Post on 27-Jul-2018
A hiatus exists between the inventor who knows what they could invent, if they only knew what was wanted,
and the soldiers who know, or ought to know, what they want and would ask for it if they only knew how much science could do for them.
- Winston S. Churchill (1929)
WHAT ARE THE DOD MEDICAL RESEARCH PRIORITIES? (WHERE DO THEY COME FROM?)
• National strategic plans (e.g., Quadrennial Review)
• Secretary of Defense & other authoritative sources in the DoD and Services
• Armed Services Biomedical Research Evaluation and Management
• Near-term problems identified by field commanders & COCOMs
CORE MEDICAL R&T RESPONDS TO THREATS TO SOLDIER HEALTH AND PERFORMANCE
Environmental Hazards
Heat and Cold
Altitude
Toxic Industrial Chemicals & Materials
Systems Hazards
Laser
Blast
Biomechanical Insults and Stresses
Noise
Operational Stressors
Sleep Deprivation
Traumatic Stress and Situational Stressors
Physical Work Load
Cognitive Burden & Operational Complexity
Endemic Disease Threats
Parasitic Diseases
Bacterial Diseases
Viral Diseases
Chemical/Biological
Warfare Threats
Bacterial Threats
Viral Threats
Toxin Threats
Nerve Agents
Vesicant Agents
Blood Agents
Combat Injuries
Hemorrhage
Head Trauma
Blast Injury
Inadequate
Medical C4ISR
TAKING CARE OF INJURED SOLDIERS HAS BEEN A HIGH PRIORITY
Apart from the war, this department and I have no higher priority than to ensure wounded servicemembers have the best care and facilities and ample assistance navigating the next step in their lives. That is what we intend to give them.
Secretary Gates, 2007
Recognize the critical and permanent nature of wounded, ill and injured, traumatic brain injury, and psychological health programs. This means institutionalizing and properly funding these efforts in the base budget and increasing overall spending by $300 million. The department will spend over $47 billion on healthcare in FY10.
Secretary Gates, 2009
DOD BLAST INJURY RESEARCH EXTENDS BACK TO WORLD WAR II
Cave blasts
Armored Med Res Lab
Nuclear &
conventional explosions
Los Alamos & Albuquerque
“Laying the tracks for the train”
New Science and Technology Options:Modernization of Military Medical R&D
Prevention
(Mitigate Risk)
Acute Treatment
(Mitigate Injury)
Reset
(Mitigate Disability)
Personalized Medicine Diagnostics Regenerative Medicine
Individual Resilience Provider Training Individual Retraining
Biomedical Standards Wound Care Advanced Prosthetics
Injury Surveillance Optimized InterventionsReturn-to-Duty
Standards
Systems Biology Methods
Advanced Training Technologies & Neuroplasticity
Computational Bioengineering, Biomaterials & Nanotechnologies
Electronic Health Record Outcomes Research
MEDICAL RESEARCH AND RELATED PROGRAMS IN THE DOD
USAMRMCARO
NMRC
ONR
AFMOA
AFRL
ONR
AFOSR
Services
DARPA (e.g., DSO)
DTRA (e.g., TMTI)
SOCOM (e.g., BISC)
VA-DoD sharing
(e.g., JIF)
Other Agencies
Understanding underlying science creates rule base to help
solve future problems
Low Emphasis on
Fundamental
Understanding
High Emphasis on
Basic Science
Low Emphasis
on Applications
Pure basic research (Bohr)
High Emphasis
on Applications
Pure applied research (Edison)
Use-inspired
basic research
(Pasteur)
DoD Problem-solving Focus: Use-inspired Medical Research
Revolutionary
Evolutionary
TECHNOLOGY READINESS LEVELS (TRLS)
Source: http://as.nasa.gov/aboutus/trl-
introduction.html
Not our job/no requirement for this research (lack of commitment; lack of agility)
Users don’t want it/don’t know how to use it (no CONOPS; no voice for user “pull”)
We’ve never done it that way before(disruptive to current processes)
Ideas and data cannot be shared!(secrecy, stovepipes, meeting restrictions)
Important but it has never been done before (no protected incubator; zero risk mentality)
It will never fly (SWaP, affordability..)(lack of vision; no sense of urgency)
BUREAUCRATIC READINESS LEVELS (BRL)
Not our job/no requirement for this research (lack of commitment; lack of agility)
Users don’t want it/don’t know how to use it (no CONOPS; no voice for user “pull”)
We’ve never done it that way before(disruptive to current processes)
Ideas and data cannot be shared!(secrecy, stovepipes, meeting restrictions)
Important but it has never been done before (no protected incubator; zero risk mentality)
It will never fly (SWaP, affordability..)(lack of vision; no sense of urgency)
SOLUTIONS
Convene meetings and facilitate
idea generation and collaboration
Develop resourced centers and
protected research incubators
Facilitate translation of research
findings and talk about science!
Trafficking of single groups of 5-HT1A receptors in
distinct endosomal pathways measured by QDs
Fichter K M et al. PNAS 2010;107:18658-18663
©2010 by National Academy of Sciences
The current model of GPCR recycling includes a short (blue arrows) and a long (black arrows)
recycling pathway
CONVERGENCE SCIENCE
Fichter and Vu, Oregon Health and Science University
Flajolet and Greengard, The Rockefeller University
DEVELOP THE CONCEPT AND SMART ENGINEERS WILL ALWAYS FIGURE OUT HOW TO REDUCE SWaP
1996 COL Fred Goeringermobile satellite station beaming
images from the satellite dish from
a mobile surgical center
2009 LTC Sloane Guy performed surgery in Iraq with a
head-mounted camera and other
cameras that could be maneuvered
by remote medical consultants
Surgical telementoring
ADVANCED PHASE SYSTEM-ON-A-CHIP PERFORMANCE MONITORING SYSTEM
Credit: NSF, ASSIST program
NSF ASSIST program Veena Misra
VIRTUAL HOUSE CALLS
“Radio Doctor” Concept
1924
Dr. E. Ray Dorsey conducting teleconsultation with a Parkinson’s
patient in the patient’s home
THEN… AND NOW…
TELE-BEHAVIORAL HEALTH: PROVE THAT USERS WANT THE DISRUPTIVE TECHNOLOGY
Improve access to BH providers for soldiers, minimize travel, extend reach of BH far forward to deployed locations
MC4 laptops using
CENTRIXS network
Patient to Provider
TBH session
• Over 10,000 theater teleconsultations since 2004
• 70% of soldiers would not have sought behavioral health care if tele-behavioral health was not available
• BH became the primary means of delivering BH Care in Afghanistan
mCARE: SECURE MOBILE APPLICATION END USER INTERFACE TO MILITARY HEALTH CARE SYSTEM
Needed a system to allow
members of the CBWTU care
team to connect with Warriors-
in-Transition throughout their
outpatient recovery process
through a device they already
own and are familiar using --
their personal cell phone
Why can’t a soldier receive telebehavioral health services in the privacy of their own home?
• timeliness/urgency
• stigma
• travel distance
H.R. 1832, the STEP Act of 2011
Servicemembers’ Telemedicine & E-Health Portability Act
MONITORING EMOTIONAL STATUSVIRTUAL HUMANS AS BEHAVIORAL HEALTH COACHES
http://ict.usc.edu/prototypes/simsensei/
Louis-Philippe Morency
Albert "Skip" Rizzo
Institute of Creative Technologies
University of Southern California
HOW DO YOU REVIEW AND FUND SOMETHING THAT HAS NEVER BEEN TRIED BEFORE?
Triboluminescence, UCLA/TribogenicsNature 2008;455:1089-92
Biospleen, Wyss InstituteNature Med 2014;20:1211-16
Pathogen Reduction, CaridianTransf Apheresis Sci 2006; 35 (1): 5-17
ADVANCES IN PERSONAL PROTECTIVE EQUIPMENT HAVE CHANGED THE DISTRIBUTION OF INJURIES
SHELL SHOCK
BODY ARMOR
PROTECTION
IT HELPS TO BE A LEADERSHIP PRIORITY
CPT Dan Luckett leading
soldiers on patrol in Afghanistan
NEW CONCEPT:
Restore functionality
and continue the
mission
IN THE PUBLIC PERCEPTION, COOL TECHNOLOGY IS A LEVER
Social Support
Cognitive
Behavioral
Therapy
Neurorehabilitation