instruction:
Given a paragraph, generate a claim that is supported by the given paragraph. 1) The claim must contain information from within the paragraph. 2) A sentence within the paragraph can be used as a claim. 3) The claim should not have contradictions within the paragraph. 4) The claim should be at most one sentence long.
question:
In a study in the medical journal The Lancet, they said the patients, with strains of TB known as extensively-drug resistant (XDR) and totally drug resistant (TDR) TB, have exhausted all available treatment options and are sent home. “These patients can survive for months or even years and are contributing to the community-based spread of XDR-TB,” said Keertan Dheda, who led the study at the University of Cape Town’s department of medicine. Tuberculosis infects the lungs and can spread through coughing and sneezing. In recent years, drug-resistant strains have spread around the world, batting off standard antibiotics and posing an increasingly urgent public health threat. The World Health Organization (WHO) estimates that in Eastern Europe, Asia and South Africa, 450,000 people have MDR-TB, and around half of these will fail to respond to existing treatments. Dheda’s team followed 107 patients with XDR-TB from three provinces in South Africa between March 2008 and August 2012 to establish their fate. They also took samples from 56 patients and tested them to find out which and how many of 10 first- and second-line anti-TB drugs they were susceptible to. Despite being treated intensively with an average of eight anti-tuberculosis drugs, many of the patients fared poorly, with high rates of treatment failure and death. Five years after treatment initiation, only 12 of the patients had favorable outcomes and 74 percent had died. The researchers found that almost two-thirds of the tested patients had resistance to at least eight drugs, and there was one case of totally drug-resistant TB that was not susceptible to any of the 10 drugs tested. More worrisome, Dheda said, was that of the XDR-TB patients discharged into the general community, some 42 percent had failed to get better on treatment and were testing positive for active TB, and of these almost a third were at high risk of transmitting the disease. The patients also survived in the community for an average of 20 months - plenty of time to infect others. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. Another person needs to inhale only a few of these germs to become infected. “Alarmingly, we have shown for the first time that... treatment failure and discharge of such patients into the wider community is occurring systematically on a country-wide level in South Africa,” Dheda said in a statement about the findings. In one case where the researchers followed a genetic trail of transmission, they found that a patient with XDR-TB who was discharged after failing treatment went on to infect his brother, who also eventually died. Dheda said the reason many TB patients are being sent away from hospitals appeared to be lack of bed space in designated tuberculosis hospitals. “And alternative long-term residential and palliative care facilities are scarce.”  Commenting on the findings in The Lancet, Max O’Donnell from New York’s Albert Einstein College of Medicine in the United States said they should serve as an “urgent alarm”. “MDR-TB (multi-drug-resistant TB) in all its forms is an out-of-control problem with potentially vast and devastating consequences for global public health,” he wrote. “The situation regarding MDR and XDR-TB is bleak.”
answer:
South Africa risks spreading totally drug-resistant TB: study.


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Researchers set out to determine what killed coral near the $205 million dredge work at the port, which was done to make way for the larger ships sailing through an expanded Panama Canal to bring cargo to South Florida. Their study, published this month in the online journal PeerJ, compared work done in the channel to nearby coral. It puts at odds two governmental agencies that clashed over the dredge. Environmentalists had long worried that that $205 million dredging would damage the coral. The Miami Herald (http://hrld.us/2gFJYNi ) reports the Corps contended a disease outbreak was responsible. State environmental regulators argued that mud stirred up by the dredge or leaked by a barge as it ferried sediment offshore smothered coral. The research team studied pictures taken before, during and after the dredge and said sediment spread across an area about 14 times bigger than the Corps permit allowed for. The study found that warm temperatures in the summer of 2014 triggered widespread bleaching and disease and the coral — stressed by the sediment — died in larger numbers than nearby coral. The project deepened the port’s channel by 6 feet, making it 52-feet deep. It completes a $1 billion makeover that includes a new tunnel at the port. “We now know the Corps dramatically underestimated both the severity and the geographic extent of the sediment impacts on the reef,” said Miami Waterkeeper Rachel Silverstein, whose group joined other conservationists in a legal fight to clean up the dredge. “The monitoring and the protocols that were supposed to protect this reef during the dredge clearly failed and this study is providing peer-reviewed, statistically valid evidence showing that impacts from the dredging resulted in widespread impacts.” Beginning in the summer of 2015, the fisheries service repeatedly warned the Corps that damage appeared to be more widespread and the agency was in danger of violating its permit. The Herald reports that the Corps also failed to provide updated surveys of the work, which prompted the fisheries service to issue a sharp letter accusing the agency of selectively choosing “certain results to downplay the permanent effects” of the dredge. Corps officials said the study used limited data and failed to distinguish between the types of sediment that buried coral during the dredge. “Drawing broad scale conclusions based on limited data is very misleading and not good science,” Corps spokeswoman Susan Jackson told the Herald via email. She said the agency is “committed to understanding potential impacts” and has expanded monitoring efforts, which include cameras on the ocean floor to record conditions. The researchers conclude that the study highlights the need to be more careful when dredging near sensitive reefs and should serve as a warning for the upcoming $374 million expansion at Port Everglades in Fort Lauderdale. ___ Information from: The Miami Herald, http://www.herald.com
answer:
Study: Mud stirred up during PortMiami dredge killed coral.


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The decision by Cleveland County District Judge Thad Balkman in Norman, Oklahoma, came in the first case to go to trial out of 2,700 nationally by states, counties and cities seeking to hold drug companies responsible for the deadly epidemic. Balkman reduced the amount he had awarded in August by $107 million after agreeing with New Brunswick, New Jersey-based J&J that he had made a math error. J&J said it will appeal, and that the award and finding of liability were “neither supported by the facts nor the law.”  A spokesman for Oklahoma Attorney General Mike Hunter said that office is reviewing the decision and will formally respond within the next few days. Opioids were involved in almost 400,000 overdose deaths from 1999 to 2017, according to the U.S. Centers for Disease Control and Prevention. Following a non-jury trial, Balkman ruled in August that Oklahoma had proven that J&J engaged in misleading marketing about the benefits of painkillers, and that their addictive risks caused a public nuisance in the form of the opioid crisis. Hunter had sought to have J&J pay $17 billion to help fund addiction treatment and other services to repair damage from the opioid epidemic over the next 30 years. Balkman, however, awarded only enough money for one year of programs, saying Oklahoma failed to support its claims regarding the need to abate the epidemic in future years. Following the August ruling, Oklahoma asked Balkman for permission to return to his courtroom annually to prove those costs, but Balkman on Friday maintained his prior ruling. J&J, meanwhile, argued that it deserved a $355 million credit, reflecting pre-trial settlements by the drugmakers Purdue Pharma LP and Teva Pharmaceutical Industries Ltd.  Balkman concluded on Friday that state law did not allow such credits. Last month, J&J and four other companies proposed a $48 billion settlement framework to resolve all of the opioid cases they face, with J&J paying $4 billion. Lawyers for the local governments have opposed the proposal. If approved, the settlement would let J&J resolve some of the thousands of product liability lawsuits it faces. The company also faces litigation over whether its baby powder causes cancer, a claim it denies.
answer:

Oklahoma judge reduces Johnson & Johnson opioid payout to $465 million.