Women&#039;s College Hospital

Institutional Strategic Initiatives

COVID-19

Data Sciences Institute

Princess Margaret Cancer Centre

Sinai Health

Sunnybrook Health Sciences Centre

Unity Health

Computer Science

Faculty of Arts & Science

Hospital for Sick Children

Mount Sinai Hospital

University Health Network

St. Michael's Hospital

Statistical Sciences

Subheadline

With the help of �鶹��Ƶ'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 �鶹��Ƶ’s Data Sciences Institute, one of several �鶹��Ƶ 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 �鶹��Ƶ’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 �鶹��Ƶ 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 �鶹��Ƶ’s Temerty Faculty of Medicine, as well as director of the �鶹��Ƶ McLaughlin Centre
Rayjean Hung, associate director of population health at the Lunenfeld-Tanenbaum Research Institute, Sinai Health, and a professor in �鶹��Ƶ’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 �鶹��Ƶ’s Temerty Faculty of Medicine
Upton Allen, head of the division of infectious diseases at SickKids and a professor in �鶹��Ƶ’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.”

Researchers to deploy AI to help predict – and prevent - diabetes

Christopher.Sorensen — Fri, 15 Sep 2023 19:13:07 +0000

Researchers to deploy AI to help predict – and prevent - diabetes

Christopher.Sorensen Fri, 09/15/2023 - 15:13

Cutline

Researchers Jay Shaw and Laura Rosella are co-leading a team that’s developing a framework to responsibly deploy machine learning models to predict diabetes risk in Ontario’s Peel region (supplied images)

Rachel LeBeau

Topic

Artificial Intelligence

Diabetes

A team of researchers at the University of Toronto and its partner hospitals are working on a way to deploy artificial intelligence to predict diabetes risks in patients.

Jay Shaw, a scientist at Women’s College Research Institute and an assistant professor in the department of physical therapy in �鶹��Ƶ’s Temerty Faculty of Medicine, co-leads a team that was recently awarded more than $900,000 in funding over three years from CIFAR (Canadian Institute for Advanced Research) to develop a novel framework for the responsible deployment of machine learning models to predict diabetes risk in Ontario’s Peel region, one of the largest and most diverse communities in Canada.

The project, co-directed by epidemiologist Laura Rosella, a professor at the Dalla Lana School of Public Health, has developed models that use routinely collected data in the health system to help predict diabetes onset up to five years before a diagnosis.

“Our team developed and validated models that can predict diabetes incidence and complications in advance,” Shaw says. “These models have already been validated, meaning that their performance for accomplishing their goals of predicting diabetes onset and complications has already been established, allowing us to focus on how best to implement these models so that they are used effectively and responsibly.”

Shaw, Rosella, and their team will use these models to build a dashboard that can be used by health system decision-makers to plan health system interventions that address diabetes-related prevention needs and bridge gaps in health equity by identifying high-risk populations.

Peel region was selected as a site to deploy the models because it’s an area where the burden of diabetes is high, with a 2015 diabetes incidence rate of 1,192 per 100,000 – an increase of 182 per cent since 1996, according the region’s 2019 health status report. Peel also has a diverse population where 51 per cent of residents are immigrants and 62 per cent identify as a visible minority.

It is estimated that by 2030, nearly 14 million Canadians will have either diabetes or pre-diabetes. This is expected to cost health systems nearly $5 billion. The complexity of the disease progression and diagnostics, along with increasing health disparities based on socioeconomic factors, has led to worse rates and outcomes for marginalized populations.

The researchers hope the framework they develop will help decision-makers better understand how they can responsibly use resources to improve prevention and diagnosis of the disease and, in turn, improve health outcomes.

Faces of Temerty Medicine: Gazelle Halajha

Christopher.Sorensen — Tue, 12 Sep 2023 18:22:44 +0000

Faces of Temerty Medicine: Gazelle Halajha

Christopher.Sorensen Tue, 09/12/2023 - 14:22

Cutline

"During my surgery rotation at Sunnybrook’s trauma centre, I got to see and do so much," Halajha says. "I never felt more useful." (supplied image)

Deanna Cheng

Topic

Sunnybrook Health Sciences Centre

Student Experience

Gazelle Halajha, now entering her fourth year of medical school at the University of Toronto, believes it's important for doctors to recognize “when someone is struggling and needs more support.”

She witnessed those challenges first hand as her mother and “biggest role model” worked to give her children the best life possible, following the death of their father.

“I grew up in a single parent household and saw how often people in these situations can struggle to access care,” Halajha says. “I saw my mom’s health and well-being suffer as she worried about her next paycheque and how to provide for her children.”

The aspiring surgeon has conducted research in chemotherapy, quality improvement in trauma surgery and women’s health while working to help cover the cost of her education. Alongside the inspiration and support provided by her mother, Zena, she attributes her achievements and ability to balance her busy schedule to the support of multiple student awards.

She spoke with writer Deanna Cheng about what drew her to medicine and her dreams for the future.

Why did you decide to pursue medical school at the Temerty Faculty of Medicine?

I was born and raised in Toronto – my mom and my entire family lives here. When I was applying for medical school, I was looking at what was close to home and what fit my needs, as well as the kind of doctor I wanted to become. I wanted to be able to work in a place like Toronto, where there are people from all different walks of life coming into its hospitals who need help. Temerty Medicine trains you as a physician to recognize when someone is struggling and needs more support and that was big for me. It's a school that reflects my values.

What kind of doctor do you want to become?

I want to become a doctor who is inclusive and self-aware. I grew up in a single-parent household and saw how often people in these situations can struggle to access care. I saw my mom’s health and well-being suffer as she worried about her next paycheck and how to provide for her children.

What inspired you to become a doctor?

I always say that I wouldn't be anywhere in life without my mom. I learned through her what it meant to persevere and to be dedicated to what you love. My mom was 30 years old when my dad passed away in a car accident. To her, all that mattered was that she was working towards giving her two kids the best life possible. She is my biggest role model.

Now that you’re entering your fourth year of medical school, what can you tell me about your experience?

In my third year, I had my surgery rotation very early on and basically fell in love with the specialty. I know for certain it's what I want to do. During my surgery rotation at Sunnybrook’s trauma centre, I got to see and do so much. I never felt more useful. I soon realized that what I had a passion for was surgery especially in the areas of surgical oncology, breast cancer and trauma surgery.

Tell me more about your research in surgical oncology.

In my second year of the MD Program, I started working in the area of breast cancer. I found I was really interested in the surgical aspect of breast cancer treatment as well as in medications used and the effects they have on the body. I was mentored by and worked with Dr. Husam Abdel-Qadir, assistant professor of medicine at the University of Toronto and a staff cardiologist at Women's College Hospital, doing research related to chemotherapy and its cardiotoxicity. A lot of breast cancer patients are in their 20s and may wish to have children one day. I wanted to look at how chemotherapy affects egg fertilization and what it means for these patients. I’ve also started looking at caesarean section scarring. I haven't figured out exactly what I want to do in general surgery, but I just know that that feeling of excitement is something that I want to work towards.

You are also interested in trauma surgery. Can you tell me more about that?

While I was at Sunnybrook’s trauma centre, I saw patients coming in after experiencing vehicle accidents, shootings and stabbings. It's remarkable what these teams do to help patients in the operating room, while making sure their families are well supported. I lost my father quite young due to trauma from a car accident in Iran. The health-care system there is not the same as it is in Canada. Growing up, I spent a lot of time thinking about what would have happened to my dad if he had the car accident somewhere else in the world where the trauma response is faster. I'm curious to see what other parts of the world are like and am excited to take my knowledge and my skills to trauma centres around the world and to bring my experience back here, to Canada.

You received the T.S. Butcher Bursary and the Frank William Moore Award in Medicine from the Temerty Faculty of Medicine. In what ways has donor support helped bring you closer to this dream?

I committed to putting myself through school because my mom was a single parent. Medical school is costly, so I worked part time for my first two years. I was a nanny, I worked in retail, I also worked as an autism support worker at Woodview Mental Health and Autism Services and in research at Women's College Hospital. I was so thankful to have help from scholarships and bursaries, which made a huge difference. It was challenging to balance work with school and with my other extracurriculars. Support from donors meant I could focus more on my education and on myself and my well-being. Thanks to donors, I can dedicate my energy to learning and supporting patients and becoming a better doctor.

What has been your most memorable moment at Temerty Medicine so far?

One highlight was a Health Systems Research (HSR) course. I focused on types of cancers, like pancreatic cancer, which are caught so late in the game and are very devastating and very hard to recover from. A lot of my research was looking at young patients who receive chemotherapy treatments, and who later on have side-effects like heart failure. I wanted to investigate screening guidelines for these cancers. The research project yielded that lymphoma patients are at greater risk of cardiovascular events after treatment with chemotherapy. I created an abstract and was able to present it at the American College of Cardiology (ACC) annual meeting presentations. Now, we’re talking about creating guidelines that can be implemented across Toronto.

What do you think lies ahead for you?

Coming into medicine, my goal was to always, ultimately, give back. I hope that when I become a surgeon, I can make sure my patients are well supported and have adequate follow-ups. While I was clerking, I saw a lot of interdisciplinary work being done (involving social workers, occupational therapists, physical therapists, etc.). Many teams would come together to support individual patients. I hope my journey will include more training as part of interdisciplinary teams, so I can learn from different kinds of health professionals and take that knowledge to other hospitals.

Discovery of new gene mutation could play a role in breast cancer prevention: Study

Christopher.Sorensen — Mon, 03 Apr 2023 16:22:03 +0000

Discovery of new gene mutation could play a role in breast cancer prevention: Study

Christopher.Sorensen Mon, 04/03/2023 - 12:22

Cutline

(photo by Michael Hanschke/picture alliance via Getty Images)

Heidi Singer

Topic

Breaking Research

Cancer

An international team of researchers have discovered a new genetic mutation that could help predict the likelihood of hereditary breast cancer.

The discovery, published in the American Journal of Human Genetics, sprang not from the latest technology, but from decades-long research relationships that spanned continents.

Mohammad Reza Akbari

Mohammad Reza Akbari, a cancer researcher at Women’s College Hospital and professor of genetic epidemiology at the University of Toronto’s Dalla Lana School of Public Health, says he and his colleagues in Poland identified the mutation in a gene called ATRIP by working with a highly homogenous population of Polish breast cancer patients.

That, in turn, helped them to spot what might have been impossible to see otherwise.

“People say discovering a cancer-causing mutation is like finding a needle in a haystack,” says Akbari. “But I think it’s more like finding a specific piece of hay. The low-hanging fruit has already been picked, but we still don’t know what causes breast cancer in at least one-third of families with generations of cases.”

In 1994, an international group of scientists, including Akbari’s colleague Steven Narod, a senior scientist at Women’s College Hospital and a professor at Dalla Lana School of Public Health and in the Temerty Faculty of Medicine, discovered the BRCA1 and BRCA2 gene mutations that cause breast cancer in the vast majority of women who carry them. It was a momentous finding. But BRCA1/2, together with a small cluster of subsequently uncovered gene mutations only account for two-thirds of breast cancers that run in families.

For the other third, there has been no test to help members make decisions about how to protect themselves with procedures like preventative mastectomies.

It has been years since a new gene has been identified in the breast cancer world. The remaining mutations might lurk in the lesser-known quarters of our genomes or would be more rare than BRCA mutations or less obviously tied to breast cancer. But Akbari and his colleagues in Poland had something very valuable: access to a “founder” population of patients – a large group of people whose genetic mutations are magnified because they are descended from a small group. Founder populations exist in many parts of the world such as Quebec, Iceland and Poland.

Starting in 1998, the familial breast cancer research team, led by Narod, had established ties with Polish scientists, allowing the Women’s College Hospital group access to a founder population of breast cancer patients. After joining Women’s College Hospital a decade ago, Akbari cultivated these ties, working collaboratively with Cezary Cybulski at Pomeranian Medical University to establish a large breast cancer recruitment program – and making sure to visit frequently.

The two research groups clicked.

“They’ve been great collaborators,” says Akbari, of the Polish group, along with fellow researchers Jean-Yves Masson and Amir Abbas Samani, from Laval University and �鶹��Ƶ respectively. “There was no ego involved, just a willingness to work together. I’ve never seen such a thing anywhere else. We made a great team.”

Akbari and his colleagues sequenced the genomes of about 500 Polish breast cancer patients, plus a control group, and validated the preliminary findings with more than 25,000 breast cancer patients and controls from Poland. He found his smoking gun: a genetic mutation associated with more than a 100 per cent increased risk of breast cancer in the women studied. But the risk estimation was based on a single founder mutation in a gene known as ATRIP. Next, they searched for the mutations in the UK Biobank, which contains half a million genomes from a more diverse group of people. In that population, the relationship between the mutation and the likelihood of developing breast cancer was even stronger – more than 200 per cent.

The mutation is rare – affecting only 0.25 percent of breast cancer patients in the study. But the team made a parallel discovery that could help tailor treatments to the next generation of breast cancer patients. They found that the breast tumours of the patients with a germline ATRIP mutation had a hallmark trait indicating they would respond to an existing class of targeted therapies called PARP Inhibitors. And this could apply to an even wider group.

If a breast cancer patient doesn’t have the ATRIP mutation in their germline DNA, the mutation might still appear in their tumors, meaning they could potentially respond to PARP inhibitors.

“These are preliminary data and more research needs to be done before being able to use it in clinic,” Akbari cautions. “But it shows that the finding can have implications for a greater number of people.”

Akbari is hopeful about the public health ramifications since breast cancer is the leading cause of cancer death in women around the world.

“When we understand why breast cancer occurs in families, we can easily screen all the members and determine who is at high risk and who’s not,” says Akbari. “If the risk is big enough, women can choose preventive surgeries or more aggressive screenings to detect it earlier. And every gene we identify will improve our general knowledge of breast cancer biology – which will pave the road for developing more effective targeted treatment of breast cancer in all patients.”

'A creative perspective': Neurologist Suvendrini Lena on her path to playwriting

Christopher.Sorensen — Mon, 13 Mar 2023 21:12:38 +0000

'A creative perspective': Neurologist Suvendrini Lena on her path to playwriting

Christopher.Sorensen Mon, 03/13/2023 - 17:12

Cutline

Suvendrini Lena, an assistant professor in �鶹��Ƶ's Temerty Faculty of Medicine, bridges the gap between medicine and theatre in her work as a playwright (photo courtesy of Suvendrini Lena)

Tabassum Siddiqui

Topic

City & Culture

Suvendrini Lena has a foot in two worlds: she’s a staff neurologist at Women’s College Hospital and an assistant professor of neurology and psychiatry in the University of Toronto’s Temerty Faculty of Medicine – and a successful playwright.

After earning a B.A. in history and political science as an undergraduate student at Trinity College, Lena went on to a graduate degree in neurology at �鶹��Ƶ – all while exploring her longstanding interest in theatre and writing.

But the path to writing her first play was a bit of a surprise – certainly to her neurology professors. Instead of presenting a final research project, she wrote a piece of theatre – The Enchanted Loom – that explored the experience of a patient with epilepsy. It was later produced by Toronto’s Cahoots Theatre and published as a book.

Since then, Lena has continued to work in both medicine and theatre – her latest play, Rubble, is currently on stage at Theatre Passe Muraille until March 18. A dramatic imagining of the works of Palestinian poets Mahmoud Darwish and Lena Khalaf Tuffaha, the play was inspired by Lena’s work in Gaza in 2002 while still a medical student. Years later, Tuffaha’s poetry reminded her of the struggles – and the rubble – she witnessed while there.

Including fellow �鶹��Ƶ alumni Roula Said and Lara Arabian among the cast of five, Rubble unfolds in Gaza as a mother and her family receive a life-changing call: they have 58 seconds to leave their home before an explosion. Drawing on the poems of Darwish and Tuffaha, Lena examines the meaning of poetry amidst a state of siege.

Lena spoke to �鶹��Ƶ News about how her university experience informed her path to bridging the gap between medicine and the arts.

You’re a neurologist by training but now also a playwright – how did you find your way from medicine to theatre?

I always wanted to be a writer. In the neurology program at �鶹��Ƶ, you have to do a big research project in your last year of the program, but I realized my heart wasn’t really in research. I’m definitely interested in understanding things well and the arts are another way to do that – you get to interrogate something, but from a creative perspective. I ended up writing a play about a Sri Lankan patient with a complex case of epilepsy and all the difficult choices facing him and his family as a result of his illness. So that became the centre of my first play.

What was your professors’ reaction when you asked to submit a play as your final project instead of a research paper?

There’s an art to pitching – it’s about taking an idea that has legs and having people understand and feel invested. So, I think I did that convincingly and I had open-minded supervisors – I was very lucky that way. I had great support and supervision, and we presented a reading from that play at the research presentation at the end of the year. The audience gave it a standing ovation. I think there was something compelling for them because they could see themselves depicted in a very human way. Doctors are so often portrayed in a one-dimensional way in TV and film, so I try not to do that myself.

What inspired you to write Rubble?

I’m a lover of poetry – especially these two particular poets; their lyrical poems exist on many levels. You have to hear it out loud to be able to appreciate the meaning – the poems also give you a window into the humanity of people who might feel distant from you, but you can see that’s not the case. I felt like it was a doorway to explore and give voice to the Palestinian experience – in the last 60 years, they have been displaced and under occupation, and there’s been very little clarity about that historical experience; very few places for them to really tell their story. So, the play is trying to create that space as well.

Lara Arabian in Rubble (photo courtesy of Theatre Passe Muraille/Aluna Theatre)

When you think back to your �鶹��Ƶ studies, were there any mentors or faculty who made an impact on your educational and career path?

In my neurology program, Marika Hohol [Unity Health] and Richard Wennberg [University Health Network] were people I learned a lot from and who supported me. And during my undergrad years, I took courses in English and modern drama, including with an amazing professor, Alexander Leggatt – that’s really where my love of theatre was nurtured. He opened up the world of drama to many, many people. He was interested in ethics, philosophy and poetry – and really made it all accessible to us.

Left to right: Roula Said, Lara Arabian and Sam Khalilieh in Rubble (photo courtesy of Theatre Passe Muraille/Aluna Theatre)

How did your time at �鶹��Ƶ help shape the work you do today?

I first studied history and political science, but got heavily into theatre when I directed plays with the Trinity College Dramatic Society. Afterwards, I swore I would never direct anything again – everything was so complicated! But I got to understand that when you study a text as a director, it’s a completely different experience than reading it in class, right? You step into building a theatrical world – which is what playwriting and theatre-making is all about.

How does your work as a doctor intersect with your work as a playwright?

In medicine, we deal with a lot of very difficult things all the time – and there's a bit of trauma in there. If you empathize with your patients, then you can’t help but witness suffering. These are very moving things and you’ve got to stay open and alive to all that. I need an outlet – writing provides me with that outlet and theatre is special because you can explore human issues and relationships in a unique way. All kinds of writing can touch on that, but when something is written for the theatre and embodied by an actor, it gives an added dimension of reality.

What’s your approach to teaching?

I mostly do small-group teaching in the medical school curriculum and a seminar on medicine and the humanities. This semester, we’re doing a staging where we explore medical experiences and how physicians examine their own subjectivity. We also try to engage with issues of contemporary relevance, including issues of voice and representation in medicine and society.

President’s Impact Awards recognize far-reaching contributions of �鶹��Ƶ researchers

Christopher.Sorensen — Fri, 10 Mar 2023 16:30:23 +0000

President’s Impact Awards recognize far-reaching contributions of �鶹��Ƶ researchers

Christopher.Sorensen Fri, 03/10/2023 - 11:30

Cutline

(photo by Nick Iwanyshyn)

Topic

Institute of Health Policy Management and Evaluation

Unity Health

Munk School of Global Affairs & Public Policy

President's Impact Award

Creative Destruction Lab

Faculty of Applied Science & Engineering

Faculty of Arts & Science

Hospital for Sick Children

Mathematics

Ontario Institute for Studies in Education

Rotman School of Management

University Health Network

Lawrence S. Bloomberg Faculty of Nursing

From informing Ontario’s pandemic response to shaping the fields of education, social policy, robotics and entrepreneurship, the University of Toronto is recognizing researchers for the impact of their work across Canada and beyond.

Among the winners of this year’s President’s Impact Awards – which honour individual �鶹��Ƶ faculty members and teams for research that has led to significant impacts beyond academia – are 13 leaders of the Ontario COVID-19 Science Advisory Table.

The group was recognized as a team for “outstanding contributions and dedication to supporting evidence-informed decision making and response to the COVID-19 pandemic in Ontario and nationally.”

Fahad Razak

Fahad Razak, who served as the Science Table’s scientific director, says he is grateful to be celebrated alongside his colleagues, noting that it was only through their collective expertise and efforts that the Science Table was able to provide transparent scientific analysis and evidence-based, equity-minded guidance in response to an ever-shifting crisis.

“I'm really happy that University of Toronto has recognized that much of the consequential work that is done is not done by individuals – it's done by teams,” says Razak, an internist and epidemiologist at St. Michael’s Hospital, Unity Health Toronto and an assistant professor in the department of medicine in �鶹��Ƶ’s Temerty Faculty of Medicine and at the Dalla Lana School of Public Health’s Institute of Health Policy, Management and Evaluation (IHPME).

“That multidisciplinary composition of our table was one of the critical drivers of success of putting out modelling scientific briefs or other recommendations that were thoughtful and comprehensive about the effects that could happen across society.”

The other Science Table members sharing the honour with Razak are:

Peter Jüni, an affiliate scientist at Li Ka Shing Knowledge Institute, Unity Health, who was the table’s scientific director and a professor of medicine and epidemiology in the Temerty Faculty of Medicine and IHPME before leaving for University of Oxford in 2022.
Co-chairs Adalsteinn Brown, dean of the Dalla Lana School of Public Health, Brian Schwartz, a professor in the department of family and community medicine in the Temerty Faculty of Medicine, and Upton Allen, the head of infectious diseases at the Hospital for Sick Children and a professor of pediatrics in the Temerty Faculty of Medicine and at IHPME.
Assistant scientific directors Nathan Stall, a physician at Sinai Health and an assistant professor in the Temerty Faculty of Medicine, and Karen Born, assistant professor of health administration at IHPME.
Director of communications Robert Steiner, assistant professor and director of the Dalla Lana Fellowship in Global Journalism at the Dalla Lana School of Public Health.
Modelling consensus table co-chairs Beate Sander, a senior scientist at the Toronto General Hospital Research Institute, University Health Network, and a professor at IHPME, and Kumar Murty, a professor of mathematics in the Faculty of Arts & Science.
Chair of the congregate care setting working group Paula Rochon, senior scientist at the Women’s College Hospital Research Institute and professor in the Temerty Faculty of Medicine
Co-chair of the drugs and biologics clinical practice guideline working group Andrew Morris, medical director of the antimicrobial stewardship program at Sinai Health/University Health Network and professor of medicine in the Temerty Faculty of Medicine.
Mental health working group chair Linda Mah, a senior clinician scientist at the Rotman Research Institute, Baycrest Health Sciences Centre and an associate professor of psychiatry in the Temerty Faculty of Medicine.

The team joins four other �鶹��Ƶ researchers recognized this year. They are:

Ajay Agrawal, professor of strategic management and Geoffrey Taber Chair in Entrepreneurship at the Rotman School of Management. He is recognized for his “application of economic theory to the problem of market failures associated with transforming scientific inventions into scalable companies that benefit society,” which inspired the founding of the Creative Destruction Lab – a model that has been adopted by business schools around the world.

George Dei, professor in the department of social justice education at the Ontario Institute for Studies in Education. Dei was recognized for his “influential work advancing anti-racism, equity, anti-colonial thought and African Indigeneity in education and sustained impact on policies, practices and advocacy for inclusive schooling and Black youth’s educational success.”

Yu Sun, a professor in the department of mechanical and industrial engineering in the Faculty of Applied Science & Engineering and founding director of �鶹��Ƶ’s Robotics Institute. He is honoured for “outstanding contributions to robotics at micro-nano scales, whose far-reaching impacts include transformative infertility treatments for patients and materials characterization techniques for industry.”

Ito Peng, a professor of sociology in the Faculty of Arts & Science and the Munk School for Global Affairs & Public Policy. She is credited for global “social policy leadership informing national and international policy bodies on issues of gender, the work of care and care migration.” Peng, whose expertise has been sought out by policymakers across the globe, was also named the recipient of the Carolyn Tuohy Impact on Public Policy Award, presented annually to a faculty member whose scholarship has had a significant impact on public policy as part of the Awards of Excellence Program.

Winners of the President’s Impact Award are designated as members of the President’s Impact Academy, which advocates for sustained excellence in research and innovation impact within and outside of the university.

“These awards represent how �鶹��Ƶ’s research community is coming together tackle some of today’s toughest problems and making breakthroughs that result in real-world change,” says Leah Cowen, �鶹��Ƶ’s vice-president, research and innovation, and strategic initiatives.

“From global issues to micro-scale innovations, this year’s laureates have shown themselves to be visionaries in their respective fields and consummate collaborators – working with scholars across disciplines and partnering with community members, public stakeholders, industry leaders and policymakers to address our current challenges and drive progress toward a brighter future.”

Genetic testing is important for women with breast cancer, expert says

Christopher.Sorensen — Mon, 31 Oct 2022 18:19:10 +0000

Genetic testing is important for women with breast cancer, expert says

Christopher.Sorensen Mon, 10/31/2022 - 14:19

Cutline

(Photo by fstop123/Getty Images)

Topic

For close to two decades Professor Kelly Metcalfe, a senior scientist at Women’s College Research Institute and associate dean of research at the University of Toronto’s Lawrence S. Bloomberg Faculty of Nursing, has explored better treatment paths for women diagnosed with breast cancer – specifically those with the BRCA1 and BRCA2 genetic mutation.

Helping women at this vulnerable stage in their cancer journey navigate their treatment options, which can include decisions about undergoing breast conserving surgery or double mastectomy, has a significant impact on their psychosocial well-being and their rates of survival. To make a well-informed decision, Metcalfe says women need to understand their options and what she calls their “genetic status.”

“Most women who receive a breast cancer diagnosis are not aware that they have a genetic mutation,” says Metcalfe of the need for broader access to genetic testing. “We know from previous evidence that those who do have the BRCA1 or BRCA2 mutation should receive different treatment for their cancer as it may impact their survival.”

Bloomberg Nursing’s Rebecca Biason recently spoke with Metcalfe about an alternate model of care using Direct Rapid Genetic Testing (DRGT) that she and her team are currently evaluating. Metcalfe also shares how her pilot study could help bring genetic testing and changes to treatment decisions to high-risk Canadians when they need it most.

What does this new model of care look like and how does it support a woman diagnosed with breast cancer?

This proposed alternate model of care sees women who have received a breast cancer diagnosis self-refer for Direct Rapid Genetic Testing, or DRGT. Following a brief phone conversation, they are sent an at-home saliva kit, they spit into a tube and they mail in their specimen. Results can be received within a week.

What makes this process more accessible is that women can conduct the test from the comfort of their homes and without having to first speak with a genetic counsellor. Instead, they are provided with access to virtual information, videos and counselling sessions that decrease the amount of time needed for them to make an informed decision about their surgical options. We are, in essence, revolutionizing the way we provide genetic testing to these women.

What are the benefits for a woman who is considered high-risk of having a genetic mutation?

In traditional models of care, genetic testing is provided through a genetic testing clinic. Generally, these clinics are located in large urban centres that can limit access for many Canadians. There are also a few more steps involved that can seem daunting for someone who has just been informed they have cancer. Patients are required to meet with genetic counsellor, pay for parking and meet with their surgeon and oncologist. It can make it difficult for someone to make decisions about their care plan.

Understanding your risk and genetic status is an important part of the treatment process. For the average woman with breast cancer, having a lumpectomy and radiation results in a similar survival rate for a woman who chooses to undergo a bilateral mastectomy. However, our research has shown that women with the BRCA 1 or BRCA 2 genetic mutation should have a bilateral mastectomy because it increases their rate of survival due to the high risk of developing a new breast cancer.

What’s next for this model of care?

We are currently in the evaluation phase and are testing this new model to make sure women are satisfied and that they understand the information they are receiving. We are also evaluating how better access to genetic testing impacts treatment decisions.

In our previous research – which focused on offering genetic testing at diagnosis but through a different process that included a blood test and meetings with a genetic counsellor – we were able to show that 80 per cent of women who were found to have a mutation did elect to have a bilateral mastectomy.

We have also found evidence that there is no negative psycho-social outcome for women by providing genetic testing at time of breast cancer diagnosis. The majority want to know.

With respect to our current trial and study, our hope is to be able to provide evidence to policymakers that this is an effective model to provision treatment at the time of breast cancer diagnosis. If it were up to me, every woman would have access and I need to see that change. But in order to make that a reality, we need evidence to support [the idea] that this model of care – and this change in how treatment decisions are made – would be beneficial to patients.

Researchers highlight the critical role of Ontario's primary care providers during the pandemic

Christopher.Sorensen — Tue, 04 Oct 2022 13:29:00 +0000

Researchers highlight the critical role of Ontario's primary care providers during the pandemic

Christopher.Sorensen Tue, 10/04/2022 - 09:29

Cutline

(Photo by Geber86 via Getty Images)

Alisa Kim

Topic

COVID-19

Unity Health

Primary care providers have a critical role to play in the pandemic – and improving access to that care is key, say researchers from the Ontario COVID-19 Science Advisory Table.

The researchers released a three-part brief (part 1, part 2 and part 3) this week detailing the work of primary care providers during the first two years of the pandemic.

The brief, which has been widely reported, outlines issues affecting primary care in Ontario and offers lessons learned to improve access to primary care.

“The pandemic is not over, and COVID-19 is increasingly an illness that will be managed in the community, supported by family doctors, nurse practitioners and primary care teams,” said Danielle Martin, a clinician and teacher at Women’s College Hospital who is chair of the department of family and community medicine in �鶹��Ƶ’s Temerty Faculty of Medicine.

“The Science Table wanted to understand the evidence base around the contributions of primary care to the pandemic response so far, as well as current strengths and challenges that will affect response to future waves. At this time it is critical to understand the lessons learned from the last two and a half years.”

Core authors of the brief, which was concieved by Martin, include experts in primary care from across Ontario with a wide variety of backgrounds, including Imaan Bayoumi, Azza Eissa, Noah Ivers, Tara Kiran, Derelie Mangin, Sarah Newbery, Andrew Pinto and Kamila Premji. The team analyzed more than 200 articles for the research and consulted other experts broadly in its work.

The release of the briefs is the last official act of the Ontario COVID-19 Science Advisory Table. Composed of scientific experts and health system leaders, the advisory table evaluated and reported on evidence relevant to the pandemic to guide Ontario’s response.

Research shows health systems with strong primary care have better health outcomes and improved health equity at lower cost, which makes an examination of the lessons learned about primary care in the pandemic a fitting capstone activity for the Science Table.

The three-part brief involves dozens of researchers and primary care experts from across Ontario, Canada and internationally. It outlines the evidence on how primary care clinicians – family doctors, nurse practitioners, pharmacists, social workers and other allied health care providers – took on new roles and worked more days to support COVID-19 care in addition to their routine clinical work, which includes preventive, chronic and acute care.

Primary care clinicians in Ontario assumed new responsibilities such as: COVID testing, assessment and isolation; vaccine counselling and delivery; and treatment prescribing, referral and post-COVID-19 acute care. They also aided other areas of the health system such as in emergency departments, intensive care units and long-term care, and assisted people experiencing mental health issues as well as poverty and food insecurity.

“As misinformation rises around COVID-19, primary care clinicians are highly trusted members of their communities – they are an invaluable resource for conveying fast-changing scientific developments around prevention and treatment of COVID-19 to the public,” said Fahad Razak, scientific director of the Ontario COVID-19 Science Advisory Table, who is a clinician-scientist at St. Michael’s Hospital, Unity Health Toronto, and an assistant professor in the Temerty Faculty of Medicine and at the Dalla Lana School of Public Health.

Ontario faces a significant challenge in keeping up with demand for primary care, the researchers note. About 1.8 million Ontarians do not have a regular family doctor, with new immigrants and people living on low incomes least likely to have one.

Moreover, 1.7 million Ontarians have a family doctor who is of retirement age. Compounding this shortage is the decline in medical school graduates choosing to specialize in family medicine. These challenges, along with inequitable access to team-based care, shape the ability of primary care to respond to future pandemic waves and support health system recovery.

Based on their findings, the researchers outlined several lessons learned:

Care provided in formal attachment relationships and through team-based models provides superior support for COVID-19- and non-COVID-19-health issues in the community.
In the absence of additional resources, COVID-19 response results in tradeoffs and unmet needs in other areas.
Innovative models and new partnerships supported patients to get needed care, but infrastructure is needed for sustainability, spread, and scale.
The absence of an integrated data system compromised the pandemic response in primary care.
Primary care can leverage its longitudinal relationships to achieve public health aims.

Martin says the ultimate goal of the work is to provide evidence to help decision-makers, including governments, professional associations and front-line providers, to improve the ongoing pandemic response.

“We’re in a state where we’re facing significant health human resources shortages, inequitable access to teams and uncertainty about the future,” Martin said. “My hope is that the crisis we’re facing will motivate all leaders in the system to look to the evidence about how we can best improve access to high-quality primary care for all Ontarians.”

Four reflections from Elder Cindy White on National Day for Truth and Reconciliation

Christopher.Sorensen — Fri, 30 Sep 2022 13:19:44 +0000

Four reflections from Elder Cindy White on National Day for Truth and Reconciliation

Christopher.Sorensen Fri, 09/30/2022 - 09:19

Topic

Truth and Reconciliation