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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Tennis: Ferrer avoids falling into a hole

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DOHA: Top-seeded David Ferrer started the new season with a dropped first set here Tuesday to Dustin Brown, a qualifier outside the world's top 150, and a damaged court which opened like a crater on the moon.

Repairs appeared to involve tape and glue on a tear about five feet behind the baseline where Ferrer's heel had ripped into the surface.

There was also an anxious-looking conference and a ball-boys' impromptu Gangnam-style dance session on the playing area during a delay which lasted more than an hour.

It was eventually two and a half hours before the world number five from Spain survived his first round in the Qatar Open by 5-7, 6-3, 6-2 against Brown who is a tall, Jamaica-based German nicknamed "Dreddy," with impressive locks flying down to the small of his back.

"None of it was easy," said Ferrer, which was an understatement. Brown was unusual for his aggressive serving, eager forward movement, and willingness to volley, and other circumstances must have seemed to Ferrer bizarrely familiar.

Two years ago, he and Andy Roddock were forced off their court at the US Open by a crack near the baseline which let the water through, and required them to change courts, and last year at New York, a tornado forced Ferrer and Novak Djokovic to interrupt their semi-final by an entire day.

Roddick tweeted a solution for Doha, suggesting they should "move Ferrer to court 13" - the court number where the American completed his 2011 US Open win over the Spaniard. Ferrer chortled his laughter when he heard.

Later Ferrer commented on the oddities which had afflicted him in the last two years by saying: "Yeah - so many things, yeah. Too many things."

Asked if something were following him around, he said: "Something, yes - it's bad luck. I don't even know why."

This time Ferrer had a more fortunate resumption. Though a set down he broke Brown's serve at once, and consolidated that advantage right through the second set.

He then making another crucial break at the start of the third set, by which time the favourite was accelerating towards safety.

The seedings say that Ferrer should play a final on Saturday with Richard Gasquet, the world number ten from France, whose fluency appeared only intermittently during a 6-3, 6-4 over Jan Hernych, a 33-year-old Czech qualifier.

Hernych struck his ground strokes more often inside the baseline than Gasquet - often a sign of potential dominance - but missed with three of his four break point chances.

Gasquet's confidence improved markedly after breaking serve at the start of the second set and never looked like being pegged back, dropping only five points in his next five service games.

He could have a semi-final with his compatriot Gael Monfils, last year's runner-up, whose first match in two and a half months was a comfortable re-introduction, a 6-0, 6-3 win over the local wild card player, Mousa Shanan Zayed.

However, Monfils' next encounter is a potentially tough one, against Philipp Kohlschreiber, the third-seeded German.

He may also be mindful of the fate of another Frenchman, Jeremy Chardy, the fifth seed but a 6-4, 6-4 loser to a German qualifier, Daniel Brands.

-AFP/ac



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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 the deal's spending provisions.


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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Global rights bodies slam India for 'weak' rape laws

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NEW DELHI: The Indian government has come under attack from global human rights bodies for its inadequate laws against sexual violence or treatment of survivors.

Meenakshi Ganguly, South Asia director at Human Rights Watch, said, "The government needs to act now to prevent sexual assault, aggressively investigate and prosecute perpetrators, and ensure the dignified treatment of survivors."
The US embassy, in a statement, also mourned the death of the victim — ""We are deeply saddened to learn that the victim of a horrific assault in New Delhi Dec 16 has died," an embassy statement said. "As we honour the memory of this brave young woman, we also recommit ourselves to changing attitudes and ending all forms of gender-based violence which plagues every country in the world."

Meanwhile, UNICEF drew attention to the fact that an alarmingly large number of victims of sexual violence in India are children. "It is alarming that too many of these cases are children. One in three of the rape victims is a child. More than 7,200 children , including infants are raped every year. Given the stigma attached to rapes, especially when it comes to children, this most likely is only the tip of the ice berg," said Mr. Louis-Georges Arsenault, UNICEF Representative to India.

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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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