• Macnab, Andrew

    Investigator, BC Children's Hospital
    Professor, Division of Critical Care, Department of Pediatrics, University of British Columbia
    Degrees / Designations
    MB, BS, MD (London)
    Primary Area of Research
    Evidence to Innovation
    Secondary Area(s) of Research
    604-875-2850 (C&W) / 604-822-7616 (UBC Bladder Care Centre)
    604-822-7591 (UBC)
    Lab Phone
    Mailing Address
    BC Children's Hospital
    Room C234

    4500 Oak Street
    Vancouver, BC V6H 3N1

    UBC Hospital Bladder Care Centre
    Unit 1B - Room F329, 2211 Wesbrook Mall
    Vancouver, BC V6T 2B5
    Affiliate Websites
    Research Areas
    • Near infrared spectroscopy in urology, pediatric critical care, and the operating room.
    • Investigation of factors adversely affecting hemodynamics, and cerebral and tissue oxygenation in animal models, neonates, children and adults.
    • Injury prevention and early detection of developmental disability in the community.
    • Application of new technology to the critically ill or injured.
    • Inter-facility transport and emergency care of high-risk neonates and children.
    • Health education - innovation and evaluation.
    • Complementary and alternative medicine.
    • Psychosocial aspects of care

    My principal research interest is the application of near infrared spectroscopy, a non-invasive means of measuring tissue oxygenation and hemodynamics using near infrared light, to improve the care of infants, children and adults. A new patented version of this technology has been developed as an adjunct to evaluation and diagnosis in adults with symptoms related to bladder pathology. Other applications include evaluation of muscle physiology in health and disease and research to establish ways of preventing hypoxia (lack of oxygen) and ischemia (inadequate blood flow) in a variety of clinical situations, particularly those involving the brain or spinal cord. 

    My second area of interest is improving the care of sick and injured infants and children in need of inter-facility transport (transport by air ambulance from a distant hospital to specialized care). I am particularly interested in the complexities imposed by transport at altitude, the role of paramedics, and the logistics of delivery of prehospital health care services.

    The third area of interest is injury prevention and preventive strategies designed to improve the health of aboriginal children.

    Current Projects

    Using light to detect urinary tract / bladder problems
    An estimated 2 per cent of deaths in Uganda and widespread chronic illnesses are attributed to urinary tract / bladder problems. Early diagnosis will save resources now devoted to investigate, treat to save organ function, and reduce hypertension. A prototype device at the University British Columbia uses light to measure hemoglobin and oxygen levels through the skin as the bladder empties, revealing significant problems in real time.

    Novel disruptive optical technology now identifies when the bladder is significantly diseased or compromised. A prototype for Uganda will be evaluated that offers the potential for earlier diagnosis/treatment and better use of existing care resources.

    This project entitled, “Evaluation of novel optical technology to screen for bladder problems impacting health outcomes in Uganda” is supported by Grand Challenges Canada. Grand Challenges Canada is funded by the Government of Canada and is dedicated to supporting Bold Ideas with Big Impact in global health.

    Near Infrared Spectroscopy (NIRS)
    Near infrared spectroscopy (NIRS) technology allows for the non-invasive diagnosis of diseases. The potential benefits of NIRS research are considerable. I was the first scientist to bring NIRS technology to Canada; I lead a research group that is recognized to be in the forefront of basic research and medical applications of this technology, particularly with regard to measurement of oxygenation and hemodynamic change in the brain and other tissues.

    NIRS is in its infancy for urological applications. As with all medical devices, in order to obtain acceptance in the medical community and gain regulatory approvals, validation studies must be undertaken to establish the range of physiologic variables that can be detected, and to determine whether the technology can discriminate between normal, healthy physiology, and pathologic conditions. More importantly, the device must demonstrate that it reliably distinguishes between pre- and post-treatment conditions. Otherwise, it has no clinical usefulness.

    In the case of NIRS urology monitoring, we are identifying patterns of change in NIRS parameters that are able to distinguish between normal and pathological states. In addition, my team is developing new technologies to map dynamic change in hemodynamic parameters in the bladder, provide NIRS modules for ambulatory use, and to assist in biofeedback. Current work also includes collaboration with industry in a number of contexts including non-invasive evaluation of the effects of pharmacological agents on bladder physiology.

    The University of British Columbia Industrial Liaison Office has filed a number of applications for patent protection with the United States Patent and Trademark office for the latest discoveries in NIRS made by my team. A commercial partnership with Urodynamics Technologies, Inc. Vancouver begun in 2005 has resulted in the development of a NIRS instrument which, following a series of clinical trials, has US Food & Drug Agency and Health Canada approval and is now available for use by other investigators and clinicians. My team’s work has received a number of awards including: the 2004 and 2007 Cooper Award for innovation in urology research and a 2008 American Urological Association award for excellence in research. Independent industrial analysts have described my team's work as a "brilliant, new and disruptive technology."

    Pre-hospital and transport medicine
    Research activities in pre-hospital care and transport medicine have established an international reputation for the province of British Columbia’s air medical transport program based at Children’s and Women’s Hospital and operated in conjunction with the BC Ambulance Service. Consequently, this program has contributed significantly to the current evidence base for transport standards of care, and had collaborated with programs worldwide to improve the training and operational scope of air medical transport. Most recently, this assistance has included programs in Ontario, Scotland, England and Kenya.

    Currently a Vancouver-based team is part of multi-institution international consortium evaluating resuscitation outcomes funded by the National Institutes of Health. I am the only pediatric investigator on the Vancouver team. The goals are to document the cause and outcome of all acute life-threatening events involving children in the province and develop appropriate guidelines for improvement.

    Preventive health 
    This research includes:

    • An oral health program (the only one in North America to show a significant reduction in the incidence of dental caries in aboriginal children). This program has subsequently been translated to Ugandan communities.

    • A pre-diabetic screening initiative for First Nations communities. This is the first research that has defined the high incidence of metabolic syndrome and impaired glucose tolerance in a Western Canadian Aboriginal population. Nutrition, lifestyle and complementary therapy programs to address these findings are being developed collaboratively with the communities.

    • A school-based study to define the epidemiology and demographics of self-asphyxial practices (chocking game) in Canadian and American youth as a means of calling for greater understanding and awareness amongst health professionals of this problem and promoting appropriate health education for youth. 

    Selected Publications

    Macnab AJ. Children’s Oral Health: The opportunity for improvement using The WHO Health Promoting School Model. Advances in Public Health. vol. 2015, Article ID 651836, 6 pages, doi:10.1155/2015/651836 (2015)

    Macnab AJ. The evolution of near infrared spectroscopy in urology. Biomedical Spectroscopy and Imaging 3, 311-344 (2014).  doi: 10.3233/BSI-140091.

    Macnab AJ, Stewart D, Gagnon F. Health Promoting Schools: Initiatives in Africa, Health Education 114 (4), 246-259 (2014). dx.doi.org/10.1108/HE-11-2013-0057.

    Macnab AJ. The Stellenbosch consensus statement on Health Promoting Schools. Global Health Promotion 20(1), 78-81.doi:10.1177/1757975912464252 http://pedsagepub.com (2013)

    Macnab AJ, Shadgan B, Stothers L. Monitoring detrusor oxygenation and hemodynamics non-invasively during dysfunctional voiding. Advances in Urology 2012, Article ID 676303, 8 pages, doi:10.1155/2012/676303 (2012). PMID: 23019422.

    Macnab AJ, Shadgan B, Rurak D, Janssen P. Fetal oxygenation measurement using wireless near infrared spectroscopy. Proc SPIE 8229 822902-1 (2012). Abstract.

    Macnab AJ, Shadgan B, Stothers L. The evolution of wireless near infrared spectroscopy: applications in urology and rationale for clinical use. J Near Infrared Spectroscopy 20:57-73, doi:10. 1255/jnirs. 963 (2012). Abstract.

    Macnab AJ, Shadgan B, Stothers L. Functional near infrared spectroscopy (fNIRS); dynamic topography of the human bladder during voiding. J Biomed Optics 14(2):020507 (2009).

    Stothers L, Guevara R, Macnab AJ. Classification of male lower urinary tract symptoms using mathematical modeling and a regression tree algorithm of non-invasive near infrared spectroscopy parameters. European Urology doi:10.1016/j.eururo.2009.05.005 (2009).

    Macnab AJ, Deevska M, Gagnon F, Cannon WG, Andrew T. Asphyxial games or the ‘choking game’: A potentially fatal risk behavior. Injury Prevention 15(1):45-9 (2009). PMID: 19190276.

    Macnab AJ, Stothers L, Near-infrared Spectroscopy: Validation of bladder-outlet obstruction assessment using non-invasive parameters. Can J Urol 15(5):4241-8 (2008). PMID: 18814812.

    Macnab AJ, Stothers L. Development of a Near-infrared Spectroscopy instrument for applications in urology. Can J Urol 15(5):4233-4240 (2008). PMID: 18814811.

    Macnab AJ, Rozmus J, Benton D, Gagnon F. Three-year results of a collaborative school-based oral health program in a remote First Nation’s community. Rural and Remote Health (online) 8(2): Article no. 882. http://www.rrh.org.au.

    Macnab AJ, Smith T, Gagnon FA, Macnab M. Effects of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders. Inj Prev 8(4):324-7 (2002). PMID: 12460972.

    Macnab A, Christenson J, Findlay J, Horwood B, Johnson D, Jones L, Phillips K, Pollack C Jr, Robinson DJ, Rumball C, Stair T, Tiffany B, Whelan M. A new system for sternal intraosseous infusion in adults. Prehosp Emerg Care 4(2):173-7 (2000). PMID: 10782608.

    Book Chapter
    Macnab AJ, “The etiology and evolution of fetal brain injury" In ‘Brain Damage,’ Gonzalez-Quevedo A. (ed). InTech Publishing, ISBN: 979-953-307-461-9 (2012) Book

    Macnab AJ, Macrae DJ, Henning R. Care of the Critically Ill Child. Churchill Livingstone, London, Toronto, New York, third printing (2002).

    Honours & Awards

    International Awards
    "Best of the Best” Research Award. American Urological Society, USA. 2008

    Distinguished service award, Western Society for Pediatric Research - 2007

    Cooper Award (for most innovative research), American Urological Association, USA - 2004 & 2007

    Mead Johnson Scholarship, Western Society for Pediatric Research - 2006

    Honoris Causa. (Research, Education and Mentorship), Fellowship of the Royal College of Paediatrics and Child Health of England - 2005

    American Federation for Medical Research Award - 2003

    Laboratory named after A.J. Macnab in recognition for scholarship in research and education, St. Matthews University - 2003

    Mead Johnson Scholarship, Western Society for Pediatric Research - 2002

    Ross Research: St. Geme Award, Western Society for Pediatric Research (Research and Education Mentorship) – 1999

    National Awards
    Fellowship of the Canadian Academy of Health Sciences - 2007

    Jack Sarney Award, Canadian Council for Rehabilitation (Transport Research and Development) - 1990 

    Provincial Awards
    Award of Excellence, Gi’gat First Nation for community based research and contributions to aboriginal child health - 2007

    Distinguished Scholar in Residence, Peter Wall Institute for Advanced Studies, University of British Columbia - 2006 

    University of British Columbia Lectureship named after Dr. AJ Macnab in Resident Visiting Scholar Program in recognition for leadership in Postgraduate Education - 2005

    Gold Medal
    Gold Medal, Canadian Medical Design Excellence Awards - 2000 (best new medical device in Canada)

    Teaching Prizes
    Research Mentor of the Year, UBC Department of Pediatrics - 2005 and 2001

    Harvard Macey Scholar. Leadership in Education, Harvard University, USA - 2004

    Excellence in Postgraduate Education Award, Kingdom of Saudi Arabia - 2004

    Excellence in Education Award with Distinction, Children’s & Women’s Hospital of BC, 2003

    Killam University Teaching Prize, Faculty of Medicine, UBC - 2003

    Teacher of the Year, UBC Department of Pediatrics - 1999, 1987, 1985, 1981

    Research Group Members

    Near infrared spectroscopy: Lynn Stothers MD MHSc FRCSC, Ramon Guevara PhD, Babak Shadgan, MD MSc, Dr. Kourosh Afshar MD MSc FRCSC FAAP
    Aboriginal Health: C.Panagiotopolous, MD, FRCPC,
    Transport Medicine/Pre-hospital care: James Christenson, MD, FRCPC 
    Injury prevention : Thomas Andrew, MD
    International Health: Arabat Kasangaki, MD