New Horizons in Health Care

Meet six people who are challenging the clichéd image of a researcher hunched over a Petri dish or crunching data until the wee hours.

You'll find these health-care leaders out in the community, making clinical visits and making a difference. And, yes, sometimes even hard at work in the lab. But wherever their work takes them, their efforts will help improve your quality of life in the next decade.

Aging Population

Sharon Anderson '10 MSc Health Promotion

CURRENT POSITION: PhD student with Research on Aging, Policies and Practice in the Faculty of Agricultural, life & environmental sciences Field: Community living after stroke WHY SHE'S ONE TO WATCH: she expands our understanding of personal relationships in rehabilitation and quality of life. She recently received a Queen Elizabeth II Graduate Scholarship.

In 1997, Sharon Anderson and her husband, John, had a stroke. The event itself occurred in John's brain, but it transformed them both as a couple. It also drastically rerouted Sharon's career path. She left her job as a dental hygienist and headed back to school, eager to expand on her own experience in a marriage affected by stroke. She earned two master's degrees - one at the University of Calgary and one at the U of A. Now she's working on a PhD, studying the experiences of other couples who have survived strokes, and how their relationships affected their recoveries.

When John suffered his stroke, at age 46, the prognosis was grim, recalls Sharon.

The neurologist told me to put him in a nursing home. I said that wasn't an option."

Instead, Sharon brought her husband home and hired private therapists. Within a month, John had improved enough to be accepted into a rehabilitation program. Today, he maintains his own website, stroke-survivors.org.

The couple's effort not only improved their quality of life, it spared the health-care system an estimated $73,000 per year for care in a nursing home, says Sharon.

"My husband is now 15 years out of stroke. If you look at the cost of keeping him in a nursing home for 15 years, that's a lot of money."

Anderson is delving into the experiences of couples in a similar situation. "What happens in that couple's relationship to help the stroke survivor get better, or to keep the couple together?" she wonders. Existing data already show stroke survivors in stable relationships recover better and require significantly less long-term care. Anderson's findings could maximize the benefits enjoyed by stroke patients in relationships, while finding ways to provide better community support for all.

Anderson is particularly excited to be working with Norah Keating, U of A professor of human ecology, who is helping her explore medical questions from a holistic perspective.

She also continues to look forward to her shared future with John. "When people refer to me as a caregiver, I say, no - I'm my husband's wife."

Sci-Fi Diagnostics

Chances are you've never heard the word metabolomics (pronounced metabo-LOH-mics) but it just might revolutionize medical diagnostics around the world - and the U of A stands at the global epicentre of this emerging field.

David Wishart '83 BSc

CURRENT POSITIONS: Professor in the Departments of Computing Science and Biological Sciences, with adjunct appointments in Pharmacy and Laboratory Medicine & Pathology; Co-founder and Chief Scientific Officer for two companies (Chenomx and BioTools) and Project Leader of The Human Metabolome Project

FIELD: Metabolomics

WHY HE'S ONE TO WATCH: Wishart and his colleagues have made the University a leading centre of metabolomics, a technique that could revolutionize the way we diagnose illness.

"It's clinical chemistry on steroids," explains David Wishart, project leader for the U of A's Human Metabolome Project. Metabolomics seeks to identify and catalogue every chemical we produce in our bodies, and to look for the patterns that correspond to various illnesses and conditions. Instead of looking for one or two compounds - for example, blood glucose - metabolomics measures hundreds or even thousands of compounds all at once.

By doing so, metabolomics vastly expands the amount of information that we can derive from a single tissue or fluid sample, says Wishart. "In the past, it was like looking at the world through a keyhole. But now, we can look at the world through a picture window."

In other words, metabolomics allows diagnosticians to see the big picture. "Blood glucose tells you if you have diabetes or not," explains Wishart. "But there's a whole bunch of other compounds that can tell you how bad the diabetes is, whether it's going to progress, or even if you're going to get diabetes."

That kind of detail opens the door to personalized health care. "You can actually have a metabolic profile that could be used to diagnose, or predict, or prognosticate, or assess the risk for a whole bunch of different conditions."

Eventually, Wishart hopes, a urine sample could be as useful a diagnostic tool as a Star Trek tricorder (if not quite as sexy).

The Human Metabolome Project, launched by Wishart's lab in 2005, has catalogued about 40,000 different chemicals found in the human body. Although the project hasn't yet made its way into everyday medical practice, that day is definitely coming. Several companies, including three in Edmonton, have already started developing specific tests based on the data, including one for pre-colon cancer and another for HIV.

Meanwhile, the U of A's Human Metabolome Project database is accessed by millions around the globe every year. It just might be time for a new sign on Gateway Boulevard: "Welcome to Edmonton - City of Metabolomics."

Food Safety

When Kamaljit Kaur contemplates a container of yogurt, she sees much more than a topping for her morning granola. The lactic acid bacteria in yogurt produce peptides, compounds that lie at the very centre of her research. "These peptides are very friendly to humans," she says.

Kamaljit Kaur

CURRENT POSITION: Associate Professor, Faculty of Pharmacy & Pharmaceutical Sciences

FIELD: Research in Medicinal Chemistry

WHY SHE'S ONE TO WATCH: Kaur's work with peptides - compounds that occur naturally in foods such as yogurt - holds great potential in food safety and cancer treatment.

In fact, they're more than just friendly. Those peptides, it turns out, are very effective in killing pathogenic bacteria, like listeria, a foodborne illness that can cause serious infections. By harnessing the power of peptides, Kaur and her colleagues could potentially banish listeria from our food industry, along with other deadly microbes such as E. coli and salmonella.

Because they are derived from food sources, these antimicrobial peptides, also known as bacteriocins, could provide industry with a much healthier way to fight pathogens. "Current practices use a lot of chemical preservatives and conventional antibiotics," Kaur explains.

Kaur's work earned her $495,000 in funding from the Food Safety Research and Innovation Program, with the support of Alberta Innovates Bio Solutions and the Alberta Livestock and Meat Agency. During a three-year research project, Kaur and her colleagues hope to develop new methods for mass-producing these bacteriocins.

The project teams Kaur with longtime colleagues David Wishart, Computing and Biological Sciences; Lynn McMullen, Agricultural, Food and Nutritional Science; and industrial partner CanBiocin Inc.

Kaur has another major research area also focusing on peptides - using them to target cancer cells, including breast cancer. "That's equally exciting," she says modestly, "but this grant is mainly for our antimicrobial work."

Above all, Kaur is grateful for the atmosphere of support and collaboration at the U of A. "The funding makes it possible for our team to pursue our ideas," she says. "These peptides are very promising, and they haven't been explored to the extent they should have been."

Aging Population

From her earliest days as a nurse, Hannah O'Rourke has been drawn to working with people with dementia.

Hannah O'Rourke '08 BScN (Hons)

CURRENT POSITION:PhD student in Nursing

FIELD: Quality of life for dementia patients

WHY SHE'S ONE TO WATCH: O'Rourke recently received the prestigious Vanier Scholarship - $50,000 a year for three years - a rare honour for a nursing student. As our population continues to age, her work in dementia stands to become ever more important.

"Those were the people I really enjoyed working with, and who surprised me - who really got underneath my own assumptions," she recalls. "You have something in your mind of what Alzheimer's disease means, or dementia. I found, when I was actually working with these people, that things are much more hopeful and not nearly as sad or depressing as I thought they might be."

Over time, O'Rourke began to recognize that many patients face similar barriers in their day-to-day lives. "I thought, you know, there are probably some pretty simple things we could do here that could make things a lot better." She suggests giving care providers the time and training they need to develop positive, supportive, respectful - and personal - relationships with patients with dementia. She also hopes to find and document better ways to listen to people with dementia, to draw on their own experiences and knowledge in order to improve their lives.

"Persons with dementia really can speak about their lives, and can speak about what matters to them. So there's more of a drive now to actually speak to people with dementia, and not assume that we know what matters to them."

For her PhD thesis, O'Rourke is synthesizing findings from 12 studies that involved interviewing individual patients about their lives. She hopes to identify specific measures that will make the biggest difference for the largest number of patients. "My dissertation looks at identifying a common set of factors that influence quality of life. It's useful from both a health care and a research perspective to identify some common things that we can do at a health-systems level to improve quality of life."

With growing policy concerns over an aging population, O'Rourke's work could very well help improve future care for people we love.

"How can we really know how to improve their lives if we don't ask them?"

Community Health

"This is my calling," says Kathryn Dong. Based at the Royal Alexandra Hospital in Edmonton, she champions the needs of those people who live on nothing, with nothing, and who often turn to drugs and alcohol for escape and release.

Kathryn Dong '04 FRCP, '07 MSc

CURRENT POSITION: Co-Director of the Edmonton Inner City Health Research and Education Network Field: At-risk populations

WHY SHE'S ONE TO WATCH: Dong's efforts in addressing the health needs of inner city residents have made her name synonymous with a caring attitude.

For these people, a visit to the hospital is often an overwhelming and intimidating last resort, says Dong, who has worked at the Royal Alexandra Hospital since 2004. She came to the U of A specifically for its first-rate residency program. She followed that with a master's in population health.

"I think, regardless of what I might have done in medicine, I would have ended up working in this field," she says, cradling her third son in her lap.

"Addiction is a disease. Just as I may treat a person with diabetes who comes into emergency, I see addiction and alcoholism in the same way."

In 2009, she and her colleagues launched a survey to find out how satisfied at-risk inner city residents were with the care they were getting from their local hospital.

"We did not really know if we were meeting their needs, nor did we understand fully the underlying causes contributing to their health issues."

The results of this survey are still being analyzed. "We still need to figure out where the gaps are, exactly, and the community will tell us how best to address them." says Dong.

Her dream is to make the hospital a welcoming place for inner city residents and ensure it provides compassionate and more holistic care that not only deals with patients' acute issues, but also helps to improve the social determinants of their health, such as housing and social supports.

"I feel very connected and feel like this is exactly what I should be doing," she says.

Kidney Disease

Most people needn't lie awake at night worrying about kidney disease, says Marcello Tonelli. But if you have high blood pressure, diabetes or a family history of kidney disease, Tonelli wants you and your doctor to be aware of the stakes.

Marcello Tonelli

CURRENT POSITION: Canada Research Chair in Optimal Care of People with Chronic Kidney Disease

FIELD: Care delivery and quality of health care

WHY HE'S ONE TO WATCH: Kidney disease affects more than two million Canadians. Tonelli is one of Canada's top experts in identifying kidney patients at greatest risk, and in partnering with health policy-makers to get patients the most effective care possible.

"People with kidney failure have very poor quality of life and they are very likely to die," Tonelli says. "But, fortunately, there are effective treatments available that prevent the kidneys from failing. The major focus of my work is to try to figure out which patients are at highest risk, and what treatments we can use to reduce that risk and improve their outcomes.

I'm also looking at how we can make the health system work better, to deliver those treatments in a way that's easy for them to take."

Currently, Tonelli is focusing on a relatively low-tech strategy. "We're returning to an older test, for detecting protein in the urine," he says. "With a very simple and cheap urine test, you can discriminate between someone who is only at slightly greater-than-average risk, and someone who's at a very high risk."

With research partners throughout Alberta and around the world, Tonelli has his hand in a wide range of initiatives. "We meet every week or more by teleconference, and we're talking on the phone several times a day," he says. "Honestly, it's one of the best things about my job. I get to work with such a great group of people."

Tonelli also works to see that same approach reflected in patient care. "Policy-makers in Alberta are quite interested and engaged," he says. "Whether that's Alberta Health or Alberta Health Services or other organizations - people are willing to share their priorities. That helps us to do research that matters."