Saving 6-Year-Old Ameera, Shot In An Afghan Firefight

Ameera draws henna patterns with the Bagram nurses to distract her from the pain.

Ameera draws henna patterns with the Bagram nurses to distract her from the pain. Courtesy of the Craig Joint Theater Hospital staff hide caption

toggle caption Courtesy of the Craig Joint Theater Hospital staff

With American troops mostly focused on training Afghan soldiers, the hospital on the sprawling Bagram airfield doesn’t have many combat trauma cases anymore – in fact, it just has one.

A 6-year-old girl, caught in a firefight between American and Afghan soldiers and Taliban insurgents, has been in intensive care since she was shot earlier this year. The gun battle killed her father, a Taliban fighter, along with her mother and some siblings. It’s not clear who fired the bullet that struck her.

U.S. officials said the girl’s family ties to the Taliban mean it’s too dangerous to identify her or her uncle, who accompanied her to the Bagram base hospital. NPR is calling her Ameera.

In one way, she represents the way the Afghan war continues to play out since many U.S. troops have reduced their role to “advising and assisting” indigenous troops. Violence endures. More children were killed in Afghanistan last year than any since record keeping began, the United Nations says — roughly one in four of the more than 11,000 people killed or wounded in 2015.

If Ameera had gone to an Afghan clinic, “She’d definitely have had an amputation – and rightly so,” said Dr. Chance Henderson, a Texas-born orthopedic surgeon who has been treating her. “That is the best way to save her life if you don’t have the means available to do what we have done in 12 or 20 surgeries.”

Yet because Ameera was shot in a firefight that involved American troops, she wound up in an American hospital and has been receiving American care.

U.S. Air Force Lt. Col. Dr. Chance Henderson, an orthopedic surgeon, stands in the operating theater of the military hospital at Bagram Air Base in Afghanistan. Henderson is fighting to save the leg of a 6-year-old Afghan girl who was shot during a firefight between U.S. and Afghan forces and the Taliban.

U.S. Air Force Lt. Col. Dr. Chance Henderson, an orthopedic surgeon, stands in the operating theater of the military hospital at Bagram Air Base in Afghanistan. Henderson is fighting to save the leg of a 6-year-old Afghan girl who was shot during a firefight between U.S. and Afghan forces and the Taliban. David Gilkey/NPR hide caption

toggle caption David Gilkey/NPR

Saving Ameera’s leg not only could save her from the danger posed by her immediate wound, Henderson said. It would also save her from the dangers of having to return to life in Afghanistan without it.

“Her outlook on a life as a single amputee that does not have a family is much different than it would be for us in the States,” he said. “Her future would be grim, and probably her lifespan would be short.”

Air Force 1st Lt. Serena Matson remembered Ameera’s “non-stop crying” when she came in.

“She is little,” Matson said. “She does not know us. We are not familiar-looking, and there are just a lot of people in and out of the room. She was just scared. ‘Who are these strange people? They don’t look like me. Where is my family?’ “

After days and weeks in treatment, the staff did what they could to make Ameera feel more comfortable. She received toys and crayons and movies such as Frozen and cartoons starring Mickey Mouse.

Toys and gifts for Ameera fill her hospital room. She's received care packages from around the U.S., including one from a kindergarten class in Texas.

Toys and gifts for Ameera fill her hospital room. She’s received care packages from around the U.S., including one from a kindergarten class in Texas. Courtesy of the Craig Joint Theater Hospital staff hide caption

toggle caption Courtesy of the Craig Joint Theater Hospital staff

Now Matson is braiding Ameera’s hair, learning a few Pashto words and teaching the girl a little English. She receives care packages from around the U.S., including one from a kindergarten class in Texas.

But even though Ameera survived her ordeal and has found her spirits revived, the outlook for keeping her leg is not clear. Henderson called the chances for saving it little better than a coin toss, until he consulted with specialists back home and tried a procedure that directed blood flow from Ameera’s healthy right leg to the wound on her left leg.

Now, he and the rest of the American medical team say they can only wait to see how it heals – to see whether Ameera might have to face the much tougher prospects that Henderson described. It could take another month before doctors know whether for sure Ameera if can keep her leg.

“My daughter — that’s the first thing she asks me,” Henderson said. “‘How’s the leg doing, Dad?’ I do not want to give her bad news.”

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To Cut Wait Times, VA Tries MinuteClinics In Northern California

For simple care and prescriptions, veterans in Northern California can go to 14 CVS MinuteClinics.

For simple care and prescriptions, veterans in Northern California can go to 14 CVS MinuteClinics. Tom Starkweather/Bloomberg via Getty Images hide caption

toggle caption Tom Starkweather/Bloomberg via Getty Images

Struggling with long wait times, the Veterans Affairs Health Care System is trying something new: a partnership with the CVS Pharmacy chain to offer urgent care services to more than 65,000 veterans.

The experiment begins today at the VA’s operations in Palo Alto, Calif.

Veterans can visit 14 CVS MinuteClinics in the San Francisco Bay Area and Sacramento, where staff will treat them for conditions such as respiratory infections, order lab tests and prescribe medications which can be filled at CVS pharmacies.

The care will be free for veterans, and the VA will reimburse CVS for the treatment and medications. Whether the partnership will spread to other VA locales isn’t yet clear.

The collaboration comes amid renewed scrutiny of the nation’s troubled VA health system, which has tried without much success to improve long wait times for veterans needing health care.

Despite a $10 billion program called Veterans Choice that allows veterans to receive care outside the closed VA system, vets nationwide wait for an appointment even longer than they did before the program started in 2014, according to a federal audit.

The MinuteClinic partnership isn’t part of the Veterans Choice program.

“The concern has always been, how do we make sure veterans get the care they need in a timely way and in a way that works for the veteran?” said Dr. Stephen Ezeji-Okoye, the Palo Alto VA’s deputy chief of staff. The deal indicates that the VA is willing to try outside partnerships to meet veterans’ needs, he said. “We want to have not just timely access but geographic access to care.”

Sarah Russell, the Palo Alto VA’s chief medical informatics officer, came up with the idea, said Ezeji-Okoye.

The VA will integrate MinuteClinics’ patient records with its own electronic health records to provide consistency of care, Ezeji-Okoye said.

The Palo Alto VA fares better than some other facilities nationwide in providing timely care to veterans, according to VA data, and Ezeji-Okoye said most patients with urgent care needs are seen quickly.

But the system was so busy in the past year that about 11 percent of appointments at its network of hospitals and clinics – which stretch south from Sonora to Monterey – couldn’t be scheduled within 30 or fewer days, which is considered an acceptable time frame, VA data show. That includes appointments that would require urgent care.

More than 5,000 appointments systemwide were scheduled more than 30 days out, but each hospital and clinic’s performance varied widely. At a Fremont clinic, less than 2 percent of appointment requests couldn’t be scheduled within 30 days. At the VA’s rural Modesto clinic, by contrast, more than 17 percent of requests weren’t scheduled within 30 days.

Once the MinuteClinic operation is well underway, Ezeji-Okoye anticipates that between 10 and 15 veterans – from among the estimated 150 who call the Palo Alto VA’s advice nurse hotline daily – will be treated at the retail clinics on any given day.

About 95,000 veterans are eligible to use the Palo Alto system, one of the VA’s largest in the Western United States. About 65,000 use it every year.

The $330,000 pilot project will be evaluated after one year. CVS’ MinuteClinic president, Dr. Andrew Sussman, hopes it can be rolled out nationally if it succeeds. CVS is by far the biggest player in retail pharmacy clinics, operating 1,135 of them in 35 states.

“We’d love to have that opportunity to expand after we go through this phase,” Sussman said. “We’re well-suited to help because of our large footprint and ability to see people on a quick basis.”

It is unclear, however, what the VA’s nationwide plans are. The Veterans Health Administration office didn’t respond to Kaiser Health News’ request for comment.

Blake Schindler, a retired Army major who lives in Santa Clara near one of the participating MinuteClinics, was intrigued, but cautious about the idea. He counts himself lucky, because unlike some other veterans, he has access to the U.S. military’s TRICARE health insurance program for active and some retired service members.

“It could make a big difference, but how much access are the veterans going to have? That was the big problem with the Veterans Choice program; it didn’t end up the way it was supposed to,” said Schindler, 58.

“I’m always hopeful when I hear about these things; I keep an open mind until I have experience with it,” he added.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation. You can follow Barbara Feder Ostrov on Twitter: @barbfederostrov.

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Casting Aside Cold War Ghosts, Obama Reaches Out To Old Rivals

President Obama shakes hands with Vietnamese President Tran Dai Quang at the Presidential Palace in Hanoi on Monday. Obama's Vietnam trip is the latest in a series of moves reaching out to old U.S. rivals.

President Obama shakes hands with Vietnamese President Tran Dai Quang at the Presidential Palace in Hanoi on Monday. Obama’s Vietnam trip is the latest in a series of moves reaching out to old U.S. rivals. JIM WATSON/AFP/Getty Images hide caption

toggle caption JIM WATSON/AFP/Getty Images

When President Obama lifted the ban on U.S. weapons sales to Vietnam, he invoked one of his favorite themes — relics of the Cold War.

“This change will ensure that Vietnam has access to the equipment it needs to defend itself and removes a lingering vestige of the Cold War,” Obama said Monday in the capital, Hanoi.

He sounded a lot like the president who made a groundbreaking visit to Cuba in March:

“I have come here to bury the last remnant of the Cold War in the Americas,” Obama said in Havana.

And in making his case for the Iran nuclear deal last August, he spoke at American University in Washington, the same place President Kennedy chose to herald the landmark Nuclear Test Ban Treaty in 1963, at the peak of the Cold War.

“He rejected the prevailing attitude among some foreign policy circles that equated security with a perpetual war footing,” Obama said of Kennedy.

When the Soviet Union collapsed on Christmas Day in 1991, Obama had just graduated from law school. Yet when he entered the Oval Office, the U.S. was still keeping its distance from some old rivals still run by authoritarian leaders.

President Obama listens to the U.S. national anthem in Havana, Cuba, on March 21. Behind him is an image of Cuba’s revolutionary hero Ernesto “Che” Guevara. Dennis Rivera/AP hide caption

toggle caption Dennis Rivera/AP

Some foreign policy analysts argued this was as it should be, saying the world’s lone superpower had no compelling reason to make concessions to smaller, weaker, undemocratic regimes that violate the liberties of their citizens.

Conservative Republicans and human rights groups have both criticized him, and some took issue with his latest move in Vietnam, which is still under communist rule.

“In one fell swoop, President Obama has jettisoned what remained of U.S. leverage to improve human rights in Vietnam – and basically gotten nothing for it,” said Phil Robertson, who follows Asia for Human Rights Watch.

“We simply can’t give a pass to the Vietnamese regime and a pass to their oppressive government,” said John Cornyn, a Republican senator from Texas, who has introduced legislation that would impose sanctions on Vietnamese nationals linked to human rights abuses.

The president has argued that the U.S. opted for sanctions, boycotts and other punitive measures for decades, yet failed to bring about the changes sought. He’s replaced Cold War standoffs with diplomacy and engagement that he says are in the service of larger goals.

Improved ties with Vietnam and Myanmar reflect his “pivot to Asia,” the notion that the U.S. should place greater political, economic and strategic emphasis on the region. The Iran deal is part of his attempt to prevent nuclear proliferation worldwide and de-escalate tensions in the Middle East.

It’s impossible to measure how much influence Obama’s policies have or haven’t had on the governments involved. But the president has certainly carved a new path.

He’s the first sitting president to visit Cuba in nearly 90 years. The Obama administration has had more contact with Iran than any other since that country’s 1979 Islamic Revolution. And he was the first president ever to visit Myanmar, a country where generals ruled directly or indirectly for more than a half-century.

President Obama meets with Myanmar's Aung San Suu Kyi in Yangon, Myanmar in 2014. Suu Kyi was the opposition leader at the time. She effectively became the country's leader this year, marking an end to more than a half-century of military rule.

President Obama meets with Myanmar’s Aung San Suu Kyi in Yangon, Myanmar in 2014. Suu Kyi was the opposition leader at the time. She effectively became the country’s leader this year, marking an end to more than a half-century of military rule. MANDEL NGAN/AFP/Getty Images hide caption

toggle caption MANDEL NGAN/AFP/Getty Images

But since March, the government has been guided by Aung San Suu Kyi, the Nobel Peace laureate. She’s not allowed to formally hold the title of president, and the generals still have considerable clout, but the change has been substantial.

Meanwhile, Iran has abided by the terms of the nuclear deal so far, according to those monitoring the agreement, though it has continued with provocative steps like missile testing, which are not covered by the deal.

In Vietnam, where the U.S. restored diplomatic relations two decades ago, ties between the two countries have steadily improved. Still, Obama did reverse U.S. policy on Monday by agreeing to sell weapons.

Obama met with dissidents and nudged Vietnam’s leaders to improve human rights in remarks in Hanoi on Tuesday. But he focused on the rapidly expanding economic ties.

“You’ll be able to buy more of our goods, made in America,” Obama told the audience. “There are strategic benefits: Vietnam will be less dependent on any one partner, and enjoy broader ties with more partners, including the United States.”

Greg Myre is the international editor of NPR.org. Follow him @gregmyre1.

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The Madness Behind Making The Lucius Video, 'Gone Insane'

Lucius singer, Jess Wolfe in a scene from the band’s video for the song “Gone Insane.” Nathan Johnson hide caption

toggle caption Nathan Johnson

No one has ever accused Nathan Johnson of taking the easy way out. The film composer, designer and director has made a name for himself, in part, by producing videos and other creative projects that require a mind-numbing amount of monotonous drudgery to pull off, but result in something magical and one-of-a-kind.

His latest mind-blower is a visually twisted video for the Lucius song “Gone Insane,” a stop-motion film full of stunning effects and zero CGI. The whole thing, inspired by facial dysmorphia, was painstakingly pieced together over the course of a week using old-fashioned makeup, prosthetics and more than 20,000 photographs.

YouTube

By the time it was done, Lucius singer Jess Wolfe had spent more than 20 hours in a makeup chair and four full days in front of a camera shooting the entire thing frame-by-frame at glacial speed. “Since we didn’t use CGI, we needed to use simple, hidden cuts,” director Nathan Johnson says. “The thing was, every time we added a new prosthetic, we had to stop the whole shoot for two to three hours so we could send Jess to makeup.”

Johnson tells NPR Music in an email that his team at The Made Shop likes to do things “the hard stupid way,” but that he often doesn’t have a choice. “I’m definitely not trying to make things harder for myself on purpose, but in many cases, the harder way is the only way to accomplish what we’re doing when we don’t have a massive budget. If you’re willing to go down that road, it gives you the freedom to explore something a sane person would never consider.”

“Gone Insane” is from Lucius’ third full-length album, Good Grief, out now on Mom + Pop Records. Here’s the original video for the song:

YouTube

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The World Promises To Do A Better Job Aiding Refugees From Violence

Performers at the opening ceremony of the World Humanitarian Summit in Istanbul, Turkey on May 22.

Performers at the opening ceremony of the World Humanitarian Summit in Istanbul, Turkey on May 22. Berk Ozkan/Anadolu Agency/Getty Images hide caption

toggle caption Berk Ozkan/Anadolu Agency/Getty Images

Traffic is crawling, sirens wailing and police are hustling pedestrians around metal barricades. It’s not another terrorist attack in Istanbul, but super-high security precautions for the first U.N. World Humanitarian Summit.

Dozens of government and NGO delegations converged on Istanbul’s Congress Center, just down the street from central Taksim Square, posing for selfies and greeting old friends. The two-day summit is meant to lay the groundwork for a radical transformation of the way global humanitarian aid is delivered; participants say good progress on that has been made.

But it’s also supposed to enlist the aid community in the U.N.’s longstanding goal of ending need. Critics say that’s a terrible idea at a time when all attention should be focused on what the U.N. itself calls the world’s worst humanitarian situation since World War II.

Rethinking Global Aid

The latest estimates suggest that 125 million people are in need of humanitarian aid. Some 60 million are displaced, either by natural disasters (including events brought on by climate change) or violence. Those here at the summit say the world has gotten better at dealing with the former but not the latter.

“I think we’ve actually made enormous progress in addressing natural disasters,” says Nancy Lindborg, president of the United States Institute of Peace (USIP), a congressionally-funded agency aimed at preventing, mitigating and resolving conflict. Helping victims of violence, she notes, is another matter.

“These are the hardest crises to respond to, and they’re lasting longer — you have protracted crises with people who are displaced for an average now of 17 years,” she says.

Lindborg says the change has been dramatic. Ten years ago, some 80 percent of humanitarian aid money and effort went to victims of natural disasters.

“A decade later that’s flipped, and 80 percent of the funding and the effort goes to people who are victims of violent conflict,” she says. “So it has increased the intensity and the urgency of making the most of our humanitarian action.”

The Grand Bargain: Will It Work?

The summit yielded a so-called Grand Bargain, with countries, agencies and NGOs committing to provide more money and direct more resources to local governments and NGOs, and mounting an effort to end humanitarian need in the coming decades.

But not everyone has signed on. Some prominent players in the aid community decided to skip the summit, including the French medical aid group Medecins Sans Frontieres (MSF), or Doctors Without Borders. MSF Executive Director Jason Cone told NPR via email that an expensive summit eliciting non-binding commitments from governments may not be the best use of resources at a time when long-accepted humanitarian norms are being violated. MSF says in 2016 alone there have been 14 bombings or attacks on health facilities in Syria and Yemen.

In a statement on its decision to pull out of the summit, MSF says the modern aid community can provide “an effective and timely response to natural disasters” but is “seriously lacking” when it comes to epidemics, refugee crises and conflicts.”

USIP’s Lindborg considers MSF’s decision to pull out of the summit cynical — she says it’s easy to dismiss larger gatherings like this but harder, yet ultimately more productive, to come and work for change. But she doesn’t take issue with the notion that the ability to respond to violent conflicts is lagging far behind prowess in dealing with natural disasters. She’s not sure this summit can fix that.

“I have greater concern about the political will needed to end the conflicts that are driving the humanitarian need,” she says. “And we know that if we don’t address conflict more effectively we will not get ahead of the spiraling unmet needs.”

Turkey’s Lament

Turkey’s President Recep Tayyip Erdogan welcomed delegates to the summit with a speech highlighting his nation’s generous response to the refugee crisis sparked by conflicts in Syria and elsewhere — more than 2.7 million people taken in, far more than all 28 nations in the European Union. He also noted that after spending some $10 billion on the crisis, Turkey has received less than a half million dollars from the European Union, despite pledges of several billion dollars.

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Top Stories: Migrants In Greece Relocated; Tracking Zika In The U.S.

Good morning, here are our early stories:

— PHOTOS: Greece Begins Evacuating Thousands Of Asylum-Seekers From Camps.

— Mosquito Hunters Set Traps Across Houston, Search For Signs Of Zika.

And here are more early headlines:

Washington State GOP Primary May Favor Trump; Cruz Wins Delegates. (KING-TV)

Clinton Turns Down Sanders Debate On Fox. (Politico)

French Labor Strike Idles All French Oil Refineries. (BBC)

Syria Blames Other Countries For Deadly Mass Bombings. (Newsweek)

Solar Powered Plane Delayed In Dayton For Mechanical Issue. (The Morning Call)

Government Says Adult Smoking Rates Are Falling. (AP)

Some 31,000 Chinese Dancers Set Mass Dance Record. (AP)

Angelina Jolie Joins British University As Visiting Professor. (People)

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Parade Of Goofballs 2016: Can JoJo Find A Prince In A Haystack?

JoJo Fletcher and Jordan the football player/brother in the kickoff episode of the new season of The Bachelorette.

JoJo Fletcher and Jordan the football player/brother in the kickoff episode of the new season of The Bachelorette. Rick Rowell/ABC hide caption

toggle caption Rick Rowell/ABC

[Note: This is where a spoiler warning would usually go, but in this case, the warning is this: it’s a post about The Bachelorette. You should only read it if you’re interested in a post about The Bachelorette. If you’re not interested in a post about The Bachelorette, I can recommend this story about a snowy owl or this examination of ancient Chinese beer. If you’re not interested in The Bachelorette or owls or beer, I’m out of ideas.]

If you don’t remember who JoJo was on the previous season of The Bachelor, you might remember her as the girl who showed up on the first night with a unicorn head on. Or you might remember her as the girl Bachelor Ben Higgins promised not to blindside with an unexpected rejection. Or you might remember her as the girl Ben Higgins coated in aerosolized flopsweat while blindsiding her with an unexpected rejection. JoJo is the new Bachelorette, and Monday night, she met the 26 men (25 with one to grow on? Two bakers’ dozens?) from whom she must choose a husband, unless of course she wants to make the entire enterprise that is The Bachelor/Bachelorette seem meaningless. JoJo surely does not want that on her conscience.

We’re all counting on you, JoJo. Let’s look at your options.

1. The night starts with Jordan, who is the brother of Packers quarterback Aaron Rodgers and a former football player himself. Jordan looks quite a bit like his brother, if you crossed his brother with a skinny-pants Brooklynite, and he’s my early frontrunner.

2. Derek is a Florida banking guy who tells JoJo that he appreciates how “grounded” she is, which is a little like meeting someone in a doomsday cult and being like, “You seem upbeat; I’m into that.”

3. Grant the firefighter promises not to two-time JoJo by falling in love with another girl the way Ben did. Of course, Ben had other girls around. Put that fire out, Grant, and we’ll talk.

4. James F. is a boxing club owner. “I didn’t come here for a rose, I came here for a relationship,” he says, and I salute him for coming up with mild alliteration as his gimmick, given that it could have been so, so much worse, as we will see.

5. Robby is a “former competitive swimmer” who brings his own wine. As the evening will show, this is the equivalent of going to an Olive Garden with a jar of cream sauce in your pocket. They drink his wine straight from the bottle, which he says is a family tradition. Based on that, I’m not sure if he’s going to marry JoJo, but, spoiler alert: there are going to be some dudes at this cocktail party with whom I think he’ll get along great.

6. Alex is a broad-shouldered U.S. Marine in a checked tie. That’s about it.

7. Will is a civil engineer whose introduction of himself has three stages. First, he gets out of the limo with a stack of index cards. This doesn’t seem good. Then, he drops them. This seems worse. But then, it turns out dropping the cards is his setup for a dreadful bit of shtick where he says things out of order, which gives the whole thing the feel of the comedy you hear during the welcome remarks at a corporate retreat. Oh, Will. (Later in the evening, Will jokey-jokey backs her into a kiss so awkward that lovebirds around the world spontaneously drop dead and no one knows why.)

8. Chad is a “luxury real estate agent.” Chad will be an exhibit one day in the class action lawsuit of Actual Guys Named Chad v. Movies And Television, in which the worlds Chads sue for damages based on the fact that every Chad who shows up in popular culture is a goofwad. This Chad is a mean goofwad and is clearly the season’s nasty heel. Or, in television terms and the terms sometimes used by women who have never dated a nasty heel, the season’s “bad boy.” Suck on a sea urchin, Chad.

9. Daniel is listed as having the occupation “Canadian.” You have to admit, the visa application for that job has to be pretty easy, because you legitimately cannot get an American citizen who can do it. Daniel’s gimmick is quoting the “damn, Daniel” meme from a while ago, which makes him … whatever is past dated. Post-dated? (Later in the night, he will get insanely drunk, take most of his clothes off, and still get a rose. Now that is an alien of extraordinary ability.)

10. Ali is a bartender who calls JoJo “breathtaking” and cannot move his frozen smile.

11. James Taylor is a singer-songwriter. He is not that James Taylor the singer-songwriter, although you must admit that would be a pretty impressive twist. Every week, he’d sing “Fire and Rain” and make pharmaceutical sales reps cry. Anyway, this James Taylor tells JoJo she is “way more prettier” than on TV, so I’m guessing his songwriting has some extra syllables in it.

12. Jonathan tells Jojo he is half Chinese and half Scottish. His Scottish half is wearing a kilt, which is later treated like the weirdest thing ever by a bunch of dudes who quote Vines and introduce themselves by drinking wine out of the bottle.

13. Nick shows up dressed as Santa. It takes a lot for me to look at a man arriving on the first night of The Bachelorette and say “WHERE IS YOUR DIGNITY, SIR?”, but he’s … he’s dressed as Santa. And he keeps saying “Jo-jo-jo-jo.” Do you get it? Later in the evening, there is some effort on the part of the producers to allude to some sort of holiday kink, but I lack the strength to go on. (Jordan the football player/brother earns my temporary affection when JoJo later tells him that she’s so lucky, because she’d never have met all these guys in her normal life, and he says, “Even Santa? I bet you’ve been waiting to meet him since you were a little kid.”)

14. Chase wears a fake mustache, makes a “shave it for later” pun, and: no.

15. Jake is a landscape architect. He’s cute and they barely show him. He’s probably too normal.

16. Sal has a joke about some stress balls he gives Jojo to play with. You’re too good for it, and I’m too good for it (okay, at least you are).

17. “I’m hoping I’ll be the one that’s able to take you off the market,” says Coley the real estate consultant. But his heart isn’t in it, because how could it be? “That’s a good one, Coley,” says JoJo, while leaning her entire body away from him as if he’s covered in toxins.

18. Brandon’s listed profession is “hipster.” He tells JoJo he didn’t see her season of The Bachelor. HE PROBABLY DOESN’T EVEN OWN A TV! Finally, they have matched an occupation with a person who seems perfectly suited to it.

[At this point in the evening, Robby, who is inside at the cocktail party, says, “We have a modge-podge of guys here.” Decorative and sticky?]

19. James S. has the listed occupation “Bachelor Superfan.” Me too, James. Me too.

20. Nick S. is a software salesman who does the splits, likes to dance, and later gets so bombed, so hammered, so deeply and profoundly pickled, that he interrupts JoJo’s interview with the producers.

21. Vinny is a barber who says he doesn’t have champagne, but he does have a toast. His toast turns out to be a piece of toast. So now he’s just a bro in a suit standing there holding a piece of toast. If I were JoJo, I think I would struggle not to look right at him and say, “Does it still seem like a good idea?”

22. Peter, a staffing agency manager, gives JoJo a heart-shaped pillow and says, “Here’s my heart.” It’s very painful seeing them try to figure out how to integrate a cliche with a gift. What would be really fun would be if a dude came up and said, “JoJo, they always say a picture is worth a thousand words. Anyway, here’s a bag of cash.”

23. Evan is an erectile dysfunction specialist.

24. Okay, let’s discuss Wells. Wells is a Nashville radio DJ. He brought musical accompaniment in the form of the quartet All-4-One, whom you might remember from the 1994 single “I Swear.” Wells looks like … if you imagine an app that only sent birthday greetings to moms, Wells would be the developer of that app.

25. Christian is raising his two brothers, which is way more interesting than the fact that he pulls up on a motorcycle.

26. Luke is a war veteran who pulls up on a horse with a unicorn horn strapped to its head. He has season 4 Brandon Walsh hair, and if you get that reference, you know it’s a dire thing. JoJo likes him right away, too. “I’m glad you’re here,” she says. “Wait, wait, what’s your name again?”

Exactly, JoJo. Exactly.

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Doctor Yearns For Return To Time When Physicians Were 'Artisans'

Dr. Abraham Nussbaum argues for medicine to reconnect with its past: Caring for patients should be a calling, not a job.

Dr. Abraham Nussbaum argues for medicine to reconnect with its past: Caring for patients should be a calling, not a job. PhotoAlto/Michele Constantini/Getty Images hide caption

toggle caption PhotoAlto/Michele Constantini/Getty Images

In his recent book, The Finest Traditions of My Calling, Dr. Abraham Nussbaum, 41, makes the case that doctors and patients alike are being shortchanged by current medical practices that emphasize population-based standards of care rather than individual patient needs and experiences.

Nussbaum, a psychiatrist, is the chief education officer at Denver Health Medical Center and works on the adult inpatient psychiatric unit there. I recently spoke with him, and this is an edited transcript of our conversation.

Your book is in some ways a lament for times gone by, when physicians were “artisans” who had more time for their patients and professional independence. But you’re a young doctor and you must have known at the outset that wasn’t the way medicine worked anymore. Why do you stick with it?

The first thing I’d say was that I didn’t know right away that medicine is no longer universally understood as a calling instead of a job. We are describing health as if it is just another consumer good, and physicians and other health practitioners as the providers of those goods. That is the language of a job. When you remember that being with the ill is a calling, then you remember that it is a tremendous privilege to be a physician. People trust you with their secrets, their fears and their hopes. They allow you to ask about their lives and to assess their bodies. So my lament is not for the loss of physician privilege — goodbye to that — but to the understanding of medicine as a calling.

You don’t like checklists and quality improvement measures that dictate how physicians care for patients because you say it turns doctors into technicians and is an obstacle to “moral reasoning.” But those tools, which generally take a systems approach to providing care and rely on evidence-based guidelines, aren’t going away anytime soon. How do you do the kind of doctoring you want to do in this environment?

Quality improvement seems to be here to stay. Regulators at all levels require it. But I believe that evidence of its success is not as clear as they suggest. Just last week, The BMJ, formerly the British Medical Journal, published a study that found no evidence that introducing quality metrics has resulted in a significant reduction in patient mortality. The leaders of the quality movement’s version of quality improvement developed out of industrial engineering, so they are always comparing the care of patients to things like the production of cars or the flying of airplanes. People are far more varied than cars on assembly line or planes on the runway. So quality metrics always feel forced to me, especially for the more interactive medical encounters.

In my own specialty, the current quality metrics all encourage me to perform standardized screens on patients or to document carefully. None of them require me to develop a relationship with a patient so that I can, say, foster hope after a suicide attempt, or knit a psychotic person back into the life of their family. Yet that it was my patients want, those human relationships. It is also what physicians want, and the most recent studies suggest that most physicians are dispirited by quality metrics.

But not all physicians are equally skilled or conscientious. As a patient, I feel more comfortable knowing there are rules and standards that doctors have to meet.

I don’t think physicians should be free to do whatever they want. Their thinking and decision-making should be held up to scrutiny. A physician’s standard of quality should be evidence-based, but even more, it should be patient-centered. The standard should be what the patient defines as what matters. So if you are suffering chronic pain, it is not just a reduction of your score on a standardized pain scale, but your ability to resume the activities you identify as constitutive of your life.

You talk about wanting to be able to sit with a patient and talk with them, to really “see” them. All that takes time that physicians don’t generally have. I understand your book isn’t a how-to manual. But, really, how can physicians do this, even if they want to?

It’s a real challenge. It’s important to use the time you have in service of the patient’s needs. I don’t review records while I’m in the room with a patient. I try to make every question be about the patient. I have to ask standard questions, but I try to do that as way to get to know the patient. For example, if I have to ask questions about what they can remember, I’d ask about a book they have with them. Part of my concern about checklists is that they train you to follow a script instead of following your patients.

Only 55 percent of psychiatrists take insurance compared with nearly 90 percent of physicians in other specialties. That puts their services out of financial reach for many people who could use their help. How does that square with your vision of doctors as healers and teachers?

It’s deeply concerning to me. I’ve made a conscious choice to work at a safety net hospital, so I can see people regardless of their ability to pay. I hope that through things like the Medicaid expansion and mental health parity, more psychiatrists will work with people who have mental illness.

You talk about the virtues of “slow” medicine, similar to the slow food movement, where physicians reject providing care in a standardized, mass-produced fashion. One path that some physicians have chosen is to establish boutique practices that accept a limited number of patients who pay extra fees for more personal attention and better access. What’s your perspective on that?

It sounds appealing to me. In most descriptions of boutique medicine, they talk about it like a lovely restaurant, one that I couldn’t afford to go to every night. I think it’s an interesting model but not a solution to the large problems facing medicine, in particular the ability to provide care to the most needy among us and the indigent.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter:@mandrews110.

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Dubai says opens world's first functioning 3D-printed office

Dubai has opened what it said was the world’s first functioning 3D-printed office building, part of a drive by the Gulf’s main tourism and business hub to develop technology that cuts costs and saves time.

The printers – used industrially and also on a smaller scale to make digitally designed, three-dimensional objects from plastic – have not been used much for building.

This one used a special mixture of cement, a Dubai government statement said, and reliability tests were done in Britain and China.

The one-storey prototype building, with floorspace of about 250 square meters (2,700 square feet), used a 20-foot (6-metre)by 120-foot by 40-foot printer, the government said.

“This is the first 3D-printed building in the world, and it’s not just a building, it has fully functional offices and staff,” the United Arab Emirates Minister of Cabinet Affairs, Mohamed Al Gergawi, said.

“We believe this is just the beginning. The world will change,” he said.

The arc-shaped office, built in 17 days and costing about $140,000, will be the temporary headquarters of Dubai Future Foundation – the company behind the project – is in the center of the city, near the Dubai International Financial Center.

Gergawi said studies estimated the technique could cut building time by 50-70 percent and labor costs by 50-80 percent. Dubai’s strategy was to have 25 percent of the buildings in the emirate printed by 2030, he said.

(Reporting by Lara Sukhtian; Writing by Sami Aboudi; Editing by Louise Ireland)

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Songs We Love: Joseph, 'White Flag'

Joseph

Joseph Ebru Yildiz/Courtesy of the artist hide caption

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The members of Portland trio Joseph — sisters Natalie, Allison and Meegan Closner — blend their voices in the eerily close way that only siblings seem able to accomplish. The trio released its first album, Native Dreamer Kin, in 2014. A record of mostly quiet songs accompanied by acoustic guitar, it allowed the sisters’ voices to transform buttery harmonies into an unexpected, rapturous chorus.

I'm Alone No You're Not

I’m Alone No You’re Not Courtesy of the artist hide caption

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For its upcoming second release, I’m Alone, No You’re Not, Joseph paired up with producer Mike Mogis, who brought electric guitars and big percussion flourishes to support the essential sweetness of the singers. The band has said this song, “White Flag,” is about facing what scares you. But its triumphant chorus tells you that Joseph is only moving confidently forward.

I’m Alone No You’re Not is available August 26 on ATO Records.

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