TASK DEFINITION: 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.
PROBLEM: Paragraph: Moira O’Neill, director of the Office of the Child Advocate, said the center operated by Granite Pathways was unusual in that it was licensed by the Department of Health and Human Services but was not certified by the division that oversees child welfare. While that’s not a requirement because the Division for Children, Youth and Families didn’t directly place children at the facility, without that certification, it is unclear who had oversight over quality and safety, O’Neill said. “We have issues with the extent of oversight DCYF provides to certified agencies, but at a bare minimum, they know who’s there, they re-certify them every two years, they provide technical assistance. There’s some expectation that someone has an idea of what’s going on in the program,” she said in an interview. Republican Gov. Chris Sununu and the health department announced on Nov. 27 the state was canceling its contract with Granite Pathways, which had been operating the 36-bed facility in Manchester for just over a year. A summary report released by the department Monday said that in a span of less than two weeks, four of the 10 residents were taken to hospitals after taking drugs one of them smuggled in, a fifth took multiple doses of prescription medication in an apparent suicide attempt and a sixth drank a bottle of hand sanitizer. The remaining residents have since been transferred, and the contract officially ends Dec. 27. Some of the residents at the center were known to the child welfare agency, said O’Neill, who has been reviewing their records. “In our preliminary review, we found that there were children who were placed there who have really complicated needs, and we don’t know if that program had the capacity to serve those needs,” she said. O’Neill said she sent the Department of Health and Human Services a list of questions in late November about what the facility knew about the children, its capacity to meet their needs and how the program was supervised. As of Tuesday, she had not received answers. “If we are going to understand the circumstances that prompted seven ambulance transports, we must understand how those children came to be at the facility and what transpired in assessing and treating them,” she said. Jake Leon, spokesman for the Department of Health and Human Services, said the department agrees with O’Neill that it is important to ensure that children get the services they need. He said the department has addressed and continues to address similar questions, but responses must remain confidential to protect clients’ privacy. “DHHS monitored Granite Pathways’ compliance with its contractual obligations and is still compiling information regarding the organization’s noncompliance. There is also an ongoing investigation by DCYF that must be kept confidential,” he said in an email. Patrica Reed, state director at Granite Pathways, said the nonprofit’s leaders and board of directors were still reviewing the health department’s report. “The end of this contract does not end Granite Pathways’ commitment to its mission of supporting individuals with substance use disorders and mental illness in achieving their life goals as valued members of their communities,” she said in a statement. But the trouble at the youth treatment center has raised questions about the state’s approach to funding substance abuse treatment in general and Granite Pathways in particular. Since 2016, it has been a subsidiary of The Fedcap Group, a New York-based nonprofit that focuses on helping people overcome barriers to economic well-being through workforce development, education, occupational health and economic development. With close to $300 million in annual revenue, the parent organization has government contracts in 22 states, and its acquisitions include Easterseals programs New York, Rhode Island and parts of Texas. In New Hampshire, Granite Pathways was a year into a four-year, $15.6 million contract for the youth treatment center. According to the state expenditure register, the organization has been paid $4.1 million since 2012, including just under $900,000 in the current fiscal year. Under the hub-and-spoke system the state launched this year to connect people to opioid addiction resources, Granite Pathways was awarded $5 million in federal funding over multiple years to run the two largest hubs, in Manchester and Nashua. Contracts are approved by the five-member Executive Council, and at least one member has expressed concern about Granite Pathways in the past. In June, when the council approved a $345,000 contract related to treatment for adolescents, Councilor Andru Volinsky noted that the organization already was running the opioid response hubs and called for “continued vigilance” to ensure it could keep up with all its responsibilities. “We’ve had, in particular when trying to quickly build out our substance abuse response, a number of instances where the financial management of private nonprofits was not strong. We haven’t really had strong capacity to oversee that at DHHS,” he said in a recent interview. “My concern at the time of this Granite Pathways contract was that we were again placing what I think are state responsibilities onto a private contractor, and we still haven’t built an infrastructure to oversee those private contractors.” Volinsky, a Democrat, said he doesn’t know whether the state should build out its own capacity to respond to the substance abuse crisis, or whether it’s enough to rely on outside groups and closely monitor them. “I could legitimately understand the arguments either way,” he said. “But to almost blithely continue to invest in outside agencies without oversight doesn’t make sense.” In announcing the closing of the youth treatment center, officials said the state is taking 30 days to review all of its contracts with Granite Pathways and may take further action. The health department also has increased its oversight of substance use disorder treatment centers in the last year after one of the largest facilities closed. Those efforts have included financial audits and the appointment of a new director at the Office of Program Integrity. Claim: Child advocate sees lack of oversight at youth treatment hub.

SOLUTION: New Hampshire’s only residential treatment center for teens struggling with addiction operated with an apparent lack of oversight before it was shutdown earlier this month, the director of a state watchdog office said Tuesday.

PROBLEM: Paragraph: No mention of the cost of treatment. This is important if the surgery is not a permanent fix for acute sinusitis. Repeated operations and continued medications need to be compared to cost for traditional surgery. No quantitative estimate of the benefits of the new procedure. There was a study of 10 people that found “no safety concerns”, but readers should be told more about this very small group. What were the long term outcomes and did these patients eventually have to have further sinuplasty, more invasive surgery or continue to take medications to relieve sinusitits? The story mentions that a larger, randomized trial is underway to better understand the risks and benefits of sinuplasty compared to medication and traditional sinus surgery. Mentions that more information is needed and no one knows if balloon sinuplasty works as well as the more traditional surgical option for chronic sinusitis. Mentions that general anesthesia is still needed for balloon procedure and this comes with its own set of health risks. There isn’t much evidence for the story to report. The story did stress the importance of a randomized trial underway comparing medication, traditional sinus surgery and the newer balloon sinuplasty. Story describes this trial and the need for further evidence before this new procedure can be widely recommended. Mentions that this procedure should not have been FDA approved with so little quality evidence. No evidence of disease mongering. The story mentions that this procedure would be for chronic, not acute sinunitis and describes how these are different. Good balance of information on treatment options with input from otolaryngologists not affliated with the makers of the device who are able to provide perspective on the new procedure. They mention that further study is needed. There is a note that one of the physicans studying the new sinuplasty has no financial ties to Acclarent, maker of the balloon devices used in this type of sinuplasty. Mentions that this form of sinuplasty is not for everybody and that it may not prevent the need for more comprehensive surgery in which bone and tissue are removed. There is mention of other options including medication and the more traditional surgery, which is decribed as highly effective, but with a painful recovery and side effects such as scar tissue. Quantification of the incidence of this and other side effects of traditional surgery would be useful. The story is clear that the FDA approved the device but that it still needs to undergo further study via randomized controlled trials. Story mentions that this is a new procedure only offerred by 100 doctors. This story is a blananced presentation of sinuplasty and the information here does not appear to be from a press release. The are quotes from otolaryngologists not affliated with the makers of the device who are able to provide perspective on the new sinuplasty procedure. Claim: A balloon instead of a knife: Sinuplasty for ailing sinuses

SOLUTION: This story provides a good balance of information on a new treatment option for chronic sinusitis, and there is corroboration with otolaryngologists not affiliated with the makers of the balloon device who are able to provide perspective on the procedure. The story clearly notes this procedure would be for chronic, not acute sinusitis and describes how these are different. The story explains that this form of sinuplasty is not for everybody, and that it may not prevent the need for more comprehensive surgery in which bone and inflamed tissue are removed to open the sinus passages. More information is needed on the safety and efficacy of balloon sinuplasty, and no one knows if this surgery works as well as traditional surgery for chronic sinusitis. The story mentions other options for treating chronic sinusitis, including medication and sinus surgery, which is described as highly effective, but with a painful recovery and side effects such as scar tissue. Quantification of the incidence of side effects with traditional surgery would be useful. While there is not much quantitative evidence available on the new procedure, the story stresses the importance of a randomized trial underway comparing medication, traditional sinus surgery and the newer balloon sinuplasty. There is adequate description of this trial and the need for further evidence before this new procedure can be widely recommended. There is a caveat that this procedure should not have been FDA approved with so little quality evidence: a study of 10 people that found “no safety concerns”, but readers should be told more about this very small group. What were the long term outcomes and did these patients eventually have to undergo further sinuplasty, more invasive surgery or continue to take medications to relieve their chronic sinusitis? The story explains that general anesthesia is still needed for the balloon procedure and this comes with its own set of health risks and additional costs. There is no mention of the cost of this newer procedure. This is important information if the surgery is not a permanent fix for chronic sinusitis. A cost comparison of the newer sinuplasty, which may require repeated operations, sinus medications and traditional surgery is needed.

PROBLEM: Paragraph: The patient is a resident of the Middle East, where they were believed to have contracted the infection before traveling to Britain, PHE said on its website. MERS is thought to be carried by camels and comes from the same family as the coronavirus that caused China’s deadly Severe Acute Respiratory Syndrome (SARS) outbreak in 2003. Most of the known human-to-human transmission has occurred in healthcare settings, and the World Health Organisation has said hospitals and medical workers should take stringent precautions as standard to stop the disease spreading. PHE said it was the fifth case of the disease diagnosed in England, the others having been identified in 2012 and 2013. PHE deputy medical director Jenny Harries said it would monitor those who had been in close contact with the patient. “It is important to emphasize that although a case has been identified, the overall risk of disease transmission to the public is very low,” she added. Claim: Middle-East resident diagnosed with MERS in Britain.

SOLUTION:
A person in northern England has been diagnosed with the potentially deadly Middle East Respiratory Syndrome (MERS) and is being treated at hospital in Liverpool, Public Health England said on Thursday.