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VA to fund first national center of excellence for Veteran and caregiver research

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Today the U.S. Department of Veterans Affairs (VA) announced it will fund a new center of excellence to expand the department’s capacity to deliver innovative, data-driven and integrated approaches to improve services for Veterans and their caregivers.

Managed by VA’s Office of Health Services Research & Development (HSR&D), the first of its kind center will be named for Sen. Elizabeth Dole in recognition of her national leadership and advocacy on behalf of the nation’s 5.5 million military and Veteran caregivers, and her support for the landmark RAND Corp. research on their challenges.

The Elizabeth Dole Center of Excellence for Veteran and Caregiver Research will serve as the model for excellence in peer-reviewed research on innovation, training, evaluation, implementation and the dissemination and adoption of best practices in supporting the caregivers of Veterans across VA, the federal government and private and nonprofit sectors.

“Given Senator Elizabeth Dole’s significant impact on, and dedication to, military and Veteran caregivers, it is only fitting that VA names this center of excellence in her honor,” said VA Secretary Robert Wilkie. “The creation of the Elizabeth Dole Center of Excellence for Veteran and Caregiver Research is a firm example of VA’s ongoing commitment to improving services and outcomes for the families, friends and neighbors who tirelessly care for our nation’s Veterans.”

The center of excellence consists of a multidisciplinary team that takes advantage of HSR&D’s virtual network of nationally recognized VA investigators and their university affiliates to ensure that their state-of-the-art research will have the greatest possible impact on Veterans and the caregivers who support them. The team of VA investigators will be led by Dr. Luci Leykum of the South Texas Veterans Health Care System.


Amputees in High Heels: VA Research Zeroes in on Quality of Life

Amputees in High Heels


Researchers from the Department of Veterans Affairs have played roles in a number of scientific and medical breakthroughs that have had a profound impact on modern life: the liver transplant, the nicotine patch and artificial lungs, to name just three.

And now, as they seek to meet the needs of an increasingly diverse population of wounded and disabled Veterans from the current era of war, VA design experts say they're going beyond barebones medical needs and aiming to help Vets live more comfortably, with technology adapted to their lifestyle and interests. It's work that requires them to listen to Veterans more closely and involve them and their feedback in the development process to a greater extent than ever before.

One example of this work can be seen at the Office of Research and Development of the Department of Veterans Affairs, where they've come up with a 3D-printed ankle and foot device for a prosthetic leg to give amputees adjustable heels.

Thanks to this research, stilettos are no longer out of the question for Veteran amputees. Outside researchers at Johns Hopkins University and elsewhere have developed similar devices, but Dr. Andrew Hansen of the Minneapolis VA Healthcare System said the VA's "Shape & Roll" prosthetic foot is unisex.

"This study focused on high heels, but the results work just as well for cowboy boots," Hansen said in a VA release.

The adjustable-heel prosthetic was an example of VA's commitment to research in areas that haven't been pursued by the private sector, said Dr. Rachel Ramoni, the VA's chief research and development officer.

"Actually, there's a couple of things going on with 3D printing; you can print a foot for every type of shoe," Ramoni told

The foot-ankle prosthetic also demonstrates a willingness at the VA to take feedback from wounded and disabled Veterans themselves on what they need to accommodate the lifestyles they wish to return to or pursue, she said.

Ramoni also cited current research into upper-arm prosthetics for women as an example of this work.

"That's a small segment of the population; it's a small market," Ramoni said. "It's not an area where somebody would say 'Well, it's an obvious money making opportunity.' So it might not be good business, but it's the right thing to do."

The other challenge with research on upper-arm prosthetics for women is that so little work has been done in the field previously, Ramoni said.

"The sizing of the prosthetic is a big deal," she said, and "we don't know about women's upper arm satisfaction, because all of the surveys were designed for men."

The work on adjustable heels and the upper-arm prosthetic research are among more than 2,000 projects involving 3,400 researchers now underway at the Office of Research and Development. ORD operates on a budget of about $722 million from the VA, supplemented by contributions from the National Institutes of Health, the Department of Defense and others, for a total of about $1.5 billion, Ramoni said.

The money is being spent with a new emphasis on listening to Vets regarding where they want the research to go, Ramoni said.

A Disabled Vet Tackles Design

Dr. Rory Cooper was an Army sergeant in Germany in 1980 when he lost the use of his legs from spinal cord injuries in a bicycle accident.

He now is a director and senior research career scientist for the Human Engineering Research Laboratories, a VA Rehabilitation Research and Development Center and home of the VA Technology Transfer Assistance Program.

Cooper is also a Paralyzed Veterans of America distinguished professor at the University of Pittsburgh. As such, he is an advocate for what leaders in his field call "participatory action engineering," or, more simply put, listening to the people you're trying to help.

Cooper said his frustration with the ivory-tower approach to human engineering grew out of his own experience trying to get a better wheelchair.

"I was trying to solve some of my own problems," he said of his approach to design research. He found that he and other Veterans often were in "isolation" from the researchers.

Cooper said that surveys and talking to the Veterans themselves are "ways to initiate the design process, rather than having somebody sitting at their desk or surfing their computer, trying to understand what you want."

Designers and researchers should "start by asking [the Veterans] ... to prioritize," Cooper said.

He said his current research was focused on robotics, artificial intelligence and what he called "adaptive reconditioning technology" to help Veterans participate in sports and recreation.

One such example: a robotic bed. One of the little-known everyday problems for disabled Veterans, and their caregivers, is getting in and out bed, Cooper said.

"If you don't have the use of your arms or legs, or you're weakened, that's a huge problem," he said.

The bed is currently a work in progress, but Cooper said the initial thought was to have a "chair-into-bed kind of a docking system, and the chair kind of puts you into the bed while a conveyer pulls you into the bed."

A Secret Weapon: Veterans

The VA has a major advantage over the teaching hospitals and the private sector in conducting wide-ranging tests and surveys that require huge numbers of volunteers, said Ramoni, the VA's chief research officer.

"Veterans are absolutely core to our program," she said. "Our program is able to make these discoveries because of the thousands of VA patients volunteering here," and "what we do is driven by their needs."

Outside researchers, she said, often ask how they can learn from current VA practices and how VA scientists get so many people involved in the development process.

"We say what we have is not something you can learn; that you have a population of Veterans who want to continue to serve their fellow Veterans and the entire nation by participating in these studies," Ramoni said. "It's just amazing to me how committed Veterans are to continuing to serve and continuing to make discoveries that will help everybody."

The Next Big Breakthrough

Ramoni noted that VA's ongoing Million Veteran Program (MVP) on genome research has now enrolled more than 670,000 Veteran volunteers, to make it by far the world's largest genome database.

In the program, begun in 2011, participants donate blood, from which DNA is extracted. Then a baseline and periodic follow-up surveys track the Veterans' military careers, and their health and lifestyles.

The research seeks to determine whether the genetic information in the database could hold keys to preventing and treating diseases.

"We believe MVP will accelerate our understanding of disease detection, progression, prevention and treatment by combining this rich clinical, environmental and genomic data," former VA Secretary Dr. David Shulkin said.

The MVP research opened the possibility for determining whether genetic factors were contributors to PTSD and Gulf War illness, Ramoni said.

Many Veterans shared the same experiences in the same places in combat, and others were in the same places in the Gulf War; some developed PTSD and Gulf War illness, others didn't, Ramoni said.

"The question we all ask is, why is that? Are there genetic markers for PTSD susceptibility, or are there genetic markers for Gulf War illness? Genes might help reveal that," she said.


#veterans #military #amputees #womenvets

Proposing a new framework for clinical trials recruitment

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Recruiting for clinical trials can present many challenges for researchers. For this reason and others, the Clinical Trials Transformation Initiative (CTTI) was created to "develop and drive adoption of practices that will increase the quality and efficiency of clinical trials." CTTI comprises more than 80 member organizations, coming from government, private industry, professional societies, patient advocacy groups, and others.

Colorado VA researcher discusses the challenges living with chronic pain

Chronic Pain


VA’s Erica Sprey, host of the pod cast series “Voices of VA Research,” speaks with Dr. Joseph Frank, both a primary care physician at the VA Eastern Colorado Health Care System in Denver and a researcher at the Center of Innovation for Veteran-Centered and Value-Driven Care. Dr. Frank’s research is focused on improving care for Veterans who are living with chronic pain—especially strategies for safely tapering the use of long-term opioid medication. Listen to the full discussion here — an excerpt of the discussion is below.

Shanahan Launches New Task Force on Military Sexual Assault

MST Task Force


The Defense Department has created a sexual assault task force to study and make recommendations on improving how the armed services handle and prosecute sex crimes.

Pentagon officials said Tuesday that Acting Defense Secretary Patrick Shanahan ordered the establishment of a Sexual Assault Accountability and Investigation Task Force on March 27. That was the day after a Pentagon advisory committee released a report finding disparities in documentation of sexual assault cases across the services. Among the discoveries were incomplete files on how commanders made prosecution decisions.

The move also followed the January release of a report on sexual assaults at the service academies, which found that the estimated number of students who experienced unwanted sexual contact had increased 47 percent in the last two years.

The task force includes Dr. Elizabeth Van Winkle, executive director of the DoD office of Force Resiliency, and the services' top lawyers, who will review the processes used by the military to investigate sexual assault charges and prosecute cases.

The group will make recommendations "that will improve existing processes to address sexual assault while ensuring our formations, our communities, the rights of the victim and the accused and the integrity of the legal process are protected," Shanahan wrote in a memo to the service secretaries, the Joint Chiefs of Staff and other high-ranking Pentagon leaders.

"The importance of this work cannot be overstated," Shanahan said. "Only through diligence and innovation will we eliminate this reprehensible crime from our ranks."

Some Democrats in Congress have renewed efforts to amend the Uniform Code of Military Justice to remove the authority for deciding whether to prosecute sexual assault cases from military commanders.

Advocates for the change say it’s needed because the current system yields low prosecution and conviction rates and allows for retaliation against victims.

But a panel appointed by Congress in 2013 to study the command authority issue concluded that the incidence rates of sexual assault would not be reduced by removing convening authority from commanders.

That group, the Response Systems to Adult Sexual Assault Crimes Panel, also noted that, in the sexual assault investigation process, subordinate leaders such as noncommissioned officers and civilian supervisors were often the ones who ignored reports of sexual assault or retaliated against victims.

"Training and accountability for these leaders is imperative," the panel noted.

A different group, the Defense Advisory Committee on the Investigation, Prosecution and Defense of Sexual Assault, published its own report March 26. In the report, the group said it had reviewed 164 cases of penetrative sexual assault across the services and found that command decisions to refer charges were "reasonable" in 95% of the cases.

But members also noted that documentation justifying the decisions was spotty across the services. The advisory committee recommended that services have standard requirements for documenting command disposition and furnishing rationale for each decision.

Shanahan said the new task force's recommendations will complement the work of the advisory committee, and he pledged to continue preventing sexual assaults and supporting victims.

In his letter, Shanahan said the report on the service academies report and discussions with Sen. Martha McSally, R-Arizona, a retired Air Force fighter pilot who revealed during a hearing March 6 that she had been raped as a junior officer, led to his decision to create the task force.

"I pledged to do more, and I intend to carry out this commitment," Shanahan said. "Sexual assault impacts the entire force across all Military Services. None of us are immune to this crime and all of us are responsible."

The task force is expected to provide its findings in a final report to Shanahan by April 30.


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