TOI Social Impact Awards: Wheeling healthcare to remote corners

Mental health and trauma — two of India's top killers — have seldom received the attention they deserve from the government. But the awards jury turned the spotlight squarely on these problems. This year, it awarded organizations that provide emergency care or work for the welfare of persons with mental disabilities.

In the corporate category, Ziqitza Health Care, which operates over 860 ambulances in Rajasthan, Punjab, Bihar , Kerala and Mumbai, and says it has transported more than 1.8 million people, has won the award.

Ziqitza was set up to help establish an ambulance service that's accessible and affordable to all sections of society in medical emergencies, irrespective of the affected person's capacity to pay for it. It conceived a cross-subsidy , fee-based service using differential pricing where wealthier customers would pay the full rate for the ambulance service while the poor get hefty discounts and free service.

In the government category, the jury unanimously approved the National Trust for the Welfare of Persons with Autism Cerebral Palsy Mental Retardation and Multiple Disabilities. The organization provides health insurance for people with intellectual and developmental disabilities . Under the ministry of social justice & empowerment, this centre was started in 2007 when no health insurance products were available for people with intellectual and developmental disabilities.

The scheme does not discriminate on severity of any pre-insurance condition and is for all ages. It provides for a bouquet of services, including therapy, surgery and even alternative medicine up to Rs 1 lakh per annum at a nominal premium of Rs 250 per annum for those earning just Rs 15,000 per month and a premium of Rs 500 per annum for those earning more. Over 800 NGOs across India are involved in rolling out the scheme.

In the NGO category, the Karuna Trust that provides free primary healthcare in remote, tribal and insurgency-prone regions in partnership with the government left behind all other claimants. The trust was started by Dr H Sudarshan in BR Hills, Karnataka for the integrated development of tribal people. Karuna Trust has worked to "reach the unreached" and provide free primary healthcare for the past 26 years.

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Retooling Pap test to spot more kinds of cancer

WASHINGTON (AP) — For years, doctors have lamented that there's no Pap test for deadly ovarian cancer. Wednesday, scientists reported encouraging signs that one day, there might be.

Researchers are trying to retool the Pap, a test for cervical cancer that millions of women get, so that it could spot early signs of other gynecologic cancers, too.

How? It turns out that cells can flake off of tumors in the ovaries or the lining of the uterus, and float down to rest in the cervix, where Pap tests are performed. These cells are too rare to recognize under the microscope. But researchers from Johns Hopkins University used some sophisticated DNA testing on the Pap samples to uncover the evidence — gene mutations that show cancer is present.

In a pilot study, they analyzed Pap smears from 46 women who already were diagnosed with either ovarian or endometrial cancer. The new technique found all the endometrial cancers and 41 percent of the ovarian tumors, the team reported Wednesday in the journal Science Translational Medicine.

This is very early-stage research, and women shouldn't expect any change in their routine Paps. It will take years of additional testing to prove if the so-called PapGene technique really could work as a screening tool, used to spot cancer in women who thought they were healthy.

"Now the hard work begins," said Hopkins oncologist Dr. Luis Diaz, whose team is collecting hundreds of additional Pap samples for more study and is exploring ways to enhance the detection of ovarian cancer.

But if it ultimately pans out, "the neat part about this is, the patient won't feel anything different," and the Pap wouldn't be performed differently, Diaz added. The extra work would come in a lab.

The gene-based technique marks a new approach toward cancer screening, and specialists are watching closely.

"This is very encouraging, and it shows great potential," said American Cancer Society genetics expert Michael Melner.

"We are a long way from being able to see any impact on our patients," cautioned Dr. Shannon Westin of the University of Texas MD Anderson Cancer Center. She reviewed the research in an accompanying editorial, and said the ovarian cancer detection would need improvement if the test is to work.

But she noted that ovarian cancer has poor survival rates because it's rarely caught early. "If this screening test could identify ovarian cancer at an early stage, there would be a profound impact on patient outcomes and mortality," Westin said.

More than 22,000 U.S. women are diagnosed with ovarian cancer each year, and more than 15,000 die. Symptoms such as pain and bloating seldom are obvious until the cancer is more advanced, and numerous attempts at screening tests have failed.

Endometrial cancer affects about 47,000 women a year, and kills about 8,000. There is no screening test for it either, but most women are diagnosed early because of postmenopausal bleeding.

The Hopkins research piggybacks on one of the most successful cancer screening tools, the Pap, and a newer technology used along with it. With a standard Pap, a little brush scrapes off cells from the cervix, which are stored in a vial to examine for signs of cervical cancer. Today, many women's Paps undergo an additional DNA-based test to see if they harbor the HPV virus, which can spur cervical cancer.

So the Hopkins team, funded largely by cancer advocacy groups, decided to look for DNA evidence of other gynecologic tumors. It developed a method to rapidly screen the Pap samples for those mutations using standard genetics equipment that Diaz said wouldn't add much to the cost of a Pap-plus-HPV test. He said the technique could detect both early-stage and more advanced tumors. Importantly, tests of Paps from 14 healthy women turned up no false alarms.

The endometrial cancers may have been easier to find because cells from those tumors don't have as far to travel as ovarian cancer cells, Diaz said. Researchers will study whether inserting the Pap brush deeper, testing during different times of the menstrual cycle, or other factors might improve detection of ovarian cancer.

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Flu Kills 4 Seniors, Sickens 700 in Boston

An early and nasty flu season has prompted a public health emergency in Boston, where health officials say 700 people have been diagnosed with the cold-weather virus. Four Bostononians -- all elderly -- have died from flu.

"This is the worst flu season we've seen since 2009, and people should take the threat of flu seriously," Boston Mayor Thomas Menino said in a statement.

This time last year the city had seen only 70 cases of influenza, The Associated Press reported. And with flu activity likely to extend into March or even April, the number will only grow.

Menino said the city is working with health care centers to offer free flu vaccines, and he urged anyone with flu-like symptoms to stay home from work or school.

"This is not only a health concern, but also an economic concern for families," he said in the statement. "I'm urging residents to get vaccinated if they haven't already."

Eighteen people have died from flu in Massachusetts, one of 41 states battling widespread influenza outbreaks. Emergency rooms across the country have been overwhelmed with flu patients, turning away some of them and others with non-life-threatening conditions for lack of space.

The proportion of people seeing their doctor for flu-like symptoms jumped to 5.6 percent from 2.8 percent in the past month, according to the CDC.

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Northwestern Memorial Hospital in Chicago reported a 20 percent increase in flu patients every day. Northwestern Memorial was one of eight hospitals on bypass Monday and Tuesday, meaning it asked ambulances to take patients elsewhere if they could do so safely.

Dr. Besser's Tips to Protect Yourself From the Flu

Most of the hospitals have resumed normal operations, but could return to the bypass status if the influx of patients becomes too great.

"Northwestern Memorial Hospital is an extraordinarily busy hospital, and oftentimes during our busier months, in the summer, we will sometimes have to go on bypass," Northwestern Memorial's Dr. David Zich said. "We don't like it, the community doesn't like it, but sometimes it is necessary."

A tent outside Lehigh Valley Hospital in Salisbury Township, Pa., was set up to tend to the overflowing number of flu cases.

A hospital in Ohio is requiring patients with the flu to wear masks to protect those who are not infected.

State health officials in Indiana have reported seven deaths. Five of the deaths occurred in people older than 65 and two younger than 18. The state will release another report later today.

Doctors are especially concerned about the elderly and children, where the flu can be deadly.

"Our office in the last two weeks has exploded with children," Dr. Gayle Smith, a pediatrician in Richmond, Va., said

It is the earliest flu season in a decade and, ABC News Chief Medical Editor Dr. Besser says, it's not too late to protect yourself from the outbreak.

"You have to think about an anti-viral, especially if you're elderly, a young child, a pregnant woman," Besser said.

"They're the people that are going to die from this. Tens of thousands of people die in a bad flu season. We're not taking it serious enough."

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Venezuela postpones inauguration for cancer-stricken Chavez

CARACAS (Reuters) - Venezuela will postpone the inauguration of President Hugo Chavez for a new term due to health problems, the government said on Tuesday, another sign the socialist leader's cancer may be bringing an end to his 14 years in power.

The 58-year-old former soldier who has dominated the South American OPEC nation since 1999 has not been heard from since surgery on December 11 in Cuba - his fourth operation since he was diagnosed with an undisclosed type of cancer in June 2011.

The announcement outraged opposition leaders who insist that Chavez must be sworn in before the National Assembly on January 10 as laid out in the constitution, or temporarily step aside and leave an ally in power.

"The commander president wants us to inform that, based on his medical team's recommendations, the post-operative recovery should extend past January 10," said Vice President Nicolas Maduro, Chavez's chosen successor, in a letter read to the legislature.

"As a result, he will not be able to be present at the National Assembly on that date."

The letter said authorities would seek another date for the inauguration ceremony but did not say when it would take place or give a time frame for Chavez's return from Havana.

Rather than being sworn in by the legislature, he would take his oath at a later date before the Supreme Court, the letter said, as allowed by the constitution.

Government leaders insist Chavez is completely fulfilling his duties as head of state, even though official medical bulletins say he has a severe pulmonary infection and has had trouble breathing.

The government has called for a massive rally outside the presidential palace on Thursday, and allied presidents including Uruguay's Jose Mujica and Bolivia's Evo Morales have confirmed they will visit Venezuela this week despite Chavez's absence.

Argentine President Cristina Fernandez has announced plans to visit Chavez in Havana on Friday.

But the unprecedented silence by the president - famous for regularly speaking for hours in meandering broadcasts - has left many convinced he could be in his last days.

His resignation or death would upend politics in the oil-rich nation, where he enjoys a deity-like status among poor supporters thankful for his social largesse.

His critics call him a fledgling dictator who has squandered billions of dollars from crude sales while dashing the independence of state institutions.

CONSTITUTION DISPUTE

The constitution does not specify what happens if the president does not take office on January 10.

The Supreme Court, controlled by Chavez allies, called a news conference for Wednesday. It is widely expected to announce an interpretation of the constitution that will give Chavez leeway to take office when he is fit to do so.

If he dies or steps aside, new elections would be called within 30 days. Before leaving for Havana in December, the president instructed his supporters to back Maduro in that vote if he were unable to continue.

Opposition leaders argue that Congress chief and Chavez ally Diosdado Cabello should take over, as mandated by the constitution if the president's absence is formally declared.

Cabello has ruled that out, saying the president continues to be in charge.

"Who could have believed the opposition would be screaming for Diosdado Cabello to be given the presidency of the republic?" he said during a rambunctious session of Congress. "That's crazy, the opposition is losing it."

Meanwhile opposition deputies accused the Socialist Party of failing to follow Chavez's instructions - a scene that would have been unimaginable before Chavez's prolonged absence.

"President Chavez is the only one among you who has spoken clearly," said opposition leader Julio Borges.

He was drowned out by pro-Chavez deputies clapping and chanting the socialist leader's name and rebuffed by Cabello, who had long been considered a potential successor to Chavez until he was passed over for Maduro.

"It's not my fault you weren't chosen, don't take your frustration out on me," Borges quipped.

Another opposition deputy complained that during the debate a copy of the constitution was thrown across the chamber from the direction of the Socialist Party's deputies.

Chavez's supporters have held near-daily vigils for his recovery, while opposition activists accuse the president's allies of a Cuban-inspired manipulation of the situation.

Maduro has taken over the day-to-day running of the government and looks set to continue in the role past Thursday.

The mustachioed former bus driver lacks Chavez's charisma, but he has sought to imitate the president's style with vituperative attacks on the opposition and televised ribbon-cutting ceremonies.

With the micro-managing Chavez away, major policy decisions in Venezuela, such as a widely expected devaluation of the bolivar currency, appear to be on hold.

Venezuelan bond prices, which had soared in recent weeks on Chavez's health woes, dipped on Monday and Tuesday as investors' expectations of a quick government change apparently dimmed.

"The 'regime change' euphoria seems excessive taking into account the unclear legal transition and perhaps, more importantly, the risk that regime change does not allow for policy change," New York-based Jefferies' managing director Siobhan Morden said in a note on the bonds.

(Editing by Daniel Wallis and Eric Beech)

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Relatives sob as US massacre 911 calls heard in court

CENTENNIAL, Colorado: Relatives wept in court Tuesday as frantic 911 calls were played from a US theater shooting that killed 12 people last year, as prosecutors closed their case for the alleged gunman to face trial.

The court heard how suspected killer James Holmes purchased more than 6,000 rounds of ammunition in the months before last July's shooting in Colorado, and rigged up elaborate booby-traps at his apartment.

Defense lawyers will call witnesses Wednesday, the third day of hearings, to decide if there is enough evidence for Holmes to go on trial. They are expected to highlight his mental instability as a possible reason he should not do so.

In the first of 41 harrowing emergency calls made in a 10-minute period in Colorado, 30 loud booms could be heard in less than half-a-minute, making it difficult for the 911 dispatcher to distinguish what was being said.

In another, six minutes after the first call was logged at 12:38 am, 14-year-old Kaylan Bailey told the emergency operator her two cousins had been shot, and that one of them did not appear to be breathing.

"We need to start CPR (cardio-pulmonary resuscitation) on your cousin who's not breathing," said the operator.

"I can't hear you," responded Bailey, as chaos unfolded in the theater in Aurora, where Holmes -- clad in body armor and a mask -- threw at least one smoke-bomb type device before opening fire in the early hours of July 20.

The hearings opened Monday with officers choking back tears as they recalled scenes after the slaughter, which left 12 dead and 58 injured by gunshots at a packed midnight screening of the Batman film "The Dark Knight Rises."

The Aurora massacre revived the perennial US debate over gun control -- an issue re-ignited even more intensely by last month's shooting of 20 young children at a Connecticut elementary school.

Tuesday's hearing heard testimony from federal firearms supervisor Steven Beggs that Holmes made at least 16 purchases from May to July 2012 including four firearms, incendiary devices and almost 6,300 rounds of ammunition.

Holmes's lawyers could argue that he is mentally unfit to stand trial.

Defense attorney Tamara Brady asked Beggs: "Is there any process in Colorado to screen out purchases by a severely mentally ill person?"

"No," replied Beggs, who detailed the purchases made online and in person by Holmes.

FBI bomb technician Garrett Gumbinner said Holmes told investigators after being arrested that he had booby-trapped his apartment, in an attempt to draw emergency responders away from the theater shooting site.

Officers found a trip wire at the door of his home, rigged to set off flame and sparks that would catch the gasoline-soaked carpet and go on fire.

There were six-inch fireworks shells filled with improvised thermite, a hot-burning explosive.

"You can't put it out with water," Gumbinner told judge William Sylvester. There were also three containers of improvised napalm, 11 bottles of gasoline and other chemicals intended to act as fire accelerants, he said.

There were three systems in the apartment intended to initiate the explosive devices, including one linked to a trash bag near the apartment dumpster by a remote control.

Curious behavior by Holmes during police questioning was also recounted: At one point he tried to stick a metal staple into a power socket. At another he played hand puppets with gloves that had been put on him to preserve evidence.

Prosecutors are trying to build up their case that the shootings were a premeditated act of mass murder, and identifying Holmes as the lone shooter.

Supporting that strategy, Aurora police officer Tom Welton testified that Holmes made postings on two dating websites earlier in July, asking "Will you visit me in prison?"

Prosecutors wrapped up their evidence in the hearing by listing all the victims by name, the injuries they suffered and the charges -- more than 160 in all -- filed on behalf of each.

-AFP/ac

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Hate speech case: MIM MLA Akbaruddin Owaisi sent to 14- day judicial custody

HYDERABAD: Majlis-e-Ittehadul Muslimeen MLA Akbaruddin Owaisi, facing multiple cases for his alleged " hate speech", was today remanded to 14-day judicial custody by a magistrate in Nirmal town of Adilabad district.

Akbaruddin was reportedly questioned and produced before the magistrate at 5:30am, after which he was sent to judicial custody.

The Magistrate also asked the police to produce the MLA before the court later today at 10:30 am.

Owaisi has been taken to the Nirmal town police station, and his petition is expected to be listed at the Andhra Pradesh high court today.

Owaisi was arrested yesterday, a day after he returned from London and was admitted to a hospital for a medical check up, before being taken into custody.

Following the arrest of the MIM leader, the state government has imposed a prohibitory orders in the town to maintain law and order.

Additional security forces have been deployed in Hyderabad and Adilabad as a precautionary measure.

Owaisi, the floor leader of his party in the Andhra Pradesh Assembly, is facing a case against him in Adilabad for alleged provocative speeches regarding the disputed Bhagyalakshmi shrine in the Charminar area.

Complaints have been filed against him in regard to the same speeches in various police stations in Hyderabad and other parts of the state.

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Report: Death rates from cancer still inching down

WASHINGTON (AP) — Death rates from cancer are continuing to inch down, researchers reported Monday.

Now the question is how to hold onto those gains, and do even better, even as the population gets older and fatter, both risks for developing cancer.

"There has been clear progress," said Dr. Otis Brawley of the American Cancer Society, which compiled the annual cancer report with government and cancer advocacy groups.

But bad diets, lack of physical activity and obesity together wield "incredible forces against this decline in mortality," Brawley said. He warned that over the next decade, that trio could surpass tobacco as the leading cause of cancer in the U.S.

Overall, deaths from cancer began slowly dropping in the 1990s, and Monday's report shows the trend holding. Among men, cancer death rates dropped by 1.8 percent a year between 2000 and 2009, and by 1.4 percent a year among women. The drops are thanks mostly to gains against some of the leading types — lung, colorectal, breast and prostate cancers — because of treatment advances and better screening.

The news isn't all good. Deaths still are rising for certain cancer types including liver, pancreatic and, among men, melanoma, the most serious kind of skin cancer.

Preventing cancer is better than treating it, but when it comes to new cases of cancer, the picture is more complicated.

Cancer incidence is dropping slightly among men, by just over half a percent a year, said the report published by the Journal of the National Cancer Institute. Prostate, lung and colorectal cancers all saw declines.

But for women, earlier drops have leveled off, the report found. That may be due in part to breast cancer. There were decreases in new breast cancer cases about a decade ago, as many women quit using hormone therapy after menopause. Since then, overall breast cancer incidence has plateaued, and rates have increased among black women.

Another problem area: Oral and anal cancers caused by HPV, the sexually transmitted human papillomavirus, are on the rise among both genders. HPV is better known for causing cervical cancer, and a protective vaccine is available. Government figures show just 32 percent of teen girls have received all three doses, fewer than in Canada, Britain and Australia. The vaccine was recommended for U.S. boys about a year ago.

Among children, overall cancer death rates are dropping by 1.8 percent a year, but incidence is continuing to increase by just over half a percent a year. Brawley said it's not clear why.

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Holmes Played Childish Games After Aurora Carnage

As police confronted the movie theater carnage and a massive booby trap left behind by accused Aurora gunman James Holmes, the suspect loopily played with hand puppets, tried to stick a metal staple in an electrical socket and clamly flipped a styrofoam cup, according to court testimony today.

Holmes, 25, displayed the bizarre behavior once he was in custody and taken to Aurora police headquarters after the shooting that left 12 people dead and dozens injured, the lead investigator in the case testified today.

While being cross examined by Colorado public defender Daniel King, Police Detective Craig Appel was asked about the observations of two Aurora officers assigned to watch over Holmes in an interrogation room.

Appel said that to preserve possible gunshot residue, police had placed paper bags over Holmes' hands. One officer, King said, noted in a report that Holmes began moving his hands "in a talking puppet motion."

Click here for full coverage of the Aurora movie theater shooting.

King asked if Appel was also aware that the officer "observed Holmes take a staple out of the table and tried to stick it in an electrical socket?" Appel confirmed Holmes' actions.

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The officers also noted that they watched as Holmes began playing with an empty styrofoam cup, trying to "flip it" on the table.

While Holmes was carrying out his childish antics, police were puzzling over a complex booby trap Holmes had left behind in his apartment, according to testimony.

A gasoline-soaked carpet, loud music and a remote control car were part of Holmes' plan to trick someone into triggering a blast that would destroy his apartment and lure police to the explosion while he shot up a movie theater in Aurora, Colo., according to court testimony.

FBI agent Garrett Gumbinner told the court that he interviewed Holmes on July 20, hours after he killed 12 and wounded 58 during the midnight showing of "The Dark Knight Rises."

"He said he rigged the apartment to explode to get law enforcement to send resources to his apartment instead of the theater," Gumbinner said.

His plan failed to prompt someone into triggering the bombs.

Gumbinner said Holmes had created two traps that would have set off the blast.

The apartment was rigged with a tripwire at the front door connected to a mixture of chemicals that would create heat, sparks and flame. Holmes had soaked the carpet with a gasoline mixture that was designed to be ignited by the tripwire, Gumbinner said.

"It would have caused fire and sparks," the agent said, and "would have made the entire apartment explode or catch fire."

Holmes had set his computer to play 25 minutes of silence followed by loud music that he hoped would cause a disturbance loud enough that someone would call police, who would then respond and set off the explosion by entering the apartment.

Gumbinner said Holmes also told him he rigged a fuse between three glass jars that would explode. He filled the jars with a deadly homemade chemical mixture that would burn so hot it could not be extinguished with water.

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Ex-governor in North Korea with Google chief; seeks American's release

SEOUL (Reuters) - Former New Mexico Governor Bill Richardson and Google Executive Chairman Eric Schmidt began a controversial private mission to North Korea on Monday that will include an effort to secure the release of an imprisoned American.

The trip comes after North Korea carried out a long-range rocket test last month and as, according to satellite imagery, the reclusive state continues work on its nuclear testing facilities, potentially paving the way for a third nuclear bomb test.

Footage from North Korean state television showed Richardson and Schmidt at the Pyongyang airport on Monday evening.

"We are going to ask about the American who's been detained. A humanitarian private visit." Richardson said.

Richardson's efforts to seek the release of Kenneth Bae, a Korean-American tour guide who was detained last year will mark the latest in a series of high-profile visits over the years to free Americans detained by Pyongyang.

The delegation comprised Schmidt, his daughter, Richardson and Google executive Jared Cohen, according to South Korean news media and it arrived in Pyongyang on a flight from the Chinese capital, Beijing.

The mission has been criticized by the United States due to the sensitivity of the timing. The United States does not have diplomatic relations with North Korea and the isolated and impoverished state remains technically at war with U.S. ally South Korea.

"We continue to think the trip is ill-advised," U.S. State Department spokeswoman Victoria Nuland said in Washington. Last week she said the main U.S. objection was that the trip came so soon after North Korea's much-criticized December 12 rocket launch.

South Korea is in the midst of a transition to a new president who will take office in February, while Japan, another major U.S. ally in the region, has a new prime minister.

A U.S. official said the trip's timing was particularly bad from the Obama administration's point of view because it comes as the U.N. Security Council ponders how to respond to the North Korean missile launch.

"We are in kind of a classical provocation period with North Korea. Usually, their missile launches are followed by nuclear tests," said the official, who spoke on condition of anonymity.

"During these periods, it's very important that the international community come together, certainly at the level of the U.N. Security Council, to demonstrate to North Korea that they pay a price for not living up to their obligations."

Richardson, a former ambassador to the United Nations, has made numerous trips to North Korea in the past that have included efforts to free detained Americans. The reasons for Schmidt's involvement in the trip are not clear, though Google characterized it as "personal" travel.

Schmidt did not respond to requests for comment.

Richardson told CBS television last Friday that he had been contacted by Bae's family and that he would raise the issue while in North Korea.

Pyongyang's most notable success was securing a visit from former President Bill Clinton in 2009 to win the release of two American journalists.

Last year, Jared and Schmidt met defectors from North Korea, a state that ranks bottom in an annual survey of Internet and press freedom by Reporters Without Borders.

Media reports and think tanks say that officials from the North Korean government went to Google's headquarters in 2011, something the U.S. technology giant declined to comment on.

(Additional reporting by Cho Meeyoung and WASHINGTON Bureau; Editing by Michael Perry, Ron Popeski and David Brunnstrom)

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Hagel draws fire as Obama's Pentagon pick

WASHINGTON: US President Barack Obama named Chuck Hagel on Monday to lead the Pentagon, setting up an ugly confirmation battle as Republican opponents said he was too hard on Israel and too soft on Iran.

Obama's choice of John Brennan to replace scandal-tainted David Petraeus as CIA chief was seen as more straightforward despite the counter-terrorism czar's defense of "enhanced interrogation techniques" and the US drone war.

The second term revamp of the president's national security team was expected to win ultimate approval but several leading Republicans signaled they would make it tough for Hagel even though he is one of their own.

Obama paid particular tribute to retiring Pentagon chief Leon Panetta before giving ringing endorsements to the "outstanding" Hagel and Brennan and urging the Senate not to dally in confirming their important appointments.

"Chuck Hagel is the leader that our troops deserve. He is an American patriot," the president said, heaping praise on a war hero who was awarded two Purple Heart medals for his bravery as a soldier in Vietnam.

"When Chuck was hit by shrapnel, his brother saved him. When his brother was injured by a mine, Chuck risked his life to pull him to safety. To this day, Chuck bears the scars -- and the shrapnel -- from the battles he fought in our name," Obama said.

Some Republicans have never forgiven him for his outspoken criticism of ex-president George W. Bush's handling of the Iraq war, and his closeness to the Democratic president sees him regarded by others as a traitor.

But Obama, who wants to be remembered as a leader who ended wars abroad to set about the tricky task of nation-building at home following a crippling recession, described Hagel as someone perfectly fitted to that mold.

"Maybe most importantly, Chuck knows that war is not an abstraction. He understands that sending young Americans to fight and bleed in the dirt and mud, that's something we only do when it's absolutely necessary," he said.

Administration appointments are often tense affairs in the United States as confirmation hearings provide senators with opportunities to turn away unwanted candidates or score cheap political points, or both.

Hagel, 66, known for a fiercely independent streak and a tendency to speak bluntly, is expected to get particularly rough treatment due to his criticism of America's "Jewish lobby" and opposition to some Iran sanctions.

Republican Senator Lindsey Graham said Hagel would be "the most antagonistic defense secretary towards the state of Israel in our nation's history."

Another Republican senator, John Cornyn of Texas, said he would oppose the nomination, charging it would be the "worst possible message we could send to our friend Israel and the rest of our allies in the Middle East."

But in an interview with The Lincoln Journal Star, a newspaper in his home state of Nebraska, Hagel hit back at his critics.

There is "not one shred of evidence that I'm anti-Israeli, not one vote (of mine) that matters that hurt Israel," he said.

If confirmed by the Senate, Hagel will have to manage major cuts to military spending while wrapping up the US war effort in Afghanistan and preparing for worst-case scenarios in Iran or Syria.

Serving as an enlisted man who never joined the officer ranks, Hagel carries a particular empathy for the unheralded infantry "grunts" in the field.

As he grapples with budget pressures, the former sergeant will likely try to shield frontline troops from the effect of spending cuts.

In his typical straight-shooting fashion, Hagel has called the Defense Department "bloated" and said that "the Pentagon needs to be pared down."

Obama, smarting from watching Susan Rice -- reportedly his first choice to succeed Hillary Clinton as secretary of state -- fold her bid in the face of Republican opposition, pressed hard for the Senate to approve Hagel.

"He would be the first person of enlisted rank to serve as secretary of defense. One of the few secretaries who had been wounded in war and the first Vietnam veteran to lead the department," Obama said, calling his appointment "historic."

Brennan, 57, may get an easier ride but is sure to face questions over his support for the use of certain "enhanced interrogation techniques" under the Bush administration and for his staunch defense of the US drone program.

The 25-year Central Intelligence Agency veteran, an Arabic-speaking Middle East expert, replaces Petraeus, who resigned in November after confessing to an extramarital affair with his biographer Paula Broadwell.

Obama highlighted what he called Brennan's incredible work ethic, saying "John is legendary even in the White House" and reminding everyone of a now-famous quote from August 2010.

Asked if he got any down time or was all work and no play, Brennan replied: "I don't do down time."

In a moment of levity at the White House event, the avuncular 74-year-old Panetta drew loud laughs when he said he would be retiring to his walnut farm and "dealing with a different set of nuts."

- AFP/ac

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