Bibliographic record
Abstract
Vandepitte et al. raise several points1 that we discuss individually: first, we standardized the needle insertion point at the inguinal crease and measured the distance from the surface marking of the inguinal ligament to the needle insertion point at the inguinal crease. The mean distance was approximately 4 cm.2 In addition, the needle was inserted perpendicular to the skin in all cases. We chose the inguinal crease as the insertion point because of a cadaver study demonstrating that the femoral nerve is most superficial and broadest at this level.3 Our findings support a recent study published by Nader et al.4 in which the ultrasound probe was placed over the inguinal crease and, with the use of a stimulator needle, was able to stimulate the branch to quadriceps by angling the needle tip laterally in 96% of cases and similarly angling medially, the branch to sartorius was stimulated in 94% of cases. Second, Vandepitte et al. suggest that we exclude patients with unpredictable anatomy (obese patients); however, we excluded patients with a body mass index of >35, which is defined by the World Health Organization as Obese Class II; indeed, the World Health Organization classifies a person with a body mass index >30 as obese. We feel therefore that obese patients were not entirely excluded from our study. Also, we are unaware of any study that addresses an unpredictable relationship between obesity and the femoral neurovascular bundle or the distance between the inguinal ligament and the inguinal crease. Furthermore, in the studies that the authors quoted in which there is an unpredictable relationship between obesity and the neurovascular bundle, there was no mention of body habitus.3,5 Thus, we agree with Vandepitte et al. that if the insertion point was distal to the femoral artery bifurcation, eliciting only a sartorius response could result in potential failure of the block. Therefore, accepting quadriceps motor evoked twitch as an endpoint of stimulation in obese patients cannot be confirmed until this theory is addressed with a proper clinical trial. Jonathan Anns, FRCA Imad T. Awad, FCA (RCSI) Sunnybrook Health Sciences Centre University of Toronto Toronto, Ontario, Canada [email protected]
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.001 |
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 teacher head, 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".