Looking out for the blind spot
Bibliographic record
Abstract
A 49-year-old woman presented in July 2014 with a 1-week history of confusion, particularly with memory and word-finding difficulties. She also gave a 3-month history of reduced hearing, initially acutely in the right ear, and a 2-day history of vertigo and vomiting. The vertigo resolved but over the next month she noticed hearing loss affecting the left side as well. Her husband reported that she had had an episode of disorientation and confusion 2 months earlier; this had only lasted a day but her cognition had been completely normal since. She had no vascular risk factors, past medical history or history of using any recreational drug. On examination, she was afebrile and normotensive but was disorientated to day and date. Visual acuity and fundoscopy were normal. Eye movements were normal, as were the other cranial nerves, apart from bilateral hearing loss. The head impulse test was negative. There was mild impairment of rapid alternating movements in the right arm and difficulty with tandem gait. The Montreal cognitive assessment test gave a score of 18/30. A delirium screen with blood tests, including a full blood count, electrolytes, liver function tests, C reactive protein and erythrocyte sedimentation rate, was normal. A chest radiograph, urine and blood cultures were negative. A CT scan of head was normal but an MRI scan of brain was floridly abnormal (figure 1). Figure 1 MRI scan of brain (July). Images showing axial T2 (A and B); sagittal fluid-attenuated inversion recovery (C); coronal T2 (D); diffusion-weighted imaging (DWI) (E); sagittal postcontrast T1 (F). ### Question 1 What are your differential diagnoses and what further investigations would you request? The MRI scan of brain shows multiple areas of high T2 and fluid-attenuated inversion recovery (FLAIR) signal within the cerebrum, corpus callosum, cerebellum and brainstem. Acute disseminated encephalomyelitis (ADEM) was our primary differential diagnosis. There …
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.014 | 0.005 |
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".