The State of the Course – Kim Solez

1. The State of the Course – Kim Solez A year after the conception of the Technology and Future of Medicine Course (LABMP 590) it is useful to reflect on its progress and evolution.

2. Focus Groups in May 2011 Course conceptualized in March 2011, tested with focus groups in May for its suitability as a course for both undergraduate and graduate students.

3. State of the University Address March 22, 2012, “Unleash your inner radical” “Unleash your inner radical. Do it now. There are no crazy ideas.” President IndiraSamesekera

4. Technology and the Future – A Manifesto The zeal and student enthusiasm for our course is now driving the production of a book with a new title,Technology and the Future – A Manifesto that is in turn now coevolving with the course.

5. Technology and the Future – A Manifesto The book will be published on all significant Internet-mediated platforms including: Kindle, Nook, Vook, Sony Reader, Kobo, and Apple iBook (IOS).

6. Over Time Our Course’s Sessions Have Developed a Pedagogical Rhythm; Leading To A Self-organized Structure Ten minute introduction Fifty minute lecture Twenty minute discussion

7. Diverse Faculty from Across The Campus Are Increasingly Comfortable in the course Heather Graves, from Department of English and Film Studies, in Faculty of Arts.

8. Video and Audio Quality Superb Now! First teaching session 2011 Recent teaching session 2012

9. Three Remaining Goals Increase course enrollment both externally and locally Add additional topics to broaden multidisciplinary nature of course still further Replicate course widely elsewhere Masters student in College of Pharmacy, Qatar University, Doha, Qatar joining us by Skype

10. The Rest of the Story How I came to create this course How it fits into my career path How it relates to Banff Allograft Pathology Consensus Process and Nepal Initiative How it relates to Future of Pathology

11. Pioneering Work Creating Medical Resources On The Internet In 1994 created websites for CAP, ISN, and RPS and NEPHROL Email discussion group In 1997 created NKF CyberNephrology and ISN Informatics Commission In 1999 new Lab Medicine Pathology chair, Victor Tron, suggested I broaden focus to CyberMedicine, and encouraged medical humanitarian ventures

12. Humanitarian Medical Ventures In Nepal Starting in 1998 In 2007 joined medical advisory board of new medical school in Nepal devoted to rural health, Patan Academy of Health Sciences (“PAHS”). Now co-direct fundraising and public relations for PAHS, ten UofA faculty are now involved in the project.

13. In 2009 started doing video blogs on InternetEvolution.com Tech musings from the Hinterland. The first video was from Nepal. Virtual microscopy one topic.

14. In 2010 became the only full time University faculty member taking the Singularity University Executive Course

15. Initiated writing my book • In February 2011 began writing book on the same day the Singularity appeared on the cover of Time magazine.

16. The Banff Classification • In 1990 all standard textbooks were inaccurate in interpretation of kidney transplant biopsies • Suggesting, for example, that arteritis meant that the kidney was doomed and antirejection treatment should be abandoned • It became imperative for the field to correct this and standardize interpretation

17. The Banff Schema • . The Banff Schema was first developed by a group of pathologists, nephrologists, and transplant surgeons at a meetingin Banff Canada August 2-4, 1991.. It has continued to evolve through meetings every two years and has become the worldwide standard for interpretation of transplant biopsies

18. BANFF Classification Standard For Transplant Biopsy Interpretation Began in kidney (Solez et al. 1993), and was then extended to liver, pancreas, composite tissue grafts etc. Meetings also consider heart, lung, small bowel. Uses semi-quantitative lesion scoring 0-3+ and diagnostic categories.

19. Genomics Versus Traditional Pathology. A Foot Firmly Planted In Both Camps But It Seems Ok! AffymetrixGeneChip® probe array. Image courtesy of Affymetrix. A principal investigator in Phil Halloran’s 18 Million Dollar Genome Canada transplant transcriptome project. The prime mover behind the Banff Conferences and Classification which mainly uses techniques of thirty to fifty years ago. BANFF Cybernephrology

20. BANFF Conferences On Allograft Pathology 1991-?

21. BANFF Classification - Milestones • 1991 First Conference • 1993 First Kidney International publication • 1995 Integration with CADI • 1997 Integration with CCTT classification • 1999 Second KI paper. Clinical practice guidelines. Implantation biopsies, microwave. • 2001 Classification of antibody-mediated rejection • Regulatory agencies participating • 2003 Genomics focus, ptc cell accumulation scoring • 2005 Gene chip analysis. Elimination of CAN, identification of chronic antibody-mediated rejection. • 2007 First meeting far from a town called “Banff” – La Coruna, Spain. • 2009 Working groups. Meeting in Banff, Alberta, Canada for last time until 2017!

22. Diagnostic Categories • Normal • Antibody-mediated rejection, • Borderline changes: ‘Suspicious’ for acute cellular rejection • T-cell-mediated rejection (may coincide with categories 2 and 5 and 6) • Sclerosis, interstitial fibrosis, and tubular atrophy, no evidence of any specific etiology • Other changes not considered to be due to rejection

23. Lesion Scoring (0-3+) • Transplant glomerulitis - g • Chronic transplant glomerulopathy - cg • Interstitial Inflammation - i (ti) • Interstitial fibrosis - ci • Tubulitis - t • Tubular atrophy - ct • Vasculitis, intimal arteritis - v • Fibrous intimal thickening - cv • Arteriolar hyaline thickening - ah (aah) • Mesangial matrix increase - mm • Peritubular capillary cell accumulation - ptc

24. Standardization Of Tx Biopsy Interpretation - BANFF Classification • Classification begun at 1991 Banff meeting has become the worldwide standard, and the consensus process has now extended to all solid organs. Meetings continue every two years. Latest meeting was in Paris in June 2011. • Future meetings are planned every two years through 2019. • Standardization principles now being extended from biopsy reporting to tissue typing, imaging, all the other elements in transplant care.

25. Future BANFF Meetings • 2013 – Campos do Jordao, Sao Paulo, Brazil • 2015 – Istanbul, Turkey • 2017 – Banff, Alberta, Canada. • 2019 – Barcelona, Spain • 2021– Make a proposal!

26. Global Consensus Generation While Maintaining Intellectual Freedom

27. Balancing Freedom and Productive Standard-Setting • Like the mosh pit at a great rock concert. No partner, the ultimate in individuality, dangerous, but when the music is good everyone dances in sync and life is good!

28. BANFF Governance Structure - Until now we have had none beyond Drs. Racusen and Solez. Plan to form Swiss foundation, a legal entity, in 2012.

29. From Beginning to Now • It is hard to believe we have been at this for twenty years! Images from 1991

30. In Our Original Location We Had Mule Deer Poking Their Heads into the Meeting Rooms!

31. Amazing growth… • Despite a primitive beginning 21 years ago all the high tech ideas we talk about in this course are infusing their way into the Banff consensus process & meetings—completing the cycle