The Official USU Newsletter

Learning to Care for Those in Harm’s Way

Volume 10, Issue 15 August 24, 2015 

www.usuhs.edu
2 the pulse August 24, 2015

On the cover

Sharon Holland

Deputy Vice President for External 

Affairs and Managing Editor

Eric Ritter

Writer and Editor

MC3 Laura Bailey

Writer and Photographer

Alexis Christman 

Communications Intern

Kiernan Kiser 

Communications Intern 

Danielle Snowden 

Communications Intern

 

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 

301-295-3338.

Researchers identify model to 

predict successful wound healing

by Sharon Holland

Battlefield surgeons and civilian physicians could have a powerful new tool to 

help patients recover from traumatic injuries, including life-threatening wounds 

from explosions.

By studying blood and tissue samples 

from patients, a team of military and civilian researchers have identified a model to 

predict the chances for successful wound 

healing in individual patients.

These predictions could help surgeons make critical, time-sensitive decisions, such as when to close a wound. Both 

premature and late closing can lead to serious complications for the patient.

The researchers’ findings, "Lessons 

of War: Turning Data into Decisions," 

was published online July 17, 2015 in the 

journal E-Biomedicine (http://dx.doi.

org/10.1016/j.ebiom.2015.07.022).

“This study demonstrates that it is 

not merely the physical destructive nature related to the mechanism of injury in 

wounds, but the (body’s) resulting inflammatory response, that dictates wound outcome,” says the senior author, Navy Capt. 

(Dr.) Eric Elster, professor and chair of the 

Department of Surgery at the Uniformed 

Services University of the Health Sciences and the Walter Reed National Military 

Medical Center. “In this study, we have also 

determined that this response is similar between military and civilian patients, which 

is critically important because it allows us 

to translate advances in military patients 

into civilian patients and the converse as 

well.”

Elster and a team from the USU Walter Reed Surgical Critical Care Initiative 

(www.sc2i.org) collected blood, tissue and 

serum samples from 73 patients who sustained 116 life-threatening combat wounds 

in Iraq or Afghanistan and analyzed biomarker data and clinical observation to 

predict the likelihood of wound failure. 

The samples were taken prior to and during 

each surgical debridement (removal of 

dead or contaminated tissue) of the wound. 

"We’ve long suspected that young, 

previously healthy patients who had sustained blast injuries have difficulty regulating their immune system,” Navy Cmdr. 

(Dr.) Jonathan Forsberg, first author on 

this study, says. “By characterizing patterns 

of inflammation using computer-intensive 

methods, we are now able to estimate the 

probability of surgical complications before 

they occur." 

Because of body armor, improved 

tactical combat casualty care and a robust 

tertiary care system, many service members in Iraq and Afghanistan survived severe wounds that, in past wars, would have 

been fatal. But the severity of the injuries 

meant that “even highly experienced military surgeons had difficulty risk-stratifying 

their patients’ wounds because the conventional manner of visually assessing wounds 

was inadequate,” the authors wrote.

Using advanced computer analytic 

methods of the samples collected, the team 

was able to determine the presence of cytokines (proteins) that in turn could predict 

which patients would develop an inflammatory response that would lead to local 

wound failure. The result of such failure can 

include infection, amputation or death.

The result of the research is a decision-support tool to guide the timing of 

wound closure, although the paper noted 

that the process requires collection of numerous samples and advanced computer 

analysis, which would need to be carried 

out in a field hospital setting, not the front 

line of a battlefield.

In addition, a group of 18 critically 

injured civilian patients was evaluated to 

determine if similar inflammatory responses were observed. Preliminary findings 

were comparable, but the authors said that 

due to the small sample size, more patients 

would need to be studied.

If the study’s results are further validated, “consistently applying this approach 

would improve surgical outcomes, allow 

trauma patients to spend less time in intensive care, and reduce health care costs,” the 

authors concluded.

In addition to Elster and Forsberg, 

the authors were Drs. Benjamin Kyle Potter 

of USU and Walter Reed National Military 

Medical Center, Matthew Wagner of the 

Naval Medical Research Center, Andrew 

Vickers of Memorial Sloan-Kettering Cancer Center, Christopher Dente of Emory 

University, and Allan D. Kirk of Duke University Medical Center.

The Halau Ho’omau I ka Wai Ola O Hawai’i 

organization performs traditional Hawaiin 

music and dance during the USU Diversity 

Day celebration that honored the different 

cultures. See story, page 4. (photo by Eric 

Ritter)
3 the pulse August 24, 2015

School of Medicine Presents Dean’s 

Annual Faculty Teaching Awards

By the Office of Academic Affairs, F. Edward Hébert School of Medicine

USU F. Edward Hébert School of 

Medicine dean Dr. Arthur Kellermann 

recently announced the winners of the 

School of Medicine annual Faculty Teaching Awards. One winner was selected from 

a Basic Science department, and one from a 

Clinical Science department. These awards 

recognize two faculty who demonstrated 

outstanding performance in their roles as 

educators during the preceding academic 

year (July 1, 2014 – 30 June 2015). This is 

the fifth year that this prestigious honor has 

been bestowed on two School of Medicine 

faculty members. 

The number of nominations submitted, and the caliber of those nominees, 

speaks volumes about the cadre of faculty 

at USU, according to Dr. Brian Reamy, senior associate dean for Academic Affairs in 

the School of Medicine. The dean’s advisory committee reviewed the nominations, 

and after scoring and deliberation, Kellermann was honored to present Air Force 

Major (Dr.) Brian Neubauer, Department 

of Medicine, and Stephen Rothwell, Ph.D., 

Department of Anatomy, Physiology and 

Genetics (APG), with the awards.

Neubauer is an assistant professor 

in USU’s Department of Medicine. He is 

a pre-clerkship module director, serves 

on the Council of Module Directors, and 

sees patients in the general internal medicine clinic at Walter Reed National Military Medical Center. Neubauer has been an 

outstanding leader, not only in his role in 

the pre-clerkship curriculum as a module 

director, but also establishing himself as a 

respected educational leader throughout 

undergraduate and graduate medical education. Neubauer has also had an impact 

as an educator at the national level. He 

co-presented a workshop on the integration of basic sciences in clinical clerkships 

at the Academic Internal Medicine Week 

national meeting in October 2014, as well 

as at the International Association of Medical Science Educators (IAMSE) National 

Meeting in June 2015, for approximately 30 

attendees at each meeting.

“Maj. Brian Neubauer is an outstanding USU faculty member and an exceptional educator, who has been recognized as a 

role model by our medical students. Brian 

epitomizes what we hope we all can be as 

teachers. He is most deserving of recognition with a 2014-2015 Dean – School of 

Medicine (SOM) Annual Faculty Teaching 

Award,” said Paul Hemmer, vice chair for 

Education Programs, Department of Medicine.

Rothwell was appointed a module 

director in the revised curriculum and 

asked to serve as a member of the Council 

of Module Directors and the pre-clerkship 

curriculum committee. He was a member 

of the original curriculum reform team that 

built the current modular curriculum. Each 

year he evaluates the curriculum, and seeks 

to strengthen the teaching efforts of the 

faculty. Current projects include an evaluation of a new on-line learning tool and a 

computerized scanning atlas of embryonic 

specimens. 

“Dr. Rothwell’s contribution to the 

teaching mission of USU is truly exceptional, involving all aspects of teaching including course development, presentation and 

administration, as well as pedagogic innovation,” said Greg Muller, vice chair for Research, APG. 

Both winners will be recognized by 

placement of their names on tribute bricks 

in the USU courtyard.

Air Force Major (Dr.) Brian Neubauer, Department of Medicine. (Photo by Tom Balfour) 

Stephen Rothwell, Ph.D., Department of 

Anatomy, Physiology and Genetics (APG). 

(Photo by Tom Balfour).
4 the pulse August 24, 2015

USU celebrates 

Diversity Day

The Filipino Cultural Association of the University of Maryland demonstrates several folkdances of the Philippines including tinikling and 

sayaw sa bangko. (Photo by MC3 Laura Bailey)

The Uniformed Services University of the Health Sciences (USU) 

hosted a smorgasboard of culture August 13 with the annual Diversity 

Day celebration.

USU President Dr. Charles L. Rice, who spoke during the event 

opening, said that diversity makes USU a much better institution.

"While we actively celebrate Diversity Day, we need to proactively seek it all the time," said Rice. "There is little doubt that organizations 

with a great deal of diversity make better decisions."

There were many activities and performers to help celebrate the 

day, including Celtic dancers, a Pacific Islander ceremonial dance, cultural musical instrument performances and several booths highlighting a variety of cultures and their contributions to society. Face painting, balloon animals and a moon bounce helped entertain the children 

who attended.

Celtic dancers perform traditional and modern Irish 

stepdance routines. (photo by MC3 Laura Bailey)
5 the pulse August 24, 2015

Children were treated to a moonbounce and balloon animals. (photo by 

MC3 Laura Bailey)

For lunch, diners were treated to foods from around the world. 

(photo by Eric Ritter)

Several booths were on display that highlighted how different cultures contribute to diversity. (photo by MC3 Laura Bailey)
6 the pulse August 24, 2015

By MC3 Laura Bailey

Health.mil Courtesy Article

Dialogue, Cont. Page 7

The Military Health System (MHS) is 

at a pivotal time as it transfers from wartime to peacetime. According to Uniformed 

Services University Dean of the F. Edward 

Hébert School of Medicine Dr. Arthur Kellermann, trying to switch from a military to 

a civilian health care organization is not the 

military’s aim. 

“After more than 13 years of war, 

the MHS is being challenged to recapture 

care at home and achieve the Quadruple 

Aim of increased readiness, better health, 

better care and lower costs,” said Kellermann during the Military Health System 

Research Symposium in Fort Lauderdale, 

Florida. “As a civilian doc for more than 30 

years, I don’t believe the MHS can accomplish the quadruple aim by emulating private health sector competitors. We should 

leapfrog them instead.” 

Civilian health organizations and the 

MHS share a commitment to high-quality 

care, but their priorities differ. MHS seeks to 

lower costs and improve population health, 

while civilian health care systems strive to 

increase revenue and place less emphasis 

on public health. Most importantly, MHS’ 

top priority is readiness. Civilian health 

care systems don’t have this obligation. 

“The task before us is difficult but doable,” Kellermann said. “If we start playing 

by our rules rather than somebody else’s, we 

can improve access to care, promote population health, reduce per capita costs and 

generate high-value research. By drawing 

on our inherent strengths and capabilities, 

including a highly talented and versatile 

workforce, we’ll not only ‘win the peace,’ 

we’ll be better prepared for the next war.” 

The military can learn a lot from civilian researchers and health systems, Kellermann notes. The research symposium was 

created to bring the military’s top health 

leaders, researchers and clinicians together with civilian academic scientists, international partners and industry to discuss 

research and related health care initiatives. 

The collaborative environment enables 

frank discussions of global health, trauma 

care and regenerative medicine, among 

other topics. The knowledge and ideas from 

these interactions help MHS advance military health and strengthen important service-specific medical capabilities. 

During the wars in Afghanistan and 

Iraq, the military’s Joint Trauma System improved combat casualty care from the point 

of injury all the way through rehabilitation. 

In fact, despite progressively severe injuries, 

the U.S. military’s case-fatality rate declined 

during the course of the wars to the lowest 

level the world has ever seen. Kellermann 

said MHS must capitalize on the nimbleness it developed over 13 years of war. 

“These lessons came at high cost and 

must not be forgotten,” Kellerman said to 

his audience. “You must not only remember what was learned, but how you learned 

it. Let’s apply the same problem-solving 

approach to the challenges we face today. 

Nearly every military doctor and nurse I’ve 

spoken to recalls the intense demands of 

working downrange; however, all of them 

wistfully recall that they could actually get 

things done. The best advice I can offer the 

MHS today is to work every day like you’re 

downrange.”

USU, MHS focus toward peacetime 

is readiness and innovation

Brown Bag Discussion “Understanding through Dialogue”

Nearly 20 Uniformed Services University (USU) students, staff and faculty 

participated in the Brown Bag discussion, 

“Understanding through Dialogue”, sponsored by USU’s Office of Equal Employment 

Opportunity (EEO) and F. Edward Hébert 

School of Medicine (SOM) Diversity Committee, Aug. 20, 2015. Mindset was the topic 

of discussion. 

Brown Bag discussions help the USU 

EEO to promote an environment free from 

personal, social or institutional barriers. 

The discussions also promote open dialogue between USU community members 

by providing a safe place for them to discuss 

important and often sensitive social matters 

that affect everyone. 

“This month, the open group discussion started with the question, “Do we have 

a fixed mindset that prevents growth or do 

we have a growth mindset that overcomes 

obstacles?” said Army Col. (Dr.) Jeffrey 

Hutchinson, the associate dean of clinical 

affairs and chief diversity officer for the 

SOM. 

Hutchinson, who led in the discussion, drew two black lines on a white piece 

of paper. He added arrows at the end of 

each line. The lines appeared to be different 

in length (see photo). He then asked participants which line was longer. 

The truth is, the lines are the same 

size, he said. It’s an optical illusion because 

of the direction of the arrows, illustrating 

the two different mindsets. 

“A person who believes one line is 

shorter than the other, despite the facts, 

represents the fixed mindset,” said Hutchinson. “A person with a fixed mindset only 

sees obstacles. In contrast, a growth mindset sees new information and obstacles as a 

chance to grow and learn.” 

After breaking up into smaller discussion groups, the participants shared 

what they had learned from each other. 

“Good examples are necessary to 

nurture growth,” said one participant. Others agreed that without mentorship, some 

people may remain stuck in a fixed mindset. “Sometimes, we need others to make us 

aware of another way,” said another participant. 

One attendee also said that if a person is truly fixed in their mindset, a mentor, 

even a great one, may not be able to permeate the fixed mind. 

A professor shared a story about a 

poor Hawaiian child he had gotten to know 

through his church. Many years later, the 

child became very successful despite growing up in poverty. 
7 the pulse August 24, 2015

Dialogue, from Page 6

Army Col. (Dr.) Jeffrey Hutchinson, the associate dean of clinical affairs and chief diversity 

officer for the SOM draws an optical illusion to demonstrate his point about understanding 

different interpretations of dialogue. (photo by MC3 Laura Bailey)

“He told me one day that as he got 

to know me he realized that I wasn’t any 

smarter than he was and that was how the 

kid ended up getting ahead in life,” said 

the participant. “His fixed mind set was 

changed through a trust relationship that 

began with humility – being a friend to 

“other.” 

“Having these discussions is really 

beneficial to me because I am reminded 

to take my own advice,” said Navy Ensign 

Marlyn Moore, a first-year medical student 

at USU and a participant in the discussion. 

“Without hearing from others, sometimes I 

can't see the forest through the trees.”

“Answering the question is not as 

important as the discussion itself,” said 

Hutchinson. “There are numerous different answers to the posed question. Opinions vary based on the number of people 

participating and their walks of life. So, it’s 

really an opportunity to recognize our own 

diversity and then discover how to use what 

we’ve learned." 

Two current and one former faculty 

member of the Uniformed Services University of the Health Sciences' Daniel K. Inouye Graduate School of Nursing conducted a Research Design/Methods Workshop 

August 4-6 at Fort Bragg, N.C., for two of 

USU's Postgraduate Dental College (PDC) 

master's degree programs there -- the Comprehensive Dentistry and Endodontics residencies. 

Army Lt. Col. Danette Cruthirds, 

Navy Cmdr. Kenneth Wofford, and Army 

Col. Paul Lewis, respectively, taught dental 

residents how to set up and conduct a research project as part of the second annual 

workshop put on for the PDC. 

The GSN faculty discussed with the 

residents what constitutes research, how 

to identify independent and dependent 

variables, how to operationalize variables, 

how to set up research methodology, statistical analysis for different types of questions and the ethics of conducting human 

subjects research. Over the course of the 

three days, breakout sessions were held in 

which the students could present their own 

ideas and the faculty helped to shape them 

into testable hypotheses. Both first-year 

and second-year dental residents participated in the workshop, and although the 

second-year residents took the course last 

year, the refresher was helpful when they 

were actually focusing in on their master's 

project.

"This was a wonderful learning opportunity," said Lewis, now Senior Nurse 

Scientist at Womack Army Medical Center, 

Fort Bragg. "I think we learned as much 

about dentistry as they did about research."

"This was an excellent example of interprofessional education," said Dr. Thomas 

Schneid, Executive Dean of the PDC.

USU hosts collaborative GSN/PDC research workshop

by Sharon Holland

Faculty and students in USU's collaborative GSN-PDC Research Design/Methods Workshop 

at Fort Bragg included (left to right, back row) Dr. Thomas Schneid (Executive Dean, USU 

PDC), Army Capt. John Hastings, Army Lt. Col. Danette Cruthirds (USU GSN), Army Capt. 

Andrew Klish, Army Capt. Sung Kim, Army Col. Paul Lewis (Womack Army Medical Center, formerly USU GSN), Army Capt. Julie Benjamin, Army Capt. Andrew Callahan, Navy 

Cmdr. Kenneth Wofford (USU GSN); (front row) Army Maj. Larry Munk, Army Maj. Steven 

Mark, and Army Capt. Anna Yoo. (Courtesy photo)
8 the pulse August 24, 2015

Final Frame

A historian with the Antietam Battlefield memorial site displays civil war-era surgical tools to USU medical students during the Antietam 

Battlefield Medical Staff walk. The annual event is conducted during the student's first year of medical school. The Antietam Battlefield medical staff walk provides an opportunity for the students to study a military campaign rich with medical problems that – while technologically 

different – remain valid teaching points for the students if put in the modern context. (Photo by Tom Balfour)