{
  "schema_version": "chamgap-public-criteria-1.0",
  "title": "Medical-grade manuka honey × MGD dry-eye signs: formulation-specific staining and meibomian signals",
  "language": "en",
  "translation_date": "2026-10-21",
  "criteria_version": "1.0",
  "criteria_date": "2026-10-06",
  "condition_origin": "Chamgap's own application conditions",
  "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": {
    "Partly verified": "Partial information from the stored summary is linked; detailed originals and content review remain incomplete.",
    "Unverified": "Required details cannot be established within the preserved scope. This does not establish absence of effects or studies, or safety.",
    "Review incomplete": "Review of existing content remains incomplete.",
    "Met": "This state is used only within the relevant conditions after material verification and content review. It was not automatically assigned in this work.",
    "Not reported": "Unreported within material actually read. Unread external material is not relabeled as unreported.",
    "Inaccessible": "This means actual access failure. External access was not attempted in this work, so this state was not assigned.",
    "Not applicable": "Used only with an application exception and reason based on the question scope.",
    "Conflicting data": "This requires actual comparison of materials; no new conflict judgment was made in this work.",
    "Insufficient evidence for the conditions": "This indicates gaps in additional material for the selected conditions. Unread material as a whole is not converted into an efficacy grade."
  },
  "requirements": [
    {
      "item_id": "N01",
      "question_type": "Evidence condition",
      "question": "Which signs question does this evidence check cover?",
      "needed": "Formulation-specific comparisons for improvement in selected staining and meibomian signs",
      "role": "Required",
      "role_reason": "Material on Formulation-specific comparisons for improvement in selected staining and meibomian signs is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Formulation-specific comparisons for improvement in selected staining and meibomian signs must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Selected findings are not expanded into all signs or symptom effects. Original formulation, sign, control and time-specific tables, denominators and CIs require additional material. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N02",
      "question_type": "Evidence condition",
      "question": "What does the staining signal with 16% drops represent?",
      "needed": "Staining measurement with drops, between-group estimates, P values and CIs",
      "role": "Required",
      "role_reason": "Material on Staining measurement with drops, between-group estimates, P values and CIs is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Staining measurement with drops, between-group estimates, P values and CIs must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Original staining sites, scales, assessors, time points, groups, denominators, effects and CIs remain unverified. The value is not converted into a symptom or gel result. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N03",
      "question_type": "Evidence condition",
      "question": "What is the meibum quality signal with 98% gel?",
      "needed": "The definition, assessment, between-group effect, P values and CIs for gel meibum quality",
      "role": "Required",
      "role_reason": "Material on The definition, assessment, between-group effect, P values and CIs for gel meibum quality is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on The definition, assessment, between-group effect, P values and CIs for gel meibum quality must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: The same value is not copied to staining, gland expressibility or all signs. Grades, scales, assessment, expression methods, groups, denominators, time points, effects and CIs remain unverified. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N04",
      "question_type": "Evidence condition",
      "question": "What is the gland expressibility signal with 98% gel?",
      "needed": "Gland expressibility scales, measurement, between-group effects, P values and CIs",
      "role": "Required",
      "role_reason": "Material on Gland expressibility scales, measurement, between-group effects, P values and CIs is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Gland expressibility scales, measurement, between-group effects, P values and CIs must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Gland selection, measurement, grades, assessors, groups, time points, denominators, effects and CIs remain unverified. New differences are not calculated. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N05",
      "question_type": "Evidence condition",
      "question": "How do P values differ from effect size and precision?",
      "needed": "Sign-specific between-group estimates, variance and 95% CIs",
      "role": "Required",
      "role_reason": "Material on Sign-specific between-group estimates, variance and 95% CIs is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Sign-specific between-group estimates, variance and 95% CIs must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: P values alone do not newly verify large effects, precision, cure or equivalence. Original formulation-specific estimates, baseline and changes, denominators, variance, CIs and models remain unverified. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N06",
      "question_type": "Evidence condition",
      "question": "Are improvement in all groups and added sign effects distinguished?",
      "needed": "Direct comparison conditions for each formulation and sign versus common care",
      "role": "Required",
      "role_reason": "Material on Direct comparison conditions for each formulation and sign versus common care is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Direct comparison conditions for each formulation and sign versus common care must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Overall recovery is not assigned to honey as an ingredient. Common care, formulation-specific baselines, time points, all results and between-group contrast tables remain unverified. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N07",
      "question_type": "Evidence condition",
      "question": "Can drops, gel, staining and gland measures be interchanged?",
      "needed": "Matching 16% drop staining to 98% gel quality and expressibility",
      "role": "Required",
      "role_reason": "Material on Matching 16% drop staining to 98% gel quality and expressibility is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Matching 16% drop staining to 98% gel quality and expressibility must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: They are not pooled into a combined effect for one product or scale. Formulations, administration, scales, time points, group denominators and direct superiority comparisons remain unverified; formulation equivalence or superiority is not established. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N08",
      "question_type": "Evidence condition",
      "question": "Are assessors and reproducibility of staining and meibum measurement verified?",
      "needed": "Original measurement, expression, assessment sites, scales and masking methods",
      "role": "Required",
      "role_reason": "Material on Original measurement, expression, assessment sites, scales and masking methods is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Original measurement, expression, assessment sites, scales and masking methods must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Successful assessor masking is not newly added to an open trial. Tests, scales, sites, gland selection, assessors, photographs, video, measurement records and time points remain unverified. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N09",
      "question_type": "Evidence condition",
      "question": "How do the open 3-group design, multiple outcomes and selected signals relate?",
      "needed": "Prespecified primary outcomes, multiple signs and time points, and multiplicity plans",
      "role": "Required",
      "role_reason": "Material on Prespecified primary outcomes, multiple signs and time points, and multiplicity plans is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Prespecified primary outcomes, multiple signs and time points, and multiplicity plans must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Selected positive P values do not establish prespecified primary-outcome success or positive findings for all outcomes. Registration, protocols, analysis plans, all result tables and multiplicity remain unverified; no new official risk assessment is created. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N10",
      "question_type": "Evidence condition",
      "question": "Does the supporting trial's signs list also provide exact effects?",
      "needed": "Tear-film, inflammation and staining results from the 59-participant trial",
      "role": "Required",
      "role_reason": "Material on Tear-film, inflammation and staining results from the 59-participant trial is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Tear-film, inflammation and staining results from the 59-participant trial must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: SPEED values or P values are not copied into sign results. Original sign-specific results, time points, denominators, formulation, hierarchy, between-group effects and CIs remain unverified. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N11",
      "question_type": "Evidence condition",
      "question": "Are symptom superiority and sign signals different questions?",
      "needed": "The boundary of direct results for selected signs and the symptom question",
      "role": "Supplementary",
      "role_reason": "Material on The boundary of direct results for selected signs and the symptom question is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on The boundary of direct results for selected signs and the symptom question must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Original symptom and sign tables, denominators, scales and matching within the same cohort remain unverified. Shared reports across the questions are not counted as separate independent replication. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N12",
      "question_type": "Evidence condition",
      "question": "Do tear film, colonization and lubricant use share the same effect?",
      "needed": "Separate outcomes for other ocular-surface measures, mechanisms and medication use",
      "role": "Supplementary",
      "role_reason": "Material on Separate outcomes for other ocular-surface measures, mechanisms and medication use is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Separate outcomes for other ocular-surface measures, mechanisms and medication use must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: The selected 3 P values are not used as effects on remaining outcomes, clinical symptoms or infection prevention. Each original outcome, hierarchy, value, denominator and between-group contrast remains unverified; unrecorded effects or CIs are not created. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N13",
      "question_type": "Evidence condition",
      "question": "How are the principal 8 weeks, supporting 3 weeks and long-term recovery distinguished?",
      "needed": "Sign-specific time points, exposure, post-stopping and long-term follow-up",
      "role": "Supplementary",
      "role_reason": "Material on Sign-specific time points, exposure, post-stopping and long-term follow-up is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Sign-specific time points, exposure, post-stopping and long-term follow-up must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Sign signals are not expanded into permanent gland recovery or long-term durability. Report-specific sign time points, administration, long-term and post-stopping course and direct results remain unverified. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N14",
      "question_type": "Evidence condition",
      "question": "How are medical-grade sterile products distinguished from food honey?",
      "needed": "Manufacture, quality and actual administration of medical-grade 16% drops and 98% gel",
      "role": "Required",
      "role_reason": "Material on Manufacture, quality and actual administration of medical-grade 16% drops and 98% gel is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Manufacture, quality and actual administration of medical-grade 16% drops and 98% gel must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Product, sterility, ingredients, manufacture, dose, frequency and administration records remain unverified in detail. Medical-grade product records are not expanded into effects of food-grade or nonsterile products. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N15",
      "question_type": "Evidence condition",
      "question": "What was added to common lid care?",
      "needed": "Warm compresses, massage, preservative-free lubricant and formulation-specific additional care",
      "role": "Required",
      "role_reason": "Material on Warm compresses, massage, preservative-free lubricant and formulation-specific additional care is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Warm compresses, massage, preservative-free lubricant and formulation-specific additional care must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: It is not converted into evidence for stopping care or standalone treatment. Common-care rules, adherence, additional and rescue medications, formulation-specific matching and changes remain unverified. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N16",
      "question_type": "Evidence condition",
      "question": "Are MGD diagnosis and sample size the same information?",
      "needed": "Diagnosis, severity, baseline status and group-specific eligibility in evaporative dry eye",
      "role": "Required",
      "role_reason": "Material on Diagnosis, severity, baseline status and group-specific eligibility in evaporative dry eye is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Diagnosis, severity, baseline status and group-specific eligibility in evaporative dry eye must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Sample size does not replace diagnostic or eligibility criteria. Diagnosis, severity, baseline symptoms and signs, age, comorbidities and group-specific inclusion and exclusion remain unverified. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N17",
      "question_type": "Evidence condition",
      "question": "What are the selected-sign denominators in 114 participants and 3 groups?",
      "needed": "Group allocation, completion, analysis and endpoint-specific eye and patient denominators",
      "role": "Required",
      "role_reason": "Material on Group allocation, completion, analysis and endpoint-specific eye and patient denominators is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Group allocation, completion, analysis and endpoint-specific eye and patient denominators must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Group allocation, completion, formulations, care groups, endpoints, time points, bilateral-eye and patient denominators and exclusions remain unverified. Denominators absent from the original are not created. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N18",
      "question_type": "Evidence condition",
      "question": "What denominators are 59 randomized and 55 completed?",
      "needed": "Supporting-trial allocation, completion, analysis and group, eye and patient endpoint denominators",
      "role": "Required",
      "role_reason": "Material on Supporting-trial allocation, completion, analysis and group, eye and patient endpoint denominators is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Supporting-trial allocation, completion, analysis and group, eye and patient endpoint denominators must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Attrition counts or group-specific and endpoint-specific analysis denominators are not calculated or established. Group flow, reasons, time points and eye and patient denominators remain unverified. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N19",
      "question_type": "Evidence condition",
      "question": "What is the impact of missingness, attrition and measurement exclusions?",
      "needed": "Group flow, missing selected-sign outcomes, analysis populations and sensitivity analyses",
      "role": "Required",
      "role_reason": "Material on Group flow, missing selected-sign outcomes, analysis populations and sensitivity analyses is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Group flow, missing selected-sign outcomes, analysis populations and sensitivity analyses must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Unread external material is not converted into absence of missingness. Missingness, stopping, exclusions, ITT and completer analyses, missing-data handling, sensitivity and group and eye matching remain unverified. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N20",
      "question_type": "Evidence condition",
      "question": "What were the baseline adjustment, change and testing conditions?",
      "needed": "The effect of interest, baseline adjustment, change and final values, and variance",
      "role": "Required",
      "role_reason": "Material on The effect of interest, baseline adjustment, change and final values, and variance is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on The effect of interest, baseline adjustment, change and final values, and variance must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Original analysis plans, statistical tables, baseline and changes, within-eye and within-person correlation, models and CIs remain unverified. New effects or CIs are not back-calculated. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N21",
      "question_type": "Evidence condition",
      "question": "Does a registration number also verify prespecified plans?",
      "needed": "Registration, history, primary outcomes, changes and original plans for both trials",
      "role": "Required",
      "role_reason": "Material on Registration, history, primary outcomes, changes and original plans for both trials is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Registration, history, primary outcomes, changes and original plans for both trials must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: The number's existence is not promoted into registration reading in this work, prespecification, hierarchy at all time points or plan adherence. Official registration history, protocols and analysis plans were unread in this work. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N22",
      "question_type": "Evidence condition",
      "question": "Do parent and subquestions share the same reports?",
      "needed": "Report, trial and participant links between the symptom question and other questions",
      "role": "Required",
      "role_reason": "Material on Report, trial and participant links between the symptom question and other questions is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Report, trial and participant links between the symptom question and other questions must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Sheet counts are not counted as new studies or independent replications. Report, trial, registration, sample, institution, timing and additional-report matching and unique trial and participant totals remain unverified. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N23",
      "question_type": "Evidence condition",
      "question": "Is independent replication across teams, products and formulations verified?",
      "needed": "Unique trials and independent teams for the same selected signs, formulation, population, comparison and time point",
      "role": "Supplementary",
      "role_reason": "Material on Unique trials and independent teams for the same selected signs, formulation, population, comparison and time point is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Unique trials and independent teams for the same selected signs, formulation, population, comparison and time point must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Different reports or assessor masking alone do not newly establish independent teams or replication under the same conditions. Team, institution, product, funding, participant, effect and denominator matching remain unverified. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N24",
      "question_type": "Evidence condition",
      "question": "How much is known about product provision and company involvement?",
      "needed": "Trial-specific funding, product support, employee authors and conflicts",
      "role": "Required",
      "role_reason": "Material on Trial-specific funding, product support, employee authors and conflicts is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Trial-specific funding, product support, employee authors and conflicts must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Unrecorded funding, employee relationships, analysis and publication roles remain unverified. Product provision is not treated as verification of every involvement route or as absence of independence. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N25",
      "question_type": "Evidence condition",
      "question": "What is the scope of reported stinging and redness?",
      "needed": "Medical-grade product adverse reactions, collection methods, stopping and controls",
      "role": "Supplementary",
      "role_reason": "Material on Medical-grade product adverse reactions, collection methods, stopping and controls is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Medical-grade product adverse reactions, collection methods, stopping and controls must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Event counts, incidence or new causality are not created. Collection methods, group and formulation-specific events, severity, timing, stopping, missingness and controls remain unverified. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N26",
      "question_type": "Evidence condition",
      "question": "What are the eye and patient harm denominators and exposures?",
      "needed": "Safety populations, eyes, patients, formulations, durations and actual instillation exposure",
      "role": "Supplementary",
      "role_reason": "Material on Safety populations, eyes, patients, formulations, durations and actual instillation exposure is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Safety populations, eyes, patients, formulations, durations and actual instillation exposure must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Safety denominators, actual instillation, group, eye and formulation-specific events, stopping, exposure and controls remain unverified. Incidence is not calculated. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N27",
      "question_type": "Evidence condition",
      "question": "Are food or nonsterile risks distinguished from medical-grade product reactions?",
      "needed": "Manufacture, sterility, baseline eye conditions, other causes and clinical course",
      "role": "Supplementary",
      "role_reason": "Material on Manufacture, sterility, baseline eye conditions, other causes and clinical course is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Manufacture, sterility, baseline eye conditions, other causes and clinical course must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: The food-honey self-instillation question is distinguished and no new case is created. Products, baseline eye conditions, concurrent use, event timing, alternative causes, controls and course remain unverified; no new harm causality is judged. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N28",
      "question_type": "Evidence condition",
      "question": "Are long-term, rare and vulnerable-population harms verified?",
      "needed": "Long exposure, independent harm reports, vulnerable populations and follow-up",
      "role": "Supplementary",
      "role_reason": "Material on Long exposure, independent harm reports, vulnerable populations and follow-up is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on Long exposure, independent harm reports, vulnerable populations and follow-up must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: Long follow-up, independent harm reports, vulnerable populations, exposure, denominators, concurrent use and course remain unverified. No external search or new harm judgment was performed in this work. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N29",
      "question_type": "Evidence condition",
      "question": "How does stored-summary reading differ from reading external originals?",
      "needed": "The complete stored summary and the reading scope for external abstracts, full texts, registration and plans",
      "role": "Required",
      "role_reason": "Material on The complete stored summary and the reading scope for external abstracts, full texts, registration and plans is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on The complete stored summary and the reading scope for external abstracts, full texts, registration and plans must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: URLs, numbers and historical verification wording do not establish current reading, successful access or fulfilled conditions. External detailed-material availability, acquisition and actual reading remain separately unverified. This records needed materials; no new research was executed."
    },
    {
      "item_id": "N30",
      "question_type": "Evidence condition",
      "question": "What do selected C, parent C46, dates and empty values record?",
      "needed": "The selected grade, absent individual score, parent axes, evidence date and corrections",
      "role": "Required",
      "role_reason": "Material on The selected grade, absent individual score, parent axes, evidence date and corrections is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms.",
      "application_exception": "Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created.",
      "criterion": "Original material on The selected grade, absent individual score, parent axes, evidence date and corrections must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials.",
      "basis": "Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production.",
      "condition_origin": "These are formulation-specific evidence conditions for the existing subquestion of improvement in selected staining or meibomian signs. They do not establish preregistration, execution of an official assessment tool or completed clinical content review.",
      "proposed_research": "Material needed: The parent's 46 points are not assigned as a subclaim score, and the historical evidence date is not changed into a new search, external reading or completed-review date. New material, condition revisions and verdict changes are separate events. This records needed materials; no new research was executed."
    }
  ]
}