Derivation Web

source_1ec290228bc0430c

by researka:v2 · 2026-07-15 12:35:53.080149+04:00

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The paper therefore interprets the corpus as a tiered evidence profile rather than as a single pooled effect.", "type": "claim"}, {"id": "claim_4", "text": "The conclusion is that Protein supplementation remains a bounded evidence case: the retained direct, adjacent, and context evidence profile defines the scope for targeted testing, while mixed and null findings limit any unqualified broad clinical claim.", "type": "claim"}, {"id": "claim_5", "text": "In this section, the paragraph is tied to the local interpretive task. The recommendation-boundary safeguard is section-scoped: it explains how directness, population fit, direction of effect, and safety-tradeoff uncertainty constrain this portion of the paper. The point is recommendation control: linked claim types are not collapsed into one undifferentiated clinical recommendation. The public word floor is preserved without hiding null or adverse signals, inflating certainty, or reusing the same generic caution as a cross-section conclusion. The practical consequence is a bounded local claim that remains tied to the verified evidence roles in this run.", "type": "claim"}, {"id": "claim_6", "text": "This synthesis evaluates evidence on Protein supplementation across 41 included source papers and 2443 high-confidence extracted claims. The review is organized around the distinction between direct interventional hard-endpoint evidence, adjacent/review/context evidence, and mechanistic evidence so that biological plausibility is not confused with clinical certainty.", "type": "claim"}, {"id": "claim_7", "text": "The corpus contains 11 direct clinical sources, 30 adjacent, review, or context sources, and no sources classified primarily as mechanistic or model-system evidence. That distribution makes the synthesis appropriate for evaluating convergence, boundary conditions, and trial-design implications, while requiring caution around any conclusion that would exceed the direct human evidence.", "type": "claim"}, {"id": "claim_8", "text": "The introductory frame therefore treats the corpus as a set of evidence roles rather than a single directional verdict. Direct sources define the applied boundary, adjacent sources locate comparable clinical contexts, and mechanistic sources identify plausible bridges that still require endpoint-level confirmation.", "type": "claim"}, {"id": "claim_9", "text": "This distinction matters for publication because it makes the paper falsifiable. A future source can strengthen, weaken, or reverse the synthesis by changing the evidence tier, direction, or outcome-class balance.", "type": "claim"}, {"id": "claim_10", "text": "The mechanistic layer is most useful when it explains why a trial signal might appear or fail to appear. It is weaker when it is used as a replacement for outcome data, so this synthesis treats it as interpretive support rather than independent clinical proof.", "type": "claim"}, {"id": "claim_11", "text": "Null findings have a specific role in this evidence model. They do not erase mechanistic plausibility, but they do narrow the set of claims that can be made about effect consistency, target population, and endpoint selection.", "type": "claim"}, {"id": "claim_12", "text": "Adverse or negative signals are likewise retained in the main interpretation. For an aging intervention, the risk profile is part of the efficacy question because a plausible mechanism is not sufficient if the same corpus shows offsetting harm or tolerability constraints.", "type": "claim"}, {"id": "claim_13", "text": "The evidence base also distinguishes breadth from certainty. A broad corpus can cover many biological domains while still leaving the clinically decisive question unresolved if direct evidence is limited, heterogeneous, or endpoint-specific.", "type": "claim"}, {"id": "claim_14", "text": "For that reason, the manuscript does not collapse every source into a single recommendation. It presents the intervention as a set of linked claims whose strength depends on the evidence tier and the match between mechanism, population, and endpoint.", "type": "claim"}, {"id": "claim_15", "text": "The research value of the synthesis lies in making these boundaries explicit. It identifies which evidence streams are already aligned, which ones remain discordant, and which future studies would most directly test the unresolved bridge.", "type": "claim"}, {"id": "claim_16", "text": "The background evidence for Protein supplementation is heterogeneous rather than uniformly confirmatory. Direct clinical sources such as Huschtscha 2021, Kittiskulnam 2022, Kirk 2021 are interpreted separately from mechanistic studies such as the retained evidence base, because these evidence roles answer different questions about aging biology and clinical translation.", "type": "claim"}, {"id": "claim_17", "text": "The direct evidence establishes what has been observed in human or adjacent clinical settings. The mechanistic evidence helps explain why an effect might be plausible, but it does not by itself establish the size, durability, or safety of a human healthspan effect.", "type": "claim"}, {"id": "claim_18", "text": "Across the retained sources, positive signals cluster around the muscle function and contextual adjacent evidence outcome classes; null signals around the muscle function, frailty and cardiometabolic outcome classes; and negative or adverse signals around the muscle function and frailty outcome classes. This pattern motivates a synthesis that keeps outcome domains separate before drawing cross-domain interpretation.", "type": "claim"}, {"id": "claim_19", "text": "The study-level structure also prevents selective emphasis. Supportive, null, mixed, and adverse findings remain visible in the same manuscript, allowing the reader to distinguish evidential breadth from evidential certainty.", "type": "claim"}, {"id": "claim_20", "text": "The resulting paper is therefore a calibrated synthesis: it can identify plausible mechanisms, observed direct signals when present, unresolved tensions, and trial-design priorities without converting them into claims stronger than the retained corpus can support.", "type": "claim"}, {"id": "claim_21", "text": "No inferential bridge claim is made. Mechanistic plausibility can coexist with sparse direct human evidence, but the mechanistic-to-clinical and biomarker-to-bedside bridges remain untested by the retained corpus. Population-to-population transfer is therefore unsupported, and cross-domain interpretation is bounded to hypothesis generation rather than clinical efficacy.", "type": "claim"}, {"id": "claim_22", "text": "Risk-of-bias appraisal summary: The public appraisal artifact reports 41 source-level rating row(s) using ROBINS-I, RoB-2, SYRCLE; overall ratings are some concerns=41. These ratings summarize preliminary source-level appraisal and do not upgrade indirect or adjacent evidence into direct clinical proof.", "type": "claim"}, {"id": "claim_23", "text": "The following fields were extracted from each included source: study design, population / cohort, intervention or exposure, comparator, outcome class, effect direction, effect size, confidence interval or credible interval, p-value, sample size, follow-up duration, risk-of-bias rating. Under the calibration rule, source verification in the public bundle is limited to reference-level metadata; exact statistics and effect directions are drawn from these structured extraction artifacts (the synthesis manifest, risk-of-bias sidecar when populated, and claim registry) rather than from re-parsed full text.", "type": "claim"}, {"id": "claim_24", "text": "A source was coded as direct only when it tested the topic itself against a clinically proximate outcome in the relevant population. Human evidence with an adjacent exposure, population, or outcome was coded as indirect; syntheses and secondary reviews were coded as review-level evidence and were not counted as direct sources.", "type": "claim"}, {"id": "claim_25", "text": "Risk-of-bias framework assignment follows study design (RoB-2 for RCTs, ROBINS-I for non-randomised studies, AMSTAR-2 for systematic reviews / meta-analyses). Public appraisal claims are limited to populated `risk_of_bias.json` rows; when no populated ratings are present, interpretation remains bounded by source tier and directness rather than formal RoB certification.", "type": "claim"}, {"id": "claim_26", "text": "Evidence-tension synthesis: claims grouped by outcome class (cardiometabolic, contextual adjacent evidence, deficiency prevalence, frailty, immune and inflammation, longevity, muscle function); within-class agreement, disagreement, and directness gaps surfaced explicitly. Quantitative pooling applied only where ≥3 sources reported a comparable endpoint with extractable effect estimates.", "type": "claim"}, {"id": "claim_27", "text": "Source retrieval, claim extraction, evidence routing, and prose drafting were assisted by large language models under a deterministic audit-trail protocol. Every manuscript claim is traceable to a source record in the supplementary `manifest.json`. Final eligibility and interpretation decisions are author-verified.", "type": "claim"}, {"id": "claim_28", "text": "Topic-fit rationale: Sources are retained only when they operationalize protein nutrition directly or provide adjacent/contextual boundary evidence for the same construct. 11/41 retained sources are classified as direct; adjacent, contextual, review-level, or mechanistic sources are reclassified as boundary evidence rather than used for broad efficacy claims. Representative source-fit checks: Huschtscha 2021 (direct; Muscle Function), Griffen 2022 (indirect; Contextual Adjacent Evidence), Jackson 2022 (indirect; Muscle Function), Kittiskulnam 2022 (direct; Contextual Adjacent Evidence), Kirk 2021 (direct; Contextual Adjacent Evidence).", "type": "claim"}, {"id": "claim_29", "text": "| Evidence domain | Source | Direction | Directness | Tier | Evidence role | Finding |", "type": "claim"}, {"id": "claim_30", "text": "| Cardiometabolic | Hashimoto 2020: Effect of Exercise Habit on Skeletal Muscle Mass Varies with Protein Intake in Elderly Patients with Type 2 Diabetes: A Retrospective Cohort Study | direction=unclear | directness=indirect | B2 | outcome=Cardiometabolic; direction=unclear | finding=representative non-significant statistic P = 0.078; not treated as positive or negative directional support unless source direction is coded |", "type": "claim"}, {"comparator": "not extracted", "directness": "primary", "doi": "10.3389/fnut.2021.644865", "effect": "not extracted", "endpoint": "not extracted", "id": "source_1", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "The Effects of a High-Protein Dairy Milk Beverage With or Without Progressive Resistance Training on Fat-Free Mass, Skeletal Muscle Strength and Power, and Functional Performance in Healthy Active Older Adults: A 12-Week Randomized Controlled Trial", "type": "source", "url": "https://doi.org/10.3389/fnut.2021.644865", "year": 2021}, {"comparator": "not extracted", "directness": "primary", "doi": "10.14814/phy2.15268", "effect": "not extracted", "endpoint": "not extracted", "id": "source_2", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Changes in 24‐h energy expenditure, substrate oxidation, and body composition following resistance exercise and a high protein diet via whey protein supplementation in healthy older men", "type": "source", "url": "https://doi.org/10.14814/phy2.15268", "year": 2022}, {"comparator": "not extracted", "directness": "primary", "doi": "10.3390/nu14020375", "effect": "not extracted", "endpoint": "not extracted", "id": "source_3", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Effectiveness of a Per-Meal Protein Prescription and Nutrition Education with versus without Diet Coaching on Dietary Protein Intake and Muscle Health in Middle-Aged Women", "type": "source", "url": "https://doi.org/10.3390/nu14020375", "year": 2022}, {"comparator": "not extracted", "directness": "primary", "doi": "10.1038/s41598-022-08726-8", "effect": "not extracted", "endpoint": "not extracted", "id": "source_4", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "The beneficial effects of intradialytic parenteral nutrition in hemodialysis patients with protein energy wasting: a prospective randomized controlled trial", "type": "source", "url": "https://doi.org/10.1038/s41598-022-08726-8", "year": 2022}, {"comparator": "not extracted", "directness": "primary", "doi": "10.1002/jcsm.12805", "effect": "not extracted", "endpoint": "not extracted", "id": "source_5", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Leucine‐enriched whey protein supplementation, resistance‐based exercise, and cardiometabolic health in older adults: a randomized controlled trial", "type": "source", "url": "https://doi.org/10.1002/jcsm.12805", "year": 2021}, {"comparator": "not extracted", "directness": "review-level", "doi": "10.3390/healthcare13212814", "effect": "not extracted", "endpoint": "not extracted", "id": "source_6", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Effects of Whey Protein Supplementation on Body Composition, Muscular Strength, and Cardiometabolic Health in Older Adults: A Systematic Review with Pairwise Meta-Analysis", "type": "source", "url": "https://doi.org/10.3390/healthcare13212814", "year": 2025}, {"comparator": "not extracted", "directness": "review-level", "doi": "10.1002/jcsm.12922", "effect": "not extracted", "endpoint": "not extracted", "id": "source_7", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Systematic review and meta‐analysis of protein intake to support muscle mass and function in healthy adults", "type": "source", "url": "https://doi.org/10.1002/jcsm.12922", "year": 2022}, {"comparator": "not extracted", "directness": "review-level", "doi": "10.3390/nu16244350", "effect": "not extracted", "endpoint": "not extracted", "id": "source_8", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Association of Protein Intake with Sarcopenia and Related Indicators Among Korean Older Adults: A Systematic Review and Meta-Analysis", "type": "source", "url": "https://doi.org/10.3390/nu16244350", "year": 2024}, {"comparator": "not extracted", "directness": "primary", "doi": "10.1007/s00394-023-03182-0", "effect": "not extracted", "endpoint": "not extracted", "id": "source_9", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Effect of 1-year daily protein supplementation and physical exercise on muscle protein synthesis rate and muscle metabolome in healthy older Danes: a randomized controlled trial", "type": "source", "url": "https://doi.org/10.1007/s00394-023-03182-0", "year": 2023}, {"comparator": "not extracted", "directness": "primary", "doi": "10.3389/fmed.2023.1204198", "effect": "not extracted", "endpoint": "not extracted", "id": "source_10", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Impact of exercise and leucine-enriched protein supplementation on physical function, body composition, and inflammation in pre-frail older adults: a quasi-experimental study", "type": "source", "url": "https://doi.org/10.3389/fmed.2023.1204198", "year": 2023}, {"comparator": "not extracted", "directness": "primary", "doi": "10.2196/49322", "effect": "not extracted", "endpoint": "not extracted", "id": "source_11", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "The Effect of Web-Based Culinary Medicine to Enhance Protein Intake on Muscle Quality in Older Adults: Randomized Controlled Trial", "type": "source", "url": "https://doi.org/10.2196/49322", "year": 2024}, {"comparator": "not extracted", "directness": "review-level", "doi": "10.1038/s41430-022-01250-y", "effect": "not extracted", "endpoint": "not extracted", "id": "source_12", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "The impact of dietary protein supplementation on recovery from resistance exercise-induced muscle damage: A systematic review with meta-analysis", "type": "source", "url": "https://doi.org/10.1038/s41430-022-01250-y", "year": 2022}, {"comparator": "not extracted", "directness": "primary", "doi": "10.1186/s12970-020-0336-1", "effect": "not extracted", "endpoint": "not extracted", "id": "source_13", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Combined protein and calcium β-hydroxy-β-methylbutyrate induced gains in leg fat free mass: a double-blinded, placebo-controlled study", "type": "source", "url": "https://doi.org/10.1186/s12970-020-0336-1", "year": 2020}, {"comparator": "not extracted", "directness": "primary", "doi": "10.1080/15502783.2025.2590090", "effect": "not extracted", "endpoint": "not extracted", "id": "source_14", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Dileucine-supplemented essential amino acids support whole-body anabolism after resistance exercise and serum-stimulated cell-based anabolism", "type": "source", "url": "https://doi.org/10.1080/15502783.2025.2590090", "year": 2025}, {"comparator": "not extracted", "directness": "primary", "doi": "10.3389/fnut.2020.619216", "effect": "not extracted", "endpoint": "not extracted", "id": "source_15", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Mitochondrial Content, but Not Function, Is Altered With a Multimodal Resistance Training Protocol and Adequate Protein Intake in Leucine-Supplemented Pre/Frail Women", "type": "source", "url": "https://doi.org/10.3389/fnut.2020.619216", "year": 2021}, {"comparator": "not extracted", "directness": "primary", "doi": "10.1002/jcsm.13481", "effect": "not extracted", "endpoint": "not extracted", "id": "source_16", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Protein‐enriched soup and weekly exercise improve muscle health: A randomized trial in mid‐to‐old age with inadequate protein intake", "type": "source", "url": "https://doi.org/10.1002/jcsm.13481", "year": 2024}, {"comparator": "not extracted", "directness": "primary", "doi": "10.1002/jcsm.12634", "effect": "not extracted", "endpoint": "not extracted", "id": "source_17", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Blended home‐based exercise and dietary protein in community‐dwelling older adults: a cluster randomized controlled trial", "type": "source", "url": "https://doi.org/10.1002/jcsm.12634", "year": 2020}, {"comparator": "not extracted", "directness": "primary", "doi": "10.3390/nu12092537", "effect": "not extracted", "endpoint": "not extracted", "id": "source_18", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Effect of Dairy Protein Intake on Muscle Mass among Korean Adults: A Prospective Cohort Study", "type": "source", "url": "https://doi.org/10.3390/nu12092537", "year": 2020}, {"comparator": "not extracted", "directness": "primary", "doi": "10.3390/jfmk11010125", "effect": "not extracted", "endpoint": "not extracted", "id": "source_19", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Effects of Higher Dietary Protein Intake on Isokinetic Muscle Performance in Older Adults with Type 2 Diabetes Mellitus", "type": "source", "url": "https://doi.org/10.3390/jfmk11010125", "year": 2026}, {"comparator": "not extracted", "directness": "primary", "doi": "10.3389/fnut.2025.1486482", "effect": "not extracted", "endpoint": "not extracted", "id": "source_20", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Dietary protein requirements of older adults with sarcopenia determined by the indicator amino acid oxidation technology", "type": "source", "url": "https://doi.org/10.3389/fnut.2025.1486482", "year": 2025}, {"comparator": "not extracted", "directness": "review-level", "doi": "10.3390/nu15153424", "effect": "not extracted", "endpoint": "not extracted", "id": "source_21", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Effectiveness of Whey Protein Supplementation during Resistance Exercise Training on Skeletal Muscle Mass and Strength in Older People with Sarcopenia: A Systematic Review and Meta-Analysis", "type": "source", "url": "https://doi.org/10.3390/nu15153424", "year": 2023}, {"comparator": "not extracted", "directness": "primary", "doi": "10.3390/nu12103220", "effect": "not extracted", "endpoint": "not extracted", "id": "source_22", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Effect of Exercise Habit on Skeletal Muscle Mass Varies with Protein Intake in Elderly Patients with Type 2 Diabetes: A Retrospective Cohort Study", "type": "source", "url": "https://doi.org/10.3390/nu12103220", "year": 2020}, {"comparator": "not extracted", "directness": "primary", "doi": "10.3390/nu14214442", "effect": "not extracted", "endpoint": "not extracted", "id": "source_23", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Comparing Even with Skewed Dietary Protein Distribution Shows No Difference in Muscle Protein Synthesis or Amino Acid Utilization in Healthy Older Individuals: A Randomized Controlled Trial", "type": "source", "url": "https://doi.org/10.3390/nu14214442", "year": 2022}, {"comparator": "not extracted", "directness": "primary", "doi": "10.1161/JAHA.119.015553", "effect": "not extracted", "endpoint": "not extracted", "id": "source_24", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Association of Major Dietary Protein Sources With All‐Cause and Cause‐Specific Mortality: Prospective Cohort Study", "type": "source", "url": "https://doi.org/10.1161/JAHA.119.015553", "year": 2021}, {"comparator": "not extracted", "directness": "primary", "doi": "10.14814/phy2.70073", "effect": "not extracted", "endpoint": "not extracted", "id": "source_25", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "The effect of home‐based neuromuscular electrical stimulation‐resistance training and protein supplementation on lean mass in persons with spinal cord injury: A pilot study", "type": "source", "url": "https://doi.org/10.14814/phy2.70073", "year": 2024}, {"comparator": "not extracted", "directness": "review-level", "doi": "10.1016/j.advnut.2023.05.011", "effect": "not extracted", "endpoint": "not extracted", "id": "source_26", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Whey Protein Supplementation with or without Vitamin D on Sarcopenia-Related Measures: A Systematic Review and Meta-Analysis", "type": "source", "url": "https://doi.org/10.1016/j.advnut.2023.05.011", "year": 2023}, {"comparator": "not extracted", "directness": "review-level", "doi": 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public sidecar", "study": "Investigation of the Effect of Nutritional Supplementation with Whey Protein and Vitamin D on Muscle Mass and Muscle Quality in Subacute Post-Stroke Rehabilitation Patients: A Randomized, Single-Blinded, Placebo-Controlled Trial", "type": "source", "url": "https://doi.org/10.3390/nu14030685", "year": 2022}, {"comparator": "not extracted", "directness": "review-level", "doi": "10.1123/japa.2023-0285", "effect": "not extracted", "endpoint": "not extracted", "id": "source_39", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Effect of Protein Supplementation Combined With Resistance Training in Gait Speed in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials", "type": "source", "url": "https://doi.org/10.1123/japa.2023-0285", "year": 2024}, {"comparator": "not extracted", "directness": "primary", "doi": "10.1093/geroni/igae098.3982", "effect": "not extracted", "endpoint": "not extracted", "id": "source_40", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "FEASIBILITY OF WHEY PROTEIN SUPPLEMENTATION TO IMPROVE OLDER ADULT FUNCTION POST-HOSPITALIZATION", "type": "source", "url": "https://doi.org/10.1093/geroni/igae098.3982", "year": 2024}, {"comparator": "not extracted", "directness": "review-level", "doi": "10.3389/fnut.2021.685165", "effect": "not extracted", "endpoint": "not extracted", "id": "source_41", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "Evaluating the Leucine Trigger Hypothesis to Explain the Post-prandial Regulation of Muscle Protein Synthesis in Young and Older Adults: A Systematic Review", "type": "source", "url": "https://doi.org/10.3389/fnut.2021.685165", "year": 2021}, {"comparator": "not extracted", "directness": "citation", "doi": null, "effect": "not extracted", "endpoint": "not extracted", "id": "source_42", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "**Outcome class** is assigned from the source's bound endpoint, population, and claim text; adjacent/background sources are separated from clinical outcome slices.", "type": "source", "url": null, "year": null}, {"comparator": "not extracted", "directness": "citation", "doi": null, "effect": "not extracted", "endpoint": "not extracted", "id": "source_43", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "**Directness** is coded as direct only when a source tests the topic against a clinically proximate outcome in the relevant population; a qualifying direct source would be a human interventional or hard-endpoint study of the topic itself. Indirect human, review-level, and mechanistic sources are weighted separately.", "type": "source", "url": null, "year": null}, {"comparator": "not extracted", "directness": "citation", "doi": null, "effect": "not extracted", "endpoint": "not extracted", "id": "source_44", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "**Directional signal** is counted within the assigned outcome class only. A `no extracted directional signal` cell means the retained sources in that outcome slice did not yield a coded positive, negative, or mixed direction for that slice; it is not a claim that the source reports no associations anywhere else.", "type": "source", "url": null, "year": null}, {"comparator": "not extracted", "directness": "citation", "doi": null, "effect": "not extracted", "endpoint": "not extracted", "id": "source_45", "intervention_or_exposure": "not extracted", "population": "not extracted", "risk_of_bias": "not appraised in public sidecar", "study": "**Evidence tier** follows the deterministic tier/directness taxonomy used in the source builder; the prose writer cannot move a source between classes after sources are frozen.", "type": "source", "url": null, "year": null}], "publication_id": "d6b9601d-c79a-4ef6-8e70-eb0ec62f9b11", "screening": {"excluded": 0, "exclusion_reasons": ["No PRISMA full-text exclusion-stage filter was applied."], "flow": ["identified", "screened", "excluded_with_reasons", "included"], "identified": 41, "included": 41, "included_or_retained": 41, "screened": 41, "wording": "41 candidate receipts retained after source retrieval, deduplication, and topic filtering. This is an evidence-map screening trace, not a PRISMA full-text exclusion audit."}}

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