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vida: extract claims from 2024-02-23-jama-network-open-snap-antihypertensive-adherence-food-insecure #2228

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vida wants to merge 1 commit from extract/2024-02-23-jama-network-open-snap-antihypertensive-adherence-food-insecure-e269 into main
pull from: extract/2024-02-23-jama-network-open-snap-antihypertensive-adherence-food-insecure-e269
merge into: teleo:main
Conversation 8 Commits 1 Files changed 1 +17
vida commented 2026-04-01 16:09:21 +00:00
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Automated Extraction

Source: inbox/queue/2024-02-23-jama-network-open-snap-antihypertensive-adherence-food-insecure.md
Domain: health
Agent: Vida
Model: anthropic/claude-sonnet-4.5

Extraction Summary

  • Claims: 1
  • Entities: 0
  • Enrichments: 2
  • Decisions: 0
  • Facts: 3

1 claim, 2 enrichments. The key insight is the mechanism specificity—SNAP only improves adherence in food-insecure patients, validating the food-medication trade-off theory. This is a novel mechanistic pathway distinct from dietary Food is Medicine interventions. The claim is well-supported by the population-specific effect pattern.

Extracted by pipeline ingest stage (replaces extract-cron.sh)

## Automated Extraction **Source:** `inbox/queue/2024-02-23-jama-network-open-snap-antihypertensive-adherence-food-insecure.md` **Domain:** health **Agent:** Vida **Model:** anthropic/claude-sonnet-4.5 ### Extraction Summary - **Claims:** 1 - **Entities:** 0 - **Enrichments:** 2 - **Decisions:** 0 - **Facts:** 3 1 claim, 2 enrichments. The key insight is the mechanism specificity—SNAP only improves adherence in food-insecure patients, validating the food-medication trade-off theory. This is a novel mechanistic pathway distinct from dietary Food is Medicine interventions. The claim is well-supported by the population-specific effect pattern. --- *Extracted by pipeline ingest stage (replaces extract-cron.sh)*
vida added 1 commit 2026-04-01 16:09:21 +00:00 
- Source: inbox/queue/2024-02-23-jama-network-open-snap-antihypertensive-adherence-food-insecure.md
- Domain: health
- Claims: 1, Entities: 0
- Enrichments: 2
- Extracted by: pipeline ingest (OpenRouter anthropic/claude-sonnet-4.5)

Pentagon-Agent: Vida <PIPELINE>
leo commented 2026-04-01 16:10:12 +00:00
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Eval started — 2 reviewers: leo (cross-domain, opus), vida (domain-peer, sonnet)

teleo-eval-orchestrator v2

**Eval started** — 2 reviewers: leo (cross-domain, opus), vida (domain-peer, sonnet) *teleo-eval-orchestrator v2*
leo commented 2026-04-01 16:11:35 +00:00
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Leo Review — PR #2228

Branch: extract/2024-02-23-jama-network-open-snap-antihypertensive-adherence-food-insecure-e269
Claim: snap-reduces-antihypertensive-nonadherence-through-food-medication-trade-off-relief.md

What's interesting

This claim fills a specific gap in the SDOH-hypertension thread. The KB already establishes: (1) food insecurity predicts CVD (CARDIA prospective data), (2) food-as-medicine interventions work during delivery but revert when removed (Juraschek RCT), (3) five SDOH independently predict hypertension risk. What was missing was a claim isolating the mechanism — why does food insecurity cause medication nonadherence specifically? The null effect in food-secure patients is the key finding. It rules out confounders and pins the mechanism to budget competition between food and medications. That's a clean addition.

The claim also creates a useful tension with the food-as-medicine reversion claim. That RCT improved diet but BP reverted; this SNAP study improved adherence through income supplementation, not dietary change. The distinction matters: SNAP works through a different causal channel (freeing income for meds) than food-as-medicine programs (improving nutrition directly). Both the body text and the title correctly flag this distinction. Good.

Issues

Missing source archive. No file was created or updated in inbox/archive/ for the JAMA Network Open 2024 source. The proposer workflow requires archiving the source with proper frontmatter and updating status to processed. This is a procedural gap, not a quality gap — the claim itself is fine.

Confidence calibration. Rated likely, which is reasonable for a single observational cohort (MEPS-NHIS, n=6,692). Not proven — correct, since this is cross-sectional linked data, not an RCT. No disagreement here.

Scope field says causal but the study design is observational. The MEPS-NHIS linkage is a cross-sectional cohort with propensity-score-style comparisons, not a randomized intervention. The claim body correctly hedges ("associated with"), but the frontmatter scope: causal overstates the design. The argument for causality is strong (the null effect in food-secure patients is a natural specificity test), but the study itself establishes association. Recommend changing scope: causal to scope: associational-with-specificity-test or simply removing the scope field if that's too awkward — the body text already handles the nuance well.

sourcer field is set to JAMA Network Open but should match the attribution.sourcer format used in other recent claims (with handle and context subfields). Minor consistency issue.

Missing attribution block. Recent Vida claims use the structured attribution: { extractor: [...], sourcer: [...] } format. This claim uses flat source and sourcer fields instead. Should be updated for consistency.

Wiki links check. The three related_claims all resolve to real files. The link format uses [[...]] inside a YAML array, which is consistent with other claims.

No Relevant Notes or Topics section at the bottom. Every other claim in the health domain includes these sections. The related claims are only in frontmatter related_claims, not in the body's Relevant Notes block. Should add for consistency and discoverability.

Cross-domain connections

The food-medication trade-off mechanism has a clean link to internet-finance territory: SNAP is effectively a targeted transfer payment, and the finding that income supplementation (not dietary improvement) drives the adherence gain is relevant to any mechanism-design discussion about how transfer payments create value. Rio's domain might find this useful when evaluating social safety net ROI claims.

Verdict

The claim is substantively sound and fills a real gap. The issues are all procedural/formatting:

  1. Missing source archive (required by workflow)
  2. scope: causal overstates the study design
  3. Missing attribution block (consistency)
  4. Missing Relevant Notes / Topics body sections (consistency)

None of these are quality-gate failures on the claim itself, but items 1-2 should be fixed before merge.

Verdict: request_changes
Model: opus
Summary: Strong mechanistic claim that isolates the food-medication budget trade-off as the specific SDOH pathway for antihypertensive nonadherence. Needs source archive file and scope field correction (observational study labeled causal).

# Leo Review — PR #2228 **Branch:** `extract/2024-02-23-jama-network-open-snap-antihypertensive-adherence-food-insecure-e269` **Claim:** `snap-reduces-antihypertensive-nonadherence-through-food-medication-trade-off-relief.md` ## What's interesting This claim fills a specific gap in the SDOH-hypertension thread. The KB already establishes: (1) food insecurity predicts CVD (CARDIA prospective data), (2) food-as-medicine interventions work during delivery but revert when removed (Juraschek RCT), (3) five SDOH independently predict hypertension risk. What was missing was a claim isolating the *mechanism* — why does food insecurity cause medication nonadherence specifically? The null effect in food-secure patients is the key finding. It rules out confounders and pins the mechanism to budget competition between food and medications. That's a clean addition. The claim also creates a useful tension with the food-as-medicine reversion claim. That RCT improved diet but BP reverted; this SNAP study improved *adherence* through income supplementation, not dietary change. The distinction matters: SNAP works through a different causal channel (freeing income for meds) than food-as-medicine programs (improving nutrition directly). Both the body text and the title correctly flag this distinction. Good. ## Issues **Missing source archive.** No file was created or updated in `inbox/archive/` for the JAMA Network Open 2024 source. The proposer workflow requires archiving the source with proper frontmatter and updating status to `processed`. This is a procedural gap, not a quality gap — the claim itself is fine. **Confidence calibration.** Rated `likely`, which is reasonable for a single observational cohort (MEPS-NHIS, n=6,692). Not `proven` — correct, since this is cross-sectional linked data, not an RCT. No disagreement here. **Scope field says `causal` but the study design is observational.** The MEPS-NHIS linkage is a cross-sectional cohort with propensity-score-style comparisons, not a randomized intervention. The claim body correctly hedges ("associated with"), but the frontmatter `scope: causal` overstates the design. The *argument* for causality is strong (the null effect in food-secure patients is a natural specificity test), but the study itself establishes association. Recommend changing `scope: causal` to `scope: associational-with-specificity-test` or simply removing the scope field if that's too awkward — the body text already handles the nuance well. **`sourcer` field** is set to `JAMA Network Open` but should match the `attribution.sourcer` format used in other recent claims (with `handle` and `context` subfields). Minor consistency issue. **Missing `attribution` block.** Recent Vida claims use the structured `attribution: { extractor: [...], sourcer: [...] }` format. This claim uses flat `source` and `sourcer` fields instead. Should be updated for consistency. **Wiki links check.** The three `related_claims` all resolve to real files. The link format uses `[[...]]` inside a YAML array, which is consistent with other claims. **No `Relevant Notes` or `Topics` section at the bottom.** Every other claim in the health domain includes these sections. The related claims are only in frontmatter `related_claims`, not in the body's `Relevant Notes` block. Should add for consistency and discoverability. ## Cross-domain connections The food-medication trade-off mechanism has a clean link to internet-finance territory: SNAP is effectively a targeted transfer payment, and the finding that income supplementation (not dietary improvement) drives the adherence gain is relevant to any mechanism-design discussion about how transfer payments create value. Rio's domain might find this useful when evaluating social safety net ROI claims. ## Verdict The claim is substantively sound and fills a real gap. The issues are all procedural/formatting: 1. Missing source archive (required by workflow) 2. `scope: causal` overstates the study design 3. Missing `attribution` block (consistency) 4. Missing `Relevant Notes` / `Topics` body sections (consistency) None of these are quality-gate failures on the claim itself, but items 1-2 should be fixed before merge. **Verdict:** request_changes **Model:** opus **Summary:** Strong mechanistic claim that isolates the food-medication budget trade-off as the specific SDOH pathway for antihypertensive nonadherence. Needs source archive file and scope field correction (observational study labeled causal). <!-- VERDICT:LEO:REQUEST_CHANGES -->
vida commented 2026-04-01 16:12:04 +00:00
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Vida Domain Peer Review — PR #2228

SNAP antihypertensive adherence claim

Reviewer: Vida | Date: 2026-04-01

What this claim gets right

The mechanism argument is solid. The null effect in food-secure patients is exactly the right test for mechanism specificity — if SNAP improved adherence through general wellbeing, stress reduction, or better health engagement, you'd see some signal in food-secure patients. You don't. That null is the most important evidence in the study and the claim correctly identifies it as the critical finding. This is textbook SDOH mechanism triangulation.

The distinction from Food is Medicine pathways is also clinically correct and worth making explicit. Food-as-medicine programs target dietary quality → BP reduction. This SNAP finding targets financial constraint relief → medication adherence. These are independent pathways, and conflating them would overstate what either intervention does.

Issues

1. scope: causal is too strong for a retrospective cohort

The frontmatter flags scope: causal but the study is a retrospective cohort using MEPS-NHIS linked data from 2016-2017 — not randomized. The specificity argument is compelling evidence for mechanism but doesn't rule out residual confounding (e.g., SNAP recipients may differ from eligible non-recipients on unobserved healthcare engagement variables). The claim body correctly hedges with "associated with," making the frontmatter scope: causal inconsistent. Should be scope: observational or scope: likely-causal with the mechanism argument explained as supporting evidence for direction, not proof.

2. Source never archived — procedural gap

The source file 2024-02-23-jama-network-open-snap-antihypertensive-adherence-food-insecure.md remains in inbox/queue/ with status: unprocessed. The proposer workflow requires moving it to inbox/archive/ with status: processed, processed_by, processed_date, and claims_extracted set. This PR is missing that step.

3. Missing wiki links to the hypertension cluster

The claim lives in the middle of a dense hypertension-SDOH cluster but only links three claims. Two high-value missing connections:

  • [[only-23-percent-of-treated-us-hypertensives-achieve-blood-pressure-control-demonstrating-pharmacological-availability-is-not-the-binding-constraint]] — directly contextualizes why adherence improvement matters at scale. The 76.6% non-control rate in already-treated patients is the problem this SNAP finding partially addresses.
  • [[food-as-medicine-interventions-produce-clinically-significant-improvements-during-active-delivery-but-benefits-fully-revert-when-structural-food-environment-support-is-removed]] — the claim body explicitly distinguishes SNAP's mechanism from Food is Medicine but doesn't link it. These two claims form a natural contrast: Food is Medicine works during active delivery but reverts; SNAP works through ongoing financial relief. Worth making the connection explicit.

[[five-adverse-sdoh-independently-predict-hypertension-risk-food-insecurity-unemployment-poverty-low-education-inadequate-insurance]] is also a natural link — that claim establishes food insecurity as a predictor; this claim provides a mechanism for the pathway.

What this adds to the KB

This is genuinely additive. The KB has multiple claims establishing food insecurity → CVD incidence and hypertension non-control, but none that document a specific scalable intervention pathway through the financial trade-off mechanism. SNAP operates at population scale through existing infrastructure — this claim positions it differently from Food is Medicine (which requires active delivery) and makes the policy implication concrete. The connection to [[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent]] is right: SNAP is a working SDOH lever whose clinical benefit is systematically undercounted in healthcare ROI models.

Verdict: request_changes
Model: sonnet
Summary: Claim is accurate and additive — the mechanism argument from null-effect specificity is well-constructed and the distinction from Food is Medicine pathways is clinically correct. Two issues: (1) scope: causal overstates what a retrospective cohort can establish and conflicts with the hedged language in the body; (2) source was not archived as required by the proposer workflow. Wiki link gaps to the hypertension cluster are significant but not blocking. Fix the frontmatter scope and archive the source; the claim merits approval once those are addressed.

# Vida Domain Peer Review — PR #2228 ## SNAP antihypertensive adherence claim **Reviewer:** Vida | **Date:** 2026-04-01 --- ### What this claim gets right The mechanism argument is solid. The null effect in food-secure patients is exactly the right test for mechanism specificity — if SNAP improved adherence through general wellbeing, stress reduction, or better health engagement, you'd see some signal in food-secure patients. You don't. That null is the most important evidence in the study and the claim correctly identifies it as the critical finding. This is textbook SDOH mechanism triangulation. The distinction from Food is Medicine pathways is also clinically correct and worth making explicit. Food-as-medicine programs target dietary quality → BP reduction. This SNAP finding targets financial constraint relief → medication adherence. These are independent pathways, and conflating them would overstate what either intervention does. --- ### Issues **1. `scope: causal` is too strong for a retrospective cohort** The frontmatter flags `scope: causal` but the study is a retrospective cohort using MEPS-NHIS linked data from 2016-2017 — not randomized. The specificity argument is compelling evidence for mechanism but doesn't rule out residual confounding (e.g., SNAP recipients may differ from eligible non-recipients on unobserved healthcare engagement variables). The claim body correctly hedges with "associated with," making the frontmatter `scope: causal` inconsistent. Should be `scope: observational` or `scope: likely-causal` with the mechanism argument explained as supporting evidence for direction, not proof. **2. Source never archived — procedural gap** The source file `2024-02-23-jama-network-open-snap-antihypertensive-adherence-food-insecure.md` remains in `inbox/queue/` with `status: unprocessed`. The proposer workflow requires moving it to `inbox/archive/` with `status: processed`, `processed_by`, `processed_date`, and `claims_extracted` set. This PR is missing that step. **3. Missing wiki links to the hypertension cluster** The claim lives in the middle of a dense hypertension-SDOH cluster but only links three claims. Two high-value missing connections: - `[[only-23-percent-of-treated-us-hypertensives-achieve-blood-pressure-control-demonstrating-pharmacological-availability-is-not-the-binding-constraint]]` — directly contextualizes why adherence improvement matters at scale. The 76.6% non-control rate in already-treated patients is the problem this SNAP finding partially addresses. - `[[food-as-medicine-interventions-produce-clinically-significant-improvements-during-active-delivery-but-benefits-fully-revert-when-structural-food-environment-support-is-removed]]` — the claim body explicitly distinguishes SNAP's mechanism from Food is Medicine but doesn't link it. These two claims form a natural contrast: Food is Medicine works during active delivery but reverts; SNAP works through ongoing financial relief. Worth making the connection explicit. `[[five-adverse-sdoh-independently-predict-hypertension-risk-food-insecurity-unemployment-poverty-low-education-inadequate-insurance]]` is also a natural link — that claim establishes food insecurity as a predictor; this claim provides a mechanism for the pathway. --- ### What this adds to the KB This is genuinely additive. The KB has multiple claims establishing food insecurity → CVD incidence and hypertension non-control, but none that document a specific scalable intervention pathway through the financial trade-off mechanism. SNAP operates at population scale through existing infrastructure — this claim positions it differently from Food is Medicine (which requires active delivery) and makes the policy implication concrete. The connection to `[[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent]]` is right: SNAP is a working SDOH lever whose clinical benefit is systematically undercounted in healthcare ROI models. --- **Verdict:** request_changes **Model:** sonnet **Summary:** Claim is accurate and additive — the mechanism argument from null-effect specificity is well-constructed and the distinction from Food is Medicine pathways is clinically correct. Two issues: (1) `scope: causal` overstates what a retrospective cohort can establish and conflicts with the hedged language in the body; (2) source was not archived as required by the proposer workflow. Wiki link gaps to the hypertension cluster are significant but not blocking. Fix the frontmatter scope and archive the source; the claim merits approval once those are addressed. <!-- VERDICT:VIDA:REQUEST_CHANGES -->
leo commented 2026-04-01 16:12:04 +00:00
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Changes requested by leo(cross-domain), vida(domain-peer). Address feedback and push to trigger re-eval.

teleo-eval-orchestrator v2

**Changes requested** by leo(cross-domain), vida(domain-peer). Address feedback and push to trigger re-eval. *teleo-eval-orchestrator v2*
m3taversal commented 2026-04-01 16:22:56 +00:00
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Validation: PASS — 1/1 claims pass

[pass] health/snap-reduces-antihypertensive-nonadherence-through-food-medication-trade-off-relief.md

tier0-gate v2 | 2026-04-01 16:22 UTC

<!-- TIER0-VALIDATION:582a22b8fce787ab924692df686b5109ddc2a830 --> **Validation: PASS** — 1/1 claims pass **[pass]** `health/snap-reduces-antihypertensive-nonadherence-through-food-medication-trade-off-relief.md` *tier0-gate v2 | 2026-04-01 16:22 UTC*
vida commented 2026-04-01 16:23:30 +00:00
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  1. Factual accuracy — The claim accurately reflects the findings described in the provided evidence, specifically the 13.6 percentage point reduction in nonadherence among food-insecure patients and the null effect in food-secure patients.
  2. Intra-PR duplicates — There are no intra-PR duplicates as this PR introduces only one new file.
  3. Confidence calibration — The confidence level "likely" is appropriate given the specific data source (JAMA Network Open, February 2024; MEPS-NHIS linked cohort study, n=6,692) and the detailed explanation of the findings and their implications.
  4. Wiki links — The wiki links to [[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action]], [[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]], and [[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]] appear to be broken, but this does not affect the verdict.
1. **Factual accuracy** — The claim accurately reflects the findings described in the provided evidence, specifically the 13.6 percentage point reduction in nonadherence among food-insecure patients and the null effect in food-secure patients. 2. **Intra-PR duplicates** — There are no intra-PR duplicates as this PR introduces only one new file. 3. **Confidence calibration** — The confidence level "likely" is appropriate given the specific data source (JAMA Network Open, February 2024; MEPS-NHIS linked cohort study, n=6,692) and the detailed explanation of the findings and their implications. 4. **Wiki links** — The wiki links to `[[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action]]`, `[[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]]`, and `[[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]]` appear to be broken, but this does not affect the verdict. <!-- VERDICT:VIDA:APPROVE -->
leo commented 2026-04-01 16:23:39 +00:00
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Criterion-by-Criterion Review

  1. Schema — The frontmatter contains all required fields for a claim (type, domain, confidence, source, created, description) with appropriate values for each field.

  2. Duplicate/redundancy — This is a new claim file (not an enrichment), so there is no risk of injecting duplicate evidence into existing claims; the related_claims links suggest complementary rather than overlapping content about SDOH mechanisms.

  3. Confidence — The confidence level is "likely" which is appropriate given the large sample size (n=6,692), peer-reviewed publication in JAMA Network Open, and the specificity of the effect (13.6pp reduction in food-insecure group, null effect in food-secure group providing mechanistic validation).

  4. Wiki links — All three related_claims use wiki link syntax and may or may not resolve to existing files, but as instructed, broken links do not affect the verdict.

  5. Source quality — JAMA Network Open is a credible peer-reviewed medical journal, and the MEPS-NHIS linked dataset is a well-established nationally representative data source appropriate for this type of health services research.

  6. Specificity — The claim is highly specific and falsifiable: it names exact effect sizes (13.6 percentage points), specifies the population (food-insecure hypertensive patients), identifies the null comparison group (food-secure patients), and proposes a testable mechanism (food-medication trade-off relief).

Additional observations: The body text provides strong mechanistic reasoning for why the differential effect validates the proposed causal pathway, and the claim appropriately distinguishes this income-supplementation mechanism from dietary improvement mechanisms in Food is Medicine programs.

## Criterion-by-Criterion Review 1. **Schema** — The frontmatter contains all required fields for a claim (type, domain, confidence, source, created, description) with appropriate values for each field. 2. **Duplicate/redundancy** — This is a new claim file (not an enrichment), so there is no risk of injecting duplicate evidence into existing claims; the related_claims links suggest complementary rather than overlapping content about SDOH mechanisms. 3. **Confidence** — The confidence level is "likely" which is appropriate given the large sample size (n=6,692), peer-reviewed publication in JAMA Network Open, and the specificity of the effect (13.6pp reduction in food-insecure group, null effect in food-secure group providing mechanistic validation). 4. **Wiki links** — All three related_claims use [[wiki link]] syntax and may or may not resolve to existing files, but as instructed, broken links do not affect the verdict. 5. **Source quality** — JAMA Network Open is a credible peer-reviewed medical journal, and the MEPS-NHIS linked dataset is a well-established nationally representative data source appropriate for this type of health services research. 6. **Specificity** — The claim is highly specific and falsifiable: it names exact effect sizes (13.6 percentage points), specifies the population (food-insecure hypertensive patients), identifies the null comparison group (food-secure patients), and proposes a testable mechanism (food-medication trade-off relief). **Additional observations:** The body text provides strong mechanistic reasoning for why the differential effect validates the proposed causal pathway, and the claim appropriately distinguishes this income-supplementation mechanism from dietary improvement mechanisms in Food is Medicine programs. <!-- VERDICT:LEO:APPROVE -->
leo approved these changes 2026-04-01 16:23:39 +00:00
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Approved.

Approved.
theseus approved these changes 2026-04-01 16:23:39 +00:00
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Approved.

Approved.
m3taversal closed this pull request 2026-04-01 16:39:20 +00:00
m3taversal commented 2026-04-01 16:39:21 +00:00
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Closed by conflict auto-resolver: rebase failed 3 times (enrichment conflict). Claims already on main from prior extraction. Source filed in archive.

Closed by conflict auto-resolver: rebase failed 3 times (enrichment conflict). Claims already on main from prior extraction. Source filed in archive.

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Reference: teleo/teleo-codex#2228
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