A doctoral student who moved from India to Indiana to study computer science and was complaining of headaches and fatigue, shocked the medical community and herself when doctors discovered a brain tumor that contained bones, hair and teeth.
On her blog, 26-year-old Yamini Karanam wrote that initially she thought she may be tired, or that her schoolwork was too difficult. When she went on a vacation, she wound up sleeping for two weeks straight, and soon after started suffering from headaches. After three months of testing, doctors determined she had a tumor, which by that point had left her mostly bedridden.
Though doctors had located a tumor in her brain’s pineal region, they determined that removal was risky and could cause irreversible damage to her brain. After six months of searching, Karanam found Dr. Hrayr Shaninian, a neurologist at the Skullbase Institute in Los Angeles, who agreed to perform the surgery.
Friends held a fund-raiser to fly her out to Los Angeles for the procedure, which occurred April 15. Through an incision in the back of her head, doctors used an endoscope to enter the area of her brain where the tumor was, The Washington Post reported. There, instead of finding a tumor, surgeons found a teratoma — a mass of bone, hair and teeth.
Teratomas are embryonal tumors — the most common brain tumors in infants less than 36 months old — that are typically benign, but are defined as being composed either of tissues that are foreign to the area, or tissues that derive from all three of the germ layers.
VA makes little headway in fight to shorten waits for care
FAYETTEVILLE, N.C. (AP) — A year after Americans recoiled at new revelations that sick veterans were getting sicker while languishing on waiting lists — and months after the Department of Veterans Affairs instituted major reforms costing billions of dollars — government data shows that the number of patients facing long waits at VA facilities has not dropped at all.
No one expected that the VA mess could be fixed overnight. But The Associated Press has found that since the summer, the number of vets waiting more than 30 or 60 days for non-emergency care has largely stayed flat. The number of medical appointments that take longer than 90 days to complete has nearly doubled.
Nearly 894,000 appointments completed at VA medical facilities from Aug. 1 to Feb. 28 failed to meet the health system’s timeliness goal, which calls for patients to be seen within 30 days.
That means roughly one in 36 patient visits to a caregiver involved a delay of at least a month. Nearly 232,000 of those appointments involved a delay of longer than 60 days — a figure that doesn’t include cancellations, patient no-shows, or instances where veterans gave up and sought care elsewhere.
A closer look reveals deep geographic disparities.
Many delay-prone facilities are clustered within a few hours’ drive of each other in a handful of Southern states, often in areas with a strong military presence, a partly rural population and patient growth that has outpaced the VA’s sluggish planning process.
Of the 75 clinics and hospitals with the highest percentage of patients waiting more than 30 days for care, 12 are in Tennessee or Kentucky, 11 are in eastern North Carolina and the Hampton Roads area of Virginia, 11 more are in Georgia and southern Alabama, and six are in north Florida.
Seven more were clustered in the region between Albuquerque, New Mexico, and Colorado Springs, Colorado.
Those 47 clinics and hospitals represent just a fraction of the more than 1,000 VA facilities nationwide, but they were responsible for more than one in five of the appointments that took longer than 60 days to complete, even though they accounted for less than 6 percent of patient visits.
That has meant big headaches for veterans like Rosie Noel, a retired Marine gunnery sergeant who was awarded the Purple Heart in Iraq after rocket shrapnel slashed open her cheek and broke her jaw.
Noel, 47, said it took 10 months for the VA to successfully schedule her for a follow-up exam and biopsy after an abnormal cervical cancer screening test in June 2013.
First, she said, her physician failed to mention she needed the exam at all. Then, her first scheduled appointment in February 2014 was postponed due to another medical provider’s “family emergency.” She said her make up appointment at the VA hospital in Fayetteville, one of the most backed-up facilities in the country, was abruptly canceled when she was nearly two hours into the drive from her home in Sneads Ferry on the coast.
Noel said she was so enraged, she warned the caller that she had post-traumatic stress disorder, she wasn’t going to turn around — and they better have security meet her in the lobby.
“I served my country. I’m combat wounded. And to be treated like I’m nothing is unconscionable,” she said.
The AP examined wait times at 940 individual VA facilities from Sept. 1 through Feb 28 to gauge any changes since a scandal over delays and attempts to cover them up led to the resignation of VA Secretary Eric Shinseki in May and prompted lawmakers to pass the Veterans Access, Choice and Accountability Act in August. The analysis included all VA hospitals and outpatient clinics for which consistent wait time data was available. It excluded residential treatment centers, homeless dormitories and disability evaluation centers. Data for individual facilities were not available for August.
It is difficult to quantify exactly how things have changed because the VA introduced a new method for measuring wait times at the end of the summer. VA officials say the new methodology is more accurate, but its adoption also meant that about half of all patient appointments previously considered delayed are now being classified as meeting VA timeliness standards. That means published wait times now can’t be directly compared with data the VA released last spring.
The trend, however, is clear: Under the VA’s old method for calculating delays, the percentage of appointments that took longer than 30 days to complete had been steadily ticking up, from 4.2 percent in May to nearly 5 percent in September. Under the new method — the one that counts half as many appointments as delayed — the percentage went from 2.4 percent in August to 2.9 percent in February.
The number of appointments delayed by more than 90 days abruptly jumped to nearly 13,000 in January and more than 10,000 in February, compared to an average of around 5,900 the previous five months. That’s not a change that can simply be blamed on bad winter weather; many of the places reporting the largest gains are warm year-round.
VA officials say they are aware of the trouble spots in the system. They cite numerous efforts to ramp up capacity by building new health centers and hiring more staff; between April and December, the system added a net 8,000 employees, including 800 physicians and nearly 2,000 nurses.
And they say that in at least one statistical category, the VA has improved: The number of appointments handled by VA facilities between May and February was up about 4.5 percent compared to the same period a year earlier.
But they also readily acknowledge that in some parts of the country, the VA is perpetually a step behind rising demand.
“I think what we are seeing is that as we improve access, more veterans are coming,” Deputy Secretary of Veterans Affairs Sloan Gibson told the AP.
He also acknowledged that the VA has historically been “not very adroit as a bureaucracy” in responding to those changes. It takes too long to plan and build new clinics when they are needed, he said, and the VA isn’t flexible in its ability to reallocate resources to places that need them most.
“We are doing a whole series of things — the right things, I believe — to deal with the immediate issue,” Gibson said. “But we need an intermediate term plan that moves us ahead a quantum leap, so that we don’t continue over the next three or four years just trying to stay up. We’ve got to get ahead of demand.”
He also asked for patience. President Barack Obama signed legislation in August giving the VA an additional $16.3 billion to hire doctors, open more clinics and build the new Choice program that allows vets facing long delays or long drives to get care from a private-sector doctor.
It will take time to get some of those initiatives expanded to the point where they “move the needle,” Gibson said.
Between Nov. 5 and March 17, according to VA officials, only about 46,000 patients had made appointments for private-sector care through Choice — a drop in the bucket for a system that averages about 4.7 million appointments per month.
In many parts of the country, the VA can boast of being able to deliver care that is just as fast, or even faster, than patients would get in the private sector. Relatively few VA facilities in the Northeast, Midwest and Pacific Coast states reported having significant numbers of patients waiting extended periods for care.
Of the 940 hospitals and outpatient centers included in the AP analysis, 376 met the VA’s timeliness standard better than 99 percent of the time. A little less than half of all VA hospitals and clinics reported averaging fewer than two appointments per month that involved a wait of more than 60 days.
The difference between the haves and have-nots can be stark.
The Minneapolis VA, one of the system’s busiest medical centers, completed 276,094 medical appointments between Sept. 1 and Feb. 28. Only 424 of them involved a wait of more than 60 days.
At the VA’s outpatient clinic in Jacksonville, Florida, a facility handling a third of the volume, 7,117 appointments involved a wait of more than 60 days.
That means there were more vets experiencing extended delays at that one clinic than in the entire states of New York, New Jersey and Connecticut combined.
Equally surprising: The Jacksonville clinic is practically brand new. It opened in 2013 with the express intent of improving access to care in a fast-growing city with a lot of military retirees and a close relationship with three U.S. Navy bases: Naval Air Station Jacksonville, Naval Station Mayport and the Kings Bay Naval Base.
But like other VA facilities built recently in spots now struggling with long waits, the clinic took so long to plan and build — 12 years — that it was too small the day it opened, despite late design changes that added significantly more space.
“Even our best demographic models didn’t anticipate the rate at which the growth would occur,” said Nick Ross, the assistant director for outpatient clinics at the VA’s North Florida/South Georgia Veterans Health System.
In recent months, the clinic has been enrolling another 25 new patients per day — a growth rate that would require the VA to hire another doctor, nurse and medical support assistant every 10 weeks to keep up with demand, said Thomas Wisnieski, the health system’s director.
Officials are hoping to lease 20,000 square feet of additional clinic space while they begin the planning process for yet another new building.
Clinic construction is also underway in an attempt to ease chronic delays in care on the Florida panhandle. A new outpatient VA clinic is scheduled to open in Tallahassee in 2016, and a groundbreaking ceremony was held in August for a new clinic in Panama City.
A SLOW PACE OF CHANGE
The Fayetteville VA hopes to celebrate its 75th anniversary this fall with the opening of a huge new outpatient health care center that could ease the types of chronic delays that caused Rosie Noel so much anxiety. (After her canceled exam, the VA paid for Noel to get care at a private-sector clinic; she doesn’t have cervical cancer.)
With 250,000 square feet of usable space, the center will be almost as large as the main hospital building itself. The new campus will have 1,800 parking spots, a women’s clinic and scores of new treatment rooms. It is sorely needed for a region that is home to two of America’s largest military bases, the Army’s Fort Bragg and the Marines’ Camp Lejeune, and one of the highest concentrations of vets in the country. In two core counties, one in five adults is a veteran.
Yet the new building is also emblematic of the slow pace of change at the VA.
Planning for the facility began in 2008, and Congress approved funding the next year. Construction hadn’t even begun when the first target completion date came and went in June 2012. The VA’s Office of Inspector General said in a 2013 report that the VA’s management of the “timeliness and costs” of seven planned health care centers, including the one in Fayetteville, had “not been effective.”
The hospital’s director since 2010, Elizabeth Goolsby, cited the VA’s failure to expand quickly as a primary reason for why eastern North Carolina now has some of the longest waits for care in the country.
“The contracting and building time in the Department of Veterans Affairs is a lengthy process,” she said.
During her tenure in Fayetteville, Goolsby has opened new outpatient clinics in Wilmington, Goldsboro, Pembroke and Hamlet. All now rank among the VA locations with the highest percentage of appointments that fail to meet timeliness standards.
At the VA’s clinic in Jacksonville— a small medical office built in a shopping plaza near Camp Lejeune’s main gate in 2008 — nearly one in nine appointments completed between Sept. 1 and Feb. 28 involved a wait of longer than 60 days.
“It’s not big enough to accommodate the number of veterans we are seeing or the number of providers we need,” Goolsby acknowledged.
One solution, she said, has been to keep building.
A new 15,000-square-foot clinic is under construction to serve the area around Camp Lejeune. The VA also is trying to develop a clinic in Sanford, north of Fort Bragg. And there have been stopgap measures, like the construction of modular buildings at the Fayetteville hospital this winter to host mental health clinics, and an emergency lease for a temporary medical office that allowed it to bolster staff in Jacksonville.
Some vets whose doctors were moved over to the new Jacksonville space said things improved immediately, even if that has not yet been reflected in the statistics.
“It used to take me six months to a year to get a doctor’s appointment,” Jim Davis, a retired Marine who fought in the first Gulf War and now has Lou Gehrig’s Disease. Since he transferred to the temporary clinic, he said, “I’ve called, and within three or four days I can get in to see the doctor.”
He called the change a relief, because he preferred to stay within the VA system for care if he could.
“There’s not a pharmacist at Wal-Mart calling me at home and asking me if the latest change in medicine made me feel sick. But that is happening in the VA,” Davis said. “They are so much more respectful, because they know you served.”
RURAL RECRUITING CHALLENGES
After years of planning, a large, new outpatient center also is scheduled to open this fall to expand care offered at the VA medical center in Montgomery, Alabama.
That expansion also is long overdue. Among the VA’s full-service medical centers, the Montgomery VA had the highest percentage of appointments that took longer than 30 days to complete. More than one in 11 appointments completed between September and February failed to meet timeliness standards. A sister hospital, a short drive to the east in Tuskegee, was No. 2.
There’s no guarantee, though, that a new building will help the Central Alabama Veterans Health Care System solve one of its other longstanding problems — a difficulty recruiting enough doctors and specialists needed to handle demand.
Both hospitals are surrounded by largely poor, rural counties designated by the government as having severe physician shortages.
“They are on the frontier of some of the most medically underserved areas of the country,” said Dr. William Curry, associate dean for primary care and rural health at University of Alabama School of Medicine.
That could mean that veterans who might otherwise get care in the private sector are more reliant on the VA. It also has historically meant big challenges recruiting physicians, who can make more money in metropolitan areas.
“Not a lot of medical students want to go work for the VA in a rural community medical clinic,” said Dr. Kevin Dellsperger, chief medical officer at the Georgia Regents Medical Center and former chief of staff at the VA medical center in Iowa City, Iowa.
Dr. Srinivas Ginjupalli, acting chief of staff for the Central Alabama Veterans Health Care System, confirmed that recruiting is a challenge, but he said the VA has been boosting salaries since the summer in an attempt to be more competitive in attracting staff.
Goolsby cited similar rural recruiting problems in her enterprise, which serves a sprawling region of hog farms and tobacco fields. Other VA officials said difficulty attracting health care providers to remote or poor parts of the country was an issue throughout the system.
NO EASY FIX
A few places struggling the most with long waits did report improvements.
At the VA in Montgomery, Alabama, the percentage of appointments that take longer than 30 days to complete has fallen from 12.6 percent in September to 6.4 percent in February. That’s still a bad number compared to other VA hospitals but, looking at performance only in February, it would be enough improvement to take the hospital from worst to third in terms of the percentage of delays.
The VA’s most chronically delayed outpatient clinic throughout the summer and fall, located in Virginia Beach, Virginia, reported improvement, too. In September, 24 percent of its patient visits were delayed by at least 30 days. By February, that had fallen to 11 percent — still terrible, but much better.
The VA site that had the most trouble meeting the VA’s timeliness standard during the whole six-month period reviewed by the AP was a small clinic near Fort Campbell in Hopkinsville, Kentucky. One in five appointments took longer than 30 days to complete, and the rate has gotten steadily worse over time.
The centerpiece of the legislation signed over the summer was a plan to expand the number of veterans who are approved to get care outside of VA facilities. Yet the Choice program has barely gotten off the ground.
ID cards for the program were mailed starting in November, but many vets still don’t understand how it works. It theoretically is open to patients who can’t been seen within 30 days, or who have to drive longer distances for care, but enrollees still have to get VA approval to see a private-sector doctor and only some physicians participate in the payment system.
“It’s not working the way it needs to work,” said Gibson, the deputy VA secretary, though he added that he was enthusiastic about its potential. He said some consultants advising the VA said it might take 18 months to build the program.
In a meeting with congressional aides and state veterans service officials in March, Goolsby gave some figures to illustrate how the program was working in southeastern North Carolina: Of the 640 patients offered an opportunity for outside care through mid-March, only four were ultimately seen a private-sector doctor.
“We’re finding that a lot don’t want an outside appointment,” she said.
Reasons vary, she said, but one factor is that switching to a new doctor can be disruptive for someone with an ongoing medical issue.
In March, officials loosened the eligibility rules for the program slightly so it would cover more vets who have to drive longer distances for care.
The VA also has been trying to tackle long wait times in other ways.
The Central Alabama Veterans Health Care System, Ginjupalli said, has been promoting the use of “telehealth” systems that allow patients in rural or backed-up areas to see doctors elsewhere via video conferencing.
It also has reached an agreement with the Defense Department to help reduce long delays for care at its clinic in Columbus, Georgia, by moving some staff to a 19,000-square-foot building at the military’s medical center at Fort Benning.
Dr. Daniel Dahl, psychiatrist and associate chief of staff for mental health at the Central Alabama VA, said the new space will triple the VA’s capacity for mental health care in the area. In February, the average delay for a mental health appointment at the Columbus clinic was 25 days — seven times the national average.
Obama’s secretary of Veterans Affairs, Robert McDonald, has cautioned that it will take time for reforms to make a difference.
He also warned in recent testimony to Congress that the system may still be decades away from seeing peak usage by the generation of servicemen and servicewomen who fought in Iraq and Afghanistan.
Total enrollees in the VA system have ballooned from 6.8 million in 2002 to 8.9 million in 2013. During that same period, outpatient visits have soared from 46.5 million to 86.4 million annually; patient spending has grown from $19.9 billion to $44.8 billion; the number of patients served annually has grown from 4.5 million to 6 million.
McDonald told Congress the number of mental health outpatient visits alone is up 72 percent from 2005.
“Today, we serve a population that is older, with more chronic conditions, and less able to afford private sector care,” McDonald said.
That could mean that without further change, waits will only grow.
The AP National Investigative Team can be reached at firstname.lastname@example.org
Russian 30 Year Old To Receive World’s First Head Transplant
A man with a fatal medical condition has spoken exclusively to MailOnline about how he is set to become the first person to undergo a head transplant and hopes it could be as soon as next year.
Valery Spiridonov says he is ready to put his trust in controversial surgeon Dr Sergio Canavero who claims he can cut off his head and attach it to a healthy body.
Mr Spiridonov, 30, a computer scientist from Russia, said: ‘My decision is final and I do not plan to change my mind.’
As a lifelong sufferer of the rare genetic Werdnig-Hoffman muscle wasting disease, he says he wants the chance of a new body before he dies.
‘Am I afraid? Yes, of course I am. But it is not just very scary, but also very interesting,’ said Mr Spiridonov from his home in Vladimir, a city 120 miles east of Moscow.
‘But you have to understand that I don’t really have many choices’, he said. ‘If I don’t try this chance my fate will be very sad. With every year my state is getting worse.’
Dr Canavero and Mr Spiridonov have talked via Skype though they have not met yet and the doctor has not reviewed his medical records.
The Italian told CNN he has received many email and letters from people seeking the procedure but he insists the first patients will be people suffering from a muscle wasting disease.
Dr Canavero has named the procedure HEAVEN, which is an acronym for head anastomosis venture. Anastomosis involves the surgical connecting of two parts.
He insists all the necessary techniques already exist to transplant a head onto a donor body.
The first monkey head transplant was performed 45 years ago and a basic operation on a mouse was carried out in China recently.
But critics say Dr Canavero’s plans are ‘pure fantasy’. The Italian has been compared to the fictional gothic-horror character Dr Frankenstein.
And Arthur Caplan, the director of medical ethics at New York University’s Langone Medical Centre, has described Dr Canavero as ‘nuts’.
Dr Hunt Batjer, president elect of the American Association for Neurological Surgeons, told CNN: ‘I would not wish this on anyone. I would not allow anyone to do it to me as there are a lot of things worse than death.’
The cost of the 36-hour operation, which could only be performed in the one of the world’s most advanced operating theatres, has been estimated at £7.5million.
The new body would come from a transplant donor who is brain dead but otherwise healthy.
Both donor and patient would have their head severed from their spinal cord at the same time, using an ultra-sharp blade to give a clean cut.
The patient’s head would then be placed onto the donor’s body and attached using what Canavero calls his ‘magic ingredient’ – a glue-like substance called polyethylene glycol – to fuse the two ends of the spinal cord together.
The muscles and blood supply would be stitched up, before the patient is put into a coma for four weeks to stop them from moving while the head and body heal together.
When they wake the patient should be able to move, feel their face and even speak with the same voice. Powerful immunosuppressant drugs should stop the new body from being rejected.
Critics say Dr Canavero has simplified the difficulties involved in reattaching a spinal cord.
The Italian doctor has also so far failed to secure funding for the staff of 150 doctors and nurses he believes are required to complete the procedure.
However, the Italian is confident he can successfully transplant a head on to another body.
And if successful, his pioneering procedure could give new hope to thousands of paralysed and disabled people.
Mr Spiridonov was diagnosed with the rare muscle-wasting condition, Werdnig-Hoffman disease, at the age of one. Tragically the disease progresses every day.
He told MailOnline: ‘I can hardly control my body now. I need help every day, every minute. I am now 30 years old, although people rarely live to more than 20 with this disease.’
He continued: ‘My muscles stopped any development in childhood. Because of this, they do not grow and the skeleton gets deformed. The back muscles cannot support the skeleton.’
With his condition worsening each day, Mr Spiridonov is desperate for the technique to work. He told MailOnline: ‘If you want something to be done, you need to participate in it.
‘I do understand the risks of such surgery. They are multiple. We can’t even imagine what exactly can go wrong. I’m afraid that I wouldn’t live long enough to see it happen to someone else.’
He said his family fully support his decision to be the first human to undergo such surgery.
Mr Spiridonov added: ‘What’s more, there’s already a lot of effort invested in this idea and that’s why it’s too late to back out.
‘I came up with this idea quite some time ago. I read many scientific articles on this topic.’
‘The idea to transplant not only organs but the head has been studied for a long time even by Russian specialists. But an actual transplantation of the human head was never conducted.’
Mr Spiridonov contacted the controversial doctor, who is based at the University of Turin in Italy, after reading about his ambitious medical claims.
He said: ‘I contacted Professor Canavero two years ago after reading about his works. I offered myself to him to make this operation possible. We have never met and we just communicate via emails.
‘For the last two years we’ve been talking this idea through and planning the operation.
‘He’s a very experienced neurosurgeon and has conducted many serious operations. Of course he has never done anything like this and we have to think carefully through all the possible risks.’
The Russian has compared the pioneering procedure to the space race of the post-war years.
He said: ‘In the end it is like with astronauts. Before the first man we sent into space, 300 different scenarios of something going wrong were thought through but when he actually did it, it was the 301st scenario that happened.’
Mr Spiridonov denies his pledge to be a guinea pig is a stunt, and insists he goes into it with his eyes open.
‘If I want this kind of surgery to happen, I shouldn’t put the responsibility onto someone else but should try it on myself.
‘My family fully supports me. They also understand all the risks and even if they think that it’s too dangerous, they still support me in my decision.’
Despite his severe disabilities Mr Spiridonov has lead a full life, graduating from university with a degree in computer science.
‘I lost my father in a car crash 16 years ago,’ he told MailOnline. ‘He was a military man, a lieutenant colonel. So I had to start supporting the family at an early age.
‘My mother is a child psychologist in a rehabilitation centre for children who got into difficult situations.
‘I graduated from the Faculty of Information Technologies of Vladimir State University. I have a very active social life and I’m the head of a committee that deals with social policies for families and youth.’
He added: ‘I don’t do this because I don’t have a life but I think that science is developed by those who are ready to take risks and devote themselves to it.’
Mr Spiridonov has never discussed the possibility of failure with Dr Canavero.
He told MailOnline: ‘It was about me just offering myself as ready to undergo it. Of course, the professor considers the chances to succeed are quite high otherwise he wouldn’t try it.’
He says there is no ethical difference between transplanting a head on to a healthy body and replacing a damaged organ with a healthy one, which is now considered routine.
Donors could include victims of road traffic accidents or even prisoners sentenced to death, he says.
He told MailOnline: ‘I consider it to be as ethical as the transplant of the heart or kidneys. At some point of time this was considered to be unethical as well.
‘There was much talk about where the human soul is located, and if it’s ethical to do the heart transplants, but now doctors do it and save people’s lives.
‘I think it’s the normal way of technology to evolve. It would be strange to stop at this point when the neurosurgery is ready to take the next step.
‘The bodies used for transplant could be those of people whose brain was damaged, let’s say in a car crash or motorbike accident, or who are sentenced to capital punishment.
‘But, of course, in future humanity should learn how to grow healthy bodies for the transplants so there will be no shortage of organs and bodies.’
Mr Spiridonov says he understands that the Italian surgeon can only go ahead when he is satisfied that medical science is sufficiently advanced.
But the Russian he believes this moment is very close, possibly next year, 2016.
He told MailOnline: ‘We haven’t agreed on a particular date of the surgery with Dr Canavero,
‘It’s an ongoing process and a lot depends on the success of the studies that are underway now.
‘There will be a conference of neurosurgery in Annapolis in the US this summer. The professor will be reporting on his studies there.
‘He would like me to be present. I would like to attend if I can find the means to fly there. We will see what the next step is after that.’
Matter-of-factly, he adds: ‘For now we are thinking about transplanting my head in 2016.’
The Russian even jokes about what might happen if the surgery goes wrong.
He told MailOnline: ‘Maybe I would try to move my leg but instead my body will produce a litre of adrenaline. But I am willing to take the risks and try.’
In 1970 Dr Robert White transplanted the head of one monkey onto the body of another at the Case Western Reserve University School of Medicine.
The monkey died after eight days because the body rejected the head. The monkey was unable to breathe on its own. The animal could not move because the spinal cord were not connected.
Dr Batjer says White’s research does not provide evidence that a human head transplant can work.
He told CNN: ‘It’s a 45-year-old reference in a primate and there is no evidence that the spinal cord was anastomosed functionally.’
Dr Sergio Canavero could not be reached for comment.
DNA testing for dog poop on the rise in Seattle area
SEATTLE (AP) — Frustrated with dog owners who refuse to clean up after their pets, an increasing number of apartments in Seattle are opting to use DNA testing to identify the culprits.
The Seattle Times reports (http://bit.ly/1HxGgb2) that a company called BioPet Vet Lab from Knoxville, Tennessee, is providing its PooPrints testing kits to 26 apartment and condo complexes and homeowners associations in the region.
“There was poop inside the elevators, in the carpeted hallways, up on the roof,” Atkinson said. “They’re lazy, I guess.”
That’s why, since February 2014, tenants have been paying a “one-time fee of $29.95 for DNA testing.”
BioPet says in the past five years, the DNA test has been used in nearly 1,000 places around the country, and it’s especially popular in Miami, Dallas, Los Angeles and other large cities.
The marketing took a little longer to reach the Northwest, but King-Snohomish-Pierce counties are opportune sites. They are home to about 811,000 dogs. Seattle has 50 percent more dogs than kids, the Times said. One study said the average dog poop weighs one-third of a pound and the dogs in that three-county region are responsible for about 268,000 pounds of droppings a day.
Atkinson says that after some initial fines, DNA testing is working at her complex, with two dozen or so dogs.
“One person was fined five times in one week,” she said. “That’s over $500. Now people clean up after their dogs.”
The fines added up this way: $59.95 to have the poop tested, and $50 to the complex for the hassle of collecting the sample.
Atkinson says that residents at the complex are “mostly on board” for having their dogs’ DNA tested.
Night vision eyedrops allow vision of up to 150 feet in darkness
It might sound like something straight out of Q’s laboratory or the latest Marvel film but a group of scientists in California have successfully created eye drops that temporarily enable night vision.
Science for the Masses, an independent “citizen science” organisation that operates from the city of Tehacapi, theorised that Chlorin e6 (Ce6), a natural molecule that can be created from algae and other green plants, could enhance eyesight in dark environments.
The molecule is found in some deep sea fish, forms the basis of some cancer therapies and has been previously prescribed intravenously for night blindness.
Jeff Tibbets, the lab’s medical officer, said: “There are a fair amount of papers talking about having injected it in models like rats and it’s been used intravenously since the 60s as treatments for different cancers. After doing the research, you have to take the next step.”
The next step was to moisten the eyes of biochemical researcher and willing guinea pig Gabriel Licina’s eyes with 50 microlitres of Ce6.
The effect was apparently almost instantaneous and, after an hour, he was able to distinguish shapes from 10 metres away in the dark and soon at even greater distances.
“We had people go stand in the woods,” Licina said, “At 50 metres, I could figure who they were, even if they were standing up against a tree.”
The control group without Ce6 were only able to pick out the objects a third of the time, while Licina’s success was 100 per cent.
The effect of the chemical only lasted for a few hours and the test subject’s eyesight returned to normal the next day.
The organisation has released a paper that detailed the experiment in their website. It says that more research will need to be conducted to measure the actual amount of electrical stimulation increase in the eye whilst the long term effects of the procedure will require further investigation.
Tibbets says that this success is perfect demonstration of the work that his organisation conducts: “For us, it comes down to pursuing things that are doable but won’t be pursued by major corporations. There are rules to be followed and don’t go crazy, but science isn’t a mystical language that only a few elite people can speak.”
Cops Hunt For 350 Pound Armed Robber Who Stole Cash, Then Pizzas, From Domino’s
SAYVILLE, N.Y. (CBSNewYork) — A larger-than-life robber waving a gun across his hefty frame burst into a Domino’s pizzeria in a quiet Long Island village with an appetite for more than cash, victims said.
The man, believed to weigh at least 350 pounds, robbed the store in Sayville on Tuesday afternoon and demanded an employee serve him two pizzas before he left, Domino’s district manager Robert Warren told CBS2’s Jennifer McLogan in this exclusive report.
“This is the kind of guy we are dealing with here,” Warren said. “It’s odd for this in Sayville.”
The suspect then fled on Sunrise Highway.
The crime, which was caught on a security camera, has many in Sayville on edge.
Employee and victim Ray Brenkert recounted the panic.
“I’ve got to do what he says and try to get us out of here alive,” Brenkert said of his thinking during the encounter. ” … He told me get on my knees and open the safe.”
But the safe is time released and won’t open at will.
“When I told him that, he was like, ‘Well, you either open the safe or I’m going to shoot you in the head,’” Brenkert said. “And I was like, ‘Uh oh.’
“I tried to reason with him. I was like, ‘It’s not going to open. There’s nothing I can do.’ And then he got really angry and he took my cellphone, told me get on the ground and pulled the phone out of the wall. And I just did what he said because he had a gun to my head.”
Resigned to a fistful of cash from the register, the hefty robber then spotted the two bubbling pies — large with cheese.
It was approaching dinner hour.
“Taking the pizzas at the end is just a crazy twist to a maniacal story to begin with,” Warren said. “He saw the pizzas coming out of the oven and requested my employee to take them out of the oven, slice them up and box them up for him.”
The robber is described as white and 5 feet 8 inches to 5 feet 9 inches tall. He was wearing a mask.
Cops are crediting the workers for following proper protocol.
Police and Domino’s hope to be able to release the surveillance video this week, and investigators think the suspect’s distinctive looks could help lead to his capture.
Superbug outbreak extends to LA’s Cedars-Sinai hospital
By CHAD TERHUNE
In the latest superbug outbreak, Cedars-Sinai Medical Center discovered that four patients were infected with deadly bacteria from a contaminated medical scope, and 67 other people may have been exposed.
The Los Angeles hospital said Wednesday that it began investigating the possibility of patient infections after a similar outbreak at UCLA’s Ronald Reagan Medical Center that sickened seven patients, including two who died.
The widening problem is certain to ratchet up the pressure on the Food and Drug Administration, already under fire for ignoring warnings about these medical instruments.
Device makers, led by Japanese electronics giant Olympus Corp., face similar scrutiny for designing scopes that are difficult to clean of dangerous germs.
“It’s highly likely many hospitals around the country have had outbreaks, and they haven’t been able to connect the dots until this problem was disclosed at UCLA,” said Lisa McGiffert, director of the Safe Patient Project at Consumers Union.
“It’s just a little late — especially for those who got infections and maybe died as a consequence,” she said.
Cedars-Sinai said one of the four infected patients died, but for reasons unrelated to carbapenem-resistant Enterobacteriaceae, or CRE. The other three patients have been discharged from the hospital, a spokesman said.
The superbug CRE is highly resistant to antibiotics and can kill up to 50% of infected patients.
In these cases, the bacteria can be transmitted during a procedure known as endoscopic retrograde cholangiopancreatography, or ERCP.
Nationally, about half a million patients a year undergo ERCP, in which a fiber-optic scope is threaded down the person’s throat to diagnose and treat problems in the digestive tract such as gallstones, cancers and blockages in the bile duct. These instruments are not the same type used in more routine endoscopies and colonoscopies.
Patients at Cedars-Sinai may have been exposed to the superbug from one Olympus duodenoscope in use from August 2014 to mid-February, according to the hospital. That’s the same model implicated in outbreaks at UCLA and Virginia Mason Medical Center in Seattle.
In a startling admission this week, the FDA acknowledged that the Olympus scope under scrutiny has been on the market since 2010 without the necessary government approval.
Let us know if you have been affected by the hospital outbreaks
Regulators said they decided not to pull the device from the market because the scope is so widely used by doctors and hospitals and they didn’t want to trigger a product shortage.
As for the Cedars incident, an FDA spokeswoman said the agency will be working with the hospital, local health officials and the Centers for Disease Control and Prevention “to learn more about these infections, including the cleaning, disinfection and reprocessing steps in use.”
A spokesman for Olympus said the company didn’t believe further regulatory approval was necessary for the 2010 redesign of its TJF-Q180V duodenoscope. At the FDA’s request, the company subsequently filed for approval, which is pending.
Some medical experts and health officials have attributed these outbreaks to the intricate design of these scopes and how it impedes effective cleaning.
A day after the UCLA outbreak was reported by The Times on Feb. 18, the FDA warned hospitals and doctors about the infection risk from these devices. It said that following manufacturers’ cleaning instructions does not ensure that the scopes are free of bacteria, which can become trapped in tiny crevices near the tip of the devices.
Cedars emphasized Wednesday that it had meticulously followed the manufacturer’s instructions.
L.A. County health officials said they found no breaches in the cleaning protocol at Cedars. County officials also are recommending that all hospitals in the county perform a “retrospective review” of ERCP procedures to look for infections.
Before the developments at Cedars, Rep. Ted Lieu (D-Los Angeles) and Rep. Peter Roskam (R-Illinois) sent a letter to the FDA on Wednesday asking what steps the agency is taking on redesign or device cleaning to limit further infections.
They also want to know when the FDA first learned that the scope design could lead to infection.
Scope maker Olympus faces scrutiny over patient deaths, infections
Scope maker Olympus faces scrutiny over patient deaths, infections
Lieu said he pressed his concerns in a meeting Wednesday with Dr. Stephen Ostroff, the FDA’s chief scientist. Ostroff is slated to take over as acting FDA commissioner when Dr. Margaret Hamburg leaves at the end of March.
“I believe the new revelations at Cedars show that this problem is larger than people may have believed,” Lieu said. “Having met with the incoming commissioner, I am optimistic he is very focused on this issue and wants to solve it.”
FDA officials have defended their response, saying it took time to investigate the source of the infections and what could be done to reduce the risks.
Last month, the agency said it was aware of 135 possible patient infections from January 2013 to December 2014 linked to duodenoscopes.
Olympus spokesman Mark Miller noted that “while any complication affecting a patient’s health is a serious matter, the reported incidence of infections is extremely low” compared with the 500,000 ERCP procedures performed annually.
Cedars launched a review of its scopes and patient records after the UCLA incident became public. The hospital said its infection-control experts used molecular analysis to identify the unique “fingerprint” of bacteria among patients who received ERCP.
To prevent further infections, the hospital took the tainted scope out of service and adopted additional safety measures, including enhanced monitoring of scopes before and after procedures.
Cedars is offering patients who were possibly exposed a free home testing kit.
McGiffert, a consumer advocate, said the intense scrutiny comes too late for some patients.
“It’s really horrific to know so many people underwent these procedures when they could have known the danger beforehand,” she said. “They went in trusting the system, and the system broke down.”
BALTIMORE — For most of the children who fell ill last year during an outbreak of enterovirus, the symptoms were relatively mild — fever, runny nose, coughing and sneezing.
But then there was this mystery: More than 100 kids suffered an unexplained, polio-like paralysis that struck quickly but even now continues to stump researchers and upend the lives of the families across the country.
For Priya Duggal and her colleagues at the Johns Hopkins University, the biggest puzzle is why those children became paralyzed while their brothers and sisters, who also were exposed to the virus, escaped largely unscathed.
“Is there something in these [paralyzed] kids that is different than the kids that are fine?” said Duggal, a genetic epidemiologist. “Maybe it’s the host, and the virus is a trigger that sets off the paralysis. . . . Maybe it’s something in their genetic makeup.”
Duggal and fellow researchers Aaron Milstone and David Thomas, who are gathering DNA from patients around country, are among the experts trying to find answers for families affected by the paralysis.
Doctors believe the condition, known as “acute flaccid melitis,” is linked to last year’s nationwide outbreak of enterovirus D68, or EV-D68 — part of a family of viruses that appears in summer and fall — but they haven’t proved a connection. The outbreak probably sickened millions of children and sent thousands to doctors’ offices and emergency rooms with severe respiratory problems.
Many of the children with paralysis also got the virus, but initially they weren’t any sicker than their siblings or peers — until they experienced sudden muscle weakness days later.
Some of the children, whose average age is a little younger than 8, have lost the use of an arm or a leg. Some have ended up in wheelchairs or on breathing machines. Although some have improved, according to the Centers for Disease Control and Prevention, almost none have fully recovered.
When viruses mutate, scientists try to stay one step ahead. Columbia University virologist Vincent Racaniello explains the different ways that viruses like enterovirus D68 can change. (Jorge Ribas/The Washington Post)
Recently, as part of the Hopkins genetic study, Duggal sent DNA kits to some of the families wrestling with their new reality. One of the kits arrived at the Sheehan residence in Welches, Ore., a hamlet near Mount Hood.
Bailey Sheehan, then 7, had woken up Oct. 21 with a headache and pain in her neck and back. She soon developed a respiratory infection. The rest of the family — her parents; brother Caleb, 5; and sister Andi, 4 months — also came down with flu-like symptoms.
Everyone but Bailey recovered. Her respiratory problems cleared up, but the nerve pain got worse. One morning she had trouble lifting her arms. She later collapsed while trying to get up from the couch. “Mom,” she shouted, “my leg’s not working!”
Mikell Sheehan rushed her daughter to Randall Children’s Hospital in Portland, an hour’s drive away. Bailey’s right arm had grown weak from shoulder to elbow; her right leg was numb from ankle to knee. She underwent tests, including for West Nile virus and Guillain-Barré syndrome. Physicians determined that Bailey had been infected by enterovirus D68, but they couldn’t say for sure whether that caused the paralysis.
“The doctors just tell us they don’t know [the cause],” Sheehan said. “It’s the most terrible feeling to have to tell your little girl, who’s in so much pain and whose leg won’t work, ‘I don’t know how to fix it and neither do the doctors.’ ”
In her hunt for answers, Sheehan has scoured medical literature, called experts at the CDC and traded information online with other parents whose children have been affected. She has written to President Obama and other elected officials, talked to reporters, and enrolled her daughter in studies like the one at Johns Hopkins.
Nearly four months after her ordeal began, Bailey, now 8, still undergoes intense physical therapy six days a week. She’s learning to ride a bike again; her paralyzed foot must be strapped to the pedals. She recently returned to second grade but still uses a leg brace and a walker.
Other children are having similar struggles.
A 13-year-old boy from Joplin, Mo., spent months in a wheelchair after he became paralyzed in September; he still uses a cane to walk. A first-grade boy in Tennessee lost the use of his right arm. Another girl in Oregon was almost completely paralyzed from the neck down.
In Seabrook, N.H., Dan Dugan, 13, spent nearly 50 days in Boston hospitals last fall after he had paralysis in his left arm and leg. Friends and businesses organized fundraisers. A store posted a sign saying, “Pray for Danny.” After months of rehabilitation, Dan, the youngest of six children, was able to move from a wheelchair to a walker and he recently began using special crutches.
“He’s got a good attitude,” said his father, Patrick Dugan, a mechanic who owns Pat’s Towing in Seabrook. “He’s not down about what happened. He has kind of accepted everything.”
No direct link to virus found
Mary Anne Jackson, chief of infectious diseases at Children’s Mercy Hospital in Kansas City, Mo., is one of the researchers trying to explain the inexplicable condition.
When several cases surfaced at her hospital last year in children between the ages of 4 and 13, she and other doctors suspected that enterovirus was the culprit.
“We looked at blood, spinal fluid, stool — thinking we’d find [the EV-D68] virus,” Jackson said. “It just wasn’t there.”
They also saw on MRIs what other doctors nationwide were noticing: distinctive damage to a specific part of the spinal cord. “That’s the classic feature of polio,” Jackson said. “On the scan, it looks like polio.”
Doctors in Kansas City and at other children’s hospitals are examining hundreds of old MRIs of children who had suffered from limb weakness to see if the same pattern on the images may have been overlooked in the past.
Researchers at the CDC are equally perplexed.
In any given year, it’s not uncommon for several cases of acute flaccid paralysis to occur, said Jim Sejvar, a CDC neuroepidemiologist. But when the agency queried doctors around the country, he said, “almost unanimously, you get a response that they’ve really never seen anything like this.”
Like other specialists, Sejvar thinks there’s a striking association between EV-D68 and the sudden onset of paralysis. “If you overlay the epidemiological curves,” he said, “they are almost identical.”
CDC scientists haven’t had any more luck than other researchers in finding a direct link. They recently developed a test for antibodies in the blood that was designed to show whether children who became paralyzed were more likely to have had EV-D68 than other children.
But when officials tested the blood of children who had experienced severe respiratory problems and other flu-like symptoms from last fall and from previous years, nearly all of them possessed antibodies to the virus, offering no new evidence that EV-D68 was the cause of the paralysis cases. It was another dead end.
The U.S. Treasury Department has rebuffed a request by House Ways and Means Chairman Rep. Paul Ryan, R- Wis., to explain $3 billion in payments that were made to health insurers even though Congress never authorized the spending through annual appropriations.
At issue are payments to insurers known as cost-sharing subsidies. These payments come about because President Obama’s healthcare law forces insurers to limit out-of-pocket costs for certain low income individuals by capping consumer expenses, such as deductibles and co-payments, in insurance policies. In exchange for capping these charges, insurers are supposed to receive compensation.
What’s tricky is that Congress never authorized any money to make such payments to insurers in its annual appropriations, but the Department of Health and Human Services, with the cooperation of the U.S. Treasury, made them anyway.
Health and Human Services spending on these cost-sharing payments is one of the issues named in House Speaker John Boehner’s lawsuit against the Obama administration’s executive actions on Obamacare.
In a Feb. 3 letter to Treasury Secretary Jack Lew, Ryan, along with House Energy and Commerce Committee Chair Rep. Fred Upton, R-Mich., asked for “a full explanation for, and all documents relating to” the administration’s decision to make the cost-sharing payments without congressional authorization.
In response, on Wednesday, the Treasury Department sent a letter to Ryan largely describing the program, without offering a detailed explanation of the decision to make the payments. The letter revealed that $2.997 billion in such payments had been made in 2014, but didn’t elaborate on where the money came from. Over the next decade, cost-sharing payments to insurers are projected by the Congressional Budget Office to cost taxpayers nearly $150 billion.
Instead of detailing the basis for making the payments without appropriations, Treasury officials cited the ongoing House GOP litigation, and referred Ryan to the Department of Justice.
In a brief filed on Jan. 26, DOJ lawyers wrotethat the Boehner lawsuit was incorrect in saying that the payments required annual appropriation. “The cost sharing reduction payments are being made as part of a mandatory payment program that Congress has fully appropriated,” the brief read.
But this argument is undercut by the administration’s own previous budget request.
For fiscal year 2014, the Centers for Medicare and Medicaid Services (the division of Health and Human Services that implements the program), asked Congress for an annual appropriation of $4 billion to finance the cost-sharing payments that year and another $1.4 billion “advance appropriation” for the first quarter of fiscal year 2015, “to permit CMS to reimburse issuers …”
In making the request, CMS was in effect acknowledging that it needed congressional appropriations to make the payments. But when Congress rejected the request, the administration went ahead and made the payments anyway.
The argument that annual appropriations are required to make payments is also backed up by a report from the Congressional Research Service, which has differentiated between the tax credit subsidies that Obamacare provides to individuals to help them purchase insurance, and the cost-sharing payments to insurers.
In a July 2013 letter to then Sen. Tom Coburn, Congressional Research Service wrote that, “unlike the refundable tax credits, these [cost-sharing] payments to the health plans do not appear to be funded through a permanent appropriation. Instead, it appears from the President’s FY2014 budget that funds for these payments are intended to be made available through annual appropriations.”