{ "model": { "rank": 4624, "code": "thing-q189580", "model_id": "vr.tr.acromegaly", "name": "acromegaly", "purpose": "Enable an agent to recognise suspected acromegaly, record evidence of growth-hormone excess and its consequences, and support clinician-reviewed investigation, treatment and follow-up.", "family": "Thing Registry", "category": "Cross-cutting context", "status": "research-draft", "kind": "thing", "plane": "XCT", "domain": "XCT.STA", "industry": "", "version": "", "url": "/models/thing/q189580/", "tier": 2, "score": 73, "payload": { "layer": "wikidata", "aliases": [ "canine acromegaly" ], "aliasCount": 1, "merged": 1, "knownIn": 73, "facets": null, "markers": [], "lexicalClass": "", "senseRank": null, "alsoRegisteredAs": null, "source": { "dataset": "wikidata", "item": "Q189580", "url": "https://www.wikidata.org/wiki/Q189580", "license": "CC0 1.0" } }, "research": { "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-09T20:39:07Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 22.3, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a087e4-23d2-7770-8bc0-f0772df07f85\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: acromegaly\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 005: 1001 regi", "usd": 0, "recall": true }, "codex": { "seconds": 77.4, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a087e4-23e3-7213-8d65-29449494fa95\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: acromegaly\nRegistry id: vr.tr.acromegaly\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this entry: (none)\n\n\nCo" } } }, "metaModel": { "id": "THING-Q189580", "registryId": "vr.tr.acromegaly", "name": "acromegaly", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q189580/", "model": { "registry_id": "vr.tr.acromegaly", "name": "acromegaly", "purpose": "Enable an agent to recognise suspected acromegaly, record evidence of growth-hormone excess and its consequences, and support clinician-reviewed investigation, treatment and follow-up.", "definition": "Acromegaly is a chronic endocrine disorder caused by sustained growth hormone excess, usually from a pituitary somatotroph adenoma, with increased insulin-like growth factor 1 activity producing characteristic acral, facial, soft-tissue and systemic changes after epiphyseal closure.", "scope_statement": "This model owns acromegaly as the disease concept registered as vr.tr.acromegaly in XCT / XCT.STA: sustained growth-hormone excess and associated IGF-1 activity producing characteristic tissue overgrowth, principally after growth-plate closure, including diagnostic uncertainty, disease activity and persistent consequences.", "in_scope": [ "Progressive acral, facial and soft-tissue changes that prompt assessment for acromegaly", "Biochemical evidence of GH and IGF-1 excess, including assay context and discordant results", "The relationship between acromegaly and its pituitary or exceptional nonpituitary source", "Acromegaly-associated complications and functional burden", "Treatment response, biochemical control, remission and recurrence" ], "out_of_scope": [ "Pituitary gigantism as a separate growth disorder, while recording overlap when GH excess spans growth-plate closure", "Full classification and management of pituitary tumours independent of acromegaly", "Pseudoacromegaly and other causes of acromegaloid appearance as independent conditions", "Standalone models of diabetes, sleep apnoea, cardiovascular disease and arthropathy", "Drug prescribing protocols, surgical technique and radiotherapy delivery" ], "distinguishing_features": [ "Distinguish acromegaly from isolated tall stature by recording acral and soft-tissue overgrowth, biochemical evidence and timing relative to growth-plate closure. [NIDDK](https://www.niddk.nih.gov/health-information/endocrine-diseases/acromegaly)", "Distinguish a suggestive appearance from established disease using age-adjusted IGF-1 interpreted with clinical findings; appearance alone does not establish the diagnosis. [Diagnostic consensus](https://pmc.ncbi.nlm.nih.gov/articles/PMC10837217/)", "Distinguish a causal pituitary lesion from an incidental mass by requiring evidence of GH excess; imaging alone is insufficient. [Endocrine Society guideline](https://www.endocrine.org/clinical-practice-guidelines/acromegaly)", "Distinguish current biochemical activity from persistent physical changes by recording hormone results and residual manifestations separately. [Diagnostic and remission consensus](https://pmc.ncbi.nlm.nih.gov/articles/PMC10837217/)" ], "characteristics": [ { "name": "Diagnostic standing", "kind": "state", "unit_or_values": "suspected | biochemically supported | clinician-confirmed | unresolved | excluded", "why_it_matters": "Prevents a screening signal or registry label from being treated as a confirmed diagnosis." }, { "name": "IGF-1 relative to reference range", "kind": "measurement", "unit_or_values": "Laboratory concentration and units, age-specific reference interval, and ratio to upper limit of normal", "why_it_matters": "Makes the biochemical result interpretable across ages, dates and laboratories." }, { "name": "GH measurement context", "kind": "measurement", "unit_or_values": "µg/L or equivalent ng/mL; random, serial or glucose-suppression nadir; assay and sampling time", "why_it_matters": "A GH value needs its sampling and assay context before it can support an interpretation." }, { "name": "Phenotypic progression", "kind": "state", "unit_or_values": "absent | uncertain | progressive | stable | improving, with dated observations", "why_it_matters": "Separates longstanding appearance from documented change." }, { "name": "Timing relative to growth-plate closure", "kind": "category", "unit_or_values": "before closure | after closure | spanning closure | unknown", "why_it_matters": "Locates the boundary and possible overlap with pituitary gigantism." }, { "name": "Source of hormone excess", "kind": "relation", "unit_or_values": "Link to suspected or established pituitary or nonpituitary source, with supporting evidence", "why_it_matters": "Connects the endocrine syndrome to source-directed assessment." }, { "name": "Pituitary lesion extent", "kind": "measurement", "unit_or_values": "Dimensions in mm, dated anatomical extension and relationship to the optic apparatus", "why_it_matters": "Supports assessment of local effects independently of hormone concentrations." }, { "name": "Acromegaly-associated burden", "kind": "relation", "unit_or_values": "Links to complications, functional limitations and patient-reported effects, with attribution confidence", "why_it_matters": "Captures consequences without assuming every coexisting condition is caused by acromegaly." }, { "name": "Treatment exposure", "kind": "relation", "unit_or_values": "Dated links to surgery, medication or radiotherapy records", "why_it_matters": "Provides the context needed to interpret subsequent disease activity." }, { "name": "Longitudinal disease status", "kind": "state", "unit_or_values": "untreated active | persistent active | controlled on treatment | remission off medication | suspected recurrence | indeterminate", "why_it_matters": "Distinguishes treatment-dependent control from remission using explicitly recorded criteria." } ], "affordances": [ "Assemble progressive physical changes and associated symptoms into a traceable reason for endocrine assessment", "Compare serial hormone results while flagging reference-range changes, confounders and discordance", "Link biochemical disease to source investigations without inferring causation from imaging alone", "Identify documented visual or neurological warning signs for urgent clinical review", "Track treatment response alongside tumour findings, complications and patient priorities", "Surface overdue assessments and unresolved evidence for clinician review" ] }, "sources": [], "structure": { "bundles": [ { "id": "recognition-and-disease-boundaries", "name": "Recognition and disease boundaries", "description": "Establish whether the observed pattern warrants assessment for acromegaly and which neighbouring conditions remain plausible.", "rationale": "Gradual change can be missed, while a suggestive appearance can be overinterpreted.", "layers": [ { "id": "acral-and-facial-progression", "name": "Acral and facial progression", "description": "Record changes over time rather than relying on a single impression.", "findings": [ { "id": "documented-overgrowth-pattern", "name": "Documented overgrowth pattern", "description": "Record changes in hand, foot, facial and oral features with their dates and evidence. These are recognised manifestations of acromegaly. [NIDDK](https://www.niddk.nih.gov/health-information/endocrine-diseases/acromegaly)", "questions": [ { "text": "Which changes in ring fit, shoe size, facial appearance or dental spacing have developed, and over what interval?", "kind": "measurement", "id": "documented-overgrowth-pattern-q01" }, { "text": "Which observations come from examination, dated photographs, dental records or patient recollection?", "kind": "provenance", "id": "documented-overgrowth-pattern-q02" } ] } ] }, { "id": "growth-timing-and-alternatives", "name": "Growth timing and alternatives", "description": "Locate the syndrome relative to skeletal maturity and competing explanations.", "findings": [ { "id": "acromegaly-versus-neighbouring-phenotypes", "name": "Acromegaly versus neighbouring phenotypes", "description": "Record skeletal-growth timing and alternative explanations without using body size or appearance as a substitute for endocrine evidence.", "questions": [ { "text": "Did suspected GH excess begin before, after or across growth-plate closure, and what evidence supports that timing?", "kind": "boundary", "id": "acromegaly-versus-neighbouring-phenotypes-q01" }, { "text": "If biochemical excess is unconfirmed, which alternative explanations for the acromegaloid appearance require assessment?", "kind": "boundary", "id": "acromegaly-versus-neighbouring-phenotypes-q02" } ] } ] } ] }, { "id": "biochemical-establishment", "name": "Biochemical establishment", "description": "Represent the evidence and interpretation supporting or challenging the diagnosis.", "rationale": "Laboratory values cannot establish disease independently of reference ranges, clinical context and applicable criteria.", "layers": [ { "id": "igf-1-interpretation", "name": "IGF-1 interpretation", "description": "Preserve the reference context and diagnostic rule used for each interpretation.", "findings": [ { "id": "age-adjusted-igf-1-evidence", "name": "Age-adjusted IGF-1 evidence", "description": "The 2024 consensus supports diagnosis with characteristic clinical signs and IGF-1 above 1.3 times the age-adjusted upper limit of normal; equivocal results require contextual reassessment. Record the criterion applied. [Diagnostic consensus](https://pmc.ncbi.nlm.nih.gov/articles/PMC10837217/)", "questions": [ { "text": "What were the IGF-1 concentration, age-adjusted reference interval, upper-limit ratio, assay and collection date?", "kind": "measurement", "id": "age-adjusted-igf-1-evidence-q01" }, { "text": "Which clinical findings and named diagnostic criteria support the interpretation?", "kind": "definition", "id": "age-adjusted-igf-1-evidence-q02" }, { "text": "Which physiological, medical or treatment factors could affect this result?", "kind": "boundary", "id": "age-adjusted-igf-1-evidence-q03" } ] } ] }, { "id": "gh-and-discordant-results", "name": "GH and discordant results", "description": "Record supplementary testing and uncertainty when clinical and biochemical evidence diverge.", "findings": [ { "id": "contextual-gh-assessment", "name": "Contextual GH assessment", "description": "Equivocal cases may benefit from repeated IGF-1 and oral glucose testing; record assay-specific interpretation rather than embedding a universal GH cutoff. [Diagnostic consensus](https://pmc.ncbi.nlm.nih.gov/articles/PMC10837217/)", "questions": [ { "text": "If glucose suppression testing was performed, what protocol, GH nadir, assay and interpretive threshold were used?", "kind": "measurement", "id": "contextual-gh-assessment-q01" }, { "text": "Do IGF-1, GH and clinical findings agree, and which discrepancy remains unresolved?", "kind": "boundary", "id": "contextual-gh-assessment-q02" }, { "text": "What repeat testing or specialist assessment has been agreed to resolve uncertainty?", "kind": "action", "id": "contextual-gh-assessment-q03" } ] } ] } ] }, { "id": "hormone-source-and-local-effects", "name": "Hormone source and local effects", "description": "Connect the endocrine syndrome to its source and distinguish secretion from anatomical consequences.", "rationale": "Hormone excess and lesion-related injury are separate dimensions requiring different evidence.", "layers": [ { "id": "source-localisation", "name": "Source localisation", "description": "Record localisation findings and the strength of causal attribution.", "findings": [ { "id": "source-attribution", "name": "Source attribution", "description": "Most acromegaly arises from a GH-producing pituitary tumour; uncommon nonpituitary sources require separate evidence. Record the basis for attribution. [NIDDK](https://www.niddk.nih.gov/health-information/endocrine-diseases/acromegaly)", "questions": [ { "text": "What does pituitary imaging show, including lesion dimensions and anatomical extension?", "kind": "measurement", "id": "source-attribution-q01" }, { "text": "What biochemical, imaging or pathological evidence connects the proposed source to GH excess?", "kind": "provenance", "id": "source-attribution-q02" }, { "text": "If pituitary imaging is negative or discordant, what source investigation has the specialist proposed?", "kind": "action", "id": "source-attribution-q03" } ] } ] }, { "id": "compression-and-pituitary-function", "name": "Compression and pituitary function", "description": "Capture local effects that hormone concentrations alone cannot describe.", "findings": [ { "id": "local-risk-assessment", "name": "Local risk assessment", "description": "Record visual effects and other pituitary hormone deficits alongside lesion anatomy; pituitary tumours may affect nearby structures and normal pituitary tissue. [NIDDK](https://www.niddk.nih.gov/health-information/endocrine-diseases/acromegaly)", "questions": [ { "text": "Are visual-field abnormalities or other pituitary hormone deficits documented, and by which assessments?", "kind": "measurement", "id": "local-risk-assessment-q01" }, { "text": "Are new visual or neurological symptoms present that require urgent clinical assessment?", "kind": "action", "id": "local-risk-assessment-q02" } ] } ] } ] }, { "id": "systemic-and-lived-burden", "name": "Systemic and lived burden", "description": "Record clinically relevant consequences and the person's priorities.", "rationale": "Hormone control alone does not describe accumulated damage or everyday disability.", "layers": [ { "id": "associated-complications", "name": "Associated complications", "description": "Connect acromegaly to assessed comorbidities while preserving their independent records.", "findings": [ { "id": "complication-assessment-status", "name": "Complication assessment status", "description": "Track assessment of hypertension, diabetes, cardiovascular disease, sleep apnoea and osteoarthritis, as recommended in acromegaly care. [Endocrine Society guideline](https://www.endocrine.org/clinical-practice-guidelines/acromegaly)", "questions": [ { "text": "Which associated complications are confirmed, suspected, excluded or not yet assessed?", "kind": "measurement", "id": "complication-assessment-status-q01" }, { "text": "What supports attribution to acromegaly rather than simple coexistence?", "kind": "provenance", "id": "complication-assessment-status-q02" }, { "text": "Which complication assessments or follow-up actions are due under the person's care plan?", "kind": "action", "id": "complication-assessment-status-q03" } ] } ] }, { "id": "function-and-personal-impact", "name": "Function and personal impact", "description": "Capture consequences that matter to the person and may persist after treatment.", "findings": [ { "id": "patient-prioritised-burden", "name": "Patient-prioritised burden", "description": "Record pain, mobility, sleep, appearance-related distress and participation limitations as reported, separately from biochemical status.", "questions": [ { "text": "Which symptoms or limitations most affect daily activities, relationships or work?", "kind": "measurement", "id": "patient-prioritised-burden-q01" }, { "text": "Which changes would the person consider meaningful improvement?", "kind": "action", "id": "patient-prioritised-burden-q02" } ] } ] } ] }, { "id": "treatment-response-and-surveillance", "name": "Treatment response and surveillance", "description": "Relate interventions to biochemical, anatomical and patient-reported outcomes over time.", "rationale": "A treated condition may remain active, require ongoing medication or leave consequences that need continuing care.", "layers": [ { "id": "intervention-and-response", "name": "Intervention and response", "description": "Preserve treatment intent and separate response dimensions.", "findings": [ { "id": "treatment-linked-outcomes", "name": "Treatment-linked outcomes", "description": "Link surgery, medication and radiotherapy to dated outcomes and adverse effects. These are established treatment modalities for acromegaly. [NIDDK](https://www.niddk.nih.gov/health-information/endocrine-diseases/acromegaly)", "questions": [ { "text": "Which interventions occurred, when, and with what documented therapeutic objective?", "kind": "provenance", "id": "treatment-linked-outcomes-q01" }, { "text": "How did IGF-1, relevant GH measurements, lesion findings and symptoms change after each intervention?", "kind": "measurement", "id": "treatment-linked-outcomes-q02" }, { "text": "Which adverse effects, access constraints or patient preferences require treatment review?", "kind": "action", "id": "treatment-linked-outcomes-q03" } ] } ] }, { "id": "control-remission-and-recurrence", "name": "Control, remission and recurrence", "description": "Make longitudinal status explicit and dependent on dated evidence.", "findings": [ { "id": "evidence-based-follow-up-state", "name": "Evidence-based follow-up state", "description": "Record remission or control criteria, treatment context and assessment timing; biochemical interpretation and follow-up depend on treatment modality. [Diagnostic and remission consensus](https://pmc.ncbi.nlm.nih.gov/articles/PMC10837217/)", "questions": [ { "text": "Which dated results and criteria support active disease, control on treatment, remission or suspected recurrence?", "kind": "definition", "id": "evidence-based-follow-up-state-q01" }, { "text": "Were measurements obtained at an appropriate interval and interpreted for the treatment being used?", "kind": "boundary", "id": "evidence-based-follow-up-state-q02" }, { "text": "What biochemical, imaging and complication surveillance is planned, and what findings would prompt earlier review?", "kind": "action", "id": "evidence-based-follow-up-state-q03" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "This is recalled knowledge, not a source-verified account; guideline versions and current consensus criteria require checking.", "Diagnostic and treatment-response thresholds must be checked against the relevant assay and current guidance.", "The supplied domain code is retained as registry context; acromegaly is described here in its clinical disease sense." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of acromegaly this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Pituitary tumour-associated acromegaly", "Acromegaly caused by ectopic growth hormone-releasing hormone secretion", "Acromegaly caused by ectopic growth hormone secretion, which is exceptionally rare" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of acromegaly this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "ICD-10", "value_or_pattern": "E22.0", "note": "The category covers acromegaly and pituitary gigantism; it does not distinguish them." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of acromegaly this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-standards-and-regulation", "name": "Standards and regulation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Endocrine Society clinical practice guideline on acromegaly addresses diagnosis, treatment and follow-up.", "Acromegaly Consensus Group consensus statements address biochemical diagnosis, disease control and management." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of acromegaly this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Clinical recognition of progressive enlargement of hands and feet, facial changes and associated systemic disease.", "Biochemical investigation of suspected growth hormone excess.", "Pituitary imaging and assessment of tumour effects and pituitary function.", "Selection and monitoring of surgery, medical therapy or radiotherapy.", "Assessment and management of cardiovascular, metabolic, respiratory and musculoskeletal complications." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of acromegaly this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "quantity": "Serum insulin-like growth factor 1 concentration", "typical_range": "Commonly above the age-adjusted reference interval in active disease; interpretation depends on the assay and clinical context.", "unit": "ng/mL or nmol/L" }, { "quantity": "Serum growth hormone concentration, including nadir during an oral glucose tolerance test", "typical_range": "Failure of appropriate suppression can support diagnosis; thresholds depend on assay sensitivity and diagnostic context.", "unit": "ng/mL or µg/L" }, { "quantity": "Maximum pituitary tumour diameter", "typical_range": "Microadenoma: less than 10 mm; macroadenoma: 10 mm or greater.", "unit": "mm" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of acromegaly this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Slow progression can delay recognition and allow partly irreversible skeletal and joint changes.", "Hypertension, cardiomyopathy and other cardiovascular complications can increase morbidity and mortality.", "Insulin resistance, diabetes mellitus and obstructive sleep apnoea are important associated conditions.", "A pituitary tumour can cause visual impairment and deficiencies of other pituitary hormones.", "Pulsatile growth hormone secretion, assay differences and conditions affecting insulin-like growth factor 1 can complicate biochemical interpretation." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of acromegaly this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Access to hormone assays, pituitary imaging, specialist surgery and long-term medical treatment varies between health systems." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of acromegaly this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Pituitary gigantism", "difference": "Growth hormone excess begins before epiphyseal closure and causes excessive linear growth; acromegaly describes the characteristic changes after closure, although features can overlap." }, { "name": "Nonfunctioning pituitary adenoma", "difference": "It may cause similar mass effects but does not produce the growth hormone excess responsible for acromegaly." }, { "name": "Pseudoacromegaly", "difference": "Acromegaly-like physical features occur without the biochemical growth hormone and insulin-like growth factor 1 excess characteristic of acromegaly." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of acromegaly this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Which diagnostic and remission consensus, assay-specific thresholds and update policy should govern implementations of this model?", "How should borderline IGF-1 elevation and persistent GH-IGF-1 discordance be represented across different treatments and physiological contexts?", "How should cases with GH excess spanning growth-plate closure link acromegaly and gigantism without duplicating the underlying disease episode?", "Which complication surveillance schedules, including colorectal assessment, apply by jurisdiction, prior findings and individual risk?", "Does an existing Vercy world model already own this disease concept, requiring this registry entry to link to it instead of creating a separate publication?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 19, "questions": 35 } }, "draft": { "generator": "vr.draft.v3", "status": "draft-generated", "researched": false, "archetype": "abstract concept", "method": "Written from the archetype playbook - what this kind of thing needs beyond identity and provenance - and from the structure that recurred across 6,333 models already researched by two engines. Applied to this entry by rule. No source was read for this thing and no claim here is researched. This entry carries no facets of its own, so they were inferred from its domain - a guess about a whole domain applied to one thing.", "facetsInferred": true, "nextPass": "A researcher replaces this draft with a sourced specification. Treat every sentence below as a proposal to argue with.", "purpose": "Give an agent a durable, checkable way to recognise a acromegaly, record what state it is in, and decide what may be done with it.", "whatItIs": "Enable an agent to recognise suspected acromegaly, record evidence of growth-hormone excess and its consequences, and support clinician-reviewed investigation, treatment and follow-up.", "characteristics": { "substance": "abstract", "origin": "conceptual", "agency": "inert" }, "whatYouCanDoWithIt": [ "observed and measured" ], "distinguishingFeatures": [ "Names folded into this entry, which a task may need to split apart again: canine acromegaly.", "1 finer distinctions are held as aliases rather than separate entries, because telling them apart needs a task that asks for it.", "Described in 73 Wikipedia languages, which is a measure of how widely the thing is known, not of how important it is." ], "openQuestionsForResearch": [ "Which of the bundles below does a real task actually need, and which are ceremony?", "What does this thing have that the facets do not capture at all?", "Which neighbouring kind is most often confused with a acromegaly, and on what evidence are they told apart?" ], "whatItIsMadeOf": "an abstraction with no physical instance", "physicalCharacter": [ "Does nothing on its own; everything it does, something else did to it.", "These come from the domain this entry sits in rather than from the entry itself, so treat them as a first guess about the whole domain applied to one thing." ], "whatCanBeDoneWithIt": [ "observe it, measure it, record its state" ], "howItIsRecognised": [ "Nothing to see. What is recognised is an instance of it, and which instances count is exactly what is argued about." ], "relatedModels": [ { "relation": "covers", "note": "Finer kinds folded into this entry because telling them apart needs a task that asks for it. Each is a model waiting to be split out when one does.", "targets": [ "canine acromegaly" ] } ], "standing": "Described in 73 Wikipedia languages, which measures how widely it is written about rather than how important or how common it is. 1 finer distinctions are held inside this entry as names rather than as separate models.", "structure": { "bundles": [ { "id": "identity-and-classification", "name": "Identity, naming and classification", "description": "How an agent tells one acromegaly from another, and a acromegaly from things that resemble it.", "rationale": "Recognition comes before every other claim. Without stable identity nothing else in the model can be trusted to be about the same thing twice.", "layers": [ { "id": "naming-and-identifiers", "name": "Names and identifiers", "description": "The names this thing goes by and the identifiers that survive translation and time.", "findings": [ { "id": "preferred-name-and-aliases", "name": "Preferred name, aliases and local names", "description": "Which name to use, which names mean the same thing, and which merely sound similar.", "questions": [ { "id": "preferred-name-and-aliases-q01", "text": "What identifies and describes the name of a acromegaly, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "preferred-name-and-aliases-q02", "text": "Who or what asserted this about the name of a acromegaly, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "preferred-name-and-aliases-q03", "text": "What may an agent decide or do once the name of a acromegaly is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] }, { "id": "stable-identifiers", "name": "Stable identifiers and external keys", "description": "Identifiers that keep pointing at this kind of thing across systems and languages.", "questions": [ { "id": "stable-identifiers-q01", "text": "What identifies and describes an identifier for a acromegaly, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "stable-identifiers-q02", "text": "Who or what asserted this about an identifier for a acromegaly, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "stable-identifiers-q03", "text": "What may an agent decide or do once an identifier for a acromegaly is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "classification-and-granularity", "name": "Classification and granularity", "description": "Where a acromegaly sits among kinds, and how finely a task needs to cut it.", "findings": [ { "id": "kind-and-parents", "name": "Kind, parents and neighbouring kinds", "description": "The classes this thing belongs to and the ones it is next to.", "questions": [ { "id": "kind-and-parents-q01", "text": "What identifies and describes the kind of a acromegaly, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "kind-and-parents-q02", "text": "Who or what asserted this about the kind of a acromegaly, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "kind-and-parents-q03", "text": "What may an agent decide or do once the kind of a acromegaly is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] }, { "id": "distinguishing-features", "name": "Distinguishing features", "description": "What separates a acromegaly from the things most often confused with it.", "questions": [ { "id": "distinguishing-features-q01", "text": "What identifies and describes what distinguishes a acromegaly, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "distinguishing-features-q02", "text": "Who or what asserted this about what distinguishes a acromegaly, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "distinguishing-features-q03", "text": "What may an agent decide or do once what distinguishes a acromegaly is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "state-and-lifecycle", "name": "State and lifecycle", "description": "The states a acromegaly passes through and the events that move it between them.", "rationale": "Most decisions about a thing depend on what state it is in now, which is a claim with a time on it, not a property.", "layers": [ { "id": "lifecycle-stages", "name": "Lifecycle stages", "description": "From coming into existence to ceasing to be one of these.", "findings": [ { "id": "stages-and-transitions", "name": "Stages and transitions", "description": "The stages worth naming and what moves a acromegaly between them.", "questions": [ { "id": "stages-and-transitions-q01", "text": "What identifies and describes the lifecycle of a acromegaly, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "stages-and-transitions-q02", "text": "Who or what asserted this about the lifecycle of a acromegaly, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "stages-and-transitions-q03", "text": "What may an agent decide or do once the lifecycle of a acromegaly is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "observations-and-status", "name": "Observations and current status", "description": "What is observed about a acromegaly, how often and by whom.", "findings": [ { "id": "observation-record", "name": "Observation record", "description": "How an observation of a acromegaly is recorded so that it can be superseded rather than overwritten.", "questions": [ { "id": "observation-record-q01", "text": "What identifies and describes an observation of a acromegaly, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "observation-record-q02", "text": "Who or what asserted this about an observation of a acromegaly, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "observation-record-q03", "text": "What may an agent decide or do once an observation of a acromegaly is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "definitions-in-contest", "name": "Definitions and who holds them", "description": "What acromegaly is taken to mean, and by whom.", "rationale": "When a field disagrees about a concept, the disagreement is the content. A model that picks one definition silently destroys the information.", "layers": [ { "id": "competing-definitions", "name": "Competing definitions", "description": "The main readings and the traditions behind them.", "findings": [ { "id": "definition-map", "name": "Definitions and their holders", "description": "Each definition with the school or body that holds it.", "questions": [ { "id": "definition-map-q01", "text": "Which definitions of acromegaly are in use, and which tradition or body holds each?", "kind": "definition" }, { "id": "definition-map-q02", "text": "What turns on the difference between them in practice?", "kind": "boundary" } ] } ] }, { "id": "operationalisation", "name": "Operationalisation", "description": "How it is measured or applied when it has to be.", "findings": [ { "id": "operational-record", "name": "Measures and proxies", "description": "Instruments and indicators used to stand in for it.", "questions": [ { "id": "operational-record-q01", "text": "How is acromegaly operationalised or measured in practice, and by what instrument?", "kind": "measurement" }, { "id": "operational-record-q02", "text": "What does that operationalisation leave out, and when does that matter?", "kind": "boundary" } ] } ] } ] }, { "id": "instances-and-use", "name": "Instances, use and consequence", "description": "What counts as an instance of acromegaly and what follows from calling something that.", "rationale": "Applying a concept is an act with consequences, so a model must say what the label licenses and what it does not.", "layers": [ { "id": "instances", "name": "What counts as an instance", "description": "Clear cases, borderline cases and non-cases.", "findings": [ { "id": "instance-tests", "name": "Tests for an instance", "description": "What would settle whether something falls under it.", "questions": [ { "id": "instance-tests-q01", "text": "What would settle whether something is an instance of acromegaly?", "kind": "boundary" }, { "id": "instance-tests-q02", "text": "Which borderline cases are argued about, and on what grounds?", "kind": "definition" } ] } ] }, { "id": "consequence", "name": "Consequence of application", "description": "Rights, duties or decisions that follow from the label.", "findings": [ { "id": "consequence-record", "name": "What the label licenses", "description": "What an agent may do once something is classified this way.", "questions": [ { "id": "consequence-record-q01", "text": "What follows practically once something is treated as acromegaly?", "kind": "action" }, { "id": "consequence-record-q02", "text": "What must an agent not infer from the label alone?", "kind": "action" } ] } ] } ] }, { "id": "provenance-and-evidence", "name": "Provenance, evidence and time", "description": "Where every claim about a acromegaly came from and when it held.", "rationale": "A claim without a source and a time cannot be superseded, only overwritten, and an agent that overwrites loses the ability to explain itself.", "layers": [ { "id": "source-and-authority", "name": "Source and authority", "description": "Who said it, on what evidence, and how strongly.", "findings": [ { "id": "claim-provenance", "name": "Claim provenance and confidence", "description": "The authority behind each claim about a acromegaly and how confident it is.", "questions": [ { "id": "claim-provenance-q01", "text": "What identifies and describes a claim about a acromegaly, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "claim-provenance-q02", "text": "Who or what asserted this about a claim about a acromegaly, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "claim-provenance-q03", "text": "What may an agent decide or do once a claim about a acromegaly is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "time-and-versions", "name": "Time, versions and supersession", "description": "When a claim was true, when it was learnt, and what replaced it.", "findings": [ { "id": "validity-and-supersession", "name": "Validity period and supersession", "description": "How an old claim about a acromegaly is retired without being erased.", "questions": [ { "id": "validity-and-supersession-q01", "text": "What identifies and describes the validity of a claim about a acromegaly, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "validity-and-supersession-q02", "text": "Who or what asserted this about the validity of a claim about a acromegaly, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "validity-and-supersession-q03", "text": "What may an agent decide or do once the validity of a claim about a acromegaly is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] } ] }, "statistics": { "bundles": 5, "layers": 10, "findings": 12, "questions": 32 } } } }