferritin values for inflammation in regions where infections are common, but the significance of such adjustments in healthy populations is less clear. Our aims were to measure ferritin and biomarkers of inflammation in healthy pregnant women and to compare the estimates of iron deficiency prevalence among women using unadjusted ferritin and inflammationadjusted ferritin concentrations.

Methods: Serum ferritin, α1-acid glycoprotein (AGP), and C-reactive protein (CRP) were measured via a sandwich-ELISA in 52 pregnant women from the Greater Vancouver area ranging from 8-21 weeks gestation, who were enrolled in the Folate in Pregnancy clinical trial. Regression equations based on AGP and CRP concentrations were used to adjust ferritin concentrations according to globally endorsed methods (the BRINDA approach).

Results: Prevalence of acute (CRP >5 mg/L) and chronic (AGP >1 g/L) inflammation in women was 29% (n=15/52) and 0%, respectively. The prevalence of iron deficiency (Ferritin <15 μg/L) was unchanged (4%, n=2/52) after adjusting ferritin using the regression correction approach, but the prevalence of probable iron deficiency (Ferritin <30 μg/L) increased from 27% (n=14/52) to 38% (n=20/52) after inflammation-adjustment.

Conclusion: Adjusting ferritin for inflammation increased the prevalence of probable iron deficiency, but not iron deficiency in pregnant women in early gestation in Vancouver. However, the significance of adjusting ferritin for inflammation in healthy pregnant women is still unclear as this study was limited by a small sample size and did not include women in later stages of pregnancy, where inflammation is more common. More research is needed to understand the effect of inflammation on iron status among pregnant women.

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Session #2 | Poster #21 Humaira Patel, Undergraduate Student, Queen’s University Supervisor: Shelina Babul, Evidence to Innovation

Dissemination and Scale-Up of Injury Programs and Interventions for Canadian Children and Youth Humaira Patel, Shelina Babul, Ian Pike, Mariana Brussoni, Kate Turcotte, Laura Dale, Karen Sadler, Emilie Beaulieu

Background: The BC Injury Research & Prevention Unit has developed multiple research and evidence-based injury prevention programs such as Active & Safe, VOICES, Preventable, PURPLE, CATT, and Outdoor Play! The substantial investment in these evidence-based interventions have been effective in their dissemination process. However, few programs have been disseminated at a level that is widespread to target Indigenous and multicultural communities.

By further disseminating these interventions, this can prevent serious societal problems and reduce mental health costs. These programs may be adapted and culturally relevant by being available in different languages, however, little is known as to how to reach these individuals in these communities. Foundry BC is currently in the process of creating a centralized learning centre for prevention and interventions that affect youth health to aid in this dissemination process.

Methods: Key informant interviews were conducted with directors and team members of the injury prevention programs. Various questions were posed targeting each program’s objectives, dissemination strategies, and how the program is implemented.

Results: Six, five-paged reports were formulated discussing helpful strategies and advice for Foundry BC’s new upcoming centralized learning centre. Additional recommendations from key informants included a requirement of extensive amounts of resources, funding, and time to maintain the learning centre.

Conclusion: These reports will be peer-reviewed and soon to be implemented in Foundry’s centralized learning centre.

The objective for these injury prevention programs is to further target more Indigenous and multicultural communities across BC through the aid of the future learning centre.

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Session #2 | Poster #22 Maiya Rasheed, Undergraduate Student, University of British Columbia Supervisor: Tom Blydt-Hansen, Childhood Diseases

The Effect of HLA-DR/DQ Eplet Mismatch on Urinary CXCL10/Cr Expression in Children, Early Post-Kidney Transplant Maiya Rasheed, Tom Blydt-Hansen

Background: Urinary CXCL10 is a strong candidate to replace serial biopsies and creatinine monitoring in pediatric kidney transplant rejection surveillance, anticipating rejection diagnosis by 1-2 months and as an indicator of early inflammation. CXCL10 levels are also strongly associated with 1-year graft function decline; an effective surrogate for long-term outcome.

HLA eplet mismatching looks at the key determinants of antibody binding specificity within each epitope in an HLA molecule to determine immunogenic risk between the donor and recipient of a kidney transplant more precisely than current HLA mismatching methods.

The purpose of this study is to assess HLA eplet mismatching in a pediatric cohort, and to investigate if eplet mismatch is associated with early signs of subclinical inflammation.

Methods: The PROBE study was a prospective, multi-center cohort study completed in 2019 to evaluate the utility of urinary CXCL10 for rejection surveillance in 101 pediatric kidney transplant recipients. All patients underwent high-resolution HLA typing to determine eplet mismatch along with regular serological HLA typing. Urinary CXCL10 and kidney function were measured over the first post-transplant year, and long-term data on events such as acute rejection episodes, donor-specific antibody development, graft function, and graft loss will be used to measure outcome. Using PROBE study data, we aim to investigate the relationship between Class II HLA eplet mismatch, early inflammatory signals like CXCL10, and outcome.

Hypothesis: We hypothesize that Class II eplet mismatch is associated with elevated urinary CXCL10 expression early post-transplant and with 1-year allograft function.

Significance: From this study, we hope to improve the understanding of HLA eplet mismatch and the relationship between eplet matching, CXCL10 levels, and acute rejection in pediatric kidney transplant populations. Investigating HLA eplet mismatching as a more precise measure of immunologic risk assessment for these patients may allow for improved personalization of immunosuppression. Identifying patients at low risk may allow for less immunosuppression and therefore less complications from immunosuppression, while identifying higher risk patients may indicate that adherence to immunosuppression is critical and that they might benefit from more intensive monitoring of biomarkers of rejection.

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Session #2 | Poster #23 Sofia Samper, Undergraduate Student, University of British Columbia – Okanagan Supervisor: Christine Voss, Evidence to Innovation

Congratulations to Sofia on receiving a UBC Faculty of Medicine Summer Studentship

Adherence to Diabetes Canada: Clinical Practice Guidelines (2018) for Children with Type 1 Diabetes in Interior Health

Sofia Samper, Austin Pietramala, Alissa Taki, Tom Warshawski, Holly Buhler, Trish Thomson, Susi Wilkinson, Christine Voss Background: Type 1 Diabetes (T1D) is one of the most prevalent chronic conditions in children and youth and has dramatically increased throughout British Columbia in the past decade. Due to the nature of T1D education management, newly diagnosed patients are educated by an interprofessional healthcare team on various topics including but not limited to physical activity; management of hypoglycemic episodes; blood glucose and ketone monitoring; and psychological issues. Furthermore, it is recommended that clinicians follow Diabetes Canada: Clinical Practice Guidelines (2018) to ensure adequate delivery of care. However, it is unclear what the adherence level to clinical practice guidelines is, especially regarding Glycated Hemoglobin (A1C) (frequency of assessments as well as values in range) and Thyroid Stimulating Hormone (TSH) assessments to screen for thyroid dysfunction as a possible T1D comorbidity. Additionally, the average number of times a patient with T1D is seen by an Interior Health (IH) clinician each year is unknown. According to clinical practice guidelines, A1C should be taken every three months when glycemic targets are not being met or when antihyperglycemic therapy is being adjusted. A patients’ A1C should be checked more frequently if there are other health conditions in place or drastic changes are being done to antihyperglycemic therapy.

Moreover, it is recommended that Serum TSH levels should be checked every 6-12 months.

Objectives: To assess adherence to clinical practice guidelines regarding A1C and TSH screening, as well as the average number of clinical accounts per year for patients with T1D in IH between the years of 2015-2019.

Methods: A retrospective chart review of pediatric patients with T1D who received care through the IH Authority between the years of 2015-2019 was conducted. In total, 6363 patient-visits were identified. Data analyses will assess adherence to clinical practice guidelines as well as the average number of visits per patient per year. Data analyses will be done in R Studio and are ongoing.

Significance: It is expected that the results of this study will provide Interior Health and its clinical teams with valuable statistics to aid in the delivery of care to the T1D pediatric population within Interior Health.

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Session #2 | Poster #24 Anthony Yuen, Undergraduate Student, University of British Columbia Supervisors: David Moore & Jordan Sang

Congratulations to Anthony on receiving a UBC Faculty of Medicine Summer Studentship

Attitudes of GBM towards methamphetamine use and relation to reducing methamphetamine use in three Canadian Cities Anthony Yuen, Jordan Sang, Clara Wang, Justin Barath, Nathan Lachowsky, Allan Lal, Trevor Hart, Shayna Skakoon-Sparling, Syed Noor, Joseph Cox, Gilles Lambert, Daniel Grace, Jody Jollimore, Kiffer Card, Mark Hull, David Moore

Background: Methamphetamine (MA) use is common among gay, bisexual, and other men who have sex with men (GBM) and is associated with various sexual health- and drug-related harms. We sought to understand attitudes of GBM toward their own substance use and the associations with reductions in MA use.

Methods: GBM in Montreal, Toronto, and Vancouver were recruited using respondent-driven sampling into the Engage Cohort Study from February 2017 to August 2019, with follow-up visits every six months. We used logistic regression to identify correlates of self-assessed need for help in reducing the use of substances among participants who reported recent amphetamine-type stimulant (ATS) use at enrolment and three-level mixed effects logistic regression to identify correlates of reductions in ATS use at follow-up visits.

Results: Of 2449 GBM enrolled, 727 (29.7%) reported recent ATS use at enrolment, the majority of whom did not feel they needed help with reducing their substance use (n = 608). Needing help with reducing one’s substance use was significantly associated with participation in group sex events (AOR = 2.35, 95% CI = 1.25–4.44), moderate to high anxious symptomatology (AOR = 2.11, 95% CI = 1.16–3.83), use of drug-related services (AOR = 7.02, 95% CI = 3.53–13.96), higher Financial Strain Index scores (AOR = 1.35, 95% CI = 1.21–1.50), and higher Escape Motive Scale scores (AOR = 1.07, 95% CI = 1.03–1.10). Among 4434 follow-up visits completed, reductions in ATS use were observed at 534 (12.0%).

Participants who identified as African, Caribbean, or Black (AOR = 0.40, 95% CI = 0.17–0.95), reported recent ecstasy use (AOR = 0.06, 95% CI = 0.04–0.09), or viewed their ATS use as problematic (AOR = 0.12, 95% CI = 0.06–0.22) were less likely to reduce their ATS use.

Conclusion: We identified factors significantly associated with increased likelihood of needing help with reducing the use of substances and decreased likelihood of reducing ATS use among GBM. Developing future interventions to address MA use that are tailored to different subgroups of GBM may allow for greater reach and improved efficacy.

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Session #3 BASIC SCIENCE Moderator: Maryam Rahimi-Balaei Participants: Srishti Ahuja Claire Cheung Erin Tanaka Catalina Ionescu Jessica Koe Phuong Nguyen Sara Niyyati Ethan Elliot Rajkumar Amardeep Singh Sekhon Nima Toussi

Watch Virtually Live: Each presenter will have 5 minutes to discuss their poster and 5 minutes for questions from attendees.

Thursday, July 29, 2021 | 8:30 - 10:30 am www.bcchr.ca/posterday

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Session #3 | Poster #25 Srishti Ahuja, Undergraduate Student, University of Waterloo Supervisors: Michael Kobor & Fizza Fatima, Healthy Starts

mQTLHub: A database to explore mQTLs in human buccal epithelial cells Srishti Ahuja, Fizza Fatima, Chaini Konwar, Michael Kobor

DNA methylation (DNAm) is the most common form of epigenetic modification. In humans, DNAm is the covalent addition of a methyl group to cytosine residues, predominantly at CpG sites. Genetic variation, such as Single nucleotide polymorphisms (SNPs), account for 20–80% of DNAm patterns within a tissue. Associations between genetic variants and DNAm at nearby or distant CpG positions in the genome are called methylation quantitative trait loci (mQTLs).

Identification of these mQTLs will help in understanding the genetic drivers of DNAm and biological mechanisms that underlie complex human phenotypes.

Mapping of genetic effects influencing DNAm in buccal tissue has been limited. Few studies have explained the genetic variance that seems to exist, but a larger sample size is needed to help predict the effects of genetics on DNAm. Kobor Lab will overcome this limitation by performing genome-wide mQTL characterization of more than 2000 buccal samples from multiple cohorts consisting of different age groups, ethnicity and geographical location.

An important part of mQTL characterization is making the results easily available for reproducibility and follow-up studies. As a result, I created a publicly available database, mQTLhub, to catalogue the identified mQTLs in human buccal tissue. mQTLhub is an interactive and user-friendly database created with R Shiny Web Apps. mQTLhub allows users to filter and download mQTLs based on the name and/or location of associated CpG and SNP sites. Advanced filtering options include genetic distance, timepoint, P-value and effect size. mQTLhub also includes a visualization feature where users can plot CpG beta values against SNP genotypes for selected SNP~CpG pairs. Lastly, to guide users, mQTLhub includes a help page with descriptive tutorials and sample data. mQTLhub is currently based on sample mQTLs from buccal and blood tissue, but the database will further be expanded to include mQTLs identified reported in blood, cord and brain tissues. Filtering options for genetic ancestry will also be added. All in all, mQTLhub is a end-to-end tool which will allow scientists to quickly access, visualize and download mQTLs of interest and help guide epigenome and genome-wide association studies.

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Session #3 | Poster #26 Claire Cheung, Undergraduate Student, University of British Columbia Supervisor: Pascal Lavoie, Healthy Starts

Congratulations to Claire on receiving a UBC Faculty of Medicine Summer Studentship

The mTOR inhibitor DDIT4L decreases protein synthesis in monocytes Claire Cheung, Christina Michalski, Emma Ackermann, Martin A Prusinkiewicz, Constantin R Popescu, Paul C Orban, Pascal M Lavoie

During gestation, there is a need for the growing fetus to prepare its immune system for the challenges of the extrauterine world, concomitant with maintaining immunological tolerance to ensure a viable pregnancy.

Prematurely-born infants have a particularly high risk of developing severe infections during the neonatal period; this phenomenon is thought to be due to the infant still possessing an immune system that is optimized for fetal life.

Accordingly, monocytes isolated from preterm cord blood have been found to be less responsive to bacterial stimulation than their adult and term counterparts.

Previously, we reported dampened mTOR activity in preterm monocytes, along with the increased expression of DNA‐Damage‐Inducible‐Transcript‐4-Like (DDIT4L), a negative mTOR regulator. The ability of an immune cell to activate is dependent upon master regulators such as mTOR, a protein that regulates energy metabolism, protein translation, cell growth, and proliferation. In this set of experiments, we hypothesize that DDIT4L will dampen global protein synthesis and cytokine production through the inhibition of mTOR. All experiments were performed in U937 monocytes, which were previously modified using a lentivirus expression vector to overexpress DDIT4L upon addition of doxycycline. Clones expressing different levels of DDIT4L were differentiated with PMA and cultured overnight with DMSO (vehicle control), rapamycin (a known mTOR inhibitor), or doxycycline. After 5 hrs of LPS stimulation, cells were stained for flow cytometry for the detection of activated mTOR and its downstream target S6; supernatant was collected for detection of the cytokine IL-8 via ELISA. Separately, global protein synthesis was detected by incorporation of L-homopropargylglycine, a methionine analogue.

We found that DDIT4L overexpression resulted in reduced activation of both mTOR and its downstream target S6, confirming that DDIT4L serves as a negative regulator of mTOR activity. Higher expression of DDIT4L also decreased global protein synthesis, as well as moderately decreased production of the proinflammatory cytokine IL-8. Lastly, preliminary results show that DDIT4L remodels cellular metabolism by limiting mitochondrial capacity. Together, these data suggest a potential mechanism for the reduced responsiveness of preterm monocytes.

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Session #3 | Poster #27 Erin Tanaka, Master’s Student, University of British Columbia Supervisor: Ramon Klein Geltink, Childhood Diseases

Congratulations to Erin on receiving a UBC Work Learn International Undergraduate Research Award

Uncovering the regulation and function of the glycolytic enzyme triosephosphate isomerase in CD8+ T cells Erin Tanaka, Ramon Klein Geltink

Metabolic pathway activity is regulated by environmental cues to the cell, such as growth factors, cytokines and metabolite availability. Immune cells rely on different metabolic pathways for function which is extensively studied in the context of anti-tumour activity of CD8+ T cells. The most studied pathway associated with the tumour-killing activity of CD8+ T cells is glycolysis. Glycolysis is a key metabolic pathway that breaks down glucose into intermediates that can be used to build cellular components, and to generate cellular energy. Although glycolysis has been studied for over a century, the molecular mechanisms of regulation of some of its enzymes remains poorly understood. Triosephosphate isomerase (TPI) is a glycolytic enzyme that interconverts dihydroxyacetone phosphate (DHAP) and glyceraldehyde-3phosphate (GAP), effectively doubling the energy output of glycolysis. TPI is thought to be expressed in all tissues and constitutively active. However, we hypothesize that different T cells subsets, perhaps driven by different environments, would be dependent upon regulation of TPI, influencing the metabolism and function of these cells. To address this, we assessed the activity and expression level of TPI in different primary T cell subsets and pharmacologically inhibited TPI activity in these cells. We show that in CD8+ T cells, TPI and other enzymes in dependent metabolic pathways have varying degrees of protein expression during activation and expansion, between effector and memory T cells, and in glucose-fed and starved conditions. The activity of TPI is also distinct, with glucose-fed effector T cells having twice the rate of TPI enzyme activity as both glucose-starved and memory T cells. Inhibition of TPI results in striking changes to cellular metabolic activity in glycolysis, but also in mitochondrial metabolism. Our results suggest that the essential metabolic enzyme TPI is under complex environmental regulation and might play a role during growth, differentiation and during adaptations to environmental conditions of T cells. This opens up the possibility to manipulate these pathways to further improve cellular therapy of cancer by improving T cell metabolism.

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Session #3 | Poster #28 Catalina Ionescu, Undergraduate Student, University of British Columbia Supervisor: Michael Anglesio, Healthy Starts

Congratulations to Catalina on receiving a UBC Faculty of Medicine Summer Studentship

Somatic activating KRAS G12 mutations in endometriosis Natasha L Orr, Catalina L Ionescu, Paul J Yong, Julie Hong, Amy Lum, Michael Anglesio

Background: Endometriosis is characterized by cells from the innermost lining of the uterus – endometrial cells – growing outside of the uterus. Endometriosis affects 10% of people born with a uterus and is primarily found in the lower pelvis: on the ovaries, bowel, or underneath the uterus. Endometriosis occurs in three types: deep infiltrating (DIE), endometriomas (OMA), and superficial peritoneal (SUP). While endometriosis is not considered a cancer, ~1% of OMA transform into ovarian carcinoma. Recently, activating mutation in the KRAS oncogene have been described in endometriosis epithelial cells (somatic) in roughly 1/3 of DIE, without apparent risk of cancer. KRAS is a part of growth factor receptor tyrosine kinase pathways and activating mutations, typically affecting codon 12, are associated with transformation, proliferation, and invasion. Due to the functions of mutant KRAS, in the context of cancers, it has been proposed that activation of KRAS may contribute to the invasiveness and pain severity of endometriosis in some people without resulting in malignant transformation.

Objective: The objective of the study is to determine the prevalence of codon 12 KRAS mutations between the three types of endometriosis, and evaluate their association to severity of pain. We hypothesize that anatomical types of endometriosis have differing prevalence of KRAS mutations.

Methods: We analysed endometriosis lesions from 123 people. Hematoxylin & Eosin stained slides were reviewed for presence of sufficient endometrial epithelial cells for enrichment and molecular testing. Endometriosis was excised using manual needle microdissection, or laser capture microdissection, and assayed by droplet digital polymerase chain reaction (ddPCR) to detect KRAS codon 12 mutations.

Results: The prevalence of one or more somatic KRAS mutation was: 42% (21/50) in DIE, 56% (14/25) in OMA, 23.3% (24/72) in SUP. While we observed a trend of higher KRAS mutation prevalence in OMA lesions this was non-significant (p=0.13). Our analysis of the clinical data is ongoing.

Significance: In summary, the importance of determining cancer-associated mutations in a non-cancerous condition may suggest that treatments targeting molecular pathways could be considered for endometriosis. Future work includes remaining mutation analysis and exploring the relationship between somatic KRAS mutations and clinical endometriosis features including pain.

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Session #3 | Poster #29 Jessica Koe, Undergraduate Student, University of British Columbia Supervisor: Seth Parker, Healthy Starts

Congratulations to Jessica on receiving a UBC Faculty of Medicine Summer Studentship

Elucidating how post-translational modifications regulate SLC38A2/ SNAT2 localization Jessica Koe, Seth Parker

Background: SLC38A2 (SNAT2) is a transporter protein that functions at the plasma membrane to actively co-transport sodium ions and short-chained neutral amino acids from the extracellular environment to the cytosol. Previous studies show that pancreatic cancer, including pancreatic ductal adenocarcinoma (PDAC), preferentially localizes SLC38A2 to the plasma membrane to facilitate the increased uptake of alanine, a non-essential neutral amino acid. In pancreatic cancer cells, alanine enters the mitochondria to be converted to pyruvate, which supports tumour growth through its involvement in fueling biosynthesis and energy metabolism. Thus, understanding key mechanisms governing SLC38A2 activity may lead to therapeutic options for PDAC. Proteomic data suggests that SLC38A2 is highly regulated by posttranslational modifications. High prevalence modifications include phosphorylation of N-terminal tyrosines Y20, Y28, and Y41. We hypothesize that phosphorylation of these tyrosines regulates the localization of SLC38A2 between the plasma membrane and intracellular endosomes.

Methods: Two mutant SLC38A2-EGFP constructs were created by mutating three tyrosine (Y) candidates at the N-terminus to phenylalanine (F) and glutamate (E): SLC38A2-Y20F/Y28F/Y41F (phosphoresistant) and SLC38A2-Y20E/ Y28E/Y41E (phosphomimetic). These mutants and the wild-type were then transfected into pancreatic cancer cells and imaged using live-cell confocal microscopy. Co-localization with acidic organelles, including endosomes and lysosomes, was measured by staining with LysoTracker Red dye.

Expected Results: We expect the phosphoresistant SLC38A2-EGFP mutant to display a strong signal outlining the plasma membrane, while the phosphomimetic SLC38A2-EGFP mutant would colocalize with endosomes within the cell.

Significance: Our study would provide future research opportunities to identify protein tyrosine kinase(s) and phosphatase(s) involved in regulating SLC38A2 localization and to characterize location-specific functions of SLC38A2.

Further, this work has the potential to identify orthogonal strategies to de-activate SLC38A2 activity at the plasma membrane, which may lead to more effective treatments for pancreatic and other cancers.

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Session #3 | Poster #30 Phuong Nguyen, Undergraduate Student, University of British Columbia Supervisor: Christopher Maxwell, Childhood Diseases

Congratulations to Phuong on receiving a NSERC Undergraduate Student Research Award

Control of the cell division axis and daughter cell size through Hyaluronan Mediated Motility Receptor (HMMR) Phuong Nguyen, Lin Mei, Christopher Maxwell

Objective: Generate and characterize HMMR rs299290 SNP, which is associated with elevated breast cancer risk and HMMR overexpression.

Background: Cell division is an important and complex process that must be finely controlled to support multicellular life. Each division generally produces two daughter cells with identical genomes and approximately equal sizes, and these processes are coordinated by many regulatory proteins. The central position and orientation of the mitotic spindle controls the subsequent sizes of the two daughter cells. In turn, the position of the spindle is controlled by the action of microtubule motor proteins and their adaptor proteins, such as Hyaluronan mediated motor receptor (HMMR).

HMMR has been reported to control the spindle orientation by binding CHICA and dynein light chain 1 (DYNLL1).

HMMR is a breast cancer susceptibility gene that interacts with breast cancer early onset 1 (BRCA1). Common genetic variation in HMMR modifies the risk to develop breast cancer in carriers of germline BRCA1 mutations. However, the mechanism and extent to which different single nucleotide polymorphisms (SNPs) in HMMR affect cell division, daughter cell sizes, and tumorigenesis, are currently unknown.

Hypothesis: As HMMR rs299290 (V368D) occurs in the CHICA binding region, I propose rs299290 disrupts a specific protein interaction (CHICA-DYNLL1) that orients the mitotic spindle.

Methods and Results: Prime genome editing was used to introduce a HMMR rs299290 SNP in MCF10A cells. To do this, pegRNA and nicking guide RNA were designed. The design requires optimization of multiple characteristics such as GC content, distance to the protospacer adjacent motif (PAM) site, and the sequence length.

Three different pegRNAs have been generated and one has been sequenced. Sequencing results showed a lack of mutation in the desired region. Further optimization is needed to generate the rs299290 SNP mutation. Once I generate +/rs299290 MCF10A cells, I will characterize CHICA binding, DYNLL1 localization, mitotic spindle orientation and position, and cortical membrane stability in these cells.

Significance: Variation in cell size can affect homeostasis, development, and cancer cell metastasis. Findings from this study could elucidate better understanding on the role of HMMR in genomic instability and potentially, tumorigenesis.

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Session #3 | Poster #31 Sara Niyyati, Undergraduate Student, University of British Columbia Supervisor: Ramon Klein Geltink, Childhood Diseases

Congratulations to Sara on receiving a BC Children’s Hospital Research Institute Summer Studentship

Assessing and Improving the Metabolic Fitness of Expanded Human CD8+ T-cells Sara Niyyati, Erin Tanaka, Annette Patterson, Ramon Klein Geltink

Background: CD8 expressing T-cells (cytotoxic T-cells) are a crucial part of our immune system and can provide protection against viral infections and the growth of cancer. Cancer-specific T-cells can be expanded in the lab and given to patients as a therapeutic strategy. The success of T-cell infusions requires large numbers of cells to be generated in the lab.

The current procedure and medium used for clinical T-cell product expansions promotes enhanced glucose metabolism, since T-cells depend on glucose metabolism to grow rapidly. However, this is a characteristic that leads to reduced in-vivo function. In previous studies, using mouse models of cancer, we found that temporarily reducing glucose metabolism and enhancing mitochondrial metabolism via glucose restriction was associated with better anti-tumor immune function.

To translate this finding to a clinically relevant context, we hypothesize that the expanded antigen-specific T-cell products would strongly benefit from a protocol by which mitochondrial metabolism is increased by glucose restriction before infusion.

Methods: CD8+ T-cells were isolated and activated using anti-CD2/3/28 tetramers and expanded in immunocult media (StemCell Technologies). 1 and 2 weeks post-activation, expanded CD8+ T-cells were exposed to 10mM or 1mM glucose for 24-48 hours and harvested for analysis.

Relative changes in glucose and mitochondrial metabolism were assessed by Seahorse assay (Agilent). In parallel, metabolite concentrations in the media of the T-cell culture were measured at various timepoints to determine metabolite usage/production by the cells. Flow cytometry was used to assess the T-cell immune phenotypes after 1 and 2 weeks of expansion, looking for changes in cell surface markers associated with effector T-cell phenotype.

Results: The combined results (Seahorse metabolic assay, flow cytometry, and bioanalysis) demonstrated that the glucose restricted cells alter their metabolism to exhibit more mitochondrial metabolism and become less glucose dependent at 1 week after activation, relative to the control non-glucose restricted cells. This effect was blunted at the 2 week timepoint.

Conclusions: Like mouse cells, glucose restricted human CD8+ T-cells increase mitochondrial metabolism, previously associated with improved in vivo function. We will next test if our protocols can be applied to T cell expansions for clinical use.

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Session #3 | Poster #32 Ethan Elliot Rajkumar, Undergraduate Student, University of British Columbia Supervisor: Bruce Vallance, Childhood Diseases

Congratulations to Ethan on receiving a Canadian Association of Gastroenterology Summer Studentship

A Closer Examination into Innate Epithelial Response Regulation by Gut Microbiota Against Enteric Bacterial Pathogens Ethan Rajkumar, Joannie Allaire, Yan Chen, Larissa Celiberto, Mariana Hill, Elena Verdu, Bruce Vallance

Background: Our commensal gut microbiota plays several protective roles against pathogenic infection but also influences host development in various ways. Intestinal epithelial cells (IEC), a single layer of cells lining the interior of the gastrointestinal tract, confine these microbes to the intestinal lumen hence, possessing important gut functions.

Although, it is known that IEC maturation and barrier function are impacted by the establishment of a healthy gut microbiota, little is known regarding the influence that the gut microbiota has on IEC immune responses against pathogens such as enterohemorrhagic Escherichia coli (EHEC). Germfree Mice (GF) have impaired IEC gut functions suggesting that gut microbiota can influence host mucosal defenses such as cell death and mucus secretion.

Aim: The aim of this project is to develop an in vitro model of infection using Citrobacter rodentium (a mouse model analog of EHEC) and primary IEC monolayers. This implemented in-vitro model will serve to evaluate in vivo IEC innate immune responses of GF and SPF (regular) mice following C. rodentium infection.

Methods: Primary intestinal epithelial monolayers derived from SPF and GF mice were infected with overnight culture or pre-induced culture of C. rodentium. Immunostaining was performed to examine the levels of infection of the monolayer such as staining for cell death, bacterial adherence and IEC integrity. In vivo, qPCR, histology scores and pathology burdens, were used to characterize the innate immune response for both GF and SPF tissue.

Results: The use of pre-induced bacteria greatly increased the infection levels which correlated with more cell death observed on infected monolayer than the non-infected one. In vivo, histological staining showed that infected germ-free mice have increased cell death as early as day 3 post-infection whereas little to no cell death was present in infected SPF mice.

Conclusion: This in vitro infection model can serve as a standard method to determine how the microbiota is impacting IEC inflammatory response and cell death when facing Citrobacter. Combined with the in vivo data, this project will help to understand this relationship and provide key insights in promoting host defense mechanisms against enteric pathogens such as EHEC.

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Session #3 | Poster #33 Amardeep Singh Sekhon, Undergraduate Student, University of British Columbia Supervisor: Bruce Verchere, Childhood Diseases

Congratulations to Amardeep on receiving a Canucks for Kids Fund Childhood Diabetes Laboratories Summer Studentship

The role of islet amyloid polypeptide in islet function and beta-cell mass Amardeep S. Sekhon, Austin J. Taylor, C. Bruce Verchere

Background: Type 2 diabetes (T2D) is a chronic metabolic condition characterized by hyperglycemia, insulin resistance, and reduced functional beta-cell mass. Islet amyloid polypeptide (IAPP) is the second most abundant beta-cell peptide that is co-stored and co-secreted with insulin in response to nutrient stimuli. Although the detrimental effects of IAPP aggregates are well recognized, the physiological roles of IAPP as an endocrine hormone and islet paracrine signalling factor remain poorly understood. IAPP has been found to induce satiety and slow gastric emptying, and exogenous IAPP has been shown to lower body weight and glycemia in humans. We previously found trends toward hyperglycemia and obesity in our IAPP-null (IAPP-/-) male mice. Given the association between reduced functional beta-cell mass and T2D, we hypothesize that IAPP-/- mice have reduced functional beta-cell mass resulting in hyperglycemia.

Methods: Pancreases, livers, and mesenteric and inguinal fat pads from high-fat diet-fed and control diet-fed IAPP+/+ and IAPP-/- (n = 5-18) male mice were dissected at 12 months-old and weighed. Pancreas sections (3 per animal) were analyzed by immunohistochemistry for insulin, and whole pancreas sections analyzed by tiled brightfield images.

Beta-cell mass was calculated by (pancreas mass * insulin-positive area) / pancreas area.

Preliminary Results: IAPP-/- male mice showed a trend toward higher body weight and elevated fasting glycemia compared to IAPP+/+ control mice. No significant differences were observed in pancreas, liver and fat pad masses.

Image analysis for beta-cell mass calculation is still underway. However, we hypothesize that due to the significant differences in body weight seen between IAPP+/+ and IAPP-/- mice, beta-cell mass will likely be larger in the IAPP-/group, as studies have shown that increased beta-cell mass occurs as a compensatory response to obesity to provide sufficient insulin.

Conclusions: Our preliminary data suggest that the loss of IAPP alongside the loss of insulin in T2D may result in difficulties with the regulation of food intake and glucose homeostasis. However, further studies with the use of exogenous IAPP analogues as a therapy in diabetes are warranted to improve obesity and glycemia.

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Session #3 | Poster #34 Nima Toussi, Undergraduate Student, University of British Columbia Supervisor: Todd Woodward, Brain, Behaviour & Development

Congratulations to Nima on receiving a NSERC Undergraduate Student Research Award

Functional Assessment of the fMRI-derived Extraction of Meaning Network Nima Toussi, Todd Woodward

Background: The novel Extraction of Meaning (LANG) functional brain network has emerged in several task-based fMRI studies. LANG displays activation in left-lateralized regions involved in language processing, namely the left inferior frontal gyrus, superior parietal lobe, and left middle temporal gyrus, with reciprocal suppression in the posterior cingulate cortex. However, the influence of task demands and conditions on activity remains ambiguous. Estimated hemodynamic responses (HDRs) may help contextualize LANG network function.

Methods: Previous datasets were used to extract functional brain networks with constrained principal component analysis for fMRI (fMRI-CPCA). LANG networks were identified by characteristic activation and suppression patterns and a voxel-wise region-specific correlation with previously identified LANG networks. Corresponding estimated HDRs were examined for condition effects and interactions.

Results: Several datasets displayed LANG network recruitment when evaluating lexical stimuli, both in written and auditory forms. Recruitment of the LANG network was also demonstrated upon evaluation of facial emotions.

Suppression of LANG network was observed in a variety of task conditions, including pitch discrimination tasks, spatial discrimination tasks, and tasks necessitating volitional attention to changing stimulus conditions.

Conclusions: LANG network is recruited for task-relevant responses which require some form of semantic retrieval and evaluation. The LANG network appears to be recruited for primarily lexical stimuli, though this finding is not universal across all semantic tasks. Additionally, the network does not appear to discriminate between auditory or written stimuli.

Suppression of the network may occur when volitional attention is required.

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Session #4 BASIC SCIENCE, CLINICAL & POPULATION HEALTH Moderator: Emily Schaeffer Participants: Bianca Fukakusa Pardis Kazemian Anne Lesack Arielle Locke Caroline McCamus Brianna Tsui Tanisha Vallani Alissa Zhang Emma Wells-Durand

Watch Virtually Live: Each presenter will have 5 minutes to discuss their poster and 5 minutes for questions from attendees.

Thursday, July 29, 2021 | 11:00 am - 12:30 pm www.bcchr.ca/posterday

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Session #4 | Poster #35 Bianca Fukakusa, Master’s Student, University of British Columbia Supervisor: Kevin Harris, Evidence to Innovation

Congratulations to Bianca on receiving a Canada Graduate Scholarship-Master’s and a BC Children’s Hospital Research Institute Sue Carruthers Graduate Studentship

A Feasibility Study: Physical Activity Counselling in Children with Congenital Heart Disease (PACCC) Bianca Fukakusa, Nicole Hemphill, Erica Bennett, Christine Voss, Kevin Harris

Background: One in 100 children are born with congenital heart disease (CHD). There has been an increase in survival in newborns with CHD because of medical advances. However, children with CHD have an increased risk of premature cardiovascular disease and major cardiovascular events. One potential strategy to decrease this risk is through modifiable risk factors, such as physical activity (PA) promotion. Current PA guidelines for children recommend at least 60 minutes of daily moderate to vigorous PA. However, most children do not meet these guidelines, including those with CHD. Currently, there are no evidence-based guidelines for PA promotion in children with CHD, highlighting the importance of research focused on the promotion of PA in children with CHD and their families.

Objective: To assess the feasibility and acceptability of a PA counselling intervention in children with CHD and explore preliminary changes in PA during and after the intervention.

Methods: Children ages 9-12 years old with a diagnosis of moderate to complex CHD are recruited from an existing cohort at BC Children’s Hospital. The PA counselling intervention will consist of six 60-minute sessions over 12 weeks with a trained PA counsellor over Zoom or Skype. Participants and their parents will complete theoretically-based workbook activities during and between the sessions. Feasibility will be measured by successful recruitment and study completion. Acceptability will be assessed through interviews with the participant and their family, and counselling session attendance and engagement. PA data will be collected using accelerometers and questionnaires at baseline, during and after the intervention.

Results: Eight participants have been recruited and are completing baseline measures. It can be anticipated that this pilot study will be feasible and acceptable to participants and their families, and that there will be preliminary changes in PA from baseline to post-intervention.

Conclusion: It is currently not known how to best promote and increase PA in children with CHD. This project aims test the feasibility and acceptability of the intervention, and to generate pilot data for future efficacy studies in hopes of informing evidence-based PA guidelines for children with CHD.

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Session #4 | Poster #36 Pardis Kazemian, Master’s Student, University of British Columbia Supervisor: Blair Leavitt, Brain, Behaviour & Development

Pardis generously received funding for this project from a local family affected by GNAO1

Lipid nanoparticle-mediated delivery of CRISPR knockdown of GNAO1 in brain cells Pardis Kazemian, Sarah Thomson, Terri Petkau, Blair Leavitt

Background: GNAO1 is a rare neurodevelopmental genetic disorder that causes a wide range of clinical symptoms including early-onset epileptic encephalopathy, developmental delay, cognitive impairment, hypotonia, and movement disorders. To this date, more than forty pathological mutations of GNAO1 have been reported. Currently, there is no effective and permanent treatment for this disease. CRISPR-mediated gene therapy proposes a great potential for permanently treating genetic diseases such as GNAO1. CRISPR technology can be targeted to specific sequences of genes allowing for DNA editing and manipulation. This study uses lipid nanoparticles (LNPs) as a non-viral delivery platform for CRISPR to target and reduce the expression of a GNAO1 pathological mutation.

Objective: CRISPR-mediated knockdown of GNAO1 by targeting a region affected by R209H – one of the most common GNAO1 gain-of-function variants which causes a Movement Disorder.

Methods and Results: In this study, a CRISPR technology is designed to target the R209H mutation site in GNAO1 to knockdown its expression. CRISPR molecules are encapsulated in LNPs and will be delivered to human (HEK 293) and mouse (Neuro-2a) cells. So far, the project has established the LNP-CRISPR system as well as the cell lines. Upon successful target gene knockdown, the experiment will move on to GNAO1-transgenic mice for in vivo studies.

Implications: Different GNAO1 mutations result in a variety of pathological outcomes based on the type and location of the mutation on the gene; therefore, an early genetic diagnostic should be considered to pursue a more effective personalized treatment specific to patients’ variants. Hence, by targeting the root (genetic) cause of the disease we can bypass the complexity of the spectrum of GNAO1 symptoms and aim towards a cure.

Future Perspectives: This study increases our understanding of the effects of selective GNAO1 knockdown in the brain.

It will also provide important proof-of-principle to support future gene correction of GNAO1 as the first step towards an effective treatment for this disease as well as towards corrective gene editing in the brain for other neurological diseases.

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Session #4 | Poster #37 Anne Lesack, Master’s Student, University of British Columbia Supervisors: Gina Ogilvie & Sarai Racey, Healthy Starts

Willingness to Self-Collect an HPV Sample: HPV FOCAL Study Exit Survey Results Anne Lesack, C. Sarai Racey, Laurie Smith, Lovedeep Gondara, Gina S. Ogilvie

Background: Human Papillomavirus (HPV) based cervical cancer screening is being planned for or already implemented in many screening programs around the world. HPV-based screening has been shown to better detect cervical dysplasia earlier and more effectively than the traditional cytology testing. In addition, HPV testing provides the unique opportunity for individuals to self-collect their own sample.

Self-collection can increase accessibility for under-screened individuals by reducing logistical and personal barriers encountered with clinician-based sampling. Self-collection may provide an opportunity for innovation within current population-based screening programs by providing an alternative form of engagement for all individuals, including those adherent to current guidelines.

Objective: The primary objective was to determine willingness to self-collect an HPV sample and factors that impact willingness in individuals who participated in the HPV FOCAL trial, a large randomized controlled screening trial.

Methods: A cross-sectional online survey was distributed between 2017 and 2018 to individuals who participated in the FOCAL trial, and collected information on acceptability of HPV self-collection, willingness to complete self-collection in the future, and socio-demographics. Bivariate and multivariable logistic regression was conducted to assess factors that influence willingness to self-collect an HPV sample in a well screened population.

Results: Overall, 53.8% (n=2327) of respondents indicated willingness to self-collect an HPV sample. In multivariable analysis, participants who were older (P=0.002), and had completed post-secondary education or higher (P<0.001) were significantly more willing to self-collect. The odds of willingness to self-collect increased by 45% in participants who indicated screening with an HPV test instead of a Pap test was acceptable to them compared to those who were unaccepting of HPV screening in general (OR 1.45, CI: 1.15, 1.82). Respondents who indicated collecting their own HPV sample was acceptable to them were significantly more willing to self-collect compared to those who found self-collection to be unacceptable (OR 17.9, CI: 14.9, 21.8).

Conclusions: In this well screened cohort, over half were willing to self-collect an HPV sample for cervical cancer screening. These findings offer insight into the intentions to self-collect in those already engaged in screening and can inform programs interested in offering alternative approaches to HPV-based screening.

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Session #4 | Poster #38 Arielle Locke, Medical Student, National University of Ireland Galway Supervisor: Sylvia Cheng, Childhood Diseases

Outcomes of children treated with preoperative radiotherapy for local control in pediatric sarcoma Arielle Locke, Sylvia Cheng, Andrea Lo, Melissa Harvey

Background: Local control in addition to systemic chemotherapy is crucial in the survival outcomes of pediatric Ewing sarcoma (ES) and rhabdomyosarcoma (RMS). Local control consists of surgery or radiation or the combination of both; however, the optimal approach continues to be debated. In the combination approach, postoperative radiotherapy (XRT) has been used in patients with high risk for local failure after surgery. XRT can also be used in a preoperative setting and provides several theoretical advantages. In British Columbia, the institutional approach in children with ES and RMS has been to consider preoperative XRT rather than postoperative XRT for local control due to the experience of the multidisciplinary team. The survival outcomes and long-term benefits of this in children with ES and RMS are not well-established compared to the majority who receive XRT postoperatively.

Objectives: 1. To determine progression free survival (PFS), and overall survival (OS) of children with Ewing Sarcoma, rhabdomyosarcoma, and undifferentiated sarcomas treated with preoperative XRT. 2. To describe treatment complications and late effects in the study population.

Methods: A retrospective chart review will be conducted in children diagnosed with ES, RMS and undifferentiated sarcomas treated at B.C Children’s Hospital between January 1st, 1990, to December 31st, 2020. Patient and disease characteristics as well as treatment and outcome data will be obtained from patient records. Descriptive and analytical statistics including PFS, and OS will be calculated using the Kaplan-Meier method. Institutional research ethics board approval has been obtained.

Preliminary Results: Data of 50 patients diagnosed between 2014-2020 has been collected and described. The cohort was evenly split between patients with localized disease (50%) and metastatic disease (50%) at presentation. The most common primary locations were upper extremity (83.3%), pelvis (78.6%) and the abdomen (66.7%). Seven (21.1%) with ES received preoperative XRT, and 5 (15.1%) received postoperative XRT. No patients with RMS were treated with preoperative XRT. The 5-year OS with combined surgery and XRT for local control was 100% and was 30.4% with definitive radiation only. Acute treatment complications included expected chemotherapy toxicities (42%), infection (18%), expected acute XRT effects (42%) and immediate non-infectious surgical issues (22%).

Future Steps: Further elaborate analysis to be conducted, including the review of 193 more remote patients to provide long-term outcomes.

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Session #4 | Poster #39 Caroline McCamus, Medical Student, Royal College of Surgeons Supervisor: Mahmoud Pouladi, Childhood Diseases

Examining the expression of the leukodystrophy-linked Claudin-11 in Primary and Immortalized Cells Caroline McCamus, Costanza Ferrari, Oguz Ozgoren, Mahmoud Pouladi

Introduction/Background: Claudin-11 is a tight junction protein found in central nervous system (CNS) myelin, essential in the formation of the radial component. Claudin-11 protein is the main contributor to the formation of a diffusion barrier in CNS myelin, helping to maintain the strength and conductance of nerve impulses travelling down an axon and prevent the loss of stimuli. De novo stop-loss mutations in CLDN11, the gene encoding Claudin-11, have recently been shown to lead to a hypomyelination leukodystrophy resembling Pelizaeus-Merzbacher disease. These patients show symptoms such as muscular trunk rigidity, spasticity of extremities, nystagmus and strabismus. The mechanisms by which the stop-loss mutations in CLDN11 lead to disease are unclear. In this project, we will examine the expression pattern of Claudin-11 using both primary and immortalized cell lines in order to select a suitable cellular model in which to test the effect of the mutations on Claudin-11 and its cellular functions.

Methods: Claudin-11 protein expression in primary and immortalized cells was evaluated by western blot. To check for CLDN11 gene expression levels, mRNA was extracted and converted into cDNA. A positive control was used for both experiments. To test the effect of Claudin-11 mutation, we used patient fibroblasts and matched controls.

Results: Quantitative RT-PCR and Western blot analyses show that CLDN11/Claudin-11 mRNA and protein are not expressed in commonly used immortalized cell lines (e.g. HEK293 cells), unlike what has been reported for fibroblast lines. This is consistent with the tissue-specific expression pattern reported for Claudin-11 in vivo, where it is found to be enriched in the central nervous system and testes.

Conclusions: When choosing cellular systems in which to study the novel de novo stop-loss mutations in CLDN11, its endogenous expression should first be evaluated. In cell lines that lack endogenous Claudin-11 expression such as HEK293, ectopic expression of mutant versus wildtype transgenes can allow the impact of the mutation to be examined directly in the absence of potential compensatory effects of the normal allele. Use of cell lines with endogenous expression, such as fibroblasts, on the other hand, can help further validate the cellular effects of the mutation and clarify the mechanisms involved (e.g. loss-of-function, haploinsufficiency, versus gain-of-function).

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Session #4 | Poster #40 Brianna Tsui, Master’s Student, University of British Columbia Supervisor: Christine Voss, Evidence to Innovation

Determinants of Daily Physical Activity in Children and Youth with Disabilities in Canada Brianna Tsui, Emily Bremer, Kelly Arbour-Nicitopoulos, Ritu Sharma, Christine Voss

Background: Physical activity (PA) is important for physical and mental health in children. There is limited data on PA levels and its determinants in Canadian children and youth with disabilities. Currently, the National Physical Activity Measurement Study (NPAM) is the first, large scale study in Canada to investigate PA levels in children and youth with disabilities.

Research Question: What are the main demographic, environmental and social support factors that affect the amount of PA in children and youth with disabilities in Canada?

Methods: 127 children and youth with disabilities ages 4-17 years wore Fitbits® (Charge HR) for 28 days to assess PA (steps/d) in the larger NPAM study. Valid days were defined as a minimum of 600 minutes of wear time/day. Geographic Information Systems (GIS) was used to assess local environmental factors near participant homes. Participants homes’ proximity to coastline was analyzed using a 5-kilometer coastal buffer (ocean, great lake). Large urban areas, mid-sized cities and rural locations were determined using Statistics Canada classification. Daily minimum temperature (˚C) from government historical weather records was extracted for the weather station closest to each home. Demographic (age, gender, disability type) and social support data (parents providing transport, watching child’s PA) was parent reported.

Mixed effects regression analyses in R assessed associations between environmental factors, demographic factors, social support factors, and daily steps. Significance was set at p<0.05.

Results: Mean age was 10±3 years with 95 boys and 32 girls. 41 participants had a physical disability and 86 were non-physical. 69% of parents reported providing transport and 62% watched their child’s PA. Overall, mean steps/d were 9505±4844 steps across 22±6 days. Disability type was significantly and independently related to daily steps, with children with non-physical disabilities being more active than those with physical disabilities (beta=1873,p=0.00) Conclusion: Children with non-physical disabilities are more active than children with physical disabilities. Environmental, demographic, and social support factors in this study had little or no effect on daily PA in children and youth with disabilities. These findings suggest that further investigation must determine what factors influence daily PA in children and youth with disabilities.

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Session #4 | Poster #41 Tanisha Vallani, Medical Student, University of British Columbia Supervisor: S. Evelyn Stewart, Brain, Behaviour & Development

Perspectives and recommendations: Youth obsessive-compulsive disorder diagnosis disclosure in the school setting

Tanisha Vallani, Jehannine Austin, Zainab Naqqash, Boyee Lin, Juliana Negreiros, John R. Best, S. Evelyn Stewart Background: Obsessive-compulsive disorder (OCD), a psychiatric condition affecting the school functioning of 1 to 3% of adolescents, manifests as discomforting obsessions followed by compulsive actions performed to temporarily relieve distress. Safe disclosure of an OCD diagnosis to school personnel can accelerate and enhance the implementation of supports youth receive. These supports are vital for condition management, school functioning, educational attainment, and mental health. There have been no studies thus far that have explored the experiences of youth disclosing or concealing their OCD diagnosis. The depth and breadth of knowledge that a qualitative study will provide is crucial for modifying current supports and for taking the first steps toward implementing new supports to ensure a safe environment for the disclosure of an OCD diagnosis and a positive school experience thereafter.

Aims: We aim to gain insight into OCD-affected youth and their experiences with disclosing or concealing their diagnosis from school personnel, including teachers, school counsellors, administrators, and classmates, and gather their recommendations for disclosure supports.

Methods: The study population will comprise approximately 15 youth between 13 and 18 years old with a DSM-IV-TRAxis I and/or DSM-V OCD diagnosis who have attended the BC Children’s Hospital Provincial OCD Program or who are being treated for OCD by a community-based provider. Participants will engage in a 45-minute semi-structured video conference interview. Interpretive description, a readily applicable and clinically relevant methodology, will be used to analyze the transcripts to create a theoretical model that can be used by school personnel to better facilitate the disclosure process. Participants will have the option to provide input on the initial model in a second 20-minute member checking meeting to ensure that it has been correctly interpreted and satisfies the needs of OCD-affected youth.

Next Steps: We will be recruiting participants, conducting the first set of interviews, and analyzing transcripts. The resulting theoretical disclosure model will be disseminated to relevant school personnel to start improving the process for OCD-affected youth. Future research can evaluate the effectiveness of the model for diverse demographic populations diagnosed with OCD and determine whether similar models would be beneficial for other psychiatric conditions.

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Session #4 | Poster #42 Alissa Zhang, Medical Student, University of British Columbia Supervisor: Lise A. Leveille, Evidence to Innovation

Congratulations to Alissa on receiving a BC Children’s Hospital Research Institute Summer Studentship

Crossing the tibial physis in prepubescent ACL reconstructions – Is it safe?

Alissa Zhang, Christopher Reilly, Lise A. Leveille

Background: Anterior Cruciate Ligament (ACL) tears in skeletally immature patients have increased over the years with increased early participation in high-risk sports, earlier sports specialization, year-round training, and injury awareness.

Historically, skeletally immature patients were managed non-operatively until they reached skeletal maturity for fear of causing damage to the physis with ACL reconstruction techniques. However, prolonged non-operative management is associated with increased risk of recurrent instability resulting in increased meniscal and articular cartilage damage.

With the shift towards early operative management in this population, several physeal-sparing techniques have been described to reconstruct the ACL in prepubescent patients who have more than 3 years of growth remaining. These reconstructions have been favoured to avoid crossing the femoral and tibial physis due to fear of causing growth disturbances in this population. However, physeal-sparing techniques can be technically challenging and potentially compromise graft fixation and tunnel placement.

Purpose: The aim of this study is to assess the risk of damage to the growth plate with transphyseal ACL reconstruction in skeletally immature patients. Specifically, this study will: 1. document transphyseal fixation techniques used for intra-articular knee pathology at BC Children’s Hospital (BCCH) in skeletally immature patients, 2. identify radiographic evidence of growth disturbance after transphyseal fixation in skeletally immature patients, and 3. identify clinical concern of growth disturbance after transphyseal fixation in skeletally immature patients.

Methods: A retrospective chart review will be conducted on all skeletally immature patients who received knee surgery for intra-articular pathology that utilized transphyseal fixation at BCCH between January 1, 2010 and May 1, 2021.

Clinical data and radiographic data, including bone age, will be collected when available. Radiographs obtained at each clinical follow up will be reviewed for evidence of growth disturbance. Descriptive statistics will be used to analyze differences between our patient population and those described in the literature.

Significance: Results of this study will help determine the safety of crossing the tibial physis during reconstructive knee procedures in skeletally immature patients. This would simplify surgical techniques used in the management of skeletally immature patients undergoing knee surgery and potentially decrease associated complications.

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Session #4 | Poster #43 Emma Wells-Durand, Medical Student, University of British Columbia Supervisor: Jugpal Arneja, Evidence to Innovation

Congratulations to Emma on receiving a BC Children’s Hospital Research Institute Evidence to Innovation Summer Studentship

Burden of Care for Patients with Cleft Lip and Palate

Emma Wells-Durand and Angela Buchel, John Staples, Douglas Courtemanche, Richard Thomson, Jugpal Arneja Background: Cleft lip and palate (CLP) is a congenital malformation of the face, for which care in BC is based at the BC Children’s Hospital (BCCH) Craniofacial-Cleft Palate Clinic. Management of CLP lasts until 18 years of age, and requires a multidisciplinary approach to care which can include nursing, pediatrics, plastic surgery, maxillofacial surgery, anesthesiology, otolaryngology, speech therapy, audiology, social work, psychology, genetics, orthodontics, prosthodontics, and dentistry in order to optimize functional and esthetic outcomes.

Burden of care (BoC) is a term now frequently used in medicine to describe the qualitative and quantitative costs to patients and their families that result from a specific medical intervention. Anecdotal evidence shows that patients with CLP have a high frequency of encounters with the health care system. However, there has been no comprehensive review, in Canada or worldwide, that investigates the full BoC, including a utilization and economic analysis, for the complete management of non-syndromic CLP. Research Aims: This study aims to: 1. Characterize the healthcare encounters of patients with CLP from birth until 18 years of age in B.C., including: CLP repair surgery, orthodontic care, speech and feeding therapy, hearing screening, pre-surgical orthopedics, naso-alveolar molding, management of middle ear disease, fistula repair surgery, and follow-up surgery.

2. Elucidate the personal and systemic financial costs related to such health care encounters.

Purpose: This research hopes to inform patient-counselling regarding a CLP diagnosis, improve the understanding of costs associated with a CLP diagnosis, and motivate the development of more efficient healthcare systems that maximize patient access to care.

Methods: This study is designed as a retrospective chart review between January 1, 1999 and April 30, 2021 of approximately 55 patients with non-syndromic CLP. Healthcare utilization data for inpatient, outpatient, and emergency encounters will be extracted from Health Records, and electronic databases including the BCCH Discharge Abstract Database, CERNER, and ORSOS. Financial data will be extracted from BCCH Health Information Management, and also calculated using averages already established by prior research at our clinic. Descriptive statistics and micro-costing analyses will be performed.

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Session #5 BASIC SCIENCE Moderator: Anuli Uzozie Participants: Leonardo Arreaza Moses Jeong Nisha Johal Justine Lau Kelly Lau Tess Leavitt Devann Paterson Taylor Ricci Mary Rose Waniss

Watch Virtually Live: Each presenter will have 5 minutes to discuss their poster and 5 minutes for questions from attendees.

Thursday, July 29, 2021 | 11:00 am - 12:30 pm www.bcchr.ca/posterday

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Session #5 | Poster #44 Leonardo Arreaza, Undergraduate Student, University of British Columbia Supervisor: Todd Woodward, Brain, Behaviour & Development

Congratulations to Leonardo on receiving a BC Mental Health and Substance Use Research Institute Summer Studentship

Functional Assessment of the fMRI-derived Re-Evaluation Network Leonardo Arreaza, Todd Woodward

Introduction: Task-based Functional Magnetic Resonance Imaging (fMRI) and Constrained Principal Component Analysis (CPCA) have previously been used to identify twelve fMRI-derived task-based functional brain networks. One of these is the Re-Evaluation Network (REN). This network is hypothesized to be active when an individual evaluates their response to the cognitive task. The objective of this project is to examine the hemodynamic response (HDR) for this network across various fMRI studies in order to test this hypothesis, and to determine possible links between this network and the symptoms of schizophrenia or other behavioural traits.

Methods: A network classification analysis was conducted for each task to determine which of the CPCA extracted components matched the REN template. SPSS repeated measures analysis of variance (ANOVAs) was used to obtain the HDR plots. Canonical correlation analysis (CCA) was also used to explore relationships between REN activity and the activity of other networks, the severity of symptoms in patients with schizophrenia, and other behavioural factors.

Results: For the studies where both the REN and the Response Network where elicited, the constant presence of a peak in REN activity after a peak in the Response Network suggest that the REN is involved in cognitive processes that occur after the participant has responded to the task. This could involve reassessing or evaluating their response. The results of the CCA suggest that there may be possible relationships with other networks, symptoms, and behavioural traits.

Conclusions: Understanding the potential function of the REN, and the potential relationships between network activity and the symptoms of schizophrenia could help to provide the biological underpinnings for these symptoms. A previous published study has shown that during an evidence integration task, patients experiencing delusions exhibit less REN activity compared to controls. Future direction includes using other statistical methods to determine the strength of the relationships found with the CCA.

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Session #5 | Poster #45 Moses Jeong, Undergraduate Student, Simon Fraser University Supervisors: William T. Gibson & Daniel Gamu, Childhood Diseases

Examination of EZH2 in Skeletal Muscles of Differing Oxidative Capacity Moses Jeong, Daniel Gamu, William T. Gibson

Background: Skeletal muscle is a highly plastic tissue capable of remodeling its metabolism based on its energetic needs. Typically, muscles are categorized as oxidative or glycolytic in phenotype, the former of which are enriched in mitochondria and rely on aerobic metabolism to make ATP. Although transcriptional control of oxidative metabolism is well described, little is known about key epigenetic factors controlling this process. Transcription of the oxidative gene program requires chromatin remodeling in order for transcription factors to physically access target loci. Trimethylation of histone 3 lysine 27 (i.e. H3K27me3) is performed by the enhancer of zeste 2 (EZH2) methyltransferase, part of the polycomb repressive complex 2 (PRC2). Formation of H3K27me3 results in chromatin condensation and gene silencing.

Several PRC2 proteins have been shown to be enriched in glycolytic muscle, suggesting a role in suppressing oxidative gene expression. We hypothesized that EZH2 and its enzymatic product H3K27me3, would be more abundant in glycolytic compared to oxidative muscles.

Methods: Male C57BL/6J mice (n = 8) were euthanized at 10 weeks of age, and their soleus (SOL; representative oxidative muscle) and extensor digitorum longus (EDL; representative glycolytic muscle) were excised and flash frozen in liquid N2. EZH2 and its enzymatic product H3K27me3 were measured by Western blotting as optical density and expressed in arbitrary units. All values are mean ± SEM. Results: EZH2 protein expression was approximately 90% higher in EDL relative to SOL (Student’s 2-tailed t-test: P < 0.05; SOL: 1.0 ± 0.12 vs EDL: 1.93 ± 0.19). Currently, H3K27me3 analysis is ongoing.

Significance: The core enzymatic component of the PRC2 complex is enriched in glycolytic muscles, which suggests a role in suppressing oxidative gene expression. Future studies will include examination of more muscle groups, and their response to acute and chronic exercise training.

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Session #5 | Poster #46 Nisha Johal, Undergraduate Student, University of Guelph Supervisor: Seth Parker

Characterizing mitochondrial alanine transporters as novel drug targets Nisha Johal, Keeley Hewton, Amritpal Johal, Jessica Koe, Siwoo Lee, Seth Parker

Mitochondria are classically appreciated for their role in ATP production. They also play central roles in tasks like the biosynthesis of nucleotides, heme, fatty acids, cholesterol and amino acids. Notably, cancer cells have an increased demand for these mitochondrially-produced building blocks to support rapid proliferation. In this nature, developing therapies that target mitochondrial metabolism have future prospect for the medical community.

Metabolites cannot freely diffuse into the mitochondria but require specific protein transporters to facilitate their import/export across the impermeable inner mitochondrial membrane. The solute carriers (SLCs) are a major class of mitochondrial protein transporters. To date, the protein transporter(s) required to import/export many amino acids, including alanine, into and out of the mitochondria are poorly understood. Alanine uptake by cells and import into the mitochondria is important for regulating pyruvate metabolism, which sits at an intersection of key pathways of energy metabolism (e.g., glycolysis, respiration). Additionally, pyruvate metabolism and transport are implicated in many developmental disorders and cancers, and so, understanding the relationship between mitochondrial alanine import and pyruvate homeostasis may identify new therapies for these diseases.

Here, mitochondrial-localized transporter proteins were analyzed by in silico analyses where 9 SLC candidates were selected for further study based on plausible amino acid transport. Next, a CRISPR/Cas9-mediated knock-out (KO) approach was designed to study these candidates in depth, in attempt to define their role in alanine metabolite transport. The kinetics of alanine transport into the mitochondria of control and candidate SLC-knockout cells were quantified using a fluorescent reporter. Few KO candidates displayed significant decrease in kinetic activity with alanine addition, suggesting the wildtype functions in its transport. Proliferation rescue studies and stable-isotope tracing experiments were also performed to validate whether the candidate acts as the major mitochondrial alanine transporter in cells.

Overall, this study highlights a new group of potential therapeutic targets and their role in cancer cell metabolism.

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Session #5 | Poster #47 Justine Lau, Undergraduate Student, University of Western Ontario Supervisor: Michael S. Kobor, Healthy Starts

Congratulations to Justine on receiving a NSERC Undergraduate Student Research Award

The effect of SUMOylation on the histone variant, H2A.Z Justine Lau, Hilary Brewis, Michael S. Kobor

Post-translational modifications play key roles in regulating protein function, stability, interaction, and localization.

SUMOylation is one type of modification in which small ubiquitin-like modifier (SUMO) proteins covalently attach to target proteins to affect its activity. Targets of SUMOylation include histones, which are proteins that play roles in assembling and condensing chromatin. H2A.Z, a variant of the histone H2A, is broadly enriched at promoters and enhancers. The variant is involved in essential processes including transcriptional regulation, DNA repair, and maintenance of heterochromatin boundaries, and chromosome segregation. However, little is known about how SUMOylation affects the variant’s activity. Therefore, the purpose of this study was to further characterize the role of H2A.Z SUMOylation in Saccharomyces cerevisiae.

Yeast strains were transformed with plasmids containing either wild type H2A.Z or a non-SUMOylatable H2A.Z gene, H2A.Z(K125,132R). Analysis of whole protein extracts revealed that the non-SUMOylatable H2A.Z mutant had decreased protein expression relative to wild type. Conversely, the non-SUMOylatable H2A.Z mutant was found to have relatively increased stability initially after transcriptional inhibition. Moreover, in the several genotoxic stress conditions tested, SUMOylation of H2A.Z did not significantly affect the growth phenotype.

Collectively, this data suggests that SUMOylation functions to positively-regulate H2A.Z levels; however, it may also promote H2A.Z instability to an extent. Further research must be done to better understand how SUMOylation affects overall H2A.Z function, specifically during gene-instability. Next steps for this project include observing levels of H2A.Z SUMOylation in response to DNA-damage through SUMOylation immunoprecipitation assays and assessing genetic interactions of H2A.Z within the SUMOylation pathway.

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Session #5 | Poster #48 Kelly Lau, Undergraduate Student, University of British Columbia Supervisor: Bruce Vallance, Childhood Diseases

Congratulations to Kelly on receiving a BioTalent Canada Summer Student Workplace Program Placement

Inflammasome Activation Coordinates Early Intestinal Mucosal Defense Against the Enteric Pathogen Salmonella Kelly Lau, Vivian Han, Joannie Allaire, Shauna Crowley, Bruce Vallance

Background: Secreted by goblet cells, the mucus layer in the gut physically distances the intestinal epithelium from the gut microbiota and prevents invasion by enteric pathogens. However, if the mucus layer is breached, infected intestinal epithelial cells (IECs) can mount an immune response through the activation of the inflammasome pathways.

Inflammasomes are multimeric signalling platforms in the cytosol formed upon recognition of bacterial motifs. Once the platform is assembled, caspase proteases undergo autocatalytic activation, and process interleukin (IL)-18 as an antimicrobial defense. IL-18 is a pro-inflammatory cytokine, and its secretion by the IECs can stimulate mucus secretion from goblet cells and induce IL-22 secretion from lymphoid cells. This will lead to an altered mucus layer and push pathogens away from the epithelium, preventing further IEC invasion.

Objective: To determine whether inflammasomes plays a role in early mucosal defense at the intestinal epithelium against pathogenic invasion through alterations of the mucus layer.

Methodology: Using Salmonella enterica Typhimurium as a model pathogen for inflammasome activation, Caspase 1/11 (Casp1/11) wildtype (WT) and Casp1/11 knockout (KO) mice were orally administered S. typhimurium (infected) or Phosphate-buffered Saline (PBS) (control) following pre-treatment with streptomycin 24 hours prior. Mice were euthanized 18 hours after initial infection, and cecal and colonic tissues were collected. Tissues were sectioned and stained for the visualization and measurement of mucus layers. IL-22 secretion was measured by ELISA on supernatant samples collected from ex-vivo secretion experiments. Comparisons of Casp1/11 WT and KO mucus thickness measurements and IL-22 secretion levels were analyzed by t-test.

Preliminary Results: WT mice had significantly thicker mucus layers than KO mice. This suggests that inflammasomes play an important role in promoting mucus secretion during infection. However, further experiments will be needed to collect samples from control conditions to determine whether there is a difference in mucus thickness between infected and uninfected mice. IL-22 ELISA will be used to demonstrate the role of IL-22 in correlation with inflammasome pathways, as WT mice with intact inflammasome pathways are expected to have higher levels of IL-22 secretion compared to KO mice.

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Session #5 | Poster #49 Tess Leavitt, Undergraduate Student, Queen’s University

Supervisors: Michael Hayden & Nicholas Caron, Brain, Behaviour & Development

Investigating the Origin of Proenkephalin Present in the Blood and Cerebrospinal Fluid as a Potential Biomarker of Huntington Disease Tess Leavitt, Nicholas Caron

Background: Huntington disease (HD) is an inherited neurodegenerative disorder that causes early and selective neuronal death in the striatum of the brain. Proenkephalin (PENK) is part of a family of opioid receptor ligands that undergoes cleavage to produce signalling peptides that exert various biological functions. PENK expression is highly enriched in the striatum compared to other brain regions but is also expressed in the adrenal gland. A recent study found that concentrations of a specific PENK peptide (143-184) is decreased in the cerebrospinal fluid (CSF) of HD patients compared to control individuals and that its levels correlate with disease severity. This PENK peptide has also been detected in the biofluid of the YAC128 mouse model of HD. Objective: To evaluate whether PENK detected in the CSF and blood of YAC128 mice originates from the brain.

Methods: We identified an adeno-associated virus (AAV) vector, pFB-AAV, harbouring a ubiquitous CAG promoter which is an effective vehicle for gene expression. We then designed a gene block corresponding to the mouse Penk 143-184 domain with a 3’ FLAG tag and ClaI and NheI restriction sites. The vector and insert were digested using the restriction enzymes and ligated. Ligations were transformed into competent Cells and plated onto agar plates containing both ampicillin and gentamicin to grow our bacterial colonies.

Future Direction: This study is ongoing. Once the AAV-Penk plasmid has been cloned and sequenced, we will have the AAV (serotype 1) produced. This serotype is known to transduce many cell types in the brain, including neurons. This will be injected into the striatum of mice and after 4 weeks, when transgene expression has peaked, we will collect CSF and plasma samples for analysis. Penk levels will be measured using an ELISA for the FLAG tag.

Significance: Elucidating the source of PENK in the CSF and plasma will help improve our understanding of disease related changes. Once establishing the proportion of proenkephalin that originates specifically from the brain, PENK can be utilized as an effective biomarker. As a biomarker, proenkephalin may be utilized in clinical trials to determine the efficacy of potential treatments for HD.

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Session #5 | Poster #50 Devann Paterson, Undergraduate Student, Concordia University Supervisors: Bruce Verchere & Austin J. Taylor, Childhood Diseases

Congratulations to Devann on receiving a Canucks for Kids Fund Childhood Diabetes Laboratories Summer Studentship

Beta-cell prohormone convertase 1/3 deficiency increases amyloid severity in mice Devann Paterson, Austin J. Taylor, Yi-Chun Chen, C. Bruce Verchere

Background: Type 2 diabetes (T2D) is characterized by hyperglycemia, which is caused by both insulin resistance and decreased functional beta-cell mass. Beta cells are located in pancreatic islets and are responsible for the secretion of insulin and islet amyloid polypeptide (IAPP), the major constituent of islet amyloid deposits in patients with T2D. Prior to forming amyloid, IAPP aggregates into pre-fibrillar oligomers that are toxic to beta cells and promote beta-cell failure.

IAPP is first produced as the prohormone proIAPP, and is processed by prohormone convertases 1/3 (Pcsk1) and 2 (Pcsk2) into mature IAPP. Individuals with T2D show dysfunction in this processing mechanism as they have elevated circulating levels of proIAPP relative to mature IAPP. We hypothesize that Pcsk1 deficiency in beta cells will lead to elevated levels of proIAPP and islet amyloid, and worsened islet amyloid-induced hyperglycemia.

Methods: Beta-cell specific Pcsk1 KO (Pcsk1betaKO) and wild-type (Pcsk1betaWT) mice expressing human proIAPP (hIAPPTg) were generated and monitored for changes in fasting glycemia. Pancreas sections were analyzed by immunohistochemistry for insulin and amyloid (thioflavin S). Amyloid burden was determined by calculating amyloid prevalence (fraction of islets positive for amyloid) and severity (amyloid+/ insulin+ area).

Results: Pcsk1betaKO and Pcsk1betaWT mice, both expressing hIAPPTg, displayed elevated fasting glycemia, and Pcsk1betaKO male mice, with and without hIAPPTg, trended toward increased fasting glycemia. Amyloid severity was significantly increased in hIAPPTg Pcsk1betaKO mice relative to hIAPPTg Pcsk1betaWT mice (4.2±5.2% vs 0.36±0.28%; p = 0.02), while hIAPPTg Pcsk1betaKO mice showed a trend toward increased amyloid prevalence.

Conclusion: Greater amyloid severity in Pcsk1betaKO mouse islets suggests that beta-cell Pcsk1 deficiency, as observed in T2D, results in increased islet amyloid formation. Reduced beta-cell Pcsk1 activity may drive the increase in islet amyloid and beta-cell dysfunction in T2D in humans. However, elevated glycemia in Pcsk1betaKO mice without hIAPPTg suggests that Pcsk1 deficiency can also drive hyperglycemia independent of amyloid formation. Maintaining or restoring Pcsk1 activity in beta cells may improve glycemia and beta-cell function in individuals with T2D.

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Session #5 | Poster #51 Taylor Ricci, Undergraduate Student, Queen’s University Supervisor: Angela Devlin, Healthy Starts

Congratulations to Taylor on receiving a NSERC Undergraduate Student Research Award

The Role of Riboflavin in the Regulation of Vascular Endothelial Function Taylor Ricci, Nicha Boonpattrawong, Angela Devlin

Background: Riboflavin is a water-soluble B-vitamin that functions as an enzymatic cofactor as flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD). Vascular endothelial cells line the lumen of blood vessels and function in regulating how vessels respond to vasodilatory, mitogenic, and thrombogenic cues. Vascular endothelial dysfunction is an early indicator of vascular disease, and refers to a loss of the protective properties of the endothelium. Nitric oxide is one of the key signalling molecules regulating endothelial cell function. Endothelial nitric oxide synthase (Nos3) synthesizes nitric oxide from arginine using tetrahydrobiopterin (BH4), FMN/FAD, and nicotinamide adenine dinucleotide phosphate (NADPH) as cofactors. Little is known about the role of dietary riboflavin in regulating vascular endothelial function.

Objective: To determine if dietary riboflavin is an important determinant of vascular endothelial function.

Methods: Male and female Nos3 +/+ and Nos3-/- (C57BL/6J) mice were fed a control diet (6mg riboflavin/kg) or a riboflavin deficient diet (1 mg riboflavin/kg) from weaning for 6 weeks (n=8 mice/sex/diet/genotype). Nos3-/- mice were studied to determine if the effect of riboflavin deficiency on vascular endothelial function involves Nos3. At the end of the feeding period, tissues were collected. Endothelial-dependent and -independent function in aortic rings were assessed ex vivo using a wire myograph. Aortic rings were treated with increasing concentrations of phenylephrine and acetylcholine to assess endothelial-independent vasoconstriction and endothelial-dependent vasodilatation, respectively. To determine the direct effect of riboflavin on endothelial-dependent vasodilatation, we also incubated aortic rings from riboflavin-deficient mice with 20nM riboflavin for 1 hour.

Preliminary Results: To date, I have assessed n=2 Nos3-/- mice and n=2 Nos3+/+ mice fed the control diet. As expected, Nos3 -/- mice have impaired endothelial-dependent vasodilatation compared to Nos3+/+ mice. The remaining mice are currently being fed the respective diets and vascular function and tissue collection will continue over the next 2 months.

Experiments to investigate if riboflavin supplementation of the aortic rings ex vivo can improve endothelial- dependent function in aorta from riboflavin-deficient mice are currently being optimized.

Significance: These studies will provide evidence of a direct role for dietary riboflavin in regulating vascular endothelial function.

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Session #5 | Poster #52 Mary Rose Waniss, Undergraduate Student, University of Guelph Supervisor: Francis C. Lynn, Childhood Diseases

Congratulations to Mary Rose on receiving a Canucks for Kids Fund Childhood Diabetes Laboratories Summer Studentship

Mutation in type 2 diabetes susceptibility gene, CDKAL1, results in dysfunctional premature phenotype in β-cell development Mary Rose Waniss, Dahai Zhang, Francis C. Lynn

Introduction: Type 2 diabetes mellitus is characterized by an inability to regulate blood glucose due to β-cell dysfunction and death. Pancreatic β-cells synthesize and release insulin, a hormone responsible for regulating glucose metabolism.

Type 2 diabetes susceptible gene, CDKAL1, is associated with β-cell dysfunction, and thus the development of diabetes mellitus. Highly credible CDKAL1 mutations are located in a non-coding region containing islet-specific enhancers, which are hypothesized to play a role in regulating a nearby gene, SOX4. SOX4 is a transcription factor known to be important for the development of pancreatic β-cells.

Objective: This study aims to characterize whether the SNPs in CDKAL1 regulate SOX4 expression, and how the mutation impacts β-cell development.

Methods: The CRISPR-Cas9 system was used to generate a homozygous knockout of the CDKAL1 enhancer region in a human embryonic stem cell line (CDKAL1 KO). CDKAL1 KO cells were subsequently differentiated to β-cells using a stepwise protocol. Markers at various developmental stages were examined using qPCR and FACS to determine the impact of the mutation on β-cell differentiation.

Results: Preliminary data showed that CDKAL1 expression was consistent across developmental stages and between WT and KO; however, SOX4 expression was reduced in KO cells – particularly at the pancreatic progenitor stage. Pancreatic lineage markers, PDX1 and SOX9, were not affected by KO. KO cells showed earlier and higher expression of two developmental factors, NKX6.1 and NGN3, suggesting premature differentiation of pancreatic progenitors toward the endocrine lineage.

Conclusion: These findings suggest a dysfunctional premature phenotype that develops in the absence of the islet enhancer cluster located in CDKAL1. Further data collection is required to elucidate the mechanism by which the SNP-enriched enhancer causes diabetes.

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Session #6 CLINICAL & POPULATION HEALTH Moderator: Kathy Wan-Chun Chang Participants: Chihiro Abe Krystal Cardinal Lauren Caswell, Lauren Jones, Alexandra Turvey Bita Gholamian Jacob Gravelle Brody Lyons Lindy Moxham Alexandra Turvey, Lauren Jones, Lauren Caswell David Yeung

Watch Virtually Live: Each presenter will have 5 minutes to discuss their poster and 5 minutes for questions from attendees.

Thursday, July 29, 2021 | 11:00 am - 12:30 pm www.bcchr.ca/posterday

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Session #6 | Poster #53 Chihiro Abe, Undergraduate Student, University of British Columbia Supervisor: Tim Bhatnagar, Evidence to Innovation

Congratulations to Chihiro on receiving a BC Children’s Hospital Sunny Hill Summer Studentship

Interactive technology for rehabilitation: Engaging and partnering with patients, families, and clinicians to guide optimal clinical implementation and effectiveness Chihiro Abe, Stephanie Glegg, Kimberly Miller, Tim Bhatnagar

Background: Growing evidence supports Interactive technology (IT) use in rehabilitation, which allows users to interact with simulated game environments and receive real-time feedback about the results of their actions. The feasibility of its clinical implementation is strongly reliant on user experience. While commercial gaming systems provide a wide range of engaging games, they are not designed for treatment, and may not meet the capabilities and therapeutic goals of individual patients. Families’ attitudes toward their children’s interventions also impact its acceptability in the context of family-centered care. Finally, clinicians are the “gatekeepers” for technology use in clinical settings. A survey of Canadian physical and occupational therapists identified major barriers to adoption, including lack of support staff assistance, time, and appropriateness for individual patients. To assess the feasibility of a new IT system to supplement pediatric rehabilitation services, research is needed to examine the factors that make IT enjoyable for patients, acceptable for families, and usable for clinicians.

Objective: To examine factors influencing IT use by patients, families, and clinicians during its early implementation in Sunny Hill Health Centre’s Acute Rehabilitation Program (ARP).

Methods: This implementation study will recruit patients (age 8+), their parent/guardian, and therapists, rehabilitation assistants, and nurses from the Sunny Hill Motion Lab and ARP. Cross-sectional patient and family surveys and pre/ post clinician surveys administered by iPad include demographic questions and: a) Children: Faces Pain Scale-Revised, Eston-Parfitt Scale (perceived exertion), and Game Preferences Rating Scale (during session); Physical Activity Enjoyment Scale, and supplementary engagement questions (post-play); b) Families: Abbreviated Acceptability Rating Profile to explore acceptability of technology; and c) Clinicians: Assessing Determinants of Prospective Take-up of Virtual Reality-2 and System Usability Scale. Quantitative analysis will employ descriptive statistics (e.g., counts, proportions, central tendency). Open-text responses will be analyzed using conventional content analysis and frequency counts, where appropriate.

Implications: This study will document user experiences and feedback during use of a novel rehabilitation intervention, and offer insight into ways to improve the IT system for best patient, family, and clinician experiences.

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Session #6 | Poster #54 Krystal Cardinal, Undergraduate Student, University of British Columbia Supervisor: Micah Burns, Evidence to Innovation

Congratulations to Krystal on receiving a BioTalent Canada Summer Student Workplace Program Placement

Pain management for pediatric patients undergoing appendectomies: A retrospective chart review Krystal Cardinal, Gurmaan Gill, Andrew Poznikoff, Lindy Moxham, Robert Baird, Micah Burns

Background: Appendicitis is one of the most common diseases requiring emergency surgery worldwide. Laparoscopic appendectomies are ideal for surgical management, as these procedures are minimally invasive and are associated with lower rates of infection and shorter lengths of stay in the hospital than open appendectomies. Pain management is a very important consideration for these surgeries, with many strategies utilized intraoperatively and post operatively to support patient comfort. One such strategy is the administration of local anesthetics to the operative site during the procedure. At BC Children’s Hospital, it is common for patients undergoing a laparoscopic appendectomy to receive bupivacaine wound infiltration. However, there is evidence that administering local adjuncts to bupivacaine, such as dexmedetomidine, can help reduce the need for post operative analgesic administration. We believe that investigating wound infiltration adjuncts could contribute to improving the standard of care for laparoscopic appendectomies, with the goal of minimizing the use of post-operative opioids. Prior to undertaking a randomized control trial to study the effects of these locally administered adjuncts, we are completing a retrospective chart review to determine baseline pain management strategies and opioid utilization.

Aim: We will examine post-operative comfort and existing pain management strategies, with particular focus on opioid utilization, in appendectomy patients at BCCH. Methods: A retrospective chart review is being performed for patients who underwent appendectomies during 2019.

QIQA REDCap approval was obtained from the DCSSC, and a list of MRNs, patient names, and procedure dates for 119 eligible procedures were obtained. The physical charts are being pulled from health records and relevant data is being collected and stored on REDCap. Data will be tabulated and analyzed using Microsoft Excel and R. Analysis will be performed using descriptive statistics.

Next Steps: This project is currently in the data collection phase, with charts actively being pulled and relevant information extracted. The results of this review will be used to inform the design of a randomized control trial to evaluate the effect of utilizing locally administered adjuncts to bupivacaine during laparoscopic appendectomies.

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Session #6 | Poster #55 Lauren Caswell, Undergraduate Student, University of British Columbia

Congratulations to Lauren on receiving a BC Children’s Hospital Research Institute Healthy Starts Studentship

Lauren Jones, Undergraduate Student, University of British Columbia

Congratulations to Lauren on receiving funding from a Genome British Columbia research grant

Alexandra Turvey, Undergraduate Student, Pomona College

Congratulations to Alexandra on receiving a Pomona College Remote Alternative Independent Summer Experience (RAISE) Program Award Supervisors: Stuart Turvey & Bhavi Modi, Healthy Starts

Host and Viral Genomic Determinants of COVID-19

Lauren Caswell*, Lauren Jones*, Alexandra Turvey*, Conrado de Guzman, Linda Warner, Kate Del Bel, Bhavi Modi, Stuart Turvey *= denotes equal contribution Background: Coronavirus Disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), is now a global pandemic and public emergency worldwide. Disease presentation is characterised by a spectrum of symptom severity ranging from asymptomatic to fatal outcomes. Mechanisms underlying disease susceptibility and variability of symptom severity and duration are unclear.

Similar to other infectious diseases, COVID-19 is a complex interaction between the host, the pathogen and the environment, collectively forming the “infectious disease triangle”. As the COVID-19 pandemic continues to emerge and new SARS-CoV-2 variants are identified, understanding the role of individual genetic variability in disease susceptibility becomes increasingly important for prevention and management of COVID-19. Integration of large-scale genomic (human and viral) data with associated clinical outcomes is thus paramount.

Overarching Project Hypotheses: 1. Underlying host and viral genomic factors contribute to COVID-19 infection susceptibility and variable health outcomes of infection and are likely influenced by environmental factors (i.e. lifestyle and built environment).

2. The genomic factors contributing to the variable host immune response and disease mechanisms in the acute phase also determine the risk factors and health outcomes in the chronic phase of COVID-19.

Methods: Our goal is to recruit BC patients who have experienced COVID-19. We aim to recruit 2000 participants by January 2022. With appropriate ethical and institutional approvals, together with rigorous data safety standards, the contact information from the BC Center for Disease Control was utilized to invite eligible individuals to participate through a phone call or through an email invitation. Interested participants then provided informed consent using an approved e-consent tool. Subjects provided a biological sample (either blood or saliva) for whole genome sequencing.

Results: As of July 19th 2021, ~3400 eligible individuals have been invited to participate. ~600 participants have been enrolled, ~395 have signed consent, and a biological sample has been received from 169. Of those that have signed consent, 58% self-identified as female and 42% as male. Recruited participants ranged in age from 1 year to 93 years.

Significance: This research will help address critical knowledge gaps in understanding the COVID-19 disease. Additionally, it will enable effective integration of public health and research efforts towards management of the ongoing pandemic.

We have established an efficient and ethically-approved recruitment strategy that has us on target to achieve our goal of recruiting 2000 eligible subjects who have experienced COVID-19.

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Session #6 | Poster #56 Bita Gholamian, Undergraduate Student, Simon Fraser University Supervisor: Paul Yong, Healthy Starts

Congratulations to Bita on receiving a BC Children’s Hospital Research Institute Healthy Starts Summer Studentship

Patient Experiences of Endometriosis-Associated Dyspareunia Self-Management to Inform Online Resource Development

Bita Gholamian, Fuchsia Howard, Kiran Parmar, Heather Noga, Leah Tannock, Endometriosis Patient Research Advisory Board, Paul Yong Background: Endometriosis is a gynecological condition characterized by the abnormal growth of endometrial-like tissue outside of the uterus, affecting 1 in 10 reproductive-aged women. Common symptoms of endometriosis include chronic pelvic pain, physiological dysfunction, heavy menstruation, infertility, and in about half of patients, dyspareunia which is the medical term for pain during sexual intercourse. The stigma and burden associated with dyspareunia often leads people to endure the pain or avoid intercourse altogether, resulting in loss of intimacy, relationship stress, and feelings of shame and failure. Current literature about self-management strategies of endometriosis overlook the symptom of dyspareunia.

Purpose: This project aims to explore patient perspectives and experiences of a) their responses to, and selfmanagement of, challenges related to endometriosis-associated painful sex, and b) their preferences and priorities for the development of online resources.

Methods: In-depth, semi-structured interviews were conducted with twenty people with suspected or surgically confirmed endometriosis to explore challenges related to self-managing painful sex as well as their priorities for developing online resources. Analysis was guided by interpretive description, an inductive analytical methodological approach that creates knowledge by building on current understanding and relates new insights to practice. This approach is intended to simplify complex features of the health experience and uses interpretation to construct findings with clinical relevance.

Data Analysis: Qualitative analysis was assisted by NVivo software. Open coding was used to highlight thematic patterns and develop a preliminary coding framework. Constant comparative techniques were then used to compare data across codes, reflecting higher levels of conceptualization.

Significance: After an exploration of pre-existing literature on patient experiences of endometriosis self-management, we recognized a paucity of data regarding the symptom of dyspareunia. The study will use insights from patient experiences of dyspareunia self-management to inform clinical care and patients’ informational needs regarding dyspareunia self-management.

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Session #6 | Poster #57 Jacob Gravelle, Undergraduate Student, University of British Columbia Supervisor: Mark Chilvers, Childhood Diseases

Determining the prevalence of food insecurity in the pediatric cystic fibrosis population in B.C. and the Yukon and its effects on healthcare outcomes Jacob Gravelle, Alam Lakhani, Alex Johal, Christine Loong, Sara Van Horn, Mark Chilvers

Introduction: Cystic Fibrosis (CF) is a genetic disease that results in the thickening of mucous throughout the body, which has significant effects on the respiratory and gastrointestinal systems. As a result, those with CF fight chronic lung infection and are unable to digest food properly. This causes the energy requirements of a person with CF to increase significantly. Standard treatment includes a diet that is rich with fats, proteins, and carbohydrates that is 1.5 to 2 times larger than a normal diet. This diet is expensive and may not be accessible everywhere; this issue is known as food insecurity.

Objective: To determine if food insecurity is prevalent in the pediatric CF population in B.C. and the Yukon and to measure its effects on healthcare outcomes as determined by lung function and body mass index.

Methods: A cross sectional study will be conducted within the pediatric CF population at BCCH. It is anticipated that around 150 parents of CF patients will answer a survey that screens for food insecurity. Healthcare data will be extracted from patient charts and paired with food insecurity screening data. The prevalence of food insecurity and its association with related healthcare outcomes will be determined and compared to food insecurity rates in B.C. and the rest of Canada.

Results: This study is currently underway and it is hoped that food insecurity rates can be identified and afflicted families receive support.

Significance: This study is significant because it will be one of the few studies conducted on the relationship between food insecurity and CF. Families across the country with children with CF may be suffering from food insecurity and this study adds to the small amount of literature on this issue.

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Session #6 | Poster #58 Brody Lyons, Undergraduate Student, University of British Columbia Supervisor: Troy Grennan

Congratulations to Brody on receiving a UBC Faculty of Medicine Summer Studentship, William & Ada Isabelle Steel Endowment Fund

Assessing the acceptability of doxycycline (STI PrEP/PEP) in a population of men who have sex with men (MSM) Brody Lyons, Troy Grennan, Saira Mohammed, Joshua Edward, Tessa Lawson Tattersall, Amit Gupta

Background: The bacterial sexually transmitted infections (STIs) syphilis, gonorrhea, and chlamydia are a growing epidemic worldwide, many of which disproportionately affect gay, bisexual and other men who have sex with men (gbMSM). The World Health Organization estimates that there are nearly 1 million people infected with a curable STI daily. Similarly concerning trends have been noted in Canada, where increases of over 160% have been seen in bacterial STIs over the last decade. With the dramatic increases in bacterial STIs, there is a need for novel STI prevention strategies and tools to mitigate STI-related complications. One such strategy is the use of an antibiotic given either before or after sexual exposure to prevent the acquisition of STIs; in other words, STI pre-exposure prophylaxis (PrEP) and STI post-exposure prophylaxis (PEP).

Objective: To gather relevant data directly from the MSM community regarding acceptability, motivations, and concerns about doxycycline PrEP and PEP through a qualitative research process.

Methods: This study will use an electronic, self-administered, anonymous questionnaire to capture information from MSM via the online platform Checkbox. Eligible study participants are self-identified MSM of any age. Questions will be pertaining to demographics, sexual behaviour, sexual health, STI prevention, testing and treatment, and concerns regarding doxycycline PrEP and PEP. Implications: The data from this study will aid in populating the larger parent-study website with relevant, and accurate information that will be accessible to all members of the MSM community that are curious and want to learn more about doxycycline PrEP/PEP. The website will also function as a place where MSM can find answers to frequently asked questions and concerns regarding doxycycline PrEP and PEP, and as a result will help members of the community become informed on doxycycline treatment. The data from this questionnaire will also help contribute to the building evidence base for doxycycline and will ensure that its eventual roll-out in relevant populations and future studies is informed by solid evidence.

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Session #6 | Poster #59 Lindy Moxham, Undergraduate Student, University of Saskatchewan Supervisor: Simon Whyte, Evidence to Innovation

Congratulations to Lindy on receiving a BC Children’s Hospital Research Institute Summer Studentship

Genetic Differences in Pharmacodynamic Safety Endpoints with Propofol Anesthesia in Children Lindy Moxham, Andrew Poznikoff, Matthias Görges, Krystal Cardinal, Emma Nielsen, Simon Whyte

Background: Anesthesia is an integral component of care for children undergoing procedures that are painful, uncomfortable, or require them to remain still for prolonged periods. However, anesthesia is not without risks.

Propofol, the predominantly used IV anesthetic at BC Children’s Hospital, is gaining popularity for procedural sedation outside of the operating room. There is a small difference between the dose of propofol required to reach desired loss of consciousness (LOC) and the dose that will cause potentially life-threatening effects such as loss of spontaneous breathing (apnea). This is important, as non-anesthesia providers may not recognize apnea in their patients or be able to rescue them from it. Additionally, there is considerable variation in the doses required to achieve these effects, with anecdotal evidence suggesting that genetic variability may play a role.

Objectives: 1. To describe and quantify doses of propofol required to produce LOC and apnea in children of differing ages, sexes, and self-reported ethnicity.

2. To identify genomic associations that may explain variability and generate hypotheses for further study.

Methods: A prospective, non-randomized single cohort study involving children aged 3 to 18 years, scheduled to undergo anesthesia with propofol was undertaken. For recruitment, children were stratified by age and sex into six groups of 60 participants. Prior to their procedure, participants self-reported the ethnicity of the child, parents, and grandparents.

During induction of anesthesia, the doses of propofol needed for LOC and apnea were measured and buccal swabs were collected for genome-wide association study.

Results: Thus far, 221/360 participants have been recruited. Preliminary results show older children require significantly lower doses of propofol to reach apnea than younger children; also, males require significantly higher doses to reach apnea than females. Additionally, females and older children have a smaller dose margin between LOC and apnea.

Conclusion: While anesthesiologists familiar with the properties of propofol already adjust for their patient’s age and body weight, results of this study aim to generate evidence for more tailored propofol dosing recommendations that account for genetic variability and sex, with the goal of making sedation safer for children.

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Session #6 | Poster #60 Alexandra Turvey, Undergraduate Student, Pomona College

Congratulations to Alexandra on receiving a Pomona College Remote Alternative Independent Summer Experience (RAISE) Program Award

Lauren Jones, Undergraduate Student, University of British Columbia

Congratulations to Lauren on receiving funding from a Genome British Columbia research grant

Lauren Caswell, Undergraduate Student, University of British Columbia

Congratulations to Lauren on receiving a BC Children’s Hospital Research Institute Healthy Starts Studentship Supervisor: Phillip Richmond

Human Genome Analysis: Harnessing the Power of Genome Sequencing to Identify Rare Genetic Diseases Alexandra Turvey*, Lauren Jones*, Lauren Caswell*, Phillip Richmond (* denotes equal contribution)

Background: Advances in genome sequencing technology have revolutionized the diagnosis of rare genetic diseases, bringing an end to the diagnostic odyssey of patients and their families. While these new technologies are extremely useful, their recent evolution from the research domain into clinical practice has created a gap in training for interpreting candidate genomic variants. Furthermore, the lack of training resources means that the necessary skills are difficult to obtain without the help of a professional.

Objective: To create synthetic rare disease scenarios, spanning inheritance patterns, disease categories, and variant classes which can be used for training and benchmarking genome diagnostic processes. We will adapt these scenarios for use within hands-on training workshops, and benchmark the diagnostic capacity of a commonly used automated framework called Exomiser.

Methods: The first task was to gain foundational experience in genomics and Linux by completing a hands-on introduction to genomics workshop. Subsequently, we created novel rare genetic disease scenarios. This involved first identifying a rare genetic disease and a gene of interest. Each disease was linked with 2-8 associated phenotypes from the Human Phenotype Ontology database. These cases were simulated as single gene defects in the human genome using GeneBreaker (http://genebreaker.cmmt.ubc.ca). Next, the variants were buried in open source whole genome trio datasets which allowed us to run Exomiser on each of our simulated cases. We included novel variants and known pathogenic variants from ClinVar in our case creation process. Our cases span different familial inheritance patterns as well as variant genomic location (intronic, splice sites, coding regions). We created patient descriptions for each simulated case using templates provided by a genetic counselor. Finally, in order to benchmark the Exomiser tool, we included the rank of each gene in the Exomiser output for each simulated case. All of these simulations were compiled into a worksheet with more than 25 new rare disease scenarios.

Significance: We have created a catalog of new genetic variants enabling the evaluation of the efficacy and limitations of tools (such as Exomiser) for ranking candidate genes. These cases will be a key component of a new training program in rare disease diagnosis that we will continue to develop and ultimately share as an open-source module.

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Session #6 | Poster #61 David Yeung, Undergraduate Student, University of British Columbia Supervisor: Alison Elliott, Childhood Diseases

Congratulations to David on receiving a BC Children’s Hospital Research Institute Summer Studentship

How do Adolescents Perceive Peers who have Genetic Conditions?

David Yeung, Tasha Wainstein, Lauren Jennings, Alison M. Elliott

Background: Genetic information and technologies are becoming increasingly accessible to younger people, including those with genetic conditions. While prevalence rates have remained unchanged, growing population sizes have resulted in increases in the numbers of adolescents living with disabilities. Research has demonstrated that children who lack knowledge about disability may have harmful attitudes towards people with disabilities, but also that disability awareness can successfully modify these attitudes. We hypothesize that learning about the genetic etiology of diseases could have a powerful impact on the social cognition of adolescents regarding their peers living with genetic conditions.

Objective: The aim of this research study is to determine how adolescents perceive their peers who have genetic conditions. Additionally, we aim to establish whether adolescents demonstrate implicit biases towards their peers who have genetic conditions.

Methods: Recruitment will occur through social media channels and ReachBC. Once assent and consent have been received, participants (aged 10-19) will be asked to complete the Harvard “Disability Implicit Association Test” (IAT), as well as a demographic questionnaire. Both the IAT and this brief demographic survey will be administered via Qualtrics hosted by UBC. Focus group interviews will be conducted, in which an interview guide and vignette will be used to facilitate discussion. Interviews will be recorded and transcribed, followed by coding. Integration of data from the IAT and focus groups will be analyzed to yield a theoretical model for adolescents’ perceptions of peers with genetic conditions.

Implications: This study will provide insights about the experiences and understanding of adolescents with respect to genetic conditions and the perception of their peers who have been diagnosed with genetic conditions. The model generated from this study will complement and broaden the scope of ongoing research of the GenCOUNSEL Study.

Findings from this work will inform additional research that will address whether understanding the genetic cause of a peer’s condition modifies adolescents’ perceptions. It will help to inform educational tools including webinars. We anticipate that increased understanding of genetic disorders would improve adolescents’ empathy, improve social interactions, reduce prejudices, and better prepare them for the world beyond school.

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Session #7 CLINICAL & POPULATION HEALTH Moderator: Derek Chan Participants: Lindsay Booth Amarpreet Chera Bayley Dalbec Simrin Dhillon Julia Handra Austin Pietramala Bethany Poon Lara Radovic Rui Yang (Oscar) Xu Yu Wen (Jade) Zhong

Watch Virtually Live: Each presenter will have 5 minutes to discuss their poster and 5 minutes for questions from attendees.

Thursday, July 29, 2021 | 1:00 pm - 2:40 pm www.bcchr.ca/posterday

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Session #7 | Poster #62 Lindsay Booth, Medical Student, University of British Columbia Supervisor: Mark Felton, Evidence to Innovation

Congratulations to Lindsay on receiving a BC Children’s Hospital Research Institute Summer Studentship & a UBC Faculty of Medicine Summer Studentship

Assessing the impact of COVID-19 precautions on classroom communication for adolescents with hearing loss: A qualitative study Lindsay Booth, Julie Pauwels, Neil K Chadha, Mark Felton

Background and Purpose: Public health measures such as mandatory masks and social distancing have become our new normal during the COVID-19 pandemic and present unique challenges to people who are hard-of-hearing. Previous studies of adults with hearing loss have found varied results with some individuals reporting fewer communication challenges during the COVID-19 pandemic and others reporting an exacerbation of the daily effects of their hearing loss. Several studies have been conducted on adolescents with hearing loss in classroom settings and have found that classrooms are frequently inaccessible to those with hearing loss, leading to communication breakdowns and increased social isolation. To our knowledge, no equivalent studies have been conducted on classroom communication for adolescents with hearing loss during the COVID-19 pandemic and its associated public health measures, such as mandatory masks and social distancing.

Central Question: How would adolescents with varying levels of hearing describe their experiences communicating in a classroom environment during the COVID-19 pandemic and its associated public health measures, such as masks and social distancing?

Methods: Adolescents ages 12-17 in one of four groups are invited to participate in the study: those with bilateral cochlear implants, those with hearing loss secondary to mastoidectomy, those with bone-anchored hearing aids, those with normal hearing. Participants will be interviewed using a semi-structured one-on-one format virtually using Zoom.

Interview recordings will be transcribed and undergo a reflexive thematic analysis to conceptualize central themes from the data using NVivo (QSR International).

Implications: The results and analysis from this study will help to document the unique experiences of adolescents with hearing loss during this unprecedented global pandemic to provide insights into improving classroom communication under similar circumstances.

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Session #7 | Poster #63 Amarpreet Chera, Undergraduate Student, Queen’s University Supervisor: Anne Synnes, Brain, Behaviour & Development

Congratulations to Amarpreet on receiving a CHILD-BRIGHT Summer Studentship

Vignettes to Evaluate Parental Perception of Severity of Disability Amarpreet Chera , Anne Synnes, Lindsay Richter, Thuy Mai Luu

Background: Children born very preterm (<29 weeks gestational age) are at risk of developing various impairments.

Neurodevelopmental impairment (NDI) rates are used to make critical healthcare decisions. The Canadian Neonatal Follow-Up Network (CNFUN) defines severe NDI based on hearing, vision, cerebral palsy and its severity, and development assessed using the Bayley-III. However, parents have never been asked to voice which preterm outcomes they perceive to be important.

Objective: Using clinical vignettes representing traditional medical descriptions, we aim to understand how parents/key stakeholders describe the severity of NDI at 18 months corrected age in children born preterm.

Methods: Clinical vignettes that captured the most frequent combinations of single and multiple impairments based on CNFUN definitions of severe NDI were developed. The survey of 11 vignettes was distributed to: (1) British Columbia parents of very preterm children (n = 63); (2) parents & key stakeholders using a snowball sampling technique nationally (n = 384); and (3) internationally (n = 404).

Parents rated the severity of each vignette on a scale from 0 (worst possible health) to 10 (best possible health) and answered whether the vignette represents a severe disability. Median scores for each vignette were ranked to compare vignette severity.

Results: 851 participants completed the survey consisting of 62% parents/caregivers (448) and 28% healthcare professionals (204). The medians for visual impairment (6) and cerebral palsy + language delay combined (6) were lower compared to the medians of vignettes representing other impairments. Visual impairment and cerebral palsy + language delay combined were rated as a severe health condition by 56% of the participants.

Next Steps: We will conduct mixed effects regression analysis to answer the primary research question ‘Do parents/key stakeholders rank the severity of 10 clinical vignettes which represent traditional medical descriptions of severe NDI at 18 months in children born preterm differently?’.

Preliminary Conclusion: Parental perception on the severity of clinical vignettes appear to differ. Current CNFUN definitions of NDI will need to be revised.

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Session #7 | Poster #64 Bayley Dalbec, Medical Student, University College Dublin Supervisor: Ian Pike, Evidence to Innovation

Drowning Prevention Strategies in British Columbia: What has been done and how can we improve?

Bayley Dalbec, Kate Turcotte, Ian Pike

Drowning is a leading cause of unintentional injury death in British Columbia (BC) and Canada. Organizations such as the LifeSaving Society and Canadian Red Cross have invested significant time and money in drowning prevention programs to minimize the burden and frequency of drowning injuries and fatalities. The aim of this project was to determine the drowning prevention strategies currently in place in BC and Canada, and whether they can be improved upon.

A PubMed/MEDLINE literature search was conducted to find relevant data on drownings and drowning prevention strategies.

Injury and mortality data shows that drowning can affect anyone although certain groups face higher risks. Males face higher risk of drowning than females, and children under five years of age are at higher risk of near drownings (hospitalizations) than any other age group. Ethnic and racial minorities face higher risk of drowning injury and mortality than Euro-Canadians. The aim of Canadian drowning prevention programs is to create stronger swimmers and help those who struggle to feel more comfortable and confident in the water, as well as emphasize the importance of using a personal flotation device around water and ice. A strategy that has not been implemented in Canada involves the use of First Aid as prevention. This approach has been used in other countries and could have positive implications for both drowning prevention as well as overall injury prevention and preparedness.

Future drowning prevention programs should be developed as a collaboration between community leaders and water safety experts to create more effective messaging strategies and improve community uptake. Making swimming lessons, drowning prevention programs and first aid training more accessible to all Canadians is a necessary step in reducing national drowning injuries and fatalities.

Effects of Booster Seat Legislation on Child Passenger Safety and Booster Seat Adherence Bayley Dalbec, Kate Turcotte, Ian Pike

Motor vehicle collisions (MVC) are a leading cause of unintentional injury and death in British Columbia (BC) across all age groups. Substantial improvements in child passenger safety came with the introduction of the child car and booster seats to secure babies and children within vehicles to prevent injury upon collision. Current legislation in BC has been in place since 2008, when child restraint requirements were updated from age-based to weight- and height-based to ensure adequate safety, and the use of booster seats for older children (aged 4-8) became mandatory. The aim of this project was to determine whether the updated legislation was successful in reducing MVC injury in children, and whether there was increased booster seat adherence following implementation.

There is extensive literature supporting the use of booster seats as injury prevention in older children. Hospitalization data displayed a decrease in MVC-related injury in children aged 0-4 and 5-9 following enactment of the 2008 legislation.

While rates of booster seat use are increasing, there is disproportionately low adherence to proper restraint use once children advance out of a forward-facing car seat. A combination of legislation awareness, socioeconomic status, and perceived community norms were found to influence decision making for booster seat use in parents. Norms were also a factor in determining children’s attitudes towards booster seat use.

The benefits of booster seats in reducing injury in children have been proven and are widely accepted. Next steps should aim to create new marketing strategies to increase both parent and child adherence to booster seat use.

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Session #7 | Poster #65 Simrin Dhillon, Medical Student, University of British Columbia Supervisor: Margot Davis

Congratulations to Simrin on receiving a Mach-Gaensslen Foundation of Canada Undergraduate Summer Studentship Award

Associations between Anemia and Clinical Outcomes among Patients with Cardiac Amyloidosis Simrin Dhillon, Justin Buttar, Margot Davis

Introduction: Cardiac amyloidosis (CA) is an often under-reported, incurable disease characterized by the deposition of insoluble amorphous protein fibrils in the myocardial interstitium, leading to a restrictive cardiomyopathy with progressive heart failure. While it is considered a rare disease, prior literature has identified the disease in up to 25% of individuals aged 80 years.

Anemia is commonly seen in patients with heart failure, occurring in over 40% of patients overall. It is thought that amyloidosis may render patients more susceptible to anemia, however incidence rates in this population have yet to be reported. Thus, this retrospective, cohort study aims to illustrate the incidence of anemia in ATTR (transthyretin) and AL (light chain) CA in comparison with the general heart failure population.

Methods: A retrospective cohort study of patients in the VGH Cardiac Amyloidosis Clinic was conducted to illustrate the baseline prevalence and subsequent incidence of anemia in CA. In addition, renal function, amyloid type, and markers of iron deficiency as well as clinical outcomes were compared between anemic vs. non-anemic patients with cardiac amyloidosis. After obtaining ethical approval with the Clinical Research Ethics Board, patient data was collected from the iClinic electronic medical record and entered into the REDCap database. The data retrieval time interval was January 1, 2010-September 30, 2019, with about 119 patients meeting both the inclusion and exclusion criteria.

Results: The mean age of diagnosis was found to be 69 years of age, with 38.0% of patients diagnosed with AL and 62.0% with ATTR. The prevalence of anemia within the set of cardiac amyloidosis patients is 41.0%. Furthermore, patients had a mean hemoglobin of 131.36 g/L and a mean ferritin of 204.33 µg/mL. As we continue on to analyze the data, we will investigate hospitalization frequency and mortality associated with anemic patients vs nonanemic patients.

Future Aims: Limitations included difficulty accessing certain echocardiograms reports and loss of follow up with a few patients. In the future, we plan to further analyze the data to assess clinical outcomes, and provide pilot data for the planned prospective Canadian Registry for Amyloidosis Research.

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Session #7 | Poster #66 Julia Handra, Undergraduate Student, University of British Columbia Supervisor: Linlea Armstrong, Childhood Diseases

Congratulations to Julia on receiving a BC Children’s Hospital Research Institute Summer Studentship

Prototyping an End-to-End Platform for Genomic Care to Meet the Needs of Both Patients and Providers

Julia Handra, Cornelius Boerkoel, Huilin Chin, Nour Gazzaz, Sara Hamilton, Ronnalea Hamman, Shevaun Hughes, Stephanie Huynh, Mary Lee, Anne Swenerton, Lynn Warnock, Jessica Zambonin, Linlea Armstrong Background: Genomic medicine integrates understanding of genomic variation into medical decisions to guide diagnosis and management. The Provincial Medical Genetics Program (PMGP), based at BC Women’s Hospital, is receiving rapidly increasing numbers of referrals for genomics-informed care. As genomic technologies and information revolutionize care for rare and complex disorders, collection, integration, and management of multiple data streams are essential for implementation and delivery of high-quality genomic medicine. The PMGP struggles to meet care needs because of a rapidly expanding deficit in infrastructure for use of those multiple data streams; this in turn limits access to genomic medicine in BC. Objective: To prototype and implement an end-to-end platform for genomic diagnostic assessment which: 1. Hosts a patient interface, allowing patients to more easily and securely share important clinical information, access education modules, and electronically consent for care.

2. Standardizes and improves clinical care practices.

3. Streamlines and automates administrative tasks.

4. Consolidates program-wide data to more comprehensively inform clinic management and quality improvement (QI) initiatives.

Methods: Through interviews and observation of practices, we completed process modeling for current clinic workflows.

We then modeled a future state informed by clinicians and staff designing improvements in care. We then implemented these processes using the QIQA clinical REDCap, an accessible and flexible platform, and initiated iterative development and improvement cycles.

Progress & Significance: The platform currently hosts over 7,600 patient records. It is used to 1) track referrals, 2) triage patients, 3) collect patient family and medical history, photos, and consents via a secure e-questionnaire, 4) send appointment information and reminders, 5) provide a standardized phenotyping tool, 6) generate summaries for patient charts, 7) track testing and outcome tracking, and 8) provide a genomic standardized variant interpretation tool.

With this integrated system, an array of clinic Excel trackers are being phased-out and the consolidated data is informing QI initiatives. Next steps include further improving and expanding functionality, evaluating impact, and onboarding other clinics at C&W that make use of genomic testing.

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Session #7 | Poster #67 Austin Pietramala, Medical Student, University of British Columbia Supervisor: Christine Voss, Evidence to Innovation

Congratulations to Austin on receiving a Southern Medical Program Studentship

Social, Behavioural, and Environmental Correlates of Glycemic Control in Pediatric Type 1 Diabetics in the BC Interior Austin Pietramala, Sofia Samper, Alissa Taki, Tom Warshawski, Holly Buhler, Trisha Thomson, Susi Wilkinson, Christine Voss

Background: Management of type 1 diabetes (T1D) is often determined through the patient’s glycemic control, which is measured by the amount of glycosylated hemoglobin (HbA1C) they have. It is recommended that children and youth with T1D maintain a HbA1C of 7.5% or lower to help minimize long-term microvascular and macrovascular complications.

HbA1C fluctuates and can be affected by many social, behavioural, and environmental factors. These risk factors for suboptimal glycemic control are routinely documented during clinical encounters as part of the pediatric diabetes care delivery in Interior Health (IH), but the association between risk factors and glycemic control in children and youth with T1D in IH is unknown.

Objective: To determine the association between social, behavioural, and environmental factors of glycemic control in pediatric T1D patients within the IH region.

Methods: A retrospective chart review was conducted for pediatric patients with T1D who received diabetes care through IH between 2015-2019. An IH data analyst performed a data pull of electronic medical records. At the patient level, variables included date of birth, sex and/or gender, time of diagnosis, treatment regimen; at each clinical encounter, variables included date (to calculate age), HbA1C, and other pertinent information (e.g. blood pressure).

Other qualitatively documented data, such as physical activity assessments, sleep quality screens, as well as tobacco, alcohol, and chemical substance usage, were collected and reviewed from each visit. An IH data analyst used GIS to geospatially link patient residential addresses with relevant area-level variables, such as median household income, population dwelling type (urban/suburban/rural/remote), and distance to their IH clinic. Statistical analyses are ongoing and conducted through R. Significance: IH has the highest incidence of pediatric T1D in BC. Through this work, we expect to identify factors related to glycemic control in these patients, with the view to inform the development of additional supports or screenings within IH. As well, the Diabetes Canada pediatric clinical practice guidelines do not mention sleep quality as a screening recommendation, and we expect to add useful information to the scarce evidence base on this topic.

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Session #7 | Poster #68 Bethany Poon, Undergraduate Student, University of Alberta Supervisor: Pascal Lavoie, Healthy Starts

Development of an in vitro neonatal gut model to investigate necrotizing enterocolitis

Bethany Poon, Zohreh Sharafianardakani, Mariana Hill, Hannah Piper, Kevan Jacobson, Pascal Lavoie, Bruce Vallance, Joannie Allaire Necrotizing enterocolitis (NEC) is an intestinal inflammatory disease that mainly affects premature infants. The infection of intestinal tissues and resultant inflammation can cause destruction of the bowel wall, leading to lasting complications and even death. Multiple factors contribute to NEC, including the immature neonatal immune and gut systems. However, due to the lack of accurate human intestinal models, the exact cause of NEC remains unclear.

The gut immune system response to pathogens is influenced by interactions between intestinal epithelial cells (IECs) and T cells. Studies in mouse models have demonstrated an excessive level of cytokine IL-17, secreted by T-helper 17 cells, in NEC inflamed tissue. This suggests that IL-17 plays an important role in the underlying mechanisms of NEC. Another cytokine, IL-22, regulates and maintains homeostasis in the gut.

The objective of this project is to explore NEC by developing an experimental 3D model of the neonate gut and observing the interactions between healthy neonatal immune and gut cells.

In this project, in vitro 3D gut models, called “organoids”, will be grown from neonatal intestinal biopsies. The experimental model will mimic the neonatal intestinal environment and be used to observe the interactions between neonatal gut cells and Th17 cell cytokines. Organoids will be co-cultured with the supernatant of activated T cells or recombinant cytokines, including IL-17 and IL-22. It is hypothesized that neonatal IECs treated with IL-22 will demonstrate changes in IEC function, which can be observed through changes in barrier function, proliferation, production of mucins and anti-microbial peptides (AMP). Analysis will be conducted through the use of qPCR, flow cytometry and confocal microscopy.

Study findings can provide clinically relevant information and implications of how developmental changes in the newborn intestine can influence susceptibility to NEC while providing evidence of a simplified, yet accurate, applicable, and successful neonatal gut model.

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Session #7 | Poster #69 Lara Radovic, Undergraduate Student, University of British Columbia Supervisor: Jennifer S. Coelho, Brain, Behaviour & Development

Congratulations to Lara on receiving a Dr. Glenda MacQueen Summer Studentship

Parental Coping and Self-Efficacy in a Mixed-Gender Sample of Youth with Eating Disorders Lara K. Radovic, Jennifer S. Coelho

Background: Due to the focus on female samples in eating disorder (ED) research, a gap in knowledge exists regarding ED symptoms and outcomes in families of male and transgender youth. Males make up ~16.5-25% of early adolescent ED patients, and transgender youth are at risk for developing an ED, with more severe symptoms if they do. Inclusion of these populations in ED research is therefore vital to understanding outcomes. Additionally, parent factors have been emerging as better predictors of ED recovery than youth factors. While parental self-efficacy was found to increase over treatment and predict greater decreases in youth ED symptoms, literature on parental predictors of ED outcomes remains sparse.

Objective: To examine changes in parent behaviour and psychological well-being over the course of their child’s ED treatment, and to investigate group differences between parents of male, female, and gender-diverse youth.

Methods: Data comes from a prospective longitudinal study conducted at the Provincial Eating Disorders Program that assessed youth ED clinical features and treatment outcomes in 51 families. Questionnaires assessing accommodating behaviours, self-efficacy, and generalized anxiety were administered to parents at admission and discharge. A transdiagnostic matched sample of 23 male and 23 female youth, and 5 gender-diverse participants was used.

Kruskal-Wallis tests were used to test differences between parents based on child gender. Paired t-tests were employed to investigate changes in parent behaviour over time.

Results/Conclusion: Parental self-efficacy and confidence relating to ED symptoms significantly increased from admission to discharge, while the degree of family accommodating behaviours decreased, indicating greater ability to cope with the ED. There were no significant changes in general self-efficacy or anxiety, or group differences between parents based on child gender. Results may inform family ED treatment planning and skills training. Given the lack of gender-based differences in parental reports, parents of youth of different genders appear to show similar baseline levels of coping.

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Session #7 | Poster #70 Rui Yang (Oscar) Xu, Medical Student, University of British Columbia Supervisor: Pascal Lavoie, Healthy Starts

Congratulations to Oscar on receiving a BC Children’s Hospital Research Institute Summer Studentship

Decreased population immunity against respiratory syncytial virus in women and infants during the COVID-19 pandemic Rui Yang (Oscar) Xu, Frederic Reicherz, Bahaa Abu Raya, Inna Sekirov, Queenie Lai, Zenon Cieslak, Neil Desai, Anil Chako, Pascal M. Lavoie

Background: Before the pandemic, Respiratory Syncytial Virus (RSV) was the leading cause of lower respiratory tract infections in infants, resurging year after year predictably during the winter months. However, with social distancing measures, the periodicity of RSV cases has drastically changed. Canada saw virtually no RSV cases during the past winter, and RSV cases have started peaking untypically during summer in Australia and the US. This suggests that both population immunity and social proximity behaviors drive RSV cases at the population level. Transplacental passage of maternal RSV antibodies to the fetus is a key factor protecting infants from severe RSV infections during the first months of life. The objective of this study was to compare RSV-specific antibody levels and neutralization capacity in females of child-bearing age and infants early on (May-June 2020) and towards the end (after March 31st, 2021) of the pandemic in the Greater Vancouver region.

Methods: Samples were analyzed from paired samples of women aged 25-46 from 2020 and 2021, age-matched samples from previous years (2018-2019), and infants in their first winter season (born after April 1, 2020). RSV antibody levels (IgG) were measured using a highly sensitive multiplex assay. RSV-neutralizing antibody titers (NT95) in adults and infants were measured using a recombinant RSV-GFP microneutralization assay.

Preliminary Results: Adult RSV-specific IgG-antibody levels dropped significantly over the 2020-2021 winter, compared to previous years (p<0.05). RSV-specific IgG-antibody levels were significantly lower in infants in 2021 compared to 2020 (p<0.0001), with no significant difference between preterm and term infant antibody levels (p>0.05). Strikingly, we detected a major drop in RSV neutralization in sera in both women and infants over the same period (p<0.0001).

Conclusion: The decrease in RSV-neutralizing antibodies observed in 2021 serum samples suggests that infants born after March 31st, 2020, may not have sufficient protection against RSV due to a lack of maternally transferred IgG antibodies.

With RSV cases showing a resurgence in countries including Australia and the US, it is imperative that measures are taken to protect those at high risk of severe RSV infection, such as preterm babies, and babies with chronic lung and heart disease.

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Session #7 | Poster #71 Yu Wen (Jade) Zhong, Medical Student, University of British Columbia Supervisor: Hannah Piper, Healthy Starts

Congratulations to Jade on receiving a UBC Faculty of Medicine Summer Studentship

Standardizing Vitamin D Administration to Minimize Deficiency in Children with Intestinal Failure Yu Wen (Jade) Zhong, Debby S. Martins, Hannah Piper

Background: Vitamin D deficiency is present in as many as 40-60% of children with intestinal failure (IF). Frequently the needs of these children exceed recommended daily intake due to malabsorption and gut dysfunction. However, there are no published guidelines for repleting and maintaining vitamin D levels within this population. In 2017, the intestinal rehabilitation program at BC Children’s Hospital (CHIRP) developed a vitamin D supplementation algorithm to optimize management. The purpose of this study is to evaluate the efficacy of the algorithm in reducing vitamin D deficiency in this population.

Methods: A retrospective chart review was performed in pediatric patients with IF who were cared for by the CHIRP team between 2014 to 2016 (pre-algorithm) and 2018 to 2020 (active algorithm). Children with IF and at least 1 serum vitamin D (25(OH)D3) measurement within the study period were included. Clinical data was collected including: etiology of IF, age at enrollment, nutritional intake (including vitamin D) and anthropometrics. Serum vitamin D levels pre and post algorithm were compared and statistically analyzed using Welch’s t-test. Vitamin D levels were classified as severe deficiency (<12.5 nmol/L), mild deficiency (12.5-39 nmol/L), insufficiency (40-74 nmol/L), optimal (75-224nmol), or toxicity (>225nmol/L).

Results: Initial screening identified 33 patients with IF and 29 met inclusion criteria. Mean age at enrollment was 1.87 years and mean small bowel length was 118.71cm. 182 vitamin D measurements were collected, 67 pre-algorithm and 115 post-algorithm. In general vitamin D levels after algorithm introduction improved in all categories (67% vs. 45% insufficiency, 13% vs. 10% mild deficiency, and 19% vs. 44% optimal). In the post-algorithm group, 1 measure (0.87%) was in the toxic range. No severe deficiency was observed in either group. Mean serum vitamin D (25(OH)D3) levels were significantly higher in the post-algorithm group (75.4nmol/L +/-36.89, range = 24-247nmol/L) as compared to the pre-algorithm group (59.94nmol/L +/-20.24, range = 30-122nmol/L; t = 3.66, 95% CI [7.13, 23.79], p < 0.0005).

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Session #8 CLINICAL & POPULATION HEALTH Moderator: Kaie Rosborough Participants: Dilpreet Bharaj Tereza Blahova Tara Gholamian Jasleen Grewal Kaitlyn Kwok Nikita Menon Ashleigh Nazareth Sumara Stroshein Stephanie U Adrian Haasler

Watch Virtually Live: Each presenter will have 5 minutes to discuss their poster and 5 minutes for questions from attendees.

Thursday, July 29, 2021 | 1:00 pm - 2:40 pm www.bcchr.ca/posterday

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Session #8 | Poster #72 Dilpreet Bharaj, Undergraduate Student, University of British Columbia Supervisor: Theodore Steiner, Childhood Diseases

Congratulations to Dilpreet on receiving a BC Children’s Hospital Research Institute Childhood Diseases Summer Studentship

A study to detect and measure food sensitivities in children and adolescents with Eosinophilic Esophagitis (EoE) or Food Protein Induced Enterocolitis (FPIES) Dilpreet Bharaj, Laura Oliveira, Chad Poloni, Stacy Wang, Theodore Steiner

Background: Eosinophilic esophagitis (EoE) and food protein induced enterocolitis syndrome (FPIES) are diseases resulting from repeated allergic reactions to food. Activated food antigen-specific T-lymphocytes drive these chronic disease states, as they provide immunologic memory and recognize various food peptides. The allergic reactions result in painful chronic inflammation of the esophagus and/or intestines, resulting in tissue pathology. Therefore, diagnosing what foods trigger EoE/FPIES is important. However, there are currently no clinical tests that accurately identify which specific food-allergen triggers the reaction. Common tests that are used for other allergic diseases, including positive serum food-specific IgE levels, food skin prick test responses, and food patch tests alone, are not sufficient to diagnose food triggers for EoE/FPIES. Objectives: This study aims to assess the sensitivity and specificity of a novel assay, the activation induced marker (AIM) assay, in measuring T cell responses, of patients with EoE/FPIES, to specific food-antigens.

Methods: This is a single-centre pilot observational study. 20 children and adolescents with EoE (aged 7-18 years) or FPIES (from birth to 18 years) will be recruited using referrals from the Allergy Clinic at the BC Children’s Hospital. 10 control patients without food allergies or confirmed EoE/FPIES will be recruited in parallel. One 4mL blood sample will be collected from participants, and used to perform the assay. The AIM assay measures low-frequency allergen-specific CD4+ and CD8+ T-lymphocytes by quantifying activation-induced upregulation of co-expressed CD25 and OX40 or CD69 and CD137 markers, respectively, using flow cytometry. The following food antigens will be tested: milk, egg, wheat, soy, and rice, depending on what food-allergens are suspected triggers for each participant. The following clinical data will also be collected from participants: demographics, medical and allergy history, and a food consumption diary for 7 days prior to blood sample collection.

Implications: Since this is a pilot study, results from this study will be able to inform research protocols and techniques for larger future studies. The ultimate aim of the study is the clinical implementation of the AIM assay as a diagnostic tool for EoE/FPIES. Future Steps: This study is currently in the recruitment phase and undergoing an ethics amendment to optimize clinical data collection and increase recruitment.

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Session #8 | Poster #73 Tereza Blahova, Undergraduate Student, University of Toronto

Supervisors: Gabriella Horvath & Osman Ipsiroglu, Brain, Behaviour & Development

The Interconnection of Sleep Disturbances in Rett Syndrome: A Scoping Review Tereza Blahova, Scout McWilliams, Gabriella Horvath, Osman Ipsiroglu

Introduction: Rett syndrome (RS) is a rare X-linked neurodevelopmental disorder, affecting almost exclusively female patients, and is characterized by a decline in cognitive and motor skills, slowed growth, breathing irregularities, and sleep disturbances (SD). SD are prevalent in 80% of patients and result in a significant burden to the health of the patient and their family. We are investigating the role of SD in RS patients and are conducting a scoping review to address the following research questions: a) what tools were used to assess sleep as an outcome, b) the effects on sleep of interventions used to treat symptoms or SDs, and c) the correlation between the genotype, clinical phenotype, and SDs. Methods: The scoping review follows the methodological framework outlined by Arksey and O’Malley (2005). A literature search was conducted across four databases; Medline, Embase, PsychInfo, and CINAHL using a search strategy developed with a librarian. The scoping review screening process was completed via Covidence.

Results: Data was extracted from 91 studies describing SDs in RS. The largest proportion were association studies, consisting of 28 cohort studies, 16 case reports, and 5 retrospective chart reviews. Comorbidities such as breathing irregularities and epilepsy were associated with worsened sleep efficiency, and sleep disturbances tended to improve with advancing age. Of the 11 treatment studies, sleep was assessed as a primary outcome in 4 and as a secondary outcome in 7 with 4 reported adverse effects on sleep. Symptoms of RS were treated using pharmacological interventions such as anticonvulsants and CNS agents (e.g. SSRIs and dopamine receptor agonists), while only melatonin and L-carnitine have been used to treat SDs. EEG and PSG patterns in RS were analyzed in 23 studies, and the prevalence SDs and other comorbidities were outlined in 8 systematic reviews.

Conclusion: The results of this scoping review demonstrate that SDs are common in patients with RS, and most prevalent in younger populations. The most frequent SDs were night laughing and screaming, seizures, and bruxism. Common medications used in RS (e.g. anticonvulsants) have the potential to negatively affect sleep architecture, and therefore, sleep must be integrated as an outcome measure.

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Session #8 | Poster #74 Tara Gholamian, Medical Student, University of Ottawa Supervisor: Anthony Cooper, Evidence to Innovation

Congratulations to Tara on receiving a BC Children’s Hospital Research Institute Summer Studentship

Morquio B Disease: A Case Report

Tara Gholamian, Harpreet Chhina, Sylvia Stockler, Anthony Cooper Background: Morquio B Disease (MBD or mucopolysaccharidosis IV type B) is an autosomal recessive condition caused by a genetic mutation in the GLB 1 gene coding for β-galactosidase on chromosome 3p22.33. β-galactosidases are a family of glycoside hydrolase enzymes that catalyze the breakdown of various β-galactosides such as keratin sulfate, that can accumulate in the retina and cartilage if not processed correctly. β-galactosidase deficiency can result in two different conditions, GM1 gangliosidosis and MBD, of which MBD has a milder phenotype and presents later.

Aims: As MBD is extremely rare with a worldwide prevalence of less than 70 patients, we hope to outline all aspects of care that a patient with MBD received to offer clinical guidance for the treatment of such patients. Additionally, we hope to improve the care received by MBD patients as there are currently no case reports outlining the in-depth orthopaedic treatment a patient with MBD has undergone throughout their childhood and adolescence.

Report: In this case report we discuss a patient with MBD that was diagnosed at the age of 5 after initially presenting with the Morquio dysostosis multiplex. This includes a bell-shaped chest, pectus carinatum, long and hyperextensible limbs, and a short neck. Radiographic characteristics at diagnosis included flat vertebrae, a hypoplastic odontoid with a stable relationship between C1 and C2, platyspondyly and hip dysplasia. Genetic testing showed the patient to have a β-galactosidase deficiency with mutation W273L/N484K on the GLB1 gene with polymorphisms on the gene. At diagnosis, the patient did not have issues with gait and ambulation, but his ability to walk has progressively deteriorated in his adolescence as a result of ankle, knee, and hip joint instability and pain. The patient underwent ankle epiphysiodesis for their ankle valgus and a guided growth procedure for their knee valgus using bilateral eight-plate application. This case report provides an in-depth exploration of the orthopaedic follow-up and treatment this patient received for symptom relief and improved walking ability.

Next Steps: The first draft of the case report is complete and is currently undergoing editing. We hope to have the final draft ready for submission to an appropriate journal by the end of August.

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Session #8 | Poster #75 Jasleen Grewal, Undergraduate Student, Queen’s University Supervisor: Ian Pike, Evidence to Innovation

Congratulations to Jasleen on receiving a BC Injury Research and Prevention Unit Summer Student Research Award

Indigenous Driver Training; Aiming to Bridge the Injury Gap between Indigenous and non-Indigenous Populations in BC Jasleen Grewal, Kate Turcotte, Ian Pike

Background: Road safety remains one of the most significant public health issues in BC. Motor vehicle accidents are a leading cause of morbidity and mortality among Indigenous people in BC; Indigenous communities face almost twice the risk of injury due to transport causes than the non-Indigenous population.

Geographical and systemic barriers to driver training and licensing services exist for Indigenous people living in rural and remote communities; up to 75% of Indigenous people living on reserve do not hold a valid driver’s license. As demonstrated in the Aboriginal and Torres Strait Islander population in Australia, barriers to accessing a driver’s license can indicate disparities in social determinants of health. Lack of driver licensing and training can reduce access to employment opportunities, healthcare, and education.

In 2018, Lucy Sager founded All Nations Driving Academy, a driving school aimed at increasing access for remote Indigenous communities in BC. With the help of Sager and her organization, the Haisla and 6 Nations Driving schools have been established.

Objective: To develop a case study evaluating Indigenous driving schools as injury prevention initiatives in BC. Methods: Key informant interviews were conducted with experts in driver licensing in BC and Australia. A review of available publications relevant to BC road safety data and Indigenous driver licensing in BC and Australia was conducted.

Results: From 2019 to 2020, over 700 students in 21 Indigenous communities in BC have benefited from driver training through All Nations Driving Academy and over 200 licensed drivers have been produced. Individuals and communities have reported increased access to healthcare, education, and employment opportunities outside of their rural areas.

Conclusions: There is considerable evidence for All Nations Driving Academy and additional Indigenous driving schools as initiatives to reduce motor vehicle-related injuries and fatalities among the Indigenous population. While the burden of Indigenous motor vehicle accidents in BC remains high, ongoing efforts are being made to reduce preventable accidents and injuries. Based on expert opinion and available injury publications, further implementation of culturally responsive driver training initiatives show promise for decreasing injury rates for Indigenous road users.

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Session #8 | Poster #76 Kaitlyn Kwok, Undergraduate Student, McMaster University Supervisor: Srinivas Murthy, Healthy Starts

Congratulations to Kaitlyn on receiving a BC Children’s Hospital Research Institute Summer Studentship

A Scoping Analysis of Trial Sponsorship and Data Flows of Global Clinical Trials Kaitlyn Kwok, Neha Sati, Louis Dron, Srinivas Murthy

Background: Clinical trials frequently require recruitment across different countries and income-groupings to improve generalizability. Increasing concerns about data sharing equity and ownership highlights a disproportionate flow of clinical trial data collected in the Global South yet analyzed and managed in the Global North.

Aims: This analysis seeks to document the extent of clinical trial data flow from Global South to Global North in studies published in major journals.

Methods: The search strategy was performed in CENTRAL to retrieve randomized clinical trials published between 2013-2021 from The BMJ, BMJ Global Health, the Journal of the American Medical Association, the Lancet, Lancet Global Health, and the New England Journal of Medicine. Studies were included if they involved recruitment and author affiliation across different country income-groupings using World Bank definitions. We excluded studies if only one income-grouping was involved, or the article was not a full publication. The direction of data flow was extracted with a data collection tool using sites of trial recruitment as the starting point and the location of authors conducting statistical analysis as the ending point.

Results: Of 1993 records initially retrieved, 517 studies underwent abstract screening, 348 studies underwent full-text screening, and 305 studies were deemed eligible for inclusion. Countries with high-income economies were sole funders of the majority (82.3%) of clinical trials. Unidirectional data flow from one income-grouping to another occurred in 84 of the studies, within which all data flowed from lower- and middle-income countries towards high-income countries.

Within 190 cases of non-unidirectional data flow, authors conducting statistical analysis were mostly affiliated with institutions in high-income countries sixty percent of the time. Across all studies, a total of 13 (4.3%) were analyzed by a majority of authors affiliated with institutions in low-income or lower-middle-income countries. The location of data management and housing was not reported in 230 (75.4%) of studies, and the majority of those who reported managed their data in high-income countries.

Conclusions: Clinical trial data flow for global clinical trials demonstrates a Global South to Global North trajectory.

Policies should be re-examined to assess how data sharing across country income-groupings can move towards a more balanced and equitable model.

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Session #8 | Poster #77 Nikita Menon, Medical Student, University of British Columbia Supervisor: Christine Voss, Evidence to Innovation

Exploring the journey of patients with congenital heart disease in the context of physical activity education: A narrative review Nikita Menon, Christine Voss

Background: Congenital heart disease (CHD) affects approximately 1 in 100 live births and given recent advances in the management of CHD, over 90% of patients are expected to live into adulthood. Therefore, there is an increased focus on the prevention of long-term complications in this population. It has been shown that children with CHD do not engage in enough physical activity (PA) to meet current guidelines, an important factor in optimizing long-term cardiovascular health. Studies have shown that exercise interventions are safe and beneficial for the CHD population, but evidence regarding the effectiveness to increase PA behaviours is scarce and conflicting. Information regarding the optimal timing and format of strategies to promote PA participation remains limited.

Objective: The aim of this review is to explore the patient’s journey with CHD in order to identify the optimal time to begin interventions related to PA. Methods: A search for relevant studies was conducted on MEDLINE and CINAHL using terms for CHD in combination with terms about the patient experience, healthcare interventions and continuity of care. The results were filtered for being published in English between January 2006 and April 2021. Studies were screened for research being conducted in North America and relating to experiences of patients, their families, and their healthcare team, as well as recommendations for the care of CHD patients.

Results: The search resulted in 1861 articles, of which 24 were included in the review. Key milestones in the patient journey such as diagnosis, surgery, transition, and transfer of care were identified. These milestones provide a basis for understanding the patient’s journey and their varying perceptions of PA. Conclusions: The results indicate that there is a need for PA education and the initiation of transition from pediatric to adult care, at approximately age 12, may be an appropriate opportunity to begin PA interventions. During this period, patients are encouraged to begin gaining personal and medical autonomy and the knowledge to make informed decisions about their health. Further research is required to determine the optimal type of intervention to increase PA and ultimately improve long-term cardiovascular health in the CHD population.

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Session #8 | Poster #78 Ashleigh Nazareth, Medical Student, University of British Columbia Supervisor: Robert Baird, Evidence to Innovation

Congratulations to Ashleigh on receiving a UBC Faculty of Medicine Summer Studentship

External Validation of the PRESTO Pediatric Trauma Risk Adjustment Tool

Ashleigh Nazareth, Recep Gezer, Jaimini Thakore, Etienne St-Louis, Genevieve Ernst, Robert Baird Trauma remains a leading cause of death and disability in the pediatric population, where outcomes depend on injury severity as well as trauma system performance. A trauma system refers to the collective infrastructure dedicated to the treatment and prevention of traumatic injury. Benchmarking outcomes through risk-adjusted modelling is a key analytic process in objectively evaluating observed versus expected outcomes. The Pediatric Resuscitation and Trauma Outcome (PRESTO) tool is a risk adjustment model that was recently derived from an American data-source (the National Trauma Databank) as a means of simplifying outcome benchmarking in the pediatric trauma population. It has since been validated in several low- and middle-income settings and has been proven superior to a widely used, non-pediatric, risk adjustment tool, the Injury Severity Score (ISS), in these resource-constrained contexts without a mature trauma system.

However, the PRESTO model has not yet been externally validated in a high-income context. As such, the primary aim of this project is to use data from the BC Trauma Registry to externally validate the PRESTO tool in a high-income setting.

The effectiveness of the PRESTO and ISS models will also be compared. This project will support the use of PRESTO and may lead to further validation in broader high-income settings, such as a nation-wide validation of Canadian data. A secondary aim of this work is to develop an alternate form of the PRESTO score which uses the Glasgow Coma Scale (GCS) as a measurement of neurological status instead of the Alert-Verbal-Pain-Unresponsive (AVPU) scale. The PRESTO model was originally developed using the AVPU scale as it is easier to assess in a low resource setting. However, GCS is more commonly recorded in high-income settings. The ability to use GCS instead of AVPU would simplify calculation of the PRESTO score in high-income settings by eliminating the need for conversion. A future benefit of this work is that PRESTO may eventually be used by researchers, health authorities and other governing bodies to assess trauma system effectiveness and identify those systems that require further quality improvement.

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Session #8 | Poster #79 Sumara Stroshein, Medical Student, University of British Columbia Supervisor: Rachel Murphy

Congratulations to Sumara on receiving a UBC Faculty of Medicine Summer Studentship

Developing a Community Food Security Indicator Framework

Sumara Stroshein, Seri Niimi-Burch, Sara Kozicky, Casey Hamilton, Carmen Kim, Tamasha Hussein, Lauren Ebert, Rachel Murphy Background: Food insecurity, defined as inadequate or insecure access to food due to financial constraints or other resources, affects approximately 40% of UBC students. The prevalence of food insecurity is higher among those that experience systemic marginalization such as international students, Black, Indigenous, students of colour, and transgender/non-binary students. The health impacts of food insecurity are significant, including mental health issues and increased risk of chronic conditions. Community Food Hubs (CFH) which integrate support services, programming, and opportunities for community connection and advocacy, have been proposed as a long-term, sustainable approach to address food insecurity. Therefore, a student-driven team is undertaking a series of coordinated research projects to create a UBC Community Food Security Hub. Aim: Currently, food security at UBC is captured at an individual level with versions of the Household Food Security Survey Module (HFSSM). However, developing a food secure campus-community necessitates community-level food security indicators. Developing a framework and identifying indicators of food security in the UBC community will 1) inform the scope, scale, and needs of the CFH and 2) provide a ‘baseline’ measure of community-level food security to enable assessment of the impact of the CFH. Methods: The framework will be developed by 1) drawing on a conceptual model for community food security assessment created by the BC Centre for Disease Control (BCCDC) and 2) through CB-PAR community engagement methods.

Preliminary Results & Next Steps: A literature review of food security assessment tools was completed, a three-stage engagement plan was designed, and a draft framework has been developed. The four major themes in the framework are: Household Food Insecurity, Food Environment, Food Systems, and Capacity. 17 sub-themes and 71 specific indicators have been identified. Additionally, consultation with BCCDC and UBC staff has been initiated and a survey has been developed for initial community consultation to identify and prioritize indicators. Moving forward, key informant interviews will be completed and UBC students will be engaged to centre the perspectives of those affected by food insecurity.

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Session #8 | Poster #80 Stephanie U, Undergraduate Student, Simon Fraser University Supervisor: Osman Ipsiroglu, Brain, Behaviour & Development

Sleep and Traumatic Brain Injury: A Scoping Review of Polysomnography Findings Stephanie U, Scout McWilliams, Jacqueline Purtzki, Calvin Kuo, Osman Ipsiroglu

Introduction: Sleep disturbances are commonly exhibited following traumatic brain injury (TBI) and are associated with cognitive, behavioural, and/or health-related quality of life impairments. Sleep architecture, the basic organization of sleep, is affected by TBI. Polysomnography (PSG) measures multiple sleep-related neurophysiological parameters and is considered to be the gold standard assessment tool. We are conducting a scoping review of PSG findings in order to understand the dimension of sleep disturbances faced by individuals with TBI. Methods: The scoping review uses the methodological framework outlined by Arksey & O’Malley (2005). Search terms were identified through trial searches and approved by a librarian. Four databases were used: Medline, Embase, CINAHL, and PsycINFO. A protocol for the scoping review was created and registered in Open Science Framework.

Results: 77 papers were identified for data extraction. Studies were grouped according to TBI type (mild, moderate, and severe) with many studies including multiple degrees of TBI severity. 4 pediatric studies (<18 years old), 68 adults (≥18 years old) studies, and 2 studies of all ages were identified (3 studies had unspecified ages). Studies were further categorized into association (n=59), treatment (n=7), and reviews (n=11). The association studies consisted of crosssectional (n=17), case reports (n=6), retrospective chart reviews (n=8), and case controls with various groups (healthy controls, n=22; psychiatric and/or medical patients as controls, n=5; healthy and psychiatric patients as controls, n=1). Of the review articles, 2 were scoping reviews, 5 were systematic reviews, 1 was a meta-analysis, and 3 were systematic reviews and meta-analyses. Interventions used in the treatment studies included methylphenidate, modafinil, pramipexole, zopiclone, steroids, and CPAP. Conclusion: Among moderate and severe TBI, increased slow wave sleep and increased total sleep duration was commonly described. Among mild TBI, a common theme was that results did not significantly differ between the patient and control groups. Given the inconsistencies in study methodology and design, future research would require an in-depth analysis of the PSG methodology and harmonization of outcome measures.

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Session #8 | Poster #81 Adrian Haasler, Undergraduate Student, McGill University Supervisors: Rajavel Elango & Catherine Brunel-Guitton

In-vivo assessment of energy metabolism in metabolic myopathies: Repeatability of the 13C-glucose breath test

Adrian Haasler, Betina Rasmussen, Abrar Turki, Kerri Scherbinsky, Shaymaa Shurrab, Rajavel Elango, Catherine BrunelGuitton Background: Metabolic myopathies (MM) are a group of genetic conditions that can affect the production of energy (ATP) in muscles. It is difficult to assess the effectiveness of treatments for patients with MM as ATP production cannot be measured in-vivo and requires invasive methods. Traditionally, substrate oxidation or ATP production are measured by invasive in-vitro methods using tissue specimens taken from biopsies. One way to indirectly measure ATP production in-vivo is through the measurement of glucose oxidation as this contributes to ATP synthesis. A newer minimally invasive approach, the 13C-glucose breath test (13C-GBT), utilizes isotopically D-labelled glucose to measure glucose oxidation.

However, the repeatability of the current method is unknown.

Objectives: To measure glucose oxidation, using U-13C-glucose and demonstrate the repeatability (low intra-individual variability, <10% CV) of the 13C-GBT as a proof of principle in healthy adults and children.

Methods: Three healthy adults underwent 13C-GBT protocols on three alternating days. Each study involved an oral dose of 75g glucose along with 75mg U-13C-glucose. Breath samples were collected at baseline and every 30 min for 240 min; finger-prick blood glucose was measured hourly. The rate of carbon dioxide production (VCO2) was measured using indirect calorimetry. 13CO2 oxidation of glucose was measured using an isotope ratio mass spectrometer and compared using repeated measures ANOVA. As a next step, the study will be conducted in ten healthy children (10-14 y).

Expected Outcomes and Implications: The experiment will determine whether the 13C-GBT is repeatable in healthy individuals. If proven repeatable this method can be helpful for monitoring the effectiveness of therapies and drugs for MM with single assessments. Furthermore, results will provide guidance and can be utilized in subsequent breath tests for patients with metabolic myopathies.

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Session #9 BASIC SCIENCE, CLINICAL & POPULATION HEALTH Moderator: Martin Prusinkiewicz Participants: Brooke Cheng Jasjot Kaur Deol Emily Johnston Jalisa Karim Anmol Mattu Emma Nielsen Andrew D Pauls Mohammadali Saffarzadeh Amit Sharma Arnima Singh Helen Hsiao

Watch Virtually Live: Each presenter will have 5 minutes to discuss their poster and 5 minutes for questions from attendees.

Thursday, July 29, 2021 | 1:00 pm - 2:50 pm www.bcchr.ca/posterday

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Session #9 | Poster #82 Brooke Cheng, Medical Student, University of British Columbia Supervisor: Jocelyn Srigley, Evidence to Innovation

Congratulations to Brooke on receiving a UBC Department of Pathology and Laboratory Medicine Summer Student Fellowship Award

Becoming Hand Hygiene Heroes: A public health campaign for patient & family safety in the hospital setting Brooke Cheng, Mavis Chan, Jocelyn Srigley

Background: Hand hygiene is crucial in breaking the chain of infection transmission. Although health care worker hand hygiene has been well established as a method to prevent health care associated infections, there has been far less emphasis on patient and family hand hygiene. Previous studies at BC Children’s and Women’s Hospital campus found patient and family hand hygiene rates to be under 10%. During the COVID-19 pandemic, hand hygiene has become increasingly relevant as a key public health message.

Aim: To develop, launch and evaluate a targeted educational campaign focused on patient and family hand hygiene at the BC Children’s & Women’s Hospital campus. Our objective is to increase hand hygiene rates in this population from 10% to 20% in three months, and to 60% in one year.

Methods: The “Hand Hygiene Heroes” campaign was designed to have multiple phases, lasting from summer 2021 until summer 2022. Firstly, visual resources (e.g. posters, activity sheets, stickers) were designed for dissemination via on-site display boards, health authority emails and digital signage screens. Secondly, unit-specific initiatives were developed by identifying staff “champions” and tailoring educational activities to accommodate each department. Patient/family and health care worker/staff hand hygiene rates were measured covertly by a trained medical student.

Results & Next Steps: Currently, we have engaged 7 units in communications for launching tailored initiatives and further meetings with staff “champions” are ongoing. Baseline hand hygiene rates collected over four weeks between June to July 2021 were measured at 14.1% for patients and families, and 54.3% for health care workers. Post-intervention hand hygiene audits will be conducted serially for comparison after three months.

Implications: The initial results show that, while there has been some improvement in baseline patient and family hand hygiene compared to previous studies, rates among this population are still suboptimal. There is significant opportunity for targeted interventions in this field to prevent the spread of infections and improve patient safety in the hospital environment. Health care workers and staff can play an important role in educating and role modelling hand hygiene.

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Session #9 | Poster #83 Jasjot Kaur Deol, Undergraduate Student, Simon Fraser University Supervisor: Srinivas Murthy, Healthy Starts

VITdALIZE-KIDS: Rapid Correction of Vitamin D Deficiency in Pediatric Critical Illness (A Phase III Multicentre Randomized Controlled Trial) Jasjot Kaur Deol, Srinivas Murthy

Background: Vitamin D deficiency (VDD) has been linked to prolonged hospital stay and increased susceptibility to a wide-range of disorders including rickets, seizures, and heart disease. Currently, there are no specific guidelines on the treatment of VDD in the pediatric intensive care unit. Dosage is often based from studies on long-term treatment of healthy children to prevent bone disease, conditions not generalizable for children with critical illnesses. Therefore, determining an appropriate method to correct VDD would be valuable in bettering outcomes for these children.

Primary Objective: To see if a rapid normalization of VDD in critically ill children increases their health related quality of life (HRQL).

Methods: Participants with VDD are randomized into either the treatment arm (receiving 10,000 IU/kg of an oral cholecalciferol solution) or the control arm (placebo solution). Blood [25OHD] will be measured within 2-7 days to assess vitamin D levels post-intervention. The HRQL is being measured using the Pediatric Quality of Life Inventory Scale questionnaire. Baseline scores will be collected within 3 days of enrollment and once again on the 28th day; statistical analysis will be conducted using a two-tailed t-test analysis (p<0.05).

Results: Expected results for this trial are inferred from previous literature. A meta-analysis on the appropriate dosage to correct VDD in critically ill children determined a dose of 10,000 IU/kg (maximum of 400,000 IU) as being a safe and likely method to normalize VDD in this population. The effectiveness of this dose was evaluated in a phase II pilot study on critically ill children and was found to increase [25OHD] to over 75 nmol/L in more than 75% of the study group.

Conclusion & Implications: The data of this trial would contribute to creating specific treatment instructions to treat VDD in critically ill children. As this population lacks appropriate intervention, determining an effective and safe approach to quickly normalize vitamin D levels would add to supporting literature of making the treatment of VDD a valuable and feasible endeavor. This will not only help children experiencing critical illness but also extending the positive effects into their family and social life.

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Session #9 | Poster #84 Emily Johnston, Medical Student, University of British Columbia Supervisor: Hal Siden, Brain, Behaviour & Development

Caregiver-reported nociceptive pain responses in children with significant neurological impairment

Emily Johnston, Julia Orkin, Christina Vadeboncoeur, Vithya Gnanakumar, Tammie Dewan, Anamaria Richardson, Liisa Holsti, Bruce Carleton, Tim Oberlander, Hal Siden Background: Significant Neurological Impairment (SNI) describes a group of congenital and acquired disorders affecting the neurological system that result in significant motor and cognitive impairment. Children with SNI often have pain-like sensations that can’t be attributed to a nociceptive-inflammatory source completely; this is termed Pain and Irritability of Unknown Origin (PIUO). However, these children also experience regular nociceptive-inflammatory pain, such as during medical procedures. Children with SNI have historically been considered pain insensitive, however emerging research suggests individuals with intellectual disability may be more sensitive to painful stimuli. We are interested in looking at the acute nociceptive pain responses in children experiencing chronic PIUO as reported by their caregivers’.

Methods: We analyzed data collected from 52 participants in an ongoing study which is evaluating a PIUO assessment and treatment pathway. The caregiver was asked “what is your child’s behaviour or reaction to a commonly painful stimulus (e.g. venipuncture, immunization, minor injury)?” and to rate their child’s response as “normal, lessened or none, overly-painful or other”. We analyzed these categories with the baseline results of observational and behavioural pain assessment tools targeted to evaluate their PIUO: the Non-communicating Children’s Pain Checklist – Revised (NCCPC-R) and the Face, Legs, Activity, Cry, Consolability scale – Revised (FLACC-R).

Results: The caregivers of children with SNI most frequently reported their response to common painful stimuli as normal (48%), followed by lessened or none (36%). The least frequently reported responses were overly painful (8%) and other (8%). There was no significant difference in the NCCPC-R scale (p > 0.05) or the FLACC-R scale (p > 0.05) results between the nociceptive pain response categories.

Significance & Future Research: The majority of caregivers reported that their child had a normal or lessened response to painful, nociceptive stimuli. This did not significantly correlate to the pain intensity experienced with PIUO evaluated by the NCCPC-R or FLACC-scales. The caregivers are the primary individuals evaluating their children’s pain daily and their reports are foundational to medical assessments. A future study could determine the consistency of these reports with objective measures of nociceptive pain responses in these children.

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Session #9 | Poster #85 Jalisa Karim, Undergraduate Student, University of Waterloo

Supervisors: Tim Oberlander & Gillian Hanley, Brain, Behaviour & Development

Congratulations to Jalisa on receiving a BC Children’s Hospital Research Institute Brain, Behaviour & Development Summer Studentship

Investigation of the effects of oxytocin for induction and augmentation of labour on ASD in the child Jalisa Karim, Tim Oberlander, Gillian Hanley

Background: There remain many unknowns about the origins of autism spectrum disorder (ASD), and research is increasingly focused on identifying modifiable risk factors for ASD. Evidence from studies investigating the association between maternal oxytocin administration and risk of ASD is conflicting.

Objective: In this population-based retrospective cohort study, we aim to analyze the relationship between the use of oxytocin to induce or augment labour and risk of ASD in the offspring.

Methods: This study included term singleton children born in British Columbia, Canada between April 1, 2000 to December 31, 2014. Stillbirths and caesarean births were excluded. Clinical ASD diagnostic data was obtained from the BC Autism Assessment Network and the BC Ministry of Education. All children were followed until clinical diagnosis of ASD, death, or the study end date of December 31, 2016. The exposures of interest were induction with oxytocin and augmentation with oxytocin. The outcome was a clinical diagnosis of ASD. Time-to-event analyses will be conducted using Cox proportional hazards models. We will also conduct a sibling matched analysis using conditional logistic regression to further control for unmeasured maternal factors.

Preliminary Results: Of the 401,906 children included in the cohort (49.4% female, mean follow-up time 8.8 years), 5658 were diagnosed with ASD (1.4%). Of the mothers, 38,704 (9.6%) were induced with oxytocin and 61,835 (15.4%) were augmented with oxytocin. The unadjusted hazard ratios for the induced and augmented mothers are 1.32 [95% CI (1.21, 1.43)] and 1.28 [95% CI (1.19, 1.37)], respectively. After adjusting for maternal sociodemographic characteristics, pregnancy conditions and risk factors, labour and delivery characteristics, and neonatal characteristics, the hazard ratios are attenuated to 1.07 [95% CI (0.98, 1.18)] and 1.05 [95% CI (0.97, 1.14)]. Next steps include refining the cohort by indication for induction to remove all fetuses and mothers with indications for induction that might increase risk for ASD. Significance: The results will contribute to the informed decision-making of healthcare providers and prospective parents when considering administration of oxytocin to induce or augment labour. If our null findings hold, this will combat misinformation and fears surrounding administration of oxytocin.

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Session #9 | Poster #86 Anmol Mattu, Medical Student, University of British Columbia Supervisor: Ian Pike, Evidence to Innovation

Congratulations to Anmol on receiving a BC Injury Research and Prevention Unit Summer Student Research Award

A synthesis of the evidence for prevention of non-contact anterior cruciate ligament injuries among youth female athletes: Implications for family physicians and general practitioners Anmol T. Mattu, Brianna Ghali, Ian Pike

Background: Anterior cruciate ligament (ACL) injuries account for a large proportion of knee injuries. Therefore, several ACL injury prevention programs targeting high risk populations, such as young female athletes, have been implemented to reduce non-contact ACL injuries. To help physicians stay current, there have been many systematic reviews and meta-analyses published examining ACL injury prevention. With secondary literature increasing in frequency, we aimed to synthesize the evidence contained within systematic reviews to provide an up-to-date summary for easy reference.

Purpose: The purposes of this study were to: 1) perform a systematic overview of systematic reviews and meta-analyses evaluating the effectiveness of ACL injury prevention programs in reducing non-contact ACL injury rates among youth female athletes; 2) determine the components proven effective in ACL injury prevention programs; and 3) provide clinical recommendations for general practitioners and family physicians to aid in patient counselling.

Methods: The review protocol was registered in PROSPERO (ID: CRD42021253575). Twelve databases reflecting peer-reviewed and grey literature publications (Medline, Embase, Cochrane Database of Systematic Reviews, Sportdiscus, CINAHL, PEDro, Web of Science Core Collection, Epistemonikos, TRIP, BC Guidelines and Protocols, CPG Infobase, ProQuest Dissertations and Theses Global) were searched to find systematic reviews and meta-analyses related to the research question. Studies were included if they were systematic reviews and/or meta-analyses of randomized control trials or prospective cohort studies, included any intervention preventing primary non-contact ACL injuries, and included female athletes (<19 years old) as participants.

Results: After searching 12 databases, 4353 studies were identified. 1470 duplicates were removed, and 2883 titles and abstracts were screened. 100 titles and abstracts were found to be relevant. There were 54 conflicts between reviewers following title and abstract screening (κ=0.742; p<0.0005). After reading the full-texts, 14 reviews were included, and there were 7 disagreements between reviewers (κ=0.733; p<0.0005). Using backwards reference tracking, an additional three reviews were found as relevant, resulting in 17 reviews included in the synthesis.

Conclusion: Next steps include data extraction and quality assessment (AMSTAR 2) of the included reviews.

Subsequently, the data will be synthesized in a manuscript for peer-reviewed publication and key recommendations will be communicated through a concise knowledge translation tool.

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Session #9 | Poster #87 Emma Nielsen, Medical Student, University of British Columbia Supervisor: Robert Purdy, Evidence to Innovation

Congratulations to Emma on receiving a BioTalent Canada Summer Student Workplace Program Placement

Bloody Blockers: Developing a model of massive pulmonary hemorrhage to assess a novel device for lung isolation Emma Nielsen, Matthias Görges, Andrew Morrison, Renelle Myers, Michael Barker, Lindy Moxham, Andrew Poznikoff, Robert Purdy

Background: Despite the considerable size of the medical device industry, the market for pediatric devices remains relatively small. When developing tools for pediatric use, it is advantageous to demonstrate its utility and safety in adults first, as this may increase the potential for commercialization. A new method of lung isolation for infants, allowing single lung ventilation, was recently found to be more efficiently placed and favored by airway experts over conventional methods. The novel device involves a bronchial blocker that is fastened to the outside of an endotracheal tube, which helps with ease of placement and secure attachment for positioning. This device could also be useful for managing massive pulmonary hemorrhage (MPH), an airway emergency often requiring bronchial blockade, in the adult population. To ensure safety and demonstrate ease of use, the novel device must be first tested in a simulated environment. However, a physical model allowing for simulation of MPH has not been described previously.

Objective: The purpose of this project is to develop a model of MPH that can be used to test the performance of a novel device in comparison to standard methods of lung isolation.

Methods: After consultation with experts in anesthesia and pulmonology a prototype was designed; our model utilizes a carbon fiber TruCorp AirSim manikin which contains a plastic reconstructed bronchial tree. At the site of the hemorrhage, the distal base of the bronchial tree, an infusion of fake blood is injected via a catheter. Balloons, serving as the lungs, provide indicators of lung ventilation, with unilateral inflation of the non-bleeding lung indicating successful device placement. Simulated coughs reproduce the physiological response associated with stimulation of the airway during intubation and bronchoscopy.

Impact: This project allows for the evaluation of the novel blocker device and assessment of a high-fidelity simulation that can be used to support training in the management of MPH.

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Session #9 | Poster #88 Andrew D Pauls, Medical Student, University of British Columbia Supervisor: Kishore Mulpuri, Evidence to Innovation

Variability in Post-Operative Management of Developmental Dysplasia of the Hip: A Surgeon’s Survey Andrew D Pauls, Akshdeep Sandhu, Nicole Banting, Kishore Mulpuri, IHD Study Group, Emily K Schaeffer

Developmental Dysplasia of the Hip (DDH) is the most common pediatric hip condition, occurring in 1 in 1000 births.

It consists of a spectrum of hip abnormalities that range from mild hip instability to severely dislocated hips. Currently, it is not known if there is variability amongst pediatric orthopaedic surgeons regarding treatment and post-operative management of DDH. The main objectives of this project are to investigate the variation in post-operative management of DDH between surgeons, and to develop a consensus treatment protocol for post-operative management of patient’s with DDH. Using REDCap, survey questionnaires were sent to pediatric orthopaedic surgeons who treated patients with DDH. We received 48 responses from surgeons practicing worldwide. The survey questionnaire includes sections of quantitative and qualitative questions regarding the surgeon’s imaging choice, procedural decisions, and case-specific questions. The main variables collected were age range for procedure, spica cast usage, type of spica cast, angle of flexion, angle of abduction, spica cast replacement, if immobilization was necessary, and the length of immobilization.

If performing a unilateral closed reduction, surgeons would conduct the procedure in 66.7% (n=28) of patients with DDH <6 months old, 90.5% (n =38) from 6 months to 1 year, and in 38.1% (n=16) of patients 1-2 years where 97.6% (n=41) of surgeons would also perform a concomitant adductor tenotomy and 90.5% (n=38) would apply a spica cast “all of the time”. If performing a bilateral closed reduction, surgeons would conduct the procedure in 66.7% (n=28) of patients < 6 months, 88.1% (n=37) of patients 6 months to 1 year, and 31% (n=13) of patients 1-2 years old, with the majority performing an adductor tenotomy (95.2%, n=40) and applying a spica cast “all of the time” (92.9%, n=39). No surgeon would perform a combined closed reduction and osteoplasty (0%, n=39). Data was collected for open reductions, open reduction with a pelvic osteotomy, and open reduction with a femoral osteotomy. This survey provides quantifiable data regarding variability in post-operative management of DDH that could foster discussion amongst surgeons, and encourage development of a DDH treatment algorithm.

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Session #9 | Poster #89 Mohammadali Saffarzadeh, Medical Student, University of British Columbia Supervisor: Amin R. Javer

A Comparative Study Assessing Improvement in Cognitive Deficit Secondary to CRS in Patients Treated with Surgical Management: A Prospective Trial Mohammadali Saffarzadeh, Laura Samson, Jenna Gill, Amin Javer

Background: Cognitive performance is negatively impacted in patients with chronic inflammatory conditions. Functional Endoscopic Sinus Surgery (FESS) has shown to improve cognition in patients with Chronic rhinosinusitis (CRS). However, there are currently no studies that have evaluated the effects of delay in surgery on long-term cognitive function while on the waitlist. Additionally, it remains unclear if receiving surgery earlier will have an effect on the degree and length of improvements in cognitive performance.

Purpose: This study aims to compare cognitive improvements in patients who are undergoing FESS earlier for CRS treatment to that of patients who receive surgery later as a result of long waitlists.

Methods: This prospective cohort series will be conducted at St. Paul’s Sinus Centre and aims to recruit 100 patients diagnosed with CRS (with or without polyps) who are on the waitlist to receive FESS. Participants will be separated into one of 2 study arms: group 1 will consist of patients in the private system who are undergoing surgery within three months of signing their consent for surgical management, and group 2 will include patients on the public surgical waitlist receiving sinus surgery after a minimum waiting period of at least 1-year. The primary outcome measure is the change in cognitive performance assessed by the Modified Mini Mental Examination (3M). Secondary outcome measures include the change in Sino-Nasal Outcome Test-22 (SNOT-22), Cognitive Failures Questionnaire, and nasal endoscopy. All outcome measures will be obtained at the time of recruitment for establishing a baseline, 1 week before surgery, and again at 6 and 12 months after the operation.

Significance: The results of this trial will inform healthcare professionals about the effect of surgical wait-time on cognitive improvements of patients with CRS undergoing FESS. We hypothesize that cognitive deficits secondary to CRS will improve quicker post-operatively in patients who receive surgery within 3 months compared with patient who are on the surgical waitlist for more than 12 months . If the results support our hypothesis, healthcare providers will be able to utilize this data to advocate for faster surgical intervention for patients with CRS.

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Session #9 | Poster #90 Amit Sharma, Undergraduate Student, University of British Columbia Supervisor: Lindsay Machan

Congratulations to Amit on receiving a UBC Faculty of Medicine Summer Studentship

Correlation of Hysterosalpingogram and Fallopian Tube Recanalization in Infertile Women Amit K. Sharma, Lindsay Machan

Background: The incidence of infertility is increasing in the Western world. Fallopian tube disease is the most common cause of female infertility. The standard method to assess fallopian tubes is a hysterosalpingogram (HSG), a radiology exam where contrast is injected into the uterus. Selective salpingography is a procedure where a catheter is guided into a fallopian tube to allow more detailed imaging and possible reopening through fallopian tube recanalization (FTR).

There is a lack of awareness around selective salpingography due to small published data sets that are primarily generated outside of North America and Europe. A more detailed assessment of the procedure with a large data set will potentially allow more women the opportunity to conceive naturally.

Aim: To define the findings on selective salpingography performed in infertile women in whom a prior hysterosalpingogram has demonstrated unilateral or bilateral fallopian tubal occlusion.

Methods: In an ongoing study, radiographic images on women referred for selective salpingography/FTR to UBC Hospital were reviewed and the findings collated with the initial HSG results. To date, the past three years of FTR procedure reports have been summarized totaling 494. The following procedural data is being recorded: prior HSG findings, uterine findings, fallopian tube findings, and radiation exposure.

Results: The findings of 494 patients with abnormal prior HSGs have been reviewed. 358 demonstrated non-filling of one tube; 185 had one tube reopened, 37 required both. 113 had previously recorded bilateral tubal occlusion; 74 had both tubes reopened, in 12 one tube was reopened (other normal). Prior HSG findings were unavailable for 23; unilateral recanalization was necessary in 5, bilateral in 2, and 16 had normal tubes. In total, 128 patients (25.9%) had a normal HSG at UBCH indicating the initially questioned tubal blockage was temporary spasm.

Conclusions: The interim data set (which is already larger than any published study) demonstrates selective salpingography provides significant clarification of findings on HSGs which are otherwise non-specific, allowing more directed therapy for the patient’s infertility. In particular, 25.9% of patients initially thought to have tubal disease, had normal tubes.

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Session #9 | Poster #91 Arnima Singh, Undergraduate Student, University of British Columbia Supervisors: Astrid Christoffersen-Deb & Nicole Prestley Stuart, Healthy Starts

Early Pregnancy Assessment Clinic (EPAC) Data Registry Arnima Singh, Astrid Christoffersen-Deb, Nicole Prestley Stuart

Background: In Canada, it is estimated that up to 25% of females will experience a miscarriage in their lifetime.

BC Women’s Hospital + Health Centre’s Early Pregnancy Assessment Clinic (EPAC) provides care for these patients in the first trimester of pregnancy such as bleeding, cramping, and miscarriage. The services of EPAC are accessible through self-referral or by a provider. EPAC provides access to urgent diagnostic care and provides women multiple options in the case of pregnancy loss such as surgical or medical management. Despite miscarriage is extremely common, there exist several distinct gaps in the literature on complications in the first trimester of miscarriage. The Early Pregnancy Assessment Clinic Data Revision project aims to build evidence to fill these gaps through the creation of a clinical data registry.

Purpose/Significance of the Data Registry Project: The purpose of the Early Pregnancy Assessment Clinic (EPAC) REDCap data registry project is to characterize the patient population within EPAC at BC Women’s Hospital & Health Centre.

The project aims to improve care for patients at BC Women’s hospital as well as other facilities serving these patients.

It can be utilized to assist future research opportunities and promote the improvement of the care provided at EPAC by incorporating patient feedback.

Objective (of the Recruitment Project): Determine whether current recruitment methods result in a biased patient sample via a three-month trial of recruitment and recruitment tracking.

Recruitment Method: Utilizing a script, EPAC Nurses (during a Triage Call) obtain consent from patients interested in learning more about the study. A few days later, a study coordinator will contact them directly through phone, email, and mail during which the potential participant will learn more about the research and may then provide consent to participate.

Preliminary Results: The three-month recruitment trial is almost halfway through and, within that range, 168 patients have been referred to EPAC. Of the 168, 65 have agreed to be contacted, 24 have declined to be contacted, and 79 were not approached. Of the 79 who were not approached, the main barrier was English was not their primary language.

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Session #9 | Poster #92 Helen Hsiao, Undergraduate Student, University of British Columbia Supervisor: Todd Woodward, Brain, Behaviour & Development

fMRI analysis of functional brain networks involved in memory tasks and visual and verbal discrimination tasks in healthy individuals Helen Hsiao and Todd Woodward

This project aims to investigate task-based brain networks and patterns in whole-brain activation in the functional MRI (fMRI) Midnight Scanning Club dataset. 10 healthy subjects completed three Incidental Memory tasks and two Coherence Semantic tasks. For the Incidental Memory tasks, subjects completed the Memory faces, Memory scenes, and Memory words tasks where subjects indicated the gender, location, and word type presented to them, respectively.

For the Coherence Semantic tasks, subjects completed the visual discrimination and verbal discrimination tasks, where they made binary Concrete/Abstract and Noun/Verb judgements for dot patterns and words, respectively.

Constrained Principal Component Analysis for fMRI (fMRI-CPCA) was used to determine functional brain networks and associated hemodynamic responses engaged in each of the tasks. Statistical significance of hemodynamic responses was determined with repeated measures ANOVAs. Brain networks were classified based on differences in estimated HDR, location of anatomical peaks and cluster shapes, and comparison to networks in literature for similar tasks.

Four networks were identified for the Coherence Semantic task: Two-Handed Response, Traditional Default Mode, Focus on Visual Features, and Novel Default Mode. Five networks were identified in the Incidental Memory task: Focus on Visual Features, Two-Handed Response, Traditional Default Mode, Linguistic Processing, and External Attention.

The extracted networks match the hypothesized results and are expected based on the tasks involved.

This study will contribute to the future use of neuromodulation to increase or decrease activation of brain networks as an intervention to treat brain disorders.

Watch Presentations Online: www.bcchr.ca/posterday | Poster Day Participants

Watch Presentations Online: www.bcchr.ca/posterday | Poster Day Participants