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.

Example Input: - Frustration over limited time spent with patients. - Inordinate amounts of time inputting required data. - Side effects including high levels of stress. The patient? Herself. The remedy? “I did the research and found direct primary care,” said Anderson-Elder of Windsor. And in June she joined Dr. Frank Morgan at Balance Health in Greeley, a direct primary care clinic he founded four years ago in Greeley. Leaving her family practice at UCHealth Medical Clinic in Windsor after seven years wasn’t an easy decision, she said, but it was the right decision for her. Many physicians — from all specialties — share Anderson-Elder’s frustration and levels of stress incurred while working in insurance-based health care systems. In the 2018 Medscape National Physician and Depression Report, 42 percent of family physicians admitted to having burnout or depression, listing “too many bureaucratic tasks (charting, paperwork)” and “too many hours at work” as the leading factors in burnout. Although direct primary care has been around for some time, it is just now gaining a toehold with both physicians contemplating the switch to a different way of providing care and patients willing to give it a shot, so to speak. In 2017, there were more than 600 direct primary care clinics in the U.S., 10 percent of those in Colorado, according to the Colorado Independent. Anderson-Elder said in her research she found 1,000 out of the 80,000 family doctors practicing in the U.S. have gone the direct primary care route. DIRECT PRIMARY CARE What is direct primary care? And why the interest? First and foremost, the major difference is that direct primary care does not accept insurance. Patients instead pay a monthly membership fee that includes unlimited visits, calls and emails, along with many routine services and access to prescriptions and lab work at a reduced cost. For the physician, it means quality time spent with patients and no more time filling out paperwork to satisfy health insurance company regulations. What the monthly fee is varies from clinic to clinic. At Balance Health, it is $99 for adults, $180 for couples and $30 for children. Those who sign up for direct primary care are asked to sign an annual contract but can be released from it with 30 days’ notice, Anderson-Elder said. “We want to be accessible to our patients. We don’t want them to go to urgent care or ER if they don’t have to,” she said. And yes, that includes calls at 3 a.m., but if it can wait till morning, the patient is worked into that day’s schedule. Anderson-Elder typically sees eight to 17 patients per day, depending on whether it’s cold and flu season. And she spends as much time as needed with them. At her previous practice, she was limited to spending 15 to 20 minutes per patient. “People service their cars,” she said. “They should do the same thing with their bodies. You should be looked at and tuned up.” While most people think of going to the doctor only when they don’t feel well or need a physical for work or school, Anderson-Elder said she likes to see patients even when they feel healthy so she can check in on their well-being and talk about proper nutrition. “Oftentimes patients think they’re healthy, but then we do an exam and sometimes find things,” she said. Direct primary care works best when combined with a high-deductible health plan, Anderson-Elder said, for those times when unexpected surgeries are scheduled and for patients who suffer from chronic illnesses. But she said about one-third of her patients have no health insurance at all. She also noted direct primary care should not be confused with concierge medicine, which also provides direct access to providers for a flat fee but still bills insurance companies for services provided. Another key distinction between the two is direct primary care is mentioned in the Affordable Care Act as an acceptable option for receiving medical care without insurance, while concierge medicine is not, according to the American Academy of Family Physicians. And last year, Colorado Gov. John Hickenlooper signed Colorado HB17-1115, which establishes that direct primary health care can operate without regulation of the division of insurance. Windsor Republican Rep. Perry Buck was a primary sponsor of the bill. Patients at Balance Health also can tap into other healthy-living services for additional fees. Dr. Dana Morgan, a family care physician, specializes in bioidentical hormone replacement therapy. Balance Health also has a small fitness gym replete with trainers and classes. Wellness coaching also is offered. Leaving her practice in Windsor, though a hard decision, has been the right prescription for her, she said. “I no longer take paperwork home,” she said. “I’m happier and less stressed.” ___ Information from: The Tribune of Greeley, Co, http://greeleytribune.com
Example Output: Windsor doctor joining direct primary care movement.

Example Input: 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.
Example Output: Lymph Node Study Shakes Pillar of Breast Cancer Care

Example Input: Two doctors and a hospital administrator have died and at least 51 staff members have been infected since the new coronavirus was detected at the IMSS General Hospital in Monclova in the northern state of Coahuila in late March, the state health department said. The hospital became Mexico’s first hot spot for the COVID-19 illness caused by the coronavirus. At least four of the infected workers are currently hospitalized as a result of the outbreak, which has fed concerns that Mexico’s underfunded healthcare system is ill prepared to cope with a major epidemic in the nation of nearly 130 million people. At the beginning of the outbreak, managers “said that protective equipment wasn’t necessary,” said nurse Charly Escobedo Gonzalez who works at the Monclova hospital. Answering questions from Reuters about the reports that hospital management told staff not to wear masks, a senior official at Mexico’s main public health service IMSS which runs the hospital said that the health workers should be believed, but he did not confirm details of the reports. “Specifically, if they are saying that then of course we have to believe it,” said the IMSS official, Raul Pena Viveros. He said there can be misunderstandings inside a hospital about where it is appropriate to wear protective equipment. “Not all of the workers have to wear the same equipment inside the hospital. And when this type of equipment is used badly...it runs out more quickly and they put workers who are in contact with patients at risk,” he said. Mexico has registered 4,661 people with the coronavirus and 296 deaths, a fraction of the figures in the neighboring United States, but the coronavirus arrived weeks later in the Latin American country. The Monclova hospital became a coronavirus focal point in the third week of March, highlighting a lack of masks and even soap and bleach there, staff said. As staff began to fall ill, hospital floor managers instructed healthcare workers not to use facemasks, which some had bought for themselves due to the lack of hospital equipment, seven workers told Reuters. Pena Viveros said the hospital had been short of protective equipment as well as other materials to fight the coronavirus in March. Health officials have not given a detailed explanation of why so many Monclova healthcare workers became infected. Hospital workers are at greater risk of contracting the coronavirus if they do not wear protective equipment like facemasks and gloves. The N95 respiratory masks offer more protection from other people who are infected while more simple surgical masks help the wearer avoid spreading the virus. Due to a lack of proper N95 masks, some staff at the hospital were also wearing inappropriate industrial-style masks that were donated to them, Pena Viveros said. The lack of N95 masks was later resolved, said Pena Viveros, who was sent by the head of the IMSS from Mexico City to investigate the Monclova hospital and spent a week there in early April. Staff say the hospital has more protective equipment now but that they still lack gear such as masks. Three nurses said that while some colleagues chose not to wear facemasks after being told by managers or supervisors that they were not necessary, other staff kept wearing them. On the night of March 22, one of the heads of the nursing staff told a group of doctors and nurses gathered in the emergency room to take off their N95 masks because they were not necessary, according to a nurse who heard the order. Another nurse, surnamed Hernandez Perez, was given a similar order by a deputy head of nursing a few days earlier. “In a morning clinical class, the sub-head told us not to create panic...that we shouldn’t wear facemasks because we were going to create a psychosis,” said Hernandez Perez, who did not want her full name used. She is now at home sick and has tested positive for the COVID-19 respiratory illness caused by the coronavirus. A second nurse confirmed Hernandez Perez’s account. Reuters was unable to speak to two of the nursing managers who nurses say spoke at that meeting. After media accusations that the Monclova hospital badly lacked equipment to deal with the virus, the head of the IMSS, Zoe Robledo, announced in early April that the director of the hospital had been temporarily replaced. Neither the suspended hospital manager, Ulises Mendoza, nor the current hospital director answered repeated requests from Reuters for comment. One nurse, who asked that her name not be used for fear of retaliation, said that during the second half of March she was repeatedly told by superiors not to wear a facemask while working in high-risk areas such as on the ground floor of the hospital, where the emergency room is located. As well as the 51 confirmed cases, Pena Viveros said more than 300 other workers were temporarily sent home as the hospital scrambled to contain the outbreak. He said the hospital contracted nurses and doctors from other facilities to address the personnel shortage, nevertheless the hospital’s ability to care for patients has been impeded, some staff said.
Example Output:
Exclusive: Nurses at Mexico hospital hit by coronavirus say they were told to avoid masks.