High dose HBO2 Ineffective for Post Concussion Syndrome
U.S. Army Medical Materiel Development Activity HBO2 Project Management Office FORT DETRICK, MD. (October 24, 2012) — The U.S. Air Force, along with partners from McGuire Veterans Affairs Medical Center and U. S. Army Medical Research and Material Command (USAMRMC), announced the results of the first ever randomized, placebo-controlled trial of hyperbaric oxygen to treat symptoms and cognitive impairments resulting from concussions or mild traumatic brain injury (mTBI) Oct. 16. The pilot study, released to the public on the Journal of Neurotrauma website, demonstrated that high doses of hyperbaric oxygen 2.4 atmospheres absolute (ATA), given daily over six weeks showed no added benefit in symptom relief of mTBI or post traumatic stress disorder symptoms over a group receiving a sham therapy consisting of breathing room air in the chamber under mild pressure (1.3 ATA). Hyperbaric oxygen (HBO2) is a drug treatment in which a patient breathes oxygen under pressure to achieve elevated oxygen levels in the blood and tissue for a period of time. It is an approved therapy for 14 medical conditions, including non-healing diabetic wounds and carbon monoxide poisoning, at pressures ranging from 2.0 to 3.0 ATA. Although it has not been approved for TBI, anecdotes and small case studies have suggested a possible benefit for service members with post concussion syndrome and post traumatic stress when using HBO2 at 1.5 ATA. A review of HBO2 and TBI by the Agency for Healthcare and Research Quality in 2003 suggested TBI research studies should look at hyperbaric oxygen in a dose-response fashion. This study was conducted at the U.S. Air Force School of Aerospace Medicine in San Antonio from 2009 to 2011 involving wounded service members still on active duty, who were still symptomatic three to 71 months after their TBI injury. Volunteers were recruited from military hospitals and flown to San Antonio for eight weeks to receive the intensive study intervention. The 2.4 ATA dose of HBO2 selected was based on clinical observations that TBI symptoms improved while a service member was receiving standard hyperbaric therapy to assist in healing a traumatic jaw wound. According to Dr. George Wolf, a study investigator, participation in the study resulted in symptoms improvement in about 80 percent of the volunteers. However, those receiving oxygen showed no statistical improvements above the control or non-treatment arm. This higher dose of HBO2 was safely administered to and well-tolerated by the service members suffering from TBI symptoms. This pilot study infers that 2.4 ATA is not the optimal treatment dose. This study is the first of four randomized clinical trials being conducted by a Department of Defense/Veterans Affairs consortium assembled to evaluate rigorously the potential for hyperbaric oxygen in the treatment of TBI. “The lack of benefit in this study may be due to dose selected, as many experts have argued a lower dose (1.5 ATA) may be superior, and alternate doses are now under investigation,” said COL Scott Miller, director of the HBO2 Project Management Office at the U.S. Army Medical Materiel Development Activity and the physician leading the coordinated research effort. Two additional clinical trials which are designed to examine those alternate regimens are nearing completion, with results expected within the year. These studies are also evaluating alternate ways to administer the placebo dose to evaluate whether the slightly pressurized air in the sham design may have contributed to any of the improvement. This study was primarily funded by the U.S. Air Force Medical Support Agency Medical Modernization Directorate and the 711th Human Performance Wing, with additional support of the U.S. Navy Bureau of Medicine and Surgery and the USAMRMC.
PD ALTESS Achieves Multiple Honors, Sets Precedent for Acquisition IT
[author type="author"]Scott Friend and Charles Smith[/author] Project Director Acquisition, Logistics & Technology Enterprise Systems & Services (PD ALTESS), part of Program Executive Office Enterprise Information Systems, received three national honors. The Radford, VA-based ALTESS, a provider of information technology (IT) systems, services, and security for the Army’s acquisition domain, learned in February that it would receive a Government Information Technology Executive Council (GITEC) Project Management Award. Less than a week later, ALTESS’ Service Level Management Branch Chief, Debbie Jenkins, was selected as Pink Elephant Inc.’s Information Technology Infrastructure Library (ITIL) Practitioner of the Year. Then, in March, ALTESS was named runner-up for Excellence.gov’s Going Green Award. ALTESS’ 2011 awards reflect the cutting-edge technologies and peerless support that it provides to warfighters to succeed in their missions. GITEC Project of the Year: ITIL Implementation GITEC honored ALTESS’ ITIL process deployments with its annual “Technology That Is Reshaping America: Best Practices in Information Life Cycle Management” Project Management Award. ALTESS received the award for successfully incorporating industry best practices into federal computing. [image align="right" caption="ALTESS’ IT Service Management Team is responsible for implementing ITIL across the organization. ALTESS’ ITIL process deployments were recognized by GITEC with the “Technology That Is Reshaping America: Best Practices in Information Life Cycle Management” Project Management Award. (U.S. Army photos by Ed Blackford.)" linkto="/web/wp-content/uploads/GroupImage.jpg" linktype="image"]“/web/wp-content/uploads/GroupImage.jpg” height=”167″width=”246″[/image] ALTESS implemented ITIL-based processes and tools in 2007. By 2010, ALTESS had implemented the Service-Level Management, Incident Management, Problem Management, and Change Management processes. BMC Software’s Remedy application, an ITIL-based enterprise solutions tool, was procured and configured to serve as ALTESS’s conduit for service requests, work records, and performance metrics. The benefits of ALTESS’ ITIL deployments have been far-reaching. After acquiring the BMC Remedy application and designing a mature Change Management process, PD ALTESS’ weekly total of documented changes more than tripled, ensuring effective management of actions affecting the organization and its customers. ALTESS’ Incident Management process raised the Service Desk’s customer support rating to an unparalleled 92 percent, far above the 45-55 percent average reported in a 2008 Forrester Research study. The Service Desk’s 2.1 million end users include deployed warfighters and high-ranking military officials, and ALTESS’ Incident Management process ensures that the support they receive is prompt and consistent. Richard T. Eva, ALTESS’ Project Director, recognizes ITIL as a vital tool for providing exceptional service to customers. “It is so critical, when delivering cost-effective IT services, to have efficient documented and measurable processes. ITIL is the methodology that provides us the framework to be successful.” Pink Elephant ITIL Practitioner of the Year ALTESS’ workforce is diverse, from accountants to network engineers. Designing a Change Management process suitable for the entire organization was no small undertaking. Had it not been for Debbie Jenkins, ALTESS’ Change Management process might have languished indefinitely in the planning phase. [image align="left" caption="ALTESS Service Level Management Branch Chief Debbie Jenkins is congratulated by Richard T. Eva, ALTESS Project Director, for her selection as Pink Elephant’s ITIL Practitioner of the Year." linkto="/web/wp-content/uploads/DJenkinsPinkElephantMrEva-compressed.jpg" linktype="image"]“/web/wp-content/uploads/DJenkinsPinkElephantMrEva-compressed.jpg” height=”167″width=”246″[/image] Jenkins, then ALTESS’ acting Division Chief for the Enterprise Services Division, led a successful effort to produce a Change Management process that would meet each team’s unique needs. For her tireless efforts, Jenkins was awarded Pink Elephant’s prestigious ITIL Practitioner of the Year Award. Pink Elephant provides consulting services focusing on IT management. Since Change Management was deployed, the average time needed to complete change requests has dwindled from seven days to less than three. Change requests now follow an automated approval cycle that requires multiple reviews before and after implementation. Because of Jenkins’ patience and perseverance, changes to ALTESS’ data infrastructure can be performed more quickly and efficiently than ever. What Jenkins finds most fulfilling is ALTESS’ support to its customers. “The thing I’m proudest of is the way we’ve been able to use Change Management to improve customer service. We have greater awareness of what goes on in the organization [and] better documentation,” she said. Excellence.gov: Going Green From more than 70 nominees, Excellence.gov selected ALTESS as runner-up for its 2011 Going Green Award. ALTESS’ green energy initiatives began several years ago with the adoption of virtual machine (VM) server technology. Using VMs, ALTESS could house multiple customer systems on a single physical server. In addition to conserving physical space, VMs reduced emissions and energy waste. According to software publisher VMware Inc., virtual machines consume up to 80 percent less energy than traditional servers and can reduce carbon emissions as much as 94 percent. ALTESS began offering virtualized environments in 2007. By 2012, the organization plans to support 80 percent of its hosted systems on VMs. To cool its VM servers, ALTESS has implemented an in-row cooling solution, using variable-speed fans that operate only as needed. The result is a 43 percent energy saving over standard cooling systems. Additional energy savings have resulted from upgrades to ALTESS’ lighting and temperature control systems. A new high-efficiency lighting system has reduced the electrical load for facility lighting by 50 percent. Occupancy sensors have been installed to eliminate unnecessary use of lighting and temperature control systems. Although the green initiatives’ benefits have varied in magnitude, each has contributed to a “big picture” envisioned by ALTESS’ leadership. The ultimate goal of the green project is to create a proven “blueprint,” optimizing the energy efficiency for Army data centers. Green initiatives implemented thus far have reduced ALTESS’ Power Usage Effectiveness (PUE) score to 1.46—far below the 2.0 national average. The facility’s PUE will continue to decrease as additional efficiency initiatives are implemented. Commitment to the Future Excellence.gov, GITEC, and Pink Elephant have affirmed ALTESS’ current capability. But to continue providing high-quality support for its 43 customers, 77 supported applications and 2.1 million end-users, ALTESS remains focused not only on today’s capabilities, but also on tomorrow’s innovations. [list type="arrow"] SCOTT FRIEND is Chief of ALTESS’ Enterprise Systems Division. He holds a degree in electrical engineering from Virginia Polytechnic Institute and State University. Friend is Level III certified in IT III and is a U.S. Army Acquisition Corps member. CHARLES SMITH is an ALTESS technical writer/editor. He holds a B.A. and an M.S. in English from Radford University and is Level I certified in program management. [/list]
Next-Generation Blue Force Tracking System to be Featured in Army Exercise
[author type="author"]Claire Heininger[/author] The latest version of the Army’s friendly force tracking and messaging software will get a key tryout with Soldiers as part of the unprecedented combined test and evaluation at Fort Bliss, TX, and White Sands Missile Range, NM, this month. Among the six programs of record undergoing limited user testing (LUT) is the new version of Force XXI Battle Command Brigade-and-Below/Blue Force Tracking (FBCB2/BFT), called Joint Capabilities Release (JCR). The new version is faster, more versatile, and better connected to the Marine Corps. “It is not only easier to navigate, but it is a lot faster,” said SSG Tony B. Sosa, a Military Intelligence System Maintainer/Integrator with A Company, Special Troops Battalion, 2nd Brigade, 1st Armored Division. “I think it will be an excellent tool to help save lives.” [image align="left" caption="A Soldier types a message into the FBCB2/BFT system. The latest version of FBCB2, Joint Capabilities Release, will undergo limited user testing during the Network Integration Evaluation, which marks a new approach to testing and delivering networked capabilities. (U.S. Army photo.)" linkto="/web/wp-content/uploads/FBCB2-rvs330-armysoldier_compressed.jpg" linktype="image"]“/web/wp-content/uploads/FBCB2-rvs330-armysoldier_compressed.jpg” height=”167″width=”246″[/image] The LUT will support a decision on wider fielding of the capability, which thus far has been fielded to several brigades inside the United States. The LUT also marks a step in a broader plan to move to the next-generation FBCB2/BFT technology for tactical aircraft, vehicles, and dismounted forces, called Joint Battle Command-Platform (JBC-P). “JBC-P is a foundation for achieving information interoperability between joint warfighting elements on current and future battlefields,” said GEN Peter W. Chiarelli, Vice Chief of Staff of the Army, in recent testimony to the House Armed Services Tactical and Land Forces Subcommittee. “It will be the principal command and control system for the Army and Marine Corps at the brigade-and-below level, providing users access to the tactical information necessary to achieve information dominance on the battlefield.” JCR acts as a “bridge” to JBC-P, providing today’s deployed units with Army-Marine Corps interoperability, a faster satellite network, advanced mapping kits, secure data encryption, and integration with historical information key to counterinsurgency operations. At White Sands, which has mountainous terrain resembling that of Afghanistan, Soldiers will run missions to test JCR’s effectiveness and reliability for exchanging messages, providing situational awareness of fellow “blue” forces to guard against fratricide, navigating the battlefield, and other capabilities. “With these digital capabilities, you’re able to see where all the friendly forces are, regardless of service or unit, and you’re able to communicate with all of them via free text and graphics,” said MAJ Shane Robb, Assistant Product Manager for JBC-P. The system’s new satellite infrastructure is known as BFT 2, a communications network that can handle significantly more data than the existing BFT system. [quote align="right"]JBC-P will be the principal command and control system for the Army and Marine Corps at the brigade-and-below level, providing users access to the tactical information necessary to achieve information dominance on the battlefield.[/quote] “The new network increases the size of the pipe, which has a direct correlation to the system’s ability to update and refresh information,” said LTC Bryan Stephens, Product Manager for BFT. “In the end, this capacity increase allows for more frequent and larger message traffic and a change in many cases of refresh rates from minutes to seconds.” Also being integrated into the Army’s network is Tactical Ground Reporting (TIGR), a collaborative software tool that uses a “Google Earth”-like interface, pictures, and text to provide a searchable database of unit activities. Along with routes and places, TIGR is valuable for tracking people such as local police chiefs, religious leaders, or other key figures for counterinsurgency and stability operations. Such information is known as area, structures, capabilities, organizations, people, and events (ASCOPE) data. TIGR, developed by the Defense Advanced Research Projects Agency, is scheduled to formally transition to Project Manager FBCB2 on Oct. 1. In JCR, users can toggle between TIGR and FBCB2 windows. In JBC-P, ASCOPE functionality similar to TIGR will display on a single user-friendly screen inside the tactical vehicle. “Where we are going with JBC-P on the platform is to develop a user interface that is similar to things that are normally done in gaming, in Facebook and Twitter,” said COL Buddy Carman, U.S. Army Training and Doctrine Command Capability Manager for Brigade Combat Team Mission Command. “The more we can make [functions] translatable, Soldiers are going to use it more often, and we’re going to eliminate a huge training burden on them.” Feedback from the JCR LUT will influence JBC-P design and capabilities, as well as inform a JCR fielding decision for the fiscal year starting in October 2011. [list type="arrow"] CLAIRE HEININGER is a staff writer for Symbolic Systems Inc., supporting the Army’s Program Executive Office Command, Control, and Communications-Tactical MilTech Solutions Office. She holds a B.A. in American studies and a minor in journalism, ethics, and democracy from the University of Notre Dame. [/list]
Military Surgeons Association Names MC4 Top IT Team
[image align="right" caption="LTC Rafael G. Semidei Sr. (on screen), a psychiatrist with the 883rd Medical Detachment (Combat Stress Control), and SGT Marie Swieta, Noncommissioned Officer in Charge with the 547th Area Support Medical Company (Combat Stress Control), demonstrate the tele-behavioral health system in Baghdad, Iraq. (Photo courtesy of Medical Communications for Combat Casualty Care (MC4).)" linkto="/web/wp-content/uploads/MC4_SSG_Swieta_nmn2.jpg" linktype="image"]“/web/wp-content/uploads/MC4_SSG_Swieta_nmn2.jpg” height=”167″ width=”246″[/image] The U.S. Army’s Medical Communications for Combat Casualty Care (MC4) Program has earned the distinction of having the 2011 top information technology (IT) team from the Association of Military Surgeons of the United States (AMSUS). The AMSUS Information Technology Award honors organizations that have made significant contributions in IT, specifically those that improve the effectiveness and cohesiveness of federal health care initiatives. In 2010, MC4 helped field the rapid expansion of technology used to connect Soldiers remotely with mental health physicians in the combat zone. The Army’s MC4 Program, within Program Executive Office Enterprise Information Systems, trains, fields, and supports IT systems that allow deployable medical staff to document and track patient care, digitally manage medical supplies, and conduct health surveillance in the combat zone. In addition to fielding new technology, last year MC4 launched new training initiatives to improve electronic medical record-keeping on the battlefield. MC4 users have realized faster setup times and easier use of the medical records system, while combatant commanders have gained better data integrity and a clearer picture of the population’s health. “By redirecting our resources away from classroom training and engaging users in garrison and in field exercises, deployed medical staff are now better prepared to use MC4 systems downrange,” said MC4 Product Manager LTC William E. Geesey. In addition to improving end users’ proficiency, MC4’s involvement in the Army’s Tele-behavioral Health Initiative is helping to connect at-risk Soldiers with mental health providers. [image align="left" caption="MC4 Product Manager LTC William E. Geesey (right) accepts the 2011 Information Technology Award on behalf of the MC4 Program, from MG M. Ted Wong, Commanding General, Brooke Army Medical Center and Southern Regional Medical Command and Chief, Dental Corps, at the Association of Military Surgeons of the United States (AMSUS) Annual Meeting Nov. 9. (Photo courtesy of AMSUS and Gibbons Photography.)" linkto="/web/wp-content/uploads/MC4_AMSUS_Geesey3_n.jpg" linktype="image"]“/web/wp-content/uploads/MC4_AMSUS_Geesey3_n.jpg” height=”167″ width=”246″[/image] “Virtual consultations with Soldiers are allowing medical staff to recognize and treat post-traumatic stress disorder symptoms and other mental health issues faster,” Geesey said. “Health care providers don’t have to wait until they arrive at the Soldier’s location to meet with them. Now they can chat virtually when both their schedules allow.” Initial data indicate that more than 70 percent of the Soldiers seen through this capability probably would not have received services otherwise. The technology also reduces the frequency with which specialists must travel to remote outposts to meet with patients. The initial capability was implemented in October 2010 and completed within six weeks of identifying the requirement. The Army has endorsed this solution and has directed rapid expansion of the technology and capability throughout Afghanistan. The MC4 team received the AMSUS Information Technology Award Nov. 9 at the AMSUS Annual Meeting in San Antonio, TX. Geesey was also a nominee for the 2011 Secretary of the Army Product Manager of the Year Award. In September, InformationWeek magazine named the MC4 team one of the Top 15 Government IT Innovators of 2011. For more information on MC4, go to www.mc4.army.mil. For more information on AMSUS, go to www.amsus.org. [list type="arrow"] MEDICAL COMMUNICATIONS FOR COMBAT CASUALTY CARE COMMUNICATIONS OFFICE [/list]
ACC integrates contracting Soldiers into stateside operations
Edward G Worley REDSTONE ARSENAL, Ala.–In an effort to streamline command and control of its military contracting Soldiers, the Army Contracting Command is attaching portions of its Expeditionary Contracting Command forces to several of ACC’s stateside organizations. The action reduces the ECC span of control from the day-to-day oversight of Soldiers executing their stateside contracting mission, allowing the ECC commander to focus on overseas installation and contingency support, explained Lt. Col. Kevin Nash, ACC Integration project officer. It also gives the Mission and Installation Contracting Command and ACC contracting centers direct supervision of Soldiers supporting stateside operations within their organizations, he said. Maj. Gen. Camille M. Nichols, ACC commanding general, said her intent is to “streamline mission command, better manage our military contracting Soldiers’ workloads and enhance contracting Soldier professional development. “This action provides greater predictability for our civilian contracting leaders in assigning work to Soldiers in their offices,” she said. “It also provides greater professional development opportunities for contracting Soldiers as they are offered increased contracting experiences.” Nichols said it also allows ECC to focus on the day-to-day overseas contracting mission and operational contract support tasks associated with Army Service Component Commands. Brig. Gen. Ted Harrison, ECC commanding general, said the realignment will help 51C contingency contracting Soldiers develop their contracting skills. “Future military operations will continue to demand expeditionary contracting Soldiers who are trained and ready to meet Army Service Component Command needs,” Harrison said. “ACC integration allows the Expeditionary Contracting Command’s 51Cs to hone their skills in day-to-day contracting missions in Mission and Installation Contracting Command installation contracting offices as they support the Army’s generating force. This ‘work as they fight’ strategy will prepare them to deploy and support Army operational forces anywhere in the world. ECC is confident that the MICC civilian contracting experts will equip our contracting Soldiers with technical knowledge and provide hands-on experience through coaching, teaching and mentoring.” Brig. Gen. Kirk Vollmecke, MICC commanding general, said the integration improves both the civilian and military contracting workforce. “The synchronization and integration of uniformed members across the Mission and Installation Contracting Command provides indispensable technical, hands-on contracting training and experience for Army contingency contracting Soldiers,” Vollmecke said. “Soldiers and contracting civilians working alongside one another drives positive change and brings balance, skill and depth to the acquisition workforce. This unified teamwork and collaboration with ACC and our Army customers is a key to continued success.” Nash said the operation will occur in four phases. It began in December with the realignment of MICC contracting offices under four field directorate offices. MICC FDOs are aligned at sites with their major customers, and the 34 MICC subordinate contracting offices are grouped by customer to bring consistency to operations and improve contract administration and oversight. Phase 2 begins in February, Nash said, attaching MICC-associated contingency contracting battalions, senior contingency contracting teams and contingency contracting teams to the MICC. ACC contracting center-associated contingency contracting teams will also be attached to their corresponding contracting centers during Phase 2. “Attaching a unit to another unit means that, while the attached unit still ‘belongs’ to its higher headquarters, it takes its daily taskings from the unit to which it is attached,” Nash explained. “The units we’re attaching still ‘belong’ to ECC, but they are working directly for the organizations they are attached to.” Phase 3 begins in April, he said. ECC will add two contracting support brigades that will be attached to the MICC headquarters. The 418th CSB will be headquartered at Fort Hood, Texas, and the 419th CSB will be headquartered at Fort Bragg, N.C. The final phase calls for the 412th CSB, Joint Base San Antonio-Fort Sam Houston, Texas, to be attached to the MICC headquarters on Oct. 1. Nash said ECC will retain assignment of the CONUS-based CSBs and continue to be the ACC lead for operational contract support activities. In the event of a mission requiring CONUS-based ACC units attached to the MICC or centers, Nash said ACC will publish an operation order that detaches those selected units back to the ECC for execution of the required mission. Upon completion of the mission, units would redeploy and be re-attached to the MICC or centers as required, he explained. ECC will continue to be the ACC lead for all contingency contracting Soldier individual and unit training functions, he said.