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.

Ex Input:
Paragraph: The story does not mention the cost of mammography (or of follow up tests and treatments) to the individual, or, collectively, to society. And these costs are substantial. Based on the results of this study, 2,500 women would have to be screened every other year for a decade in order to prevent one death from breast cancer. As the story points out, during that same time 1,000 of those women would have at least one false alarm and 500 would undergo an unnecessary biopsy, thus adding to the price tag. On balance, this story does a fair job of describing the benefits of screening mammography as seen in this study. It reports the apparent 10 percent reduction in breast cancer deaths, while also pointing out that because relatively few women in the 50-69 age group die of breast cancer, that reduction can also be described as cutting the 10-year risk of death from 4.4 per 1,000 women to 4 per 1,000. The second statistic helps counteract popular assumptions about how many middle-aged women die from breast cancer. However, the framing of a story – and who gets the last word – sometimes overwhelms evidence-based explanations earlier in the story. That almost happened with this story, which gives the final word to an advocate of annual breast cancer screening for all women beginning by age 40, which is just the sort of blanket recommendation this latest study calls into question. The story includes a comment that because mammograms detect lumps that would not have become life-threatening, five to 15 women may be treated for every one whose life is saved by treatment. The story oversimplifies the methods used by researchers, saying they compared “women who were similar in most ways, except that one group received mammograms and the other didn’t,” without explaining that this was not a randomized trial where some women were assigned to screening and others weren’t, but rather an observational study that looked at data on women during a 9-year period when Norway phased in mammography region by region. The story does alert readers to some of the limitations of the study: one, that a longer follow-up period might have shown more benefit to screening and, two, that the researchers had no information on whether any of the women received mammograms outside of the national screening program. It’s a tossup for us to grade and, as we do in most such cases, we’ll give the story the benefit of the doubt. Claim: Mammogram benefits more modest than doctors thought

Ex Output:
However, it does not explain to readers what is new or different about this study compared to earlier reports. Also, the final word in the story goes to an expert who touts benefits of mammography screening that clash with what was seen in this study. By comparing this story with, for example, the Philadelphia Inquirer and WebMD stories, you see how some of the gaps we’ve identified were addressed by competitors, giving readers a more complete and helpful story.


Ex Input:
Paragraph: That— and some TLC — usually does the job. At a recent meeting, the Janesville School Board received the annual school nursing report. The report showed that while Band-Aids and ice packs are applied by the hundreds, school nurses are dealing with more serious concerns. Between the 2014-15 school year and the 2018-19 school year, the number of students requiring health plans, daily medication, inhalers and emergency medication has slowly crept up. Nurses, with the help of health aides, hand out daily medication; set up medical kits for field trips; work with doctors, nurses and parents to serve students with medically complex needs; give eye exams; and provide education and support to parents on everything from bed bugs to seizures and toilet training to allergies, The Janesville Gazette reported. That’s the short list. By the numbers In the 2018-19 school year, the Janesville School District had five nurses serving 10,049 students at 21 district schools and 13 private or nonprofit four-year-old kindergartens. That’s a ratio of one nurse to 2,010 students. Student numbers will remain about the same for the 2019-20 school year. “While the Department of Public Instruction does not mandate a specific ratio to school districts, the average ratio of school nurses to pupils in Wisconsin school districts is 1 to 1,625,” district Director of Pupil Services Kimberli Peerenboom wrote in her report to the board. State law does not require schools to have nurses but does say “emergency nursing services shall be available during the regular school day and during all school sponsored activities of students.” Along with the five nurses, the district also uses health aides. Each elementary school has four hours a day the principal can designate as health aide hours, according to Peerenboom’s report. In the upper grades, principals don’t have hours to designate, but they can assign health-aide duties to office staff, the report stated. Some health aides are also secretaries or serve in other paraprofessional roles that involve working with students. Apart from the general cuts and scrapes, 1,715 students had a documented health condition. Asthma, allergies and attention deficit disorder make up the majority of those cases. Other conditions include Crohn’s disease, diabetes, migraines, cerebral palsy, depression, anxiety and autism spectrum disorders. In addition, 227 students take a daily medication at school, that’s up from 183 students in the 2016-17 school year. The number of students who need emergency medication has gone from 134 students in the 2014-15 school year to 231 in the 2018-19 school year. Nurses aren’t in charge of figuring out why those numbers have increased, they just have to deal with the results. In the 2018-19 school year, nurses and health aides reported 161,089 visits from students, according to Peerenboom’s report. A visit counted as anything from needing a Band-Aid to taking daily medication, the report said. With 21 schools, that’s an estimated 43 visits per day. The numbers in action Based on a recent morning spent with school nurse Heidi Bakke, 43 students a day seemed like a reliable count. An hour before the 8:20 a.m. bell at Wilson Elementary, Bakke was updating a health plan. Such plans are for students with chronic conditions who might need monitoring or intervention during the school day. Creating a plan involves a complex back and forth among the school nurse, parents, and physicians and their nurses. It can be a complicated process. ″(The nurses) are probably not going to be in the building when the emergency happens, so we train medical emergency response teams at each school,” Bakke said. The nursing team recently implemented “grab-and-go bags.” The bags contain all the emergency supplies for children with medical needs and a copy of each child’s health plan. Nurses also must prepare a similar kit when a student with a health plan goes on a field trip. And the nurses also have to let teachers know what to look for. “The kiddos who have diabetes — those are the hardest ones to train teachers on because they have frequent blood sugar checks.” Bakke said. “If the kid is out hiking at the Janesville Schools Outdoor Lab, their blood sugar might drop, so you have to have snacks available.” The morning we visited, Bakke was mentoring a new nurse, Holly Cavey. Also in the small office was Cheri Diehls, the school’s part-time health aide. Once Cavey is trained, she will have five schools to cover, while Bakke has six. That’s another change. Nurses used to travel to all schools, now they’re assigned to five or six. “It’s a better model,” Bakke said. “It provides better continuity of care. I want the kids to get to know nurse Heidi.” While the nurses worked on reports, responded to emails and took calls from physicians’ offices and parents, kids needing immediate attention trooped in and out of the office. There were general owies, issues with hearing or sight, a bloody nose, a student needing their daily medication, another needing help with an inhaler, and a half dozen other issues traditionally associated with a trip to the nurse’s office. Cavey and Bakke then headed to Franklin Middle School, where there seemed to be a lunch rush in the nurse’s office. Health aide Angela Basurto-Bonilla was keeping things calm, explaining to students that if their temperature was normal and they weren’t throwing up, it would be best for them to stay in school. The nurse’s office is across from the main office, and sometimes the new students got them mixed up. The proximity works well since sometimes the office secretaries worked as health aides. “Do you feel sick? Well, you’re in the right place,” Basurto-Bonilla told a student. Bakke said the health aides were crucial to the success of the district’s nursing program. Their skills, demeanor and their day-to-day knowledge of students are crucial to the nurse’s work. Despite the number of reports she writes and the amount of training she does, it’s the interaction with students that’s the most important to her. ___ Information from: The Janesville Gazette, http://www.gazetteextra.com Claim: School nurses serve many needs.

Ex Output:
School injuries usually don’t require much care: a Band-Aid for a scraped knee, an ice pack for a bump or bruise, or a tissue for a bloody nose.


Ex Input:
Paragraph: In September 2017, numerous news accounts reported that the Healthcare.gov web site was scheduled to be shut down for maintenance on several occasions during the 2018 “Obamacare” health insurance open enrollment period, which runs from 1 November to 15 December 2017, prompting queries to us from readers about the issue. Kaiser Health News, a self-described “nonprofit news service committed to in-depth coverage of health care policy and politics,” reported that: The Trump administration plans to shut down the federal health insurance exchange for 12 hours during all but one Sunday in the upcoming open enrollment season. The shutdown will occur from 12 a.m. to 12 p.m. ET on every Sunday except Dec. 10. The Department of Health and Human Services will also shut down the federal exchange — healthcare.gov — overnight on the first day of open enrollment, Nov. 1. More than three dozen states use that exchange for their marketplaces. HHS officials disclosed this information during a webinar with community groups that help people enroll. Kaiser Health News reporter Phil Galewitz tweeted what appeared to be a slide from a related presentation, including details of the scheduled maintenance: ..@HHSGov plans to shut down @HHSGov for 12 hours during all but one Sunday during the upcoming 6 week open enrollment season pic.twitter.com/0d5WUtLc9G — Phil Galewitz (@philgalewitz) September 22, 2017  The same slide was independently tweeted by Vox‘s Sarah Kliff: HHS will take https://t.co/hHpJTTaZfz offline nearly every Sunday from 12 a.m. to 12 p.m. of open enrollment, per presentation sent to me. pic.twitter.com/0n5cZ9ENOK — Sarah Kliff (@sarahkliff) September 22, 2017  A spokesperson for the Center for Medicare and Medicaid Services (CMS), which runs Healthcare.gov, confirmed the maintenance schedules reported by Kaiser Health News and Sarah Kliff: Maintenance outages are regularly scheduled on HealthCare.gov every year during open enrollment. This year is no different. The maintenance schedule was provided in advance this year in order to accommodate requests from certified application assisters. System downtime is planned for the lowest-traffic time periods on HealthCare.gov including Sunday mornings. That spokesperson also said the periods set out for web site maintenance constituted the maximum anticipated amount of downtime, and averred that the actual amount of downtime might end up being less. (We asked CMS to clarify the times involved in the 1 November downtime, which the presentation slide only describes as “overnight,” but we did not receive a response in time for publication.) The Trump administration has already cut in half the Obamacare open enrollment period, truncating the original period of 1 November 2016 to 31 January 2017 (three months) to the shorter period of 1 November to 15 December 2017 (six weeks). As pointed out by Kaiser Health News, this year’s web site maintenance schedule means that Healthcare.gov will be online for 93% of the total time during the six-week open enrollment period. (If we assume the “overnight” downtime on 1 November will last 12 hours, then the web site will be online for 1,008 out of 1,080 hours.) Claim: The Department of Health and Human Services has scheduled web site maintenance for Healthcare.gov on most Sundays during Obamacare open enrollment.

Ex Output:

According to the United States Digital Service, which is part of the Executive Office of the President, the Healthcare.gov web site was online 99.9% of the time during the 2015 and 2016 open enrollment periods, which were themselves twice as long as the upcoming open enrollment period.