Reply to the Letter to the Editor
Bibliographic record
Abstract
To the editor, We would like to thank Drs. Rhon and Hando for their interest and insightful comments regarding our recently published study. While we would wholeheartedly agree that a period of immobilization longer than the 3 or 4 weeks employed in our study and others [1-3] would be beneficial to soft tissue healing, the practicalities of doing so may limit its utility. According to our (as well as Professor Itoi's) observations, compliance with brace wear was a time-limited phenomenon. In fact, only 53% of patients were compliant with full-time sling use for 3 weeks in the Itoi et al. [2] study. The unfortunate reality is that the exact patient group who would potentially benefit from longer immobilization (young, active patients), and who are at highest risk of recurrent instability, is the group that can least tolerate a prolonged period of time away from full participation in studies, family demands, work, or sport. Strategies to improve compliance with immobilization have not been fully explored. An interesting (albeit anecdotal) observation from our own study was that some patients preferred the externally rotated position because it permitted keyboard use and positioned the hand of the affected shoulder in a more functional position in front of the body. One patient even continued to work as a waiter with his tray positioned on his brace during the immobilization period. While the externally rotated position may not considered to confer significant benefit in terms of reducing recurrence versus sling immobilization, there may be some merit to its capacity to allow a more functional position of the ipsilateral hand. We are enthused that our work has generated discussion and thought regarding nonoperative approaches to reduce the relatively high rate of recurrence in young patients following primary dislocation. There are still many questions to be answered — not the least of which are the best position and duration of immobilization. However, any discussion of either question must take into consideration the practical issue of compliance in the target population.
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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 | 0.005 | 0.053 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.004 | 0.006 |
| Open science | 0.005 | 0.002 |
| Research integrity | 0.032 | 0.031 |
| Insufficient payload (model declined to judge) | 0.013 | 0.010 |
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".