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Libin Life The Libin Cardiovascular Institute of Alberta Magazine

Spring 2013 libininstitute.org

THE SOCIAL (SUPPORT) NETWORK

Cardiac patient support groups in Southern Alberta

When Engineering and Medicine Meet A CUT ABOVE

Minimally invasive surgery techniques performed by Libin surgeons

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How a medical school in the Philippines has ties to Libin

Research

Education

Care Delivery


MESSAGE FROM THE DIRECTOR

Inspire and Be Inspired

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y mantra for 2013 is to inspire and be inspired. I hope this new design of our Institute magazine echoes that sentiment for you. It showcases many inspirational stories that highlight the truly remarkable calibre of the people associated with Libin. Last year, Dr. Merril Knudtson was inducted into the Order of Canada for advancing percutaneous coronary intervention and documenting outcomes through the APPROACH registry. Dr. Eldon Smith, Chair of our Strategic Advisory Board, received the Alberta Medical Association Medal for Distinguished Service for his long-term commitment to cardiovascular care. Dr. Brent Mitchell, the inaugural Director of the Libin Institute was also recently named President-Elect of the Canadian Heart Rhythm Society. In patient care, exciting new advances have been rolled out. Dr. Andrew Maitland successfully introduced a minimally invasive mitral valve surgery program. The impact the Institute is making stretches beyond our borders as several Libin members have shared their medical expertise in underserviced areas abroad such as the Philippines (Dr. Israel Belenkie) and Guyana (Drs. Debra Isaac and Kishan Narine). What is also exciting is the realization of what lies ahead for us. Due to the tremendous work done over the past six months by Dr. Ed O’Brien, Research Director, we are now armed with a new Strategic Research Plan. This forms the backbone of the overall Libin Strategic Plan and the implementation priorities for our Institute. On the research front, we will concentrate our resources on two foundational priorities (Heart Rhythm and Sudden Cardiac Death; Heart Health Services), our two emerging priorities (Vascular Dynamics and Disease; Advanced Heart Failure) and our enabling priority of Cardiac Imaging. In 2013, we will also expand our educational portfolio by featuring Libin Research Day on March 28. We will be presenting the Libin/AHFMR research prize to renowned cardiovascular scientist Dr. Eric Topol, author of The Creative Destruction of Medicine, and director of the Scripps Translational Science Institute in California. We are also committed to augmenting our engagement with our researchers, health care providers, community partners and students through improved website functionality and other avenues of communication. The strategic plan maps out our future for the next three years, but we will think beyond this. With the University of Calgary currently embarking on a Spatial Master Plan, this will allow us to envision optimal space utilization and expansion over the next decade. These developments will lay the foundation for our current and next generation of cardiovascular researchers. Whether you’re looking back at the last year or dreaming about what is ahead, it’s clear that it’s an exciting time to be at the Libin Institute. If we all strive on a daily basis to inspire and be inspired, much success will be reached in 2013.

Dr. Todd Anderson Director, Libin Cardiovascular Institute of Alberta 2 LIBIN LIFE

Libin Life Libin Life is published twice a year by the Libin Cardiovascular Institute of Alberta, an entity of the University of Calgary and Alberta Health Services (Calgary Zone). The Libin Life mission is to share news and information about the Institute’s impact in research, education and patient care. Institute Director Dr. Todd Anderson Director of Research Dr. Ed O’Brien Education Council Chair Don Welsh, PhD Associate Director Al-Karim Walli Editor Lynda Sea Copy Editor/Proofreader Judy Siu Contributors Amber Arsneau, Valerie Ball, Karen Cook, Kelly Edmonds, Aisling Gamble, Gregory Harris, Afdal Kunting, Michiko Maruyama, Julia McGregor, Paul Rotzinger, Judy Siu, Colin Zak Design and Layout Steven Tov Printer McAra Printing

Libin Cardiovascular Institute of Alberta Foothills Medical Centre C830A, 1403 29 Street NW Calgary, AB, T2N 2T9 P 403.210.6271 E libin@ucalgary.ca W libininstitute.org Twitter @libininstitute Editorial Inquiries Lynda Sea Communications Coordinator lsea@ucalgary.ca Send comments, requests for magazine copies, digital magazine issue subscriptions or change of mailing address notifications to libin@ucalgary.ca. Please request permission to reproduce any part of this publication. All rights reserved. © 2013 Libin Cardiovascular Institute of Alberta


contents // Spring 2013

departments

2 Message from the Director 4 Awards & Accolades 5 News & Highlights 11 Community Engagement 14 Libin Abroad 16 Spotlight on Trainees

12 7 8 8 9 10 10 15

feature

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The Social (Support) Network

Meet three cardiac support groups in Calgary that are lending emotional, financial and social support to heart patients and their families.

care delivery

Minimally Invasive Valve Procedure an Alberta First

Dr. Andrew Maitland conducts minimally invasive heart valve repairs without cutting through breastbone.

Albertans are getting smarter about their hearts

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A study shows province-wide improvements in cardiac health trends.

X-ray free ablations a safer approach

Dr. Robin Clegg gives an Okotoks teen a safer non-flouroscopic catheter ablation to fix his SVT.

research

When Engineering & Medicine Meet

Biomedical engineering resources at the Libin Institute offer collaborative opportunities to tackle heart and vascular disease research.

Analyze This

Turning information into knowledge, the Libin Institute Analysis Centre is a new resource for all.

Hybrid surgery technique repairs total arch

Discover Dr. Jehangir Appoo’s thoracic aortic surgery that deals with multiple issues in one operation.

Education

The Learning Curve

Q&A with Education Council Chair Don Welsh, the philanthropists behind Libin scholarships and details about 2013 Libin Research Day.

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On the Cover “Spirit of the Heart” is a limited edition hand-pulled acrylic silkscreen print by M. Michiko Maruyama. Myrna and Don McDonald kindly donated a framed print of this artwork to the Libin Cardiovascular Institute of Alberta. It is on display in the Foothills’ Heritage Medical Research Building, Rm 68. (artoflearning.ca)

LIBIN LIFE 3


Dr. L. Brent Mitchell on CHRS Presidential Track

AWARDS & ACCOLADES

Dr. Brent Mitchell was elected as vice-president of the Canadian Heart Rhythm Society (CHRS) last October. He will become president of this professional organization of Canada’s heart rhythm specialist physicians and allied health professionals in October 2014.CHRS is a coalition of arrhythmia practitioners including physicians and allied health professionals. It works through research and education programs in the field of cardiac electrophysiology. Mitchell was the inaugural director of the Libin Institute.

Dr. Eldon R Smith Recieves Alberta Medical Association Medal

The Alberta Medical Association (AMA) honoured Dr. Eldon R. Smith for his dedication to health care and the people of Alberta with the Medal for Distinguished Service. The AMA’s Medal of Honor and Medal for Distinguished Service represent the highest honours bestowed by the AMA and its members. It is given to physicians who made outstanding personal contributions to the medical profession and to the people of Alberta. Dr. Smith, former Dean of Medicine at the University of Calgary, was instrumental in establishing Calgary as one of the strongest cardiology centres in Canada. He is a respected cardiologist who worked tirelessly to build the clinical and research leadership for cardiac sciences in Calgary.

Diamond Jubilee Honours Last year, 60,000 Canadians were recognized with the Diamond Jubilee Medal. The program was created to mark the 60th anniversary of Her Majesty Queen Elizabeth II’s accession to the Throne as Queen of Canada. Alvin Libin and Drs. Eldon R. Smith and Henry Duff were among the Calgarians who received the medal. It honours significant contributions and achievements by Canadians. Alvin Libin is the Libin Institute’s founding donor and Chair of the Community and Partners Advisory Committee. Dr. Smith is Chair of the Strategic Advisory Board. Duff is a cardiologist and researcher who’s also the Heart and Stroke Foundation of Alberta’s Chair in Cardiovascular Research.

Dr. Merril Knudtson at Order of Canada Investiture Ceremony

The Faculty of Nursing’s Kathryn KingShier, PhD has been recognized by the Canadian Association of Schools of Nursing (CASN) with their 2012 Award of Excellence in Nursing Research. King-Shier is a full professor in the Faculty of Nursing and is an Alberta Innovates Health Solutions scholar. She holds a joint appointment in the Department of Community Health Sciences. She is a Libin member and research associate in the Epidemiology Coordinating and Research Centre at the University of Alberta. As one of Canada’s leading cardiovascular nurse scientists, she has developed and led a multi-disciplinary program of research in the area of determinants of cardiovascular health behaviour and health-care decisions and delivery. She is currently leading or co-leading several studies that focus on the influence of ethno-cultural affiliation and gender on secondary prevention decisionmaking.—Karen Cook 4 LIBIN LIFE

On November 23, 2012, Dr. Merril Knudtson was inducted at the Order of Canada investiture ceremony at Rideau Hall as one of 44 recipients of this prestigious honour. Known as the father of interventional cardiology in Canada, he is one of the first cardiologists in the country to perform a coronary angioplasty. In 1981, he completed the first procedure to open a narrow or blocked artery in the heart and went on to establish a training program to teach other doctors how to do it. He also created the APPROACH project (Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease) in 1995.

L-R Diane Galbraith, PhD, Dr. Merril Knudtson, Colleen Norris.

Kathryn King-Shier recognized with Nursing Research Award


Libin CAHS Fellows

news & highlights

Last fall, two Libin members were inducted as Fellows to the Canadian Academy of Health Sciences (CAHS). Dr. Todd Anderson, Director of the Libin Cardiovascular Institute of Alberta and Dr. Brenda Hemmelgarn, Associate Professor in the Departments of Medicine and Community Health Sciences were among the three faculty members from the University of Calgary who were inducted. They are recognized for their demonstration of leadership, creativity, distinctive competencies and a commitment to advance academic health science. The CAHS recognizes individuals of great accomplishment and achievement in the academic health sciences in Canada. The academy provides timely, informed and unbiased assessments of urgent issues affecting the health of Canadians.—Aisling Gamble

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Our cardiac sciences footprint at Calgary’s newest hospital

Stephenson Cardiovascular MR SHC outpatient services include: 1 The 4 Centre has a new 3-Tesla Echocardiography (TTEs; TEEs; Cardiac MRI machine. It has been in Stress Echo), Electrodiagnostics full operation at SHC since January. It will help alleviate wait time for patients waiting for a cardiac MRI in Calgary. Previously, the only cardiac MRI machine in the city was the 1.5-Tesla machine at the Foothills Hospital.

inpatient beds will 2 16openCardiology on April 8, 2013. Four of those

NASA Bestows Top Achievement Medal to Dr. Douglas Hamilton

beds will be high observation care level beds. More than 90% of inpatient beds at SHC are located in single patient rooms.

heart clinics include: Cardiac 3 SHC Function, Atrial Fibrillation, General

Cardiology, Arrhythmia Clinic and a Device Clinic. The new heart failure clinic will be the largest one in Alberta.

(ECGs; Clinical Stress Testing; BP Monitoring; Holter Monitoring; Event Recording; Metabolic Testing) and CT/Nuclear (CTAs; Calcium Scores; MPI and MUGAs). In addition, there is a procedure room for invasive procedures, and observation area where electrical cardioversions may occur.

promotion is integrated 5 Wellness into the design of this hospital. There is a 29,000-sq.-ft. Wellness Centre which features an onsite YMCA with fitness facilities and programs, a demonstration kitchen for healthy eating and a resource centre and community meeting rooms. —LS

“The South Health Campus represents major enhancement

in our ability to provide services to patients with, or at risk of, cardiovascular disease. We believe that there will be a significant improvement in our inpatient care, and that there will be major improvement in access to outpatient cardiac services. The impact will be felt all throughout the region, not just in Calgary.”

Exterior photo by Kelly Edmonds.

Last fall, former NASA flight surgeon Dr. Douglas Hamilton MD, PhD was presented the Exceptional Engineering Achievement Medal at the NASA Honor Awards Ceremony at the Johnson Space Center in Houston, Texas. Hamilton is an Associate Professor of Medicine at the University of Calgary. He is a member of both the Libin Cardiovascular Institute of Alberta and W21C (a research program within the Institute for Public Health). He received this award for his work in identifying and clarifying the potential risk of electric shock that could happen to astronauts who were performing spacewalks (also referred to as extra-vehicular activities or EVAs) on the International Space Station. Through collaboration with the Naval Medical Research Unit Directed Energy Weapons Laboratory and NASA/Boeing Space Environments Division, Hamilton was instrumental in the development of super-computer models to predict where electric discharge may occur along the metal points in spacesuits during EVA. Hamilton’s work has served to inform the design of new EVA suits, has reworked the space vehicle electrical human systems standards, and is being considered for use in the automotive, aerospace, and toy manufacture industries to increase public safety.—Julia McGregor

Things You Should Know About South Health Campus (SHC)

—Dr. Jonathan Howlett, Cardiac Sciences Site Lead, South Health Campus and director of Heart Failure at Foothills Medical Centre


Libin Leaders Behind Newest CCS Guidelines For Professionals

Wonders of the Mitral Valve

Cardiovascular guidelines are a resource, not only for members of the cardiovascular community, but for healthcare practitioners throughout Canada. Practice guidelines can play an important role in helping to improve the quality of patient care and manage limited resources. The Canadian Cardiovascular Society (CCS) Guidelines are published in the Canadian Journal of Cardiology. To reference the full papers online, visit ccs.ca or onlinejc.ca. —LS 2012 CCS Dyslipidemia Guideline Update

What’s New?

Lead author Dr. Todd Anderson, co-chaired (with Dr. Jean Grégoire) the group of leading experts who published the “2012 Update of the Canadian Cardiovascular Society Guidelines for the Diagnosis and Treatment of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult.” The Canadian Cardiovascular Society Dyslipidemia Guidelines help physicians to diagnose and treat dyslipidemia (high lipid count) in patients.

• Introduction of the concept of Cardiovascular Age • Recommending more frequent monitoring of patients with FRS >5% and <10% • Using both apo B or non-HDL-C as alternate lipid markers • Removing hsCRP from the main treatment table • Addition of chronic kidney disease as a high risk feature • Specific recommendations about health behaviours • New recommendation about statin adverse effects • Use of GRADE recommendations and process

CCS 2012 Consensus on the Use of Cardiac Resychronization Therapy (CRT) Lead author Dr. Derek V. Exner co-chaired (with Dr. Ratika Parkash) the panel who published “Canadian Cardiovascular Society Guidelines on the Use of Cardiac Resynchronization Therapy: Evidence and Patient Selection.” It serves as a framework for the prescription of CRT within the Canadian health care system and beyond.

Smart phone apps for heart health

What’s New? • Substantial revision of existing CRT guidelines • New criteria for patient selection • Altered recommendations for specific patient sub-groups • Focus on atrial fibrillation, non-left bundle branch block conduction, prior chronic pacing • Guidance related to CRT platform selection • Guidance on pre-selection with echocardiography

myCMR

Want to know what to expect at your Cardiovascular Magnetic Resonance Imaging (CMR or Cardiac MRI) procedure, long before you arrive at the clinic? This app, developed out of The Stephenson CMR Centre at the Foothills Medical Centre, helps users understand MRI basics through interactive audio/visual procedures and by explaining various CMR images.

Med-HF

This interactive heart-failure tool puts comprehensive medication and side-effects information at the fingertips of Alberta’s physicians and pharmacists. Med-HF walks users through the initiation, titration, assessment and monitoring of four drug classes commonly used to treat heart failure: ACEIs/ARBs, Beta-Blockers, Diuretics, and Aldosterone Antagonists.

Alberta Health Services

Find the nearest hospitals, healthcare facilities, programs and services and view real-time wait times for emergency departments and urgent care centres throughout Alberta. You can also access important contact numbers including HealthLink, Poison Control, Mental Health Help Line and more.

CCS Lipid Guidelines

The current app is based on the 2009 guidelines but users can expect a new update to reflect the 2012 guidelines later this year. Features include the Framingham Risk Score calculator and Reynolds Risk Score calculator for comparison so users can look up the corresponding treatment recommendations and calculate the 50% LDL treatment reduction target right away. —LS

For many passersby on the 8th floor of the Foothills Medical Centre, this painting has been a common sight outside the cardiology offices of the Libin Institute. It also graces the cover of the institute’s history book Hearts, Minds and Vision: Roots of the Libin Cardiovascular Institute of Alberta 1930-2010. Here’s the story behind the artwork. The Artist Karen Elizabeth Wonders. She holds a PhD in art history from the University of Uppsala in Sweden, an MA in art history from the University of Victoria and a BFA in visual arts from the University of Alberta. She was a a research fellow at the Institute for the History of Science at Göttingen University in Germany (2001–2009). The Art Having seen many echocardiograms of her own heart, she painted this iconic mitral valve, a cross-sectional “slice” of a beating heart as it is imaged by ultrasound technology. It is a medical subject executed in a romantic style to remind the viewer that not all that relates to the human heart is a matter of scientific rationality. The Inspiration “I donated the painting in 1985 in tribute to the skills of the physicians who saved my life, and especially to Dr. Eldon R. Smith, then head of the Department of Medicine. His expertise in the field of echocardiology was critical to my care. I became fascinated by how echocardiograms function and the role of echocardiography in multidimensional imaging of the heart. I also became fascinated by the heart’s anatomy and physiology, as well as by myocardial function and flow.” —LS


care delivery

Minimally Invasive Heart Valve Procedure an Alberta First Leaky valves repaired without cutting through breastbone, speeding recovery By Colin Zak • Photo by Paul Rotzinger

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n an Alberta first, local cardiac specialists are now repairing leaky heart valves using a minimally invasive procedure that reduces hospital stays, speeds recovery and leaves smaller scars. Twelve patients have already undergone minimal-incision aortic and mitral valve repair since the procedure was first performed on May 30, 2012 at the Libin Cardiovascular Institute of Alberta. The procedure is used to treat mitral and aortic regurgitation, conditions in which blood leaks backwards through the heart valve, which can lead to irregular heartbeats (arrhythmias) or heart failure if left untreated. “The main benefit to patients is quality of life—it allows them to return to their normal lives and resume their normal level of physical activity sooner,” says Dr. Andrew Maitland, the cardiac surgeon who led the Foothills Medical Centre team performing the procedures. Maitland Cardiac surgeon Dr. Andrew Maitland points at the minimal scars on former is also an Associate Professor in the Departments of Cardiac Sciences/Surgery in the Faculty of Medicine at the Canadian Olympian Romel Raffin who had a leaky heart valve repaired. University of Calgary. Traditional valve repair involves making a 10-centimetre Three-time Canadian Olympian Romel Raffin underwent incision down the centre of the chest and cutting through the procedure last summer. He says his top the breastbone. Instead, priority was getting back to his normal routine the new procedure involves “This new procedure will likely lead of working out every day and playing hockey making a four- to fiveto better outcomes for patients. twice a week. centimetre incision to “The day after the procedure, I was up the side of the chest, Another plus of this procedure is that walking around. Six weeks after the operation, without cutting any bone. it leaves less visible scars, rather I was back at the gym and going for walks Instruments are then every day,” says the 58-year-old, who was on inserted and the valve is than having a big scar going down the Canadian men’s basketball team at the repaired via telescope. the front of the chest.” 1976, 1984 and 1988 Summer Olympics. The entire operation takes Dr. Imtiaz Ali, Section Chief of Cardiac several hours, with patients Surgery for Alberta Health Services, says that refining skills and spending three or four days recovering in hospital—about half the time they would spend after traditional valve repair introducing leading-edge procedures has become a hallmark of the work happening at the Libin Cardiovascular Institute of Alberta. surgery. Patients can expect to make a full recovery within “Our cardiac surgeons have continued to lead the province— six weeks. and the country—when it comes to pioneering new and innovative “This new procedure will likely lead to better outcomes procedures,” says Ali. “Ultimately, this will not only improve for patients,” says Maitland. “Another plus of this patient outcomes but recovery time and overall quality of life after procedure is that it leaves less visible scars, rather than their operation.” having a big scar going down the front of the chest.” LIBIN LIFE 7


Albertans Are Getting Smarter About Their Hearts

X-Ray Free Ablations a Safer Approach

Study shows heartening improvements in cardiac health across the province

Using non-fluoroscopic mapping techniques, Libin pediatric cardiologist Dr. Robin Clegg gives an Okotoks teen a catheter ablation using electrical signals to create a 3D heart model

By Gregory Harris • Illustration by Steven Tov

Story and Photo by Lynda Sea

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new analysis of cardiac procedures performed across the province from 2003 to 2010 shows the heart health of Albertans may be improving. Although the raw number of cardiac procedures hasn’t changed significantly during that period, figures adjusted for population growth tell a different story. “It may be that many Albertans have reduced their cardiovascular risk factors by quitting smoking, eating better and exercising more, thereby improving population health. However, medical practice has also changed, with angioplasty being used more frequently as a treatment option than cardiac bypass surgery,” says lead author of the research study Dr. Sean McMurtry, assistant professor in the University of Alberta’s Faculty of Medicine and Dentistry, and a cardiologist at the Mazankowski Alberta Heart Institute. Alberta is unique in the country in that it maintains a comprehensive database of information about cardiac procedures called the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH). APPROACH currently tracks more than 200,000 patients with chronic heart disease in the province. It was started in 1995 by Dr. Merril Knudtson of the Libin Cardiovascular Institute of Alberta. “Ultimately the information helps physicians, administrators and even patients make the most informed decisions they can when it comes to cardiovascular health care,” says Dr. Knudtson, co-author of the study. “At the same time, there is a dynamic and complex interplay of factors and the data doesn’t always lend itself to conclusive, blackand-white interpretation.” For example, the research paper notes there are geographic differences in the use of cardiac procedures, with northern Alberta consistently having higher rates of use than the provincial average and southern Alberta consistently having lower rates than the provincial average. Although the news about apparent improvements in cardiovascular health is encouraging, people still need to pay attention to their own heart health. “There have been healthy improvements in the population whether it’s been reduced cigarette smoking, increasing exercise, dietary adjustments—simple things like that are the biggest drivers,” says Knudtson. Paper Highlights Cardiac catheterizations rates

Acute coronary syndrome cases

Coronary artery bypass surgeries in Alberta

2003: 480 per 100,000 people 2010: 430 per 100,000 people

2000: 435 per 100,000 2010: 281 per 100,000

2003: 2,013 surgeries 2009: 1,266 surgeries

8 LIBIN LIFE

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wo years ago, 15-year-old Dallas Forno felt his heart race uncontrollably. It wasn’t because of a girl or from the fact that he was playing basketball in the school gym. He was experiencing the first signs of an arrhythmia, an abnormal rhythm in his heartbeat. “All of a sudden, my eyes started getting all blurry and I was lightheaded,” says Forno. When the school nurse took his pulse, it was pounding at 290 beats per minute. He was rushed to the hospital in Okotoks where his heart was stopped and reset, so to speak, so it could stabilize back to a normal resting heart rate.

Forno was diagnosed with supraventricular tachycardia (SVT)—the most common heart rhythm problem in children. The majority of SVT occurs in structurally normal hearts. Seven months after his incident, on March 23, 2012, he underwent a minimal fluoroscopic catheter ablation. A catheter is inserted through a vein in the groin and threaded to the heart. The procedure then corrects the arrhythmia by “scarring” and destroying the abnormal tissue causing the irregular heartbeat. Forno’s doctor was Libin’s own Dr. Robin Clegg, a pediatric cardiologist at the Alberta Children’s Hospital who performed the first pediatric ablation in Calgary in 2008. Clegg says that while there is minimal risk with this type of procedure, it is typically conducted with x-rays. But since children are much more vulnerable to the negative effects of x-ray exposure in childhood, recently, there has been a huge shift towards minimizing fluoroscopy in ablations for both young and adult patients. “We use non-fluoroscopic mapping techniques. We can use the electrical signals to create a 3D model of the heart to map out where the heart’s normal electrical tissue lies,” says Clegg. “Then, when we put the patient into their abnormal rhythm, we can identify what type of rhythm it is and where the abnormal tissue is.” “In most cases, [SVT] isn’t a life-threatening problem but it’s very disruptive,” she says. “It disrupts school and extracurricular activities and kids withdraw. They stop participating in sport and other social activities. These activities are immensely important to health, in general, and normal development. It’s great to be able to fix this problem and to address it in a readily accessible way in Calgary.” For recovery, after the three-to-five hour procedure, Forno only had to spend one night in the hospital. A week later, he was playing sports again, namely pitching for the Okotoks Dawgs Baseball Academy. “It’s as if my life before had one part of it that went weird or wonky,” he says. “Now I feel totally normal, as if nothing had ever happened.”


research

When Engineering

& Medicine Meet

From electrophysiology and biomechanics to tissue engineering, biomedical engineering resources at the Libin Institute offer new collaborative and translational ways to address heart and vascular diseases By Al-Karim Walli (with files from Tina Rinker)

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s an entity of Alberta Health Services (Calgary) and the University of Calgary as a whole, the Libin Cardiovascular Institute of Alberta has always been inclusive of researchers beyond the Faculty of Medicine. From the grand perspective of the field of cardiovascular sciences overall, be it in relation to implantable devices, electrical modeling, pump function and transplant, vascular intervention, and certainly to the evolution of imaging modalities, there’s always been a historically significant partnership with engineering. From an Institute perspective, engineers have also been key enablers at Libin. There have been numerous and fruitful collaborations across a number of labs from the mechanical testing of Paul Fedak’s “Kryptonite” sternal-closure bone glue to Dr. Henry J. Duff ’s mysterious “Black Box” diagnostic tool. Libin is also proud to have graduated Dr. Gregory S. Nelson MD, PhD, the first Biomedical Engineering, PhD of this university, from Dr. John V. Tyberg’s laboratory. The newly renovated GC45 lab within the Libin Institute’s Health Research Innovation Centre footprint was designed to provide new biomedical engineering (BME) resources in the areas of electrophysiology, biomechanics, and tissue engineering. Collectively, the cardiovascular BME researchers who will occupy this lab have the expertise to generate tissue-engineered constructs and to assess their mechanical and electrical properties and functions. They will perform mechanical and biocompatibility testing on materials; develop cell- and tissue-based models for device, drug, nanoparticle, and MR contrast agent testing; and analyze tissue and fluid mechanics in animals and humans using various modalities. Anders Nygren, PhD and Tina Rinker, PhD are two of the Libin Institute’s researchers involved in the laboratory. Along with their colleagues in cardiovascular biomedical engineering, they are excited about working side-by-side with other Libin researchers, and look forward to exploring new collaborative and translational work focused upon heart and vascular diseases.

Anders Nygren, PhD Nygren is an electrophysiologist with expertise in experimental characterization and computer modeling. His main experimental tool is voltagesensitive dye imaging, and his group has used this approach in recent years to assess electrical coupling abnormalities between cells at the level of whole hearts in the context of diabetes and ischemia. His current work is focused on image-processing and instrumentation to remove artifacts caused by the heart pumping. This will allow imaging of arrhythmia mechanisms due to repolarization or calcium-handling abnormalities, in a mechanically active heart. He also works on vascular smooth muscle modeling, and has an interest in vascular electrophysiology. His lab is equipped to image small/thin preparations such as cultured monolayers or slices of tis sue, which can then be used to investigate mechanisms and drug therapies that could ultimately affect tissue electrophysiology. Tina Rinker, PhD Rinker’s research is largely focused on investigating fluid-flow dependent cell physiology, including how vascular disease develops and influence stem cell fate. An additional area of interest is the development of diagnostic strategies for atherosclerosis and breast cancer. Her work involves developing bioreactor systems to generate custom fluid flow conditions, and using these systems to identify flow-dependent molecular signaling pathways and biomarkers. The same bioreactor systems are also used for evaluating responses to drugs or gene expression modifications, as well as the characterization of nanoparticle/cell interactions. Her team is synthesizing nanoparticles and investigating properties that affect nanoparticle targeting and uptake in blood vessels. Nanoparticles have potential to be quickly delivered within the body through the vascular system. However, nanoparticle size, charge, and chemistry impacts accumulation (in both desired and undesired regions), and has toxic effects on cells and tissues. Collaborations with scientists, clinicians and surgeons are integral to her research program. Rinker’s current projects involve investigators in Canada, the United States and South Korea. Technology development and commercialization is also a strong aspect of her group and they already have several product development projects underway. LIBIN LIFE 9


Hybrid Surgery Technique Repairs Total Aortic Arch By Lynda Sea

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analyze this The new Libin Institute Analysis Centre (LIAC) aims to aid researchers with statistical and analytical support and ultimately, to transform information into knowledge By Judy Siu • Photo by Lynda Sea

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hile the Libin Cardiovascular Institute of Alberta’s Strategic Research Plan was being developed, it became clear that the Institute needed a shared resource to manage health data, to provide epidemiological and statistical consultation, and to translate information into knowledge for action. As a result, Heart Health Services emerged as one of the Institute’s top priorities for the next three years. To address this new priority, the Institute has established a shared resource centre that aims to improve and enhance the quality of research conducted within Libin. The Libin Institute Analysis Centre (LIAC) is a new resource now available to all Libin Institute members, faculty, staff and students. The Centre provides statistical consultation and expertise in the development of research questions, study design, statistical analyses and interpretation, and preparing statistical materials for grants and publications. The Centre also provides training and mentoring to graduate students, residents and fellows. Led by principal investigators Dr. Hude Quan and Dr. Brenda Hemmelgarn, the LIAC staff has expertise in epidemiology, health services research, biostatistics, and data analysis software and methods. Guanmin Chen, the Centre’s Research Manager Biostatistician, received his PhD in China in 1997 and has more than ten years of experience with health services research methodology using administrative data and statistical counseling. The Centre’s services range from simple consultation to complex project data analyses. “Some clinicians have data, but they don’t know how to synthesize it,” says Quan. “The LIAC will provide analytical and statistical support for translating information and data into knowledge.” The LIAC does not collect data, but rather, manages health information. It helps researchers based on need, whether that need is helping to identify the appropriate statistical method used for a research project, to produce and interpret statistical reports, or to create tables and figures that best represent their analyses. The LIAC is still in its infancy but the Centre is already receiving requests for their services. “I am expecting that demands of the LIAC will grow and its contribution to grant development and publications will be significant,” says Dr. Quan. “Sustaining the LIAC will be fundamental in the long term.” 10 LIBIN LIFE

he aorta, the largest artery in the body, which delivers oxygenated blood from the heart to the body, is a complex circulatory system. For this reason, open heart surgery to address heart diseases in this area often involves complex valve reconstruction. In the past, these valves were replaced. Now, the approach is all about repair. Here at the Libin Cardiovasclar Institute of Alberta, cardiovascular surgeon Dr. Jehangir Appoo is the director of the Thoracic Aortic Surgery Program. In 2006, he implanted the first left ventricular assist device (VAD) in Southern Alberta. Appoo is currently preforming a new type of surgery to better tackle life-threatening Type A aortic dissections—tears in the aorta wall. The procedure, hybrid aortic arch reconstruction surgery, doesn’t require circulatory arrest (cooling the patient down to 18 degrees and stopping blood flow for up to 90 minutes) and more importantly, addresses multiple areas in a single operation. Top Illustration of completed hybrid arch reconstruction with endovascular stent graft across aortic arch. Left Four-branched “Bavaria” graft used for ascending aortic replacement and arch debranching.

“Some patients have complex pathologies that involve the ascending, the arch and the descending [aorta] and it usually involves two or three different operations to try and fix,” he says. Using a special “Bavaria” graft to replace the ascending aorta, this process allows him to connect to the heart’s head vessels and place an anendovascular stent graft—all at the same time. “We’ve been able to do things in one operation rather than two or three and we’ve found that at three years, these grafts look stable in the aorta and haven’t had any complications,” says Appoo. “This allows for more complete aortic repair.” Appoo says that the current understanding of when a dissection is going to occur or when an aorta is going to rupture is still very rudimentary. It’s essentially based on size but researchers think there’s more to it than that. “We’re trying to use engineering principles to determine things like wall stress and strain in the aorta,” he explains. He is collaborating more closely with the biomedical engineering group at the University of Calgary, specifically with Dr. Elena Di Martino, to further explore aortic mechanics.


community engagement

The

HEART of the Matter

A new Cardiac Hybrid Operating Room slated for the Foothills Hospital means clinicians can treat complex heart conditions with real-time diagnostic imaging for quicker and safer procedures

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By Valerie Ball • Photos courtesy of the Calgary Health Trust

argot Kitchen was the picture of health at age 70. As a yogi, she ate the right things, stayed active through her yoga practice and even took the time to extend her teaching to training others. She and her husband David celebrated life to the fullest, travelling to India, Mexico and Europe and spending time with their family. Like every proud grandparent, she looked for ways to connect with her grandchildren through dance recitals and hockey tournaments, but found a special bond with them through yoga. But while preparing to host a yoga seminar in February 2012, Margot’s entire life was put on hold. “I had this unbelievable pain that went straight through from the front of my chest to the back and I knew something awful was happening. I said, somebody call an ambulance, I’m having a heart attack.” But it was actually worse than a heart attack—Margot had a dissected aorta. She was rushed to the cardiac unit under the care of Dr. Jehangir Appoo. With multiple tears in the inner wall of the aorta, her blood was flowing between the layers causing blood loss. Needing to work quickly, Dr. Appoo used a hybrid surgery technique, allowing him to repair the arch of the aorta in one surgery instead of two. It’s a type of surgery that required pin-point precision and Dr. Appoo had approximately one millimetre before he would reach a major

part of the aorta that pushes blood to the brain. Even with an amazing surgeon caring for her, the road to recovery has been long. Margot has undergone two extensive surgeries and spent a month in the hospital, all of which had taken a toll on her body. Now recovering at home, Margot refuses to let this set her back from living her life how she wants. “My friends all say to me that I am the last person they thought would have cardiac problems because I am the healthiest person they know. But you can’t prepare for everything— especially where genetics are concerned.” Individuals like Margot Kitchen are the reason why Calgary Health Trust is heading a $5.1 million campaign to fund a Cardiac Hybrid OR as part of The Heart Project. Money raised will go towards the purchase of equipment needed to bring this leading-edge cardiac operating room to Calgary. The new OR will enable clinicians to work together in treating complex heart conditions, lessening the number of procedures each patient requires. The availability of state-of-theart technology allows for less invasive procedures and shortens recovery time, returning patients to their lives and families as quickly as possible. Learn more about The Heart Project at calgaryhealthtrust.ca/heartproject

Why a Cardiac Hybrid OR? • With the new hybrid OR, clinicians can work together in the same space to treat certain conditions quicker and safer, lessening the number of procedures each patient goes through.

On November 1, 2012, the Calgary Health Trust hosted the Foothills Medical Centre Cabaret at the Hyatt Regency Hotel in support of this project. See more photos from the event at libininstitute.wordpress.com.

• Incorporating new diagnostic imaging equipment such as x-rays, CT scans, ultrasound machines and MRIs in one room, doctors have the advantage of real-time imaging to aid in performing less invasive procedures. • A cardiac hybrid OR can help to free up operating rooms and shorten the wait time for surgeries. • Leading-edge technology, such as the Cardiac Hybrid OR, assists in attracting and retaining specialists from around the world.

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did you know?

1 in 2 people in Southern Alberta will require some sort of cardiac care or cardiac diagnostic imaging in their lifetime

LIBIN LIFE 11


FEATURE

The Social (Support) Network Thanks to various cardiac support groups in Calgary, heart patients and their families are getting financial and emotional support so they don’t have to face the life-altering diagnoses and treatment of their conditions alone By Lynda Sea

Individuals affected by cardiac disease seek out professional help from their doctors but they also rely on support from family members, peers and fellow patients. Whether it’s finding reliable sources of patient information, reaching out for financial help or just simply connecting to other individuals who’ve been through similar circumstances, they are socializing, learning and networking to cope and adapt. Here are three support and advocacy groups in Calgary helping cardiac patients and their families to live normal and healthy lives.

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The Heart Beats Children Society of Calgary Like most expectant mothers, Jen Beleshko went to her 18-week ultrasound nervous and excited to find out if she was having a boy or girl. She wasn’t prepared to find out her baby had complex congenital heart defects. Not only was his heart was on his right side instead of the left (dextrocardia), he also had no left ventricle and his main arteries were reversed. Her son Roman was born in the fall of 2007 in Edmonton and has since gone through two open heart surgeries and one heart catheterization. Now five, he is totally healthy. You’d never know he used to be sick, except for the scars on his chest. “It’s life-changing,” says Beleshko. “Having a chronically sick child who you know will have to undergo multiple surgeries is very challenging.” According to The Heart and Stroke Foundation, one in every 100 babies born has some form of heart defect. Heart Beats is a local support group, started 26 years ago by two Calgary moms. It helps families in Southern Alberta with kids with congenital heart defects (CHD) via emotional and financial support. The cardiology clinic at the Alberta Children’s Hospital typically refers families to Heart Beats. The group’s Helping Hands Fund helps to reimburse families a small stipend when they have to travel to Edmonton for surgeries. In addition to alleviating travel costs, Heart Beats hosts meetings for parents and siblings and patients to discuss their concerns and fundraise for equipment for the clinics. The group is all about rallying around families to help them feel less alone. “Basically we’re a group of families that come together,” says Beleshko. “There’s a bond there and understanding of what we’re going through even though we’re all from different walks of life.” Heart Beats hosts a number of events throughout the year including an annual Family Fun Run (next one is October 5, 2013) and the Congenital Heart Defect Awareness Week from February 7 to 14. It offers meetings “Just for Dads” to allow fathers to help one another as well as Offbeats for older children with CHD. “We’re very inclusive of everybody because congenital heart defects affect everyone in the family.”(heartbeats.ca)

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4 1 Jen Beleshko and her son Roman. 2 Kids with CHD at The Heart Beats Annual Family Event. 3 Roman Beleshko atfter his first open-heart surgery at 3 1/2 months of age. 4 Heart to Heart volunteers present a cheque to the Calgary Health Trust – Cardiac Wellness. 5 Danny Stachiw. 6 Leslie Crawford (right) and attendees at the 2012 Danny Stachiw Memorial Golf Tournament.

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Heart to Heart Support Society

Dear Heart Foundation

A heart attack is the ultimate unexpected. But for a group of Calgarians who have all dealt with heart problems personally, it’s all about helping others to see that heart disease is not the end of something but the start of a new chapter. Heart to Heart Support Society was founded in 1985. It supports and encourages heart disease sufferers, helps their partners, families and friends adjust and brings public awareness to the risks of the condition. The members firmly believe in giving back to health programs that they were a part of themselves, while receiving care for cardiac issues. Heart to Heart volunteers visit cardiac patients in the hospital and after discharge, follow-up with peer support. They do this to motivate and inspire hope by sharing their own personal stories. “They get input from medical professionals but what they get from us is at a peer level,” says Tony Schlee, past-president and one of the group’s directors. Glen Clark, Heart to Heart’s treasurer, says it’s important to keep morale up. He recalls one patient vividly. “I went into the room and the patient was so afraid of anything related to heart disease. He didn’t want any intervention,” says Clark. “But by the time I finished explaining to him who I was and that I had gone through bypass surgery myself, and here I was visiting with him now, I think it showed him there’s always hope.” The group also fundraises through events to raise money for cardiac units throughout the city. Last year, Heart to Heart donated $60,000 back to into Alberta Health Services through the Calgary Health Trust and different hospitals and clinics in the city for equipment, programs and more. There are around 110 members in Heart to Heart. They currently meet every third Wednesday of the month and hosts guest speakers—nurses, cardiologists, nutrition and fitness experts—to talk about how to live with heart disease. Heart to Heart also has special interest subgroups including Woman to Woman Cardiac Support for female heart disease sufferers and Phoenix Club for active younger men. The group has expanded to include branches in Brooks, Drumheller, Lethbridge and Medicine Hat. (hearttoheartsupportsociety.ca)

What would you do with a second chance? In the case of Danny Stachiw, after receiving a transplant heart in 2002, he founded the Dear Heart Foundation to give hope to other cardiac transplant patients, promote organ donation and to help fund cardiac transplant research. Even though Stachiw’s transplant heart eventually failed him and he died on November 16, 2011 waiting for a new heart, his legacy and generosity of spirit lives on in this charity. His partner Leslie Crawford, a nurse clinician with Alberta Health Services, is currently running the foundation with two other board members; Libin Insitute’s own Dr. Debra Isaac and one of Stachiw’s close friends Doug Johnson. Deart Heart started in 2009 after Stachiw had received his transplant heart. “He would write letters to his donor’s family to let them know how he was doing,” says Crawford. “He didn’t hear back for some time in a couple of years. One Christmas, he did get a letter from the donor’s mom and it was addressed to ‘Dear Heart.’” Stachiw used the salutation to name his foundation, a fitting name considering his aim for the foundation was to help other cardiac transplant patients through financial, emotional and social hardships. He saw the financial burdens of job loss, transportation, medications, job re-training, housing, rehabilitation and family strains experienced by many cardiac transplant patients and wanted to help. To that end, Dear Heart provides financial assistance for patients, public education, donor awareness and support for heart transplant research and education. In April 2012, The Dear Heart Foundation presented the 2012 Transplant Games with $25,000. The money was raised at the first annual Danny Stachiw Memorial Golf Tournament. The next golf tournament will be held this year on May 23. “My wish is that we keep focusing on transplant awareness,” says Crawford. “My inspiration is doing it for Danny, for sure. I’m doing this to keep Danny’s memory alive.” (dearheartfoundation.ca) LIBIN LIFE 13


libin abroad

Project Zamboanga International cross-collaboration strengthens University of Calgary partnership with a medical school in the Philippines By Al-Karim Walli

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n 2012, Dr. Fortunato Cristobal, founding and current Dean of the Ateneo de Zamboanga University School of Medicine (ADZU-SOM) in the Philippines, visited the University of Calgary to give the Dr. Clarence Guenter Lecture on Global Health. He reported that infant mortality rates in the Zamboanga Peninsula of the Southern Philippines decreased from the range of 50 to 80 deaths per 1,000 live births in 1995 to approximately three to eight in 2008. This significant drop is a huge achievement because Zamboanga is an impoverished region on the Philippines’ Mindanao Island where 80 per cent of the rural population has limited or no access to health care. In 1994, Ateneo de Zamboanga University launched the medical Dr. Afdal Kunting at the new heart failure clinic school, and Cristobal opened subsequent to his advanced training was named Dean. visit to Calgary in 2012. The new school was founded on problembased learning that went beyond acute care and sometimes beyond healthcare in the traditional sense. Numerous individuals including University of Calgary’s Dean of Medicine, at the time, Dr. Eldon R. Smith and Dr. Clarence Guenter helped to shape the vision for this school with their input and inspiration. In 1994, Cristobal met Smith in Calgary and

this initial connection led to both Guenter and Smith making multiple trips to the region. It was the start of a protracted partnership that continues to this day. ADZU-SOM has since produced more than 200 medical board-certified graduates with 97 per cent serving in the Philippines, and 75 per cent still working in South-Western Mindanao. In September 2011, heart failure specialist Dr. Israel Belenkie visited Zamboanga to explore ways he could contribute. It was an opportunity to witness a very progressive program of student community initiatives, and to start to plan the next phases of Calgary’s participation in what is now being called Project Zamboanga. “It became clear that much can be done to support education at the medical school and post-graduate (resident) training as well as improve health care in the area,” says Belenkie. An immediate outcome of Citation presented to Dr. Eldon R. Smith Belenkie’s visit was the invitation from the Republic of the Philippines House of Representatives. for Dr. Afdal Kunting, a senior resident from ADZU-SOM, to visit Calgary for advanced training. During the summer of 2012, Kunting visited the Libin Cardiovascular Institute of Alberta. He was personally hosted by Belenkie, and spent time meeting and learning from the Institute’s heart failure team. Since returning to the Philippines, Kunting has started the first heart failure clinic in Zamboanga. The vision of Project Zamboanga is not just limited to cardiovascular sciences or the further development of the medical school, but to slowly and surely make foundational impact on the quality of life of this impoverished region. We look forward to more visits to, and more visits from, our friends in the Philippines. (projectzamboanga.com)

To Russia (and India), With Norm

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or Dr. Norm Campbell, Canadian Chair in Hypertension Prevention and Control, his international activities are all about sharing experiences. He co-chairs the Pan American Health Organization (PAHO) Technical Advisory Group on salt. The group is tasked with supporting governments of the Americas to help them develop recommendations for policies and actions to lower salt consumption in the Western Hemisphere. Last December, he visited the World Health Organization (WHO) Regional Office for South-East Asia in India. This region is currently developing its own technical advisory group to assess dietary salt and overall reduction strategies and Campbell was invited as an external consultant to share his expertise. In September 2012, he also made a trip to Russia to do a one-year follow-up since presenting Canadian hypertension prevention and control programs in Yaroslavl and Moscow. “Russia has a really high prevalence of hypertension,” says Campbell. “They want to develop a model program to improve treatment and control and they looked to the Canadian program to adopt part of our knowledge translation program.” Campbell says this collaboration is definitely not a one-way street. “When we bring our ‘advances’ to these countries, sometimes we see that we often have solutions we can take back, too.”—LS

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education

The Learning Curve Q&A with Don Welsh, Chair of the Libin Education Council

Our progeny are our future, and ultimately, that’s what carries the impression. If you want to elevate the status of the Libin Institute, you elevate the trainees.

Don Welsh, PhD

Associate Professor, Physiology and Pharmacology, UCalgary CanadaResearch Chair, Gap Junction and Vascular Control Graduate Director, Cardiovascular Respiratory Program

Where are you from originally?

“I was born in Alberta. My dad worked for a big bank so we moved all across Canada and North America. I graduated high school here, did undergrad here and then my Graduate degrees in Vancouver and Toronto. There was a 16-year hiatus between finishing undergrad and coming back here. Those 16 years consisted of a Masters in Kinesiology from the University of British Columbia, a PhD from the University of Guelph and two post-docs [Yale University School of Medicine; University of Vermont, School of Medicine].”

Tell us about the Education Council and its role within the Libin Institute.

2013 Libin Research Day March 28, 2013 8:15 am to 4:30 pm (Reception 3:45 pm) Foothills Campus (Theatre 4 and HRIC Atrium) This is an exciting day of presentations that will showcase insightful, cutting edge cardiovascular and vascular research across the Libin Institute. Morning sessions will be trainee-driven and feature short talks and a lunch-hour poster competition. The afternoon talks include a series of lectures by Libin members in heart electrophysiology and a keynote talk from Dr. Mark Anderson, MD, PhD, 2013 ER Smith Lectureship Awardee, whose research is focused on cellular signaling and ionic mechanisms that cause heart failure and sudden cardiac death.

Meet the Libin Education Council Left to right Dr. Xi-long Zheng, Dr. SR Wayne Chen, Dr. Matthew James, Dr. Don Welsh, Dr. Andrew Braun

“I have been Chair of the Education Council for approximately a year now. Our role is currently centered on promoting educational opportunities for students and trainees within the Libin Institute. Our primary focus has been on undergraduate and graduate students, postdoc or fellows, so far. We do try to include cardiology trainees as part of what we call broader educational activities and eventually, we would like to become more involved in the clinical trainee side of things. At this point, we are focusing on doing the few things we do well, with the aspiration to grow in the future.”

What are some key initiatives that the Education Council is behind?

“This year, we have chosen to focus on four key initiatives. The first is starting to set the foundation for a scholarship to attract and reward new students. The Tine Haworth Scholarships in Cardiovascular Research has provided a fund for first- or second-year students. During these years, it can be very difficult to receive an external scholarship. To provide students and trainees the opportunity to discuss their research and others, we have put together a journal club called RUSS (Research Update Seminar Series). RUSS gives students a forum to present their own work or a paper which can then be critiqued and discussed. The idea is to really get them talking and working on their presentation skills. We also now fund an external seminar series through the Education Council. Wayne Chen has put together a seminar series; five excellent speakers have already presented. Libin Research Day has recently been taken over by the Education Council.” —As told to Amber Arsneau

Paying it Forward

Philanthropists behind two trainee scholarships from the Libin Education Council Kertland Doctoral Scholarships The Kertland Scholarship is awarded one to two times per year and tends to be more vascularoriented. This scholarship is geared towards trainees in their first two years of training. Namesake: David S. Kertland David S. (Kim) Kertland has been a significant supporter of the scientific community at the University of Calgary. Through his contributions, Mr. Kertland has fostered the development of vascular biology within the Faculty of Medicine. This scholarship reflects his commitment to the next generation of scientists involved in basic vascular biology research. Tine Haworth Scholarships in Cardiovascular Research The Libin Education Council has allocated funds to support two scholarships ($11,000 each) for a period of one year. This is a new offering where funds will be directed to PhD students in the first two years of their program. Namesake: Tine Haworth Tine Haworth spent some of her early days as a one-room school-teacher in rural Saskatchewan. While her life path took many turns since then, education remained a common theme. From earning her pilot’s license to building her own real estate investment business, she never stopped learning something new. Her support of the Education Council reflects this passion and her encouragement for others to continue in their pursuit of knowledge.

LIBIN LIFE 15


Spotlight on trainees

Bright Minds, Bright Futures Ceara Cunningham

Abdulhameed Al-Ghabkari Current Pursuit PhD student in Biochemistry and Molecular biology, University of Calgary (2011-present) Supervisor Dr. Justin MacDonald Degrees Bachelor degree in Biotechnology (2005) and M.Sc. in Applied Biological Sciences (2008), Jordan University of Science and Technology, Jordan Research Interests Identifying the molecular mechanism of Zipper-Interacting Protein Kinase (ZIPK) which has important clinical applications for treatment of contractile disorders and exploring additional functions of this critically important kinase (e.g., inflammation and cancer/metastasis) Future Ambition To develop research skills to help patients in this community and to provide better healthcare for them About Me “I was born in Irbid, north of Jordan. I spent three years of research at the Jordan University of Science and Technology trying to help bladder cancer patients by addressing novel biomarkers specific to this disease. I joined Dr. MacDonald’s lab in 2011 and I enjoy the outstanding supervision and collaborative environment provided by my lab members. I also play soccer.”

Dr. Amal Muthumala Current pursuit Fellowship in electrophysiology and heart failure Supervisor Dr. Vikas Kuriachan Degrees MB BChir, University of Cambridge, UK; MRCP (UK), MD (Res) University College London, CCDS Research Interests Previously, he was examining genetic influences in cardiovascular disease. Now, he is exploring mechanisms underlying benefits of cardiac synchronization techniques (CRT) Future Ambitions To be a specialist in complex devices and heart failure About Me “Since starting medical school, I have had an interest in underlying human physiology, which has led me to pursue a career in electrophysiology and heart failure. I am from the UK and came to Canada to further my training in these areas. I am enjoying our new life exploring Calgary and the mountains with my wife and baby daughter. My hobbies include photography and hiking.”

Dr. Anna (Serletis) Bizios Current Pursuit Chief resident in last year of core cardiology program; starting a two-year Interventional Fellowship at the University of Calgary, July 2013 Supervisor Dr. Katherine Kavanagh (current), Dr. Michael Curtis (future) Degrees Doctor of Medicine, University of Calgary; Internal Medicine, FRCPC, University of Toronto Research Interests During medical school and internal medicine residency, her projects focused on the area of vasovagal syncope under Dr. Robert Sheldon’s supervision. She became interested in Interventional Cardiology and recently worked with Dr. Dean Traboulsi examining the role of primary percutaneous intervention in the elderly Future Ambitions To incorporate formal clinical outcomes research training into a fellowship with the aim of merging clinical research into an interventional cardiology career About Me “Born and raised in Canada, I have been incredibly fortunate to maintain the Greek heritage and culture passed along by my parents. My family is the most important part of my life. Nothing makes me happier than coming home to my daughter, Adia, and my husband Tony.”

Current Pursuit PhD in the Community Health Sciences Department at the University of Calgary Supervisor Dr. Hude Quan Degrees Undergraduate degree and Master of Arts degree (specialty in health psychology), Physical Education and Recreation Department (University of Alberta) Research Interests How to improve health care delivery and management through improvements to large databases of coded health information and address surveillance of chronic diseases (eg. heart failure, hypertension, diabetes), health services and outcomes research Future Ambitions To work as a program leader specializing in health care system performance to inform public health policy for a government or international health agency About Me “People are always surprised to find out my favourite music to listen to are the golden oldies. I love anything from the ’40s, ’50s and the ’60s; The Supremes, Sam Cooke and the Shirelles are at the top of my iPod playlist.”

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Libin Life Spring 2013