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.

"Costs and the cost-effectiveness of this strategy are not discussed. Any discussion of a preventive strategy should include comments on cost. Avandia and metformin, at the doses used in the study, cost about $195 a month, according to drugstore.com. We get absolute benefits, relative benefits, and the all-important number needed to treat (NNT). Very nice. While harms weren’t quantified, the story provided a good amount of detail, context, and caveat about the safety of this regimen. We get many important details about the study: the number of patients, the enrollment criteria, randomization, placebo control, half doses, and the length of follow-up. It also describes some limitations of the study, such as its inability to detect rare adverse events due to its size. It’s an important caveat, particularly with a cardiovascular cloud hanging over rosiglitazone. The author also points to the editorial’s observation that the approach didn’t affect the problems in the pancreas that underly diabetes and which must be addressed by such a strategy. The author is very specific about the thresholds for the patient population, and who was considered at high risk to progress to diabetes. We note that it was judiciously limited in its use of the term ""prevention."" Props to the author for citing the editorial written by two independent experts and published in the same issue of the Lancet. This article selects several of their many cogent comments. Ideally, another independent source outside the publication would’ve been consulted, too. The story describes how GSK has a dog in this fight, funding the study and manufacturing Avandia. The story also provides the institutional affiliations of Zinman and the two editorialists. While it’s probably covered in the GSK funding source, we’ll point out that several investigators had other financial ties to GSK, too. The article talks about the effectiveness of lifestyle changes and the challenge of implementing them. It also reviews the barriers to using full-dose rosi because of adverse events. It’s clear Avandia and metformin are currently available. We’re told of similar prior studies and the novelty of attempting a low-dose regimen to block progression. We don’t see evidence that the article relied on any news releases."
Low-dose combination of Avandia and metformin decreases progression to diabetes by two-thirds with few side effects

The first Democrat-only televised debate is Wednesday, a natural forum for the three candidates to tout their agendas to a broader audience after several weeks of unveiling fresh items. Gretchen Whitmer, Shri Thanedar and Abdul El-Sayed agree on many issues, like raising the minimum wage to $15 an hour, spending much more on roads and other infrastructure, shutting down twin oil pipelines in a waterway linking two of the Great Lakes and repealing the state’s emergency manager law. But there are some differences that are being emphasized more in the stretch to the Aug. 7 election. El-Sayed, Detroit’s former health director, has proposed a plan to provide all Michigan residents with government-financed “Michicare” until they reach Medicare age, including 600,000 who have no insurance. He hopes to make it a “wedge issue,” especially with Whitmer, who has not embraced the single-payer concept and whom he has criticized for accepting campaign donations from the political action committee of Blue Cross Blue Shield, the state’s dominant insurer. “Health care is a human right,” he said, contending that raising taxes to fund the Medicare-for-all-style system while eliminating premiums, deductibles and copays would save both residents and businesses overall. Whitmer is expected to announce her own health care plan before the primary and most recently has rolled out education and economic proposals while also focusing on her mantra to “fix the damn roads.” The former Senate minority leader frequently points to her role in the bipartisan expansion of Medicaid to more than 600,000 adults, including in a TV ad that is airing. “She’s the only candidate in the race who has actually expanded coverage for Michiganders,” said spokesman Zack Pohl. El-Sayed, who is courting the party’s liberal wing and in recent days outlined a plan to address high auto insurance premiums, proposes paying for Michicare with a 2 percent or 2.25 percent gross receipts tax on businesses, depending on their size, with the first $2 million exempt from taxation. He also would effectively raise the state’s 4.25 percent personal income tax to between 5 percent and 8 percent, via a graduated payroll tax. Thanedar, a multimillionaire businessman, also supports a universal, single-payer system but has not elaborated. He is recommending tax increases to fund signature facets of his economic plan — expanding child care subsidies to cover 345,000 additional low-income children, ten times more than now, and paying for 78,000 more 3- and 4-year-olds to attend preschool. He says the moves would allow thousands of women to re-enter the workforce and improve students’ educational outcomes. He wants to boost the 6 percent corporate income tax to 7.5 percent for businesses with at least $350,000 in gross receipts and assess a 10 percent tax on the portion of receipts exceeding $1 million. He also would assess an 8.85 percent personal income tax for individuals earning at least $200,000 and a 10 percent rate for millionaires. Households with less than $50,000 income would pay no income tax. “We are one big family. We need to chip in to make it helpful to the ones who need help,” Thanedar said during a recent joint Democratic-Republican debate on Mackinac Island. Both he and El-Sayed, if elected, would face steep obstacles, including a Republican-led Legislature — unless power shifts — and the constitutional requirement that voters approve a graduated income tax. Whitmer, with an eye toward the general election, has been more pragmatic — focusing on what her camp says is actually achievable in the current budget and political environment. While not ruling anything out, she has not called for changes to business or income taxes and has proposed repealing the taxation of retirement income that was enacted as part of a GOP-written tax overhaul. She pledges to work with lawmakers to fund an infrastructure bank to upgrade roads through user fees such as higher fuel taxes or, if that is unsuccessful, to ask voters to approve bonding. Thanedar wants to borrow money, while El-Sayed also proposes an infrastructure bank funded with increased fuel taxes and other revenue-raising mechanisms. The centerpiece of Whitmer’s jobs plan is providing a two-year maximum $3,040 annual scholarship to high school graduates who attend an in-state university, community college or receive technical training, as long as they do community service, maintain a certain grade point average and have a good attendance record. The estimated cost is $100 million a year. “It’s about creating a path for everyone in to a high-wage skill,” she said. ___ Online: Policy plans for — El-Sayed: https://abdulformichigan.com/issues — Thanedar: https://www.shri2018.com/ — Whitmer: https://www.gretchenwhitmer.com/issues/ ___ Follow David Eggert on Twitter at https://twitter.com/DavidEggert00 . His work can be found at https://apnews.com/search/David%20Eggert
Democrats unveil new policies before gubernatorial primary.

Five hours later, Soni was dead, one of more than 100 children to die this month from Acute Encephalitis Syndrome (AES), or ‘brain fever’, in one district of eastern Bihar state. “I still see her in my dreams,” said Sahana Khatun, Soni’s mother. “I can’t accept she is gone.”  The deaths were preventable, doctors say, if poor families had access to good food, clean water and better medical care in Muzaffarpur district, 80 km (50 miles) from the state capital Patna. The epidemic has sparked a debate over growing inequality in India and focused attention on a free healthcare scheme for the poor - known as “Modicare” after Prime Minister Narendra Modi - eight months after it was launched. The precise causes of AES, which killed more than 350 in Bihar in 2014, are not known, though a majority of medical professionals say it is linked to a ferocious heat-wave that has gripped Bihar for the last month. Some studies have blamed toxins in lychees, a fruit grown in abundance in orchards around Muzaffarpur, though many families told Reuters their children had not eaten them in recent weeks. The victims come from poor families who often suffer from malnutrition and dehydration, doctors in Muzaffarpur said. If caught quickly, AES patients can often recover with simple rehydration treatment, doctors said, but delayed care can lead to convulsions and eventual death. “It is a preventable disease,” said Dr. Chaitanya Kumar at the district’s Kejriwal Maternity Hospital, one of two treating young AES patients. “Glucose and providing meals to some of the poorest districts – these are not expensive things.”   India has world-class hospitals in major cities like New Delhi and Mumbai, but rural facilities like those in Muzaffarpur are overstretched, doctors say. The 600-bed Sri Krishna Medical College Hospital in Muzaffarpur has more than 900 patients, a third of them children with AES. Ninety-three AES patients have died at the facility since the outbreak began. Stray goats roam over rubbish and rubble on the hospital grounds. The building has frequent power cuts and the stench of urine lingers in the hallways. The hospital evicted a group of sick inmates from a ward to accommodate the surge in AES patients, but at times there are still two or three children assigned to one bed. “It is incredibly difficult to be a doctor in a place like this,” said Ravikant Singh, a volunteer doctor from Mumbai who was giving rehydration solutions to patients at the hospital. Other doctors said they felt powerless. “I can’t do anything. It is the social conditions that have to change,” said Rajkumar Goenka, secretary of the trust that operates Kejriwal hospital. “The government – state and national – has to do something,” he added. Nearly half of all children in Muzaffarpur are underweight, and a similar number are stunted, or too short for their age, according to government data. In Marwan, a village of thatched huts where many residents belong to one of the lowest rungs in India’s caste system, some children have swollen stomachs – a common sign of malnutrition. Residents interviewed by Reuters said they were unaware of Ayushman Bharat, the program known as ‘Modicare’ launched in 2018 to give India’s poorest free access to private healthcare. Nand Lal Mandhji, 61, whose four-year-old granddaughter died from AES, said the family was given a flyer about the scheme during a hospital visit in May. The family is illiterate and the program was not explained to them, he said. “They gave us something but we didn’t understand what it meant,” he said, clutching the flyer with Modi’s image. Eight families in Marwan with sick relatives said they had never heard of Modicare, and did not receive warnings from authorities about the dangers of AES. “No one comes here. Not politicians, health workers, no one,” said Sahana Khatun, Soni’s mother. ($1 = 69.6350 Indian rupees)

'Brain fever' blamed for India child deaths preventable: doctors.