Volume 9, Issue 18• October 1, 2014

www.usuhs.edu

The Official USU Newsletter
On the cover

Dr. Laura Neely, the associate director of the 

Laboratory for the Treatment of Suicide-Related 

Ideation and Behavior at the Uniformed Services 

University of the Health Sciences, talks with a study 

participant during a follow-up booster session. 

See story page five

Photo by MC3 Laura Bailey 

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

MC3 Laura Bailey

Editor and Layout Design

MC2 Brittney Cannady

Writer and 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 laura.bailey@

usuhs.edu or by calling 301-295-

3116.

2 the pulse October 1, 2014

Migraine-sufferers at possible risk for 

Parkinson’s, movement disorders later

by Sharon Holland, managing editor 

 Migraine suffers may be at greater 

risk for developing Parkinson’s 

disease or other movement disorders later in life, according to a 

new study published in the Sept. 17, 

2014, online issue of Neurology®, 

the medical journal of the American 

Academy of Neurology. Those who 

have migraine with aura may be at 

double the risk for developing these 

disorders. 

 “Migraine is the most common 

neurologic disorder in both men and 

women,” said study author Ann I. 

Scher, PhD, professor of Epidemiology at the F. Edward Hébert School 

of Medicine, Uniformed Services 

University of the Health Sciences. “It 

has been linked in other studies to 

cerebrovascular and heart disease. 

This new possible association is one 

more reason research is needed to 

understand, prevent and treat the 

condition.” 

 Scher and her colleagues from 

the National Institute on Aging, 

the University of Iceland, and the 

Icelandic Heart Association, studied 

5,620 people between the ages of 33 

and 65 for more than 25 years. At 

the beginning of the study, 3,924 of 

the participants did not suffer from 

headaches, 1,028 had headaches 

without migraine symptoms, 238 

had migraine with no aura, and 430 

had migraine with aura. They later 

assessed whether participants had 

any symptoms of parkinsonism or 

had been diagnosed with Parkinson’s disease or had symptoms of 

Willis-Ekbom disease, a related 

disorder more commonly known as 

“restless legs syndrome (RLS).” 

 The study found that people with 

migraine with aura were more than 

twice as likely to be diagnosed with 

Parkinson’s than people with no 

headaches. A total of 2.4 percent of 

those with migraine with aura had 

the disease, compared to 1.1 percent 

of those with no headaches. People 

with migraine with aura had 3.6 

times the odds of reporting at least 

four of six parkinsonian symptoms, 

while those with migraine with no 

aura were 2.3 times the odds of these 

symptoms. Overall, 19.7 percent of 

those with migraine with aura had 

symptoms, compared to 12.6 percent 

of those with migraine with no aura 

and 7.5 percent of those with no 

headaches. Women with migraine 

with aura were also more likely to 

have a family history of Parkinson’s 

disease compared to those with no 

headaches. 

 The risk of RLS was increased for 

people with all types of headache. A 

total of 20 percent of those with no 

headaches had RLS, compared to 

28 percent of those with headaches 

with no migraine symptoms and 30 

percent of those with migraine with 

aura.

“These findings suggest that there 

may be a shared vulnerability to 

migraine and parkinsonism in a 

small number of people. This could 

be related to dysfunction in the brain 

messenger dopamine, head injury, 

cerebrovascular disease, or some 

other mechanism. More research 

should focus on exploring this possible link through focused longitudinal studies,” said Scher. 

 The study was funded by the National Institutes of Health, National 

Institute on Aging, the Icelandic 

Heart Association and the Icelandic 

Parliament. 
3 the pulse October 1, 2014

USU awarded Sexually Transmitted Infections Cooperative Research Center 

grant from National Institute of Allergy, Infectious Diseases 

The Atlantic Coast Sexually 

Transmitted Infections Cooperative Research Center, a collaboration between the Uniformed Services University, the University of 

North Carolina, Emory and Duke 

Universities, directed by Ann E. 

Jerse, Ph.D., professor of Microbiology and Immunology at USU, 

was awarded one of five Umbrella-19 STI CRC grants from the 

National Institute of Allergy and 

Infectious Diseases, Aug 2014. 

 Globally, more than 100 million 

individuals are infected with Neisseria gonorrhoeae each year and 

the incidence of chlamydia infections is similar, said Jerse. Here in 

the U.S. it is estimated that there 

are 19 million new STIs reported 

each year. Indiscriminate STIs are 

a growing problem everywhere 

including within the military 

population. With the recent U-19 

award, the AC STI CRC is able to 

investigate their targeted focus. 

“The AC STI CRC is unique 

among other STI CRCs due to its 

emphasis on high priority questions about the immunobiology 

of gonorrhea, the spread of antibiotic resistant gonorrhea, and 

the under-studied research area 

of gonorrhea and chlamydia coinfection,” said Jerse.“STIs are 

prevalent in the military. Gonorrhea and chlamydia are the most 

frequently reported infections in 

the U.S. armed forces. Co-infection is also very common.”

According to Jerse, the AC STI 

CRC has two programmatic research goals, the first being an investigation of immunosuppressive 

mechanisms of gonorrhea during 

single infection and co-infection 

with chlamydia. This research is a 

vital not only to the discovery of a 

safe and effective vaccine, but also 

to addressing another elephant in 

the room – what to do if gonorrhea can’t be treated which subsequently increases the spread of 

HIV. 

“Gonorrhea is now a superbug 

and there’s no single class of antibiotics now left to treat it,” said 

Jerse, whose laboratory at USU 

serves as the USU Department 

of Defense GC Isolate Reference 

Laboratory repository for antibiotic-resistant gonococcal strains. 

“It is resistant to everything. The 

AC STI CRC will look at how resistance mutations to specific antibiotics impact or alter the ability 

of the gonococcus to infect even 

when the antibiotic’s not around 

– basically how these mutations 

actually spread.” 

Secondly, the group will investigate the genetic basis of the spread 

of antibiotic resistant gonorrhea. 

 “Due to the threat of untreatable 

gonorrhea, this research goal is of 

paramount importance because it 

could lead to identifying new drug 

targets and adjunctive therapies,” 

said Jerse. “These fitness studies 

will also help to predict the global 

spread of certain mutations.” 

Also included in the funding is 

the administration of two Developmental Research Proposals which 

extends research opportunities to 

the inquisitive young minds of the 

future. These research proposals 

will hopefully lure new talent to 

the front lines of the war on STIs. 

“Providing such an opportunity 

is crucial to combating the problems of antibiotic resistant gonorrhea and the need for a gonorrhea 

vaccine, since doing so will attract 

promising new talent in the areas 

of antibiotic resistance and the 

immunobiology of gonorrhea,” 

Jerse said. 

The next several months will no 

doubt have its challenges, but will 

ultimately lead to an increased 

understanding. 

“It’s an opportunity to look at 

things that we’ve always wanted to 

look at,” said Jerse. “We have very 

good models set up and to be able 

to use them to study these questions is really exciting and satisfying. I think that the emphasis on 

antibiotic resistance is synergistic 

with the Global Emerging Infections Surveillance and Response 

System’s interest in antibiotic resistance. Also, researchers have 

been working on vaccines for gonorrhea for 10 years. It’s very slow. 

The information that comes from 

looking at host responses during gonorrhea and gonorrhea/

chlamydia co-infection using the 

mouse models that we developed 

here at USU should give us some 

fundamental information that’s 

missing which would help to get 

these vaccines to work.”

by MC3 Laura Bailey, editor 
4 The Pulse The Official USU Newsletter

USU faculty take part in congress on Soldier ’s physical 

performance

Photo by MC3 Laura Bailey 

 Uniformed Services University faculty and staff 

recently participated in the 3rd International Congress 

on Soldier’s Physical Performance in Boston, Mass. 

Hosted by the United States Army Research Institute 

of Environmental Medicine, the conference offered 

attendees an opportunity to exchange dialogue and 

research with more than 300 international experts in 

human performance optimization and military physical 

performance research. To stay current with the various 

threats soldiers face in the combat environment the 

congress offered information to help keep service 

members in the best state of physical fitness.

The ICSPP, formed in 2005, aims to ensure optimal 

physical health and wellness for soldiers as they face 

current and emerging threats in combat environments.

Dr. Patricia Deuster and Army Col. (Dr.) Francis 

O’Connor served as invited speakers along with other 

members of the USU Consortium for Health and 

Military Performance who gave podium presentations on 

research related to fitness testing and injury prevention 

in the military community. 

“We had a group of really great speakers at the 

congress.” said Dr. Dianna Purvis, director, Strategic 

Operations and Special Projects for CHAMP.

“The USU tagline is ‘Learning to care for others in 

harm’s way,’ we do that through human performance 

optimization which is everything skin in and skin out, 

everything from the physiology to service members’ 

mental status, family and relationships. 

 “We look for ways to improve them and that was 

the value of us attending the congress,” said Purvis, 

whose own presentation, ‘Systematic Review of the 

Association of Fitness Components with Musculoskeletal 

Injury,’ studied the correlation between physical fitness 

and musculoskeletal injury in athletic and military 

populations. 

The three-day congress featured exhibits and poster 

sessions as well as a roundtable on the role of aerobic 

fitness in warfighter readiness. Congress discussions on 

nutrition, physical training and resiliency directly impact 

current research in human optimization of service 

members.

The CHAMP is a Department of Defense Center of 

Excellence for integration, translation, and education of 

all topics related to human performance optimization 

and total force fitness and is tasked with incorporating 

research for military operational applications and DoD 

policy development.

by MC2 Brittney Cannady, writer 

e 
5 The Pulse The Official USU Newsletter

Unsung heroes help researchers combat suicide

by MC3 Laura Bailey, editor 

 Helping service members at risk for 

suicide is tricky even with all of the 

military training on suicide awareness 

and prevention. What happens when 

at-risk service members do not receive 

timely help and end up making a 

suicide attempt? Some help researchers in the Department of Medical and 

Clinical Psychology Laboratory for the 

Treatment of Suicide-Related Ideation 

and Behavior at USU. 

 “The work that we do in the lab 

heavily focuses on individuals who are 

already at risk and who desperately 

need evidence-informed treatment to 

get better,” said Dr. Marjan Holloway, 

associate professor of Medical and 

Clinical Psychology and director of the 

LTSRIB at the Uniformed Services 

University. “The suicide behavior 

that we deal with the most is a suicide 

attempt.” 

 The lab’s mission is to best understand why service members who think 

about suicide subsequently act on 

the suicidal thoughts that they have. 

The ultimate goal is to teach service 

members that suicidal urges can be 

overcome by having the right tools 

and coping strategies. Dr. Holloway 

and collaborators have developed 

several treatments for the prevention 

of suicide-related behaviors, such as an 

inpatient cognitive behavior therapy 

intervention called Post-Admission 

Cognitive Therapy. The new Veterans’ Affairs - Department of Defense 

Clinical Practice Guidelines for suicide 

refers to inpatient cognitive behavior 

therapy as a promising intervention 

under development that may help 

high-risk individuals while they are 

hospitalized. The details about how to 

implement the cognitive behavioral 

intervention, for outpatients and inpatients, are described in the new Air 

Force’s Guide on Suicide Risk Assessment, Management, and Treatment 

put out by the LTSRIB in 2013, in collaboration with Air Force colleagues. 

 “Once service members who have 

attempted suicide consent to the 

study, we provide a specialized type of 

cognitive behavior therapy for suicide 

prevention, which is named PACT. 

PACT consists of approximately six 

to eight individual psychotherapy 

sessions, 90 minutes each, followed 

by telephone booster sessions from 

the patient’s therapist,” said Dr. Laura 

Neely, the associate director of the 

LTSRIB. “We focus on three phases. 

The first phase is about information 

gathering. We’re trying to understand 

their story, the thoughts, emotions and 

behaviors that led up to their decision 

to kill themselves. The second phase 

is skill building. We teach service 

members ways to manage whatever 

those triggers were for their suicidal 

thoughts and behaviors – things like 

emotion regulation and coping skills 

... building hope. Then the third phase 

is about relapse prevention which is 

trying to re-write that suicide story, 

imagining future situations where they 

might feel suicidal again and how they 

can implement those new skills that 

they just learned. Finally, we work on 

developing a safety plan for when they 

leave the hospital.” 

 Other research findings are shifting 

the focus of patient treatment in an 

entirely new direction. 

 “Often times, psychological treatment is focused on the diagnosis,” 

said Holloway, “such as depression, 

Post-Traumatic Stress Disorder or 

alcohol dependence. Our lab is trying 

to change that. If a person has suicidal 

thoughts and/or behaviors, the psychiatric diagnosis, of course, matters but 

the diagnosis should not be the primary focus and in this case, we want to 

make sure that service members know 

how to manage a future suicidal crisis 

– that they can keep themselves safe. 

That’s the most important thing. The 

diagnosis-related issue you can deal 

with at a later time when the person 

actually has a desire to live.” 

 Additionally, the LTSRIB is breaking new ground in an effort to provide 

guidance to military leadership. 

 “One of our current studies focuses 

on generating evidence-informed 

decision aids to Army behavioral 

health providers, chaplains, and leaders in terms of how to best manage 

future suicide-related events during 

deployment,” Holloway said. “For this 

purpose, we are conducting interviews 

and focus groups followed by survey 

research and a series of expert consensus meetings.” 

 The decision aids will provide guidance on issues such as when to return 

a weapon to an at-risk service member or when to medically evacuate a 

service member with suicidal thoughts 

from a deployment setting and even 

the very controversial issue of how to 

most sensitively handle a suicide and 

its impact on the military unit in the 

post-vention phase. 

 “We are trying to come up with 

lessons learned based on our conversations with Army behavioral health 

providers, chaplains, and leaders,” 

said Holloway. “Those lessons learned 

will help us in providing guidance for 

what should be systematically done in 

future situations when decisions about 

a suicidal service member need to be 

made within the stressful deployed 

setting.” 

 

 Continued on page six 
Mindfulness training offers users a way to live in the ‘here and now’

by MC2 Brittney Cannady, writer

6 the pulse October 1, 2014

 Researchers at the LTSRIB are gaining ground against 

the war on suicide within the DoD and it is greatly due in 

part to the unsung heroes, service members – who in the 

midst of their worst days, find strength to help others by 

placing their trust in the hands of doctors trained in the 

PACT intervention by Holloway and Neely. 

 “The suicidal service members that we work with are 

research volunteers who agree to participate in one of 

our studies. They are playing an active role in terms of 

helping us determine what type of interventions would 

be best for individuals, similar to them, who attempt 

suicide,” said Holloway. “I would say a number of service 

members who participate in our studies – they’re doing 

it, not necessarily because they want to get something 

out of it themselves, but it’s because of that altruistic kind 

of mentality of wanting to help other service members 

who are suicidal. I think that is an amazing act, especially 

when you’ve been in such distress that you’ve thought 

about, and at times acted upon, killing yourself. The 

most rewarding part of our job as researchers is to work 

collaboratively with these suicidal service members to 

find interventions that work and to ultimately make a 

difference.” 

Researchers combat suicide (continued from pg. 5)

 Students and faculty at the 

Uniformed Services University 

learned the relationship between 

mindfulness and cognitive 

performance and ways to 

improve it through a lecture 

sponsored by the Consortium 

for Health and Military 

Performance. 

 With research gathered from 

resiliency training done in 

the military population, Dr. 

Amishi Jha associate professor 

of Psychology at the University 

of Miami shared her study 

‘Strengthening Attention 

and Working Memory with 

Mindfulness Training in High 

Stress Cohorts’. Mindfulness is 

defined as the state of active, 

open attention to the present 

where a person intentionally 

aware of their thoughts and 

actions. Events Dr. Jha labeled 

‘high stress intervals’, such as 

caring for ill spouse or parents, 

prolonged injury, academic 

training or military deployment 

can all take a toll on mindfulness 

and working memory. 

 “Mindfulness can be 

characterized by attention to 

the present moment and putting 

focus on the here and now, 

it’s about holding steady in a 

stressful setting with clarity and 

calmness.” said Jha. “What we 

learned was those individuals 

who did mindfulness training 

showed signs of healthier 

brains and depressive symptom 

reduction compared to those 

who didn’t.” 

 Research has shown the 

inability to tackle negative 

emotions associated with high 

stress events can also degrade 

physical health, pain tolerance 

and impede treatment for those 

suffering from post-traumatic 

stress disorder. 

 “For those in a combat 

environment having offtask thoughts during an 

ongoing task or activity where 

situational awareness is key 

can be very problematic.” 

said Jha. 

 Techniques like meditation 

or breathing exercises can help 

focus on what an individual 

is currently experiencing by 

acknowledging both good and 

bad emotions without trying to 

force them to go away. Breathing 

exercises have been shown to 

strengthen mental capacities at 

risk of being degraded due to 

persistent stressors and decrease 

mind wandering over time. The 

Human Performance Resource 

Center, the education arm of 

CHAMP, offers a vast collection 

of tips, exercise tools and other 

help for service members and 

their families looking to explore 

the benefits of mindfulness and 

can be found at hprc-online.org/

mind-tactics.

Courtesy of Human Performance Resource Center 
7 The Pulse The Official USU Newsletter

Possible new treatment in burn victims may hold promise for blast injured 

by Sharon Holland, managing editor

Courtesy of Dr. Brad Isaacson, from Annals of Biomedical Engineering, Vol. 38, No. 9, September 2010 (2010) pp. 2968–2978 

 

 A possible new treatment for 

stopping bone growth in soft tissue 

following third-degree burns 

may also prove to be beneficial 

to combat troops suffering high 

energy orthopaedic trauma or blast 

injuries, according to an article in 

the Sept. 24, 2014, edition of Science 

Translational Medicine. 

 Navy Cmdr. (Dr.) Jonathan 

Forsberg, associate professor of 

Surgery at the F. Edward Hébert 

School of Medicine, Uniformed 

Services University of the Health 

Sciences (USU), and head, 

Department of Regenerative 

Medicine at the Naval Medical 

Research Center, and his co-authors 

Dr. Eric Elster, professor and Chair, 

Norman M. Rich Department of 

Surgery at USU; Dr. Tom Davis, 

scientific director, Department 

of Regenerative Medicine, Naval 

Medical Research Center; and Dr. 

Jeffrey M. Gimble, Center for Stem 

Cell Research and Regenerative 

Medicine, Tulane University School 

of Medicine, suggest that findings 

by a team of scientists led by Dr. 

Benjamin Levi at the University 

of Michigan, also reported in the 

same issue of Science Translational 

Medicine, could pave the way for 

improved methods to prevent 

heterotopic ossification, or 

bone formation in soft tissues, 

a significant complication in 

battlefield wounds. 

 Third degree burns, like combat 

injuries, can cause bone to form 

in soft tissues where it normally 

does not appear, creating major 

problems for patients and their 

surgeons. Levi’s team developed 

a mouse model to replicate the 

abnormal bone growth. The 

scientists then added a protein 

over the surface of the burn that 

removes energy molecules from 

the environment. The body’s 

cells normally release this energy 

molecule when exposed to trauma 

like a burn. The presence of the 

molecule outside the cell signals 

the cell to turn on its bone-forming 

machinery. By removing this energy 

molecule from the environment, 

Levi’s team has shown that the 

cell’s bone-forming machinery is 

turned off and bone formation is 

substantially reduced. Forsberg 

and his co-authors believe the 

process could be applied to military 

orthopaedic trauma patients, and 

suggest further exploration using a 

blast injury model that Forsberg’s 

lab has recently developed. 

The frequency of HO formation 

from injuries sustained by 

improvised explosive devices 

and rocket propelled grenades 

in Operation Enduring Freedom 

and Operation Iraqi Freedom 

have been reported as high as 63 

percent in the wounded warfighters. 

“Combat-related HO represents a 

key clinical problem that’s emerged 

during the present conflicts– 

afflicting a higher percentage of 

combat-injured personnel than 

either traumatic brain injury or 

post-traumatic stress disorder. For 

many patients, combat-related 

HO represents a critical barrier; 

limiting return to duty or regaining 

functional independence,” Forsberg. 

“The work by Dr. Levi’s research 

team and ours in the Regenerative 

Medicine Department at NMRC 

is designed to address these gaps 

through multi-faceted, multiinvestigator, and multi-institutional 

collaborations.” “What impresses 

me about this study by Dr. Levi’s 

group,” said Gimble, “is how well 

findings based on civilian injuries 

and trauma can help the military 

address combat casualty care and 

vice versa. This just reinforces 

my growing appreciation of how 

well civilian and military medicine 

and surgery can complement each 

other!”
Final Frame

Students from the class of 2018 as well as new graduate students of the F. Edward Hébert School of Medicine along with the incoming class of the Daniel K. 

Inouye Graduate School of Nursing participate in the official fall convocation at the Uniformed Services University Sep. 19. 

Photo by Thomas Balfour