@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/Evidence/example-stroke-3-4half-alteplase-vs-no-alteplase-mRS0-2> a fhir:Evidence;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "example-stroke-3-4half-alteplase-vs-no-alteplase-mRS0-2"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n      <p>\n        &quot;Effect of Alteplase vs No alteplase on mRS 0-2 at 90 days in Stroke 3-4.5 hours prior&quot; is a comparative effect estimate.\n      </p>\n	</div>"
  ];
  fhir:Evidence.url [ fhir:value "http://hl7.org/fhir/Evidence/example-stroke-3-4half-alteplase-vs-no-alteplase-mRS0-2"];
  fhir:Evidence.title [ fhir:value "Effect of Alteplase vs No alteplase on mRS 0-2 at 90 days in Stroke 3-4.5 hours prior"];
  fhir:Evidence.status [ fhir:value "draft"];
  fhir:Evidence.useContext [
     fhir:index 0;
     fhir:UsageContext.code [
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/usage-context-type" ];
       fhir:Coding.code [ fhir:value "focus" ]
     ];
     fhir:UsageContext.valueCodeableConcept [
       fhir:CodeableConcept.text [ fhir:value "Stroke" ]
     ]
  ];
  fhir:Evidence.relatedArtifact [
     fhir:index 0;
     fhir:RelatedArtifact.type [ fhir:value "citation" ];
     fhir:RelatedArtifact.label [ fhir:value "Lees 2016" ];
     fhir:RelatedArtifact.display [ fhir:value "Figure 2 Lees 2016" ];
     fhir:RelatedArtifact.citation [ fhir:value "Lees KR, Emberson J, Blackwell L, Bluhmki E, Davis SM, Donnan GA, et al; Stroke Thrombolysis Trialists’ Collaborators Group. Effects of alteplase for acute stroke on the distribution of functional outcomes: a pooled analysis of 9 trials. Stroke. 2016;47:2373-2379. PMID 27507856" ];
     fhir:RelatedArtifact.url [ fhir:value "https://doi.org/10.1161/STROKEAHA.116.013644" ]
  ];
  fhir:Evidence.description [ fhir:value "mRS 0-2 at 90 days Odds Ratio 1.2 for Alteplase vs. No Alteplase in patients with acute ischemic stroke 3-4.5 hours prior"];
  fhir:Evidence.variableDefinition [
     fhir:index 0;
     fhir:Evidence.variableDefinition.variableRole [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/variable-role" ];
         fhir:Coding.code [ fhir:value "population" ];
         fhir:Coding.display [ fhir:value "population" ]
       ]
     ];
     fhir:Evidence.variableDefinition.observed [
       fhir:link <http://hl7.org/fhir/EvidenceVariable/Stroke-Thrombolysis-Trialists-2014-2016-IPD-MA-Cohort>;
       fhir:Reference.reference [ fhir:value "EvidenceVariable/Stroke-Thrombolysis-Trialists-2014-2016-IPD-MA-Cohort" ];
       fhir:Reference.type [ fhir:value "EvidenceVariable" ];
       fhir:Reference.display [ fhir:value "Stroke Thrombolysis Trialists’ 2014-2016 IPD-MA Cohort" ]
     ];
     fhir:Evidence.variableDefinition.intended [
       fhir:link <http://hl7.org/fhir/Group/AcuteIschemicStroke3-4halfHours>;
       fhir:Reference.reference [ fhir:value "Group/AcuteIschemicStroke3-4halfHours" ];
       fhir:Reference.type [ fhir:value "Group" ];
       fhir:Reference.display [ fhir:value "stroke at 3-4.5 hours" ]
     ];
     fhir:Evidence.variableDefinition.directnessMatch [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/directness" ];
         fhir:Coding.code [ fhir:value "moderate" ];
         fhir:Coding.display [ fhir:value "Moderate quality match" ]
       ]
     ]
  ], [
     fhir:index 1;
     fhir:Evidence.variableDefinition.variableRole [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/variable-role" ];
         fhir:Coding.code [ fhir:value "measuredVariable" ];
         fhir:Coding.display [ fhir:value "measured variable" ]
       ]
     ];
     fhir:Evidence.variableDefinition.observed [
       fhir:link <http://hl7.org/fhir/EvidenceVariable/example-mRS0-2-at-90days>;
       fhir:Reference.reference [ fhir:value "EvidenceVariable/example-mRS0-2-at-90days" ];
       fhir:Reference.type [ fhir:value "EvidenceVariable" ];
       fhir:Reference.display [ fhir:value "mRS 0-2 at 90 days" ]
     ];
     fhir:Evidence.variableDefinition.intended [
       fhir:link <http://hl7.org/fhir/EvidenceVariable/example-alive-independent-90day>;
       fhir:Reference.reference [ fhir:value "EvidenceVariable/example-alive-independent-90day" ];
       fhir:Reference.type [ fhir:value "EvidenceVariable" ];
       fhir:Reference.display [ fhir:value "Alive and not functionally dependent at 90 days" ]
     ]
  ], [
     fhir:index 2;
     fhir:Evidence.variableDefinition.variableRole [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/variable-role" ];
         fhir:Coding.code [ fhir:value "exposure" ];
         fhir:Coding.display [ fhir:value "exposure" ]
       ]
     ];
     fhir:Evidence.variableDefinition.observed [
       fhir:link <http://hl7.org/fhir/EvidenceVariable/example-alteplase-for-stroke>;
       fhir:Reference.reference [ fhir:value "EvidenceVariable/example-alteplase-for-stroke" ];
       fhir:Reference.type [ fhir:value "EvidenceVariable" ];
       fhir:Reference.display [ fhir:value "Alteplase for Stroke" ]
     ];
     fhir:Evidence.variableDefinition.intended [
       fhir:link <http://hl7.org/fhir/EvidenceVariable/example-alteplase-for-stroke>;
       fhir:Reference.reference [ fhir:value "EvidenceVariable/example-alteplase-for-stroke" ];
       fhir:Reference.type [ fhir:value "EvidenceVariable" ];
       fhir:Reference.display [ fhir:value "Alteplase for Stroke" ]
     ]
  ], [
     fhir:index 3;
     fhir:Evidence.variableDefinition.variableRole [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/variable-role" ];
         fhir:Coding.code [ fhir:value "referenceExposure" ];
         fhir:Coding.display [ fhir:value "reference exposure" ]
       ]
     ];
     fhir:Evidence.variableDefinition.observed [
       fhir:link <http://hl7.org/fhir/EvidenceVariable/example-no-alteplase>;
       fhir:Reference.reference [ fhir:value "EvidenceVariable/example-no-alteplase" ];
       fhir:Reference.type [ fhir:value "EvidenceVariable" ];
       fhir:Reference.display [ fhir:value "no alteplase" ]
     ];
     fhir:Evidence.variableDefinition.intended [
       fhir:link <http://hl7.org/fhir/EvidenceVariable/example-no-alteplase>;
       fhir:Reference.reference [ fhir:value "EvidenceVariable/example-no-alteplase" ];
       fhir:Reference.type [ fhir:value "EvidenceVariable" ];
       fhir:Reference.display [ fhir:value "no alteplase" ]
     ]
  ];
  fhir:Evidence.synthesisType [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/synthesis-type" ];
       fhir:Coding.code [ fhir:value "IPD-MA" ];
       fhir:Coding.display [ fhir:value "individual patient data meta-analysis" ]
     ]
  ];
  fhir:Evidence.studyType [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/study-type" ];
       fhir:Coding.code [ fhir:value "RCT" ];
       fhir:Coding.display [ fhir:value "randomized trial" ]
     ]
  ];
  fhir:Evidence.statistic [
     fhir:index 0;
     fhir:Evidence.statistic.statisticType [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/statistic-type" ];
         fhir:Coding.code [ fhir:value "C16932" ];
         fhir:Coding.display [ fhir:value "Odds Ratio" ]
       ]
     ];
     fhir:Evidence.statistic.quantity [
       fhir:Quantity.value [ fhir:value "1.2"^^xsd:decimal ]
     ];
     fhir:Evidence.statistic.sampleSize [
       fhir:Evidence.statistic.sampleSize.numberOfStudies [ fhir:value "9"^^xsd:nonNegativeInteger ]
     ];
     fhir:Evidence.statistic.attributeEstimate [
       fhir:index 0;
       fhir:Evidence.statistic.attributeEstimate.description [ fhir:value "95% CI 1.06 to 1.3" ];
       fhir:Evidence.statistic.attributeEstimate.type [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/attribute-estimate-type" ];
           fhir:Coding.code [ fhir:value "C53324" ];
           fhir:Coding.display [ fhir:value "Confidence interval" ]
         ]
       ];
       fhir:Evidence.statistic.attributeEstimate.level [ fhir:value "0.95"^^xsd:decimal ];
       fhir:Evidence.statistic.attributeEstimate.range [
         fhir:Range.low [
           fhir:Quantity.value [ fhir:value "1.06"^^xsd:decimal ]
         ];
         fhir:Range.high [
           fhir:Quantity.value [ fhir:value "1.3"^^xsd:decimal ]
         ]
       ]
     ]
  ];
  fhir:Evidence.certainty [
     fhir:index 0;
     fhir:Evidence.certainty.description [ fhir:value "Very low certainty due to risk of bias, inconsistency, imprecision, and indirectness" ];
     fhir:Evidence.certainty.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/certainty-type" ];
         fhir:Coding.code [ fhir:value "Overall" ];
         fhir:Coding.display [ fhir:value "Overall quality" ]
       ]
     ];
     fhir:Evidence.certainty.rating [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/certainty-rating" ];
         fhir:Coding.code [ fhir:value "very-low" ];
         fhir:Coding.display [ fhir:value "Very low quality" ]
       ]
     ];
     fhir:Evidence.certainty.subcomponent [
       fhir:index 0;
       fhir:Evidence.certainty.type [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/certainty-type" ];
           fhir:Coding.code [ fhir:value "PublicationBias" ];
           fhir:Coding.display [ fhir:value "Publication bias" ]
         ]
       ];
       fhir:Evidence.certainty.rating [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/certainty-rating" ];
           fhir:Coding.code [ fhir:value "no-concern" ];
           fhir:Coding.display [ fhir:value "no serious concern" ]
         ]
       ]
     ], [
       fhir:index 1;
       fhir:Evidence.certainty.note [
         fhir:index 0;
         fhir:Annotation.text [ fhir:value "IST-3 had inconsistent results and contributed large proportion of data" ]
       ];
       fhir:Evidence.certainty.type [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/certainty-type" ];
           fhir:Coding.code [ fhir:value "Inconsistency" ];
           fhir:Coding.display [ fhir:value "Inconsistency" ]
         ]
       ];
       fhir:Evidence.certainty.rating [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/certainty-rating" ];
           fhir:Coding.code [ fhir:value "serious-concern" ];
           fhir:Coding.display [ fhir:value "serious concern" ]
         ]
       ]
     ], [
       fhir:index 2;
       fhir:Evidence.certainty.note [
         fhir:index 0;
         fhir:Annotation.text [ fhir:value "results derived from figure with limited data reported to support the specific effect estimate; derived odds ratio in figure does not match results from rates of mRS 0-2 reported in Supplementary Figure 3b" ]
       ];
       fhir:Evidence.certainty.type [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/certainty-type" ];
           fhir:Coding.code [ fhir:value "Imprecision" ];
           fhir:Coding.display [ fhir:value "Imprecision" ]
         ]
       ];
       fhir:Evidence.certainty.rating [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/certainty-rating" ];
           fhir:Coding.code [ fhir:value "serious-concern" ];
           fhir:Coding.display [ fhir:value "serious concern" ]
         ]
       ]
     ], [
       fhir:index 3;
       fhir:Evidence.certainty.note [
         fhir:index 0;
         fhir:Annotation.text [ fhir:value "resuts derived for 3 - 4.5 hours assume data from 0 - 6 hours is informative" ]
       ];
       fhir:Evidence.certainty.type [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/certainty-type" ];
           fhir:Coding.code [ fhir:value "Indirectness" ];
           fhir:Coding.display [ fhir:value "Indirectness" ]
         ]
       ];
       fhir:Evidence.certainty.rating [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/certainty-rating" ];
           fhir:Coding.code [ fhir:value "serious-concern" ];
           fhir:Coding.display [ fhir:value "serious concern" ]
         ]
       ]
     ], [
       fhir:index 4;
       fhir:Evidence.certainty.note [
         fhir:index 0;
         fhir:Annotation.text [ fhir:value "results largely influenced by IST-3 trial which was unblinded and ECASS III which had baseline imbalances" ]
       ];
       fhir:Evidence.certainty.type [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/certainty-type" ];
           fhir:Coding.code [ fhir:value "RiskOfBias" ];
           fhir:Coding.display [ fhir:value "Risk of bias" ]
         ]
       ];
       fhir:Evidence.certainty.rating [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/certainty-rating" ];
           fhir:Coding.code [ fhir:value "serious-concern" ];
           fhir:Coding.display [ fhir:value "serious concern" ]
         ]
       ]
     ]
  ] .

<http://hl7.org/fhir/EvidenceVariable/Stroke-Thrombolysis-Trialists-2014-2016-IPD-MA-Cohort> a fhir:EvidenceVariable .

<http://hl7.org/fhir/Group/AcuteIschemicStroke3-4halfHours> a fhir:Group .

<http://hl7.org/fhir/EvidenceVariable/example-mRS0-2-at-90days> a fhir:EvidenceVariable .

<http://hl7.org/fhir/EvidenceVariable/example-alive-independent-90day> a fhir:EvidenceVariable .

<http://hl7.org/fhir/EvidenceVariable/example-alteplase-for-stroke> a fhir:EvidenceVariable .

<http://hl7.org/fhir/EvidenceVariable/example-no-alteplase> a fhir:EvidenceVariable .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/Evidence/example-stroke-3-4half-alteplase-vs-no-alteplase-mRS0-2.ttl> a owl:Ontology;
  owl:imports fhir:fhir.ttl;
  owl:versionIRI <http://build.fhir.org/Evidence/example-stroke-3-4half-alteplase-vs-no-alteplase-mRS0-2.ttl> .

# -------------------------------------------------------------------------------------