IMS Magazine Spring/Summer 2021 by IMS Magazine

Behind every discovery, there’s a story. New episodes available every other Wednesday.

Raw Talk is a graduate student-run podcast at the University of

Toronto about medical science, and the people who make it happen. We focus on the journeys, perspectives, and expertise of health researchers, professionals, students, patients, and community members at the University of Toronto and beyond.

Listen wherever you get your podcasts or at

www.rawtalkpodcast.com

Get started with some of our favourite episodes: Ep. 95

Live or Be Alive: Medical Assistance in Dying

Ep. 89

Vaccines: Making History

Ep. 91

Social Determinants of Health: Care beyond the Clinic

Ep. 80

COVID Decoded: Science and Society in the New Normal

Ep. 90

Anti-Black Racism in Healthcare

Ep. 75

The Healing Power of Music

IN THIS ISSUE Letters from the Editors................................ 4 Director’s Message........................................ 5 Contributors................................................... 6 Infographic..................................................... 8 Features....................................................... 10 BMC Showcase............................................ 16 Viewpoints................................................... 18 Faculty Highlights........................................ 22 Faculty Spotlight.......................................... 24 Student Spotlight......................................... 26 Alumni Spotlight.......................................... 28 Diversity in Science .................................... 30 SURP Contest Winner.................................. 33 Book Review................................................ 34

MAGAZINE STAFF EDITOR-IN-CHIEF:

PHOTOGRAPHERS:

Natalie Osborne

Krystal Jacques (Director) Dorsa Derakshon Mikaeel Valli

EXECUTIVE EDITORS:

Jonathon Chio Krystal Jacques Mikaeel Valli

JOURNALISTS & EDITORS:

Stacey Butler Dorsa Derakshon Sonja Elsaid Shahrzad Firouzian Rehnuma Islam Elizabeth Karvasarski Zahra Khan Jason Lo Hog Tian Nayaab Punjani Dorsa Rafiei Cricia Rinchon Natalie Simonian Archita Srinath Sajeevan Sujanthan Stephanie Tran Beatrix Wang Shenhab Zaig

SOCIAL MEDIA:

Sandy Lee (Director) DESIGN EDITORS:

Jennifer Barolet (Director) Ingrid Barany Katrina Hass Colleen Paris Ava Schroedl Amy Zhang Amy Assabgui Abeeshan Selvabaskaran Michie Wu Mimi Guo

FEATURE INFOGRAPHIC

By Colleen Paris, MScBMC Candidate (2T1)

Copyright © 2021 by Institute of Medical Science, University of Toronto. All rights reserved. Reproduction without permission is prohibited. The IMS Magazine is a student-run initiative. Any opinions expressed by the author(s) are in no way affiliated with the Institute of Medical Science or the University of Toronto.

COVER ART By Ingrid Barany, MScBMC Candidate (2T1)

LETTERS FROM THE

EDITORS

t is fitting that the final issue of IMS Magazine I have the privilege to be a part of is about social determinants of health. When I began my PhD at the IMS five years ago, I was overwhelmed by the variety of disciplines represented by my peers. How could I hope to understand their work when it was so different from mine? But after five years interviewing, writing, and editing for IMS Magazine, I’ve learned how to speak the universal scientific language. I’ve witnessed how the IMS’ multidisciplinary community allows its members to exchange ideas, share techniques, and form unique collaborations. This alchemy of different perspectives and approaches drives innovative, comprehensive research – the kind that is desperately needed to address multifaceted, systemic issues such as social determinants of health. In this issue you will read about the inescapable interconnectedness of health and society: how poverty, racism, bias, education, public policy, and the environment interact to influence the health of an individual. Therefore, the best solution for improving health outcomes will come from a societal effort – one that values the health and well-being of all its members. These solutions require interdisciplinary teamwork combined with genuine interest and empathy for one another – all qualities I’ve seen at the IMS. While I’m sad to leave, I will continue to follow the fascinating work of its members detailed in the pages of IMS Magazine, now led by brilliant and dedicated co-Editors-inChief, Mikaeel Valli and Jason Lo Hog Tian. Best wishes,

Natalie Osborne Natalie is a 5th year PhD student using neuroimaging and sensory testing to study sex differences in chronic pain under the supervision of Dr. Karen Davis. @NatalieRaeOz www.natalieraeosborne.com

irstly, we would like to thank the outgoing Editor-in-Chief, Natalie, for her contributions to the magazine and for setting such a high bar for this publication. We have both been active contributors for many years now and are honoured to have the opportunity to shape the future of IMS Magazine as the new co-Editors-in-Chief. Social determinants of health have received a surge of attention in recent years and are now essential to consider when trying to understand any health condition. We believe that this issue provides an excellent overview of the ongoing research at IMS examining these factors. For example, Dr. Teresa To tells us how socioeconomic and environmental factors impact asthma risk, Dr. Sean Kidd explains the complex nature of youth homelessness and challenges with intervention strategies, and Dr. Aileen Davis illustrates how healthcare education can improve outcomes in patients with osteoarthritis. We also have some relevant Viewpoint articles highlighting the importance of collecting accurate race and ethnicity data in research and examining the different ways in which people use drugs. We would like to take the time to acknowledge the writers, editors, and designers that made this publication possible as well as all the readers, without whom we would not be where we are today. We hope you enjoy the issue and we look forward to continuing the legacy of IMS Magazine! Sincerely, Mikaeel Valli

Jason Lo Hog Tian

Mikaeel is a 5th year PhD student. He works with Dr. Antonio Strafella’s lab that uses neuroimaging techniques to understand the underlying mechanisms in Parkinson’s disease with nonmotor complications. linkedin.com/in/mikaeel-valli/

Jason is a 3rd year PhD student examining the mechanisms linking HIV stigma and health under the supervision of Dr. Sean Rourke. @JasonLoTweets

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DIRECTOR’S MESSAGE

DIRECTOR’S

MESSAGE B

eginning in the Fall of 2021, it is heartwarming to see a sense of normalcy as UofT’s campus doors re-open allowing students to return to the classroom for in-person along with online learning. For new students joining the large IMS family, welcome! I cannot wait to see the discoveries, successes and accolades you each will achieve with us at IMS. Reflecting since the start of the pandemic, it was a roller coaster ride with high peaks and low troughs in the number of cases. In this ride, the very social fabric of society was put to the test. Some communities rebounded in health while others were in despair. The COVID-19 pandemic harshly exposed the pre-existing health inequalities that are present in the Canadian healthcare system. The pandemic reminds us that despite having universal healthcare, there remains social determinants that impacts a Canadian’s overall health and quality of life. Hence, this current issue seeks to highlight social factors that contribute to driving the health inequality among Canadians. This issue features researchers involved in public health with the goal to combat health inequalities. Read the work by Dr. Teresa To and her group that aims to understand social factors underlying childhood asthma and implementing ways to improve access for these patients. In another feature, you will learn about homelessness among Canadian youths, their health outcomes, and how Dr. Sean Kidd and his team are working to fix this. Dr. Aileen Davis and her colleagues implemented a novel exercise program for osteoarthritic patients, read how that impacted patient access and outcomes. Every year we host a “Summer Undergraduate Research Program” (SURP) which attracts many talented undergraduate and medical students to be involved in projects relating to biomedical research at IMS. I am grateful for the ingenuity of the supervising faculties and IMS team members to make this program possible online. You can read about one of our SURP students’ projects on pages 33. I would like to take this opportunity to congratulate the faculty who have been promoted to associate and full members as well as the new faculty of the IMS. Check out pages 22-23 about their inspiring research! Welcome to the IMS and I am looking forward to your continued excellence as graduate faculty members! I extend my gratitude to Natalie Osborne for her tireless hard work and leadership in her tenure as an Editor in Chief for the IMS Magazine. To Jason Lo Hog Tian and Mikaeel Valli, the incoming co-Editors in Chiefs, my heartfelt congratulations. I am proud of the excellent work put together by all the editors, journalists, photographers and the design team. This Spring/Summer issue underscores the topical issues of social determinants that impacts Canadian health. I encourage you to turn the page and read on! Sincerely,

Dr. Mingyao Liu

IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH |

CONTRIBUTOR PAGE

Contributors

Summer 2021

Beatrix Wang is a 2nd year MSc student trying to better understand the workings of postnatal neural stem cells under the supervision of Dr. Freda Miller. In her spare time, she’s passionate about reading, writing, and learning martial arts.

Dorsa Rafiei is an MSc student under the supervision of Dr. Nathan Kolla at CAMH. Her research investigates the endocannabinoid system in major depression using PET imaging. Outside of the lab, she enjoys tweeting about science and making pottery @cherubshop @dorsa_rafiei

Nayaab Punjani is a first year MSc student at IMS working with Dr. Michael G. Fehlings. Her research is examining a preclinical drug treatment that aims to provide a multifaceted approach targeting neural regeneration and inflammation following cervical spinal cord injury, in order to ameliorate patient quality of life.

Sajeevan Sujanthan is currently an MSc student at IMS investigating cognitive changes following acute stroke interventions in ischemic stroke survivors, under the supervision of Dr. Richard Swartz at Sunnybrook. In his free time, he enjoys working out, drinking a lot of coffee, and hanging out with his friends and family.

Serena Peck is an IMS MSc student studying under the supervision of Dr. Paaladinesh Thavendiranathan. Her research looks at physical activity levels during cancer treatment and posttreatment cardiac function, cardiorespiratory fitness, and quality of life in women with breast cancer. Serena loves being in nature and tending to her plants!

Sonja (Kasapinovic) Elsaid is a third-year Ph.D. student investigating brain function and cannabis use in individuals with social anxiety. Prior to going back to school, Sonja was clinical research and medical communications professional with nearly 20 years of experience.

6 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

Graphic design by Ava Schroedl

CONTRIBUTOR PAGE Stacey Butler is a 3rd year PhD student at IMS, specializing in respiratory medicine and epidemiology, under the supervision of Dr. Andrea Gershon. Outside of academia, Stacey enjoys creative activities, board games and cooking hearty vegetarian meals.

Stephanie Tran is a 3rd year PhD student at the IMS with Dr. Robert Chen. She specializes in non-invasive brain stimulation and Parkinson’s disease research. Outside the lab, she enjoys cooking and hiking.

@StaceyBeePhD

The 2020

IMS Design Team

is a group of students in the MSc in Biomedical Communications (BMC) program. Turning scientific research into compelling visualizations is their shared passion, and they are thrilled to contribute to the IMS magazine.

2T1

Jennifer Barolet @bioscivisuals www.BioSciVisuals.com (Director)

Ingrid Barany @visuals.by.ingrid www.ingridbarany.com

Katrina Hass @khassvisuals www.khassvisuals.com

Colleen Paris @cparisvisuals www.colleenparis.com

Ava Schroedl @schroedl_sci_vis www.avaschroedl.com

2T2

Amy Zhang (Incoming Director) @accompagnat_o www.amykzhang.com

Amy Assabgui @amya_visuals www.amyassabgui.com

Mimi Guo @mimi.guo.art www.mimiguo.art.com

Abeeshan Selvabaskaran @abeeshan.art

Michie Wu @michiewu www.michiewu.com

IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH |

INFOGRAPHIC

8 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

Graphic design by Colleen Paris

INFOGRAPHIC

IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH |

FEATURE

By Nayaab Punjani

sthma is an inflammatory lung condition that affects one in four Canadian children.1,2 Certain triggers may increase the incidence of asthma attacks - which involve wheezing and shortness of breath - resulting in hospital admissions.1 Currently, 2.3 million Ontarians are diagnosed with asthma, with 50 000 new cases in 2020 alone.2 These statistics prompted Dr. Teresa To’s research pursuit into the epidemiology of respiratory diseases, with an emphasis on childhood asthma. Dr. To is currently a professor of Biostatistics and Epidemiology at the Dalla Lana School of Public Health with an IMS cross-appointment. She is a Senior Scientist in the Department of Child Health Evaluative Sciences at The Hospital for Sick Children, while also serving as a Senior Adjunct Scientist for ICES, an organization that compiles databases examining patterns of healthcare access and use in Ontario. When Dr. Teresa To was first hired by ICES, no one was focused on pediatrics, so Dr. To partnered with The Hospital for Sick Children to study the conditions responsible for hospital admissions. While examining the data from emergency department admissions, she mentions, “One of the top reasons for children being admitted, 10 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

was asthma…I repeated my analysis to ensure findings were accurate, and it came out the same and it sort of blew my mind, why would kids, even in the late 90s… be admitted for something so treatable?” Over the years she realized the situation is quite complex, requiring consideration of social determinants and access to Canada’s healthcare system. Dr. To’s research began through the examination of asthma epidemiology to understand factors relating to the incidence of cases, hospital admissions, and causes of death. Dr. To features findings of this research in a website known as OASIS–the Ontario Asthma Surveillance Information System (https://lab.research.sickkids.ca/oasis/). Dr. To found that one of the key factors contributing to asthma is socioeconomic status. Despite having universal health care access in Canada, we do not have a universal drug plan. She explains,

“Even if you have a drug to treat asthma, if you do not have the money or a drug insurance plan to pay for it, or do not have means to support adherence to the disease management, it is difficult to gain control of [a] condition like asthma.” Dr. To’s passion for health care access, policy, and environmental impacts fuel her

involvement as a Tier 1 Canada Research Chair for Asthma, and a Lead for the Environmental Health Platform of the Canadian Respiratory Research Network. The environmental focus of her work aims to examine the influence of air pollution on the exacerbation of asthma symptoms. One of her published studies found that when exposed to air pollutants, people with asthma were three times more likely to develop chronic obstructive pulmonary disease (COPD), also known as asthma-COPD overlap syndrome (ACOS), which is associated with worsened lung functioning and a significantly higher need for health care services.3 For children, Dr. To aimed to study early life exposures to air pollution and lung health, as the lungs continue to mature until the early 20s. Early life exposure to pollutants - such as nitrogen dioxide and ozone - resulted in a 17% elevation in the risk of asthma development among a cohort of newborns that were followed for an average of 17 years.4 Therefore, Dr. To suggests that being aware of the conditions of the ambient environment (such as air quality level and temperature) will help guide the time and level of outdoor activities. For example, simple lifestyle changes such as avoiding walking with children in high-traffic streets during poor air quality hours, may help protect these children’s delicate immature organs. Graphic design by Katrina Hass

FEATURE Since asthma is a chronic condition, taking medications daily is critical to manage it and prevent asthma attacks. However, people tend to take their medications on an “as-needed” basis. Dr. To aims to help individuals be better informed about asthma and modifiable factors, such as smoking. She employs the use of infographics released via social media to improve outreach and education for youth. Dr. To also works with health care providers to optimize the quality of care provided to patients. This involves promoting the use of individualized action plans that have three zones—green, yellow, and red. With the red zone indicating severe symptoms and the need to seek emergency medical treatment. She has also developed the Asthma Quality of Care Indicator checklist that ensures consistent quality of care for patients, while also providing doctors with feedback. Furthermore, Dr. To has helped develop a mobile application called BREATHE, which helps patients track their symptoms with a symptom diary and indicates to the user the air pollution levels in the area. There is also a built-in action plan that informs patients the zone (i.e., green, yellow, or red) of their asthma control. Dr. To’s research involves integrating various techniques and sources of data. This includes statistics generated by linking multiple annual population-level databases housed at ICES, including data on hospital admissions, emergency department visits, outpatient visits, and laboratory testing. She also linked health administrative data to air pollution data obtained from Environment Canada and Health Canada. Through all her research findings, Dr. To aims to advocate for patients and inform the government of the needs of the asthma population. She also joins forces

with the Lung Health Foundation every year to lobby at the parliament “for better coverage, for medication, for better care for people with asthma.” In terms of the future of her research, Dr. To aims to explore a few emerging areas in respiratory health; 1) examine the impact of COVID-19 in people with asthma, 2) better understand and manage severe asthma, 3) focus on the development and progression of asthma in the pediatric population in order to reduce hospitalizations and 4) look at the effect of vaping on the frequency of asthma attacks and exacerbations in younger populations, with funding from the Canadian Institutes of Health Research (CIHR). Her latest findings showed that one in eight e-cigarette users had asthma, and those with asthma had nearly 24% increased odds of having an asthma attack within 12 months. Dr. To hopes to use findings from this research to raise the awareness of the potential harmful health effects of vaping and develop and implement evidence-based strategies to prevent and reduce e-cigarette use, especially in youth.5 Dr. To leaves a few pieces of advice for future graduates and researchers. Regardless of the specific research question that you are trying to answer, it is important to employ an evidence-based approach. Building one’s research foundation based on strong data collection methods, sound analytical tools, and formal research training are all paramount. Furthermore, one needs to appreciate the relevance of “knowledge translation.” Its impact relies on how effective and efficient research findings are translated and transferred to the general public, including patients, health care providers, and the government. “It is not ideal to simply

do research and publish papers…that is old school now…it is also our responsibility to pass the findings and information to the public…to the people who need it [and] who can benefit from it,” while also helping contribute to systemic change at the government level.

Dr. Teresa To Professor in Biostatistics and Epidemiology at the Dalla Lana School of Public Health Professor at the Institute of Health Policy, Management and Evaluation (IHPME) Cross appointed Professor with the Institute of Medical Science (IMS) Senior Scientist, Child Health Evaluative Sciences, The Hospital for Sick Children Senior Adjunct Scientist ICES/ Scientific Lead from Sick Kids for ICES UofT Tier 1 Canada Research Chair, Asthma Lead, Environmental Health Platform, Canadian Respiratory Research Network Associate Editor, Canadian Journal of Respiratory, Critical Care and Sleep Medicine

Photo credit: Dr. To

References 1. Asthma Canada. Understanding Asthma [Internet]. Asthma Canada. [cited 2021 May 25]. Available from: https://asthma.ca/get-help/understanding-asthma/ 2. SickKids. THE ONTARIO ASTHMA SURVEILLANCE SYSTEM (OASIS) [Internet]. OASIS. 2021 [cited 2021 May 25]. Available from: https:// lab.research.sickkids.ca/oasis/ 3. To T, Zhu J, Larsen K, et al. Progression from Asthma to Chronic 4. Obstructive Pulmonary Disease. Is Air Pollution a Risk Factor? Am J Respir Crit Care Med. 2016 Aug 15; 194(4): 429–38. 5. To T, Zhu J, Stieb D, et al. Early life exposure to air pollution and incidence of childhood asthma, allergic rhinitis and eczema. Eur Respir J. 2020 Feb; 55(2):1900913. 6. To T, Zhang K, Terebessy E, et al. Does Vaping Increase the Odds of Asthma? A Canadian Community Health Survey Study. Session TP16: Clinical

BREATHE App: Tool for asthma patients to analyze environmental factors and track symptoms, in order to develop individualized action plans.

and research updates on tobacco cessation, vaping, and e-cigarettes. ATS 2021 International Conference, 14-19 May.

IMS MAGAZINE SPIRNG/SUMMER 2021 PUBLIC HEALTH | 11

FEATURE

A Population in Flux:

Interventions in the Youth Homelessness Space By Beatrix Wang

outh aged 13 to 24 comprise roughly 12% of Canada’s populace, but account for 20% of its homeless population.1 This disparity underscores youth homelessness as a major concern within Canada, with young people representing one of its fastest growing homeless populations.2 Though a largely overlooked issue in the past, a growing body of research has recently begun to shed light on the complex, intersecting forces that result in young people experiencing homelessness. Dr. Sean Kidd, Clinical Psychologist, Senior Scientist, and Division Chief of Psychology at the Centre for Addiction and Mental Health (CAMH) and Associate Professor in the Department of Psychiatry, is a leading expert within this space. “We can sometimes think about youth homelessness as this binary sort of thing,” Dr. Kidd says. “Like there’s a bad situation at home … or a young person has a mental health crisis or a justice interaction, then they’re homeless. And that’s really not how it works for the vast majority. For most, it’s a long trajectory of challenge, marginalization, and interacting problems.” These factors include poverty, discrimination, and intergenerational trauma. Consequently, there is an overrepresentation of 2SLGBTQ+ and Indigenous youth among those experiencing homelessness. The lack of safe, stable housing has farreaching consequences. Not having an address can prevent individuals from obtaining employment and accessing services. Housing instability can increase the chance of young people being in environments wherein abuse and sex 12 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

trafficking are risks. Safe housing, furthermore, is a vital determinant of health—both mental and physical—and its absence makes wellness difficult to achieve in innumerable ways. However, for many, the story does not end when they obtain housing. This was something Dr. Kidd saw firsthand in research performed with colleagues at the University of Dalhousie, which followed the trajectories of 51 youth transitioning out of homelessness for a year.3 The outcomes, to put it mildly, were not good. “It was a very depressing study to run,” Dr. Kidd says. “In that year, we saw about a quarter were street homeless again. And you could count on one hand the number that were flourishing.” For many who retained housing, the team observed continued marginalization, mental health crises, and trouble engaging with work and school.

of homelessness and housing insecurity. “You’ve got a moment,” Dr. Kidd says, “when a young person has some housing, some stability. It’s very precarious. But if you can double down on supports at that transition time, you have a chance of improving their outcomes such that they’re keeping their housing and flourishing more.” HOP-C, a multi-agency collaboration between CAMH, LOFT Community Services, Covenant House, the Wellesley Institute, and others, combines outreach, case management, peer support, and mental health services in a team-based approach that provides programming for youth in this window of time. Initial pilot and feasibility studies in Toronto showed high levels of engagement and improved short-term outcomes in education, employment, and housing. Dr. Kidd and his colleagues next partnered

There was a silver lining to this study, however. These findings, though bleak, demonstrated a need for continued support for youth exiting homelessness, and led Dr. Kidd to embark on a research journey wherein he has worked to develop a critical time intervention called the “Housing Outreach Program Collaboration” (HOP-C).4 With HOP-C, Dr. Kidd and his colleagues are asking an essential question: If youth who have experienced homelessness have difficulty succeeding within the current system, even when they do obtain housing, can their chances of success be increased by intervening in the right ways and at the right time? The key time frame for intervention is when individuals are transitioning out

DR. SEAN KIDD Associate Professor in the Department of Psychiatry, Associate Member of IMS, Associate Faculty in the Department of Psychological Clinical Science at the University of Toronto Scarborough Photo credit: Dr. Kidd

Graphic design by Amy Assabgui

FEATURE

with Lakehead University and Dilico Anishinabek Family Care to co-develop and pilot an extremely successful Indigenous-led HOP-C program in Thunder Bay. These successes led to a substantial CIHR grant, totalling nearly $1 million, which will fund a fully powered HOP-C randomized control trial in Toronto starting in September 2021. In the largest application of the program yet, over 100 youth will experience the intervention for a year and their outcomes will be followed for six months afterwards. Part of what has made HOP-C so unique is how it redefines what peer support can be. After seeing the effectiveness of the initial study in Toronto, the team, led by youth with lived experiences of homelessness, wanted to do even more. “Later in the project,” recalls Mardi Daley, a HOP-C peer specialist, “there was the question of, how can we build something? How do we build a product to show what we’ve done in this housing intervention?” With this goal in mind, the team hired HOP-C participants to create something that imparted knowledge that would have helped them at the onsets of their journeys. What resulted was the MY Guide, a 90-page booklet filled with encouragement, tips, recipes, and activities to aid youth transitioning out of homelessness in Toronto and beyond. This process, which gave participants the opportunity to produce something impactful for their peers, proved to be empowering. “Homelessness is so highly stigmatised, especially for young people, that a lot of them are written off before they’ve even had a chance to try things,” Daley says. “So it’s key to allow them to

MARDI DALEY A peer support worker in the HOP-C program and a BYFY initiative leader Photo credit: Mardi Daley

learn how to be leaders for themselves, to see that they’re capable beyond the stereotypes and limitations of being homeless. Plus, having young people lead younger people shows that you, too, can do this, even if you’ve been homeless; that there’s a future for you after this.” The guides have since been distributed worldwide, and this concept—youth empowering other youth—has grown into what is now the “By Youth For Youth” (BYFY) Initiative.5 In Thunder Bay, Indigenous young people have developed their own culturally-grounded BYFY guide with consultation from community elders. In Nicaragua, the initiative has taken the form of graffiti art, a hip-hop video, and a theatre piece. More projects are on the horizon as BYFY continues to expand.

Owing to such initiatives, significant progress is beginning to be made. Over the course of his career, Dr. Kidd has watched and helped the field shift from its humble beginnings to its current form, which is increasingly rich in policy- and intervention-based research. Much work remains to be done, however. “A whole system’s response is what we need to end ongoing chronic youth homelessness in Canada,” Dr. Kidd says. “And what I’m trying to do is carve out one part of that and really validate, with a good amount of evidence, that one piece of the picture.” The monumental task of ending youth homelessness requires effort on a massive scale to evolve the current system into something less crisis-oriented and more geared towards prevention and continued support for youth. In recent years, this has taken the form of a national coalition called A Way Home Canada, in which dedicated individuals are engaged across a broad range of sectors to make this aim a reality.6 It is in this manner that the field is coming together, engaging policymakers, and bringing about systemwide transformation. References 1. Gaetz S, Gulliver T, Richter T. The State of Homelessness in Canada: 2014. In Toronto: The Homeless Hub Press; 2014. 2. Laird G. Shelter: homelessness in a growth economy : Canada’s 21st century paradox : a report for the Sheldon Chumir Foundation for Ethnics in Leadership [Internet]. Calgary, Alta.: Sheldon Chumir Foundation for Ethics in Leadership; 2007. Available from: http:// epe.lac-bac.gc.ca/100/200/300/sheldon_chumir_foundation/shelter/ LAIRD_Homelessness_Report.pdf 3. Kidd SA, Frederick T, Karabanow J, et al. A Mixed Methods Study of Recently Homeless Youth Efforts to Sustain Housing and Stability. Child Adolesc Soc Work J. 2016 Jun 1;33(3):207–18. 4. HOP-C: Housing Outreach Program Collaborative [Internet]. The Homeless Hub. [cited 2021 Jun 26]. Available from: https://www. homelesshub.ca/HOP-C 5. By Youth For Youth Initiative [Internet]. The Homeless Hub. [cited 2021 Jun 13]. Available from: https://www.homelesshub.ca/byyouth-for-youth-initiative 6. A Way Home Canada [Internet]. A Way Home Canada. [cited 2021 Jun 26]. Available from: https://awayhome.ca/

IMS MAGAZINE SPIRNG/SUMMER 2021 PUBLIC HEALTH | 13

FEATURE

By Sonja Elsaid

“I

t is like you are an athlete, and you go to being a couch potato.” These are the words commonly heard from patients with osteoarthritis, describing the consequences of their symptoms. Osteoarthritis (OA) is the most common form of joint disease occurring in the knee, hip, and joints. It is associated with abnormal joint load or injury and the body’s inability to repair joint tissue. As a result, joint tissue breaks down over time, causing inflammation, immobility, and pain. The older we get, the more likely we are to develop OA.1 Research shows that over 23% of people suffer from OA between ages 65-69.2 However, by the time people reach 80 years, a staggering half will be affected.2 Unfortunately, OA has no cure. The current treatment is purely to control the symptoms.1,2 Initially, with mild OA, people start experiencing joint stiffness, and some pain; however, the pain becomes more severe with time, causing functional limitations. Eventually, the walking speed gets slower, going up and down the stairs becomes problematic, and the constant feeling of pain ultimately leads to generalized fatigue and depression.1,3 Avoiding pain and activities causes most patients afflicted with OA to become ‘couch potatoes.’ “But, what if I told you that the very same cause of pain could make the pain go away?” said Dr. Aileen Davis, Professor Emeritus at the Department of Physical Therapy and Surgery, and the 14 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

Graduate Departments of Rehabilitation Science, Health Policy, Management and Evaluation, and the Institute of Medical Science at the University of Toronto. Contrary to popular belief that movement and exercise could wear out or even cause damage to joints affected by OA, teaching patients how to align their joints properly during exercise could mitigate the joint pain. “It is a paradox! It tells us that when we use proper nutrition, manage our weight and engage in a supervised exercise making the affected cartilage as healthy as possible; we are reducing and not increasing the pain.” Dr. Davis, who is also recently retired from the Senior Scientist position at the Healthcare and Outcomes Research division of Krembil Research Institute (formerly Toronto Western Research Institute) at the University Health Network, was referring to the outcomes of one of her most notable achievements, which is bringing GoodLife with osteoArthritis in Denmark (GLA: D®) to Canada. Access to the right type of healthcare programs is one of the most important social determinants of health. GLA:D is an education and targeted exercise program for people with OA of the knee and hip. The program originated from the University of Southern Denmark.3 The idea of implementing such a program in Canada surfaced in 2014 by Dr. Davis — then the Director of Osteoarthritis Research at Bone and Joint Canada, which had a mandate to address a huge

gap in provision of social determinants of health to Canadians—a program that addresses conservative management of OA. Given that GLA:D is an evidencedbased program for managing OA, it seemed like a good idea to bring this program to Canada.3 With the help of her colleagues at the Holland Centre at Sunnybrook Hospital, Dr. Davis conducted a pilot study initially testing the program only in Toronto. Subsequently, after receiving a three-year Trillium Foundation grant with Bone and Joint Canada, the research project expanded to include several sites in Ontario and eventually British Columbia and Alberta due to its popularity. As of January 2020, the program is no longer just a research project, but a fully implemented community-based clinical program. Essentially, GLA:DTM Canada (http:// gladcanada.ca/)3 consists of three main elements. The first element is a certifiable education program for healthcare workers willing to implement the GLA:D program in their practice. Initially taught by Dr. Davis herself across Canada, the course is currently being delivered by knee and hip OA experts to physiotherapists, regulated kinesiologists, and chiropractors. The second element of the GLA:D program is patient education and exercise. During the two- to three-day education session, patients learn how to keep their OA-affected cartilage as healthy as possible by engaging in proper nutrition and Graphic design by Katrina Hass

FEATURE

improving muscle strength to minimize the load to the affected joints.3 “One of the aims of patient education is to help them learn the importance of healthy weight management and how simply losing 5-10 lbs could significantly reduce pain,” Dr. Davis explained. “The six-to-eight-week supervised exercise program”, continued Dr. Davis, “follows the educational component of GLA:D. Under ordinary circumstances, patients with OA receive a picture with a diagram of the types of exercises they should engage in at home. However, exercising alone may be particularly challenging for those who have never been active. For this reason, GLA:D program offers in-person instruction on exercising correctly during the 12 sessions. The key feature of the exercise program is to supervise the initial stages of learning how to exercise.” “The third component of the GLA:D program”, emphasized Dr. Davis, “is the quality monitoring part.” At this stage, patient outcomes are evaluated and recorded in the national electronic GLA:D registry. Namely, patient-reported, validated outcome measures and functional tests are assessed at baseline, at three months—after completing the program—and at 12-month follow-up. Among other outcomes, pain, quality of life, and mobility/function are tracked throughout the three-time points. According to the GLA:DTM Canada outcomes data, significant improvements in functional abilities have been demonstrated by 65% of hip and 73% of knee patients.3 The

survey tracked 1,601 patients with hip and 2,774 with knee OA across 209 Canadian sites between 2016 and 2019.3 Moreover, clinically significant improvements in quality of life and walking speed were observed.3 The most striking results were recorded with the 30%-improvement in pain. It was noted that in nearly half of patients with knee and hip OA that pain markedly improved one year after enrolling in the program.3 Furthermore, compared to the baseline, at both three and 12-month timepoints, knee patients indicated using fewer intra-articular injections to manage pain. Significant decreases were also seen in the percentage of patients being afraid of damaging their joints by exercise.3 Overall, the program addresses one of the social determinants of health—improving access to healthcare—as it significantly improved OA patient health outcomes. Although Dr. Davis retired in June 2020, the GLA:D program remains her legacy, passed on to her colleagues at the Schroeder Arthritis Institute, and Bone and Joint Canada to cultivate, expand and evolve it further. During the COVID-19 pandemic, the program has already moved to the online platform to accommodate the mandated social isolation during the lockdown. As for Dr. Davis, many of her former colleagues are enormously grateful that they get to carry on her legacy of showing the world how science can improve lives.

Dr. Aileen Davis Ph.D. Professor Emeritus at the Department of Physical Therapy and Surgery and the Graduate Departments of Rehabilitation Science, Health Policy, Management and Evaluation, and the Institute of Medical Science at the University of Toronto. Photo credit: Dr. Davis

References 1. Cramer P and Hochberg MC. Osteoarthritis. Lancet. 1997;350:503-09. 2. Public Health Agency of Canada (PHAC). Osteoarthritis in Canada. Ottawa (ON): PHAC; 2019 [cited 2021 Jun 01]. Available from:https:// www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/osteoarthritis/osteoarthritis-factsheet.pdf 3. Zywiel MG and McGlasson R. GLA:DTM Canada Implementation and Outcomes: 2019 Annual Report. Bone and Joint Canada. [Internet] 2020 June 1 [cited 2021 June 1]. Available from: http://gladcanada.ca/

IMS MAGAZINE SPIRNG/SUMMER 2021 PUBLIC HEALTH | 15

BMC FEATURE

Master of Science in

biomedical Communcations All MScBMC graduate students complete a Master’s Research Project (MRP) as part of the program curriculum. The MRP is a platform for research into the visual communication of science and/or medicine. It provides an opportunity for students to develop their abilities in literature evaluation, research design, audience analysis, and the design, iteration, and implementation of a comprehensive communications instrument. To see more work created by our graduate students visit: https://bmc.med.utoronto.ca/meet-our-students

My name is Cassie and I am a recent graduate of the MScBMC program at UTM. My Master’s Research Project is a 4 minute 2D and 3D animation visualizing skeletal adaptations that led to a new behaviour hypothesis in a species of dinosaur named Pachycephalosaurus. I will be starting another Master’s Degree in Laboratory Medicine at UofT in the fall and hope to continue my love for anatomy, pathology and scientific illustration.

Cassie Hillock-Watling 2T1

Supervisor: Dave Mazierski, BScAAM, MSc, CMI www.cassiehwvisuals.com

16 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

BMC FEATURE

Martin Shook is a designer whose work explores medical marketing, communication, and education. His passion for medical communication drew him to pursue a Masters’s of Biomedical Communications. Through his master’s research project, Martin successfully visualized DNA nanotechnology. Martin is employed at Maven Medical Marketing, where he collaborates in the design of marketing collateral for pharmaceutical industries. Supervisor: Nicholas Woolridge, BFA, BScBMC, MSc, CMI

Katrina Hass 2T1

www.linkedin.com/in/martin-shook-729b26104

Martin Shook 2T1

Katrina is a biomedical communicator, specializing in visualization design. She is graduating this year from the M.Sc. in Biomedical Communications program at the University of Toronto. Her Master’s Research Project is a 3D animation that aims to not only inform but compel surgeons to adopt the Liver Airbag device. This device is a new surgical tool recently invented by Dr. Joao Rezende-Neto. It is a transparent, non-adherent inflatable bag designed to surround the liver and control bleeding. Supervisor: Marc Dryer, Hons BA, MSc, MScBMC

www www.khassvisuals.com

IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH | 17

VIEWPOINT

By Stacey Butler

anada may have a universal healthcare system, however the treatment Canadians receive is far from equal. Canadian rapper, John River, was experiencing shortness of breath and severe headaches, yet these symptoms were dismissed by hospitals in Toronto, simply because of his appearance and skin colour. Instead of his complaints being taken seriously, he was stereotyped, viewed as uneducated, and assumed to be faking symptoms to obtain drugs. This case of systemic racism resulted in significant delays in treatment and left John River in severe pain for months on end.1

construct that categorizes people based on visual traits such as the colour of their skin.4 Ethnicity refers to groups with a shared culture, ancestry, language, or belief system.4 Race has been used both historically and currently to discriminate against, exclude, or marginalize a group of people, and results in unequal opportunities. It is crucial to understand how both race and ethnicity contribute to health inequalities in Canada. Data on race can be used to identify health inequalities that exist due to bias and racism. While data on ethnicity can be used to understand and identify cultural barriers to healthcare.4

Stories like this bring to light the health inequalities experienced by racialized individuals in Canada. Despite culture and race (or more accurately, racism) being recognized by Health Canada as important social determinants of health,2 our healthcare system does not routinely collect data on race or ethnicity, with the exception of indigenous identity. Failing to collect race or ethnicity-based data in Canada is a major limitation that negatively impacts the quality of our research and our healthcare system. It prevents us from understanding the diversity of our patients and from being able to detect inequalities that we know exist as a result of systemic racism.3

Since individual-level data on race or ethnicity is not routinely collected in Ontario’s healthcare system, population health studies have resorted to using alternative methods to measure health inequalities. Typically these methods rely on neighbourhood, or area-level data available from the Canadian Census. For example, the Ontario Marginalization Index (ON-Marg) addresses race and ethnicity by identifying areas of Ontario with a high ‘ethnic concentration’, defined as areas with a high proportion of the population who identify as a visible minority or are a recent immigrant (arrived to Canada in the past five years).5 The ON-Marg tool is limited by its use of aggregated, area-level data, as opposed to data on each individual’s ethnicity. An additional limitation is the so-called ‘healthy immigrant effect’, where

The terms race and ethnicity are often used interchangeably, despite having different meanings and contexts. Race is a social 18 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

recent immigrants are generally healthy but their health deteriorates over time. Furthermore, in the case of diabetes, this deterioration is greater for immigrants who belong to a visible minority group.6 Nonetheless, the ON-Marg tool is still useful to study several social determinants of health in Ontario at the neighbourhood level. Given the limitations of area-level data, epidemiologists at ICES, a population health research institute in Ontario, have gotten creative with their approach to addressing ethnicity. They have developed a tool that uses surnames to identify people of South Asian and Chinese ethnicity.7 Using this method, researchers have uncovered differences in the risk of several diseases and in the severity of mental illness.8 However, the surname algorithm is only able to categorize people into two distinct ethnic groups (South Asian and Chinese) and lumps the remainder into a ‘general population’ category. Thus, it cannot measure health inequalities in other ethnic groups that exist within the Ontario population, reiterating the need for individual-level data on ethnicity. The COVID-19 pandemic has put race and ethnicity in Canada in the spotlight, as aggregate, neighbourhood level data draws our attention to the disproportionate rates of infection and mortality among racialized communities.9 Visible minority groups are seven times more likely to have Graphic design by Ava Schroedl

VEIWPOINT

"The COVID-19 pandemic has put race and ethnicity in Canada in the spotlight, as aggregate, neighbourhood level data draws our attention to the disproportionate rates of infection and mortality among racialized communities.9" COVID-19 than White Torontonians.10 These observations have created a call to action for the collection of individual-level race or ethnicity-based data in our healthcare system. Local public health units began collecting race-based data for patients with COVID-19 in the spring of 2020 and by the summer, information on race, income, household size and language was being collected across Ontario.11 This is a positive step forward, but it should not have taken a pandemic to propel us to collect this information and begin to address health inequalities in Canada that have existed for decades. Although there are difficulties in navigating the collection of race or ethnicity-based data, it is essential to collect this information in order to properly measure and address health inequalities in Canada.3 We must ensure that this data is used to improve the health of racialized individuals and not to further marginalize or segregate them. It is also essential that privacy and confidentiality

is maintained.4 The Canadian Institute for Health Information (CIHI) recommends working with community groups that represent racialized individuals, in order to identify relevant research priorities.4 Simply collecting the data is not sufficient if the results are not communicated to the public and policy-makers. Most importantly, any findings of inequalities must be addressed with targeted interventions to create substantial change. Lastly, it is important to recognize that many social determinants of health are inter-related and changes outside of the healthcare system are needed to have a widespread impact. Systemic racism affects opportunities and access to employment, education, housing, clean water, healthy food, and a safe environment.3 We can all do our part in addressing these social determinants of health by acknowledging our privilege and getting involved with underserved communities. The Wellesley Institute (https://www. wellesleyinstitute.com/) and FoodShare

(https://foodshare.net/) are two great examples of local initiatives that strive for health equity in Toronto. References 1. Amin F. Falling through the cracks of Canada’s healthcare system: the John River story. City News. 2019 Dec 4; Available from: https://toronto.citynews.ca/2019/12/04/canada-healthcare-system-john-river/ 2. Health Canada. Social determinants of health and health inequalities [Internet]. 2020 [cited 2021 Jun 8]. Available from: https://www. canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html 3. Nestel S. Colour Coded Health Care The Impact of Race and Racism on Canadians’ Health. Toronto, ON; 2012. 4. Canadian Institute for Health Information. Proposed Standards for Race-Based and Indigenous Identity Data Collection and Health Reporting in Canada [Internet]. Ottawa, ON; 2020. Available from: https://www.cihi.ca/sites/default/files/document/proposed-standard-for-race-based-data-en.pdf 5. Public Health Ontario. Ontario Marginalization Index (ON-Marg) [Internet]. 2018. Available from: https://www.publichealthontario. ca/en/data-and-analysis/health-equity/ontario-marginalization-index 6. Adjei JK, Adu PA, Ackah BBB. Revisiting the healthy immigrant effect with diabetes risk in Canada: why race/ethnicity matters. Ethnicity and Health. 2020;25(4):495–507. 7. Shah BR, Chiu M, Amin S, Ramani M, Sadry S, Tu J V. Surname lists to identify South Asian and Chinese ethnicity from secondary data in Ontario, Canada: A validation study. BMC Medical Research Methodology. 2010;10. 8. Chiu M. Ethnic Differences in Mental Health and Race-Based Data Collection. Healthcare Quarterly. 2017;20(3):6–9. 9. Subedi R, Greenberg L, Turcotte M. COVID-19 mortality rates in Canada’s ethno-cultural neighbourhoods [Internet]. 2020. Available from: https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/ article/00079-eng.htm 10. IMS Magazine. Answering the call for COVID-19 research: PUBLIC HEALTH & EPIDEMIOLOGY. IMS Magazine. :8–9. 11. McKenzie K. Race and ethnicity data collection during COVID-19 in Canada - If you not counted you cannot count on the pandemic response. The Royal Society of Canada. 2020;1–12.

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VIEWPOINT

Drug Use for Grown-Ups:

A Radical Discussion on Drugs

By Dorsa Rafiei & Stephanie Tran

arlier this year, Dr. Carl Hart, a neuroscientist and professor at Columbia University, released a book entitled Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear,1 arguing for people’s freedom to alter their consciousness with drugs. The book’s provocative topic certainly ruffled some feathers in both the general public and academic communities. Meanwhile, the book received glowing reviews from publications such as NPR and the New York Times, to name a few. In Drug Use for Grown-Ups, Hart points out the way society has demonized drugs as well as users—particularly black and brown drug users—leading to policies that have contributed to social injustices, such as the disproportionate incarceration and harsher sentencing of black and brown people compared to white people for nonviolent drug offences.2 An important step in providing a solution to this problem, Hart argues, is the decriminalization and legalization of all drugs, which allows for regulation and quality control of substances. However, we believe Hart’s argument becomes dangerous when he provocatively muses about his recreational use of heroin and states that he is a better person because of drugs, claiming that if he can use drugs safely, so could other “grown-ups.” Therefore, readers 20 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

should be cautioned for the book’s lack of acknowledgement of variable social and biological predispositions for addiction, innate discrepancies of drug properties, and limitations of current scientific evidence. The target demographic of Drug Use for Grown-Ups are, well, “grownups”. Hart defines a grown-up as a healthy adult who is “autonomous, responsible and well-functioning” and fulfills their social, parental, and occupational responsibilities.1 But how do we distinguish between the grownups that can use drugs responsibly versus the grown-ups that cannot? Hart argues that many drug users (like himself) do not meet the criterion for impaired functioning and thus do not have a substance use disorder (SUD) or an addiction. In fact, Hart’s argument dismisses the role of genetic predisposition and the environment, two common risk factors for mental illness and addiction.3 So, while a “well-functioning” adult can choose to responsibly use recreational drugs, environmental or situational factors (e.g., acute stress or trauma) may trigger increased use, dependence or even abuse, which can in turn impact, as Hart would suggest, “responsible use”. Ultimately, as Dr. William Haning, editor-in-chief of the American Society of Addiction Medicine, so eloquently puts, the fulcrum is “our

inability to satisfactorily predict who will develop the illness state once they have first been exposed to the substance. It’s difficult enough to determine even the prevalence of substance use disorders, despite our having descriptive criteria.”4 In addition to user variability, there are innate differences in drug properties that cannot be overlooked. Hart resents the more accepting attitude of the public toward some drugs, such as psilocybin, versus the negative attitude toward “harder” drugs, such as heroin: “I had grown increasingly annoyed with the mental gymnastics that some psychedelic users perform in order to distance themselves from other drug users.”1 While psilocybin is a powerful psychoactive substance, it is physiologically safer than heroin.5 Psilocybin overdoses may include vomiting, paranoia, psychosis, and seizures and are rarely life-threatening. On the other hand, heroin can cause respiratory depression and overdose, which can be lethal. Although Hart’s intentions are to increase unity among drug users by emphasizing the positive effects of drug use, he fails to adequately address the different neurophysiological effects of drugs. An overwhelming emphasis in Drug Use for Grown-Ups is on the positive effects of drugs which fails to highlight disparities in the social and biological predispositions of Graphic design by Abeeshan Selvabaskaran

VEIWPOINT

different “grown-ups”. Hart cites his own studies that investigated cannabis, cocaine, and methamphetamine, to name a few. However, the majority of these studies consisted of small sample sizes (< 10 participants) and looked at acute shortterm effects (< 2 weeks).7,8 Hart draws on evidence suggesting that the majority of drug users do not become addicted and are able to function normally. However, the number that do become addicted is no small number. In 2017 alone, the global estimate of opioid overdose deaths was 109 500, of which 43% were in the USA.9 Even in new heroin users, approximately 30% of people become dependent within the first year.10 According to Hart, “the opioid problem is not really about opioids” but rather a problem of “ignorance.”1 He argues that fatal opioid overdoses have been largely overstated, citing that the majority of overdoses are a result of contaminated opioid drugs or opioids combined with another downer (e.g., alcohol). Hart’s solution for ignorance is better educating the public about how to use drugs to increase desired effects and reduce adverse effects; however, this approach hasn’t worked with other drugs. For example, many “grown-ups” know they shouldn’t take a benzodiazepine with alcohol… but they do it anyway. People know they shouldn’t abuse alcohol, but alcohol-related incidents still make up

a large proportion of emergency room visits.11 In fact, alcohol is the cause of 5.3% of deaths worldwide every year.12 Therefore, as we have seen with alcohol, education will not solve the issue of “ignorance” and the risk of addiction should not be overlooked to solely focus on the positive effect of drugs. All in all, it is our opinion that illicit drugs should be decriminalized and legalized to allow for better therapeutics for people with SUDs, without the stigmatization and risk of incarceration—but there are dangers in Hart’s method of advocacy. He states that the book is “unapologetically not about addiction.” But to talk about drugs without considering the neuropsychopharmacological outcomes is simply irresponsible. Nevertheless, Hart’s radical opinions are an important part of the discussion to be had regarding reforming drug policies and de-stigmatization of drug use.

References 1. Hart CL. Drug use for grown-ups chasing liberty in the land of fear. New York: Penguin Press; 2021. 2. Vogel M, Porter LC. Toward a Demographic Understanding of Incarceration Disparities: Race, Ethnicity, and Age Structure. Journal of Quantitative Criminology. 2015;32(4):515–30. 3. Vink JM. Genetics of Addiction: Future Focus on Gene × Environment Interaction? Journal of Studies on Alcohol and Drugs. 2016;77(5):684–7. 4. Haning W. American Society of Addiction Medicine [Internet]. Editorial Comment 1/19/2021: Drug Use for Grown-Ups. [cited 2021May6]. Available from: https://www.asam.org/Quality-Science/ publications/asam-weekly/asam-weekly-archive/asam-weeklyeditorial-comment/2021/01/19/editorial-comment-1-19-2021drug-use-for-grown-ups 5. Nichols DE. Psychedelics. Pharmacological Reviews. 2016;68(2):264–355. 6. White JM, Irvine RJ. Mechanisms of fatal opioid overdose. Addiction. 1999;94(7):961–72. 7. Comer S, Hart C, Ward A, Haney M, Foltin R, Fischman M. Effects of repeated oral methamphetamine administration in humans. Psychopharmacology. 2001;155(4):397–404. 8. Haney M, Rabkin J, Gunderson E, Foltin RW. Dronabinol and marijuana in HIV+ marijuana smokers: acute effects on caloric intake and mood. Psychopharmacology. 2005;181(1):170–8. 9. James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1789–858. 10. Santiago Rivera OJ, Havens JR, Parker MA, Anthony JC. Risk of Heroin Dependence in Newly Incident Heroin Users. JAMA Psychiatry. 2018;75(8):863. 11. Myran DT, Hsu AT, Smith G, Tanuseputro P. Rates of emergency department visits attributable to alcohol use in Ontario from 2003 to 2016: a retrospective population-level study. Canadian Medical Association Journal. 2019;191(29). 12. Addiction Statistics - Facts on Drug and Alcohol Use. Addiction Center. [updated 2021 March 24; accessed 2021 July 14]. Available from: https://www.addictioncenter.com/addiction/addictionstatistics/.

IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH | 21

FACULTY SPOTLIGHT PROMOTED MEMBERS

FACULTY HIGHLIGHTS

Dr. Gary Levy (O. ONT., MD, FRCPC, AGAF,

Dr. Kirsten Wentlandt (PhD, MD, FCPC (PC), FRPCP) is a palliative care Dr. from Toronto, and is the W. Gifford-Jones Professor in Pain Control and Palliative Care, and Head of the Division of Palliative Care. Her clinical work and research are focused on nonmalignant palliative care populations, with ambulatory clinics supporting advanced lung, heart, pulmonary hypertension and transplant populations.

Dr. Andrea Furlan (MD, PhD) is a physician and Senior Scientist at KITE Toronto Rehab (UHN). She is a clinician scientist in the Division of Physical Medicine and Rehabilitation, Department of Medicine and Scientist at the Institute for Work & Health in Toronto. She obtained her PhD from IHPME in Clinical Epidemiology.

Dr. Vijay S. Chauhan (MD, FRCPC) is investigating mechanisms of ventricular arrhythmias, electrical dysynchrony, and sudden death in patients with heart failure. His lab is also characterizing the abnormal electrical substrate in patients with atrial fibrillation. The findings of these studies may ultimately improve patient selection and outcomes for antiarrhythmic therapies, such as defibrillators, cardiac resynchronization pacing, and catheter ablation.

Dr. Herman Yeger (PhD). At University

Dr. Monika K. Krzyzanowska

Dr. Sakina Rizvi’s (PhD) research expertise

of Toronto, he has benefited from a close association with the Institute of Medical Science. As a Professor Emeritus in IMS, he continues to have the opportunity to provide mentorship, supervise graduate students, and contribute to the success of colleagues as they strive to build their careers.

(MD MPH FRCPC FASCO) focuses on the quality of care received by patients with cancer. By combining patient-level studies with population-based research she is able to look at quality issues from different, but complementary perspectives, have impact at both the micro (institution) as well as macro (population) levels and close the loop between quality measurement and improvement.

spans neuroimaging, psychotherapy, pharmacology, and scale development; with a focus in Major Depressive Disorder. Her research aims to characterize the neurobiology of suicide risk and treatment resistant depression, primarily through the use of fMRI and PET neuroimaging, and to develop and test novel psychotherapeutic strategies.

CAGF, FAASLD) co-founded the Multi-Organ Transplant Program at the University Health Network. He has published over 400 peer-reviewed articles and has trained over 60 masters and PhD students. Prof. Levy has received numerous awards and lectureships throughout his career and in 2015 was appointed to the Order of Ontario.

22 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

Graphic design by Ava Schroedl

FACULTY SPOTLIGHT NEW MEMBERS

Dr. Jesse Pasternak (MD, MPH, FRCSC) is an Endocrine Surgeon at UHN. He is a surgeon-investigator, Adjunct Member of ICES and at the Institute for Medical Science. His research is centered in the area of endocrine oncology where he studies surgical innovation in the optimization of clinical outcomes including intraoperative technology, localization imaging and standardized treatment pathways.

Dr. Brodie Nolan (MD, MSc FRCPC) is an emergency physician and trauma team leader at St. Michael’s Hospital, transport medicine physician for Ornge and Assistant Professor in the Department of Medicine at the University of Toronto. Dr. Nolan’s research interests are in trauma, prehospital care and patient safety.

Dr. Jennifer Beck (PhD, MSc) is an independent researcher at University of Toronto (Dept of Pediatrics) and St. Michael’s Hospital. Dr. Beck developed technology to monitor breathing in ICU patients and to control mechanical ventilation and has published >75 papers. Her current work is focused on ventilation for preterm newborns

Dr. Michael Chaiton (PhD) is a Scientist at the Centre of Addiction and Mental Health, Director of Research at the Ontario Tobacco Research Unit and Associate Professor in Epidemiology at the Dalla Lana School of Public Health University of Toronto. He is co-director of the Collaborative Specialization on Addiction Studies.

Dr. Alexander Bilbily (MD) is a dualtrained radiologist and nuclear medicine physician at Sunnybrook Hospital with a background in machine learning. Dr. Bilbily and his team have won multiple international competitions for medical AI systems. He strongly believes that AI will improve healthcare quality, efficiency, and equity for all patients.

Dr. Raphael Schneider (MD, PhD, FRCPC, CIP) is a Neurologist at the BARLO Multiple Sclerosis Centre in Toronto. He completed a PhD in Neuroscience at the University of Toronto and a Postdoctoral Fellowship in Neuroimmunology at the Université de Montréal. His main research focus is finding new blood biomarkers for people with multiple sclerosis.

Dr. Naveed Siddiqui (MD, MSc). The focus of Dr. Siddiqui’s anesthesia research is “patient safety” and “medical education”. He has successfully supervised many anesthesia trainees to achieve their clinical and professional goals. An important focus of his research is the application of ultrasound in anesthesia practice. Obstetric anesthesia and perioperative pain management, especially in the context of Enhanced Recovery after Surgery, is his passion and current research interest.

Dr. Elizabeth Asztalos (MD, MSc, FRCPC) received her MD from the University of Toronto and an MSc in Health Research Methodology from McMaster University. Her research interests have focused on studying interventions in maternal-fetal medicine and neonatology and their impact on the outcomes of high-risk neonates and, in particular, the very preterm neonate.

Dr. Osami Honjo (MD, PhD) is a staff cardiovascular surgeon in The Hospital for Sick Children and an associate professor in the University of Toronto. Dr. Honjo is the surgical director of heart transplantation and mechanical circulatory support, and a senior associate scientist in Translational Medicine in the Research Institute.

IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH | 23

FACULTY SPOTLIGHT

By Stephanie Tran

rom bedside to bench to bedside again, Dr. Moumita Barua uses nextgeneration sequencing to discover novel genes involved in chronic kidney disease and to develop clinical tools for treatment. Dr. Barua is a Clinician-Scientist and Assistant Professor in the Division of Nephrology at the University Health Network and the Department of Medicine at the University of Toronto. “Chronic kidney disease is an underestimated worldwide health problem,” says Dr. Barua. “If you look at the statistics, 10% of the global community has it.” Current treatment options for kidney failure are limited to dialysis and organ transplantation, both of which are costly and subject to major disparities in access, being more widely available in developed countries. Furthermore, though kidney transplantation is preferred over dialysis in many cases, it is associated with lengthy wait times, perioperative comorbidities, risk of rejection, and long-term complications due to immunosuppression. “There is a lack of awareness about kidney disease and, as a result, there is a lack of funding. Because there is a lack in funding, there is also a paucity of research 24 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

in areas trying to understand mechanisms underlying the disease and its therapeutic development,” Dr. Barua notes. Her research aims to address these gaps in the field by understanding the causes of chronic kidney diseases from a genetic perspective. Using patient DNA samples, her lab identifies genetic variants that increase disease risk and examines them in clinically relevant genetic models to uncover mechanisms. Her lab has received several grants within the past year, including two Canadian Institutes of Health Research (CIHR) project grants. Throughout her life, Dr. Barua has been fortunate to have received tremendous support from dedicated mentors. The first of these mentors were her family members, who supported her passion for science at a young age. Even as a child, she was drawn to the areas of math and science. When it was time to make decisions about what to pursue following high school, she decided to do a Bachelor of Science at the University of New Brunswick in Fredericton, her hometown. A big inspiration for Dr. Barua is her late father, Dr. Subodh Barua, who paved the way for her when he moved to Canada. Her father attended the best engineering school in Bangladesh (BUET), where he

became interested in research. In pursuit of this passion, he went on to complete a Masters degree in the United States and obtained his Ph.D. in Chemical Engineering at the University of Waterloo. His work was highly regarded, winning prestigious national awards. He then took on an industry position and settled in Fredericton, New Brunswick, where Dr. Barua spent her childhood. Growing up, her parents encouraged her to participate in extracurricular activities, so she wrote for the city and school newspapers. Her father supported her by editing all her written work, and, in doing so, taught her a great deal about the art of writing well. To this day, Dr. Barua attributes much of her success to the writing skills her father instilled in her, which she continues to use daily. It was in medical school that Dr. Barua met an individual who would shape the course of her academic career. After her third year of undergrad, Dr. Barua began her medical education at the University of Toronto. This is where she was introduced to the world of academia. “Medical school in Toronto was a very vibrant research environment,” said Dr. Barua. “There is a huge concentration of research activities in the downtown core, and the students in my medical class Graphic design by Michie Wu

FACULTY SPOTLIGHT

Photo credit: Krystal Jacques

had more exposure to research than I had. Through the influence of friends in medical school, I decided to just spend my summers in a research lab. And that led me to meet the person who really influenced my decision to pursue research in my career, even as a medical doctor.” This pivotal person was Dr. Steven Balk, an oncologist and Clinician-Scientist at the Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School. “He was an outstanding mentor. It was important to him to be a mentor to even the summer students.” So, what made him so memorable? Dr. Balk helped her foster a passion for research by giving her a discrete project that she could carry from start to finish. He provided all students, including her, with close supervision, personally training them on how to conduct several of the fundamental lab techniques. More importantly, he met with his students regularly to discuss not only data but career goals. He was very supportive of Dr. Barua’s aspirations and encouraged her to continue in academia. Her experience was so positive that she returned the following summer and published two papers. “It was really at that time where I said, ‘I want to be a clinicianscientist,’” she said. “I had never thought of

DR. MOUMITA BARUA, MD Assistant Professor, Department of Medicine Clinician-Scientist, University Health Network that before and didn’t even know what that was growing up.” With this new goal in sight, Dr. Barua continued to conduct research. Throughout her residency at the University of Toronto and post-doctoral fellowship at the Beth Israel Deaconess Medical Center, her mentors made sure she had defined projects that allowed her to publish more papers. This proved to be vital to her success and, in October 2015, she started her own laboratory within the Toronto General Hospital Research Institute. She attributes her success to her excellent mentors. She pays it forward in her own lab by committing to the career development of her trainees and staff. To end the interview, she shares a piece of advice for research trainees: “ Talk to a lot of people who know

you and people who you can tell your story to and what your goals are. Get their advice. Because everyone who is at my stage of career or later will look back and see that there were people along the way, though they didn’t realize it at the time, that were really defining in their progression.”

Dr. Barua with her parents at her MD graduation

Thank you to Dr. Barua for sharing her research journey! The Barua Lab is currently recruiting postdoctoral fellows and graduate students. For more information, see www.barualab.com or follow Dr. Barua at @MoumitaBaruaTO. IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH | 25

STUDENT SPOTLIGHT

From PhD to MD: The Journey of Dr. Jonathon Chio through IMS By Nayaab Punjani

onathon Chio recently completed his PhD in Dr. Michael Fehlings’ Laboratory for Neural Repair and Regeneration, focusing on immunological therapies for spinal cord injury (SCI). The IMS Magazine had the pleasure of interviewing Jonathon, hereby referred to as Jon, as he culminates his seven-year long journey at the Institute of Medical Science (IMS).

from former lab members, with special shout-outs to Pía María Vidal, Anna Badner, and Antigona Ulndreaj. Jon also spoke about his mentor, Jared Wilcox, who helped “ease the transition”. “He was hard but taught me how to troubleshoot experiments, read papers, how to plan out what to do”. He also advised Jon to transfer to the PhD program prior to pursuing an MD; giving him time to learn more about himself and explore other careers.

Jon obtained a Bachelor in Biochemistry and Neuroscience at the University of Toronto Scarborough. When trying to find his first medical research opportunities, he Googled “U of T Summer Research Program” which led him to the IMS Summer Undergraduate Research Program (SURP), a search result that would guide the next decade of his life. He began in cystic fibrosis research, then his curiosity and interest in the brain encouraged him to shift gears into neuroscience. He eventually found Dr. Michael Fehlings’ research group, a lab led by a clinician scientist with a MD and PhD. This piqued his interest in the PhD route, alongside his goal of becoming a physician.

Jon’s interest in neuroimmunology specifically was fueled by an article in the magazine Scientific American, which stated “neuroscience and the immune system is a booming field” with a lot of potential. Jon’s PhD project examined the use of intravenous human immunoglobulin G (IVIg) to modulate the immune response after SCI. To facilitate clinical translation, a human molecule was used in a rat model, and three questions were answered, “finding the best dose (of IVIg), the length of time IVIg can be administered after SCI and remain effective, and how IVIg works”. He dabbled in other projects too, such as assessing tissue histology following stem cell therapy to treat SCI.

When first beginning at the lab as a Master of Science student, he received support

Jon looks back on some key successes and learning experiences in research,

26 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

such as the late nights conducting flow cytometry that worked “on the tenth time”. He explains, “you go from pure sadness to pure joy, and at like 3:30 in the morning, the elation is magnified”. Another positive experience was Jon’s first poster presentation at an international conference in California, where he felt the impact of his research. Besides research, Jon has been extremely involved in extracurriculars throughout IMS and other graduate departments at the University of Toronto, working with student council and assisting faculty. Through senior roles here at IMS Magazine, he was able to “see the magazine flourish and mature”. Jon also assisted the Collaborative Program in Neuroscience (CPIN) Director, Dr. Zhong-Ping Feng, with various programming such as the Brain Bee, which aims to provide high school students with “increased access to neuroscience, without having them overcome additional financial barriers”. Dr. Feng also comments that Jon played instrumental lead roles in CPIN activities with dedication to fulfilling the responsibilities and commitments that he made. Dr. Feng concluded, “I have always been impressed by Jonathon’s high energy level and outstanding multitasking ability, Graphic design by Mimi Guo

STUDENT SPOTLIGHT

Photo credit: Krystal Jacques

“

It felt nice to see how far that I’ve grown, but at the same time I realized how much further that I can go and who I can become. ” Dr. Jonathon Chio

supporting his successes in his academic/ research programs and leadership activities”. Jon had a chance to contribute to academic mentorship in his lab and as a teaching assistant (TA) in the Human Biology Program. He aims to create an “equal playing field”, ensuring students are comfortable asking questions early on. Jon recalls one student who was struggling in class, and he tried his best to help. Despite initially dropping the course, the student retook it the next year and requested Jon be their TA. “I felt so proud because, I was actually making an impact in their life, not just in science, but their overall development…and at the end they did great,” says Jon. As Jon reflects upon his seven years at IMS, he mentions, “it felt nice to see how far that I’ve grown, but at the same time I realized how much further that I can go and who I can become”. Graduate school helped him develop independence and lifelong skills in “troubleshooting, perseverance, grit, and thinking on his

feet”. Jon leaves three pieces of advice for future IMS students. The first is to “optimize a routine and be able to dedicate the time to optimize it”. For Jon, this involved journaling, exercise, and meditation to balance stress. Secondly, he highlights being nice to others as even little moments of active listening and encouragement can be what people need. In this regard, Jon thanks his parents for their continuous support. Lastly, he indicates the importance of embracing imposter syndrome. Most graduate students feel like they do not belong in their lab or program, but they made it so far already, which means their supervisors saw something in them. Honouring this will allow you to realize your potential to get where you want to be, so try to reframe imposter syndrome as a positive force to improve every day. Dr. Fehlings, who is Jon’s PhD supervisor, summarizes his journey. “It has been such a pleasure supervising Jonathon. I have watched Jon emerge from a junior student fresh in the lab to an accomplished young

scientist. Jon has shown an incredible level of determination in his research, and he has made very important discoveries. In addition, Jon has become a mentor in my lab to young students which is wonderful to watch. Jon is now embarking on a new career direction and is seeking to combine his PhD with a future as a physician.” The MD chapter of Jon’s journey will commence in August 2021 at Tulane University School of Medicine in New Orleans, Louisiana. He would like to be able to merge his medical knowledge with “[his] research training… to help improve patient outcomes”, truly embodying the IMS focus on bench to bedside applications. Jon hopes to gather experience in clinical research to be “able to learn both parts of the research spectrum”, with the goal of eventually becoming a Principal Investigator. We at IMS Magazine wish Jon the very best for his future goals!

IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH | 27

ALUMNI SPOTLIGHT

By Archita Srinath, Shahrzad Firouzian & Natalie Osborne

stablishing your own research lab in academia sometimes feels like a near-impossible feat achieved only by those with a singular focus and the best laid plans. But dedication, curiosity, flexibility, and the courage to do things “differently” can be just as important to success. These are the qualities exemplified by IMS alumni Dr. Amanda Ali, who shared her unique journey from grad student to Assistant Scientist at Henry Ford Health System in Detroit, Michigan. Starting university, Dr. Ali did not know what she wanted as a future career, so she kept her options open. By the time she decided to take on a research project in her 4th year, most lab positions had already been filled up. So, she had a decision to make; either forgo research altogether or take on any placement she could find. She decided to go for a position in a plant biology lab, seizing the opportunity to build her research skills and even publish a paper. Even though she describes her time at this lab as “not the greatest research experience”, she still enjoyed what she learned and decided to continue her research career through graduate studies with the IMS. “When the time came to decide on a supervisor, I had two research areas I was interested in; osteoarthritis (OA) and diabetes, because I had a grandma suffering with each. I thought this would give me personal motivation to spend the next however many years toiling away learning about these conditions,” explains Dr. Ali. She ultimately chose to work with Dr. Benjamin Alman, an orthopeadic surgeon with the Hospital for Sick Children with access to clinical samples. Dr. Alman’s 28 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

lab was large and had a great breadth of knowledge on various musculoskeletal disorders, which Dr. Ali felt would inform her own project. And so began her (now illustrious) research career in OA, a disease that involves the wearing down of the protective cartilage on the ends of bones, and which currently has no cure. Dr. Ali quickly transferred from an MSc to a PhD, with an ambitious project on the hedgehog signalling pathway, which is important for the development of the musculoskeletal system. This pathway, which normally should be inactive in adults, becomes active during OA, and is thought to drive some of the pathologies seen in patients. Dr. Ali’s aim was to determine how this occurred, and she made a critical discovery – the hedgehog signalling was regulating cholesterol stores within individual cells in the cartilage, and exacerbating OA. While cholesterol’s role in OA had previously been explored, Dr. Ali was the first to demonstrate intracellular [disbalances] in cholesterol homeostasis. “I was very fortunate to have built an amazing network of people, but this only started towards the end of my PhD. In the beginning I was sort of a fish out of water – I had very little research experience in molecular biology, so it took me a long time to get my bearings and learn some of the basic techniques that my peers already had mastered,” explains Dr. Ali. “At a critical point I met my (then and now) best friend Natalie Vanier – the founding editor of IMS Magazine. She was one of those really instrumental people in my life who helped me become more involved.” Dr. Ali’s involvement with the magazine allowed her to develop and flex her

“writing muscles” and learn that writing was an outlet for her. She became an exceptionally skilled science communicator whose articles remain some of the most read IMS pieces to this day. Dr. Ali credits her IMS Magazine experience with shaping her career and improving her experience of science; “Not only was I engaged in science, I also saw myself as someone who was commenting on science. I had the opportunity to formulate and express my opinion on relevant hot topics and ongoing issues,” she explains. Dr. Ali still applies these writing skills daily, from popular press articles to scientific manuscripts and grants, and finds writing in a journal to be therapeutic way to express herself. But at the end of her PhD, Dr. Ali came to a crossroads; “I was convinced I would never do a postdoc. I was really burned out, I didn’t want to continue in the lab, I didn’t want to see another mouse, I didn’t want to run another PCR. So I started to explore every possible avenue for what I could use my PhD for and how I could build my career beyond the IMS.” A career in science writing was a reassuring backup plan, but she systematically ruled out the common alternatives, industry, pharma, and government. “I realized that I really did love research, I loved the pursuit of knowledge; I was just tired.” It was then Dr. Ali decided to make a strategic move in her career - instead of pursuing a post-doc in the molecular biology of OA, she would study the same disease but from a vastly different perspective. She won a fellowship for a postdoc position in applied research at Western University that used qualitative methods to study how OA is managed in community settings. While information Graphic design by Ava Schroedl

ALUMNI SPOTLIGHT OA. Her research goals now include a move towards precision medicine in OA: using genetics to individualize patient care. She hopes to dispel common misconceptions about OA; that it is an “inevitable” part of ageing, or that there’s “nothing” you can do about it. She says that although there is no cure, there are clinical guidelines for OA prevention and management. “It’s a bit counter-intuitive, but exercise is the best thing you can do to delay progression of the disease; both targeted exercises to strengthen specific muscles, and general aerobic activity,” explains Dr. Ali. “Tailoring exercise prescriptions to patients is one of the many areas that needs to be developed, so that when my work is applied to diagnose the disease at earlier stages, we know how to make sure they’re taking the best care to delay its progression.”

Dr. S. Amanda Ali- PhD, assistant scientist, Henry Ford Photo credit: Tim Fraser UHN

on helpful OA management strategies is available, patients are not always aware that these resources exist. Under the supervision of Drs. Joy MacDermid and Marita Kloseck, Dr. Ali developed a new peer-mentor-based program to allow seniors in the community to take OA pain management into their own hands. “My basic science colleagues couldn’t understand why I wanted to switch to a “softer” type of science, as they viewed it. Similarly, the applied science researchers viewed me at first a someone with no experience, no appreciation and understanding of their methods. So initially I was criticized on both sides,” explains Dr. Ali. “At the same time, I was motivated to bridge those two silos. I realized that learning both “languages” would help me be a better communicator, do more translational research, and overcome some of the systemic barriers that exist trying to translate basic research findings to clinical practice.” Now equipped with a PhD in basic science and a postdoc in applied research, Dr. Ali felt she was missing the middle piece – an understanding of the clinical research

that bridges the lab and the community. For her second postdoc, she joined the Arthritis Program at the University Health Network (UHN) under the supervisions of Drs. Mohit Kapoor and Rajiv Gandhi. Here, Dr. Ali delved into translation research investigating biomarkers for early OA detection, which would make interventions at the community level more effective. She was able to optimize a technique used for next generation sequencing of patient blood samples from a large biobank. Interestingly, Dr. Ali had first encountered gene sequencing during her PhD and found it puzzling and extremely sophisticated. As a postdoc, she applied a novel sequencing technology to study patients’ unique phenotypes at an individual level, and then explored how these results at a systematic level could be categorized to understand what was occurring at different stages of the disease. In this manner Dr. Ali created a unique niche for herself. She was recruited as an Assistant Scientist to the Bone and Joint Centre at Henry Ford Hospital for her expertise in next generation sequencing technology and genomic technologies as well as her translational background in

The COVID-19 pandemic started three months into running her own lab, and Dr. Ali found it difficult to hire new research staff, begin wet lab work and travel to networking events with her colleagues. However, she is overwhelmed with gratitude for being able to do a job that she loves. When asked what advice she could give to students considering the academic route, Dr. Ali says that flexibility in terms of research program and geography are key to finding better opportunities. “I think the early establishment of a unique set of skills that distinguishes you from your peers, either within or beyond academia (i.e., learning various research methods or science communication) is of vital importance,” Dr. Ali advises “In academia, the best mental health maintenance strategy that I employ is to cultivate strong and lasting relationships with a few key people who understand and bring out the best in you. As my PhD supervisor once told me, ‘you only really need one friend.” So, what can we learn from Dr. Ali’s career path? We can worry a little less about defining and diligently sticking to a plan for our careers knowing that the journey to success may take us to places that we could never have imagined!

IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH | 29

DIVERSITY IN SCIENCE

Addressing Institutional Bias at UofT Discussing Diversity in Science with Dr. Sunit Das & Anita Balakrishna By Sajeevan Sujanthan and Rehnuma Islam

ursuing a career in science and medicine is a dream for many individuals in STEM–whether it be in an operating room as a brain surgeon, or carrying out impactful research to mitigate global crises as a Graduate student. However, the deeply rooted biases and systemic barriers that exist in graduate and professional fields hinder opportunities for many Black, Indigenous and People of Color (BIPOC). Despite recent efforts from different institutions to increase opportunities for BIPOC students, challenges and barriers have been present for far too long, instilling the idea that science and medicine are an unattainable goal for many individuals. Employing the principles of equity, diversity, and inclusion; we can begin to tackle the pressing issues that impact our community while at the same time, critically addressing the system that tends to fail those in need. There are times in history when society enacts a change; a change of morals, a change for justice, and a change in obligation to give equal footing to those that historically were footnotes on pages. But where do we begin to understand the inequities and discrimination that are ingrained in the very institutions we revere? It starts with a conversation and the willingness to undue and rewrite what was wronged. 30 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

An individual that upholds the importance of achieving a more equitable, diverse and inclusive community at the graduate level within the Institute of Medical Science is our very own Dr. Sunit Das. Dr. Das is a neurosurgeon and scientist at St. Michael’s Hospital and the Keenan Research Centre, and an assistant professor in the Department of Surgery at the University of Toronto. Dr. Das is passionate about EDI efforts at IMS because of his personal narrative, and is leading this effort with Ms. Kaki Blackwood (Academic Advisor, Scholarships and Awards) as a co-director for the IMS EDI committee at UofT.

DR. SUNIT DAS Associate Professor, Neurosurgery, Co-Director of the Equity, Diversity & Inclusion at IMS Photo credit: Dr. Sunit Das

Dr. Das grew up in a mixed cultural background, as he is half Indian and Black. He completed the majority of his education and medical training in the United States, however, he was fortunate enough to not have his background be a barrier against pursuing and climbing the rankings. Nonetheless, at times he felt like an outsider in academia and medicine, due to micro and macro aggression towards him. He believes this stems from people’s stereotypes of what a Doctor and a Professor should look like, which isn’t necessarily someone of color. Early on in his career, Dr. Das understood the importance of equity, “the idea that not everyone gets to play on the same playing field with the same tools or starting points”. He also feels that “these are the issues that, if not corrected, lead to a community that doesn’t reflect our true values and beliefs of being equal and fair”. Dr. Das has taken on this role on the EDI committee with desire to change the community and create equal opportunities for future generations. The IMS EDI committee involves both the faculty and students, with opportunities for any student with a passion for EDI to get involved. The committee is organized into various core areas: outreach to high school & universities, incorporation of an EDI lens to already established committees

DIVERSITY IN SCIENCE

and organizations at IMS and at UofT (e.g. The Summer Student Research Program (SURP)), and EDI inclusion in faculty development & growth. The current working group’s approach to tackling EDI efforts at IMS is split into two avenues. The first, immediate plan, is focused on increasing the opportunity for more funded summer student positions. Summer research programs provide high school and university students an opportunity to get exposed to the research done at IMS. Volunteer positions at labs are a valuable experience for individuals to build their network and CV, however, inadvertently, university systems are currently structured so that these opportunities are made less accessible to people who can’t afford to spend a summer in a position that doesn’t provide a stipend. Therefore, without intent we have structured these positions in a way that limits who could partake and benefit from these opportunities. This is a change that both the UofT and IMS have agreed to support Dr. Das and Ms. Blackwood to carry forward–to expand the reach and “level out the playing field” for all students. More broadly, the committee’s second plan is to change the culture and begin to speak on issues such as inherent biases, unintended racism, homophobia, and sexism that is present in our community. Dr. Das states that these things do exist, and at times we may find it difficult to accept that we aren’t perfect. For example, a recent survey conducted by his team showed that about 80% of IMS students have faced Graphic design by Amy Zhang

“A recent survey conducted by his team showed that about 80% of IMS students have faced racism and sexism in the IMS community, from their own mentors and advisors.” racism and sexism in the IMS community, from their own mentors and advisors. This survey revealed that discrimination is quite prevalent in this progressive institution, and that actions are needed. The plan that Dr. Das has in mind would create workshops to teach and properly communicate these issues to increase awareness of inherent biases and find solutions to tackle systemic inequalities within IMS. However, Dr. Das explains, “the efforts to improve the community are not going to be easy, and it’s something we all have to actively take part in changing”. Dr. Das and the EDI committee’s longterm goals include looking critically at the culture and the community as a whole, and recognizing places that we can change in ways that are more welcoming. Certainly, this means looking beyond IMS and viewing UofT as a broader community; comprising all the departments, students, alumni, staff and faculties. Raising awareness of EDI and all forms of oppression, as Ms. Anita Balakrishna eloquently describes, aims “to dismantle and eliminate systems and structures of oppression, whether those structures are educational, - or justice system, or the healthcare system”.

WHAT IS EDI? In accordance with the best practice in Research by the Government of Canada; Equity is defined as “the removal of barriers and biases that hinder individuals from obtaining an equal opportunity for success”. Equity provides every individual equal access and rights, so that every person is able to exist on a leveled playing field, including those that were historically disadvantaged because of systems of oppression. This can include creating opportunities and providing resources and scholarships for marginalized communities. Diversity is defined as the difference in age, sex, race, color, religion, ethnic origin, sexual orientation, gender identity, gender expression and many more. Diversity seeks to include all those represented within our modern-day society. Inclusion is defined as “the practice to ensure that all individuals are supported, valued and respected for their contribution”.1 Giving voices to every member of the community to create a sense of belonging. Together, EDI is an umbrella term for institutional bias, discrimination, antioppression, anti-racism, homophobia, and transphobia. IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH | 31

DIVERSITY IN SCIENCE “The efforts to improve the community are not going to be easy, and it’s something we all have to actively take part in changing”. The Temerty Faculty of Medicine first established the office of inclusion and diversity (OID) as part of an Academic Strategic Plan initiated in 20182, to collaboratively advocate for change and the creation and enhancement of equity, diversity and inclusion initiatives across all the departments within the faculty. Ms. Anita Balakrishna has been working at the OID for the past four and a half years under the leadership of Dr. Lisa Robinson, formerly Associate Dean, Inclusion and Diversity (now Vice-Dean, Strategy and Operations). Ms. Balakriskna began her career as a lawyer advocating and supporting people experiencing discrimination or harassment at work, in housing, or while getting a service. She realized her passion was much bigger and obtained a Master’s degree in Adult Education and Community Development to work towards providing more proactive and strategic education in order to initiate organizational change. During her time at the OID, Ms. Balakrishna and her OID colleagues, Shannon Giannitsopoulou and Christina Stevancec, have helped organize events to raise awareness on many topics, such as addressing Islamophobia and AntiAsian racism, and standing in solidarity with Indigenous land defenders. In addition to many other programs, the OID team has also established an EDI Action Fund to support student led EDI initiates, which helps to coordinate a student-led EDI advisory committee (LEAD), and has helped bring graduate student inequities to the forefront through educational workshops and presentations. Graduate students are at the heart of future mandates to gear community support and resources towards their needs, as graduate students have been largely neglected within the Temerty Faculty of Medicine. Ms. Balakrishna and Dr. Lisa Robinson have helped establish a Diversity Advisory Council, which provides recommendations and shares promising practices on EDI throughout the Faculty. The OID also seeks input regularly from the LEAD committee, whereby graduate 32 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

students and medical trainees inform the OID on areas of neglect or improvement. Some of the concerns that have been raised by graduate students most recently have included 1) an overwhelming lack of a sense of community in such a large faculty, 2) some members felt subject to discrimination and harassment and 3) the graduate programs disproportionately under-represents certain ethnic groups such as Black, Indigenous or individuals from lower socioeconomic backgrounds. To begin combating these issues, the OID has provided guidance and support to various Faculty departments to encourage the sharing of promising practices in admissions and recruitment as well as the creation of more equity-based scholarships to enhance enrollment to a greater diverse pool of candidates, particularly those most underrepresented. The OID is attempting to create safer spaces for graduate students to obtain help and support and aims to hold people accountable for misconduct.

ANITA BALAKRISHNA Director, Equity, Diversity & Inclusion Photo provided by Anita Balakrishna

Science is an unbiased method of observation, but the structures around it are anything but unbiased. In broaching the topic of “Women in STEM”, Ms. Balakrishna highlighted barriers that currently plague the system, such as stereotypes of women in science involving how they should look or behave, not being treated equally to male peers, and questioning of their background and credentials. All of which creates the sense of being an imposter within science. And those that speak out against these hurdles are sometimes made to hang their careers

in the balance. Nevertheless, women are speaking out! These inequities are magnified for those women who also identify as racialized, particularly Black and/or Indigenous, and/or whose identities intersect with other axes of oppression (including but not limited to disability, sexuality, gender expression, and minoritized faith group). Therefore, the work is just beginning, and much work is left to be done.

“To think differently about groups of people - that will take exposure and constantly challenging yourself to better understand your own areas of bias and privilege”. The first step in resolving EDI related inequalities requires acknowledgement. As an individual it is up to us to bring about self-awareness and recognize that we all struggle with our own biases. As Ms. Balakrishna notes, “To think differently about groups of people -that will take exposure and constantly challenging yourself to better understand your own areas of bias and privilege”. For people that consider themselves an ally, in Ms. Balakrishna’s words, being an ally means to “take a stand, to intervene, show support, to empathize”. She also recognizes that power dynamics may limit an individual from taking direct action against injustice; however, an ally can still recognize and do what they can to work in solidarity with those minority communities. Allyship is a practice, not an identity, and it is up to each of us as individuals to ensure that we are doing what we can to break down barriers and address oppression at the systemic level, not just at the individual level. We highlighted the work of two incredible individuals working to break down barriers preventing equal opportunity for all. We look forward to seeing their work bear fruition, not only for us, but for generations to come. References 1. Social Sciences and Humanities Research Council. 2021. 2021 Innovative Approaches to Research in the Pandemic Context: Competition Overview. [online] Available at: <https://www.sshrccrsh.gc.ca/funding-financement/nfrf-fnfr/special/2021/call-appel-1/ competition-concours-eng.aspx> [Accessed 31 July 2021]. 2. Temerty Faculty of Medicine University of Toronto. About the Office of Equity, Diversity & Inclusion. [online] Available at: <https:// medicine.utoronto.ca/about-office-equity-diversity-inclusion> [Accessed 31 July 2021].

SURP

STUDENT SPOTLIGHT

Bioprinting the Future of Burn Care

SURP Writing Contest Winner

About SURP: The Summer Undergraduate Research Program provides an opportunity for undergraduate B.Sc. and medical students to become involved in biomedical research. Participants selected for the program spend 3 months in the summer in a laboratory or clinical setting, working on a research project. Projects range across a broad spectrum of disciplines, from molecular biology and cognitive science to clinical investigation and bioethics. The IMS Magazine holds a yearly writing competition where SURP participants write an article about their project. The winning article is published in the magazine, you can read it below!

By Shanti E. Mehta

ccording to the World Health Organization, over 180,000 people die from burns each year1. Advancements in medicine have led to a greater standard of care for burn patients, however, wound healing and burn coverage is an essential factor in determining survival2. This summer I have had the privilege to work under Dr. Marc G. Jeschke in his lab, at Sunnybrook Research Institute. Autologous skin grafts (i.e. the individual’s own tissue) are the current standard of care for severe burn injuries, however, there is often an insufficient amount of viable donor skin3 to cover the wound. Allographs are also used but pose the risk of graft rejection and infection4. The limitations posed by autografts and allografts have led to the development of dermal substitutes through bioprinting. My project focused on bioprinting human stem-cell laden extracellular matrix hydrogel for skin bioengineering. Throughout the summer I have worked on developing bio-ink and performing in vitro characterization as well as developing a bioprinting platform. The end goal of this research is to be able to obtain mesenchymal stem cells from burn patients, and bio-print personalized skin to be used in grafts, thus eliminating the drawbacks associated with both autographs and allographs.

The results I have obtained thus far focus primarily on characterization studies, specifically the morphological, histological, and biological characteristics of the bioink. It has been demonstrated that porcine tissue can successfully be decellularized while reserving a minimum of 40% of collagen content when compared to native tissue, which is essential in the development of bio-ink. We were able to show that fibroblasts can proliferate over time using the decellularized extracellular matrix as a scaffold, while also maintaining cell viability. This is important because fibroblasts produce collagen and extracellular matrix components, and are important for building and repairing skin’s structural framework. In the bioprinting platform development, we proved that pH-adjusted hydrogel can be extruded from a bioprinter. Working on this project provided me with numerous learning opportunities, from zoom lab meeting presentations to hands-on work and learning lab techniques. I have learned that failure is part of success – not every experiment will go as planned, but these challenges only further developed my skills by providing an opportunity to understand, question, and learn from what went wrong the first time, so I can determine areas to be improved upon. I have learned so much about burn care and treatment, including

future directions in research, such as using computational fluid dynamics to determine important rheological properties before the bioprinting process to maintain optimal cell viability and quality of the printed construct5. I am thankful for the guidance and support I have received this summer at the lab, specifically from Yufei Chen, and I am confident the skills I have acquired and lessons I have learned will serve me in the years to come. My project is far from over, and next steps include continuing rheological characterization studies and performing simulation studies to examine the stressors experienced by the bio-ink during the printing process. With my findings thus far, in the future, I hope that burn-derived mesenchymal stem cells and keratinocytes can be incorporated to form biolayer skin substitutes for burn patients. References 1. World Health Organization, Burns. 2018 Mar 6; Available from: https://www.who.int/news-room/fact-sheets/detail/burns 2. Jeschke, M.G., van Baar, M.E., Choudhry, M.A. et al. Burn injury. Nat Rev Dis Primers, 2020 Feb; available from: https://doi. org/10.1038/s41572-020-0145-5 3. Sheikholeslam M, Wright MEE, Jeschke MG, Amini-Nik S. Biomaterials for Skin Substitutes. Advanced Healthcare Materials, available from 2018 Mar; Available from: 10.1002/adhm.201700897 4. Amini-Nik S, Dolp R, Eylert G, Datu AK, Parousis A, Blakeley C, Jeschke MG. Stem cells derived from burned skin - The future of burn care. The Lancet, 2018 Nov; Available from: 10.1016/j. ebiom.2018.10.014 5. Magalhães, Isabela & Oliveira, Patrícia & Dernowsek, Janaína & Las Casas, Estevam & las Casas, Marina. (2019). Investigation of the effect of nozzle design on rheological bioprinting properties using computational fluid dynamics. Matéria (Rio de Janeiro). 2019 Jan; Available from 10.1590/s1517-707620190003.0714.

IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH | 33

BOOK REVIEW

Serena’s Pick

“The reason is that we are far too comfortable being lazy and sticking to our current habits.” By Serena Peck

picked up this book in January 2021 when setting new goals for myself. I was reflecting on how different life has been a year into the COVID-19 pandemic and needed some inspiration. That’s when I discovered “Don’t Stop Won’t Stop” by Alec Moonee. Reading the reviews, it was described as a short read to open your mind, written with enthusiasm and insight. So, I decided to give it a try and am so grateful for my decision. Moonee begins with the idea that many of us are merely existing, not living. You may have heard a statement like this before, but have you unpacked it? He proceeds to describe very common examples of this. Moonee says, “Every day, you spend hours and hours going through YouTube or Netflix browsing through endless lists of content and shows…you can comfort yourself by rationalizing just how you had nothing more to do”. Yikes. I know I can’t be the only 34 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH

student guilty of this, especially during a time of online school and endless lockdowns. Moonee continues with this idea by asking the reader questions and introducing moments in the book to pause and reflect. He encourages us to think about what we are doing when we are the happiest and to identify things we want to do, but are too afraid to start. Questions began to flood my mind. What am I doing when I spend time on YouTube or Netflix? I am watching other people do the things that I want to do! Next, he proposes his five—step system to find what we all may be missing: passion, personality, or purpose. In chapter one (step one), Moonee describes some of the invisible barriers we face that can stop us from finding our passion. “The reason is that we are far too comfortable being lazy and sticking to our current habits”, he says. Okay. It is starting to come together. How often have I made excuses for not doing things that make me happy?

Moonee proceeds to take you through the steps of recognizing poor habits, reflecting on why they occur, and describes solutions for it. As the chapters and steps progress, they become more specific and task—oriented. For example, chapter four is about making small daily changes and setting achievable goals for yourself. It can be as small as learning a new task or hobby for ten minutes a day. These small actions can help us find our passion and put us back on track for a happy and purposeful life. For me, I started doing yoga every day for at least ten minutes and it has been amazing. Did I use the five—step system? Not in its entirety. However, reading this book gave me the push I needed to make real changes within myself. So, if there are passions or hobbies you want to work on, this book may bring you one step closer to finally getting them started. It is important to take time, reflect, and find that passion, so we can stop existing and start living.

IMSSA POSTER Incoming co-presidents, Kayvan Aflaki and Serena Peck, would like to thank the outgoing executive team for their excellent leadership and support with transitioning roles to the new executive team

Meet the Incoming Executives Kayvan Aflaki Co-President, MSc. Student Kayvan studies maternal mortality with the Ontario Coroner. His favourite snack is bananas with peanut butter and if he could have any superpower, it would be the ability to steal other people's superpowers.

Serena Peck Co-President, MSc. Student Serena studies the cardiovascular health of women with breast cancer during and after treatment. Her favourite snack is chocolate covered pretzels and if she could have any superpower it would be to read minds.

Alex Boshart VP External Affairs, MSc. Student Alex studies kidney transplant rejection, focusing on antibody-mediated rejection. His favourite snack is flat pretzels from Costco with hummus. If he could have any superpower, it would be telekinesis so he could get food from the fridge while sitting on the couch.

Upcoming Events

September September 10th IMS Mandatory Virtual Orientation September 23rd IMSSA Election Night September 30th IMSSA First General Meeting

October October 7th Friendsgiving Celebration

Isis So VP Internal Affairs, MSc. Student Isis studies brain recovery after traumatic brain injury. Her favourite snack is sour cream and onion chips. If she could have any superpower, it would be flying so she could beat traffic while commuting and because it would be so cool.