I am currently a postdoctoral researcher at UHN’s KITE Research Institute (KITE). My two research projects focus on upper limb rehabilitation using novel robotic training and neuromodulation modalities after stroke and spinal cord injury.
I am also a member of the UHN Research IDEA Curriculum Advisory Sub-Committee. As a woman from a minority background, this has been a great opportunity for me to share my experience working in diverse healthcare systems. I am particularly interested in helping trainees integrate IDEA principles into their work and understand how to navigate working in diverse clinical and research environments. Given the diversity of the Canadian population, researchers need to understand how to effectively address gaps in health care and meet the needs of our patients.
I have been at UHN for 3 years. I am originally from the Republic of Mauritius where I studied to become a physiotherapist. I have an MSc in Physiotherapy-Neurorehabilitation from the University of Nottingham, United Kingdom, and a PhD in Physiotherapy from the University of Newcastle, Australia. I previously was also faculty at the University of Mauritius for 7 years leading the physiotherapy education program. In 2021, I immigrated to Canada to fulfill my research career aspirations and challenge myself to do a postdoctoral fellowship.
As a postdoctoral researcher at UHN, I am passionate about developing new neurorehabilitation technologies for people with stroke and spinal cord injury. I enjoy the opportunity to work with advanced robotics and neuromodulation modalities that could be pivotal in optimizing recovery for neurological patients. I also enjoy engaging in stimulating scientific discussions with other researchers and trainees. As a clinician and researcher, I find that pursuing a career in health research can be quite challenging; however, working with a great team helps maintain resilience.
I believe that health research is the driving force behind optimal care for our patients and should be prioritized. As health research goes hand-in-hand with healthcare delivery, more effort should be concentrated on overcoming obstacles in translating research into clinical practice.
My mission is to develop rehabilitation approaches to help restore movement for people with neurological conditions and improve their quality of life. My research program specifically focuses on developing complex neurorehabilitation approaches using clinical restorative therapy and advanced rehabilitation technology like robotic training, haptic training using pressure sensors, and neuromodulation.
My research addresses a unique area of research designed to advance our understanding of the complex interactions between sensory function, motor function, and cognitive processes necessary for upper limb function. I am particularly interested in studying young and older stroke survivors to better understand the effects of age on upper limb recovery after stroke. I am also interested in studying people who have reintegrated into the community to understand how we can meet their rehabilitation needs in the long-term.
I feel privileged to conduct my post-doctoral research at KITE and the Toronto Rehabilitation Institute (Toronto Rehab), one of the world’s top-ranked rehabilitation research institutes. I have developed an extensive network of multidisciplinary collaborators to advance my research program beyond traditional rehabilitation to integrate several aspects of biomedical engineering such as artificial intelligence and advanced robotics. I have also met many scientists who have mentored me in various academic pursuits.
Additionally, Toronto Rehab has connections with several research platforms which allows for unique opportunities to connect with leading researchers from across Canada. There is a lot of support provided within the UHN network that makes UHN an excellent environment for researchers to advance health research.
I have enjoyed learning Kathak, which is an Indian form of classical dance, for 9 years and have a degree in Kathak dance. I occasionally practice Kathak whenever I feel inspired. But my main hobby is reading books or listening to podcasts about self-development and personal growth. I also enjoy travelling both locally and abroad, exploring nature like trails and snorkeling.
I think the future of health research lies in integrating advanced technologies such as artificial intelligence, big data, and innovative technological devices. This will help us provide more personalized medicine and rehabilitation for our patients.
The future of health research is even more promising with increasing contributions from diverse researchers, trainees, healthcare leaders, and patient partners. As an immigrant, it is an exciting opportunity for me to be part of this process in Canada. I am excited about collaborating with local and international collaborators to advance the field of physiotherapy and neurorehabilitation. I am also enthusiastic about trialing new rehabilitation technologies that have the potential to revolutionize rehabilitation and impact the lives of patients.
You @TeamUHN is a campaign to highlight the important scientific contributions that research lab staff, trainees and learners, administrative staff, core facilities staff, Research Solutions & Services staff, and volunteers make towards A Healthier World through discovery and innovation. If you’re interested in sharing your story, we invite you to complete this form here (open to UHN staff, trainees and volunteers).
“It is a scary topic when someone tells you that your job is going to be replaced by AI,” says Dr. Phedias Diamandis, a neuropathologist at UHN.
Modern AI's image analysis mirrors a pathologist's clinical skills in examining microscopic tissue images to diagnose diseases. Concerns about AI overtaking pathology have existed for years.
To transform the challenge into opportunities, Phedias stepped foot in the world of AI in 2017, when the concerns began to spread.
“I wanted to see if AI can interpret pathology images like humans are trained to do.”
Drawing upon his neuroscience background and extensive self-learning, Phedias discovered that AI learns in a manner comparable to humans.
"Our perception relies on neural networks in our brain. In the visual system, primary visual centers detect basic shapes like circles and squares, while higher-level centres integrate them into complex objects. Similarly, AI analyzes images by identifying basic shapes through spatial coordinates and checking for spatial distribution to recognize familiar patterns."
With an understanding of how AI works and a goal to apply AI in pathology, Phedias’ team started a research project to train AI to recognize tumour histology slides.
The team fed AI nearly 1 million images collected from over 1,000 brain tumors, each annotated by pathologists. Using deep neural networks, they developed a tool to analyze cell patterns and generate a map highlighting distinct regions of the tumor with their unique histomorphological features.
They call this AI-driven tool “HAVOC” (Histomic Atlases of Variation Of Cancers). HAVOC aims to help researchers better understand tumour heterogeneity–a phenomenon where different regions of a tumour can have different biology, which can lead to different treatment responses and resistance. Understanding cancer variations helps guide personalized treatment and improve precision medicine.
But how well does it work?
The team used whole slide images from six high-grade glioblastomas to test HAVOC’s accuracy. As the images are processed through the deep neural networks, HAVOC extracts the morphology features from small patches of each image and clusters the patches by similarity to mark different regions in the original image.
It turned out that the results obtained by HAVOC are consistent with the interpretations made by human experts and are correlated to the molecular variations in the sample. In some cases, the variations in molecular features predicted by HAVOC could support the use of personalized combination therapies for patients (published in Science Advances).
“HAVOC can assist pathologists to understand tumour heterogeneity directly from histology slides,” says Phedias. “It’s a useful tool to complement other molecular approaches and contribute to ongoing personalized medicine efforts.”
Using deep neural networks to map tumour histomorphology variations. The first row of images are H&E histological slides from a high-grade glioma and the second row includes their respective HAVOC heterogeneity maps. The coloured clusters proposed by HAVOC map are intra-tumour variations in cancer biology that can one day help inform custom therapy design for patients (from Science Advances).
“The danger of AI is that we are not really sure how it behaves in new situations,” says Phedias.
“When humans encounter an unexpected situation, we know it's better to be cautious and avoid a mistake rather than trying to fit it into a mathematical formula, but this is not the case for AI.”
Taking a rare brain tumour as an example, a case that only occurs once every ten years can still fire up the neuronal connections in a pathologist’s brain to alert them to be mindful when making a diagnosis. However, when a computer encounters a rare tumour, it can make a guess based on probability and problems arise. When adding up the probabilities of running into different types of rare tumours, it can mount up to 10-20% of the total cases and it is very difficult to train a system to properly react to them.
“In addition to a large training data set, it's also important to consider the creator's artistic ability to develop intelligent algorithms that perform well in specific circumstances,” says Phedias. “We need to rely on the community through crowdsourcing to solve some of those rare circumstances.”
To better include rare cases and expand HAVOC’s application in different disease areas in pathology, Phedias’ team has developed PHARAOH (PHenotyping And Regional Analysis Of Histology), an open online platform that makes the HAVOC map accessible and easy to generate.
Researchers and pathologists can tweak the parameters to design and develop their own AI tools on PHARAOH, based on their specific pathology expertise and needs. PHARAOH allows users to share their creations with the entire community to avoid duplicating efforts.
“The motivation behind PHARAOH is to enable clinicians to contribute and utilize computational pathology without the need to have a deep understanding of the advanced coding needed to design AI algorithms,” says Phedias.
Phedias explained how to utilize PHARAOH in this YouTube video in detail.
In 2019, Phedias created the YouTube channel NeuroscIQ, an online space to foster education and curiosity within the world of neuroscience. He and motivated students in his lab have been contributing to the channel over the years, sharing their most updated research information, and dissecting neuroscience breakthroughs for lay audiences.
“It has been something I wanted to do since my residency, because I’m fascinated by the idea of disseminating knowledge quickly in a free and scalable manner to anyone who wants to consume it. That is how I learned.”
“It took me eight years to take the action, and I wish I started earlier,” Phedias recalls. “When I was contemplating it, I feared that people might not receive my content well. But it turns out, people generally see sharing as a positive thing and they are appreciative to hear other people’s points of view.”
The complexity of neuroscience initially deterred Phedias from studying the brain systematically, until it became a necessity for his PhD work.
The daunting task of starting a YouTube channel was not realized for eight years until his motivation to share eventually overcame perfectionism and the fear of potential critique.
The rise of AI poses an uncertainty for the future but Phedias jumped in to make it a tool that can empower the field.
Each time when facing unfamiliarity, the fear does not go away, but it takes Phedias less time than before to react to it.
“If you're scared of something, it's probably something that will make you stronger if you eventually embrace it,” says Phedias.
Phedias trained for a marathon once. Eight weeks in, he went from only being able to run two kilometers on the first practice, to finishing the entire 42 kilometers on the day of the marathon. This training experience has shed light for him on how to approach the daunting quests in life.
“I don't get as overwhelmed trying to learn a new skill as I did before,” says Phedias. “During training, you never actually fully run a marathon. You just need to get yourself to a specific level where mentally you know that this can be done and you can complete it.”
“Some of the biggest barriers are not our capabilities, but our mental approach to the problem in front of us. My training partner at the time gave me some good advice. If something seems outside of your current capabilities, start by breaking it into smaller pieces that you know you can achieve. For running, he would say, just try and get to the next lamppost on the road. Once you get there, then just do that again and again until the run is over.”
Meet PMResearch is a story series that features Princess Margaret researchers. It showcases the research of world-class scientists, as well as their passions and interests in career and life—from hobbies and avocations to career trajectories and life philosophies. The researchers that we select are relevant to advocacy/awareness initiatives or have recently received awards or published papers. We are also showcasing the diversity of our staff in keeping with UHN themes and priorities.
Welcome to the latest issue of The Krembil.
The Krembil is the official newsletter of the Krembil Research Institute, highlighting recent news and awards, innovative research and exciting events happening at Krembil.
Stories in this month’s issue include:
● Women Changing the Game: Krembil highlights some of its talented women researchers and health care providers.
● Season 3: Your Complex Brain: Krembil Brain Institute launches a new season of its award-winning podcast Your Complex Brain.
● Classifying Parkinson’s Disease: Scientists propose new, biologically based classification system for Parkinson’s disease.
● Blueprinting Lupus Flares: Researchers identify immune profiles associated with changes in disease activity in lupus.
● Resolving Inflammation: UHN researchers uncover potential therapeutic targets for treating neuroinflammation.
● Healthy Liver, Healthy Brain: Molecules secreted by the liver help maintain blood vessels in the brain.
Read these stories here. To read previous issues, see the newsletter archive.
Welcome to the latest issue of Research Spotlight.
As Canada’s largest research hospital, UHN is a national and international source for discovery, education, and patient care. This newsletter highlights top research advancements from over 5000 members of TeamUHN—a diverse group of trainees, staff, and principal investigators that conduct research at UHN.
Stories in this month’s issue:
● Fast-tracking Cancer Classification: Researchers develop a way to distinguish between pediatric cancer types in 10 seconds.
● The Messages in Your Cells: Researchers uncover how blood vessel cells directionally communicate with surrounding cells.
● Medical Education in a Global Crisis: UHN researchers unravel the experiences of medical students during the COVID-19 pandemic.
● UHN Empowering Women in Heart Health: KITE researchers address gaps in cardiac rehabilitation educational resources for women.
Read these stories and more online here. To read previous issues, see the newsletter archive.
A recent study by UHN KITE Research Institute scientists has highlighted the disproportionate impact of post-stroke depressive symptoms on women compared to men upon entry to cardiac rehabilitation programs. Their findings underscore how rehabilitation programs can tailor their strategies to optimize outcomes for patients.
Cardiac rehabilitation programs have been increasingly recognized for their benefits to individuals following stroke. Participation in exercise-based rehabilitation programs has been found to reduce mortality, recurrent stroke and rehospitalisation.
These programs are also well-suited for addressing and managing post-stroke depressive symptoms (PSDS) due to their comprehensive approach offering exercise training, lifestyle modification support, psychosocial support, nutrition counseling and education, as well as pre-screening for depressive symptoms.
“PSDS is among the most common neuropsychiatric effects of stroke and has significant implications for recovery and quality of life,” says Dr. Susan Marzolini, KITE Scientist and senior author of the study. “It is critical to understand sex-related differences in PSDS as it can pose a greater burden on women compared to men.”
In stroke recovery, men and women experience differences in symptom presentation, rehabilitation needs, psychological impact, coping strategies and access to healthcare services. PSDS may have a greater impact on women post-stroke due to greater functional impairment, fatigue and pain as well as lower quality of life experienced by women compared to men. Understanding risk factors and sex differences in PSDS helps researchers understand how to better tailor treatment approaches that can improve stroke outcomes following cardiac rehabilitation programs.
Researchers analyzed data from over 1300 stroke patients enrolled in a cardiac rehabilitation program at the Toronto Rehabilitation Institute at UHN and found that a higher proportion of women experienced PSDS compared to men.
Their findings also revealed unique factors associated with PSDS among women and men. The most common factor associated with PSDS in women was obesity. Additionally, a significant proportion of women aged 51-70 years experienced PSDS, potentially influenced by menopausal transitions, caregiving demands, and social factors such as marital status and living arrangements. Interventions within cardiac rehabilitation programs targeting obesity through diet and nutrition counseling, as well as efforts to improve social connectedness, may help mitigate PSDS in women post-stroke.
On the other hand, unemployment emerged as a common factor associated with PSDS in men as well as sleep apnea and a chronic lung condition known as chronic obstructive pulmonary disease. This highlighted the need for cardiac rehabilitation interventions to assist in finding employment opportunities, providing financial support resources and helping improve continuous positive airway pressure (CPAP) compliance in men post-stroke.
“By recognizing the unique factors influencing PSDS in women and men, we can better tailor interventions within cardiac rehabilitation programs to alleviate the burden of post-stroke depression,” says Xiao Wei (Olivia) Du, a previous graduate student in Dr. Marzolini’s lab and first author of this study. “By understanding and targeting the specific needs of individuals, these rehabilitation programs can play a pivotal role in promoting holistic post-stroke care and improve the outcomes for stroke survivors.”
Future research should focus on understanding the effects of cardiac rehabilitation on PSDS.
This work was supported by the Heart and Stroke Foundation of Canada Seed/Catalyst grant, the Frederick Banting and Charles Best Canada Graduate Scholarship-Master’s Scholarship from the Canadian Institutes of Health Research and UHN Foundation. Dr. Marzolini is also an Associate Professor in the Rehabilitation Sciences Institute and the Faculty of Kinesiology & Physical Education at the University of Toronto.
Du X, Brooks D, Oh P, Marzolini S. Sex Differences in Depressive Symptoms in 1308 Patients Post-Stroke at Entry to Cardiac Rehabilitation. J Cardiopulm Rehabil Prev. 2024 Feb 2. doi: 10.1097/HCR.0000000000000848.
In a recent realist review at The Institute for Education Research (TIER) at UHN, scientists investigate How and Why diabetes care training programs for care providers from vulnerable communities may or may not work. Their findings offer insights into strategies to improve healthcare outcomes and promote health equity among vulnerable groups.
Diabetes affects around 5.7 million Canadians, with foot ulcers being one of its most severe complications. If left untreated, diabetic foot ulcers can result in amputations and higher mortality rates compared to other diabetic complications. Amputations can be prevented with regular foot screenings. However, shortages of clinicians, coupled with inadequate consideration of socioeconomic and cultural disparities, have restricted access for high-risk groups.
Indigenous Peoples, Black, and South Asian Canadians often encounter elevated risks of disease complications due to limited access to healthcare services, cultural and socioeconomic barriers, and increased prevalence of conditions such as obesity and hypertension.
In response to these challenges, upskilling programs have emerged as a strategy to train care providers from these communities—including healthcare workers, personal support workers, and family caregivers—with the skills to conduct foot screenings and help identify potential complications early on.
"While previous research suggests that these programs improve patient outcomes, little is known about how they are developed and in what situations they are effective. By investigating their development process, we aim to provide valuable insights to create better programs in the future," explains Dr. Nicole Woods, Senior Scientist at TIER and senior author of this study.
Dr. Woods and a team of UHN researchers examined 52 existing studies on upskilling programs that employed diverse methodologies and took place in outpatient clinics, hospitals, or community centers.
Researchers found that considering the specific needs and circumstances of the communities served by these programs helped increase the number of people using the services. By addressing disparities like lack of health literacy, inadequate patient-provider communication, and social service disconnection, these upskilling programs trained care providers to deliver accessible care in community settings while also performing other roles like providing patient education, connecting individuals to community services and advocating for patients.
"Incorporating cultural sensitivity into the program was crucial. Cultural competency training enhances a care provider’s ability to provide culturally sensitive care to patients from marginalized communities," highlights Dr. Samah Hassan, postdoctoral researcher and first author of this study.
Researchers also found that providing clearer incentives, continuous training, defined competencies, and ongoing evaluation of training effectiveness for care providers would significantly impact the retention of care providers as well as the maintenance and success of these programs.
Preventive foot care is complex and requires a holistic approach and the collaboration of diverse care providers. Implementing structured healthcare pathways and coordination would help sustain the success of these programs.
The results of this review suggest that these initiatives hold promise in addressing healthcare disparities. However, ongoing evaluation and strategic development are needed to maximize their effectiveness.
"By focusing on these areas, we can ensure that upskilling programs for care providers not only continue to bridge healthcare gaps but also contribute to a more equitable and accessible healthcare system for all," concludes Dr. Woods. "As researchers and policymakers collaborate on these efforts, the potential for positive change in diabetes care for marginalized communities becomes increasingly attainable."
We would like to acknowledge Dr. Val E. Rac and Dr Brian D. Hodges for their invaluable guidance and support throughout this project. We are also grateful to the whole team (Patti Leake, Saul Cobbing, Catharine Marie Gray, Nicola Bartley, Andrea Etherington, Munira Abdulwasi, Hei-Ching Kristy Cheung, Nikki N. Woods, and Samah Hassan) for their expertise and assistance. This project would not have been possible without their continuous support and hard work.
This work was supported by Future Skills Canada and the UHN foundation. Dr. Valeria E. Rac holds a Tier 2 Canada Research Chair in Health System and Technology Evaluation
Hassan S, Rac VE, Hodges B, Leake P, Cobbing S, Gray CM, Bartley N, Etherington A, Abdulwasi M, Cheung HK, Anderson M, Woods NN. Upskilling programmes for unregulated care providers to provide diabetic foot screening for systematically marginalised populations: how, why and in what contexts do they work? A realist review. BMJ Open. 2024 Jan 22;14(1):e081006. doi: 10.1136/bmjopen-2023-081006.
UHN’s Krembil Brain Institute is proud to announce the highly anticipated launch of Season 3 of its acclaimed podcast, Your Complex Brain.
Hosted by Heather Sherman, Manager of Communications at the Krembil Brain Institute, Your Complex Brain offers listeners a guided journey into the fascinating world of brain science and the unique perspectives and experiences of researchers, clinicians, patients and their loved ones.
With in-depth interviews, scientific discussions and powerful patient stories, the podcast aims to teach listeners about the complexities of the human brain and the importance of brain research.
Episodes in this season cover a wide range of topics, including:
● strategies for reducing one’s risk of Alzheimer’s disease
● the role of exercise in managing Parkinson’s disease
● advancements in spinal cord injury research
● the impact of loneliness on the brain
● what women need to know about stroke prevention and recovery
This season will also take listeners to the frontline of AI-powered brain research, dive into the link between genetics and reading disabilities, and explore why getting a good night's sleep is crucial for brain health.
Your Complex Brain also shines a light on the collaborations between the Krembil Brain Institute and other leading research institutions, including the University of Toronto, The Hospital for Sick Children, the Centre for Addiction and Mental Health, and the University of Waterloo.
To learn more, watch the Season 3 trailer here.
"We are thrilled to be able to inform and engage the public through our podcast and introduce listeners to some of our key research teams, clinical leaders and patient partners," says Heather Sherman. "There are countless amazing things to learn about the brain, and we couldn't be more excited to explore them with you."
Following the success of previous seasons, which have garnered over 32,000 downloads and earned the podcast the 2024 People's Choice Award for Best Science & Medicine Podcast, the upcoming season promises to captivate, educate and inspire audiences once again.
"Your Complex Brain is a fantastic resource for anyone interested in understanding the brain and the latest advancements in neuroscience," says Dr. Jaideep Bains, Krembil Director and Season 3 guest. “We invite everyone to tune in and join the growing community of supporters for the incredible work being done at UHN and our partnering institutions.”
Your Complex Brain is available on all major podcast platforms, including Apple Podcasts, Spotify and Google Podcasts. New episodes will air every other Tuesday. Subscribe so you don’t miss an episode!
Your Complex Brain is produced by Heather Sherman, Jessica Schmidt, Dr. Amy Ma, Kim Perry, Sara Yuan, Meagan Anderi, Liz Chapman and Lorna Gilfedder. For more information, visit https://www.uhn.ca/Krembil/Complex-Brain-Podcast.
Research conducted at UHN's research institutes spans the full spectrum of diseases and disciplines, including cancer, cardiovascular sciences, transplantation, neural and sensory sciences, musculoskeletal health, rehabilitation sciences, and community and population health.
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