Obstetric Antiphospholipid Syndrome: Has the Black Swan Swallowed a Red Herring?
Bibliographic record
Abstract
Several years after the first description of the antiphospholipid syndrome (APS) in 19831, Nigel Harris warned that, although they do exist, patients with APS are as rare as black swans — and predicted that “the value of studying antiphospholipid antibodies (aPL) [might] easily be lost in a sea of overinterpreted and over-reported laboratory and clinical findings2.” Twenty-seven years later, the Obstetric Task Force of the 14th International Congress on Antiphospholipid Antibodies has confirmed the continuing lack of evidence supporting an association between aPL and recurrent early miscarriage (REM)3. They noted the absence of consistent, predictable clinical outcomes from therapeutic trials and suggested potential causes. Despite apparent adherence to the 1999 initial Sapporo4 and 2006 revised Sydney5 criteria, studies have used heterogeneous patient selection protocols, variable laboratory inclusion criteria, and small sample sizes. In addition, there has been a lack of pathological or genetic evaluation to determine the nature of pregnancy losses when they occurred. The Task Force expressed concern regarding what they termed the “considerable enthusiasm” for “diagnosing APS and treating as yet unrecognized obstetric morbidities in the setting of positive aPL results.” Given the absence of critical studies of association and therapeutic benefit, they felt that such diagnostic fervor would serve only to further obscure the search for genuine associations and proven treatments. After 30 years of APS investigations, it would be reasonable to expect increased understanding of the obstetric complications related to aPL, but unfortunately, despite or perhaps because of the “considerable enthusiasm” noted above, there is less clarity, particularly with regard to how or even whether REM fits into the puzzle3,6,7,8. At the Treatment and Evaluation of Recurrent Miscarriage (TERM) program in Toronto, we have been involved in therapeutic and observational … Address correspondence to Dr. C.A. Clark, Suite 1800, 655 Bay St., Toronto, Ontario, Canada M5G2K4; E-mail: cclarksolo{at}aol.com
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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 | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.002 | 0.005 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.006 | 0.007 |
| Insufficient payload (model declined to judge) | 0.003 | 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 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".