The DOI matches its Crossref record; 26 of the 26 references it cites were found in a registry or an index; none of the 19 sources its claims cite is checked for support yet.
High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors
Open accessAbstract
OBJECTIVES: Abscesses and chronic wounds are common among injection drug users (IDUs) though chronic wounds have been understudied. We assessed the risk factors associated with both acute and chronic wounds within a community-based population of IDUs frequenting the Baltimore City Needle Exchange Program (BNEP). METHODS: We performed a cross-sectional study of BNEP clients aged 18 years or more who completed an in-person survey regarding active or prior wounds including abscesses (duration <8 weeks) and chronic wounds (duration ≥8 weeks), injection practices, and skin care. Factors associated with wounds were analyzed using univariate and multivariate logistic regressions. RESULTS: Of the 152 participants, 63.2% were men, 49.3% were white, 44.7% were African American, 34.9% had any type of current wound, 17.8% had an active abscess, and 19.7% had a current chronic wound. Abscesses were more common in women (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.10-5.97) and those reporting skin-popping (OR, 5.38; 95% CI, 1.85-15.67). In a multivariate model, risk factors for an abscess included injecting with a family member/partner (adjusted OR [AOR], 4.06; 95% CI, 0.99-16.58). In a multivariable analysis of current chronic wounds, cleaning skin with alcohol before injection was protective (AOR, 0.061; 95% CI, 0.0064-0.58). CONCLUSIONS: Abscesses and chronic wounds were prevalent among a sample of IDUs in Baltimore. Abscesses were associated with injection practices, and chronic wounds seemed linked to varying skin and tool cleaning practices. There is a pressing need for wound-related education and treatment efforts among IDUs who are at greatest risk for skin-related morbidity.
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Written from the paper’s full text.
TL;DR
In a cross-sectional survey of 152 Baltimore needle-exchange clients, 34.9% had a current wound, 17.8% had an active abscess, and 19.7% had a current chronic wound. Abscesses were linked to injection practices such as skin-popping, kicking, and injecting with a family member/partner, while chronic wounds were associated with longer injection history and certain skin/needle-cleaning behaviors.
Key findings
- Current wound prevalence was 34.9%; active abscesses 17.8% (n=27) and current chronic wounds 19.7% (n=30). Lifetime wound-related skin disease burden was 75.0% (114/152).
- Current abscess on univariate analysis was associated with female gender (OR 2.56; 95% CI 1.10–5.97), skin-popping (OR 5.38; 95% CI 1.85–15.67), injecting with a family member/partner (OR 3.78; 95% CI 1.38–10.31), and kicking occasionally (OR 3.09; 95% CI 1.02–9.37). In multivariable analysis, injecting with a family member/partner (AOR 4.06; 95% CI 0.99–16.58) and kicking occasionally (AOR 4.88; 95% CI 1.09–21.90) remained associated.
- Current chronic wound in multivariable analysis was protective when cleaning skin with water (AOR 0.018; 95% CI 0.00054–0.60) or alcohol (AOR 0.061; 95% CI 0.0064–0.58) before injection; associated factors included Native American identity (AOR 128.1; 95% CI 1.86–8800.41), injection history ≥15 years (AOR 76.2; 95% CI 1.55–3753.56), and cleaning needles with bleach/bleach-water vs water only (AOR 17.9; 95% CI 2.14–149.95).
- Among women, reusing needles 5–7 times was associated with 18.0-fold greater odds of current abscess vs never reusing (95% CI 1.37–235.69); skin-popping among women was associated with current abscess (OR 8.22; 95% CI 1.72–39.35).
Methods
- Cross-sectional study of Baltimore City Needle Exchange Program (BNEP) clients aged ≥18 years, regardless of wound status, recruited May 2012–November 2013 at five exchange sites (most from Sites A and B). Participants completed an in-person paper survey (~20 minutes) on demographics, injection behaviors, pre-injection skin care, wound history/care, and medical history; current abscesses and wounds were visually verified by study staff.
- Wound definitions: chronic wounds were open, non-healing skin areas present ≥8 weeks; abscesses were swollen, red, painful lumps under the skin lasting <8 weeks.
- Analysis used Stata 12 with χ2, univariate, multivariable, and multinomial logistic regression; p≤0.05 was significant, covariates with p≤0.15 on univariate testing entered multivariable models, and odds ratios with 95% confidence intervals were reported.
Limitations
- The paper states that the survey was primarily conducted in the morning and early afternoons, potentially excluding more nocturnal clients; participants were active BNEP members and may differ from IDUs not accessing harm reduction services; the survey-based design produced associations requiring further study; and data relied on self-report.
- Evident from the text: the cross-sectional design cannot establish temporality or causality between injection/skin-care behaviors and wound outcomes.
- Evident from the text: some subgroup estimates are imprecise with very wide confidence intervals (e.g., Native American identity AOR 128.1, 95% CI 1.86–8800.41; injection history ≥15 years AOR 76.2, 95% CI 1.55–3753.56), and multiple comparisons were performed without stated adjustment.
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Claims the paper makes
34 Own result · 6 Own interpretation · 5 Own method · 4 No full text of the sources · 2 Sources not found · 2 Check pending · 1 Not checked yet · 1 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“injecting into the leg (OR, 3.12; 95% CI, 1.34–7.30)”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > RESULTS > Factors Associated with a Current Chronic Wound
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“17.8% had an active abscess”
- Also stated in: § Prevalence of Abscesses and Chronic Wounds · plain
“Current abscesses were reported by 17.8% of participants (n=27).”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > Abstract > Results
plainn = 27- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Prevalence of Abscesses and Chronic Wounds · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“skin-popping (OR, 4.04; 95% CI, 1.12–14.59) at the univariate level.”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > RESULTS > Factors Associated With a History of Chronic Wound
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“cleaning needles with bleach or bleach/water combination before reuse, compared to cleaning needles with water only (OR, 4.44; 95% CI, 1.36–14.51)”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > RESULTS > Factors Associated with a Current Chronic Wound
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“those reporting skin-popping (OR, 5.38; 95% CI, 1.85–15.67)”
- Also stated in: § Results · plain
“skin-popping (OR, 5.38; 95% CI, 1.85–15.67)”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“34.9% had any type of current wound”
- Also stated in: § Prevalence of Abscesses and Chronic Wounds · plain
“The prevalence of any active wound at the time of the interview, including abscesses and chronic wounds, was 34.9%, as seen in Table 2.”
- Also stated in: § DISCUSSION · plain
“IDU participants in the BNEP harm reduction program have a high prevalence of current wounds (34.9%).”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > Abstract > Results
plainn = 152- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Prevalence of Abscesses and Chronic Wounds · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of clients without a current chronic wound (n=122), 19.7% reported having had a chronic wound in the past.”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > RESULTS > Prevalence of Abscesses and Chronic Wounds
plainn = 122- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the clients without a current abscess (n=125), more than half reported having at least one abscess anytime in the past.”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > RESULTS > Prevalence of Abscesses and Chronic Wounds
plainn = 125- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“using filters appeared to be protective against having a current chronic wound (OR, 0.15; 95% CI, 0.024–0.94).”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > RESULTS > Factors Associated with a Current Chronic Wound
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“identifying as Native American (AOR, 128.1; 95% CI, 1.86–8800.41)”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > RESULTS > Factors Associated with a Current Chronic Wound
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 3
- Probably not a substantial claim. 11
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Vein injury occurs through scarring, non-sterile injection, and direct toxic effects of the drug and can lead to chronic venous insufficiency (CVI), which increases the risk for chronic lower extremity ulcers (Pieper & Templin, 2001; Pieper, Kirsner, Templin, & Birk, 2007).”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > Abstract > Conclusions
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“These statistics were representative of the overall BNEP client population.”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > RESULTS > Demographics and Injection Behaviors
plainn = 152- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This study offers insight into behavioral, environmental and biological risk factors associated with these wound types, which can help guide intervention efforts.”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > CONCLUSIONS
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
In the paper
“Prior studies have suggested that women are at increased risk for developing abscesses (Ebright & Pieper, 2002; Fink, Lindsay, Slymen, Kral, & Bluthenthal, 2013; Hope, Marongiu, Parry, & Ncube, 2010; Lloyd-Smith et al., 2005; Lloyd-Smith et al., 2008; Spijkerman, van Ameijden, Mientjes, Coutinho, & van den Hoek, 1996)”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > Abstract > Conclusions
What the sources say
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Prior study has shown that IDUs treated for SSTIs in EDs faced a higher risk for future hospitalization and death (Binswanger et al., 2008).”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > Abstract > Conclusions
What the sources say
- Not checked yetcites Binswanger et al., 2008 source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Wounds can also lead to more severe SSTIs, including gangrene and sepsis, potentially resulting in amputation or death (Callahan, Schecter, & Horn, 1998).”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > Abstract > Conclusions
What the sources say
- Not matchedcites Callahan, Schecter, & Horn, 1998
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“The chronic pain, reduced mobility, malodor and stigma can marginalize these individuals and may make it difficult to maintain financial security and social support (Palfreyman et al., 2007; Pieper et al., 2007; Pieper, Templin, Goldberg, DiNardo, & Wells, 2013; Pieper, Templin, & Ebright, 2006).”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > Abstract > Conclusions
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Skin and soft tissue infections (SSTIs), including cellulitis and abscesses, are the primary reason that IDUs present to emergency departments (EDs) (Palepu et al., 2001).”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > Abstract > Conclusions
What the sources say
- Not matchedcites Palepu et al., 2001
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Participants were active members of the BNEP, and therefore they may report different injection and skin care practices than IDUs not accessing community-based harm reduction services and education.”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The survey was primarily conducted in the morning and early afternoons, potentially excluding more nocturnal clients.”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Finally, the survey relied upon self-reported data.”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Study team members visually verified the presence of current abscesses and wounds at the time of the survey.”
- Also stated in: § Prevalence of Abscesses and Chronic Wounds · plain
“Current wounds were self-reported and then visually verified by study staff at the time of the survey.”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > METHODS > Study Design
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § Prevalence of Abscesses and Chronic Wounds · plain
The paper relies on this without support.
Chronic wounds, and acute and chronic wounds jointly, have been understudied in IDU populations.
“though chronic wounds have been understudied”
“The prevalence of and risk factors for chronic ulcers in the IDU population has not been well studied or evaluated concurrently with risk factors for abscesses in this population.”
“Chronic wounds in IDUs in particular have been understudied.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“39/149 shared filters (26.7%)”
§ High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors > RESULTS > Demographics and Injection Behaviors
Reported 26.7 · recomputed 26.174497
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Falls and balance confidence in persons with and without injection-related venous ulcers.
Pieper, B., Templin, T. N., Goldberg, A., DiNardo, E., & Wells, M. (2013) · Journal of Addiction Medicine · doi:10.1097/adm.0b013e31827ea882 · Cited by 6
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Metadata
- Authors
- Smith, M. E., Robinowitz, N., Chaulk, P., & Johnson, K. E.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Johnson, Kristine E.
- ORCID
- Robinowitz, Natanya
- Venue
- Journal of Addiction Medicine
- Published
- 2015-03
- Volume
- 9
- Issue
- 2
- Pages
- 87-93
- ISSN
- 1932-0620 (ISSN-L)
- PMC
- PMC4375012
- OpenAlex
- W2330700047
- Semantic Scholar
- ac7bd3f1de418e8069110f2181e8b4791da747d1
- Cited by
- 55
- References
- 26
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 4 · 2023: 5 · 2022: 2 · 2021: 10 · 2020: 9 · 2019: 8 · 2018: 3 · 2017: 4 · 2016: 5
- FWCI
- 2.10
- Type
- journal article
- Language
- en
- Open access
- green
- pmc.ncbi.nlm.nih.gov
- Locations
- Journal of Addiction Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Public Health Service (1P30A1094189)
- National Institute of Allergy and Infectious Diseases (K23AI083100)
- Topics
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Social Sciences › Cultural Studies › Tattoo and Body Piercing Complications
- Health Sciences › Medicine › Emergency Medicine › Intramuscular injections and effects
- Keywords
- people who inject drugs, abscess, chronic wounds, needle exchange programs, skin popping, injection practices, skin care, risk factors
- MeSH terms
- Abscess, Adult, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Risk Factors, Wounds and Injuries, Baltimore, Substance Abuse, Intravenous, Prevalence, Drug Users, Protective Factors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-11-11, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-11-11 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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