Systemic steroids in severe forms of COPD exacerbations: a question of balance?
Bibliographic record
Abstract
Systemic steroids in mechanically ventilated COPD: the absence of obvious benefit should make prescription the exception http://ow.ly/spRFxChronic obstructive pulmonary disease (COPD) is a lung disorder with systemic inflammatory-related consequences, for which there is no cure.Beside tobacco cessation (of which the beneficial effects are many), the only available therapeutic interventions in COPD target exercise-related dyspnoea and exacerbations.There is extensive solid evidence to support the use of bronchodilators and pulmonary rehabilitation to address these clinically relevant issues [1].The corpus of data supporting the beneficial effects of pulmonary rehabilitation is vast and has been built through the years by several convergent studies from independent investigators [2].It is widely acknowledged that locomotor muscles are dysfunctional in COPD [3], and also widely acknowledged that rehabilitation in COPD improves exercise tolerance, decreases the rate of exacerbations, ameliorates quality of life and might prolong survival in certain contexts (e.g. after an exacerbation of the disease) [2,4,5].Exercise training (or re-training) is a major driver of the success of pulmonary rehabilitation in COPD.Thus, the current state of the evidence suggests that patients with COPD who want to tackle their disease should quit smoking, inhale bronchodilating substances, be they associated or not with corticosteroids, and seriously think about rebuilding the strength and endurance of their meagre quadriceps.To do so, exercise is needed, but so is an adequate balance between muscle anabolism and muscle catabolism.
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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 | 0.004 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.002 | 0.006 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.036 | 0.030 |
| Insufficient payload (model declined to judge) | 0.004 | 0.004 |
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".