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.
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Question: Paragraph: As the new coronavirus spreads from China, travel guidelines being issued by governments across the world all express notes of growing caution. But they contain subtle differences on where to avoid, how to behave and what to do after a trip. With few exceptions, the prevailing advice of national authorities is to avoid Hubei province - epicenter of an outbreak that has now infected 80,000 people worldwide - and to reduce Chinese travel to the bare minimum. Once inside China, Swiss travelers for example are urged by their government to avoid large gatherings and “cough or sneeze into a tissue, or use the crook of your arm”. France tells its nationals not to eat raw meat or visit animal markets. The Spanish Foreign Ministry also urges against contact with animals in China and suggests making sure that you stay at least one meter away from the next person. For travelers to Italy - the country most badly hit by the virus in Europe - the Dutch government recommends that its citizens avoid areas already locked down by local authorities and only travel to parts of the wider Lombardy region around the closed-off towns if necessary. The Finnish Foreign Ministry advice on Italy is simply to “take special care”. Differences also emerge in the advice to travelers on their return from an affected area. Germany’s main authority for infectious diseases tells those returning with symptoms from outbreak regions in Italy to see a doctor and call prior to their visit. But France asks such people not to visit the doctor but to call emergency services. Britain urges its nationals to “self-isolate” at home if they have been to the areas quarantined by Italy whether or not they have symptoms. The Danish Health Authority currently stipulates no routine quarantine or isolation of people who have traveled to China or other places hit by the outbreak. Countries outside Europe take different stances. Turkey advises against all but essential travel to China but has not yet issued travel advice on Italy. Nigeria has a voluntary two-week self-quarantine in place for all passengers arriving from China or any country with “a major outbreak”. Guidance for returning air passengers says “try to avoid” going out but wear a mask if you do. Claim: Coronavirus travel: national advice not all of a piece.

Answer: Should travelers avoid parts of the world near coronavirus hotspots? Or go - but then tread carefully? The official advice they receive may depend on whether they live in Amsterdam, Helsinki, Madrid or Lagos.


Question: Paragraph: Mentions cost for one year of Herceptin as $40,000-$50,000. Mentions quantitative benefit of 9 weeks of Herceptin vs. no Herceptin with certain chemotherapy. Also, while no women in the Herceptin group had cardiac failure at 3 years, the follow-up period may not be long-enough to determine the effects of chemotherapy and Herceptin on the heart. Mentions potential harms of Herceptin on the heart, especially when given after certain chemotherapy. The story does not mention that there were side effects with certain chemotherapy drugs and doses needed to be decreased during the course of the trial. One aspect of this trial focused on randomization of women with Her2/neu overexpression to 9 weeks of Herceptin or no Herceptin immediately following breast cancer surgery. The drug was given in conjunction with certain types of chemotherapy, but before radiation and chemotherapy regimens known to damage the heart. The journalist states the Herceptin was given “prior to chemotherapy”, which is not completely accurate. There is an adequate mention of the study design and discussion of disease-free survival at 3 years follow-up. Good job putting the results into context of other trials, and into context of how this may or may not change providers’ practice. The story could have better stated the limitations of analysis for such a small subgroup – 116 in each arm. Appropriately discusses the percentage of women who are eligible for Herceptin due to overexpression of HER2/neu. The story would have been helped by some context for the risk these women face. As Herceptin is used earlier and earlier these women have less to gain because they have less risk to begin with. Relative risk reductions may be very high but the absolute is not as big. Sources in addition to study authors are cited. No mention that this trial was funded in part by pharmaceutical companies. Some study investigators also receive research funding drug companies. Other doctors cited express caution about the early results of Herceptin studies, so there is some balance to the piece. The women in this trial had undergone breast cancer surgery and those with ER+ tumors were taking Tamoxifen. This is not explicitly mentioned, only that treatment took place following surgery. Still OK. Herceptin is only FDA approved to treat advanced breast cancer, but is used in clinical trials in early-stage breast cancer. This is not mentioned in the story. Novel use of Herceptin for short-term treatment prior to anthracycline chemotherapy. No evidence that this story relies on a press release. Claim: Short stint of Herceptin holds promise for breast cancer

Answer: This story discusses the results of a recent study involving women with high-risk early breast cancer (node positive or >2cm, age younger than 66 – there were 25 year olds on the trial). One aspect of this trial focused on the short-term use of Herceptin with chemotherapy. Women with overexpression of the HER2/neu gene, as measured by the CISH immunohistochemistry, were randomly assigned 9 weeks of Herceptin or no Herceptin immediately following breast cancer surgery and in conjunction with certain types of chemotherapy. This regimen of treatment differed from other trials in which Herceptin was given for 12 months following chemotherapy. In this study, the drug was given in conjunction with certain types of chemotherapy, but before radiation and chemotherapy regimens known to damage the heart. The journalist states the Herceptin was given “prior to chemotherapy,” which is not completely accurate. Herceptin is only FDA approved to treat advanced breast cancer, but it is used in clinical trials in early-stage breast cancer. However, this is not mentioned in the story. There is adequate discussion of the study design and reporting of disease-free survival at 3 years follow-up. There was little discussion in the piece of the side effects of chemotherapy as reported in the trial, but the addition of Herceptin was the main focus of the story. While the journalist provides quantitative benefit of 9 weeks of Herceptin vs. no Herceptin, and notes no cardiac failure in the Herceptin group, the follow-up period of 3 years may not be long-enough to determine the effects of chemotherapy and Herceptin on the heart. Overall, the journalist did a good job describing the randomization, as well as putting the results into context of other trials, and into context of how this may or may not change providers’ practice. The story could have better stated the limitations of analysis for such a small subgroup (116 in each arm). The small sample randomized to Herceptin certainly warrants more study, and although the relative benefits were large, these women still had fairly good recurrence free survival — 80% w/o and 90% with — so although it looks like that will translate to overall survival. The question for women with overexpression of the HER/neu gene is: How much do you want to do to avoid recurrence? Sources in addition to the study investigators are cited, which provides some balance to the piece, however, there is no mention that the trial was funded in part by pharmaceutical companies. Some study investigators also receive research funding from drug companies.


Question: Paragraph: Although the peer-reviewed study on which this story seems to have been based on makes the point that text messages could offer a low-cost strategy for reducing the chances of subsequent heart attacks, the story does not reflect on cost. A clear and readable chart in the story quantifies the apparent benefits of these text messages. But what’s missing here is some nuance: The control group saw a rise in blood pressure, whereas the experimental group remained relatively the same–their blood pressure didn’t actually get lower. So, does that even translate to an actual reduced heart disease risk? And does any of this actually prevent heart attacks? These unanswered questions could have been better emphasized. The concept of “harm” does not appear to be relevant here. Individuals may find text messages to be annoying, of course, but the study itself notes that participants “overwhelmingly” reacted positively to the intervention. That doesn’t make it into the story. The story makes it clear that the study utilized an experimental and a control group, and that this study duration was longer than past studies. Yet the headline suggests that text messages can “prevent” heart attacks. The study offers no evidence for that link: There was no measurement of heart attack rates between groups. Instead, they measured several surrogate markers associated with heart disease, such as lipid levels and blood pressure. This should have been stressed. Repeat heart attacks are relatively common, making continued, at-home treatment of heart attack victims important. The story clearly identifies one source as the leader of the study and includes a second source who appears to be independent of the research. Funding sources are missing from the story, but the study’s declarations of funding do not seem eyebrow-raising. The story does mention some other interventions used to prevent heart attacks, such as typical medications taken to lower blood pressure or cholesterol. The story explains that the study leader is now involved in an effort to replicate her results, which implies that the treatment regimen is not available at present. However, studies of social media and apps used to promote healthy behaviors are ubiquitous, so it might have been useful for the reporter to explore the availability of this strategy compared to others on the market now. The text does a decent job of explaining the novel aspects of the study compared to some similar efforts, though more could have been included on the results of the previous research. Also, since this particular study was actually published nearly a year ago, in September 2015, an effort to update our understanding of message effects would seem to make sense. We weren’t able to locate a news release, but the inclusion of an independent source in the story is a reliable indicator that the story didn’t rely on one. Claim: How to Prevent a Heart Attack: Text Patients on Healthy Habits

Answer:
This is a story about a now year-old study looking at whether a program of semi-personalized mobile phone text messages supporting healthy lifestyle choices led to significant differences in cholesterol levels, systolic blood pressure, and BMI in a group of patients with known coronary heart disease, compared to those who did not receive such messages. The story makes those differences clear in an accessible chart. What is less clear is whether these differences are due to beneficial changes caused by the text messages or other factors. For example, in a subsequent letter to the journal, a researcher notes that the differences in blood pressure between the two groups were due mainly to 7-point increase in the control group, whereas the text message group’s blood pressure stayed about the same over the course of the study. Similarly, the BMI differences between the groups were due partly to an increase in BMI in the control group and weren’t entirely due to reductions in the text message group. The story communicates the study results accurately and doesn’t suggest that the text messages lowered CVD risk factors from baseline. Without a more specific explanation, however, many readers may assume that’s what happened. Another cautionary note is that the headline goes beyond the findings, suggesting that text messages can possibly “prevent” heart attacks. The study offers no evidence for that link: There was no measurement of heart attack rates between groups. Instead, they measured several surrogate markers associated with heart disease, such as lipid levels and blood pressure. According to the story, more than 25% of all heart attacks in the United States are “repeat” events, making treatment—both medication and lifestyle elements—of heart attack victims once they have returned home important. Social media and text messaging offer means for providing informational interventions, and studies of the impact of messages on a host of illnesses is brisk. So far, past studies indicate that people abandon healthy behaviors far more quickly than would be perhaps predicted, so a new study showing the potential that text messaging can be an effective behavior-changing intervention is welcome news.