commitment dedication collaboration

NCIRE Report
2008 and 2009
dedication
commitment
collaboration
ncire
The Veterans Health
Research Institute
NCIRE Report
2008 and 2009
NCIRE Report
2008 and 2009
Table of Contents
3
Forward
4
From the Chairman of the Board 2008
5
From the Chairman of the Board 2009
dedication
9
Bringing Scientific Innovation to Veterans Health – Judy Yee, MD
11
Video Teleconferencing in Battlefield Surgery – LTC T. Sloane Guy, MD
12
A New Generation of Veterans – Chris Loverro, United States Army
commitment
16 NCIRE Research – A Chain of Knowledge
18
Basic Research – Robert Nissenson, PhD
19
Clinical Research – Beth Cohen, MD, MAS
20
Health Services Research and Development –
Mary-Margaret Chren, MD / Sara Knight, PhD
Rehabilitation Research – Gary Abrams, MD
21
collaboration
24
Strength Building on Strength – The Neuroscience Center of Excellence
27
Center for Imaging of Neurodegenerative Diseases
28
NCIRE Presents The Brain at War
30
Supporting Veterans Health Research
32
Philanthropy and Veterans Health
34
Leading Through Generosity – Our Donors and Supporters
38
From the Executive Director
40 From the Chief Financial Officer
41
Financial Summary – Years ending September 30, 2008 and 2009
42
Board of Directors 2008 and 2009
44
In Memoriam – T.S. Benedict Yen, MD, PhD
NCIRE Report
2008 and 2009
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dedication
commitment
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NCIRE Report
2008 and 2009
In 2008, NCIRE – the Veterans Health Institute
adopted a new logo to better represent the
three principles for which NCIRE stands:
dedication to our Veterans, commitment
to research, and collaboration with our
research partners.
Just as our logo’s three color fields
overlap, so do these three tenets
interlock and support each other.
Devotion to the health of our Veterans
is the engine that drives our passion
for research. Our collaborative research
associates – the VA, the University of
California, San Francisco, the Department
of Defense, the National Institutes of Health,
private industry, other nonprofit institutions
and Veteran support organizations – each
offer something unique to the cause of
Veterans health.
NCIRE is proud to be the nexus of such
profound fervor, zeal, and teamwork in
the service of medical science. The pages
that follow illustrate the real meaning of
these words and concepts, in real ways.
We hope you become as inspired
as we are.
NCIRE Report
2008 and 2009
page 3
Chairman of the Board 2008
During my tenure as Chair of
NCIRE’s Board of Directors, I
have been privileged to be on
hand as our already formidable
commitment to Veterans
health research has grown
and strengthened even more.
Not only has our research
portfolio increased in size
and scope, but our research
collaborations have expanded
greatly — particularly with our
colleagues in the Department
of Defense. The DoD/SFVAMC/
NCIRE Neuroscience Center
of Excellence today covers an
extremely broad range of research areas that are vital
to the well-being of our current and former men
and women in uniform: PTSD, traumatic brain injury,
Parkinson’s disease, dementia, epilepsy, peripheral
neurological injury, and a host of related conditions.
The primacy of our advanced brain imaging
program at SFVAMC was acknowledged as well,
when a research group headed by Michael Weiner,
MD, Director of the Center for the Imaging of
Neurodegenerative Diseases at SFVAMC, was
granted a $6 million Biomedical Technology Research
Centers (BTRC) Award from the National Institutes
of Health – one of only two such awards nationally.
Our investigators approach their research from
a variety of perspectives: basic, clinical, and
translational. Thanks to NCIRE’s culture of crossdisciplinary collaboration, such categories are not,
page 4
in practice, separate. Instead,
they represent a continuum of
scientific investigation, starting
at the molecular level and
progressing to studies that will
have an impact on the way
medicine is practiced throughout
the entire VA health care system
and beyond.
Of course, there are many
practical challenges, not the
least of which is a need for more
research space on a campus that
has many physical constraints.
However, we have been working
diligently with VA leadership to create new strategies
that will enable us to move our research program
forward.
This has been my final year as Board Chair. It is with
some small measure of regret, and a great deal of
pride, that I welcome my colleague Paul Volberding,
MD, as our new Chair. As Chief of Medicine at
SFVAMC and a member of the NCIRE Board, Paul
has already contributed a great deal to NCIRE’s
progress. As Chair, I am sure that he will lead us
to new successes. I know I join the entire Board
in wishing Paul the best.
Sincerely,
Raymond A. Swanson, MD
NCIRE Report
2008 and 2009
Chairman of the Board 2009
My first year as Chair of the
NCIRE Board of Directors has
been an eventful one, to say
the least.
NCIRE continued to expand
its unique and productive
partnership with the
Department of Defense. Not
only did we receive our eighth
year of research support for
the Neuroscience Center of
Excellence from the US Army’s
Telemedicine and Advanced
Technology Research Center
(TATRC), but we also extended
and deepened our strategic
partnership with the Defense Centers of Excellence
for Psychological Health and Traumatic Brain Injury,
directed by Brigadier General Loree K. Sutton, MD.
Relations with SFVAMC remain strong with the arrival
of Medical Center Director Lawrence Carroll. Our
affiliation with UCSF is as close as it has ever been,
thanks in part to our warm relations with Chancellor
Susan Desmond-Hellmann and Dean Sam Hawgood
of the School of Medicine, who are new to those
particular jobs but close colleagues of long standing.
Internally, we have begun reinvigorating the NCIRE
Board of Directors with the addition of some
spectacularly talented new members and advisors,
with the promise of more to come.
Of course, we face challenges as well. Here on the
SFVAMC campus, we must reckon with the departure
of the internationally renowned Dr. Charles Marmar
as Chief of Mental Health and Director of the PTSD
research program. Fortunately, the unparalleled depth
of talent and experience among Dr. Marmar’s peers
and successors guarantees our ability to expand our
NCIRE Report
2008 and 2009
portfolio of care and research
on behalf of returning Iraq and
Afghanistan Veterans.
At the state level, there is an
ongoing (and deepening) multi-year
budget shortfall; as UCSF faculty
members, SFVAMC investigators
have not been immune from some
of its effects. On the positive side,
NCIRE as a whole has been sheltered
from the worst of this crisis by its
status as an independent nonprofit
institute that is mostly funded by
federal dollars.
Nationally, though, NCIRE must deal
with the consequences of an anemic economy and its
resulting long-term potential effects on the budget
of the National Institutes of Health, which supports
so much of our research. The next few years are likely
to provide further tests of our abilities to be efficient,
resourceful, and creative in maintaining our current
funding sources and cultivating new ones.
To that end, we are working with our Development
Department to vigorously expand NCIRE’s base of
donors and supporters, with the goal of establishing
a research endowment that will grant us some
measure of independence from the ups and downs
of grant-based research funding. This is an exciting
prospect, and I look forward to sharing more with
you in future letters.
Cordially,
Paul Volberding, MD
page 5
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NCIRE Report
2008 and 2009
dedication
NCIRE Report
2008 and 2009
cancer is among the
“ Colon
most preventable of cancers.
“
– Judy Yee, MD
page 8
NCIRE Report
2008 and 2009
Bringing Scientific Innovation
to Veterans Health
Colon cancer is among the most preventable
cancer screening was performed using virtual
of cancers. Unlike lung cancer or breast cancer
colonoscopy. So we’re definitely moving into a phase
screening, which look for cancerous tumors, colon
where this technology will be disseminated and
cancer screening looks for precursor lesions that can
become widely available to millions of Americans.”
be removed before they become cancerous. “The
problem,” says SFVAMC Chief of Radiology Judy
Yee, MD, “is that only 40 percent of Americans
who should be screened for colon cancer actually
get screened.”
For Dr. Yee and her VA colleagues in radiology,
imaging goes well beyond thecolon. In 2008, Dr. Yee
presided over the grand opening of the 3D Imaging
Laboratory at SFVAMC. “This facility offers our
Veterans cutting-edge, state-of-the-art, non-invasive
Dr. Yee can understand why: current conventional
3D imaging of any part of the body as a tool in
screening methods such as colonoscopy are
diagnosis and treatment,” she says. “We can develop
considered invasive and uncomfortable. Fortunately,
3D models of any organ, rotate them in any direction
Dr. Yee can offer Veterans a less invasive alternative:
or orientation, and zoom in and out at will.” Imaging
virtual colonoscopy, which uses x-ray technology to
is not restricted to the major organs: “We see a lot
create a complete three-dimensional picture of the
of patients with vascular disease, and we are able
entire colon in just minutes. “We’ve demonstrated
to use 3D images of blood vessels to better evaluate
that it’s just as good as conventional colonoscopy
large and small vessel involvement.”
at detecting precancerous lesions,” says Dr. Yee.
“What’s more, it also reveals previously unsuspected
lesions, tumors, and other problems in nearby
organs such as the liver and kidneys.”
“The 3D lab is also a medical educational tool,” says
Dr. Yee. “Just getting a good image is not enough.
It’s essential to know how to correctly interpret what
you’re seeing. Besides all the UCSF residents who
Dr. Yee concedes that since she began working on
rotate through here every month, I have medical
virtual colonoscopy over a decade ago, acceptance
students from all over the country who come here
of the new procedure in the medical community
to work with me on 3D imaging research. We have
has not been as swift as she might have liked.
research fellows, and we train radiologists here
“Nonetheless, thanks in large part to the initial
as well. Four times a year, we hold an intensive
landmark work that was done here at the San
interactive workshop on performing and interpreting
Francisco VA, virtual colonoscopy has recently been
virtual colonoscopy. Physicians come from all over
endorsed by the American Cancer Society in their
the world to train with us. We have an international
cancer screening guidelines,” she notes proudly.
presence.”
“In fact, in March 2010, President Obama’s colon
NCIRE Report
2008 and 2009
page 9
T. Sloane Guy, MD, from 47th CSH, Iraq, pictured during a video teleconference at The Brain at War 2009
cannot emphasize how ambitious this is.
“ IThis
will be the first time this has ever been
“
done in the US Army, anywhere.
– LTC T. Sloane Guy, MD
page 10
NCIRE Report
2008 and 2009
Video Teleconferencing
in Battlefield Surgery
Before joining the staff of the San Francisco VA
Medical Center in 2006, United States Army
Lieutenant Colonel T. Sloane Guy, MD, served two
tours in a forward surgical hospital in Afghanistan,
where he performed trauma surgery on soldiers with
many different types of wounds: “Penetrating injuries
from IEDs, gunshot wounds, motor vehicle accidents
– I did orthopedic surgery, vascular surgery, and
virtually any other kind of surgery if we didn’t have
a specialist available. And that experience was what
led me to begin my research at SFVAMC.”
Dr. Guy explains that as a cardiothoracic surgeon
with training in general surgery, he was often
confronted with surgical problems for which he did
not have specific expertise. “The military cannot have
every single surgical specialty at every single location.
It’s just not feasible. So you do the best you can with
the limited resources available to you in a theater
of war.”
When he returned to the States and was assigned
to SFVAMC under an agreement between the
Department of Defense and the Department of
Veterans Affairs, “I came up with the idea that
it would be nice if surgeons in the middle of
nowhere in Iraq and Afghanistan could use modern
teleconferencing technology to get a surgical
consultation over the Internet from a specialist back
home. As physicians, we are extremely used to
getting consults from other doctors, so it’s a natural
extension of what we do anyway.”
his idea to Colonel Karl Friedl of the US Army
Telemedicine and Advance Technology Research
Center (TATRC), which funds many research projects
in the NCIRE/SFVAMC/DoD Neuroscience Center of
Excellence. TATRC funded Dr. Guy to work with SRI
International, which already had extensive experience
in telemedicine and robotic surgery, to create
prototype hardware and software.
“We created the system and tested it with three
surgeons at SFVAMC — neurosurgeon Dr. Grant
Gauger, orthopedic surgeon Dr. Hubert Kim, and
myself,” Dr. Guy recalls. “We remotely proctored a
group of surgical residents through three different
types of surgical procedures, and demonstrated that
the procedures were easier and had better results
with the system than without.”
In the spring of 2009, Dr. Guy was assigned to the
47th Combat Support Hospital near Mosul, Iraq as
Chief of Surgery. During his tour of duty there,
he successfully set up and field-tested the new
telesurgery system, performing a complex procedure
while a colleague looked on and consulted via laptop
computer from Brooke Army Medical Center in Fort
Sam Houston, Texas.
Now that Dr. Guy has proved that the concept
works, “We can start to make the case that remote
teleconferencing should become part of the military
operating room of the future — integrated into the
battle plan, if you will, for providing surgical care in
theater.”
Dr. Guy, whose clinical focus at the VA is on robotic
and minimally invasive cardiac surgery, proposed
NCIRE Report
2008 and 2009
page 11
A New Generation of Veterans
“Iraq is a different type of war,” says Chris Loverro.
Over the course of a year as a staff sergeant with the
US Army’s First Stryker Brigade, the former Berkeley
city police officer built schools, assisted refugees,
designed basic training programs for the Iraqi Army,
and went on counterinsurgency missions in and
around Mosul. He says that even as a member of a
police SWAT team, he never experienced anything
approaching the psychological and physical pressures
he and his comrades encountered in Iraq.
“You’re exposed to people trying to kill you basically
every single day,” explains Chris. “Even if you didn’t
run missions, didn’t go outside the wire, you were still
mortared every day. People were killed in the gym,
people were killed in the latrine, people were killed
in the chow hall, people were killed in their quarters.
So you never really could relax. Plus there was the
fact that people were doing multiple tours – being
separated from their families for long periods of time,
guys missing the birth of their first child, that kind of
thing.”
In those extraordinary circumstances, thinks Chris,
post-traumatic stress disorder is an understandable
response. “What’s interesting, though, is that PTSD
symptoms usually don’t manifest themselves until
you get back home. When you’re over there, you’re
in this fight-or-flight, what we call ‘hunter-killer’
mode. So you tend to internalize it more.” Back home
in the Bay Area, “I had some readjustment issues.
I was really angry, really intense, always on edge,
always hypervigilant. It took about a year to not be
consciously obsessed with the war.”
“The unspoken sentiment among Veterans is if you
have PTSD symptoms, if you’ve been psychologically
affected by the war, then you’re weak. Because you’re
a warrior, in a warrior culture. Then there’s the stigma
that society puts on you: ‘Oh, look, an unstable vet –
is he gonna go postal?’ So you get it from both sides.
And it really shatters your self-esteem. You can’t help
but feel weak. So there’s reluctance for Veterans to
talk about it and to get help.”
Eventually, Chris linked up with a counselor at a Vet
Center. “He was a Vietnam Veteran. He probably
saved my life. That’s why NCIRE’s Welcome Home
DVD is so important,” he says. “It’s like, ‘hey, welcome
back, here’s some stories of guys who went through
what you’re going through, you’re not alone, and
here’s some resources, and we’re doing this research
too.’”
Chris is particularly excited by scientists’ efforts to find
a physical diagnosis for PTSD. “I think that’s huge,
that’s monumental. Because it pulls it away from the
mental health stigma and puts it into the category of
a physical wound. I think that alone will significantly
help with the stigma.”
Today, Chris is in film school, learning the skills
needed to direct “Hidden Casualties,” a documentary
about “Veterans coming home and how combat has
changed them.” He says, “What I can tell you as a
Veteran is that we appreciate what NCIRE is doing.
You are literally going to be saving lives by breaking
down that stigma, which is going to get more soldiers
help sooner. You’re going to be preventing suicides.”
Chris explains that one of the main reasons that more
Veterans don’t seek help with readjustment is stigma.
page 12
NCIRE Report
2008 and 2009
I can tell you as a Veteran is that
“ What
we appreciate what NCIRE is doing.
“
– Chris Loverro, United States Army
NCIRE Report
2008 and 2009
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NCIRE Report
2008 and 2009
commitment
NCIRE Report
2008 and 2009
NCIRE Research
A Chain of
Knowledge
Science begins with inspiration, but achieves its goals through experimental
design and hard work. NCIRE is committed to supporting many different
kinds of scientific investigation at SFVAMC, from laboratory studies of cell
cultures to nationwide research involving thousands of patients, linked
together in a chain of discovery, development, translation, and application.
page 16
NCIRE Report
2008 and 2009
Basic Research: The Foundation of Discovery
Basic researchers develop cellular and molecular models in order to explore the mechanisms that underlie
neurodegeneration, prostate cancer, cardiovascular disease, stroke, and many other conditions that are
common among our Veteran patients. Armed with this new knowledge, they then partner with our
clinical and translational investigators to identify new strategies for the prevention and treatment of
these and other conditions.
Clinical Research: Assessing the Impact on People
Clinical research at SFVAMC is focused on many of the illnesses that affect the health of our nation’s
Veterans, including chronic viral diseases (HIV, hepatitis B and C), cancer, neurodegenerative diseases,
post-traumatic stress disorder and Gulf War Syndrome, kidney disease, metabolic diseases, and
cardiopulmonary diseases.
Health Services Research and Development:
Improving Health Care
The mission of HSR&D is to advance knowledge and promote innovations that improve the health and
care of Veterans and the nation. Many of the studies conducted by HSR&D have been used to assess
new health care technologies, explore strategies for improving health outcomes, inform health policy,
and evaluate the efficiency of services and therapies.
Rehabilitation Research: Promoting Neurological Recovery
Rehabilitation Research studies the combined effects of physical therapy, anti-inflammatory drugs,
and agents that promote the growth and survival of new neurons on experimental models of recovery
from TBI and stroke.
NCIRE Report
2008 and 2009
page 17
Basic Research
The building
blocks of health
care research
Robert Nissenson, PhD
SFVAMC Senior Research Scientist Robert Nissenson,
PhD, studies the biology of bone formation. His
specialty is cell signaling, which he defines as
“everything that the cell does in response to what’s
happening outside itself. When a cell encounters a
hormone or a particular environment, how does the
information about that hormone or environment get
into the cell? And then what changes go on inside the
cell that allow it to respond?”
Dr. Nissenson does not pursue laboratory science simply
for its own sake. “At the VA, you can see the clinical
problems to which basic research can be applied,”
he says. One such problem is osteoporosis, the loss
of bone with age. “Obviously,” he notes, “this is an
important issue for our aging Veterans.” His hope is
that by discovering the signaling pathways that control
osteoblasts, the cells that form bone, he can lay the
groundwork for new treatments.
Most of today’s osteoporosis therapies inhibit the
loss of existing bone, explains Dr. Nissenson, but
don’t stimulate the new bone formation. In a recent
experiment with transgenic mice, however, he and
his colleagues found that one particular cellular signal
results in bones that are enormously thicker and larger.
“Now we want to understand the mechanics of how
this signal actually works,” he says. “What cells are
involved, and what other signals?”
page 18
In related research, Dr. Nissenson is collaborating
with UCSF researchers on new experimental models
for fracture healing. “Can activation of certain
signaling pathways accelerate or improve healing after
fracture?” he asks. “This could potentially help people
with delayed fracture healing, such as patients with
diabetes.”
Dr. Nissenson would like to investigate the question
of peak bone mass. “Normally, bone mineral density
peaks at around age 30,” he explains. “After that,
everyone begins to lose bone, and becomes more
susceptible to fractures.” He wonders if there is a
simple, safe way to increase peak bone mass, “sort of
like the way fluoride is given to improve the structure
of your teeth.” He speculates that “maybe you could
increase peak bone mass by 10 percent, which could
make the difference between having a high risk for
fracture at age 65 and being protected.”
Dr. Nissenson credits his scientific successes to a
willingness to follow his natural curiosity. “You allow
your work to take its natural course and you follow
the excitement, and be confident that in the end, your
work will be clinically applicable and important.”
NCIRE Report
2008 and 2009
The emotional and psychological effects of post-traumatic stress
disorder (PTSD) are well known – but what are the physical
effects? With an estimated one in five Veterans returning from
Iraq and Afghanistan with PTSD, it’s an important question.
SFVAMC physician Beth Cohen, MD, MAS, is looking for answers
in several ways.
Working with Karen Seal, MD, Co-Director of the SFVAMC
Operation Enduring Freedom/Operation Iraqi Freedom Integrated
Care Clinic, Dr. Cohen is analyzing heart disease risk factors in
Veterans of Iraq and Afghanistan.
“With an average age of 30, these men and women are typically
too young to have heart disease,” she notes. “So we’re looking
at risk factors for future diseases such as high blood pressure,
smoking, obesity, cholesterol, and type 2 diabetes, and looking at
associations between those risk factors and mental health issues.”
Clinical Research
Where
research
interacts
with
people
The B
Beth Cohen, MD, MAS
Dr. Cohen found that Veterans with diagnoses such as depression
and PTSD have much higher rates of all heart disease risk factors
than Veterans without those diagnoses. “This goes with what
we’re seeing in the OEF/OIF Integrated Clinic,” she says. “A lot of
younger Veterans describe smoking or using alcohol to ‘calm their
nerves’ and self-treat their symptoms. Some say that they used to
be very physically active but since they’ve been back, low motivation or physical injuries prevent them from exercising, and they’ve
gained a lot of weight.”
Dr. Cohen is also working with SFVAMC physician Mary Whooley,
MD, on the Mind Your Heart Study. “We are recruiting Veterans
from any war, both with and without PTSD,” she explains. “We
will evaluate their heart health now, and then follow them over
time. Hopefully, we can find clues to the mechanisms that link
PTSD to heart disease.”
Dr. Cohen has some thoughts on what those mechanisms might
be. “For people struggling with mental health issues, it may be
harder to keep a healthy diet and exercise regularly,” she observes.
“They may smoke or drink more, which can certainly damage the
heart. But the biological effects of PTSD itself are also important.
For example, many patients with PTSD experience hyperarousal
symptoms, where they feel constantly on guard and the sympathetic (fight-or-flight) nervous system is activated. Prior studies
have shown this can have damaging effects on the heart.”
Dr. Cohen hopes that as a result of her work, physicians will be
able to reduce heart disease risk in patients with PTSD. “It will
also be interesting to see,” she concludes, “if treating PTSD can
directly improve heart disease risk.”
NCIRE Report
2008 and 2009
page 19
Health Services Research & Development
Improving
health care for everyone
The B
Mary-Margaret Chren, MD / Sara Knight, PhD
SFVAMC physician Mary Margaret Chren, MD (pictured
left), directs the Program to Improve Care for Veterans
with Complex Comorbid Conditions. Its mission, she
says, is profoundly simple: “Research that focuses on the
quality of health care — how to define it, measure it,
learn about it as it’s currently practiced, and improve it
where it falls short of where we want.”
“We investigate how health care can be delivered in an
equitable and fair way,” explains Associate Director Sara
Knight, PhD (pictured center), a staff psychologist at
SFVAMC. “If we somehow cured cancer, the question
would be, how do you deliver that cure in a way that
results in quality outcomes for all patients, according to
what patients want?”
The path to effective care is fraught with potential
stumbling blocks, says Dr. Knight, whose research
focuses on how to give prostate cancer patients the
best information to help them make care and treatment
decisions. “Currently, it’s very difficult for patients and
health care professionals to spend the time that’s needed
for patients to understand what they want, or even to
be informed about all possible options. So our work is to
make that process easier.”
“Sara’s own work illustrates that,” notes Dr. Chren. “A
doctor may want to give the best prostate cancer care,
page 20
but has no easy way to measure a patient’s preferences
for the many different acceptable therapies. Her work is
to figure out a way to measure patients’ preferences in a
way that will be clinically useful.”
Dr. Chren, a dermatologist at SFVAMC, is widely known
for developing Skindex, a tool that helps clinicians
measure quality of life for patients with skin disease.
“Skin diseases usually don’t affect survival, but can
certainly affect quality of life in many ways, especially
if they’re disfiguring,” she says. Skindex is used in the
United States and abroad and has been translated into
more than 15 languages. Among Dr. Chren’s current
research projects is a long-term study of patients with
non-melanoma skin cancer. “People live with this
common condition, or with the results of treatment,
rather than die from it. There are a lot of different treatments, but no good data about their effectiveness in
many situations, and thus no good treatment guidelines
for most tumors. Our study is comparing the effectiveness of these treatments.”
In directing the program, Drs. Chren and Knight work
hard to foster an atmosphere of collaboration. “Researchers need more than money to thrive,” says Dr.
Chren. “They need mentors and an environment where
scientists from many different fields can nurture their
work and make it the best it can be.”
NCIRE Report
2008 and 2009
As the Rehabilitation Section Chief at the San Francisco VA
Medical Center, Gary Abrams, MD, has a simple goal: “Take
people who have injuries, no matter how catastrophic, and help
them maximize function.”
Since the advent of the wars in Iraq and Afghanistan, Dr. Abrams
and his colleagues have seen more and more cases of closedhead traumatic brain injury in their Veteran patients. Known as
“mild TBI,” its effects can be anything but mild. “There are a lot
of Veterans who look great, but inhabit the world of the walking
wounded. They never seem to be able to get their lives together,
and go through successive failures that haunt them forever.”
In a typical scenario, he says, “a soldier in a Humvee in Iraq rides
over an IED [improvised explosive device]. He’s far enough from
the blast not to have obvious physical injuries, but nonetheless his
head has been exposed to the blast wave, which in turn affects
his brain.”
Rehabilitation
Research
Essential
research
in brain
trauma
Gary Abrams, MD
Symptoms include disabling chronic headaches, sleep problems,
memory loss, irritability, and difficulty concentrating and paying
attention, “all of which overlap the symptoms of PTSD,” says Dr.
Abrams. “And of course, someone whose vehicle has been blown
apart by a roadside bomb might have PTSD as well. So that’s one
of our main challenges: distinguishing mild TBI from PTSD so that
we can treat both effectively.”
To help in diagnosis, Dr. Abrams uses the advanced MRI brain
imaging facilities at the SFVAMC Center for Imaging of Neurodegenerative Diseases to look for the subtle physical changes caused
by mild TBI. “On the rehabilitation end, I’m collaborating with my
VA colleagues Anthony Chen, MD, and Tatiana Novakovic-Agopian, PhD,” he reports. “We’re using a technique called functional
MRI to evaluate the effectiveness of cognitive rehabilitation, which
is a method of retraining individuals with memory and attention
problems. If this retraining actually brings about physiological
changes in areas of the brain that are involved with cognition, this
would give us a definitive way of measuring the progress of rehabilitation. And so far, the results look very encouraging.”
If cognitive rehabilitation works, says Dr. Abrams, “then we can
not only do cognitive rehab at other VA medical centers, but
we might be able to adapt it for telemedicine, so that we can
remotely treat Veterans who live too far from a clinic or hospital
to come in and be treated in person. It’s a way of using advanced
research to help people live better lives.”
NCIRE Report
2008 and 2009
page 21
NCIRE Report
2008 and 2009
collaboration
NCIRE Report
2008 and 2009
Strength Building on Strength
The Neuroscience Center of Excellence is a unique research partnership between
the US Army Telemedicine and Advanced Technology Research Center (TATRC),
Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury
(DCoE), SFVAMC, and NCIRE. The Center was established to bring VA, Department
of Defense, academic, and industry resources together to build on NCIRE’s core
research strengths in neuroimaging, neurorehabilitation, PTSD, TBI, sleep and human
performance, and telemedicine.
At the heart of the program is the SFVAMC Center for Imaging of Neurodegenerative
Diseases (CIND), the only imaging center in the VA system dedicated exclusively to
brain imaging.
The Center’s goal is to bring experts in individual specialties into focused alliances in
order to hasten the development of the clinical services most crucial to the health
and well being of warriors. This research program benefits from a comprehensive
view of the entire life course of the warrior, from preparation and training,
pre-deployment, and management of mental and physical stressors in the
combat theater to recognition and treatment of post-deployment
health concerns.
The Center of Excellence has become an exemplar
of seamless inter-agency cooperation and collaboration,
and a model for NCIRE’s collaborative partnerships.
page 24
NCIRE Report
2008 and 2009
TATRC funds 43 research projects at NCIRE. A number of
related projects leverage TATRC-supported personnel and
research to bring added value to NCIRE’s research.
Successes include:
Identifying brain biomarkers for PTSD, potential molecular
targets to protect the brain from post-TBI inflammation,
markers of predisposition and resilience to PTSD in police
officers and other first responders, a link between PTSD
and increased risk of dementia in Veterans, and a potential
neurodegenerative agent in Gulf War illness
Ongoing projects include:
Trial of a safe, approved drug to dramatically improve
effectiveness of PTSD therapy; search for biomarkers of
PTSD in blood; explore links between PTSD, TBI, and other
neuropsychiatric conditions; explore links between PTSD
and cardiovascular risk; identify new therapies to recover
mental and physical function after TBI
Future projects and initiatives
include:
Install advanced 7-Tesla and 3-Tesla MRI units at CIND;
establish PTSD Center of Excellence at NCIRE/SFVAMC;
create National Brain Imaging Database, centered at CIND;
establish Musculoskeletal Center of Excellence, building
on bone research programs at NCIRE/SFVAMC; conduct
long-term national prospective study of PTSD in military
personnel
NCIRE Report
2008 and 2009
page 25
shown that we
“ We’ve
can successfully share
vast amounts of scientific
data among a huge group
of investigators.
“
– Michael Weiner, MD
page 26
NCIRE Report
2008 and 2009
Center for Imaging of Neurodegenerative Diseases
CIND: At the Forefront
of Brain Imaging for Veterans
For millions of older Veterans, Alzheimer’s disease and Parkinson’s disease represent the threat of a blighted
old age as well as a terrible financial burden for families and caregivers. For numerous men and women who
have served in Iraq and Afghanistan, post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) will
become chronic injuries, the impacts of which will extend beyond their own lives to those of their loved ones
and society at large.
Fortunately, the advanced brain imaging team at the SFVAMC Center for Imaging of Neurodegenerative
Diseases (CIND) have dedicated their careers to the prevention, diagnosis, and treatment of these and
many other neurological conditions. NCIRE is proud to have CIND as a research partner. A world leader
in neuroimaging, CIND is the only center in the VA system devoted exclusively to advanced brain imaging.
MD/PhD research investigators who are faculty members of the University of California, San Francisco work
with expert personnel including postdoctoral fellows, MRI technicians, medical imaging analysts, programmers, and administrative staff.
CIND is the vital heart of the Neuroscience Center of Excellence, a unique research partnership between the
VA, the Department of Defense, and NCIRE that works to solve the health challenges experienced today by
Veterans of Iraq and Afghanistan as well as by their older colleagues from earlier wars.
CIND is also the lead institution for the Alzheimer’s Disease Neuroimaging Initiative (ADNI), one of the largest
collaborative research enterprises in the United States, comprised of 58 imaging centers across the country.
This multi-year, multi-million dollar project brings together government, academic research institutions, and
private industry in order to discover reliable, reproducible methods for tracking Alzheimer’s disease – and
measure the effects of new treatments as they are developed.
“ADNI represents a model for the creation of new biomedical research networks,” says CIND Director
Michael Weiner, MD (pictured opposite page), who serves as Principal Investigator for both the
Neuroscience Center of Excellence and ADNI. “We’ve shown that we can successfully share vast amounts of
scientific data among a huge group of investigators. Potentially, we can use the same types of collaborative
research networks in the fight against many other neurological diseases and conditions, such as TBI.”
NCIRE Report
2008 and 2009
page 27
NCIRE Presents The Brain at War
Neurocognitive
Consequences of Combat
NCIRE sponsored the second annual gathering of
The Brain at War conference at SFVAMC on May
28, 2009. The event brought together some of the
world’s leading experts on PTSD, TBI, and related
neurological and psychological conditions.
Distinguished presenters and guests included
Brigadier General Loree K. Sutton, MD, Director of
the Defense Center of Excellence for Psychological
Health and Traumatic Brain Injury; Michael E. Selzer,
MD, PhD, Director of Rehabilitation Research and
Development at the Department of Veterans Affairs;
and Colonel Karl Friedl, PhD, Director of the US
Army’s Telemedicine and Advanced Technology
Research Center (TATRC), which funds much of
NCIRE’s military-related neuropsychological research.
One of the highlights of the day was a research
presentation on “Advances in Telesurgery and
Telementoring” by US Army surgeon Lieutenant
Colonel T. Sloane Guy, MD, who spoke via video
teleconference from the 47th Combat Support
Hospital in Mosul, Iraq. Dr. Guy did the initial research
on his project while serving in his previous posting
as a cardiothoracic surgeon at SFVAMC.
“Dr. Guy’s story exemplifies the kind of multi-institutional scientific initiative that NCIRE works to foster,”
said NCIRE Executive Director Robert E. Obana.
page 28
“An active-duty Army surgeon assigned to a VA
hospital, with a UCSF appointment as Assistant
Professor of Surgery, leveraged a US Army TATRCfunded project into research that is of vital interest
to all the armed services as well as to the Defense
Center of Excellence. What is more, Dr. Guy demonstrated his results direct from the war zone in Iraq,
over seven thousand miles away, using the very sort
of technology that is at the heart of his research
project. It’s hard to describe how exciting this was
for everyone at the conference.”
Other presenters included Thomas Neylan, MD,
Director of the PTSD Program at SFVAMC and
UCSF Professor of Psychiatry; Raymond Swanson,
MD, SFVAMC Chief of Neurology and Rehabilitation
and UCSF Professor and Vice Chair of Neurology;
and Karen Seal, MD, Co-Director of the OEF/OIF
Integrated Care Clinic at SFVAMC and UCSF Assistant
Professor of Medicine.
Speaker of the House Nancy Pelosi (D-Calif.) said in
a letter to conference participants, “It is a privilege
to support NCIRE – The Veterans Health Research
Institute and your The Brain at War conference... It is
essential that we lift the unwarranted stigma associated with these injuries and work vigorously to offer
the best available treatment to all our Veterans.”
NCIRE Report
2008 and 2009
“ It is essential that we lift the unwarranted
stigma associated with these injuries and
work vigorously to offer the best available
treatment to all our Veterans.
“
NCIRE Report
2008 and 2009
– Speaker of the House
Nancy Pelosi
page 29
Supporting Veterans Health Research
For NCIRE’s donors and supporters, fiscal 2008 got off
to a scintillating start with “Above and Beyond,” a gala
fundraiser in celebration of Veterans health research.
In large part, the gala was a success thanks to the hard
work, creativity, and dedication of event producer Ann
Fox (below, right) and sponsorship coordinator Ann
Haruki-Pinedo (below, left). Through different paths,
these two friends have become steadfast allies of NCIRE.
Their latest project together is Welcome Home: Support
from the Ground Up, a DVD conceived and produced
for NCIRE by Ann Fox as a resource guide for warriors
returning from Iraq and Afghanistan and for their loved
ones.
“I grew up in Washington, DC, where my father was a
producer of many key events in the city – inaugurations,
festivals, and the like,” recalls Ann Fox. “Of all the
ceremonies I witnessed, it was the annual laying of the
wreath on the Tomb of the Unknown Soldier that had
the strongest effect on me as a child.”
After a successful career in advertising, television, and
media production, Ann was “motivated to become
involved with NCIRE through my friendship with Dr. Lynn
Pulliam,” chief of microbiology at SFVAMC and a leading
investigator in neuroimmunology. “I was struck by Lynn’s
dedication to her research,” says Ann, “and then when
she told me about the important work being done on
PTSD and TBI by San Francisco VA scientists, I knew I had
to help,” first with “Above and Beyond,” then through
the Welcome Home DVD.
Ann Fox is no stranger to the consequences of combat,
for those who fight as well as for those who care for
them. “Vietnam took away friends, both from the war
and from suicide afterwards. And my cousin’s child is
currently serving in Afghanistan. So I see the effects of
war both from the perspective of a contemporary of
our warriors and from the perspective of a mother.” Her
knowledge inspired her to create the Welcome Home
DVD, which includes a question-and-answer session on
PTSD and TBI featuring Bay Area members of the Blue
Star Mothers of America, an organization of mothers
of men and women serving in the armed forces. “For
me, a defining moment was attending my first meeting
of the Blue Star Moms, who meet regularly to support
Through different paths,
these two friends have
become steadfast allies
of NCIRE.
page 30
NCIRE Report
2008 and 2009
Welcome Home: Support from the Ground Up
A Resource Guide for Returning Service Members,
Their Families, and Loved Ones
Almost 2 million Americans in uniform have been deployed to Iraq,
Afghanistan, and other contemporary theaters of conflict. Nearly 40
percent have been deployed more than once. The physical and emotional
consequences of military service are serious and complicated. Readjustment
to civilian life can be difficult and can bring up challenges that affect not
only Veterans but their loved ones, professional colleagues, and communities.
NCIRE is proud to sponsor Welcome Home, a DVD resource guide for
the brave Americans who have served our country in the Armed Forces.
each other with incredible pride and courage while their
loved ones are serving,” she says. “They are the ones
who motivated a lot of the work on the Welcome Home
DVD, and they’ve done so much to support it.”
Ann Haruki-Pinedo’s father fought in the Second World
War with the famed 100th /442nd Regimental Combat
Team, an all-Japanese-American US Army unit whose
members became renowned for their toughness and
valor in battle even as many of their families were
confined to internment camps in the United States.
“We went to 442nd events all through our childhood,”
remembers Ann, a native of Hawaii. “We went to
reunions. They were always at the house. They were
very much like family. And when my father passed away
suddenly at age 64, they were there within hours from
different islands.”
Her involvement with Veterans continued into
adulthood. “When I went to graduate school as a
medical social worker, the VA helped to pay for my
education, and I interned at the Seattle VA. I also
worked at an all-Japanese-American nursing home
that a great many members of the 442nd helped found.”
Ann Haruki-Pinedo notes that aside from their combat
experiences, which included hard fighting across Europe
and being among the first troops to liberate Jewish
prisoners from the Dachau concentration camp, the
men of the 442nd had to deal with racism and prejudice
at home. “In many respects, they never even talked
NCIRE Report
2008 and 2009
about their experiences with their families, because that
just wasn’t something you did,” she observes. “But for
the past 20 years, more than a thousand oral histories
from the men of the 442nd RCT have been recorded, and
it’s OK for them to talk about it. And to get some relief
at this point is huge for them, I think.”
She confides an additional, and very personal, reason
for her support of medical research. “One of my children
has autoimmune-related health issues that don’t have a
cure or even necessarily a treatment, so the importance
of research is obvious to me. Working with NCIRE and
other health-related nonprofit organizations is really a
way of giving back, or paying forward. I’m lucky I have
the time and training to do it.”
Ann Haruki-Pinedo hopes that the DVD Welcome Home:
Support from the Ground Up will reach “a lot of people
who would not necessarily have sought help, and that
they understand that this is something that they can get
relief from if they deal with it. If word gets out that they
have an opportunity to significantly improve the quality
of their lives, that would be very big. People are looking
for help yesterday.”
“I hope that this work results in a whole new way of
looking at PTSD,” adds Ann Fox. “That one day, it will
no longer be considered a ‘disorder,’ but an honorable
wound of war.”
page 31
SCIENCE DEDICATED TO Veterans HEALTH
Philanthropy and Veterans Health
Every donation makes a difference
in the health of our Veterans
role is to match
“ My
our donors’ passion
for helping Veterans
with key research
initiatives that will
help those who
have served.
“
– Robin Morjikian
page 32
NCIRE Report
2008 and 2009
One of the consequences of my having studied Charles Dickens as an undergraduate is that his intricate
story lines, social commentary, colorful characters, and turns of phrase frequently come to mind, often
without warning. And so, as I thought about my message for this Annual Report, the opening lines
of his novel A Tale of Two Cities came back to me: “It was the best of times, it was the worst of times…”.
How interesting that Dickens’ words, penned almost 150 years ago, so accurately depict both the challenges
and the opportunities facing NCIRE – The Veterans Health Research Institute. Without question, the
financial turmoil and uncertainty affecting the U.S. economy and financial markets worldwide have had a
deep impact on the ability of many of our friends and supporters to give at the levels to which they once
aspired. Yet even in the face of unprecedented economic and financial contraction – for many in our midst,
what can only be described as “the worst of times” – NCIRE and
our Veterans continue to benefit from dedicated and caring individuals who are committed to our mission:
Advancing Veterans Health Through Research. On the pages that follow, I invite you to read the names
of these wonderful and gracious donors and supporters.
In other ways, however, this is “the best of times” for NCIRE. Why do I believe this? First, there has never
been a better opportunity to do something good for our Veterans. Of the nearly 2 million Americans
deployed to date in the conflicts in Iraq and Afghanistan, approximately 15% are women. Additionally,
recent research by NCIRE investigators has indicated that Veterans of Iraq and Afghanistan with posttraumatic stress disorder and other mental health diagnoses have two to three times the rate of heart
disease risk factors compared with Veterans without such diagnoses. Additionally, as our Vietnam-era
Veterans grow older, they are at risk for chronic conditions of aging being exacerbated by the effects of
undiagnosed or untreated combat-induced trauma.
Given NCIRE’s strategic partnerships with the San Francisco Veterans Affairs Medical Center and the
University of California, San Francisco, plus other federal partners including the National Institutes of Health
and the Department of Defense, NCIRE is uniquely positioned to have a positive impact on the life course
of our Veteran population. My role is to match our donors’ passion for helping Veterans with key research
initiatives that will help those who have served.
At NCIRE, my colleagues and I honor those who support research that directly affects the lives of Veterans.
From where we stand, that opportunity to help – indeed that duty – is what makes today “the best of
times” to do something good for Veterans by supporting research.
Robin L. Morjikian
Director of Development
NCIRE Report
2008 and 2009
page 33
Leading Through
Generosity
Our Donors
and Supporters
page 34
NCIRE Report
2008 and 2009
We appreciate the thoughtfulness and generosity of the many
individuals, foundations, and corporations who provide support
to NCIRE – the Veterans Health Research Institute.
Individual Donors
Anonymous
Marc Abrahams
Ira A. Alderson, Jr.
Robin Allgren, MD
Taryn Altman
Myrna and Stuart Aronoff
Anne Baele
Cedric and Dorothy Bainton, MD
Francie and Marc Bala
Lenore Bartz
Ernest A. Bates, MD
Arthur Berman, MD
Joane Berry
Angela Bianchi
Elizabeth and Daniel Bikle, MD, PhD
Renee Binder, MD
John E. Bitoff, Rear Admiral
US Navy (Ret.)
Ralph and Elayne Blair
Candyce and Leonard Blanchard
Lydia Blednyh
Gayle and Michael Blum
Linda Blum
Lilly Bourguignon, PhD
James Broderick
James K. Brown, MD
Justin Brown and Yleanna Garcia
Warren S. Browner, MD, MPH
Amer Budayr, MD
Martha D. Buffum, RN, DNSc., CS
Howard and Mickey Burns
Samantha Cabot
Harry and Judy Camp
Angela Cao
Joseph and Margaret Caramucci
Lawrence H. Carroll, MBA
George Caughey, MD
Ralph and Diana Cavalieri
Russ Cerminaro
Wenhan Chang, PhD
Steven W. Cheung, MD
Maggie and Eric Chow, MD, PhD
Mary-Margaret Chren, MD
and Seth Landefeld, MD
Mark P. Christiansen, MD
Orlo H. Clark, MD
Joan C. and S. Thomas
Cleveland, PhD, MBA, CPA
Fred E. Cohen, MD, PhD
Neal H. Cohen, MD, MPH, MS Gerard Choucroun
NCIRE Report
2008 and 2009
Kenneth Covinsky, MD, MPH
Vicki Cox
Richard Cramer
Florence Cruz
Sheila M. Cullen
David I. Daikh, MD, PhD
Rebecca and Eric Dane
Larraine M. Decker
Eleanor B. Delventhal
Betty and Bernard Diaz
David and Helen Dichek
Eileen Dickson
Lisa DeGisi-Glassner
Diane Dillon
Susan and Donald Dugdale
Quan-Yang Duh, MD
Gitty Duncan
Shirley Eager
Peter M. Elias, MD
Robert Emblanc
Charles J. Epstein, MD
Lois B. Epstein, MD
Sandra Erickson, PhD
Amy Esposito
Cheryl and Al Falchi
Robert Farese, MD
Patricia and Kenneth Feingold, MD
Frank and Linda Ford
Daniel W. Foster, MD
Ann Fox
Ellie Fox
Irina Foxman
Friends and Family of Nisei Veterans
Idelle Frug
John Fuller and Sandra L. Huling
Janet Funk, MD and Jeffrey Jacobs
Margarita L. Garcia
David Gardner, MD
Laurence A. Gavin, MD
Barbara George and The Honorable Ronald M. George
Diane George and
William H. Stephens
Barry Gertz
Laura L. and James G. Ghielmetti
Joan Gibson
Chris and Ed Gio
Lorraine Goepp
Jeanne and Alan Goldfien, MD
Lee Goldman, MD, MPH
Mrs. Ralph Goldsmith
Joseph L. Goldstein, MD
Gretchen Gooding, MD
Philip Gorden, MD
Deborah Greenspan, DSC, BDS
Francis Greenspan, MD
John Greenspan, PhD, BDS,
FRCPath
Kayla and Gerold M. Grodsky, PhD
Andrew P. Grose, Brigadier General US Air Force (Ret.)
Judy B. Grossman
Melvin M. Grumbach, MD
Carl Grunfeld, MD, PhD
Sohee Ha
Fleurette Halpern
Esther and Richard Harris
Mary T. Hartfield and
Timothy L. Johansen
Mandi Heater
Ruth Heller
Deirdre Henderson
Pam and Juancho Herranz
Jerry Hill
Jeanne L. Himy
Catharine C. Holden
Mark Holm
Joi and Jimmy Horowitz
Frank Hsu, MD
Allison Huegel and Jim Sergi
Millie Hughes-Fulford, PhD
Valeria Huneeus, PhD
Marc Jaffe, MD
Maria and Juan Carlos Jaume, MD
Ken Jenkins
Cheryl Jennings
Deborah Jones and Brian Rood, MD
Mr. and Mrs. Robert L. Kahan
Vicki and Scott Kahn
Christina and Andrew Kalman
H. Benfer Kaltreider, MD
and Nancy Kaltreider, MD
Mercina and John Karam
Joel S. Karliner, MD
Laurent Katgely
The Honorable Marcus Kaufman
Margel F. Kaufman
John A. Kerner, MD
Paulette and David A. Kessler, MD
Darla J. Kilgannon
Abbas E. Kitabchi, MD, PhD
Vicki and Paul Klapper
Gregg S. Kleiner and
Cathlin H. Milligan, MD
Sara J. Knight, PhD
Zandra C. Krischer
page 35
Sara Merrick Lake
Harry W. Lampiris, MD
Heidi Lang and David Goepp
Jennifer H. Lavail, PhD
H. Jeffrey Lawrence, MD
Jill LeCount
Regina and Leon Levintow, MD
Jacob and Terye Levy
Devan Lew
Ken Lewis
Patricia G. Libien
James and Beverly Lill
Joannie Liss
Jane G. Logan
Frank Longo, MD, PhD
Eleanor J. Lopez
James P. Luby, MD
Anne Ludvik
Nina Lui
Mary and Alan MacLeod
Charles R. Marmar, MD
Jill Ann Marshall
Tex Martin
Stephen Massa, MD, PhD
Leigh Matthes
John Mayer
Dennis McGarry, MD
Linda Membreno, MD
Carl Mendel, MD
Ann Midler and Mark Goldsmith, MD
Walter L. Miller, MD
Marilyn Mindel
Pamela and Stephen Mittel
Alexander Monto, MD
Stephen and Mary Alice Morange
Alexandra Morgan
and H. Sanford Rudnick
Cindy and Craig Morris
Arthur Moser
Karen and Thomas Mulvaney
J. Michael Myatt, Major
General USMC (Ret)
Jack Nagan, JD
Thomas C. Neylan, MD
Ellen and Walter Newman
C. Diana Nicoll, MD, PhD, MPA
Robert Nissenson, PhD
Robert and Liz Obana
Robert Ockner, MD
Marge O’Halloran, MBA, MPH
Newton Ong
James and Nancy Osborn
Maxine Papadakis, MD
Carmen A. Peralta
Helen Pearl
Stephen Peary, JD, LLM
Mike Penn
Perloff Family Foundation
Patricia Perry and Stephen J. McPhee, MD
Frances S. Petrocelli
and Charles B. Wilson, MD
Pamela and Paul Petroff
Ann Haruki-Pinedo and Ed Pinedo
Jaime Pinedo
page 36
Robert Praetzel
Linda Pruzan
Deborah H. Pulliam
Lynn Pulliam, MS, PhD
Kin Kee Pun, MD, PhD
Basil Rapoport, MD
Mark B. Ratcliffe, MD
Norma Raymond
Martha Rice
Evan Richardson
Susan and Jesse Roth, MD
Carole Rubinger
James Ryan
David Saloner, PhD
Rajabrata Sarkar, MD. PhD
Morris Schambelan, MD
Marcia and Stephen Schneider
Paula and Frank Schultz
William Seaman, MD and
Maxine A. Papadakis, MD
Donald W. Seldin, MD
John Severinghaus, MD
Dana and Gary Shapiro
Ritu Sharma
Allen C. Shepard, Jr.
Judy and Mark Shigenaga
Dolores Shoback, MD
Kendrick Shunk, MD
Paul C. Simpson, Jr., MD
Eleanor Siperstein, PhD
Sean Sinatra
Lenore R. and Marvin H. Sleisenger, MD
Lloyd H. Smith, Jr., MD
Steven Snyder, MD
Judy and Norman Sobel
Paul Srere, PhD
Joyce and Peter Stacpoole, PhD, MD
Janet and Alan G. Stanford
Regina Stiefel and Robert Klein, MD
Gene Stollerman, MD
Suzanne Stolowitz
Suzy and Ron Stolowitz
Bernard Stone, MD
Gordon Strewler, MD
Paul Sullam, MD
Rita and Lawrence Susnow
Raymond A. Swanson, MD
Nick Swisher
Kiyo Takahashi
Alvin Taurog, PhD
L.M. Tierney, Jr., MD
Millicent Tompkins
David Torres
Linda Trozzolino, PhD
Connie Trump
Roger H. Unger, MD
Mary Letty Upton
Craig Van Dyke, MD
Barbara Verby
Maria and Riccardo Vigneri, MD
Paul A. Volberding, MD
Louise C. Walter, MD
Michael W. Weiner, MD
Minott Wessinger
Barbara F. West
Mary A. Whooley, MD
Deborah A. Widener
Suzanne Will, JD
Barbara Willenborg
Jean D. Wilson, MD
David and Helen Wofsy, MD
Major Theodore L. Wong
Ladonna Wood and Matthew Ashby
Teresa L. Wright, MD and Frederick Dorey
Kristine Yaffe, MD
Keith R. Yamamoto, PhD
Jan Yanehiro
Judy Yee, MD
T.S. Benedict Yen, MD, PhD
Midori Yenari, MD
Janet Yokoyama
Marie Zec
Morris Ziff, MD, PhD
Barry Zito
Frank Zitzelsberger
Lora and Douglas Zlock, MD
Corporate Donors
ABC7-KGO-TV/DT
ABD Insurance and Financial Services
ABIM Foundation
Abiomed, Inc.
ASBMR
Acusphere, Inc
Allheart Uniforms
American Association of
Clinical Endocrinologists
American Board of Certification
for Gastroenterology Nurses
American College of Endocrinology
Amgen Health Care Institute
Angiotech Pharmaceuticals
Another Planet Entertainment, LLC
Aqua Restaurant
Arnowitz-Hurn
AstraZeneca
BAE Systems
Baltimore Research and Education
Foundation
Bank of America
Basic Research, LLC
Bay Medical Research Foundation, Inc.
Biosite Incorporated
Blood Systems Research Institute
Boehringer Mannheim GmbH
Boulevard Restaurant
Bracco Diagnostics, Inc.
Bristol-Myers Squibb Company
Burson-Marsteller
bushi tei Restaurant
CC Myers, Inc.
California College of the Arts
California Dried Plum Board
California Walnut Commission
The Office of the Chancellor, UCSF
Chapeau! Restaurant
NCIRE Report
2008 and 2009
The Chatham Institute, LLC
Clare Cavanaugh Medical-Surgical
Nursing Consortium
Covance Research Products, Inc.
Duke Clinical Research Institute
Department of Dermatology,
School of Medicine, UCSF
Department of Pathology,
School of Medicine, UCSF
Department of Radiology,
School of Medicine, UCSF
Department of Surgery,
School of Medicine, UCSF
Department of Urology,
School of Medicine, UCSF
Designer Consigner
Discount Fabrics
East Bay Blue Star Moms
EcoNugenics, Inc.
Embryon
The Endocrine Society
Expanscience Laboratories
F. Hoffmann-La Roche Ltd.
Fashion Institute of Design
& Merchandising
Fender Musical Instruments Corp.
Ferring Research Institute, Inc.
Fleur de Lys Restaurant
Forest Laboratories, Inc.
FoxHollow Technologies, Inc.
Garibaldi’s Restaurant
Gilead Sciences
GlaxoSmithKline
Goodbyes
Gregangelo & Velocity Circus Troupe
Hesperion US, Inc.
The Holbrooke Hotel
ICON Clinical Research, Inc.
Idenix Pharmaceuticals, Inc.
Innovative Technologies, Inc.
Institute for the Study of Aging, Inc.
Integrated Therapeutics Corp.
Intermune, Inc
International Specialty Products
ISP Technologies, Inc.
Joannie Liss Events
Kerner Cancer Research
and Education Fund
KPMG LLP
KRL Sales LLC
K.W.C. Complex
Laboratory Skin Care, Inc.
Life Uniform
Lightning Direct, Inc.
Live Nation
Mannequin Madness
The McKenzie River Corporation
McNeil Consumer Healthcare
Medical Surgical Nursing Conference
Medical-Surgical Nursing Consortium
Merck & Co. Inc.
Myogen, Inc.
Myth Restaurant
NeoPharm Co., Ltd.
Novartis Pharma. Inc,
Novo Nordisk Pharmaceuticals, Inc
The Oakland A’s
Office Team Health Care Group
OraSure Techonologies
Orthopaedic Research and
Education Foundation
Partners Healthcare
PEAK Surgical, Inc.
Pfizer, Inc.
Pfizer Pharmaceuticals Group
Point Biomedical
Proctor & Gamble
Pharmaceuticals, Inc.
Prostate Cancer Foundation
The Queen Anne Hotel
Renaissance Corp.
Revascular Therapeutics, Inc.
Roche Laboratories, Inc.
Salt House Restaurant
The San Francisco Giants
Santa Clara Valley Medical Center
Saxon-Hamilton
Schering Corporation
Schering Plough Research Institute
“Scrubs” Television Show
Seperex Nutritionals LTD
Shiseido Research Center
Siemens Medical Solutions USA, Inc.
Siena Restaurant
Singing Blue Stars
Smith and Nephew
South Bay Blue Star Moms
Spectrum Pharmaceuticals, Inc.
Stanford University
The Standard
Strikeouts for Troops
Symrise GmbH & Co., KG.
Theratechnologies, Inc.
Thomas J. Stephens & Associates, Inc.
Tibotec Pharmaceuticals Ltd.
Town Hall Restaurant
Union Bank of California
University Hospital
Hamburg-Eppendorf
University of California San Francisco
University of San Diego
Valeant Pharmaceuticals
Velocimed, Inc.
Velvet da Vinci
Vertex Pharmaceuticals
Wells Fargo Bank
Whyte Hirschboeck Dudek
Government Affairs, LLC
Wright Medical Technology
In Memory of
Edwin B. Boldrey, MD
Grant Gauger, MD
Hiroshi Haruki
Ann Haruki-Pinedo
Trinidad Gal-lang Miguel
Judith Miguel Yoro
Miguel-Yoro Families
John Morgan
Friends of Diana Nicoll
Andrea Ibarra
C. Diana Nicoll, MD, PhD, MPA
Lynn Pulliam MS, PhD
John G. Yee
Kenneth A. and Elaine S. Chew and Family
George Chin and Jennie Fong Chin
Wayman and Holly Ching
Elvira L. Fong and Debra F. Borthne
Robert Ho
Wayland Ho
Raymond and Fair Ho-Fung
Peggy K. Imai
Jeffrey R. Kawaguchi
Tracey M. Kinahan
Lucille Kong
Alvin and Victoria Lee
Bernice G. Lee
Kate McCormick
Wahly Quan
Collin P. Quock and Betty Y. Quock
Charles and Joan Sung
Veterans of Foreign Wars,
Chinatown Post 4618
Andrew and Deborah Vollmer
Ronald and Marian Won
David Wong and Marilyn J. Wong
Grace Yee and Family
Sondra Sen Yee
In Honor of
Gayle Blum
David S. Pottruck and
Emily Pottruck
Joannie Liss
Shirley and Ben Eisler
Walter Newman
Frances S. Petrocelli and
Charles B. Wilson, MD
Frances S. Petrocelli
Dagmar and Ray Dolby
Every effort has been made to provide an accurate listing of donors. In case of an inadvertent error or omission, please call 415.750.6954, ext 4545.
NCIRE Report
2008 and 2009
page 37
From the Executive Director
In the course of my work as
Executive Director, I often
encounter some variant of the
question, “What is NCIRE?” In
one sense, the answer is easy:
NCIRE is the nonprofit institute
that administers medical research
at the San Francisco VA Medical
Center. But in a more profound
way, this response is woefully
inadequate, and not at all descriptive of who we really are and
what we actually do. It leaves out
the commitment to scientific truth
that drives our research enterprise.
It disregards our shared dedication to the Veterans we serve. And it ignores our unique
strength: research collaboration.
When I describe NCIRE as the “leading” or “best”
research institute devoted to Veterans health, I am
not simply referring to our position as the largest
VA-associated nonprofit in the nation, with the largest
research portfolio. What I mean is that our model of
cross-disciplinary and cross-institutional collaboration is
simply the best way to go about solving the questions
that will lead to improved health for Veterans, men
and women now in uniform, and the general public.
Organizationally, NCIRE consists of several hundred
people in offices and laboratories; highly talented and
extremely hard-working people, to be sure, but seemingly
not enough to make a national impact. In reality, thanks
to our collaborative research enterprise, NCIRE represents
the distilled wisdom, experience, and perseverance of
many thousands of physicians, clinicians, researchers,
laboratory workers, and military experts from the
Department of Veterans Affairs, the University of
California, San Francisco, and the Department of Defense
and its associated service branches. NCIRE is in the
page 38
fortunate position of being able to
channel this collective brilliance and
direct it where it is most needed.
In addition, we actively encourage
experts from widely separate fields
— immunology and psychiatry, or cell
signaling and orthopedic surgery —
to work together on new solutions.
As a result, we are able to deliver
innovations that result in the best
health care for our Veterans, while
retaining the flexibility and nimbleness
that go with our compact size.
The energy, initiative, and fresh ideas
contributed by our collaborative culture
has another benefit: it keeps us from
institutional complacency. Our collaborators drive us to
constantly challenge ourselves.
There are about 23 million Veterans — a population that
on the one hand is aging and on the other is expanding
every day as young Veterans of Iraq and Afghanistan
return home. It is the most diverse group of Veterans in
history, with the most diverse needs. In this environment,
I am confident that our collaborative model will serve us
well as we bring creative approaches to challenges both
new and old. For NCIRE, as for those who serve
our country, diversity means strength.
On a closing note, the NCIRE community lost a
paradigm of intellectual strength and diversity: former
Board of Directors member T.S. Benedict (Ben) Yen, MD,
PhD. We are deeply saddened by his passing, but take
inspiration from his example.
Robert E. Obana
NCIRE Report
2008 and 2009
energy, initiative,
“ The
and fresh ideas contributed
by our collaborators drive
us to constantly challenge
ourselves. Their examples
inspire us every day on
behalf of the Veterans
we serve.
“
– Robert E. Obana
NCIRE Report
2008 and 2009
page 39
From the Chief Financial Officer
Reflecting not only the important
research developments and collaborations which have come about over
the past years, this annual report consolidates the presentation of financial
activities for NCIRE’s last two fiscal
years. This not only provides for a
comparison of the results of separate
fiscal years but highlights those fluctuations in levels of research activity
and associated expenditures which
require our continuing diligence and responsiveness.
The complexities of recovery of NCIRE’s indirect costs
through the federal process will continue to highlight
the need to expand and diversify our sources of funds.
NCIRE’s indirect cost rate is based on estimated future
indirect costs as a function of estimated direct costs
of sponsored research activities. Negotiations with
the Department of Health and Human Services,
NCIRE’s cognizant agency, resulted in a provisional
rate of 57.6% for fiscal year 2007 and 55% for 2008
and 2009. If actual costs in a fiscal year are lower
than those estimated, NCIRE is required to make a
downward adjustment to its future draw of federal
funds in order to appropriately reflect actual indirect
costs for the period.
FY 2009 – SOURCES OF FUNDS
n Federal grant funding n Foundation and other grants n Clinical research revenue
n Other income and interest n Contributions and other
page 40
92%
3.8%
3%
.8%
.4%
The calculation of actual indirect costs for
fiscal 2007 and 2008 revised the final rates
for those years and resulted in a payable to
the federal government which is included in
the September 30, 2009 Balance Sheet.
During fiscal 2008 and 2009, 334 proposals
were submitted by NCIRE researchers,
representing applications for over $351
Million of new and continuing direct and
subcontracted federal and private foundation
support. As a result of those two years of submissions, total grant dollars of more than $88.4 Million
have been awarded to NCIRE researchers. Additionally, NCIRE administered research activities saw a
significant increase late in 2009 with the award of
17 new grants totaling over $30.6 Million in new
federal stimulus funding. NCIRE is proud to be one
of the largest single recipients of stimulus funding
for biomedical research.
Stephen Morange
FY 2009 – USES OF FUNDS
n Direct Research Program n Management and General
n Research Support
n Development
NCIRE Report
85%
9%
5%
1%
2008 and 2009
Financial Summary
Year ending September 30, 2009
ASSETS
Year ending September 30, 2008
ASSETS
Cash and cash equivalents
Receivables
Prepaid expenses and other assets
Property, Plant, and Equipment – Net
$7,665,502 5,808,060
169,534 3,839,336 Total $17,482,432 LIABILITIES AND NET ASSETS Cash and cash equivalents
Receivables
Prepaid expenses and other assets
Property, Plant, and Equipment – Net
$6,584,612 8,200,119
182,081 4,231,515 Total $19,198,327 LIABILITIES AND NET ASSETS Liabilities
Accounts payable
$4,043,055 Accrued expenses
2,507,188 Unearned revenue
5,913,483
Capital Lease
46,857
Total Liabilities
$12,510,583 Net Assets
Unrestricted
$4,493,696 Temporarily restricted
478,153 Total Net Assets $4,971,849 Total
Liabilities and Net Assets
$17,482,432
Liabilities
Accounts payable
$3,389,095 Accrued expenses
4,671,760 Unearned revenue
3,872,860 Total Liabilities
$11,933,715 Net Assets
Unrestricted
$6,791,211 Temporarily restricted
473,401 Total Net Assets
$7,264,612 Total Liabilities and Net Assets
$19,198,327
SOURCES AND USES OF FUNDS
SOURCES AND USES OF FUNDS
Sources of Funds
Federal grant funding
$39,711,843
Foundation and other grants
1,666,720
Contributions and other
174,116
Clinical research revenue
1,285,365
Other income and interest
348,447
Total Sources
$43,186,491 Uses of Funds
Direct research program
$38,604,267 Management and General
4,294,874
Research support
2,259,153
Development
248,529
Total Uses
$45,406,823
Sources of Funds
Federal grant funding
$44,725,187
Foundation and other grants
1,988,269
Contributions and other
369,313
Clinical research revenue
1,664,612
Other income and interest
723,126
Total Sources
$49,470,507 Uses of Funds
Direct research program
$43,532,910 Management and General
4,529,890
Research support
2,431,049
Development
178,343
Total Uses
$50,672,192
For a complete presentation of NCIRE’s financial condition, our audited Financial Statements and OMB Circular A-133 Reports,
which have been prepared with an unqualified opinion by Deloitte & Touche LLP, are available at www.ncire.org.
NCIRE Report
2008 and 2009
page 41
Board of Directors 2008
Raymond A. Swanson, MD
Chairman of the Board, NCIRE
Chief of Neurology and Rehabilitation Service, SFVAMC
Professor and Vice Chair of Neurology, UCSF
Leonard Blanchard
Business Executive and Retired Bank President and CEO
Lilly Bourguignon, PhD, MBA
Research Career Scientist, SFVAMC
Professor of Medicine, UCSF
Stephen Peary, JD, LLM
General Counsel
Firepond, Inc.
Lynn Pulliam, MS, PhD
ACOS for Research, SFVAMC
Chief of Microbiology, SFVAMC
Professor of Laboratory Medicine, UCSF
Mark Ratcliffe, MD
Chief of Surgical Service, SFVAMC
Professor and Vice Chair of Surgery, UCSF
George Caughey, MD
Chief of Pulmonary and Critical Care
Medicine Section, SFVAMC
Professor of Medicine,
Julius and Lillian Nadel Endowed Chair,
Investigator, Cardiovascular Research Institute, UCSF
S. Thomas Cleveland, PhD, MBA, CPA
President and CEO,
Management and Capital Group
Ezra Safdie, PE
Acting Medical Center Director, SFVAMC
Paul A. Volberding, MD
Chief of Medical Service, SFVAMC
Professor and Vice Chair of Medicine, UCSF
Co-Director, UCSF-GIVI Center for AIDS Research
Kristine Yaffe, MD
Chief of Geriatric Psychiatry, SFVAMC
Director of Memory Disorders Clinic, SFVAMC
Professor of Psychiatry, Neurology,
Epidemiology and Biostatistics, UCSF
Neal H. Cohen, MD, MPH, MS
Vice Dean, School of Medicine, UCSF
Professor of Anesthesia and
Perioperative Care and Medicine, UCSF
Director, International Medical Services, UCSF
Keith R. Yamamoto, PhD
Executive Vice Dean, School of Medicine, UCSF
Professor of Cellular and Molecular
Pharmacology, UCSF
H. Jeffrey Lawrence, MD
Senior Director of Genomics and Oncology,
Medical Affairs, Roche Molecular Systems
Clinical Professor of Medicine, UCSF
Charles Marmar, MD
ACOS and Chief of Mental Health Service, SFVAMC
Professor and Vice Chair of Psychiatry, UCSF
C. Diana Nicoll, MD, PhD, MPA
Chief of Staff, SFVAMC
Chief, Laboratory Service, SFVAMC
Associate Dean, School of Medicine, UCSF
Professor and Vice Chair of Laboratory Medicine, UCSF
Judy Yee, MD
Chief of Radiology Service, SFVAMC
Professor and Vice Chair of Radiology
and Biomedical Imaging, UCSF
T.S. Benedict Yen, MD, PhD
Chief of Pathology, SFVAMC
Professor and Vice Chair of Pathology, UCSF
Advisors to the Board
NCIRE Officers
SFVAMC Advisors
Walter S. Newman
Major, US Army (Ret.)
Community Leader
Robert Obana
Executive Director and CEO,
NCIRE
Judi A. Cheary
Director of Public Affairs,
SFVAMC
Marvin Sleisenger, MD
Staff Physician, SFVAMC
Professor of Medicine
Emeritus, UCSF
Stephen Morange
Chief Financial Officer, NCIRE
Suzanne Will, J.D.
VAMC Regional Counsel
Alan Stanford
Live Oak Consulting
page 42
NCIRE Report
2008 and 2009
Board of Directors 2009
Paul A. Volberding, MD
Chairman of the Board, NCIRE
Chief of Medical Service, SFVAMC
Professor and Vice Chair of Medicine, UCSF
Co-Director, UCSF-GIVI Center for AIDS Research
Judy Yee, MD
Vice Chair of the Board, NCIRE
Chief of Radiology Service, SFVAMC
Professor and Vice Chair of Radiology
and Biomedical Imaging, UCSF
John W. Bitoff, Rear Admiral, US Navy (Ret.)
Executive Director, Facilities
Maintenance and Operations,
San Francisco Unified School District
Leonard Blanchard
Business Executive and Retired
Bank President and CEO
Lawrence Carroll, MBA
Medical Center Director, SFVAMC
S. Thomas Cleveland, PhD, MBA, CPA
President and CEO,
Management and Capital Group
Neal H. Cohen, MD, MPH, MS
Vice Dean, School of Medicine, UCSF
Professor of Anesthesia and
Perioperative Care and Medicine, UCSF
Director, International Medical Services, UCSF
Charles Marmar, MD
ACOS and Chief of Mental Health Service, SFVAMC
Professor and Vice Chair of Psychiatry, UCSF
J. Michael Myatt, Major General, US Marine Corps (Ret.)
President and CEO
Marines’ Memorial Association
C. Diana Nicoll, MD, PhD, MPA
Chief of Staff, SFVAMC
Chief, Laboratory Service, SFVAMC
Associate Dean, School of Medicine, UCSF
Professor and Vice Chair of Laboratory Medicine, UCSF
Stephen Peary, JD, LLM
General Counsel
FPX, LLC
Lynn Pulliam, MS, PhD
ACOS for Research, SFVAMC
Chief of Microbiology, SFVAMC
Professor of Laboratory Medicine, UCSF
Mark Ratcliffe, MD
Chief of Surgical Service, SFVAMC
Professor and Vice Chair of Surgery, UCSF
Raymond A. Swanson, MD
Chief of Neurology and Rehabilitation Service, SFVAMC
Professor and Vice Chair of Neurology, UCSF
Keith R. Yamamoto, PhD
Executive Vice Dean, School of Medicine, UCSF
Professor of Cellular and Molecular Pharmacology, UCSF
Andrew P. Grose, Brigadier General
US Air Force (Ret.)
Retired Nonprofit Executive
Advisors to the Board
NCIRE Officers
SFVAMC Advisors
John A. Kerner, MD, US Army
Medical Corps (Ret.)
Professor of Obstetrics and
Gynecology Emeritus, UCSF
Robert Obana
Executive Director and CEO,
NCIRE
Judi A. Cheary
Director of Public Affairs,
SFVAMC
Stephen Morange
Chief Financial Officer, NCIRE
Suzanne Will, JD
VAMC Regional Counsel
Walter S. Newman
Major, US Army (Ret.)
Community Leader
Marvin Sleisenger, MD
Staff Physician, SFVAMC
Professor of Medicine
Emeritus, UCSF
Alan Stanford
Live Oak Consulting
NCIRE Report
2008 and 2009
page 43
In Memoriam
T.S. Benedict Yen, MD, PhD
The NCIRE community was saddened by the passing of Dr. T.S. Benedict
(Ben) Yen, MD, PhD, a former member of the NCIRE Board of Directors who
passed away on August 31, 2009 after a long and courageous fight with
myelodysplastic syndrome.
In addition to his role at NCIRE, Dr. Yen was Chief of Anatomic Pathology
at the San Francisco VA Medical Center and Professor and Vice Chair of the
Department of Pathology at UC San Francisco.
As a physician, scientist, administrator, and member of the academic
community, Ben Yen was a strong, creative, and tireless advocate for
Veterans health. He was a joy to work with, as the many patients, medical
colleagues, researchers, and students whose lives he touched over the
decades can attest. He will be greatly missed.
page 44
NCIRE Report
2008 and 2009
NCIRE Report
2008 and 2009
Photography / Roy Kaltschmidt
Writing / Steve Tokar
Design / Susan Dugdale
Editorial Staff / Linda Acton, Gerard Choucroun,
Stephen Morange, Robin Morjikian, Robert Obana
NCIRE – The Veterans Health Research Institute
Advancing Veterans Health Through Research
www.ncire.org
NCIRE Report
2008 and 2009