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'.

Input: Consider Input: Paragraph: More than 115,000 people have tested positive for the virus in Italy since the outbreak was discovered in its wealthy northern regions on Feb. 21 and almost 14,000 have died, the highest death toll in the world. But daily tallies of new infections and fatalities have been steady in recent days, which experts hope points to a decline soon. Pressure is growing to find out who has been exposed to the virus and whether some people have developed immunity, in order to soften the severe lockdown measures the government has imposed to curb the contagion. Franco Locatelli, the head of Italy’s Higher Health Council, said a reliable antibody testing system to use at the national level had still to be identified, though various products had already been proposed. Locatelli told reporters that government scientists were working hard to analyse the tests and hoped to have a result “in a few days”. He added that it would probably then take another month before the health authorities are able to roll out recommendations on a nationwide testing procedure. Some badly hit Italian regions have already started buying some of the tests already on the market. Speaking at the same news conference, health officials said the lockdown had prevented a potentially ruinous spread of the contagion from its northern epicentre to less developed southern regions. “The social distancing measures adopted on a national scale have meant that where the number of infections was relatively low, it remained low,” said Giovanni Rezza, director of infectious diseases at the national health institute. The government said this week that curbs on movement and business activities introduced nationwide on March 9 would stay in place until at least April 13. The head of the Civil Protection Agency, Angelo Borrelli, said on Friday he expected them to remain beyond May 1. Claim: Italy experts say reliable coronavirus antibody test may be ready soon.

Output: 2


Input: Consider Input: 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There are three costs not mentioned in this news release that are critical in evaluating the relevance of this unpublished study.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

Output: 1


Input: Consider Input: Paragraph: Microwave ovens are a favorite bugaboo of the natural health set, and claims that they were once banned in various countries, including the Soviet Union, are repeated uncritically on numerous natural health websites espousing their purported dangers. For example, a 24 August 2016 article published on the conspiracy-obsessed website Natural News stated: The electromagnetic field (EMF) produced by common household microwaves is something Russia has taken seriously in the past. After conducting thorough research into the health effects of microwave EMFs, Russia determined in 1976 that microwaves were dangerous to their people. In that year, Russia banned the devices to protect their citizenry. Most (but not all) websites ambiguously state that the ban was lifted sometime during or before perestroika, in an effort to warm relations between the two countries. From a purely historical standpoint, this is a dubious narrative at best. However, there is some historical precedent for the purported relationship between microwaves and the Soviet Union. For at least fifteen years prior to 1976, the Soviets had literally been beaming microwave radiation at the American embassy in Moscow in an effort (by their own account) to prevent the United States from electronically eavesdropping — a fact made public that year, in a 28 February 1976 New York Times report: At least the main outlines of what might be called the Case of the Moscow Microwaves have finally emerged. For at least fifteen years the United States Embassy in Moscow has been systematically irradiated by microwaves generated in equipment installed nearby by Soviet intelligence agencies. The objectives of this bombardment presumably were to eavesdrop on conversations in the embassy and to attempt jamming of electronic monitoring equipment installed in and on the embassy. The United States State Department knew about this irradiation and protested from time to time, but the facts were kept secret from both the American public and most of the people in the embassy complex. This public acknowledgement spurred American research into the biological effects of low dose microwave radiation, and later led to an agreement between the Soviets and Americans to reduce the amount of microwave radiation to which the the embassy was exposed. Coverage of this event brought American concerns about microwave radiation to the forefront for the first time, spawning myriad articles and discussions at the time about a lack of research regarding its safety. The notion that a Russian ban on microwaves would go unreported in major United States newspapers during a time that the Soviets were downplaying the risk of their own intentionally beamed microwave radiation is unlikely, given the perceived hypocrisy it would have engendered. Further, there were in fact a number of different microwaves available in the USSR during this supposed ban. Though they were unaffordable to the average Russian at the time — the first Soviet manufactured microwaves hit the scene in the 1970s. According to an article in the 16 August 2016 issue of Russia’s version of Popular Mechanics about this very myth, at least twenty-three different models were manufactured during this time period. This one, from 1981 (smack dab in the time period of the purported ban), is described by that article’s author as “famous”:  The origin of this myth, however, lies over 5000 miles away from Moscow in America’s Pacific Northwest — Portland, Oregon. Every claim made regarding a Russian ban on microwaves stems from an article published in the first (and as far as we can tell, the only) issue of a mysterious publication called the “Journal of Natural Science.” While the article from the “April-June 1998 issue” lists myriad claims about the dangers of microwave radiation, it is published without a single citation. That article also incorrectly asserts that the Nazis invented the microwave oven, and both the Soviets and Americans got their hands on the details after the war for further research: These documents and the experimental microwave equipment was transferred to the U.S. War Department, and classified for reference and scientific investigation. The Soviet Union also retrieved some of the devices, and proceeded to undertake experimentation on a separate basis. The Russians have been the most diligent in their research on the biological effects of microwave ovens, and have outlawed their use, and have also issued an international warning concerning the possible biological and environmental damage that can be caused by the use of this similar-frequency electronic apparatus. The author of this article is listed as “William P. Kopp,” whose biography is included at the end of the article: The original of this forensic research document is to be found in the Archives of the Atlantis Rising Educational Center in Portland, Oregon. The author William Kopp worked there from 1977 to 1979. Already twenty years ago Kopp gathered all documents known so far concerning the scientific proofs about microwaves’ harmful effects on humans. By doing this he got in the way of a powerful lobby and was forced later on to even change his name and to disappear. While it is hard to verify the authenticity of an unsourced document written by someone who claims to have changed his name to disappear from the dangerous microwave lobby, it is possible to ascertain what (at least in the late 1970s) the “Atlantis Rising Educational Center” was all about. Based on a classified ad placed in a January 1979 issue of the magazine Yoga Journal, it appears that this center was an alternative health bookstore selling herbal supplements:  The allegation of a Soviet ban on microwave ovens may well have stayed within the walls of the Atlantis Rising Educational Center if not for the misleading promotion of this remarkably questionable document. Perhaps most notably, the claim was repeated by the natural health evangelist Joseph Mercola who parroted the claim almost word for word on his web site, citing this Atlantis Rising “study”: The Nazis are credited with inventing the first microwave-cooking device to provide mobile food support to their troops during their invasion of the Soviet Union in World War II. These first microwave ovens were experimental. After the war, the US War Department was assigned the task of researching the safety of microwave ovens. But it was the Russians who really took the bull by the horns. After the war, the Russians had retrieved some of these microwave ovens and conducted thorough research on their biological effects. Alarmed by what they learned, the Russians banned microwave ovens in 1976, later lifting the ban during Perestroika. Claim: Microwave ovens were banned in the USSR in 1976 to protect its citizens from harmful health effects.


Output: 0