Mount Sinai Hospital

Institutional Strategic Initiatives

Monkeypox

Sinai Health

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 ��ֱ��’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 The study, which has not yet been peer-reviewed, suggests that the greatest number of infections could be prevented by prioritizing vaccines to bigger cities with larger networks of communities at risk, the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 ��ֱ��’s Temerty Faculty of Medicine.

Mishra and Tan are also co-leads of EPIC’s monkeypox rapid research response. EPIC is one of several ��ֱ�� 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 ��ֱ��, 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.”

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

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

��ֱ�� 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

Sinai Health

Faculty of Arts & Science

Massey College

Meric Gertler

Munk School of Global Affairs & Public Policy

Queen

Royalty

St. George

Thomas Fisher Rare Book Library

��ֱ�� Libraries

��ֱ�� Mississauga

��ֱ�� 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 ��ֱ�� 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.

��ֱ�� President Meric Gertler said the ��ֱ�� 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, ��ֱ�� Mississauga, St. George and ��ֱ�� 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 ��ֱ�� 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 ��ֱ�� 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 ��ֱ�� 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 ��ֱ�� 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 ��ֱ�� 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 ��ֱ��’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 ��ֱ��’s 175^th anniversary. During the celebrations, the Queen visited a ��ֱ�� 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 ��ֱ�� Mississauga’s Office of Communications, who was present at the ��ֱ�� 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 ��ֱ�� 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 ��ֱ��’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 ��ֱ�� 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.

��ֱ��’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 ��ֱ�� chancellor from 1947 to 1953.

Letters written by the Queen to Massey – and preserved at ��ֱ��’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 ��ֱ�� – and share tips for future students

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

Medical school grads reflect on their time at ��ֱ�� – 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

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 ��ֱ��. 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

Cutline

Erin Bearss, chief of family medicine and an ER doctor at Mount Sinai Hospital, is pictured last spring in the vaccine clinic at ��ֱ��'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 ��ֱ��’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 ��ֱ��’s department of family and community medicine in the Temerty Faculty of Medicine.

She spoke to ��ֱ�� 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.

��ֱ�� is also offering COVID-19 vaccinations at the Discovery Pharmacy at the Leslie Dan Faculty of Pharmacy, where members of the ��ֱ�� community who do not have an Ontario Health Card – such as international students – can register for an appointment. ��ֱ�� 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 ��ֱ�� Mississauga in partnership with Trillium Health Partners and Peel Public Health last spring, a regular pop-up clinic at ��ֱ�� 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 ��ֱ�� 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.

��ֱ�� 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 ��ֱ�� 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: ��ֱ�� study

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

Female patients operated on by male surgeons more likely to die, suffer complications: ��ֱ�� 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 ��ֱ�� 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: ��ֱ��’s EPIC consortium

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

Preventing the next pandemic: ��ֱ��’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 ��ֱ��'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

The University of Toronto’s Combined Containment Level 3 (C-CL3) unit, equipped to safely study pathogens that cause infectious disease, was among the first labs in Canada to enable researchers to work with SaRS-CoV-2 samples.

While similar facilities elsewhere had closed after the 2003 SARS outbreak, the ��ֱ�� lab remained open – supporting a vast research community including academic, hospital and industrial research needs – and was able to make a significant contribution to understanding and addressing the COVID-19 pandemic.

Now, the 20-year-old lab is also the heart of the Emerging and Pandemic Infections Consortium (EPIC) – a new ��ֱ�� Institutional Strategic Initiative (ISI) that will unite top university, hospital and global experts in infectious diseases, as well as other fields.

The goal? Prepare for future pandemics.

Scott Gray-Owen, a professor of molecular genetics in the Temerty Faculty of Medicine and academic director of the C-CL3 facility, is eager to bring together everyone from cancer researchers to policy-makers – along with the next generation of student researchers – to study the lessons of COVID-19.

“As the Emerging and Pandemic Infections Consortium comes together, we want [researchers] to be thinking about infection broadly – from molecular biology to aerosol transmission, to clinical intervention, harnessing immune responses and manufacturing,” he says.

EPIC’s hospital partners include the Hospital for Sick Children, Unity Health Toronto, Sunnybrook Health Sciences Centre, University Health Network and the Lunenfeld-Tanenbaum Research Institute at Sinai Health.

Emerging and Pandemic Infections Consortium (EPIC)

Combat infectious diseases
Prevent future pandemics
Advocate for science-based policies
Train future infectious disease leaders

From petroleum to public health: ��ֱ�� Nursing grad embarks on second career

rahul.kalvapalle — Thu, 18 Nov 2021 16:42:45 +0000

From petroleum to public health: ��ֱ�� Nursing grad embarks on second career

rahul.kalvapalle Thu, 11/18/2021 - 11:42

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After more than a decade working in Canada's oil sands, ��ֱ�� grad Jacqueline Wetton decided to launch a new career in nursing (photo courtesy of Jacqueline Wetton)

Rahul Kalvapalle

Topic

Lawrence S. Bloomberg Faculty of Nursing

Convocation 2021

With a degree in engineering and over a decade of experience working for some of Canada’s largest oil sands producers, Jacqueline Wetton built a strong foundation for a long career in the oil and gas industry.

But two years ago, the mother of two decided to leave it all behind and start over as a nurse – in part due to the circumstances surrounding the birth of her first child, but also because of a nagging feeling that the oil and gas business ultimately wasn’t a good fit.

So, she enrolled in the bachelor of science program at the University of Toronto’s Lawrence S. Bloomberg Faculty of Nursing.

“It sounds really cliché, but I wanted my children to see me doing something that made a difference in people’s lives everyday,” says Wetton, 37, of her decision to switch careers. “I felt that I wasn’t doing that in my previous job.”

Going back to school while raising a young family was tricky enough, but Wetton – like all ��ֱ�� students – also had to navigate an unexpected and unprecedented challenge: a global pandemic. Yet, she still managed to earn the Dean’s Medal, the highest academic honour offered by the faculty.

Wetton graduated with her first degree in environmental engineering from Dalhousie University in 2008, at the height of the oil sands boom. She and her husband, whom she met at Dalhousie, settled in Alberta and established careers in oil and gas. But working in an industry that is contributing so directly to climate change didn’t sit right with them.

“Something we talked about a lot and always struggled with was the moral issue of working for oil and gas,” says Wetton. “We tried to justify it to ourselves by saying, ‘Well, the world needs energy’ or ‘If we weren’t doing this job, somebody else would be.’”

Jacqueline Wetton is pictured with her two sons, Nash (left) and Milo (right), and the Dean’s Medal from the Lawrence S. Bloomberg Faculty of Nursing (photo courtesy of Jacqueline Wetton)

She also endured struggles as a woman in a male-dominated environment.

“I was very stressed at times trying to hold my own with guys that were my dad’s age or older telling me ‘I don’t have to listen to you’ and that sort of thing.”

Eventually, the couple moved to Toronto to be closer to family, while maintaining their jobs in Alberta and regularly flying out to their work camp north of Fort McMurray.

They also decided to start a family of their own, with Wetton becoming pregnant in late 2014.

In late April 2015, while her husband was in Alberta for his camp rotation, Wetton’s water broke a month prematurely. She was rushed to what is now Michael Garron Hospital to give birth while her husband scrambled to get a flight back to Toronto.

She says the experience of being helped through a successful premature birth was one of the factors that ultimately nudged her toward a career in nursing.

“Even though it was stressful dealing with the uncertainties of what was going on, having those medical professionals – especially the nurses, because they’re the ones who are there round the clock, checking on you every hour, providing emotional support and doing a lot of the hands-on tasks – was really eye-opening to me.”

In 2017, Wetton became pregnant for the second time and went on maternity leave. By then, her husband had quit his engineering job and started his own business – but Wetton still had to figure out her next career move.

At the time, her younger sister was starting a career as a nurse. Wetton recalls a conversation with her that had a huge impact.

“[It was] this sentiment she had of like, ‘Even when I have a really bad day at work, I come away from it feeling like at least I helped somebody and I made a difference in their life that day,” she says. “I really admired that, and it was something that made me think, ‘Geez, if I could go back and do it all over, maybe I should’ve done nursing.’”

And so she did. Wetton settled on the Lawrence S. Bloomberg Faculty of Nursing’s two-year bachelor of science, a second-entry program that caters to students with previous university education and career experiences.

She says the first fall semester was relatively smooth sailing. But by the time winter set in, Wetton was in clinical environments on a regular basis and noting something worrisome was around the corner due to COVID-19 – even if she didn’t comprehend the scale of what was to come.

In March 2020, with Toronto experiencing its first pandemic lockdown, Wetton found herself having to run the household and watch the kids during the day and then catch up on recorded lectures late at night.

The following fall and winter would prove to be even more stressful. Wetton was now doing in-person clinical shifts twice a week and worried constantly about potentially exposing her family to the virus. She and her husband could also no longer rely on family or hired help for childcare. “That was really hard. There were a lot of late nights for both of us – just trying to catch up on whatever we didn’t accomplish during the day,” she says.

Then, this past April, Wetton began her 12-week practicum at Mount Sinai Hospital, doing a mix of daytime and evening shifts on a full-time schedule, which meant little time with her kids.

While completing a practicum amid a pandemic brought challenges, it also heightened Wetton’s interest in public health and strengthened her conviction that she belonged in nursing.

“I saw how the social determinants of health can influence why a person might get sick and why certain populations are more affected than others. I saw the benefits of public health and what people in public health can do with the right guidance and influence on the population,” she says. “It cemented my gut feeling that I had when I started the program that this would be a good fit for me.

“I really felt I’d found my spot in the universe.”

Wetton also credits her second-year course, NUR461 (Primary Health Care: Nursing Perspectives), with fostering her interest in community and public health nursing. “You’re looking at things from a holistic, preventative viewpoint. You’re not just engaging with individuals or families – you’re engaging with communities, and there’s a social justice aspect to it as well,” she says. “It just really spoke to me.”

Wetton is now on the lookout for jobs in public health nursing. “I’d really like to get involved with Toronto Public Health or Public Health Ontario,” she says. “I’d like to continue with health promotion, illness prevention and looking at how we can make whole communities of people healthier.”

As she prepares for that first job, albeit in a second career, Wetton says her early fears around leaving engineering, being too old to start a second degree or not fitting in with younger classmates all proved to be unfounded.

“Everybody’s in the program because they want to be a good nurse and they care about other people, and everyone was so supportive,” she says. “The faculty as well were so supportive of people with different work-life situations. They value that expertise because the more viewpoints you can get from people, the more it just enriches everybody’s experience.”

'A Swiss Army knife': Daniel Drucker bets the gut hormone GLP-1 can be used to treat far more than diabetes

Christopher.Sorensen — Wed, 03 Nov 2021 14:28:07 +0000

'A Swiss Army knife': Daniel Drucker bets the gut hormone GLP-1 can be used to treat far more than diabetes

Christopher.Sorensen Wed, 11/03/2021 - 10:28

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A pioneer of gut hormone research that led to therapies for type 2 diabetes, obesity and short bowel syndrome, Daniel Drucker is investigating whether the same hormones can help treat everything from heart disease to Alzheimer's (photo by Johnny Guatto)

Brianne Tulk

Topic

Insulin 100

Diabetes