Congratulations to NCIRE-supported Principal Investigator and Board Member, Dr. Kristine Yaffe and colleagues who recently received new funding through the National Institutes on Health’s National Institute on Aging (NIH/NIA) to study the connection between chemical exposure and dementia risks.

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Dr. Yaffe, through her appointment at the University of California, San Francisco, joins a team of researchers from the Perelman School of Medicine at Pennsylvania, Northwestern University, and Emory University, in a research study to better understand how day-to-day exposures to chemicals earlier in life can contribute to conditions like Alzheimer’s disease later on.

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The study will use almost four decades of data pulled from participants of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, which launched in 1983, many of whom were on average 25 years old when they joined the study that has followed them into their 60s.

NCIRE-supported Principal Investigator, Dr. Stephen Thaddeus Connelly, joins Dr. Urban Keirnan on his show Decoding Health to discuss his specialization as an Oral and Maxillofacial Surgeon in diagnosing and treating joint issues, highlighting the signs and solutions for common problems. Dr. Connelly also details the impact of sleep issues on neurodegenerative conditions, explaining how changes in the brain occur during different sleep phases and why these stages are crucial for overall health.

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NCIRE-supported Principal Investigator and NCIRE Board Member, Dr. Bruce Ovbiagele, joins the Abridge Research Collaborative’s (ARC) inaugural steering committee that will oversee the first clinical research collaboration dedicated to studying the impact of ambient AI across five key focus areas: clinician experience, patient experience, healthcare costs, outcomes, and health equity. This independent research effort will bring together experts across academia, professional well-being, informatics, health operations, and policy. The goal is to provide evidence-driven guidance on the use of ambient AI as it becomes ubiquitous in clinical settings.

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NCIRE-supported Principal Investigator, Dr. Michael Steinman, and his colleague, Dr. Matthew Growdon, were quoted in the New York Times article, ‘The Painkiller Used for Just About Anything’. The article tackled the issue of the extensive and growing use of gabapentin—much of it for uses not approved by FDA and with little evidence.

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Read more: https://www.nytimes.com/2024/08/17/health/gabapentin-seniors-pain.html

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Dr. Steinman was also featured in a national NPR radio segment "Here and Now" discussing the overuse of gabapentin.

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Listen here: https://www.wbur.org/hereandnow/2024/09/10/gabapentin-prescription

Congratulations to NCIRE-supported Principal Investigator, Dr. Michael Steinman, for receiving the George F. Archambault Award from the American Society of Consultant Pharmacists!

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The Archambault Award is the Society’s highest honor, conferred to an individual who has made outstanding contributions to consultant or senior care pharmacy practice through one or more specific areas of achievement. Winners of this award are selected by past Archambault Award recipients.

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NCIRE-supported Principal Investigator Dr. Judith Ford shares vital information about metabolic psychiatry in Season 9 Episode 1 of the PBS program ‘Healthy Minds with Dr. Jeffrey Borenstein’.

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Congratulations to NCIRE-supported Principal Investigator Dr. Daniel Mathalon for being recognized by the University of California, San Francisco (UCSF) with its J. Elliott Royer Award for Excellence in Psychiatry!

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The Royer Award for Excellence in Academic Psychiatry is awarded to Dr. Daniel Mathalon in recognition of his long track record of outstanding contributions as a mentor, educator, clinician, and researcher to the UCSF Department of Psychiatry and Behavioral Sciences (DPBS) and the San Francisco VA Health Care System (SFVAHCS).

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The award will be presented at the UCSF Psychiatry faculty meeting on September 17, 2024.

Congratulations to NCIRE-supported Principal Investigator Dr. Jeffrey Zimmet and his research team for setting another record-breaking month in July 2024 with 134 subjects enrolled, and a total of 1,712 randomized subjects for the IMPROVE Study at the San Francisco VA Health Care System site. This marks the fourth consecutive month with more than 100 randomize subjects.

NCIRE-supported Principal Investigators Drs. Salomeh Keyhani and Carolyn Gibson will be the Director and Associate Director, respectively, of the Center for Data to Discovery and Delivery Innovation (3DI), a new Health Systems Research Center of Innovation (COIN) funded by the San Francisco VA Health Care System (SFVAHCS) through an award from the Veterans Affairs (VA) Office of Research and Development.

3DI is focused on improving health by supporting research and training that advance patient-centered health behavior change. The Center brings together a multidisciplinary group of 25 core investigators from the School of Medicine and the School of Nursing at the University of California, San Francisco (UCSF). The Center will partner with numerous centers, programs, and institutes across UCSF including the UCSF institute for Health Policy Studies, the UCSF Center for Tobacco Control Research and Education, the UCSF Osher Center for Integrative Health, and the UCSF UC Berkeley Joint Program in Computational Precision Health.

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The Center will support quantitative and qualitative methodologic resources, Veteran engagement in all stages of the research process, health services mentorship and training, and a national network focused on fostering collaborations and community around research on behavior change.

3DI will provide much needed infrastructure to advance Health Systems Research and health care transformation within the SFVAHCS, VISN 21, and National VA.

VA funds COINs to reward and advance research that has the greatest possible impact on improving Veteran health.

Salomeh Keyhani, MD is a primary care provider and UCSF Professor of Medicine based at the SFVAHCS. She is currently leading multiple studies examining the health effects of cannabis and gaps in health care delivery related to cannabis use.

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Carolyn Gibson, PhD, MPH is a Clinical Research Psychologist at SFVAHCS and Assistant Professor in the UCSF Department of Psychiatry & Behavioral Sciences. Her research focuses on women’s physical and mental health related to menopause and aging.

Dementia can be a challenging experience for those with the neurogenerative disease, as well as for their loved one’s charged with their care. Particularly spouses of persons living with dementia may face heightened psychosocial distress in the years immediately before and after their partner's death.

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NCIRE-supported Principal Investigator Dr. Alexander K. Smith joined his colleagues in a clinical investigation which compared the psychosocial needs of spouses of partners with dementia with spouses of partners with non-impaired cognition nearing and after the end of life, focusing on loneliness, depression, life satisfaction, and social isolation.

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The research team used nationally representative Health and Retirement Study data of married couples (2006–2018), restricting to spouses 50+ years old. They included 2,098 spouses with data on loneliness and depressive symptoms two years before and after their partner's death.

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The research team’s study “Psychosocial distress among spouses of persons with dementia before and after their partner's death” was published in the Journal of the American Geriatrics Society. 

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Alexander K. Smith, MD, MS, MPH is a geriatrics and palliative care Staff Physician with the San Francisco Veterans Affairs Health Care System, and Professor of Medicine with the Division of Geriatrics at the University of California. He co-developed ePrognosis, an online guide for older patients seeking to determine if they should be screened for cancer. He has been a NCIRE-supported Principal Investigator since 2008.

Natural products are often used to relieve chronic pain symptoms, despite mixed evidence regarding their safety and efficacy. Use of these products is prevalent among Veterans, who have disproportionately high rates of chronic pain. To date, however, there is limited research on Veterans’ beliefs and attitudes about natural products and their communication with healthcare providers about their natural product use.

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The paper, “Natural Product Use Among Veterans with Chronic Pain: A Qualitative Study of Attitudes and Communication with Healthcare Providers”, explores how Veterans experiencing chronic pain choose to use natural products, their beliefs regarding the products’ safety, and how they discuss that with their providers.

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NCIRE Clinical Research Coordinator Liliana Moore co-authored the paper with NCIRE-supported Principal Investigators Drs. Karen Seal and Natalie Purcell. The paper was published in the research journal Springer Nature.

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Liliana Moore is a Clinical Research Coordinator with Northern California Institute for Research and Education (NCIRE) at the San Francisco Veteran's Affairs Health Care System (SFVAHCS).

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Karen Seal, MD is a primary care internist and Chief of the Integrative Health Service for the SFVAHCS, and a Professor of Medicine and Psychiatry in Residence at UCSF. She directs the Integrated Care Clinic for Iraq and Afghanistan Veterans, the Integrated Pain Team Clinic and the roll-out of Complimentary and Integrative Health (CIH) services for veterans and VA staff.

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Natalie Purcell, PhD, MPA is a sociologist who specializes in the study of violence, trauma, and pain across healthcare contexts. Her work uses mixed methods drawn from the social sciences and the humanities, as well as program-evaluation and implementation-science techniques.

NCIRE-supported Principal Investigators Drs. Natalie Purcell, Shira Maguen, and Karen Seal co-authored an article titled “Moral Injury Awareness and Prevention in Healthcare Organizations: A Blueprint Informed by the COVID-19 Pandemic”.

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This blueprint is based upon research conducted for the study, “Moral Injury Among Healthcare Workers on the Frontlines of the COVID-19 Crisis,” funded by the National Institutes for Occupational Safety and Health at the Centers for Disease Control and Prevention (CDC). Morally distressing experiences that could lead to moral injury were reported by 39% of 2,004 surveyed VA healthcare workers in inpatient units, emergency rooms, and community living centers at 21 VA medical centers across the United States during the COVID-19 pandemic. In-depth interviews were conducted with 46 VA workers who completed the survey and volunteered for a follow-up interview.

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You can read more about it and access the blueprint here:

https://healthforce.ucsf.edu/publications/moral-injury-awareness-and-prevention-healthcare-organizations-blueprint-informed-covid

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Natalie Purcell, PhD, MPA is a sociologist who specializes in the study of violence, trauma, and pain across healthcare contexts. Her work uses mixed methods drawn from the social sciences and the humanities, as well as program-evaluation and implementation-science techniques.

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Shira Maguen, PhD is the Mental Health Director of the Post-9/11 Integrated Care Clinic and Staff Psychologist on the Posttraumatic Stress Disorder Clinical Team (PCT) at the San Francisco VA Health Care System (SFVAHCS), and Vice Chair of SFVAHCS and Professor in the Department of Psychiatry and Behavioral Sciences, UCSF School of Medicine.

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Karen Seal, MD is a primary care internist and Chief of the Integrative Health Service for the SFVAHCS, and a Professor of Medicine and Psychiatry in Residence at UCSF. She directs the Integrated Care Clinic for Iraq and Afghanistan Veterans, the Integrated Pain Team Clinic and the roll-out of Complimentary and Integrative Health (CIH) services for veterans and VA staff.

NCIRE-supported Principal Investigator Dr. Daniel Bikle recently co-authored two major publications that provide guidelines for vitamin D use in clinical applications.

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The guideline titled “Vitamin D for the Prevention of Disease Guideline Resources” updates and replaces the 2011 Evaluation, Treatment, and Prevention of Vitamin D Deficiency guideline and focuses on the use of vitamin D to lower the risk of disease in individuals without established indications for vitamin D treatment or 25(OH)D testing.

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The article titled “Consensus Statement on Vitamin D Status Assessment and Supplementation: Whys, Whens, and Hows” is the result of the 6th International Conference “Controversies in Vitamin D” that was held in Florence, Italy on September 21-24, 2022. The conference featured international experts with the objective to review, present and discuss controversial topics regarding vitamin D. The two main topics addressed were recommendations on assessing vitamin D deficiency and vitamin D supplementation. This paper summarizes the findings on the “whys, whens, and hows” of these two topics.

Both publications were put forward by the Endocrine Society:

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Vitamin D for the Prevention of Disease Guideline Resources. https://www.endocrine.org/clinical-practice-guidelines/vitamin-d-for-prevention-of-disease

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Consensus Statement on Vitamin D Status Assessment and Supplementation: Whys, Whens, and Hows; Endocrine Reviews; https://academic.oup.com/edrv/advance-article/doi/10.1210/endrev/bnae009/7659127

Daniel Bikle, MD, PHD, is a Professor of Medicine and Dermatology with the San Francisco VA Health Care System and the University of California, San Francisco. His clinical activities and direct well-funded laboratory investigate hormonal regulation of fracture healing and vitamin D and calcium regulation of both skin cancer and wound response.

NCIRE-supported Principal Investigator Mary Whooley was awarded the 2023 Daniel Deykin Award for Outstanding Mentor from VA Health Systems Research! The prestigious national award honors Health Systems Research (HSR) researchers who exhibit outstanding dedication in mentoring the next generation of researchers—particularly by fostering an appreciation for the vital input provided by the Department of Veterans Affairs stakeholders, including policymakers and Veterans, and guiding mentees toward an understanding of the positive impact research can have on the health and care of Veterans.

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The receipt of this award highlights Dr. Whooley’s incredible dedication to her large, multidisciplinary group of mentees.

It is widely recognized that clinical research in the United States, as well as in other countries, tends to overrepresent well-educated White individuals while under-representing people of color, individuals with lower education levels and those with lower socio-economic status compared to the census-defined population.

Several factors contribute to the lack of diversity in clinical research populations. Unfortunately, this absence of diversity undermines the generalizability of clinical research results. This could imply that the outcomes are limited to the participants involved in the study and may not hold true for individuals not represented in the research cohort. This issue is particularly relevant to neuroscience research and clinical trials of treatments aimed at Alzheimer’s disease.

To address this challenge, investigators from NCIRE and UCSF, collaborating with the Brain Health Registry, have launched several efforts. These initiatives utilize culturally tailored digital marketing to recruit under-represented populations and online assessments to evaluate their eligibility for various clinical studies. Specifically, these efforts include:

• The California Latino Brain Health Registry (CAL-BHR), sponsored by the California Department of Health, aims to improve the inclusion and engagement of older Latino adults using a community-engaged research approach. As a result of these efforts, within a span of 12.5 months, the proportion of Latino participants increased from 6% to 12% of the overall cohort, with a total of 5662 Latino individuals enrolled in the project. For more information, visit https://es.brainhealthregistry.org.

• The Community Engaged Digital Alzheimer’s Research Study (CEDAR), sponsored by Genentech, Inc., aims to improve the retention and engagement of older adult individuals from Black/African American communities in the Brain Health Registry.  For more information, visit https://www.brainhealthregistry.org/cedarstudy/.

• Both the CAL-BHR and CEDAR studies recently received funding to expand efforts for increasing participation from additional underrepresented groups.

The Alzheimer’s Disease Neuroimaging Initiative (ADNI), sponsored by the National Institute of Aging (NIA), aims to increase the enrollment of underrepresented people in its study. For this, the ADNI team is using multiple strategies, including a ‘boots on the ground’ approach to improving recruitment and retention of underrepresented participants, utilizing community engagement ambassadors to foster partnerships, encourage enrollment and connect participants directly with clinical site staff.

The team of scientists at ADNI is using culturally tailored digital marketing, including the creation of locally branded websites that incorporate themes specifically designed to resonate with older Black and Latino adults. These efforts help recruit participants for ADNI clinics across the United States. Presently, 49% of enrollments in the digital study are from underrepresented groups. Additional ADNI activities that focus on improving diversity are: 1) loosened criteria for study enrollment, 2) updated study design to make participation accessible to more people, 3) expanded capacity for assessment of individuals in the Spanish language, and 4) collection of detailed social determinant of health data.  

It's important to emphasize that our digital marketing/website registry approach complements the local ‘boots on the ground’ recruitment efforts. Our findings strongly indicate that digital marketing and web-based recruitment, assessment, and prescreening can help address the lack of generalizability observed in many clinical studies.

Learn more: https://adni.loni.usc.edu/

A recent study conducted by NCIRE-supported Principal Investigator Linda Chao, PhD suggests losing one’s sense of smell could be a sign of neurodegenerative issues.

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Because olfactory deficit is a prodromal symptom of neurodegenerative diseases like Parkinson’s and Alzheimer’s disease, and because Chao’s research team previously reported suggestive evidence that deployed Gulf War (GW) Veterans may be at increased risk for Mild Cognitive Impairment (MCI) and dementia, the current study examined the relationship between olfactory and cognitive function in deployed GW Veterans.

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Eighty deployed GW Veterans (mean age: 59.9, ±7.0; 4 female) were tested remotely with the University of Pennsylvania Smell Identification Test (UPSIT) and the Montreal Cognitive Assessment (MoCA). Veterans also completed self-report questionnaires about their health and deployment-related exposures and experiences.

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The study, titled “Olfactory and cognitive decrements in 1991 Gulf War veterans with gulf war illness/chronic multisymptom illness”, was published in the science journal Environmental Health.

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Linda Chao, PhD is a Professor of Radiology & Biomedical Imaging and Psychiatry at the University of California, San Francisco. She is also a Research Biologist and Neuroscientist with the San Francisco VA Health Care System. Her scientific investigations primarily consist of conducting basic research using neuropsychological and imaging techniques to characterize how normal aging, neurodegenerative processes, stress, and exposure to neurotoxins affect the brain and cognition.

Prescribing cascades, or the treatment of an adverse drug reaction with another drug, are significant contributors to polypharmacy, where a patient takes multiple medications in day. However, little is known about which older adults are at the highest risk of experiencing prescribing cascades.

NCIRE-supported researchers Drs. Amy Byers, John Boscardin, and Michael Steinman were part of a research team that explored which older veterans are at the highest risk of the gabapentinoid (including gabapentin and pregabalin)–loop diuretic cascade, given the dramatic increase in gabapentinoid prescribing in recent years.

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The research team used Veterans Affairs and Medicare claims data (2010–2019) and performed a prescription sequence symmetry analysis (PSSA) to assess loop diuretic initiation before and after gabapentinoid initiation among older veterans (≥66 years).

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The study was published in the Journal of the American Geriatrics Society.

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Amy Byers, PhD is a Professor of Psychiatry and Behavioral Health Sciences, and Professor of Medicine with the Division of Geriatrics at the University of California, San Francisco (UCSF). Dr. Byers is also a Research Career Scientist with the San Francisco VA Health Care System (SFVAHCS). Dr. Byers leads an independent program and oversees the Byers Lab, which focuses on determining the incidence, prevalence, risk factors, and outcomes of late-life mental health disorders and behaviors, with a focus on late-life suicide and neuropsychiatric disorders using large, epidemiologic, and administrative datasets.

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W. John Boscardin, PhD is a biostatistician with a joint appointment as Professor of Medicine and Epidemiology & Biostatistics at UCSF. His primary roles with the Department of Medicine are as Director of the Statistical Laboratory in the UCSF Division of Geriatrics, co-leader (with Dr. Michael Steinman) of the UCSF Pepper Center Data and Analysis Core, and co-leader (with Dr. Amy Kelley of the Icahn School of Medicine at Mt. Sinai) of the Analytics Core for the UCSF/Mount Sinai DEVELOP AD Research Program Project.

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Michael Steinman, MD is a national leader in identifying and improving the quality of medication prescribing in older adults, particularly those with multiple chronic conditions. Other research interests include improving care for older adults with multiple chronic conditions, and mentorship for junior investigators. Dr. Steinman is also involved in several local and national initiatives, including co-chair of the Beers Criteria Guideline of Potentially Inappropriate Medications for Older Adults.

The challenges often experienced by those getting older can have an impact on medication management, says a recent article co-authored by NCIRE-supported PrincipaI Investigator Michael Steinman, MD titled “Cognitive, physical, and sensory deficits that can affect everyday medication use among older adults: A national view”.

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Challenges in the domains of cognition (e.g., dementia, which may lead to issues with remembering medication schedules and dosages), physical ability (e.g., hand dexterity and strength, which may include difficulty opening pill bottles), and/or sensory ability (e.g., limited vision, which may present as problems reading medication labels) are associated with non-adherence, medication errors, and preventable medication-related hospital admissions.

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The study, published in the Journal of the American Geriatrics Society, consisted of a cross-sectional investigation of a nationally representative sample group of 6,592 older adults aged 65 and over, who reported taking a prescription medication in the last month, from the 2015 National Health and Aging Trends Study (NHATS).

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Michael Steinman, MD is a Professor of Medicine at the University of California, San Francisco, and is a national leader in identifying and improving the quality of medication prescribing in clinically complex older adults. He devotes most of his time to research, while also maintaining an active clinical practice in the geriatrics clinic and inpatient general medicine service at the San Francisco VA Health Care Center. Dr. Steinman's research program focuses on improving how medications are prescribed for older adults and is supported by grants from the National Institutes of Health and other funders. His research interests also include improving evaluation and care for older adults with multiple chronic conditions and he has a strong interest in mentorship and supporting career development for junior investigators.

NCIRE-supported Principal Investigators Ken Covinsky, MD, MPH, and Sei Lee, MD, MAS presented at the Congress of Geriatrics and Gerontology of Sao Paolo, Brazil Apr 4-6, 2024. The sessions were wide-ranging focusing on opportunities for international collaboration, ePrognosis and the central role of function in geriatrics.

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In the co-authored study “Risk of dementia in older veterans with multiple sclerosis” published in the medical journal Multiple Sclerosis and Related Disorders, NCIRE-supported Investigator and NCIRE Board Member Dr. Kristine Yaffe and her fellow investigators found that among older veterans with multiple sclerosis (MS), risk of dementia diagnosis was higher compared to matched controls even after controlling for comorbidities. The risk difference was highest in northern regions and in younger patients. Clinicians caring for older MS patients should be aware of this risk and offer screening and treatment accordingly.

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The study used data from a random sample of U.S. Veterans aged ≥ 55 years followed at Veterans Affairs Health Care Systems nationwide from 1999 to 2019.

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In an additional study, “Trajectories in depressive symptoms and midlife brain health”, co-authored and published in the journal Translational Psychiatry, Dr. Yaffe and her colleagues investigated how depressive symptoms may either be a risk factor or prodromal to dementia in middle-aged adults. Investigating such an association in midlife may help clarify the role of depression in cognitive aging. The study aimed to identify trajectories in depressive symptoms in early to mid-life and related cognitive and brain outcomes in midlife.

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The study included 3,944 Black and White participants (ages 26−45 years at baseline) from the Coronary Artery Risk Development in Young Adults (CARDIA) study with 20 years of follow-up.

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Kristine Yaffe, MD is the Director of NeuroPsychiatry and Director of the Memory Evaluation Clinic at SFVAHCS. She is also the Scola Endowed Chair and Vice Chair, Professor of Psychiatry, Neurology, and Epidemiology, Director of the Center for Population Brain Health at UCSF, and NCIRE Board Member. She is an internationally recognized expert in the epidemiology of dementia and cognitive aging and the foremost leader in identifying modifiable risk factors for dementia. Her research, currently supported by over a dozen NIH, Department of Defense, VA, and foundation grants, bridges the fields of neurology, psychiatry, and epidemiology.

Read more:

1. “Risk of dementia in older veterans with multiple sclerosis”. Multiple Sclerosis and Related Disorders, Volume 82 https://doi.org/10.1016/j.msard.2023.105372

2. “Trajectories in depressive symptoms and midlife brain health”. Translational Psychiatry, Volume 14  https://doi.org/10.1038/s41398-024-02883-2

NCIRE-supported investigators Drs. Natalie Purcell, Shira Maguen, and Karen Seal co-authored the recent publication “Moral Injury Awareness and Prevention in Healthcare Organizations: A Blueprint Informed by the COVID-19 Pandemic”.

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The publication is a result of the NCIRE CDC project titled “Moral Injury Among Healthcare Workers on the Frontlines of the COVID-19 Crisis.” (1 R21OH012201-01-00); and serves as a public-facing document with guidance for healthcare leaders and managers on preventing moral injury in the workplace. 

Moral injury is lasting psychological and spiritual distress that stems from violating one’s values or feeling betrayed by a trusted institution or authority. It is often associated with posttraumatic stress (PTSD), depression, anxiety, substance use, functional impairments, and suicide risk.

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Healthcare workers whose jobs put them in high-stakes life-or-death situations, and who may experience intense and prolonged work stress, may be especially vulnerable to moral injury.

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The research team surveyed 2,004 healthcare workers at VA inpatient units, emergency rooms, and community living centers during the COVID-19 pandemic with 39% reporting morally distressing experiences that could lead to moral injury.

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The most common type of moral injury was betrayal-based moral injury: 30% of surveyed workers felt betrayed by healthcare leaders, coworkers, or others. Among the workers who reported potential moral injury, 79% reported burnout and 60% screened positive for posttraumatic stress (PTSD).

The guidance outlines five protective factors that could help prevent moral injury:

1. Community support: Distressing events are not faced alone, and responsibility is meaningfully shared.

2. Processing & debriefing: There is time and opportunity to process and discuss distressing events; there are breaks that allow for reflection and recovery.

3. Learning & making change: It is possible to make meaningful changes to the situation or environment and to address the factors that caused moral distress.

4. Leadership presence & communication: Leaders/managers are present and visible on the frontlines. Frontline workers feel heard and appreciated by leaders.

5. Shared risks and burdens: There is an effort to share major risks and burdens, and to meaningfully acknowledge workers who must carry more than their share.

The guide was published by the Healthforce Center at the University of California San Francisco (UCSF).

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Natalie Purcell, PhD, MPA is a sociologist who specializes in the study of violence, trauma, and pain across healthcare contexts. Her work uses mixed methods drawn from the social sciences and the humanities, as well as program-evaluation and implementation-science techniques.

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Shira Maguen, PhD is the Mental Health Director of the Post-9/11 Integrated Care Clinic and Staff Psychologist on the Posttraumatic Stress Disorder Clinical Team (PCT) at the San Francisco VA Health Care System (SFVAHCS), and Vice Chair of SFVAHCS and Professor in the Department of Psychiatry and Behavioral Sciences, UCSF School of Medicine.

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Karen Seal, MD is a primary care internist and Chief of the Integrative Health Service for the SFVAHCS, and a Professor of Medicine and Psychiatry in Residence at UCSF. She directs the Integrated Care Clinic for Iraq and Afghanistan Veterans, the Integrated Pain Team Clinic and the roll-out of Complimentary and Integrative Health (CIH) services for veterans and VA staff.