{
  "schema_version": "chamgap-public-evidence-check-1.0",
  "public_id": "v3005-s1",
  "verdict_number": "3005",
  "title": "Laughter Yoga × Reduced Salivary Cortisol · Evidence and Gaps Sheet",
  "view_version": "1.0",
  "view_created_date": "2026-10-19",
  "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": "Direct cortisol reports involve 75 first-year nursing students and 120 healthy university students. Parent stress reports involving 70 psychiatric nurses and 83 nursing students provide separate context. Psychiatric nurses are an occupational sample, not diagnosed patients. Direct-trial eligibility, baseline, medication and lifestyle factors and applicability to other populations are unverified.",
    "intervention": "The program combines laughter, clapping, breathing, movement and group participation. Humorous video is a separate intervention. Components, instructors, contact, expectations, adherence and laughter-only contributions in direct cortisol trials are unverified. Recorded research exposure is not converted into new yoga, breathing or mental-health treatment instructions.",
    "dose": "Ozturk's 8 sessions and Fujisawa's acute single exposure are separate conditions. The parent program of 8 sessions of 30 minutes belongs to the Bilgihan stress-trial context. That specification is not transferred to direct cortisol trials. Actual participation, adherence and correspondence between saliva-collection times and exposure are unverified for each direct trial.",
    "comparator": "Fujisawa has 3 arms: laughter yoga, humorous video and reading. Ozturk's exact control, contact and expectations are unverified. Parent stress-trial no-intervention controls and combined roles are not automatically assigned to direct cortisol trials. Video-related and time-related changes are not converted into laughter-yoga-specific between-arm effects.",
    "endpoint": "The selection is reduced salivary cortisol. Distinguish Ozturk's between-arm positivity in 3 of 8 sessions from Fujisawa's time change, changes with video and null DHEA result. Original subclaim C and the explanatory 46-level wording are retained without a separate score. Exact units, collection, direct between-arm effects, confidence intervals, denominators, models, hierarchy and clinical meaning are unverified.",
    "duration": "Acute single-exposure and 8-session results are kept separate. Session-specific collection intervals, daily conditions, persistence after completion and long-term observation are unverified. Short-term salivary cortisol changes are not extended to daily averages, long-term normalization, improved perceived stress or treatment of diagnosed patients.",
    "excluded_extensions": [
      "Positive findings in some sessions are not converted into consistent reduction across all sessions, new rates or pooled effects.",
      "Time change and video-related change are distinguished from direct laughter-yoga-specific between-arm effects.",
      "Cortisol, DHEA, PSS, GHQ, burnout, well-being, self-efficacy and mental symptoms are distinct outcomes.",
      "Large parent PSS/multivariate statistics and conflicting statements are not reassigned as direct cortisol values or exact null effects.",
      "Parent samples, exposure, controls, blinding and roles are not automatically assigned to direct cortisol trials.",
      "Total samples are not used as valid specimen denominators for each arm/session, and no new unique participant, trial or event totals are created.",
      "Original explanatory numbers are not turned into structured scores, and biomarker changes are not converted into safety, long-term normalization or treatment of diagnosed conditions.",
      "No new yoga, breathing or mental-health treatment methods are provided."
    ]
  },
  "requirements": [
    {
      "item_id": "N01",
      "question_type": "Evidence condition",
      "question": "What are the selected cortisol question and verdict?",
      "needed": "The existing subclaim, grade and explanation versus the parent verdict",
      "role": "Required",
      "role_reason": "This condition connects The existing subclaim, grade and explanation versus the parent verdict with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for The existing subclaim, grade and explanation versus the parent verdict must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: The selection has no separate score, status or assessment axes. The explanatory number is not turned into a new structured score or filled with the parent score. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The selection is reduced salivary cortisol. Original subclaim C and the explanation of a weak 46-level signal with insufficient laughter specificity and session-to-session consistency are retained. The parent is nonclinical stress C50.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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 selection has no separate score, status or assessment axes. The explanatory number is not turned into a new structured score or filled with the parent score.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "The selection has no separate score, status or assessment axes. The explanatory number is not turned into a new structured score or filled with the parent score."
    },
    {
      "item_id": "N02",
      "question_type": "Evidence condition",
      "question": "Who participated in the cortisol trials?",
      "needed": "Trial-specific health, age, recruitment and baseline characteristics",
      "role": "Required",
      "role_reason": "This condition connects Trial-specific health, age, recruitment and baseline characteristics with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Trial-specific health, age, recruitment and baseline characteristics must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Exact eligibility, sex, age, medication and lifestyle factors and baseline values in the direct cortisol trials are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "Ozturk included 75 first-year nursing students; Fujisawa included 120 healthy university students. The 70 psychiatric nurses belonged to a different stress trial.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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 eligibility, sex, age, medication and lifestyle factors and baseline values in the direct cortisol trials are unverified.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Exact eligibility, sex, age, medication and lifestyle factors and baseline values in the direct cortisol trials are unverified."
    },
    {
      "item_id": "N03",
      "question_type": "Evidence condition",
      "question": "Is laughter itself the same as the combined program?",
      "needed": "Components involving laughter, clapping, breathing, movement and group participation",
      "role": "Required",
      "role_reason": "This condition connects Components involving laughter, clapping, breathing, movement and group participation with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Components involving laughter, clapping, breathing, movement and group participation must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Cortisol-trial-specific session components, instructors, contact and actual participation are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The original program combines laughter with clapping, breathing, movement and group participation. It is not treated as a laughter-only effect, and no new practice method is provided.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "Cortisol-trial-specific session components, instructors, contact and actual participation are unverified.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Cortisol-trial-specific session components, instructors, contact and actual participation are unverified."
    },
    {
      "item_id": "N04",
      "question_type": "Evidence condition",
      "question": "How do acute, repeated and parent-program exposures differ?",
      "needed": "Trial-specific actual exposure, schedules and observation times",
      "role": "Required",
      "role_reason": "This condition connects Trial-specific actual exposure, schedules and observation times with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Trial-specific actual exposure, schedules and observation times must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: The parent-program specification is not applied to other cortisol trials. Exposure, adherence and observation windows in direct trials are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "Fujisawa used an acute 3-arm design; Ozturk used 8 sessions. The recent positive program of 8 sessions of 30 minutes in the parent explanation belongs to the Bilgihan stress-trial context.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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 parent-program specification is not applied to other cortisol trials. Exposure, adherence and observation windows in direct trials are unverified.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "The parent-program specification is not applied to other cortisol trials. Exposure, adherence and observation windows in direct trials are unverified."
    },
    {
      "item_id": "N05",
      "question_type": "Evidence condition",
      "question": "What comparison do humorous video and reading provide?",
      "needed": "Control components, contact, emotion, breathing and direct contrasts",
      "role": "Required",
      "role_reason": "This condition connects Control components, contact, emotion, breathing and direct contrasts with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Control components, contact, emotion, breathing and direct contrasts must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Arm-specific expectations, contact, breathing and emotional components and exact between-arm contrasts are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The trial in 120 healthy students had 3 arms: laughter yoga, humorous video and reading. Video results are not reassigned to laughter yoga.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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 expectations, contact, breathing and emotional components and exact between-arm contrasts are unverified.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Arm-specific expectations, contact, breathing and emotional components and exact between-arm contrasts are unverified."
    },
    {
      "item_id": "N06",
      "question_type": "Evidence condition",
      "question": "What were the repeated trial's controls, expectations and contact?",
      "needed": "Correspondence of controls, social contact and expectations",
      "role": "Required",
      "role_reason": "This condition connects Correspondence of controls, social contact and expectations with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Correspondence of controls, social contact and expectations must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: The exact components, contact amount and expectation assessment of the Ozturk control are unverified. The parent's no-intervention label is not automatically assigned to this trial. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "Ozturk is preserved as an 8-session randomized trial. The parent explanation describes insufficient active social controls as a limitation.",
      "condition_status": "Unverified",
      "status_reason": "Direct cortisol evidence and parent context were 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 exact components, contact amount and expectation assessment of the Ozturk control are unverified. The parent's no-intervention label is not automatically assigned to this trial.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "The exact components, contact amount and expectation assessment of the Ozturk control are unverified. The parent's no-intervention label is not automatically assigned to this trial."
    },
    {
      "item_id": "N07",
      "question_type": "Evidence condition",
      "question": "Were randomization and laboratory blinding verified?",
      "needed": "Allocation, concealment and collection, assay and analysis roles",
      "role": "Required",
      "role_reason": "This condition connects Allocation, concealment and collection, assay and analysis roles with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Allocation, concealment and collection, assay and analysis roles must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Trial-specific allocation procedures, assessment and laboratory blinding and responsible roles in the direct cortisol trials are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The direct cortisol reports are randomized trials. Parent concerns about lack of blinding and combined instructor/assessor roles are distinguished as context from the recent stress trial.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "Trial-specific allocation procedures, assessment and laboratory blinding and responsible roles in the direct cortisol trials are unverified.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Trial-specific allocation procedures, assessment and laboratory blinding and responsible roles in the direct cortisol trials are unverified."
    },
    {
      "item_id": "N08",
      "question_type": "Evidence condition",
      "question": "When were saliva samples repeatedly collected?",
      "needed": "Collection times, pre/post intervals, session windows and within-person repeats",
      "role": "Required",
      "role_reason": "This condition connects Collection times, pre/post intervals, session windows and within-person repeats with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Collection times, pre/post intervals, session windows and within-person repeats must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Collection times, pre/post-session intervals, repeat counts and daily conditions are unverified. These are not converted into daily averages or long-term reductions. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The original statements are retained: Ozturk was between-arm positive in only 3 of 8 sessions; Fujisawa showed acute cortisol change over time.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "Collection times, pre/post-session intervals, repeat counts and daily conditions are unverified. These are not converted into daily averages or long-term reductions.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Collection times, pre/post-session intervals, repeat counts and daily conditions are unverified. These are not converted into daily averages or long-term reductions."
    },
    {
      "item_id": "N09",
      "question_type": "Evidence condition",
      "question": "What were the assay method and concentration units?",
      "needed": "Assay, units, detection limits, batches and specimen quality",
      "role": "Required",
      "role_reason": "This condition connects Assay, units, detection limits, batches and specimen quality with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Assay, units, detection limits, batches and specimen quality must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Quantitative values, units, assay methods, detection limits, batches, specimen handling and quality criteria are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The endpoint of the direct reports is salivary cortisol.",
      "condition_status": "Unverified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "Quantitative values, units, assay methods, detection limits, batches, specimen handling and quality criteria are unverified.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Quantitative values, units, assay methods, detection limits, batches, specimen handling and quality criteria are unverified."
    },
    {
      "item_id": "N10",
      "question_type": "Evidence condition",
      "question": "Can baseline, final, change and between-arm effects be determined?",
      "needed": "Trial-, session- and arm-specific estimates and confidence intervals",
      "role": "Required",
      "role_reason": "This condition connects Trial-, session- and arm-specific estimates and confidence intervals with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Trial-, session- and arm-specific estimates and confidence intervals must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Arm-specific baseline and final values, changes, between-arm effects, confidence intervals and exact significance levels are unverified. No new effects or intervals are calculated. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The stored summary contains mixed session results and changes over time; the original statement that exact between-arm confidence intervals are unverified is retained.",
      "condition_status": "Unverified",
      "status_reason": "Direct cortisol evidence and parent context were 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 baseline and final values, changes, between-arm effects, confidence intervals and exact significance levels are unverified. No new effects or intervals are calculated.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Arm-specific baseline and final values, changes, between-arm effects, confidence intervals and exact significance levels are unverified. No new effects or intervals are calculated."
    },
    {
      "item_id": "N11",
      "question_type": "Evidence condition",
      "question": "Do positive results in some sessions establish a consistent overall reduction?",
      "needed": "Session-specific results, selection, multiplicity and prespecified contrasts",
      "role": "Required",
      "role_reason": "This condition connects Session-specific results, selection, multiplicity and prespecified contrasts with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Session-specific results, selection, multiplicity and prespecified contrasts must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Which sessions were positive, directions and magnitudes, exact results in other sessions, prespecification and multiplicity adjustment are unverified. This is not converted into consistent reduction across all sessions. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The original Ozturk result is between-arm positivity in only 3 of 8 sessions.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "Which sessions were positive, directions and magnitudes, exact results in other sessions, prespecification and multiplicity adjustment are unverified. This is not converted into consistent reduction across all sessions.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Which sessions were positive, directions and magnitudes, exact results in other sessions, prespecification and multiplicity adjustment are unverified. This is not converted into consistent reduction across all sessions."
    },
    {
      "item_id": "N12",
      "question_type": "Evidence condition",
      "question": "Does acute change over time establish a laughter-yoga-specific effect?",
      "needed": "Time effects, between-arm and group-by-time effects and prespecified comparisons",
      "role": "Required",
      "role_reason": "This condition connects Time effects, between-arm and group-by-time effects and prespecified comparisons with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Time effects, between-arm and group-by-time effects and prespecified comparisons must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Exact laughter-yoga between-arm and group-by-time contrasts, net effects, confidence intervals and baseline adjustment are unverified. Time change is not promoted to a laughter-specific effect. This records needed materials; no new research was executed.",
      "current_reports": [
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The original Fujisawa statements of cortisol change over time and changes with humorous video are retained.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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 laughter-yoga between-arm and group-by-time contrasts, net effects, confidence intervals and baseline adjustment are unverified. Time change is not promoted to a laughter-specific effect.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Exact laughter-yoga between-arm and group-by-time contrasts, net effects, confidence intervals and baseline adjustment are unverified. Time change is not promoted to a laughter-specific effect."
    },
    {
      "item_id": "N13",
      "question_type": "Evidence condition",
      "question": "Are DHEA and cortisol the same outcome?",
      "needed": "Separate biomarker analyses, denominators and results",
      "role": "Required",
      "role_reason": "This condition connects Separate biomarker analyses, denominators and results with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Separate biomarker analyses, denominators and results must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: The biomarkers are not combined or converted into general physiological improvement. Exact values and outcome hierarchy for each biomarker are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The original Fujisawa result retains both cortisol change and null DHEA findings.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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 biomarkers are not combined or converted into general physiological improvement. Exact values and outcome hierarchy for each biomarker are unverified.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "The biomarkers are not combined or converted into general physiological improvement. Exact values and outcome hierarchy for each biomarker are unverified."
    },
    {
      "item_id": "N14",
      "question_type": "Evidence condition",
      "question": "Is the total sample a valid saliva-analysis denominator?",
      "needed": "Allocation, completion and arm- and session-specific valid specimens and missingness",
      "role": "Required",
      "role_reason": "This condition connects Allocation, completion and arm- and session-specific valid specimens and missingness with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Allocation, completion and arm- and session-specific valid specimens and missingness must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Arm-specific allocation, completion, saliva denominators, specimen exclusions and time-specific missingness are unverified. Complete validity and session-specific denominators are not created. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "Original total samples of 75 in Ozturk and 120 in Fujisawa are retained.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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, saliva denominators, specimen exclusions and time-specific missingness are unverified. Complete validity and session-specific denominators are not created.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Arm-specific allocation, completion, saliva denominators, specimen exclusions and time-specific missingness are unverified. Complete validity and session-specific denominators are not created."
    },
    {
      "item_id": "N15",
      "question_type": "Evidence condition",
      "question": "How were missing and repeated data analyzed?",
      "needed": "Analysis populations, missing specimens, repeated-data models and adjustment",
      "role": "Required",
      "role_reason": "This condition connects Analysis populations, missing specimens, repeated-data models and adjustment with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Analysis populations, missing specimens, repeated-data models and adjustment must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Missing saliva, correlations across sessions, specimen exclusions and adjustment for baseline, time and lifestyle factors are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The stored summary lacks details of quantitative analysis models and missing-data handling.",
      "condition_status": "Unverified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "Missing saliva, correlations across sessions, specimen exclusions and adjustment for baseline, time and lifestyle factors are unverified.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Missing saliva, correlations across sessions, specimen exclusions and adjustment for baseline, time and lifestyle factors are unverified."
    },
    {
      "item_id": "N16",
      "question_type": "Evidence condition",
      "question": "Were cortisol hierarchy and registration prespecified?",
      "needed": "Primary/secondary outcomes, collection, analysis, registration and amendments",
      "role": "Required",
      "role_reason": "This condition connects Primary/secondary outcomes, collection, analysis, registration and amendments with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Primary/secondary outcomes, collection, analysis, registration and amendments must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Registration originals and times, cortisol hierarchy, protocols, analysis plans and amendments are unread. An identifier alone does not certify prespecification. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The original records are retained: Ozturk registration was unable to be verified, and Fujisawa has UMIN000019409. The UMIN identifier also appears in the original citation annotation.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "Registration originals and times, cortisol hierarchy, protocols, analysis plans and amendments are unread. An identifier alone does not certify prespecification.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Registration originals and times, cortisol hierarchy, protocols, analysis plans and amendments are unread. An identifier alone does not certify prespecification."
    },
    {
      "item_id": "N17",
      "question_type": "Evidence condition",
      "question": "Does a large PSS statistic establish a cortisol effect?",
      "needed": "Scope and role of the parent stress outcome",
      "role": "Required",
      "role_reason": "This condition connects Scope and role of the parent stress outcome with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Scope and role of the parent stress outcome must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: These statistics are not used as salivary cortisol effects or denominators or as disorder-treatment evidence. The original report's endpoint list does not include cortisol. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "Bilgihan's 70 participants, all completing at 35 versus 35, and PSS F(1,68)=251.56, P<.001, partial eta-squared=.787 are original parent stress-trial values.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "These statistics are not used as salivary cortisol effects or denominators or as disorder-treatment evidence. The original report's endpoint list does not include cortisol.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "These statistics are not used as salivary cortisol effects or denominators or as disorder-treatment evidence. The original report's endpoint list does not include cortisol."
    },
    {
      "item_id": "N18",
      "question_type": "Evidence condition",
      "question": "Are conflicting abstract and main-text statements cortisol results?",
      "needed": "Attribution of statements and multivariate tests to their own endpoints",
      "role": "Required",
      "role_reason": "This condition connects Attribution of statements and multivariate tests to their own endpoints with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Attribution of statements and multivariate tests to their own endpoints must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: These statistics and conflicts are not reassigned as direct cortisol effects or exact null effects. Original endpoints are well-being, PSS and self-efficacy. This records needed materials; no new research was executed.",
      "current_reports": [
        "S02"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The original Yaş account retains 83 analyzed, 41 versus 42, coexisting abstract null and main-text multivariate interaction F=10.69, P<.001, and retrospective registration.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "These statistics and conflicts are not reassigned as direct cortisol effects or exact null effects. Original endpoints are well-being, PSS and self-efficacy.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "These statistics and conflicts are not reassigned as direct cortisol effects or exact null effects. Original endpoints are well-being, PSS and self-efficacy."
    },
    {
      "item_id": "N19",
      "question_type": "Evidence condition",
      "question": "Does a short-term biomarker change establish clinical meaning and persistence?",
      "needed": "Meaning of change, long-term outcomes and disorder outcomes",
      "role": "Required",
      "role_reason": "This condition connects Meaning of change, long-term outcomes and disorder outcomes with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Meaning of change, long-term outcomes and disorder outcomes must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Direct links to normalization, meaningful change, long-term persistence and depression/anxiety treatment are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The original explanation retains mixed cortisol results and gaps in exact between-arm confidence intervals as a separate weak signal.",
      "condition_status": "Unverified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "Direct links to normalization, meaningful change, long-term persistence and depression/anxiety treatment are unverified.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Direct links to normalization, meaningful change, long-term persistence and depression/anxiety treatment are unverified."
    },
    {
      "item_id": "N20",
      "question_type": "Evidence condition",
      "question": "Was independent replication under the same conditions established?",
      "needed": "The same biomarker, comparator, duration and report/cohort relationships",
      "role": "Required",
      "role_reason": "This condition connects The same biomarker, comparator, duration and report/cohort relationships with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for The same biomarker, comparator, duration and report/cohort relationships must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Independent confirmation under the same comparison conditions, heterogeneity and unique trial and participant totals are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "Single-exposure and 8-session direct reports are distinguished from separate stress reports. Group participation, breathing, attention and comedy effects are not combined as laughter-specific effects.",
      "condition_status": "Unverified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "Independent confirmation under the same comparison conditions, heterogeneity and unique trial and participant totals are unverified.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Independent confirmation under the same comparison conditions, heterogeneity and unique trial and participant totals are unverified."
    },
    {
      "item_id": "N21",
      "question_type": "Evidence condition",
      "question": "What were concurrent factors and collection environments?",
      "needed": "Research records of treatment, lifestyle, performance and collection conditions",
      "role": "Supplementary",
      "role_reason": "This condition connects Research records of treatment, lifestyle, performance and collection conditions with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Research records of treatment, lifestyle, performance and collection conditions must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Medication, lifestyle, activities, collection environments and adherence in direct cortisol trials are unverified. Causes of biomarker changes are not newly established. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The original explanation distinguishes the combined program from social-participation and breathing effects.",
      "condition_status": "Unverified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "Medication, lifestyle, activities, collection environments and adherence in direct cortisol trials are unverified. Causes of biomarker changes are not newly established.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Medication, lifestyle, activities, collection environments and adherence in direct cortisol trials are unverified. Causes of biomarker changes are not newly established."
    },
    {
      "item_id": "N22",
      "question_type": "Evidence condition",
      "question": "What support and conflicts were disclosed in direct cortisol reports?",
      "needed": "Funding, training support, employee authors and conflicts",
      "role": "Required",
      "role_reason": "This condition connects Funding, training support, employee authors and conflicts with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Funding, training support, employee authors and conflicts must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Evidence is lacking to establish the absence of support, affiliations, conflicts or involvement, or to certify independence. This records needed materials; no new research was executed.",
      "current_reports": [
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The original record that funding in Ozturk and Fujisawa was unable to be verified is retained.",
      "condition_status": "Unverified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "Evidence is lacking to establish the absence of support, affiliations, conflicts or involvement, or to certify independence.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Evidence is lacking to establish the absence of support, affiliations, conflicts or involvement, or to certify independence."
    },
    {
      "item_id": "N23",
      "question_type": "Evidence condition",
      "question": "Does a no-support declaration verify role separation and independence?",
      "needed": "Support/conflict declarations and instructor/assessor roles",
      "role": "Required",
      "role_reason": "This condition connects Support/conflict declarations and instructor/assessor roles with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Support/conflict declarations and instructor/assessor roles must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: The declaration is not converted into confirmation of all support, blinding or independence. Original support disclosures were not read in this work. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "Bilgihan's declaration of no external funding or conflicts is retained alongside combined instructor/assessor roles.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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 declaration is not converted into confirmation of all support, blinding or independence. Original support disclosures were not read in this work.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "The declaration is not converted into confirmation of all support, blinding or independence. Original support disclosures were not read in this work."
    },
    {
      "item_id": "N24",
      "question_type": "Evidence condition",
      "question": "What context do other stress trials' registration and support provide?",
      "needed": "Unverified support, retrospective registration and the scope of originals",
      "role": "Required",
      "role_reason": "This condition connects Unverified support, retrospective registration and the scope of originals with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Unverified support, retrospective registration and the scope of originals must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: The registration, support and amendment originals are unread. They do not substitute for prespecification in direct cortisol trials. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "Yaş's unverified support and retrospective NCT06175936 registration and Bilgihan's NCT07015372 date-consistency concerns are retained separately.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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 registration, support and amendment originals are unread. They do not substitute for prespecification in direct cortisol trials.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "The registration, support and amendment originals are unread. They do not substitute for prespecification in direct cortisol trials."
    },
    {
      "item_id": "N25",
      "question_type": "Evidence condition",
      "question": "How were harms collected and compared?",
      "needed": "Harms definitions, events, denominators, exposure, discontinuation and missingness",
      "role": "Supplementary",
      "role_reason": "This condition connects Harms definitions, events, denominators, exposure, discontinuation and missingness with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Harms definitions, events, denominators, exposure, discontinuation and missingness must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Harms events, denominators, arm-specific comparisons, timing, missingness and discontinuation data are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "Parent safety is Unknown, with insufficient arm-specific adverse-event and long-term safety numbers. A biomarker reduction is not converted into safety.",
      "condition_status": "Unverified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "Harms events, denominators, arm-specific comparisons, timing, missingness and discontinuation data are unverified.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Harms events, denominators, arm-specific comparisons, timing, missingness and discontinuation data are unverified."
    },
    {
      "item_id": "N26",
      "question_type": "Evidence condition",
      "question": "What are the boundaries for long-term and vulnerable-population harms and guidance?",
      "needed": "Populations, concurrent exposures, long-term harms and the original safety explanation",
      "role": "Supplementary",
      "role_reason": "This condition connects Populations, concurrent exposures, long-term harms and the original safety explanation with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Populations, concurrent exposures, long-term harms and the original safety explanation must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Long-term and vulnerable-population evidence, alternative causes and concurrent exposures are unverified. Unknown is not converted into safe or no events. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The parent safety explanation is preserved as historical context. No new yoga or mental-health treatment instructions are created.",
      "condition_status": "Unverified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "Long-term and vulnerable-population evidence, alternative causes and concurrent exposures are unverified. Unknown is not converted into safe or no events.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Long-term and vulnerable-population evidence, alternative causes and concurrent exposures are unverified. Unknown is not converted into safe or no events."
    },
    {
      "item_id": "N27",
      "question_type": "Evidence condition",
      "question": "How are explanatory numbers, languages and parent axes retained?",
      "needed": "Original Korean/English explanations, parent precision and corrections",
      "role": "Required",
      "role_reason": "This condition connects Original Korean/English explanations, parent precision and corrections with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Original Korean/English explanations, parent precision and corrections must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: Historical review and explanatory numbers are not inherited as new structured scores, current review or certification. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "Parent C50, Korean/English originals, unspecified precision, evidence date 2026-09-07, an empty corrections list and empty deliberation are retained. The subclaim C's 46-level and English C46 expressions are original explanation, with no separate score.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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": "Historical review and explanatory numbers are not inherited as new structured scores, current review or certification.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Historical review and explanatory numbers are not inherited as new structured scores, current review or certification."
    },
    {
      "item_id": "N28",
      "question_type": "Evidence condition",
      "question": "What was actually read, and what is the status of external materials?",
      "needed": "Reading status of stored summaries, originals, registration, plans and support",
      "role": "Required",
      "role_reason": "This condition connects Reading status of stored summaries, originals, registration, plans and support with direct salivary cortisol trials, populations, combined programs, actual controls, collection, units, timing, denominators, models, prespecification, between-arm effects or harms, distinguishing parent stress reports.",
      "application_exception": "Distinguish original subclaim C, explanatory 46-level wording and absent separate score/status/axes from parent C50 and Unknown safety. Positivity in some sessions, acute time changes and video-related changes are not converted into consistent overall reduction or laughter-specific effects. Parent PSS/multivariate statistics, headline samples, programs and blinding context are not reassigned as cortisol values, denominators or procedures. No new effects, confidence intervals, rates, clinical totals, independence/safety certification or practice instructions are created.",
      "criterion": "Material for Reading status of stored summaries, originals, registration, plans and support must be linked to the relevant cortisol trial, session, arm and outcome, distinguishing what the stored summary records from unread and unverified external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, exposure, comparators, reports versus trials, outcomes, denominators and harms were referenced.",
      "condition_origin": "These are in-house application conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed individual content review.",
      "proposed_research": "Material needed: External papers, registration, protocols, analysis plans and support disclosures were unread and access was not attempted. Historical verification and URLs are not promoted to current reading. This records needed materials; no new research was executed.",
      "current_reports": [
        "S01",
        "S02",
        "S03",
        "S04"
      ],
      "existence": "Relevant stored-summary statements were used; exact external-original content and acquisition are unverified.",
      "acquired_read": "Stored summary read; external papers, registration, protocols, analysis plans and support disclosures unread",
      "observation": "The complete stored parent summary and bibliography were read for production. Material links, reading of stored summaries and unread external materials are distinguished.",
      "condition_status": "Partly verified",
      "status_reason": "Direct cortisol evidence and parent context were 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, analysis plans and support disclosures were unread and access was not attempted. Historical verification and URLs are not promoted to current reading.",
      "uncertainty": "External originals are unread and review of existing content remains incomplete. Original grades, explanatory numbers, parent axes and historical narratives are not used as new verdicts, scores, current verification or independence certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "External papers, registration, protocols, analysis plans and support disclosures were unread and access was not attempted. Historical verification and URLs are not promoted to current reading."
    }
  ],
  "reports": [
    {
      "report_id": "S01",
      "title": "Bilgihan S, Dost A. The effect of laughter yoga on the general health status, perceived stress and burnout levels of psychiatric nurses: a randomized controlled study. Discover Psychology. 2026;6:200. DOI: 10.1007/s44202-026-00725-4.",
      "url": "https://doi.org/10.1007/s44202-026-00725-4",
      "report_type": "Randomized controlled trial",
      "existence": "The stored summary contains a bibliography; acquisition and reading of external originals are unverified.",
      "acquired_read": "Stored summary read; external materials unread",
      "study_family": "Original report shared across parent/subclaims; unique counts and independence unverified",
      "independent_replication": "The parent, perceived-stress and cortisol subclaims share the four original reports. Direct cortisol reports are distinguished from background stress reports. Original report-specific groups are retained, but exact recruitment, cohort and registration relationships and unique trial, participant and event counts are unverified. Other sheets, arms and sessions are not added as new independent replications.",
      "observed_result": "PSS group-by-time F(1,68)=251.56, P<.001, partial eta-squared .787; trial and registration dates raised timing concerns",
      "result_level": "Parent stress-trial PSS/GHQ/burnout context: 70 participants, all completing at 35 versus 35. The original list has no salivary cortisol endpoint; these statistics, denominators, program and combined roles are not reassigned as direct biomarker results.",
      "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 DOI 10.1007/s44202-026-00725-4, NCT07015372 and timing concerns. PMID/PMCID are unrecorded. No-external-funding/COI declarations and combined instructor/assessor roles provide parent stress context, not current full-text or registration-content verification."
        },
        {
          "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 DOI 10.1007/s44202-026-00725-4, NCT07015372 and timing concerns. PMID/PMCID are unrecorded. No-external-funding/COI declarations and combined instructor/assessor roles provide parent stress context, not current full-text or registration-content verification."
        },
        {
          "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 DOI 10.1007/s44202-026-00725-4, NCT07015372 and timing concerns. PMID/PMCID are unrecorded. No-external-funding/COI declarations and combined instructor/assessor roles provide parent stress context, not current full-text or registration-content verification."
        },
        {
          "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 DOI 10.1007/s44202-026-00725-4, NCT07015372 and timing concerns. PMID/PMCID are unrecorded. No-external-funding/COI declarations and combined instructor/assessor roles provide parent stress context, not current full-text or registration-content verification."
        },
        {
          "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 DOI 10.1007/s44202-026-00725-4, NCT07015372 and timing concerns. PMID/PMCID are unrecorded. No-external-funding/COI declarations and combined instructor/assessor roles provide parent stress context, not current full-text or registration-content verification."
        },
        {
          "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 DOI 10.1007/s44202-026-00725-4, NCT07015372 and timing concerns. PMID/PMCID are unrecorded. No-external-funding/COI declarations and combined instructor/assessor roles provide parent stress context, not current full-text or registration-content verification."
        }
      ],
      "links": [
        {
          "label": "Official source",
          "url": "https://doi.org/10.1007/s44202-026-00725-4"
        }
      ]
    },
    {
      "report_id": "S02",
      "title": "Yaş MA, et al. The effect of laughter yoga on well-being, perceived stress, and academic self-efficacy in nursing students: A randomized controlled trial. Appl Psychol Health Well Being. 2025;17:e12610. PMID: 39415513. PMCID: PMC11635907. DOI: 10.1111/aphw.12610.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/39415513/",
      "report_type": "Randomized controlled trial",
      "existence": "The stored summary contains a bibliography; acquisition and reading of external originals are unverified.",
      "acquired_read": "Stored summary read; external materials unread",
      "study_family": "Original report shared across parent/subclaims; unique counts and independence unverified",
      "independent_replication": "The parent, perceived-stress and cortisol subclaims share the four original reports. Direct cortisol reports are distinguished from background stress reports. Original report-specific groups are retained, but exact recruitment, cohort and registration relationships and unique trial, participant and event counts are unverified. Other sheets, arms and sessions are not added as new independent replications.",
      "observed_result": "A null between-group abstract statement coexisted with a multivariate interaction F=10.69, P<.001; registration was retrospective",
      "result_level": "Parent stress context: 83 analyzed, 41 versus 42. Original abstract between-arm null, main-text multivariate interaction and retrospective-registration statements are retained together. Well-being, PSS and self-efficacy statistics are not converted into cortisol effects or exact null effects.",
      "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 PMID 39415513, PMC11635907, DOI 10.1111/aphw.12610 and NCT06175936. Abstract/main-text conflict and retrospective registration are original narratives, not newly resolved. Funding is unverified; these are not direct salivary cortisol results."
        },
        {
          "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 PMID 39415513, PMC11635907, DOI 10.1111/aphw.12610 and NCT06175936. Abstract/main-text conflict and retrospective registration are original narratives, not newly resolved. Funding is unverified; these are not direct salivary cortisol results."
        },
        {
          "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 PMID 39415513, PMC11635907, DOI 10.1111/aphw.12610 and NCT06175936. Abstract/main-text conflict and retrospective registration are original narratives, not newly resolved. Funding is unverified; these are not direct salivary cortisol results."
        },
        {
          "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 PMID 39415513, PMC11635907, DOI 10.1111/aphw.12610 and NCT06175936. Abstract/main-text conflict and retrospective registration are original narratives, not newly resolved. Funding is unverified; these are not direct salivary cortisol results."
        },
        {
          "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 PMID 39415513, PMC11635907, DOI 10.1111/aphw.12610 and NCT06175936. Abstract/main-text conflict and retrospective registration are original narratives, not newly resolved. Funding is unverified; these are not direct salivary cortisol results."
        },
        {
          "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 PMID 39415513, PMC11635907, DOI 10.1111/aphw.12610 and NCT06175936. Abstract/main-text conflict and retrospective registration are original narratives, not newly resolved. Funding is unverified; these are not direct salivary cortisol results."
        }
      ],
      "links": [
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/39415513/"
        }
      ]
    },
    {
      "report_id": "S03",
      "title": "Ozturk FO, Tezel A. Effect of laughter yoga on mental symptoms and salivary cortisol levels in first-year nursing students: A randomized controlled trial. Int J Nurs Pract. 2021;27:e12924. PMID: 33580606. DOI: 10.1111/ijn.12924.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/33580606/",
      "report_type": "Eight-session randomized controlled trial",
      "existence": "The stored summary contains a bibliography; acquisition and reading of external originals are unverified.",
      "acquired_read": "Stored summary read; external materials unread",
      "study_family": "Original report shared across parent/subclaims; unique counts and independence unverified",
      "independent_replication": "The parent, perceived-stress and cortisol subclaims share the four original reports. Direct cortisol reports are distinguished from background stress reports. Original report-specific groups are retained, but exact recruitment, cohort and registration relationships and unique trial, participant and event counts are unverified. Other sheets, arms and sessions are not added as new independent replications.",
      "observed_result": "Mental symptoms favored intervention; cortisol was between-group positive in only 3 of 8 sessions",
      "result_level": "Directly relevant original account: 75 participants over 8 sessions, with between-arm cortisol positivity in 3 of 8 sessions. Positive mental-symptom findings are separate. Session- and arm-specific concentrations, specimen denominators, direct contrasts, CIs, collection, assays, prespecified hierarchy and multiplicity 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 PMID 33580606 and DOI 10.1111/ijn.12924. PMCID is unrecorded; registration and support are unverified. Between-arm positivity in some sessions is not extended to consistent overall reduction; external originals and plans were unread in this work."
        },
        {
          "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 PMID 33580606 and DOI 10.1111/ijn.12924. PMCID is unrecorded; registration and support are unverified. Between-arm positivity in some sessions is not extended to consistent overall reduction; external originals and plans were unread in this work."
        },
        {
          "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 PMID 33580606 and DOI 10.1111/ijn.12924. PMCID is unrecorded; registration and support are unverified. Between-arm positivity in some sessions is not extended to consistent overall reduction; external originals and plans were unread in this work."
        },
        {
          "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 PMID 33580606 and DOI 10.1111/ijn.12924. PMCID is unrecorded; registration and support are unverified. Between-arm positivity in some sessions is not extended to consistent overall reduction; external originals and plans were unread in this work."
        },
        {
          "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 PMID 33580606 and DOI 10.1111/ijn.12924. PMCID is unrecorded; registration and support are unverified. Between-arm positivity in some sessions is not extended to consistent overall reduction; external originals and plans were unread in this work."
        },
        {
          "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 PMID 33580606 and DOI 10.1111/ijn.12924. PMCID is unrecorded; registration and support are unverified. Between-arm positivity in some sessions is not extended to consistent overall reduction; external originals and plans were unread in this work."
        }
      ],
      "links": [
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/33580606/"
        }
      ]
    },
    {
      "report_id": "S04",
      "title": "Fujisawa A, et al. Effect of laughter yoga on salivary cortisol and dehydroepiandrosterone among healthy university students: A randomized controlled trial. Complement Ther Clin Pract. 2018;32:6-11. PMID: 30057059. DOI: 10.1016/j.ctcp.2018.04.005.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/30057059/",
      "report_type": "Three-arm laughter-yoga, humorous-video, and reading randomized trial",
      "existence": "The stored summary contains a bibliography; acquisition and reading of external originals are unverified.",
      "acquired_read": "Stored summary read; external materials unread",
      "study_family": "Original report shared across parent/subclaims; unique counts and independence unverified",
      "independent_replication": "The parent, perceived-stress and cortisol subclaims share the four original reports. Direct cortisol reports are distinguished from background stress reports. Original report-specific groups are retained, but exact recruitment, cohort and registration relationships and unique trial, participant and event counts are unverified. Other sheets, arms and sessions are not added as new independent replications.",
      "observed_result": "Cortisol changed over time, humorous video also changed it, and DHEA was null",
      "result_level": "Directly relevant original account from an acute 3-arm comparison in 120 healthy students: cortisol changed over time, video also changed and DHEA was null. Exact laughter-yoga between-arm and group-by-time contrasts, CIs, denominators, collection and long-term persistence 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 PMID 30057059, DOI 10.1016/j.ctcp.2018.04.005 and UMIN000019409. PMCID is unrecorded; support and exact comparative CIs are unverified. UMIN is not relabeled as NCT, and the identifier is not treated as current registration-content verification."
        },
        {
          "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 PMID 30057059, DOI 10.1016/j.ctcp.2018.04.005 and UMIN000019409. PMCID is unrecorded; support and exact comparative CIs are unverified. UMIN is not relabeled as NCT, and the identifier is not treated as current registration-content verification."
        },
        {
          "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 PMID 30057059, DOI 10.1016/j.ctcp.2018.04.005 and UMIN000019409. PMCID is unrecorded; support and exact comparative CIs are unverified. UMIN is not relabeled as NCT, and the identifier is not treated as current registration-content verification."
        },
        {
          "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 PMID 30057059, DOI 10.1016/j.ctcp.2018.04.005 and UMIN000019409. PMCID is unrecorded; support and exact comparative CIs are unverified. UMIN is not relabeled as NCT, and the identifier is not treated as current registration-content verification."
        },
        {
          "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 PMID 30057059, DOI 10.1016/j.ctcp.2018.04.005 and UMIN000019409. PMCID is unrecorded; support and exact comparative CIs are unverified. UMIN is not relabeled as NCT, and the identifier is not treated as current registration-content verification."
        },
        {
          "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 PMID 30057059, DOI 10.1016/j.ctcp.2018.04.005 and UMIN000019409. PMCID is unrecorded; support and exact comparative CIs are unverified. UMIN is not relabeled as NCT, and the identifier is not treated as current registration-content verification."
        }
      ],
      "links": [
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/30057059/"
        }
      ]
    }
  ],
  "method_sources": [
    {
      "id": "M03",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2023-08",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03",
      "section": "§3.1, §3.2.1–3.2.3, MECIR C5/C7/C13",
      "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."
    },
    {
      "id": "M04",
      "version": "Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04",
      "section": "§4.5, §4.6.1–4.6.3, MECIR C42",
      "official_principle": "Distinguish studies from reports and link them; do not omit a study solely because results are unreported.",
      "review_level": "Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed."
    },
    {
      "id": "M08",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2019-10",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08",
      "section": "§8.1–8.2.3, Table 8.2.a",
      "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."
    },
    {
      "id": "M15",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2023-08",
      "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."
    },
    {
      "id": "M19",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2019-10",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-19",
      "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."
    }
  ],
  "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": "The parent, perceived-stress and cortisol subclaims share the four original reports. Direct cortisol reports are distinguished from background stress reports. Original report-specific groups are retained, but exact recruitment, cohort and registration relationships and unique trial, participant and event counts are unverified. Other sheets, arms and sessions are not added as new independent replications."
  },
  "history": [
    {
      "date": "2026-10-19",
      "kind": "Separation of public-facing pages and materials",
      "view_version": "1.0",
      "change": "Public reader pages and material were prepared from the existing 28 items. No new clinical searches, verification-state changes or scoring were performed."
    }
  ],
  "language": "en",
  "translation_date": "2026-10-19"
}