Injuries secondary to explosive blast are a significant source of casualties in North Atlantic Treaty Organization (NATO) operational environments. Tremendous resources, therefore, have been invested in researching the spectrum of these injuries (see What is Blast Injury?). However, this spectrum is broad and as a result, knowledge gaps have arisen, particularly in a research atmosphere that too often fosters isolated achievements rather than comprehensive solutions. The nine nations comprising the NATO Human Factors and Medicine (HFM) Research Task Group (RTG) HFM-234 cooperatively framed the problem as one of "environmental toxicology," that is, understanding the consequences of any individual blast injury requires knowledge of the dose, mechanism of delivery, and dose-response endpoints.
Initiated in July of 2013, and chaired by the PCO director, Mr. Leggieri, NATO HFM-234 included members from the United States, Germany, Canada, United Kingdom, France, Estonia, the Netherlands, Sweden, and Norway, all of whom have various academic, military, and/or research affiliations. In December 2018, after several years, six international meetings, and long-distance collaboration, the full HFM-234 Report was released to the public according to schedule. This comprehensive report includes the four predetermined deliverables:
The HFM-234 RTG was a call for researchers to reconcile and optimize their experimental approaches to blast injury research such that questions regarding the mitigation, treatment and/or prevention of blast injuries can be answered collectively. It is to the credit of the nine NATO nations' collaborative efforts that all of the deliverables were completed, per the charter, and three were published as original articles in the Journal of the Royal Army Medical Corps.1-3
Indeed, this Report will guide future research to ensure that it is applicable and can be built upon by the larger blast injury research community. Ultimately, contributions made by the HFM-234 and others will improve the process of obtaining optimal solutions to address the needs of Service members and civilians.
1 Bieler D, Cernak I, Martineau L, et al. Guidelines for conducting epidemiological studies of blast injury. Journal of the Royal Army Medical Corps. 2018.
2 Watts S, Kirkman E, Bieler D, et al. Guidelines for using animal models in blast injury research. Journal of the Royal Army Medical Corps. 2018.
3 Josey T, Ouellet S, Bieler D, et al. Guidelines for reproducing blast exposures in the laboratory. Journal of the Royal Army Medical Corps. 2018.
The NATO Human Factors and Medicine (HFM)-234 Research Task Group (RTG), "Environmental Toxicology of Blast Exposures: Injury Metrics, Modeling, Methods and Standards," chaired by the PCO Director, Mr. Leggieri, developed three guidelines that have been published in the Journal of the Royal Army Medical Corps. These include "Guidelines for using animal models in blast injury research" published online 10 April 2018; "Guidelines for conducting epidemiological studies of blast injury" published online 17 April 2018; the "Guidelines for Reproducing Blast Exposures in the Laboratory" published online 7 May 2018; and an editorial overview of the RTG "Environmental toxicology of blast exposures: injury metrics, modelling, methods and standards" published on 6 June 2018. The importance of these publicly available guidelines is to expand the knowledge base on the environmental toxicology of blast exposure and promote international collaboration and cross-study comparison through standardized research methodologies. The DoD Blast Injury Research PCO's participation in NATO HFM activities is critical for promoting information sharing and partnerships among the international blast injury research community and directly supports key responsibilities of the DoD Executive Agent for Blast Injury Research.
On 10-12 July 2018, the PCO participated in the sixth, in-person meeting of the Human Factors and Medicine-270 (HFM-270) Research Task Group (RTG) titled, "Framework for Modeling and Simulation of Human Lethality, Injury, and Impairment from Blast-Related Threats." The meeting took place at the Defence Research and Development Canada (DRDC), Suffield Research Centre, in Medicine Hat, Alberta, Canada.
The HFM-270 (RTG) Technical Team comprises 22 members from ten nations. Mr. Leggieri, the Director of the DoD Blast Injury Research Program Coordinating Office (PCO), chairs the Team, and his Deputy, Dr. Gupta, serves as the Team's Executive Secretary and computational modeling subject matter expert. The Team's objective is to develop a framework that integrates existing computational models and guides the development of future ones to predict human lethality, injury, impairment, and long-term health effects across the spectrum of blast-related threats. Once established, this computational modeling framework can support the rapid development and fielding of improved blast injury protection systems by providing a means for developing and testing protection concepts in a virtual environment.
During this meeting, Team members ran through a practical exercise in which they used a screening tool that they had previously developed to assess a candidate computational model to determine its feasibility for inclusion in the Framework. Through this practical exercise, the Team confirmed the suitability of the screening tool for assessing computational models. Following the practical exercise, subject matter experts from the DRDC Suffield Research Centre gave a series of presentations on the application of computational modeling to blast injury. The meeting concluded with an in-depth discussion of next steps in developing the computational modeling framework and creating an example threat scenario to demonstrate the framework's feasibility. Finally, the Team reviewed and revised the outline for the HFM-270 (RTG) final technical report that the Team will prepare and submit to the NATO Science and Technology Organization, Collaboration Support Office in the fall of 2019.
During the remaining three meetings of this Technical Team's three-year term, the Team will use the screening tool to assess existing computational models to determine their suitability for inclusion in the framework, demonstrate the feasibility of the framework using an example threat scenario, and draft the final technical report.
Explosions often result in multiple traumatic injuries, including penetrating injuries, burns, fractures, and traumatic amputations, which are complicated by infections. Ms. Susan Taylor, Blast Injury Research Program Coordinator, attended the Trauma-Related Infections Research Area 9th Annual Investigators Meeting hosted by the Uniformed Services University of the Health Sciences Infectious Disease Clinical Research Program (IDCRP). The purpose of the meeting was to present research and operational updates and to strategize future initiatives.
At the meeting, researchers presented assessments of the utility of using molecular techniques to diagnose invasive fungal wound infections (IFI). Investigators also reported on an update of an epidemiological assessment of combat-related IFIs. Preliminary IFI epidemiology data were presented at the 2016 DoD Blast Injury Research Program International State-of-the-Science (SoS) Meeting on Minimizing the Impact of Wound Infections Following Blast-Related Injuries. Researchers also presented analysis of data from a study of patients with trauma-associated osteomyelitis, a serious complication of open fractures, to better understand the long-term impact of open bone fractures, risk factors, co-morbidities, and healthcare economics. Also presented were analyses from the Multidrug-Resistant and Virulent Organisms Trauma Infections Initiative, which are being used to understand the combat trauma-related wound microbiome, impact of multidrug-resistance on clinical outcomes, and to develop novel antimicrobial countermeasures. Complete highlights and impacts from Trauma-Related Infections Research Area are presented in the 2017 annual report.
Many research topics presented at this meeting align with objectives and recommendations of the 2016 International SoS Meeting, including, identifying early indicators of health consequences from blast-related exposures and addressing key research gaps. Information from these endeavors can be used to design blast-related wound research programs, establish requirements, and ultimately close capability gaps to improve clinical outcomes and inform best practices.
The PCO is sponsoring a breakout session at the upcoming 2018 Military Health System Research Symposium titled "Minimizing the Impact of Wound Infections Following Blast-related Injuries." The session is an opportunity for researchers to share the latest developments on combating blast-related wound infections to address the knowledge gaps identified and recommendations made during the 2016 SoS meeting.
On 17-18 January 2018 the PCO held the second meeting of the DoD Working Group on Computational Modeling of Human Lethality, Injury, and Impairment from Blast-related Threats (WG). The WG meeting was facilitated by The MITRE Corporation at their campus in McLean, VA. The WG membership includes representatives from 24 DoD and seven government organizations.
The purpose of the WG is to shape, focus, and coordinate the DoD's computational modeling efforts to enable a new capability for modeling and simulation of human lethality, injury, and impairment from the entire spectrum of blast-related threats and environments.
During the meeting, participants approved the WG Charter, and reviewed and concurred with the roadmap and milestones for the development of the strategic plan. The WG members reviewed and modified a draft Modeling Questionnaire intended to capture information about existing computational models of human injury, impairment, and lethality. Other items that were discussed included a planned Computational Model Registry that will house information on computational human body models, and summary factors which will be used to group, evaluate, and better understand broad limitations in existing models. Discussion around the Modeling Questionnaire and the Model Registry included the challenges with data collection and availability, non-government partnerships, and model accessibility. Participants also discussed plans for a computational modeling Performer Workshop. The planned Performer Workshop supports the WG's desire to learn about the state of the science, future directions, and difficulties in establishing public-private partnerships.
The WG meeting concluded with unanimous concurrence on the scope of the desired DoD modeling capability for modeling and simulation of human lethality, injury, and impairment from the entire spectrum of blast-related threats and environments. This WG effort supports the responsibilities of the Executive Agent for the DoD Blast Injury Research Program, to promote partnerships and facilitate collaborations that further blast injury research, and will lead to improved strategies to prevent, mitigate, and treat blast injuries.
The Advanced Regenerative Manufacturing Institute (ARMI) opened on July 28, 2017 in Manchester, NH, and will focus on developing transplant tissues and organs for injured patients and Service Members. ARMI is led by Mr. Dean Kamen, who is best known for inventing the Segway, an all-terrain personal transporter. ARMI's mission is to make the large-scale manufacturing of engineered tissues and tissue-related technologies practical in order to benefit existing industries, and grow new ones.
More than 400 people attended the launch event, including many top names from the political, business, and technology world. The Brain Health Research Program Coordinator, COL Sidney Hinds II, attended as an in-person representative for US Army Medical Research and Materiel Command (USAMRMC) Commanding General, MG Barbara Holcomb. He accompanied numerous USAMRMC representatives, including Ms. Kristy Pottol and Mr. John Getz from the US Army Medical Materiel Development Activity, who are managing the DoD's partnership with ARMI.
ARMI is a public-private partnership, which brings together 26 universities and medical centers, 80 private companies, 14 government and nonprofit organizations, and almost $300 million in funding ($80 million from DoD; >$214M from industry). The goal of ARMI is to be self-sustaining within 5-7 years by spinning off companies, providing contract development and manufacturing services, and licensing technologies.
The launch event featured tours, demonstrations, and an overview of ARMI's five thrust areas: (1) cell selection, culture and scale-up; (2) biomaterial selection and scale-up; (3) tissue process automation and monitoring; (4) tissue maturing technologies; and (5) tissue testing, preservation, and transport.
COL Hinds discussed with Mr. Kamen and other ARMI representatives their efforts to grow neurons accounting for the central and peripheral nervous systems' ability to promote tissue regeneration. The New York Times reported that Mr. Kamen is optimistic that ARMI will develop artificial skin, bones, and nerves, and eventually organs that could be implanted into recipients in the next few years.
The launch received widespread coverage from more than a dozen international, national, and local news organizations. Links to several of these reports are below:
The objective of the NATO Human Factors and Medicine-270 (HFM-270) Research Task Group (RTG), "Framework for Modeling and Simulation of Human Lethality, Injury, and Impairment from Blast-Related Threats," is to develop a framework that integrates existing computational models and guides the development of future ones to predict human lethality, injury, impairment, and long-term health effects across the spectrum of blast-related threats. Mr. Leggieri, Director, DoD Blast Injury Research Program Coordinating Office (PCO) serves as the chair and the Technical Team is made up of 20 members from nine nations. The impact of HFM-270 (RTG) will be a roadmap for a human blast effects computational modeling capability that will support the rapid development and fielding of improved strategies to prevent, mitigate, and treat blast injuries.
On July 11-13, 2017, the PCO participated in the third face-to-face meeting of the HFM-270 RTG Technical Team, at Porton Down in Salisbury, England. The purpose of this meeting was to identify existing, ongoing, and planned models, databases, and injury criteria. During the meeting Technical Team members briefed the group on the scope of existing computational models and modeling capabilities in their respective nations and heard presentations from computational modeling subject matter experts from the United Kingdom. Dr. Raj Gupta, Deputy Director, PCO, provided an overview of the status of past and on-going human modeling projects in the United States. Following the presentations, the Technical Team developed an objective methodology for assessing the suitability of existing models for inclusion in the computational modeling framework which the Technical Team developed in a previous meeting. The Technical Team will use this methodology to assess existing models during the next several meetings.
Representatives from US and Israeli military medicine participated in the 2017 Shoresh Conference on March 2729 in Rockville, Maryland, to discuss a broad array of medical research issues. More than 60 Israelis, primarily from the Israeli Defense Forces (IDF), and more than 300 representatives from across the US, participated in the conference, which included both plenary and working group sessions.
The biennial Shoresh Conference is the key event and primary venue for the exchange of information under the US/Israel Data Exchange Agreement (DEA) for Military Medicine. The 2017 Shoresh conference was the 18th in the series, which began in the 1980s and continues to be a valuable opportunity to bring together the top scientists and researchers from the US and Israel to find medical solutions for common military threats.
For the 2017 Shoresh Conference, the DoD Blast Injury Research Program Coordinating Office (PCO) and the USAMRMC Combat Casualty Care Research Program (CCCRP) co-organized a joint combat casualty care/blast injury working group session that focused on blast injury prevention. At this working group, PCO Director, Mr. Leggieri, discussed a PCO initiative for constructing a framework for modeling and simulating human lethality, injury, and impairment from blast-related threats. In addition, PCO Deputy Director, Dr. Gupta, discussed another PCO initiative to preserve and disseminate historical DoD blast data. Additional presentations in the working group session covered a range of topics, including: genitourinary injuries in Service Members; prediction of carbon monoxide toxicity, environmental sensors in training; and novel concepts in head protection.
During the conference, Mr. Leggieri, Dr. Gupta, and IDF representatives identified several opportunities for future partnerships, including sharing of blast injury research data (e.g., US historical blast bioeffects data and data from IDF blast injury research) and participation of an IDF representative on the North Atlantic Treaty Organization (NATO) Human Factors and Medicine (HFM) Research Task Groups (RTG) initiated by PCO leadership.
The NATO Human Factors and Medicine-270 (HFM-270) Research Task Group (RTG), "Framework for Modeling and Simulation of Human Lethality, Injury, and Impairment from Blast-Related Threats," is developing a framework that integrates existing computational models and guides future ones to predict human lethality, injury, impairment, and long-term health effects across the spectrum of blast-related threats. The DoD Blast Injury Research Program Coordinating Office (PCO) Director, and PCO Deputy Director, serve as the chair and executive secretary, respectively, for this Technical Team, which has 19 appointed members from nine nations. The impact of HFM-270 (RTG) will be improved strategies to prevent, mitigate, and treat blast injuries.
On January 1012, 2017, the PCO hosted the second face-to-face meeting of the HFM-270 RTG Technical Team, in Frederick, Maryland. The purpose of the second meeting was to identify elements of the computational modeling framework and to develop a survey for identifying existing, ongoing, and planned models, databases, and injury criteria for each element. Prior to the working portion of the meeting, the technical team was briefed on a range of modeling topics by four invited US subject matter experts.
For more information on promoting information sharing and partnership, read more...
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