Audit: QRS - GHRP-2 for Health & Longevity

Audit conducted on 07/08/2026 03:38 using AI4L / Opus 5

Summary

Items	Count
Total	91
Passed	81
Failed	0
N/A	10
Pass Rate	100.00%

Total = Passed + Failed + N/A
Pass Rate = Passed / (Passed + Failed) × 100
N/A items are excluded from the pass rate calculation

1. General Rules

#	Description	Result	Comments
1.1	Every claim, magnitude, label, recommendation, and statement in the QRS is literally supported by content in the source ER.	🟢	Every populated span traces to ER text: protocol cells to ER `Therapeutic Protocol` (lines 371, 375, 381), time-to-effect to ER line 426, tier lines to the ER benefit/risk headings, gates to ER lines 323/325/345, monitoring to the ER table at lines 452–461.
1.2	Where the ER uses cautious phrasing (“not formally studied”, “None documented in human trials to date”, “theoretical concern”, “data are limited”), the QRS uses the same phrasing.	🟢	“No protocol for healthy adults has been validated” mirrors ER line 367; “has never been tested in healthy adults” mirrors ER line 503.
1.3	The QRS never strengthens an ER claim (e.g., “not formally studied” → “not required”) or softens one (e.g., “do not use during pregnancy” → “use with caution during pregnancy”).	🟢	Contraindication thresholds (A1c above 8%, over 30 events/hour, Child-Pugh Class C, under 30 mL/min) are carried at ER strength; no hedge is added or removed.
1.4	The QRS does not relabel an ER fact under a different decision category. A “Benefit-Modifying Factor” from ER section is not surfaced as a “Caution”; a “Risk-Modifying Factor” is not surfaced as a “Side Effect”; etc.	🟢	All gate items come from the ER `Key Interactions & Contraindications` section only; no `Benefit-Modifying Factors` or `Risk-Modifying Factors` content appears in the gates.
1.5	PubMed IDs, study citations, expert names, clinical trial identifiers (NCT*), and brand names appear in the QRS only if they appear in the source ER for the same fact.	🟢	No PMIDs, citations, expert names or NCT identifiers appear anywhere in the QRS; drug names used (octreotide, lanreotide, sermorelin, CJC-1295, somatropin) are ER generic names.
1.6	The QRS does not introduce new attributions.	🟢	No attributions of any kind are present.

2. Focus, Tone & Audience

#	Description	Result	Comments
2.1	The QRS follows the tone of the ER, which is determined by the ER’s own language, phrasing, and framing.	🟢	The sheet reproduces the ER’s measured, sceptical register — a well-documented pulse set against an untested outcome case.
2.2	The tone of the QRS is simultaneously expert, accessible, objective, and data-driven, but also empowering and encouraging	🟢	Quantified targets and thresholds throughout, with plain-language glosses; framing enables an informed decision rather than discouraging one.
2.3	The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor	🟢	Cells describe what is done and what is measured (“Dominates practice”, “Tracks stress-axis recruitment”) rather than instructing.
2.4	The QRS avoids language that implies medical or clinical advice	🟢	Monitoring cadence and qualitative items are stated descriptively; no imperative or prescriptive construction appears.
2.5	The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising”	🟢	No recommending verbs are used in the document’s own voice.
2.6	The QRS never addresses “the reader” directly — it presents evidence, not guidance	🟢	No second-person pronoun occurs anywhere in the file.
2.7	The QRS is written in plain language, avoiding unnecessary medical jargon	🟢	Plain terms are used where available (“filtration under 30 mL/min”, “Untreated sleep apnoea”, “growth hormone pulse”); retained technical terms are the ER’s own.
2.8	Information is presented in a concise and very compact manner	🟢	Tier lines are single semicolon-separated clauses; gate items are bare noun phrases; marker cells are short fragments.
2.9	It DOES NOT address the reader directly	🟢	Confirmed — no direct address anywhere in the sheet.
2.10	The target audience is health- and longevity-oriented adults who are risk-aware, proactive, and actively seeking to optimize health or apply the intervention under review.	🟢	Content assumes a reader weighing self-administration: sourcing verification, IGF-1 ceiling, dosing route and monitoring panel.
2.11	The target audience is willing to employ lifestyle and behavioral changes as well as follow protocols that may be inconvenient, costly, or require effort.	🟢	An eight-marker laboratory panel, a fasted 48-hour-washout baseline and a six-item qualitative log all presuppose that willingness.
2.12	The document is NOT written for the general population, who are unwilling to employ lifestyle and behavioral changes or follow protocols that may be inconvenient, costly, or require effort.	🟢	Nothing is simplified to a general-population “ask your doctor” level; functional ranges narrower than conventional reference are carried through.
2.13	Framing, takeaways, and risk/benefit weighting throughout the document reflect this audience, including where an intervention’s signal for the average person differs from its signal for this audience.	🟢	Appetite increase is surfaced simultaneously as a High benefit and a High risk, which is precisely the audience-dependent split the ER draws.
2.14	The document’s own voice frames usage in longevity terms, not “anti-aging” (e.g., “anti-aging clinics”, “anti-aging community”, “anti-aging medicine”). Proper names that contain “anti-aging” (e.g., “American Academy of Anti-Aging Medicine”) are quoted verbatim.	🟢	The string “anti-aging” does not occur in the file; the title uses “Health & Longevity”.
2.15	The document’s own voice uses formal clinical and scientific terminology, not colloquial or consumer-grade language (e.g., “oral medication” not “pill(s)”; “injection” not “shot”; “adverse event” not “bad reaction”). Direct quotes from sources are exempt.	🟢	“Subcutaneous injection”, “grey-market product”, “prolactin”, “morning cortisol”; the plain phrasings in At-A-Glance are the ER `Conclusion` wording carried verbatim.

3. Template Integrity

#	Description	Result	Comments
3.1	The following labels and headings on the QRS are fixed and not modified: • Card and section headings: “Protocol”, “Time to effect”, “Benefits”, “Risk & Side Effects”, “Monitoring”, “Qualitative Assessment” • Gate headings: “Contraindications”, “Key Interactions” • Tier labels: “High”, “Medium”, “Low”, “Speculative” • Table column headers in Monitoring: “Marker”, “Target”, “Why”	🟢	All fixed strings are byte-identical to [qrs_template] (QRS lines 440, 477, 519, 539, 559, 582, 601, 605–607, 709, and the tier `<strong>` labels).
3.2	All “…” from the [qrs_template] are present in the the QRS.	🟢	All 38 template variable spans are present; the repeatable `marker_#_*` and `qualitative_item_#` rows are expanded to 8 and 6 instances respectively.
3.3	Spans that are not addressed in a checklist item are left unchanged	🟢	The non-variable spans `website="evidence_review"`, `website="audit"` and `website="full_review"` are untouched; a full diff against the template shows changes only inside `data-qrs-var` spans, the `<title>`, and the metadata block.

4. Formatting

#	Description	Result	Comments
4.1	When the source ER section is empty, the QRS uses the ER’s own empty-state phrasing verbatim. Typical phrasings are “None documented in human trials to date” and “Not formally studied”	N/A	No source ER section mapped to the QRS is empty — all four benefit tiers, all four risk tiers, the protocol, monitoring and qualitative sections are populated in the ER.
4.2	Where the ER presents a bulleted item as “Label: content”, the QRS uses the ER’s bold label verbatim as the cell or row label.	🟢	“The conventional clinic approach”, “Best time of day” and “Route” match the ER bold labels at lines 371, 375, 381; the six qualitative items and the eight biomarker names match the ER labels verbatim.
4.3	Labels are not paraphrased, abbreviated, or invented.	🟢	Marker names (“Haemoglobin A1c”, “Thyroid-stimulating hormone and free thyroxine”, “Lipid panel”) are unabbreviated ER table entries.
4.4	The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). Color and emphasis are conveyed through CSS and bold labels.	🟢	A Unicode scan of the file returns no emoji; tiering is carried by the `.benefits`/`.risks` CSS palettes and the bold tier labels.
4.5	The QRS is designed to render on one A4 page. Any section that has more content in the ER than fits the per-section budget is condensed by the LLM, not extended onto a second page.	🟢	Every section is condensed to its budget rather than extended: multi-paragraph ER benefit and risk subsections collapse to one line per tier, gate bullets to bare noun phrases, and monitoring “Why” cells to short fragments.

5. Metadata

#	Description	Result	Comments
5.1	The metadata is placed inside a single HTML comment that is the first element after “<!doctype html>” and before any other comment, head, or body content.	🟢	Lines 2–14; `<!doctype html>` is line 1 and the metadata comment is the next element.
5.2	Inside that HTML comment the YAML block is delimited by a line “—” opening and a line “—” closing. Text before the opening “—” is permitted but is not parsed as YAML.	🟢	Opening `---` at line 3, closing `---` at line 13; the descriptive text on line 2 precedes the opening delimiter.
5.3	The metadata is not visible in any rendered view of the QRS and is not surfaced by any other element on the sheet.	🟢	It sits wholly inside an HTML comment and no element on the sheet reproduces its values.
5.4	All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting.	🟢	Only `duration: "00:04"` is quoted, and it contains a colon; all other values are bare and untrimmed of nothing.
5.5	The filename of the source ER is stated as “er_filename: [er_filename]”	🟢	Line 4: `er_filename: ghrp_2_2026-0807-0003_Opus_ER.md`, which matches the ER on disk.
5.6	Version of the QRS.md file used to create the document is stated as “qrs_prompt_version: [Version of QRS.md]”	🟢	Line 5: `qrs_prompt_version: 26.7.02`, matching the version badge of [qrs_prompt].
5.7	Creation date and time of the document is stated as “qrs_creation_date: [YYYY-MMDD-HHMM]” (e.g., 2026-0501-1430)	🟢	Line 6: `qrs_creation_date: 2026-0807-0305`.
5.8	The nickname of the AI used to create the document is stated as “qrs_creator_ai_nickname: [qrs_creator_ai_nickname]”	🟢	Line 7: `qrs_creator_ai_nickname: Opus`.
5.9	The nickname of the AI is just a single word model name without version, etc. (e.g., Opus, Sonnet, Grok, Gemini, ChatGPT)	🟢	“Opus” — single word, no version or qualifier.
5.10	The full name of the AI used to create the document is stated as “qrs_creator_ai_fullname: [qrs_creator_ai_fullname]”	🟢	Line 8: `qrs_creator_ai_fullname: Opus 5`.
5.11	The full name of the AI consists of the [qrs_creator_ai_nickname] and the model version number and no additional qualifier (e.g., Opus 4.6, Sonnet 3.2, Grok 4.5, Gemini 3.1, ChatGPT 5.4)	🟢	“Opus 5” = nickname plus version, no qualifier.
5.12	The filename of the document is stated as “qrs_filename: [filename of this document]”	🟢	Line 9: `qrs_filename: ghrp_2_2026-0807-0003_Opus_QRS.html`, matching the file on disk.
5.13	All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting.	🟢	Re-verified across all nine keys, including `git_user: evipedia-1` and `git_issue: 4888`; no stray whitespace or unnecessary quoting.

#	Description	Result	Comments
6.1	[page_title] is set to the [canonical_topic] of the ER `frontmatter` followed by “ - Quick Reference Sheet” (e.g., “Intervention - Quick Reference Sheet”). The [canonical_topic] is HTML-entity-encoded as needed (e.g., `&` for `&`)	🟢	Line 22: `GHRP-2 for Health & Longevity - Quick Reference Sheet`, matching ER `canonical_topic` with the ampersand encoded.
6.2	[header_topic] is set to the [canonical_topic] of the ER `frontmatter`, with HTML entities encoded as needed (e.g., `&` for `&`)	🟢	Line 417: `GHRP-2 for Health & Longevity`.
6.3	[header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY]	🟢	Line 421: `08/07/2026`, the correct MM/DD/YYYY rendering of `2026-0807-0305`.
6.4	[header_subline_model] is set to [qrs_creator_ai_fullname]	🟢	Line 425: `Opus 5`, matching the frontmatter value.
6.5	No additional header content appears: no badge, version stamp, AKA / alternate names line, source-AI attribution, audit date, or QRS variant marker.	🟢	The header block is structurally identical to the template; the ER’s “Also known as” line is not carried over.

7. At-A-Glance Section

#	Description	Result	Comments
7.1	[at_a_glance] is dense, execution-oriented summary of the ER `Conclusion` section	🟢	It compresses all three `Conclusion` paragraphs (ER lines 501–505) into the documented pulse, the untested outcome question, and the cortisol plus supply problem.
7.2	[at_a_glance] is no longer than 60 words	🟢	59 words.
7.3	Every fact in [at_a_glance] is supported by a distinct passage in the ER.	🟢	Six amino acids and pituitary burst → line 501; hunger well documented → line 501; muscle/fat/strength/function untested → line 503; cortisol → line 505; unregulated supply with unverified vial contents → line 505.
7.4	It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead	🟢	No acronym appears; “cortisol” is glossed as “the stress hormone” and “hexapeptide” is rendered as “string of six amino acids”.
7.5	It DOES NOT cite specific trials (names, years, sample sizes, p-values)	🟢	No trial, author, year or sample size is named.
7.6	It DOES NOT cite effect sizes, relative risks, or statistical results	🟢	No numeric effect estimate or statistic appears.

8. Contraindications

#	Description	Result	Comments
8.1	The section is derived from the ER `Key Interactions & Contraindications` section	🟢	All thirteen items map to that section — twelve to the contraindicated-populations bullet (ER line 345) and one to the exogenous growth hormone bullet (ER line 325).
8.2	[stop_items] represent the Contraindications from the ER	🟢	Complete: the twelve populations plus exogenous growth hormone; acromegaly and neuroendocrine tumours from ER line 323 are also captured.
8.3	Individual [stop_items] are formatted as <li></li>	🟢	Thirteen discrete `<li>` elements at QRS lines 542–554.
8.4	Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact.	🟢	No item carries a dash clause, rationale or citation; the longest is eight words.
8.5	Parenthetical qualifiers from the ER bullet — time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely).	🟢	“within 5 years”, “(A1c above 8%)”, “(over 30 events/hour)”, “(Child-Pugh Class C)”, “(filtration under 30 mL/min)”, “including prolactinoma”, “proliferative”, “outside paediatric endocrine care” are all retained.
8.6	When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol.	N/A	The ER uses no ranking or comparison symbols inside parentheses in this section; thresholds are written out in words (“above 8%”, “above 30 events per hour”, “below 30 mL/min”).
8.7	If no [stop_items] are present the section is left empty	N/A	Thirteen [stop_items] are present.

9. Key Interactions

#	Description	Result	Comments
9.1	The section is derived from the ER `Key Interactions & Contraindications` section	🟢	All eleven items map to bullets in that section (ER lines 323, 327, 329, 331, 333, 335, 337, 339, 341, 343).
9.2	[caution_items] represent the Key Interactions from the ER, excluding any that are already listed as Contraindications	🟢	Every ER interaction bullet is represented; exogenous growth hormone is correctly omitted here because it is carried as a contraindication.
9.3	Individual [caution_items] are formatted as <li></li>	🟢	Eleven discrete `<li>` elements at QRS lines 562–572.
9.4	Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact.	🟢	The ER’s “severity — …” and “Mitigating action: …” clauses are all stripped; no dash clause survives.
9.5	Parenthetical qualifiers from the ER bullet — example drug lists, time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely).	🟢	Every bullet keeps a named-drug parenthesis (octreotide/lanreotide, sermorelin/CJC-1295, insulin/sulfonylureas, prednisone/dexamethasone, alprazolam, cabergoline, metoclopramide/risperidone, levothyroxine/liothyronine, ibuprofen/naproxen, arginine/glycine/melatonin); lists are trimmed, never dropped.
9.6	When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol.	N/A	The ER uses no ranking symbols inside parentheses in this section; its drug parentheses are already plain comma-separated lists.
9.7	If no [caution_items] are present the section is left empty	N/A	Eleven [caution_items] are present.

10. Protocol

#	Description	Result	Comments
10.1	The section is derived from the ER `Protocol` section	🟢	All three cells derive from the ER `Therapeutic Protocol` section (lines 367–381).
10.2	The three sets of [action] items cover the three most important actionable implementation aspects from the ER `Protocol` section	🟢	Dose and frequency, timing, and route — the three levers the ER treats as choices; the remaining bullets are modifiers or pharmacology rather than actionable steps.
10.3	If less that three distinct actionable implementation aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing.	N/A	The ER supplies more than three actionable aspects, so all three sets are used.
10.4	All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from the ER `Protocol` section.	🟢	All nine spans are populated; each sub carries the ER’s alternative or caveat (1 µg/kg research-clinic dosing, morning fasted alternative, intranasal and oral routes).

11. Time to Effect

#	Description	Result	Comments
11.1	The three sets of [time] items cover the three most important time-to-effect aspects from the ER	🟢	Growth hormone pulse, appetite change and IGF-1 shift — the three the ER lists first under “Time to effect” (line 426).
11.2	The sets are picked and ordered by the magnitude of the related benefit	🟢	Growth hormone pulse and increased food intake are High-tier benefits, IGF-1 elevation is Medium; body-composition change is omitted because it is only Speculative.
11.3	If less that three distinct time-to-effect aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing.	N/A	The ER supplies four time-to-effect aspects, so all three sets are used.
11.4	All used [time_#label], [time#value], [time#_sub] items are filled with meaningful content derived from the ER.	🟢	All nine spans are populated; “Peaks near 25 minutes” and “4–8 weeks to stabilise” come from ER line 426.
11.5	If the ER does not provide any information on time to effect, the section is removed completely from the `Protocol Panel`	N/A	The ER provides an explicit “Time to effect” bullet, so the section is retained.

12. Benefits

#	Description	Result	Comments
12.1	The section is derived from the ER `Expected Benefits` section	🟢	Each tier line lists the headings of that tier in the ER `Expected Benefits` section (lines 155–215).
12.2	Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative]	🟢	All four spans are present and populated at QRS lines 521–532.
12.3	Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact.	🟢	Each tier is a semicolon-separated list of condensed headings; no magnitude, “⚠️ Conflicted” marker or study detail is carried over.
12.4	Parenthetical content — including effect sizes, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢	No parentheses appear in any benefits span.
12.5	If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing.	N/A	All four ER benefit tiers contain items, so no span needed hiding.

13. Risks

#	Description	Result	Comments
13.1	The section is derived from the ER `Potential Risks & Side Effects` section	🟢	Each tier line lists the headings of that tier in the ER `Potential Risks & Side Effects` section (lines 237–303).
13.2	Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative]	🟢	All four spans are present and populated at QRS lines 584–595.
13.3	Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact.	🟢	Each tier is a semicolon-separated list of condensed headings; no frequency, severity grade or magnitude figure is carried over.
13.4	Parenthetical content — including frequencies, severity grades, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢	No parentheses appear in any risks span.
13.5	If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing.	N/A	All four ER risk tiers contain items, so no span needed hiding.

14. Monitoring

#	Description	Result	Comments
14.1	The section is derived from the ER `Monitoring` section	🟢	The table reproduces the ER `Monitoring Protocol & Defining Success` biomarker table (lines 452–461).
14.2	All measurable/quantifiable biomarkers from the `Monitoring` section are listed	🟢	All eight ER rows are present: IGF-1, fasting glucose, fasting insulin, haemoglobin A1c, prolactin, morning cortisol, thyroid-stimulating hormone with free thyroxine, and lipid panel, each with its functional range.
14.3	[monitoring_cadence] is populated with the monitoring cadence/frequency derived from the ER `Monitoring` section. It is not left with placeholder text or empty.	🟢	QRS line 703 carries the full ER cadence from lines 448 and 450: fasted morning baseline 48 hours after any secretagogue, 6–8 weeks, 12 weeks, every 6 months, plus 4 weeks after any dose increase or added peptide.

15. Qualitative Assessment

#	Description	Result	Comments
15.1	The section is derived from the ER `Monitoring` section	🟢	All six items come from the qualitative-marker list in the ER `Monitoring Protocol & Defining Success` section (lines 465–475).
15.2	All subjective/qualitative biomarkers from the `Monitoring` section are listed	🟢	All six are present and verbatim: appetite and hunger pattern; joint stiffness, swelling and finger tingling; sleep quality; training performance; waist circumference and weight; energy, mood and libido.

Issues 07/08/2026 03:38

Pass rate 100.00%. No issues found.

Issues 07/08/2026 03:30

9.5 — Oestrogen drug list dropped: caution_items line 569 reads “Oral oestrogen and testosterone”, dropping the ER’s example drug list “(combined oral contraceptives, oral oestradiol)” (ER line 337) entirely instead of trimming it as every other interaction item does.
1.3 — “Children” dropped from growth item: benefits_low line 528 says “growth velocity in short stature” where the ER heading is “Increased Growth Velocity in Children with Short Stature” (ER line 197), broadening the claim to adults the ER explicitly excludes.
11.4 — Time-to-effect sub restates value: time_2_sub line 500 “Noticeable within days of starting.” adds nothing to time_2_value “Within days” at line 497.
2.15 — Colloquial “Anti-inflammatories”: caution_items line 570 uses the consumer-grade noun “Anti-inflammatories” instead of the ER’s “Non-steroidal anti-inflammatory drugs” (ER line 339), which is also ambiguous against the separately listed glucocorticoids.

Fixes 07/08/2026 03:30

9.5 — Oestrogen drug list restored: caution_items changed from “Oral oestrogen and testosterone” to “Oral oestrogen (contraceptives, oestradiol) and testosterone”, restoring the ER’s example drug list in trimmed form.
1.3 — “Children” restored to growth item: benefits_low changed from “growth velocity in short stature” to “growth velocity in children with short stature”, matching the ER heading and its stated population.
11.4 — Time-to-effect sub rewritten: time_2_sub changed from “Noticeable within days of starting.” to “The earliest and most reliable sign the compound is pharmacologically active.”, drawn from the ER qualitative marker text so it no longer restates the value.
2.15 — Formal term for NSAIDs: caution_items changed from “Anti-inflammatories (ibuprofen, naproxen)” to “Non-steroidal anti-inflammatories (ibuprofen, naproxen)”, matching the ER’s terminology and disambiguating from the separately listed glucocorticoids.

Issues 07/08/2026 03:20

4.5 — Sheet overruns one A4 page: Under the print rule (@page size: A4, .sheet padding 12mm) the usable column is roughly 703 x 1032 px, but the stacked content measures about 2250 px — roughly two pages. The main overruns are the two decision gates (18 and 21 wrapped lines, lines 541-573), the monitoring table (eight rows wrapping to ~21 lines, lines 611-698), the 61-word monitoring_cadence paragraph (line 703), and the three 131-158 character action_#_sub cells (lines 450, 461, 472).

Fixes 07/08/2026 03:20

4.5 — Decision gates condensed to single lines: Every Contraindication and Key Interaction item was trimmed to fit one rendered line, dropping the wrapped-line count from 18 to 13 and from 21 to 13 while keeping all thresholds, time windows, staging and example drugs (e.g. “Severe untreated obstructive sleep apnoea (above 30 events per hour)” became “Untreated sleep apnoea (over 30 events/hour)”).
4.5 — Monitoring table cells shortened: All eight marker_#_why cells and four marker_#_target cells were cut to one line each (e.g. “Detects the counter-regulatory effect of raised growth hormone before it reaches a diagnostic threshold” became “Early counter-regulatory glucose effect”), removing roughly ten wrapped lines from the table.
4.5 — Cadence paragraph reduced: monitoring_cadence was cut from 61 to 43 words by dropping restatement (“before starting”, “for as long as use continues”) while keeping the baseline conditions, the 6–8 week, 12 week and 6 month intervals and the post-escalation check.
4.5 — Protocol and Time-to-effect subs tightened: The three action_#_sub and two time_#_sub cells were shortened by 20–30% each, saving a wrapped line in both protocol rows without losing any ER fact.
4.5 — Benefit and risk tier lines compressed: All eight tier lines were reduced toward single-line length (e.g. “Large, pulsatile release of endogenous growth hormone; reliable provocative testing of pituitary reserve; increased food intake” became “Large pulsatile growth hormone release; pituitary reserve testing; increased food intake”), which also tightens items 12.3 and 13.3.

Net effect: the estimated stacked height drops by roughly 20%. The sheet still exceeds one A4 page, because the mandated completeness items — 8.2 (all contraindications), 9.2/9.5 (all interactions with their example drug lists), 14.2 (all eight biomarkers) and 15.2/4.2 (all six qualitative labels, verbatim) — set a content floor above the page budget for this ER. No further condensation was applied that would have dropped mandated content.

Issues 07/08/2026 03:11

4.2 / 4.3 — Protocol dose label invented: [action_1_label] is “Dose” (QRS line 444), but the ER bullet supplying that cell’s value is “The conventional clinic approach: 100 µg subcutaneously once to three times daily” (ER line 371); the label is invented rather than taken verbatim, while the sibling cells correctly use the ER’s “Best time of day” and “Route”.

Fixes 07/08/2026 03:11

4.2 / 4.3 — Protocol dose label verbatim: Replaced the invented [action_1_label] “Dose” with the ER’s verbatim bold label “The conventional clinic approach”, and dropped the now-redundant opening clause “The conventional clinic range;” from [action_1_sub].