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: 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.”

A: South Africa risks spreading totally drug-resistant TB: study.
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Q: A bill that would allow trained pharmacists to administer the influenza vaccine to children 12 years and older cleared the General Assembly’s Public Health Committee in a 17-7 vote this year, but it later died on the Senate calendar due to inaction. Bill supporter, Nathan Tinker, CEO of the Connecticut Pharmacists Association, said his organization doesn’t plan to push hard for it again in the next regular legislative session because he is worried the debate over the General Assembly’s efforts to scrap a religious exemption for some vaccines will ultimately spill over into discussions about the flu shot and likely doom the bill in the short, three-month session. “There is a community of people who are concerned about the impact or potential impact, whether real or perceived, about vaccines,” Tinker said. “And they get a lot of attention from legislators and that can make it difficult.” When the new legislative session opens in February, lawmakers are expected to consider ending the state’s longstanding religious exemption after newly released data showed a continued decline in immunization rates for measles, mumps and rubella among kindergarteners. That proposal has already met resistance and some of the concerns raised are like the ones voiced during this year’s discussion of the flu vaccine bill. Legislators were flooded with testimony earlier this year from parents with concerns about whether making the vaccine more convenient could lead to injuries that pharmacists might not be trained recognize. Others questioned the motives of the pharmaceutical industry and necessity of flu shots. Dr. Sandra Carbonari, a primary care pediatrician in Waterbury and the medical director of the Connecticut Chapter of the American Academy of Pediatrics, also opposed the bill, but for different reasons. She questioned whether state regulations for providing the flu vaccine to children who receive Medicaid benefits might ultimately make the shot too expensive, and whether DPH’s vaccine program can handle a large increase in the number of providers. She also noted that immunizing a child can be complicated. “Determining the appropriate vaccine for a pediatric age patient is not simple and requires accurate information about the medical history and current state of health,” she said in written testimony. Supporters of the flu shot bill argue that allowing parents to drop by a pharmacy, rather than make an appointment with a pediatrician, would ultimately lead to higher flu immunization rates. The bill had the support of the state’s Department of Public Health, which noted three children in Connecticut died from flu-related complications during the 2017-18 flu season. Pharmacists in Connecticut are currently allowed to vaccinate people 18 years or older. According to DPH, individuals under 18 can be administered the flu vaccine by advanced practice registered nurses at retail locations, such as a CVS MinuteClinic. Sen. Heather Somers, of Groton, the top Senate Republican on the Public Health Committee who co-sponsored this year’s bill, stressed that the legislation is voluntary and requires the consent of a parent or guardian. Somers contends the legislature just ran out of time to act on the bill earlier this year, and she plans to resurrect it when lawmakers convene again in February for the 2020 session. “This is something that saves lives,” said Somers, who helped to organize a mobile flu clinic in her district last year. “I think accessibility is key in our health care system.”

A: Bill allowing pharmacists to give kids the flu shot at risk.
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Q: It is one of the first times researchers have shown that a truly autonomous surgical robot can navigate inside the heart, not controlled by a doctor with a joystick, according to a study in Wednesday’s journal Science Robotics . Heart surgeons routinely push a thin tube called a catheter through twisting and turning blood vessels to make repairs in the heart without open surgery. But how does a robotic version find its own way through moving heart tissue and with blood swishing in the way? Researchers at Boston Children’s Hospital turned the catheter’s camera tip into essentially an “optical whisker,” said cardiac bioengineering chief Pierre Dupont, the lead researcher. Just as cockroaches navigate along walls and rats reach out with their whiskers, the catheter maps its path through the heart, tapping periodically against the heart’s valve and wall ever so lightly — with about the force of a stick of butter sitting in your hand, Dupont said. The technology combines the camera’s images with machine learning to interpret what tissue it’s touching and how hard. “This robot is trying to walk along the wall of the heart until it gets to the valve,” Dr. Uma Duvvuri of the University of Pittsburgh Medical Center, who heads a robotic innovation lab but wasn’t part of Wednesday’s study. “That’s a pretty exciting development but this is still very, very preliminary.” The demonstration technology is still years away from any operating room, and isn’t designed to replace a surgeon, Dupont said. Instead, he said it might free up a surgeon’s time to focus on harder tasks, comparing it to a plane’s autopilot — and also reduce the time patients and medical staff are exposed to X-rays that currently are needed for navigation. “The easiest part of autonomy in surgery is the technology,” Dupont said. “The hardest parts are the politics, the regulatory” approval and legal efforts. Dupont’s team tested the robotic catheter in 83 procedures in live pigs in a lab. The device found its target, on average taking seconds longer than a doctor threading a catheter into place. But Dupont said the robotic catheter will learn, just like humans, and get better and faster with more practice. Russ Taylor, a medical robotics specialist at Johns Hopkins University, called the technology clever and the study “a significant achievement, but I wouldn’t flag it as a breakthrough.” Robots with different levels of autonomy have been used in surgery for radiation therapy and orthopedics, said Taylor, who wasn’t part of the research. And Pittsburgh’s Duvvuri pointed to studies with a robot that can stitch tissues together without human help. Still, true autonomy, “in my humble opinion, it’s still a hammer looking for a nail,” said Duvvuri, who couldn’t think of an area where it would improve a procedure. And while the new study focused on a potential heart use, Duvvuri said adding that sensing technology to catheters could have other uses, such as helping to diagnose risky growths in the colon. Added Hopkins’ Taylor, “I see things evolving where the machine keeps undertaking more and more discrete tasks while working in partnership with the humans.” ___ Follow Seth Borenstein on Twitter: @borenbears . ___ The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

A:
Robotic device winds its own way through beating pig heart.
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