fhir 1.0.0

//! Evidence
//!
//! URL: http://hl7.org/fhir/StructureDefinition/Evidence
//!
//! Version: 5.0.0
//!
//! Evidence Resource: The Evidence Resource provides a machine-interpretable expression of an evidence concept.
//!
//! FHIR: <https://build.fhir.org/>
//!
//! UML: <https://build.fhir.org/uml.html>

// Allow unused crate::r5::types as types;
#![allow(unused_imports)]

use crate::r5::types;
use ::serde::{Deserialize, Serialize};
use fhir_derive_macros::Validate;

/// The Evidence Resource provides a machine-interpretable expression of an
/// evidence concept including the evidence variables (e.g., population,
/// exposures/interventions, comparators, outcomes, measured variables,
/// confounding variables), the statistics, and the certainty of this evidence.
/// It is used to summarize research findings and support evidence-based
/// clinical decision making and knowledge management in FHIR R5.
///
/// Conceptually, an `Evidence` resource packages the outcome of a single
/// piece of research or a synthesis of research (such as a systematic review
/// or meta-analysis) into a structured, shareable form. It captures what was
/// studied (via `variable_definition`), the resulting numeric findings (via
/// `statistic`), and an assessment of how much confidence can be placed in
/// those findings (via `certainty`). This allows clinical decision support
/// tools, guideline authors, and evidence synthesis platforms to reference
/// and reason about evidence programmatically rather than relying solely on
/// free-text publications. `Evidence` is part of the FHIR Evidence-Based
/// Medicine (EBM) framework and is commonly referenced from, or used
/// alongside, other knowledge artifacts such as `EvidenceReport` and
/// `EvidenceVariable`, as well as citation metadata expressed via
/// `RelatedArtifact`.
///
/// # Related resources
///
/// - [`CodeableConcept`](crate::r5::types::CodeableConcept) is used
///   throughout this resource to represent coded concepts such as variable
///   roles, statistic types, and certainty ratings.
/// - `EvidenceReport` and `EvidenceVariable` are companion resources in the
///   same Evidence-Based Medicine framework.
/// - [`Reference`](crate::r5::types::Reference) fields link an `Evidence`
///   resource to the underlying observed and intended variables.
///
/// # Examples
///
/// ```ignore
/// use fhir::r5::resources::evidence::Evidence;
///
/// let value = Evidence::default();
/// let json = ::serde_json::to_value(&value).unwrap();
/// let back: Evidence = ::serde_json::from_value(json).unwrap();
/// assert_eq!(value, back);
/// ```
#[serde_with::skip_serializing_none]
#[derive(Debug, Clone, Serialize, Deserialize, PartialEq, Eq, Validate)]
#[serde(rename_all = "camelCase")]
pub struct Evidence {
    /// Logical id of this artifact.
    pub id: Option<types::String>,

    /// Metadata about the resource.
    pub meta: Option<types::Meta>,

    /// A set of rules under which this content was created.
    pub implicit_rules: Option<types::Uri>,
    /// Primitive extension sibling for [`implicit_rules`](Self::implicit_rules) (FHIR `_implicitRules`).
    #[serde(rename = "_implicitRules")]
    pub implicit_rules_ext: Option<types::Element>,

    /// Language of the resource content.
    pub language: Option<types::Code>,
    /// Primitive extension sibling for [`language`](Self::language) (FHIR `_language`).
    #[serde(rename = "_language")]
    pub language_ext: Option<types::Element>,

    /// Text summary of the resource, for human interpretation.
    pub text: Option<types::Narrative>,

    /// Contained, inline Resources.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub contained: Vec<::serde_json::Value>,

    /// Additional content defined by implementations.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub extension: Vec<types::Extension>,

    /// Extensions that cannot be ignored.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub modifier_extension: Vec<types::Extension>,

    /// Canonical identifier for this evidence, represented as a globally
    /// unique URI, used to reference this specific version of the evidence
    /// from other artifacts.
    pub url: Option<types::Uri>,
    /// Primitive extension sibling for [`url`](Self::url) (FHIR `_url`).
    #[serde(rename = "_url")]
    pub url_ext: Option<types::Element>,

    /// Additional identifier for the summary.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub identifier: Vec<types::Identifier>,

    /// Business version of this summary.
    pub version: Option<types::String>,
    /// Primitive extension sibling for [`version`](Self::version) (FHIR `_version`).
    #[serde(rename = "_version")]
    pub version_ext: Option<types::Element>,

    /// The `Evidence.versionAlgorithm[x]` choice element (0..1); see [`EvidenceVersionAlgorithm`].
    #[serde(flatten)]
    pub version_algorithm: Option<EvidenceVersionAlgorithm>,

    /// Name for this summary (machine friendly).
    pub name: Option<types::String>,
    /// Primitive extension sibling for [`name`](Self::name) (FHIR `_name`).
    #[serde(rename = "_name")]
    pub name_ext: Option<types::Element>,

    /// Name for this summary (human friendly).
    pub title: Option<types::String>,
    /// Primitive extension sibling for [`title`](Self::title) (FHIR `_title`).
    #[serde(rename = "_title")]
    pub title_ext: Option<types::Element>,

    /// The `Evidence.citeAs[x]` choice element (0..1); see [`EvidenceCiteAs`].
    #[serde(flatten)]
    pub cite_as: Option<EvidenceCiteAs>,

    /// The publication lifecycle status of this evidence: draft | active |
    /// retired | unknown.
    pub status: crate::r5::coded::Coded<crate::r5::codes::PublicationStatus>,
    /// Primitive extension sibling for [`status`](Self::status) (FHIR `_status`).
    #[serde(rename = "_status")]
    pub status_ext: Option<types::Element>,

    /// For testing purposes, not real usage.
    pub experimental: Option<types::Boolean>,
    /// Primitive extension sibling for [`experimental`](Self::experimental) (FHIR `_experimental`).
    #[serde(rename = "_experimental")]
    pub experimental_ext: Option<types::Element>,

    /// Date last changed.
    pub date: Option<types::DateTime>,
    /// Primitive extension sibling for [`date`](Self::date) (FHIR `_date`).
    #[serde(rename = "_date")]
    pub date_ext: Option<types::Element>,

    /// When the summary was approved by publisher.
    pub approval_date: Option<types::Date>,
    /// Primitive extension sibling for [`approval_date`](Self::approval_date) (FHIR `_approvalDate`).
    #[serde(rename = "_approvalDate")]
    pub approval_date_ext: Option<types::Element>,

    /// When the summary was last reviewed by the publisher.
    pub last_review_date: Option<types::Date>,
    /// Primitive extension sibling for [`last_review_date`](Self::last_review_date) (FHIR `_lastReviewDate`).
    #[serde(rename = "_lastReviewDate")]
    pub last_review_date_ext: Option<types::Element>,

    /// Name of the publisher/steward (organization or individual).
    pub publisher: Option<types::String>,
    /// Primitive extension sibling for [`publisher`](Self::publisher) (FHIR `_publisher`).
    #[serde(rename = "_publisher")]
    pub publisher_ext: Option<types::Element>,

    /// Contact details for the publisher.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub contact: Vec<types::ContactDetail>,

    /// Who authored the content.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub author: Vec<types::ContactDetail>,

    /// Who edited the content.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub editor: Vec<types::ContactDetail>,

    /// Who reviewed the content.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub reviewer: Vec<types::ContactDetail>,

    /// Who endorsed the content.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub endorser: Vec<types::ContactDetail>,

    /// The context that the content is intended to support.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub use_context: Vec<types::UsageContext>,

    /// Why this Evidence is defined.
    pub purpose: Option<types::Markdown>,
    /// Primitive extension sibling for [`purpose`](Self::purpose) (FHIR `_purpose`).
    #[serde(rename = "_purpose")]
    pub purpose_ext: Option<types::Element>,

    /// Use and/or publishing restrictions.
    pub copyright: Option<types::Markdown>,
    /// Primitive extension sibling for [`copyright`](Self::copyright) (FHIR `_copyright`).
    #[serde(rename = "_copyright")]
    pub copyright_ext: Option<types::Element>,

    /// Copyright holder and year(s).
    pub copyright_label: Option<types::String>,
    /// Primitive extension sibling for [`copyright_label`](Self::copyright_label) (FHIR `_copyrightLabel`).
    #[serde(rename = "_copyrightLabel")]
    pub copyright_label_ext: Option<types::Element>,

    /// Link or citation to artifact associated with the summary.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub related_artifact: Vec<types::RelatedArtifact>,

    /// Description of the particular summary.
    pub description: Option<types::Markdown>,
    /// Primitive extension sibling for [`description`](Self::description) (FHIR `_description`).
    #[serde(rename = "_description")]
    pub description_ext: Option<types::Element>,

    /// Declarative description of the Evidence.
    pub assertion: Option<types::Markdown>,
    /// Primitive extension sibling for [`assertion`](Self::assertion) (FHIR `_assertion`).
    #[serde(rename = "_assertion")]
    pub assertion_ext: Option<types::Element>,

    /// Footnotes and/or explanatory notes.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub note: Vec<types::Annotation>,

    /// Evidence variables such as population, exposure, or outcome, that
    /// define what this evidence measured or compared.
    pub variable_definition: vec1::Vec1<EvidenceVariableDefinition>,

    /// The method to combine studies.
    pub synthesis_type: Option<types::CodeableConcept>,

    /// The design of the study that produced this evidence.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub study_design: Vec<types::CodeableConcept>,

    /// The quantitative findings of the evidence: values and parameters for
    /// each single statistic produced by the study or synthesis.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub statistic: Vec<EvidenceStatistic>,

    /// Certainty, confidence, or quality of the evidence, typically graded
    /// using a framework such as GRADE.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub certainty: Vec<EvidenceCertainty>,
}

/// Evidence variable such as population, exposure, or outcome.
#[serde_with::skip_serializing_none]
#[derive(Debug, Default, Clone, Serialize, Deserialize, PartialEq, Eq, Validate)]
#[serde(rename_all = "camelCase")]
pub struct EvidenceVariableDefinition {
    /// Unique id for inter-element referencing.
    pub id: Option<types::String>,

    /// Additional content defined by implementations.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub extension: Vec<types::Extension>,

    /// Extensions that cannot be ignored even if unrecognized.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub modifier_extension: Vec<types::Extension>,

    /// A text description or summary of the variable.
    pub description: Option<types::Markdown>,
    /// Primitive extension sibling for [`description`](Self::description) (FHIR `_description`).
    #[serde(rename = "_description")]
    pub description_ext: Option<types::Element>,

    /// Footnotes and/or explanatory notes.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub note: Vec<types::Annotation>,

    /// population | subpopulation | exposure | referenceExposure | measuredVariable | confounder.
    pub variable_role: types::CodeableConcept,

    /// Definition of the actual variable related to the statistic(s).
    pub observed: Option<types::Reference>,

    /// Definition of the intended variable related to the Evidence.
    pub intended: Option<types::Reference>,

    /// low | moderate | high | exact.
    pub directness_match: Option<types::CodeableConcept>,
}

/// Values and parameters for a single statistic.
#[serde_with::skip_serializing_none]
#[derive(Debug, Default, Clone, Serialize, Deserialize, PartialEq, Eq, Validate)]
#[serde(rename_all = "camelCase")]
pub struct EvidenceStatistic {
    /// Unique id for inter-element referencing.
    pub id: Option<types::String>,

    /// Additional content defined by implementations.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub extension: Vec<types::Extension>,

    /// Extensions that cannot be ignored even if unrecognized.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub modifier_extension: Vec<types::Extension>,

    /// Description of content.
    pub description: Option<types::Markdown>,
    /// Primitive extension sibling for [`description`](Self::description) (FHIR `_description`).
    #[serde(rename = "_description")]
    pub description_ext: Option<types::Element>,

    /// Footnotes and/or explanatory notes.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub note: Vec<types::Annotation>,

    /// Type of statistic, e.g., relative risk.
    pub statistic_type: Option<types::CodeableConcept>,

    /// Associated category for categorical variable.
    pub category: Option<types::CodeableConcept>,

    /// Statistic value.
    pub quantity: Option<types::Quantity>,

    /// The number of events associated with the statistic.
    pub number_of_events: Option<types::UnsignedInt>,
    /// Primitive extension sibling for [`number_of_events`](Self::number_of_events) (FHIR `_numberOfEvents`).
    #[serde(rename = "_numberOfEvents")]
    pub number_of_events_ext: Option<types::Element>,

    /// The number of participants affected.
    pub number_affected: Option<types::UnsignedInt>,
    /// Primitive extension sibling for [`number_affected`](Self::number_affected) (FHIR `_numberAffected`).
    #[serde(rename = "_numberAffected")]
    pub number_affected_ext: Option<types::Element>,

    /// Number of samples in the statistic.
    pub sample_size: Option<EvidenceStatisticSampleSize>,

    /// An attribute of the Statistic.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub attribute_estimate: Vec<EvidenceStatisticAttributeEstimate>,

    /// An aspect of the statistical model.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub model_characteristic: Vec<EvidenceStatisticModelCharacteristic>,
}

/// Number of samples in the statistic.
#[serde_with::skip_serializing_none]
#[derive(Debug, Default, Clone, Serialize, Deserialize, PartialEq, Eq, Validate)]
#[serde(rename_all = "camelCase")]
pub struct EvidenceStatisticSampleSize {
    /// Unique id for inter-element referencing.
    pub id: Option<types::String>,

    /// Additional content defined by implementations.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub extension: Vec<types::Extension>,

    /// Extensions that cannot be ignored even if unrecognized.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub modifier_extension: Vec<types::Extension>,

    /// Textual description of sample size for statistic.
    pub description: Option<types::Markdown>,
    /// Primitive extension sibling for [`description`](Self::description) (FHIR `_description`).
    #[serde(rename = "_description")]
    pub description_ext: Option<types::Element>,

    /// Footnote or explanatory note about the sample size.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub note: Vec<types::Annotation>,

    /// Number of contributing studies.
    pub number_of_studies: Option<types::UnsignedInt>,
    /// Primitive extension sibling for [`number_of_studies`](Self::number_of_studies) (FHIR `_numberOfStudies`).
    #[serde(rename = "_numberOfStudies")]
    pub number_of_studies_ext: Option<types::Element>,

    /// Cumulative number of participants.
    pub number_of_participants: Option<types::UnsignedInt>,
    /// Primitive extension sibling for [`number_of_participants`](Self::number_of_participants) (FHIR `_numberOfParticipants`).
    #[serde(rename = "_numberOfParticipants")]
    pub number_of_participants_ext: Option<types::Element>,

    /// Number of participants with known results for measured variables.
    pub known_data_count: Option<types::UnsignedInt>,
    /// Primitive extension sibling for [`known_data_count`](Self::known_data_count) (FHIR `_knownDataCount`).
    #[serde(rename = "_knownDataCount")]
    pub known_data_count_ext: Option<types::Element>,
}

/// An attribute of the Statistic.
#[serde_with::skip_serializing_none]
#[derive(Debug, Default, Clone, Serialize, Deserialize, PartialEq, Eq, Validate)]
#[serde(rename_all = "camelCase")]
pub struct EvidenceStatisticAttributeEstimate {
    /// Unique id for inter-element referencing.
    pub id: Option<types::String>,

    /// Additional content defined by implementations.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub extension: Vec<types::Extension>,

    /// Extensions that cannot be ignored even if unrecognized.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub modifier_extension: Vec<types::Extension>,

    /// Textual description of the attribute estimate.
    pub description: Option<types::Markdown>,
    /// Primitive extension sibling for [`description`](Self::description) (FHIR `_description`).
    #[serde(rename = "_description")]
    pub description_ext: Option<types::Element>,

    /// Footnote or explanatory note about the estimate.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub note: Vec<types::Annotation>,

    /// The type of attribute estimate, e.g., confidence interval or p value.
    pub r#type: Option<types::CodeableConcept>,

    /// The singular quantity of the attribute estimate, for attribute estimates
    /// represented as single values.
    pub quantity: Option<types::Quantity>,

    /// Level of confidence interval, e.g., 0.95 for 95% confidence interval.
    pub level: Option<types::Decimal>,
    /// Primitive extension sibling for [`level`](Self::level) (FHIR `_level`).
    #[serde(rename = "_level")]
    pub level_ext: Option<types::Element>,

    /// Lower and upper bound values of the attribute estimate.
    pub range: Option<types::Range>,

    /// A nested attribute estimate; which is the attribute estimate of an attribute estimate.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub attribute_estimate: Vec<EvidenceStatisticAttributeEstimate>,
}

/// An aspect of the statistical model.
#[serde_with::skip_serializing_none]
#[derive(Debug, Default, Clone, Serialize, Deserialize, PartialEq, Eq, Validate)]
#[serde(rename_all = "camelCase")]
pub struct EvidenceStatisticModelCharacteristic {
    /// Unique id for inter-element referencing.
    pub id: Option<types::String>,

    /// Additional content defined by implementations.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub extension: Vec<types::Extension>,

    /// Extensions that cannot be ignored even if unrecognized.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub modifier_extension: Vec<types::Extension>,

    /// Model specification.
    pub code: types::CodeableConcept,

    /// Numerical value to complete model specification.
    pub value: Option<types::Quantity>,

    /// A variable adjusted for in the adjusted analysis.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub variable: Vec<EvidenceStatisticModelCharacteristicVariable>,

    /// An attribute of the statistic used as a model characteristic.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub attribute_estimate: Vec<EvidenceStatisticAttributeEstimate>,
}

/// A variable adjusted for in the adjusted analysis.
#[serde_with::skip_serializing_none]
#[derive(Debug, Default, Clone, Serialize, Deserialize, PartialEq, Eq, Validate)]
#[serde(rename_all = "camelCase")]
pub struct EvidenceStatisticModelCharacteristicVariable {
    /// Unique id for inter-element referencing.
    pub id: Option<types::String>,

    /// Additional content defined by implementations.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub extension: Vec<types::Extension>,

    /// Extensions that cannot be ignored even if unrecognized.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub modifier_extension: Vec<types::Extension>,

    /// Description of the variable.
    pub variable_definition: types::Reference,

    /// continuous | dichotomous | ordinal | polychotomous.
    pub handling: Option<crate::r5::coded::Coded<crate::r5::codes::VariableHandling>>,
    /// Primitive extension sibling for [`handling`](Self::handling) (FHIR `_handling`).
    #[serde(rename = "_handling")]
    pub handling_ext: Option<types::Element>,

    /// Description for grouping of ordinal or polychotomous variables.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub value_category: Vec<types::CodeableConcept>,

    /// Discrete value for grouping of ordinal or polychotomous variables.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub value_quantity: Vec<types::Quantity>,

    /// Range of values for grouping of ordinal or polychotomous variables.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub value_range: Vec<types::Range>,
}

/// Certainty or quality of the evidence.
#[serde_with::skip_serializing_none]
#[derive(Debug, Default, Clone, Serialize, Deserialize, PartialEq, Eq, Validate)]
#[serde(rename_all = "camelCase")]
pub struct EvidenceCertainty {
    /// Unique id for inter-element referencing.
    pub id: Option<types::String>,

    /// Additional content defined by implementations.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub extension: Vec<types::Extension>,

    /// Extensions that cannot be ignored even if unrecognized.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub modifier_extension: Vec<types::Extension>,

    /// Textual description of certainty.
    pub description: Option<types::Markdown>,
    /// Primitive extension sibling for [`description`](Self::description) (FHIR `_description`).
    #[serde(rename = "_description")]
    pub description_ext: Option<types::Element>,

    /// Footnotes and/or explanatory notes.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub note: Vec<types::Annotation>,

    /// Aspect of certainty being rated.
    pub r#type: Option<types::CodeableConcept>,

    /// Assessment or judgement of the aspect.
    pub rating: Option<types::CodeableConcept>,

    /// Individual or group who did the rating.
    pub rater: Option<types::String>,
    /// Primitive extension sibling for [`rater`](Self::rater) (FHIR `_rater`).
    #[serde(rename = "_rater")]
    pub rater_ext: Option<types::Element>,

    /// A domain or subdomain of certainty.
    #[serde(default, skip_serializing_if = "Vec::is_empty")]
    pub subcomponent: Vec<EvidenceCertainty>,
}

/// The `Evidence.citeAs[x]` choice element (see spec/11-choice-types.md).
#[derive(Debug, Clone, PartialEq, Eq, fhir_derive_macros::FhirChoice, Validate)]
#[allow(clippy::large_enum_variant)]
pub enum EvidenceCiteAs {
    /// `citeAsReference` variant.
    #[fhir("citeAsReference")]
    Reference(Box<types::Reference>),
    /// `citeAsMarkdown` variant.
    #[fhir("citeAsMarkdown")]
    Markdown(crate::r5::choice::Primitive<types::Markdown>),
}

/// The `Evidence.versionAlgorithm[x]` choice element (see spec/11-choice-types.md).
#[derive(Debug, Clone, PartialEq, Eq, fhir_derive_macros::FhirChoice, Validate)]
#[allow(clippy::large_enum_variant)]
pub enum EvidenceVersionAlgorithm {
    /// `versionAlgorithmString` variant.
    #[fhir("versionAlgorithmString")]
    String(crate::r5::choice::Primitive<types::String>),
    /// `versionAlgorithmCoding` variant.
    #[fhir("versionAlgorithmCoding")]
    Coding(Box<types::Coding>),
}