Generate an explanation for the given claim using the provided supporting material from the paragraph. Please consider the following points while generating an output. 1) The claim will always have supporting proof in the paragraph, and the paragraph will have a clear point of view supporting the claim. 2) There can be instances where direct correlation to the claim is not available. Make use of the sentences in the paragraph to provide a corresponding output supporting the claim. 3) The explanation should be at least one and at most twelve sentences long.

Paragraph: Costs of the MRIdian on-table adaptive radiotherapy in comparison to conventional radiotherapy are not discussed. Given that it is new and more personalized than current treatment options it’s likely to be correspondingly more expensive. Certainly, more frequent MRIs would be very costly. The release provides exact information about increased survival rates in the cohorts of individuals treated with the adaptive versus the convention radiotherapy techniques. “The cohort receiving a higher dose demonstrated a near doubling of median overall survival (Kaplan-Meier estimated median overall survival of 27.8 months compared to 14.8 months).” The news release provides specific results regarding experiences of both groups with regard to toxicity from radiotherapy. We appreciate that the headline of this release starts with the words “early data” because this report deals with preliminary and retrospective research. It was not a clinical trial. Instead, results are based on retrospectively comparing treatment of two groups of patients at four institutions. Respective comparisons can’t account for a host of factors that might influence results. At the end of the news  release readers are told that on the basis of these promising results a clinical trial is being planned. With five-year survival rates of 1 to 14%, it would be hard to engage in disease mongering about pancreatic cancer. This research was sponsored by ViewRay, the company that developed the MRIdian system, and the release does a good job calling attention to this. However, according to the published study, at least one of the co-authors received honoraria from ViewRay Medical Systems. Since this was not included in the release we’re rating this criteria Not Satisfactory. This study was all about comparing alternatives, so it scores Satisfactory on that criterion. It would have helped readers if alternatives would have been described more in laymen’s terms. The news release notes that the next step is a prospective clinical trial and that tells savvy readers that this treatment strategy has a long road of testing ahead. Still, we think the release could have done a better job clarifying that this therapy is not yet ready for patients, outside of the clinical trial. A study that suggests a doubling of median survival is sure to capture the attention of patients newly diagnosed with pancreatic cancer. These patients and their families are closely aware of the glum statistics for the disease. This is a practical concern that the release should have touched on. This technology is indeed novel and unique to ViewRay, though it is becoming available in more and more cancer treatment centers. No unjustifiable language was identified in the news release. Claim: Early data shows nearly 2x prolonged median survival for inoperable pancreatic cancer
This news release reports results of a retrospective study comparing conventional radiotherapy for inoperable pancreatic cancer versus an adaptive radiation therapy that allows clinicians to see the tumor in real time and respond to changes on a daily basis. Targeting the tumor more specifically means higher doses of radiation can be used without increasing damage to surrounding tissues. The study, funded by ViewRay, maker of the MRIdian system, is admittedly preliminary. It is to be followed up by a clinical trial. The release would have been more helpful to readers had it mentioned costs and disclosed a conflict of interest between one of the study authors and the device manufacturer. Surgery is an option only for certain less common types of pancreatic cancer. The five-year survival rates for pancreatic cancers that cannot be treated with surgery are 12% to 14% even for those diagnosed in stage I; the five-year survival rate for cancers detected at stage IV is about 1%, according to the American Cancer Society. ACS reminds readers that five-year survival rates are estimates and that “many people live longer – often much longer – than 5 years.” In that context, a treatment that could extend the lives of the 1.5% of Americans who develop pancreatic cancer is big news.

Paragraph: There is also the revival of the humble foam roller, which experts say, like old-time push-ups, squats and planks, has never been more popular. Anita Golden, fitness manager at a Crunch gym in New York City, said she’ll be giving clients a foam roller called the GRID. “We’ve always had foam rollers in the club but now more people are using them as a way to ease post-workout muscles, prevent injuries and exercise the core,” Golden said. When it comes to big-ticket items, Colleen Logan of Icon Health and Fitness, which manufactures a number of fitness brands, said the treadmill remains the most popular gift. “Treadmills continue to lead the industry in terms of home fitness purchases,” said Logan. They account for about 57 percent of fitness purchases, while elliptical trainers and stationary bicycles are a distant second and third place at about 8 percent each. The average home treadmill costs about $700, said Logan, but the technology revolution has transformed even this stalwart at the high end. The ultimate splurge, at $4,000, she said, is the Boston Marathon Treadmill, which allows users to adjust speed in 1/10 of a mile per hour increments without touching the console. It also lets users run a virtual Boston Marathon. For people on a smaller budget, there is the iFit app that lets the iPhone capture a favorite vacation run or bike ride in Hawaii, store it in data centers all over the world which collectively are referred to as the “cloud,” and download it to an iFit-enabled treadmill at home. “You’ll view the exact route and experience the same terrain again,” Logan explained. Devices, gadgets and apps proliferate as tech-savvy fitness becomes more accessible, according to Jessica Matthews of the American Council on Exercise (ACE). “There’s a lot of interest in on-body monitoring devices as ways to motivate and track progress,” she said. “They run the gamut from basic devices to track hours, steps, and caloric expenditure to full-body tracking.”  Nike+ Sportsband has a series of small lights on the wrist band that change from red to green as the runner nears his goal, while the BodyMedia FIT Armband tracks everything from the number of calories burned to the quality and quantity of sleep. ACE also studied fitness DVDs released for the holidays. “We evaluated them for quality of instruction, safety, effectiveness and design of workout,” Matthews said. Among the best were “Amy Dixon’s Breathless Body Vol.2: The Edge.” Matthews called it a challenging cardio workout best suited to those on your list with “an established base of fitness.”  “Jessica Smith’s 10 Pounds Down Better Body Blast” also got a thumbs up for its well-rounded routine and clarity of instruction. For people seeking a mind-body approach, Matthews praised “STOTT Pilates Intense Body Blast: Pilates Interval Training: Level I,” which she said is accessible for someone new to fitness. “They do a great job queuing movements and creating flow,” she said. Richard Cotton of the American College of Sports Medicine suggests giving the fitness novice the gift of a personal trainer. “The best is human assistance,” he said. “Another way is a beginner group exercise class.”  He also suggests a gift certificate for shoes at a running store equipped with a treadmill. “You need shoes that fit your gait,” he said. “People should always get their gait analyzed.”  Golden likes to cite the law of reciprocity to the personal trainers she manages. “I always tell them to get their clients something,” she said. And what does the personal trainer want for Christmas? “I like the roller, or a new jump rope,” she said. “Fitness people aren’t hard to please. Get me a new yoga mat and I’m happy.” Claim: Holiday fitness gifts trend from high-tech to basic.
Looking for the perfect holiday present for a fitness fan? Gift offerings this year range from apps that can store a run in the country to be viewed later to gadgets so sophisticated they measure quality of sleep as well as calories burned.

Paragraph: - Frustration over limited time spent with patients. - Inordinate amounts of time inputting required data. - Side effects including high levels of stress. The patient? Herself. The remedy? “I did the research and found direct primary care,” said Anderson-Elder of Windsor. And in June she joined Dr. Frank Morgan at Balance Health in Greeley, a direct primary care clinic he founded four years ago in Greeley. Leaving her family practice at UCHealth Medical Clinic in Windsor after seven years wasn’t an easy decision, she said, but it was the right decision for her. Many physicians — from all specialties — share Anderson-Elder’s frustration and levels of stress incurred while working in insurance-based health care systems. In the 2018 Medscape National Physician and Depression Report, 42 percent of family physicians admitted to having burnout or depression, listing “too many bureaucratic tasks (charting, paperwork)” and “too many hours at work” as the leading factors in burnout. Although direct primary care has been around for some time, it is just now gaining a toehold with both physicians contemplating the switch to a different way of providing care and patients willing to give it a shot, so to speak. In 2017, there were more than 600 direct primary care clinics in the U.S., 10 percent of those in Colorado, according to the Colorado Independent. Anderson-Elder said in her research she found 1,000 out of the 80,000 family doctors practicing in the U.S. have gone the direct primary care route. DIRECT PRIMARY CARE What is direct primary care? And why the interest? First and foremost, the major difference is that direct primary care does not accept insurance. Patients instead pay a monthly membership fee that includes unlimited visits, calls and emails, along with many routine services and access to prescriptions and lab work at a reduced cost. For the physician, it means quality time spent with patients and no more time filling out paperwork to satisfy health insurance company regulations. What the monthly fee is varies from clinic to clinic. At Balance Health, it is $99 for adults, $180 for couples and $30 for children. Those who sign up for direct primary care are asked to sign an annual contract but can be released from it with 30 days’ notice, Anderson-Elder said. “We want to be accessible to our patients. We don’t want them to go to urgent care or ER if they don’t have to,” she said. And yes, that includes calls at 3 a.m., but if it can wait till morning, the patient is worked into that day’s schedule. Anderson-Elder typically sees eight to 17 patients per day, depending on whether it’s cold and flu season. And she spends as much time as needed with them. At her previous practice, she was limited to spending 15 to 20 minutes per patient. “People service their cars,” she said. “They should do the same thing with their bodies. You should be looked at and tuned up.” While most people think of going to the doctor only when they don’t feel well or need a physical for work or school, Anderson-Elder said she likes to see patients even when they feel healthy so she can check in on their well-being and talk about proper nutrition. “Oftentimes patients think they’re healthy, but then we do an exam and sometimes find things,” she said. Direct primary care works best when combined with a high-deductible health plan, Anderson-Elder said, for those times when unexpected surgeries are scheduled and for patients who suffer from chronic illnesses. But she said about one-third of her patients have no health insurance at all. She also noted direct primary care should not be confused with concierge medicine, which also provides direct access to providers for a flat fee but still bills insurance companies for services provided. Another key distinction between the two is direct primary care is mentioned in the Affordable Care Act as an acceptable option for receiving medical care without insurance, while concierge medicine is not, according to the American Academy of Family Physicians. And last year, Colorado Gov. John Hickenlooper signed Colorado HB17-1115, which establishes that direct primary health care can operate without regulation of the division of insurance. Windsor Republican Rep. Perry Buck was a primary sponsor of the bill. Patients at Balance Health also can tap into other healthy-living services for additional fees. Dr. Dana Morgan, a family care physician, specializes in bioidentical hormone replacement therapy. Balance Health also has a small fitness gym replete with trainers and classes. Wellness coaching also is offered. Leaving her practice in Windsor, though a hard decision, has been the right prescription for her, she said. “I no longer take paperwork home,” she said. “I’m happier and less stressed.” ___ Information from: The Tribune of Greeley, Co, http://greeleytribune.com Claim: Windsor doctor joining direct primary care movement.

Dr. Emily Anderson-Elder carefully considered her patient’s symptoms: