Bibliographic record
Abstract
We thank Dr. Klatsky (1) for his interest in our paper (2) and his discussion of the outbreak of cases of heart failure during the episode of arsenic-contaminated beer poisoning in Manchester in 1900 (3, 4). This study was not included in our systematic review of arsenic and cardiovascular disease (5) because it lacked a comparison group. While we identified this outbreak and other papers using the electronic database OLDMEDLINE and the manual review of references, most of these early reports were case series. Indeed, of the studies on arsenic and cardiovascular disease published before 1950 that we identified, only the study by Bradford Hill and Faning in 1948 (6) fulfilled all the inclusion criteria for our systematic review. Since none of the studies included in our review investigated the link of arsenic with heart failure, we focused the discussion on the association of arsenic with arteriosclerotic cardiovascular outcomes, such as coronary heart disease or peripheral arterial disease. Motivated by Dr. Klatsky's highlight of the Manchester arsenic-beer episode, we discuss herein additional case series of heart failure or cardiomyopathy in which arsenic has been implicated. In addition to the Manchester outbreak, heart failure had been reported in a smaller arsenic-beer episode in Halifax in 1902 (7), in a heavy drinker patient receiving weekly injections of arsenic for therapeutic use in 1946 (8), and in a French vintner poisoned by arsenic in 1968 (9). Cardiomegaly was also described in eight of 10 autopsies conducted among children and young adults exposed to arsenic in drinking water in Antofagasta, Chile (10). In Región Lagunera, Mexico, maleolar edema was common, in particular among subjects with cutaneous signs of arsenic poisoning (11, 12). In Antofagasta, Chile, and in Región Lagunera, Mexico, study participants were characterized by severe malnutrition in addition to high-chronic arsenic exposure in drinking water. Finally, in a small study in Rome, Italy, the concentration of arsenic in endomyocardial tissue obtained through cardiac catheterization biopsy was 213 times higher in 13 subjects with idiopathic dilated cardiomyopathy compared with 14 controls with normal left ventricle (13). The source of arsenic exposure was not identified, and arsenic accumulation was interpreted to be a consequence of cardiomyopathy progression (13). We could not identify any reference to the association of arsenic exposure with heart failure in populations chronically exposed to high arsenic in drinking water from Taiwan (14), China (15), or Argentina (16), populations that have been extensively studied for other health outcomes.
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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 | 0.007 | 0.098 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.004 | 0.005 |
| Research integrity | 0.027 | 0.027 |
| Insufficient payload (model declined to judge) | 0.041 | 0.024 |
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".