TASK DEFINITION: Given a paragraph and a claim, classify it this way: If the claim contradicts the evidence present in the paragraph, classify the claim as '0'. If the claim has multiple supporting *AND* contradicting evidences, classify the claim as '1'. If the claim has supporting evidence and the paragraph is in overall favor of the claim, then classify the claim as '2'.
PROBLEM: Paragraph: There are three costs not mentioned in this news release that are critical in evaluating the relevance of this unpublished study. First, the release could have compared the costs of “dual mobility cup” hip transplants vs. conventional implants. We’re told the former are “more expensive” but it would be helpful to know by how much, since the study suggests dual mobility cup transplants may be indicated in patients at high risk for dislocation. Second, the study is based on a “novel risk assessment tool” which suggests pre-operative scans in the sitting and standing positions. How much does this cost? It’s not mentioned. Third, how much money could potentially be saved by reducing the need for “revision surgeries” in patients whose implant becomes dislocated? It is unlikely that this will reduce costs overall given the small number of individuals who may require repeat surgery, even in this high risk group. Thus, the question is whether this is a cost-effective strategy or not. This study was done in two parts. Part one: a retrospective review of 1,082 conventional (not dual cup) total hip replacements (THRs), over 2 years, in which the dislocation rate was 1.8% (19 patients). We’re told about a third of the total cohort (320 of the 1,082) had “spinal disease and deformity” on imaging scans. In this group of 320, 10 patients (3.1%) had subsequent dislocations. Part two: Beginning in 2016 researchers began employing their risk assessment tool — pre-operative sitting/standing scans of the hip, and factoring in other risk factors like previous spinal fusion — and identified 192 of 1,009 patients (19%) as ‘high risk’ for dislocation. About three-fourths of these patients received dual cup transplants with only 1 having a subsequent dislocation (0.5%). The news release gives us the absolute rate of dislocations in both high-risk groups (3.1% vs. 0.5%), which is vital information to understand the scope of the potential benefit. And on that basis we’ll award a satisfactory grade here. However, we note limitations under the Evidence criterion below that have a bearing on these statistics. The news release does not mention any risks associated with hip replacement surgery in general, nor does it address potential harms specific to dual mobility cups, which are described in the release as the recommended approach to reduce risk for dislocations. The release notes that dual mobility cups may carry risks “if implanted unnecessarily” but doesn’t describe or quantify those risks. Of note, there is some concern that this type of replacement joint may release higher levels of metal ions than conventional joints when implanted in younger, more active patients. As presented, the only downside of these newer devices are the increased cost. It would be helpful to know if there are any other risks. Newer devices may have some risk simply due to not having long-term experience with them. Current hip replacement devices have been shown to work for 20+ years. It will take considerable time to know whether the same may hold for these newer devices. The release provides a relatively thorough description of how the study was conducted, noting that one group of patients was treated before the introduction of a new assessment protocol (in 2014-2015), and that the second group had their treatment guided by the new protocol (introduced in 2016). The fact that the second group had better outcomes (i.e. a lower rate of dislocations following hip replacement) indicates that the protocol must be helpful for identifying high-risk patients and treating them more appropriately, the release suggests. What’s lacking, though, is any acknowledgment that these two groups of patients might not be directly comparable. For example, did these two groups have the same types of “spinal disease and deformity” — the nature of which might impact the failure rate for their hip replacements? Did they also have the same level of mobility and co-existing illnesses? Did anything else about the treatment provided to patients change in the time between the first group’s treatment and the second group? Were both groups followed for the same length of time post-surgery? Differences in any of these areas could have biased the results. To conclusively demonstrate the effectiveness of the new protocol, researchers would need to randomly assign patients to receive the new protocol, or not, and document how both groups fared following treatment. A brief note to that effect, or at least a mention of some of the limitations inherent in the current study’s design, would have been helpful. The report should have mentioned that the comparison was not a direct one. The best way to examine these outcomes would be to compare patients screened to be at high risk and then randomize them to the new device or a standard one. It is possible that the benefit is from knowing that they are at higher risk. For example, physical therapy or other instruction may be given to mitigate the risk, irrespective of the device inserted. No disease mongering. The release states that dislocations occur in about 1% of patients following hip replacement. The release doesn’t discuss funding for the study or possible conflicts of interest among the study authors. A quick search of the federal Open Payments database shows that the lead author, Dr. Jonathan Vigdorchik, receives payments from a number of device companies, including those that make dual mobility hip implants. Since we’re not aware of alternatives to this tool we’ll rate this criteria Not Applicable. It’s clear that patients who undergo hip replacement at NYU Langone Orthopedic Hospital have access to the risk assessment screening and treatment algorithm prior to surgery. But what about patients who can’t travel to New York? Is anything similar in use at other institutions? The release is silent on this point. The release clarifies the problem this new assessment tool is trying to solve and why it’s worth reading about: Some newer hip implants are designed with dual mobility cups that allow for increased range of motion, which helps reduce dislocation risk. However, no guidelines currently exist to aid clinicians in deciding when to use these more flexible implants, which are often more expensive than conventional implants, may not be medically necessary, and may carry added risks if implanted unnecessarily. No unjustifiable language. Claim: New tool helps identify risk for post-surgical dislocations following hip replacement

SOLUTION: 1

PROBLEM: Paragraph: "President Donald Trump took a swipe at former President Barack Obama as he renewed his pledge to tackle the opioid epidemic, which claims the lives of tens of thousands of people a year. Trump said that opioid overdose deaths have nearly quadrupled since 1999, speaking after a briefing on the issue. But while deaths soared, Trump said overall drug prosecutions declined in recent years -- a trend Trump vowed to reverse. ""We're going to be bringing them up and bringing them up rapidly,"" he said Aug. 8. ""At the end of 2016, there were 23 percent fewer than in 2011. So they looked at this scourge, and they let it go by, and we're not letting it go by."" We found that Trump is correct that federal drug prosecutions declined from 2011 to 2016 under Obama, but he lacks evidence to prove that’s the culprit for the opioid overdose crisis. A White House spokesman declined to comment on the record. The Justice Department filed drug charges against 24,638 defendants in 2016, down 23 percent from 2011, according to the Pew Research Center, which analyzed federal data. The data reflects felonies and some serious misdemeanors. But that’s overall drug prosecutions, not just prosecutions related to opioids. And it only includes federal prosecutions -- the vast majority of criminal prosecutions are in state courts. We found that the drop was due to some of the specific actions the Obama administration took to stop the prosecution of low-level offenders. Pew noted that in 2013, then-Attorney General Eric Holder directed federal prosecutors to ensure that each case they brought served ""a substantial federal interest."" Holder mandated that certain low-level nonviolent drug offenders, with no ties to gangs or cartels, would no longer face mandatory minimum sentences. He called for more treatment and alternatives to prison. Also in 2013, U.S. Deputy Attorney General James Cole issued a memorandum to federal attorneys related to prioritizing marijuana prosecutions. He directed attorneys to focus on cartels or other criminal organizations and the use of violence to distribute the drug. Federal marijuana prosecutions fell to 5,158 in 2016, down 39 percent from five years earlier, Pew found. Trump implied that lack of prosecutions likely led to a worsening of the opioid crisis. But experts we contacted had a different view. ""No serious analyst would argue that federal prosecutions have consequences for opioid overdoses,"" said University of Maryland criminology professor Peter Reuter. ""The drivers of that increase are the arrival of fentanyl, since about 2012, and the overprescription of opioids before it. There has been some decline in heroin retail prices. But no prior effort against high-level distributors and traffickers has ever had sustained success at the retail level."" Some drug experts including Dr. Andrew Kolodny, co-director of opioid policy research at Brandeis University's Heller School for Social Policy and Management, have criticized Obama for taking too long to address the crisis, but not because of a lack of prosecutions. ""Obama deserves blame for neglecting the epidemic and failing to ensure a coordinated federal response,"" Kolodny said. ""I can think of several areas where it's fair to criticize him. The decline in federal drug prosecutions is not one of them."" Trump has a point that the Obama administration was slow to respond to the opioid crisis, said Jon Caulkins, a Carnegie Mellon professor and expert on drug policy. ""Anyone looking at the basic death stats knew we had a problem by 2000,"" Caulkins said. ""So this is a national disgrace, and Obama was in power for eight of the more recent years, and if ‘the buck stops on the president’s desk’ then it’s fair to put some blame there."" A September 2016 report from the Obama administration’s Justice Department found that prosecutors could help combat the epidemic by prioritizing prosecution of heroin distributors and of medical professionals who improperly prescribe opioids. The report also stated that federal prosecution had ""lagged,"" and more prosecutors were needed. The report noted, however, that investigations ""can be difficult when the victim is deceased and the source of the drugs is not immediately obvious."" Trump said ""at the end of 2016, there were 23 percent fewer federal prosecutions than in 2011, so (prosecutors) looked at this surge and they let it go by."" Trump made the statement in the context of rising opioid overdose deaths. An analysis of data shows that federal drug charges overall declined 23 percent between 2011 and 2016. But that data doesn’t tell us anything about opioid cases specifically. Where Trump misses the mark is his suggestion that the drop in prosecutions is to blame for the opioid epidemic, which started before Obama’s tenure and then grew worse during his presidency. Obama could have done more earlier to address the epidemic, experts said, but there is no evidence that his strategy on federal drug prosecutions led to a spike in opioid overdose deaths." Claim: At the end of 2016, there were 23 percent fewer federal prosecutions than in 2011, so (prosecutors) looked at this scourge (opioid deaths) and they let it go by.

SOLUTION: 1

PROBLEM: Paragraph: The residents at the Weiss nursing home in eastern France want to chat face to face, to play board games, to share meals. And so each gave a vial of blood to be tested for the coronavirus, as did each staff member — about 580 tests in all. The goal: to identify who must be isolated and who will be allowed the freedom to leave their rooms. “We spend all our days between those four walls — that’s it, we are not allowed to go out. We don’t even have the right to go out in the hallway,” said Henry Bohn, a 69-year-old who suffered a stroke that has left him in a wheelchair. “They bring us breakfast, lunch and dinner here in the room. Luckily, we have the sun these days and it helps, but we do miss the essential things.” An Associated Press photographer spent two days chronicling the virus testing at three of the 10 nursing homes in France’s Haut-Rhin region, where comprehensive testing was ordered by local authorities. The site in Ammerschwir poses particular problems with its small rooms and long corridors, and residents with often-severe cognitive difficulties. “It is hard for them to remember the rules that we give them. When we put masks on them, they hardly keep them on, and they need to socialize and leave their rooms,” said Sylvie Ghiringhelli, the head nurse. Some patients wander out anyway, clustering in hallways or taking seats in the common room before they can be led gently back. The elderly make up a disproportional share of coronavirus victims globally, and that is especially true in nursing homes, which have seen a horrific number of deaths around the world. In France, nursing home deaths account for more than a third of the country’s total 17,000 coronavirus victims — figures the government now documents meticulously after weeks of pressure. Infections have swept through the country’s 7,000 residences for the elderly, with more than 15,000 confirmed cases among patients and 8,900 among staff between March 1 and April 14. And nowhere has it been deadlier than in France’s east, near the border with Germany, where the outbreak began at an evangelical gathering in the city of Mulhouse. Overall mortality in the Haut-Rhin was up 143% from March 1 to April 6, according to government figures. Restricting residents to their rooms can take a different kind of toll. “The confinement stopped all the communal meals in the dining room, stopped every form of social life,” Ghiringhelli said. “There are no more activities, no more visits. Our residents bear the consequences.” Marie Louise Kopp’s room is filled with souvenirs — photos, china cats, octagonal paintings — to help jog a 79-year-old memory that waxes and wanes. “My son was coming to visit me and some family, but now nobody can,” she said, an untouched newspaper on her lap. “Everyone stays at home with this crisis.” France’s health minister, Olivier Véran, said family visits would again be permitted beginning Monday, at a resident’s request and as long as the nursing home staff can organize a system of ensure protection against the virus. “There will not be physical contact but there can be visual contact, and that can provide solace,” Véran said Sunday. It’s not clear how quickly visitors will be allowed again in Ammerschwir, but the nursing home staff hope testing everybody will enable most residents to at least leave their rooms without fear of infection. Results are expected next week and the local administration and nursing home directors will then meet to discuss the next steps. Elsewhere, France has locked down nursing homes after two positive tests and simply assumed that anyone with symptoms was infected. “The testing will perhaps allow us to partially resume life, communal meals and activities in small groups,” Ghiringhelli said. “And to mend the social ties.” ___ Lori Hinnant reported from Paris. ___ Follow AP coverage of the pandemic at http://apnews.com/VirusOutbreak  and https://apnews.com/UnderstandingtheOutbreak Claim: Mass virus test in nursing home seeks to combat loneliness.

SOLUTION:
2