const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE"; // 13.3 x 7.5 inches

// ─── COLOR PALETTE ───────────────────────────────────────────────
const C = {
  navy:    "0D1B2A",   // dominant dark background
  teal:    "1B7F8E",   // accent / section label
  amber:   "E8A838",   // highlight / key numbers
  white:   "F4F7FA",   // body text on dark
  lightBg: "EDF2F7",   // light slide background
  midGray: "6B7280",   // secondary text on light
  red:     "C0392B",   // warning / negative
  green:   "1A8754",   // positive
  slate:   "1E3A5F",   // second dark shade
};

// ─── MASTER HELPERS ──────────────────────────────────────────────
function darkSlide(slide) {
  slide.background = { color: C.navy };
}
function lightSlide(slide) {
  slide.background = { color: C.lightBg };
}
function addTag(slide, label, x, y) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w: 2.2, h: 0.32, fill: { color: C.teal }, line: { type: "none" },
    rectRadius: 0.04,
  });
  slide.addText(label.toUpperCase(), {
    x, y, w: 2.2, h: 0.32,
    fontSize: 9, bold: true, color: C.white, align: "center", valign: "middle",
    charSpacing: 2,
  });
}
function sectionDivider(slide, title, sub) {
  darkSlide(slide);
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 2.8, w: 13.3, h: 0.06, fill: { color: C.teal }, line: { type: "none" } });
  slide.addText(title, {
    x: 1, y: 1.4, w: 11.3, h: 1.4,
    fontSize: 44, bold: true, color: C.white, align: "center", valign: "middle",
  });
  if (sub) slide.addText(sub, {
    x: 1, y: 3.1, w: 11.3, h: 0.7,
    fontSize: 18, color: C.amber, align: "center",
  });
}

// ─── SLIDE 1 — TITLE ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  darkSlide(s);
  // Left accent bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.22, h: 7.5, fill: { color: C.teal }, line: { type: "none" } });
  // Amber rule
  s.addShape(pres.ShapeType.rect, { x: 0.22, y: 3.55, w: 12.9, h: 0.06, fill: { color: C.amber }, line: { type: "none" } });

  s.addText("ALPS TRIAL", {
    x: 0.55, y: 0.65, w: 12.0, h: 0.55,
    fontSize: 16, bold: true, color: C.teal, charSpacing: 5,
  });
  s.addText([
    { text: "Amiodarone, Lidocaine,", options: { breakLine: true } },
    { text: "or Placebo in", options: { breakLine: true } },
    { text: "Out-of-Hospital Cardiac Arrest", options: {} },
  ], {
    x: 0.55, y: 1.2, w: 12.0, h: 2.1,
    fontSize: 40, bold: true, color: C.white, lineSpacingMultiple: 1.15,
  });

  s.addText("Kudenchuk PJ et al.  •  N Engl J Med 2016;374:1711–22", {
    x: 0.55, y: 3.75, w: 12.0, h: 0.45,
    fontSize: 15, color: C.amber,
  });
  s.addText("Resuscitation Outcomes Consortium (ROC-ALPS)", {
    x: 0.55, y: 4.25, w: 12.0, h: 0.38,
    fontSize: 14, color: C.white, italic: true,
  });

  // Bottom meta row
  s.addShape(pres.ShapeType.rect, { x: 0.22, y: 6.7, w: 12.9, h: 0.04, fill: { color: C.slate }, line: { type: "none" } });
  s.addText("JOURNAL CLUB PRESENTATION  •  EMERGENCY MEDICINE / CRITICAL CARE", {
    x: 0.55, y: 6.8, w: 12.0, h: 0.4,
    fontSize: 10, color: C.midGray, charSpacing: 1.5,
  });
}

// ─── SLIDE 2 — OVERVIEW / AGENDA ─────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addTag(s, "Agenda", 0.5, 0.4);

  s.addText("What We'll Cover", {
    x: 0.5, y: 0.85, w: 12.0, h: 0.7,
    fontSize: 32, bold: true, color: C.navy,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.55, w: 3.5, h: 0.05, fill: { color: C.teal }, line: { type: "none" } });

  const items = [
    ["01", "Background & Clinical Context", "Why do we give antiarrhythmics in OHCA?"],
    ["02", "PICO Framework", "Population · Intervention · Comparison · Outcome"],
    ["03", "Study Design & Methods", "RCT design, randomization, blinding, endpoints"],
    ["04", "Results", "Primary, secondary, subgroup, mechanistic outcomes"],
    ["05", "Critical Appraisal", "Strengths, limitations, bias assessment"],
    ["06", "Clinical Implications", "What should change at the bedside?"],
  ];

  items.forEach(([num, title, sub], i) => {
    const col = i < 3 ? 0 : 1;
    const row = i % 3;
    const x = col === 0 ? 0.5 : 6.9;
    const y = 1.85 + row * 1.55;

    s.addShape(pres.ShapeType.rect, { x, y, w: 5.9, h: 1.35, fill: { color: C.white }, line: { color: C.teal, pt: 1.5 } });
    s.addText(num, { x: x + 0.15, y: y + 0.1, w: 0.65, h: 0.55, fontSize: 22, bold: true, color: C.teal });
    s.addText(title, { x: x + 0.82, y: y + 0.08, w: 4.9, h: 0.52, fontSize: 14, bold: true, color: C.navy });
    s.addText(sub, { x: x + 0.82, y: y + 0.6, w: 4.9, h: 0.55, fontSize: 11, color: C.midGray, italic: true });
  });
}

// ─── SLIDE 3 — BACKGROUND ────────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addTag(s, "Background", 0.5, 0.4);

  s.addText("Why Does This Trial Matter?", {
    x: 0.5, y: 0.85, w: 12.0, h: 0.65,
    fontSize: 30, bold: true, color: C.navy,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.5, w: 4.5, h: 0.05, fill: { color: C.teal }, line: { type: "none" } });

  // Stat box left
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.75, w: 3.8, h: 2.4, fill: { color: C.navy }, line: { type: "none" } });
  s.addText("300,000+", { x: 0.5, y: 1.9, w: 3.8, h: 0.9, fontSize: 40, bold: true, color: C.amber, align: "center" });
  s.addText("OHCA deaths per year\nin North America", { x: 0.5, y: 2.8, w: 3.8, h: 0.9, fontSize: 13, color: C.white, align: "center" });

  const bullets = [
    "VF/pVT is the most treatable OHCA rhythm — responsive to defibrillation",
    "Most defibrillation attempts do NOT result in sustained ROSC",
    "VF/pVT persists or recurs in many patients → shock-refractory state",
    "Amiodarone & lidocaine widely used, but prior RCTs only showed ROSC/admission benefit — no proven survival-to-discharge benefit",
    "Previous small RCTs (Kudenchuk 1999; Dorian 2002) favored amiodarone for short-term endpoints only",
  ];

  bullets.forEach((b, i) => {
    s.addShape(pres.ShapeType.ellipse, { x: 4.65, y: 1.78 + i * 0.97, w: 0.28, h: 0.28, fill: { color: C.teal }, line: { type: "none" } });
    s.addText(b, { x: 5.05, y: 1.73 + i * 0.97, w: 7.7, h: 0.9, fontSize: 13, color: C.navy, valign: "middle" });
  });

  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 4.55, w: 12.3, h: 0.06, fill: { color: C.amber }, line: { type: "none" } });
  s.addText("ALPS was designed to definitively answer: does antiarrhythmic therapy improve survival to hospital discharge?", {
    x: 0.5, y: 4.75, w: 12.3, h: 0.55,
    fontSize: 14, italic: true, color: C.slate, bold: true,
  });
}

// ─── SLIDE 4 — PICO ──────────────────────────────────────────────
{
  const s = pres.addSlide();
  darkSlide(s);
  addTag(s, "PICO Framework", 0.5, 0.3);

  s.addText("PICO at a Glance", {
    x: 0.5, y: 0.75, w: 12.0, h: 0.65,
    fontSize: 32, bold: true, color: C.white,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.38, w: 3.5, h: 0.05, fill: { color: C.amber }, line: { type: "none" } });

  const picoData = [
    {
      letter: "P",
      label: "POPULATION",
      color: C.teal,
      lines: [
        "Adults ≥18 yrs with nontraumatic OHCA",
        "Initial rhythm: VF or pVT",
        "Shock-refractory (≥1 shock delivered)",
        "IV/IO vascular access obtained",
        "Enrolled by paramedics at 10 North American sites",
        "Excluded: prior open-label amiodarone/lidocaine, known hypersensitivity",
      ],
    },
    {
      letter: "I",
      label: "INTERVENTION",
      color: C.amber,
      lines: [
        "IV Amiodarone (Captisol-based Nexterone)",
        "Initial dose: 300 mg (2 syringes × 150 mg)",
        "Supplemental dose: 150 mg (1 syringe) if VF/pVT persisted",
        "Total max dose: 450 mg",
        "Given after vasopressor, during ongoing ACLS",
        "Administered by EMS paramedics prehospital",
      ],
    },
    {
      letter: "C",
      label: "COMPARISON",
      color: "5BA4CF",
      lines: [
        "Arm 1: IV Lidocaine 120 mg (2 × 60 mg)",
        "Arm 2: Normal Saline Placebo (identical packaging)",
        "Triple-arm, double-blind, placebo-controlled",
        "Syringes identically appearing — indistinguishable",
        "Randomized 1:1:1 by EMS kit-opening",
        "Standard ACLS continued in all arms",
      ],
    },
    {
      letter: "O",
      label: "OUTCOME",
      color: C.amber,
      lines: [
        "PRIMARY: Survival to hospital discharge",
        "SECONDARY: Favorable neurologic outcome at discharge (mRS ≤3)",
        "MECHANISTIC: ROSC at ED arrival, hospital admission rate, shocks after drug",
        "SAFETY: Adverse events within 24 hrs (bradycardia, seizures, anaphylaxis)",
        "SUBGROUP: Witnessed vs. unwitnessed arrest interaction",
      ],
    },
  ];

  const positions = [
    { x: 0.4, y: 1.6 },
    { x: 6.85, y: 1.6 },
    { x: 0.4, y: 4.25 },
    { x: 6.85, y: 4.25 },
  ];

  picoData.forEach((item, i) => {
    const { x, y } = positions[i];
    s.addShape(pres.ShapeType.rect, { x, y, w: 6.05, h: 2.5, fill: { color: C.slate }, line: { color: item.color, pt: 2 } });
    // Letter badge
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.65, h: 2.5, fill: { color: item.color }, line: { type: "none" } });
    s.addText(item.letter, { x, y: y + 0.8, w: 0.65, h: 0.85, fontSize: 36, bold: true, color: C.navy, align: "center" });
    s.addText(item.label, { x: x + 0.75, y: y + 0.08, w: 5.1, h: 0.38, fontSize: 10, bold: true, color: item.color, charSpacing: 2 });
    item.lines.forEach((line, li) => {
      s.addShape(pres.ShapeType.rect, { x: x + 0.75, y: y + 0.53 + li * 0.32, w: 0.06, h: 0.16, fill: { color: item.color }, line: { type: "none" } });
      s.addText(line, { x: x + 0.87, y: y + 0.47 + li * 0.32, w: 4.98, h: 0.3, fontSize: 10.5, color: C.white });
    });
  });
}

// ─── SLIDE 5 — STUDY DESIGN ──────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addTag(s, "Study Design", 0.5, 0.4);

  s.addText("Trial Design & Methods", {
    x: 0.5, y: 0.85, w: 12.0, h: 0.65,
    fontSize: 30, bold: true, color: C.navy,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.5, w: 4.0, h: 0.05, fill: { color: C.teal }, line: { type: "none" } });

  // Design badge
  const designItems = [
    ["Design", "Randomized, Double-Blind, Placebo-Controlled, 3-Arm Trial"],
    ["Setting", "Prehospital — 55 EMS agencies, 10 North American communities (ROC network)"],
    ["Period", "May 7, 2012 – October 25, 2015"],
    ["Funding", "NHLBI, Canadian Institutes of Health Research; Baxter provided drugs at no cost"],
    ["Analysis", "Per-protocol (primary) + Intention-to-treat (secondary)"],
    ["Sample Size", "3,026 per-protocol (974 amiodarone / 993 lidocaine / 1,059 placebo)"],
    ["Power", "90% power to detect 6.3 pp absolute difference in survival (amiodarone vs. placebo)"],
    ["Blinding", "Patients, EMS, investigators, hospital providers — all blinded to assignment"],
  ];

  designItems.forEach(([lbl, val], i) => {
    const col = i < 4 ? 0 : 1;
    const row = i % 4;
    const x = col === 0 ? 0.5 : 6.9;
    const y = 1.75 + row * 1.25;
    s.addShape(pres.ShapeType.rect, { x, y, w: 5.9, h: 1.1, fill: { color: C.white }, line: { color: "C8D6E5", pt: 1 } });
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.12, h: 1.1, fill: { color: C.teal }, line: { type: "none" } });
    s.addText(lbl.toUpperCase(), { x: x + 0.22, y: y + 0.08, w: 5.5, h: 0.3, fontSize: 9, bold: true, color: C.teal, charSpacing: 1.5 });
    s.addText(val, { x: x + 0.22, y: y + 0.38, w: 5.5, h: 0.62, fontSize: 11.5, color: C.navy, valign: "top" });
  });
}

// ─── SLIDE 6 — FLOW DIAGRAM ───────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addTag(s, "Population Flow", 0.5, 0.4);

  s.addText("Patient Enrollment & Allocation", {
    x: 0.5, y: 0.85, w: 12.0, h: 0.65,
    fontSize: 30, bold: true, color: C.navy,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.5, w: 5.0, h: 0.05, fill: { color: C.teal }, line: { type: "none" } });

  // Flow boxes
  const box = (slide, x, y, w, h, text, bg, tc, fs) => {
    slide.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: bg }, line: { color: C.teal, pt: 1.5 } });
    slide.addText(text, { x, y, w, h, fontSize: fs || 12, color: tc, align: "center", valign: "middle", bold: true });
  };
  const arrow = (slide, x, y, h) => {
    slide.addShape(pres.ShapeType.rect, { x: x - 0.03, y, w: 0.06, h, fill: { color: C.teal }, line: { type: "none" } });
    slide.addShape(pres.ShapeType.triangle, { x: x - 0.15, y: y + h - 0.01, w: 0.3, h: 0.2, fill: { color: C.teal }, line: { type: "none" } });
  };

  // Top box
  box(s, 4.0, 1.7, 5.3, 0.65, "37,889 OHCA Patients Screened", C.navy, C.white, 13);
  arrow(s, 6.65, 2.35, 0.4);
  box(s, 4.0, 2.75, 5.3, 0.65, "7,051 (18.6%) Potentially Eligible\n(Shock-refractory VF/pVT)", "E8F4FD", C.navy, 12);
  arrow(s, 6.65, 3.4, 0.4);
  box(s, 4.0, 3.8, 5.3, 0.65, "4,667 Randomized\n(Kit opened by EMS)", C.teal, C.white, 12);
  arrow(s, 6.65, 4.45, 0.35);
  box(s, 4.0, 4.8, 5.3, 0.55, "4,653 Intention-to-Treat Population", "E8F4FD", C.navy, 11);
  arrow(s, 6.65, 5.35, 0.35);

  // Three arms
  box(s, 0.4, 5.7, 3.5, 0.75, "AMIODARONE\nn = 974", C.navy, C.amber, 12);
  box(s, 4.0, 5.7, 3.5, 0.75, "LIDOCAINE\nn = 993", C.navy, C.white, 12);
  box(s, 7.6, 5.7, 3.5, 0.75, "PLACEBO\nn = 1,059", C.navy, C.white, 12);

  // Connector lines from ITT box to three arms
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 5.68, w: 12.1, h: 0.04, fill: { color: C.teal }, line: { type: "none" } });

  // Side note
  s.addText("30,838 (81.4%) ineligible — did not have shock-refractory VF/pVT, no vascular access, or prior antiarrhythmic use", {
    x: 0.3, y: 6.6, w: 12.7, h: 0.45,
    fontSize: 10.5, italic: true, color: C.midGray, align: "center",
  });
}

// ─── SLIDE 7 — PRIMARY RESULTS ───────────────────────────────────
{
  const s = pres.addSlide();
  darkSlide(s);
  addTag(s, "Primary Results", 0.5, 0.3);

  s.addText("Survival to Hospital Discharge", {
    x: 0.5, y: 0.75, w: 12.0, h: 0.65,
    fontSize: 32, bold: true, color: C.white,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.38, w: 5.0, h: 0.05, fill: { color: C.amber }, line: { type: "none" } });

  // Three big number boxes
  const arms = [
    { drug: "AMIODARONE", n: "974", pct: "24.4%", n_surv: "237", col: C.amber },
    { drug: "LIDOCAINE", n: "993", pct: "23.7%", n_surv: "233", col: "5BA4CF" },
    { drug: "PLACEBO", n: "1,059", pct: "21.0%", n_surv: "222", col: "8899A6" },
  ];

  arms.forEach((arm, i) => {
    const x = 0.4 + i * 4.3;
    s.addShape(pres.ShapeType.rect, { x, y: 1.6, w: 3.9, h: 2.6, fill: { color: C.slate }, line: { color: arm.col, pt: 2 } });
    s.addText(arm.drug, { x, y: 1.68, w: 3.9, h: 0.4, fontSize: 11, bold: true, color: arm.col, align: "center", charSpacing: 2 });
    s.addText(arm.pct, { x, y: 2.1, w: 3.9, h: 1.0, fontSize: 52, bold: true, color: arm.col, align: "center" });
    s.addText(`${arm.n_surv} / ${arm.n} survived`, { x, y: 3.1, w: 3.9, h: 0.45, fontSize: 12, color: C.white, align: "center" });
    s.addText(`n = ${arm.n}`, { x, y: 3.6, w: 3.9, h: 0.4, fontSize: 11, color: "8899A6", align: "center", italic: true });
  });

  // Comparisons table
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 4.45, w: 12.5, h: 0.38, fill: { color: C.slate }, line: { type: "none" } });
  s.addText("Comparison", { x: 0.5, y: 4.45, w: 3.5, h: 0.38, fontSize: 11, bold: true, color: C.teal, valign: "middle" });
  s.addText("Absolute Risk Difference", { x: 4.0, y: 4.45, w: 4.5, h: 0.38, fontSize: 11, bold: true, color: C.teal, valign: "middle" });
  s.addText("95% CI", { x: 8.5, y: 4.45, w: 2.5, h: 0.38, fontSize: 11, bold: true, color: C.teal, valign: "middle" });
  s.addText("P-value", { x: 11.0, y: 4.45, w: 1.8, h: 0.38, fontSize: 11, bold: true, color: C.teal, valign: "middle" });

  const rows = [
    ["Amiodarone vs. Placebo", "+3.2 pp", "−0.4 to +7.0", "0.08 (NS)"],
    ["Lidocaine vs. Placebo", "+2.6 pp", "−1.0 to +6.3", "0.16 (NS)"],
    ["Amiodarone vs. Lidocaine", "+0.7 pp", "−3.2 to +4.7", "0.70 (NS)"],
  ];

  rows.forEach((row, i) => {
    const y = 4.92 + i * 0.55;
    const bg = i % 2 === 0 ? "1E3A5F" : C.navy;
    s.addShape(pres.ShapeType.rect, { x: 0.4, y, w: 12.5, h: 0.52, fill: { color: bg }, line: { type: "none" } });
    s.addText(row[0], { x: 0.5, y, w: 3.5, h: 0.52, fontSize: 11.5, color: C.white, valign: "middle" });
    s.addText(row[1], { x: 4.0, y, w: 4.5, h: 0.52, fontSize: 11.5, color: i === 0 ? C.amber : C.white, valign: "middle", bold: i === 0 });
    s.addText(row[2], { x: 8.5, y, w: 2.5, h: 0.52, fontSize: 11.5, color: C.white, valign: "middle" });
    s.addText(row[3], { x: 11.0, y, w: 1.8, h: 0.52, fontSize: 11.5, color: C.red, valign: "middle", bold: true });
  });
}

// ─── SLIDE 8 — SECONDARY & SUBGROUP RESULTS ──────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addTag(s, "Secondary & Subgroup Results", 0.5, 0.4);

  s.addText("Neurologic Outcome & Subgroup Analysis", {
    x: 0.5, y: 0.85, w: 12.0, h: 0.65,
    fontSize: 28, bold: true, color: C.navy,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.5, w: 5.5, h: 0.05, fill: { color: C.teal }, line: { type: "none" } });

  // Secondary outcome box
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.7, w: 6.0, h: 2.7, fill: { color: C.navy }, line: { type: "none" } });
  s.addText("SECONDARY OUTCOME\nFavorable Neurologic Status (mRS ≤3)", { x: 0.6, y: 1.8, w: 5.8, h: 0.7, fontSize: 12, bold: true, color: C.amber, lineSpacingMultiple: 1.3 });

  const neuro = [
    { label: "Amiodarone", val: "18.8%", sub: "182/967" },
    { label: "Lidocaine", val: "17.5%", sub: "172/984" },
    { label: "Placebo", val: "16.6%", sub: "175/1,053" },
  ];
  neuro.forEach((n, i) => {
    s.addText(n.label, { x: 0.65, y: 2.57 + i * 0.57, w: 2.0, h: 0.35, fontSize: 11.5, color: C.white });
    s.addShape(pres.ShapeType.rect, { x: 2.65, y: 2.63 + i * 0.57, w: 2.5, h: 0.22, fill: { color: C.teal }, line: { type: "none" } });
    s.addText(n.val, { x: 5.2, y: 2.57 + i * 0.57, w: 1.0, h: 0.35, fontSize: 11.5, color: C.amber, bold: true });
  });
  s.addText("No significant differences (all p>0.05)", {
    x: 0.6, y: 3.85, w: 5.8, h: 0.38, fontSize: 12, color: "8899A6", italic: true,
  });

  // Subgroup box
  s.addShape(pres.ShapeType.rect, { x: 6.9, y: 1.7, w: 5.9, h: 2.7, fill: { color: C.white }, line: { color: C.teal, pt: 1.5 } });
  s.addText("KEY SUBGROUP: WITNESSED STATUS\n(Heterogeneity p = 0.05)", { x: 7.0, y: 1.8, w: 5.7, h: 0.65, fontSize: 12, bold: true, color: C.navy, lineSpacingMultiple: 1.3 });

  s.addShape(pres.ShapeType.rect, { x: 6.9, y: 2.6, w: 5.9, h: 0.06, fill: { color: C.teal }, line: { type: "none" } });

  s.addText("Bystander-Witnessed Arrest (n=1,934)", { x: 7.0, y: 2.75, w: 5.7, h: 0.35, fontSize: 11, bold: true, color: C.navy });
  s.addText([
    { text: "Amiodarone ", options: {} },
    { text: "27.7%", options: { bold: true, color: C.teal } },
    { text: " vs Lidocaine ", options: {} },
    { text: "27.8%", options: { bold: true, color: C.teal } },
    { text: " vs Placebo ", options: {} },
    { text: "22.7%", options: { bold: true, color: C.red } },
  ], { x: 7.0, y: 3.1, w: 5.7, h: 0.35, fontSize: 11.5, color: C.navy });
  s.addText("Amio vs Placebo: +5.0 pp (95% CI 0.3–9.7, p=0.04) ✓\nLido vs Placebo: +5.2 pp (95% CI 0.5–9.9, p=0.03) ✓", {
    x: 7.0, y: 3.48, w: 5.7, h: 0.6, fontSize: 11, color: C.green, bold: true, lineSpacingMultiple: 1.3,
  });

  s.addShape(pres.ShapeType.rect, { x: 6.9, y: 4.12, w: 5.9, h: 0.06, fill: { color: "C8D6E5" }, line: { type: "none" } });
  s.addText("Unwitnessed Arrest: No significant difference in any arm", {
    x: 7.0, y: 4.22, w: 5.7, h: 0.35, fontSize: 11, color: C.midGray, italic: true,
  });

  // Mechanistic outcomes
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 4.6, w: 12.3, h: 0.4, fill: { color: C.teal }, line: { type: "none" } });
  s.addText("MECHANISTIC OUTCOMES", { x: 0.5, y: 4.6, w: 12.3, h: 0.4, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle", charSpacing: 2 });

  const mech = [
    ["Hospital Admission", "Amio 45.7% / Lido 47.0% vs Placebo 39.7%", C.green],
    ["ROSC at ED Arrival", "Lido significantly higher vs placebo (p=0.01)", C.green],
    ["Shocks after drug", "Fewer in Amio & Lido vs Placebo (p<0.001)", C.green],
    ["Temporary Pacing", "Amio 4.9% vs Lido 3.2% vs Placebo 2.7% (p=0.02)", C.amber],
  ];
  mech.forEach((m, i) => {
    const col = i < 2 ? 0 : 1;
    const row = i % 2;
    const x = col === 0 ? 0.5 : 6.9;
    const y = 5.1 + row * 0.65;
    s.addShape(pres.ShapeType.ellipse, { x: x + 0.05, y: y + 0.09, w: 0.22, h: 0.22, fill: { color: m[2] }, line: { type: "none" } });
    s.addText(m[0] + ": ", { x: x + 0.35, y, w: 5.7, h: 0.42, fontSize: 11, bold: true, color: C.navy });
    s.addText(m[1], { x: x + 0.35, y: y + 0.22, w: 5.7, h: 0.35, fontSize: 10.5, color: C.midGray });
  });
}

// ─── SLIDE 9 — ADVERSE EVENTS ─────────────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addTag(s, "Safety", 0.5, 0.4);

  s.addText("Adverse Events (Per-Protocol Population)", {
    x: 0.5, y: 0.85, w: 12.0, h: 0.65,
    fontSize: 28, bold: true, color: C.navy,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.5, w: 5.5, h: 0.05, fill: { color: C.teal }, line: { type: "none" } });

  // Table header
  const cols = [3.0, 2.5, 2.5, 2.5, 2.0];
  const headers = ["Adverse Event", "Amiodarone\n(n=974)", "Lidocaine\n(n=993)", "Placebo\n(n=1,059)", "P-value"];
  let cx = 0.5;
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.7, w: 12.5, h: 0.5, fill: { color: C.navy }, line: { type: "none" } });
  headers.forEach((h, i) => {
    s.addText(h, { x: cx + 0.05, y: 1.7, w: cols[i] - 0.1, h: 0.5, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });
    cx += cols[i];
  });

  const tableData = [
    ["Anaphylaxis", "0", "0", "0", "N/A"],
    ["Thrombophlebitis (24 hr)", "0.1%", "0.3%", "0.2%", "0.61"],
    ["Clinical Seizure (24 hr)", "3.2%", "5.1%", "3.7%", "0.07"],
    ["Temporary Cardiac Pacing ⚠", "4.9%", "3.2%", "2.7%", "0.02 ✓"],
    ["Any serious adverse event", "1.1%", "1.2%", "0.4%", "0.09"],
    ["Any adverse event (24 hr)", "8.3%", "8.5%", "6.5%", "0.18"],
    ["Death before discharge", "75.3%", "75.7%", "78.8%", "0.16"],
  ];

  tableData.forEach((row, ri) => {
    const bg = ri % 2 === 0 ? C.white : "EDF2F7";
    s.addShape(pres.ShapeType.rect, { x: 0.5, y: 2.2 + ri * 0.53, w: 12.5, h: 0.5, fill: { color: bg }, line: { type: "none" } });
    let cx2 = 0.5;
    row.forEach((cell, ci) => {
      const isSig = cell.includes("✓");
      const isWarn = cell.includes("⚠");
      s.addText(cell, {
        x: cx2 + 0.05, y: 2.2 + ri * 0.53, w: cols[ci] - 0.1, h: 0.5,
        fontSize: 11.5, color: isSig ? C.red : (isWarn ? C.amber : C.navy),
        align: ci === 0 ? "left" : "center", valign: "middle",
        bold: isSig || isWarn,
      });
      cx2 += cols[ci];
    });
  });

  s.addText("⚠ Temporary pacing significantly more frequent with amiodarone — likely reflects bradycardia from drug effect. No anaphylaxis observed.", {
    x: 0.5, y: 6.0, w: 12.3, h: 0.55,
    fontSize: 11, italic: true, color: C.midGray,
  });
}

// ─── SLIDE 10 — CRITICAL APPRAISAL ───────────────────────────────
{
  const s = pres.addSlide();
  darkSlide(s);
  addTag(s, "Critical Appraisal", 0.5, 0.3);

  s.addText("Strengths & Limitations", {
    x: 0.5, y: 0.75, w: 12.0, h: 0.65,
    fontSize: 32, bold: true, color: C.white,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.38, w: 4.5, h: 0.05, fill: { color: C.amber }, line: { type: "none" } });

  // Strengths
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.55, w: 5.9, h: 0.42, fill: { color: C.green }, line: { type: "none" } });
  s.addText("✓  STRENGTHS", { x: 0.5, y: 1.55, w: 5.8, h: 0.42, fontSize: 13, bold: true, color: C.white, valign: "middle", charSpacing: 2 });

  const strengths = [
    "Largest RCT of antiarrhythmics in OHCA (n=3,026 per-protocol)",
    "Triple-arm design — simultaneously tests amiodarone vs lidocaine vs placebo",
    "Double-blind with identically packaged syringes — robust blinding",
    "Real-world prehospital setting — high external validity",
    "Well-balanced baseline characteristics across groups",
    "Mechanistic outcomes explain biological plausibility",
    "Prespecified subgroup analysis (witnessed arrest)",
    "Independent DSMB; FDA/Health Canada oversight; exception from consent protocol",
  ];
  strengths.forEach((st, i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.4, y: 2.0 + i * 0.49, w: 0.06, h: 0.28, fill: { color: C.green }, line: { type: "none" } });
    s.addText(st, { x: 0.55, y: 1.97 + i * 0.49, w: 5.65, h: 0.45, fontSize: 11, color: C.white, valign: "middle" });
  });

  // Limitations
  s.addShape(pres.ShapeType.rect, { x: 6.9, y: 1.55, w: 5.9, h: 0.42, fill: { color: C.red }, line: { type: "none" } });
  s.addText("✗  LIMITATIONS", { x: 7.0, y: 1.55, w: 5.8, h: 0.42, fontSize: 13, bold: true, color: C.white, valign: "middle", charSpacing: 2 });

  const limits = [
    "Possibly underpowered — actual survival difference smaller than projected (3pp vs 6.3pp assumed)",
    "~9,000 patients needed to confirm 3 pp absolute difference with 90% power",
    "Late drug administration (~19 min from call) may have attenuated treatment effect",
    "In-hospital care NOT standardized — potential confounding post-ROSC",
    "Single dosing strategy only; no crossover; alternative protocols not tested",
    "Selection bias possible; non-enrollment reasons tracked but some patients may be systematically excluded",
    "Subgroup finding (witnessed arrest) is post-hoc in context of negative primary — not adjusted for multiple comparisons",
  ];
  limits.forEach((lt, i) => {
    s.addShape(pres.ShapeType.rect, { x: 6.9, y: 2.0 + i * 0.52, w: 0.06, h: 0.28, fill: { color: C.red }, line: { type: "none" } });
    s.addText(lt, { x: 7.05, y: 1.97 + i * 0.52, w: 5.65, h: 0.48, fontSize: 11, color: C.white, valign: "middle" });
  });

  // Bias assessment footer
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 6.35, w: 12.5, h: 0.78, fill: { color: C.slate }, line: { color: C.amber, pt: 1 } });
  s.addText("BIAS ASSESSMENT:", { x: 0.55, y: 6.4, w: 2.2, h: 0.35, fontSize: 10, bold: true, color: C.amber });
  s.addText("Selection: Low  |  Performance: Low (double-blind)  |  Detection: Low  |  Attrition: Low (99.5% outcomes obtained)  |  Reporting: Low", {
    x: 2.8, y: 6.4, w: 9.8, h: 0.35, fontSize: 10, color: C.white,
  });
}

// ─── SLIDE 11 — CLINICAL IMPLICATIONS ────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addTag(s, "Clinical Implications", 0.5, 0.4);

  s.addText("What Should Change at the Bedside?", {
    x: 0.5, y: 0.85, w: 12.0, h: 0.65,
    fontSize: 28, bold: true, color: C.navy,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.5, w: 6.5, h: 0.05, fill: { color: C.teal }, line: { type: "none" } });

  const implics = [
    {
      icon: "→",
      head: "Overall: No significant survival benefit",
      body: "Neither amiodarone nor lidocaine improved survival to discharge or neurologic outcome vs placebo in the overall population. Current AHA guidelines should be interpreted with this in mind.",
      col: C.red,
    },
    {
      icon: "→",
      head: "Witnessed arrest subgroup: Potential benefit",
      body: "Both drugs significantly improved survival in bystander-witnessed arrest (~+5 pp). This suggests patient selection and timing of drug administration matters. Early drug delivery may confer benefit.",
      col: C.green,
    },
    {
      icon: "→",
      head: "Both drugs reduce shock burden",
      body: "Mechanistically, both drugs facilitated VF/pVT termination with fewer shocks and increased hospital admission rates. Short-term benefits exist even without proven survival improvement.",
      col: C.teal,
    },
    {
      icon: "→",
      head: "Amiodarone vs Lidocaine: Equivalent",
      body: "No meaningful difference between the two drugs in any outcome. Lidocaine (cheaper, fewer pacing requirements) is a reasonable alternative to amiodarone in shock-refractory VF/pVT.",
      col: C.teal,
    },
    {
      icon: "→",
      head: "Timing is the critical variable",
      body: "Average time to drug was 19 minutes. Patients in the 'electrical phase' of VF may not benefit; the 'metabolic phase' may render drugs ineffective. Faster drug delivery or earlier rhythm conversion is key.",
      col: C.amber,
    },
    {
      icon: "→",
      head: "Future directions",
      body: "Trials should target witnessed arrest specifically, test earlier administration strategies, standardize post-ROSC care, and consider alternative drug regimens or combinations.",
      col: "8B5CF6",
    },
  ];

  implics.forEach((item, i) => {
    const col = i % 2 === 0 ? 0 : 1;
    const row = Math.floor(i / 2);
    const x = col === 0 ? 0.4 : 6.9;
    const y = 1.7 + row * 1.7;
    s.addShape(pres.ShapeType.rect, { x, y, w: 6.05, h: 1.55, fill: { color: C.white }, line: { color: item.col, pt: 2 } });
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.22, h: 1.55, fill: { color: item.col }, line: { type: "none" } });
    s.addText(item.head, { x: x + 0.32, y: y + 0.1, w: 5.6, h: 0.38, fontSize: 12, bold: true, color: item.col });
    s.addText(item.body, { x: x + 0.32, y: y + 0.5, w: 5.6, h: 0.95, fontSize: 10.5, color: C.navy, valign: "top" });
  });
}

// ─── SLIDE 12 — SUMMARY / CONCLUSION ─────────────────────────────
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  const s = pres.addSlide();
  darkSlide(s);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: C.navy }, line: { type: "none" } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.22, h: 7.5, fill: { color: C.amber }, line: { type: "none" } });
  s.addShape(pres.ShapeType.rect, { x: 0.22, y: 3.6, w: 13.0, h: 0.05, fill: { color: C.teal }, line: { type: "none" } });

  s.addText("TAKE-HOME MESSAGES", {
    x: 0.5, y: 0.45, w: 12.3, h: 0.5,
    fontSize: 14, bold: true, color: C.teal, charSpacing: 4,
  });

  const msgs = [
    ["01", "No overall survival benefit", "Neither amiodarone nor lidocaine improved survival to discharge vs placebo in shock-refractory VF/pVT OHCA (primary outcome negative)."],
    ["02", "Witnessed arrest signal", "Both drugs significantly improved survival in bystander-witnessed arrest (+~5 pp). Timing and patient selection are critical determinants of drug efficacy."],
    ["03", "Short-term mechanistic benefit", "Both drugs reduced shocks and increased hospital admission rates, demonstrating antiarrhythmic effect even without confirmed survival benefit."],
    ["04", "Lidocaine = Amiodarone", "No difference between the two active drugs. Lidocaine is a cost-effective, safe alternative with lower pacing requirements."],
    ["05", "Guideline context", "ALPS does not definitively prove antiarrhythmics are futile — the trial may be underpowered for a 3 pp effect. A confirmed 3 pp benefit = ~1,800 lives/year saved in North America."],
  ];

  msgs.forEach((m, i) => {
    const y = 1.1 + i * 1.2;
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    s.addText(m[1], { x: 1.2, y: y + 0.02, w: 3.8, h: 0.4, fontSize: 13, bold: true, color: C.amber });
    s.addText(m[2], { x: 1.2, y: y + 0.45, w: 11.6, h: 0.6, fontSize: 11.5, color: C.white, valign: "top" });
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  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 7.1, w: 12.5, h: 0.05, fill: { color: C.amber }, line: { type: "none" } });
  s.addText("Kudenchuk PJ et al. N Engl J Med 2016;374:1711–22  |  ROC-ALPS Trial  |  NCT01401647", {
    x: 0.4, y: 7.18, w: 12.5, h: 0.25,
    fontSize: 9, color: "6B7280", align: "center",
  });
}

// ─── SLIDE 13 — DISCUSSION PROMPTS ───────────────────────────────
{
  const s = pres.addSlide();
  lightSlide(s);
  addTag(s, "Discussion", 0.5, 0.4);

  s.addText("Journal Club Discussion Questions", {
    x: 0.5, y: 0.85, w: 12.0, h: 0.65,
    fontSize: 28, bold: true, color: C.navy,
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  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.5, w: 5.5, h: 0.05, fill: { color: C.teal }, line: { type: "none" } });

  const questions = [
    "Should a 'negative' primary outcome automatically change clinical practice, even when subgroup and mechanistic data suggest benefit?",
    "Was the trial adequately powered? How would you design a follow-up trial to definitively address the 3 pp survival difference question?",
    "How should the witnessed vs. unwitnessed arrest subgroup finding influence prehospital protocols, given it was not adjusted for multiple comparisons?",
    "What is the clinical significance of the mechanistic benefits (fewer shocks, higher admission rates) if survival is not improved?",
    "Given equivalent outcomes, would you preferentially use lidocaine over amiodarone in your EMS system? What factors would guide this decision?",
    "How does late drug administration (avg 19 min) affect your interpretation, and how might earlier delivery change outcomes?",
  ];

  questions.forEach((q, i) => {
    const y = 1.7 + i * 0.92;
    s.addShape(pres.ShapeType.rect, { x: 0.4, y, w: 0.55, h: 0.68, fill: { color: C.navy }, line: { type: "none" } });
    s.addText(`Q${i + 1}`, { x: 0.4, y: y + 0.12, w: 0.55, h: 0.44, fontSize: 16, bold: true, color: C.amber, align: "center" });
    s.addShape(pres.ShapeType.rect, { x: 1.05, y, w: 11.8, h: 0.68, fill: { color: C.white }, line: { color: "C8D6E5", pt: 1 } });
    s.addText(q, { x: 1.15, y, w: 11.6, h: 0.68, fontSize: 12, color: C.navy, valign: "middle" });
  });
}

// ─── WRITE FILE ───────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/alps-journal-club/ALPS_Trial_Journal_Club.pptx" })
  .then(() => console.log("Done: ALPS_Trial_Journal_Club.pptx"))
  .catch(e => { console.error(e); process.exit(1); });