4
7 10
13
3
9
22
17
27
19
25
23
28 29
advancing in all the priority areas of our strategic plan. An update in the area of diversity: our Equity and Professionalism Office has joined a cross-campus network to make the University of Calgary one of the most diverse, welcoming campuses in Canada. As we ushered in our newest MD class, the Dholes, this summer, we also bid farewell to one of our muchloved staff members, Adele Meyers, as she moved into a well-deserved retirement. Adele worked at our medical school for 40 years and has played a significant role in the lives of thousands of medical students. Adele will be greatly missed, but we wish her nothing but the best in this next phase of her life. We are pleased to share more of Adele’s story with you on page 13.
nother academic year is now in full swing and, in addition to welcoming you to a new edition of UCalgary Medicine, I’d like to take this time to share some wonderful news. I’m very proud to let you know that the Cumming School of Medicine has successfully been accredited for another eight years. Since our first medical students arrived in 1970, we have been able to continually maintain our accredited status, which is a tremendous feat that should make us all proud. To the hundreds of faculty, staff and students who contributed to the accreditation planning and preparation, thank you. Your efforts are greatly appreciated. In addition to this great news, I’d like to share that I have been reappointed as dean for a six-year term. I am very pleased to continue in my role as we work towards becoming a national and global leader in precision medicine and precision public health,
Among the many bright and talented students we welcomed this year are our first cohort of the Pathways to Medicine students. The Pathways scholarship was initiated to support the enrolment and success of future MD students from traditionally under-represented groups throughout Alberta. This year, we are pleased to have offered scholarships to five young, promising students. They have chosen to begin their undergraduate studies in a number of faculties and we are looking forward to when they will join us to complete their MDs. While this past summer has been an exciting time for the medical school, our achievements extend beyond the constraints of a season. Our researchers and students are diligently hard at work every day to ensure we remain leaders in health. In this issue of UCalgary Medicine, we have compiled a selection of some of our most compelling stories that illustrate how our bright and talented people are utilizing and/ or creating technologies to impact our health and health-care delivery. The advancements being made are truly remarkable and I do hope that you enjoy reading these stories as much as I have. Jon Meddings, MD Dean, Cumming School of Medicine
The Mobility and Joint Health centre (MoJo) was established with support by a $4.7-million grant from the Canada Foundation for Innovation (CFI), a $4.7-million grant from the Province of Alberta, industry partners and private donors.
Bone and joint disorders are one of the most common chronic conditions affecting Canadians and are the leading cause of disability worldwide. Evidence suggests that early diagnosis and intervention can positively influence the long-term outcome of these chronic diseases.
A number of faculties are contributing to this multidisciplinary project include the Cumming School of Medicine, Schulich School of Engineering and the faculties of kinesiology and veterinary medicine.
opulations are increasing and health-care budgets are tight. With an unlimited need for health-care services, difficult decisions need to be made regarding how best to meet those needs. HTA units help to inform those decisions. “We’re a policy-responsive unit,” says Fiona Clement, PhD (PhD’06), HTA director and associate professor in the
Department of Community Health Sciences. “Our day-to-day work is evidence synthesis of all kinds in response to policymakers’ needs.” The HTA Unit is a team comprised of a diverse group of experts ranging from health services researchers and policy analysts to patient-engagement experts. In response to direct requests
from policy-makers, they gather evidence to answer questions such as: Can this program or treatment result in a positive health impact? What is the value for money and the total financial impact for the province? What is the patient experience? The team analyzes the clinical evidence, cost evidence and patient experience evidence. They then provide policy options and analyze the pros and cons of each option. To date, the team has been asked to provide evidence synthesis on a wide array of projects including the development of a province-wide hepatitis C screening program, the effectiveness of genetic testing to determine treatment response in specific types of breast cancer and issues surrounding the legalization of marijuana. And that’s the short list of ongoing projects. “Every time we get a new project, we engage a new group of stakeholders that can support disease evidence and can provide information about treatment,” says Eldon Spackman, PhD, HTA co-director and assistant professor in the Department of Community Health Sciences.
Clement adds one of the markers of a good HTA Unit is openness and being welcoming to capitalize on the diverse perspectives we have in our world. “Every person on the team enriches the analysis because they think about things differently,” she says. The HTA Unit has been involved in collaborations with other HTA units in Alberta and elsewhere in Canada, and is building a strong collaborative network with the United Kingdom. As both Clement and Spackman have a desire to improve health care and healthcare delivery across all spectrums, they are not only committed to their work, but to the well-being of our population as a whole. “We get a broad understanding of different patients experiencing different difficulties and are able to have a very broad impact,” says Spackman. Adds Clement: “It’s about using the best evidence available and the best analytic methods available to try to make sure we’re doing things the best way we can. Fiona Clement, PhD, and Eldon Spackman, PhD, are both members of the O’Brien Institute for Public Health.
ntibiotics are part of life-saving treatments for many infectious diseases. However, with the overuse and misuse of these important medications, also termed antimicrobials, resistance is on the rise worldwide. Antimicrobial stewardship is the practice of minimizing antibiotic resistance by moderating and limiting antimicrobial use. During their residencies, Drs. Elizabeth Parfitt (Infectious Disease'14) and Paul Campsall (Critical Care Medicine'14) conceptualized the Spectrum MD app. Designed with the busy physician in mind, the app is a point-of-care tool that aids in the selection of appropriate microbial therapy for various diseases.
It’s not uncommon that physicians have limited antimicrobial pharmacology knowledge. Since the microbiology of each medical facility varies, it is suggested that each facility carry its own antimicrobial guidelines. But, while prescribing guidelines and information is available online, many physicians may not have time to navigate the vast amount of information. “The idea was to replace multiple resources with a single resource in a handheld device to save time and to hopefully
get more clinicians using this information that is important for antimicrobial stewardship,” says Campsall.
Overuse of antimicrobials can lead not only to drug resistance, but other health issues such as drug toxicity, or complications such as C. difficile colitis. Prolonged hospital stays, secondary infections and the treatment of other various adverse side effects of antimicrobials also result in increased costs to the health-care system. Parfitt says that while antimicrobial stewardship probably sounds quite boring, she and Campsall hope the app makes it more accessible, interesting and more mainstream.
Parfitt and Campsall collaborated with a soft ware-development group as well as a multidisciplinary team from the University of Calgary. The final product, which took nearly two years from conception to implementation, allows health-care professionals to enter select patient factors directly into the app and receive treatment recommendations specific to that patient. Furthermore, because guidelines and microbial resistance patterns differ among cities and provinces, the app is customizable to incorporate local sensitivity patterns. Currently, customizable microbial profiles are available for hospitals throughout Calgary and the Providence Health Care group of hospitals in Vancouver. The team is also working on a children’s hospital version that will be launched later this year. “We essentially imagined the tool we as physicians wanted to use, and created it,” says Parfitt.
As for future goals, there are many. The doctors not only hope to increase the number of medical centres that use the app, they hope to one day expand its capacity so it becomes a useful tool for outpatient care, in addition to the inpatient population it currently targets.
The free app is currently only available for iPhones through the AppStore. Implementation of Spectrum MD in Calgary was recently recognized with a LEADing practice award from Canada Health Infoway and Accreditation Canada.
UCALGARY MEDICINE | Fall 2016
10
Dr. Irene Ma (left) guides Julie Babione, Senior Research Associate at W21C, through the CVC procedure.
A view through the special glasses. r. Irene Ma (PhD’15) has a different vision for AR outside of gaming. She wants to take this technology into the medical school and residency training program, to train the next generation of physicians how to insert a central venous line correctly and safely. “We know that simulationbased education improves outcomes in central venous catheterization (CVC),” says Ma, associate professor in the Division of General Internal Medicine at the Cumming School of Medicine (CSM) and faculty member in the university’s Ward of the 21st Century (W21C), O’Brien Institute
for Public Health. “As educators, studies have found that we unintentionally miss teaching 50 to 70 per cent of elements to learners by accidently skipping steps and omitting explanations.” Inserting a central venous line is a complicated and time-consuming procedure that can take four hours or more to teach. In the United States alone, physicians insert more than 5 million central lines every year to allow medication delivery, nutritional support and the measurement of blood flow within the body’s organs and tissues. They are necessary to care delivery, but there are numerous risks to patients if this procedure is performed incorrectly. The procedure involves inserting a catheter into a patient’s internal jugular
The CVC procedure. vein, which requires physicians to simultaneously operate a needle and an ultrasound machine. Ma and the W21C have been working with Edmonton-based company Scope AR to build the medical education content for the CVC procedure into an augmented reality application. After donning a pair of special glasses that contain an outward-facing camera, learners can see their real-world surroundings overlaid with instructional content and images. They then go step-by-step through the procedure with a task-trainer mannequin. Perceived benefits of the finalized augmented reality application will be the ability to deliver a standardized curriculum and user-based “education on demand.”
The CVC procedure as seen through the special glasses. “Rather than any one individual holding up a small group of learners to master a certain step, each learner may go at his or her own pace to practice and develop the skill,” says Ma. W21C researchers are currently working with Scope AR on evaluating the different iterations of the CVC application through a variety of methods. After the application is finalized, next steps are to bring this technology into the Cumming School of Medicine’s Post Graduate Medical Education Program and evaluate its effectiveness with real medical learners. If there is supporting evidence that augmented reality can effectively teach a complicated procedure such as CVC, this technology could then be used to teach
learners a wide array of bedside procedures and aid in reducing faculty teaching demands. “The field of augmented reality is new territory for me,” says Ma. “To work with the W21C team and Scope AR in translating the educational content into this application is very exciting.”
dele Meyers was Dr. Lanette Prediger’s lampbearer. As a second-year medical student in the class of 2005 at the Cumming School of Medicine (CSM), Prediger was only in her early 20s when she was diagnosed with cancer. “I think of Adele often, and so does my husband because we got engaged between the chemotherapy and the radiation, and she was around for all of that,” she says. “It was a really dark time in my life, and therefore a really dark time in his life. She was like our lamp-bearer — the person who holds the light and goes through the dark tunnel with you.” When Meyers retired this past summer as CSM’s co-ordinator of admissions and student affairs after 40 years at the medical school, the faculty established the Adele Meyers Award in her honour. It will be given to second- or third-year medical students who exemplify the qualities of kindness, compassion and enthusiasm toward their fellow classmates. For Prediger, Meyers was the first person she turned to when she found out she had Hodgkin’s lymphoma. Faced with the prospect of balancing cancer
treatments with her demanding studies as a medical student, she didn’t know how she could continue. “I was in medical school and this was the dream of my life,” says Prediger. “I had worked so hard for this for so many years and I was like: ‘Is this the end? Am I going to have to drop out?’ All my family was in Camrose or Edmonton and my boyfriend, who is now my husband, was in Montreal. I just knew that Adele was the person who could help me get through this.” The cancer treatments caused Prediger to lose her nearly waist-length hair. Meyers decided to shave her own hair for a cancer fundraiser. “We talked together a lot,” says Meyers. “One of the things I said was: ‘I know you’ve got a relationship with your hair, so when it goes, mine is going to go. I just want you to know that I’m with you.’” Prediger not only recovered from cancer, she graduated with her class. “Adele helped me so much through the diagnosis, the surgery and then the chemotherapy and everything. I felt so supported and loved, and just taken care of, that it became totally manageable,” she says. Currently a physician at South Calgary Urgent Care, Prediger is also competing for a place on the Canadian skeleton team at the 2018 Winter Olympics. “She’s a little powerhouse, that one,” says Meyers, who was honoured with the Order of the University of Calgary in 2004. The award recognizes people who have a record of exemplary and distinguished service to the university.
or Dr. Benjamin Goldstein (MD’01), Meyers was “the human side” of the Cumming School. “You bump into random Calgary grads and one of the first things they’ll mention is Adele Meyers,” says Goldstein, who is now an associate professor of psychiatry and pharmacology at the University of Toronto, as well as director of the Centre for Youth Bipolar Disorder at Sunnybrook Health Sciences Centre. As someone who grew up on a farm near Drumheller, Alta., Meyers doesn’t see being kind or compassionate as anything exceptional. “We should all be like that all the time to each other, anyway, in life, but I think medical school is exceedingly stressful,” she says. “It’s really important that the students know they are not alone and that somebody cares about them.” Meyers kept her office stocked with gummy bear candies. “I told students they could come in, that no matter what, we will help them,” she says. Graduates know she still cares about them, says Dr. Bruce Wright (MD’87), who is currently the head of the division of medical sciences at the University of Victoria and executive medical director of academic integration at the Island Health Authority. He worked with Meyers as director of student affairs at the Cumming School from 1997 to 2003.
“A lot of people, when they are in a job for more than five or 10 years, they might lose that passion and that underlying emotive reason for why they are involved with the medical school, but not Adele,” says Wright. “I would even say that, over time, it strengthened.” Meyers enjoyed laughing with students, adds Dr. James Kennedy (MD’84). As someone who had played in rock bands, he found himself facing an unusual question during his interview to get into medical school. Someone asked if he had ever smoked marijuana. “I said something along the lines of what (former U.S. President) Bill Clinton said 15 years later, that I had tried it, it made me kind of ill and I didn’t pursue it any further,” says Kennedy. “Adele got a big laugh out of that. She explained they will ask you a totally unexpected, sharp, intrusive question just to see how you will react, so she helped me make sense of it all.” After he was accepted into medical school, Kennedy was in a cover band called Young Doctors In Love. “Adele knew all the band members because they were all medical students,” says Kennedy, who is now a fellow of the Royal Society of Canada and head of the brain and therapeutics division of the department of psychiatry at the University of Toronto. “I remember her dancing down below the stage to our music, so that was great.” Before the Cumming School switched to emailing acceptance notifications, Meyers also enjoyed being the person who telephoned applicants to give them the good news they’d been accepted as medical students. “I did it on Mother’s Day quite regularly,” she says. “I can remember someone who is now a really great friend of mine. I was able to let him know he’d been accepted and his mom just went bananas with happiness on the other end of the phone.
“It was a lot of fun to do that. There are lots and lots of students that I still have a very close and warm relationship with.”
The number of students Meyers helped over the years totals more than 4,300, which is nearly the population of the town of Didsbury, north of Calgary.
Goldstein keeps in regular touch with Meyers by email. “I remember seeing the look on her face for each student who was walking across the stage to pick up their diploma from her, and seeing such a genuine investment of one person in so many people — it was just that recollection of seeing her beaming,” he says.
“Forty years is a nice round number and I thought, ‘Good grief, if I get to 41 years, I might decide I should go for 50 or something,’” Meyers says of her retirement. “I loved working there, but they say when you know it’s time to retire, you know it, and that was my experience.” For more information on Adele’s award, or to donate, visit: netcommunity.ucalgary.ca/adelemeyers.
he usability of technology offers new solutions to integrate daily medicine and interact with the community. Members of the Cumming School of Medicine are working in collaboration with other faculties at the University of Calgary, along with app developers and community members to develop new and innovative solutions to everyday problems. The use of smartphone technology in the medical community can improve the outcome of illnesses and day-to-day treatments, as well as assist people living in developing countries. The following are some examples of the apps developed by the Cumming School of Medicine’s researchers, students and alumni.
Dr. Bin Hu and his team at the University of Calgary have developed the Ambulosono (or Walking-Song) app as a part of a larger program to help Parkinson’s disease patients in overcoming their walking disabilities. For many people living with Parkinson’s, the disease can not only dramatically affect their gait — the way they walk — but deter them from participating in social activity and physical exercise. Hu’s research discovered that brain circuits for music perceptions can help initiate and control a movement response if the sound cues can be modified to activate brain systems for motivation and rewardbased learning.
To use the app, patients strap the motion sensors in a music player to their arm or leg and use the device to produce signals with their body movements that can turn music on or off. Patients can use music to reward and motivate their own movements by walking continuously with a step length above a certain threshold. Freezing and shuffling steps stop the music from playing. After each walk, the app automatically sends the data to co-ordinators who can remotely customize program settings to ensure patients can walk safely with optimal outcomes. An ongoing multi-centre trial found Ambulosono training substantially reduced motor and psychological barriers affecting step size, walking speed, freezing and fear of falling. The program has been implemented in 12 Canadian and international sites and is being tested for use with patients with other neurological diseases such as stroke, autism and cerebral palsy. Dr. Bin Hu is a professor in the Department of Clinical Neurosciences and a member of the Hotchkiss Brain Institute.
Dr. Aravind Ganesh (MD'12) worked with fellow University of Calgary Alumni, Dr. Rahul Mehta (Internal Medicine'15), Dr. Mike Braganza (Internal Medicine'15) and Dr. Darrel Cotton (MD'12) are developing tools to improve patient care by providing physicians with access to current research-based treatments. SnapDX Clinical helps record and synthesize patient data, thereby aiding in optimizing and standardizing care. While similar tools are currently used to record patient information, this app gives recommendations based on this information and provides physicians with solutions based on more than 130 clinical studies and statistical analysis. Research is quickly and continually evolving, making it challenging for physicians to keep up with advancing industry standards. The free app contains information on more than 50 key diseases spanning diverse areas of medicine. SnapDX Clinical was vetted by more than 100 clinical beta testers to ensure all information is reliable and up to date. Medical professionals using this tool can rely on it for the most current information when treating patients, which has proven to be more reliable than their memory. SnapDX Clinical was the winner of the 2014 Innovation Academy Award from the University of Calgary’s Ward of the 21st Century.
Time2Doc aims to improve the communication of wait times for walk-in clinics in south Calgary. Developed in partnership with the South Calgary Primary Care Network (PCN), Time2Doc is a free mobile app that increases patient access to primary care and improves patient engagement. The app displays a map and list of current wait times for walk-in clinics, urgentcare centres and hospitals. It features turn-by-turn directions, hours, upcoming holidays and calling features. Additionally, Time2Doc includes a directory of specialized treatment options with clinics for self-referral and provides timely public health notices such as flu shot reminders. The smartphone application allows people seeking care to make informed decisions about their health-care needs based on up-to-date information provided by each medical centre. The app’s founders, Jaron Easterbrook (MD’16) and Amrit Sehdev (MD’15), hope to see the app expand to include appointment cancellations so the clinics can see more patients.
Cumming School of Medicine medical student Bruce Gao is working in collaboration with the Schulich School of Engineering to create a free smartphone app that helps optimize solar panel efficiency by up to 40 per cent. While Gao was volunteering at an orphanage in Rongshui, China, he noticed that the children were shivering and the orphanage was struggling to produce warm water. When he recognized the source of this issue, Gao traveled to the nearest WiFi hotspot to research solar panel-optimization methods. Upon returning to the orphanage and realigning the panels, the living spaces’ heat improved drastically and the water was warm again. Once back in Calgary, Gao quickly partnered with co-founder Matt Privman to bring this knowledge to users without a WiFi connection. Simply Solar takes location and time of day into account and uses smartphone sensors to help angle the panels. This allows users with solar panels to enhance the collection of solar rays. A notification system provides patrons with the ability to adjust the panels throughout the day, improving the quality of life in developing countries that rely on solar energy.
more or less just wanted to get an understanding of what you can do with a 3D printer and see how I could benefit from it in my day-to-day life as a clinician,” says Chee, clinical assistant professor at the Cumming School of Medicine’s Department of Medicine and member of the Snyder Institute for Chronic Diseases. “The concept of being able to print anything you design was fascinating.” Chee and his colleagues purchased two printers, both which are now housed in the Snyder Institute Live Cell Imaging Facility (LCI). They started simple and first used the printer to make lab equipment. Many lab accessories such as microscope stage adapters and mounting hardware were 3D-printed at a much cheaper price than if they had to be purchased. On occasion, some adapters were designed from scratch and printed because they didn’t previously exist. Chee realized the value this type of tool offered in the evolving worlds of health care and research.
“A 3D printer is basically a glorified glue gun,” Chee says. “A glorified glue gun that has transformed the way we teach and the way we learn.” A computed tomography or CT scan, combines a series of X-ray images (a two dimensional picture) taken from different angles. It uses computer processing to create cross-sectional images, or slices, of the bones, blood vessels and soft tissues inside of the body. These exact slices from the CT scan can then be plugged into a computer, transferred to a printer and reconstructed in 3D using the printer. Chee recalls a young cancer patient who had narrowing of her airways. He put in a stent to open up her trachea and, before she left the hospital, he 3D-printed a model of what her trachea looked like at that exact moment. She was fascinated. As she continued therapy, she kept getting new scans.
Dr. Lorraine Chow (left), talks with Dr. Chee.
“Every time she got a new scan, I would take the scan to the printer and make a 3D model of it. This way, she could actually see the evolution of her own airway,” he says. The patient had the models at her house and, when people would visit her, she found the confidence to explain what she was going through and was also able to physically show how far she had come. “It is so much easier for patients to understand their own disease if they are shown it,” says Chee. “If we tell someone they have a mass in their lung, oftentimes they will have no clue what that is. Since we are now able to print the mass from the scan, patients can actually hold their own mass in their hand and get a better understanding of what they have and what we are trying to do to fix it.” The models can also be used to explain a patient’s condition to their families. From a patient-satisfaction standpoint, 3D printing may become an essential component. Three-dimensional printing has the potential to revolutionize the way individuals prepare for surgeries. If there is a difficult procedure or an interesting case, 3D printing enables the review of a plan with a surgical team and can even support testing a procedure on the bench before going to the bedside. These models are also helpful for medical students and have become a very versatile teaching tool.
“Colleagues are asking me to print complex models of abnormal airways or abnormal vessels so they can physically touch and see what they are dealing with,” Chee says. The ability to translate patient-specific data into an accurate and tangible model can improve the way the medical community is addressing the challenges of the modern health-care system. The holy grail of 3D printing is printing organs and, although there is still a lot of work to be done before that happens, Chee says the next step is simply getting more printers to work with. “We are now in a culture where we have become independent and empowered to make our own things,” he says. “People are more inclined to experiment and that is where the breakthroughs will happen.” When asked where he will go next with 3D printing, the answer was simple. “What I have discovered is that, in this new era, we are only limited by our own imaginations,” Chee says. Dr. Alex Chee’s work has benefitted from his relationships with LCI staff Andrew Chojnacki, PhD, Katarzyna Stevens, PhD, and Joel Glover, as well as Dr. Mark Ungrin and Doug Kondro from the Faculty of Veterinary Medicine. His work has also received continued support from the Snyder Institute’s Live Cell Imaging Facility (LCI).
• Methods Hub researchers are using big data to examine rates, patterns, seasonal effects and appropriateness of antibiotic-prescribing practices in primary care across Canada. • In 2015, the O’Brien Institute was officially designated a World Health Organization (WHO) Collaborating Centre for Classification, Terminology and Standards. As part of this network, Methods Hub researchers are working collaboratively with other institutes like the Mayo Clinic and Stanford University to maintain and revise the WHO’s International Classification of Diseases (ICD) standard. Classification, terminology, standards of diseases and causes of death are critical for collecting meaningful and powerful big data on a global scale, says Quan. hen health researchers are able to leverage this big data, which exists in several forms — electronic medical records (EMRs), administrative health-care data, laboratory data and population censuses — they are better able to improve health, prevent and detect disease at an earlier stage and personalize interventions, says University of Calgary big data guru Hude Quan, PhD (PhD’98). Quan, director of the O’Brien Institute for Public Health’s Methods Hub — a group of researchers with expertise in methodology — has been working with big data for more than two decades and says he is starting to see big changes in the field. “This is a really exciting time — a century of information,” says Quan. “I’m seeing
data become more accessible, with richer information being extracted and more integration with clinical information.” But it’s not the vast quantity of data that we’re seeing that’s exciting, says Quan. Rather, it’s the fact that more and more new approaches to analyzing data and linking datasets across disciplines are coming together to pave the way for revolutionary applications in fields such as public health surveillance, health research and precision medicine. However, Quan says, health-related datasets in the province are currently created and held by diverse entities. “Centralizing this extensive amount of information is key to its usability,” he says.
• Universal health-care produces a wide variety of information that is routinely collected and covers large segments of the population. However, not all of this data is created equal, explains Quan. As such, the Methods Hub is working on a tool to assess the quality of data being harnessed from sources — such as health insurance registries, inpatient hospital care, day surgery, emergency departments and outpatient physician services — to identify the quality data necessary for monitoring how frequently diseases occur, while evaluating the quality of care in health-care settings.
tephanie Coward (MSc’14) is currently a PhD Candidate in Community Health Sciences (Epidemiology) at the University of Calgary. A pop-culture and zombie enthusiast, she applies real-life principles of epidemiology to the fictional scenario of a zombie outbreak. She has presented these applications to audiences of fellow pop-culture and science devotees at Calgary’s Nerd Nite and the Calgary Comic and Entertainment Expo. This is an excerpt from her talk: First, during a zombie outbreak, you need to prepare a case definition; this is a method of differentiating the cases from the non-cases. To do this, one needs to define the characteristics of an individual with the disease, or, more specifically, identify the signs and symptoms. These should be simple to identify, but allow for enough specificity that a zombie can be correctly identified, i.e., differentiated from an individual high on (the recreational designer drug known as) bath salts. There are two separate scenarios that need to be accounted for: the transition period after infection and the resulting “zombification” of an individual. During transition, an individual will have a mortal wound or bite accompanied by fever, flulike symptoms or weakness and fatigue. Once transitioned, the classic zombie has the following characteristics: cannibalistic, blank/empty stare, slow-moving, distracted by motion and sound, impaired cognition, viscous blood, cellular necrosis and no pain response. Neither of these are exhaustive lists, but give an overarching example of some of the possible signs and symptoms.
Mathematical modelling of infectious disease is done with pathogens to model disease outbreak and also to quantify the effects of different interventions and possible scenarios. Research by Munz, et al (2009), has modelled various interventions on a zombie outbreak, from using quarantine to impulsive eradication. It seems that the only intervention that would allow humans to survive a zombie outbreak is to quickly eradicate them. With any other intervention, the model shows that the zombies would still overtake humanity. Even a cure would only allow humans and zombies to co-exist.
Through the “zombocalypse,” the incidence — new cases — and prevalence — total cases — of zombies will rise drastically, at a rate that has never been previously seen in any known disease. They will rise until there are no more susceptible individuals — i.e., humans — at which point the incidence will stop rising, even decrease, and the prevalence will plateau. The prevalence of zombies will never reach the total prevalence of humans as some humans will likely survive and kill zombies in order to survive. Applying incidence and prevalence concepts to zombies pushes them further in their application than any natural disease has previously.
There is a lot of debate around possible causes of a zombie outbreak, from fungus to virus, with each theory having a valid basis in differing scenarios. From an epidemiologic perspective, we are able to gain a greater understanding of the nature of the disease. Application of epidemiologic concepts to zombies is similar as with other diseases, but the disease challenges their application.
hese are just two examples of thousands of scenarios available through cards – a modern take on traditional flash cards for medical students. “Many of the clinical learning opportunities throughout a medical student’s education are a lot like scratch-and-win cards,” says Mike Paget, manager of e-learning for undergraduate medical education at the Cumming School of Medicine, and one of the masterminds behind cards. “Once you’ve seen a test question the first time or a simulation (SIM) scenario once, it’s used up and you can’t go through the process again.” Cards are essentially interactive, digital flashcards that provide students a safe opportunity to practice clinical problem solving. The concept was created after various other digital learning opportunities were unsuccessful, due to low student engagement, high authorship time commitments and/or costs of delivery. Available on mobile digital devices and computers, cards are sorted by clinical presentation, framing a group of illnesses
When students use the technology during class, instructors have access to a digital dashboard displaying card stats: which questions students are navigating successfully and which require further review. While writing clinical problem questions is time consuming, authors of cards need only meet with the e-learning team once or twice. The software takes care of the rest. or treatments, thereby giving students the opportunity to learn in areas such as hepatology, hematology and geriatrics. With the information authored and verified by physicians, cards allow students to practice clinical problem solving through repetition – a cognitive psychology concept that has shown to improve learning and retention. They are designed to represent an exam, SIM or hospital ward learning opportunity but the cards have the added benefit of providing students with immediate feedback. “In a SIM lab or when working out a long, text-based case, students may make a bad decision early but they won’t get feedback on that decision for quite some time,” says Paget. “That may be how it is in real life, but we were interested in creating a more effective type of educational model to teach them.” Student engagement has been high with cards. They have been adapted into the UME curriculum — being mandatory in some classes and optional in others — and student committees have shown interest in having more created. In addition, early studies have shown marked improvement in exam scores related to the topics offered through cards. “Cards is a product that gives students something that reflects both their practice and their exams,” says Paget.
The content is programed in such a way that it’s randomized and thus no two cards are the same. This removes the opportunity for students to memorize specific cards/scenarios.
Cards was launched in 2014; the program is unique to the University of Calgary. The e-learning team hopes they will eventually be available to medical students worldwide.
is an easy-to-use online questionnaire. Its algorithms can predict which individuals are at high risk of experiencing a major depressive episode within four years. The tool can be accessed at predictingdepression.com. Cumming School of Medicine (CSM) researchers investigated the use of email among a group of diabetes care providers and found the use of, and attitudes towards, the technology was divided among different health professionals. The findings suggest the development of guidelines for appropriate clinical use to improve health-provider efficiency and access in diabetes care would be helpful.
istockphoto.com/ca/portfolio/exdez
With an estimated 2.8 per cent of Canadian men experiencing a major depressive disorder each year, a University of Calgary professor wants to find a way to reach these men. “Men are less likely than women to seek help and to disclose depressive symptoms. They will often delay seeking help until symptoms become severe, compounding risks,” says JianLi Wang, PhD (PhD’00), professor in the Department of Psychiatry and member of UCalgary’s Hotchkiss Brain Institute and O’Brien Institute for Public Health Wang and his team conducted a recent survey of Canadian men to determine if they would be likely to use electronic mental health programs (e-mental health programs) — programs accessible via
the Internet. More than 70 per cent of men at high risk of experiencing a major depressive episode said they would be interested in exploring e-mental health programming. The programs are a good option as they are confidential, easily accessible and are often inexpensive. Wang says the next step is to determine the effectiveness of e-mental health programs in preventing major depression in individuals of various demographics. This study was a part of the BroMatters Study, which aims to speak openly about mental health in working men. JianLi Wang, PhD, and his team also created a depression-risk calculator that can be used by men and women. Based on sex-specific predictive algorithms, the tool
Forms of electronic communications are routinely used for clinical purposes in some parts of the world, such as Denmark, where physicians are expected to provide email as an option for their patients. Additionally, various types of electronic communications are proving to be valuable resources in developing countries where health centres are few and the geography is vast. Currently in North America, both the Canadian and American Medical Protective associations have guidelines for safe use of email in clinical practice — focusing mainly on dealing with privacy matters. No guidelines currently exist to outline when and where clinical use of electronic communications are appropriate. The study was conducted by Dr. Doreen Rabi (MSc’06), a member of the Libin Cardiovascular Institute of Alberta and the O’Brien Institute for Public Health and associate professor in the departments of medicine, community health sciences and cardiac sciences.
teaches multiple UME courses, supervises residents and presents at continuing medical education and other education events. She has served on several supervisory committees for graduate students in medical education and is a mentor in both student and faculty mentorship programs.
he Cumming School of Medicine is known for its innovative curriculum as well as its dedicated educators who create a successful learning environment for our future doctors. This year, one such innovator, Dr. Pamela Veale (MD‘93, Paediatrics’98, MSc’00) has been awarded the 2016 Alumna of Distinction Award for Education. This prestigious award will be given at the 2016 University of Calgary’s ARCH Awards Ceremony in recognition of her significant and ongoing contributions to the education of students and the development of programs in the Cumming School of Medicine’s Undergraduate Medical Education (UME) portfolio. Veale is currently an associate professor in the Department of Paediatrics and Assistant Dean of Undergraduate Medical Education. Over the past 15 years she has served as Course Chair, Director of Student Evaluation and Assistant Dean, Undergraduate Medical Education. Her leadership activities extend beyond UME to other levels of education. She has had various roles in post graduate medical education including pastprogram director for the post-graduate program in developmental paediatrics.
Veale’s contributions in leadership and education have been recognized both locally and nationally. In 2012, she was appointed Faculty Fellow for the Cumming School of Medicine. Nationally, she received the designation of Founder, Developmental Paediatrics from the Royal College of Physicians and Surgeons of Canada in 2012.
She played a key leadership role in the recent successful UME accreditation process and was also part of the team responsible for the successful accreditation of the program in 2008. While contributing to many administrative and leadership activities in medical education, Veale also continues to demonstrate a passion for teaching at all levels. She regularly
Veale will be presented with the Alumni of Distinction Award at 2016 University of Calgary ARCH Awards Ceremony. To learn more about the Cumming School of Medicine’s alumni and alumni awards visit: ucalgary.ca/alumni
dults whose chronic diseases put them at risk of pneumonia — but who are too sick to receive a vaccine — may still be protected. A new study authored by the Cumming School of Medicine’s Dr. Jason Cabaj (MSc’14) and Dr. Jim Kellner (MD’84) has found that vaccinating children against the most common bacterial cause of meningitis and pneumonia is also very effective in preventing disease in unvaccinated adults — a phenomenon commonly referred to as the "herd effect." n Alberta-led team of researchers headed by the University of Calgary's Suzanne Tough, PhD (MSc’07), has developed a blood test to identify pregnant women at risk of delivering babies prematurely — before the usual 40 weeks of gestation. The study was recently published in the journal PLOS One. Premature birth remains the main cause of child-related mortality in the developed world. The technique was developed by Preterm Birth and Healthy Outcomes Team (PreHOT) members that also included Jan Heng, PhD, at Harvard Medical School; Stephen Lye, PhD, at the
University of Toronto; and Donna Slater, PhD, at UCalgary. The Alberta researchers looked at women who participated in the All Our Babies study, a community-based pregnancy study in Calgary. Suzanne Tough, PhD, is a professor in the departments of paediatrics and community health sciences, and is a member of the Alberta Children’s Hospital Research Institute. Donna Slater, PhD, is as assistant professor in the Department of Physiology & Pharmacology and is a member of the Alberta Children’s Hospital Research Institute.
The benefit in adults appears to be similar for both healthy adults and those with underlying chronic illnesses. The study was published in Clinical Infectious Diseases. Dr. Jason Cabaj is a clinical assistant professor in the Department of Community Health Sciences and member of the O’Brien Institute for Public Health. Dr. Jim Kellner is head of the Department of Paediatrics and a member of the Alberta Children’s Hospital Research Institute.
nflammation is a necessary process that helps control tissue injury and contain infection. However, inflammation that is not controlled can have serious and lifethreatening consequences. A new study conducted by the University of Calgary's Kris Chadee, PhD, and PhD student Leanne Mortimer (PhD’15) has looked at one arm of the inflammatory process and discovered a molecule that is responsible for shutting off the inflammatory process. The study, recently published in Nature Immunology, gives the scientific community greater insight into the role of the NLRP3 inflammasome (an engine to drive inflammation) in a number of inflammatory processes. It has also identified a key regulatory pathway for a disease-causing NLRP3 mutation in patients affected by an autoinflammatory disorder called cryopyrin-associated periodic syndrome, or CAPS. Kris Chadee, PhD, is a professor in the Department of Microbiology, Immunology and Infectious Diseases and member of the Snyder Institute for Chronic Diseases.
pilepsy is a common chronic neurological condition. Often starting in childhood, it causes seizures and negatively affects an individual’s quality of life. The International League Against Epilepsy is a 110-year-old volunteer organization that works to improve epilepsy research, education and care around the world. The organization’s 114 member countries recently elected the university’s Dr. Samuel Wiebe as their president for the 2017-21 term.
and treatment is typically carried out by traditional healers. With many causes such as brain injuries, infection or injury from birth, approximately 80 per cent of people who suffer from epilepsy live in countries where few, if any treatment options are available. In conjunction with numerous international neurological associations, lay organizations and the World Health Organization, the International League works to improve and establish standards of care worldwide.
The league works with all countries, from industrialized regions where state-ofthe-art technology and highly trained neurologists are prevalent, to resourcepoor areas where technology is lacking
Dr. Samuel Wiebe is a professor in the Department of Clinical Neurosciences and member of the Alberta Children’s Hospital Research Institute, Hotchkiss Brain Institute and O’Brien Institute for Public Health.
isphenol A, better known as BPA, is a chemical commonly found in household plastics, and studies have shown that fetal exposure to this compound is associated with behavioural problems in children later in life. While some plastic manufacturers have stopped using BPA in certain products, sometimes bisphenol S (BPS) is used as a replacement and it is now known to be just as harmful.
Kurrasch and her team are using mouse neural stem cells grown in culture that allow them to observe the cell cycle properties both in the presence and absence of hormones. This will help the team determine if BPA or BPS are disturbing the process of neurogenesis.
In order to understand how environmental contaminants or compounds such as BPA and BPS cause these neurological problems, Deborah Kurrasch, PhD, says it’s important to understand how hormones influence these cells under normal biology.
Deborah Kurrasch, PhD, was one of 118 UCalgary researchers and students to receive federal government funding for fundamental research in the latest round of NSERC funding. She is an assistant professor in the Department of Medical Genetics and is a member of the Alberta Children’s Hospital Research Institute.