Generate an explanation for the given claim using the provided supporting material from the paragraph. Please consider the following points while generating an output. 1) The claim will always have supporting proof in the paragraph, and the paragraph will have a clear point of view supporting the claim. 2) There can be instances where direct correlation to the claim is not available. Make use of the sentences in the paragraph to provide a corresponding output supporting the claim. 3) The explanation should be at least one and at most twelve sentences long.

Paragraph: Costs are mentioned reasonably early in the story, and with specificity. This was good to see. Benefits of these tests are touted, but not quantified. An officer of the National Ovarian Cancer Research Fund Alliance, an advocacy group, testifies that the outcomes of women who have surgery from a gynecologic oncologist “are much better.” But we don’t know what that means. Is it longer survival? Later the story explains that combining the two blood tests with assessment by a clinician “better determined the patients who should be referred to a [gynecological oncologist], identifying well over 90 percent of the women who actually had cancer.”  (Note that this statistic reflects only referral to a gyn-onc, not patient survival.) But how does that compare to the standard assessment tools? A 2016 study described as publication “of the first clinical utility data” demonstrating that use of OVA1 resulted in referral of ovarian patients to gynecologic oncologists offers similar outcomes but is not mentioned in the story. We’re told that experts fear that these tests could lead to unnecessary surgery or delayed diagnosis, and that’s sufficient for a Satisfactory rating. The story could have delved into a bit more of the specifics: What is the evidence for these concerns? What are the false positive and false negative rates? These details are useful because the point of the story is that clinicians are not using these tests to try to improve outcomes of ovarian cancer patients. Are the possible debits–or uncertainties driven by lack of clinical data–contributing to these decisions? There isn’t sufficient information on the evidence behind these tests. The FDA has approved ROMA and OVA1 for use, but the studies that led to that decision are not discussed. Nor is there sufficient discussion of why the physician groups that write guidelines haven’t endorsed the tests. Their concerns are raised, but the evidence is not presented or analyzed. A late diagnosis of ovarian cancer is way too common, and the outcome is grim. At the same time, the anecdotes seem to highlight the sad aspect of the disease without necessarily providing a relevant case in which the tests described would have helped (any more than a basic blood test would have). The companies responsible for developing and marketing these two tests are front and center in this story, with scientists affiliated with the companies clearly identified. At least two sources in the story—one of them a scientist affiliated with the National Comprehensive Cancer Network—appear to be independent of the companies. The story makes it clear that no effective early detection screening test exists. Existing strategies—the CA125 blood test and vaginal ultrasound—are mentioned and then discounted, in part via a personal narrative of a young woman who received a late diagnosis of cancer. While data-driven specifics aren’t included on why standard methods aren’t sufficient, this is enough to rate Satisfactory. A direct comparison of survival stemming from existing diagnostic tests relative to survival stemming from ROMA and OVA1 would have strengthened the story. If those numbers aren’t available, that should have been pointed out. The story makes it clear that the two blood tests have been available since 2009. The story mentions that the tests are combinations of existing tests with a “proprietary” formula (essentially a risk prediction tool) to translate the results to likelihood of cancer. But, the article should have talked about whether the tests, other than CA-125, have been used before. This appears to be an enterprise story, and does not rely on a news release. Claim: Ovarian cancer blood tests: Available, not widely used
This is a story about the apparent underuse of two blood tests—ROMA and OVA1—that are FDA approved to help clinicians decide whether surgery to investigate abnormal growths should be performed by a gynecologic oncologist (“gyn-onc”) trained to remove malignant ovarian cancer, rather than an obstetrician-gynecologist or a general surgeon. The gist of the story is that the tests have not been widely adopted in the ensuing years, “largely because they haven’t been recommended by the physician groups that write the care guidelines.” The story hit on a lot of important notes–it told readers the cost of these tests, and it included comments from independent sources. What is not clear is the extent to which clinical evidence supports the increased use of the two tests. We’re told they accurately picked up about 90 percent of cancer cases. But we’re not told how that compares to standard methods of detection. As the story notes, surviving ovarian cancer is an uphill battle–it is often a deadly disease caught too late. Any procedure that increases the probability of survival is worth careful consideration.

Paragraph: Roy treads carefully as the water rises to his knees, seeming for a moment to lose sight of his prey. Then in one swift action he steps back, takes aim and shatters the outback calm, and a crocodile, with a single booming shotgun blast. I am definitely not in Sydney anymore. For more than 10 years I have dreamed of photographing the daily lives of Aboriginal Australians in the northern-most tip of the Northern Territory, Australia’s rugged “Top End”. Their Arnhem Land reserve - closer to Bali than Sydney - covers an area of around 97,000 sq km (37,500 sq miles), has a population of around 16,000 and access for non-Aborigines is by invitation only. Australia’s Aborigines are the custodians of the longest unbroken cultural tradition on Earth, having migrated Down Under from Africa via Asia between 40,000 and 60,000 years ago, and connection to the land is practically written into their DNA. But the arrival of European settlers in the 18th century marked the beginning of a painful disenfranchisement. Massacres are still tearfully remembered and today the majority of Aborigines live in abject poverty. Last year, while on patrol with the Indigenous Australian Army unit known as NORFORCE, I met Sergeant Norman Daymirringu, a Yolngu Aborigine, who invited me to go hunting with him near Ramingining, located a bumpy and dusty 600 km drive east of Darwin. Norman is allowed by tradition to share his ancient culture with those he deems worthy, and I was honoured to have been told the Yolngu people’s creation stories and shown their sacred sites. But entering Arnhem Land as a “White Fella” means changing gears and seeing the world through a completely different set of eyes, a great challenge for a photographer. For example, an outsider might struggle to understand a site such as “Dog’s Tongue”, an orange rock amid a barren salt pan, but for Norman it is an integral part of the creation of the universe. The rock has tipped over from its normal position and Norman, as custodian of the land, affords me the rare honor of watching as he puts it back in place, where it has stood for countless millennia. At Yathalamarra, a community consisting of around a dozen houses, we pick up some relatives for the hunt and head on foot to an isolated billabong. With the sun blazing and temperatures reaching 40 degrees Celsius, or 104 Fahrenheit, I am getting pessimistic, when suddenly Roy fires his shotgun. At his feet lies a dead crocodile. Roy pulls the beast from the water, while Marcus keeps lookout. Not far from the shoreline the water starts moving. Suddenly Marcus pounces and, from just beneath the surface, he pulls another crocodile, this one a bleating baby. Roy is nervous about crossing the billabong carrying a heavy dead crocodile, but wanders downstream and grabs a boat hidden in the bushes. Using a stick as a paddle he navigates towards us, throwing the two crocs onto the muddy shore. Wow, its over, I think. We can head off with a great catch and potential feast awaiting. Roy has other ideas: “It’s easier to carry them without all that skin,” he tells me. Any butcher would have been extremely impressed with the skill he showed at filleting this massive beast. The baby was carried out alive. As we are leaving, Roy wraps the intestines in leaves, as nothing that can be eaten is wasted, and he and his sons walk the few kilometers back to the car with crocodile meat and a goanna lizard slung over their shoulders. As for me, I walked away with a unique insight into their culture and some photographs that not many others have had the privilege of taking. Claim: Hunting for pictures, and crocodiles, in remote Aboriginal country.
We are deep in a forest crowded by Australian paperback trees, the air thick with humidity but eerily silent save for the screeching of tropical birds, when Marcus shouts: “Look, crocodiles!”    As a Reuters photojournalist, I’m a trained observer, but I can’t see any crocs. I can’t see anything beyond mud and what little water is left in the small billabong. Aboriginal hunters Marcus and Roy, a father and son team, take off running past a herd of water buffalo and by the time I catch up Roy is standing ankle-deep in murky water, his shotgun pointed at the surface. Hang on a minute: wasn’t your son pointing at crocodiles in that water ten seconds ago? Is this safe?

Paragraph: With increasing diarrhea diseases, more dangerous heat waves, air pollution and increases in mosquito-borne diseases such as dengue fever and malaria, man-made global warming is already harming public health around the world, the annual climate change and health report from the medical journal The Lancet said Wednesday. But the report and its authors said they worry that the future health of the world’s youngest people will get even grimmer if emissions of heat-trapping gases aren’t curbed. “A child born today as they go through their lives they are going to be increasingly exposed to more and more harms that I did not experience,” said study co-author Dr. Renee Salas, a Boston emergency room physician and professor at Harvard. “I cannot think of a greater health emergency,” Salas said. Already, the number of days when conditions are ripe for the spread of the water-borne bacteria Vibrio, a major cause of debilitating diarrhea, have doubled since 1980 with last year ranking second highest on record, the report said. Because of the warming climate, 29% more of the U.S. coastline is vulnerable to Vibrio. The report also said the cholera version of Vibrio has increased nearly 10%. Nine of the top 10 years where conditions were most ripe for dengue fever transmission have occurred since 2000, the report said. Those diseases hit children harder, the report said. And children, the elderly, the poor and the sick are most hurt during extreme heat with dangerous overheating, respiratory disease and kidney problems. “Children are the most vulnerable. They will bear the vast majority of the burden of climate change,’’ said Dr. Nick Watts, an Australian emergency room physician and the lead author of the global report. “Their health will be hit by climate change in a profoundly different way.” While medicine and public health have improved over the decades, allowing people to live longer, climate change “threatens to undermine all of the gains we’ve had,” Salas said. Dr. Cindy Parker, an environmental health professor at Johns Hopkins University, praised the peer-reviewed report, which she wasn’t part of, but she worried that focusing on the health effects that have already happened lessens the urgency of the future. “Climate change is a risk amplifier,” Parker said in an email. So as bad as the health problems are, add in water and food shortages caused by climate-change and there will be more social unrest and conflict around the world that will still hit the United States in indirect ways, she said. As an emergency room doctor, Salas said diseases that spread farther because of a changing climate, such as Lyme Disease, are something she has to consider when she treats patients. During an emergency room shift in July, Salas saw an elderly man during a heat wave with a body temperature of 106 degrees. The ambulance crew said he lived on the top floor of a public housing complex with no air conditioning and when they opened the door “there was this wave of heat that hit them.” Salas was able to save him. But as a doctor she struggles with cases where there is no way to treat the patient, such as with devastating bleeding inside the brain. With climate change health problems, she said, the remedy is stopping emissions of heat-trapping gases from the burning of coal, oil and gas. “We can’t ‘doctor’ our way out of this,” said Dr. Georges Benjamin, executive director of the American Public Health Association, who wasn’t part of the study but praised it. “We must address the root causes of climate change.” ___ Follow Seth Borenstein on Twitter at @borenbears . ___ The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content. Claim: Doctors: Warmer world is unhealthier place for children.

Children are growing up in a warmer world that will hit them with more and different health problems than their parents experienced, an international report by doctors said.