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Audit: QRS - Lactobacillus acidophilus for Health & Longevity

Audit conducted on 05/09/2026 05:30 using AI4L / Opus 5

Iterations

Summary

Items Count
Total 93
Passed 84
Failed 0
N/A 9
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. 🟢 All content traced to the ER: protocol lines 386/388/394, time-to-effect line 441, benefit and risk headings, contraindication list lines 339-364, monitoring table lines 471-489, conclusion lines 513-517.
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. 🟢 Cautious ER phrasing preserved, e.g. time_3_sub “Needed more than four weeks to separate from placebo” mirrors ER line 441.
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”). 🟢 No strengthening or softening; “Excess mortality in severe acute pancreatitis” and “Delayed gut recovery after antibiotics” keep the ER’s direction and force.
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. 🟢 Absolute-contraindication interactions (immunosuppressants, cytotoxic chemotherapy) correctly sit under Contraindications, matching the ER’s own labelling at lines 341-343; no 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. 🟢 Only the strain designations DDS-1, NCFM and CL1285 appear, all present in the ER Protocol section for the same facts; no PMIDs, NCT IDs, author names or brand names.
1.6 The QRS does not introduce new attributions. 🟢 No new attributions; the ER’s “Leading practitioners choose by documented strain” is rendered without the attribution.

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. 🟢 Matches the ER’s sober, hedged register.
2.2 The tone of the QRS is simultaneously expert, accessible, objective, and data-driven, but also empowering and encouraging 🟢 Expert, objective and data-driven while remaining accessible and actionable.
2.3 The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor 🟢 Presents options and evidence rather than issuing instructions.
2.4 The QRS avoids language that implies medical or clinical advice 🟢 No clinical directives; the footer disclaimer is the template’s own.
2.5 The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising” 🟢 Content is framed as what was used or measured, not as recommendations.
2.6 The QRS never addresses “the reader” directly — it presents evidence, not guidance 🟢 No second-person address anywhere in the file.
2.7 The QRS is written in plain language, avoiding unnecessary medical jargon 🟢 Plain-language throughout; technical terms are expanded (“low-density-lipoprotein cholesterol”).
2.8 Information is presented in a concise and very compact manner 🟢 Compact phrasing throughout; single-page budget respected.
2.9 It DOES NOT address the reader directly 🟢 No direct reader address; no imperatives directed at the reader.
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 proactive, risk-aware reader (strain-level selection, biomarker panel, breath testing).
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. 🟢 Protocol assumes willingness to select by strain, dose daily and track eight biomarkers.
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. 🟢 Not pitched at the general population; assumes effortful protocol adherence.
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. 🟢 Weighting reflects the audience: paediatric-only benefits are flagged as such, and infection risk is tied to catheters/immunosuppression rather than generalised.
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 term “anti-aging” does not appear; ageing is framed neutrally (“maintenance of the ageing gut barrier”).
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. 🟢 Formal register maintained; “brain fogginess” is the ER’s own heading term drawn from the cited source (ER line 293).

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 headings verified: Protocol, Time to effect, Benefits, Risk & Side Effects, Monitoring, Qualitative Assessment, Contraindications, Key Interactions, High/Medium/Low/Speculative, Marker/Target/Why.
3.2 All “…” from the [qrs_template] are present in the the QRS. 🟢 All 34 template variables present; marker_#* and qualitative_item# correctly expanded to marker_1..8 and qualitative_item_1..6.
3.3 Spans that are not addressed in a checklist item are left unchanged 🟢 Head, CSS block and the website=”evidence_review”/”audit”/”full_review” spans are byte-identical to the template.

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 is empty; the ER’s High-risk tier carries an explanatory sentence handled under 13.5, not empty-state phrasing.
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. 🟢 ER bold labels used verbatim: “Standard maintenance dose”, “Strain-first selection”, “Best time of day”, “Systemic antibiotics”, “Proton pump inhibitors and antacids”, “Antimicrobial botanicals”, “Prebiotic supplements”, “Cholesterol-lowering supplements”, “Other live-microbe products and faecal microbiota transplantation”, “Immunosuppressants”, “Cytotoxic chemotherapy causing neutropenia”.
4.3 Labels are not paraphrased, abbreviated, or invented. 🟢 No bold ER label is paraphrased or invented.
4.4 The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). Color and emphasis are conveyed through CSS and bold labels. 🟢 No emoji indicators anywhere in the file; tiers are conveyed by bold labels and CSS.
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. 🟢 Content condensed to the per-section budget; no section overruns onto a second page.

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. 🟢 Metadata comment occupies lines 2-14, immediately after <!doctype html> and before any other content.
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. 🟢 YAML opens at line 3 and closes at 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; not surfaced by any rendered element.
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. 🟢 All values trimmed; only duration is quoted, correctly, because it contains a colon.
5.5 The filename of the source ER is stated as “er_filename: [er_filename]” 🟢 er_filename: lactobacillus_acidophilus_2026-0905-0002_Opus_ER.md matches the source ER.
5.6 Version of the QRS.md file used to create the document is stated as “qrs_prompt_version: [Version of QRS.md]” 🟢 qrs_prompt_version: 26.7.02 matches the QRS.md version badge.
5.7 Creation date and time of the document is stated as “qrs_creation_date: [YYYY-MMDD-HHMM]” (e.g., 2026-0501-1430) 🟢 qrs_creation_date: 2026-0905-0431 in YYYY-MMDD-HHMM form.
5.8 The nickname of the AI used to create the document is stated as “qrs_creator_ai_nickname: [qrs_creator_ai_nickname]” 🟢 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) 🟢 Single word, no 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]” 🟢 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) 🟢 Nickname plus version number, no qualifier.
5.12 The filename of the document is stated as “qrs_filename: [filename of this document]” 🟢 qrs_filename matches the actual filename 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. 🟢 Frontmatter values trimmed and consistently unquoted apart from duration.

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., &amp; for &) 🟢 page_title is “Lactobacillus acidophilus for Health & Longevity - Quick Reference Sheet”, with the ampersand entity-encoded.
6.2 [header_topic] is set to the [canonical_topic] of the ER frontmatter, with HTML entities encoded as needed (e.g., &amp; for &) 🟢 header_topic matches the ER canonical_topic with & encoding.
6.3 [header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY] 🟢 header_subline_date 09/05/2026 is qrs_creation_date 2026-0905-0431 in MM/DD/YYYY form.
6.4 [header_subline_model] is set to [qrs_creator_ai_fullname] 🟢 header_subline_model is “Opus 5”, matching qrs_creator_ai_fullname.
6.5 No additional header content appears: no badge, version stamp, AKA / alternate names line, source-AI attribution, audit date, or QRS variant marker. 🟢 Header carries only the template’s date, source and model line; no badge, AKA line or audit stamp.

7. At-A-Glance Section

# Description Result Comments
7.1 [at_a_glance] is dense, execution-oriented summary of the ER Conclusion section 🟢 Condenses the ER Conclusion (lines 513-517) into what the substance is, what works, the strain caveat and where harm concentrates.
7.2 [at_a_glance] is no longer than 60 words 🟢 57 words, within the 60-word limit.
7.3 Every fact in [at_a_glance] is supported by a distinct passage in the ER. 🟢 Each of the four facts maps to a distinct Conclusion passage at ER lines 513, 515 and 517.
7.4 It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead 🟢 No acronyms or specialist classifications; “laboratory lines”, “loose stools”, “suppressed immunity” used in place of technical terms.
7.5 It DOES NOT cite specific trials (names, years, sample sizes, p-values) 🟢 No trial names, years, sample sizes or p-values.
7.6 It DOES NOT cite effect sizes, relative risks, or statistical results 🟢 No effect sizes, relative risks or statistical results.

8. Contraindications

# Description Result Comments
8.1 The section is derived from the ER Key Interactions & Contraindications section 🟢 Derived from the ER Key Interactions & Contraindications section, lines 337-364.
8.2 [stop_items] represent the Contraindications from the ER 🟢 All eight avoid-populations from ER lines 357-364 plus the two absolute-contraindication drug classes from ER lines 341-343.
8.3 Individual [stop_items] are formatted as <li></li> 🟢 Ten <li> elements inside the stop_items 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. 🟢 Each item is a bare fact; no mechanistic rationale, attribution or trailing dash clause.
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). 🟢 Thresholds retained: “below 500 cells/µL”, “CD4 below 200 cells/µL”, “below 1,500 g”; drug parentheticals trimmed but not dropped.
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 inside parentheses 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. 🟢 Section is correctly non-empty; the ER names eight avoid-populations and two absolute contraindications.
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 Section is not empty, so no explanatory HTML comment is required.

9. Key Interactions

# Description Result Comments
9.1 The section is derived from the ER Key Interactions & Contraindications section 🟢 Derived from the ER Key Interactions & Contraindications section, lines 339-353.
9.2 [caution_items] represent the Key Interactions from the ER, excluding any that are already listed as Contraindications 🟢 Six interactions carried over; the two absolute contraindications are correctly excluded and placed in the Contraindications gate.
9.3 Individual [caution_items] are formatted as <li></li> 🟢 Six <li> elements inside the caution_items span.
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. 🟢 Each item is label, example drugs and the ER’s action word; no mechanism or rationale carried through.
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). 🟢 Example drug lists preserved in shortened form for every item, e.g. “(amoxicillin, ciprofloxacin)”, “(inulin, lactitol)”.
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 inside parentheses 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. 🟢 Section is correctly non-empty; the ER names eight interactions.
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 Section is not empty, so no explanatory HTML comment is required.

10. Protocol

# Description Result Comments
10.1 The section is derived from the ER Protocol section 🟢 Derived from the ER Therapeutic Protocol section, lines 384-408.
10.2 The three sets of [action] items cover the three most important actionable implementation aspects from the ER Protocol section 🟢 Dose, strain selection and timing are the three actionable aspects; the remaining ER bullets are competing approaches, kinetics or modifiers.
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 Three distinct actionable aspects exist in the ER, so no set is unused.
10.4 All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from the ER Protocol section. 🟢 All nine action fields carry ER-derived content from lines 386, 388 and 394.

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 🟢 All three time-to-effect aspects given in the ER (line 441) are used: bowel habit and bloating, IBS symptom scores, lipids.
11.2 The sets are picked and ordered by the magnitude of the related benefit 🟢 Ordered High-tier benefits first (bowel/bloating, IBS symptom scores) then the Medium-tier lipid endpoint.
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 Three distinct time-to-effect aspects exist in the ER, so no set is unused.
11.4 All used [time_#label], [time#value], [time#_sub] items are filled with meaningful content derived from the ER. 🟢 All nine time fields populated from ER lines 441 and 396.
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 does provide time-to-effect information, so the section is correctly retained.

12. Benefits

# Description Result Comments
12.1 The section is derived from the ER Expected Benefits section 🟢 Derived from the ER Expected Benefits section, lines 151-237.
12.2 Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative] 🟢 All four benefit variables present and populated.
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 entry is the condensed ER benefit heading with no effect size, citation or mechanism.
12.4 Parenthetical content — including effect sizes, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved. 🟢 No parenthetical content carried through.
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, so no span needs hiding.

13. Risks

# Description Result Comments
13.1 The section is derived from the ER Potential Risks & Side Effects section 🟢 Derived from the ER Potential Risks & Side Effects section, lines 257-319.
13.2 Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative] 🟢 All four risk variables present.
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 entry is the condensed ER risk heading with no frequency, citation or mechanism.
13.4 Parenthetical content — including frequencies, severity grades, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved. 🟢 No parenthetical content carried through.
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. 🟢 risks_high is set to style=”display: none” with no content, matching the ER’s “No risk reaches High” at line 263.

14. Monitoring

# Description Result Comments
14.1 The section is derived from the ER Monitoring section 🟢 Derived from the ER Monitoring Protocol & Defining Success section, lines 465-480.
14.2 All measurable/quantifiable biomarkers from the Monitoring section are listed 🟢 All eight ER biomarker-table rows are present: LDL, total cholesterol, hs-CRP, fasting glucose, HbA1c, faecal calprotectin, breath hydrogen/methane, IBS Symptom Severity Scale.
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. 🟢 monitoring_cadence carries the ER cadence from line 469: symptoms at 2/4/8 weeks, lipids at 8-12 weeks then every 6-12 months, blood counts on immune change.

15. Qualitative Assessment

# Description Result Comments
15.1 The section is derived from the ER Monitoring section 🟢 Derived from the ER Monitoring Protocol & Defining Success section, lines 482-489.
15.2 All subjective/qualitative biomarkers from the Monitoring section are listed 🟢 All six qualitative markers from ER lines 484-489 are listed verbatim.

Issues 05/09/2026 05:30

Pass rate 100.00%. No issues found.

Issues 05/09/2026 05:28

  1. 8.5 — “long-term” qualifier dropped: QRS line 542 states “Central venous catheter or parenteral nutrition”, dropping the ER’s duration qualifier from “on long-term parenteral nutrition” (ER line 357) and thereby widening the contraindication to any parenteral-nutrition exposure.

Fixes 05/09/2026 05:28

  1. 8.5 — “long-term” qualifier restored: Changed the first contraindication from “Central venous catheter or parenteral nutrition” to “Central venous catheter or long-term parenteral nutrition”, restoring the ER’s duration qualifier (ER line 357).

Issues 05/09/2026 05:21

  1. 4.3 — Contraindication label abbreviated: The ER bold label “Cytotoxic chemotherapy causing neutropenia (cyclophosphamide, doxorubicin, docetaxel):” (ER line 343) is rendered at QRS line 551 as “Cytotoxic chemotherapy while neutropenic”, abbreviating the label and dropping the parenthetical drug list entirely.

Fixes 05/09/2026 05:21

  1. 4.3 — Contraindication label restored verbatim: The chemotherapy contraindication at QRS line 551 was changed from “Cytotoxic chemotherapy while neutropenic” to “Cytotoxic chemotherapy causing neutropenia (cyclophosphamide, docetaxel)”, restoring the ER’s bold label verbatim and reinstating a trimmed parenthetical drug list.

Issues 05/09/2026 05:15

  1. 1.1 — Unqualified “largest positive trial”: action_1_sub (line 450) says “the largest positive trial used 10 billion of DDS-1”, dropping the ER’s “irritable bowel syndrome” qualifier (ER line 386) and creating a superlative the ER itself contradicts with its larger 503-patient antibiotic-diarrhoea trial.
  2. 1.3 — Transplant avoidance softened: The last caution_items entry (line 564) reduces the ER’s “Caution, escalating to avoidance around a planned transplant” (ER line 353) to “caution near transplant”, weakening the avoidance instruction and misplacing where it applies.
  3. 4.2 / 4.3 — Interaction label abbreviated: The same entry bolds “Other live-microbe products and faecal transplantation” instead of the ER’s verbatim bold label “Other live-microbe products and faecal microbiota transplantation” (ER line 353).

Fixes 05/09/2026 05:15

  1. 1.1 — Restored trial-scope qualifier: action_1_sub changed from “the largest positive trial used 10 billion of DDS-1” to “the largest positive irritable bowel trial used 10 billion of DDS-1”, matching the ER’s scoped claim.
  2. 1.3 — Transplant avoidance restored: The final Key Interactions item now reads “caution; avoid near a planned transplant” instead of “caution near transplant”, reinstating the ER’s escalation to avoidance.
  3. 4.2 / 4.3 — Verbatim interaction label: The bold label was expanded from “Other live-microbe products and faecal transplantation” to the ER’s verbatim “Other live-microbe products and faecal microbiota transplantation”.

Issues 05/09/2026 05:07

  1. 4.5 — QRS overruns one A4 page: Estimated rendered height is roughly twice the A4 print box (703 px content width, 1033 px usable height); the Contraindications gate (lines 542–551, ~21 wrapped lines) and the Monitoring table (lines 601–688) each consume ~450 px, leaving no room for Benefits, Risks and Qualitative Assessment on page one.

Fixes 05/09/2026 05:07

  1. 4.5 — Contraindication items condensed: All ten stop_items were shortened to single-line form (e.g. “Indwelling central venous catheter or long-term parenteral nutrition” → “Central venous catheter or parenteral nutrition”), cutting the gate from ~21 wrapped lines to ~11 while keeping every item and its threshold qualifier.
  2. 4.5 — Key Interaction parentheticals trimmed: Example-drug lists were reduced to one or two agents each (e.g. “(omeprazole, famotidine, calcium carbonate)” → “(omeprazole)”) and the FMT item shortened to “caution near transplant”, with the ER’s bold labels left verbatim.
  3. 4.5 — Monitoring cells shortened: Eight target/why cells were condensed to one line each (e.g. “The validated scale on which the strongest benefit was measured” → “The scale the strongest benefit used”), marker_7_name to “Breath hydrogen/methane”, marker_8_name to “IBS symptom severity”, and the cadence to numeric intervals.
  4. 4.5 — Protocol sub-cells condensed: The three action_#_sub cells were trimmed by one to two wrapped lines each, e.g. the strain-selection cell from a 136-character sentence to “DDS-1 for irritable bowel; NCFM for antibiotic cover; CL1285 for hospital use.”
  5. 4.5 — Risk tier items reduced to key facts: Residual qualifiers were stripped per the tiered-descriptor rule, e.g. “Excess mortality in critical illness with predicted severe acute pancreatitis; bloodstream infection and infective endocarditis in vulnerable hosts” → “Excess mortality in severe acute pancreatitis; bloodstream infection and endocarditis”, taking the card from seven wrapped lines to four.

Estimated rendered height fell from ~2085 px to ~1710 px against a 1033 px A4 print box. Further reduction would require dropping contraindications, interactions, biomarkers or qualitative markers, which items 8.2, 9.2, 14.2 and 15.2 require to be listed in full.

Issues 05/09/2026 05:01

  1. 4.2 / 4.3 — Interaction label abbreviated: The final caution_items entry at line 564 reads “Other live-microbe products and faecal transplantation”, abbreviating the ER’s bold label “Other live-microbe products and faecal microbiota transplantation” (ER line 353).

Fixes 05/09/2026 05:01

  1. 4.2 / 4.3 — Interaction label restored verbatim: The final caution_items entry now reads “Other live-microbe products and faecal microbiota transplantation”, matching the ER bold label instead of the abbreviated “faecal transplantation”.

Issues 05/09/2026 04:54

  1. 4.5 — Sheet exceeds one A4 page: The combined content of the gates, benefits, risks, monitoring and qualitative blocks runs roughly double the available A4 print height; the contraindications column alone (lines 542–551) wraps to about 21 lines, and several gate items, protocol subs and tier strings carry avoidable length.

Fixes 05/09/2026 04:54

  1. 4.5 — Protocol and time-to-effect subs trimmed: Removed the second ER bullet merged into action_1_sub (split-dosing sentence), and shortened action_2_sub, action_3_sub, time_1_sub, time_2_sub and time_3_sub to their load-bearing clause.
  2. 4.5 — Contraindication items condensed: Shortened all ten gate items where item 8.5 permits trimming — e.g. “Critically ill intensive-care patients” to “Critically ill patients”, “absolute neutrophil count” to “neutrophil count” — and trimmed the immunosuppressant and chemotherapy drug lists to two exemplars each without dropping any item.
  3. 4.5 — Key interaction items condensed: Trimmed the prebiotic and cholesterol-lowering drug lists by one exemplar each and shortened “faecal microbiota transplantation” to “faecal transplantation”, bringing three three-line items down to two lines.
  4. 4.5 — Benefit and risk tier strings shortened: Condensed benefits_medium (“fewer respiratory infection episodes” to “fewer respiratory infections”) and risks_low (“gas, bloating and transient digestive discomfort” to “gas, bloating and digestive discomfort”; “dairy-based products” to “dairy products”).
  5. 4.5 — Monitoring cells condensed: Reformatted marker_1_target to “Below 100 mg/dL; below 70 mg/dL at elevated cardiovascular risk” and trimmed the redundant “if continued” clause from monitoring_cadence.

Issues 05/09/2026 04:45

  1. 4.5 — Content exceeds one A4 page: Several cells carry whole ER bullets instead of condensations — action_1_sub (line 450) merges ER bullets 386 and 398 into 39 words inside a one-third-width 8.5pt cell, while action_3_sub (472), time_3_sub (511), the longer stop_items (544, 551), caution_items (564) and the cadence line (693) are near-verbatim ER sentences, pushing the sheet past the single-page budget.

Fixes 05/09/2026 04:45

  1. 4.5 — Protocol dose cell condensed: action_1_sub cut from 39 to 27 words by replacing “Doses up to 10 billion are usually taken once daily; above that, splitting into two improves tolerability” with “Above that, splitting into two doses improves tolerability”, removing three wrapped lines from the tallest protocol cell.
  2. 4.5 — Timing cell condensed: action_3_sub changed from “improves survival of live cells through the stomach” to “improves live-cell survival”, keeping both the buffering rationale and the bedtime alternative.
  3. 4.5 — Time-to-effect subs condensed: time_1_sub dropped the redundant “of starting”, time_2_sub dropped “irritable bowel” already carried by its label, and time_3_sub was shortened from “Required more than four weeks to separate from placebo, and effects were larger beyond that point” to “Needed more than four weeks to separate from placebo; effects were larger beyond”.
  4. 4.5 — Gate items tightened: The cytotoxic-chemotherapy contraindication lost its comma before “while counts are suppressed”, and the live-microbe interaction changed from “caution, escalating to avoidance around a planned transplant” to “caution; avoid around a planned transplant”, each preserving its qualifier.
  5. 4.5 — Monitoring cadence condensed: Cut from 34 to 28 words (“Symptoms at two, four and eight weeks; lipids at eight to twelve weeks, then every six to twelve months if continued; blood counts only if immune status changes”) with every interval retained.

Issues 05/09/2026 04:38

  1. 2.4 / 2.5 — Imperative protocol phrasing: action_2_value (line 458) states “Choose by documented strain, not by species” and action_1_sub (line 450) ends “above that, split into two” — both are directives, whereas the ER presents these descriptively as “Leading practitioners choose by documented strain, not by species” (ER line 388) and “splitting into two doses improves tolerability” (ER line 398).

Fixes 05/09/2026 04:38

  1. 2.4 / 2.5 — Imperative protocol phrasing: Replaced the directive action_2_value “Choose by documented strain, not by species” with the descriptive “Selection by documented strain, not by species”, and changed the close of action_1_sub from “above that, split into two” to “above that, splitting into two improves tolerability”, matching the ER’s own descriptive wording.