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: Clearly, the costs involved in cancer treatment already are high. By removing a layer of treatment from an estimated 40,000 patients, those costs would have to drop, but it is unclear from the story by how much. Also, it would have been worth mentioning whether this is likely to affect how insurance companies handle lymph node removals. The story did a good job providing some numbers on benefits, but we wish it had provided more and explained some things a bit more. It says, for example, “In 27 percent of the women who had additional nodes removed, those nodes were cancerous.” How many women had additional nodes removed and, of those, how many had cancerous nodes? A figure like 27% means 1 out of every 4 women had nodes that were, indeed, cancerous, which seems to conflict with other statements in the story about chemotherapy and radiation wiping out the cancer. The story discusses several harms from lymph node removal, and shows that the difference in survival for women who had nodes removed and those who did not was not significant. “Indeed, women in the study who had the nodes taken out were far more likely (70 percent versus 25 percent) to have complications like infections, abnormal sensations and fluid collecting in the armpit. They were also more likely to have lymphedema.” This is where the story really outperformed some of the competition covering the same news. It placed the study into the broader context of a movement in cancer care away from surgeries that don’t provide a clear benefit, and it also explained the study design and the limitations of the study in several ways. “The study, at 115 medical centers, included 891 patients. Their median age was in the mid-50s, and they were followed for a median of 6.3 years. … One potential weakness in the study is that there was not complete follow-up information on 166 women, about equal numbers from each group. The researchers said that did not affect the results. A statistician who was not part of the study said the missing information should have been discussed further, but probably did not have an important impact. It is not known whether the findings also apply to women who do not have radiation and chemotherapy, or to those who have only part of the breast irradiated. Nor is it known whether the findings could be applied to other types of cancer.” It was too bad that it did not mention limitations in terms of lack of enrollment. The targeted enrollment was 1900. There also was an imbalance in the randomization that should have been mentioned. The story is careful to explain to readers that the research findings only apply to a subset of women with breast cancer. “Now, researchers report that for women who meet certain criteria — about 20 percent of patients, or 40,000 women a year in the United States — taking out cancerous nodes has no advantage. It does not change the treatment plan, improve survival or make the cancer less likely to recur. And it can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling.” The Q&A that ran with the story provided more detail about the different types of cancers and cancer patients, noting, for example, “First of all, 20 percent (the estimate of the study’s lead author, Dr. Armando E. Giuliano) refers to 20 percent of all the newly diagnosed cases of invasive breast cancer each year. This does not include noninvasive breast cancer, or DCIS, ductal carcinoma in situ. The total is about 207,000, so 20 percent is roughly 40,000 women. That is about how many women would match those in the study, in terms of tumor status, affected lymph nodes and course of treatment.”  The story also says, “The results mean that women like those in the study will still have to have at least one lymph node removed, to look for cancer and decide whether they will need more treatment. But taking out just one or a few nodes should be enough.” Good quotes including from Dr. Monica Morrow, chief of the breast service at Sloan-Kettering and an author of the study, but also a few fromindependent experts toward the end. Dr. Grant W. Carlson, a professor of surgery at the Winship Cancer Institute at Emory University, and the author of an editorial accompanying the study, provides some soul-searching context by saying that, in taking out so many lymph nodes, “I have a feeling we’ve been doing a lot of harm.” Dr. Elisa R. Port, the chief of breast surgery at Mount Sinai Medical Center in Manhattan, said, “It’s definitely practice-changing.” And Dr. Alison Estabrook, the chief of the comprehensive breast center at St. Luke’s-Roosevelt hospital in New York said, “In the past, surgeons thought our role was to get out all the cancer. … Now he’s saying we don’t really have to do that.” The story does a great job explaining the history of this form of treatment and how it has evolved over time. “But doctors have continued to think that even microscopic disease in the lymph nodes should be cut out to improve the odds of survival. And until recently, they counted cancerous lymph nodes to gauge the severity of the disease and choose chemotherapy. But now the number is not so often used to determine drug treatment, doctors say. What matters more is whether the disease has reached any nodes at all. If any are positive, the disease could become deadly. Chemotherapy is recommended, and the drugs are the same, no matter how many nodes are involved.” The story goes on to do something that stories like this rarely do, it compares compares the harms from different forms of treatment, saying “After armpit surgery, 20 percent to 30 percent of women develop lymphedema, Dr. Port said, and radiation may increase the rate to 40 percent to 50 percent. Physical therapy can help, but there is no cure.” The story makes it clear that removing all under-arm lymph nodes is the standard of care for women with breast cancer and that feelings about that standard are entrenched. The story establishes that a change in treatment protocol away from removing all the lymph nodes under the arms of women with breast cancer would be novel. There is some nuance, here, though that could be missed by a casual reader. Women who have one to two positive lymph nodes would avoid having additional lymph node surgery. The overall tone of the story may make it appear to some readers that women get to avoid lymph node surgery altogether, but they don’t. The story goes well beyond any news release.

A: Lymph Node Study Shakes Pillar of Breast Cancer Care
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Q: In April 2018, the right-leaning Turning Point USA posted a Facebook meme which attacked Independent Vermont Senator Bernie Sanders for once supporting a proposal to “dump nuclear waste” in a “poor Latino community in Texas”: In the 90’s, Trump supported a bill to dump nuclear waste in Sierra Blanca, a poor Latino community in Texas where the average yearly income was $8,000. When asked if he would visit the site, he said “Absolutely not.”  Oh wait! Never mind, that was Bernie Sanders! And he actually co-sponsored the bill! The meme was re-posted by the “Capitalism” Facebook page:  In 1997 and 1998, Sanders did indeed support a measure that gave Congressional approval to an arrangement that would have allowed the states of Maine and Vermont to transport and dispose of nuclear waste at a proposed site in the sparsely populated town of Sierra Blanca in Hudspeth County, close to the Mexican border in West Texas. As the meme suggests, Sierra Blanca was (and is) a predominantly Latino community. U.S. Census Bureau records show that in 2000, two years after the proposal, 73 percent of the town’s 533 residents identified as Hispanic or Latino, and almost all of those as Mexican. In 2016, some 69 percent of Sierra Blanca’s 557 residents identified as Hispanic or Latino. In 1999, the annual per capita income of Sierra Blanca residents was $10,768, which was 45 percent lower than that of Texans at large ($19,617). In 2016, the median household income in Sierra Blanca was estimated to be $41,875 as compared to $54,727 in the state of Texas. As an Independent member of the U.S. House of Representatives for Vermont, Sanders was one of 23 co-sponsors of House Resolution 629, which called for Congress to give its consent to the Texas Low-Level Radioactive Waste Disposal Compact — an agreement between the states of Texas, Maine, and Vermont. Speaking on the floor of the house in October 1997, Sanders said he was in “strong support” of the resolution for environmental reasons, and stressed that he personally was opposed to the use of nuclear power, but that the waste it produces had to be disposed of as safely as possible. It is worth reading a relatively extensive excerpt from his remarks in order to get a good sense of Sanders’ stated reasoning: Let me touch, for a moment, upon the environmental aspects of this issue. And let me address it from the perspective of someone who is an opponent of nuclear power, opposes the construction of nuclear power plants and if he had his way, would shut down the existing nuclear power plants as quickly and as safely as we could. One of the reasons that many of us oppose nuclear power plants is that when this technology was developed, there was not a lot of thought given as to how we dispose of the nuclear waste. But…the reality, as others have already pointed out, is that the waste is here. We can’t wish it away. It exists in power plants in Maine and Vermont, it exists in hospitals, it is here…So the real environmental issue here is not to wish it away, but to make the judgement, the important environmental judgement as to what is the safest way of disposing of the nuclear waste that has been created. …Leaving the radioactive waste at the site where it was produced — despite the fact that that site might be extremely unsafe in terms of long-term isolation of the waste, and was never intended to be a long-term depository of low-level waste  — is horrendous environmental policy…No reputable scientist of environmentalist believes that the geology of Vermont or Maine would be a good place for this waste. In the humid climate of Vermont and Maine, it is more likely that ground water will come in contact with that waste and carry off radioactive elements to the accessible environment. There is widespread scientific evidence to suggest, on the other hand, that locations in Texas — some of which receive less than 12 inches of rainfall a year, a region where the groundwater table is more than 700 feet below the surface — is a far better location for this waste. This is not a political assertion, it is a geological and environmental reality. A video clip of his comments can be viewed here. Congress passed the resolution comfortably by 305 votes to 117, as did the Senate, by 78 votes to 15. The proposal had much stronger support among Republicans than among Democrats. GOP members of the House voted 197-26 in favor, while Democrats were more evenly split, voting 107-91 in favor. In the Senate, not a single Republican opposed H.R. 629, while 51 of them voted for it. Fifteen Democratic Senators opposed the bill, while 27 of them voted in support. At that time, five out six Senators from Texas, Vermont, and Maine were Republicans. All five of them voted in favor of the proposal. Both of Maine’s Representatives voted for the disposal site, as did 10 out of the 13 Republican Congress members from Texas. In the House, the proposal had 23 co-sponsors. Eleven were Republicans, eleven were Democrats, and one was Sanders himself, an Independent. The author of the resolution was Joe Barton, a Republican from Texas. Despite Congressional approval for the agreement, authorities in Texas ultimately rejected the proposal to establish a disposal site at Sierra Blanca. In October 1998, the Texas Natural Resource Conservation Commission voted 3-0 against issuing a permit for the construction of a nuclear waste dump there. According to the Associated Press, commission chairman Barry McBee said the disposal site could have provided a much-needed economic boost to the area, but commission members were sufficiently concerned about safety issues to deny the permit. According to a September 1998 article in the Texas Observer, a group of activists opposed to the Sierra Blanca waste site approached Sanders at an anti-nuclear weapons rally in Vermont that year:  Sanders left the stage, which surprised no one in the small Texas delegation. Earlier, he had told them, “My position is unchanged, and you’re not gonna like it.” When they asked if they would visit the site in Sierra Blanca, he said, “Absolutely not. I’m gonna be running for re-election in the state of Vermont.” We contacted Bill Addison, a leading opponent of the Sierra Blanca proposal, who was identified in the Texas Tribune article as having attended that Springfield rally. He confirmed that he was present and corroborated the article’s account of the activists’ interaction with Sanders. We asked a spokesperson for Sanders whether he agrees that this exchange took place, but we did not receive a response to that specific question. Instead, the spokesperson offered a broader explanation and defense of the Senator’s support of H.R. 629: The only reason Senator Sanders was ever involved is because the constitution requires Congress to approve interstate compacts. Texas Representative Joe Barton introduced such legislation in 1998, and twenty-three members of the Vermont, Texas and Maine congressional delegations cosponsored it. The bill did not endorse a specific site — in fact, it did not mention Sierra Blanca at all. Nor did the bill override the local and state approval process. In the end, the Texas agency in charge of permitting ruled against the Sierra Blanca site, choosing another site in Texas instead. So, the process worked. The compact, much less the site selection were never Sen. Sanders’ idea. He disagrees with the very premise of the 1980 law that led to the Texas-Vermont-Maine compact, since it put the burden of disposing of low-level waste on the states, rather the nuclear energy companies that produced much of the waste. In fact, he has long been an opponent of nuclear power precisely it produces waste for which we still have no solution (the Texas site is just for low-level contamination — there is still no plan for all of the high-level nuclear waste all across the country). Sanders’ spokesperson is right to point out that the text of H.R. 629 did not mention Sierra Blanca, but the town was widely known and discussed as the proposed location of the disposal site throughout the time that Sanders and others supported the bill. For example, in April 1998 (three months before Sanders and others in the House voted in favor of H.R. 629) the late Minnesota Senator Paul Wellstone condemned the proposed Sierra Blanca site from the floor of the Senate: What has troubled me from the very beginning is that this legislation would result in the dumping of low-level radioactive waste in a small, poor, majority-Latino community in rural West Texas — a town called Sierra Blanca. The Texas legislation in 1991 identified the area where the dump will be located. The Texas Waste Authority designated the site near Sierra Blanca in 1992. A draft license was issued in 1996. Whether we like it or not, this knowledge makes us responsible for what happens to Sierra Blanca. The Turning Point USA meme is accurate in claiming that Sanders supported and co-sponsored a proposal that would have seen nuclear waste from Maine, Vermont and (principally) Texas disposed of at a site in Sierra Blanca, and that Sierra Blanca was (and still is) a predominately Latino and relatively poor community. The meme leaves out important and relevant context by failing to mention the key role that Republicans played in crafting and passing that proposal; instead, it singles out Sanders and does not offer the reader any inkling of his environmentalist rationale. Sanders stood to gain politically from supporting a plan that would remove nuclear waste from his constituency, but this does not necessarily mean he wasn’t motivated by a sincere desire to dispose of the waste in a manner and location that he genuinely believed to be safer. However, whether or not you believe his stated rationale was sincere, no proper analysis of a particular politician’s policy position or Congressional vote should leave out the reasons put forward by that politician. Finally, we were not able to corroborate the “Absolutely not” quotation attributed to Sanders, and his spokesperson did not address our question about it.

A: "Sen. Bernie Sanders once supported a proposal to ""dump nuclear waste"" in the ""poor Latino community"" of Sierra Blanca, Texas."
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Q: News outlets report the Macon County Public Health Department announced Wednesday that a second death within the past three weeks is also suspected to be caused by the disease. That death is still under investigation. No further details were provided, with the department citing privacy laws. County officials say preventative antibiotics are being given to those who came in close contact with people infected with the Neisseria meningitidis bacteria. They’re working with the state Division of Public Health to help contain the outbreak. Officials say anyone experiencing symptoms of bacterial meningitis, which include sudden fever, severed headache, a stiff neck and stomach pain, should go to the emergency room. Macon County is in western North Carolina.

A:
1 confirmed bacterial meningitis death in North Carolina.
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