Developing research led by Myrtede Alfred (MIE) offers new insight to address racial and ethnic maternal care disparities in the United States.   

Evaluating clinical systems issues using 528 incident reports in 476 deliveries, Alfred found that Non-Hispanic Black (NHB) patients are represented disproportionately in incident reports from a large academic hospital in the southeastern United States.   

The study, published in a special issue of the Joint Commission Journal on Quality and Patient Safety, analyzed incident reports documented in 2019 and 2020 from the labour and delivery unit (L&D) and the antepartum and postpartum unit (A&P) of the hospital.   

The investigation is among a few that use incident reports to explore differences in adverse outcomes for birthing in racialized groups. Supported by the 2023 BRN IGNITE grant and the Agency for Healthcare Research and Quality (AHRQ), the project is part of Alfred’s work to ensure equitable maternal care.  

“The emphasis of this work was to disaggregate commonly used patient-safety data by race to understand whether there were certain outcomes where we saw marginalized women, mostly Black women, being disproportionally represented,” says Alfred.  

The paper notes that while NHB and Non-Hispanic white (NHW) patients saw similar rates of reported incidents (ranging at about 43% for both), NHB patients account for 36.5% of the hospital’s birthing population, making them disproportionally represented in reports.   

Incident reports drive patient safety and quality improvement initiatives. Some of the top five reported incidents included communication, medication-related incidents and omission/errors in assessment, diagnosis or monitoring.   

NHB patients accounted for 54% of omission/error events — the only incident category that had a clear correlation to race and ethnicity, compared to other incidents. More than half of NHB patients reported events that include infrastructure failures, complications of care, and falls, to name a few.  

Alfred explains that the population within the southeastern United States has higher rates of comorbidities, like diabetes and hypertension, which leaves them at a higher risk for harm, especially with delayed lab tests and blood glucose level readings.  

“When those things are not happening, what that is doing is putting patients at a level where they are potentially declining in health, and it’s not captured quickly enough to support interventions,” she says.   

The report also found that NHB patients experienced a longer length of stay compared to NHW patients. This may be due to the higher rates of caesarean deliveries, which increases likeness of harm and the chance of repeating the procedure in a future delivery.  

“We know NHB patients are getting more caesarean deliveries, which are associated with more time in a hospital and exposes them to harm, particularly if they are monitored less,” Alfred says.  

“What we’re trying to do is build that connection between what is causing the higher levels of harm that we are seeing for Black women. We are moving away from outcomes to understand the reason behind them.”  

Since incident reports are voluntary, this leaves a question of incident frequency, which is likely under-reported, Alfred says.  

Unlike in Canada, U.S. health-care systems collect race-based data. While maternal health disparities are recognized at the national or state level, local hospitals and health systems need more data to provide responsive care for NHB patients. 

Such data could be used in the development of an equity dashboard that could support shared understandings of issues and establish precise interventions to reduce disparities. Part of the accountability in reaching health equity goals includes acknowledgment of the historic harm in the United States in denying care and rebuilding patient trust, Alfred says. 

“We largely think about harm in terms of physical harm, but there is an emotional side to harm that we could be incorporating. There is a big push for implicit bias training, which will be part of the solution.” 

– This story was originally published on the University of Toronto’s Faculty of Applied Science and Engineering News Site on March 5, 2024 by Tina Adamopoulos.

A team of researchers at the University of Toronto, led by Professor Craig Simmons, has introduced a novel method to engineer soft connective tissues with prescribed mechanical properties similar to those of native tissues. This finding, published in the journal Advanced Functional Materials, can propel the generation of more realistic tissues and organs for regenerative medicine in the future.

“Soft connective tissues, including heart valves, possess highly nonlinear and anisotropic mechanical properties that haven’t been accurately replicated in tissue-engineered structures before,” said Bahram Mirani, a PhD candidate and the leading author of the research. “Current tissue-engineered heart valves often fall short of accurately mimicking the intricate mechanical properties of native valves, leading to their eventual failure.”

The research team’s innovative approach combines computational modeling, statistical optimization, and a cutting-edge fabrication method known as Melt Electrowriting (MEW). MEW, a fusion of 3D printing and electrospinning, enables the precise deposition of fine fibers with complex architectures. This method stands out for its ability to create structures with microscopic features that yield native tissue mechanics.

“Melt electrowriting is a powerful biofabrication method to produce intricate fiber architectures. Its ability to precisely print fibers with complex shapes in specific patterns has garnered significant attention in the biomedical field, especially in recent years.” said Mirani.

 

One of the critical features of soft connective tissues is their nonlinearity and anisotropy. Nonlinearity refers to how a tissue stiffens as it is stretched, whereas anisotropy means that the tissue’s stiffness varies in different directions. The MEW method, coupled with computational modeling, enables the replication of these intricate mechanical characteristics.

The computational modeling aspect played a pivotal role in streamlining the optimization process. Mirani elaborated, “Without an optimization method or computational modeling, we would have had to test hundreds of conditions experimentally. Through computational modeling, we reduced the number of experimental conditions needed for optimization down to only five. This significantly accelerated the entire optimization process.”

The research has far-reaching implications beyond cardiovascular applications. Mirani stated, “While our examples focused on heart valve and pericardium tissues, the methodology we’ve developed is applicable to a wide range of tissues and organs with non-linear mechanical properties, such as tendons, ligaments, and skin.”

The ultimate goal of this research is to develop living tissue constructs that can be implanted into patients in the future, such as children with congenital heart conditions. These engineered tissues could grow and remodel alongside the patient, potentially reducing the need for multiple interventions over their lifetime.

“Current treatments for children born with defective heart valves are quite limited. The living replacement heart valves engineered with this new biofabrication approach have unmatched mechanical function, which we expect will contribute to longer-term success than what is possible currently,” said Simmons, the corresponding author of this research.

Collaborators from Queen’s University and the University of Ottawa played crucial roles in the success of this research. The project received funding from various sources, including the Natural Sciences and Engineering Research Council of Canada (NSERC), the Canadian Institutes of Health Research (CIHR), and the Translational Biology and Engineering Program in the Ted Rogers Centre for Heart Research.

This pioneering study opens up new avenues in tissue engineering, promising not only improved clinical outcomes for patients with heart conditions but also paving the way for advancements in various other fields of medicine.

– This story was originally published on the University of Toronto’s Biomedical Engineering News Site on November 15, 2023.

Hydrogen will play a crucial role in enabling countries worldwide to reach net-zero emission by 2050. But a sustainable hydrogen economy will require global collaboration and knowledge sharing to drive the necessary technological developments, says Professor Murray Thomson (MIE).  

Thomson is the one of four national leads of the newly established Global Hydrogen Production Technologies (HyPT) Center, along with professors from Arizona State University in the United States, the University of Adelaide in Australia and Cranfield University in the United Kingdom.   

The Center will advance net-zero hydrogen production technologies with the goal of making it more energy efficient and affordable by reaching US$1 per kilogram. Researchers will also explore the social and environmental system changes that are needed to build a global hydrogen economy.  

“Our goal is to connect researchers and students worldwide to share insights and work synergistically to create a sustainable energy resource,” says Thomson.  

“It is about connecting Canadians who work in hydrogen production and technology, but also connecting Canadians with researchers around the world, which I think is a great benefit to our students to promote new ideas, expertise and approaches.”  

The Canadian component of the project will receive $3.6 million over five years from the Natural Sciences and Engineering Research Council of Canada (NSERC), providing the Center with a total of $25.5 million to support student training and mobility.  

Thomson’s research is focused on methane pyrolysis, and he has co-founded a company, Aurora Hydrogen, which is creating low-cost, low-carbon hydrogen production. 

“Aurora Hydrogen is growing very quickly,” he says. “We’ve hired 30 people and should have a pilot-scale plant built by the end of the year.” 

He is also the methane pyrolysis leader of the new HyPT Center, which is one of three technologies the Center aims to advance. The methane pyrolysis subgroup includes researchers from Adelaide, University of British Columbia (UBC), Stanford and Cambridge.  

“Methane pyrolysis is a process that uses heat to break down natural gas into hydrogen gas and solid carbon particles, so that you don’t produce carbon dioxide. But that carbon is also a useful product,” says Thomson.   

“My team at U of T is using microwave energy to break apart methane. Stanford and Cambridge are working more on the carbon byproduct side, while Adelaide and UBC are exploring different catalysts.  

“We each have a different focus, but by interacting as a group we can work together to provide a more compelling technology.”  

The other two hydrogen technologies the Center is exploring are water electrolysis, where water is split into hydrogen and water using electrical energy; and photocatalytic water splitting, which uses sunlight to separate hydrogen and oxygen.   

Since both methods require lots of clean water, the Center is also exploring challenges related to this crucial resource.   

“Hydrogen production is expected to increase dramatically over the next decade,” says Thomson.  

“We have a role to play in better training the next generation of students working in hydrogen energy, in developing the scientific foundations that these hydrogen production technologies are based on, and in ensuring our approaches consume less electricity, use better catalysts and make more efficient use of the carbon and oxygen byproducts.  

“The goal is to provide the energy that the world needs with much less greenhouse gas emissions — that is the motivation.”

– This story was originally published on the University of Toronto’s Faculty of Applied Science and Engineering News Site on September 26, 2023 by Safa Jinje.

Small modular reactors (SMRs) represent a new paradigm that could change how and where nuclear power is used to meet our energy needs — and U of T Engineering research could help point the way forward.

Professors Greg Jamieson (MIE), Oh-Sung Kwon (CivMin) and Yu Zou (MSE), recently received funding from the NSERC-CNSC Small Modular Reactors Research Grant Initiative. Over the next three years, each of them will be leading a project that seeks to improve the design of SMR technology, from the materials used in their manufacture to the ways in which they are operated.

“Canada has a long history in the nuclear space, and a lot of experience building and operating nuclear power plants,” says Jamieson.

“So far, these have all been large facilities designed to meet the needs of major population centres. But we also have many communities and natural resources that are located hundreds or thousands of kilometres away from these big cities. With a geography like that, SMRs start to make a lot of sense.”

While there are currently no SMRs in commercial operation, several companies and organizations around the world are working on pilot facilities to demonstrate proof-of-concept. For example, Ontario Power Generation has begun site preparation activities for an SMR project at its existing Darlington site in the Greater Toronto Area.

These plants would be small — producing less than 300 megawatts of power, as compared to two or three times that amount from Canada’s existing plants — and built with pre-fabricated components that could be shipped to remote locations and assembled on site.

Since they operate without producing any greenhouse gas emissions, SMRs are seen as a potentially cleaner replacement for the diesel generators that are currently the industrial standard in remote locations. And electricity isn’t all they produce.

“Like all nuclear plants, SMRs generate heat, which produces the steam that is used to run the turbines,” says Jamieson.

“But you could also use this heat in other ways: for example, district heating, or for industrial processes such as hydrogen generation or the early stages of oil sands processing. There are a lot of possibilities.”

As a human factors researcher, Jamieson will be focusing on how the plant’s operators will monitor and control the technology. His project builds on some of his previous experience with the nuclear industry, but also represents a contrast to current industry standards.

“Large nuclear plants have operating procedures oriented around a single crew of operators monitoring a single reactor,” says Jamieson.

“But small modular designs open up new possibilities, such as a single crew monitoring multiple reactors, which raises questions about how you distribute human attention.”

Many proposed SMR systems also include what is known as ‘inherently safe design.’ This means that systems are designed to passively shut down if operating conditions deviate from normal.

“Inherently safe design is a good idea, but we want to understand if there are situations where operators, possibly as a result of misinterpreting data, might mistakenly override those systems,” says Jamieson.

“This is something that was a factor in previous nuclear accidents, such as at the Three Mile Island facility in the U.S.”

In addition to differences in their potential modes of operation, SMRs might also require the use of different materials than current reactors, ones that can stand up to harsher working environments. This aspect is the focus of Zou’s research project.

“In today’s reactors, water is usually used as the cooling fluid,” says Zou.

“But many SMR designs use molten salts as the coolant, which can be more corrosive than water. Other designs use water, but they operate at much higher temperatures and pressures than traditional reactors. This means that the pipes, heat exchangers and other components need to be able to stand up to much harsher conditions.”

Zou and his team are working with collaborators at Natural Resources Canada and Dalhousie University to study how various materials might react to these tougher conditions. These might include nickel or iron-based alloys in common use today, but they will also consider new materials, such as high-entropy alloys, that haven’t been used for these applications before.

Components for SMRs could be made via additive manufacturing, also known as 3D printing. This method, which Zou’s team has expertise in, can significantly reduce the time from the development to the production.

The team will conduct physical experiments in the lab to test the mechanical properties of these materials, then feed the results into a set of computer simulations. Those simulations, in turn, will inform the development of future lab experiments in an iterative approach.

“Our goal is to build up a database that could be consulted by the designers of future SMRs,” says Zou. “It would also help regulators, as the lack of data about material behaviour under the relevant conditions makes it hard to assess safety.”

For their part, Kwon and his team are looking at how SMRs might react to seismic activity.

“Seismic analysis involves looking at how vibrations caused by seismic waves will affect a structure, including whether or not there are resonances that would amplify the effects of these vibrations,” says Kwon.

“In the case of a nuclear plant, we are interested not only in how vibrations might affect the building itself, but also the equipment within the building.”

One of the factors that Kwon and his team are focusing on is the properties of the soil underneath the reactor and containment buildings.

“Today’s plants undergo a lengthy site selection process that ensures they are seated on stiff, compacted soil that will not liquify in the case of a seismic event,” he says.

“But SMRs are designed to be shipped to remote locations, where there is less choice about where to situate them, so they may have to be designed to work on softer soils. In Canada’s North in particular, they might be seated on permafrost. If climate change causes that permafrost to melt, it could affect the seismic resilience of the facility.”

While SMRs are still a long way from widespread application, research from projects such as these can inform their development and keep Canada at the forefront of innovation in this dynamic sector.

– This story was originally published on the University of Toronto’s Faculty of Applied Science and Engineering News Site on July 12, 2023 by Tyler Irving.

Two multidisciplinary teams led by U of T Engineering researchers will train a new generation of experts to address challenges in health care, from organ rejuvenation to more equitable access to treatment for heart failure. 

Professor Michael Sefton (BME, ChemE) is leading Cell and Engineering Approaches to Preserve and Rejuvenate Organs (CEAPRO), one of two projects that have been awarded a total of more than $3 million in Collaborative Research and Training Experience (CREATE) grants from the Natural Science and Engineering Research Council of Canada. 

He says that regenerative medicine has the potential to transform health care as we know it by treating incurable diseases, but that to enable this future, researchers and clinicians will need to address key issues.  

“There is a great need to provide students and trainees with a stronger knowledge of transplant problems,” says Sefton, who is also the scientific director of Medicine by Design, a research hub at the University of Toronto that aims to advance regenerative medicine discoveries.  

Some of the challenges facing Sefton and his team include understanding cell states that are required for tissue-specific regeneration, as well as developing and enhancing these processes at the organ level.  

CEAPRO will build on the expertise of Medicine by Design and the University Health Network’s Ajmera Transplant Centre, which is Canada’s largest transplant program, to train a skilled workforce that can bring living therapy technologies from laboratories into clinical practice. Trainees will receive interdisciplinary technical training, mobility opportunities and mentorships, and professional skills training across three pillars:   

• Fundamental biology and target discovery
• Organ rejuvenation technologies 
• Pre-translation and commercialization

“The ultimate goal of the program is to build better organs,” says Sefton. “We want to train scientists to not only engineer new organs, but to understand the behaviour of the organs once implanted in bodies, including immunology issues.” 

Among CEAPRO’s multi-disciplinary team of 11 professors and 21 collaborators from industry, academia, government and the community is Professor Sonya MacParland (Medicine & Pathology), a scientist and immunologist at the Ajmera Transplant Centre, who is especially critical to the project. 

Her research expertise includes using single cell RNA sequencing to explore the microenvironment of healthy and diseased human livers.  

“Working with RNA sequencing will help us understand the fundamentals of the immune response that happens when a lab-grown organ is implanted in a human body,” Sefton says. “Our goal is to be able to tune the immune response to do what we want to circumvent transplant issues.”  

The second CREATE grant will be led by TRANSFORM HF, a joint initiative between U of T and the Ted Rogers Centre for Heart Research that aims to address inequalities in heart failure care through innovations in digital technologies.  

Cardiovascular disease (CVD) is a leading cause of hospitalization and death in Canada. While these diseases can often be managed, individuals from structurally disadvantaged groups carry the greatest burden of morbidity and mortality because of barriers that prevent access to high-quality cardiovascular care.  

“Digital health innovations can address these barriers, but they must be co-developed and co-implemented through a health equity lens to ensure we aren’t exacerbating existing disparities,” says Professor Azadeh Yadollahi (BME), a senior scientist at UHN-KITE, and the principal investigator of the NSERC CREATE in Translating Cardiovascular Remote Diagnostic and Monitoring Technologies for Equitable Healthcare​​ (CaRDM Eq).  

“CaRDM Eq aims to bridge the digital divide by training innovators to consider a suite of factors as they deliver impactful and equitable solutions.”   

​​​The new training program will be dedicated to supporting digital innovation, such as remote diagnostic and monitoring technologies, for equitable access to high-quality heart failure care. This will be accomplished through four key objectives:  

• Deliver technical training in cardiovascular digital health innovation.
• Develop professional skills to design for equity. 
• Provide experiential learning opportunities in designing for equity. 
• Facilitate mobility between institutions, disciplines and sectors. 

The multidisciplinary ​​team led by Yadollahi is comprised of 10 professors from U of T and McMaster University, spanning engineering, chemistry, public health and medicine. More than 30 industry, community, academic and clinical collaborators will help deliver CaRDM Eq’s training components.  

“The motivation behind our CREATE program is to train the next generation of engineers, scientists and clinicians to develop digital health technologies, such as point-of-care diagnostic devices, wearables and other sensors for monitoring heart function and heart failure. But we are doing this in a way that ensures equitable access to heart failure care,” says Professor Craig Simmons (MIE, BME), co-lead of TRANSFORM HF.  

“We want to build a community where we have multiple disciplines working together to enable better heart failure care for all.” 

– This story was originally published on the University of Toronto’s Faculty of Applied Science and Engineering News Site on April 18, 2023 by Safa Jinje.

October 3, 2018 — High atop the Myhal Centre for Engineering Innovation & Entrepreneurship, a group of 100 engineering graduate students, faculty members, research scientists, and alumni gathered on October 1 to mark a decade of progress toward the goal of smarter health-care delivery.

The expansive terrace on the Dr. Woo Hon Fai Innovation Floor provided attendees with a breathtaking night view of the city’s Discovery District—a cluster of hospitals, research centres, and U of T—that makes Toronto one of the best places in the world to study health-care engineering.

Established in 2008 to bridge academic research with practice, U of T Engineering’s Centre for Healthcare Engineering (CHE) has pioneered data-driven research to improve efficiency and enhance patient care.

At the celebration, current students working with CHE showcased their latest research, while alumni discussed the state of their fields with faculty members. Many old friends reconnected over memories rekindled by the event.

Professor Timothy Chan (MIE), director of the CHE, said the event felt more like a family reunion than a typical wine-and-cheese affair.

“You really felt a strong sense of camaraderie,” he said. “It was great to see old students reconnecting, and new connections forming between current students, alumni, and faculty. While health care engineering as a field has grown quickly, especially over the past 10 years since CHE began, it’s still a tight-knit community.”

After an introduction by Chan, Professor Michael Carter (MIE), CHE’s first director and a newly appointed Fellow of the Canadian Academy of Health Sciences, addressed the gathered crowd—a third of whom were his former students or associates.

“Tim’s introduction sounded like a retirement speech,” he said. “I have no intention of retiring yet! There is still a lot of work to do, and I believe I can still make a contribution.”

“It’s an honour to be surrounded by friends and close colleagues,” Carter added. “I loved talking to everyone, to hear what projects they’re working on, what challenges they hope to tackle. That CHE can serve as a platform to get their ideas out in the world is immensely important.”

The keynote address was given by Dr. David Jaffray, Executive VP of Technology and Innovation at University Health Network, and was focused on the role engineers play in steering society towards progress.

“When Captain Kirk needs help, he says, ‘Get me engineering!’” said Jaffray. He went on to explain that a hospital, like a spaceship, is a system, not a large inert object. Systems can be studied and improved, and that is exactly what associates of CHE are doing.

Despite big data and efficiency being a strong focus of CHE, a concern for people’s well-being remains at the heart of health care engineering.

“None of us would be working in health care engineering if we didn’t care about making things better for patients, doctors, and the whole health-care system,” said Chan. “Engineers bring a unique set of skills and perspectives to tackling health-care issues. These past 10 years are just the beginning. CHE is going to keep pushing forward with research that will save lives, reduce costs, and improve efficiency.”

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View more photos from this event on MIE’s Flickr album.