Bibliographic record
Abstract
Division of Gastroenterology, McMaster University, Hamilton, Ontario Corrrespondence: Dr Harith Baharith, McMaster University, Division of Gastroenterology, 1280 Main Street West, Hamilton, Ontario L8N 3Z5. Telephone 289-700-2244, fax 905-648-1906, e-mail harith.baharith@medportal.ca Received for publication November 10, 2014. Accepted December 5, 2014 CASE PRESENTATION An 85-year-old female nursing home resident presented with a medical history of dementia, stroke, hypertension, gastroesophageal reflux disease and cholethiasis. The patient was referred because of four episodes of coffee-ground emesis and symptoms of right upper quadrant abdominal pain, with no issues with bowel movements. There was limited other information available due to the underlying history of dementia. The patient’s vital signs were stable. Physical examination revealed normal cardiorespiratory parameters. The abdominal examination revealed a tender right upper quadrant, with no palpable mass and the presence of bowel sounds. Laboratory investigations revealed a white blood cell count of 18.4×109/L (normal 4.0×109/L to 11.0×109/L), alkaline phosphatase level of 131 U/L (normal 40 U/L to 120 U/L) and gamma-glutamyl transferase level of 116 U/L (normal <37 U/L). The remaining laboratory investigations were unremarkable. An abdominal x-ray revealed a large, rounded, lamellated calcification in the epigastric region measuring approximately 4.5 cm × 3.3 cm (Figure 1). The patient underwent a computed tomography scan, which revealed gastric outlet obstruction secondary to an impacted gallstone within the duodenum, a cholecystoduodenal fistula and a collpased gallbladder, with thickening of the gallbladder wall and air within the gallbladder (Figure 2). The patient was initially managed with intravenous fluids, nasogastric tube, antiemetics and antibiotics. An urgent endoscopy was arranged by gastroenterology, revealing a stone impacted in the duodenal cap (Figure 3). Attempts to push or bypass the stone were unsuccessful, followed by attempts at retrieval with snare, basket, pronged grasper and Roth net, all of which were also unsuccessful. Additional attempts by another gastroenterologist and surgeon using endoscopic therapy to disimpact the stone were unsuccessful. The surgeon then suggested operative management for the patient; however, due to the patient’s deteriorating medical condition, the palliative team involved in her care and the family elected to proceed with palliation instead of surgery. After a three-week hospital stay, the patient was transferred to a hospice care facility where she died within one week.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.006 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.007 | 0.007 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".