research VA currents

Research news from the u.s. department of veterans affairs • Dec. 2007–Jan. 2008 New research center to focus on returning veterans

new research program based at the largest Army base in the U.S., from which A Waco campus of the Central Texas more than 40,000 troops have deployed to Veterans Healthcare System will study Iraq. The fMRI machine, one of few such brain and mental-health conditions com- mobile research units in the world, will be mon among troops returning from Iraq and used to correlate activity in different areas Afghanistan: posttraumatic stress disorder, of brain with patients’ PTSD symptoms traumatic brain injury, depression, and and with the effects of treatment. substance abuse. According to Gulliver, the center will The Center for Excellence for Research emphasize translating research findings on Returning War Veterans, supported into practice so that veterans can be helped by Veterans Integrated Service Network as soon as possible. (VISN) 17, will be led by psychologist “There is a reputation that scientists are

Photo by Terry Minton Terry Photo by Suzy Gulliver, PhD, former director of hiding out in the ivory tower, and that is Research by Erin Krebs, MD, MPH, found that a commonly outpatient mental health care at the Brock- just not going to do for this center,” she told used screening tool may not be as accurate as thought. ton (Mass.) VA. The program will feature the Waco Tribune-Herald. “We are going to a $3.5-million mobile functional MRI be in the trenches. We are going to be mak- Study sheds doubt on machine that will travel between Waco, the Temple VA, and nearby Fort Hood, the see CENTER on pg. 7 pain rating scale

The most common method for pain screening may only be modestly accurate, reported VA investigators and colleagues in the Oct. 2007 Journal of General Internal Medicine.

In a study involving 275 adult clinic patients, the researchers tested the pain numeric rating scale, which asks patients to rate their current pain from 0 (“no pain”) to 10 (“worst possible pain”). The researchers also verified patients’ pain us- ing other clinical measures.

Though easy to use, the numeric rat- ing scale failed to identify about one in three patients with pain serious enough to interfere with everyday functioning. “Even Deb Meyer Photo by Keith Young, PhD (right), seen here with colleague Willy Bonkale, PhD, will be studying the genetic and biological see PAIN on pg. 6 underpinnings of PTSD as part of VA’s new Center for Excellence for Research on Returning War Veterans in Waco, Tex. VA Research Currents/Dec. 2007–Jan. 2008 Brain-computer interfaces: Has science fiction become reality? W hen a team led by John Donoghue, PhD, and Leigh Hochberg, MD, PhD, In the BrainGate system, published results from their pilot study of a sensor with 100 the BrainGate system in Nature in 2006, hair-thin electrodes is the headline in one Canadian newspaper implanted in the brain.

proclaimed, “Movement by Thought: Sci- It is wired to a small pedestal, resembling a ence Fiction to Fact.” A London newspaper watch battery, that is referred to the trial participant as “the first implanted in the skull bionic man.” The editors at an Oakland and that serves as a daily were equally impressed, running the port to connect the headline: “Paralyzed Man Moves Moun- electrodes to an outside

tains with Mind.” computer. Researchers hope to develop a It was hard for even the most serious wireless version of the science journalists to ignore the fascina- system in the future. tion surrounding the researchers’ stunning achievement. The scientists—from Brown University, VA and other institutions— had enabled a 25-year-old man with quad- Development of the system is spear- Notwithstanding Hochberg’s tempered riplegia to operate a computer cursor and headed by Donoghue, a Brown neurosci- view, it may be fair to say that in the case perform other tasks solely through his entist who became affiliated with VA when of brain-computer interfaces, yesterday’s thoughts. the agency established its Providence-based science fiction—for example, the 1938 The technology, called BrainGate, uses a Center for Restorative and Regenerative Andre Maurois novel The Thought- tiny sensor implanted in the motor cortex, the Medicine in 2004. Donoghue is also chief Reading Machine—has indeed become part of the brain that controls movement. The scientific officer at Cyberkinetics Neuro- today’s reality. sensor, about the size of Lincoln’s head on a technology Systems, a company formed by Even so, what’s been realized by penny, has 100 hair-thin electrodes that pick Donoghue and colleagues in 2001 to bring researchers to date has clear boundaries. up brain signals. The signals are sent to an ex- BrainGate to market. BrainGate and similar technologies have ternal decoder that turns them into commands little applicability with regard to “higher” for electronic or robotic devices. For now, the A ‘nascent science’ functions of the human mind: that which is brain implant is wired to a computer, but the Hochberg, lead author on the landmark uniquely individual, such as memory, emo- researchers hope to go wireless in the future. Nature paper and the principal investiga- tions, creativity. “For the moment, that’s tor on current trials involving BrainGate, a theoretical discussion,” notes Hochberg. VA Research Currents admits there has been some hype in media “The technology is not even close to being coverage of the technology, but says most able to read into memories or thoughts in is published 10 times per year for the reports have been balanced and accurate. the general sense. The leading edge of the Office of Research and Development field is the ability to extract a neural signal “Overall, many people have been capti- of the U.S. Dept. of Veterans Affairs that’s related to the intention to move one’s vated by the potential of the technology. But by VA R&D Communications limb—and thereby a computer cursor—in a thankfully, the media has generally been 103 S. Gay St., Rm. 517 particular direction.” responsible in describing these as early tri- Baltimore, MD 21202 als [and making clear] that this is a nascent And even the notion of “reading (410) 962-1800, ext. 223 science—that we’re really at the beginning thoughts,” while not wholly inaccurate, is [email protected] of a tremendous period of learning and op- more a handy catchphrase for the media Editor: Mitch Mirkin portunity in terms of restoring lost function than a precise description of what the tech- 2 for people with paralysis or limb loss.” nology is designed to do. VA Research Currents/Dec. 2007–Jan. 2008

“‘Thoughts’ is a useful word because it’s immediately meaningful to everyone,” says Hochberg, “and the concept of being able to ‘read thoughts’ has been around in science fiction a long time. But that’s not what we’re doing in our current research. The focus now, for people with spinal cord injury, brain stem stroke, ALS, and other diseases or injuries of the nervous system, is to be able to restore movement and com- munication.”

Hochberg is principal investigator on Medicine and Regenerative ofRestorative Philippi/Courtesy Center for Karen Photo by two BrainGate trials now underway: one involving people with ALS and related motor-neuron diseases, the other for people with spinal cord injury, muscular dystrophy or stroke. Photo by Ray Leber

Enabling those with paralysis to Leigh Hochberg, MD, PhD, is lead investigator on two clinical trials of a brain-computer interface called BrainGate. move, communicate Yet another method for restoring com- proaches. Most past FES work has in- The main way in which BrainGate could munication—this one focused on patients volved people with intact but non-function- restore communication for people who have who’ve lost their speaking ability—is being ing limbs—such as those with spinal cord lost motor ability is to enable them to move developed by a private Georgia-based com- injury or stroke. Electrodes are implanted a computer cursor, which in turn could pany called Neural Signals, Inc., the only not in the brain but in the weakened or allow them to use email, the Internet and other neuroprosthetics group worldwide, to paralyzed muscles that would normally word processing, or operate a TV set. Hochberg’s knowledge, that is using record- move the limb. Small electrical currents Similar results have been achieved ing sensors inside the brain. Their product is from external or implanted devices activate through somewhat different means by Dr. a computer-controlled prosthetic device that the muscles and restore movement and Jonathan Wolpaw and colleagues at the would be controlled by brain signals and function. Only recently, research there has Wadsworth Center, part of the New York reproduce the sounds of natural speech. expanded to prosthetics applications. In State Department of Health. Their method one project, electrodes would be implanted relies on EEG technology—electrodes Brain waves may drive natural or onto intact arm and shoulder muscles near placed on the scalp, not inside the brain. artificial limbs the amputation and pick up brain signals to Users wear a breathable cap on their head drive an artificial hand. As for enabling movement, BrainGate that contains eight electrodes—down from has already enabled research participants to The new FES-BrainGate collaboration is 64, just a few years ago—wired to a laptop open and close a robotic arm. This aspect “potentially very promising,” says Hoch- loaded with software that translates the of the work—using brain signals to acti- berg, in that two groups of patients might brainwaves into commands for devices. vate limbs—may benefit from a new $6.5 benefit: those using prosthetics limbs, and This approach avoids some of the risks million grant from the National Institutes those whose natural limbs are intact but of brain implants, and may eventually prove of Health to Cyberkinetics, Brown and the disconnected from the brain and ner- viable for many patients with disabilities. Cleveland Functional Electrical Stimulation vous system. Either way, what BrainGate One drawback with EEG, however, is that (FES) Center, which is sponsored jointly by inventor John Donoghue has described as the output is less precise than with implants, VA and Case Western Reserve University. the ultimate goal of the technology—“to and users need far more training than with reconnect brain to limb”—may eventually The partnership with the FES Center BrainGate to effectively control a cursor. be within reach. represents an intriguing melding of ap- 3 VA Research Currents/Dec. 2007–Jan. 2008

Recent publications and presentations by VA researchers

MD, MPH: Dan R. Berlowitz, MD, MPH. Below is a brief sampling of recent scien- “Cyclooxygenase-2 Linked Pathways San Antonio, Pittsburgh, Albuquerque, tific publications and presentations by VA Leading to Neuronal Injury.” Noel Carson, Bedford. American Epilepsy Society An- investigators. Only VA-affiliated authors are PhD. Salt Lake City. Gerontological Soci- nual Meeting, Dec. 3, 2007. listed here, due to space constraints. ety of America Meeting, Nov. 17, 2007. “Does Compensation Status Influ- “Prevalence of Potential Medication “Amyloid-Beta Precursor Protein ence Treatment Participation and Course Problems Among Dually Eligible Older Expression and Modulation in Human of Recovery From Post-Traumatic Stress Adults in Medicaid Waiver Services.” Embryonic Stem Cells: A Novel Role for Disorder?” Craig S. Rosen, PhD; Paula P. Gretchen E. Alkema, PhD. Sepulveda. An- Human Chorionic Gonadotropin.” Prashob Schnurr, PhD; Matthew J. Friedman, MD, nals of Pharmacotherapy, Dec. 2007. PhD. Palo Alto, White River Junction. Porayette, MBBS, MS; Miguel J. Gallego, “Race and Dialysis-Free Mortal- Military Medicine, Oct. 2007. MS; Maria M. Kaltcheva; Sivan Vadakka- ity Among Patients With Diabetes and dath Meethal, PhD; Craig S. Atwood, PhD. “Experimental Examinations of Cogni- Advanced CKD.” Chin-Lin Tseng, DrPH; Madison. Biochemical and Biophysical tive Psychopathology in PTSD.” Suzanne Anjali Tiwari, MBBS, MS; Elizabeth F. Research Communications, Dec. 2007. Pineles, PhD; Jillian Shipherd, PhD. O. Kern, MD, MS; Donald Miller, ScD; “Asymmetric Paternalism to Improve Boston. 23rd Meeting of the International Miriam Maney, MA, CPHQ; Leonard Health Behaviors.” Kevin G. Volpp, MD, Society for Traumatic Stress Studies, Nov. Pogach, MD, MBA. East Orange, Cleve- PhD. Philadelphia. Journal of the American 15 – 17, 2007. land, Bedford. The 5th National Health Medical Association, November 28, 2007. Disparities Conference, Nov. 12, 2007. “Health Services Use Among Gulf War “The Burden of Stroke Scale (BOSS) Veterans and Gulf War-Era Nondeployed “Racial/Ethnic Differences in Patient Provided Valid, Reliable, and Responsive Veterans: A Large Population-Based Sur- Experiences with and Preferences for Score Estimates of Functioning and Well- vey.” Drew A. Helmer, MD, MS; Mindy E. Computed Tomography Colonography and Being During the First Year of Recovery Flanagan, PhD; Bradley N. Doebbeling, MD, Optical Colonoscopy.” Edmund J. Bini, From Stroke.” Patrick J. Doyle, PhD; MSc. East Orange, Indianapolis. American MD. New York. Clinical Gastroenterology Malcolm R. McNeil, PhD; Katherine Ross, Journal of Public Health, Dec. 2007. and Hepatology, Nov. 2007 PhD; Julie Wambaugh, PhD; William D. “Hemispheric Contributions to Nonver- “Reducing Iron Stores Lowers Cancer Hula, MS. Pittsburgh, Phoenix, Salt Lake bal Abstract Reasoning and Problem Solv- Risk in Patients with Peripheral Arterial City. Quality of Life Research, Oct. 2007. ing.” Gerald Goldstein, PhD. Pittsburgh. Disease.” Leo R. Zacharski, MD. White “Cardiac Certificate of Need Regulations Neuropsychology, Nov. 2007. River Junction. 2007 Annual Meeting of and the Availability and Use of Revascu- the American Society of Hematology, Dec. “Language Barriers in Health Care.” larization Services.” Joseph S. Ross, MD, 9, 2007. Somnath Saha, MD, MPH. Portland. Jour- MHS; Brahmajee K. Nallamothu, MD, nal of General Internal Medicine, Nov. 2007. “Survival in End Stage Renal Disease: MPH. Bronx, Ann Arbor. American Heart Calcium Carbonate vs Sevelamer.” Ann “Mortality After Nonemergent Ma- Journal, Oct. 2007. M. Borzecki, MD, MPH: Austin Lee, PhD; jor Surgery Performed on Friday Versus “Case-Finding Algorithm for Post-Stroke Stanley W. Wang, MA; Lewis E. Kazis, Monday Through Wednesday.” Tracy L. Depression in the Veterans Health Adminis- ScD. Bedford. The 38th Annual American Schiffner, MS; William G. Henderson, PhD; tration.” Indianapolis, Gainesville. Interna- Society of Nephrology Meeting, Nov. 10, Shukri F. Khuri, MD. Boston. VA National tional Journal of Geriatric Psychiatry, Nov. 2007. Surgical Quality Improvement Project: 14, 2007. Aurora, Colo. Annals of Surgery, Nov. 2007. “Use of the Electrocardiogram in “The Changing Relationship of Obesity and Optimizing Reperfusion for ST-Elevation “Potential Drug Interactions Among Disability, 1988-2004.” Virginia W. Chang, Myocardial Infarction: A New Role for an Older Veterans Newly Treated for Epilepsy: MD, PhD. Philadelphia. Journal of the Ameri- Old Tool?” Brahmajee K. Nallamothu, MD. A Common Event.” Mary Jo Pugh, PhD, can Medical Association, Nov. 7, 2007. Ann Arbor. European Heart Journal, Nov. RN; Anne Van Cott, MD; Janice E. Knoefel, 4 15, 2007. VA Research Currents/Dec. 2007–Jan. 2008

VA researchers in the news

Wes Ely, MD, MPH, was quoted in an Oct. 17 Wall Street Journal article about hospitals’ efforts to prevent the complication of delirium. Ely is founder of the ICU Delirium and Cognitive Impairment Study at the Nashville VA and Vanderbilt University Medical Center. The group studies brain dysfunction in critically ill patients. Ely is also associate director of research for the Nash- ville VA’s Geriatric Research Education and Clinical Center.

Gregory Goodrich, PhD, a research psychologist at the VA Palo Alto Health Care System, was quoted in a Nov. 14 USA Today article on the effects of traumatic brain injuries on vision. A study by Goodrich “found that 40 to 45 percent of patients with mild traumatic brain injuries suffered vision loss even though their eyes were physically healthy. The biggest problem was an inabil- ity for both eyes to operate precisely together,” which “can lead to eye strain and blurred vision.”

Ross Fletcher, MD, chief of staff and a researcher at the Washington, DC, VA Medical Center, was cited in a Nov. 12 Los Angeles Times news brief on his study that found that high blood pressure can be tougher to control in winter than in summer. The study included more than 443,000 veterans in 15 cities, from Anchorage to San Juan. Fletcher said the “trend may be driven by weight gain, different eating habits and less exercise during winter.”

Rajiv Jain, MD, chief of staff and an investigator at the Pittsburgh VA Medical Center, was quoted in an Oct. 24 Associ- Bioengineer Hugh Herr,PhD (right), seen here speaking at a recent ated Press article about hospitals’ battles against the spread of event at the Providence VA Medical Center, accompanied by Iraq war veteran Garth Stewart, was methicillin-resistant Staphylococcus aureus, commonly known as featured in an Oct. 17 CBS “Early Show” segment titled “Researchers Developing High-Tech MRSA. Jain led a successful pilot study at the Pittsburgh VA that Prosthetics for Damaged Legs.” Herr, himself a double amputee, is with MIT and VA’s cut infection rates by 50 percent and served as the model for VA’s Providence-based Center for Restorative and Regenerative Medicine. nationwide MRSA prevention program. Odysseus in America: Combat Trauma and the Trials of Homecom- Jonathan Shay, MD, PhD, a staff psychiatrist with the VA ing, Shay focuses on the veteran’s experience upon returning from Boston Healthcare System, was profiled on National Public war and highlights the role of military policy in promoting the Radio’s “Morning Edition” on Sept. 25 as one of 24 winners of mental and physical safety of soldiers. a 2007 fellowship from the John D. and Catherine T. MacArthur Foundation. The fellowships, commonly referred to as the “ge- Tony Wyss-Coray, PhD, an investigator with Stanford University nius awards,” include $500,000 over five years. They recognize and the Geriatric Research, Education and Clinical Center at the “individuals who show exceptional creativity in their work” and VA Palo Alto Health Care System, was interviewed by Ira Flatow who have a “track record of significant achievement.” Shay has on National Public Radio’s “Talk of the Nation” show on Oct. 19 combined his treatment of combat trauma with critical and imagi- regarding a new blood test that Wyss-Coray’s team is developing native interpretations of the ancient accounts of battle in Homer’s to screen for Alzheimer’s disease. The researchers reported in the Iliad and Odyssey. His 1994 book Achilles in Vietnam: Combat Nov. 2007 issue of Nature Medicine on a set of 18 proteins in the Trauma and the Undoing of Character draws parallels between blood—all of them “signaling” molecules that enable communication the depiction of the epic warrior-hero Achilles and the experiences between cells—that appear to predict the onset of the disease. The of individual Vietnam veterans whom he treated. In his 2002 work test is now undergoing further study. 5 VA Research Currents/Dec. 2007–Jan. 2008

Figure from “Military and PAIN (from pg. 1) VA telemedicine systems a pain screening cutoff of 1 missed nearly for patients with traumatic brain injury,” JRRD Vol. a third of patients with clinically important 44, No. 7, 2007. The pain,” wrote the authors. article, by Philip Girard The study was the first to test the scale of the Manchester (NH) VA and the Defense and in a general population in primary care. Veterans Brain Injury According to study leader Erin Krebs, MD, Center, describes traditional MPH, “These measures were developed for telemedicine services such use in patients with pain, and their reliabil- as home telehealth and ity and validity were evaluated in patients teleconsultation, as well with chronic and acute pain. Their reliabil- as newer concepts that are allowing distance ity and validity as screening measures to identification, treatment, identify the presence of pain in a general and rehabilitation of population was not assessed before they patients with TBI. were widely implemented.” She empha- sized that “validity is not just a charac- teristic of a measure—it’s a characteristic Journal issue focuses on brain injury, polytrauma of a measure in a certain population for a certain purpose.” The current issue of the Journal of Palo Alto Polytrauma Network Site; a neu- Krebs is with the Center on Implement- Rehabilitation Research and Development ropsychiatric perspective on TBI; hearing, ing Evidence-Based Practice at the Roude- (JRRD), an international, peer-reviewed vision, awareness and balance problems bush VA Medical Center in Indianapolis. journal published by VA, focuses on trau- following TBI; and community-integrated She is also with Indiana University School matic brain injury (TBI) and polytrauma. rehabilitation for TBI. of Medicine and the Center for Health Guest editor is Henry L. Lew, MD, PhD, The journal is available for free viewing Services and Outcomes at the Regenstrief director of Physical Medicine and Reha- and download at ww.rehab.research.va.gov. Institute. bilitation at the VA Palo Alto Health Care Printed copies can be requested by emailing System and a noted expert in research and The pain scale—which is sometimes ac- [email protected]. care related to these topics. companied by graphics such as smiling or grimacing faces, especially in pediatric set- “The conflicts in Iraq and Afghani- TBI conference planned tings—is ubiquitous in U.S. medical care. stan have resulted in a new generation of The Joint Commission on Accreditation of combat survivors with complex physical in- It is estimated that at least 20 percent of Healthcare Organizations (JCAHO), the juries and emotional trauma including post- U.S. troops wounded in Iraq or Afghanistan nation’s main body for standard-setting and concussive symptoms, posttraumatic stress, have suffered some degree of traumatic accreditation of hospitals and clinics, re- poor cognitive performance, head and back brain injury. To help advance research and quires routine assessment of all patients for pain, auditory and visual symptoms, and care on this issue, VA’s Office of Research pain. VA’s health system, which is accred- problems with dizziness or balance,” said and Development is planning a “state-of- ited by JCAHO, uses the scale as part of its Lew. “The purpose of this special issue is to the-art” conference for spring 2008 titled “Pain as the Fifth Vital Sign” campaign. document lessons learned that will enhance “Research to Improve the Lives of Veter- the identification and treatment of veterans ans: Approaches to Traumatic Brain Injury Krebs said that if screening tests are with polytrauma across the country.” Screening, Treatment, Management, and inaccurate and don’t provide information Rehabilitation.” VA and non-VA investiga- that can be used to improve care, “doctors Articles in the issue cover topics such tors, clinicians, managers, and policymakers learn to tune out the numbers.” She said as treatment of patients with posttraumatic taking part in the invitation-only event will physicians might need to adopt other ways stress disorder and mild TBI; military and work to develop a research agenda that will of assessing pain in primary care patients. VA telemedicine systems for patients with help promote optimal care for veterans with TBI; an operational description of the VA traumatic brain injury. see PAIN on pg. 8 6 VA Research Currents/Dec. 2007–Jan. 2008

CENTER (from pg. 1) ing sure that what we are finding out in the laboratory makes it into clinical practice.” Photo by Lupe Hernandez Lupe Hernandez Photo by She expects the center to eventually be home to some 10 core faculty members and between 50 and 60 staff to assist them. One of the core investigators will be Keith Young, PhD, co-director of the Neuropsychiatry Re- search Program at the Temple VA and Texas A&M University Health Sciences Center College of Medicine. With $5.7 million in funding from the Department of Defense, along with other support, his team is study- ing the role of genes and brain anatomy in PTSD. The study will screen and follow 1,400 troops from Fort Hood. In another study, Young is seeking to identify blood and brain markers of traumatic brain injury. Sunil Ahuja, MD (left), of VA consults with study collaborator Matthew Dolan, MD, of the San Antonio Military Medical Center and the Infectious Disease Clinical Research Program of the Uniformed Services University of Health Sciences. According to Rep. Chet Edwards (D-Waco), who led the effort to secure funding for the PTSD research, “This groundbreaking research project is an important part of realizing our goal Two genes found to play major role in of making the Waco VA a world-class PTSD and mental health care research center, and it is progression of HIV to AIDS one of the few programs in the country focused on the links between genes and brain anatomy V iral load—the amount of virus in the immune responses and a greater decline in in the development of PTSD and mental illness blood of a person infected with CD4 T cells, the two main signs of pro- in our combat soldiers.” HIV—has long been seen as the main fac- gressive disease. In HIV-infected subjects, tor in how fast HIV infection progresses viral load contributed only 9 percent to the to full-blown AIDS. Now, an international variability in rate of progression to AIDS, team including researchers with VA and the whereas variations in CCR5 and CCL3L1 University of Texas Health Sciences Center together accounted for 6 percent. Photo by Nelia Schrum Photo by (UTHSC) in San Antonio has confirmed “What we show is that genetic variations that two genes also figure largely in the in [CCR5] and [CCL3L1] contribute nearly process, and could eventually play a role in as much to the extent of inter-individual how AIDS risk is assessed or how new vac- variability in AIDS progression rates as cines are evaluated. The findings appear in does HIV-1 viral load,” said Ahuja, director the Dec. 2007 issue of Nature Immunology. of the VA Research Center for AIDS and Researchers led by Sunil Ahuja, MD, of HIV Infection in the South Texas Veterans VA and UTHSC examined genetic informa- Health Care System and a professor of tion from more than 3,500 people, nearly medicine, microbiology, immunology and half of whom were infected with HIV-1, the biochemistry at UTHSC. main virus that causes AIDS. They found Ahuja said physicians “should become that those who had specific combinations of familiar with the notion that although viral two genes—CCR5, which helps HIV enter Suzy Gulliver, PhD, photographed while in the midst of her entry, replication and spread [as reflected cells; and CCL3L1, an immune response recent move to the Waco VA, envisions a center that will be home to 60 to 70 staff overall. gene—were more likely to have reduced see GENES on pg. 8 7 VA Research Currents/Dec. 2007–Jan. 2008

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GENES (from pg. 7) VA Research Week 2008 by viral load] are important determinants on the way of AIDS progression rates, host factors Scenes like the one at the right, from Park Warren Photo by [such as variations in the genes CCR5 and an event last May at the VA Pittsburgh CCL3L1] can have an equal or even greater Healthcare System, will be repeated this impact on AIDS progression rates.” coming spring as VA medical centers First author Matthew Dolan, MD, nationwide commemorate VA Research Week from the San Antonio Military Medical 2008. The exact dates will be announced Center and the Infectious Disease Clini- and posted on the VA research website cal Research Program of the Uniformed (www.research.va.gov) in the near future. Services University of Health Sciences Veterans, their families and other in Bethesda, said the finding could have members of the community, as well as major implications for the care of HIV- VA staff and other stakeholders, will have positive patients. “It brings us closer to the an opportunity to learn more about possibility of using genetic information local and national VA research through along with laboratory tests such as the laboratory tours, lectures, exhibits, CD4 count and viral load to assess AIDS poster presentations, contests and other risk.” Furthermore, he said, the research educational activities. suggests how genetic information could be used to evaluate potential new vaccines. On that point, Ahuja noted that “clinical PAIN (from pg. 7) Collaborating with Krebs were Timothy trials of potential vaccines certainly need “Universal pain screening has become Carey, MD, MPH, of the University of to look at other endpoints than reduction widespread despite a lack of research North Carolina School of Medicine; and of viral load, and may need to account evaluating its accuracy and effectiveness. Morris Weinberger, PhD, of the University for the disease-modulating effects of host We know that pain is a serious problem in of North Carolina School of Public Health genotype.” primary care, but pain screening may not and the Center for Health Services Re- search in Primary Care at the Durham VA Their study was funded mainly by VA be the best way to address this problem,” Medical Center. The study was funded by and the National Institutes of Health. said the researcher. the Robert Wood Johnson Foundation. 8