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: There was no mention of the potential costs of screening women for vitamin D levels (as encouraged in the release in a statement from the principal investigator) or the cost of supplementation. The release does a good job of comparing data and providing explanations for the measurements used. We’ll award a Satisfactory for that precision, but as noted below under “Evidence,” there was no explicit caution regarding the fact that measurements of interleukin-6 (IL-6) are only surrogates for the effects of weight loss and vitamin D on clinical outcomes related to inflammation (e.g. cancer diagnoses). IL-6 levels dropped in both the placebo and vitamin D arms, and it’s not clear whether the statistically significant additional decline in IL-6 observed in the vitamin D group is clinically important. Because some of the participants were vitamin D-deficient and the dose of vitamin D provided was modest (2000 IU/d), this was a tough call. But supplementation is often so misunderstood, overhyped and oversold that some statement cautioning readers to pay attention to the specifics of this study and not apply its recommendations to everyone seems prudent. For the most part, the release provides a cautious and accurate description of what appears to be a well-conducted clinical trial in a well-defined population. For example, it notes that weight loss and vitamin D lowered inflammation LINKED to cancer — not that these things reduced cancer risk itself (something this study couldn’t establish). But as noted above, we would have appreciated an explicit acknowledgment that IL-6 is a surrogate marker for the clinical outcomes that people care about. And more importantly, we’re concerned about the closing comment that women should talk to their doctors about measuring their vitamin D levels to determine the most appropriate dose. The problem is there is no evidence supporting screening or treating to a level — and certainly not from this study. The US Preventive Services Task Force has concluded that evidence is insufficient to recommend routine vitamin D screening and the IOM has said that while there are data supporting the benefits of vitamin D supplementation with bone health and fall prevention, there is no evidence supporting benefits for cancer. While testing may be warranted in those with signs or symptoms of clinical deficiency, the statement made here implies that everyone should be tested so that an appropriate dose of vitamin D can be selected. That goes beyond the available evidence. It’s hard to argue that overweight, vitamin deficiency, chronic inflammation and cancer are not real threats, so no mongering apparent here. Funding sources are well documented. The study didn’t discuss alternative preventive measures or genetic causes of increased cancer risks. But this is such a broad and expansive topic that we don’t think the release should have been expected to address those myriad issues. We’ll rate this Not Applicable. Primary care physicians and other health providers are well positioned to monitor blood levels of vitamin D, along with dietary and exercise regimens. The news release makes that clear, albeit indirectly. As noted above, we think the release goes too far in suggesting that people ask their doctors about having their vitamin D levels checked. But we’ve already docked points for that, so we’ll award a Satisfactory rating here. The release makes a case for this being the first clinical trial of its kind; although it’s always difficult to make that statement absolutely, the writer of the release attributes the statement to the study author. As a general rule, it’s probably best to say “believed to be the first.”  While the release meets our standard here, we also wish it had delved a bit into the background of previous vitamin D research and the conflicting and confusing messages that research has generated. Without that context, the typical reader might wrongly jump to the conclusion, based on the wording of the lede and other parts of the release, that this study of vitamin D supplementation — because it was a controlled clinical trial — has somehow settled the important questions about the role of vitamin D and inflammation in cancer risk. The debate remains alive and well. None detected. Claim: Weight loss plus vitamin D reduces inflammation linked to cancer, chronic disease

Output: This news release describes a randomized, controlled clinical trial designed to learn whether adding vitamin D supplements to substantial weight loss regimens would have a synergistic effect in reducing inflammatory chemicals in the bodies of overweight, older women with levels of vitamin D considered too low. The study, published in Cancer Prevention Research, has potential relevance for cancer prevention because inflammatory cytokines have been implicated in the genesis and progression of some cancers, as well as heart disease and other disorders. The release offers substantial details about the design, metrics and outcomes of the clinical trial and does a pretty good job of defining the possible reasons for the effects of chronic inflammation and weight loss on cancer development. It goes to some lengths to narrowly define the results and avoid overstatement. That said, the release ends on a sour note by encouraging readers to talk to their doctors about vitamin D testing — a recommendation not consistent with U.S. Preventive Services Task Force guidelines and which is not supported by this research. Readers might also have been better informed if the release had offered more context regarding the many conflicting and sometimes confusing studies that have previously looked for links among vitamin D, inflammatory responses, diet, overweight, sun exposure and cancer. News releases that include the words “diet,” “overweight,” “vitamin,” and “cancer” are almost narrative nuclear events, often guaranteeing an explosion of coverage, souped up vitamin sales pitches, and lots of negative fallout whose half-life seems forever. Cancer remains the second biggest killer disease overall of Americans, and some experts believe that it will soon push heart disease and stroke out of first place. Thus cancer prevention is a deservedly hot topic, and it is no surprise that Americans are eager for information about ways to limit their risk. News releases that describe research on these topics have enormous power to inform and misinform.


Input: Consider Input: Paragraph: Trinity Lewis had asked Judge Sandee Bryan Marion to issue an injunction in Tarrant County district court to ensure that Cook Children’s Medical Center doesn’t end her daughter Tinslee Lewis’ life-sustaining treatment. Texas Right to Life, an anti-abortion group that is advocating for Tinslee, said the girl’s mother will appeal the judge’s decision. Doctors at the Fort Worth hospital had planned to remove Tinslee from life support Nov. 10 after invoking Texas’ “10-day rule,” which can be employed when a family disagrees with doctors who say life-sustaining treatment should be stopped. The law stipulates that if the hospital’s ethics committee agrees with doctors, treatment can be withdrawn after 10 days if a new provider can’t be found to take the patient. In a statement issued by Texas Right to Life, which opposes the “10-day rule,” Lewis said she was “heartbroken” over the judge’s decision. “I feel frustrated because anyone in that courtroom would want more time just like I do if Tinslee were their baby,” she said. The hospital said in a statement Thursday that in order to keep Tinslee alive, she’s on a constant stream of painkillers, sedatives and paralytics. She currently has severe sepsis, which isn’t uncommon when patients require deep sedation and chemical paralysis, it said. “Even with the most extraordinary measures the medical team is taking, Tinslee continues to suffer,” the hospital said. Efforts to find another facility to take her have been unsuccessful. The hospital said it has reached out to more than 20 facilities. Texas Right to Life and Protect TX Fragile Kids have also been trying to find a facility to take her. Prior to Thursday’s ruling, both sides agreed that if Marion denied the injunction request, the hospital would wait at least seven days before taking Tinslee off life-support. In her decision, Marion said the seven-day period would give the girl’s mother time to file a notice of appeal and a motion for emergency relief with a state court of appeals. Tinslee has been at Cook Children’s since her premature birth. The hospital said she has a rare heart defect and suffers from chronic lung disease and severe chronic high blood pressure. She hasn’t come off a ventilator since going into respiratory arrest in early July and requires full respiratory and cardiac support. Lewis testified at a hearing last month that despite her daughter’s sedation, she has a sense of the girl’s likes and dislikes, describing her as “sassy.” She said Tinslee likes getting her nails done but doesn’t like having her hair brushed. “I want to be the one to make the decision for her,” Lewis said about removing her daughter from life support. At the hearing last month, Dr. Jay Duncan, one of Tinslee’s physicians, described the girl’s complex conditions and Cook Children’s efforts to treat her, which have included about seven surgeries. The cardiac intensive care doctor said that for the first five months of Tinslee’s life doctors had hope she might one day at least be able to go home. But Duncan said there came a point when doctors determined they had run out of surgical and clinical options, and that treatment was no longer benefiting Tinslee. Duncan said last month that the girl would likely die within half a year, and noted the hospital has made “extraordinary” efforts to find another facility for her. “She is in pain. Changing a diaper causes pain. Suctioning her breathing tube causes pain. Being on the ventilator causes pain,” he said. Duncan said there had been “many, many” conversations with Tinslee’s family about her dire condition. Tarrant County Juvenile Court Judge Alex Kim issued a temporary restraining order to stop the removal of life support on Nov. 10. But Kim was removed from the case after the hospital filed a motion questioning his impartiality and saying he had bypassed case-assignment rules to designate himself as the presiding judge. After his removal, Judge Marion, who is chief justice of Texas’ Fourth Court of Appeals, was assigned to hear the request for an injunction in Tarrant County district court. The case has become a rallying point for Republicans in Texas, with the attorney general stating his opposition to the “10-day rule” and GOP state Rep. Tan Parker saying it “doesn’t fit with Texas values.” The 1999 law that shields from lawsuits doctors who follow the process of going through an ethics committee was crafted by a task force that included lawmakers, attorneys, doctors and anti-abortion groups. Supporters of the law passed when George W. Bush, a Republican, was governor include the Texas Alliance for Life, the Texas Catholic Conference of Bishops and the Texas Medical Association. Supporters say the law provides a framework for doctors and hospitals to resolve differences and ensures that doctors can’t be forced to perform medical interventions that cause harm or suffering. Claim:  Texas judge: Hospital can remove baby from life support.

Output: A Texas judge on Thursday sided with a hospital that plans to remove an 11-month-old girl from life support after her mother disagreed with the decision by doctors who say the infant is in pain and that her condition will never improve.


Input: Consider Input: Paragraph: But during her 16 years as a librarian on New York’s Long Island, Narkiewicz has also faced a man threatening to kill her and a patron screaming while cutting her own hair in the bathroom. For her job, Narkiewicz has been trained in CPR and mental health crisis response and carries the opioid overdose antidote naloxone with her. As libraries nationwide contend with a surge in patrons seeking refuge in the stacks because of poverty, drug addiction or mental illness, a growing number of institutions have social workers on staff. It’s the latest step in an evolution that libraries have been dealing with for years as homelessness and the opioid crisis reach emergency levels and patrons have come to rely on libraries as free, safe spaces open to all. Though homelessness has seen some declines in the U.S. since the recession, it has surged in cities like Seattle, where a homelessness state of emergency and a spike in questions from library patrons about things like housing, transportation and food led the public library system to hire its first full-time social worker in 2018. Other libraries, unable to afford such a step, have trained librarians to handle certain emergencies themselves. That’s caused some debate among library workers about whether they’re being asked to adapt to an evolving job or to do work that goes too far beyond their expertise. “I can get you a phone number, I can get you a book you want ... but when you’re dealing with mental health issues, I don’t feel appropriately trained for it,” Narkiewicz said. A few master’s degree programs for aspiring librarians have classes on mental health, but most don’t. To help fill in the gaps, an estimated 40-plus library systems have full-time social workers on staff, according to Whole Person Librarianship, an organization that tracks such partnerships. At the Queens Public Library in New York City, resident social worker Shantel Johnson oversees a team of library case managers, but she’s also available to help librarians communicate with struggling patrons, connect visitors to services or just listen to people. “They’ll open up to staff, and staff is doing 14 different things,” Johnson said. She says she regularly helps patrons who are homeless, experiencing abuse or having trouble applying for jobs. The Queens Public Library also started stationing New York University social work interns in some branches last year, as does the New York Public Library, which got its first interns two years ago. Library patron Sofia Ciniglio was meeting twice weekly with an intern at a Manhattan branch last year for career advice. But their conversations eventually involved her family, feelings and personal life. The intern introduced Ciniglio to a library where she could learn Braille, which she’d been curious about. “She was very much a good listener, very attentive, and she knew who I was and the nuances of how I go about things,” Ciniglio said. The NYPL’s librarians, meanwhile, are trained to de-escalate conflicts but aren’t asked to do more in-depth mental health crisis training. Spokeswoman Amy Geduldig notes that the library “is not a social services organization, and its staff are not medical or mental health professionals.” The NYPL, the nation’s busiest library system, still hasn’t hired a full-time licensed social worker, though Brooklyn did in 2015 and Queens did in 2018. In some libraries without professional social work help, employees are being asked to take on new tasks. At the San Diego Public Library, a state library grant has funded employee trainings in mental health first aid since 2016. Librarian Joseph Miesner says the training helped him personally when he came across a suicidal patron. In small town Titusville, Pennsylvania, library director Justin Hoenke recently agreed with his library’s board that all staffers should be trained to administer naloxone if needed. “This is a new requirement of the job,” Hoenke said. “If they’re not comfortable with it, they kind of have to reevaluate their life and their job. You have to change with the times.” Fobazi Ettarh doesn’t see it that way. An academic librarian at Rutgers University in Newark, she says too many expectations can distract librarians from their work, and she personally wouldn’t feel comfortable as a first responder to an overdose. “It would just be a lot for my mental health,” she said. Research suggests other librarians feel the same way. A 2018 survey of librarians in Pennsylvania found many reported they already felt stressed from trying to answer questions from patrons about mental health and social services, even without handling acute emergencies in the library. Meanwhile, some librarians, like Amanda Oliver, have begged in vain for more preparation. Oliver said she quit her public library job in Washington when she asked supervisors for more training and “was largely ignored.” District of Columbia Public Library Executive Director Richard Reyes-Gavilan says Oliver’s branch offered at least two trainings related to mental health during her tenure, but the library is also “committed to doing even more” to support staff. Despite fraught encounters with people in crisis, Narkiewicz, who works part time right now, still hopes to find a full-time job in the library field. “Some days are really difficult. Some days are amazing and terrific,” she says. “It’s quite an eye-opening, but an amazing, wonderful career.” Claim: Librarians facing new tasks say crisis isn’t in the catalog.


Output: When Jackie Narkiewicz switched careers and became a librarian, she thought she’d spend her workdays “drinking hot beverages and discussing literature with people.”