{
  "schema_version": "chamgap-public-evidence-check-1.0",
  "public_id": "v2998-s0",
  "verdict_number": "2998",
  "title": "Birth and peanut balls × acute labor pain",
  "view_version": "1.0",
  "view_created_date": "2026-10-16",
  "criteria_version": "1.0",
  "criteria_date": "2026-10-06",
  "review_date": null,
  "legacy_evidence_date": "2026-09-07",
  "review_scope": {
    "materials_read": "Existing review summaries and stored records of methodological application",
    "clinical_papers_directly_read": false,
    "new_clinical_search": false,
    "limitation": "Existing stored summary and preserved methodology application records. External papers, abstracts, registration, protocols, SAPs, original result tables and support disclosures are unread, and review of existing content remains incomplete.",
    "date_meaning": "This is the date the stored materials were checked, not the date of a new search of the clinical literature."
  },
  "claim_context": {
    "population": "The selected question is acute labor pain. S01 Payton provides epidural labor-duration background with no recorded numeric sample size. S02 Alan Dikmen records 90 participants; S03 Ozkececi records high-BMI participants with 70 randomized/59 analyzed. Exact eligibility, anesthesia, parity, BMI thresholds, baseline pain and arm-/endpoint-specific denominators are unverified.",
    "intervention": "The parent distinguishes round birth balls from peanut balls and ball-only use from positioning/pelvic-movement packages. The direct bibliographies concern peanut-ball reports. Ball specifications, providers, supervision, actual components and exposure are unverified. Results of varied programs are not assigned to a ball alone or turned into new instructions.",
    "dose": "S02 pain/fatigue after 15 minutes is an original measurement time. Exact S03 pain timing/exposure is unverified and a program name is not a numeric dose. No new duration of use, repetition count or individualized delivery method is created or calculated from a measurement time.",
    "comparator": "The parent comparator label is standard care. Actual controls, anesthesia/analgesics, positioning, contact, other labor management and delivery of the intervention are unverified by report. Epidural conditions or a representative comparator are not automatically assigned to all S02/S03 participants or treated as isolated ball/non-drug effects.",
    "endpoint": "The selected endpoint is patient-reported acute pain. Distinguish S02 positive 15-minute pain/fatigue from total labor duration P=.177, and S03 pain P=.001 from active-labor duration 202.9±59.5 versus 213.6±67.5 minutes/P=.522. S03 co-primary success rules are unverified. S01 first-stage subgroup/pushing durations are not direct pain estimates.",
    "duration": "Preserve S02 measurement after 15 minutes and the acute scope of the index labor. Exact S03 pain windows, persistence, other stages and long-term maternal/neonatal outcomes are unverified. Distinguish total, active-labor, first-stage and pushing durations; do not extend pain signals into shorter labor or surgical prevention.",
    "excluded_extensions": [
      "Transferring acute pain/fatigue into total labor duration, operative delivery, reduced analgesics or long-term maternal/neonatal benefit",
      "Substituting ball shapes, anesthesia, controls or positioning/pelvic-movement packages for the same ball-only intervention",
      "Using duration P values as pain P values or upgrading positive pain within co-primary outcomes into joint success",
      "Summing randomized/analyzed populations, subgroups, sheets or reports into new participant, unique-trial or independent-replication totals",
      "Inheriting parent C50, axes or historical verification as missing subclaim values or a new verdict",
      "Creating new effects, CIs, attrition counts/rates, grades, independence/safety certification or labor-ball, delivery or treatment instructions"
    ]
  },
  "requirements": [
    {
      "item_id": "N01",
      "question_type": "Evidence condition",
      "question": "Which acute labor-pain claim is being checked?",
      "needed": "Selected claim, original grade/note and parent context",
      "role": "Required",
      "role_reason": "This condition connects Selected claim, original grade/note and parent context with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Selected claim, original grade/note and parent context must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Subclaim score, status and axes are absent. Do not fill them from parent values. This records needed materials; no new research was executed.",
      "current_reports": [
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve the selected acute labor-pain claim, subclaim C and the note describing a short-term signal from small unblinded trials. Parent C50 remains parent context.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Subclaim score, status and axes are absent. Do not fill them from parent values.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Subclaim score, status and axes are absent. Do not fill them from parent values."
    },
    {
      "item_id": "N02",
      "question_type": "Evidence condition",
      "question": "Which populations, epidural conditions and high-BMI groups were studied?",
      "needed": "Report-specific eligibility, parity, anesthesia and baseline conditions",
      "role": "Required",
      "role_reason": "This condition connects Report-specific eligibility, parity, anesthesia and baseline conditions with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Report-specific eligibility, parity, anesthesia and baseline conditions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Exact S02/S03 eligibility/anesthesia, parity, BMI threshold, baseline pain and recruitment/exclusions are unlinked. Do not automatically transfer conditions between trials. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Payton concerns epidural laboring women; S02 records 90 participants and S03 high-BMI participants with 70 randomized/59 analyzed.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Exact S02/S03 eligibility/anesthesia, parity, BMI threshold, baseline pain and recruitment/exclusions are unlinked. Do not automatically transfer conditions between trials.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Exact S02/S03 eligibility/anesthesia, parity, BMI threshold, baseline pain and recruitment/exclusions are unlinked. Do not automatically transfer conditions between trials."
    },
    {
      "item_id": "N03",
      "question_type": "Evidence condition",
      "question": "Are peanut balls, round birth balls and movement packages the same?",
      "needed": "Ball shape/device, positioning/movement and actual delivery of the intervention",
      "role": "Required",
      "role_reason": "This condition connects Ball shape/device, positioning/movement and actual delivery of the intervention with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Ball shape/device, positioning/movement and actual delivery of the intervention must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Ball specifications, positioning/movement components, providers, supervision and actual exposure are unlinked. Do not attribute varied package effects to a ball alone. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original manuscript distinguishes ball shapes and ball-only versus positioning/pelvic-movement packages. Direct citations concern peanut balls. This table does not provide labor-ball or delivery instructions.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Ball specifications, positioning/movement components, providers, supervision and actual exposure are unlinked. Do not attribute varied package effects to a ball alone.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Ball specifications, positioning/movement components, providers, supervision and actual exposure are unlinked. Do not attribute varied package effects to a ball alone."
    },
    {
      "item_id": "N04",
      "question_type": "Evidence condition",
      "question": "Were controls, labor management and contact comparable?",
      "needed": "Standard care, anesthesia/analgesics, positioning/attention and cointerventions",
      "role": "Supplementary",
      "role_reason": "This condition connects Standard care, anesthesia/analgesics, positioning/attention and cointerventions with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Standard care, anesthesia/analgesics, positioning/attention and cointerventions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Report-specific controls/contact, anesthesia/analgesics, other labor management and intervention details are unlinked. Do not assign the representative control to every trial. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent's representative summary says standard care; the original manuscript records different trial protocols and controls.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Report-specific controls/contact, anesthesia/analgesics, other labor management and intervention details are unlinked. Do not assign the representative control to every trial.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Report-specific controls/contact, anesthesia/analgesics, other labor management and intervention details are unlinked. Do not assign the representative control to every trial."
    },
    {
      "item_id": "N05",
      "question_type": "Evidence condition",
      "question": "What are S02 pain and fatigue after 15 minutes?",
      "needed": "Separate patient-reported scales, original times and assessors",
      "role": "Required",
      "role_reason": "This condition connects Separate patient-reported scales, original times and assessors with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Separate patient-reported scales, original times and assessors must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Scales, assessment windows, baseline/end values, units and between-group effects/CIs/P values are unlinked. Fatigue is not a substitute for pain. This records needed materials; no new research was executed.",
      "current_reports": [
        "S02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Alan Dikmen's endpoints are pain/fatigue after 15 minutes and total labor duration. Preserve the positive pain/fatigue wording.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Scales, assessment windows, baseline/end values, units and between-group effects/CIs/P values are unlinked. Fatigue is not a substitute for pain.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Scales, assessment windows, baseline/end values, units and between-group effects/CIs/P values are unlinked. Fatigue is not a substitute for pain."
    },
    {
      "item_id": "N06",
      "question_type": "Evidence condition",
      "question": "What does the S02 sample of 90 establish?",
      "needed": "Allocation/completion, arm-/endpoint-specific denominators and missing data",
      "role": "Required",
      "role_reason": "This condition connects Allocation/completion, arm-/endpoint-specific denominators and missing data with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Allocation/completion, arm-/endpoint-specific denominators and missing data must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Arm-specific allocation/completion, the 15-minute pain denominator, missing data/exclusions and analysis population are unlinked. Do not treat 90 as everyone analyzed or as one arm's denominator. This records needed materials; no new research was executed.",
      "current_reports": [
        "S02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve the original S02 sample wording of 90 participants.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Arm-specific allocation/completion, the 15-minute pain denominator, missing data/exclusions and analysis population are unlinked. Do not treat 90 as everyone analyzed or as one arm's denominator.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Arm-specific allocation/completion, the 15-minute pain denominator, missing data/exclusions and analysis population are unlinked. Do not treat 90 as everyone analyzed or as one arm's denominator."
    },
    {
      "item_id": "N07",
      "question_type": "Evidence condition",
      "question": "How are S02 pain and total-duration P=.177 separated?",
      "needed": "Separate attribution of acute pain and total duration",
      "role": "Required",
      "role_reason": "This condition connects Separate attribution of acute pain and total duration with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Separate attribution of acute pain and total duration must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Do not use duration P as pain P or replace duration/operative benefit with pain findings. Duration models and precision are also unlinked. This records needed materials; no new research was executed.",
      "current_reports": [
        "S02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve positive S02 pain/fatigue alongside null total labor duration P=.177.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Do not use duration P as pain P or replace duration/operative benefit with pain findings. Duration models and precision are also unlinked.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not use duration P as pain P or replace duration/operative benefit with pain findings. Duration models and precision are also unlinked."
    },
    {
      "item_id": "N08",
      "question_type": "Evidence condition",
      "question": "What is the scope of S03 pain P=.001?",
      "needed": "High-BMI pain measurement, timing, original estimate and CI",
      "role": "Required",
      "role_reason": "This condition connects High-BMI pain measurement, timing, original estimate and CI with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for High-BMI pain measurement, timing, original estimate and CI must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Scales, times, arm-specific baseline/end values, between-group effects/CIs and clinical-importance thresholds are unlinked. One P value does not establish effect size or generalizability across labor conditions. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve original positive S03 pain P=.001 wording.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Scales, times, arm-specific baseline/end values, between-group effects/CIs and clinical-importance thresholds are unlinked. One P value does not establish effect size or generalizability across labor conditions.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Scales, times, arm-specific baseline/end values, between-group effects/CIs and clinical-importance thresholds are unlinked. One P value does not establish effect size or generalizability across labor conditions."
    },
    {
      "item_id": "N09",
      "question_type": "Evidence condition",
      "question": "What do 70 randomized, 59 analyzed and completer wording mean?",
      "needed": "Arm-specific flow, attrition/exclusions and pain denominators",
      "role": "Required",
      "role_reason": "This condition connects Arm-specific flow, attrition/exclusions and pain denominators with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Arm-specific flow, attrition/exclusions and pain denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Arm-specific losses/reasons, pain/duration denominators, missing data and all-randomized outcomes are unlinked. No new attrition counts, rates or denominators are calculated. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve S03's 70 randomized/59 analyzed and the citation flag separating completer and joint-endpoint findings.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Arm-specific losses/reasons, pain/duration denominators, missing data and all-randomized outcomes are unlinked. No new attrition counts, rates or denominators are calculated.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Arm-specific losses/reasons, pain/duration denominators, missing data and all-randomized outcomes are unlinked. No new attrition counts, rates or denominators are calculated."
    },
    {
      "item_id": "N10",
      "question_type": "Evidence condition",
      "question": "What does co-primary pain and active-labor duration require?",
      "needed": "Prespecified joint contract, multiplicity and success rules",
      "role": "Required",
      "role_reason": "This condition connects Prespecified joint contract, multiplicity and success rules with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Prespecified joint contract, multiplicity and success rules must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Exact prespecified outcome hierarchy, joint success rules, multiplicity and amendments are unread. Positive pain does not establish success on both endpoints. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "S03 is a high-BMI co-primary trial with pain and active-labor-duration endpoints.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Exact prespecified outcome hierarchy, joint success rules, multiplicity and amendments are unread. Positive pain does not establish success on both endpoints.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Exact prespecified outcome hierarchy, joint success rules, multiplicity and amendments are unread. Positive pain does not establish success on both endpoints."
    },
    {
      "item_id": "N11",
      "question_type": "Evidence condition",
      "question": "What do active-labor times 202.9/213.6 and P=.522 describe?",
      "needed": "Duration/dispersion, groups, timing and separation from pain",
      "role": "Required",
      "role_reason": "This condition connects Duration/dispersion, groups, timing and separation from pain with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Duration/dispersion, groups, timing and separation from pain must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: The meaning of ±, group correspondence, denominators and duration models/CIs are unlinked. Do not transfer this into pain effects, total labor duration or surgical prevention, or calculate a new difference. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve original active-labor duration 202.9±59.5 versus 213.6±67.5 minutes, P=.522.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "The meaning of ±, group correspondence, denominators and duration models/CIs are unlinked. Do not transfer this into pain effects, total labor duration or surgical prevention, or calculate a new difference.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "The meaning of ±, group correspondence, denominators and duration models/CIs are unlinked. Do not transfer this into pain effects, total labor duration or surgical prevention, or calculate a new difference."
    },
    {
      "item_id": "N12",
      "question_type": "Evidence condition",
      "question": "What is Payton's epidural-duration/subgroup context?",
      "needed": "First-stage/parity/interaction and pushing scope",
      "role": "Required",
      "role_reason": "This condition connects First-stage/parity/interaction and pushing scope with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for First-stage/parity/interaction and pushing scope must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Subgroup-duration P values are not selected pain values/effects. Exact pain, denominators, interaction models and prospective status are unlinked. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "S01 endpoints are first-stage and pushing duration. Preserve primiparous interaction P=.018, multiparous P=.057 and null pushing wording.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Subgroup-duration P values are not selected pain values/effects. Exact pain, denominators, interaction models and prospective status are unlinked.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Subgroup-duration P values are not selected pain values/effects. Exact pain, denominators, interaction models and prospective status are unlinked."
    },
    {
      "item_id": "N13",
      "question_type": "Evidence condition",
      "question": "Is the parent's representative duration endpoint direct pain evidence?",
      "needed": "Original representative context versus direct pain reports",
      "role": "Required",
      "role_reason": "This condition connects Original representative context versus direct pain reports with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Original representative context versus direct pain reports must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Do not use this as S02/S03's representative primary pain endpoint or denominator. Link direct pain measurement separately by report. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent's representative population is a laboring-women trial without a numeric sample size; its recorded endpoint is first-stage/pushing duration.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Do not use this as S02/S03's representative primary pain endpoint or denominator. Link direct pain measurement separately by report.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not use this as S02/S03's representative primary pain endpoint or denominator. Link direct pain measurement separately by report."
    },
    {
      "item_id": "N14",
      "question_type": "Evidence condition",
      "question": "What are allocation, concealment and blinding for patient-reported pain?",
      "needed": "Allocation, assessment/analysis roles, expectations and selection bias",
      "role": "Required",
      "role_reason": "This condition connects Allocation, assessment/analysis roles, expectations and selection bias with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Allocation, assessment/analysis roles, expectations and selection bias must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Report-specific concealment, pain-assessor/analyst blinding and anesthesia/contact/expectation matching are unlinked. Do not assign one bias value to every role. This records needed materials; no new research was executed.",
      "current_reports": [
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve original manuscript/subclaim wording concerning small randomized trials and absent/difficult blinding.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Report-specific concealment, pain-assessor/analyst blinding and anesthesia/contact/expectation matching are unlinked. Do not assign one bias value to every role.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Report-specific concealment, pain-assessor/analyst blinding and anesthesia/contact/expectation matching are unlinked. Do not assign one bias value to every role."
    },
    {
      "item_id": "N15",
      "question_type": "Evidence condition",
      "question": "Are ITT/PP, baseline, repeats and missing data known?",
      "needed": "Pain target effect, models, repeats/baseline and sensitivity analyses",
      "role": "Required",
      "role_reason": "This condition connects Pain target effect, models, repeats/baseline and sensitivity analyses with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Pain target effect, models, repeats/baseline and sensitivity analyses must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Pain ITT/PP, baseline adjustment, repeated measurements, post-analgesic measurements and missing-data/sensitivity analyses are unlinked. This records needed materials; no new research was executed.",
      "current_reports": [
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve the original statement that completer material was not interpreted as surgical prevention.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Pain ITT/PP, baseline adjustment, repeated measurements, post-analgesic measurements and missing-data/sensitivity analyses are unlinked.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Pain ITT/PP, baseline adjustment, repeated measurements, post-analgesic measurements and missing-data/sensitivity analyses are unlinked."
    },
    {
      "item_id": "N16",
      "question_type": "Evidence condition",
      "question": "What is known about prespecification and NCT05276947?",
      "needed": "Original registration, dates, pain hierarchy, amendments and SAP",
      "role": "Required",
      "role_reason": "This condition connects Original registration, dates, pain hierarchy, amendments and SAP with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Original registration, dates, pain hierarchy, amendments and SAP must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original registry/protocol/SAP, hierarchy, amendments and multiplicity are unread. Identifiers or summaries do not establish verified prospective status. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original S01/S02 registration fields read unconfirmed; S03 evidence records NCT05276947.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original registry/protocol/SAP, hierarchy, amendments and multiplicity are unread. Identifiers or summaries do not establish verified prospective status.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original registry/protocol/SAP, hierarchy, amendments and multiplicity are unread. Identifiers or summaries do not establish verified prospective status."
    },
    {
      "item_id": "N17",
      "question_type": "Evidence condition",
      "question": "Are clinically important pain effects and precision available?",
      "needed": "Between-group estimates/CIs, meaningful change and sample-size plans",
      "role": "Required",
      "role_reason": "This condition connects Between-group estimates/CIs, meaningful change and sample-size plans with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Between-group estimates/CIs, meaningful change and sample-size plans must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Pain effects/CIs, scale-specific clinical-importance thresholds and sample plans are unlinked, leaving exact ball-specific effect size unverified. No new effects, CIs or numerical examples are created. This records needed materials; no new research was executed.",
      "current_reports": [
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve the original short-term positive pain signal from small unblinded trials.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Pain effects/CIs, scale-specific clinical-importance thresholds and sample plans are unlinked, leaving exact ball-specific effect size unverified. No new effects, CIs or numerical examples are created.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Pain effects/CIs, scale-specific clinical-importance thresholds and sample plans are unlinked, leaving exact ball-specific effect size unverified. No new effects, CIs or numerical examples are created."
    },
    {
      "item_id": "N18",
      "question_type": "Evidence condition",
      "question": "Are analgesics, positioning and movement separated?",
      "needed": "Anesthesia/analgesics, usual labor care, exposure and adherence",
      "role": "Supplementary",
      "role_reason": "This condition connects Anesthesia/analgesics, usual labor care, exposure and adherence with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Anesthesia/analgesics, usual labor care, exposure and adherence must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Concurrent analgesics/care, intervention delivery/supervision and post-rescue-treatment outcome policy in direct pain reports are unlinked. Do not establish isolated ball or non-drug effects. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original manuscript records comparing differences in epidural status, ball shape, timing and positioning/pelvic movement.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Concurrent analgesics/care, intervention delivery/supervision and post-rescue-treatment outcome policy in direct pain reports are unlinked. Do not establish isolated ball or non-drug effects.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Concurrent analgesics/care, intervention delivery/supervision and post-rescue-treatment outcome policy in direct pain reports are unlinked. Do not establish isolated ball or non-drug effects."
    },
    {
      "item_id": "N19",
      "question_type": "Evidence condition",
      "question": "Does short-term pain establish operative or other obstetric outcomes?",
      "needed": "Cesarean/instrumental delivery, analgesics and maternal/neonatal boundaries",
      "role": "Required",
      "role_reason": "This condition connects Cesarean/instrumental delivery, analgesics and maternal/neonatal boundaries with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Cesarean/instrumental delivery, analgesics and maternal/neonatal boundaries must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Do not transfer positive pain into shorter labor, surgical prevention or long-term neonatal/maternal effects. Original event counts, denominators and CIs are unlinked. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent records uncertain precise reductions in operative delivery/analgesics and does not interpret vaginal delivery among all completers as prevention.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Do not transfer positive pain into shorter labor, surgical prevention or long-term neonatal/maternal effects. Original event counts, denominators and CIs are unlinked.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not transfer positive pain into shorter labor, surgical prevention or long-term neonatal/maternal effects. Original event counts, denominators and CIs are unlinked."
    },
    {
      "item_id": "N20",
      "question_type": "Evidence condition",
      "question": "Are persistence, other labor conditions and independent replication established?",
      "needed": "Protocols/controls, ball shape, anesthesia, duration and shared cohorts",
      "role": "Required",
      "role_reason": "This condition connects Protocols/controls, ball shape, anesthesia, duration and shared cohorts with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Protocols/controls, ball shape, anesthesia, duration and shared cohorts must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Strict independent confirmation of the same pain/ball/control contract, persistence/other populations and unique-trial/participant totals are unconfirmed. No report/population totals are summed. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve short-term signals from small, differing programs. S01 supplies duration context; S02/S03 concern direct pain.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Strict independent confirmation of the same pain/ball/control contract, persistence/other populations and unique-trial/participant totals are unconfirmed. No report/population totals are summed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Strict independent confirmation of the same pain/ball/control contract, persistence/other populations and unique-trial/participant totals are unconfirmed. No report/population totals are summed."
    },
    {
      "item_id": "N21",
      "question_type": "Evidence condition",
      "question": "What is known about funding, support and COI?",
      "needed": "Funding, device/material support, employee authors and separate roles",
      "role": "Required",
      "role_reason": "This condition connects Funding, device/material support, employee authors and separate roles with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Funding, device/material support, employee authors and separate roles must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Do not fill product/ball support, employee authorship, COI or analysis/assessment/publication roles with no involvement or established independence. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "All three original evidence entries record unverified detailed funding.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Do not fill product/ball support, employee authorship, COI or analysis/assessment/publication roles with no involvement or established independence.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not fill product/ball support, employee authorship, COI or analysis/assessment/publication roles with no involvement or established independence."
    },
    {
      "item_id": "N22",
      "question_type": "Evidence condition",
      "question": "Are maternal/fetal harms, collection and denominators known?",
      "needed": "Harm definitions, arm-specific events/denominators, timing and discontinuation/missing data",
      "role": "Supplementary",
      "role_reason": "This condition connects Harm definitions, arm-specific events/denominators, timing and discontinuation/missing data with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Harm definitions, arm-specific events/denominators, timing and discontinuation/missing data must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original fall/positioning-related and maternal/fetal/neonatal event counts/denominators, collection, discontinuation and missing data are unlinked. Pain or completer findings do not certify safety. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve original parent Caution safety wording and its labor-safety context.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original fall/positioning-related and maternal/fetal/neonatal event counts/denominators, collection, discontinuation and missing data are unlinked. Pain or completer findings do not certify safety.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original fall/positioning-related and maternal/fetal/neonatal event counts/denominators, collection, discontinuation and missing data are unlinked. Pain or completer findings do not certify safety."
    },
    {
      "item_id": "N23",
      "question_type": "Evidence condition",
      "question": "What are vulnerable conditions, shared exposures and instruction limits?",
      "needed": "Labor/anesthesia-specific harms, alternative causes and persistence",
      "role": "Supplementary",
      "role_reason": "This condition connects Labor/anesthesia-specific harms, alternative causes and persistence with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Labor/anesthesia-specific harms, alternative causes and persistence must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Population-/anesthesia-/time-specific harms, shared exposure and long-term maternal/neonatal material are unlinked. Unsupervised use or safety in other populations is not established. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve original parental safety wording as historical context; create no new labor-ball, delivery, treatment or action instructions.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Population-/anesthesia-/time-specific harms, shared exposure and long-term maternal/neonatal material are unlinked. Unsupervised use or safety in other populations is not established.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Population-/anesthesia-/time-specific harms, shared exposure and long-term maternal/neonatal material are unlinked. Unsupervised use or safety in other populations is not established."
    },
    {
      "item_id": "N24",
      "question_type": "Evidence condition",
      "question": "Are original bibliography, languages, grades/axes and empty history preserved?",
      "needed": "Original report wording, parent/subclaim distinction, unrecorded precision and dates",
      "role": "Required",
      "role_reason": "This condition connects Original report wording, parent/subclaim distinction, unrecorded precision and dates with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Original report wording, parent/subclaim distinction, unrecorded precision and dates must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original external bibliography and historical cross-check wording do not establish review/certification in this work. No new grades, numbers or hypothetical examples. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve original PMID/DOI/journal wording. Retain parent C50/unrecorded precision, Korean/English, 2026-09-07, empty corrections/deliberation and selected C/note with absent score/status/axes.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original external bibliography and historical cross-check wording do not establish review/certification in this work. No new grades, numbers or hypothetical examples.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original external bibliography and historical cross-check wording do not establish review/certification in this work. No new grades, numbers or hypothetical examples."
    },
    {
      "item_id": "N25",
      "question_type": "Evidence condition",
      "question": "What distinguishes summary reading from external links?",
      "needed": "Report-specific reading versus original papers, registration, plans and support access",
      "role": "Required",
      "role_reason": "This condition connects Report-specific reading versus original papers, registration, plans and support access with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.",
      "application_exception": "Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.",
      "criterion": "Material for Report-specific reading versus original papers, registration, plans and support access must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: External papers, registration, protocols/SAPs and support originals are unread and access was not attempted. URLs or historical verification wording do not establish current reading or external link tests. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "This work prepares materials from the complete stored summary and bibliography, distinguishing summary reading, unread external materials and source URLs.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "External papers, registration, protocols/SAPs and support originals are unread and access was not attempted. URLs or historical verification wording do not establish current reading or external link tests.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "External papers, registration, protocols/SAPs and support originals are unread and access was not attempted. URLs or historical verification wording do not establish current reading or external link tests."
    }
  ],
  "reports": [
    {
      "report_id": "S01",
      "title": "Payton CL, et al. Randomized Controlled Trial of Use of the Peanut Ball During Labor. Nurs Womens Health. 2016. PMID: 26859467. DOI: 10.1097/NMC.0000000000000232.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/26859467/",
      "report_type": "Randomized epidural peanut-ball trial",
      "existence": "Report linked in the original parent stored summary evidence/citation lists. External public availability, access and current acquisition of the original are unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "study_family": "Original report S01; unique counts and independent replication unverified",
      "independent_replication": "Parent 2998 and the pain/duration-operative subclaim sheets share the same three reports. S01 provides epidural duration/subgroup background; S02/S03 concern direct pain, with different ball shapes, anesthesia, movement packages, controls and endpoints. Randomized/analyzed populations, subgroups, outcomes, sheets and reports are not summed into new participant, unique-trial or independent-replication totals. Cohort relationships, confirmed totals and independence are unverified.",
      "observed_result": "Primiparous interaction P=.018; multiparous P=.057; pushing null",
      "result_level": "For the selected pain question, this is epidural labor-duration background. Preserve first-stage primiparous interaction P=.018, multiparous P=.057 and null pushing time. Numeric sample size, direct pain values, subgroup denominators/models, prospective status and effects/CIs are unverified.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
          "material_type": "Stored existing review summary",
          "public_status": "Preserved copy of the complete parent-verdict stored summary",
          "access_status": "Stored summary",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred."
        },
        {
          "material_type": "External paper",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred."
        },
        {
          "material_type": "Registration material",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred."
        },
        {
          "material_type": "Protocol",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred."
        },
        {
          "material_type": "Statistical analysis plan",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred."
        },
        {
          "material_type": "Funding, product-support and COI material",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred."
        }
      ],
      "links": [
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/26859467/"
        }
      ]
    },
    {
      "report_id": "S02",
      "title": "Alan Dikmen H, et al. Effects of peanut ball use on perceived labor pain, fatigue, and mother's perception of childbirth: a randomized controlled trial. Arch Gynecol Obstet. 2025;311. PMID: 39103620. PMCID: PMC12055654. DOI: 10.1007/s00404-024-07656-2.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/39103620/",
      "report_type": "Randomized acute pain and fatigue trial",
      "existence": "Report linked in the original parent stored summary evidence/citation lists. External public availability, access and current acquisition of the original are unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "study_family": "Original report S02; unique counts and independent replication unverified",
      "independent_replication": "Parent 2998 and the pain/duration-operative subclaim sheets share the same three reports. S01 provides epidural duration/subgroup background; S02/S03 concern direct pain, with different ball shapes, anesthesia, movement packages, controls and endpoints. Randomized/analyzed populations, subgroups, outcomes, sheets and reports are not summed into new participant, unique-trial or independent-replication totals. Cohort relationships, confirmed totals and independence are unverified.",
      "observed_result": "Pain and fatigue positive; total labor duration P=.177",
      "result_level": "Direct acute-pain report. Distinguish 90 participants and positive pain/fatigue after 15 minutes from null total labor duration P=.177. Exact pain scales, effects/CIs/P values, arm-/endpoint-specific denominators, anesthesia and control are unverified. Duration P is not pain P.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
          "material_type": "Stored existing review summary",
          "public_status": "Preserved copy of the complete parent-verdict stored summary",
          "access_status": "Stored summary",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred."
        },
        {
          "material_type": "External paper",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred."
        },
        {
          "material_type": "Registration material",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred."
        },
        {
          "material_type": "Protocol",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred."
        },
        {
          "material_type": "Statistical analysis plan",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred."
        },
        {
          "material_type": "Funding, product-support and COI material",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
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      "title": "Ozkececi F, et al. The Effect of Peanut Ball Use on the Labour Process and Maternal-Neonatal Outcomes in Parturient Women With High Maternal Body Mass Index: A Randomized Controlled Trial. Int J Nurs Pract. 2026;32:e70144. PMID: 42026814. PMCID: PMC13106928. DOI: 10.1111/ijn.70144.",
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      "study_family": "Original report S03; unique counts and independent replication unverified",
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      "observed_result": "Pain P=.001; duration 202.9±59.5 vs 213.6±67.5 min, P=.522",
      "result_level": "High-BMI co-primary report. Distinguish 70 randomized/59 analyzed, pain P=.001 and active-labor duration 202.9±59.5 versus 213.6±67.5 minutes/P=.522. Pain scales, exact timing, effects/CIs, denominators, the meaning of ± and joint success rules are unverified. Completer results do not establish duration/surgical prevention.",
      "source_evidence_date": "2026-09-07",
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      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03",
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      "official_principle": "Clearly record the question, eligibility conditions and reasons for changes, and distinguish variations in interventions.",
      "review_level": "Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed."
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      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04",
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      "review_level": "Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed."
    },
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      "id": "M08",
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      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08",
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      "official_principle": "Define the outcome and effect of interest, then examine randomization, deviations, missing data, measurement and selective reporting.",
      "review_level": "Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed."
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      "id": "M15",
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      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-15",
      "section": "§15.2.4, §15.3.1–15.3.3",
      "official_principle": "Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision.",
      "review_level": "Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed."
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      "section": "§19.1.2, §19.2.1–19.2.4",
      "official_principle": "Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates.",
      "review_level": "Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed."
    }
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  "status_dictionary": {
    "Met": "A state used when required evidence is confirmed after user review. This production does not declare that review complete.",
    "Partly verified": "Some information in the stored summary is linked into the table. External comparison/content review is not complete.",
    "Unverified": "The article leaves this unverified, or required material is absent from the current stored summary. This is distinct from zero, absence or safety.",
    "Review incomplete": "User review pending.",
    "Not reported": "Not reported within the stored material actually read; not extended to the entire primary paper.",
    "Inaccessible": "Means an actual access failure. Access not attempted here is not assigned this state.",
    "Not applicable": "Not used as a substitute for an evidence gap.",
    "Conflicting data": "Requires an observed disagreement under the same comparison criteria; not automatically judged in this production.",
    "Insufficient evidence for the conditions": "Marks a gap in additional material required by the selected conditions; not a new efficacy grade."
  },
  "study_overlap": {
    "state": "Unverified",
    "unique_trial_count": null,
    "unique_participant_count": null,
    "reason": "Parent 2998 and the pain/duration-operative subclaim sheets share the same three reports. S01 provides epidural duration/subgroup background; S02/S03 concern direct pain, with different ball shapes, anesthesia, movement packages, controls and endpoints. Randomized/analyzed populations, subgroups, outcomes, sheets and reports are not summed into new participant, unique-trial or independent-replication totals. Cohort relationships, confirmed totals and independence are unverified."
  },
  "history": [
    {
      "date": "2026-10-16",
      "kind": "Separation of public-facing pages and materials",
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      "change": "The public page and data were prepared from the existing 25 items. No new clinical search, verification-status change or scoring was performed."
    }
  ],
  "language": "en",
  "translation_date": "2026-10-16"
}