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.
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Question: 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

Answer: Telehealth rises as medium increases in validity.


Question: P&G, with roughly $68 billion in annual revenue, said it has invested millions in creating and testing refills for detergents over the years and is now trying to push in to mainstream beauty and body care refills – which are virtually  unheard of. It recently began offering some Olay face-cream jars with refill pouches on Olay.com, telling Reuters it has plans to expand the sales of the pouches in Europe early next year. “We’re learning on our legs so I don’t know that we’re in a position to say, ‘Hey, here’s the magic to selling refills,’” P&G spokesman Damon Jones said. Beauty products retailer The Body Shop, owned by Brazil’s Natura Cosmeticos SA NATU3.SA, says it plans to roll out “refill stations” in its stores globally next year, allowing shoppers to buy reusable metal containers to fill with Body Shop shower gels or creams. The company had offered refills at its stores in the early 1990s, but discontinued them in 2003, citing a lack of consumer demand. Unilever, which has set targets for reducing and recycling plastic by 2025, in October announced the planned launch of “refill sticks” of deodorants under its Dove line of personal care products on Loopstore.com. The website, operated by recycling company TerraCycle, offers consumers the chance to buy some household products in ultra-durable packaging with refills delivered to their doors, milkman-style. Across the consumer goods industry, results for refillable products have been mixed so far as many shoppers are far too set in their ways to be easily weaned from living in a throwaway culture. While refills are less expensive to purchase - generally priced at 20% to 30% less per item than the containers they are aimed to replenish, according to Unilever - shoppers have so far, for the most part, failed to snap them up, the companies said. SC Johnson & Son Inc, marketer of Windex and Pledge, said refills and concentrates so far have not played well with either Americans or Europeans over the decade they have been offered, with unit sales of such products pretty much flat. It pulled concentrated refills for Shout stain remover off the shelves because they were not selling very well. In 2010, Unilever put 20-liter tanks to dispense detergents in Walmart Inc’s (WMT.N) British supermarket chain Asda, and provided flexible pouches for customers to refill. But with leaky machines, safety and maintenance problems and the high costs of upkeep, Unilever said the tests fell short of expectations. Asda was also unhappy because the tanks occupied a lot of space. “None of them sell very well – it is a convenience issue,” SC Johnson CEO Fisk Johnson told Reuters. Johnson said some people find it painstaking to wash and refill bottles themselves while others worry that smaller bottles filled with concentrates are less “bang-for-your-buck” than the larger ones they have used for years. Still, the privately held company said it was expanding its refill offerings this year to address concerns surrounding plastic waste and is also testing refill stations for cleaning products with UK retailer Waitrose, owned by Britain’s John Lewis [JLPLC.UL]. The Waitrose tests are showing the first signs of progress in refill sales, Johnson said, and the company is now thinking of expanding the project. Even if consumers are comfortable using refills for some household goods, it is more complicated to sell them for products like Pantene shampoo and Olay creams, P&G spokesman Jones said. For instance, with beauty products, the look and feel of packaging is a big factor in creating and maintaining customer loyalty, while delivering an environmental benefit, he said. Some shoppers say they want to buy refillable products, but that the offerings are not available at many stores. Earlier this year, dozens of consumers took to social media to urge The Body Shop to bring back its refill counters. “Refill, refill, refill!” Twitter user @JaiChipperfield said on July 22, joining a thread in which several other shoppers demanded the return of refills. “Seems to me that judging by these comments your customers want to see the return of refills,” @JaiChipperfield added. “Me too, it would be brilliant to see that return.”  The Body Shop eventually responded to those pleas. “Now with the renewed focus on sustainability, we believe it is the right time to return with it,” Body Shop spokeswoman Lucy Muircroft told Reuters this week.

Answer: Procter & Gamble, rivals take refills into beauty aisle.


Question: "Just as fans were filing into the Brickyard 400 NASCAR race at the Indianapolis Motor Speedway, a big television screen by the entrance displayed a pro-pot ad with the headline ""A new beer?"" The ad, which opens with smiling young adults hoisting their brew mugs, drew outrage from lots of sources, including the St. Petersburg-based Drug Free America Foundation. The TV screen company, Grazie Media, pulled the ad after a few hours. The ad said: ""If you’re an adult who enjoys a good beer, there’s a similar product you might want to know about, one without all the calories and serious health problems. Less toxic so it doesn’t cause hangovers or overdose deaths. And it’s not linked to violence or reckless behavior. Marijuana. Less harmful than alcohol and time to treat it that way."" In this fact-check, we decided to focus on the idea that marijuana is ""less toxic"" than alcohol. ""I don’t see how this could be a more open-and-shut case,"" Mason Tvert, communications director for the Marijuana Policy Project, which produced the ad, told PolitiFact Florida in an email. ""If you consume too much alcohol in a sitting or over the course of your life, you can die. If you consume too much (marijuana) in a sitting or over the course of your life, you do not die. What more could be needed to prove marijuana is ‘less toxic’ than alcohol?"" Yet, as a rebuttal, some health professionals say it’s a matter of picking your poison. ""It’s like trying to compare different weapons. Both have the potential to cause harm,"" said Dr. Scott Teitelbaum, professor and vice chairman of the Department of Psychiatry and chief of the Division of Addiction Medicine, at University of Florida. ""I don’t know that there’s a clear answer."" For starters, the term toxic can be vague. Dr. Cynthia Lewis-Younger, medical director of the Florida Poison Information Center in Tampa, said toxic can be ""anything that causes harm. It is possible to drink enough water to poison yourself. It’s more related to the dose than anything else."" The Marijuana Policy Project’s claim that marijuana is ""less toxic"" rankles some health professionals and anti-drug organizations who criticize the inference that using the drug is okay. Calvina Fay, executive director of the Drug Free America Foundation, said she wants the public to realize that ""these are two drugs that are both addictive and impairing and they both create unsafe situations."" Briefly, here’s a look at how the National Institute on Drug Abuse describes each drug. Alcohol is produced by the fermentation of yeast, sugars and starches and while it may start as a stimulant in small doses, NIDA describes it as a central nervous system depressant that is rapidly absorbed from the stomach and small intestine into the bloodstream. Intoxication can impair brain function and motor skills and heavy use can increase risk of certain cancers, stroke, and liver disease. Marijuana is a dry, shredded green and brown mix of leaves, flowers, stems and seeds from the hemp plant Cannabis sativa. The main psychoactive (mind-altering) chemical in marijuana is delta-9-tetrahydrocannabinol, or THC. When marijuana is smoked, THC rapidly passes from the lungs into the bloodstream, which carries the chemical to the brain and other organs. Activists on both sides of the marijuana issue can find studies that back up their claims about the health impact of smoking weed. NIDA states in an email that the effect of marijuana can depend on the person (their biology) who’s using it, the amount and under what circumstances. ""Claiming that marijuana is less toxic than alcohol cannot be substantiated since each possess their own unique set of risks and consequences for a given individual,"" according to an agency email statement. Statistics certainly paint a grim picture of the lethal impact of alcohol abuse. The Centers for Disease Control’s National Center for Health Statistics reports that there were 41,682 deaths attributed to alcohol in 2010, the last year with the most exact statistics. That breaks down to 15,990 deaths attributed to alcoholic liver disease and 25,692 other alcohol-induced deaths, excluding accidents and homicides. The center doesn’t have any reports of marijuana listed as a cause of death. In 2006, there were more than 1.2 million emergency room visits and 2.7 million physician office visits due to excessive drinking, the CDC reports on its website. ""Alcohol in excess is probably the No. 1 cause of toxicities from drugs of abuse in the world simply because it’s most widely used,"" Lewis-Younger said. Robert Gable wrote in an American Scientist article in 2006 that ""simply tallying the number of people who die or who show up at emergency rooms is, by itself, meaningless,"" because that figure is influenced by the number of people using the substance. Yet the Marijuana Policy Project’s Tvert said Gable’s eight-year study on recreational drugs bolsters their assertion. Gable, a retired professor of psychology at Claremont Graduate University in California, compared the toxicity of 20 abused substances using reports of experimental human and animal research and on published data of overdose fatalities. He compared the drugs by developing a safety ratio -- the ratio of an effective dose (eliciting a ""relaxed affability"") to a lethal dose. ""Two drinks makes you buzzy, 20 drinks puts you in the emergency room or the morgue,"" Gable said in a phone interview. ""Ten is the safety ratio"" for alcohol, among the most toxic recreational drugs, he said. The least physiologically toxic substances -- those requiring 100 to 1,000 times the effective dose to cause death -- included marijuana when ingested. He couldn’t find any cases of documented deaths from smoked marijuana ""so the actual dose is a mystery."" ""No drug is good for teenagers,"" he said,  ""but when it comes to the chances of immediate death by chemical toxicity, marijuana is about a hundred times less toxic than alcohol or cocaine."" Dr. Ihsan Salloum, professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine, notes: ""People could argue it (marijuana) is a weaker chemical in terms of toxicity, but it does have its consequences. It doesn’t mean marijuana is harmless."" Experts say one concern is the impact of marijuana on the brain, particularly for teens who start smoking early. Teitelbaum says marijuana can ""flip"" adolescents predisposed to mental problems into having a psychotic disorder. A 2012 study from Duke University, the University of Oregon, King’s College London and the University of Otago (New Zealand) published in the Proceedings of the National Academy of Sciences, ""Persistent Cannabis Users Show Neuropsychological Decline from Childhood to Midlife,"" examined the potential relationship between the long-term use of marijuana and declines in IQ scores. The study was based on data from more than 1,037 individuals followed from birth until age 38 and determined those who began using cannabis before age 18 and became persistent users (more than once a week) suffered the greatest decline in mental functioning (an average of eight IQ points) that didn’t improve once they stopped. Those who started using marijuana when they were adults didn’t show the same decline. Another concern has come up in recent years. The use of synthetic marijuana, often called Spice, has become a problem, and health professionals caution that it’s vastly different from natural marijuana and more toxic. ""Many Spice smokers have experienced agitation, paranoia and mental illness,"" JoAnn Chambers-Emerson, certified specialist in poison information/educator at the Florida Poison Information Center in Tampa, wrote in an email. ""Some Spice smokers have ended up having a stroke, heart attack, seizures and kidney failure. Synthenetic marijuana, however, is not marijuana. Our ruling An ad from the Marijuana Policy Project claims marijuana is ""less toxic"" than alcohol. Our job as fact-checkers in this case is not to decide whether marijuana is good or harmful. We're focused on whether the drug in its natural form is ""less toxic"" than alcohol. In that regard, science and statistics present a strong case."

Answer:
"Marijuana is ""less toxic"" than alcohol."