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.

[EX Q]: Paragraph: Dr. Neelu Pal poses for a portrait in New York, July 23, 2010. Pal was fired weeks after authorities at New York University Langone Medical Center Surgical Weight Loss Program learned she had contacted patients about the dangers of Lap-Band surgery in January 2006. REUTERS/Shannon Stapleton Pal had previously raised her concerns with hospital officials, complaining — to no avail — about the lack of care given after surgery and incomplete or inaccurate medical forms that were taken prior to surgery. She was fired weeks after hospital authorities learned she had contacted patients in January 2006. She has filed a wrongful termination lawsuit — the case is pending — and enrolled in law school. Pal, who came to the United States from India a little over a decade ago to practice medicine, says she has been blackballed from her chosen profession. The NYU bariatric surgery practice where she worked is widely considered one of the world’s most experienced. But in an interview with Reuters, Pal described the facility as a hectic Lap-Band factory. “My impression at the time was that the practice was disorganized, but once I knew more about the system, I could see what they were trying to do was get as many patients on to the operating table as possible,” she said. During her three months at NYU Langone Medical Center’s Surgical Weight Loss Program in late 2005 and early 2006, two surgeons — Dr. Christine Ren and Dr. George Fielding, who are married — implanted gastric bands into as many as 20 patients in a single day, according to Pal. Known as pioneers in the field, Fielding and Ren are also paid consultants of Allergan Inc, the Botox and breast implant maker which is the leading manufacturer of the gastric band. Though rivals have been gaining, Allergan’s Lap-Band still commands more than two-thirds of a $300 million to $400 million market. To critics, Pal’s allegations — some of which were corroborated by a New York State Health Department investigation around that time — underline the potential risks that go along with the industry’s rapid growth. And the business could soon swell even more if U.S. regulators grant permission to perform the procedure on the nation’s bulging ranks of overweight teens. Ren was an investigator in an Allergan-sponsored clinical trial studying the use of bands on teens. And the company has an application with the U.S. Food and Drug Administration seeking approval to market the device to teens as young as 14. A decision could come any time. Winning regulatory approval for the gastric band in teenagers would allow the companies that make the devices — Allergan, Johnson & Johnson and others — to target that specific age group. Today, regulators consider performing the procedure on teens “experimental” as it has not been approved for that age group. But, like any device, it may be used on teens at a doctor’s discretion. Allergan declined to comment on Pal’s lawsuit or disclose how much it pays the surgeons, though the company did confirm that both remain on the payroll. Through a NYU spokeswoman, Ren and Fielding — who have been the subject of some controversy — declined to be interviewed for this article, also citing the lawsuit. But in some medical circles, concern over gastric banding for teenagers is growing nearly as fast as American waistlines. In particular, some doctors worry about the device’s long-term safety and effectiveness. A gastric band is just what it sounds like: an inflatable silicone band placed around the top portion of the stomach to create a pouch that restricts food intake. It has become increasingly popular in the United States in recent years, and results in reasonable weight loss. The procedure is considered less invasive and risky than gastric bypass. Banding could also be an especially attractive option for teens, say proponents, because it is reversible, whereas bypass is not. The 30- to 60-minute procedure, typically performed with a laparoscope, might require one night in the hospital but can also be done on an outpatient basis. But certain data show gastric bands are less effective and more problematic for teens than adults, said Dr. Thomas Inge, chair of a government study to assess bariatric surgery in adolescents called Teen Longitudinal Assessment of Bariatric Surgery, or Teen-LABS for short. The Teen-LABS study aims to determine if adolescence is the best time to intervene with surgery. It was launched in 2007 and is expected to report results in about five years. In more than one in five teens in another study, Inge noted a high rate of “symmetric pouch dilation” — a complication in which the small pouch created at the top of the stomach by the band gets bigger, allowing patients to consume more food. This issue was reported in the journal Obesity Surgery, and later in the Journal of the American Medical Association. “We await the U.S. trial data, PMS (post-marketing surveillance) data, and confirmation from non-industry-run trials to make final recommendations,” said Inge, who is the surgical director of the weight loss program for teens at Cincinnati Children’s Hospital. As Inge and others are quick to point out, trials that studied how teens fared with a gastric band over the short term have been few, and those that were conducted show the device generally is safe and effective, with a relatively low risk for complications or death. But there is a dearth of long-term data on the outcomes from gastric band surgery. And that worries Dr. Mary Brandt, an investigator in the Teen-LABS study, among other experts. “I think there’s a fundamental problem with putting a rigid plastic object around a moving organ. You’re asking it to stay in place and not erode over a long period of time,” said Brandt, who is also director of the pediatric surgical program at Texas Children’s Hospital in Houston. “I’ll be happy to reverse my position as soon as I see 10 or 20 year data. Unfortunately, that’s not something that industry is excited about funding.”   She acknowledged a bias against gastric bands, citing a Swiss long-term follow-up study of 167 adults that showed the band failed almost a third of the time after 10 years. About a fifth of the patients required another operation. And while fewer than 8 percent reported complications in the 30 days following surgery, more than 40 percent had problems after a decade. Long-term complications included the erosion and slippage of the band, both of which might require another operation, and a dilation of the esophagus, which could result in difficulty swallowing. Infections around the port that sits below the skin and allows the doctor to add or remove saline with a syringe to tighten or loosen the band, as well as leaks, were also common. “Bands are definitely safe in the short term and definitely work in the short term. What we don’t know is about the long term,” Brandt said. “I’m not saying it should never be used. We just have to be more careful about how we’re using it.”   The Swiss study of adults who had gastric banding, published in Obesity Surgery, came to the same conclusion. Because of complications, the need for another operation, and long-term failure rates, gastric banding should be performed in “selected cases only” until more data are available, it said. Another group of 276 adults who underwent gastric band surgery had similarly disappointing results in a long-term Austrian study published in the same journal. Only a little under 54 percent of the patients still had their original band after nine years, with nearly 18 percent having the original replaced with a new one and nearly 29 percent having it removed. Of those who no longer had any band, more than half had a second bariatric operation. Gastric banding demands that teens do something they often aren’t very good at — sticking to a rigorous follow-up routine. Dr. Roberta Maller Hartman, a psychologist and Lap-Band patient herself, counsels teens and adults after receiving the gastric band. “I’ve worked with a lot of high school students and they just want to be like everyone else and go out and eat pizza with their friends,” she said. “They can, but they have to take little bites and chew a lot.”   Success depends most on a patient’s ability to modify their behavior. “The band doesn’t reduce the desire to eat emotionally. That has to be addressed,” said Dr. Maller. “Teens tend to need more hands-on, one-to-one support.”   Indeed, there are many success stories of obese teens losing weight, keeping it off and staving off a host of related illnesses, such as diabetes, arthritis and high blood pressure. Surgery — banding or bypass — has been shown to produce the most sustainable results when compared with diet and exercise. Nevertheless, critics abound. Dr. Susan Woolford, Medical Director of the Pediatric Comprehensive Weight Management Center at the University of Michigan, conducted a study, published in Obesity Surgery, to find out how readily primary care physicians and pediatricians — those in the front lines of obesity treatment — would refer patients for bariatric surgery. Nearly half, or 48 percent of the 381 physicians surveyed, said they would never refer an adolescent for any type of bariatric surgery. The controversies swirling around NYU’s influential bariatric surgery center — as well as its two top surgeons — have done little to ease concerns. An investigation by the New York State Department of Health in 2006 found that Fielding falsified data on Vincent Esposito, a 14-year-old boy who was part of the FDA-authorized study that was looking at the use of the device in obese teens. A week after Esposito’s Lap-Band surgery, he developed an infection with an abscess — a common complication with gastric banding — and returned to the NYU facility, where Fielding performed an appendectomy. The investigation by New York health authorities determined there was no evidence of appendicitis, according to the report. “They told me I was a ticking bomb,” Esposito had told the Daily Times in Salisbury, Maryland in 2007, referring to his obesity. Reached by telephone, his father said his son was “fine” and that they are being represented by an attorney and declined to comment. NYU also declined to comment. In its response to the NYDH report, the university maintained no wrongdoing, saying “the surgeon probably misinterpreted his operative findings.” In a statement at the time, the school added, “...we are persuaded that he assumed that the infection did not begin in the gastric band device.”   The response and NYU’s plan to correct the issues were accepted by state regulators. In the NYSHD report, Fielding was also cited for failing to address a post-operative patient’s persistent lack of urine output. The patient went into cardiac arrest and died 36 hours later. This was the death that alarmed Pal and led her to warn patients. The same report said the program director, Ren, had permitted two surgeons to practice without the appropriate licenses, in violation of the law. For four months, the unlicensed physicians “performed multiple surgical procedures, made pre- and post-op assessments, and wrote orders to be carried out by nursing staff,” the report said. After Ren learned she was being investigated by an internal committee, she went back and removed the name of the unlicensed surgeon from the operative report, according to court testimony. She was found to have committed professional misconduct and received a letter of reprimand that was put in her file for a year. Fielding, who got a gastric band himself in 1999, is from Australia, where he left behind multiple personal injury lawsuits, most of which have been settled. Dr. Robert “Skip” Nelson, a pediatric ethicist at FDA, said he had no specific knowledge about the incident at NYU Medical Center. If the agency did learn that an investigator has entered false data, he said, there would be an investigation. He added that if the FDA doubted the integrity of the data, they would not be considered in the decision-making process. An investigator, as doctors who run clinical trials are called, could also be disqualified as a result. Despite the reports of misconduct, the NYU Langone Weight Management Program has retained its status as a “Center of Excellence,” a designation conferred by the Surgical Review Corp, an entity created by the American Society for Bariatric and Metabolic Surgery. Surgical Review Corp CEO Gary Pratt said that he was unaware of the incidents and the NYSHD report. He said the corporation’s reviews maintain the highest standards with the goal of advancing the safety and efficacy of bariatric surgery. The company intends to put out a new list of approved bariatric clinics that treat teens later this year — which may coincide with the FDA granting approval, or not. If the FDA does greenlight it, insurers would be more likely to pay for the procedure, which costs the insured patient $2,000 to $4,000. The uninsured, making up about a third of patients who have the surgery in the United States, pay about $15,000 for the surgery. Some health professionals worry that band manufacturers will target teens with direct-to-consumer (DTC) ads on television and radio or in subway stations that have proven effective at luring people to doctors’ offices. The FDA said there is no guidance or regulation on DTC ads to young users. For Allergan, based in Irvine, California, the implications are significant. And the company is acting accordingly. It recently launched a campaign with bariatric surgeons to invite their patients to enter an essay contest and win a chance to go to Washington, D.C. to “share their personal stories with legislators and media.”   Allergan has seen its stock underperform the S&P 500 year to date. Botox remains its key product and has weathered increased competition amid the recession, while obesity intervention was hit hardest by the economy. At the same time, Lap-Band has also been slowly losing market share to Johnson & Johnson’s competing device called Realize. In 2009, Allergan’s obesity products generated revenue of $258 million, down 13 percent from 2008. Management is betting that continued investment in direct-to-consumer advertising will stimulate growth in the obesity segment, said Gleacher & Co analyst Amit Hazan. He estimates there will be 83,500 gastric band procedures in the United States in 2010, up 6 percent from 2009. Sanford Bernstein analyst Aaron Gal said FDA approval of the Lap-Band for teens could increase sales by as much as $20 million for Allergan. Even critics of gastric band surgery acknowledge that there are few good solutions to adolescent obesity. It is a mounting problem, affecting nearly 1 in 5 American teens, and many doctors believe that it should be addressed sooner rather than later when other health problems can develop. Some experts are wary but believe the benefits may outweigh the potential harm. “My conclusion is that it makes sense to intervene sooner because surgery can head off other related problems. Kids are better surgical risks, but the downside is that I suspect most teenagers are doing it less for health and more for social and psychological reasons,” said Dr. Jeffrey Zitsman, who is leading an independently funded teen study at Columbia University. Those who do it out of vanity, he cautioned, may have a harder time. “When health reasons don’t motivate them,” he said, “sometimes there are compliance issues.”   Yet, Dr. Robert Murray, director of Nationwide Children’s Hospital Center for Healthy Weight and Nutrition, argues that the heavy psychological problems obese teens carry should not be ignored. “They’ve been teased out of school, they have social issues, many are depressed, and their quality of life is equal to that of a kid with cancer,” he said. “If you get them at 14 and reverse weight and health problems, they’ve got a shot at a normal life.”   To critics, at least, the question is at how big a price. Claim: Special report: Targeting teens for gastric bands.
[EX A]: After one patient died and others suffered serious complications following Lap-Band surgery, Dr. Neelu Pal had seen enough. A petite surgical resident now aged 40, she began quietly calling patients about to undergo the weight-loss procedure at New York University’s Medical Center, telling them she feared for their safety.

[EX Q]: Paragraph: There are 16,481 fewer beds in hospitals since 2010. This is in the right ballpark, but it doesn’t seem to be the best comparison. It seems to compare the number of beds at different times of the year, but the number available fluctuates seasonally. Comparing July-September in 2010 and 2017, the decrease in beds available overnight in England is closer to 13,200. 66 A&E and maternity wards have been closed. We don’t know, as this information isn’t collected nationally. In 2014, there were reportedly plans to close or downgrade 66 in England, but while some have been, others have stayed open. 103 NHS walk-in centres have closed or been downgraded since 2010. We don’t know exactly, as this information isn’t collected centrally. Research from an NHS regulator and from campaign group 38 Degrees suggests more than 90 have been closed or downgraded. 60 ambulance stations have closed since 2010. We don’t know how many ambulance stations have closed since 2010 as national figures on this aren’t regularly published. 1,000 GP practices have closed since 2010. There are around 1,000 fewer GP practices in England in 2017 than in 2010. Some practices may have merged together, rather than closing completely, but we don’t know how many have done so. A&E four hour targets have been missed more than 10 million times since 2010. Correct. Between 2010/11 and 2017/18, around 12 million A&E attendances in England took over four hours from arrival to admission, transfer or discharge. The number of patients waiting more than 12 hours in A&E is up 2,700% since 2010. Correct (although not all patients will necessarily have been waiting in A&E). In 2011/12, 120 patients in England waited 12 hours between the decision to admit them to emergency admissions and their actual admission, compared to 3,500 in 2017/18. Spending on social care is down 8% since 2010. Analysis by the Institute for Fiscal Studies last year said that between 2009/10 and 2016/17, councils’ spending on adult social care in England fell 8% in real terms. Newer analysis says that it fell by 6% over the same period. We’ve asked it for more information. There are 5,240 fewer mental health nurses since 2010. This seems to be looking at different months in 2010 and 2017, which isn’t the best comparison. Comparing the number of full-time equivalent mental health nurses between January 2010 and January 2018 (the latest figures), the drop is closer to 4,500. The number of operations classed as urgent that have been cancelled twice have doubled since 2010. Correct. The number of urgent operations in England cancelled for the second time or more for non-medical reasons more than doubled between 2011/12 and 2017/18. There has been a 22% drop in ambulances meeting their 15 minute transfer target since 2010. The decrease is actually greater—28%. In 2010/11 in England 80% of ambulance transfers were done in 15 minutes, in 2015/16 it was 58%. Claim 1 of 12 Claim: Spending on social care is down 8% since 2010.
[EX A]: Analysis by the Institute for Fiscal Studies last year said that between 2009/10 and 2016/17, councils’ spending on adult social care in England fell 8% in real terms. Newer analysis says that it fell by 6% over the same period. We’ve asked it for more information.

[EX Q]: Paragraph: While the flavors may be sinful, the shakes are not. Each protein shake has just 200 calories and only 11 to 15 grams of carbs. As an added bonus, each shake offers 24 grams of protein and 21 vitamins and minerals. “It’s everything you need in a healthy meal,” said Seth McMurry, Nutrition Hub and Nutrition Bar co-owner. This new smoothie bar concept that is spreading across the Memphis area started as a family affair. Seth McMurry and his wife, Cymber, along with Seth’s brother Nathan McMurry and his wife, Katelyn, opened The Nutrition Hub in Germantown in April. It was the first of these smoothie bar and meal replacement shops to open in the area. In September, the couples opened Nutrition Bar in Laurelwood in East Memphis. The names of the two businesses are slightly different, but each offers a similar menu. The focus is on shakes, teas and aloe shots. The shakes are creamy, filling and surprisingly tasty. They taste like a sinful milkshake, not a healthy meal replacement. “Protein shakes have been a big part of our life since we are athletes,” Katelyn said. “These are healthy, not chalky and taste like a dessert.” The protein shakes are made with water and ice as the base. Using water instead of milk helps keep the calories down. Each shake is made with protein powder and Healthy Meal meal-replacement shake mixes from Herbalife Nutrition. “We currently have three different protein powders and 11 healthy meal flavors,” Seth said of how they can make so many shake flavors. The current menu boasts about 40 flavors, and Seth is working on adding approximately 20 more flavors. “These shakes give you everything you need in a full meal without the calories,” Seth said. “Our shakes are a way to get a lot of protein in one meal with low calories,” Katelyn added. “When exercising, you need protein to build your muscles back up.” So what to order? Start with some of the owners’ favorites. Katelyn’s favorite flavors are the Blueberry Muffin and Cinnamon Toast. Nathan goes for the Elvis, a chocolate, peanut butter and banana concoction, or Salted Caramel. At $8 per shake, it’s a quick and affordable fast food. The tea at the Nutrition Bar and Hub is not your traditional Earl Grey or chamomile tea. Instead it’s a fruity-flavored energy tea that can be ordered cold or hot. “It gives you extra energy like a double espresso. But unlike espresso, it is a clean, natural energy, so you will have no jitters,” Seth said of the stevia-based teas that have only 15 calories and no added sugar. Each tea is made from a combination of a tea and an energy supplement. Seth recommends Pomegranate + Pomegranate, Chai + Orange, and Pomegranate + Orange. You can also add a “booster” to your tea. They offer seven different boosters that range from a collagen “Beauty Booster” to an “Immune Booster” with vitamin C and zinc. Teas are $4, with an extra charge for the boosters. When you visit the Nutrition Bar or Hub, Seth recommends you start with an aloe shot. Made from aloe vera, this shot is for gut health. Benefits include soothing the stomach, relieving indigestion and supporting nutrient absorption. The shots come in mango, mandarin and cranberry and are just $1. Unlike aloe water, which can contain jelly-like pieces of aloe plants, these shots are smooth and go down easily. “I have had customers tell me they been able to stop taking acid reflux medication after taking aloe shots daily,” Seth said. Customers can also purchase products to make their own shakes, teas and even aloe shots at home. As part of Herbalife Nutrition’s sales program, business owners like the McMurrys can receive a percentage of sales from other businesses that use their account to get up and running. “As they are more successful, we are more successful,” Katelyn said of this win-win to help others open a similar concept. “Plus, the percentage comes from Herbalife, not directly from their business.” In addition to the health aspect, Seth said a big reason the family started the business was to build community. “Each location has a big bar so folks can sit and talk with each other and us,” he said. “I know most of my customers here in Germantown by name.” Each location has comfortable seating, both at the bar as well as throughout the store. The atmosphere encourages guests to hang out for a bit, as they sip their shake. “All of us are athletes and we have been drinking protein shakes for years,” Seth said. “We have friends in Little Rock who have a similar business, and we wanted to create the same thing here in Memphis.” Katelyn said they also saw a big need in Memphis. “We are trying to make a difference by offering a healthy and fast alternative.” The McMurrys are growing their business by helping others open similar concepts. Last year, the McMurrys partnered with another family to open a third location on Main Street. Downtown Nutrition is co-owned by couple Preston and Jackie Butts and Anthony Hollins, Jackie’s brother. The menu and feel of the new location, which opened in early December, reminds you of the other two locations. Jackie described the business relationship with the McMurrys as “each is independently owned but we all work together.” “I liked the community aspect of the business, the health awareness piece and the impact it can have on a community,” Preston said. “Plus, we live Downtown, and we wanted to give a great product to the underserved health and fitness community in Downtown Memphis.” “We are opening a second location for us in Oxford, Mississippi, within the month,” Preston said. The new location will be much larger than the Downtown location, at more than 2,000 square feet, and is located at 1101 Merchants Drive, across the street from the Dick’s Sporting Goods. Ole Miss students will be happy to know that the shakes will be on the university’s meal plan. ___ Information from: The Commercial Appeal, http://www.commercialappeal.com Claim: Nutrition Hub starts a nutrition bar craze in Memphis area.
[EX A]:
Salted Caramel, Reese’s, Blueberry Muffin, Cinnamon Toast and Strawberry Cheesecake. The menu at the new Nutrition smoothie bars reads like an ice cream shop or bakery, not a health food shop.