Bibliographic record
Abstract
Sir: We thank Dr. Ferriero and colleagues for their interesting comments highlighting the intriguing and complex subject of skin scarring and tissue “pliability.” Because of the complicated individual nature of skin scarring and the continuum of scar types, accurate assessment of the biomechanical properties of the skin remains a complex task to perform clinically. Difficulty arises from the fact that without laboratory analysis of the affected scar, it is not possible to accurately determine the exact effect of the scar tissue present. For example, when a scar is less mobile than normal skin, it is not feasible to classify adherence to one particular point seen against adherence between various cutaneous layers, as this cannot be visualized with the naked eye. Subjectively, this could secondarily restrict extensibility or elasticity; therefore, the capacity of a scar to glide and to stretch individually remains a deceptive measure to quantify exactly. We believe that, as it can be difficult to clearly establish on clinical examination the effect of the scarring present, the collective term of pliability is consequently best applied currently. Biological elasticity and maximum distention are the most important biophysical parameters of pliability assessed using objective devices in establishing what maintains the normal appearance of skin.1 Various noninvasive mechanical instruments have been discussed in our review2 article that record skin deformation with a component of adherence during loading and after force release, charting the skin's recovery and permitting treatment modality evaluation to be obtained. In addition, Ferriero et al.3 have reported their validation study of a new four-way horizontal orthogonal tension device to determine restriction of scar mobility from the worst operator-determined adherent point along the length of the lesion. The new Adheremeter device would be a suitable addition to clinical practice because of its simplicity of use and low cost. The tool correlated moderately well to the Vancouver Scar Scale and the nonvalidated pliability subscale, demonstrating a sensitivity to change, a good to excellent interrater reliability, and an excellent intrarater reliability (when assessed on normal skin). Despite being adaptable to different anatomical sites, the authors acknowledge the difficulty in regions of greater convexity or concavity, and further studies are warranted in different pathologic scar types. The Adheremeter presents a welcome simplistic device for examining the tension component of pliability with relation to adherence. However, in our opinion, researchers and clinicians still need to select the most appropriate device for the scar type and specific concept of pliability that they wish to assess formally. Donna M. Perry, M.C.P.S. Ardeshir Bayat, Ph.D., M.R.C.S. Plastic and Reconstructive Surgery Research School of Translational Medicine University of Manchester Manchester Interdisciplinary Biocentre, and Manchester Academic Health Science Centre Department Plastic and Reconstructive Surgery University Hospital of South Manchester Wythenshawe Hospital Manchester, United Kingdom
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
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; both teacher heads agree on what is shown here.
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".