Ma Fulltext Management

1. Create 04_fulltext/ and build manifest.csv with record_id, DOI, PMID, title, and access notes.
   • Read from 03_screening/round-01/included.bib
   • Use references/manifest-template.csv as template
   • Write to 04_fulltext/manifest.csv (columns: record_id, DOI, PMID, title, access_method, confidence_score)
2. Automatically run web extraction for all included studies using Claude Code's WebSearch and WebFetch tools:
   • Query PubMed structured abstracts (https://pubmed.ncbi.nlm.nih.gov/<pmid>/)
   • Query ClinicalTrials.gov registries (https://clinicaltrials.gov/study/<nct_id>)
   • Search Europe PMC, journal supplementary materials
3. Record confidence scores per field (see references/web-extraction.md for scoring).
   • Update 04_fulltext/manifest.csv (confidence_score column)
4. Flag studies with confidence < 0.7 for primary outcome fields → these need PDFs.
   • Mark in 04_fulltext/manifest.csv (needs_pdf = TRUE)

Phase 2: Targeted PDF Retrieval (Only for Low-Confidence Studies)

5. For flagged studies only (~20-30%), query Unpaywall for OA links using scripts/unpaywall_fetch.py via uv run.
   • Use scripts/unpaywall_fetch.py
   • Read from 04_fulltext/manifest.csv (needs_pdf = TRUE rows)
   • Write to 04_fulltext/unpaywall_results.csv
6. Download available PDFs with scripts/download_oa_pdfs.py.
   • Use scripts/download_oa_pdfs.py
   • Write to 04_fulltext/<record_id>.pdf
7. Optionally render PDF previews with scripts/render_pdf_previews.py for visual QA.
   • Use scripts/render_pdf_previews.py
   • Write to 04_fulltext/previews/<record_id>_page1.png
8. Request user to manually deposit any remaining PDFs that cannot be auto-retrieved.
   • Update 04_fulltext/manifest.csv (access_method = "manual")
9. Run OCR only when needed and preserve original files.

Why Web-First?

• Speed: 50-70% faster than PDF-only (2-3h vs 8-12h)
• No institutional access required for Phase 1
• 90-95% completeness with hybrid approach
• PDFs are only needed for ~20-30% of studies

Resources

• references/manifest-template.csv provides a manifest header.
• scripts/unpaywall_fetch.py queries Unpaywall for open-access links.
• scripts/analyze_unpaywall.py analyzes Unpaywall results and generates summary statistics.
• scripts/download_oa_pdfs.py downloads open-access PDFs automatically from Unpaywall URLs.
• scripts/render_pdf_previews.py renders PDF pages to PNG previews. Note: Unpaywall requires UNPAYWALL_EMAIL in .env. Note: PDF previews require pdftoppm or mutool installed.

Stage 04b: Full-Text Eligibility Screening (PRISMA Item 16)

⚠️ MANDATORY — PRISMA 2020 requires reporting the number of full-text articles excluded with reasons.

After completing full-text retrieval (Phases 1-2 above), re-screen all included studies against the full text to confirm eligibility. This step catches issues not visible at the abstract stage (e.g., wrong population subgroup, insufficient sample size, protocol-only publications).

Workflow

1. Run AI full-text screening (Reviewer 1):

   uv run tooling/python/ai_screen.py --project <project-name> --stage fulltext --reviewer 1
   

2. Run AI full-text screening (Reviewer 2) for dual review:

   uv run tooling/python/ai_screen.py --project <project-name> --stage fulltext --reviewer 2
   

3. Compute full-text inter-rater agreement (Cohen's kappa):

   uv run ma-screening-quality/scripts/dual_review_agreement.py \
     --file projects/<project-name>/04_fulltext/fulltext_decisions.csv \
     --col-a FT_Reviewer1_Decision --col-b FT_Reviewer2_Decision \
     --out projects/<project-name>/04_fulltext/ft_agreement.md
   

4. Resolve conflicts (if any) — update FT_Final_Decision and FT_Exclusion_Code columns.

5. Only studies with FT_Final_Decision = include proceed to Stage 05 (data extraction).

Output Schema (fulltext_decisions.csv)

Exclusion Codes

Reuses standard codes from ma-screening-quality/references/screening-labels.md: P1/P2 (population), I1/I2 (intervention), C1 (comparator), S1-S4 (study design), O1/O2 (outcomes), T1/T2 (time), L1 (language), D1 (duplicate).

QA Thresholds

• Full-text kappa ≥ 0.60 (same threshold as abstract screening)
• All exclusions must have a documented reason and code
• FT_Exclusion_Code feeds directly into PRISMA flow diagram item 16

Validation

• Ensure every included record has a matching full-text file or a documented reason for absence.
• Ensure record_id continuity with screening decisions.
• Ensure fulltext_decisions.csv exists before proceeding to Stage 05.
• Ensure all FT_Final_Decision values are resolved (no blanks) before extraction.

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