IMS Magazine Fall 2023

THINK. LEARN. DISCOVER.

Invisible Threats: Infectious Diseases

IN THIS ISSUE

EDITORS-IN-CHIEF:

Jason Lo Hog

Stacey

EXECUTIVE DIRECTORS:

Elizabeth Karvasarski

Iciar Iturmendi Sabater

Kyla Trkulja

Niki Akbarian

PHOTOGRAPHERS:

Niki Akbarian (Director)

DESIGN EDITORS:

Jayne Leggatt (Director)

Josephine Choi

Genevieve Groulx

Brendan Lazar

Andrew Janeczek

Anne McGrath

By Brendan Lazar,

SOCIAL MEDIA TEAM:

Elizabeth Karvasarski (Director)

Lizabeth Teshler

Mahbod Ebrahimi

JOURNALISTS & EDITORS:

Kyla Trkulja

Nayaab Punjani

Kristen Ashworth

Jennifer Ma

Mahbod Ebrahimi

Janet Z. Li

Samantha Ricardo

Iciar Iturmendi Sabater

Sipan Haikazian

Lizabeth Teshler

Kevan Clifford

Sara Shariati

Eileen Liu

Kateryna Maksyutynska

Vaidhehi Veena

Sanmugananthan

Denise Sabac

Beatrix Wang

Usman Saeed

Archita Srinath

Bahar Golbon

Atefeh Mohammadi

Hannah Shuster-Hyman

Soha Usmani

By Josephine Choi,

Jason is a 5th year PhD student examining the mechanisms linking HIV stigma and health under the supervision of Dr. Sean Rourke.

@JasonLoHogTian

Stacey Butler

Stacey is a PhD candidate. Under the supervision of Dr. Andrea Gershon, she is evaluating the quality of care for patients with respiratory disease using a population-based approach.

@StaceyJButler

Letter from the EDITORS

As the new academic year begins, we welcome back all returning students and hope all incoming IMS students are excited for a new adventure. With the changing seasons comes change at IMS Magazine. We are saying goodbye to our Editors-in-Chief Jason Lo Hog Tian and Stacey Butler as they go on to defend their PhD dissertations in the coming year.

Jason has contributed to every IMS Magazine issue since he began his journey at IMS in September 2018. He primarily contributed as a journalist writing insightful and thought-provoking Viewpoint articles on current controversial topics and has served for the past two years as Editor-in-Chief. He left us with a few parting words:

“It is surreal to be writing this letter as a departing Editor-in-Chief of IMS Magazine. I still remember listening to the recruitment presentation at my IMS Orientation and thinking this was something I wanted to be a part of. I knew I wanted to dedicate my extracurricular activities to science communication and I fell in love with writing Viewpoint articles for IMS Magazine. When I got the opportunity to become Editorin-Chief I jumped at the chance. It has been a great privilege to lead a team of inspirational journalists, editors, and designers whose dedication and hard work made my job easy. I am also thankful for my co-Editor-in-Chief Stacey Butler who made for a great partner throughout this year. This was truly an unforgettable experience – I am still proud after holding each magazine issue in my hands and I am incredibly grateful to have had the opportunity to contribute to the IMS community in this way.”

Stacey has also contributed to the magazine since the beginning of her PhD in September 2019. She contributed as a journalist writing features, spotlights, and viewpoints before taking on the role of Executive Editor (Features) where she managed the section and coordinated all our beautiful infographics and then going on to serve as Editor-in-Chief for the past year. She also had a few final words to say:

“Being part of IMS Magazine has truly been the highlight of my graduate training at UofT. Our team’s shared passion for science communication provided a much-needed sense of comradery throughout graduate school. I found myself continually inspired by the incredible artwork created by our graphic designers and the impactful stories told by our talented writers. Each issue of IMS Magazine is a collaborative effort and involves a great deal of coordination behind the scenes. I am grateful for the support of my Co-Editor in Chief, Jason Lo Hog Tian and our executive team. It was also a pleasure to work more closely with our design teams and learn about how art can be used to visually communicate our stories. When I joined the magazine, I expected to leave with improved writing and editing skills but over the past four years I have gained new skills in teamwork, project management, leadership, and most importantly, I have learned how to be an effective science communicator. My time with IMS Magazine will always be one of my most cherished memories of my PhD and I look forward to seeing what our team has in store for future issues.”

Jason Lo Hog Tian

IMS Magazine is certainly being left in good hands as we introduce our new Editors-in-Chief - Kyla Trkulja and Iciar Iturmendi. They have both written countless articles and contributed over the past year as Executive Editors. They had a few welcome words to say:

“It is my honour to be continuing my journey with the IMS Magazine as Editor-in-Chief. I have been inspired by the Magazine and its mission since I began my studies at IMS in 2021, and since then, I have written a variety of different articles, enjoying the freedom to write about controversial topics and the opportunities to share research outside of my main field. I echo Stacey and Jason’s statement that being a part of such a wonderful initiative has been the highlight of my graduate school experience, and I look forward to continuing my involvement and playing an instrumental role in the Magazine’s mission in the coming years!” – Kyla Trkulja

“Learning how to communicate complex scientific ideas to the public was one of my learning goals from the beginning of my graduate experience in 2021. The IMS Magazine has been the ideal context to build on my confidence as a writer with the support of such an enthusiastic team. I only hope that as an Editor-in-Chief, alongside Kyla, we can keep encouraging new students to write and express themselves in the collaborative and nurturing learning space offered by the IMS Magazine.” – Iciar Iturmendi Sabater

On behalf of both the outgoing and incoming Editors-in-Chief, we would like to thank all our journalists, editors, and designers who have been part of the team who make this production possible. We are looking forward to the upcoming year of magazine issues and we hope you all have a great year!

Kyla is a PhD student studying the mechanism of action of novel therapies for lymphoma under the supervision of Dr. Armand Keating, Dr. John Kuruvilla, and Dr. Rob Laister.

@kylatrkulja_

Iciar is a PhD student under the supervision of Dr. Meng-Chuan Lai and Dr.Hsiang-Yuan Lin. She investigates social adaptive behaviors in children and adolescents with neurodevelopmental conditions such as autism, attention-deficit hyperactivity disorder, and obsessive-compulsive disorder.

@iciar_itur

Kyla Trkulja

Iciar Iturmendi Sabater

Kyla Trkulja

Iciar Iturmendi Sabater

Director, Institute of Medical Science Professor, Department of Surgery Senior Scientist, Toronto

General Hospital Research Institute, University Health Network

DIRECTOR’S MESSAGE

In the academic world, the fall semester is the beginning of a new year and a time to welcome over 100 new students to the IMS community. They are joining a multidisciplinary community with a global reach, a theme that is evident in the Fall 2023 issue of IMS Magazine which shines the spotlight on infectious diseases.

In recent years there have been monumental advances in the treatment and prevention of infectious diseases. The key to eradicating viral diseases is through vaccine development, which has been a hot topic since the COVID-19 pandemic. We have seen first-hand the need for the COVID vaccines to be modified as the virus evolves. In this issue, Drs. Jordan Feld and Mario Ostrowski discuss the complexity of creating a vaccine that can prevent other highly variable viruses such as hepatitis C virus or human immunodeficiency virus (HIV). With antiretroviral therapy, people with HIV are living longer and healthier lives with minimal risk of disease transmission. However, Dr. Lena Serghides discusses how it is important to understand how these treatments affect unique populations such as the babies born to mothers with HIV. In this issue we also learn about how Dr. Angela Cheung responded to the pandemic by creating a national, interdisciplinary network to study the long-term effects of COVID-19.

This issue also features two recent graduates of the IMS, Noor Al Kaabi and Dr. Michelle Dubinsky, both of whom were prominent student leaders in our community and have promising careers ahead of them. Three exciting IMS events are also covered in this issue. The annual Summer Undergraduate Research Program (SURP) Research Day took place on August 17th at Hart House. IMS faculty member Dr. Mojgan Hodaie gave the keynote address and 80 summer students presented their research. This summer also saw the return of two IMS events, UofT Talks and the Healthcare Innovation Challenge. This year’s theme for UofT Talks was ‘food science’ where experts presented on emerging topics in this field ranging from how genetics influence taste to lab-grown meat and sustainability. In the exciting Healthcare Innovation Challenge teams pitched their proposals for how we can use AI-based solutions to improve healthcare infrastructure.

I would like to extend a sincere thank you to Jason Lo Hog Tian and Stacey Butler for their continued dedication to the IMS Magazine and wish them the best of luck with their dissertations and future careers. I would also like to congratulate the incoming Co-Editors in Chief, Kyla Trkulja and Iciar Iturmendi Sabater. As always I applaud the journalists, editors, photographers and design team for their contributions to the Fall 2023 issue. I hope you enjoy reading about the promising advancements in infectious disease research.

Sincerely,

Dr. Mingyao Liu Director, Institute of Medical Science

DR. MINGYAO LIU

Photo Credit: Mikaeel Valli

Contributors

Fall 2023

Kristen Ashworth is an MSc student working under the supervision of Dr. Brian Ballios at the Donald K. Johnson Eye Institute and Krembil Research Institute. Her thesis work is focused on developing a retinal organoid model in which to evaluate stem cell therapies for USH2A- and CRB1-related inherited retinal diseases. Kristen loves cross country running, reading a good book, going to Marshalls, and most importantly, doting on her two adorable golden retrievers.

Mahbod Ebrahimi is a secondyear MSc student investigating the association between immune gene expression and schizophrenia subphenotypes under the supervison of Dr. James Kennedy. Outside of research, Mahbod enjoys a good book, playing chess, and listening to Jazz music. Mahbod is also a member of our social media team.

Iciar Iturmendi Sabater is a PhD student researching how youth with neurodevelopmental conditions (autism, ADHD, learning disabilities, etc) adapt to their social environments under the supervision of Dr. MengChuan Lai and Dr. Hsiang-Yuan Lin. Iciar hopes to one day run a marathon, but for now enjoys training for the half, and spending time with friends and family.

Kevan Clifford is a PhD candidate in the IMS program, with a crossappointment at the Centre for Addiction and Mental Health. Working under the supervision of Dr. Yuliya Nikolova, his research combines bioinformatics and neuroimaging to characterize mechanisms of brain aging at the genetic level, and outcomes on brain structure and function. Outside of the lab, Kevan enjoys trail running, photography, and a good book.

Sipan Haikazian is a second-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.

Janet Z. Li is a second-year MSc student studying the brain-behavior relationships between conditioned pain modulation capability and functional connectivity of key pathways in the dynamic pain connectome. She is supervised by Dr. Karen Davis at the Krembil Brain Institute in Toronto Western Hospital. Outside of research, she can be found practicing piano, figure skating, creating fashion content, and café hopping.

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sipan_haikazian

iciar_itur

jan.et.li

Contributors

Fall 2023

Eileen (Xiao Yu) Liu is a secondyear 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, bouldering, playing badminton, exploring new activities and trying new food.

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Jennifer Ma is a second-year MSc student investigating the functional neural networks involved in suicide, and their relation to pain perception as a potential biomarker of suicide risk. She is under the supervision of Dr. Sakina Rizvi at the Arthur Sommer Rotenberg Suicide and Depression Studies Program at St. Michael’s Hospital. Outside of the lab, she enjoys crochet, painting and acting in local theatrical productions.

Kateryna Maksyutynska is a PhD candidate 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 lake.

Samantha Ricardo is a first-year MSc student studying mechanisms of Alport Syndrome under the supervision of Dr. Moumita Barua at PMCRT. Outside of the lab, you can catch her biking around the city, trying new cuisines, or attempting to play chess.

Nayaab Punjani is a 4th year PhD student at the Krembil Research Institute in Dr. Michael Fehlings’ Lab. She is studying a neuroprotective peptide drug therapy to treat cervical traumatic spinal cord injury. In her free time she enjoys digital art, outdoor photography, Nintendo Switch Mario Kart and Smash Bros tournaments, as well as watching mystery, action, and sci-fi TV shows and movies.

Vaidhehi (Veena) Sanmugananthan is a fourth-year 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 with chronic pain, and understanding the bidirectional relationship between pain-attention. Outside of the lab, she loves to play squash, flag football, and challenge herself to try different art mediums.

nayaab_punjani

sanmugananthan

EileenLiuXY

SamanthaRicard6

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sarashariati_

kylatrkulja_

Sara Shariati is a second-year MSc student at Toronto General Hospital, investigating gene expression changes in mesothelioma patients postradiotherapy under the supervision of Dr. Marc de Perrot at the Toronto General Hospital. Outside of academia, she enjoys embroidery, swimming, cafe hopping, and reading about sociology.

Lizabeth Teshler is a second-year MSc student in the IMS program 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. Lizabeth is also a member of our social team.

Social Media Team

Kyla Trkulja is a third year PhD student at IMS studying under the supervision of Dr. Armand Keating, Dr. John Kuruvilla, and Dr. Rob Laister at Princess Margaret Hospital. Her work focuses on better understanding the mechanism of action of a novel cancer therapy for lymphoma so it can be better utilized in the clinic. Outside of academia, Kyla enjoys reading, writing, video games, and going for road trip adventures across the province.

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 and effective visualisations is their shared passion, and they are thrilled to contribute to the IMS Magazine.

Elizabeth Karvasarki (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.

Brendan Lazar

Infectious Diseases: What Are They, And What Can We Do About Them?

What Causes Infectious Diseases?1

Infectious diseases are caused by microorganisms known as pathogens that can be spread among people or animals

Pathogens include viruses, bacteria, and parasites

(eg. Hepatitis, influenza)

(eg. Worms)

We get sick from pathogens because

• They damage our cells and tissues when they replicate

• They release toxins into our bodies

• Our immune response to clear the infection causes damage

barrier (skin and mucous membranes)

T cells (kill infected cells or help activate other immune cells)

B cells (release antibodies) Antibodies (recognize & attach to pathogens, recruit immune cells to attack) Response

Infectious diseases are spread in different ways

Bodily fluids such as blood (eg. human immunodeficiency virus/HIV)

Airborne droplets via coughing or sneezing (eg. SARS-CoV-2 and influenza)

Ingesting contaminated food or water (eg. hepatitis A) How Do Our Bodies Fight Infections?1,2

The Role of Research and Medicine in Combatting Infections3,4,5

Research and medicine help in the prevention and treatment of infectious diseases

• Prevention: vaccines train our adaptive immune system to respond to something specific (like a certain virus) so we can clear it quickly in the future, before it causes illness

COVID-19 mRNA vaccines are quickly produced and easily modifiable to respond to new pathogens, saving millions of lives around the world

• Treatments: help eliminate the pathogen or manage the symptoms

The Rise in Infectious Diseases

Despite scientific advances, new infectious diseases have become more frequent in recent decades. This is due to:

References

Poor public health systems

• Underfunding

• Lack of staff to keep up with growing populations

Evolution of pathogens

• Escape our immune response

• Resistance to therapies

1. Janeway CA, Travers P, Walport M, et al. Chapter 10: Adaptive Immunity to Infection. In: Immunobiology, 5th edition: The immune system in health and disease. Garland Publishing; 2001.

2. Institute for Quality and Efficiency in Health Care (IQWiG). The innate and adaptive immune systems [Internet]. National Institutes of Health; 2006. Available from: https://www.ncbi.nlm.nih. gov/books/NBK279396/

3. Le T, Sun C, Chang J, et al. MRNA vaccine development for emerging animal and Zoonotic Diseases. Viruses. 2022;14(2):401. doi:10.3390/v14020401

4. HIV.gov. HIV and AIDS epidemic global overview [Internet]. 2023. Available from: https://www. hiv.gov/federal-response/pepfar-global-aids/global-hiv-aids-overview

5. National Institutes of Health. Decades in the making: mRNA covid-19 vaccines [Internet]. U.S. Department of Health and Human Services; 2023. Available from: https://covid19.nih.gov/ nih-strategic-response-covid-19/decades-making-mrna-covid-19-vaccines

6. Ellwanger JH, de Kaminski V, Chies JAB. Emerging infectious disease prevention: Where should we invest our resources and efforts? Journal of Infection and Public Health. 2019;12(3):313–6. doi:10.1016/j.jiph.2019.03.010

Antiretroviral (ARV) medications for HIV have been shown to reduce the number of new infections by 59% since 1995 with the virus being undetectable in the patient over 6 months of therapy

Climate change

• Human migration introduces pathogens to a new environment

• Temperature & environmental changes allow new pathogens to thrive

“Canada Without Long-COVID”

Developing a Patient-Focused Knowledge Base on Post-COVID Condition

By Kyla Trkulja

With the acute crisis of the COVID-19 pandemic mostly behind us, it’s easy to feel as though the pandemic is over. However, for those who experience long-term symptoms after COVID-19, going back to normal is much more difficult. Long-COVID, or Post-COVID Condition (PCC), is a challenge that remains troublesome around the world, as an estimated 17% of adults experience long-term symptoms including fatigue, shortness of breath, and difficulty concentrating or thinking.1 These symptoms persist for a year or longer in 47% of these individuals, and 21% of them say that their daily activities are limited as a result.1 PCC remains such a significant challenge because the biological basis for these complex symptoms are still largely unknown, hindering diagnosis and care.1 As a result, there is no standardized practice for diagnosing and treating PCC.2

Dr. Angela Cheung is a clinician-scientist at Toronto General Hospital working to accelerate research and standardize practices to improve outcomes for those with PCC. Her undergraduate education in physics, medical education at Johns Hopkins University, and PhD training at Harvard University has equipped her with a diverse toolkit that has allowed her to branch out in her work and interests. Although she is a general internist by training, she has worn many different hats during her career, being involved in projects related to stroke, breast cancer, and osteoporosis, establishing the Center of Excellence in Skeletal Health

Assessment at the University of Toronto and the Osteoporosis Program at the University Health Network.

During the onset of the pandemic in March 2020, Dr. Cheung was working in acute care and noticed the influx of patients into hospitals. “There were so many people so unwell, we can certainly do something about that,” she thought, and together with a colleague, Dr. Margaret Herridge, obtained funding from the University of Toronto to start the Ontario COVID-19 Prospective Cohort Study. The goal of this project was to develop a dataset providing detailed outcomes on patient follow-ups one-year after COVID-19 infection, and use interconnected networks of scientists, clinicians, rehabilitation specialists, and health services researchers to improve care for patients and facilitate their recovery. They then got funding from the Canadian Institutes of Health Research to expand the project, now called CANCOV, across the country, with 18 participating sites across five provinces.

As CANCOV was progressing, Dr. Cheung noticed the large proportion of individuals that had lingering symptoms after COVID-19 infection and started the REcovering from COVID-19 Lingering Symptoms Adaptive Integrative Medicine (RECLAIM) trial to find ways to improve outcomes. The goal of the trial is to scientifically test different treatments for PCC, looking at anything that may work, “whether it’s vitamins or supplements or acupuncture, as long as it helps patients”.

Due to the innovative adaptive nature of the trial, treatment arms can be dropped if they are not found to be effective, or added if new research emerges. The trial, which is currently recruiting participants, will provide high-quality evidence on how to effectively cure long COVID, which will help standardize and deliver effective care to those who need it.

To further accelerate this research, Dr. Cheung seized an opportunity to establish a PCC research network across Canada, where the government would provide the network $20 million in funding over five years. She is now the lead for Long COVID Web, an integrative network of over 400 researchers, clinicians, and patient partners with lived experiences of COVID19 that work together to accelerate the discovery of Canadian science on PCC. The network is comprised of four pillars of science–biomedical, clinical, health services research, and population health–that are interconnected through patients, clinicians, and researchers that share knowledge amongst each other to comprise holistic

solutions to patient-focused questions.

“Long COVID Web is an integrative network of over 400 researchers, clinicians, and patient partners with lived experiences of COVID-19”

Dr. Angela Cheung MD, PhD, FRCPC

Chair of Integrative Medicine University of Toronto

Senior Physician Scientist University Health Network

Canada Research Chair (Tier 1) in Musculoskeletal and Postmenopausal Health

Long COVID Web Lead

“The vision of the network is to have Canada without long COVID,” Dr. Cheung explained, as accelerating the discovery of Canadian science on PCC will develop accurate diagnostics, treatments, and rehabilitation regimens and identify the best therapeutics, practices, and strategies for equitable access to PCC care. To reach this endpoint, the interdisciplinary pillars of the Web are investigating mechanisms, biomarkers, therapeutic targets, and novel therapies for PCC, as well as inequities among those affected by the condition and optimal solutions for accessible care and recovery. The end goal is to activate a “learning health system”, where anything

learned from the network is fed back to the clinical system so they can effectively address the needs of those with PCC.

Another key feature of the Web is their adaptability to focus on what is most critical as time evolves. The project started in March 2023, and the team already had a prioritization meeting in June 2023 to identify which questions should be most focused on for the foreseeable future. Dr. Cheung described how the network will evolve, as they “want to prioritize what we have an advantage on from a global perspective, where the expertise is and what we can do.”

“Everyone has a short attention span, most people think COVID is over,” Dr. Cheung said when describing the importance of the research. “But it’s not over, and as long as COVID is not over, there’s a risk of long COVID, which affects employment, the labour force, and our economy. It goes beyond health … I think we will learn from this from the science perspective as well, and I’m certainly hoping that we learn about the response as well so that we can do better the next time we have a pandemic.”

The multidisciplinary team that Dr. Cheung is overseeingas partof the Web fits with her quality as a generalist, as she describes herself as someone who likes to know a little bit of everything. “That’s why I got into general internal medicine,” she explained, “I like to know what to do with someone with lupus, or HIV, or whatever it is.”

The natural curiosity and desire to branch out is not uncommon among budding academics, who want to broaden their skill set and explore the different fields around them. To them, Dr. Cheung says to practice thinking outside the box, but take advantage of your specific training as well. “You need to master something,” she says. “That’s how you establish yourself in your future career … but once you have experience in a certain area, you should keep an open mind and try to learn from other things … I think those sorts of things sometimes will help you take a different view and to take a more holistic view of the problem and find more holistic solutions as well.

If you’re interested in learning more about Dr. Cheung’s Canada-wide projects, visit the sites below. The RECLAIM trial is actively recruiting, so if you or someone you know has PCC and would like to participate in the research please email reclaim@uhn.ca.

CANCOV: https://cancov.org/ RECLAIM Trial: https://www.clinicaltrials. gov/study/NCT05513560, https://www. reclaimtrial.ca/

References

1. Public Health Agency of Canada. Covid-19: Longer-term symptoms among Canadian adults - highlights [Internet]. 2023. Available from: https://health-infobase.canada.ca/covid-19/post-covid-condition/

2. Government of Canada. Post-COVID-19 Condition in Canada: What we know, what we don’t know, and a framework for action [Internet]. 2023 [cited 2023 Aug 2]. Available from: https:// science.gc.ca/site/science/en/office-chief-science-advisor/initiatives-covid-19/post-covid-19-condition-canada-what-we-knowwhat-we-dont-know-and-framework-action

Photo Credit: Dr. Cheung

Revolutionizing HIV Maternal and Fetal Care

By Nayaab Punjani

According to the World Health Organization (WHO), 39 million people are living with human immunodeficiency virus (HIV).1 HIV causes weakening of the immune system through progressive loss of white blood cells, leaving patients susceptible to other infectious conditions like tuberculosis.2 Anti-retroviral (ARV) therapy (ART) has revolutionized patient care through drugs such as integrase strand transferase inhibitors and protease inhibitors, which inhibit the virus’ replication cycle, and reduce the amount of virus within the body (known as “viral load”). In addition to alleviating patient’s symptoms, these drugs also limit transmission to one’s sexual partner. For pregnant women living with HIV, ARVs improve maternal health and prevent transmission of HIV to the fetus, although they have been associated with pre-term births, as well as placental and metabolic changes. New drugs continue to be developed for HIV, however pregnancy relevant safety data often lags decades behind and is reliant on researchers to acquire. There is a need to better understand the nature of how ARVs change the in utero environment and the impacts post-birth for children who are HIV-uninfected and ARV-exposed.

Dr. Lena Serghides, a senior scientist and principal investigator at the Toronto General Hospital Research Institute (TGHRI), studies the effects of ART on pregnant women and the developmental outcomes of their children. Dr. Serghides did not follow a typical research path.

Switching from business school to a PhD initially in the malaria field, her postdoctoral fellowship was the first time she began exploring HIV research by examining malaria HIV co-infection in pregnant women. With an interest in HIV and pregnancy, Dr. Serghides consulted HIV community members and found that their primary concern was not how HIV was affecting their pregnancies, but instead how ARV drugs were affecting their babies. Dr. Serghides explains, “each year approximately 1.5 million women with HIV become pregnant and most of these pregnancies are exposed to HIV antiretrovirals. This means that close to 1.2 million children are born HIV/ARV exposed uninfected each year. This makes these children the fastest rising HIV affected population and not much work is being done to understand how their in utero exposures affect their long term health, and to make sure that these kids meet their full potential.” Dr. Serghides also highlights the importance of patient engagement in her research, as “the whole HIV movement was driven by the HIV community”, prompting research and funding to be put towards drugs to treat HIV. “Greater involvement and meaningful engagement of people living with HIV is a foundation for the HIV movement

"...it is our duty as HIV researchers to meaningfully involve people living with HIV in all steps of our research."

and it is our duty as HIV researchers to meaningfully involve people living with HIV in all steps of our research.”

Dr. Serghides’ early research focused on hormonal dysregulation in pregnancy by protease inhibitor ARV drugs, whereby a decrease in progesterone and increase in oestradiol was observed.3 Using a mouse model developed in her lab, they found that providing progesterone supplementation early during pregnancy helped recover some of the fetal growth restriction and placental vasculature changes observed following protease inhibitor exposure. This prompted her lab to conduct a progesterone supplementation trial, although the low number of available participants in Toronto prevented the trial from being feasible. In a comparable trial in Zambia, however, progesterone supplementation

was found to improve pregnancy outcomes in women taking protease inhibitors.4

A lot of Dr. Serghides’ work looks at examining the “morphometry and morphology of the placenta and how it relates to fetal outcomes.” She has a current Canadian Institutes of Health Research (CIHR)-funded international collaboration, working with Drs. Lisa Bebell and Clive Gray, to recruit pregnant women in Toronto, Uganda, and South Africa. This study will allow the team to directly compare differences in placental structure, vascularization, and nutrient transport taking into consideration the types of ARV therapies available globally.

Dr. Lena Serghides, PhD

Senior Scientist, Toronto General Hospital Research Institute (TGHRI), University Health Network

Associate Professor, Department of Immunology and Institute of Medical Science, University of Toronto

Adjunct Scientist Women’s College Research Institute

Tier 1 Canada Research Chair, MaternalChild Health and HIV

Moving beyond the in utero placental changes, Dr. Serghides is also in the process of recruiting children born to mothers living with HIV, to examine the impact of the ARV–associated placental, hormonal, and immune changes on their neurodevelopment. This CIHR-funded study is also being paralleled with studies done in the mouse model, providing a controlled experimental comparison that is not influenced by other factors such as socioeconomic status and environment, which can tie into some of the developmental differences observed clinically.

In addition to her research, Dr. Serghides is part of the Canadian Infant Feeding in HIV network. As part of a CIHR funded dissemination grant she helped organize workshops at HIV service organizations across Ontario to provide information that would facilitate conversations about infant feeding choices for women living with HIV. Formula feeding is recommended for all women living with HIV and in Ontario, formula is provided free for one year. However some women living with HIV are considering breastfeeding due to various cultural, emotional, and health factors. It is important that all women are provided with the information needed to make their own informed decision on infant feeding choices. Thus, these workshops ensured that front line staff can educate new parents about the risk of HIV transmission through breastmilk and ways to minimize it, such as maintaining ART. An informational video developed by Dr. Serghides and Sarah Crawley, a graduate of the Biomedical Communications Program, explaining the associated risks of HIV transmission during breastfeeding won the CIHR 2019 Institute of Human Development, Child and Youth Health (IHDCYH) Talks video competition.5

There is still a lot of stigma surrounding HIV, and a continued fear of transmission. However, Dr. Serghides emphasizes that “research has shown us that if people take their antiretrovirals and their viral load is undetectable then the chance of transmission to a sexual partner is zero.” Furthermore, “good data are available

showing that if women come into a pregnancy already on antiretrovirals and with an undetectable viral load the chance of transmitting HIV to their baby during pregnancy is again zero.”

Dr. Serghides wants the public to understand that “these drugs have revolutionized HIV. HIV is now a manageable chronic ailment and people with HIV are living normal lives with a lifespan that is similar to the general population. Women living with HIV wishing to have a baby can do so without fear that they are going to transmit HIV to their baby as long as they are well-treated.” It is exciting to see the evolution of new therapies becoming available such as longterm injectables which allow people living with HIV to take a drug injection every few months rather than take a pill every day. Research will be ongoing in tandem to continue to test the safety of these new ARV drugs in pregnancy through mixed clinical and basic science models, to be able to provide the best possible care to mothers living with HIV and their children.

References

1. HIV [Internet]. [cited 2023 Aug 22]. Available from: https://www. who.int/data/gho/data/themes/hiv-aids

2. HIV and AIDS [Internet]. [cited 2023 Aug 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids

3. Dunk CE, Serghides L. Protease inhibitor-based antiretroviral therapy in pregnancy: effects on hormones, placenta, and decidua. The Lancet HIV. 2022 Feb 1;9(2):e120–9.

4. Conner MG, Vwalika B, Freeman BL, et al. Effect of weekly 17-hydroxyprogesterone caproate on small for gestational age among pregnant women with HIV in Zambia. AIDS. 2022 Nov 15;36(14):2079–81.

5. "Winner IHDCYH Talks 2019: HIV transmission through breastfeeding" Youtube, IHDCYH Talks, Nov 1 2019. https://www. youtube.com/watch?v=n7sRKeUTmeE

Photo Credit: Niki Akbarian

Viral Vanguard

Dr. Jordan Feld’s Odyssey Toward an HCV-Free Future

By Kristen Ashworth

Hepatitis C Virus (HCV), alongside the commonly associated hepatitis B, is recognized as a significant global health concern. In fact, by 2040, chronic infection by these two bloodborne diseases will cause more deaths than HIV, tuberculosis, and malaria combined.1 HCV raises particular concern due to its propensity to progress into a chronic condition. It is often referred to as a ‘silent killer’ because it can manifest without symptoms and quietly develop in a host for decades before eventual diagnosis, which often coincides with the emergence of advanced-stage liver disease or liver cancer.

Fortunately, there has been remarkable progress in treatment for HCV. With welltolerated oral therapy, HCV can be cured in almost all those treated, making it the first curable chronic viral infection. This has led the World Health Organization (WHO) to an ambitious goal: to eliminate viral hepatitis as a public health threat by 2030. However, there is currently no vaccine to help prevent transmission of HCV from occurring in the first place. Without this, true eradication of HCV is near impossible.

Determined to overcome this challenge is Dr. Jordan Feld, a trailblazer in the field of hepatitis research. Dr. Feld is a clinicianscientist at Toronto General Hospital, where he works as a hepatologist and is the interim Director of the Toronto Centre for Liver Disease. Together with his lab and an esteemed team of collaborators

from across Canada, his mission is to eliminate HCV in our country within the next decade.

To reach this target, Dr. Feld’s team is using a two-armed approach. The first is to investigate strategies to improve both HCV diagnosis and the dissemination of antiviral drug treatment for those already infected with the virus. This is a collaborative effort that is being facilitated in conjunction with CanHepC, the Canadian Network on Hepatitis C, which seeks to tackle the current landscape of health outcomes for people living with HCV at all stages of care. The network has worked together to establish a national framework, entitled the Blueprint, that sets measurable goals in accordance with HCV elimination efforts that aim to bridge the gap between epidemiology, public policy, and scientific discovery in HCV research. Dr. Feld explains why the Blueprint, which focuses on diagnosis and care, is an important piece of the puzzle to eradicate HCV, but acknowledges that there are inherent challenges in disseminating this care to Canadians who need it. “All the people who are undiagnosed living with hepatitis C – how do we find them and get them into care?” he asks. “How do we overcome some of the social, financial and other barriers that inhibit people from accessing this care?” To address these obstacles, Dr. Feld has co-led the development of the Roadmap for HCV Elimination in Ontario that was launched earlier this year and brings together stakeholders across the province to address

specific barriers to HCV prevention, care, and treatment to ensure we reach the elimination targets within the province.

The second arm of Dr. Feld’s research involves developing the HCV vaccine itself. To guide their current vaccine work, Dr. Feld’s team first evaluated HCV transmission events by studying the virus in people who received organ transplants from donors with HCV. Prior to this work, donors with HCV were not considered for organ donation due to the risk of HCV transmission to the recipient. Dr. Feld’s team found that HCV infection from a donor can be efficiently treated post-transplant and, remarkably, can even be prevented by starting therapy before the transplant. This approach to organ transplantation has now been adopted as an effective standard of care at Toronto General Hospital and is being implemented

at other centres across Canada, increasing organ availability and providing life-saving opportunities for patients who otherwise may die on a transplant waitlist.

This research also shed new light on the variable nature of HCV itself. In a single infected person, billions of related but slightly distinct variants of HCV circulate, making it among the most variable human pathogens known, and serving as a major impediment to vaccine development.2 Dr. Feld’s team is carefully studying the specific variants of the virus that are transmitted to organ recipients, which they hope will allow them to identify what needs to be targeted by a vaccine. Dr. Feld explains, “We

Dr. Jordan J. Feld MD, MPH

Senior Scientist, Toronto General Hospital Research Institute (TGHRI)

R. Phelan Chair in Translational Liver Research

Interim Director and Research Director, Toronto Centre for Liver Disease Toronto General Hospital, University Health Network Professor of Medicine, University of Toronto

know from all these variants that exist in a donor [that] only a very small number of them actually establish infection.” From this understanding, the path toward discovery of a broad-spectrum HCV vaccine became clearer. To this end, Dr. Feld’s team used a novel strategy that combined different versions of an extremely variable region of the virus to train the immune system to find commonalities amongst the diversity. Antibodies generated in mice that received this vaccine candidate prevented infection by all six major genotypes of HCV.2 This approach holds promise for HCV, but, importantly, it could also potentially be applied to other highly variable pathogens, like HIV.

The challenge doesn’t end with the development of a vaccine—it also needs to be tested. There is no current animal model for HCV, therefore vaccines must be evaluated on people at risk of HCV infection. Dr. Feld’s team is collaborating with researchers across Canada to consider an alternative approach–developing a Controlled Human Infection Model for HCV. This study involves intentionally infecting healthy volunteers with HCV with the goal to test vaccine candidates. Dr. Feld emphasizes that because this unique approach involves infecting healthy people with HCV, extreme care must be taken to ensure safety. Fortunately, if people do not clear the infection on their own, they can be treated with well-tolerated oral antiviral medication. Dr. Feld and his team believe that such an approach will be required to develop an HCV vaccine, and they are working closely with ethicists, virologists, immunologists, and people with lived experience of HCV to design and carry out the CHIM studies efficiently, and, most importantly, safely.

While HCV is a global health concern that disproportionately impacts nations where non-sterile medical practices are more prevalent than in Canada, the ramifications of HCV infection are felt locally as well. From our biggest cities to the rural north, the consequences of the ongoing opioid epidemic are everpresent, leading to a situation in which new HCV infections continue to outpace cures. Dr. Feld explains that, in addition to new infections, the rise in advanced

liver disease from HCV currently observed in Canadian hospitals is likely linked to the lingering impact of the 1970s drug epidemic and the Tainted Blood Scandal of the 1980s (where contaminated blood products infected thousands of Canadians). To stop this scenario from repeating in future generations, it is imperative that an HCV vaccine is developed. Until then, efforts to expand diagnosis and treatment, particularly to marginalized populations who often fall through the cracks of the healthcare system, will be critical. With that, Dr. Feld and the researchers of CanHepC are determined to ensure Canada meets the WHO’s 2030 HCV elimination targets through their combined, ground-breaking research efforts.

References

1. El-Sayed,MH, Feld,JJ.Vaccination at the forefront of the fight against hepatitis B and C.Nat.Rev.Gastroenterol.Hepatol.2022;19(2):87–88.

2. Mosa,AI, Campo,DS, Khudyakov,Y, AbouHaidar,MG, Gehring,AJ, Zahoor,A, Ball,JL, Urbanowicz,RA, Feld,JJ.Polyvalent immunization elicits a synergistic broadly neutralizing immune response to hypervariable region 1 variants of hepatitis C virus.Proc.Natl.Acad. Sci.U.S.A.2023;120(24):e2220294120.

Photo provided by Dr. Feld

Dr. Mario Ostrowski: Multidisciplinary Efforts Meet at the Push to Develop an HIV Therapeutic Vaccine

By Jennifer Ma

The human immunodeficiency virus (HIV) epidemic swept through the world in the 1980s and 1990s. By the time it reached its peak in 1995, the World Health Organization (WHO) estimated that at least 15 million people had been infected. Without medical management, HIV will target an individual’s white blood cells and accumulate in viral reservoirs, gradually weakening the immune system.1 After approximately 7-8 years, this weakened state typically develops into acquired immunodeficiency syndrome (AIDS), leaving the individual susceptible to potentially fatal diseases, including pneumonia, tuberculosis or other opportunistic infections with a 50% mortality over two subsequent years.1 This was this context that motivated Dr. Mario Ostrowski, who was training in internal medicine at the time, to pursue HIV research.

“Previously healthy people were suddenly developing multiple opportunistic infections at once,” he said. “It was quite devastating.”

Following the completion of his research training with Dr. Anthony Fauci, he is now a Professor of Medicine, Immunology, and Laboratory Medicine and Pathobiology at the University of Toronto, and an infectious diseases consultant at St. Michael’s Hospital, where he studies the immunopathogenesis of HIV. Significant advancements in treatment, primarily due to anti-retroviral therapy (ART), can reduce the viral load to undetectable levels, meaning HIV rarely progresses to AIDS if managed properly. However, ART is not able to eradicate the virus entirely, meaning the accumulated

viral reservoirs have the potential to activate and progress the disease resulting in an increased incidence of chronic conditions like cardiovascular disease; bone, liver, kidney disease and advanced aging. Dr. Ostrowski’s research is therefore focused on understanding how the immune system interacts with HIV, with the goal of developing a therapeutic vaccine or cure. Lifetime costs of daily antiretroviral treatment is over a million dollars per person living with HIV.

The COVID-19 pandemic is one such example, as individuals with HIV generally face more severe symptoms and a higher risk of mortality following infection due to immune suppression.2 It was therefore unclear whether these individuals could mount a sufficient neutralizing response to the vaccines, even on ART. Additionally, people do not respond uniformly to ART, with the CD4+ T cell count of so-called nonresponders remaining suppressed, indicating that the immune system has not completely recovered, despite the virus stopping its replication. A recent study from Dr. Ostrowski’s lab enrolled older HIV patients on treatment, most of whom received a mRNA COVID-19 vaccine. They observed “quite poor neutralizing antibody response[s] with the vaccine” following the standard two doses compared to controls. A third dose did improve the antibody response, suggesting a third dose may be necessary for HIV patients. As well, mRNA vaccines can be immune activating, which has the potential to reactivate HIV or increase viral reservoirs. However, Dr. Ostrowski’s team only found

increases in these reservoirs among patients with low levels of virus circulating in blood while on treatment, with no detrimental clinical effect. The meaning of this finding is still unclear.

Additionally, Dr. Ostrowski has been working with Providence Therapeutics, a Canadian company specializing on mRNA vaccines, on the pre-clinical development of their mRNA vaccines. He is also interested in optimizing current COVID-19 mRNA vaccines by exploring a vaccine delivered mucosally or orally, as opposed to intramuscularly.

“[mRNA injected into muscle] mostly makes Immunoglobulin G (IgG),” he explained. “But Immunoglobulin A (IgA) is more potent for mucosally-transmitted viruses, so [delivering a vaccine] mucosally might offer better protection through IgA.” There is indeed great promise in mRNA vaccine technology,

which can potentially be applied to develop novel therapeutic options for currently tough-to-treat diseases, such as HIV.

One of the key reasons the effort to develop an HIV therapeutic vaccine or cure has been so difficult is the sheer diversity. Since HIV mutates so quickly, every patient’s specific virus has slight genetic differences, making them uniquely difficult to target in a vaccine. HIV is also able to “hide” from the immune system, as it contains a protein called Nef, which can both enhance viral replication and reduce the ability for the immune system to recognize and destroy infected cells. Dr. Ostrowski’s work is therefore aimed at understanding the immunological

Dr. Mario Ostrowski, MD

Professor, Department of Immunology, Laboratory Medicine and Pathobiology, Institute of Medical Science, University of Toronto Scientist & Consultant Clinician, St. Michael’s Hospital, Unity Health

Photo Credit: Niki Akbarian

mechanisms of control to try to reproduce these effects in others by harnessing a patient’s own immune system.

One strategy is simply blocking the pathway that allows HIV to hide. Dr. Ostrowski is collaborating with medicinal chemists to develop new compounds that can block Nef, as downregulating its activity would help the immune system target infected cells, and therefore reduce HIV reservoirs.

Another strategy is to assist a patient’s immune system and directing them to target

HIV-infected cells. Dr. Ostrowski emphasized that current therapeutic vaccination efforts “[do not] seem to be that effective, so we’re thinking to use personalized ways.” He is collaborating with Moderna to apply mRNA vaccine technology to HIV. Their strategy borrows from the cancer vaccine field, as cancer is also able to “hide” from the immune system, preventing the tumour from being destroyed. Personalized cancer mRNA vaccines therefore aim to identify the cancer in an individual, and modify the proteins on cancer cells so their immune system recognizes it as foreign, destroying them.3 Similarly, Dr. Ostrowski’s strategy involves “studying patients’ immune response against the virus, characterizing their virus’ sequence, and identifying the parts of the virus where the immune response does not work [in order to] expand the cytotoxic killer T cell response.” Currently, he is studying virus samples from patients to see if they can first reproduce these findings in vitro. They are using these samples to redirect a patient’s own cells to target new epitopes, regions that can bind antibodies and elicit an immune response, from their own unique virus, as well as examining antigens that may be expressed on latently infected cells.

“Can we make people like long-term nonprogressors?” Dr. Ostrowski asked. “It is a test of concept since nobody knows how to get rid of the virus entirely.” Realistically, he imagines a multi-pronged approach using a combination of techniques, including a Nef inhibitor and mRNA therapeutic vaccine alongside ART, may prove most effective. The large stigma from the peak of the HIV/AIDS

epidemic also still lingers, despite the major treatment advances that have been made, and serves as a source of motivation for Dr. Ostrowski to pursue research looking for a cure.

“The virus usually stops growing [following treatment],” he emphasized. “The CD4+ T cell count can be reconstituted back to normal, and [a patient] will likely not develop AIDS. The life expectancy is slowly approaching that of someone without HIV, but [because of the stigma,] most people would rather have a condition like diabetes, [where treatment involves] more burden on the patient, constant monitoring, and will not prevent all the complications.”

In borrowing techniques from both the COVID-19 and the cancer vaccine field, Dr. Ostrowski’s work highlights the multidisciplinary scope involved in the effort to develop an HIV therapeutic vaccine. Though major strides in HIV therapy have already been made, perhaps these are the strategies that will help cure it completely.

References

1. Norris S, Nixon A, Murray W. AIDS: Medical and Scientific Aspects. Government of Canada Publications [Internet]. 2001 Dec 18 [cited 2023 Sep 9];95(5E). Available from: https://publications.gc.ca/Pilot/ LoPBdP/CIR/935-e.htm

2. Matveev VA, Mihelic EZ, Benko E, et al. Immunogenicity of COVID-19 vaccines and their effect on the HIV reservoir in older people with HIV [Internet]. bioRxiv; 2023 [cited 2023 Sep 11]. p. 2023.06.14.544834. https://www.biorxiv.org/content/10.1101/2023 .06.14.544834v1

3. Sample I. Vaccines to treat cancer possible by 2030, say BioNTech founders. The Guardian [Internet]. 2022 Oct 16 [cited 2023 Sep 8]; Available from: https://www.theguardian.com/society/2022/oct/16/ vaccines-to-treat-cancer-possible-by-2030-say-biontech-founders

Master of Science in

Biomedical Communications

Show The Unseeable: Superficial Structures of the Eye and Bony Orbit

Like many of my peers, I aspire to be both a designer and a scientist, but I truly believe that I am a teacher first and foremost! Inspired by my undergraduate experiences at McMaster University, my main passion has been education, facilitated visual storytelling and curated graphical explanations. As part of BMC’s class of 2024, I am thrilled to continue honing my craft at U of T, with the hopes of designing interactive tools for science and medical education in my future career.

Samantha Li

Naomi Wee

Coral Crisis

I’ve always been captivated by the intricate and complex nature of science, particularly the illustrations in textbooks that elucidate challenging concepts. To pursue this interest further, I embarked on a journey that included a Bachelor of Science in Biology and various art courses, ultimately culminating in my enrollment in the Master’s of Science in Biomedical Communications program at UofT. My goal is to collaborate with molecular medicine researchers, visualizing scientific breakthroughs to advance research and educate diverse audiences.

The Dark Side of Human Nature: The Dark Triad Personality

By Mahbod Ebrahimi

There has been an everlasting debate regarding whether humans are inherently “good” or “evil.” As many people might argue, the answer to this philosophical question is contingent on the person, and there’s no one-size-fits-all template for human behaviour. Therefore, psychologists have come up with personality traits to better understand human thoughts and behaviours. Personality is defined as the unique combination of traits that differentiate one person from another, with personality traits representing the specific dimensions along which individuals can vary.1

The best empirically validated model for determining someone’s personality is by assigning each person to the “Big Five” personality traits, commonly known as the OCEAN model with the following traits: Openness (tendency for creativity and curiosity), Conscientiousness (tendency for organization, goal orientation), Extraversion (being outgoing or sociable), Agreeableness (being tolerant, cooperative), Neuroticism (tendency for anxiety, temperamentality).2 It is important to note that people may vary considerably in these traits, making each person unique. The OCEAN model has been around for decades as one of the primary means of assessing one’s personality.

However, in the early 2000s, two researchers, Delroy Paulhus and Kevin Williams, coined the term “Dark Triad Personality,” which could be considered an extension of the commonly known personality traits.3 In their landmark paper in 2002, Paulhus and Williams studied 245 students to explore their inclinations

toward narcissism, Machiavellianism, and psychopathy. This effort to examine the offensive yet non-pathological aspects of personality unveiled a darker side to human nature, which has real-world implications and often manifests in our daily social interactions.3

Now, take a moment and think about the following questions: Have you ever found yourself feeling manipulated, exploited, and emotionally drained after an encounter with someone? Have you ever constantly felt used for someone else’s personal gain? If you’ve answered yes to any of these questions, then you might have crossed paths with an individual exhibiting what some psychologists call a dark triad personality.3

What is the dark triad personality?

The dark triad personality is composed of three negative personality traits: narcissism (entitled self-importance), Machiavellianism (strategic exploitation and deceit), and subclinical psychopathy (insensitivity or disregard for others). Each of these traits may mix to create a toxic combination that can manifest in one person, although they can also exist independently. It is important to note that these traits are thought to exist along a spectrum, and people might have varying degrees of each trait. People with one or more of these toxic traits tend to possess a propensity for readily exploiting others (this could be a close family member or a random stranger) without any sense of remorse as they impose harm on those around them. 3

Research has demonstrated that people with these traits are extremely manipulative and will relentlessly pursue their goals, often disregarding the well-being of those in their vicinity. On average, compared to the population mean, these people usually have difficulties understanding human emotions and struggle with feelings of compassion and empathy.4,5 The purpose behind identifying the dark triad personality traits is to shed light on the parasitic and manipulative behaviours that conventional personality traits fail to capture. Now, let’s delve deeper into the dark triad personality traits.

Narcissism: The term narcissism originates from Greek mythology, and it is based on the story of Narcissus, a handsome and arrogant hunter who falls in love and becomes obsessed with his own reflection in a pond of water, resulting in him eventually drowning.6 The story of Narcissus serves as a cautionary tale

to extreme self-love, vanity, and self-obsession. In modern psychology, people with narcissistic tendencies can have grandiosity (an unrealistic sense of superiority), arrogance, a constant need for admiration and a lack of empathy for others.2,3 In addition, people who rank high in narcissism often have an inflated sense of personal achievements, concurrently adopting a sense of superiority and entitlement over others, which could serve as a coping mechanism to mask their perceived inadequacies.

Machiavellianism (manipulative personality): The term Machiavellianism emerged from the 16th-century Italian politician and writer Niccolo Machiavelli. In his famous book, “The Prince,” Machiavelli gives advice to

rulers on how to govern their states by being practical and strategic, even at the expense of using manipulation, violence, and deception to achieve their goals and strengthen their control. The common traits associated with Machiavellianism are manipulation, lack of emotion and moral compass, exploitation of others, and deceit.2,3 People with this trait do not have a moral “stop button” and believe that the ends justify the means.

Subclinical Psychopathy: You might have heard of the term “psychopath” often these days, especially in the media. Psychopathy has recently been added to the subclinical sphere of dark personality traits. The key characteristics of psychopathy are high impulsivity, lack of empathy, volatility, and being without remorse. It is important to note that psychopathy in this context of the dark triad is different from a clinical diagnosis of antisocial personality disorder in adults, which is mainly characterized by serious psychopathic traits.1,⁷ Overall, there are some common features between the three dark triad personality traits. To varying degrees, all three traits describe a socially malevolent character with a high tendency toward self-promotion and emotional coldness.

How to identify someone with the dark triad personality?

Honestly, there’s no easy way! The researchers who originally introduced the concept of the dark triad personality have also devised a measurement scale to assess an individual’s inclination towards these traits, known as

the Short Dark Triad (SD3). Several studies have already employed this scale to assess its reliability and validity, with promising results for a wide-scale implementation.⁸ However, further research and validation efforts are required to establish its reliability for practical use. Nonetheless, there are some common signals that you could potentially use to identify people with these traits in your day-to-day life.

Firstly, due to a constant thirst to be fulfilled, you might feel emotionally, physically, and

financially depleted after every interaction with people who possess the dark triad personality, making it possible that you are being manipulated and used for personal gain. Secondly, people with the dark triad personality are experts at emotional abuse and gaslighting (making you question your sense of self and reality). Therefore, when you try to confront these individuals, they quickly turn the table and become the victim, making you the villain of every situation. Lastly, it is hard for people with dark triad personalities to sustain healthy long-term relationships with friends, partners, family, or work colleagues.2 Therefore, if you’ve noticed a pattern of frequent unsuccessful relationships, this could be a red flag, hinting that an individual might have some of the dark personality traits. Despite the complexities in identifying those with a dark triad personality, being aware of these warning signs can assist in protecting oneself from potential harm and exploitation.

Moral of the Story?

Obviously, having an instance or a specific situation that could be associated with any of

the abovementioned traits does not mean that an individual has a dark personality trait. It is the pattern of constant behaviours and actions that are important and worth consideration to identify someone with a dark triad personality. It could be quite a dangerous road to be in any kind of relationship with an individual with these personality traits. If you identify someone who has a dark triad personality, the best advice could be to distance yourself as much as possible.

References

1. Epstein, S. (1994). Trait theory as personality theory: Can a part be as great as the whole? Psychological Inquiry, 5(2), 120–122. https:// doi.org/10.1207/s15327965pli0502_4

2. .McCrae RR, John OP. An introduction to the five-factor model and its applications. J Pers. 1992 Jun;60(2):175-215. doi: 10.1111/j.14676494.1992.tb00970.x. PMID: 1635039.

3. Paulhus, DL, Williams, KM. The Dark Triad of personality: Narcissism, machiavellianism, and psychopathy. Journal of Research in Personality. 2002;36(6):556–563. https://doi.org/10.1016/s00926566(02)00505-6

4. Frothingham, M. B. (2023, July 26). Dark Triad personality traits. Simply Psychology. https://www.simplypsychology.org/dark-triad-personality.html

5. Loggins, B. (2023, April 11). Dark Triad personality: What it is and how to spot it. Verywell Mind. https://www.verywellmind.com/ what-is-the-dark-triad-personality-5217146#citation-1

6. Encyclopædia Britannica, inc. Narcissus. Encyclopædia Britannica. https://www.britannica.com/topic/Narcissus-Greek-mythology

7. Zimmerman, M. (2023, August 29). Antisocial personality disorder (ASPD) - psychiatric disorders. MSD Manual Professional Edition. https://www.msdmanuals.com/professional/psychiatric-disorders/ personality-disorders/antisocial-personality-disorder-aspd

8. Jones, D. N., & Paulhus, D. L. (2013). Introducing the short dark triad (SD3). Assessment, 21(1), 28–41. https://doi. org/10.1177/1073191113514105

Let’s Unpack That:

The Biopsychosocial Effects of Infectious Disease

By Janet Z. Li

When we think about infectious diseases, we tend to focus on the biological aspects–the “science” behind it. This is likely because historically, they have demonstrated the potential for widespread damage, in some cases resulting in fatalities as high as 60% of populations, as seen during the 14th century European Black Plague.1 In modern times, infectious diseases continue to be one of the leading causes of death worldwide, particularly in lower income countries and amongst younger individuals.2 Over the past few years, the entire world was brutally reminded of the vicious reality that is living amidst a pandemic, with around 104 million cases of COVID-19 having been reported in North America as of April 2022.3 Beyond the physical implications of acquiring an infectious disease, the biopsychosocial repercussions are equally as far-reaching and detrimental, despite rarely being talked about.

Infectious diseases bring extensive harmful impact, encompassing the general public and already vulnerable populations. During the COVID19 pandemic, social distancing and isolation regulations minimized faceto-face contact, promoting significant increases in depression amongst the general population.4 Furthermore, fear of infection was a significant contributor for anxiety rate spikes. In combination with other factors related to lethargy and grief, the overbearing trepidation of contraction caused pre-existing social divides to

deepen at dramatic rates.5 Trauma expert Steven Hobfoll notes that “the human brain searches gains for hidden losses”, meaning that people are more likely to think about the bad as opposed to the good,6 a phenomenon that is even more prevalent in times of uncertainty.

At a population level, social consequences may arise as a result of emotional fluctuations and can manifest as empathy gaps. Also known as cognitive biases, these are systemic errors that arise when people’s judgement deviates from their norm, and they exist in different contexts.4 One example is where individuals are less likely to help outgroup members as opposed to ingroup members.4 This was particularly visible when looking at pro-vaccination and anti-vaccination groups, demonstrating this natural human phenomena getting disproportionately escalated in times of crises,4 whereas in a more neutral state, they may be less prone to externalization. During the pandemic, an increase in susceptibility to others’ criticism has also been found, relating to the concept of other-focused concerns,4 when we focus on how others perceive us to be.

Another social ramification of infectious diseases are looping effects. This refers to how beliefs, when interacting with physiological processes, can result in disparate outcomes in different cultural contexts.7 In situations of tension and risk of spread, such as a pandemic, individuals’ beliefs about how to balance

health and economy, trust in political or medical authorities, and ingrained customs are core values that can be either re-shaped or fortified when faced with adversity. These unstable shifts contribute to the rising outbursts, additionally fueled by widespread pandemic-induced vulnerability and a lack of a visible endpoint.8 Societal trust has plummeted in the last few years and researchers have begun to see the repercussions of the ‘rudeness epidemic’ that is just as contagious as an infectious disease.6

Sociologists and epidemiologists have studied the negative societal responses to a threat as natural collective behavior. In fact, some argue that the ways in which individuals vary in their social behavior and patterns of these contact networks actually mitigate the variation of disease dynamics.8 Although seemingly stochastic, the route of infectious disease transmission is actually highly predictable when factoring in known elements such as age or geography.9 Research suggests that behavioral responses to disease follow one of two patterns: to cause local pathogen extinction and epidemic burn-out, or naturally push a system towards more

stable endemic disease dynamics. Broadly speaking, there are two relevant categories of behaviors, the sickness behavior of infected individuals and the behavior shown by uninfected individuals towards those with symptoms of infection. The latter includes important concepts of avoidance and empathy, both of which are strongly influenced by personality traits which are normally seen as stable throughout life but can be negatively exacerbated by perceived danger. Known as the ‘parasite-stress model’, the protective behaviors that humans display in response to illness aversion comes at the expense of intergroup relationships.7 In modern society, avoidance of unfamiliar outgroup members can ultimately lead to intensified stereotyped perceptions, prejudiced attitudes and feelings, and discriminatory behavior without guaranteed reduced risk of infection.7

Psychologist and professor Dr. David Rosmarin of Harvard Medical School states that during COVID-19, there was significantly increased anger as an artefact of the heightened tension.10 The recurring cycle of anxiety and depression, often manifesting as anger, has been explained from a clinical standpoint by classifying anger as a primary emotion, but often expressed in secondary ways, meaning it is more intensive and defensive.10 With the pandemic making people more on edge, this dynamic may be involved in the increase of domestic violence and homicide crimes over the last few years.10,11 Faced with sickness, daily issues may diminish in importance, unveiling the fragility and malleability of our emotional strength. We are able to see the ugly side of humanity more clearly and how when confronted with infectious diseases, we have less control than we think.

In a way, infectious diseases equalize us, since it transcends our man-made categorizations of social, economic, and demographic statuses. However, underlying this seemingly equitable illusion, pre-existing divisions are deepening at accelerated rates. We are only beginning to realize the effects of infectious disease on our biopsychosocial actions. To put it simply, our current tendency to focus on “under the skin” phenomena needs to be expanded to include the crucial aspect of what happens “outside the skin” before we can fully understand just how toxic we are.

References

1. Martin J. The Black Death [Internet]. Uiowa.edu. 2017. Available from: http://hosted.lib.uiowa/uiowa.edu/histmed/plague/

2. Baylor College of Medicine. Introduction to Infectious Diseases [Internet]. Baylor College of Medicine. 2016. Available from: https:// www.bcm.edu/departments/molecular-virology-and-microbiology/ emerging-infections-and-biodefense/introduction-to-infectious-diseases

3. COVID-19/Coronavirus Real Time Updates With Credible Sources in US and Canada | 1Point3Acres [Internet]. Coronavirus.1point3acres.com. Available from: https://coronavirus.1point3acres.com/en

4. Gaertmer SL, Dovidio JF, Anastaso PA, Bachman BA, Rust MC. The Common Ingroup Identity Model: Recategorization and the Reduction of Intergroup Bias. European Review of Social Psychology. 1993 Jan;4(1):1-26.

5. Wilson ME. Geography of Infectious Diseases. Infectious Diseases [Internet]. 2017;938-947.e1. Available from: https://www.ncbi.nlm. nih.gov/pmc/articles/PMC7150158/

6. The pandemic has caused nearly two years of collective trauma. Many people are near a breaking point. [Internet]. Washington Post. 2021. Available from: https://www.washingtonpost.com/ health/2021/12/24/collective-trauma-public-outbursts/

7. Bayeh R, Yampolsky MA, Ryder AG. The Social Lives of Infectious Diseases: Why Culture Matters to COVID-19. Frontiers in Psychology. 2021 Sep 23;12

8. Silk MJ, Fefferman NH. The role of social structure and dynamics in the maintenance of endemic disease. Behavioral Ecology and Sociobiology. 2021 Aug;75(8)

9. Wilson ME. Geography of Infectious Diseases. Infectious Diseases [Internet]. 2017;938-947.e1. Available from: https://www.ncbi.nlm. nih.gov/pmc/articles/PMC7150158/

10. Writer APHS. A closer look at America’s pandemic-fueled anger [Internet]. Harvard Gazette. 2020. Available from: https://news. harvard.edu/gazette/story/2020/08/a-closer-look-at-americas-pandemic-fueled-anger/

11. Nivette AE, Zahnow R, Aguilar R, Ahven A, Amram S, Ariel B, et al. A global analysis of the impact of COVID-19 stay-at-home restrictions on crime. Nature Human Behaviour [Internet]. 2021 Jul 1;5(7):868–77. Available from: https://www.nature.com/articles/ s41562-021-01139-z

Conceptual overview of the links between sociality, demography and disease dynamics taken from Silk & Fefferman.8

The Rise of Infectious Diseases

A Call for Healthcare Adaptation

The adverse effects of climate change can be readily observable. Sea level rise, shrinking glaciers, and abnormally intense wildfire seasons are only a few examples of how the changing climate is impacting our world today. Beyond its influence on weather conditions, natural habitats, and long-standing environmental monuments, climate change is also affecting human health, both directly and indirectly. One indirect health impact is the rise of infectious diseases and their transmission.

Infections diseases are characterized by infections caused by various pathogens, including bacteria, viruses, fungi, parasites, and prions. These diseases can be transferred via a variety of modes including insect bites (vector-borne diseases), animal interaction (zoonotic diseases), and the consumption of contaminated water or food. Pathogens require very specific conditions to survive, reproduce, and spread.1 According to the Centers for Disease Control and Prevention (CDC), infectious diseases are on the rise. This includes diseases such as Lyme disease, West Nile disease, and Valley fever.2

So, how exactly is climate change increasing the spread of infectious diseases?

By Samantha Ricardo Migration

Climate change is contributing to the destruction of animal habitats leading to the migration of animals and insects into regions that were previously unsuitable for

these species. This is specifically relevant regarding urban environments where humans live. These migrating animals and insects often carry disease which can be transferred to humans through bites or contamination of food or water.1 For instance, blacklegged ticks, once highly localized in the continental U.S. are migrating northwards, potentially leading to an increased occurrence of Lyme disease in Canada.3 Human climate-related migration is also a potential mechanism for infectious disease transmission. As individuals are being forced to leave their homes because of climate impacts, migration may push individuals into areas prone to infectious diseases and introduce infectious diseases to areas where diseases were previously absent.

Enhanced Survival and Reproduction

Climate change in Canada has also led to longer summer seasons, milder winters, and changing rainfall patterns. Warmer temperatures can enhance the survival and reproduction of certain species of pathogens and vectors. This is particularly relevant in the context of waterborne diseases. Notably, warming oceans have provided a favorable habitat for the bacterium Vibrio cholera, which leads to cholera.1

Lastly, climate change creates conditions which often leads to a scarcity of basic resources such as food, water, and suitable habitat. Individuals experiencing malnutrition or living in unsanitary

environments due to these limitations are more vulnerable to contracting illnesses including infectious diseases.1

While some pathogens have a lower survival rate under high temperatures and thrive in cold temperatures, the threat of disease by many other pathogens will be heighted as temperatures continue to rise and the local environments continue to change.1 It is essential to acknowledge that the increase of infectious diseases both now and in the foreseeable future is not equally distributed across communities. Populations with fewer adaptive resources and measures in place will be more likely to experience health casualties. The spread of infectious diseases due to climate change is most pronounced in areas with inadequate sanitation, limited access to safe drinking water, and poor hygiene practices.

So, what can be done? Traditionally, the public sphere has focused on mitigation and reversal through education, outreach, and initiatives. However, reports by the Intergovernmental Panel on Climate Change (IPCC) have confirmed that many of the climate effects caused by human activity are irreversible and unfortunately inevitable.4

As the effects of climate change are already being felt, health care systems have a critical responsibility to enhance support for individuals and populations at high risk for disease contraction. There are three key ways the healthcare system can play a role in adopting adaptive measures: remodeling public health infrastructure, incorporating a One Health approach within the medical

system, and increasing funding for vaccine development and awareness.

Remodeling Public Health Infrastructure

Public health agencies play a crucial role in surveillance, education, and outreach. When it comes to the spread of infectious diseases, a strong emphasis should be placed on raising awareness among highrisk populations. To achieve this, education for public health agencies and professionals should have a directed focus on effective public outreach for vulnerable groups both locally and globally.

Incorporating a One Health Approach Within the Medical System

The One Health approach recognizes the interconnection between human health, animal health, and environmental health.5 It is a multidisciplinary method to better recognize, analyze, and treat human symptoms in collaboration with different disciplines that are not localized to medicine. Regarding infectious diseases, adopting a One Health approach would involve medical professionals collaborating with health agencies responsible for monitoring infectious diseases, veterinarians, and ecologists. This collaboration would facilitate the effective dissemination of infectious disease

information and a better understanding of how disease is spread among species and environments. By gaining deeper insights into the origins and transmission rates of a disease, medical professionals, clinics, and hospitals can be better equipped to treat patients and provide educational resources.

Increasing funding for vaccine development and awareness

Vaccines are one of the most effective mechanisms for preventing infectious diseases. However, many of the infectious diseases believed to be impacted by climate change do not have vaccines associated with them or have vaccines which are in early trial stages.1 Increased funding for vaccine research and development would be a positive step in combating an increase in infectious disease. In addition to existing infectious diseases, vaccine development should also be focused on emerging infectious diseases as climate change is likely to contribute to the expansion of new infectious diseases.6 For diseases in which a vaccine does exist, investment in educational and outreach programs for individuals lacking knowledge related to vaccination would be an additional positive step in preventing infectious disease occurrence. Without proper medical preparation, intervention, and multi-disciplinary collaboration, the threat of climate change and the infectious diseases associated with it, are likely to overwhelm the health care system. Reflecting on infectious diseases

which have overwhelmed the healthcare system in Canada and abroad in the past (namely COVID-19), it is crucial for the health system to respond proactively to the current challenges. By doing so, we can better serve vulnerable populations and support a functional, effective, and adaptative health system.

References

1. Wu, X., Lu, Y., Zhou, S., Chen, L. & Xu, B. Impact of climate change on human infectious diseases: Empirical evidence and human adaptation. Environ Int 86, 14–23 (2016).

2. Centers for Disease Control and Prevention. Climate Change and Infectious Diseases. (2022).

3. Canadian Public Health Association. Infectious Disease and Climate Change in Canada: Key informant interviews. (2021).

4. Edelson, P. J. et al. Climate Change and the Epidemiology of Infectious Diseases in the United States. Clinical Infectious Diseases 76, 950–956 (2023).

5. Mackenzie, J. S. & Jeggo, M. The One Health Approach—Why Is It So Important? Trop Med Infect Dis 4, 88 (2019).

6. Carignan, A., Valiquette, L. & Laupland, K. B. Impact of climate change on emerging infectious diseases: Implications for Canada. Official Journal of the Association of Medical Microbiology and Infectious Disease Canada 4, 55–59 (2019).

Fighting Windmills or Giants

Is Neural Regeneration

Possible?

By Iciar Iturmendi-Sabater

Don Quixote1 was published in 1615, 44 years after Miguel de Cervantes lost all sensitivity in his left hand in the largest naval battle of Western history. Had the Ottoman beat the Spanish Empire in the Battle of Lepanto, the foundations of Europe could have been rooted in Islam rather than Christianism. Perhaps less thought of is what would have happened if Cervantes’ left hand had not been hurt. Or if he had lost his right hand instead. Would Cervantes never have had the time to write what is now considered the first modern novel of time? Would Don Quixote ever have fought windmills confusing them for giants? What if there had been a remedy for Cervantes’ lesion?

Current neuroscience is exploring if nerve regeneration is possible. Nerves consist of bundles of axonal fibres which transmit electrochemical signals from neuron to neuron, connecting the central nervous system (CNS)—the brain and the spinal cord—with the rest of the body, allowing for the control of movement and sensibility. Prior to learning that electrochemical signalling allows communication between neurons, the first surgical treatments for nerve damage were performed as early as the 1820’s. Had Cervantes been born 200 years later, his left-hand median nerve could have been invasively substituted with another, not so important nerve. Give it another 50 years and physicians may have considered ‘decompression’ to treat Cervantes, whereby external pressure could have been released from his left median nerve to recover its function.2

These surgical approaches may have helped Cervantes because axonal and neural regeneration generally (i.e., neurogenesis) is possible in the peripheral nervous system (PNS). The PNS, to which the hand median nerve and other axonal bundles connecting the CNS to the rest of the body belong to, provides an ideal environment for regeneration.3 Yet had Cervantes’ lesion taken place in the CNS, regeneration would have been unlikely even today. In 1913, Santiago Ramón y Cajal, father of modern neuroscience and a Spanish compatriot of Cervantes’, already believed that neurogenesis in the CNS was impossible.4 Still, whether nerve regeneration can be achieved in the CNS remains a controversial research topic today.

“Axonal and neural regeneration generally (i.e., neurogenesis) is possible in the peripheral nervous system.”

A recent Nature publication by Grégorie Courtine’s team in Lausanne reported that a patient with damage in his cervical spinal cord, which caused total paralysis of his four limbs and torso (i.e., tetraplegia), recovered his ability to walk through a digital interface that transmitted brain signals from his brain to his spine.5 Those who don’t believe axonal regeneration in

the CNS is possible may be supportive of approaches whereby functionality is recovered through external aids, such as brain-computer digital interfaces or exoskeletons. These however may better serve those more psychologically resilient and in better health, who are more likely to stick to demanding training programs— the participant in Courtine’s study had endured three years of neurorehabilitation. Still, external aids are far from facilitating natural gait and body movements, as one can tell watching Courtine’s patient walk against a dreamy Swiss lake background.6

Accomplishing better intervention outcomes for patients with tetraplegia also lies in the hands of neuroscientists who defy the evidence that a neural master plan prenatally dictates and determines all postnatal neurodevelopment, making human neurogenesis in the CNS impossible after birth.7 Neurogenesis has been allegedly found in the primate neocortex,8 which carries out high level cognitive processes, and in the human

hippocampi,9 two seahorse-shaped brain nuclei involved in long-term memory formation and spatial navigation. However, these findings have been readily criticized since they could be attributed to statistical false positive errors. An influential critical review on this topic alluded to this in its title: “everything that glitters isn’t gold”.10

Fighting against statistical power limitations and what embryological development dictates, biomaterial and tissue engineers still hope that

nanomaterials such as graphene, a honeycomb-like spongy bi-dimensional material made of hexagonal carbon atoms whose first developers were awarded the 2010 Physics Nobel Prize, can provide an optimal environment to promote neurogenesis in vitro. Graphene sponges have been then transplanted into mice and rats’ spinal cords, achieving partial regeneration in the CNS in vivo.11 Still, there is a long way to go until scientists can conclude if graphene facilitates long-term neurogenesis and if animal models are optimal models for predicting transplantation success in humans.

“Neurogenesis

has been allegedly found in the primate neocortex, which carries out high level cognitive processes, and in the human hippocampi.”

Whether neural regeneration is possible in the CNS seems now more of an openended question than it was to Ramón y Cajal. Believing in this possibility may provide comfort to patients with tetraplegia and neurodegenerative diseases like dementia. But there may also be a reason why our CNS insists on preserving its structure immutable. In a hypothetical reality where Cervantes’ brain, instead

of his hand, had been injured and then regeneration been achieved… I doubt if Cervantes’ sense of self and personality had been well preserved to still imagine Don Quixote’s adventures in the fields of “somewhere in La Mancha, in a place whose name I never care to remember…

“Believing in this possibility may provide comfort to patients with tetraplegia and neurodegenerative diseases like dementia.”

References

1. De Cervantes M. Don Quixote. Lulu. com; 2016.

2. Krishnan KG, Worsch M, Boroumand M, Uhl E. Retractor endoscopic techniques in the treatment of entrapment peripheral neuropathies. Neurology, Psychiatry and Brain Research. 2018 Jun 1;28:19–23.

3. Huebner EA, Strittmatter SM. Axon Regeneration in the Peripheral and Central Nervous Systems. Results Probl Cell Differ. 2009;48:339–51. Aliquam venenatis libero eu ultrices pharetra.

4. Ramón y Cajal S. Estudios sobre la degeneración y regeneración del sistema nervioso. Madrid: Imprenta de Hijos de Nicolás Moya. 1913;

5. Lorach H, Galvez A, Spagnolo V, Martel F, Karakas S, Intering N, et al. Walking naturally after spinal cord injury using a brain–spine interface. Nature. 2023 Jun;618(7963):126–33.

6. Paralyzed man walks again with brain-spine device [Internet]. 2023. Available from: https://www.youtube.com/watch?v=lwt3nEoAAtQ

7. Rubenstein JLR, Martinez S, Shimamura K, Puelles L. The Embryonic Vertebrate Forebrain: the Prosomeric Model. Science. 1994 Oct 28;266(5185):578–80.

8. Gould E, Reeves AJ, Graziano MSA, Gross CG. Neurogenesis in the Neocortex of Adult Primates. Science. 1999 Oct 15;286(5439):548–52.

9. Moreno-Jiménez EP, Terreros-Roncal J, Flor-García M, Rábano A, Llorens-Martín M. Evidences for Adult Hippocampal Neurogenesis in Humans. J Neurosci. 2021 Mar 24;41(12):2541–53.

10. Breunig JJ, Arellano JI, Macklis JD, Rakic P. Everything that Glitters Isn’t Gold: A Critical Review of Postnatal Neural Precursor Analyses. Cell Stem Cell. 2007 Dec;1(6):612–27.

11. Domínguez-Bajo A, González-Mayorga A, López-Dolado E, Serrano MC. Graphene-Derived Materials Interfacing the Spinal Cord: Outstanding in Vitro and in Vivo Findings. Frontiers in Systems Neuroscience [Internet]. 2017 [cited 2023 Jul 25];11. Available from: https://www.frontiersin.org/articles/10.3389/fnsys.2017.00071

PhD Graduate Highlights

A Protocol for In Vivo Lung Perfusion Assisted Photodynamic Therapy of Lung Metastases

Supervisor: Dr. Marcelo Cypel Research site: Toronto General Hospital Research Institute (TGHRI)

Development and Validation of the Juvenile Idiopathic Arthritis Magnetic Resonance Imaging - Sacroiliac Joint Scoring System (JAMRIS-SIJ)

Supervisor: Dr. Andrea S. Doria Research site: The Hospital for Sick Children (SickKids)

Supervisors: Dr. Chaim Bell & Dr. Hannah Wunsch

Research site: Mount Sinai Hospital & Sunnybrook Hospital

Dr. Khaled Ramadan

Dr. Tarimobo Otobo

Dr. Lisa Burry

Prescription Sedative Use in Older Adults After Critical Illness

How Words Can Inspire A

Spotlight on Noor Al-Kaabi

By Sipan Haikazian

Noor Al-Kaabi is a recent graduate of the Master’s thesis program at the IMS, and I had the privilege of interviewing her about her journey through the program. Noor completed secondary school in the United Arab Emirates and moved to Mississauga, Canada, in 2017 to start her new life here. She fell in love with biology and the social sciences throughout high school and enrolled at the University of Toronto, double majoring in biology and psychology. Here, she was involved in several research projects in both subject areas. She described one particularly impactful research project where she had the opportunity to investigate the mental health of refugees post-migration. She enjoyed interviewing people to gain insight into their health and lives, something she would continue to build through research and her extracurriculars in the future.

Highly motivated and eager to participate in more research, she finished her undergraduate degree in three years and enrolled at IMS in 2021. She explained that IMS is the only program she applied to due to the many highly qualified researchers and clinicians within the program and the vibrant student body that the program possesses. Interestingly, she gained this insight from connecting with IMS students as a volunteer show host of the Raw Talk Podcast, a podcast that highlights medical, scientific, and health stories at the Temerty Faculty of Medicine and beyond. She received positive feedback about the program and decided to pursue research here.

Noor joined Dr. Dmitry Rozenberg’s laboratory, who is a respirologist with expertise in skeletal muscle dysfunction as well as the physical functioning and quality of life of patients who have undergone lung transplantation. Dr. Rozenberg also provides consultation and conducts research with patients of the Good Hope Ehlers-Danlos Syndrome Clinic located at Toronto General Hospital. Ehlers-Danlos Syndrome is a group of genetic disorders affecting the connective tissue in several ways. These include joint hypermobility, skin hyperextensibility (or how far the skin can stretch), and tissue fragility (tissues being much more vulnerable to damage).

Noor’s thesis focused on the impact of respiratory conditions on quality of life in people with Ehlers-Danlos syndrome and hypermobility spectrum disorders, a study conducted using both quantitative and qualitative methods. With several ongoing studies occurring in the lab involving patients of multiple disorders, Noor was a part of more than one project throughout her Master’s. She had extensive opportunities to help with some of the lab’s clinical trials in-person, including a randomized clinical trial using inspiratory muscle training to relieve dyspnea in people with Ehlers-Danlos syndrome.

Some of the best experiences that Noor has had as a graduate student were with patient research encounters. “I loved providing a space where patients felt valued and appreciated. Speaking to patients, learning about their stories, and seeing them

improve with time is highly motivating for both me and the patients. One of the most notable patient encounters was during a palliative care-related project I was working on in my Master’s. A patient I was interviewing reached out and exclaimed gratitude for allowing me to create a space, as she’s not able to have conversations like that with everybody. It reaffirmed the power of words and conversation”. As somebody who also conducts clinical research, impactful patient encounters also top my list of memorable graduate school experiences. And I know first-hand the value this can have for patients.

“I loved providing a space where patients felt valued and appreciated. Speaking to patients, learning about their stories, and seeing them improve with time is highly motivating for both me and the patients.”

Along with her research commitments, Noor was and will continue to be heavily involved in extracurriculars on campus. As mentioned earlier, Noor joined the Raw Talk Podcast as a show host but she quickly gained experience and became an executive producer. The podcast, which

touches on topics related to graduate school, medical science, and the sociology of science and medicine, has over 100 episodes available on all podcasting platforms. The Raw Talk Podcast satisfied Noor’s curiosity about research, graduate life, and the art and science of providing medical care. “It’s so meaningful that we create content that displays our ideas, experiences, and safe spaces to a broader community of researchers and students. There’s an art to making somebody feel like they’re safe during an interview, and it’s something I’m always striving to improve”.

Noor was involved in mentorship throughout her undergraduate years as well. “I benefited a lot from mentors throughout this journey, so I wanted to give back and create connections to those who come from marginalized backgrounds. I think it’s so important for somebody to know how to expand your background and connect with others, especially in the academic community”. Noor became a functional strength training coach as part of the Nike x FitSquad program, where she found a new-found love for sports, fitness, and an outlet to build community and connect with

people. As a Muslim woman, she empowers women in her community to focus on positive health practices.

Noor will enter the medical program at the Temerty Faculty of Medicine at the University of Toronto in the 2023-2024 school year. In response to what she would like to accomplish in her career as a physician, Noor said, “It’s varied; you can put me in any corner on Earth, and I will create something out of it. So, I’m open to anything. However, there are certain values I want to develop throughout my career; this includes working with disadvantaged populations in her specialty and creating deep and meaningful conversations with patients and colleagues. From my research and extracurriculars, I’ve seen the healing power that conversation has, and that’s something that I want to explore.” Whatever specialty she plans on choosing, Noor will undoubtedly make a positive impact on every patient that she interacts with.

Noor Al-Kaabi MSc Institute of Medical Science and Toronto General Hospital, University Health Network Show Host & Executive Producer, Raw Talk Podcast

Photo Credit: Noor Al-Kaabi

Dr. Michelle Dubinsky’s Journey as a Researcher, Mentor, and Medical Science Liaison

By Lizabeth Teshler

Dr. Michelle Dubinsky’s interest in scientific research was sparked by her involvement in a research based laboratory course during her BSc in Biochemistry and Molecular Biology at McMaster University. Dr. Dubinsky further contributed to multiple research projects during her undergrad. Subsequently, she pursued a MSc in Biochemistry at Western University, studying proteins involved in cancer and Alzheimer’s disease. More specifically, she studied a protein called Pin1–a peptidyl-prolyl cis/trans isomerase. This protein was found to be up-regulated in cancer and down-regulated in Alzheimer’s disease. During her MSc, Dr. Dubinsky also had the opportunity to be a teaching assistant for a third year biochemistry course where many accessible databases and biophysical techniques were used to assist with student learning.

Pursuing a PhD in the field of molecular biology and epigenetics was always part of Dr. Dubinsky’s academic ambitions, and she was especially excited to join the IMS community. Consequently, she started her research at the Keenan Research Centre for Biomedical Science at St. Michael’s Hospital under the supervision of Dr. Philip Marsden. During this time, Dr. Dubinsky investigated how blood flow patterns affect gene expression through cardiovascular epigenetics. This was done using the aorta as a model to observe different blood flow patterns and their effects on flow-responsive genes. The main focus of the project was exploring a cis-DNA element, termed the Shear Stress

Responsive Element (SSRE), located in the promoter of the endothelial nitric oxide synthase gene (eNOS) and determining the nucleo-protein complex that formed on this small piece of DNA. Additionally, she helped to uncover that this element was necessary for eNOS transcription and expression in vitro and in vivo, as a mutation in the sequence caused the gene to be methylated and turned off.

Throughout her doctoral studies, Dr. Dubinsky always challenged herself, both within and outside of her research. She actively took on and led initiatives where she could give back to the IMS student community through teaching and mentorship. Dr. Dubinsky contributed to the growth of the IMS Peer-to-Peer Mentorship program (P2P), which connects incoming IMS graduate students with upper year mentors. She also ran the IMS Summer Undergraduate Research Program (SURP) after having held various roles such as poster judge, seminar facilitator, research day master of ceremonies and virtual research day event organizer. Dr. Dubinsky strongly encourages anyone to get involved in extracurricular activities, and is thankful for these opportunities which contributed to both her personal and professional development and helped her decide on a career path in the pharmaceutical industry.

Furthermore, Dr. Dubinsky combined her love of mentorship and medical affairs in her role as a team lead for the Life Sciences Career Development Syndicate

Mentorship program (LSCDS). Dr. Dubinsky recruited 63 mentors, organized workshops, and successfully bridged the gap between industry professionals and graduate students. She also gained industry experience by contributing to the project as part of the Industry Team Case Study (ITCS). The case study allowed Michelle to collaborate with pharmaceutical partners and contribute to a meaningful medical affairs project with real world applications. Her group conducted a gap analysis of the Alopecia Areata medical landscape and the available therapeutics undergoing clinical trials. Excitingly, her peers from this experience have gone on to make meaningful impacts in their chosen fields–consulting and entrepreneurship.

Dr. Dubinsky has led many other community initiatives during her time in the IMS. She was a planning committee

member for the Ori Rotstein Lecture, taught lectures, and pioneered a new Senior Advisor role on the St. Michael’s Hospital Research Student Association. Throughout graduate school, Dr. Dubinsky also enjoyed teaching dance and presenting at various international conferences.

Currently, Dr. Dubinsky is a Cardiometabolism Medical Science Liaison (MSL) at Boehringer Ingelheim. Through this role, she has room to combine scientific curiosity, patient impact, as well as teaching and networking with healthcare professionals. This role allows her to engage in scientific exchange meetings, meet with physicians to discuss

new data and answer any questions, and learn about new trials and therapies.

Dr. Dubinsky believes that her extensive mentorship, teaching and scientific experiences during graduate school at the IMS allowed her to succeed in her current role. Dr. Dubinsky summarizes her best advice for graduate students in three tips:

1. Know yourself and be introspective–take time to think about your likes and dislikes in a safe space.

2. Network and scope out what roles exist–try new things and explore opportunities. It is much easier to cross something off your list of next steps.

3. Find mentors and sponsors–these can be formal (through mentorship programs) and informal (senior labmates).Think of people around you who would say your name in a room of possibilities and keep in touch with them.

More specific to the MSL role, Dr. Dubinsky believes that planning her degree timelines, gaining industry experience, therapeutic area knowledge, and networking helped her obtain her job even prior to defending her PhD. It is also important to research and know the differences between pharmaceutical companies with MSL roles as these may vary.

Dr. Dubinsky recommends not only making new relationships through reaching out personally, but “keeping your

network warm” through consistent checkins. She also highlights that thinking about your current peers is important as these individuals may be your future colleagues. She further notes that throughout the interview process it is important to showcase that you have been “doing the MSL role before they have given you the job”. This means highlighting the specific skills they are looking for through your previous experiences.

Dr. Michelle Dubinsky is extremely passionate about her work as an MSL, and she sees many parallels between her PhD involvements and current role. Her love for educating students evolved towards having meaningful conversations with physicians and specialists. Dr. Dubinsky greatly appreciates this aspect of her role, and sees this as a great opportunity for positive healthcare impact. Dr. Dubinsky is able to relay new information on trials and new data to healthcare professionals, and to learn about their care practices and challenges. She also enjoys networking and bringing back new scientific knowledge from various conferences she attends.

Dr. Dubinsky’s academic journey teaches us that no matter what career path we pursue, openness to community involvement during grad school is extremely valuable in shaping who we become and what career ambitions we go after. By following Dr. Dubinsky’s three tips and career insights, we are all equipped to turn our sparks of potential into flames of achievement.

Dr. Michelle Dubinsky, PhD Medical Science Liaison, Boehringer Ingelheim

Photo Credit: Niki Akbarian

Chez OBHM in Montreal

By Janet Z. Li

The Organization for Human Brain Mapping (OHBM) celebrated 29 years of scientific meetings in imaging this year in Montréal, Québec. This international organization is dedicated to advancing the understanding of the anatomical and functional organization of the human brain using various modes of neuroimaging.1 Some methods of focus are magnetic resonance imaging (MRI), functional MRI, position emission tomography (PET), electroencephalogram (EEG), magnetoencephalography (MEG), electrophysiology, preclinical imaging, and genetics.

On our first conference day in Montréal, my lab mates and I attended various educational courses designed to delve deep into niche topics of interest. I sat in on the morning course titled “Advanced methods for cleaning up fMRI time-series” and the afternoon course “Why it all comes back to Anatomy”. The evening Talairach Lecture was a very technical overview of developmental critical periods and Alzheimer’s Disease and was succeeded by a grandiose welcome reception at Old Port.

The following four days were packed with back-to-back seminars and talks on a multitude of topics. Being from a pain neuroimaging lab, and with my personal research being on conditioned pain modulation and descending antinociceptive pathway fMRI strength, I attended various sessions that focused on brain mapping, fMRI technical advancements, and connectome connectivity. A highlight keynote was from Dr. Emily Jacobs who spoke about gonadal hormones as powerful neuromodulators of learning and memory.

In addition to presentations, OHBM also hosted several discussion panels and roundtable events where experts shared their personal advice on subjects such as life after grad school, how to acquire funding, and data sharing. My personal favorite symposia was a morning talk titled “Addressing the challenges of Global Brain Health and Diversity through Neuroimaging.” This session heavily showcased longitudinal research, which is more difficult to find in the field of neuroscience, so it was an interesting opportunity to hear about the extended work being done across the world.

Despite having a tight schedule, I was able to spend a bit of time exploring the city of Montréal between sessions and in the late evenings. Our lab attended two evening events which brought us to Old Port and St Henri area, respectively. During both of these excursions we took advantage of the local food and basked in the European-inspired vibrancy of the community. After sunset, the streets became alive with music and laughter

and the Grande Roue shined brightly. I also took a quick tour around Chinatown and even biked along the Pont Concorde on my way to visit Parc Jean-Drapeau where the Biosphere and famous F1 racetrack are located.

Besides sight-seeing, we got to try some stunning restaurants and cafés. Notable mentions go to La Finca café, Chifa, and Mlle Catherine for some of the best ice-cream I have ever had.

I know I speak for many of us when I say that we are extremely grateful to have had the opportunity to attend OHBM in Montréal this year.

Palais des Congrès, where OBHM was hosted

References

Davis Lab at the OHBM welcome reception in Old Port

Investigating the Brain and Sunny San Diego at the Society of

Psychiatry Annual Meeting Investigating the Brain and Sunny San Diego at the

Biological

Society of Biological Psychiatry Annual Meeting

By Kevan Clifford

For those of us in neuroscience-based mental health research, the Society of Biological Psychiatry (SOBP) annual meeting is a cornerstone in the conference circuit. With COVID-19 thwarting our plans last year, the opportunity to experience cutting-edge research at my first international conference was all too welcome. The chance to explore the southernmost coast of California was, of course, also quite welcome. After a cold and hectic winter semester, it was finally time to slow things down with a sunny stint in San Diego.

After a five-hour flight, my fellow students and I arrived at the Hilton San Diego Bayfront Hotel, which, true to its name, hugs the boardwalk along beautiful San Diego Bay. We basked in four days of lavishness, far beyond what our graduate stipends normally afford us. The conference was held within the hotel, and our packed days consisted of early breakfasts, plenary talks, lunches, oral presentations, symposiums, and bustling poster sessions. The theme of SOBP 2023 was ‘Healing the Brain with Neuroscience and Technology’, with the most prominent topic being psychedelic drugs in psychiatric research. This included the opening plenary talk from eminent researcher Dr. David Nutt, ‘Psychedelic Medicine: From Brain Science to Clinical Trials’. Another popular topic was combining neuroimaging with transcranial magnetic stimulation, to find precise targets for brain stimulation used in mood disorder treatment. Personally, I most enjoyed the themed symposium presentations, particularly one exploring transcriptomic changes underlying bipolar disorder.

Outside of the compelling science at SOBP, San Diego was brimming with touristfriendly activities. The Hilton was a short walk from the Gaslamp Quarter district, an exceedingly quaint downtown area full of shops and restaurants, many of which reflect San Diego’s close proximity to the Mexican border. Its weekly market (held on Sundays) was a perfect chance to browse locally made goods. While quite idyllic, the self-contained Gaslamp Quarter did not reflect the city’s struggles with homelessness, which we encountered only several blocks away.

San Diego is most known for the San Diego Zoo, located in Balboa Park, which ranks among the top in the world. Balboa Park also includes the House of Pacific Relations International Cottages. Each of these 32 cottages display the culture of a country that has influenced San Diego’s history. We also enjoyed exploring La Joya Cove, which boasts picturesque beaches at the bottom of sheer cliffs. Tourists flock to these beaches (perhaps in excessive numbers) for pictures of the candid sea lions that occupy the coves.

As the conference came to an end, two poster presentations and endless socializing left me exhausted. Still, as a trail runner, I had been longingly eying up the surrounding mountains throughout the trip. Mustering up my remaining energy, I travelled to Paradise Mountain (located in the diametrically named ‘Hellhole Canyon’). The mountain was nestled among several others, with sprawling views of bright vegetation contrasted by red clay paths. I ran despite mountain lions being native to California mountains, after learning proper safety

etiquette and of their tendency to rarely interact with humans.

Filled to the brim with neuroscience and San Diego lore, I was quite happy to board my flight back to Toronto, where much-needed sleep awaited me. My first international conference left me feeling rejuvenated in my day-to-day scientific pursuits, and eagerly awaiting the next opportunity to blend scientific curiosity with adventure.

A group of sea lions strike a candid pose in La Joya cove

Photo Credit: Kevan Clifford

Hidden Wounds Hidden Wounds

Tuberculosis, Colonialism, and the Unsettling Story of Indian Hospitals

By Sara Shariati

In the forgotten folds of Canadian history lies an unsettling narrative, where colonialism, segregated hospitals, and tuberculosis intersect, casting a long shadow over Indigenous communities. Although the history of segregated hospitals is not as wellknown as residential schools–which were government-funded religious schools that aimed to forcefully assimilate Indigenous children into the Euro-Canadian culture during the 19th and 20th centuries–these so-called “Indian hospitals” have left a lasting scar on Indigenous survivors and their families across Canada.1,2

What is tuberculosis?

Tuberculosis (TB), caused by the airborne pathogen Mycobacterium tuberculosis, is the world’s top infectious killer.3 TB mainly affects the lungs, and its symptoms include prolonged cough (sometimes with blood), fever, chest pain, fatigue, and weight loss.3 This disease was first introduced to Indigenous communities in Canada by European settlers.4 TB is a disease of poverty; poor ventilation, crowded living conditions, malnutrition, and limited healthcare access contribute to its spread.5 As a result of these risk factors, TB spread rapidly among Indigenous peoples upon its introduction to this population. The burden of TB in Canada disproportionately affects Indigenous peoples to this day. Despite constituting only 4% of the population, Indigenous peoples account for 19% of TB cases in Canada.4

History of Indian Hospitals and Tuberculosis Sanitariums

The first Indian hospitals originated from Christian missionaries associated with residential schools in the late 19th century; children of these schools constituted the majority of patients in these facilities.6 The federal government began aggressive expansion of the racially-segregated hospital system following World War II in the 1940s, and Indian hospitals remained in operation until the 1980s.2,6

These hospitals, in addition to tuberculosis sanitariums, were aimed to control TB transmission and provide care to TB patients across Canada. TB sanitariums were first focused on managing TB cases among the general Canadian population; however, with the advancement of modern medicine and development of effective antibiotics against TB, non-Indigenous patients began to leave these facilities and were gradually replaced by Indigenous patients from remote areas.2

One of these sanitariums was the Queen Mary Hospital for Tuberculosis Children in Toronto, which began its operations in 1913.2 Survivors who were hospitalized there recall being subjected to physical torture and barbaric punishments for “bad behaviour”. They also recollect memories of loneliness and homesickness, as they were separated from their communities and support systems.2

Queen Mary Hospital was shut down in 1970; it was later turned into another

healthcare facility, named West Park Healthcare Centre.2

Mistreatment of Indigenous Patients in Indian Hospitals and TB Sanitariums

In an interview with CBC, Dr. Maureen Lux, author of Separate Beds: A History of Indian Hospitals in Canada, describes that the same mindset applied to both Indian hospitals and TB sanitariums. She notes that these facilities were not meant to help Indigenous peoples but rather to keep “disease-ridden Indians” separate from the rest of the population.2

Indian hospitals and TB sanitariums were under-staffed, under-funded, and over-crowded.6,7 Questionable treatment methods, aggressive surgeries without anesthesia, and medical experimentation

were common in these facilities.8 Records also indicate that numerous cases of forced sterilization were performed in Indian hospitals across Canada during the 20th century.2

Patients in Indian hospitals were forcefully removed from their communities; they were treated with biomedicine and not allowed to access the traditional healing methods common in Indigenous tribes.2 Staff at Indian hospitals also enforced a strict dress code, communicated exclusively in English, and addressed patients by English names.2 Since numerous Indigenous patients were forced to spend years in Indian hospitals

Thousands

in Indian hospitals during the 19th and 20th centuries. This photo shows a group of children in one of these hospitals in 1945.

or TB sanitariums, isolated from their communities, many–especially children–forgot their culture and language.2,8 After spending years in Indian hospitals, many children who returned home found themselves unable to communicate effectively with their families.2

Furthermore, survivors of TB sanitariums recall memories of the differential treatment of Indigenous and non-Indigenous patients. While nonIndigenous TB patients received pills for treatment, Indigenous patients endured daily injections with large needles and occasional invasive chest surgeries.2

It is also important to acknowledge the symbiotic relationship between residential

schools and Indian hospitals. The overcrowded setting of residential schools contributed to the spread of TB, resulting in many transfers to Indian hospitals.8 This cooperative link between Indian hospitals and residential schools ensured both institutions maintained their funding and remained operational.8 Enduring such painful experiences in these facilities for years has left lifelong scars on survivors and led to collective trauma amongst Indigenous communities.

Truth and Reconciliation

Indian hospitals and TB sanitariums operated while state-of-the-art local hospitals were being developed for nonIndigenous patients across Canada.2 This created a two-tier system of care that exacerbated the effects of colonialism and systemic racism on Indigenous peoples.

Researchers estimate that approximately 20 to 30 Indian hospitals operated in Canada until the late 20th century.2 These government-run facilities, like residential schools, were part of the colonial system that aimed to erase Indigenous people’s identity and isolate them from the settler Canadian population. Colonialism has had profound impacts on Indigenous communities across Canada, resulting in a legacy of discrimination, marginalization, and substantial health disparities. The discourse surrounding Indian hospitals highlights the susceptibility of healthcare to integration within an overbearing societal framework and underscores the

importance of diversity in healthcare leadership positions in averting such integration. We must acknowledge the trauma the Indigenous communities have endured as a result of colonial practices and collaborate with Indigenous peoples to address the harm caused to the greatest extent possible.

Rates of TB remain higher amongst Indigenous peoples compared to the nonIndigenous population in Canada to this day.4 A comprehensive plan is required to tackle this issue, which addresses sociodemographic factors including poverty that contribute to the spread of this disease. During the development of such a plan, it is especially important to engage with Indigenous scientists and experts in order to ensure the plan is culturally sensitive. Without taking sociodemographic factors and cultural sensitivity into account, health disparities will continue to prevail in Canada.

References

1. Miller, J. R. Residential Schools in Canada. The Canadian Encyclopedia https:// www.thecanadianencyclopedia.ca/en/article/residential-schools (2012).

2. Pelley, L. Mistreated: Legacy of segregated hospitals haunts Indigenous survivors. CBC News http://www.cbc.ca/news2/interactives/sh/jTCWPYgkNH/mistreated.

3. Tuberculosis. World Health Organization https://www.who.int/health-topics/ tuberculosis.

4. Hick, S. The Enduring Plague: How Tuberculosis in Canadian Indigenous Communities is Emblematic of a Greater Failure in Healthcare Equality. J. Epidemiol. Glob. Health 9, 89–92 (2019).

5. Global Tuberculosis Programme | Social Determinants. World Health Organization https://www.who.int/teams/global-tuberculosis-programme/populations-comorbidities/social-determinants.

6. Lux, M. Indian Hospitals in Canada. The Canadian Encyclopedia https://www. thecanadianencyclopedia.ca/en/article/indian-hospitals-in-canada (2017).

7. The story of a separate and unequal Canadian health care system | CBC Radio. CBC Radio https://www.cbc.ca/radio/sunday/revolver-at-50-canada-s-history-ofsegregated-healthcare-frog-march-firings-penny-lang-1.3707673/the-story-of-aseparate-and-unequal-canadian-health-care-system-1.3707678 (2016).

8. A Brief Look at Indian Hospitals in Canada. Indigenous Corporate Training https://www.ictinc.ca/blog/a-brief-look-at-indian-hospitals-in-canada (2017).

of Indigenous children were removed from their communities and placed

UofT Talks 2023 UofT Talks 2023

By Mahbod Ebrahimi

On June 9, 2023, UofT Talks held its annual TED Talk-style scientific symposium, and it was a huge success! UofT Talks is a student-led initiative at the Institute of Medical Science (IMS) with the goal of presenting multidisciplinary perspectives on pertinent and relevant topics in healthcare. UofT Talks has been holding events since 2016. This year, the event returned to an in-person format and was held at the Innis Town Hall Theater. “After dealing with COVID and virtual events for three long years, we really wanted to shake things up and get people to come out of their shells and join us in person. And what a better way to entice them [the target audience] than with a food-related topic?” says Shaghayegh, one of the co-leads of UofT talks.

Every year, a core theme is selected by the UofT Talks team. Food science was the main theme for this year’s event, and four speakers with relevant expertise were invited to present a 10-minute TED Talk on their field of interest. The evening kicked off with Dr. Ahmed El-Sohemy talking about the role of genetics in our nutrition. One exciting segment of Dr. El-Sohemy’s talk explained how some people might have a particular genetic variant and how this could result in having varying caffeine tolerance or cause us to taste food products (e.g., cilantro) differently. This excellent talk was followed by Dr. Karen Davison, who told the audience about the relationship between nutrition, mental health, and physical health. The third speaker, Dr. Ravi Selvaganapathy, introduced the audience to the novel topic of cultured

meat, which is meat that is composed in the laboratory, with the hope of having more sustainable meat production in the future. The fourth and final speaker, Dr. Sarah Elton, finished the first half of the event with a great talk on food sustainability.

After all the talks were completed, the audience had a short break to enjoy some food and treats prepared by the event’s sponsors. There were healthy dinner options prepared by “imPerfect Fresh Eats,” and for dessert, popsicles were provided by “Happy Pops.”

After the break, everyone reconvened for the second and final half of the event, which was a panel discussion moderated by Dr. Denis Collier. The audience had a chance to ask their thought-provoking questions, resulting in a great opportunity for discussion. The speakers wrapped up the discussion segment by succinctly summarizing the main

Elton (second person from left), Dr. Davison (first person from left), and moderated by Dr. Collier (behind the podium).

takeaways, with Dr. El-Sohemy driving home the point that “eat according to your genes.” As a closing remark, the IMS director, Dr. Mingyao Liu, gave a short speech on the IMS mission and the importance of knowledge translation to a broader audience.

With a sold-out venue of over 200 people attending in person and even more people joining the online live stream, this year’s event was a great success, and it achieved great attention from both UofT students and the public. The event would not have been possible without the effort of many UofT Talks team members led by Muzaffar Bhatti and Shaghayegh Foroozan. One of the highlights of the event was having an informative discussion on recent scientific trends, and as Muzaffar puts it, “the bridging of academia and the layperson was a significant achievement that we are proud of.” Hopefully, UofT Talks will be back next year with an even more entertaining event!

The UofT Talks team, Dr. Mingyao Liu (first person standing from the right), the moderator, and the four speakers..

Panel Discussion with Dr. Elsohemy (first person from right), Dr. Selvaganapathy (second person from right), Dr.

IMS Events: 2023 Healthcare Innovation Challenge IMS Events: 2023 Healthcare Innovation Challenge

By Eileen (Xiao Yu) Liu

Since the beginning of 2023, technological innovation has witnessed an unprecedented global dissemination, reshaping industries and everyday life through groundbreaking advancements in AI, blockchain, renewable energy, and decentralized technology. This year, the Healthcare Innovation Challenge focused on improving healthcare infrastructure through AI-based solutions. University of Toronto graduate teams submitted 1-page proposals and presented 5-minute live pitches to expert judges. The challenge provides a competitive learning environment, encouraging students to solve real-world healthcare problems. This year, 5 teams presented solutions, with the top 3 teams winning cash prizes of over $1,000.

This year’s competition featured four esteemed panelists and judges from the University of Toronto including Dr. Pascal Tyrrell, Dr. Beverley Essuel, Dr. Muhammad Mamdani, and Dr. Laura C. Rosella. The day started with the panel discussion highlighting key considerations for implementing AI in healthcare. The focus was on the private sector’s successful use of AI in various aspects and the importance of identifying specific needs, seeking precedents, and choosing the right partners when deploying AI solutions. The challenges of coordinating hospitals and finding end users for appropriate AI solutions were also discussed, along with the need for champions to drive change in the risk-averse healthcare system.

The first team to present was Team 13 and they aimed to address a common challenge faced by patients – comprehending the medical jargon used by their healthcare professionals, which can impact the overall patient experience. To tackle this issue, the team used AI to improve health literacy and elevate patient experience. MEDUCATE, their innovative mobile app, interprets and explains a patient’s health status using voice and text inputs. Users can ask questions conversationally, utilizing data from the patient’s chart. This tool empowers patients by improving health literacy, autonomy, and selfdetermination in their healthcare journey.

Apart from addressing the challenges faced by patients, Team 26 focused on physician burnout due to heavy administrative workload, proposing PHYSCRIBE. This technology uses voice recognition to convert voice data into structured text and NLP to interpret and comprehend the text. PHYSCRIBE aims to reduce administrative burden and improve physician-patient interaction.

Team 2 explored potential solutions targeting the nursing crisis. Their innovation is called Nurse ROSTER, which stands for Recruitment Optimization Support Through Efficient Real-time prediction. The roster uses an AI predictive model with nurse staffing data and population health data to output the number of future nurses needed to achieve optimal patient care. This enables the system to proactively address a need before it arises.

Team 11 focused on addressing Indigenous health inequality related to chronic obstructive pulmonary disease (COPD), a prevalent cause of chronic disease hospitalization in Canada. Their solution, Project AIR-CO, is an AI-assisted remote monitoring system using smartwatch technology to predict acute exacerbation of COPD (AECOPD) weekly, complemented by a health communication application. This innovation aims to reduce emergency care reliance, enhance the management of COPD, and improve the quality of life for the Indigenous community.

The paramedic service’s timely and lifesaving assistance during emergencies is crucial. However, as the largest municipal land ambulance service in Canada, the Toronto Paramedic Services faces challenges due to inefficient coordination. Team 24, the competition’s winner, proposed an application using an algorithm trained on historical data to estimate patient conditions, urgency, offload time, travel, traffic, and weather. The algorithm provides optimal hospital destination recommendations, ensuring timely care, efficient ambulance resource allocation, and improved hospital preparedness for incoming patients.

The 2023 Healthcare Innovation Challenge was a resounding success, offering graduate students a valuable opportunity to collaborate with diverse teams in solving real-world healthcare challenges. It fostered innovation, improved problem-solving skills, and encouraged the exploration of cuttingedge healthcare solutions.

IMS Events: SURP Research Day 2023

By Kristen Ashworth

ROn August 17, 2023, the Institute of Medical Science Summer Undergraduate Research Program (SURP) celebrated a day of sharing science at its annual SURP Research Day, held at Hart House at the University of Toronto. SURP students had the opportunity to present their research projects in the form of poster presentations to a panel of judges, faculty members, graduate students, and fellow SURP peers. The day began with a keynote speech by surgeon-scientist Dr. Mojgan Hodaie, who gave an intriguing account of her laboratory’s recent progress towards finding a treatment for trigeminal neuralgia pain. The focus of the afternoon revolved around the student poster presentations, during which students shared their work with one another in small groups. Each student had eight minutes to deliver a compelling overview of their summer research project, followed by a twominute question session with the judges. At the end of the day, outstanding participants in each group were recognized with awards for first place and honourable mention.

Foram Naik is a SURP student working under the supervision of Dr. Brian Ballios in the field of vision science. She received an award for her poster presentation, which focused on investigating the disease phenotype of retinal organoids derived from patients with Leber’s Congenital Amaurosis (a type of genetic eye disease). She reflects that this summer, the SURP

program allowed her to grow deeply both academically and interpersonally. “My project at the Ballios Lab challenged me in a field I was unfamiliar with prior to the SURP program and taught me how to be adaptable – for example, when encountering experimental obstacles, or having to refine my hypothesis. In addition, as someone interested in pursuing a career in healthcare, it was valuable to meet so many like-minded individuals at research day, hear about their career trajectories and the amazing research they pursued this summer.” She adds, “The SURP program is an excellent opportunity to explore what really excites you about research, step out of your comfort zone, and work with some remarkable Principal Investigators.”

Cindy Wen was awarded first place in her SURP poster group, presenting her research about the role of culturallyresponsive education for kidney transplant recipients in Canada (PI: Dr. Istvan Mucsi). She reflects that her favourite part about SURP Research Day was being able to learn new science from her fellow peers. She explains, “Over the summer, I have been really immersed with my own lab, so being able to hear about other research –basic research, clinical research, qualitative research – [...] it was really nice to see the large diversity of work that is being presented here for research day.”

At the end of the day, I had a chance to sit down with Dr. Ted Brown, Director of SURP. He discussed with me the valuable

scientific skills, personal development, and networking opportunities that SURP offers for young, flourishing scientists, many of whom are interested in pursuing graduate school. Speaking to the high-calibre nature of the science presented today, he adds that, “The presentations I listened to were so well done. I was very impressed by our students. [...] I truly believe all of them were winners.” With that sentiment, I think he captured the essence of the day perfectly.

Congratulations to all our SURP 2023 students – and looking forward to next year!

Graphic design by Jayne Leggatt

Hart House in the morning of SURP Research Day, set up for a wonderful day of science-sharing.

An Ode to Re-Birth and Recovery: A Book Review of Between Two Kingdoms: A Memoir of a Life Interrupted

By Kateryna Maksyutynska

As a graduate student, I have the opportunity to work on various clinical trials that allow me to interact with diverse patient populations. These experiences encourage me to reflect on the unique nature of each participant’s story. Particularly, working with young adult and adolescent patients has emphasized the transformative power of diagnosis and its impact on the trajectory of one’s life. This motivated me to further understand the patient experience from various perspectives. This is exactly what drew me to Suleika Jaouad’s memoir Between Two Kingdoms: A Memoir of Life Interrupted, which offered me a glimpse into her exceptional story.

Jaouad’s memoir takes readers through her inspiring and unpredictable journey transitioning from diagnosis to remission while battling acute myeloid leukemia. It captures the intricacies of guilt, uncertainty, and self-discovery through Jaouad’s retelling of her experiences. The narrative incorporates recurring contrasting themes and highlights the fine line separating love and loss, sickness and health, and denial and acceptance, as Jaouad teeters between these “kingdoms” throughout her life. Having the opportunity to read this memoir at the same age as the beginning of Jaouad’s story helped me to understand her mindset during this time; appreciating the hope she felt for the future as a young adult, but riddled with uncertainty amplified by her diagnosis. This lends to the power of this memoir, such that Jaouad’s vulnerability

invites readers to reflect on the physical and mental resilience of humans, supported by modern medicine, that defies the odds.

A remarkable and moving element of this memoir was the message that recovery is not always synonymous with restoration; returning “back to normal” does not equate to living the same life as before. Instead, recovery involves appreciating and accepting the changes and learning to adapt to them. Jaouad openly grapples with this notion throughout her journey, and best summarizes it in the following quote:

“Recovery isn’t a gentle self-care spree that restores you to a preillness state. Though the word may suggest otherwise, recovery is not about salvaging the old at all. It’s

about accepting that you must forsake a familiar self forever, in favor of one that is being newly born. It is an act of brute, terrifying discovery.”

A key factor that contributes to this re-birth is the relationships that are either newly developed or strengthened throughout the process of recovery. In this memoir, Jaouad

sought solace in her connections with others to escape her reality, while also seeking comfort in the unspoken understanding she shared with those who reflected her own journey. The power of social supports is of note, as they have been associated with better general health and quality of life in cancer patients, emphasizing the importance of their role during recovery.1 This is evident through the family and friends that were introduced to readers in the memoir.

Overall, this inspiring memoir is an ode to the non-linear path to recovery, often leaving “life interrupted.” It candidly touches on themes to which all readers can relate by masterfully outlining the darkest, but also highlighting the most beautiful elements of life. To those hoping to appreciate the meaning of resilience, vulnerability, and growth, this book is for you. Just remember to grab some tissues as Jaouad’s memoir will have you shedding tears of both joy and sorrow.

It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.”

References

1. Payne N, Palmer Kelly E, Pawlik TM. Assessing structure and characteristics of social networks among cancer survivors: impact on general health. Supportive Care in Cancer. 2019 Aug;27(8):3045–51.

Insights into Diagnosis Delay and Endometriosis Education

By Vaidhehi (Veena) Sanmugananthan

Imagine having pain for years of your life, but being told that there was nothing wrong with you. How would you feel if it took you years before you were finally diagnosed with an underlying condition that you’ve never heard of or know little about? Even after being diagnosed, you felt pressure and discomfort talking about your experience of pain to the people around you because of the fear of being perceived poorly. Unfortunately, this is the reality of many people diagnosed with endometriosis.

What is endometriosis? Endometriosis is a condition that can affect anyone with a uterus.1 The endometrium, which is the lining of the uterus, is made up of endometrial tissue. During each menstrual cycle, a new endometrium is grown in preparation for a fertilized egg. Endometriosis occurs when this tissue implants outside of the uterus, which can eventually lead to scar tissue formation and inflammation in the pelvic region and other parts of the body.2 This can cause severe pain in the pelvic region, particularly during menstruation, sexual intercourse and/or when using the washroom. As well, people with endometriosis can have difficulty getting pregnant.3 According to the World Health Organization (WHO), endometriosis affects approximately 10% of individuals with a uterus that reach reproductive age.3 This condition can start at the first point of menstruation and continue into menopause.4

How are individuals typically diagnosed with endometriosis? In episode #117 of Raw Talk Podcast, Dr. Jaime Kroft, an obstetriciangynaecologist at Sunnybrook Health Sciences

Center and an Assistant Professor at the University of Toronto, stated “...the traditional way of diagnosing endometriosis was always surgically and where a surgeon had to perform what’s called a laparoscopy”. During a laparoscopy, a small incision is made close to a patient’s belly button and the abdomen is filled with gas for a better view of the internal organs.5 A laparoscope (a thin tube with a video camera) is inserted in order to look for scarring that may exist in the uterus, ovaries, fallopian tubes, bladder, and/or other organs.5

Amanda Weston, a Research Administrator at the University Health Network and guest on episode #117, shared her diagnosis journey of endometriosis with us. “I didn’t receive that diagnosis until after I’d had the surgery to remove the fibroid. It obviously affects everyone differently. But at the same time, it was also kind of validating to hear. I’ve had some friends who have taken years to get a diagnosis of endometriosis. So at the same time, I also felt kind of lucky that I was able to get this surgery, they found it because I’m pretty sure that’s the only way you can actually determine that you have it is to get a biopsy or some form of invasive procedure to get the tissue and see that it is endometriosis”. Amanda’s and every other patient’s journey to diagnosis is variable and can be inconsistent. To receive a diagnosis can take years of long struggle for many individuals. As Amanda highlighted, a diagnosis alone can have a validating and lasting impact.

According to Dr. Kroft, in Europe and Canada there has been an increase in diagnosing endometriosis in clinics rather than through

surgery, to expedite the process of diagnosis and to avoid having to operate on every person that shows symptoms of the condition. Despite these changes, there are still notable challenges in diagnosing patients in a timely manner. One study sought to conduct one of the first comprehensive cross-sectional surveys to determine the prevalence and symptomatic burden of endometriosis among the general population of women in Canada.6 In total, 30,000 Canadian women responded to the survey from December 2018 to January 2019. In this survey, they reported an average diagnostic delay of 5 years from the time of symptom onset.6 They also mention that other studies found diagnostic delays of 6.8 years6,7 and 10 years.6,8

The diagnosis delay is thought to be a result of different factors and is only one part of the bigger story of the struggle of endometriosis. Many patients report that they are often dismissed by their practitioners when they first address their symptoms. Amanda shared with us that she often felt “brushed off” by a lot of practitioners with her symptoms of pain during sexual intercourse. “It was like, oh, well, you know, you’re not dying…so there’s nothing we can really do beyond that”. “The sort of lack of support for me…that issue was glaring”

One factor that may lead to this dismissiveness and delay in diagnosis is the lack of normalization of menstrual pain.9,10 There may be stigma surrounding people speaking up about menstrual pain that puts these individuals in violation of menstrual etiquette.9,10 According to Dr. Kroft, “a lot of

patients are brought up in an environment where friends or family tell them that that’s just normal, and it’s minimized. And so they don’t recognize that it’s an issue because of the societal impact surrounding acceptance of painful periods.” Many people are unaware of what is considered “normal” and “abnormal” menstrual pain.9,10 As well, there are different types of menstrual pains that exist. Primary dysmenorrhea is menstrual pain that people normally experience when having their period. Secondary dysmenorrhea is menstrual pain that is caused by another underlying problem, such as endometriosis. This type of pain can be severe and can impact quality of life.11 Identifying the difference between these two types of menstrual pain could help people identify that their painful experiences may have an underlying cause, such as endometriosis. As such, further education in understanding these aspects of menstrual pain could assist with the diagnosis of this condition.

What efforts are being made to help expand the general knowledge of menstrual health and pain? Menstrual health education and literacy are key to help people understand what is and isn’t normal when experiencing menstrual pain. There has been a push towards improving menstrual education in youth. For example, The Centre for Pelvic Pain & Endometriosis at BC Women’s Hospital + Health Centre conducted Canada’s first high school-based endometriosis lessons, as part of a research study to improve menstrual and endometriosis education in youth.12 Opening up the conversation surrounding “period talk” could lead people to feel more comfortable

speaking about their menstrual pain earlier in life and subsequently aid in early identification of abnormal pain. Additionally, there are many research networks and non-profit organization that are working towards improving endometriosis awareness and public education (e.g., The Endo Organization of Canada, The Endometriosis Foundation of America, The Endometriosis Network of Canada, EndoMarch). All of these initiatives play a vital role in bringing endometriosis to the forefront of public and healthcare awareness, and hopefully improve significant delays in diagnosis.

There are clearly gaps surrounding the care and understanding of menstrual pain and endometriosis from a patient, healthcare, and societal perspective. In this episode, both Amanda and Dr. Kroft highlighted the importance of speaking out about pain, advocating for yourself, and seeking community with others who have similar experiences. There needs to be a push towards normalizing the discussion about menstrual pain and increasing efforts to promote menstrual health literacy and education in various communities.

We would like to acknowledge the efforts and ideas of the rest of the episode #117 team: This episode was hosted by Madi, and Hannah. Noor, Hannah, Madi, and Mayowa conducted the interviews. Atefeh, Veena, and Raina developed content. Raina and Tima were our audio engineers, Anam helped with promotions, and Noor and Atefeh were our executive producers

To learn more about this topic, please check out episode #117 of RawTalk Podcast: Endometriosis: Common Disease, Uncommon Diagnosis.

References

1. Endometriosis [Internet]. [cited 2023 Sept 21]. Available from: https:// www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis

2. Lee HJ, Park YM, Jee BC, Kim YB, Suh CS. Various anatomic locations of surgically proven endometriosis: A single-center experience. Obstetrics & Gynecology Science. 2015;58(1):53. doi:10.5468/ogs.2015.58.1.53

3. Endometriosis [Internet]. World Health Organization; [cited 2023 Sept 21]. Available from: https://www.who.int/news-room/fact-sheets/detail/ endometriosis#:~:text=Key%20facts,age%20women%20and%20girls%20 globally.

4. Secosan C, Balulescu L, Brasoveanu S, Balint O, Pirtea P, Dorin G, et al. Endometriosis in menopause—renewed attention on a controversial disease. Diagnostics. 2020;10(3):134. doi:10.3390/diagnostics10030134

5. Laparoscopic surgery for endometriosis: Procedure, risks, recovery [Internet]. WebMD; [cited 2023 Sept 21]. Available from: https://www. webmd.com/women/endometriosis/laparoscopic-surgery

6. Singh S, Soliman AM, Rahal Y, Robert C, Defoy I, Nisbet P, et al. Prevalence, symptomatic burden, and diagnosis of endometriosis in Canada: Cross-sectional survey of 30 000 women. Journal of Obstetrics and Gynaecology Canada. 2020;42(7):829–38. doi:10.1016/j.jogc.2019.10.038

7. Bernuit D, Ebert AD, Halis G, Strothmann A, Gerlinger C, Geppert K, et al. Female perspectives on endometriosis: Findings from the uterine bleeding and pain women’s research study. Journal of Endometriosis. 2011;3(2):73–85. doi:10.5301/je.2011.8525

8. Levy AR, Osenenko KM, Lozano-Ortega G, Sambrook R, Jeddi M, Bélisle S, et al. Economic burden of surgically confirmed endometriosis in Canada. Journal of Obstetrics and Gynaecology Canada. 2011;33(8):830–7. doi:10.1016/s1701-2163(16)34986-6

9. Seear K. The etiquette of endometriosis: Stigmatisation, menstrual concealment and the diagnostic delay. Social Science & Medicine. 2009;69(8):1220–7. doi:10.1016/j.socscimed.2009.07.023

10. Sims OT, Gupta J, Missmer SA, Aninye IO. Stigma and Endometriosis: A Brief Overview and Recommendations to Improve Psychosocial Well-Being and Diagnostic Delay. International journal of environmental research and public health. 2021;18(15):8210–.

11. Dysmenorrhea and endometriosis in the adolescent [Internet]. [cited 2023 Sept 21]. Available from: https://www.acog.org/clinical/ clinical-guidance/committee-opinion/articles/2018/12/dysmenorrhea-and-endometriosis-in-the-adolescent#:~:text=Secondary%20 dysmenorrhea%20refers%20to%20painful,of%20secondary%20dysmenorrhea%20in%20adolescents

12. Canada’s first school-based lessons on endometriosis [Internet]. [cited 2023 Sept 21]. Available from: http://www.bcwomens.ca/about/news-stories/stories/lessons-endometriosis#:~:text=This%20month%2C%20 the%20Centre%20for,high%20school%2Dbased%20endometriosis%20 lessons.&text=%E2%80%8BThe%20lessons%20are%20part,menstrual%20health%20among%20young%20Canadians

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