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.

Input: Consider Input: On 5 December 2018, the Seattle Times published an article whose terrifying headline ensured its own virality: “Rare brain-eating amoebas killed Seattle woman who rinsed her sinuses with tap water. Doctor warns this could happen again.” Sadly for those who visited this page hoping to find that the reporting was exaggerated or made-up, this really happened. Though her anonymity was maintained, the story of a 69-year-old Seattle woman who used tap water in her Neti pot for over a year and then died from a Balamuthia mandrillaris brain infection was documented in a 20 September 2018 case study published in the International Journal of Infectious Diseases: We report the case of a 69-year-old female who presented with a chronic nasal skin rash, new onset focal seizure, and a cerebral ring-enhancing lesion after a year of improper nasal irrigation. Despite aggressive and novel anti-amoebic treatment, she died as a result of a Balamuthia mandrillaris brain infection. One year before developing the brain infection, the authors reported, the woman developed a chronic sinus infection whose symptoms were not relieved by medication. She turned to using a Neti pot to rinse her sinuses, but instead of using sterile or saline water as directed, she used tap water filtered with a Brita system. After a month of this practice, and without any relief of her sinus symptoms, “she developed a quarter-sized, red raised rash on the right side of the bridge of her nose and raw red skin at the nasal opening.” Though several misdiagnoses followed, no doctor correctly recognized the rash as a symptom of an amoebic infection. The report stated that a year after that initial rash developed, the woman developed a seizure that required hospitalization. At that time, the doctors identified a lesion on the right side of the brain which they decided to biopsy. Some 19 days later, after a continued decline in the patient’s health, scientists from Johns Hopkins University suggested the possibility that the cause of her malady was an amoebic infection, and the Centers for Disease Control rushed a novel drug for her treatment. Unfortunately, they were unable to halt the progression of the disease, and the patient’s family made the decision to remove her from life support. An autopsy determined the cause of death to be Granulomatous Amebic Encephalitis (GAE), which the CDC defines as “a serious infection of the brain and spinal cord that typically occurs in persons with a compromised immune system.” In this case, the causative agent was an extremely rare amoeba named Balamuthia mandrillaris, one of three forms of amoeba known to be capable of infecting and consuming the human brain. Amoebas are a broad group of taxonomically mixed unicellular organisms that consume surrounding cellular material through absorption, and that express an ability to take on a variety of shapes. Several different species are associated with disease, most notably Naegleria fowleri, commonly known as the “brain-eating amoeba” that can cause a different kind of brain infection called primary amebic meningoencephalitis (PAM). Balamuthia mandrillaris was discovered in 1986 in the brain of a mandrill monkey during an autopsy at the San Diego Zoo and is now recognized to be a cause of GAE in both humans, several primates, and other animals, with an estimated 200 cases of human infection ever documented. The amoebae are ubiquitous in soil and groundwater although their presence is not expected in city-treated water, according to Liz Coleman, a spokeswoman for the Environmental Public Health division of Washington State’s Department of Health, quoted in the Seattle Times’ reporting. Merely ingesting the thing will not lead to health problems, but in rare cases (usually instances involving people with weakened immune systems, or those who are young or old), the organisms can infect a host through skin breakage or via the respiratory system. If they infect the central nervous system, they “ingest bits and pieces of host tissue [and produce] enzymes that degrade the tissue.” Nasal irrigation involves rinsing one’s sinus cavity with distilled or sterile water (or water that has been filtered to remove potentially infectious organisms), and one such method of water delivery is a Neti pot. The need for sterility is explicitly stated due to the (extremely small) risk posed by another amoeba, Naegleria fowleri, and it is the reason the FDA requires (in the absence of sterile water) a specific kind of filter capable of removing the amoeba and similarly-sized organisms from water before it is pushed through fragile sinus tissue. While the authors of this case report could not state with absolute certainty that the Neti pot was to blame, it is far and away the most likely explanation given the fact that the patient had been rinsing her sinuses with tap water regularly for an extended period of time: While it is recommended that only sterile water or saline be used … the patient used tap water that was filtered with a Brita Water Purifier … Improper nasal irrigation has been reported as a method of infection for the comparably insidious amoeba, N. fowleri. This precedent led us to suspect the same route of entry for the Balamuthia amoeba in our case. Although this hypothesis is consistent with the patient’s history and ultimate diagnosis, the water supply to the patient’s home was not tested, hence our ability to definitively trace the patient’s infection to improper nasal lavage is limited. Other routes of exposure are possible, according to a 2013 review of amoebic infections: Epidemiology of Balamuthia GAE is not well understood. However, based on several case reports it can be hypothesized that gardening, playing with dirt, or exposure to dust while motorcycling may play significant roles in the acquisition of Balamuthia infection. It has been shown that Balamuthia is found in the soil and dust in air and the route of infection is probably via inhalation of Balamuthia either present in soil or carried by the wind or the amebae entering the body through a cut or puncture. Once it gains entry into the body it is likely to spread hematogenously to the brain. Additionally, there is some indication that water may serve as a vehicle for acquiring the infection. Although the water used in the Neti pot likely caused this infection, Dr. Cynthia Maree, a co-author of the report and a member of the team that treated the woman in question, told the Seattle Times that “the risk of infection to the brain is extremely low,” adding that “people who use neti pots or other nasal-irrigation devices can nearly eliminate [that risk] by following directions printed on the devices, including using only saline or sterilized water.”

Output: A woman who rinsed her nasal passages using a neti pot filled with tap water contracted a fatal “brain-eating” amoeba infection.


Input: Consider Input: A still image provided by KPIX TV and taken from the broadcaster's video footage shows Timothy Ray Brown during an interview at his home in San Francisco. Timothy Ray Brown, was a young HIV-positive American living and working in Berlin who had developed leukaemia and suffered a relapse after initial treatment. REUTERS/Courtesy KPIX TV/Handout Dramatic scientific advances since HIV was first discovered 30 years ago this week mean the virus is no longer a death sentence. Thanks to tests that detect HIV early, new antiretroviral AIDS drugs that can control the virus for decades, and a range of ways to stop it being spread, 33.3 million people around the world are learning to live with HIV. People like Vuyiseka Dubula, an HIV-positive AIDS activist and mother in Cape Town, South Africa, can expect relatively normal, full lives. “I’m not thinking about death at all,” she says. “I’m taking my treatment and I’m living my life.”   Nonetheless, on the 30th birthday of HIV, the global scientific community is setting out with renewed vigor to try to kill it. The drive is partly about science, and partly about money. Treating HIV patients with lifelong courses of sophisticated drugs is becoming unaffordable. Caring for HIV patients in developing countries alone already costs around $13 billion a year and that could treble over the next 20 years. In tough economic times, the need to find a cure has become even more urgent, says Francoise Barre Sinoussi, who won a Nobel prize for her work in identifying Human Immunodeficiency Virus (HIV). “We have to think about the long term, including a strategy to find a cure,” she says. “We have to keep on searching until we find one.”   The Berlin patient is proof they could. His case has injected new energy into a field where people for years believed talk of a cure was irresponsible. Timothy Ray Brown was living in Berlin when besides being HIV-positive, he had a relapse of leukemia. He was dying. In 2007, his doctor, Gero Huetter, made a radical suggestion: a bone marrow transplant using cells from a donor with a rare genetic mutation, known as CCR5 delta 32. Scientists had known for a few years that people with this gene mutation had proved resistant to HIV. “We really didn’t know when we started this project what would happen,” Huetter, an oncologist and haematologist who now works at the University of Heidelberg in southern Germany, told Reuters. The treatment could well have finished Brown off. Instead he remains the only human ever to be cured of AIDS. “He has no replicating virus and he isn’t taking any medication. And he will now probably never have any problems with HIV,” says Huetter. Brown has since moved to San Francisco. Most experts say it is inconceivable Brown’s treatment could be a way of curing all patients. The procedure was expensive, complex and risky. To do this in others, exact match donors would have to be found in the tiny proportion of people — most of them of northern European descent — who have the mutation that makes them resistant to the virus. Dr Robert Gallo, of the Institute of Virology at the University of Maryland, puts it bluntly. “It’s not practical and it can kill people,” he said last year. Sinoussi is more expansive. “It’s clearly unrealistic to think that this medically heavy, extremely costly, barely reproducible approach could be replicated and scaled-up ... but from a scientist’s point of view, it has shown at least that a cure is possible,” she says. The International AIDS Society will this month formally add the aim of finding a cure to its HIV strategy of prevention, treatment and care. A group of scientist-activists is also launching a global working group to draw up a scientific plan of attack and persuade governments and research institutions to commit more funds. Money is starting to flow. The U.S. National Institutes of Health is asking for proposals for an $8.5 million collaborative research grant to search for a cure, and the Foundation for AIDS Research, or amfAR, has just announced its first round of four grants to research groups “to develop strategies for eradicating HIV infection.”   Until recently, people in HIV and AIDS circles feared that to direct funds toward the search for a cure risked detracting from the fight to get HIV-positive people treated. Even today, only just over five million of the 12 million or so people who need the drugs actually get them. HIV first surfaced in 1981, when scientists at the U.S. Centers for Disease Control and Prevention discovered it was the cause of acquired immunodeficiency syndrome (AIDS). An article in the CDC’s Morbidity and Mortality Weekly Report of that June referred to “five young men, all active homosexuals” from Los Angeles as the first documented cases. “That was the summer of ‘81. For the world it was the beginning of the era of HIV/AIDS, even though we didn’t know it was HIV then,” says Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, who has made AIDS research his life’s work. In the subsequent three decades, the disease ignorantly branded “the gay plague” has become one of the most vicious pandemics in human history. Transmitted in semen, blood and breast milk, HIV has devastated poorer regions, particularly sub-Saharan Africa, where the vast majority of HIV-positive people live. As more tests and treatment have become available, the number of new infections has been falling. But for every two with HIV who get a chance to start on AIDS drugs, five more join the “newly infected” list. United Nations data show that despite an array of potential prevention measures — from male circumcision to sophisticated vaginal or anal microbicide gels — more than 7,100 new people catch the virus every day. Treatment costs per patient can range from around $150 a year in poor countries, where drugs are available as cheap generics, to more than $20,000 a year in the United States. The overall sums are huge. A recent study as part of a non-governmental campaign called AIDS2031 suggests that low and middle-income countries will need $35 billion a year to properly address the pandemic by 2031. That’s almost three times the current level of around $13 billion a year. Add in the costs of treatment in rich countries and experts estimate the costs of HIV 20 years from now will reach $50 to $60 billion a year. “It’s clear that we have to look at another possible way of managing of the epidemic beyond just treating everyone forever,” says Sharon Lewin, a leading HIV doctor and researcher from Monash University in Melbourne, Australia. In some ways, we have been here before. Early AIDS drugs such as AZT came to market in the late 1980s, but within a decade they were overtaken by powerful cocktail treatments known as HAART, or highly active antiretroviral treatment. HAART had a dramatic effect — rapidly driving the virus out of patients’ blood and prompting some to say a cure was just around the corner. But then scientists discovered HIV could lie low in pools or reservoirs of latent infection that even powerful drugs could not reach. Talk of a cure all but died out. “Scientifically we had no means to say we were on the way to finding a cure,” says Bertrand Audoin, executive director of the Geneva-based International AIDS Society. “Scientists ... don’t want to make any more false promises. They didn’t want to talk about a cure again because it really wasn’t anywhere on the horizon.”   The ultimate goal would allow patients to stop taking AIDS drugs, knocking a hole in a $12 billion-a-year market dominated by Californian drugmaker Gilead and the likes of Pfizer, GlaxoSmithKline and Merck. It’s unlikely to happen anytime soon, but Brown’s case has opened the door to new ideas. “What it proved was that if you make someone’s cells resistant to HIV...then all the last bits of HIV, that hang around for a long time in patients on treatment, did in fact decay and disappear,” says Lewin. Now scientists working on mimicking the effect of the Berlin patient’s transplant have had some success. One experimental technique uses gene therapy to take out certain cells, make them resistant to HIV and then put them back into patients in the hope they will survive and spread. At an HIV conference in Boston earlier this year, American researchers presented data on six patients who had large numbers of white blood cells known as CD4 cells removed, manipulated to knock out the existing CCR5 gene, and then replaced. “It works like scissors and cuts a piece of genetic information out of the DNA, and then closes the gap,” says Huetter. “Then every cell arising from this mother cell has this same mutation.”   Early results showed the mutated cells managed to survive inside the bodies of the patients at low levels, remaining present for more than three months in five. “This was a proof of concept,” says Lewin. Another potential avenue is a small group of patients known as “elite controllers”, who despite being infected with HIV are able to keep it under control simply with their own immune systems. Researchers hope these patients could one day be the clue to developing a successful HIV/AIDS vaccine or functional cure. Scientists are also exploring ways to “wake up” HIV cells and kill them. As discovered in the late 1990s, HIV has a way of getting deep into the immune system itself — into what are known as resting memory T-cells — and going to sleep there. Hidden away, it effectively avoids drugs and the body’s own immune response. “Once it goes to sleep in a cell it can stay there forever, which is really the main reason why we can’t cure HIV with current drugs,” says Lewin. Her team in Melbourne and another group in the United States are about to start the first human trials using a drug called SAHA or vorinostat, made by Merck and currently used in cancer treatment, which has shown promise in being able to wake up dormant HIV. As scientists begin to talk up a cure, the old question of whether that’s the right goal has re-emerged. Seth Berkley, a medical epidemiologist and head of the U.S.-based International AIDS Vaccine Initiative (IAVI) is concerned. An HIV-positive person holds a placard during a programme organized to mark World AIDS Day in Kathmandu December 1, 2010. To match Special Report AIDS/ REUTERS/Deepa Shrestha “From a science point of view, it’s a fabulous thing to do. It’s a great target and a lot of science will be learned. But from a public health point of view, the primary thing you need to do is stop the flow of new infections,” says Berkley. “We need a prevention revolution. That is absolutely critical.”   Vuyiseka Dubula agrees. The South African activist finds talk of a cure for HIV distracting, almost disconcerting. “This research might not yield results soon, and even when it does, access to that cure is still going to be a big issue,” she says. “So in the meantime, while we don’t have the answer on whether HIV can be cured or not, we need to save lives.”

Output: Special Report: An end to AIDS?.


Input: Consider Input: The Coast Guard prohibits vessels from getting closer than 984 feet (300 meters) from where Kilauea volcano’s lava oozes into the sea. The agency had been allowing experienced boat operators to apply for a special license to get closer up to 164 feet (50 meters), but it stopped allowing those exceptions Monday morning. A woman in her 20s was transported to Honolulu in serious condition with a broken thigh bone. The other 22 people injured were treated for minor burns and scrapes, including 12 who were treated at a hospital in Hilo. Moku Nui Lava Tours Captain Kanoa Jones, whose boat was not involved in Monday’s incident at Kilauea volcano, said not running the tours would only withhold income from local restaurants and other businesses dependent on tourism, he said. “If we stop operating, it not only hurts us, it hurts the community,” Jones said. The Coast Guard, state and local officials were investigating what happened. Coast Guard spokesman Petty Officer 3rd Class Matthew West said the agency can’t say whether it will change its safety zone rules until it finishes its investigation. The county strictly limits access to the lava on land for safety reasons, making boat and helicopter tours the only options people have to witness volcanic spectacle in person. The ocean and aerial tours each cost about $250. The restrictions have deterred many travelers from visiting the Big Island in general, and Puna near the volcano in particular. Shane Turpin, the owner and captain of the vessel that was hit, said he never saw the explosion. He and his tour group had been in the area for about 20 minutes making passes of the ocean entry about 500 yards — which is the length of five football fields — offshore, Turpin said. He didn’t observe “any major explosions,” so he navigated his vessel closer, to about 250 yards (228 meters) away from the lava. “As we were exiting the zone, all of a sudden everything around us exploded,” he said. “It was everywhere.” The U.S. Geological Survey says explosions of varying sizes occur whenever 2,000-degree (1,093-degree Celsius) lava enters much colder seawater. Monday’s large blast may have been amplified by the relatively shallow water at the point where the lava entered the sea. That’s because explosions occur much closer to the surface in such spots. In contrast, lava that entered the ocean in 2016 hit a steep slope and quickly fell to deeper parts of the sea, said Janet Babb, a geologist with the U.S. Geological Survey. The volcano has also been pumping more lava into the water now compared to past years, Babb said. Kilauea is sending to the sea as much as 26 times the amount of lava per second than it did during the 2016-17 eruption. Officials have warned of the danger of getting close to lava entering the ocean, saying the interaction can create clouds of acid and fine glass. Despite the hazards, several companies operate such tours. The Coast Guard said tour vessels have operated in the area going back at least 20 years. The molten rock is coming from the Kilauea volcano, which has been erupting continuously for the past 35 years. In May, its eruption entered a new phase when it began spurting lava through newly formed fissures in a residential neighborhood. It has destroyed more than 700 homes since then. But the only serious injury over the past two months was to a man who was hit by flying lava that broke his leg. Captain Jones said an evening boat tour left for the ocean-entry site and it was business as usual. “It is Mother Nature,” Jones said. “You never know.”


Output: Hawaii lava boat tours continue after explosion, injuries.