Mount Sinai Hospital

Lunenfeld-Tanenbaum Research Institute

Institutional Strategic Initiatives

Subheadline

Research from Sinai Health and U of T found early exposure to dogs is linked to a healthier gut and reduced risk of developing Crohn's disease

Dog lovers can attest to the range of benefits that come with having a canine companion, but improved gut health likely isn’t one of them.

That may be about to change following research from Sinai Health and the University of Toronto that shows exposure to dogs during childhood is linked to beneficial changes in gut bacteria, gut permeability and blood biomarkers.

The study, published in Clinical Gastroenterology and Hepatology, found living with a dog between ages five and 15 is associated with a healthier gut microbiome and reduced risk of developing Crohn’s disease.

The research shines new light on how environmental factors influence the onset of Crohn’s – an inflammatory bowel condition – and could inform future prevention strategies.

For the study, researchers led by Kenneth Croitoru and Williams Turpin of Mount Sinai Hospital’s Centre for Inflammatory Bowel Disease (IBD) investigated how dozens of environmental factors impact the likelihood of developing Crohn’s as part of their overarching effort to be able to predict those at risk and potentially intervene early.

“The idea behind predicting someone's risk of disease is that you can then also begin to understand who you might want to do something to try and prevent disease,” says Croitoru, a clinician-scientist at the Lunenfeld-Tanenbaum Research Institute (LTRI), part of Sinai Health, and a professor of medicine and immunology at U of T’s Temerty Faculty of Medicine.

Croitoru notes the study doesn’t reveal why living with a dog makes someone less prone to Crohn’s disease. “We have established associations between environmental factors and Crohn’s and are now trying to understand how these environmental factors affect the triggering of the disease,” says Croitoru, who is also a gastroenterologist at Mount Sinai Hospital.

The study also found living with a large-sized family in the first year of life to reduce the likelihood of getting Crohn’s. It also found people who lived with a bird at the time of study were more likely to develop the disease.

Caused by inflammation in the gastrointestinal tract, Crohn’s disease can have far-reaching consequences on overall health and well-being. Its incidence among children under 10 has doubled since 1995, while the annual cost of inflammatory bowel disease to Canada is estimated at $5.4 billion per year, according to Crohn’s and Colitis Canada, a national non-profit.

The likelihood of getting Crohn’s is strongly influenced by genetics, but the environment also plays a role, says Croitoru, who holds the Canada Research Chair in Inflammatory Bowel Diseases. While we can’t change our genes, we can modify our surroundings and diet, for example, to potentially prevent the disease from occurring.

These findings come from the Genetic, Environmental and Microbial (GEM) Project, the largest study of its kind that seeks to identify potential triggers of Crohn’s disease.

Coordinated at Mount Sinai Hospital since 2008, the GEM Project has been collecting comprehensive medical and lifestyle data from over 5,000 healthy first-degree relatives of people who have Crohn’s and come from all over the world, including Australia, Canada, Israel, New Zealand, the U.K. and the U.S.

The project is funded by Crohn’s and Colitis Canada, the Canadian Institutes of Health Research and the Helmsley Charitable Foundation.

In the 15 years since the study began, over 120 people have developed the disease. “By understanding what is different about those who develop the disease, we should be able to predict who is at risk,” says Croitoru.

Previously, the group identified differences in the microbiome and other biomarkers in people who go on to develop Crohn’s and those who don’t.

In another recent report published in Gastroenterology, Sun-Ho Lee, a clinician-scientist at Mount Sinai Hospital’s IBD Centre and an assistant professor at the Institute of Medical Science at Temerty Medicine, used available data and machine learning to develop an “integrative risk score” that predicts the risk of Crohn’s with a high degree of accuracy.

But risk prediction is only the first step, says Croitoru, whose ultimate goal is to be able to intervene and prevent the disease from starting.

He and his team are now conducting research that seeks to devise and test strategies for prevention by, for example, adding supplements to the diet to promote a healthy microbiome.

“Sinai Health is committed to groundbreaking research and bringing those discoveries to patients," said Anne-Claude Gingras, director of LTRI and vice-president of research at Sinai Health.

“By integrating genetic, environmental, and microbial data, Dr. Croitoru and colleagues are paving the way towards personalized intervention strategies that could significantly reduce the incidence of Crohn’s disease.”

Why is COVID-19 more severe in some people? Researchers use genetics, data science to find out

Christopher.Sorensen — Wed, 25 Oct 2023 14:08:53 +0000

Why is COVID-19 more severe in some people? Researchers use genetics, data science to find out

Christopher.Sorensen Wed, 10/25/2023 - 10:08

Cutline

(Photo by Cole Burston/AFP/Getty Images)

Tyler Irving

Topic

Our Community

COVID-19

Data Sciences Institute

Princess Margaret Cancer Centre

Sunnybrook Health Sciences Centre

Dalla Lana School of Public Health

Unity Health

Computer Science

Faculty of Arts & Science

Hospital for Sick Children

Research & Innovation

St. Michael's Hospital

Statistical Sciences

Institutional Strategic Initiatives

Women's College Hospital

Subheadline

With the help of U of T's Data Sciences Institute, researchers from the university and partner hospitals gathered more than 11,000 full genome sequences from across Canada

Why do some people have a more severe course of COVID-19 disease than others? A genome sequence database created by an international collaboration of researchers, including many from the University of Toronto and partner hospitals, may hold the answers to this question – and many more.

The origins of the Canadian COVID-19 Human Host Genome Sequencing Databank, known as CGEn HostSeq, can be traced to the earliest days of the pandemic.

Lisa Strug, senior scientist at The Hospital for Sick Children (SickKids) and academic director of U of T’s Data Sciences Institute, one of several U of T institutional strategic initiatives, says genetic data was top of mind for her and other researchers in late 2019 and early 2020 as reports of a novel form of coronavirus emerged from China and then other locations across the globe.

Lisa Strug (Photo courtesy The Hospital for Sick Children)

“In my research, I use data science techniques to map the genes responsible for complex traits,” says Strug, who is a professor in U of T’s departments of statistical sciences and computer science in the Faculty of Arts & Science and in the biostatistics division of the Dalla Lana School of Public Health.

“We knew that genes were a factor in the severity of previous SARS infections, so it made sense that COVID-19, which is caused by a closely related virus, would have a genetic component, too.

“Very early on, I started getting messages from several scientists who wanted to set up different studies that would help us find those genes.”

Over the next few months, Strug – who is also the associate director of SickKids’ Centre for Applied Genomics, one of three sites across Canada that form CGEn, Canada’s national platform for genome sequencing infrastructure for research – collaborated with nearly 100 researchers from across U of T and partner hospitals and institutions, as well as other researchers from across Canada to enrol individuals with COVID-19 and sequence their genomes.

Some of the key team members from the Toronto community included:

Stephen Scherer, chief of research at SickKids Research Institute and a University Professor in U of T’s Temerty Faculty of Medicine, as well as director of the U of T McLaughlin Centre
Rayjean Hung, associate director of population health at the Lunenfeld-Tanenbaum Research Institute, Sinai Health, and a professor in U of T’s Dalla Lana School of Public Health
Angela Cheung, clinician-scientist at University Health Network, senior scientist at Toronto General Hospital Research Institute and a professor in U of T’s Temerty Faculty of Medicine
Upton Allen, head of the division of infectious diseases at SickKids and a professor in U of T’s Temerty Faculty of Medicine

The projected was initiated by Scherer and CGEn’s Naveed Aziz, along with Strug, and a $20-million grant was secured from Innovation, Science and Economic Development Canada, administered through Genome Canada.

“We had to go right to the top to get this project funded fast and our labs and teams worked seven days a week on the project right through the pandemic,” Scherer recalls.

Identifying associations between individual genes and complex traits typically requires thousands of genomes – both from those with the trait and those without. Though there was no shortage of cases to choose from, it was critical to gather and sequence DNA – and then organize the data in a way that would be ethical, efficient and useful to researchers now and in the future.

“One of our key mandates at the Data Sciences Institute is developing techniques and programs that ensure that data remains as open, accessible and as re-producible as it can be,” Strug says.

“That vision was brought to bear as we assembled the data infrastructure for this project – for example, ensuring that consent forms were as broad as possible so that this data could be linked with other sources, from electronic medical records to other health databases.

“We wanted to be sure that even after the COVID-19 pandemic was over this could be a national whole genome sequencing resource to ask all kinds of questions about health and our genes. The development of the database and its open nature also enabled Canada to collaborate effectively with similar projects in other countries.”

Partner hospitals and institutions:

The Hospital for Sick Children (SickKids)
Lunenfeld-Tanenbaum Research Institute, Sinai Health
Mount Sinai Hospital, Sinai Health
St Michael’s Hospital, Unity Health Toronto
University Health Network (UHN)
Princess Margaret Cancer Centre, UHN
Ontario Institute for Cancer Research
Women’s College Hospital
Toronto General Hospital, UHN
Baycrest Health Sciences

In the end, the project gathered more than 11,000 full genome sequences from across Canada, representing patients with a wide range of health outcomes. Those data were then combined with even more sequences from patients in other countries under what came to be called the COVID-19 Host Genetics Initiative.

It didn’t take long for patterns to start to emerge. A paper published in Nature in 2021 identified 13 genome-wide significant loci that are associated with SARS-CoV-2 infection or severe manifestations of COVID-19.

Since then, even more data have been added, and subsequent analysis has confirmed the significance of existing loci while also identifying new ones. The most recent update to the project, published in Nature earlier this year, brings the total number of distinct, genome-wide significant loci to 51.

“Identification of these loci can help one predict who might be more prone to a severe course of COVID-19 disease,” says Strug.

“When you identify a trait-associated locus, you can also unravel the mechanism by which this genetic region contributes to COVID-19 disease. This potentially identifies therapeutic targets and approaches that a future drug could be designed around.”

While it will take many more years to fully untangle the effects of the different loci that have been identified, Strug says that the database is already showing its worth in other ways.

“It can be difficult to find datasets with whole genome sequence and approved for linkage with other health information that are this large, and we want people to know that it is open and available for all kinds of research well beyond COVID through a completely independent data access committee,” she says.

“For example, several investigators from across Canada have been approved to use these data and we’ve even provided funding to trainees to encourage them to develop new data science methodologies or ask novel health questions using the CGen HostSeq data.”

“This was a humongous effort, where researchers from across Canada came together during the COVID-19 pandemic to recruit, obtain and sequence DNA from more than 11,000 Canadians in a systematic, co-operative, aligned way to create a made-in-Canada data resource that will hopefully be useful for years to come. I think that was really miraculous.”

Monkeypox studies suggest ways to reduce viral spread

Christopher.Sorensen — Mon, 03 Oct 2022 17:21:55 +0000

Monkeypox studies suggest ways to reduce viral spread

Christopher.Sorensen Mon, 10/03/2022 - 13:21

Cutline

(Photo by MediaNews Group/Orange County Register via Getty Images)

Betty Zou

Topic

Our Community

Monkeypox

Sunnybrook Health Sciences

Unity Health

Princess Margaret Cancer Centre

St. Michael's Hospital

Less than three months since it launched, the monkeypox rapid research response led by the University of Toronto’s Emerging and Pandemic Infections Consortium (EPIC) and three partner hospitals is generating results that could help curb transmission of the virus.

“When monkeypox first arrived in Canada, we quickly learned about the stockpile of smallpox vaccine [which also protects against monkeypox],” said Jesse Knight, a PhD student in U of T’s Institute of Medical Science in the Temerty Faculty of Medicine. “Given that the vaccine supply was quite limited early on, it was important to use it quickly and efficiently to help reduce cases.”

Knight is the first author on a new modelling study that looks at how to optimize the initial rollout of vaccine to prevent the most infections. The study, which has not yet been peer-reviewed, suggests that the greatest number of infections could be prevented by prioritizing vaccines to bigger cities with larger networks of communities at risk, the highest epidemic potential and largest number of initial cases.

Knight notes these results do not mean that areas outside of big cities should not receive vaccines, but rather they provide guidance on how to maximize immediate impact – early in an epidemic – of an extremely limited supply until more doses become available. Indeed, while Ontario’s vaccination efforts initially centred on Toronto, they soon expanded to areas outside the city.

Darrell Tan and Sharmistha Mishra

The preliminary findings were co-authored by Knight’s academic supervisor Sharmistha Mishra and collaborator Darrell Tan, both clinician-researchers at St. Michael’s Hospital, Unity Health Toronto, and associate professors in U of T’s Temerty Faculty of Medicine.

Mishra and Tan are also co-leads of EPIC’s monkeypox rapid research response. EPIC is one of several U of T institutional strategic initiatives.

For their study, the researchers built a mathematical model that simulated the potential transmission of monkeypox virus in the context of sexual networks of gay, bisexual, and other men who have sex with men. The model reflects two interconnected sexual networks that can be thought of as communities within two cities – one larger network like in Toronto and a smaller network in a medium-sized Ontario city – and simulated the roll-out of 5,000 vaccine doses starting two months after the first case of monkeypox.

The team tested scenarios in which they changed the relative population size in each network (i.e., city), the interconnectedness between the two sexual networks (sex among individuals between cities), epidemic potential of the virus in each city and the distribution of initial “imported” cases across cities.

A city’s epidemic potential reflects how likely a person carrying the virus is to pass it on to others by taking into account the density and configuration of the sexual network, access to prevention and care and the underlying social and structural contexts that shape sexual networks and shape access.

“Early insights from these analyses helped inform vaccine prioritization by health units across Ontario, which to date has centred on community-based organizations, service providers, health units and public health teams at every level working together to mobilize access and deliver vaccines to gay, bisexual and other men who have sex with men who may be most at risk of infection,” said Mishra.

From the start, Mishra said, community leadership has been at the forefront of the response, including the science – with modeling questions, inputs, interpretation and application shaped by communities and the public health actors working to serve communities.

Knight hopes that this work will also have an impact on how vaccines are deployed globally.

“Given our increasingly connected world, our findings really highlight the importance of global vaccine equity in responding to outbreaks, and also in preventing them in the first place," he said.

Vaccines can help break chains of transmission when deployed strategically, but another opportunity to stop transmission is in the environment — where people infected with the virus may shed it onto surfaces and objects.

“We knew very little about fomite [surface] transmission of monkeypox prior to this outbreak,” said Christopher Kandel, an infectious disease physician at Michael Garron Hospital, Toronto East Health Network, and assistant professor in the Temerty Faculty of Medicine’s department of medicine.

To study the risk of environmental transmission of monkeypox, Kandel and Sharon Sukhdeo, an infectious diseases resident at U of T, teamed up with EPIC faculty members Allison McGeer, who is at Mount Sinai Hospital and is a professor in the Temerty Faculty of Medicine and at the Institute of Health Policy, Management and Evaluation (IHPME) in the Dalla Lana School of Public Health, Adrienne Chan, who is at Sunnybrook Health Sciences Centre and is an associate professor in the Temerty Faculty of Medicine and the Dalla Lana School of Public Health, and Matthew Muller, who is at St. Michael’s Hospital and is an associate professor in the Temerty Faculty of Medicine and at IHPME.

For the first part of their study, the team swabbed a mixture of high- and low-touch surfaces in hospital exam rooms where patients with monkeypox had received care. They tested the same surfaces again after the rooms had been cleaned.

Their preliminary results showed detectable levels of monkeypox DNA on many high-touch and a few low-touch surfaces. Encouragingly, the researchers could not detect the virus on the majority of surfaces after cleaning. Where they did detect the virus after cleaning, levels were significantly reduced.

Kandel notes that while they were able to detect monkeypox DNA, their methods can’t determine whether the detected virus was infectious.

As a next step, the researchers will expand their study to look at environmental transmission within households. They will ask people who are self-isolating with monkeypox to swab objects and surfaces in their home at different timepoints, which will provide insight into how long an infected person sheds the virus and whether common at-home cleaning products can effectively disinfect contaminated surfaces.

“There are so many questions that need to be answered,” said Kandel. “With these studies, we’ll have a much better understanding of monkeypox transmission, including how infectious people are and how long isolation should last to best protect others.”

U of T mourns the death of Queen Elizabeth II, lowers flags to half-mast

Christopher.Sorensen — Thu, 08 Sep 2022 23:35:48 +0000

U of T mourns the death of Queen Elizabeth II, lowers flags to half-mast

Christopher.Sorensen Thu, 09/08/2022 - 19:35

Cutline

Her Majesty Queen Elizabeth II, who died at the age of 96, was the longest-serving monarch in British history (photo by Tim Graham/Getty Images)

Rahul Kalvapalle

Topic

Global Lens

Faculty of Arts & Science

Massey College

Meric Gertler

Munk School of Global Affairs & Public Policy

Queen

Royalty

St. George

Thomas Fisher Rare Book Library

U of T Libraries

U of T Mississauga

U of T Scarborough

The University of Toronto is mourning the death of Her Majesty Queen Elizabeth II, the longest-serving monarch in British history, who visited the university on numerous occasions.

Flags on all three U of T campuses are being lowered to half-mast in memory of the Queen, who died Thursday at Balmoral Castle in Scotland at the age of 96. They will remain at half-mast until the day of her state funeral.

The university will also mark the event by having carillonists play the bells in Soldiers’ Tower on Friday at noon, tolling the largest bell once for each year of the Queen’s age at the time of her passing. The royal anthem and O Canada will also be played.

U of T President Meric Gertler said the U of T community joins all Canadians in mourning the loss of the sovereign, noting that, before acceding to the throne, she promised to devote her life to the service of her people.

“She fulfilled that promise with unparalleled grace and dignity, and in so doing set a magnificent example for us all,” President Gertler said in a statement. “Her unfailing devotion to duty has been a constant source of strength and continuity for generations of Canadians as well as countless others around the world.

“Indeed, it is difficult to imagine a world without her.”

Flags fly at half mast at, from left to right, U of T Mississauga, St. George and U of T Scarborough to mark the Queen’s death on Sept. 8, 2022 (photos by Nick Iwanyshyn, Johnny Guatto and Raquel Russell)

He also highlighted the Queen’s contributions to international peace and solidarity through the Commonwealth and noted the U of T community has been enriched by the contributions of students, faculty, librarians, staff and alumni who arrived from or live in fellow Commonwealth countries.

“In tribute to Her Majesty, in this time of sadness and in the years to come, let us remember and learn from her life of dedicated and extraordinarily generous service to others, and give thanks for a life very well lived.”

Princess Elizabeth and the Duke of Edinburgh are greeted at Hart House by U of T Chancellor Vincent Massey (Walter F. Mackenzie/University of Toronto Archives)

The Queen’s passing comes 14 months after her husband Prince Philip, the Duke of Edinburgh, died aged 99.

Princess Elizabeth visits Hart House with U of T Chancellor Vincent Massey on Oct.13, 1951 (Walter F. Mackenzie/University of Toronto Archives)

Prime Minister Justin Trudeau said that it is with the “heaviest of hearts” that Canadians learned of the passing of the country’s longest-reigning sovereign.

“For most Canadians, we have known no other Sovereign. Queen Elizabeth II was a constant presence in our lives. Time and again, Her Majesty marked Canada’s modern history,” he said in a statement.

Born Elizabeth Alexandra Mary on April 21, 1926, Queen Elizabeth II ascended to the crown in 1952 at age 25. She went on to become the longest-reigning monarch in British history, marking her Platinum Jubilee this past February.

She is to be succeeded as monarch by her eldest son Charles, Prince of Wales – now King Charles III.

David Onley, former lieutenant governor of Ontario and a senior lecturer in the department of political science at U of T Scarborough, said he has warm recollections of meeting the Queen at Buckingham Palace in 2008.

“The experience my wife and I had was quite amazing to us in that the conversation was not superficial. The Queen really engaged in our conversation,” Onley said.

He added that the Queen took great interest in the results of Canada’s federal election, which had taken place the night before. “I was really quite amazed as to how well-briefed she was. She wanted to know about Stephen Harper, she wanted to know about why the Liberals had lost so badly on that occasion – so it wasn’t just a superficial chit-chat.

“At the same time, I would say that she interacted with everybody like that – and that was one of the fundamental reasons for her passing being felt by so many people. Because everybody has stories – if you met the Queen, you had a story – and that was because of her degree of engagement.”

Onley said the Queen’s impeccable reputation during her seven-decade reign – he noted that her first prime minister was Winston Churchill and her last, the recently elected Elizabeth Truss; and that she had met all but one of the U.S. presidents since the Second World War – was testament to her complete devotion to the role.

“This is a particular accomplishment, and you would not have that kind of reputation if you were just effectively mailing in the responsibilities,” Onley said. “She saw it as a lifetime of service and executed that service right to the very end.”

He added that the frequency and range of the Queen’s visits to Ontario and Canada “give you the sense of the degree of interest that she had in this province, and other provinces as well.”

Queen Elizabeth II attends the Festival of Ontario at the CNE in 2002, making a stop in front of the U of T Blue Sky Solar Racing Team’s display (photo via Flickr)

Queen Elizabeth II and the Duke of Edinburgh visited Toronto seven times, with their first visit taking place in 1951, four months before the Queen’s coronation. On that occasion, the royal couple were driven to the steps of Hart House, where they waved to cheering crowds and posed for photos.

In 1973, the Queen returned to Toronto and laid the cornerstone for the new Mount Sinai Hospital, part of Sinai Health and one of U of T’s partner hospitals. The hospital is located next to Princess Margaret Cancer Centre, named in honour of the Queen’s sister.

In 2002, the royal couple visited Toronto again during the Queen’s Golden Jubilee, which coincided with U of T’s 175^th anniversary. During the celebrations, the Queen visited a U of T display where she spoke with undergraduate students from the Blue Sky Solar Racing team who were present with their solar-powered car.

“I recall that the Queen had such a presence,” said Nicolle Wahl, director of content in U of T Mississauga’s Office of Communications, who was present at the U of T display. “[She was] very warm and curious – and it was wonderful to see how excited the students were to meet her.”

A letter written by Princess Elizabeth to U of T Chancellor Vincent Massey dated Feb. 17, 1952 (photo by Larysa Woloszansky)

The Queen’s 22^ndand final tour of Canada took place in 2010 and included a visit to Queen’s Park – named in honour of her great-great-grandmother Queen Victoria and located amid U of T’s St. George campus – where she presented Ontario Medals for Good Citizenship and waved to thousands of cheering well-wishers.

The Queen’s impact on U of T did not end with her last visit to Toronto, however. In 2017, Massey College announced that the Queen agreed to designate the college’s St. Catherine’s Chapel as the third Chapel Royal in Canada, which made it the first interdenominational Chapel Royal in the country.The request for the designation was made by John Fraser, then the master of Massey College, with the support of the Mississaugas of the New Credit First Nation. It was inspired in part by the Truth and Reconciliation Commission of Canada’s Calls to Action.

U of T’s Thomas Fisher Rare Book Library has one of 25 souvenir Bibles created to mark the Queen’s coronation in 1953 (photo by Johnny Guatto)

The Queen’s ties with Massey College can be traced back to her close relationship with the college’s founder Vincent Massey, who was Canada’s 18^th Governor General and a U of T chancellor from 1947 to 1953.

Letters written by the Queen to Massey – and preserved at U of T’s Thomas Fisher Rare Book Library – speak to a warm personal rapport.

In one letter dated February 1952, the Queen responded to a letter of condolence sent to her by Massey upon the passing of her father, King George VI. In her letter, the Queen expresses her gratitude for Massey’s condolences and notes that her father was in much better condition when Massey had last met him, but had then taken a turn for the worse. The Queen also states her regret at the fact that she was on a tour in Africa when her father died and was saddened by not being able to be home to comfort and console her mother and sister.

Another letter written from Balmoral Castle – where the Queen would eventually take her last breath – thanked Massey for being a great governor general. In another letter to Massey, written from Buckingham Palace in 1957, the Queen recounts her visit to the United States.

A letter written by Queen Elizabeth II to Vincent Massey on the occasion of his retirement as governor general of Canada (photo by Johnny Guatto)

The Thomas Fisher Rare Book Library is also in possession of one of 25 souvenir Bibles created to mark the Queen’s coronation in 1953. Bible #1 was used for the coronation ceremony – the Queen gifted Bible #17 to Massey.

Randall Hansen, professor in the department of political science in the Faculty of Arts & Science and the director of the global migration lab at the Munk School of Global Affairs & Public Policy, said the Queen’s many accomplishments include overseeing a modernization of the monarchy – noting as examples her decision to agree to pay income tax and the landmark wedding of Prince Harry and Meghan Markle.

“Leaving aside how it all ended, the marriage of Meghan Markle and Prince Harry was a moment of a highly modern monarchy – an inter-racial marriage and a Black Baptist American minister who oversaw the service.”

He added that the Queen’s son and heir to the throne will benefit from the prestige of the monarchy and the Queen’s impact on the institution.

“It is the institution of the Crown, it is the institution of the monarchy that bestows the prestige … that institution will bequeath on him the full prestige of the monarchy,” Hansen said. “I suspect that he’s going to be quite a successful King.”

Hansen said it was remarkable that Queen Elizabeth II, over the course of an extraordinarily long reign, was not embroiled in a scandal of any significance.

“The Queen somehow managed to be above all of that, decade after decade after decade.”

Medical school grads reflect on their time at U of T – and share tips for future students

Christopher.Sorensen — Tue, 07 Jun 2022 14:40:09 +0000

Medical school grads reflect on their time at U of T – and share tips for future students

Christopher.Sorensen Tue, 06/07/2022 - 10:40

Cutline

Left to right: Happy Inibhunu, Justin Lim, Alainna Jamal, Siraj Zahr and Jordi Klein (all photos by Julia Soudat)

Julia Soudat

Topic

Our Community

Convocation 2020

Dalla Lana School of Public Health

Before trading their white coats for black gowns and receiving their degrees at Convocation Hall, several members of the Temerty Faculty of Medicine's Class of 2022 recently looked back on their time in med school and shared advice for future students.

Five of those students – MD graduates Happy Inibhunu, Justin Lim and Jordi Klein, as well as MD/PhD grads Alainna Jamal and Siraj Zahr – describe the rollercoaster of emotions they felt during their education at the University of Toronto, from delivering their first baby to losing their first patient.

Here is a snapshot of their reflections:

Happy Inibhunu

Graduating from: MD Program
Up next: Residency in neurosurgery, Western University

Time goes by really fast, as sometimes I often rewind back to orientation and am amazed of the incredible friends I have made these last four years. Some highlights of my medical school journey are my first-ever triathlon, receiving an honorable mention by the Canadian Society of Palliative Care for my written piece, "10:30,” providing care to patients throughout the COVID-19 pandemic through virtual and in-person means, and, undoubtedly, achieving my dream of becoming a neurosurgery resident.

These last four years in Toronto helped define the physician I aspire to be by building interdisciplinary and multidisciplinary networks in a harmonious manner, creating positive, empathetic and trustworthy rapport with patients, and having the extraordinary opportunity of striving diligently to provide care to neurosurgical patients as a life-long vocation.

Being part of the Class of 2022, which did more than half of medical school during the pandemic, and navigating clerkship within the pandemic was certainly a hard obstacle to overcome. Striving to build rapport and guidance with patients through the distance created with the application of Personal Protective Equipment (PPE) while balancing the uncertainty of the pandemic placed another layer of complexity to our learning. However, a defining characteristic that resonated through the pandemic is the ability to recognize, acknowledge and strengthen virtues of humanity. For instance, sharing a laugh, providing extra time within visits, supporting one another and always remembering the person is separate from the disease. With this mindset, more unique aspects of clerkship and the pandemic shone through while building a harmonious community throughout my rotations among physicians, residents, allied health-care professionals, patients and caregivers.

I have been aspiring to this moment for a long time. To be one of the incoming PGY1 neurosurgery residents at Western University is a humbling honour. I am excited to continue on this path towards providing optimal care for patients, similar to my mentors, paving the way for me to soon become a well-rounded, skillfully trained neurosurgeon.

Advice for incoming students: It is often common to feel out-of-place in new situations, especially in medical school. You might hear of the phrase "imposter syndrome" in your first few weeks of orientation and throughout your career. Try not to be intimated by this phrase. Instead use it as a template to branch from. To get to where you are, it takes sacrifice, passion and excitement to dedicate your life to the betterment of others.

Justin Lim

Graduating from: MD Program
Up next: Residency in ObGyn, University of Toronto

I don't think I truly knew what I was getting myself into when I decided I wanted to become a physician. I just knew I wanted to contribute to my community in a meaningful way. Through the growing pains of medical school, I learned that there is something incredibly special about how our profession affords us the opportunity to be with people at some of their most vulnerable moments. The highs are high and the lows are low, but ultimately caring for others is central to what continues to draw me in to this profession.

Without a doubt, the most remarkable highlight of medical school has been watching my friends and classmates grow as people, as a community and as future physicians – and growing alongside them. It was so wonderful watching everyone comfortably settle into their future specialties this last stretch of medical school, and be truly excited about going into our respective clinical spaces.

Medical school has been filled with many “firsts,” which is what makes these four years so fulfilling and exciting, but so darn challenging at the same time. Navigating these firsts kept me on my toes as I quickly learned that we all have things we’re good at (and things we're not so good at). It's funny remembering how nervous I was to take my first patient history. Now, that list of new experiences has grown exponentially – all the way from delivering my first baby to experiencing my first patient death. Learning how to sit with these experiences will be something I will be working on for years to come.

I am extremely excited – and nervous – for the many upcoming milestones that come along with an ObGyn residency, and am really looking forward learning how to do things with my hands. I remember learning how to throw my first knot a few years ago, and it still hasn't hit me that soon enough I'll be learning how to operate.

Advice for incoming students: you will constantly feel like you don’t have enough hours in a day. I remember feeling like I just did not ever have enough time. But I promise you that you do have time, and you will finish medical school excellent and competent.

The truth is, your to-do list will never end and the demands of medical school will feel overwhelming at times, but give yourself permission to do the things you need to do for you.

Jordi Klein

Graduating from: MD Program
Up next: Residency in emergency medicine, University of Toronto

I became interested in medicine because of my own experiences as a patient, which led to an academic interest in co-design for health-care systems and institutions. I’ve had some opportunities to use a co-design approach in creating lectures and resources for the MD program, and am excited to continue this work in residency. My experiences as a patient also cemented the importance of medicine as advocacy, and I’m motivated to continue my advocacy work supporting the health-care needs of marginalized and under-represented communities.

It’s true what they say: the days are long but the years are short. Med school was a collection of so many highlights. From de-stressing in the med lounge after an anatomy bellringer to delivering a baby for the first time, it’s amazing how much you grow in such a short amount of time. Among my greatest highlights were getting to know so many bright, hardworking, passionate future colleagues, who inspire me to be a better doctor and a better person.

I struggled a lot with imposter syndrome in medical school. I felt like I wasn’t cut out to be a doctor, that I didn’t belong here. It got worse in clerkship, as I would agonize over every little mistake, fearing it was evidence that all my worst fears were true and I actually wasn’t good enough after all. Over the course of clerkship, my mentors helped me feel more grounded and learn to adopt a growth mindset. The imposter syndrome is still a work-in-progress but it’s become easier to see mistakes as opportunities to grow. Learn by failing!

I’ve been incredibly lucky to have so many supportive mentors and colleagues throughout my training, and I’m looking forward to having the opportunity to pay it forward by teaching, supporting and mentoring other learners here at U of T. My training would not have been the same without the residents who taught me procedures, got me coffee on night shifts, cried with me after patient deaths, coached me through tough days and so much more. I hope to be that resident for future medical students.

Advice for incoming students: Each of you has something special to bring to this work. Don’t be afraid to bring your full self into medical training. Let your strengths be your strengths, and find the people and places that help you feel like the best, most authentic version of yourself.

Alainna Jamal

Graduating from: MD/PhD Program
Up next: Residency in internal medicine, University of Toronto

I started my first research project as a bachelor of science student in 2010 under the skillful mentorship of Dr. S. Joseph Kim (an associate professor at the Institute of Health Policy, Management and Evaluation in the Dalla Lana School of Public Health) and Dr. Shahid Husain (a clinician investigator in the department of medicine in the Temerty Faculty of Medicine) in the multi-organ transplant program at Toronto General Hospital. They were the first to show me the physician-scientist career path, and I was fascinated. I saw research and clinical medicine as inextricably linked. I wanted to treat individual patients, while leading a research program that improves patient care and health-care systems. I am most interested in infectious diseases and epidemiology, particularly antibiotic resistance.

My research focuses on understanding transmission of antibiotic resistant bacteria in hospitals and communities, using epidemiological and genomic methods. These data allow us to make policy recommendations for infection prevention and control programs in Ontario.

The greatest highlight of my experience in the MD/PhD program was the opportunity to be rigorously research-trained by my PhD supervisor, Dr. Allison McGeer [a professor in the Temerty Faculty of Medicine and Dalla Lana School of Public Health and clinician scientist at the Lunenfeld-Tanenbaum Research Institute at Sinai Health) as our team worked on new and evolving public health challenges (antibiotic resistance, and toward the end of my PhD, COVID-19). She is an authority in her field who also takes mentorship seriously. She gave me independence, while always offering constructive criticism and generous support.

I'm looking forward to honing my clinical skills and gaining independence as a physician, serving as a teacher and mentor to my junior peers, and answering the next question on my research agenda.

Advice for incoming students: Open doors for junior peers. Approach everything with a diversity, equity and inclusivity mindset.

Siraj Zahr

Graduating from: MD/PhD Program
Up next: Residency in anesthesiology, University of Toronto

Looking ahead, anesthesiology offers many avenues for scientific investigation as it encompasses the entire spectrum of medicine and surgery. I’m interested in mechanisms of action of certain anesthetics on brain activity, as well as chronic pain mechanisms and treatment. The interplay between what we categorize as psychiatric/mental versus physical in chronic pain disorders – and therapeutic modalities that target both – is a particularly exciting area to me.

My main doctoral research under the supervision of Dr. Freda Miller [in the department of physiology] and Dr. David Kaplan [in the department of molecular genetics] revolved around how neurons are generated from neural stem cells to build the mammalian cortex. The cortex underlies our perception of sensory information, performance of motor activities and higher-order cognition, so you can imagine that aberrations in this process can lead to a whole host of disorders.

Honestly, my biggest highlight [of med school] would have to be meeting my wife, Tina Marvasti, who I couples matched with. Other highlights are the friendships I’ve made and inspiring mentors I have met who have made me feel at home in Toronto.

I have faced many challenges, both academically and personally. Not to bore you with the details, but some useful things I have learned are that challenges are inevitable and necessary for growth, and that it is OK to lean on others for advice and guidance when you’re stuck.

As I embark on the next phase of training, I look forward to developing focused clinical expertise and independence in managing patients of varying complexity and acuity. I’m also looking forward to learning from the fantastic clinical and scientific mentors in anesthesiology.

There is a proverb of unclear origin that goes: "The person who asks is a fool for five minutes, but the person who does not ask remains a fool forever.” In medicine and science, you are faced with many unknowns or unfamiliar territory that naturally evoke fear. I’ve noticed that there is sometimes a hidden pressure that even the most junior and inexperienced trainees need to always appear more certain and knowledgeable than is the case. So, in addition to the natural fears one has, there is an added pressure to behave with false certainty despite lack of experience. I think this really stunts learning and understanding, and is ultimately bad for patient care.

Advice for incoming students: Be humble, stay curious, maintain a growth mindset, and ask genuine questions if you don’t understand something. Essentially, be willing to be a fool for a bit.

Reopened vaccine clinic on St. George campus set to deliver more than 30,000 doses during latest wave

Christopher.Sorensen — Fri, 14 Jan 2022 19:24:24 +0000

Reopened vaccine clinic on St. George campus set to deliver more than 30,000 doses during latest wave

Christopher.Sorensen Fri, 01/14/2022 - 14:24

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Erin Bearss, chief of family medicine and an ER doctor at Mount Sinai Hospital, is pictured last spring in the vaccine clinic at U of T's Exam Centre, which is operated by University Health Network (Photo by Johnny Guatto)

Topic

Leslie Dan Faculty of Pharmacy

St. George

Sunnybrook Health Sciences

Vaccines

When the Omicron variant hit Ontario late last year, Erin Bearss remembers thinking to herself: “Here we go again.”

Chief of family medicine and an ER doctor at Mount Sinai Hospital, Bearss helps run a vaccine clinic – operated by University Health Network, with significant participation by Sinai Health and University of Toronto clinicians, administrators and faculty – that’s located in U of T’s Exam Centre on McCaul Street.

The McCaul Street clinic re-opened its doors on Dec. 19 (it was previously in operation from March through September last year) and has since delivered roughly 1,500 shots a day and will soon surpass the 30,000-mark. Appointments can be made online through the provincial booking system.

More than 23 months into the pandemic, Bearss said it’s disappointing to see case counts at record highs, but stresses that her staff remain eager to get shots in arms.

“As soon as it became apparent that there was going to be a demand for boosters and that our clinic was going to be needed again, everybody was right back in there putting their hand up, wanting to help out,” said Bearss, an assistant professor in U of T’s department of family and community medicine in the Temerty Faculty of Medicine.

She spoke to U of T News while she was self-isolating after family members contracted the virus and were experiencing mild symptoms.

“Anyone who visits our clinic will be impressed with the efficiency, processes and organization and what have you – and that’s in large part due to the people who are here day in and day out.”

The McCaul Street clinic – which will be the subject of an upcoming art exhibit – follows the vaccine eligibility criteria and ethical guidelines set by the province. In recent weeks, staff have mainly been delivering booster shots, but have days reserved for children aged five to 11 receiving their first or second dose.

“Adults who need their first or second dose are obviously very welcome,” Bearss noted.

U of T is also offering COVID-19 vaccinations at the Discovery Pharmacy at the Leslie Dan Faculty of Pharmacy, where members of the U of T community who do not have an Ontario Health Card – such as international students – can register for an appointment. U of T Scarbough is hosting a testing centre on its campus.

From March to September last year, roughly 56,000 people received their shots at the McCaul Street clinic. The university also hosted a large vaccine clinic at U of T Mississauga in partnership with Trillium Health Partners and Peel Public Health last spring, a regular pop-up clinic at U of T Scarborough in partnership with Scarborough Health Network and several pop-up clinics across the city, delivering hundreds of thousands of additional doses. There were also special pop-up clinics that allowed Indigenous community members to get their doses in a culturally safe space.

The ongoing immunization drive at U of T is a co-ordinated effort involving faculty and students in the Temerty Faculty of Medicine, Lawrence S. Bloomberg Faculty of Nursing and Leslie Dan Faculty of Pharmacy. Actors from the standardized patient program, which provides patient simulations for students in health-care fields, work as clerical staff.

U of T pharmacists, pharmacy students, along with pharmacists and technicians from hospital partners belonging to the Toronto Academic Health Science Network, work behind the scenes to prepare vaccines at the McCaul Street clinic. They also supported a low-barrier, one-day vaccination clinic recently at Zanzibar Tavern, an adult entertainment nightclub on Yonge St. As part of a pilot project, the pharmacy team prepared vaccines at the McCaul Street clinic – where there was more space – and sent the doses to Zanzibar using a specialized courier service.

“The University Health Network team wanted to use our pharmacy team as a way to try this model – to see if it could be an efficient and effective way to get doses mass produced and safely transported to another nearby site,” says Linda Dresser, an assistant professor in the Faculty of Pharmacy. “We were there in the background, as pharmacy often is – the cog that makes the magic happen out front.”

The demand for shots at Zanzibar exceeded expectations, with a line that at times stretched from the front door to Yonge-Dundas Square. Although they only planned to prepare 800 doses for that day, the pharmacy team ended up making 1,100, Dresser said.

“It resulted in, sometimes, a little bit of catching up to do … but everybody was very patient, and more people got vaccine that day than we had planned – so that was all good,” Dresser said.

One upshot of organizing the vaccine clinics has been the opportunity to collaborate with faculty and clinicians across U of T and Toronto-area hospitals, Dresser added.

“The university will be richer for this whole endeavour that we’ve gone through, and faculties that maybe haven’t collaborated in such a way before now have something they can draw on again in the future.”

Female patients operated on by male surgeons more likely to die, suffer complications: U of T study

Christopher.Sorensen — Tue, 11 Jan 2022 16:54:56 +0000

Female patients operated on by male surgeons more likely to die, suffer complications: U of T study

Christopher.Sorensen Tue, 01/11/2022 - 11:54

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(Photo by Manfred Weis/Westend61 via Getty Images)

Gabrielle Giroday

Topic

Breaking Research

Institute of Health Policy Management and Evaluation

Research & Innovation

Princess Margaret Cancer Centre

Female patients were more likely to die or experience complications after being operated on by a male – as opposed to a female – surgeon, according to a new study by researchers in the University of Toronto’s Temerty Faculty of Medicine.

The paper, recently published in JAMA Surgery, looked at 1.3 million adult patients in Ontario over a period of 12 years. It suggests women were 15 per cent more likely to experience a bad outcome if their surgeon was a man.

There was also a 32 per cent greater chance that a female patient would die in the 30 days after a procedure.

The researchers say their findings underscore the need to understand the reasons for the apparent disparity.

“To deny the results of this study is both non-scientific and a marker of our own implicit bias,” says Angela Jerath, an associate professor at Temerty Medicine’s department of anesthesiology and pain medicine, who worked on the study with Christopher Wallis, an assistant professor at Temerty Medicine’s division of urology.

Angela Jerath and Christopher Wallis

The study also indicated female patients treated by a male surgeon had a 16 per cent increase in major complications following their surgery and an 11 per cent increase in the likelihood of re-admission, compared with having the same procedure done by a female surgeon.

“We believe that the issues that are causing this gap are extremely complicated, and likely to enter behavioural science. We need to understand these issues and fill the gap in care for female patients,” says Jerath, who is also an associate professor with the Dalla Lana School of Public Health’s Institute for Health Policy, Management and Evaluation and a staff cardiac anesthesiologist at Sunnybrook Health Sciences Centre.

The study focused on 21 types of surgery, including procedures in cardiothoracic surgery, neurosurgery and orthopedic surgery.

The data also factored in procedures in otolaryngology, plastic surgery, thoracic surgery, urology and vascular surgery, as well as general surgery.

“Overall, male patients have comparable results when treated by either male or female surgeons while female patients have worse outcomes when treated by male surgeons than female surgeons,” says Wallis, who is also a urologic oncologist at the division of urology at Mount Sinai Hospital and University Health Network.

“As a male surgeon, these findings really highlight a learning opportunity for me personally and for our profession,” he adds. “An operating surgeon’s sex shouldn’t affect a female patient’s outcomes. We need to do more work to understand why these discrepancies are happening.”

“There are social and cultural factors that may get in the way of providing the best care for female patients, and we need to investigate that further.”

Of the study of sample of more than 2,900 surgeons, 82 per cent were male while 18 per cent were female.

Further work needs to be done examining ways male and female surgeons communicate with patients, the researchers say.

There is also the need to study the ways patients and surgeons of both sexes establish trust, they added.

“Beyond performing the actual surgical procedure, there are complex processes in the care pathway before and after surgery that male and female surgeons may do differently surrounding clinical decision making, exercising personal judgement and team management,” Jerath says.

“It’s also possible that male and female patients communicate differently with surgeons of different sexes. Understanding these differences is important in improving outcomes after surgery for all patients.”

Jerath, who is also a scientist at Sunnybrook Research Institute and adjunct scientist at ICES, says she was “astonished” by the findings.

She says further research will hopefully examine if there are some practices among female surgeons that are leading to better outcomes, especially for female patients.

“We know this is a really uncomfortable piece of work. I work with a lot of terrific male surgeons. The results we found are at a population level and do not reflect any one surgeon’s practice,” she says.

“Our advice to all patients – female or male – is that they should be able to speak and have a good, trusting relationship with their physician.”

The findings also indicate the importance of increasing the number of female surgeons, Wallis says.

“This research really supports the goal of diversifying the surgical workforce to better match the characteristics of the patients we’re treating,” he says.

Common diabetes drug not effective against early-stage breast cancer, researchers say

Christopher.Sorensen — Wed, 08 Dec 2021 03:53:19 +0000

Common diabetes drug not effective against early-stage breast cancer, researchers say

Christopher.Sorensen Tue, 12/07/2021 - 22:53

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(Photo by andresr via Getty Images)

Amanda Ferguson

Topic

Breaking Research

Institute of Health Policy Management and Evaluation

Lunenfeld-Tanenbaum Research Institute

Breast Cancer

Cancer

Dalla Lana School of Public Health

Research and Innovation

Institutional Strategic Initiatives

A widely used and inexpensive type 2 diabetes drug, once hoped to hold enormous promise in treating breast cancer, does not prevent or stop the spread of the most common forms of the disease, according to new research.

The study, which has yet to be peer-reviewed, was led by Toronto researchers and run by the Canadian Cancer Trials Group under the umbrella of the Breast International Group network. It is the largest study of its kind to date, tracking more than 3,600 breast cancer patients from across Canada, the U.S., Switzerland and the U.K.

Pamela Goodwin (photo courtesy of Sinai Health)

The randomized, double-blind trial enrolled patients who were treated with two pills a day of either placebo or the diabetes drug metformin. Overall, researchers found the addition of metformin to standard breast cancer treatments did not improve outcomes in the two most common types of breast cancer, hormone receptor-positive or negative.

“The results tell us that metformin is not effective against the most common types of breast cancer and any off-label use of this drug for the treatment of these common types of breast cancer should be stopped,” said Pamela Goodwin, a professor in the department of medicine at the University of Toronto’s Temerty Faculty of Medicine, who also is a medical oncologist at Sinai Health and a clinician scientist at the Lunenfeld-Tanenbaum Research Institute.

Goodwin presented the findings this week at the 2021 San Antonio Breast Cancer Symposium.

While metformin was found not to be effective in treating the most common forms of breast cancer, Goodwin said the trial found a potentially important result for individuals with a less common but aggressive form of the disease called HER2-positive breast cancer.

For this subtype of breast cancer, researchers found there was evidence that use of metformin for five years might lead to a reduction in deaths. HER2-positive cancer makes up about 20 per cent of all breast cancers.

“Metformin is not beneficial for use in most common breast cancers, but in the cases of HER2 positive breast cancer, our findings suggest it may be beneficial,” said Goodwin, who is also a professor in the Institute of Health Policy, Management and Evaluation at the Dalla Lana School of Public Health.

“These results need to be replicated in future research before metformin is used as a breast cancer treatment, however, it could provide an additional treatment option for HER2-positive breast cancer,” said Goodwin.

Metformin belongs to a class of drugs called biguanides, which are used to treat high blood sugar or diabetes. Previous observational and pre-clinical studies suggested metformin may also reduce the risk of development and increase survival of some cancers, including breast cancer.

It was theorized the drug may slow breast cancer growth by improving patient metabolism, notably insulin levels, leading to reduced growth of cancer cells, or that it might impact cancer cells directly.

The results have been submitted for publication. A potential next step will be to prospectively test the impact of metformin in patients with HER2-positive breast cancer in a randomized clinical trial.

The multinational trial involved a large team of scientists including Goodwin and Vuk Stambolic, a professor of medical biophysics at U of T and at senior scientist at the Princess Margaret Cancer Centre, University Health Network.

Professors Wendy Parulekar and Bingshu Chen of Queen's University and the Canadian Cancer Trials Group were also involved with the study.

The research was funded by the Canadian Cancer Society Research Institute, National Cancer Institute (U.S.), Canadian Breast Cancer Foundation, Breast Cancer Research Foundation, Cancer Research UK, Hold’Em for Life Charity Challenge and Apotex (Canada).

Preventing the next pandemic: U of T’s EPIC consortium

Christopher.Sorensen — Wed, 24 Nov 2021 20:09:39 +0000

Preventing the next pandemic: U of T’s EPIC consortium

Christopher.Sorensen Wed, 11/24/2021 - 15:09

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Lab manager Betty Poon wears protective gear while working in U of T's Combined Containment Level 3 facility, which is equipped to safely study pathogens that cause infectious disease (photo by Lisa Lightbourn)

Topic

Sunnybrook Health Sciences

Hospital for Sick Children

Research & Innovation

St. Michael's Hospital