Helping VA rehabilitate those with multiple wounds of war

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Micaela Cornis-Pop oversees more than 110 rehabilitation facilities around the country, helping the Department of Veterans Affairs (VA) stay at the forefront of developments in treating traumatic brain injury and other medical injuries and issues facing injured veterans and military service members.


With the increase in battlefield survival rates of military personnel serving in Iraq and Afghanistan, service members live with more complex casualties, which led the VA to coin the word “polytrauma” to describe multiple injuries to one person, the most prevalent of which is traumatic brain injury, but also can include post-traumatic stress disorder, multiple amputations, burns, auditory and visual impairments and mental health issues.


In 2005, Cornis-Pop helped conceive, develop and implement the VA’s Polytrauma System of Care, an integrated network of facilities that provide specialized programs to help wounded men and women recover, and move from acute care to outpatient rehabilitation and reintegration into the community. She now leads and manages the system, developing policies and procedures and monitoring their implementation.

“We have a direct impact on how health care is delivered and is impacting veterans and service members, and that is tremendously gratifying,” said Cornis-Pop, national program manager of the Polytrauma System of Care at the Veterans Health Administration, Rehabilitation and Prosthetic Services, at the VA.

She also is responsible for providing education opportunities for VA health care providers who treat traumatic brain injuries. And the system works with another 39 VA locations that provide some, but not all elements of comprehensive polytrauma rehabilitation care, to define the care those facilities can provide and help make the decision when to refer patients to another level of care.

In addition, Cornis-Pop was the lead author and editor of a “massive project” to publish a 166-page book that came out in April 2010, which serves as an accredited independent study course on traumatic brain injury for members of VA health care teams around the country, said Joel Scholten, director of Special Projects at the Physical Medicine and Rehabilitation Program Office (PM&R), which manages the Polytrauma System of Care. Nearly 12,000 clinicians have completed the course between April 2010 and July 2012, using either the book or a Web version of it.

Cornis-Pop “has the innate ability to pull people together and get focused on a task and think creatively, and, most amazingly, develop an end product that is useful and veteran-centric,” Scholten said. “She develops programs and projects that have been sustained because they are clinically relevant. It’s not just policy that is developed and sits there.”

Dr. David Cifu, national director of the PM&R office, not only relies on Cornis-Pop to coordinate the care programs around the country but also to respond to outside requests for information, including from Congress. “She’s the person who makes it all happen,” he said. “She doesn’t care about getting credit. She just gets things done. That’s gold.”

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Britain urges bold G8 action on global economy

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LONDON: British Prime Minister David Cameron called on his fellow G8 leaders on Wednesday to start work now on agreeing "bold steps" to help boost global economic growth, ahead of a summit he will host in June.

In a letter marking the start of Britain's presidency of the Group of Eight richest nations, Cameron laid out his three priorities for the year: to extend free trade, tackle tax evasion and combat corruption.

Writing to the leaders of Canada, France, Germany, Italy, Japan, Russia and the United States, Cameron said: "It is clear that in 2013 the world will continue to face grave economic uncertainty."

While each country would rightly focus on their own challenges, he said, "the ambitious standards we set and the bold steps we take by working together through the G8 can make a tangible difference by firing up economies and driving prosperity, not just in our own countries, but all over the world".

But he warned that if the G8 is to see progress in these areas, leaders meeting in Northern Ireland in June need to do more than "whip out a chequebook at the 11th hour, pledge some money and call it a success".

"What we are talking about are long-term changes in our countries and the rules that govern the relationships between them. With ambition on this scale, I am convinced that success depends on us starting a debate on these changes now."

Cameron said the G8 nations, which together account for about half of global economic output, could offer leadership to ease trade negotiations, adding that the start of talks on a deal between the European Union and the United States would be "perhaps the single biggest prize of all".

The G8 could also "galvanise collective international action" to tackle tax evasion and avoidance by sharing information and looking at whether global standards need to be extended and tightened, he said.

And the prime minister urged the G8 to "put a new and practical emphasis on transparency, accountability and open government" in its relations with less developed and emerging economies, including by improving the way aid is spent.

Cameron added that he was reviewing why Britain had not yet signed up to the Extractive Industries Transparency Initiative, which is designed to shed light on who earns what from the exploitation of natural resources.

The United States was the only G8 country to have joined, he said, adding: "We need to change that. We cannot call on other countries to live up to these high standards if we are not prepared to do so ourselves."

The last time Britain held the G8 presidency was in 2005, when the summit at Gleneagles in Scotland was overshadowed by the bombings on the London transport system which left 52 people dead.

- AFP/jc



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Geetika suicide is a minor case: Haryana minister

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CHANDIGARH: Haryana's minister of state for public relations and cultural affairs Shiv Charan Lal Sharma is under fire for describing Geetika Sharma as his former colleague Gopal Kanda's "mere servant". Kanda, a former Haryana home minister, is in jail for allegedly pushing Geetika to suicide.

Sharma had also described Geetika's suicide as a "minor one" while speaking at a gathering in Sirsa to celebrate Kanda's birthday on December 29.

"This is not a big case. It is a matter of time," he had said. "He hired a servant (Geetika) by mistake."

Sharma's statement triggered outrage with All-India Democratic Women Association's state unit vice-president Savita Malik asking chief minister Bhupinder Singh Hooda to seek a clarification from him for passing such remarks.

Sarv Jat Sarv Khap Mahapanchayat women's wing president Santosh Dahiya said, "Allegations against Gopal Kanda are serious and the case cannot be termed as minor."

BJP national general secretary Captain Abhimanyu said such statement shows how Congress leaders have little respect for women. "It is a crude display of power."

Sharma was unavailable for comments on Tuesday.

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Space Pictures This Week: Ice “Broccoli,” Solar Storm

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House Hesitates, Cites Cliff Deal Spending

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Top House Republicans today opposed a bipartisan compromise that passed the Senate in the wee hours of New Year's Day to avert the "fiscal cliff," amid concerns about the cost of spending and extending tax cuts in the plan.


If House Republicans tweak the legislation, as they seem likely to do, there's no clear path for its return to the Senate before a new Congress is sworn in Thursday.


GOP leaders emerged from a morning conference meeting disenchanted by the legislative package devised by Senate Minority Leader Mitch McConnell and Vice President Biden early this morning, with several insisting they cannot vote on it as it now stands.


"I do not support the bill," House Majority Leader Eric Cantor, R-Va., said as he left the meeting. "We're looking for the best path forward. No decisions have been made yet."


It's almost certain that Republicans will attempt to amend the bill in order to win over the support of more conservatives.


House Speaker John Boehner refused to comment on the meeting, but his spokesman said "the lack of spending cuts in the Senate bill was a universal concern amongst members in today's meeting."


"Conversations with members will continue throughout the afternoon on the path forward," Brendan Buck said in a statement.


As lawmakers wrestled with the legislation, the non-partisan Congressional Budget Office estimated that the bill's added spending combined with the cost of extending tax cuts for those making under $400,000 would actually add $3.9 trillion to the deficit over the next 10 years. The Joint Committee on Taxation reached a similar conclusion.






Bill Clark/Roll Call/Getty Images











Fiscal Cliff Countdown: Missing the Deadline Watch Video











Obama on Fiscal Cliff: 'Agreement Within Sight' Watch Video





The impasse once again raised the specter of sweeping tax hikes on all Americans and deep spending cuts' taking effect later this week.


"This is all about time, and it's about time that we brought this to the floor," House Minority Leader Nancy Pelosi said after emerging from a meeting with Democrats.


"It was a bill that was passed in the U.S. senate 89-8. Tell me when you've had that on a measure as controversial as this?" she said of the overwhelming vote.


Pelosi could not say, however, whether the measure had the backing of most House Democrats. "Our members are making their decisions now," she said.


Biden, who brokered the deal with McConnell, joined Democrats for a midday meeting on Capitol Hill seeking to shore up support for the plan.


While Congress technically missed the midnight Dec. 31 deadline to avert the so-called cliff, both sides have expressed eagerness to enact a post-facto fix before Americans go back to work and the stock market opens Wednesday.


"This may take a little while but, honestly, I would argue we should vote on it today," said Rep. Tom Cole, R-Okla., who sits on the Budget Committee. "We know the essential details and I think putting this thing to bed before the markets is important.


"We ought to take this deal right now and we'll live to fight another day, and it is coming very soon on the spending front."


The Senate passed legislation shortly after 2 a.m. that would extend current tax rates on 98 percent of Americans, raise taxes on the wealthiest earners and delay by two months the pending automatic spending cuts to defense and domestic programs, known as the "sequester."


The measure passed by an overwhelming majority vote of 89-8, boosting the prospects that enough House members would follow suit to make it law.


If the House amends the bill, however, the fragile compromise could get shattered. The Senate would need to reconvene to consider the changes.


A Senate Democratic leadership aide told ABC News, "we did our work, and McConnell's office said they were confident of House passage. All bets are off if they amend our bill."


Meanwhile, most Senators have already returned home, dismissed early this morning by Majority Leader Sen. Harry Reid.


"I've said all along our most important priority is protecting middle-class Americans, this legislation does that," Senate Majority Leader Harry Reid, D-Nev., said early this morning prior to the vote.






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Obama says ‘fiscal cliff’ deal is within sight but some issues still unresolved

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President Obama said Monday that an agreement to avoid the worst effects of the year-end fiscal cliff is “within sight,” but he stressed that a deal is “not done yet,” and House Republican leaders announced they would hold no votes Monday night, ensuring that the nation would go over the “fiscal cliff” for at least a day.


The Senate was moving, however, toward a late-night or early-morning vote on a potential agreement being negotiated by Vice President Biden and Senate Minority Leader Mitch McConnell (R-Ky.). With the House likely to reconvene at noon on Tuesday, negotiations appeared likely to stretch into the new year in the effort to reach a deal to cancel historic tax hikes for most Americans.


“I think it’s highly likely that some time this evening there’ll be a vote on the Senate side,” Sen. Bob Corker (R-Tenn.) said Monday evening as he emerged from a meeting with fellow Republicans and signaled that talks are continuing. “This is one of those things that could well go into the early morning by the time it goes to a vote. ... I think they’re attempting to get the legislative language in order and vote on it tonight, you know, 1, 2, 3, 4 in the morning, whatever.’’

Regardless of whether an agreement is reached to avoid the fiscal cliff, many Americans are all but certain to face a broad hike in taxes starting Tuesday because of the expiration of the payroll tax cut, which was enacted in 2011 as a temporary measure to boost economic growth. The increased payroll taxes, combined with hikes affecting the very wealthy, would effectively mark the end of a prolonged period of declining taxation that has become a defining characteristic of the American economy

The announcement that the GOP-controlled House would not vote on New Year’s Eve came after Obama urged lawmakers to “stop taxes going up for middle-class families, starting tomorrow,” and he called on them to remain focused on the needs of the American people rather than politics.

In what the White House billed as an event with middle-class Americans, Obama said there were “still issues left to resolve” in the talks. He said he was “hopeful that Congress can get it done. But it’s not done.”

Obama said the potential agreement that Biden and McConnell are crafting would prevent federal income taxes from rising on middle-class families, extend tax credits for children and college tuition, provide tax breaks to clean-energy companies and extend unemployment insurance for 2 million Americans.

He would have preferred to “solve all these problems in the context of a larger agreement,” the so-called grand bargain, that would have dealt with spending in a “balanced way,” he said.

“But with this Congress, that was obviously a little too much to hope for at this time,” Obama said, adding that perhaps “we can do it in stages.”

Congressional Republicans immediately pushed back, objecting to comments that one GOP senator described as “heckling Congress.”

The president made the remarks as negotiators moved closer to a deal but were still hung up on spending, with Democrats so far resisting Republican proposals for spending cuts that would come in exchange for delaying automatic spending cuts at federal agencies for just three months.

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No House vote before US 'fiscal cliff' deadline

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WASHINGTON: The US House of Representatives will not vote on Monday on an 11th-hour proposal to prevent the country from tottering over the so-called "fiscal cliff," a senior Republican source told AFP.

US markets will not immediately feel the shock of the failure as January 1 is a public holiday, giving lawmakers a short breathing space in which to hammer out a stop-gap deal and pass it through the Senate and House on Tuesday.

Lawmakers worked feverishly through the night to hammer out a deal that would raise tax rates on the wealthy but preserve tax breaks for the middle class and maintain some key stimulus benefits like unemployment insurance.

At the end of the day Monday, while President Barack Obama and lawmakers acknowledged they were close, there was still no finalised deal between Senate Republicans and Democrats, including Vice President Joe Biden who is now playing a key part in negotiations.

"We don't have anything to vote on," the senior House Republican source said, referring to the lack of any bill in the Senate.

There was "no chance they pass something early enough that we could (vote) before midnight, even if we wanted to," he said.

Another House Republican source sought to downplay the fact that lawmakers were missing their self-imposed deadline.

"If a deal is reached, there's little difference between a vote tonight or tomorrow to give members a chance to review," the source said.

Some would argue there is a very clear distinction.

Passing a measure on New Year's Eve would mean Republicans - who by and large oppose raising taxes on anyone - vote for a tax hike on the wealthy.

If they wait until January 1, when the tax cuts first enacted under president George W. Bush expire and rates go up on everyone, Republicans could then turn around and vote to reduce taxes on the middle class.

As for whether the Senate could get it together to at least present a bipartisan deal before the year end, the number-two Republican in the chamber was non-committal.

"I don't know" if a Monday night vote was still possible, Senator Jon Kyl told AFP.

The Republican caucus was going to "try to get together here before long, and at least review the bidding and see where we are," he said.

"A lot of progress has been made, and I think it's obvious that we either have to have something finished here very soon or it's not going to happen."

- AFP/de



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More cases of alleged sexual assault reported from Punjab, Haryana

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CHANDIGARH: Amid outrage and condemnation against the brutal Delhi gang-rape, more cases of alleged sexual assault were reported from Punjab and Haryana on Monday. However, the demand for immediate action against the perpetrators seems to have ensured swift action and police arrested the accused in most cases.

Jhajjar police have booked two persons for allegedly abducting and raping a 19-year-old girl from Bahadurgarh. In her complaint, the victim said that she had gone for a walk in a park on Sunday when two persons -- Anil Kumar, 20, of Barahi village and Subhash Kumar, 30, of Sonipat district -- bundled her into a car and sped away. They raped her before dumping her near her residence the next morning.

Jhajjar SP Anil Dhawan said the accused were booked under sections 365 (kidnapping or abducting) and 376 (rape) of IPC and arrested within hours of the complaint being lodged.

In another case, a doctor allegedly raped a girl after inviting her to Ludhiana with the promise of getting her admission in a post-graduate course. He has been arrested and sent to police remand till January 1. According to the police, Kanwar Samrat was arrested after a complaint by a 29-year-old divorcee woman, who had got in touch with the accused from Samana through the internet. They had got engaged on May 22. Samrat called her to Ludhiana city on October 10 and violated her . When he neither got her an admission nor married her, she went to the police.

"We have registered a case of cheating and rape against the accused on the basis of complaint. He was produced before the court which sent him to two days police remand. We are interrogating him," a police officer said.

Two more cases were reported in Amritsar. While police arrested a migrant worker for allegedly raping a minor girl for over four months, they have registered a case against a local, Milan Kapoor, for raping a woman on the pretext of marrying her and is now absconding. Police said Dhoti Yadav, a resident of Bihar, allegedly raped the 13-year-old girl repeatedly for months.

In a similar case in Mansa, an Armyman has been booked for raping a 24-year-old woman for about two years on the pretext of marriage. When the girl came to know that her perpetrator, Sukhpal Singh, was already married, she approached the police on Saturday and was registered. Sukhpal is a resident of Chak Bhai Ka village and at present posted in Rajasthan.

Similarly in Ferozepur's Jhirka town, three youths were arrested for allegedly raping and blackmailing an 18-year-old girl for six months, said SP Sukhbir Singh. The victim, in her complaint, had alleged that the accused had raped her and made an MMS of the same for the purpose of blackmailing, he said.

In Gurdaspur district, a labourer Radhey Shyam was arrested on Saturday for allegedly raping and killing a minor girl, police said. The 13-year-old's body was found in a sugarcane field at Hassanpur village. In Jalandhar, four persons were arrested for allegedly raping a minor girl in Bhogpur area and making her pregnant, local SHO B S Bajwa said.

A youth Abhimanyu was arrested by the Mohali police for allegedly molesting a girl and making an MMS of the act after taking the victim to Kasauli in Himachal Pradesh on the pretext of attending a marriage, SSP (Ludhiana) G P S Bhullar said.

Meanwhile, a 19-year-old student of a private engineering college, arrested for allegedly abducting and raping his dalit classmate in Kurukshetra, was produced in a court on Monday and remanded in judicial custody. Both the victim and the accused, Gugandeep Virk, are BTech students of a private engineering college

in Karnal.In Sirsa, students blocked the Sirsa-Hisar-Delhi highway for more than an hour on Monday, demanding death penalty for the Delhi gang rape and murder accused and a new legislation to curb crime against women. The entire traffic on NH-10 had to be diverted from Sirsa bypass as students refused to lift the blockade and raised slogans demanding death penalty to the rapists and murderers.

Roshan Suchan, a student, said, "The rapists must be hanged and the government must bring fast track courts to dispose of all rape case." Heavy police force was rushed to the spot and students were finally persuaded to lift the blockade.

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Space Pictures This Week: Ice “Broccoli,” Solar Storm

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Clinton's Blood Clot Could've Been Life Threatening

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Hillary Clinton's latest health update -- cerebral venous thrombosis -- is a rare and potentially "life-threatening" condition, according to medical experts, but one from which the globe-trotting secretary of state is likely to recover from.


In an update from her doctors, Clinton's brain scans revealed a clot had formed in the right transverse venous sinus, and she was being successfully treated with anticoagulants.


"She is lucky being Hillary Clinton and had a follow-up MRI -- lucky that her team thought to do it," said Dr. Brian D. Greenwald, medical director at JFK Johnson Rehabilitation Center for Head Injuries. "It could have potentially serious complications."


The backup of blood flow could have caused a stroke or hemorrhage, according to Greenwald.


"Imagine this vein, where all the cerebral spinal fluid inside the head and spine no longer flows through this area," he said. "You get a big back up and that itself could cause a stroke. In the long-term … the venous system can't get the blood out of the brain. It's like a Lincoln Tunnel back up."


A transverse sinus thrombosis is a clot arising in one of the major veins that drains the brain. It is an uncommon but serious disorder.






Morne de Klerk/Getty Images











Hillary Clinton Has Blood Clot From Concussion Watch Video









Members of Hillary Clinton's State Department Team Resign Watch Video









Hillary Clinton's Concussion: Doctor Orders Rest Watch Video





According to Greenwald, the clot was most likely caused by dehydration brought on by the flu, perhaps exacerbated by a concussion she recently suffered.


"The only time I have seen it happen is when people are severely dehydrated and it causes the blood to be so thick that it causes a clot in the area," said Greenwald. "It's one of the long-term effects of a viral illness."


Drs. Lisa Bardack of the Mt. Kisco Medical Group and Dr. Gigi El-Bayoumi of George Washington University discovered the clot during a routine follow-up MRI on Sunday.


"This is a clot in the vein that is situated in the space between the brain and the skull behind the right ear," they said in a statement today. "It did not result in a stroke, or neurological damage. To help dissolve this clot, her medical team began treating the secretary with blood thinners. She will be released once the medication dose has been established."


Clinton is "making excellent progress," according to her doctors. "She is in good spirits, engaging with her doctors, her family, and her staff."


Clinton, 65, was hospitalized at New York-Presbyterian Hospital Sunday. She suffered a concussion earlier this month after she hit her head when she fainted because of dehydration from a stomach virus, according to an aide.


Dehydration can also precipitate fainting, according to Dr. Neil Martin, head of neurovascular surgery at University of California, Los Angeles Medical Center.


He agreed that the condition could potentially have caused a brain hemorrhage or stroke and been fatal.


"In patients with no symptoms after many days, full recovery is the norm," said Martin. "However, some cases show extension of the thrombus or clot into other regions of the cerebral venous sinuses, and this can worsen the situation considerably -- thus the use of anticoagulants to prevent extension of the thrombus."


But, he said, anticoagulants can be a "double-edged sword." With even a tiny injury within the brain from the concussion, these medications can cause "symptomatic bleed," such as a subdural or intracerebral hemorrhage.


The clot location is not related to the nasal sinuses, but are rather large venous structures in the dura or protective membrane covering the brain, which drains blood from the brain.






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