Learning to Care for Those in Harm’s Way
Sharon Holland 

Deputy Vice President for External Affairs 

and Managing Editor

Gwendolyn Smalls 

Chief, Media Affairs 

Master Sgt. Oshawn Jefferson 

NCOIC of VPE and Deputy Chief, Media 

Affairs 

Christine Creenan-Jones

Editor and Layout Design 

MC2 Brittney Cannady

Writer 

MC3 Laura Bailey

Writer 

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Esteemed physician delivers USU’s Packard Lecture

By MC3 Laura Bailey, writer 

On the cover 

Navy Lt. Cmdr. Carolyn Howard completed a medical 

mission in Haiti before enrolling in the Graduate School 

of Nursing at the Uniformed Services University. Read 

more about Howard’s life and career on page 6.

2 The Pulse · The Official USU Newsletter Courtesy photo 

Photo by Thomas Balfour 

 Dr. Brent James, executive 

director of the Institute for 

Health Care Delivery Research 

and the chief quality officer for 

Intermountain Health Care, 

was the 2014 keynote speaker at

the 29th Annual David Packard 

Lecture at the Uniformed Services University. 

 James, an internationally 

known medical expert in the 

field of clinical quality improvement, presented, “We Count 

Our Successes in Lives: The 

Best Clinical Result at the Lowest Necessary Cost.”

 “Higher quality is usually lower cost,” he said. “Fifty percent 

of all resource expenditures in 

hospitals are quality-associated 

waste.” 

 Recovering from preventable 

foul-ups, building unusable 

products, providing unnecessary treatments and simple inefficiency are all examples of 

quality-associated waste, according to James. 

 Other major themes of James’ 

talk were captured in three important lessons – “we count our 

successes in lives,” “better care 

is cheaper care,” and “there is 

nothing new here except the 

idea that it takes a team.”

 James’ message is substantiated by his impressive professional record, which includes 

recognition from the White 

House and Dartmouth Atlas for 

efficient operational costs that 

averages 30 percent less than 

his peers. Furthermore, James 

was also named one of the “50 

Most Influential Physician Executives in Health Care.” 

 “We were very fortunate to 

have Dr. James as this year’s 

Packard Lecturer. His address 

was provocative and motivating, especially during this time 

of fiscal challenges. Dr. James 

is a leading figure in American 

medicine whose career has focused on consistent and sustainable improvements in quality to improve patients’ experience and outcomes,” said USU 

President Dr. Charles Rice. 

Army Lt. Col. (Dr.) Justin Woodson, president of the Faculty Senate 

at the Uniformed Services University, presents a token of appreciation 

to Dr. Brent James, the university’s 2014 David Packard Lecturer.
March 24, 2014 3

 Most mental health disorders 

and suicidal ideation among U.S. 

Army soldiers start before enlistment, according to findings published in the March 3, 2014, 

online version of JAMA Psychiatry.

 The study findings are from 

the Army Study to Assess Risk 

and Resilience in Servicemembers, or “Army STARRS,” the 

largest study of mental health 

risk and resilience ever conducted among U.S. Army personnel.

 Army STARRS researchers, led 

by study co-principal investigators, Dr. Robert J. Ursano, 

chairman of the Department of 

Psychiatry at the Uniformed Services University, and Dr. Murray 

B. Stein, professor of Psychiatry 

and Family and Preventive Medicine at the University of California, San Diego, found that a majority (58.2 percent) of soldiers 

who ever thought of suicide had 

these thoughts before enlistment, 76.6 percent of soldiers 

with current mental disorders 

had onsets before enlistment, 

and nearly half (47 percent) of 

soldiers who ever made a suicide 

attempt did so for the first time 

before enlistment. Furthermore, 

nearly 60 percent of soldier suicide attempts can be traced to 

pre-enlistment mental disorders, which are more common 

among non-deployed U.S. Army 

soldiers than demographically 

similar populations of civilians 

(25.1 percent vs. 11.6 percent).

 These initial published findings include three papers that 

use different strategies to evaluate suicide risk and protective 

factors among service people, 

including an analysis comparing 

the prevalence of mental disorders among Army and civilian 

populations.

 “Some of the differences in disorder rates are truly remarkable,” said Ronald Kessler, 

McNeil Family Professor of 

Health Care Policy at Harvard 

Medical School and senior author of the paper on mental disorder prevalence. “The rate of 

major depression is five times as 

high among soldiers as civilians, 

intermittent explosive disorder 

six times as high, and PTSD 

nearly 15 times as high.”

 The most common disorders in 

the Army STARRS survey were 

attention-deficit hyperactivity 

disorder and intermittent explosive disorder, which is characterized by recurrent and uncontrollable anger attacks, Kessler 

said. The findings suggest that 

soldiers did not have higher 

rates of most “internalizing disorders” (anxiety disorders and 

depression) than civilians before 

enlistment, but rather developed 

high rates of these disorders only after they enlisted in the Army. The situation was different, 

though, for “behavioral disorders” (ADHD, IED, and substance abuse), which were much 

more common among young 

people who subsequently enlisted in the Army than those who 

did not and increased even more 

after enlistment. Nearly half of 

current soldier internalizing disorders and 80 percent of behavioral disorders started before 

enlistment.

 “These results are a wake-up 

call highlighting the importance 

of outreach and intervention for 

new soldiers who enter the Army 

with pre-existing mental disorders,” said Ursano.

 The second of the three Army 

STARRS papers appearing 

in JAMA Psychiatry revealed 

that 13.9 percent of soldiers considered suicide at some point in 

their lifetime, 5.3 percent made 

a suicide plan, and 2.4 percent 

attempted suicide, with between 

47 to 60 percent of these outcomes first occurring prior to 

enlistment. Prior mental disorders were found to be by far the 

strongest predictors of these suicidal behaviors.

 “It is striking that nearly 50 

percent of the soldiers who attempted suicide made their first 

attempt before joining the Army, 

as history of suicide attempts is 

asked about in recruitment interviews and applicants who report such a history typically are 

excluded from service,” said 

Matthew Nock, professor of Psychology at Harvard University 

and lead author of the STARRS 

report on soldier suicidality.

 Nock noted that the most practical implication of this finding 

might be for the Army to develop outreach and intervention 

programs for new soldiers based 

on the realization that a nontrivial proportion of new soldiers

come into the Army with a history of mental disorder and suicidality, and that they are not always forthcoming about these 

concerns during the recruitment 

process. Importantly, findings 

also show that that it is not only 

depression and PTSD that predict suicide attempts.

 The third JAMA Psychiatry article by lead author Michael Schoenbaum of the National Institute of Mental Health 

at the National Institutes of 

Health, examined the suicide 

and accident death rates in relation to basic socio-demographic 

and Army experience factors in 

the 975,057 regular Army soldiers who served between Jan. 1, 

2004 and Dec. 31, 2009, charting variations in the rates based 

on a variety of factors including 

sex, race, education level, and 

rank.

 Enhanced screening of applicants and expanded interventions to help new soldiers with 

mental disorders hold promise 

for reducing the high suicide 

rate in the U.S. Army.

Largest-ever study of mental health risk, resilience in Army personnel releases findings

By Sharon Holland, managing editor and deputy vice president for External Affairs
4 The Pulse · The Official USU Newsletter 

By Christine Creenan-Jones, editor

Congratulations to Marsha Howell for being the first person to correctly 

answer last issue’s Trivia Question: 

Who delivered the 34th commencement address at USU?

Her response, Bob Kerry, is correct. Kerry was a United States Senator and 

Congressional Medal of Honor recipient.

Countdown to Commencement

Trivia Answer #2

 Throughout history, brain injuries have presented challenges for military medicine. This is 

particularly true for brain injuries on the mild 

end of the spectrum, which have traditionally taken a backseat to some of the more severe and life 

threatening injuries common in combat. Furthermore, because mild brain injuries can result 

in cognitive and psychiatric disorders, rather 

than more visible injuries, they have largely been 

ignored in past conflicts.

 But new science over the past 10 years, and the 

wars in Iraq and Afghanistan, have catalyzed 

greater understanding about the effects of brain 

trauma and ways to heal these complex wounds. 

 Although progress is being made worldwide, the 

Uniformed Services University is leading the TBI 

charge with programs like the Center for Neuroscience and Regenerative Medicine. 

 The CNRM was established at USU by an act of 

Congress in 2008. Since then, it has catapulted 

novel TBI research by uniting creative minds with 

cutting-edge technology. 

 Dr. Ramon Diaz-Arrastia, the director of Clinical Research at the CNRM, oversees much of this 

work. He collaborates with investigators at USU, 

Walter Reed National Military Medical Center 

and the National Institutes of Health, and mentors junior scientists while leading his own TBI 

studies. The latter includes a pilot study to investigate the use of sildenafil citrate – or Viagra – to 

treat cerebral vascular reactivity after brain injury.

 “Blood vessels – like axons and neurons – are 

damaged by brain injury. But vascular disease is 

a relatively understudied area of TBI research, 

despite evidence that it is common,” said DiazArrastia. “We wanted to learn more about this 

problem, and study the use of sildenafil to potentiate the signaling of nitric oxide, which may correct the deficits of cerebral vascular reactivity 

common in patients with TBI.” 

 Insufficient production of nitric oxide when 

needed by the brain can lead to dizziness, fatigue, 

and memory loss. But Diaz-Arrastia’s sildenafilresearch is showing tremendous promise for mitigating these side effects of TBI across both short

and long-term trajectories.

 “Besides studying the immediate benefits of using sildenafil to improve blood flow, we’re also 

measuring any lasting clinical benefits,” he said. 

Diaz-Arrastia’s pilot study is complemented by 

dozens of research programs at the CNRM, which 

tackle TBI from every angle. 

 “Brain injury is complex. It can lead to many 

long-term complications, some of them very debilitating. But the science being done at the 

CNRM is incredibly exciting, and we’re finally 

making important headway for TBI,” said DiazArrastia. 

 Visit http://www.usuhs.mil/cnrm/ for more information about the CNRM.

Dr. Ramon Diaz-Arrastia

USU research closing knowledge gap on TBI

Courtesy photo
March 24, 2014 5

by MC2 Brittney Cannady, writer

Photo by Thomas Balfour

 Army Lt. Col. (Dr.) Brigilda 

Teneza was selected as the new 

commandant of the F. Edward 

Hébert School of Medicine at the 

Uniformed Services University 

in January. As commandant, 

Teneza serves as the senior military officer-in-charge of all assigned students to the School of 

Medicine. 

 As a 1997 USU alumna, Teneza 

believes her background will 

resonate with the students here.

 “I understand the hardships 

and stressors that USU students 

go through and I can empathize 

with them,” she said. “The fact 

that I’ve been here before makes 

the transition to this new position easier. It allows me to focus 

earlier on implementing programs that enhance the students’ training as military physicians.” 

 Teneza’s clinical and military 

experience from various assignments laid the groundwork for 

her return to USU in a leadership position. After graduating 

from USU, Teneza completed 

her pediatric residency at Tripler Army Medical Center in 

Honolulu. She also provided 

comprehensive healthcare to 

thousands of infants, children, 

and adolescents of military families at Fort Hood in Texas and

Fort Belvoir in Virginia. She 

served in various leadership capacities at these treatment facilities, such as inpatient pediatric 

chief, pediatric clinic chief, and 

pediatric service chief. In addition, Teneza taught pediatric 

and family medicine residents at 

these teaching facilities.

 Furthermore, Teneza was assigned to several units and participated in training exercises at 

Fort Hood and Fort Irwin in California. In 2006, she deployed

for one year and served as a supervisory medical officer for Detainee Healthcare at Camp 

Bucca, the largest detention 

camp in Iraq. Teneza was 

awarded the Bronze Star Medal 

for her service.

 Teneza returned to USU and 

received a Master in Public 

Health in 2009. She completed 

sequential residencies in preventive medicine and occupational/

environmental medicine in 2011 

and served as chief resident for 

the latter. Teneza is board certified in pediatrics, preventive 

medicine and occupational medicine.

 Prior to returning to USU this 

winter, Teneza served as assistant director of the Epidemiology and Analysis Division at the 

Armed Forces Health Surveillance Center in Silver Spring, 

Md. At AFHSC, Teneza supervised a robust health surveillance and analysis portfolio on 

military-relevant disease and 

injuries that affect the operational readiness of the U.S. 

Armed Forces. Many of these 

health surveillance and analyses 

are used by policy makers and 

military leaders at the Office of 

the Army Surgeon General, the 

Office of the Assistant Secretary 

of Defense for Health Affairs 

and Army Medical Command for 

their action to improve the 

health and readiness of America’s troops.

 Teneza’s new commandant position gives her the opportunity 

to continue shaping future military medical leaders by providing leadership and professional 

development support to students at USU with help from 

service-specific company commanders and senior enlisted advisors. 

 “As clinicians, it’s easy to focus 

on taking care of patients and 

we forget about things we need 

to do for ourselves to continue to 

progress in our military careers,” said Teneza. Helping 

students understand the importance of striving for excellence in their military careers 

and academics are the main 

goals for Teneza’s tenure as 

commandant. She also hopes to 

instill among the students a lasting sense of a deeper purpose 

that extends beyond USU.

 “When students leave USU, 

they represent this institution, 

their service, and the military. 

As military medical officers, we 

should always uphold professionalism and integrity, so I 

want the students to understand 

and appreciate the importance 

of military core values before 

they leave USU,” said Teneza.

USU welcomes new School of Medicine commandant

Army Lt. Col. (Dr.) Brigilda Teneza
6 The Pulse · The Official USU Newsletter 

Countdown to Commencement: A Look at the Class of 2014

Navy Lt. Cmdr. Carolyn Howard, Graduate School of Nursing

By MC3 Laura Bailey, writer 

 Some people grow up knowing 

they want to be a nurse. But, 

that’s not the case for everyone, 

including Navy Lt. Cmdr. Carolyn Howard – who didn’t realize her calling until some careful 

soul searching during her college years. 

 “I started out as a biology major with intentions to become a 

surface warfare officer upon 

graduation,” said Howard. “I 

had some interest in premedicine as well, but wasn’t sure 

if that was for me.” 

 Her focus shifted toward nursing when she started talking 

with fellow cadets who were 

pursuing the nurse option in the 

Naval Reserves Officer Training 

Corps program at the University 

of North Carolina at Chapel Hill. 

They talked about the evolving 

roles in nursing, and how members of this community were 

taking on greater responsibility. 

This, along with the ability to 

help another person feel better 

emotionally and physically, appealed to Howard. 

 “I think just having the chance 

to actually make a difference for 

somebody is really rewarding,” 

she said. “You may not remember a specific patient, but the 

patient will most likely remember you and how you made them 

feel.” 

 With new resolve, Howard 

switched to the nursing program 

at UNC and graduated with a 

Bachelor of Science in Nursing. 

 After serving as an active-duty 

nurse for eight years, she had 

the desire to return to school. 

But before Howard began pursuing a master’s degree in nursing, she went on her first mission trip to Haiti in 2012. 

 “Soon after returning from a 

deployment to Afghanistan, I 

felt a desire to do some good in 

the world, hopefully using my 

nursing skills,” said Howard. “I 

found a North Carolina church 

group that performed medical 

missions to Haiti every year, led 

by a family nurse practitioner. 

We set up clinics in various villages, seeing and treating the 

local people there.”

 The mission clinics in Haiti 

saw 2,000 patients in a sevenday period with three to four 

hundred patients being seen 

daily. Howard and other 

healthcare providers administered vitamins, basic over-thecounter medication, antibiotics 

and diabetes medications during 

the mission. 

 The mission experience and a 

desire to gain the expertise 

needed to better care for patients was the driving force behind her decision to enroll in the 

Family Nurse Practitioner program at the Daniel K. Inouye 

Graduate School of Nursing. 

 About midway through her 

program, Howard returned to 

Haiti in 2013 as a part of her 

clinical rotation, using some of 

the experience she gained at 

USU to improve patient care in 

an underserved community.

 “I feel like as a nurse practitioner I’ll have a lot more diversity in skills and ability to make 

a difference – more opportunities to be able to better assess 

and better treat patients to do 

more service,” she said. 

 Howard is gearing up for graduation in May, and she’s excited 

about her next duty assignment, 

but will miss the camaraderie at 

USU. Howard’s teachers have 

also positively influenced her 

experience on campus. 

 “The faculty is very supportive 

and gives us a lot of positive 

feedback and encouragement, 

even when we feel like we’re 

drowning,” said Howard. 

“They’re trying to make the program as good as possible for us 

students.”

 Howard is looking forward to 

her future as a nurse practitioner, where she’ll leverage all of 

her experiences and skills to improve military medicine. 

 “As a family nurse practitioner, I look forward to intertwining my previous nursing experience with my newly developed 

practitioner skills to provide the 

best kind of care for patients in 

need.” 

 Robert Carter, a materials handler in the Logistics Division, and Barbara Shelton, a program analyst in the Office of Accreditation and Organizational Assessment, were selected as the Junior 

and Senior Employees of the Year at the Uniformed Services University for 2013.

 Carter and Shelton were selected for this prestigious honor after previously being named Junior and Senior Employees of the Quarter for 

demonstrating exemplary dedication to workplace excellence.

 As Employees of the Year, Carter and Shelton 

received a 16-hour time off award.

Junior, Senior Employees of the Year selected

By Christine Creenan-Jones, editor 
March 24, 2014 7

By Christine Creenan-Jones, editor 

New guidelines for 

CAC replacement

 The Security Office at the Uniformed Services University routinely stresses the importance of 

safeguarding the Common Access Card, which provides access to Department of Defense 

computer networks and systems. 

 Because of the sensitive nature of the CAC, it should never 

be left unattended, but if it does 

get lost or stolen, USU’s Security Office must be notified immediately. Security staff members will provide USU personnel 

with the documentation needed 

to obtain a new CAC. A report 

will also be filed in the Defense 

Enrollment Eligibility Reporting System – a worldwide, electronic database managed by the 

Department of Defense.

 Beginning in April, this procedure, and the requirement to 

bring supporting documentation, will be enforced across the 

DoD, and noncompliant personnel will not be issued a new 

CAC.

 For more information about 

the CAC, visit 

http://www.cac.mil/. 

PMB faculty to serve on national Drowning 

Prevention Advisory Group

By Sharon Holland, managing editor 

 Dr. Deborah Girasek, associate 

professor and director of Social 

and Behavioral Sciences in the 

Department of Preventive Medicine and Biometrics at the F. Edward Hébert School of Medicine, 

was invited by the National Park 

Service Office of Risk Management to serve as a member of the 

newly-formed Drowning Prevention Advisory Group.

 Drowning is the leading cause 

of fatal injuries in national parks. 

Since 2008, there have been 

more than 400 deaths due to 

drowning-related incidents in 

the parks. This group will be 

comprised of NPS staff with expertise in emergency medical 

services, search and rescue, and 

water safety as well as national 

experts in drowning prevention 

from scientific organizations, academia and federal land management agencies. 

 Girasek was invited based on 

her many years of expertise in 

the field. During her graduate 

training, Girasek specialized in 

the social and behavioral aspects 

of unintentional injury prevention. While pursuing her doctoral 

degree at Johns Hopkins University, Girasek contributed to a 

study of boating and alcohol use. 

In 2002, she was asked to advise 

intramural researchers from the 

National Institute for Child 

Health and Development on the 

design of a major drowning prevention study.

 Since coming to the Uniformed 

Services University, Girasek has 

developed and evaluated an intervention designed to protect 

toddlers from drowning in residential swimming pools. The 

drowning prevention video that 

was created for that study was 

recognized by the International 

Safety Media Awards “for excellence in safety and injury prevention messages.” In 2007, she presented her 

work on 

persuading 

mothers 

with backyard pools 

to take infant/child 

CPR training at the 

World Water Safety 

Conference in 

Portugal. 

 Girasek 

was later asked to serve as an instructor for the National Park 

Service’s Public Risk Management Internship Training Program at Prince William National 

Park in Virginia. For the past 

two years, she has been collaborating with the Preventive Search 

and Rescue staff at Yosemite National Park to increase the understanding of when and why 

hikers leave the trail to approach 

water hazards. 

 “The Park Service is to be congratulated,” said Dr. Girasek, “for 

taking a data-driven approach to 

reducing visitor injuries. I am 

honored and excited to contribute to their efforts.”

 The Drowning Prevention Program was established to assist 

parks – at a national level -- to 

implement science-based drowning prevention efforts where 

there is high risk for waterrelated incidents caused by recreational activities in and around 

natural/open water sources such 

as lakes, streams, rivers and 

oceans. The program will provide 

park managers with technical 

assistance via the Drowning Prevention Advisory Group. The 

Group will provide input into the 

design, pilot, implementation 

and evaluation of park drowning 

prevention initiatives. 

Dr. Deborah Girasek

Courtesy photo

U.S. Air Force photo illustration

New regulations are being enforced for lost or stolen Common Access Cards, which includes contacting the Security 

Office at the Uniformed Services University before campus 

personnel can be issued a new 

CAC.
Final Frame

Naval Security Force officers subdue an “active shooter,” during the 

base-wide Active Shooter drill held at the Uniformed Services University, Feb. 27. 

Photo by Sarah Marshall, Walter Reed National Military Medical Center Public Affairs