stemedb/uat/consumer-health/anecdotal-signal-precedence.md

UAT: Anecdotal Signal Precedence (Cluster Escalation)

Date: YYYY-MM-DD Feature: Escalation Signals Status: [ ] PASS / [ ] FAIL / [ ] BLOCKED

Scenario

When 500+ Tier 5 (Anecdotal) reports cluster around a subject with NO Tier 0-2 coverage, this should trigger an escalation signal. This represents "something the community is seeing that hasn't been validated yet."

Key validation: The system detects an information gap that needs expert investigation.

Acceptance Criteria

Criterion	Expected	Met?
500+ Tier 5 assertions exist	All ingested	[ ]
No Tier 0-2 for same subject	Verified	[ ]
Escalation signal created	event_type = "anecdotal_cluster"	[ ]
Signal includes cluster metadata	count, subject, predicate	[ ]
Threshold is configurable	Can adjust 500 limit	[ ]

Test Matrix

Step	Action	Expected	Actual	Status
1	Ingest 500 Tier 5 assertions	500 hashes returned		[ ]
2	Verify no Tier 0-2 exists	Empty result		[ ]
3	Query escalation events	Signal present		[ ]
4	Check signal metadata	count >= 500		[ ]
5	Add Tier 1 assertion	Signal resolved		[ ]

Escalation Logic

IF count(subject, predicate, tier=5) >= threshold
AND count(subject, predicate, tier IN [0,1,2]) == 0
THEN create_escalation_signal({
    event_type: "anecdotal_cluster",
    level: "investigate",
    subject: subject,
    predicate: predicate,
    cluster_count: count,
    message: "High-volume anecdotal reports with no authoritative coverage"
})

Setup Commands

# Start StemeDB
cargo run --bin stemedb-api &
sleep 2

Test Commands

Step 1: Ingest 500 Anecdotal Reports (New Symptom)

# A new symptom not yet documented by FDA/clinical
for i in $(seq 1 500); do
  HASH=$(printf '%064d' $((1000 + i)))
  curl -s -X POST http://localhost:18180/v1/assertions \
    -H "Content-Type: application/json" \
    -d "{
      \"subject\": \"Semaglutide\",
      \"predicate\": \"hair_loss_reported\",
      \"object\": {\"Boolean\": true},
      \"confidence\": 0.70,
      \"source_class\": \"Anecdotal\",
      \"source_hash\": \"$HASH\"
    }" > /dev/null
done
echo "Created 500 anecdotal hair loss reports"

Expected: 500 assertions created Actual: Status: [ ]

Step 2: Verify No Authoritative Coverage

# Check for Tier 0-2 assertions on hair_loss
curl "http://localhost:18180/v1/query?subject=Semaglutide&predicate=hair_loss_reported&source_class=Regulatory"
curl "http://localhost:18180/v1/query?subject=Semaglutide&predicate=hair_loss_reported&source_class=Clinical"
curl "http://localhost:18180/v1/query?subject=Semaglutide&predicate=hair_loss_reported&source_class=Observational"

Expected: All queries return empty results Actual: Status: [ ]

Step 3: Query Escalation Events

curl "http://localhost:18180/v1/escalations?subject=Semaglutide"

Expected:

{
  "events": [
    {
      "event_type": "anecdotal_cluster",
      "level": "investigate",
      "subject": "Semaglutide",
      "predicate": "hair_loss_reported",
      "cluster_count": 500,
      "message": "High-volume anecdotal reports with no authoritative coverage",
      "created_at": "..."
    }
  ]
}

Actual: Status: [ ]

Step 4: Check Signal Metadata

From Step 3 response, verify:

• cluster_count >= 500
• subject and predicate match
• level is "investigate"

Expected: All metadata correct Actual: Status: [ ]

Step 5: Resolve by Adding Authoritative Source

# Clinical study addresses the hair loss question
curl -X POST http://localhost:18180/v1/assertions \
  -H "Content-Type: application/json" \
  -d '{
    "subject": "Semaglutide",
    "predicate": "hair_loss_reported",
    "object": {"Text": "Post-hoc analysis shows 2.3% incidence, similar to placebo"},
    "confidence": 0.88,
    "source_class": "Clinical",
    "source_hash": "0000000000000000000000000000000000000000000000000000000000000099"
  }'

# Check if escalation is resolved
curl "http://localhost:18180/v1/escalations?subject=Semaglutide&status=active"

Expected: Escalation marked as "resolved" or removed from active list Actual: Status: [ ]

Sign-Off Checklist

• 500 anecdotal assertions ingested
• Escalation triggered for coverage gap
• Signal includes cluster count and metadata
• Adding authoritative source resolves signal
• Threshold is configurable (default 500)

Notes

Escalation signals are for investigation workflow. They don't change assertion storage or query results - they're a separate alert system.

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Tester: Date: Result: