Volume 10, Issue 21 n December 21, 2015

www.usuhs.edu

Learning to Care for Those in Harm’s Way

The Official USU Newsletter
2 the pulse December 21, 2015

On the cover

WRNMMC 3-D Medical Application Center 3-D Printing Service Medical Director 

Kevin Wurth monitors as layers of a 3-D 

print are created with lasers that shape material into the medical products. The 3-D 

prints will be used by WRNMMC doctors 

to aid in care, and products can be made to 

aid in patient quality of lifeSee story, page 4. 

(photo by Eric D. Ritter)

Sharon Holland

Deputy Vice President for External Affairs and Managing Editor

Eric Ritter

Writer and Editor

MC3 Laura Bailey

Writer and Photographer

Tom Balfour

Photographer

 

Production

Editorial content is edited, prepared and 

provided by the USU Office of External 

Affairs unless otherwise indicated. The 

Pulse staff may include or exclude articles based upon news value, impact on 

the university and space availability.

Submissions

The Pulse is published biweekly on 

Mondays. The deadline for submissions 

is at 4 p.m. Tuesday prior to the publication date. Submissions can be sent to 

eric.ritter2@usuhs.edu or by calling 301-

295-3791.

By Eric D. Ritter

USU obesity study now open to 

all children of service members

The Uniformed Services 

University’s (USU) Developmental 

Research Laboratory on Eating and 

Weight Behaviors at USU’s F. Edward Hebert School of Medicine is 

looking for adolescent military dependents for a volunteer program to 

help understand and prevent obesity and eating disorders in children 

of military members.

According to professor of 

Medical and Clinical Psychology 

and Director at the research lab, 

Marian Tanofsky-Kraff, Ph.D., obesity rates among children of military 

members is nearly parallel to the civilian population. Also, the rates of 

disordered eating in military adolescents may be high – or more problematic - than in civilian youth. In 

fact, previous data suggest that military personnel may be more likely to 

engage in disordered eating.

“Part of being in the military is ‘making weight’, and trying to 

control weight can sometimes lead 

to disordered eating behaviors," she 

said. “Since military dependents are 

more likely to go into the military, 

and many of them are boys, both 

male and female children of military 

parents may be at high risk for disordered eating.” 

Earlier this year, USU held a 

similar study, but it was only open 

to girls. However, prior research 

suggests that men in the military 

may have the same rates – or actually higher rates of disordered eating 

than military women. She said that 

data goes against data in the civilian 

world.

Interestingly, obesity and 

eating disorders often co-occur. She 

said this study is important, because 

it may help identify an approach to 

prevent both obesity and eating disorders. 

Obesity isn’t just a problem 

of the health of the dependent. Tanofsky-Kraff also said it is costing 

the Military Health System around 

$1 billion to treat morbidities associated with obesity. She also said 

identifying disordered eating in adolescence is important, because she 

has determined that many adults 

with eating disorders began in their 

adolescent years.

She said they believe one 

main factor military dependent 

children face more than civilian 

children is a higher level of stress.

“Adolescent military dependents can experience stress due to 

moving often, stress from their parent’s career and other disruptive factors,” she said. “This may cause them 

to overeat or use food to cope.”

Tanofsky-Kraff said she 

doesn’t believe those children from 

the military members are necessarily at a greater risk for an eating disorder, but the environment they are 

in can have an effect.

The study is ongoing and is 

in collaboration with Walter Reed 

National Military Medical Center (WRNMMC) and Fort Belvoir 

Community Hospital. Groups are 

being run at both sites and at Ft. 

Meade.

Some of the aspects she 

said the study will involve is weight 

tracking, disordered eating such 

binge eating or bulimic episodes, 

obesity-related physiological measures. The data collected will be 

used to help understand weight gain 

trajectories and prevent worsening eating problems and metabolic 

functioning among the dependents. 

To receive more information 

about volunteering, call 301-295-

1598. Qualified individuals who 

volunteer will be compensated for 

their time. 
3 the pulse December 21 2015

Avatars to offer new realism in training

Members of the class of 

2018--military medical students 

at the F. Edward Hébert School of 

Medicine (SOM) at the Uniformed 

Services University of the Health 

Sciences (USU)--will be the first to 

use a new simulated technology in 

January 2016. 

Since 2001, USU’s SOM students going through their Psychiatry clerkships in the National Capital Area have come weekly to the 

Val G. Hemming Simulation Center 

(SIMCEN) to train with paid actors 

who portray patients (standardized 

patients) visiting a simulated clinic. 

Standardized patients are the “gold 

standard” of simulated training, because they allow students to practice 

their clinical skills in a realistic and 

controlled environment with real 

people. However, paid actors can be 

costly, said Air Force Col. (Dr.) Rita 

L. DuBoyce, the principal investigator of the Virtual Patient (VP) project and senior director of clinical 

education at USU’s SIMCEN. Patient simulation is about to get even 

better for USU SOM students with 

the launch of VP, a computer program developed by the University of 

Southern California (USC) Institute 

for Creative Technologies (ICT). 

Using virtual human technology to create life-like avatars, 

the VP will train USU clinicians in 

interpersonal areas such as rapport, 

interviewing and diagnosis, much 

like standardized patients do, but 

without scripts to memorize, coaching for the actors and expensive 

hourly wages. 

In addition to cutting costs, 

other benefits include ease of access 

and variety. 

The future VP system will 

be delivered over the web and mobile devices such as tablets for easy 

and continuous training, according 

to the USC ICT website. Virtual patients will be available 24/7 and can 

portray a multitude of conditions 

that might be difficult for actors to 

represent or repeat with success. 

The fact students will be able 

to access the program easily is a big 

benefit, because it means more practice for the students, said Duboyce. 

“We want them to make all 

their mistakes here while they’re 

practicing so they can safely learn 

from them and avoid making those 

same mistakes with real world patients,” she said. “I think it could 

work really well for remedial instruction as well – for those students 

who may be struggling and need the 

extra practice. Also, having an array 

of characters available from elderly 

and young patients in different genders and cultures is really great.”

This technology is the wave 

of the future, said Duboyce. But even 

though VP is geared toward today’s 

generation of young, tech-savvy 

medical students, VP by no means 

replaces standardized patients. The 

two methods will work together 

and provide a more well-rounded 

learning experience for SOM students and ultimately give real-world 

patients a more prepared doctor in 

their time of need. 

“I think our students are 

really going to like using the program,” she added. “A lot of time has 

gone into the preparations for this 

launch – more than a year from start 

to finish, which included writing 

the grant proposal, waiting for the 

approval and funding, then authoring the program to depict certain 

scenarios for the students. I’m really 

excited to see how the students do 

with the addition of Virtual Patient. 

We plan to launch the program 

to our first batch of SOM students 

sometime in January 2016. The class 

of 2018 will be USU’s pioneers for 

the program, but I think in a fun 

way. I’m confident the program and 

the students will do well.”

By MC3 Laura Bailey

Air Force Col. (Dr.) Rita L. DuBoyce, the principal investigator of the Virtual Patient (VP) project and senior director of clinical education at USU’s 

SIMCEN monitors a simulation program used to aid in more realistic training 

for students. (Photo by MC3 Laura Bailey)
4 the pulse December 21, 2015

By Eric D. Ritter

USU, WRNMMC 3-D printing offers 

better quality of life for some patients

See 3-D, Page 5

3D Printing has quickly gone 

from something out of a science 

fiction movie to something that 

is printing things we either come 

across on a daily basis or can conceptualize on a computer screen.

Numerous applications have 

been developed in the 3-D printing 

field such as every day household 

items, prosthetic limbs and even animal and human cells for research or 

medical treatment.

The Uniformed Services University (USU) radiology department 

is collaborating with Walter Reed 

National Military Medical Center 

(WRNMMC) to 3-D print items 

and devices that will help doctors 

with patient care and help improve 

the quality of life for wounded warriors. 

According to WRNMMC 3-D 

Medical Application Center 3-D 

Printing Service Chief and assistant 

professor in USU's Department of 

Radiology and Radiological Sciences, U.S. Air Force Maj. (Dr.) John 

Lichtenberger, using the 3-D technology will better the lives of many 

of the hospital’s patients.

“We are primarily using this 

technology to improve the quality of 

life for patients such as our wounded 

warriors,” Lichtenberger said. “For 

example, after an amputation injury, we work in an interprofessional 

environment to design and print 

custom, personalized prosthetics. 

We have even made a device that 

can help a wounded warrior attach a 

fishing pole to their prosthetic arm. 

That’s one example of how we are 

meeting their needs of a better quality of life.”

Lichtenberger did add that the 

prosthetics they print at the hospital 

are not the mechanical prosthetics 

that have been seen going viral on 

the news and social media recently. 

They primarily focus on designing 

and printing what patients need for 

their medical and surgical care and 

to improve the quality of their dayto-day activities.

WRNMMC 3-D Medical Application Center 3-D Printing Service Medical Director, Kevin 

Wurth, displays a fabricated metal plate to be attached to a patient's skull that was developed 

using 3-D printing technology. (Photo by Eric D. Ritter)
5 the pulse December 21 2015

“Sometimes a whole prosthetic limb is not what they want,” he 

said. “For example, someone who 

lost their legs may not want to put 

on full-sized prosthetic legs to go 

just a few feet or when they need 

more mobility such as working on a 

car. We can print out titanium plate 

prosthetics that can be comfortably 

and easily attached to the residual 

limbs to protect them. In addition 

to that, we also create a lot of cranial 

and oral implants for patients who 

require surgical implants. Those 

prints are used in the medical care 

of patients and help the patients become more functional.”

Lichtenberger said many of the 

computer models used for the 3-D 

prints are designed by graphic artists who add a great deal of expertise 

and aesthetic to the products. However, the graphic artists there aren’t 

just trained graphic artists. They are 

also trained CT techs.

“They bring a lot of image-processing knowledge to what we are 

doing,” he said. “They have an intimate knowledge of the layers and 

angles of the images and then transfer that into the computer model 

that will be used in the print.”

The other major significance of 

being able to print a model based on 

MRI and CT scans is that it can print 

specific areas of the body without 

the need for a surgeon to perform 

an operation in order to physically 

see the area they need to see. It can 

print out specific vessels, muscles 

and so forth.

“It really does minimize operating time,” he said. “It helps the 

medical team understand the patient before the surgery begins. In 

fact, they may even be able to see 

anatomic relationships they may not 

have anticipated like a vessel near a 

tumor that they should be aware of 

and will know to address it during 

surgery. Whenever we can assist 

with surgical planning and minimize surgical time like this, it will 

benefit the patient.”

3-D printing has actually been 

around since the mid-1980s. However, its purpose was more to create 

machine parts in the industrial sector. The medical applications in 3-D 

printing have only recently taken 

off. Lichtenberger said the hospital 

doesn’t yet have the ability to print 

with cells to make human tissue, 

also known as bioprinting. However, it is something they plan to add 

in the near future.

The three printer types Lichtenberger said they use at the hospital are the Electron Beam Melter 

(EBM), which melts metal powder 

layer by layer with an electron beam 

to fabricate a print, Fused Deposition Modeling, which lays down 

material like acrylonitrile butadiene 

styrene (ABS) plastic in layers until 

the print is finished, and Stereolithography which can lay down clear 

material like plastics and produce 

larger prints such as a human pelvis.

There’s also a major time benefit to these 3-D prints. Previously, 

for many prosthetic pieces, for example, molds needed to be made, 

and then the molds would be sent 

off to be developed at an off-site 

manufacturer. The 3-D-printing 

ability has eliminated that step and 

can print out a product for a patient 

that day instead of waiting. 

“This is ultimately all about 

personalized patient care,” he said. 

“This is giving the patient the products they need to live a better life, 

and it provides doctors with a quality and accurate product that assists 

them in better medical care.” 

3-D from Page 4

WRNMMC 3-D Medical Application Center 3-D Printing Service Chief US 

Air Force Maj. (Dr.) John Lichtenberger displays how the 3-D printer can 

print out specific body parts like blood vessels taken from CT or MRI scans of 

a patient to help doctors understand affected areas before surgeries. (Photo by 

Eric D. Ritter)
6 the pulse December 21, 2015

See WAVE, Page 7

by MC3 Laura Bailey

WAVE simulator provides realistic field medical 

scenarios at Val G. Hemming Simulation Center

CH47 Chinook helicopters 

land under fire in the Khyber Pass, 

Afghanistan to a mass casualty air 

disaster. Two wounded airmen lay 

on the ground nearby. One is unconscious and bleeding heavily from 

the knee where his leg has been 

blown off and the other, with visible 

wounds to the abdomen and chest, 

is in a state of panic. 

Over the sounds of bomb 

blasts, rapid gunfire and sirens, her 

desperate screams for help call combat medics into action. Staying close 

to the ground in a military crawl, 

they make their way through blasts, 

shooting debris, clouds of smoke 

and heavy enemy gun fire, to reach 

the wounded.

The medics are on a dangerous rescue mission: save lives even 

while putting their own lives on the 

line. One medic says to the wounded, “We’ve got you. You’re going to 

make it.” He and his team quickly 

apply bandages and tourniquets. 

Stop the bleeding. Check. 

Monitor vital signs. Check. Working 

diligently through the distracting 

sounds of a most hostile environment – the medics remain undeterred. 

Like a dream that ends upon 

waking, the completed training scenario comes to a halt. Bright lights 

come on inside the Wide Area Virtual Environment (WAVE) at the 

Val G. Hemming Simulation Center (SIMCEN) at the Uniformed 

Services University of the Health 

Sciences (USU). The wounded 

role-player jumps to her feet completely unharmed. Sound effects 

dissipate into silence and a smoke 

machine exhales its final plume as 

SIMCEN staff enter the scene to 

reset the mannequin for the next 

WAVE simulator programmers operate software that delivers realistic training scenarios for students at the Val G. 

Hemming Simulation Center (SIMCEN). (Photo by Tom Balfour)
7 the pulse December 21 2015

WAVE, from Page 6

by Sharon Holland

training group. 

“Last year, this center supported about 36,000 active duty 

training hours,” said Gil Muniz, the 

deputy director of the center. “We 

support the military’s medical students at USU, as well as medics from 

the military and civilian first responders. Keeping all of this as close 

to reality as possible is key. And with 

our trainers right there, we can give 

immediate feedback and make sure 

when these medics hit the real reality, they’ll be ready.”

Unlike simulators that use 

computer monitors or head-mounted displays, the 8,000-square-feet 

virtual space created by the WAVE 

allows up to 18 team members to 

interact with each other and real 

equipment, and gives instructors 

the opportunity to teach and assess 

teamwork skills. Stereoscopic images are displayed on the screens 

with paired DLP projectors while 

users wear lightweight stereoscopic 

glasses to view the scene. The WAVE 

boasts two pods 20 feet in diameter, 

eighteen 9-feet tall and 12-feet wide 

movie screens surrounding the 

two pods, 144 image projectors, a 

5.1-channel sound system that generates a “soundscape” to enhance 

the realism of the experience with 

flying bullets, screams and explosions, and smoke generators and debris scattered across the floor to add 

to the mayhem. One pod simulates 

the aftermath of the first scenario 

such as a firefight. Students evacuate patients along the corridor to the 

second pod where a second scenario such as helicopter transport plays. 

Meanwhile the first pod is being restaged as a field hospital. Thus training can be sustained in real time for 

extended periods.

“The WAVE is the world’s 

largest virtual environment for 

medical training,” said Dr. Alan Liu, 

director of the Virtual Medical Environments Laboratory and creator 

of WAVE. “It’s a room with 24 3-D 

screens that puts users inside a virtual reality game, surrounding and 

immersing medics into any kind of 

environment – from downtown Iraq 

in the middle of a firefight to inside 

a cargo aircraft. “There’s nothing 

else like this in the world.” 

Fourteen members of the F. 

Edward Hébert School of Medicine 

class of 2018 competed against 108 

other candidates for the Expert Field 

Medical Badge, Dec. 15-18, 2015, at 

Fort Irwin, California. When it was 

all over, half of them walked away 

with coveted badge.

The soldiers spent 72 hours 

on the vast training base located 

in the Mojave desert vying for the 

badge, which is considered one 

of the Army’s most difficult and 

prestigious to earn. According to 

the Army Medical Department 

(AMEDD) website, “the EFMB test 

is the utmost challenge to the professional competence and physical 

endurance of the soldier medic. It 

is the most sought after peacetime 

award in the AMEDD, and while 

the Combat Medical Badge is the 

‘portrait of courage’ in wartime, the 

Expert Field Medical Badge is undoubtedly the ‘portrait of excellence’ 

in the army all of the time.” Over the 

last 50 years, members of the U.S. 

Army, Air Force and Navy medical 

departments, along with their counterparts from allied nations, have 

had the opportunity to compete in 

this grueling competition, in the 

hopes of earning the EFMB.

Candidates completed a series of training lanes where they 

were tested, while under “enemy” 

fire, on combat care and various 

military survival skills. Candidates 

also took a comprehensive written 

exam on the skills they learned, 

completed day and night land navigation, and if they made it to the 

end, finished a 12-mile road march 

in full gear, within three hours.

The pass rate for the badge 

typically falls between 15 and 20 

percent. “The members of my class 

achieved an outstanding 50 percent pass rate,” said Army 2nd Lt. 

Andrew Jacobson, president of the 

SoM Class of 2018. 

This year’s USU EFMB recipients include Army 2nd Lts. John 

Blickle, Rachel Bridwell, Charles 

Llewellyn, Thomas Peterson, Oriana 

Ellis, Kimberly Gerling, and Kaoru 

Song.

USU students compete for 

expert field medical badge
8 the pulse December 21, 2015

Final Frame

USU held its annual Holiday Party on Thursday, Dec. 17. Events and activities included games, music, dancing, a 

photo booth, Combined Federal Campaign giveaways, and a visit by Santa Claus. (photo by Sharon Holland)

Happy Holidays!