IMS Magazine Winter 2023

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THINK. LEARN. DISCOVER.

Disorders of the CNS

WINTER

The Power of Technology Personality Changes Following a TBI

Student Spotlight on Donna Yang

Student-led initiative
A
Charging-up People with Dementia Does a Person Become their Disease? Stepping out of your Comfort Zone 2023
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IN THIS ISSUE

EDITORS-IN-CHIEF: Jason Lo Hog Tian Stacey J.

EXECUTIVE DIRECTORS:

Dorsa Derakhshan

Elizabeth Karvasarski

Iciar Iturmendi Sabater

Kyla Trkulja

PHOTOGRAPHERS:

Dorsa Derakhshan (Director)

Niki Akbarian

SOCIAL MEDIA TEAM:

Elizabeth Karvasarski (Director)

Nikou Kelardashti

Lizabeth Teshler

DESIGN EDITORS:

Xinyi Li (Director)

Joshua Koentjoro

Anais Lupu

Vanessa Nguyen

Emily Tjan

Livia Nguyen

Stephen Nachtsheim

JOURNALISTS & EDITORS:

Bahar Golbon

Vaidhehi (Veena)

Sanmugananthan

Goldin Joghataie

Eileen Liu

Mahbod Ebrahimi

Lindsey Thurston

Iciar Iturmendi Sabater

Kateryna Maksyutynska

Jasmine Ali-Gami

Archita Srinath

Molly Zhang

Dhvani Mehta

Sipan Haikazian

Sally Wu

Akshat Pai

Carmen Li

Beatrix Wang

Madhumitha (Madhu)

Rabindranath

Shu’ayb Simmons

Carmen Li

Nikou Kelardashti

Rehnuma Islam

Ben Traubici

Lizabeth Teshler

Letter from the Editors 4 Director’s Message 5 Features 10 BMC Showcase 20 Viewpoints 22 Commentary 30 Faculty Highlights........................................ 32 Alumni Spotlight 36 Diversity in Science..................................... 38 Travel Bite 40 IMS Events 41 Book Review 42 Raw Talk 107th Episode 44 Contributors 6 Infographic 8 Copyright © 2023 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.
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FEATURE INFOGRAPHIC COVER ART By Joshua Koentjoro, MScBMC Candidate (2T3)
8 Student Spotlight 34 3 IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS |
By Anais Lupu, MScBMC Candidate (2T3)

Letter from the EDITORS

We hope you all had a restful winter break as we ring in what will hopefully be a fantastic new year. We reflect on a successful 2022 year at IMS Magazine, continuing to release quarterly issues and ramping up the production of our beautiful hard copies now that COVID19 restrictions have lifted. This is also the first issue produced with our new 2022/2023 team. We are grateful to all our returning journalists, editors, and designers for their commitment to the magazine and we are excited to showcase the some of the work of our new members.

In this issue, we focus on Diseases of the Central Nervous System, a critical research area for human health. We highlight the work of Drs. Arlene Astell, Corrine Fischer, James Kennedy, Charles Tator, and Cecil Hahn, all of whom are doing innovative research examining CNS-related conditions such as dementia, epilepsy, concussions, and neuropsychiatric disorders. We also spotlight the lives of interesting members of the IMS community including Dr. Gabriella Chan who advocates for better education around intellectual property and Donna Yang, a researcher with the Reach Alliance who is aiming to address the UN Sustainable Development Goals.

We have some insightful Viewpoint articles covering topics such as the impact of a traumatic brain injury on a person’s personality, understanding consciousness through psychoanalysis and neuroscience, improving the affordability of dementia care, and finding your sense of community as a graduate student. We also have a Diversity in Science article examining the state of rural healthcare in Canada, an interesting Travel Bite comparing one students’ experience attending conferences in different countries, and a Commentary on the recent overturning of Roe v. Wade. Lastly, we are pleased to continue our ongoing collaboration with Raw Talk Podcast with an article on their recent episode on Neonatology.

We hope you enjoy reading this issue and learning about the incredible work going on at IMS. We wish you all an excellent 2023 and stay tuned for exciting new initiatives from IMS Magazine this year!

Jason is a 4th year PhD student examining the mechanisms linking HIV stigma and health under the supervision of Dr. Sean Rourke.

JasonLoTweets

Stacey Butler

Stacey is a 4th year PhD student under the supervision of Dr. Andrea Gershon evaluating the quality of care for patients with respiratory disease using a population-based approach.

Jason Lo Hog Tian
LETTER FROM THE
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EDITORS

DIRECTOR’S MESSAGE

The start of a new year is a chance to reflect on where we have been and look forward to what lies ahead. This past year we were once again able to gather with our colleagues and celebrate our achievements after a long hiatus. We were reminded of the importance of human connection and the power it has to uplift our spirits. I am looking forward to the many events to come in 2023 and the opportunity to celebrate the achievements of our IMS community.

The Winter 2023 issue of IMS Magazine focuses on the brain and spinal cord, highlighting the breadth of research being conducted in the IMS and the many advances in our understanding of the central nervous system. This issue features faculty who are working hard to effectively translate research into clinical practice and improve the lives of patients living with neurological disorders. Dr. Arlene Astell’s lab is making technology accessible to individuals living with dementia and witnessing the impact this has on the patient’s quality of life. The work of Dr. Corrine Fischer and Dr. James Kennedy recognizes the diverse ways neuropsychiatric diseases can present and the need for a personalized approach to diagnosing and treating these conditions. A feature article on Dr. Charles Tator discusses the need for a better diagnostic tool for concussions. Dr. Cecil Hahn’s work is enabling intensive care unit (ICU) workers to recognize and quickly treat non-convulsive seizures in newborns.

Two fields you may not expect to see covered in IMS Magazine are law and economics, but in this issue, we showcase how embracing new opportunities can lead our students and alumni to unique places. Dr. Gabriella Chan, a lawyer and IMS alumnus, shares how critical it is for scientists to understand intellectual property. This is particularly relevant given the innovative discoveries made by IMS researchers. Master’s student Donna Yang is travelling to Rwanda next year to study economic justice with the University of Toronto’s Reach Alliance and IMS Magazine Co-Editor in Chief, Jason Lo Hog Tian. We wish them best of luck on this adventure and look forward to hearing about their experience when they return.

This past year, we celebrated the accomplishments of students in the Summer Undergraduate Research Program (SURP) at the annual SURP Research Day. You can find a recap of the day in this issue and hear from the Jasmine Quigley Memorial Award winners, Wenzhu Ye and Cherrie Zhu. Applications for the 2023 SURP program are open, and I am already looking forward to seeing what the students accomplish at the 2023 SURP Research Day.

I would like to thank the Editors-in-Chief, Jason and Stacey, along with the editors, journalists, photographers, and design team for putting together another great issue of IMS Magazine. I hope you will find enough inspiration in this issue to make it through yet another Canadian winter.

Sincerely,

DR. MINGYAO LIU Director, Institute of Medical Science Professor, Department of Surgery Senior Scientist, Toronto General Hospital Research Institute, University Health Network
DIRECTOR’S MESSAGE 5 IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS |
Photo Credit: Mikaeel Valli

Contributors Winter 2023

Jasmine Ali-Gami is a MSc student at IMS researching the long-term neurological impacts in patients who have had a pediatric Enterovirus (EV-71) infection. Her work is under the supervision of Dr. Hsiang-Yuan Lin at CAMH. Outside of academia, Jasmine enjoys spending her time swimming, reading, and exploring different coffee shops!

Bahar Golbon is a second year MSc student investigating the surgical outcomes of primary hyperparathyroid patients in Ontario under the supervision of Dr. Jesse Pasternak. In her free time, you can find Bahar completing her millionth puzzle, and drinking a cup of coffee!

Mahbod Ebrahimi is a first year MSc student investigating the association between immune gene expression and suicide risk in schizophrenia patients under the supervison of Dr. James Kennedy. Outside of research, Mahbod enjoys a good book, playing chess, and listening to Jazz music.

Sipan Haikazian is a first year MSc student researching the efficacy and safety of maintenance ketamine infusions for relapse prevention in patients with treatment-resistant bipolar depression, under the supervision of Dr. Joshua Rosenblat. Outside of research, Sipan enjoys playing the piano, exercising, and being around good company.

Iciar Iturmendi Sabater is a PhD student researching social processing and adaptation across neurodevelopmental conditions (autism, ADHD, learning disabilities, etc) under the supervision of Dr. Meng-Chuan Lai and Dr. Hsiang-Yuan Lin. Iciar likes reading, exploring new places, and spending time with family and friends.

Eileen Liu is a first year PhD student supervised by Dr. Sunit Das and Dr. Vitor Pereira at St. Michael’s Hospital. Her research project focuses on the use of endovascular radiosurgery as a way to treat brain tumors. Outside of academia, Eileen enjoys running, exploring new activities and trying new food.

Goldin Joghataie is a first year MSc student supervised by Dr. Carmela Tartaglia at the Krembil Brain Institute, Toronto Western Hospital. Her research focuses on neurodegeneration and concussion, specifically post concussion neuropsychiatric issues faced by ND patients who experience falls. Outside of academia she enjoys writing, skating, listening to music and reviewing movies.

Kateryna Maksyutynska is a second year MSc student investigating whether brain insulin resistance is a feature of the biology of depression under the supervision of Dr. Mahavir Agarwal and Dr. Margaret Hahn at CAMH. Outside of the lab, she can be found enjoying a good book, painting, or biking along the water.

Dhvani Mehta is a first year MSc student investigating the effectiveness of repetitive transcranial magnetic stimulation in treating cannabis use disorder under the supervision of Dr. Tony George and Dr. Victor Tang at CAMH. Outside of the lab, Dhvani enjoys reading, writing poetry, sketching, and hiking.

Akshat Pai is a PhD student investigating the role of health inequities in childhood stroke care and outcomes under the supervision of Dr. Nomazulu Dlamini at the Hospital for Sick Children. Outside of the lab, Akshat is a longdistance runner, enjoys reading non-fiction books, and is passionate about mentorship.

jasminealigami BaharGolbon mahbooli99 gol_99 sipanhaikazian iciar_itur gol.joghata EileenLiuXY d.vani.m
Graphic design by Xinyi Li CONTRIBUTORS 6 | IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS
AkshatMPai

Vaidhehi (Veena) Sanmugananthan is a PhD student under the supervision of Dr. Karen Davis at the Krembil Brain Institute, Toronto Western Hospital. Her research focuses on examining pain and attention interactions in people that suffer chronic pain. Outside of the lab, Veena loves to run, play squash, sketch, and challenge herself to learn new art mediums!

Lindsey Thurston is a PhD candidate studying sex/gender and sex steroid hormones in the brain. She investigates biopsychosocial relationships in white matter microstructure using diffusion tensor imaging. Lindsey’s work with transgender and gender non-conforming populations bridges social and scientific disciplines by drawing on neurofeminist theory.

Sally Wu a PhD student under the supervision of Drs. Mahavir Agarwal and Margaret Hahn at the Centre for Addiction and Mental Health. Her research focuses on investigating the effects of antipsychotics on central insulin dysregulation using 2DG autoradiography. Outside of the lab, Sally enjoys reading, traveling, and eating her way through the city!

Social Media Team

Elizabeth Karvasarski (Lead) is a PhD IMS at Mount Sinai Catheterization Laboratory under the supervision of Dr. Susanna Mak. Her research involves investigating right ventricular and pulmonary arterial interactions in patients with pulmonary hypertension and heart failure. Outside of research, Elizabeth practices martial arts and is a 4th degree black belt.

Lizabeth Teshler is a first year MSc student at IMS supervised by Dr. Brian Feldman at The Hospital for Sick Children. Her research investigates physical joint health assessment in people with Hemophilia. Outside of research, Lizabeth loves biking, spending time outdoors and volunteering for various community initiatives.

Nikou Kelardashti is a first year MSc student under the supervision of Dr. Karen Davis. Her research focuses on neural oscillations and attentional focus in chronic pain. Outside of academia, Nikou enjoys reading poetry and classic literature, watching old movies, and going for long walks.

Archita Srinath is a second year PhD student at Toronto Western Hospital studying the pathogenesis of Ankylosing Spondylitis. She is also passionate about mentorship, science communication and spending time with her two adorable puppies.

Kyla Trkulja is a second year MSc student studying under Dr. Armand Keating, Dr. John Kuruvilla, and Dr. Rob Laister at Princess Margaret Hospital. Her work focuses on understanding the mechanism of action of a novel cancer therapy for lymphoma. Outside of academia, Kyla enjoys reading, writing, video games, and going on road trip adventures.

Molly Zhang is a first year MSc student at IMS studying the effects of cannabis abstinence on MDD symptoms under the supervision of Dr. Tony George and Dr. David Castle at CAMH. Outside of academia, she can be found hiking, enjoying a good book, or looking online for silly outfits to dress up her dog in.

2T3 IMS Design Team

The IMS Design Team is a group of second year MSc students in the Biomedical Communications (BMC) program. Turning scientific research into compelling visualisations is their shared passion, and they are thrilled to contribute to the IMS Magazine.

Joshua Koentjoro joshuakoentjoro.com Anais Lupu art.anais_ Stephen Nachtsheim panicatthestevo Vanessa Nguyen vanesola_numyen Emily Tjan chemdrop Livia Nguyen livia.n.art sanmugananthan
CONTRIBUTORS 7 IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS |
kylatrkulja_
Compiled
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by Kyla Trkulja
Graphic Design
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by Joshua Koentjoro

Charging-up People with Dementia: The Power of Technology

Approximately 55 million individuals around the world are living with dementia, and this number is expected to reach 139 million by 2050 due to the growing elderly population.1 Dementia is defined as cognitive deterioration beyond the expected effects of biological ageing, affecting many functions including thinking, learning, orientation, social behaviour, and emotion.1 According to current research, a challenge for people living with dementia and their caregivers is identifying engaging activities that are both familiar and understood by the individual.2 Participating in activities can demonstrate these individuals’ capabilities, shocking both caregivers and the patients themselves.

Dr. Arlene Astell has been tackling this problem for more than 20 years. Dr. Astell is an Assistant Professor at the University of Toronto’s Institute of Medical Science (IMS) and the Faculty of Occupational Science and Occupational Therapy. Additionally, she is the director of the Dementia Ageing Technology Engagement (DATE) Lab at the KITE Research Institute.

Naturally, participating in entertaining activities can decrease boredom and encourage positive emotions.3 A study completed in 2016 by Dr. Astell’s lab states that “there is no reason to believe that a diagnosis of dementia should alter people’s interests and hobbies.” Although this is a very simple statement, it holds immense power. The public seems to believe that a

dementia diagnosis is equivalent to a death sentence, but this could not be further from the truth.

The DATE Lab focuses on “promoting positive ageing” by employing technology to engage older adults. One of their projects uses Xbox Kinect to involve older adults in a game of virtual bowling. The Kinect does not have a controller –the player makes movements with their hands and arms to control the action on the screen. This is straightforward and user-friendly making it an ideal tool to introduce to a generation who tend to be unfamiliar with new-age technology. Importantly, this device employs the use of both visuals and sound effects to acknowledge the user’s interaction and accommodate possible comorbidities such as hearing or vision loss. This activity provides socialization with new groups, a light workout, but most significantly, a fun experience. Dr. Astell recounts how successful this activity has been because of the encouragement players receive from their fellow competitors and the confidence it instills; to the point where they forget about their walker, eagerly waiting for their turn!

Another tool that the lab often employs are tablets. Similarly, devices with touchscreens have simple controls that make them suitable for this population. An innovative venture initiated by the DATE Lab is Accessible Touchscreen Apps for Dementia, otherwise known as ‘AcTo Dementia’. The project’s goal

is to improve accessibility of digital activities to adults with dementia by providing recommendations of preexisting apps that are appropriate for this population. On their website, one can find an abundance of information to assist caregivers in selecting and tailoring games to the needs of their loved one or patient. The website includes over 60 tablet game recommendations that have been selected using an evidence-based review criteria, strengths and limitations of each activity, and recommended app settings. Encouraging individuals with dementia to participate in appropriate and independent activities can be highly beneficial as it promotes autonomy and minimizes dependence on others, catering to a very important need in the community.

A challenge that many encounter, especially in culturally diverse areas like the Greater Toronto Area, are language barriers. AcTo Dementia has attempted to mitigate this issue by concentrating on popular games that many would have played prior to the onset of dementia, such as sudoku and tic-tac-toe. AcTo Dementia also provides information on available languages offered by each app. Impressively, most of the information found on the website is available in Spanish and some is also available in Chinese.

Part of the reason behind AcTo Dementia’s broad and effective considerations are due to the fact that it was designed alongside people with dementia to maximize

FEATURE 10 | IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS Graphic design by Livia Nguyen

accessibility and meet these individuals’ unique needs. Dr. Astell explains that the DATE Lab heavily relies on feedback from people living with dementia, families, and other caregivers to improve how technology is used and formatted for this patient population. In fact, their research into investigating the potential of tablet use was inspired by “an Alzheimer's Society members survey highlighting the need for stimulating recreational activities for people with dementia.”4

Technology is more accessible now than ever before. However, it can still be very

costly for families to dedicate a device to a single user strictly for entertainment purposes. The DATE Lab is striving to resolve this concern through the ‘Let’s Connect’ project by providing devices and activity sessions at long-term care homes and adult day programs. During these sessions, individuals participate in engaging activities on tablets, both independently and in pairs. People living with dementia tend to have difficulty socializing because of their disease impediments or simply because they are out of practice. But, contrary to popular belief, the computer plays a vital role in facilitating connections. Dr. Astell notes, “the computer plays an interesting part, it is like a third-party in the interaction. If people can’t think of something to say, having this thing that you can both look at, this shared focus, provides a very good medium in the conversation.” After participating in the sessions, families can also take a Let’s Connect kit to test out at home. One of the main drawbacks is extending this activity format to remote, rural areas with limited access to Wi-Fi and learning facilities. Hopefully, spreading information about projects done by researchers like Dr. Astell and her team diminishes the stigma surrounding the capabilities of dementia patients and expands funding for the distribution of technology to a greater population.

Most people with dementia quickly transition from living independently and taking care of themselves to having to solely rely on others for every aspect

of their life. This little bit of alone time and control, provided by the techniques employed by the DATE Lab, has made a substantial difference in the lives of many. Dr. Astell continues to empower elders with the goal to maintain happiness and autonomy in the ageing population.

If you would like to learn more about Dr. Astell’s work, please visit:

DATE Lab website: https://www.date-lab.com/

AcTo Dementia website: https://www.actodementia.com/

References

1. Dementia https://www.who.int/news-room/fact-sheets/detail/dementia (accessed Nov 9, 2022).

2. Joddrell, P.; Astell, A. J. Studies Involving People with Dementia and Touchscreen Technology: A Literature Review. JMIR Rehabil. Assist. Technol. 2016, 3 (2). https://doi.org/10.2196/rehab.5788.

3. Leng, F. Y.; Yeo, D.; George, S.; Barr, C. Comparison of IPad Applications with Traditional Activities Using Person-Centred Care Approach: Impact on Well-Being for Persons with Dementia. Dementia 2014, 13 (2), 265–273. https://doi. org/10.1177/1471301213494514.

4. Joddrell, P. Investigating the Potential of Touchscreen Technology to Create Opportunities for Independent Activity with People Living with Dementia. 2017

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Photo provided by Dr. Astell

A New Frontier of Neonatal Epilepsy Research:

Empowering Bedside Workers to Recognize Subclinical Seizures in Neonates through EEG Monitoring and Quantitative EEG

Seizures are alterations in neurologic function characterized by excessive, hypersynchronous activity of networks of neurons in the brain.1,2 Epilepsy is characterized by recurrent seizures that are unprovoked.1,2 Seizures can be diagnosed and monitored using a tool called an electroencephalogram (EEG), which permits the non-invasive observation of electrophysiological dynamics of the brain by measuring brain electrical fields through an array of electrodes that are placed on the scalp.3 Acute neonatal seizures are the most common expression of neurological injury among newborns that are critically-ill or comatose in neonatal intensive care units (NICUs).1,4 Ultimately, these neonates are at risk of developing neuro-developmental disabilities which could severely affect their quality of life.

Dr. Cecil Hahn is a neurologist, clinical neurophysiologist and researcher at Toronto’s SickKids Hospital studying epilepsy, neurocritical care, and neonatal neurology. He has made it his goal to find ways to maximize the outcomes for newborns with acute seizures. To do this, he has tailored his research questions to complement his clinical work in neonatal neurocritical care. We sat down with Dr. Hahn to discuss some of the key questions and challenges that he tries to tackle in his work as a clinicianinvestigator in neonatal neurocritical care and epilepsy, a very niche and exciting field in pediatric neurology.

Why are seizures and seizure intervention in neonates the focal point of Dr. Hahn’s research?

According to Dr. Hahn, different types of seizures may occur in critically ill patients, some of which are harder to detect than others. By applying continuous EEG monitoring, his team has identified that about 25% of children who are in a coma in the ICU are experiencing electrographic seizures, and that “about 70-80% of those seizures are what we call subclinical seizures, or non-convulsive seizures.” It is difficult or impossible to notice these subclinical seizures by looking at the patient; the only way to identify them is by using EEG. One of the major challenges faced in neonatal neurocritical care research is identifying “whether those subclinical seizures are also causing harm [and] whether they also warrant treatment”.

What sorts of interventions can be made in the ICU to identify subclinical seizures in neonates?

In order to address the challenge of identifying and learning about subclinical seizures in neonates, Dr. Hahn and his team have been working on improving the standard of neonatal care at SickKids Hospital and finding new ways to recognize subclinical seizures in the ICU. Surprisingly, it is not a universal

standard of care to do brain monitoring on all critically ill newborns. However, SickKids has played a leading role in the implementation of EEG-based brain monitoring5 alongside other types of physiological monitoring (e.g., heart, respiration) in NICU care.

Critical care EEG monitoring is not without its challenges. Formal EEG interpretation can only be done by clinical neurophysiologists who have specialized in this field. According to Dr. Hahn, there are not enough such experts available to actively monitor EEGs on every newborn in the NICU and accurately pinpoint whether seizures are occurring. This creates a large constraint on identifying the occurrence of subclinical seizures in critically ill newborns.

How can we empower ICU bedside caregivers to recognize seizures?

In light of these limitations, Dr. Hahn and his team have been developing a new type of EEG display that will hopefully empower bedside caregivers who are not typically trained to interpret EEGs to recognize subclinical seizures in newborns. Their aim is to create “a monitor that would display brain activity that’s simplified enough that it could be interpreted by someone who’s not an EEG expert in order to recognize subclinical seizures.”

FEATURE 12 | IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS Graphic design by Emily Kate Tjan

Dr. Cecil Hahn

MD, MPH, FRCPC; Senior Associate Scientist, Program in Neurosciences and Mental Health, SickKids Research Institute; Staff Neurologist, Division of Neurology, SickKids Hospital; Associate Professor, Department of Pediatrics (Neurology), Associate Member, Institute of Medical Science, University of Toronto

Quantitative EEG6 is a method used to transform the raw EEG signal into a visually simplified signal, typically through color coding, time-compression, and reducing the number of EEG channels to take up less display space on a monitor. Dr. Hahn’s team has evaluated the sensitivity and specificity7 of quantitative EEG displays for seizure detection by EEG experts and non-experts (e.g. ICU nurses, ICU physicians). Based on this work, Dr. Hahn feels that anyone can learn how to recognize seizures using these tools. “You don’t need to know a lot about EEG, or seizures; there is a characteristic ‘fingerprint’ of what a seizure looks like, which anyone can learn to recognize with about an hour of training.”

How has quantitative EEG been useful in a clinical setting?

According to Dr. Hahn, quantitative EEG displays have been helpful in several cases when seizures have occurred in the middle of the night. ICU caregivers who are not typically trained in reading regular EEGs have been able to use quantitative EEG displays to recognize seizures occurring in their newborn patients, which has enabled them to treat their seizures quickly. As exciting as this implementation is, he emphasizes that this tool does not replace the expertise of clinical neurophysiologists like himself. “You still need confirmation of seizures by an expert, but quantitative EEG can shorten the time between seizure occurrence, recognition and treatment, and can empower bedside caregivers to make timely treatment decisions.”

What has been shared here is just the tip of the iceberg of Dr. Hahn’s research in neonatal neuromonitoring. His work-to-date demonstrates an extensive multi-dimensional research approach that aims to simultaneously develop a fundamental understanding of the impact of acute neonatal seizures, as well as develop creative solutions for their identification through technology and education that can be applied in a clinical setting. “Research operates at a very different timeframe from clinical care, in that can take years to see progress. But research discoveries, can have an impact well beyond the individual patient.”

We look forward to seeing what’s to come in Dr. Hahn’s journey in identifying and understanding subclinical seizures in neonates.

References

1. Pisani F, Facini C, Pavlidis E, Spagnoli C, Boylan G. Epilepsy after neonatal seizures: Literature review. European Journal of Paediatric Neurology. 2015 Jan 1;19(1):6–14.

2. Stafstrom CE, Carmant L. Seizures and Epilepsy: An Overview for Neuroscientists. Cold Spring Harb Perspect Med. 2015 Jun;5(6):a022426.

3. Cohen MX. Where Does EEG Come From and What Does It Mean? Trends in Neurosciences. 2017 Apr 1;40(4):208–18.

4. Pellegrin S, Munoz FM, Padula M, Heath PT, Meller L, Top K, et al. Neonatal seizures: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine. 2019 Dec 10;37(52):7596–609

5. McCoy B, Hahn CD. Continuous EEG monitoring in the Neonatal Intensive Care Unit. Journal of Clinical Neurophysiology. 2013;30(2):106–14.

6. Stewart CP, Otsubo H, Ochi A, Sharma R, Hutchison JS, Hahn CD. Seizure identification in the ICU using quantitative EEG displays. Neurology. 2010;75(17):1501–8.

7. Department of Health [Internet]. Disease Screening - Statistics Teaching Tools - New York State Department of Health. [cited 2022Oct26]. Available from: https://www.health.ny.gov/diseases/ chronic/discreen.htm#:~:text=Sensitivity%20refers%20to%20a%20 test%27s,have%20a%20disease%20as%20negative.

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Photo Credit: Niki Akbarian Photo Credit: Niki Akbarian

Neuropsychiatry and Dementia

How much do we really know? And how much of what we know, can we use right now?

This is the day and age of neuroscience, specifically, neurodegeneration and neuropsychiatry. But how much of the excitement from the progress we’re making with research impacts patients who are currently on waitlists to be treated by a clinician?

The number of people diagnosed with diseases that have dementia as a symptom is rising rapidly. It is estimated that currently, ~55 million people have dementia.1 This alarming number will grow exponentially in the next thirty years with the aging population.

These increasing numbers are not just because of better diagnostic techniques and public health literacy, but also because of an exponentially growing population of older adults who are facing many risk factors for the disease: loneliness, depression, stress-induced triggering of a hereditary gene, a suddenly activated dormant virus from a previous infection (ex. chickenpox or COVID-19), improper sleep and an unhealthy diet. With all these confounds, uncertainties, and multiple causes, it may seem easier to say that the only way to treat a neurodegenerative disease like Alzheimer’s disease (AD) is to prevent it.

However, the ironic statement of treatment is prevention cannot satisfy the immense pressure and hardship felt by Alzheimer’s patients and their families. Specifically, neuropsychiatric symptoms alone that result from AD cannot be ignored when a person has passed the initial stages of disease onset. “I hear a lot about prevention.

I think prevention is great.”, says Dr. Corinne Fischer, an associate professor in the IMS. “But the reality is that even if you do everything completely right, there is still a risk that you are going to develop dementia and behaviour sequelae of dementia. Some things you cannot prevent entirely, and often by the time we see patients with neuropsychiatric symptoms, the clock is ticking, and they are already manifesting a disorder.”

Dr. Fischer, who has been a geriatric psychiatrist for over 20 years, states that her main interest in research is identifying specific markers and finding the association between neuropsychiatric symptoms in AD and abnormalities in the brain. She finds this to be the most immediate and crucial gap in the field. Most of her work focuses on finding the neural correlates of neuropsychiatric symptoms, specifically psychosis, in dementia among older patients through analyzing brain scans, genetics, pathological markers, and clinical and cognitive markers.

Currently, there are many differing narratives about biomarkers in neurodegeneration. Alzheimer’s disease, for example, has been linked to the aggregation of the misfolded versions of the amyloid beta and tau proteins. In recent years, however, these correlations have been questioned in terms of direct impact, validity, and specificity to the disease.

“There isn’t such a good relationship between a biomarker and clinical disease,”

Dr. Fischer adds. “You can have lots of amyloid pathology and be normal. Or have a little bit and be quite impacted. Even more so with neuropsychiatric symptoms, there isn’t even a basic marker here. Does more tau and amyloid equate to more symptoms? Maybe. Maybe not. But not for sure.” Dr. Fischer also stated that there is no specific age of onset for diseases such as Alzheimer’s, and notes that demonstrable changes in memory, behaviour and general functioning should be the indicators more so than age. “Some say [at] 65 years [of age], but then there are people who are 85 years old and have absolutely no issue, and there are those who are 45 and have significant impairment. I would flag and look out for signs based on clinical symptoms.”

But diagnosing AD based on clinical symptoms isn’t always easy. Mild or common symptoms like anxiety, depression, or apathy often do not even come to clinical attention as people are usually more worried about frontal lobe symptoms such as disinhibition, aggression, and psychosis, which are fortunately not as frequent. However, symptoms of anxiety and depression can be connected to the diagnosis of mild behavioural impairment (MBI), which may suggest that the emergence of these symptoms prior to the onset of cognitive decline could be a marker of dementia. People with MBI are also at more risk for experiencing cognitive decline.

Continuing with this, another part of the puzzle is the chicken and egg situation when it comes to neuropsychiatry. How can

FEATURE 14 | IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS

Associate Professor, Division of Geriatric Psychiatry and the Institute of Medical Science, University of Toronto

you tell if a present issue such as anxiety or depression is the cause or the result of dementia or AD? In other words, how can one know if a symptom is a prodromal warning sign of neurodegenerative disease onset, or if it is the aftermath of already progressed brain deterioration? Dr. Fischer adds that this issue is also due to the fact that we currently do not have clear, direct, biomarkers that can be identified in brain scans or blood tests.

Dr. Fischer also highlighted that since individuals with dementia often may not recall their situation accurately, a crucial step for clinicians is to get a really good

history, specifically collateral history and to ask family members about the patient’s medical background. “You want to know if this is an emergent problem, if it has been there before, or if it is an exacerbation of something that was already there.” Dr. Fischer adds that she also tries to find non-drug approaches that may be helpful to some patients such as redirection from topics that causes them distress or certain activities that will engage them. Patients and their caregivers need effective treatments now.

As students just starting research in the field, it may be useful to wonder: has sharp focus on certain proteins over the past decade, the rush and popularity of publications, somehow diverted us from other discoveries that could have had more impact in terms of finding a direct biomarker? What have we learned from all this specific research and how can we continue?

When it comes to neuropsychiatric treatment, where are we now compared to thirty years ago?

Indeed, it seems that recognizing clinical symptoms is the best bet we have. Onset and prodromal stages are identified through behaviour changes and the majority of medical treatment is for soothing or treating the symptoms. “We [have] some treatments that are actually pretty good, but we need more effective therapeutics specific to neuropsychiatric symptoms in dementia.”

These drugs in themselves have many

side effects and though the suggestion is to re-evaluate use every three months, many such medications are prescribed for the long term. What’s more is that many of these drugs (such as antipsychotics) were not made for the older population. “What we typically do now is that we prescribe the same medications that we would prescribe for psychiatric symptoms in a younger person, so they don’t always translate into effectiveness in older people.” Dr. Fischer says that it is important that we tailor treatment for the older demographic with neurodegenerative diseases. We must “distinguish, what is it about these symptoms in dementia or cognitive decline that are different from the same symptoms that we see in people who are younger that have no cognitive decline?”

With this, we can conclude that new research findings need to be assessed for both validity and effectiveness. Data collected regarding dementia and AD must be translated to the clinic and be personcentred. New treatments are needed that will yield significant improvement with the utmost minimum number of side effects that can delay brain deterioration and improve quality of life.

References

Photo provided by Dr. Fischer Dr. Corinne Fischer
FEATURE 15 IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS | Graphic design
by Vanessa Nguyen 1. World Health Organization. Fact Sheets: Dementia. https://www. who.int/news-room/fact-sheets/detail/dementia

Past, Present, and Future: The Journey of Spinal Cord Injury and Concussion Research

Our current understanding on the different types of trauma that can affect an individual’s nervous system, such as spinal cord injury and concussion, has not been without difficulty. Spinal cord injury is damage to the spinal cord, impacting the conduction of sensory and motor signals between the brain and the body. Concussion is a type of mild traumatic brain injury; as defined by the International Consensus Conference on Concussion in Sports, it is a “complex pathophysiological process affecting the brain, induced by traumatic biomechanical force”.1 Although we have made terrific progress in our understanding of spinal cord injury and concussion, and how best to prevent these conditions, Dr. Charles H. Tator, who has immersed himself in these two fields for the past 30 years, believes there are still important fundamentals questions that remain to be answered.

Dr. Tator is a pioneer in the research of concussion and spinal cord injury. He is currently a Scientist at the Krembil Brain Institute and the Director of the Canadian Concussion Centre at Toronto Western Hospital. Dr. Tator obtained his medical degree from the University of Toronto in 1961. During his residency, Dr. Tator became involved in the care of patients with spinal cord injury. He also observed that this patient population suffered from poor quality of life and high mortality rates due to the limited treatment options available at that time. Thus, Dr. Tator felt there was a clinical urgency for more research in spinal cord injury.

Dr. Tator’s resulting experimental research has sought to improve the prognosis and outcome for patients with spinal cord injury. Earlier in his career, Dr. Tator contributed to the grading and scoring of spinal cord injury.2 He and his team also devised injury models including small animal models of acute spinal cord injury induced by inflatable cuffs or compression clips to deliver injury.3-5 Furthermore, he demonstrated that earlier management following injury is highly beneficial for recovery and outcome.6,7 Recently, Dr. Tator and his team researched the use of antibodies against inhibitor proteins, which accumulate at the site of injury and impede the recovery process. This treatment promotes functional recovery after spinal cord injury in experimental models.8,9 His group also studied the natural defense mechanism that the endogenous spinal cord stem cells can offer following injury, along with ways to enhance this underlying process of recovery and regeneration. Altogether, his work has been instrumental in furthering our understanding of spinal cord injury and has gained him immense recognition.

As time passed, Dr. Tator noticed an accumulation of young individuals who suffered from head injuries as a result of sports activities, motor vehicle collisions, and other recreational activities. This observation led to his involvement in concussion research. Concussion is defined as a transient disturbance of brain function due to trauma. However, the exact location of injury cannot be easily deciphered. Dr.

Tator described the location of concussion symptoms to be everywhere in the brain. Information provided by various highresolution imaging modalities suggests that more attention should be directed to the brainstem, which has always been thought as a major source of concussion symptoms. However, the animal models for concussion have not been sufficient to validate this theory. Currently, rodents are more frequently used for modeling and studying brain injury. The relevance of these brain injury models to human concussion is debatable because the amount of linear and angular acceleration during a concussion event experienced

of Toronto Photo provided by Dr. Tator
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by the human brain is very different than that of a mouse or a rat. In addition to animal models and brain imaging, biofluid biomarkers are also important for understanding concussion. Biomarkers of concussion have been studied in the biological fluids of patients, including the plasma, serum, saliva and cerebrospinal fluid. From years of research, we now have a whole range of biofluid biomarkers for potential indicators of injury to the brain or spinal cord. If used in combination, these biomarkers may someday identify the signature of concussion. Clinical application of these biomarkers requires additional work to improve their sensitivity and specificity. With the absence of diagnostic biomarkers, the current diagnosis of concussion relies on the signs and symptoms following injury. These are often self-reported signs and symptoms by the patient in addition to the results from various clinical assessment tools. Other methods being applied to diagnosing concussion by Dr. Tator’s team is artificial intelligence, neuropsychological evaluation, biomarkers of the blood and cerebrospinal fluid, eye movement tracking, and various brain imaging modalities including magnetic resonance

imaging to augment the diagnosis of concussion.

Following a concussion, approximately 25% of patients experience persistent concussion symptoms after 30 days. For some, these symptoms can last from months to years, and may even persist for their lifetime. Currently, Dr. Tator is conducting research on enhancing early return to work or school following a concussion. A frequent symptom that concussed individuals develop is computer screen intolerance. This is a major concern because of how heavily we rely on the use of computers on a daily basis. Dr. Tator and his team aim to find a solution by testing alternative screens that can be used by these patients.

As a clinician-scientist, Dr. Tator endorses the concept that scientists can pursue multiple scientific interests, and these can be in the same or different fields. For Dr. Tator, an immense sense of balance in his neurotrauma research came from having one major scientific interest in laboratory research in spinal cord injury, and another in clinical research in concussion. Although there is still a long road ahead in both areas, Dr. Tator is hopeful there will be significant

improvements in treatment of patients with concussion and spinal cord injury in the next five to ten years.

References

1. McCrory P, Meeuwisse WH, Aubry M, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 47, 250-258, doi:10.1136/bjsports-2013-092313 (2013).

2. Tator CH, Rowed DW & Schwartz ML. Sunnybrook cord injury scales for assessing neurological injury and neurological recovery. (Raven Press New York, 1982).

3. Tator CH. Acute spinal cord injury in primates produced by an inflatable extradural cuff. Can J Surg 16, 222-231 (1973).

4. Tator CH. Experimental circumferential compression injury of primate spinal cord. Proc Veterans Adm Spinal Cord Inj Conf 18, 2-5 (1971).

5. Rivlin AS & Tator CH. Effect of duration of acute spinal cord compression in a new acute cord injury model in the rat. Surg Neurol 10, 38-43 (1978).

6. Tator CH & Rowed DW. Current concepts in the immediate management of acute spinal cord injuries. Canadian Medical Association journal 121, 1453-1464 (1979).

7. Tator CH & Edmonds VE. Acute spinal cord injury: analysis of epidemiologic factors. Can J Surg 22, 575-578 (1979).

8. Mothe AJ, Jacobson PB, Caprelli M, et al. Delayed administration of elezanumab, a human anti-RGMa neutralizing monoclonal antibody, promotes recovery following cervical spinal cord injury. Neurobiol Dis 172, 105812, doi:10.1016/j.nbd.2022.105812 (2022).

9. Mothe AJ, Coelho M, Huang L, et al. Delayed administration of the human anti-RGMa monoclonal antibody elezanumab promotes functional recovery including spontaneous voiding after spinal cord injury in rats. Neurobiol Dis 143, 104995, doi:10.1016/j. nbd.2020.104995 (2020).

FEATURE 17 IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS | Graphic design by Stephen Nachtsheim
[Concussion] symptoms can last from months to years, and may even persist for [the patient’s] lifetime.

Finding the genetic material in personalized medication

It is estimated that 1 in 5 Canadians will suffer from a psychiatric disorder in their lifetime. At present, there are 6.7 million Canadians suffering from various mental illnesses, and this is predicted to increase to 8.9 million people within the next generation.1 There has been a myriad of research on the etiology of psychiatric disorders such as schizophrenia, but our limited knowledge of the underlying mechanisms for their development results in the suboptimal treatment of psychiatric patients.

Dr. James L. Kennedy, a clinical psychiatrist, scientist, and the head of the Tanenbaum Centre for Pharmacogenetics at the Centre for Addiction and Mental Health (CAMH) has led pioneering investigations to identify genes involved in psychiatric disorders and personalizing psychiatric treatment. After completing his medical degree at University of Calgary and residency in psychiatry at Yale University, he returned to Canada and started his molecular genetics laboratory in Toronto at CAMH and has been one of the leaders in psychiatric research over the past 30 years. Dr. Kennedy aims to improve our understanding of the genetic mechanisms causing psychiatric disorders, and also predicting and improving patient outcomes to psychiatric medications.

Currently, for the prescription of psychiatric medication, it is common practice to use the trial-and-error approach. This approach could be influenced by many external factors, including the patient’s age, gender, and dietary habits, which can

increase response variability and limit drug effectiveness. Another influence is physicians’ personal preference for prescribing drugs. Some physicians might be more familiar with a particular drug, leading to prescribing the drug for a majority of psychiatric patients rather than focusing on the best option for each individual. In Canada, 7.5% of all patients admitted to hospitals have experienced at least one adverse drug effect, of which nearly 37% have been determined to be preventable.2 Overall, the trial-and-error approach leaves a great deal of uncertainty associated with effective patient treatment.

The lack of accurate and effective treatment for psychiatric disorders, particularly schizophrenia, causes patients to suffer many side effects. The reason for this imprecise treatment is the lack of understanding of the underlying mechanisms of psychiatric disorders and how drugs affect the brain. “The brain is the target organ, and it’s so complicated to figure out all the different interactions for someone getting depressed or someone suffering from schizophrenia,” Dr. Kennedy explains. Unlike other medical fields, such as cardiology or oncology, in psychiatry, researchers cannot conduct direct tissue studies on the target organ, adding another layer of complexity to the patient’s treatment plan.

In response to the lack of effective treatment options for psychiatric disorders, Dr. Kennedy launched the ‘Individualized Medicine: Pharmacogenetics Assessment

and Clinical Testing’ (IMPACT) study in 2012—a seven-year study utilizing genetic information to guide physicians’ decisions on the best antidepressant or antipsychotic medication for each patient.3 To this day, the IMPACT study is the largest conducted study on pharmacogenetic testing ordered by physicians, which also included follow-up with patients after the test.

At the beginning of the IMPACT study, Dr. Kennedy and his lab innovated an in-house genetic test and tested over 2000 patients. Upon growing interest and demand for pharmacogenetic information, Dr. Kennedy

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Photo Credit: Niki Akbarian

Imagine if we had Google for our genes!

partnered with the largest psychiatric pharmacogenetic testing company in the US and tested a total of nearly 12,000 patients’ DNA samples. The genetic test, called the “GeneSight test,” was used to analyze six liver enzyme genes and two brain genes from the serotonin pathway. The results of the GeneSight test included recommendations and rank-ordering of antidepressants and antipsychotic medications. The results were delivered to the patient’s physician to help guide their decision on prescribing the best medication for the patient.

In parallel to Dr. Kennedy’s efforts for personalizing psychiatric treatment in the IMPACT study, he has also led research to identify genes that cause psychiatric disorders, especially schizophrenia. “The best way to treat a patient is to know the exact biology of their disorder,” Dr. Kennedy explains. Although this is a very complicated task, Dr. Kennedy is currently applying advanced molecular genetic techniques to study an array of psychiatric disorders, including bipolar disorder, obsessive-compulsive disorder, anxiety disorders, personality disorders, and most extensively, schizophrenia.

Dr. Kennedy has dedicated a large proportion of his research career to furthering our understanding of the etiology and genetics of schizophrenia. He was one of the contributors to finding novel loci that are associated with schizophrenia, which was published in Nature in 2014.4 Complementing his research, Dr. Kennedy

routinely examines and aids schizophrenic patients in his clinical practice.

When asked about his interest in schizophrenia, Dr. Kennedy replied, “I’m fascinated by how a healthy young person, who might be a top performer in high school, could stop socializing with their friends, start developing strange ideas about aliens sending them messages, and become paranoid,”. He continued to explain, “It’s a fascinating question of why the brain would go wrong to create what we call schizophrenia.”

Schizophrenia is a severe mental illness characterized by symptoms such as psychosis, social withdrawal, and cognitive impairment. Dr. Kennedy’s current research focus in schizophrenia is related to the C4 gene, which is an immune system gene involved in our complement system. Due to the strong association with schizophrenia in genome-wide studies, and the fit of the C4 gene with the neuroimmune theory of the illness, it has recently been a major interest in this field.

The C4 gene is long known to play an important role in the immune system for identifying pathogenic cells. Surprisingly, the complement C4 gene also has a nonimmune function in the development of the human brain. During adolescence, the complement C4 protein identifies synapses in the brain that are no longer useful. The C4 protein then facilitates the pruning of these synapses to make the brain more efficient and help transition the person

from adolescence into adulthood. However, the normal function of complement C4 in directing the healthy pruning of synapses might be defective in young people who start to develop schizophrenia. One of the ongoing projects in Dr. Kennedy’s lab looks at the relationship between the complement C4 gene and schizophrenia symptoms.

With more than 30 years of genetic and psychiatric research and sampling and analyzing over 35,000 patient DNA samples, Dr. Kennedy and his lab continue to generate ground-breaking research that increases our understanding of psychiatric disorders. Dr. Kennedy hopes to generate better pharmacogenetic testing for people to provide more understandable information on how their body reacts to drugs. “There is no downside to having your genetics measured, particularly for your risk of having side effects to medications,” Dr. Kennedy says. “I think the near future [of psychiatric research] will see value in application of measuring more and more genes that play some role in the brain to mediate drug response and generation of side effects.”

References

2.

3.

4. Schizophrenia Working Group of the Psychiatric Genomics Consortium. Biological insights from 108 schizophrenia-associated genetic loci. Nature. 2014;511(7510):421–7.

1. Smetanin P, Briante C, Khan M, Stiff D, Ahmad S. The life and economic impact of major mental illnesses in Canada / : Economic impact of major mental illnesses in Canada. Policy Commons. Canadian Electronic Library; 2022. Available from: https://policycommons.net/artifacts/1218759/thelife-and-economic-impact-of-major-mental-illnesses-in-canada/1771835/ Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004 May 25;170(11):1678. Herbert D, Neves-Pereira M, Baidya R, Cheema S, Groleau S, Shahmirian A, et al. Genetic testing as a supporting tool in prescribing psychiatric medication: Design and protocol of the Impact Study. Journal of Psychiatric Research. 2018;96:265–72.
FEATURE 19 IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS | Graphic design by Xinyi Li
Dr. James Kennedy discusses his research on pharmacogenetic testing and mental health research.

Master of Science in Biomedical Communications

Remi Gao

“It looked just like the real thing!” remarked my grandmother as she proudly described a basket I drew with my fingertips on the layer of dust on top of her TV stand. She would also say that I had been barely as tall as her waist back then. I cherish this tale which grandma often recounts not only because it warms me with her encouragements but also because for me, it marks my earliest demonstration of an affinity for drawing. I later obtained my Honours B.Sc. from the University of Toronto which furthered my other interest: science. I had thought that my two passions, visual art and science, would not mesh with one another in the workplace. However, that was only until I learned about the MScBMC program at Institute of Medical Science. Biomedical Communicators thrive at the intersection of design, technology, and medicine and I am so thankful to have found and have become a part of this amazing and innovative community.

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Tunyalux Langsub

During my elective placement in Thailand in 2019, I created an infographic to educate the community about the risk factors and signs of stroke so individuals could promptly receive treatment. This experience taught me how valuable graphics can be in healthcare education, and I became inspired by the power of art to improve patient outcomes, support public health initiatives, and make science accessible to wide audiences. My goal is to create 2D illustrations, 2D/3D animations, and digital interactive experiences to tackle problems surrounding healthcare education, environmental conservation, and accessible scientific research communication for the public. I believe it is important to create human-focused designs that serve and represent the populations they are designed for. It is an honor and privilege to be able to develop my skills and expand my knowledge of science communication in the BMC program.

Nadine Tan

My journey into the field of medical illustration began with a small art studio in Kensington Market. I woke up at the crack of dawn to attend life drawing classes every Saturday. Around the same time, I was taking a course in Cell Biology which screened an animation called The Inner Life of the Cell. At that moment I realized how incredibly powerful visuals could be for shedding light on scientific processes unseen by the naked eye, and I wanted to be a part of that creative process. In pursuit of my interest in biochemistry, I worked in several labs at York University and SickKids Hospital. I studied the premature aging disease progeria with Dr. Samuel Benchimol and assayed potential therapeutics for neuroblastoma with Dr. Meredith Irwin. My research position with Dr. Irwin led me to several scientific illustration opportunities that furthered my interest in medical illustration. I felt as though I was acting as a translator between two languages that I love. I am further expanding my mental toolkit at the BMC program to develop my skills as a visual problem-solver and to have a command over various technologies to diversify the types of visual information I can convey. My ultimate goal is to translate complex scientific ideas into effective, captivating visuals, and to make scientific information accessible to everyone.

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Finding a scientific sense of community

In June 2022, I had the opportunity to attend and present at the Organization of Human Brain Mapping (OHBM) annual conference. This was many attendees’ first conference in over two years, and the excitement was palpable. I was excited to get back into conferencing and to probe the great minds of neuroimaging for new insight on my research. However, I received much more from my experience at OHBM than initially expected.

I have been fortunate to attend many conferences during graduate school, but this was my first OHBM conference. OHBM specializes in neuroimaging research using magnetic resonance imaging and similar tools to visualize the human brain. The international expertise that gathers at this conference annually is intimidating, to say the least. Yet, with every interaction I had at the conference, I felt encouraged to join this community.

What is Community?

The idea of community often comes up in science, like in “the scientific community” as a whole. It can refer to a sub-specialty of researchers or your cohort of graduate students. But community should also involve a sense of belonging,1 including feelings of acceptance, comfort to show up as yourself, and a sense of ease. In reflecting on what makes a community, I noticed parallels with the psychological theory of attachment style. There are three

attachment styles: two insecure, anxious and avoidant, and a secure attachment style.2 Traditionally, attachment theory is applied to parent-child or romantic relationships,3 but the psychology can be broadly applied. In this analogy, a scientist with a secure community attachment might explore a new idea without fear of being wrong; ask a “silly” question at a conference without being embarrassed; or receive a manuscript rejection without taking the criticism personally. Each of these is a challenging hurdle in a scientific career that I believe is made much easier by experiencing a sense of community.

The consequences of feeling a lack of belonging have been well investigated, including the negative impact on underrepresented students.3 On the other hand, feeling a sense of belonging to your field influences how you engage with your research and can positively impact your scientific output.4 Below, I consider how experiencing a sense of belonging to a scientific community can benefit innovation, progress, and motivation in your field.

As scientists, we are asked to push the limits of our current understanding and to lean into new discoveries. A strong sense of community could benefit scientific innovation by offering an environment conducive to asking new questions, making mistakes, and trying again. A scientist with a secure community attachment might experience

comfort in curious exploration of new ideas.2 Similarly, a strong community promotes scientific progress by welcoming constructive criticism. It is often easier to receive constructive feedback in a supportive environment,5 leading to more open discussion. An environment rich in support creates learning opportunities for all members, regardless of their tenure in the community. Finally, a sense of community could improve a scientist’s motivation to pursue a research question by positively influencing their mental health.6

Community as a Graduate Student

In addition to the benefits above, feeling a sense of community during graduate school can motivate progress in the program,4 support conflict resolution,7 and help build soft skills that may not be the focus of your research training. Students can find peer-to-peer community in courses, research labs, and extracurricular activities (like volunteering with the IMS Magazine!) However, despite these benefits and institutional efforts to foster community, being a graduate student can still feel isolating.

Finding a sense of community at OHBM was a welcome surprise for me. As I begin my last year of graduate school, I feel a renewed excitement about my research and contribution to my sub-specialty of neuroimaging. To those wondering where to find a sense of community, my advice

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is to remain open-minded, seek out new opportunities for connection, and be patient with yourself. Like working towards a secure relational attachment,3 feeling comfortable and confident in your field may require additional reflection and seeking out the right community fit for you.

I appreciate the efforts OHBM has made to create an inclusive and supportive space for their community members.8 At OHBM, feeling a sense of community meant I felt comfortable candidly engaging in discussions with senior scientists. The conference had an overall interest in collaboration and a willingness to learn from others’ experiences. It is possible that I am at a more confident stage in my PhD, and this may have allowed me to overcome barriers I had previously felt at other conferences.

However, I think it’s worth emphasizing, for graduate students and senior scientists alike, the impact that an environment can have when it is genuinely conducive to

collaboration and innovation. Indeed, our scientific communities will flourish better by cultivating a true sense of community.

References

1. Allen K. The science behind our need to belong. Psychology Today [Internet]. 2022. Available from: https://www.psychologytoday. com/ca/blog/sense-belonging/202202/the-science-behind-ourneed-belong

2. Lancer D. How to change your attachment style and your relationships. Psychology Today [Internet]. 2021. Available from:https:// www.psychologytoday.com/ca/blog/toxic-relationships/202104/ how-change-your-attachment-style-and-your-relationships

3. Walton GM, Cohen GL. A question of belonging: race, social fit, and achievement. Personality and social psychology [Internet]. 2007;92(1): 82-96.

4. Fisher AJ, Mendoza-Denton R, Patt C, Young I, Eppig A, Garrell RL, et al. Structure and belonging: Pathways to success for underrepresented minority and women PhD students in STEM fields. PLoS One [Internet]. 2019;14(1): e0209279.

5. McQuaid M. 3 ways to make receiving feedback easier. Psychology Today [Internet]. 2020. Available from: https://www.psychologytoday.com/ca/blog/functioning-flourishing/202008/3-ways-make-receiving-feedback-easier

6. Arslan G. Understanding the association between school belonging and emotional health in adolescents. International Journal of educational psychology [Internet]. 2018;7(1): 21-41.

7. Walton GM, Cohen GL. A brief social-belonging intervention improves academic and health outcomes of minority students. Science [Internet]. 2011;331(6023): 1447-1451

8. Badhwar A, Borghesani V, Kam J, Lee K, Olsen R, Raamana P, et al. Organization for human brain mapping [Internet]. 2022 Apr. Results from the survey on inclusivity at OHBM: summary and future directions. Available from: https://www.ohbmbrainmappingblog. com/blog/results-from-the-survey-on-inclusivity-at-ohbm-summary-and-future-directions

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...community should also involve a sense of belonging, including feelings of acceptance, comfort to show up as yourself, and a sense of ease.

The Hidden Spring:

Can psychoanalysis and neuroscience answer how consciousness arises?

“Tell me where is fancy bred, or in the heart or in the brain,” wrote Shakespeare in 1605 to illustrate a question that has lingered in big thinkers’ minds since Aristotle: “What makes us who we are?” Dr. Mark Solms, a neuropsychologist at the University of Cape Town, started pondering this when his older brother Lee suffered a traumatic brain injury at six years of age. Despite no physical changes, Lee was no longer interested in playing games with his sibling and began missing critical developmental milestones like learning how to tell the time from a clock, becoming highly dependent. His personality dramatically changed. How could changes in the brain lead to such a sudden shift in Lee? In his book The Hidden Spring, 1 Solms attempts to answer this question by taking the reader on a journey alongside Sigmund Freud.

Motivated by the uncanny feeling that his sibling’s transformation aroused in him, Solms studied psychology and specialized as a neuropsychologist. Since the pioneering–but also contentious–1848 case of Phineas Gage, a railroad worker whose personality changed (similarly to Lee’s) after a metal bar traversed his frontal lobe, neuropsychology has built its knowledge by linking loss of specific psychological functions to brain regions with visible damage. Yet, Solms soon

recognized neuropsychology’s limitations. In his 1973 book Awakenings, 2 Dr. Oliver Sacks confessed that medicine was insufficient to understand the subjective experiences of his catatonic patients. Analogously, later in the 1980s, Solms realized neuropsychology’s scientific method was not enough to empathize with his neurologic patients at Johannesburg’s Baragwanath Hospital and the Royal London Hospital.

A similar disenchantment inspired Freud’s psychoanalytic theory at the end of the 19th century. The science of his time was not ready to answer what allows the recognition of a sense of self in others. Instead, psychoanalysis became Freud’s new approach to understanding human consciousness through conversation and self-examination.

In The Hidden Spring1 essays and throughout his clinical practice, Solms utilizes psychoanalysis to understand brain conditions from a subjective, firstperson lens. But the reader cannot help recalling that Freud, the first to take on this task, had failed. After World War II, psychoanalysis was confined to a long exile from the land of empirical sciences. It is crucial to inspect where Solms differs from Freud to understand why Solms’ psychoanalytic efforts may succeed this time.

First, Freud believed consciousness resides in “the outermost cortex” of the brain. Since Phineas Gage, the claim that consciousness resides in the brain’s highly evolved prefrontal cortex has barely been contested. But Solms turns the tide: he “decorticates” consciousness suggesting it arises in the brainstem (the most primitive brain structure) together with affect.3 Since affect is always felt, it must always

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Book cover of The Hidden Spring (2021)

be conscious. Instead, Freud argued that consciousness resides in the “ego”, the structure of the mind that rationalizes and controls affect, whereas affects are unconscious processes of the “id”, the mind structure that governs instincts and impulses.4 Thus, Freud relegated affect to the intangible realm of the unconscious id. In contrast, Solms renders conscious affect a subject of scientific study by locating it in the brain stem. Therefore, Solms' psychoanalytic proposal can survive in the sciences today since it can be empirically tested.

Second, Freud conformed to explaining conscious experience from a subjective, psychological standpoint and hoped that “all our provisional ideas in psychology will presumably someday be placed on an organic foundation.”3 He was not wrong: Solms is advancing this goal. But Solms further argues that solely physical and biological explanations cannot answer “why should any function be accompanied by experience.”1 Even if we perfectly understand the mechanisms that enable a bat to see in the dark and fly, we will never know what it is like to fly at night.5 These questions comprise the Hard Problem of Consciousness5, a philosophical problem Solms aims to solve scientifically. Even if Freud’s omen is fulfilled and our psychological theories are grounded on an organic base, we will still be unable to

answer how consciousness emerges. So, Freud’s goal was not final. Solms’ question reaches even further.

Fortunately, Solms provides a tentative roadmap to solve the Hard Problem of Consciousness, whereas Freud—after surviving two wars, the holocaust, and fleeing his home in Vienna at the end of his life—ended his work on a negative note: “The question of the purpose of life...has not yet received a satisfactory answer and perhaps does not admit of one.”6 Solms suggests that the Free Energy Principle,7 where living systems tend to return to equilibrium states to satisfy needs cued by affects, likely constitutes a fundamental law underpinning both psychological and neural explanations of consciousness. This law may answer the Hard Problem of Consciousness.

Solms suggests it is “astonishing how close [Freud] got to the truth”.1 The Free Energy Principle seems nothing more than Freud’s Pleasure Principle, which rules our behaviour orienting it towards the attainment of pleasure. But this time in history, the affective forces—the hidden spring—driving pleasure-seeking have become open to Solms’ and others’ scientific inquiry. So eventually, we may be able to answer how fancy is bred not in the heart but the brain.

References

1. Solms M. The hidden spring: a journey to the source of consciouness. London: Profile Books; 2021.

2. Sacks O. Awakenings. Pan Macmillan; 1991.

3. Freud S. Beyond the pleasure principle. In: The standard edition of the complete psychological works of Sigmund Freud, Volume XVIII (1920-1922): Beyond the pleasure principle, group psychology and other works. 1955. p. 1–64.

4. Freud S. The Ego And The Id. TACD Journal; 1989. (Originally published in 1923)

5. Nagel T. What Is It Like to Be a Bat? The Philosophical Review. 1974;83(4):435–50.

6. Chalmers D. The Hard Problem of Consciousness. In: The Blackwell Companion to Consciousness. John Wiley & Sons, Ltd; 2017. p. 32–42.

7. Freud S. Civilization and its discontents. Broadview Press; 2015. (Originally published in 1930)

8. Friston K, Kilner J, Harrison L. A free energy principle for the brain. Journal of physiology-Paris. 2006;100(1–3):70–87.

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Healthcare, Affordability, and Dementia: Can All Three Coincide?

There are over 402,000 senior Canadians living with dementia and the count increases by approximately 76,000 cases each year.1 Dementia is an umbrella term used to describe a condition in which an individual loses cognitive function and experiences symptoms such as impairment of memory, problem-solving, attention, and thinking. There are a variety of diseases and conditions that put individuals at greater risk of developing dementia, ranging from cardiovascular disease to traumatic brain injury, that damage brain cells and signaling in the brain. Alzheimer’s disease, which is the leading cause of dementia contributing to 60-70% of cases, is a highly heritable neurodegenerative disease that is marked by progressive brain atrophy and memory loss. Dementia is a complex disorder that must be explored from various perspectives to be able to provide the best care to patients.

There is currently no cure for dementia, but there are pharmacological and non-pharmacological treatments designed to manage symptoms arising from the underlying diseases and disorders. However, the drugs that have been approved in Canada to treat cognitive impairment, including Donepezil, Rivastigmine, Galantamine, and Memantine, do not target all the symptoms associated with dementia and are not always effective in severe cases of dementia.3 This results in some individuals still requiring additional supports to

manage their symptoms. As a result, many individuals with dementia are transferred to long-term care facilities or taken care of in their community by their family members or personal support workers, where they can be closely monitored throughout the day. This puts significant financial burden on both caregivers and the healthcare system as they incur higher treatment costs which amount to more than any other disease, including heart disease and cancer.4

on the type of accommodation (basic, semi-private, or private). Although there are government financial supports and insurance programs available to offset the costs and make the care more affordable, not all individuals qualify for the programs or coverage. Two thirds of costs remain to be paid out-of-pocket by seniors or their caregivers.5 The total annual out-of-pocket costs to dementia caregivers in Canada are projected to rise to the billions by 2031.5 In addition to the monetary costs, caregivers

Annually, dementia costs the Canadian economy and healthcare system about $10.4 billion.5 This encompasses a variety of costs generated by ambulatory care, rehabilitation, prescription drugs, physician and healthcare services, and inpatient hospital care.6 However, the most significant costs stem from long-term care, home care, and complex continuing care where individuals with dementia are monitored and/or treated for a longer duration of time.6,7

To put this into perspective, long-term care accommodation costs in Ontario range from $63 to $91 per day, depending

of individuals with dementia experience significant stress which often comes at the cost of social isolation, and physical and psychological health problems.8 There are significant costs associated with symptom management and care for individuals with dementia.

Despite this, as of May 2021, over 38,000 individuals were waiting to access a long-term care bed in Ontario, with wait times averaging up to 171 days.9 It is evident that costs associated with healthcare for individuals with dementia does not eliminate the need for such

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Annually, dementia costs the Canadian economy and healthcare system about $10.4 billion.

services, especially since 69 percent of long-term care patients are diagnosed with dementia.10 With a growing prevalence of dementia in the population, this may put a significant strain on long-term care services and impact the healthcare system, while also impacting economic development because of the costs associated with dementia treatment.

Women with dementia tend to have greater costs associated with their care due to comorbid health conditions that present more frequently in women than men.11 Interestingly, there is a disparity in spending such that the prevalence of dementia is higher in low- and middleincome countries, but dementia spending costs are greatest in high-income countries where dementia rates are lower.12 This may be due to a difference in use of long-term care homes because of their significant costs and varying cultural norms. Often, in low- and middle-income countries, caregivers tend to the dementia patients themselves which limits their ability to work, and in turn presents as an economic burden. These are additional considerations that must be reviewed when making reforms to ensure affordability of healthcare for individuals with dementia. Such healthcare disparities must lead future research and policies to optimize the treatment and care of individuals with dementia around the globe.

In 2017, the World Health Organization released the Global Action Plan on the Public Health Response to Dementia

2017–2025 which states that universal health coverage and social care must be provided to protect individuals with dementia and their caregivers from financial risk while offering access to resources to promote their care. Furthermore, dementia research must be prioritized to keep up with the demands for novel therapies and treatments to mitigate the various stressors of the disorders, ranging from the affected individual to the community. This effort must be well-funded and supported. Specifically, research in this field requires $359 million to translate dementia-treating drugs from bench to bedside.5 Thus, further advances are urgently needed in this field to optimize the care of patients and their caregivers.

With the population aging and the life expectancy increasing in Canada, dementia is a growing topic of concern. Healthcare and supports for individuals with dementia must be made affordable and this should be prioritized due to its significant impact on a multifaceted network of individuals, starting from the patient and branching out to their caregivers, community, and healthcare system.

References

1. Public Health Agency of Canada. Dementia in Canada, including Alzheimer’s disease [Internet]. 2017. Available from: https://www. canada.ca/en/public-health/services/publications/diseases-conditions/dementia-highlights-canadian-chronic-disease-surveillance. html#shr-pg0

2. Shepherd H, Livingston G, Chan J, et al. Hospitalisation rates and predictors in people with dementia: a systematic review and meta-analysis. BMC Med. 2019;17(1):130.

3. Li DD, Zhang YH, Zhang W, et al. Meta-Analysis of Randomized Controlled Trials on the Efficacy and Safety of Donepezil, Galantamine, Rivastigmine, and Memantine for the Treatment of Alzheimer’s Disease. Front Neurosci. 2019;13:472.

4. Kelley AS, McGarry K, Gorges R, et al. The Burden of Health Care Costs for Patients With Dementia in the Last 5 Years of Life. Ann Intern Med. 2015 Oct 27;163(10):729–36.

5. Alzheimer Society of Canada. Prevalence and Monetary Costs of Dementia in Canada. Toronto; 2016.

6. Bronskill SE, Maclagan LC, Mondor L, et al. Phase-specific health system costs of dementia in Ontario, Canada: A propensity score-matched cohort study. Alzheimer’s Dement. 2021 Dec 1;17(S10):e055003.

7. Schaller S, Mauskopf J, Kriza C, et al. The main cost drivers in dementia: a systematic review. Int J Geriatr Psychiatry. 2015 Feb 1;30(2):111–29.

8. Brodaty H, Donkin M. Family caregivers of people with dementia. Dialogues Clin Neurosci. 2009;11(2):217–28.

9. Ontario. Ontario Welcomes New Long-term Care Development Proposals [Internet]. 2021. Available from: https://news.ontario.ca/ en/release/1001009/ontario-welcomes-new-long-term-care-development-proposals

10. Canadian Institute for Health Information. Dementia in long-term care. 2022.

11. Azad NA, Al Bugami M, Loy-English I. Gender differences in dementia risk factors. Gend Med. 2007 Jun;4(2):120–9.

12. Velandia PP, Miller-Petrie MK, Chen C, et al. Global and regional spending on dementia care from 2000-2019 and expected future health spending scenarios from 2020-2050: An economic modelling exercise. EClinicalMedicine. 2022 Mar;45:101337.

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Changes Following a Traumatic Brain Injury Does a person become their disease?

Thirteen pounds, one metre, and a diameter of 3.2 centimetres. 1

These were the metrics of the bar that was blasted into twenty-fiveyear-old Phineas Gage’s skull. Gage was employed in a railroad construction business in Vermont, USA, in 1848. The construction group was responsible for blasting a rock, of which Gage was assigned the task of putting gunpowder into a hole. Unfortunately, there was a miscalculation in trajectory and the bar entered Gage’s skull through his left cheek and destroyed his left eyeball before making its way into his frontal lobe. What remains so astonishing, is that Gage survived. In fact, he remained conscious and verbal the whole way to his doctor’s office. 3 Gage’s treatment included the removal of his left eye and the bar being surgically extracted from his brain, leaving the frontal bone of his skull fractured. He was released from the hospital only three weeks after.

Before his accident, Gage was a competent employee, with a strong sense of leadership, and known to have a gentle personality. 1 But do you think that changed post-accident? Would the projection of the metal bar into his frontal lobe ultimately lead to a demise in his notable personality?

“Is it neurological, or is it psychological?”

This is an age-old question set to differentiate disorders, behaviour, and personality traits from one field of study to the other. Some academics before the 20th century believed both fields to be mutually exclusive; meaning neither field is influential on the other.2 Changes in psychology were presumed to be solely the result of external factors like diet, environment, or even evolution. The idea of a “mind-brain” dichotomy was rejected based on the belief that psychiatric diseases exist without any corresponding brain pathology. This sounds hard to grasp given neuropsychology’s recognition today. But in the past, without proof of an association, scientists didn’t buy it. And we can’t blame them for that, because science is only science with well-supported evidence. However, with the case of Phineas Gage, it became clear that the brain and mind are connected. Gage remains one of the most famous patients in the history of neuropsychology and neuroscience 3 Many undergraduate students can attest to that—he is one of the hallmark cases introduced in Psychology 101 courses.

Gage’s physician, Dr. John Harlow, determined the accident profoundly changed Gage’s personality. 1 The once gentle and reliable foreman was now

The exhumed skull of Phineas Gage adjacent to the metal bar that was propelled into his skull1
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by Vanessa Nguyen
“Is it neurological, or psychological?”

irritable, unreliable, rude, and hostile.4 He ultimately lost his job due to his consistent use of profanity and hostility toward coworkers. Gage couldn’t hold a steady job and his life changed, his temper shortened, and his relationships ran sour to the point of his family and friends saying he was “no longer Gage.”

Thus, Gage’s changes post-accident can be understood from both a neurological and psychological perspective.4 He suffered a severe traumatic brain injury to his frontal cortex, leaving irreversible damage, and also suffered from long-term psychological damage exemplified by his drastic change in personality.

Another key element in Gage’s case is that it disproved the mainstream understanding of the function of the frontal cortex1. The frontal cortex was known to be a “silent structure,” having little involvement with a person. However, it became clear that the frontal cortex was far from silent, but rather responsible for mood, personality, self-awareness, and moral reasoning, all of which were severely impacted by the injury to Gage’s brain5

Traumatic Brain Injuries

A Traumatic Brain Injury (TBI) is defined as damage to the brain upon an external

force.6 The diagnosis of a suspected TBI includes one or more of the following clinical signs immediately after the event:

1. Loss or decreased level of consciousness

2. Loss of memory of event

3. Alterations in mental state

4. Neurological deficits (i.e., loss of balance, change in vision, balance etc.)

Does a person become their disease?

There is ample evidence of the association between personality changes after a TBI, and the pure abundance of cases can be daunting for people who have loved ones who’ve suffered from a recent TBI. So, I’d say no. A person does not become their disease, nor should they be reduced to their trauma. Yes, the impact on the brain can be devastatingly detrimental to one’s well-being and psyche, but the level of plasticity in our brain can be repaired and changes are possible.7 Even in the case Phineas Gage, studies reported the personality changes stayed for four years. Afterwards, he improved and was able to hold onto a steady job. Gage’s story was a landmark case for neuropsychology. I think his improvement post-accident can be just as important to learn for those who have suffered from a TBI. After a

severe injury to the brain, normalcy is possible and improvements can be made.

References

1. Teles Filho RV. Phineas Gage’s great legacy. Dementia & Neuropsychologia. 2020 Dec 11;14:419-21

2. Price BH, Adams RD, Coyle JT. Neurology and psychiatry: closing the great divide. Neurology. 2000 Jan 11;54(1):8-

3. Schleim S. Neuroscience Education Begins With Good Science: Communication About Phineas Gage (1823–1860), One of Neurology’s Most-Famous Patients, in Scientific Articles. Frontiers in Human Neuroscience. 2022;16.

4. Oni MB, Wilde EA, Bigler ED, McCauley SR, Wu TC, Yallampalli R, Chu Z, Li X, Hunter JV, Vasquez AC, Levin HS. Diffusion tensor imaging analysis of frontal lobes in pediatric traumatic brain injury. Journal of child neurology. 2010 Aug;25(8):976-84.

5. Mckee AC, Daneshvar DH. The neuropathology of traumatic brain injury. Handbook of clinical neurology. 2015 Jan 1;127:45-66.

6. Blennow K, Brody DL, Kochanek PM, Levin H, McKee A, Ribbers GM, Yaffe K, Zetterberg H. Traumatic brain injuries. Nature reviews Disease primers. 2016 Nov 17;2(1):1-9.

7. Bherer L. Cognitive plasticity in older adults: effects of cognitive training and physical exercise. Annals of the New York Academy of Sciences. 2015 Mar;1337(1):1-6.

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The Fall of Roe v. Wade

Norma McCorvey was only 21 years old in September of 1969 when she found herself pregnant without a job, partner, or familial support. Her first two children had been given up for adoption as she was battling a drug and alcohol addiction. Norma was not ready to give birth to another child that she could not care for and wanted to terminate her pregnancy. Unfortunately, as a resident of Texas, the law stated that abortions are illegal unless the mother’s life is in danger. Feeling hopeless, Norma was told to contact lawyers Sarah Weddington and Linda Coffee to explore her options. They sued the Dallas County district attorney (DA) Henry Wade to challenge the law as unconstitutional and infringing on her right to reasonable privacy. To protect Norma’s identity, she was given the name “Jane Roe” in the lawsuit, thereby dubbing the famous case Roe v. Wade. The district court ruled in Norma’s favour, but the DA appealed the decision to the United States Supreme Court. 1

In a historic decision, on January 22nd, 1973, the court issued a ruling that legalized abortion in all states. Pregnant people in the United States could now legally get an abortion before the fetus could survive outside the womb, which is around 24 weeks. Since then, antiabortion activists have unsuccessfully tried to overturn the decision. However, with the advent of Donald Trump’s presidency and his promise to “make abortion illegal

again”, individual states started introducing restrictive abortion laws called “heartbeat bills” to challenge Roe v. Wade.1

The Summer 2019 issue of IMS Magazine contained an article titled “The Heartbeat Movement” by Jason Lo Hog Tian who wrote excellently on this topic. Briefly, “heartbeat bills” are abortion laws that state that a pregnancy cannot be terminated if a “heartbeat” can be detected. This is usually around 6 weeks by vaginal ultrasound, before most individuals even know that they are pregnant. Moreover, this term is intentionally misleading, as a 6-week-old embryo does not possess a fully formed heart, but rather a mass of cells that will eventually become the heart. The “heartbeat” that is detected comes from early electrical activity of these cells. Although an exception to this bill is if the mother’s life is in danger, some states, like Texas, provide no concessions in terms of rape or incest. However, since the ruling in Roe v. Wade deemed individual state restrictions on abortion before fetal viability (i.e., before the fetus can survive outside the womb) unconstitutional, these laws were unenforceable.2

In March of 2018, the Jackson Women’s Health Organization in Mississippi sued state health officer Thomas E. Dobbs over the passing of the unconstitutional law banning abortion at 15 weeks of pregnancy. In December 2021, the case was presented to a conservative leaning Supreme Court. On January 24th, 2022,

the Supreme Court of the United States threw away 50 years of legal precedent and abolished the federal right to abortion under Roe v. Wade. Individual states are now allowed to make their own decisions about abortion laws, and almost 50% of states are expected to or already have severely restricted abortion. This is accomplished by reviving pre-Roe bans that were unenforceable post-Roe, trigger bans which took effect as soon as Roe was overturned, and pre-viability gestational bans that restrict abortion much earlier than fetal viability outside the womb. 3 So, what does this mean for people who wish to have an abortion in America?

Experts say that the people who will be most affected by the fall of Roe v. Wade are Black and Indigenous people. These populations already face disproportionate health risks when pregnant and are 2-4 times more likely to die from giving birth than their white counterparts. For Black and Indigenous pregnant people, getting an abortion is much safer than giving birth to an unwanted child.

Moreover, the states that are more likely to ban or severely restrict abortions have higher proportions of Black and Indigenous people, not to mention existing inadequacies in access to prenatal healthcare. Consequently, these states have high rates of infant and maternal mortality. Taken together, researchers predict that maternal deaths

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will likely rise in a world without abortion access. 4

Although not much research exists on the impact of having an abortion compared to being denied one, one study stands out. The Turnaway study, conducted by a group of scientists at the University of California San Francisco, compared the differences between pregnant people who were denied abortions because they were just over the legal gestational limit under Roe (24 weeks) and those who got the procedure within this limit. This study recruited over 1000 women from abortion clinics across the country between 2008 and 2010 and followed up with them every 6 months until 2016.

The team reported that the people who were denied an abortion were more likely to live in poverty, have a lower socioeconomic status, and be unemployed than those who got the procedure.

People who were denied an abortion also reported physical and mental health challenges including depression, anxiety, low self-esteem, and low lifesatisfaction. Finally, feelings of relief

were reported by people who had the procedure even 5 years later. The Turnaway study provides qualitative and quantitative evidence that being forced to give birth has lasting impacts on a person’s health and financial situation. 5

Since the Summer 2019 IMS Magazine viewpoint on restrictive abortion laws in the United States, the government has overturned Roe v. Wade. Jason Lo Hog Tian was optimistic that this would not happen since a fundamental right protected by years of legal precedent had never been taken away from the American people before. This decision is a shocking setback for all pregnant people in the United States, a decision that more than two thirds of Americans disagree with. 3 Now more than ever, advocacy by healthcare professionals and policymakers is vital to ensuring that legal abortions can be equitably accessed by all Americans.

References

1. Solly M. Who Was Norma McCorvey, the Woman Behind the Roe v. Wade Supreme Court Decision? | Smart News| Smithsonian Magazine [Internet]. [cited 2022 Sep 28]. Available from: https://www. smithsonianmag.com/smart-news/who-was-norma-mccorvey-thewoman-behind-roe-v-wade-180980311/

2. Rogers A. “Heartbeat” Bills Get the Science of Fetal Heartbeats All Wrong | WIRED [Internet]. [cited 2022 Sep 28]. Available from: https://www.wired.com/story/heartbeat-bills-get-the-science-offetal-heartbeats-all-wrong/

3. U.S. Supreme Court Takes Away the Constitutional Right to Abortion | Center for Reproductive Rights [Internet]. [cited 2022 Sep 28]. Available from: https://reproductiverights.org/supreme-courttakes-away-right-to-abortion/

4. Dirks S. Abortion is also about racial justice : NPR [Internet]. [cited 2022 Sep 28]. Available from: https://www.npr. org/2022/05/14/1098306203/abortion-is-also-about-racial-justiceexperts-and-advocates-say

5. Lenharo M. Being Denied an Abortion Has Lasting Impacts on Health and Finances - Scientific American [Internet]. [cited 2022 Sep 28]. Available from: https://www.scientificamerican.com/ article/being-denied-an-abortion-has-lasting-impacts-on-healthand-finances

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Experts say that the people who will be most affected by the fall of Roe v. Wade are Black and Indigenous people.

IMS Faculty Highlights

Promoted to Full Member Promoted to Associate Member New IMS Member

Dr. Dany Weisz is an associate professor in the Department of Paediatrics and a neonatal intensivist at Sunnybrook Health Sciences Centre. His research focuses on the epidemiology and management of patent ductus arteriosus among preterm infants, the evaluation and management of transitional hemodynamics, and chronic pulmonary hypertension.

Dr. Laura Avila is a staff physician in the Division of Haematology/ Oncology at SickKids. She leads a research program in long-term outcomes of pediatric thrombosis. Her research interests are focused on measurement in medicine, observational and longitudinal studies and outcome prediction.

Dr. Lindsay Jibb (RN PhD) is a scientist-track investigator with Child Health Evaluative Sciences at the SickKids Research Institute and an assistant professor at the University of Toronto’s Lawrence S. Bloomberg Faculty of Nursing. Dr. Jibb currently holds the Signy Hildur Eaton Chair in Pediatric Nursing Research at SickKids and the University of Toronto. Her research is focused on pursuing better ways to understand and optimize the psychosocial health of those affected by childhood cancer—particularly through family research partnerships.

Dr. Victor M. Tang is a psychiatrist and scientist at CAMH. His research focuses on the development of novel therapeutics in the field of addiction psychiatry through translational neuroscience, brain stimulation, and innovative approaches to treatment delivery.

Dr. Matthew R. Lincoln is a clinician-scientist at the BARLO Multiple Sclerosis Centre. His lab uses genetic and epigenetic techniques to identify molecular mechanisms that cause and sustain multiple sclerosis.

Dr. Bryan Coburn is a clinician-scientist in the Division of Infectious Diseases at the University Health Network. His research interest is observational and interventional studies of human microbiomes, including clinical trials of microbiome targeting interventions in infectious and non-infectious diseases. His lab is in the MaRS complex (PMCRT). He is cross-appointed in Medicine, Immunology and Laboratory Medicine and Pathobiology.

Dr. Boris Hinz is Keenan Research Chair in Fibrosis Research at St. Michael’s Hospital, Unity Health and University of Toronto Distinguished professor in Tissue Repair and Regeneration. He studies the role of contractile myofibroblasts in physiological tissue repair and in causing pathological tissue fibrosis.

Dr. Liisa Galea studies hormonal influences on neuroplasticity, with a focus on dementia and stress-related psychiatric disorders. Her research goal is to improve brain health by examining the influence of sex and sex hormones in health and disease.

Dr. Michael Ko is a thoracic surgeon at Unity Health Toronto (St. Joseph’s Site) and is an assistant professor in the Department of Surgery. His basic science research interests are in cell cycle checkpoint and centrosome regulation as it relates to carcinogenesis.

Dr. Matthew J. Burke is a cognitive neurologist at Sunnybrook Health Sciences Center and is cross appointed between Psychiatry and Neurology. His research focuses on investigating complex topics at the interfaces between psychiatry, neurology and neuroscience.

Graphic design by Vanessa Nguyen
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Dr. Paul Krueger, Associate Professor Emeritus, is an epidemiologist with research experience in primary care, long-term care, palliative care, and public health. He has taught a variety of graduate level research methods courses and has an expertise in survey design and implementation methods.

Dr. Sean Nestor is an interventional psychiatrist at Sunnybrook. His research involves the use of neuroimaging to optimize neuromodulation therapies such as transcranial magnetic stimulation and deep brain stimulation for treatment resistant psychiatric disorders.

Dr. Heather Baltzer is a hand surgeon and surgeon investigator at UHN. She is an assistant professor at the University of Toronto. Her research focuses on the pathobiology of hand osteoarthritis and development of smart digital prosthetic devices.

Dr. Abhi Bhaskaran is a cardiologist at Toronto General Hospital. His focus of research is on improving outcomes in ventricular tachycardia ablation. He is the PI for MASIV study, “MRI assisted substrate ablation in VT” and co PI for the non-invasive VT ablation using radiotherapy.

Dr. Steve Lin is an emergency physician at St. Michael’s Hospital, and an associate professor at the University of Toronto. His translational research program (research. unityhealth.to/lin) is dedicated to improving outcomes in cardiac arrest patients.

Dr. Benjamin Lok is a radiation oncologist clinician-scientist at the Princess Margaret Cancer Centre. His lab is interested in DNA repair, novel therapeutic development, and translational lung cancer research.

Dr. Frances Chung is UHN ResMed Research Chair of Anesthesia, Sleep, & Perioperative Medicine and Uof T professor. Her research interests are in perioperative medicine, cognitive screening tools, obstructive sleep apnea, and patient safety (https//:stopbang.ca).

Dr. Mahavir Agarwal is a psychiatrist at CAMH working on understanding the mechanisms underlying metabolic dysfunction in mental illness, with specific focus on insulin signaling in the brain, and discovering new treatments for these abnormalities.

Dr. Mohammad Qadura is a vascular surgeonscientist at St. Michael’s Hospital, and an assistant professor at the University of Toronto. His research interests include discovering biomarkers for peripheral arterial disease and personalization of antiplatelet therapy in vascular disease patients.

Dr. Daniel Felsky leads the Whole Person and Population Modelling Group (felskylab.com) in the Krembil Centre for Neuroinformatics at CAMH. His team explores the interplay of biological, social, and environmental factors in mental health across the lifespan using big data.

Dr. Brodie Nolan is an emergency physician and trauma team leader at St. Michael’s Hospital and a transport medicine physician for Ornge. His research interests are in trauma, prehospital care and patient safety.

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Patent Pending - Bridging the Gap Between Law and Science

In a culture where our minds are permanently settled into a tedious routine of planning ahead, the concept of “leave the future open” seems almost impractical. Breaking through this norm is Dr. Gabriella Chan. In addition to being a scientist and educator, Dr. Chan is also the founder of Yocto Law, a specialty firm that advises clients in the life and health science sectors.

That being said, there was a time when law was not a field of interest for Dr. Chan, let alone her future career. Dr. Chan began her post-secondary education at the Loyola University of Chicago, where she studied biology and art history. At this stage, she worked as a research assistant on a NIH-R01 study evaluating the quality of life of lung transplant patients. Despite initial plans to attend medical school, she learned that lung transplant recipients with cytomegalovirus (CMV) infections experienced poor outcomes, which sparked an interest in infectious diseases. This led her to pursue graduate studies at the Institute of Medical Science (IMS) wherein she focused on molecular diagnostics for infectious diseases under the supervision of Dr. Kevin Kain.

Coincidently, half of Dr. Chan’s PhD was during the 2002-2004 outbreak of SARSCOV-1. As real time PCR was relatively new at the time, she worked with a German start-up to validate an assay to detect SARS-COV-1 as early as possible. She was subsequently involved in another start-up spun out of Dr. Kain’s laboratory,

which focused on rapid point-of-care hand-held diagnostic devices for infectious diseases. It was at this time that the seeds of her interest in intellectual property (IP) law were first sown. Working with the start-up team, she participated in meetings with the company’s IP lawyers to prepare the first patents. It became quickly apparent that lawyers and scientists did not speak the same language nor viewed scientific research results through the same lens. In an evolving world of biotechnology and science-driven entrepreneurship, this apparent dilemma highlighted a need. Thus began Dr. Chan’s unforeseen journey into business law and IP.

This shift from science to law might appear disparate and arduous. But in the end, Dr. Chan discovered that much like research, law was all about using critical thinking to piece a story together. Dissecting a case and applying it in an argument was not dissimilar from referencing various papers when writing a manuscript. Dr. Chan says: “There is nothing more valuable than the skills you foster through graduate education. They will apply to any path you choose. It teaches you a form of critical thinking that is lacking most of the time.”

After training as a lawyer on Bay Street and working as Vice President of Legal Affairs at another Toronto-based nanotechnology start-up, she started her own law firm in 2014 which gave her the autonomy to pick her own clients. As the founder of Yocto Law, a boutique law practise focusing on individuals,

start-ups, and businesses in the life and health science sectors, Dr. Chan acts as a mentor for several of her clients who are budding entrepreneurs. As they learn to operate and thrive in the world of business and IP, her guidance allows them to achieve conversational literacy in these domains and avoid common pitfalls. Through her insightful legal counsel, strengthened by her background as a scientist, she can both understand her client’s products from a scientific perspective, and provide knowledge in commercializing their innovations.

Prior to launching her law practice, Dr. Chan returned to IMS to highlight the pervasive lack of understanding about IP she observed in founders of start-ups and spin-outs from academic institutions: “Students graduating from a worldrenowned research institution such as U

of T should have at least a conversational understanding of IP to be better prepared to function in a knowledge economy.”

Dr. Chan believes that “Academia is a crucible of innovation and academics submit thousands of grant applications for taxpayer-funded research support in which they highlight the potential of their research to, either directly or indirectly, provide some societal benefit. At the same time, there is a persistent (although less pervasive) school of thought in academic circles which posits that the purity of academic scholarship ought not be tainted by the world of business, including IP and commercialization. While not every type

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or piece of research is innovative, graduate students and researchers alike should appreciate that, for ground-breaking research that generates inventions, fulfilling that promise of societal benefit entails the arduous next steps of protecting, translating, and hopefully commercializing those inventions.”

Dr. Chan states that “setting aside whether IP, translation, and commercialization ought to fall within or outside the realm of academia, publishing results of innovative research, or presenting them at conferences before being protected by

at least a provisional patent application, can diminish or worse, evaporate, the commercial viability of that invention.

She adds: “Few inventions withstand the rigour of translation, and fewer still will be commercialized, but academics ought to be at least conversant in the language of IP and particularly appreciate the perils of premature disclosure to at least give those inventions a chance to provide that societal benefit first espoused in their applications for those taxpayer-funded grants.”

To that end, in 2014 she developed a series

of modules in IP at IMS in which students learn how their professional and private lives are awash in IP, how to navigate it, translate it, and commercialize it. Her teaching philosophy is centred around application. Rather than reading about these principles from a textbook, students are presented with a case study centered around a research paper which acts as the stand-in for their invention, and work in groups to commercialize it. Along the way, students familiarize themselves with the IP policies of their institutions, form a mock company, select a corporate and product name, undertake steps to protect the IP, and chart a strategy for acquiring rights to use that IP from their respective institutions. The first module culminates with the students pitching the product to mock investors who are not scientists. This process aims to empower students to be prepared and educated when venturing down their career paths, wherever they may lead.

In all aspects of her career, Dr. Chan has been a mentor, whether it be with her legal clients or her students. Her devotion to bridge the gap between the scientific and corporate worlds has been consistent in her work, along with the desire to best prepare individuals for their future.

With respect to what her future holds, her philosophy is: “Leave yourself open to new opportunities. Let life happen. It’s a journey. If you pin it on a destination, you may let important things pass you by.”

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Dr. Gabriella Chan PhD (Molecular Diagnostics for Infectious Diseases), JD. Assistant Professor (Department of Laboratory Medicine & Pathobiology), University of Toronto. Founder of Yocto Law. Photo provided by Dr. Chan

Stepping Out of Comfort and Into Opportunity:

A Student Spotlight on Donna Yang

Familiarity and routine bring comfort and ease, and more often than not, we find ourselves satisfied with what we know, and what we are good at. While it is easy to shy away from new challenges, Institute of Medical Science (IMS) student Donna Yang demonstrates that the best place to be might be outside of your comfort zone. Throughout the trajectory of her education, Donna has pushed beyond what she knew and was comfortable with. Continuously seeking opportunities to learn, Donna, now in her second year of her master’s program and has become part of a research team at the Reach Alliance, an opportunity that will bring her to Rwanda to study global economics.

Donna began post-secondary education at the University of Toronto, doing a bachelor’s degree in kinesiology. However, to broaden her experiences, she took several elective courses in her final two years. Becoming involved in an interdisciplinary engineering capstone project with aspects of clinical neuroscience, Donna found herself wanting to explore neuroscience further. Hence, she set out to complete her MSc at the IMS. Through the IMS, she has been able to work with Dr. Mark Boulos at the Sunnybrook Health Sciences Centre to investigate sleep disorders and fatigue in patients with Myasthenia Gravis, an autoimmune neuromuscular disorder that currently has no cure. While Donna loves her thesis work, she has always been open to exploring and learning which led her to seek out opportunities that extend beyond science.

When looking back at her undergraduate degree, one thing that Donna wishes she could have done was take courses outside of science. Now, being able to see how research and healthcare are intertwined, she continues to look for opportunities that allow her to learn about various factors that influence healthcare and access to it. One of the factors she became interested in was socioeconomic status, and so as Donna began to look for opportunities to explore other fields, she applied to the Reach Alliance.

The Reach Alliance is a student-driven research and leadership initiative founded in 2015 at the University of Toronto’s Munk School of Global Affairs and Public Policy. Reach was inspired by the United Nations’ Sustainable Development Goals (SDGs) and is designed to equip students

with skills to assess global challenges and produce actionable insights. Donna describes Reach as “a chance for students to discover new topics or new fields”, and this is exactly what she is getting out of her experience with Reach.

When applying, Donna already knew that she wanted to work on a project unlike anything that she has done before, emphasizing that she wanted something that was outside of healthcare. In pushing herself outside of her comfort zone like this, she hoped to gain skills that eventually would allow her to bring an interdisciplinary approach to the healthcare research she is already comfortable with. This has brought her to now working on a project that assesses financial inclusion in Rwanda. Donna and her teammates, Jason Lo Hog Tian

STUDENT SPOTLIGHT 36 | IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS Graphic design by Livia Nguyen
“ “
I think all the most exceptional leaders are willing to experiment with different risk and initiatives, and that starts when you’re a student by taking small steps to experience things you maybe haven’t been familiar with.

(PhD candidate at the Institute of Medical Science), Cheikh (Tidiane) Diop (Honours Bachelor of Arts and Science, Specialist in Peace Conflict & Justice and Major in Economics), and Fawziyah Ibrahim (Honours Bachelor of Science in Molecular Biology, Immunology & Disease, and Health Studies) are working to analyze the Umurenge Saving and Credit Co-operative Societies (SACCOs) Initiative, which successfully increased Rwandan financial inclusion from 21% to 89% in just over a decade. They want to determine factors that lead to success, as well as how this initiative can be implemented globally, in other areas where financial inclusion is an issue.

Tackling SDGs one, eight, and ten, which are No Poverty, Reduced Inequalities, and Decent Work and Economic Growth, respectively, Donna has spent her time with Reach learning more about the SACCOs initiative, reviewing the literature, and identifying key stakeholders of the initiative. Next year, Donna plans to travel to Rwanda to fill in the missing gaps in the literature by interviewing stakeholders and gathering information directly from those who played a role in the success of SACCOs. The end goal is to “create adoptable lessons from our research that other countries and organizations can use to create other programs to improve financial inclusion in their own countries”.

Outside of being able to explore something completely new to her, Donna also spoke on how Reach has helped advance her professional development. She has gained experiences in teamwork and effective communication, learned how to set deliverables and expectations she can keep on schedule for, and gained skills to help her succeed in a professional workplace. Advancing these skills is an important goal of the Reach Alliance. Therefore, all students are set up for success through team and individual coaching sessions, workshops, and more, and for Donna, she knows these skills will be applicable to all other aspects of her life, including, for example, her master’s degree.

To be complacent and comfortable can be tempting, but the pursuit of knowledge and experiences rarely lends itself to the

confinement that comfort will bring. In staying static, it is too easy to miss opportunities, and this can make it harder to grow, whether that is as a student, in your career, or in life as a whole. While she does not fully know what is in store for her next, Donna Yang hopes to continue to push beyond the boundaries of what she knows. In stepping out of her comfort zone, Donna has stepped into countless new opportunities, something that she hopes to inspire others to do as well.

STUDENT SPOTLIGHT 37 IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS |
Donna Yang Photo provided by Donna Yang
When you step out of your comfort zone is when you can learn and grow the most.
MSc Student, Institute of Medical Sciences, University of Toronto

The State of Rural and Remote Health Care in Canada

Section 3 of the Canada Health Act of 1984 states as its primary objective: “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers”.1 Despite the talks about long emergency room (ER) wait times, waitlists for certain physician consultations, and COVID-19-related setbacks, downtown Toronto and other large urban centers have a plethora of hospitals and health-related services available for its citizens to access. Most of us would not compare the health care we observe to that of a third-world or underdeveloped country. After all, we have some of the best health care in the world.

For citizens of the two Wapekeka First Nation Reserves (pronounced Wap-ehkey-ka) located in Northern Ontario, a very different health care system is in place. The estimated 350+ residents across the reserves have access to rudimentary health services, with the only permanent health staff being a few registered nurses. X-rays and other health imaging equipment are not present.2 A family physician visits the reserve for only a week out of the entire month. For more severe conditions, residents must board a plane and fly 450 km to Sioux Lookout, the “Hub of the North.” The Sioux Lookout Meno-Ya-Win Health Centre provides care for citizens of Sioux Lookout and the numerous other northern remote communities, whose citizens must also travel great distances to access the coveted health care services.2

Wapekeka and the other communities in Northern Ontario are classified as some of the most remote communities in Canada and together, their area makes up the size of France.2 What determines whether a community is remote or not is done using the remoteness index presented by Statistics Canada.3 Using population size, proximity to other populations and services, and travel cost, this index measures how disconnected some populations are from the rest of Canada. A critical study, published in 2019 by Statistics Canada, found that mortality rates, both preventable and treatable, are higher in remote areas.4 Combined with previous knowledge about higher avoidable mortality in many Indigenous groups, these studies demonstrate that access to healthcare and treatment is not equal for all Canadians.4

So, why might this be?

Rural communities receive less funding for health care than urban areas due to the segregated nature of the communities and the smaller number of people who reside there. In addition, health care worker shortages exist in these communities. In 2020, the Canadian Institute for Health Information (CIHI), a corporation that provides data on Canada’s health systems and population-wide data, reported that just 7.6% of physicians in Canada practice in rural areas.5 In Nunavut, a territory where all practicing physicians are said to be practicing in rural areas, the ratio of physicians per 100,000 patients numbered

63. In contrast, Ontario’s ratio was 229, nearly a four-fold difference.5 In addition, just 4.4% of Ontario’s 33,830 physicians practice in rural areas.5

In many rural and remote communities in Canada, the family physician acts as a general practitioner while taking on more specialized responsibilities typically fulfilled by anesthesiologists, pediatricians, and mental health specialists.6 Looking at data from the physician residency match of 2022, 99 positions for family medicine remained unfilled even after two rounds of matching, up from 89 in 2021. With 1,399 positions available, 7% of spots are not being filled up, with many communities not having access

DIVERSITY IN SCIENCE 38 | IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS Graphic design by Stephen Nachtsheim
For [more] severe conditions, residents must board a plane and fly 450 km to Sioux Lookout.

to enough family physicians.6 No other medical speciality comes close to the number of unfilled positions. It should go without saying that specialist care in Canada also suffers: a recent study looking at patients living in a community in Northwestern Ontario found that living in a rural area is associated with a decreased likelihood of receiving a specialist oncology consultation.7

But what about nurses, essential healthcare workers in both urban and rural health networks? According to data from 2010, the number of registered nurses working in rural areas per 100,000 is half that of urban areas.8

Why do so many healthcare workers not choose to work in these communities?

Why do so many healthcare workers not choose to work in these communities?

For many, it’s a lack of appeal. These communities are separated from urban centers and sometimes even other communities. Healthcare workers are hundreds of kilometres away from their family and friends. Workers may be dissuaded from starting families in these communities due to a perceived lack of funding and attention to services like education. Not to mention the lesser healthcare resources and funding these communities receive, which adds to workers’ hesitation.

In response to the stresses placed on rural health and well-being, the Rural Roadmap for Action (RRM) was developed by a task force created by the College of Family Physicians and the Society of Rural Physicians of Canada.9 It lists 20 recommendations for planning and executing rural healthcare services and aims at interventions in universities, policymakers, health professionals, and the communities that will be served.9 Thus far, they have implemented strategies to improve patient transport from urban to rural areas, integrate input from Indigenous health leaders, and advocate for the CIHR to increase funding in rural health research.9

Some provinces have already begun implementing their own programs to improve access to healthcare. The government of British Columbia has responded by increasing the number of doctors and paramedics in professional schools, training nurses to work in rural and remote communities, and scaling up virtual care.10 Other proposed strategies to help chip away at the problem include providing incentives to healthcare workers to work in these communities, increasing resources for workout fatigue, and helping patients access clinical trials for novel interventions for complicated diseases.

With the help of policies, interventions, and increasing attention to the problem, the fight to get equal access to healthcare for all Canadians is ongoing. It is up to the stakeholders in Canadian health

care, including future physicians and researchers studying with IMS, to help solve the problem.

References

1. Canada Health Act 1984 (Can) c. 6, s. 3.

2. CBC News: The National. Canada’s struggle to provide health care to northern communities [video on the Internet]. 2018 March 5. Available from: https://youtu.be/0stGbq22cL0

3. Alasia A, Bédard F, Bélanger J, Guimond E, Penney C. Measuring remoteness and accessibility – A set of indices for Canadian communities. Statistics Canada. 2019 May 9.

4. Subedi R, Greenberg TL, Roshanafshar S. Does geography matter in mortality? An analysis of potentially avoidable mortality by remoteness index in Canada. Health Rep. 2019 May 15;30(5):3–15.

5. Canadian institute for Health Information. Supply, distribution and migration of physicians in Canada 2015 – data tables [Internet]. Canadian institute for Health Information, 2016 [cited 2022 Oct 18]. Available from: https://secure.cihi.ca/estore/productSeries. htm?pc=PCC34

6. Canadian Resident Matching Service. 2022 R-1 match data snapshot [Internet]. Canadian Resident Matching Service. 2022 May 12 [cited 2022 Oct 18]. Available from: https://www.carms.ca/pdfs/2022-R-1data-snapshot.pdf

7. Febbraro M, Conlon M, Caswell J, Laferriere N. Access to Cancer Care in Northwestern Ontario—A Population-Based Study Using Administrative Data. Current Oncology. 2020 Jun 1;27(3):271–5.

8. MacLeod MLP, Stewart NJ, Kulig JC, Anguish P, Andrews ME, Banner D, et al. Nurses who work in rural and remote communities in Canada: a national survey. Hum Resour Health. 2017 Dec 23;15(1):34.

9. Wilson CR, Rourke J, Oandasan IF, Bosco C. Progress made on access to rural health care in Canada. Can Fam Physician. 2020 Jan;66(1):31-36.

10. British Columbia Ministry of Health. New health workforce strategy improves access to health care, puts people first [Internet]. Vancouver: British Columbia Government; 2022 Sep 29 [cited 2022 Oct 18]. Available from: https://news.gov.bc.ca/27538

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From Florence to New Orleans: my experience attending international conferences after the pandemic

Asuccessful graduate school experience is comprised of many elements. Conferences are an essential part of academia and attending your first conference as a graduate student may be a daunting experience. Having begun my Master’s degree during the COVID-19 pandemic when all conferences were cancelled or moved online, I thought that I might never have the opportunity to attend an in-person conference during my graduate program. As conferences began to adopt a hybrid format, I was thrilled when my abstracts for the 2022 Schizophrenia International Research Society (SIRS) Annual Congress and Society of Biological Psychiatry (SOBP) Annual Meeting were accepted. I was so excited to share my work, meet new people in similar fields across the world, and fulfill my graduate student dream of attending an international conference.

While both conferences shared the unifying topic of psychiatric research, my experiences were intimately tied to the culture of the host country. Italy is a country known for its history, culture, and more laidback lifestyle. The SIRS 2022 Annual Congress was a four-day event held at Fortezza da Basso, a beautiful fortress located in the heart of Florence. The programming of the symposia and workshops were more spaced out, allowing for more opportunities to network and to explore the city. This was in contrast to the SOBP Annual Meeting in New Orleans, where I really felt the influence of the fast-paced North American lifestyle in the organization of the conference. There was a variety of concurrent symposia covering a broad range of topics, as well as activities planned from morning to night. There were also organized social events at the infamous House of Blues and the famous restaurant, Mambo’s, where I was able to connect with other researchers and students. While the event-filled days were educational, they often left me feeling quite drained, mentally and socially. For me, the conference schedule felt more structured which did not leave a lot of time for exploring or experiencing the distinctive culture and music of the city.

Another benefit of international conferences is the ability to travel before or after the conference. As most of the senior graduate students attended the SIRS 2022 Annual Congress, our lab took a day trip to the gastronomic capital of Italy – Bologna. We shared traditional Italian dishes together and drank Aperol Spritzes at a famous piazza under the hot Italian sun. It was really nice to slow down and get to know each other outside of a lab-setting. As a bonding event, we also climbed 463 steep steps to reach the top of the Duomo in Florence. It was definitely a struggle, but also a positive experience (for most of us). Nevertheless, it was really fun and I felt like these activities really strengthened the relationship and dynamic of our lab.

From the knowledge I gained, to the fun bonding experiences we shared as a lab, attending international conferences has been both a highlight and milestone in my research journey.

TRAVEL BITES 40 | IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS

SURP Research Day 2022

This year, the students in the Summer Undergraduate Research Program (SURP) showed us just how much you can accomplish in one summer, when they gathered at Hart House on August 10th, 2022, for SURP Research Day. The keynote address entitled “How Do I Plan My Career? From Summer/ Medical Student to Clinician-Scientist” was given by Dr. Fei-Fei Liu. The SURP students had the opportunity to share their exciting research with podium and poster presentations. The event concluded with an awards ceremony and remarks from the Director of IMS, Dr. Mingyao Liu. The day was a cause for celebration and the comradery of the students in the program was evident as they eagerly cheered on the award winners.

The Jasmine Quigley Memorial Award was given to two students this year, Cherrie Zhu and Wenzhu Ye, who both exemplified Jaz’s devotion to research in neuroscience and mental health. The Quigley family was in attendance to present the award and congratulate Cherrie and Wenzhu on their hard work this summer. We asked Cherrie and Wenzhu to share their thoughts on SURP, winning the Jasmine Quigley Memorial Award, and their time spent in the IMS this summer.

“I think SURP is a meaningful program and it provides a platform for all of the researchloving students to socialize and share each other’s work.” – Wenzhu Ye

As graduate students in the IMS, we had the unique opportunity to be poster co-judges. It was a surreal experience to be on the other side of the poster competition. We were amazed by how well the undergraduate students in our group presented their research and how much they were able to accomplish in such a short time. Below are our thoughts on the experience.

“Nearly 10 years ago, I had the opportunity to participate in SURP at the University of Guelph. At the 2022 IMS SURP Research Day, I could not help but reflect on my own experiences with this incredible program and how it kick-started my career in research.” – Stacey Butler

“SURP provided me with an amazing summer research experience and helped me narrow down my research interests. I am grateful to the Quigley family and hope that I can continue their legacy in the field of mental health and neuroscience.” – Cherrie Zhu

“Being a co-judge was truly an eye-opening experience for me. Aside from being inspired by all students and their research, I enjoyed participating in the adjudication process with a faculty member. This experience was valuable in illustrating the key aspects of a high-calibre research study which I aim to incorporate in my own research.” – Akshat Pai

Overall, the 2022 IMS SURP Research Day was a huge success. It achieved the goal of providing undergraduate and medical students, who are conducting biomedical research projects, an opportunity to present their work to a multi-disciplinary audience of students and faculty members at the University of Toronto. We cannot

Graphic design by Livia Nguyen Wenzhu is a 4th year undergraduate student in the Bioinformatics and Computational Biology program at the University of Toronto. Their SURP supervisor was Dr. Clement Zai. Photo provided by Wenzhu Ye Wenzhu Ye and Jasmine Quigley’s family. Photo provided by Wenzhu Ye Cherrie Zhu is a recent graduate from the University of Toronto, majoring in Neuroscience and Immunology. Their SURP supervisor was Dr. Aristotle Voineskos. Photo provided by Cherrie Zhu
PAST EVENTS 41 IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS |

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. 102 Healthcare Behind Bars

Ep. 101

The Many Faces of Burnout in Healthcare

Ep. 100

100 Years Later: Insulin and Beyond

Ep. 99 Refugee Healthcare in Canada

Ep. 98

Podium Pills: Fame or Folly?

Ep. 97 Let’s Talk

Grad School

Ne w e pi so de s ava il a b l e e v e ry ot h er We d n e s d ay .
Be h ind every di s covery , there’s a story.
RAW TALK AD 42 | IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS

The Not so Kind History of Humankind

Ifirst heard about Sapiens: A Brief History of Humankind by Yuval Noah Harari from an article outlining books that former United States president Barack Obama recommends. This book has also received praise from technology titans like Bill Gates and Mark Zuckerberg. As someone who is perpetually interested in how humans have evolved from living in dark caves to potentially becoming inter-planetary species within the next few decades, this book immediately piqued my interest. I could not resist reading it. I began reading this book during my daily commute between Toronto and Mississauga (what better place to read about the history of human civilization than amongst strangers commuting to and from the most densely populated city in Canada).

In this non-fiction book, which is also a prequel to Homo Deus: A Brief History of Tomorrow, Harari segments 13.5 billion years of history into various revolutions until modern day while also providing a brief outlook on the future of humankind. From the agricultural revolution that began 12,000 years ago to the technological revolution we are currently in; he walks the reader through different defining moments of human history.

Overall, the book was an interesting read. Although, I noticed that whenever Harari was about to provide more details about each time period, he quickly moved on to

the next one. I found this quite lackluster at times since I expected more information regarding the defining moments in each era. This pattern contributed to this book feeling ingenuine. I was, however, not alone as quite a few historians and anthropologists have expressed similar opinions about this book’s content and the author’s writing style.

Furthermore, Harari seems to mainly showcase theories that are considered to be low hanging fruits in the world of evolutionary psychology and fails to present opposing theories. Moreover, throughout the book, he continued to take a nihilistic or dismissive approach that instills a sense of pessimism into the reader (regardless of this being his primary goal or not). On page 179, he says “How do you cause people to believe in an imagined order such as Christianity, democracy or

capitalism? First, you never admit that the order is imagined”. Statements like these seem to undermine the role and power of social constructs that continue to form the backbone of our modern society.

I would have appreciated if he provided different perspectives on a certain paradox and then explained which theory is widely accepted by experts. I believe that Sapiens: A Brief History of Humankind should be read as an introductory work on evolution as it falls short as a literary work rooted in evidence (due to a lack of peerreviewed references throughout the book along with the presentation of anecdotal evidence which may further contribute to the author’s confirmation bias). As controversial as this book is within academic circles, I would still recommend the book, however it must be supplemented by Bill Bryson’s A Short Theory of Nearly Everything and other books in this genre.

BOOK REVIEW 43 IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS |
design
Graphic
by Vanessa Nguyen

Neonatology

The Science of Newborn Care and Medicine

The advances in neonatology—a pediatric subspecialty focused on newborn babies up to 28 days of life—have facilitated high life expectancy and survival rates in developed countries like Canada. Neonatal intensive care units (NICU) have become a staple of hospitals in first-world nations as wards for premature (born less than 37 weeks of pregnancy) and ill newborns. Common neonatal complications include congenital disorders, infections, low birth weight, and organ-related conditions. In the latest Raw Talk Podcast episode, the team discussed current trends and gaps in neonatal care and research with various experts in the field.

Organ Development

Organ-related issues constitute a leading cause of modern NICU admissions. One notable condition is brain damage, caused by complications such as birth asphyxia, which causes low oxygen delivery and blood flow to the brain, and brain hemorrhages, resulting in conditions such as cerebral palsy, epilepsy, and other neurodevelopmental problems. Dr. Pia Wintermark, a physician-scientist from the McGill University Health Centre, expressed indignation about being unable to treat brain injuries compared to other organs due to the lack of available treatments. “As a neonatologist, I always find it frustrating because other organs you can fix, but when you have a brain injury, there is not much you can do to improve [it],” Dr. Wintermark notes.

This experience inspired her to start the current research program in her lab, which replicates the pathology of birth asphyxia in rat models. The lab uses these models to test potential new treatments to alleviate organ damage and prevention strategies.

Lung-related issues such as pulmonary hypertension and respiratory distress syndrome (RDS) are also common causes of NICU admission. Pulmonary hypertension prevents proper oxygen delivery due to high blood pressure in the lungs. RDS occurs from fluid buildup and lack of surfactant due to underdeveloped lungs, making breathing more difficult and reducing oxygen intake. Congenital heart defects are also prevalent and cause neonatal cardiovascular disease. All these conditions make up the most cases of neonatal death in Canada, with a 2020 Statistics Canada report ranking congenital malformations and deformations as the leading cause, followed by birth asphyxia, heart disease and respiratory distress.

The Head of the Neonatology division at SickKids, Dr. Estelle Gauda, noted the vast improvements in neonatal survival rates, such as the minimum viable age for premature babies dropping from 24 to 22 weeks of gestation. She attributes this to improved technologies such as pressure ventilators and the development of interdisciplinary NICU teams, including respiratory therapists, nutritionists, occupational therapists, and social workers. However, with the rising survival rates of premature babies,

neonatology teams now must care for increased numbers of sick babies with underdeveloped and injured organs alongside other medical conditions unique to premature babies that require NICU admissions.

Drug Development

The lack of available drugs tailored to babies admitted to the NICU is another pressing issue. Pharmaceuticals must undergo expensive and time-consuming phase I to III trials before approval for general use. This is not the case for drugs used to treat NICU patients. “Unfortunately, most drugs have not gone through this rigorous phase 1-2-3 study. Instead, we commonly take medicines approved in adults and older children, and we begin to use them in the NICU without adequate evidence and labeling,” says Dr. Tamorah Lewis, Division Head of Clinical Pharmacology and Toxicology at SickKids. She further relates how this shortcoming resulted in a lack of specialized drugs for neonates and increased use of off-label medications, leaving neonatologists to reuse medicines designed for other patient populations with inaccurate formulations. To Dr. Lewis, this is likely due to NICU patients being a relatively small patient population with rare conditions and pharmaceutical companies incentivizing common conditions affecting larger patient populations.

Drug testing in newborn babies presents unique challenges because of drastic

RAW TALK PODCAST 44 | IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS Graphic design by Stephen Nachtsheim

physiological changes developing as babies age throughout the weeks. This impacts drug dosing and raises the ethical question of obtaining consent. One of the treatments the Wintermark lab is researching is sildenafil, commonly used to lower blood pressure in neonatal lungs. Given promising results in safety and animal model trials, the lab is currently testing the efficacy of sildenafil with an ongoing Gates Foundation-funded phase I trial in Uganda. Dr. Wintermark mentioned a ‘tunnel vision’ in neonatology research that leads researchers to focus only on a single organ rather than multiorgan applications of drugs.

Gaps in Developing Countries

One active area of research is analyzing and solving the gaps between developing and developed countries, as the prevalence and severity of the conditions mentioned above are exacerbated in lower-income countries. Dr. Zulfiqar Bhutta, Co-Director of Research at SickKids Centre for Global Child Health, emphasized that the drop in total infant mortality rate from four to two million is unequally distributed, as progress in low-income countries is slower than in other higher-income nations.

This is primarily due to the shortage of trained medical professionals and suboptimal resources and infrastructure for neonatal care and complications, alongside external factors: “About 30 to 40% of all neonatal mortality and morbidity is now in geographies affected by conflict, climate change, extreme poverty, population migration and movements,” says Dr. Bhutta, “you cannot construct facilities and have human resources at the same level as you have in normal circumstances.”

These obstacles translate into inadequate health facilities and scarcity of pharmaceuticals we take for granted, such as vaccines and oxygen, driven by exorbitant prices and a lack of cold storage. This scarcity also results in high malnutrition rates, poor sanitation, and a lack of access to electricity and clean water. All these combined factors worsen health outcomes, with a prime example being enhanced susceptibility to infectious diseases, including vaccinepreventable and drug-treatable ones, such as hepatitis B, group B strep, tetanus, HIV, rubella and Zika. These microbes increase the risk of preterm birth, birth defects, miscarriage/stillbirth, chronic illnesses, and other fatal complications.

What next?

This episode just scratched the surface of this critical interdisciplinary field. It intersects various specialties, including but not limited to immunology, pharmacology, global health, and physiology. Despite advances, gaps in knowledge and room for improvement on the clinical side still exist. The synthesis of ongoing research from current and future scientists and clinicians from diverse subdisciplines, such as the guests featured in this article and the episode, will translate into enhanced health outcomes for neonates worldwide.

Acknowledgements

We want to acknowledge the hard work and ideas of the rest of the team and our guests, Drs. Bhutta, Gauda, Lewis and Wintermark, and the Foreman family who shared their NICU experience with us. To learn more about neonatal care and research in Canada, stay tuned for the release of the episode of the Raw Talk Podcast, which will be available on Spotify on November 23, 2023.

References

1. Birth Asphyxia [Internet]. Seattle Children’s Hospital. Available from: https://www.seattlechildrens.org/conditions/birth-asphyxia/

2. Intraventricular Hemorrhage [Internet]. Johns Hopkins Medicine. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/intraventricular-hemorrhage#:~:text=What%20 is%20intraventricular%20hemorrhage%3F,higher%20the%20 risk%20for%20IVH.

3. Newborn Respiratory Distress Syndrome [Internet]. National Health Service. Available from: https://www.nhs.uk/conditions/ neonatal-respiratory-distress-syndrome/#:~:text=Newborn%20 respiratory%20distress%20syndrome%20

4. Persistent Pulmonary Hypertension of the Newborn [Internet]. Nationwide Children’s Hospital. Available from: https://www. nationwidechildrens.org/conditions/persistent-pulmonary-hypertension-of-the-newborn-pphn

5. Table 13-10-0395-01 Leading causes of death, infants [Internet]. Statistics Canada. Available from: https://doi. org/10.25318/1310039501-eng

6. What infections can affect pregnancy? National Institute of Child Health and Human Development. Available from: https://www. nichd.nih.gov/health/topics/pregnancy/conditioninfo/infections

RAW TALK PODCAST 45 IMS MAGAZINE WINTER 2023 DISORDERS OF THE CNS |
Neonatal intensive care units have become a staple of first-world nations
“ “
READ IT ONLINE issuu.com/imsmagazine imsmagazine.com @IMSMagazine

Articles inside

Neonatology

5min
pages 44-45

The Not so Kind History of Humankind

2min
page 43

SURP Research Day 2022

2min
pages 41-42

From Florence to New Orleans: my experience attending international conferences after the pandemic

2min
page 40

The State of Rural and Remote Health Care in Canada

5min
pages 38-39

Stepping Out of Comfort and Into Opportunity:

3min
pages 36-37

Patent Pending - Bridging the Gap Between Law and Science

4min
pages 34-35

IMS Faculty Highlights

3min
pages 32-33

The Fall of Roe v. Wade

4min
pages 30-31

Changes Following a Traumatic Brain Injury Does a person become their disease?

4min
pages 28-29

Healthcare, Affordability, and Dementia: Can All Three Coincide?

4min
pages 26-27

The Hidden Spring:

4min
pages 24-25

Finding a scientific sense of community

4min
pages 22-23

Tunyalux Langsub

1min
page 21

Master of Science in Biomedical Communications

1min
page 20

Finding the genetic material in personalized medication

4min
pages 18-19

Past, Present, and Future: The Journey of Spinal Cord Injury and Concussion Research

5min
pages 16-17

Neuropsychiatry and Dementia

5min
pages 14-15

A New Frontier of Neonatal Epilepsy Research:

4min
pages 12-13

Charging-up People with Dementia: The Power of Technology

4min
pages 10-11

Contributors Winter 2023

4min
pages 6-7

DIRECTOR’S MESSAGE

2min
page 5

Letter from the EDITORS

1min
page 4
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