Navy Researchers’ Work Helps Wounded Warriors

By Shannon Collins

DoD News, Defense Media Activity

WASHINGTON, May 18, 2015 – Within the laboratories of Naval Medical Research Unit-San Antonio, or NAMRU-SA, interdisciplinary teams of biomedical engineers, environmental microbiologists, dentists, chemists and other researchers work to research technology that will help wound treatment for the Defense Department warfighter.

NAMRU-SA’s mission is to conduct medical, craniofacial and biomedical research, which focuses on ways to enhance the health, safety, performance and operational readiness of Navy and Marine Corps personnel and addresses their emergent medical and dental problems in routine and combat operations. They share their findings with the other service branches.

Within NAMRU-SA, the Craniofacial Health and Restorative Medicine Directorate team focuses on research to re-engineer wound healing, infection control and dental treatments.

It also advances DoD’s environmental stewardship and assists wounded warriors.

“The research here encompasses everything above the shoulders,” said Navy Capt. Rita Simmons, NAMRU-SA’s commanding officer. “And the most common injuries now -- with the body armor being so effective -- we’re looking at wounds in the head and face area. That area of research has really moved to the forefront of our wounded warrior issues.

“Groups of scientists are spending a lot of time looking at ways to fight infection caused by injuries of various forms to the head, face and neck areas, and we are working to improve outcomes,” Simmons said.

Cranial Implants

The researchers at NAMRU-SA do not create the cranial implants, but they are working on redesigning the surface of titanium implants and developing nano delivery systems for antimicrobials and local anesthetics for controlling pain and infection after a burn or head injury, said Mauris DeSilva, a principle investigator with the directorate.

DeSilva said a patient who has a traumatic head injury may suffer the loss of portions of their skull bone or could have an elevation of intracranial pressure requiring the removal of a portion of the skull by surgeons to relieve pressure from excess fluid build-up. Replacing the skull bone often requires an implant. These implants are typically made of durable polymers or titanium. Patients who go through this surgery have a high rate of post-surgical infections, which may necessitate removal and replacement of the implant. Warfighters going through these surgeries could get post-surgical infections, which is what DeSilva’s team is trying to reduce.

“Obviously, through any type of force, whether it’s some sort of blunt force trauma or blast injury to the head, quite often, the skull will be damaged during that process,” Simmons said. “But there are ways to improve the cranial implants that are used as part of the recovery process and ways that we can help fight infection. We don’t make the implants here but we investigate new surface materials to improve the implant’s function and reduce the rates of infection that can directly improve quality of life outcomes after the injury.”

Simmons added, “Infections beget surgery and if there are more infections, there’s more surgery, lost tissue, lost recovery time, psychological impact.”

DeSilva said his team is working on optimizing the surface roughness of the implants. His team is also developing a nano coating that has nano materials with antimicrobials so they will have a controlled release over a specific duration of time.

“What we hope is, after recommending the roughness scale that’s optimized for this implant, we want to take it a step further and have the implant produce an acute antimicrobial release for at least 30 days,” he said. “This is the time period that they’re seeing is therapeutically effective to kill most infections.”

Wound Dressing

Currently, wound dressings used on the battlefield are traditional bandages, officials said. They help control hemorrhage but do not actively help in the healing process. Researchers are looking into creating bandages with bioactive factors such as growth factors, antibiotics and other agents that may speed up healing and reduce scar formation, said Navy Capt. Jonathan Stahl, a research dentist.

The engineers and scientists at NAMRU-SA have built an electrospinning device that researchers can use to make dressings using nanofiber technology. Biologically compatible natural and synthetic polymers are dissolved into a solvent along with bioactive agents and spun into a wound dressing using electrical forces. The resulting wound dressing will release the growth factors and other drugs over time and can be tested to determine if they improve and possibly accelerate the wound healing process. If successful, the new dressing may speed up healing and reduce scars for those injured on the battlefield.

Cracked Teeth

“Fractured teeth and restorations are the most commonly reported dental emergencies among military personnel,” said Navy Cmdr. David Leal, acting director for the Craniofacial and Restorative Medicine Department directorate. “This can be a showstopper for them, and it can affect their work schedules. If they’re deployed, they may have to get sent back home so somebody can take care of the problem.”

Current methods for detection of enamel cracks provide limited information, Leal said. For example, he said, trans-lumination uses a bright visible light, which scatters when reflected on enamel. The dentist can see the fracture but is unable to determine the depth or extent of it. X-rays are not very diagnostic unless the fracture is grossly displaced.

The researchers at NAMUR-SA designed the Optical Coherence Tomography, or OCT. It uses non-ionizing laser light for obtaining sub-surface images of translucent or opaque materials.

“Our team’s goal is to use OCT as a new tool to develop a predictive model that dentists can use chairside to quickly scan a tooth and help them to evaluate the severity of tooth cracks,” Leal said.

With OCT, the dentists will be able to obtain live 3-D images instantly, Leal said, that will aid them in making diagnostic decisions to assist them with appropriate treatment plans to prevent or reduce dental emergencies.

Nano Technology in Fillings

Navy researcher Dr. Amber Nagy, an environmental microbiologist and biomedical scientist, said one of the projects they are working on is improving resin formulations used to treat cavities. When a patient has a cavity cleaned out, he or she may receive an amalgam filling or a filling with resin that is tooth colored so that it is more aesthetically pleasing.

Nagy said the resin fillings will be modified to have nanoparticles in it, which can use visible light to activate antibacterial activity. The goal is to eventually issue each patient a toothbrush that has a light emitting diode in the toothbrush head so that every time he or she brushes his or her teeth, the resin antibacterial process will be activated by the toothbrush.

“We want to prevent bacteria from attaching to the tooth because bacteria are what cause the decomposition of the tooth or the decay of the tooth in the first place,” Nagy said. “By adding nano particles to the resin and hitting it with a light, it will prevent the bacteria from binding which will help to reduce cavity formation.”

Environmental Stewards

“All military installations want to be good stewards in the towns and cities in the states in which they live,” Simmons said. “Our goal and mission is to make sure our military dental treatment facilities properly handle and dispose of dental amalgam waste from fillings.”

A large number of cavities are filled with dental amalgam each year by Navy dentists to ensure sailors are ready for deployment, said Nagy, who’s the principal investigator for NAMRU-SA’s mercury abatement project. Dental amalgam is a safe, cost-effective, and durable metallic mixture consisting of about 50 percent liquid mercury and a powdered alloy that contains silver, tin, and copper. When mixed, the two components harden and become a solid material, commonly referred to as silver fillings, which is used to fill cavities in teeth.

“After dentists go in and drill to take out a filling, we don’t want the amalgam filling waste, which contains mercury, to go into the public wastewater stream,” Nagy said. “To combat this issue, we use a dental chair filter that was designed, developed, prototyped and patented by NAMRU-SA researchers for Navy dental chairs throughout the Navy and Marine Corps dental clinics. This novel filter can capture 96.7 percent of amalgam from dental wastewater before it enters the public wastewater stream, and it is inexpensive, easy to install, and available for use across all services.”

NAMRU-SA, the lead agent for mercury abatement, has patented and developed this chairside dental wastewater filtering system with a special focus on the accumulation of inorganic chemical contaminants such as mercury. The Navy is ahead of the Environmental Protection Agency proposed nationwide requirement that will mandate amalgam separators to reduce mercury and other chemical contaminants from dental wastewater in all dental facilities in the country, Nagy said.

“We’re ahead of the curve there, and we want to stay ahead of the curve and be the gold standard for environmental surveillance for all of the DoD,” Simmons said. She said this is a collaborative effort, and the Air Force is working with the Navy to help develop filter systems that also remove organic contaminants from dental wastewater.

Teamwork

Nagy said the success of the research could not happen without teamwork.

“This research isn’t possible without our interdisciplinary team,” she said. “We have an excellent, dedicated and diverse team working together to solve these problems to save lives out there in the field.”

Simmons said those interdisciplinary teams seek to address the problem by bringing together people with varying expertise to answer questions from many different approaches.

“This way, they can downscale to a more workable solution to tackle that problem from the onset, rather than taking that very serial approach of, ‘Well, we tried that and it didn’t work, now what am I going to do?’” Simmons explained.

She said the teams have been successful at developing synergistic cross-talk between departments and directorates with research.

“Teams come together to come up with the best solution in the fastest means possible,” Simmons said. “Whether it’s a device, a capability or a scientific innovation that can be pushed forward, NAMRU-SA continues to make great progress in research that optimizes warfighter readiness and saves lives.”

AFNORTH CC Hosts Commanders Call

by TSgt Ed Staton
AFNORTH Public Affairs

5/18/2015 - Tyndall Air Force Base, Fla. -- The First Air Force commander emphasized new responsibilities, a continued focus on homeland defense and an increased tempo heading into the hurricane and fire-fighting season during a Commander's Call held May 4 at Horizons Community Center.

Speaking to a combined gathering of AFNORTH and 601st Air Operations Center personnel, Lt. Gen. William Etter, Continental U.S. North American Aerospace Defense Command Region - 1st Air Force (Air Forces Northern) commander, expressed thanks for everyone's accomplishments while challenging them to meet future personal and mission challenges.  Etter highlighted several missions.

"What we do is crystal clear," said Etter. "We defend the airspace on the NORAD side. Deter, detect, dissuade and if necessary we defeat.  This is a busy place and we've flown over 8,000 scrambles since 9-11."

While providing a NORAD mission support overview, Etter offered insight on the unique U.S.-Canadian NORAD relationship that features Canadian Brig. Gen. Alain Pelletier as CONR deputy commander.

"We are the only bi-national command in the world," Etter said. "General Pelletier is not an exchange officer.  He has command responsibility and that makes us different."

Etter also noted management of the Joint Land Attack Cruise Missile Defense Elevated Netted Sensor System, or JLENS, is a new role for AFNORTH.  JLENS features an airship that floats 10,000 feet in the air and carries powerful radars designed to detect airplanes and cruise missiles.

"JLENS will bring a huge protection capability to the NCR (National Capitol Region)," Etter said.  "They put it on top of a balloon and balloons are fragile.  We've got to make sure we watch it and we're creating developmental software and programs for it."

The fast-approaching hurricane season and the likelihood of many western fires caused by drought conditions in the Western United States are sure to task U.S. Northern Command's homeland and civil defense missions this summer, Etter added.

"We need to anticipate the threat and we can't be late," said Etter.  "We're in the business of saving lives and speed counts.  If someone says we 'need you by Sunday,' that doesn't mean that we wait until Sunday to arrive."

The AFNORTH commander and his command chief, Chief Master Sgt. Ronald Anderson, also stressed the importance of individuals doing their professional military education.  They cited recent examples of people rendered ineligible for promotion without that requirement.

"We make sure we stay physically fit to do the mission to the best of our ability," Anderson said.  "Our mental fitness toward the mission is just as critical, and completing our PME ensures that."

Face of Defense: Service Dog Helps Soldier Move On

By Army Sgt. Zach Sheely

Kansas Adjutant General Department

TOPEKA, Kan., May 18, 2015 – Master Sgt. Lyle Babcock is a combat veteran who’s served more than 30 years in the Army. He is an avid fisherman. He loves to kayak.

He also suffers from post-traumatic stress disorder. Fortunately, he has help from a four-legged friend.

Gunther, a 2-and-a-half year old, 100-pound yellow Labrador retriever, is Babcock’s service dog. His duty is to be at Babcock’s side at all times, allowing Babcock to live and work through his PTSD.

“He’s been a godsend to me,” Babcock said of Gunther. “He’s allowed me freedom from my own prison.”

An Internal Battle

Babcock was deployed nearly 15 months to Afghanistan as the noncommissioned officer in charge of the 102nd Military History Detachment, Kansas National Guard. He returned home to Topeka, Kansas, to his wife Traci and went back to work at Joint Forces Headquarters as the management analyst of the Human Resources Office, Kansas Adjutant General’s Department.

On the surface it was business as usual, but internally, the battle was still raging.

He struggled to reintegrate with society. He suffered from anxiety, problems sleeping and concentrating. He had panic attacks. His immediate instinct, however, was not to seek help out of fear of a stigma he thought people may place on him. Not until he started volunteering in the PTSD clinic at the Colmery-O’Neil Veterans Affairs Medical Center in Topeka did Babcock realize he wasn’t alone, others were struggling with the same inner turmoil.

“It was good to just sit down and talk with other vets and realize we’re all dealing with the same stuff,” Babcock said.

Another way Babcock relieved stress was through his love of being on the water. While researching kayaks to purchase, he discovered a group called Heroes on the Water, a nonprofit organization that helps service members and veterans relax, rehabilitate and reintegrate through kayaking and fishing.

Discovering Service Dogs

A few months later, Babcock, along with a group of volunteers, started the Kansas chapter of Heroes on the Water. Through HOW, Babcock learned of a group that provides service dogs to veterans and service members struggling with PTSD and/or a traumatic brain injury.

Joe Jeffers founded Warrior’s Best Friend based in Kansas City, Missouri, with the goal of pairing wounded warriors with trained service dogs rescued from animal shelters throughout the United States. Jeffers contacted Babcock about the possibility of pairing an interested veteran from Heroes on the Water with a trained yellow Labrador.

As Babcock learned more about Warrior’s Best Friend and the service dog available, he realized that he might be interested in being paired with the dog himself. After discussing it with family, friends and a Veterans Affairs counselor, Babcock decided to take a leap of faith and filled out the application to be paired with Gunther.

A Hard but Necessary Step

“Our pairing was quite unique,” Babcock said. “He’d never been around water, so the first time I took him to the lake, of course it was like glass. He stepped right off the dock, headfirst into the water. His eyes were huge. I was right down there encouraging him and pulled him out of the water. That was the instant we connected.”

The two go everywhere together -- restaurants, the grocery store, the lake, and even to work.

However, gaining clearance to bring him to the office was a lengthy process for Babcock. The most difficult part was disclosing to his leadership that he needed help.

“You want me to admit to you that I’m broken and that I want to start bringing a service dog in,” Babcock said. “That was a road block. That took me a long time to write that request and actually send it in. Looking back, it was a hard, but a necessary step.”

Babcock said that there are other service members in the Kansas National Guard who are living with PTSD, trying to fight it on their own, afraid, as he was, to admit they need help.

Extended Family

“The first thing is coming to grips with recognition that you do need some help and there’s no shame or embarrassment in that,” said Army Maj. Gen. Lee Tafanelli, Kansas adjutant general. “We all find ourselves at points in our lives where we do need somebody to lean on and do need the ability to reach out.”

Tafanelli said the Kansas National Guard is an “extended family” and that the first step to getting better is recognizing there’s a problem.

“We owe it to all of our soldiers and airmen to look out for their wellbeing,” he said. “It really isn’t a weakness. In many cases, these traumatic events have had a lasting impact,” an impact that Babcock and Gunther outwardly embody.

Gunther wears a service vest akin to a uniform while he’s on duty. A patch on it reads “PTSD service dog -- ask to pet.” Babcock does allow people to pet Gunther if they ask -- which, according to Jeffers, is not the case with most service dogs. Jeffers compared service dogs to other medical tools, like a wheelchair or crutches -- their purpose is to help their user to live as normal a life as possible.

Gunther ‘is Right There’

“This is something I spoke to the trainer with during the pairing process,” Babcock said. “I decided that as long as Gunther would maintain focus on me, I would allow others to pet him with my permission. He has always got an eye on me. When I say something, he’s up and moving and he’s focused strictly on me. If I start getting nervous, or anxious, or loud, he’s right there.”

At work, Gunther soon became one of the “employees.”

“I know my co-workers had some apprehensions about me bringing a service dog into the work area,” Babcock said. “Most of them had never been around a service dog before. I think some of them thought that Gunther would be like their pets at home -- constantly seeking attention or being a distraction at work. I think they were shocked at how well trained Gunther is and most of the time they don’t even realize he’s there with me.

“When Gunther walks into the office with me, my co-workers greet him and tell him good morning. They look after him -- the way they look after me. I understood that by taking this step there was a chance it would have a negative impact on others around me, which is the last thing I wanted. But the opposite has been true. They have been very accepting of Gunther and of the fact that I am receiving counseling for PTSD.”

Gunther didn’t only have to integrate at work, but also at home with Traci, the family’s Pomeranian, Pookie, and their three cats.

Ground Rules

“We laid a few ground rules,” Traci said. “I don’t need the added work. It’s his dog, but Gunther is definitely part of the family. He’s really grown on me. He’s a real likable dog. He’s well-mannered and well trained.”

“I learned, during the pairing process, that having a service dog is a lot of work and responsibility,” Babcock said. “They are 100 percent dependent on you, from feeding to cleaning up. They become dependent on you as much as you become dependent on them. A service dog is not for every service member or veteran dealing with PTSD, but he’s changed my life for the better.”

Gunther’s training was provided by Warrior’s Best Friend. Jeffers said the organization looks at 200-300 dogs to every one dog that they deem a service dog candidate. The dog has to demonstrate a certain level of focus and eagerness to learn in order to be considered for service. The dog’s training alone can take up to 14 months.

“It’s important that we get the dogs as early as possible,” Jeffers said. “The dog must be able to work in a minimum of three-hour segments and respond to roughly 25 commands, including block, wait and release.”

Once trained, an eligible veteran applicant is selected and is put through a familiarization process with the dog, which can take three to six months.

One of Many Treatment Options

“When you think about PTSD in terms of the symptom clusters (avoidance, intrusive, negative thoughts/emotions and hyper arousal) the ways in which a dog can help are many,” said Dr. Chalisa Gadt-Johnson, a licensed psychologist who works at the Topeka VA Medical Center. “The companionship is great for those who feel a sense of isolation, along with helping with those who may be avoiding people and/or places.”

While Gunther has helped him, Babcock acknowledged that a service dog may not be the best treatment option for all. Gadt-Johnson said there are other treatment options including peer-to-peer, group and peer-to-counselor counseling, which can teach better coping strategies. The VA Hospital in Topeka offers many education groups and treatment programs for substance abuse, addiction and psychiatric disorders, including a seven-week inpatient stress disorder treatment program, open to affected service members and veterans from around the country.

PTSD is not a new affliction, nor is it new to the Kansas National Guard, but for those suffering in silence, Babcock shared this advice.

“The first step in reclaiming your quality of life is to seek out help,” he said. “There are a lot of veterans and service members struggling with PTSD every day. We think the only solution is avoidance, isolation, drinking, drugs or even suicide. Sometimes the biggest step is admitting to ourselves that we can’t do it on our own, putting our pride aside and asking others for help.”

Babcock added, “I was afraid to take that first step. But now that I have, I wish I’d done it sooner. I’m starting to feel more in control of my life. My battle buddy, Gunther, is by my side, helping me get through the rough spots in my day. I don’t know what I’d do without him, but it took admitting that I needed help in order to get where I am today.”

Leaders hail 552nd ACW's 60th anniversary

by John Parker and Darren D. Heusel
Tinker Public Affairs

5/18/2015 - TINKER AIR FORCE BASE, OKLA -- Bookended with addresses from two former wing commanders, the 552nd Air Control Wing's three-day Diamond Anniversary Salute "exceeded all expectations," wing Commander Col. Jay Bickley said.

The extravaganza drew hundreds of distinguished visitors, past wing commanders, current and former Airmen, family members and community guests for activities May 7-9. The 60th anniversary events included a 5K run, golf tournament, tours, festivities and a Saturday evening gala.

"It was a tremendous tribute to the men and women of the 552nd ACW past and present, and I'm sure it won't soon be forgotten," Colonel Bickley said. "We owe a lot of thanks and gratitude to all of Team Tinker and our community partners for pulling it all together."

Pacific Air Forces Commander Gen. Lori J. Robinson spoke at the kickoff reception May 7 in the Tinker Club ballroom. The general is a former 552nd ACW commander.
"We all stand on the shoulders of giants," the general said. "You all are making history every day. What you do is important, and we talk about it at the most senior-level places ... The four stars know that what you bring to the fight each and every day is important, and we couldn't do it without you."

Colonel Bickley unveiled a 60th anniversary commemorative lithograph by aviation artist Darby Perrin as a gift to the Pacific Air Forces. General Robinson joked that she could now tell Pacific Air Forces that she'll be bringing back another much-wanted E-3 for them.

"Congratulations to the 552nd Air Control Wing and the families," the general said. "We couldn't do it without our spouses and families. I don't know how to thank you enough for what you do each and every day."

Lt. Gen. James M. Kowalski, U.S. Strategic Command deputy commander and a former 552nd ACW commander, was the keynote speaker at a gala at the Petroleum Club, May 9, in downtown Oklahoma City.

General Kowalski referred to the men and women of the airborne early warning community both past and present as a "band of brothers," adding that their contribution to the warfighter over the past 60 years is beyond reproach.

"The 552nd ACW has a tremendous history and reputation," he said. "Since its inception 60 years ago, the 552nd has been involved in every significant combat operation the United States has participated in and has performed with distinction. It is a true honor to be among those who have had the privilege of commanding it."

General Kowalski also highlighted the relationship the 552nd ACW enjoys with its community partners. Their support to the wing is unlike anything he's experienced throughout his career, he said.

Ready to roll: Production miliestone revs up AWACS upgrades

by John Parker
Tinker Public Affairs

5/18/2015 - TINKER AIR FORCE BASE, OKLA. -- The 552nd Air Control Wing recently received its first full-rate production E-3G AWACS aircraft, a milestone marking the start of faster upgrades for the rest of the surveillance and battle management fleet.

E-3 Program Manager Thomas Ramsey with the Air Force Life Cycle Management Center said the turning point means Tinker AFB's 566th Aircraft Maintenance Squadron can now modify up to five or more aircraft a year.  The Air Force currently fields 31 "Sentry" planes.

"It will allow us to retrofit the 552nd's fleet as fast as money and schedules allow," Mr. Ramsey said. "And the faster that we can get the capability out there, the better it is for the warfighter."

On April 8, tail number 76-1604 became the seventh Airborne Warning and Control System plane retrofitted with the latest Block 40/45 technology upgrades. Last June, the 566th AMXS delivered the last of six low-rate production aircraft with the advanced modifications.

The Block 40/45 modification is the most comprehensive in the 38-year history of the U.S. E-3 weapon system. The cockpit-to-cabin changes improve communications, computer processing power, threat tracking and other capabilities. The upgrades replace some hardware and software that dates to the 1970s.

"Block 40/45 provides solutions for the current systems' operational and technological obsolescence, rapidly decreasing reliability, maintainability, supportability and inability to integrate future technologies and growth opportunities," said Don Gricol, AWACS Triage Team member.

The AWACS Modification-Programmed Depot Maintenance Integration Team under the AFLCMC partnered with the 566th AMXS and the Boeing Co. to upgrade the remaining aircraft as they come due for normal PDM, said Deputy Chief Karen Burrell, HBS Modification-PDM Integration.

The rest of the Air Force E-3s are slated for the upgrades through 2020 at the Oklahoma City Air Logistics Complex.

Ms. Burrell said combining each aircraft's depot maintenance with the modification upgrades "reduces up to eight months of aircraft downtime, thus returning the jet back to the 552nd ACW warfighter to maximize aircraft availability. As a combined AWACS Mod Integration and 566th AMXS Production Team, we are proud to share in delivering this critical capability to our 552nd ACW customer for in-theater use."

Ms. Burrell said the older Block 30/35 weapon system in use on most of the fleet today was designed for a 15-year service life, but is now over 30 years old.

The new modifications automate previously manual functions and improve the amount of data that E-3 aircrews can receive and share with allied forces on missions such as counter drug surveillance. Boeing Design engineers drew on commercial, off-the-shelf technology for the modifications, greatly reducing costs, Ms. Burrell said.

While upgrading the fleet is the program's primary mission, Mr. Ramsey said the challenge of developing and managing such a large modification program at Tinker also led to a bonus: a management blueprint for reducing snags in future aircraft retrofitting projects.

"What we did to attack those problems was to have the E-3 program office, the depot and Boeing have open, transparent, recurring meetings to identify all of the seams, identify all of the roles and responsibilities, and address them before we started the mod so that we could make sure that they didn't come up in the middle of the mod," Mr. Ramsey said.

"The process worked so well that we developed a standard process guide for other major mods that any weapon system can use if they're doing big mods at the OC-ALC," he added. "The Air Force Sustainment Center was particularly and intimately involved in the process."

Col. Jay Bickley, 552nd ACW commander, said the E-3Gs have been flown in counterdrug and other missions, but not in a combat theater. He said he's eager for three more 40/45 planes scheduled to enter the fleet by the end of summer.

"The partnership between the depot, the OC-ALC, the AFSC and our wing has just been phenomenal," the colonel said. "Getting to this milestone is really a tribute to all the hardworking men and women over in the depot, our Boeing partnership and the men and women of the 552nd.  I think those folks take a lot of pride in the aircraft and seeing the modification come to fruition."