Chest computed tomography: is it ready for major studies of chronic obstructive pulmonary disease?
Bibliographic record
Abstract
Chronic obstructive pulmonary disease (COPD) requires for diagnosis the presence of chronic airflow limitation and emphysema or chronic bronchitis.In the USA, the disease causes w100,000 deaths annually, it is the fourth most important cause of death and afflicts about 16 million persons.About 1% of COPD in the USA is associated with a 1 -antitrypsin (a 1 -AT) deficiency and is conveniently referred to as a 1 -AT-COPD.This form of the disease occurs in younger persons, progresses more rapidly, is associated with a higher frequency of panlobular emphysema (PLE) than usual COPD, and may be treated by augmentation therapy with concentrated human a 1 -AT.However, there is limited evidence that a 1 -AT replacement modifies the rate of progression of a 1 -AT-COPD.How can the rate of progression be monitored?Using tools derived from usual COPD to monitor a 1 -AT-COPD might not be correct.These diseases share pathophysiological similarities but there are also important differences.a 1 -AT-COPD is mostly due to the rapid development of PLE predominantly in the lower lobes; airflow obstruction and hyperinflation are mainly due to emphysema and losses of elastic recoil.In usual COPD, airflow limitation is largely secondary to airway damage and remodelling and emphysema (mainly centrilobular emphysema (CLE)) predominates in the upper lobes with a heterogeneous distribution in the lung.The extent of CLE is quite variable for a given level of airflow limitation.Moreover, SANDERS et al. [1] and SANTIS et al. [2] found that 68 -80% of smokers showed emphysema by high-resolution computed tomography (HRCT) in the presence of normal lung function tests.These facts highlight the complexity of COPD and the relative independence and at the same time interdependence of airway remodelling and emphysema in their contribution to the development of COPD.Which end-points should then be used to assess available and future new drugs for the treatment of both forms of COPD?The rate of decline of forced expiratory volume in one second (FEV1), the traditional end-point used, requires a large number of subjects studied over a period of years [3], and does
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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 | 0.003 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.002 | 0.006 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.029 | 0.022 |
| Insufficient payload (model declined to judge) | 0.006 | 0.007 |
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".