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Recommends initiating hydrocortisone replacement at a total starting dose of 8 mg/m2 body surface area per day, given in three or four divided doses, for children with confirmed primary adrenal insufficiency (PAI). Use when starting glucocorticoid therapy in pediatric PAI patients, adjusting the dose according to individual clinical response, growth, and need for stress coverage.

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Recommends equipping every patient with primary adrenal insufficiency (PAI) with a glucocorticoid injection kit for emergency self‑administration and providing training on its use. Trigger when preparing a PAI patient for stress dosing, adrenal crisis prevention, or when prescribing glucocorticoid replacement and needing to ensure emergency preparedness.

日本語の概要は準備中です。原文の説明を表示しています。

Helps distinguish unilateral from bilateral adrenal disease based on 18-oxocortisol levels, which are typically higher in aldosterone-producing adenoma than idiopathic adrenal hyperplasia. Use when evaluating 18-oxocortisol results during PA workup to guide subtype classification after a positive ARR.

日本語の概要は準備中です。原文の説明を表示しています。

Determines follow‑up interval for patients with primary adrenal insufficiency (PAI) based on age: annual visits for adults and children, and every 3–4 months for infants. Triggered when establishing routine endocrine care after PAI diagnosis or during stable management.

日本語の概要は準備中です。原文の説明を表示しています。

Educates patients with primary adrenal insufficiency on increasing glucocorticoid dosage during intercurrent illness, fever (≥38°C), or physiological stress, including recognition of precipitating symptoms (e.g., fever, vomiting, trauma) and actions to prevent impending adrenal crisis. Trigger phrases: fever, intercurrent illness, stress, vomiting, inability to tolerate oral meds, need for parenteral glucocorticoid.

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Suggests testing HPA axis functionality before and after starting GH replacement in patients not receiving glucocorticoid replacement with apparently normal pituitary-adrenal function. Triggers include initiating GH replacement in a GHD patient who is not on glucocorticoids and has normal adrenal function.

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In patients with adrenal insufficiency receiving dexamethasone replacement, the guideline suggests increasing the dexamethasone dose when enzyme-inducing antiepileptic drugs are co-administered. Trigger phrases include "AI patient on dexamethasone starts enzyme-inducing antiepileptic drug" or "AI patient on dexamethasone requiring enzyme-inducing AED".

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Decide whether a kidney from a brain-dead deceased donor (DBD) with diabetes mellitus and/or hypertension is suitable for transplantation, using the ISOT 2025 Delphi consensus and Table 4 eligibility checklist. Trigger when a clinician asks "can I use a kidney from a diabetic deceased donor", "is this DBD with HTN/DM acceptable", "ECD donor with diabetes — accept or decline", "DBD eligibility for hypertensive donor", or shares a deceased donor with diabetes or hypertension and needs an accept/borderline/decline decision.

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Set absolute LDL-C, non-HDL-C, and ApoB treatment goals, PLUS percent LDL-C reduction, for a primary-prevention patient on lipid-lowering therapy per the re-introduced treatment goals in the 2026 ACC/AHA multisociety dyslipidaemia guideline. Covers goals by PREVENT-ASCVD category (low / borderline / intermediate / high), by CAC score, in severe hypercholesterolaemia / FH, in diabetes with multiple ASCVD risk factors, and the ApoB targets once LDL-C and non-HDL-C goals are met. Use when a clinician asks what LDL goal to aim for, LDL target for intermediate risk, non-HDL goal, ApoB target, dual goals on statin, patient at goal or not, how low should LDL go, statin not enough what next. Grounded in the 2026 ACC/AHA multisociety dyslipidaemia guideline.

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Administers immediate parenteral injection of 50–100 mg hydrocortisone for suspected adrenal crisis secondary to adrenal insufficiency. Triggers include hypotension, hypoglycemia, or acute illness in a patient with known adrenal insufficiency.

日本語の概要は準備中です。原文の説明を表示しています。

Suggests using longer-acting glucocorticoids when standard hydrocortisone regimens are impractical due to nonavailability, poor adherence, or need for once-daily dosing. Triggers include glucocorticoid replacement therapy decisions where patients report difficulty with multiple daily doses, lack of access to hydrocortisone, or preference for simplified regimens.

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Read-only release + backlog recap. Reports the last release, commits-since-tag classified by conventional-commit type with the semver bump they trigger and pushed-vs-origin state, the backlog bucketed (open/picked-up/dropped with epic parent→child nesting), the roadmap epics with their per-task tallies, and condensed open questions — then recommends the next pickup. One `cli.mjs recap` call returns all six recap keys. Invoke any time (on demand) to plan a release or choose the next thing to build; a compact form is also surfaced at session start. Not a workflow phase; never writes CHANGELOG; never starts or commits work.

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Cycle-end retrospective converting recurring judgment failures into durable enforcement. Reviews the cycle's friction — repeated user corrections, guard trips, RCA themes, integrate failures — and turns each recurring one into a landmines.md entry, then proposes graduation candidates up the enforcement funnel (landmine → advisory hook → hard gate). Pairs with standup: standup says what shipped and what's next; retrospective says what kept going wrong and how to stop it structurally. Writes only memory entries and a report — graduation proposals are advisory and require the normal seed.md amendment path to become enforcement. Invoke at the end of a release cycle, an epic, or any stretch of work with repeated friction.

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The primary tool for code-navigation questions in ANY language (frontend or backend) — walk the structural graph from an entry point (page, route, handler, command, `main`) down through imports to the IO boundary (network call, query, file read). Use this skill, in preference to the Explore agent or global grep, whenever the user asks "where does X come from?", "what API/data populates Y?", "what renders or wraps the Z panel?", "which file for feature F?", "how is this wired up?", or any code-navigation question mapping a UI element, route, or feature concept to source files. Also reverse queries ("what uses /api/foo?", "who consumes this service?"). Keyword search routinely picks up unrelated flows sharing a domain word and produces wrong answers; the walk follows the actual graph. The JS/TS `walk.mjs`/`discover.mjs` are an optional accelerator, not required — the walk is language-agnostic.

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Generate or repair a project's .gitignore. Composes the baseline must-ignore set (the single source of truth in baseline-ignores.json) with optional gitignore.io enrichment, and merges add-only so existing entries are never lost. Use when a repo has no .gitignore, when the commit-leak guard reports a gap, or when onboarding a new stack. Trigger: "set up gitignore", "fix my gitignore", "ignore node_modules/secrets", "gitignore for <stack>".

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Workflow track for tasks that need no TDD — documentation edits, governance count bumps, vendored-skill content updates, configuration tweaks, formatting, typo fixes, dependency bumps where no project code changes. Skips `/scenario` and `/implement` (no failing test to drive) and runs the work directly. `archive`, `memory-sync`, `/grant-commit`, and `/commit` remain mandatory. `verify`, `simplify`, `integrate`, and `document` are conditional — required when the diff hits one of the listed triggers, optional otherwise. `verify` is skipped only when the diff is pure-docs/prose AND `project.json → test.kind` is `behavior` (absent/invalid `test.kind` → `structural` → verify runs). Chore is a stripped-down pipeline, not a bypass; never silently skip a conditional phase whose triggers apply.

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Derive an execution roadmap from a project's vision/spec docs by first principles, then diff that fresh derivation against the existing roadmap to prove the task ORDER is correct. Use this whenever the user wants to review, validate, re-derive, or sanity-check an execution roadmap or delivery plan; asks whether the tasks/epics are "in the right order"; suspects a task is scheduled before its prerequisite (a producer-after-consumer / dependency-inversion error like "OpenAPI after the web client that consumes it", OR a cross-cutting inherited default like observability/auth/tenancy scheduled after the feature work that inherits it — a seam-after-consumer error); wants to find missing tasks, circular dependencies, or over-fragmented epics; or wants to compact a plan to raise velocity. Also trigger on "review the roadmap", "re-derive the plan from the spec", "is this the right build order", "check the dependency graph of our epics", "which task should come first". It reads the vision + spec corpus, decomposes actors → use-cases → modules → epics → typed tasks, identifies cross-cutting inherited-default seams, builds a real dependency graph with hard + soft (seam) edges (deterministic helper), breaks cycles, topologically orders, compacts, and emits a derived roadmap PLUS a delta report against the current one — it never blindly overwrites a hand-crafted roadmap.

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Write executable failing tests from a recipe handed to you by the main context. Used by `/tdd` Step 2 and ad-hoc when a phase needs tests-first to drive implementation. Decisions about which scenarios to cover, which categories matter, and which fixtures to use are made by the caller — this skill executes that recipe with code-structure discipline.

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Bootstrap the central system spec at `docs/system/` for a repository that has never had one. Scans the governed surface, proposes a concept map clustered by directory, and materializes elements + shards ONLY after a human confirms that map. Use when adopting the baseline on an existing project, or when the corpus needs re-deriving from scratch. Re-runnable. Requires `memory.architecture_map.enabled` and a declared `governed_surface`.

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Prepare amux for a new release. Updates version numbers, docs, getting-started, release notes, and blog post. Does NOT run the release script.

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Use for prioritization, or when there are more tasks than capacity: "what should we do first?", "rank this backlog", "cut scope for the MVP", "RICE score these". Picks a method (RICE, ICE, MoSCoW, impact-effort), scores items and sets a cut line. Skip for choosing between two designs.

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Use for tradeoff analysis, or when the user must pick between concrete options: "A or B?", "which library should we use?", "build vs buy", "compare these approaches". Scores options on weighted criteria, tests sensitivity and reversibility. Skip for open ideation or single-option reviews.

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Use for systems thinking, or when a change may ripple beyond its target: "what are the side effects?", "why does this keep coming back?", "how do these teams or services affect each other?". Maps loops, delays and leverage points. Skip for single-step fixes.

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Plan and implement infrastructure, CI/CD, container, deployment, observability, and operational configuration changes with least privilege, staged validation, and rollback awareness. Use for pipelines, infrastructure as code, Kubernetes, containers, release automation, monitoring, and production-readiness work; do not use to perform destructive production actions without explicit authorization.

日本語の概要は準備中です。原文の説明を表示しています。