1997

ANNUALREPORT

OFFICEOFRESEARCH&DEVELOPMENT

VETERANSHEALTHADMINISTRATION

DEPARTMENTOFVETERANSAFFAIRS

for

HEALTH

CARE

Improving

Veterans
for

HEALTH

CARE

Improving

Veterans

1997ANNUALREPORT

OFFICEOFRESEARCH&DEVELOPMENT

VETERANSHEALTHADMINISTRATION

DEPARTMENTOFVETERANSAFFAIRS
Kenneth W. Kizer, M.D., M.P.H.

Under Secretary for Health

Message from the Under Secretary

“Nothing endures but change.”

 — Heraclitus, 500 BC

“The health of the people is really the foundation upon which all

their happiness and all their powers as a State depend.”

 — Disraeli, 1877

The Veterans Health Administration (VHA) is in the business of providing high quality, cost

effective health care to veterans. The size and scope of the veterans healthcare system

necessitate many inputs to ensure that we successfully meet our quality and value goals.

VHA's Office of Research and Development plays a major role in this regard by assisting us

in identifying “what works” and “what doesn't work” and by creating new knowledge that

helps us provide better care.

The VHA research program covers the entire spectrum of biomedical, clinical, health services

delivery and rehabilitation research, as well as technology assessments. Its many talented

investigators, most of whom have multiple roles as clinicians, educators and investigators, are

committed to veterans' health issues. Its administration, under the leadership of Chief

Research and Development Officer, John R. Feussner, M.D., is responsive to the system's

new and emerging needs and is committed to working closely with managers, researchers,

clinicians and other decision makers to translate research into practice.

This first annual VA research report is designed to provide an overview of the VA Research

and Development program structure and funding and to highlight recent VA research

contributions to improved health care for veterans. I am delighted to provide you with this

overview document, and I hope that it is a useful resource for you.

Kenneth W. Kizer, M.D., M.P.H.

Under Secretary for Health

Veterans Health Administration
TABLE OF CONTENTS

Message from the Chief ..................................................................................................... 1

Research and Development: Organizational Framework..................................................... 3

Cooperative Studies Program (CSP) ..................................................................... 4

Health Services Research and Development (HSR&D) ........................................ 5

Medical Research Service (MRS) .......................................................................... 7

Rehabilitation Research and Development (RR&D) ............................................. 9

VA Research Collaborations............................................................................................. 10

Funding: Building Bridges to Innovation......................................................................... 14

New Initiatives ................................................................................................................ 16

Outlook for Fiscal Year 1998 ........................................................................................... 19

Highlights from FY 1997 ................................................................................................ 21

Summary of FY 1997 Research and Development Projects .............................................. 29

Research and Development Career Development Awardees ............................................. 49
John R. Feussner, M.D.

Chief Research and

Development Officer

Message from the Chief

“ . . . every difference must make a difference. . .”

 — William James

“Research is good, results are better.”

 — Lyndon B. Johnson

This past year has been a year of change for VA’s Office of Research and Development. We

have made great strides in refining our research portfolio to focus on areas of unique or

special concern to veterans. We have embarked on a strategic planning process that is moving

us toward an integrated view of the Research Office and the reengineering of its key components: creating research policy, scientific peer review, research career development, dissemination and communications processes, budgeting and operations. Our very successful programs

in medical research, cooperative studies, health services and rehabilitation research have

begun to work together to identify synergies that amplify our activities and increase our

overall value to veterans health.

We have made these changes purposefully to adapt to the changing veterans health care

environment. To keep pace with societal and healthcare industry-wide forces, the Veterans

Health Administration (VHA) has been reorganized over the past two years from a hospital

based management structure into twenty-two Veterans Integrated Service Networks (VISNs)

with an emphasis on primary care. Clearly these far reaching changes have created opportunities to strengthen the link between VA’s mission of research and scientific discovery and its

missions of providing high quality patient care and medical education.

Since the VA Research and Development program was created, VA research has made

landmark contributions to veterans health care as well as to the overall health care community. VA research has resulted in actions that have, among other advances, saved lives by

treating high blood pressure; prevented heart attacks, stroke, and death by promoting the

prophylactic use of aspirin; and have revolutionized the design and development of prostheses thus making a range of athletic activities possible for people with lower limb amputations.

We have taken a close and critical look at our structure, our research priorities and the
2 V A R E S E A R C H & D E V E L O P M E N T

internal and external stakeholders and dynamics that influence our decision making. As a

result of our research portfolio review, the strategic planning process and the recommendations of the Research Realignment Advisory Committee, the Office of Research and Development has introduced a number of new initiatives this past year. The new initiatives cover

all aspects of VA research and development, including health services delivery and quality of

care, biomedical research, multi-center cooperative studies, and rehabilitation. Specifically,

these new initiatives:

expand health services research;

create an epidemiologic research capacity;

revitalize the Cooperative Studies Program;

create new research training and career development pathways

in all research disciplines;

reassess the objectives of biomedical research;

strengthen the portfolio of rehabilitation research; and

promote an R&D infrastructure designed to best meet the needs of today’s veterans.

These initiatives represent the cornerstone of the strategic planning effort that the Office of

Research and Development has launched in order to better integrate the work of its four

research services, rather than treat them as discrete units.

This annual report explores these initiatives in more detail, explains the current structure of

the Office of Research and Development, and offers examples of how existing and new

efforts will help improve the effectiveness of health care and efficiencies of health care

delivery to our nation’s veterans.

VA’s Office of Research and Development has worked hard to be positioned and prepared to

meet the challenges of a changing health care environment. We will continue to strive to

“make a difference” in addressing the health care needs of veterans.

John R. Feussner, M.D.

Chief Research and Development Officer

Office of Research and Development

Veterans Health Administration

Department of Veterans Affairs
A N N U A L R E P O R T 1 9 9 7 3

VA RESEARCH AND DEVELOPMENT:

ORGANIZATIONAL FRAMEWORK

The Office of Research and Development allocates funds to support research projects

among 115 VA facilities nationwide that currently participate in R&D activities.

The funded research projects are initiated by VA scientists on their own or in response

to solicitations from the R&D headquarters. VA research is conducted in any number of

ways: with VA medical centers; in collaboration with other federal government agencies;

with non-government organizations such as universities or pharmaceutical companies; or any

combination of these.

The Office of Research and Development oversees four services that explore all phases of

veterans health care—Cooperative Studies, Health Services Research and Development,

Medical Research, and Rehabilitation Research and Development.

The particular expertise of each of these four services allows the Office of Research and

Development to explore the health care issues of importance to veterans from multidimensional perspectives, providing a more holistic view. In the treatment of diabetes, for

example, one medical research Center for Diabetes focuses on the effects of diabetes on the

vascular system that lead to increased heart attacks, stroke and peripheral vascular disease.

Some Rehabilitation research in diabetes focuses on proper orthotic support, such as the

design and use of customized insoles combined with depthinlay shoes, to reduce limb-threatening ulcerations in diabetic

patients. Health Services research helps design and test diabetic

health care interventions and programs, such as the HSR&D

study that found that diabetic veterans who received their care

in a primary care practice model had improved blood sugar

control and higher patient satisfaction. Through a large-scale,

multi-center trial evaluating the safety and efficacy of an

implantable insulin pump, the Cooperative Studies Program

found that patients preferred the pump and had better blood

sugar levels and quality of life than they did with multiple daily

insulin injections. The Office of Research and Development

successfully utilizes this four-pronged approach to tackle

complex health care issues of special importance to veterans.

Following is a brief description of each of the four research

services.
4 V A R E S E A R C H & D E V E L O P M E N T

Cooperative Studies

Program (CSP)

Cooperative Studies began in 1946 with

landmark research in the treatment of

tuberculosis. The Cooperative Studies

Program (CSP) has evolved into its own

service within VA’s Office of Research and

Development, now encompassing the fields

of: medical research, health services

research, and rehabilitation research. CSP

provides centralized proposal review and

statistical and administrative coordination

to VA investigators who wish to conduct

multi-center clinical trials. Its mission is to

conduct clinical research on health issues

that are vital to our nation’s veterans, to

define research results that establish new

standards of care and improve veterans’

health, improve the efficiency of the VA

health care system and improve the health

of the population as a whole.

The Veterans Health Administration, with

its many facilities and twenty-two networks, is an ideal place to conduct largescale cooperative research. The CSP’s

strength lies in its ability to organize

multiple medical centers within VHA to

conduct more definitive research than may

be achieved in single-site studies. CSP has

sponsored a wide variety of studies from

treatments for heart disease, cancer, AIDS,

schizophrenia and prostate disease to

dental implants and hearing aids; and from

evaluation of geriatric care to provision of

primary care to seriously ill patients.

VA Cooperative Studies are usually conducted over a five year period. In the

course of a year CSP generally oversees 30

ongoing studies, 10 studies in planning and

15 in final analysis.

Although most studies are organized

within the VA health care system, CSP has

conducted a number of studies in partnership with the National Institutes of Health,

the Department of Defense, and pharmaceutical corporations. More than 100 VA

hospitals are involved in cooperative studies

and thousands of veterans have participated

in CSP research. Moreover, national

medical experts often cite the impact of VA

Cooperative Studies results on their

medical practice.

Statistical and methodological guidance in the conduct

of CSP clinical trials is

provided by four statistical

Coordinating Centers that

provide design, data

management, statistical

analysis and administrative

support to all VA Cooperative

Studies.

Cooperative Studies Program

Coordinating Center

Hines, Illinois

William G. Henderson, Ph.D.,

Chief

Cooperative Studies Program

Coordinating Center

Palo Alto, California

Philip W. Lavori, Ph.D., Chief

Cooperative Studies Program

Coordinating Center

Perry Point, Maryland

Joseph F. Collins, Sc.D., Chief

Cooperative Studies Program

Coordinating Center

West Haven, Connecticut

Dorothea Collins, Sc.D.,

Chief

CSP runs a Clinical Research

Pharmacy to coordinate

studies that involve drugs or

medical devices.

Cooperative Studies

Program Clinical

Research Pharmacy

Coordinating Center

Albuquerque,

New Mexico

Mike R. Sather, M.S.,

F.A.S.H.P., Chief

Cooperative Studies Program
A N N U A L R E P O R T 1 9 9 7 5

Health Services Research

and Development

CAREER DEVELOPMENT PROGRAM

The Career Development Program

encourages VAMC clinicians and scientists

to pursue HSR&D careers by providing

stable research and salary support. Established in 1991, this program has been

successful in fulfilling its mission to provide

talented investigators with protected time

to advance their research careers, increase

the health services research knowledge of

other VA clinicians/non-clinicians, and

retain many talented clinicians and investigators in VA.

CORE SUPPORT PROGRAMS

Core Support Programs are peer-reviewed

programs designed to build or to help

support health services research capacity

system-wide. They include HSR&D

Service Developmental Projects Program

and four pre- and post-doctoral training

programs in health services research and

medical informatics (in collaboration with

VHA’s Office of Academic Affiliations).

SERVICE DIRECTED RESEARCH

Service Directed Research (SDR) is

solicited by HSR&D to address health care

issues relating to the veteran population,

the VA’s system of health care networks,

and the nation as a whole. SDR projects

are conducted in response to mandates and

requests from a variety of constituencies,

Center for Practice

Management & Outcomes

Research

Ann Arbor, Michigan

Rodney A. Hayward, M.D.,

Director

Center for Health Quality,

Outcomes, and Economic

Research

Bedford, Massachusetts

Mark Prashker, M.D.,

M.P.H., Director

Center for Health Services

Research in Primary Care

Durham, North Carolina

Eugene Z. Oddone, M.D.,

Director

Midwest Center for Health

Services and Policy

Research

Hines, Illinois

John Demakis, M.D.,

Director

Houston Center for

Quality of Care and

Utilization Studies

Houston, Texas

Nelda Wray, M.D., M.P.H.,

Director

HSR&D Field Program for

Mental Health

Little Rock, Arkansas

G. Richard Smith, M.D.,

Director

Center for Health Care

Evaluation

Palo Alto California

Rudolf H. Moos, Ph.D.,

Director

Northwest Center for

Outcomes Research in

Older Adults

Seattle, Washington

Stephan D. Fihn, M.D.,

M.P.H., Director

Center for the Study of

Healthcare Provider

Behavior

Sepulveda, California

Lisa V. Rubenstein, M.D.,

M.S.P.H., Director

Management Decision and

Research Center

Boston, Massachusetts

Martin P. Charns, D.B.A.,

Director

Research supported by the Health Services

Research & Development Service

(HSR&D) examines the effects of organization, financing, and management on a

wide range of issues in health care delivery

including: quality of care, access, cost and

patient outcomes. HSR&D’s key operating

units are its nine field programs, each of

which is a center of excellence in a particular domain of health services research, plus

the Management Decision and Research

Center (MDRC) which was established to

facilitate the interaction between HSR&D

and VHA senior managers and policy

makers. HSR&D funding is awarded

through the following programs:

INVESTIGATOR-INITIATED

RESEARCH (IIR)

HSR&D’s peer-reviewed InvestigatorInitiated Research (IIR) enables investigators at individual VA Medical Centers to

conduct a wide range of health services

research. The IIR Program emphasizes

projects that will strengthen knowledge

about and strategies for improving health

care outcomes, access to care, cost and

cost-effectiveness, assessment and assurance

of quality, alternative organizational and

delivery models, and the development of

new research methods and measurement

tools. A growing number of IIR projects

are in areas HSR&D has targeted as high

priority areas.

HSR&D Field Programs
6 V A R E S E A R C H & D E V E L O P M E N T

including Congress, federal agencies (e.g.,

Office of Management and Budget and the

General Accounting Office), the Secretary,

the Under Secretary for Health, the

HSR&D Service, and other VA health care

system managers and administrators.

DISSEMINATION AND PUBLICATIONS

In addition to the hundreds of articles by

HSR&D investigators that appear in peer

reviewed journals annually, HSR&D places

a high priority on targeted products and

presentations to disseminate important

findings to decision makers and the field.

Examples include:

• FORUM, the HSR&D newsletter

that brings useful information,

questions, observations and

comments to the attention of VA

clinicians, managers and health

services researchers;

• Primer series, whose question and

answer format provides a broad

audience with a tool for explaining

complex health care issues;

• Management Briefs, which

provide senior managers with

HSR&D research results in a

concise and timely manner and

in language that is easily

accessible;

• HSR&D/Veterans Integrated

Service Network Directors

Committee, a group representing both VHA network

decision makers and HSR&D,

that meet regularly to ensure

that research findings inform

management decisions and

policy making and that management needs inform research

questions;

• Transition Watch, a quarterly

publication that provides

managers in both headquarters

and the field with information

about organizational changes in

VA and specifically about

implementation of service lines,

quality initiatives and hospital

integrations.

PIVOT

The Prostate Cancer

Intervention Versus

Observation Trial, (PIVOT)

is comparing radical

prostatectomy (surgical

removal of the prostate)

with expectant management for men with early,

localized prostate cancer.

The potential cost to VA of

a comprehensive screening

and treatment program for

prostate cancer may be

from $1.8-$13 billion each

year. As screening programs

result in the diagnosis of

more early cancers, it is

crucial to determine the

best treatment. If surgery is

not the better option, men

can be spared surgery’s

potential risk and negative

impact on quality of life,

and the savings to the

health care system will be

significant. If surgery saves

lives, it will underscore the

importance of early

detection and treatment.
A N N U A L R E P O R T 1 9 9 7 7

FUNDEDRESEARCHCENTERS

Special Research Centers receive core funding to support a

coordinated research program

CENTER LOCATION

Alcohol West Haven, Connecticut; Omaha, Nebraska;

Denver, Colorado

AIDS & HIV Infection Atlanta, Georgia; Durham, North Carolina

New York, New York; San Diego, California

Schizophrenia Denver, Colorado; Brockton, Massachusetts;

West Haven, Connecticut

Environmental Hazards Boston, Massachusetts; East Orange, New Jersey;

Portland, Oregon; Louisville, Kentucky

Diabetes San Diego, California; Iowa City, Iowa;

Nashville, Tennessee

Medical Research

Service

The primary goals of the Medical Research

Service are to support high quality biomedical research relevant to veterans’ health and

illnesses, develop and enhance an intramural

research environment that promotes the

conduct of research, and attract and retain

productive biomedical research scientists.

The Medical Research portfolio is largely VA

investigator-initiated and peer-reviewed by

nationally recognized scientific experts.

While the research is not centrally directed,

the Medical Research Service targets 17

disease categories that are highly prevalent in

the veteran population and funds research

centers that specifically focus research

efforts.

MERIT REVIEW PROGRAM

The Medical Research Service, through its

Merit Review Program, funds individual

scientists and works toward assuring adequate time for researchers to pursue their

research goals. Researchers who are funded

through the Merit Review Program focus

their efforts on etiology, pathogenesis,

diagnosis, and treatment of a wide range of

diseases and disorders affecting the veteran

population.

To strengthen the Merit Review Program,

the Medical Research Service has taken two

major steps over the past year:

• The Service increased the number of

awards in a funding cycle—from 112

in Fall 1995 to 143 in Fall 1996, a

27% increase; and

• Together with the HSR&D and

RR&D services, the Medical

Research Service will revitalize the

Career Development Program for

clinician scientists.

The Medical Research Service has also

worked to retain and enrich research

expertise that is relevant to VA’s

research priorities by creating a new

program for first-time principal investigator applicants to enhance their

competitiveness for merit review awards

and by introducing a program that

provides bridge funding to applicants

who are between awards to ensure

continuity of their work.
8 V A R E S E A R C H & D E V E L O P M E N T

MINORITY RECRUITMENT INITIATIVE

The Medical Research Service also oversees

the Minority Recruitment Initiative, which

involves a Research Training Initiative for

Historically Black Colleges and Universities

(HBCUs) and Hispanic-Serving Institutions (HSIs). The initiative’s primary

objectives are to create collaborative

research activities between VA and these

institutions, strengthen the research skills

of their faculty scientists, stimulate their

students’ interest in pursuing VA careers in

biomedical and biobehavioral research, and

enhance VA’s efforts to address the health

care needs of the country’s African American and Hispanic American veterans.

Funded programs have examined a wide

range of medical issues, including noninsulin-dependent diabetes mellitus,

hypertension, sickle cell anemia, lung

cancer, and leukemia, to name a few. To

date, 30 faculty scientists representing 20

minority-serving institutions in 11

states have participated in this

program. A total of $4,605,495

has been allocated for the applications selected for funding under

the first three cycles of review; a

fourth review cycle is under way

for funding in fiscal year 1998.

DEPARTMENT OF DEFENSE

Medical Research Service coordinates VA’s

collaboration with the Department of

Defense in areas of common interest to VA

and the DoD. Projects selected within four

agreed upon initiatives are slated to be

funded beginning in fiscal year 1998. (See

VA Research Collaborations.)

NATIONAL INSTITUTE ON DRUG

ABUSE (NIDA): NIDA/VA

SUBSTANCE ABUSE MEDICATION

DEVELOPMENT RESEARCH UNITS

These units serve as centers for conducting

Phase I, II, and III drug trials on pharmacotherapeutic compounds for the treatment of substance abuse and addiction.

Five sites were selected for these centers:

Boston Outpatient Clinic, New York/

Northport, Philadelphia, Cincinnati, and

West Los Angeles. A total of $41,411,259

will fund projects from 1995 to 1999.

• aging, autoimmune allergic,

and hematopoietic disorders;

• cancer;

• chronic disorders

of the gastrointestinal system;

• chronic infectious

disease;

• chronic renal

disease;

• central nervous

system injury and

associated

disorders;

• degenerative

diseases of bones

and joints;

• dementia and

neuronal

dysfunction and

degeneration;

• diabetes

and major

complications;

• emerging

pathogens;

• environmental

exposure (dermal

and pulmonary);

• major psychoses,

mood disorders,

and stress;

• sensory disorders;

• substance abuse

(alcohol, drug,

nicotine);

• trauma and

wound healing;

• vascular diseases.

Medical Research Priorities
A N N U A L R E P O R T 1 9 9 7 9

Rehabilitation

Research and

Development

Since World War II, Rehabilitation Research and Development (RR&D) has

been the nationally recognized leader in

disability research to benefit veterans with

amputations, spinal cord injury, vision

impairment, hearing loss, or multiple

communication disorders. As the average

age of veterans has increased, RR&D has

established research priorities in rehabilitation of disabilities caused by aging.

RR&D investigations focus on concepts,

products, and processes that promote

greater functional independence and

improve quality of life for veterans who

have been disabled as a consequence of

trauma or disease. RR&D accomplishes

these important goals through its diverse

programs listed below.

INVESTIGATOR-INITIATED RESEARCH

RR&D is committed to giving priority

funding to ideas that arise from rehabilitation professionals treating veterans.

Approximately 75% of the Service’s resources fund proposals through a national

peer review and evaluation process. Products such as the Seattle foot, a prosthetic

foot designed for use with either an above

knee or below knee prosthesis, have been

developed through this program.

REHABILITATION RESEARCH CENTERS

RR&D Centers cultivate communities of

scientific investigators and clinicians

focused on the many domains of human

rehabilitation. Through this program, VA

is able to direct resources toward areas of

identified need to benefit veterans with

disabilities. In response to an FY 97 Office

of Research and Development request for

applications, funding was awarded for six

new Rehabilitation Research and Development Centers of Excellence. The new

centers will focus on rehabilitation for

physical disabilities due to traumatic

accidents and injuries as well as stroke,

falls, and degenerative musculoskeletal or

neurologic diseases. The rehabilitative

services to be studied will include those

designed to restore or compensate for lost

ambulation, speech, vision, aging with a

disability and other functions that affect

independent living and quality of life.

TECHNOLOGY TRANSFER

RR&D actively seeks to transfer technology into the VA health care delivery system

through its Technology Transfer activities.

These activities provide for coordination of

new prototype and technique development

REHABILITATION RESEARCH &

DEVELOPMENT CENTERS

VA Atlanta RR&D Center

Joseph G. Ouslander, M.D.,

Director

Focus Areas: Geriatric

Rehabilitation, Low Vision

VA Cleveland RR&D Center

Hunter Peckham, Ph.D.,

Director

Focus Area: Functional

Electrical Stimulation

VA Houston RR&D Center

Arthur M. Sherwood, Ph.D.,

Director

Focus Area: Aging with a

Disability

VA Palo Alto RR&D Center

Felix E. Zajac, Ph.D.,

Director

Focus Areas: Rehabilitation

Engineering and Spinal Cord

Injury

VA Portland RR&D Center

Stephen Fausti, Ph.D.,

Director

Focus Area: Aural

Rehabilitation

VA Puget Sound RR&D Center

Bruce J. Sangeorzan, M.D.,

Director

Focus Areas: Prosthetics and

Consequences of

Amputation
10 V A R E S E A R C H & D E V E L O P M E N T

to facilitate prompt transfer of promising

products and processes into commercial

production and clinical use. Evaluations of

prosthetic limbs, wheelchair designs and

vision enhancements have all resulted in

improved products for use by veterans and

within the nation’s health care system.

SCIENTIFIC AND TECHNICAL

PUBLICATIONS

RR&D promptly disseminates information

about its rehabilitation and engineering

projects among scientists, engineers,

clinicians, and veteran consumers through

the quarterly Journal of Rehabilitation

Research and Development and its companion publications. The Journal has received

international recognition as the only

publication of its type to offer comprehensive coverage of all disciplines in rehabilitation research.

CAREER DEVELOPMENT

The newest of RR&D programs, Career

Development provides a structured system

for mentoring new researchers with future

promise of having an impact on the

rehabilitation and disability management

field. Currently funded post-doctoral

awardees are pursuing studies in Cerebrovascular Disorders, Audiology, Gait,

and Rehabilitation Engineering.

Researchers at VA Medical

Centers at Seattle, Chicago

(Lakeside) and New York

evaluated computer aided

design and manufacture

technology for applicability to prosthetic fitting,

design, and manufacture.

The result revolutionized

the prosthetics industry. A

cumbersome trial and error

process that took weeks

was reduced to one day.

The process created a

more exact fit of the

prosthesis to the residual

limb. Today, persons

with amputations can

engage in far more

activities of choice,

including sports like

running, skiing and

basketball, because of

this improved interface.

Moreover, VA evaluations indicate that this

superior product can be

provided to veterans at

an annual savings of

$10 million.

VA RESEARCH COLLABORATIONS

VA research is further enhanced through collaborative arrangements with other government

agencies and with non-government entities. Important current collaborative activities are

those with the Department of Defense, several institutes at the National Institutes of Health,

the Juvenile Diabetes Foundation and pharmaceutical companies.

Revolutionizing Prosthetics
A N N U A L R E P O R T 1 9 9 7 11

Government Collaborations

VA/DEPARTMENT OF DEFENSE (D OD)

COLLABORATIVE RESEARCH PROGRAM,

will study four areas of common interest to

VA and the DoD:

systems on the stress reaction, and the

identification of genetic markers which

might be associated with control of

stress responses and PTSD. Twelve

proposals will be funded and are

expected to begin June 1, 1998.

PROSTATE DISEASE, INCLUDING

PROSTATE CANCER

Slated to begin in fiscal year 1998, this

three-year initiative will address the cellular

and molecular biology concerning the

pathogenesis of prostate cancer, diagnostic

developments, and treatment of benign

and malignant prostate diseases. Up to ten

proposals will be funded beginning in

September, 1998.

VA/DEPARTMENT OF DEFENSE,

HEALTH AND HUMAN SERVICES AND

ENVIRONMENTAL PROTECTION

AGENCY

VA, through the Research Working Group

(RWG) of the Persian Gulf Veterans

Coordinating Board leads the federal

research effort on Persian Gulf veterans’

illnesses. VA’s Chief Research and Development Officer chairs the RWG which is

composed of scientific leaders from VA,

HHS, DoD and EPA. The RWG developed A Working Plan for Research on

Persian Gulf Veterans’ Illnesses to guide

federal decision makers in establishing

research priorities and providing information to members of Congress, the scientific

community, the public and the veterans of

the Persian Gulf conflict, about the manner

in which the federal government is carrying

out important research on Persian Gulf

veterans’ illnesses.

MECHANISMS OF

EMERGING PATHOGENS

Under this three-year initiative, investigators aim to find ways that newly discovered

microorganisms become infectious to

humans; identify the ways existing infections change to cause more serious disease;

examine the effects of climate, ecological,

and population changes on the spread of

infections; and determine the ways in

which pathogenic organisms infect immunosuppressed individuals. Eighteen

proposals will be funded and are slated to

begin October 1997.

COMBAT CASUALTY AND

WOUND REPAIR

This three-year initiative will fund research

that examines: cellular and molecular biology

issues that affect tissues and organs during

shock and trauma; immediate and delayed

effects of thermal injury such as burns and

frostbite; and abnormal wound healing, to

name a few. Nine proposals will be funded,

with a January 1, 1998, start date.

STRESS RELATED CHRONIC ILLNESSES,

INCLUDING POST-TRAUMATIC STRESS

DISORDER (PTSD) AND RELATED

GULF WAR ILLNESSES

In this three-year project, researchers will

study the biological aspects of traumatic

and non-traumatic stress related disorders,

for example, the role of the nervous,

endocrine (hormone), and immune
12 V A R E S E A R C H & D E V E L O P M E N T

VA and Department

of Health and

Human Services

Collaborations

VA collaborates on important research with

a number of Institutes within the National

Institutes of Health and with the Agency

for Health Care Policy and Research.

Examples of these collaborative relationships follow:

NATIONAL INSTITUTES FOR HEALTH

VA collaborates with a number of Institutes

on a variety of projects including:

The National Heart, Lung

and Blood Institute and VA

are collaborating on a

major cooperative study

called the Beta-Blocker

Evaluation of Survival Trial

(BEST).

The National Cancer

Institute, and VA with

additional support from

the Agency for Health Care

Policy and Research,

collaborate on the Prostate

Cancer Intervention Versus

Observation Trial

(PIVOT): a randomized

trial comparing radical

prostatechtomy versus palliative expectant

management for the treatment of clinically

localized prostate cancer.

The National Institute on Deafness and

Other Communication Disorders and VA

are working together on a hearing aid

clinical trial.

The National Institute on Drug Abuse and

VA are working together on several studies

including the evaluation of drugs for

treating heroin addiction which are less

addictive than methadone and cannot be

abused, to expand the ability of VA to treat

these patients as well as evaluating treatments for cocaine addiction, the most

critical part of the nation’s drug abuse

epidemic.

AGENCY FOR HEALTH CARE POLICY

AND RESEARCH

The Agency for Health Care Policy and

Research and VA work together in a

number of ways including:

• By collaborating with AHCPR to

encourage VA participation in a set

of Evidence-based Practice Centers,

VA has formed partnerships with

other medical and research organizations to produce “evidence reports”

that will provide clinicians and

health care organizations with stateof-the-art scientific information on

the effectiveness of treatments for

common, costly medical conditions.

• VA’s Chief Research and Development Officer serves on the AHCPR

Advisory Council and selected

AHCPR individuals have served as

VA peer reviewers.

A CSP study of patients

with a certain type of heart

attack called Non-Q-Wave

Infarction, found that these

patients can be managed

using non-invasive testing

rather than invasive

angiography.

Study results showed

decreased mortality among

persons treated noninvasively in the early

stages following a heart

attack and up to three

years later, compared with

the use of angiography.

CSP S tudy
A N N U A L R E P O R T 1 9 9 7 13

• AHCPR and VA are collaborating

on a Cooperative Study of a comparison of subcutaneous and

intravenous administration of

recombinant human erythropoietin

in dialysis patients.

• Together with the National Cancer

Institute, AHCPR and VA are

collaborating on the PIVOT trial

mentioned above.

Industry

Collaborations

Private industry, particularly biotechnology

and pharmaceutical companies, also

collaborate with the Office of Research and

Development on major research initiatives.

These collaborations have included

financial support and/or donated drugs in

support of large scale clinical trials. In FY

97 industry collaborators have included,

Amgen, Astra Merck, CPEC, DuPont,

Glaxo-Wellcome, Hybritech, Intercardia,

Marion Merrell Dow, Warner Lambert/

Parke-Davis, Bayer Corporation,

Boehringer Ingelheim, Hoescht Marion

Roussel, Rhône-Polenc Rorer, Sandoz,

Schein Pharmaceuticals and Schwartz

Pharmaceuticals.

VA/Juvenile Diabetes

Foundation (JDF)

Diabetes Research

Centers

In 1995 VA and JDF entered into an

agreement to jointly fund up to six

Diabetes Research Centers to study Type I

and Type II diabetes, with a focus on

clinical complications. In fiscal year 1997

three VA medical centers, Iowa City, San

Diego, and Nashville, competed successfully for funding. The Iowa City Diabetes

Research Center will focus on ways that

vascular function is affected by diabetes

mellitus; the San Diego Diabetes Research

Center will investigate insulin resistance in

Type II diabetes; and the Nashville

Diabetes Research Center will study the

adverse side effects, such as hypoglycemia

and obesity, often associated with intensive

diabetes treatment.
14 V A R E S E A R C H & D E V E L O P M E N T

FUNDING: BUILDING BRIDGES

TO INNOVATION

The Office of Research and Development administers the research appropriation for Medical

Research, Rehabilitation Research and Development, Health Services Research and Development, and Cooperative Studies. These funds currently support research projects conducted

by over 2300 VA medical center employees

in 115 VA facilities. These projects are

either initiated on the basis of VA employees’ own scientific interests or in response

to invitations from the R&D Office in

Headquarters.

The number of R&D funded research

projects is contingent on the level of

appropriated resources, and the average

cost per project. The nature and quality of

this research are influenced by identified

priorities that focus efforts on the veteran

patient population and the training,

interests and availability of research time

for VA’s health care providers/investigators.

SUMMARY OF BUDGETARY RESOURCES (DOLLARS IN THOUSANDS)

1995 1996 1997

Actual Actual Estimate

Medical and prosthetic research appropriation $251,426 $256,678 $262,000

Medical care support 377,748 334,700 328,273

Federal grants 185,102 209,470 216,800

Other grants (voluntary agencies) 97,566 105,903 109,600

DoD reimbursements* 14,242 16,242 15,376

 Total budgetary resources $926,084 $922,933 $932,049

* For each year Medical and Prosthetic Research receives DoD reimbursement, partial funding lapses to the next fiscal year.

APPROPRIATIONHIGHLIGHTS

BUDGETAUTHORITY

0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

1996 Actual 1997 Budget 1997 Current 1998 Current

$256,678 $257,000 $262,000 $272,000

Millions
A N N U A L R E P O R T 1 9 9 7 15

DEPARTMENT OF DEFENSE/VA

COLLABORATION (DOD/VA)

The DOD/VA Collaborative Research

Program has helped increase funding

opportunities for VA investigators by

infusing additional funds into the VA

research program. Generally, VA and DOD

investigators are eligible to compete for

funding in designated areas. A large

portion of the funds is spent on joint

efforts regarding Persian Gulf related

illnesses, Post Traumatic Stress Disorder

(PTSD), combat trauma, prostate cancer,

and emerging pathogens. Projects have

been funded in all of these areas and are

set to begin in FY 1998.

Outside VA or

Extramural Sources

The ability of VA researchers to leverage

funds from other federal agencies,

foundations, nonprofit agencies, and

various external sources has allowed the

Office of Research and Development to

continue to conduct health research in

varied environments and patient settings.

Over the past few years, VA researchers

have competed more actively and have

been successful in obtaining non-VA

research funding. This trend of increasing

extramural funds indicates that R&D

researchers compete well against top

researchers elsewhere and

that VA sustains a level of

research funding sufficient

to continue to attract and

retain high quality

researchers.

The Office of Research and

Development is working to

expand its efforts to

collaborate with nongovernment entities, such as

foundations and with

pharmaceutical and technology development companies, which are helping to

fund several multi-center

clinical trials. In 1996, 59%

of all research projects

initiated by VA investigators

were funded by extramural,

or non-VA funds.

Research efforts

lower incidence of

pressure ulcers

Pressure ulcers cause a great

deal of pain and suffering

among patients in long-term

care facilities that, for the

most part, could be

prevented. HSR&D’s

research into the causes,

prevention and treatment of

pressure ulcers has led to a

25 percent reduction in

pressure ulcer development

among long-term care

patients studied. As a result,

VA is now examining ways

to further improve pressure

ulcer care through use of

clinical practice guidelines

and long-term care

performance measures.

Berlowitz DR and Halpern J.

Evaluating and improving

pressure ulcer care: the VA

experience using administrative data. Joint Commission

Journal on Quality Improvement, August, 1997.

Pressure Ulcers
16 V A R E S E A R C H & D E V E L O P M E N T

NEW INITIATIVES

IN 1997

The evolution of health care, both within

and outside VA, has had a significant effect

on research priorities. Veterans Affairs’

Secretary Jesse Brown established a

Research Realignment Advisory Committee in FY 1996 to assess the focus of VA

research efforts and its appropriateness to

the needs of veterans. As a result of the

final report of the committee released in

early FY 1997, the Office of Research and

Development launched a number of new

initiatives. These new initiatives focus VA’s

research portfolio specifically on areas of

unique or special interest to veterans. Some

examples of these new initiatives follow.

EPIDEMIOLOGICAL RESEARCH AND

INFORMATION CENTERS

An important Research and Development

initiative is the creation of the Epidemiological Research and Information Centers.

As a research paradigm, epidemiology is

well-suited for addressing the process and

distribution of chronic diseases among

various subgroups of veterans. To promote

a greater interplay between clinical practice

and the epidemiology of medical care, the

Office of Research and Development

requested applications, reviewed, and then

funded three Epidemiological Research and

Information Centers. Centers will develop

studies that address such issues as the use of

risk assessment, surveillance and control

techniques, and population-based epidemiological surveys that can be targeted

toward selective health behaviors.

NURSING RESEARCH INITIATIVE

A Research and Development initiative

managed by HSR&D, the Nursing

Research Initiative has been in operation

for three years and is currently funding

eight new research studies conducted

expressly by nurse investigators. Proposals

to date include studies that explore a range

of areas: psychophysiology of post-traumatic stress disorder in female nurse

veterans of Vietnam; daily living with

chronic disease; physical activity counseling

of primary care patients; cultural barriers to

access to VA blind rehabilitation services;

patients at risk of developing pressure

ulcers; an intervention to reduce falls

among elderly veterans; and women with

spinal cord injuries.

INTERFACE OF MANAGED CARE AND

PRIMARY CARE

HSR&D has funded several projects aimed

at answering timely questions about how

VHA’s simultaneous movement toward

managed care and more primary care

affects important patient and system

outcomes. Investigators will focus on

questions whose answers will have immediate importance for guiding the continuing

changes in the VA system or for providing

baseline data that will be essential in

continuing efforts to monitor and manage

change.

Several studies directed at

improving the functional

capacity and capabilities of

stroke victims are

underway by rehabilitation

investigators. These

include:

• research to determine

the efficacy of functional

electrical stimulation in

the lower extremities for

improving motor

recovery and gait

patterns;

• development of two

modifications to

“constraint-induction”

therapy designed to

improve motor function

deficits;

• evaluation of a graded

weight-bearing regime

designed to improve the

lower limb mobility

function of veterans with

post-stroke hemiplegia;

• a study of central

mechanisms responsible

for restitution of wrist

movement.

Stroke Rehabilitation
A N N U A L R E P O R T 1 9 9 7 17

GENDER DIFFERENCES IN HEALTH

CARE AND IMPROVING HEALTH

SERVICES FOR WOMEN VETERANS

HSR&D continues to support research on

women veterans’ health, including research

on improving outcomes and increasing

access for women veterans, breast cancer,

reproductive health, post-traumatic stress

disorder, sexual abuse, mental illness, and

alcohol and substance abuse. This new

initiative funds work that explores gender

differences in veterans’ health care or

investigates problems identified in nonveteran female populations that have not

been studied among female veterans.

EVALUATION OF A COMPUTER

ASSISTED NEUROPSYCHOLOGICAL

SCREENING BATTERY

Many neurological conditions can have an

effect on the functioning of the brain in

different areas such as cognition, memory,

vigilance, and motor skills. Measurement

of these functions can be of critical importance in the diagnosis of different neurological disorders and in determinations of

their severity. This CSP study will evaluate

a brief computerized battery of tests for

patients referred for neuropsychological

testing. This test battery can be an important adjunct in evaluating patients for the

effects of exposure to neurotoxic environmental pollutants, such as in Persian Gulf

veterans.

THE CORONARY ARTERY

REVASCULARIZATION PROPHYLAXIS

TRIAL (CARP TRIAL)

Cardiovascular disease accounts for 1

million deaths/year and is the leading

cause of death among Americans. Studies

have shown that in patients scheduled for

elective vascular surgery, the frequency of

coronary artery disease exceeds 50%. It is

not surprising therefore, that the leading

cause of complications is “post-operative

cardiac morbidity” (defined as the occurrence of heart attacks, unstable angina,

congestive heart failure, arrhythmia, and

cardiac death). This CSP study is designed

to answer the question: Should prophylactic coronary artery revascularization

(surgical restoration of blood flow to the

heart) be performed prior to elective

vascular surgery?
18 V A R E S E A R C H & D E V E L O P M E N T

DIABETES MELLITUS

(TYPE II) RESEARCH

The Cooperative Studies

Program recently released

a research priority

announcement for the

conduct of multi-site,

randomized clinical trials

that will address the

effectiveness of treatment

and clinical management

of Diabetes Mellitus

(Type II).

MANAGING ACCESS TO

IMPROVE OUTCOMES

Access to VHA health care is affected by a

variety of managerial and policy decisions,

including eligibility criteria, clinical protocols, referral practices, staffing patterns, and

service location and capacity. Network

Directors participated in developing this

initiative which will fund studies that focus

on the effects of interventions intended to

enhance, restrict or redistribute access

across populations or places.

ESTABLISHMENT OF A NEW HSR&D

FIELD PROGRAM

HSR&D Field Programs are “Centers of

Excellence” in selected health services

research focus areas that provide the

primary means of enhancing VHA’s

technical expertise in the area of patient

outcomes research. Nine Centers of

Excellence currently receive core funding

and this solicitation will establish a tenth

Center.

REHABILITATION OUTCOMES

Research focused on the outcomes of

rehabilitation services provided by VHA

will be initiated. The work will have a

broad scope encompassing rehabilitation

for physical disabilities due to traumatic

accidents and injuries as well as stroke, falls,

and degenerative musculoskeletal or

neurologic diseases.

CAREER DEVELOPMENT

Career Development was identified by the

VA Research Realignment Advisory

Committee as a vital area of the Research

and Development program that should be

continued and expanded. The Office of

Research and Development has taken steps

to improve the recruitment, training and

retention of outstanding clinician investigators. Announcements have gone out to the

field accepting applications for a number of

career development awards.

Rehabilitation Research & Development

established a Career Development program

in 1997 to nurture promising VA investigators interested in disability research. In

addition, a pre-doctoral fellowship program

has been established through the Office of

Academic Affiliations.

Medical Research Service and Health

Services Research and Development

continue to support their Career Development Programs first established in 1956

and 1991 respectively.
A N N U A L R E P O R T 1 9 9 7 19

OUTLOOK FOR

VA RESEARCH

IN FY 1998

The research described in the preceding

pages represents an incredible set of

resources within VA – creative and committed investigators, a nationwide system

of facilities and support staff, and a large

and increasingly diverse patient population.

Looking ahead to 1998 and beyond, VA

will continue to expand these resources,

better integrate our research services,

further leverage research dollars, and

enhance capacity to disseminate new

information rapidly and effectively.

Human resources: The future success of

VA research depends on our ability to

retain and develop our unique all-intramural research team. Increased competition

for both VA and non-VA funding ensures

that successful VA investigators are extraordinarily capable researchers. At the same

time, because they are VA employees, these

investigators have a special relationship

with veterans and with the institutions in

which veterans receive health care; and,

because so many have dual roles as clinician

and investigator (within VA and external

institutions), their research is informed by

multiple perspectives. To maintain and

nurture a large and talented pool of

investigators, we have a variety of Career

Development programs, which we will

continue to develop and “grow” over the

coming years.

Integrated programs: VA research covers

the entire spectrum from basic biology to

clinical studies, to health services research, to demonstrations and evaluations of management strategies and

technology assessments. The establishment of Designated Research Areas that

cut across the traditional boundaries of

our Medical, Health Services, and

Rehabilitation programs marks a new

commitment to recognizing and developing the potential synergy of our various

research activities. Major initiatives in the

coming years will reflect the conviction

that solving complex health problems

requires specialized expertise as well as

continual synthesis, re-examination of

the issues, and communication.

Clear priorities: While we take pride in

knowing that VA-sponsored research has

importance to the nation and often to

the scientific community worldwide, the

primary concern of all VA-sponsored

research is U.S. veterans. The adoption

of Designated Research Areas, and the

more specific priorities within each, is an

attempt to be clear about the categories

of research questions within our scope.

We are developing a set of priorities that

is clear, manageable, and unique to VA.

Already, the vast majority of ongoing

research projects fits into these areas.

We are now working to develop capacity,

via internal data management systems

and the Internet, to increase awareness

of these priority areas and our accomplishments in each.

The Office of Research and

Development is funding four

centers for AIDS research in

the Atlanta, Durham, New

York, and San Diego VA

medical centers. Researchers

at the Georgia Research

Center for AIDS and HIV

Infection in Atlanta will

define the spectrum of HIV

disease and develop new

agents that may be effective

against HIV and associated

infections. Among the many

studies the Durham

Research Center for AIDS

and HIV Infection has

conducted since 1988 when

it was established is a new

project that will study HIV

preparedness among almost

2,000 at-risk injection drug

users eligible for care within

the VA in three cities—

Baltimore, New York City,

and Washington, D.C.

AIDS Research
20 V A R E S E A R C H & D E V E L O P M E N T

Leveraged dollars: Sufficient, and stable

research funding is critical to our success.

We encourage appropriate collaborations

with other Federal agencies, especially the

National Institutes of Health and the

Department of Defense, private foundations and institutions, and private corporations. VA’s Cooperative Studies Program

sponsors several major projects that

exemplify successful collaborations. Over

the coming years, we will continue to seek

new mechanisms and new funding partners within and outside government, and

to be accountable for all our research

investments.

Research utilization: We are seeking new

ways to get VA research findings into the

hands of potential users — patients,

clinicians, administrators, policymakers and

scientists. To accomplish this, we are

building communication with VA

policymakers and clinical managers in

Headquarters and the individual Networks,

encouraging investigators to present plans

for disseminating their findings, and

designing a new information system for

rapidly “getting the word out.”

This report on VA research, the first of our

planned annual reports, sets the stage. We

are proud of the quality and quantity of the

work described herein and the strong

tradition on which it is built. At this

juncture, we are looking forward — to

reporting on the research completed in FY

1997 and the new work launched in 1998,

and to seeing the results of our increasingly

integrated research plan.
A N N U A L R E P O R T 1 9 9 7 21

HIGHLIGHTS

FROM FY 1997

Research that enhances veterans

health care is one of the four

missions of the Department of

Veterans Affairs. The Office of

Research and Development carries

out this mission by setting research

policy and direction and overseeing

the work of its four productive

services. In a given year, VAaffiliated investigators publish about

3000 papers in Clinical Medicine

and about 1000 in Biomedical

Research. Highlighted below by

major health care categories, are a

mix of some of the most significant

on-going or new studies VA has

conducted on a range of health care

conditions and issues in FY 1997

and VA research findings published

in FY 1997.

AGING

At the Seattle VA Medical Center,

investigators have identified the

genetic defect in Werner’s syndrome, an inherited disorder that

causes premature aging in multiple

organ systems. This finding may

help to identify targets for diagnostic and treatment strategies for agerelated organ dysfunction.

A current CSP study, Evaluation

of Geriatric Evaluation and

Management Units and Geriatric

Follow-up, will examine the

value of specialized inpatient and

outpatient units for geriatric

care. The results will inform how

VA will care for the most rapidly

growing segment of the veteran

population as health care systems

move toward managed care.

Home-based primary care

(HBPC) holds great potential for

lowering total health care and

hospital readmission costs among

severely disabled and terminally

ill patients. A new study will

investigate whether these and

other benefits can be conferred

among other VA patients as well.

Although the study is still in an

early stage, it has already had an

impact on policy at several

VAMCs that had been considering closing their HBPC programs because of financial

constraints. It is hoped that this

project will identify a new role

for HBPC in VA’s evolving longterm care strategy for veterans.

CHRONIC DISEASES

CANCER

A VA prostate cancer study will

examine patient involvement in

treatment decisions. Some research

has suggested that patients who are

more active in their treatment

decisions tend to be more satisfied

with the results. HSR&D researchers examining this issue will shed

light on decision making for

prostate cancer and help design

better interventions to encourage

informed decision making in men

with prostate cancer.

A CSP trial, 18-F-Fluorideoxyglucose

(FDG) Positron Emission Tomography (PET) Imaging in Patients with

Solitary Pulmonary Nodules, will

assess whether this diagnostic

method can be used to accurately

determine if solitary pulmonary

nodules are malignant. The study

will attempt to determine the cost

and benefit of this technology

through its ability to screen patients

and avoid unnecessary procedures

and for its potential to improve

outcomes.

A CSP trial, Prospective Evaluation

of Risk Factors for Large Colonic

Adenomas in Asymptomatic Subjects, will identify patients with and

HIGHLIGHTS

AGING • CHRONIC DISEASES
22 V A R E S E A R C H & D E V E L O P M E N T

without colonic adenomas by

colonoscopy and follow them for

five years to determine the appropriate interval for follow-up

colonoscopies in patients with no

initial adenomas or small adenomas.

The study will attempt to identify

risk factors for colon cancer and

determine the appropriate follow-up

intervals for screening.

BENIGN PROSTATIC

HYPERPLASIA

Most men over the age of 50

experience enlargement of the

prostate gland, which surrounds the

male urethra. This enlargement,

benign prostate hyperplasia (BPH),

results in problems with urination.

Previous treatment for this condition included surgical removal of

portions of the enlarged prostate

gland. Healing after this procedure

is slow. A new tool for removing

excess tissue, a laser, was evaluated

in this study. Evaporation of prostate

tissue by laser surgery for the

treatment of symptomatic BPH is

safe and efficient.

NEUROLOGY

A recently completed and yet-to-be

released CSP study, Treatment of

Status Epilepticus, examined four

drugs that are commonly used to

treat this disorder which poses a lifethreatening state of prolonged

epileptic seizures. Preliminary results

of the study show that one of the

drugs is not as effective as the

others. There were also differences

in the ease of administration

between the drugs, which may help

make emergency care simpler.

ALZHEIMER’S DISEASE

There is a wide range in age related

onset for chromosome 1-related

familial Alzheimer’s disease. Studies

have indicated that identical changes

in three specific chromosomes are

related to inherited forms of

Alzheimer’s disease. Changes in

chromosome 14 caused an earlier

onset of the disease than changes in

chromosome 1, which caused onset

at an age similar to the more

common form of Alzheimer’s

disease. Studies of the genetic and

environmental factors that contribute to delayed onset of the disease in

individuals with chromosome 1

changes are now under further

study.

VASCULAR DISEASE

Cholesterol screening guidelines by

HSR&D researchers have nationwide impact. HSR&D researchers

wrote clinical practice guidelines on

cholesterol screening for the

American College of Physicians that

were published in the Annals of

Internal Medicine and distributed to

physicians nationwide. These

guidelines consist of seven specific

recommendations and supporting

evidence for cholesterol screening.

Garber AM, Browner WS,

Mazzaferri EL, et.al. Guidelines for

using serum cholesterol, high density

lipoprotein cholesterol, and triglyceride levels as screening tests for

preventing coronary heart disease in

adults. Annals of Internal Medicine

124:515-17, 1996.

A study shows benefits of “clotbusting” drugs compared with

angioplasty. Balloon angioplasty is

an established method for opening

blocked arteries, but it is not always

feasible for VA hospitals that do not

have the staff or facility to support

this procedure. This study showed

that “clot-busting” drugs achieved

similar outcomes to those of

angioplasty at $3,000 less per

patient. This approach not only

produces excellent outcomes at less

expense; it also spares heart attack

patients the risk of an invasive

procedure. Every NR, Parsons LS,

Hlatky M, et.al. A comparison of

HIGHLIGHTS

CHRONIC DISEASES
A N N U A L R E P O R T 1 9 9 7 23

thrombolytic therapy with primary

coronary angioplasty for acute

myocardial infarction. New England

Journal of Medicine 336:1253-60,

1996.

An ongoing CSP trial in secondary

prevention of heart disease, the VA

HDL Intervention Trial, will

compare gemfibrozil versus placebo

in improving cholesterol levels.

Results of the study could have cost

saving implications if gemfibrozil is

effective and could be used in place

of expensive statin drugs.

The Beta-Blocker Evaluation of

Survival Trial (BEST), an international trial sponsored jointly by VA

and the National Heart, Lung and

Blood Institute, is aimed at determining whether patients in the

United States and Canada with

moderate to severe heart failure live

longer on beta-blockers compared

with patients on placebo. Within the

main study, five substudies will also

be conducted to examine: physical

aspects of heart functioning; the

relationship between specific

hormones and heart function; and

potential genetic causes of heart

failure.

A completed CSP observational

study found that smokers are five

times more likely to experience an

abdominal aortic aneurysm than

non-smokers after adjustment for

other significant risk factors. Other

results also showed an association

between smoking history and

coronary artery disease and hypertension.

OTHER CHRONIC ILLNESSES

The CSP study, Sulfasalazine Versus

Placebo in Treatment of Seronegative Sponyloarthropathies, evaluated

the drug sulfasalazine as treatment

for three related arthritic conditions.

The study found that sulfasalazine

was effective in treating Reiter’s

Syndrome which can cause severe

joint pain. It was somewhat effective

in treating psoriatic arthritis which

can disfigure the skin and somewhat

effective in certain patients with

ankylosing spondylitis which can

produce fusion of the spinal vertebrae. Therefore, sulfasalazine is

another treatment option for

patients who do not respond to

commonly used nonsteroidal antiinflammatory drugs.

A brief, self-administered questionnaire is being used to measure

health-related quality of life among

patients with chronic obstructive

pulmonary disease. Quality of life is

an important aspect of treatment

effectiveness. Tu S-P, McDonell MB,

Spertus HA, Steele BG, Fihn SD. A

new self-administered questionnaire

to monitor the health-related quality

of life of patients with chronic

obstructive pulmonary disease. Chest

In Press, 1997.

AIDS

Patients with HIV infections and

AIDS are very likely to have a weak

immune system. This permits

infection by organisms that would

not cause clinical problems in other

patients. The most common

infection is caused by an organism

that inhabits the lungs of patients

and causes pneumonia. If not

treated, these pneumonias can be

fatal. This project uses a mouse

animal model that simulates the

depressed immune system of AIDS

patients. After infecting these mice

with the organism that causes

pneumonia in AIDS patients, this

model is ideal for testing new drugs

that might be effective in killing the

infecting organism.

Assessment tool identifies AIDS

patients who qualify for step-down

care. Intermediate skilled nursing

facilities, or “step-down” units, may

provide more cost-effective care for

AIDS patients who no longer

require acute care hospital services.

HIGHLIGHTS

CHRONIC DISEASES
24 V A R E S E A R C H & D E V E L O P M E N T

VA researchers developed a simple

bedside index method for early

identification of those patients who

may benefit from step-down care.

Bennett CL, Ullman M, Dickinson

GM, et al. Patterns of care for HIVrelated PCP in a university medical

program: a case study. Clinical

Performance and Quality Health

Care 14(4): 186-89, 1996.

Clinical staging for HIV will support

decision-making. Effective clinical

staging systems for HIV infection

can be developed based on relatively

few variables, for which the needed

data are readily available in clinical

practice settings, according to this

study. These results will facilitate the

development of clinical staging

systems that can be used to guide

clinical decision-making and help

clinicians advise patients on their

futures. Rabeneck L, Hartigan PM,

Huang IW, et al. An evaluation of

two approaches. Journal of General

Internal Medicine 11: 622-4, 1996.

The recently completed CSP study,

Clinical Significance of Surrogate

Marker Changes for HIV Infection,

showed which blood tests best

determine if treatment for AIDS is

effective. The results are important

for testing new drugs to treat HIV.

DIABETES

The Implantable Insulin Pump

Study is a randomized trial that

found that the insulin pump is a

better treatment for persons with

adult-onset diabetes than are

multiple daily injections of insulin.

The insulin pump was better at

reducing the daily variation in a

person’s blood sugar, eliminating

weight gain from insulin treatment,

reducing the frequency of low blood

sugar reactions, and improving

patients’ self-reported quality of life.

INFECTIOUS DISEASES

A completed CSP prospective study,

Evaluations of Corticosteorids for

Treatment of Severe Sepsis, followed

patients for eight years and showed

that even when patients recover

from infection, they continue to die

at a rate higher than expected and

the likelihood of dying is related to

how serious the infection was.

Treatments aimed at limiting

damage to vital organs in patients

with serious infections may save lives

by preventing long-term sequelae of

the infection and thus reduce health

care costs.

A planned CSP study, Trial of

Varicella Vaccine for the Prevention

of Herpes Zoster and its Complications, will examine whether immunization with live attenuated varicella

vaccine can reduce the incidence and

severity of herpes zoster and its

complications in elderly patients.

TRAUMA RELATED

IMPAIRMENT

AMPUTATION

A series of HSR&D studies among

diabetic veterans with foot ulcers

found footwear as the most frequent

initiating cause of an event leading

to amputation. These findings have

been incorporated into a number of

research and educational initiatives,

including the VA Diabetes Guideline

Project and the “Feet Can Last a

Lifetime” campaign by the National

Institutes of Health.

Rehabilitation researchers have

incorporated these findings into a

computer-aided design and manufacture system for footwear. The

resulting process has been successful

in reducing the number of incidents

leading to foot ulcers. A second

generation of customized footwear

is able to provide the same protection with more normative shoe

styles.

PROSTHETICS

An extended physiological proprioception controller designed to be

used as a position controller in the

operation of electric-powered upper

limb prostheses was developed and

clinically tested. The possibility of

independent, but coordinated

control of two electric powered

components in upper extremity

prostheses was demonstrated.

HIGHLIGHTS

CHRONIC DISEASES • TRAUMA RELATED IMPAIRMENT
A N N U A L R E P O R T 1 9 9 7 25

VA technology in computer-aided

design and manufacture for prosthetics was put in use by the

Prosthetic Research Foundation, a

non-profit group, to bring “American Limbs” to Vietnam and other

war-torn countries. Wijeyupta

Ellepola, RR&D Prosthetics

Program Analyst, has been asked by

this Foundation to study the

feasibility of establishing a similar

program in his native country of Sri

Lanka.

SPINAL CORD INJURY

Functional Electrical Stimulation

(FES) is a technology that allows

individuals with spinal cord injury to

exercise paralyzed muscles, control

bladder and bowel function, and

alleviate tissue breakdown. Researchers are studying use of FES in

helping individuals regain such

functions as grasping or even

walking. The first dual FES hand

grasping system was implanted in a

patient allowing for increased

function over previous implants in

one hand.

The recent development of the

Spinal Cord Dysfunction (SCD)

National Registry will provide

clinicians a demographic profile of

veteran patients with spinal cord

dysfunction. The profile provides a

comprehensive view of patient

health and functional status and

health care utilization for a range of

services, such as pharmacy, laboratory, and radiology. Because the

SCD National Registry consolidates

local data into a national database, it

has broad applications. For example,

doctors and other providers can use

the information to identify and

study certain populations; to

evaluate programs within their own

institution or practice; and they can

use the profiles to measure how

effective their program is in improving patients’ health and functional

status.

A Wheelchair Aerobic Fitness

Trainer (WAFT) for cardiovascular

assessment and conditioning has

been developed through VA RR&D.

This unit employs digital

echocardiography to provide a

unique and clinically useful

noninvasive method for the detection of coronary artery disease in

persons with spinal cord injuries.

The WAFT was featured in the 1996

Paralympics and Abilities Expo and

received strong positive response

from wheelchair athletes who

suggested it also had a role as a

valuable athletic training tool.

J OINT REPLACEMENT

Continuing investigations by

rehabilitation researchers revealed an

answer to the question of why many

polyethylene bearings in orthopedic

prostheses become fatigued and fail

earlier than laboratory testing would

indicate. The use of gamma radiation for sterilization of the polymer

components, a common process for

sterilization, resulted in initiation of

a breakdown process that continues

in the patient As a result, orthopedic manufacturers have altered their

modes of sterilization. In response

to a related study, orthopedic

manufacturers have modified their

design and manufacturing processes

based on findings of VA-funded

analysis of old components that

were removed from patients, to

document joint implant performance and failure modes.

HEALTH SYSTEMS

Building on an HSR&D collaborative effort with VHA’s Office of

Quality Management, the National

VA Surgical Quality Improvement

Program is a study that is examining

patient-specific factors that affect

post-surgical mortality and morbidity. The results will help the VA

identify high quality providers and

best practices to improve surgical

care.

HIGHLIGHTS

TRAUMA RELATED IMPAIRMENT • HEALTH SYSTEMS
26 V A R E S E A R C H & D E V E L O P M E N T

An HSR&D study has demonstrated

that patients should express their

preferences for life-sustaining

treatment in advance care directives.

The study found that physicians,

nurses, and spouses were unable to

accurately judge what in the

patient’s opinion, would constitute

“futile treatment.” A workbook,

Your Life, Your Choices, was developed to help patients personalize

their own advance directives.

Beginning in Fall 1997, VA launched a Technology Recommendations

Panel (TRP) to evaluate health care

technologies and make recommendations on their use. For instance,

the panel may evaluate a technology

(such as a therapy, procedure, or

treatment) to determine whether it

is an experimental or non-experimental treatment, or whether it is

clinically effective and cost-effective.

A CSP trial, A Multi-Site Randomized Trial of Team-Managed HomeBased Primary Care (HBPC), will

determine the cost-effectiveness of

team-managed HBPC versus

customary care for patients with

severe disabilities or who are

terminally ill. Results should be

helpful to determine the emphasis of

HBPC in the future.

Hughes S, Ulasevich A, Weaver F,

Henderson W, et al. Impact of home

care on hospital days: a meta-analysis.

Health Services Research, 1997.

MENTAL ILLNESSES

POST-TRAUMATIC STRESS

DISORDER

Post-traumatic stress disorder is a

clinical problem for veterans,

particularly for those who have seen

combat. Why some veterans are

more likely to suffer from PTSD

after combat than are others is not

known. Magnetic resonance imaging

(MRI), has been used to measure

volumes of specific brain areas of

patients with combat-related PTSD,

in combat-exposed patients without

PTSD, and in patients without

PTSD. Results indicate that the

volume of a particular area of the

brain associated with memory, the

hippocampus, is smaller in PTSD

patients than in patients without

PTSD. This difference may be useful

as a diagnostic indicator for those

individuals for the development of

PTSD upon combat exposure.

The Post-Traumatic Stress Disorder

(PTSD) Treatment Outcomes

Study, is one of the largest and most

carefully designed studies of a

psychotherapeutic treatment for

PTSD. This study will test a longheld but never demonstrated

hypothesis that a controlled “reliving” of trauma in a group setting

reduces stress disorder disabilities,

and may have important implications for treatment of this debilitating condition.

SCHIZOPHRENIA

Investigators have discovered a gene

that may carry a major part of the

risk for schizophrenia, a disabling

mental illness suffered by four

million Americans and one of the

most common causes of disabilities

among VA patients. The gene codes

a brain receptor for nicotine, perhaps explaining why schizophrenics

as a group are very heavy smokers.

Researchers studied a defect associated with schizophrenia—the

inability to screen out irrelevant

stimuli such as background sights

and sounds—by tracing the inheritance of the problem in nine families

with multiple cases of the disability.

They found the defect was linked to

the nicotine receptor gene, suggesting that drug or gene therapy that

targets the receptor may improve

symptoms for schizophrenics.

Freedman R, Coon H, Myles-Worsley

M, et al. Linkage of a neurophysiological deficit in schizophrenia to a

chromosome 15 locus. Proceedings of

the National Academy of Sciences 94:

587-92, 1997.

HIGHLIGHTS

HEALTH SYSTEMS • MENTAL ILLNESSES
A N N U A L R E P O R T 1 9 9 7 27

A completed CSP study, the Clinical

and Economic Impact of Clozapine

Treatment on Refractory Schizophrenia, showed the new drug

clozapine to be more effective than

haloperidol in treating schizophrenia. While much more costly than

haloperidol, clozapine led to fewer

hospital days—offsetting its higher

costs—and thus may be a more costeffective long-term treatment.

Rosenheck R, Cramer J, Xu W, et al.

A comparison of clozapine and

haloperidol in hospitalized patients

with refractory schizophrenia.

Department of Veterans Affairs

Cooperative Study Group on

Clozapine in Refractory Schizophrenia. New England Journal of

Medicine 337: 809-815, 1997.

A recent CSP study, Vitamin E

Treatment of Tardive Dyskinesia,

will determine the usefulness of

vitamin E in treating the side effect

“tardive dyskinesia,” disfiguring

facial movements caused by the use

of anti-psychotic medications.

Since 1988, three VA medical

centers—in West Haven, Connecticut; Denver, Colorado; and

Brockton, Massachusetts,— have

been studying the causes of and new

ways to treat schizophrenia.

A rehabilitation study demonstrated

that schizophrenic patients participating in a work-for-pay-program

designed as a therapeutic tool

showed increased self-esteem, had

less frequent hospitalizations and

longer periods of productive activity

between hospitalizations. Results of

this study will be applied to guidelines for planning programs in the

rehabilitation of schizophrenic

veterans.

SUBSTANCE ABUSE

A CSP study, Buprenorphone/

Naloxone for Treatment of Opiate

Dependence, will determine the

efficacy and safety of the combination drug Buprenorphone/Naloxone for use in treating individuals

addicted to opiates. The data from

this study will be used to support a

New Drug Application to the Food

and Drug Administration for the

combination product.

Four alcohol research centers

comprise the VA’s Alcohol Research

Center Program, which was established in 1989. The centers are

based in West Haven, Connecticut;

Omaha, Nebraska; and Denver,

Colorado. The VA-Yale Alcoholism

Research Center focuses on the

molecular mechanisms underlying

alcoholism and the development of

new drugs to treat veterans with the

disease. At the Omaha Research

Center for Basic and Clinical Studies

of Alcoholism 13 VA investigators

and 11 investigators from the

University of Nebraska Medical

Center and Creighton University are

studying how to prevent liver disease

and other immune system disorders

associated with alcoholism. At the

Denver center, eight investigators

are studying genes responsible for

alcoholism and alcoholic liver

disease. Current studies are aimed at

liver disease among alcoholic

women.

A CSP study, Colchicine in the

Treatment of Alcoholic Cirrhosis of

the Liver, is designed to assess

whether colchine prolongs life in

alcoholic cirrhosis patients and

reduces disease-associated illnesses

and improves liver functioning.

SENSORY LOSS

LOW VISION

Collaborations have led to the

development of numerous assistive

technologies, including the Low

Vision Enhancement System

(LVES), a portable headset with

miniaturized optics, video camera,

and electronic technology that

enhances image resolution for low

vision users. The Baltimore VAMC,

Johns Hopkins University, NASA,

and Polaroid Corporation developed

HIGHLIGHTS

MENTAL ILLNESSES • SUBSTANCE ABUSE • SENSORY LOSS
28 V A R E S E A R C H & D E V E L O P M E N T

this first-ever low vision assistive

product to allow users to simultaneously move freely about and

control their visual focus and

magnification.

The Kansas City Rehabilitation

R&D Team developed the use of

the scanning laser ophthalmoscope

in Low-Vision Rehabilitation. For

this work, they received the Olin E.

Teague Award given to the individual or clinical team in VA who

has had the most impact on the

rehabilitation of veterans.

Initial clinical trials of Liquid Crystal

Dark-Adapting Eyeglasses show

promise of improved acuity, contrast

sensitivity and assurance in traveling

for persons with low vision. Information from these trials has been

applied to developing prototypes for

commercial use.

AUDIOLOGY

Rehabilitation researchers began a

study designed to predict the success

or failure of prosthetic ossicular

reconstruction for patients with

hearing loss due to dysfunction of

the middle ear. The research will

utilize knowledge of the preoperative status of the patient and

the function of the eustachian tube.

Direct and indirect operative and

assessment techniques will be

involved.

A national research center in

Rehabilitative Auditory Research has

been established at Portland VAMC.

The Center’s primary objective is

the alleviation of communicative,

social, and economic problems for

veterans resulting from auditory

system impairment, sensorineural

hearing loss and tinnitus.

PERSIAN GULF

Beginning in 1994, three VA

medical centers—Boston VAMC,

East Orange VAMC, and Portland

VAMC—were selected to study the

effect of environmental hazards on

the health of Persian Gulf veterans.

The centers focus on a wide range of

neuropsychological, immunological,

pulmonary, neurological and

psychological health concerns of

Persian Gulf veterans and have been

established as part of a long-term

commitment to support environmental and occupational health

research. In FY 1997, the Louisville

VAMC was selected as the fourth

Environmental Hazards Research

Center. The Office of Research and

HIGHLIGHTS

SENSORY LOSS • PERSIAN GULF

Development also funds the population-based VA National Survey of

Persian Gulf Veterans. Phase I, a

mail survey of 30,000 deployed and

non-deployed veterans, has been

completed; Phase II, a telephone

follow-up and medical records

review of a subset of the 30,000 is

nearing completion; and Phase III,

which involves physical examinations

of approximately 5,000 veterans

from Phases I and II and their family

members, will commence in Spring

1998 under the auspices of the

Hines VA Cooperative Studies

Coordinating Center.
A N N U A L R E P O R T 1 9 9 7 29

The summary of 1997 Research and

Development Projects is organized by

research service, (Cooperative Studies,

Health Services Research and

Development, Medical Research, and

Rehabilitation Research and

Development), and then alphabetically

by investigator. The listing of projects for

Medical Research, the largest service

within the Office of Research and

Development, reflects only those projects

funded in the Fall 1996 merit review

round.

COOPERATIVE STUDIES

Vitamin E Treatment of Tardive

Dyskinesia

Adler, Lenard, M.D.,

Rotrosen, John, M.D.

$293,857

Reducing the Efficacy-Effectiveness

Gap in Bipolar Disorder

Bauer, Mark S., M.D.

$79,595

Multi-Site Study of Computer

Generated Reminders to Enhance

Adherence to Standards of

Ambulatory Care

Beauchamp, Charles, M.D.,

Demakis, John G., M.D.

$149,529

VA Non-Q-Wave Infarction

Strategies In-Hospital

(VANQWISH)

Boden, William E., M.D.

$351,342

The Clinical and Economic

Impact of Clozapine Treatment on

Refractory Schizophrenia

Charney, Dennis S., M.D.,

Rosenheck, Robert, M.D.

$73,420

Evaluation of GEM Units and

Geriatric Follow-up

Cohen, Harvey J. M.D.,

Feussner, John, M.D.

$1,003,181

Beta-Blocker Evaluation of Survival

Trial (BEST)

Eichhorn, Eric J., M.D.,

Domanski, Michael, M.D.

$847,062

Systemic Corticosteroids in COPD

Exacerbations (SCCOPE)

Erbland, Marcia L., M.D.,

Niewoehner, Dennis, M.D.

$418,794

Utilizing Computer Networks in the

Study of Disease: Refractory

Immune Thrombocytopenia Trial

Fiore, Louis, M.D.

$78,200

Warfarin and Aspirin in Secondary

Prevention

Fiore, Louis, M.D.,

Ezekowitz, Michael, M.D., Ph.D.

$1,872,496

Group Treatment of PTSD for

Vietnam Theater Veterans (TOP)

Friedman, Matthew J., M.D., Ph.D.,

Schnurr, Paula, Ph.D.

$882,973

Registry to Obtain Long Term

Patency Data on Saphenous

Vein and Internal Mammary

Artery Grafts

Goldman, Steven, M.D.

$181,167

Processes, Structures, and Outcomes

of Care in Cardiac Surgery

Hammermeister, K.E., M.D.,

Glover, Frederick, M.D.

$1,076,025

Oral Anticoagulant Therapy to

Improve Patency of Small Caliber

Prosthetic Bypass Grafts

Johnson, Willard, M.D.

$949,688

A Comparison of Subcutaneous and

Intravenous Administration of

Recombinant Human

Erythropoietin in Dialysis Patients

Kaufman, James S., M.D.

$54,455

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
30 V A R E S E A R C H & D E V E L O P M E N T

Antithrombotic Agents in the

Prevention of Hemodialysis

Access Thrombosis

Kaufman, James, M.D.

$3,558

Naltrexone in the Treatment of

Alcoholism

Krystal, John, M.D.,

Rosenheck, Robert, M.D.

$889,848

Natural History of Large Abdominal

Aortic Aneurysms

Lederle, Frank A., M.D.

$52,695

Aneurysm Detection and

Management (ADAM)

Lederle, Frank A., M.D.,

Wilson, Samuel E., M.D.

$1,460,408

Effect of Polyunsaturated Lecithin

on Liver Fibrosis

Lieber, Charles W., M.D.

$1,495,014

Prospective Evaluation of

Risk Factors for Large (> 1 cm)

Colonic Adenomas in

Asymptomatic Subjects

Lieberman, David, M.D.

$684,055

The Coronary Artery

Revascularization Prophylaxis Trial

(CARP Trial)

McFalls, Edward O., M.D., Ph.D.

$120,188

Colchicine in the Treatment of

Alcoholic Cirrhosis of the Liver

Morgan, Timothy R., M.D.

$1,139,608

Urgent Revascularization in

Unstable Angina (AWESOME)

Morrison, Douglass, M.D.,

Gulshan, Sethi, M.D.

$859,290

Treatment of Seizures in the Elderly

Population

Rowan, A. James, M.D.,

Ramsay, R. Eugene, M.D.

$221,970

The VA HDL Intervention Trial

(HIT): Secondary Prevention of

Coronary Heart Disease in Men

with Low HDL-Cholesterol and

Desirable LDL-Cholesterol

Rubins, Hanna, M.D., M.P.H.,

Robins, Sander, M.D.

$1,225,763

The Effects of Antiarrhythmic

Therapy in Maintaining Stability of

Sinus Rhythm in Atrial Fibrillation

Singh, Steven N., M.D.,

Singh, Bramah N., M.D., Ph.D.

$213,985

Comparison of Anterior and

Posterior Chamber Lens Implants

After Vitreous Loss in Attempted

Extracapsular Cataract Extraction

Smith, Thomas, M.D.

$479,778

A Genetic Linkage Study of

Schizophrenia

Tsuang, Ming, M.D., Ph.D.

$491,620

A Multi-Site Randomized Trial of

Team Managed Hospital Based

Home Care

Weaver, Frances, Ph.D.,

Cummings, Joan, M.D.,

Hughes, Susan, D.S.W.

$1,415,340

Costs and Outcomes of

Telephone Care Pilot

Welch, H. Gilbert, M.D., M.P.H.

$217,688

Normative Evaluation of a

Computer-Assisted

Neuropsychological Screening

Battery Pilot

White, Roberta, Ph.D.

$51,147

Prostate Cancer Intervention Versus

Observation Trial (PIVOT): A

Randomized Trial Comparing

Radical Prostatectomy versus

Palliative Expectant Management

for the Treatment of Clinically

Localized Prostate Cancer

Wilt, Timothy J., M.D., M.P.H.,

Brawer, Michael, M.D.

$805,703

The Iron (Fe) and Atherosclerosis

Study (FeAST) - Pilot

Zacharski, Leo R., M.D.

$23,800

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
A N N U A L R E P O R T 1 9 9 7 31

HEALTH SERVICES

RESEARCH AND

DEVELOPMENT SERVICE

Practice Patterns and Variations in

Care of VA Patients with Acute MI

AMI Center, West Roxbury

$238,100

Preventing Progression to Chronic

Back Pain

Atkinson, Joseph, M.D.

$157,300

Rehabilitation Issues of Concern for

Women with Spinal Cord Injuries

Bach, Carol Ann, Ph.D.

$23,625

HSR&D Developmental Project at

Providence, Rhode Island

Bauer, Mark, M.D.

$50,000

Quality of Life and Patient Utility

for Veterans with Prostate Cancer

Bennett, Charles, M.D., Ph.D.

$197,952

Pressure Ulcer Incidence Rates as a

Quality Measure for Long-Term

Care

Berlowitz, Dan, M.D.

$93,050

Quality Assessment in Ambulatory

Care: A Pilot Study

Berlowitz, Dan, M.D.

$37,890

Impact of Provider Substance Abuse

Education Guideline

Implementation

Berlowitz, Dan, M.D.

$41,735

HSR&D Developmental Project at

Baltimore, Maryland

Bradham, Douglas, M.D., Ph.D.

$49,834

Social Factors and Cardiac

Outcomes: A Prospective Study

Camberg, Lois, Ph.D.

$112,980

Cognitive-Behavioral Pain

Management and Health Outcome

Carmody, Timothy, Ph.D.

$20,783

Psychophysiology of PTSD in

Female Nurse Vietnam Veterans

Carson, Margaret, R.N., Ph.D.

$205,750

Reducing Lower Back Injuries in

VAMC Nursing Personnel

Caska, Barbara, Ph.D.

$113,050

Implementation and Impact of

Quality Improvement (QI) Practice

in VHA Hospitals

Charns, Martin, D.B.A.

$214,794

Reliability and Validity of a Health

Status Measure for Skin Disease

Chren, Mary, M.D.

$23,812

Effectiveness of Screening for

Prostatic Cancer: A Cohort Study

Concato, John, M.D.

$150,700

Risk of Mortality in Prostate Cancer

Concato, John, M.D.

$37,968

Educational Efforts to Reduce the

Cultural and Ethnic Variation in

Cardiac Procedure Use

Conigliaro, Joseph, M.D., M.P.H.

$15,375

Relationship of Race to

Cardiovascular Procedure Use at

VAMCs

Conigliaro, Joseph, M.D., M.P.H.

$81,567

Migration Patterns of U.S. Veterans

Cowper, Diane, M.A.

$51,000

Familial Patterns in Prostate Cancer

Cunningham, Glenn, M.D.

$134,375

Reproductive Health in Women

Veterans Related to Military

Experience and PTSD

DelJunco, Deborah, Ph.D.

$62,000

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
32 V A R E S E A R C H & D E V E L O P M E N T

SAFE-GRIP Fall/Injuries

Interventions: A Randomized Trial

Devito, Carolee, Ph.D., M.P.H.

$186,700

Nurse Counseling for Physical

Activity in Primary Care Patients

Dubbert, Patricia, Ph.D.

$97,125

HSR&D Developmental Project at

Omaha, Nebraska

Duckworth, William, M.D.

$50,342

A Follow-up Investigation

of the Effectiveness and Efficiency of

GEM Care

Engelhardt, Joseph, Ph.D.

$59,500

HSR&D Developmental Project at

Decatur, Georgia

Etchason, Jeff, M.D.

$32,900

Evaluation of Subacute

Rehabilitation Care

Evans, Ron, M.S.W.

$69,225

Ambulatory Care Quality

Improvement Project: ACQUIP

Fihn, Stephan, M.D., M.P.H.

$815,949

Schizophrenia Outcomes Module:

Enhancement and Field Testing

Fisher, Ellen, Ph.D.

$229,928

A Pilot Study: Effectiveness

of Telecare in the Management

of Diabetes

Gaehde, Stephen, M.D.,

Berlowitz, Dan, M.D.

$108,150

Gait and Balance Training in

Reducing Occurrence and Fear of

Falls in the Elderly

Galindo-Ciocon, Daisy, Ph.D.

$44,700

Dental Longitudinal Study

Garcia, Raul, D.M.D.

$200,000

Assessment of Respiratory Function

in Chronic Spinal Cord Injury

Garshick, Eric, M.D.

$87,263

Utility of PTF Data in Monitoring

Outcomes of Surgical Care

Geraci, Jane, M.D.

$88,214

The Association of Hospital

Complications and Process of Care

Geraci, Jane, M.D.

$34,511

Improved Management of Patients

with Chronic Airflow Obstruction

Goldman, Michael, M.D.

$37,900

Costs, Quality of Life and

Functional Outcomes in

Veterans Treated for MS with

Beta-Interferon 1-B

Guarnaccia, Joseph, Ph.D.

$117,450

Cocaine Abuse:

A Cognitive-Behavioral Intervention

Hall, Sharon, Ph.D.

$28,300

Ethnicity and Veteran Identity

as Determinants of VA

Ambulatory Care Use

Harada, Nancy, Ph.D.

$98,733

Effectiveness of Team Treatment of

Depression in Primary Care

Hedrick, Susan, Ph.D.

$56,548

Evaluating Quality of Care Screens

from Laboratory Databases

Hofer, Timothy, M.D.

$232,700

HSR&D Developmental Project at

Lexington, Kentucky

Holleman, Donald, M.D.

$93,767

Clinical Management and Outcomes

of Veterans with Strokes at VAMC

Horner, Ronnie, Ph.D.

$347,708

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
A N N U A L R E P O R T 1 9 9 7 33

HSR&D Developmental Project at

Charleston, South Carolina

Hutchinson, Florence, M.D.

$14,335

HSR&D Developmental Project at

Philadelphia, Pennsylvania

Johnson, Caroline, M.D.

$18,320

Oral Health and Quality of Life in

Older Veterans

Jones, Judith, D.D.S.

$176,800

Impact of Therapeutic Work

on Homeless, Substance

Dependent Veterans

Kashner, Michael, Ph.D.

$26,913

HSR&D Developmental Project at

Tucson, Arizona

Katz, Murray, M.D.

$72,435

Cultural Factors in Adaptation to

Chronic Illness

Katz, Murray, M.D.

$71,700

Health Related Quality of Life in

Veterans: A Pilot Study

Kazis, Lewis, Sc.D.

$669,560

Productivity and Labor

Requirements of VAMCs

Lehner, Laura, Ph.D.

$23,553

Mental Health Outcomes Associated

with Bosnia Peacekeeping Mission

Litz, Brett, Ph.D.

$27,534

Design and Validation of a VA

Clinical Dietetic Staffing Model

Lowery, Julie, Ph.D.

$33,200

Development of Individual-Patient

Physical Health Profiles with IRT

McHorney, Colleen, Ph.D.

$33,875

Practice Patterns in Care of

Chronically Mentally Ill and

Homeless Veterans

Mental Health Care, West Haven

$308,922

HSR&D Developmental Project at

Augusta, Georgia

Middelton, Henry, M.D.

$41,830

Utilization of Dental Resources by

VA HIV/AIDS Patients

Mohart, Robert, D.M.D.

$9,250

Determinants of VA and

Non-VA Health Care Use

among Elderly Veterans

Morgan, Robert, Ph.D.

$34,300

The Effects of Exercise Training in a

Frail Group of Older Veterans

Muelman, John, M.D.

$35,462

HSR&D Developmental Project at

Tampa, Florida

Nelson, Audrey, M.D.

$61,498

Race, Patient Preference and Stroke

Risk Reduction

Oddone, Eugene, M.D., M.H.Sc.

$98,733

Is Carotid Endarterectomy UnderUtilized in Black Patients?

Oddone, Eugene, M.D., M.H.Sc.

$33,325

A Multi-site Study of Strategies for

Implementing Schizophrenia

Guidelines

Owen, Richard, M.D.

$48,284

The Quality of Medication

Management for Schizophrenia

Owen, Richard, M.D.

$198,010

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
34 V A R E S E A R C H & D E V E L O P M E N T

Are Clinical Vignettes Better

than Chart Abstraction to

Measure Quality?

Peabody, John W., M.D., Ph.D.

$135,268

Development and Evaluation of an

Advance Care Planning Workbook

Pearlman, Robert, M.D., M.P.H.

$31,468

Evaluation of a Comprehensive

Advance Care Planning Intervention

Pearlman, Robert, M.D., M.P.H.

$78,797

Appropriateness and Necessity

of Cardiac Procedure Use after

AMI in VHA

Peterson, Laura, M.D., M.P.H.

$366,404

Factors that Influence the Demand

for Outpatient VA Services

Phibbs, Ciaran, Ph.D.

$101,350

Automated Calls with Nurse

Follow-up to Improve Diabetes

Ambulatory Care

Piette, John, Ph.D.

$139,771

Predicting Inpatient Service Use

among VA Substance Abuse Patients

Piette, John, Ph.D.

$68,400

HSR&D Developmental Project at

Columbia, South Carolina

Pillinger, Carole, M.D.

$47,890

VA and Non-VA Resource Use and

Outcomes in HIV Infected Men

Rabeneck, Linda, M.D.

$49,901

Effect of Activity on Sleep of

Cognitively-Impaired Veterans

Richards, Kathleen, Ph.D., R.N.

$39,725

Coronary Angioplasty Outcomes—

Veterans and the Private Sector

Ritchie, James L., M.D.

$75,741

HSR&D Developmental Project at

Cincinnati, Ohio

Roselle, Gary, M.D.

$44,474

Decline in Functional Status

as a Quality Indicator for

Long-Term Care

Rosen, Amy, Ph.D.

$41,600

A Regional Market-Based Analysis

of Patient Outcomes in a VA

Hospital

Rosenthal, Gary, M.D.

$110,200

A Casefinding and Referral System

for Older Veterans within Primary

Care

Rubenstein, Laurence, M.D.,

M.P.H.

$206,200

A Prospective Study of Patient

Preferences for Prostatic Cancer

Treatment

Schapira, Marilyn, M.D.

$101,894

The Impact of a Specific Drug

Program on Alcoholics

Schukit, Marc, M.D.

$148,974

Quality of Life in Women Veterans

Using VA Ambulatory Health Care

Skinner, Catherine, Ph.D.,

Kazis, Lewis, Sc.D.

$211,305

Objective Measurement of Daily

Activity in COPD

Steele, Bonnie, Ph.D.

$104,043

Causes of Protein-Energy

Undernutrition among Elderly

Patients

Sullivan, Dennis, M.D.

$122,074

Health Services Databases and Data

Quality Information

Swindle, Ralph, Ph.D.

$102,400

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
A N N U A L R E P O R T 1 9 9 7 35

An Integrated Model of Primary

Care in Mental Health

Swindle, Ralph, Ph.D.

$35,674

Computerized Guidelines Enhanced

by Symptoms and History: Clinical

Effects

Tierney, William, M.D.

$46,366

Defining the Attributes of the

Quality of Dying

Tulsky, James, M.D.

$7,069

HSR&D Developmental Project at

Buffalo, New York

Ventura, Marlene, R.N.

$28,995

Normative Aging Study

Vokonas, Pantel, M.D.

$405,000

HSR&D Developmental Project at

Iowa City, Iowa

Wakefield, Bonnie, Ph.D., R.N.

$46,230

Development of a VA Long-Term

Care Database

Weaver, Frances, Ph.D.

$80,403

Teledermatology: Diagnosing

Dermatologic Lesions by Digital

Imaging

Whited, John, M.D.

$35,800

Cultural Barriers to Access to VA

Blind Rehabilitation Services

Williams, Marjory, R.N.

$60,150

An Objective Indicator of Risk of

Developing a Pressure Ulcer

Wilson, Paulette, Ph.D.

$53,779

Female Veterans’ Perceptions and

Experiences in Accessing VHA Care

Wolfe, Jessica, M.D.,

Daley, Jennifer, M.D.

$136,625

Patient Preferences in End Stage

Prostate Cancer

Wray, Nelda, M.D., M.P.H.

$140,436

MEDICAL

RESEARCH SERVICE

Medical Research Service funded

1,221 projects in FY97, totalling

$98,856,745. The following listing

represents only those projects funded in

the Fall of 1996 Merit Review round.

Antigenicity of Human Prostatic

Proteins in Prostatic Cancer

Alexander, Richard, M.D.

$58,750

Pathophysiology of the Kidney in

Aging

Anderson, Sharon, M.D.

$49,450

Cortical control of Dynamic

Isometric Force

Ashe, James, M.D.

$37,900

Inhibition of B Cell Apoptosis by

CpG Oligodeoxyribonucleotides

Ashman, Robert F., M.D.

$50,000

Renal Biology of the Isoprostanes

Badr, Kamal F., M.D.

$50,000

Insulin Sensitivity, Vascular Tone

and Hypertension

Baron, Alain D., M.D.

$58,200

Low Renin Hypertension and All

Nuclear Receptors

Barrett, Jack D., Ph.D.

$75,400

Regulation of Intestinal Epithelial

Phenotype by Strain: An In Vitro

Model

Basson, Marc D., M.D., Ph.D.

$61,900

Paradigms of Molecular Mimicry

in Syphillis

Baughn, Robert E., Ph.D.

$72,900

Angiotensin-Adrenergic Interactions

in the Kidney

Blantz, Roland C., M.D.

$50,000

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
36 V A R E S E A R C H & D E V E L O P M E N T

Cognitive and Imaging Studies of

Older Adults with the ApoE-E4

Allele

Bondi, Mark W., Ph.D.

$98,900

Adrenergic Regulation of Cardiac

Calcium Channels

Boutjdir, Mohamed, Ph.D.

$104,550

Biology of Macrophage TransferrinIndependent Fe Uptake

Britigan, Bradley E., M.D.

$101,900

Prediction of Clinical

Pharmacokinetics/Dynamics using

Empirical Methods

Brier, Michael E., Ph.D.

$80,876

Mechanism of Degeneration of

Adrenergic Neurons in Alzheimer’s

Dementia

Burke, William J., M.D., Ph.D.

$50,000

Alternaria Asthma: A Model of

Airway Inflammation and

Hyperreactivity

Bush, Robert K., M.D.

$87,700

Attaching-Effacing Escherischia coli

as Vaccine Vectors

Cantey, Robert J., M.D.

$41,000

Calcium-mediated Signal

Transduction in Neutrophils

Clark, Robert A., M.D.

$100,750

Aggregated A/Beta in Alzheimer’s:

Behavior and Neural Effects in

Aging Rats

Cleary, James P. Ph.D.

$49,900

Control of Esophageal Motor

Function; Roles of Antioxidant

Enzymes and Superoxide

Conklin, Jeffrey L., M.D.

$52,500

Mechanisms of Induction of

Mucosal Immunity; Rotavirus

Model

Conner, Margaret E., Ph.D.

$67,100

Functional and Molecular

Characterization of an 18KD

Inhibitor Protein

Cooper, Jr., John Allen D., M.D.

$40,300

Age-related Mechanisms of Prostatic

Growth

Dahiya, Rajvir, Ph.D.

$50,900

Molecular and Cellular

Determinants of Immunity in

Histoplasmosis

Deepe, George S., M.D.

$49,800

Regulation of Neurohormones in

the Interstitial Fluid Space in the

Heart

Dell’Italia, Louis J., M.D.

$63,600

Control of Fetal Hemoglobin

Synthesis

DeSimone, Joseph, Ph.D.

$47,500

Structure, Function and Regulation

of Renal Potassium Channels

Desir, Gary V., M.D.

$48,900

Mechanisms of Virus Persistence in

Neurons

Dhib-Jalbut, Suhayl, M.D.

$47,050

Long-Term Effects of Psychologic

Stress on Memory and Hippocampal

Function

Diamond, David M., Ph.D.

$125,476

Structure-Function Analysis of

Rab5, a GTPase that Regulates

Endocytosis

Dickey, Burton F., M.D.

$99,250

Mechanism of Insulin Action

Draznin, Boris, M.D., Ph.D.

$104,000

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
A N N U A L R E P O R T 1 9 9 7 37

Regulation of Gene Expression in

Brain Injury and Recovery

Dwyer, Barney E., Ph.D.

$158,561

Alcohol-Induced Alterations in Sex

Steroid Receptor Function

Eagon, Patricia K., Ph.D.

$51,050

TGF/B Induced Mediators of the

Pathogenesis of Arthritis:VPF/

VEGF

Fava, Roy A., Ph.D.

$173,400

Electrophysiological Abnormalities

in PTSD

Fein, George, Ph.D., Neylan,

Thomas C., M.D.

$50,000

Mechanisms Mediating Insulin’s

Inhibition of Pancreatic Bicarbonate

Secretion

Fink, Aaron S., M.D.

$59,100

Induction of an Asthma-like

Disorder in the Mouse by IL-4 and

IL-5

Finkelman, Fred D., M.D.

$49,950

Serial CSF Studies in Combat

Veterans with PTSD

Geracioti, Thomas D., M.D.

$49,700

Parietal Cells, Transforming Growth

Factor-alpha and Gastric Mucosal

Homeostatis

Goldenring, James R., M.D., Ph.D.

$95,150

Pathogenesis of Gastroparesis: Role

of Inhibitory Nerves

Goyal, Raj K., M.D.

$89,150

Cell Specific Mitogens for

Engineered Re-Endothelialization

Greisler, Howard P., M.D.

$58,900

Genetic Deletion and

Recombination in Nasopharyngeal

Carcinoma

Gulley, Margaret L., M.D.

$35,300

Heparan Sulfate Proteoglycans in

Human Hematopoiesis

Gupta, Pankaj, M.D., M.B.B.S.

$29,050

Mechanisms of Group A

Streptococcal Adhesion and

Colonization

Hasty, David L., Ph.D.

$166,084

Chondrocyte Collagenases and

Cartilage Degradation

Hasty, Karen A., Ph.D.

$78,750

Molecular Characterization of

Receptor Mediated Uptake of

Naked DNA

Hefeneider, Steven H., Ph.D.

$124,488

Insulin and IGF Regulation of p38

MAP Kinase and Neuronal Survival

Heidenreich, Kim A., Ph.D.

$90,397

Mechanisms of Insulin Resistance in

Skeletal Muscle of NIDDM

Henry, Robert R., M.D.

$100,250

Genetics and Neuroleptic Response

Hitzemann, Robert J., Ph.D.

$135,093

Catecholamine Action in Aging

Hoffman, Brian B., M.D.

$35,300

Skeletal Fixation of Porous

Coated Devices

Hofmann, Aaron A., M.D.

$29,350

Pathobiochemistry of

Acute Lung Injury

Hoidal, John R., M.D.

$104,300

Molecular Mapping of the

Calcitonin Gene-Related Peptide

(CGRP) Receptor

Howard, Guy A., Ph.D.

$98,450

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
38 V A R E S E A R C H & D E V E L O P M E N T

Genetics of Superoxide Production

by Enterococcus faecalis

Huycke, Mark M., M.D.

$47,800

Paracrine and Autocrine Control of

Bone Cell Development by

Interleukin-11

Jilka, Robert L., Ph.D.

$139,389

Acute Pancreatitis Pathogenesis:

Studies in Surgical Models

Joehl, Raymond J., M.D.

$55,950

The Fetal Acetylcholine Receptor

and Myasthenia Gravis

Kaminski, Henry J., M.D.

$60,350

Singlet-Oxygen Production from

Cell-Membrane-Bound

Photosensitizers

Kanofsky, Jeffrey R., M.D., Ph.D.

$95,400

The Effects of Exercise Training on

Mental Stress-Induced Silent

Ischemia

Katzel, Leslie I., M.D., Ph.D.

$52,400

Molecular Changes in Brain Band 3

in Alzheimer’s Disease

Kay, Marguerite, M.D.

$149,350

Characterization of a Cloned

Receptor for Human CMV gH

Keay, Susan K., M.D., Ph.D.

$45,450

Skeletal Muscle Glucose Transport

and Phosphorylation in NIDDM

Kelley, David E., M.D.

$74,050

Colonic Sialyltransferase Expression

Lance, M. Peter, M.D.

$49,950

The Role of cAMP and Phosphatase

Cascade in LTP

Landau, Emmanuel M., M.D.,

Ph.D.

$50,200

The Role of the HOXC4

Homeobox Gene in Leukemia and

Prostate Cancer.

Lawrence, H. Jeffrey, M.D.

$97,950

Analysis of PTH and Dopamine

Receptor Signalling in Proximal

Tubules

Lederer, Eleanor, M.D.

$49,850

Signals that Regulate BCR/ABL

Leibowitz, David, M.D.

$62,250

Nicotinic Receptor Expression and

Mutation in Schizophrenia

Leonard, Sherry, Ph.D.

$125,988

Diaphragmatic Adaptation Elicited

by COPD in Man

Levine, Sanford, M.D.

$55,050

GMF as a Signaling Molecule

Lim, Ramon, M.D., Ph.D.

$71,000

Hepatitis B virus (HBV) Mutations

and Seronegative HBV Infections

Lok, Anna S., M.D.

$64,150

Metabolic Regulation of InsulinLike Growth Facator I Gene

Expression

Lowe, William L., M.D.

$73,800

The Aging Gut: Regulation of Cell

Proliferation

Majumdar, Adhip N., Ph.D., D.Sc.

$51,150

Mechanisms of Chemoprevention of

Mammary Carcinogenesis

Malejka-Giganti, D., Ph.D.

$50,000

Regulation of the Glial Responses to

Neuronal Injury

Mantyh, Patrick W., Ph.D.

$77,350

Vascular Smooth Muscle

Immortalization and Cell Cycle

Control

March, Keith L., M.D., Ph.D.

$54,750

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
A N N U A L R E P O R T 1 9 9 7 39

Predicting the Optimal

Pharmacotherapy for Outpatients

with Schizophrenia

Marder, Stephen R., M.D.

$53,200

SP-A Structure/Function

Relationships in Transgenic Mice

McCormack, Francis X., M.D.

$55,800

Contractile Regulation of

Cardiocyte Protein Synthesis

McDermott, Paul J., Ph.D.

$119,598

Altered Biliary C1- Channel

Regulation as a Mechanism of

Cholestasis

McGill, James M., M.D.

$42,950

Novel Approaches to Chemotherapy

of Cryptosporidiosis

Mead, Jan R., Ph.D.

$61,550

P16 Expression and Growth

Control in Melanocytic Nevi

Meyer, Laurence J., M.D., Ph.D.

$40,000

Regulation of Immune Responses

by Regulators of Complement

Activation

Molina-Vicenty, Hector D., M.D.

$38,750

Regulation of T-Cell Activation and

Cytokines in Autoimmune

Thyroiditis

Mullen, Helen B., Ph.D.

$71,150

Mechanism of Cytokine Action on

Bone Cells

Nanes, Mark S., M.D., Ph.D.

$83,900

Neutrophil Myeloperoxidase:

Structure, Function and

Biosynthesis

Nauseef, William M., M.D.

$87,300

Preclinical Studies of the BloodBrain Barrier and its Manipulation

Neuwelt, Edward A., M.D.

$49,600

Peptide Receptors and the Digestive

System

Nguyen, Toan D., M.D.

$57,500

Structure and Function of

Parathyroid Hormone Receptors

Nissenson, Robert A., Ph.D.

$122,550

Mechanism for Altered PlateletMediated Vasodilation in Diabetes

Mellitus

Oskarsson, Helgi J., M.D.

$60,300

Coordinate Regulation of

Cholesterol/Bile Acid Metabolism

Pandak, William M., M.D.

$56,600

Functional Significance of Multiple

Phosphorylation Sites on Rhodopsin

Peachey, Neal S., Ph.D.

$82,950

PET Study of Cerebral Blood Flow

During Traumatic Mental Imagery

in PTSD

Pitman, Roger K., M.D.

$108,800

Non-Insulin Dependent Diabetes;

Etiology and Pathophysiology

Porte, Jr., Daniel, M.D.

$99,000

Diabetes-Associated Insulin

Secretory Defects

Powers, Alvin C., M.D.

$57,400

Prognostic Factors in Renal Cell

Carcinoma

Presti, Jr., Joseph C., M.D.

$45,550

Interleukin-15: A Novel Anabolic

Cytokine for Skeletal Muscle

Quinn, Le Bris S., Ph.D.

$34,150

Alzheimer’s Disease and Aging:

Psychoneuroendocrinology

Raskind, Murray, M.D.

$123,750

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
40 V A R E S E A R C H & D E V E L O P M E N T

Development of Viscoelastic Probes

for Understanding the Mechanism

of Presbyopia

Ravi, V. Nathan, M.D., Ph.D.

$44,100

Cholecystokinin Mechanisms in

Control of Digestive Functions

Reidelberger, Roger D., Ph.D.

$119,211

Effects of Lung Volume Reduction

Surgery in the Treatment of Severe

Emphysema

Reinoso, Mauricio A., M.D.,

Jones, James W., M.D., Ph.D.

$36,550

LFA-1 Overexpression, T Cell

Autoreactivity and Lupus

Richardson, Bruce C., M.D., Ph.D.

$66,250

The Effect of Priming Combat

Memories on Marital

Communication

Riggs, David S., Ph.D.

$38,400

Role of CD8 T Lymphocytes in

Chronic Retrovirus Infection

Robbins, Deanna Sydney, Ph.D.

$101,306

Detection of Drug Resistant Cells in

Acute Leukemia

Ross, Douglas D., M.D., Ph.D.

$56,150

Myocardial Ischemia and

Inflammation

Rossen, Roger D., M.D.

$58,050

The Molecular Mechanism of Folate

Transport in Vascular Smooth

Muscle

Rubin, Stanley A., M.D.

$43,050

Basic Mechanisms in Hearing Loss

of Cochlear Origin

Ryan, Allen F., Ph.D.

$68,650

Dynamic Mechanisms Initiating

Temporal Lobe Seizures

Sackellares, James C., M.D.

$37,350

Leptin; Regulation by Sympathetic

Activity and Role in Energy

Expenditure

Scarpace, Philip J., Ph.D.

$49,500

Control Factors in B Lymphocyte

Growth Regulation

Schubach, William H., Ph.D., M.D.

$96,750

Computer-Assisted Infusion of

Drugs

Shafer, Steven L., M.D.

$86,350

Sphingolipids and the Cellular Stress

Response

Shayman, James A., M.D.

$26,500

Cholinergic and Monoaminergic

Influences on Sleep

Shiromani, Priyattam J., Ph.D.

$157,410

Noradrenergic Modulation of SleepRelated Seizures

Shouse, Margaret N., Ph.D.

$43,900

Neurochemical Prerequisites of

Sensitivity and Tolerance to Ethanol

Smith, Thomas L., Ph.D.

$25,150

Cardiovascular Surgery: Effects of

Heparin on Vascular Cells

Sobel, Michael, M.D.

$110,400

Calcium-Activated Potassium

Channels in Blood Cell Activation

Sullivan, Jr., Fred Richard, M.D.

$85,900

Regulation and Function of the

Alveolar Type 1 Cell Gene T1alpha/

OTS8

Thet, Lyn Aung, M.D.

$57,550

Neurobiological Properties of the

HIV-1 nef and tat Genes

Thomas, Florian P., M.D., Ph.D.

$81,700

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
A N N U A L R E P O R T 1 9 9 7 41

Molecular and Genetic Basis for

Viral Injury to Target Cells and

Host Tissues

Tyler, Kenneth L., M.D.

$68,800

Pro Atrial Natriuretic Peptides:

Physiologic and Therapeutic Effects

Vesely, David L., M.D., Ph.D.

$47,450

Alloreactivity to Donor Endothelial

Cells in Transplant Chronic

Rejection

Wagner, Cynthia R., Ph.D.

$140,079

Alcohol Neurotoxicity; Role of

Neurotrophic Factors

Walker, Don W., Ph.D.

$123,050

In Vivo Pharmacology of Delta

Opioid Receptors

Weinger, Matthew B., M.D.

$31,589

Transforming Growth Factor Beta

in Chlamydia Trachomatis Infection

Williams, Dwight M., M.D.

$43,950

Osteoblast Derived Phosphaturic

Factor in Hyp Mice

Yanagawa, Norimoto, M.D.

$46,300

Mechanisms of Mucolliary

Transport

Yeates, Donovan B., Ph.D.

$53,100

Molecular Mechanisms of

Hepatocarcinogenesis

Yeldandi, Anjana V., M.D.

$113,750

Therapy to Enhance Anti-Cancer

Immune Reactivity

Young, M. Rita, Ph.D.

$93,700

Stiffness in Hypertrophy-Role of the

Cardiac Cytoskeleton

Zile, Michael R., M.D.

$101,150

Neurologic Studies of Medial

Temporal Lobe Function

Zola, Stuart M., Ph.D.

$51,150

Cancer Metastasis and Angiogenesis:

Mechanism of Activation of

Progelantinase A

Zucker, Stanley, M.D.

$72,500

REHABILITATION

RESEARCH AND

DEVELOPMENT SERVICE

Factors Contributing to Older Adult

Disability in Rising from a Bed and

From the Floor

Alexander, Neil, M.D.

$124,046

Effect of Surgical Procedures on the

Stability of the Lumbar Motion

Segment

Andersson, Gunnar, M.D.

$108,011

Orthotics Design with Advanced

Materials and Methods

Armesto, David, M.D.

$50,000

Factors Affecting Time Between

CVA Onset and Rehabilitation in

the VA

Bates, Barbara, M.D.

$34,700

Skeletal Changes After Spinal Cord

Injury and Cast Immobilization

Beaupre, Gary S., Ph.D.

$136,300

Effects of Work Activity and

Cognitive Rehabilitation on

Schizophrenia: A Matching Study

Bell, Morris, Ph.D.

$212,000

Rehabilitation Effects of Pay,

Activity and Support on

Schizophrenia

Bell, Morris, Ph.D.

$183,700

Development of a Data Base of

Cane Techniques

Blasch, Bruce, Ph.D.

$96,300

The Effect of Hydrostatic Pressure

on Intervertebral Disc Metabolism

Boden, Scott, M.D.

$179,300

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
42 V A R E S E A R C H & D E V E L O P M E N T

Synergy of Osteoinductive Protein

and Electric Stimuli for Spinal

Fusion

Boden, Scott, M.D.

$146,500

Neuroprosthetic Control of Bladder

and Bowel in Spinal Cord Injury

Patients

Bodner, Donald R., M.D.

$193,700

Minimizing Falls in the Elderly

Boninger, Michael L., M.D.

$87,800

Quantification of Prosthetic

Treatment Outcomes

Boone, David, C.P.

$219,255

Investigation of Dynamic Prosthetic

Function: Flexibility

Boone, David, C.P.

$221,058

Development and Pilot Testing of

Plantar Ulcer Healing Boot

Boone, David, C.P.

$49,826

Exercise Program Designs for Older

Adults

Boyette, Lisa W., M.Ed.

$103,175

A Prospective Study of Plantar Foot

Pressure and Diabetic Foot Ulcer

Risk

Boyko, Edward, M.D.

$189,200

Long Term Strength Training and

Functional Status in Older Adults

Brandon, L. Jerome, Ph.D.

$168,150

Obstacle Avoidance Training with

Computer Simulated Environments

Brown, David, Ph.D.

$50,000

Graded Weight-Bearing Exercise for

Improving Ambulation after Stroke

Brown, David, Ph.D.

$101,700

Mechanically Assisted Upper Limb

Movement for Assessment and

Therapy

Burgar, Charles G., M.D.

$98,400

Differential Pressure Walking

Assistance

Burgar, Charles, M.D.

$69,400

Limb Manipulation Under Patient

Control: A Pilot Study

Burgar, Charles, M.D.

$49,700

Feasibility of Priming to Predict

Cuing-Responsiveness in Aphasia

Therapy

Bushell, Camille, Ph.D.

$19,100

Pilot Study to Model Tendon

Development, Adaptation, and

Regeneration

Carter, Dennis, Ph.D.

$39,200

Stimulation of Bone Healing Using

Bone-Matrix Related Biomaterials

Chakkalakal, Dennis, M.D.

$119,200

Generalized EPP Position

Controller for Electric-Powered

Upper-Limb Prostheses

Childress, Dudley, Ph.D.

$160,000

Finite Element and Gait Analysis:

Tools for Prosthesis Design

Childress, Dudley, Ph.D.

$194,000

Technology Transfer of a Computer

Aided Socket Fabrication Technique

Childress, Dudley, Ph.D.

$181,958

Out of Laboratory FeedbackControlled FNS for Locomotion

Chizeck, Howard J., D.Sc.

$407,600

Age Variance in Nystagmus

Suppression: A Pilot Study

Cobb, Frederick, Ph.D.

$27,800

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
A N N U A L R E P O R T 1 9 9 7 43

The Examination of Explanted,

Uncemented Orthopaedic

Prostheses

Collier, John P., D.E.

$142,436

Quantitative Posturography: AgeRelated Changes in Postural

Stability

Collins, James, Ph.D.

$155,522

Characterizing Postural Stability in

Relation to Age and Susceptibility to

Falling

Collins, James, Ph.D.

$165,067

Behavioral and Functional Problems

in Dementia Patients with Sensory

Loss

Connell, Bettye Rose, Ph.D.

$178,584

Manual Wheelchair User Upper

Exremity Pain

Cooper, Rory A., Ph.D.

$207,200

Design and Selection Guidelines for

Wheelchair Ride Comfort

Cooper, Rory A., Ph.D.

$175,600

Measurement and Prediction of

Benefit from Amplification

Cox, Robyn, M., Ph.D.

$179,200

Restoration of Forearm and Elbow

Functions by FNS

Crago, Patrick E., Ph.D.

$244,800

Recurrence of Bacteriuria and

Progress to Symptomatic UTI in

SCI Patients

Darouiche, Rabih O., M.D.

$113,900

UTI Prophylaxis Using Bacterial

Interference Following SCI

Darouiche, Rabih, M.D.

$116,709

Musculoskeletal Complications of

Spinal Cord Injury

Deftos, Leonard, J., M.D.

$106,100

Computerized Adaptive Methods

for Selecting Hearing Aids

Dirks, Donald, Ph.D.

$142,181

Gait Mechanics of the Partial Foot

Amputee

Dorostkar, Mohammad G., M.D.

$253,319

Quantifying Spoken Language

Handicap in Aphasia

Doyle, Patrick, Ph.D.

$129,200

Post-Stroke Rehabilitation Pilot

Study

Duncan, Pamela, Ph.D.

$49,600

Characterizing Measures of Stroke

Rehabilitation Outcomes

Duncan, Pamela, W., Ph.D.

$219,300

Effects of Aging on Motor Unit

Firing Behavior

Erim, Zeynep, Ph.D.

$160,094

Biochemical Analysis of Synovial

Activation in Joint Dysfunction

Evans, Christopher H., Ph.D.

$109,800

Development of an Automated

Technique for the Clinical

Evaluation of Tinnitus

Fausti, Stephen A., Ph.D.

$79,800

Early Detection of Hearing Loss

Due to Ototoxic Agents by HighFrequency

Fausti, Stephen, Ph.D.

$245,000

Effect of Supported Standing and

Upper Body Exercise on Lower

Extremity Spasticity in Persons

with Spinal Cord Injury

Fehr, Linda S., M.S.

$93,500

Optokinetic Testing for Diagnosis

and Rehabilitation of Balance

Disorders

Fowler, Cynthia G., Ph.D.

$105,500

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
44 V A R E S E A R C H & D E V E L O P M E N T

A Study to Determine the

Biomechanical Effects of ShockAbsorbing Pylons

Gard, Steven, Ph.D.

$100,400

Development of an Assistive Device

for Severely Amnesic Patients

Goldstein, Gerald, Ph.D.

$49,700

Development of Improved Middle

Ear Prostheses

Goode, Richard, M.D.

$75,600

N-Acetyl-Aspartate: A Predictor of

Outcome in Neuro-Rehabilitation

Graham, Steven H., M.D.

$161,818

Cortical Sensorimotor

Reorganization in Spinal Cord

Injury

Green, Joseph, M.D.

$50,000

Soft Tissue Attachment to Proximal

Femoral Allografts for Hip Revision

Heiner, John P., M.D.

$207,500

Functional Restoration of Grasp in

Quadriplegia

Hentz, Vincent R., M.D.

$139,900

A Study of VA Stroke Rehabilitation

Services and Patient Outcomes

Hoenig, Helen M., M.D.

$50,800

Prevention of Recurrent Pressure

Ulcers after Myocutaneous Flap

Holmes, Sally, M.D.

$59,300

Changes in Auditory Abilities with

Hearing Aid Use

Holte, Lenore, Ph.D.

$94,700

Development Enhancement and

Application of the DVA ProstheticOrthotics Optical Digitizer

Houston, Vern L., Ph.D.

$212,880

Clinical Testing of the Enhanced

VA-Cyberware BK Prosthetics

Optical Digitizer

Houston, Vern, Ph.D.

$281,460

Orthopedic Footwear CAD/CAM

and Diabetic Risk of Pedal

Ulceration

Houston, Vern, Ph.D.

$477,314

Spinal Cord Injury - Induced Bone

Loss

Howard, Guy A., Ph.D.

$77,200

Disuse Induced Articular Cartilage

Atrophy, Over Exercise and Arthritis

Howell, David, M.D.

$91,500

Cause of Male Infertility After

Spinal Cord Injury and Its

Prevention

Huang, Hosea F.S., Ph.D.

$178,060

Quantitative Study and

Augmentation of Cough in Persons

with Spinal Cord Injury

Jaeger, Robert, Ph.D.

$79,700

Treatment of Sciatic Nerve Injury

with Gonadal Steroids

Jones, Kathryn J., Ph.D.

$99,700

Gonadal Steroids as Rehabilitative

Agents After Partial

Spinal Cord Injury

Jones, Kathryn, Ph.D.

$127,200

Electric Fields and Carbon Fibers in

the Treatment of Spinal Cord Injury

Kahn, Talat, Ph.D.

$189,000

Enhanced Carbon Filament

Prostheses As Substrates For

Regrowth of Injured Spinal Cord

Kahn, Talat, Ph.D.

$129,800

Electric Field Effects on Slow

Axonal Transport Components in

SCI

Kahn, Talat, Ph.D.

$174,900

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
A N N U A L R E P O R T 1 9 9 7 45

Frequency Selectivity Assessment:

Implications for Auditory

Rehabilitation

Kane, James, Ph.D.

$87,300

Transport of NGFs + MIF-1 into

Spinal Cord

Kastin, Abba J., M.D.

$182,548

Assessing Information Masking in

Listeners with Sensorineural

Hearing Loss

Kedd, Gerald, Ph.D.

$50,000

Fracture Occurrence and Healing in

Spinal Cord Injured Patients

Kiratli, Beatrice, Ph.D.

$86,900

The Effects of Spinal

Instrumentation

Kirkpatrick, John, M.D.

$85,225

Polestriding Exercise and

Vitamin E for Management of

Claudication Pain

Langbein, W. Edwin, Ph.D.

$115,300

Physical Exercise Strength Training

to Improve the Health of Dialysis

Patients

Leaf, David, M.D.

$98,250

Comparison of Lower Extremity

Artery Size in Men and Women with

and without Peripheral Vascular

Disease

Lee, Bok, M.D.

$25,000

Biomechanics of Patellofemoral

Joint and Peripatellar Retinaculum

Lee, Thay Q., M.S.

$41,500

Effect of the Bankart Lesion on

Anterior Joint Stability with

Simulated Glenohumeral Muscle

Forces

Lee, Thay Q., M.S.

$41,500

Physiological Basis of Strength

Following Surgical Tendon Transfer

Lieber, Richard L., Ph.D.

$210,500

High-Frequency Magnetic

Stimulation of the Bladder and

Bowel

Lin, Vernon W., M.D.

$127,700

Acute Effects of Spinal Cord Injury

on Sperm Function

Linsenmeyer, Todd, M.D.

$99,100

Eustachian Tube and Middle-Ear

Prosthesis Implants: Chronic Ear

Disease

Linstrom, Christopher, M.D.

$222,084

Quantitative Measurement of Upper

Limb Spasticity

Little, James, M.D.

$38,600

A Biodegradable Device for

Peripheral Nerve Repair

Madison, Roger, Ph.D.

$141,500

Development of Scanning Laser

Opthalmoscope for Low Vision

Rehabilitation

Maino, Joseph H., O.D.

$293,700

Design of a Motorized Prone Cart

Malassigne, Pascal

$113,800

Factors Leading to Disuse of Low

Vision Devices by Visually Impaired

Elderly

Mancil, Gary L., O.D.

$215,981

Use of Tretinoin to Prevent Pressure

Ulcers in Spinal Cord Injury

Patients

Markowski, Janusz, M.D.

$55,800

Problem Solving Strategies of Brain

Injured and Normal Subjects

Marshall, Robert C., Ph.D.

$67,700

FES Mobility in Paraplegia: RFControlled Implanted System

Marsolais, E. Byron, M.D.

$650,600

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
46 V A R E S E A R C H & D E V E L O P M E N T

Low Vision Enhancement System

(LVES)

Massof, Robert W., Ph.D.

$535,800

Vision Evaluation and Training

System

Massof, Robert, Ph.D.

$230,600

A Pilot Study of Muscle Strength

and Functional Performance in

Parkinson’s Disease

Mathews, Thomas, M.D.

$50,000

Long-term Evaluation of Maxillary

Sinus Bone Grafts with Dental

Implants

McAnear, Jon Tom, D.D.S.

$24,120

An In-Vivo Model for Cartilage

Regeneration

McGuire, Jr., Hunter H., M.D.

$116,300

Development of Quality of Life

Measures for Use in Dysphagia

McHorney, Colleen, Ph.D.

$88,100

Performance-Based Prevention/

Rehabilitation of Falls in Elderly

Veterans

Means, Kevin M., M.D.

$128,633

Establishing Standard of Care:

Upper Limb Prosthetic Services

Monda, Trilok N., M.D.

$82,032

Electrical Activation of the

Diaphragm for Ventilatory Assist

Mortimer, J. Thomas, Ph.D.

$259,500

A Minimal Test Effort for Patients

in Pain Using the Back Analysis

System

Oddsson, Lars, Ph.D.

$181,176

Optimized Surface Bonding and

Stiffness of Femoral Endoprostheses

Orr, Tracy, Ph.D.

$99,994

Compliance Monitor to Measure

Patient Wearing-Time for Spinal

Orthoses

Patwardhan, Avinash, G., Ph.D.

$75,100

Microphotodiode Tiles as Prostheses

for the Restoration of Visual

Function

Peachey, Neal, Ph.D.

$154,880

Functional Neuromuscular Systems

for Upper Extremity Control

Peckham, P. Hunter, Ph.D.

$393,600

Improvements in a New Technique

for Increasing Movement After

Stroke

Pidikiti, Rama, M.D.

$123,600

Exercise Testing and Training of

Multiple Sclerosis Patients

Ponichtera-Mulcare, Janet A., Ph.D.

$154,600

Effects of Medications on Spasticity

in Spinal Cord Injury

Priebe, Michael, M.D.

$163,000

Evaluation of Non-Auditory Factors

Which Affect Hearing Aid Use in

Elderly Veterans

Rappaport, Bruce Z., Ph.D.

$98,500

Clinical Trial of Footwear in Patients

with Diabetes

Reiber, Gayle, Ph.D.

$535,617

Colonic Rehabilitation with

Microstimulators after Spinal Cord

Injury

Riedy, Lisa, Ph.D.

$124,200

Fecal Incontinence Treatment in

SCI Patients

Riedy, Lisa, Ph.D.

$49,450

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
A N N U A L R E P O R T 1 9 9 7 47

Effects of Age on Oropharyngeal

Swallowing

Robbins, JoAnne, Ph.D.

$173,600

Back Exercise Prescription and

Implementation by Surface

Electromyographic Procedures

Roy, Serge H., Sc.D.

$223,426

Effect of Component Placement on

the Patellofemoral Joint in TKA

Rubash, Harry E., M.D.

$67,300

Restoration of Gait for Acute Stroke

Patients Using FES

Ruff, Robert, M.D.

$127,000

Clinical Trial of Artificial Peripheral

Nerve Graft

Sabelman, Eric, Ph.D.

$182,800

Comparison of Semi-Synthetic and

Antologous Connective Tissue

Grafts

Sabelman, Eric, Ph.D.

$50,000

Reliability and Validity of

Accelerometric Gait and Balance

Diagnosis

Sabelman, Eric, Ph.D.

$186,100

Is There an Acclimatization Effect

with Hearing Aids?

Sammeth, Carol A., Ph.D.

$52,761

Biomechanics of Foot Deformities

and Alternatives for Surgical

Correction

Sangeorzan, Bruce, M.D.

$91,600

Fatigue Strength of Composite

Femoral Components for Hip

Arthroplasty

Schutte, Jr., H. Del, M.D.

$126,600

FES on Spinal Cord Injured

Patients: Effects on Muscle Blood

Flow and Metabolism

Scremin, A.M. Erika, M.D.

$148,000

The Role of Imagery in Auditory

Comprehension in Brain Damaged

Adults

Selinger, Marilyn, Ph.D.

$60,100

Evaluation of Word-Recognition

Performance with Sentence

Materials

Shanks, Janet E., Ph.D.

$172,300

Computer-Aided Wheelchair

Prescription System (CAWPS)

Shapcott, Nigel, M.Sc.

$173,800

Acclimatization in Monaurally Fitted

Adults

Silman, Shlomo, Ph.D.

$168,203

Treatment Strategies in Spinal Cord

Injury Role of Spinal Blood Flow

Sloan, Tod B., M.D.

$34,000

Mechanical Loading Effects on

Cartilage Repair and Regeneration

Smith, Robert Lane, Ph.D.

$107,600

Randomized Controlled Trial of

Upper-Extermity Exercise Training

in Patients with Chronic

Obstructive Pulmonary Disease

(COPD)

Sparrow, David, D.Sc.

$137,000

Modification of Polyethylene to

Improve the Wear Performance of

Joint Replacement Prostheses

Spector, Myron, Ph.D.

$90,792

Developing Veterans Administration

Rehabilitation Related Groups: A

Pilot Study

Stineman, Margaret, M.D.

$49,838

Team Characteristics and Patient

Outcomes on VA Rehab Services

Strasser, Dale, M.D.

$181,820

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
48 V A R E S E A R C H & D E V E L O P M E N T

Vertebral Fusion by New

Osteogenic Agents to Accelerate

Rehabilitation

Strates, Basil S., M.D.

$80,700

Cortical Contributions to the

Recovery of Motor Function

Strick, Peter, Ph.D.

$240,200

Evaluation of Central and Peripheral

Vision Enhancement Devices for

Driving

Szlyk, Janet P., Ph.D.

$233,300

Computer Assisted Speech

Rehabilitation System

Till, James A. Ph.D.

$112,800

Video-Based Functional

Performance Assessment and

Training Tool

Van Der Loos, H.F. Machiel, Ph.D.

$39,500

Development of an Assistive Robot

for Effective Health Care Delivery

Van Der Loos, H.F., Ph.D.

$150,500

An Interactive Video System to Test

and Treat Nonliteral Language

Disorders

Van Lancker, Diana, Ph.D.

$89,918

Personal Relevance and Ethnicity in

Stoke Patients as a Health Care

Delivery Issue

Van Lancker, Diana, Ph.D.

$49,900

Prophylactic Monitoring of Bladder

Pressure and Volume

Walter, John S., Ph.D.

$114,200

Analysis and Treatment of Apraxic

Sound Errors

Wambaugh, Julie L., Ph.D.

$126,000

Measuring Low Vision Reading

Assessments Using a Scanning Laser

Ophthalmoscope

Watson, Gale R., M.A.Ed.

$125,700

A Study of Illumination Sources for

Low Vision Individuals

Watson, Gale R., M.A.Ed.

$93,000

Cultural Influence on Aphasia in

African Americans

Wertz, Robert, Ph.D.

$84,170

Noninvasive Recording of Bladder

Pressure in Elderly Males

Wheeler, John S., M.D.

$82,500

Predicting Real-World Visual

Problems in the Elderly from Vision

Tests

White, Janis, Ph.D.

$112,100

Improved Bone Cement Fatigue

Resistance Via Controlled Strength

Interfaces

Winter, William G., M.D.

$400,581

Immunological Responses to

Implant Biomaterials Following

Arthroplasty

Wooley, Paul H., Ph.D.

$197,000

Biological Responses in the

Pathogenesis of Aseptic Loosening

Wooley, Paul, Ph.D.

$265,900

SUMMARY OF FY 1997

RESEARCH AND DEVELOPMENT PROJECTS
A N N U A L R E P O R T 1 9 9 7 49

HEALTH SERVICES RESEARCH AND

DEVELOPMENT SERVICE

David A. Asch, M.D., M.B.A., Philadelphia, PA

Steven Asch, M.D., Los Angeles, CA

Charles L. Bennett, M.D., Ph.D., Chicago, IL

Brenda Booth, Ph.D., Little Rock, AR*

Samuel A. Bozzette, M.D., Ph.D.,

San Diego, CA

John Concato, M.D., M.S., M.P.H.,

West Haven, CT

Kendon Conrad, Ph.D., Hines, Il*

Jennifer Daley, M.D., Brockton, MA

Nathan R. Every, M.D., M.P.H., Seattle, WA

Alan M. Garber, M.D., Palo Alto, CA

Raul I. Garcia, D.M.D., Boston, MA

Jane Marie Geraci, M.D., Boston, MA

Megan Gerety, M.D., San Antonio, TX

Mary Goldstein, M.D., Palo Alto, CA

Catherine Hayes, D.M.D., Boston, MA

Susan Hedrick, Ph.D., Seattle, WA*

Timothy Hofer, M.D., M.Sc., Ann Arbor, MI

Susan Hughes, D.S.W., Seattle, WA*

T. Michael Kashner, Ph.D., M.P.H.,

Dallas, TX*

Lewis Kazis, Sc.D., Bedford, MA*

JoAnn Kirchner, M.D., Little Rock, AR

C. Seth Landefeld, M.D., Cleveland, OH

Richard A. Marotolli, M.D., M.P.H.,

West Haven, CT

Rudolf Moos, Ph.D., Palo Alto, CA*

Cynthia Mulrow, M.D., San Antonio, TX

Eugene Oddone, M.D., Durham, NC

Richard Owen, M.D., Little Rock, AR

Douglas Owens, M.D., M.Sc., Palo Alto, CA

Laura Petersen, M.D., M.P.H., Brockton, MA

Dawn Provenzale, M.D., Durham, NC

Linda Rabeneck, M.D., M.P.H., Houston, TX

Jaya Rao, M.D., Indianapolis, IN

Gary Rosenthal, M.D., Cleveland, OH

Paul Shekelle, M.D., Ph.D., Los Angeles, CA

Peter Ubel, M.D., Philadelphia, PA

Morris Weinberger, Ph.D., Indianapolis, IN*

H. Gilbert Welch, M.D., M.P.H.,

White River Junction, VT

John Williams, Jr., M.D., San Antonio, TX

Eric W. Young, M.D., Ann Arbor, MI

* HSR&D Research Career Scientist

MEDICAL RESEARCH SERVICE

Sherry L. Abboud, M.D., San Antonio, TX

Carlos Arteaga, M.D., Nashville, TN

Anthony L. Back, M.D., Seattle (Tacoma), WA

Raj Batra, M.D., West LA, CA

James M. Beck, M.D., Ann Arbor, MI

Peter Bloom, M.D., Baltimore, MD

Douglas Bremner, M.D., West Haven, CT

Mathew D. Breyer, M.D., Nashville, TN

David Calverley, M.D., Seattle, WA

Blas A. Carabello, M.D., Charleston, SC

Paul Christensen, M.D., Ann Arbor, MI

Melissa Clark, M.D., Nashville, TN

Robert J. Coffey, M.D., Nashville, TN

Mark E. Dibner-dun, M.D., Cleveland, OH

Dennis E. Doherty, M.D., Denver, CO

Michael Gaziano, M.D., Brockton, MA

Lois J. Geist, M.D., Iowa City, IA

Scott D. Gitlin, M.D., Ann Arbor, MI

Martin Gluck, M.D., Bronx, NY

Carla Greenbaum, M.D., Seattle, WA

Harry Greenberg, M.D., Palo Alto, CA

Kathleen Y. Haaland, Ph.D, Albuquerque, NM

Timothy G. Hammond, M.D.,

New Orleans, LA

Michael C. Heinrich, M.D., Portland, OR

Margaret Holyst, M.D., Columbia, MO

Karl P. Houglum, M.D.,

Salt Lake City, UT

Arif Hussain, M.D.,

Baltimore-Perry Point, MD

Frank F. Isik, M.D.,

Seattle-Am. Lake (Tacoma), WA

Randy H. Kardon, M.D., Iowa City, IA

Carolyn J. Kelly, M.D., San Diego, CA

Amy D. Klion, M.D., Iowa City, IA

Ruth Kohen, M.D., Seattle-Am.

Lake (Tacoma), WA

William Kovacs, M.D., Nashville, TN

Michael Kozal, M.D., Iowa City, IA

Arthur M. Krieg, M.D., Iowa City, IA

David K. Kusner, M.D., Iowa City, IA

Jeffrey Lawrence, M.D., San Francisco, CA

Steven R. Lentz, M.D., Iowa City, IA

Daniel E. MacDonald, M.D., Bronx, NY

Richard Macko, M.D., Baltimore, MD

Rama K. Mallampali, M.D., Iowa City, IA

Peter J. Mannon, M.D., Durham, NC

Stephen E. McGowan, M.D., Iowa City, IA

Catherine C. McGowan, M.D., Nashville, TN

Irvine G. McQuarrie, M.D., Cleveland, OH

Barbara E. Menzies, M.D., Nashville, TN

Joseph Moates, M.D., Nashville, TN

Joseph A. Murray, M.D., Iowa City, IA

Michael D. Norenberg, M.D., Miami, FL

James Oates, M.D., Charleston, SC

Terrence X. O'Brien, M.D., Charleston, SC

Bishr M. Omary, M.D., Palo Alto, CA

Dan Oren, M.D., West Haven, CT

John Peters, M.D., West LA, CA

Joseph Pisegna, M.D., West LA, CA

Barbara Ramlo-Halsted, M.D., San Diego, CA

Michael Reale, M.D., West Haven, CT

Robert Reilly, M.D., West Haven, CT

Jane Reusch, M.D., Denver, CO

George Sachs, M.D., West LA, CA

Barbara E. Scanley, M.D, West Haven, CT

Andrew V. Schally, Ph.D., New Orleans, LA

Jeremiah E. Silbert, M.D., Bedford, MA

Catherine Stehman-Breen, M.D., Seattle, WA

Richard T. Stravitz, M.D., Richmond, VA

William J. Talman, M.D., San Diego, CA

Roger H. Unger, M.D., Dallas, TX

Douglas E. Vaughan, M.D., Nashville, TN

J. Brice Weinberg, M.D., Durham, NC

Barbara W. White, M.D.,

Baltimore-Perry Point, MD

Margaret E. Wierman, M.D., Denver, CO

REHABILITATION RESEARCH AND

DEVELOPMENT SERVICE (1998)

Linda Auther, Ph.D., Nashville, TN

Carolynn Patten, M.S., P.T., Palo Alto, CA

Karen L. Perell, Ph.D., West Los Angeles, CA

Anne Strouse Carter, Ph.D.,

Mountain Home, TN

Research and Development Career

Development Awardees 1997
50 V A R E S E A R C H & D E V E L O P M E N T

VA Research and Development

Information

Copies of this annual report and other VA Research and Development

information are available on the World Wide Web at:

http://www.va.gov/resdev

Look under “What's New?” to see recent

additions to the R&D web page.

For additional information on

VA Research and Development activities,

contact:

Office of Research and Development (12)

Veterans Health Administration

Department of Veterans Affairs

810 Vermont Avenue, NW

Washington, D.C. 20420

(202) 273-8284
A N N U A L R E P O R T 1 9 9 7 51

High quality health care research in VA is possible because

of the cooperation of thousands of veteran patients.

Their partnership with VA investigators allows us to do research that

contributes to the health of veterans and the community at large.

We are deeply grateful to all veterans who have participated in our studies.

Our Thanks

To Veterans
Office of Research and Development (12)

Veterans Health Administration

Department of Veterans Affairs

810 Vermont Avenue, NW

Washington, D.C. 20420

(202) 273-8284