instruction:
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.
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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
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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."

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Paragraph: In recent decades, laughter has been touted as a possible cure for many ills, including cancer and heart trouble. But could mirth also be deadly, making the phrase "I just about died laughing" as much about accuracy as it is hyperbole? On 24 March 1975, 50-year-old bricklayer Alex Mitchell of King's Lynn in Norfolk, England, kicked the bucket while roaring with laughter at one of his favorite television shows, the comedy program The Goodies. The skit that precipitated Mitchell's fatal fit of glee involved a kilted Scotsman's flailing away with his bagpipe at a vicious black pudding intent upon attacking him. Mitchell was unable to stop laughing, and after twenty-five minutes of uproar gave one last "tremendous belly laugh, slumped on the settee, and died," said his widow, who witnessed his passing. While Mitchell had expired from heart failure, what felled him was not a classic heart attack, but rather the result of an unusual inheritable heart rhythm disorder that routinely takes the lives of even apparently robust 20-somethings. Mitchell had Long QT syndrome, an affliction in which the heart is prone to experiencing long pauses between heart beats, especially after instances of excitement or exertion. After such an incident, the heart resets itself after a few beats, but in some cases (such as this) the person is not so fortunate. An odder account of a "dying laughing" incident was reported in Bangkok in 2003: An ice cream truck driver in Thailand died while laughing in his sleep. Damnoen Saen-um, 52, laughed for about two minutes yesterday and then stopped breathing, The Nation newspaper reported. Damnoen's wife tried to wake him up but he kept laughing. An autopsy suggested that he might have had a heart attack. "I have never seen a case like this. But it is possible that a person could have heart seizure while laughing or crying too hard in their sleep," said Dr Somchai Chakrabhand, deputy director-general of the Mental Health Department. On the anecdotal side, Schott's Original Miscellany attributes the death of Burmese king Nandabayin in 1599 to his having "laughed to death when informed, by a visiting Italian merchant, that Venice was a free state without a king." And on the fictional front, one version of the demise of Pecos Bill, the legendary cowboy hero of American folklore, has him dying from laughter after an encounter with a Boston dude: When Bill was gettin' on in years, a Boston man came down to New Mexico for a visit. He fancied himself a bit of a cowboy. Got himself one of them mail-order suits, don't ya know. The ones with the lizard skin boots, a shiny brass belt buckle, a new pair of blue jeans and a huge ten gallon hat with not a speck of dust on it. Well, when Pecos Bill saw him trying to swagger into a bar, he jest lay down on the sidewalk and laughed himself to death! Not enough information was given in the (real) cases cited above to know whether laughter was a coincidental, contributory, or causal element of the deaths, but linguistically we've been tossing about "dying laughing" expressions for centuries; the Oxford English Dictionary records a use of this phrase as far back as 1596 ("Went they not quickly, I should die with laughing"). We also employ similar phrases to indicate intense feelings of humiliation ("I almost died of embarrassment"), and in a more generic sense we use 'dying' to indicate great longing ("I'm just dying to see you") or excellence ("It's to die for"). It therefore comes as a bit of a shocker to realize that there might be at least a smidgen of truth buried deep beneath all this overblown emoting. Claim: People have died laughing.
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Yet even if there may have been an occasional death from guffawing, it's still possible merriment is far more healthy than harmful (at least for the ones who survive). Some studies assert laughing produces beneficial effects on physical health, including decreasing the secretion of serum cortisol (a stress hormone) and boosting the blood levels of immunoglobulin A, an antibody that fights bacterial and viral infections in the upper respiratory and gastrointestinal tracts. However, not everyone in the scientific community has jumped on this bandwagon: in a study reported upon in 2002 in Current Directions in Psychological Science ("Is Laughter the Best Medicine? Humor, Laughter, and Physical Health) researchers reported that the connection between humor and wellness was "less conclusive than commonly believed" and that "future research in this area needs to be more theoretically driven and methodologically rigorous."

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Paragraph: Yet his service of tattooing realistic-looking nipples onto women who have had their breasts reconstructed after mastectomies signals the final step of recovery from cancer, and women react with emotion to the process. "They leave crying and hugging me. This is therapy," says 32-year-old Quesada, who takes time out from his tattoo parlor to attend patients at the hospital. Reconstruction can occur months, or even years, after breast cancer surgery with tissue expanders typically installed to stretch the skin and make room for a future implant. Creating the nipple comes later and involves one more operation. "At this point most patients are exhausted," said Lorenzo Rabadan, the doctor who first approached Quesada about providing women with an alternative to surgery. He invited the tattoo artist to train staff on the technique. Clutching a pale pink tattoo gun, Quesada creates the three-dimensional illusion of a nipple on a patient's reconstructed breast, mixing colors with names like 'rose pink', 'brown sugar' and 'tribal black' to mimic the natural shade of an areola. Half-blind, Quesada offers his service free of charge. The national health service did not cover the cost of his false eye after he lost his left eye to a benign tumor. For many, a quick and relatively painless session marks the end of a chapter. "This means it's over and I can pick up my life again," said Mamen Malagon, 43. She was diagnosed with the disease in 2011 resulting in the mastectomy or removal of her left breast. "All done," she sighed as she got dressed. "Do you know what it means to say that it's over?" Claim: Spanish hospital offers nipple tattoos to breast cancer survivors.
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Arms covered in red and green ink, tattoo artist Alvaro Quesada is hardly what cancer survivors expect at a Madrid infirmary, the first public hospital in Spain to offer nipple and areola tattooing.