An Evaluation of Primary Biliary Cholangitis as a Lifelong Disease: Insights from Canadian Cohort Studies
Bibliographic record
Abstract
Primary Biliary Cholangitis (PBC) is a rare chronic autoimmune liver disease that results in morbidity, mortality, and quality of life impairment. This thesis includes four projects designed to inform our understanding of the progression of a patient’s journey with PBC and contribute new knowledge that may inform clinical decision making and advance clinical research. The first study investigated patterns of biochemical response to long-term ursodeoxycholic acid treatment. This study found that achievement of adequate biochemical response was associated with improved liver transplant-free survival regardless of prior history of inadequate response, highlighting response as an important longitudinal treatment goal. The second study aimed to evaluate the real-world effectiveness of obeticholic acid (OCA), a new second-line therapy. This study found that OCA was associated with improvements in biochemical surrogates of outcome and was well tolerated. The third study investigated associations between ethnicity and disease severity, quality of life, and survival. This study found that Indigenous Canadians presented with more advanced disease, had impaired quality of life, and worse liver transplant-free survival compared to White patients. The fourth study investigated the in-hospital burden of liver disease and compared the burden of PBC to other common liver diseases. This study found that liver disease inpatients had premature morbidity, mortality, and high resource use and that PBC inpatients represented a similar resource burden to other common liver diseases. These findings provide evidence to support clinical decision making for patients with PBC and contribute to a growing body of literature.
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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 | 0.011 | 0.024 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.004 | 0.011 |
| Science and technology studies | 0.006 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".