Audit: QRS - Hyaluronic Acid for Health & Longevity

Audit conducted on 10/09/2026 08:18 using AI4L / Opus 5

Iterations

Summary

Items	Count
Total	93
Passed	83
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

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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.	🟢	Spot-checked every populated span against the ER: protocol doses (ER 342, 346, 348), time-to-effect (ER 397), all six biomarker rows (ER 429–434), cadence (ER 425), all benefit/risk tier items (ER 153–219, 243–285), gates (ER 303–322) and the lede (ER 462–464).
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.	🟢	time_3_sub keeps the ER’s hedge “where present” (ER 397); marker 5/6 targets keep “No established target” (ER 433–434).
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”).	🟢	Contraindications remain contraindications and cautions remain cautions; the intra-articular protocol keeps “guideline bodies disagree” (ER 346).
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.	🟢	stop_items come only from the ER’s “Populations who should avoid” list (ER 317–322); caution_items only from the ER’s six interaction bullets (ER 303–313). No Benefit- or Risk-Modifying Factor is surfaced as a gate.
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, NCT identifiers, author names or brand names appear anywhere in the QRS (verified by search).
1.6	The QRS does not introduce new attributions.	🟢	No attributions of any kind in the QRS body.

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.	🟢	Sober, comparative framing of the three routes mirrors the ER’s Conclusion.
2.2	The tone of the QRS is simultaneously expert, accessible, objective, and data-driven, but also empowering and encouraging	🟢	Concrete doses, windows and markers are given without hype and without discouraging language.
2.3	The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor	🟢	No imperative instructions to a reader; content is stated as protocol facts.
2.4	The QRS avoids language that implies medical or clinical advice	🟢	No “should”, “must”, or “recommended” in the QRS voice.
2.5	The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising”	🟢	Cells state observed protocols and measures, e.g. “Cross-linked gel, repeated at nine to eighteen months” (line 461).
2.6	The QRS never addresses “the reader” directly — it presents evidence, not guidance	🟢	No second-person pronouns anywhere in the file (verified by search).
2.7	The QRS is written in plain language, avoiding unnecessary medical jargon	🟢	Technical terms retained are unavoidable marker and route names carried verbatim from the ER.
2.8	Information is presented in a concise and very compact manner	🟢	Gate items, tier lines and biomarker cells are all single short clauses.
2.9	It DOES NOT address the reader directly	🟢	Confirmed; no “you”/”your” anywhere.
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.	🟢	Optimal functional targets (hs-CRP below 1.0 mg/L, ALT below 25/20 U/L, HbA1c below 5.4%) are pitched at an optimising audience, not at conventional cut-offs.
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.	🟢	Eight-to-twelve-week continuous dosing before judging effect, and multi-point injection follow-up, assume 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.	🟢	Content is not simplified to a mass-market “try this supplement” register.
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.	🟢	The lede separates the three routes by both effect and harm, matching the ER’s Conclusion weighting.
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.	🟢	“anti-aging” does not occur; 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)”; “oral” / “administered orally” not “taken by mouth” / “given by mouth”; “injection” not “shot”; “adverse event” not “bad reaction”). This holds on EVERY surface, including the QRS lede — the stricter plain-language bar (see 2.7) does not license lay phrasing for route of administration. Direct quotes from sources are exempt.	🟢	Routes are named formally throughout (“oral use”, “intra-articular injection”, “injected skin gel”); no “pill”, “shot” or “taken by mouth”.

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 present verbatim (lines 440, 477, 519, 539, 552, 570, 589, 593–595, 676) and identical to the template.
3.2	All “…” from the [qrs_template] are present in the the QRS.	🟢	All 38 template variable names are present; the repeatable marker_#_* and qualitative_item_# spans are instantiated as markers 1–6 and items 1–5.
3.3	Spans that are not addressed in a checklist item are left unchanged	🟢	A structural diff against the template shows only variable substitution and repeated-row instantiation; the website="evidence_review", website="full_review" and website="audit" spans, the stylesheet block and the footer are untouched.

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 relevant to the QRS is empty.
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.	🟢	Protocol labels “Standard oral protocol”, “Competing approach — dermal filler”, “Competing approach — intra-articular” are verbatim ER bold labels (ER 342, 346, 348); interaction items reuse the ER bold labels verbatim.
4.3	Labels are not paraphrased, abbreviated, or invented.	🟢	No invented labels; time-to-effect cells draw on the ER’s single “Time to effect” bullet (ER 397), which carries no per-item bold labels.
4.4	The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). Color and emphasis are conveyed through CSS and bold labels.	🟢	No emoji codepoints in the file; the ER’s ⚠️ Conflicted markers and tier squares were correctly dropped.
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.	🟢	Six gate items per column, one line per tier, six biomarker rows and five qualitative items sit within the template’s A4 budget; no rows or cards were added.

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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, immediately after <!doctype html> on line 1.
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 --- on line 3, closing --- on line 13.
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.	🟢	Enclosed in an HTML comment; no metadata value is repeated in the header or footer.
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: "00:03" is quoted, correctly, because it contains a colon.
5.5	The filename of the source ER is stated as “er_filename: [er_filename]”	🟢	Line 4: er_filename: hyaluronic_acid_2026-0910-0534_Opus_ER.md.
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 QRS.md.
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: 2026-0910-0756.
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” is a single word without version.
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” carries no additional qualifier.
5.12	The filename of the document is stated as “qrs_filename: [filename of this document]”	🟢	Line 9 matches the file’s actual name 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 and git_issue, which are unquoted.

6. Page Title & Header

#	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: “Hyaluronic Acid for Health & Longevity - Quick Reference Sheet”, matching ER canonical_topic (ER 8).
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: “Hyaluronic Acid for Health & Longevity”.
6.3	[header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY]	🟢	Line 421: “09/10/2026”, the correct MM/DD/YYYY form of 2026-0910.
6.4	[header_subline_model] is set to [qrs_creator_ai_fullname]	🟢	Line 425: “Opus 5”.
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 (lines 415–428) is structurally identical to the template; the ER’s “Also known as” line was 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	🟢	Line 433 compresses the ER Conclusion’s route-by-route efficacy and safety split (ER 462–464).
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.	🟢	“share only the molecule” (ER 462), oral skin/knee signal (ER 462), “no established harm beyond occasional digestive upset” (ER 464), filler six-to-twelve months and arterial blockage/sight loss (ER 462, 464), joint change too small to feel (ER 462).
7.4	It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead	🟢	No acronyms; “injected skin gel”, “facial artery” and “digestive upset” are all lay-legible.
7.5	It DOES NOT cite specific trials (names, years, sample sizes, p-values)	🟢	No trial identifiers of any kind.
7.6	It DOES NOT cite effect sizes, relative risks, or statistical results	🟢	No numbers other than the duration “six to twelve months”.

8. Contraindications

#	Description	Result	Comments
8.1	The section is derived from the ER Key Interactions & Contraindications section	🟢	All six items map one-to-one to the ER’s “Populations who should avoid Hyaluronic Acid” list (ER 317–322).
8.2	[stop_items] represent the Contraindications from the ER	🟢	Six ER contraindications, six QRS items, none added or dropped (lines 542–547).
8.3	Individual [stop_items] are formatted as <li></li>	🟢	Each item is its own <li> inside the span.
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.	🟢	The ER’s rationale clause “on absence-of-data grounds rather than demonstrated harm” was correctly stripped from the pregnancy item; no dashes carry trailing clauses.
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).	🟢	“until resolved”, “(absolute, intra-articular)”, “below 50 × 10⁹/L”, “(injected routes)” and “(injected cosmetic routes)” 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 notation in this section.
8.7	The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no population, condition, or scenario for which the intervention should be avoided, deferred, or used only under specialist supervision.	🟢	The ER names six such populations and the section is correctly populated.
8.8	If the section is left empty, an HTML comment inside the [stop_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g.	N/A	The section is not empty.

9. Key Interactions

#	Description	Result	Comments
9.1	The section is derived from the ER Key Interactions & Contraindications section	🟢	All six items map to the ER’s six interaction bullets (ER 303–313).
9.2	[caution_items] represent the Key Interactions from the ER, excluding any that are already listed as Contraindications	🟢	No overlap with the contraindication gate.
9.3	Individual [caution_items] are formatted as <li></li>	🟢	Each item is its own <li> inside the span (lines 555–560).
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.	🟢	Mechanistic rationale and mitigation sentences from the ER bullets are all stripped; only the applicability tag survives (“injected routes”, “before injections”, “no restriction”).
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).	🟢	Named drug lists are retained and trimmed rather than dropped (warfarin/apixaban/clopidogrel; aspirin/ibuprofen/naproxen; fish oil/vitamin E/Ginkgo/garlic; glucosamine/chondroitin; laser/radiofrequency/ultrasound).
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 notation in this section.
9.7	The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no interaction, additive effect, or exposure that changes how the intervention is used.	🟢	The ER names six interactions and the section is correctly populated.
9.8	If the section is left empty, an HTML comment inside the [caution_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g.	N/A	The section is not empty.

10. Protocol

#	Description	Result	Comments
10.1	The section is derived from the ER Protocol section	🟢	All three cells come from the ER Therapeutic Protocol bullets (ER 342, 346, 348).
10.2	The three sets of [action] items cover the three most important actionable implementation aspects from the ER Protocol section	🟢	Standard oral protocol plus the two routes with distinct, actionable dosing (dermal filler, intra-articular); the topical bullet, tied to a Medium-tier benefit, is the correct omission.
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 provides more than three actionable aspects; 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.	🟢	Nine of nine spans populated: 120–240 mg daily, 0.5–2 mL per area, 20–25 mg weekly, each with an ER-derived sub-line.

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	🟢	Filler (immediate), oral skin moisture (2–4 weeks, wrinkle 8–12 weeks) and joint pain (4–8 weeks) cover every time-to-effect fact in ER 397.
11.2	The sets are picked and ordered by the magnitude of the related benefit	🟢	Filler correction first (the ER’s only visible, sustained structural effect, ER 348), oral skin second (High tier, ER 153), joint pain last (ER 173 reports an effect below the noticeable threshold).
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 provides four time-to-effect facts; 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.	🟢	Nine of nine spans populated, each traceable to ER 348 or ER 397.
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 time-to-effect information (ER 397); the section is correctly retained.

12. Benefits

#	Description	Result	Comments
12.1	The section is derived from the ER Expected Benefits section	🟢	All nine listed benefits map to ER benefit headings (ER 153–219), in the ER’s own order.
12.2	Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative]	🟢	All four spans present and populated (lines 521–532), each matching its ER tier.
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 benefit is reduced to a noun phrase plus route; no magnitudes, confidence intervals or sponsorship notes carried over.
12.4	Parenthetical content — including effect sizes, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢	No parentheses in any benefits line; the ER’s ⚠️ Conflicted flags were also dropped.
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 benefit tiers carry items in the ER.

13. Risks

#	Description	Result	Comments
13.1	The section is derived from the ER Potential Risks & Side Effects section	🟢	All seven listed risks map to ER risk headings (ER 243–285), in the ER’s own order.
13.2	Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative]	🟢	All four spans present and populated (lines 572–583), each matching its ER tier.
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.	🟢	Relative risks, odds ratios and incidence rates from the ER Magnitude lines are all absent.
13.4	Parenthetical content — including frequencies, severity grades, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢	No parentheses in any risks line.
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 risk tiers carry items in the ER.

14. Monitoring

#	Description	Result	Comments
14.1	The section is derived from the ER Monitoring section	🟢	Marker names, targets and rationales are taken from the ER biomarker table (ER 429–434).
14.2	All measurable/quantifiable biomarkers from the Monitoring section are listed	🟢	All six ER rows present: serum hyaluronic acid, hs-CRP, ALT, HbA1c, skin surface hydration, knee pain and function score.
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.	🟢	Line 670 reproduces the ER’s three route-specific schedules (ER 425).

15. Qualitative Assessment

#	Description	Result	Comments
15.1	The section is derived from the ER Monitoring section	🟢	Items are taken from the ER’s qualitative marker list (ER 438–442).
15.2	All subjective/qualitative biomarkers from the Monitoring section are listed	🟢	All five ER qualitative markers present, verbatim (lines 679–691).

Issues 10/09/2026 08:18

Pass rate 100.00%. No issues found.

Issues 10/09/2026 08:15

1. 1.3 — Universalised joint-effect claim: [at_a_glance] (line 433) says “Joint injections change too little to feel”, while the ER conclusion (line 462) says “a change too small for most to feel”; dropping “for most” strengthens a majority claim into a universal one.
2. 8.4 — Rationale kept in contraindication: The pregnancy/breastfeeding item (line 547) carries the ER’s evidentiary rationale “absence of data” inside the parenthesis, which is an explanation rather than a qualifier preserved under 8.5.

Fixes 10/09/2026 08:15

1. 1.3 — Restored ER hedge in lede: [at_a_glance] changed from “Joint injections change too little to feel” to “Joint injections change too little for most to feel”, matching the ER conclusion; the lede remains within the 60-word limit at 58 words.
2. 8.4 — Rationale stripped from contraindication: The pregnancy/breastfeeding [stop_items] entry was reduced from “(injected cosmetic routes, absence of data)” to “(injected cosmetic routes)”, keeping the route qualifier and dropping the evidentiary rationale.

Issues 10/09/2026 08:10

1. 12.3 / 12.4 — Qualifier retained in benefits: [benefits_high] at line 522 keeps the parenthetical qualifier “(conflicted)” on both the dry-eye and intra-articular knee-pain entries; Section 12 requires bare key facts with parenthetical content stripped.

Fixes 10/09/2026 08:10

1. 12.3 / 12.4 — Qualifier stripped from benefits: Removed both “(conflicted)” parentheticals from [benefits_high] (line 522), leaving “dry eye relief from hyaluronate drops” and “knee pain from intra-articular injection” as bare key facts.

Issues 10/09/2026 08:03

1. 4.5 — One-page budget exceeded: The populated sheet runs roughly 1.6–1.7 A4 pages against the 273 mm print box; the header, at-a-glance, protocol panel, decision gates and Benefits card alone consume the full page before Risks, Monitoring and Qualitative Assessment begin. The worst offenders are action_3_sub (line 472, 132 chars in a one-third-width cell), benefits_high (line 522) and benefits_medium (line 525) at three wrapped lines each, the fourteen-line stop_items block (lines 542–547), the three-line risks_high/risks_low/risks_speculative items (lines 573–582), and the 70-character marker_5_target/marker_6_target values (lines 648, 659) in the narrow Target column. time_1_sub (line 489) additionally repeats action_2_sub (line 461) verbatim.

Fixes 10/09/2026 08:03

1. 4.5 — At-a-glance shortened: Reworked the lede to the ER’s own conclusion wording (“Gel injected under the skin” → “Injected skin gel”), cutting it from 59 to 57 words and from five wrapped lines to four.
2. 4.5 — Duplicate protocol clause removed: Dropped “; the only route with a visible, sustained structural effect” from action_2_sub, since time_1_sub already carries that exact phrase; the fact remains on the sheet once.
3. 4.5 — Protocol sub-cells trimmed: Shortened action_1_sub (“taken continuously for” → “taken for”) and action_3_sub (“a single cross-linked 48–88 mg dose; guideline bodies disagree sharply on whether this is worth doing” → “one cross-linked 48–88 mg dose; guideline bodies disagree”), taking the protocol row from four wrapped lines to two.
4. 4.5 — Benefits tiers condensed: Reduced benefits_high from 277 to 212 characters and benefits_medium from 262 to 171 by dropping redundant leading verbs and repeated route phrases (“relief of vaginal atrophy symptoms from topical hyaluronic acid” → “vaginal atrophy relief”), saving two wrapped lines.
5. 4.5 — Risk items tightened: Condensed risks_high, risks_low and risks_speculative to single wrapped lines each (“transient local reactions at the injection site” → “transient local injection-site reactions”; “promotion of tumour growth by” → “tumour growth promotion by”).
6. 4.5 — Contraindication gate condensed: Trimmed all six stop_items to two wrapped lines each, shortening rather than dropping every parenthetical qualifier and time window as item 8.5 requires (e.g. “(absolute contraindication for intra-articular injection)” → “(absolute, intra-articular)”).
7. 4.5 — Interaction gate condensed: Trimmed four caution_items parentheticals while keeping each ER bold label verbatim and every drug list present, per item 9.5 (“blood thinners: warfarin, apixaban, rivaroxaban, clopidogrel” → “warfarin, apixaban, clopidogrel”).
8. 4.5 — Monitoring targets shortened: Cut marker_5_target and marker_6_target from 70 to 53 characters (“track change from the individual’s own baseline” → “track change from own baseline”), taking both rows from three wrapped lines to two in the narrow Target column.