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'.
One example is below.
Q: Paragraph: While the financial costs of screening mammography&!1-positive recalls&biopsies were not included in the study,readers would benefit from being reminded that recall mammography&biopsies increase patient financial costs.This article leads with valuable information for all women over age 40 by stating “Getting screening mammograms every two years instead of annually reduces the chance of a!1 alarm,a new study shows.” Unfortunately the writer doesn’t quantify or elaborate adequately on that reduction.Instead,the writer later focuses on how women undergoing screening mammography shouldn’t be anxious if they experience a recall because over half of women who have screening mammograms for 10 years will be recalled.Readers would have been better served if the writer had emphasized the significant reduction in both recall mammograms&!1-positive biopsies in women who are screened every two years rather than annually.Part of the continuing controversy over screening mammography focuses on annual versus biennial screening.Because this study showed a significant reduction in the percentage of those recalled&needing biopsies among women who are screened every other year,with no statistically significant increase in late-stage diagnosis of breast cancer,the article should have emphasized those important findings.The piece states that the researchers noted that “…!1 positive recalls may cause inconvenience&anxiety and biopsies can cause pain and scarring.” This article fails to include several important facts about the study.1)This is a prospective cohort study of women screened between 1994-2006.2)Most of the mammograms were film rather than digital.3)Few women underwent screening for the entire 10 year period.4)Screening mammography recall rates are influenced by the skill of the radiologists who read the mammograms.There was no disease mongering.No independent experts were quoted.The story did an adequate job comparing – at a very high level – annual screening versus biennial screening.Screening mammography is widely available throughout the United States.The study did not examine a new procedure.There’s no evidence that the story relied solely on a news release. 
Claim: Annual Mammograms May Have More False-Positives
A: 1
Rationale: This article reports on the results of a study of nearly 170,0 women who had screening mammograms beginning between age 40-59.The study found that over ten years of screening mammograms,over half of the women will experience a!1-positive recall for additional mammography.In addition,7%-9%of the women will have a biopsy for a suspicious lump which is not cancerous.Both of those percentages decrease if the woman is screened every other year rather than every year.Even with biennial mammography,41%of women will experience a recall over 10 years of mammography.The study’s Principal Investigator emphasized that “in most cases,a recall doesn’t mean you have cancer.” She hoped this knowledge would reduce the anxiety of women who are recalled.The story never explained the size of the decrease in the number of!1 positives between annual(61.3%) and biennial screening(41.6%).Our first two reviewers were a researcher who specializes in health decisions and a breast cancer survivor trained in evidence by the Natiional Breast Cancer Coalition’s Project LEAD.This study is valuable because it helps to quantify and compare the harms of annual and biennial screening,specifically the number of!1 positives and the number of unnecessary biopsies.Prior to this study,estimates of!1 positive screening mammography rates varied widely.The critical question is whether you can do less frequent screening,subject women to fewer harms and get similar results in terms of detection of “early stage” cancer.This study’s data seems to suggest that answer is yes.
Q: Paragraph: There is no mention of costs for the surgical implants or any of the other treatment methods. Whether insurers are likely to cover such treatments and whether they cover current treatment approaches would have been helpful information as well. The cost of medical devices needs to be considered for a host of reasons. A similar technology (vagal nerve stimulation) costs about $20,000 and could have been used as a useful example. No data on benefits are given for the “undisputed best treatment, called CPAP. ” Regarding the new devices, because they are in early studies, any suggestion of benefit must be made carefully. While a number of provisos were included in the story, the single patient anecdote and the “What we’re looking for is actually cure” quote from one of the investigators provide the reader with an imbalanced perspective. There is no mention of potential harms. This is troubling because the devices described would require a surgery. To be eligible for one of the devices, a person would need to undergo some fairly extensive testing, much of which is rather unpleasant, including having “a tube snaked down the airway” to see whether their sleep apnea  is being caused by a qualifying condition. The device is surgically implanted in the chest with wires run up the neck and into the base of the tongue. Once implanted the device now needs to be programmed to deliver the stimulation at the right time. There is a potential for nerve damage with long term use and the devices (as we have learned from the recent recall of heart defibrillator leads) are not infallible. There is no attempt to evaluate the quality of the evidence. We are given one anecdote of a man presumably enrolled in a clinical trial, but we don’t learn how much research has been done – only that a “key study” of 100 people is planned. There is also no evaluation of the evidence for “today’s undisputed best treatment, called CPAP” – only estimates of how many people won’t or can’t use it. This lead made us stop in our tracks. “Loud snoring may do more than irritate your spouse: It can signal sleep apnea, depriving you of enough zzzz’s to trigger a car crash, even a heart attack.” Car crashes and heart attacks? This sounds like a national emergency. The story goes on to say, “More than 12 million Americans have obstructive sleep apnea, according to the National Institutes of Health….Yet going untreated is more dangerous than just feeling tired. Sleep apnea stresses the body in ways that increase the risk of high blood pressure, heart attack, stroke and diabetes. More immediately, severe apnea increases the chance of a car crash sevenfold. Last year, the National Transportation Safety Board recommended that pilots, truck drivers and other commercial transportation operators start being screened for apnea, saying it has been a factor in incidents involving every mode of transit.” How many incidents? Is sleep apnea more dangerous than, say, texting while driving? Without any context, these facts serve only to scare, not to inform. There are many quotes in this story but none comes from an independent source. Meir Kryger, a sleep medicine specialist at Gaylord Hospital in Connecticut, is the most quoted and is receiving money from Inspire Medical Systems, a device maker, for clinical trials. Rik Krohn, a 67-year-old from suburban Minneapolis (where the company is based – how was he chosen?) is quoted as a sleep apnea sufferer who may have been helped by the Inspire device. We’re not told what connection Dr. Rick Odland, Krohn’s surgeon at Minneapolis’ Hennepin County Medical Center, may have with the company. He is the co-founder of his own medical device company, Twin Star. There is apparently one independent perspective – a voice of caution relegated to the very end in a two sentence paraphrase. “These experiments are only now beginning, with a handful of implants performed so far—and while it’s an interesting concept, frustrated patients should try some proven steps first, cautions, Dr. Amy Atkeson of Columbia University Medical Center in New York. Her advice: Don’t give up on CPAP without first seeing an experienced sleep technician to adjust humidity levels and take other steps that not every CPAP prescriber knows to try—and if you’re overweight or obese, apnea greatly improves with weight loss.” The imbalance in the quotes provided, and the absence of any conflict of interest disclosure leads us to give an unsatisfactory score. The story does not do an adequate job comparing these devices to other treatments or to weight loss. The story ends with this brief statement:  “Don’t give up on CPAP without first seeing an experienced sleep technician to adjust humidity levels and take other steps that not every CPAP prescriber knows to try—and if you’re overweight or obese, apnea greatly improves with weight loss.” But, as noted, no data is given on CPAP’s benefits – only discussion of what doesn’t work with CPAP. And no data were given – only this one line – about the role of overweight, obesity, and weight loss in sleep apnea. The story provides a very good overview of the ongoing trials of the various companies’ devices and notes an upcoming clinical trial. The story makes it clear that there are several devices in competition to be the dominant sleep apnea device. “By the end of January, Minneapolis-based Inspire Medical Systems plans to begin enrolling 100 apnea patients in a key study in the U.S. and Europe to see if so-called hypoglossal nerve stimulation really could work. Two competitors are developing similar implants: ImThera Medical of San Diego says it hopes to begin U.S. studies later next year, and Apnex Medical of St. Paul, Minn., has announced some small-scale testing.” The story does not rely on a news release. Claim: Experiments test if implant can block sleep apnea
A:
0