BACKGROUND/RATIONALE:
Over the past 15 years I have conducted population-based research on Veterans with complex comorbidity to improve the quality of their care and optimize health and functional outcomes. My research portfolio uses rich longitudinal data from VA and DoD and advanced methods that allow the ability to visualize and understand patterns of complex comorbidity and long-term outcomes associated with military injuries and deployment exposures. This work, described briefly below, is the foundation of my research career scientist award application.
My early work focused on quality of care and associated outcomes in older Veterans, but as the wars in Iraq and Afghanistan continued, the priority areas of VA and VA HSR&D changed, with an emphasis on post-deployment health and traumatic brain injury (TBI). Accordingly, I adapted my interests and skills to address those goals. Specifically, my focus turned to the impact of the signature injuries of those wars (TBI and posttraumatic stress disorder [PTSD]) and the impact of military experiences and exposures in this new generation of Veterans deployed in support of the wars.
My published work describes patterns of comorbidity (traumatic brain injury and its sequelae, mental health, pain, and chronic disease) early in the course of VA care for the population of Veterans deployed in support of wars in Iraq and Afghanistan (IAV), and functional status of those with different patterns of comorbidity. That work provided the foundation for current studies with my DoD colleagues to examine the long-term neurodegenerative, neurosensory, pain and mental health outcomes among IAV with mild TBI.
As the wars progressed it became apparent through our VA-DoD collaboration that the blast injuries associated with TBI and PTSD often included extremity injuries such as traumatic amputations, complex fractures, and vascular injuries. Other associated trauma that, while less common (e.g., burns, urogenital injury), also has profound impact on Veteran quality of life, mental health and physical function, and are often comorbid with TBI, PTSD, and other extremity injuries. Therefore, we focused our VA-DoD collaboration on these injuries that were a high priority for DoD at that time, and which have profound impact on VA resources including healthcare. The aims of this research career scientist award are informed by and designed to address current goals outlined in the VA Strategic Plan 2014-2020 and VA HSR&D priority areas.

OBJECTIVE(S):
Aim 1: Build health services research that spans DoD-VA via integrated mentoring programs.

Aim 2: Develop predictive models that identify individuals at greatest risk for adverse outcomes using diverse data from the DoD and VA.

Aim 3: Contribute to national VA Service opportunities, especially those related to DoD-VA research [and clinical] collaboration. This aim also builds upon VA Strategic Plan Objective 2.1.

METHODS:
Aim 1 builds upon VA Strategic Plan Objective 2.1: Enhance VA's partnership with DoD. By conducting mentorship/training that unites DoD and VA clinicians and researchers we begin to improve mutual understanding between agencies and develop researchers who are able to span agency boundaries to address mutual goals.

Aim 2 addresses VA strategic plan Objective 1.1: Improve Veteran wellness and economic security and several HSR&D priority areas: a) Healthcare Informatics; b) Mental and Behavioral Health; c) Women's Health (focus on sub-populations in trauma/post-deployment health research). This Aim will use merged VA and DoD data and deep learning models to develop prognostic models to identify Veterans at risk for adverse outcomes including suicide, overdose, homelessness, justice involved veteran programs, and mortality.

For Aim 3, effort will be used to contribute to work groups that have as a goal, enhancement of DoD-VA collaboration, identification of Veterans at risk for adverse outcomes, and non-pharmacological treatment approaches in addition to tradition service such as Merit Review and promotion panels.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
A significant goal of the VA strategic plan is to strengthen VA-DoD collaboration and clinical care continuity. My RCS addresses this priority by focusing on training, research and service. For training I focus on the development of the next generation of scientists in culturally competent VA-DoD collaboration, scientific approaches using merged DoD-VA data, and service that merges VA and DoD. Research will incorporate trainees and DoD collaborators using longitudinal methods that will allow VA and DoD to identify patterns and outcomes previously impossible based on silos within VA and DoD. Service includes contributing to joint work groups and organizations such as the Defense and Veterans Brain Injury Centers.

Only by this joint work in training, research and service using culturally competent methods can we truly strengthen VA-DoD collaboration.

PUBLICATIONS:

Journal Articles

1. Pugh MJ, Haun JN, White PJ, Cochran G, Mohanty AF, McAndrew LM, Gordon AJ, Nelson RE, Vanneman ME, Naranjo DE, Benzinger RC, Jones AL, Kean J, Zickmund SL, Fagerlin A. Developing Evidence to Support Policy: Protocol for the StrAtegic PoLicy EvIdence-Based Evaluation CeNTer (SALIENT). JMIR research protocols. 2024 Sep 19; 13:e59830.
2. O'Neil ME, Cameron D, Krushnic D, Baker Robinson W, Hannon S, Clauss K, Cheney T, Cook L, Niederhausen M, Pugh MJ. Using harmonized FITBIR datasets to examine associations between TBI history and cognitive functioning. Applied neuropsychology. Adult. 2024 Sep 17; 1-9.
3. Stewart IJ, Howard JT, Amuan ME, Kennedy E, Balke JE, Poltavskiy E, Walker LE, Haigney M, Pugh MJ. Traumatic brain injury is associated with the subsequent risk of atrial fibrillation or atrial flutter. Heart Rhythm. 2024 Sep 13.
4. Bouldin ED, Brintz BJ, Hansen J, Rupper R, Brenner R, Intrator O, Kinosian B, Viny M, Dang S, Pugh MJ, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research Team. Trajectories and Transitions in Service Use Among Older Veterans at High Risk of Long-Term Institutional Care. Medical care. 2024 Oct 1; 62(10):650-659.
5. Kennedy E, Manhapra A, Miles SR, Martindale S, Rowland J, Mobasher H, Myers M, Panahi S, Walker WC, Pugh MJ. The Impact of Non-Pain Factors on Pain Interference Among U.S. Service Members and Veterans with Symptoms of Mild Traumatic Brain Injury. Journal of Neurotrauma. 2024 Jul 5.
6. Jak AJ, Merritt VC, Thomas ML, Witten C, Talbert L, Agyemang A, Pugh MJ. Sex differences in postconcussive symptom reporting in those with history of concussion: Findings from the federal interagency traumatic brain injury research (FITBIR) database. The Clinical Neuropsychologist. 2024 Aug 1; 38(6):1468-1480.
7. Roghani A, Wang CP, Henion A, Amuan M, Altalib H, LaFrance WC, Baca C, Van Cott A, Towne A, Kean J, Hinds SR, Kennedy E, Panahi S, Pugh MJ. Mortality among veterans with epilepsy: Temporal significance of traumatic brain injury exposure. Epilepsia. 2024 Aug 1; 65(8):2255-2269.
8. Kalvesmaki AF, Trevino AY, Charron E, Kroll-Desrosiers A, Peterson K, Pugh MJ. The Impact of Resilience on Employment Among Post-9/11 Veterans With and Without Military Sexual Trauma Exposure. Military medicine. 2024 Feb 27; 189(3-4):e493-e501.
9. Panahi S, Mayo J, Kennedy E, Christensen L, Kamineni S, Sagiraju HKR, Cooper T, Tate DF, Rupper R, Pugh MJ. Identifying clinical phenotypes of frontotemporal dementia in post-9/11 era veterans using natural language processing. Frontiers in neurology. 2024 Feb 15; 15:1270688.
10. Stromberg KM, Martindale SL, Walker WC, Ou Z, Pogoda TK, Miles SR, Dismuke-Greer CE, Carlson KF, Rowland JA, O'Neil ME, Pugh MJ. Mild traumatic brain injury, PTSD symptom severity, and behavioral dyscontrol: a LIMBIC-CENC study. Frontiers in neurology. 2024 Jan 11; 14:1286961.
11. Kennedy E, Ozmen M, Bouldin ED, Panahi S, Mobasher H, Troyanskaya M, Martindale SL, Merritt VC, O'Neil M, Sponheim SR, Remigio-Baker RA, Presson A, Swan AA, Werner JK, Greene TH, Wilde EA, Tate DF, Walker WC, Pugh MJ. Phenotyping Depression After Mild Traumatic Brain Injury: Evaluating the Impact of Multiple Injury, Gender, and Injury Context. Journal of Neurotrauma. 2024 Apr 1; 41(7-8):924-933.
12. McGeary D, Swan AA, Kennedy E, Dismuke-Greer CE, McGeary C, Sico JJ, Amuan ME, Manhapra A, Bouldin ED, Watson P, Kenney K, Myers M, Werner JK, Mitchell JL, Carlson K, Delgado R, Esmaeili A, Pugh MJ. Chronic headaches after traumatic brain injury: Diagnostic complexity associated with increased cost. Neurorehabilitation. 2024 Jan 1; 55(3):303-317.
13. Henion AK, Wang CP, Amuan M, Altalib HH, Towne AR, Hinds SR, Baca C, LaFrance WC, Van Cott AC, Kean J, Roghani A, Kennedy E, Panahi S, Pugh MJV. Role of Deployment History on the Association Between Epilepsy and Traumatic Brain Injury in Post-9/11 Era US Veterans. Neurology. 2023 Dec 12; 101(24):e2571-e2584.
14. Howard JT, Stewart IJ, Amuan ME, Janak JC, Howard KJ, Pugh MJ. Trends in Suicide Rates Among Post-9/11 US Military Veterans With and Without Traumatic Brain Injury From 2006-2020. JAMA neurology. 2023 Oct 1; 80(10):1117-1119.
15. Pogoda TK, Adams RS, Carlson KF, Dismuke-Greer CE, Amuan M, Pugh MJ. Risk of Adverse Outcomes Among Veterans Who Screen Positive for Traumatic Brain Injury in the Veterans Health Administration But Do Not Complete a Comprehensive Evaluation: A LIMBIC-CENC Study. The Journal of head trauma rehabilitation. 2024 May 1; 39(3):171-182.
16. Panahi S, Kennedy E, Roghani A, VegaYon G, VanCott A, Gugger JJ, Raquel Lopez M, Jo Pugh M. Veteran perspectives of epilepsy care: Impact of Veteran satisfaction, knowledge, and proactivity. Epilepsy & Behavior : E&B. 2023 Jul 1; 144:109218.
17. Roghani A, Bouldin E, Mobasher H, Kalvesmaki A, Panahi S, Henion A, VanCott A, Raquel Lopez M, Jo Pugh M. COVID-19 pandemic experiences among people with epilepsy: Effect on symptoms of co-occurring health conditions and fear of seizure. Epilepsy & Behavior : E&B. 2023 Jul 1; 144:109206.
18. Viny M, Trevino AY, Bouldin ED, Kalvesmaki A, Roghani A, Pugh MJ. Caregiver burden and COVID-19: How epilepsy caregivers experienced the pandemic. Epilepsy & Behavior : E&B. 2023 Apr 1; 141:109151.
19. Kalvesmaki AF, Gonzales E, George RT, Nguyen H, Pugh MJ. Post-9/11 veterans perceptions of the pandemic: Areas of greatest impact on health and well-being. PEC innovation. 2022 Dec 1; 1:100096.
20. Stewart IJ, Amuan ME, Wang CP, Kennedy E, Kenney K, Werner JK, Carlson KF, Tate DF, Pogoda TK, Dismuke-Greer CE, Wright WS, Wilde EA, Pugh MJ. Association Between Traumatic Brain Injury and Subsequent Cardiovascular Disease Among Post-9/11-Era Veterans. JAMA neurology. 2022 Nov 1; 79(11):1122-1129.
21. Rivera JC, Amuan ME, Pugh MJ. Musculoskeletal Conditions and Secondary Cardiovascular Morbidity Increase Veterans' Rehabilitation and Orthopaedic Service Utilization. Cureus. 2022 Jul 1; 14(7):e27139.
22. Song K, Brintz BJ, Wang CP, McGeary DD, McGeary CA, Potter JS, Jaramillo CA, Eapen BC, Pugh MJ. Complex pain phenotypes: Suicidal ideation and attempt through latent multimorbidity. PLoS ONE. 2022 Apr 29; 17(4):e0267844.
23. Gugger JJ, Kennedy E, Panahi S, Tate DF, Roghani A, Van Cott AC, Lopez MR, Altalib H, Diaz-Arrastia R, Pugh MJ. Multimodal Quality of Life Assessment in Post-9/11 Veterans With Epilepsy: Impact of Drug Resistance, Traumatic Brain Injury, and Comorbidity. Neurology. 2022 Apr 26; 98(17):e1761-e1770.
24. Kennedy E, Panahi S, Stewart IJ, Tate DF, Wilde EA, Kenney K, Werner JK, Gill J, Diaz-Arrastia R, Amuan M, Van Cott AC, Pugh MJ. Traumatic Brain Injury and Early Onset Dementia in Post 9-11 Veterans. Brain injury. 2022 Apr 16; 36(5):620-627.
25. Howard JT, Stewart IJ, Amuan M, Janak JC, Pugh MJ. Association of Traumatic Brain Injury With Mortality Among Military Veterans Serving After September 11, 2001. JAMA Network Open. 2022 Feb 1; 5(2):e2148150.
26. Longoria AJ, Horton A, Swan AA, Kalvesmaki A, Pugh MJ. Effect of multimorbidity and psychosocial factors on posttraumatic stress symptoms among post-9/11 veterans. Rehabilitation Psychology. 2022 Feb 1; 67(1):69-78.
27. Frech TM, Murtaugh MA, Amuan M, Pugh MJ. The frequency of Raynaud's phenomenon, very early diagnosis of systemic sclerosis, and systemic sclerosis in a large Veteran Health Administration database. BMC rheumatology. 2021 Oct 15; 5(1):42.
28. Pugh MJ, Kennedy E, Gugger JJ, Mayo J, Tate D, Swan A, Kean J, Altalib H, Gowda S, Towne A, Hinds S, Van Cott A, Lopez MR, Jaramillo CA, Eapen BC, McCafferty RR, Salinsky M, Cramer J, McMillan KK, Kalvesmaki A, Diaz-Arrastia R, MINUTE Study Group. The Military Injuries: Understanding Post-Traumatic Epilepsy Study: Understanding Relationships among Lifetime Traumatic Brain Injury History, Epilepsy, and Quality of Life. Journal of Neurotrauma. 2021 Oct 15; 38(20):2841-2850.
29. Altalib H, McMillan KK, Padilla S, Pugh MJ. Epilepsy quality performance in a national sample of neurologists and primary care providers: Characterizing trends in acute and chronic care management. Epilepsy & Behavior : E&B. 2021 Oct 1; 123:108218.
30. Blakey SM, Halverson TF, Evans MK, Patel TA, Hair LP, Meyer EC, DeBeer BB, Beckham JC, Pugh MJ, Calhoun PS, Kimbrel NA. Experiential avoidance is associated with medical and mental health diagnoses in a national sample of deployed Gulf War veterans. Journal of psychiatric research. 2021 Oct 1; 142:17-24.
31. Delgado RE, Peacock K, Wang CP, Pugh MJ. Phenotypes of caregiver distress in military and veteran caregivers: Suicidal ideation associations. PLoS ONE. 2021 Jun 11; 16(6):e0253207.
32. Pugh MJ, Kennedy E, Prager EM, Humpherys J, Dams-O'Connor K, Hack D, McCafferty MK, Wolfe J, Yaffe K, McCrea M, Ferguson AR, Lancashire L, Ghajar J, Lumba-Brown A. Phenotyping the Spectrum of Traumatic Brain Injury: A Review and Pathway to Standardization. Journal of Neurotrauma. 2021 Dec 1; 38(23):3222-3234.
33. Bouldin ED, Swan AA, Norman RS, Tate DF, Tumminello C, Amuan ME, Eapen BC, Wang CP, Trevino A, Pugh MJ. Health Phenotypes and Neurobehavioral Symptom Severity Among Post-9/11 Veterans With Mild Traumatic Brain Injury: A Chronic Effects of Neurotrauma Consortium Study. The Journal of head trauma rehabilitation. 2021 Jan 1; 36(1):10-19.
34. Mansi IA, English JL, Alvarez CA, Mortensen EM, Pugh MJ. Statins in survivors of traumatic brain injury: a propensity score-matched analysis. Brain injury. 2020 Aug 23; 34(10):1367-1374.
35. Swan AA, Nelson JT, Pogoda TK, Akin FW, Riska KM, Hall CD, Amuan ME, Yaffe K, Pugh MJ, Chronic Effects of Neurotrauma Consortium. Association of Traumatic Brain Injury With Vestibular Dysfunction and Dizziness in Post-9/11 Veterans. The Journal of head trauma rehabilitation. 2020 May 1; 35(3):E253-E265.
36. Reyes-Miranda A, Chan S, Gowda S, Kean J, Cramer JA, Pugh MJ. Assessing the personal impact of epilepsy in a population-based cohort of Veterans. Epilepsy & Behavior : E&B. 2020 May 1; 106:107047.
37. Pugh MJ, Swan AA, Amuan ME, Eapen BC, Jaramillo CA, Delgado R, Tate DF, Yaffe K, Wang CP. Deployment, suicide, and overdose among comorbidity phenotypes following mild traumatic brain injury: A retrospective cohort study from the Chronic Effects of Neurotrauma Consortium. PLoS ONE. 2019 Sep 20; 14(9):e0222674.
38. Altalib HH, Lanham HJ, McMillan KK, Habeeb M, Fenton B, Cheung KH, Pugh MJ. Measuring coordination of epilepsy care: A mixed methods evaluation of social network analysis versus relational coordination. Epilepsy & Behavior : E&B. 2019 Aug 1; 97:197-205.
39. Nnamani NS, Pugh MJ, Amuan ME, Eapen BC, Hudak SJ, Liss MA, Orman JA. Outcomes of Genitourinary Injury in U.S. Iraq and Afghanistan War Veterans Receiving Care from the Veterans Health Administration. Military medicine. 2019 Mar 1; 184(3-4):e297-e301.
40. Dismuke-Greer CE, Gebregziabher M, Ritchwood T, Pugh MJ, Walker RJ, Uchendu US, Egede LE. Geographic Disparities in Mortality Risk Within a Racially Diverse Sample of U.S. Veterans with Traumatic Brain Injury. Health equity. 2018 Oct 25; 2(1):304-312.
41. Finley EP, Noël PH, Lee S, Haro E, Garcia H, Rosen C, Bernardy N, Pugh MJ, Pugh JA. Psychotherapy practices for veterans with PTSD among community-based providers in Texas. Psychological Services. 2018 Nov 1; 15(4):442-452.

DRA: Health Systems Science, Brain and Spinal Cord Injuries and Disorders
DRE: none
Keywords: none
MeSH Terms: none