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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Primordial Pathophysiology Layer v0.1 Β· OAM-Governed Biological Degradation Mapping</title>
<style>
@import url('https://fonts.googleapis.com/css2?family=Instrument+Serif:ital@0;1&family=JetBrains+Mono:wght@300;400;600&family=Syne:wght@400;600;700&display=swap');

*{box-sizing:border-box;margin:0;padding:0}
:root{
  --bg:#f6f4ef;--bg2:#edeae2;--bg3:#e3dfd4;
  --ink:#181614;--ink2:#36302a;--ink3:#66584a;
  --rule:#cbc3b5;
  --cv:#7a1a1a;--cv-bg:rgba(122,26,26,.07);--cv-border:rgba(122,26,26,.25);
  --met:#1a5c6a;--met-bg:rgba(26,92,106,.07);--met-border:rgba(26,92,106,.25);
  --inf:#7a4e0a;--inf-bg:rgba(122,78,10,.07);--inf-border:rgba(122,78,10,.25);
  --ren:#4a6a1a;--ren-bg:rgba(74,106,26,.07);--ren-border:rgba(74,106,26,.25);
  --neu:#1a3a7a;--neu-bg:rgba(26,58,122,.07);--neu-border:rgba(26,58,122,.25);
  --oam:#5a2a7a;--oam-bg:rgba(90,42,122,.08);--oam-border:rgba(90,42,122,.28);
  --allow:#1a5c3a;--allow-bg:rgba(26,92,58,.07);--allow-border:rgba(26,92,58,.25);
  --caution:#7a6a0a;--caution-bg:rgba(122,106,10,.07);--caution-border:rgba(122,106,10,.25);
  --block:#6a1a1a;--block-bg:rgba(106,26,26,.07);--block-border:rgba(106,26,26,.25);
  --mono:'JetBrains Mono',monospace;--serif:'Instrument Serif',serif;--sans:'Syne',sans-serif;
}
html{background:var(--bg)}
body{background:var(--bg);color:var(--ink);font-family:var(--sans);font-size:14px;line-height:1.6;
     padding:40px 24px 80px;max-width:1140px;margin:0 auto}

.hdr{border-bottom:2px solid var(--ink);padding-bottom:20px;margin-bottom:26px}
.hdr-kicker{font-family:var(--mono);font-size:9px;letter-spacing:3px;color:var(--ink3);text-transform:uppercase;margin-bottom:8px}
.hdr-title{font-family:var(--serif);font-size:34px;line-height:1.1;color:var(--ink)}
.hdr-title em{font-style:italic;color:var(--oam)}
.hdr-sub{font-family:var(--mono);font-size:10px;color:var(--ink3);margin-top:6px;letter-spacing:1px;line-height:1.7}
.hdr-meta{display:flex;gap:10px;flex-wrap:wrap;margin-top:10px}
.hdr-chip{font-family:var(--mono);font-size:8px;padding:3px 10px;border:1px solid var(--rule);border-radius:2px;color:var(--ink3);letter-spacing:1.5px;text-transform:uppercase}

.invariant{border-left:3px solid var(--cv);background:var(--cv-bg);padding:10px 14px;margin-bottom:20px;font-family:var(--mono);font-size:9px;color:var(--cv);line-height:1.8}
.invariant strong{color:var(--ink);font-size:9.5px}

.layer-link{border:1px solid var(--oam-border);border-radius:3px;background:var(--oam-bg);padding:10px 14px;margin-bottom:20px;font-family:var(--mono);font-size:9px;color:var(--oam);line-height:1.7}
.layer-link strong{color:var(--ink)}

.section{margin-bottom:38px}
.section-num{font-family:var(--mono);font-size:9px;letter-spacing:2px;color:var(--ink3);text-transform:uppercase;margin-bottom:4px}
.section-title{font-family:var(--serif);font-size:24px;color:var(--ink);border-bottom:1px solid var(--rule);padding-bottom:8px;margin-bottom:14px}
.section-title em{font-style:italic}
.section-body{font-family:var(--sans);font-size:13.5px;color:var(--ink2);line-height:1.7;margin-bottom:12px}
.section-body p{margin-bottom:10px}

.div-rule{border:none;border-top:1px solid var(--rule);margin:32px 0}

/* TABLES */
table{width:100%;border-collapse:collapse;font-family:var(--mono);font-size:10.5px;margin:10px 0}
thead th{background:var(--bg3);border:1px solid var(--rule);padding:5px 9px;text-align:left;letter-spacing:1px;text-transform:uppercase;font-size:8.5px;color:var(--ink3);font-weight:600}
tbody td{border:1px solid var(--rule);padding:5px 9px;vertical-align:top;line-height:1.5}
tbody tr:hover td{background:var(--bg2)}
.td-key{color:var(--ink);font-weight:600}
.td-sm{font-size:9.5px}

/* CHIPS */
.chip{display:inline-block;font-family:var(--mono);font-size:8px;padding:1px 5px;border-radius:2px;margin:1px;letter-spacing:.5px;white-space:nowrap}
.ch-cv{background:var(--cv-bg);color:var(--cv);border:1px solid var(--cv-border)}
.ch-met{background:var(--met-bg);color:var(--met);border:1px solid var(--met-border)}
.ch-inf{background:var(--inf-bg);color:var(--inf);border:1px solid var(--inf-border)}
.ch-ren{background:var(--ren-bg);color:var(--ren);border:1px solid var(--ren-border)}
.ch-neu{background:var(--neu-bg);color:var(--neu);border:1px solid var(--neu-border)}
.ch-oam{background:var(--oam-bg);color:var(--oam);border:1px solid var(--oam-border)}
.ch-a{background:rgba(26,58,122,.08);color:var(--neu);border:1px solid var(--neu-border)}
.ch-b{background:rgba(122,26,26,.08);color:var(--cv);border:1px solid var(--cv-border)}
.ch-ok{background:var(--allow-bg);color:var(--allow);border:1px solid var(--allow-border)}
.ch-warn{background:var(--caution-bg);color:var(--caution);border:1px solid var(--caution-border)}
.ch-block{background:var(--block-bg);color:var(--block);border:1px solid var(--block-border)}

/* CODE / JSON */
pre{background:var(--bg3);border:1px solid var(--rule);border-radius:3px;padding:14px 16px;
    font-family:var(--mono);font-size:10.5px;line-height:1.7;overflow-x:auto;margin:10px 0;color:var(--ink2)}
pre .k{color:var(--neu);font-weight:600}
pre .v{color:var(--allow)}
pre .s{color:var(--inf)}
pre .c{color:var(--ink3);font-style:italic}
pre .e{color:var(--cv)}
pre .o{color:var(--oam)}

/* RULE BLOCKS */
.rule-block{border:1px solid;border-radius:3px;padding:10px 14px;margin:7px 0;font-family:var(--mono);font-size:10.5px;line-height:1.7}
.rb-allow{border-color:var(--allow-border);background:var(--allow-bg);color:var(--allow)}
.rb-caution{border-color:var(--caution-border);background:var(--caution-bg);color:var(--caution)}
.rb-block{border-color:var(--block-border);background:var(--block-bg);color:var(--block)}
.rb-label{font-size:8.5px;letter-spacing:2px;text-transform:uppercase;margin-bottom:4px;opacity:.85}
.rb-content{color:var(--ink2)}

/* OAM MAP */
.oam-grid{display:grid;grid-template-columns:repeat(3,1fr);gap:8px;margin:12px 0}
.oam-card{border:1px solid var(--oam-border);border-radius:3px;background:var(--oam-bg);padding:9px 11px}
.oam-var{font-family:var(--serif);font-size:20px;font-style:italic;color:var(--oam);line-height:1;margin-bottom:3px}
.oam-name{font-family:var(--mono);font-size:8.5px;font-weight:600;letter-spacing:1px;color:var(--ink);margin-bottom:4px;text-transform:uppercase}
.oam-bio{font-family:var(--mono);font-size:9px;color:var(--ink3);line-height:1.5}
.oam-eq{font-family:var(--mono);font-size:8.5px;color:var(--oam);margin-top:3px;font-style:italic}

/* PATHWAY CARDS */
.pathway-block{border:1px solid var(--rule);border-radius:4px;padding:10px 13px;margin-bottom:10px;background:var(--bg2)}
.pb-header{display:grid;grid-template-columns:auto 1fr auto;align-items:center;gap:10px;margin-bottom:7px}
.pb-id{font-family:var(--mono);font-size:9px;color:var(--ink3);letter-spacing:2px}
.pb-name{font-family:var(--sans);font-size:14px;font-weight:600;color:var(--ink)}
.pb-domain{font-family:var(--mono);font-size:8px;padding:2px 7px;border-radius:2px}
.pathway-chain{display:grid;grid-template-columns:repeat(6,1fr);gap:4px;margin:7px 0}
.pc-step{border:1px solid var(--rule);border-radius:3px;padding:5px 7px;background:var(--bg);font-family:var(--mono);font-size:8.5px;line-height:1.4}
.pc-label{font-size:7.5px;letter-spacing:1.5px;text-transform:uppercase;color:var(--ink3);display:block;margin-bottom:2px}
.pc-val{color:var(--ink);font-size:9px}
.pb-oam{font-family:var(--mono);font-size:9px;color:var(--oam);margin-top:6px;line-height:1.7;border-top:1px solid var(--rule);padding-top:6px}
.pb-uncertainty{font-family:var(--mono);font-size:8.5px;color:var(--ink3);margin-top:4px;line-height:1.6}
.pb-blocked{font-family:var(--mono);font-size:8.5px;color:var(--cv);margin-top:3px}

/* SAMPLE RECORDS */
.sample-record{border:1px solid var(--oam-border);border-radius:4px;padding:11px 13px;margin-bottom:12px;background:var(--bg2)}
.sr-header{font-family:var(--sans);font-size:13.5px;font-weight:600;color:var(--ink);margin-bottom:7px;display:flex;align-items:center;gap:8px}
.sr-id{font-family:var(--mono);font-size:8px;color:var(--oam);padding:2px 6px;border:1px solid var(--oam-border);border-radius:2px;letter-spacing:1px}

/* DOMAIN CARDS */
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<body>

<!-- ══ HEADER ══ -->
<div class="hdr">
  <div class="hdr-kicker">Primordial Architecture Series Β· Pathophysiology Layer Β· v0.1 Β· OAM-Governed</div>
  <div class="hdr-title">Primordial Pathophysiology Layer v0.1<br><em>Biological Degradation Mapping Under HIR Evidence Boundaries</em></div>
  <div class="hdr-sub">
    Pressure Source Β· System Strain Β· Degradation Pathway Β· Feedback Failure Β· Measurable Sign Β· Downstream Effect Β· Uncertainty Boundary<br>
    <strong>NOT diagnosis Β· NOT treatment recommendation Β· NOT clinical opinion Β· NOT individual risk assessment Β· Architecture planning document only</strong>
  </div>
  <div class="hdr-meta">
    <span class="hdr-chip">Created and Developed by Collin D. Weber</span>
    <span class="hdr-chip">April 30, 2026</span>
    <span class="hdr-chip">HIR Evidence Governance Β· OAM Degradation Engine</span>
    <span class="hdr-chip">Extends Brain + Biofeedback Layers</span>
  </div>
</div>

<!-- INVARIANT -->
<div class="invariant">
  <strong>Core Invariant (governing all outputs):</strong><br>
  Risk factor β‰  diagnosis. Symptom β‰  confirmed cause. Biomarker β‰  disease by itself. Single reading β‰  persistent condition. Population risk β‰  individual certainty. Wearable signal β‰  clinical diagnosis.<br>
  Unknown mechanism may not become hidden positive evidence. Measurement/provenance weakness may downgrade, suspend, or invalidate interpretation.<br>
  <strong>No treatment recommendation. No person-level blame, shame, morality, or character claim. No clinical opinion of any kind.</strong>
</div>

<!-- LAYER LINK -->
<div class="layer-link">
  <strong>Canonical source:</strong> Primordial Calculus / HIR Γ— OAM framework (project bundle). OAM variables used as defined in <code>primordial_os/hir/equations.py</code> and <code>primordial_os/hir/config.py</code>.<br>
  <strong>Inherited layers:</strong> Brain Layer v0.1 (BR, PW, OUT IDs) Β· Biofeedback Layer v0.1 (BF, BP signal/protocol IDs).<br>
  <strong>This layer adds:</strong> BD-01–08 (biological domains) Β· PP-01–17 (condition pathways) Β· PA/PB uncertainty classes Β· R-01–R-15 (pathophysiology rule set) Β· OAM degradation variable mapping to biological systems.
</div>

<!-- ════════════════════════════════════════════════════ -->
<!-- SECTION 1: SCOPE -->
<!-- ════════════════════════════════════════════════════ -->
<div class="section">
  <div class="section-num">Section 1</div>
  <div class="section-title">Scope and <em>Boundary Statement</em></div>
  <div class="section-body">
    <p>This layer maps common pathophysiological failure modes as structured degradation pathways using the OAM (Organismal Autonomy Model) as the degradation engine and HIR (Honesty, Integrity, Respect) as the evidence-governance boundary. Each condition is represented as a causal chain: pressure source β†’ system strain β†’ degradation pathway β†’ feedback failure β†’ measurable sign β†’ downstream effect β†’ uncertainty boundary.</p>
    <p>This is a biological architecture planning study. It is not a clinical tool, a diagnostic system, a risk-scoring instrument, a treatment protocol, or a medical opinion. It maps degradation mechanisms as they appear in the biomedical literature; it does not prescribe, diagnose, or predict outcomes for any individual.</p>
  </div>

  <table>
    <thead><tr><th>In scope</th><th>Out of scope</th></tr></thead>
    <tbody>
      <tr><td>Degradation pathway structure for common chronic conditions</td><td>Individual risk scores, diagnostic labels, prognosis</td></tr>
      <tr><td>OAM variable mapping (P, D, Θ, C, Ξ, S, U) onto biological mechanisms</td><td>Treatment recommendations, medication guidance</td></tr>
      <tr><td>HIR evidence boundary classification per pathway</td><td>Claims beyond declared evidence limits</td></tr>
      <tr><td>Measurement/provenance uncertainty per biomarker type</td><td>Wearable signals treated as clinical diagnoses</td></tr>
      <tr><td>Cascade pathways between biological systems (Ξ)</td><td>Person-level blame, moral inference, character claims</td></tr>
      <tr><td>Feedback failure identification (where repair mechanisms break)</td><td>Overclaiming mechanistic certainty where mechanisms are contested</td></tr>
    </tbody>
  </table>
</div>

<hr class="div-rule">

<!-- ════════════════════════════════════════════════════ -->
<!-- SECTION 2: HIR Γ— OAM RELATIONSHIP TABLE -->
<!-- ════════════════════════════════════════════════════ -->
<div class="section">
  <div class="section-num">Section 2</div>
  <div class="section-title">HIR Γ— OAM <em>Relationship Table</em></div>
  <div class="section-body">
    <p>HIR governs what evidence claims are permitted. OAM provides the mathematical structure for modeling degradation dynamics. Together they produce a bounded, auditable pathophysiology mapping engine.</p>
  </div>

  <table>
    <thead><tr><th>Layer</th><th>Variable / Gate</th><th>Pathophysiology Role</th><th>What it constrains or models</th></tr></thead>
    <tbody>
      <tr><td class="td-key">HIR β€” H</td><td class="td-sm">Honesty</td><td class="td-sm">Biomarker/signal fidelity</td><td class="td-sm">Label what is directly measured vs. inferred. Declare biomarker limitations, provenance, and unknown mechanisms. Unknown must remain unknown.</td></tr>
      <tr><td class="td-key">HIR β€” I</td><td class="td-sm">Integrity</td><td class="td-sm">Category coherence</td><td class="td-sm">Do not collapse: risk factor β‰  diagnosis; symptom β‰  cause; single reading β‰  condition; population β‰  individual; wearable β‰  clinical. Degradation pathways are not deterministic individual predictions.</td></tr>
      <tr><td class="td-key">HIR β€” R</td><td class="td-sm">Respect</td><td class="td-sm">Person-level protection</td><td class="td-sm">Block person-level blame, shame, capacity, moral, or character claims. No treatment recommendation. Outputs must protect the person from overclaiming.</td></tr>
      <tr><td colspan="4" style="background:var(--bg3);font-family:var(--mono);font-size:8px;color:var(--oam);letter-spacing:2px;padding:4px 9px">OAM β€” Degradation Engine (canonical equations: primordial_os/hir/equations.py)</td></tr>
      <tr><td class="td-key">OAM β€” P</td><td class="td-sm">Pressure Field<br><code>P = w_WΒ·W + w_FΒ·F + w_WFΒ·WF</code></td><td class="td-sm">Biological stressor load</td><td class="td-sm">W = acute stressor intensity (BP spike, glycemic load, inflammatory trigger). F = chronic background load (sustained HTN, low-grade inflammation, sleep fragmentation). WF = coupling between sustained and acute load.</td></tr>
      <tr><td class="td-key">OAM β€” B</td><td class="td-sm">Base Field<br><code>B = H+I+R+k(HI+HR+IR)</code></td><td class="td-sm">Biological homeostatic capacity</td><td class="td-sm">Integration of signal fidelity (H), structural integrity (I), and regulatory coherence (R) with interaction coupling k. Represents intact homeostatic reserve before pressure is applied.</td></tr>
      <tr><td class="td-key">OAM β€” S</td><td class="td-sm">Stability<br><code>S = A_auditΒ·B βˆ’ P</code></td><td class="td-sm">Physiological compensation</td><td class="td-sm">Homeostatic capacity minus pressure load. S > 0 = compensated (stable disease). S β†’ 0 = decompensating. S = 0 or negative = decompensated state requiring intervention.</td></tr>
      <tr><td class="td-key">OAM β€” U</td><td class="td-sm">Usable Autonomy<br><code>U = AΒ·BΒ·(1+g_GΒ·G)Β·F_int</code></td><td class="td-sm">Functional organ capacity</td><td class="td-sm">Actual functional capacity available: modulated by grit/reserve (G), intrinsic function (F_int), and homeostatic field. Declines as D accumulates and K (resistance) rises.</td></tr>
      <tr><td class="td-key">OAM β€” C</td><td class="td-sm">Carrier Density<br><code>C_{t+1} = C + Ξ±Β·E·Ξ·UΒ·(1βˆ’C) βˆ’ Ξ΄_CΒ·C</code></td><td class="td-sm">Biological reserve</td><td class="td-sm">Reserve capacity of the system: nephron mass, coronary flow reserve, hepatocyte reserve, Ξ²-cell mass, alveolar surface area. Decays at rate Ξ΄_C; replenishes via E (exposure to healing resources) Γ— Ξ Γ— U.</td></tr>
      <tr><td class="td-key">OAM β€” Θ</td><td class="td-sm">Repair Traction<br><code>Θ = Οƒ(Θ_base + ΞΈ_CΒ·C + ΞΈ_EΒ·E βˆ’ ΞΈ_KΒ·K)</code></td><td class="td-sm">Biological repair capacity</td><td class="td-sm">Repair sigmoid: rises with C (reserve) and E (healing resources), falls with K (resistance to repair β€” fibrosis, calcification, Ξ²-cell depletion). Θ_base = βˆ’1.0 (repair starts hard, requires overcoming basal friction).</td></tr>
      <tr><td class="td-key">OAM β€” K</td><td class="td-sm">Resistance<br>(config: K=0.3)</td><td class="td-sm">Biological resistance to repair</td><td class="td-sm">Structural resistance: arterial calcification, fibrosis, scar tissue, Ξ²-cell depletion, epigenetic changes in immune cells. Represents the biological friction that opposes normalization. Rises as degradation accumulates.</td></tr>
      <tr><td class="td-key">OAM β€” E</td><td class="td-sm">Exposure<br>(config: E=0.6)</td><td class="td-sm">Biological exposure surface</td><td class="td-sm">Endothelial surface exposed to dyslipidemia; nephrons exposed to pressure; hepatocytes exposed to fat; alveolar surface exposed to hypoxia. Also: exposure to repair resources (exercise, sleep, nutrition).</td></tr>
      <tr><td class="td-key">OAM β€” Ξ</td><td class="td-sm">Propagation<br><code>Ξ = Ξ_base + (ΟƒΒ·Ξž_unitΒ·Act_{tβˆ’Ο„})Β·Ξ›</code></td><td class="td-sm">Cascade between systems</td><td class="td-sm">How one degrading system drives degradation in another: HTN β†’ CKD β†’ cardiovascular β†’ metabolic cascade; inflammation β†’ insulin resistance β†’ MASLD. Trusted carriers = functional organ systems maintaining cascade propagation. Lambda (Ξ›) = cascade coupling strength.</td></tr>
      <tr><td class="td-key">OAM β€” Ξ”D</td><td class="td-sm">Degradation Reduction<br><code>Ξ”D = Ξ²Β·UΒ·CΒ·L_lifeΒ·R_sΒ·E·Θ</code></td><td class="td-sm">Biological repair rate</td><td class="td-sm">Rate at which biological repair reduces accumulated damage. High when U (function), C (reserve), L_life (life-supporting conditions), R_s (risk reduction), E (healing resources), and Θ (repair traction) are all elevated. Falls when any factor is depleted.</td></tr>
      <tr><td class="td-key">OAM β€” D</td><td class="td-sm">Cumulative Degradation<br><code>D_{t+1} = D_t + growth βˆ’ Ξ”D</code></td><td class="td-sm">Cumulative biological damage</td><td class="td-sm">Accumulated tissue damage: atherosclerotic plaque burden, fibrosis extent, nephron loss, Ξ²-cell depletion, hepatic fat accumulation. Grows at rate `growth_per_cycle` (0.05 default), reduced by Ξ”D. Floored at 0 (cannot be negative).</td></tr>
    </tbody>
  </table>
</div>

<hr class="div-rule">

<!-- ════════════════════════════════════════════════════ -->
<!-- SECTION 3: OAM DEGRADATION MODEL -->
<!-- ════════════════════════════════════════════════════ -->
<div class="section">
  <div class="section-num">Section 3</div>
  <div class="section-title">OAM <em>Degradation Model</em> Applied to Biology</div>
  <div class="section-body">
    <p>The OAM degradation cycle, as defined in the canonical runtime, maps onto biological pathophysiology as a sustained pressure-versus-repair dynamic. The key relationship: <strong>chronic disease occurs when P (biological pressure) persistently exceeds repair capacity (Θ Γ— C) over time, causing D (cumulative damage) to accumulate faster than Ξ”D (repair) can reduce it.</strong></p>
  </div>

  <div class="oam-grid">
    <div class="oam-card"><div class="oam-var">P</div><div class="oam-name">Biological Pressure</div><div class="oam-bio">Chronic stressor load: sustained hypertension, glycemic burden, inflammatory cytokine exposure, hypoxia, mechanical obesity load</div><div class="oam-eq">P = w_WΒ·W + w_FΒ·F + w_WFΒ·WF</div></div>
    <div class="oam-card"><div class="oam-var">S</div><div class="oam-name">Physiological Stability</div><div class="oam-bio">Compensated vs. decompensated: LV hypertrophy maintains output (compensated); falling EF marks decompensation. S = compensatory reserve βˆ’ pressure.</div><div class="oam-eq">S = AΒ·B βˆ’ P</div></div>
    <div class="oam-card"><div class="oam-var">U</div><div class="oam-name">Functional Organ Capacity</div><div class="oam-bio">GFR, cardiac output, hepatic synthetic function, pulmonary diffusion capacity, insulin secretory reserve β€” falls as D accumulates</div><div class="oam-eq">U = AΒ·BΒ·(1+g_GΒ·G)Β·F_int</div></div>
    <div class="oam-card"><div class="oam-var">C</div><div class="oam-name">Biological Reserve</div><div class="oam-bio">Nephron mass, coronary flow reserve, hepatocyte reserve, Ξ²-cell mass, alveolar surface area, endothelial progenitor pool</div><div class="oam-eq">C_{t+1} = C + Ξ±Β·E·Ξ·UΒ·(1βˆ’C) βˆ’ Ξ΄_CΒ·C</div></div>
    <div class="oam-card"><div class="oam-var">Θ</div><div class="oam-name">Repair Traction</div><div class="oam-bio">Endothelial progenitor mobilization, immune resolution (SPMs), Ξ²-cell regeneration potential, hepatic regeneration, autophagy, sleep-dependent repair</div><div class="oam-eq">Θ = Οƒ(Θ_base + ΞΈ_CΒ·C + ΞΈ_EΒ·E βˆ’ ΞΈ_KΒ·K)</div></div>
    <div class="oam-card"><div class="oam-var">K</div><div class="oam-name">Resistance to Repair</div><div class="oam-bio">Arterial calcification, fibrosis, Ξ²-cell depletion, adipose macrophage M1 polarization, epigenetic immune memory β€” biological friction opposing normalization</div><div class="oam-eq">K rises with D; depresses Θ</div></div>
    <div class="oam-card"><div class="oam-var">Ξ</div><div class="oam-name">Cascade Propagation</div><div class="oam-bio">HTNβ†’CKDβ†’CVD; insulin resistanceβ†’MASLDβ†’inflammation; sleep apneaβ†’HTNβ†’arrhythmia; metabolic syndromeβ†’multi-organ cascade</div><div class="oam-eq">Ξ = Ξ_base + (ΟƒΒ·Ξž_unitΒ·Act)Β·Ξ›</div></div>
    <div class="oam-card"><div class="oam-var">Ξ”D</div><div class="oam-name">Degradation Reduction</div><div class="oam-bio">Rate of biological repair: highest when U, C, L_life, R_s, E, and Θ are all elevated. Depressed by K, low sleep quality, malnutrition, chronic stress</div><div class="oam-eq">Ξ”D = Ξ²Β·UΒ·CΒ·L_lifeΒ·R_sΒ·E·Θ</div></div>
    <div class="oam-card"><div class="oam-var">D</div><div class="oam-name">Cumulative Damage</div><div class="oam-bio">Plaque burden, fibrosis extent, nephron loss, Ξ²-cell depletion, liver fat, left ventricular mass, arterial stiffness β€” accumulates when P > repair capacity sustained over time</div><div class="oam-eq">D_{t+1} = D_t + growth βˆ’ Ξ”D</div></div>
  </div>

  <div class="callout">
    <strong>The key OAM pathophysiology insight:</strong> Compensation (LV hypertrophy, nephron hyperfiltration, Ξ²-cell hypersecretion, collateral vessel formation) represents biological attempts to maintain S (stability) as P rises. Decompensation occurs when K (resistance) rises faster than Θ (repair) can compensate, Ξ”D falls below growth, and D accumulates to the point where U collapses. This is the OAM framing of chronic disease progression β€” not a clinical prediction, but a structural model of the degradation dynamics.
  </div>
</div>

<hr class="div-rule">

<!-- ════════════════════════════════════════════════════ -->
<!-- SECTION 4: BIOLOGICAL DOMAIN REGISTRY -->
<!-- ════════════════════════════════════════════════════ -->
<div class="section">
  <div class="section-num">Section 4</div>
  <div class="section-title">Biological <em>Domain Registry</em></div>

  <div class="domain-grid">
    <div class="domain-card" style="border-left:3px solid var(--cv)">
      <div class="dc-id">BD-01</div>
      <div class="dc-name">Cardiovascular</div>
      <div class="dc-body">Heart, arteries, veins, endothelium. OAM reserve C: coronary flow reserve, LV contractile reserve. Key degradation: atherosclerotic plaque, vascular stiffness, LV remodeling, fibrosis</div>
    </div>
    <div class="domain-card" style="border-left:3px solid var(--met)">
      <div class="dc-id">BD-02</div>
      <div class="dc-name">Metabolic</div>
      <div class="dc-body">Insulin signaling, glucose/lipid metabolism, adipose tissue regulation. OAM reserve C: Ξ²-cell mass, insulin secretory capacity. Key degradation: insulin resistance, Ξ²-cell exhaustion, ectopic fat</div>
    </div>
    <div class="domain-card" style="border-left:3px solid var(--inf)">
      <div class="dc-id">BD-03</div>
      <div class="dc-name">Inflammatory</div>
      <div class="dc-body">Systemic immune activation, inflammatory cytokines, resolution pathways. OAM Θ: SPM-mediated resolution, IL-10, regulatory T cells. Key degradation: endothelial activation, plaque destabilization</div>
    </div>
    <div class="domain-card" style="border-left:3px solid var(--ren)">
      <div class="dc-id">BD-04</div>
      <div class="dc-name">Renal</div>
      <div class="dc-body">Glomerular filtration, tubular function, RAAS, pressure autoregulation. OAM reserve C: nephron mass, GFR reserve. Key degradation: glomerulosclerosis, tubular atrophy, CKD progression</div>
    </div>
    <div class="domain-card" style="border-left:3px solid var(--neu)">
      <div class="dc-id">BD-05</div>
      <div class="dc-name">Neurological / Autonomic</div>
      <div class="dc-body">ANS (sympathetic/parasympathetic), HPA axis, chronic stress, sleep architecture. OAM W/F: SNS activation as workload and chronic fatigue. Key degradation: autonomic dysregulation, HRV↓</div>
    </div>
    <div class="domain-card" style="border-left:3px solid var(--oam)">
      <div class="dc-id">BD-06</div>
      <div class="dc-name">Respiratory / Oxygenation</div>
      <div class="dc-body">Airways, alveoli, gas exchange, sleep-related breathing. OAM P: hypoxic episodes as acute pressure; E: alveolar surface. Key degradation: hypoxia-reoxygenation injury, pulmonary fibrosis, Oβ‚‚ debt</div>
    </div>
    <div class="domain-card" style="border-left:3px solid var(--allow)">
      <div class="dc-id">BD-07</div>
      <div class="dc-name">Hepatic / Metabolic</div>
      <div class="dc-body">Lipid processing, gluconeogenesis, detoxification, bile synthesis. OAM reserve C: hepatocyte functional mass. Key degradation: hepatic steatosis, MASH, fibrosis, cirrhosis progression</div>
    </div>
    <div class="domain-card" style="border-left:3px solid var(--caution)">
      <div class="dc-id">BD-08</div>
      <div class="dc-name">Mechanical / Musculoskeletal</div>
      <div class="dc-body">Joint loading, spinal mechanics, adipose mechanical load, chronic pain. OAM K: fibrosis/degeneration resisting repair. Key degradation: cartilage loss, disc herniation, chronic pain sensitization</div>
    </div>
  </div>
</div>

<hr class="div-rule">

<!-- ════════════════════════════════════════════════════ -->
<!-- SECTION 5: CONDITION / FAILURE-MODE REGISTRY -->
<!-- ════════════════════════════════════════════════════ -->
<div class="section">
  <div class="section-num">Section 5</div>
  <div class="section-title">Condition / Failure-Mode <em>Registry</em></div>
  <div class="section-body">
    <p>Each condition is mapped as an OAM degradation pathway. The chain reads: pressure source β†’ system strain β†’ degradation pathway β†’ feedback failure β†’ measurable sign β†’ downstream effect. Uncertainty boundaries are stated for each. These pathways describe population-level biological mechanisms, not individual predictions.</p>
  </div>

  <!-- PP-01: Hypertension -->
  <div class="pathway-block">
    <div class="pb-header">
      <div class="pb-id">PP-01</div>
      <div class="pb-name">Systemic Hypertension</div>
      <span class="chip ch-cv">BD-01 Cardiovascular</span>
    </div>
    <div class="pathway-chain">
      <div class="pc-step"><span class="pc-label">Pressure Source</span><span class="pc-val">Elevated arterial pressure Β· SNS/RAAS activation Β· sodium retention Β· vascular stiffness Β· primary (mechanism largely unknown) or secondary</span></div>
      <div class="pc-step"><span class="pc-label">System Strain</span><span class="pc-val">Endothelial shear stress Β· vascular wall tension (law of Laplace) Β· cardiac afterload increase Β· renal filtration pressure</span></div>
      <div class="pc-step"><span class="pc-label">Degradation Pathway</span><span class="pc-val">Endothelial dysfunction Β· vascular wall remodeling/hypertrophy Β· left ventricular hypertrophy Β· glomerulosclerosis Β· microalbuminuria</span></div>
      <div class="pc-step"><span class="pc-label">Feedback Failure</span><span class="pc-val">Baroreceptor resetting at elevated set-point Β· RAAS perpetuation Β· endothelial NO↓ β†’ impaired vasodilation β†’ worsened HTN</span></div>
      <div class="pc-step"><span class="pc-label">Measurable Signs</span><span class="pc-val">BP readings Β· LV mass index Β· pulse wave velocity Β· microalbuminuria Β· fundoscopic changes</span></div>
      <div class="pc-step"><span class="pc-label">Downstream Effects</span><span class="pc-val">Stroke Β· MI Β· CKD Β· heart failure Β· hypertensive retinopathy Β· aortic dissection (risk)</span></div>
    </div>
    <div class="pb-oam"><strong>OAM mapping:</strong> P = sustained elevated MAP Γ— duration; K = baroreceptor resetting + arterial stiffness (resist normalization); D = LV mass + vascular remodeling + nephron loss; Θ = endothelial repair (depressed by chronic oxidative stress); C = vascular compliance reserve, nephron mass; Ξ β†’ BD-04 (renal cascade) + BD-01 (coronary).</div>
    <div class="pb-uncertainty"><strong>Uncertainty:</strong> <span class="chip ch-a">PA-01</span> Primary HTN mechanism unknown in most cases. <span class="chip ch-b">PB-01</span> Single reading insufficient β€” requires confirmed elevation across β‰₯2 separate occasions. <span class="chip ch-b">PB-02</span> White coat HTN / masked HTN confound; ambulatory monitoring needed. Individual target-organ response to equivalent pressure varies substantially (PA-02).</div>
    <div class="pb-blocked"><strong>HIR blocks:</strong> "You have hypertension" from a single wearable reading. Cause-of-damage claims without clinical correlation. Treatment recommendations. Capacity or character inferences.</div>
  </div>

  <!-- PP-02: Atherosclerosis -->
  <div class="pathway-block">
    <div class="pb-header">
      <div class="pb-id">PP-02</div>
      <div class="pb-name">Atherosclerosis</div>
      <span class="chip ch-cv">BD-01 Cardiovascular</span>
    </div>
    <div class="pathway-chain">
      <div class="pc-step"><span class="pc-label">Pressure Source</span><span class="pc-val">Oxidized LDL Β· endothelial shear stress at bifurcations Β· hyperglycemia Β· smoking Β· hypertension as co-driver</span></div>
      <div class="pc-step"><span class="pc-label">System Strain</span><span class="pc-val">Endothelial activation Β· monocyte recruitment β†’ macrophage foam cell formation Β· smooth muscle migration Β· intimal thickening</span></div>
      <div class="pc-step"><span class="pc-label">Degradation Pathway</span><span class="pc-val">Fatty streak β†’ fibrofatty plaque β†’ fibrous cap development β†’ lipid core growth β†’ potential calcification β†’ plaque instability risk</span></div>
      <div class="pc-step"><span class="pc-label">Feedback Failure</span><span class="pc-val">Endothelial NO↓ β†’ impaired vasodilation; plaque-derived inflammation amplifies endothelial dysfunction; HDL dysfunction impairs reverse cholesterol transport</span></div>
      <div class="pc-step"><span class="pc-label">Measurable Signs</span><span class="pc-val">LDL-C Β· hsCRP Β· coronary artery calcium (CAC) score Β· carotid intima-media thickness (CIMT) Β· ABI (peripheral)</span></div>
      <div class="pc-step"><span class="pc-label">Downstream Effects</span><span class="pc-val">ACS (unstable angina, NSTEMI, STEMI) Β· stroke Β· peripheral artery disease Β· sudden cardiac death (plaque rupture risk)</span></div>
    </div>
    <div class="pb-oam"><strong>OAM mapping:</strong> P = oxidized LDL burden Γ— time + inflammation + shear; K = calcification + dense fibrous cap (resist plaque modification); D = plaque volume + lipid core size; Θ = endothelial progenitor mobilization, reverse cholesterol transport; E = endothelial surface exposed to atherogenic milieu; C = coronary flow reserve, collateral development.</div>
    <div class="pb-uncertainty"><strong>Uncertainty:</strong> <span class="chip ch-a">PA-03</span> Plaque stability vs. size is not directly predictable from imaging alone. <span class="chip ch-a">PA-06</span> Threshold for plaque rupture risk is individual and multifactorial. <span class="chip ch-b">PB-03</span> LDL-C and hsCRP are non-specific; elevated values do not confirm atherosclerotic disease. CAC score is more specific but has device-exposure (radiation) tradeoff.</div>
    <div class="pb-blocked"><strong>HIR blocks:</strong> "Your LDL means you have blocked arteries." "Your hsCRP confirms plaque." Treatment direction. Statin or intervention recommendation of any kind.</div>
  </div>

  <!-- PP-03: CAD -->
  <div class="pathway-block">
    <div class="pb-header">
      <div class="pb-id">PP-03</div>
      <div class="pb-name">Coronary Artery Disease (CAD)</div>
      <span class="chip ch-cv">BD-01 Cardiovascular</span>
    </div>
    <div class="pathway-chain">
      <div class="pc-step"><span class="pc-label">Pressure Source</span><span class="pc-val">Advanced atherosclerosis (PP-02) + HTN (PP-01) + DM + smoking + dyslipidemia β€” typically multi-factor</span></div>
      <div class="pc-step"><span class="pc-label">System Strain</span><span class="pc-val">Epicardial coronary stenosis β†’ coronary flow reserve↓ β†’ myocardial oxygen supply-demand mismatch</span></div>
      <div class="pc-step"><span class="pc-label">Degradation Pathway</span><span class="pc-val">Stable ischemia β†’ recurrent supply-demand mismatch β†’ myocardial stunning/hibernation β†’ microvascular disease β†’ scar formation</span></div>
      <div class="pc-step"><span class="pc-label">Feedback Failure</span><span class="pc-val">Ischemia β†’ sympathetic activation β†’ demand↑ β†’ worsening ischemia; scar tissue replaces contractile myocardium; remodeling ↑ wall stress</span></div>
      <div class="pc-step"><span class="pc-label">Measurable Signs</span><span class="pc-val">Stress testing (ETT/imaging) Β· coronary angiography Β· CCTA Β· fractional flow reserve (FFR) Β· troponin (ACS context) Β· ECG</span></div>
      <div class="pc-step"><span class="pc-label">Downstream Effects</span><span class="pc-val">ACS Β· heart failure (PP-16) Β· arrhythmia (PP-15) Β· sudden cardiac death Β· reduced exercise tolerance</span></div>
    </div>
    <div class="pb-oam"><strong>OAM mapping:</strong> C = coronary flow reserve (direct: FFR, CFR measurements); D = scar burden + stenosis degree + microvascular damage; K = calcified stenosis (resist normalization), scar tissue; U = ejection fraction Γ— cardiac output capacity; Ξ β†’ PP-16 (heart failure), PP-15 (arrhythmia).</div>
    <div class="pb-uncertainty"><strong>Uncertainty:</strong> <span class="chip ch-a">PA-06</span> Symptom-flow correlation is imperfect; stenosis severity β‰  symptoms always. <span class="chip ch-b">PB-07</span> Comorbidity confound high. Microvascular disease is difficult to image and often underrecognized (PA-01).</div>
    <div class="pb-blocked"><strong>HIR blocks:</strong> ETT result β‰  angiographic confirmation. Non-invasive imaging alone cannot exclude significant disease in all presentations. No treatment recommendation.</div>
  </div>

  <!-- PP-04: Stroke -->
  <div class="pathway-block">
    <div class="pb-header">
      <div class="pb-id">PP-04</div>
      <div class="pb-name">Stroke Risk Pathways</div>
      <span class="chip ch-cv">BD-01 Cardiovascular</span> <span class="chip ch-neu">BD-05 Neurological</span>
    </div>
    <div class="pathway-chain">
      <div class="pc-step"><span class="pc-label">Pressure Source</span><span class="pc-val">HTN (strongest modifiable risk) Β· AFib β†’ cardioembolic Β· carotid atherosclerosis β†’ embolic Β· small vessel disease (lacunar) Β· coagulopathy</span></div>
      <div class="pc-step"><span class="pc-label">System Strain</span><span class="pc-val">Cerebrovascular shear stress Β· endothelial activation Β· atrial remodeling (Afib) Β· plaque/thrombus formation in carotid/intracranial</span></div>
      <div class="pc-step"><span class="pc-label">Degradation Pathway</span><span class="pc-val">TIA β†’ silent infarcts β†’ white matter changes (leukoaraiosis) β†’ symptomatic stroke; cerebral autoregulation loss with severe HTN</span></div>
      <div class="pc-step"><span class="pc-label">Feedback Failure</span><span class="pc-val">Ischemic penumbra: partial blood supply; reperfusion injury; cerebral edema post-ischemia; hemorrhagic transformation risk</span></div>
      <div class="pc-step"><span class="pc-label">Measurable Signs</span><span class="pc-val">NIHSS Β· MRI DWI Β· CTA Β· carotid ultrasound Β· ECG/Holter (AFib) Β· BP patterns Β· eGFR</span></div>
      <div class="pc-step"><span class="pc-label">Downstream Effects</span><span class="pc-val">Focal neurological deficits (function of territory) Β· cognitive impairment Β· vascular dementia risk Β· recurrent stroke risk</span></div>
    </div>
    <div class="pb-oam"><strong>OAM mapping:</strong> Multiple pressure sources (P = HTN + AFib + dyslipidemia) converge; Ξ = cardioembolic or artery-to-artery propagation; D = white matter lesion burden + infarct volume; C = collateral cerebral circulation; K = large-vessel calcification, established atrial fibrosis.</div>
    <div class="pb-uncertainty"><strong>Uncertainty:</strong> <span class="chip ch-a">PA-04</span> Mechanism type (embolic/thrombotic/lacunar/hemorrhagic) changes interpretation substantially. <span class="chip ch-b">PB-05</span> Clinical context is essential β€” stroke pathway without cardiology/neurology context cannot be interpreted.</div>
    <div class="pb-blocked"><strong>HIR blocks:</strong> Risk factor presence β‰  stroke prediction. No individual stroke probability from risk scores alone without full clinical workup.</div>
  </div>

  <!-- PP-05: Renal Vascular Strain -->
  <div class="pathway-block">
    <div class="pb-header">
      <div class="pb-id">PP-05</div>
      <div class="pb-name">Renal Vascular Strain / CKD Progression</div>
      <span class="chip ch-ren">BD-04 Renal</span>
    </div>
    <div class="pathway-chain">
      <div class="pc-step"><span class="pc-label">Pressure Source</span><span class="pc-val">HTN β†’ glomerular hypertension; DM β†’ hyperglycemia-driven glomerular hyperfiltration; AKI episodes; NSAIDs/nephrotoxins</span></div>
      <div class="pc-step"><span class="pc-label">System Strain</span><span class="pc-val">Afferent arteriole + glomerular wall stress; proteinuria-driven tubular toxicity; endothelial dysfunction in renal microvasculature</span></div>
      <div class="pc-step"><span class="pc-label">Degradation Pathway</span><span class="pc-val">Glomerulosclerosis β†’ nephron loss β†’ hyperfiltration in remaining nephrons β†’ maladaptive hypertrophy β†’ further sclerosis (vicious cycle)</span></div>
      <div class="pc-step"><span class="pc-label">Feedback Failure</span><span class="pc-val">Remaining nephrons hyperfiltrate (compensate) β†’ accelerated damage; RAAS activation β†’ systemic and intra-renal pressure ↑; anemia (EPO↓) β†’ reduced oxygen delivery β†’ tubular ischemia</span></div>
      <div class="pc-step"><span class="pc-label">Measurable Signs</span><span class="pc-val">eGFR (trend) Β· urine ACR Β· serum creatinine Β· potassium Β· hemoglobin Β· BP patterns</span></div>
      <div class="pc-step"><span class="pc-label">Downstream Effects</span><span class="pc-val">CKD G3β†’G4β†’G5 progression Β· ESRD risk Β· cardiovascular mortality amplification Β· anemia Β· metabolic acidosis Β· mineral bone disease</span></div>
    </div>
    <div class="pb-oam"><strong>OAM mapping:</strong> C = nephron mass (declining); D = glomerulosclerosis extent; K = established glomerular scarring (irreversible); Ξ = CKD β†’ cardiovascular risk amplification; U = GFR; Θ = podocyte repair, endothelial progenitors (depressed in CKD).</div>
    <div class="pb-uncertainty"><strong>Uncertainty:</strong> <span class="chip ch-b">PB-01</span> Single eGFR insufficient for staging; requires repeat measurements β‰₯ 3 months apart. eGFR equations have population-specific limitations (PA-02).</div>
    <div class="pb-blocked"><strong>HIR blocks:</strong> Single creatinine β‰  CKD staging. eGFR formula assumptions may not apply to all individuals.</div>
  </div>

  <!-- PP-06: Insulin Resistance -->
  <div class="pathway-block">
    <div class="pb-header">
      <div class="pb-id">PP-06</div>
      <div class="pb-name">Insulin Resistance</div>
      <span class="chip ch-met">BD-02 Metabolic</span>
    </div>
    <div class="pathway-chain">
      <div class="pc-step"><span class="pc-label">Pressure Source</span><span class="pc-val">Chronic caloric excess Β· visceral adipose dysfunction (adipokine dysregulation) Β· sedentary pattern Β· sleep disruption Β· chronic inflammation from adipokines</span></div>
      <div class="pc-step"><span class="pc-label">System Strain</span><span class="pc-val">GLUT4 translocation impairment in skeletal muscle Β· pancreatic Ξ²-cell hypersecretion (compensation) Β· hepatic glucose production dysregulation Β· adipose lipolysis excess</span></div>
      <div class="pc-step"><span class="pc-label">Degradation Pathway</span><span class="pc-val">Compensated IR β†’ impaired fasting glucose / impaired glucose tolerance β†’ Ξ²-cell exhaustion β†’ progressive hyperglycemia β†’ AGE accumulation β†’ end-organ effects</span></div>
      <div class="pc-step"><span class="pc-label">Feedback Failure</span><span class="pc-val">Ectopic fat (intramyocellular, hepatic) β†’ ceramide accumulation β†’ insulin signaling block; adiponectin ↓; leptin resistance; oxidative stress perpetuates IR</span></div>
      <div class="pc-step"><span class="pc-label">Measurable Signs</span><span class="pc-val">Fasting glucose Β· HbA1c Β· fasting insulin (calculated HOMA-IR proxy) Β· TG/HDL ratio Β· waist circumference</span></div>
      <div class="pc-step"><span class="pc-label">Downstream Effects</span><span class="pc-val">T2DM progression Β· MASLD (PP-13) Β· cardiovascular risk ↑ Β· CKD (PP-05) Β· neuropathy Β· retinopathy (with prolonged hyperglycemia)</span></div>
    </div>
    <div class="pb-oam"><strong>OAM mapping:</strong> C = Ξ²-cell secretory reserve (declining with progression); K = ectopic fat, ceramide accumulation (resist insulin sensitization); Θ = exercise-induced GLUT4 upregulation, GLP-1 signaling; D = Ξ²-cell depletion + AGE burden + end-organ damage; Ξ β†’ MASLD (PP-13), cardiovascular cascade (PP-02).</div>
    <div class="pb-uncertainty"><strong>Uncertainty:</strong> <span class="chip ch-b">PB-03</span> HOMA-IR is a calculated proxy β€” not a direct insulin resistance measurement; significant individual variation. HbA1c has limitations in hemoglobin variants, anemia, chronic kidney disease. <span class="chip ch-a">PA-02</span> High inter-individual variation in glucose handling at equivalent adiposity.</div>
    <div class="pb-blocked"><strong>HIR blocks:</strong> "Your fasting glucose means you have insulin resistance." HOMA-IR β‰  confirmed diagnosis. Waist circumference is a population-level proxy, not an individual metabolic measure. No dietary/medication recommendation.</div>
  </div>

  <!-- PP-07: Metabolic Syndrome -->
  <div class="pathway-block">
    <div class="pb-header">
      <div class="pb-id">PP-07</div>
      <div class="pb-name">Metabolic Syndrome</div>
      <span class="chip ch-met">BD-02 Metabolic</span> <span class="chip ch-cv">BD-01 Cardiovascular</span>
    </div>
    <div class="pathway-chain">
      <div class="pc-step"><span class="pc-label">Pressure Source</span><span class="pc-val">Convergence of: central adiposity + insulin resistance + dyslipidemia (TG↑, HDL↓) + hypertension + dysglycemia β€” co-occurring pressure fields</span></div>
      <div class="pc-step"><span class="pc-label">System Strain</span><span class="pc-val">Multi-domain simultaneous strain: cardiovascular (PP-01), metabolic (PP-06), inflammatory (PP-08), hepatic (PP-13) β€” cascading simultaneously</span></div>
      <div class="pc-step"><span class="pc-label">Degradation Pathway</span><span class="pc-val">Each domain (BD-01 through BD-03 and BD-07) degrades simultaneously; Ξ between them amplifies total degradation rate</span></div>
      <div class="pc-step"><span class="pc-label">Feedback Failure</span><span class="pc-val">Each component worsens others: IR β†’ dyslipidemia β†’ inflammation β†’ endothelial dysfunction β†’ HTN β†’ IR; multi-system feedback loops</span></div>
      <div class="pc-step"><span class="pc-label">Measurable Signs</span><span class="pc-val">Waist circumference Β· BP Β· TG Β· HDL-C Β· fasting glucose (three of five criteria per IDF/AHA/NHLBI thresholds)</span></div>
      <div class="pc-step"><span class="pc-label">Downstream Effects</span><span class="pc-val">T2DM risk ↑↑ Β· cardiovascular event risk ↑ Β· MASLD Β· sleep apnea amplification Β· CKD risk</span></div>
    </div>
    <div class="pb-oam"><strong>OAM mapping:</strong> P = sum of multiple simultaneous pressure fields; Ξ = high cascade coupling between domains (Ξ› elevated); S = total stability = multi-domain B minus total P; simultaneous degradation across D in BD-01, BD-02, BD-03, BD-07.</div>
    <div class="pb-uncertainty"><strong>Uncertainty:</strong> <span class="chip ch-b">PB-08</span> Diagnostic thresholds for metabolic syndrome vary across guideline bodies (IDF vs. AHA/NHLBI vs. WHO β€” different waist cut-offs). Population reference ranges ethnicity-specific. <span class="chip ch-a">PA-04</span> No single dominant mechanism β€” metabolic syndrome is a syndrome definition, not a single disease entity.</div>
    <div class="pb-blocked"><strong>HIR blocks:</strong> "Metabolic syndrome" is a syndrome cluster, not a single disease. Criteria met β‰  any specific component is clinically severe. No individual outcome prediction.</div>
  </div>

  <!-- PP-08: Chronic Inflammation -->
  <div class="pathway-block">
    <div class="pb-header">
      <div class="pb-id">PP-08</div>
      <div class="pb-name">Chronic Low-Grade Inflammation</div>
      <span class="chip ch-inf">BD-03 Inflammatory</span>
    </div>
    <div class="pathway-chain">
      <div class="pc-step"><span class="pc-label">Pressure Source</span><span class="pc-val">Visceral adipose (adipokine secretion: TNF-Ξ±, IL-6, leptin) Β· gut dysbiosis Β· psychosocial chronic stress β†’ HPA/SNS β†’ IL-6 ↑ Β· environmental pollutants Β· chronic infection</span></div>
      <div class="pc-step"><span class="pc-label">System Strain</span><span class="pc-val">Sustained low-level cytokine exposure Β· endothelial activation (ICAM-1, E-selectin) Β· NF-ΞΊB pathway activation Β· coagulation system activation (fibrinogen ↑)</span></div>
      <div class="pc-step"><span class="pc-label">Degradation Pathway</span><span class="pc-val">Endothelial dysfunction Β· plaque destabilization (PP-02 amplification) Β· insulin signaling impairment (PP-06 amplification) Β· tissue damage via oxidative stress</span></div>
      <div class="pc-step"><span class="pc-label">Feedback Failure</span><span class="pc-val">NF-ΞΊB β†’ perpetuates pro-inflammatory cytokine production; adipose M1 macrophage polarization persists; impaired SPM (specialized pro-resolving mediator) production limits resolution</span></div>
      <div class="pc-step"><span class="pc-label">Measurable Signs</span><span class="pc-val">hsCRP Β· ESR Β· IL-6 Β· fibrinogen Β· WBC count β€” all non-specific to cause or source</span></div>
      <div class="pc-step"><span class="pc-label">Downstream Effects</span><span class="pc-val">Cardiovascular risk amplification Β· T2DM progression Β· MASLD contribution Β· plaque destabilization Β· cognitive risk (long-term, mechanism uncertain)</span></div>
    </div>
    <div class="pb-oam"><strong>OAM mapping:</strong> P = adipokine + cytokine burden (F-dominant: chronic, sustained); Θ = SPM-mediated resolution capacity (depressed in chronic inflammation); K = M1 macrophage epigenetic programming + metabolic endotoxemia (resist resolution); Ξ β†’ amplifies PP-02, PP-06, PP-13 simultaneously.</div>
    <div class="pb-uncertainty"><strong>Uncertainty:</strong> <span class="chip ch-b">PB-03</span> Inflammation markers are highly non-specific β€” hsCRP elevated in infection, autoimmune, trauma, obesity, smoking; cannot determine source from value alone. <span class="chip ch-a">PA-01</span> Mechanism of "chronic low-grade inflammation" and its precise role in specific disease pathways is incompletely characterized. <span class="chip ch-a">PA-07</span> Interaction with other pathways complex and bidirectional.</div>
    <div class="pb-blocked"><strong>HIR blocks:</strong> "Your hsCRP means you have chronic inflammation." Source of elevation cannot be determined from value. No causal inference from single elevated marker.</div>
  </div>

  <!-- PP-09 through PP-17 compact registry -->
  <table style="margin-top:14px">
    <thead><tr><th>ID</th><th>Condition</th><th>Domain</th><th>Key OAM pressure</th><th>Key degradation</th><th>Measurable sign</th><th>Key HIR block</th></tr></thead>
    <tbody>
      <tr>
        <td class="td-key">PP-09</td><td class="td-sm">Endothelial Dysfunction</td>
        <td><span class="chip ch-cv">BD-01</span></td>
        <td class="td-sm">Oxidative stress Β· low NO bioavailability Β· inflammatory cytokines Β· hyperglycemia; F-dominant pressure</td>
        <td class="td-sm">Reduced flow-mediated dilation; impaired vasodilation β†’ downstream perfusion↓; permissive for PP-02</td>
        <td class="td-sm">FMD (research tool) Β· biomarkers (non-specific)</td>
        <td class="td-sm">No direct wearable signal for endothelial function. <span class="rv">FMD is a research measure, not clinical standard</span></td>
      </tr>
      <tr>
        <td class="td-key">PP-10</td><td class="td-sm">Sleep Apnea-Related Strain</td>
        <td><span class="chip ch-oam">BD-05/06</span></td>
        <td class="td-sm">Intermittent hypoxia (W: acute) + chronic sleep fragmentation (F) + SNS surges; intrathoracic pressure swings</td>
        <td class="td-sm">Endothelial dysfunction; atrial remodeling (PP-15 risk); nocturnal HTN; sympathetic hyperactivation; metabolic dysregulation</td>
        <td class="td-sm">AHI Β· SpO2 nadir Β· time below 88% Β· BP nocturnal dipping loss</td>
        <td class="td-sm">Home sleep test β‰  full PSG in many cases. AHI alone β‰  clinical severity. Wearable SpO2 not equivalent to polysomnographic oximetry.</td>
      </tr>
      <tr>
        <td class="td-key">PP-11</td><td class="td-sm">Chronic Stress / Autonomic Load</td>
        <td><span class="chip ch-neu">BD-05</span></td>
        <td class="td-sm">Sustained HPA activation (cortisol F) + SNS surge W; psychosocial stressors β†’ glucocorticoid + catecholamine excess</td>
        <td class="td-sm">HRV↓ Β· HTN contribution Β· visceral fat accumulation Β· immune dysregulation Β· sleep architecture disruption</td>
        <td class="td-sm">HRV metrics Β· cortisol (AM) Β· BP Β· subjective stress measures</td>
        <td class="td-sm">HRV is a cardiac metric, not a direct brain measurement (from BF Layer). Cortisol is context-sensitive; single measurement insufficient.</td>
      </tr>
      <tr>
        <td class="td-key">PP-12</td><td class="td-sm">Obesity-Related Strain</td>
        <td><span class="chip ch-met">BD-02</span> <span class="chip ch-cv">BD-01</span> <span class="chip ch-oam">BD-08</span></td>
        <td class="td-sm">Mechanical (joint, spinal loading) + metabolic (visceral adipose, adipokines) + respiratory (upper airway narrowing) pressure β€” multi-domain simultaneous P</td>
        <td class="td-sm">Osteoarthritis acceleration Β· sleep apnea (PP-10) Β· insulin resistance (PP-06) Β· cardiovascular risk Β· MASLD (PP-13)</td>
        <td class="td-sm">BMI Β· waist circumference Β· adiposity measures</td>
        <td class="td-sm">BMI is a population-level statistical measure; poor individual predictor of metabolic health or risk. No weight-related shame claim permitted.</td>
      </tr>
      <tr>
        <td class="td-key">PP-13</td><td class="td-sm">Fatty Liver Pathway (MASLD)</td>
        <td><span class="chip ch-met">BD-07</span></td>
        <td class="td-sm">Caloric excess β†’ hepatic lipid overflow (W); insulin resistance β†’ FFA excess delivery to liver (F); fructose overload; gut-derived LPS (endotoxemia)</td>
        <td class="td-sm">Hepatic steatosis β†’ MASH (inflammation) β†’ fibrosis β†’ cirrhosis risk; hepatic insulin resistance amplifies systemic IR</td>
        <td class="td-sm">Liver enzymes (ALT/AST, non-specific) Β· hepatic steatosis index Β· FIB-4 Β· elastography</td>
        <td class="td-sm">Elevated ALT β‰  MASLD without imaging. Liver enzymes are non-specific to etiology. <span class="rv">REVIEW_REQUIRED for non-invasive fibrosis staging thresholds</span></td>
      </tr>
      <tr>
        <td class="td-key">PP-14</td><td class="td-sm">Respiratory / Oxygenation Impairment</td>
        <td><span class="chip ch-oam">BD-06</span></td>
        <td class="td-sm">Airway obstruction (structural or inflammatory) Β· alveolar damage Β· pulmonary vascular resistance Β· ventilation-perfusion mismatch</td>
        <td class="td-sm">Hypoxemia β†’ multi-organ demand; hypercapnia β†’ acidosis; pulmonary hypertension β†’ RV strain; impaired exercise capacity</td>
        <td class="td-sm">SpO2 (resting + exertional) Β· spirometry Β· ABG Β· 6MWD Β· DLCO</td>
        <td class="td-sm">Wearable SpO2 at rest is not equivalent to exertional SpO2. Spirometry requires technique validation. Single SpO2 reading β‰  chronic impairment.</td>
      </tr>
      <tr>
        <td class="td-key">PP-15</td><td class="td-sm">Arrhythmia Risk Pathways</td>
        <td><span class="chip ch-cv">BD-01</span> <span class="chip ch-neu">BD-05</span></td>
        <td class="td-sm">Atrial remodeling (PP-10, HTN, CAD) Β· electrolyte disturbance Β· autonomic dysregulation Β· ischemia β†’ re-entry substrate Β· genetic channelopathy</td>
        <td class="td-sm">Atrial fibrosis β†’ AFib substrate; QT prolongation β†’ VF risk; ischemia β†’ re-entry circuits; autonomic β†’ triggered activity</td>
        <td class="td-sm">ECG Β· Holter Β· cardiac event monitor Β· electrolytes Β· echocardiography Β· BNP</td>
        <td class="td-sm">Wearable ECG single-lead β‰  12-lead clinical ECG. Wearable AFib detection: sensitivity/specificity depends on device and algorithm β€” not equivalent to Holter.</td>
      </tr>
      <tr>
        <td class="td-key">PP-16</td><td class="td-sm">Heart Failure Progression</td>
        <td><span class="chip ch-cv">BD-01</span></td>
        <td class="td-sm">Advanced CAD (PP-03) + HTN (PP-01) + DM + arrhythmia β†’ progressive LV dysfunction; P = volume/pressure overload</td>
        <td class="td-sm">Neurohormonal activation (RAAS, SNS) β†’ maladaptive remodeling; cardiomyocyte loss; fibrosis ↑; HFrEF or HFpEF phenotype</td>
        <td class="td-sm">LVEF Β· BNP/NT-proBNP Β· 6MWD Β· functional class Β· diuretic requirement</td>
        <td class="td-sm">LVEF is a single-modality measure with significant inter-observer and modality variation. BNP elevated in obesity, AF, CKD independently. <span class="rv">REVIEW_REQUIRED for HFpEF diagnostic criteria evolution</span></td>
      </tr>
      <tr>
        <td class="td-key">PP-17</td><td class="td-sm">Chronic Pain / Injury Feedback Loops</td>
        <td><span class="chip ch-oam">BD-08</span> <span class="chip ch-neu">BD-05</span></td>
        <td class="td-sm">Tissue injury β†’ peripheral sensitization β†’ central sensitization β†’ allodynia/hyperalgesia β†’ pain behavior β†’ reduced activity β†’ deconditioning β†’ increased vulnerability</td>
        <td class="td-sm">Nociceptive pathway sensitization; HPA activation; sleep disruption amplifying pain; social/psychological comorbidity; medication effects</td>
        <td class="td-sm">Pain scales (subjective) Β· functional capacity measures Β· sleep quality Β· psychological measures</td>
        <td class="td-sm">Pain is subjective β€” pain scale β‰  objective nociception. "Pain behavior" must not be used to question legitimacy of experience. No character inference from pain report.</td>
      </tr>
    </tbody>
  </table>
</div>

<hr class="div-rule">

<!-- ════════════════════════════════════════════════════ -->
<!-- SECTION 6: MEASUREMENT / PROVENANCE MODEL -->
<!-- ════════════════════════════════════════════════════ -->
<div class="section">
  <div class="section-num">Section 6</div>
  <div class="section-title">Measurement / <em>Provenance Model</em></div>

  <table>
    <thead><tr><th>Measurement Type</th><th>What it directly produces</th><th>Key limitations</th><th>Default uncertainty</th></tr></thead>
    <tbody>
      <tr><td class="td-key">Clinical BP (office)</td><td class="td-sm">Auscultatory or oscillometric arterial pressure at a moment in time</td><td class="td-sm">White coat effect; masked HTN; position/arm; single reading insufficient; requires β‰₯2 separate occasions</td><td><span class="chip ch-b">PB-01</span> <span class="chip ch-b">PB-02</span></td></tr>
      <tr><td class="td-key">Wearable BP / cuffless</td><td class="td-sm">Oscillometric or pulse transit time estimate of blood pressure</td><td class="td-sm">Not validated as clinical standard in most devices; accuracy varies by device, individual, arm position, arrhythmia; cannot diagnose HTN</td><td><span class="chip ch-b">PB-04</span> <span class="chip ch-b">PB-01</span></td></tr>
      <tr><td class="td-key">Fasting lipid panel</td><td class="td-sm">Serum concentrations of TC, LDL-C, HDL-C, TG at blood draw time</td><td class="td-sm">LDL-C is calculated in most labs (Friedewald equation, inaccurate at high TG); acute illness, diet, medication alter values; non-fasting affects TG</td><td><span class="chip ch-b">PB-03</span> <span class="chip ch-b">PB-06</span></td></tr>
      <tr><td class="td-key">HbA1c</td><td class="td-sm">% of glycated hemoglobin reflecting ~3-month average glucose exposure</td><td class="td-sm">Altered by hemoglobin variants (HbS, HbC), hemolysis, iron deficiency, CKD, transfusion; not equivalent across all populations; reflects average, not variability</td><td><span class="chip ch-b">PB-08</span> <span class="chip ch-b">PB-07</span></td></tr>
      <tr><td class="td-key">hsCRP</td><td class="td-sm">Serum C-reactive protein concentration (high-sensitivity assay)</td><td class="td-sm">Non-specific acute phase reactant; elevated in infection, trauma, autoimmune, obesity, smoking; cannot identify source; single value limited</td><td><span class="chip ch-b">PB-03</span> <span class="chip ch-b">PB-01</span></td></tr>
      <tr><td class="td-key">eGFR (calculated)</td><td class="td-sm">Estimated glomerular filtration rate from serum creatinine (+/- cystatin C) + demographic inputs</td><td class="td-sm">Equation-dependent; muscle mass confounds creatinine; CKD staging requires β‰₯3 months confirmed; cystatin C more accurate in certain populations</td><td><span class="chip ch-b">PB-01</span> <span class="chip ch-b">PB-08</span></td></tr>
      <tr><td class="td-key">Wearable heart rate</td><td class="td-sm">Inter-beat interval from PPG or optical sensor at wrist/finger</td><td class="td-sm">Not equivalent to ECG; motion artifact; poor accuracy in arrhythmia (AFib); pigmentation affects optical accuracy; no waveform morphology</td><td><span class="chip ch-b">PB-04</span> <span class="chip ch-b">PB-09</span></td></tr>
      <tr><td class="td-key">Wearable SpO2</td><td class="td-sm">Estimated oxygen saturation from pulse oximetry at peripheral site</td><td class="td-sm">Not calibrated for clinical use in most consumer devices; skin pigmentation affects accuracy; nail polish, cold extremities, motion artifact; not equivalent to arterial blood gas</td><td><span class="chip ch-b">PB-04</span></td></tr>
      <tr><td class="td-key">Wearable ECG (single lead)</td><td class="td-sm">Single-lead rhythm strip; can detect rate and some rhythm</td><td class="td-sm">Not equivalent to 12-lead; cannot evaluate ST segments, axis, QRS morphology, or most ischemia patterns; AFib detection sensitivity/specificity device-dependent</td><td><span class="chip ch-b">PB-04</span></td></tr>
      <tr><td class="td-key">Wearable sleep staging</td><td class="td-sm">Accelerometer/PPG-derived estimate of sleep stages</td><td class="td-sm">Not equivalent to polysomnography; significantly less accurate for N1/N2 discrimination; REM detection variable; cannot detect sleep apnea events</td><td><span class="chip ch-b">PB-04</span> <span class="chip ch-b">PB-05</span></td></tr>
      <tr><td class="td-key">Liver enzymes (ALT/AST)</td><td class="td-sm">Serum transaminase concentrations reflecting hepatocellular injury</td><td class="td-sm">Non-specific β€” elevated in alcohol, MASLD, medications, muscle injury, celiac, thyroid; normal values do not exclude liver disease; significant inter-lab variation</td><td><span class="chip ch-b">PB-03</span> <span class="chip ch-b">PB-07</span></td></tr>
      <tr><td class="td-key">Self-report scales</td><td class="td-sm">Subjective ratings by the person (pain, fatigue, stress, mood)</td><td class="td-sm">Subjective by design; affected by recall bias, social desirability, scale interpretation; not convertible to objective biological measures without validation in that context</td><td><span class="chip ch-b">PB-05</span></td></tr>
    </tbody>
  </table>
</div>

<hr class="div-rule">

<!-- ════════════════════════════════════════════════════ -->
<!-- SECTION 7: DEGRADATION UNCERTAINTY TAXONOMY -->
<!-- ════════════════════════════════════════════════════ -->
<div class="section">
  <div class="section-num">Section 7</div>
  <div class="section-title">Degradation <em>Uncertainty Taxonomy</em></div>

  <div class="unc-grid">
    <div class="unc-card uc-a">
      <div class="unc-title" style="color:var(--neu)">Category PA β€” Pathophysiological Unresolvedness</div>
      <div style="font-family:var(--mono);font-size:9.5px;color:var(--ink3);line-height:1.6">Unknowns arising from the biology itself β€” mechanism incompletely characterized, individual variation, compensatory states, pathway interactions. Does NOT automatically invalidate observation. May NOT become positive evidence.</div>
    </div>
    <div class="unc-card uc-b">
      <div class="unc-title" style="color:var(--cv)">Category PB β€” Measurement / Provenance Unresolvedness</div>
      <div style="font-family:var(--mono);font-size:9.5px;color:var(--ink3);line-height:1.6">Unknowns arising from data quality, provenance, or clinical context limitations. MAY downgrade, suspend, or invalidate interpretation. Hard override if severe. May NOT become positive evidence.</div>
    </div>
  </div>

  <table>
    <thead><tr><th>Class ID</th><th>Class</th><th>Cat.</th><th>Effect</th><th>May suspend?</th><th>May raise confidence?</th></tr></thead>
    <tbody>
      <tr><td class="td-key">PA-01</td><td class="td-sm">mechanism_incompletely_characterized</td><td><span class="chip ch-a">PA</span></td><td class="td-sm">Biological mechanism producing observed degradation is not fully established; known associations do not equal confirmed mechanism</td><td>No</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PA-02</td><td class="td-sm">individual_pathway_variation_high</td><td><span class="chip ch-a">PA</span></td><td class="td-sm">Group-level degradation pathway does not apply uniformly; individual variation in progression rate, threshold, and target-organ response is substantial</td><td>No</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PA-03</td><td class="td-sm">compensation_state_unknown</td><td><span class="chip ch-a">PA</span></td><td class="td-sm">Whether system is compensated (stable with elevated D) or decompensating cannot be determined from single-time-point data; requires longitudinal context</td><td>Conditional</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PA-04</td><td class="td-sm">multi_domain_cascade_active</td><td><span class="chip ch-a">PA</span></td><td class="td-sm">Degradation propagating across multiple biological domains simultaneously; attribution to single condition inappropriate; Ξ coupling complicates isolation</td><td>No</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PA-05</td><td class="td-sm">progression_rate_individual_unknown</td><td><span class="chip ch-a">PA</span></td><td class="td-sm">Rate of D accumulation for this individual is unknown; population-level trajectories do not determine individual timeline</td><td>No</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PA-06</td><td class="td-sm">threshold_effect_unresolved</td><td><span class="chip ch-a">PA</span></td><td class="td-sm">The pressure or degradation threshold beyond which decompensation occurs is individual-specific and not predictable from current data</td><td>No</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PA-07</td><td class="td-sm">interaction_effects_complex</td><td><span class="chip ch-a">PA</span></td><td class="td-sm">Interaction between co-morbid conditions (PP-07, metabolic syndrome) is non-linear and bidirectional; single-condition framing is incomplete</td><td>No</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr style="background:var(--bg2)"><td colspan="6" style="font-family:var(--mono);font-size:8px;color:var(--cv);padding:4px 9px;letter-spacing:1px">CATEGORY PB β€” MEASUREMENT / PROVENANCE</td></tr>
      <tr><td class="td-key">PB-01</td><td class="td-sm">single_measurement_insufficient</td><td><span class="chip ch-b">PB</span></td><td class="td-sm">Single reading (BP, glucose, biomarker) insufficient to establish a persistent pattern; repeated confirmed measurements required per clinical standards</td><td>Yes</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PB-02</td><td class="td-sm">situational_or_white_coat_effect</td><td><span class="chip ch-b">PB</span></td><td class="td-sm">Reading may reflect situational state (white coat HTN, anxiety-driven glucose spike, post-exercise) rather than persistent condition; ambulatory/home monitoring needed</td><td>Yes</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PB-03</td><td class="td-sm">biomarker_nonspecific</td><td><span class="chip ch-b">PB</span></td><td class="td-sm">Biomarker elevation has multiple possible causes; elevated value cannot be attributed to specific condition without clinical context and differential</td><td>Conditional</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PB-04</td><td class="td-sm">wearable_not_clinically_validated</td><td><span class="chip ch-b">PB</span></td><td class="td-sm">Consumer wearable signal (HR, SpO2, ECG, BP, sleep) does not meet clinical standard; accuracy claims depend on device, population, and validation study context</td><td>Yes β€” may not support clinical interpretation</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PB-05</td><td class="td-sm">missing_clinical_context</td><td><span class="chip ch-b">PB</span></td><td class="td-sm">No clinical referral question, examination findings, medication list, or differential diagnosis provided; interpretation without clinical context cannot be validated</td><td>Yes</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PB-06</td><td class="td-sm">medication_effects_undocumented</td><td><span class="chip ch-b">PB</span></td><td class="td-sm">Medications that alter biomarker values (statins β†’ LDL, beta-blockers β†’ HR, diuretics β†’ electrolytes) not documented; biomarker interpretation unreliable</td><td>Yes</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PB-07</td><td class="td-sm">comorbidity_confound</td><td><span class="chip ch-b">PB</span></td><td class="td-sm">Comorbid condition (CKD, anemia, obesity, liver disease) alters biomarker expected values or interpretation; standard reference ranges may not apply</td><td>Conditional</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PB-08</td><td class="td-sm">population_reference_mismatch</td><td><span class="chip ch-b">PB</span></td><td class="td-sm">Reference ranges or diagnostic thresholds derived from different population; ethnicity, age, sex, or body composition of index population differs from guideline source</td><td>Conditional</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PB-09</td><td class="td-sm">provenance_or_chain_unverified</td><td><span class="chip ch-b">PB</span></td><td class="td-sm">Source, collection conditions, lab accreditation, or chain of custody cannot be confirmed; results unreliable</td><td>Yes β€” hard override</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
      <tr><td class="td-key">PB-10</td><td class="td-sm">technical_error_suspected</td><td><span class="chip ch-b">PB</span></td><td class="td-sm">Result implausible given clinical context; possible hemolysis, lipemia, calibration failure, sample mix-up; requires repeat before interpretation</td><td>Yes β€” hard override</td><td style="color:var(--cv);font-weight:600">Never</td></tr>
    </tbody>
  </table>
</div>

<hr class="div-rule">

<!-- ════════════════════════════════════════════════════ -->
<!-- SECTION 8: TYPED SCHEMA -->
<!-- ════════════════════════════════════════════════════ -->
<div class="section">
  <div class="section-num">Section 8</div>
  <div class="section-title">Typed JSON-Style <em>Schema β€” Degradation Pathway Record</em></div>

  <pre><span class="c">// Pathophysiology degradation pathway record β€” Primordial Pathophysiology Layer v0.1</span>
{
  <span class="c">// --- Identity ---</span>
  <span class="k">"record_id"</span>:                    <span class="s">"string  // unique record ID"</span>,
  <span class="k">"condition_id"</span>:                 <span class="s">"enum    // PP-01 through PP-17"</span>,
  <span class="k">"condition_name"</span>:               <span class="s">"string"</span>,
  <span class="k">"biological_domain"</span>:            <span class="s">"enum[]  // BD-01 through BD-08"</span>,
  <span class="k">"created_at"</span>:                   <span class="s">"ISO8601"</span>,
  <span class="k">"schema_version"</span>:               <span class="s">"string"</span>,

  <span class="c">// --- OAM Pathway Variables ---</span>
  <span class="o">"oam_pressure_source"</span>:          <span class="s">"string  // W (acute stressor) and F (chronic load) components described"</span>,
  <span class="o">"oam_system_strain"</span>:            <span class="s">"string  // how P manifests as tissue/organ strain"</span>,
  <span class="o">"oam_degradation_pathway"</span>:      <span class="s">"string  // mechanism by which D accumulates"</span>,
  <span class="o">"oam_feedback_failure"</span>:         <span class="s">"string  // where repair (Θ) breaks down or K rises"</span>,
  <span class="o">"oam_cascade_targets"</span>:          <span class="s">"enum[]  // PP IDs that receive Ξ propagation from this condition"</span>,
  <span class="o">"oam_P_estimate"</span>:               <span class="s">"enum    // low | moderate | high | very_high | unknown"</span>,
  <span class="o">"oam_D_estimate"</span>:               <span class="s">"enum    // none | mild | moderate | severe | unknown"</span>,
  <span class="o">"oam_Theta_estimate"</span>:           <span class="s">"enum    // high | moderate | low | depleted | unknown"</span>,
  <span class="o">"oam_C_estimate"</span>:               <span class="s">"enum    // preserved | reduced | significantly_reduced | unknown"</span>,
  <span class="o">"oam_K_estimate"</span>:               <span class="s">"enum    // low | moderate | high | unknown  // resistance to repair"</span>,
  <span class="o">"oam_compensation_state"</span>:       <span class="s">"enum    // compensated | decompensating | decompensated | unknown"</span>,

  <span class="c">// --- Measurable Signs ---</span>
  <span class="k">"measurable_signs"</span>: [
    {
      <span class="k">"sign_id"</span>:                  <span class="s">"string"</span>,
      <span class="k">"measurement_type"</span>:         <span class="s">"enum    // clinical_bp | lab_biomarker | wearable | imaging | exam | functional_test | self_report"</span>,
      <span class="k">"measurement_label"</span>:        <span class="s">"string  // e.g. hsCRP, eGFR, LVEF, SpO2"</span>,
      <span class="k">"what_it_directly_measures"</span>: <span class="s">"string  // NOT what it is claimed to represent"</span>,
      <span class="k">"uncertainty_classes"</span>:       <span class="s">"enum[]  // PB-01 through PB-10 active for this sign"</span>,
      <span class="k">"single_value_sufficient"</span>:   <span class="s">"bool   // false = PB-01 applies; repeat required"</span>,
      <span class="k">"wearable_not_clinical_std"</span>: <span class="s">"bool   // true = PB-04 applies"</span>
    }
  ],

  <span class="c">// --- Downstream Effects ---</span>
  <span class="k">"downstream_effects"</span>:           <span class="s">"string[]  // described as risks or associated pathways, not predictions"</span>,
  <span class="k">"cascade_pathway_ids"</span>:          <span class="s">"enum[]  // PP IDs downstream via Ξ"</span>,

  <span class="c">// --- Pathophysiological Uncertainty (Category PA) ---</span>
  <span class="k">"path_unknown_class"</span>:           <span class="s">"enum[]  // PA-01 through PA-07 | none"</span>,
  <span class="k">"mechanism_status"</span>:             <span class="s">"enum    // well_characterized | partially_characterized | contested | unknown"</span>,

  <span class="c">// --- Measurement / Provenance Uncertainty (Category PB) ---</span>
  <span class="k">"measurement_unknown_class"</span>:    <span class="s">"enum[]  // PB-01 through PB-10 | none"</span>,
  <span class="k">"provenance_class"</span>:             <span class="s">"enum    // verified | partially_documented | unverified"</span>,
  <span class="k">"hard_override_triggered"</span>:      <span class="e">"bool   // true = PB failure sufficient to invalidate interpretation"</span>,

  <span class="c">// --- HIR Claims Governance ---</span>
  <span class="k">"hir_inference_allowed"</span>:        <span class="s">"bool   // DEFAULT false. true only if PA none + PB none + provenance verified + repeated measures confirmed"</span>,
  <span class="k">"claims_permitted"</span>:             <span class="s">"string[]  // what may be stated, bounded to evidence"</span>,
  <span class="k">"claims_blocked"</span>:               <span class="e">"string[]  // explicit list of overclaims blocked for this record"</span>,
  <span class="k">"person_level_claim_blocked"</span>:   <span class="e">"bool   // ALWAYS true β€” R gate active unconditionally"</span>,
  <span class="k">"treatment_recommendation"</span>:     <span class="e">"bool   // ALWAYS false β€” never produced by this system"</span>,
  <span class="k">"diagnosis_label"</span>:              <span class="e">"bool   // ALWAYS false β€” never produced without validated clinical context"</span>,

  <span class="c">// --- Interpretation Status ---</span>
  <span class="k">"interpretation_status"</span>:        <span class="s">"enum    // valid | caution | suspended | invalidated"</span>,
  <span class="k">"notes"</span>:                        <span class="s">"string[]"</span>,
  <span class="k">"source_needed"</span>:                <span class="s">"string[]  // any items requiring SOURCE_NEEDED or REVIEW_REQUIRED"</span>
}</pre>
</div>

<hr class="div-rule">

<!-- ════════════════════════════════════════════════════ -->
<!-- SECTION 9: HIR/OAM RULE SET -->
<!-- ════════════════════════════════════════════════════ -->
<div class="section">
  <div class="section-num">Section 9</div>
  <div class="section-title">HIR / OAM <em>Rule Set</em> β€” R-01 through R-15</div>

  <div class="rule-block rb-block">
    <div class="rb-label">R-01 β€” Risk factor β‰  diagnosis</div>
    <div class="rb-content">The presence of any pressure source (W or F in OAM terms), risk factor, or elevated biomarker does not establish a clinical diagnosis. A risk factor shifts population-level probability. It does not confirm the condition in an individual. Claims_permitted may describe the risk factor as present; claims_blocked must include the corresponding diagnosis label unless validated clinical context exists.</div>
  </div>

  <div class="rule-block rb-block">
    <div class="rb-label">R-02 β€” Symptom β‰  confirmed cause</div>
    <div class="rb-content">An observed symptom, sign, or biomarker may be associated with multiple conditions. Attribution to a specific degradation pathway requires clinical differential evaluation. PB-03 (biomarker nonspecific) applies by default to all non-imaging, non-biopsy biomarker values. Symptom alone cannot confirm OAM degradation domain or mechanism.</div>
  </div>

  <div class="rule-block rb-block">
    <div class="rb-label">R-03 β€” Biomarker β‰  disease by itself</div>
    <div class="rb-content">A biomarker value (hsCRP, LDL-C, ALT, eGFR, HbA1c, BNP, troponin, fasting glucose) provides evidence about a biological state at a moment in time. It does not confirm the presence, severity, or stage of a disease without: repeated measurement (when indicated), clinical context, differential exclusion, and qualified clinical interpretation. PB-01, PB-03, and PB-07 apply by default.</div>
  </div>

  <div class="rule-block rb-block">
    <div class="rb-label">R-04 β€” Single reading β‰  persistent condition</div>
    <div class="rb-content">Blood pressure, fasting glucose, eGFR, and most biomarkers require confirmed repeated elevation across β‰₯2 separate occasions (per relevant clinical guidelines) before a persistent condition can be inferred. Single-time-point data triggers PB-01 and limits interpretation_status to "caution" or lower. A single wearable reading is never sufficient for condition inference.</div>
  </div>

  <div class="rule-block rb-block">
    <div class="rb-label">R-05 β€” Population risk β‰  individual certainty</div>
    <div class="rb-content">Relative and absolute risk estimates derived from epidemiological cohort data describe population-level probabilities. They do not determine outcomes for any individual. PA-02 (individual pathway variation) applies to all population-level risk claims. "Your 10-year cardiovascular risk is X%" is a population-derived estimate, not a personal prediction.</div>
  </div>

  <div class="rule-block rb-block">
    <div class="rb-label">R-06 β€” Wearable signal β‰  clinical diagnosis</div>
    <div class="rb-content">Consumer wearable outputs (heart rate, SpO2, single-lead ECG, sleep stage estimates, cuffless BP, HRV) do not meet the accuracy, calibration, or validation standards required for clinical diagnosis. PB-04 applies to all wearable-derived values. A wearable flag may indicate a signal warranting clinical evaluation β€” it does not confirm the condition flagged. interpretation_status for wearable-only records may not exceed "caution."</div>
  </div>

  <div class="rule-block rb-block">
    <div class="rb-label">R-07 β€” Unknown mechanism may not become hidden positive evidence</div>
    <div class="rb-content">Where PA-01 (mechanism_incompletely_characterized) is active, the unknown mechanism is a limit on inference, not a space that can be filled with assumed positive claims. An incompletely understood degradation pathway does not support extended inferences about disease severity, progression, or individual outcomes. Uncertainty preserves possibility space β€” it does not fill it.</div>
  </div>

  <div class="rule-block rb-caution">
    <div class="rb-label">R-08 β€” Measurement weakness may downgrade, suspend, or invalidate interpretation</div>
    <div class="rb-content">PB-01 through PB-10: each class has a defined effect on interpretation_status. PB-09 and PB-10 trigger hard_override_triggered = true and interpretation_status = invalidated. PB-04 alone caps at "caution." Missing clinical context (PB-05) triggers "suspended." Provenance failure (PB-09) triggers "invalidated." No compensation or averaging across PB classes is permitted β€” the most severe active class governs.</div>
  </div>

  <div class="rule-block rb-block">
    <div class="rb-label">R-09 β€” No treatment recommendation</div>
    <div class="rb-content">This system produces architecture, pathway mappings, and bounded interpretations. It does not produce treatment recommendations, medication suggestions, lifestyle prescriptions, or referral decisions. treatment_recommendation = false is a non-negotiable field default. Any output that implies treatment direction is architecturally invalid.</div>
  </div>

  <div class="rule-block rb-block">
    <div class="rb-label">R-10 β€” No person-level blame, shame, morality, or character claim</div>
    <div class="rb-content">No degradation pathway, biomarker value, or condition classification may be used to infer a person's character, moral worth, willpower, effort, discipline, or capacity. Obesity-related pathways (PP-12) may not produce moral inference. Chronic pain (PP-17) may not produce legitimacy questioning. Metabolic syndrome (PP-07) may not produce lifestyle-blame framing. person_level_claim_blocked = true is unconditional and cannot be overridden.</div>
  </div>

  <div class="rule-block rb-caution">
    <div class="rb-label">R-11 β€” Degradation pathways are probabilistic population models, not individual predictions</div>
    <div class="rb-content">Every condition pathway (PP-01 through PP-17) describes mechanisms and associations as observed in population studies. Individual trajectories may differ substantially due to genetic variation, unmeasured protective factors, medication effects, and non-linear dynamics (PA-02, PA-05, PA-06). The OAM degradation model provides a structured mapping of known mechanisms β€” it does not predict individual disease progression.</div>
  </div>

  <div class="rule-block rb-caution">
    <div class="rb-label">R-12 β€” Compensation state must be assessed, not assumed</div>
    <div class="rb-content">OAM stability S = AΒ·B βˆ’ P. A system may have elevated D (degradation) while remaining compensated (S > 0). Conversely, a system with moderate D may be rapidly decompensating if P is rising and Θ is depleted. Compensation state (PA-03) must be explicitly evaluated from longitudinal data β€” it cannot be assumed from cross-sectional biomarker values. "Stable" and "normal" are not equivalent.</div>
  </div>

  <div class="rule-block rb-block">
    <div class="rb-label">R-13 β€” Multi-system cascade requires multi-system validation</div>
    <div class="rb-content">When OAM propagation Ξ is active (PA-04: multi-domain cascade), the downstream condition claim requires its own independent evidence. Confirming PP-06 (insulin resistance) does not automatically confirm PP-13 (MASLD) without independent hepatic evidence. Each downstream condition in the Ξ cascade must meet its own measurement and provenance standards.</div>
  </div>

  <div class="rule-block rb-caution">
    <div class="rb-label">R-14 β€” OAM pressure Γ— time does not confirm damage without direct measurement</div>
    <div class="rb-content">Even if OAM pressure P is estimated as high and duration is long, cumulative degradation D cannot be assumed β€” it must be measured or observed. Biological compensation (G, C reserve) may have partially offset D accumulation. Repair mechanisms (Θ) may be unexpectedly intact. The OAM model describes the mechanism of damage accumulation; it does not replace direct measurement of damage state.</div>
  </div>

  <div class="rule-block rb-block">
    <div class="rb-label">R-15 β€” OAM feedback failure identification does not confirm irreversibility</div>
    <div class="rb-content">Identifying that repair is failing (Θ falling, K rising) describes the current dynamic state β€” it does not confirm irreversibility. Biological systems have demonstrated unexpected recovery in some contexts (hepatic steatosis regression, cardiac remodeling reversal, nephron compensatory response). K (resistance to repair) may be high without being absolute. Irreversibility claims require direct longitudinal evidence, not OAM pathway inference alone.</div>
  </div>
</div>

<hr class="div-rule">

<!-- ════════════════════════════════════════════════════ -->
<!-- SECTION 10: FIVE SAMPLE RECORDS -->
<!-- ════════════════════════════════════════════════════ -->
<div class="section">
  <div class="section-num">Section 10</div>
  <div class="section-title">Five <em>Sample Records</em></div>

  <!-- SAMPLE 1: Hypertension -->
  <div class="sample-record">
    <div class="sr-header"><span class="sr-id">PP-01</span>Hypertension β€” Sample Record</div>
    <pre><span class="c">// Sample record β€” confirmed sustained HTN pathway</span>
{
  <span class="k">"condition_id"</span>: <span class="s">"PP-01"</span>, <span class="k">"biological_domain"</span>: [<span class="s">"BD-01"</span>],
  <span class="o">"oam_pressure_source"</span>: <span class="s">"W: acute SNS surges, exertion spikes; F: sustained elevated MAP, RAAS activation, sodium retention"</span>,
  <span class="o">"oam_system_strain"</span>: <span class="s">"Endothelial shear stress; LV afterload increase; renal glomerular pressure; arteriolar remodeling"</span>,
  <span class="o">"oam_degradation_pathway"</span>: <span class="s">"Endothelial dysfunction β†’ vascular hypertrophy β†’ LV mass ↑ β†’ glomerulosclerosis β†’ microalbuminuria"</span>,
  <span class="o">"oam_feedback_failure"</span>: <span class="s">"Baroreceptor resetting at elevated setpoint; endothelial NO↓ β†’ impaired vasodilation β†’ worsened HTN; RAAS perpetuation"</span>,
  <span class="o">"oam_P_estimate"</span>: <span class="s">"high"</span>, <span class="o">"oam_D_estimate"</span>: <span class="s">"mild_to_moderate"</span>,
  <span class="o">"oam_Theta_estimate"</span>: <span class="s">"moderate β€” depressed by chronic oxidative stress"</span>,
  <span class="o">"oam_K_estimate"</span>: <span class="s">"moderate β€” baroreceptor resetting, arterial stiffening resist normalization"</span>,
  <span class="o">"oam_compensation_state"</span>: <span class="s">"compensated β€” LV hypertrophy maintaining output; state unknown without echo"</span>,
  <span class="o">"oam_cascade_targets"</span>: [<span class="s">"PP-03"</span>, <span class="s">"PP-04"</span>, <span class="s">"PP-05"</span>, <span class="s">"PP-15"</span>, <span class="s">"PP-16"</span>],
  <span class="k">"measurable_signs"</span>: [
    { <span class="k">"sign"</span>: <span class="s">"BP readings"</span>, <span class="k">"uncertainty"</span>: [<span class="s">"PB-01"</span>, <span class="s">"PB-02"</span>], <span class="k">"single_value_sufficient"</span>: <span class="v">false</span> },
    { <span class="k">"sign"</span>: <span class="s">"Wearable BP"</span>, <span class="k">"uncertainty"</span>: [<span class="s">"PB-04"</span>], <span class="k">"wearable_not_clinical_std"</span>: <span class="v">true</span> }
  ],
  <span class="k">"path_unknown_class"</span>: [<span class="s">"PA-01"</span>, <span class="s">"PA-02"</span>],
  <span class="k">"mechanism_status"</span>: <span class="s">"partially_characterized β€” primary HTN mechanism unknown in ~90% of cases"</span>,
  <span class="k">"claims_permitted"</span>: [<span class="s">"BP readings above thresholds noted"</span>, <span class="s">"sustained elevation requires confirmation"</span>, <span class="s">"downstream organ strain is plausible if sustained"</span>],
  <span class="e">"claims_blocked"</span>: [<span class="s">"Single wearable reading = hypertension diagnosis"</span>, <span class="s">"Confirmed organ damage without measurement"</span>, <span class="s">"Treatment recommendation of any kind"</span>],
  <span class="e">"person_level_claim_blocked"</span>: <span class="v">true</span>, <span class="e">"treatment_recommendation"</span>: <span class="v">false</span>, <span class="e">"diagnosis_label"</span>: <span class="v">false</span>,
  <span class="k">"interpretation_status"</span>: <span class="s">"caution β€” sustained elevation requires confirmed repeated measurements + clinical evaluation"</span>
}</pre>
  </div>

  <!-- SAMPLE 2: Atherosclerosis -->
  <div class="sample-record">
    <div class="sr-header"><span class="sr-id">PP-02</span>Atherosclerosis β€” Sample Record</div>
    <pre>{
  <span class="k">"condition_id"</span>: <span class="s">"PP-02"</span>, <span class="k">"biological_domain"</span>: [<span class="s">"BD-01"</span>, <span class="s">"BD-03"</span>],
  <span class="o">"oam_pressure_source"</span>: <span class="s">"W: oxidized LDL load, inflammatory triggers; F: chronic dyslipidemia, endothelial shear at bifurcations, sustained hyperglycemia"</span>,
  <span class="o">"oam_degradation_pathway"</span>: <span class="s">"LDL oxidation β†’ endothelial activation β†’ monocyte recruitment β†’ foam cell β†’ fatty streak β†’ fibrous plaque β†’ potential calcification"</span>,
  <span class="o">"oam_feedback_failure"</span>: <span class="s">"Endothelial NO↓ β†’ impaired vasodilation; plaque-driven inflammation amplifies endothelial dysfunction; HDL dysfunction impairs reverse cholesterol transport"</span>,
  <span class="o">"oam_K_estimate"</span>: <span class="s">"high when calcified plaques present β€” calcification resists modification"</span>,
  <span class="o">"oam_Theta_estimate"</span>: <span class="s">"reduced β€” endothelial progenitor mobilization impaired by chronic oxidative stress"</span>,
  <span class="o">"oam_cascade_targets"</span>: [<span class="s">"PP-03"</span>, <span class="s">"PP-04"</span>, <span class="s">"PP-09"</span>],
  <span class="k">"measurable_signs"</span>: [
    { <span class="k">"sign"</span>: <span class="s">"LDL-C"</span>, <span class="k">"uncertainty"</span>: [<span class="s">"PB-03"</span>, <span class="s">"PB-06"</span>], <span class="k">"what_it_measures"</span>: <span class="s">"serum LDL cholesterol concentration β€” not plaque burden directly"</span> },
    { <span class="k">"sign"</span>: <span class="s">"hsCRP"</span>, <span class="k">"uncertainty"</span>: [<span class="s">"PB-03"</span>], <span class="k">"what_it_measures"</span>: <span class="s">"non-specific acute phase reactant β€” cannot confirm atherosclerotic inflammation specifically"</span> },
    { <span class="k">"sign"</span>: <span class="s">"CAC score"</span>, <span class="k">"uncertainty"</span>: [<span class="s">"PB-05"</span>], <span class="k">"what_it_measures"</span>: <span class="s">"coronary calcium burden β€” more specific for established atherosclerosis; does not assess non-calcified plaque or stability"</span> }
  ],
  <span class="k">"path_unknown_class"</span>: [<span class="s">"PA-03"</span>, <span class="s">"PA-06"</span>],
  <span class="k">"mechanism_status"</span>: <span class="s">"well_characterized at plaque formation level; plaque stability and rupture prediction remains incompletely characterized"</span>,
  <span class="e">"claims_blocked"</span>: [<span class="s">"Elevated LDL = blocked arteries"</span>, <span class="s">"hsCRP confirms plaque"</span>, <span class="s">"Plaque size = rupture risk"</span>, <span class="s">"Any treatment direction"</span>],
  <span class="e">"person_level_claim_blocked"</span>: <span class="v">true</span>, <span class="k">"interpretation_status"</span>: <span class="s">"caution"</span>
}</pre>
  </div>

  <!-- SAMPLE 3: Insulin Resistance -->
  <div class="sample-record">
    <div class="sr-header"><span class="sr-id">PP-06</span>Insulin Resistance β€” Sample Record</div>
    <pre>{
  <span class="k">"condition_id"</span>: <span class="s">"PP-06"</span>, <span class="k">"biological_domain"</span>: [<span class="s">"BD-02"</span>, <span class="s">"BD-03"</span>],
  <span class="o">"oam_pressure_source"</span>: <span class="s">"W: glycemic/FFA spikes; F: chronic caloric excess, visceral adipose adipokine secretion, sleep disruption, sedentary pattern"</span>,
  <span class="o">"oam_degradation_pathway"</span>: <span class="s">"GLUT4 signaling impairment β†’ Ξ²-cell hypersecretion (compensation) β†’ ectopic fat accumulation β†’ ceramide β†’ Ξ²-cell exhaustion β†’ progressive hyperglycemia"</span>,
  <span class="o">"oam_feedback_failure"</span>: <span class="s">"Ectopic fat (hepatic, intramyocellular) blocks insulin signaling; adiponectin ↓; oxidative stress perpetuates IR; K ↑ as ectopic fat accumulates"</span>,
  <span class="o">"oam_C_estimate"</span>: <span class="s">"Ξ²-cell secretory reserve: initially preserved (compensatory), declining with progression"</span>,
  <span class="o">"oam_K_estimate"</span>: <span class="s">"rising β€” ectopic fat, ceramide accumulation resist insulin sensitization"</span>,
  <span class="o">"oam_Theta_estimate"</span>: <span class="s">"moderate β€” exercise-induced GLUT4 upregulation, GLP-1 signaling partially maintain repair"</span>,
  <span class="o">"oam_cascade_targets"</span>: [<span class="s">"PP-07"</span>, <span class="s">"PP-08"</span>, <span class="s">"PP-13"</span>, <span class="s">"PP-02"</span>],
  <span class="k">"measurable_signs"</span>: [
    { <span class="k">"sign"</span>: <span class="s">"Fasting glucose"</span>, <span class="k">"uncertainty"</span>: [<span class="s">"PB-01"</span>, <span class="s">"PB-02"</span>], <span class="k">"single_value_sufficient"</span>: <span class="v">false</span> },
    { <span class="k">"sign"</span>: <span class="s">"HbA1c"</span>, <span class="k">"uncertainty"</span>: [<span class="s">"PB-07"</span>, <span class="s">"PB-08"</span>], <span class="k">"what_it_measures"</span>: <span class="s">"~3-month average glycated hemoglobin β€” affected by hemoglobin variants, anemia, CKD"</span> },
    { <span class="k">"sign"</span>: <span class="s">"HOMA-IR (calculated)"</span>, <span class="k">"uncertainty"</span>: [<span class="s">"PB-03"</span>], <span class="k">"what_it_measures"</span>: <span class="s">"calculated proxy from fasting glucose Γ— fasting insulin β€” NOT a direct IR measurement; significant individual variability"</span> }
  ],
  <span class="k">"path_unknown_class"</span>: [<span class="s">"PA-02"</span>, <span class="s">"PA-05"</span>],
  <span class="e">"claims_blocked"</span>: [<span class="s">"HOMA-IR = confirmed insulin resistance diagnosis"</span>, <span class="s">"Fasting glucose alone = T2DM"</span>, <span class="s">"Dietary or medication recommendation"</span>, <span class="s">"Lifestyle blame or shame"</span>],
  <span class="e">"person_level_claim_blocked"</span>: <span class="v">true</span>, <span class="k">"interpretation_status"</span>: <span class="s">"caution"</span>
}</pre>
  </div>

  <!-- SAMPLE 4: Sleep Apnea Strain -->
  <div class="sample-record">
    <div class="sr-header"><span class="sr-id">PP-10</span>Sleep Apnea-Related Strain β€” Sample Record</div>
    <pre>{
  <span class="k">"condition_id"</span>: <span class="s">"PP-10"</span>, <span class="k">"biological_domain"</span>: [<span class="s">"BD-05"</span>, <span class="s">"BD-06"</span>, <span class="s">"BD-01"</span>],
  <span class="o">"oam_pressure_source"</span>: <span class="s">"W: episodic hypoxia + arousal-triggered SNS surges + intrathoracic pressure swings; F: chronic sleep fragmentation, chronic SNS activation"</span>,
  <span class="o">"oam_system_strain"</span>: <span class="s">"Repeated hypoxia-reoxygenation injury; sustained SNS hyperactivation; nocturnal HTN; HPA axis disruption; metabolic dysregulation from sleep fragmentation"</span>,
  <span class="o">"oam_degradation_pathway"</span>: <span class="s">"Endothelial dysfunction β†’ nocturnal HTN β†’ atrial remodeling β†’ pulmonary pressure ↑ (if severe); metabolic syndrome amplification"</span>,
  <span class="o">"oam_feedback_failure"</span>: <span class="s">"Obesity perpetuates airway obstruction β†’ structural K ↑; HIF-1Ξ± upregulation; impaired baroreflex; oxidative stress from reoxygenation"</span>,
  <span class="o">"oam_cascade_targets"</span>: [<span class="s">"PP-01"</span>, <span class="s">"PP-07"</span>, <span class="s">"PP-11"</span>, <span class="s">"PP-15"</span>],
  <span class="k">"measurable_signs"</span>: [
    { <span class="k">"sign"</span>: <span class="s">"AHI (apnea-hypopnea index)"</span>, <span class="k">"what_it_measures"</span>: <span class="s">"events per hour on sleep study β€” PSG gold standard; home sleep test is limited by no EEG, no leg movements, no RERA detection"</span>, <span class="k">"uncertainty"</span>: [<span class="s">"PB-01"</span>, <span class="s">"PB-05"</span>] },
    { <span class="k">"sign"</span>: <span class="s">"Wearable SpO2 / sleep staging"</span>, <span class="k">"uncertainty"</span>: [<span class="s">"PB-04"</span>], <span class="k">"what_it_measures"</span>: <span class="s">"peripheral SpO2 estimate β€” NOT equivalent to polysomnographic oximetry; cannot detect respiratory events or arousals"</span> }
  ],
  <span class="k">"path_unknown_class"</span>: [<span class="s">"PA-02"</span>, <span class="s">"PA-06"</span>],
  <span class="k">"mechanism_status"</span>: <span class="s">"well_characterized for cardiovascular strain pathway; individual oxygen sensitivity and threshold for harm varies (PA-02)"</span>,
  <span class="e">"claims_blocked"</span>: [<span class="s">"Wearable SpO2 dips = sleep apnea diagnosis"</span>, <span class="s">"AHI alone = clinical severity"</span>, <span class="s">"CPAP or treatment recommendation"</span>, <span class="s">"Home sleep test = PSG equivalence"</span>],
  <span class="e">"person_level_claim_blocked"</span>: <span class="v">true</span>, <span class="k">"interpretation_status"</span>: <span class="s">"caution"</span>
}</pre>
  </div>

  <!-- SAMPLE 5: Chronic Inflammation -->
  <div class="sample-record">
    <div class="sr-header"><span class="sr-id">PP-08</span>Chronic Low-Grade Inflammation β€” Sample Record</div>
    <pre>{
  <span class="k">"condition_id"</span>: <span class="s">"PP-08"</span>, <span class="k">"biological_domain"</span>: [<span class="s">"BD-03"</span>, <span class="s">"BD-02"</span>, <span class="s">"BD-01"</span>],
  <span class="o">"oam_pressure_source"</span>: <span class="s">"F-dominant: visceral adipose adipokine secretion (TNF-Ξ±, IL-6, leptin), gut dysbiosis, chronic psychosocial stress β†’ HPA/SNS β†’ IL-6; environmental pollutants"</span>,
  <span class="o">"oam_degradation_pathway"</span>: <span class="s">"Sustained cytokine exposure β†’ endothelial activation β†’ NF-ΞΊB perpetuation β†’ coagulation activation β†’ plaque destabilization β†’ insulin signaling impairment"</span>,
  <span class="o">"oam_feedback_failure"</span>: <span class="s">"NF-ΞΊB perpetuates cytokine production; adipose M1 macrophage polarization persists; SPM (pro-resolving mediator) production impaired β†’ resolution failure"</span>,
  <span class="o">"oam_Theta_estimate"</span>: <span class="s">"reduced β€” SPM capacity depressed; K rising from M1 epigenetic programming"</span>,
  <span class="o">"oam_K_estimate"</span>: <span class="s">"moderate β€” M1 macrophage polarization, metabolic endotoxemia resist resolution"</span>,
  <span class="o">"oam_cascade_targets"</span>: [<span class="s">"PP-02"</span>, <span class="s">"PP-06"</span>, <span class="s">"PP-09"</span>, <span class="s">"PP-13"</span>],
  <span class="k">"measurable_signs"</span>: [
    { <span class="k">"sign"</span>: <span class="s">"hsCRP"</span>, <span class="k">"what_it_measures"</span>: <span class="s">"non-specific acute phase reactant β€” elevated in infection, trauma, autoimmune, obesity, smoking; source cannot be determined from value"</span>, <span class="k">"uncertainty"</span>: [<span class="s">"PB-03"</span>, <span class="s">"PB-01"</span>] },
    { <span class="k">"sign"</span>: <span class="s">"IL-6, fibrinogen, WBC"</span>, <span class="k">"what_it_measures"</span>: <span class="s">"additional non-specific inflammation markers β€” directional but not source-specific; require clinical context"</span>, <span class="k">"uncertainty"</span>: [<span class="s">"PB-03"</span>, <span class="s">"PB-05"</span>] }
  ],
  <span class="k">"path_unknown_class"</span>: [<span class="s">"PA-01"</span>, <span class="s">"PA-07"</span>],
  <span class="k">"mechanism_status"</span>: <span class="s">"partially_characterized β€” 'chronic low-grade inflammation' as a unified entity is contested; multiple overlapping mechanisms"</span>,
  <span class="e">"claims_blocked"</span>: [<span class="s">"Elevated hsCRP = confirmed chronic inflammation"</span>, <span class="s">"Source of inflammation inferred from hsCRP alone"</span>, <span class="s">"Anti-inflammatory diet/supplement recommendation"</span>, <span class="s">"Lifestyle attribution or blame"</span>],
  <span class="e">"person_level_claim_blocked"</span>: <span class="v">true</span>, <span class="k">"interpretation_status"</span>: <span class="s">"caution β€” elevated non-specific markers require clinical differential"</span>
}</pre>
  </div>
</div>

<hr class="div-rule">

<!-- ════════════════════════════════════════════════════ -->
<!-- SECTION 11: STAGED INGEST PLAN -->
<!-- ════════════════════════════════════════════════════ -->
<div class="section">
  <div class="section-num">Section 11</div>
  <div class="section-title">Staged <em>Ingest Plan</em></div>

  <div class="stage-row"><div class="stage-num">1</div><div class="stage-body"><div class="stage-title">Biological Domain Registry</div><div class="stage-source">BD-01 through BD-08 · OAM variable mapping per domain</div><p>Define each biological domain with its OAM reserve (C), primary degradation pattern (D), and repair mechanism (Θ). Schema must be stable before any condition pathway is added.</p></div></div>
  <div class="stage-row"><div class="stage-num">2</div><div class="stage-body"><div class="stage-title">OAM Variable Calibration Per Domain</div><div class="stage-source">P, D, Θ, C, K, Ξ, S, U definitions per biological system</div><p>For each domain, define what W, F, C, K, Θ, and E represent biologically, with example biomarker proxies where available. Distinguish OAM model-level constructs from direct clinical measurements.</p></div></div>
  <div class="stage-row"><div class="stage-num">3</div><div class="stage-body"><div class="stage-title">Core Condition Pathways</div><div class="stage-source">PP-01 through PP-17 Β· degradation chains Β· feedback failures</div><p>Define each condition pathway with its OAM structure. Mechanism status (PA-01), individual variability (PA-02), and compensation state (PA-03) flags set per condition before any measurable sign is added.</p></div></div>
  <div class="stage-row"><div class="stage-num">4</div><div class="stage-body"><div class="stage-title">Measurement / Provenance Registry</div><div class="stage-source">Biomarker types Β· wearable types Β· default uncertainty class assignment</div><p>Each measurement type is assigned its default PB uncertainty classes before any measurement values are processed. Wearable measurements are categorized as PB-04 by default.</p></div></div>
  <div class="stage-row"><div class="stage-num">5</div><div class="stage-body"><div class="stage-title">Cascade Propagation Map (Ξ)</div><div class="stage-source">Inter-condition PP cascade edges Β· Ξ› coupling strength estimates</div><p>Document which conditions drive which via OAM propagation Ξ. Each cascade edge must cite published epidemiological or mechanistic evidence supporting the association. SOURCE_NEEDED where not well-established.</p></div></div>
  <div class="stage-row"><div class="stage-num">6</div><div class="stage-body"><div class="stage-title">Schema Extension + Sample Records</div><div class="stage-source">15–20 sample records Β· all five example conditions Β· validation cases</div><p>Sample records must include: a clean single-domain record, a multi-cascade record, a wearable-only suspended record, a provenance-failed invalidated record, and a record where OAM D is high but Θ is also high (not decompensated despite degradation).</p></div></div>
  <div class="stage-row"><div class="stage-num">7</div><div class="stage-body"><div class="stage-title">Biofeedback Layer Integration</div><div class="stage-source">BF/BP signal IDs β†’ PP condition pathway targets</div><p>Link biofeedback signal modalities (BF-01 through BF-08) to pathophysiology pathway targets where relevant (e.g., HRV biofeedback β†’ PP-10, PP-11; EMG β†’ PP-17; respiratory β†’ PP-14). All biofeedback linkages carry inherited biofeedback layer uncertainty.</p></div></div>
  <div class="stage-row"><div class="stage-num">8</div><div class="stage-body"><div class="stage-title">Clinical Interpretation Layer (Conditional β€” Same Requirements as Brain Layer)</div><div class="stage-source">Requires qualified clinical context + explicit activation</div><p>Same conditional requirements as Brain Layer Layer 8. Pathophysiology-specific: requires licensed clinician with relevant specialty competence per condition domain. Not activated by default. Cannot produce diagnoses β€” produces bounded, clinician-reviewed interpretation notes only.</p></div></div>
</div>

<hr class="div-rule">

<!-- ════════════════════════════════════════════════════ -->
<!-- SECTION 12: OSF PACKET -->
<!-- ════════════════════════════════════════════════════ -->
<div class="section">
  <div class="section-num">Section 12</div>
  <div class="section-title">OSF-Ready <em>Packet Recommendation</em></div>
  <div class="tree">
<span class="dir">Primordial_Pathophysiology_Layer_v0.1_Collin_D_Weber/</span>
β”‚
β”œβ”€β”€ <span class="dir">000_READ_ME_FIRST.md</span>                    <span class="ann">← scope, core invariant, what this is and is not, layer links</span>
β”œβ”€β”€ <span class="dir">001_SCOPE_AND_BOUNDARY.md</span>                <span class="ann">← not diagnosis, not treatment, not individual prediction; OAM as engine; HIR as governance</span>
β”œβ”€β”€ <span class="dir">002_HIR_OAM_RELATIONSHIP.json</span>            <span class="ann">← full HIR Γ— OAM variable table with biological pathway mappings</span>
β”œβ”€β”€ <span class="dir">003_OAM_DEGRADATION_MODEL.json</span>           <span class="ann">← canonical OAM equations + biological interpretation per variable (P, D, Θ, C, K, Ξ, S, U)</span>
β”œβ”€β”€ <span class="dir">004_BIOLOGICAL_DOMAIN_REGISTRY.json</span>      <span class="ann">← BD-01 through BD-08 with OAM variable assignments per domain</span>
β”œβ”€β”€ <span class="dir">005_CONDITION_PATHWAY_REGISTRY.json</span>      <span class="ann">← PP-01 through PP-17: pressure source, strain, degradation, feedback failure, signs, effects, OAM estimates</span>
β”œβ”€β”€ <span class="dir">006_CASCADE_PROPAGATION_MAP.json</span>         <span class="ann">← Ξ edges between PP conditions with evidence status per edge</span>
β”œβ”€β”€ <span class="dir">007_MEASUREMENT_PROVENANCE_MODEL.json</span>    <span class="ann">← measurement types Γ— default PB uncertainty assignments Γ— what each directly measures</span>
β”œβ”€β”€ <span class="dir">008_UNCERTAINTY_TAXONOMY.json</span>            <span class="ann">← PA-01–07 and PB-01–10 as typed objects with effect, suspension, and confidence rules</span>
β”œβ”€β”€ <span class="dir">009_FEATURE_SCHEMA_v0.1.json</span>             <span class="ann">← full typed schema with required fields, enums, defaults, and hard-override rules</span>
β”œβ”€β”€ <span class="dir">010_HIR_OAM_RULE_SET_v0.1.json</span>           <span class="ann">← R-01 through R-15 as machine-readable rule objects</span>
β”œβ”€β”€ <span class="dir">011_SAMPLE_RECORDS.jsonl</span>                 <span class="ann">← five primary + 10–15 additional records: clean, wearable-suspended, provenance-failed, multi-cascade</span>
β”œβ”€β”€ <span class="dir">012_STAGED_INGEST_PLAN.md</span>                <span class="ann">← stages 1–8 with prerequisites</span>
β”œβ”€β”€ <span class="dir">013_BIOFEEDBACK_LINKAGE_MAP.json</span>         <span class="ann">← BF/BP signal IDs β†’ PP condition targets with inherited uncertainty</span>
β”œβ”€β”€ <span class="dir">014_VALIDATION_REPORT_TEMPLATE.md</span>        <span class="ann">← per-record validation checklist: claims_permitted, claims_blocked, uncertainty status</span>
β”œβ”€β”€ <span class="dir">015_MANIFEST.md</span>                          <span class="ann">← file inventory with classification and provenance</span>
└── <span class="dir">016_SHA256_CHECKSUMS.txt</span>                 <span class="ann">← checksums for all files</span>
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<div class="section">
  <div class="section-num">Section 13</div>
  <div class="section-title">Plain-Language <em>Explanation</em></div>

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    <div class="plain-card" style="border-left:3px solid var(--allow)">
      <div class="plain-card-title">What this does</div>
      <div class="plain-card-body">
        It maps how common chronic health conditions develop β€” not as a list of facts about diseases, but as structured degradation pathways: what creates biological pressure, how that strain builds up over time, where the body's repair mechanisms start to fail, and what effects downstream.<br><br>
        It uses the OAM (Organismal Autonomy Model) to give this mapping mathematical structure β€” the same pressure, stability, degradation, and repair variables used throughout the Primordial Calculus, now applied to biological systems. Blood pressure becomes a pressure field (P). Fibrosis becomes accumulated damage (D). Endothelial repair becomes repair traction (Θ).
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    <div class="plain-card" style="border-left:3px solid var(--cv)">
      <div class="plain-card-title">What it does not do</div>
      <div class="plain-card-body">
        It does not diagnose anyone. It does not recommend treatment. It does not produce individual risk scores. It does not tell you whether a wearable reading is clinically significant.<br><br>
        It does not blame people for their health conditions. It does not infer character, discipline, or moral worth from biological degradation patterns. It does not use elevated biomarkers to make claims about who a person is.<br><br>
        It does not treat a single reading as a confirmed condition, a risk factor as a disease, or a population probability as an individual prediction.
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    <div class="plain-card" style="border-left:3px solid var(--oam)">
      <div class="plain-card-title">Why it matters for health AI</div>
      <div class="plain-card-body">
        AI systems applied to health data face a constant pressure to overclaim β€” to turn an elevated biomarker into a diagnosis, a wearable reading into a confirmed condition, or a population risk factor into a personal certainty.<br><br>
        This architecture builds the limits into the foundation. The schema has a field that defaults to "claims_blocked." The rules make wearable signals explicitly not equivalent to clinical standards. The uncertainty taxonomy requires that non-specific biomarkers carry PB-03 (non-specific) flags by default.<br><br>
        The goal is a health AI architecture that is actually honest about what it knows β€” which is much less than it might appear to know.
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    <div class="plain-card" style="border-left:3px solid var(--inf)">
      <div class="plain-card-title">How HIR and OAM work together</div>
      <div class="plain-card-body">
        <strong>OAM</strong> provides the biological model: pressure (P) builds over time, damage (D) accumulates when pressure exceeds repair capacity (Θ Γ— C), and one failing system can drive cascades into others (Ξ).<br><br>
        <strong>HIR</strong> governs what can be claimed about that model for a specific person: Honesty requires labeling what is measured vs. inferred; Integrity blocks collapsing categories (symptom β‰  cause; biomarker β‰  disease); Respect blocks person-level blame, shame, or moral inference.<br><br>
        Together: OAM says how degradation works. HIR says what you're allowed to conclude about it.
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<!-- FOOTER -->
<div class="footer">
  <strong>Created and Developed by Collin D. Weber</strong> Β· Primordial Pathophysiology Layer v0.1 Β· OAM-Governed Biological Degradation Mapping Β· April 30, 2026<br>
  Canonical OAM source: Primordial Calculus / HIR Γ— OAM project bundle Β· <code>primordial_os/hir/equations.py</code> Β· <code>primordial_os/hir/config.py</code><br>
  Builds on: Primordial Brain Layer v0.1 Β· Primordial Biofeedback Layer v0.1 Β· Primordial DNA Layer v0.1 (GRCh38 First Pass)<br><br>
  This document is a bounded architecture planning study. It is not a clinical tool, a diagnostic instrument, a treatment protocol, or a medical opinion. All pathophysiological pathway descriptions are derived from published biomedical literature and are subject to the uncertainty taxonomy defined in Section 7. No condition pathway in this document constitutes a diagnosis, prognosis, or treatment recommendation for any individual. Wearable measurements described here are not equivalent to validated clinical measurements. Where source validation is required, items are marked SOURCE_NEEDED or REVIEW_REQUIRED.<br><br>
  This module maps biological degradation pathways using OAM equations as structural scaffolding, governed by HIR evidence boundaries, ensuring that unknown mechanisms and measurement limitations cannot be converted into unsupported claims about a person.
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