Exploring the impacts of extreme weather on children during the school day

Dr. Brenton Button

Contributing partner: Children's Hospital Research Institute of Manitoba

Affiliations: University of Winnipeg

Outdoor school recess is an important part of the school day. It gives children chances to be active, spend time outside and play with friends. These activities have been linked to improved health and well-being.

Due to school rules, approximately 30 per cent of recesses are modified to be indoors under certain weather conditions. During indoor recess, children have fewer chances to be active, play outside or play with friends.

This project aims to work with children to explore their thoughts and feelings of play in extreme weather and during indoor recess. Manitoba has some of the harshest winters in Canada. These findings can help change rules to give students chances to play and be active during indoor recess.

Convergence of epidemics: The effects of methamphetamine use and concurrent STBBI on the immune system and HIV susceptibility

Dr. Catherine Card

Affiliation: University of Manitoba

There is a merging between the methamphetamine (meth) and HIV epidemics. Since 2018, more than half of new HIV infections in Manitoba have been among people who inject drugs (PWID), with meth as the leading substance injected.

People who inject drugs are more likely to have multiple infections transmitted by sexual contact or blood products (referred to as STBBI), and women tend to be more affected than men. Meth use and STBBI can have dramatic impacts on the immune system, with each independently leading to inflammation and increased susceptibility to other infections, including HIV. However, the combined effects of meth use and STBBIs on inflammation and immune system function in PWID are unclear.

This study aims to address these gaps in knowledge by measuring inflammation, immune cell activation and immune function in blood samples from PWID who use meth. We’ll also try to determine whether STBBIs further aggravate these immune outcomes.

We’ll also test the extent to which cells from the study participants are readily infected with HIV in the lab, to see whether the immune outcomes are related to HIV susceptibility. We will explore how biological sex and gender impact these effects in PWID.

This study will reveal important information regarding the immune health of PWID. It’ll help guide approaches to engaging them in STBBI prevention and harm reduction strategies that address their needs.

Travelling for Abortion Care: A Critical Qualitative Analysis of Experiences Accessing Therapeutic Abortion in Winnipeg

Dr. Sabrina Lee

Affiliation: University of Manitoba

Despite Canada’s global leadership in reproductive rights, there remain significant barriers to accessing comprehensive abortion care due to inequitably distributed services, prohibitive costs due to loss of employment and travel, and lack of knowledge among providers and those seeking abortion services.

With the vast majority of abortion care involving a surgical procedure, comprehensive abortion services are concentrated in large cities along the southern border of Canada. The recent introduction of mifepristone (the gold standard in medication abortion) following Health Canada approval in 2015 and commercial availability in 2017 has transformed the Canadian abortion care landscape. This oral regimen offers the opportunity to improve the geographical inequities described in the literature when examining access to abortion services.

This qualitative study aims to provide insight into the experiences of those travelling to Winnipeg for both surgical and medical abortion care. We hypothesize that experiences of people travelling to Winnipeg for abortion care will similarly reflect logistical, emotional, and financial barriers associated with travelling for abortion care. Using Critical and Feminist lenses, we will conduct semi-structured interviews to achieve the following objectives:

1. To explore the experiences of those travelling at least one hour by road or any travel-time by flight to Winnipeg for induced abortion services.
2. To understand the process behind the choice of abortion method in those travelling at least one hour by road or by flight to Winnipeg for induced abortion services.
3. To investigate perceptions and attitudes towards surgical and medical abortion among those travelling at least one hour by road or by flight to Winnipeg for induced abortion services.
4. To provide insights into facilitators and barriers to accessing abortion services in those travelling at least one hour by road or any time by flight to Winnipeg for induced abortion, potentially identifying areas for improvement in abortion health policy and abortion service delivery.

This study will add unique insight to the young knowledge base in Canada of experiences in those needing to travel for their abortion care. Our results will have the potential to improve abortion services in rural and remote areas, improve our understanding of travel experiences for abortion care when necessary, and bolster provider knowledge in ways to better serve this particular population in the outlined circumstances.

The impact of varying weightbearing restrictions on postoperative outcomes following arthroscopic surgery for femoroacetabular impingement: a randomized trial

Dr. Devin Lemmex

Affiliation: Pan Am Clinic Foundation, University of Manitoba

Femoroacetabular impingement is a condition of the hip that primarily causes pain in young and active individuals. It is caused by irregularities in the shape of the bones that make up the hip joint, leading to tears in the cartilage. It can eventually lead to arthritis.

To treat this condition, patients often undergo lengthy periods of physiotherapy, use anti-inflammatory medication and undergo injections into the joint. However, if these are not effective, then surgery may be performed.

This type of surgery is done through small incisions, using a camera, and is minimally invasive. The available studies evaluating this type of surgery tell us that it is safe, reproducible and very effective.

Despite technological advances and modern techniques used inside the operating room, it is unclear on how patients should start their rehabilitation process afterwards. Specifically, should they be using crutches to protect the hip from weightbearing, or should they begin walking as soon as possible? This is a simple question but one that potentially can make a big difference in early recovery and comfort after surgery.

This study aims to help answer that question by comparing patients placed into two separate groups and following their post-operative outcomes. We will also be evaluating our physiotherapy techniques to determine when a patient is fit to return to sports after this type of hip surgery.

Discerning neuroregressive ataxia and autism in two novel knock-in mouse models.

Dr. Paul Marcogliese

Recipient of the Shaun Lamoureux Best Operating Grant Award

Contributing partner: Children's Hospital Research Institute of Manitoba

Affiliation: University of Manitoba

Manitoba has a critical, unmet need to understand and treat developmental disorders, including autism spectrum disorder. We and others have identified different types of variants in the gene called IRF2BPL associated with both autism spectrum disorder and a highly severe neurological disorder that presents in children around the age of five years old called NEDAMSS.

Although variable, NEDAMSS patients have neurological regression including loss of speech, loss of developmental milestones, seizures, and movement abnormalities where they eventually become immobile in adolescence. Beyond being an important human disease gene, IRF2BPL is an interesting gene as it is enriched in the brain and mostly unstudied.

We and our collaborators have made models of IRF2BPL in fruit flies and zebrafish. However, there are no models in mice, which are needed for translating pre-clinical drug screening studies to patients. In this proposal, we have generated two patient-specific mouse lines associated with either autism or NEDAMSS. We will characterize both of these novel mouse models, determining if there are behavioural defects as well as pathology in the brain.

Moreover, we can use these two mouse lines to discern, mechanistically, why certain mutations lead to autism spectrum disorder and other mutations lead to a severe neurological disorder like NEDAMSS. Both models will deepen our understanding of neurodevelopment and neurodegeneration.

Development of a Culturally Appropriate Gestational Diabetes Mellitus Prevention Program for Urban-dwelling Indigenous Individuals in Manitoba

Dr. Leslie Redmond

Affiliation: University of Manitoba

This project will develop an intervention that will aim to decrease the risk of gestational diabetes mellitus, or GDM, in urban-dwelling Indigenous people in Manitoba.

GDM is a serious health condition that can put both the pregnant person and the baby at risk for complications, both during pregnancy and well into the future. Preventing GDM is especially important for Indigenous people, as prevalence is high and many other health disparities are also present.

Country foods (foods supplied by the land) and lifestyle activities have many health benefits, including the prevention of type 2 diabetes and GDM. However, country foods and lifestyle activities are less available and accessible to urban-dwelling Indigenous people in Canada, and those at risk for GDM may not be able to benefit from them.

This project will work with urban-dwelling Indigenous people and stakeholders committed to improving Indigenous health to develop a GDM risk-reduction intervention that focuses on country foods and lifestyle activities. We hope that this intervention will lead to improved personal health of urban-dwelling, pregnant Indigenous people and contribute to overall better population health through the prevention of health risks and complications in future generations.

Circadian Dependent Cardiometabolic Heart Failure

Dr. Inna Rabinovich-Nikitin

Affiliation: University of Manitoba

Shortness of breath (dyspnoea) is a common, debilitating symptom that affects patients with respiratory disease, but it also occurs in healthy adults during physical exertion. Females report greater levels of dyspnoea during exercise and activities of daily living than males, but it is unclear why. Most research has focused on how biological factors (such as lung size, airway size, and pulmonary function) influence the perception of dyspnoea in males and females; however, these biological factors fail to fully explain sex differences in dyspnoea. Gender, which encompasses several psychological, social and cultural factors, may better explain why females experience dyspnoea more than their male counterparts.

This study seeks to determine the impact of both sex and gender on the perception of dyspnoea in healthy males and females. To accomplish this goal, male and female participants will undergo detailed analysis of gender-related factors, pulmonary function testing, exercise testing, and a series of experimental trials designed to provoke sensations of dyspnoea. Throughout testing, the perception of dyspnoea will be evaluated using validated scales, while the ventilatory, cardiovascular and metabolic responses will be recorded using a cardiopulmonary testing system. We will determine, for the first time, how gender-related factors influence the perception of dyspnoea.

The results of this study will contribute to improving our understanding of causes of dyspnoea and how they may differ in men, women, boys, girls, and gender-diverse individuals. This work is important given that dyspnoea is an independent predictor of mortality, is remarkably common in older adults, and is difficult to treat effectively.

Uptake of fetal extracellular vesicles (EVs) across placental barrier

Dr. Ayesha Saleem

Recipient of the Kerry Bittner Communication Award

Contributing partner: Children's Hospital Research Institute of Manitoba

Affiliations: University of Manitoba

The process of cell-to-cell communication involves small bubbles of cellular material called extracellular vesicles (EVs), which are released from all cells.

Think of EVs as emails – just like an email can have text, video or audio files, EVs are versatile in the messages they can carry. EVs can hold different combinations of proteins, fatty acids and nucleic acids, and this cargo can change depending on the cell type of origin, physiological conditions, and the intended recipient cell.

Several studies have explored the mechanisms of EV synthesis and release and catalogued the variety of enclosed biochemical content.

Interestingly, EVs have been shown to cross physiological barriers, like the blood-brain barrier. If EVs can cross the (almost impenetrable) blood-brain barrier, it is likely that they can also cross the placental barrier. This makes them ideal candidates for mediating communication between fetus and mother.

This project will investigate whether EVs form the main biological communication link between mother and fetus. If fetal EVs can be detected in maternal blood/tissues, it will not only advance basic science knowledge, but also lead to the development of improved blood-based diagnostic markers that can be used to identify fetal abnormalities in a timely and safe manner. Early diagnosis may help prognosis and facilitate improved health outcomes for the unborn child.

Effect of Pulmonary Telerehabilitation and Telemonitoring for patients with chronic respiratory diseases: a feasibility study.

Dr. Diana Sanchez-Ramierz

Affiliation: University of Manitoba

Pulmonary rehabilitation (PR) has shown great benefits in patients with chronic respiratory diseases. Unfortunately, this intervention is frequently inaccessible to patients.

Remote rehabilitation and monitoring of patient’s vital signs (e.g., heart rate) are potentially valuable mechanisms to improve patient care and access, especially in rural areas. However, further research is needed to assess the effect and practicality of delivering PR programs using telerehabilitation and telemonitoring.

This study aims to evaluate the effects of a pulmonary telerehabilitation program that incorporates telemonitoring on patients with chronic lung diseases. It also aims to assess the feasibility of using videoconference and commercial wearable devices in patient treatment.

In this study, 24 patients with chronic obstructive pulmonary disease and/or pulmonary fibrosis will participate in a pulmonary telerehabilitation program involving group exercise and education sessions via videoconference.

Heart rate, blood oxygen level and physical activity will be monitored using a smart watch and a finger pulse oximeter connected to a smart phone or tablet. We anticipate that people will experience improvement in their health outcomes and be satisfied with receiving the intervention in the comfort of their home.

Additionally, results of this study will guide the planning and development of alternative formats for PR programs in Manitoba, which could improve access to this much-needed service, especially for patients with mobility difficulties and patients who live outside Winnipeg.

Improved prediction of subclinical and early clinical kidney transplant rejection by a CXCL10 isoform specific mass spectrometry assay

Dr. Rene Zahedi

Affiliation: Univeristy of Manitoba

More than 40,000 Canadians have end-stage kidney disease (ESKD). Approximately 60 per cent of these undergo dialysis. The cost of dialysis can reach $200,000 per patient per year in remote areas of Manitoba and amounts to over $2 billion per year in Canada.

Nevertheless, approximately 50 per cent of these patients typically die within four years. Kidney transplantation improves ESKD patient survival and quality of life and reduces costs. Unfortunately, one in three patients will experience transplant rejection within a year, leading to a considerably reduced survival rate.

Although early detection and early treatment can dramatically reduce the risk of rejection and death, current clinical testing fails to detect rejection early enough. Therefore, we are investigating whether a specific molecule in urine, the protein CXCL10, enables early detection of rejection and can predict outcomes.

CXCL10 urine levels are clearly higher in patients with transplant rejection, allowing not only early detection but also personalized treatment. However, predictions made based on the currently available testing method are often not accurate. A probable reason is that these tests cannot distinguish between different forms of the CXLC10 protein. Although these different forms are almost identical, they have very different effects – some of them may accelerate rejection, while others may slow it down.

We will develop a more specific test to clearly distinguish these different forms of urinary CXCL10 and thus improve its diagnostic value for transplant patients. Ultimately, this will enable more personalized patient treatment to yield better outcomes, higher survival rates and a better quality of life, while reducing costs.