Page 1

Vol. 24

No. 36

www.bethesda.med.navy.mil

September 6, 2012

Scoville Named Finalist for Prestigious Federal Award By David A. Dickinson WRNMMC Journal staff writer Foresight to confront hurdles without a blueprint is a talent few possess. Retired Army Col. Chuck Scoville has that vision, which is part of the reason why he’s a finalist for a 2012 Samuel J. Heyman Service to America Medal, also known as the “Sammie.” While Scoville was still in uniform in 2001, then-U.S. Army Surgeon General, Lt. Gen. James B. Peake, charged him and his colleagues with determining how to prepare military medicine to care for U.S. troops returning from war with traumatic limb loss. At the time, Scoville served as the surgeon general’s chief physical therapy consultant. “General Peake asked what we would do in response of going into Afghanistan and the number of amputees we might have and how we would care for these individuals,” Scoville recalled. The answer led to the development of the Military Ad-

vance Training Center (MATC) at the former Walter Reed Army Medical Center (WRAMC), which moved to Walter Reed National Military Medical Center (WRNMMC) when WRAMC integrated with the former National Naval Medical Center (NNMC) last summer, forming WRNMMC. “I took my sports medicine background and applied that to our wounded warriors, who are tactical athletes,” explained Scoville, who now serves as chief of Amputee Patient Care Service at WRNMMC. More than 1,500 injured service members have received care in the MATC, with many returning to active duty thanks to Scoville and his team. “It was Chuck’s drive and vision that really changed the paradigm for the way we rehab amputee patients,” said Dave Laufer, chief of orthotics and prosthetics services at WRNMMC. “Wounded warriors are being treated now like tactical athletes as opposed to older am-

Photo by David A. Dickinson

Chuck Scoville (center), chief of the Amputee Patient Care Service at Walter Reed National Military Medical Center, has been nominated for a 2012 Samuel J. Heyman Service to America Medal, also known as the "Sammie," a prestigious federal worker award for his development of a sports-based rehabilitation program credited with helping hundreds of combat amputees lead active lives.

See SCOVILLE page 4

AFRRI: A Global Authority on Ionizing Radiation By Mass Communication Specialist 3rd Class Nathan Parde NSAB Public Affairs staff writer

Photo by Dave Morse

Ms. Cyndi Inal a research assistant at the Armed Forces Radiobiology Institute in Bethesda, Md., prepares gel plates for the cultivation of cells.

The Armed Forces Radiobiology Research Institute (AFRRI) in Bethesda, Md., is a Department of Defense (DoD) research laboratory and the nation’s authority on the effects of ionizing radiation. “There’s no other place in the United States that has the kind of research support and radiation source as we have,” said Air Force Col. Andrew Huff, interim director of AFRRI. “We have about 200 people here, a 90,000 square foot research facility, and a yearly budget of around $15 million. With that, we conduct all of the Department of Defense’s research program in radiation biology.”

AFRRI is part of the Uniformed Services University of the Health Sciences, and is a tenant command at Naval Support Activity Bethesda. Congress approved the construction of the AFRRI facility on June 8, 1960, and the ground-breaking occurred later that year. “In the height of the Cold War, Congress thought that the Army might face tactical nuclear weapons and that it would be good to have some sort of medication that would prevent the terrible effects of ionizing radiation,” said Huff. “Ionizing radiation does damage immediately to macromolecules and proteins in the body. So, more than 50 years ago, they commissioned the construction of this tri-service radiobiology research institute here on the grounds of what was then Naval Hospital Bethesda.”

Following the breakup of the Soviet Union and the destruction of the Berlin wall in the late 1980s, AFRRI faced eminent budget cuts and there was an uncertainty of whether the institution would still receive funding for research, said Huff. “The Cold War ended, and dangerous but rational actors gave way to failed governments and terrorism. Nothing instills fear like ionizing radiation. AFRRI developed and continues to develop countermeasures,” said Huff. Radiation countermeasures is the first of five program areas that AFRII research focuses on, said Huff. “The biggest and most important program area here is medications and pharmaceuticals that could be used as countermeasures, either before or just after exposure to ionizing

See AFRII page 8


The Journal

2 Thursday, September 6, 2012

Commander's Column In a few days, we will observe the 11th anniversary of one of the most infamous days in U.S. history – a day most of us will never forget. Watching the horror unfold before our eyes early that crisp fall morning as the two planes flew into the World Trade Center towers, only to be followed by reports and dreadful images of our nation’s defense headquarters, the Pentagon, under attack by a third aircraft, was an event that will be emblazoned in our minds for years to come. If that were not enough, later that fateful day, we learned that a fourth aircraft, possibly destined for our nation’s Capitol, had crashed into a remote field in Shanksfield, Pa., because the heroic passengers onboard had taken matters in their own hands, and took down those who commandeered the plane. Thousands of lives were lost that tragic day 11 years ago, including many of our brothers and sisters in uniform at the Pentagon. It’s ironic that Tuesday morning began beneath a bright, clear blue sky that held promise for a beautiful day, and yet this Tuesday will mark the 11th anniversary of the events that occurred Sept. 11, 2001. For nearly 11 years, we have fought a war against the forces of evil that brought those acts of terrorism to our shores. Our brave men and women in uniform have responded heroically in this war. Many have made the ultimate sacrifice or endured life-changing injuries, both visible and unseen.

Published by offset every Thursday by Comprint Military Publications, 9030 Comprint Court, Gaithersburg, Md. 20877, a private firm in no way connected with the U.S. Navy, under exclusive written contract with the Walter Reed National Military Medical Center, Bethesda, Md. This commercial enterprise newspaper is an authorized publication for members of the military services. Contents of The Journal are not necessarily the official views of, nor endorsed by, the U.S. Government, the Department of Defense, or the Department of Navy. The appearance of advertising in this publication, including inserts or supplements, does not constitute endorsement by the Department of Defense or Comprint, Inc., of the products or services advertised. Everything advertised in this publication shall be made available for purchase, use or patronage without regard to

We care for them each and every day at Walter Reed National Military Medical Center. Their sacrifices, as well as the sacrifices of their families and loved ones, have kept us and our friends safe and upheld our Nation’s values and beliefs in freedom and democracy. The world class care that we continue to provide to our Nation’s heroes could not have been possible without the dedication of the staff at Walter Reed Bethesda. Your immeasurable contributions at our Nation’s Medical Center have been instrumental to our success here and abroad. Those of you in uniform – you not only bring your remarkable skills and talents here to serve the nation, but you take them with you to serve others throughout the world. In addition, the efforts and continuity of our civilians, contractors, and volunteers are vital to maintaining the home front. To all of you, your Nation is eternally grateful. We will never forget the tragic events of Sept. 11, and the nation will never forget what you do here at its medical center, the Nation’s Medical Center. Please remember always that, What You Do Matters. Continue to keep those whose lives have been affected by this horrible tragedy in your thoughts and prayers on Tuesday and in the years to come. Commander sends, Rear Adm. Alton L. Stocks MC, USN Walter Reed National Military Medical Center

race, color, religion, sex, national origin, age, marital status, physical handicap, political affiliation, or any other non-merit factor of the purchaser, user, or patron. Editorial content is edited, prepared and provided by the Public Affairs Office, Walter Reed National Military Medical Center, Bethesda, Md. News copy should be submitted to the Public Affairs Office, Bldg. 1, 11th Floor, by noon one week preceding the desired publication date. News items are welcomed from all WRNMMC complex sources. Inquiries about news copy will be answered by calling (301) 295-1803. Commercial advertising should be placed with the publisher by telephoning (301) 921-2800. Publisher’s advertising offices are located at 9030 Comprint Court, Gaithersburg, Md. 20877. Classified ads can be placed by calling (301) 670-1700.

Bethesda Notebook Volunteers Needed for Day of Remembrance Project

This year's Joint Services “National Day of Remembrance” project takes place Saturday from 8:30 a.m. until noon at the Historic Congressional Cemetery in Washington, D.C. Military personnel, their family members and Department of Defense civilians are needed as volunteers to help restore grave markers, remove weeds, plant trees and perform minor landscaping around the cemetery’s roadways and path to the 9/11 Memorial. Volunteers will receive T-shirts, water and lunch. Transportation will be provided as needed, and will leave at 7:15 a.m. from the America Building patient drop-off area. To register for the event, email your name and phone number to Hospital Corpsman 1st Class Elizabeth Patterson at Elizabeth.j.patterson@med.navy.mil, or call her at 301-319-8576, or Hospital Corpsman 1st Class Arnel Galapir at 301-319-4654.

Staff Flu Shots Available

Staff members at Walter Reed Bethesda can obtain a free flu shot today through Monday, from 7:30 a.m. to 4:30 p.m. in Building 7, Floor 2, adjacent to Military Health Records. A staff badge or Common Access Card is required. For more information, contact Lt. Cmdr. Nancy Delahoya at 301-295-4738 or nancy.c.delahoya.mil@he alth.mil.

Half Marathon, 5-Miler Need Volunteers

Volunteers from Walter Reed Bethesda are needed to help with the Inaugural Navy-Air Force Half Marathon and Navy 5-Miler in Washington, D.C., on Sept. 15-16. Transportation will be provided on an as needed basis, with a bus departing from the America Building at noon on Sept. 15. The event begins at 1 p.m., and will run until approximately 7 p.m. The bus on Sept. 16 departs from the base at 4:15 a.m., as the activities begin at 5 a.m., and are expected to run until noon. Snacks will be provided. Volunteers must be at least 10 years old, and each will receive a T-shirt. Volunteers will staff water stations and the Morale, Welfare, Recreation booth, hand out T-shirts, and assist with setting up and taking down for the event. For more information, call Hospital Corpsman 2nd Class Michael Strong at 301-295-3936, or Hospital Corpsman 1st Class Elizabeth Patterson at 301-319-8576.

Naval Support Activity (NSA) Bethesda Commanding Officer: Capt. Frederick (Fritz) Kass Public Affairs Officer NSAB: Joseph Macri Public Affairs Office NSAB: (301) 295-1803

Journal Staff Staff Writers

MC2 John Hamilton Sarah Marshall Sharon Renee Taylor Cat DeBinder Katie Bradley Helen Hocknell

Managing Editor

MC1 Ardelle Purcell

NSAB Editor WRNMMC Editor

MC3 Nathan Parde Bernard Little

Walter Reed National Military Medical Center Office of Media Relations (301) 295-5727 Fleet And Family Support Center (301) 319-4087 WRNMMC Ombudsman Julie Bondar

(443) 854-5167

NSAB Ombudsman Jojo Lim Hector

(703) 901-6730

Visit us on Facebook:

Naval Support Activity Bethesda page: https://www.facebook.com/NSABethesda Walter Reed National Medical Center page: http://www.facebook.com/pages/Walter-ReedNational-Military-MedicalCenter/295857217111107


The Journal

Thursday, September 6, 2012

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161st Anniversary of Maj. Walter Reed’s Birth Nears By Bernard S. Little WRNMMC Journal staff writer September 13 marks the 161st anniversary of Maj. Walter Reed’s birth. Born in 1851 in Belroi, Va., to Lemuel Sutton Reed, a Methodist minister, and his wife, Pharaba White, Reed achieved fame for leading the team that confirmed yellow fever is transmitted by a particular mosquito. “He was highly motivated,” said retired Col. (Dr.) John R. Pierce, in the PBS documentary “The Great Fever,” which tells of Reed’s medical team’s efforts to eradicate yellow fever. Pierce is a medical inspector for the Veterans Health Administration and historian for the Walter Reed Society. While on active duty in the Army, he worked more than 15 years in various leadership positions at the former Walter Reed Army Medical Center (WRAMC).

Courtesy photo

“[Maj. Walter Reed] worked most of his life with the idea that there was going to be an opportunity for him to make a big difference,” said Pierce, who co-authored a book with Jim Writer about yellow fever and the discoveries made by Reed and his team in Cuba during the early 1900s. Reed, the youngest of five children, completed his medical degree at the University of Virginia in 1869, two months before he turned 18 (then the

youngest graduate in the history of the university's medical school), Pierce explained. Reed earned a second medical degree a year later at the Bellevue Hospital Medical College in New York, and joined the U.S. Army Medical Corps in 1875. Writer described Reed as “a frontier doctor” who had spent most of his career on the frontier in Arizona, Kansas and Nebraska. “He [took] a class in bacteriology at Johns Hopkins, and it [transformed] him, [brought] him into contact with the new science of medicine. He [moved] from this frontier doctor, working in small Army posts, and [became] a scientist,” Writer said. Reed joined the faculty of George Washington University School of Medicine and the Army Medical School in Washington, D.C. in 1893, where he was professor of bacteriology and clinical microscopy. He also did

medical research and served as curator of the Army Medical Museum, which later became the National Museum of Health and Medicine, now located at Forest Glen in Silver Spring, Md. He then went to Cuba in 1899 to study disease in U.S. Army camps, where yellow fever was a problem during the Spanish-American War. In May 1900, Army Surgeon General George Sternberg appointed him to head the board charged with studying infectious disease in Cuba. That team would prove yellow fever was transmitted by the common domestic mosquito, aedes aegypti, and disprove the disease was transmitted by the soiled clothing and bedding of yellow fever sufferers, articles known as fomites, Pierce explained. “The results of this research were quickly applied ... with remarkable success,

essentially ending yellow fever’s long reign of terror,” Pierce added. Reed returned to Washington to assume other military duties, and over the course of the next year, he received recognition and acclaim for his scientific work, Pierce continued. “However, in the fall of 1902, he felt ill and made the self-diagnosis of appendicitis. He visited his friend Maj. William C. Borden, commander of the Army General Hospital in Washington, D.C., who after a period of observation, operated on Reed on Nov. 17. Borden was shocked to find his condition much worse than expected. Reed developed peritonitis; without antibiotics, it was hopeless,” said Pierce.” Reed died on Nov. 22, 1902, and was buried in Arlington National Cemetery. He was 51. “Borden, devastated by

See REED page 9

WRNMMC Supports National Breastfeeding Month By Cat DeBinder WRNMMC Journal staff writer The Mother Infant Care Center (MICC) at Walter Reed Bethesda is focused on raising awareness about the benefits of breastfeeding for babies and new mothers. “Breastfeeding is overwhelmingly recommended by numerous health agencies as the optimal nutrition for infants, as well as proven health benefits for moms,” said Shannon Riley, registered nurse and board certified lactation consultant in the MICC. Information for staff and patients is available about the BabyFriendly Hospital Initiative — a world-recognized quality assurance program outlining 10 steps hospitals can take to improve breastfeeding outcomes for new mothers and babies, said Riley. In January 2011, U.S. Surgeon General Vice Adm. Regina Benjamin issued a

Courtesy photo

“Call to Action to Support Breastfeeding,” which indicated breastfeeding protects babies from infections and illnesses, including diarrhea, ear infections and pneumonia. The initiative also cited breastfed babies are less likely to develop

asthma, and mothers themselves who breastfeed have a decreased risk of breast and ovarian cancers. Riley said the American Academy of Pediatrics (AAP) is also a strong advocate for breastfeeding. “According to a 2010 re-

search article published in Pediatrics, if 90 percent of mothers of newborns complied with the AAP’s recommendation, we could save in excess of $13.1 billion in health care expenses and prevent more than 911 deaths in mostly newborns

annually,” Riley said. At a time when the economy is so poor and people everywhere are trying to spend less, it’s comforting to know that breastfeeding not only has health benefits, but economical benefits as well, said Eddie Horne, a registered nurse and board certified lactation consultant in the MICC. Horne’s views are substantiated by the U.S. Department of Health and Human Services Office on Women’s Health in the publication, “Why Breastfeeding is Important,” which claims that breastfeeding can save money. The publication states, “Formula and feeding supplies can cost well over $1,500 each year, depending on how much your baby eats. It also claims breastfed babies are also sick less often, which can lower health care costs.” Both Riley and Horne agree that hospitals and

See NURSING page 9


The Journal

4 Thursday, September 6, 2012

SCOVILLE Continued from 1 putees,” he added. Today, wounded warrior care includes the services of multi-disciplinary teams and high-tech, computerized equipment and systems. A native of Ohio, Scoville’s training in sports medicine and physical rehabilitation began at Ohio University, where he earned a degree in physical education. He was a substitute teacher before joining the Army for what he thought would be a short commitment. “I had plans to go to Duke University and work in sports medicine,” Scoville said. Those plans changed. Earning his master’s degree in physical education exercise physiology through the Army/Baylor University Physical Therapy Program, he then served in the Army for 29 years, with stints as a physical therapist in Berlin, Hawaii, the Pentagon and the U.S. Military Academy in West Point, N.Y., where he proposed and established a sports-based physical therapy program. Retiring from the Army in 2003, following his assignment in the Army surgeon general’s office, the Army asked him to take a civilian

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job to oversee the amputee care program at WRAMC. Scoville said he was honored to be considered for the job. “It kind of evolved based on my experience with the administrative work with the surgeon general’s office,” he explained. Scoville has watched the amputee care program grow from those early years to what it has become today, incorporating his experience in sports medicine and physical rehabilitation with traditional medical care. “We’ve made a lot of changes with prosthetic devices and advances with our treatment of the pain associated with limb loss

[known as phantom limb pain] and advances in the rehabilitation,” Scoville said. “The work we are doing with mind interface research are advancing on a fairly rapid basis and we are getting closer to a mind/machine interface. We are getting closer to powering prosthetic devices so they do perform closer to what the physiological human body performs.” “He gives folks new hope that they can function and strive for independence,” said Brig. Gen. Joseph Carvalho Jr., commander of the Army’s Northern Regional Medical Command. “Chuck will go down as one of the leaders in the care of amputees.” Scoville downplays his role, and attributes Walter Reed Bethesda’s success in rehabilitation to his colleagues and the wounded warriors themselves. “A lot of my job is to make sure everyone has what they need, and then stay out of the way,” he said in a Washington Post interview. He said, “[Wounded Warriors] do things they never did before and reach more high level activities than in the past.” The Samuel J. Heyman Service to America Medal that Scoville is a finalist for is considered an “Oscar” of American government service. The medals have been awarded annually since 2002. Samuel J. Hey-

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man, an American businessman and philanthropist, founded and chaired the Washington-based Partnership for Public Service, a nonprofit, nonpartisan organization with a mission of inspiring public service. He died at the age of 70 in 2009, but the award which bears his name continues to annually salute the accomplishments of federal employees. Honorees are chosen based on “their commitment and innovation, in addition to the effect of their work on addressing the needs of the nation,” according to Partnership for Public Service officials. Honorees are chosen from nominations collected each winter, and narrowed down to 32 finalists announced mid-spring of each year. The 32 finalists are assessed, and from their ranks, nine awardees are selected by early fall. Medal categories include federal employee of the year; call to service; career achievement; citizen services; homeland security; justice and law enforcement; management excellence; national security and international affairs; and science and environment. Scoville is a finalist in the national security and international affairs category. This year’s annual award ceremony and gala will be held Sept. 13 in Washington, D.C.


The Journal

Thursday, September 6, 2012

MWR Brings a Day of Hawaiian Fun to NSAB

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Above: Volunteers learn to hula dance at a Luau hosted by Morale, Welfare and Recreation last week. Right: Army Spc. Eric Hunter, a wounded warrior, holds Shiloh, a Moluccan Cockatoo.

Photos by Helen Hocknell

Army 2nd Lt. Nathan Davidson, a student at the Uniformed Services University of the Health Sciences, and his daughter, Alexandra, make new feathered friends from the Wilson Parrot Foundation, a nonprofit bird rescue organization.Alexandra celebrated her 4th birthday at the Luau.

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1030947


The Journal

6 Thursday, September 6, 2012

90 Minutes to Financial Stability By Mass Communication Specialist 2nd Class John K. Hamilton NSAB Public Affairs staff writer

Naval Support Activity Bethesda’s (NSAB) Fleet and Family Support Center (FFSC) offers financial counseling to all base personnel and their families. Financial counseling can be an excellent start on your journey toward superb financial standing. "Financial counseling or coaching provides [participants] an opportunity to complete a financial assessment to see where they are from a 45,000 foot view, make necessary financial adjustments, perhaps some behavioral changes and set themselves up for success on their financial journey in life," said Brian Pampuro, work and family life consultant at FFSC. The counseling appointments are booked in 90-minute increments. The time allows counselors to be thorough in their analysis of the counselee’s financial situation. "I usually set a financial coaching appointment at a time that is most convenient for the individual," said Pampuro. "I want them to be relaxed and rested if possible. If the person is asking for a complete financial assessment, I will send them paperwork to complete prior to their appointment. I try to include financial education tips that will help them better understand personal finance and have a better approach to managing their money each month. I like to tell [people] when they visit our of-

fice that, ‘Today will be the first day of the rest of your life’ in terms of how you look at your personal finances. Establishing a healthy balance between spending and saving is the key to sound money management. “We encourage a 70/20/10 percent split of net income – 70 percent to living expenses, no more than 20 percent to debt payments and at least 10 percent towards savings,” he said. Pampuro recommends creating financial goals before making any major purchases. A good short-term goal (shorter than five years) is creating an emergency savings account. A longterm goal is retirement savings. He added that this type of planning is especially important for married couples. “When shopping for a house or car, you want to establish goals, complete a financial assessment to determine what you can reasonably afford and get a pre-approved loan through

your bank or credit union,” said Pampuro. “Most importantly, shop conservatively and smartly through product research, comparison and bargain shopping and good use of consumer skills. It is also important to know and understand any legal aspects of major purchases. It might be wise to have a legal officer review any contracts prior to putting pen to paper.” Keeping a close eye on your credit report can help you dispute any discrepancies that may arise and help you to feel more in control of your finances. "At a minimum, [people] should check their credit reports annually to ensure that all the information reported by the credit reporting agencies, Experian, Equifax and TransUnion is correct and to make sure that there is no threat of identity theft or anyone tampering with their credit accounts,” said Pampuro. “There is a chance that everyone has some ‘false negative’ information on their credit report and if a person has a common last name such as Smith, Jones or Johnson, there is an even greater chance. Individuals can obtain a free credit report annually by visiting www.annualcreditreport.com.” Master-at-Arms 1st Class Craig Hector, NSAB career counselor and drug screening coordinator said the counseling session helped him gauge where he was in his career and avoid financial pitfalls. “I learned budgeting, how to avoid bad debt and get good debt and how to avoid overspending on things you don’t need," said Hector. "Some people like

shoes or other things, but you learn to curb it because [the budget] shows you where all your money goes.” Hector recommends junior service members sign up for financial counseling because it helps avoid situations that could negatively impact your military career. "Some people are very bad with money and they may not know it until they get the wrong letter, like a letter of indebtedness that requires the CO (commanding officer) to take action, then your evaluation or fitness report can go down. Receiving financial counseling will help you make better choices about how to spend your money,” said Hector. There are three accredited financial coaches at FFSC that provide their services at no cost. "We are here to serve the community, uniformed services, military families and civilian personnel alike and our goal is to provide the necessary support and guidance to help people succeed in their quest to become financially fit,” Pampuro said. “Doing so gives individuals ‘peace of mind’ and allows them freedom to focus on their job and the mission and not worry about the things that are bothering them financially.” To make an appointment with one of the financial counselors, contact Demetrius Gonzalez at 301-400-2413, demetrius.gonzalez@med.navy.mil; Brian Pampuro at 301-400-2414, brian.pampuro@med.navy.mil; or Lee Acker at 301-295-5081, lee.acker@me d.navy.mil.

Workshop on goal-setting motivates, inspires By Helen Hocknell NSAB Public Affairs staff writer

Photo by Helen Hocknell

Kaprece James, a life skills education services facilitator with the Fleet and Family Support Center, teaches a workshop on motivation and goal-setting.

Kaprece James, a life skills education services facilitator with the Fleet and Family Support Center (FFSC), recently delivered a workshop on motivation and goal-setting at Naval Support Activity Bethesda (NSAB). “Sometimes we get so busy working, we just go along with our daily tasks and lose sight of our goals and greater purpose,” said James. “It’s important to take time to identify your strengths, set goals and design a plan for achieving them.” Workshop attendees included a mix of NSAB and Walter Reed National Military Medical Center personnel. A comprehensive workbook helped guide students through an

eight-step “success map.” These steps included examining your identity, defining your values, establishing goals, putting together an action plan, figuring out what motivates you, establishing discipline, maintaining flexibility and reaching an outcome. James said many people set unrealistic goals because they don’t properly identify their skills and motivations first. “You can’t set a goal if you don’t know your strengths, skills and weaknesses,” said James. “You can’t force yourself to perform in a way that is not in alignment with your values. Determining who you are is the first step in deciding where you want to go.” She added it’s important to focus on self identity. Once you’ve done a thorough self-inventory, you can set goals that are tailored to your capa-

See GOAL page 8


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Thursday, September 6, 2012

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Steering Committee Focuses on Patient, Family-Centered Care By Terry Sellars Patient Advocate/PFCC Steering Committee To promote Patient and Family Centered Care (PFCC), the PFCC Steering Committee strives to enhance communication and foster relationships between patients, their families and providers. Currently made up of about 30 members, the open committee welcomes volunteers. “Patient and Family Centered Care is an integral part of the Walter Reed Bethesda Strategic Plan under the Quality of Care Pillar,” explained Col. John Spain, committee champion and deputy commander for clinical support at Walter Reed Bethesda. “By getting our patients and their families more involved in managing their own healthcare,

Photo by Terry Sellars

The Patient and Family Centered Care Steering Committee strives to enhance communication and foster relationships between patients, their families and providers.The committee welcomes volunteers. they will feel like a part of the healthcare team developing a positive and rewarding relationship with their providers. This relationship produces better outcomes for the patients and their families,” he said. The Army colonel has championed the PFCC

Steering Committee since December 2010, and will soon head to the Army Surgeon General’s Office. The committee recently welcomed his successor, Lt. Col. Scott Petersen, chief of medical staff. “His great interest and experience in patient and family-centered care will

make him a most welcome addition,” Spain said. The committee is driven by “seed projects” where “one person” can make a difference. Committee members have undertaken seed projects, focusing on patient and family centered care at Walter Reed Bethesda, including a patient brochure for the Breast Imaging Center, a new PFCC policy for the medical center in the works, as well as a new patient “Welcome Guide.” Members are also coordinating a nonmedical attendance training program for patients and their families. It assists in the improvement of inpatient room preparation and orientation standards as well as information technology processes in the pharmacy to help ease patient access. Additionally, members are involved with Tracer Team activities, as

well as a study of inpatient treatment differences to determine whether changes are needed. According to committee members, they are constantly working to make a difference, and there are plenty of opportunities to get involved. “The [PFCC] steering committee strives to improve the patient experience by involving everyone on all levels to share ideas, time and resources in making positive changes to the patient experience at Walter Reed National Military Medical Center,” added Michael Joseph, committee member and patient relations service chief. The PFCC Steering Committee meets on the fourth Thursday of every month at noon. For more information, call Terry Sellars at 301-3193882.

3D technology supports unique amputee needs: The science of 3DMAC By Sharon Renee Taylor WRNMMC Journal staff writer In this second of a twopart story, engineers explain the science behind the 3D technology they use to create one-of-a-kind prostheses for amputees at Walter Reed National Military Medical Center. When Zach Harvey, chief prosthetist at Walter Reed National Military Medical Center (WRNMMC), learned the 3D Medical Application Center (3DMAC) at Walter Reed Bethesda could help him create titanium parts, he found the solution to a design problem that halted his progress on a unique prosthetic for a bilateral, above the knee amputee. Harvey and engineers at the 3DMAC collaborated to make a set of “flat bottom rockers,” short feet that attach to the amputee’s sockets that enable him to walk on uneven surfaces, or climb in and out of the pool by himself. Peter Liacouras, a biomedical engineer who serves as director of services for the 3DMAC, explained the science behind the prosthetic project that generated three dimension-

al solid objects from virtual, computer-generated images by adding materials layer by layer. Additive Manufacturing After measuring the joint that fits on the end of the prosthetic piece Harvey provided, Liacouras created a top portion as well as a bottom foot pad with a rocking mechanism using computer aided design (CAD) software. The team completed a prototype design and manufactured it in plastic on one of their stereolithography machines, a type of additive layer manufacturing machine. “Basically what we’re doing here is adding material, layer by layer,” Liacouras said. The 3D Medical Applications Center has several different additive manufacturing machines. The machine that produced Harvey’s plastic prototype uses a liquid, photopolymer resin and laser. According to Liacouras, a stainless steel platform is initially aligned with the surface of the resin. The laser bounces off a mirror and hits the surface of the resin. Wherever the laser path goes, the resin hardens into a plastic material. The

platform sinks 0.15 millimeters and the process repeats again and again, with each layer fusing together until the end, emerging from the vat of resin as a solid object. The first plastic the lab made for Harvey comprised of more than 800 layers and took four hours to build the five inch part. Once Harvey fitted the amputee with the plastic part to test, the 3D MAC engineers worked with the prosthetist to make additional enhancements. Wurth used an electron beam melting (EBM) machine to produce the final design in titanium. The EBM machine spreads a layer of titanium powder and uses an electron beam to melt the layer in a specific area representing a two dimensional slice of the three dimensional part. The process repeats, layer by layer, bonding each together to create the three dimensional part. The machine manufactures the titanium under a controlled vacuum of helium at approximately 700 degrees Celsius and uses magnetic fields to control and direct the beam’s path. The parts were taken to a blasting cabinet, where they were blasted with additional titanium powder, to remove and

Photo by Sharon Renee Taylor

Zach Harvey, chief prosthetist, fits Marine Cpl.Tyler Southern (right) with the new prosthetics Harvey developed with engineers in the 3D Medical Applications Center at Walter Reed Bethesda.The engineers used computer-aided design software to create the short feet that enable the amputee to climb in and out of the pool by himself. recycle the titanium powder that did not melt. Wurth estimated the final version of the prosthetic part took five hours to print in titanium with an additional two to three hours to cool using electron beam (EBM) technology. The history Additive manufacturing began in the early 1980s, Wurth explained. It was introduced to the automobile industry in the late 1980s, slowly used in medical ap-

plications, and later, titanium emerged in the last 10 years. He said there are about 20 EBM machines in North America and perhaps another 40 or more throughout the rest of the world. The Walter Reed Bethesda 3DMAC produces medical models, surgical guides and custom implants for the medical center, as well as VA hospitals and other DoD facilities, according to Navy Capt. Gerald

See3-D 3D page 9 See


The Journal

8 Thursday, September 6, 2012

AFRII Continued from 1 radiation. That’s our theme song here at AFRRI,” said Huff. “The damage after ionizing radiation is immediate, but the secondary damage is what we try to prevent to limit further damage.” After the tragic events of Sept. 11, AFRRI received increased funding to investigate the relation between radiation and biological agents, resulting from a state of war or terrorism. This second program area is called, ‘Agent Defeat,’ said Huff. “The method of exposure that we are most concerned about is through terrorism, with an imposed nuclear device that would set off a nuclear chain reaction, or a dirty bomb that would spread radioactive materials in a conventional bomb.” A nuclear chain reaction releases massive amounts of energy, most of which is blast and thermal, which could result in compounded, or combined injury: a third program area, said Huff. “So, what happens if you get radiation sickness from exposure to ionizing radiation and you were burned or injured from a falling building? There are certain things you can do that will improve people’s condition or outcome,” explained Huff. “That’s our newest program, and we will be opening new labs for combined injury here over the next few weeks.” The fourth program area of research at AFRRI is biodosimetry – the process of determining the amount of exposure to ionizing radiation following an incident. This is used to determine the appropriate response and treatment to prevent further damage down the line, said Huff. “The final of the five programs here is internal contamination, and that is internalizing (swallowing) or being poisoned by something

GOAL Continued from 6 goals that are tailored to your capabilities and interests, explained James. “If you have a clear picture of your destination in mind, you can develop an idea of how to get there and visual-

Courtesy photo

Air Force Maj. Jama Vanhorne-Sealy speaks at the Armed Forces Radiobiology Institute (AFRRI) Military Medical Operation Symposium on March 27. that is radioactive. Our program investigates how to neutralize or remove those radiation sources from the body,” said Huff. In addition to the five programs of research, the AFRRI maintains a Military Medical Operation (MMO) team that travels to teach about the effects of ionizing radiation, and responds in the case of an incident involving radiation. “In Military Medical Operations, we have a very small team of six members,” said MMO Acting Director Air Force Capt. Brian Livingston. “Our job is to take the research that is done at AFRRI and bring it out to the war fighters, and we do that in two different ways. “Our first mission is to teach the Medical Effects of Ionizing Radiation (MEIR) course, which is a graduatelevel course that we teach to 800-1000 people a year about how to deal with radiological and nuclear scenarios. It is targeted towards physicians

and nurses, but is offered at no cost for anyone who would like this education.” Livingston has been a member of the MMO team for two years, and has traveled across the globe to provide education about radiobiology to military members and civilians in other countries. “Our second focus in MMO is the Medical Radiobiology Advisory Team (MRAT) team: a unique, deployable asset that we have within AFRRI,” said Livingston. “It consists of a physician and a health physicist. We augment and support DTRA (Defense Threat Reduction Agency at Fort Belvoir, Va.) as subject matter experts on the medical effects of radiation. We advise commanders in the case of a radiological incident involving nuclear weapons, nuclear reactors, dirty bombs, or an incident like the one last year in Japan.” When a 9.0 magnitude earthquake struck Japan on

March 11, 2011, and a loss of electricity at the Fukushima Daiichi power plant allowed three reactors to overheat, AFRRI sent two MMO representatives overseas to assist. “On March 15, we deployed two health physicists to go over there and be direct advisors to the USFJ (U.S. Forces Japan) Surgeon for about seven weeks. We advised him on radiological effects, the use of Potassium Iodine, decontamination standards, public affairs communication and contingency plans for what to do if the situation continued to develop.” Livingston said the reaction to the threat of radiation is usually worse than the actual exposure. “We spend a lot of time in public affairs and relations, convincing people that they are safer than they think they are. In this instance, we had two employees who got beta burns in their boots while working on the reactor in Japan. This is comparable in severity to sunburn, yet we

shut down the reactors in Japan and other countries. People fear radiation because it is an unseen force. But, that is understandable because the knowledge of radiation and nuclear materials can be hard to come by. That is why we are a unique asset with our ability to educate and advise others in this area.” In addition to educating others about a largely unknown force, Huff said another challenge of working in a field involving radiation is researching when there are no events or real-world examples of ionizing radiation available. However, he added that the effort at AFRRI is worthwhile. “It is a challenge to learn about something that doesn’t happen to people very often, but through the Uniformed Services University, we are taking a 50-year-old set of buildings and really making them new again through renovating, so that we can continue to lead the nation in radiation research.”

ize a path,” said James. She added it’s better to set specific, short-term goals (six to nine months) rather than vague goals that take years to achieve. James encouraged students to utilize the workbook and keep a visual reminder of their goals in a prominent place, such as a notepad on their refrigerator or next to a calendar at their desk.

Matt Toone, who works in the information technology (IT) department at NSAB, said the workshop showed the importance of putting goals down on paper. “Writing down my plans makes them more real and helps me stay focused on achieving my goals,” said Toone. He said he came to the workshop because he’s trying to establish some firm

career goals. As the youngest of nine siblings growing up in a rural area, Toone had no idea what he wanted to do for a living when he was a child. “We never really talked about goals as a family. I was just always fixing others’ computers, and learned by doing,” said Toone. “That’s how I ended up in IT.” Now married with two

children of his own, 24-yearold Toone said he wants to plan for the future. “I used to do everything on a whim, but now I want to set my own goals and make a plan. I’m trying to look ahead.” To learn more about FFSC programs and services, call 301-319-4087 or email FFSC@med.navy.mil.


The Journal

Thursday, September 6, 2012

3D 3-D Continued from 7

Courtesy photo

NURSING Continued from 3 health care facilities, places of employment and society in general should adopt procedures that make breastfeeding more convenient for mothers and more readily accepted. Retired Navy Medical Corps Capt. Jeffrey Greenwald, a staff physician in the Newborn Medicine Division of WRNMMC’s Pediatric Department, is a strong supporter of breastfeeding who understands that the process can sometimes be difficult. “We are prepared to support our families in a way to assure optimal benefit for both mom and baby,” said Greenwald. “This includes continued lactation support in our outpatient clinics in addition to providing family-friendly areas in the medical center for pumping and feeding as necessary.” Shannon Johnson, a MICC patient and the mother of six, said she is a big believer in breastfeeding. She breastfed all of her children and said she believes it’s the healthiest thing for babies. “There are so many health advantages for myself and the baby,” Johnson said. “I also feel breastfeeding is very special – it gives you a chance

REED Continued from 3 Reed’s death, dedicated himself to honoring his friend,” Pierce stated. “Borden worked for several years to raise funds for a new hospital to replace the inadequate one at Washington Barracks (now Fort Lesley J. McNair). He also worked to have the new hospital named after his friend, Walter Reed. “In his desire to honor Reed, Borden succeeded in ways he could not

to bond with your baby and have skin-on- skin contact, which I think is really important,” she added. “Plus it makes night feedings much easier – I don’t have to make anything or wash anything.” Greenwald agreed. "I think it is wonderful in these days of high-tech medicine, that something as natural and simple as breastfeeding can provide the best nutritive and immunologic support to our future generation,” he added. But while breastfeeding is encouraged, some women cannot breastfeed for a number of reasons, including pain, inability of the baby to latch on to the breast, and the mother not being able to produce enough milk. "We know that women sometimes face challenges with breastfeeding that can be difficult or even make breastfeeding impossible despite their every intention to breastfeed,” said Navy Lt. Andrea Hernandez, assistant service chief on the MICC. “On the MICC, we do our best to support and empower moms with their personal infant feeding goals,” Hernandez added. For more information on breastfeeding, call Shannon Riley of the MICC at (301) 319-5048. To learn more above the initiative to make breastfeeding easier for mothers in hospitals, visit www.babyfriendlyusa.org.

Grant, a maxillofacial prosthodontist who serves as the center’s service chief. “We’re possibly the largest medical additive manufacturing center in a medical facility within the United States, possibly in the world, military or civilian,” Grant said. “The facility — with its equipment, software and personnel — represents big technology and we’re all trying to learn how to use it for patient care, explore possibilities through active research, and teach providers how to use it,” he added. Revolutionary The use of 3D additive manufacturing technology to create flat bottom rockers for the bilateral amputee reduced nearly a month’s worth of trial and error to a little more than a week, which will enable the prosthetic and orthotic lab at WRNMMC to service many more amputees, more precisely than ever before. Once 3DMAC churned out the first part for Harvey, he considered a dozen other projects “on hold” that the technology could aid. Some are small scale, ways to make things

9

more streamline or efficient. “Everything sort of evolves and comes to a standstill to a certain point where there are mechanical limitations,” Harvey said. “Now there’s a way to make this work pretty easily just with the missing part.” The prosthetist and certified orthotist colleagues call “the idea guy,” envisioned a host of new projects with the help of 3D imaging and manufacturing technology: an alignment adapter that would attach to the bottom of a socket and allow rapid change alignments as a person’s flexibility improves with therapy; an upper terminal device that would work well with parallel bars for triple amputees, or for hand railing on stairs — devices Harvey said don’t exist. “There’s been talk about 3D [technology], in fact a lot of talk, about the socket, the actual interface with the patient, begin constructed in a positive fashion rather than using our traditional moldmaking techniques which are very time consuming and hard to repeat,” said Harvey, who called the use of 3D imaging “revolutionary” for prosthetics. “Those are the kinds of things in the future this technology could bring,” Harvey said. “It’s what we’ve been waiting for.”

have imagined,” Pierce added. On May 1, 1909, Walter Reed General Hospital opened. In September 1951, to mark the 100th anniversary of the birth of Walter Reed, Walter Reed General Hospital along with the additional buildings now on the installation, was renamed WRAMC. In 1977, a new, larger hospital was dedicated at WRAMC. In 2011, WRAMC integrated with the former National Naval Medical Center to form Walter Reed National Military Medical Center, where the legacy of Maj. Walter Reed continues.

For more news from other bases around the Washington, D.C. area,

visit www.dcmilitary.com.

1032373


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10 Thursday, September 6, 2012

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