Day 19: The End Of An Era

Rest and Relaxation is the only thing on our minds for our final weekend. We’re spending the last of our time in the Markwell Holiday Home in
Collingwood, Blue Mountain. “The shack with metal bunk beds” as Chris liked to put it, is beautiful getaway and the perfect place to end our trip.

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-“the shack”

As part of our last couple of days we tried our hands at golf under the tuition of Chris. Even managed to get a few good drives out between us!

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We also went to a lovely Farmers market in the village and of course we ate a lot of samples and bought some nice souvenirs such as maple sugar candies.

We also went to the beach and we tasted lake Huron (I think Chris’s wackiness has rubbed of on us). So we’ve got a little bit of Canada inside of us!

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We then went into the blue mountain village and went on a bobsleigh type ride. It was a lot of fun!

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After the excitement we went up blue mountain and some beautiful views of Collingwood.

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Finally the legendary PS section! We went out for burgers at Kaytoo, Bonnie had a glazed maple chicken burger with Canadian peameal bacon and Canadian smoked chedder. I had the Bison Burger cooked to a beautiful medium rare it was very tasty and juicy.

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We’d both like to give a huge thank you to all the supporters that have made this trip possible. Its an experience that will be impossible for us to forget and the networks we’ve made will be so important for us in the future. The people we’ve met and the things we’ve learned are just incredible.

A special thank you has to be given to Mrs Louise Nicol for helping organise the trip and supporting us and the scholarship to completion

Finally our hosts Dr. Hazel Markwell and the wacky but wonderful Mr. Christopher Markwell thank you so much for organising the hectic but perfectly paced schedule. We’re sad to be leaving but we’ll see you again soon in sunny Scotland!

-Bonnie and Joshua

Day 18: Final day at St. Michaels!

Disclaimer: Most of the information in today’s blog was provided by the researchers and staff at St. Michael’s Hospital and the Li Ka Shing Knowledge Institute who we have been working with. Other information comes from the public domain. We have been registered as student observers here for a few days through the Office of Research Administration

We completed our Tri-Council Policy Statement in Ethical Conduct for Research Involving Humans! We were presented our certificates by the Director of The Centre for Clinical Ethics. (Pictured above)

Our last day in the city began with a meeting with the Rescu research Program. Rescu is the largest research program of its kind in Canada. Their research focuses in deriving and evaluating processes of care and timely interventions that could improve outcomes for patients who suffer life threatening trauma and cardiac emergencies out of hospital setting. The Rescu program works closely with paramedics to research new practices that could help to improve the quality of care given to patients prior to reaching the hospital. One of the studies they conducted was on CPR and how effective the paramedics were at providing it. So, to measure if the CPR being given was reaching the right check points such as depth of compression and volume of oxygen being given between rounds of compression, pads that attached to the body were designed. These pads would give paramedics real time data on the quality of the CPR being given. We also got to practice our CPR skills and see the real time data to check if we we could give a good standard of CPR.

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*The gentleman in the background is Adam, a paramedic and has given us to use a picture with him in it.

We then went to see the medical imaging side of medicine. Our hosts for this portion of our tour round the hospital have provided a short description of what they do.

St. Michael’s department of MRI research has two MRI scanners available for research studies in addition to two clinical scanners. There are 2 Philips 1.5T Intera scanners as well as 2 Siemens 3T Skyra scanners.

In addition to routine neurologic, body, cardiac, and musculoskeletal MRI imaging St. Michael’s department of MRI research has the capability of performing more advanced imaging such as:
· Diffusion Tensor Imaging (DTI)= diffusion tensor imaging is a type of MRI scan that allows physicians to look at this diffusion of water molecules in white-matter tracts.
Advanced methods such as color coding and tractography (fiber tracking) have been used to investigate directionality. Some clinical applications of DTI are in the tract-specific localization of white matter lesions such as trauma and in defining the severity of traumatic brain injury. In surgical planning for some types of brain tumors, surgery is aided by knowing the proximity and relative position of these white matter tracts and a tumor.
· Functional MRI (fMRI)
· MRI Elastography
· MRI Cartilage Imaging

By Kishwar Ali (Research Assistant) and Anthony Sheen (MRI Research Tech.)

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Our final part of the day took place at the Human Eye Bio Bank. The Human Eye Biobank for Research was founded by Dr. Yeni Yucel and Dr. Neeru Gupta at St. Michael’s Hospital. The Bank is a resource of human eye tissue accessible to researchers around the world. With over 2,000 readily available eyes for study, its growing collection includes diseases such as age-related macular degeneration, glaucoma, diabetic retinopathy, corneal disease, cataract, retinitis pigmentosa, pediatric conditions, Parkinson’s, Alzheimer’s, and stroke. All cases are examined by a specialized eye pathologist.
The Human Eye Biobank for Research addresses the problem of a shrinking supply of human eye tissue for research, and will stimulate discoveries into human eye and brain disease. Examples of how the eyes available in the eye biobank can be used are:
– Scientific breakthroughs into human diseases
– New targets for novel treatments
– Validation of animal models
– The study of the eye as a window to other diseases of the brain and the body.
Researchers can get more information on how to request tissue at http://www.humaneyebank.com.

So that’s the end of our science adventure in Canada! We have a couple days to relax before coming home (there will be blogs of this) but I hope all the readers have enjoyed reading about our time in Canada as much as we have had being in Canada

Thanks for reading

-Bonnie and Joshua

Day 17: Neurosurgery and Genetics

Disclaimer: Most of the information in today’s blog was provided by the researchers and staff at St. Michael’s Hospital who we have been working with. Other information comes from the public domain. We have been registered as student observers here for a few days through the Office of Research Administration.

The first half of our day was spent in the Neurosurgery Clinic at St. Michael’s Hospital.

The Neurosurgery service at St. Michael’s Hospital is a busy inner city urban practice and one of 11 neurosurgical centres in Ontario. It is one of the largest of less than a handful that provide highly specialized neurovascular services including endovascular neurosurgery, aneurysm coiling, carotid stenting and vascular malformation management.

The Division of Neurosurgery distinguishes itself by providing neurosurgical care to patients with neurovascular diseases including strokes, aneurysms and AVMs. In addition, the clinic sees patients with complex skull bases lesions and brain tumours of all kinds. The surgeons provide combined neurosurgeon and orthopedic spinal care for patients with spinal disease.

Dr. Michael Cusimano is a neurosurgeon at St. Michael’s Hospital conducting clinical research in neurosurgery (e.g. cognition and memory, cerebellum, pituitary, and brain tumours, aneurysms, AVMs, normal pressure hydrocephalus (NPH), subarachnoid hemorrhage (SAH), quality of life (QOL), coma, etc.) as well as extensive research injury prevention, traumatic brain injury and medical education. Recent projects in his lab include various assessment tools and risk factors of traumatic brain injury and vulnerable populations. Moreover, he has recently published research on fractal analysis of AVMs and intracranial pressure as well as reviews on pituitary tumours.

Dr. Cusimano supervises students at various levels of education and training. Summer students conduct their own research and also visit clinics/seminars to apply knowledge and skills. Many students from his lab have recently authored publications as experimental research or a literature reviews.

Recent publications:
http://www.ncbi.nlm.nih.gov/pubmed/24662509
http://www.ncbi.nlm.nih.gov/pubmed/24821329
http://www.ncbi.nlm.nih.gov/pubmed/24739366

We also spent time with Dr. Hussein Fathalla, he spoke with us about the techniques they use when treating brain legions, tumours and other brain related diseases. He specifically talked to us about a relatively new procedure they use when as a therapy for brain tumours the Gamma Knife which is far more accurate for stopping the growth of tumours rather than traditional radiation therapy. We also spoke about how bad news is broken to patients and what steps must be taken when informing patients about procedures so they will have both the risks and benefits of the possible treatments they have been offered.

The second half our day was spent at the research facility at another hospital. We were looking at the research that was taking place there in the field of genetics. At the research facility they are looking into designing gene therapies to attempt to cure the progression of diseases such as Cystic Fibrosis and Duchenne’s Disease which are caused by mutations in the DNA. Gene therapy is basically the use of DNA as a drug to treat disease by delivering therapeutic DNA into a patient’s cells. The most common form of gene therapy involves using DNA that encodes a functional, therapeutic gene to replace a mutated gene. We also had some more hands on experience in the Lab. In the Lab we were allowed to run our own protein assay and help with preparing DNA to analyse its genotype.

On to our last day in Toronto and at the hospital tomorrow!

-Bonnie and Joshua

Day 16: St. Michael’s + The Li Ka Shing Knowledge Institute.

Disclaimer: Most of the information in today’s blog was provided by the researchers and staff at St. Michael’s Hospital and the Li Ka Shing Knowledge Institute who we have been working with. Other information comes from the public domain. We have been registered as student observers here for a few days through the Office of Research Administration

Today we did some more tours and meetings at St Michael’s and found out more about the Li Ka Shing Knowledge Institute. The LKSKI literally bridges the bench to the bedside as there is a bridge between it and St. Michael’s Hospital. The LKSKI has a huge amount of resources from fully functional and equipped wet labs and specialist equipment to basic offices and conference rooms. The building is designed in such a way that will promote the sharing of ideas and having informal meetings by having large communal spaces which even include a ping pong table and a foozball table.

One of the many areas that the LKSKI operates is Knowledge Translation. We learned more about Knowledge Translation at the LKSKI during a morning meeting with Gail Klein, KT Canada Training Program Manager. We spoke about how research findings often take years to be applied at the patient bedside, instilled in curriculums, and used in the wider community. Bridging the research, education, and clinical worlds is a significant challenge with far-reaching consequence. So the goal of Knowledge Translation is to create a bridge between knowledge and the actual implementation of new practices and strategies that will help to improve the quality of care that hospitals can provide.

We then met with two doctors, Dr. Corinne Fischer, geriatric psychiatrist and Dr. Luis Fornazzari, behavioural neurologist from the Memory Clinic and the challenges that they face when consulting a patient. The memory clinic assesses and treats adults with impairment in memory, communication, and thinking. This includes individuals with Alzheimer’s disease, dementia, and stroke, as well as individuals at increased risk of dementia due to family history or other predisposing factors. They spoke to us about how they assess people using standardised cognitive tests such as the MOCA: Montreal Cognitive Assessment which also comes in different languages for all possible patients.

Finally, we met with Eugene Park, a senior research associate in the Li Ka Shing Knowledge Institute for the Trauma Lab. Eugene showed us around Dr. Andrew Baker’s trauma research lab. Dr. Baker’s research laboratory investigates the cellular and molecular effects of brain injury in a variety of models. We were told about how the brain continues to degenerate after an injury, even a concussion, which can worsen the outcome of the injury event. They are particularly interested in understanding how and why the brain continues to degenerate. They also use cell culture systems to evaluate therapeutics and investigate mechanisms of cellular and axonal injury. Their use of molecular techniques help to examine changes in protein expression after injury. Fluorescence microscopy is used to visualise these changes. An electrophysiology (patch clamp rig) microscope (shown below) is used to evaluate the electrical function of neurons with injury and treatment.

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We were shown one of their current projects which include the development of a model for brain injury to take advantage of novel technologies that will allow us to screen thousands of compounds for effectiveness in treating cellular injury after traumatic brain injury.

This experience has been incredibly important in showing us how important it is to get knowledge and research to the bedside as quick as possible while still being well tested and studied.

Thanks for reading!

-Bonnie and Joshua

Day 15: St. Michael’s Hospital

Disclaimer: Todays information in this blog was provided by the researchers at St Michael’s Hospital who we have been working with and all of the information is in the public domain. We are registered as two student observers here for a few days and registered through the office of research administration.

We started the day with a visit to Dr T. Scheweizer’s lab where we had the chance to view some of the departments latest neurology research involving mechanisms that mimic videogames. The first study focused on driving and what parts of the brain are utilised when performing basic driving manoeuvres. The patients are hooked up to a simple driving simulator while undergoing an MRI scan. The study included both healthy people and also people who are in the ‘acute’ stage after having a stroke and also the ‘chronic’ stage. This allows researchers to examine patients brain activity while driving after having a stroke. The study also investigated the concept of whether using hands free devices while driving would impair the persons driving ability. This was done by having to answer true and false questions while driving. We also spoke with neuroscientists that had developed an “app” for the iPad that would help stroke patients rehabilitate their co-ordination and with scientist that were looking into why music ability is still retained in Alzheimer’s patients, in this study it was found that patients who had played music at an amateur level even in well progressed Alzheimer’s could still play and follow music.

We then had a tour of Dr Phillip Marsden’s Lab and spoke with a representative for the lab. He and his team are studying gene expression and how certain gene expressions can lead to disease. His team are looking specifically at endothelial cells which line blood vessels. Studying gene expression in blood vessels is important as it provides a unique insight into important cardiovascular diseases and the control of angiogensis (blood vessels forming) on tumours.

After this we had a meeting with Mr. Karthik Raj who manages SEISR (Surgical Education, Innovation and Safety Research Group). Under the leadership of Dr. Teodor Grantcharov, the group is currently working on the “O.R Black Box™”. Inspired by a crucial element of aircraft-accident investigations, the respected surgeon has developed an operating room Black Box to help get to the bottom of potentially harmful errors made during operations — errors that are blamed for hundreds of deaths in Canada every year.
The equipment simultaneously records video and audio of what is happening both in the operating room and inside the patient’s body, generating a detailed electronic log of the treatment, mistakes and all.
The idea is not to aid personal-injury lawyers, but to encourage better work and identify when and why problems occur, so they can be prevented in future and to act as an educational tool in simulations. For the full article on the black box project click here: http://news.nationalpost.com/2013/09/27/toronto-doctor-develops-or-black-box-to-catch-potentially-deadly-errors-made-during-surgeries/

To end the day we had a meeting with Anthony Mohamed a Diversity and Special projects coordinator who works specifically on inner city projects. His field of work is to better the quality of care for all patients and from all backgrounds. Through projects he has coordinated he has been able to better the quality of care for patients such as the “My Baby and Me Passport Program” which is a portable health record for young pregnant homeless/underhoused women. We discussed the program which according to the St. Michael’s Hospital Health Equity Report for the Toronto Central Local Health Integration Network 2009 stated that “From 2005-2007, 101 young homeless/underhoused pregnant women participated in the program. More than half attended 9-15 prenatal clinic appointments and feed back has been overwhelmingly positive.”

So another busy day for us! Lots more work to do during our last week so keep reading!

-Bonnie and Joshua

Day 14: St Joseph’s Health Centre

Today was our first experience of the “Bedside” stage of our scholarship. We first met with Dr. Michael Szego who studied Genetics at University but came across the field of bio-ethics after attending a talk by another bio-ethicist.

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Dr Szego gave us a brief history of Bio-Ethics which comes from surprising roots. Not so long a go, in history, there was no rules or regulations on human research so this lead to major breaches in current research ethics. The Nazi’s carried out a lot of human testing on prisoners in the infamous death camps and after the war the Nazi doctors were tried for their atrocities. This lead to the Nuremberg Code which is set of research ethics principles for human experimentation set as a result of the Nuremberg Trials at the end of the Second World War.

However, even after these guidelines were drawn up other huge breaches in human research ethics were made such as in Tuskegee, Alabama. The Tuskegee syphilis experiment was an infamous clinical study conducted between 1932 and 1972 by the U.S. Public Health Service to study the natural progression of untreated syphilis in rural African American men who thought they were receiving free health care from the U.S. So after many years of terrible atrocities and mistakes made in human research ethics the current guidelines for Human Research Ethics were written and act as the guidelines all research must abide by.

We learned that current ethics have three main principles, Respect for Persons, Welfare and Justice. Whenever any researchers want to use humans in their trials they must submit their proposal to a Research Ethics Board who will decide if then proposal will be approved or not.

After our meeting with Dr. Szego we had the opportunity to sit in on a Research Ethics Board Meeting. Where proposals for research are discussed and either accepted, accepted with modifications or declined.

We then went on a tour of St. Joseph’s hospital guided by Dr. Markwell. We saw the different areas of the hospital and how it works. As part of the tour we met with Dr. David Tal who treats geriatric patients and has been specifically with frail patients on improving their mobility. A link to the work he is carrying at St Joseph’s is here: http://www.stjoe.on.ca/about/media/media_detail.php?id=77&print

Our meeting of the day was with Ms Elizabeth Buller, the CEO of St Joseph’s Health Centre. She spoke with us about the overall workings of the hospital and the healthcare system in Canada. We also spoke about the differences in studying in the Scotland and in Canada and her own experience of University.

To end the day we worked on the Tri-Council Policy Statement in Ethical Conduct for Research Involving Humans. This is qualification all researchers must take in Canada to be allowed to carry out any research on with human participants.

A very very busy day overall but very useful for us to see the inner workings of a hospital and the process of getting research closer to the bedside.

-Bonnie and Joshua

Day 13: Wet and Wild!

Today we went on the adrenaline fuelled, exhilarating Whirlpool Jet Boat Tour of the Niagara River rapids!

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The boats were powered by 3 diesel turbo engines which gave the jet boat 1500 horsepower to rip through the Niagara rapids and this also gave the boats the power to battle the ferocious rapids the Niagra River offers.

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The goal of the jet boat tour is to ensure that no one leaves dry! And they more than succeeded, we were soaked right through! It was a fantastic experience and it was incredibly exciting. We absolutely loved it!

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The link to the experience is here: https://www.facebook.com/photo.php?v=10201943096130726

After all the adrenaline, we explored Niagara on the Lake. A lovely little town that is just like a step back in time. While we were exploring we found a Scottish shop with all the typical Scottish sweets and foods and even kilts.

We also had the chance to have a look at the Sir Adam Beck Hydroelectric Generating Stations are two hydroelectric generating stations in Niagara Falls.

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Sir Adam Beck Hydroelectric Generating Stations are two hydroelectric generating stations in Niagara Falls, Ontario, Canada. The stations divert water from the Niagara and Welland Rivers above Niagara Falls which is then released into the lower portion of the Niagara River, and together produce up to 1,997 MW and so provide a large amount of energy for the power grid in Canada.

Now the weekend is over we shall be returning to the world of science and continuing our journey from bench to bedside at the hospitals in Toronto

One more jam packed week so keep reading!

-Bonnie and Joshua

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