Uniformed Services University

Uniformed Services University

of the Health Sciences

October 2013

Board of Regents Quarterly Meeting

BOARD OF REGENTS UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES

185th MEETING

October 23, 2013 Bethesda, Maryland

CONTENTS

Matters of Information

Federal Register: Notice of Partially Closed Meeting .........................................................1 Board of Regents..................................................................................................................2 Charter..................................................................................................................................3 Bylaws..................................................................................................................................4 Meeting Calendars ...............................................................................................................5

Winter Meeting: February 3-4, 2014 Spring Meeting: May 15-17, 2014 Summer Meeting: August 4-5, 2014 Fall Meeting: November 3-4, 2014

Meeting Notes .................................................................................................................................6 Matters of General Consent

Board Meeting Minutes, July 30, 2013 ................................................................................7 Board Actions

Degree Granting, School of Medicine Graduate Programs ........................................... 8-15 Degree Granting, Graduate School of Nursing ..................................................................16 Faculty Appointments and Promotions, Postgraduate Dental College ..............................17 Faculty Appointments and Promotions, Graduate School of Nursing ...............................18 Faculty Appointments and Promotions, School of Medicine ............................................19

President’s Report .......................................................................................................................20 Reports to the Board of Regents Executive Dean’s Report, Postgraduate Dental College ....................................................21 Dean’s Report, Graduate School of Nursing .....................................................................22 Dean’s Report, School of Medicine ............................................................................. 23-24

Armed Forces Radiobiology Research Institute ................................................................25 USU Inspector General ......................................................................................................26

TAB 1

Federal Register: Notice of Partially Closed Meeting

61344 Federal Register / Vol. 78, No. 192 / Thursday, October 3, 2013 / Notices

The report will contain a detailed statement of the findings and conclusions of the Commission, together with its recommendations for such legislation and administrative actions it may consider appropriate in light of the results of the study. The comprehensive study of the structure of the U.S. Air Force will determine whether, and how, the structure should be modified to best fulfill current and anticipated mission requirements for the U.S. Air Force in a manner consistent with available resources.

Dated: September 30, 2013. Aaron Siegel, Alternate OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2013–24255 Filed 10–2–13; 8:45 am]

BILLING CODE 5001–06–P

DEPARTMENT OF DEFENSE

Office of the Secretary

Board of Regents, Uniformed Services University of the Health Sciences; Notice of Federal Advisory Committee Meeting

AGENCY: Uniformed Services University of the Health Sciences (USU), DoD. ACTION: Quarterly meeting notice.

SUMMARY: The Department of Defense is publishing this notice to announce the following meeting of the Board of Regents, Uniformed Services University of the Health Sciences. DATES: Wednesday, October 23, 2013, from 8:30 a.m. to 10:30 a.m. (Open Session) and 10:30 a.m. to 11:30 a.m. (Closed Session). ADDRESSES: Tower Suite 2, Hershey Lodge, 325 University Drive, Hershey, Pennsylvania 17033. FOR FURTHER INFORMATION CONTACT: S. Leeann Ori, Designated Federal Officer, 4301 Jones Bridge Road, D3011, Bethesda, Maryland 20814; telephone 301–295–3066; email [email protected].

SUPPLEMENTARY INFORMATION: This meeting notice is being published under the provisions of the Federal Advisory Committee Act of 1972 (5 U.S.C., Appendix, as amended), the Government in the Sunshine Act of 1976 (5 U.S.C. 552b, as amended), and 41 CFR 102–3.150.

Purpose of the Meeting: The purpose of the meeting is to review the operations of USU, particularly the academic affairs, and provide advice to the USU President and the Assistant Secretary of Defense for Health Affairs. These actions are necessary for the

University to pursue its mission, which is to provide outstanding healthcare practitioners and scientists to the uniformed services, and to obtain institutional accreditation.

Agenda: The actions that will take place include the approval of minutes from the Board of Regents Meeting held on July 30, 2013; recommendations regarding the approval of faculty appointments and promotions; recommendations regarding the awarding of master’s and doctoral degrees in the biomedical sciences and public health; and the approval of awards and honors. The USU President will provide a report and information from both academic and administrative USU officials will be provided during the meeting. A closed session will be held to discuss personnel actions and active investigations.

Meeting Accessibility: Pursuant to Federal statute and regulations (5 U.S.C. 552b and 41 CFR 102–3.140 through 102–3.165) and the availability of space, the meeting is open to the public from 8:30 a.m. to 10:30 a.m. Seating is on a first-come basis. Members of the public wishing to attend the meeting should contact S. Leeann Ori at the address and phone number noted in the FOR FURTHER INFORMATION CONTACT section. Pursuant to 5 U.S.C. 552b(c)(2, 5–7) the Department of Defense has determined that a portion of the meeting shall be closed to the public. The Acting Under Secretary of Defense (Personnel and Readiness), in consultation with the Office of the DoD General Counsel, has determined in writing that a portion of the committee’s meeting will be closed as the discussion will disclose sensitive personnel information, will include matters that relate solely to the internal personnel rules and practices of the agency, will involve accusing a person of a crime or censuring an individual, and may disclose investigatory records compiled for law enforcement purposes.

Written Statements: Pursuant to 41 CFR 102–3.140, 102–3.150, 102–3.155, and 102–3.160, interested persons may submit a written statement for consideration by the Board. Individuals submitting a written statement must submit their statement to the Designated Federal Officer at the address listed in FOR FURTHER INFORMATION CONTACT. If such statement is not received at least 5 calendar days prior to the meeting, it may not be provided to or considered by the Board of Regents until its next open meeting. The Designated Federal Officer will compile all timely submissions with the Board’s Chairman and ensure such submissions are provided to Board Members before the meeting.

Dated: September 30, 2013.

Aaron Siegel, Alternate OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2013–24264 Filed 10–2–13; 8:45 am]


DEPARTMENT OF DEFENSE

Office of the Secretary

Reserve Forces Policy Board (RFPB); Notice of Federal Advisory Committee Meeting; Cancellation of Meeting

AGENCY: Office of the Secretary of Defense, Reserve Forces Policy Board, DoD.

ACTION: Notice of Federal Advisory Committee meeting; cancellation of meeting.

SUMMARY: On Friday, September 13, 2013 (78 FR 56680–56681), the Department of Defense published a notice announcing a meeting of the Reserve Forces Policy Board (RFPB) that was to take place on Wednesday, October 2, 2013. The meeting of October 2, 2013 was cancelled.

FOR FURTHER INFORMATION CONTACT: Reserve Forces Policy Board. (703) 681– 0600 (Voice), (703) 681–0002 (Facsimile), Mailing address is Reserve Forces Policy Board, 5113 Leesburg Pike, Suite 601, Falls Church, VA 22041. Web site: http://ra.defense.gov/ rfpb/. The most up-to-date changes to the meeting can be found on the RFPB Web site.

SUPPLEMENTARY INFORMATION: Due to the uncertainty surrounding the Fiscal Year 2014 budget, the previously scheduled meeting of October 2, 2013, of the Reserve Forces Policy Board the requirements of 41 CFR 102–3.150(a) were not met. Accordingly, the Advisory Committee Management Officer for the Department of Defense, pursuant to 41 CFR 102–3.150(b), waives the 15-calendar day notification requirement.

Dated: September 30, 2013.

Aaron Siegel, Alternate OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2013–24228 Filed 10–2–13; 8:45 am]


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MEMORANDUM FOR DESIGNATED FEDERAL OFFICER, BOARD OF REGENTS, UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES

SUBJECT: Determination to Close a Portion of the Board of Regents, Uniformed Services University of the Health Sciences Meeting on October 23,2013

I fmd that the request to close a portion of the fall meeting of the Board of Regents, Uniformed Services University of the Health Sciences ("the Board"), from roughly 10:30 a.m. until 11 :30 a.m. on October 23,2013, is consistent with provisions outlined in the Government in the Sunshine Act, as amended, 5 U.S.C. § 552b(c)(2, 5-7), and the Federal Advisory Committee Act, as amended, 5 U.S.C. Appendix. Therefore, I determine that the prescribed portion of the meeting shall be closed to the public.

The reason for my determination is that this portion of the meeting will disclose sensitive personnel information, includes matters that relate solely to the internal personnel rules and practices of the University, will involve accusing a person of a crime or censuring an individual, and may disclose investigatory records compiled for law enforcement purpose.

Specifically, the portions of the meeting that will be closed are the discussion on personnel actions and active investigations.

As required by 41 C.F.R. § 102-3.155, the Board of Regents shall insure that a copy of this determination is made available to the public upon request. In light of this determination, the Board of Regents shall also comply with all requirements for reporting closed meetings as specified in DoD Instruction 5105.04.

• cc: Group Federal Officer Advisory Committee Management Officer

TAB 2

Board of Regents

UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES BOARD OF REGENTS

October 2013

NAME

TITLE TERM EXP

Ronald R. Blanck, D.O. Chair, Board of Regents June 20, 2013 Otis W. Brawley, M.D. Member, Board of Regents May 01, 2015 Sheila P. Burke, M.P.A. Member, Board of Regents May 01, 2017 Haile T. Debas, M.D. Member, Board of Regents June 20, 2013 GEN Ronald H. Griffith, USA (Ret) Member, Board of Regents May 01, 2015 Michael M.E. Johns, M.D. Member, Board of Regents June 20, 2013 Kenneth P. Moritsugu, M.D., M.P.H. Member, Board of Regents June 20, 2013 Gail R. Wilensky, Ph.D. Member, Board of Regents June 20, 2013 Jonathan Woodson, M.D. Assistant Secretary of Defense for Health

Affairs* Ex Officio

Charles L. Rice, M.D. President, USU** Ex Officio LTG Patricia D. Horoho, AN, USA Surgeon General, United States Army Ex Officio VADM Matthew L. Nathan, MC, USN Surgeon General, United States Navy Ex Officio Lt Gen Thomas W. Travis, USAF, MC Surgeon General, United States Air Force Ex Officio RADM Boris D. Lushniak, USPHS Acting Surgeon General of the United States Ex Officio Gen Thomas R. Morgan, USMC (Ret) Military Advisor to the Board Advisor Arthur L. Kellermann, M.D., M.P.H. Dean, F. Edward Hébert School of Medicine Advisor Ada Sue Hinshaw, Ph.D., R.N., FAAN Dean, Graduate School of Nursing Advisor Patrick D. Sculley, D.D.S., M.A. Executive Dean, Postgraduate Dental College Advisor Col L. Andrew Huff, USAF, MC Director, Armed Forces Radiobiology

Research Institute Advisor

RDML Raquel C. Bono, MC, USN Director, National Capital Region Medical Advisor Maj Gen Byron C. Hepburn, USAF, MC Commander, 59th Medical Wing Advisor MG M. Ted Wong, DC, USA Commanding General, Northern Regional

Medical Command Advisor

Maj Gen Gerard A. Caron, USAF, DC Commander, 79th Medical Wing Advisor BG Jeffrey B. Clark, MC, USA Commander, Walter Reed National Military

Medical Center Advisor

COL John H. Garr, MC, USA Commander, Defense Medical Readiness Training Institute

Advisor

Joshua Girton, J.D. Legal Advisor to the Board of Regents Advisor Jeffrey L. Longacre, M.D. Executive Secretary S. Leeann Ori Designated Federal Officer Jennifer Nuetzi-James Alternate Designated Federal Officer

*The Assistant Secretary of Defense for Health Affairs is not a statutory member of the Board of Regents but represents the Secretary of Defense, who is by statute an ex officio member

**The President, USU is a non-voting ex officio member as defined by statute

TAB 3

Charter

Charter Board of Regents, Uniformed Services University of the Health Sciences

1

1. Committee’s Official Designation: The Committee shall be known as the Board of Regents, Uniformed Services University of the Health Sciences (“the Board”).

2. Authority: The Secretary of Defense, pursuant to the provisions of 10 U.S.C. § 2113a, the

Federal Advisory Committee Act (FACA) of 1972 (5 U.S.C., Appendix, as amended), and 41 C.F.R. § 102-3.50(a), established the Board.

3. Objectives and Scope of Activities: The Board shall assist the Secretary of Defense in an

advisory capacity in carrying out the Secretary’s responsibility to conduct the business of the Uniformed Services University of the Health Sciences (“the University”), as set out in paragraph four below.

4. Description of Duties: The Board shall provide advice and recommendations on academic

and administrative matters critical to the full accreditation and successful operation of the University.

5. Agency or Official to Whom the Committee Reports: The Board shall report to the Secretary

of Defense, through the Under Secretary of Defense for Personnel and Readiness (USD(P&R)). The USD(P&R), pursuant to Department of Defense (DoD) policy, may act upon the Board’s advice and recommendations.

6. Support: The DoD, through the Office of the USD(P&R), shall provide support, as deemed

necessary, for the performance of the Board’s functions and shall ensure compliance with the requirements of the FACA, the Government in the Sunshine Act of 1976 (5 U.S.C. § 552b, as amended) (“the Sunshine Act”), governing Federal statutes and regulations, and established DoD policies and procedures.

7. Estimated Annual Operating Costs and Staff Years: The estimated annual operating cost, to

include travel, meetings, and contract support, is approximately $212,000.00. The estimated annual personnel costs to the DoD are 1.8 full-time equivalents.

8. Designated Federal Officer: The Board’s Designated Federal Officer (DFO), pursuant to

DoD policy, shall be a full-time or permanent part-time DoD employee, and shall be appointed in accordance with established DoD policies and procedures. The Board’s DFO is required to be in attendance at all meetings of the Board and its subcommittees for the entire duration of each and every meeting. However, in the absence of the Board’s DFO, a properly approved Alternate DFO, duly appointed to the Board according to established DoD policies and procedures, shall attend the entire duration of meetings of the Board or its subcommittees. The DFO, or the Alternate DFO, shall call all of the Board and its subcommittees meetings; prepare and approve all meeting agendas; and adjourn any meeting when the DFO, or the Alternate DFO, determines adjournment to be in the public interest or required by governing regulations or DoD policies and procedures.


2

9. Estimated Number and Frequency of Meetings: The Board shall meet at the call of the Board’s DFO, in consultation with the Board’s Chairperson. The Board shall meet at least once a quarter.

10. Duration: The need for this advisory function is on a continuing basis; however, this charter

is subject to renewal every two years.

11. Termination: The Board shall terminate upon repeal of 10 U.S.C. § 2113a. 12. Membership and Designation: Under the provisions of 10 U.S.C. § 2113a(b), the Board shall

be composed of 15 members, appointed as specified below:

a. Nine persons outstanding in the field of health care, higher education administration, or public policy, who shall be appointed from civilian life by the Secretary of Defense;

b. The Secretary of Defense, or his designee, who shall be an ex-officio member;

c. The Surgeons General of the Uniformed Services, who shall be ex-officio members; and

d. The President of the University, who shall be a non-voting, ex-officio member.

As directed by 10 U.S.C. § 2113a(c), the term of office for each member of the Board (other than ex-officio members) shall be six years except that:

a. Any member appointed to fill a vacancy occurring before the expiration of the term for

which his predecessor was appointed shall be appointed for the remainder of such term; and,

b. Any member whose term of office has expired shall continue to serve until his successor

is appointed.

In accordance with 10 U.S.C. § 2113a(d), one of the members of the Board (other than an ex-officio member) shall be designated as Chairman by the Secretary of Defense and shall be the presiding officer of the Board.

Board members that are not ex-officio members shall be appointed by the Secretary of Defense and their appointments will be renewed on an annual basis according to DoD policies and procedures. Members of the Board, who are not full-time or permanent part-time Federal employees, shall be appointed as experts and consultants, under the authority of 5 U.S.C. § 3109, to serve as special government employee (SGE) members. Pursuant to 10 U.S.C. § 2113a(e), members of the Board (other than ex-officio members), while attending conference or meetings or while otherwise performing their duties as members, shall be entitled to receive compensation at a rate to be fixed by the Secretary of Defense; and shall also be entitled to receive an allowance for necessary travel expenses while so serving away from their place of residence.


3

Each member of the Board is appointed to provide advice to the Government on the basis of his or her best judgment without representing any particular point of view and in a manner that is free from conflict of interest.

13. Subcommittees: DoD, when necessary and consistent with the Board’s mission and DoD

policies and procedures, may establish subcommittees, task forces, and working groups to support the Board. Establishment of subcommittees will be based upon a written determination, to include terms of reference, by the Secretary of Defense, the Deputy Secretary of Defense, or the USD(P&R), as the DoD Sponsor. All subcommittees, task forces, or working groups shall operate under the provisions of FACA, the Sunshine Act, governing Federal statutes and regulations, and established DoD policies and procedures. Such subcommittees shall not work independently of the Board, and shall report all their recommendations and advice solely to the Board for full and open deliberation and discussion. Subcommittees have no authority to make decisions and recommendations, verbally or in writing, on behalf of the Board. No subcommittee or any of its members can update or report, verbally or in writing, on behalf of the Board, directly to DoD or any Federal officer or employee. The Secretary of Defense shall appoint subcommittee members even if the member in question is already a Board member. Subcommittee members, with the approval of the Secretary of Defense, may serve a term of service on the subcommittee of one-to-four years, as determined by the Secretary; however, no member, unless authorized by the Secretary of Defense, may serve more than two consecutive terms of service. Subcommittee members, if not full-time or part-time Government employees, shall be appointed as experts and consultants, under the authority of 5 U.S.C. § 3109, to serve as SGE members. The Secretary of Defense or the Deputy Secretary of Defense must renew appointments on an annual basis. With the exception of travel and per diem for official travel related to the Board or its subcommittees, subcommittee members shall serve without compensation. Each subcommittee member is appointed to provide advice to the Government on the basis of his or her best judgment without representing any particular point of view and in a manner that is free from conflict of interest. All subcommittees operate under the provisions of the FACA, the Sunshine Act, governing Federal statutes and regulations, and established DoD policies and procedures.

14. Recordkeeping: The records of the Board and its subcommittees shall be handled according

to Section 2, General Records Schedule 26, and governing DoD policies and procedures. These records shall be available for public inspection and copying, subject to the Freedom of Information Act of 1966 (5 U.S.C. § 552, as amended).

15. Filing Date: May 2, 2013

TAB 4

Bylaws

Bylaws

of the

Board of Regents

of the Uniformed Services University of the Health Sciences

Article I

Establishment. The Board of Regents of the Uniformed Services University of the Health Sciences (USU), hereinafter the Board, is established by 10 U.S. Code § 2113a.

Description. The Board is a Federal Advisory Committee within the Department of Defense and operates in accordance with the Federal Advisory Committee Act (FACA), DoD Instruction 5105.04, "Federal Advisory Committee Management Program," DoD Directives and Instructions specifically and generally applicable to USU, and its DoD Charter.

Article 1I

Purpose.

A. The purpose of the Board shall be to provide advice and guidance to the Secretary of Defense; the Under Secretary of Defense for Personnel and Readiness; the Assistant Secretary of Defense for Health Affairs; the Director, TRICARE Management Activity; and the USU President in order to ensure that the operation ofUSU is effective, in compliance with all applicable accreditation standards, and in the best traditions of academia.

B. The purpose of these bylaws is to set forth the organization of the Board and to outline the procedures it uses to accomplish its responsibilities as an advisory committee.

Article TIl

Members. Pursuant to 10 U.S. Code § 2113a, the Board shall consist of:

A. Nine persons, outstanding in the fields of health care, higher education administration, or public policy, who shall be appointed from civilian life by the Secretary of Defense;

B. The Secretary of Defense, or the Secretary's designee, who shall be an ex officio member;

C. The Surgeons General of the Uniformed Services who shall be ex officio members; and

D. The USU President, who shall be a nonvoting ex officio member.

Representatives. Individual members orthe Board, to include the designee of the Secretary of Defense, may be represented at meetings of the Board and at committee meetings by rcpresentatives, provided these representatives are Federal government employees or members of the Armed Services and provided they arc appointed in advance and in writing. Representatives should be appointed with continuity in mind and should have authority to speak for the represented members.

Tefm of Officc. The teml of office for each member of the Board (other than an ex~

officio member) shall be six years except that:

A. Any member o[the Board appointed to fill a vacancy occurring before the expiration of the term for which a predecessor was appointed, shall be appointed for the remainder of such tenn.

ll. Any membcr of the Board whose term of office has expired shall continue to serve until a successor is appointed. These appointments will be renewed annually on the anniversary of the original appointment date.

Appointment of Chair. One of the members of the Board (other than an ex officio member) shall be designated by the Secretary of Defense as Chair and shall be the presiding officer of the Board. The term of the Chair shall continue until a successor is appointed.

Selection or Vice-Chair. The Chair of the Board shall select an appointed member of the Board to serve as Vice Chair.

Article IV

Duties and Responsibilities. The Board shall:

A. Advise the Secretary or Derense, through the Assistant Secretary of Defense for Health Affairs and the Under Secretary of Defense for Personnel and Readiness, regarding the appointment of the USU President and advise the USU President regarding the appointments of deans ofUSU schools, directors ofUSU institutes and similar USU administrative positions;

2

B. Be informed by the USU President of the appointments ofviee presidents, assistant vice presidents and s imilar USU staff positions; or by the appropriate dean of the appointments of associate deans, assistant deans, department chairs and similar USU faculty positions;

C. Advise the USU President on the awarding of appropriate academic degrees to successful candidates after first receiving and considering the recommendations of the faculty and deans ofUSU schools;

D. Advise the USU President on thc conferring of honors (to include Professor Emeritus, Senior Lecturer, and Distinguished Professor) and honorary degrees after first receiving and considering the recommendations of the deans ofUSU schools;

E. Provide its advice on policies and procedures intended to ensure that USU maintains appropriate accreditation requirements;

F. Consider recommendations made by USU Committees on Appointments, Promotion, and Tenure and provide its advice on these recommendations to the USU President;

G. Consider recommendations made to establish new academic programs at USU. (Recommendations for new programs will be read into the minutes at the Board meeting when they are first presented. Advice on whether or not to approve new programs will ordinarily be provided to the USU President at the next regularly scheduled Board meeting.); and

H. Perform other dUlies as deemed appropriate and within its Charter, to include (I) assessing and providing advice to the Assistant Secretary of Defense [or Health Affairs, the Under Secretary of Defense for Personnel and Readiness, and the Secretary of Defense on the performance oflhe USU President; the performance ofUSU as an institution (including major academic programs and divisions); the well-being of USU facuity, students, and staff; the adequacy ofUSU financial resources and their management; and the adequacy ofUSU's physical facilities; and (2) serving as an advocate for USU and its needs.

Article V

Advisors . Advisors to the Board shall include:

A. USU deans;

B. Commanders of affiliated teaching hospitals;

C. A legal advisor (the USU General Counsel);

D. A military advisor to provide advice to the Board from an operational perspective;

3

and

E. Other individuals invited by the Board to serve in this capacity.

Article VI

Committees.

A. Designation: The Board of Regents, as a body, shaH designate either standing or ad hoc committees as necessary.

B. Purpose: Board cOlnmittees shall be responsible for in-depth considerat ion of assigned Board agenda items and/or special projects between scheduled meetings.

C. Membership: The Chair of the Board of Regents shall appoint committee members and designate their chairs. Ordinari ly, at least one appointed member of the Board and at least one ex officio member of the Board will be appointed to each committee.

D. Meetings: Each committee shaH meet either at the call of its chair, or at the request of any two members other than the chair. Meetings may be held in person or via conference call.

Article VII

Awards.

A. Board of Regents Awards: The Board shaH annually recognize four outstanding students selected by the Dean, School of Medicine; the Dean, Graduate School of Nursing; the Associate Dean, Graduate Education; and the Executive Dean, Postgraduate Dental College. in accordance with separately established criteria.

B. Carol J. Johns, M.D. Medal: The Board shall review and approve or disapprove the Carol 1. Johns, M.D. Medal recognizing an outstanding faculty member selected by the Faculty Senate in accordance with separately established criteria.

C. The Distinguished Service Award, Exceptional Service Award, and the University Medal: The Board shall review and approve or disapprove Distinguished Service and Exceptional Service awards and the University Medal.

4

Article Vlll

General Procedures.

A. Regular Meetings: The Board shall hold at least four (4) meetings in an annual period from October I to September 30, or morc often if the Secretary of Defense, the designee of the Secretary of Defense, or the Chair of the Board of Regents shall deem it necessary. Unless otherwise determined by the Board, meetings shall be held in the Everett Alvarez Jr. Board of Regents Conference Room at the University. 4301 Jones Bridge Road, Bethesda, MD 20814.

B. Additional Meetings: Additional meetings shall be called by the Designated Federal Officer of the Board upon the direction of the Chair of the Board of Regents, the USU President, or upon written request of three or more members of the Board. Additional meetings of the Board shall be held at such times and places as shall be specified in the notice of the meeting.

C. Notice of Meetings:

1. Notice of all meetings of the Board shall be sent by the Designated Federal Officer to each member of the Board by mail, fax, electronic mail or telephone.

2. The Designated Federal Offieer shall mail a notice not less than fifteen (IS) days before any regular meeting. Faxing, emailing, or telephoning a notice shall be done not less tban seven (7) days before a regular meet ing.

3. The recital by the Executive Secretary in the minutes tbat notice was given shall be sufficient evidence of the fact.

4. Public announcement orthe meetings of the Board shall appear in the Federal Register as provided in the Government in the Sunshine Act. (5 U.S.c. 552b(e)(3))

D. Closure of Meetings: Meetings of the Board shall be open to the public unless a written detenn ination is made to close all or part of a meeting in coordination with General Counsel. The determination shall cite those provisions of 5 U.S.C. 552b(c)(l) that justify closure and a summary of meeting activities shall be prepared and maintained as part of nonpublic Board of Regents files.

E. Quorum: Thc presence ofa majority of all members of the Board will constitute a quorum of the Board. When there are no vacancies on the Board, a quorum means at least eight (8) members must be present in person or via electronic means. A member's duly designated representative, provided the designation includes a proxy, counts for purposes of a quorum.

5

F. Voting:

I. During a meeting, if a quorum is called for by a member and found not to be present, no further business may be transacted.

2. During a meeting, issues will be determined by voice balloting, unless an individual member of the Board of Regents requests a written ballot.

3. The Chair, Board of Regents, is a member of the voting assembly and has the samc right to vote as any other member.

4. Unless otherwise specified, a simple majority vote will determine matters of issue before the Board. In the event of a tie vote, the proposed resolution is lost.

5. At the direction of the Chair, Board of Regents, action may also be taken by a majority of the members by notation voting (that is to say by voting on material circulated to the members individually or serially, or by polling members individually or collec tively by mail, telephone, fax, e-mail or a similar procedure). Such action will be reported by the Executive Secretary at the next meeting of the Board.

6. The Secretary of Defense, or the Secretary's designee, or a duly appointed representative of the Secretary's designee is authorized to vote.

7. The Surgeons General of the Uniformed Services, or their duly appointed representativcs, arc authorized to votc.

8. The USU President is precluded by statute from voting.

9. Except for the USU President, indi vidual members of the Board, to include the designee of the Secretary of Defense, may give proxies to their representatives or to other members of the Board of Regents (allowing them to be counted for quorum purposes and to vote) provided this is done in advance and in writing.

G. Order of Business: The order of business will be at the di scretion of the Chair, Board o/" Regents, unless otherwise specified by the Board.

H. Rules of Order: The rules contained in the current edition of Robert's Rilles of Order Newly Revised shall govern the Board in all cases in whieh they arc applicable and in which they arc not inconsistent with applicable statutes and directives, these bylaws, and any special rules the Board may adopt.

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Article IX

Amendment and Effective Date.

A. Amendment: These bylaws may be amended at any meeting of the Board as long as each proposed amendment has been provided to the members at least 60 days before the next scheduled meeting. Amendments will take effect by the affirmative vote of twothirds (2/3) of the members present.

B. Effective Date: These bylaws are effective May 18, 2012, and supersede previously published bylaws dated February 7, 2012 .

Ronald R. Blanck, D.O., Chair, Board of Regents

7

TAB 5

Meeting Calendars

2013 December 2014 January February

S M T W T F S 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31

S M T W T F S 1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

S M T W T F S 1 2 BOR BOR 5 6 7 8 9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28

March April May

S M T W T F S 1 2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29 30 31

S M T W T F S 1 2 3 4 5 6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

S M T W T F S 1 2 3

4 5 6 7 8 9 10

11 12 13 14 BOR BOR BOR

18 19 20 21 22 23 24

25 26 27 28 29 30 31

June July August

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

S M T W T F S

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

S M T W T F S 1 2 3 BOR BOR 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

31

September October November

S M T W T F S

1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

S M T W T F S 1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

S M T W T F S 1 2 BOR BOR 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

23 24 25 26 27 28 29

30

2014 December 2015 January February

S M T W T F S

1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

S M T W T F S

1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

S M T W T F S

1 BOR BOR 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

March April May

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31

S M T W T F S

1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30

S M T W T F S 1 2

3 4 5 6 7 8 9

10 11 12 13 BOR BOR BOR

17 18 19 20 21 22 23

24 25 26 27 28 29 30

31

June July August

S M T W T F S

1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

S M T W T F S

1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

S M T W T F S 1

2 BOR BOR 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

September October November

S M T W T F S

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

S M T W T F S

1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

S M T W T F S

1 BOR BOR 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28 29 30

TAB 6

Meeting Notes

October 2013

Opening Comments by the Chair

• Annual assessment, USU President – Board’s input sent to Assistant Secretary of Defense for Health Affairs on September 6, 2013

• Closed session this morning

o personnel actions o active investigations

• USU’s mission, vision and values (Attachment 1)

Attachment 1

Uniformed Services University of the Health Sciences

Mission

The mission of the Uniformed Services University of Health Sciences is to train, educate and prepare uniformed services health professionals, officers and leaders to directly support the Military Health System, the National Security and National Defense Strategies of the United States and the readiness of our Armed Forces.

Vision

By the end of 2015, the Uniformed Services University of the Health Sciences, recognized as the preeminent educational institution for the creation of career uniformed services health professionals and leaders prepared to serve the nation wherever and whenever duty calls, will be a central hub for military-related health education and research, and the nation’s center of excellence for the health dimensions of our national security strategies. USU will insure that each graduate is prepared with an outstanding health education, inter-professional health training, and a deep and abiding commitment to selfless service and responsible leadership, the military ethos and the security of the United States.

Values

The University is unique within the Department of Defense and, indeed, across the entire health education and training community. We serve one of our nation’s most values-centric and trusted institutions: the Armed Forces of the United States. Our institutional values reflect the community we serve and include: Courage and Integrity We foster a culture of academic, physical and moral courage in all our graduates, faculty and leaders, and we are uncompromising in our adherence to the highest standards of intellectual and personal integrity. Innovation As an academic institution, our faculty and researchers continuously and aggressively push back the frontiers of knowledge in areas crucial to America’s national security. Caring We foster an atmosphere of caring, mutual respect, courtesy, pride in work and combined military and academic professional development. Communication We interact and share information in a timely manner with openness, candor and sensitivity. Scholarship We are committed to academic freedom as fundamental to the advancement of knowledge and a lifetime of learning. Service We are committed to serving those who defend the nation, and we are sensitive to the unique role that our Soldiers, Sailors, Airmen and Marines play in our national security. Collaboration and Teamwork We value the contributions of each member of our community and work to achieve an environment characterized by cooperation, collegiality, tolerance, mutual respect and an appreciation of diversity, and we facilitate cooperation and collaboration in our science, educational, methodologies, research and leadership.

TAB 7

Board Meeting Minutes: July 30, 2013

Minutes of the Board of Regents of the Uniformed Services University of the Health Sciences

Meeting No. 184

July 30, 2013

The Board of Regents of the Uniformed Services University of the Health Sciences met on July 30, 2013, at the Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland. The meeting date and agenda items were published in the Federal Register and each Regent was duly notified prior to the meeting. The Board Executive Secretary, Jeffrey L. Longacre, M.D., was present during the meeting along with the Designated Federal Officer, Mrs. S. Leeann Ori. The Chair called the meeting to order at 8:00 a.m. Members and advisors listed below were in attendance: Board Members Ronald R. Blanck, D.O., Chair Otis W. Brawley, M.D., Member Sheila P. Burke, M.P.A., Member Haile T. Debas, M.D., Member (participated telephonically) GEN Ronald H. Griffith, USA (Ret), Member Kenneth P. Moritsugu, M.D., Member Gail R. Wilensky, Ph.D., Member Jonathan Woodson, M.D., Assistant Secretary of Defense for Health Affairs Charles L. Rice, M.D., President, USU MG M. Ted Wong, DC, USA, Representing the Surgeon General, U.S. Army RADM Alton L. Stocks, MC, USN, Representing the Surgeon General, U.S. Navy Brig Gen James J. Carroll, USAF, BSC, Representing the Surgeon General, U.S. Air Force RADM Boris D. Lushniak, USPHS, Acting Surgeon General of the United States Advisors to the Board John E. McManigle, M.D., Acting Dean, F. Edward Hébert School of Medicine, USU Ada Sue Hinshaw, Ph.D., R.N., Dean, Graduate School of Nursing, USU Patrick D. Sculley, D.D.S., M.A., Executive Dean, Postgraduate Dental College, USU Col L. Andrew Huff, USAF, MC, Director, Armed Forces Radiobiology Research Institute, USU Maj Gen Gerard A. Caron, USAF, DC, Commander, 79th Medical Wing COL Michael R. Nelson, MC, USA, Representing the Commander, Walter Reed National Military Medical Center Joshua Girton, J.D., Legal Advisor to the Board of Regents, USU OPENING COMMENTS In his opening comments, Dr. Blanck welcomed MG Ted Wong, the new Commanding General of the Northern Regional Medical Command. Also present for the meeting were Mr. Martin Lancaster and Dr. Elizabeth Isler, the USU and Medical Education and Training

2

Campus affiliation consultants. The following points were also included in Dr. Blanck’s opening remarks:

• The October Board of Regents meeting will be held as an offsite in conjunction with the Bushmaster/FTX101 exercises. The Board meeting will take place on the morning of October 23, 2013 in Hershey, Pennsylvania, followed by an observation of the student field exercises at Fort Indiantown Gap on the afternoon of October 23 and the morning of October 24.

• USU received ten-year institutional re-accreditation from the Middle States Commission on Higher Education following the recent self-study process. Two items were addressed during the study: the President’s inability to hire due to the civilian hiring freeze and the need for a new centralized student records information system. Dr. Blanck reported that thanks to the support of Dr. Woodson, the hiring authority was recently delegated to Dr. Rice, alleviating the first concern.

• Following the Military Health System restructure in fiscal year 2014, the University will be placed under the Assistant Secretary of Defense for Health Affairs.

• A closed session was scheduled to occur following the open meeting to discuss personnel actions, the annual assessment of the University President and the brigade environment survey.

• Mrs. Jennifer Nuetzi James has been appointed as the new Alternate Designated Federal Officer for the Board of Regents. Dr. Blanck introduced Mrs. Nuetzi James to members of the Board.

MATTERS OF GENERAL CONSENT

Dr. Blanck presented the matters of general consent listed below. • The meeting dates for the next two years • Minutes of the May 17, 2013 Board of Regents meeting • Electronic approval by the Board of the following action:

o The faculty appointment of Arthur L. Kellermann, M.D., M.P.H. to the rank of Professor with tenure in the Department of Military and Emergency Medicine

Upon motion duly made and seconded, the Board Vote by voice vote: Approved the matters of general consent as presented. PRESIDENT’S REPORT In his report to the Board, Dr. Rice summarized the points below.

• After receiving a list of three highly qualified candidates from the search committee, Dr. Rice selected Dr. Kellermann as the next Dean of the School of Medicine. Dr. Rice thanked the University, including Dr. Hinshaw and members of the committee, for their full participation in the search process.

3

• As mentioned in the opening comments, the Deputy Secretary of Defense has made the decision to place the University under the Assistant Secretary of Defense for Health Affairs.

• The Under Secretary of Defense for Personnel and Readiness has delegated hiring authority and travel approval to the President of USU. One concern remains in that the hiring authority is restricted to the allotted full-time equivalents (FTE) for the organization. Because the FTE established for USU does not account for additional personnel in support of new missions, such as those mandated by Congress, the University is currently in excess of the FTE ceiling.

• Sequestration continues to impact the University with a $30 million budget reduction. This is primarily absorbed through funding cuts to research and sustainment and modernization accounts. If the cuts continue into the FY14 fiscal year, current operations will be unsustainable.

• Mandatory furloughs for civilian and contracted employees began in early July. The reduction in workforce has resulted in a significant impact on operations and is being further exacerbated as overtime is prohibited.

• The Postgraduate Dental College conferred degrees at the Naval Postgraduate Dental School, the Air Force Postgraduate School at Joint Base San Antonio-Lackland, and the Army Postgraduate Dental School at Fort Bragg, Fort Hood and Schofield Barracks.

• The Brain Tissue Repository for Traumatic Brain Injury Research Project, led by Daniel Perl, M.D., is attempting to better understand the anatomic consequences of exposure to blast injuries. Dr. Rice thanked Dr. Woodson for his efforts in promoting the program.

BOARD ACTIONS Degree Granting - Graduate Education Dr. McManigle presented for certification ten candidates to receive graduate degrees in the biomedical sciences and public health. Four candidates were presented to receive the degree of Doctor of Philosophy, one candidate was presented for the Doctor of Public Health degree and five candidates were presented for the degree of Master of Science in Public Health. Upon motion duly made and seconded, the Board Vote by voice vote: Concurred with the recommendations as presented by Dr. McManigle and recommended that the President confer the degrees as stated. Faculty Appointments and Promotions – School of Medicine Dr. McManigle presented the recommendations made by the School of Medicine Committee on Appointments, Promotion and Tenure at a meeting held on June 13, 2013. Thirty-two individuals were recommended for faculty appointments or promotions. Upon motion duly made and seconded, the Board Vote by voice vote: Concurred with the recommendations as presented by Dr. McManigle and recommended that the President implement the actions.

4

Awards and Honors Dr. McManigle presented the request that Ms. Hermelinda Licona receive the USU

Exceptional Service Medal. As the Program Administration Specialist in San Antonio, Ms. Licona supported thousands of medical students on clerkship rotations to Wilford Hall Medical Center and at Brooke Army Medical Center. After 26 years of exceptional service to the University, Ms. Licona will retire from federal service. Upon motion duly made and seconded, the Board Vote by voice vote: Approved the nomination for Ms. Licona as presented by Dr. McManigle. DOD CIVILIAN HIRING FREEZE

Following the Middle States Commission on Higher Education (MSCHE) accreditation visit, concern was raised regarding the Department of Defense’s civilian hiring freeze. In its Characteristics of Excellence, MSCHE requires that the Chief Executive Officer have authority and the resources to adequately staff the institution to fulfill its mission. As the hiring freeze restricted Dr. Rice’s ability to recruit faculty and staff members, the policy had the potential to result in an adverse accreditation decision. On behalf of members of the Board, Dr. Blanck sent a letter to the Secretary of Defense describing the situation and possible consequences. Though the initial concern was satisfied with the delegated hiring authority previously discussed, the action was presented in an open forum and no comments were made.

REPORT ON THE UNIVERSITY MISSION, VISION AND VALUES As was discussed during the Spring Board of Regents Meeting, the University is in the

process of revising the University Mission, Vision and Values. Dr. Rice presented the proposed language for the Board’s recommendation. Dr. Johns complimented the University for creating a clear statement with an end goal.

Upon motion duly made and seconded, the Board Vote by voice vote: Approved of the new University Mission, Vision and Values as presented by Dr. Rice.

BOARD PREPARATORY MEETINGS Academics Dr. Johns, Chair of the Academics Working Group, led a discussion on the potential USU and Medical Education and Training Campus (METC) affiliation. Responding to a request from the METC Board of Governors, the University is exploring the possibility of granting undergraduate degrees to several METC programs. The report, created by consultants Mr. Martin Lancaster and Dr. Elizabeth Isler, was presented to the Board. The items below were included in this discussion.

• The academics group saw this affiliation as a way to maintain and strengthen 17 military-based allied health programs offered at METC. The conversion would be done progressively until the faculty and programs were fully accredited. Eventually the group envisioned establishing a School of Allied Health Sciences at USU.

5

• As oversight of the program was not addressed in the Lancaster and Isler report, the academics group requested further exploration into the structure of the relationship, as the affiliation would require substantial involvement by the University.

• Though the University’s current authority to grant undergraduate degree is under review, language in the Senate’s version of the National Defense Authorization Action would expand the University’s legal authority to grant such degrees.

• Dr. Wilensky noted that this relationship recognizes the direction of national healthcare in terms of team training and the integration of programs. RADM Stocks, representing the Navy Surgeon General, added that this measure would improve the quality of care for the military healthcare system and that it aligns well within the mission and vision of the University.

• One concern addressed by the Board is the geographic distance from the University. This concern is somewhat alleviated by the USU branch campus in San Antonio, which is accredited by the Middle States Commission on Higher Education.

• Dr. Blanck noted that this has the potential to significantly affect the character of the University. The Faculty Senate has appointed a committee to study the impact.

• Adding to the benefits of the proposal, Dr. Woodson commented that this affiliation would strengthen the position of the University within the military healthcare system and improve credentials for METC active duty service member students as they transfer their skills to civilian communities. RADM Stocks mentioned this would also standardize credentials across the services.

• Dr. Lancaster advised the Board that one obstacle that requires further investigation is the general education credits required of an undergraduate degree. Currently, credits offered at METC focus on technical skills. Over time, Dr. Lancaster recommends that these credits be offered at a level where they are transferable to a Bachelor’s degree. As the report addresses, this could be done through several venues, including distance learning, a partnership with an established undergraduate institution, or internally by building faculty.

Upon motion duly made and seconded, the Board Vote by voice vote: Concurred with the proposal to explore the USU and METC affiliation and asked that Dr. Woodson establish a working group to address the issues discussed. In addition to the discussion on the METC affiliation, Dr. Johns provided the following points from the preparatory meeting.

• Dr. McManigle reported that curriculum reform continues to progress satisfactorily. The first class fully integrated into the program is now halfway through their clerkship rotations.

• The Enlisted to Medical Degree Preparatory Program (EMDP2) is envisioned to increase matriculation from the armed services and minority groups. The 24-month post-bachelorate program will begin with its first class in July 2014.

• Dr. Hinshaw notified the Board that the Doctor of Nursing Practice program self-accreditation study is due August 2013. A positive external preparatory review showed that the program is in good standing and should perform well next month.

6

• The Women’s Health Nurse Practitioner track within the Family Nurse Practitioner program is expected to begin in May 2014.

• The 20th Anniversary celebration for the Graduate School of Nursing and the renaming of the school in honor of Senator Daniel K. Inouye, is tentatively scheduled for September 17, 2013.

• In his report from the Faculty Senate, LTC Woodson provided results from the recent election, including the new President-Elect, Simon Auster, M.D., J.D. In addition, LTC Woodson reiterated the negative effects of sequestration and travel restrictions on operations and morale.

• The Office of Research reported on the significant impact of sequestration and the $20 million budget cut to research programs.

• In an update on the Postgraduate Dental College, Dr. Sculley notified the Board that the Keesler Air Force Base Comprehensive Dentistry program has matriculated its first class.

• At the request of Maj Gen Gerard Caron, USAF, DC, Dr. Sculley proposed an expansion of the Air Force Postgraduate Dental School to include the endodontic programs at Joint Base San Antonio-Lackland and Keesler Air Force Base.

Upon motion duly made and seconded, the Board Vote by voice vote: Concurred with the recommendations as presented by

Dr. Sculley and recommended that the President establish the additional programs.

Finance and Administration GEN Griffith, Acting Chair of the Finance and Administration Working Group, summarized items of discussion at the working group. This included the following remarks.

• The Vice President for Finance and Administration provided an update on several items being considered under the Program Objective Memorandum (POM) 2015, including e-learning, the Enlisted to Medical Degree Preparatory Program and the Global Health Measures of Effectiveness.

• Mr. Rice reported that the University received $2 million for AFRRI cobalt refueling. In addition, phase two of the USU Simulation Center renovation has received funding, along with the renovation of the cafeteria, mailroom and duplicating center. To support the relocation of the Southern Region Office $500,000 was allocated for renovation and out-fitting costs. Dr. Sculley added that this funding is sufficient to support the transition.

• Beyond fiscal year 2013, Mr. Rice notified the Board that significant budget cuts are expected. In a letter to the Senate Armed Services Committee, Secretary Hagel provided a contingency plan for FY 2014 should the approximately $52 billion cut be realized. These cuts would have a significant impact on future operations at USU. Dr. Rice, however, has insured the Board that the core mission will be accomplished.

• GEN Griffith attributed the strength of the University during these austere times to the leadership of the organization. Dr. Wilensky added that although the impact on several programs was significant, to include research, the current standing of the University is surprisingly strong.

• In supporting the military mission of the University, GEN Griffith suggested that a combat officer be assigned to the Brigade and proposed that a transitional wounded warrior would be advantageous as a mentor to the students.

• Following a di rective from the Secretary of Defense, the Brigade's mandatory sexual harassment trai ni ng for active duty service members is nearl y complete. GEN Griffith emphasized the need to stress a zero tolerance policy fo r the Univers ity.

• The General Counsel reported that the court martial ofMA] Hasan will begin on September 6. Twelve members of the University have been requested to test ify for the court martial.

A I)JOURNMENT There being no further business on the agenda, Dr. Blanck adjourned the open portion of

the meeting at II :00 a.m.

SUBMITTED:

Prepared by S. Leeann Ori

7

APPROVED:

Ronald R. Blanck Chair, Board of Regents

TAB 8

Degree Granting: School of Medicine Graduate Programs

Recommended Graduate Degrees - School of Medicine October 2013

Tab 9 Ellen C. Fox Doctor of Philosophy Emerging Infectious Diseases Graduate Program Tab 10 Capt William F. Kerst

Doctor of Philosophy Department of Medical and Clinical Psychology Tab 11 CPT Angela M. Yarnell

Doctor of Philosophy Department of Medical and Clinical Psychology

Tab 12 MAJ John E. Buonora Doctor of Philosophy Neuroscience Graduate Program Tab 13 LTC Jennifer Coyner Doctor of Philosophy Neuroscience Graduate Program Tab 14 LT Nicole A. Steele Master of Science Department of Medical and Clinical Psychology Tab 15 Master of Public Health Certification of Graduate Education Student

TAB 9


Ellen C. Fox

UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES F. EDWARD HEBERT SCHOOL OF MEDICINE

4301 JONES BRIDGE ROAD BETHESDA, MARYLAND 20814-4799

September II. 201 3

MEMORANDUM FO R BOARD OF REGENTS

Through: Charle~ M.D .. President

SUBJECT : Cert ification of Graduate Student

The graduate student listed below is presented for certification to receive the Doctor of Philosophy effective upon your approval:

Ellen C. Fox

DOCTOR OF PHI LOSOPHY

Emerging Infectious Diseases Graduate Program

Anached is the candidate's certification of successful completion of the Final Examination. Also attached are the Dissertation Approval Form. certification of authorized use of copyrighted materials, Thesis Abstract. Thesis Title Page. and Curriculum Vitae.

)<JP'Y/ IiJl6 n E. McManigle, MD.

ean, USU, School of Medicine (Acti ng)

Attachments: As stated

P,,,'ned on (i) RecyCled Paper

UNIFORMED SERVICES UNIVERSITY, SCHOOL OF MEDICINE GRADUATE PROGRAMS Graduate Educat ion Office (A 1045), 4301 Jones Bridge Road, Bethesda, MO 20814

FINAL EXAMINATIONIPRlV ATE DEFENSE FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE EMERGING INFECTIOUS DISEASES GRADUATE PROGRAM

Name of Student: Ellen Fox

Date of Examination: August 5, 2013

Time: 10:OOam

Place: 83004

DEC ISION OF EXAMINATION COMMITTEE MEMBERS;

PA SS FAIL

Dr. Ann(- E. Jerse DEPARTMENT, MICROBIOLOGY AND IMMUNOLOGY

com~i'/U

Dr: Edward Mitre DEPART T OF MICROBIOLOGY AND IM MUNOLOGY

a a~pallil NT OF MICROBIOLOGY AND IMMUNOLOGY

DMriKliO: l NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES EOS INO PHI L PATHOLOGY UN IT Committee Member

Eleanor S. Metcalf, Ph.D., Associate Dean II www.usuhs.mil/graded gradualeprogram@usuhs,edu Toll Free 800-772-1747 II Commercia L 301-29S-3913 / 9474 DSN : 29S-9474 II Faw:301·295-6772

UNIFORMED SERVICES UNIVERSITY, SCHOOL OF MEDICINE GRADUATE PROGRAMS

Graduate Education Office (A 1045), 4301 Jones Bridge Road, Bethesda, MO 20814

DISSERTATION APPROVAL FOR THE DOCTORAL DISSERTATION IN THE EMERGING INFECTIOUS DISEASES GRADUATE PROGRAM

Title of Di ssertation: "Mechanisms of immune modulation: Histamine in Filarial infections and murine models of allergen-specific desensiti z<uion"

Name of Candidate: Ellen Fox Doctor of Phi losophy Degree August S. 2013

DISSERTATION AND ABSTRACT APPROVED:

DATE:

'g S-/s

MICROBIOLOGY AND IMM UNOLOGY

comm91ThJ-- " /r h Dr. Edward Mitre DEPARTMENT OF M ICROBIOLOGY AND IMM UNOLOGY

Dr:Jc;~~~lljpOla~I7;;I--F MICROBIOLOGY AND IMMUNOLOGY

Committee Member

~ &15/13 Dr./GKIiOl1 NA T10NAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES EOS INOPHIL PATHOLOGY UNIT Committee Member

Eleanor 5 Metcalf, Ph.D., Associ<lte Dean www.usuhs.mil/graded [email protected] Toll Free: 800·772·1747 Commercial 301·295·3913/9474 DSN· 295·9474 II Fa x: 301·295·6772

The author hereby certifies that the use of any copyrighted material in the thesis manuscript entitled:

"Mechanisms of Immune Regulation in Chronic Helminth Infections and Allergen-Specific Immunotherapy"

is appropriately acknowledged and, beyond brief excerpts, is with the permission of the copyright owner.

{(}2cI} Ellen C. Fox Emerging Infectious Diseases, Department of Microbiology and Immunology Unifonned Services University 09/12113

ABSTRACT

Title of Dissertation:

Mechanisms of immune regulation in helminth infection and allergen-specific

immunotherapy

Ellen Mueller Fox, Doctor of Philosophy, 2013

Thesis directed by: Dr. Edward Mitre. Associate Professor, Department of Microbiology

and Immunology

Helminth infections and type I hypersensitivities both elicit type 2-mediated

immune responses characterized by IL-4, fL-5, IL-1 3, IgE and IgE-mediated activation of

basophils and mast cells. Additionally. following a period of repeated antigen exposure ,

such as chronic helminth infection or the treatment of allergic hypersensitivities by

allergen-specific immunotherapy, immune responses become suppressed by a variety of

regulatory mechanisms. Interestingly, the mechanisms responsible for initiating

regulatory networks are not full y understood. The purpose of this thesis research was to

invest igate mechanisms of immune regulation in helminth infection and allergen-specific

immunotherapy (ASIT). For studies investigating the role of histamine in helminth

infections, mice were infected with Lilomosodies sigmondonris and evaluated for

vi

histamine release through the course of infection. Histamine was found to increase

through the course of infection, peaking at 30 minutes and 8 weeks post-infection.

Blockade of histamine receptor I (HR I ) by fexofenadine resulted in a sign ificant

reduction in adult worm burden 8 weeks post infection and an increase in eosinophil

accumulation in the pleural cavity. This suggests that histamine release mediated by

helminths may aid parasite survival by diminishing eosinophil ic responses. For studies

investigating the mechanisms responsible for suppressing allergic responses allergen

specific immunotherapy. mice were sensitized to ovalbumin (OVA) and desensitized

with three different regimens developed to mimic protocols used in a cl inical selling. At

the conclusion of treatment, all mice had a decrease in clinical sensitivity to local antigen

challenge. Additionally, mice in all treatment groups had reduction in allergen-specific

IgE and basophil responses following OVA and IgE activation suggesting that

suppression of effector cell function is a key mechanism for allergen to lerance in

allergen-specific immunotherapy. Despite this, only mice in the illtemlediate and gradual

treatment groups exhibited increases in regulatory mechanisms such as fL-l 0 and T

regulatory cells. These results suggest that the induction ofregulatory networks may be

necessary for ASIT regimens to establish long-tenn protect ion from allergy. The results

of these studies provide valuable insight into the immune regulatory mechanisms elicited

in helminth infections and a llergen-specific immunotherapy. Furthennore. the results of

these stud ies will provide knowledge advancing development of effective treatment

protocols for helminth infections and type I hypersensitivities.

vii

MECHANISMS OF IMMUNE REGULATION IN HELMINTH INFECTION AND

ALLERGEN-SPECIFIC IMMUNOTHERAPY

by

Ellen Christine Mueller Fox

Dissertation submitted to the Faculty of the Emerging Infectious Diseases Graduate Program

Uniformed Services University of the Health Sciences in partial fulfillment of the requirements for the degree of

Doctor of Philosophy 20 13

Education

Ellen Christine Fox 4501 Connect icut Ave, N.W., Apt 207

Washington DC, 20008 (651)206-5539

[email protected]

Uniformed Services UniversIty of the Health Sciences Doctor of Philosopy, August 2006- August 2013 Emerging Infectious Diseases Graduate Program, GPA: 3.21 Dissertation Topic: Mechanisms of Immune Regulation in Chronic Helminth Infections and Allergen-specific Immunotherapy

Concordiif College Bachelor of Arts In Biology, 2002 -2006 Cum laude

Speaking Engagements

Bethesda, MO

Moorhead, MN

• American Society for Tropical Medicine and Hygiene Annual Meeting (November 2012), Invited Speaker

o ~ H lstamlne release during Litomosoldes sigmondontis infection enhances adul t worm burden"

Woods Hole Immunoparasltology Meeting (April 2012)

o ~ Histamine release during Litomosoides sigmondontls infection enhances adult worm burden"

American Society for Tropical Medicine and Hygiene Annual Meeting (December 2011)

o "Histamine release during Litomosides sigmondontls infect ion enhances adult worm burden"

Woods Hole Immunoparasitology Meeting (April 2011)

o "Histamine release during Litomosoides sigmondotls infection leads to the development of a type 2 response"

• USUHS Research Day, Bethesda MD (May 2010)

o "Rapid allergen desensitization causes suppressed basophil releasability and decreased allergenspecific IgE"

Simley High School Honors Biology Classes (December 2007 and December 200B), invited speaker

o ~From 5imley to Worms to Beyond: Finding an alternative career in science

Poster Presentations Woods Hole Immunoparasltology Meeting (April 2012)

o "Histamine R~ease During IJtamo5Ides SIg~ti5lnfection Enhances Adult Worm Burden"

The American Society of TroPical Medicine and Hygiene Annual Meetmg Young Investigator Competition (December 201 1) o "Hlstamme release during Utomosodies SlgmO(J,:t::vmsenhances adult WOfm burden"


o "Histamine release dunng Utomosoides sigmondotis infection leads to the development of a type 2 response"


o "Histamine does not playa Role in VacCine-Mediated Immunity to Litomodoldes Sigmondontis, a Murine model of Lymphatic Filanasis

The American Society of Tropical Medicine and Hygiene Annual Meeting (December 200B)

o "Histamine does not playa Role in Vaccine-Mediated Immunity to Litomodoides Sigmondontis, a Murine model of lymphatic Fllanasls"

USUHS Research Day, Bethesda MD (May 2008)

o " Histamine does not playa Role in Vaccine-Mediated Immunity to Litomodoides Sfgmondontls, a Murine model of lymphatic Filariasis ..

Manuscripts

• Ellen Mueller Fox, et at ~Histamine receptor I bI()(j(a(1e enhances eosmophil mediated dearaoce of chroniC filarial mfection~ (SUbmitted to Journal of Immunology, 28 June 2013)

Ellen Mueller Fox, et al. "Mechanisms of allergen desensitization In 3 murine models of allergen-specific Immunotherapy" (Submitted to the Journal of Allergy and Olnicallmmunology, July 26111 2013)

Ellen Mueller Fox, at al. - Histamine is not reqUired for vacone-mecliated immunity In LltomOSOIdes sigmondonlls model of filnal infection" ( In preparation)

- saSOphiiS help establish protective Immunity induced by irradiated larval vacanation for filanas-s. ~ Torrero MN, Moms CP, Mitre 8K, Hubner MP, Fox EM, Karasuyama H, Mitre E. Vaccine. 2013 Jun IS [Epub ahead of print]

~Mol ecular mimicry between cockroach and helminth glutathione S transferases promotes crossreactivity and crosssensitization In humans and mice~ Heltof\ Santiago, Elyse LeeVan, Saslsekhar BennullJ, Flavia Ribeiro-Gomes, EJlen Mueller, Mark Wilson, Thomas Wynn, David Garboczi, Joe Urban, Edward Mitre, Thomas 8. Nutman J Allergy Oln Immunol. 2012 Jul;13O(l)

• "Helminth protection against autoimmune diabetes in NOD mice is Independent of a type 2 immune shift and requires TGFa~ Marc P. Hubner, Yinghui Shi, Marina N. Terrero, Ellen Mueller, David larson, Kateryna SoIovinla, J Thomas StOCker, Stephen J Davies, Kristin V Tarbell, Edward Mitre. J Immunol. 2012 Jan 15; 188(2):559-£8

• "Anti-FaRI antibody injections activate basophils and mast cells and delay Type I diabetes onset in NOD mlce~ Marc P. Hubner, David larson; Ellen Mueller; Yinghui Shi; Edward Mitre, M.D. Oln Immunol. 2011 Nov;14l(2):20S-l7

Societal Affiliations

USUHS Student Chapter-Am er ican Society for Microbiology

o President since 2009

o Founder of Student Chapter

The American Association for the Advancement of Science (AAAS)

o Member since 2008

The American Society for Microbiology

o Member since 2008

The American Society of Tropical Medicine and Hygiene

o Student member since 2009

Beta Beta Beta, National Biological Honor Society

o Member since 2005

Awards and Honors

Finalist in Uniformed Services Unillersity Research Week Graduate Student Oral Presentation Competition (May 2010) 15111 Annual Woods Hole Immunoparasitology Meeting Student Fellowship (April 2011)

• 16'" Annual Woods Hold ImmlMlOparas-tOiogy Meeting Student FelloWShip (Apol 2012) American Association of Immunologists Young Inllestigator Best Poster Award-Woods Hole Immunoparasltology Meeting, Apnl 2012 Invited Speaker, American Society (Of'Tropical Medidne and Hygiene Annual Meeting, (The Amencan Committee of Molecular, Cellular and Immunoparas-tology InVitation), November 2012

Community Service

Laboratory Instructor, Medical Parasitology 2007-20U Laboratory Instructor for Medical Parasitology Course (2007-201I) VIrginia JunlOf' Academy of Sdence--EvaluatOf' of student research projects (2009-20ll)

TAB 10


Capt William F. Kerst



Seplember I I. 2013

MEMORANDUM(,OR BOARD OF REGENTS

Through: Charle~e, M.D .. President

SUBJECT : Ccnification of Graduate Student

The graduate student listed below is presented for certification (0 receive the Doctor of Philosophy effective upon your approval:

Capt William f. Kerst

DOCTOR OF PHI LOSOPHY

Department of Medical and Clinical Psychology

Attached is the candidate's cenification of successful completion of the Final Examination. Also attached are the Dissenation Approval Form. cenification of authorized use of copyrighted materials. Thesis Abstract, Thesis Title Page. and Curriculum Vitae.

J1~!r~ Dean, USU, School of Med icine (Acl ing)


""'"ted on @ Recycled Paper

UNIFORMED SERVICES UNIVERSITY, SCHOOL OF MEDICINE GRADUATE PROGRAMS Graduate Education Office (A 1045), 4301 Jones Bridge Road, Bethesda, MD 20814

FINAL EXAMINATIONfPRIVATE DEFENSE FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE MEDICAL AND CLlNlCAL PSYCHOLOGY DEPARTMENT

Name of Student: William Kerst

Date of Examination: August 30, 20]3

Time: 1230

Place: B3079

DECISION OF EXAMINATION COMMITTEE MEMBERS:

PASS FAIL

..,/ Dr. David Krantz DEPARTMENT OF MEDICAL AND CLINlCAL PSYCHOLOGY Committee Chairperson

;o,n v Dr. Andrew Waters DEPARTMENT OF MEDICAL AND CLINICAL PSYCHOLOGY

Di~or V

Dr. Mark ttenhofer DEPARTMENT OF MEDICAL AND CLINICAL PSYCHOLOGY Commi ttee Member

LO,l!,<= Dr. Cara Olsen DEPARTMENT OF PREVENTIVE MEDICINE AND BIOMETRICS Committee Member

Eleanor S. Metcalf, Ph.D., Associate Dean II www.usuhs.mil/graded II [email protected]

Toll Free: 800·772-1747 II Commercial: 301-29S-3913 / 9474 II DSN: 295-9474 II Fa~: 301-29S·6772

UNIFORMED SERVICES UNIVERSITY, SCHOOL OF MEDICINE GRADUATE PROGRAMS Graduate Education Office (A 1045), 4301 Jones Bridge Road, Bethesda, MD 20814

DISSERTA nON APPRO V AL FOR THE DOCTORAL DISSERTATION IN THE MEDICAL AND CLINICAL PSYCHOLOGY DEPARTMENT

Tille of Dissertation: "Atlenlional Retraining Administered in the Field : Effects on Auentional Bias, Craving. and Smoking"

Name of Candidate: William Kerst Doctor of Philosophy Degree August 30. 2013

DISSERTATION AND ABSTRACT APPROVED:

~'

i -, '

Dr. David Krantz

DATE:

8-3c.> - i>

DEPARTMENT OF MEDICAL AN D CLINICAL PSYCHOLOGY Committee Chairperson

IrCtH g -')0-1) Dr. Andrew Waters DEPARTMENT OF MEDICAL AND CLINICAL PSYCHOLOGY

dvisor

~ <t (,oi 13 Dr.Mark Ellenoter DEPARTMENT OF PREVENTIVE MEDICINE AND BIOMETRICS Committee Member

Dr. eara Olsen DEPARTMENT OF PREVENTIVE MEDICINE AND BIOMETRICS Committee Member

Eleanor S. Metcalf, Ph.D. , Associate Dean II www.usuhs.mil/graded II [email protected]

Toll Free: 800-772 -1747 II Commercial: 301-295 ·3913 / 9474 II DSN : 295-9474 II Fax : 301-295-6772

COPYRIGHT STATEMENT

The author hereby certi fies that the use of any copyrighted material in the

dissenation manuscript entitled: "Attenlionai Retraining Administered to Cigarette

Smokers in the Field: Effects on Atlentional Bias, Craving, and Smoking" is

appropriately acknowledged and, beyond brief excerpts, is with the permission of the

copyright owner.

William F. Kerst

September 6th, 2013

v

ABSTRACT

Attentional Retraining Administered to Cigarette Smokers in the Field: Effects on

Attentional Bias. Craving. and Smoking:

William F. Kerst, Doctor of Philosophy, 2013

Dissenation directed by: Andrew ]. Waters, Ph.D. , Associate Professor, Medical and

Clinical Psychology

AUentiona l retraining (AR) for cigarette smokers involves train ing smokers to

attend away from smoking cues. Accord ing to theory. AR should reduce cue-provoked

craving and reduce smoking behavior. Ordinarily AR has been delivered in a laboratory

seuing. In this study we tested the efficacy of delivering AR on a hand-held computer

(PDA) in the field. Cigarette smokers in the Washington D.C. metropolitan area (n=60)

were randomly assigned to an AR training group or a control (no training) group. They

carried a PDA around for one week and were prompted by the PDA to complete AR (AR

group) or a control task (control group) three times a day. They also completed an

assessmen t of altentional bias once per day on the PDA in the field. During the week. AR

group participants completed an average of 15.0 atlentional relrainings and the control

group completed an average of 14.9 control trainings. As hypothesized. attentiona1 bias

assessed in the field declined over the week in the AR group, but not in the con trol group.

In a novel eye tracking measure of attentional bias admin istered post-training, the AR

VI

ATTENTIONAL RETRAI NING ADM INISTERED TO CIGARETTE SMOKERS IN THE

FIELD: EFFECTS ON ATTENTIONAL BIAS, CRAVING, AND SMOKING

by

William F. Kerst, M.S.

Dissertation submitted to [he Faculty of the Medical and Clinical Psychology Graduate Program

Unifonned Services University of the Health Sciences In partial fu lfillment of the requirements for the degree of

Doctor of Philosophy 2013

Address:

Phone:

E-mail: Birth Date:

I Educa/ion 2007·Present

2005-2007

2005-2007

200 t -2005

I Publications

Kerst CV Updated: September, 2013

William F. Kerst, Capt, USAF, BSC CURRICULUM VITAE

Department of Medical and Clinical Psychology Uniformed Services Un iversity of Health Sciences Bethesda, M D 20814 Cell : (907) 33 1-7515 Work: (907) 580-2181 wi [email protected] l September 10, 1980

Uni fo rmed Services University of Health Sciences Ph.D. (Doctor of Philosophy) expected 2013 Clinical Psychology Doctoral Dissertation: Atten tional retraining administered (0 cigarette smokers in the field: Effects on attentional bias, craving, and smoking M.S. (Master of Science) Clinical Psychology Master's Thesis: Attention training in smokers: A feasib ility study of an ecological momentary assessment approach Research Advisor: Andrew J. Waters, Ph.D.

Chapman Uni vers ity B.A. (Bachelor of Ans) Psychology Thesis Advisor: J. Xavier Apodaca, Ph. D. Thesis: The noncustodial father faci litation model: Father centered change in the fractured family

Community College of the Air Force A.A. (Associate of Ans) Instructor of Technology and Military Science

Community College of the Air Force A.A.S. (Associate of Applied Science)

Kerst, W.F. , & Waters, AJ. (2013). Attentional Retraining Administered in the Fie ld Red uces Smokers' Auentional Bias and Craving. Health Psychology. Manuscript accepted for publicat ion.

Waters, A. 1., Caner, B. L., Robinson, J. D., Wetter, D. W., Lam, C. Y. , Kerst, W. , & Cinciripini , P. M. (2009). Attentional bias is associated with incentive-related physio logical and subjective measures. Experimetltal alld Clinical Psychopharmacology. 17(4),247-257.

Dodge, L.G., & Kerst, W.F. (2008). Raising a child with special needs: Hope sustains. Manuscri pt in preparation

Kerst CV Updated: September, 2013

I PresenlaliollS

Kerst, W., Mi ll er, E .. Rowell , B., Ritzau, M., & Waters. A. (2010). Cogniti ve retrain ing can be ad ministered on a PDA in an Ecological Momentary Assess ment study. Poster presented at the mobile Health Summit, Wash ington, D.C.

Dodge, L.G., & Kerst, W.F. (2008, February). Nine sror;e.f a/hope: Parents' gifts to their children. Paper presented at the 40(h ann ual convention of the National Association of School Psychologists, New Orleans, LA.

I Current Clinical Experience 20 l 2-Present Mental Health Provider, Joinl Base Elmendorf-Richardson Hospital; MenIal Health

Flight

20 11·2012

2009·2011

Supervisor: Kevin Cunis. Psy.D.

Clinical Psychology Resident. Wrighf-Pouerson Medical Center; Mental Health Flight, Dayton, OH Supervisor: Kirk Rowe, Ph.D.

Senior Student, National Institutes of Health; Neuropsychology Consulting Group, Bethesda, MD SuperviJor: Joseph Snow, Ph.D., AB PP(CN) and Edythe Wiggs , Ph.D.

I Research Experience 20 12·Present Research Coordinator, Polytraurna AJseSsrnenl and Intervention, Joint Base Elemendorf·

Ric hardson Hospital, Mental Health Flighl.

2008·2011

2009·2011

Principal Investigator: Wi lli am F. Kerst, Capt, USAF, S SC

Student Researcher, Attention Training in Smokers, Un iformed Services University of Health Sciences, Depanmen t of Medica l and Clinical Psychology. Principal Investigator: Andrew J. Waters, Ph.D.

Student Research Assistallt, Traumatic Injury Research Program (TlRP), Unifonned Services Univers ity of Health Sciences, Depanment of Military and Emergency Medici ne. Principal Investigator: Paul E. Rapp, Ph.D.

I Prof essionallTeaching Experience

201 1

2010

Teaclling Assistant, Unifomzed Services University, Depanmem of Medical and C linical Psychology MP0533 Neuropsychology

Teaching Assistant, Uniformed Services University, Department of Medical and C linical Psychology: MP0502 Psychophys iology

I Professional and HotlOr Societies

American Psychological Association (student) Association for Psychological Science (student) Psi Chi National Honor Society in Psychology (member)

2

TAB 11


CPT Angela M. Yarnell



September 11. 2013

MEMORANDUM FOR BOARD OF REGENTS

Through: Charles ~. M.D .. President

SUBJECT: Cert ification of Graduate Student

The graduate student listed below is presented for certification to receive the Doctor of Philosophy effective upon your approval:

CPT Angela M. Yarnell

DOCTOR OF PHILOSOPHY


Attached is the candidate's certification of successfu l completion of the Final Examination. Also aunched are the Dissen.alion Approval Form. cenification of authorized use of copyrighted materials. Thesis Abstract. Thesis Title Page. and Curriculum Vitae.

nE. M1.!~0 ean, USU, School or Medicine (Acting)


Pm1ted on @ Rl!cvcled Paper


GraduatE: Educatiar, Office (A 1045), 4301 Jones Bridge Road, Bethesda, MD 20814

FfNAL EXAMfNATIONIPRIV A TE DEFENSE FOR THE DEGREE OF DOCTOR OF PHILOSOPHY fN THE MEDICAL AND CLfNICAL PSYCHOLOGY DEPARTMENT

Name of Student: Angela M. Yarnell

Dale of Examinalion: July 26. 2013

Time: 9:30am

Place: 83079

DECISION OF EXAM INATION COMMITTEE MEMBERS:

PASS FAIL

"\. Or. Andrew J. Walers DEPARTMENT OF MEDICAL AND CLINICAL PSYCHOLOGY Committee Chairperson

i:./~: - '- ---' L _ Dr. Neil E. Grunber ,/ 'J DEPAR'TMENT OF ME[)lcAL AND CLfNICAL PSYCHOLOGY Dissep,aJion Advisor

//1/1, ) f.-OfMark L Ettenhofer DEPARTMENT OF MEDICAL AND CLfNICAL PSYCHOLOGY Comtttc~ Membe~..,q

-1}&h?i----Or. William D. Wa~on DEPARTMENT OF NEUROLOGY Committee Member

EI~ar,()r~, Metcilrf, Ph.D .• Assljr.,ate Dean I VJVlw.u~:Jhs.mil/grilded II graduat€program@usu!'Js.edtJ

T r,ll F ...... : 8'10·772·1747 (cm'l'leroa' 30:-295-3913/9474 O!)N: 295-9.4 74 far 301-295-677L

UNIFORMED SERVICES UNIVERSrTY, SCHOOL OF MEDICINE GRADUATE PROGRAMS

Graduatf.; [dur."tl(m OffiGe (A 1045). 4301 Jones Bridge Road, fSethesda, 11110 20814

DISSERTATION APPROVAL FOR THE DOCTORAL DISSERTATION IN THE MEDICAL AND CLINICAL PSYCHOLOGY DEPARTMENT

Title of Dissenation: "Characterization of psychological and biological factors in an animal model of Warrior Stress"

Name of Candidate: Angela M. Yarnell Doctor of Philosophy Degree July 26. 2013

DISSERTA TION AND ABSTRACT APPROVED:

DATE:

try) f5kbU3 Dr. A'narew J. Waters • DEPARTMENT OF MEDICAL AND CLIN1CAL PSYCHOLOGY Co e Ch . rperso

ICAL AND CLINICAL PSYCHOLOGY Dissenalion Advisor

.~~ ~13 Dr. Mark L. Ettenhofer DEPARTMENT OF PREVENTIVE MEDICINE AND BIOMETRICS

Dr. William D. Watson -===-DEPARTMENT OF NEUROLOGY Committee Member

[IHJn'.r" ~<i\f'tu,I', Ph.[.,., J."'Cf.lcHe Jean IJW"I.u~u~'-" •. mi!/graded fra~urep'pgr"m@u~lJn~.eou

T'J. ~rf"" I1'Y,·77i·1747 C'),",'fIe'c:a; 3:::·295·3313/9474 I OSN 295-9'74 II ~aJ 301·29S-6772

The author hereby certifies that the use of any copyrighted material in the thesis manuscript entit led:

"Characterization of psychological and biological factors in an animal model of Warrior Stress"


Ang M. Yarnell MEDICAL AND CLfNICAL PSYCHOLOGY Uniformed Services Univers ity Date 0811 6/20 I 3

ABSTRACT

Title of Dissertation: Characterization of psychological and biological factors in an

animal model of Warrior Stress

Angela M. Yarnell, Ph.D., 2013

Thesis directed by: leil E. Grunberg, Ph.D., Professor, Medical and Clinical Psychology

For over a decade, American serv ice members have been vigorously defending

this nation and, in the process, have been exposed to death or the threat of death,

explosive blasts, debilitating injuries. and other environmental stressors (e.g.. noise,

heat), not to mention separation from loved ones and unpredictable deployment

schedules. Because serv ice members are exposed to physical and psychological

stressors , it is important to understand the effects of stress on psychobiological processes

to better prevent and/or treat resulLing illness or injury. Despite increased awareness that

Warriors exposed to stress and blast may experience cognitive effects (e.g., memory and

attention problems) and other post-deployment symptoms (e.g., chronic pain)

mechanisms underlying psychological effects of stress and blast injury have yet to be

identified. Therefore, basic research must be conducted 10 understand the complex

response to injury and stress.

The purpose of this doctoral dissertation project was to characterize psychological

and biological responses in a rodent model of Warrior Stress using males and female rat s.

VII

Characterization of psychological and biological factors in an animal model of

Warrior Stress

by

Angela M. Yarnell

Doctoral Thesis submitted to the Faculty of the Department of Medical and Clinical Psychology Graduate Program

Uniformed Services Univers ity of the Health Sciences In partial fulfill ment of the requirements fo r the degree of

Doctor of Philosophy, 2013

CURRICULUM VITAE

Add ress: ANGELA MARIE YARNELL

Department of Medical and Clinical Psychology Uniformed Services University of the Health Sciences 430! Jones Bridge Road Bethesda, Maryland 20814-4799

Telephone: 301 ·295·9670 Fax: 301·295·3034 E-mai l: ange la.yame [email protected]

EDUCATION School and Location Indiana Uni versity of Pennsy lvania Indiana, PA Un iformed Services Univers ity Bethesda, MD Unifonned Services University Bethesda, MD SCHOLARLY WORKS

Oeeree B.A.

M.S.

Ph.D.

Year 2005

2012

2013

Criminology & Psychology

Medica l Psyc hology

Medical Psychology

Yarne ll, A.M. (2012). A neurobehavioral phenotype of blast traumatic brain injury and psychological stress in male and female rats. Master's Thesis, Uniformed Services Univers ity of the Health Sciences, Bethesda. MD.

Yarnell, A.M. (expected 2013). Characterization of psychological and biological factors in an an imal model of Warrior Stress. Doctoral Thesis, Uniformed Services University of the Health Sciences, Bethesda, MD.

P UBLICATIONS Cole, J.T.. Yarnell , A.M. , Kean, W.S., Gold, E., Lewis, B., Ren, M., McMullen , D.C.,

Jacobowitz, D., Pollard, H.B. , O'Neill, J.T., Grunberg, N.E., Oalgard. c.L., Frank, J,. & Watson, W.O. (20 Ii). Craniotomy: True sham for traumatic brai n injury, or a sham of a sham? Journal of Neurolrauma, 28(3). 359-69.

Cole, J .T., McMullen , D.C., Kean, W.S. , Yarnell, A." Lucky, U., Selak, M.A., Buonora, J., Grunberg, N.E., Verma, A., Watson, W.D. (2012). Manipulating thyroid status impairs endoplasmic reticulum ca lcium homeostal ic mechan isms in rat cerebel lum. Indian Journal of Experimental Biology. 50, 7-18 .

Yarnell, A.M. , Shaughness, M.C., Barry, E.S., Ahlers, S.T., McCarron, R.M., & Grunbe rg, N.E. (2013). Blast trau matic brain inj ury in the ral lIsing a blasl overpressure model. Currenr Protocols in Neuroscience, 9.41.1-9.41.14.

Turlzo, L.C.. Budde, M.D., Gold, E.M., Lewis, B.K., Janes, L., Yarnell , A., Grunberg, N.E., Watson, W., Frank, J.A. (2012). The Evo lution ofTraumalic Brain Injury in a Rat Focal Contusion Model: implications for Ce ll Tracki ng with MR I. NMR in Biomedicine, online: 6 DEC 2012.

POSTER PRESENTATIONS Cole, J.T., Yarnell, A., Kean, W. S., Gold, E., Lewis, B., Ren, M., McMul len, D.C. ,

Jacobowitz, D., Pol lard, H. B., O'Neill, J.T., Grunberg, N. Dalgard , C. L., Frank, J. , Watson, W.O. Craniotomy: True sham fo r traumatic bra in injury or a sham of ash am. Presented al the Society for Neuroscience. November 20 I O. San Diego, CA.

Walson, W.O., Lucky, J.J .. Buonora, J. E .. Se lak. M.A ., Kean , W.S., Yarnell, A.M., McMullen, D.C., Grunberg, .E., & Cole J.T. (20 II, July). Post-traumatic changes in mitochondrial funclion precede cognitive impainnent. 'Presented at the

International Brain Research Organization, Florence, Italy. Lucky. J.J., Buonora. J.E., Selak, M.A. , Kean , WS, Yarnell ,A.M., McMullen, D.C., Grunberg, N.E.,

Watson, W.O., & Cole J.T. (20 II, November). Cortical mitoc hondrial dysfunction after traumatic brain injury precedes loss of memory. Presented at the Society for Neuroscience meeting, Washington, D.C.

Grover, D., Starosc iak. A., Verma, R. , Xu, X., Bhanacharyya, 5., Biswas, R., Jacobowitz, D.M., Yarnell, A., Grunberg, N.E., Galdzicki, Z. (2011, November). MicroRNA signature in a mouse model ofposl-lraumatic stress disorder. Presented at Society for Neu roscience, Washington, D.C.

Grunberg, N.E., Yarnell , A.M. , Hamilton, K.R .. Starosciak, A.K., Chwa, A., Hutchison, E.S., & Barry, E.S. (20 I I, November). A revised neurological severity scale for rodents (20 11, November). Presen ted at annual meet ing of Society for Neuroscience, Washington, D.C.

Barry. E.S., Yarnell, A.M .. McCarron R., Jacobowitz, D.M., Eidehnan 0., Dalgard C.L., Joswick, c., Pollard, H. , & Grunberg, N.E. (2012, May). Psychological mess alters plasma cylokines and chemokines in male and female rats. Presented aI Center for Neuroscience and Regenerative Medicine Annual Meeting, Bethesda, Maryland.

Yarnell, A.M., & Grunberg, N.E. (2012, October). A neurobehavioral phenotype of blast traumatic brain injury and psychological stress in male and female rats. Presented at the Society for eurosc ience meeting, New Orleans, La.

Bauman. M., Chwa, A., Cravedi, K.D., Barry, E.S., Yarnell, A.M., Jacobowitz, D.M., McCarron, R. o & Grunberg, N.E. (2012, October). Psychologica l stress and blast overpressure exposure differentially alter central monoamine transmission in male and female rats. Presented at the Society for Neuroscience meeting, New Orleans, La.

REFERENCES Nei l E. Grunberg. Ph.D. Professor of Medical & Clinical Psychology Professor of Neuroscience Un iformed Services University of the Health Sciences 4301 Jones Bridge Road. Bethesda, MD 20814 (301) 295-9670 n gru n ben!? \lSll hS.ed u

David M. Jacobowitz, Ph.D. Professor of Anatomy, Physiology, & Genetics Professor of Neuroscience Unifonned Services University of the Health Sciences 430 I Jones Bridge Road. Bethesda, MD 20814 (301)295-3519 djacobo\\ itl.wusuhs.edu

CAPT William D. Watson, M.D., Ph.D. Assoc iate Professor and Vice Chair, Department of Neurology Director, Comprehensi ve National Neuroscience Program Unifonned Services University of the Health Sciences 430 I Jones Bridge Road, Bethesda, MD 20814 (301) 295-3840 [email protected]

2

TAB 12


MAJ John E. Buonora



September 11,2013


Through: Charles~ M.D .. President

SUBJECT: Certification of Graduate Student

The graduate student listed below is presented for certification to receive the Doctor of Philosophy effective upon your approva l:

MAJ John E. Buonora


Neuroscience Graduate Program

Attached is the candidate's certification of successful completion of the Final Examination. Also attached are the Dissertation Approval Form. certificati on of authorized use of copyrighted materials. Thesis Abstract Thesis Title Page. and Curriculum Vitae.

/)/)/c'£~ n E. McManigle, M.D.

ean , USU, School of Medicine (Acting)


P"fllild on @ Recvcled Paper


Graduat'! Education Office (A 1045), 4301 Jones Bridge Road, Bethesda, MD 20814

FINAL EXAM INA TlONfPRIVATE DEFENSE FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE NEUROSC IENCE GRADUATE PROGRAM

Name of Student: John Buonara

Date of Examination: July3 ,2013

Time: IO :30am

Place: B 2090

DECISION OF EXAMINATION COMM ITTEE MEMBERS: PASS FAIL

Jose h McCabe DEPARTMENT OF ANATOMY. PHYSIOLOGY. A iD GENETICS Committee Chairperson

-J;~;~uf?'Jkh 0£-, ~ -DEPART:l"'E T OF ANATOMY. PHYSIOLOGY. AN D GENETICS J1i.s?ert8~Advisor

.---:(~ - /' Dr. ~ erley Byrnes DEPARTMENT OF NATOMY. PHYSIOLOGY. AND GENETICS Committee Member

he

Dr. aniel Perl DEPARTMENT OF PATHOLOGY Committee Member

L

L

EI1'!ano~ S. Metcalf, Pn.D., AS~O(late Dean II www.usi.lhs.mil/graded II g~aduat ... [email protected]

Tol FfP<' 8Q1·7n-~747 Commercia 301-295·3913/9474 OS"": 295-9.<;74 Fall": 301-295-6772

UNIFORMED SERVI CES UNIVERSITY. SCHOOL OF MEDICINE GRADUATE PROGRAMS

Graduate Education Office (A 1045), 4301 Jones Bridge Road, Bethesda, MD 20814

DISSERTATION APPROVAL FOR THE DOCTORAL DISSERTATION IN THE NEUROSCIENCE GRADUATE PROGRAM

Title of Dissertation: "Development of a Traumatic Brain Injury Assessment Score Using Novel Biomarkers Discovered Through Autoimmune Profiling"

Name of Candidate: John Buonara Doctor of Philosophy Degree July 3, 2013

DISSERTATION AND ABSTRACT APPROVED: DATE:

-&~t1er;h, < <17#lf3 ARTMENT OF ANATOMY, PHYSIOLOGY, AND GENETICS

Committee Chairperson (J

~UJ1i~ CJ#~OD i5;&egOMelier DEPARTMENT OF ANATOMY, PHYS IOLOGY, AND GENETICS Di

,~~::;;==--r. 'mberley Byrnes

DEPARTMENT OF ANATOMY, PHYS IOLOGY, AND GENETICS Committee Member

Dr. Daniel Perl DEPARTMENT OF PATHOLOGY Committee Member

fl(:anrjf 0;,. Mete"I:, F'h.O .• h~)l)cjat~ Dean ,I www.u~uhs.mil/gr .. ded graduateprl)gfam@u~uh~.edu

T '" f'M RI')(J·77' · 1747 (.ol""""-,e'c:a i : 30~-295· 35013/9474 DSN' 295-947': Fax 301· 295-05772

The author hereby ceni ties that the use of any copyrighted material in the thesis manuscript entitled:

"Development of a Traumatic Brain Injury Assessment Score Using Novel Biomarkers Discovered through Autoimmune Profiling"


rogram in Neuroscience, APG Uniformed Services University 07/3112013

ABSTRACT

Development of a Traumatic Brain Injury Assessment Score Using Novel Biomarkers

Discovered Through Autoimmune Profiling:

John E. Buenora, Doctor of Philosophy, 2013

Dissertation directed by: Gregory P. Mueller Ph.D., Professor, Department of Anatomy,

Physiology and Genetics

The high rate of head trauma in deployed military personnel and in civilians

involved in automobile accidents and in contact sports is well recognized. The extent to

which these head traumas result in mild brain injury, however, cannot be determined due

to the lack of suitable diagnostic tools, including biomarkers. At present, there is no

effective way to assess mild traumatic brain injury (TB I) and the ri sks it brings for

underlying neuropathology and second injury syndrome. For more than a decade,

traditional approaches in biomarker research have failed to identify a means for

diagnosing mild TBI. Much of this work has focused on single proteins thought to be

relevant to TBI but subsequently shown to be ineffective for the diagnosis of mild TBI. It

is now clear that new approaches to the discovery of biomarkers and their applications in

diagnosis are needed. The goals of this research were to identify novel brain proteins

targeted by TBI-induced autoantibodies and to detenn ine if these proteins contribute to a

circulating biomarker signature for TBl. We reasoned thallhe humoral immune response

Autoimmune profiling for TBI-induced autoantibodies was carried out by

immunoblotting in rodents and protein microarray in humans. Serum from control and brain

injured rats was used to in terrogate immunoblots of the entire rat brain proteome fractionated on

large 2-dimensional gels. Prote ins revealed by autoreact ive immunoglobulins were then mapped

to corresponding protein gels and identified proteomically by peptide mass flllgerprinting. A

related analysis of the human aUlOimmune response to TBI was performed using a protein

microarray platform containing over 9,000 human proteins. Within-subject comparisons were

made between samples that were collected immediately following TBI and 30 days post-injury,

times that would reveal the full express ion of a TBI-induced autoimmune response. A total of 43

proteins showed enhanced antigenicity following TBI; the propollion of central nervous system

proteins in this group was an order of magnitude higher than the representation of brain-centric

proteins on the enti re array. These findings suggest there is an autoimmune response to TBI that

is directed towards the central nervous system.

Findings from the two auto immune profiling approaches were used to create a list of 12

proteins cons idered to be the best candidales for having roles as novel TBI biomarkers. This

selection was based upon their repolled localization and functions in the brain. These proteins,

which include peroxiredoxin 6, cyelin-dependent kinase 5, collapsin response medialor protein 2,

neuronal pentraxin I, and presynaptic cytomatrix protein, have been formally recorded in an

invention disclosure document. lmmunosorbent assays developed for peroxiredoxin 6 and

cyeli n-dependent kinase 5 demonstrated that these two proteins were informative biomarkers for

TBl. It was shown that the plasma profiles of these novel biomarkers, when considered in

conjunct ion with the profiles of other established biomarkers. could be interpreted to create an

assessmen t score that identifies mild TBI. Specifically, it was demonstrated how fold changes in

plasma levels of a panel of biomarker proteins can be formulated to produce a TBI Assessment

Score that identifies mild TBI in humans. This score offers a long-sought solution to the need for

a sensi ti ve and objecti ve tool for diagnosing mjJd TBI in adu lt patients. Because the TBI

Assessment Score is based upon definitive measures of ci rculating biomarkers, it is an objecti ve

assessmenllhal is easily standardized across clinical settings.

In summary, this research has two major outcomes. First, it demonstrates that

autoimmune profiling can be used to identify novel biomarkers fo r TBI. Second, this

investigation demonstrates for the first time that a profile of biomarker responses can be used to

formulate a diagnostic assessment score that is sensitive for the detection of mild TBI.

DEVELOPMENT OF A TRAUMA TIC BRAIN INJUR Y ASSESSMENT SCORE USING

NOVEL BIOMARKERS DISCOVERED THROUGH AUTOIMMUNE PROFILING

by

MAJ John E. Buonora, CRNA

Dissenation submilted to the Faculty of the Neuroscience Graduate Program

Uniformed Services University of the Health Sciences in partial fulfillment of the requirements for the degree of

Doctor of Philosophy 2013

Professional Goal

Ed ucation

Militarv Education

Honors and Awards

John E. Buonora CRNA, MS 7808 Forest Path

Live Oak, DC 78233-4353 (240) 429-8870

Email: [email protected]

Nurse Anesthetist Educator for the US Army Nurse Corps

Ph.D. Neuroscience, 2009-2013 Uniformed Services University of the Health Sciences

M.S. Nursing Anesthesia I Health Administration, 1988-1990 Saint Joseph's University

Certificate of Nurse Anesthesia, 1986-1988 Nazareth Hospital School of Anesthesia for Nurses

BS Nursing, \980-\984 Thomas Jefferson University

Officer Basic Leadership Course, 2009

2012 Finalist USU Research Week - Graduate Student Colloquium 2011 Finalist USU Research Week - Poster Presentation

AANA 2008 Ira P. Gunn Award for Outstanding Professional Advocacy -Presented to an indi vidual who, through leadership and/or personal etTon, has made a highly sign ificant contribution to the preservation and advancement of the nurse anesthesia profession through legislative, legal and/or regulatory cfTons_

Abstract Poster Presentations

John E. Buonora*l, Michael Mousseau *2, Lawrence Latour3, Ramon Diaz-Arrastia4

, Harvey Pollard2, Sandro B. Rizoli5, Andrew J. Baker6, Shawn G. Rhind7, Gregory P. Mueller2

INeuroscience, USUHS; 2Anatomy, Physiology and Genetics, USUHS; 3NIHlNfNDS; 4Neurology, USUHS, sDept. of Surgery & Critical Care Medicine. Sunnybrook Health Sciences Centre; 6Brain Injury Laboratory, Cara Phelan Centre for Trauma Research Keenan Research Centre, Li Ka Shing Knowledge Institute, S1. Michael's Hospital , University of Toronto; 7Defence Research & Development Canada, Toronto, Canada. Peroxiredoxin 6: A Novel Candidate fo r a TBI Biomarker Signature. Abstract, 31 st Annual National Neurotrauma Symposium, August 2013, Nashville, TN.

John E. Buonora CRNA, MS

John E. Buonora\ Carol Moore2, Ramon Diaz-Arrastia2, Harvey Pollard}, Gregory P. Mueller}

1 Program in Neuroscience, Departments of2~eurology, } Anatomy, Physiology and Genetics, USUHS,Bethesda, MD. Immune Response Biomarker Profiling for Human Traumatic Brain Injury. Abstract, Center for Neuroscience and Regenerative Medicine Annual Meeting, May 2012, Bethesda, MD.

John E Buonora, Rachel Lazarus, CamiJa Almeida, David Jacobowitz, Maria Braga, William Watson, Harvey Pollard, Gregory P Mueller. Autoantibodies identify novel biomarkers for brain injury. Abstract, Society for Neuroscience Meeting, November 2011, Washington, DC.

J ohn E Buonora, Camila Almeida, Jeffrey McCue, David Jacobowitz, Maria Braga, William Watson, Harvey Pollard, Gregory P Mueller. Tracing the identity of nove! brain biomarkers through the immune system. Abstract, Experimental Biology Meeting, April 2011, Washington, DC.

Publications

Cole, J . T., McMullen, D. C., Kean, W. S., Yarnell, A., Lucky, J. 1., Selak, M. A., Buonora, J., Grunberg, N.E., Verma, A, Watson, W.O. (2012). "Manipulating thyroid status alters endoplasmic reticulum calcium homeostasis in rat cerebellum." Indian J Exp Bioi 50(1): 7-18.

Manuscript under review Journal of Neuroimmunology

Discovery that Peroxiredoxin 6 (PRDX6) is an Autoantigen in Plasma from Brain-Injured Rats, and Development of a Sensitive and Specific Assay for PRDX6 in Human Plasma. Michael Mousseaul,2, John E. Buonora 1

, Rachel C. Lazarus!, David M. Jacobowitz!. Harvey B. PoIlard 1•2 and Gregory P. Mueller l

,2

1 Department of Anatomy, Physiology and Genetics and 2Center for Neuroscience and Regenerative Medicine at !he Uniformed Services University of the Health Sciences 4301 Jones Bridge Road Bethesda, Maryland 20814-4799

Manuscript in Preparation

Development of a Traumatic Brain Injury Assessment Score Using Novel Biomarkers Discovered Through Autoimmune Profiling

TAB 13


LTC Jennifer Coyner



September 13.2013


Through: Charles ~M. D. , President

SUBJECT: Certification of Grad uate Student

The graduate student listed below is presented fo r certification to receive the Doctor of Philosophy effective upon your approval:

LTC Jennifer Coyner


Neuroscience Graduate Program

Attached is the candidate's certification of successfu l completion of the Final Examination. Also attached arc the Dissertation Approval Form. cenification of authorized use of copyrighted materials. Thesis Abstract. Thesis Title Page. and Curriculum Vitae.

nE.M:~t.~ ean, USU, School of Medicine (Acting)


Pr,nted on @ ReCyr:lltd Paper


Gr"duato: £dur;.atlc:.!'" Office fA 1045/. 430l Jones Brioge ?lJad. B€the~da. MD 20214

FINAL EXAMINA TIONIPRIV ATE DEFENSE FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE NEUROSCIENCE GRADUATE PROGRAM

Name of Student: LTC Jennifer Coyner

Date of Examination: July 2, 2013

Time: 10:30am

Place: Leet Hall B

DECISION OF EXAMINATION COMM ITTEE MEMBERS: PASS FA IL

Dr. go Mueller DEPAR MENT OF ANATOMY, PHYS IOLOGY, AND GENETICS

- Johnson RTMENT OF NEUROSCIENCE

Dissertat ion Advisor

Dr. Sharon Ju liano

p

DEPA RTMENT 0, ANATOMY, PHYS IOLOGY, AND GENETICS Comnynee Member

1<----11 C:ck l Dr_Brian Cox DEPARTMENT OF PHARMACOLOGY Committee Member

~~ C...- Pn'n..:::>("J c:>C Dr. R pa Blswas /J - -r I [.s DEPARTMENTOFI'A'FHGLOG¥- ANA TO I,,{ '1 ) PI-l '1~ i ()l-rJG.cl g, ""ENe

Dr. u - ne Bausch DEPARTMENT OF PHARMACO LOGY Committee Member

~''':i:'''''' -, ·1"·~CI!". ~~, J. I-'.~',( <,I; :::'!a- ·IN;JI . ..I~''··-''-'''Ig·a::l'''::: g-.. o~:;~>:!';;·')gr;;""-~..I~.J~': <;0

TOI ~'H ?'J',·772-:7t.7 ',,--""~;a ~::·:Z:;~·3"":!: ' ''11.74 :>Sf\ "S~·;(7( :~t 3-;:·235·£772

UNIFORMED SERVICES UNIVERSITY, SCHOOL OF MEDICINE GRADUATE PROGRAMS Graduate Edur..ation Offic..e (A 1045), 4301 Jones Bridge Road, Bethesda, MD 20814

DISSERTATION APPROVAL FOR THE DOCTORAL DISSERTATION IN THE NEUROSCIENCE GRADUATE PROGRAM

Tille of Dissertation: "Differential expression of phosphorylated mitogenaclivated protein kinase (pMAPK) in the lateral amygdala of mice se lectively bred for High and Low Pavlovian conditioned fear"

Name of Candidate: LTC Jennifer Coyner Doctor of Philosophy Degree July 2, 2013

DISSERTATION AND ABSTRACT APPROVED, DATE,

ueller NT OF ANATOMY, PHYSIOLOGY, AND GENETICS

e Johnson RTMENT OF NEU ROSCIENCE

Dissertation Advisor

, ~,K' ~ -:;f(;f./(~ Dr. Sharon Ju lia! r----DEPARTMENT OF ANATOMY, PHYSIOLOGY, AND GENETICS Committee Member

.(" r I C s.X Dr. Brian Cox DEPARTMENT OF PHARMACOLOGY Committee Member

J(~W;;was J~'<rvJ<0 DEPARTMENT OF PAHIObOGY

~ Dr. Suzanne Bausch DEPARTMENT OF PHARMACOLOGY Comm ittee Member

EI"ar,(,r s. rJ,er: .. :!, ~~. :J_. t.~~o(.at'! Dea'" "lIw.v~w~~.m! /grao'!:j erad .. 3·eprog' .. m@"~'J",~.e(L ~ 'ill F'p" f'.'J(j. 77~· i71. 7 r.c. "",rr,e'C'i~ 3,:; :'295-~~ U / 9': 7.: OS'; 295 ·S': 7.: Fay: 301· 295-5772

COPYRIGHT STATEMENT

The author hereby certifies that the use afany copyrighted material in the thesis manuscript entitled:

"Differential expression of phosphorylated mitogen-activated protein kinase (pMAPK) in the lateral

amygdala of mice selectively bred for high and low fear" is appropriately acknowledged and,

beyond brief excerpts, is with the permission of the copyright owner.

JeJ:;:~r, LTC, US Army Program in Neuroscience Uniformed Services University 06/21/3013

ABSTRACT

Differential expression of phosphorylated mitogen-activated protein kinase (pMAPK) in

the lateral amygdala of mice selectively bred for high and low fear

Jennifer L. Coyner, Doctor of Philosophy, 2013

Thesis directed by: Luke Johnson, Assistant Professor, Department ofPsycho!ogy and

The Center for the Study of Traumatic Stress, Unifonned Services University. Bethesda,

Maryland

Post traumatic stress disorder (PTSD) is a serious medical condition affecting

both military and civilian populations. While its etiology remains poorly understood

PTSD is characterized by high and prolonged levels of fear response. The neuronal

processing of fear occurs in the amygdala, a complex structure located in the temporal

lobe of the brain. A known requirement for the long-tenn storage or consolidation of fear

memory is the phosphorylation of mitogen activated protein kinase (p44/42 (ERK I 12)

pMAPK) in the lateral amygdala (LA), a subnucleus of the amygdala. Increased

expression ofpMAPK in the LA is a reliable marker of the neuroplasticity underlying

fear learning. One important biological unknown however, is whether individuals

expressing high or low conditioned fear memory consolidate the memory differently. and

if that difference underlies differences in fear response. A strategy for investigating this

question is to examine the regional expression ofpMAPK in the amygdala in animals that

IX

exhibit high and low fear. Using a mouse model selectively bred to exhibit high and low

fear, we used Pavlovian fear conditioning to examine pMAPK expression in the LA in

these divergent lines of mice. We hypothesized that high fear mice would have greater

pMAPK expression in the LA following fear conditioning as compared to low fear mice.

Further, we hypothesized that phannacologic inhibition ofpMAPK in high fear mice

would reduce fear memory strength to that of low fear mice. To examine these

hypotheses, we quantified pMAPK-expressing neurons in the LA at baseline and at one

hour following fear conditioning. Results indicate that after fear conditioning, high fear

mice have more pMAPK-expressing neurons in the dorsa-lateral amygdala (LAd) a

discrete subregion of the LA. We then used a selective inhibitor of the phosphorylation

of MAPK prior to fear conditioning and examined its effects on fear memory strength

and the quantity ofpMAPK-expressing neurons in the LAd. The results indicate that

inhibition of pMAPK reduces contextual and cued fear memory in high fear mice, and

reduces contextual but not cued fear memory in low fear mice. Additionally, we found a

dramatic decrease in pMAPK expressing neurons in the LAd of high fear mice in which

MAPK phosphorylation was pharmacologically inhibited. This suggests that the reduced

fear memory is due in part to decreased pMAPK in the LAd. These findings suggest that

increased plasticity in the LAd is a component of higher conditioned fear responses and

begins to explain, at the cellular level, how different fear responders may encode fear

memories differently. Uhimately, this understanding may help (0 identify novel ways for

both identifying and treating individuals who have developed fear-related disorders such

as PTSD.

x

Differential expression of phosphorylated mitogen-activated protein kinase (pMA PK) in the

lateral amygdala of mice selectively bred for high and low fear

by

Jennifer L. Coyner, LTC, US Anny Nurse Corps

Dissertation submitted to the Faculty of the Graduate Program in euroscience

Unifonned Services University of the Health Sciences In partial fulfillment of the requ irements for the degree of

Doctor of Philosophy 20 13

Curriculum vitae

Jennifer Coyner, CRNA, Ph.D. Lieutenant Colonel, US Army

415 Alamo Heights Blvd., San Antonio, TX 78209 (210) 295-47941(301) 525-8581 jennjfer.!,coyoor.mil@mail,mil

Profe •• lonal profile

Certified Registered Nurse Anesthetist (CRNA), United States Army Nurse Corps

Ph.D. Neuroscience

Education

August 2013: Doctor of Philosophy, Neuroscience, Unifonned Services University, Bethesda, MD

December 2002: MSN, US Army Graduate Program in Anesthesia Nursing, AMEDD C&S, Fort Sam Houston, TX

June 1994: BSN, University of South Florida College of Nursing, Tampa, FL

Academic honors and awards

2013: Poster Presentation Finalist, Uniformed Services University Research Days

2011: Tri Service Nursing Research Program Graduate Research Award ($40,000)

Research experience

Doctoral research: -Differential expression of phosphorylated mitogen...activated protein kinase (pMAPK) in the fateral amygdala of mice selectively bred for high and low fe8~. Advisor: Luke Johnson, PhD, Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, MD.

Teaching experience

Guest lecturer, Uniformed SelVlces University Graduate School of Nursing: "Fundamentals of Neurophysiology", summer 2012

"Emergency Airway Managemenr, Uniformed Services University School of Medicine Field Medicine Course, 2012

"Brain Awareness Week- volunteer educator, Armed Forces Research Institute, Maryland, 2012

Labor Epidural Education Course leader, Department of Anesthesia , 121 S1 General Hospital, Yongson, Korea

Work experience

2009-2013: Graduate student, PhD Program in Neuroscience. Uniformed Services University, Bethesda, MD

2007-2009: Assistant Chief, Anesthesia Nursing, Walter Reed Army Medical Center, Washington, DC

2005-2007: Assistant Chief, Anesthesia Nursing, Kimbrough Ambulatory Care Center, Fort Meade, MD

03/2006-10/2006: Deployed CRNA, 10th Combat Support Hospital, Baghdad, Iraq

2004-2005: CRNA, 135111 Forward Surgical Team and 12111 General Hospital, Yongson, Korea

10/2003-03/2004: Deployed CRNA, 2811'1 Combat Support Hospital, Baghdad, Iraq

2003: CRNA, Walter Reed Army Medical Center, Washington, DC

Publications

Coyner J, McGuire JL, Par1<.er CC, Ursano RJ, Palmer AA, Johnson LR (2013), Mice selectively bred for high and low fear behavior show differences in the number of pMAPK (p44142 ERK) expressing neurons In lateral amygdala following Pavlovian fear condffioning. Neurobiology of leamlng and Memory, available online 27JUN2013.

Coyner J, McGuire Jl. Par1<.er CC, Ursano RJ . Palmer AA, Johnson LR (submitted manuscript 2013). The MEK inhibitor SL327 differentially inhiMs contextual and cued fear memory strength in mice selectively bred for hIgh and fow fear.

Choi K, Le T, McGuire J, Coyner J, Higgs BW, Diglisic S, Johnson LR, Benedek DM, Ursano RJ (2012), Expression profiles of mitochondrial genes in the frontal cortex and the caudate nucleus of developing humans and mice selectively bred for high and low fear. PLoS One 7(11).

McGuire JL. Coyner J, Johnson LR (2012) Rodent models of conditioned fear: Behavioral measures of fear end memory, book chapter In "trp channels in drug discovery" vol. 2, chapter 11. (Invited book chapter),

Presentations

July 2013: Doctoral dissertation defense, "Differential expression of phosphorylated mitogen-activated protein kinase (pMAPK) In the lateral amygdala of mice selectively bred for high and low fear"

2013: Poster Presentation (Finalist), Uniformed Services University Research Days, "High and low fear phenotype mice show differential expression of phosphorylated (p44/42 ERK 1/2) MAPK in the dorsolateral amygdala following Pavlovian fear conditioning"

2012: Poster Presentation, "High and low fear phenotype mice show differential expression of phosphorylated (p44/42 ERK 112) MAPK in the dorso-Iateral amygdala following Pavlovian fear conditioning", SOCiety for Neuroscience Annual Meeting, New Orleans, LA

Professional Associations

American Association of Nurse Anesthetists (AANA); member

The Association of Military Surgeons of the United States (AMSUS); member

Intemational Anesthesia Research Society (lARS); member

TAB 14


LT Nicole A. Steele



September 13,2013

ME MORANDUM FOR BOARD OF REGENTS

Throueh: Charles L~. M.D., President

SUBJ:CT : cenXa\ion of Graduate Student

The graduate student li sted below is presented for certification to receive the Master of Science effeclive upon your approval:

LT Nicole Ann Steele

MASTER OF SCIENCE


Attached is the candidate's Dissertat ion Approval Fonn, certification of authorized use of copyrighted materials. Thesis Abstract. Thesis Title Page, and Curriculum Vitae.

n E. McManigle, M.D. Dean, USU, School of Medicine (Act ing)

Auachments: As stated

Prrnled m @ Recycilld Paper

UNIFORMED SERVICES UNI VERSITY, SCHOOL OF MEDICINE GRADUATE PROGRAMS Graduate Education Office fA 1045), 4301 Jones Bridge Road, Bethesda, MD 20814

September 24, 2012

APPROVAL SHEET

Title of Dissertat ion: " The Prevention of Pediatric Obesity During Pregnancy: A Pilot Study"

Name of Candidate: Nicole A. Steele, Master of Science in MedicalllDd Clinical Psychology,

September 6, 2012

THES IS AND ABSTRACT APPROVED:

DATE:

Marian Ta~fs - raff, DEPARTMENT OF MED CAL AND CLINICAL PSYCHOLOGY Thesis Advisor

~~ v?~d-DEPARTMENT OF MEDICAL AND CLIN ICAL PSYCHOLOGY

c=,fee Me~ ___ _

DEPARTMENT OF FAMILY MEDICINE Committee Member

Eleanor 5. Metcalf, Ph.D., Associate Dean II www.usuhs.mil/graded II [email protected] l Toll Free· 800-772.·1747 Commercial: 301-2.95·3913 / 9474 D5N: 2.95-9474 II Fax: 301-2.95-6772.

COPYRIGHT STATEMENT

The author hereby certi lies that the use of any copyrighted material in this thesis manuscript entitled:

"The Prevention of Pediatric Obes ity During Pregnancy: A Pilot Study"

"

beyond brief excerpts is with the pe rmission of the copyri ght owner, and will save and ho ld harmless the Uniformed Services University of the Health Sciences from any damage which may arise from such copyright violation.

~ Nicot. Steele Department of Medical and Cli nica l Psychology Uniformed Services University of the Health Sciences

Title of Thesis:

Author:

Thesis directed by:

ABSTRACT

The Prevention of Pediatric Obesity During Pregnancy: A

Pilot Study

Nicole A. Steele, M.P.H., B.S.

Marian Tanofsky~Kraff, Ph.D.

Associate Professor


III

American children arc becoming increasingly overweight. The prevalence of

childhood obesity has tripled in recent decades. Obesity during childhood places youth at

high risk for poor health outcomes as adults. Factors associated with the prenatal and early

infant envirorunent are some of the earliest predictors of excessive weight gain in children

that have been studied. Both excess and insufficient maternal prenatal weight gain have

been associated with adverse cardiometabolic outcomes in late childhood and adulthood.

Factors assoc iated with childhood weight gain include maternal weight gain during

pregnancy (either too much or too little), weight gain during the first 6 months oflife, and

parental feeding behaviors after birth. Indeed, pregnant women may 'program' their child 's

metabolism during the time that the child is a fetus . By targeting these early risk factors,

the prevalence of pediatric overweight may be reduced. First-time pregnant women (N = 8)

voluntarily participated in a 6-session counseling intervention designed to prevent pediatric

obesity. The intervention appeared to be feasible, acceptable to participants, and contribute

to healthy weight gain in women and healthy birth weight in infants.

THE PREVENTION OF PEDIATRIC OBESITY DURING PREGNANCY:

A PrLOT STUDY

by

LT Nicole A. Steele

M asters Thesis submitted lO the faculty of the


Graduate Program of the Uniformed Services University

of the Health Sciences in partial fulfillment

of the requirements for the degree of

Master of Science. 2013

iii

Address: Telephone: E-Mai l: Curren t Position: Military Statu s:

NICOLE ANN STEELE

10101 Grosvenor Place Unit 1617, North Bethesda, MD 20852 (760) 362-3323 Mobile [email protected] Clinical Psychology Intern Lieutenant, Medical Service Corps, United States Navy

Education

Year Degree Field Institution

2008- Master of Science Medical and Clinical Uniformed Services University of the Health 2011 Thesis : Prevention of Pediatric Psychology Sciences, Bethesda, MD

Obesity During Pregnancy

1999 Master of Public Health Health Services San Diego State University, Administration San Diego, CA

1996 Bachelor of Science Biology San Diego State University, (Cum Laude) San Diego, CA

Clinical Experience

Year

2011

2010

2009

Practica

Outpatient psychotherapy for military and civilian patients. Supervisor: Roderick Bacho, Ph.D.

Inpatient and outpatient psychotherapy for severe and persistent mental illness Supervisor: Donald Cassidy, Ph.D.

Outpatient intake interviews and reports . Supervisor: Kathryn Lindsey, Ph.D.

Location

Naval Health Clinic Annapolis, United States Naval Academy: Annapolis , MD

SI. Luke's House Community Mental Health Center, Department of Health and Human Services; Bethesda, MD

Outpatient Behavioral Health Clinic: National Naval Medical Center, Bethesda, MD

Research Experience

2008 -Present

Prevention of Pediatric Obesity - Uniformed Services University, Bethesda, MD Overseeing pilot clinical trial for prevention of pediatric obesity in pregnan t women and infants. Responsible for Uniformed Services University and National Military Medical Center IRB approval , overseeing and guiding the study counselors , and conducting counseling sessions with study participants. Responsible for educational tools for study participants and counselors . Presented poster on study results at Uniformed Services University Research Week 2011 . Article currently under submission to the Journal of American Board of Family Medicine: Steele, N., Stephens, M., Tanofsky-Kraff, M., "Prevention of Pediatric Overweight Using A Patien t Centered Medical Home Model." Study results to be presented at Uniformed Serv ices Academy of Family Physicians in 2012.

Volunteer Experience

2006 -2008

Volunteer Crisis Counselor - Morongo Basin Sexual Assault Services, Yucca Valley, CA Ca lifornia State Office of Emergency Services Certified Crisis Counselor. Provided crisis interven tion and educa tion for community members with anxiety , depression, panic disorders, eating disorders. and substance abuse and dependence.

2005-2008

NICOLE ANN STEELE

Casualty Assistance Calls Officer (CACO) • Naval Hospital Twentynine Palms, CA Mainta ined training to notify and provide counseling to family members experiencing death of service member. Established, coordinated , and managed the command Casually Assistance Calls Officer Watch bill. Ensured an adequate number and train ing of Casualty Ass istance Calls Officers for the command

2005-2006 Volunteer Victim Advocate - Naval Hospital Twentyn ine Palms, CA U. S. Navy Sexual Assault Victim Intervention (SAVI) Advocate.

2001-2007 Volunteer Instructor - American Red Cross, San Diego and Twentynine Palms. CA Provided didactic training and evaluation of skills performance. Trained, tested , and certified active duty and civilian adults on infant, child, and adult cardiopulmonary resuscitation techniques, automatic external defibrillator techniques , and first aid, crisis management, and workplace sa fety skills . Lectured, moderated class discussions, and demonstrated rescue techniques.

Military Experience

2007- 2008 Healthcare Operations Officer· Naval Hospital Twentynine Palms, CA

2007

Contributed to the development and improvement of the command's business practices. Prepared and presented recommendations and solutions by developing, analyzing, evaluating, advising on, and improving the effectiveness of work methods. Captured and analyzed utilization, capacity, and demand data to improve clinical operation of General Surgery, Orthopedic, Chiropractic, and Obstetrics service lines.

Command Fitness Leader - Naval Hospital Twentynine Palms, CA Successfully planned, managed, administered, and monitored continuity and integrity of Physical Fitness Assessment (PFA) for 400 members involved in 15 Spring Physical Readiness Tests (PRTs) (run and swim tests) and 18 Fall PRTs (run, swim, elliptical , and treadmill tests) . Achieved success rate at or above the Navy-wide PFA average of 96% {hospital average of 97% PFA success rate}. Implemented system of using one physician to screen medical waivers resulting in 60% decrease in number of full PRT medical waivers . Initiated, maintained, and monitored new swim component at command for Fitness Enhancement Program.

2006- 2007 Central Appointments Supervisor· Naval Hospital Twentynine Palms, CA Responsible for Central AppOintments management and supervision of staff and policy. Managed dai ly patient satisfaction issues involving telephone consults, phone systems, appointments, and staff. Directly supervised five civilian staff members involved in the first step in the process by which 100,000 Marines, Sailors, and family members go through to receive medical care . Successfu!ly implemented and provided oversight for installation of the Central AppOintments Microlog Telephony Software System in order to measure and track clerk workload and effectiveness of appointment booking.

2005- 2006 Manpower Division Officer - Naval Hospital Twentynine Palms, CA Responsible for overseeing administrative functions for 400 staff members throughout the hospital. Stream lined officer and enlisted performance evaluation process, resu lting in increased quality, accuracy, and timeliness of 258 reports . Involved in Enlisted Staffing Board , Awards Board, Performance Evaluation Board, and Position Management Committee.

,

TAB 15


Master of Public Health


4301 JONES BRIDGE ROAD BETHESDA. MARYLAND 20814-4799

September 20. 2013


Through: Charles L. ~.D .. President

SUBJECT: Certification of Expected Preventive Medicine and Biometrics Graduate

The graduate student. Maj William Washington, was approved to receive the degree Master of Public Health at the May 2013 Board of Regents meeting. This memo cenifies that Maj Washington met the requirements on September 5,2013:

J~~Z~ Dean, USU, School of Medicine (Acting)

Eleanor S. Metcalf, Ph.D ., Associate Dean II www.usuhs.mil/graded II [email protected]

Toll Free: 800-772·1747 II Commercial: 301-295-3913/9474 II OSN: 295-9474 II Fax: 301-295 -6772

Printed on @ Recycled Paper

TAB 16

Degree Granting: Graduate School of Nursing

Master of Science in Nursing

Nurse Anesthesia

UNIFOI~M~:D SERVICES UNIVERSITY OF THE HEALTH SCIENCES GRADUATE SCHOOL OF NURSING

4301 JONES BRIDGE ROA D BETHESDA, MARYLAND 2081+-4712

MEMORANDUM FOR BOARD OF REGENTS TL . THROUGH: PRESID ENT, USU J-I S ~~ ~ . ~ SUBJECT: Grndualing Nurse Anesthesia Students for 2013

September 20. 2013

The following Uniformed Serv ices Univers ity of the Healt h Sc ience Graduate School of Nursing students arc scheduled 10 complete their program ;n December 20 13. Requesllhat the Dean be authori zed 10 award the Master of Science in Nursing degree based 111)011 the successful completion of their req uirements. The 20 13 Nurse Anesthesia students arc listed be low:

, , Fi.-sl Name Rank Branch of Service Blanton Rachel MAl USA Carlson Johanna LT USN Cason Roger LT USN Duran Anthony LT USN Eason Danny LT USN Fol som Kenneth LCDR USN GaUircaux Sleven Capt USAF Holmes Elisabeth LT USN Keller Andy LT USN Kn ight-)ohnsol1 Capricc MAl USA Lang Ilenry LT USN Lum Andy LT USN Martinez Gissel1a LT USN Malclla Jr Thomas LT USN Moore Matthcw LT USN Nikolaus Aaron LT USN Philip-Cypricn Wcndyalinc LT USN Price Jacquelinc LT USN Radnkovic Marko LCDR USN Reeder Nicholas Capt USAF Rotrud. Sharman LT USN Schwartz Nathaniel LT USN St. Rose Tcisha Capt USAF Susz.:m Lauren LT USN Turner Nicolc Capl USAF

I Wienhotr Rodriguez

I USAf ~SPHS

LT Kristy Rodriguez will graduate on January 8, 2014. since she had an extension.

A~~P~ Dean and Professor Graduate School of Nursing

TAB 17

Faculty Appointments and Promotions: Postgraduate Dental College

UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES POSTGRADUATE DENTAL COLLEGE

7800 IH·10 West, Suite 220 San Antonio, Texas 78230

www.usuhs.mlllpdc

September 23,2013


SUBJECT: Faculty Appointments, Postgraduate Dental College

The attached is the recommendation made by the Postgraduate Dental College's Committee

on Appointments and Promotion at a meeting on September 4th, 2013. I recommend that you

approve this recommendation and forward it to the President of the University for further action.

Attachments

~~ Patrick D. Sculley, DDS, MA Executive Dean and Professor Postgraduate Dental College

Learning to Care for Those in Harm's Way

1

PROPOSED FACULTY RECOMMENDATIONS October 23, 2013

BOARD OF REGENTS

ACTION/CURRENT SCHOOL/NAME PROPOSED RANK DUTY STATION AIR FORCE POSTGRADUATE DENTAL SCHOOL KIRKPATRICK, Timothy Professor Promotion Col, USAF, DC Keesler AFB, MS WAJDOWICZ, Michael Professor Promotion Col, USAF, DC Keesler AFB, MS YACCINO, John Associate Professor Appointment Col, USAF, DC San Antonio, TX

TAB 18

Faculty Appointments and Promotions: Graduate School of Nursing

UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES GRADUATE SCHOOL OF NURSING

4301 JONES BRIDGE ROAD BETHESDA, MARYlAND 208' .... 799

_ .usuhs.mll

September 23, 2013


SUBJECT: Faculty Appointments

The Graduate School of Nursing Committee of Appointments, Promotion and Tenure made the attached recommendations. I recommend that you approve the recommendations and forward it to the President of the University for further action.

Attachment

V4~~ Ada Sue Hinshaw, Ph.D. , RN, FAAN Dean and Professor Graduate School of Nursi ng

GRADUATE SCHOOL OF NURSING FACULTY RECOMMENDATIONS October 23, 2013 BOARD OF REGENTS DEPARTMENT/ NAME PROPOSED RANK ACTION/CURRENT DUTY STATION GRADUATE SCHOOL OF NURSING OSBORNE, Lisa A. Associate Professor Promotion CDR, NC, USN (Tenure Ineligible Track) Bethesda, MD SPENCE, Dennis Adjunct Associate Professor Promotion CDR, NC, USN (Tenure Ineligible Track) San Diego, CA

*Indicates non-billeted

TAB 19

Faculty Appointments and Promotions: School of Medicine

OFFICE OF THE DEAN



hHp:fI_ .usuhS.mil

September 5, 20 13


SUBJECT: Faculty Appointments

The attached are recommendations made by the Committee of Appo intments. Promotion and Tenure at a meet ing on August 28, 20 13. J recommend that you approve these recommendat ions and forward them to the President of the University for further act ion.

Sincerely,

Attachments

Learning to Care for 1host! in Harm's ffily

1

PROPOSED FACULTY RECOMMENDATIONS October 23, 2013

BOARD OF REGENTS

ACTION/CURRENT DEPARTMENT/NAME PROPOSED RANK DUTY STATION BIOMEDICAL INFORMATICS CIMINO, James Professor* Appointment M.D. Bethesda, MD GIMBEL, Ronald Associate Professor Promotion Ph.D. (W/Tenure) USUHS EMERGING/INFECTIOUS DISEASES KNOLLMANN-RITSCHEL B. Professor Promotion CAPT, MC, USN (Secondary) USUHS MEDICINE TORRES, Dawn Associate Professor* Promotion MAJ, MC, USA WRNMMC PATHOLOGY KNOLLMANN-RITSCHELL, B. Professor Promotion CAPT, MC, USN (Primary) USUHS SUMMERS, Thomas Associate Professor* Promotion MAJ, MC, USA WRNMMC PEDIATRICS HOKE, Eileen Clinical Associate Professor* Promotion CDR, MC, USN San Diego, CA * Indicates non-billeted

2

PREVENTIVE MEDICINE/BIOMETRICS OTTO, Jean Adjunct Associate Professor* Promotion Dr.P.H. Silver Spring, MD SCHER, Ann Professor Promotion Ph.D. (W/Tenure) USUHS PSYCHIATRY GABBAY, Frances Research Associate Professor Promotion Ph.D. USUHS SURGERY BAILEY, Jeffrey Associate Professor* Appointment Col, USAF, MC San Antonio, TX BELMONT, Philip Professor* Promotion LTC, MC, USA El Paso, TX BITONTI, David Clinical Associate Professor* Appointment CAPT, DC, USN WRNMMC BOJESCUL, John Associate Professor* Promotion LTC, MC, USA Fort Gordon, GA CHO, Raymond Associate Professor* Promotion COL, MC, USA WRNMMC DAVIS, Michael Associate Professor* Appointment LtCol, USAF, MC San Antonio, TX LIM, Robert Associate Professor* Promotion LTC, MC, USA Honolulu, HI MATURO, Stephen Associate Professor* Promotion LtCol, USAF, MC Ft. Sam Houston, TX * Indicates non-billeted

3

OWENS, Brett Professor* Promotion LTC, MC, USA West Point, NY RUE, John-Paul Associate Professor* Promotion CDR, MC, USN Annapolis, MD WADE, David Clinical Professor* Promotion M.D. Washington, DC * Indicates non-billeted

TAB 20

President’s Report

October 2013

President’s Report

• Government shutdown

• Hiring freeze: continuing impact

• Enlisted to Medical Degree Preparatory Program status

• Alumni achievements

TAB 21

Executive Dean’s Report: Postgraduate Dental College

October 2013

Uniformed Services University of the Health Sciences Board of Regents

Board Brief

Submitted by: Patrick D. Sculley

Date: 20 Sept 2013

Title & Department: Executive Dean, Postgraduate Dental College (PDC); Sr. VP for University Programs (SVS)

Phone 210-292-3281

Purpose:

Information X

Action

Subject: PDC and USU Southern Office Update

Significant Issues:

1. The lease for the East Beach Bldg 2398, Ft. Sam Houston, Texas building has been signed and renovations are underway. The renovation is expected to take 90-120 days to complete. When a more concrete date of occupancy is set, a ribbon cutting ceremony will be planned. Dr. Sculley and Ms. Rebecca Patterson, Administrative Officer for the Southern Office, have worked with Insight Architects to select finishes for renovations and work stations at the new location. Anticipated occupancy per the renovation schedule is 1 December 2013.

2. The Keesler and Lackland Air Force Base Endodontics Programs have both come under the aegis of USU, matriculating their first students of the USU affiliated Master of Science in Oral Biology degree program on 1 July 2013. Dr. Sculley performed a site visit in July to the new Keesler programs.

3. Ms. Linda Licona, Internal Medicine Program Administrator, retired from USU after many years of service on 1 August 2013. The Internal Medicine clerkship program at San Antonio Military Medical Center (SAMMC) is currently seeking a means to fill her position.

4. On 8 August 2013, the SVS office had the pleasure of supporting a visit of Dr. Kellerman, incoming Dean of the School of Medicine.

5. Also on 8 August, Dr. Sculley participated via teleconference in a meeting of the Faculty Senate to provide an update on the status of the Medical Education and Training Campus (METC) affiliation.

October 2013

6. The St. Mary’s University Reserve Officers’ Training Corps (ROTC) Battalion invited Dr. Sculley to present a briefing on USU to their cadets on 14 August 2013. The briefing introduced the students to opportunities at USU upon graduation from their respective universities.

7. Dr. Sculley was honored to be the guest speaker at the Navy Dental Corps Birthday Ball in Bethesda, Maryland on 17 August 2013.

8. Dr. Sculley attended the 21 August 2013 meeting of the METC Board of Governors to provide an update on the completion of the subject matter expert report and the Board approval of exploring the concept of affiliation of USU and METC. Dr. Sculley had also provided a pre-brief to RADM William Roberts, METC Commandant, the previous day.

9. Members of the PDC were able to participate via video teleconference in a teacher training workshop held by the Henry M. Jackson Foundation in late August.

10. Dr. Sculley also provided a leadership seminar for students and a faculty development presentation at the Schofield Barracks Comprehensive Dentistry program on 15 and 16 September.

11. COL Priscilla Hamilton, Dean, Army PDS, and Dr. Sculley are working on the substantive change package for the Middle States Commission on Higher Education (METC) reflecting the proposed affiliation of the Ft. Gordon Endodontics, Periodontics, and Prosthodontics residency programs and will provide updates as they are available. We hope to bring these programs into the PDC for next academic year.

Current & Future Concerns: None Funding/Budget Estimate/Fiscal Impact: Lease at approximately $215,000 per annum. Staffing Impact: Need for replacement of Internal Medicine clerkship program administrator. Board Action Requested: For information only

TAB 22

Dean’s Report: Graduate School of Nursing

October 2013


Board Brief

Submitted by: Ada Sue Hinshaw, RN, PhD, FAAN

Date: Sept 23, 2013

Title & Department: Dean, Graduate School of Nursing

Phone 301-295-9004

Purpose:

Information X

Action

Subject: Dean’s Report: Graduate School of Nursing

• Significant Announcements

o October 29th, 2013 is the GSN 20th Anniversary and School Naming Ceremony The speaker for the naming of the school ceremony is

LTG Patricia Horoho, AN, USA, Surgeon General, US Army Draft agenda available (Attachment 1)

• Doctor of Nursing Practice (DNP) Update

o There are 74 students enrolled in the DNP programs. Class of 2015 has 21 students and the Class of 2016 has 53 students

o The conversion by service from Master of Science in Nursing (MSN) to DNP is on track (Attachment 2)

o One of the requirements for the DNP is student documentation of clinical scholarship in a portfolio. The portfolio includes student manuscripts, case studies, literature reviews and journals.

o The faculty designed an e-portfolio, using Sakai, for the student’s scholarly inquiry project (Capstone).

• Commission on Collegiate Nursing Education (CCNE) Site Visit 25 – 27 September 2013 to evaluate the DNP Program

• Jonas Scholarship project award o The Jonas Center has as its focus building the effectiveness of America’s

professional nurses by developing outstanding faculty, advancing scholarship and sparking innovative practice. The national grant award program is administered by the American Association of Colleges of Nursing.

o The GSN was invited to submit applications for awards for student DNP and PhD scholarly projects.

October 2013

• Faculty Announcements o Diane Padden, CRNP, PhD, FAANP, retired in September and joined the

American Association of Nurse Practitioners as Vice President, Policy and Education

o CAPT John Maye NC, USN, CRNA, PhD, returned to the CRNA program faculty after three years as Executive Director, Tri-Service Nursing Research Program

o MAJ Gregory Lara, AN, USA, joined the faculty of the Adult-Gerontology Clinical Nurse Specialist program

o CDR Lisa Osborne, NC, USN, PhD, CRNA, was promoted to Captain

• Student Announcements o LTC Ann Ketz, AN, USA received a funded Tri-Service Nursing Research

Program (TSNRP) Graduate Proposal award for her study: "Neuropathic Pain: Characterization and Modulation of the M1/M2 Monocyte Spectrum."

o Maj Rachelle Hartze, USAF, NC will receive the Association of Military Surgeons of the U.S. (AMSUS) Nursing Award at the 2013 AMSUS meeting in November.

o The PhD students will attend the Center for Advancement in Nursing Science, “ Innovative Approaches to Symptom Science: Measurement and Analysis,” meeting October 16, 201

• November 2013 Journal of Emergency Nursing

Attachment 1

Version #11 09/12/13

GSN 20th Anniversary 29 October 2013

Time Location Event 0700-0745 Flag Hallway Continental breakfast of Coffee and Bagels Sanford

Auditorium GRADUATE SCHOOL OF NURSING 20TH ANNIVERSARY CELEBRATION

0745-0800 National Anthem and Posting of the Colors 0800-0815 Opening Remarks

Dr Ada Sue Hinshaw, Dean GSN 0815-0830 Chair, Federal Service Nursing Chief Remarks

(TBD) 0830-0840 President, USU Remarks

Dr. Charles Rice 0840-0910 Distinguished Speaker

TBD 0910-0940 The Beginnings – Panel Discussion

Dr Pat DeLeon, Dr. Dale Smith 0940-1000 BREAK

1000-1050 The Growth of the GSN (10 minutes each) • Dr Diane Seibert – FNP Program • Dr Robert Hawkins – CRNA Program • Dr Linda Wanzer – Adult-Gerontology CNS Program • Dr Penny Pierce – PhD in Nursing Science Program • Dr Sean Convoy – Psychiatric- Mental Health NP Program

1050-1200 Looking to the Future for the GSN (15 min each) • Dr Marguerite Littleton-Kearney – Research within the GSN • Dr. Sandra Bibb – Growth and achievements of the Faculty • Dr Carol Romano – Transition to the DNP Program • Dr Ada Sue Hinshaw – The Future for the GSN

1200-1300 Lunch Break SENATOR INOUYE PROGRAM DEDICATION 1300-1305 Introduction of Activities and Recognition of Dignitaries 1305-1310 Introduction of Key Note Speaker – Dr Rice 1310-1340 Key Note Speaker:

LTG Patricia Horoho, Army Surgeon General 1340-1400 Service Corps Chief: Tribute to Sen. Inouye 1400-1500 Naming of GSN program:

• BOR, Congressional representatives and others TBD • Mrs Inouye and Ken Inouye • President Rice with Dean Hinshaw

1500-1530 Hallway Dedication (announced in Sanford Auditorium) 1530-1600 Closing Comments: Dean Ada Sue Hinshaw 1600-1615 Ribbon cutting for renamed Senator Inouye Graduate School of

Nursing 1600-1800 GSN Patio SOCIAL HOUR (HJF?)

Conversion by Service Plan 2012

Army Navy Air Force USPHS

2012 FNP & PMH PMH

2013 Nurse Anesthesia

Nurse Anesthesia

Nurse Anesthesia

Nurse Anesthesia

2014 FNP

2015 FNP & PMH

9/20/2013

Attachment 2

TAB 23

Dean’s Report: School of Medicine

October 2013


Board Brief

Submitted by: Art Kellermann, MD, MPH

Date: Sept. 20, 2013

Title & Department: Dean, School of Medicine

Phone 301-295-3016

Purpose:

Information X

Action

Subject: Dean’s Report: School of Medicine

Achievements • USU faculty assisted in the aftermath of the Navy Yard shootings (Attachment 1)

Within two hours of the onset of the Navy Yard shootings, USU’s Department of Psychiatry and its Center for the Study of Traumatic Stress (CSTS) established a subject matter expert team and provided support to the Navy Yard and various responding services. The Center rapidly created and distributed health educational materials for disaster responders, community leaders and victims of the emergency. Consultation was offered and accepted by key decision makers and responders within DoD, WRNMMC, Portsmouth and Washington DC. USU’s fact sheets were distributed to all organizations involved in the response, including the mental health consultants to the Surgeons General of each of the services, the office of the Assistant Secretary of Defense for Health Affairs (ASDHA), directors of all state mental health programs in the United States through their organization (NASMHPD); the membership of the American Psychological Association’s (APA) Division of Military Psychology, the National Defense University, and senior leaders in the Military District of Washington. The President of the APA included USU’s materials in his letter of condolence and offer of assistance. Members of USU’s CSTS, including RADM (Ret) Brian Flynn, USPHS, a Senior Scientist in CSTS, are a part of ongoing response team consultations convened by the District of Columbia’s Director of Disaster Mental Health Services. CDR Patcho Santiago, MC, USN (MD, MPH and graduate of Department of Psychiatry’s Disaster and Preventive Psychiatry Fellowship program) is leading the mental health response team for WRNMMC.

October 2013

• USU grad one of the first responders to the Navy Yard LCDR Mike Melia, MD, an emergency physician and recent USU graduate, performed heroically during the 16 Sept shootings at the Navy Yard. Dr. Melia happened to be nearby for a 0900 scheduled EMS meeting at JBAB and immediately responded to render assistance before the scene was secured. Dr. Melia was suited for this role, because he teaches tactical EMS, had his own tactical gear in the trunk of his car, and was talking by telephone with the Head of EMS at CNIC when the shooting started.

• USU a leader in developing control systems for robotic prostheses (Attachment 2) Researchers from USU, Walter Reed National Military Medical Center and the Alfred Mann Foundation are collaborating to evaluate the safety and effectiveness of the first ever implantation of electronic sensors within the residual limb of an amputee to control a robotic arm. Existing state-of-the-art technology utilizes electrodes that are placed on the skin of residual limbs, but are limited to only two sites of control, unnatural use of muscle contractions (e.g. contracting the forearm muscle to close the hand), and loss of good surface contact with the sensors in periods where the patient is sweating or using their prosthetic outside desk level activities. Implantable sensors offer much more reliability, higher fidelity signals, and naturally intuitive control of the prosthesis. In addition, they offer a 400% increase in the user’s control of a prosthesis by now allowing 8 sites of simultaneous control. A young marine who lost his right hand below the elbow as the result of a blast injury sustained in Afghanistan during his 5th combat deployment overseas became the first person in the world to ever receive this technology. The procedure was a success. All 8 implanted electrodes are providing excellent and reliable signals. The marine is currently participating in outpatient rehabilitation and exceeding expectations utilizing a state-of-the-art prosthesis that will need to be re-engineered to capitalize on the enhanced functions now possible through this implant technology. Dr. Paul Pasquina, Chair of Physical Medicine and Rehabilitation at USU, is currently working with DARPA and the AMF to identify a more advanced prosthetic arm for the marine to control. The study is FDA approved to recruit two additional subjects.

• USU’s “Enlisted to Medical Degree Preparatory Program (EMDP2)” moving ahead (Attachment 3)

EMDP2, USU’s pipeline program for enlisted service-members to gain admission to medical school, has made great strides. At the urging of USAF SG Tom Travis, a USU alumnus, the Air Force has fully committed to 5 billets for students to start in 2014, Army staffing processes have reached the level of the Office of the Secretary of the Army, and the Navy has recently made progress towards allocating billets to the program. Talks are currently underway exploring the expansion of the program to the Marines and the Coast Guard.

October 2013

• USU partnering with the National Library of Medicine for Biomedical Informatics: On May 1, 2013, President Charles Rice, MD and NLM Director Donald A.B. Lindberg, MD fully executed a formal Research and Education Partnership Agreement (REPA) for Biomedical Informatics. The REPA is a permissive document that encourages collaboration and sharing among scientists at both institutions. The Biomedical Informatics Department has acted on the REPA through ongoing research and will be proposing a new graduate degree program within 60 days.

• Curriculum reform update

“Molecules to Military Medicine (M2MM),” continues to progress. For example: o The 3rd class (Class of ’17) to start the new M2MM curriculum began formal

instruction on 26 Aug ’13 o The inaugural class (Class of ’15) is now approximately 2/3rds of the way through

their clerkship year and doing well; o The class of ’15 will have a dedicated, 4 week study block reserved for Step I

board preparation in Jan ’14; o Plans for the inaugural “roll-out” of the Bench to Bedside & Beyond (B3) segment

of the post-clerkship curriculum are proceeding well. B3 involves a series of 1-week “micro-modules” patterned after the pre-clerkship period & includes completion of ACLS & ATLS training. A segment on Integrative Medicine, with a “menu” of workshop selectives, will also be included. One of the more innovative approaches planned for B3 includes an immersive simulation experience at the Sim Center, involving an IED explosion.

• USU’s Master in Healthcare Administration and Policy degree program accepted for candidacy by the Commission on Accreditation Healthcare Management Education. This favorable decision means that the program will start its self-study year with the next entering class, and submit its application for full accreditation in 2015. This pace is well ahead of most new programs.

• USU medical students save lives During the past quarter, four (4) USU medical students in the class of 2016 provided lifesaving emergency care to patients in public settings. Navy Ensign Thomas Klotz witnessed a motorcycle accident on Route 50 in Maryland. He helped make sure the driver was stable and conscious until paramedics arrived on the scene. Navy Ensign Teresa Gilbride was swimming laps in the Olympic-sized pool at Naval Support Activity Bethesda when she noticed a man lying motionless at the bottom of the pool in the lane next to hers. She brought the man to the surface and administered CPR with another bystander until he regained consciousness. Navy Ensign John Hunt and Army 2LT Wells Weymouth were shopping at Sam's Club when an elderly man drove through the store's wall, injuring several bystanders in the process. The two students immediately triaged the wounded shoppers and quickly identified an elderly man who was bleeding to death because his leg was nearly severed in the crash. Using their uniform belts and the belts of bystanders as tourniquets they decreased blood loss until emergency personnel

October 2013

arrived. They will receive an award from the City of Gaithersburg (Md.) Police Department for their actions on Oct. 7. All four students had completed the School’s emergency medical skills course shortly before these incidents.

• USU research team scores major Gates Foundation “Grand Challenge” grant. This past spring, USU won a highly competitive Gates Foundation Grand Challenge grant for an in vitro culture of filarial worms. This one year award was given to less than 5% of applicants. The goal of the project is to develop in vitro culture methods to maintain filarial nematodes -- parasitic worms that cause diseases such as elephantiasis – a disabling and painful condition that afflicts millions of people worldwide.

Concerns:

• The major concerns of the SOM are the same as those of the university. They include the crippling effect of the hiring freeze and travel restrictions, the corrosive effects of the budget sequester, the looming prospect of a government shutdown, and the acute financial challenge to civilian students and staff furloughs.

Priorities:

• Our top priority is to support the University’s leadership as it seeks to address current and potential threats to the school’s mission and workforce. In addition, the SOM is pursuing the following short-to middle term priorities within the limits of its available resources:

o Education: Pursue curriculum reform (M2MM), enhance diversity (EMDP2), secure accreditation of the Healthcare Administration and Policy degree program and strengthen linkages with USU’s other major training sites, particularly SAMMC. We will soon begin the labor-intensive process of a self-study to prepare for reaccreditation of the SOM.

o Research: Sustain and grow the School’s portfolio of basic and clinical research focusing on issues of direct relevance to the DoD’s evolving mission. Explore the potential to create a new institutional focus on systems innovation to support a more effective and affordable MHS. Help the newly created DHA use its resources in the most efficient and effective way. Diversify and expand sources of extramural support for high impact research

o Service: Boost the School’s support, and thereby relevance to WRNMMC and other components of the MHS in the National Capitol Area; identify innovative strategies to recapture lost patient volume to sustain the MHS and reduce fiscal pressure on the DHA; develop a formal program to enhance the leadership skills of physicians and other healthcare providers in the MHS.

Good News

• Dr. Robert DeFraites, a member of USU’s Department of Preventive Medicine and Biometrics, will receive the 2013 William Gorgas Preventive Medicine Award from the Association of Military Surgeons of the United States (AMSUS) for exemplary work in

October 2013

preventive medicine, education and research. He’ll accept the award at AMSUS’ annual meeting in Seattle later this year.

• Dr. Norman Rich, professor and emeritus chair of the Department of Surgery, was presented with a Lifetime Achievement Award from the Society for Vascular Surgery for his exemplary leadership and professional practice.

• Dr. William Gilliland earned the Legion of Merit for his outstanding service to the nation. He was presented with the commendation by United States Congressman Chris Van Hollen.

• Dr. Paul Pasquina, chair of the Department of Physical Medicine and Rehabilitation, has been selected to receive the American Academy of Physical Medicine and Rehabilitation's Distinguished Clinician Award for 2013.

• Dr. Christopher Broder and his team are being awarded the 2013 Federal Laboratory Consortium (FLC) Award for Excellence in Technology Transfer for their work on developing a Hendra/Nipah vaccine and a human monoclonal antibody antiviral treatment. His Hendra virus research team is also receiving the Commonwealth Scientific and Industrial Research Organization (CSIRO) Chairman’s Medal for 2013 (to be announced October 14, 2013). CSIRO is Australia's national science agency, and this is their most prestigious award.

• Dr. Marian Tanofsky-Kraff, Associate Professor in the Department of Medical and Clinical Psychology is the 2012-2013 President of The Eating Disorders Research Society (EDRS). EDRS is an international organization whose members study anorexia nervosa, bulimia nervosa, binge-eating disorder and obesity.

• Dr. Mark Ettenhofer, Assistant Professor in the Department of Medical and Clinical Psychology, has received a $3.3M research grant from the DOD Telemedicine and Advanced Technology Research Center (TATRC) for his project entitled, “Integrated Eye Tracking and Neural Monitoring for Enhanced Assessment of TBI.” This four-year project will develop and validate advanced tools for assessing traumatic brain injuries using a combination of eye tracking, EEG, and fMRI.

• Cendrine Robinson, M.S., a doctoral student in the Department of Medical and Clinical Psychology who is working with Andrew Waters, Ph.D., Associate Professor of Medical and Clinical Psychology, has been awarded a American Lung Association research grant for her dissertation project entitled, " Smartphone Intervention to Reduce the Influence of Smoking Cues for Black Smokers" Compared to white smokers, black cigarette smokers have higher rates of lung cancer, lower rates of smoking cessation, and live in communities that have a disproportionately high number of tobacco advertisements. This proposal will explore the use of a Smartphone intervention to decrease exposure to smoking cues.

• COL Lisa Moores USA, Associate Dean (Acting), Office of Student Affairs, will present the Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture at CHEST 2013, the Annual Meeting of the American College of Chest Physicians.

• Lt Col Rechell Rodriguez USAF MC, Associate Professor of Medicine and USU clerkship director in San Antonio has been awarded the Air Force Medical Corps special experience identifier, “Academic Grand Master.”

October 2013

• Maj Temple Ratcliffe USAF MC has been awarded 2013 Lt Gen PK Carlton Award, as top AF educator for SAUSHEC, San Antonio.

• Professor Paul Hemmer (Col. [Ret.] USAF MC) is the 2013 recipient of 2013 Clerkship Directors in Internal Medicine Louis N. Pangaro Educational Program Development Award. Of dozens of awardees, Dr. Hemmer is only the second person in CDIM history to have won all three of its annual awards, including the Educational Research and Service awards.

• USU’s Alumni Association presents its first annual awards for career achievement On September 21, at the USU Alumni Association’s annual Alumni Day Dinner, the Association was proud to present its first annual USUAA Distinguished Alumni Awards. Dozens of outstanding nominations were received by the Awards Committee. The following recipients were selected to receive awards. All recipients were able to be present at the dinner receive their awards, and the alumni and University’s appreciation for their contributions to Military Medicine and the health of our Nation:

o 2013 USU Alumni Lifetime Achievement Award: Brooks D. Cash, MD, CAPT, MC, USN, Professor of Medicine and Associate Chair of Medicine for the Uniformed Services University; nationally recognized researcher and author

o 2013 USU Alumni Military Medicine Award: Rhonda L.S. Cornum, MD, PhD, BG, MC, USA (Ret) General officer, superior urological physician, professor, author, researcher, combat veteran and former prisoner of war

o 2013 USU Alumni School of Medicine Award: James R. Ficke, MD, COL, MC, USA; Chairman of the Department of Orthopaedics and Rehabilitation at the San Antonio Military Medical Center; -Nationally-recognized researcher and author, with over sixty publications in top-tier medical journals and textbooks on the treatment of battlefield orthopedic injuries, combat medical care, and extremity injuries.

o 2013 USU Alumni Graduate School of Medicine Award: Bruce A. Schoneboom, PhD, CRNA, COL, ANC, USA; Commander, US Army Medical Research Institute for Chemical Defense, the nation’s premier laboratory for medical countermeasure research and development.

o 2013 USU Graduate School of Nursing Award: Heather L. Johnson, DNP, LT COL, USAF (Ret), USU faculty member, course coordinator for 7 GSN courses and nationally recognized expert in the medical care of children during disasters and humanitarian operations.

October 2013

• Two USU alumni recently named Department Chairs at the Johns Hopkins School of Medicine Dr. Andrew Satin (class of 1986), who is a retired USAF Colonel and former chair of USU's Department of OB/GYN. He will be chair of the Gynecology/Obstetrics at JHU. His wife is Dr. Gail Seiken, class of 1986. She is a former AF nephrologist.

Dr. James Ficke (class of 1987), who is a retired USA Colonel and former head of the Department of Orthopaedics at BAMC. He will be chair of the Orthopaedics Department at JHU as well as JHU's Surgeon-in-Chief. His wife is Dr. Roberta Ficke, class of 1988. She is a former Army internist.

GRIEF LEADERSHIP: Leadership in the Wake of Tragedy

In a world where we learn about traumatic events quickly and suddenly through television, social media, or newspaper coverage, many people can be suddenly and deeply affected by grief over the loss of loved ones, friends or relatives. Both in government and in business, leaders play critical roles in the recovery of communities and individuals after disasters. Leaders identify the way forward, and hear and understand the present emotions and needs of their community. They communicate and reflect the community’s feelings and shared experience in order to lead the community in recovery. Understanding how people react to tragic events and the roles leaders play in recovery is critical to effective leadership. In the aftermath of traumatic events, many children and their parents, even those not living in close proximity to the event, want to hear guidance from their community’s leaders. In this acute phase, leaders must communicate effectively to people who have questions, seek reassurance, and want to take action. As shock and horror turn to sorrow and mourning, leaders are responsible for identifying the timing of when a community is ready for the next step forward and how best to speak the language of each community to help individuals, families, and care providers. Understanding Traumatic Grief People vary in their reactions to experiencing or learning about traumatic losses. Most will do fine over time, while for some the immediate reactions can last longer than normal and interfere with their return to their work and families. In the short term, many people experience transient, but powerful, grief symptoms. Early grief can include: ■ Waves of sadness ■ Intrusive images of the traumatic event and lost loved ones ■ Withdrawal from close relationships with family and friends ■ Avoidance of activities that are reminders of the event For some people, grief can be delayed. For others, grief may not ever be evident. Communicate Effectively with Your Community Worry and distress can spread within and among communities, resulting in rumors and distortion of the facts of the event. Therefore, special attention should be given to optimizing communication with members of your community and with those outside of your community. Formal and informal leaders can be role models for the importance of sharing grief, communicating hope, identifying facts, managing rumors and providing support to others as needs change over time.

Attachment 1

IMMEDIATE RESPONSE Be Visible -‐ Make Public Announcements and Appearances By providing useful and accurate information, leaders can re-‐establish a sense of safety and enhance the community’s trust in leadership. Provide Accurate, Timely Information on: What Is Known, What Is Not Known, and When More Information Will Be Communicated Press briefings, use of social media, and community meetings can reassure families and dispel rumors. Always say when more information will be available. Understand that People Process Information Differently in High Stress Situations Keep messages as simple as possible, repeat frequently, and emphasize positive messages (people tend to focus on negative information when stressed). Use Multiple Channels of Communication People seek information from multiple sources depending on culture, ethnicity, geography, community composition, and history. TV, newspapers, radio, ministers, teachers, firefighters, and local places of gathering (e.g. post office, grocery, PTA) provide channels for communication. Speak Calmly and Encourage Working Together Leaders promote calmness, empathy, optimism, a can-‐do attitude, and collective healing and recovery. Direct communication between parents and children is important. Return to school nearly always calms children but can be stressful for parents. MOVING AHEAD Know the Status of Existing and Available Resources Monitor emerging needs, and support fellow community leaders and structures (such as schools, health, public safety). Provide Policy and Guidance Without Micromanagement Provide support to workers and volunteers with a framework for organizing and communicating policy. Recognize you cannot be “at the front” everywhere and others must make the tactical decisions. Foster initiative and cooperation.

Attachment 1

Organize Memorial Services and Sites Recognizing the Diversity Within your Community Respect the desires and needs for families who have sustained losses. The timing of services is important. Attending Funerals Is Important Tears and grieving in public by leaders gives “permission” to others to express grief and humanizes unthinkable tragedies. Provide Common Goals for Future Direction RECOVERY Focus on Future Goals Reorient the community to future objectives, enhanced preparedness, and “we can do it.” Acknowledge those from Within and Outside the Community Who Want To and Do Help Establish a climate of healing and community support. Redirect energy into needed recovery projects and respectful remembering and rebuilding efforts. Avoid Blaming Blame directed towards groups or individuals leads to stigma, anger, and desire for retribution. Redirect energy to providing support and future needs. GROWING ■ Work to return community or business activities to normal, but tolerate if the recovery is slow. ■ Recovery takes time, is not linear, and is influenced by future events that are always unknown. ■ Set and celebrate achievable goals. ■ Community rituals provide an opportunity for individuals and families to heal and reflect on their experience in their own style. These can cross racial, cultural, and socioeconomic divides. ■ Beware of identifying a ‘we’ and ‘they.’ ■ Be alert to the “fault lines” such as racial or socioeconomic differences of the community. These tend to expand and become areas for conflict. ■ Expect community disappointment and anger after the initial sense of togetherness. Help the community understand the changing trajectory of recovery. ■ Take care of yourself. You need supporting staff, friends, family who remind you to rest and can objectively advise you about things you do not see or do not recognize the importance of. Keep your advisors informed and listen to their perspectives.

Attachment 1

ONLINE RESOURCES Center for the Study of Traumatic Stress www.cstsonline.org National Child Traumatic Stress Network www.ncstn.org American Academy of Child and Adolescent Psychiatry

www.aacap.org

American Academy of Pediatrics www.aap.org American Psychiatric Association www.psych.org American Psychological Association www.apa.org American Red Cross www.redcross.org

Center for the Study of Traumatic Stress Uniformed Services University of the Health Sciences 4301 Jones Bridge Road, Bethesda, MD 20814-‐4799

Tel: 301-‐295-‐2470 | Fax: 301-‐319-‐6965 www.usuhs.mil/csts | www.CSTSonline.org

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Managing a Workplace or an Organization after Disaster Workplace disasters, such as a shooting or other act of personal violence, create unusual challenges for management. You and your staff may find yourselves suffering from its effects. Emotional stress, physical injury, grief, and disruption of normal routines may limit the availability and energy of your work group. At the same time, the group may face new responsibilities — caring for its own members and facilitating community recovery. Besides meeting customers' special needs for assistance following a disaster, personnel may have other unique requirements and stressors. Much of the human suffering associated with a disaster happens after the event itself, and can be mitigated by effective management. The following can help you structure your response.

Take care of your people first. First locate your staff and assure that they and their families have necessary medical care and other necessities so they can be effective in the workplace. This task will be easier if you have planned for it in advance. Modify office rules and procedures that are counterproductive after a disaster. Dress codes, rules about children in the office, and restrictions on using telephones for personal business, for example, may need to be adjusted in the post-‐disaster period. Take steps to prevent accidents and illness. Review the workplace for physical risks recognizing that attention and energy will be less than usual. Reinstate training for emergency response and communications for help. People who are exhausted often forget to take necessary steps to prevent injury and illness. Reminders and retraining can be valuable. Prevent overwork and exhaustion. After an initial crisis period during which overwork may be necessary, develop procedures to assure that employees do not work too many hours without rest. It is particularly important to prevent the overwork and exhaustion that can occur as people throw themselves into disaster recovery operations, because exhaustion raises the risk of accidents in the already dangerous post-‐disaster environment. Exhaustion and lack of sleep can decrease alertness, impair judgment, and make people more vulnerable to accidents. Establish work and rest times. Rest is best when it is away from work unless safety at work is greater. Attempt to provide adequate staffing for all new responsibilities created after the disaster, and for usual responsibilities that become more demanding as a result of the disaster. Prior planning and cross-‐training can make a big difference. Set clear priorities, including identifying work that simply will not be done in the short term. Be sure that no employee has an essential task that no one else knows how to do, or that person will surely be overworked. Train managers to monitor their subordinates. Ensure that personnel are not working excessive hours, and check for signs of exhaustion. In stressful times, leaders and highly dedicated employees are more likely to overwork than other personnel. It may seem ironic but, after a disaster, senior leaders need to pay more attention to the conscientious individuals who normally need the least

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supervisory attention. Point out to subordinate leaders that they need to model healthy behaviors; this will help them monitor their own tendencies to overwork. Encourage and facilitate healthy, safe behavior. Remind employees of the importance of getting adequate sleep and rest, drinking enough water, and taking whatever precautions are necessary in the environment. Avoid unnecessary travel. When travel is necessary, try to organize carpools with a well-‐rested driver who knows the area rather than sending each employee off alone. Consider alternative work arrangements that can reduce the time employees spend commuting. Most people are resilient and will recover from their traumatic experiences. To facilitate the recovery process, survivors of disasters often need to talk about what they have gone through, compare their reactions with those of others, exchange information, and provide one another with support and consolation. The most effective way is usually to make it easy for people do it when they feel ready, not to pressure them to talk about the traumatic situation at a time when they feel the need to be silent. Provide an informal break area where employees can gather for snacks or lunch and spend a little time talking with their co-‐workers. Whenever possible, try to keep existing work groups together to build on the strength of existing ties among co-‐workers. If an employee must be deployed alone or with strangers, find a way for them to communicate with the larger organization, get information about how their co-‐workers are faring, and be assured they are still part of the group. Visits by management to the site of deployment can help improve morale. If you have a mental health caregiver such as an employee assistance professional (EAP), make that person available in an informal way to talk with employees where they work. Most people will not need extensive personal counseling, but will appreciate information and advice about issues such as how to deal with their children’s reactions to the disaster. A few people may need more extensive mental health assistance. EAPs are traditionally well informed and resourceful about locating professional care for those who need it.



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Recovery in the Aftermath of Workplace Violence: Guidance for Workers

Returning to work routines following any violent incident at the workplace can be very

challenging. Even after the work area is secured, and victims or perpetrators are no longer present, emotional reactions and distress may reduce concentration, motivation, and performance. However, there are steps you can take to reduce the negative impact of your traumatic experience.

The first requirement for individual and office recovery after violence is assuring safety. You should know that victims, intended victims, colleagues and bystanders may experience significant emotional distress whether or not they were physically injured. People closest to the event or those with close relationships to the victim(s) or perpetrator(s) will likely be most affected. For the majority of people the cornerstone of emotional recovery is talk. You can help yourself and your colleagues by talking with them. When you demonstrate your willingness to discuss the event and your own emotions you help others do so. Some people will not want to participate in group discussions.

If you are very uncomfortable in group settings it is important to be able to speak one-‐to-‐one to a supervisor. After workplace violence many supervisors have an “open door policy” to allow this to happen. Since a sense of “normalcy” and a return to normal work schedules and routines helps most people adjust after violence, your supervisors will encourage this. A sense of normalcy occurs gradually. The more traumatic and dramatic the event, the more likely that people will be emotionally affected, and these memories and reactions will only gradually fade. Most people move on to integrate a tragedy or otherwise significant event into their consciousness without continuing mental distress or disability. The actions below will help you develop a sense of safety and speed return to normalcy.

Immediately after the event, make sure that: ■ All employees or others at the workplace are accounted for. ■ Medical attention has been received or ordered for all who need it. ■ You have a way to contact family and friends. ■ Others who are distressed have someone to look out for them. As soon as possible after the event, Returning to work routines following any violent incident at the workplace can be very challenging. ■ Help clarify what actually occurred and provide accurate information. Help supervisors discuss: ■ What is known about the event? ■ Who was the victim? ■ Who was the perpetrator? ■ How did the incident happen? ■ Why did the incident happen?

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Before you leave work on the day of the incident, make sure your questions have been answered about what is known and further instructions. Try to provide as much information as you can about what occurred. When you go home: ■ Limit your use of alcohol, tobacco, and junk food to usual levels. ■ Drink water. ■ Limit unnecessary driving. ■ Talk to your family and friends about what happened. ■ Sleep and rest. ■ Exercise can also help reduce distress. Days following the event: If you are close to someone has been killed or injured in the event a hospital visit with family members may be helpful to you and the family. If a friend or loved was killed or injured, or if you were directly exposed to the violence, you may experience strong emotions, difficulty concentrating, or hopeless thoughts. It is important to talk with a counselor or seek medical attention if these symptoms persist. If your workplace is closed due to damage or an ongoing investigation your employer should provide instructions about alternative meeting places to discuss events and to keep work flowing. Returning to work is important to recovery, and work routines contribute to the sense of normalcy. When your work group meets again, your supervisor will probably review what was known at the time, review security and safety procedures, and update you on new developments. Listen to others who were present during the incident to get a full perspective. Feel free to provide input and answer questions but do not be afraid to say “I don’t know.” If there are legal (privacy) issues, you should be informed about limits on what you can talk about. Meetings should be short. If more discussion seems necessary, additional meeting times will be scheduled. Talk to your supervisor about attendance at funerals or memorial services. These may be difficult—but also helpful. Advice for workers who must continue to function following an incident: ■ Try to pace yourself and pace your decisions. ■ Consider different courses of action. ■ Avoid snap decisions that may have to be changed). ■ Take breaks when possible and relax ways that helped in the past. Exercise helps. ■ Rest and relax off of your feet when there are opportunities. ■ Identify a trusted co-‐worker to bounce ideas off, serve as a buddy and look out for after you. ■ If you must continue to work immediately after workplace violence limiting alcohol and tobacco use, excessive junk food, and unnecessary driving are particularly important. ■ Do not overwork. Trust others to help and get the job done.



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Attachment 2

Title: A Feasibility Study to Assess Safety and Functionality of Implantable Myoelectric Sensors for Upper Extremity Prosthetic Control in Transradial Amputees

Summary: Researchers from the Uniformed Services University, Walter Reed National Military Medical Center and the Alfred Mann Foundation are collaborating to evaluate the safety and effectiveness of the first ever implantation of electronic sensors within the residual limb of an amputee to control a robotic arm. Existing state-of-the-art technology utilizes electrodes that are placed on the skin of residual limbs, but are limited to only two sites of control, unnatural use of muscle contractions (e.g. contracting the forearm muscle to close the hand), and loss of good surface contact with the sensors in periods where the patient is sweating or using their prosthetic outside desk level activities. Implantable sensors offer much more reliability, higher fidelity signals, and naturally intuitive control of the prosthesis. In addition, they offer a 400% increase in the user’s control of a prosthesis by now allowing 8 sites of simultaneous control.

A young marine, who lost his right hand below the elbow and the vision from his left eye, as the result of a blast injury during his 5th combat deployment overseas (3 to Iraq, 2 to Afghanistan), while performing his duties as an Explosive Ordnance Disposal (EOD) specialist in Afghanistan, became the first person in the world to ever receive this technology. Placement of the electrodes was conducted two months ago under an FDA approved protocol. The procedure went without complications and all 8 implanted electrodes are providing excellent and reliable signals. The marine is currently participating in outpatient rehabilitation and exceeding expectations utilizing a state-of-the-art prosthesis that need to be re-engineered to provide enhanced functions now possible through this implant technology. Dr. Pasquina (Principle Investigator at USU and WRNMMC) is currently working with DARPA and the AMF to identify an even more advanced prosthetic arm for this marine to control. The study is FDA approved to recruit an additional two subjects to test this technology.

Attachment 3 Enlisted to Medical Degree Preparatory Program (EMDP2) Update

Summary:

The Enlisted to Medical Degree Preparatory Program (EMDP2) is a partnership between the Uniformed Services University (USU) and the Armed Services to provide a new opportunity for highly-motivated, academically promising enlisted service members to complete the necessary coursework to meet the requirements for application to medical school while remaining on active duty.

EMDP2 is part of a comprehensive plan that supports the USU strategic objective to promote student diversity by increasing matriculation from among the ranks of Armed Forces enlisted members.

Program Timeline:

• Now - Jan 2014: Services screen and select candidates • Jan - Feb 2014: USU select/notify candidates via Services • July 2014: Candidates report to USU to in-process and begin program

Status of Resources/Service Commitments:

Funding:

• EMDP2 continues to move through the Program Operating Memorandum (POM) process and was approved at the ASD-HA level for inclusion in the FY 2015-2019 POM ($9.2M)

• First year of the Program will be funded with FY 2014 funds - $676K

Service Commitments:

• Air Force: Five Candidates/cycle (confirmed) o Program Announcement - published

http://www.af.mil/News/ArticleDisplay/tabid/223/Article/466826/enlisted-airmen-may-be-eligible-for-medical-prep-school.aspx

o Candidate vetting process - ongoing o Selection panel - December 2013

• Army: Seven Candidates/cycle (pending)

o Program awaiting final signature from Sec Army o Program Announcement - pending

• Navy: Training Billets Identified (# candidates TBD)

o Program of Record TBD

• Discussions underway to possibly expand program to Coast Guard and Marines

Academic Partner/Contracting:

• Acquisition plan submitted to USU contracting – being coordinated with TMA • Accredited post-baccalaureate degree granting institution TBD NLT Feb 2014



TAB 24

Dean’s Report: School of Medicine

School of Medicine Graduate Programs

October 2013


Board Brief

Submitted by: Eleanor S. Metcalf

Date: Sept. 12, 2013

Title & Department: Associate Dean SOM Graduate Programs

Phone 295-1104

Purpose:

Information x

Action

Subject: SOM Graduate Ed Program Matriculants for 2013-14

Significant Issues: New Students. The 2013-2014 academic year for the USU School of Medicine (SOM) Graduate Programs has begun, and both military officers and civilian master’s and doctoral students are immersed in their rigorous academic schedules. The three Interdisciplinary Programs: Emerging Infectious Disease (EID), Molecular and Cell Biology (MCB), and Neuroscience (NES) have 19 new doctoral students, all of whom are currently taking courses and doing laboratory rotations. Only one M.D./Ph.D. student joined our SOM Graduate Programs this year; and she will enter the NES Program when she begins her doctoral studies. The SOM Graduate Programs also has two departmental programs. The Department of Medical and Clinical Psychology Graduate Program has two clinical degree tracks: the clinical track for active duty military officers (CPS) and the clinical track for civilians (MCP). A third track (medical) is a laboratory-based basic research degree and is primarily for civilians (MPS). This year, a total of 11 new students matriculated in the department’s graduate program: 6 in CPS and 5 in MCP/MPS. The other major department that offers graduate degrees is Preventive Medicine (PMB). The three doctoral programs in PMB matriculated new students: Ph.D. Medical Zoology, 0; Ph.D. Environmental Health Science, 1; and the Dr.PH, 2. In addition, PMB offers four master’s degrees and new students matriculated in each program: Master of Public Health (25); Master of Science in Public Health (6); Master of Tropical Medicine and Hygiene (2), and Master of Health Administration and Policy (9). In summary, 76 new graduate students were enrolled in and have begun our SOM Graduate Programs. Of this total, 51 (67%) are military officers. Current & Future Concerns: To accommodate the increase in the size of the SOM graduates student cohort, the Graduate Education Office needs additional personnel. To adequately process the increase in the number of applications, as well as the attendant paperwork and the increase in regulatory and reporting requirements, we could effectively add one additional staff person. Also the Associate Dean of

October 2013

Graduate Education (ADGE), has no professional personnel on her staff, and thus the ADGE has no back up or help which would facilitate her ability to complete her responsibilities efficiently. Thus a second professional in the office at the Assistant Dean level, would enable the Office of Graduate Education to be more effective supporters of the SOM graduate student cohort. The current situation is compounded by the newest task assigned to the offices that oversee the University student cohorts [in response to concerns raised by the Middle States Commission on Higher Education (MSCHE)]. This project involves the development of a long-needed formal student record system for the University. The man-hours required for each student-centric office to develop their part of the system is overwhelming for the GEO which currently oversees all the activities normally associated with multiple offices within a university. As mentioned previously, GEO also would like to consolidate the offices of the main GEO staff but such a consolidation would require additional office space adjacent to the current office and would require the relocation of a couple of offices in the Deptartment of PMB. Funding/Budget Estimate/Fiscal Impact: Funds to support 2 new hires. Staffing Impact: See above Board Action Requested: Support for those actions requested above to ensure continued normal functioning of the GEO during these complex times within the University.

TAB 25

Armed Forces Radiobiology Research Institute

October 2013

Uniformed Services University of the Health Sciences

Board of Regents

Board Brief Submitted by: Col L. Andrew Huff, USAF, MC, SFS

Date: 20 Sep 2013

Title & Department: Director, AFRRI

Phone 301-295-1210

Purpose:

Information X

Action

Subject: Director’s Report for AFRRI

Academic shift at AFRRI:

1. Due to uncertainty over basic research funding within DOD, we have paused further planning and development of a radiobiology doctoral track collaboration with the School of Medicine.

2. Radiobiology researchers within USU: a. Vijay Singh, PhD (Associate Professor, and Acting Chair, Radiation Biology

Department). Dr. Singh is the only faculty with a primary tenure track appointment in Radiation Biology.

b. LT Joshua Swift, Assistant Professor c. Lt Col (Dr) William Skinner, Assistant Professor d. Sanchita Ghosh, PhD, Assistant Professor e. John Kalinich, PhD, Assistant Professor f. Juliann Kiang, PhD, Professor g. Alexandra Miller, PhD, Assistant Professor h. Maria Moroni, PhD, Assistant Professor

3. Institute of Medicine review of AFRRI research portfolio, knowledge gaps in radiobiology research, analysis of needs of low-level/late effects: results of study pending

Scientific Advisor named: Mark Whitnall, PhD

1. Advise Director on scientific research; quarterly reports 2. Oversee research quality and direction 3. Enhance collaborations within AFRRI’s research areas; between AFRRI and the SOM, between

AFRRI and outside organizations 4. Organize team efforts around large projects to gain unity of effort when needed

Facility modernization/renovation (major):

1. Completed in FY13 a. LINAC/CT areas b. Small Animal Radiation Research Platform area c. Radiation physics lab

October 2013

d. Combined injury open lab e. Three other general purpose labs

2. Nearing completion a. AFRRI main conference room b. Main lobby and security operations center c. Eleven laboratories

3. Projects for FY14 a. Repair damaged roof for CT facility b. Expand veterinary support space c. Physical security upgrades (software, cameras, exterior lighting) d. Add shielding for cesium-137 lab e. Renovate nine laboratories

Veterinary sciences:

1. Training and continuity in a complex setting a. Military staff and changeover b. Technicians on protocols

2. Institutional Animal Care and Use Committee a. Training the Chair (frequent changes)

Military Medical Operations: new Head – COL Neil Page, MC, USA

1. Medical Effects of Ionizing Radiation a. 24 courses in FY13 (vs 23 in FY12) b. 817 students in FY13 (vs 625 in FY12) c. Increased interest as non-governmental CME opportunities/travel declined

2. Medical Radiobiology Advisor Teams – 2 teams expandable to 4 a. Consist of health physicist and physician b. Deployable subject matter experts with reachback to AFRRI

Radiation sciences: providing radiation sources, precise measurement of dose delivered (dosimetry), radiation safety program, and training.

1. Small Animal Radiation Research Platform (SARRP) a. Reinforcement of wall between SARRP and Cs-137 calibration lab b. May delay availability until March 2014

2. Linear Accelerator/CT facility a. Damage to ceiling while underground cable being placed outside b. Affected CT room and network for the LINAC c. Awaiting final design/construction plan, which will provide a rough timeline for

completion 3. Control console replacement for research reactor (TRIGA) and cobalt irradiator 4. Cobalt refueling: irradiator and low level facility; spent fuel will remain 5. Ongoing Nuclear Regulatory Agency activities

a. Relicensing the Training, Research, Isotope General Atomics reactor b. Broad scope license (radionuclides at AFRRI) c. Cobalt facility

6. Recaptured parking/block parking closest to facility; still technically in violation

October 2013

Scientific research: 1. Move AFRRI radiation countermeasures into advanced development and through FDA

certification 2. Current countermeasure candidates causing a 25% increase in the radiation dose required to

cause lethality would be significant after a nuclear detonation: possibly tens of thousands of lives saved

3. Refining biodosimetry to easily and quickly triage thousands 4. Polymers to get internalized radionuclides out of the body 5. Collaborations with over ten researchers at the SOM; one at the GSN

Good Laboratory Practices (GLP) Program:

1. Biomedical Advanced Research and Development Authority (BARDA) 2. Veterinary facility (including tissue lab) 3. Cobalt irradiator 4. Small research protocol slated for March 2014 5. Successful audits

Recent accomplishments:

1. Minipig established as Acute Radiation Syndrome model for countermeasure testing: embraced by NIAID and BARDA. DARPA interested

2. Panel of biomarkers identified with good sensitivity and specificity for assessing radiation exposure

3. Ciprofloxacin appears promising as a countermeasure for combined injury 4. Low dose-rate research initiated, collaboration with NASA

TAB 26

USU Inspector General

October 2013


Board Brief

Submitted by: Stephen Henske

Date: Sept 20, 2013

Title & Department: University Inspector General

Phone 301-295-3681

Purpose:

Information X

Action: None

Subject: Quarterly Report

Significant Issues: July 2013 – September 2013 President’s Open Door update: Four Inquiries:

• Concerns about a comment an employee made (1) • Concerns about a rumor of a student contracting Ebola at a USU lab (1) • A USU spending expense during the furlough (1) • Department visual and access availability to assist students (1)

Current & Future Concerns: June 2012 – An employee of the University filed a complaint with the DoD Inspector General’s office alleging a violation of the Whistleblower Act. DoD IG launched an investigation through the Tricare Management office (TMA) and the Assistant Secretary of Defense for Health Affairs (HA). On site interviews conducted in December 2012 and were reported back through HA channels to the DoD IG. As of June 25, 2013, the DoD IG advises the USU Office of General Counsel (OGC) that the investigation is not closed. No estimated date for closure was provided. As of September 20, 2013 no additional information or update has been received from the DoD IG. Remains open at DoD IG level. April 2013 - WRNMMC Command Investigation into allegations of reprisal, unfair treatment and hostile work environment against the Director of the Radiology Department at WRNMMC. USU tangentially involved as the Director is an employee of USU. USU supported the investigation in allowing investigating officer to review our selection and hiring process and documents. To date, no additional support has been requested. Open at the TMA/DoD IG level. Funding/Budget Estimate/Fiscal Impact: None Staffing Impact: None Board Action Requested: None

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