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 Input:
Paragraph: During the warm, waning summer days, fresh air workouts offer a wealth of new ways to boost the mood, channel the inner child and even burn extra calories. Chris Freytag, a personal trainer and health coach with the American Council on Exercise, loves the gym but lives in Minneapolis, Minnesota, a city notorious for brutal winters. “I’m a big believer in change of venue, of getting away from the same treadmill, the same spot. And there’s something about fresh air and moving in space,” said Freytag, who leads boot camp and circuit classes in parks and parking lots during the summer months. The changing terrain can also inspire the solitary exerciser to mix it up. “I’m all about hills: every time you see a hill or steps or stairs, lunge at it,” said Freytag. “Step up and down on curbs and park benches.”  A child’s playground offers core-strengthening possibilities from deep plank pushups, with feet placed on swings, to training with resistance bands slung around poles, to monkey bar pull-ups, she explained. Research suggest the outdoor boost can be mental as well as physical. In a 2014 study on indoor versus outdoor activity published in the journal Applied Psychology: Health and Well-Being researchers analyzed national survey data from Finland. They found that nature provides an added value to the known benefits of physical activity and repeated exercise in nature is, in particular, connected to better emotional well-being. In his book “Beat the Gym,” Connecticut-based running coach and personal trainer Tom Holland said running on a treadmill is slightly easier than running on the ground. “You don’t have to deal with changing terrain, wind resistance,” he said, adding that the zero incline on most treadmills is actually slightly downhill. New York City-based personal trainer JR Allen, said the first benefit of the outdoor workout is balance. “You have to be aware of your surroundings because you could step in a pothole,” Allen said. “It is a less safe, more uncontrolled environment that is more of a strain on your body.”  Allen suggests the newcomer to outdoor exercise should start with a simple walk around the neighborhood. The seasoned exerciser should head to the park for sprints, power push ups, in which hands leave the ground, and walking planks, moving side to side and back to back on hands and feet. Daniel Taylor, author of the book “Conditioning to the Core,” thinks outdoor training is great as long as people take some precautions. “People who utilize children’s playground equipment ought to double check it. Make sure bars aren’t slippery,” he said. “One of the reasons we go to the gym is it’s safe and dry.” Claim: Parks, playgrounds offer fresh air alternatives to gym workouts.

Ex Output:
From park bench pushups and monkey bar lifts to open air runs, fitness experts say the workout possibilities of playgrounds and parks are worth the consideration of even the most diehard gym users.


Ex Input:
Paragraph: The story focused on costs, including information about the relative cost comparison between what are called “open” surgeries and those done laparoscopically (with a thin flexible tube.) The release summarized how minimally invasive techniques reduced the length of hospital stay and complication rates for patients. “Researchers also found that, on average, the minimally invasive approach reduced length of hospital stay by approximately two days, and open operations were more than $9,000 more expensive than minimally invasive procedures. The researchers also found that laparoscopic procedures were better for patients in terms of fewer complications. Laparoscopic anti-reflux operations were less likely to result in postoperative blood clots, wound complications, surgical site infection, esophageal perforation (which can be life threatening), bleeding, cardiac failure, and death.” We rate this, but just barely, for citing cost differences between the two types of surgery and the average reduction in the number of days a patient must remain hospitalized. We do wish the release had delved more into the specifics of reduced complications. How common were the surgical complications in each surgical method? The release names complications associated with both types of surgery for GERD, while stating that patients undergoing laparoscopic procedures encountered fewer of them: “postoperative blood clots, wound complications, surgical site infection, esophageal perforation (which can be life threatening), bleeding, cardiac failure, and death.” The news release gave details about how the study examined records of about 75,000 patients from 1,000 hospitals to compare outcomes in the records for open vs. the minimally invasive laparoscopic surgeries. That’s all to the good. However, the news release didn’t mention any of the study’s limitations. The key one is that this is a retrospective, observational review of records that isn’t capable of supporting cause and effect statements such as the minimally invasive approach “reduced length of hospital stay by approximately two days.” Nor should this kind of evidence be used as the basis for statements such as laparoscopic procedures “were better for patients” and “should be the standard of care.” Patients receiving open vs. laparascopic procedures could differ in unknown ways, which is why the superiority of one approach over the other should ideally be established by a prospective, randomized controlled trial. There were other limitations outlined in the journal article that were not mentioned in the release. Because the NIS database doesn’t link to hospital records, researchers weren’t able to track and measure outcomes “including complications, readmission, and mortality, occurring after the initial hospital discharge.” The researchers were also unable to determine which open surgeries were “re-dos” of previous surgeries. The potential for errors in coding which procedures were used was also cited as a possible limitation. There was no disease mongering. The release also provided useful context on the prevalence of GERD and further specified that smaller group of patients, from the many heartburn suffers, might be candidates for the surgery. Well done. The release does not list any funding source for the research and the published study notes that authors had “nothing to disclose.”  We’ll rate this not applicable since this is an examination of existing data, and there may have been no additional outside funding. The news release does a good job here. It compares different surgical methods and it also names alternatives for treating GERD such as medications and changes in the diet. It also states which group of patients the surgery is aimed at: “Anti-reflux surgery should be considered in patients who do not achieve complete control of their symptoms [regurgitation or cough] with medications; who do not want to take medications for the rest of their lives; or who experience complications of medical therapy.” It’s clear from the release that both methods of surgery have been widely available nationally and the outcomes of 75,000 surgeries were tracked by the National Inpatient Sample (NIS) database. The release also notes that “urban academic or teaching hospitals” perform laparoscopic anti-reflux surgery more often than “open” procedures, 54.4 percent versus 45.6 percent. And it recommends that anti-reflux surgery should be performed laparoscopically in specialized centers. The news release was not about a novel procedure and made no claim of novelty. However, this isn’t the first study to examine laparoscopic vs. open surgery. For example, the British Journal of Surgery published results of a randomized trial of the two methods and the Scandinavian Journal of Gastroenterology published research on long-term outcomes following laparoscopic and open procedures for GERD. We did not observe any unjustifiable language. Claim: Laparoscopic anti-reflux operation for GERD linked to fewer postoperative complications

Ex Output:
A new study by the American College of Surgeons, a professional organization, compared records for 75,000 patients who underwent surgery for GERD, or gastrointestinal esophageal reflux disease. The study looked at two different surgical procedures and found the less invasive one seemed equally effective, but kept patients in the hospital a shorter time with fewer complications. The news release did a good job of discussing surgical alternatives and costs, which were estimated to be $9,000 lower for the less invasive laparoscopic procedure. The release would have been better had it spelled out some of the study limitations, the key one being that a retrospective, observational review of hospital records — as this study was — isn’t capable of supporting the cause and effect statements sprinkled throughout the release. Millions of Americans complain of occasional heartburn, sometimes called a burning sensation in the throat from food coming back up from the stomach. But some estimates are that about 20 percent of US adults fit the definition of GERD, which means they suffer symptoms at least every week. If patients consider a surgical fix, this study shows that a less-invasive procedure could reduce their complications and shorten their hospital stay. It’s hard to pin down stats on GERD prevalence. A 2014 review of 16 epidemiological studies of GERD prevalence published in the journal Gut suggest GERD prevalence ranges from “18.1%-27.8% in North America, 8.8%-25.9% in Europe, 2.5%-7.8% in East Asia, 8.7%-33.1% in the Middle East, 11.6% in Australia and 23.0% in South America.”


Ex Input:
Paragraph: The increased scrutiny of medical exemptions was announced Friday and follows the elimination of religious exemptions. The new regulations aim to keep people from obtaining medical exemptions for non-medical reasons. The Department of Health says doctors who issue medical exemptions will now be required to complete a state form specifically outlining medical reasons preventing a child from receiving each required vaccine. Amid the nation’s worst measles outbreak in decades, Democratic Gov. Andrew Cuomo in June signed a law ending all non-medical exemptions for vaccines required for children to attend school in the state. The Centers for Disease Control has counted nearly 1,200 cases of measles in 30 states this year. Claim: New York issues stricter rules on vaccine medical exemptions.

Ex Output:

New York health officials have issued emergency regulations restricting medical exemptions from vaccination for children attending school or child care.