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tv   Medical Technology for Veterans  CSPAN  May 22, 2018 3:53pm-5:52pm EDT

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that we may succeed in life. >> and i think the most important issue anywhere, and especially in the state of nevada and in our northern nevada region is two things. one, affordable housing, whatever affordable housing may mean and number two is workforce, because we're growing so rapidly that we just don't have enough people to build and to fill the jobs. >> biggest issue going on in our state is poverty. we need to add more jobs so that these people can work and make more money for their families and have a good life. >> the most important issue i would say is keeping our environment clean and safe for all kinds of organisms and species. >> voices from the states. part of c-span's 50 capitals tour and our stop in carson city, nevada. >> next, two house science, space and science subcommittees
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lock at new and emerging medical technologies designed to help veterans. members heard from the founders of the veteran advocacy group soldier strong and project hero and the chief scientists with the energy department's national nuclear security administration. this is about two hours. >> the committee will come to order. without objection, the chair is authorized to declare recesses of the committee at any time. good morning, and welcome to today's hearing entitled empowering u.s. veterans through technology. i now recognize myself for five minutes for an opening statement. the impetus for today's hearing goes back a year or so to may 2017 when i first met one of our witnesses john warden at a ride to recovery event for veterans in my district in manassas, virginia. i heard firsthand from john about the hero track system and
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the wearable health monitoring device with software designed to help veterans suffering from post-traumatic stress disorder. i was fascinated by this technology and the research going on with it and its potential to help our veterans. in my district, so many others are home to so much research and technology companies on the forefront of tej logical innovation, so i am particularly pleased also with the large veterans population to chair this hearing today to profile technologies to help our ked kated veterans who have served our nation. by shining a spotlight on cutting-edge technologies designed to help combat injured veterans the science committee can help spread the word about the wonderful efforts in which our witnesses are engaged and their impact on the lives of our brave men and women whose sacrifice deserve our care attention, and i also look forward to hearing more about the joint department of energy and department of veterans affairs collaboration that will
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leverage the higher learning and machine cape abilities to analyze health records of more than 20 million veterans maintained by the va. the goal of this partnership is to arm the va with data it can use potentially use health care offered to veterans by providing new treatments and preventive strategies. this win-win enterprise could improve health care for veterans and simultaneously providing the department of energy with unique insight and information to support development of next generation technologies. we also have representing soldiers strong mr. meek who will describe the soldier suit in its efforts to purchase and donate this transformation of robotic exskelton device. amazingly it can help paralyzed veterans the ability to once again stand, walk and hug a loved one eye to eye, appoint eloquently emphasize in mismccullum's testimony and miss
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mccullum, probably more familiar being on the other side of being an interviewer of us is one of the witnesses today, and we really appreciate her being here and her work for veterans. now, i mentioned john warden who founded project hero ten years ago to help veterans and first responders affected by injuries including traumatic brain injury and ptsd through the program such as ride to recovery. while the success of the program and the therapeutic benefits of cycling which is one of the main activities that he's engaged in with the ride to recovery obviously have benefited thousands of veterans. but i also appreciate the opportunity to highlight today how the hero track monitoring system can benefit veterans with ptsd, including how it can help generate more data and best practices to improve the lives of veterans, and since we did get to get together with mr. warden with the veterans roundtable in my district yesterday i can just tell you and i know this will apply to
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all of the others testifying today how excited our veterans services organizations were to hear about these new technologies and how we can partner with them. for example, we have a lot of equine therapy groups that service veterans in my district and they understood how when we can get more data here they can now demonstrate how impactful the equine therapy is for our veterans. they know that instinctively, but now we have a way of demonstrating that through data. and i also welcome dr. major who will describe his very important research on motor control related to veterans and service members, prosthetics and orthotics and the underlying factors of falls. an added important benefit of today's hearing is that the technologies, research and federal programs we'll hear about have promising implications for the population at large. i thank all our witnesses for joining us today and for your service and efforts to help improve the lives of our nation's veterans.
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i now recognize the ranking member of research and technology subcommittee, the gentleman from illinois, mr. lipsky for his opening statement. >> thank you, chairwoman comstock and thanks for holding today's hearing. i was just looking up honor ride on moy ipad here and seeing when the one in chicago is. it's good to have you. we're only six days away from memorial day and it's the busiest day for me for public events in my district because of the importance moy constituents and i place on honoring the men and women who serve in our armed forces. i'm sure my colleagues on both side of the aisle and the subcommittee present here this morning agree that supporting technologies improved lives of these men and women should be a high priority. unfortunately, many face an uphill battle to overcome the physical and mental toll of war once they return home. that's why this hearing is so
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important. i want to thank our witnesses for being here, to share with us their efforts to provide veterans with the latest technologies, to improve the quality of life for our veterans. almost 20 million u.s. veterans are living today and just under half are enrolled in the department of vet reason affairs healthcare system. the records generated from decades of care provide a trove of information that may lead to more accurate diagnosis and treatment of certain conditions and diseases. high-performance computing can help analyze this massive amount of data to make it useful for delivering better healthcare outcomes not only for veterans but also for the general population. the federal government has made strategic investments over the years to advance data analytics and data science research and development. i look forward to hearing from dr. kuznetsov about the progress
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of the data science initiative being conducted by the va and department of energy, some of which is taking place in my district at argan national laboratories leadership computing facility. i would also like to hear about the privacy and security measures the agencies are taking to protect our veterans' personal information. in addition the diseases and chronic conditions that va, doe collaboration will address, veterans who survive combat may have to adapt to civilian life with limited mobility due to it is injuries sustained in war. a number of federal efforts support research in related areas, including advanced robotics, prosthetics and full body exskelton suits. for example, the national science foundation funds work examining the interface of brain and machine for mind control of robotic prosthetics. the national institute of standards and technology has
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established an international committee to bring together public and prif sector stakeholders to define standards for wearable robotics. while the physical wounds of war can be seen, the mental scars are below the surface. combat and other traumatizing experience may result in long-term damage for veterans. homelessness and suicide may be manifestations of these wounds. 11% to 20% of veterans from the most recent combat operations suffer from post-traumatic stress disorder or ptsd. these figures are similar for gulf war veterans and, unfortunately, even greater 30% for vietnam veterans. i look forward to the witnesses' testimony about their efforts to provide it is and mental rehabilitation technologies to our deserving veterans who have already sacrificed so much for our nation. i also look forward to hearing
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the witnesses' ideas about what more the federal science agencies can be doing to accelerate the development of such technologies. thank you, madam chair. look forward to hearing the testimony, and i yield back. >> thank you, and i now recognize the chair of the committee, mr. smith. >> thank you chairwoman come stack for holding such an interesting and important hearing today. today's hearing will highlight some fascinating technologies and efforts that will empower veterans. the titan supercomputer at oak ridge national laboratory can process a quadrillion calculations per second. that's a number followed by 15 zeros. thanks to collaboration between the department of energy and the department of veterans affairs, this computer will be used to analyze health records of 24 million veterans to provide improved care. the partnership between the va and doe can transform the delivery of healthcare to our veterans as we use complex
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computer models to learn more about the causes and warning signs of various diseases. the va has identified three priority areas of focus for early delivery impacts. suicide prevention, prostate cancer and cardio vascular disease. by providing doe with access to a large-scale database the va will help the energy department develop next generation algorithms and modeling capability while ultimately providing the va with data it can use to improve veterans quality of life. one of the witnesses today, mr. john warden, is collaborating with the texas a & mr. university professor on a wearable device to help veterans suffering from post-traumatic stress disorder, and we welcome the assistant department of industrial and systems engineering at a&m. thank you and your team in texas for your hard work and efforts to support our veterans. i would also like to thank
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mr. chris meek and miss martha mccallum for their respective efforts on behalf of soldiers strong. in january soldier strong donated a robotic exoskelton to the you had ai l. fur my va hospital in san antonio which i represent. this donation will help the facility provide state of the art rehabilitative care to veterans. one of the benefits of hearing from the experts tail is that the phrase of their labor are not limited to help the veterans though they do that so well. they can be applied to people all over the country and the world who suffer from similar ailments and injuries. in addition to this hearing, the science committee passed legislation last november to help veterans overcome obstacles as they re-enter the workforce. hr-4323 the supporting veterans and s.t.e.m. career act was introduced by representative
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dunn. it passed the house in the senate and waits action in the senate to. me the subject of the hearing shows yet again how technology can meet the world's challenges, and we look forward to our witnesses' testimony today and finding more about how that technology can help not just veterans but as i said people around the world. thank you, madam chair, and i yield back. >> and i now recognize the ranking member, miss johnson. >> thank you very much, chairwoman comstock and ranking member lips memory pinsky to help improve the quality of life of our injured veterans. this is a topic close to my own heart. before i ran for political office i served as a chief psychiatry nurse as the va hospital in dallas where i actually helped to start that
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service. i saw up close the toll that serving in a combat zone can take on our men and women in uniform. i developed a deep appreciation for human fraility and strength alooking and i carried those lessons forward into my political career. i regularly meet with veterans in my district in dallas to learn about the challenges they face, re-entering civilian life and to discuss what the federal government can be doing better to help ease their transition. today there are about 20 million veterans in the u.s. advances in medical response and technology in the battlefield have meant that more veterans are surviving and returning home with traumatic injuries that meant certain death in earlier generations. the protracted conflicts in iraq and afghanistan resulted in many of our veterans serving multiple deployments in combat zone.
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even if they survive these deployments without any visible injuries, some almost certainly suffer in other ways. veterans experience mental health disorders, substance use disorders, post-traumatic stress and traumatic brain injury at a disproportionate reach compared to their civilian counterparts. 18 to 22 american veterans commit suicide daily. younger veterans are at the highest risk while an exact count is hard to come by, approximately 40,000 veterans today are homeless. these are statistics that should alarm us all. technology will not solve all of these challenges. i have a technology that can go a long way to aid veterans suffering from physical injuries and mental health discords. continued advancements in prosthetics and exoskelton will help improve the quality of life
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of veterans who have lost limbs. more accurate and wearable predictors of ptsd attacks will help veterans keep themselves and their loved ones safe and better understanding of the range of conditions that occur in the veterans population will help medical professionals and policy-makers alike develop more effective interventions. i look forward to hearing more about the technologies that today's witnesses are working on, and i look forward to a discussion of the role that our science agencies such as the science foundation and national institute of standards and technology can play in advancing these and other technologies to aid our u.s. veterans. our veterans deserve nothing less than our -- from our nation and our government than our full dedication to helping them repair the wounds of war that they suffered on our behalf. i thank you and yield back. >> thank you.
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and i'm now going to introduce our witnesses. before i do i did want to recogni recognize steve jordan of the northern virginia technology council who has worked for the veteran employments initiative which has been an initiative of our technology companies in northern virginia which is just done wonderful work with our veterans and i really appreciate having you here to hear about these great technologies and both public and private investment so thank you. our first witness today is dr. dmitry kuznetsov, chief scientist at the national nuclear security administration at the u.s. department of energy. prior to nasa he served as director of the office of research and development for national security and science and technology. dr. kuznetsov earned a bachelor of arts in physics and pure mathematics from the university
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of california-berkeley. he also holds had a masters of science in physics as well as a phd in theoretical nuclear physics both from princeton university. our second witness today is mr. christopher meek, founder and chairman of soldiers strong. soldier strong helps america's service men, women and veterans take their next steps forward by identifying and filling gaps in the traditional systems supporting veterans and the members of the original. originally called soldier socks, soldier strong stems from mr. meek's first project, organizing donations of socks and other supplies from communities and businesses. mr. meek holds a batch lover arts in economics and political science from syracuse university, and a masters of business administration in financial management from pace university in new york city. our third witness today is miss martha mccallum, advisory board member of soldier strong. she's here in that capacity today. of course, we also know her as a
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fox news anchor where she has highlighted numerous military achievements on her show, "the story with martha mccallum." miss mccullum's coverage has included the accomplishments and personal stories of the green berets, navy s.e.a.l.s and medal winners for extreme bravery in afghanistan. she earned her bachelor's degree in political science from st. lawrence university and also studied in the circle in the square theater school. mr. john worden, our fourth witness is president and founder of project hero. his work to improve suicide prevention and help veterans and first responders has earned him national recognition. he began his career as a cyclist, participating in three u.s. trials and earned a bronze medal in the 1989 u.s. national championships. mr. worden was also president and founder of the fitness challenge foundation which was the genesis of ride to recovery founded in 2008.
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mr. worden holds a bachelors of science in finance from california state university at northridge, and i did want to mention and someone just told me the vice president tweeted about the hearing this morning, i know, and when we first met you had started your ride to recovery at the vice president's house, so i guess he's watching to catch up on this, too, so i thank you again for joining us today. and our final witness is dr. matthew major research health scientist and assistant professor of physical medicine and reputation at northwestern university. dr. major's witness focuses on improving mobility and function of veterans with neurolage call and muss caw larskel toll pathology through rehabilitation technology and therapeutic intervention. he holds a bachelor of science and masters of science degrees in mechanical engineering from the university of illinois as urbana champagne as well as a phd in biomedical engineering
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from the university of southford manchester in the united kingdom so i now recognize dr. kuznetsov for his five minutes to present his testimony. >> thank you, chairman smith, ranking member johnson, chairwoman comstock, chairman wieber, ranking member lipinski and ranking member veasey and distinguished members on the research and technology and the subcommittee on energy, i thank you for taking up this morning issue and for the opportunity to address the members and share with the department of energy in collaboration with the department of veterans affairs is trying to do at the intersex of next generation artificial intelligence, supercomputing, u.s. innovation and veterans health. at the department of energy driven by where our missions are heading, we work at the forefront of technologies, and today we are embracing artificial intelligence this. coincides with diminishing
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returns from moore's law where squeezing the most out of 70 years of the supercomputing paradigm remains important. in post-moore's law era supports. a i. inspired architect tours to navigate an increasingly data-driven world. i believe that a cornerstone for progress will be how rapidly we embrace a next generation of ai-enabled predictive supercomputing tools. precision medicine data can accelerate this technology change by driving the development with likely the world's most complex data. this brings with it subject matter experts and unique opportunities to rethink many of our traditional approaches from post-moore's law hybrid architect tours to quantification to computer codes. our work with the va is underpinned by several opportunities for innovation that were captured in the 21st century kearse act, the cancer
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moon shot in 2016 and the national strategic computer initiative in 2015. more recently secretary perry's commitment to technology and the service of veterans as well as this administration's commitment to veterans issues has allowed the rethinking of traditional paradigms and facilitated novel approaches on how to solve complex problems. the va has a unique data set of medical records, whole gene yoems and imaging datas that's one of the most comprehensive in the dimensions of time, scale and breadth, and in many aspects this data set is considered to be the largest and most comprehensive in the world. both the va and the department of injuring are alert to the unique privacy and security sensitives of the veterans health data. today our artificial drive big data science initiative includes mvp champion and a complementary effort called active. last year in april va and doe
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scientists and physicians in leadership came together to develop technical road maps for driving hypocomputers in artificial intelligence while developing solutions for caring for our veterans. va priorities that were identified that could deliver early impackets were patient specific analysis for suicide prevention, helping doctors make decisions around prostate cancer and enhanced prediction and diagnose of cardio vascular disease. since then additional areas of interest from poly pharmacy to traumatic brain injury have surfaced. the fy-'19 budget request includes $27 million to support these initiatives. we recognized the critical role of the private sector in this effort. recently the va and doe held a meeting with technology startups focused on precision medicine to understand the direction of the technology and the commercial sector. as with the human genome prom or the exorescale initiative today
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partnerships with labs and academia and the private sector are important. a concerted effort here will lead to innovation tied to design and development of doe's next generation supercomputing that will merge big data, artificial intelligence and high-performance computing to. better healthcare, via our strategy for precision medicine, through super computing and artificial intelligence that could inform when and how to treat our veterans to improve outcomes and control costs, to better science, via a cadre of researchers and clinicians who specialize in healthcare with doe experts in big data, ai and high-performance computing, and to better government via interagency collaborations bringing to bear the full capabilities and expertise within public and private partnerships. thank you, and i look forward to answering your questions. >> thank you, and we now recognize mr. meek for his
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testimony. >> chairwoman come stack and ranking member lipinski, chairman wieber an ranking member johnson of the subcommittee on energy and members of both subcommittees, thanks for having me here today. on september 11th, 2001 i was running floor-treating operations for goldman sachs at ground zero in new york city. as i watched the first responders running into the carnage of that day i was resolved to do something to give back to those who served. i'm still a financial services executive and in the years since that day my passion project has become soldier strong which is a 501-c-3 charitable organization committed to improving the lives of our service men, women and veterans. i cherish the organization. soldiers strong works started with a request from a forward operating base in afghanistan to send bucik supplies like tube socks and baby wipes for our forward deployed troops. over the years we've assembled and sent over 75,000 pounds of
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supplies to 73 units in iraq and afghanistan. as the war has wound down we contemplated closing down until the board members asked if the troops we served had everything they needed to start life anew as veterans. in retrospect, one day in particular would bring this question into folk. april 44, 2011 was my daughter's 5th birthday. we celebrated with cake and ice cream without a care in the world. 6,800 miles away army sergeant dan rose was being medevaced to kandahar. the vehicle he was in was hit by an ied and it would rob him of his ability to walk again. dan's experience that day was a personal reminder of how much we owe our veterans and how mu. two years after his injury he would become the recipient of
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the soldier suit that enabled him to walk again. today prosthetics are made available to injured veterans who otherwise would not have access to them. the collection of devices we currently fund comprise the soldier suit which comprise upper and lower body and mobility devices. one example is the exosuit which allows paralyze the veterans to stand and walk again with assistance. the physical and psychological impacts of getting um out of a wheelchair and stand at eye level with the world again are profound. in fact, we're partnering with the denver va to conduct a formal study on the mental health impacts of access to this technology. another example is the luke arm which is replaces the full range of motion from the shoulder to the elbow and wrist and hand. it's the first harm that works just like the original equipment. as with many advanced technologies, these devices tend to be extremely expensive with the average device costing nearly $100,000, two of more capable devices cost nearly $200,000 each.
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we've learned over the years that most of these devices were first evolved for front line service men and women via darpa. america's commitment to putting cutting-edge technology on our war fighters is exceptional. as a point of national pride and should extend but currently does not to our veterans who bear the physical consequences of service to our country. we work closely with more than a dozen va medical centers around the country which have received one or more of our devices. the people of the va care very deeply about our veterans but are sometimes held back but archaic regulations that have not kept base with modern technological advancement. thanks to soldier strong nearly 25,000 veterans have access to these device. we believe every injured veteran should have the best technology available. too many veterans must rely on charitable organizations like
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that for the access to medical help they need. it really hits you these capabilities are quite real when you see a veteran roll into a room in a wheelchair and stand for the first time in years and walk out back how the in the same room. this video is made during one of our device donations. madam chair and mr. chair, this concludes my remarks today and i look forward to answering questions from the subcommittee. >> a mission in the field and the home front and help our soldiers take the next step forward. we've done that with socks and baby wipes for our troops and forward operating basis. today we're here to demonstrate a particular exciting part of our mission. we're pride to partner with exo bionics and provide revolutionary piece of equipment with our group, something a few years oag would only be possible
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in a science fiction movie. you [ applause ] >> thank you. i would now recognize mismccullum. chairman comstock -- need to turn on the microphone, knew at these things. chairman comstock, chairman smith and ranking member lipinski and ranking member johnson, members of the committee, thank you so much for having me here today. in my work i'm fortunate to speak with generals, military leaders and pentagon officials,
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navy s.e.a.l.s and green berets as well as many other great men and women who serve or have served our country. in fact, yesterday i spoke with vice president pence who was very interested in the subject matter of our discussion here today and in particular the work of mr. worden and also the work of soldier strong and the u.s. technology that can grow and benefit our veterans and other members of society. like most of us as a citizen i'm enormously grateful for them to their service and hummedbled by their sacrifice knowing that as much as i love my country i could never live up to the measure of their bravery and heroism. >> like most of us i want to show my gratitude to those who put their lives on the line, those who make the sacrifices, who face the danger and who go to the front lines and the freedom that we cherish as americans. soldier strong was born out of 9/11. out of chris meek's desire to
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prove to our patriots that we are forever thankful. >> what we do as citizens and as a country -- through what we do as citizens and a country is to make sure we're willing to move forward in combat and that they will be now able to move forward in life. whatever they lost on the battlefield or in injuries after they served we can help them overcome to the greatest of our and the. 9/11 was a day that changed us forever. as a lifelong new york/new jersey resident i watched as the towers came down and with them the lives of people that i knew. of those who were lost, 13 fathers and one mother from my hometown. i vowed that day to tell the story of the war on terror and the battles that continue and to support those who heard the call of president bush when he said the people who knock these buildings down will hear from all of us soon. the men and women of our armed forces made that message heard
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loud and clear. some paid the ultimate price carrying that message to our enemies so when chris meek came to see me about the organization he started with the simple mission of sending basic supplies to our troops and show them we cared and how that mission evolved into opening up the world of possibility for our injured patriots when they came back home i was in. i joined the advisory board in 2014 and have been dedicated to using my voice and the platform that i have through my work to raise awareness and support and to spread the word about cutting-edge technologies emerging in this field and the life-changing impact that they can have for those to whom i owe so much. the response has been incredible. i believe our viewers and americans across this country want better for our veterans, better than a system that leaves gaps and does not allow them to access to the ingenuity of these new devices. i will never forget the day that sergeant dan rose came to our studio to demonstrate how his
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soldier suit allowed him to get up from the wheelchair and take the steps that he never dreepd he'd be able to take care. the look on his face said it all, will, possibility and promise. as americans we must make sure that we give back but give back in a way that's uniquely american, that relies on this cutting-edge technology and never take no for an answer. as jfk once said about the u.s. space mission we choose to go to the moon not because it is's you but because it is hard. we live in a time when iron man is not just a movie. it is a moment when technology made in america can rebuild arms with full mobility and allow bodies with severed spinal cords to stand up and walk. companies like exo bionics, bionics and mobius bionics and others are leading the way. there's still a long way to go, not because it is's you, because
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it is and because it's the right thing to do. this makes sense on every level. thanks to the work of a very lean and dedicated team soldier strong operates on a budget that puts 9% to 12% towards operating cost, more than 80% goes directly to bringing this technology to more than 25,000 veterans at rehab centers and va facilities across the country so far. soldier strong has donated more than $2.5 million in high technology medical devices that directly help our injured armed forces and 500,000 towards scholarships for those whose way forward is through education that opens doors for the next steps in their lives. i encourage you to think about how the funding that supports our fighting forces in the field can be extended to support the extraordinary research that's being done with taxpayer fund that will ensure injured veterans have access to the scientist advances that come from it. i thank you very much for your
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time today and look forward to your questions. >> thank you. and we now hear from mr. worden. >> good morning, chairman woman stock, chairman wieber and ranking memz lipinski and vesey and distinguished members of the energy, research and technology committee. i would like to introduce an industrial and systems engineer at texas a&m and we have with us some veterans from the walter reed hub program here today. project hero is an organization that brings our nation's veterans and first responders together through sports, activities and community helping them overcome challenges associated with their visible and invisible wounds. being a catalyst for the adaptive sports movement project hero continues to be the industry leader, ted kated research, including a georgetown university study of methods confirms the work being keyied out since its inception is
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changing andism proving the lives of tens of thousand of veterans, first responders and their families. remember, the veterans volunteer and the families are drafted. our mission is to save lives by restoring hope, recovery and resilience to america's finest. we've had a tremendous impact. 62% of our prom participants reduce or eliminate their prescription drug use including opioids and anti-depressants. ptsd related stress attacks as measured by the hero track are reduced by 83%. the annual project participant saves the va more than $9 million exclusion prescription drugs annually. we want to look at suicides to look at the cause and effects and provide data to show why 20 veterans commit suicide each day. what are the risk factors, diagnosis and family components that are at the root cause of
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suicide? the review find that diagnosis is most common and all suicides are depression, ptsd, anxiety and alcohol use disorder with the average suicide having multip multiple diagnoses. most of the suicides were not identified as high risk in their medical records. of the 20 suicides per day, only three were receiving va mental health services at the time of their death. the reasons, inconvenience, long wait times, paperwork, transportation and stigma. the top recommendation of this report is to come up with an enhanced suicide risk assessment and safety planning capability that addresses the complex care needs of our veterans use
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technology, clinician training and extending more into the community. there is a need for a more systematic assessment tool that can document risk. the hero track initiative solves this vital need for a technology-based objective conclusion for suicide and mental health software. currently no ptsd tool exists with remote capabilities to complement ongoing treatment. the hero track will be an f-robert kardashian approved device that will allow continuous monitoring and projection of ptsd triggers using sensors and machine learning algorithms and can measure the ptsd episode within two or four seconds. this has been tested exclusively at project hero events to learn a user's physiological accuse. our goal will be to prevent and illuminate suicide in the first
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responder population and provide an active duty component with a focus on improving the overall readiness of the force by providing better health and health care analytics and provide support for survivors of sexual trauma and other mental health dgz with the care that they need. the result will be better therapeutic outcomes at less cost. using a combination of heart rate and heart rate variability monitoring the ptsd alarm will identify triggers. the tool creates a personalized profile that monitors patterns to infer a ptsd episode. if an episode is detected alarm vibration goes off with a visual prop that the user will set up four options of support. self-resiliency tools they can connect to and peer-to-peer support network that they program into the watch themselves which can include family, friends or clinicians. it can automatically call the va crisis hotline or 911.
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the device pairs with a smartphone and can interface with a website to offer more features including direct connect to peers, military command or clinicians either by phone or video as desired. the user will be able to share information with peers and their social network that they wish to create for their own personal support system. the device can best be utilized when a person first joins the active duty military to create a baseline and then constantly and consistently collect data on the mental and physical health, record stress events and traumas during their service. the advantage is to maintain objective rather than subjective data and feedback and integrate this information into one's electronic medical records. this biometric collective data can then provide a medical clinician with the complete mental health picture whenever the participant visit their he can air provider thereby understanding whether the prescription drugs they are using are working or whether the care path they have been put on
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by the v.a. o or active duty clinician is actually working. the overall advantage is a more comprehensive octoberive measurement of their disability metrics that will lead to increased abilities and a better care continuum. for the patient it's a creative way for them to have -- for them and their family to understand the environment and surroundings that cause stress episodes in their life. they can look back at the minute and five minutes and 30 minutes prior to a ptsd episode and understand what was the trigger. up on the screen we have some strewn shots of the app that the device pairs with so you can see your data. on here you can see your heart rate, your resting heart rate, your physical activity, the number of stress events and -- and also your tools. there will be accurate information on the meant call and physical state of mind. it will be a patient-centered
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divide that provides a 24/7 support network with medical resiliency and per-to-peer support if you have a ptsd episode. it's gps-enableded so if you become disoriented or pass out the person who has been alerted to your ptsd episode will be able to know exactly where you are. a per-to-peer support can provide motivation, feedback and the support of knowing that you're not alone. for the clinicians it provides a complete mental and physical healthcare picture of their patients. a more comprehensive measurement with disability metrics which lead to increased abilities and provide a more informed care continuum. up on the screen we have an actual data that was driven from one of our testing where you can see how a ptsd episode would look to a clinician. it starts out during sleep and then you can see the spike in their heart rate that causes the alarm to go off, and it also knows the difference between physical activity and actual
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episodes. for the dod it creates a baseline that consistently and constantly collects data on the mental and physical health so that they know the readiness of their troops before going on deployment. it maintains objective data and feedback on the overall readiness of the force, and that information could be integrated into the electronic medical records. the most important need we have right now as a nation is to prevent more suicides and improve the mental health of those who serve our country. although the conflicts may be winding down, there is a lifelong commitment we owe to these men and women. the hero track is vital to that commitment to ensure that they can see their children grow up in a supportive community. we all understand the need to reduce suicide and improve mental health for veterans that live and work in each of our districts. there are veterans in your district right now that can be saved by utilizing the hero track. thank you very much for your time.
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>> and we'll now hear from dr. major. >> thank you. i would first like to thank chairman barbara come stack, ranking manies will lipinski and ranking member wieber and vesey and i want to recognize chairman smith and ranking member johnson for joining us this morning. there exists a large and growing number of veterans who rely on va rehabilitative care for functional restoration. when medically indicated a team delivers custom the pro threatics and trains the veterans how to use the devices effectively and assure long-term rehabilitation success. you look at fall risk and persons with upper and lower limb loss. we do not fully understand why nearly 50% of community living persons with limb loss fall at least once per year, many of whom experience a fall-related injury.
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this has considerable implications and the veteran quality of life and va healthcare costs. my studies aim to identify factors useful for fall risk screening and modifiable through targeted risk interventions uniquely these studies utilize technologies to discover how prosthetics users respond to disturbances. moreover, these can train and who to manage disturbances and provide falls. i'll provide two examples. first example we use a robot that supplies a controlled pull to the tell advice through motorized cables. the second example we see use of an interactive system which provides both virtual and augmented reality as a means to deliver walking disturbances. the system is used physical training that requires controlled movements and is combined with cognitive behavioral therapy as part of a holistic treatment and the remaining projects focus on projects and evaluation of
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prosthetic devices. we're addressing the unique needs of women with limb loss and prosthetics that can accommodate changes in footwear and a new medal to personalite prosthetic feet and knees based on an individual's body structure and activity level. finally, we're designing technology to suspend prosthetics from the amputated limb using vacuum suction to improve mobility and limb health. while prosthetic and orthotic technologies are advancing rapidly the most critical access to successful rehabilitation are the veterans using these devices. research and development has granted us the ability to empower veterans with functional impairments but understanding how veterans interact with this technology is crucial. therefore, we should support parallel research efforts on development of technology and its clinical application. the success of the rehabilitation process is dependant on clinician uses of evidence-based practice which is generated from quality clinical research that considers the holistic needs of patients.
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furthermore, veteran rehabilitation does not end once it's fitted with the device and deployed into the community. real world use of this technology provides a window into reputation progress and quality of life. advances and wearable sensors have improved our ability to collect data on community-based outcomes such as activity level and participation. research is needed to best integrate sensors into devices to monitor user status with minimal interruption with daily activity and we need to see how this data can guide devices and rehabilitation strategies to better support independent function. overall, veteran rehabilitation research must continue to be interdisciplinary to accelerate its progress, integrating science from medicine. i argue we still lack a thorough understanding of the interaction between the human elements and rehabilitation technology. more research is needed to better understand, a, how a body responds to different pros thektic designs, and, b, which
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therapies are most effective and, c, with the long-term outcomes of rehabilitation are on veteran quality of life. filling these gaps will improve personalized rehabilitation interventions and help close the loop between technologies and clinical practice. ultimately i believe the technology is driving us towards a future where we can fine tune rehabilitation interventions with extreme precision, accuracy and speed. devices and therapies will be personalized based on individual patient characteristics and short prosthetics and orthosis will collect data with on board sensors and clinicians will use data to make adjustments and improvements. combined with the advances in telehealth therapies will bed a minstrerd remotely without traveling to a clinic thereby improving access to care. realtime monitoring and remote intervention delivery will promote rehabilitation of veterans while permitting continued community engagement. our end goal is to restore the
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greatest level of independence and ambulation and quality of life to veterans which reflects a main priority of the vh ha. i once again thank the research and technology subcommittee and energy subcommittee for this opportunity to testify, and i'm looking forward to the discussion. thanks. >> great. thank you all so much. what inspiring work you're all doing and the innovation is real exciting. so i kind of picking up when from we had our veterans roundtable yesterday, one of the things was how to integrate these services. first of all, mr. marred ebb and then i wanted to kind of ask everything this question. what three things can we do? maybe give us some action items for each of you to get what you're working on advanced and out to more of our veterans? >> well, the first thing is easy. it's funding. i mean, the technology groups i
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think in all the speeches talked about funding and the need for more funding for technology because it will have such a large impact. i mean, we talked yesterday in the forum about how, for example, people are trying to justify or understand how valuable equine therapy is. well, if every participant was wearing a hero track device you'd be able to tell immediately the overall mental and physical impact that that therapy was having on that particular person, and so then you can make better injured decisions as both a patient and clinician and congress on where to appropriate and prioritize that funding. technology will continue to evolve, and would i say that's the second issue is as technology evolves, particularly our device will become even more powerful. as phones become more powerful and wearable technology becomes more powerful and the battery life improves and the
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reliability of the algorithm improves, the device will become even more efficient and even more valuable. and then the third thing is just being able to work within the va system which i think is this biggest source of frustration for veterans, and in that study that was quoted where they talked about inconvenience, long wait times, paperwork, transportation and stigma, you know, the va has its challenges, but also the way that va treats non-profits, outside groups and how we can interact with them is very, very complicated. i mean, we're lucky. we're one of the few. we were the first with secretary shulkin to be an authorized mental health and suicide prevention program at the va, but even with that official designation we still have a hard time working with individual va medical centers.
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so how can we fix -- i don't know if fix is the right word. how can we make it while that's a lot easier to deal with active component with dod it's very, very complicated with the va and it's still the federal government. there is still supposed to be one rule book. >> miss mccullum and mr. meek, what has been your experience in working with the va, and how can we help advance and obviously all agree getting more funding directed into this, but how can we integrate better? >> well, just looking at the have a request for 2019, $198 billion, $727 million of that request is for medical prosthetic research so funding is clearly one of the big issues, and when i think about soldier strong, there's 170 va medical centers in the country and this goes what mr. warden was saying. we have devices in 12 of them so
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far, so the issue of scale and scaling up so that these devices are more available to veterans across the country it clearly one of the big goals here, and then, you know, in terms of what i do, i just think communication and helping people to understand across the country what our veterans go through when they get home. i mean, i think that's a message that we need to continue to -- to spread, and that's something that, you know, i would like to see more news organizations spend more time on and that's an effort i would make. look at the quote from one of the veterans we've spoken to. he said you feel like a burden and you avoid social situations so that alone is such a hampering factor to moving forward, so we want to find a way to, you know, help veterans feel, especially when they are using these veterans, that they are not in the way, that they are normal and part of society and i think raising awareness through greater communication is something that will go a long
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way to that. >> thank you. >> i think i would agree with mr. worden. the two things that you can do are first to pass legislation, making this technology available to all veterans, but more importantly is funding appropriations. it's one thing to pass a bill, but if you can't pay for it it's not going to do anybody any good. you know, there's several great organizations up here all doing great things, but at the end of the day we're all fighting for the same private sector and private donor dollar. the there's only so much that have out there and getting help from people in the committee will really help transform the lives of the veterans who need it. >> i think up of the things that you've all demonstrated and testified to, when these devices and these things are made available, it's lower ptsd, if it improves where we actually do have long-term savings here as well as improved quality of life and the right thing to do so there is a win-win result from this. >> well, as you mentioned before, a lot of these devices
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are originally funded through darpa and we're finding there's no darpa for veterans when they come back home, and that's why organizations like ours are trying to backfill and step upped and
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to leverage to reach this target. >> thaupg for the question. yeah ipg in term of the challenges we face, it's difficult to find ways to effectively integrate these sensors. there are a lot of sensors that are available. neutralization helps to provide the ability in such devices like these, but again, i think what we're lacking is once the sensors are included is to try to use that mapping between the data that's being derived from real world use and what that essentially means and how we should direct that to how these devices interact with the patients, help the user, learn from the user and improve mobility essentially. so i think there's still some gaps that are mising miss ng term of research in the sense that again, once the data is available. how do you use it? and i think we need to make certain that research is
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directed in a way that we can answer those questions. the sensor technology has improve d dramatically and it's rapidly advancing. so they're getting smaller and smaller. our ability to include them is much improved. i don't think that's one of the biggest challenges. now powering those devices, that is a challenge of course because they require on board battery power as well. again, research needs to be b addressed on how we can use the data effectively. how clinicians can use the data, but also protecting the privacy of the patient. >> are we training the next generation of scientists to do this work that reaches across a
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lot of different areas. do you think we're doing an a adequaad adequate job of that? do you think we need to do more and focus? what do we need to do more of there? >> i'd be hesitant to speak more broadly, but i think we are. i think we, one of the benefits of this type of research that it is interdisciplinary and we need to make sure it continues to be so. it is this combination of engineering and medicine, but we need to start integrating other disciplines as well. whether that's science, robotics, psychology, whatever that might be. we need to make sure we're promote iing that research to s competitive and advance the progress of this particular science. so i think we are doing an excellent job. of course we can also do better. as long as we continue on this track, i think this research will remain competitive and we'll be able to take steps we need to elevate this type of technology. >> and moving on, it's great to
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see the work you're doing there. at hero trek. we still you know, better than suicide datainconclusive, still trying to understand this. what does your you know, what does hero track really provide in that direction? what else can be done to leverage commercial technologies in order to do this? >> with this report that's about to come out is pretty clear on what the root causes and diagnosis of suicide are. when you get into depression, anxiety, hopelessness, you know, those are all factors. what we found in our research so far and testing of the hero
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track is that veterans feel like they have a support system with th them 24/7 on their wrist because it can connect to a loved one, a clinician, a family member or a peer so that if they have an episode, they're able to get help immediately and it's something they direct and they're in control. so the feedback we've been getting from our focus groups have been has been remarkable in the acceptance of being able to wear a technology monitoring device that understanding what's going on with you mentally and physically. and so, that power helps alleviate that hopelessness. so if you are feeling depressed, you know, hey, if i have an episode, it automatically will text message my buddy from iraq or my wife or my girlfriend or my father or whatever you know, you program in. and that ability really creates
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that sliver of hope that's the difference between suicide and not suicide. >> thank you very much. my time is up. i thank you all for the work that you're doing. >> i now recognize mr. webber. >> you talk eed b about how the deo national labs have a history of research collaboration and ability to confront short and long temperatuterm science chal. hold that thought in mind for just one second. you said you talked to a vet who felt a stigma in trying to interact with -- >> going out and socializing and being in a wheelchair and trying to get around people and feeling that he was quote in the way. >> perfect. mr. warden, you listed all of the causes of suicide and you have that list available for us
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where we can get that later? anxiety and depression? was stigma one of those causes? >> no, but it's one of the reasons why they don't receive da medical services. >> thank you. now, back to you. the doe has a history f of working with some of those other agencies. i think quite frankly, you said that the va working with outside groups. i'm coming back to you. i've got a point to this dialogue here. how does the department benefit from performing data analytics and research on behalf of the va and how do we nail this problem together? >> that's the right question to ask. for us, the data with its unique complexity that comes with subject matter experts that is
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cu cure ated by experts brings with it a team of specialists that allows us to attack the artificial intelligence and technology challenge with our experts. so the meeting happens when we look at the questions that the veterans administration surfaced. you gather specialists, the hardware, the software, the engineers and ask how do we answer those questions. >> many time, those are outside industry and groups. keep going. >> yes, so the nexus is the two agencies coming together. we draw from the breath of the laboratories. we engage the private sector and academia as needed. we recognize it's going to be an all of the above type activity
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to answer these areas. >> that's a perfect marriage, if you will, we're able to do that. there by, do away with the stigma, the nonability to work with nonoutside groups and to make this as seamless as possible. still going to come back for one more. these research partnerships have the potential to accelerate scientific breakthroughs and health care delivery systems and bio sciences. should the department replicate this model in other field of research and what steps can we take to facilitate that? >> i think the answer is yes in terms of replication. our focal point now has been on the veterans health data and on the precision medicine data set because of its unique complexities. it comes with annotations with handwritten notes, with data streams and imagery and the collections of multi modal data
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that talks to a situation in unique ways that is going to test how we develop predictive technologies, artificially intelligent based computing. when we start to get our head around what those hardware and software technologies are, these are ones we want to apply to other areas, but we find the ones with the highest leverage opportunities for us is around this data set because it draws in so many other partners who want to come, who want to participate and it's a forced multiplier for our activities. >> that brings me to another question. do you see any problems with the doe and va working together? >> no. not at all. on the beginning of april, secretary perry did sign a new moa to work together that we have started to implement now. it identifies more data than we
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plan to aggregate, so we have a nice path forward. >> what process would you use to report back to congress to say this is working. we're making huge steps in the right direction. how do we get that from you? >> i think at your discretion, coming to you with the with the effective means to do that. >> thank you. i'll yooeield back. >> thank you. >> thank you, madame chair. i wanted to ask a couple of questions on day the privacy and cybersecurity. the data is very sensitive information. almost 600 veterans have given dna and other samples that can be used and what i want to know is how is the va and doa working
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together to implement federal requirements for cybersecurity? >> thank you very much. i would add to your list of the veterans who have signed up, the secretary of nrng energy, secretary perry also joined personally in may of 2017, donating his dna and his medical records to the set. so the security of course is important. the personal health information enclave that the initial one we launched at oak ridge national laboratory is what's considered a moderate with enhanced controls under the fits 199 stapf dard that meets the hippa and high-tech act requirements. we've set up an enclave consistent with protection standards, but with cybersecurity specialists and privacy specialists, we do external reviews of the enclave.
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we also have engaged the va counterparts and the information security offices for their assessment of how we protect the data. in addition, we were sensitive to appropriate use. housing the data is one thing. but who gains access through training programs. we identify laboratory people who will be engaged, but we run that through the va. we have created teams, va and doe laboratory scientists who are attacking the key problems the va has surfaced. the pedata has -- we worry abou the control, we won't worry about the use of the data for the purpose and we monitor that through irb processes as well. so we've set up an intersurpren
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sensitive to the use and protection of the data for the very reason you remarked. with you putting in those perimeters to protect that information, are there any challenges of veterans when need be? >> there are two parts to your question. >> it's easy to access now, no interpreters of the tools, the infrastructure. the irb process, what we've been doing here is new. every step we take is new for everybody in terms of how we access ta ta and as we try and
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create the irb structure, for accessing veteran's data, we're sensitive to the fact that machine learning and artificial sbintelligence will kind of invt the world that people are used to. if you're trying to learn from more than 22 million veterans health records that span decades from genomic data, images and so on and apply machine learning, the way you access the patterns of use are quite different than how anyone else has ever looked at this data. so working through the irb and setting up the right protocols is a process we're still working through. so we've done some. we can access the data. we have accesses and controls in place, but the policy side, we are still working through how we get everyone to think about
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where the future is in terms of learning from data. >> thank you. >> i yield back. >> thank you. let me just, this is not directly on technology. but dealing with vrka issues. some of the things you're describing that have f you motivated on trying to find technological solutions like depression, sense of hopelessness, et cetera, a lot of that can be traced, some believe, to the use of opiates by the va and some believe that the va has taken the easy way out by prescribing opiates to somebody with problem b. which which when you supply that kind of drug, you're going to
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end up with someone with serious problems. now, should the va be permitted to use cannabis, should they have that as an option rather than opiates? i've got other questions that go direct ly to technology. but do i have your opinions on that? just a yes, no, or something like that? >> i'll jump in. >> should cannabis be an option for va in options of treatment rather than just opiates. well, not just opiates. >> i understand your question. i've been doing this for ten years and have had over 30,000 veterans come through my program. i will tell you that many of the veterans in our program use cannabis and they use it as an alternative to opioids. >> is that good? >> it seems to be working
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because they're all still alive. >> does anyone else have an opinion on that? okay, i want to comment publicly on that. yes, there are controversial issue issues. i would suggest that it is sinful that we do not permit our veterans that option. the veterans, doctors i know countless, not countless, i know a number of veteran who is the doctors have had to pull aside and go to them in their, in a off campus situation where they could then recommend marijuana and it's ridiculous we have to put doctors in a situation like that where they can't even recommend what they think is the right treatment. mr. meeks, or meek, i should say, you mentioned that it is difficult for medical devices to
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get approval and maybe you could give us some -- we find that same true with commercial. as well as other regulatory things that are, could you give us more detail on that? >> i'll reference the exo suit, the primary device we fund. certainly, you have to go through many phases of the clinical trials then different phases for fda approval. that takes years. literally, years. >> people are suffer during those years. do you have an example of a device that was left behind or delayed so much that people were left to suffer? >> again, just not to beat a dead horse, but this is proven to, i know a veteran what fr iowa told he would never walk
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gone again going thu with a device, he was able to walk his daughter down the aisle at her wed, so it works. >> let me just note that i had serious troubles with my arms and i know a lot of veterans get this. when i actually all the ca cartilage was gone. i was a surfer, surf fed all the cart lidge away in my arms. i know how painful that was. i have had shoulder replacements that are i believe developed to help our veterans and now they've helped all of us. do we have a situation where veterans are having to wait? because i know how painful that was. having to use the technology we've developed. >> private rehabilitation will get it much more quekly and accessible. going through the fda approvals.
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it doesn't come from here in washington. it's up to them to figure out what they deem appropriate or necessary for their veterans care. so that's where we step in. >> new technologies and medicines, it elongated in the process. >> batteries will help and many of these challenges we face are helping the disabled. let met note there are new batteries on the way and the inventer of lithium battery has had a major breakthrough that should have an incredible impact on things we're talking about but then again, we have to make sure that the fda approves the use of these batteries. to alert us to the bureaucratic
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problems that have to be overcome in utilize iing new technologies for our veterans. thank you very much. >> thank you and i now recognize miss e srstee for five minutes. >> i want to thank the chairwoman and ranking member lipsky. as a member of the veteran's committee, i want to thank you for your important work here today and give a real shoutout to mr. meek and soldier strong based in connecticut. we're grateful for the work you're done. all of us in connecticut know people who died in the twin towers and that's a sere memory and your commitment to that, my niece was one of that. my niece answered that cull and served in afghanistan and i know how important work all of you are doing. i think it was you, mr. meek mentioned, no darr vaa for the
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va. it has ageing facilities during research. so i have a couple of questions here. so i'm going ask all of you to stay whether you think there ought to be a darpa for the va or whether we should be using it as it exists, but task them with va specific goals. that's what's happened around exo skeletons. through darpa. they've kind of dropped it. it's now been left for va to pursue. so quick if people could opine on that, please. >> in terms of funny mechanisms, they're all for funding. the typical way that the mechanisms run in the va, there are certain priorities that research is directed towards. for instance, prosthetic needs of women. that's something that's come about mainly because of the growing population of women veterans. but those type of priorities are fit into existing mechanisms,
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right. and i actually would look forward to something where there is maybe more targeted mechanisms targeted funding mechanisms speaking specific towards certain priorities. darpa may be a way to do that or in some different formation similar to that, which could be implemented in the va. maybe not darpa in and of of itself, but something that could work effectively that would allow individuals to target certain priorities. i think something that would help would be technology development, advancement and implementation in the va specifically, which is something that is essentially badly needed. so thank you. >> i know that actually under dr. shulkin, his only clinical. you've talked about a lot of feedback.
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as well as the research beginning to be done about feedback. do we have an ability to share or how would we go about share ing that important information that basically, you're developing with the privacy concerns about as proprietary to you and so here's part of challenge. we have innovative work being done on the private sector in order to push it through all of va then we have questions about who has access to the data. how do we safeguard and it share the information you're developing that would help us develop better programs for veterans. >> i'll tackle that in pieces. first off, under shulkin and trump, suicide prevention is the number one priority, yet there's no funding for technology that addresses those issues. not a inning is l dime. single dime. that's one of concern that we have.
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we're not identifying the individuals. so it's a blind study,there's no privacy krps with that. with our program in general, we partner with the va and we track and that information is contained or. >> howard: housed in their va medical records. as long as the va medical records are private and they have security, then the information that we're gaining will have that same security. >> and work that l.a. is doing through text to deal with students who have suicide l ideation and other issues. i think there may be other alternatives that could help
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marry the technology you're developing to help connect to say the va hot line. how can we have an ability to connect. that's one of those issues we have. how do people know about the va hot line. make sure you have staffed. i don't know if you've looked at that at all? >> when we do our focus groups, and as the device has been developed, it has four opgs when you have a ptsd episode. whether it's self-resiliency or it's contacting a family member or a peer or contacting the va hot line or 911. what we find is that most veterans i would say over 80% of veterans would rather connect with a peer or family member rather than a stranger on the va crisis hot line. >> that tracks with all the other research we have that they'd rather have. so again, i'm over time, but i want to thank you you for your important work on these initiatives and urge you to continue to bring your ideas forward so we can do a better job b. thanks very much.
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thank you. i know recognize mr. hob gren. >> thank you all so much. this is really important. there's nothing more important that we can be doing than caring ofor our veterans, letting them have every opportunity for full lives that are fulfilling and amazingly productive, so thank you for your work. doctor, if i could trace a couple of question to you. the oak ridge national lab facility will be able to hosted va hemt data. what tepsteps is doe doing to protect the personal information of our veterans and should do, be allowed to hold secure data from private industry? >> thank you very much for that question. the data security piece is very important the to us. with hippa and high-tech are
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important. we have a a process we put in place to secure the data in the enclave. it includes an annual external review. from a third party that reports back to the feds. and then we provide the authority to operate the enclave. we engage our cybersecurity and privacy experts and counterpart from the va. we're careful about data use and protection. >> dune there's opportunities to host other data? >> there are things duo from other agencies for many different reasons. simple answer is great. >> doe houses some of the top fastest computers in the world. how will providing it help benefit health care research?
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specifically for veterans? >> i think that we've started to find in applying the existing tools and artificial intelligence is they break rather easily at the scales of the veterans data set. already exceed what the standard tool sets are. can accommodate. these kinds of stresses have intere interesting to us. in terms of where the more cognitive tools will come from. we're going to be push thg ding the data. it's the mechanism in which we set tuiasosopo next frontier of ai inspired simulation.
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>> great. thank you for being here. >> that come out of your work. getting older. brings with it many challenges including the kanger of falls. does your research provide anymore data and in as compared to veteran ts who don't require such devices? >> thank you for the question. i'm not particularly aware of any research that's targeted veterans of that nature. in terms of falls and fall ri s risks. i think in materials of looking at different type of veterans, the air which they come from, the combats which they maybed, i
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think that research would be helpful in trying to target certain rehabilitation technology. whether it's prosthetic devices or other technology in order to target and specifically to individual cohorts. i think it's something that can be done and speaking again to some of the issues brought up today, the veteran statistics, the type of data that we have because it's such an integrated system, it's right for that type of research. cannot be conducted on a wider scale. i think the resources we have available to us through the vha, it's a perfect opportunity to do that type of work. it is currently, some of which is being done, but i think we can take better opportunity of that. >> quickly, doctor, if i can follow up. i wonder with your research and work in prosthetics, how is it making it wa twi companies that develop such devices that could benefit from your findings and
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in turn provide better technologies to veterans and all tome "peopl to all people? >> one of the benefits is the partnerships that we develop. so just use an example. my research in particular, even though it's through va funding, it includes partnerships with northwestern university. in addition to that, even industry pat ners as well. much of the technology and patents developed through those efforts are jointly owned. so would be owned by vba as well as industry partners or a krr academia. it's a method in which the technology that's developed by funding can be brought out and benefit civilians. so we do a lot of that in fact and i think it is a great mechanism. i will say that you know, in terms of technology transfer, i think if certain mechanisms could be developed within the va to help that advance that process, would certainly be beneficial because there's a lot
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of great technology and the funding supports that, but trying to get that out to civilian population will be b a great benefit. >> would love to see that. my time has expireded. i yield back. >> thank you. i now recognize mr. mcinerney for five minutes. >> i thank the chair and committee for having this hearing. got excited litsenning to your testimony. a federal government scientist who worked for the va since 1983 made more than $400 million when we sold a company to this pharmaceutical giant gilead in 2012. the drug was then discovered with this, the drug was discovered with federal resources. and treated shveterans hepatiti krrk. once it was so as the va and doe
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work together, how do we ensure that data and technology resulting from taxpayer resources and is not exploilted by start ups and the private sector entities. >> that's a great question. in our partnerships, there's some fundamental tentatives we have. one is open source for the tools we create for the reason you mepgsedded. we have some partnerships with pharma. for example, with glaxosmithkline right now. called adam, which is related to this activity. it's open to other entities and available and accessible for that reason.
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we're sense thetive to the question you're asking and we have to manage the middle ground in a suitable way. and so precompetitive are foun dagal here. we have access and medicines we've developed with federal money, we need to work on strengthening those protections. mr. wharton, i was pretty excited about your ptsd alarm. you're using data and the graphs you shows saw a spike in heart
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rate then additional sort of physical indicators after that. were your able to identify in those cases, the physical event or emotional event that triggered those reactions? >> we aren't able to do that, but we ask the participants in our study to keep a journal and they were able to document what the environment was. we try to look at both immediately before, a few minutes before and maybe a half hour before and it's, it's great empowerment to an individual veteran to understand what causes a ptsd episode for them because it's different for each. >> absolutely and if you could understand what's triggering it, that leads to all kind of treatments. >> absolutely and the great thing about the device is that
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it will measure that and see what you're going is working. or whether you see if the prescription drug or therapy options that the va or health care provider has given to you, you can objectively understand how it's working, what the wois working and if it's working. that's great thing about the device. it's comet compleatly optative. it is what it is. >> do you see with other individuals, in regard to ptsd trigger sns. >> when you look at the spike, yes. that's a common theme. that's how the device detects the episode is through the spike in r heart rate. >> we saw a spike then a quiet period then additional -- >> yeah. the congratulagraph you were re, that showed physical activity. one of the questions i all always get is how does it know
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whether it's fiscal activity or a ptsd episode. the device is able to detect because of the steepness of the curve than say riding your bike. there's a difference in how your heart rate elevates and how fast. >> thank you. i yield back. >> mr. meek, you talked about, i don't know your dpaexact words,t the fact that technology was ahead of the va's practice in a sense and that you've got these technological advances that are not a part of the normal va treatment.
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i make the asunlgs that advances in technology usually cost more and that if it does more, b probably costs more. but my question would be how do we balance and mold together availability and advancement. so that i mean, you could have this scenario where you make an advancement and if you spend all your money making advancements, then you could come up with something that helped veteran ten types bimes better than cur practice. however, you could only afford one out of ten where under the old technology, you could afford ten out of ten. is there a balance there? do you see what we might be able to do to make advancements, but also pay for it? >> so back to the other question about whether the darpa should be a model to transform the va.
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i think it should be. we put the most advanced technology we can in our war fighters, but once it's done and inspected for the battle feed, that's it. funding stops. there's nothing to commercialize that for the private sector back home. so you look at these devices, how the average cost is 100,000 with a kouchl them almost 200,000. think about the original cell phone. it's the size of the small suitcase and cost $1000. today, it's the size of a calculator and fits nd your pocket and is a supercomputer. so having that continue ed resurgery and development, where the funding comes from, there are certain pools that we could look at, but you have to keep it going because over time, it will bring costs down. a lot of these devices are so advan advanced, that yes, they cost a lot new, but ten, 20 years from now, they're hard wiring some of these devices in individual's
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brains. i've seen virtual reality of someone who lost his arm in vietnam and felt a doorknob and cried because it was the first time he touched something this 25 years. in time, not only will it reduce the cost of the devices, but of medical and va care for those patients. >> the type of technology showed in your video, i was just total ly astounded and position with rise and no help at all. not even necessarily using their arms. they could just get up. so i want everybody to have that. it's just the idea of making it available is expensive. i had another question. mr. ward, you mentioned, this doesn't have anything to do with that particular issue. it has to do with self-directed
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mental health care. which i have, you said something about that, i don't know exactly what you said, but it struck a note that's what you were talking about. in that the person would help direction of what they would be choosing. for their mental health care. i have seen that work in the private sector. do you think that ought to be more uniformly applied in the va? >> i don't know if i'd use the word uniformly, but i think it needs to be available. because every veteran that suffers from ptsd is different. if you've seen one with ptsd, you've seen one veteran with ptsd. i think what they find as their support system individually is the most important path. and the great thing about the hero track device is that it gives them feedback individually so then they can make decisions for themselves based on how their qualify of life is that they want or that they have right now. and so if you go to the va and
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you see your mental health clinician and he goes, how you sleeping? not so good. we're going to give you ambien. how do you know if that does good? with the device, you're able to monitor and look at sleep patterns, look at ptsd episodes during sleep and decide whether or not that's something, because every prescription drug you take has a side effect or has some kind of addictive quality. that affects your quality of life as well. we have veterans in our program that literally have suitcases full of prescription drugs that the va sends them on a regular basis then when they get into our program, they get tau'fo'of yet the va kocontinues to send them the prescription drugs. technology is way cheaper than prescription drugs. >> yes. that's not shocking. and awesome. thank you all for appearing, ef
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one of you. it's been very encouraging. each of you and your work. yield back. >> thank you and i just want the to take a little prerogative, too. on that particular point, that if you can send us some of those exampleses, you know with whatever twha protects the patient's privacy, that would be helpful in us making this case. this is great disruptive technology that is going to save money. and the more we can highlight examples like that. i now recognize mr. dunn for five minutes. >> thank you, madame chair. i love these committee meetings. we're all gathered, sort of underscores our interconnectedness. we're sitting here talking about quantum computing from our national labs. it's being aplayed to translation at gee no, ma'amics. and all this on the subject of yet another committee of
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veteran's health. great. doctor, i'm a yurologist, pros ta tate cancer is near and dear to my heart. i know you're working on ways to determine bio markers. what needs to be b treated and how aggressively. can you find a couple of those for us? >> i can talk more to the technology side than the side that you might be more familiar. >> i want to know the bio marker, but i do appreciate what you're doing. that's key. mr. meek. you've partnered with va hospitals, also. just like walter reed. >> they're separate. they don't need your help. so you partner with the va hospitals. how do you select which ones? >> we work with the device manufacturers. depending on what the device is. if it's for an individual, sometimes, they fall through the va cracks and the manufacture
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you are finds somebody b that maybe the va won't fund it so they'll reach out to us to fill that void. in terms of the exo skeleton twidevices, we work with the manufacture. there are 24 spinal cord centers. so for example, richard in virginia serves the larger with 5,000 veterans. one device. they could use 25. also three to 4,000 veterans they serve. so one doesn't cut it. the it's a rehabilitative device where somebody goes in like going to a gym gym a personal trainer and you set your 45 minute time and do laps around the va. >> >> when you provide one of these suits to the veterans, coydo yo provide continuous support? >> it comes with four-year warranty as well as training for
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the entire staff at the va. >> you mentioned the regulatory burdens. we have been tasked by no less than the president to streamline the burdens, so if you have regulations you think are bad, bring them to us. we'd love to get rid of regulations. especially bad ones. you're sort of a people specialist. you deal with a lot of people and a lot of different -- have you in your opinion, seen the va and the veterans themselves, are they receptive to some of these new technologies? ? >> absolutely. you know, but i think about the fact that just demonstrates with sergeant rose on our set, we were able to raise enough money to buy an exo suit for a veteran's hospital in one day. so i just think that the awareness that people need to have and also i think the
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partnership between public and private entities is so important. and i think about the new va bill that is moving its way through congress and where the gaps exist and the va can't provide that stance. they are now allowed to turn to a private entity in order to fill that gap. i think we need to look for more ways to do that, so that private intersurprise prooiz and t interprize and the va can work efficiently together. then i think we'll see a scaling up of this technology. >> and i think when you look at the cost benefit analysis in temperature terms of taking care of vet long-term. and hopefully make some of those unnecessary. >> well, i share your optimism
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an thank you for the gratuitous plug for the mission act. the bill we're carrying across the finish line right now. i sit on that committee as well. look at 20 seconds leflt on the clock. t not fair to bring up the question you brought up, so in your report. the stigma that we attach to ptsk and tbi. in our active duty troops. this is a major, marriage problem that we have been whistling past the graveyard yard on. we still aren't allowed to diagnose your active duty troops. i'm glad you brought it up. >> one of the things brought up.
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but because it's an apple watch, it makes them cool. so the stigma has been removed. they're getting them they wouldn't normally get. we're very aware of stigma in our organization. >> excellent. >> i have to preside over the house in a few minutes. i really appreciate you this started with soldier strong. some friends of mine signed lance corporal thomas rivers'
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sister started that program and sending everything from sporting magazines to staples essential thing and they got to the point where her brother would get things and the other guys would say, could you share that? turned into a program called support our soldiers. unfortunately, lance corporal rivers was killed in helmand province in april 2010. an ied, but the program continues and has expanded. also for the families. a lot of these guys don't get letters or things from home. so thank you for what you're doing. mr. warden. open oids and others and at the present used significantly.
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i think the process deals before they get home. the whole thing about ptsd, all that begins before they get home. one of my concerns, we've got 22 veterans per day ha commit suicide. what you're trying to do to reduce the dependence on drugs, i think mr. warden, could you comment on that? how that might help us reduce what i think is an unbelievable tragedy that's occurring every day with veterans? >> sure, when b you look at the report that's going to come out, the ris bing factors they lookeded at, worsening of health status and decline in physical ability, those can be directly
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related to prescription drug yugs. and it's not working. it stars depression. eventually, that's what leads to suicide. >> for doctors. here's a pill, it's going to make you all bert. that's not necessarily in the best interest of that individual. that's one of the great and exciting things about the hero tract. you're going to be able to figure out what's in the best interest of the individual and be able to prescribe for that person a health thath that's going to make a difference for him. >> thank you. i told mr. -- if he would yield to me. i would hold you to throw minut minutes. with that, madam chairman, i yield back. >> now, mr. dunn.
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mr. norman, i'm sorry. >> thank you each of you for taking the time. i'll emphasize what dr. dunn said. if you see regulations that are impeding what you do, let us know because we've got a body that is strong and will take your case to get needless regular lace out of the wachlt it's the goefl the president and this body of the house. you've got an interesting roll. what is your opinion on this? and on the specific technology of veterans that is ektive with raising money and the awarness? one or two that you can point to? >> i think when people hear the stories of these veterans, here's one veteran, who was who have a soldier strong exo suit beneficiary.
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you can't put a price on someone's b ability to be six feet tall again and stand up and kiss your wife or hug your daughter or son. you can't put a price on that. we talk a lot b about money because we have to. because it's poofrt f bringing this technology to our veterans, but you know, i think there's a will in america. i know there's a will in america to provide for that and people are very much aware. you talk about regular lactions the waste that exists in the federal government and its good efforts to solme of these problems. i think everyone is working towards efficiency in improving the lives of our veterans and i think that through technology and awareness, a lot of theodis ideas can help us to cut some of the west in these programs and to produce more benefit. >> that's you know, we doen't know what we don't know. i'm glad you brought up waste because every agency,
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particularly now, can give us a road map as to where there is waste and specifics on how we can address it. and i hope y'all will do that as you move forward. because every dollar saved through waste goes back, would go back into potential good use. mr. meeks, how did we decide what on the soldier strong which va hospitals will receive the soldier suit sns. >> we work with the device manufacturer and in the medical system, there are 24 facilities that have a spinal cord unit. we work with those that have a traumatic unit as well and so the spinal cord unit b will be focused on more spinal cord uniunit with a goal of getting the lashlgest population a device first then going from there.
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sfwl perfect. >> thank y'all. appreciate your testimony. i yield back. >> thank you so much and i thank the witnesses for their testimony today and the members for their questions. without objection, chairman webber and ranking member's stasta statement, which were not able at the beginning, were made part of the record. i really so appreciate the great testimony here today. i think we're really seeing disruptive, positive, innovative technology and i think there's no question that we need to reallocate resources, get new resources and make sure we're providing this choice because a lot of the things we're talking about are veterans, what we're trying to improve are more veteran's choice and what you're offering is more choice and more positive outcomes an i really do think it's a lot of win win solutions that you have here. so we look forward to working with you on how we can redirect
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and reprioritize this so we actually end up with better outcomes that will ultimately most importantly save lives, but also save money, so this is a real exciting and i think this is a beginning of what i hope will be a continued discussion on this. we were already discussing some legislation and efforts that we can work on with our colleagues here on this committee who are on the veterans community, so thank you for your inspirational work and the record will remain open for two weeks for additional written comments and questions from members and this hearing is now adjourned.
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secretary of state mike pompeo testifies on capitol hill about his department's 2019 budget. he's also expected to get questions about iran and south korea. live coverage beginning at 9:00 a.m. eastern here on c-span3. in the afternoon, student victims of gun violence gather in washington at a forum hosted by the house democratic gun violence prevention task force. that's live at 2:00 p.m. eastern. you can follow both of these events at or the free c-span radio app. >> this marks great skill as a grand strategist, was that he knew the advantages of shock and awe, and this is how he unified
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germany in the 1860s. he instigated wars with denmark, austria, hungary, and eventually france itself. but then having done that, and having achieved his objective, which was the unification of germany, he stopped, and he became a consolidator rather that an instigator. and his next 20 years in power as german chancellor were devoted to a web of alliances with germany's neighbors. >> that's sunday night at 8:00 eastern on


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