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The American Shoulder and Elbow Surgeons association has awarded a team of London researchers the 2017 Charles S. Neer Award for Clinical Science, one of the most prestigious awards in the areas of shoulder and elbow surgical research in North America.

The award recognizes the scientists’ development of the PCR-RFLP (polymerase chain reaction restriction fragment length polymorphism) assay, a test that can accurately identify Propionibacterium acnes (P acnes) infection of the shoulder within 24 hours. Current methods take an average of six or more days, and are prone to sample contamination and false-positive results.

“We are incredibly honoured to receive this award,” says Dr. David O’Gorman, Lawson scientist, Co-Director of Molecular and Cellular Research at the Roth McFarlane Hand and Upper Limb Centre (HULC) at St. Joseph’s Health Care London, and senior author of the publication. “We believe it illustrates the high quality of research being done at Lawson and marks the beginning of another clinically relevant research program at HULC.”

P acnes is a type of bacteria typically found deep in the hair follicles and sebaceous pores of the skin. A P acnes infection of the shoulder is a common and serious complication that occurs after arthroplasty (surgery to replace a damaged joint, most commonly with artificial material). It can cause pain in the shoulder joint and often loosens the implant. In most cases, the patient requires additional surgery to remove the infection and replace the implant.

It can be difficult to diagnose a P acnes infection as it often presents without symptoms that would be characteristic of an infection, such as pain, skin reddening or wound drainage. The prevalence of P acnes in the deeper layers of the skin also increases the chance of sample contamination and false-positive results making it hard to isolate and identify in a pathology lab.

Currently P acnes infection is identified by administering a tissue swab for anaerobic culture, which takes an average of six or more days but could take up to three weeks. This technique also carries substantial risk of contamination from the adjacent skin and other sites where P acnes is present.

The PCR-RFLP assay can identify P acnes in tissue from a shoulder biopsy within a 24-hour period. The extremely sensitive technology also has the ability to detect fewer than ten P acnes cells in the sample, which may decrease the false-positive rate in cultures caused by swab contamination.

“The accuracy of this test and the shorter period of time needed for identification can help with treatment decision making, targeted antibiotic therapy, and monitoring to minimize implant failure and revision surgery,” explains Dr. O’Gorman, who is also an Assistant Professor in the Departments of Surgery and Biochemistry at Western University’s Schulich School of Medicine & Dentistry. “We hope that the test can be further developed into a ‘point of case’ assay that can detect P acnes in tissue samples in real time while the patient is undergoing shoulder surgery.”

Since the PCR and RFLP mapping used for the assay are techniques routinely performed in many clinical microbiology and pathology labs, the test would be a cost-efficient approach not restricted to highly specialized research labs.

Other scientists who were part of the study include Dr. George Athwal and Dr. Kenneth Faber, HULC orthopaedic surgeons, Lawson scientists and Schulich professors; Ana Pena Diaz, research technician for the HULC Molecular and Cellular Biology Research Lab; and Scott Holmes, a medical student and Schulich Research Opportunities Program participant who was primarily responsible for designing and optimizing the assay.

Both Dr. O’Gorman and Dr. Faber are also members of Western’s Bone and Joint Institute.

“A rapid method for detecting Propionibacterium acnes in surgical biopsy specimens from the shoulder” was published in the Journal of Shoulder and Elbow Surgery (JSES). 

When cases of COVID-19 began spreading in the London region, Lawson Health Research Institute (Lawson) had to rapidly adjust to a new environment.

As a hospital based research institute, Lawson is uniquely positioned to address the medical questions posed by a new virus. The expertise and infrastructure to begin these investigations was already in place. The global shortage of supplies, as well as physical distancing measures, forced many research projects to be put on hold. Other areas, however, were ramping up their work to support the scientists and physicians eager to figure out how we can better prevent, detect, and treat patients with COVID-19.

Lawson Clinical Research Services (LCRS) and the Center for Clinical Investigation and Therapeutics (CCIT) got to work immediately. The teams responded rapidly to research requests, getting new studies up and running within days.

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Dr. Douglas Fraser, Lawson Scientist and Paediatric Critical Care Physician at London Health Sciences Centre (LHSC), initiated a study to examine the immune response in patients with COVID-19. Reports from other parts of the world identified a heightened immune response in more severe cases of the infection, also labeled the ‘cytokine storm’. Laboratories at Lawson were ready to handle this type of research, as close proximity to patients and sample collection is essential.

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“Our world changed almost overnight,” adds Tereschyn. “We had to pivot on a dime and change the entire way we do business. Our staff have really risen to the challenge.”

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The LCRS and CCIT teams are supporting essential research in other ways as well, including logistics and administrative support, and supply sharing.

“We’ve developed many new partnerships throughout this pandemic, and figured out in very short order how to work efficiently together,” says Tereschyn. “While COVID-19 has presented us with many challenges, it has also been a great opportunity for us to support one another in ways that I don’t believe would have transpired otherwise.”

Dr. Dalton Wolfe, scientist, Lawson Health Research Institute, led a tour of the physiotherapy gym at St. Joseph Health Care London’s Parkwood Institute for 14 nursing students from Kyungil University in South Korea.

The nursing students have spent six weeks in Canada as part of the Health Care and English as a Second Language Program at King’s University College, during which they focused on English as a language instruction with a focus on medical terminology.

Dr. Wolfe showcased various physiotherapy tools, including a locomat and exoskeleton and explained how holistic and practice-based research can lead to better patient outcomes.  

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Lawson researchers impact the lives of people not just locally, but around the world with groundbreaking studies and translational research that enhances care, health and wellbeing.
Here are some of the research highlights of 2021.

Differences in walking patterns could predict type of cognative decline in older adults

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Canadian researchers are the first to study how patterns in the way older adults walk could more accurately diagnose different types of dementia and identify Alzheimer’s disease. A new study by a Canadian research team, led by London researchers from Lawson Health Research Institute and Western University, evaluated the walking patterns and brain function of 500 participants currently enrolled in clinical trials. Read more.

COVID-19 shown to leave a unique lung fingerprint

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Kidney transplant patient experiences positive recovery with the help of a simple device

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Air pollution exposures contributes to childhood asthma, population-based study shows

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Getting the data on homelessness

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Examining the health impact the COVID-19 pandemic is having on mothers and their new babies

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New therapeutic tool proven effective for MS patients with mental health challenges

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Researchers using MRI scans to pinpoint moral injury effects in health care workers

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Moral injury refers to an injury to an individual’s moral conscious, which can produce profound emotional guilt and shame. Recognizing this is a growing concern, a London research team from Lawson Health Research Institute and Western University’s Schulich School of Medicine & Dentistry is examining moral injury amongst health care workers by imaging the effects on the brain. Read More.

Scientists studying carbon monoxide as a possible treatment for sepsis

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Global study on heart valve repair surgery will improve patient outcomes around the world

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Researchers at Lawson Health Research Institute and Western University had a leading role in a new global study that will change the way surgeons repair leaky valves in the heart. It’s one of the most common heart valve conditions, affecting around two per cent of the population, where many patients don’t even realize they have a leaky valve and are asymptomatic, often presenting to doctors once they are late stage into the disease. Read more.

New study will assess fecal transplants in treatment of pancreatic cancer

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The city of London, Ontario is home to a vibrant health research community. On Wednesday, May 9, researchers from across the city gathered to discuss the importance of equity, diversity and inclusivity (EDI) in the careers of health researchers. Through participation at Exchange: A London Health Research Day Forum on Diversity & Inclusivity, guests discussed the challenges associated with EDI and potential solutions for the future.

Exchange was held the evening before London Health Research Day, the region’s premier research showcase event which features nearly 400 trainee presentations. Trainees are the future of Canadian science and EDI is crucial to that future. This is a topic of national importance that has garnered attention and action from the federal government, funding agencies and scientists across the country.

Recognizing the importance of this topic, Canada’s Minister of Science, The Honorable Kirsty Duncan, and local Member of Parliament for London North Centre, MP Peter Fragiskatos, shared video greetings with Exchange guests.

“The Exchange event highlights a vital area of discussion. It is important to not only recognize but embrace the differences between scientists and the diverse perspectives they bring to research,” said Rebecca Sullivan, a third year PhD candidate at Western University’s Schulich School of Medicine & Dentistry, training in Savita Dhanvantari’s lab at Lawson Health Research Institute, and one of the organizers of the event. “Becoming aware of our own unconscious biases and trying to change these culturally ingrained implicit associations is the only way to make active change in science!”

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Above: Rebecca Sullivan, a third year PhD candidate, leading a scenario-based group activity at Exchange

The evening’s first presenter was Dr. Janet Smylie, Director of the Well Living House Applied Research Centre for Indigenous Infant, Child and Family Health at St. Michael’s Hospital and CIHR Applied Public Health Research Chair in Indigenous Health Knowledge and Information. Dr. Smylie, who also delivered the keynote presentation at London Health Research Day, spoke about the role of anti-Indigenous racism and discrimination within health care professions, including its impact on research. This included a discussion of Dr. Smylie’s own research in the field of Indigenous health.

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Above: Dr. Janet Smylie presenting on "Addressing anti-Indigenous racism and discrimination within health care professions"

Greta Bauer, PhD, a professor in the Department of Epidemiology and Biostatistics at Schulich Medicine & Dentistry, spoke about the role of epidemiology as a toolkit for building equity in health research. This included a discussion on incorporating intersectionality and multidimensionality into population health research methodology.

“The purpose of this work is to give researchers the measurement and statistical tools they need to shift the focus from studying broad population average effects to more heterogeneity within populations,” said Greta. “The whole point is to better study not only diversity in health outcomes, but in the processes that generate those outcomes.”

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Above: Greta Bauer, PhD, presenting on "Epidemiology as a toolkit for building equity"

This talk was followed by a presentation on Gender-Based Analysis Plus (GBA+). GBA+ is an analytical tool used to assess how diverse groups of women, men and gender-diverse people may experience policies, programs and initiatives. The “plus” in GBA+ acknowledges that GBA goes beyond biological (sex) and socio-cultural (gender) differences. We all have multiple identity factors that intersect to make us who we are; GBA+ also considers many other identity factors, like race, ethnicity, religion, age, and mental or physical disability. GBA+ is a method for collecting and reviewing data in an unbiased manner, one that leaves aside many of the assumptions that can mask the GBA+ impacts of a given initiative. Alysha Croker, PhD, Manager, Tri-Agency Institutional Program Secretariat, discussed how GBA+ is being used in research and grant funding, including at the federal funding agencies.

“Diverse research teams can lead to more innovation, greater collective intelligence and an increased capacity to tackle complex issues,” said Alysha, when discussing the importance of EDI in the careers of health researchers.

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Above: Alysha Croker, PhD, presenting on "Incorporating Gender-Based Analysis Plus (GBA+) in research and beyond"

The evening also included a presentation from Shantal Feltham, founder and CEO of Stiris Research, a North American clinical trials management company based in London. Shantal discussed the importance of ensuring that clinical trials are designed to recruit diverse research participants that represent real patient populations. She also discussed her own experiences and perspectives as a female entrepreneur.

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Above: Shantal Feltham delivering a presentation titled "That’s a great idea – It’ll never work"

A group of health research trainees concluded the night with a scenario-based presentation and activity. Audience members were divided into small groups and given a diversity scenario to discuss. Topics ranged from the experiences of LGBTQ+ researchers, racial diversity, physical ability barriers in research labs and more. Notes and ideas from these conversations were recorded and displayed the next day at London Health Research Day.

“Exchange highlighted EDI in health research in action. It featured talks by leading female researchers on issues in Indigenous health and LGBTQ health, implementation of equity in the Canada Research Chairs program, and female entrepreneurship in the field of health research,” said Savita Dhavantari, PhD, assistant director and scientist at Lawson and assistant professor at Schulich Medicine & Dentistry. Savita was also one of the Exchange organizers and the facilitator for the event. “Above all, I hope attendees were encouraged to be fearless in advocating for equity, diversity and inclusivity in health research.”

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Above: Guests at Exchange discussing a diversity scenario

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Above: Savita Dhanvantari, PhD, facilitating the Exchange event

Psychiatric disorders are often difficult to diagnose. As research advances, we are learning there are multiple subtypes of illness that differ in symptoms and treatment needs, making classification even harder. Post-traumatic stress disorder (PTSD) is one example. Individuals with the more common type of PTSD experience active defensive responses like hyperarousal or outbursts of emotion while those with the dissociative subtype experience additional passive defensive responses like ‘shutting down’ or out-of-body experiences.

In a new study from Lawson Health Research Institute and Western University, researchers combined brain imaging and machine learning to classify with 92 per cent accuracy whether individuals had PTSD and whether or not it was the dissociative subtype. The results highlight the promise of brain imaging as a tool for early diagnosis of psychiatric illness, helping to predict symptom development and treatment needs. 

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Brains scans and machine learning were combined to classify PTSD with 92 per cent accuracy. 

The study involved 181 research participants, including those diagnosed with the more common form of PTSD, the dissociative subtype of PTSD, and healthy individuals with no history of PTSD. They participated in functional magnetic resonance imaging (fMRI) at St. Joseph’s Health Care London and Robarts Research Institute.

Researchers used the high-powered imaging to analyze patterns of resting-state brain activity where participants simply remained in a state of restful wakefulness in an fMRI scanner. The team found that unique patterns of brain activity differed significantly between the three groups.

“Our research group has been leading a number of studies that have shown differences in brain activity and neural connections between healthy individuals and those with different subtypes of PTSD,” says Dr. Ruth Lanius, a researcher at Lawson, professor at Schulich School of Medicine & Dentistry at Western University and psychiatrist at London Health Sciences Centre. “This study further validates that unique patterns of brain activity are associated with different forms of PTSD.”

In the second part of the study, the research team inputted the patterns of brain activity into a machine learning computer algorithm. They found the machine learning system could analyze brain scans to predict whether an individual had PTSD, the dissociative subtype of PTSD or no PTSD with 92 per cent accuracy. 

“Our study suggests brain activity can be used to assist diagnosis of psychiatric disorders and help predict symptoms,” says Andrew Nicholson, PhD, lead author on the study and a post-doctoral fellow at Schulich Medicine & Dentistry who is conducting research at Lawson.  “Patterns of brain activity are objective biomarkers that could be used to diagnose PTSD and, with more research, even predict response to treatment.”

Objective biomarkers hold promise for transforming psychiatric medicine.

“The field of psychiatry does not currently have objective biomarkers like those used to diagnose and understand other illnesses or diseases like cancer,” says Nicholson. “By discovering and validating patterns of brain activity as biomarkers, we can bring objective measures to psychiatry and transform patient care.”

The study, “Machine learning multivariate pattern analysis predicts classification of posttraumatic stress disorder and its dissociative subtype: A multimodal neuroimaging approach,” is published in Psychological Medicine. 
 

Pregnancy is a 40 week-long journey for both mom and baby. This time of growth and development can have impacts on current and future health including a person’s risk of diabetes. Specifically for women who are obese, research has shown this group is at higher risk of adverse pregnancy outcomes like gestational diabetes. What do these concerns mean for both mom and baby, and how can an individual help improve outcomes?

Not only do one third of obese pregnant women develop gestational diabetes, they are also more likely to deliver babies with neonatal adiposity – a term to describe an increased amount of fat. These babies are more likely to be obese in childhood which increases their risk of developing type 2 diabetes. 

In a new analysis from a multi-centre randomized clinical trial, researchers found that counselling obese expectant mothers on both healthy eating and physical activity during pregnancy reduced the risk of neonatal adiposity. In particular, less time spent sitting was associated with improved outcomes. This is the first study to show that a lifestyle change during a mother’s pregnancy can influence the amount of fat present in a baby at birth. 

The DALI Lifestyle Study included expectant mothers classified as obese from nine European countries and a total of 334 babies. The expectant mothers were randomized to receive lifestyle counselling on physical activity, healthy eating or a combination of the two during pregnancy, and were compared to a control group of women who received no counselling. 

The study found that mothers who receive combined counselling on healthy eating and physical activity gain less weight during pregnancy, increase their physical activity, improve their eating habits and reduce their time spent sitting. But, most importantly, their babies have less fat at birth when compared to babies from women who did not receive lifestyle advice.

Since weight alone is not an accurate marker, the amount of fat for each baby was determined through a number of measures including skinfold thickness and estimated fat percentage. 

“We wanted to take a closer look at what specific lifestyle change was related to this reduction in fat. Through further analysis, we found that it was the amount of time spent simply sitting,” says Dr. David Hill, Lawson Scientist and collaborator on this study. “As part of recommendations on healthy eating and physical activity, pregnant women who are obese should be counselled on ways to reduce the time they spend sitting.” 

Less time spent sitting was also associated with reduced levels of leptin, a hormone produced by fat tissue and the placenta. When levels become too high during pregnancy, this hormone can inhibit insulin production and increase the risk of gestational diabetes. Reducing levels of this hormone during pregnancy may help lower risk of gestational diabetes and prevent transfer of excess nutrients to the fetus, which is then stored as fat. 

“Treating pregnant women with medication to control gestational diabetes risks unwanted effects on the fetus,” explains Dr. Hill, also a Professor at the Schulich School of Medicine & Dentistry, Western University. “Identifying effective lifestyle modifications would be the safest, most affordable method of preventing short-term and long-term disease for both the mother and baby.” 

Dr. Hill’s research focuses on understanding gestational diabetes. His team is testing novel drug interventions with the potential to prevent the disease. This includes exploring new molecules identified through the DALI study.

The study, “A reduction in sedentary behaviour in obese women during pregnancy reduces neonatal adiposity: The DALI randomized controlled trial,” is published in Diabetologia. Lawson researchers designed the research database used for the DALI study, and archived and supervised use of the research data. 

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Above: Dr. David Hill

St. Joseph’s Health Care London and Lawson Health Research Institute have announced plans to move forward with clinical trials testing a drug that could potentially be used to prevent and treat COVID-19. St. Joseph’s Health Care Foundation will accelerate the creation of the studies by providing seed funding to get the research started through donor support. Based on the immediate need, The St. Joseph’s Health Crisis Fund has been created by St. Joseph’s Health Care Foundation to enable these and other research studies currently in development through Lawson, the research arm of St. Joseph’s. 

While supporting urgent COVID-19 clinical trials will be an immediate focus, The St. Joseph’s Health Crisis Fund will also support critical patient care equipment and care and comfort items for healthcare staff and volunteers working on the frontlines of the pandemic across St. Joseph’s.

Led locally by Dr. Michael Silverman, Medical Director of St. Joseph’s Infectious Diseases Care Program, one trial will assess the safety and efficacy of using hydroxychloroquine (HCQ) to prevent COVID-19 in health care workers recently exposed to the virus. This trial will also assess the drug as a treatment for non-hospitalized patients with mild cases of the illness. St. Joseph’s will be one of many participating sites in the trial, which is being led by the Research Institute of the McGill University Health Centre.

“There is much debate surrounding the drug hydroxychloroquine. We do not yet know whether it’s safe or effective, and it should not be routinely recommended until we do,” says Dr. Silverman, also a Lawson Associate Scientist and city-wide Chair/Chief of Infectious Diseases. “We plan to carefully study the drug through a randomized controlled trial and assess whether it can help combat COVID-19.”

Dr. Silverman is also partnering with Dr. Michael Borrie, Geriatrician at St. Joseph’s and Lawson Scientist, on a prevention trial to test the safety and efficacy of the drug for patients and residents at Parkwood Institute who have been exposed to COVID-19. They are at a higher risk of infection, as well as serious complications and potential admission to acute care.

“There are two critical goals with this prophylactic trial,” explains Dr. Borrie. “First, we want to see if the drug, taken for five days, is safe for the participants in the study. We will then look to see whether it is effective to prevent illness or lessen symptoms and complications.” 

They are testing whether HCQ may inhibit the coronavirus similar to how the antiviral drug Tamiflu is used to prevent influenza after exposure. The research team will recruit patients and residents who have been accidentally exposed to the virus by a confirmed or presumed case of COVID-19, but who aren’t yet experiencing symptoms. In addition to cardiograms and blood tests for safety, they are collaborating with Dr. Saman Maleki, Lawson Scientist and Immunologist, to analyze the blood for a variety of indicators including the presence of antibodies and immune response. They will collect clinical data and information on common health conditions to gain insights into why some vulnerable individuals get the disease and others don’t.

“We are aware of two small studies that were published rapidly last week, one in France and the other in China, testing the use of chloroquine for potentially treating COVID-19. Further studies are greatly needed,” adds Dr. Borrie. “This study at Parkwood Institute is a good start and we hope to have other Canadian sites join us in recruiting participants so that we can offer statistically significant results as soon as possible.”  

Those interested in donating to St. Joseph’s Health Crisis Fund are asked to visit St. Joseph’s Health Care Foundation’s website to learn more at sjhcfoundation.org. Donations can be made online, through direct mail submissions or by calling the Foundation directly at 519-646-6085. 

“The Sisters of St. Joseph, who founded our organization, faced contagious diseases and other pandemics at different times in our 150+ year history,” says Michelle Campbell. “Today, it’s a different time, and a new disease. Now, more than ever, we ask our community to help us address the crisis facing us all.” 

In the news:

• Global News - London, Ont., researchers to study hydroxychloroquine’s potential to prevent, treat coronavirus
• CTV - London researchers testing drug to prevent COVID-19 spread in long-term care homes
• The London Free Press - New fund set up to help bankroll London research into COVID-19 drug