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.

Input: Consider Input: Paragraph: The number of EU nurses coming to the UK has fallen by 90% since the Brexit vote. The number of nurses and midwives from the EEA joining the Nursing and Midwifery Council’s register fell by 91% from 2015/16 to 2017/18. The number of EU nationals leaving the NHS jumped by 14% in 2017. EU nationals have fallen as a percentage of those joining the NHS. EU nationals made up 8% of new staff (whose nationality was known) joining the NHS in England in the year to June 2018. That compares to 11% in the year to June 2016. It’s possible that the number in June 2016 was unusually high. Claim 1 of 4 Claim: EU nationals have fallen as a percentage of those joining the NHS.

Output: EU nationals made up 8% of new staff (whose nationality was known) joining the NHS in England in the year to June 2018. That compares to 11% in the year to June 2016. It’s possible that the number in June 2016 was unusually high.


Input: Consider Input: Paragraph: Cancer patients increasingly are having their care guided by gene tumor boards, a new version of the hospital panels that traditionally decided whether surgery, radiation or chemotherapy would be best. These experts study the patient’s cancer genes and match treatments to mutations that seem to drive the disease. “We dissect the patient’s tumor with what I call the molecular microscope,” said Dr. Razelle Kurzrock, who started a board at the University of California, San Diego, where Cairnes is treated. It’s the kind of care many experts say we should aim for — precision medicine, the right drug for the right person at the right time, guided by genes. There are success stories, but also some failures and many questions: Will gene-guided care improve survival? Does it save money or cost more? What kind of gene testing is best, and who should get it? “I think every patient needs it,” especially if cancer is advanced, said Kurzrock, who consults for some gene-medicine companies. “Most people don’t agree with me — yet. In five years, it may be malpractice not to do genomics.” Few people get precision medicine today, said Dr. Eric Topol, head of the Scripps Translational Science Institute. “The only thing that’s gone mainstream are the words.” HOW IT WORKS NOW If you have a cancer that might be susceptible to a gene-targeting drug, you may be tested for mutations in that gene, such as HER2 for breast cancer. Some breast or prostate cancer patients also might get a multi-gene test to gauge how aggressive treatment should be. Then most patients get usual guideline-based treatments. If there’s no clear choice, or if the disease has spread or comes back, doctors may suggest tumor profiling — comprehensive tests to see what mutations dominate. That’s traditionally been done from a tissue sample, but newer tests that detect tumor DNA in blood — liquid biopsies — are making profiling more common. The tests cost about $6,000 and many insurers consider them experimental and won’t pay. Gene tumor boards analyze what the results suggest about treatment. They focus on oddball cases like a breast cancer mutation in a colon cancer patient, or cancers that have widely spread and are genetically complex. The only options may be experimental drugs or “off-label” treatments — medicines approved for different situations. But as tumor profiling grows, it’s revealing how genetically diverse many tumors are, and that oddball cases are not so rare, said Dr. John Marshall. He heads the virtual tumor board at Georgetown Lombardi Comprehensive Cancer Center that also serves cancer centers in Pennsylvania, North Carolina, Michigan and Tennessee. “There is a little bit of faith” that testing will show the right treatment, but it’s not a sure thing, said Dr. Lee Schwartzberg, who heads one participating center, the West Cancer Center in Memphis. Dr. Len Lichtenfeld, the American Cancer Society’s deputy chief medical officer, is optimistic yet wary. Drugs that target BRAF mutations work well for skin cancers called melanomas, but less well for lung or colon cancers. “Just because a mutation occurs it doesn’t mean that drug is going to work in that cancer,” he said. LUCKY CASES When it does, results can be dramatic. Cairnes’ cancer was between her stomach and esophagus, and had spread to her liver, lungs and lymph nodes. Tissue testing found 10 abnormal genes, but on the liquid biopsy only EGFR popped out as a good target. Two drugs aim at that gene but aren’t approved for her type of cancer. A tumor board advised trying both — Erbitux and Tarceva, the drug her husband also had taken. Within two weeks, she quit using pain medicines. After two months, her liver tumor had shrunk roughly by half. There are signs that cancer may remain, but it is under control. She feels well enough to travel and to take care of her granddaughter. “I’m very, very grateful to have a targeted therapy,” Cairnes said. “I cannot expect a better outcome than what we’re seeing right now,” said her doctor, Shumei Kato. WHAT STUDIES SHOW But is gene-guided treatment better than usual care? French doctors did the first big test, with disappointing results. About 200 patients with advanced cancer were given whatever their doctors thought best or off-label drugs based on tumor profiling. Survival was similar — about two months. Another French study, reported in June, was slightly more encouraging on survival but exposed another problem: No drugs exist for many gene flaws. Tests found treatable mutations in half of the 2,000 participants and only 143 got what a tumor board suggested. Some doctors worry that tumor boards’ recommending off-label treatments diverts patients from research that would benefit all cancer patients. For example, the American Society of Clinical Oncology’s TAPUR study tests off-label drugs and shares results with their makers and federal regulators. LETTING PATIENTS CHOOSE Ann Meffert, who lives on a dairy farm in Waunakee, Wisconsin, endured multiple standard treatments that didn’t defeat her bile duct cancer. “She was going to be referred to hospice; there was not much we could do,” said Dr. Nataliya Uboha, who took the case to a tumor board at the University of Wisconsin-Madison. The panel gave several options, including off-label treatment, and Meffert chose a study that matches patients to gene-targeting therapies and started on an experimental one last October. “Two weeks in, I started feeling better,” she said, and when she saw test results, “I couldn’t believe the difference.” Many lung spots disappeared and the liver tumor shrank 75 percent. She is not cured, though, and doctors are thinking about next steps. And that could involve a fresh look at her tumor genes. ___ Marilynn Marchione can be followed at @MMarchioneAP __ This Associated Press series was produced in partnership with the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content. Claim: Ultra-personal therapy: Gene tumor boards guide cancer care.

Output: Doctors were just guessing a decade ago when they gave Alison Cairnes’ husband a new drug they hoped would shrink his lung tumors. Now she takes it, but the choice was no guesswork. Sophisticated gene tests suggested it would fight her gastric cancer, and they were right.


Input: Consider Input: Paragraph: Given that this is an illegal substance banned by the U.S. Drug Enforcement Agency, cost as a therapeutic would be difficult to ascertain. We liked that the story took pains to explain that approval of this drug faces many hurdles. This is a tough one. While the story tells us what percentage of patients benefited from treatment, it does not, in fact, quantify the extent of those benefits–which is precisely what this category is designed to assess. However, the story does do a good–and thorough–job of describing the benefits in qualitative terms. That said, if the story had only chosen one or two examples of changes in the standardized measures of depression or anxiety, this would have received an enthusiastic “Satisfactory” rating. One strong word of caution though: The story cites one source as saying that psilocybin may one day be used to treat a wide range of mental health issues ranging from drug addiction to obsessive-compulsive disorder. The story offers no evidence to support these claims, which were made by a source associated with an organization that exists specifically to promote research on hallucinogens. Substantial claims require substantial evidence. The story would have been much stronger if it had eliminated the unsubstantiated remarks from the source — particularly since they had no bearing on the subject of the story. The story addresses this issue thoroughly. Well done. The story does a good job of both describing the design of the studies and explaining why the study design is relevant. For example, the story notes: “But both [studies] were considered to be double-blind placebo trials — the gold-standard of medical research in which subjects are left to guess whether they have gotten the active study drug or an inactive lookalike.” This is the sort of thing we like to see. However, we did want to note that in the NYU study, researchers did state in the limitations section that there was “limited blinding” — how did that possibly affect the outcomes? No disease mongering here. However, the story should have been more cautious about claims of benefit for conditions ranging far beyond the scope of the research at hand, which focused on mental health problems among people with advanced cancer. The story clearly states who funded the studies, and what that organization’s long-term goals are. Further, the story clearly identified individuals quoted in the story who have ties to the studies or the funding organization. Lastly, the story incorporates input from an independent expert. However, the story would have been stronger if there had been a skeptical take on the research, which saw in some other coverage, such as this New York Times piece. The story does not address other treatment options for anxiety or depression, such as talk therapy or other pharmaceutical interventions. The story does a good job here. For example, the story notes: “[F]inding drugs like psilocybin effective is by no means the final hurdle to their widespread availability. None are currently in production, and no for-profit pharmaceutical company would likely invest millions of dollars to bring to market a pill intended effectively for one-time use.” Well done. This is a close call. The story does do a good job of placing the work in context in regard to overall research involving hallucinogens. That’s enough to earn it a “Satisfactory” rating. However, the story doesn’t mention any of the work done in the past 10 years on the use of psilocybin specifically to address anxiety in cancer patients, such as this 2007 study, this one from 2011, or this one from 2013. Are the results from the two new studies consistent with these earlier findings? Do they differ in a meaningful way? That would be good to know. The story does not appear to rely on a news release. Claim: Ingredient in magic mushrooms is shown to ease anxiety and depression in cancer patients in one dose


Output: The story focuses on two recent studies that find a single application of the hallucinogen psilocybin is effective at providing meaningful relief to cancer patients suffering from severe depression or anxiety. The studies were published in the Journal of Psychopharmacology, and can be found here and here. In some ways, the story is thorough, addressing potential side effects and conflicts of interest very well. The story discusses the potential benefits in depth, which is good, but fails to quantify those benefits — which is problematic. The story also does a good job of placing the work in context, highlighting the increasing profile of research into the use of hallucinogens as therapeutic tools for mental health problems. However, the story would have been even stronger if it had discussed the existing literature on the use of psilocybin to address anxiety in cancer patients. We also reviewed two news releases related to the research:   Depression and other mental health struggles are common and significant among people with cancer, especially terminal cancer. This makes it especially important for reporters to write responsibly about studies like those discussed in this story. You want to give readers enough information to help them make informed decisions. You don’t want to raise false hopes, or sensationalize the work. Overall, this story does a nice job of handling a delicate subject well.