JOINT BASE LEWIS-MCCHORD, Wash. -- Whether they were potentially life-saving new methods for opening airways or effectively placing tourniquets, or searching for ways to prevent cerebral palsy or to avoid surgery complications, the best Madigan Army Medical Center research projects got some time in the spotlight as residents, fellows and staff members presented their research findings to their peers and other medical experts at Madigan Research Day on April 28.

Although only 18 research projects were presented at the event, more than 100 were submitted for consideration and 50 projects were highlighted as poster displays. Madigan researchers earned $6 million in grants in the past year, a jump of $5 million from the year prior.

"Madigan Research Day is our one day that we really focus on and showcase the high-impact research that is occurring here at Madigan," said Col. (Dr.) Richard Burney, chief of Madigan's Department of Clinical Investigation. He emphasized that the widespread involvement from Madigan staff makes the event possible, from those who conduct research and contribute abstracts on their work, to volunteers who review the abstracts, and to mentors who oversee research.

One of the presenters hopes that her work will help contribute to the prevention of cerebral palsy.

"We are studying how does pre-term labor affect the brain," said Maj. Sarah Estrada, a maternal fetal medicine fellow at Madigan. "That's important because pre-term babies are much more likely to go on to develop cerebral palsy, which is a lifelong neuro-developmental disease that affects not only the patient but the families and the people surrounding that individual."

Estrada's research is part of multi-year effort to discover what might contribute to the development of cerebral palsy and to then find out how to prevent it. Under the mentorship of Dr. Nicholas Ieronimakis and Col. (Dr.) Peter Napolitano, Estrada's predecessor discovered that the gene called Nur 77 is involved in inflammation that occurs with preterm delivery and often results in brain injury. While the gene is not normally present, their team discovered that it is activated with pre-term delivery. Estrada delved deeper into why Nur 77 was turned on and discovered that this gene is required for the full spectrum of brain inflammation to occur.

In the careful language of science, while Estrada can't say there's a direct link between this gene and cerebral palsy, she can state that the brain inflammation that correlates with preterm labor relates to poor functioning neuro-developmentally or cognitively, and to cerebral palsy. Next up is not only more research to prevent the disease, but also participation in a separate project that looks at adult implications of preterm labor to include if adults are more susceptible to dementia or Alzheimer's, or even to traumatic brain injuries.

Like Estrada's work, military medicine research can contribute to advancing healthcare in general or zero in more specifically on addressing the needs of service members downrange.

"There are some projects that literally have the potential to change field manuals," Burney said.

That includes work aimed at directly saving lives on the battlefield, such as assistance in placing tourniquets.

"The big issue with tourniquets is that people have a hard time placing them, that's something that requires a lot of training. It's a very intuitive device but getting it to actually work can be pretty difficult, and sometimes even when you do get it to be placed right they can subsequently release … and have blood flow past that," said Capt. Morgan Barron, a Madigan general surgery resident. "People are dying from it; Soldiers are dying from it."

Although there are no current monitoring devices being used on the battlefield to gauge the effectiveness of tourniquets, Barron and his fellow researchers are studying whether thermal imaging cameras connected to smartphones can do so.

"The real surprising thing about this was the thermal imaging camera was reliable. You could see this decrease in temperature over time, and the decrease in temperature was staggeringly different between an adequately placed tourniquet and an inadequately placed tourniquet," said Barron. "If there was any blood flow going past that tourniquet, then there was no temperature change."

Better yet, the thermal images were easy to interpret. Barron showed thermal images of tourniquets correctly applied versus tourniquets poorly (and ineffectively) placed; the residents who participated in the study correctly read the images greater than 95 percent of the time.

Next, Barron hopes to partner with other Madigan surgeons to check the effectiveness of thermal imaging cameras in the setting in which tourniquets are used the most here -- total joint replacement surgeries. Given the methodical and rigorous demands of medical research, it could take years more to prove that the devices would be effective on the battlefield.

Still, this is the hope that drives Barron on in his studies -- the idea that medics on the battlefield could someday use the results of this research to save service members.

"If you were able to have a medic on a medevac flight just take a little camera out and start looking at people's legs, and say … 'This guy is probably re-bleeding; let me re-tighten that tourniquet,' (then) you could save a life," he said.

Barron placed first in the pre-clinical session at Madigan Research Day, while Capt. Aurora Vincent and Capt. Jessica Lentscher tied for the prospective/retrospective session and Dr. Tim Hoyt placed first in the staff session. Capt. Brandon Shornack placed first for the case report poster, and Capt. Donald Moe earned top billing for the original research poster.