Audit: QRS - Vagus Nerve Stimulation for Health & Longevity

Audit conducted on 11/10/2026 14:33 using AI4L / Opus 5.5

Iterations

Summary

Items	Count
Total	97
Passed	85
Failed	0
N/A	12
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.	🟢	Lede, Protocol, Time to effect, Benefits, Risks, gates and Monitoring all trace to ER text (Conclusion, Therapeutic Protocol, Practical Considerations, Key Interactions & Contraindications, Monitoring table).
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.	🟢	Hedges kept: “has not been evaluated in these groups”, “Safety is not established”, theoretical items keep “Could”; lede keeps “modestly” and “unproven”.
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 found; lede “lower inflammation is unproven” matches ER “Net: unproven” / “has not held up consistently”.
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.	🟢	Contraindications come from “Populations who should avoid”, Key Interactions from “Documented”/”Theoretical” lists, markers from the Monitoring section.
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 IDs, trial or expert names; only brand-type term “AutoStim” appears, as in the ER for the same fact.

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.	🟢	Measured, evidence-led tone mirrors the ER.
2.2	The tone of the QRS is expert, accessible, objective, and data-driven	🟢
2.3	The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor	🟢
2.4	The QRS avoids language that implies medical or clinical advice	🟢	Content states facts; no advice wording.
2.5	The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising”	🟢
2.6	The QRS never addresses the reader directly — it presents evidence, not guidance	🟢	No second-person address.
2.7	The QRS is written in plain language, avoiding unnecessary medical jargon	🟢	Acronyms expanded (nVNS to neck non-invasive stimulation); remaining clinical terms sit in ER labels carried verbatim.
2.8	Information is presented in a concise and very compact manner	🟢
2.9	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.	🟢
2.10	The target audience is willing to employ lifestyle and behavioral changes as well as follow protocols that may be inconvenient, costly, or require effort.	🟢
2.11	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.	🟢
2.12	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.	🟢	Lede separates disease-specific benefits from what applies to healthy adults.
2.13	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.	🟢	No “anti-aging” framing.
2.14	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.	🟢	No colloquial or consumer-grade terms found.

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, gate headings, tier labels and column headers unchanged.
3.2	Every element carrying a data-qrs-var attribute in [qrs_template] is present in the QRS with the same name	🟢	All template data-qrs-var names present; marker_# and qualitative_item_# expanded to 1..5.
3.3	Everything outside the data-qrs-var spans — markup, text, styles, comments — is as in the template; spans that no checklist item addresses are left unchanged as well	🟢	Source diff against the template shows changes only inside data-qrs-var spans (plus workflow metadata fields).

4. Formatting

#	Description	Result	Comments
4.1	An empty ER section never produces visible empty-state text in the QRS: the corresponding region is hidden or left empty. Phrases such as “None documented in human trials to date” or “Not formally studied” appear only where the ER uses them for a fact the QRS carries over.	🟢	Only “Not specified in the ER” appears, as 14.3 requires.
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 (“Ear regimen for AF”, “Ear regimen for autonomic function”, “Implanted epilepsy regimen”) and gate labels use ER bold labels.
4.3	Labels are not paraphrased, abbreviated, or invented.	🟢	Labels trimmed only of glosses and surplus examples.
4.4	The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). Color and emphasis are conveyed through CSS and bold labels.	🟢	No emoji in the QRS.
4.5	The QRS is designed to render on one A4 page. It fails this item only for one of four things: a trailing clause after a dash, an optional gloss, an example list left untrimmed, or a repetition. Nothing else is cut to fit.	🟢	No trailing dash clauses, glosses dropped, long example lists trimmed to three, no repetition found.

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.	🟢
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.	🟢
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.	🟢
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 is quoted (contains a colon).
5.5	The filename of the source ER is stated as “er_filename: [er_filename]”	🟢
5.6	Version of the QRS.md file used to create the document is stated as “qrs_prompt_version: [Version of QRS.md]”	🟢	26.11.9 matches 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)	🟢	2026-1110-1408
5.8	The nickname of the AI used to create the document is stated as “qrs_creator_ai_nickname: [qrs_creator_ai_nickname]”	🟢	Opus
5.9	The nickname of the AI is the full name without the version number, with all remaining words joined by hyphens (e.g., Opus, Sonnet, Grok, Gemini-Flash, GPT); when the full name has no version number or is “Unknown”, the nickname equals the full name	🟢
5.10	The full name of the AI used to create the document is stated as “qrs_creator_ai_fullname: [qrs_creator_ai_fullname]”	🟢	Opus 5.5
5.11	The full name of the AI consists of the model name (the word or words directly before the version number, leaving out the first if there is more than one, e.g., Claude Opus 5.5 → Opus 5.5), the model version number and the variant (if any) as stated in the system prompt or developer instructions of the creating model, with every word capitalized and without product, effort or pricing names (e.g., Opus X.Y, Sonnet X.Y, Grok X.Y, Gemini X.Y Flash, GPT X.Y), the model name alone when the system prompt or developer instructions name a model without a version number (e.g., Grok), or “Unknown” when neither the system prompt nor the developer instructions of the creating model name a model	🟢
5.12	The filename of the document is stated as “qrs_filename: [filename of this document]”	🟢

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 &)	🟢
6.2	[header_topic] is set to the [canonical_topic] of the ER frontmatter, with HTML entities encoded as needed (e.g., & for &)	🟢
6.3	[header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY]	🟢	11/10/2026
6.4	[header_subline_model] is set to [qrs_creator_ai_fullname]	🟢	Opus 5.5
6.5	No additional header content appears: no badge, version stamp, AKA / alternate names line, source-AI attribution, audit date, or QRS variant marker.	🟢

7. At-A-Glance Section

#	Description	Result	Comments
7.1	[at_a_glance] opens by saying what the intervention is — its kind (e.g., dietary supplement, prescription medication, peptide, plant, procedure, practice) — and what it is used for, in plain language, before any verdict on the evidence	🟢	Opens with electrical pulses delivered via implants or neck and ear devices, for specific diseases or sold for wellness.
7.2	[at_a_glance] is dense, execution-oriented summary of the ER Conclusion section	🟢	Condenses all four Conclusion paragraphs.
7.3	[at_a_glance] is no longer than 70 words	🟢	70 words (script count).
7.4	Every fact in [at_a_glance] is supported by a distinct passage in the ER.	🟢
7.5	It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead	🟢	No acronyms or specialist terms.
7.6	It DOES NOT cite specific trials (names, years, sample sizes, p-values)	🟢
7.7	It DOES NOT cite 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	🟢
8.2	[stop_items] represent the Contraindications from the ER	🟢	All seven ER “Populations who should avoid” items present.
8.3	Individual [stop_items] are formatted as <li></li>	🟢
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.	🟢	Attribution “labeling advises evaluation before implantation” and glosses stripped.
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).	🟢	“(heart rate below 50 beats per minute)” and “(pacemaker, defibrillator, hearing implant)” preserved.
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	ER uses no ranking notation.
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 populated; ER names populations to avoid.
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.

9. Key Interactions

#	Description	Result	Comments
9.1	The section is derived from the ER Key Interactions & Contraindications section	🟢
9.2	[caution_items] represent the ER’s documented interactions — the items under its “Documented interactions:” label — excluding any that are already listed as Contraindications and any entry phrased as no interaction found	🟢	Five documented items; Diathermy excluded as already a Contraindication.
9.3	[caution_theoretical_items] represent the ER’s theoretical interactions — the items under its “Theoretical interactions (inferred from mechanism, not studied in humans):” label	🟢	All nine theoretical items present.
9.4	The ER placeholder “None identified” is never an item: it means that group is empty	🟢
9.5	Individual [caution_items] and [caution_theoretical_items] are formatted as <li></li>. The template’s bold “Theoretical (inferred from mechanism)” sub-heading is the only marker of the second list’s status: no item carries “(theoretical)”, “inferred from” or a mechanism clause	🟢	No “(theoretical)” markers or mechanism clauses.
9.6	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.	🟢
9.7	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 kept (five- and four-item lists trimmed to three).
9.8	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	ER uses no ranking notation.
9.9	If the ER’s theoretical group is empty, the whole Theoretical block — the caution_theoretical span with its sub-heading and list — is hidden with style="display:none", not removed: its spans stay in place, empty.	N/A	ER theoretical group is not empty.
9.10	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 populated.
9.11	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, and the Theoretical block is hidden per 9.9. E.g.	N/A	Section is not empty.

10. Protocol

#	Description	Result	Comments
10.1	The section is derived from the ER Therapeutic Protocol section	🟢
10.2	The three sets of [action] items cover the three most important actionable implementation aspects from that section	🟢	Two longevity-relevant ear regimens (AF, older-adult autonomic) plus the High-evidence implanted epilepsy regimen.
10.3	If fewer than three distinct actionable implementation aspects are mentioned in the ER, the unused sets are left empty and hidden with style="display:none", not filled with placeholder text or empty-state phrasing.	N/A	ER offers more than three actionable aspects.
10.4	All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from that section.	🟢

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	🟢	AF 6 months, headache 30 minutes, RA 3 months from ER Practical Considerations.
11.2	The sets are picked and ordered by the magnitude of the related benefit	🟢	AF (85% lower burden) first, then headache, then RA.
11.3	If fewer than three distinct time-to-effect aspects are mentioned in the ER, the unused sets are left empty and hidden with style="display:none", not filled with placeholder text or empty-state phrasing.	N/A	ER gives at least three time-to-effect aspects.
11.4	All used [time_#label], [time#value], [time#_sub] items are filled with meaningful content derived from the ER.	🟢
11.5	If the ER provides no information on time to effect at all, the whole Time to effect block (its subhead and all three sets) is hidden with style="display:none", not removed: its spans stay in place, empty.	N/A	ER provides time-to-effect information.

12. Benefits

#	Description	Result	Comments
12.1	The section is derived from the ER Expected Benefits section	🟢	Tiers match ER: 1 High, 10 Medium, 7 Low, 2 Speculative.
12.2	Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative]	🟢
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.	🟢	Items are ER headings with flags removed.
12.4	Parenthetical content — including effect sizes, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢
12.5	If a tier (high, medium, low, speculative) has no items, its span is hidden with style="display:none", not filled with “None documented in human trials to date” or similar empty-state phrasing.	N/A	Every tier has items.

13. Risks

#	Description	Result	Comments
13.1	The section is derived from the ER Potential Risks & Side Effects section	🟢	Tiers match ER: 1 High, 2 Medium, 4 Low, 3 Speculative.
13.2	Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative]	🟢
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.	🟢
13.4	Parenthetical content — including frequencies, severity grades, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢
13.5	If a tier (high, medium, low, speculative) has no items, its span is hidden with style="display:none", not filled with “None documented in human trials to date” or similar empty-state phrasing.	N/A	Every tier has items.

14. Monitoring

#	Description	Result	Comments
14.1	The section is derived from the ER Monitoring Protocol & Defining Success section	🟢
14.2	All measurable/quantifiable biomarkers from that section are listed, one table row per marker; the template’s # row is the pattern, repeated with # replaced by 1, 2, 3 … in the data-qrs-var names	🟢	Resting heart rate, electrolytes, AHI from the ER table plus resting ECG and blood pressure from the section text.
14.3	[marker_#name] is the marker, [marker#target] its target value or range as given in the ER, [marker#_why] its purpose in a few words; a target the ER does not give is written “Not specified in the ER”	🟢	ECG and blood pressure targets correctly “Not specified in the ER”.
14.4	[monitoring_cadence] is populated with the monitoring cadence/frequency derived from that section. It is not left with placeholder text or empty.	🟢
14.5	If the ER names no measurable biomarker, the table is hidden with style="display:none" and the single # row is left as in the template	N/A	ER names measurable biomarkers.

15. Qualitative Assessment

#	Description	Result	Comments
15.1	The section is derived from the ER Monitoring Protocol & Defining Success section	🟢
15.2	All subjective/qualitative markers from that section are listed, one <li> per marker; the template’s # item is the pattern, repeated with # replaced by 1, 2, 3 …	🟢	All five ER qualitative markers listed.
15.3	If the ER names no qualitative marker, the card’s list is hidden with style="display:none" and the single # item is left as in the template	N/A	ER names qualitative markers.

Issues 11/10/2026 14:33

Pass rate 100.00%. No issues found.

Issues 11/10/2026 14:32

1. 2.7 — Jargon in contraindication content: The obstructive sleep apnea contraindication at line 554 reads “Higher risk of apneic events and aspiration with implanted stimulation”, keeping specialist terms where the ER offers plain wording (breathing pauses; inhaling food or fluid into the airways).

Fixes 11/10/2026 14:32

1. 2.7 — Plain wording in contraindication: Changed “apneic events and aspiration” to “breathing pauses and inhaling food or fluid into the airways” in the obstructive sleep apnea contraindication.

Issues 11/10/2026 14:27

1. 14.3 — Overlong marker purpose: marker_5_why at line 676 reads “Identifies groups in which neck non-invasive stimulation has not been evaluated” (11 words) rather than a purpose in a few words.

Fixes 11/10/2026 14:27

1. 14.3 — Overlong marker purpose: Shortened marker_5_why from “Identifies groups in which neck non-invasive stimulation has not been evaluated” to “Screening before neck non-invasive stimulation”, matching the ER’s “Before neck nVNS, a blood pressure and resting heart rate check”.

Issues 11/10/2026 14:24

1. 2.7 — Unexplained nVNS/VNS acronyms: “nVNS” (lines 550, 551, 566, 676, 683) and “VNS” (lines 548-549) are never expanded on the sheet; plain wording such as “neck non-invasive stimulation” or “implanted stimulation” would carry the same fact.

Fixes 11/10/2026 14:24

1. 2.7 — Unexplained acronyms replaced: Replaced “Implanted VNS” with “Implanted stimulation” (2 contraindications) and “neck nVNS” with “neck non-invasive stimulation” in two contraindications, the TENS interaction, marker_5_why and monitoring_cadence.

Issues 11/10/2026 14:20

1. 2.7 — Acronym in time label: time_1_label at line 489 reads “Lower AF burden”, an unexplained acronym plus clinical jargon that is not an ER bold label; the ER heading “Less time in atrial fibrillation” says the same in plain language.

Fixes 11/10/2026 14:20

1. 2.7 — Acronym in time label: Changed time_1_label from “Lower AF burden” to the ER heading “Less time in atrial fibrillation”.

Issues 11/10/2026 14:16

1. 7.2 — Lede summary incomplete: The at_a_glance span at line 439 names only epilepsy and stroke recovery as best-supported benefits, although the ER Conclusion also lists rheumatoid arthritis, headache relief and irregular heart rhythm, and it leaves out the Conclusion’s risk paragraph and evidence limits (industry funding, consumer devices rarely tested in approved forms).

Fixes 11/10/2026 14:16

1. 7.2 — Lede summary completed: Rewrote the at_a_glance span (70 words) to list all five disease-specific best-supported benefits from the ER Conclusion (epilepsy, stroke recovery, rheumatoid arthritis, headache, irregular heart rhythm) and to add implant surgical and voice risks and that makers fund most trials.

Issues 11/10/2026 14:11

1. 2.7 — Redundant jargon in sub: time_2_sub at line 506 reads “Cervical non-invasive neck stimulation”; “Cervical” is unnecessary jargon that merely repeats “neck”.
2. 4.5 — Untrimmed example lists: Theoretical interaction labels at lines 577–578 carry full example lists “(digoxin, verapamil, diltiazem, amiodarone, ivabradine)” and “(alprazolam, zolpidem, oxycodone, gabapentin)” on an already dense sheet.
3. 7.1 — Lede omits intended use: The at_a_glance opening sentence (line 439) says what the intervention is but not what it is used for before the evidence verdict.

Fixes 11/10/2026 14:11

1. 2.7 — Redundant jargon removed: Changed time_2_sub from “Cervical non-invasive neck stimulation” to “Non-invasive neck stimulation”.
2. 4.5 — Example lists trimmed: Trimmed the theoretical-interaction example lists to “(digoxin, verapamil, amiodarone)” and “(alprazolam, zolpidem, oxycodone)”.
3. 7.1 — Lede states intended use: Rewrote the at_a_glance opening to add “implants treat specific diseases, and ear devices are also sold for wellness” before the evidence verdict, keeping 70 words.