Approximately 120 of the top subject matter experts in the area of brain health and blast injuries convened in McLean, Virginia, Nov. 3 for the 5th International State-of-the-Science meeting.

Established in 2009, the now annual state-of-the-science meeting series, organized on behalf of the DOD Executive Agent for Medical Research for the Prevention, Mitigation and Treatment of Blast Injuries, maintains an explicit focus on the identification of knowledge gaps, with this year's meeting focusing on the linkage between blast-related trauma, neurodegeneration and chronic traumatic encephalopathy. Brought together this year by the overarching question: "does repeated blast-related injury trauma contribute to the development of chronic traumatic encephalopathy?" the participating subject matter experts volunteered their valuable time in hopes of gaining the knowledge necessary to shape medical research in an effort to deliver timely and effective prevention, mitigation and treatment strategies for our Service Members.

Michael Leggieri, director of the Department of Defense Blast Injury Research Program Coordinating Office and planning committee chair, welcomed attendees Tuesday morning during the opening plenary session; excited for how the next three days would guide current and future research and encourage continued collaboration.

"We need to understand what we don't understand," emphasized Leggieri. "We need to go back with the purpose of guiding current and future research; focusing limited resources in those areas where we need to focus."

Between the documented 300,000 U.S. Service Member diagnoses of traumatic brain injury since 2000, and the well-publicized parallel that exists within the civilian contact sports community regarding CTE, it is no surprise that considerable investments are now being made to establish multi-institutional and multi-disciplinary collaborative research programs focused on CTE.

The annual meeting series places great emphasis on collaboration and communication, strongly encouraging and expecting all attendees to engage with one another; to share their diverse backgrounds in an attempt to fill the identified knowledge gaps in support of our Service Members.

"The really key point is we can't solve blast injury problems with one community," said Leggieri. "We can't solve them just within the DOD; we've got to reach out beyond the DOD and take advantage of expertise wherever that expertise resides."

Leggieri then issued a charge to the participants, "I challenge you to think about what it is we can do immediately, or in the very near term, that will make a difference for Service Members; because that's really what this is all about. When we leave here today, the work is not done; we need your help, we need continuing help."

Dr. John F. Glenn, principal assistant for research and technology at the U.S. Army Medical Research and Materiel Command, followed Leggieri in the opening plenary session, delivering this year's keynote address with a focus on medical research and technology in relation to the chronic effects of blast-related traumatic brain injury specific to military service.

"The problems are tough, and they are unique," Glenn began, referring to the significant differences that exist within the military concerning blast-related traumatic brain injury versus that of the civilian sector. "We have to be responsive to the need," the ever-changing needs associated with combat in austere environments; with priorities varying based on where forces are fighting, how forces are fighting and who forces are fighting.

"This is a different force than those of the drafts of last century," continued Glenn, "this is an all-volunteer force, our Nation's sons and daughters who volunteered their service, and we owe it to those people who volunteered, and to the American public who provided them to us, to restore them to function and maintain their functions through their life; to try to mitigate the risks associated with military service. We are responsible for making sure that the 'players' are ready to play; that when they need to take a break, they take a break, and that they can recover rapidly and return to full function."

Glenn focused on the importance of maintaining the readiness of our Soldiers, our most valuable assets; closing with a reiteration of the importance of collaboration in maintaining that desired readiness.

"We really can't do anything alone," said Glenn. "This is a team sport and you are all representatives of the many teams that have come together in collaboration here to participate in this particular event. I think the discussions that are going to be had individually in the groups all need to come back and be captured to help shape the path for research for the future."

Following the keynote address, a series of topic presentations began that were intended to help set the stage for the meeting by identifying requirements and describing the scope of the problem. Topic presentations began with a presentation by Col. Sidney Hinds from the Defense and Veterans Brain Injury Center, who emphasized the importance of selfless collaboration; a presentation describing "annual blast overpressure exposure of mortar and artillery men" from Lt. Uade Olaghere DaSilva from the Naval Medical Research Center; and a presentation from Theresa Lattimore from the Office of the Assistant Secretary of Defense, Health Affairs, regarding future policy considerations. Additional topic presentations included perspectives from the Department of Veterans Affairs, the National Institutes of Health and the National Collegiate Athletic Association - Dr. Stuart Hoffman, Dr. Patrick Bellgowan and Dr. Steven Broglio, respectively.

Subsequent scientific presentations that took place over the next day and a half were broken up into 5 different topic-based sessions with specific focus on I) pathological characteristics of blast-induced TBI, II) risk factors and CTE, III) blast-induced neurodegenerative mechanisms, IV) neuroimaging and biomarkers, and V) treatment strategies. All scientific presentations were selected from submitted abstracts on issues concerning repeated blast-related trauma and CTE. Speakers during afternoon scientific sessions included Dr. William Stewart from the University of Glasgow/University of Pennsylvania; Dr. Daniel Perl from the Uniformed Services University of the Health Sciences, Center for Neuroscience and Regenerative Medicine; Dr. Robert Cantu from Boston University School of Medicine; Dr. Gregory Elder from the James J. Peters VA Medical Center; Dr. Peethambaran Arun from the USAMRMC's Walter Reed Army Institute of Research; and Dr. Alexander Lin from the Brigham and Women's Hospital, Harvard Medical School. All presentations- keynote, topic and scientific- were presided over by an expert panel, charged with asking questions and, in some cases, challenging assumptions. The panel is composed of a multi-disciplinary group of six scientists and clinicians, representing the DOD, academia and including two members from the international community. Panel members included Col. Jamie Grimes (panel chair), Dr. Stephen Ahlers, Dr. Kelley Brix, Dr. David Brody, Dr. William Stewart and Lt. Col. Avraham Yitzhak.

Together, the efforts of such a wide range of subject matter experts at this year's annual meeting will hopefully serve to achieve the ultimate objective of gaining the knowledge needed to identify the critical knowledge gaps and provide recommendations on the pivotal research required to improve the overall well-being and safety of our Service Members.