2023 Summer Student Research Program - Abstract Booklet

2023 SUMMER STUDENT POSTER DAY

Welcome to the 2023 Summer Student Research Program Poster Day! Each year we host this event to showcase unique and innovative research being conducted by undergraduate, medical and graduate students on the Oak Street campus over the summer.

The research community at BC Children’s Hospital provides students with a true ‘bench to bedside’ opportunity for research. Since the early 1990s, the Summer Student Research Program has provided 1,000+ students an opportunity to participate in research projects related to children’s and women’s health.

The diversity of the research here is remarkable. It is amazing to see the activities the students are involved with, including basic science, 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 respective fields.

Thursday, July 27, 2023 10:00 – 11:30 AM

MORNING POSTER 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.

Watch Virtually: www.bcchr.ca/posterday Session #1: Clinical & Population Health | Basic Science Watch In-Person: Chieng Family Atrium, BCCHR Session #2: Clinical & Population Health | Basic Science Session #3: Basic Science Session #4: Clinical & Population Health

1:30 – 3:00 PM

AFTERNOON POSTER SESSIONS: Watch Virtually: www.bcchr.ca/posterday Session #5: Clinical & Population Health Watch In-Person: Chieng Family Atrium, BCCHR Session #6: Clinical & Population Health | Basic Science Session #7: Clinical & Population Health | Basic Science Session #8: Clinical & Population Health Session #9: Clinical & Population Health

3:30 – 3:45 PM

AWARDS CEREMONY Watch In-Person: Chan Auditorium, BCCHR OR Watch Virtually: www.bcchr.ca/posterday Join us in celebrating the accomplishments of our colleagues and the positive impact of research taking place in our community. The awards ceremony will feature the best poster presentation awards.

Showingcasing excellence in our talented research community!

2023 Poster Participants Participant Hadil Alfares

Farah Tabassum Azim Ally Baaske

Pamela Bai

Layan Bashi

Rachel Bates

Sabine Bonnor

Kate Borgert

Research Team Harris Research Team

Abstract Title The SEARCH study: Study Evaluating Adolescents for Risk factors associated with Cardiovascular Health Bhatnagar A Novel Use of Motion Capture to Quantify Research Team Kinematic Changes Following myoActivation® Therapy Chan Research Team Soluble protein content and sublingual penetration rate of commercially available food powders versus glycerinated extracts for the treatment of food allergy Taubert Investigating the role of efk-1/eEF2K in Research Team translation regulation in the C. elegans starvation response Dell Research Team Variability of Ventilation Outcome Measures using Hyperpolarized 129 Xenon MRI in Children with Primary Ciliary Dyskinesia Lauder Research Team The effect of intravenous lidocaine infusion on intraoperative neurophysiological monitoring in adolescents during surgery for idiopathic scoliosis correction; a retrospective study Dennis Research Team Depression and Anxiety Trajectories in Older Adult Canadians: An Analysis of Genetic and Non-Genetic Factors Gibson Research Team Genotype-Phenotype Correlations in SETD1BRelated Neurodevelopmental Disorder

Mackenzie Campbell

Robinson Research Team

Reconsidering the Hardy-Weinberg equilibrium threshold in genetic data quality control

Jessica Chan

Verchere Research Team

Using Islet Amyloid Polypeptide (IAPP) as a Biomarker for Type 1 Diabetes

Maggie Chan

Decker Research Team The Patient Facing Roadmap as a Tool for Overcoming Language Barriers in New Cancer Diagnosis Education Blydt-Hansen Clinical Utility of Routine MAG-3 Scan for Research Team Surveillance of Kidney Allograft Injury at 48h Post-Kidney Transplant

Serena Chan

Hannah Chang

Cohen-Eilig Research Team

The role of intersectionality in identity formation of young adults with ASD

Session # Session #7: 1:30 - 3:00 pm In-Person Session #4: 10:00 - 11:30 am In-Person Session #2: 10:00 - 11:30 am In-Person Session #3: 10:00 - 11:30 am In-Person Session #2: 10:00 - 11:30 am In-Person Session #4: 10:00 - 11:30 am In-Person Session #8: 1:30 - 3:00 pm In-Person Session #4: 10:00 - 11:30 am In-Person Session #6: 1:30 - 3:00 pm In-Person Session #6: 1:30 - 3:00 pm In-Person Session #5: 1:30 - 3:00 pm Virtual Session #8: 1:30 - 3:00 pm In-Person Session #5: 1:30 - 3:00 pm Virtual

Participant Naomi Choong

Research Team Guzman & Rheumatology Research Team

Makenna Clement-Ranney

Devlin Research Team

Laura Cunningham Pike Research Team

Abstract Title The Relationship of Fatigue, Pain Interference and Physical Disability in Children Newly Diagnosed with Juvenile Idiopathic Arthritis: Results from the CAPRI Registry The impact of riboflavin deficiency and folic acid supplementation on individual and transgenerational metabolic health Exploring emergency room doctors’ occupational experiences with patient recovery and their child safety, injury, and play perspectives Optimizing the Management of Pain and Irritability in Children with Severe Neurological Impairment

Mahnoor Faisal

Siden Research Team

Anya Fineman

Kobor Research Team

Epithelial to Mesenchymal Transition Phenotype in a Model of Inflammatory Bowel Disease

Ethan Fong

Carwana Research Team

Understanding Pediatrician Knowledge and Perspectives on Barriers and Facilitators to Social Prescribing: An Exploratory Study

Simran Gill

Voss Research Team

Beatrice Gonzales

Bhatnagar Research Team

Physical activity behaviours and determinants thereof in children with type 1 diabetes in the Interior of BC: a mixed methods feasibility study Enhancing Muscle Activity Measurement in the Motion Laboratory

Jasleen Grewal

Vercauteren Research Team

Electronic vs. Paper: Participant Satisfaction with Informed Consent for Biobanking

Sanya Grover

Carwana Research Team

Perspectives of Trauma-Informed Care in Pediatric Populations: A Scoping Review

Kevin Jeong

Maxwell Research Team

Analyzing the loss of binucleate cells during fluorescence activated cell sorting

Rita Jin

Woodward Research Team

Characterization of a Novel Task-Based fMRI Functional Brain Network: Auditory

Session # Session #4: 10:00 - 11:30 am In-Person Session #6: 1:30 - 3:00 pm In-Person Session #7: 1:30 - 3:00 pm In-Person Session #5: 1:30 - 3:00 pm Virtual Session #7: 1:30 - 3:00 pm In-Person Session #8: 1:30 - 3:00 pm In-Person Session #5: 1:30 - 3:00 pm Virtual Session #6: 1:30 - 3:00 pm In-Person Session #4: 10:00 - 11:30 am In-Person Session #2: 10:00 - 11:30 am In-Person Session #7: 1:30 - 3:00 pm In-Person Session #5: 1:30 - 3:00 pm Virtual

Participant Research Team Natasha Kaprelova Lim Research Team

Abstract Title Investigating MYC Amplification in IL-6/JAK/ STAT3-Mediated Treatment Resistance in Group 3 Medulloblastoma Quality of Life after Surgery for Adolescent Gynecomastia: Preliminary Results

Marta Karpinski

Arneja Research Team

Caroline Kim

Miller Research Team

Zoe Kore

Hynes Research Team

Zoe Kortje

Lang Research Team

Assessing cardiovascular health via retinal imaging in chronically treated schizophrenia patients

Katarina Krivokapic

Datta Research Team

Significance of Frontal Intermittent Rhythmic Delta Activity (FIRDA) on EEG in the Pediatric Population

Madeleine Kruth

Joharifard Research Team

Rachel Lai

Haji Research Team

Kaitlin Law

Beasley Research Team

Perspectives of surgical care providers in Liberia regarding ethical challenges in global surgery collaborations Creating a Database to track the Natural History and Surgical Outcomes of Pediatric Patients with Spinal Dysraphism Followed in the British Columbia Children’s Hospital’s Spinal Cord Clinic Plasma-Derived Exosomes as a Biomarker of Traumatic Brain Injury and Predictor of Long-term Psychiatric Symptoms

Effects of Chronic Lung Disease and Postnatal Infection on Brain Development and Long-term Outcomes in Preterm Newborns Child Life for Children with Burns: Impact on Patient Experience

Session # Session #1: 10:00 - 11:30 am Virtual Session #9: 1:30 - 3:00 pm In-Person Session #2: 10:00 - 11:30 am In-Person Session #9: 1:30 - 3:00 pm In-Person Session #9: 1:30 - 3:00 pm In-Person Session #8: 1:30 - 3:00 pm In-Person Session #2: 10:00 - 11:30 am In-Person Session #9: 1:30 - 3:00 pm In-Person Session #6: 1:30 - 3:00 pm In-Person

Participant Jennifer Law

Research Team Cheng Research Team

Athena Li

Barakauskas Research Team

Sirui Li

Lavoie Research Team

Viviana Li

Goldowitz Research Team

Heather Lu

Beasley Research Team

Jessica Luo

Brown Research Team

Tyrone Ly

Woodward Research Team

Kyle Ma

Austin Research Team

T. Mitchell Mazza

Abby McCluskey

Hana Miller

Abstract Title Impact and Use of Patient-Reported Outcomes to measure Quality of Life in Pediatric Neuro-oncology and Hematopoietic Stem Cell Transplantation Care in British Columbia Review of Quality Indicators in Pediatric Lab and Future Steps Towards Better Pediatric Care Post-Covid Outcomes Among Education Workers in the Vancouver, Richmond, and Delta School Districts: A Cross-Sectional Study The Role of Mab21l1 in Cerebellar and Neurodevelopmental Disorders Effects of Exercise and the Antipsychotic Drug Olanzapine on Microglia in the Hippocampus of Rats A facilitated peer discussion program for improving anesthesia resident wellness: a preliminary analysis of benefits and suggested improvements Task-based Working Memory Functional Brain Networks Detectable by fMRI

Does the Provision of Improved Information Mitigate Negative Reactions to Receiving Direct-To-Consumer Polygenic Risk Scores Beasley The Complement System in Schizophrenia: Research Team The effect of antipsychotic drug administration on inflammatory activity in the brain Lim Research Team Investigating the role of integrin activation in CD47-mediated cell death in T-cell acute lymphoblastic leukemia Singhal Research Team Remoteness of Residence and Pediatric Surgical Outcomes in British Columbia

Jessica Moh

Tucker Research Team

Kudrat Mundi

Wright Research Team Use of long term ventilation for preterm infants with severe bronchopulmonary dysplasia in British Columbia Biggs Research Team Newborn Screening for Severe Combined Immunodeficiency in British Columbia

Abigail Netanya Ngan Samantha Pang

Fatigue in Children and Teens with Systemic Auto-inflammatory Diseases

Görges Research Team Ambulatory adductor canal catheter program: reducing opioid requirements after anterior cruciate ligament reconstruction surgery in adolescents

Session # Session #6: 1:30 - 3:00 pm In-Person Session #5: 1:30 - 3:00 pm Virtual Session #8: 1:30 - 3:00 pm In-Person Session #3: 10:00 - 11:30 am In-Person Session #3: 10:00 - 11:30 am In-Person Session #8: 1:30 - 3:00 pm In-Person Session #2: 10:00 - 11:30 am In-Person Session #9: 1:30 - 3:00 pm In-Person Session #7: 1:30 - 3:00 pm In-Person Session #6: 1:30 - 3:00 pm In-Person Session #7: 1:30 - 3:00 pm In-Person Session #8: 1:30 - 3:00 pm In-Person Session #2: 10:00 - 11:30 am In-Person Session #7: 1:30 - 3:00 pm In-Person Session #6: 1:30 - 3:00 pm In-Person

Participant Ariel Qi

Solana RedwayZiola

Abstract Title Exploring Family Factors in Pediatric ObsessiveCompulsive Disorder and Psychiatric Outpatient Controls Görges Research Team Bubble Blowing as an Effective Method for Distraction during Pediatric IV Insertion: A Randomized Controlled Trial Woodward How important are task diagrams for interpreting Research Team HDR shapes?

Caroline Ruus

Deyell Research Team

Whole Abdominal Radiotherapy in Children and Adults with Sarcoma: A CanSaRCC Study

Samuel Salitra

Reid Research Team

Long-term Co-Culture as a Model of B-ALL Leukomogenesis

Maisa Samiee

Massey Research Team

Iqbal Sarai

Cohen-Eilig Research Team

Monitoring Antagonism of Neuromuscular Blockade: BCWH Current Practice Compared to the American Society of Anesthesiologists 2023 Practice Guideline: a retrospective clinical audit The role of Baclofen in the treatment of Pediatric Gastroesophageal Reflux Disease: A Scoping Review

Setareh Setayesh

Richardson Research Team

Jenna Ramji

Laura Seyler

Ty Sideroff

Emily Simpson

Liam Stanley

Research Team Stewart Research Team

Graphic Arts-based Thematic Analysis: A Novel Methodology to Promote Equity in Exams Under Anesthesia Schultz Research Team Impact of Puberty on the Biology and Development of Chronic Graft-versus-Host Disease after Stem Cell Transplantation Voss Research Team A Longitudinal Study of Physical Activity and Quality of Life in Children and Youth with Diabetes in the BC Interior Voss Research Team Sleep quality in children and youth with type 1 diabetes: a validation study utilizing commercial activity trackers Verchere Antigen presentation and T cell responses to Research Team multicargo lipid nanoparticles in type 1 diabetes

Alexander Stolz

Gan Research Team

Selina Sun

Wasserman Research Team

Eduardo Sutherland

Chau Research Team

Modification of Automated Cardiac Function Prediction Algorithms from ‘Non-Expert’ Echocardiographers in Pediatric Patients Identifying Enriched Terms in PubMed Abstracts for Distinct Transcription Factors using Advanced Natural Language Processing and Machine Learning Techniques Duration of Urinary Catheterization After Cesarean Deliveries – A Retrospective Cohort Study

Session # Session #1: 10:00 - 11:30 am Virtual Session #8: 1:30 - 3:00 pm In-Person Session #3: 10:00 - 11:30 am In-Person Session #5: 1:30 - 3:00 pm Virtual Session #3: 10:00 - 11:30 am In-Person Session #1: 10:00 - 11:30 am Virtual Session #2: 10:00 - 11:30 am In-Person Session #4: 10:00 - 11:30 am In-Person Session #8: 1:30 - 3:00 pm In-Person Session #9: 1:30 - 3:00 pm In-Person Session #1: 10:00 - 11:30 am Virtual Session #3: 10:00 - 11:30 am In-Person Session #9: 1:30 - 3:00 pm In-Person Session #3: 10:00 - 11:30 am In-Person Session #9: 1:30 - 3:00 pm In-Person

Participant Valerie Swanston

Research Team Rayment Research Team

Rene Tandun

Biggs Research Team

Venessa Thorsen

Harris Research Team

Rory Trevorrow

Leveille Research Team

Amrith Vincent

Armstrong Research Team

Thumri Waliwitiya

Oberlander Research Team

Rachel Wang

Sly Research Team

Abstract Title Assessing the safety and efficacy of home-collected airway microbiological samples in children with cystic fibrosis at BC Children’s Hospital Beyond infections: Immune dysregulation in patients with Inborn Errors of Immunity Knowledge to Action: Developing a Knowledge Translation Strategy to Improve Management of Familial Hypercholesterolemia in British Columbia Perioperative Management of Juvenile Idiopathic Arthritis (JIA) in Anterior Cruciate Ligament (ACL) Reconstruction Path to Progress: Managing Leukemia Predisposition in Pediatric Patients Game Based Intervention for Improving Executive Function in Children with Congenital/Acquired Heart Disease Targeting IL-13 to treat Crohn’s disease-associated intestinal fibrosis

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

Session # Session #9: 1:30 - 3:00 pm In-Person Session #2: 10:00 - 11:30 am In-Person Session #1: 10:00 - 11:30 am Virtual Session #1: 10:00 - 11:30 am Virtual Session #1: 10:00 - 11:30 am Virtual Session #1: 10:00 - 11:30 am Virtual Session #7: 1:30 - 3:00 pm In-Person

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

Participant Jack Pearce Wong

Research Team Retallack Research Team

Aimee Xinxo

Horvath Research Team

Zixin Grace Yang

Armstrong Research Team

Chen Yu (Daisy) Sun

Cohen Research Team

Erica Zeng

Woodward Research Team

Abstract Title Exploring an Accessible Instant Video Telemedicine Tool to Support Pediatric Critical Care Triage and Transport During the 2022/2023 Pediatric Respiratory Surge Induced Pluripotent Stem Cells: A Versatile Tool for Disease Modelling and Drug Discovery with a Focus on Neuronal Progenitor Cell Differentiation Understanding the Care Provided to Patients With a Pediatric Cancer Predisposition Syndrome Across British Columbia Comparing health outcomes of children and adolescents with obesity who attend an in-person vs. virtual multidisciplinary family-based behavioural lifestyle intervention Profiling the fMRI derived Language-Based Network for pre- and post-surgical monitoring

Cindy Zhang

Robillard Research Team

How Does Social Media Impact Parent-Adolescent Communication? Exploring Cultural Perspectives

Sarah Zhang

Verchere Research Team

Immune response to lipid nanoparticle delivered therapies in type 1 diabetes

Serena Zhang

Harris Research Team

Jenicia Zhen

Verchere Research Team

Zurui Zhu

Bush Research Team

READYorNotTM Feasibility Trial: Assessing the Efficacy of an App-Based Transition Intervention in Adolescents with Congenital Heart Disease Peptidylglycine alpha-amidating monooxygenase is involved in islet cilia formation and hormone secretion Development of Rhabdoid Tumor Patient-Derived Xenografts Using the Chorioallantoic Membrane System

Session # Session #4: 10:00 - 11:30 am In-Person Session #6: 1:30 - 3:00 pm In-Person Session #2: 10:00 - 11:30 am In-Person Session #5: 1:30 - 3:00 pm Virtual Session #5: 1:30 - 3:00 pm Virtual Session #4: 10:00 - 11:30 am In-Person Session #3: 10:00 - 11:30 am In-Person Session #5: 1:30 - 3:00 pm Virtual Session #7: 1:30 - 3:00 pm In-Person Session #3: 10:00 - 11:30 am In-Person

In-Person Presentations: Chieng Family Atrium Finding a Poster

Session #2

Patio

Session #6

Room 2108

Session #3

Registration

Session #9 Session #4

Refreshments

Chan Centre for Family Health Education

Morning In-Person Sessions: 10:00 – 11:30 AM Session #2 | Posters – #10 – 18A Session #3 | Posters – #19 – 27 Session #4 | Posters – #28 – 35

Main Entrance

Reception

Session #8

Session #7

Afternoon In-Person Sessions: 1:30 – 3:00 PM Session #6 | Posters – #45 – 53 Session #7 | Posters – #54 – 62 Session #8 | Posters – #63 – 71 Session #9 | Posters – #72 – 80

*This drawing is intended for visual reference only and is not to scale

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.

110

25+

$150,000+

2023 Registered Summer Student

Hours of professional development

BCCHR & Partnered Summer Studentship funding awarded

97 17

110 research projects pursuing new discoveries and innovations to transform the lives of families in BC and beyond

Onsite projects

Remote projects

Participant Details

80 Undergraduate Students 24 Medical Students 6 Alumni & Master’s Students 82 BCCHR Research Teams Participant Universities

13 National Universities |11 International Universities BC Institute of Technology Johns Hopkins University McGill University McMaster University New York University Pitzer College Pomona College Queen’s University

Royal College of Surgeons in Ireland Simon Fraser University University of Galway University of Alberta University of British Columbia University of British Columbia, Okanagan University of California

www.bcchr.ca/ssrp

University of Edinburgh University of Ottawa University of Southern California University of St Andrews University of Toronto University of Waterloo University of Western Ontario Western University

SESSION #1: BASIC SCIENCE & CLINICAL

Moderator: Enav Zusman

10:00 – 11:30 AM Online: bcchr.ca/posterday

Participants: Maisa Samiee Natasha Kaprelova Ariel Qi Emily Simpson Venessa Thorsen Rory Trevorrow Amrith Vincent Thumri Waliwitiya

SESSION #1 Poster #2

Watch Online: Thursday, July 27 | 10:00 - 11:30 am https://bcchr.ca/posterday

Maisa Samiee

Undergraduate Student, University of British Columbia | Supervisor: Simon Massey

Monitoring Antagonism of Neuromuscular Blockade: BCWH Current Practice Compared to the American Society of Anesthesiologists 2023 Practice Guideline: a retrospective clinical audit Maisa Samiee, Eduardo Sutherland & Simon Massey

Background: 2023 American Society of Anesthesia (ASA) guidelines recommend using a Quantitative Neuromuscular Monitor (QNM) when administrating muscle relaxants and reversal agents for surgery. Research reveals that undetected residual muscle block causes Post Operative Pulmonary Complications. QNM measures a train of four counts (To4) and provides a T ratio; which is a ratio of the fourth twitch compared to the first. T ratios of 0.9 or greater are the current standard for safe extubation without reversal agents such as sugammadex or neostigmine. T ratios below 0.90 require neuromuscular blocking agent reversal.

Objective: QNM’s provide both the train of four counts and the T ratio; neither is automatically recorded onto the Electronic Patient Record (EPR), unlike most other monitor data. For an anesthetist to record this data into the EPR, currently, they must manually enter it. This Retrospective Audit reviews EPRs to identify the recorded use of Neuromuscular Monitors at BC Womens’ Hospital compared to the ASA Practice Guidelines.

Methods: 200 Retrospective Laparoscopic Anaesthesia patient records were reviewed. The data collected includes; use of muscle relaxant, QNM or Manual Qualitative Neuromuscular Monitor (MQNM), T ratios and/or To4 count recorded on EPR during the procedure.

Results: Our institution’s EPR’s indicate; 176 (88%) patients undergoing laparoscopic surgery received muscle relaxants.

Of these 176, only 88 (50%) indicate the use of neuromuscular monitoring; 32 of 88 (36%) used QNM, and 56 (64%) used MQNM. Of the 32 cases using QNM, 13 (41%) recorded only To4 count values, 17 (53%) recorded T ratios, and 2 (6.25%) recorded neither.

Conclusion: Our EPR Audit results suggest that our current practice does not meet the 2023 ASA Guidelines. In only 18% of cases where QNM is recommended, was it used. This EPR data may not reflect true practice because, currently, QNM data is manually and not automatically entered into the EPR, although the QNM results are displayed during use.

Our anesthetic department requires consultation on the implementation of the 2023 ASA guideline. Thereby possibly improving practice which may reduce postoperative pulmonary complications. Improved practice implementation and automated QNM EPR data entry are necessary prior to repeating the Audit cycle.

--- 2023 Poster Participants ---

SESSION #1 Poster #3

Watch Online: Thursday, July 27 | 10:00 - 11:30 am https://bcchr.ca/posterday

Natasha Kaprelova

Master’s Student, University of British Columbia | Supervisor: Chinten James Lim

Investigating MYC Amplification in IL-6/JAK/STAT3-Mediated Treatment Resistance in Group 3 Medulloblastoma Natasha Kaprelova, Chinten James Lim

Medulloblastoma (MB) is the most common malignant brain tumor diagnosed in children, accounting for 20% of all pediatric brain cancers. MB has been classified into four molecular subgroups, Sonic Hedgehog (SHH), Wingless (WNT), Group 3 (Grp3), and Grp 4. Each subgroup exhibits distinct biology, prognoses, and risks. Currently, the 5-year overall survival rate for MB is about 70%. Group 3 makes up 25% of all MB cases and is the most aggressive MB subgroup, characterized by rapid tumor growth, metastasis, and disease relapse. Grp3 has a 5-year overall survival rate of 50%, which drops further to 20% for a subtype of Grp3 tumors with amplified cancer-inducing gene, MYC. Chemotherapy, in combination with surgery and radiation, remains the gold standard for treatment of MB. However, a major drawback of chemotherapy is the ability of tumor cells to acquire drug resistance, resulting in treatment failure and relapse. The molecular pathways that drive drug resistance in Grp3 MBs remain undefined, emphasizing the need for research into mechanisms that contribute to the dismal prognosis of this subgroup.

My research aims to provide further understanding of how MYC, a gene known to drive Grp3 MB tumors, renders Grp3 tumors drug resistant. We will use cutting edge genetic tools such as CRISPR to abolish MYC function in Grp3 MB cell lines and establish its contribution to tumor cell survival and drug resistance. In addition, I will evaluate the ability of selective MYC inhibitors as a therapeutic to overcome drug resistant Grp3 MB. The acquired knowledge will aid in future development of novel therapeutic regimes that can be used to manage the most aggressive forms of pediatric brain tumors.

--- 2023 Poster Participants ---

SESSION #1 Poster #4

Watch Online: Thursday, July 27 | 10:00 - 11:30 am https://bcchr.ca/posterday

Ariel Qi

Medical Student, Queen’s University | Supervisor: S. Evelyn Stewart

Exploring Family Factors in Pediatric Obsessive-Compulsive Disorder and Psychiatric Outpatient Controls Ariel Qi, John R. Best, Gordon Andjelic, Anna MacLellan, Boyee Lin, Cynthia Lu, S. Evelyn Stewart

Background: Child and youth psychiatric illness can place a heavy burden on the family. In turn, the family environment could impact prognosis and treatment adherence in the youth. Thus, consideration of family factors is critical in the context of pediatric psychiatric illness. Disorder-related family functioning assessment provides a nuanced examination of family routines, emotional responses and socio-occupational impacts. Family functioning impairment has been well studied in pediatric obsessive-compulsive disorder (OCD) patients, and exerts a negative influence on treatment trajectory. Further, parents with low tolerance of their child’s distress may struggle to respond with behaviors that alleviate disease severity. In pediatric OCD, parents’ poor child distress tolerance and accommodation behaviors are associated with increased symptom severity and treatment resistance. There is limited knowledge on how family functioning impairment and parental tolerance of child’s distress (PTCD) in OCD compare to that experienced in families coping with other youth psychiatric conditions.

Objectives: 1. Compare various aspects of family functioning impairment and PTCD between pediatric OCD and non-diagnostically selected psychiatric controls.

2. Explore how patient/family characteristics influence the degree of disease-related family functioning impairment and PTCD. Methods: We will analyze data from the psychiatry outpatient clinics (n=6) at BC Children’s Hospital in the Family Input Tool database (FIT: n=3560, years 2019-2023), and previously collected data of the Provincial OCD Program (n=405).

Family functioning and PTCD are measured by the 21-item Family Functioning Impairment Scale (modified from the validated OCD Family Functioning Scale) and the 3-item PTCD Scale (modified from the validated Distress Tolerance Scale), respectively. Other factors of interest include patients’ demographic factors, medical history and family characteristics. Statistical analysis will utilize multivariable linear regression models, whereby the family-related outcome score is regressed on clinical predictors and covariates.

Significance: This project will characterize and compare family functioning impairment and PTCD in non-OCD youth psychiatric disorders in relation to OCD. Results will aid in identifying populations of patients who experience greater family dysfunction. Our findings could also inform targeted interventions, treatment strategies and social supports that are catered to the unique circumstances of the youth patients and their families.

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

--- 2023 Poster Participants ---

SESSION #1 Poster #5

Watch Online: Thursday, July 27 | 10:00 - 11:30 am https://bcchr.ca/posterday

Emily Simpson

Medical Student, University of British Columbia | Supervisor: Christine Voss

Sleep quality in children and youth with type 1 diabetes: a validation study utilizing commercial activity trackers Emily Simpson, Ty Sideroff, Nick Wall, Elizabeth Keys, Quevie Reinz Abalde, Calli Davidson, Simran Gill, Holly Buhler, Trent Smith, Deanne Taylor, Christine Voss

Background: Diabetes is a common chronic condition in children and youth, with over 2,500 youth and children in BC living with the disease. Children with type 1 diabetes are particularly vulnerable to disturbed sleep, which has negative implications for their health and wellbeing. Adequate sleep is crucial for facilitating biological processes, and inadequate sleep has been linked to reduced executive functioning, problematic behaviours, and decreased quality of life. Previous studies have shown there to be a bidirectional relationship between sleep and glycemic control in children with type 1 diabetes. However, more research is needed to fully understand the underlying mechanisms and potential implications for diabetes management in children and youth.

Objective: To establish validity of a consumer wearable, the Fitbit Charge 5, for the assessment of sleep behaviours in children and youth with type 1 diabetes.

Methods: Participants were recruited from an ongoing longitudinal study that utilizes Fitbit Charge devices to assess physical activity in children and youth with diabetes. For this validation study, parents/guardians initially completed the ‘Sleep Disturbance Scale for Children (SDSC)’ – a validated and clinically relevant questionnaire to identify sleep issues. Following this, participants wore their Fitbit continuously for 7 days. Every morning, participants received a SMS message, prompting them to complete an electronic daily sleep log. During this 7-day period, REDCap was used to extract min-by-min Fitbit sleep data via a custom-written API. Correlations between the electronic sleep log and Fitbit data is being assessed for key sleep behaviours.

Results: Data analysis is ongoing at the time of abstract submission.

Conclusions: We anticipate that this research will identify whether Fitbit Charge devices can be used in sleep research involving children and youth with diabetes. Furthermore, we expect to gain useful insight into the sleep behaviours of children and youth with type 1 diabetes in the Central Okanagan area.

Congratulations to Emily on receiving a Centre for Chronic Disease Prevention and Management (CCDPM) Clinical Research & QI Incubator Award

--- 2023 Poster Participants ---

SESSION #1 Poster #6

Watch Online: Thursday, July 27 | 10:00 - 11:30 am https://bcchr.ca/posterday

Venessa Thorsen

Master’s Student, University of British Columbia | Supervisor: Kevin Harris

Knowledge to Action: Developing a Knowledge Translation Strategy to Improve Management of Familial Hypercholesterolemia in British Columbia Kevin Harris, Stephanie Glegg, Jason Sutherland, Venessa Thorsen

Introduction/Background: Familial Hypercholesterolemia (FH) is a common, under-diagnosed genetic condition where cholesterol is improperly metabolized and exists at dangerously high levels, decreasing circulatory health. Years of cholesterol build-up blindside patients with heart attacks and strokes in young adulthood, which are preventable with early intervention.

Due to a current lack of screening, 90% of FH cases are not diagnosed during childhood. In response, the Canadian Cardiovascular Society published guidelines recommending universal screening of all children aged 9-11 for elevated cholesterol.

Research Objectives: The primary outcomes of this project are to assess: 1. Physician self-reported confidence and familiarity with the Pediatric Lipid Guidelines.

2. Baseline cross-sectional provincial data on rates of lipid screening, diagnosis of FH and statin prescription.

Follow-up will determine if a Knowledge Translation (KT) intervention impacts adherence to guidelines and increases screening, diagnosis, and treatment of FH based on reassessment of provincial data 1-year post-intervention. We are hopeful that data from this project may also help inform the need for a National Pediatric FH Registry.

Methods: We will use PopData BC for children <18 to define baseline levels of childhood screening, diagnosis, and treatment for FH in BC. An interactive KT module intervention featuring experts in cardiology and cholesterol disorders will be delivered to participants synchronously or asynchronously, as well as one-month post-module assessments of familiarity and confidence with the guidelines.

Results: N/A Conclusion: N/A

--- 2023 Poster Participants ---

SESSION #1 Poster #7

Watch Online: Thursday, July 27 | 10:00 - 11:30 am https://bcchr.ca/posterday

Rory Trevorrow

Medical Student, University of British Columbia | Supervisor: Lise Leveille

Perioperative Management of Juvenile Idiopathic Arthritis (JIA) in Anterior Cruciate Ligament (ACL) Reconstruction Rory Trevorrow, Daniella D’Amici, Joyce He, Helen Crofts, Hayley Spurr, Kristin Houghton, Lise Leveille

Background: Juvenile idiopathic arthritis (JIA) refers to a group of conditions of unknown etiology characterized by joint inflammation presenting prior to 16 years of age and persisting for a minimum of 6 weeks duration. JIA may co-occur with other musculoskeletal injuries and diseases, including anterior cruciate ligament (ACL) rupture. In the paediatric population, early operative management of ACL rupture is associated with a decreased likelihood of joint instability, pathological laxity, and symptomatic meniscal tears compared to non-operative management. In children with JIA, the inherent inflammatory environment of the joint may interfere with post-surgical healing and rehabilitation.

As such, optimal management of disease activity in the perioperative period may be critical to improve surgical outcomes and reduce complication rates following paediatric ACL reconstruction.

Objective: The aim of the present study is to determine best practices for the medical management of JIA during the perioperative period of pediatric ACL reconstruction.

Methods: Existing literature on the management of inflammatory arthritis in the perioperative period was gathered through a structured search of MEDLINE, Embase and CINAHL databases. A combination of keywords and subject headings related to juvenile arthritis, ACL reconstruction, orthopaedic procedures, and perioperative care was used to identify articles with potential relevance. In addition, recent cases of ACL reconstruction in patients diagnosed with JIA will be identified from the health records of BC Children’s Hospital and reviewed for trends in JIA management and surgical outcomes.

Preliminary Results: A total of 1688 references were identified by the initial search, with 1297 references remaining after the removal of duplicates. Title and abstract screening by a single reviewer yielded 383 articles for full-text review.

Implications: The findings of the present study may serve to guide the management of DMARDs, corticosteroids, and other antirheumatic medications in the perioperative period. Optimal medical management of JIA in the perioperative window could serve to improve surgical outcomes and reduce complication rates for paediatric ACL reconstruction and other orthopaedic procedures.

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

--- 2023 Poster Participants ---

SESSION #1 Poster #8

Watch Online: Thursday, July 27 | 10:00 - 11:30 am https://bcchr.ca/posterday

Amrith Vincent

Medical Student, Royal College of Surgeons in Ireland | Supervisor: Linlea Armstrong

Path to Progress: Managing Leukemia Predisposition in Pediatric Patients Amrith Vincent, Linlea Armstrong, Caron Strahlendorf

Background: As one of the most common childhood cancers, accounting for 29% of childhood cancers, leukemia presents several complex challenges in the pediatric population. While most pediatric leukemia patients have sporadic somatic variants, some are at risk due to germline variants. These genetic variants affect key regulatory processes at the cellular level. The most common genes affected are ones that can be somatically mutated in other cancers (eg. TP53, RUNX1, IKZF1, and ETV6).

Objectives: The primary objective is to create a comprehensive care pathway that will allow clinicians to identify pediatric patients at risk for leukemia due to predisposition syndromes and provide these patients and their families with personalized care plans.

Methods: A comprehensive literature search was performed using the PubMed database and internet search engines.

Search terms included “leukemia,” “pediatric,” “predisposition,” and “therapeutics.” Exclusion criteria included adult only predisposition syndromes.

Significance/Overview: Through a systematic review of the literature, we are developing a comprehensive care pathway to assist clinicians identify and manage pediatric leukemia patients with predisposition syndromes. The pathway encompasses all stages of clinical care. Topics included are: prevention and early detection strategies, diagnosis focused on recognition of genetic syndromes, investigations, referral guidelines and evidence-based management recommendations. The care pathway will also provide guidance on transitioning pediatric patient care to adult care.

In addition to patient care, predisposition syndromes have implications for family members. The care pathway will provide recommendations for at-risk family screening.

Conclusion: The care pathway will be a valuable resource for clinicians navigating the complex landscape of pediatric leukemia predisposition syndromes. The care pathway provides the blueprint for the creation of personalised care plans throughout the patient’s journey.

--- 2023 Poster Participants ---

SESSION #1 Poster #9

Watch Online: Thursday, July 27 | 10:00 - 11:30 am https://bcchr.ca/posterday

Thumri Waliwitiya

Medical Student, University of British Columbia | Supervisor: Tim Oberlander

Game Based Intervention for Improving Executive Function in Children with Congenital/Acquired Heart Disease

Thumri Waliwitiya, Sarah M. Hutchison, Yaewong Kim, Buse Bedir, John Sheehan, Astrid De Souza, Kathryn R. Armstrong, Sarah J. Macoun, Tim F. Oberlander Background: More than 90% of children with congenital heart disease (CHD) survive into adulthood, and despite improvements in survival, many are at risk of poor executive function (EF). EF skills are required to plan and execute complex tasks that are critical for academic and social success, self-care, and successful transition from the pediatric to adult medical system. EF is a multi-process system that functions in a coordinated manner to permit decision making and goal driven behavior. Children with CHD may have problems with working memory, inhibition, and shifting in both performance-based tasks. Thus, early intervention in children with CHD could have long term health benefits. Recently there has been interest in delivering online cognitive interventions. There is mounting evidence that computerized attention/EF training can be effective for developmentally and neurologically diverse populations if delivered appropriately.

Study Objectives: 1. To work with stakeholders (CHD patients and team) to administer the EF intervention.

2. To determine the feasibility of using this intervention, the level of engagement, and satisfaction of CHD patients, their family, and their CHD team with the EF intervention.

3. To measure EF, academic outcomes, and brain function in children with CHD. To measure quality of life (QoL) in parents of children with CHD pre- and post-implementation of the EF intervention.

Methods: The EF intervention is DinoIsland, a therapeutic computer ‘game’ designed to strengthen EF measures through massed practice distributed over several weeks. Eligible participants in the BC Children Heart Center will be contacted will complete EF testing measuring verbal intelligence, fluid reasoning, verbal working memory, cognitive flexibility, spatial working memory, and sustained attention.

Significance: As most children with CHD survive into adulthood, there has been a shift to optimize long-term outcomes in these patients. Our study will aim to improve EF in children with CHD using innovative game-based intervention which has shown to be effective in other clinical populations with poor EF skills. Improving EF and academic skills may be beneficial for long-term health outcomes and QoL in children with CHD.

Congratulations to Thumri on receiving a Sunny Hill Health Centre Research Summer Studentship

--- 2023 Poster Participants ---

SESSION #2: BASIC SCIENCE & CLINICAL

Moderator: Rozalyn Chok

10:00 – 11:30 AM In-Person: Chieng Family Atrium

Participants: Ally Baaske Sanya Grover Caroline Kim Madeleine Kruth Tyrone Ly Kudrat Mundi Iqbal Sarai Rene Tandun Zixin Grace Yang Layan Bashi

SESSION #2 Poster #10

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Ally Baaske

Medical Student, University of British Columbia | Supervisor: Edmond Chan

Soluble protein content and sublingual penetration rate of commercially available food powders versus glycerinated extracts for the treatment of food allergy Ally Baaske, Edmond S. Chan, Lianne Soller, Yigong Guo, Anubhav Pratap-Singh, Bryant Hartono, Brock A. Williams, Stephanie C. Erdle

Introduction: Sublingual immunotherapy (SLIT) is a safe, effective therapy for food allergy. SLIT consists of a small dose of the allergenic food held under the tongue for ≥1 minute with the remainder swallowed. Studies demonstrating SLIT efficacy have relied on glycerinated food extracts for the administration of food allergens, which are less accessible and more expensive than whole food alternatives, limiting treatment availability.

Objective: This study compared the soluble protein content and sublingual protein penetration rates of whole food powders with glycerinated extracts (the current standard in research).

Methods: Peanut, cashew, egg, cow’s milk, salmon, and sesame powders were tested for soluble protein content (average±standard deviation) using Bradford protein assay and in vitro sublingual protein penetration rates using human buccal carcinoma cell lines at 1 hour incubation at 37oC, in comparison to glycerinated extracts.

Results: Soluble protein content for peanut, cashew, egg, cow’s milk, salmon, and sesame powders and extracts was: 0.33±0.0004mg/mg and 7.75±0.001mg/mL, 0.20±0.002mg/mg and 10.42±0.002mg/mL, 0.57±0.004mg/mg and 4.71±0.03mg/mL, 0.36±0.003mg/mg and 2.56±0.01mg/mL, 0.040±0.01mg/mg and 0.0088±0.0004mg/mL, and 0.44±0.2mg/mg and 0.88±0.002mg/mL, respectively.

At 1 hour incubation, the simulated sublingual penetration rate for peanut, cashew, egg, cow’s milk, salmon, and sesame powders versus extracts was: 72.1±1.5% vs. 82.2±2.0% (p<0.05), 76.3±3.2% vs. 74.0±2.3%, 80.3±1.3% vs. 86.0±1.0% (p<0.05), 84.3±1.5% vs. 89.5±1.9% (p<0.05), 65.3±3.5% vs. 84.6±2.1% (p<0.05), and 71.4±1.8% vs. 82.4±1.5% (p<0.05), respectively.

Conclusions: Overall, powders showed lower soluble protein content than food-matched extracts, except for salmon powder. However, conclusions comparing powder and extract protein contents are limited as the units of measurement for powders (mg) and extracts (mL) are not directly comparable. At 1 hour incubation, all food powders showed slower penetration rates than extracts except for cashew, for which rates were equivalent. Future research will focus on recipe development for whole food SLIT doses, and safety and efficacy assessments of whole food SLIT.

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

--- 2023 Poster Participants ---

SESSION #2 Poster #11

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Sanya Grover

Medical Student, University of British Columbia | Supervisor: Matthew Carwana

Perspectives of Trauma-Informed Care in Pediatric Populations: A Scoping Review Grover S, Pawliuk C, Greyson D, Udall B, Carwana M

Background: Children are at risk to experience trauma in many forms, including developmental or intergenerational (especially related to the effects of colonization). Existing literature has demonstrated that early-years trauma has the potential to cause many physical and emotional effects that may impact overall health and wellbeing. Furthermore, those that experience childhood trauma are also more likely to avoid health interactions. Trauma-informed practice is a patient-centered approach that has potential to create more safe and accessible interactions for families. It involves many multi-faceted elements, such as: acknowledging that trauma may commonly come up in clinical encounters; recognizing possible symptoms of trauma, promoting cultural safety; establishing trust in patient-provider relationships; and focusing on taking a strengths-based approach that honors resiliency. While there have been some guidelines established on trauma-informed care, little research has been done on patient and caregiver perspectives for best practices, specifically missing the lens of children and families who have experienced marginalization.

Primary Objective: To identify existing evidence regarding patient and/or caregiver perspectives on best practice guidelines for trauma informed care for children and families in pediatric settings.

Methods: A scoping review will be conducted and original peer-reviewed literature around perspectives of pediatric patients (18 years and younger), caregivers, and health providers in inpatient and/or outpatient healthcare settings will be included. The databases to be searched include MEDLINE, Embase, PsycINFO (EBSCOhost), Scopus, CINAHL (EBSCOhost), Social Work Abstracts (EBSCOhost), Academic Search Complete (EBSCOhost) and Google Scholar. Two reviewers will independently screen studies at Level 1 and 2. Data will be extracted, analyzed, and presented as a narrative synthesis of findings.

Significance: This review bridges the current literature gap by assessing the extent of evidence on patient and caregiver perspectives. These missing perspectives have the potential to further guide our understanding of trauma-informed care, allowing providers to cultivate a safer space in healthcare settings. Furthermore, too often, the experience and expertise of individuals who are marginalized and oppressed is excluded or not adequately considered in policy development.

The findings of this review can spark meaningful dialogue and partnerships with vulnerable communities to assess and reform best practice guidelines.

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

--- 2023 Poster Participants ---

SESSION #2 Poster #12

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Caroline Kim

Medical Student, University of British Columbia | Supervisor: Steven P. Miller

Effects of Chronic Lung Disease and Postnatal Infection on Brain Development and Long-term Outcomes in Preterm Newborns Caroline Kim, Steven Ufkes, Jessie Guo, Vann Chau, Anne Synnes, Ruth Grunau, Steven P. Miller

Introduction: In preterm neonates, chronic lung disease (CLD) and postnatal infection are robust predictors of abnormal neonatal white matter development and adverse neurodevelopmental outcomes into preschool-age. Our data examining outcomes in children born preterm revealed clinically-relevant motor impairment at 4.5-years of age which was not detected at earlier assessments. These data suggest a need for continued assessment of children born preterm to identify the brain changes underlying neurodevelopmental concerns at school-age, and their relationship to CLD and postnatal infection.

Methods: 124 preterm newborns (mean gestational age 28.2 weeks, SD 2.4) were studied prospectively with longitudinal assessment from birth to 8-years of age. Detailed clinical data (birth weight, infection, CLD, etc.) were collected day-byday through the neonatal intensive care course. White matter injury (WMI) was quantified at term-equivalent age using structural magnetic resonance imaging (MRI). Diffusion tensor imaging was acquired at 8-years of age (mean scan age 8.4 years, SD 0.4) and tract-based spatial statistics were used to compute fractional anisotropy (FA), a measure of white matter maturation. Neurodevelopmental outcomes were assessed at the same visit using the Movement Assessment Battery for Children, 2nd Edition, Kaufman Test of Educational Achievement, 3rd Edition, and the Weschler Abbreviated Scale of Intelligence, 2nd Edition, full-scale IQ. Results: 33 newborns (27%) developed CLD, defined as requiring supplemental oxygen at 36 weeks postmenstrual age.

At 8-years of age, children who had CLD exhibited significantly reduced FA (p<0.05) compared to their peers, controlling for degree of prematurity, age at scan, and presence of moderate-severe WMI on neonatal MRI. Preliminary analyses suggest CLD is associated with significantly lower scores on motor and writing assessments (p<0.05), controlling for the same clinical factors. 51 newborns (42%) were infected postnatally with positive blood, urine, or cerebrospinal fluid cultures. Preliminary analyses found no differences in white matter microstructure or neurodevelopmental outcomes at school-age compared to children without postnatal infection.

Conclusions: In children born preterm, CLD is associated with abnormal white matter maturation and adverse neurodevelopmental outcomes at school-age, suggesting early-life lung disease has long-term links with brain development. Further research is required to understand the neural mechanisms underlying abnormal brain development in children with CLD.

Congratulations to Caroline on receiving a UBC Faculty of Medicine Summer Studentship, co-funded by the Edwin S.H. Leong Centre for Healthy Aging

--- 2023 Poster Participants ---

SESSION #2 Poster #13

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Madeleine Kruth

Medical Student, University of Alberta | Supervisor: Shahrzad Joharifard

Perspectives of surgical care providers in Liberia regarding ethical challenges in global surgery collaborations

Madeleine Kruth, Lemfuka Dieudonné, Farhad Udwadia, Catherine Binda, Kayoung Heo, Emilie Joos, Shahrzad Joharifard Objective: To understand the ethical concerns, considerations, and priorities in global surgery collaborations from the perspective of surgical care providers in Liberia.

Background: As the field of global health continues to develop, including increased consensus on the field’s key definitions and priorities, increased attention is being paid to its ethical considerations. Many ethical issues in the field of global health and global surgery have been identified, including dissonance between the assumed needs of communities and local realities, lack of adequate pre-departure training for visitors, and the burden that visitors place on their host communities. However, there is a significant dearth in literature reviews and original research that includes the voices of providers from Low- and Middle-Income Countries (LMICs). Acknowledging the vastness, diversity, and value of the voices of surgical care providers in LMICs, this project seeks to begin to fill this gap in research by centering the voices of surgical providers in Liberia.

Methods: Using purposive/convenience sampling methods, we recruited surgical care providers (surgeons, nurses, OR technicians, and others) working in Liberia who have been involved with international partnerships for humanitarian work. Semi-structured interviews are conducted using a structured interview guide with open-ended questions.

The interview guide is divided into three sections: provider background and scope of practice; experiences with high-income country partnerships; and barriers and facilitators of past partnerships and ethical challenges identified.

Interviews are transcribed, made software ready (NVivo14), and analyzed using conventional thematic qualitative analysis. A preliminary codebook has be drafted based review of the interview transcripts and the lived experiences of team members practicing on the ground in Liberia.

Discussion: While still in preliminary stages of data analysis, some preliminary themes have emerged around ethical challenges and recommendations for best practice in establishing surgical partnerships. These recommendations include ensuring sustainability in partnerships; focus on capacity building; and engagement with local staff and communities.

We hope this project will provide much-needed insight into key ethical considerations within the field of global surgery, prompting reflection on the value of global surgical partnerships and how to best foster supportive and impactful bidirectional coparticipatory models.

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

--- 2023 Poster Participants ---

SESSION #2 Poster #14

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Tyrone Ly

Master’s Student, University of British Columbia | Supervisor: Todd S. Woodward

Task-based Working Memory Functional Brain Networks Detectable by fMRI Tyrone Ly, Linda Chen, Todd S. Woodward

Research Objectives: In cognitive neuroscience, fMRI investigation of the working memory through analysis of the Sternberg delayed recognition task has been a prominent research area for decades, but the field has yet to arrive at a consensus for a set of macroscale functional brain networks. In the present study, we utilized a version of the task called Sternberg Item Recognition Paradigm and hypothesized the emergence of the Working Memory Big Five brain networks that were established in previous research. They consist of Response, Focus on Visual Features, Initiation, Internal Attention, and Default Mode Networks.

Methods: fMRI data was obtained from the Function Biomedical Informatics Research Network phase II multi-site study in which 55 healthy controls and 54 patients with schizophrenia or schizoaffective disorder performed the Sternberg task while undergoing fMRI scanning sessions. Constrained Principal Component Analysis for fMRI (fMRI-CPCA) was employed to identify and characterize functional brain networks that emerged during task performance and their associated hemodynamic responses.

Preliminary Results: Auditory Attention for Response Network was extracted together with three of the Big Five, which included Response, Focus on Visual Features, and Traditional Default Mode Networks. Traditional Default Mode Network had the most significant effect of group, while Response demonstrated load-dependency. Interestingly, Focus on Visual Features Network showed patterns of activation, instead of suppression as expected from previous findings. Internal Attention Network was potentially merged into the extracted Response Network, and Initiation was potentially merged into Focus on Visual Features.

Future Directions: These findings suggest that Traditional Default Mode Network have reduced activity in schizophrenia patients, implicating their dysfunction may underlie cognitive impairments in schizophrenia. The effects of site difference, sex differences in brain networks, and neuropathological differences between schizophrenia and schizoaffective disorder will be further investigated. Correlations with symptoms will also be established, which will contribute to advancements in diagnosis and the development of novel treatment options.

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

--- 2023 Poster Participants ---

SESSION #2 Poster #15

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Kudrat Mundi

Medical Student, University of British Columbia | Supervisor: Marie Wright

Use of long term ventilation for preterm infants with severe bronchopulmonary dysplasia in British Columbia Kudrat Mundi, Marie Wright, Emily Kieran, Jessie Van Dyk

Background: Advancements in care have resulted in improved survival of infants born at increasingly low gestational age, however, these interventions have not lowered the prevalence of chronic lung disease of prematurity, also known as bronchopulmonary dysplasia (BPD).

An increasing number of infants are therefore being discharged from the neonatal intensive care unit (NICU) who require ongoing management of BPD. Home respiratory management options include: supplementary oxygen, non-invasive positive pressure ventilation (NIPPV), and invasive ventilation via tracheostomy.

There is a lack of information about the trajectory of this patient population including the duration for which respiratory support is needed, long term respiratory/non-respiratory outcomes, and differences in outcomes depending on the type of support received.

Study Objectives: 1. Characterize the population of infants with BPD managed with home respiratory support in terms of their gestational age and antenatal background, early neonatal management, and medical comorbidities.

2. Describe their clinical outcomes including duration of respiratory support, treatment-related complications, growth trajectory, neurodevelopment, and hospital admissions in the two years after NICU discharge.

3. Investigate for predictors of the above outcomes in terms of patient characteristics and the type of respiratory support used.

Methods: A retrospective review of all infants with severe BPD requiring home respiratory support, discharged from a Level 3 NICU in British Columbia between January 2013 and December 2022.

Cases were identified from clinical databases of the BC Children’s and Women’s Hospital (BCWH) Neonatal Follow-up (NFU) and Home Tracheostomy & Ventilation (HTV) programs, and from BCWH NICU discharge coding. Data were also collected about infants with severe BPD who died prior to hospital discharge while still on respiratory support.

Significance: Our center is uniquely placed to answer these important questions because of our large BPD population who are closely followed by specialist outpatient services (HTV and NFU), and our extensive experience of using NIPPV in this patient group.

Findings will address existing knowledge gaps around optimal management and long-term outcomes of infants with severe BPD. It will also characterise the size, healthcare utilization, and long-term medical issues of this patient group within British Columbia which will help to plan future medical services.

Congratulations to Kudrat on receiving a Florence E Heighway Summer Research Award, UBC Faculty of Medicine Summer Student Research Program --- 2023 Poster Participants ---

SESSION #2 Poster #16

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Iqbal Sarai

Medical Student, University of Galway | Supervisor: Mor Cohen-Eilig

The role of Baclofen in the treatment of Pediatric Gastroesophageal Reflux Disease: A Scoping Review Iqbal Sarai, Ram Mishaal, Mor Cohen-Eilig

Background: Gastroesophageal reflux disease (GERD) is a pathological condition that results in persistent reflux of stomach contents into the distal esophagus and is quite common in pediatric patients. A major contributing factor to GERD is a compromised lower esophageal sphincter (LES). Transient lower esophageal sphincter relaxations (TLESRs) are one of the emerging theories, another is that the lower esophageal sphincter (LES) tension is weakened. Current treatments of GERD in pediatric patients focus on using Proton pump inhibitor (PPI’s). These classes of drugs are effective but do not work in all cohort of patients to the same degree. Baclofen is a drug that has been shown to help relieve symptoms of GERD in adults and may be a promising therapeutic option that could be explored in this condition.

Methods: Literature searching using PubMed and Ovid Medline databases. Finding individual studies to construct a literature review on the use of baclofen in pediatric patients who have GERD. Results: Literature searching showed that baclofen has a major impact on reducing TLESRs. In pediatric patients’ baclofen shows significant reduction of symptoms such as vomiting, regurgitation, abdominal pain and heartburn. Studies also show similar results in animals, and in adult patients and healthy volunteers. Baclofen increases the threshold volume needed to trigger secondary peristalsis and decreased the frequency of secondary peristalsis. Other papers also showed that the LES tension was increased with administration of baclofen resulting in reduction of acid reflux episodes. Adverse effects associated with baclofen were dizziness and drowsiness.

Conclusion and Future Directions: Baclofen shows promise to be an option in treating GERD in pediatric patients.

Reduction in TLESRs and increase in LES tension both help with the two major theories of why GERD occurs. The data is however lacking for normalized values in children and more experiments with larger cohorts should be established.

--- 2023 Poster Participants ---

SESSION #2 Poster #17

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Rene Tandun

Medical Student, University of British Columbia | Supervisor: Catherine Biggs

Beyond infections: Immune dysregulation in patients with Inborn Errors of Immunity Rene Tandun, Abigail Netanya Tan Ngan, Catherine Biggs

Background: Inborn Errors of Immunity (IEI) are disorders caused by monogenic germline mutations that affect how the immune system works or develops. More emphasis has been given to recurrent infections as a clinical presentation, and less to immune dysregulation, a process of uncontrolled immune responses leading to inflammation, allergy and malignancy. Understanding non-infectious manifestations are key to reducing diagnostic delays and reducing morbidity and mortality seen in IEIs. Purpose: The purpose of the study is to determine the frequency of immune dysregulatory complications in children with IEIs. We hypothesize that immune dysregulation is a common initial manifestation, and that the presence of immune dysregulation is associated with worse clinical outcomes in this patient population.

Methods: In this retrospective chart review, data was extracted from medical records of pediatric patients with confirmed IEIs seen at BC Children’s Hospital (BCCH). Deidentified demographics, diagnosis, treatment and clinical outcomes were collected in REDCap. Immune dysregulatory features included lymphoproliferation, granuloma, autoimmunity, allergy or autoinflammation. Outcome variables included age at initial presentation, age at diagnosis, and chronic disease or end-organ involvement.

Preliminary Results: Among the forty-two pediatric patients with IEI (76% males) identified, infection was the most common initial symptom (n=18, 42.9%) followed by immune dysregulation (n=11, 26.2%). Thirty-two patients (76.2%) reported a history of immune dysregulation, with allergic disease being the most common. The mean age at diagnosis was 35.7 months.

Significance: Given the prevalence of immune dysregulatory symptoms in patients with IEI, it is important that health care providers consider an IEI diagnosis when investigating non-infectious presentations even in the absence of recurrent infections. The results of this study can inform clinical guidelines, with the goal of improving outcomes for patients with IEI.

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

--- 2023 Poster Participants ---

SESSION #2 Poster #18

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Zixin Grace Yang

Medical Student, University of Edinburgh | Supervisor: Linlea Armstrong

Understanding the Care Provided to Patients With a Pediatric Cancer Predisposition Syndrome Across British Columbia Zixin G. Yang, Linlea Armstrong, Caron Strahlendorf, Pediatrics CPS Team members

Background: A pediatric cancer predisposition syndrome (CPS) increases the chances of cancer due to a sporadic or inherited gene variant. Common cancer predisposition syndromes include: Li-Fraumeni, familial adenomatous polyposis, and neurofibromatosis type 1. Literature shows that cancer predisposition syndromes account for 5-10% of all cancers, and that the quality-of-life following diagnosis and treatment is decreased. There are also physical, neurocognitive, and psychosocial late effects after recovery from cancer. Currently there are no provincial guidelines on care provided to children and at risk family members with a pediatric CPS in British Columbia (BC).

Objective: The project goal is to develop a care pathway for patients with a, or suspected, pediatric CPS. The initial step is to identify all the children in BC then determine if they are accessing suitable care with regards to referrals, triaging, genetic testing and treatment.

Methods: An Excel database was created. The data variables were identified through an environmental scan of clinics across North America. To ensure consistency, Excel data entry forms were coded using Visual Basic Application.

Most fields have a dropdown list to minimize free text entry. Patient information will be entered if under 19 yearsold and suspected to have a CPS, or diagnosed with a CPS and symptomatic or asymptomatic. The exclusion criteria are individuals diagnosed with a CPS after turning 19. Electronic and paper charts will be used to retrieve patient information. Historical and prospective patients will be assessed through referrals to the Medical Genetics Department.

It is estimated that there are around 200 historical patients and 20-40 prospective patients annually.

A patient and healthcare provider symposium is planned for 2024 to explore how the information collected in the database can be utilized to improve patient care. This engagement event is crucial to understand what is important to patients, families and healthcare providers.

Conclusion: The development of a patient database will support qualitative improvement projects and research regarding pediatric CPS. The database is a stepping stone to a defined and resourced care pathway for CPS patients, allowing equitable and consistent care to be provided across British Columbia.

--- 2023 Poster Participants ---

SESSION #2 Poster #18A

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Layan Bashi

Master’s Student, University of British Columbia | Supervisor: Sharon Dell

Variability of Ventilation Outcome Measures using Hyperpolarized 129 Xenon MRI in Children with Primary Ciliary Dyskinesia Layan M. Bashi, Jonathan Rayment, Rachel Eddy, Sharon D. Dell

Primary Ciliary Dyskinesia (PCD) is a genetic disorder causing recurrent lower respiratory infections and lung damage.

Current lung function tests lack sensitivity for early detection, necessitating improved tools. Hyperpolarized 129 Xenon MRI (XeMRI) offers a sensitive technique for visualizing and quantifying lung ventilation using the Ventilation Defect Percent (VDP) as the primary outcome measure. However, XeMRI’s short-term variability in children with PCD is unestablished. This study aims to: (1) Investigate and compare VDP variability in healthy children and PCD patients; (2) Evaluate VDP against existing breathing tests; and (3) Assess the relationship between VDP variability and changes in PCD quality of life questionnaire scores.

This observational study will recruit 15 PCD participants and extract data from 10 healthy controls from a XeMRI registry.

Two study visits will be conducted, separated by 28 days, procedures include Spirometry, Multiple Breath Washout (MBW) testing, Xenon MRI, and a PCD quality of life questionnaire. VDP will be generated using a semi-automated k-means clustering approach. Baseline characteristics will be summarized using descriptive statistics, and statistical tests will determine VDP variability and compare it with secondary measures.

Drawing from similar pediatric cystic fibrosis study designs, we anticipate increased VDP variability in children with PCD, with values comparable to current clinical outcome measures, and associations with the PCD quality of life questionnaire scores.

This study aims to establish XeMRI as a tool for monitoring lung function in children with PCD, determining whether differences in VDP are typical or clinically significant. The results will facilitate clinical translation of XeMRI technology for pulmonary function monitoring and its application in patient care. The findings will be relevant as a novel PCD drug undergoes clinical trials. In conclusion, this research has the potential to enhance PCD management and contribute to the development of effective treatment strategies for this rare genetic disorder.

--- 2023 Poster Participants ---

SESSION #3: BASIC SCIENCE

Moderator: Amanda Nitschke

10:00 – 11:30 AM In-Person: Chieng Family Atrium

Participants: Pamela Bai Viviana Li Heather Lu Solana Redway-Ziola Samuel Salitra Liam Stanley Selina Sun Sarah Zhang Zurui Zhu

SESSION #3 Poster #19

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Pamela Bai

Undergraduate Student, University of British Columbia | Supervisor: Stefan Taubert

Investigating the role of efk-1/eEF2K in translation regulation in the C. elegans starvation response Pamela Bai, Judith Yan, Stefan Taubert

Background: Aberrant activation of cellular stress response pathways is prevalent in pediatric cancers and childhood diabetes. Specifically, many cancers feature inappropriate activation of the starvation response regulatory kinase, efk-1/eEF2K. In cancer cells, efk-1/eEF2K promotes acute starvation survival by phosphorylating its target EEF-2/eEF2 and thus attenuating translation elongation. efk-1/eEF2K is also known to attenuate translation initiation by phosphorylating eIF2a during prolonged oxidative stress. To study how efk-1/eEF2K promotes starvation survival, we use the genetic model organism C. elegans. In the nematode worm C. elegans, efk-1/eEF2K is conserved in its ability to phosphorylate EEF-2/eEF2 and to promote starvation survival. However, it is unknown whether efk-1 promotes starvation survival through the canonical pathway of EEF-2/eEF2 phosphorylation, and/or via the alternative mechanism of eIF2a phosphorylation.

Hypothesis: I hypothesize that the kinase efk-1 promotes starvation survival by phosphorylating translation factors eEF2 and/or eIF2a to decrease translation elongation and/or initiation, respectively.

Methods: Wild-type and efk-1 mutant worms were either fed or starved acutely for 8 hours before extracting protein samples. Western blotting was used to quantify expression levels of EEF-2, phospho-EEF-2 (p-EEF-2), p-eIF2a, and tubulin, which were visualized via film and chemiluminescence imaging (Vilber Fusion FX). Normalized EEF-2, p-EEF-2, p-eIF2a levels were quantified in ImageJ. The experiment was also performed in wildtype C. elegans starved chronically for 0, 4, and 9 days.

Results: Consistent with mammalian data, p-EEF-2 is solely dependent on efk-1 in unstressed conditions. However, in 8-hour acutely starved wild-type C. elegans, p-EEF-2 levels did not increase and p-eIF2a levels increased slightly. In 4 and 9-day chronically starved C. elegans, p-EEF-2 levels significantly decreased with starvation duration, while p-EIF2a levels slightly increased.

Conclusions: In C. elegans, efk-1 may not regulate starvation survival by p-EEF-2 induction either in acute or chronic starvation. It is possible that efk-1 promotes starvation survival via p-eIF2a induction instead. To test this, we will quantify p-eIF2a levels in chronically starved efk-1 mutant C. elegans in the future. We will also use CRISPR to construct a kinasedead efk-1 mutant to determine if efk-1 kinase activity is required for starvation survival.

Congratulations to Pamela on receiving a UBC Faculty of Medicine Summer Studentship & NSERC Undergraduate Student Research Awards

--- 2023 Poster Participants ---

SESSION #3 Poster #20

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Viviana Li

Undergraduate Student, Johns Hopkins University | Supervisor: Dan Goldowitz

The Role of Mab21l1 in Cerebellar and Neurodevelopmental Disorders Viviana Li, Dan Goldowitz, Joanna Yeung

Background: Pax6 is a master control gene in several regions of development and is a transcription factor that regulates downstream target genes. A recent single-cell RNA-sequence analysis examining the transcriptome of Pax6 and Pax6null cerebellum found that Mab21l1 is expressed in glutamatergic lineages, including the granule cells in the developing cerebellum. In addition, the gene expression of Mab21l1 is downregulated in organisms that lack Pax6, suggesting that it is normally under the control of Pax6. Earlier work of the parental gene Mab21 has shown its expression in the developing mouse cerebellum; however, more detailed studies have yet to examine the developmental role of Mab21l1.

It is recognized that the Mab-21 family of proteins is involved in cell fate determination, regulation of cell proliferation and differentiation in the developing nervous system. A rare human genetic disorder that includes intellectual disability and cerebellar hypoplasia is identified as a mutation in Mab21l1 causing cerebral, occipital, craniofacial, genital (COFG) syndrome, potentially due to an impairment of the TGF-β/BMP pathway.

Objective: This project examines the developmental expression of the Mab21l1 gene and the role it may have regarding cerebellar development in the mouse, highlighting potential cerebellar and neurodevelopmental disorders that could arise from deficiencies of this gene. This is achieved by analyzing the gene interactions and identifying the regulatory targets of Mab21l1 in the developing cerebellum.

Methods and Analysis: To investigate the relationship between Mab21l1 and Pax6, cerebella dissected from wildtype and Pax6-null mutant mice at varying ages will be examined using in situ hybridization (ISH) and immunohistochemistry (IHC) techniques to determine the spatial expression of Mab21L1 transcript and protein, respectively. The potential downstream target genes of Mab21L1 will be explored using bioinformatics analysis, and the top candidate will be further studied using ISH or IHC. Outcomes: Through the application of bioinformatics, it is discovered that Mab21l1 mRNA can regulate the BMPmediated pathway during ocular development. This finding can apply to its role in the cerebellum as BMP4 is a key regulator in neuronal development from neural precursor cells in the embryonic, postnatal, and injured CNS. Although several downstream genes of Mab21l1 have been determined, more information is needed to analyze the role of Mab21l1 in the cerebellum.

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

--- 2023 Poster Participants ---

SESSION #3 Poster #21

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Heather Lu

Undergraduate Student, University of British Columbia | Supervisor: Clare Beasley

Effects of Exercise and the Antipsychotic Drug Olanzapine on Microglia in the Hippocampus of Rats Heather Lu, Clare Beasley

Background: Schizophrenia is a mental disorder that is characterized by the presence of psychosis and commonly develops in late adolescence or early adulthood. Decreased volume of the hippocampus, a brain region essential for learning and memory, has been associated with this disorder. Antipsychotic medications, such as olanzapine, are used to treat schizophrenia, but can have adverse effects such as weight gain. We have previously reported that olanzapine decreases hippocampal volume in sedentary rats, and that exercise prevents this volume loss. Notably, lower hippocampal volume is correlated with increased abdominal fat. While the biological causes of olanzapine-associated hippocampal volume loss and the prevention of volume loss by exercise remain unknown, there is evidence that exercise reduces hippocampal inflammation in rats. Since excess abdominal fat is associated with neuroinflammation, these observed volume changes could implicate brain immune mechanisms.

We hypothesize that olanzapine reduces hippocampal volume via increased density and activation of microglia, brain cells that mediate neuroinflammation. We further propose that exercise decreases microglial density and activation, alleviating olanzapine-induced inflammation.

Objective: To determine whether microglial density and activation are increased in the dentate gyrus of the hippocampus of rats following olanzapine treatment, and if microglial density and activation are ameliorated by exercise.

Methods: In a previous study, rats were administered olanzapine or vehicle, and assigned to running wheel exercise or sedentary conditions for 9 weeks. In the current project, light microscopy images of hippocampal tissue sections from these rats, stained for the microglial marker IBA-1, were analyzed. The areas of the granule cell layer and subgranular zone of the dentate gyrus and microglia count were quantified using Image-Pro software. Microglial density was calculated as the microglia count per unit area for each region.

Results: Results are currently being analyzed.

Conclusion: Findings from this study will contribute to the understanding of the effects of chronic antipsychotic use.

This may lead to improved medications or therapeutic treatments, such as exercise, for individuals with schizophrenia.

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

--- 2023 Poster Participants ---

SESSION #3 Poster #22

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Solana Redway-Ziola

Undergraduate Student, University of Waterloo | Supervisor: Todd Woodward

How important are task diagrams for interpreting HDR shapes?

Solana Redway-Ziola, Todd Woodward

Background/Introduction: Hemodynamic responses (HDR) from Blood Oxygen Level Dependent (BOLD) signalling are generated from brief stimuli that are dependent on changes in blood flow, volume and oxygenation. BOLD is the technique used in fMRI to generate images and the HDR shapes. BOLD signalling is used while participants complete tasks in order to measure changes in different areas of brain activation. Task diagrams are created to visually represent the flow of the task-based event and the step-by-step breakdown of the process that the participant undertakes.

Purpose: The purpose of the analysis is to determine and communicate the importance of task diagrams as a tool to interpret HDR shapes from BOLD signalling.

Methods: Previous task-based experiments that produced a HDR curve from BOLD signalling were analyzed. For example, we studied experiments that tested paired associates memory encoding, memory recall and imagination, and working memory. Then by comparing the HDR shapes with the task diagrams specific to each task, we were able to compare the changes to the curve that correlates to what is happening in the task.

Significance: It is difficult to understand the HDR curve without the use of task diagrams. Task diagrams allow us to better determine the specific reason for the changes of the HDR shape. We have improved the prior task diagrams to include specific breakdowns of the time interval of the task as a step-by-step process. This update allows for a more concise reasoning of changes in neural network activation. For example, in the Functional Brain Networks Underlying Memory Recall and Imagination study, there was a rise in the estimated HDR signalling. This increase was correlated to the same time interval that individuals were instructed to press buttons, including during the completion of the rating scales. Therefore, by using this task diagram, we were able to show that the reason for the increased estimated HDR was because of the increase in interacting stimuli in the environment that required them to pay attention. Overall, task diagrams can help clearly communicate results of an experiment, especially ones that use HDR shapes, and for that reason it can be a significant tool in scientific research.

--- 2023 Poster Participants ---

SESSION #3 Poster #23

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Samuel Salitra

Undergraduate Student, University of British Columbia | Supervisor: Gregor Reid

Long-term Co-Culture as a Model of B-ALL Leukomogenesis Samuel Salitra, Tanmaya Atre, Ali Farrokhi, Gregor Reid

B-cell Precursor Acute Lymphoblastic Leukemia (B-ALL) is the most common pediatric malignancy, accounting for roughly 25% of childhood cancer diagnoses in Canada. Almost one third of cases present with the hyperdiploid sub-type (HDALL), making it the single largest contributor to ALL incidence peak in 3-5 year-olds. HD-ALL begins in-utero, where B-cell precursors acquire chromosomal abnormalities, arresting their development and giving rise to a small population of clinically silent Leukemia-initiating-cells (LIC). Subsequent oncogenic events transform the LIC into a malignant state, initiating a program of uncontrolled proliferation in the bone marrow, blood, and extra-medullary sites Our lab has established that HD-ALL LIC can be sustained for many weeks by co-culture on bone marrow stromal cells (BMSC). These extended cultures may be sufficient to observe transformation of LIC into HD-ALL cells for the first time in vitro. However, a standardized analysis of this transformation has not been conducted and the associated mechanisms remain unclear. To address this, we performed a longitudinal analysis of LIC in long-term co-culture with BMSC. LIC isolated from the bone marrow and spleen of mice predisposed to HD-ALL were seeded on established BMSC cultures. Cell number, viability, and immuno-phenotypic markers were recorded weekly periods of up to 3 months.

Transformation was then characterized using cell surface marker expression, IL-7 dependence, and adoptive transfer experiments.

LIC tended to remain stable in number and viability throughout the first month of co-culture, which was subsequently followed by a period of expansion in month 2. Prior to day 35, 0/11 co-cultures had doubled in cell number. However, by day 50, 5/9 co-cultures exhibited increases in cell number greater than 2x their number at day 35. Changes in cell number corresponded to a shift away from the baseline LIC immunophenotype.

Ex-vivo murine LIC and leukemic cells are also currently being compared to LIC at multiple timepoints in-vitro via bulk RNA-sequencing. These analyses will allow further insight into the changes undergone by LIC in our new in-vitro model of leukemogenesis. This would improve our understanding of HD-ALL biology and facilitate the discovery of points at which the disease can be arrested.

Congratulations to Samuel on receiving a BC Children’s Hospital Research Institute Summer Studentship, UBC Faculty of Medicine Summer Studentship, Andy & Lena Chabot Studentship for Undergraduates, Cancer Research Society

--- 2023 Poster Participants ---

SESSION #3 Poster #24

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Liam Stanley

Undergraduate Student, McGill University | Supervisors: Heather Denroche & Bruce Verchere

Antigen presentation and T cell responses to multicargo lipid nanoparticles in type 1 diabetes

Liam Stanley, Lindsay P. Pallo, Victoria Ng, Sam Chen, Yuen Yi C. Tam, Heather C. Denroche, C. Bruce Verchere Type 1 diabetes mellitus (T1D) is an autoimmune disease caused by the destruction of insulin-producing beta cells in the pancreas by auto-reactive T cells that recognize and target multiple beta-cell epitopes. These T cells are activated by antigen-presenting cells (APCs) presenting beta-cell antigens in an inflammatory context. Tolerogenic APCs that present the same beta-cell antigens and immune-regulatory signals to autoreactive T cells can induce immune tolerance responses in these T cells and are a promising therapeutic approach for T1D. Our preliminary data has shown that co-delivery of mRNA-encoded diabetes antigens and immune modulators to APCs using lipid nanoparticles (LNPs) delays diabetes in the NOD mouse model of T1D. We hypothesize that LNPs co-delivering diabetes autoantigens and immune modulators induces tolerance responses in antigen-specific T cells. We are testing this hypothesis by 1) validating presentation of mRNA-encoded antigen by APCs in vitro and 2) assessing T cell responses to LNP-treated APCs. To achieve these aims we are using in vitro proliferation assays in which bone marrow-derived dendritic cells are treated with LNPs carrying mRNA-encoded antigens with/without immune modulators. These cells are then cocultured with antigenspecific or polyclonal CD4 helper T cells or CD8 cytotoxic T cells, before proliferation of T cells is measured using flow cytometry. Expected results should show that the APCs presenting mRNA-encoded antigens without immunomodulators induce high levels of antigen-specific T cell proliferation. We also expect that presentation of the same antigens co-delivered with immune modulators will reduce antigen-specific T cell proliferation. In addition we anticipate that antigen and immunomodulator co-delivery may induce regulatory T cells.​​

--- 2023 Poster Participants ---

SESSION #3 Poster #25

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Selina Sun

Undergraduate Student, New York University | Supervisor: Wyeth Wasserman

Identifying Enriched Terms in PubMed Abstracts for Distinct Transcription Factors using Advanced Natural Language Processing and Machine Learning Techniques Selina Sun, Wyeth Wasserman

Background: With an ever-expanding pool of articles published on PubMed, manual curation and synthesis of knowledge regarding specific genes has become a challenge. Leveraging Natural Language Processing (NLP) tools and Machine Learning algorithms, we can now efficiently process vast amounts of data and extract insightful data profiles and conclusions from a multitude of articles.

Objective: This study seeks to identify terms that are significantly enriched in a foreground corpus (a set of documents pertaining to a specific transcription factor) compared to a background corpus (documents pertaining to any transcription factor).

Methods: In the initial stages of data pre-processing, we utilized SciSpacy for lemmatizing words from PubMed abstracts and stored the structured information in a MongoDB database. Acknowledging a Class Imbalance problem (i.e., far fewer foreground articles than background ones), we investigated mitigative strategies such as Synthetic Minority Over-sampling Technique (SMOTE) and assigning class weights. Subsequent to this, we experimented with a variety of analytical techniques and tools, including performing Chi-Square tests to identify enriched terms. Further, we leveraged Term Frequency-Inverse Document Frequency (TF-IDF) calculations to generate an alternate set of outputs. Several Machine Learning techniques, including Random Forest, eXtreme Gradient Boosting (XGBoost), Logistic Regression, and Multinomial Naive Bayes were employed to yield distinct results. We used scikit-learn’s Grid Search method for model hyperparameter tuning, with F1 scores set as the target for optimization. The enriched words were identified through feature importance analysis in the Machine Learning algorithms. For non-interpretable algorithms, we employed SHAP (SHapley Additive exPlanations) to generate graphical interpretations.

Significance: One goal of this study is to generate a Word Cloud visualization for each human transcription factor, grounded on relevant PubMed articles. These visualizations can offer concise, yet comprehensive overviews of specific transcription factors, hence providing a time-efficient strategy for researchers to gain knowledge regarding individual transcription factors. Future works will incorporate these same transcription factor data profiles into knowledge relationship graphs well suited to modern artificial intelligence methods.

--- 2023 Poster Participants ---

SESSION #3 Poster #26

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Sarah Zhang

Undergraduate Student, University of British Columbia | Supervisor: Bruce Verchere

Immune response to lipid nanoparticle delivered therapies in type 1 diabetes

Sarah Zhang, Victoria Ng, Lindsay P. Pallo, Sam Chen, Yuen Yi C. Tam, Heather C. Denroche, C. Bruce Verchere In type 1 diabetes (T1D), antigen presenting cells including dendritic cells (DCs) activate effector T cells against autoantigens produced by insulin-producing beta cells. Lipid nanoparticle (LNP) technology provides a method of antigen-specific immunotherapy for autoimmune diseases by enabling drug delivery to antigen presenting cells, with the goal of inducing immune tolerance and reducing the need for broad immunosuppression. We hypothesize that LNPs delivering immune modulators and mRNA encoded T1D autoantigens can tolerize DCs to promote the proliferation of regulatory T cells (Tregs).

Using a T1D mouse model, 7-week-old NOD mice were intraperitoneally immunized with either vehicle or LNP formulations containing 5 µg mRNA, either with or without immune modulators. When mice turned 9 weeks old, spleens were collected for flow cytometry to quantify Tregs and immune markers of tolerance, including cytotoxic T-lymphocyte associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1). Treatment groups receiving T1D antigen had an increased frequency of CD25-FoxP3+ Treg and PD-1+ T cells compared to irrelevant antigen- and vehicle-injected control groups. This indicates that LNPs carrying T1D autoantigen and immune modulators induce Tregs, providing insight into their mechanism of action. Future studies will investigate whether repeated immunizations can induce a more robust Treg response and measure additional T cell populations, such as Tr1s, that play a key role in establishing immune tolerance.

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

--- 2023 Poster Participants ---

SESSION #3 Poster #27

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Zurui Zhu

Undergraduate Student, University of British Columbia | Supervisor: Jonathan Bush

Development of Rhabdoid Tumor Patient-Derived Xenografts Using the Chorioallantoic Membrane System Zurui Zhu, Tariq Bhat, Seohee An, Jonathan Bush

Background: Rhabdoid tumors are highly aggressive tumors that typically occur in infancy in the brain (called atypical teratoid/rhabdoid tumors), and in the kidneys and soft tissues (called malignant rhabdoid tumors). Unfortunately, patient samples of rhabdoid tumors are difficult to obtain because these tumours are often not suspected at the time of triaging and are not encountered frequently. Collaboration with the Bush and Lim lab has developed a unique, first-inCanada pipeline for pediatric tumor cryopreservation and the development of patient-derived xenografts (PDXs) using the chorioallantoic membrane (CAM) system which allows propagation of tumor tissue for expanded experimental use.

This system has been optimized using more common tumors, including non-viably frozen tumor samples, and we aim explore the role of CAM as a method to develop PDXs of rare tumors from a clinical archival collection that are not viably cryopreserved.

Aims: 1. Demonstrate that the CAM system is suitable for PDX development using snap frozen rhabdoid tumor samples.

2. Describe the histologic appearance of rhabdoid tumors modeled in the CAM system.

3. Understand the tumor differences between CAM generated PDX tumors at various CAM passages.

Methods: Snap frozen samples from 4 different types of rhabdoid tumours were implanted into CAMs and grown for five days. Tumours from the CAMs are then made into formalin-fixed paraffin-embedded (FFPE) tissue specimens or directly implanted into a new CAM for the next passage. For each passage, FFPE specimens are collected and sectioned to obtain slides which are stained using hematoxylin and eosin (H&E) staining or immunohistochemistry (IHC) for the identification of tumour cells.

Results: Preliminary results show viable tumour cells for a rhabdoid tumour sample in the first passage according to H&E staining and IHC. H&E staining and IHC will also be performed on the other tumour samples as well as the same tumour sample from later passages to understand the tumour differences between different passages.

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

--- 2023 Poster Participants ---

SESSION #4: CLINICAL

Moderator: Thais Rangel Bousquet Carrilho

10:00 – 11:30 AM In-Person: Chieng Family Atrium

Participants: Farah Tabassum Azim Rachel Bates Kate Borgert Naomi Choong Jasleen Grewal Setareh Setayesh Jack Pearce Wong Cindy Zhang

SESSION #4 Poster #28

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Farah Tabassum Azim

Undergraduate Student, University of British Columbia | Supervisor: Tim Bhatnagar

A Novel Use of Motion Capture to Quantify Kinematic Changes Following myoActivation® Therapy

Farah T. Azim, Karen Davies, Diane Wickenheiser, Mona Behrouzian, Gail Jahren, Nicholas West, Lise Leveille, Gillian R. Lauder, Tim Bhatnagar Introduction: The Complex Pain Service (CPS) interventional care team at BC Children’s Hospital is a multidisciplinary service which provides holistic pain management for pediatric patients. Children with chronic myofascial pain are offered myoActivation® treatment as part of routine clinical care. MyoActivation® is comprised of (i) movement tests to assess pain and range of motion (ROM), and (ii) a needling technique to activate muscles, release fascial restrictions and/or scar tissue. Following treatment, an immediate change in ROM is observed which has previously not been quantified in an objective manner.

Aim: To demonstrate the use of motion capture to objectively quantify changes in participant ROM and speed of motion during the myoActivation® movement tests.

Methods: Five participants were recruited as part of this non-randomized, longitudinal pilot study (REB #H20-00463) to receive myoActivation® in The Motion Lab at Sunny Hill Health Centre. The number and location of myoActivation® treatments received were individualized based on each participant’s unique pain history. The myoActivation® movement tests were performed at baseline and after all interventions. These movements were collected and analyzed using motion capture technology with a 12-camera marker based Qualisys motion capture system and Visual3D. Due to the unique nature of the treatments received, participants served as their own control and no statistics and effect size calculations were performed.

Results: Five females of median age of 16 (16-18 years) were included and all participants were experiencing chronic pain for over a year. The CPS physician performed a qualitative assessment to assess any changes in ROM for each participant.

The following two tests were predicted to change for all participants: extension arms down and flexion arms down.

Most participants demonstrated a significant improvement in ROM and speed in performing the movements.

Discussion: This study demonstrated the feasibility of using clinical motion analysis to provide an objective and quantitative measure of assessing myoActivation®. The improvement in ROM and speed was quantified using motion capture technology. Findings from this study warrant a need for a larger clinical trial to perform further analyses.

Congratulations to Farah on receiving a BioTalent Canada Award

--- 2023 Poster Participants ---

SESSION #4 Poster #29

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Rachel Bates

Undergraduate Student, University of British Columbia | Supervisor: Gillian Lauder

The effect of intravenous lidocaine infusion on intraoperative neurophysiological monitoring in adolescents during surgery for idiopathic scoliosis correction; a retrospective study Rachel Bates, Fiona Cave, Bradley Hofmann, Nicholas West, Jeffrey N. Bone, Firoz Miyanji, Gillian Lauder

Purpose: Posterior spinal instrumentation and fusion (PSIF) is a common surgery at BC Children’s hospital for the correction of adolescent idiopathic scoliosis. Intraoperative neurophysiological monitoring (IONPM) assesses intraoperative spinal cord function during PSIF. IONPM includes the monitoring of Somatosensory Evoked Potentials (SSEPs) and Transcranial Electric Motor Evoked Potentials (MEPs). IONPM can be affected by some anesthetic agents.

Intravenous lidocaine therapy is used to improve postoperative pain and minimize opioid requirements following adolescent PSIF procedures. However, its effect on IONPM during adolescent scoliosis surgery is unknown.

Objective: To investigate the effect of intravenous lidocaine infusion on monitoring of SSEPs and MEPs during adolescent scoliosis surgery.

Methods: This was a retrospective study of single-stage PSIF procedures between January/2012 and February/2021 with data abstracted by chart review. Anesthetic and surgical information, IONPM events and hourly snapshots were retrieved for each patient from archived data held within the neurophysiology department. A reportable event was defined as a decrease of 50% MEP or SSEP amplitude from baseline or an increase of 10% SSEP latency from baseline. Number of IONPM events and hourly snapshot changes from baseline for upper and lower limb MEPs and SSEPs were compared between two groups: 1) patients who received intraoperative lidocaine infusion and 2) a random sample of controls who did not receive a lidocaine infusion.

Results: Data were available from 39 cases with lidocaine infusion and 42 cases with no lidocaine infusion. Of these, 60 were female (75.9%), and the median age [interquartile range] was 14.0 [12.2-15.0] years. Out of all recorded reportable events, 25/55 (45.4%) occurred in patients receiving lidocaine and 30/55 (54.5%) occurred in patients who did not receive lidocaine. Median time to first event was similar between groups (Hazard Ratio[HR]=1.13,95%CI,0.61-2.09).

Hourly snapshot data showed no significant effect of lidocaine on MEP amplitudes in both lower (median difference [MD]41.91,95%CI,-304.46-388.27;p=0.182) or upper limbs (MD-279.00,95%CI,-562.45-4.44;p=0.054), and no effect on SSEP amplitudes in lower (MD16.41,95%CI,-17.68-50.50;p=0.345) or upper limbs (MD-2.37,95%CI,-14.51-9.76;p=0.701).

Conclusion: We found no detriment of intraoperative lidocaine infusion on IONPM during adolescent idiopathic scoliosis surgery. Despite limitations associated with the retrospective nature of the study, these findings suggest appropriate variables and design considerations for a subsequent prospective randomized controlled trial.

Congratulations to Rachel on receiving a Biotalent Canada Award

--- 2023 Poster Participants ---

SESSION #4 Poster #30

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Kate Borgert

Undergraduate Student, Queen’s University | Supervisor: William T. Gibson

Genotype-Phenotype Correlations in SETD1B-Related Neurodevelopmental Disorder Kate Borgert, William Gibson

Background: Disease phenotypes can be influenced by both genetic and environmental factors. Such genotypephenotype correlations can predict physical characteristics or abnormalities an individual with a particular mutation may display. SETD1B is a histone methyltransferase within an epigenetic regulatory complex called Complex Protein Associated with Set1 (COMPASS). The COMPASS complex directs the methylation of histone 3 at lysine 4s. Rare variants in the SETD1B gene can hinder the protein functionality causing altered gene transcriptional programming with downstream effects. This disease state is referred to as SETD1B-related neurodevelopmental disorder (SETD1B-NDD).

While there is large phenotypic heterogeneity in SETD1B-NDD, global developmental delay, intellectual disability, and seizures are commonly observed in these patients.

Objective: To find genotype-phenotype correlations in SETD1B-NDD. Methods: To expand our understanding of SETD1B-NDD disease phenotypes, we conducted interviews with newly identified patients and their families referred throughout the globe to our lab. To find possible unique genotypephenotype correlations, we plan to identify the regional variation within SETD1B with the heterogeneity and severity of patient phenotypes. Additionally, we are planning to collect whole blood samples from patients and perform long-read whole genome sequencing to create an epigenome-wide profile of SETD1B. Preliminary Results: To date, we have identified several unique phenotypes, including early puberty and recurrent pre-cancerous nevi.

Significance: Creating an epigenome-wide profile of SETD1B will help identify epigenetic changes induced by rare variants and give more insight into the downstream effects that result in SETD1B-NDD disease phenotypes. By characterizing genotype phenotype correlations in SETD1B-NDD, personalized patient management plans will be better informed, leading to increased quality of life for SETD1B-NDD patients.

--- 2023 Poster Participants ---

SESSION #4 Poster #31

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Naomi Choong

Undergraduate Student, University of British Columbia | Supervisor: Jaime Guzman; Rheumatology Research Team

The Relationship of Fatigue, Pain Interference and Physical Disability in Children Newly Diagnosed with Juvenile Idiopathic Arthritis: Results from the CAPRI Registry Naomi Choong, Michelle Batthish, Roberta Berard, Gaëlle Chédeville, Jean-Philippe Proulx-Gauthier, Jaime Guzman

Background: Juvenile idiopathic arthritis (JIA) is the most prevalent childhood rheumatic disease worldwide and characterized by persistent joint inflammation. Despite effective contemporary treatments, children with JIA often suffer from pain, fatigue and physical disability. Studies show that fatigue can have a negative impact on pain intensity and functional ability. Pain interference has also been associated with physical disability. However, there is a lack of knowledge on the relationship between fatigue and pain interference in JIA. Additionally, the mechanisms by which pain interference and physical disability are related are not clear.

Objective: To investigate whether there is a significant relationship between fatigue and pain interference, and test whether fatigue mediates the relationship between pain interference and physical disability.

Methods: Data from the Canadian Alliance of Pediatric Rheumatology (CAPRI) Registry collected from newly diagnosed JIA patients between February 2017 and February 2023 was analyzed. Physical disability, fatigue, and pain interference were measured using standardized parent-proxy questionnaires. Relationships between variables were analyzed using Pearson’s correlation and multiple linear regression. Structural equation modeling (SEM) will later be used to test if fatigue mediates the relationship between pain interference and physical disability.

Results: The study included 855 patients, 61% female, with a median age of 9.3 years at enrollment. The most frequent JIA category was oligoarthritis (44%). Fatigue was significantly and strongly correlated with pain interference (r = .72, p < .001, 95% CI [.69, .75]) and physical disability (r = .60, p < .001, 95% CI [.55, .65]). Pain interference was also strongly associated with physical disability (r = .63, p < .001, 95% CI [.60, .67]). After adjusting for confounders, fatigue (b = .028, p < .001), and pain interference (b = .040, p < .001) both independently predicted physical disability. In a model where fatigue and pain interference were adjusted for each other and confounders, pain interference (b = .028, p < .001) was a stronger predictor of physical disability than fatigue (b = .013, p < .001). The R2 value for this model was 0.53. The larger drop in the fatigue beta coefficient when pain interference was included in the regression suggests it may be a mediator.

SEM analysis to investigate mediation fully is ongoing.

Implications: Findings from this study provide insight into the importance of assessing and addressing fatigue and pain interference in clinical settings to mitigate physical disability in the early stages of JIA.

--- 2023 Poster Participants ---

SESSION #4 Poster #32

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Jasleen Grewal

Undergraduate Student, Queen’s University | Supervisor: Suzanne Vercauteren

Electronic vs. Paper: Participant Satisfaction with Informed Consent for Biobanking Jasleen Grewal, Veronica Chow, Ashton Ellis, Jonathan Bush, Suzanne Vercauteren

Background: Human biospecimens, linked with medical health records, enable researchers to conduct a diverse range of genetic or biomarker studies. Patients undergoing collection procedures at BC Children’s Hospital, and caregivers on their behalf can consent to donate extra or left-over samples to the BioBank where they are de-identified, cryopreserved, and stored for future ethically-approved research. Recently, the BCCH BioBank has adopted an electronic consent method for participant recruitment. Traditionally, biobanks have recruited patients through targeted mailings, in-person encounters with research assistants, or opt-out methods. Mailing and in-person recruitment strategies are effective but are timeconsuming and expensive to scale in terms of personnel and resources.

Objective: The study will explore and compare patient engagement and satisfaction with electronic informed consent and traditional paper consent methods for sample collection at the BCCH BioBank. Through survey responses, the study aims to better understand participant reasoning for selecting paper or electronic consent platforms and characterize participants’ experiences based on their choice. Recognized barriers to biobank participation include literacy and language, age, cultural differences, and public distrust. Through data collection and survey analysis, the aforementioned barriers can be studied in the electronic consent process and compared to traditional consenting to improve participant recruitment and satisfaction.

Methods: Upon initiation of the BCCH BioBank in-person consent process, every patient is given a choice of paper or electronic consent platforms. After participants consent to the BioBank they are invited to complete an anonymous voluntary e-consent opinion survey. Survey responses will be examined to track participant satisfaction, engagement, and perception of either choice of consent platform. Based on these results, recommendations will be made to improve or remodel consent delivery for the BCCH BioBank.

Significance: Informed consent for the research use of biospecimens and clinical data is an essential component of precision and translational medical research. Studies examining the implementation of electronic consent for biobanking in the pediatric or British Columbian setting are absent from the literature. Results from this project may identify issues relating to informed consent, diversification in sample collection, and scalability and cost-effectiveness of the process of biobanking recruitment for personnel and resources.

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

--- 2023 Poster Participants ---

SESSION #4 Poster #33

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Setareh Setayesh

Undergraduate Student, McGill University | Supervisor: Anamaria Richardson

Graphic Arts-based Thematic Analysis: A Novel Methodology to Promote Equity in Exams Under Anesthesia Setareh Setayesh, Elizabeth Nijdam, Aaron K. W. Ooi, Anamaria Richardson

Background: The Exams Under Anaesthesia (EUA) project is a quality improvement project seeking to better understand the process of EUAs for children with complex behaviours and promote health equity by identifying areas for improvement. Children with complex behaviours include those with autism, intellectual impairment, limited verbal capacity, and genetic syndromes. For these children, medical exams and interventions can be very difficult and result in aggression, self-injury, and bolting. Sedation is used to facilitate this process, but it can be very traumatic for children, caregivers, and clinicians. The investigators conducted interviews with parents of children with complex behaviours and collected data from patient chart reviews. As part of the knowledge translation, a parent partner was consulted to create a graphic representation of themes identified in the study. This artwork inspired inquiry into how we may be able to use graphic art as a methodology for thematic analysis of research.

Traditional knowledge creation in research often diminishes and excludes intersectional voices and knowledge translation lacks in its inclusion of a non-academic audience. The objective of this study is to explore new methodologies for thematic analysis of scientific research results with the goal of more authentic knowledge co-creation.

Methods: Graphic artists will be recruited based on criteria including self-identified understanding of the scope of the project and ability to quickly produce work, with priority given to autistic and Indigenous artists. Artists will be provided with 9 recorded and transcribed interviews from the previous study that have been anonymized and de-identified.

A workshop will be held to educate artists on the project and finished artwork will be displayed and open to public viewing.

Anticipated Outcomes: The project is exploratory, but we may be able to extract new themes from the data and gain knowledge about how alternative methodologies can be useful in knowledge co-creation.

Implications: Exposing alternative methodologies for knowledge co-creation can allow us to better extract information from data, particularly in order to amplify the voices of marginalised and fringe groups who often have a limited platform to communicate needs and issues.

--- 2023 Poster Participants ---

SESSION #4 Poster #34

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Jack Pearce Wong

Undergraduate Student, University of British Columbia | Supervisor: Jennifer Retallack

Exploring an Accessible Instant Video Telemedicine Tool to Support Pediatric Critical Care Triage and Transport During the 2022/2023 Pediatric Respiratory Surge Jack Pearce Wong, Adela Matettore, Jonathan Wong, Steven Brown, Jennifer Retallack

Background: In British Columbia (BC), the vast geography and centralized pediatric tertiary care services requires interfacility transfers to support patient care. These pediatric transports are coordinated through the pediatric intensive care unit (PICU) at BC Children’s Hospital in collaboration with BC Emergency Health Services Patient Transfer Network.

In 2022, a surge of pediatric respiratory illnesses overwhelmed existing resources and required rapid collaboration between health agencies. To support transport triaging and medical advice for pediatric patients requiring a higher level of care, GoodSAM Instant Help was rapidly piloted. This platform, widely used in pre-hospital settings, utilizes users’ own smartphones to facilitate two-way video via text link.

Aims: Review the rapid deployment of GoodSAM Instant Help to establish the foundation for continued usage.

Methods: A mixed methods approach was utilized with surveys for physician providers, transfer coordinators, and patient partners. Quantitative data from clinical systems, GoodSAM metrics and surveys were collected with qualitative survey data.

Results: During Nov 2022 - March 2023 consultations to the PICU Transport Advisors increased over 45% (167 compared 114 during the same time period the year prior). Eighty-one of these consultations used the GoodSAM video platform.

Surveys were completed by PICU physicians for 32 cases and demonstrated changes in the PICU physician’s perception of the acuity in 38% of responses, and that transport to a tertiary center was averted in 6 cases due to the video consultation. Some minor technical difficulties with the platform were identified. Family partner surveys (n=25) indicated 100% of those surveyed identified benefits of the integration of video into the consultation.

Discussion and Conclusion: This pilot study demonstrates the successful rapid deployment of GoodSAM within the context of pediatric critical care transfers. GoodSAM represents a relatively low barrier technology which can be widely distributed across a large geographic area and used to support emergency room and inpatient providers. Further evaluation of this technology within the context of pediatric interfacility transport and triage is needed. As this was a rapid implementation further robust analysis is ongoing and will supplement initial findings in determining clinical and operational benefits for the usage of this platform.

--- 2023 Poster Participants ---

SESSION #4 Poster #35

Watch In-Person: Thursday, July 27 | 10:00 - 11:30 am Chieng Family Atrium, BCCHR

Cindy Zhang

Undergraduate Student, University of British Columbia | Supervisor: Julie Robillard

How Does Social Media Impact Parent-Adolescent Communication?

Exploring Cultural Perspectives Mallorie T. Tam, Cindy C. Zhang, Julie M. Robillard

Background: Social media is ubiquitous in today’s society. Research shows it can have both positive and negative impacts on adolescents. However, few lines of inquiry have explored its impacts on family communication, which predicts many outcomes in adolescents including communication skills, self-esteem, and mental well-being. Family communication patterns theory, first proposed by McLeod and Chaffee (1972) postulates that families use different communication strategies to develop a shared reality. Given cultural differences in Canadian families, family dynamics, and attitudes toward social media, research and knowledge exchange in this area must also consider culture as a key factor.

Aim: To explore the cultural perspectives of parents and adolescents on the impact of social media on family communication.

Methods: We are conducting 45-minute Zoom interviews with adolescents and parents of adolescents of diverse cultural backgrounds (14 completed to date, 60 projected). The interviews are semi-structured around an interview guide and includes questions about cultural identity, social media use, family communication style, self-esteem, and mental well-being. Interview recordings will be transcribed and inductively analyzed using constant comparative thematic analysis. Identified themes will be mapped onto dimensions of the family communication patterns theory, using this framework to ground our understanding of communication patterns in multicultural families.

Results and Implications: The interview findings will contribute to deeper understandings of how social media, culture, and family communication interact and influence adolescent development and well-being. The study will also inform the next steps of this project, where we plan to hold co-creation workshops with adolescents and parents to develop a culturally sensitive resource for healthy social media use.

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

--- 2023 Poster Participants ---

SESSION #5: CLINICAL

Moderator: Becci Venema

1:30 – 3:00 PM Online: bcchr.ca/posterday

Participants: Maggie Chan Hannah Chang Mahnoor Faisal Rita Jin Caroline Ruus Simran Gill Chen Yu (Daisy) Sun Erica Zeng Serena Zhang Athena Li

SESSION #5 Poster #36

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Maggie Chan

Undergraduate Student, University of British Columbia | Supervisor: Danielle Decker

The Patient Facing Roadmap as a Tool for Overcoming Language Barriers in New Cancer Diagnosis Education Maggie Chan, Danielle Decker

Receiving a new cancer diagnosis is a challenging and overwhelming experience for pediatric patients and their families that involves many changes to their lifestyle. The experience is an even greater challenge for families who are English language learners (ESL). In such cases, parents and caregivers may not understand their child’s care and treatment as well as their peers who are fluent in English, thus presenting an additional barrier during their stay in the hospital.

After reviewing the current literature surrounding new cancer diagnosis education in ESL families, we found that there are few concrete solutions for breaking down language barriers even though the problem has been identified in multiple studies. Instead, studies suggest multiple methods of simple, culturally appropriate communication to improve the family’s understanding of their current situation and their care.

Our patient facing roadmap was developed to outline the education pathway that patients follow throughout their stay in the Oncology/Hematology/Bone Marrow Transplant (BMT) unit at BC Children’s Hospital. Information about the typical inpatient experience and feedback from several inpatient families were collected and used to create the roadmap.

The roadmap shows the different stages of information patients will encounter and learn about throughout their stay, from the time of admission to the time of discharge. Within each stage, there are sub-topics so that the patient is aware of what they should be educated on and can evaluate their progress. Ultimately, the aim of the roadmap is to ensure that ESL patients and their families can receive care in a way that is accessible to them. Eventually, the patient facing roadmap will be available as a resource for all patients throughout their hospital stay.

--- 2023 Poster Participants ---

SESSION #5 Poster #37

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Hannah Chang

Undergraduate Student, University of Toronto | Supervisor: Mor Cohen-Eilig

The role of intersectionality in identity formation of young adults with ASD Hannah Chang, Mor Cohen-Eilig

Background: Autism spectrum disorder (ASD) is a developmental disorder characterized by social communication impairment and repetitive behaviors. While ASD prevalence has greatly increased, the development of personal, subjective perceptions of identity among autistic individuals remains unclear. Clinicians and families often struggle deciding when and how to disclose ASD diagnosis to the individual themselves. Identity is closely linked to mental health, and especially for ASD in which masking can lead to poor mental health outcomes. Thus it is important to understand how ASD identity develops and how diagnostic pathways may affect this process. Gender dysphoria (GD) is the distress from the incongruence between gender identity and assigned sex at birth. While GD is often found comorbid with ASD, how this cross-sectionality creates unique implications for this particular population has yet been studied. In addition, external social-cultural factors may affect the development of both ASD and gender identities.

Study Purpose: The goal of this study is to investigate how ASD diagnostic pathway, intersectionality between ASD and gender identity development, and cultural influences may impact identity formation, mental health, and functionality of autistic individuals. This study will help establish guidelines on diagnosis disclosure process, and meaningful interventions to support healthy identity development.

Methodology: We will recruit 20-30 young-adults (age>16) who are diagnosed with ASD. The study will be conducted in two stages. First, quantitative data will be collected through an online survey that will include various scales to measure autistic phenotype, gender identity, mental well-being, and level of social support. In the second stage, we will create an individual “intersectionality map” for each participant and conduct a semi-structured online interview.

Future Directions: This project is in the progress of solidifying study protocol for submission to the ethics board within the next month. Participant recruitment and data collection is scheduled to begin in the fall. Expected outcome will be an in-depth understanding on the role of intersectionality in the diagnosis pathway. We predict that a comprehensive disclosure and understanding of the factors affecting identity will lead to more positive perceptions of autistic individuals and higher functionality in society.

--- 2023 Poster Participants ---

SESSION #5 Poster #38

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Mahnoor Faisal

Undergraduate Student, University of British Columbia | Supervisor: Hal Siden

Optimizing the Management of Pain and Irritability in Children with Severe Neurological Impairment Mahnoor Faisal, Hal Siden, Anne-Mette Hermansen

Background: The PIUO study focuses on serving children with severe neurological impairment (SNI) who are typically non-verbal, non-mobile, and cognitively impaired. These children often experience pain and irritability daily, yet the source of their discomfort is difficult to identify because they are non-verbal. Many primary caregivers have expressed their concern regarding this matter and instead rely on behavioural observations such as grimacing or vocalizations to assess their child’s pain. New research has also demonstrated that individuals with intellectual disabilities may be more sensitive to painful stimuli, but physicians still have no standardized method for treating them.

Objective: Our team believes that the lack of a standardized approach for investigating and managing pain and irritability of unknown origin (PIUO) contributes to the persistence of pain in this population. To address this issue, this study uses a systematic approach for assessing the treatment of pain and irritability called the PIUO Pathway.

Method: This study tests children aged 6 months to 18 years with severe neurological impairment and who have PIUO. The PIUO Pathway consists of a series of tests and treatments that first look at the patient’s history and then conduct a physical exam, followed by screening tests, and then pharmacology to treat the pain.

Results: The Pathway has produced 30% of resolved or identified pain. It may streamline pain management for this population and improve the well-being of children and their families. In the cases where pain persists beyond the PIUO Pathway, we know that the participants and their families still benefit from the relationship they built with our team of nurses and doctors. The majority of caregivers welcome this holistic, patient-centred approach to their child’s treatment.

Update: This study is shifting to Phase II where we will implement our findings in community settings using the principles of implementation science. We want to produce a guideline for pediatricians that can be implemented across British Columbia. Our poster update will present the trial’s results at a glance and how they inform our overall data analysis and provide an overview of our next steps.

--- 2023 Poster Participants ---

SESSION #5 Poster #39

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Rita Jin

Undergraduate Student, University of British Columbia | Supervisor: Todd S. Woodward

Characterization of a Novel Task-Based fMRI Functional Brain Network: Auditory Yu Xuan (Rita) Jin, Todd S. Woodward

Functional magnetic resonance imaging (fMRI) is a method for tracking blood oxygen level-dependent (BOLD) signals as they move in different network configurations around the brain. The available network configurations are currently unknown. This study includes various analyses of fMRI signals during multiple cognitive tasks, curations of anatomical configurations that repeat over tasks, and interpretations of BOLD signal changes between task conditions. The project focuses on the discovery and study of the auditory perception (AUD) network involved in linguistic processing. Through two key cognitive tasks, the Thought Generating Task and the Radio Speech Task, the activation of the novel AUD network is measured during times of auditory perception. Data from the functional brain network and its associated hemodynamic responses (HDRs) were analyzed through fMRI Constrained Principal Component Analysis (fMRI-CPCA), two-way repeated-measures ANOVA, and SPSS Analysis of Predictor Weights.

--- 2023 Poster Participants ---

SESSION #5 Poster #40

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Caroline Ruus

Undergraduate Student, University of British Columbia | Supervisor: Rebecca Deyell

Whole Abdominal Radiotherapy in Children and Adults with Sarcoma: A CanSaRCC Study Caroline Ruus, Sylvia Cheng, Hagit Peretz Soroka, Derek Tsang, Abha Gupta, Rebecca J Deyell

Background: The Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC) is a national registry and virtual biobank that was created in order to facilitate research and improve outcomes of sarcoma patients. Sarcoma is an aggressive form of cancer that arises from bones and soft tissues in young people, and radiotherapy often has a role in local control. Rarely, children and young adults have peritoneal dissemination of sarcoma, and although whole abdominal radiotherapy (WART) is recommended, there is limited data regarding toxicity or evidence of efficacy.

Objective: We aim to describe indications and evaluate outcomes for pediatric and young adult sarcoma patients treated with WART with a primary aim of describing time to treatment failure (i.e. recurrence within the WART field), toxicity, progression-free and overall survival.

Methods: Patients aged 0-39 years at diagnosis with sarcoma who received WART between January 1, 2000 and May 1, 2023 will be identified from CanSaRCC nationally. Data collection includes patient demographics, clinicopathologic factors including histology, age, extent of disease and therapy, radiation planning and therapy techniques, toxicities and survival outcomes. Estimated sample size is 40 patients across Canada. Descriptive statistics will be used to summarize the treatments received, and the Kaplan-Meier method will be used to analyze time to treatment failure and survival outcomes.

Progress: CanSaRCC was recently activated at BC Children’s Hospital and 45 patients have been enrolled, including five who received WART for diagnoses of rhabdomyosarcoma or desmoplastic small round cell tumor. In collaboration with pediatric and adult cancer sites nationally, we are undertaking work to systematically identify, collect data and analyze outcomes of these patients.

Conclusion: We anticipate study results to describe indications, tolerability and efficacy of WART for young patients with abdominal dissemination of sarcoma.

Congratulations to Caroline on receiving a Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC) Summer Studentship

--- 2023 Poster Participants ---

SESSION #5 Poster #41

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Simran Gill

Master’s Student, University of British Columbia | Supervisor: Christine Voss

Physical activity behaviours and determinants thereof in children with type 1 diabetes in the Interior of BC: a mixed methods feasibility study Simran Gill, Ty Sideroff, Trent Smith, Tricia S Tang, Christine Voss

In BC, over 2,500 children live with diabetes. The fear of inadequate blood glucose control following physical activity (PA) may deter children with T1D from engaging in regular PA, despite its importance in reducing the risk of developing cardiovascular disease. A better understanding of the PA behaviours of children with T1D is necessary.

The study describes objectively measured (moderate-to-vigorous) physical activity (MVPA) levels of children with T1D aged 8-15yrs in BC’s Interior. We also explored patient- and parent-reported barriers, facilitators and experiences related to their PA. In this sequential mixed methods study, parent-child dyads were recruited from communities across BC’s Interior.

Parents completed an electronic demographics and child PA questionnaire. Participants were mailed an accelerometer (ActiGraph GT3X) to be worn around the waist for 7 consecutive days to measure MVPA. Virtual semi-structured interviews were conducted via Zoom, one with the child and one with the parent. Device-based PA data informed the initial probing questions during the interviews.

Fifteen children (9 boys and 6 girls, age 10.9±2.3 years) with T1D (average time since dx 3.5±3.4 years) participated in the study. All participants were using a continuous glucose monitor and 66% reported using an insulin pump. Mean daily MVPA was 43.6±26.4 min/day with 40% meeting PA guidelines of 60 mins/day of MVPA. Children were more active during weekdays (47.1±26.8 mins/day) compared to weekends (29.7±26.4 mins/day) p=0.002. There were no significant differences in recorded PA in boys vs girls. Interview analysis showed diabetic youth are comparatively active to their peers despite barriers to PA such as hypoglycemia.

This project provides important insight regarding the PA behaviours of children with T1D living in BC’s Interior. This information will be useful for parents and clinical care providers who support children with T1D. Furthermore, the findings from this work may guide future research endeavours that aim to promote PA participation and optimized health outcomes in this population.

Congratulations to Simran on receiving a BC Children’s Hospital Research Institute Master’s Studentship

--- 2023 Poster Participants ---

SESSION #5 Poster #42

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Chen Yu (Daisy) Sun

Undergraduate Student, McMaster University | Supervisor: Tamara Cohen

Comparing health outcomes of children and adolescents with obesity who attend an in-person vs. virtual multidisciplinary family-based behavioural lifestyle intervention Chen Yu Sun, Madelaine Gierc, Tamara Cohen

Introduction: The Shapedown BC program is a provincially funded 10-week family-based behavioural lifestyle intervention designed for children and adolescents aged six to 17 years living with obesity. The program involves participation in weekly educational and interactive sessions on topics related to nutrition, physical activity, screen time, sleep, body image, self-esteem, family meals, and healthy family communication. Since 2006, the program has been implemented in-person across six clinics in BC; however, due to the COVID-19 pandemic, it was forced to adapt to a fully virtual format. It is unclear how the virtual format compares to the in-person intervention in shaping health behaviour changes and consequently body mass index (BMI) outcomes in participants. Therefore, the primary objective of this study is to compare the health outcomes of children who participated in the virtual Shapedown program to pre-COVID in-person delivery.

Methods: This retrospective chart review study of n=80 children (ages six to 17 years old) will use non-identifying data collected by the Shapedown BC multidisciplinary team. Participants from the virtual intervention (n=40; September 2021 to December 2022) will be matched with those from the in-person intervention (n=40; 2016 to 2019) based on age, sex, BMI-z, and enrollment season at baseline. Anthropometric measures (body weight and height) are assessed and recorded at three different time points: during clinical intake, pre-intervention, and post-intervention. Surveys were used to capture health outcomes, including diet quality, exercise patterns, sedentary behaviour, and family habits pre- and post-intervention. Student T-tests will be used to assess the group differences between the groups.

Results: Data is currently being retrieved from the databased and matched accordingly.

Study Impact: This study will provide insights into the effectiveness of the virtual multidisciplinary family-based behavioral lifestyle intervention in improving BMI-z and related health outcomes, compared to the conventional in-person intervention. These findings will contribute to the future design and delivery of virtual weight management programs aimed at preventing and managing childhood and adolescent obesity.

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

--- 2023 Poster Participants ---

SESSION #5 Poster #43

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Erica Zeng

Undergraduate Student, University of Western Ontario | Supervisor: Todd Woodward

Profiling the fMRI derived Language-Based Network for pre- and postsurgical monitoring Erica Zeng, John Shahki, Todd S. Woodward

Background: In neurosurgery, pre- and post-surgical planning and monitoring are crucial in ensuring optimal conservation and recovery of cognitive function. A key focus during this process is on the Broca’s and Wernicke’s area (BWA) because impairment of this brain area can negatively impact linguistic function and quality of life. Task-based fMRI has detected a left-lateralized network that simultaneously engages BWA. This study will assess this network’s activation over a range of cognitive fMRI tasks in order to establish a baseline hemodynamic response (HDR) profile of this network.

Methods: This study included 163 healthy controls from five different cognitive tasks. Constrained Principal Component Analysis for fMRI was employed to identify and characterize functional brain networks that emerged while undergoing tasks and their associated hemodynamic responses.

Results: The studied network was activated during each of the linguistic- and emotion-based tasks and was characterized by left-lateralized activation with simultaneous engagement of the BWA. Further, each cognitive task exhibited distinct hemodynamic response patterns specific to their conditions.

Conclusion: Activation of this network during the linguistic and emotion recognition tasks suggests that this network’s function lies in the extraction of linguistic- and emotion-based meaning. The derived task-specific HDR profiles will serve as a baseline against which a patient’s HDR profile can be compared to. This comparison will allow for the monitoring of linguistic changes in patients pre- and post-operation.

Congratulations to Erica on receiving a NSERC Undergraduate Student Research Award

--- 2023 Poster Participants ---

SESSION #5 Poster #44

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Serena Zhang

Undergraduate Student, University of British Columbia | Supervisor: Kevin C. Harris

READYorNotTM Feasibility Trial: Assessing the Efficacy of an App-Based Transition Intervention in Adolescents with Congenital Heart Disease Serena Zhang, Bianca Fukakusa, Najah Adreak, Simran Gill, Venessa Thorsen, Kevin C. Harris

Background: The growing number of children with congenital heart disease (CHD) who survive into adulthood constitute one of the fastest growing populations in adult cardiology practices. However, many children with CHD face challenges continuing regular cardiology follow-up, particularly as they graduate from pediatric to adult healthcare. This population is vulnerable to gaps in care, and we are unsure of how to best close the gap. E-Health solutions, such app-delivered transitions in care (TiC) interventions, have the potential to offer cost-effectiveness, accessibility to rural patients, and long-term support for young adults as they enter the adult healthcare system.

Objective: To compare the efficacy of the MyREADY TransitionTM CHD with a 1-on-1 nurse-led TiC intervention in improving self-management skills.

Methods: We recruited 16-17-year olds with moderate to complex CHD from the Children’s Heart Centre at BC Children’s Hospital. This is a multi-centre study with 4 sites in total. Participants are randomized to the app or nurse intervention group based on their week of appointment. Those in the app group receive a 30-minute session with a nurse and access to the app for 18 months, while participants in the nurse intervention group meet once with a nurse during a clinic appointment for one hour. Health behaviours and cognitive factors are measured in both groups using questionnaires (Transition Readiness Assessment Questionnaire, my HeartScale, General Self-Efficacy Questionnaire) at various time points before, during, and after the intervention. Optional qualitative interviews are conducted to obtain participant feedback on the intervention in both groups.

Expected Outcome: We anticipate that the app, offering repeated exposure over time, will yield superior selfmanagement skills over 18 months compared to the nurse-led intervention. We expect that app-group participants will also have a better understanding of their CHD anatomy and a higher self-efficacy compared to those in the nurse group.

Conclusion: This trial investigates the feasibility and preliminary efficacy of an intervention for effective transition intervention in children with CHD. The findings aim to inform evidence-based TiC guidelines and future studies in this population.

--- 2023 Poster Participants ---

SESSION #5 Poster #44A

Watch Online: Thursday, July 27 | 1:30 - 3:00 pm https://bcchr.ca/posterday

Athena Li

Undergraduate Student, University of British Columbia | Supervisor: Vilte Barakauskas

Review of Quality Indicators in Pediatric Lab and Future Steps Towards Better Pediatric Care Athena Li, Vilte Barakauskas

To objectively measure and manage lab quality, labs need to define their service goals and objectives. Clinical quantitative quality requirements in the form of quality indicators (QI) are then established to meet set goals.

Starting from 2008, the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) established the Working Group on ‘‘Laboratory Errors and Patient Safety’ (WG-LEPS project) to define specifications for QI’s across labs independent from the size of organization and type of activities, the complexity of processes undertaken and the different degrees of knowledge and ability of the staff. The final goal is to establish a Model of Quality Indicators (MQI) that can provide labs with a way to monitor processes, improve performance and decrease error rates.

However, established MQIs so far do not generally differentiate between adult or pediatric labs. This review seeks to explore and search through any existing literature on QI’s in pediatric labs and other quality assessment methods in pediatric healthcare. Search parameters will focus on the Quality Indicators consisting of the 10 key core lab indicators recommended by the Laboratory Medicine and Pathobiology (LMP) Quality Council and population set to neonates (0-28 days) and infants (>28 days to 1 year). Then a general search for quality assessment in pediatric healthcare will be conducted to gather information about the this gap in knowledge of lab QI’s in pediatrics.

--- 2023 Poster Participants ---

SESSION #6: BASIC SCIENCE & CLINICAL

Moderator: Larissa Celiberto

1:30 – 3:00 PM In-Person: Chieng Family Atrium

Participants: Mackenzie Campbell Jessica Chan Makenna Clement-Ranney Beatrice Gonzales Kaitlin Law Jennifer Law Abby McCluskey Samantha Pang Aimee Xinxo

SESSION #6 Poster #45

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Mackenzie Campbell

Undergraduate Student, University of British Columbia | Supervisor: Wendy Robinson

Reconsidering the Hardy-Weinberg equilibrium threshold in genetic data quality control Mackenzie Campbell, Li Qing Wang, Amy Inkster, Giulia Del Gobbo, Victor Yuan, Wendy P. Robinson

Background: Methylation quantitative trait loci (mQTLs) are single nucleotide polymorphisms (SNPs) associated with changes in DNA methylation and likely to have functional significance by affecting gene expression. Most mQTL studies use a Hardy-Weinberg equilibrium (HWE) threshold as a quality control measure to exclude SNPs thought to be genotyping errors. However, deviations from HWE can occur due to population sub-structure, especially if genotypes show a deficiency of heterozygotes.

Objectives: To investigate whether SNPs excluded by the HWE threshold are not genotyping errors, but rather a consequence of population substructure, and to explore if these previously excluded SNPs have functional importance.

Methods: SNP array data from three independent, ethnically diverse, cohorts were accessed: Epigenetic studies of the Placenta In Complications of pregnancy (EPIC, n=74), the NICHD Fetal Growth Study (NICHD, n=289, dbGaP phs001717. v1.p1), and the Rhode Island Child Health Study (RICHS, n=137, dbGaP phs001586.v1.p1). SNPs failing HWE in the full cohorts were identified and tested for HWE within ethnicity/race/ancestry sub-groups (EPIC: n=16 East Asian, 47 European, 11 South Asian (clustering); NICHD: n=48 Asian/Pacific Islander, 98 Hispanic, 69 Non-Hispanic Black, 74 NonHispanic White; RICHS: n=10 African, 5 Asian, 121 Caucasian (clustering)).

Results: 1. We found that SNPs failing the HWE threshold (EPIC: 3986 SNPs, NICHD: 37541, RICHS: 3703) were mostly due to a deficiency of heterozygotes (EPIC: 98.2% deficient, NICHD: 99.6%, RICHS: 83.3%), and many of these SNPs were associated with ethnicity and/or ancestry cluster (EPIC: 63% associated, NICHD: 92%, RICHS: 44.5%).

2. Of SNPs that deviated from HWE in the full cohorts, very few also deviated within all ancestry-related groups (EPIC: 0.6%, NICHD: 0.2%, RICHS: 0.05%). Results were confirmed by testing for HWE in randomly selected small groups (ethnically diverse), to rule out sample size as a factor.

3. These SNPs were involved in 2.9% of the unique SNPs in mQTL-CpG associations.

Conclusions: Our results suggest that SNPs showing fewer heterozygotes than expected are not genotyping errors, but instead deviate from HWE due to population substructure. These results have implications for researchers working with genetic data and suggest that the HWE threshold may not be useful when applied to ethnically diverse populations.

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

--- 2023 Poster Participants ---

SESSION #6 Poster #46

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Jessica Chan

Undergraduate Student, University of British Columbia | Supervisor: Bruce Verchere

Using Islet Amyloid Polypeptide (IAPP) as a Biomarker for Type 1 Diabetes Jessica Chan, Lindsay P. Pallo, C. Bruce Verchere

Background: Type 1 Diabetes (T1D) is an autoimmune disease that affects over 300,000 Canadians. T1D emerges when insulin-secreting beta cells in pancreatic islets are destroyed by autoimmune attack, leading to chronic hyperglycemia and exogenous insulin dependence. Previous studies have determined that beta cells undergo secretory pathway stress which impairs prohormone processing, leading to the secretion of incompletely processed peptide species. Islet amyloid polypeptide (IAPP) is a hormone processed in beta cells by sequential cleavage of its precursor proIAPP1-67 into its intermediate form, proIAPP1-48, and then into mature IAPP1-37. Our lab previously found an elevated ratio of proIAPP1-48 to mature IAPP in children with T1D. However, research investigating levels of circulating proIAPP1-67 in individuals has been limited due to the lack of a sensitive and specific assay for this proIAPP species.

Objective: Establish a sandwich ELISA to measure circulating proIAPP1-67 in humans, then determine whether intact proIAPP1-67 circulates in disproportionate amounts in people with long-standing or recent-onset T1D compared to nondiabetic individuals.

Methods: We used western blot and immunohistochemistry to validate the reactivity and specificity of multiple monoclonal mouse antibodies raised against human proIAPP-derived peptides. To generate an immunoassay specific for human proIAPP1-67, we compared different antibody pairs for a sandwich ELISA using synthetic proIAPP1-67 peptide. To determine whether our ELISA could detect endogenous human proIAPP1-67, we assayed human islet lysates and plasma samples from non-diabetic and T1D donors. Upon validating the proIAPP1-67 ELISA, we will measure and compare the ratios of (pro)IAPP species across T1D and non-diabetic individuals.

Anticipated Results: In people with T1D, circulating levels of proIAPP1-67 will be significantly decreased relative to nondiabetic individuals. However, the relative level of proIAPP1-67 to mature IAPP will be elevated in T1D. Future Directions: By comparing levels of precursor to mature forms of IAPP, we can assess beta-cell dysfunction as a measure of beta-cell prohormone processing efficiency. Once the proIAPP1-67 ELISA is validated, we aim to measure (pro) IAPP levels in larger clinical cohorts to assess how prohormone processing changes over the course of the T1D and assess the value of proIAPP biomarkers in evaluating the efficacy of immunotherapies in clinical trial.

--- 2023 Poster Participants ---

SESSION #6 Poster #47

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Makenna Clement-Ranney

Undergraduate Student, University of Western Ontario | Supervisor: Angela Devlin

The impact of riboflavin deficiency and folic acid supplementation on individual and transgenerational metabolic health Makenna Clement-Ranney, Adam Hung, Coralie Bergeron, Taylor Ricci, Angela Devlin

Background: Folic acid, the synthetic form of folate, and riboflavin are essential micronutrients for biochemical processes such as cellular metabolism, DNA synthesis, and methylation. Both are involved in a metabolic cycle known as onecarbon metabolism. Findings from observational studies performed by our lab and others have noted a prevalence of high folate status and riboflavin deficiency among Canadian women. Individual impacts of riboflavin deficiency and excess folic acid supplementation on individual and transgenerational metabolic health have been identified. However, little is known regarding the mechanisms behind these impacts.

Aims: We aim to assess the following using a mouse model: • To determine the effect of low-riboflavin status on adiposity.

• To conduct a confirmatory analysis of upregulated 3-hydroxyanthranilate, 3,4-dioxygenase (Haao) expression in placenta from male offspring of folic acid-supplemented dams.

• To characterize the endothelial cell population in gestational day 18.5 placenta using FACS. Methods: Male and female C57BL/6J mice were treated with a control diet (6mg riboflavin/kg) or a riboflavin deficient diet (1 mg riboflavin/kg) for 8 weeks. Body composition was measured at 4 and 8 weeks by EchoMRI; weekly body weights were measured, and fat pads were collected and analyzed following the 8-week feeding period.

Fluorescent immunohistochemistry will be used to confirm differential expression of Haao as previously identified by our lab through Nanostring analysis performed on placenta of male offspring from dams fed a control (2 mg/kg folic acid, 10% kcal fat), control folic acid-supplemented (10 mg/kg folic acid, 10% kcal fat), western (45% kcal fat, 2 mg/kg folic acid), or western folic acid-supplemented diet (10 mg/kg folic acid, 45% kcal fat).

At gestational day 18.5, 3-5 placentas from C57BL/6J dams will be harvested and pooled. Endothelial cells will be isolated and characterized using fluorescence-activated cell sorting.

Results: Studies remain ongoing. Preliminary results reveal no effect of diet on body composition. Significant upregulation of Haao expression is present in folic acid-supplemented groups.

Significance: This project acts as an exploratory analysis to provide data that can be used in planning future studies towards understanding the combined effects of gestational riboflavin deficiency/excess folic acid supplementation on growth and development.

Congratulations to Makenna on receiving a NSERC Undergraduate Student Research Award

--- 2023 Poster Participants ---

SESSION #6 Poster #48

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Beatrice Gonzales

Undergraduate Student, University of British Columbia | Supervisor: Tim Bhatnagar

Enhancing Muscle Activity Measurement in the Motion Laboratory Beatrice Gonzales, Tim Bhatnagar

Introduction: The Motion Lab (TML) performs gait analyses for children with mobility issues to quantify gait metrics and suggest interventions to improve their gait. Electromyography (EMG) is used as part of this analysis to determine how muscles are activating during gait. EMG sensors can be affected by various factors such as baseline noise, adherence to skin and skin impedance. Literature suggests a number of “best practices” for achieving the highest quality signal, however, there is little investigation into the exact effect the intervention has on the signal quality. Currently at TML, EMG sensors are placed directly on children’s skin without any skin preparation (e.g. cleaning) which could affect signal quality.

Objective: To investigate and assess the literature-defined “best practices” for collecting EMG data to ensure reliable data collection for clinical decision-making.

Methods: Five young adults ranging from 19 to 24 years were recruited as part of this quality improvement (QI) study.

Eight EMG sensors were placed in established locations on the skin to measure muscle activation signals from: 1) the medial gastrocnemius, 2) the tibialis anterior, 3) the semimembranosus (hamstring), and 4) the rectus femoris, for each leg. The sensors are secured with stretchable straps that cover and wrap around the leg. For the baseline condition, participants walked for 6m with the sensors applied without any intervention. The following conditions were then tested: (i) cleaning skin with alcohol pads, (ii) cleaning skin with soap and water, (iii) shaving body hair, (iv) using abrasive gel to clean the skin, and (v) application of higher tension to the sensor straps. The participants repeated the 6m walk for eight trials under each condition. Signal-to-noise ratio scoring and signal quality analysis were conducted to quantify the effects of the interventions.

Expected Results: The observed differences in EMG signals will reveal the impact of specific interventions on signal quality. Analysis of such effects will reveal on the most effective practices for obtaining reliable EMG data.

Discussion: The findings of this study will serve to provide some clarity on best practice guidelines for collecting EMG for children coming to TML for clinical gait analysis.

--- 2023 Poster Participants ---

SESSION #6 Poster #49

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Kaitlin Law

Undergraduate Student, University of British Columbia | Supervisor: Clare Beasley

Plasma-Derived Exosomes as a Biomarker of Traumatic Brain Injury and Predictor of Long-term Psychiatric Symptoms Kaitlin Law, Li Shao, Clare Beasley, William Panenka

Background: Over 160,000 Canadians each year sustain at least one traumatic brain injury (TBI). The current leading diagnostic tool is a combination of subjective reports, physical exams, and cognitive tests. As such, many patients with TBI remain undiagnosed. Such injury results in increased risk of developing mood or anxiety disorders and worsening of symptoms of those diagnosed. Since the biological mechanisms causing such a risk are unknown, identifying blood biomarkers could be used as a diagnostic tool to predict mental health consequences of TBI. Exosomes are extracellular vesicles released from cells and produced in the endosomal compartment of most eukaryotic cells. Exosomes have been implicated with the immune response and removal of unnecessary proteins among other functions. As such, difference in presence of potential biomarkers in TBI injury versus controls can predict development or worsening of psychiatric symptoms.

Purpose: To determine if exosomes can be a useful biomarker in identifying brain cell damage following TBI with the further goal of predicting long term mental health consequences.

Methods: Subjects included children and young adults between the ages of 14-24 years with mild (n=15) or moderate/ severe (n=15) TBI and orthopedic or soft-tissue trauma controls (n=15). For each subject, blood samples, and clinical CT and MRI data were obtained along with cognitive and behavioural assessments at multiple times points up to 18 months, depending on TBI severity. Blood samples were taken at <12 hours post injury.

Samples were centrifuged at 5,000g for 20 minutes to pellet platelets. Then total exosomes were extracted from 500uL of plasma using iZON columns. Total exosomes were then incubated with L1CAM-biotinylated antibody and bound to streptavidin-plus ultra-link resin to isolate neuronal derived exosomes (NDEs).

Results: Exosomes were successfully isolated from control samples using size exclusion chromatography. Nanoparticle Tracking Analysis demonstrates particle counts in NDE fraction. Potential protein biomarkers on exosomes are being analyzed.

Applications: If differences in biomarkers between control and TBI groups are identified, a blood-based test could be developed to assist in diagnosing TBI. Furthermore, if differences in neuronal biomarkers can be identified, such biomarkers can act as predictors for long term mental health consequences.

Congratulations to Kaitlin on receiving a BC Mental Health and Substance Use Services Summer Studentship

--- 2023 Poster Participants ---

SESSION #6 Poster #50

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Jennifer Law

Undergraduate Student, University of British Columbia | Supervisor: Sylvia Cheng

Impact and Use of Patient-Reported Outcomes to measure Quality of Life in Pediatric Neuro-oncology and Hematopoietic Stem Cell Transplantation Care in British Columbia Jennifer Law, Meera Rayar, Rebecca Deyell, Caron Strahlendorf, Hal Siden, Justin Lee, Sylvia Cheng

Background: Providing comprehensive care to pediatric oncology patients is crucial, as treatment and diagnosis often lead to adverse psychological, pain, cognitive, and mobility complications. Previous research has shown that obtaining quality of life (QOL) information can give new insight into the experience of cancer treatment. One method to obtain QOL data systematically is through patient reported outcomes (PROs). PROs are self-reported measures without input from healthcare providers (HCPs).

Objective: To determine the feasibility, acceptability, and impact of PRO implementation for pediatric neuro-oncology and Hematopoietic Stem Cell Transplantation (HSCT) patients.

Methods: Neuro-oncology and HSCT patients aged ≥ 5 years and their parents/caregivers were recruited at all stages of cancer care from the BCCH oncology program. PROs were measured using PROMIS®, a suite of evaluation tools that has been validated in previous studies involving pediatric oncology patients to measure change over time. PROs were collected every 3 months using REDCap. Reports of PRO data were returned to HCPs, accompanied by a post-review survey. Participants and HCPs will have the opportunity to participate in semi-structured interviews at the completion of this study.

Results: Pre-surveys indicated that HCPs faced barriers to obtaining PROs including time, inconsistent collection methods, and patient difficulty in comprehending surveys. Nine neuro-oncology and 8 HSCT participants have been recruited, 5 of which include dyads (parent and patient both participating). Currently, 7 of 12 participants have completed 3 time points.

Amongst the dyads, parent reported measures were consistent with patient reported measures across all domains, except peer relationships. Seven post-review surveys were completed by HCPs, revealing a mean score of 8.7 on a 0-10 scale for the helpfulness of PRO data in clinical management.

Conclusion: PRO information on QOL can be helpful to clinicians. Attention will need to be paid to what factors influence ongoing participation by children and parents in providing PRO QOL information. This study can foster the development of an infrastructure for PRO collection for pediatric oncology patients, allowing for better understanding of patient perspectives and improvement of clinical care.

Congratulations to Jennifer on receiving a Porte Hungerford Neuro-oncology Endowment Fund Award

--- 2023 Poster Participants ---

SESSION #6 Poster #51

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Abby McCluskey

Undergraduate Student, Queen’s Univeristy | Supervisor: Chinten James Lim

Investigating the role of integrin activation in CD47-mediated cell death in T-cell acute lymphoblastic leukemia Abby McCluskey, Pasal Leclair, Chinten James Lim

T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive hematologic malignancy accounting for approximately 15% of pediatric ALL cases. T-ALL carries a worse 5-year prognosis than other ALL forms, with current chemotherapeutics resulting in secondary life-threatening side effects. Emerging treatments for T-ALL include targeting cell markers over-expressed on malignant cells, such as CD47. CD47 is a cell surface marker primarily known for helping cells evade immune surveillance. Overexpression of CD47 has been phenotypically observed in T-ALL. Ligation of CD47 by certain monoclonal antibodies has been shown to facilitate “type 3” cell death characterized by exposure of phosphatidylserine (PS) on the plasma membrane’s outer leaflet, mitochondrial membrane potential disruption, and increased reactive oxygen species. This pathway of cell death is still minimally understood as the primary focus of CD47 research has been on its anti-phagocytic functions.

Previously, CD47 has been shown to have a role in integrin activation. To explore the relationship between CD47 and integrins, we investigated the effect of activating β1 integrins – the most prevalent integrin subunit in leukocytes – on CD47-mediated cell death. Cell death assays were performed with the co-incubation of integrin activator MnCl2 with anti-CD47 antibody CC2C6 in wild-type (WT) Jurkat cells. Cell death was analyzed using flow cytometry by assessing Annexin-V PS binding. These experiments showed a synergistic effect between MnCl2 and CC2C6 on CD47-mediated cell death, suggesting that integrins are involved with this pathway. To determine if this phenomenon is reliant on β1-integrins, the assay was repeated with β1-null Jurkat cells. Surprisingly, β1-nulls showed significantly higher CD47-mediated cell death induced by CC2C6 ligation, while co-incubation of CC2C6 and MnCl2 did not produce the synergistic effect on cell death observed in WT cells.

Our findings suggest that inactive β1 integrins have an inhibitory effect on CD47-mediated cell death. These results provide further insight into the mechanisms of CD47-mediated cell death and continue to cement CD47 as a potential therapeutic target for T-ALL. This project’s next steps include assessing β1-integrin activation in CC2C6-treated cells and exploring the relationship between integrins, actin, and CD47 in T-ALL models.

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

--- 2023 Poster Participants ---

SESSION #6 Poster #52

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Samantha Pang

Undergraduate Student, University of British Columbia | Supervisors: Randa Ridgway & Matthias Görges

Ambulatory adductor canal catheter program: reducing opioid requirements after anterior cruciate ligament reconstruction surgery in adolescents

Samantha Pang, Lorna Murphy, Kathleen Duddy, Nicholas West, Matthias Görges, Katherine Lanigan, Randa Ridgway Background: Anterior cruciate ligament (ACL) reconstruction surgery typically requires an overnight hospital stay and opioid-based postoperative analgesia. The BCCH Acute Pain Service (APS) developed a program using a perineural catheter to allow continuous infusion of analgesia at home using an elastomeric pump to facilitate day-case surgery in adolescents undergoing ACL reconstruction surgery.

Objectives: This study aimed to compare the use of a perineural catheter with an elastomeric pump against different analgesic modalities to investigate its impact on opioid requirements.

Methods: This was a retrospective audit of adolescent ACL reconstruction surgery between 2018-2022. Patients were divided into three groups: intraoperatively, group A received local infiltration analgesia (LIA), group B received a single-shot adductor canal block (ACB), and group C received an ACB and a catheter, with an elastomeric pump attached in the post-anesthetic care unit, before same-day discharge. Patients in group C received a daily phone call from APS, who documented opioid requirements. A Pairwise Wilcoxon Rank-Sum Test was used to compare opioid consumption between the three groups.

Results: Data were available from 55 patients (14 males) who were median [IQR] 16 [15-17] years old, with n=20 patients in group A, n=15 in group B, and n=20 in group C. There were no significant differences between groups B and C in intraoperative opioid consumption. There was no reduction in opioid consumption in the immediate postoperative period between those who received LIA (group A) and those who received ACB (groups B and C) (MD 0.0 mg/kg, 95% CI -0.05 to 0.01, p=0.360). On postoperative day 1, rescue opioid analgesia was required by 14/19 (74%) patients in group A, 10/14 (71%) in group B, but only 4/19 (21%) in group C (p=0.002; MD compared to group A 0.05 mg/kg, 95% CI 0.0 to 0.09, p=0.033; MD compared to group B 0.06 mg/kg, 95% CI 0.0 to 0.11, p=0.067).

Implications/Future Directions: This study identified reduced opioid consumption post-ACL reconstruction surgery in adolescent patients who received an ambulatory adductor canal perineural catheter and elastomeric pump. Despite the small sample size, our results suggest potential benefit of this technique, which requires confirmation in a prospective study.

Congratulations to Samantha on receiving a BioTalent Canada Award

--- 2023 Poster Participants ---

SESSION #6 Poster #53

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Aimee Xinxo

Undergraduate Student, University of Waterloo | Supervisors: Gabriella Horvath & Aamina Shah

Induced Pluripotent Stem Cells: A Versatile Tool for Disease Modelling and Drug Discovery with a Focus on Neuronal Progenitor Cell Differentiation Aimee Xinxo, Aamina Shah, Glen Sequiera, Gabriella Horvath

Induced pluripotent stem cells (iPSC’s) offer a versatile and powerful tool for scientific research, disease modeling, and drug discovery. iPSC’s are somatic cells which have been reprogrammed back to their pluripotent state through the use of different transcription factors. Therefore their ability to be generated from patient cells, differentiate into various cell types, and replicate disease characteristics makes them a valuable resource for advancing our understanding of human biology and developing innovative therapies. In particular, iPSC’s can be differentiated into neuronal progenitor cells (NPC’s) which can then be further differentiated towards specific neural lineages. In this experiment, our goal is to differentiate the iPSC’s into forebrain cortical neurons, using a dual SMAD inhibition method which blocks BMP and TGFB pathways to rapidly differentiate iPSC’s into early neuroectoderm. However, before specific neural lineages can be made, the presence of NPC’s in a culture was confirmed through the detection of certain protein biomarkers which were used as a control.

NPC’s contain a unique mixture of intracellular molecules and proteins expressed on their cellular surface which can be detected through immunofluorescent staining. Immunofluorescent staining is a commonly used technique in molecular biology research which helps understand the localization and propagation of protein biomarkers expressed in different parts of tissue. This process involves stimulating the production of targeted antibodies that recognize specific antigenic markers. These antibodies are linked to an enzyme that, when triggered, initiates a chemical reaction that results in the production of colour at the site of the antigenic marker. Some primary antibodies which confirm the presence of NPC’s in a culture include Nestin, and Sox 2.

Once forebrain cortical neurons have been generated from NPC’s, Ca2+ imaging will then be utilized as a tool to provide insights to neuronal activity. Ca2+ ions play a critical role in neuronal signalling and can help researchers investigate how alterations in activity are linked to various neurological diseases, including Epilepsy and Parkinson’s Disease. By studying Ca2+ dynamics, researchers can better understand functioning of healthy and diseased neurons, and further our understanding of neurological disorders in hopes of finding potential therapeutic interventions.

--- 2023 Poster Participants ---

SESSION #7: BASIC SCIENCE & CLINICAL

Moderator: Maryam Rahimi Balaei

1:30 – 3:00 PM In-Person: Chieng Family Atrium

Participants: Hadil Alfares Laura Cunningham Anya Fineman Kevin Jeong T. Mitchell Mazza Hana Miller Abigail Netanya Ngan Rachel Wang Jenicia Zhen

SESSION #7 Poster #54

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Hadil Alfares

Undergraduate Student, University of British Columbia | Supervisor: Kevin Harris

The SEARCH study: Study Evaluating Adolescents for Risk factors associated with Cardiovascular Health Hadil Alfares, Bianca Fukakusa, Najah Adreak, Christine Voss, Kevin Harris

Background: According to the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) health index, fewer than 1 in 5 Canadian youth (age 12-19) are in ideal cardiovascular health. The CANHEART health index is a tool used to monitor the prevalence of modifiable cardiovascular risk factors (diet, smoking status, physical activity, and weight) in pediatric populations. Longitudinal data on cardiovascular health and the relationship with other related factors (quality of life, role of parents, environmental factors, and medical history) in pediatric populations is needed.

Objective: To describe prevalence of cardiovascular risk factors using the CANHEART index in our pediatric population at the Children’s Heart Centre over time in relation to their cardiac condition.

Method: Children and adolescents ages 8-19 years old who were seen at the Children’s Heart Centre, regardless of their reason for visit, were invited to participate in the study. Participants and their parents completed annual surveys over the duration of five years, including questionnaires regarding their own health behaviors (diet, physical activity, smoking status) and quality of life, measured through child self-report and parent-proxy report of the PedsQL (Pediatric Quality of Life Inventory). Chart reviews were performed to obtain participant’s characteristics (age, natal sex, cardiac diagnosis, height, and weight).

Results: This is a cross-sectional analysis of a longitudinal study. Recruitment began in June 2016 and is still ongoing.

We recruited 695 participants at baseline, in which 49.6% were male and 50.4% were female. There were 241 participants with congenital heart disease, 133 with heart disease, 275 with a healthy heart and 34 participants with other serious/chronic conditions with a healthy heart. There were 31 (4.7%) participants who consumed 5 servings of fruit and vegetables per day. The mean self reported moderate/vigorous physical activity is 77.9 (72.2) minutes per day.

There were 435 (91%) participants who reported to be non-smokers and 464 (70.6%) participants were in the normal BMI category.

Conclusion: Understanding the relationship between modifiable cardiovascular risk factors, and other related factors is critical, as it will help tailor future prevention programs and promote ideal health amongst pediatric populations.

--- 2023 Poster Participants ---

SESSION #7 Poster #55

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Laura Cunningham

Undergraduate Student, University of British Columbia | Supervisors: Michelle Bauer & Ian Pike

Exploring emergency room doctors’ occupational experiences with patient recovery and their child safety, injury, and play perspectives Laura Cunningham, Michelle Bauer, Ian Pike

Background: Literature suggests that the work life of an emergency room (ER) doctor is not easily balanced with family duties and child rearing. Overtime hours, shift work systems, and the risk of illness transmission to family members can intensify stress parents experience and shape parenting practices. Examinations of ER doctors’ parenting practices, involvement in patient recovery, and conceptualizations of injury and safety can help researchers understand how their occupational experiences may shape their children’s engagement in risky play and operationalizations of hazards, risks, and dangers. Conducting research with this population can provide important understanding about how experience with risk and injury is processed and translated into everyday life and their unique perspectives on injury and danger.

Objectives: We aim to illustrate the viewpoint of ER doctors who are parents on a variety of topics, including COVID-19 changes in parenting and work, views on work-life balance, involvement in children’s lives, and emotional aspects related to work and parenting. In addition, the area of risky play will receive particular focus, specifically relating to serious injury, differences between risky and dangerous play, and involvement in childhood safety and injury mitigation.

Methods: 40 participants will be recruited for this study. They must work as a medical doctor currently or within the past 2 years in an emergency care role and have at least one child between the ages of 4 and 13. Semi-structured interviews will be conducted online or in person, lasting approximately 1 hour. Interviews will be auto-recorded on passwordprotected personal recording device. Post-interview, the option of engaging in member checking will be presented to participants. We are intending to analyze data using critical discourse analysis, narrative analysis, and reflexive thematic analysis.

Direction of Study: Results from this study will help demonstrate how experiences as ER doctors influence perspectives on their children’s risky play. Findings may influence scholarly conversation surrounding gender and cultural expectations as well as work and home life balance support for ER doctors.

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

--- 2023 Poster Participants ---

SESSION #7 Poster #56

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Anya Fineman

Undergraduate Student, Pitzer College | Supervisor: Michael Kobor

Epithelial to Mesenchymal Transition Phenotype in a Model of Inflammatory Bowel Disease Anya Fineman, Paula T. Littlejohn, Bruce Vallance, Michael S. Kobor

Inflammatory Bowel Disease (IBD) is a chronic disorder affecting millions of individuals annually, with steadily increasing prevalence. Fibrosis, the thickening and scarring of tissue in the gastrointestinal (GI) tract, is a common complication in IBD patients that arises from excessive activation of normal wound healing processes due to chronic inflammation. One crucial mechanism involved in fibrosis development is the epithelial-to-mesenchymal transition (EMT), wherein epithelial cells in the GI tract undergo a phenotypic change, transforming into fibrotic mesenchymal cells. EMT is regulated by a network of transcription factors (TFs), some of which have been associated with KDM1A, a histone demethylase that can repress or heighten the expression of genes through the removal of methyl groups.

In this study, we investigate the expression of KDM1A and related TFs in the gut tissues of mice with IBD compared to wild-type controls. We use quantitative polymerase chain reaction (qPCR) and Western blot analyses to assess the mRNA and protein levels, respectively. To explore these mechanisms, we utilize MUC2 knockout mice, which serve as a spontaneous model for ulcerative colitis, a subtype of IBD. Despite the increasing prevalence of IBD, treatment options remain limited in their range and effectiveness. By gaining a deeper understanding of the key mechanisms involved in the disease process at the molecular level, we aim to identify potential targets for tailored treatments, providing new avenues for therapeutic interventions.

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

--- 2023 Poster Participants ---

SESSION #7 Poster #57

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Kevin Jeong

Undergraduate Student, University of British Columbia | Supervisor: Christopher Maxwell

Analyzing the loss of binucleate cells during fluorescence activated cell sorting Kevin Jeong, Ryan Ghorayeb, Christopher Maxwell

Young women with BRCA1 mutations are often diagnosed with aggressive, hormone receptor negative breast cancer, termed triple negative breast cancer (TNBC). In multiple mouse models with Brca1 mutations that develop TNBC, ectopic alveologenesis precedes overt tumor formation. Therefore, it is important to study alveolar cells and their potential impact on the formation of triple negative tumors. Under normal conditions, alveologenesis occurs during pregnancy and lactation, and during this process, alveolar cells become binucleate by undergoing mitosis, but not completing cytokinesis. Binucleate alveolar cells, however, are likely more fragile than mononucleated cells, and may be lost through experimental techniques such as fluorescence activated cell sorting (FACS) and/or single cell RNA-sequencing.

Importantly, these challenges may lead to false conclusions or hinder the potential to make discoveries.

Here, we investigated if binucleate mammary epithelial cells are lost during FACS compared to mononucleate cells.

We used the normal mouse mammary epithelial cell line (nMuMG) transduced with fluorescence ubiquitin cell cycle indicator (FUCCI) vectors to discriminate between mononucleate 4N and binucleate 2N+2N cells. We treated nMuMG FUCCI cells with dihydrocytochalasin B (DCB), a cytokinesis inhibitor, to induce binucleation. We then quantified the proportion of binucleate cells via confocal immunofluorescence, and compared this to the proportion of binucleate cells observed through FACS. We observed a decrease in the number of binucleate cells captured through FACS compared with the number of binucleate cells we quantified using confocal microscopy. This study provides evidence that binucleate mammary epithelial cells are lost during FACS, and this should be considered when working with primary human tissue samples that are expected to contain binucleate cells. Moreover, previous studies that sorted samples containing binucleate cells using FACS prior to downstream analyses should be reinterpreted.

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

--- 2023 Poster Participants ---

SESSION #7 Poster #58

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

T. Mitchell Mazza

Undergraduate Student, Syracuse University | Supervisor: Clare Beasley

The Complement System in Schizophrenia: The effect of antipsychotic drug administration on inflammatory activity in the brain T. Mitchell Mazza, Li Shao, Clare L. Beasley

Background: Schizophrenia is a major psychiatric disorder involving a range of symptoms including hallucinations, delusions, and disorganized thinking, and it affects approximately 1% of the population in Canada. Recent studies in genetic and molecular biology have demonstrated dysregulated immune system activity in individuals with schizophrenia and other psychiatric disorders, but the exact relationship between the immune system and mental illnesses remains to be elucidated. The complement cascade is a set of proteins involved in innate immunity and first-line defense against pathogens. This system of proteins has recently received increased attention as a result of evidence suggesting elevated activity in individuals with schizophrenia.

Objective: This study aims to contribute to this field by examining the effect of antipsychotic medications on complement component 3 (C3) protein, which plays a central role in all three complement cascade pathways and may provide important insight into complement activity.

Methods: Rats (n = 30) were administered antipsychotic medications (clozapine or haloperidol) or a control (saline) for 28 days, and samples were isolated from multiple brain regions and peripheral tissues. Levels of C3 present in orbitofrontal cortex in each sample will be analyzed using Western blotting techniques.

Results: Data is currently being analyzed.

Conclusion: This study serves to contribute to experimental research examining immune system dysregulation in psychiatric disorders. It uniquely incorporates an analysis of common psychiatric medications used as treatment for schizophrenia to provide further insight into mechanistic effects of medications. As researchers begin to better understand the molecular biology of schizophrenia and other mental illnesses, more targeted and specific therapeutics may be developed in order to more effectively treat this debilitating and often treatment-resistant disorder.

Congratulations to Mitchell on receiving a Fulbright Canada Mitacs Globalink Program Studentship

--- 2023 Poster Participants ---

SESSION #7 Poster #59

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Hana Miller

Undergraduate Student, McGill University | Supervisor: Ash Singhal

Remoteness of Residence and Pediatric Surgical Outcomes in British Columbia Hana Miller, Ash Singhal

Background: The Canadian healthcare system strives to provide high-quality care to its residents regardless of geographic location. In British Columbia (BC), there is one pediatric tertiary care hospital serving a population of almost 5 million people over an area of 944,735 square kilometers. This requires families living in rural areas to travel long distances for necessary surgical interventions. This research project investigates the association of remoteness of residence (RoR) with pediatric surgical outcomes in BC. Methods: All patients with surgical outcomes and address data from 2017-2022 in the BC Children’s Hospital (BCCH) National Surgical Quality Improvement Program (NSQIP) database were collected (n=3277). Patients with addresses outside BC, Yukon, and the Northwest Territories were excluded. The driving time of patients in the study (n=3254) were calculated using google maps. Patients were categorized as close (<2 hour drive; n=2415) or far (> 2 hours drive; n=839) from BCCH. Chi squared test was used to assess differences in surgical outcomes between groups.

Preliminary Results: The following outcomes were recorded and were not statistically significant (p>0.05): hospital length of stay (5.0 day average), readmission within 30 days (3.8%), surgical site infections (3.6%), adverse events (composite; 2.1%), and 30-day mortality (0.2%). There was a statistically significant difference between the need for an unplanned second surgical procedure between the close and far group (close=2.8%, far=1.4%; p=0.03).

Conclusions: Those who live close to BCCH are more likely to require an unplanned second surgical procedure. The reason for this requires further investigation. The remainder of the data suggests that the current model of a single high-resource intensive care setting is able to provide similar surgical results to all patients, regardless of a patient’s geographic location.

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

--- 2023 Poster Participants ---

SESSION #7 Poster #60

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Abigail Netanya Ngan

Undergraduate Student, University of British Columbia | Supervisor: Catherine Biggs

Newborn Screening for Severe Combined Immunodeficiency in British Columbia

Abigail Netanya Ngan, Kyla Hildebrand, Stuart Turvey, Elliot James, Victoria Cook, Scott Cameron, Audi Setiadi, Gurdip Hulait, Graham Sinclair, Catherine M Biggs Background: Severe combined immunodeficiency (SCID) is an inborn error of immunity characterized by severely low T cell counts and predisposition to infections. Early diagnosis is essential so that infants can be urgently referred for lifesaving treatment. Newborn screening for SCID provides a method to detect SCID and other conditions associated with T cell lymphopenia (TCL), and was introduced in BC in October 2022. The purpose of this project was to assess outcomes from the first 8 months of newborn screening for SCID in BC. Methods and Results: A chart review was conducted to investigate the geographic distribution, T cell values, diagnoses, and outcomes of infants who had a positive newborn screen for SCID. Between October 3 and June 16, 2023, 28,816 initial samples were tested, and 30 infants screened positive. Infants who screened positive had a broad geographic distribution that included the Yukon and all 5 health authorities of BC. Of the 30 infants, 13 had normal repeat testing and were discharged from the program, 2 were lost to follow up, and 15 were referred for immunologic evaluation.

So far, no infant identified through the screening program has been found to have SCID, however, 10 were diagnosed with conditions associated with TCL, including: a non-SCID form of T cell immunodeficiency (1 infant), chromosomal microdeletion syndromes (3), leukemia (1), congenital infection (1), hydrops (1), extreme prematurity (1), and idiopathic TCL (2). The performance of the newborn screening test has a positive predictive value of 30%, where the 10 infants diagnosed with conditions associated with TCL were categorized as a true positive result.

Significance: Introducing the newborn screening program for SCID in BC facilitated early diagnosis and treatment of medically actionable conditions associated with TCL. Our experience highlights the broad range of causes of TCL in newborns, and the importance of this screening program for optimizing outcomes through prompt recognition.

--- 2023 Poster Participants ---

SESSION #7 Poster #61

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Rachel Wang

Undergraduate Student, University of British Columbia | Supervisor: Laura Sly

Targeting IL-13 to treat Crohn’s disease-associated intestinal fibrosis Rachel Wang, Kwestan Safari, Sue Menzies, Laura Sly

Background: Crohn’s Disease (CD) is a type of inflammatory bowel disease that results in patchy, transmural gastrointestinal inflammation. Due to prolonged inflammation, over 50% of people with CD develop intestinal fibrosis, a life-threatening complication characterized by increased collagen deposition and muscle thickening. Fibrosis can lead to strictures that require surgical intervention. However, since CD is chronic and recurring, many people with CD need to undergo multiple surgeries. Despite the importance of intestinal fibrosis, there are currently no drugs used to target CD-associated fibrosis.

To study CD, the Sly Lab works with a SHIP knockout mouse model that spontaneously develops intestinal inflammation and fibrosis in the distal ileum. Our laboratory found that blocking IL-13 signalling in SHIP knockout mice prevents the development of intestinal fibrosis. Thus, we wanted to find the cellular source of IL-13. Single-cell RNA (scRNA) sequencing data on people with CD reveals that mast cells are key producers of IL-13. Since the scRNA sequencing data is from humans, we want to ask whether mast cells are also the main producers of IL-13 in our SHIP knockout mouse model.

Objective: To determine whether mast cells are the main producers of IL-13 in SHIP knockout mice and evaluate their impact on intestinal fibrosis outcomes.

Methods: We will perform scRNA sequencing on the small intestine of SHIP KO mice to confirm that our model’s mast cells have IL-13 transcripts and to determine whether other cell type(s) also have IL-13 transcripts. Subsequently, immunofluorescence will be used to co-localize IL-13 and c-kit, a mast cell marker. We will also deplete mast cells from SHIP KO mice using an anti-c-kit antibody to provide evidence that mast cells produce IL-13 in our mouse model.

Implications/Significance: Since there are currently no anti-fibrotic drugs, many people with CD-associated intestinal fibrosis require surgery. By identifying specific cell types and underlying mechanisms that contribute to intestinal fibrosis, we may identify potential therapeutic targets that can be used to develop drugs to treat intestinal fibrosis and reduce the incidence of this devastating complication in people with CD.

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

--- 2023 Poster Participants ---

SESSION #7 Poster #62

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Jenicia Zhen

Undergraduate Student, University of British Columbia | Supervisor: Bruce Verchere

Peptidylglycine alpha-amidating monooxygenase is involved in islet cilia formation and hormone secretion Jenicia Zhen, Yi-Chun Chen, Nils Back, Richard Mains, Betty Eipper, Mitsuhiro Komba, Anna Glyon, Patrick MacDonald, C. Bruce Verchere

Introduction: Pancreatic islet cells release peptide hormones, such as insulin, to regulate blood glucose levels. In islet cells, peptide hormone precursors undergo enzymatic modification to become biologically active hormones.

Peptidylglycine alpha-amidating monooxygenase (PAM) is an enzyme that catalyzes the modification of peptide precursors to amidated peptides. Carriers of Pam polymorphisms have an increased risk of developing type 2 diabetes (T2D) and show reduced insulin secretion from islets, however, the underlying cellular mechanism remains unclear. PAM is suggested to be involved in primary cilia assembly, and recent research has demonstrated a critical role of β-cell cilia in regulating pancreatic islet cell communication and hormone secretion.

Aim and Hypothesis: We aim to investigate whether PAM is involved in pancreatic islet cilia formation and hormone secretion. We hypothesize that the loss of PAM in β-cells would result in altered cilia morphology and disrupt the crossregulation of islet cells.

Methods: To test whether PAM affects islet cell cilia morphology, we performed immunostaining on islets from β-cell specific PAM knockout (βPamKO) and wild-type (Wt) mice using anti-acetylated α-tubulin antibody and used ImageJ and CiliaQ softwares to quantify cilia length and number. To examine whether PAM impacts islet hormone secretion, we incubated βPamKO and Wt islets at low (1mM) and high (11mM) glucose media and analyzed insulin, proinsulin, glucagon, and somatostatin levels in the media via ELISAs. To study whether PAM affects islet cell composition, we performed immunostaining on βPamKO and Wt mouse pancreatic sections using anti-insulin, anti-glucagon and antisomatostatin antibodies and analyzed different cell number in islet via QuPath software.

Results: Islets from βPamKO mice have reduced cilia length and density compared to control. Islets from βPamKO mice also showed reduced insulin, glucagon, and somatostatin secretion. Furthermore, islets from βPamKO mice displayed a lower percentage of insulin-positive cells.

Conclusion: Our findings suggest that PAM plays a role in mediating pancreatic islet cilia formation, islet hormone secretion, and orchestrating islet cell composition. Further research should be conducted to explore the role of PAM in autocrine and paracrine signaling via cilia and understand how the impairment of PAM in β-cell may contribute to the development of T2D.

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

--- 2023 Poster Participants ---

SESSION #8: CLINICAL

Moderator: Thais Rangel Bousquet Carrilho

1:30 – 3:00 PM In-Person: Chieng Family Atrium

Participants: Sabine Bonnor Serena Chan Ethan Fong Katarina Krivokapic Sirui Li Jessica Luo Jessica Moh Jenna Ramji Laura Seyler

SESSION #8 Poster #63

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Sabine Bonnor

Undergraduate Student, University of British Columbia | Supervisor: Jessica Dennis

Depression and Anxiety Trajectories in Older Adult Canadians: An Analysis of Genetic and Non-Genetic Factors Bonnor, Sabine; Singh, Karanvir; Dennis, Jessica

Getting older comes with many life changes, including transitions in occupation, social environments, and health status. Mental health too changes as individuals age, yet the factors that influence shifts in mental health are poorly understood, despite their public health relevance. According to the World Health Organization, more than 1-in-5 adults aged 60 years and older have a mental health condition such as depression or anxiety, both of which have wellestablished genetic components. However, few studies have investigated how genetics affects changes in mental health as people age. The genetic and environmental factors that affect changes in mental health could be different from those that affect mental health per se, and distinguishing these factors could help us better identify individuals who need extra support as they age. This study aims to address the gap by analyzing the impact of genetic and non-genetic factors on the mental health trajectories of older adult Canadians participating in the Canadian Longitudinal Study on Aging.

The study includes over 26,000 genotyped participants aged 45-85 at baseline, who have completed detailed health, lifestyle, and behavioural questionnaires, at three separate time points, each separated by three years. Our study aims to characterize changes in anxiety and depressive symptoms over time and quantify the association between genetic risk factors and these symptoms. We will use polygenic scores to capture the genetic components of depression and anxiety in the cohort, growth curve models to illustrate the patterns in how depression and anxiety changes over time, and linear regression to enable predictive results. The findings of this analysis will provide valuable evidence to guide the development of targeted prevention and treatment strategies for older adults.

Congratulations to Sabine on receiving an Edwin S.H. Leong Centre for Healthy Aging Award

--- 2023 Poster Participants ---

SESSION #8 Poster #64

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Serena Chan

Undergraduate Student, University of British Columbia | Supervisor: Tom Blydt-Hansen

Clinical Utility of Routine MAG-3 Scan for Surveillance of Kidney Allograft Injury at 48h Post-Kidney Transplant Serena Chan, Tom Blydt-Hansen, Sharon Gershony

Background: Currently, routine surveillance with mercaptoacetyltriglycine-3 (MAG-3) renal scan is used to evaluate the severity of acute kidney injury in the first 48 hours post-kidney transplant in all patients. This test is sensitive in identifying regional perfusion defects (e.g. infarction), ureteral leak or delayed excretion. The MAG-3 scan is, however, an expensive test with logistical challenges to coordinate on short notice, in addition to radiation exposure. Although identification of regional perfusion defects or leaks would prompt urgent intervention, it is a relatively uncommon finding; and in most cases the scan may not directly change management in the short term. Recent work in our lab has identified functional indicators of acute kidney injury caused by ischemia-reperfusion injury, but they have not been compared with MAG-3 scan in terms of prognostic utility. Thus, this project aims to evaluate the continued utility of routine surveillance MAG-3 scans for detecting early acute kidney injury and prognosticating time to recovery.

Methods: Pediatric patients who have undergone kidney transplants from 2016 to 2023 at BCCH have been included in this study. Clinical data, including donor, recipient and functional parameters related to risk of acute kidney injury and graft outcome, are extracted from the HOPESOT clinical transplant registry. Data from MAG-3 scans, including perfusion time, excretory phase and specific abnormalities, are extracted from imaging and diagnostic reports. Statistical tests will be run to compare the prognostic utility of the MAG-3 scan results with the previously identified allograft functional indicators.

Results: Data analysis is in progress at the time of abstract submission.

Significance: The findings from this project will help to guide the use of the MAG-3 scan in the immediate post-operative time period after a kidney transplant, and inform the optimal utilization of MAG-3 scans more broadly for the pediatric transplant community.

--- 2023 Poster Participants ---

SESSION #8 Poster #65

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Ethan Fong

Undergraduate Student, Pomona College | Supervisor: Matthew Carwana

Understanding Pediatrician Knowledge and Perspectives on Barriers and Facilitators to Social Prescribing: An Exploratory Study Ethan Fong, Britt Udall, Matthew Carwana

Background: Social prescribing (SP) is an intervention that targets social conditions through community referrals to assistance for issues such as income security, food security, mental health, and justice. Few examples of successful long-term implementation of SP have been reported in primary care settings in North America, while SP practices are well integrated into the UK’s healthcare system. While patient perspectives on the efficacy of social prescribing are numerous, few studies have examined how providers engage in SP. Likewise, there is no information on practitioner involvement in SP in BC. Overall, a large provider know-do gap exists between the praxis and practice of SP. Objectives: 1. To determine how much pediatric primary care providers participate in social prescribing.

2. To understand the barriers and facilitators to the implementation of social prescribing practices for pediatric primary care providers in British Columbia.

3. To produce a checklist tool that providers can use to improve their ability to engage in effective social prescribing.

Methods: Semi-structured qualitative Zoom interviews will be conducted when participants have been voluntarily recruited via BC Pediatric Society newsletters and purposive sampling to ensure the involvement of various specialties of pediatricians from around the province. Interviews will be transcribed, then analyzed. Discussion questions allow pediatricians to define social prescribing and community-referral practices, discuss how they address social stressors and supports, gauge buy-in with the practice, and explore barriers, then facilitators of SP integration.

Analysis: Grounded theory analysis, across-case, and within-case strategies will be applied to identity themes and relationships, followed by an iterative thematic analysis process aided by NVIVO. Future: Participant recruitment will begin later this summer.

Anticipated Results: While general pediatricians will be familiar with SP practices, specialized practitioners will be less proficient at describing the integration of SP into their practice. Facilitators may include the presence of social worker/ occupation therapist coworkers and SP-informed curriculum, whereas barriers may consist of visitation length and practitioner and patient knowledge of community resources.

Implications: For the first time in BC, pediatricians’ knowledge and perspectives on social prescribing will be consolidated to inform the implementation of future SP practices and policy.

--- 2023 Poster Participants ---

SESSION #8 Poster #66

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Katarina Krivokapic

Undergraduate Student, Queen’s University | Supervisor: Anita Datta

Significance of Frontal Intermittent Rhythmic Delta Activity (FIRDA) on EEG in the Pediatric Population Katarina Krivokapic, Anita Datta, Inderpal Gill

Introduction: Frontal intermittent rhythmic delta activity (FIRDA) is an electroencephalogram (EEG) pattern that primarily occurs in adults. Characterized by a 2-3 Hz delta frequency activity and an amplitude of 50-100 mv that occurs predominantly in the bilateral frontal lobes, it was first described in 1945 and initially attributed to deep midline lesions and posterior fossa tumours. Subsequently, FIRDA was demonstrated to occur with hemispheric brain tumours, ischemic brain injury, and metabolic derangements. The pathophysiological significance of FIRDA is yet to be fully understood.

Although FIRDA has been shown to occur in children, limited literature exists on the significance of this EEG finding in the pediatric population. A small (n = 22) study found FIRDA to be rare and a non-specific indication of brain abnormality.

This study aims to investigate the significance of FIRDA in the pediatric population through the collection and analysis of electrographic and clinical data of patients with FIRDA, bifrontal slowing, and dysrhythmic background EEG findings.

Methods: For this retrospective chart review, patients from the BC Children’s Hospital (BCCH) EEG database were arranged into three groups for clinical data collection: FIRDA group, bifrontal slowing group (control), and background dysrhythmia group (control).

Preliminary Results: 21 FIRDA patients were identified from the database of 43,061 patients, comprising 0.049% of all patients referred to BCCH for an EEG. 17 of the 23 FIRDA patients (74%) had a history of seizures. 2 of the 23 FIRDA patients (8.7%) are deceased. Co-occurring conditions were diverse and included malignant neoplasms, traumatic and anoxic brain injuries, metabolic and genetic disorders, and exposure to toxins.

Conclusion: Our preliminary results suggest that FIRDA is rare and associated with a non-specific range of adverse neurological outcomes. Further comparison with control groups and statistical analysis is pending to delineate differences between FIRDA and other abnormal EEG pattern

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

--- 2023 Poster Participants ---

SESSION #8 Poster #67

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Sirui Li

Undergraduate Student, University of British Columbia | Supervisor: Pascal Lavoie

Post-Covid Outcomes Among Education Workers in the Vancouver, Richmond, and Delta School Districts: A Cross-Sectional Study

Sirui Li, Allison W. Watts, Louise C. Mâsse, David M. Goldfarb, Kathy O’Sullivan, Tisha Montgomery, Mark Pitblado, Liam Golding, Jacob Shew, Claire Cheung, Pascal M. Lavoie Background: After infection with COVID-19, some patients continue to report symptoms that persist long-term beyond the acute infection period (post-COVID). There is a lack of information about the burden of post-COVID outcomes among education workers, who experienced major physical and mental effects during the pandemic due to learning disruptions.

Quantifying the burden of post-COVID symptoms within this occupational group will be important to inform and adapt school-related policies.

Objective: To assess the prevalence of post-COVID symptoms among education workers of three school districts in the Vancouver metropolitan area (Vancouver, Richmond, and Delta).

Methods: A cross-sectional study of education workers who were enrolled by email (to the school districts) between January and May of 2023 from 3 school districts: Vancouver, Richmond, and Delta. Participants were invited to answer an online questionnaire and provide a blood sample for SARS-CoV-2 nucleocapsid (N) serology testing. In the questionnaire, de-identified demographic data and post-COVID symptom responses were collected. Patients who tested positive for SARS-CoV-2 by viral nucleic acid amplification (NAAT), rapid antigen testing (RAT) technology, or N serology were considered to have a prior COVID infection.

Results: 1128 participants were enrolled, 1100 answered the post-COVID symptom questionnaire and 998 provided a blood sample. The cohort had a median age of 49 (IQR: 41, 56), was 78% female sex (n=859), and 59% were teachers (n=646). 652/1128 (57.8%) staff tested positive for SARS-CoV-2. 338/1100 (30.7%) reported at least 1 postCOVID symptom. Out of 18 post-COVID symptoms, persistent fatigue was most common (n=146, 13.4%), followed by decreased energy to exercise (n=145, 13.3%), and then by difficulty concentrating (i.e. “brain fog) (n=144, 13.3%). In 240 participants, the most common symptom length was 3-6 months (n=88, 36.7%). In 238 participants, symptoms most reduced their ability to carry out daily activities ‘a little’ (n=156, 65.6%). In participants who tested positive for SARS-CoV-2, the chance of participants experiencing post-COVID symptoms was similar by age category: 20-29 (34.3%), 30-39 (32.3%), 40-49 (35.9%), 50-59 (35.8%), 60-69 (37.1%), and 70-79 (60.0%), respectively.

Implications: This data reinforced the idea that after SARS-CoV-2 infection, long-lasting symptoms may negatively impact everyday life, especially in female patients - even within a highly vaccinated group of education workers. Even in the aftermath of the pandemic, preventative measures against viral infection should continue to warrant attention.

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

--- 2023 Poster Participants ---

SESSION #8 Poster #68

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Jessica Luo

Undergraduate Student, University of British Columbia | Supervisor: Zoë Brown

A facilitated peer discussion program for improving anesthesia resident wellness: a preliminary analysis of benefits and suggested improvements Jessica Luo, Nicholas West, James D Taylor, Theresa Newlove, Zoë Brown

Background: Pediatric anesthesiologist trainees commonly experience a second victim response following both patient safety incidents and non-safety-related situations (such as physical and emotional stress) that occur during perioperative patient care. In a 2020 survey of anesthesia residents at a Canadian institution, over half experienced a second victim response following near-miss events during their pediatric anesthesia rotation. Additionally, a majority rated “discussion with peers” as a desirable support option following perioperative near-miss events. Although the need for resident support resources is well established, interventions for resident wellness not been well studied.

Objectives: Better REsident Wellness (BREW) rounds are an ongoing quality improvement initiative at BC Children’s Hospital (BCCH) aimed at improving second victim responses following adverse perioperative events. The BREW program was evaluated using pre- and post-intervention surveys to 1) identify the most beneficial components of BREW Rounds, and 2) understand how BREW rounds may be improved.

Methods: All R2 – R5 residents are invited to participate during their pediatric anesthesiology rotations. The weekly 1-hour, in-person, peer discussions are facilitated by a clinical psychologist. Pre- & post-intervention REDCap surveys used to evaluate the BREW program included closed Likert-style and open response questions. Free-text feedback from follow-up surveys were qualitatively analyzed in NVivo.

Results: BREW rounds began in July 2021, with evaluation from October 2021 to February 2023. Overall, 33/48 (69%) invited residents completed both pre- & post-surveys, and all respondents attended one or more BREW rounds. 32/33 (97%) respondents considered BREW “helpful,” “safe,” and “would recommend to future residents.” Within 50 follow-up, open responses, the most noted benefits included themes involving discussion of shared experiences (n=25), bonding with colleagues (n=17), having an open and/or safe space (n=12), and being validated by a proficient and trained facilitator (n=8). Common suggestions for improvement included: session availability (n=9), desire for specific discussion topics/talking points (n=5), and establishing protected time for BREW rounds (n=4).

Conclusion: BREW rounds received overwhelmingly positive feedback from residents. Prospective work may include extending BREW rounds to other BCCH/UBC programs, as well as incorporating semi-structured interviews to further understand the positive impacts and directions for program improvement.

Congratulations to Jessica on receiving a BioTalent Canada Award

--- 2023 Poster Participants ---

SESSION #8 Poster #69

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Jessica Moh

Undergraduate Student, Simon Fraser University | Supervisor: Lori B. Tucker

Fatigue in Children and Teens with Systemic Auto-inflammatory Diseases Jessica Moh, Lori Tucker

Background: Systemic auto-inflammatory diseases (SAID) are rare diseases commonly presenting in childhood characterized by episodic or persistent unprovoked inflammation. Children with SAID may have fever episodes with associated symptoms, or bone inflammation called chronic recurrent multifocal osteomyelitis (CRMO). These diseases can affect children’s functioning and quality of life, but there have been few reports regarding fatigue in children with SAID. Objective: To evaluate self-reported fatigue among children with SAID, and explore differences between children with periodic fever syndromes (PFS) and children with CRMO in disease-related fatigue.

Methods: Children and their families seen at the BC Children’s Hospital Division of Rheumatology’s Auto-inflammatory Clinic were invited to participate in the CAN-Fever Registry, a single-centre, longitudinal registry of children with SAID. Data collected includes demographics (sex, current age, diagnosis, age at diagnosis, time from symptom to diagnosis), symptoms, physician and parent global assessments. The Pediatric Quality of Life (PedsQL) Multidimensional Fatigue questionnaire was the primary outcome measure; children ages 8 and older completed self-report, and a parental form was completed for children < age 8. The PedsQL score ranges from 0-100, with higher scores indicating less fatigue.

Descriptive statistics were used, and comparison of PedsQL Fatigue scores to previously published reports of children with chronic arthritis was done.

Results: 162 SAID patients completed the PedsQL questionnaire at study enrollment; 115 subjects with PFS, 47 subjects with CRMO. The mean time from symptom onset to diagnosis for PFS was 2.5 yrs, and for CRMO 0.8 yrs. Subjects with PFS reported significantly higher fatigue (median PedsQL score 58.33, IQR 47.22-69.44) than children and teens with CRMO (median PedsQL score 68.95, IQR 59.72-79.16) (p<0.0001). Active disease rated by Physician Global Assessment > 0 was associated with higher fatigue. Subjects with SAID reported significantly higher fatigue compared with published data from children with juvenile idiopathic arthritis (SAID mean PedsQL score 61.5; JIA mean 80; p<0.001).

Conclusion: Children and teens with SAID report significant fatigue associated with active disease periods, and higher compared to children with JIA. Attention to assessment of fatigue, impact on quality of life, and directed treatment are important for children with SAID.

--- 2023 Poster Participants ---

SESSION #8 Poster #70

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Jenna Ramji

Undergraduate Student, University of British Columbia | Supervisor: Matthias Görges

Bubble Blowing as an Effective Method for Distraction during Pediatric IV Insertion: A Randomized Controlled Trial

Jenna Ramji, Matthias Görges, Nicholas West, Bianca Vizcaino, Steffanie Fisher, Christa Morrison, Lisa Daechsel, James Chen Background: Anxious children have increased pain awareness and consequently experience greater pain. Therefore, managing pre-procedural anxiety and pain in children is essential to their care. Intravenous cannula (IV) insertion is a painful procedure that causes significant anxiety in some children. Distraction-based methods provide an inexpensive and safe option to reduce anxiety and pain perception in children. Bubble blowing was previously used in the operating room (OR) and other areas of BC Children’s Hospital during painful procedures, including IV insertion. Video watching replaced bubble blowing in the OR due to potential infection control issues. However, some anesthesiologists feel that video watching is less effective than bubble blowing, especially in younger children.

Objectives: The primary aim of this study is to determine if bubble blowing is a more effective method of reducing perceived pain than video watching during IV insertions before induction of anesthesia for medical imaging. The secondary objective is to compare pre-procedural anxiety between the bubble-blowing and video-watching groups.

Methods: This study is a randomized controlled superiority trial. One hundred and twenty children between the ages of 2 and 5 years, who need an IV for their medical imaging procedure, will be recruited. With parental consent, children will be randomly assigned to blow bubbles (experimental) or watch a video (control). Both groups will undergo standard IV insertion procedures, while using their assigned distraction method. Children will have their pain and pre-procedural anxiety scored by a trained observer, at specific timepoints before, during, and (for pain only) immediately after the IV insertion procedure. A linear regression model, controlling for age, sex, and baseline pain score, will be used to compare the differences in pain between the bubble-blowing and video-watching groups. A similar analysis will be conducted for pre-procedural anxiety scores.

(Anticipated) Results: Patient recruitment is expected to start in July 2023 and complete by Spring 2024.

(Anticipated) Conclusions: If we can demonstrate benefit of bubble distraction, we can recommend bubble blowing as an effective technique for other areas of the hospital and re-visit infection control guidelines preventing their current use in the operating room.

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

--- 2023 Poster Participants ---

SESSION #8 Poster #71

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Laura Seyler

Undergraduate Student, University of British Columbia | Supervisor: Kirk Schultz

Impact of Puberty on the Biology and Development of Chronic Graft-versus-Host Disease after Stem Cell Transplantation Laura Seyler, Kirk Schultz

Background: Chronic Graft-versus-Host Disease (cGvHD) occurring after stem cell transplantation (SCT) is caused by an immune-mediated rejection of the recipient by the donor immune system. cGvHD is the primary non-malignant complication after SCT, involving and potentially lifelong chronic inflammation, dysregulated immunity, aberrant tissue repair, and fibrosis. It has been well established that pediatric recipients of SCT exhibit lower incidences of cGvHD compared to adults. Previous investigations into the influence of recipient age on cGvHD biology have unveiled disparities in the immune profiles of prepubertal children compared to adults, suggesting that post pubertal children exhibit profiles more closely aligned with adults. This difference is due either to an age-related decrease in thymic function or a surge of sex hormones during puberty may altering the biology of cGvHD. In the analyses on the large (N=302) pediatric multicenter ABLE study database that showed the impact of puberty, we “estimated” the onset of puberty by utilizing the mean age of the onset of Tanner stage 2 based on Tanner staging tables.

Purpose: Because clinical Tanner staging is not available from the ABLE database, we proposed to investigate whether the accuracy of the estimated onset of puberty by evaluating sex hormone measurement pre stem cell transplantation to accomplish this, archived plasma patient samples obtained before the start of the transplant from the ABLE cohort (N = 165) were analyzed using enzyme-linked immunosorbent assay (ELISA) to determine hormone levels. By completing a more definitive measurement to the onset of puberty by determining hormonal levels we can determine the accuracy of previous estimates in the ABLE studies.

Methods: Competitive ELISA techniques quantitatively measure testosterone or estradiol levels in plasma samples obtained. A microplate is precoated with the hormone, and a labeled antigen will be introduced with the patient sample. The capture antibody will selectively bind to the target hormone antigen, and unbound components will be removed through washing. An enzymatic reaction triggered by a substrate will generate a measurable signal, inversely proportional to the hormone concentration. The results will be compared against a standard curve to accurately quantify hormone levels.

Results: Graphical analysis suggests that estimating hormone levels in male patients should rely on either accurate clinical Tanner staging information or measurement of testosterone levels. However, in the case of female patients, the results of hormonal measurement do not appear to be accurate and clinical tanner stages is optimal.

Conclusion: Because of the variability of the hormonal levels, possibly due the inflammatory environ in the peri-transplant setting in females, accurate clinical Tanner staging is the optimal approach to evaluate the onset of puberty in future studies.

Congratulations to Laura on receiving a Canadian Institutes of Health Research Summer Studentship --- 2023 Poster Participants ---

SESSION #9: CLINICAL

Moderator: Katelynn Boerner

1:30 – 3:00 PM In-Person: Chieng Family Atrium

Participants: Eduardo Sutherland Zoe Kore Marta Karpinski Rachel Lai Valerie Swanston Ty Sideroff Alexander Stolz Zoe Kortje Kyle Ma

SESSION #9 Poster #72

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Eduardo Sutherland

Master’s Student, University of British Columbia | Supervisor: Anton Chau

Duration of Urinary Catheterization After Cesarean Deliveries – A Retrospective Cohort Study Eduardo Sutherland, Thomas Yang, Anton Chau

Background: An indwelling urinary catheter is routinely placed to prevent over-distension of the bladder in women having cesarean birth under neuraxial anesthesia. The urinary catheter often remains in place during the postpartum period because there is inhibition of ambulation and spontaneous micturition from the neuraxial local anesthetic and opioids administered. With an increasing focus on enhanced postpartum recovery, the Society for Obstetric Anesthesia and Perinatology (SOAP) guideline recommends that removal of urinary catheter at 6-12 hours postpartum can promote ambulation, decrease incidence of urinary tract infections, and reduce urethral pain. The purpose of this study is to determine the current duration of urinary catheterization at BC Women’s hospital following cesarean deliveries. We hypothesized that the current duration of urinary catheterization is significantly greater than what is recommended by the SOAP guideline.

Methods: This study was deemed a quality improvement project and ethics committee review was not required. All pregnant patients undergoing a scheduled or unscheduled cesarean delivery at BC Women’s Hospital in July 2023 were included. Data on the time of neuraxial anesthesia, urgency of procedure, time of delivery, time of recovery of hip flexion, time of ambulation and time of urinary catheter removal were retrospectively collected from the electronic medical record. The primary outcome was the mean duration of urinary catheterization stratified by anesthetic techniques analyzed by unpaired t-test. Secondary outcome was the mean time to recovery of hip flexion and ambulation and the relationship between duration of urinary catheterization with these covariates analyzed using a multivariable linear regression model.

Results: To date, a total of 73 patients were included. The mean(SD) duration of urinary catheterization was 19.2 (4.7) h. When stratified for anesthetic technique, those who received spinal anesthesia had a significantly shorter mean duration of urinary catheterization compared to epidural anesthesia (18.7 h vs. 21.6 h, p = 0.004). The mean (SD) time to hip flexion recovery and ambulation were 5.1 (2.2) h and 14.6 (6.5) h, respectively. There was no significant relationship between the duration of urinary catheterization duration with any of the time variables.

Conclusions: The current duration of urinary catheterization after cesarean delivery at BC Women’s is significantly longer than what is recommended by national society guidelines. The urinary catheter remains in place beyond the time for recovery of hip flexion strengths and ability to ambulate. The next step is to survey the nursing practice to determine the barriers contributing to this delay in catheter removal.

--- 2023 Poster Participants ---

SESSION #9 Poster #73

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Zoe Kore

Medical Student, University of British Columbia | Supervisor: Sally Hynes

Child Life for Children with Burns: Impact on Patient Experience Zoe Kore, Rebecca Courtemanche, Young Ji Tuen, Jackie Nixon, Gloria Kwong, Sally Hynes

Background: Child Life Specialists (CLS) apply evidence-based psychosocial interventions to improve coping skills in pediatric patients undergoing medical procedures. They provide age-appropriate preparation, procedural support, and education to children and families. CLS support is particularly relevant in the context of burn wound care, as children with burns experience high levels of pain and distress. This quality improvement project aims to estimate the effect of the introduction of CLS support on patient experience for children receiving burn wound care at the BC Children’s Hospital (BCCH) Medical Day Unit (MDU).

Methods: This project is an observational, survey-based study. The first phase involves standard care, while the second includes CLS support. Following consent, surveys about patient experience are administered to children, parents, nursing staff, plastic surgeons, and the CLS. Procedural pain is measured using the Wong-Baker Faces Pain Scale (0-10).

Procedural anxiety for children is assessed with the Venham Picture Test (0-8), while observational reports are scored using Venham’s Anxiety Rating Scale (0-5). Data are obtained from patients’ medical charts regarding burn characteristics and other relevant clinical information. Data were analyzed descriptively for all visits, and by visits with and without a CLS. Preliminary Results: Eighteen children (mean age=6.38 years) have been recruited to date. Of the 36 total MDU visits, 7 involved CLS. For all visits, mean procedural pain scores were 3.81/10, 2.71/10, and 2.59/10; mean procedural anxiety scores were 1.76/8, 0.97/5, and 1.19/5, as reported by the child, parent, and staff, respectively. When a CLS was present, children reported less pain (-3.6) and higher anxiety (+1.1). Pain and anxiety scores reported by parents and staff were similar (mean differences <1).

Conclusion: While a larger sample size and a more robust statistical analysis are necessary to estimate the effect of CLS, preliminary feedback suggests this support is valued by parents and staff and improves patients’ coping skills during burn wound care. Enhanced coping skills may build children’s self-confidence when undergoing medical procedures and promote positive care experiences for patients, families, and the healthcare team.

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

--- 2023 Poster Participants ---

SESSION #9 Poster #74

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Marta Karpinski

Medical Student, University of Toronto | Supervisor: Jugpal Arneja

Quality of Life after Surgery for Adolescent Gynecomastia: Preliminary Results Marta Karpinski, Young Ji Tuen, Rebecca Courtemanche, Jugpal Arneja

Background: Adolescent gynecomastia has detrimental impacts on patients’ psychosocial well-being. Surgical intervention for gynecomastia has been shown to significantly improve patients’ quality-of-life. However, to date, the impact of gynecomastia surgery in adolescents has only been assessed using generic quality-of-life scales, which may not sensitively capture important issues pertaining to the chest. The purpose of this study is to assess patients’ postoperative quality-of-life using a patient-reported outcome measure specific for body contouring procedures, and to identify patient and treatment factors associated with quality-of-life scores.

Methods: Patients were recruited from the senior author’s (JA) clinical practice at BC Children’s Hospital. Adolescent patients undergoing surgical treatment for Simon Grade I, IIa, or IIb gynecomastia from May 2009–November 2022 were eligible for inclusion. Eligible patients were invited to participate in the study via post mail and telephone call. Patients agreeing to participate completed the BODY-Q Satisfaction with Chest and Psychological Function scales, either on an online platform or over the phone, as per the participants’ preference. Raw scores were summed and converted into Rasch transformed scores (scale 0-100), and were averaged. Chart review was also performed to collect information on BMI, Simon Grade, post-operative complications, and revision procedures.

Results: Of the 79 patients invited to participate in the study, 26 (32.9%) completed the questionnaire. At the time of survey completion, the average age of participants was 23.5 years, and average BMI was 27.1. The median score on the Satisfaction with Chest scale was 70 (IQR, 55.5-100), and 73% of patients reported being “very satisfied” with the appearance of their surgical scars. The median score on the Psychological Function scale was 72.5 (IQR, 56.5-92). The average time from surgery to survey completion was 6.6 years. BMI, Simon Grade, post-operative complications and revision procedures were not significant predictors of satisfaction and psychological function scores.

Conclusion: This study shows that patients who underwent surgery for gynecomastia report good satisfaction with chest appearance and psychological function, with BODY-Q scores higher than those reported in the general population (54 and 61.14, respectively). The results of this study may have an important role in destigmatizing gynecomastia surgery for adolescents.

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

--- 2023 Poster Participants ---

SESSION #9 Poster #75

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Rachel Lai

Master’s Student, University of British Columbia | Supervisor: Faizal Haji

Creating a Database to track the Natural History and Surgical Outcomes of Pediatric Patients with Spinal Dysraphism Followed in the British Columbia Children’s Hospital’s Spinal Cord Clinic Rachel Lai, Belinda Dundon, Mark Williamson, Faizal Haji

Background: Spinal dysraphism in the pediatric population consists of a heterogeneous collection of different pathologies. This makes surgical decision making in this population challenging and complex. In open spinal dysraphism (e.g. myelomeningocele), the cord is directly exposed to the outside environment, requiring surgical intervention in utero or within days of life and potentially requiring management of associated complications (e.g. hydrocephalus and hindbrain herniation). Conversely, closed spinal dysraphisms involve the cord covered by other normal mesenchymal elements, and can include various pathologies (e.g. lipomyelomeningocele, terminal myelocystocele, limited dorsal myeloschisis, thickened/fatty filum terminale, split cord malformations, and caudal regression syndrome), which may remain asymptomatic or cause tethering of the spinal cord, with subsequent neurological deterioration. While it is likely that each of the aforementioned pathologies have distinct natural histories and potential morbidity associated with surgical correction, currently data related to these issues is scarce. This makes surgical decision making challenging, complex, and subject to surgeon or center preference. To overcome these challenges, we have created a new longitudinal dataset that captures the natural history, decision making process, and surgical outcomes of children with spinal dysraphism followed in the BC Children’s Hospital’s (BCCH) Spinal Cord Clinic (SCC).

Methods: The database utilizes REDCap to house the patient visit entries and is divided into the different specialties (neurosurgery, urology, orthopedics, physiatry, etc.) that follow the patient in the SCC. Data are extracted retrospectively from SCC joint reports (for patient visits prior to June 2023) and prospectively during patient visits (June 2023 onward).

The neurosurgery domain of the dataset looks at multiple variables , including the type of spinal dysraphism, symptoms of cord tethering (neurological, urological and/or orthopedic), the Spina Bifida Neurological Scales (SBNS) score, changes on cranial or spinal imaging, and surgical interventions (e.g. cord detethering) and their outcomes.

Significance: We hope that the creation and implementation of this longitudinal dataset will better inform local surgical decision making for children with spinal dysraphism who present to the SCC. Once successfully pilot tested with the BCCH-SCC cohort, we plan to expand this database into a national and/or international prospective registry, from which larger scale studies to to identify risk factors for neurological deterioration and factors influencing outcome from surgical intervention in this population can be conducted.

--- 2023 Poster Participants ---

SESSION #9 Poster #76

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Valerie Swanston

Medical Student, University of British Columbia | Supervisor: Jonathan Rayment

Assessing the safety and efficacy of home-collected airway microbiological samples in children with cystic fibrosis at BC Children’s Hospital Valerie Swanston, Jonathan Rayment

Background: Lung disease caused by chronic infection and inflammation is the prominent source of morbidity and mortality in people with cystic fibrosis (CF). Current guidelines recommend at least quarterly airway microbiological surveillance, traditionally performed in clinic with sputum collection or airway swabs. During the coronavirus disease 19 (COVID19) pandemic, restrictions on in-person clinic visits resulted in reduced frequency of airway microbiological sample collection. There was a concern that virulent organisms could be missed in the CF population at BC Children’s Hospital (BCCH). In response, we developed a home culture program whereby kits containing sputum containers and airway swabs were mailed to the families of CF patients and parents were coached in collecting samples over Zoom.

The clinic continues to use this technique for virtual appointments and for sample collection in the case of increased respiratory symptoms. However, the quantitative results of the samples collected as part of this initiative have not been assessed.

Methods: This is a retrospective quality improvement analysis of all children receiving care at the CF clinic at BCCH. Culture data was derived from the Sunset microbiological database at BCCH and clinical information was retrospectively collected from patient charts. Our outcomes of interest include (1) to characterize the frequency of home screening versus in-clinic screening, (2) to investigate the positivity rates of different pathogens in both screening methods, and (3) to compare the percentage of sampling methods used by home vs in-clinic screening.

Preliminary Results: Included in our analyses are 2853 culture results from respiratory samples collected between January 1st, 2019, to May 16th, 2023. Of these, 2086 were collected by healthcare providers at BCCH, 566 were collected by parents and/or caregivers in patients’ homes, and 201 were collected by healthcare providers at community outreach clinics. Overall positivity rates of all pathogens was higher in home-collected cultures compared to in-clinic cultures (64.7% versus 42.8%).

Discussion: The results of this study have an opportunity to directly impact the care of children with CF at BCCH. If home collection appears to provide microbiological data similar to that obtained with in-person collection, we may consider revisiting our practice in clinic.

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

--- 2023 Poster Participants ---

SESSION #9 Poster #77

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Ty Sideroff

Undergraduate Student, University of British Columbia – Okanagan | Supervisor: Christine Voss

A Longitudinal Study of Physical Activity and Quality of Life in Children and Youth with Diabetes in the BC Interior Ty Sideroff, Nick Wall, Alex Myshak-Davis, Kiera Lee-Pii, Simran Gill, Holly Buhler, Deanne Taylor, Trent Smith, Christine Voss

Background: Inadequate physical activity (PA) is common for all populations, including those with diabetes. Beyond diabetes disease management, PA may have an important role in a child’s quality of life (QoL). This ongoing observational longitudinal study aims to quantitatively assess habitual PA levels via commercial activity trackers (Fitbit Charge 5) and explore associations between PA levels and perceived QoL in children and youth with diabetes in the BC Interior.

Methods: Children and youth (5-19yrs) with diabetes (any type), who had received pediatric diabetes care through Interior Health in the Okanagan region during the previous 12 months, were invited to the study. At baseline, participants completed a validated, age-appropriate Pediatric Quality of Life Inventory (PedsQL) survey via REDCap (8-19yrs only).

A higher PedsQL score (0-100) indicates better QoL. To assess PA, participants wore a commercial activity tracker (Fitbit Charge 5) consecutively for 28 days. These assessments were repeated six months following baseline if consent was given. Intra-day Fitbit data were extracted to REDCap via a custom-written application programming interface (API), and median steps/d were calculated for valid days (>600 min wear time). Analyses were completed in R, and significance was set at p<0.05.

Results: 58 participants (12.8+3.9yrs, 41% girls) have completed baseline data collection. Thus far, 10 participants (13.3+4.9yrs, 50% girls) have also completed data collection for the 6-month follow-up. At baseline, their median total PedsQL score was 77.0 (IQR: 74.8-78.6), and the median steps/day was 9493 (IQR: 7771-11654). There was a significant correlation between total PedsQL score and steps/day (rho=0.29; p=0.04). There was no significant difference in age, steps/day or PedsQL score between those who have and haven’t completed the follow-up assessments. At six months follow-up, neither QoL nor daily PA significantly changed from baseline (p=0.93 and 0.38 respectively): Median PedsQL was 73.75 (IQR: 71.72-75.47) and median steps/day was 10002 (IQR: 9075-12519).

Conclusion: This preliminary analysis suggests that there may be an association between QoL and PA levels in children and youth with diabetes in the BC Interior. Future follow-up and qualitative assessments will shed light on potential causal associations and will help to improve clinical recommendations and adherence.

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

--- 2023 Poster Participants ---

SESSION #9 Poster #78

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Alexander Stolz

Undergraduate Student, University of British Columbia | Supervisor: Heng Gan

Modification of Automated Cardiac Function Prediction Algorithms from ‘Non-Expert’ Echocardiographers in Pediatric Patients Alex Stolz, Steffanie Fisher, Rachel Bates, Matthias Görges, Brendan Smith, Kandice Mah, Katherine Taylor, Simon Whyte, Heng Gan

Purpose: Cardiac output (CO) is the volume of blood pumped by the heart per minute. It is an important consideration during anesthesia care, with low-CO states being associated with adverse health outcomes if improperly treated. Ejection fraction (EF) measures how efficiently your heart pumps blood out, and can be used to identify the cause of low CO thus dictating treatment. Echocardiography (ECHO) is a technique where ultrasound images of heart structures are taken to visualize its function, and analyzed to determine CO and EF. ECHO is typically performed only by specialist cardiologists, decreasing its accessibility. There is increasing demand on anesthesiologists to intra-operatively perform ECHOs to guide clinical decision-making. The assessment of CO and EF using ECHO is difficult however, especially for practitioners with limited experience in it.

Recently the ECHONet-Dynamic algorithm, a machine-learning model for automatically assessing CO and EF using uploaded ECHO images/videos, was developed. This offers the potential to be a clinical tool for anesthesiologists, but has not been clinically validated in pediatric populations using ECHO taken by practitioners inexperienced with ECHO. Objective: To investigate the clinical usability of the Prediction Algorithm for measuring CO and EF in pediatric patients under anesthesia, given ECHO images taken by practitioners without ECHO expertise. Mean absolute error under 15% and maximum error under 30% between model and cardiologist estimates are established performance goals.

Methods: This cohort study will recruit from a convenience sample of patients 0-18 years undergoing general anesthesia, without hemodynamically significant heart defects. Recruited providers will take transthoracic ECHO images after anesthetic induction. These providers will come from a pool of doctors with limited ECHO experience. Images will be uploaded to the algorithm and resulting CO and EF measurements will be compared to cardiologist estimates, which are considered the Gold Standard. Model performance will be stratified along various patient metrics such as age.

Future Direction: If validated, the ECHONet-Dynamic Algorithm offers clinicians a new tool for identifying low-CO states and EF during general anesthesia, ultimately improving clinical decision-making. If performance thresholds are not met, the model will be refined by applying its machine-learning capabilities to the dataset.

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

--- 2023 Poster Participants ---

SESSION #9 Poster #79

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Zoe Kortje

Undergraduate Student, Queen’s University | Supervisor: Donna Lang

Assessing cardiovascular health via retinal imaging in chronically treated schizophrenia patients Zoe Kortje, Donna Lang, Ava Grier

Background: Persons with schizophrenia spectrum disorders (SSD) are disproportionately impacted by cardiovascular disease (CVD), likely due to genetic, pharmacological and lifestyle factors. Most studies find that CVD mortality in this population reaches frequencies of 40-50%, which is significantly higher than the general population. Despite this, cardiovascular screening in patients with SSD is not sufficiently prioritized or standardized.

Retinal fundus imaging allows for the direct and non-invasive assessment of the cerebral vasculature; the retinal and cerebral small vessels share physiological properties and embryological origins. With the assistance of semi-automated computer programs, retinal images can be analyzed for isolated vascular markers (eg. microaneurysm) and early changes in blood vessel patency, diameter, and tortuosity. A wide range of these microvascular signs have been correlated with worsened outcomes in cardio- and cerebrovascular health. Retinal fundus imaging may therefore have the potential to act as a screening tool for cardiovascular risk in vulnerable individuals with SSD. Methods: Data are currently being collected from inpatients with chronic schizophrenia and from matched healthy control volunteers. Data collection entails retinal imaging with a non-mydriatic fundus camera, a fitness assessment, standard bloodwork, and a neurocognitive assessment battery. Individual retinal deficits in each image are identified by an ophthalmologist and documented by research assistants using a qualitative rating scale. VAMPIRE, a vessel segmentation program, allows for quantitative data to be collected from the images.

Anticipated Results: Our team expects to expose an increased volume of retinal deficits in the schizophrenia patient group. Secondary to this, it is expected that increased retinal deficit scores will be positively correlated with BMI and blood pressure.

Implications: Results from this pilot study may facilitate the development of a rapid and tolerable method for detecting the risk of adverse cardio- and cerebrovascular events in a vulnerable patient population. Further, this study may provide more insight on the retinal vasculature and its relationship to cognition in individuals with SSD. Lastly, this study will allow for the practical implementation of our team’s qualitative retinal rating scale, which has been an ongoing project since 2022.

Congratulations to Zoe on receiving a BC Mental Health and Substance Use Services Summer Studentship

--- 2023 Poster Participants ---

SESSION #9 Poster #80

Watch In-Person: Thursday, July 27 | 1:30 - 3:00 pm Chieng Family Atrium, BCCHR

Kyle Ma

Undergraduate Student, University of British Columbia | Supervisor: Jehannine Austin

Does the Provision of Improved Information Mitigate Negative Reactions to Receiving Direct-To-Consumer Polygenic Risk Scores Kyle Ma, Kennedy Borle, Jehannine Austin. Lasse Folkersen

Background: A polygenic risk score (PRS) estimates an individual’s genetic predisposition to a specific trait or condition by combining the estimated contribution or effect of a large number of known genetic variants, each contributing a small amount of risk. PRSs are increasingly available to people without the involvement of a healthcare provider, through commercial, direct-to-consumer genetic testing companies themselves, and from third-party services that allow users to upload raw genetic data to calculate PRSs for various complex conditions. A previous study found that over half of users (61%) who accessed direct to consumer PRSs experienced a negative reaction, and that this outcome was associated with lower understanding of PRSs. Objective: To investigate whether improving the information provided about PRS reduces negative reactions experienced by users accessing PRSs without the involvement of healthcare provider through a not-for-profit third-party tool called Impute.me.

Methods: Data from a previous study about reactions to PRS among users of this website were used as baseline data. Specifically, to collect baseline data, individuals using Impute.me were invited to participate in an anonymous study in which they completed a questionnaire evaluating their reactions to PRS results using the Feelings About genomiC Testing Results (FACToR) questionnaire and the Impact of Event Scale–Revised (IES-R), understanding of the meaning of a PRS through five true/false questions, interpretation of a sample PRS result through three true/false questions, and questions about demographics and numeracy. Over 200 responses were collected in the baseline study after which it was closed.

Subsequently, the information about PRS that was provided to Impute.me users was enhanced through addition of a pie chart to visualize the portion of variability that can be explained by the PRS result, removal of complex information, and increasing digestibility of explanations to enhance readability. Individuals were again invited to participate in a study involving the same instruments as the baseline study. We conducted statistical tests (Chi Square and Mann Whitney-U) to assess differences in understanding and negative reactions before and after changes were made in how PRSs were communicated through Impute.me.

Results: 441 Impute.me users were recruited and completed the questionnaire. There were no significant changes in understanding of a PRS result (χχ2(1, n = 529) = 0.093, p = 0.415) or interpretation of a sample PRS result (χχ2(1, n = 492) = 0.422, p = 0.289). There were no significant changes in negative reactions to a PRS as measured by the FACToR scale (χ2(4, n = 481) = 0.422, p = 0.289) and the IES-R scale (U = 24593, p = 0.772), A significant relationship was found between lower understanding of a PRS result and experiencing a negative reaction measured by both the FACToR scale (U = 5133, p = 0.019) and IES-R scale (U = 4348, p = 0.02).

Conclusion: Our results indicate that improved information about PRS did not reduce negative reactions amongst impute.me users.

There are several possible explanations for this finding: i) the improved information we provided was not sufficient in improving understanding, ii) the improved information we provided did improve understanding, but other variables contributed to experiencing a negative reaction, or iii) users did not read the information we provided to understand the implications of the PRS. For future studies, we suggest the creation and evaluation of a patient decision aid to support value-based decision making for users unsure if pursuing PRSs is the right decision for them and explore whether this mitigates negative reactions arising from the receipt of PRSs in this context.

--- 2023 Poster Participants ---