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Dr. Donald Brown inoculated Kelly Kent with the HPV vaccine in his Chicago office in the summer of 2006 -- not long after the first version of the vaccine reached the market. (AP)

U.S. Teens Still Lag In Getting Vaccinated Against HPV

by Nicholas St. Fleur
Jul 24, 2014

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Though the vaccine against human papilloma virus is highly effective in preventing certain forms of cancer, the number of preteens getting the vaccine is still dismally low, doctors from the Centers for Disease Control and Prevention announced Thursday.

"One of the top 5 reasons parents listed is that it hadn't been recommended to them by a doctor or nurse," the CDC's Dr. Anne Schuchat told reporters at a press briefing.

"Parents who aren't planning to vaccinate lacked knowledge and didn't hear a physician recommendation," said Schuchat, who directs the CDC's National Center for Immunization and Respiratory Diseases. "We don't think it's an issue of politics. This is something that parents seem to be open to."

Federal health officials have for several years been recommending that all preteen boys and girls be vaccinated around age 11 or 12 — before the initiation of sexual activity. That's when the vaccine has been shown to be most protective against HPV infections that can lead to cervical cancer, genital warts and oral and anal cancers.

But data from the national survey released Thursday, and published in this week's Morbidity and Mortality Weekly Report, suggest that only 57 percent of young women ages 13-17 — and only 35 percent of young men that age — have received one or more vaccine doses.

Every year more 27,000 people in the U.S. get cancer caused by HPV, Schuchat said.

Protection against the virus did go up a little bit in 2013, the survey showed, compared with 2012, when 53.8-percent of young women and 20.8 percent of young men had received the vaccine. Still, more needs to be done, Schuchat said.

Doctors and nurses are missing many good opportunities to vaccinate for HPV, she said. For example, they are already successfully immunizing preteens at high rate against tetanus, diphtheria and pertussis (Tdap) and against meningitis. Roughly 77 percent of 13-17 year olds have been immunized against meningitis, and about 86 percent have received the Tdap vaccine.

The problem is not that doctors are reluctant to give the vaccine, Schuchat said; it's more often a problem of miscommunication. Surveys show many are actually forgetting to mention it to patients.

"Physicians need to know that the vaccines they give can prevent very serious cancers in the U.S.," she said.

At every appointment for adolescents, doctors should tell parents, " 'Today there are three recommended vaccines,' " Schuchat advised. Had shots against HPV been administered when other routine vaccines were given to preteens in the last several years, she says, about 91 percent of today's 14-year-old girls would be protected.

NIS-Teen, which collected information on more than 18,000 teens in the 2013 survey, has been collecting vaccination information since 2006 through use of random-digit-dialing of both landlines and cellphones. After a teen's parent or guardian provided permission to contact the teen's health provider, the survey team mailed the parents a questionnaire. Results from the survey were then verified via a check of medical records.

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Bill Simon, head of Wal-Mart's U.S. division, is leaving the retail giant after being passed over for the company's top post. (Reuters/Landov)

Four Theories About Why Wal-Mart Changed Its U.S. Chief

Jul 24, 2014

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Greg Foran, Wal-Mart's Asia chief, is taking over the company's U.S. division.

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Bill Simon, head of Wal-Mart's U.S. division, is leaving the retail giant, the company said Thursday.

Any major shakeup at Wal-Mart is closely watched because the company is so important — it tops the Fortune 500 list with annual sales approaching a half-trillion dollars. So lots of people are speculating about what Simon's departure really means. Here are some theories:

The Simplest Explanation

Simon was a top candidate to become the chief executive after the previous CEO, Michael Duke, retired. But in February, Doug McMillon stepped into that job.

Wal-Mart spokesman David Tovar has been telling reporters that it's "not unusual" for one executive to leave when passed over for the top spot. Simon himself said in a statement: "This felt like the right time to move on and focus on my next opportunity."

So this may be a routine career move. Nothing to see here, please move along.

The Small-Store Explanation

Charles Fishman, author of "The Wal-Mart Effect," says Simon may have been pushed out in favor of someone who's better at operating small-format stores.

Wal-Mart's shift to smaller grocery and convenience-type stores has been dramatic. This year — for the first time ever — the company will open more small stores, i.e., those with less than 40,000 square feet, than superstores, with 200,000 square feet.

As that trend accelerates, Wal-Mart wants Greg Foran, who was head of Wal-Mart Asia, to run its U.S. operations. Before coming to Wal-Mart, he worked for Woolworths Ltd. in Australia. So Foran has overseen stores of varying sizes, Fishman noted.

Fishman says the smaller-store trend is here to stay because so many Wal-Mart customers have complained that "it takes me too long to walk from my car." When customers see a superstore these days, many think "it's just too big," he said.

At Wal-Mart, "they clearly were looking for fresh eyes" that could see stores the way today's customers do, he said.

The Five-Failed-Quarters Explanation

At Wal-Mart, U.S. same-store sales have declined for five straight quarters. Simon himself admitted in a recent Reuters interview that sales were not improving, blaming the still-tough job market.

"It's really hard to see in our business today ... that it's gotten any better," he said.

A can't-do attitude is rarely welcome in corporate America, where executives are expected to spur growth even through hard times.

So Simon may have doomed himself by sounding too down in the Reuters interview. Brian Sozzi, founder of Belus Capital Advisors, put it this way: "That is a no-no, perhaps a final straw in light of poor management of the business during his tenure."

The Time-For-A-Fresh-Face Explanation

Wal-Mart, which has a lot of low-wage positions among its 1.3 million U.S. workers, has been hit with protests by union-backed groups. Polling suggests the focus on Wal-Mart's reputation for low wages may have dinged its image with some consumers.

And some investors also have gotten tired of Wal-Mart's lackluster stock performance.

So maybe it was just time for a change. Sandy Skrovan, research director at Planet Retail, wrote that to get moving again, Wal-Mart "is definitely open to bringing in fresh blood and new thinking."

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Bill Simon, head of Wal-Mart's U.S. division, is leaving the retail giant after being passed over for the company's top post. (Reuters/Landov)

Brad Katsuyama, Co-Founder Of IEX

Jul 24, 2014

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Greg Foran, Wal-Mart's Asia chief, is taking over the company's U.S. division.

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Host Jessica Harris speaks with Brad Katsuyama, co-founder of IEX- the Investor's Exchange.

Harris also speaks with Marc DaCosta, the co-founder of Enigma, a company that works to make public data accessible and understandable.

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Palestinian men walk amidst debris following an Israeli military strike in Gaza city, on July 23, 2014. (AFP/Getty Images)

Is NPR Biased In Its Gaza Coverage?

Jul 24, 2014

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Israeli soldiers return from the Gaza Strip at an army deployment area near Israel's border with the besieged Palestinian territory on July 23, 2014, as the conflict entered its third week with neither side showing any sign of willingness to pull back. Ari Shapiro is NPR's London bureau chief who filled in to cover the conflict in Gaza.

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Fred Rogers of Northfield, Minn, was clearly upset.

I am appalled at the coverage NPR is providing for the current crisis in Palestine/Israel. All of the stories I have heard have origins in Israel and they all begin with a profusion of support for Israel's defending itself. None express any insight about the three weeks of warfare against the Palestinian population that led up to this conflict.

Hundreds of other listeners and Web readers who wrote in similarly agreed. Yet, even more complaints have poured in like this one from Wendy Zuckerberg of Woodcliff Lake, N.J.:

I am fed up with NPR for its constant bias against Israel. Your news reports only talk about Palestinian casualties. What about the tragedies in Israel? Israeli civilians have lost their homes, been forced into bomb shelters and evacuated, but I've never heard about this on NPR! Also, let's remember who started this. The initial rockets were fired from Gaza!!!

It is tempting to say that if both sides are angry, then NPR must be doing something right. Sociological studies, moreover, find that we all tend to remember news we disagree with more than news we agree with. In other words, our perceptions of bias tend to be exaggerated. But while these observations suggest that we should double-check ourselves, neither proves that there is not in fact a bias in the coverage.

After reviewing, however, all of NPR's stories of the Gaza conflict since June 30, when the bodies of three kidnapped Israeli teens were found, I find that the coverage has been fair and accurate. It has not leaned toward one side or the other.

The passionate responses from listeners are understandable, given that many of them have an emotional investment in a conflict involving religion, identity, or homeland. And, of course, all of us can have strong feelings about news coverage involving life-and-death struggles, wherever they occur.

Public opinion in the United States still overwhelmingly sympathizes with the Israelis, but similar support in much of the rest of the world has eroded over the years and may be slowly tattering in the US, too. The message traffic to me and the main radio shows at NPR seems to be running roughly 60:40 pro-Israel, if you assume that criticism of the coverage for being "pro-Palestinian" reflects a pro-Israeli stance. I suspect that in previous decades, the margin would have been wider. Regardless, it is not for NPR to take sides.

Does this mean that NPR is ducking a journalistic responsibility to find truth, that it is guilty of some sort of false equivalence by not concluding who is right and wrong? Many of the opposing letter writers say yes, holding up morality as being on their side. Robert Siegel raised the question of "moral equivalence" early on in an interview with Israeli author Ari Shavit. No answers were reached, other than Shavit saying that extremists among both Palestinians and Israelis are dangerous.

I asked foreign editor Edith Chapin about how much she thought of these matters in directing NPR's coverage.

"We always think about questions of balance and moral equivalence," she replied, "but sadly there is no tape measure and absolute answer. Journalism is art, not science as many a practitioner has said over the centuries."

The issue of arriving at conclusions can be more clearly done in reporting on any one slice of the story. To their credit, the four reporters on the ground—Jerusalem bureau chief Emily Harris, visiting London bureau chief Ari Shapiro, visiting Berlin correspondent Soraya Sarhaddi Nelson, and stringer Daniel Estrin—have pulled no punches in describing the horror felt by Israelis subject to the ongoing rocket attacks, and the horror felt by Palestinians in Gaza subject to Israeli bombings and ground attacks.

Who started the fighting? Listeners and readers who write in, like Rogers and Zuckerberg above, regularly come back to this critical slice. Each accuses NPR of not correctly assessing blame on the other side.

What I found was that NPR reported that Hamas in Gaza dramatically upped the ante in this latest round of violence by launching the rocket attacks. Shapiro and Estrin did most of the reporting in the early weeks. Harris was on vacation in the western United States at the time, Chapin said, but she hustled back and her return, combined with the passing of time and online explainers by NPR.org international editor Greg Myre, has led to more background analysis on the players and their motivations in the fighting. This has added nuance to the "who started it" question and what to expect next.

Harris in particular has been risking her own life to tell the human side of the story from Gaza. Some pro-Israeli listeners have complained that these Palestinian stories are tear jerk "propaganda," as David Feller-Kopman of Stevenson, Md., wrote in. But the major fighting has been in Gaza, and the unavoidable fact was that as of Thursday morning, 729 Palestinians were reported killed, most of them civilians, versus at least 35 Israelis, two of them civilians.

Many listeners and readers have protested that NPR's reporting on the disproportionate death toll is misleading because Hamas uses civilians as so-called "human shields" by hiding its rockets in neighborhoods and even in mosques. I found that many of the stories indeed reported that many of the rockets were fired from populated urban areas. Siegel, in an on-air interview, bluntly asked a Hamas spokesperson, Ihab al-Ghussein, if Hamas wasn't using a strategy of "victimization" of civilians. Al-Ghussein evaded the answer, but the point was made.

But through the spokesperson and many of the ordinary Gazans interviewed by Harris and Shapiro, we in the audience began to learn another reality, too. In addition to Hamas religious ideology and political calculations being behind the rocket attacks, many civilian Gazans also were willing to risk the high death toll from an inevitable Israeli retaliation because of feeling enraged over what they call Israel's longtime "siege" of Gaza. Despite some relaxation of Israeli restrictions in recent years, most Gazans remain cut off by Israel from trade, business, and travel with most of the world — in large part because of Egyptian restrictions on Gaza's borders, too.

Questions of root causes are never simple in this tiny piece of the world. Each side of the Israeli-Palestinian conflict has its own narrative that emphasizes wrongs committed by the other side over the past 60 or even 100 years. No single story, indeed no group of stories, can possibly put all that bitter history into a context that will satisfy everyone, or anyone. The best NPR can do on this score is to show how the competing convictions about the wider blame have themselves contributed to the continuation of the conflict.

Even then, some Palestinian supporters regularly complain that NPR, and much of the Western media, is blind to a fundamental bias in their framing of stories. NPR does so, these critics claim, by accepting the legitimacy of the state of Israel as fact. There is no blindness here. The framing correctly reflects not just what have come to be bedrock American values, but also international law and a moral decision made by most of the world long ago. This does not mean, however, that the framing should adopt an attitude of Israel right or wrong, and the coverage of the Gaza conflict correctly doesn't.

Related to framing is another frequent complaint of conflicts of interest. As Robert Schaible of Buxton, Maine wrote:

I'd like to expect better from NPR than Ari Shapiro's report yesterday. To begin, your only correspondent in the report was Jewish. What would your pro-Israel listeners say if your only correspondent was an Arab?

I have no idea what Shapiro's religious conviction is. I see nothing in his reporting that reflects a religious bias, and so see no reason to ask him. As Chapin wrote to me:

Ari is an established journalist with a long track record of outstanding reporting at NPR. He is a former White House correspondent, considered one of the most important beats in the US. He has been subjected to spin before. He does his job with great care and attention.

Up until the 1980s, it was common for the American news media not to assign Jewish reporters to the Middle East. This has changed, as it has changed for assigning blacks to cover civil rights, women and LGBT reporters to cover gender and sexuality, Hispanics to cover Latin America, Iranian-Americans to cover Iran, and so on. While Schaible's concern is understandable, the real issue is professionalism, not the religious, racial, national or sexual background of the individual reporter.

As it was, Shapiro and NPR's Arabic translator Nuha Musleh, found themselves caught in the middle of high tensions in Jerusalem's Old City. They walked into a hail of rocks being thrown at passing Palestinian women. Shapiro reported that the police suspected that the perpetrator was an ultra-Orthodox Jew. Recently, Shapiro has rotated out to fill in as a host back in Washington, Chapin said.

Public scrutiny of the reporters covering the conflict between Israelis and Palestinians reflects how sensitive the assignment is and how it can become a career minefield. In public splashes over complaints, one NBC reporter was pulled out of Gaza, as was one CNN reporter, though the former has since returned to his post.

But focusing on the reporters additionally misses a basic point. The most common complaints from both sides have to do with inherent weaknesses in broadcast journalism, especially as practiced by NPR. However, I think that most of us would agree that what is gained in the trade-off that NPR makes by design is more than worth it.

The complaint is that a particular story or on-air interview appears biased because it focuses mostly on one view or one side in the fighting. Pro-Palestinian listeners, for example, complained ferociously early on about the sympathetic stories about the three murdered Israeli boys. They either didn't hear or—as those sociological studies suggest—didn't particularly remember other stories about the impact on Palestinian families of mass arrests and house destructions by Israeli soldiers. Similarly, pro-Israelis have complained vociferously about stories sympathetic to Gazans suffering under Israeli bombing, but didn't hear or overlooked the many stories reporting the fear caused in Israeli towns and cities by Hamas rockets and tunnels.

Shortly before the Israeli ground invasion last week, Sumner Stone, of East Greenwich, R.I., telephoned me at around 3 in the afternoon to complain that NPR had failed to report that 13 heavily armed Palestinian infiltrators had been caught trying to sneak through a tunnel with the apparent intention of attacking the small Israeli kibbutz of Sufa near the Gaza border. The incident had been on the Israeli news for the "last 12-14 hours," he said. Yet NPR seemed only to be carrying stories about the four Palestinian children killed on the beach by Israeli fire.

"Was it INTENTIONALLY IGNORED," Stone soon wrote me of Sufa, "while the tragic story of the UNINTENTIONAL killing of the four youths was SENSATIONALIZED for two days in a row?"

Nothing of the kind, Robert Garcia, the managing editor of NPR's hourly newscasts, told me. Stringer Estrin, as part of the excellent fill-in he has been doing since the crisis broke out, reported on the Sufa incident in the lead story package of the hourly newscast at 6 a.m. Eastern time.

This is not to fault Stone; I wasn't listening at that hour, and I presume he wasn't either. NPR's newscasts, moreover, are not transcribed or stored online. Other events soon took over the hourly reports. Still, by that night the many tunnels found by Israel had become a central part of NPR's invasion coverage, and continue to be.

Interviews by the show hosts come in for particular criticism for being one-sided, or not pushing far enough.

The Committee for Accuracy in Middle East Reporting in America, or CAMERA, a pro-Israeli group, accused Siegel, for example, of conducting a "softball interview" with Gazan political scientist Mkhaimer Abu Sada on All Things Considered that "fails to challenge the professor's multiple falsehoods."

On the other side, "simply disgraceful" was how Marcus Hamilton of Tijeras, N.M., described an interview by Steve Inskeep with Israeli Ambassador Ron Dermer which aired the next day. "Mr. Inskeep allowed the Israeli ambassador to further the water-thin Israeli propaganda machine and offered absolutely no counter to his ridiculous claims."

But the beauty of radio as practiced by NPR is that it is willing to devote many precious minutes to take us into one side or the other so that we hear their voices and understand their passions, either through narrative storytelling or the relatively long on-air interviews. No doubt there could be a little more push by NPR hosts here or there in some of the interviews, but generally I found that there was acceptable skepticism within the bounds of politeness and the limits of time.

Rather than get sound bites, I myself want to hear Israeli Prime Minister Benjamin Netanyahu talk for seven minutes on many issues as he did in response to questions from Steve Inskeep. I also want to hear something we almost never hear, a Hamas spokesperson, in this case Ihab al-Ghussein, for nearly six minutes on All Things Considered, showing me the thinking inside Hamas. We know both are spinning, but the questions by the hosts point to the indications of that, and we can discount the spinning ourselves, aided by what we learn in other stories and other interviews.

I can't accept the objections of some advocates that giving air time to views the advocates find offensive amounts to NPR endorsing those views. All of us need to be willing to listen attentively even to views we find offensive if we are to understand the world we live in.

But there is the rub and weakness of radio. If you are not listening at certain times, you might miss other views or other information, and then jump to the conclusion that NPR has ignored it.

While most of the email complaints have been about the radio coverage, NPR's online site has a wealth of additional information. For example, Myre, the online international editor, who covered the Israeli-Palestinian conflict from 1999 to 2007 and is the author of a book on it, has consistently written superb analytical pieces on all of the Mideast tensions for NPR's Parallels blog.

These analytical pieces don't translate well to NPR's news-magazine shows, and the broadcaster is about to cancel the last of its own talk shows, Tell Me More, that did delve at length into one issue in one sitting. Editors and reporters are constantly struggling to get enough analysis into the balance of their on-air storytelling and one-on-one interviews, and are largely successful over the arc of their stories. But as more of us migrate online, we have the riches of a multimedia presentation that includes both the broadcast stories and the additional information on demand when we want it.

Editorial researcher Annie Johnson contributed to this article.

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Protective gear runs from goggles and head covering to gloves and boots. This health worker was photographed leaving the isolation area at the treatment center in Kailahun, Sierra Leone. (Tommy Trenchard for NPR)

This Suit Keeps Ebola Out — So How Can A Health Worker Catch It?

by Marc Silver
Jul 24, 2014

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A health worker just needs goggles to complete the protective suit for the Ebola treatment center in Kailahun, Sierra Leone. Ari Shapiro is NPR's London bureau chief who filled in to cover the conflict in Gaza.

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The fight against Ebola in West Africa suffered a setback Wednesday. Dr. Sheik Umar Khan, one of the top doctors treating patients caught the virus, even though he was wearing protective gear.

"Even with the full protective clothing you put on," Khan has said, "You are at risk."

That statement made us wonder about those yellow and white suits you see in photos: Just how good are they at protecting health workers from the bodily fluids that can transmit the virus — vomit, blood, sweat, mucus?

To learn more about the gear known as PPE (Personal Protective Equipment), we spoke to Armand Sprecher, the medical adviser to Doctors Without Borders for hemorrhagic fevers, such as Ebola.

Does the suit have any weaknesses that put a health worker at risk?

The yellow suit that MSF [Medicins Sans Frontieres] uses is [made of] a woven plastic fiber. And they throw a laminate on it. It's very fluid impervious. But to work, it has to be used in conjunction with a set of behaviors and procedures.

Where we see health care worker infections when the PPE is in place, [the worker] did something to override the PPE: they didn't wear it appropriately or contaminated their hands in the process of getting [the suit] off.

So the hands could come in contact with fluids on the suit. Then what would happen?

The presumed way you get sick is virus gets into a mucus membrane inside your mouth, nose or eyes. If you were very, very good about keeping your hands off your face, you could probably get away with more exposed skin above the neck. But we like to cover [health workers] from the neck up. So when the hand goes to the face in an unconscious movement, it doesn't touch anything.

To reiterate: It's not the suit's fault. Things can just go wrong sometimes.

Yes. You can stick yourself with a needle, you can use your gear improperly or you can undress improperly.

Could you get away with a less protective suit?

Let's say you're wearing some sort of material that covers you from the neck down — something that's permeable — and somebody vomited on your sleeve and fluid got through and got on your arm. Honestly you should be okay. It won't get on you in a large volume. [The vomit] dries out and [the virus] becomes inactive. Ebola doesn't last very long on a clean dry surface.

But if you're caring for somebody and have virus on your hands, getting it into your nose, eyes or mouth is fairly common. So we wear the Dupont products that are fairly fluid resistant.

You've worn the suits. Are they heavy?

It doesn't weigh all that much, a few ounces really. It's just that they're suffocating. If you wear something very fluid-resistant, it's also very air-resistant. It's hotter than hell. You're unable to wear the PPE for more than 30 or 40 minutes in tropical heat.

Could there be a better suit?

The ideal suit would offer enough protection to keep filoviruses [such as Ebola] out but let in a certain amount of air flow. Some newer suits are more impermeable up in the front, more breathable in the back. I haven't had the chance to look at them.

How has the medical community in West Africa reacted to the news of Dr. Khan's infection?

It's shaking things up. A lot of people know Dr. Khan. He is a fun guy. He is fascinated by [Ebola]. He wasn't mailing it in. He wasn't doing his job just to get through the day.

You'd go visit him in Kenema [where he worked in the hospital], he'd be like, "Hey, take a look at this." And with his digital camera, he'd show you a rash he saw on a patient. He'd say, "I just saw that patient an hour ago. I'm going to write this one up."

He took great pleasure in his work and brought an infectious enthusiasm. He's a pleasant person to talk to. He wasn't one of these people who put on airs. You're familiar with all of the character failings of doctors and the stereotypes — he didn't fit into any of those.

I hope he recovers.

Cross my fingers.

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