Military Operational Medicine Research Program Overview2018/06/06 · Acting Director: LCDR Chris Steele Ronald Hoover, Ph.D. Psychiatry and Clinical Psychology Research Portfolio

Military Operational Medicine Research ProgramUS ARMY MEDICAL RESEARCH AND MATERIEL COMMAND

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Science to Service Member

Military Operational Medicine

Research Program Overview

Acting Director: LCDR Chris Steele

Ronald Hoover, Ph.D.Psychiatry and Clinical Psychology Research Portfolio Manager

US Army Medical Research and Materiel Command

31 May 2018

The views expressed in this presentation are those of the author(s) and may not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.


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Responsively and responsibly create, develop, deliver, and sustain medical

capabilities for the Warfighter

Lead the advancement of military medicine

MISSION VISION

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Principal Assistant for Research and Technology

• Dir, Infectious Diseases Res Prog

• Dir, Combat Casualty Care Res Prog

• Dir, Military Operational Medicine Res Prog

• Dir, Clinical & Rehabilitative Medicine Res Prog

• Dir, Medical Simulation and Information Sciences Res Prog

• Dir, CBRN Defense Medical Research Coordination Office

• Dir, Blast Injury Research Program Coordinating Office

• Joint Trauma Anal & Prev of Inj in Cmbt (JTAPIC)

Deputy Commander

Command Sergeant

Major

Principal Assistant for Acquisition

Other Organizations• Congressionally Directed Medical Research

Programs (CDMRP)• Telemedicine and Advanced Technology

Research Center (TATRC)

Deputy Commander Special Staff• Dir, Office of Small Business Prog• Dir, Office of Research Protections• Dir, Quality Management• International Affairs Officer• Strategic Partnerships Office

Commanding General Special Staff• Inspector General• Principal Assistant Resp. for Contracting• Staff Judge Advocate• Equal Opportunity Advisor• Safety Office• SARC/SHARP

• Proj Mgr, Pharmaceutical Systems

• Proj Mgr, Medical Support Systems

• Proj Mgr, HIV Vaccine

• Proj Mgr, Armed Forces Inst of Regenerative Medicine

• Proj Mgr, Hyperbaric Oxygen

• Proj Mgr, Medical Devices

• Proj Mgr, Integrated Clinical Systems

• Proj Mgr, Helicopter Medevac Med Equip Pkg

• Proj Mgr, USAMRMC Enterprise IM/IT

• Proj Mgr, Neurology and Psych Health

Chief of Staff

Chief of Staff Special Staff• Dir, Med Systems Office, ASAALT• Dir, Plans, Programs, Analysis, & Eval• Dir, Materiel• Dir, Surety & Environmental• Internal Review• Protocol Officer• Public Affairs Officer• Enlisted Senior Career Counselor• Transformation Officer

Deputy Chiefs of Staff• DCS, Human Resources (G1)• DCS, Operations (G3)• DCS, Logistics (G4)• DCS, Info Mgmt / Info Tech (G6)• DCS, Resource Management (G8)

Secretary of the General Staff

Commanding General

Medical Advanced

DevelopmentCommands

Dir, Military Operational Medicine Res Prog

USAMRMC Organization


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Overview of MOMRP

MOMRP is an extremely diverse program

Supports operational health, readiness and performance of the Joint

Warfighter across the range of military operations and Service member

life-cycle

Manages R&D to understand novel mechanisms and develop focused

solutions at the group and individual level for Precision Operational

Medicine

~90% of MOMRP projects are linked to knowledge products


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MOMRP Mission and Focus Areas

Science

Service Member

ENVIROEnvironmental Health

and ProtectionTHREATS

Heat/Humidity StressDehydration

Dust and Air PollutionToxic Industrial

Chemicals and Toxic Industrial Materials

(TICs and TIMs)Water Contaminants

Cold StressAltitude/Hypoxia

PHYSIOPhysiological Health

and PerformanceTHREATS

Disaggregated/Continuous Operations

Sleep Deficit and Circadian Desynchrony

Sustained Fatiguing Work (Physical/Mental)

MalnutritionDietary Supplements

Misuse

PSYCHPsychological Health (PH)

and ResilienceTHREATS

PTSD/Other PH DisordersSuicide Behavior

Alcohol/Other Drug UseCo-occurring Mental

Disorders Access/Retention in

Behavioral Health CareFamily Transitions and

Well-being

INJURYInjury Prevention and

ReductionTHREATS

Musculoskeletal InjuryBlast Overpressure

Blunt Head/Body TraumaFace/Eye/Spinal Injury

Acoustic TraumaLaser Eye/Directed Energy

InjuryDegraded Visual

EnvironmentBiomedical Performance Enhancement

Wearables for Health, Readiness and PerformanceMedical Aspects of Manned/Unmanned Teaming

Develop effective medical countermeasures against operational stressors and to prevent physical and psychological injuries during training and operations in order to maximize the health, readiness and performance of Service members and their Families, in support of the Army Human Performance Optimization (HPO), Human Dimension (HD), Multi-Domain Battle (MDB), and the DoD Total Force Fitness (TFF) concepts.


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Clinical Psych Challenges & Priorities❑ Posttraumatic Stress Disorder (PTSD) and other anxiety disorders

▪ Psychotherapeutic Treatments

▪ Treatment duration, modality, and efficacy can deter service members from seeking healthcare (Accessibility, Treatment Interval, Patient satisfaction, Scheduling, other considerations)

▪ Psychotherapy challenges (not evidence-based, eclectic, scheduling, patient “fit,” variable and unpredictable outcomes

▪ Current evidence-based psychotherapies for PTSD are moderately effective but only if treatment is completed.

▪ Pharmacologic Interventions

▪ Only 2 FDA-approved medications for PTSD: sertraline (Zoloft), paroxetine (Paxil)

▪ Both have limited efficacy, include significant unwanted side effects, and have compliance issues.

▪ Off label prescribing: help for the patient, may impede research

▪ Need for far-forward, immediate treatments

▪ Veterans and Service members can participate in medication trials

▪ PTSD comorbidities also need to be addressed (e.g., depression, substance use, sleep disorders, chronic pain, anxiety disorders…)


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Clinical Psych Challenges & Priorities❑ Major Depressive Disorder (MDD) and Suicidality

❑ MDD is the most frequent behavioral health diagnosis among Service

members.

❑ Better antidepressant medications

❑ immediate interventions for risk mitigation (psychotherapeutic and

pharmacologic)

❑ Substance Use Disorders

❑ As either a primary diagnosis or as a comorbidity of PTSD and/or MDD.

❑ Current research focus: Alcohol Abuse, Opioids, Synthetic Cannabis

❑ Increased interest in Sleep

❑ Sleep disorders

❑ Sleep cycle pertubations (shift work, sleep disruption)


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Previous PTSD Medication Studies

Which would be best?

Sleep, Nightmares• prazosin

• risperidone• nabilone

Avoidance/ Numbing

• venlafaxine• ???

Comorbid AUD

• topiramate• doxazosin• prazosin

• ???

Re-Experiencing• risperidone

• ???

Global Symptoms

• olanzapine• venlafaxine• tramadol

• ???

SSRI-Resistant• ketamine

• quetiapine• ???


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PTSD State of the Science Summit (SoSS)

Held June 2017

❑ ~140 participants from government, industry and academia

❑ Included knowledge experts in the fields of PTSD pathophysiology,

endocrinology, neuroimaging, genomics, and CNS drug development

❑ Aim is to shape future medical science and strategy in the

development of medications to treat PTSD and its associated

symptoms and comorbid disorders

❑ Identify the most promising drug targets

❑ Initiate future Advanced Development partnerships

❑ Desirability of Adaptive Designs in Pharmacologic Research

❑ MTEC program announcement


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Funding Opportunities❑ Broad Agency Announcements (BAAs)

❑ https://www.arl.army.mil or http://grants.gov:

• e.g., “Psychological Health and Resilience: The psychological health research program area is interested in research aimed at increasing resilience and psychological health and decreasing post-traumatic stress disorder (PTSD), suicide, and risk behaviors (e.g., substance abuse, anger/aggression, sexual harassment and assault, and violence within the military). Additional psychological health areas of interest……..” from BAA W81XWH-17-R-BAA1 at grants.gov website.

• Open year round for pre-application (pre-proposals) submissions

❑ Pre-applications are submitted electronically to the Electronic Biomedical Research Application

Portal (eBRAP) https://ebrap.org.

❑ Full applications, following an invitation to submit, are submitted electronically to http://grants.gov.

❑ Medical Technology Enterprise Consortium (MTEC)

• conduct research and prototyping to support the USAMRMC requirements

• capitalization of private-sector and government opportunities

• provide funding for critical studies that may attract other investors

• commercialization of government intellectual property

https://www.arl.army.mil/

http://grants.gov/

https://ebrap.org/

http://grants.gov/


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Funding Opportunities cont’d

❑ Congressionally Directed Medical Research Program

(CDMRP) Program Announcements (PAs)

❑Peer Reviewed Medical Research Program (PRMRP)

http://cdmrp.army.mil/prmrp/:

• e.g., Technology/ Therapeutic Development Award - Translation of promising preclinical findings into clinical applications for prevention, detection, diagnosis, treatment, or quality of life. Product-oriented (e.g., device, drug, clinical guidelines). The product(s) to be developed may be a tangible item such as a pharmacologic agent (drugs or biologics) or device, or a knowledge-based product.

❑ Topic Specific Program Announcements • occasionally occur throughout the year and usually have a limited window of time for

submissions• often fairly narrow in terms of research proposal sought, focused to fill a clearly identified

capability gap• regular monitoring of grants.gov ensures opportunities are not missed• MOMRP does maintain a list-server where we email recipients when a PA of this nature is

released. Email Drs. Hoover or Renosky to be added to the list-server (contact information on next page)

http://cdmrp.army.mil/prmrp/


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LCDR Christopher SteeleActing Program Area Director

Military Operational Medicine Research Program (MOMRP)

Fort Detrick, MD 21702

LTC James McKnightActing Deputy Director

Military Operational Medicine Research Program (MOMRP)

Fort Detrick, MD 21702

Ron Hoover, PhDPsychiatry and Clinical Psychology

Research Portfolio Manager

301.619.6602

[email protected]

MOMRP Contacts

Ronda Renosky, PhDPsychiatry and Clinical

Psychology Research Deputy

Portfolio Manager

301.619.9943

[email protected]

mailto:[email protected]

mailto:[email protected]

Documents

Military Operational Medicine Research Program Overview2018/06/06 · Acting Director: LCDR Chris Steele Ronald Hoover, Ph.D. Psychiatry and Clinical Psychology Research Portfolio