{
  "title": "Nicotinamide riboside (NR; salt and product details unverified) × Improvement of usual gait speed in frail older adults",
  "criteria_version": "NGM-v3093-NR-FRAIL-USUAL-GAIT-1.0",
  "criteria_date": "2026-10-05",
  "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": "Reuse of actual original-byte/SHA copies of the methodological files preserved from the 1585 pilot. The full methodological texts were not newly read this time, nor were the official methods implemented in full."
    },
    {
      "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 exclude a study solely because its results are unreported.",
      "review_level": "Reuse of actual original-byte/SHA copies of the methodological files preserved from the 1585 pilot. The full methodological texts were not newly read this time, nor were the official methods implemented in full."
    },
    {
      "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": "Fix the outcome and effect of interest when reviewing randomization, deviations, missingness, measurement, and selective reporting.",
      "review_level": "Reuse of actual original-byte/SHA copies of the methodological files preserved from the 1585 pilot. The full methodological texts were not newly read this time, nor were the official methods implemented in full."
    },
    {
      "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. Precision is not determined by sample size alone.",
      "review_level": "Reuse of actual original-byte/SHA copies of the methodological files preserved from the 1585 pilot. The full methodological texts were not newly read this time, nor were the official methods implemented in full."
    },
    {
      "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": "Questions about harms may require designs, populations, and follow-up that differ from those for efficacy. Case reports do not establish incidence rates.",
      "review_level": "Reuse of actual original-byte/SHA copies of the methodological files preserved from the 1585 pilot. The full methodological texts were not newly read this time, nor were the official methods implemented in full."
    }
  ],
  "status_dictionary": {
    "Verified": "Verification of the stated question and boundaries in the preserved materials; not confirmation of efficacy or safety.",
    "Partly verified": "Only some information has been verified; the full set of necessary conditions remains unverified.",
    "Unverified": "Direct materials, methods, and results within the scope of the current input are unverified. This does not mean that studies are absent or that the intervention is ineffective.",
    "Not met": "The actual population, endpoint, or exposure in the materials does not match the fixed question. This is not a judgment of efficacy failure.",
    "Not applicable": "An extension condition outside the narrow question. This status must not be used in place of recording that a full text has not been read."
  },
  "schema_version": "chamgap-public-criteria-1.0",
  "condition_origin": "Chamgap’s own application conditions",
  "requirements": [
    {
      "item_id": "N01",
      "question_type": "Independent question",
      "question": "Does the table address only the between-group change in usual gait speed in frail older adults?",
      "needed": "Explicit boundaries of the original claim, population, planned oral NR, placebo, and change in usual speed at 52 weeks",
      "role": "Required",
      "role_reason": "Needed to avoid combining the ingredient's overall functions or different walking endpoints into a single effect.",
      "application_exception": "If the frailty definition or endpoint actually changes, reassess whether separation is needed while retaining the link to the same original ID. Do not automatically create a new table for another combination.",
      "criterion": "Link the original /ko/effect to the question identity and identify 6-minute walk distance, muscle strength, cognition, and NAD results as separate questions.",
      "basis": "Principles for clarifying the question in M03 §3.1, §3.2.1–3.2.4; detailed separation rules are internally designed / M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptation is internally designed",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "In a new study, specify usual speed as a single outcome of interest and prespecify the population, comparison, measurement time points, and analysis."
    },
    {
      "item_id": "N02",
      "question_type": "Ingredient identity",
      "question": "Are the NR salt, product, dosage form, and batch in the plan verified?",
      "needed": "Documentation of the exact NR salt, product, manufacturer, assayed purity, batch, and release form in NADage",
      "role": "Required",
      "role_reason": "Needed to avoid directly transferring results and safety findings from different salts, dosage forms, or products.",
      "application_exception": "If the original source does not clarify the relationship between salt mass and active-moiety amount, retain the reported mg without conversion.",
      "criterion": "Verify the identity of the substance actually used in this plan; do not substitute NIAGEN or NR chloride information from another trial.",
      "basis": "M03 §3.2.2–3.2.3; reverse-direction labeling and test adaptation are internally designed",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "A suitable comparative study records the test product's analytical results, batch, and active ingredient together with the placebo composition to define a reproducible exposure."
    },
    {
      "item_id": "N03",
      "question_type": "Single intervention",
      "question": "Are other active ingredients or exercise packages separated from the NR-versus-placebo comparison?",
      "needed": "Full product composition and rules for exercise, rehabilitation, diet, and active-ingredient use in both groups",
      "role": "Required",
      "role_reason": "Needed because differences in other active ingredients or rehabilitation may be mixed with the planned contribution of NR.",
      "application_exception": "The comparison can be retained even when common care is present if its role in both groups is verified. Do not assume that all concomitant interventions were absent.",
      "criterion": "Verify that the selected contrast is the difference between NR and placebo; do not attribute combined active ingredients or differences in exercise between groups to NR alone.",
      "basis": "M03 §3.2.2–3.2.3; reverse-direction labeling and test adaptation are internally designed / M03 §3.2.3, M08 §8.2.2–8.2.3; internal application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Specify standard care in both groups and record differences in exercise or rehabilitation, or design these as a separate factor, to estimate the NR contrast."
    },
    {
      "item_id": "N04",
      "question_type": "Frail population",
      "question": "Are the criteria of age 75 or older and Fried score 3 or higher, and the population actually selected, verified?",
      "needed": "Full eligibility criteria, selection flow, Fried components, and actual baseline characteristics table",
      "role": "Required",
      "role_reason": "Needed to avoid confusing older age alone, prefrailty, MCI, or PAD with the fixed frailty criteria.",
      "application_exception": "If data from a mixed population are available, retain the definition of the frail subgroup and its separate results. Do not discard results from other populations or combine them as direct results.",
      "criterion": "Distinguish the plan's age and frailty criteria read in the official index from whether the population actually recruited and analyzed matches those criteria.",
      "basis": "M03 §3.2.1; detailed population conditions are internally designed",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Record the actual selection criteria, baseline Fried components, and comorbidities, and link the analysis denominator for the frail population of interest."
    },
    {
      "item_id": "N05",
      "question_type": "Baseline status",
      "question": "Are baseline usual speed, nutrition, and deficiency status verified?",
      "needed": "Data on baseline gait speed, nutrition and dietary assessment, deficiency testing, medications, and walking aids",
      "role": "Required",
      "role_reason": "Needed to avoid interpreting results from people with different baseline function or nutritional status as having the same scope of applicability.",
      "application_exception": "Do not newly impose a deficiency-treatment condition on a trial that did not select participants for deficiency. Retain deficiency status as unverified.",
      "criterion": "Verify the actual baseline speed and nutrition-related selection criteria; do not substitute deficiency correction or healthy-participant results for this frailty question.",
      "basis": "M03 §3.2.1; detailed population conditions are internally designed / M03 §3.2.1–3.2.4; details concerning dose, persistence, and effect modification are internally designed",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Specify baseline functional and nutritional measures, and, if an effect-modification analysis is needed, prespecify its rationale and analysis plan."
    },
    {
      "item_id": "N06",
      "question_type": "Planned dose",
      "question": "Does 2,000 mg/day represent a value for which the actual intake and dosing schedule are also verified?",
      "needed": "Amount per dose, frequency, dose escalation, basis for salt conversion, and actual medication-taking and adherence records",
      "role": "Required",
      "role_reason": "Needed because confusing the nominal dose with the exposure actually received changes how efficacy and safety apply.",
      "application_exception": "Do not calculate a new mass or salt conversion or an optimal dose. Distinguish information that may exist in the original paper from what remains unverified in the current input.",
      "criterion": "Distinguish the daily amount in the reported plan from actual exposure; do not invent an unknown amount per dose or adherence level.",
      "basis": "M03 §3.2.2–3.2.3; reverse-direction labeling and test adaptation are internally designed / M03 §3.2.3, M08 §8.2.2–8.2.3; internal application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "In the trial, collect records of each administration and adherence, discontinuations, and dose reductions, and distinguish the prespecified effect of assignment from analyses of actual exposure."
    },
    {
      "item_id": "N07",
      "question_type": "Planned duration",
      "question": "Is the 52-week plan linked to actual exposure, measurement, and follow-up after discontinuation?",
      "needed": "Records of actual initiation, discontinuation, the week 52 visit, observation windows, and follow-up after discontinuation",
      "role": "Required",
      "role_reason": "Needed to distinguish the original question's change at 52 weeks from short-term effects or effects after discontinuation.",
      "application_exception": "Do not make all post-treatment follow-up studies mandatory for the current question. Separate the 52-week result from a distinct claim of persistence.",
      "criterion": "Do not turn the planned 52 weeks of treatment and assessment into actual visits or a subsequent maintenance effect.",
      "basis": "M03 §3.2.2–3.2.3; reverse-direction labeling and test adaptation are internally designed / M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptation is internally designed / M03 §3.2.1–3.2.4; details concerning dose, persistence, and effect modification are internally designed",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Record visit windows, actual days of exposure, and missing data appropriate to the original question; if persistence is a separate objective, design follow-up after discontinuation separately."
    },
    {
      "item_id": "N08",
      "question_type": "Placebo comparison",
      "question": "Are the placebo composition, matching method, and common care in both groups verified?",
      "needed": "Placebo composition, appearance/sensory matching, and rules for common medications, diet, exercise, and rehabilitation",
      "role": "Required",
      "role_reason": "The actual content of the control must be clear to distinguish NR's contribution to the comparison from influences on measurement.",
      "application_exception": "Do not conclude that an unverified composition means the placebo was absent or blinding failed.",
      "criterion": "Distinguish the existence of a placebo plan from verification of the actual composition, blinding, and common care.",
      "basis": "M03 §3.2.2–3.2.3; reverse-direction labeling and test adaptation are internally designed / M03 §3.2.3, M08 §8.2.2–8.2.3; internal application / M08 Table 8.2.a, M03 §3.2.4; internal application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Disclose the placebo and common care, and record blinding for medication taking and assessment and differences in care between groups."
    },
    {
      "item_id": "N09",
      "question_type": "Allocation implementation",
      "question": "Are the actual implementation and concealment of the randomized, double-blind plan verified?",
      "needed": "Full protocol, allocation-sequence generation/concealment, and data on actual allocation and baseline balance",
      "role": "Required",
      "role_reason": "Needed because the label of a planned RCT alone does not establish that an actual causal comparison was implemented.",
      "application_exception": "Do not replace an unverified design status with nonapplicability of crossover or cluster designs. Retain the plan and actual implementation separately.",
      "criterion": "Distinguish the design label from actual allocation implementation; do not describe unverified implementation as actual nonimplementation.",
      "basis": "M08 §8.1–8.2.3; internal application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Document the actual allocation sequence, concealment, blinding, and baseline characteristics, and report results for the selected effect of assignment."
    },
    {
      "item_id": "N10",
      "question_type": "Measurement of usual speed",
      "question": "Are the test distance, acceleration section, repetitions, and instrument for usual speed verified?",
      "needed": "Usual-speed measurement manual, walking aids, assessors, repetitions, and unit definitions",
      "role": "Required",
      "role_reason": "Needed to prevent differences in measurement methods from being mixed with actual functional change.",
      "application_exception": "Do not assume measurement is free of problems because the test is objective. Do not declare that information is unreported throughout the original source merely because it is absent from the plan.",
      "criterion": "Verify the actual m/s test method for habitual/comfortable pace; do not substitute maximal speed or endurance speed.",
      "basis": "M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptation is internally designed / M08 Table 8.2.a, M03 §3.2.4; internal application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Standardize the usual gait-speed procedure and specify assessment time points, aids, assessor blinding, and repeated measurements."
    },
    {
      "item_id": "N11",
      "question_type": "6-minute-walk boundary",
      "question": "Is NADage's 6-minute walk with concurrent sensors the same endpoint as usual speed over a short course?",
      "needed": "Definitions of the 6-minute walk/sensors and data on equivalence with the usual-speed test and separately reported results",
      "role": "Required",
      "role_reason": "This is a key endpoint condition for upgrading the closest study to direct evidence of the effect.",
      "application_exception": "Do not deem it equivalent to comfortable walking over a short course merely because sensors collect speed.",
      "criterion": "Do not currently equate the planned 6-minute walk with usual gait speed; require actual verification of equivalence or a separate result.",
      "basis": "M03 §3.2.4, M15 §15.3.1–15.3.3; question-specific outcome adaptation is internally designed / M08 Table 8.2.a, M03 §3.2.4; internal application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Measure the two tests separately, describe their protocols, units and observation windows, and report a usual gait speed estimate that matches the question."
    },
    {
      "item_id": "N12",
      "question_type": "Endpoint hierarchy",
      "question": "Are the page's usual gait speed endpoint and its actual trial hierarchy as primary, secondary or post hoc verified?",
      "needed": "The hierarchy of usual gait speed and reasons for changes in dated registration histories, protocols and analysis plans",
      "role": "Required",
      "role_reason": "The editor's chosen question must be distinguished from the original trial's prespecified outcome selection.",
      "application_exception": "Do not treat failure to acquire the registration history as confirmation of nonregistration or selective reporting.",
      "criterion": "Do not turn the page's single primary endpoint and the investigator page's description of the 6-minute walk as primary into a primary usual gait speed outcome within the trial.",
      "basis": "M08 Table 8.2.a, M04 §4.6.3; project-specific application / M03 §3.2.4, M15 §15.3.1–15.3.3; adaptation of outcomes to each question is project-specific",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Specify the hierarchy and analysis of usual gait speed in the advance plan, and compare the reasons for changes in the actual report together with their dates."
    },
    {
      "item_id": "N13",
      "question_type": "Planned sample",
      "question": "Are the planned 100 participants distinguished from the actual enrolled, randomized, completed and usual gait speed analysis counts?",
      "needed": "Participant flow diagram; enrollment, allocation and completion by group; usual gait speed analysis denominators and reasons for exclusion",
      "role": "Required",
      "role_reason": "This is needed to avoid claiming precision of an effect or completion on the basis of a planned number.",
      "application_exception": "Do not create a recruitment status or analysis count at the cutoff solely from historical wording that enrollment had actually begun.",
      "criterion": "Do not use planned enrollment as the outcome analysis n; link the actual denominators at each stage.",
      "basis": "M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; adaptation by study design is project-specific",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Report the actual sample flow at each stage, the corresponding usual gait speed analysis n and reasons for missingness alongside the results."
    },
    {
      "item_id": "N14",
      "question_type": "Current registry status",
      "question": "Can the latest recruitment and results-posting status as of the reference date be verified?",
      "needed": "NCT06208527 registration history, status and posted results documents as of the relevant reference date",
      "role": "Required",
      "role_reason": "This is needed to avoid wrongly attributing generic wording on the registry screen to the trial's actual progress.",
      "application_exception": "Distinguish the current status of access not attempted from the failure to acquire the body text at that earlier time. Do not use a valid response with 0 results or an unverified status to mean that research does not exist.",
      "criterion": "Distinguish the historical description of recruitment starting and the registry index from the actual status/posted results as of the reference date.",
      "basis": "M04 §4.5–4.6 principles for data collection/selection; separation of access from reading and the hyperlink contract are project-specific / M04 §4.5, §4.6.3; limits on conversion of current materials follow the user's scope and project-specific design / M08 Table 8.2.a, M04 §4.6.3; project-specific application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Verification of suitable materials means linking registry versions and results documents to their dates at the time; it is distinct from conducting a new trial itself."
    },
    {
      "item_id": "N15",
      "question_type": "Effect of interest",
      "question": "Are the actual between-group analysis, ITT/PP and adjustment for usual gait speed verified?",
      "needed": "Documents defining the estimand of interest, analysis population, model, adjustment and actual results",
      "role": "Required",
      "role_reason": "This is needed to avoid treating within-group change, the effect of adherence and the planned effect of assignment as the same actual between-group value.",
      "application_exception": "Do not fill unverified analysis information with an arbitrary ITT, complete-case or PP analysis.",
      "criterion": "Distinguish the question of the NR−placebo effect of assignment on change from baseline to 52 weeks from the actual analysis.",
      "basis": "M08 §8.2.2, M15 §15.3.1; project-specific application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Prespecify the effect of interest, handling of missingness and adherence, and adjustment in the analysis plan, and report an estimate for that contrast."
    },
    {
      "item_id": "N16",
      "question_type": "Missingness and attrition",
      "question": "Who was missing from the 52-week speed measurement, and how was this handled?",
      "needed": "Missed visits, discontinuation, death/illness, inability to measure, handling of missingness and sensitivity analyses by group",
      "role": "Required",
      "role_reason": "This is needed to distinguish values from only those with measured outcomes from the effect of assignment during long-term observation of frail participants.",
      "application_exception": "Do not turn the possibility of missingness into a confirmed magnitude of actual bias or a finding that the trial is invalid.",
      "criterion": "Link actual measurement and analysis denominators to reasons for missingness; do not turn unverified information into no attrition or 0 events.",
      "basis": "M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; adaptation by study design is project-specific / M08 §8.2.2, M15 §15.3.1; project-specific application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Report visit flow, including discontinuation, death and inability to measure, together with prespecified handling of missingness and sensitivity analyses."
    },
    {
      "item_id": "N17",
      "question_type": "Target effect estimate",
      "question": "Are direct usual gait speed changes, the between-group difference and CI verified?",
      "needed": "Group-specific original usual gait speed values/changes, between-group estimate and CI for the fixed population, exposure and time point",
      "role": "Required",
      "role_reason": "This is a key condition for distinguishing the existence of direct results from plans and adjacent numerical findings.",
      "application_exception": "Do not convert distance, within-group P values or NAD values into a direct between-group effect in m/s.",
      "criterion": "Link the m/s result corresponding to the original question; if absent, leave the value null.",
      "basis": "M03 §3.2.4, M15 §15.3.1–15.3.3; adaptation of outcomes to each question is project-specific / M15 §15.3.1–15.3.3; project-specific application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "An eligible study reports group-specific results for the defined usual gait speed test together with the estimate, CI and denominator for the selected contrast."
    },
    {
      "item_id": "N18",
      "question_type": "Variance and intervals",
      "question": "Are the SD, SE, covariance and interval type for the target change verified?",
      "needed": "Variance type, analysis n and model for usual gait speed change, and the reported between-group interval",
      "role": "Required",
      "role_reason": "This is needed to avoid creating a nonexistent interval by combining numerical values with different variance types or targets.",
      "application_exception": "Do not use an assumed variance in a plan as an actually observed variance. Do not make a broad declaration of nonreporting by saying it is absent from the original text either.",
      "criterion": "Use only variance and intervals belonging to the direct result; do not import SD or a one-sided CI from another trial.",
      "basis": "M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; adaptation by study design is project-specific / M15 §15.3.1–15.3.3; project-specific application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Disclose the variance type, denominator, interval construction and analysis model for the relevant usual gait speed result."
    },
    {
      "item_id": "N19",
      "question_type": "Clinical importance",
      "question": "Is a clinically important between-group difference appropriate to this frail population and test verified?",
      "needed": "Evidence for a clinically important between-group difference for the relevant frail population and usual gait speed protocol",
      "role": "Required",
      "role_reason": "This is needed to avoid equating nominal statistical significance with a clinically important improvement in usual gait speed.",
      "application_exception": "Because the usual gait speed value itself is the original question, do not impose a separate mortality trial as a prerequisite for that value.",
      "criterion": "Distinguish statistical success from clinical importance, and do not set an unsupported common MCID, minimum participant count or duration.",
      "basis": "M15 §15.3.1–15.3.3; project-specific application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "First justify the evidence for an important difference appropriate to the population, test and between-group contrast, then interpret it alongside the estimated interval."
    },
    {
      "item_id": "N20",
      "question_type": "Funding and provision",
      "question": "Are the plan's funding, product provision and authors' conflicts of interest directly verified?",
      "needed": "NADage's original funding information, product provision, author roles, and patent/employment/declared conflicts of interest",
      "role": "Supplementary; required for a claim of independence",
      "role_reason": "This is needed to avoid inferring independent funding or manufacturer involvement from an unverified supply chain.",
      "application_exception": "Do not exclude a result solely because a conflict of interest exists. Do not use unverified information as evidence of independence.",
      "criterion": "Separate the existence of a funding description from full verification of provision/conflicts of interest, and do not assign an independence score to a missing result.",
      "basis": "Chamgap's own conditions for independence and attribution. The official methods sections used in this pilot do not endorse all of these detailed items",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Link funding, product provision and author roles to the results data, and verify the actual study families when claiming independent replication."
    },
    {
      "item_id": "N21",
      "question_type": "Studies and reports",
      "question": "Are plans, papers, registrations and corrections kept from being double-counted as independent trials of effect?",
      "needed": "A mapping of report identifiers, native F01–F05 relationships, and eligible results/endpoints/time points",
      "role": "Required",
      "role_reason": "This is needed to avoid erasing gaps by counting materials as human trials or replication confirmations.",
      "application_exception": "If bibliographic details or report families are unresolved, retain provisional relationships and omissions; do not create new reports.",
      "criterion": "Group the investigator page and registration for the same plan, and papers/corrections for the same trial, leaving unresolved unique trial and participant counts null.",
      "basis": "M04 §4.6.1–4.6.2 distinction between studies and reports; cohort/outcome linkage is a project-specific application / M04 §4.6.1–4.6.2, M15 §15.3.1; project-specific application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "When collecting materials, verify the relationships between registration numbers/DOIs and results/time points/analyses to link multiple reports of the same study."
    },
    {
      "item_id": "N22",
      "question_type": "Adjacent trial in prefrailty",
      "question": "Is the NR-VETS population the same as the selected frail population with Fried scores of 3 or higher?",
      "needed": "Complete NR-VETS eligibility criteria, amendment history and usual gait speed results by frailty stratum",
      "role": "Required",
      "role_reason": "This is needed to avoid repurposing prefrail or non-frail results as direct results for the target frail population.",
      "application_exception": "Reconsider eligibility if the latest complete registration is acquired and shows population amendments or separate results.",
      "criterion": "Distinguish the Fried<3 description in the currently retained official institutional index from the selected frailty criterion, leaving the latest amendments or target-stratum results unverified.",
      "basis": "M03 §3.2.1; detailed population conditions are project-specific / M04 §4.6.1–4.6.2, M15 §15.3.1; project-specific application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Verify separate results by frailty stratum in that study, or perform the same usual gait speed comparison in the selected Fried≥3 population."
    },
    {
      "item_id": "N23",
      "question_type": "Within-group MCI results",
      "question": "Are Orr's two p-values a between-group effect on usual gait speed in frail participants?",
      "needed": "Orr's gait test, actual between-group m/s estimate/CI and results tables by population",
      "role": "Required",
      "role_reason": "Within-group contrasts must be distinguished from an actual between-group difference.",
      "application_exception": "Retain within-group p-values as original adjacent results, but do not calculate a new difference or CI.",
      "criterion": "Do not read the respective within-group p-values for placebo and NR as a between-group test or a result for the target frail population.",
      "basis": "M03 §3.2.4, M15 §15.3.1–15.3.3; adaptation of outcomes to each question is project-specific / M08 §8.2.2, M15 §15.3.1; project-specific application / M04 §4.6.1–4.6.2, M15 §15.3.1; project-specific application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Report a direct between-group estimate appropriate to the population of interest and usual gait speed test, and distinguish it from within-group results."
    },
    {
      "item_id": "N24",
      "question_type": "MCI denominators and schedule",
      "question": "Are Orr's actual completion count, gait analysis denominator and dosing schedule verified?",
      "needed": "Orr’s participant flow by stage, gait-analysis n, dose escalation/treatment days, and data for the target frail population",
      "role": "Required",
      "role_reason": "Needed to prevent the completed counts and schedules of adjacent trials from being imported as the exposure and denominator for the direct question.",
      "application_exception": "Detailed counts that may appear in another retained assessment of the same Orr family are not automatically imported into this manuscript.",
      "criterion": "Do not repurpose the 20 completers or descriptions of schedules from other trials as the analysis denominator or 52-week duration for the target usual gait speed.",
      "basis": "M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; adaptations by study design are internally designed / M03 §3.2.2–3.2.3; reverse-direction labeling and test adaptations are internally designed / M03 §3.2.1–3.2.4; details on dose, persistence, and effect modification are internally designed",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "For adjacent evidence, verify the actual participant flow and analysis denominator in its original table; assess the target comparison using a separate eligible population and 52-week results."
    },
    {
      "item_id": "N25",
      "question_type": "Healthy-participant crossover",
      "question": "Are Martens’ motor-function results in healthy participants equivalent to the target frailty comparison?",
      "needed": "Exposure, duration, baseline function, usual-speed results, and crossover analysis in the healthy-participant crossover trial",
      "role": "Required",
      "role_reason": "Needed to retain the existence of contrary results while preventing refutation in a different population from being transferred to this question.",
      "application_exception": "Retain the original crossover design, but do not estimate the paired variance for the target usual speed from these data.",
      "criterion": "Do not aggregate statements of no difference in motor function among healthy participants as repeated refutations of the target frailty comparison.",
      "basis": "M03 §3.2.1; detailed population criteria are internally designed / M04 §4.6.3, M15 §15.3.1–15.3.3; separation of statuses is internally designed / M08 §8.2.2, M15 §15.3.1; internal application / M04 §4.6.1–4.6.2, M15 §15.3.1; internal application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Verify results using the same frail population, exposure, and test; when using crossover data, report period, sequence, and carryover effects and a paired analysis."
    },
    {
      "item_id": "N26",
      "question_type": "Positive PAD result",
      "question": "Is NICE’s +17.6 m an effect on usual gait speed in m/s in the frail population?",
      "needed": "NICE’s original 6-minute-walk table and separate usual-speed results for the selected frail population",
      "role": "Required",
      "role_reason": "Needed to retain positive adjacent results without elevating them to direct efficacy evidence.",
      "application_exception": "Attribute the original +17.6 m and the historical 7.0−(−10.6) cross-check only to that PAD distance result.",
      "criterion": "Retain the positive 6-month result for 6-minute walk distance in its original unit, population, and contrast; do not divide by time to create a usual-speed result.",
      "basis": "M03 §3.2.4, M15 §15.3.1–15.3.3; adaptations of outcomes to each question are internally designed / M08 Table 8.2.a, M15 §15.3, M19 §19.1.2–19.2.4; adaptations by study design are internally designed / M04 §4.6.3, M15 §15.3.1–15.3.3; separation of statuses is internally designed / M04 §4.6.1–4.6.2, M15 §15.3.1; internal application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Measure usual speed separately in the target frail population and report the selected contrast, time point, and denominator."
    },
    {
      "item_id": "N27",
      "question_type": "PAD interval and criterion",
      "question": "Are NICE’s one-sided 90% CI and p=0.08 distinguished from its study-specific criterion?",
      "needed": "NICE’s prespecified statistical criterion, definition of the one-sided interval, and location of the original between-group report",
      "role": "Required",
      "role_reason": "Needed to avoid changing the meaning by misrepresenting the adjacent study’s interval type and study-specific criterion.",
      "application_exception": "Do not calculate a new two-sided CI, standardized effect, or MCID. Verify only at the level of the explanation in the manuscript at that time.",
      "criterion": "Do not convert the reported one-sided 90% interval’s lower bound and open upper bound +∞, or p=0.08, into a two-sided 95% interval or a CI in the target m/s unit.",
      "basis": "M03 §3.2.4, M15 §15.3.1–15.3.3; adaptations of outcomes to each question are internally designed / M04 §4.6.3, M15 §15.3.1–15.3.3; separation of statuses is internally designed / M15 §15.3.1–15.3.3; internal application / M08 Table 8.2.a, M04 §4.6.3; internal application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Future direct studies should disclose the prespecified statistical criterion, interval type, and contrast of interest alongside the results, distinguishing these from clinical importance."
    },
    {
      "item_id": "N28",
      "question_type": "Scope of the correction notice",
      "question": "Are the actual content of the NICE correction notice and its impact on the results verified?",
      "needed": "The original article’s change history, the full correction notice, and links between results/tables before and after the correction",
      "role": "Required",
      "role_reason": "Needed to prevent bibliographic information about a correction from being overstated as a review of its content or verification of changes to results.",
      "application_exception": "Do not label the lack of an attempt this time as an actual access failure at that earlier time.",
      "criterion": "Distinguish the correction notice’s existence/DOI from its content, and do not speculate about what was corrected.",
      "basis": "M04 §4.5–4.6 principles for data collection/selection; separation of access from reading and the hyperlink contract are internally designed / M04 §4.5, §4.6.3; limits on conversion to current materials derive from the user-defined scope and internal design / M04 §4.6.3, M15 §15.3.1–15.3.3; separation of statuses is internally designed",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "When reviewing materials, compare what the full correction notice changes with the original table and record it. This is a verification task distinct from designing a new clinical trial."
    },
    {
      "item_id": "N29",
      "question_type": "Other molecules",
      "question": "Are NMN, NAM, niacin, and tryptophan materials evidence for NR alone?",
      "needed": "The actual active ingredient, product composition, endpoint, and population identity of candidate studies",
      "role": "Required",
      "role_reason": "Needed to prevent distinct exposures from being merged under the collective term NAD precursors.",
      "application_exception": "Do not elevate a record of screening the substance from the title to verification of the full product composition or reading of the full results text.",
      "criterion": "Do not use other molecules as synonyms for NR, and do not change nicotinamide in the NICE-FIT title to NR.",
      "basis": "M03 §3.2.2–3.2.3; reverse-direction labeling and test adaptations are internally designed / M04 §4.6.1–4.6.2, M15 §15.3.1; internal application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "When checking study eligibility, verify the active molecule, salt, and composition, and design a separate direct study for the NR question."
    },
    {
      "item_id": "N30",
      "question_type": "Combination with exercise",
      "question": "Is the NR+exercise trial in hypertension a contrast of NR alone for gait speed in frailty?",
      "needed": "S15’s exercise requirements in both arms, NR contrast, frail stratum, and usual-speed results",
      "role": "Required",
      "role_reason": "Needed to avoid confusing the contribution of exercise with that of NR alone.",
      "application_exception": "Do not state that review of the full results and exercise control is complete on the basis of screening only the publisher’s abstract.",
      "criterion": "Distinguish the combination with aerobic exercise in participants with hypertension from the target contrast of NR alone versus placebo.",
      "basis": "M03 §3.2.1; detailed population criteria are internally designed / M03 §3.2.3, M08 §8.2.2–8.2.3; internal application / M04 §4.6.1–4.6.2, M15 §15.3.1; internal application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Specify the exercise common to both arms and the NR difference, or separate their contributions using a factorial design, and measure usual speed in the target frail stratum."
    },
    {
      "item_id": "N31",
      "question_type": "Species and combination products",
      "question": "Does the combination-product cognition study in senior dogs address the NR gait question in older humans?",
      "needed": "S18’s species, active ingredients, and measured outcomes, and direct evidence in humans",
      "role": "Required",
      "role_reason": "Needed to prevent automatic attribution of nonhuman, combination-product, and other-function data to this question.",
      "application_exception": "Retain nonhuman materials as identity-screening records, but do not add them to the count of human trials.",
      "criterion": "Do not transfer combination-product and owner-assessed cognition results in dogs to usual speed with NR alone in humans.",
      "basis": "M03 §3.2.1; detailed population criteria are internally designed / M03 §3.2.2–3.2.3; reverse-direction labeling and test adaptations are internally designed / M03 §3.2.4, M15 §15.3.1–15.3.3; adaptations of outcomes to each question are internally designed",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "A direct comparison with the target human population, exposure to the single intervention, and a usual-speed test is needed."
    },
    {
      "item_id": "N32",
      "question_type": "Mechanism and function",
      "question": "Are direct usual-speed results verified separately from NAD increases, SPPB, strength, and fatigue?",
      "needed": "A report distinguishing direct results for the target usual speed from other functional and biochemical results",
      "role": "Required",
      "role_reason": "Needed to prevent mechanism and function from automatically being interpreted as the same outcome.",
      "application_exception": "Because the functional score itself is the original question, do not require separate death events as a prerequisite for that value.",
      "criterion": "Do not substitute mechanism or other tests for the selected functional endpoint, or vice versa; require direct results for this question.",
      "basis": "M03 §3.2.4, M15 §15.3.1–15.3.3; adaptations of outcomes to each question are internally designed / M03 §3.2.4; internally defined scope-expansion boundary",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Measure the selected usual speed separately from mechanisms and other functions, and prespecify and report each contrast of interest."
    },
    {
      "item_id": "N33",
      "question_type": "Harms for the target question",
      "question": "Are events, discontinuations, and denominators verified for this plan in the frail population at 2,000 mg/day for 52 weeks?",
      "needed": "Arm-specific AE/SAE, numbers of people and events, discontinuations, collection periods, and collection methods for the same population, product, and exposure",
      "role": "Supplementary; required for expansion to safety",
      "role_reason": "Needed to prevent data gaps from being elevated to a guarantee of safety or confirmation of NR harm.",
      "application_exception": "Even if a signal without a denominator is added, do not convert it into an incidence rate; retain separate efficacy and harm statuses.",
      "criterion": "Distinguish an efficacy plan from direct safety data, and do not record unverified events as 0 or as confirmation of safety.",
      "basis": "M19 §19.1.2–19.2.4; internal application / M19 §19.1.2–19.2.4; detailed distinctions are internally designed / M19 §19.2 harm questions by study design; details of temporal relationships are internally designed / M19 §19.2.2–19.2.4, M03 §3.2.3; internal application / M19 §19.2.2–19.2.4 design considerations; detailed confounding records are internally designed / M19 §19.1.2–19.2.4, M04 §4.6.3; internal application / Chamgap’s own interpretive boundary. References M19 principles; not an application of an official causality tool",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "In long-term comparisons, collect event definitions, collection schedules, discontinuations, exposure time, concomitant treatments, and arm-specific numbers of people and events. Consider follow-up designs suited to rare events separately."
    },
    {
      "item_id": "N34",
      "question_type": "Scope of official safety assessments",
      "question": "Does EFSA’s assessment of specified NR chloride for use at 300 mg/day in healthy adults guarantee safety for the target question?",
      "needed": "The substance, use amount, population, and duration in the EFSA assessment, and direct safety data from the target trial",
      "role": "Supplementary; required for expansion to safety",
      "role_reason": "Needed to avoid extending the authority of an official assessment to a guarantee of safety for all other exposures.",
      "application_exception": "Official documents are not independent new events or trials; do not double-count safety data they cite again. Do not use a use assessment as personal dosing instructions.",
      "criterion": "State the scope of the official use assessment, and do not transfer assessments of different substances, doses, or populations to the overall safety of the target plan.",
      "basis": "M19 §19.1.2–19.2.4; internal application / M04 §4.6.1–4.6.2; adaptations of harm data are internally designed / Chamgap’s own interpretive boundary. References M19 principles; not an application of an official causality tool",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Separately review long-term safety follow-up appropriate to the target product, dose, and frail population, along with data on concomitant treatments and vulnerable groups."
    },
    {
      "item_id": "N35",
      "question_type": "Actual concomitant treatments and adherence",
      "question": "Are arm-specific changes in medicines, diet, exercise, rehabilitation, and dose reduction/discontinuation verified?",
      "needed": "Lists and timing of concomitant treatments in both arms, medication adherence, dose reduction/discontinuation, rescue treatment, and analytical handling",
      "role": "Required",
      "role_reason": "Concurrent exposures, selection, and losses must be distinguished when attributing the actual effect of interest and harms.",
      "application_exception": "Do not exclude solely because concomitant treatment is present; compare differences between arms, the contrast of interest, and handling methods.",
      "criterion": "Connect differences in actual exposure and concurrent treatments to interpretation of results and safety, and do not confirm actual implementation from planned rules alone.",
      "basis": "M03 §3.2.3, M08 §8.2.2–8.2.3; internal application / M19 §19.2.2–19.2.4 design considerations; detailed confounding records are internally designed / M19 §19.1.2–19.2.4, M04 §4.6.3; internal application",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Collect the timing of medication changes and concurrent treatments, and explicitly distinguish the effect of assignment, the effect of adherence, and attribution of harms."
    },
    {
      "item_id": "N36",
      "question_type": "Extension to dose and persistence",
      "question": "Does the claim also extend to the optimal dose, maintenance after discontinuation, and effects in other frailty strata?",
      "needed": "Direct dose comparisons, follow-up after discontinuation, and prespecified subgroup/interaction data needed when making such extended claims",
      "role": "Supplementary; required for extended claims",
      "role_reason": "A boundary condition to prevent a narrow result from being extended to optimal treatment, maintenance, or all subgroups.",
      "application_exception": "Actual 52-week results for the original question are needed. Separate evidence of maintenance effects after discontinuation is not imposed as a mandatory requirement for this table.",
      "criterion": "Separate the narrow planned contrast from effects at other doses, after discontinuation, and in subgroups; do not require extension trials unnecessary for the current question.",
      "basis": "M03 §3.2.1–3.2.4; details on dose, persistence, and effect modification are internally designed",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "If a new extension question is requested, first define separate questions and plans for dose comparisons, follow-up after discontinuation, and effect modification."
    },
    {
      "item_id": "N37",
      "question_type": "Extension to clinical events",
      "question": "Does the claim also encompass prevention of falls, hospitalization, and death, and improvement in quality of life?",
      "needed": "Event definitions, observation windows, comparison denominators, and direct estimation data required when making claims about those events",
      "role": "Supplementary; required for extension to clinical events",
      "role_reason": "This is needed to prevent a functional-measurement question from automatically being extended to prevention of separate events.",
      "application_exception": "A mortality trial is not uniformly required for a question about change in usual speed itself. If the claim is extended, separate direct-evidence conditions are fixed.",
      "criterion": "Direct evidence on other clinical events and quality of life is addressed separately from the usual-speed question.",
      "basis": "M03 §3.2.4; internally designed boundaries for extensions / M03 §3.1, §3.2.1–3.2.4 principles for clarifying the question; detailed separation rules are internally designed",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "If event prevention becomes a new question, a design with definitions, follow-up, denominators, and comparisons for those events is reviewed separately."
    },
    {
      "item_id": "N38",
      "question_type": "Search scope and 0",
      "question": "Do 0 direct results and no_human_study mean that all human NR research amounts to 0?",
      "needed": "The original search reference date, selection records, and explicit scope within which directly eligible results were checked",
      "role": "Required",
      "role_reason": "This is needed so that the different meanings of the numeric value 0 and the historical boolean do not produce a false declaration of absence.",
      "application_exception": "The original log files and ZIP were not opened this time, so the search as of the reference date is neither rerun nor presented as a current, up-to-date comprehensive review.",
      "criterion": "The scope of the original 0 and the compatibility boolean is preserved, without extending it to 0 effect, 0 human studies, or worldwide absence.",
      "basis": "M04 §4.5, §4.6.3; limits on the current data transformation follow the user's scope and internal design / M03 §3.1, §3.2.1–3.2.4 principles for clarifying the question; detailed separation rules are internally designed",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Future evidence updates retain the same boundaries, search dates, and eligibility records, and distinguish new results from existing plans and other outcomes."
    },
    {
      "item_id": "N39",
      "question_type": "Reading of materials",
      "question": "Are the currently preserved archived summaries distinguished from external access and full-text reading at that earlier time?",
      "needed": "Each report's actual material type, original address, current access-not-attempted/unread status, historical access_level/date, and original location",
      "role": "Required",
      "role_reason": "This is needed to avoid confusing links, historical access records, and local summaries with current full-text reading.",
      "application_exception": "Current access that was not attempted is not labeled as failed. A historical description of full-text access is not copied to another material type for the same article.",
      "criterion": "Reading the local summaries now is not presented as current reading of external abstracts, full texts, or registrations; historical access levels are kept separate for each report.",
      "basis": "M04 §4.5–4.6 principles for data collection/selection; the separation of access from reading and the hyperlink contract are internally designed / M04 §4.5, §4.6.3; limits on the current data transformation follow the user's scope and internal design",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "When materials are acquired, their original locations, access events, dates, and material types are recorded by report, and original summaries are distinguished from directly obtained full texts. This is a method for reviewing materials, separate from a clinical trial proposal."
    },
    {
      "item_id": "N40",
      "question_type": "Preservation of history",
      "question": "Were the original ?, null values, axes, calculations, and publication metadata preserved without a new judgment?",
      "needed": "The exact original values for the original judgment, unscored axes, historical arithmetic, document quality, and manuscript publication/deployment metadata",
      "role": "Required",
      "role_reason": "This is needed to prevent the status of the table conversion from being misread as an existing grade, a calculated value, or a public publication event.",
      "application_exception": "Values, grades, and reading scopes from other current judgments are not carried over to this table. The original ? is not used as a simple substitute label for unread materials.",
      "criterion": "Native typed values and historical records are preserved in their original form, without elevating them to new efficacy or safety grades, check scores, or completed publication.",
      "basis": "M04 §4.5, §4.6.3; limits on the current data transformation follow the user's scope and internal design / M04 §4.6.3, M15 §15.3.1–15.3.3; separation of statuses is internally designed",
      "condition_origin": "Chamgap internal design and adaptation for the individual model; not a formal RoB/GRADE assessment, preregistration, or independent clinical certification",
      "proposed_research": "Future updates preserve the source bytes before and after changes and the reasons for changes, and distinguish changes in conditions, additions of materials, and new publication events."
    }
  ],
  "language": "en",
  "translation_date": "2026-11-01"
}