medsci-skills 4.1.0

package/skills/present-paper/SKILL.md

@@ -0,0 +1,675 @@
+---
+name: present-paper
+description: >
+  Academic presentation preparation — paper-driven (journal club, grand rounds, seminar) and
+  lecture/teaching decks (course material, workshop slides, conference talks). Analyzes source
+  material, finds supporting references, drafts audience-adapted speaker scripts, generates or
+  augments PPTX with speaker notes, and prepares Q&A.
+triggers: present paper, paper presentation, journal club, seminar presentation, grand rounds, academic presentation, presentation prep, lecture, lecture material, teaching slides, course slides, 강의자료, 발표자료, 슬라이드, pptx
+tools: Read, Write, Edit, Bash, Grep, Glob
+model: inherit
+---
+
+# Present-Paper Skill
+
+## Purpose
+
+Prepare a polished academic presentation from a research paper. The skill walks through a 5-phase
+pipeline: paper analysis, supporting research, script writing, slide note injection, and Q&A
+preparation.
+
+Use it when:
+
+- preparing a journal club or seminar presentation
+- presenting a paper for a graduate course
+- preparing grand rounds or conference talks based on a published paper
+- building speaker notes for an existing slide deck
+
+---
+
+## Communication Rules
+
+- Communicate with the user in their preferred language.
+- Use English for medical, statistical, and methodological terminology.
+- Add pronunciation guides for drug names and technical abbreviations in the user's language.
+- Be direct about paper limitations, but frame them constructively.
+
+---
+
+## Phase 0: Init & Outline
+
+### Step 0a — Load design references (read before drafting outline)
+
+Before collecting inputs, the skill loads three reference files:
+
+1. **`references/slide_design_principles.md`** — Reynolds (Presentation Zen) +
+   Duarte (Slide:ology Glance Test™) + Knaflic (Storytelling with Data preattentive
+   attributes) + Tufte (Cognitive Style of PowerPoint). Defines the 5 design
+   principles, reading-time budgets per audience, cognitive-load ceilings, and the
+   anti-patterns this skill is built to avoid. **Read this first** — it shifts the
+   outline from "what content fits" to "what should the audience remember 10 seconds
+   after each slide."
+2. **`references/medical_presentation_templates.md`** — Section structure, slide counts,
+   and design seeds for the 5 contexts: journal club, grand rounds, conference talk,
+   lecture, and academic lecture multi-paper survey. Pick the matching template after
+   Phase 0 inputs are collected, then customize.
+3. **`references/slide_visual_styles/`** — visual style specs (color palette, typography,
+   layout grid, slide-type templates) callable from any of the 5 context templates.
+   Currently available: `nature_lancet.md` (Nature/Lancet aesthetic — white background,
+   navy primary, coral accent, Inter/Pretendard). Default for academic lectures per
+   `~/.claude/rules/academic-lecture-style.md`. Paired with the generic builder
+   `templates/build_pptx_nature_lancet.py` and the PDF figure extractor
+   `scripts/extract_pdf_figures.py`.
+
+These two files mirror the entry-point pattern used in
+`make-figures/references/design_principles.md` (Step 1 "Specify"). Both skills share
+the same Reynolds / Knaflic / Tufte foundations — slide-level (this skill) and
+figure-level (make-figures) are companions, not duplicates.
+
+### Required Inputs
+
+Before starting, collect these from the user:
+
+| Input | Why |
+|-------|-----|
+| **Paper** | PDF path, DOI, or PMID |
+| **Presentation time** | Determines depth and slide count |
+| **Target audience** | Specialty mix, knowledge level — controls terminology depth |
+| **Context** | Course name, conference, journal club format, prior session topics |
+| **Extension section** | Optional topic to include (e.g., AI directions, clinical implications). Default: none |
+
+### Paper Analysis
+
+Read the paper and produce a structured analysis:
+
+```text
+## Paper Analysis
+
+### Citation
+[Full citation with DOI]
+
+### Background
+- What gap does this paper address?
+- What was known vs. unknown before this study?
+
+### Study Design
+- Type: [RCT / cohort / case series / meta-analysis / etc.]
+- Subjects: [n, inclusion/exclusion]
+- Methods: [key methodological choices]
+- Primary outcome: [what was measured]
+
+### Key Results
+1. [Finding 1 with effect size and CI/p-value]
+2. [Finding 2]
+3. [Finding 3]
+
+### Patient/Case Summary Table
+[If applicable — structured table of individual cases or subgroups]
+
+### Limitations
+1. [Limitation 1]
+2. [Limitation 2]
+
+### Significance
+- Why does this matter?
+- What changes because of this paper?
+```
+
+### Slide Outline
+
+Create a slide-by-slide outline with time allocation:
+
+```text
+## Slide Outline ([N] slides, [M] minutes)
+
+| # | Title | Time | Key Content |
+|---|-------|------|-------------|
+| 1 | Title slide | 0:30 | Paper citation, presenter |
+| 2 | Context / Prior sessions | 1:00 | How this connects to prior knowledge |
+| 3 | Background | 1:30 | The gap this paper fills |
+| ... | ... | ... | ... |
+| N | Take-home messages | 0:30 | 3-5 key points |
+```
+
+**Gate: User approves outline before proceeding.**
+
+---
+
+## Phase 1: Supporting Research
+
+### Search Strategy
+
+Find references that strengthen the presentation:
+
+1. **Follow-up studies** — Has the main finding been replicated or extended?
+2. **Clinical trial data** — Large-scale data that contextualizes the findings
+3. **Review articles** — Authoritative summaries that frame the topic
+4. **Contradicting evidence** — Important for balanced Q&A preparation
+
+**Efficiency rule:** Limit supporting references to 5-8 total. Only search categories
+that the approved outline (Phase 0) actually requires. Skip categories not needed for
+the presentation type (e.g., skip clinical trials for a methods-focused paper).
+
+### Selection Criteria
+
+Do NOT summarize every paper found. Extract only:
+
+- Specific data points needed for slides (incidence rates, OR/HR, AUC values)
+- Findings that directly support or challenge the main paper
+- Context that helps the audience understand significance
+
+### Output
+
+```text
+## Verified References
+
+### Main Paper
+1. [Citation] — PMID: XXXXX, DOI: XX.XXXX/XXXXX
+
+### Supporting References
+2. [Citation] — PMID: XXXXX
+   → Used for: [specific data point or context]
+3. [Citation] — PMID: XXXXX
+   → Used for: [specific data point or context]
+
+### Key Data for Slides
+- [Statistic 1]: [value] — Source: [Ref #]
+- [Statistic 2]: [value] — Source: [Ref #]
+```
+
+**Every reference must have a verified DOI or PMID. Mark unverified references with [UNVERIFIED].**
+
+---
+
+## Phase 2: Script & Content
+
+### Speaker Script
+
+Draft a complete speaker script with these requirements:
+
+1. **Language**: User's preferred language for narration; English for technical terms
+2. **Audience adaptation**: Adjust explanation depth based on Phase 0 audience profile
+   - For mixed audiences: add one-line plain-language explanations for specialty-specific terms
+   - Example: "FLAIR sequence — an MRI technique that suppresses fluid signal to highlight edema"
+3. **Pronunciation guide**: Include native-language pronunciation for drug names, abbreviations
+   - Example: "lecanemab (leh-KAN-eh-mab)" or local equivalent
+4. **Timing markers**: Note approximate time per slide
+5. **Transition phrases**: Connect each slide to the narrative arc
+
+### Structure
+
+```text
+## Speaker Script
+
+### Slide 1: Title (0:30)
+"[Opening — introduce yourself and the paper]"
+
+### Slide 2: Context (1:00)
+"[Connect to prior knowledge or clinical relevance]"
+
+...
+
+### Slide N: Take-home Messages (0:30)
+"[Summarize 3-5 key points. Thank audience. Invite questions.]"
+```
+
+### Extension Section (Optional)
+
+Only include if user requested in Phase 0. Examples:
+
+- AI/computational research directions stemming from the paper
+- Clinical practice implications
+- Policy or guideline implications
+- Connections to the user's own research
+
+**Gate: User reviews script before proceeding.**
+
+---
+
+## Phase 3: Slides & Notes
+
+### Two Modes
+
+**Mode A: Generate new slide deck**
+
+Generate a fully-editable PPTX from structured inline data using `python-pptx`. Two
+canonical template libraries:
+
+- `${CLAUDE_SKILL_DIR}/references/generate_pptx_templates.py` — generic T_lead /
+  T_text / T_table / T_image_right / etc. templates with smoke-tested `main()`. Use
+  for journal club, grand rounds, conference talk, and short paper talks.
+- `${CLAUDE_SKILL_DIR}/templates/build_pptx_nature_lancet.py` — Nature/Lancet visual
+  style (white + navy + coral, Inter/Pretendard, 47-slide academic lecture proven).
+  Use for **academic lecture multi-paper survey** (template #5). Functions:
+  `new_presentation`, `add_title_slide`, `add_toc_slide`, `add_section_divider`,
+  `add_transition_slide`, `add_content_slide`, `add_glossary_slide`,
+  `add_closing_slide`, plus `fix_app_xml()` helper. Style spec:
+  `references/slide_visual_styles/nature_lancet.md`.
+
+For lecture decks pulling figures from PDFs (rather than from `/make-figures`
+output), use `${CLAUDE_SKILL_DIR}/scripts/extract_pdf_figures.py` — pdftoppm + PIL
+crop with normalized (0–1) box coordinates. Supports both single-crop CLI and YAML
+batch config.
+
+After raw extraction, run `${CLAUDE_SKILL_DIR}/scripts/trim_caption.py` to
+**auto-remove journal headers / figure captions / surrounding whitespace** so
+that only the figure body remains — the Adobe-Acrobat-crop equivalent in
+automation. The script uses horizontal-projection segmentation plus
+text-band detection (height + density + gap + line-pattern signature) and
+preserves multi-panel figures intact:
+
+```bash
+python3 "${CLAUDE_SKILL_DIR}/scripts/trim_caption.py" \
+  --in-dir  figures/extracted \
+  --out-dir figures/cropped
+```
+
+Handles four common journal layouts: top running-head bar, bottom multi-line
+caption (sparse text), bottom caption *fused* with figure body (no clear gap,
+detected via narrow dark/light alternation), and multi-row tables with
+footnotes (footnote cut, table rows preserved). No tesseract / OCR
+dependency — Pillow + numpy only. Verified on 12-figure academic deck
+(80–95% height retention; captions, journal banners, and CellPress-style
+headers all removed). When the deck slot expects only the figure body
+(default for `build_pptx_nature_lancet.py`), point `FIG_DIR` at the cropped
+output dir.
+
+### Word-boundary aware markdown parser (mandatory for HLA-rich decks)
+
+When the build script parses inline `**bold**` / `*italic*` markers in slide
+body or speaker notes, the italic rule must use **word-boundary lookahead /
+lookbehind** so asterisk-bearing scientific tokens (HLA alleles like
+`DRB1*07:01`, `HLA-A*02:01`, SNP IDs, footnote markers) are not eaten as
+italic delimiters:
+
+```python
+import re
+pattern = re.compile(
+    r"(\*\*(?:(?!\*\*).)+?\*\*"                           # bold; inner single * allowed
+    r"|(?<![A-Za-z0-9])\*[^*\n]+?\*(?![A-Za-z0-9]))"      # italic (word-boundary)
+)
+```
+
+Two regex tricks together:
+1. **Italic with boundary**: `(?<![A-Za-z0-9])` and `(?![A-Za-z0-9])` reject
+   `*` adjacent to alphanumerics, so `DRB1*07:01` is left intact.
+2. **Bold tolerates inner single `*`**: `(?:(?!\*\*).)+?` allows
+   `**DRB1*04:02**` (HLA allele inside bold) to match as a single bold span.
+
+Without these, a naive `\*[^*]+\*` italic pattern silently corrupts every
+HLA allele in the deck. Add the regex to `add_styled()` (or equivalent) in
+every Nature/Lancet-style build script.
+
+### Pronunciation auto-augment for non-native presenters
+
+For decks where the presenter is uncomfortable with English pronunciation of
+acronyms, author names, drug names, or gene symbols, append a per-slide
+`[ Pronunciation ]` section to the speaker notes (audience sees nothing —
+only Presenter View). Use
+`${CLAUDE_SKILL_DIR}/scripts/inject_pronunciation_notes.py`:
+
+```bash
+python3 "${CLAUDE_SKILL_DIR}/scripts/inject_pronunciation_notes.py" \
+  input.pptx output.pptx \
+  --dict pron_dict.yaml \
+  --header "[ 발음 ]"            # or any header you like
+```
+
+The script:
+- Loads a YAML/JSON `PRON_DICT` (term → [reading, full_name]) supplied by
+  the caller. The dict is domain-specific — assemble it for your audience
+  (Korean readings, French readings, Spanish readings, etc.).
+- Uses **word-boundary regex** `(?<![A-Za-z0-9_]) … (?![A-Za-z0-9_])` so
+  short acronyms (e.g. `AE`, `OR`) only match when standalone, never inside
+  other words.
+- Recognizes allele-style tokens via a separate regex
+  (`\b(?:HLA-)?[A-Z]{1,5}[0-9]?\*[0-9]{2}:[0-9]{2}\b` by default) and
+  synthesizes their reading from the base allele entry in the dict.
+- Skips slides that already contain the header (idempotent — safe to re-run).
+
+Realistic yield on a 47-slide academic deck: ~38 slides receive a section,
+~300 total term entries, 5–10 per annotated slide. Transition and divider
+slides have empty notes and are auto-skipped.
+
+### Speaker notes statistics density
+
+When the slide body already shows exact OR / 95% CI / p-value, the notes
+should NOT repeat the same numbers — the presenter ends up reading
+statistics aloud and the audience cannot keep up. Notes should be a
+**narrative** (key anchors + one-line "see the slide body for the exact
+numbers" reminder), not a numeric listing.
+
+Quick measurement to spot dense slides during QC:
+
+```python
+import re
+text = slide.notes_slide.notes_text_frame.text.split(pron_header)[0]
+n_char = len(text)
+n_stat = len(re.findall(r"\b(?:OR|p|CI)\s*[=<>]?\s*\d|\d+\.\d+|\d+%|×10", text))
+needs_compression = n_char > 1000 and n_stat >= 5
+```
+
+Rule of thumb: 700–1,000 chars + 0–2 stat tokens is fine (30–60-second
+narrative). >1,000 chars + ≥5 stat tokens → compress to narrative tone and
+point at the slide body. Exact numbers belong in the slide body and
+footnotes (SSOT), not the notes.
+
+### Sharing-ready notes-stripped variant
+
+After the presentation, when the deck is shared with the audience (e.g. a
+professor asking for the slides), the speaker notes typically contain
+presenter-only material — second-language narrative, pronunciation hints,
+self-referential reminders ("Prof. ○○ will likely ask about …"). Stripping
+notes is mandatory before circulation. Use
+`${CLAUDE_SKILL_DIR}/scripts/strip_notes_for_sharing.py`:
+
+```bash
+python3 "${CLAUDE_SKILL_DIR}/scripts/strip_notes_for_sharing.py" \
+  presenter_v9.pptx share/<topic>_<initials>.pptx
+```
+
+The script:
+- Clears every slide's `notes_text_frame` (idempotent, slide body and
+  figures untouched).
+- Re-writes `docProps/app.xml` with the correct `Slides=` and `Notes=`
+  counts so PowerPoint Mac does not show its repair dialog (see also the
+  app.xml canonical fix in `pptx-mac-compatibility.md` §5).
+- Verifies that zero notes characters remain.
+
+Recommended 3-file sharing package (filename pattern `<topic>_<initials>`):
+- `<topic>_<initials>.pptx` — notes-stripped variant for slide reuse
+- `<topic>_<initials>.pdf` — same deck, PDF for environment-agnostic
+  preview (LibreOffice `--convert-to pdf` automatically drops the cleared
+  notes pages)
+- `<topic>_<initials>_references.zip` — optional bundle of the reference
+  PDFs; if it exceeds the email attachment limit, send a Google Drive link.
+
+In the cover email, mention the PPTX is included specifically so the
+recipient can reuse individual slides if useful.
+
+### Architecture
+
+```
+inline structured data (lists/dicts in build_*_slides())
+    ↓ template functions (T_lead / T_text / T_table / ...)
+editable PPTX with native text frames (selectable, restyleable in PowerPoint)
+```
+
+Three rules that keep slides stable:
+
+1. **No markdown parsing.** Every slide is a function call with explicit inline data.
+2. **No `cur_top` cumulative position tracking.** Use the fixed coordinate zones below — `cur_top` accumulates rounding errors and breaks layout after ~10 slides.
+3. **No Marp.** Marp renders to images; the deck becomes uneditable and reviewers cannot copy text or restyle.
+
+### Slide-type templates
+
+| Template | Use for | Required fields |
+|----------|---------|-----------------|
+| `T_lead` | Title slide, section divider | `title`, `subtitle?`, `extra?` |
+| `T_text` | Bullet body (most common) | `title`, `body_lines[]`, `subtitle?` |
+| `T_table` | Cohort tables, comparisons | `title`, `headers[]`, `rows[][]`, `body_before?` |
+| `T_image_right` | Body + figure on right | `title`, `body_lines[]`, `img_path`, `img_pct?` (PNG ≥300dpi or vector PDF — see Figure source formats below) |
+| `T_quote_slide` | Verbatim citations, witness quotes | `title`, `quotes[]`, `body_after?`, `img_path?` |
+| `T_two_col` | Compare/contrast | `title`, `left_lines[]`, `right_lines[]` |
+| `T_two_col_with_box` | Compare + emphasis | as above + `metaphor_col`, `metaphor_lines[]` |
+| `T_highlight_slide` | Single key result | `title`, `highlight_lines[]`, `body_before?` |
+| `T_metaphor_body` | Body + analogy footer | `title`, `body_lines[]`, `metaphor_lines[]` |
+| `T_table_two_col` | Take-aways + numeric table | `title`, `left_lines[]`, `headers[]`, `rows[][]` |
+
+### Figure source formats (when consuming `/make-figures` output)
+
+When the deck pulls figures from `analysis/figures/` produced by `/make-figures`:
+
+- **Preferred for slides**: PNG at ≥300 dpi. python-pptx `add_picture()` handles this directly. Set `img_pct` (template `T_image_right`) so the figure occupies ≥40 % of slide width on a 13.33 × 7.5-in widescreen layout.
+- **Vector source available**: prefer PDF only if the slide will be projected at >1080p or printed as a handout — convert PDF → PNG at the target DPI (`pdftoppm -r 300 input.pdf out_prefix`) before insertion, because python-pptx PDF embedding is unreliable across PowerPoint versions.
+- **Forbidden**: TIFF (Mac PowerPoint silently drops it — see Mac compatibility checklist below); JPEG for line art (compression artifacts on diagonal lines); raw SVG (PowerPoint Mac handles it inconsistently).
+- **Caption / legend**: re-draft for spoken-narration context, not the journal legend verbatim. The journal legend assumes a reader; the slide caption assumes a listener with 5–10 seconds of attention.
+
+### Helpers (used by templates — usually you do not call directly)
+
+| Helper | Role |
+|--------|------|
+| `_text` | Single text box with `**bold**` inline markup |
+| `_multiline` | Multi-line block with bullet (`- `, `✓ `) and `### subhead` support |
+| `_title_block` | Title + teal underline + optional subtitle |
+| `_table` | Styled table (teal header row, alternating rows) |
+| `_quote` | Blockquote — teal left bar + light-blue background |
+| `_highlight` | Yellow rounded box + orange 2pt border |
+| `_metaphor` | Same shape as quote, lighter font |
+| `_image` | PIL aspect-preserving image insert (handles iPhone EXIF if you transpose first) |
+| `_slidenum` | Bottom-right page number |
+
+### Design tokens (defaults — change to fit institution/journal)
+
+```python
+NAVY    = #1B2A4A   # title text, section divider background
+TEAL    = #0072B2   # subtitle, underline, table header bg, quote bar
+ORANGE  = #D55E00   # highlight box border
+GRAY    = #333333   # body text
+FONT    = 'Apple SD Gothic Neo'   # use a Latin-only font on non-Korean decks
+```
+
+### Fixed coordinate zones (16:9 = 13.333" × 7.5")
+
+```
+ML / MR = 0.8"     MT = 0.5"     CW = SW − ML − MR = 11.733"
+
+TITLE_Y = 0.5"    TITLE_H = 0.8"
+SUB_Y   = 1.3"    SUB_H   = 0.5"
+BODY_Y  ≈ 1.9"    BODY_H  ≈ 5.1"
+```
+
+### Build script responsibilities
+
+A from-scratch generation script must:
+
+- Convert TIFF images to PNG before `add_picture` (Mac PowerPoint silently drops TIFF).
+- Apply EXIF transpose to iPhone photos before insertion.
+- After inserting/removing slides, sync `docProps/app.xml` (`<Slides>`, `<Notes>`, `HeadingPairs`, `TitlesOfParts`) to the actual count, or PowerPoint Mac will raise a recovery dialog on open.
+- If you copy `<a:srcRect>` from another deck, copy the values verbatim — they are 1/1000-percent (cap 100000), never EMU. A unit conversion bug here crops 99% of the image off-slide.
+- Print slide count, notes count, file size, and editability check at the end.
+
+### Forbidden in Mode A
+
+- ❌ Marp CLI for PPTX (always image-rendered, uneditable).
+- ❌ Markdown auto-parsing into slides (layout drifts on every regeneration).
+- ❌ `cur_top` cumulative top tracking (accumulates rounding error).
+- ❌ Direct iPhone photo insert without EXIF transpose (rotated 90° in PowerPoint).
+- ❌ Using `python-pptx` from-scratch rebuild to *edit* an existing deck — see Patch over Rebuild below.
+
+### Mac PowerPoint compatibility checklist
+
+PowerPoint Mac is stricter than Windows / Keynote / LibreOffice on OOXML defects.
+Verify before delivering any deck destined for a Mac viewer:
+
+| Defect | Detect | Fix |
+|---|---|---|
+| **TIFF images** | `find ppt/media -iname '*.tif*'` | `sips -s format png in.tif --out out.png` + replace `.tif`→`.png` in `_rels/*.rels` |
+| **`<a:sp3d>` in rPr** | `grep -l '<a:sp3d>' ppt/slides/*.xml` | Regex-strip the `<a:sp3d>...</a:sp3d>` block (renders as red outline only on Mac) |
+| **`app.xml` count mismatch** | `<Slides>` value + `HeadingPairs` count + `TitlesOfParts` size vs actual slide files | Sync all four fields to real count |
+| **`srcRect` corruption** | Any value > 100000 (1/1000-percent cap) | Compare with original deck; restore verbatim |
+
+Validation must run on **PDF export AND Mac PowerPoint** — neither alone catches all four. PDF misses `sp3d` outlines and `srcRect` corruption.
+
+### Patch over Rebuild — editing an existing PPTX
+
+When the user supplies an existing deck and asks for surgical edits (textbox width, image
+crop, font swap, sp3d removal), prefer **regex/sed patching of the unzipped XML** over
+regenerating with `python-pptx`. From-scratch rebuild loses:
+
+- `<a:srcRect>` image crops
+- `<a:sp3d>` / `<a:scene3d>` (when intentional)
+- Slide master / layout / theme details
+- `app.xml` and `core.xml` metadata
+
+```bash
+unzip -q original.pptx -d /tmp/work
+python3 -c "
+import re; from pathlib import Path
+p = Path('/tmp/work/ppt/slides/slide23.xml')
+s = p.read_text()
+s = s.replace('cx=\"9504720\"', 'cx=\"11200000\"')
+p.write_text(s)
+"
+cd /tmp/work && zip -rq ../patched.pptx . -x '*.DS_Store'
+```
+
+`python-pptx` is reserved for (a) brand-new decks built via the templates above, or
+(b) appending speaker notes via `slide.notes_slide.notes_text_frame.text`. The skill's
+`scripts/inject_speaker_notes.py` is the canonical example of (b).
+
+### Standard structure (10–15 min paper talk)
+
+1. Title slide (`T_lead`) — paper citation + presenter
+2. Background (`T_text` × 1–2)
+3. Study design / Methods (`T_text` or `T_two_col`)
+4. Key results with figures (`T_image_right` / `T_table` × 2–3)
+5. Discussion (`T_text`)
+6. Limitations (`T_two_col_with_box` works well)
+7. Take-home (`T_text` or `T_highlight_slide`)
+
+### Output
+
+Save to `output/presentation.pptx`. Speaker notes go into the notes pane only — never
+modify slide design when adding notes.
+
+### Step 3.5 — Slide critic (run before delivering deck)
+
+After exporting the PPTX, run the slide critic rubric at
+`references/critic_rubrics/slide.md`. Score each slide and the deck-level Mac
+compatibility checks (Section F) as PASS / PARTIAL / FAIL. Produce concrete edits for
+every FAIL or PARTIAL item before treating the deck as ready.
+
+Mandatory deck-level checks (cross-link with `~/.claude/rules/pptx-mac-compatibility.md`):
+
+```bash
+# F.22 No TIFF
+find ppt/media -iname '*.tif*' || true   # must be empty
+
+# F.23 No 3-D bevel
+grep -l '<a:sp3d>' ppt/slides/*.xml      # must be empty
+
+# F.24 app.xml count sync
+grep -c '<Slides>\|<Notes>' docProps/app.xml
+ls ppt/slides/slide*.xml | wc -l         # must match
+
+# F.25 srcRect bounds (any value > 100000 = bug)
+grep -oE '"[0-9]{6,}"' ppt/slides/*.xml | head
+```
+
+Record `critic_pass: yes | partial | no` and `refine_rounds: N` in `_quick_review.md`.
+
+**Mode B: Add notes to existing slides** (more common)
+- Read existing PPTX to understand slide structure and count
+- Map speaker script sections to corresponding slides
+- Generate `inject_notes.py` script tailored to the specific presentation
+
+### Note Injection Script
+
+Generate a tailored `inject_notes.py` following the pattern in
+`${CLAUDE_SKILL_DIR}/scripts/inject_speaker_notes.py`. The generated script should
+contain only the `notes` dictionary customized for this presentation and the main
+injection loop from the template.
+
+### Critical Rule
+
+**Speaker notes are injected without modifying slide design, layout, text, or images.**
+The script only touches the notes pane. Verify by comparing slide content before and after.
+
+---
+
+## Phase 4: Q&A Preparation
+
+### Question Generation
+
+Generate questions from multiple perspectives:
+
+1. **Methodology critics**: "Why this design? Why not...?"
+2. **Domain experts**: Deep technical questions about the specific field
+3. **Generalists**: "What does this mean for clinical practice?"
+4. **Students/trainees**: Clarification questions about unfamiliar concepts
+
+### Answer Structure
+
+Every answer should follow the pattern:
+
+```
+Acknowledge → Evidence → Conclude
+
+"That's an important limitation. [Acknowledge the concern honestly.]
+However, [cite specific supporting evidence — author, year, finding].
+So while [restate limitation], [conclude with the paper's contribution despite it]."
+```
+
+### Quick Review Sheet
+
+A single-page reference for last-minute review:
+
+```text
+## Quick Review
+
+### Must-Know Numbers
+| Metric | Value | Source |
+|--------|-------|--------|
+| [Key stat 1] | [value] | [Ref] |
+| [Key stat 2] | [value] | [Ref] |
+
+### Common Pitfalls
+- Don't confuse [X] with [Y]
+- [Classification A] and [Classification B] are independent frameworks
+- Slide says [rounded value], precise value is [exact value]
+
+### Key Takeaways (memorize these)
+1. [Point 1]
+2. [Point 2]
+3. [Point 3]
+```
+
+---
+
+## Output File Structure
+
+All outputs go in the user's presentation directory:
+
+```
+{presentation_dir}/
+├── _analysis.md              # Phase 0: Paper analysis + outline
+├── _references.md            # Phase 1: Verified references + key data
+├── _script.md                # Phase 2: Speaker script
+├── _qa_prep.md               # Phase 4: Expected Q&A
+├── _quick_review.md          # Phase 4: Pre-presentation review sheet + critic_pass record
+├── _slide_critic.md          # Phase 3.5: Slide rubric scores per slide
+├── inject_notes.py           # Phase 3: Tailored note injection script
+├── figures/                  # Extracted paper figures (if needed)
+└── reference/                # Supporting paper PDFs (if downloaded)
+```
+
+## Cross-skill / Cross-rule integration
+
+This skill composes with adjacent skills and global rules:
+
+| When | Use | Why |
+|---|---|---|
+| Need a figure on a slide (ROC, forest, KM, flow) | `/make-figures` first, then embed | Both skills share Reynolds/Knaflic/Tufte foundations; figure-level + slide-level companions |
+| Manuscript reporting checklist parallel | `/check-reporting` for the same paper | Paper presentations often shadow manuscript revision; reporting-guideline gaps surface in Q&A |
+| Visual abstract / Central Illustration | `/make-figures` visual-abstract templates | Then verify against `~/.claude/rules/journal-ai-image-policies.md` (JACC prohibits, Radiology allows with disclosure) |
+| PPTX edits to existing institutional template | `~/.claude/rules/pptx-mac-compatibility.md` | Patch over rebuild; preserve master/layout/srcRect |
+| Manuscript companion deck | `~/.claude/rules/manuscript-style-classical.md` | Heading style, AI-Disclosure policy, em-dash discipline carry over to slides for senior MA reviewer audiences |
+| References on slides | `/verify-refs` (audit-only) before delivery | Same anti-hallucination gate as manuscript references |
+
+---
+
+## Constraints
+
+- **Never fabricate references.** Every citation must be verified against PubMed, DOI, or the PDF itself.
+- **Never modify slide design** when injecting notes. Notes and slides are separate concerns.
+- **Always ask audience first.** Do not start drafting until the target audience is defined.
+- **Extension sections are opt-in.** Do not add AI/clinical/policy sections unless explicitly requested.
+- **Respect presentation time.** Script length must match allocated time (roughly 130-150 words per minute for academic presentations).
+
+## Anti-Hallucination
+
+- **Never fabricate references.** All citations must be verified via `/search-lit` with confirmed DOI or PMID. Mark unverified references as `[UNVERIFIED - NEEDS MANUAL CHECK]`.
+- **Never invent clinical definitions, diagnostic criteria, or guideline recommendations.** If uncertain, flag with `[VERIFY]` and ask the user.
+- **Never fabricate numerical results** — compliance percentages, scores, effect sizes, or sample sizes must come from actual data or analysis output.
+- If a reporting guideline item, journal policy, or clinical standard is uncertain, state the uncertainty rather than guessing.