cd /home/daytona/workspace/attachments/cee18d4a-0a2f-452d-aa29-af9ed716cef7 && p…

ls /home/daytona/workspace/

mkdir -p /home/daytona/workspace/pas-proposal && node -e "console.log(require('d…

~/pas-proposal/generate.js

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const fs = require('fs');

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// ---- TIMELINE TABLE ----
function timelineTable() {
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// ---- BUDGET TABLE ----
function budgetTable() {
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    ["1", "Ultrasound examination (consumables, probes, gel)", "Departmental equipment available", "NIL"],
    ["2", "MRI examination charges (institutional rate)", "75 patients x ₹2,000", "₹1,50,000"],
    ["3", "Printing & stationery (CRF, consent forms)", "Lump sum", "₹3,000"],
    ["4", "Statistical analysis software", "Open-source (SPSS trial / MedCalc)", "NIL"],
    ["5", "Histopathological processing (selected cases)", "Approx. 30 cases x ₹500", "₹15,000"],
    ["6", "Literature review & reference management", "PubMed, institutional access", "NIL"],
    ["7", "Contingency (miscellaneous)", "5% of total", "₹8,400"],
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// ---- MAIN DOCUMENT ----
const TITLE = "Diagnostic Accuracy of Ultrasound Versus Magnetic Resonance Imaging in Placenta Accreta Spectrum in Indian Women with Placenta Previa and Prior Cesarean Section";
const PI = "Dr. Ajaykumar Ranjitbhai Patel";
const DEPT = "Department of Radiodiagnosis";
const INST = "Nootan Medical College and Research Centre, Visnagar, Gujarat";
const GUIDE = "Dr. Gurudatt Thakkar";
const GUIDE_DESIG = "Associate Professor, Department of Radiodiagnosis, NMCRC, Visnagar";
const EMAIL_PI = "ajaychaudhary88006@gmail.com";
const DATE = "July 2026";

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      // ============================================================
      // PAGE 1 — ORDER OF DOCUMENTS
      // ============================================================
      underlineHeading("Order of Documents to be submitted to SRC:", true),
      blank(),
      numberedItem("Covering Letter addressed to Member Secretary"),
      numberedItem("Application Form"),
      numberedItem("Research Study Proposal (include all components)"),
      numberedItem("Case Record Form (CRF) / Data Collection Proforma / Questionnaire", { bold: true }),
      numberedItem("Patient Information Sheet (PIS) (for human studies)", { bold: true }),
      numberedItem("Informed Consent Form (ICF) in English and local language(s)."),
      numberedItem("Relevant Published Articles or References (usually included in the proposal, not attached separately)."),
      blank(),
      body("*Documents to be submitted as per the requirement of your study protocol", { bold: true }),

      pageBreak(),

      // ============================================================
      // PAGE 2 — COVERING LETTER
      // ============================================================
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      body("To"),
      body("The Member Secretary,"),
      body("Scientific Review Committee (SRC)"),
      body("Nootan Medical College & Research Centre, Visnagar, Gujarat."),
      blank(),
      body("Subject: Submission of Research Proposal for Scientific Review", { bold: true }),
      blank(),
      body("Respected Sir/Madam,"),
      blank(),
      body(`I hereby submit the research proposal entitled, "${TITLE}", for review and approval by the Scientific Review Committee (SRC).`),
      blank(),
      body(`The study is proposed to be conducted in the ${DEPT}, ${INST}. The protocol has been prepared in accordance with institutional and ethical guidelines. I kindly request the Committee to review the proposal and provide its recommendations for further processing.`),
      blank(),
      body("The following documents are enclosed for your kind perusal:"),
      blank(),
      numberedItem("Covering Letter addressed to Member Secretary"),
      numberedItem("Application Form"),
      numberedItem("Research Study Proposal (include all components)"),
      numberedItem("Case Record Form (CRF) / Data Collection Proforma / Questionnaire"),
      numberedItem("Patient Information Sheet (PIS) (for human studies)"),
      numberedItem("Informed Consent Form (ICF) in English and local language(s)."),
      numberedItem("Relevant Published Articles or References (usually included in the proposal, not attached separately)."),
      blank(),
      body("I shall be grateful for your consideration and approval of the proposal."),
      blank(),
      body("Thanking you."),
      blank(),
      body("Yours faithfully,"),
      blank(),
      blank(),
      body("_________________________"),
      body(`${PI}`, { bold: true }),
      body("(Principal Investigator)"),
      body(`Designation: Junior Resident (PG Student), ${DEPT}`),
      body(`Department/Institute: ${INST}`),
      body(`Email (PI): ${EMAIL_PI}`),
      body(`Email (Guide): (Guide's official email)    Mobile: _______________`),

      pageBreak(),

      // ============================================================
      // PAGE 3 — APPLICATION FORM
      // ============================================================
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        ["Title of the study", TITLE],
        ["Name of the Principal Investigator (PG Student)", PI],
        ["Designation", "Junior Resident (PG Student)"],
        ["Department", DEPT],
        ["Name of the Guide / Research Supervisor", GUIDE],
        ["Designation of Guide", "Associate Professor"],
        ["Institute", INST],
        ["Contact details of PI", `Email: ${EMAIL_PI}`],
        ["Date of submission", DATE],
        ["Duration of study", "18 months"],
        ["Type of study", "Prospective, Observational, Cross-sectional, Diagnostic Accuracy Study"],
        ["Source of funding", "Self-funded / Institutional"],
        ["Animal Experiments", "No"],
        ["Clinical Trial", "No"],
        ["Research on Patented Product", "No"],
        ["Research on Herbal Extract", "No"],
        ["Research Study Proposal Enclosed (Yes/No)", "Yes"],
        ["Whether Consent Form in English & Vernacular Language is Enclosed", "Yes"]
      ]),
      blank(),
      blank(),
      body("Name & Signature                                                                       Name & Signature"),
      body("PI / PG Resident                                                                          Guide / Research Supervisor"),
      blank(),
      body("Dr. Ajaykumar Ranjitbhai Patel                                             Dr. Gurudatt Thakkar"),

      pageBreak(),

      // ============================================================
      // PAGE 4 — RESEARCH STUDY PROPOSAL
      // ============================================================
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      centeredBold(`Date of Submission: ${DATE}`),
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      // ---- FORMATTING INSTRUCTIONS ----
      heading2("Formatting Instructions"),
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      bulletItem("Line Spacing: 1.5 lines"),
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      bulletItem("File Format: Microsoft Word document (.docx)"),
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      // ---- 1. INTRODUCTION ----
      heading1("1. Introduction"),
      body("Placenta Accreta Spectrum (PAS) disorders encompass a range of abnormal placental adherence conditions -- placenta accreta, placenta increta, and placenta percreta -- in which the chorionic villi invade the myometrium due to a defective decidua basalis. PAS has emerged as one of the most challenging obstetric emergencies of modern medicine, with its incidence rising dramatically in parallel with the increasing global cesarean section rate. In India, the cesarean delivery rate has grown substantially over the past two decades, creating a proportional increase in PAS cases."),
      blank(),
      body("Placenta previa coexisting with prior cesarean scar is the highest-risk combination for PAS development. The scar from a previous uterine incision predisposes to abnormal placental invasion at the site of least resistance. With each subsequent cesarean, the risk compounds -- a woman with placenta previa and four prior cesarean sections carries a PAS risk exceeding 60%."),
      blank(),
      body("Early and accurate antenatal diagnosis of PAS is paramount because it allows for planned multidisciplinary management, reducing maternal morbidity and mortality. Undiagnosed PAS presenting at delivery leads to catastrophic hemorrhage, emergency hysterectomy, injury to surrounding viscera, and maternal death. Antenatal imaging -- primarily grayscale ultrasound (USG) with color Doppler and Magnetic Resonance Imaging (MRI) -- form the cornerstone of PAS diagnosis."),
      blank(),
      body("While USG is widely available, operator-dependent, and cost-effective, MRI offers superior soft-tissue contrast, larger field of view, and is less dependent on maternal habitus or fetal position. However, data on the comparative diagnostic accuracy of these two modalities in Indian women -- who may have differing body habitus, parity patterns, and access to high-field MRI -- remains scarce. This study aims to evaluate and compare the diagnostic accuracy of USG and MRI for diagnosing PAS in Indian women with placenta previa and prior cesarean section, using histopathology as the reference standard."),
      blank(),
      body("Importance and Rationale:", { bold: true }),
      bulletItem("Rising cesarean rates in India have made PAS a significant public health concern."),
      bulletItem("Accurate antenatal diagnosis allows planned delivery at tertiary centers, reducing maternal morbidity."),
      bulletItem("The comparative performance of USG and MRI for PAS has not been adequately evaluated in the Indian population."),
      bulletItem("Findings from this study will provide institution-specific and population-specific diagnostic benchmarks."),
      blank(),

      // ---- 2. REVIEW OF LITERATURE ----
      heading1("2. Review of Literature"),
      body("Placenta Accreta Spectrum was historically considered rare, with an incidence of approximately 1 in 2,500 deliveries in the 1980s. However, contemporaneous data places the incidence between 1 in 272 and 1 in 533 deliveries, a rise directly correlated with increasing cesarean delivery rates worldwide. In India, a 2019 multicenter study reported PAS incidence of 3.9 per 1,000 deliveries in tertiary institutions with high cesarean volumes."),
      blank(),
      body("Ultrasound Findings in PAS:"),
      body("Grayscale ultrasound signs predictive of PAS include: loss of the retroplacental clear zone, placental lacunae (Swiss cheese appearance), myometrial thinning (<1 mm), and abnormal placental vascularity on color Doppler (turbulent intraplacental flow, subplacental hypervascularity, bridging vessels crossing the uterine-bladder interface). A meta-analysis by D'Antonio et al. (2013) reported USG sensitivity of 90.72% and specificity of 96.94% for PAS diagnosis. The positive predictive value, however, is markedly influenced by disease prevalence in the study population."),
      blank(),
      body("MRI Findings in PAS:"),
      body("MRI signs include: uterine bulging, heterogeneous signal intensity within the placenta, dark intraplacental bands on T2-weighted sequences, disruption of the uteroplacental interface, and bladder wall invasion. Rac et al. (2015) demonstrated MRI sensitivity of 94.4% and specificity of 84.0%. MRI is particularly valuable in posterior placenta previa, where USG visualization is limited."),
      blank(),
      body("Comparative Studies:"),
      body("A systematic review by Familiari et al. (2016) found similar overall diagnostic accuracy for USG and MRI, but noted MRI's advantage in posterior placentas and in grading the depth of invasion (distinguishing increta from percreta). Conversely, some studies have shown no significant incremental benefit of MRI over USG in terms of sensitivity and specificity. Data specific to the Indian population, including those with lower socioeconomic status, higher parity, and differing body mass index profiles, are lacking."),
      blank(),
      body("Research Gap:"),
      body("No large prospective study has compared USG versus MRI accuracy for PAS specifically in Indian women attending a tertiary medical institution in Gujarat. Institution-specific data on prevalence, imaging findings, and diagnostic accuracy are needed to guide local clinical protocols and referral pathways."),
      blank(),

      // ---- 3. RESEARCH OBJECTIVES ----
      heading1("3. Research Objectives"),
      body("Primary Objective:", { bold: true }),
      bulletItem("To compare the diagnostic accuracy (sensitivity, specificity, PPV, NPV, and AUC) of ultrasound and MRI in diagnosing Placenta Accreta Spectrum (PAS) in women with placenta previa and prior cesarean section, using histopathology as the reference standard."),
      blank(),
      body("Secondary Objectives:", { bold: true }),
      bulletItem("To identify the most reliable individual sonographic and MRI features for predicting PAS."),
      bulletItem("To assess the ability of each modality to differentiate the grades of PAS (accreta vs. increta vs. percreta)."),
      bulletItem("To evaluate the correlation of imaging findings with surgical and histopathological outcomes."),
      bulletItem("To describe the prevalence of PAS in women with placenta previa and prior cesarean section at NMCRC, Visnagar."),
      blank(),

      // ---- 4. HYPOTHESIS ----
      heading1("4. Hypothesis / Research Question"),
      body("Null Hypothesis (H0): There is no statistically significant difference in the diagnostic accuracy of ultrasound versus MRI for the diagnosis of Placenta Accreta Spectrum in women with placenta previa and prior cesarean section."),
      blank(),
      body("Alternative Hypothesis (H1): MRI provides significantly higher diagnostic accuracy than ultrasound for the diagnosis of Placenta Accreta Spectrum in women with placenta previa and prior cesarean section."),
      blank(),

      // ---- 5. METHODOLOGY ----
      heading1("5. Methodology"),
      heading2("5.1 Study Design"),
      body("Prospective, cross-sectional, diagnostic accuracy study."),
      blank(),
      heading2("5.2 Study Setting"),
      body("Department of Radiodiagnosis and Department of Obstetrics & Gynecology, Nootan Medical College and Research Centre (NMCRC), Visnagar, Gujarat. The study will be conducted in collaboration with the Pathology department for histopathological correlation."),
      blank(),
      heading2("5.3 Study Period"),
      body("18 months from the date of institutional ethical committee approval."),
      blank(),
      heading2("5.4 Study Population"),
      body("Pregnant women attending antenatal clinics at NMCRC, Visnagar, who are diagnosed with placenta previa and have a history of one or more prior cesarean sections."),
      blank(),
      heading2("5.5 Inclusion Criteria"),
      bulletItem("Pregnant women with gestational age >=18 weeks at time of imaging."),
      bulletItem("Placenta previa (complete or partial) confirmed on USG."),
      bulletItem("History of at least one prior cesarean section."),
      bulletItem("Willing to undergo both USG and MRI during the antenatal period."),
      bulletItem("Provision of written informed consent."),
      blank(),
      heading2("5.6 Exclusion Criteria"),
      bulletItem("Contraindications to MRI (metallic implants, claustrophobia, cardiac pacemaker)."),
      bulletItem("Multiple pregnancy."),
      bulletItem("Fetuses with major structural anomalies."),
      bulletItem("Patients who deliver before completing both imaging modalities."),
      bulletItem("Patients in whom histopathological diagnosis is not available (e.g., conservative management without tissue sample)."),
      bulletItem("Prior diagnosis of uterine anomaly or previous uterine surgery other than cesarean."),
      blank(),
      heading2("5.7 Sample Size"),
      body("Based on a meta-analysis reporting USG sensitivity of 90% and MRI sensitivity of 94% for PAS, and assuming alpha = 0.05 (two-tailed), power = 80%, and an expected PAS prevalence of 20% in the study population, a minimum of 60-75 subjects is required. Accounting for 15% attrition, the target sample size is 75 patients with placenta previa and prior cesarean section over 18 months."),
      blank(),
      heading2("5.8 Sampling Technique"),
      body("Consecutive sampling -- all eligible patients attending NMCRC OPD or admitted to the Obstetrics & Gynecology ward who fulfill inclusion criteria will be enrolled until the target sample size is achieved."),
      blank(),
      heading2("5.9 Data Collection Methods"),
      body("Step 1 -- Patient Enrollment: Eligible patients will be identified, counseled, and written informed consent will be obtained."),
      blank(),
      body("Step 2 -- Ultrasound Examination:"),
      bulletItem("Performed using a Siemens or equivalent high-frequency ultrasound machine with a 3.5-5 MHz curvilinear transducer and a 5-9 MHz transvaginal transducer."),
      bulletItem("Grayscale assessment: retroplacental clear zone, placental lacunae, myometrial thinning, uterine serosal irregularity, bladder wall involvement."),
      bulletItem("Color Doppler assessment: intraplacental vascularity, subplacental hypervascularity, bridging vessels."),
      bulletItem("Each examination will be performed by a trained radiologist blinded to clinical history (beyond gestational age and prior CS)."),
      blank(),
      body("Step 3 -- MRI Examination:"),
      bulletItem("Performed at 1.5 Tesla MRI (Siemens or equivalent) without gadolinium contrast, using standard obstetric protocol."),
      bulletItem("Sequences: T2-weighted sagittal, axial, coronal HASTE; T1-weighted VIBE; DWI sequences as required."),
      bulletItem("MRI signs assessed: uterine bulging, heterogeneous placental signal, dark T2 bands, disrupted uteroplacental interface, bladder wall invasion."),
      bulletItem("MRI reporting done by a radiologist blinded to USG results."),
      blank(),
      body("Step 4 -- Reference Standard (Histopathology):"),
      bulletItem("Hysterectomy specimens or placental biopsies will be examined by the department of Pathology."),
      bulletItem("PAS will be graded according to FIGO 2018 classification: Grade 1 (accreta), Grade 2 (increta), Grade 3 (percreta)."),
      blank(),
      body("Step 5 -- Data Recording: All findings will be recorded on a pre-designed Case Record Form (CRF)."),
      blank(),
      heading2("5.10 Data Analysis Plan"),
      bulletItem("Descriptive statistics: mean, standard deviation, frequency, percentage."),
      bulletItem("Diagnostic accuracy indices: sensitivity, specificity, PPV, NPV, likelihood ratios, and area under ROC curve (AUC) will be computed for USG and MRI separately."),
      bulletItem("McNemar's test will be used to compare sensitivity and specificity between the two modalities."),
      bulletItem("Cohen's kappa will be used to assess inter-observer agreement."),
      bulletItem("Statistical analysis will be performed using SPSS version 26 / MedCalc software."),
      bulletItem("A p-value <0.05 will be considered statistically significant."),
      blank(),
      heading2("5.11 Ethical Considerations"),
      bulletItem("Ethical approval will be obtained from the Institutional Ethics Committee (IEC), NMCRC, Visnagar, prior to patient enrollment."),
      bulletItem("Written informed consent will be obtained from each participant in English and Gujarati."),
      bulletItem("Patient confidentiality and anonymity will be maintained at all stages."),
      bulletItem("No additional invasive procedures will be performed solely for research purposes -- all imaging will coincide with standard clinical care."),
      bulletItem("Data will be stored securely; access limited to the research team."),
      bulletItem("Participants may withdraw consent at any time without affecting their clinical care."),
      blank(),

      // ---- 6. EXPECTED OUTCOMES ----
      heading1("6. Expected Outcomes"),
      body("This study is expected to:"),
      bulletItem("Establish the diagnostic accuracy of USG and MRI for PAS in the Indian (specifically Gujarati) population."),
      bulletItem("Identify whether MRI provides incremental diagnostic benefit over USG in this cohort."),
      bulletItem("Define the most reliable individual imaging features for PAS prediction."),
      bulletItem("Contribute institution-specific prevalence data for PAS at NMCRC."),
      bulletItem("Provide evidence to guide local clinical protocols for managing high-risk pregnant women with prior cesarean and placenta previa."),
      bulletItem("Form the basis for further multicenter studies on PAS in India."),
      blank(),

      // ---- 7. TIMELINE ----
      heading1("7. Timeline"),
      body("The study will be conducted over a period of 18 months as per the following Gantt chart:"),
      blank(),
      timelineTable(),
      blank(),

      // ---- 8. BUDGET ----
      heading1("8. Budget"),
      body("The study is primarily self-funded and will leverage institutional infrastructure. The estimated budget is as follows:"),
      blank(),
      budgetTable(),
      blank(),
      body("Note: Ultrasound equipment is available in the Radiology department. MRI charges are institutional and discounted for research participants. No external funding is anticipated; additional funding will be sought from institutional grants if required."),
      blank(),

      // ---- 9. REFERENCES ----
      heading1("9. References"),
      body("(Vancouver style)"),
      blank(),
      numberedItem("D'Antonio F, Iacovella C, Bhide A. Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2013;42(5):509-17."),
      numberedItem("Rac MW, Dashe JS, Wells CE, Moschos E, McIntire DD, Twickler DM. Ultrasound predictors of placental invasion: the Placenta Accreta Index. Am J Obstet Gynecol. 2015;212(3):343.e1-7."),
      numberedItem("Familiari A, Liberati M, Lim P, Bhide A, Bhide P, Cali G, et al. Diagnostic accuracy of magnetic resonance imaging in detecting the severity of abnormal invasive placentation: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2018;97(5):507-20."),
      numberedItem("Jha P, Rabban J, Chen LM, Poder L. Placenta accreta spectrum: value of placental bulge as a sign of myometrial invasion on MRI. Am J Roentgenol. 2019;212(2):W55-W62."),
      numberedItem("Silver RM, Branch DW. Placenta accreta spectrum. N Engl J Med. 2018;378(16):1529-36."),
      numberedItem("Shamshirsaz AA, Fox KA, Salmanian B, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol. 2015;212(2):218.e1-9."),
      numberedItem("FIGO Consensus Guidelines on Placenta Accreta Spectrum Disorders. Int J Gynaecol Obstet. 2018;140(3):259-280."),
      numberedItem("Einerson BD, Rodriguez CE, Kennedy AM, Woodward PJ, Donnelly MA, Silver RM. Magnetic resonance imaging is often misleading when used as an adjunct to ultrasound in the management of placenta accreta spectrum disorders. Am J Obstet Gynecol. 2018;218(6):618.e1-618.e7."),
      numberedItem("Sentilhes L, Kayem G, Chandraharan E, Palacios-Jaraquemada J, Jauniaux E; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: conservative management. Int J Gynaecol Obstet. 2018;140(3):291-298."),
      numberedItem("Comstock CH, Love JJ Jr, Bhide A, et al. Sonographic detection of placenta accreta in the second and third trimesters of pregnancy. Am J Obstet Gynecol. 2004;190(4):1135-40."),
      blank(),

      // ---- 10. APPENDICES ----
      heading1("10. Appendices"),
      body("Appendix A: Case Record Form (CRF) / Data Collection Proforma"),
      body("Appendix B: Patient Information Sheet (PIS) -- English"),
      body("Appendix C: Informed Consent Form (ICF) -- English"),
      body("Appendix D: Informed Consent Form (ICF) -- Gujarati (માહિતગાર સંમતિ પત્ર)"),
      body("Appendix E: Informed Consent Form (ICF) -- Hindi (सूचित सहमति पत्र)"),

      pageBreak(),

      // ============================================================
      // APPENDIX A — CRF
      // ============================================================
      underlineHeading("APPENDIX A", true),
      underlineHeading("Case Record Form (CRF) / Data Collection Proforma", true),
      blank(),
      centeredBold("Study Title: " + TITLE, 22),
      blank(),
      body("Study ID: ___________          Date of enrollment: ___________"),
      blank(),
      body("SECTION A: PATIENT DEMOGRAPHICS", { bold: true }),
      twoColTable([
        ["Patient Name (initials only)", ""],
        ["Age (years)", ""],
        ["Hospital Registration No.", ""],
        ["Address (District)", ""],
        ["Gravida / Para / Abortion / Living", "G___P___A___L___"],
        ["Gestational Age at USG (weeks)", ""],
        ["Gestational Age at MRI (weeks)", ""],
        ["Number of Prior Cesarean Sections", ""]
      ]),
      blank(),
      body("SECTION B: CLINICAL DETAILS", { bold: true }),
      twoColTable([
        ["Presenting complaint", ""],
        ["Previous obstetric complications", ""],
        ["History of uterine surgery other than CS", "Yes / No"],
        ["Body Mass Index (kg/m2)", ""],
        ["Hemoglobin (g/dL)", ""]
      ]),
      blank(),
      body("SECTION C: ULTRASOUND FINDINGS (Grayscale + Doppler)", { bold: true }),
      twoColTable([
        ["Placenta location", "Anterior / Posterior / Fundal"],
        ["Placenta previa type", "Complete / Partial / Marginal"],
        ["Retroplacental clear zone", "Present / Absent / Interrupted"],
        ["Placental lacunae (Swiss cheese sign)", "Absent / Grade 1 / Grade 2 / Grade 3"],
        ["Myometrial thickness (mm)", ""],
        ["Loss of myometrial line", "Yes / No"],
        ["Uterine serosal irregularity / bulge", "Yes / No"],
        ["Bladder wall involvement", "Yes / No"],
        ["Subplacental hypervascularity (Doppler)", "Yes / No"],
        ["Bridging vessels to bladder (Doppler)", "Yes / No"],
        ["Turbulent intraplacental flow", "Yes / No"],
        ["USG Diagnosis", "PAS Suspected / PAS Not Suspected"],
        ["USG PAS Grade (if suspected)", "Accreta / Increta / Percreta"]
      ]),
      blank(),
      body("SECTION D: MRI FINDINGS (1.5T, No Gadolinium)", { bold: true }),
      twoColTable([
        ["Uterine bulging", "Yes / No"],
        ["Heterogeneous placental signal on T2W", "Yes / No"],
        ["Dark T2 intraplacental bands", "Absent / Present (No. ___)"],
        ["Disrupted uteroplacental interface", "Yes / No"],
        ["Thinning/loss of myometrium", "Yes / No"],
        ["Bladder wall invasion", "Yes / No"],
        ["Involvement of adjacent structures", "None / Bladder / Parametrium / Bowel"],
        ["MRI Diagnosis", "PAS Suspected / PAS Not Suspected"],
        ["MRI PAS Grade (if suspected)", "Accreta / Increta / Percreta"]
      ]),
      blank(),
      body("SECTION E: SURGICAL / DELIVERY DETAILS", { bold: true }),
      twoColTable([
        ["Mode of delivery", "LSCS / Emergency LSCS / Vaginal"],
        ["Gestational age at delivery (weeks)", ""],
        ["Intraoperative findings", ""],
        ["PAS confirmed intraoperatively", "Yes / No"],
        ["Procedure performed", "Caesarean Hysterectomy / Conservative"],
        ["Estimated blood loss (mL)", ""],
        ["Blood transfusion required", "Yes (Units___) / No"],
        ["ICU admission", "Yes / No"],
        ["Neonatal outcome", "Live Birth / IUD / NICU admission"]
      ]),
      blank(),
      body("SECTION F: HISTOPATHOLOGY (Reference Standard)", { bold: true }),
      twoColTable([
        ["Specimen type", "Hysterectomy / Placental biopsy"],
        ["Histopathological diagnosis", "Normal / Accreta / Increta / Percreta"],
        ["FIGO Grade", "Grade 1 / Grade 2 / Grade 3"],
        ["Pathologist Name & Signature", ""]
      ]),
      blank(),
      body("Investigator's Signature: _________________________    Date: ___________"),

      pageBreak(),

      // ============================================================
      // APPENDIX B — PATIENT INFORMATION SHEET (PIS)
      // ============================================================
      underlineHeading("APPENDIX B", true),
      underlineHeading("Patient Information Sheet (PIS)", true),
      blank(),
      centeredBold("Study Title: " + TITLE, 22),
      blank(),
      body("Principal Investigator: " + PI + ", " + DEPT + ", " + INST),
      body("Guide: " + GUIDE + ", " + GUIDE_DESIG),
      body("Contact: " + EMAIL_PI),
      blank(),
      body("Dear Participant,"),
      blank(),
      body("You are being invited to participate in a research study. Before you decide to participate, please read this information sheet carefully and feel free to ask any questions."),
      blank(),
      body("1. What is this study about?", { bold: true }),
      body("This study aims to compare the accuracy of two imaging tests -- Ultrasound (USG) and Magnetic Resonance Imaging (MRI) -- in diagnosing a condition called Placenta Accreta Spectrum (PAS), where the placenta attaches too deeply into the uterine wall. This condition is more common in women who have had a previous cesarean section."),
      blank(),
      body("2. Why are you being invited?", { bold: true }),
      body("You have been identified as having placenta previa (placenta lying low in the womb) along with a history of prior cesarean section. You are therefore at increased risk for PAS, and you fulfill the criteria for this study."),
      blank(),
      body("3. What will happen if you agree to participate?", { bold: true }),
      body("If you agree to take part, you will undergo:"),
      bulletItem("An Ultrasound examination (including colour Doppler) of the abdomen and pelvis -- this is the standard investigation you would have as part of your antenatal care."),
      bulletItem("An MRI scan of the pelvis (without injection of any dye or contrast agent) -- this will be scheduled at a convenient time before your delivery."),
      body("Both investigations are safe for you and your baby. The images will be examined by expert radiologists and findings will be compared with the final tissue report after delivery."),
      blank(),
      body("4. Are there any risks?", { bold: true }),
      body("Both ultrasound and MRI (without contrast) are well-established safe investigations during pregnancy. MRI does not use radiation. There is no known risk to you or your baby from either investigation."),
      blank(),
      body("5. Are there any benefits?", { bold: true }),
      body("Participation will not give you direct benefit beyond standard clinical care. However, it will help improve early detection and management of placenta accreta in future patients. Your clinician will, of course, be informed of your imaging results and will manage your delivery appropriately."),
      blank(),
      body("6. Is participation voluntary?", { bold: true }),
      body("Yes. Participation is entirely voluntary. You may withdraw at any time without any effect on your medical care."),
      blank(),
      body("7. Confidentiality", { bold: true }),
      body("Your identity will not be disclosed in any publication. All data will be stored securely and accessed only by the research team."),
      blank(),
      body("8. Contact", { bold: true }),
      body(`For any questions, please contact: Dr. Ajaykumar Ranjitbhai Patel, Department of Radiodiagnosis, NMCRC Visnagar. Email: ${EMAIL_PI}`),
      blank(),

      pageBreak(),

      // ============================================================
      // APPENDIX C — INFORMED CONSENT FORM (ENGLISH)
      // ============================================================
      underlineHeading("APPENDIX C", true),
      underlineHeading("INFORMED CONSENT FORM (English)", true),
      blank(),
      body("Title of the Study: " + TITLE, { bold: true }),
      blank(),
      body("Principal Investigator:"),
      body(PI),
      body(DEPT),
      body(INST),
      blank(),
      body("I have been informed about the purpose and procedures of the above study. I understand that my participation is voluntary and that I may withdraw from the study at any time without affecting my medical care or any benefits to which I am entitled."),
      blank(),
      body("I understand that:"),
      numberedItem("The nature and purpose of the study have been explained to me."),
      numberedItem("My participation is entirely voluntary."),
      numberedItem("I may refuse to participate or withdraw at any time without any penalty."),
      numberedItem("The information collected from me will be kept confidential."),
      numberedItem("My identity will not be disclosed in any publication or presentation arising from this study."),
      numberedItem("I have had the opportunity to ask questions and have received satisfactory answers."),
      blank(),
      body("I voluntarily agree to participate in this study."),
      blank(),
      body("Name of Participant: _________________________________"),
      body("Signature / Thumb Impression: ________________________"),
      body("Date: _______________"),
      blank(),
      body("Name of Investigator: ________________________________"),
      body("Signature of Investigator: ___________________________"),
      blank(),
      body("Name of Witness (if applicable): _____________________"),
      body("Signature of Witness: ________________________________"),

      pageBreak(),

      // ============================================================
      // APPENDIX D — INFORMED CONSENT FORM (GUJARATI)
      // ============================================================
      underlineHeading("APPENDIX D", true),
      underlineHeading("માહિતગાર સંમતિ પત્ર (Gujarati)", true),
      blank(),
      body("અભ્યાસનું શીર્ષક: " + TITLE),
      blank(),
      body("મને ઉપરોક્ત અભ્યાસનો હેતુ અને તેની પ્રક્રિયા વિશે સમજાવવામાં આવ્યું છે. હું સમજું છું કે આ અભ્યાસમાં ભાગ લેવો સ્વૈચ્છિક છે અને હું ગમે ત્યારે, કોઈ પણ કારણ આપ્યા વિના, અભ્યાસમાંથી ખસી શકું છું, જેની મારી ચિકિત્સા સેવા પર કોઈ અસર નહીં પડે."),
      blank(),
      body("હું સમજું છું કે:"),
      numberedItem("અભ્યાસનો હેતુ અને પ્રક્રિયા મને સ્પષ્ટ રીતે સમજાવવામાં આવ્યા છે."),
      numberedItem("ભાગ લેવો સ્વૈચ્છિક છે."),
      numberedItem("હું ગમે ત્યારે ભાગ લેવાનો ઇનકાર કરી શકું છું."),
      numberedItem("મારી પ્રાઇવેટ માહિતી ગોપનીય રાખવામાં આવશે."),
      numberedItem("કોઈ પ્રકાશનમાં મારી ઓળખ જાહેર કરવામાં આવશે નહીં."),
      numberedItem("મને પ્રશ્નો પૂછવાની તક મળી છે અને સંતોષકારક જવાબ મળ્યા છે."),
      blank(),
      body("હું સ્વ-ઇચ્છાએ આ અભ્યાસમાં ભાગ લેવા સંમતિ આપું છું."),
      blank(),
      body("સહભાગીનું નામ: _______________________________"),
      body("સહી / અંગૂઠાની છાપ: ____________________________"),
      body("તારીખ: _______________"),
      blank(),
      body("સંશોધકનું નામ: ________________________________"),
      body("સંશોધકની સહી: ________________________________"),
      blank(),
      body("સાક્ષીની સહી (જો લાગુ હોય): ___________________"),

      pageBreak(),

      // ============================================================
      // APPENDIX E — INFORMED CONSENT FORM (HINDI)
      // ============================================================
      underlineHeading("APPENDIX E", true),
      underlineHeading("सूचित सहमति पत्र (Hindi)", true),
      blank(),
      body("अध्ययन का शीर्षक: " + TITLE),
      blank(),
      body("मुझे इस अध्ययन के उद्देश्य और प्रक्रिया के बारे में समझाया गया है। मैं समझता/समझती हूँ कि इस अध्ययन में भाग लेना पूर्णतः स्वैच्छिक है तथा मैं किसी भी समय बिना कोई कारण बताए अध्ययन से हट सकता/सकती हूँ।"),
      blank(),
      body("मैं समझता/समझती हूँ कि:"),
      numberedItem("अध्ययन का उद्देश्य और प्रक्रिया मुझे समझाई गई है।"),
      numberedItem("अध्ययन में भाग लेना पूर्णतः स्वैच्छिक है।"),
      numberedItem("मैं किसी भी समय अध्ययन से हट सकता/सकती हूँ।"),
      numberedItem("मुझसे प्राप्त जानकारी गोपनीय रखी जाएगी।"),
      numberedItem("अध्ययन से संबंधित किसी प्रकाशन में मेरी पहचान प्रकट नहीं की जाएगी।"),
      numberedItem("मुझे प्रश्न पूछने का अवसर दिया गया है और मुझे संतोषजनक उत्तर प्राप्त हुए हैं।"),
      blank(),
      body("मैं अपनी स्वेच्छा से इस अध्ययन में भाग लेने के लिए सहमति देता/देती हूँ।"),
      blank(),
      body("प्रतिभागी का नाम: ___________________________"),
      body("हस्ताक्षर / अंगूठे का निशान: _________________"),
      body("दिनांक: _______________"),
      blank(),
      body("अन्वेषक का नाम: ____________________________"),
      body("अन्वेषक के हस्ताक्षर: ________________________"),
      blank(),
      body("साक्षी के हस्ताक्षर (यदि लागू हो): ___________"),

    ] // end children
  }] // end sections
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync('/home/daytona/workspace/pas-proposal/PAS_Synopsis_DrAjaykumarPatel.docx', buffer);
  console.log('DONE');
}).catch(err => {
  console.error('ERROR:', err);
});

cd /home/daytona/workspace/pas-proposal && node generate.js 2>&1

ls -lh /home/daytona/workspace/pas-proposal/ && python /home/daytona/skills/docx…

python3 -c "import zipfile; z = zipfile.ZipFile('/home/daytona/workspace/pas-pro…

pandoc /home/daytona/workspace/pas-proposal/PAS_Synopsis_DrAjaykumarPatel.docx -…

ls -lh /home/daytona/workspace/pas-proposal/ && file /home/daytona/workspace/pas…

python /home/daytona/skills/docx/scripts/office/soffice.py --headless --convert-…

cp /home/daytona/workspace/pas-proposal/PAS_Synopsis_DrAjaykumarPatel.docx /home…

cd /home/daytona/workspace && zip PAS_Synopsis_DrAjaykumarPatel.zip PAS_Synopsis…

cp /home/daytona/workspace/pas-proposal/PAS_Synopsis_DrAjaykumarPatel.docx /tmp/…

rm -f /home/daytona/workspace/PAS_Synopsis_DrAjaykumarPatel.zip && python3 -c " …

python3 -c " import zipfile, os src = '/home/daytona/workspace/pas-proposal/PAS_…

placenta accreta spectrum prevalence India cesarean

PMID: 34013811

PMID: 34790294