Response by Rollins and Dowling to Letter Regarding Article, “Dynamic Arterial Compression in Pediatric Vertebral Arterial Dissection”
Bibliographic record
Abstract
We thank Drs Yu and Liu for their interest in our article. 1With respect to their query about the use of systemic anticoagulation, we have several points.In the International Stroke Trial in adults, patients given heparin were shown to have significantly fewer recurrent ischemic strokes within 2 weeks.However, this benefit was completely offset by a similar-sized increase in hemorrhagic stroke, and thus, heparin is not recommended for the treatment of ischemic stroke in adults. 2 However, the risk factors for hemorrhagic conversion, including advanced age, increased blood pressure, and large infarcts, are not usually relevant in pediatric stroke.There is at least a hypothetical benefit to anticoagulation in stroke resulting from dissection, cardioembolic events, and prothrombotic states, which are highly prevalent in children with arterial ischemic stroke.Thus, in the pediatric stroke community, it is felt that the risk:benefit ratio favors anticoagulation for the initial treatment of pediatric arterial ischemic stroke given both fewer risk factors for hemorrhage and potentially increased benefit in conditions common in pediatric stroke.This approach is supported by the major published guidelines for the treatment of stroke in children from the American Heart Association 3 and the American College of Chest Physicians guidelines for antithrombotic therapy in neonates and children. 4 In the pediatric stroke community in the United States, there is equipoise for anticoagulation at pediatric stroke centers with respect to anticoagulation versus antiplatelet agents for initial treatment.Initial anticoagulation is more prevalent in Europe, Canada, and Australia with initial antiplatelet therapy favored in South American and Asian sites. 5The best treatment is unknown, and we look forward to addressing this in future studies.With respect to bow hunter's syndrome, we refrained from using this term because it describes a syndrome the symptoms of which young children cannot articulate.We assume dynamic compression of the vertebral artery is a risk factor for the development of posterior circulation strokes in some children, although additional nonmechanical subclinical prothrombotic risk factors may also play a role.
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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 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.034 | 0.037 |
| Insufficient payload (model declined to judge) | 0.007 | 0.008 |
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".