On the application side, our research involves collaborating with cross-disciplinary teams to create tools to inform the design of health interventions that are high leverage, robust, and cost-effective. We employ many approaches to aid this process, but specialize in the design and analysis of systems simulation models based upon a firm mathematical foundation, typically informed by rich data drawn from Saskatchewan's administrative databases, or from our iEpi smartphone-based data collection system. Depending on the questions being asked and technical aspects of the system at issue, we create and apply both models those that characterize population health as resulting from a collection of explicitly represented individuals (typically conducted using Agent-Based Modelling), as well as those that operate at an aggregate level. Whatever the level of detail of such models, we strive to consider the broad set of feedbacks that govern the dynamics of the system and response to interventions. In addition to informing planning and intervention choice, such models can aid in understanding of health trends, help prioritize data collection, and aid in communicating high-level consequences of many diverse pieces of related data.
Our preferred approaches involve hybridizing dynamic models with other approaches, formalisms and tools, including those drawn from statistical (particularly Markov Chain Monte Carlo) approaches, control theory, decision analysis, and wireless sensor networks/ubiquitous sensing.
Such applications are almost always pursued in close collaboration with broader teams, frequently including those with close clinical familiarity of the diseases and/or pathogens involved (particularly doctors and nurses), epidemiologists, biostatisticians, public health nurses, and researchers or others involved in data collection and surveillance.
- Systems models for chronic disease, particularly Type 2 Diabetes Mellitus and its comorbidities. Ongoing work in this area includes a simulation model of T2DM in the Saskatoon Health Region (work conducted jointly with Prof. W. Grassmann and the Saskatoon Health Region) and a model of intergenerational interactions between T2DM and Gestational Diabetes in Saskatchewan (work conducted jointly with W. Grassmann and R. Dyck).
- Systems models for infectious disease. We have active projects in the area of Tuberculosis, Chlamydia, and West Nile virus.
- Tuberculosis. Our Tuberculosis work is focused on Saskatchewan's North, which has historically suffered from very high rates of TB infection, and continues to exhibit TB incidence at over 15x the rates of the south. Our TB models are built in consultation with Saskatchewan TB Control. Our existing models focus on provice-wide epidemiology as well as dynamics and prioritization of contact tracing. Over the long term, we are workig to include risk factors could have a particularly large impact on the future spread of TB in North. These include both widely recognized risk factors (such as crowding) as well as other, less acknowledged but high-prevalence risk factors (such as smoking and diabetes). We are particularly interested in the impact of changes in understanding how the rapid rise of obesity and diabetes (and sequelae such as End Stage Renal Disease) will affect TB in that population.
- Chlamydia. Both Saskatoon and Regina suffer from very high rates of Chlamydia; some rural regions are also badly affected. Much of our Chlamydia work is currently focused on explaining the reversal (in the past decade) of years of progress in the management of Chlamydia in the population, and gaining insights into full extent of the disease burden of Chlamydia.
- West Nile Virus. Saskatchewan has the highest rates of reported West Nile Virus cases in North America. The illness has caused fatalities, and many cases of severe neurological illness. Clinical evidence also suggests that some individuals who lack pronounced neurological symptoms may in fact suffer from longer-term effects of the virus. Our West Nile Virus models include models of the breeding cycle between mosquitoes and their avian reservoirs, as well as infection of humans, and are designed to permit study of the effects of a broad range of interventions. With input from the Saskatoon Health Region, and Saskatachewan Health, and researchers at VIDO and WCVM, we have built a WNV model that combines decision analytic and simulation modeling to reason about intervention planning in the context of weather uncertainties.
- Influenza and related.In recent years, motivated by data collected from our first-generation flunet system and the iEpi smartphone-based data collection system, we made contributions examining the spread of H1N1 influenza and related illnesses in Saskatoon. More recent work in this area has leveraged location data collected by iEpi to highlight the potential contribution of environmental reservoirs of infection.
- Chronic Wasting Disease Together with colleagues Dr. Trent Bollinger, Dr. Cheryl Waldner, and Dr. Vahid Anvari, we are working with two models focusing on the spread of chronic wasting disease among mule deer in Saskatchewan.
- Systems Effects: Several additional models we have developed in this area share a concern for broader feedbacks (reflecting behavioural changes and interactions with the health care system), and multi-level effects. We have a particular interest on the interplay between the immune system (each individual's "personal health care system") and the public health care system. The use of models in this area can help reduce the likelihood that the two systems work at cross-purposes (e.g. public health policies that inadvertently blunt development of individual immune responses, or increase vulnerability of the population by allowing immune memory to decay to the point where a major outbreak is more likely). To investigate this, we make use of "immuno-epidemiological" models that characterize the interaction between the dynamics of individual's immune response (e.g. response to infection and the buildup and decay of immune memory) and the spread of disease in the population. An additional area of significant interest lies in the mutual interaction between the health care system and the burden of illness in the population, for both chronic and infectious illness.
I have a particularly strong interest in the health of Aboriginal Peoples. Consistent with observations in the literature, I believe that the best way to pursue such projects is in partnership with communities themselves. I am currently working towards initial experience with community-based interventions, and hope to pursue future close partnerships in this area.