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Research Foci of Ontario’s Academic Health Science Centres Looking Ahead to the Challenges of Tomorrow March 2010 Introduction This document is a compilation of the strategic research foci of the CAHO hospitals. Ontario’s health research is both broad and deep, with some of the best and brightest health researchers in the world working here to improve the health of our population. Table of Contents BAYCREST CENTRE FOR GERIATRIC CARE........................................................................................... 2 BLOORVIEW KIDS REHAB.......................................................................................................................... 3 BRUYÈRE CONTINUING CARE.................................................................................................................. 4 CENTRE FOR ADDICTION AND MENTAL HEALTH .................................................................................. 5 THE HOSPITAL FOR SICK CHILDREN....................................................................................................... 6 KINGSTON GENERAL HOSPITAL .............................................................................................................. 7 LONDON HEALTH SCIENCES CENTRE & ST. JOSEPH’S HEALTH CARE, LONDON ........................... 9 MONTFORT HOSPITAL ............................................................................................................................. 10 MOUNT SINAI HOSPITAL.......................................................................................................................... 11 NORTH YORK GENERAL HOSPITAL ....................................................................................................... 12 THE OTTAWA HOSPITAL.......................................................................................................................... 13 PROVIDENCE CARE ................................................................................................................................. 14 ROYAL OTTAWA HEALTH CARE GROUP ............................................................................................... 15 ST. JOSEPH’S HEALTHCARE HAMILTON ............................................................................................... 16 ST. MICHAEL’S HOSPITAL........................................................................................................................ 18 SUNNYBROOK HEALTH SCIENCES CENTRE........................................................................................ 19 THUNDER BAY REGIONAL HEALTH SCIENCES CENTRE .................................................................... 20 TORONTO REHABILITATION INSTITUTE................................................................................................ 22 UNIVERSITY HEALTH NETWORK............................................................................................................ 23 WOMEN’S COLLEGE HOSPITAL .............................................................................................................. 24 1 Baycrest Centre for Geriatric Care – Rotman Research Institute, Toronto, ON Baycrest’s Rotman Research Institute aims to advance insights into the effects of aging on cognition, mechanisms of neural protection, injury and repair and the potential of cognitive neurorehabilitation to maintain and restore function. 1. Using prospective longitudinal data, establish the biological, psychosocial, and contextual factors that will predict the course of recovery or deterioration in those diseases that are Baycrest’s major clinical foci: stroke, dementia, depression. Impact: This baseline knowledge will enable tracking of the normal progression of brain changes with age as well as the course of recovery or deterioration in clinical conditions. 2. Develop a computational modeling framework to integrate basic cognitive theory and neuroimaging with clinical research. Baycrest’s scientists are at the forefront of the understanding of brain function and dysfunction from the perspective of interacting networks. These networks operate at a high level of complexity, which requires sophisticated mathematical algorithms to encapsulate brain network dynamics. Impact: Such modeling efforts will increase Baycrest’s understanding of how all cognitive functions are expressed in the context of neural network dynamics, and most importantly lead to a new perspective that views brain disorders as a disruption of critical dynamics. 3. Develop predictive models of disease and a complete evaluation (genetics, cognition, emotions, online imaging of brain activity, medication use, functional and psychosocial well-being) for disease and healthy aging. The combination of a strong neuroinformatics base and sophisticated neural network modeling will enable us to merge behavioural, biological and psychosocial data for an individual. Placing these data in the broader context of the whole person, and the person’s physical and social environment, will enable sensitive prediction of cognitive changes the person will likely encounter, enabling targeted treatment in aging. 4. Develop individual wellness plans, including diet, exercise, cognitive rehabilitation and caregiver support, for the prevention, maintenance and enhancement of abilities that alter with aging, targeted for those in different decades from 40 onward. 5. Commercialization of the Rotman Research Institute’s evidence-based interventions for cognitive maintenance. In 2008, the Baycrest Centre for Brain Fitness was launched to commercialize Baycrest’s scientific discoveries and it recently created a company called Cogniciti, that will market products resulting from Baycrest research such as scientifically based games for brain fitness, memory training programs for employee assistance programs and computerized cognitive assessment tools for hospitals and doctors offices. 2 Bloorview Kids Rehab – Bloorview Research Institute, Toronto, ON Research activities in the Bloorview Research Institute at Bloorview Kids Rehab are organized around three theme areas: 1. Evaluation of Care (health measurement; development and evaluation of novel treatments) 2. Innovation & Development (development and commercialization of assistive technologies) 3. Inclusion and Participation (understanding and redressing the physical, environmental, social, and policy barriers facing children with disabilities and their families) Within the disability research community, there are often distinctions made between disability as a medical construct, a bio-technological construct, and a social construct. The overarching research vision for the Bloorview Research Institute is to bridge the rehabilitation sciences, the physical sciences, the social sciences and the humanities. The three theme areas attempt to bring together and reconcile the different constructs. The thematic structure is intended to focus research activities; however, collaboration across theme areas is encouraged. The aim is to encourage novel breakthroughs on common and burdensome childhood disability issues by bringing together scientists from across many disciplines and professions (clinician-scientists, engineers, and social scientists). The focus of the Bloorview Research Institute is on applied clinical and social research. Applied research is defined at Bloorview as research at the client, family, or systems level; the findings from which can have immediate application. In other words, the development of a new measurement scale, or novel clinical intervention, or assistive technology, or critique of an accessibility policy will have an immediate impact on the health and well being of children with disabilities and their families around the world. 3 Bruyère Continuing Care – Élisabeth Bruyère Research Institute, Ottawa, ON The Élisabeth Bruyère Research Institute’s mandate is to conduct applied health research in continuing care - from health promotion to palliation. This includes: health promotion, disease prevention, primary care, management, restoration and rehabilitation, health of the elderly and palliation, with a particular focus on improving the quality of life of the elderly population and those who are palliative and with chronic illness. ÉBRI’s priority research themes are: 1. Primary Care 2. Care of the Elderly 3. Palliation The Institute’s domains of research are designed to address and answer a variety of questions. Examples of these questions include: • Education and Learning - How can ÉBRI contribute information for policy-related decisions regarding the effectiveness of education programs? • Clinical Practice - How can ÉBRI improve clinical practice? • Organization and Delivery of Health Services – How can ÉBRI organize and manage health services to best meet the needs of patients, residents and their families? In addition to the collaborations that exist among scientists, the Institute has many affiliations with clinicians and staff in Bruyère Continuing Care, as well as faculty in various post-secondary institutions. Furthermore, the Institute regularly collaborates and networks with municipal, provincial, federal government and other not-for-profit organizations. 4 Centre for Addiction and Mental Health, Toronto, ON From neurons to neighbourhoods: The foundational document CAMH Strategic Plan 2009-2010 includes a commitment to “Foster a climate of discovery, innovation, and knowledge exchange.” In 2009-2010, this is embodied by a $37 million award from Canada Foundation for Innovation/Research Hospital Fund – Large Scale Institutional Endeavours to fund a far-reaching CAMH research project, Transforming Care for Mental Health and Addiction – An Integrated Approach. CAMH is integrating research and care across its six research foci: Transforming Care in Mood Disorders; Transforming Care in Addictions; Community Health and Knowledge Exchange; Transforming Care in Schizophrenia; Neuroimaging; Pharmacogenetics & Neuroscience. CAMH multi-disciplinary research platforms across these foci include: 1. Personalized medicine: By combining pharmacology, brain imaging, and genetics research CAMH is developing tools that will allow clinicians across Ontario to “treat right the first time.” A key is using gene science to identify individuals with schizophrenia who are at highest risk of suffering severe side effects from specific medications, so that individualized treatments can be offered as first-line therapy. 2. Epigenetics: The Krembil Family Epigenetics Laboratory at CAMH is among the world’s foremost laboratories exploring environmental “on/off” switches that activate both protective and risk genetic factors in mental health and addiction (MHA). 3. Brain imaging: CAMH has a brain imaging facility in addiction and mental health that is unmatched world-wide. This clinical and research facility affords safe, noninvasive, real-time images of brain function and pharmacology to dozens of CAMH research projects across all MHA subject areas. In 2010, it is using grant funding to expand capacity with a magnetic resonance imaging (MRI) machine and the addition of a second cyclotron to support its positron emission tomography (PET) laboratory. 4. The Ontario Communities Project: CAMH will use a novel mobile community research laboratory in southwestern Ontario to improve understanding, treatment and prevention of addiction and mental illness co-morbidities at the individual and community level. 5. Work and Well-Being Lab: This lab will help reduce costs related to productivity and absenteeism associated with mental health and addiction problems in the workplace, and provide knowledge exchange and training for business and industry stakeholders. 6. Genetic testing: In early 2010, CAMH has signed three international licensing agreements for novel genetic tests developed at CAMH to help families determine their risk of specific forms of intellectual disability, muscle disorder, and autism. 5 The Hospital for Sick Children – SickKids Research Institute, Toronto, ON The main strategic research foci of the SickKids Research Institute are: 1. A key priority will be completion and occupation of the new Research Tower at the corner of Elm and Bay Streets. This world class facility is essential to the SickKids Research Institute’s long term success and will enable us to further the gains resulting from child health research to benefit all Ontarians by deepening the integration and collaboration of researchers across the Institution and providing much-needed cutting-edge research facilities. 2. The Research Institute will continue to focus on opportunities for commercialization as well as ensuring new research innovations translate into improved clinical care. 3. Over the next five years, SickKids and its Research Institute will have an explicit focus on further strengthening clinical research capacity within the organization, leveraging SickKids’ significant strengths to ensure that the care children and families receive is based on the best-evidence available. 4. Building on SickKids’ strengths in key area of research. These include: • • • • • • • • • • Population Health Research Lung Biology cystic fibrosis brain cancer/tumours structural biology cellular neurobiology model organism genetics human genomics stem cell/cancer stem cell neuropsychiatric research 5. New areas of focus will include Health Policy Research and metabolics/nutrition research. 6 Kingston General Hospital, Kingston, ON Kingston General Hospital (KGH) and Queen’s University have a highly integrated health research program which operates though the jointly coordinated offices of VP Health Sciences Research at the Hospital and Vice Dean Research in the Faculty of Health Sciences. Together, these two institutions are committed to fostering an environment of transdisciplinary research in a number of biomedical areas, as well as studies of population health and health services research. Examples of priority areas, where basic and applied researchers, spanning all life science disciplines through various branches of engineering, work together with clinicians and allied health professionals include: 1. Neurosciences (http://whitespacenorth.com/Gilron/index.html): Improving the clinical management of pain by advancing knowledge about analgesic pharmacology and sensory pain mechanisms. This research group works closely with the multidisciplinary Queen’s Centre for Neuroscience Studies (http://www.queensu.ca/neurosci/). 2. Reproductive Sciences: Centre for Advanced Urologic Research: sexual dysfunction, inflammatory diseases of the urinary tract, chronic pelvic pain, benign diseases of the prostate gland, and prostate and bladder cancers. Obstetrics and Neonatology: gynaecologic oncology, reproductive endocrinology and infertility, paediatric and adolescent gynaecology, urogynaecology and reconstructive pelvic surgery, and maternal-fetal health (Perinatal Research Unit (http://www.qpru.ca/)). 3. Respiratory and Cardiovascular Research: • Asthma Research: asthma symptom perception and lung mechanics, asthma epidemiology, asthma management (clinical trials and education based), and asthma guidelines dissemination. • Chronic Respiratory Diseases: mechanical, chemical and psychological mechanisms of dyspnea and activity limitation in patients with a variety of cardio-respiratory diseases (e.g. emphysema, chronic bronchitis, asthma, heart failure, etc.) and the effects of pregnancy, aging, gender and obesity. • Sleep Research: pathogenesis and management of sleep apnea, investigation of upper airway physiology during sleep, and the effects of the menstrual cycle and pregnancy on sleep. • Cardiovascular Diseases: clinical use of nitrates in coronary disease and development of tolerance, coronary artery disease in women, new ICD technologies, and investigation and management of syncope and atrial fibrillation. 4. Cancer Cytogenetics and Prognostics: Translational research using molecular, genomic and cytogenetic methods to provide new information and hypotheses concerning the onset, cause and progression of cancer. The program involves close interactions with the Queen’s University Cancer Research Institute, particularly with the National Cancer Institute of Canada’s-Clinical Trial Group (NCIC-CTG). 5. Musculoskeletal (http://me.queensu.ca/hmrc/index2.html): Human Mobility Research Centre focuses on helping people live fuller, more mobile lives by pioneering the development of innovative and effective treatment strategies for bone and joint disorders caused by arthritis, osteoporosis, injury, and related problems. The Centre has specialized 7 labs for connective tissue, bio-simulation, tissue processing, prosthesis design, software development, and gait analysis, as well as one of the world’s first computer-enhanced surgical suites, OR 2010. 6. Gastrointestinal (http://meds.queensu.ca/gidru/): Gastrointestinal Diseases Research Unit (GIDRU) is a diverse multidisciplinary group that focuses primarily on studies of inflammatory bowel diseases, colitis, Crohn’s disease, and colon cancer. GIDRU facilities include a leading-edge molecular biology and tissue culture facilities, confocal microscopy, and an ion imaging and electrophysiology laboratory. 7. Population Health and Health Services Research: • Emergency Medicine and Injury Research Group (EMIRG): surveillance and study of agricultural injuries, child injuries, intentional injuries (e.g. homicide, suicide), neurotrauma, whiplash disorders, and applied use of cardiac markers in the emergency department. The EMIRG group coordinates a national program for the surveillance of agricultural injuries (the Canadian Agricultural Injury Surveillance Program or CAISP), and is a regional site of the Canadian Hospitals Injury Research and Prevention Program (CHIRPP). • Clinical Evaluation Unit (http://www.criticalcareconnections.com/): improving clinical care provided in a critical care setting through knowledge discovery, knowledge synthesis, and knowledge translation, including nutrition, family satisfaction with ICU care, best practice guidelines associated with ventilator-associated pneumonia, innovative weaning strategies, health resource utilization and long-term follow-up of critically ill patients. The Clinical Research Evaluation Unit is closely linked with Critical Care Research. 8 London Health Sciences Centre & St. Joseph’s Health Care, London – Lawson Health Research Institute, London, ON The main strategic research foci of the Lawson Health Research Institute are: 1. The Lifecycle Research Network (LRN): A joint venture between Lawson, The University of Western Ontario, and the Universities of Windsor, Waterloo and Guelph. This project represents a region-wide chronic diseases management research initiative, including an innovative health informatics core facility. Lawson and its partners have actively started to fundraise for this project for equipping the new centre. The research behind LRN includes evaluation of new models of prevention and intervention in diabetes, cardiovascular disease, cancer, neurological disorders and mental health, with a focus on community health care delivery. The Institute funded a first generation diabetes research electronic management system and is now developing an integrated, regional electronic registry platform. 2. Non-invasive Molecular Imaging: Diagnosis of diseased and abnormal tissue has been extended close to the resolution of present invasive pathology, and hybrid imaging platforms are used to explore and develop molecular-level imaging using PET/CT, SPECT/CT and PET/MRI for new imaging applications in the areas of cardiology, neurology, mental health, metabolic disease, and cancer. A recent award of $27 million from CFI and the ORF has additionally provided a cyclotron and radiopharmacy laboratory. 3. Translational Cancer Research Program: The program seeks to identify new diagnostic markers and strategies to prevent metastasis, to utilize non-invasive molecular imaging to identify the genetic basis of individual cancers, to identify genetic polymorphisms that convey risk for particular forms of cancer to the individual, and to prevent neoplastic growth through the innovative use of siRNA to silence key genes controlling cell cycle progression. Three basic and one clinical scientist were additionally recruited in 2006/7 and 10,000 sq. ft. of new translational cancer research space is planned to open in 2009 at the Victoria Hospital of LHSC. 4. Centre for Clinical Investigation and Therapeutics: The focus is to establish a national clinical investigation unit for clinical trials to examine new drug therapies for the management of chronic diseases, including degenerative neural and neuromuscular disorders. The centre will study undesired and adverse effects of drugs and chemicals, and the interaction of individual genetic traits with drug action and interaction. 9 Montfort Hospital – Montfort Research Institute (Institut Francophone de Recherche Interdisciplinaire en Santé), Ottawa, ON The main strategic research foci of the Montfort Research Institute are: 1. Health of francophones in a Minority context: Research Includes the social and environmental determinants of health, access to health information, models of service delivery and health policy. A multidisciplinary group of researchers is developing an Applied Health Research Network on the health of francophones in Ontario. This cross-cutting network is part of the Applied Health Research Network Initiative of the Minister of Health and Long Term Care. 2. Health of individuals: A team of researchers in psychology and psychiatry is carrying out projects in the area of mental health and substance abuse. This includes the validation and determination of the psychometric properties of tools for the francophone population and the development and evaluation of certain types of therapeutic approaches. The goal is to better assess and serve francophones in Ontario, with mental health and substance abuse problems. Researchers in the Research Unit on Behaviour and Metabolism are using basic, clinical, and behavioural research to study the impact of nutrition and exercise on the metabolism of individuals with chronic medical conditions such as diabetes and obesity. This multidisciplinary team with expertise in nutrition, genetics, physiology and human kinetics is also investigating the impact of extreme environmental conditions on human performance and metabolism. 3. Health professions: learning and practice: As a community based hospital which offers training in French for future health care professionals, the learning environment and the francophone minority context present certain challenges. These are being addressed by a team of researchers and clinicians who are investigating the best learning strategies for future health professionals. In addition, interprofessional practice is a main focus of inquiry. Researchers and clinical teachers are developing a body of theoretical and practical knowledge in this area. New models for interprofessional training and practice are being developed and evaluated. 10 Mount Sinai Hospital – Samuel Lunenfeld Research Institute, Toronto, ON The main strategic research foci of the Samuel Lunenfeld Research Institute are: 1. Prosserman Centre for Health Research: Focused on population analysis of cancer (especially breast, colorectal and lung) as well as identification of environmental factors impacting cancer and heart disease (e.g. diet). The group performs research into new statistical methodologies as well as analysis of genetic variations and gene expression data. 2. Centre for Systems Biology: This group studies critical signal transduction systems and pathways, builds protein:protein interaction networks and develops bioinformatic approaches for data assimilation and analysis. The group has foci in cancer, DNA damage, diabetes, developmental biology and technology development and uses proteomics and live cell microscopy for functional genomic analyses. 3. Centre for Stem Cells and Tissue Engineering: This Centre is focused on regenerative medicine and works with mouse and human embryonic stem cells, umbilical cord stem cells and precursor cells from various tissues including cartilage and bone. The group is closely tied to mouse genetic technologies and most recently has made significant advances in induced pluripotential stem cell technologies. 4. Centre for Modelling Human Disease: This program has undertaken genome-wide generation and analysis of mouse mutations relevant to human biology and disease. The Centre's goal is to provide a platform for integrative analysis of mouse models related to pregnancy and development, diabetes, neurobehaviour, cancer, cardiovascular disease, bone and connective tissue formation, and kidney function and exploits facilities in the state-of-the-art Toronto Centre for Phenogenomics. 5. Fred A. Litwin Centre for Cancer Genetics: The Litwin Centre for Cancer Genetics includes principal investigators in the Research Institute as well as clinical and laboratory staff of Mount Sinai Hospital. The goal of the Centre is to translate the concepts and techniques of molecular oncology into new initiatives in the detection, treatment and prevention of cancer. The main research activities are focused on colorectal, pancreatic and breast cancers and sarcoma. 6. Centre for Genomic Medicine: This team of scientists share common interests in extraction and use of genomic information for the purposes of gleaning clinical insight into prognostic information, correlating genetics and phenotypic data and identifying patient populations at most risk or most likely to benefit from a given intervention. The group is particularly interested in advancing and realizing the goals of personalized medicine and is focused on auto-immunity, kidney disease and arthritis. 7. Centre for Neurodevelopment and Cognitive Function: The Centre for Neurodevelopment and Cognitive Function focuses on using both vertebrate and invertebrate animal model systems to study the development and function of the nervous system. The research foci include understanding memory, the genetic contributions to schizophrenia and OCD and nerve guidance mechanisms. 8. Research Centre in Women's and Infants' Health: This centre, the largest in Canada focused on research into all aspects of maternal and fetal health, is closely integrated with a cognate clinical program within Mount Sinai Hospital (6,000 births annually). The group is investigating a variety of pregnancy-related complications including pre-eclampsia, gestational diabetes, pre-term birth, developmental origins of disease, placental health, fertilty and gynocological malignancies. 11 North York General Hospital, Toronto, ON The main strategic research foci of North York General Hospital are: 1. North York General Hospital is committed to become a recognized centre of research in the Canadian spectrum by the year 2015. NYGH currently has a strong reputation for providing excellent medical education, as well as pockets of patient-centred research. NYGH is in the final stages of the development of an academic strategy, “Innovation and Learning,” which will focus on three domains: Research, Education, and Creative Professional Activity. 2. NYGH feels there is a need for more practical, applicable research that bends the cost curve to ensure the sustainability of Ontario’s future health system. NYGH is spectacularly positioned to develop a niche in this new environment based upon its large, undifferentiated patient base. Traditional academic hospitals focus on tertiary and quaternary care, with referrals from community hospitals. Research in these centres tends to be focused on selected patient populations. NYGH is well poised to provide more generalized, population-based research. 3. NYGH is a very busy community hospital with 400 inpatient beds and over 100,000 emergency visits annually. This, along with the generalized profile of patients, provides excellent opportunities for NYGH to study a wide variety of process improvements and quality of care initiatives in the aging population. 4. NYGH’s current competencies and interests in research focus on: a. Quality and patient safety b. eHealth for patient outcomes in primary and secondary care c. Improving the patient experience d. Process improvement and re-engineering 12 The Ottawa Hospital – Ottawa Hospital Research Institute, Ottawa, ON The Ottawa Hospital Research (OHRI) Institute has developed two Strategic Research Priorities: 1. Regenerative and Biological Therapeutics: This priority is designed to foster “bench to bedside” research – turning basic discoveries in cellular and molecular biology into new regenerative and biological therapeutics to improve health. 2. Practice-changing Research: This priority is designed to put knowledge to work – performing high quality clinical research that can inform health decisions and ensuring that results are optimally applied to improve health. OHRI has also developed a cross-cutting Strategic Research Theme: • Vascular Health: This theme is designed to foster an exciting area of interdisciplinary translational research that focuses in the role of blood vessels in health and disease. This theme cuts across all of OHRI’s existing Programs and interfaces with areas of strength and focus at OHRI and at OHRI’s partner organizations. It addresses a major challenge for the health and well-being of Canadians. 13 Providence Care, Kingston, ON Providence Care researchers are actively engaged in a number of initiatives that actively inform and influence clinical programs and outcomes. The following examples are illustrative of some of their key foci: • Providence Care’s Centre for Studies in Aging & Health (CSAH): Key foci are: 1. Aging and Health 2. Knowledge to Practice 3. Interprofessional and Collaborative Practice 4. WWW-based learning The CSAH team includes an inter-professional group of researchers, educators, clinicians and technologists with expertise in aging, collaborative healthcare practice, adult education and training, multimedia and effective use of information technology. Through an innovative combination of a webbased knowledge and information platform and collaborative interaction of the knowledge creators and users they have created a unique series of educational resources and decision-supports relevant to clinicians within multiple health care sectors and topics. • Research in Physical Medicine and Rehabilitation: Key Foci are: 1. Interventional Studies 2. Quantifying Impairments and Disability 3. Optimizing Function and Community Participation 4. Identifying Barriers to Community Based Rehabilitation This research is often collaborative in nature, engaging various groups, including Queen’s School of Rehabilitation Therapy, Queen‘s Centre for Health Services and Policy Research, The Centre for Neuroscience Studies and the Department of Physiology. 14 Royal Ottawa Health Care Group – University of Ottawa Institute of Mental Health Research, Ottawa, ON In strong partnership with the Royal Ottawa Health Care Group (ROHCG), the University of Ottawa Institute of Mental Health Research (IMHR), a relatively young entity, strives to continuously improve mental health and well-being through leadership, collaborative discoveries and innovation in research, patient care and education. The IMHR's neuron to neighborhood approach (involving promotion, prevention, early detection, and intervention) examines mental illness on a continuum that spans basic biology to the level of the community itself. 1. While the ROHCG offers clinical programs supporting recovery, rehabilitation and well-being in mood disorders, anxiety disorders, schizophrenia, youth program, forensic psychiatry, geriatric psychiatry, substance use and concurrent disorders, intensive assessment and intervention/ACTT, operational stress injury clinic, and community mental health, Phase I of ROHCG’s research roadmap has been completed and capitalizes on existing strengths of IMHR researchers in five clinical research units: mood disorders, stress and anxiety disorders, schizophrenia, youth psychiatry, and forensic psychiatry. 2. Phase II of the research roadmap has been initiated to incorporate additional research platforms in translational neuroscience; mind, brain imaging and neuroethics; program development and evaluation research; and population/biopsychosocial research areas. Additional research themes will include workplace mental health consortium, stress and trauma research centre and the WHO population mental health collaborative. Furthermore, the IMHR is currently in the process of developing a multidisciplinary Depression Intervention Research Centre (DIRC) with national collaborations to address the increasing burden of depression and associated risk factors on global health and wellbeing. 3. Several core technologies such a sleep and clinical neuroelectrophysiology; brain imaging (fMRI); and, preclinical laboratories span across all existing research foci. 4. Research partnerships exist with other universities/research institutes, the community, and regional, national, international and industry entities. 15 St. Joseph’s Healthcare Hamilton, Hamilton, ON The main strategic research foci of St. Joseph’s Healthcare Hamilton are: 1. Respirology research (Firestone Institute for Respiratory Health): The Firestone Institute for Respiratory Health (FIRH) is sited in the Innovation Tower of St Joseph’s Healthcare Hamilton (SJHH) and is the flagship research endeavor at SJHH. Its facilities for researching airway diseases are amongst the most advanced and sophisticated in the world. FIRH embraces both preclinical and clinical research. At the bench, there are biochemical, molecular and advanced imaging investigations in animal models that mimic the human lung diseases. Clinically, FIRH has state-of-the-art facilities that allow for translational medicine projects on biomarkers of the disease. These include the world’s first sputum research laboratory, the AllerGen clinical investigator collaborative and aerosol and allergen challenge research laboratories. The advanced Imaging Research Centre (IRC) at SJHH is a facility that allows for the non-invasive evaluation of lung function. Another of the unique features of the FIRH is its adjacency to the FIRH respiratory clinic which is the regional centre caring for patients with lung diseases. Thus, the advances in understanding of lung diseases, unraveled in the research laboratories, are readily incorporated into clinical practice to improve the well-being of patients. The FIRH research laboratories house between 40 and 50 scientific investigators at any one time. The clinical service is manned by 15 physicians, 3 allergists and 6 surgeons. There are more than 40,000 patient visits annually to the FIRH clinics and in an average week 66 half-day clinics are conducted. A marker of the research productivity of FIRH is attested to by the high quality and impact of peer-reviewed publications. Over the past 5 years FIRH has published ~350 separate peerreviewed scientific/clinical papers of which 120 have appeared within the last two years. This, by any yardstick set in the scientific community, is an extremely high level of accomplishment which is why the FIRH is ranked at the top of the Canadian respiratory research centres and amongst the top ten lung research centres in the world. The academic output of the FIRH ranks with the very best in the world. Testament to this fact is that the FIRH was responsible for the discovery and development of the Aerochamber, the most commonly used inhalation spacer device used by asthmatics worldwide. FIRH was also responsible for advancing diagnostic techniques for asthma that led to the development and implementation of new asthma management guidelines for Canada. FIRH is also the home of the CHILD (Canadian Healthy Infant Longitudinal Development) birth cohort study that will follow some 5000 infants for the first five years of life to determine how environmental factors (both internal and external) influence the development of allergic and other airway diseases in later life. This CHILD study is an international first (see CHILD details in section 2 below). 2. Nephrology research (Hamilton Centre for Kidney Research): The mandate of the HCKR is to combine expertise in clinical and basic research in order to reduce the risk of kidney disease and its complications. Specific research objectives are to better understand the underlying mechanisms that modulate diabetic nephropathy, vascular calcification associated with end stage renal disease, renal fibrosis, wound healing, prostate cancer development and progression and cellular pathways. The overall objective of these studies is to develop an active, translational research program for the development of novel therapeutic approaches aimed at diminishing the risk and complications of renal disease and cancer. HCKR is intimately associated with the clinical renal programs that include dialysis and organ transplantation (see 2.4 below). 3. Mental Health research (including Brain-Body Institute: The mental health and addictions program places a strong emphasis on clinical research. The principal areas of interest are; mood disorders, anxiety and depression, substance use disorders, schizophrenia, women’s health concerns, obsessive-compulsive behavior, autism and post-traumatic stress disorder. In conjunction with the Brain-Body Institute extended foci are; effects of stress on 16 pregnancy, fetal development and their long term outcomes, using both clinical and basic science approaches. Recent attention has also been devoted to the action of commensal organisms including probiotics on intestinal function, nervous system and behavior patterns. 4. Programs for the Assessment of Technology in Health (PATH Research Institute): The PATH Research Institute conducts and promotes evidence-based evaluations of the effectiveness and efficiency of new and existing health care technologies. It has extensive expertise in conducting literature reviews, evidence synthesis, biostatistics, economic evaluation, costing, budget impact analysis, decision analytic modeling, policy analysis, health systems impact analysis, and techniques of research translation and knowledge uptake for new policy formation. PATH is particularly well suited to assist program, service and policy makers, at all levels of decision making, in making difficult decisions about efficient and equitable health care resource utilization. The four principal areas of focus for PATH are: • • • • Field Evaluation and Economic Assessment Program (FEEAP) Health Technology Assessment Program (HTAP) Trial and Economic Modelling Methodology Program (TEMMP) Health Technology Assessment Educational Learning Program (HELP) 17 St. Michael’s Hospital, Toronto, ON The main strategic research foci of St. Michael’s Hospital are: 1. Critical Care and Organ Dysfunction: The goal of this research group is to generate new knowledge of fundamental mechanisms of organ dysfunction that is readily amenable for translation into improvement in patient outcomes. This research thrust was born out of the existing strengths of researchers at SMH in cardiology, nephrology, diabetes, respirology and neurotrauma, and has been expanded over the past eight years to include research platforms with direct relevance to the most severely ill patients within those disease specific areas. However, “critical care” within this context encompasses far more than just activities directly related to the intensive care unit, and includes research on mechanisms and novel therapies for acute organ dysfunction from the heart to the brain, and addresses the needs of patients with multiple organ system failure due to disease or injury which is commonly associated with high mortality rates. 2. Inner City Health: St. Michael’s Hospital is one of the only hospitals in Canada that has declared Inner City Health to be a strategic research focus. The Centre for Research on Inner City Health (CRICH) is dedicated to reducing health inequities through innovative research that supports social change. The Centre conducts research to better understand the linkages between poverty, social exclusion, and poor health. Researchers work in partnership with community agencies and decision-makers to evaluate “what works” to improve health outcomes for inner city populations. CRICH research is genuinely transdisciplinary. Strengths include clinical epidemiology, health economics, ethics, geography and GIS mapping techniques, health services research, medicine, population health, psychology, psychiatry, knowledge translation, and social epidemiology. CRICH research programs include: (i) homelessness, housing and health, (ii) neighbourhoods and health, (iii) maternal and child health, (iv) mental health and substance abuse and (v) urban Aboriginal peoples and health. 3. Global Health: The Centre for Global Health Research was established at St. Michael’s Hospital in 2003. Its mission is to conduct high-quality research that advances global health. The CGHR uses biomedical, epidemiological, economic and research ethics sciences to develop evidence-based policies that can be adopted by organizations and governments. Research focuses on the epidemiology and prevention of premature mortality in developing countries, specifically on HIV/AIDS, tuberculosis and chronic diseases, as well as research ethics to advance equitable sharing of scientific benefits. Currently, CGHR is leading a largest epidemiological a study of six million people in 1.1 million homes in India. 4. Knowledge Translation: Knowledge Translation is the newest research program developed in collaboration with the University of Toronto, and supported by the Li Ka Shing Knowledge Institute of St. Michael’s Hospital. The Knowledge Translation Program designs and evaluates interventions to increase the likelihood of incorporating the best available evidence into practice and policy, and researches the best strategy to implement knowledge in a variety of areas, including: critical care and trauma, diabetes, patient education, continuing medical education, interprofessional care, and the management of chronic diseases in the developing world. 18 Sunnybrook Health Sciences Centre – Sunnybrook Research Institute, Toronto, ON The main strategic research foci of the Sunnybrook Research Institute are: 1. Cancer: Research is concentrated on three disease sites: breast, colorectal and prostate. Examples of activity are looking at the cellular structure of cancer cells to be able to identify a “signature” for cancer; and inventing imaging technologies that can detect and diagnose cancer earlier, and treat it better and with greater precision. 2. Heart and stroke: Research in this area focuses on developing and testing new ways to harness the therapeutic potential of interventional cardiovascular medicine; and inventing new ways to detect, treat and prevent stroke. Scientists are designing and testing new methods and devices to detect, diagnose and treat cardiac conditions. These include biological (for example, cell-based therapies) and physical (for example, focused ultrasound) methods and devices. 3. High-risk maternal and newborn health: Research goes from bench to bedside in this area. For example, in the lab, scientists are studying the cellular basis of pulmonary hypertension in newborns, to be able to develop a treatment for a chronic lung injury that affects premature infants and for which no effective therapies exist. More clinically, Sunnybrook’s Centre for Mother, Infant and Child Research is leading international practice-changing clinical trials, such as a study to determine the best way to deliver twins. 4. Major trauma: As the first and the largest designated trauma centre in Canada, Sunnybrook leads in this area. Researchers are developing and evaluating resuscitation strategies; understanding and treating coagulation and inflammation in hemorrhagic shock; pioneering new methods in prehospital care; studying interprofessional education and simulation in emergency and critical care; and evaluating burn wounds and graft evaluation. The overarching aims are to improve survival and quality of life outcomes, and deliver high-quality, evidence-based care. 5. In addition to the four strategic priorities that are defined according to the clinical conditions they seek to address, Sunnybrook Research Institute is internationally renowned for its imaging expertise, which cuts across all clinical program areas. The Research Institute’s flagship project in this area is the Centre for Research in Image-Guided Therapeutics, a $160-million project now being built at Sunnybrook. This centre will be unique in Canada. Research here will be dedicated to discovering new and better ways to detect, diagnose and treat some of the most pressing problems in health care, among them cancer, heart disease, musculoskeletal disorders, immune-system deficiencies, stroke and Alzheimer’s disease. 19 Thunder Bay Regional Health Sciences Centre – Thunder Bay Regional Research Institute, Thunder Bay, ON Canada’s newest health research institute has a unique mission - to improve the quality of healthcare through excellence in patient-centred research. At the Thunder Bay Regional Research Institute, the patient is at the start of the research journey, bringing science to life through discovery, early detection, new treatments, and cures. Thunder Bay will pioneer a new standard of excellence in the clinical investigation of novel molecular imaging-based diagnostic technologies for disease prevention, early detection and image-guided treatment. Scientists and clinicians work together with academic and industry partners to develop tools to efficiently bring molecular imaging and advanced diagnostic technologies to the patient in a research setting. This will happen under three key research themes: 1. Imaging Guided Interventions: Imaging guided interventions, such as High Intensity Focused Ultrasound (HIFU), can be used to improve imaging guided surgical procedures that result in better outcomes and faster recovery for patients. By using arrays of ultrasound transducers, a sonic beam can be created which, at its focus deep within the body, can ablate unwanted tissue without harming normal tissues, cutting the skin or requiring general anesthesia. Specially modified MRI’s help direct the beam focus and monitor the temperature of the thermal lesion, resulting in incision-less surgery. Under this theme, Thunder Bay Regional Research Institute scientists will collaborate with Dr. Kullervo Hynynen at Sunnybrook Research Institute, an international expert on HIFU. Working with Philips Healthcare under a Master Research Agreement, the Thunder Bay Regional Research Institute and its partners will together pioneer a new generation of commercial systems, the first of which is a system designed to eliminate uterine fibroids and lead to developments in cancer treatment. For the past five years, Dr. Laura Curiel has been specializing in HIFU therapy, working at Sunnybrook Health Sciences Centre since 2006. As a scientist with the Thunder Bay Regional Research Institute, Dr. Curiel will be responsible for the HIFU uterine fibroid clinical trial and then focus on liver cancer. 2. Advanced Detection Devices: Advanced Detection Devices, including x-ray, PET and MRI imaging, can better detect small tumours in the body and improve surgical planning. Dr. John Rowlands, scientist Dr. Alla Reznik and others will work in the Advanced Detection Devices program as they plan to apply novel solid-state technology to x-ray and PET systems. In particular, Dr. Reznik is developing an advanced technology for breastdedicated PET imagers, which will facilitate early detection of breast cancer and accurate monitoring of treatment. Initiatives will be directed at a new generation of whole body PET-MRI scanners which will produce improved functional and anatomical images in perfect registration. To facilitate this translational research a PET-CT system was installed at the Thunder Bay Regional Health Sciences Centre in June 2008. This technology will be used for cancer diagnosis and staging research as well as planning for the early installation of an advanced MRI system. 3. Probe Development and Biomarker Exploration: Biomarker Exploration involves a biomarker, or a drug, entering the body and seek out cancer cells at the molecular level. Using an MRI or other imaging tool, any cancerous cells that exist will light up, making early detection possible through non-invasive techniques. These allow scientists and clinicians to define disease-specific therapeutics and customize/optimize individual therapy. 20 Building on their experience in Molecular Biology, Dr. John Th’ng and Dr. Ingeborg Zehbe are expected to contribute greatly to the biomarker discovery research platform. In current successes Dr. Zehbe received a $150,000 NSERC grant for 2008-2013 to investigate strains of the HPV virus, which causes cervical cancer. Dr. Th’ng, in collaboration with Dr. Michael Hendzel in Edmonton, Alberta, received a $700,000 grant from NCIC in May 2008 to monitor how specific proteins affect DNA in cells, and how this affects the development of cancer cells. The Research Institute will continue to recruit outstanding investigators to reach its first goal of 24 independent scientists, beginning with proven leaders in molecular imaging, to complement the teams that currently exist. The goal is to provide these scientists with an environment that enables them to be productive as rapidly as possible. 21 Toronto Rehabilitation Institute, Toronto, ON The main strategic research foci of the Toronto Rehabilitation Institute are: 1. Develop new and improved treatments and technologies that increase the level and speed of recovery from disabling injury and disease; 2. Develop affordable technologies that increase accessibility and enable people to age in place in their familiar homes and communities with a high quality of life; 3. Develop technologies that support the safety and effectiveness of professional and family caregivers; 4. Develop technologies and interventions to prevent injuries and disease that lead to disability and to help achieve and sustain fitness; 5. Assist the MOHLTC in the provision of equitable and cost effective rehabilitation services. 22 University Health Network – Ontario Cancer Institute, Toronto General Research Institute and Toronto Western Research Institute, Toronto, ON The main strategic research foci of the University Health Network are: 1. Genes, Proteins and People: encompassing research into molecular mechanisms of disease, pathway-specific inhibitors and therapies, and personalized medicine. 2. Health Informatics: encompassing research into improving patient care and population health outcomes through health care research and clinical trials. 3. Medical Technology Innovation: encompassing research into human and animal imaging from molecules to networks, robotics-assisted procedures, prototyping and medical devices and artificial organs. 4. Regenerative Medicine: encompassing stem cell biology, tissue engineering, molecular therapy, cell tracking and functional imaging, live-cell imaging, cell processing and living cell banking, and tolerance induction. 23 Women’s College Hospital – Women’s College Research Institute, Toronto, ON The main strategic research foci of the Women’s College Research Institute (WCRI) are: 1. Create knowledge that enables women’s health across the lifespan: A commitment to continue Women’s College’s unwavering commitment to research that improves women’s lives and offers women, and their health care providers, tools and information to help manage individual health concerns. The WCRI will work to expand its research to meet the needs of underserved communities of all ages and to support women as they age. 2. Move beyond a focus on single conditions to explore the complex health needs of women: Women are more likely than men to live with multiple chronic conditions and more likely to be disabled by those conditions. The WCRI will recognize this reality, prioritizing work which acknowledges that women frequently deal with overlapping health concerns, that their needs often extend beyond the active treatment period, and that protecting their own health may be only one of several competing priorities. The WCRI will address this critical gap in care provision with cross-disciplinary research approaches to devise pragmatic real-world responses. 3. Reinvent systems of care using innovative ambulatory care models to better serve women and their families: The WCRI must become collectively engaged in the process of defining innovative ambulatory care, and in the broader challenge of improving the accessibility and sustainability of Ontario’s health care system. Health services research will be the Research Institute’s tool to develop new systems of care to more effectively link health resources together, better support frontline care providers and address inequities in health care delivery, while providing the necessary tools to assess system performance. 4. Develop, recruit and support women’s health research leaders: Women’s College Hospital and the WCRI are focal points for women’s health research and training in Canada. The WCRI will continue to lead by nurturing outstanding scientists and trainees and building their capacity for collaboration and visionary research. The WCRI will work with its clinical partners to recruit and develop additional research leaders. The WCRI recognizes that its scientists and trainees are its most important research assets. 24