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.

Q: Hookah smoking among Californians jumped more than 40 percent between 2005 and 2008, said Dr. Ron Chapman, the state director of public health, citing a 2011 state tobacco survey published in the American Journal of Public Health. He said the trend was particularly pronounced among college-age adults, with nearly a quarter of men 18 to 24 years old reporting they had used a hookah at least once, according to the same study. Experts say the growing popularity of hookahs has been fueled in part by a perception that the water pipes are more socially acceptable than cigarettes and the erroneous belief that inhaling tobacco smoke drawn through the water filters out some of its toxins. But smoke from hookah tobacco — which comes in such flavors as apple, strawberry, honey and mint — retains all the carcinogens of cigarette smoke while adding more carbon monoxide and extra carcinogens from the use of burning coals that are used to keep the nicotine flowing, health officials say. During a typical hour-long session, a hookah user inhales 100 to 200 times the volume of smoke inhaled from a single cigarette, according to the U.S. Centers for Disease Control and Prevention. “There is a very, very concerning misperception about the use of hookahs among youth, thinking it’s somehow safer. In fact, it puts you at the same risk,” Chapman said. The warning came as Chapman announced an anti-smoking advertising campaign aimed at those most likely to light up - low-income, minority youth, especially African-Americans. While California has in many ways led the nation in discouraging smoking, “tobacco use is still the No. 1 cause of death and disease in California,” he said. Tobacco kills nearly 34,000 Californians a year and leads to annual healthcare costs of $6.5 billion, or $400 for each state taxpayer, he said. Although pubs and restaurants in California have banned smoking since 1998, hookah bars and cafes are permitted under exemptions for owner-operated tobacco shops or other businesses where no food or beverages are sold without employees or staff, said Corey Egel, a state public health department spokesman. The growing popularity of hookahs among young adults in California mirrors a broader trend nationwide. A study in May by the University of Pittsburgh School of Medicine of 152 universities nationwide found that over 30 percent of students had smoked tobacco from a hookah during the previous month. Hookah smoking, which originated in Persia and India, has seen a resurgence in Middle Eastern countries and elsewhere, too, with water pipes referred to as narguila in Syria, Lebanon and Turkey and as sheesha in Egypt.

A: California health officials sound alarm over hookah smoking.
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Q: "Like its competitors, the Times did not discuss costs–an omission which perhaps is more acceptable in this story since it clearly indicated that this is not very close to being a marketable product. Nevertheless, we would have liked to have seen some mention of the financial impact. Many patients with type 1 diabetes are not using currently available pumps and sensors because of the high cost of these devices. It seems likely that this new treatment, if it ever becomes widely available, will be as expensive or more so than the current pump and sensor technology. We applaud the Times for avoiding the term ""artificial pancreas"" in the headline and using it sparingly in the body of the story. The competing stories couldn’t resist it. We can understand why marketers and media relations people would favor this term because of its promotional value, but we don’t think it’s a good way to describe this technology in an objective piece of journalism. ""Artificial pancreas"" is misleading because we’re not really anywhere close to being able to replicate what the normal human pancreas does through artificial technology. Forgetting for a moment that the pancreas does much more than simply dispense insulin (it also produces a number of other hormones and digestive enzymes that aren’t impacted by diabetes), what’s more important is how the pancreas works in concert with the brain and other systems to regulate glucose in a very tight range. The normal human pancreas starts releasing insulin before we eat in response to complex environmental cues, whereas any artificial system would need to be told that meal is coming or react to the rise in glucose after the fact. Plus, insulin produced by the body starts acting right away, whereas insulin analogues take about 20 minutes to take effect. Put this all together and we see that the ""artificial pancreas"" will, for the foreseeable future, require human intervention to predict post-meal insulin needs and dosing or else patients will be at risk of post-meal blood sugar spikes. And it’s not at all clear that such a system will improve overall blood sugar management compared with existing methods. The term ""artificial pancreas"" conjures up a vision of totally automated glucose management and essentially a ""cure"" for type 1 diabetes. This is overselling what the technology can do. The Times waited until the last 3 paragraphs of an 1,100-word story to hint that an automated system could deliver unsafe doses of insulin. It isn’t until the last sentence that we learn that the system would need to be ""exquisitely reliable"" in order to be safe. We feel the story should have raised these issues earlier and that it could have done more to emphasize just how difficult it will be for any device to calculate insulin requirements on the fly. Insulin dosing is affected by factors ranging from how much a person has exercised to what and how much they have eaten. It’s conceivable that technology can account for all of these variables, but there are a lot ways things could go wrong, with potentially deadly results. It’s a close call, but we don’t feel the story did enough to call attention to these issues. In contrast to its competitors, which all led readers to believe there had been a fully automated system sensing glucose levels and dispensing insulin to the participants in this study, the Times noted that the insulin was dispensed by a nurse based on calculations made by a computer algorithm. The Times clearly indicated that the significance of this test was as a ""proof of concept"" that the algorithm works and is safe, not as a test of any specific device. It noted that a fully automated system combining glucose monitoring and insulin delivery was still ""hypothetical."" In addition, the Times story was the only one to draw attention to the small size of this study and the fact the findings were not statistically significant for the primary outcomes. This note of caution was completely lacking from the competing coverage. The story did not exaggerate the effects of type 1 diabetes. The story includes quotes from interviews with one of the study investigators and another researcher, and identifies both as having ties to diabetes products manufacturers. It also quotes an analyst at an investment firm. It would have been better had they included one more source who didn’t have commercial ties to specific products. The story describes currently available technology for glucose monitoring and insulin infusion. It describes the limitations of current approaches for managing insulin, especially during the overnight period. The story is a bit misleading in that it leaves the impression that all type 1 diabetics are currently using pumps at night. This is not actually the case. Most people are doing self monitoring of blood glucose and making judgement calls on whether and how much insulin to administer. However, the story does enough for a satisfactory in our view. The Times did a good job of describing the system used in this study and how close it is to being commercially available. It called the system ""experimental"" and said that it was ""not fully automated."" It said that a fully automated glucose monitor/insulin delivery system was still ""hypothetical"" and would face regulatory hurdles before it could be marketed to the public. The story describes the progression from skin prick glucose testing to continuous monitoring and insulin pumps. It places the new developments in this field on this continuum. There could have been more discussion of many of the recent advances that have made daytime hyper- and hypoglycemia less of a problem such as the newer short-acting insulins. The story did not rely on any news release."

A: Insulin Study Could Lead to New Dosage Devices
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Q: Dozens of people are missing and 1.2 million are sheltering in the camps, state officials said, as water receded and a huge clean-up gathered pace. “The death toll has risen to 373,” an official of the state’s disaster management authority told Reuters. Kerala received rainfall more than 40 percent greater than normal for the monsoon season, which runs from June to September. Torrential rain in the last 10 days forced officials to release water from dozens of dangerously full dams. The Indian government classified the floods as a “calamity of severe nature.” Kerala has pitched it as a national disaster, which if accepted by the federal government, is likely to prompt greater commitments of funds for relief and rebuilding efforts. But, without a yardstick for such a declaration, it could be an uphill task, state officials involved with disaster management said. Kerala Chief Minister Pinarayi Vijayan called the flood one of the worst in India’s history, displacing more than half a million people. Federal health minister J.P. Nadda said more than 3,500 medical camps were set up across a region roughly the size of Switzerland, where rains since Aug. 8 have swelled rivers and triggered landslides. “There is a requirement for 90 different medicines and the first installment has reached,” he added. “The biggest challenges immediately ahead are cleaning of the flood-hit houses, rehabilitation, and prevention of water-borne diseases,” said Mahesh P., a village official in Rayamangalam, about 45 km (28 miles) from Kerala’s financial capital of Kochi. Mahesh oversees four relief camps in his village, which itself escaped flood damage. The camps accommodate people rescued from neighboring areas, which were among the worst affected. The villagers had all pulled together to rescue people and prevent an even bigger disaster, Mahesh said. “The flood has bonded the people like never before, sharing whatever they had.”  Chlorine powder to disinfect water and other cleaning material are distributed by the camps Mahesh oversees, along with a basic survival kit consisting of a five-day supply of rice and food, toiletries and clothing. Light to moderate rain was expected across Kerala on Monday, promising respite to rescue workers, who have battled rising waters and mudslides to reach tens of thousands of stranded villagers. In one of the worst-hit areas, Chengannur, about 100 km (62 miles) from Kochi, a long queue of women snaked out of a medical camp at the main relief center. As a helicopter hovered overhead, doctors checked elderly men and women lying on wooden benches in an engineering college. “People are being screened for respiratory infections,” said a camp doctor, Rajesh Parameshwaran, adding that another infection doctors were targeted was leptospirosis, which can strike people wading through stagnant water. Those returning home from the camps as the waters recede face a difficult clean-up. The insides of many homes will have about 60 cm (24 inches) of mud, officials said. Wells, commonly used in Kerala, are contaminated and few places have electricity to pump water. Kochi’s airport has suspended operations until Sunday. National carrier Air India on Monday began flying turboprop planes from the city’s naval airport to the cities of Bangalore and Coimbatore in neighboring states. To assist passengers, India’s aviation regulator asked domestic airlines to cap maximum fares to and from Kerala and nearby airports. Kerala faces no shortage of food, at least. Traders had stocked up before the Hindu harvest festival of Onam on Saturday, the chief minister said. Kerala has canceled all official celebrations of what is usually its biggest festive event. Rahul Gandhi, the leader of the opposition Congress party, urged Modi not to discriminate between states controlled by his Bharatiya Janata Party and those such as Kerala, which it does not rule. The state, ruled by the communist party, has received just a third of the immediate assistance of 20 billion rupees ($285 million) it sought from the federal government.

A:
Death toll nears 400 in India's flood-hit Kerala, dozens missing.
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