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.

The study evaluated the combined effect of six lifestyle habits on prostate cancer mortality. Those six factors were, as described in the journal article: “not currently smoking or quit 10 or more years ago, body mass index under 30 kg/m2, high vigorous physical activity, high intake of tomatoes and fatty fish, and low intake of processed meat.” It’s tough to put a price tag on those lifestyle choices. How much does “high vigorous physical activity” cost? How much does it cost to avoid eating processed meat? It would be easy to say this category doesn’t apply. But the release does address the issue, saying the study findings underscore “the ongoing need for more effective prevention measures and policies to increase exercise, improve diet quality and reduce tobacco use in our population….It takes co-operation and effort from multiple areas, like insurance companies, employers, policy makers and city planners, to figure out how to creatively support and encourage more exercise into most busy adults’ working day.” Recognizing the need for policies that support these lifestyle changes is important — and addresses the cost issue in a meaningful way. This is where things get a little tricky. The research described in this journal article looked at data from two different studies: the Health Professionals Follow-Up Study (HPFS) and the Physicians’ Health Study (PHS). The HPFS tracked 42,701 men from 1986-2010. The PHS tracked 20,324 men from 1982-2010. The release (and journal article) explain that the researchers used the HPFS data to develop a “healthy lifestyle score,” and then applied that score to the men in the PHS to see if it predicted whether someone would contract a lethal form of prostate cancer. The researchers identified the number of lethal cases of prostate cancer in each group to calculate benefits. The release states: “Participants with 5 to 6 points [the highest scores] in the HPFS had a 68 percent decreased risk of lethal prostate cancer[,] and a 38 percent decreased risk was observed in the [PHS] for the same comparison.” Several points to make here. First, the ‘healthy’ group appeared to have been compared to the ‘least healthy’ group (score 0-1) and not all the other groups combined. This was noted in the published results but not mentioned in the release. That’s important. Second, the release does not note (but the journal article does) that the 38 percent decreased risk seen in the PHS was not found to be statistically significant. That’s also an important distinction. Third, this is the relative reduced risk, and doesn’t tell readers what the actual, absolute reduction of risk is. The release doesn’t address harms. But the lifestyle choices at issue here are (for the most part) so broadly defined that it would be difficult to say what the harms would be. What harms are associated with eating tomatoes, avoiding processed meats, or not smoking? We’ll rate this one not applicable. The release does a good job of explaining what is a somewhat complicated study design. The study is basically an analysis of data drawn from two large, previous studies — and the release describes the overall sample size, age range, and length of those two studies. But the language used to describe the results is inappropriate. Since this was an analysis of observational study data that’s unable to prove cause and effect, it’s misleading to use active verbs to describe the results. The release does this in several places: It’s more appropriate to state that these habits were “associated with” reduced risk — not that the habits “save lives” or “cut” risk. Another thing that’s not clearly explained to readers (as noted above) is what it means to develop a lifestyle scoring system based on one study’s data set, and then apply that scoring system to a second data set, when the results section is provided for both data sets. It’s confusing. We’d encourage public affairs specialists preparing news releases and reporters using them as their initial sources to focus more on the limitations of this type of research. Sometimes referred to as “data dredging,” it’s basically finding statistically significant results only by chance. In this case it’s a statistic of a statistic (up to 47% of cancer cases could be prevented with these lifestyle interventions). No disease mongering here. Funding sources were clearly identified, and there are no clear conflicts of interest. Things get tricky again here. As the release notes, most prostate cancers don’t metastasize and aren’t life threatening. But some do metastasize and can be fatal. Are there different types of prostate cancer, just like there are different types of flu? Are there genetic factors that affect risk? Readers would have benefited from that information. And we suppose that the release could have also mentioned other dietary or lifestyle factors that might help reduce risk that were not considered in the paper. However, the range of healthy behaviors discussed here is pretty broad, and it seems excessive to expect the release to address an entire laundry list of possibilities. We’ll give this a Satisfactory rating. The study was limited to a relatively high level income group and the interventions may not be attainable for all men, in all socioeconomic groups. Does partaking of vigorous physical exercise on a regular basis require access to a gym or just a high degree of motivation? Are tomatoes and fish attainable year round for all socioeconomic groups? The study addresses this to some extent when it says, “It takes co-operation and effort from multiple areas, like insurance companies, employers, policy makers and city planners, to figure out how to creatively support and encourage more exercise into most busy adults’ working day.” We’ll award a Satisfactory here. There are a lot — a lot — of papers out there on lifestyle choices and prostate cancer. In fact, the opening sentences in the abstract for the journal article says as much, while articulating what sets this research apart: “Several lifestyle factors have been associated with risk of lethal prostate cancer, but little is known about their combined effect. Our objective was to develop and apply a lifestyle score for prevention of lethal prostate cancer.” However, the release does not acknowledge all of the existing work on lifestyle and prostate cancer, and therefore fails to highlight how this paper fits into that broad body of work. Apart from the cause-and-effect statements addressed above, there is no unjustifiable language used here.
Working up a sweat may protect men from lethal prostate cancer

"There’s a new sheriff in charge of the U.S. Senate, and he’s eager to show how he’s shaking up the law of the land. We’re talking, of course, about new Senate Majority Leader Mitch McConnell, R-Ky., who took over the Senate’s top slot after the midterm elections bounced Democrats from power. And in this new world, Republicans are touting an eye-catching factoid as evidence of a functional Senate, one they say runs on fairness and order under GOP control. ""Amazing fact: Senate has already voted on more amendments in 2015 than Reid allowed ALL YEAR last year,"" tweeted Phil Kerpen, opinion-writer and president of conservative 501(c)(4) American Commitment, on Jan. 22, 2015. Kerpen, formerly of Americans for Prosperity, the Club for Growth and the libertarian Cato Institute, told us he heard the statistic from McConnell himself. We wanted to know if it was true that the Senate has already allowed more votes on amendments in less than one month than all of 2014. And why? On Senate stoppage and filled ‘trees’ The simple answer on the number of votes is that Kerpen is correct. But the reason behind it varies depending on your particular political lens. A simple search of Senate roll call votes on amendments in 2014 and 2015 backs up Kerpen’s statement. In 2014, there were 15 roll call votes on amendments. As of Jan. 22, 2015, the date of Kerpen's tweet, there were 16 roll call votes on amendments. There have since been 17 more votes on amendments to the bill to approve the Keystone XL pipeline, which passed a week later but will likely face President Barack Obama’s veto pen. Kerpen came at the tally a different way, counting ""real"" votes on amendments, a distinction that also includes roll call votes on motions to table amendments, which effectively kills them. By his math, there were 16 votes allowed on amendments in 2014 and 26 so far in 2015. By either count, the numbers work. What changed? In 2014, then-Senate Majority Leader Harry Reid, D-Nev., relied on a funny-sounding procedure called ""filling the amendment tree."" Basically, Reid filled the docket allowed for amendments by adding amendments with inconsequential changes that no one else could override. The procedural tactic prevented Republican-sponsored amendments from being heard on the floor. ""He did that more than any of his predecessors,"" Donald Ritchie, Senate historian, told PunditFact. Reid wasn’t doing this just to be a not-so-nice guy. To Democrats, it was to counter Republican tactics. Unlike the House, the Senate does not have strict rules for the substance of amendments that can be attached to bills (i.e., you could add a health care amendment onto a defense spending bill). And that’s exactly what happened in years past. Republicans began introducing off-topic amendments that, for example, cut off U.S. aid to Egypt or, a favorite of Sen. David Vitter, R-La., to eliminate health care subsidies for Senate staffers. No matter what the topic of the bill. Sometimes this was in effort to force difficult votes for Democrats back home. To Republicans, Reid’s style of blocking amendments emulated an uncooperative and off-the-rails leadership style -- one that is tremendously well-documented -- that stymied policymaking. To Democrats, it was necessary to get anything accomplished. Republicans were filibustering votes on the underlying bills and not committing to a vote in exchange for allowing some amendments, said Steven S. Smith, a political science professor at Washington University in St. Louis. ""Reid saw they were filibustering everything, bringing the place to a standstill,"" Smith told us. ""So he wondered why he should give them votes at all."" Reid’s office does not dispute the number of votes on amendments, but they do take issue with what they deem an ""empty talking point"" that neglects Republican responsibility for the gridlock. His spokesman argues that Republicans blocked their own share of amendments by not compromising on potential amendments to be heard on the floor and refusing to come to an agreement about when a bill should come to a vote. ""(Reid) makes no apologies for blocking what we all consider to be extremely pointless political amendments that were just designed not to improve the bills we were working on but to run 30-second political ads against Democratic senators,"" said spokesman Adam Jentleson. ""Republicans are entirely culpable in that number being what it is."" Reid’s style of blocking amendments irritated Republicans, sure, but it also flared up during the 2014 midterms with Republicans using it to attack Democrats. The GOP pounced on Alaska Democratic incumbent Sen. Mark Begich, for instance, for his lack of roll-call votes on his amendments. McConnell, conversely, said he would allow open amendments on the Keystone XL bill, hence the GOP celebrating its ""new management"" style. As political experts told us to expect, there have already been clashes with McConnell’s methods a few days after the initial celebration. During the Keystone debate, Democrats objected to McConnell tabling Democratic amendments and not letting Democrats debate their amendments for a minute. Reid, perhaps ironically, tweeted, ""I've never seen debate shut down as aggressively as when Sen. McConnell refused to allow Dems to debate their own amendments for just 1 min. ... and that’s saying something."" What the experts tell us Bottom line, experts said, voters shouldn’t take the new tactics as evidence that McConnell’s ""return to normal order"" will give the Democrats an easy path to voting on the amendments of their choice. ""It’s not going to happen,"" said Roy Meyers, University of Maryland, Baltimore County affiliate professor of public policy. University of Kansas political science professor Burdett Loomis agreed, saying, ""The overall idea isn’t trivial (‘regular order’), but the exact number isn’t very significant, especially if McConnell, as expected, runs the Senate almost completely to the (Republicans’) advantage."" It’s too early to know whether we have a ""sea change"" of order on our hands in the Senate, said Sarah Binder, George Washington University political science professor. ""In other words, the intense partisanship of the Senate that led Sen. Reid to all-but shut down the amendment process last year has not dissipated,"" Binder said. ""I think the question going forward is whether McConnell can find a way to conduct the Senate such that senators from both parties believe their legislative needs are being met."" Our ruling Kerpen, among others, tweeted, ""Amazing fact: Senate has already voted on more amendments in 2015 than (Harry) Reid allowed ALL YEAR last year."" On the numbers, that is right. But experts cautioned us that the claim falls more in the interesting factoid category than a sign of a different or more cooperative Senate leadership. The statement is accurate but needs clarification and additional information. That meets our definition of . Correction: An earlier version of this fact-check incorrectly described Sen. David Vitter's amendment."
Amazing fact: Senate has already voted on more amendments in 2015 than Reid allowed ALL YEAR last year.

The plague outbreak has killed 63 people in the Indian Ocean island nation, Madagascar’s government says. For the first time, the disease long seen in the country’s remote areas is largely concentrated in its two largest cities, Antananarivo and Toamasina. Global health officials have responded quickly. The World Health Organization, criticized for its slow response to the 2014 Ebola epidemic in West Africa, has released $1.5 million and sent plague specialists and epidemiologists. The Red Cross is sending its first-ever plague treatment center to Madagascar. On Wednesday, Madagascar’s minister of public health rallied doctors and paramedics in a packed auditorium at the country’s main hospital, saying they’re not allowed to go on vacation. “Let’s be strong, because it’s only us. We’re at the front, like the military,” Mamy Lalatiana Andriamanarivo said. The outbreak could continue until the end of infection season in April, experts warn. Madagascar has about 400 plague cases per year, or more than half of the world’s total, according to a 2016 World Health Organization report. Usually, they are cases of bubonic plague in the rural highlands. Bubonic plague is carried by rats and spread to humans through flea bites. It is fatal about the half the time, if untreated. Most of the cases in the current outbreak are pneumonic plague, a more virulent form that spreads through coughing, sneezing or spitting and is almost always fatal if untreated. In some cases, it can kill within 24 hours. Like the bubonic form, it can be treated with common antibiotics if caught in time. The WHO calls plague a “disease of poverty” caused in part by unsanitary living conditions. Madagascar has a per capita GDP of about $400, and national programs to control the disease have been “hampered by operational and management difficulties,” according to a report by the European Centre for Disease Prevention and Control. But the airborne pneumonic plague, which accounts for about 75 percent of cases in the current outbreak, makes no class distinctions. “Normally, the people who catch the plague are dirty people who live in poor areas, but in this case we find the well-to-do, the directors, the professors, people in every place in society, catching the disease,” said Dr. Manitra Rakotoarivony, Madagascar’s director of health promotion. The current outbreak began in August, earlier than usual, when a 31-year-old man who had spent time in a village in the central highlands, Ankazobe, traveled by bush taxi to the east coast, unaware that he had the plague. He died en route and was buried without any safety precautions in Toamasina. Four people in contact with him also died. Residents of the capital began to relax in recent days amid the global response to the outbreak, but the disease remains a serious threat with the number of new cases per day remaining steady. Madagascar has fought the disease for more than a century. It was introduced to the island in 1898 when steamships from India brought rats infected with the bacteria that causes the disease. The plague nearly disappeared from Madagascar for 60 years, starting in 1930, but re-emerged in recent decades. The black rats that carry the disease in the highlands have gradually developed resistance to it. Unsafe burial practices that involve touching corpses are another reason the disease spreads, according to a 2015 study by scientists at the Pasteur Institute in Madagascar. The outbreak has alarmed neighboring countries. A 34-year-old man in another Indian Ocean island nation, the Seychelles, contracted the pneumonic plague while in Madagascar. He was treated in his own country and no longer has symptoms. It was the first-ever plague case in the Seychelles, said the country’s public health commissioner, Dr. Jude Gedeon. Another Seychellois, a 49-year-old basketball coach, died of the plague last month while in Antananarivo for a tournament. Seychelles authorities have established a plague isolation ward and announced that schools will be closed through Tuesday. Foreign travelers who have recently visited Madagascar are not being allowed into the country. While the WHO says the risk of the epidemic spreading beyond the region is very low and does not advise restrictions on travel to Madagascar, Air Seychelles has canceled all flights to and from the island until further notice. “The situation is still not under control in Madagascar,” Gedeon said.

In Madagascar, plague outbreak now threatens largest cities.