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: After hearing about a few more episodes Breckenridge had, Berger suggested she get a gate for the top of the stairs, in case Breckenridge were to fall. She then asked Breckenridge if she had set up Alexa, the virtual assistant developed by Amazon, which she had. They then discussed different exercises they had gone over in the past. Berger asked the patient about her arm mobility — asking her to lift her arm — and stability, prompting her to stand up without holding on to anything. After about a 30-minute session, they said their goodbyes and logged off their computers. Berger, a physical therapist, certified dementia specialist and owner of Rehab Smarter, conducted the entire session online. Rehab Smarter is a local telehealth business that provides comprehensive rehabilitation services to patients over the internet. “This has been a saving grace for me,” Breckenridge said. “It’s not because I don’t want to go to the doctor’s office. It’s because I can’t get to them. If I could, I would be there.” The Brunswick resident turned to telehealth services due to her decreased mobility. She is, for the most part, homebound due to having multiple seizures a day. While she has online sessions with doctors, they still recommend that she come into the office at times to run certain tests and other functions that physicians are not yet capable of completing online. She works with Berger through online sessions about twice a week. Working with her is “completely the same” as if she were sitting with Berger face to-face. “Just because you’re stuck at home doesn’t mean that you can’t get the help that you need,” she said. “People just need to find the help that they need, and sometimes it’s on the internet.” Berger started Rehab Smarter about 18 months ago. She conducts sessions with her patients through an online portal where she can email with them directly, upload videos and add notes for their benefit. Everything is Health Insurance Portability and Accountability Act, or HIPAA, compliant. She typically doesn’t do a face-to-face assessment with the patient, but she has gone in-home to see the setup and suggested any modifications to help the patient with mobility. She may also do an initial assessment and meet with the caregiver, if there is one, and ask what the patient’s goals are. “Most of what clinicians do is educate and teach the client how to take care of themselves,” she said. She demonstrates different exercises with her patients online and, with her expertise, can detect muscle strength and functionality by just observing them perform simple tasks. “You can test cognition over the internet, you can test sensation,” she said. “You can’t listen to the heart without special equipment, but that exists.” Her average client has COPD, heart failure, diabetes, kidney disease, arthritis, high blood pressure and other conditions, all at once. They turn to telehealth because it’s difficult for them to get out of the home and go to a doctor’s office, although they sometimes do so. “It’s not really home care,” she said. “It’s not really outpatient. It’s a platform for clients that either have maxed out their benefits through traditional means or have prevention and wellness issues that will not be covered. It’s another opportunity for people.” Telehealth can be beneficial to the healthcare provider as well. When Berger provides home care through a company she works for, she can see up to six clients a day and then has hours of paperwork to complete, for insurance purposes. Through virtual care, she can see up to 12 patients with minimal paperwork. Her telehealth service is not covered under insurance, which cuts out a lot of the paperwork. A session can range from $80 to $200. With telehealth, a patient is not limited to one doctor. If Berger finds that a patient needs care in an area in which she’s not an expert, she can consult with a doctor across the country to get the patient the care they need. “So you can now get care by anybody who’s appropriate, wherever you are, at least to a point that you could not have gotten before,” she said. But even with the internet playing such a vital role in the future of medicine, there are still many limitations to telehealth. “You can’t touch a patient,” Berger said. “If you have an abdominal problem and your physician is palpitating your stomach to feel for tension and different things, you can’t do that (over the internet). Blood tests and physical surgeries also can’t be done, at this point in time at least.” Frederick Memorial Hospital is also making headway in telehealth services. The Chronic Care Management Program gives patients tablets, blood pressure monitors, a pulse oximeter and a scale to detect their vitals in the comfort of their own home. They consult with a nurse on the team once a week by phone. By the end of the summer, they plan to have video conferencing, according to Lisa Hogan, a nurse at FMH and the team lead for both the Chronic Care Management and telemonitoring programs. The program took off in 2017 and started with 30 monitors for in-home patients. Today it has 203 in the community. Up to 200 more monitors will be added in 2020. There is already a waiting list to be a part of the program. This past winter, the hospital also launched a separate Virtual Visit Program through Monocacy Health Partners, the hospital’s own physician group. The program is for employees and primary care patients of MHP, according to Alex Nason, director of IT innovation at FMH. Through a series of questions, primary care providers can assess ailments such as upper respiratory infections, flu, cold, rash and pink eye. Although physicians can make diagnoses and write prescriptions after conducting a telehealth session, about 20 percent of the time the provider decides that they would like to see the patient in person. Through these efforts, FMH saw an 84 percent reduction in readmission rates and a 56 percent reduction in emergency room visits in 2018, according to Hogan. “Telehealth as technology has become easier to use, less expensive and more accepted. And the clinical validation is there as more and more parts of health care are embracing it,” Nason said. “I think as the technology advances, the research continues to accrue validation and the economics of healthcare continue to evolve, we’re seeing more and more movement, acceptance and options of telehealth because the stars are starting to align.” ___ Information from: The Frederick (Md.) News-Post, http://www.fredericknewspost.com

Output: Telehealth rises as medium increases in validity.


Input: Consider Input: The question of cost is cited in the final line of the story, which suggests that the scoring system can “address escalating health care cost issues.” But we didn’t think that was specific enough to warrant a Satisfactory score. The story doesn’t clue readers in to the fact that the financial burden can be measured in billions of dollars — a single screening test recommended for millions of Americans can cost thousands of dollars apiece. The other cost issue specific to this test is that it takes valuable time for providers to retrieve a reputable risk calculator when sitting with a patient and enter in the specific data points, including in this case waist circumference, which clinicians often do not measure as a ‘vital sign’ per se. The story cites a study that credits colonoscopy with reducing the risk of death from colon cancer by about 50 percent, by removing polyps. It would have been helpful for the story to explain what that relative reduction in risk means in absolute terms (e.g. did the rate of cancer death go from 50% to 25% or from 2% to around 1%?) The story also notes that the study found that patients with a low to intermediate risk score “still have a risk between of between 1.9 percent to 9.9 percent of harboring a polyp that can develop into cancer.” We’ll give credit here for the story’s provision of these key statistics, which do give a sense as how well the test accurately identifies truly low-risk individuals. However, we’d note that the benefit here should ideally refer to the ability of the algorithm to classify people at all risk levels (including high-risk), and therefore target the highest-risk patients for colonoscopy. The story doesn’t really get into discussion of the predictive power of the test, referred to as a likelihood ratio, which is in the study manuscript. However, this is a difficult concept for most health care providers and patients, and we think it’s understandable that the story did not include a full discussion of this topic. The harm of a screening test such as this really is “getting it wrong” in terms of predicting someone to be at low risk and finding them to have a higher risk polyp or malignancy. As noted above, the story cautions that “low- to intermediate-risk patients still have a risk between of between 1.9 percent to 9.9 percent of harboring a polyp that can develop into cancer.” This story accurately explains that the research was about predictive modeling, and explains the components of the risk score as well as the study design. There are some cautionary notes in the text, including a statement from outside expert that “the data from this study is not strong enough to spur any changes in current screening recommendations,” an opinion shared by an editorialist on the study. We think this is sufficient for a Satisfactory rating. The story does not hype the incidence or seriousness of the disease. The prevalence statistics cited are consistent with these National Cancer Institute figures. The story contains two independent voices. The perspective they provide is a particular strength of the article. We wish that more stories would reach out to experts not affiliated with the studies being reported on for context. The story notes that a variety of screening tests exist, but the relevant alternative here is actually other risk calculators, which the authors of the study describe and cite but are not routinely used. The story doesn’t mention these other calculators and why they are seldom used — context that would have deepened reader understanding of the issue. Although availability isn’t explicitly addressed, this risk calculator is now available (implicitly) by virtue of publication of the paper. It is a simple scoring system that can be implemented based on the information in the paper, and the story makes this clear. We’ll rate this Satisfactory. The story makes it sound as if this is a first-of-its-kind tool. However, risk calculation tools for colon cancer have been in circulation for many years. We could not find a news release related to this study. But in any case, the comments from two independent experts assure us that the story wasn’t based on a news release.

Output: 'Scoring System' May Spot Those in Greatest Need of Colonoscopy; But one expert cautions that even 'low risk' patients can still develop suspicious polyps


Input: Consider Input: Unions and professional groups for such employees say those jobs often are lower priority when budgets are tight, but their absence can have profound effects on student learning and teachers’ work. They contend support staff is vital to properly address everyday student issues such as physical and mental health problems or homelessness. In Chicago, the nation’s third-largest school district, the teachers who have been out on strike since last Thursday are seeking commitments for support staff hiring alongside other demands including higher pay and affordable housing citywide. The demands are part of the union’s “social justice” agenda. Bridget Nelson, a social sciences teacher at a magnet high school in Chicago, said her school is lucky to have a nurse most days but a social worker still is responsible for more than 2,000 students. “Adolescence is a challenging time, and we worry about depression and stress like a lot of educators,” Nelson said. “Some students have support at home, but others don’t. They should have support at school to help give them what they need.” The support-staff issue has come up elsewhere in spring protests by thousands of educators in North Carolina and South Carolina; in Minnesota, where a state survey recently found an increase in students’ mental and emotional health concerns; and in strikes in California, where teachers won promises for hundreds of additional nurses and more counselors in Los Angeles schools and more psychologists and special education instructors in Oakland. Shortages are causing problems in schools across the country, said Melissa Cropper, president of the Ohio Federation of Teachers. While discussing labor unions on a visit this month to a government class in an urban Ohio high school, Cropper said she asked the students what they would want prioritized in negotiations. A girl who had attempted suicide answered first: a counselor. Another student wanted a nurse. “We’ve got kids who are dealing with thinking about committing suicide or coming to school hungry or watched a domestic abuse situation over the weekend,” Cropper said. “We can’t possibly begin to think that we’re going to teach them something that’s going to stick with them until we’ve dealt with these other issues.” Most teachers don’t have specific training to tackle those sorts of concerns, so they’re advocating for schools to add more colleagues who do, American Federation of Teachers President Randi Weingarten said. The American School Counselor Association recommends one counselor for every 250 students but has found the average ratio to be nearly double that. The National School Nurses Association’s most recent estimates, from a study published early last year, indicated less than 40% of schools had a full-time nurse and about a quarter didn’t employ one at all. In those cases, teachers may have to assess and address issues such as gym class injuries, and preventive care can dwindle, said Donna Mazyck, the executive director of the nurses association. At John Tartan Elementary School in North Las Vegas, an assistant trained in basic first aid often handles minor injuries and distributes basic medications because the nurse splits duty at multiple schools, said Marie Neisess, a veteran teacher and reading specialist there. The school of 400-plus students also has a counselor, a social worker and a psychologist, but they struggle to keep up with the needs of the student body, which includes children facing challenges such as severe behavioral problems, foster care or a parent’s incarceration, she said. “We’re all kind of putting Band-Aids on the very big problem that we have here,” Neisess said. In Chicago, Mayor Lori Lightfoot had campaigned with an education plan that included staffing schools with full-time nurses, social workers and librarians, and enabling students to get mental health services. The district has committed to hiring more nurses, social workers and support staff but objected to making that part of the teachers’ contract. The union also has expressed concern about the various roles counselors are expected to fill, including as substitute teachers and lunchroom help, and asked for contract language that spells out that people will only be asked to do the jobs for which they are hired. Pushing for something enforceable in writing makes sense to Matt Mandel, a middle-school English teacher in the Philadelphia School District, who said the local union there has fought to have a nurse and counselor at each school. “In these urban districts like Philadelphia and Chicago, our kids need more,” Mandel said, “and we always find ways to justify giving them less.” ___ Associated Press reporter Kathleen Foody in Chicago contributed to this report.


Output: Chicago teachers’ strike highlights support staff shortages.