const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  AlignmentType, HeadingLevel, BorderStyle, WidthType, VerticalAlign,
  ShadingType, UnderlineType, PageNumber, NumberFormat, Footer, Header,
  TabStopType, TabStopPosition
} = require('docx');
const fs = require('fs');

// ── helpers ──────────────────────────────────────────────────────────────────
const DARK_BLUE  = "1F3864";
const MID_BLUE   = "2E74B5";
const LIGHT_BLUE = "D6E4F0";
const HEADER_BG  = "1F3864";
const ROW_ALT    = "EBF3FB";

function bold(text, size = 22, color = "000000") {
  return new TextRun({ text, bold: true, size, color });
}
function normal(text, size = 20, color = "000000") {
  return new TextRun({ text, size, color });
}
function blankLine() {
  return new Paragraph({ children: [new TextRun({ text: "", size: 20 })] });
}
function sectionHeading(text) {
  return new Paragraph({
    children: [new TextRun({ text, bold: true, size: 24, color: "FFFFFF" })],
    alignment: AlignmentType.LEFT,
    spacing: { before: 200, after: 100 },
    shading: { type: ShadingType.SOLID, color: HEADER_BG, fill: HEADER_BG },
    indent: { left: 100 }
  });
}
function qHeading(num, text) {
  return new Paragraph({
    children: [
      new TextRun({ text: `Q${num}. `, bold: true, size: 22, color: MID_BLUE }),
      new TextRun({ text, bold: true, size: 22, color: "000000" })
    ],
    spacing: { before: 160, after: 60 }
  });
}
function option(text) {
  return new Paragraph({
    children: [new TextRun({ text: `☐  ${text}`, size: 20 })],
    spacing: { before: 40, after: 40 },
    indent: { left: 400 }
  });
}
function optionsRow(opts) {
  // Put options side by side using tabs
  const runs = [];
  opts.forEach((o, i) => {
    runs.push(new TextRun({ text: `☐  ${o}`, size: 20 }));
    if (i < opts.length - 1) runs.push(new TextRun({ text: "     ", size: 20 }));
  });
  return new Paragraph({ children: runs, spacing: { before: 40, after: 40 }, indent: { left: 400 } });
}
function note(text) {
  return new Paragraph({
    children: [new TextRun({ text, italics: true, size: 18, color: "595959" })],
    spacing: { before: 20, after: 60 },
    indent: { left: 400 }
  });
}
function fieldLine(label, lineLen = 40) {
  return new Paragraph({
    children: [
      new TextRun({ text: `${label}: `, bold: true, size: 20 }),
      new TextRun({ text: "_".repeat(lineLen), size: 20 })
    ],
    spacing: { before: 60, after: 60 },
    indent: { left: 400 }
  });
}

// ── table helpers ─────────────────────────────────────────────────────────────
function makeHeaderCell(text, widthPct = 25) {
  return new TableCell({
    children: [new Paragraph({
      children: [new TextRun({ text, bold: true, size: 20, color: "FFFFFF" })],
      alignment: AlignmentType.CENTER
    })],
    shading: { type: ShadingType.SOLID, color: HEADER_BG, fill: HEADER_BG },
    verticalAlign: VerticalAlign.CENTER,
    width: { size: widthPct, type: WidthType.PERCENTAGE }
  });
}
function makeCell(text, shade = false, widthPct = 25) {
  return new TableCell({
    children: [new Paragraph({
      children: [new TextRun({ text, size: 19 })],
      alignment: AlignmentType.LEFT
    })],
    shading: shade ? { type: ShadingType.SOLID, color: ROW_ALT, fill: ROW_ALT } : undefined,
    verticalAlign: VerticalAlign.CENTER,
    width: { size: widthPct, type: WidthType.PERCENTAGE }
  });
}
function makeInputCell(shade = false, widthPct = 25) {
  return new TableCell({
    children: [new Paragraph({
      children: [new TextRun({ text: "", size: 19 })],
    })],
    shading: shade ? { type: ShadingType.SOLID, color: ROW_ALT, fill: ROW_ALT } : undefined,
    verticalAlign: VerticalAlign.CENTER,
    width: { size: widthPct, type: WidthType.PERCENTAGE }
  });
}

// ── ANTHROPOMETRY TABLE (Q6) ──────────────────────────────────────────────────
function anthropoTable() {
  const headers = ["Parameter", "Value", "Percentile / Z-score", "Classification"];
  const rows_data = [
    ["Weight (kg)", "", "", ""],
    ["Height (cm)", "", "", ""],
    ["BMI (kg/m²)", "", "", ""],
    ["BMI-for-age", "", "", "☐ 85–94th (Overweight)  ☐ ≥95th (Obese)"],
    ["Waist circumference (cm)", "", "", ""]
  ];
  const widths = [28, 18, 27, 27];
  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({
        children: headers.map((h, i) => makeHeaderCell(h, widths[i])),
        tableHeader: true
      }),
      ...rows_data.map((row, ri) => new TableRow({
        children: row.map((cell, ci) => makeCell(cell, ri % 2 === 0, widths[ci]))
      }))
    ]
  });
}

// ── LAB RESULTS TABLE (Q20) ──────────────────────────────────────────────────
function labTable() {
  const headers = ["Investigation", "Result", "Reference Range", "Classification"];
  const rows_data = [
    ["Haemoglobin (g/dL)", "", "Age/sex specific (WHO)", "☐ Normal  ☐ Anaemia"],
    ["MCV (fL)", "", "80–100 fL", "☐ Normal  ☐ Microcytic"],
    ["MCH (pg)", "", "27–33 pg", "☐ Normal  ☐ Low"],
    ["Serum Ferritin (µg/L)", "", "< 15 = deficient", "☐ Normal  ☐ Low  ☐ Elevated"],
    ["CRP (mg/L)", "", "< 5 = normal", "☐ Normal  ☐ Elevated"],
    ["Serum Iron (µg/dL)", "", "50–120 µg/dL", "☐ Normal  ☐ Low"],
    ["TIBC (µg/dL)", "", "250–370 µg/dL", "☐ Normal  ☐ High"],
    ["Transferrin Saturation (%)", "", "> 16% = normal", "☐ Normal  ☐ Low"]
  ];
  const widths = [28, 15, 27, 30];
  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({
        children: headers.map((h, i) => makeHeaderCell(h, widths[i])),
        tableHeader: true
      }),
      ...rows_data.map((row, ri) => new TableRow({
        children: row.map((cell, ci) => makeCell(cell, ri % 2 === 0, widths[ci]))
      })),
      // Final classification row
      new TableRow({
        children: [
          makeCell("Final Iron Status Classification", true, 28),
          new TableCell({
            children: [new Paragraph({
              children: [new TextRun({
                text: "☐ Normal   ☐ Iron Deficiency (ID)   ☐ Iron Deficiency Anaemia (IDA)   ☐ Anaemia of Inflammation",
                size: 18, bold: true
              })],
            })],
            shading: { type: ShadingType.SOLID, color: ROW_ALT, fill: ROW_ALT },
            columnSpan: 3
          })
        ]
      })
    ]
  });
}

// ── NOTES TABLE ───────────────────────────────────────────────────────────────
function notesTable() {
  const rows_data = [
    ["Q1–Q5", "Demographic profile; SES correlation with iron deficiency"],
    ["Q6", "Primary outcome — BMI classification; anthropometric correlation with iron parameters"],
    ["Q7–Q12", "Dietary iron intake adequacy; vegetarian vs. non-vegetarian iron risk; tea/tannin inhibition"],
    ["Q13–Q14", "Physical activity — correlate sedentary behaviour with BMI severity"],
    ["Q15–Q16", "Eligibility screening (exclusion criteria)"],
    ["Q17", "Clinical symptom burden of hidden anaemia"],
    ["Q18–Q19", "Family history as risk modifier for obesity and anaemia"],
    ["Q20", "Primary and secondary outcome data; final iron status classification"]
  ];
  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({
        children: [makeHeaderCell("Questions", 15), makeHeaderCell("Purpose in Analysis", 85)],
        tableHeader: true
      }),
      ...rows_data.map((row, ri) => new TableRow({
        children: [makeCell(row[0], ri % 2 === 0, 15), makeCell(row[1], ri % 2 === 0, 85)]
      }))
    ]
  });
}

// ── DOCUMENT ──────────────────────────────────────────────────────────────────
const children = [

  // ── TITLE BLOCK ──
  new Paragraph({
    children: [new TextRun({ text: "STUDY PROFORMA", bold: true, size: 36, color: DARK_BLUE })],
    alignment: AlignmentType.CENTER,
    spacing: { before: 0, after: 100 }
  }),
  new Paragraph({
    children: [new TextRun({
      text: "Estimation of Hidden Anemia (Serum Ferritin) in Overweight/Obese Children of Kamothe:",
      bold: true, size: 22, color: MID_BLUE
    })],
    alignment: AlignmentType.CENTER,
    spacing: { before: 0, after: 60 }
  }),
  new Paragraph({
    children: [new TextRun({
      text: "Investigating the Sideropenic Obesity Phenomenon",
      bold: true, italics: true, size: 22, color: MID_BLUE
    })],
    alignment: AlignmentType.CENTER,
    spacing: { before: 0, after: 160 }
  }),
  new Paragraph({
    children: [new TextRun({ text: "ICMR Short Term Studentship (STS) Project  |  Individual Study", size: 20, italics: true, color: "595959" })],
    alignment: AlignmentType.CENTER,
    spacing: { before: 0, after: 240 }
  }),

  // ── META FIELDS ──
  new Paragraph({
    children: [
      bold("Participant Code: "), normal("_________________     "),
      bold("Date: "), normal("_________________")
    ],
    spacing: { before: 60, after: 60 }
  }),
  new Paragraph({
    children: [
      bold("OPD No.: "), normal("_________________     "),
      bold("Investigator: "), normal("_________________________________")
    ],
    spacing: { before: 60, after: 200 }
  }),

  // ══ SECTION A ══
  sectionHeading("SECTION A — DEMOGRAPHIC INFORMATION"),
  blankLine(),

  qHeading(1, "What is the child's age?"),
  optionsRow(["6–8 years", "9–11 years", "12–13 years", "14–15 years"]),
  blankLine(),

  qHeading(2, "What is the child's sex?"),
  optionsRow(["Male", "Female"]),
  blankLine(),

  qHeading(3, "What is the child's current class/grade in school?"),
  optionsRow(["Class 1–3", "Class 4–6", "Class 7–9", "Class 10 or above", "Not attending school"]),
  blankLine(),

  qHeading(4, "What is the family's monthly income? (Modified Kuppuswamy Scale)"),
  optionsRow(["< ₹5,000", "₹5,000–10,000", "₹10,001–20,000", "₹20,001–50,000", "> ₹50,000"]),
  blankLine(),

  qHeading(5, "What is the highest education level of the primary caregiver?"),
  optionsRow(["Illiterate", "Primary (up to Class 5)", "Secondary (Class 6–10)"]),
  optionsRow(["Higher secondary (Class 11–12)", "Graduate and above"]),
  blankLine(),

  // ══ SECTION B ══
  sectionHeading("SECTION B — ANTHROPOMETRY  (Filled by Investigator)"),
  blankLine(),

  qHeading(6, "What is the child's weight, height, and BMI? (Measured values)"),
  anthropoTable(),
  blankLine(),

  // ══ SECTION C ══
  sectionHeading("SECTION C — DIETARY HABITS"),
  blankLine(),

  qHeading(7, "How many meals does the child eat per day?"),
  optionsRow(["1 meal", "2 meals", "3 meals", "More than 3 meals"]),
  blankLine(),

  qHeading(8, "How often does the child consume fast food / junk food (burgers, pizza, chips, noodles)?"),
  optionsRow(["Daily", "4–6 times/week", "2–3 times/week", "Once a week", "Rarely/Never"]),
  blankLine(),

  qHeading(9, "How often does the child consume iron-rich foods (green leafy vegetables, dal, beans, meat/chicken/fish, eggs)?"),
  optionsRow(["Daily", "4–6 times/week", "2–3 times/week", "Once a week", "Rarely/Never"]),
  blankLine(),

  qHeading(10, "Does the child consume tea or coffee around mealtimes?"),
  note("(Tea/coffee contain tannins that inhibit iron absorption)"),
  optionsRow(["Yes — regularly with meals", "Yes — but between meals", "Occasionally", "Never"]),
  blankLine(),

  qHeading(11, "What best describes the child's dietary pattern?"),
  optionsRow(["Strictly vegetarian", "Eggetarian (veg + eggs)", "Non-vegetarian", "Mixed (occasional non-veg)"]),
  blankLine(),

  qHeading(12, "Does the child regularly consume iron-fortified foods or iron supplements?"),
  optionsRow(["Yes — iron supplements prescribed", "Yes — fortified foods", "No"]),
  fieldLine("If YES, specify"),
  note("(If YES to supplements → apply Exclusion Criterion; do not enroll)"),
  blankLine(),

  // ══ SECTION D ══
  sectionHeading("SECTION D — PHYSICAL ACTIVITY"),
  blankLine(),

  qHeading(13, "How many hours per day does the child spend on screens (TV, mobile, tablet, video games)?"),
  optionsRow(["< 1 hour", "1–2 hours", "3–4 hours", "> 4 hours"]),
  blankLine(),

  qHeading(14, "How many days per week does the child engage in outdoor play or physical activity (≥ 30 minutes)?"),
  optionsRow(["Every day (7 days)", "4–6 days", "2–3 days", "Once a week", "Rarely/Never"]),
  blankLine(),

  // ══ SECTION E ══
  sectionHeading("SECTION E — CLINICAL & FAMILY HISTORY"),
  blankLine(),

  qHeading(15, "Has the child been diagnosed with any of the following? (Tick all that apply)"),
  option("Thalassaemia / haemoglobinopathy"),
  option("Chronic kidney disease"),
  option("Juvenile idiopathic arthritis or other autoimmune disease"),
  option("Inflammatory bowel disease"),
  option("Malignancy"),
  option("None of the above  ✦  (Must tick this to be eligible)"),
  blankLine(),

  qHeading(16, "Has the child had any acute febrile illness in the past 2 weeks?"),
  optionsRow(["Yes  (Exclude from study)", "No"]),
  blankLine(),

  qHeading(17, "Does the child have any symptoms suggestive of anaemia? (Tick all that apply)"),
  option("Unusual tiredness / easy fatigue"),
  option("Pallor (pale skin, conjunctiva, nails)"),
  option("Pica (eating mud, chalk, ice)"),
  option("Reduced attention / concentration in school"),
  option("Breathlessness on mild exertion"),
  option("None of the above"),
  blankLine(),

  qHeading(18, "Is there a family history of obesity in parents or siblings?"),
  optionsRow(["Both parents obese", "One parent obese", "Sibling obese", "No family history"]),
  blankLine(),

  qHeading(19, "Is there a family history of anaemia or iron deficiency in the mother or siblings?"),
  optionsRow(["Yes — mother", "Yes — sibling", "Yes — both", "No", "Not known"]),
  blankLine(),

  // ══ SECTION F ══
  sectionHeading("SECTION F — LABORATORY RESULTS  (Filled by Investigator after reports)"),
  blankLine(),

  qHeading(20, "Laboratory Investigation Results:"),
  labTable(),
  blankLine(),
  blankLine(),

  // ══ CONSENT BLOCK ══
  new Paragraph({
    children: [new TextRun({ text: "CONSENT & DECLARATION", bold: true, size: 24, color: DARK_BLUE })],
    spacing: { before: 200, after: 100 }
  }),
  new Paragraph({
    children: [
      new TextRun({ text: "Informed Consent obtained from parent/guardian: ", size: 20 }),
      new TextRun({ text: "☐ Yes     ☐ No", size: 20, bold: true })
    ],
    spacing: { before: 60, after: 60 }
  }),
  new Paragraph({
    children: [
      new TextRun({ text: "Assent obtained from child (≥ 7 years): ", size: 20 }),
      new TextRun({ text: "☐ Yes     ☐ No     ☐ Not applicable (< 7 years)", size: 20, bold: true })
    ],
    spacing: { before: 60, after: 60 }
  }),
  new Paragraph({
    children: [
      bold("Eligibility confirmed (all exclusion criteria checked): "),
      new TextRun({ text: "☐ Yes     ☐ No", size: 20, bold: true })
    ],
    spacing: { before: 60, after: 120 }
  }),
  new Paragraph({
    children: [
      bold("Investigator Signature: "),
      normal("____________________________     "),
      bold("Date: "),
      normal("________________")
    ],
    spacing: { before: 80, after: 200 }
  }),

  // ══ NOTES TABLE ══
  new Paragraph({
    children: [new TextRun({ text: "GUIDE TO SECTIONS — Purpose in Analysis", bold: true, size: 22, color: DARK_BLUE })],
    spacing: { before: 200, after: 100 }
  }),
  notesTable(),
  blankLine(),
  new Paragraph({
    children: [new TextRun({
      text: "Note: Q10 (tea/coffee with meals) and Q11 (dietary pattern) are key modifiable risk factors. Q17 documents symptom burden of hidden anaemia — children with low ferritin but normal Hb often report fatigue and poor concentration, strengthening the case for ferritin-based screening.",
      italics: true, size: 18, color: "595959"
    })],
    spacing: { before: 60, after: 60 }
  })
];

const doc = new Document({
  styles: {
    default: {
      document: {
        run: { font: "Calibri", size: 20 }
      }
    }
  },
  sections: [{
    properties: {
      page: {
        margin: { top: 900, bottom: 900, left: 1080, right: 1080 }
      }
    },
    headers: {
      default: new Header({
        children: [
          new Paragraph({
            children: [
              new TextRun({ text: "ICMR STS Project — Study Proforma", bold: true, size: 18, color: MID_BLUE }),
              new TextRun({ text: "        Sideropenic Obesity | Kamothe District", size: 18, color: "595959" })
            ],
            alignment: AlignmentType.CENTER
          })
        ]
      })
    },
    footers: {
      default: new Footer({
        children: [
          new Paragraph({
            children: [
              new TextRun({ text: "Page ", size: 18, color: "595959" }),
              new TextRun({ children: [PageNumber.CURRENT], size: 18, color: "595959" }),
              new TextRun({ text: " of ", size: 18, color: "595959" }),
              new TextRun({ children: [PageNumber.TOTAL_PAGES], size: 18, color: "595959" }),
              new TextRun({ text: "          Participant Code: __________          Confidential — Research Use Only", size: 18, color: "595959" })
            ],
            alignment: AlignmentType.CENTER
          })
        ]
      })
    },
    children
  }]
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync('/home/daytona/workspace/icmr-sts/ICMR_STS_Proforma.docx', buffer);
  console.log('Done: ICMR_STS_Proforma.docx');
});

const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  AlignmentType, HeadingLevel, BorderStyle, WidthType, VerticalAlign,
  ShadingType, Header, Footer, PageNumber
} = require('docx');
const fs = require('fs');

// ── Colours ───────────────────────────────────────────────────────────────────
const DARK_BLUE  = "1F3864";
const MID_BLUE   = "2E74B5";
const LIGHT_BLUE = "D6E4F0";
const ROW_ALT    = "EBF3FB";

// ── Helpers ───────────────────────────────────────────────────────────────────
function blankLine() {
  return new Paragraph({ children: [new TextRun({ text: "", size: 20 })] });
}

function sectionHeading(text) {
  return new Paragraph({
    children: [new TextRun({ text, bold: true, size: 26, color: "FFFFFF" })],
    alignment: AlignmentType.LEFT,
    spacing: { before: 280, after: 120 },
    shading: { type: ShadingType.SOLID, color: DARK_BLUE, fill: DARK_BLUE },
    indent: { left: 100 }
  });
}

function subHeading(text) {
  return new Paragraph({
    children: [new TextRun({ text, bold: true, size: 22, color: MID_BLUE })],
    spacing: { before: 160, after: 60 }
  });
}

function bodyPara(text, indent = 0) {
  return new Paragraph({
    children: [new TextRun({ text, size: 20 })],
    spacing: { before: 60, after: 60 },
    indent: indent ? { left: indent } : undefined,
    alignment: AlignmentType.JUSTIFIED
  });
}

function boldBodyPara(parts) {
  // parts = [{text, bold}]
  return new Paragraph({
    children: parts.map(p => new TextRun({ text: p.text, bold: !!p.bold, size: 20 })),
    spacing: { before: 60, after: 60 },
    alignment: AlignmentType.JUSTIFIED
  });
}

function bullet(text) {
  return new Paragraph({
    children: [new TextRun({ text: `•  ${text}`, size: 20 })],
    spacing: { before: 40, after: 40 },
    indent: { left: 400, hanging: 200 }
  });
}

function numberedItem(n, text) {
  return new Paragraph({
    children: [
      new TextRun({ text: `${n}.  `, bold: true, size: 20, color: MID_BLUE }),
      new TextRun({ text, size: 20 })
    ],
    spacing: { before: 40, after: 40 },
    indent: { left: 400 }
  });
}

// ── Two-column table helper ───────────────────────────────────────────────────
function makeHeaderCell(text, widthPct) {
  return new TableCell({
    children: [new Paragraph({
      children: [new TextRun({ text, bold: true, size: 19, color: "FFFFFF" })],
      alignment: AlignmentType.CENTER
    })],
    shading: { type: ShadingType.SOLID, color: DARK_BLUE, fill: DARK_BLUE },
    verticalAlign: VerticalAlign.CENTER,
    width: { size: widthPct, type: WidthType.PERCENTAGE }
  });
}

function makeCell(text, shade, widthPct, bold = false) {
  return new TableCell({
    children: [new Paragraph({
      children: [new TextRun({ text, size: 19, bold })],
      alignment: AlignmentType.LEFT
    })],
    shading: shade ? { type: ShadingType.SOLID, color: ROW_ALT, fill: ROW_ALT } : undefined,
    verticalAlign: VerticalAlign.CENTER,
    width: { size: widthPct, type: WidthType.PERCENTAGE },
    margins: { top: 60, bottom: 60, left: 80, right: 80 }
  });
}

function twoColTable(headers, rows, widths) {
  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({
        children: headers.map((h, i) => makeHeaderCell(h, widths[i])),
        tableHeader: true
      }),
      ...rows.map((row, ri) => new TableRow({
        children: row.map((cell, ci) => makeCell(cell, ri % 2 === 0, widths[ci]))
      }))
    ]
  });
}

// ── Budget Table ─────────────────────────────────────────────────────────────
function budgetTable() {
  const headers = ["Expense Head", "Amount (₹)"];
  const rows = [
    ["Laboratory investigations (50 × ₹1,065)", "₹53,250"],
    ["Stationery & printing (proformas, consent forms)", "₹1,000"],
    ["Consumables (gloves, cotton, spirit swabs)", "₹800"],
    ["Report preparation & binding", "₹500"],
    ["Contingency / miscellaneous (~5%)", "₹2,700"],
    ["TOTAL ESTIMATED EXPENDITURE", "₹58,250"]
  ];
  const widths = [72, 28];
  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({
        children: headers.map((h, i) => makeHeaderCell(h, widths[i])),
        tableHeader: true
      }),
      ...rows.map((row, ri) => {
        const isTotal = ri === rows.length - 1;
        return new TableRow({
          children: row.map((cell, ci) => new TableCell({
            children: [new Paragraph({
              children: [new TextRun({ text: cell, size: 19, bold: isTotal, color: isTotal ? DARK_BLUE : "000000" })],
              alignment: ci === 1 ? AlignmentType.RIGHT : AlignmentType.LEFT
            })],
            shading: isTotal
              ? { type: ShadingType.SOLID, color: LIGHT_BLUE, fill: LIGHT_BLUE }
              : ri % 2 === 0
                ? { type: ShadingType.SOLID, color: ROW_ALT, fill: ROW_ALT }
                : undefined,
            verticalAlign: VerticalAlign.CENTER,
            width: { size: widths[ci], type: WidthType.PERCENTAGE },
            margins: { top: 60, bottom: 60, left: 80, right: 80 }
          }))
        });
      })
    ]
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// DOCUMENT CONTENT
// ═════════════════════════════════════════════════════════════════════════════
const children = [

  // ── TITLE ──
  new Paragraph({
    children: [new TextRun({ text: "CONCEPT NOTE", bold: true, size: 40, color: DARK_BLUE })],
    alignment: AlignmentType.CENTER,
    spacing: { before: 0, after: 80 }
  }),
  new Paragraph({
    children: [new TextRun({ text: "ICMR Short Term Studentship (STS) — Individual Project", size: 22, italics: true, color: "595959" })],
    alignment: AlignmentType.CENTER,
    spacing: { before: 0, after: 200 }
  }),
  new Paragraph({
    children: [new TextRun({
      text: "Estimation of Hidden Anemia (Serum Ferritin) in Overweight/Obese Children of Kamothe: Investigating the Sideropenic Obesity Phenomenon",
      bold: true, size: 26, color: MID_BLUE
    })],
    alignment: AlignmentType.CENTER,
    spacing: { before: 0, after: 300 }
  }),

  // ── TITLE SECTION ──
  sectionHeading("TITLE"),
  bodyPara("Estimation of Hidden Anemia (Serum Ferritin) in Overweight/Obese Children of Kamothe: Investigating the Sideropenic Obesity Phenomenon"),
  blankLine(),

  // ══════════════════════════════════════════════════════════════════════════
  // INTRODUCTION
  // ══════════════════════════════════════════════════════════════════════════
  sectionHeading("INTRODUCTION"),
  blankLine(),

  bodyPara("India carries a dual nutritional burden: iron deficiency anaemia (IDA) affects over 53% of Indian children, while childhood obesity is rising sharply in urban and peri-urban communities due to sedentary lifestyles and consumption of calorie-dense, micronutrient-poor diets.¹ Kamothe, a rapidly urbanising township in Navi Mumbai, reflects this epidemiological transition."),

  bodyPara("Clinicians traditionally associate obesity with excess nutrition and therefore overlook the possibility of concurrent micronutrient deficiency. This assumption is flawed. Obese children frequently harbour subclinical iron deficiency without overt anaemia — a state termed 'hidden anemia' — escaping detection on routine haemoglobin screening. The phenomenon of coexisting obesity and iron deficiency is described as 'Sideropenic Obesity'."),

  bodyPara("Three mechanisms underlie this paradox. First, obese children preferentially consume refined carbohydrates and processed foods low in bioavailable iron, leading to absolute iron insufficiency.² Second, their expanded blood volume and greater lean mass increase total iron demand beyond dietary supply. Third, adipose tissue secretes pro-inflammatory cytokines (IL-6, TNF-alpha) that stimulate hepatic hepcidin synthesis. Elevated hepcidin suppresses intestinal iron absorption and sequesters iron in macrophages, producing functional iron deficiency.³ Critically, serum ferritin — the primary marker of iron stores — is itself an acute-phase reactant elevated by the same inflammation, potentially masking true iron depletion. Simultaneous measurement of C-reactive protein (CRP) is therefore essential to correctly interpret ferritin in this population."),

  bodyPara("A 2025 systematic review and meta-analysis of 42 studies (49,206 children) confirmed obese children have 64% greater odds of iron deficiency (pooled OR 1.64; 95% CI 1.22-2.21) with significantly lower serum iron and higher hepcidin than normal-weight peers.⁴ An Indian study from Chandigarh found a 62% prevalence of hypoferraemic state in overweight/obese children — far exceeding Western estimates of 2-15%.⁵"),

  bodyPara("Despite this, no data exist from the Kamothe/Navi Mumbai region. This study addresses that gap by simultaneously measuring serum ferritin, CRP, serum iron, TIBC, and CBC to accurately characterise hidden anaemia in this overlooked population."),
  blankLine(),

  // ══════════════════════════════════════════════════════════════════════════
  // OBJECTIVES
  // ══════════════════════════════════════════════════════════════════════════
  sectionHeading("OBJECTIVES"),
  blankLine(),

  subHeading("Primary Objective:"),
  bodyPara("To estimate the prevalence of hidden anaemia (iron deficiency without overt anaemia, assessed by serum ferritin corrected for inflammation using CRP) in overweight and obese children aged 6-15 years in Kamothe district."),

  subHeading("Secondary Objectives:"),
  numberedItem(1, "To assess iron status using serum iron and TIBC (transferrin saturation)."),
  numberedItem(2, "To determine the prevalence of frank IDA using CBC parameters."),
  numberedItem(3, "To correlate BMI z-score with serum ferritin, iron, TIBC, and CRP."),
  numberedItem(4, "To compare iron parameters between overweight and obese subgroups."),
  blankLine(),

  subHeading("Hypothesis:"),
  bodyPara("The prevalence of inflammation-corrected iron deficiency (low serum ferritin, adjusted using CRP) is significantly higher in overweight/obese children than reported population norms for Indian children of the same age group."),
  blankLine(),

  // ══════════════════════════════════════════════════════════════════════════
  // METHODOLOGY
  // ══════════════════════════════════════════════════════════════════════════
  sectionHeading("METHODOLOGY"),
  blankLine(),

  subHeading("Study Design:"),
  bodyPara("Cross-sectional, observational study."),

  subHeading("Study Setting:"),
  bodyPara("Outpatient department, Kamothe district."),

  subHeading("Study Population:"),
  bodyPara("Children aged 6-15 years with overweight or obesity attending OPD."),
  blankLine(),

  // ── SAMPLE SIZE ──
  subHeading("Sample Size:  50 children"),

  bodyPara("Sample size was calculated using the standard formula for single proportion estimation:"),
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  bodyPara("Using an expected prevalence of iron deficiency of 62% in overweight/obese Indian children (Siyaram et al., Indian Pediatrics, 2018) as the reference value (p = 0.62), at a 95% confidence level (Z = 1.96) and 15% absolute precision (d = 0.15), the minimum required sample size is 40 children. Adjusting for a 20% contingency for incomplete data or participant dropouts, the final target sample size is 50 children (40 x 1.20 = 48, rounded to 50)."),

  bodyPara("This sample size is further independently validated by financial feasibility. The per-participant laboratory cost is Rs. 1,065 (covering all four investigations: Serum Ferritin, C-Reactive Protein, Serum Iron with TIBC, and Complete Blood Count). The total ICMR STS stipend of Rs. 60,000, after deducting an estimated Rs. 6,000 for non-laboratory project expenditure, leaves Rs. 54,000 available for investigations — sufficient for a maximum of 50 participants (50 x Rs. 1,065 = Rs. 53,250)."),

  bodyPara("This study is therefore designed as a pilot prevalence study. Findings will establish the first local baseline data on hidden anaemia in this population and will serve as reference data for a future larger-scale investigation."),
  blankLine(),

  subHeading("Proposed Budget:"),
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  // ── OPERATIONAL DEFINITIONS ──
  subHeading("Operational Definitions:"),
  twoColTable(
    ["Term", "Definition"],
    [
      ["Overweight", "BMI-for-age >= 85th and < 95th percentile (IAP/WHO Indian growth charts)"],
      ["Obesity", "BMI-for-age >= 95th percentile"],
      ["Iron Deficiency (ID)", "Serum ferritin < 15 microg/L, corrected for inflammation if CRP > 5 mg/L"],
      ["Iron Deficiency Anaemia (IDA)", "ID + Hb below WHO age/sex-specific cut-offs"],
      ["Hidden Anaemia", "Low serum ferritin with normal haemoglobin"]
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  blankLine(),

  // ── INCLUSION/EXCLUSION ──
  subHeading("Inclusion Criteria:"),
  bullet("Age 6-15 years"),
  bullet("BMI-for-age >= 85th percentile (overweight or obese)"),
  bullet("Written informed consent from parent/guardian; assent from child >= 7 years"),
  blankLine(),

  subHeading("Exclusion Criteria:"),
  bullet("Known haemoglobinopathy (thalassaemia, sickle cell disease)"),
  bullet("Currently receiving iron supplementation or haematinics"),
  bullet("Chronic inflammatory disease (JIA, IBD, CKD, malignancy)"),
  bullet("Acute febrile illness within 2 weeks of sampling"),
  blankLine(),

  // ── DATA COLLECTION ──
  subHeading("Data Collection Instruments:"),
  bodyPara("A pre-structured proforma capturing: age, sex, dietary history (frequency of fast food and iron-rich food intake), physical activity level, socioeconomic status (modified Kuppuswamy scale), and anthropometry (weight, height, BMI, waist circumference)."),

  subHeading("Anthropometry:"),
  bodyPara("Weight and height measured with calibrated instruments; BMI calculated (kg/m²); BMI-for-age z-score plotted on WHO/IAP growth charts."),
  blankLine(),

  // ── BLOOD TESTS ──
  subHeading("Blood Tests (single venipuncture; ~5 mL fasting sample):"),
  twoColTable(
    ["Investigation", "Rationale"],
    [
      ["Serum Ferritin", "Primary marker of iron stores; detects depleted stores before Hb falls (hidden anaemia)"],
      ["C-Reactive Protein (CRP)", "Corrects ferritin for obesity-associated chronic inflammation; confirms low-grade inflammatory state"],
      ["Serum Iron & TIBC", "Transferrin saturation (serum iron / TIBC x 100) < 16% confirms functional iron deficiency; TIBC rises in true iron deficiency"],
      ["Complete Blood Count (CBC)", "Detects anaemia (Hb), microcytosis (MCV, MCH); confirms IDA and excludes other causes of anaemia"]
    ],
    [30, 70]
  ),
  blankLine(),

  subHeading("Justification of Panel:"),
  bodyPara("Ferritin alone is unreliable in obesity due to inflammation-driven false elevation. CRP co-measurement allows interpretation of ferritin in the correct inflammatory context. Serum iron and TIBC provide transferrin saturation, a functional measure of iron supply to erythroid precursors. CBC identifies the downstream haematological consequence of iron deficiency."),
  blankLine(),

  // ── QC & CONFIDENTIALITY ──
  subHeading("Quality Control:"),
  bullet("Analyser calibrated daily with standard controls"),
  bullet("Duplicate testing for outlier ferritin values (> 2 SD from group mean)"),
  bullet("Laboratory personnel blinded to BMI category of participant"),
  blankLine(),

  subHeading("Confidentiality:"),
  bodyPara("Participants assigned unique numeric codes. Names and hospital identifiers excluded from data files. Data stored in password-protected databases accessible only to the investigator and guide."),
  blankLine(),

  // ── STATISTICAL ANALYSIS ──
  subHeading("Plan of Analysis / Statistical Tools:"),
  bullet("Descriptive: Prevalence of ID and IDA with 95% CI; mean ± SD for continuous variables"),
  bullet("Correlation: Spearman's rank correlation — BMI z-score vs. ferritin, serum iron, transferrin saturation, CRP"),
  bullet("Comparison: Mann-Whitney U test — iron parameters in overweight vs. obese subgroups"),
  bullet("Logistic regression: Predictors of iron deficiency (age, sex, BMI category, CRP level)"),
  bullet("Software: SPSS v23 / GraphPad Prism"),
  blankLine(),

  // ── ETHICS ──
  subHeading("Ethical Considerations:"),
  bullet("Institutional Ethics Committee approval will be obtained before study commencement"),
  bullet("Written informed consent from parent/guardian; written assent from children >= 7 years"),
  bullet("Study is purely observational; no experimental intervention"),
  bullet("Blood volume drawn (<= 5 mL, single prick) is within safe paediatric limits"),
  bullet("Participants identified with IDA will be referred to the treating paediatrician for standard management"),
  bullet("Participation is voluntary; withdrawal does not affect clinical care"),
  blankLine(),

  // ══════════════════════════════════════════════════════════════════════════
  // IMPLICATIONS
  // ══════════════════════════════════════════════════════════════════════════
  sectionHeading("IMPLICATIONS / STUDY OUTCOME"),
  blankLine(),

  bodyPara("This study will generate the first local prevalence data on hidden anaemia in overweight/obese children from Kamothe district, contributing evidence on the under-recognised 'Sideropenic Obesity' phenomenon in urban Maharashtra. Findings will challenge the clinical assumption that obese children are adequately nourished, supporting the case for routine iron screening in this population. Results may inform local paediatric screening protocols and serve as pilot data for a future larger ICMR-funded multicentre study. The student will gain skills in clinical research design, paediatric anthropometry, interpretation of iron biomarkers in the context of inflammation, and biostatistical analysis."),
  blankLine(),

  // ══════════════════════════════════════════════════════════════════════════
  // REFERENCES
  // ══════════════════════════════════════════════════════════════════════════
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      new TextRun({ text: "Sharma N, Sanjeevi RR, Balasubramanian K. A systematic review on prevalence of overweight and obesity among school children and adolescents in Indian population. Indian J Endocrinol Metab. 2024 Mar-Apr;28(2):105-115. PMID: 38911116.", size: 20 })
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      new TextRun({ text: "Ortiz Perez M, Vazquez Lopez MA, Ibanez Alcalde M. Relationship between obesity and iron deficiency in healthy adolescents. Child Obes. 2020 Sep;16(6):401-408. PMID: 32877290.", size: 20 })
    ],
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      new TextRun({ text: "Dogan G, Andiran N, Celik N. Iron parameters, pro-hepcidin and soluble transferrin receptor levels in obese children. Minerva Pediatr. 2020 Jun;72(3):219-226. PMID: 28006888.", size: 20 })
    ],
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      new TextRun({ text: "Sachdeva M, Malik M, Purohit A, Jain L, Kaur K, Pradhan P. Association of iron deficiency and anemia with obesity among children: a systematic review and meta-analysis. Obes Rev. 2025 Jun;26(6):e13892. PMID: 39843408.", size: 20 })
    ],
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      new TextRun({ text: "Siyaram D, Bhatia P, Dayal D, Bhalla AK, Marathe R. Hypoferremic state in overweight and obese children. Indian Pediatr. 2018 Jan 15;55(1):72-73. PMID: 29067916.", size: 20 })
    ],
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      new TextRun({ text: "Gosdin L, Sharma AJ, Suchdev PS. Limits of detection in acute-phase protein biomarkers affect inflammation correction of serum ferritin for quantifying iron status among school-age children. J Nutr. 2022 May 5;152(5):1283-1293. PMID: 35179209.", size: 20 })
    ],
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  }),
  new Paragraph({
    children: [
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      new TextRun({ text: "Mei Z, Addo OY, Jefferds ME, et al. Physiologically based serum ferritin thresholds for iron deficiency in children: a NHANES cross-sectional study. Lancet Haematol. 2021 Aug;8(8):e572-e582. PMID: 34329578.", size: 20 })
    ],
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    // ── CRP
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    children: [new TextRun({ text: "STUDY PROFORMA", bold: true, size: 40, color: DARK_BLUE })],
    alignment: AlignmentType.CENTER,
    spacing: { before: 0, after: 80 }
  }),
  new Paragraph({
    children: [new TextRun({
      text: "Estimation of Hidden Anemia (Serum Ferritin) in Overweight/Obese Children of Kamothe:",
      bold: true, size: 22, color: MID_BLUE
    })],
    alignment: AlignmentType.CENTER,
    spacing: { before: 0, after: 50 }
  }),
  new Paragraph({
    children: [new TextRun({
      text: "Investigating the Sideropenic Obesity Phenomenon",
      bold: true, italics: true, size: 22, color: MID_BLUE
    })],
    alignment: AlignmentType.CENTER,
    spacing: { before: 0, after: 100 }
  }),
  new Paragraph({
    children: [new TextRun({ text: "ICMR Short Term Studentship (STS)  |  Individual Project", size: 20, italics: true, color: "595959" })],
    alignment: AlignmentType.CENTER,
    spacing: { before: 0, after: 240 }
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  // Meta fields
  new Paragraph({
    children: [
      new TextRun({ text: "Participant Code: ", bold: true, size: 20 }),
      new TextRun({ text: "_______________     ", size: 20 }),
      new TextRun({ text: "Date: ", bold: true, size: 20 }),
      new TextRun({ text: "_______________", size: 20 })
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  new Paragraph({
    children: [
      new TextRun({ text: "OPD No.: ", bold: true, size: 20 }),
      new TextRun({ text: "_______________     ", size: 20 }),
      new TextRun({ text: "Investigator: ", bold: true, size: 20 }),
      new TextRun({ text: "________________________________", size: 20 })
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  // ══ SECTION A ══════════════════════════════════════════════════════════════
  secHeading("SECTION A — DEMOGRAPHIC INFORMATION"),
  blank(),

  qHead(1, "What is the child's age?"),
  optsInline(["6-8 years", "9-11 years", "12-13 years", "14-15 years"]),
  blank(),

  qHead(2, "What is the child's sex?"),
  optsInline(["Male", "Female"]),
  blank(),

  qHead(3, "What is the child's current class/grade in school?"),
  optsInline(["Class 1-3", "Class 4-6", "Class 7-9", "Class 10 or above", "Not in school"]),
  blank(),

  qHead(4, "What is the family's monthly income? (Modified Kuppuswamy Scale)"),
  optsInline(["< \u20b95,000", "\u20b95,000-10,000", "\u20b910,001-20,000", "\u20b920,001-50,000", "> \u20b950,000"]),
  blank(),

  qHead(5, "What is the highest education level of the primary caregiver?"),
  optsInline(["Illiterate", "Primary (up to Class 5)", "Secondary (Class 6-10)"]),
  optsInline(["Higher secondary (Class 11-12)", "Graduate and above"]),
  blank(),

  // ══ SECTION B ══════════════════════════════════════════════════════════════
  secHeading("SECTION B — ANTHROPOMETRY  (Filled by Investigator)"),
  blank(),

  qHead(6, "Measured anthropometric values:"),
  anthropoTable(),
  blank(),

  // ══ SECTION C ══════════════════════════════════════════════════════════════
  secHeading("SECTION C — DIETARY HABITS"),
  blank(),

  qHead(7, "How many meals does the child eat per day?"),
  optsInline(["1 meal", "2 meals", "3 meals", "More than 3 meals"]),
  blank(),

  qHead(8, "How often does the child consume fast food / junk food (burgers, pizza, chips, noodles)?"),
  optsInline(["Daily", "4-6 times/week", "2-3 times/week", "Once a week", "Rarely/Never"]),
  blank(),

  qHead(9, "How often does the child consume iron-rich foods (green leafy vegetables, dal, beans, meat/chicken/fish, eggs)?"),
  optsInline(["Daily", "4-6 times/week", "2-3 times/week", "Once a week", "Rarely/Never"]),
  blank(),

  qHead(10, "Does the child consume tea or coffee around mealtimes?"),
  noteLine("(Tea/coffee contain tannins that inhibit non-haem iron absorption)"),
  optsInline(["Yes — regularly with meals", "Yes — between meals", "Occasionally", "Never"]),
  blank(),

  qHead(11, "What best describes the child's dietary pattern?"),
  optsInline(["Strictly vegetarian", "Eggetarian", "Non-vegetarian", "Mixed (occasional non-veg)"]),
  blank(),

  qHead(12, "Does the child regularly consume iron supplements or iron-fortified foods?"),
  optsInline(["Yes — iron supplements prescribed", "Yes — fortified foods only", "No"]),
  fieldLine("If YES, specify"),
  noteLine("(If YES to iron supplements \u2192 apply Exclusion Criterion; do not enrol)"),
  blank(),

  // ══ SECTION D ══════════════════════════════════════════════════════════════
  secHeading("SECTION D — PHYSICAL ACTIVITY"),
  blank(),

  qHead(13, "How many hours per day does the child spend on screens (TV, mobile, tablet, video games)?"),
  optsInline(["< 1 hour", "1-2 hours", "3-4 hours", "> 4 hours"]),
  blank(),

  qHead(14, "How many days per week does the child engage in outdoor play or physical activity (>= 30 minutes)?"),
  optsInline(["Every day (7 days)", "4-6 days", "2-3 days", "Once a week", "Rarely/Never"]),
  blank(),

  // ══ SECTION E ══════════════════════════════════════════════════════════════
  secHeading("SECTION E — CLINICAL & FAMILY HISTORY"),
  blank(),

  qHead(15, "Has the child been diagnosed with any of the following? (Tick all that apply)"),
  opt("Thalassaemia / haemoglobinopathy"),
  opt("Chronic kidney disease"),
  opt("Juvenile idiopathic arthritis or other autoimmune disease"),
  opt("Inflammatory bowel disease"),
  opt("Malignancy"),
  opt("None of the above   \u2726  (Must tick this box to be eligible)"),
  blank(),

  qHead(16, "Has the child had any acute febrile illness in the past 2 weeks?"),
  optsInline(["Yes  (Exclude from study)", "No"]),
  blank(),

  qHead(17, "Does the child have any symptoms suggestive of anaemia? (Tick all that apply)"),
  opt("Unusual tiredness / easy fatigue"),
  opt("Pallor (pale skin, pale conjunctiva, pale nails)"),
  opt("Pica (craving for mud, chalk, ice)"),
  opt("Reduced attention / poor concentration in school"),
  opt("Breathlessness on mild exertion"),
  opt("None of the above"),
  blank(),

  qHead(18, "Is there a family history of obesity in parents or siblings?"),
  optsInline(["Both parents obese", "One parent obese", "Sibling obese", "No family history"]),
  blank(),

  qHead(19, "Is there a family history of anaemia or iron deficiency in the mother or siblings?"),
  optsInline(["Yes — mother", "Yes — sibling", "Yes — both", "No", "Not known"]),
  blank(),

  // ══ SECTION F ══════════════════════════════════════════════════════════════
  secHeading("SECTION F — LABORATORY RESULTS  (Filled by Investigator after reports)"),
  blank(),

  qHead(20, "Blood investigation results (4 tests):"),
  labTable(),
  blank(),
  blank(),

  // ══ CONSENT BLOCK ══════════════════════════════════════════════════════════
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    children: [new TextRun({ text: "CONSENT & ELIGIBILITY DECLARATION", bold: true, size: 24, color: DARK_BLUE })],
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      new TextRun({ text: "Informed Consent obtained from parent/guardian: ", size: 20 }),
      new TextRun({ text: "\u2610 Yes     \u2610 No", bold: true, size: 20 })
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    children: [
      new TextRun({ text: "Assent obtained from child (\u2265 7 years): ", size: 20 }),
      new TextRun({ text: "\u2610 Yes     \u2610 No     \u2610 Not applicable (< 7 years)", bold: true, size: 20 })
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    children: [
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      new TextRun({ text: "\u2610 Yes     \u2610 No", bold: true, size: 20 })
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      new TextRun({ text: "Date: ", bold: true, size: 20 }),
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  // ══ PURPOSE TABLE ══════════════════════════════════════════════════════════
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    children: [new TextRun({ text: "GUIDE TO SECTIONS — Purpose in Analysis", bold: true, size: 22, color: DARK_BLUE })],
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      text: "Note: Q10 (tea/coffee with meals) and Q11 (dietary pattern) are key modifiable risk factors. Q17 documents the symptom burden of hidden anaemia — children with low ferritin but normal Hb often report fatigue and poor concentration, strengthening the argument for ferritin-based screening over routine Hb-only assessment.",
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