Bibliographic record
Abstract
The controversy over corticosteroids and bacterial meningitis is reviewed once again in the following papers. Hearing loss occurs early in the course of bacterial meningitis in both humans and animals. Animal experiments have shown that cochlear damage follows a definite temporal sequence: hearing loss was detectable by 12 h after inoculation of the cerebrospinal fluid and progressed rapidly. Treatment with antibiotics alone or antibiotics plus dexamethasone initiated at 12 h after onset prevented the development of severe hearing loss. The animal studies highlighted the crucial issue of timing of treatment. If treatment is to reduce the frequency and severity of deafness (and, presumably, other forms of neurological damage), it must be started early in the course of the disease. Unfortunately, it is impossible to identify the onset of meningitis in humans. Therefore, all of the steroid studies have a fatal flaw: the failure to stratify patients on the basis of duration of illness at the time treatment is started. To learn whether corticosteroids are beneficial, patients would have to be stratified before treatment on the basis of the duration of illness; the presence or absence of hearing loss, and, if present, the severity of such loss; or the presence or absence of neurological damage or dysfunction. However, it is impossible to determine the duration of illness with any accuracy, and the urgency of the clinical situation makes it impossible to determine the second and third criteria before starting treatment. A possible solution would be to randomize all patients to treatment or no treatment, evaluate hearing within 24 h of admission using auditory evoked potentials and then stratify patients during data analysis on the basis of the results of the hearing test. Such a study can no longer be done in any developed country because of the success of Haemophilus influenzae type b and pneumococcal vaccines. Studies carried out in less-developed countries are also unlikely to answer the question because most children present far too late in the course of illness for corticosteroids to have any benefit. Therefore, it is very unlikely that we will ever have a definitive answer to the question addressed in the following papers on corticosteroids and meningitis.
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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 | 0.010 | 0.048 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.007 | 0.022 |
| Scholarly communication | 0.010 | 0.010 |
| Open science | 0.004 | 0.005 |
| Research integrity | 0.024 | 0.032 |
| Insufficient payload (model declined to judge) | 0.030 | 0.009 |
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".