Bibliographic record
Abstract
Question A 75-year-old male presents to the ophthalmology service with a drooping left upper eyelid. Upon further questioning, he states that he feels his visual acuity has deteriorated in the left eye, but only in the dark. On testing his best corrected visual acuity is 20/25 in the right eye and 20/30 in the left eye. His pupils are equal, round, and reactive to light and accommodation. His intraocular pressures are 14mmHg bilaterally. His past medical history is significant for type 2 diabetes mellitus, hypertension, hypercholesterolemia, and obesity. He states that his dropping eyelid does not get better or worse during the day and he first noticed his drooping eyelid this morning. He also states that he has been experiencing some horizontal diplopia since this morning. Your clinical examination reveals no significant ocular misalignment, but the patient is unable to fully adduct, infraduct, or supraduct his left eye. His margin to reflex distance 1 is 2mm and his levator function is markedly decreased. His ESR and CRP are within normal limits. He is scheduled for a follow-up visit in 6 weeks at which point his symptoms have almost completely resolved. Third Nerve palsy Myasthenia gravis Congenital ptosis Horner syndrome Aponeurotic ptosis Answer A) Given his history and clinical examination, this patient likely has a third cranial nerve palsy. Furthermore, given no pupillary involvement and systemic risk factors (obesity, diabetes mellitus, hypertension, hypercholesterolemia), an ischemic third nerve palsy is favoured. Typically, ischemic third nerve palsies are self-resolving and the patient can be scheduled for follow-up in 4-6 weeks. Pupil involvement or a lack of improvement at follow-up are indications for head imaging (CT angiography) to rule out an aneurysm or other compressive causes. In this case, since the ptosis does not worsen as the day goes on and improve after rest, myasthenia gravis is unlikely. Additionally, this autoimmune condition would present at an earlier age than 75. Similarly, congenital ptosis would present in the first years of life. Horner syndrome would include miosis and facial anhidrosis alongside the ptosis. Aponeurotic ptosis is a possible diagnosis, however, is less likely given this presentation with an inability to fully adduct, infraduct, or supraduct his left eye.
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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 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.147 | 0.061 |
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".