{
  "schema_version": "2.0.0",
  "note": "Unified registry of everything measurable: symptoms, case definitions, functional outcomes, lab analytes, physiologic tests, events. Namespaced ids (sym:, case-def:, func:, lab:, physio:, event:) make the kind obvious in any observation. HPO for symptoms, LOINC for labs, UCUM for units, SNOMED where the others lack a term. measure_verbatim on each observation preserves the source wording and is never normalised.",
  "measures": [
    { "id": "sym:fatigue", "kind": "symptom", "label": "Fatigue", "domain": "fatigue_pem", "ontology": { "hpo": "HP:0012378", "snomed": "84229001", "loinc": null }, "default_value_type": "proportion", "synonyms": ["fatigue", "tiredness", "asthenia", "lassitude", "exhaustion", "fatigue or muscle weakness"], "boundary_note": "Never merged with sym:post-exertional-malaise, even where the source conflates them.", "unit": null, "unit_ucum": null },
    { "id": "sym:post-exertional-malaise", "kind": "symptom", "label": "Post-exertional malaise", "domain": "fatigue_pem", "ontology": { "hpo": null, "snomed": "1217738000", "loinc": null }, "default_value_type": "proportion", "synonyms": ["post-exertional malaise", "PEM", "post-exertional symptom exacerbation", "PESE", "relapse after exertion"], "boundary_note": "Never merged with sym:fatigue.", "unit": null, "unit_ucum": null },
    { "id": "sym:cognitive-dysfunction", "kind": "symptom", "label": "Cognitive dysfunction", "domain": "neurocognitive", "ontology": { "hpo": "HP:0100543", "snomed": "386806002", "loinc": null }, "default_value_type": "proportion", "synonyms": ["cognitive dysfunction", "brain fog", "impaired concentration"], "boundary_note": "Concentration/processing/executive impairment; distinct from sym:memory-impairment.", "unit": null, "unit_ucum": null },
    { "id": "sym:memory-impairment", "kind": "symptom", "label": "Memory impairment", "domain": "neurocognitive", "ontology": { "hpo": "HP:0002354", "snomed": "386807006", "loinc": null }, "default_value_type": "proportion", "synonyms": ["memory troubles", "memory problems", "forgetfulness"], "boundary_note": null, "unit": null, "unit_ucum": null },
    { "id": "sym:sleep-disturbance", "kind": "symptom", "label": "Sleep disturbance", "domain": "sleep", "ontology": { "hpo": "HP:0002360", "snomed": "301345002", "loinc": null }, "default_value_type": "proportion", "synonyms": ["sleep disorders", "insomnia", "unrefreshing sleep"], "boundary_note": null, "unit": null, "unit_ucum": null },
    { "id": "sym:depression", "kind": "symptom", "label": "Depression / depressed mood", "domain": "psychiatric", "ontology": { "hpo": "HP:0000716", "snomed": "35489007", "loinc": null }, "default_value_type": "proportion", "synonyms": ["depression", "depressed mood", "low mood"], "boundary_note": null, "unit": null, "unit_ucum": null },
    { "id": "sym:headache", "kind": "symptom", "label": "Headache", "domain": "other", "ontology": { "hpo": "HP:0002315", "snomed": "25064002", "loinc": null }, "default_value_type": "proportion", "synonyms": ["headache", "headaches"], "boundary_note": null, "unit": null, "unit_ucum": null },
    { "id": "sym:dyspnea", "kind": "symptom", "label": "Dyspnoea", "domain": "respiratory", "ontology": { "hpo": "HP:0002094", "snomed": "267036007", "loinc": null }, "default_value_type": "proportion", "synonyms": ["dyspnea", "breathlessness", "shortness of breath"], "boundary_note": null, "unit": null, "unit_ucum": null },
    { "id": "sym:anosmia-dysgeusia", "kind": "symptom", "label": "Loss of smell/taste", "domain": "sensory", "ontology": { "hpo": "HP:0000458", "snomed": "44169009", "loinc": null }, "default_value_type": "proportion", "synonyms": ["loss of taste and/or smell", "anosmia", "ageusia", "dysgeusia"], "boundary_note": null, "unit": null, "unit_ucum": null },
    { "id": "sym:myalgia", "kind": "symptom", "label": "Myalgia", "domain": "musculoskeletal", "ontology": { "hpo": "HP:0003326", "snomed": "68962001", "loinc": null }, "default_value_type": "proportion", "synonyms": ["myalgia", "muscle pain"], "boundary_note": null, "unit": null, "unit_ucum": null },
    { "id": "sym:muscle-weakness", "kind": "symptom", "label": "Muscle weakness", "domain": "musculoskeletal", "ontology": { "hpo": "HP:0001324", "snomed": "26544005", "loinc": null }, "default_value_type": "proportion", "synonyms": ["muscle weakness", "weakness"], "boundary_note": null, "unit": null, "unit_ucum": null },
    { "id": "sym:arthralgia", "kind": "symptom", "label": "Arthralgia / rheumatic musculoskeletal pain", "domain": "musculoskeletal", "ontology": { "hpo": "HP:0002829", "snomed": "57676002", "loinc": null }, "default_value_type": "proportion", "synonyms": ["arthralgia", "joint pain", "rheumatic musculoskeletal pain", "long-lasting rheumatic musculoskeletal pain", "polyarthralgia"], "boundary_note": "Reported symptom, not radiographic arthritis.", "unit": null, "unit_ucum": null },
    { "id": "sym:irritable-bowel-syndrome", "kind": "symptom", "label": "Irritable bowel syndrome (post-infectious)", "domain": "gastrointestinal", "ontology": { "hpo": null, "snomed": "197130004", "loinc": null }, "default_value_type": "proportion", "synonyms": ["irritable bowel syndrome", "IBS", "post-infectious IBS"], "boundary_note": "Rome-criteria IBS as a GI symptom-cluster outcome.", "unit": null, "unit_ucum": null },
    { "id": "case-def:cfs", "kind": "case_definition", "label": "Chronic fatigue syndrome / ME-CFS caseness", "domain": "fatigue_pem", "ontology": { "hpo": null, "snomed": "52702003", "loinc": null }, "default_value_type": "proportion", "synonyms": ["chronic fatigue syndrome", "met CFS criteria", "ME/CFS caseness"], "boundary_note": "Meeting a formal CFS case definition (Fukuda/CDC etc.), a symptom-cluster outcome distinct from the single symptom sym:fatigue.", "unit": null, "unit_ucum": null },
    { "id": "case-def:cfs-like", "kind": "case_definition", "label": "CFS-like illness", "domain": "fatigue_pem", "ontology": { "hpo": null, "snomed": "52702003", "loinc": null }, "default_value_type": "proportion", "synonyms": ["chronic fatigue syndrome-like illness", "CFS-like illness"], "boundary_note": "Author-defined CFS-like caseness that does not claim a formal case definition.", "unit": null, "unit_ucum": null },
    { "id": "func:recovery", "kind": "functional", "label": "Felt fully recovered", "domain": "constitutional", "ontology": { "hpo": null, "snomed": null, "loinc": null }, "default_value_type": "proportion", "synonyms": ["felt fully recovered", "full recovery"], "boundary_note": "Self-reported global recovery.", "unit": null, "unit_ucum": null },
    { "id": "func:qol-impairment", "kind": "functional", "label": "Impaired quality of life", "domain": "constitutional", "ontology": { "hpo": null, "snomed": null, "loinc": null }, "default_value_type": "proportion", "synonyms": ["impaired quality of life", "severely affected quality of life", "functionally-impairing symptoms"], "boundary_note": null, "unit": null, "unit_ucum": null },
    { "id": "func:unable-to-work", "kind": "functional", "label": "Not working due to illness", "domain": "constitutional", "ontology": { "hpo": null, "snomed": null, "loinc": null }, "default_value_type": "proportion", "synonyms": ["not working due to illness", "unable to work"], "boundary_note": null, "unit": null, "unit_ucum": null },
    { "id": "func:any-persistent-symptom", "kind": "functional", "label": "Any persistent symptom", "domain": "constitutional", "ontology": { "hpo": null, "snomed": null, "loinc": null }, "default_value_type": "proportion", "synonyms": ["any persistent symptom", "persistent symptoms"], "boundary_note": "A composite 'one or more symptoms' outcome; not a specific symptom and not comparable to single-symptom prevalences.", "unit": null, "unit_ucum": null },
    { "id": "event:narcolepsy", "kind": "event", "label": "Narcolepsy (incident)", "domain": "sleep", "ontology": { "hpo": "HP:0030050", "snomed": "60380001", "loinc": null }, "default_value_type": "rate", "synonyms": ["narcolepsy", "incident narcolepsy"], "boundary_note": "Incident diagnosed narcolepsy, typically an incidence rate.", "unit": null, "unit_ucum": null },
    { "id": "event:guillain-barre-syndrome", "kind": "event", "label": "Guillain-Barré syndrome", "domain": "neuropathic", "ontology": { "hpo": "HP:0007113", "snomed": "40956001", "loinc": null }, "default_value_type": "proportion", "synonyms": ["Guillain-Barré syndrome", "GBS"], "boundary_note": "Acute post-infectious immune neuropathy.", "unit": null, "unit_ucum": null },
    { "id": "physio:skeletal-muscle-pathology", "kind": "physiologic", "label": "Skeletal muscle pathology (biopsy)", "domain": "musculoskeletal", "ontology": { "hpo": null, "snomed": null, "loinc": null }, "default_value_type": "qualitative", "synonyms": ["exercise-induced myopathy", "muscle amyloid deposits", "muscle fibre atrophy/necrosis"], "boundary_note": "Tissue-level muscle findings from biopsy; typically qualitative or paired_change (pre/post exertion), not a prevalence.", "unit": null, "unit_ucum": null },
    { "id": "sym:exercise-intolerance", "kind": "symptom", "label": "Exercise intolerance", "domain": "fatigue_pem", "ontology": { "hpo": "HP:0003546", "snomed": "27641005", "loinc": null }, "default_value_type": "proportion", "synonyms": ["exercise intolerance", "reduced exercise capacity"], "boundary_note": "Reduced tolerance of exertion; related to but not identical with sym:post-exertional-malaise (which is delayed symptom worsening).", "unit": null, "unit_ucum": null },
    { "id": "sym:paresthesia", "kind": "symptom", "label": "Paraesthesia / numbness", "domain": "neuropathic", "ontology": { "hpo": "HP:0003401", "snomed": "91019004", "loinc": null }, "default_value_type": "proportion", "synonyms": ["tingling", "numbness", "paresthesia", "pins and needles", "numbness sensations"], "boundary_note": null, "unit": null, "unit_ucum": null },
    { "id": "lab:il-6", "kind": "lab", "label": "Interleukin-6 (elevated)", "domain": "other", "ontology": { "hpo": null, "snomed": null, "loinc": "26881-3" }, "default_value_type": "proportion", "synonyms": ["IL-6", "interleukin 6"], "boundary_note": "Stored here as the proportion of the cohort with an elevated value; the raw distribution would be a mean_sd observation.", "unit": "pg/mL", "unit_ucum": "pg/mL" },
    { "id": "lab:il-8", "kind": "lab", "label": "Interleukin-8 (elevated)", "domain": "other", "ontology": { "hpo": null, "snomed": null, "loinc": "27141-1" }, "default_value_type": "proportion", "synonyms": ["IL-8", "interleukin 8", "CXCL8"], "boundary_note": null, "unit": "pg/mL", "unit_ucum": "pg/mL" },
    { "id": "lab:ft3-low", "kind": "lab", "label": "Free tri-iodothyronine (low)", "domain": "other", "ontology": { "hpo": null, "snomed": null, "loinc": "3051-0" }, "default_value_type": "proportion", "synonyms": ["free T3", "fT3", "free tri-iodothyronine"], "boundary_note": "Proportion with a low fT3.", "unit": "pmol/L", "unit_ucum": "pmol/L" },
    { "id": "lab:snfl", "kind": "lab", "label": "Serum neurofilament light chain (elevated)", "domain": "neurocognitive", "ontology": { "hpo": null, "snomed": null, "loinc": null }, "default_value_type": "proportion", "synonyms": ["sNfL", "neurofilament light chain", "serum neurofilament"], "boundary_note": "Marker of axonal injury; stored as proportion above a percentile threshold.", "unit": "pg/mL", "unit_ucum": "pg/mL" }
  ]
}