IMS Magazine Fall/Winter 2020/21

THINK. LEARN. DISCOVER.

FALL/WINTER 2020/21

Pandemic Tales From a respirologist at the forefront of COVID-19 research

A Cure for Covid?

Soluble form of ACE2 may be the key

The 4th Wave Preparing for the pandemic’s effects on mental health

ANSWERING THE CALL FOR

COVID-19

RESEARCH Student-led initiative

RAW TALK PODCAST

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

Follow us for updates, photos, and videos @rawtalkpodcast

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

Live or Be Alive: Medical Assistance in Dying

Ep. 89

Vaccines: Making History

2 | IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL

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 IMSSA Poster Part 1................................ 21 BMC Showcase........................................ 22 Viewpoints............................................... 24 Faculty Highlights.................................... 30 Faculty Spotlight...................................... 32 Alumni Spotlight...................................... 34 Diversity in Science................................. 36 IMSSA Poster Part 2................................ 39

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MAGAZINE STAFF EDITOR-IN-CHIEF:

Natalie Osborne EXECUTIVE EDITORS:

Jonathon Chio Krystal Jacques Mikaeel Valli PHOTOGRAPHERS:

Krystal Jacques (Director) Mikaeel Valli Dorsa Derakshon SOCIAL MEDIA:

Sandy Lee (Director) Cindy Ha

JOURNALISTS & EDITORS:

Stacey Butler Dorsa Derakhshan Nadia Boachie Laura Best Natalie Simonian Stephanie Tran Jason Lo Hog Tian Sally Wu Elizabeth Karvasarski Sajeevan Sujanthan Shenhab Zaig Nayaab Punjani Zahra Khan Valera Castanov Mashal Ahmed Sonja Elsaid

DESIGN EDITORS:

Jennifer Barolet (Director) Ingrid Barany Katrina Hass Colleen Paris Ava Schroedl

FEATURE INFOGRAPHIC

By Katrina Hass, MScBMC Candidate

Copyright © 2020 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 Ava Schroedl, MScBMC Candidate

FOLLOW US ON SOCIAL MEDIA! www.imsmagazine.com @IMSMagazine @IMSMagazine IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL |

3

LETTER FROM THE EDITORS

L

ately I have been revisiting old childhood stories to avoid languishing like Artex in the Swamps of Sadness. After three devastating waves of covid-19, there is a lot to despair about. But, as I hope this special pandemic issue of the IMS Magazine will illustrate, there is also reason to be proud and thankful.

This issue features some brilliant and hard-working IMS members who pivoted their research to address covid-19. From blocking the virus’ entry into our cells to tackling inequities in healthcare infrastructure, IMS researchers are finding solutions for this and future pandemics. On page 8, you’ll find an infographic on covid-19 in Ontario, including how racialized minorities and individuals with lower incomes were disproportionately affected in Toronto.

Read how Dr. Andrea Gershon and her team adapted their smartphone app to help monitor the health of covid patients isolating at home using blood oxygen levels, temperature, and symptom reporting (page 10). Their ultimate goal is for the COVIDFree@Home app to determine when patients should seek emergency medical care. Dr. Sanjeev Sockalingam realized that the pandemic would exacerbate and add to existing mental health challenges for many Canadians, and the resulting lockdowns would increase barriers to accessing treatment. Learn how his group are analyzing and optimizing digital mental health programs to address this issue on page 12. Dr. Haibo Zhang and colleagues, building on lessons learned from SARS, have created a soluble form of ACE2 that can competitively bond with the virus and prevent it entering cells. They are currently running preclinical and clinical trials to investigate this potential new treatment for covid-19 (page 16). Dr. Sharmistha Mishra and her interdisciplinary team are applying some of the modelling techniques they use to study HIV transmission to investigate how covid-19 outbreaks occur differently province to province and within vulnerable populations (such as long-term care residents). They are also tracking the effectiveness of various interventions, to one day guide more tailored public health responses (page 18).

The pandemic has been at the forefront of students’ minds – as you can read in our viewpoints (pg 24), which include a discussion of the ethical and logistical challenges of vaccine rollout to the anticipated “4th wave” of mental health issues and its implications for grad students. Ever the optimists, IMS students also describe the “pandemic pause-itives” they have enjoyed in the past year. And see pages 32 and 34 for the inspiring journeys and encouraging advice of Faculty Spotlight Dr. Michael Fehlings and Alumni Spotlight Dr. Stephen Wright.

Photo Credit: Alaina Osborne

It has been difficult to face the terrible inequalities in our society and healthcare system laid bare by covid-19. Our Diversity in Science section (pg 36) features an interview with Dr. Chase McMurren, who explains why listening to Indigenous voices, perspectives and experiences is vital if we want to build a truly equal healthcare system.

Finally, I would like to thank all the students who volunteered their time to write, edit, photograph and design for this issue. IMS Magazine is a labour of love, and a reflection of IMS students’ earnest passion and dedication to health and science. I would also like to thank former Co-EIC Beatrice Ballarin for her many years with the magazine and wish her best of luck with her career.

We hope you enjoy this issue as a testament to the innovative and resilient spirit of the IMS community, and we’d love to hear from you: you can email us at theimsmagazine@gmail.com and visit our website at imsmagazine.com.

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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.

Twitter: @NatalieRaeOz Website: www.natalieraeosborne.com

DIRECTOR’S MESSAGE

DIRECTOR’S

MESSAGE I

t is over a year into the pandemic and we have arrived at yet another IMS Scientific Day where we cannot meet in person! However, I am extremely grateful for the ingenuity of the IMS team members who have worked diligently behind the scenes to create an engaging and fun virtual experience for us all this year. I hope you enjoy the opportunity to celebrate the work of our IMS members online and congratulate yourselves for your efforts in this difficult time.

I am immensely proud of the way the IMS community adapted to the pandemic and continued to produce excellent research despite the challenges covid-19 posed. So many IMS members have also worked as clinicians on the frontline or pivoted their research to help better understand this disease and find ways to combat it.

This issue features researchers from a variety of disciplines who have applied their expertise to covid-19. Sunnybrook respirologist Dr. Andrea Gershon and her team have modified a smartphone app to help track covid-19 patients’ symptoms as they isolate at home.

Psychiatry professor Dr. Sanjeev Sockalingam’s group quickly realized that virtual mental health services would be vital for patients in lockdown; they’re evaluating which programs are most accessible and effective. Dr. Haibo Zhang is a professor in the departments of Anesthesia, Medicine and Physiology and is part of a team conducting preclinical and clinical trials investigating the use of his soluble form of ACE2 as a novel treatment for covid-19. Dr. Sharmistha Mishra is leveraging her expertise as a scientist at the MAP Centre for Urban Health Solutions (Li Ka Shing Knowledge Institute) to model how the virus is transmitted and treated in different communities across Canada, and how public health policies can be tailored for greater efficacy.

This issue also includes interviews with outstanding IMS faculty members and alumni. You can read about the world-class research on spinal cord injury and regenerative medicine conducted by neurosurgeon Dr. Michael Fehlings and his team on page 32. Then follow the journey of IMS Alumnus Dr. Stephen Wright as he builds his research program on heart function (page 34). Finally, you can find a thoughtful and thought-provoking interview with Dr. Chase McMurren (Department of Family and Community Medicine) on the importance of compassion and accountability in efforts to improve Indigenous representation in science and medicine (page 36).

I also want to congratulate the faculty who have been promoted to associate and full members as well as the new faculty of the IMS. In-person meetings are still some months away, but you can “meet” them on pages 30-31. Learn more about them and their inspiring research! I am proud to welcome you to the IMS and I am looking forward to your continued excellence as graduate faculty members!

As usual, I would like to thank IMS Magazine’s Editor-in-Chief, Natalie, and all the editors, journalists, photographers, social media team, and design team for their excellent production of this issue. I greatly appreciate the time they dedicated to the magazine during the pandemic. I am continually inspired by the work of my fellow IMS members detailed in these pages, and I hope you are too!

Sincerely, Dr. Mingyao Liu

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL |

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CONTRIBUTOR PAGE

FA L L

2 0 2 0

CONTRIBUTORS Laura Best is currently a PhD student with Dr. Isabelle Boileau at CAMH. Her work uses neuroimaging to investigate the involvement of the endogenous cannabinoid system in alcohol use disorder.

Laura loves to spend time outside in the park, trailrunning with her rescue dog or teaching yoga.

Nadia Boachie is an MSc IMS student studying the effects of cannabis on the brain under the supervision of Dr. Isabelle Boileau. Her research uses neuroimaging techniques to assess changes in the brain of chronic cannabis users after approximately 1-week cessation.

In her free time Nadia is passionate about cooking, baking, and painting.

Stacey Butler is a 2nd year PhD student at IMS, working in the respiratory medicine field. In this issue, Stacey writes about how her supervisor, Dr. Andrea Gershon, applied her Respirology background to study COVID-19. In her spare time, Stacey enjoys reading books, creating art, and playing music.

Dorsa Derakhshan is a MSc candidate at IMS investigating cognitive effects of repetitive transcranial magnetic stimulation in treatment resistant depression under the supervision of Dr. Peter Giacobbe. She enjoys photography, painting and working on creative projects in her leisure time.

Shahrzad Firouzian is a recent MSc graduate from Dr. Karen Davis’s lab. Her research focused on psychophysical measures of pain inhibition.

Specifically, she looked at the complex interplay of personal and stimulus attributes with pain inhibition. She also witnessed an armed bank robbery!

Elizabeth Karvasarski is a 1st year MSc IMS student studying pulmonary hypertension at Mount Sinai Catheterization Laboratory under the supervision of Dr. Susanna Mak. Her research involves exploring whether the temporality of pulmonary vascular loading differ with exercise in precapillary vs. post-capillary pulmonary hypertension.

Outside of research, Elizabeth practices martial arts and is a 4th degree black belt.

@shahrzad.firo

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Graphic design by Ingrid Barany

CONTRIBUTOR PAGE Jason Lo Hog Tian is a PhD student at IMS investigating how stigma impacts the health and wellbeing of people living with HIV under the supervision of Dr. Sean Rourke. He is committed to developing his scientific communication skills and increasing science knowledge through writing for the magazine.

Natalie Simonian is a 2nd year masters student at IMS working in the lab of Dr. Harry Janssen exploring the risk and predictors of liver transplant readmissions. In her free time she likes to spend time with family and friends, write poetry, and travel (when it’s not a global pandemic that is). @_nataliesim.

@JasonLoTweets

Stephanie Tran is a 3rd year PhD student with Dr. Robert Chen at Krembil. Her research involves non-invasive brain stimulation in people with Parkinson’s disease. She enjoys hiking, trying new recipes and catching flights. To get through this pandemic, Stephanie regularly connects with her family and friends.

TH E

2020

Stacy Wu is a 2nd year MSc student at IMS investigating antipsychotic-induced cerebral insulin resistance utilizing 2DG autoradiography in a preclinical model under the supervision of Drs. Mahavir Agarwal and Margaret Hahn. Outside the lab, she enjoys weightlifting, running, and trying new restaurants in the city.

IMS

Design Team

2T1 Jennifer Barolet (Director) @bioscivisuals www.bioscivisuals.com

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

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

Katrina Hass

Colleen Paris

@khassvisuals

@cparisvisuals

www.khassvisuals.com

www.colleenparis.com

Ava Schroedl @schroedle_sci_vis www.avaschroedl.com

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL |

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INFOGRAPHIC CORRELATION BETWEEN MATERIAL DEPRIVATION AND CASES IN ONTARIO Material deprivation is connected to poverty and socioeconomic status in neighbourhoods within Ontario. This measure indexes the inability of individuals and communities to access and attain basic material needs (e.g., educational attainment and quality of housing).

Least

17.0% of cases in Quintile 1

16.4% of cases in Quintile 2

Level of material deprivation

19.4% of cases in Quintile 3

Answering the call for COVID-19 research:

PUBLIC HEALTH & EPIDEMIOLOGY

Quintile: level of material deprivation

69%

HIGHER HOSPITALIZATION RATES

2x HIGHER RATES

of cases in Quintile 4

Most

26.8%

5.3x

more likely to catch COVID-19 than those making $150,000 or more.

Black, Latin American, Arab, Middle Eastern or West Asian residents are

7x

more likely to have COVID-19 infection in comparison to white Torontonians.

ICU

ADMISSION

20.5%

Within Toronto, people earning less than $30,000 per year are

52%

HIGHER DEATH RATES

of cases in Quintile 5

8 | IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL

In Toronto, minorities make up 52% of the of the population, but account for

79%

of COVID-19 infections.

The highest infection rates in the city are concentrated in neighbourhoods with the most racialized minorities.

INFOGRAPHIC COVID-19 CASES BY EPISODE DATE IN ONTARIO Number of cases

1500 1200 900 600 300

First wave

0

Jan

Feb

Mar

Second wave

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dates Rate per 100,000 population

COVID-19 CASE RATES IN ONTARIO 3000 2500

Male rate

2000

Female rate

1500 1000 500 0

0 - 09

10 - 19

20 - 29

30 - 39

40 - 49

50 - 59

60 - 69

70 - 79

80 - 89

90 +

All ages

Ages

CHANCES OF COVID-19 TRANSMISSION

Without intervention With intervention

12.8% Physical Distancing

17.4%

16.0%

3.1%

5.5%

Face Masks

Eye Protection

<1m

2.6% REFERENCES

Graphic design by Katrina Hass

1. COVID-19 Surveillance Highlights for Ontario. Ontario Agency for Health Protection and Promotion (Public Health Ontario). 2020 [cited 9 November 2020]. Available from: https://www.publichealthontario.ca/en/data-andanalysis/infectious-disease/covid-19-data-surveillance/covid-19-data-tool 2. COVID-19 in Ontario – a focus on material deprivation: January 15, 2020 to June 3, 2020. Ontario Agency for Health Protection and Promotion (Public Health Ontario). 2020 [cited 9 November 2020]. Available from https://www.publichealthontario.ca/-/media/ documents/ncov/epi/2020/06/covid-19-epi-material-deprivation. pdf?la=en 3. ‘A fight for the soul of the city’: Report shows how COVID-19 has deepened Toronto’s racial and economic divide. The Star. 2020 [cited 9 November 2020]. Available from: https://www.thestar.com/ news/gta/2020/11/12/a-fight-for-the-soulof-the-city-report-showshow-covid-19-has-deepened-torontos-racial-and-economic-divide. html 4. Preventing person-to-person transmission. The Lancet. 2020 [cited 9 November 2020]. Available from: https://www.thelancet.com/ infographics/coronavirus/COVID-prevention

5. Canadians report worse mental health than before pandemic: Nanos survey. CTV News. 2020 [cited 9 November 2020]. Available from: https://www.ctvnews.ca/health/coronavirus/canadians-report-worse-mental-health-than-before-pandemicnanos-survey-1.5141592 6. Angus Reid Institute. (2020). Worry, gratitude & boredom: As COVID-19 affects mental, financial health, who fares better; who is worse? Retrieved from: http://angusreid.org/covid19-mentalhealth/ 7. Pfefferbaum, B. and North, C.S. (2020). Mental health and the COVID-19 pandemic. New England Journal of Medicine. DOI: 10.1056/NEJMp2008017 8. Wu, P., Fang, Y., Guan, Z., Fin, B., Kong, J., Yao, Z.,…Hoven, C.W. (2009). The psychological impact of the SARS epidemic on hospital employees in China: Exposure, risk perception, and altruistic acceptance of risk. The Canadian Journal of Psychiatry. doi. org/10.1177/070674370905400504 9. Wu, P.E., Styra, R. and Gold. W.L. (2020). Mitigating the psychological effects of COVID-19 on health care workers. Canadian Medical Association Journal, 192(17). doi.org/10.1503/cmaj.200519

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL |

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FEATURE

Pandemic tales from a Respirologist at the forefront of COVID-19 research By: Stacey J Butler

L

ike many of Toronto’s renowned respiratory disease researchers, Dr. Andrea Gershon feels it is her duty to study the emerging coronavirus. As lead of the CanBREATHE–Lung Health research group, her knowledge in the field of Respirology is highly relevant to COVID-19. An active member of both the Canadian Thoracic Society and the Canadian Respiratory Research Network, Dr. Gershon has years of experience conducting clinical and population health research with the common goal of improving health outcomes for people living with chronic respiratory disease. She is also a staff Respirologist at Sunnybrook Health Sciences Centre and has been working on the front-lines during the COVID-19 pandemic. Dr. Gershon has seen first-hand how healthcare workers have stepped up and supported each other despite the fear and anxiety that comes with their heightened risk of exposure to the novel coronavirus.

Throughout the pandemic, we have often heard the expression “these are unprecedented times”, but the early days of the COVID-19 pandemic felt like déjà vu for Dr. Gershon. In 2003, she was a young mother and a medical resident, ‘moonlighting’ at Scarborough Grace Hospital. She was asked to assess a patient in the emergency room who presented with an abnormal chest x-ray. No masks, no gowns–they were completely unaware that they were treating the first patient with severe-acute respiratory syndrome (SARS) in Canada. All they knew was that the patient’s relatives had also fallen ill, and one was in the intensive care unit (ICU) where Dr. Gershon later attended to a code blue–a medical emergency. As the investigation continued, they recognized the severity of the illness, and quickly became aware of the possibility that they were facing a new infectious disease.

Dr. Gershon’s story highlights how the early days of the COVID-19 pandemic resembled the SARS era. The initial response was similar – quarantine anyone

who may have been exposed. Dr. Gershon recalls being put in quarantine nearly a week after she treated the first SARS patient. To simply label this experience as frightening would be an understatement, yet it is one that many Canadians are all too familiar with today.

Dr. Gershon felt helpless in the early days of the COVID-19 pandemic. She wanted to find a way to apply her relevant experience in respiratory disease and

Dr. Andrea Gershon, MD, MSc Associate Professor, Department of Medicine, University of Toronto Research Director & Staff Respirologist, Division of Respirology, Sunnybrook Health Sciences Centre Scientist, Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program, Sunnybrook Research Institute Senior Core Scientist & Lung Health Lead, ICES Photo Credit: Dorsa Derakhshan

accelerate COVID-19 research. While looking for ways to pivot their research to study the new coronavirus, Dr. Gershon and her team realized they had already developed the perfect tool to monitor COVID-19 patients. Ironically, they had been testing this tool in patients with chronic respiratory disease at the beginning of the pandemic, but their study was put on hold when all clinical research came to a grinding halt. Along

10 | IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL

with an interdisciplinary team of clinicians and computer scientists, namely Dr. Robert Wu, Dr. Eyal de Lara, and Dr. Daniyal Liaqat, they had already created a smartphone application that allows health care providers to remotely monitor a patient’s health. With the support of the Canadian Institute of Health Research (CIHR), and the Physicians’ Services Incorporated (PSI) Foundation, they are now using this technology to quickly gather data that can improve our understanding of COVID-19 symptoms and disease progression.

One of the current issues with COVID-19 is not knowing when patients, who are isolating at home, need to be transitioned to hospital-based care. When someone tests positive with COVID-19 they are simply instructed to self-isolate and seek medical attention when needed. Not only can this leave patients in a state of panic, worrying about when their health will deteriorate, it also has the potential to overwhelm the healthcare system with unnecessary emergency department visits and hospitalizations. Dr. Gershon and her team’s COVIDFree@Home project uses cutting-edge technology to monitor the health of COVID-19 patients who are isolating at home. The team hopes to employ artificial intelligence and machine learning models to predict when patients need to be hospitalized. This technology allows them to do all of this without going within six feet of a patient.

The COVIDfree@Home study is enrolling patients who test positive for COVID-19 and are self-isolating in the community.

Study participants are recruited from emergency departments and clinics which receive referrals from COVID-19 screening centres at the University Health Network and Sunnybrook Health Sciences Centre. The team hopes to extend the research study to enroll patients from centres in other COVID-19 hot-spots, such as the Humber area and Peel region.

The study participants are mailed an Graphic design by Ingrid Barany

FEATURE

Photo Credit: Dorsa Derakhshan

oximeter and thermometer to measure their blood oxygen levels and temperature at home. They are asked to use an app on their smartphone to record their symptom severity, oxygen saturation, and temperature twice daily. The app can even measure respiratory rate and detect coughs, using advanced algorithms developed by the research team. Patients are monitored during the peak of their infection for two weeks.

Screenshots of the COVIDFree@Home App Photo Credit: Dr. Andrea Gershon

The research team will use this data to predict the point at which patients need to be hospitalized. The benefit is obvious–it allows a large group of patients to be monitored remotely, in real-time, by only a small number of healthcare professionals.

Widespread use of this tool will ultimately put less strain on the healthcare system, which has been the goal since the start of the pandemic. At this point, the only tools we have to mitigate the spread of COVID19 and prevent our healthcare systems from being overwhelmed are abiding

by social distancing protocols and other public health guidelines.

Currently, our brave healthcare workers have limited tools to treat patients with COVID-19. Preliminary research worldwide has assisted in identifying vulnerable groups with worse outcomes and improving hospital-based care, but little is being done for patients in the community. Research projects like Dr. Gershon’s COVIDFree@Home are vital to improve our understanding of COVID19, ensure patients are safe when isolating at home, and help the healthcare system adapt and move forward.

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL | 11

FEATURE

By Dorsa Derakhshan

N

ot all patients happen to take convenient residence in the heart of a metropolitan area. Some are living in remote areas of provinces. With a considerable distance to the closest urban centre, these patients have unique concerns regarding the lack of access to healthcare services. Even with the utilization of televideo conferencing, Dr. Sanjeev Sockalingam has realized that there are insufficient resources and services available.

“I remember several patients not having access to therapists or psychiatrists in their local settings, and they often suffered as a result since they couldn’t access proper care,” he explains. “These events inspired me to think: how can we remotely provide care, and more specifically, how can we continue to expand mental health services for those individuals so that it could help with their recovery and overall care? How can we do better for our patients and their family members?”

Dr. Sanjeev Sockalingam is Vice Chair and Professor of Psychiatry at the University of Toronto and Vice President of Education and Clinician Scientist at the Centre for Addiction and Mental Health. He is passionate about integrated care in Consultation-Liaison Psychiatry, a collaborative clinical approach that emphasizes the optimization of biopsychosocial care, as well as conducting

research on the integration of physical and mental health.

Dr. Sockalingam’s research has been primarily inspired by his personal experiences treating patients in his clinical practice, many of whom have medical comorbidities, such as metabolic syndrome and mental illness. Quality improvement has been a major driving force in his career. Dr. Sockalingam has explored its possibilities in two avenues: 1) Development of accessible programs and interventions for patients living with mental illness and physical health comorbidities who are struggling with difficulties navigating access to treatments for both conditions; and 2) Promotion of education and knowledge translation to help prepare current and future healthcare providers for managing disparities in mental healthcare using integrated care models.

Dr. Sockalingam explains that the COVID19 pandemic has deepened the current gaps and disparities in care. He proposes a solution: technology. Using technology to deliver psychotherapy and train healthcare providers may help enhance healthcare education and make care more accessible to patients. The inspiration for this project originated from the current experiences of patients and frontline healthcare workers during the COVID-19 pandemic.

“We had to rapidly scale up our ability to provide virtual care,” says Dr. Sockalingam.

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Some patients in his clinical practice have been fortunate to receive virtual care through televideo conferencing since the

Dr. Sanjeev Sockalingam B.Sc., B.A., M.D., MHPE Vice Chair, Education and Professor at Department of Psychiatry, University of Toronto VP, Education and Clinician Scientist at Centre for Addiction and Mental Health Photo credit: Mikaeel Valli Graphic design by Colleen Paris

“

FEATURE

Our team strived to curate, assess and synthesize all the available resources that are genuinely valid and appropriate for practical use.

onset of the pandemic. However, many patients were continually struggling with accessing resources and coping with the COVID-19 virus itself. These patients were presenting with a new onset of mental health distress or the exacerbation of their previous mental health conditions.

In addition to virtual visits, patients were receiving limited guidance on how to self-manage their emerging mental health issues, such as anxiety, depression, and loneliness.

Likewise, frontline care providers have been striving to cope with personal distress. They have been provided with a space to share their current challenges through The Extension for Community Healthcare Outcomes (ECHO) program, which was initially implemented across Ontario and has now expanded on a national scale.1 One of the primary hindrances for these workers is the feeling of burnout due to the increased patient workload that needs traditional in-person care. ECHO exemplifies the utility of virtual programs and resources in the domain of healthcare and highlights the value that virtual care can provide by being a novel avenue for balancing care provision among many trained professionals.

There is a critical need to investigate the currently available digital interventions, ensure these tools are aligned with best practices, and curate a comprehensive resource which is accessible for use in clinical practice. Dr. Sockalingam emphasizes the significance of this project, “We wanted to make this resource accessible in the form of a consolidated toolkit that can actually be used for clinical purposes going forward”.

Due to the urgency posed by COVID19, the development of this knowledge synthesis project has been quite rapid.

The purpose of this research project is to investigate the efficacy of current digital interventions in mental health which aim to reduce mental health impacts of COVID-19, as well as identifying barriers to their access for underrepresented populations. The overarching goal is to curate an accessible, comprehensive resource that has been scientifically evaluated for its quality and is ready to be utilized effectively for clinical purposes going forward.

This project investigation went beyond curating papers describing digital interventions focused on diagnosable psychiatric interventions; it also included studies with a focus on mental health promotion and well-being. Studies of digital interventions’ target population included Canadian adults with clinical or subclinical symptoms of mental disorders.

Dr. Sockalingam explains, “We didn’t limit our inquiry to diagnosable psychiatric conditions in order to capture tools to assist with mental health challenges more broadly. Based on COVID-19 literature, most individuals don’t develop full-blown clinical psychiatric conditions. Individuals are more likely to experience mental health distress”. Experimental variables explored in this research project included diversity of target patient population, accessibility factors such as cost of service, quality of assessment and reportable outcomes.

Race, ethnicity and culture were key areas of focus related to equity and therefore the inclusion of indigenous patient populations and other underrepresented ethnicities was ensured.

”

Advanced online searches were conducted to find sites and organizations with key stakeholders in digital health on the national scale in order to ensure the proper capturing of currently available organizations and services, as well as authentically assessing their service in terms of quality and criteria. In order to ascertain the digital interventions were contemporary, studies included were published as early as the year 2000. The studies outlined interventions regarding mental health assessment, treatment, and well-being promotion. The range of articles examined was comprehensive and inclusive of commentaries and reviews in which interventions were regarded as modern innovations. The American Psychiatric Association (APA) Assessment Tool was applied to these resources to ensure quality assessment with respect to each of these interventions. Furthermore, the digital interventions were required to be defined by World Health Organization (WHO) Classification of Digital Health Technologies.

Despite the initial illusion of abundant resources, the study team discovered that most of the currently available resources did not meet the criteria for adequately addressing mental health concerns. Regarding mental health interventions, there was limited published information for reportable outcomes of digital interventions during COVID-19. Furthermore, reports were highly diverse regarding the types of intervention and areas of focus. In relation to equity, inclusivity and diversity, there were only few resources targeting specific populations of high need. For instance, none of the reports addressed Indigenous concerns. These times call for

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL | 13

FEATURE interventions that address disparities in access to care, employ similar standards for assessment and ensure consistent quality when offered to various patient populations. As such, Dr. Sockalingam believes this project will have immense impact in advancing care in both clinical and academic realms.

Photo credit: Mikaeel Valli a heightened emphasis and consideration regarding equity and diversity issues, such as the critical inclusion and proper representation of the Indigenous patient population.2 Addressing the heterogeneity of the ‘quality’ of these resources posed a major issue. The following factors were taken into consideration: 1) Reliability: How can people access the resource in a reliable way? 2) Specificity: Is the intervention quite general or specific? How would people know whether they are meeting their specific needs? and 3) Diversity: Is there a limited number of available resources for specific patient populations?

Diverse or underrepresented groups often have less access to more tailored versions of digital interventions. In addition, curating a resource that addresses diversity in terms of mental health needs is also essential.

Such prevalent challenges in virtual care reflect the obstacles that currently exist in traditional in-person care. Namely, in-person barriers are reflected in digital interventions.

This impact of this work, which was done in collaboration with co-principal investigators Drs. Strudwick and Crawford, is critical since patients, frontline workers and healthcare providers, as well as the general public are facing a plethora of online resources regarding mental health and COVID-19.

Dr. Sockalingam emphasizes: “We went

from initially having only few resources met with reluctance to witnessing an overwhelming sea of interventions being offered. Our team strived to curate, assess and synthesize all the available resources that are genuinely valid and appropriate for practical use.”

Preliminary findings are currently being disseminated with respect to knowledge synthesis.3 The team has reviewed the literature and has grouped the studies in terms of their outcomes, the geographical location in which they were developed, and their target populations.

The purpose of the knowledge translation is to share the results through the ECHO Ontario program to healthcare providers working on the frontlines, as well as with internal and external digital health groups on a national scale through webinars, such as the Evidence Exchange Network (EENet).4 The results also led to the development of an online knowledge hub located on the CAMH website in which the online interventions and applications can be searched for by the use of keywords to make these online resources accessible to target population patients and families.5 Future directions include more focus towards select populations that are underrepresented such as youths, refugees and other marginalized groups.

Additionally, conducting more rigorous evaluations of these digital interventions is required. Clinically, it is vital to strive towards curating more inclusive

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With sincere appreciation for the impact of academic work in the ongoing state of the world, Dr. Sockalingam acknowledges the current challenges researchers may be facing during this pandemic. As a word of advice, he suggests IMS research students virtually network and collaborate with other groups on novel projects and initiatives by taking full advantage of virtual technology in assisting with recruitment, delivery of interventions, and knowledge dissemination and translation.

Dr. Sockalingam has been deeply inspired by the dedication and commitment of the clinical and research teams towards finding creative modern solutions, and taking on roles outside of their usual responsibilities to assist frontline workers while caring for patients and supporting the public during these unprecedented times.

References

1. Project ECHO Ontario [Internet]. 2019. Available from: https:// www.echoontario.ca 2. Stranges J. Indigenous led COVID-19 testing centre opens in Toronto at Na-Me-Res [Internet]. St. Michael’s Hospital. 2020 [updated 2020 Oct 21]. Available from: http://www.stmichaelshospital.com/ media/detail.php?source=hospital_news%2F2020%2F1021 3. Digital Interventions to Support Population Mental Health during COVID-19: A Knowledge Synthesis – CIHR [Internet]. Canadian Institutes of Health Research. 2021 [updated 2021 Jan 22]. Available from: https://covid19mentalhealthresearch.ca/synthesis/digital-interventions-to-support-population-mental-health-during-covid-19 -a-knowledge-synthesis/ 4. EENet – Evidence Exchange Network [Internet]. 2021. Available from: https://www.eenet.ca 5. Digital COVID-19 and mental health resource list [Internet]. 2021.

Available from: http://www.camh.ca/en/health-info/mental-healthand-covid-19/information-for-professionals/covid-19-databasepage

BMC FEATURE

Virtual Gallery Exhibition

Master of Science in Biomedical Communications Institute of Medical Science, Temerty Faculty of Medicine University ofToronto

Alumni CEU Workshops BMC75 Memorbilia

Celebrating 75 Years of Biomedical Communications Join us this June.

BMC75 Virtual Exhibition: Opens May 31, 2021

BMC 75th Gala: Reunion Social May 31, 2021 7:30 PM

Visit https://bmc.med.utoronto.ca/bmc75 for details.

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL | 15 IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL | 15

FEATURE

Making strides in prophylactic treatment for COVID-19

By Nadia Boachie

I

n March 2020, the World Health Organization (WHO) declared COVID-19 a global pandemic.

Researchers immediately began collaborating in efforts to develop a vaccine, find treatments, and better analyze the trajectory of the virus to help prepare for current and future outbreaks.

In Toronto, a number of brilliant scientists have demonstrated their ability to perform quality research when the stakes are at their highest. Now, more than ever, there is immense pressure to yield useful scientific results.

The IMS Magazine had the pleasure of sitting down with one of these researchers, Professor Haibo Zhang, to discuss his ongoing studies on COVID-19. Dr. Zhang is a staff scientist in the Keenan Research Centre for Biomedical Science at St. Michael’s Hospital. He is a professor in the Anesthesia, Medicine, and Physiology Departments at the University of Toronto.

His work is currently looking at a potential drug to treat COVID-19. Together with his team of researchers, students, and several collaborators, he is making great strides to uncover treatments that can be used globally in human patients.

Before COVID-19, Dr. Zhang’s translational research program focused on the mechanisms and therapy of acute lung injury and sepsis. “My research has been lung infection and stem cell therapy. I have been doing this for almost 20 years since I started my faculty appointment with the University of Toronto,” he recalls.

Dr. Zhang has published over 250 peerreviewed articles and is the recipient of several large research grants, the latest being a one-million-dollar grant from CIHR for COVID-19 related research. His two-year study is one of 99 COVID-19 research projects that are funded by the Canadian federal government.1

Almost 20 years ago, the world faced a similar outbreak of Severe Acute Respiratory Syndrome (SARS)—the viral respiratory illness recognized as a global threat in 2003. Researchers identified a cell membrane protein called angiotensinconverting enzyme 2 (ACE2) that is a host cell receptor for SARS coronavirus (SARSCoV) infections. Researchers quickly realized that ACE2 has even higher binding affinity to SARS-CoV-2, which causes COVID-19.

ACE2 is currently an important target for COVID-19 treatments due to its key involvement in the mechanism behind the infection. It can be considered the cellular door in which SARS-CoV-2 infects its host. Dr. Zhang describes the process by which COVID-19 infections occur, “there is receptor-ligand interaction between ACE2 on host cells and the surface spike protein on SARS-CoV-2 virus that allows the virus to penetrate into the host. The virus then replicates and causes injury to different organs through the blood stream.”

In collaboration with Professor Penninger of University of British Columbia, who co-founded a company called Apeiron Biologics located in Vienna, they produced a soluble form of ACE2 named APN01.

Dr. Zhang hopes that if a soluble form of ACE2 is administered in the infected sites, it can act as a decoy and competitively bond with the virus so that it can no longer enter cells. The immune system will then be able to tackle the already infected virus while it remains at manageable levels.

In a paper published earlier this year, Dr. Zhang and his group discussed the rationale for targeting ACE2 receptors as a specific target to treat COVID-19. This paper was published in Intensive Care

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Medicine and was cited over 1,150 times in less than 10 months.2 Currently, Dr. Zhang and international collaborators are on track to complete clinical trials that are assessing the efficacy of the soluble form of ACE2. “We have a Phase IIb trial ongoing to treat 200 severely infected COVID-19 patients. The randomized, double-blind, controlled trial will compare APN01 to a placebo at different clinical centres in Austria, Denmark, Sweden, Germany and Russia.

“We have just recruited the last patient a couple of weeks ago,” he shares.

The research group has also published a case report of a patient with a severe COVID-19 infection. They saw some promising effects, however, they “cannot make any affirmative conclusions because it is a case report,” Dr. Zhang explains. The patient described in the report is a 45-yearold woman who was diagnosed with a SARS-CoV-2 infection and 9 days after she had symptoms was treated with APN01 intravenous infusions for 5 min twice daily.

The data shows that the virus disappeared rapidly. They concluded that it remains speculative whether this decrease in viral load reflects the effect of APN01 treatment or the of the virus’ natural progression, but the results were promising overall.3 Dr. Zhang expressed his excitement to get results from the upcoming clinical trials, “we cannot do any analysis now because we are not yet finished data collection, so we are anxious to see our results,” he clarifies.

Although there is a lot of focus and excitement on clinical trials, Dr. Zhang’s group is conducting a lot of pre-clinical work on COVID-19 in a CL3 lab – a Level 3 containment lab that maintains secure facilities for work with Risk Group Graphic design by Ingrid Barany

FEATURE

Dr. Haibo Zhang Professor, Department of Anesthesia, University of Toronto Professor, Department of Medicine, University of Toronto Professor, Department of Physiology, University of Toronto Faculty Member, Institute of Medical Sciences, School of Graduate Studies, University of Toronto Photo Credit: Krystal Jacques

3 pathogens such as emerging infectious diseases.4 “For clinical trials, you can only look at the outcome and you do not know exactly what the mechanisms are. The preclinical trials tell us what key cell signaling sources are responsible for these changes.”

Prior to working at the CL3 lab of the Temerty Faculty of Medicine Dr. Zhang,in collaboration with an international team, found that the soluble human ACE2 can significantly inhibit the virus in humanengineered tissue. This earlier pre-clinical work was published in the journal Cell.

The paper also demonstrated that the virus can directly infect and replicate itself in human blood vessel and kidney organoids.5 “The University of Toronto was pretty well known in the lung research field before COVID-19,” Dr. Zhang tells IMS Magazine. “However, through our analysis of the mechanism of COVID-19 and potential drugs for treatment, people have

been far more connected with us,” he explains. Dr. Zhang elaborated how he had panel meetings every day at the beginning of the pandemic in order to figure out how to contain this virus. A lot of companies and physicians contacted his team when there were major outbreaks in countries like Italy.

Dr. Haibo Zhang is collaborating on COVID-19 related projects with several research groups and companies in and out of the Toronto community. Collaborators include team members at Stanford University, Southern California University, Columbia University, Medicago and Tailed Genes Inc., and yet Dr. Zhang seamlessly manages it all. When asked how he keeps up with everything, Dr. Zhang’s response was “you just keep going and, in the lab, we fortunately have a very strong senior research associate, research coordinator, physician-scientist fellows, PhD and master’s students, a great team. For all

the different collaborations with different companies and groups I have to keep track of progress daily. It is pretty intense, but it is going well, so we keep going to fight the terrible COVID-19.”

References 1. Canadian Institutes of Health Research. Government of Canada [Internet]. Government of Canada funds 49 additional COVID-19 research projects – Details of the funded projects. Updated April 2020. [cited 2020 Dec 4]. Available from: https://www.canada.ca/ en/institutes-health-research/news/2020/03/government-of-canada-funds-49-additional-covid-19-research-projects-details-of-thefunded-projects.html.

2. Zhang H, Penninger JM, Li Y, et al. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Medicine.

2020;46(4):586-90.

3. ClinicalTrials.gov [Internet]. NIH: US National Library of Medicine (US). Identifier NCT04335136. Recombinant Human Angiotensin-converting Enzyme 2 (rhACE2) as a Treatment for Patients With COVID-19 (APN01-COVID-19). 2020 Apr 6. [cited 2020 Dec 4]. Available from: https://clinicaltrials.gov/ct2/show/NCT04335136 4. Zoufaly A, Poglitsch M, Aberle JH, et al. Human recombinant soluble ACE2 in severe COVID-19. The Lancet Respiratory Medicine.

2020;8(11):1154-8.

5. Temerty Faculty of Medicine. [Internet]. [cited 2021 Jan 4].

Available from: https://medicine.utoronto.ca/combined-containment-level-3-unit

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL | 17

FEATURE

By Laura M. Best

T

he impact of COVID-19 has been anything but homogenous, yet the most commonly discussed solutions rest on assumptions of homogeneity and equity. The IMS Magazine recently had the opportunity to speak with Dr. Sharmistha Mishra, a clinician-scientist in the Li Ka Shing Knowledge Institute who is challenging these and other assumptions amid the COVID-19 pandemic. She is expanding perspectives beyond standardized solutions to complex, heterogeneous questions by leading a team of interdisciplinary experts who are challenged by the communities they serve.

Dr. Mishra did her undergraduate studies at Laurentian University, and then trained as an infectious disease physician at University of Toronto before heading abroad to continue her graduate school

“

education. Though her first passion was clinical infectious diseases, Dr. Mishra was eager to expand her perspective to include public health, and it was while in India for a clinical elective that she was inspired by her future graduate supervisor’s work.

She went on to complete both her Master’s and Doctoral work with them at Imperial College London, and when asked to describe her graduate school experience, Dr. Mishra reminisced, “That led to falling in love with my second thing after clinical infectious diseases, which was studying transmission dynamics and modelling.”

She went on to clarify that her interests are specifically in better understanding how infectious diseases differentially affect various populations and what factors play a role here. “It was great because now I have a job I love: I’m a clinician-scientist…

No matter what we do, there’s always this sort of element of asking questions, and the science allows me to pause to be

methodical about answering those questions.”

Flash forward to the present day and Dr. Mishra can be found helping provide care for patients at St. Michael’s Hospital or in her lab in the MAP Centre for Urban Health Solutions. She leads a team of interdisciplinary experts that thrives in collaboration and focuses on infectious disease outbreaks and epidemics in lowand middle-income settings including HIV, sexually transmitted infections, and now, COVID-19.

By incorporating the expertise of engineers, epidemiologists, mathematical modellers and social scientists, Dr. Mishra’s team is “challenging some of the narratives [of homogeneity] around transmission dynamics and response to epidemics and outbreaks” with data-driven approaches to highlight the mechanisms that underpin

It’s a little like microsystem modelling versus modelling for all of Canada - the former is much more in our wheelhouse.

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Graphic design by Colleen Paris

FEATURE leveraging their strengths and expanding their research interests. “What we realized as we were doing some of the early COVID-19 modelling, was that if we take a similar lens to that which we took with HIV, there are complete parallels when we think of inequities, and think about heterogeneity when it comes to risks and resilience and intervention reach or access and uptake,” Dr. Mishra explained, referring to the fact that heterogeneity exists across population groups that determine how vulnerable they might be to infection, or how accessible treatment and public health interventions might be for a given disease.

Dr. Sharmistha Mishra BSc, MD, MSc, PhD, DTMH Scientist, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital Assistant Professor, Faculty of Medicine, Institute of Medical Sciences Assistant Professor, IHPME heterogeneity. When asked about her overall vision, Dr. Mishra explained that her team uniquely approaches questions informed by the needs of the communities they partner with and/or serve. Each project is comprised of small, highly technical tasks, which ultimately come together and provide answers rooted in data. “The goal is… to have some impact [on these communities], and very acutely and precisely address the specificity that people who are implementing programs and services are looking for,” Dr. Mishra continued, referring to the fact that the needs of different organizations and communities are diverse. She hopes to provide information that will help them perform better in the context of infection control.

Given this unique expertise, a new opportunity presented itself in the early stages of the COVID-19 pandemic.

Questions were being raised by St. Michael’s and other hospitals, and Dr. Mishra approached her team about

For example, the city of Toronto has recognized within its TO Supports: COVID-19 Equity Action Plan1 that some communities and populations are at greater risk for negative impacts from COVID-19 and are working to differentially support these vulnerable communities. “We took what we’re trained in [examining heterogeneity] and said, you know, that this is how we can contribute. And by that, it meant expanding to investigate COVID-19 from this perspective,” concluded Dr. Mishra.

Embodying this expansive approach to research is Jesse Knight1, an IMS PhD

student working with Dr. Mishra. While taking some time to work on COVID19-related modelling, Jesse developed a “thoughtful way of estimating the reproductive rate based on infections where transmission can happen before someone becomes symptomatic…it’s a contribution that a lot of people are using,” praised Dr. Mishra.

Dr. Mishra and her team are now involved in multiple collaborative projects focused on COVID-19. One is a CIHR-funded, multi-provincial project on which she is the nominated Principal Investigator.

“It’s a great team of folks…across five provinces, Quebec, Ontario, Manitoba, Alberta and British Columbia…who are epidemiologists, modellers, public health scientists, working together on questions that are both province-specific as well as these multi-provincial analyses and comparisons.” She continued, “As a wider team, we want to understand why the size and trajectory of epidemics varied within and between provinces, how impact of interventions varied across subgroups and by social determinants of health (including occupations and household density), and what were some of the consistent patterns across provinces, and that’s what led to this multiprovincial work and analyses that now is really focused on data and

Estimated distribution of SARS-CoV-2 infectiousness (generation time) based on the distributions of time to symptom onset (incubation period) and time between symptom onset in infector-infectee pairs (serial interval)1.

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL | 19

FEATURE This is what the early data seems to suggest, as well. “What we’re finding in the data and in our models is that inequity and intervention access (be it reach or feasibility) undermines this assumption that a one size fits all is going to work to control the COVID-19 epidemic. We are definitely finding evidence to suggest that without being tailored when there’s underlying heterogeneity…we’re likely going to continue to be in a similar situation as we are facing now and amplify inequities in COVID-19 risks.”

In a landscape as rapidly evolving as COVID-19, Dr. Mishra acknowledged that it can be both inspiring and overwhelming trying to keep up with the rapid influx of new information and resources.

She challenges others working in this environment to become comfortable with uncertainty and encourages the exploration of data as they are being collected. And for those aspiring to contribute, she suggests embodying humility, asking high-risk questions and considering what your unique contribution and perspective could be.

Photo credit: Krystal Jacques transmission modelling to understand heterogeneity in COVID-19.”

Other ongoing projects are more focused, using transmission modelling to evaluate interventions and future incidence rates for vulnerable populations that have been hit harder by the effects of the pandemic.

One is supporting the work of colleague Dr. Stephen Hwang looking at COVID-19 among persons experiencing homelessness in Toronto, while another is in support of Chiefs of Ontario, looking at intervention strategies for First Nations communities on reserve. A third is supporting an effort to assist frontline workers in reducing infection rates in long-term care homes across the GTA and Champlain regions using spatial analyses combined with transmission modelling.

“So, as you can see, we’ve expanded quite a bit…” Dr. Mishra laughed. “But, you know, it’s also a lot in terms of great work that we’re excited to do, that we feel we can contribute to and that we’re going to

try to do in partnership with folks that are implementing strategies in the shelter system, in long term care homes. So it’s very much in parallel to how we do our HIV work and that’s why it felt natural to join those projects and grants.”

Dr. Mishra continued, “And I think that’s what’s been fantastic about working with folks here who are very community engaged and working with frontline organizations and supportive to that response. It’s a little like microsystem modelling versus modelling for all of Canada - the former is much more in our wheelhouse.”

And when asked about the intended significance of this work, Dr. Mishra explained that she hopes for “contextually responsive” and “tailored” public health responses rather than “top-down mandates which often sometimes cannot reach everybody or may not be accessible or equitable for everybody.”

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Reflecting on the entire experience, Dr. Mishra explained that it has expanded the scope of her lab’s vision as well as her own imagination. “For us, it was that central theme of heterogeneity that aligned and weaved through all of this. I feel that I’ve learned more than I’ve contributed.” At the end of it all, Dr. Mishra exuded gratitude and appreciation for her team and collaborators, who keep this work both fun and rewarding.

References

1. Knight J, Mishra S. Estimating effective reproduction number using generation time versus serial interval, with application to covid-19 in the Greater Toronto Area, Canada. Infect Dis Model.

2020;5:889-96.

IMSSA POSTER

I

nstitute of Medical Science Student Association (IMSSA) Co-Presidents Claire Wunker & Jesse Joynt would like to welcome to our new directors, treasurer and secretary! While our socially distanced year has been ongoing, they have been hard at work behind the scenes to coordinate and execute great initiatives. Here is some information to get to know them a little better.

Meet some of the IMSSA team!

Graphic design by Colleen Paris

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL | 21

BMC FEATURE Master of Science in

BIOMEDICAL COMMUNICATIONS Ariadna Pomada Villalbi 2T1

Art and science have always been big parts of my life. During my bachelor in Biochemistry at the Autonomous University of Barcelona I developed an interest for visualizing the intricacies of molecular world. It was not until I found out about the BMC program, that I realized I could make of my passion my profession. I’m currently working on my Master’s Research Project that aims to address student misconceptions on protein binding and interactions. In the future, I aim to create engaging visuals that enhance learning experiences and bridge the knowledge gap between science and the public, especially in the cellular and molecular field.

Ingrid Barany 2T1

Hi I’m Ingrid! I graduated with a degree in Immunology and Art History from the University of Toronto back in Summer 2019. Before coming to BMC, my twin passions for art and sciences seemed to lead down disparate paths. I would look for any excuse to integrate my artistic abilities in with my scientific courses. After I discovered BMC, I felt as if I had found my niche! Now, I am stoked to be able to carry out my passion each day while simultaneously drawing inspiration from such a talented cohort of students I am lucky to call friends.

22 | IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL

BMC FEATURE Michelle Wu 2T2

I’m Michie, a first year BMC student. I did my undergraduate specializing in forensic chemistry at UTM. I am thoroughly enjoying the BMC program and I love my professors and talented classmates! One of the projects I’ve had most fun making this semester is my infographic on the colour-changing abilities of cephalopods.

I hoped to provide a general biological overview of the scientific mechanisms and function alongside colourful visuals. I also enjoyed creating a data sculpt of a domestic cat skull from a CT scan. I’m learning so much and I’m super excited for what next semester has to offer!

Sana Khan 2T2

For as long as I can remember, drawing and painting have been a prominent part of my life: participating in my middle and high school art clubs, entering various art competitions and taking art classes to fulfill my artistic inclinations. Although I ultimately pursued a degree in neuroscience, I regularly utilized my artistic capabilities by illustrating lecture content to better understand concepts. As a result of my dependence on the visual representation of challenging scientific knowledge, I came to realize the necessity of effective visual design and clear illustrative communication in learning. As a student of BMC, I look forward to learning everything there is to know about becoming a professional science communicator!

Shehryar Saharan 2T2

About four years ago, I learned about the BMC program, and I knew this was the place to be.

Since then, I have earned an interdisciplinary degree in Biomedical Engineering, all while having sketchbooks and art supplies wedged between my Thermodynamics & Anatomy notes. Now in BMC, I am no longer confined to the role of an engineer, a scientist, or an artist - I am in a sweet spot in between. Every day, I am working towards my dream of creating clear and compelling visualizations to push the envelope of scientific knowledge and build interactive, educational & memorable experiences.

Layout by Jennifer Barolet

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL | 23

VIEWPOINT

By Natalie Simonian

I

n March 2020, the COVID-19 Pandemic hit its first peak in Toronto.

As the government coped with the economic and social ramifications of a global pandemic, new regulations were set in place day by day. For the University of Toronto IMS graduate students, this meant that lab work was halted and students began to convert to working from home.

This came with its own subset of challenges and required immense adaptation on the part of students in graduate school.

There is no doubt that the COVID-19 pandemic has brought on a host of trials and tribulations to society as a whole and uniquely on graduate students, who for months could not enter their labs to conduct research. However, it is always important to gain perspective on any issue, and a global pandemic is no different. The media has portrayed the coronavirus as a looming dark figure that has brought nothing but harm to society, however, here I will highlight some pandemic positives as experienced by IMS graduate students.

I will begin with myself, a clinical researcher. With the restrictions on physically entering labs beginning in March 2020, I began to work from home. My days were spent on zoom calls and involved long hours of staring at a computer screen. However, as I live an hour away from campus, working from home meant that I had effectively two extra hours of my day. I began to write

more short stories and poetry, a hobby that I’ve cultivated since before university. The months at home allowed me to develop a sense of direction with my poetry, draft up a manuscript, and submit this manuscript to a publishing house in Toronto. All of these efforts over the past couple of months culminated in me becoming a published author this fall and being featured in a poetry paperback book titled “You’ve Gone Incognito” that is on sale right now on TheSoapBoxPress website.

Similarly, in the same vein of cultivating hobbies, Rachel, a clinical research graduate student, expressed to me that with all her free time during the pandemic lockdown she got involved in a new hobby: growing and taking care of houseplants.

She describes this hobby as therapeutic, giving her the chance to slow down and

appreciate each plant and how much they grew in her care. Rachel has expressed that while devoting time to this new hobby, she has virtually met a lot of like-minded people.

A former IMS student gave me her two “silver linings from the pandemic.” Her wedding was postponed due to the COVID-19 pandemic. While this news was upsetting, the IMS alumna and her husband decided to jump-start their lives together and move in together. The first silver lining came here: she expressed that when moving in with her fiancé, she felt independent and the experience was freeing. The second silver lining was finally taking a pause and prioritizing her mental and physical health. As many of us have probably felt as graduate and post-graduate students, life at times can feel very

“Life at times can feel very fast-paced, and we may forget to pause”

24 | IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL

Graphic design by Colleen Paris

VEIWPOINT

“The pandemic lockdown gave students the space to ackowledge and appreciate what they have in their lives and what they are thankful for” fast-paced, and we may forget to pause and focus on things beyond academic life.

This IMS alumna exemplified the use of the lockdown to cultivate a better work-life balance as well as plan her personal life’s next steps.

The third student I spoke with, Nairy, is a commuter like myself. She lives off-campus and found it difficult to attend events, both academic and social, since they required commuting downtown. Due to the pandemic lockdown, events and clubs have become virtual. Consequently, Nairy was able to attend more events and socialize. This pandemic enriched her graduate experience by allowing her to connect with people who she probably never would have met!

The last IMS student I spoke with, Muzaffar, mentioned to me that the best thing the pandemic gave him was time. The time to create a consistent

workout plan, the time to see family and friends, and the time for self-reflection.

He mentioned that when the lockdown started, he struggled initially to figure out a balance between relaxing and working at home. He created a schedule and began feeling productive in more than one aspect of his life. He took the time to reflect on the activities he was doing outside of school and work and asked himself one important question which I believe we should all ask ourselves during this time of self-reflection: “Are the things that I spend my time doing meaningful to me, do I actually want to be doing these things?”. He has reorganized some of his commitments and has begun to feel more relaxed, and he now spends his nonresearch related time seeing family and friends, exercising, and acting as a TA and mentor to incoming students.

While the pandemic lockdown has given many IMS students more free time, I

must pause to acknowledge the many IMS students who have children or elders needing care living with them. Along with heath care workers, these students are the real heroes for being able to juggle research demands as well as taking care of family members during these isolating times.

When speaking with other IMS students a common shared realization emerged: the pandemic lockdown gave students the space to acknowledge and appreciate what they have in their lives and what they are thankful for. Whether it was achieving a dream, finding a new passion, advancing personal life goals, increasing social involvement, spending quality time with family members, or delving into active introspection, the pandemic “pause” gave IMS graduate students the space to figure out what is meaningful to them, what they want to prioritize in their lives and act on it.

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL | 25

VIEWPOINT

THE 4TH WAVE:

COVID-19 Pandemic Exacerbates the Mental Health Crisis in Graduate Students By: Stephanie Tran

Pandemic impacts mental health in the general population

I

n March 2020, U.S. critical care physician Dr. Victor Tseng predicted the Covid-19 pandemic would unfold in a series of waves. Following the virus’s infectious waves, a wave of psychological trauma, mental illness, and burnout will be the pandemic’s “largest and most sustained effect”1 Half a year later, the Centre for Addiction and Mental Health (CAMH) partnered with a research technology company, Delvinia, and conducted a series of five national surveys that supported this prediction.2 The surveys tracked mental health changes in over 1000 Englishspeaking Canadians between May and September. Over 20% of responders indicated they experienced moderate to severe anxiety and felt both lonely and depressed. Interestingly, the highest prevalence of these feelings was observed in the 18-39 age group, while the lowest was in the 60+ age group. These surveys highlight the disproportionate impact of the pandemic on mental health in young adults.

Mental health in graduate students: A crisis Graduate students are a unique demographic. They are local experts, conducting cutting-edge research, and form the next generation of scientists,

educators, leaders, and innovators. Yet, they are at risk of mental health illness.

In 2018, a study made headlines with findings that “graduate students are six times more likely to experience anxiety and depression as compared to the general population.”3 While this number has been disputed due to the lack of controls, other studies have found similarly high rates. When comparing Ph.D. students to those with higher education in the general population, Ph.D. students have a higher prevalence of mental health issues and are more likely to develop depression.4 With over 175 000 graduate students in Canada, this is creating a so-called “invisible crisis”.5 So, why are graduate students showing poor mental health? Early this year, psychologist Dr. Astrid Muller discussed this problem in an article titled, “Mental health disorders: prevalent but widely ignored in academia?”.5 She states that “the usually high workload, often associated with externally prescribed deadlines, competition for research resources, and uncertain job prospects can have an adverse impact on mental health.

Problems may be aggravated by poor management practice as well as insufficient recognition and reward”. In agreement with her article, other authors note that graduate students also feel imposter syndrome, isolation, and financial stress6, all of which can be detrimental to mental wellbeing. In a survey polling over 2000 Ontarian graduate students, nearly 70% reported that they were anxious about their degree timeline and felt pressured to overwork.7

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Pandemic exacerbates the mental health crisis in graduate students With graduate students experiencing higher than normal mental health issues, how are they affected by the pandemic? The Toronto Science Policy Network conducted a survey to answer this question. Graduate students from 45 Canadian universities were polled between April and May.8 Of 1431 respondents, most came from the life and physical sciences. Nearly half the respondents indicated that the pandemic would impact their ability to complete their degree, and over one-quarter considered taking a leave of absence. Compared to prepandemic, concerns about finances tripled during the pandemic, with over one-third of the respondents indicating financial stress.

Graduate students reported experiencing an increase in mental health issues, with 77% feeling anxious, 72% feeling overwhelmed, 76% feeling lonely and 63% feeling depressed. Overall, 72% reported that these feelings increased due to COVID-19.

Increased mental health issues in response to the pandemic have similarly been reported in graduate students worldwide.

In Australia, the pandemic increased graduate students’ stress related to finances, scholarships, and the ability to meet deadlines.9 In the UK, a survey of nearly 6000 graduate students found that most students (75%) were unable to conduct their research, had poor mental wellbeing, and showed mental distress.10 While in the US, a large-sample survey found research doctoral students had the highest overall Graphic design by Ingrid Barany

Raising awareness of this mental health crisis is critical to creating an environment where mental health can be discussed openly. This movement has become widely popular on Twitter, with many academics freely discussing their graduate school and mental health problems. Students share the ups and downs of completing a degree via hashtags like #PhDLife, while accounts such as @PhD_Balance are run by and for graduate students to provide advice for improving resilience and learning through shared experience. This online platform has become a supportive community which we should strive to mirror in our institutions.

While open communication will not solve the mental health crisis, it is the first step to inducing change. Research expectations need to be adjusted to reduce anxieties related to conducting research, meeting deadlines, and degree completion, especially in these unprecedented times.

Institutions need to provide more mental health support, including training for supervisors, faculty, and staff to recognize signs of distress before it escalates. It is vital to acknowledge the impact of this pandemic on the graduate student mental health crisis and to drive change to ensure that they no longer suffer in silence.

Back in March, critical care physician Dr. Victor Tseng warned about the pandemic’s mental health “aftershocks” prevalence of major depressive disorder and generalized anxiety disorder compared to undergraduate, master’s, and professional students.11 Compared to the 2019 survey results, graduate student depression nearly doubled, while anxiety increased by 1.5 times during the pandemic. Furthermore, the survey found the prevalence of depression and anxiety varied by field.

Depression was most prevalent in the life sciences, while anxiety was most prevalent in biomedical research.

Acknowledging the graduate student mental health crisis and call for change Pre-COVID-19, Nature demanded “urgent attention” for the mental health of Ph.D. researchers.12 Now, we must acknowledge

References

that the pandemic has exaggerated the existing mental health issues in our graduate students. As these trainees go on to become experts in all sectors of the economy, ignoring the mental health crisis in this population could negatively impact future research and innovation.

Dr. Astrid Muller acknowledges a major problem with mental illness – “most people with mental disorders suffer in silence”.5 In Ontario, students refrain from discussing mental health problems for four main reasons: fear of reprisal, fear of reporting to those who are part of the problem, the uncertainty of where to seek help, and the inability to commit the time to undergo the formal complaint process.7 Many students also have an anxiety of failing or appearing weak.7 As the stigma surrounding mental health continues to exist in academia, this mental health crisis will continue to surge.

1. Duong, D. (2020). Doctors brace for ‘fourth wave’ of the pandemic.

Healthing.ca. https://www.healthing.ca/diseases-and-conditions/ coronavirus/doctors-brace-for-fourth-wave-of-the-pandemic 2. COVID-19 National Survey Dashboard. (2020). CAMH. https:// www.camh.ca/en/health-info/mental-health-and-covid-19/ covid-19-national-survey 3. Evans, T.M., Bira, L., Gastelum, J.B., Weiss, L.T., Vanderford, N.L. (2018). Evidence for a mental health crisis in graduate education.

Nature Biotechnology, 36(6), 282-284.

4. Levecque, K., Anseel, F., De Beuckelaer, A., Van der Heyden, J, Gisle, L. (2017). Work organization and mental health problems in PhD students. Research Policy, 46(4), 868-879.

5. Muller, A. (2020). Mental health disorders: prevalent but widely ignored in academia? The Journal of Physiology, 598(7), 1729-1281.

6. Flaherty, C. (2018). A very mixed record on grad student mental health. Inside Higher Ed. https://www.insidehighered.com/ news/2018/12/06/new-research-graduate-student-mental-well-being-says-departments-have-important 7. Supporting graduate student mental health. (2017). Canadian Federation of Students – Ontario. https://cfsontario.ca/wp-content/ uploads/2017/07/Factsheet-GraduateMentalHealth.pdf 8. COVID-19 Graduate Student Report. (2020). Toronto Science Policy Network. https://tspn.ca/covid19-report/ 9. Woolston, C. (2020). Bleak financial outlook for PhD students in Australia. Nature Career News. https://www.nature.com/articles/ d41586-020-02069-y 10. Byrom, N. (2020). COVID-19 and the research community: The challenges of lockdown for early-career researchers. eLife Sciences. https://elifesciences.org/articles/59634 11. Chirikov, I., Soria, K. M., Horgos, B., & Jones-White, D. (2020).

Undergraduate and graduate students’ mental health during the COVID-19 pandemic. SERU Consortium, University of California - Berkeley and University of Minnesota. https://cshe.berkeley.edu/ seru-covid-survey-reports 12. The mental health of PhD researchers demands urgent attention.

(2019). Nature, 575(7782), 257-258.

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL | 27

VIEWPOINT

By Jason Lo Hog Tian

A

fter over a year living in a different world under the COVID-19 pandemic, people are eagerly awaiting a time when they can return to normal. For most, their hopes lie in the development of a vaccine. With some vaccines in stage 3 clinical trials, many are hopeful for regulatory approval by early 2021 so we can resume our social gatherings and beach vacations. However, an approved vaccine does not mean the pandemic will be over – it is only the first hurdle. Challenges with safety, production, and distribution could mean a significant amount of time between the first vaccine approval and its widespread availability for the average person.

immunity. The road to creating a vaccine is long and contains many stages, with most failing to reach final approval. Preclinical testing is the first step where vaccines are tested on animal models to see if they produce an immune response. In Phase 1, vaccines are given to a small number of people to test dosage and safety as well as to confirm if it produces an immune response. Phase 2 includes up to hundreds of people from different populations to verify safety and efficacy. Phase 3 is the last step leading to regulatory approval and involves administering the vaccine to thousands of people and examining how many get infected compared to a control group as well as identifying any rare side effects. Following the completion of Phase 3 trials, the data will be evaluated by regulating bodies and an approval decision will be made.

“

The purpose of a vaccine is to activate an immune response to a specific virus, resulting in long-term immunity without causing disease. When a virus enters the body, it is recognized and triggers an immune response which kills the virus as well as produces antibodies that blocks it from infecting cells and marks it for destruction.1 After being infected, the body can “remember” the virus, preventing it from causing disease if the body is re-infected and providing long-term

There are many companies competing to develop the first COVID-19 vaccine with a variety of methods available to activate the immune response. Figure 1 shows the major manufacturers and their progress in the vaccine production race.2 Controversially, the vaccines developed by Gamaleya Research Institute, Sinopharm, CanSino Biologics, and Sinovac have been given emergency approval for use in Russia, United Arab Emirates, the Chinese military, and for Chinese medical workers respectively, despite not completing Phase 3 clinical trials.3 This highlights the highly political nature of COVID-19 vaccine development which may prioritize being first over being effective. Nations are in a Cold War-like arms race – the Russian vaccine is even named “Sputnik V” in a nod to the first satellite launched during the space race of the 1950’s.4 However,

An approved vaccine does not mean the pandemic will be over – it is only the first hurdle

28 | IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL

Graphic design by Colleen Paris

VEIWPOINT

many scientists have condemned such executive oversight, fearing a lack of safety and efficacy testing. Relying on Phase 1 or 2 data and skipping large-scale clinical trials means there is no concrete evidence that the vaccine is more effective than a placebo and does not give the opportunity to detect rare side effects that may not appear in a small sample. Fasttracking approval seems like an obvious step to eradicating the disease quicker, however the real winner of the “vaccine race” may not be the one who completes development first, but the one who figures out the daunting challenge of distributing it to an entire population.

If 60-70% of the world have to be immune to achieve herd immunity (when a majority of people are immune so the virus becomes difficult to spread), up to 5.6 billion people would have to be vaccinated to end the pandemic.5 At a time when infrastructure is reduced due to the pandemic itself, distributing a vaccine is going to require the largest scale up in capacity we have ever seen. This problem is made even more challenging with the conditions under which a vaccine must be kept as well as the time-sensitive nature of the product.

The vaccines from Moderna Inc. and BioNTech/Pfizer/Fosun have arguably the most potential since they are RNAbased vaccines which require no culture or fermentation and can be produced rapidly. However, to keep the RNA stable it must be stored in a deep freeze, up to -80 degrees Celsius.3 This not only poses a significant problem for transportation, but for storage in pharmacies or clinics where they are most likely to be utilized.

Additionally, many of the vaccines being developed may require more than one dose, doubling the burden on distribution networks and adding the extra complication of re-distributing the product to people within a strict timeframe.3 To get ahead of these problems, countries are already preordering different types of vaccine and developing the manufacturing and distribution infrastructure regardless of whether it gets approved or not, hoping to land on an effective choice. Another often unconsidered factor is that the first vaccine approved may not be the best one.

While priority populations such as the elderly and healthcare workers may receive a vaccine as soon as possible, there’s no telling the length of time between the first one and the “best” one – the one you or I are more likely to receive.

These are but a few of the problems that will pose a challenge to even the most industrialized countries, not to mention areas with a lack of infrastructure and healthcare services. Unfortunately, the complex task of vaccinating most of the world is likely to highlight and reinforce existing racial and socioeconomic inequalities, further extending the time it takes to achieve widespread immunity.

While the end of the pandemic could not come soon enough, pushing a vaccine through the approval process is not the solution. We must uphold strict quality control standards and realize that the true battle will be delivering an effective vaccine to the entire world. It is in all our own interests to ensure equitable access to an effective COVID-19 vaccine, for the pandemic will be over not after the first vaccination, but after the last.

References 1. Callaway E. The race for coronavirus vaccines: a graphical guide.

Nature. 2020;580(7805):576.

2. Flanagan C, Griffin R, Langreth R. Trial Hitches Slow Covid Vaccine, Treatment Timeline: Bloomberg; 2020. Available from: https://www.bloomberg.com/features/2020-coronavirus-drug-vaccine-status/.

3. Corum J, Grady D, Wee S-L, Zimmer C. Coronavirus vaccine tracker. The New York Times. 2020;5.

4. Mahase E. Covid-19: Russia approves vaccine without large scale testing or published results. BMJ. 2020;370:m3205.

5. Bloom BR, Nowak GJ, Orenstein W. “When Will We Have a Vaccine?”—Understanding Questions and Answers about Covid-19 Vaccination. New England Journal of Medicine. 2020.

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL | 29

FACULTY SPOTLIGHT

Promoted to ASSOCIATE MEMBER

Promoted to FULL MEMBER

Dr. Dimitri Anastakis is a Professor of Surgery.

He is a member of the School of Graduate Studies, IMS, and the Krembil Research Institute. Dr. Anastakis is studying cold sensitivity in patients with compression neuropathies and, in partnership with Dr. Karen Davis, structural and functional cortical changes following peripheral nerve injury, repair and rehabilitation.

Dr. Mohammad Akbari is an assistant professor at the Dalla Lana School of Public Health, University of Toronto, and a scientist at Women’s College Research Institute, Women’s College Hospital. His research interest is in studying genetic susceptibility to cancers, including breast, ovarian, esophageal, pancreas and prostate cancers.

Dr. Ryan Brydges studies two broad areas: (i) clarifying how healthcare trainees manage their lifelong learning, and (ii) understanding how to optimize the instructional design of healthcare simulation for training and assessment. He’s a Scientist and Associate Professor, Department of Medicine, UofT, and holds a Professorship in TechnologyEnabled Education at Unity Health Toronto.

Dr. Corinne Fischer is a staff psychiatrist with the Mental Health Service at St. Michael’s Hospital, Associate Scientist, Co-director of neurodegenerative research at Keenan Research Centre for Biomedical Science and Associate Professor of Psychiatry at the University of Toronto.

Her major research focus is the interface between psychosis and neurodegeneration.

Dr. George Ibrahim is a pediatric neurosurgeon at Sick Kids and Assistant Professor at the Institute of Biomaterials and Biomedical Engineering, the IMS, and the Dept. of Surgery. His interests include the surgical treatment of medically intractable epilepsy, spasticity and functional disorders in children and the study of neural networks in children with epilepsy and functional disorders by combining connectomic, computational neuroscience and machine learning approaches.

Dr. Jennifer Jones is the Butterfield Drew Chair in Cancer Survivorship Research and the Director of the Cancer Rehabilitation and Survivorship Program at the Princess Margaret Cancer Centre. In addition, she is an Associate Professor in the Department of Psychiatry (primary) and the Dalla Lana School of Public Health, at University of Toronto.

Dr. Farzad Khalvati is the Endowed Chair in Medical Imaging and Artificial Intelligence (AI) at the Hospital for Sick Children. His research in Intelligent Medical Image Computing Systems (IMICS) Lab focuses on the design and development of AI-driven diagnostic and prognostic solutions for different diseases, including cancer, with the goal of delivering precision medicine to patients.

Dr. Istvan Mucsi (MD, PhD) is a clinician investigator, transplant nephrologist (University Health Network) and Associate Professor of Medicine (UofT).

His research focuses on equitable access to kidney transplant for patients from racialized communities. He is also building an electronic patient reported outcome measure platform for transplant recipients.

Dr. Mark Sinyor is a Psychiatrist at Sunnybrook Health Sciences Centre and an Associate Professor at the University of Toronto. His research focuses are suicide prevention and mood disorders and he is the founder of PROGRESS (the Program of Research and Education to Stop Suicide).

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Graphic design by Ingrid Barany

FACULTY SPOTLIGHT

NEW IMS FACULTY Dr. Rayzel Shulman develops and evaluates health services interventions to improve the health and quality of care for youth living with diabetes, including the transition to adult care and reducing socioeconomic disparities in care and outcomes. She is interested in developing and evaluating interventions that leverage existing population-level administrative datasets to inform health system change.

Dr. Eliane Shore is a member of the division of Gynaecologic Surgery and Pelvic Medicine at St. Michael’s Hospital.

Her research interests include surgical simulation, surgical education, resident selection, the Operating Room Black Box, and development of a Canadian obstetrics and gynecology educational video library (TVASurg.com).

Dr. Sebastian Hobson (MD, PhD, MPH FRANZCOG FACOG FRCSC) is a Maternal Fetal Medicine Specialist at Mount Sinai Hospital and Assistant Professor of Obstetrics & Gynaecology at the University of Toronto.

He has strong clinical and research interests in labour and delivery care and advanced obstetric surgery.

Dr. Pascal Tyrrell is a data scientist—a combination of research methodologist, computer/database solutions architect and innovator. He is the director of data science with the Department of Medical Imaging and associate professor with the IMS and the Department of Statistical Sciences.

Pascal’s research interests include Artificial Intelligence in Medical Imaging.

Dr. Vanessa Gonçalves is an Independent Scientist at the Tanenbaum Centre at CAMH and Assistant Professor (Dept of Psychiatry).

She has a multidisciplinary background in statistical genetics and molecular biology.

Her primary research focuses on the role of mitochondrial gene variants in the risk for and phenomenology of neuropsychiatric disorders. Her research includes pharmacogenetic studies focusing on the mitochondrial system, especially its effects on treatment response.

Dr. Farooq Naeem is a psychiatrist at CAMH, Professor of Psychiatry at U of T, and a Cognitive Behaviour Therapist (CBT) who received training in CBT for psychosis from Professor David Kingdon. He pioneered techniques for culturally adapting CBT which were used to adapt CBT for a variety of common and severe mental health problems in South Asia, North Africa, Middle East and China and now Canada.

Dr. Maryse Bouchard completed her orthopaedic surgery residency and a Masters’ at the U of T. Her fellowship training includes pediatric orthopedics at Seattle Children’s Hospital and limb reconstruction at Australia’s Royal Children’s Hospital. She cares for children with lower limb and foot and ankle deformities. Her research evaluates clinical outcomes of foot and ankle conditions, and access to orthopaedic care in resource-poor areas.

Dr. Sheryl Spithoff is a physician at Women’s College Hospital and an Assistant Professor at the University of Toronto. Her research interests include addictions and access to care as well the impact of conflicts of interest on medical education, research and technological innovations. She has expertise in qualitative and quantitative methodologies.

Dr. Venkat Bhat is a psychiatrist based at two Depression Centres (St. Michael’s Hospital and University Health Network) and Director of the Interventional Psychiatry program at St. Michael’s Hospital. He leads an interdisciplinary program to offer emerging and procedural interventions, his research program aims to understand treatmentresponse with these emerging interventions.

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL | 31

FACULTY SPOTLIGHT

By Sally Wu

O

ur spinal cord plays a vital role in day-to-day functions, serving as a bidirectional communication pathway for the brain and body. It allows us to perform a range of motions, from a simple flick of a finger to complex movements like running. Injuries to the spinal cord can result in a loss of sensation, weakness, incoordination, or even complete loss of muscle function. Most spinal cord injury (SCI) cases are now treated with surgery to restore a patient’s independence, however, there are few effective non-surgical treatment options.

Dr. Michael Fehlings and his team at the Krembil Brain Institute are pioneers in the field of neural repair and regeneration.

The Fehlings Laboratory is leading both clinical and preclinical studies that hold great promise for patients suffering from this irreversible condition.

As a University of Toronto alumnus, Dr. Fehlings completed his MD in 1983 and later received his PhD in 1989 through the Institute of Medical Science (IMS).

Growing up in a German immigrant family with minimal experience with academia and medicine, it was the guidance of notable role models that inspired Dr. Fehlings to become a clinician-scientist. As a medical student, Dr. Fehlings recalls attending inspirational talks that first exposed him to research.

One of them was presented by Dr. Nancy McKee, a remarkable plastic surgeon

with a specific research interest in microvascular reconstructive surgery. Dr. Fehlings completed a summer student project in Dr. Mckee’s lab under Dr. Howard Clarke’s supervision, who was a PhD candidate at the time. This was an eye-opening experience because it unveiled the idea that as a clinician, one can also embrace research. At the time, there was little treatment for individuals with SCIs and the impact of these injuries were profound. After a particularly difficult on-call weekend as a junior neurosurgery resident, Dr. Charles Tator invited Dr. Fehlings to visit his lab where he studied acute SCIs from a basic science perspective.

“It was transformative because it made the decision for me to pursue graduate training in science,” Dr. Fehlings explained. As both a neurosurgeon and basic researcher, Dr. Tator played a pivotal role in fostering Dr. Fehlings’ passion for scientific inquiry. After graduating from the Surgeon-Scientist program at the University of Toronto, Dr. Fehlings completed a fellowship at the New York University Medical Centre where he built upon the necessary clinical and research skills that led him to where he is today.

Dr. Fehlings also acknowledges the strong support of his family as being critical in his career development.

As a recipient of numerous prestigious national and international awards, the two most momentous awards for Dr. Fehlings

32 | IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL

Dr. Michael Fehlings

MD, PhD, FRCSC, FACS, FRSC, FCAHS Professor of Neurosurgery Vice Chair Research for the Department of Surgery Co-director of the University of Toronto Spine Program Faculty member of the Institute of Medical Science Neurosurgeon at Toronto Western

Hospital and the University Health Network Gerry and Tootsie Halbert Chair in Neural Repair and Regeneration Senior Scientist at the Krembil Research Institute McLaughlin Scholar in Molecular

Medicine Scientist at the McEwen Centre for Regenerative Medicine Graphic design by Colleen Paris

FACULTY SPOTLIGHT

“

Some of the most important work that you will do in your life is the work you’re doing right now

”

were the Olivecrona Award (2009) for his work in traumatic SCIs, and most recently the Ryman Prize (2019) for enhancing the quality of life for the elderly. The earlier discoveries from his graduate work with Dr. Tator has directly impacted clinical practice today. Traditionally, it was not recommended to operate on patients with SCIs until they are stabilized.1 However, it was the basic science discovery of the vascular hypothesis in secondary injuries in SCIs,2 that led to clinical trials for early surgical decompression within 24 hours that significantly improved neurological recovery.3 The translational efforts in this bench-to-bedside approach represent a remarkable progress for such a complex injury, improving the quality of life for patients and serving as a standard clinical guideline worldwide.

able to repair what was once thought to be irreparable damage in chronic SCIs.

Today, Dr. Fehlings combines his active clinical practice in complex spinal surgery with translationally oriented research models that specialize in novel treatments such as regenerative medicine for traumatic and non-traumatic forms of SCIs. The Fehlings Lab has developed a line of novel, genetically engineered stem cells called the Spinal Microenvironment Modifying and Regenerative Therapeutic (SMaRT) cells that have the ability to break down glial scarring, a major barrier to regeneration. Although there are limitations to their use, the proofof-concept has been established and the SMaRT cells are part of a new era of regenerative medicine that may one day be

Like everyone, Dr. Fehlings and his team had to adapt when Toronto went into lockdown for COVID-19. Although it has been “turbulent”, Dr. Fehlings shared a few projects and positive lessons that he has learned over the last eight months.

One of the projects includes providing pre and post-operative neurosurgical care virtually for patients in remote communities. This has reduced waitlists for assessments and greatly enhanced the access to care from specialists. In addition, despite the halt of international travel, the advantage of teleconference technology has been transformative in terms of facilitating international collaborations.

Going forward, there are lessons learned

However, the work at the Fehlings Lab goes beyond just SCIs. In fact, Dr. Fehlings explains that the movement towards regenerative medicine has “potential impact for a range of devastating neurological conditions including stroke, brain trauma, multiple sclerosis, Alzheimer’s disease, and Parkinson’s disease.” Dr. Fehlings described exciting future work that combines regenerative medicine with rehabilitation processes.

With the ability of SMaRT cells serving as the regenerative substrate coupled with activity-based rehabilitation, this multi-disciplinary model combines stateof-the-art strategies from both fields that could optimize clinical outcomes.

that demonstrate what can and cannot be done well virtually. Procedures that can be efficiently performed through a virtual setting can save time and costs and redirect those resources to other needed areas.

As a professor and mentor for students and surgeons across the world, Dr. Fehlings also hasn’t forgotten what it was like to be in their shoes. He stated that his greatest achievements stemmed from his graduate work at IMS and it is important to acknowledge that “some of the most important work that you will do in your life is the work you’re doing right now.”

Furthermore, he noted the importance to “try your best to get the very best training you can, because it will open your eyes and provide you with skill sets not just for your professional life, but to all sorts of other areas that will enrich your life.”

References

1. Donovan WH. Spinal cord injury—past, present, and future.

J Spinal Cord Med. 2007; 30(2):85-100.

2. Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms.

J Neurosurg. 1991; 75(1):15-26.

3. Fehlings MG, Vaccaro A, Wilson JR, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the surgical timing in acute spinal cord injury study (STASCIS).

PloS One. 2012; 7(2):e32037. Available from:https://journals.plos. org/plosone/article?id=10.1371/journal.pone.0032037 4. Fehlings MG, Tetreault LA, Wilson JR, et al. A clinical practice guideline for the management of patients with acute spinal cord injury and central cord syndrome: recommendations on the timing (≤24 hours versus >24 hours) of decompressive surgery. Global Spine J. 2017;7(3 Suppl):195S-202S.

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL | 33

ALUMNI SPOTLIGHT

By Elizabeth Karvasarski

A

s an undergraduate and graduate student in Exercise Science at the University of Toronto (UofT), Dr. Stephen Wright transitioned into the Institute of Medical Science (IMS) program to pursue his PhD, which he received in 2018. Dr. Wright sat down virtually with IMS Magazine to discuss the academic journey that led him to his current role as a post-doctoral fellow in the Center for Heart, Lung & Vascular Health at the University of British Columbia (UBC). While discussing his different research projects, Dr. Wright also shared insightful advice for future students who are interested in pursuing careers in academia.

After spending approximately seven years in the Faculty of Kinesiology at UofT, Dr. Wright wanted to gain new perspectives on research, while staying at a worldclass research university. Therefore, he decided to transition from exercise science and working in the Athletic Center, to conducting research in a hospital setting through the IMS, which he believed would be a great way to get fresh perspectives.

As a Master of Science (MSc) student in Exercise Science under the supervision of Dr. Jack Goodman, Dr. Wright started off investigating the relevance of heart function to exercise capacity for highperformance athletes. While pursuing his MSc, Dr. Wright reckoned that the MSc

degree does an excellent job of sparking your interest for further research, as you become cognizant of how little you know.

Taking a step back from athletes, Dr. Wright became particularly interested in understanding heart function. This influenced his transition from studying athletes during his MSc to investigating heart function in healthy adults during his PhD. He realized “To really understand the heart, you need to examine how it functions in a variety of scenarios.”

Dr. Wright completed his PhD at the Mount Sinai Hospital Catheterization Research Laboratory, supervised by Dr. Susanna Mak. His project explored heart function of healthy individuals.

In the literature, there was a limited understanding of normal heart function in the human heart due to the lack of data available from “truly healthy people”.

Usually, individuals who receive tests of cardiac function, such as a right heart catheterization, are referred by their

doctors due to a variety of factors. They may have limited exercise tolerance, be sick, or have heart problems. In some of these individuals, the data from a right heart catheterization will show that the heart is not the cause of their problems.

Therefore, Dr. Wright explained that often these people are the ones assigned as ‘controls’ in studies, and are used to understand normal heart function. The problem here is that these individuals may not actually be heathy or reflect ‘normal’ physiology. His project addressed this issue by recruiting 36 people who had no evidence of cardiovascular disease, respiratory disease, or other acute or chronic illnesses. In the catheterization research laboratory, they studied how these participants’ hearts function at rest and during exercise via right heart catheterization. “The project contributed a substantial amount of truly healthy control data to our society’s shared knowledge,” Dr. Wright explained.

“To really understand the heart, you need to examine how it functions in a variety of scenarios.”

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Graphic design by Colleen Paris

ALUMNI SPOTLIGHT

By the time Dr. Wright completed his PhD, he had spent approximately 12 years at the UofT. While still wanting to continue investigating heart function and continuing doing human research at world-leading institutions, Dr. Wright was ready for a different experience. He was offered opportunities to pursue a postdoctoral fellowship at the Baker Institute in Melbourne, Australia, and the Center for Heart, Lung & Vascular

Health at UBC. Dr. Wright ultimately chose UBC because it offered a hybrid between the exercise science and medical science environments. And being an avid snowboarder for 15 years, moving out West seemed like a great fit for Dr. Wright.

Currently, Dr. Wright is continuing to look at integrated heart function while ultimately addressing the question: “What determines stroke volume (the amount of blood that your heart pumps)?” He and his lab are also looking at how changes in lung function affect the heart, which is an extension of his PhD work, but now integrating multiple organ systems. The core focus of the project is to understand if age-related changes in lung mechanics change pressures inside the chest and volumes that the lungs operate at during exercise, and if this in turn mechanically impacts the heart. Dr. Wright is using echocardiography (using ultrasound waves to make images of the heart) to look at heart structure and function. Various modes of echocardiography are being used. 3D imaging measures the volume of blood in the heart chamber, while Doppler measurements allow quantification of blood flow velocities. Speckle tracking is used to assess the motion of the myocardium (heart muscle) over the cardiac cycle. Additionally, the project investigates whether those differences affect males and females in the same way, since understanding the extent to which male and female hearts function similarly is very important.

When asked what advice he would give to IMS students, Dr. Wright believes students can maximize their chances of a successful and enjoyable graduate career “by finding the ideal Venn diagram overlap between yourself, your research project, and your supervisor”. As a student, it is important to be generally curious, have the capacity to work hard, and learn to be persistent.

Your project should be something that is intrinsically interesting to you, and impactful to society. It is also vital to be able to communicate the importance of your project. Your supervisor should not only be successful in their own area, but also be a skilled mentor. A good mentor values and shows interest in your career, progress, and well-being. It is important to be aware of the difference between a successful researcher who gets funding and awards, and a successful mentor who trains highly qualified future research leaders. Some of this you can’t control, but you increase the likelihood of the ideal Venn diagram overlap if you do your homework. This can be achieved by talking to people who work in your prospective lab or previously worked with your supervisor. If these conversations are complimentary and positive, it is a good sign. Dr. Wright explains that while graduate school is a lot of work, it can and should be a fun, positive experience, and the IMS does a great job of positioning students to perform cutting-edge research with world-class mentors.

IMS MAGAZINE FALL/WINTER 2020/21 ANSWERING THE CALL | 35

DIVERSITY IN SCIENCE

Understanding

INDIGENOUS REPRESENTATION

in Research and Medicine

By Nadia Boachie and Laura M. Best

I

nclusion of Indigenous voices, perspectives and experiences is essential for achieving equitable and effective infrastructure in Canada.

However, Indigenous people remain under-represented among health care professions and other STEM (science, technology, engineering or math) fields.

When considering healthcare, specifically, it was reported that in 2016 less than one percent of the 93,985 specialists and general practitioners in Canada were Indigenous, despite Indigenous people comprising 4.9% of the population.1 This deficit may, in part, be due to intergenerational trauma as well as other embedded systemic barriers. Entering a STEM or healthcare profession often requires a university education, yet the current learning environment remains disproportionately inaccessible and unsafe for many, including those of Indigenous heritage. As such, under-representation of Indigenous students is apparent among undergraduate degree programs in STEM fields, and only eleven percent of Indigenous people in Ontario have completed a university program.2 This is in stark contrast to the almost thirty percent of non-Indigenous Canadians in Ontario who completed university.3 To learn more about the ways that the University of Toronto is investing in creating a more supportive environment for Indigenous learners, and to discuss his own experiences as an Indigenous individual trained as a medical doctor, The IMS Magazine recently had the privilege of speaking with Dr. Chase Everett McMurren.

Dr. McMurren identifies as a queer, Indigenous individual. He exudes a humble, open demeanour and is devoted to fostering safe and inclusive spaces for Indigenous learners. A member of the Turtle Clan, he is training as a nâtawihôwêw* [not-a-way-who-ee-oo], or Medicine Man (*in Michif), while currently providing at-home care for long-living elders at Taddle Creek Family Health Team. Dr. McMurren is an Assessor and Clinical Supervisor for the College of Physicians and Surgeons of Ontario, the Medical Director of the Al and Malka Green Artists’ Health Centre at Toronto Western Hospital, and a supervisor for the Psychotherapy Training Program through the Medical Psychotherapy Association of Canada (MDPAC). At the University of Toronto, Dr. McMurren is an Assistant Professor in the Department of Family and Community Medicine, and the Theme Lead for Indigenous Health in the MD Program within the Temerty Faculty of Medicine.

When asked about the difficulties that Indigenous learners may encounter, Dr. McMurren described the numerous barriers that currently exist. Dr. McMurren explains how the healthcare system is based on colonial constructs. He describes how systemic racism is quite profound; the entire training that people receive to work in the medical field is really institutionalized. When asked about ways to reconcile with the past he answers, “I think the term stolen land also comes to my mind. It is hard to know where to start when our current society is built on subjugation and the attempted eradication of Indigenous people, it is kind of hard to repair that.”

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Colonization contributed to the complete marginalization of Indigenous people from mainstream society and the disruptive effects continue to be evident in situations concerning access to healthcare and education. “For me, I think lately, in particular in my role as Indigenous Health Theme Lead for the MD program and as the chair of ISAP [the Indigenous Students Application Program for admissions], I am of multiple minds. There is a deep desire to make space for Indigenous voices and Indigenous people as well as a strong hesitation to welcome them into such a scary place. It can be quite unsafe, from a soul perspective,” he concludes.

To overcome some of these barriers, universities are working to develop more infrastructure to support Indigenous students. For example, the U of T is investing resources in dismantling forms of racism on campus. “We are very lucky at the University of Toronto,’’ Dr. McMurren says. He explains how U of T is working on improving several programs, like ISAP, to help Indigenous students along every part of the university journey, from admission to graduation. In the Temerty Faculty of Medicine, Dr. McMurren and colleagues, including Dr. Lisa Richardson and Rosary Spence (a Knowledge Keeper) are developing more inclusive resources and he explained how a change in the name of their office was a great start. Formerly the Office of Indigenous Medical Education, the now Office of Indigenous Health will “be inclusive of the MD program, the postgraduate and the graduate Health Sciences, and the Rehab Sciences.” Dr. McMurren continues, “We are also partnering with the Center for Wise Practices in Indigenous Health at Women’s Graphic design by Ingrid Barany

DIVERSITY IN SCIENCE

”When I was given my mistikwaskihk (drum), it initially felt too powerful and sacred to play. After being able to connect with it over time, it now feels like a respectful friendship. The steady beating of the drum is a reminder of our mother’s heartbeat when we were in the womb, our own heartbeat, and the heartbeat of all life. I’m reminded of what China Achebe has said: ‘Whatever music you beat on your drum there is somebody who can dance to it.’”

-Dr. Chase McMurren Photo Credit: Krystal Jacques

College, which is really delightful. There is more space being made for an Indigenous perspective and it is very exciting. I think it is coming at a very important time.”

U of T has been extremely fortunate this year “because of the huge endowment of money to the Temerty Faculty of Medicine,”3 Dr. McMurren says. He describes how the unfortunate death of Joyce Echaquan happened shortly after

receipt of the endowment, and this timing created transparency to the blatant issues of racism in healthcare.3 Joyce Echaquan was a 37-year-old Atikamekw woman who died on September 28th, 2020 at Centre hospitalier de Lanaudière in Joliette, Quebec. Joyce Echaquan recorded a Facebook Live video that showed her screaming in distress and healthcare workers abusing her. “There is a clear acknowledgement that racism is not some

remote small issue. It is front and center,” Dr. McMurren explains. Money from the endowment is being allocated toward Indigenous causes such as establishing an Elder-in-Residence and a Circle of Elders, to support Elders working with the Temerty Faculty and ensuring Indigenous health education and leadership is supported in perpetuity.4

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DIVERSITY IN SCIENCE

“I never would have imagined that harp music would be part of my formulary as a physician, though I’m honoured that I’m able to integrate prescriptive, personspecific music into the support I offer.

Studying harp therapy has made it very clear that attunement — using ourselves as “tuning forks” to care-fully connect and resonate with one another — is at the heart of being seen and understood,” says Dr. Chase McMurren.

Photo Credit: Krystal Jacques

In response to preventable deaths like that of Joyce Echaquan, there has been a lot of recent attention to social justice issues in the media, specifically on the topic of racism in society. Calls to action are often emphasized but can also be overwhelming.

Dr. McMurren explains that “it sometimes terrifies me...there can be a lot of suffering and healing that is thrown to the side because people feel like we need to focus on action.” He calls for equal parts action, advocacy and “strong change making,” as well as clear attention to wellbeing. “If we are not well, and if our actions are not coming from a place of wellness, or even a desire for wellness, it feels like eating off of plates that haven’t been washed,” he explains. “We have to focus on healing, so that is something that is really coming up for me in my role as Lead at the Office of Indigenous Health,” he shares.

Dr. McMurren concludes by explaining that in medicine, but more so in society, we tend to make immediate judgments about the quality of something. While

this behaviour can be beneficial, for diagnosticians for example, it may not promote an inclusive environment for the healing of learners or patients and, in this respect, medicine is a field that also requires humility, open-mindedness and kindness. Cultural Humility, specifically, is having a humble and respectful attitude toward people of other cultures; it is the willingness to learn from others.5 It allows people to recognize their own cultural biases, and is an important concept as the field moves forward.

“I will say that cultural humility is a very powerful medicine. People are generally not disagreeing or holding on to specific views because they are trying to be terrible people. It is usually because they are afraid and doing the best they can,” he explains.

Dr. McMurren thinks that acting through a lens of compassion will benefit healthcare overall, and he works to spread these teachings, often derived from Indigenous culture, to educate his peers and to assist new learners. Cultural humility has proven

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elemental in treatment of patients, and it must become common practice in learning environments alike. This is just one essential step to help improve the inclusivity of STEM fields, and remove barriers that still exist due to irreversible traumas toward Indigenous peoples and other minority groups.

References 1. Statistics Canada [Internet]. Aboriginal Peoples in Canada: First Nations People, Métis and Inuit. 2017 May 25. [cited 2020 Dec 4].

Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/171025/dq171025a-eng.htm?indid=14430-1&indgeo=0 2. IndeSTEAM [Internet]. Indigenous Perspectives in STEM & STEAM opening doors for all. [cited 2020 Dec 4]. Available from: https://www.indigesteam.ca 3. Canadian Federation of Students–Ontario [Internet]. First Nations, Inuit and Métis Education in Ontario. 2017 Jan. [cited 2020 Dec 4] Available from: https://www.cfsontario.ca/wp-content/uploads/2018/10/2017.01-Indigenous-Education-fact-sheet.pdf 4. U of T News [Internet]. University of Toronto receives single largest gift in Canadian history from James and Louise Temerty to support advances in human health and health care. 2020 Sept 24. [cited 2020 Dec 4].

5. Available from: https://www.utoronto.ca/news/university-toronto-receives-single-largest-gift-canadian-history-james-and-louise-temerty 6. Yeager KA, Bauer-Wu S. Cultural humility: essential foundation for clinical researchers. Appl Nurs Res. 2013;26(4):251-256. doi:10.1016/j.apnr.2013.06.008

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