{ "model": { "rank": 5500, "code": "thing-q191779", "model_id": "vr.tr.tourette-syndrome", "name": "Tourette syndrome", "purpose": "Enable an agent to recognise Tourette syndrome, represent its changing manifestations and impact, and support evidence-based assessment and care decisions.", "family": "Thing Registry", "category": "Cross-cutting context", "status": "research-draft", "kind": "thing", "plane": "XCT", "domain": "XCT.STA", "industry": "", "version": "", "url": "/models/thing/q191779/", "tier": 2, "score": 67, "payload": { "layer": "wikidata", "aliases": [], "aliasCount": 0, "merged": 0, "knownIn": 67, "facets": null, "markers": [], "lexicalClass": "", "senseRank": null, "alsoRegisteredAs": null, "source": { "dataset": "wikidata", "item": "Q191779", "url": "https://www.wikidata.org/wiki/Q191779", "license": "CC0 1.0" } }, "research": { "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-09T22:30:34Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 22.5, "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: 01a0884a-2db3-7de3-86a5-c441dbf69d1d\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: Tourette syndrome\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: 10", "usd": 0, "recall": true }, "codex": { "seconds": 76.7, "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: 01a0884a-2da4-7cd3-af97-d5b65ba25aa1\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: Tourette syndrome\nRegistry id: vr.tr.tourette-syndrome\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this entr" } } }, "metaModel": { "id": "THING-Q191779", "registryId": "vr.tr.tourette-syndrome", "name": "Tourette syndrome", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q191779/", "model": { "registry_id": "vr.tr.tourette-syndrome", "name": "Tourette syndrome", "purpose": "Enable an agent to recognise Tourette syndrome, represent its changing manifestations and impact, and support evidence-based assessment and care decisions.", "definition": "Tourette syndrome is a neurodevelopmental tic disorder characterized by multiple motor tics and at least one vocal tic occurring at some time during a course lasting more than one year since first tic onset, with onset before age 18 and symptoms not attributable to a substance or another medical condition.", "scope_statement": "This model owns the Tourette-specific condition concept registered as vr.tr.tourette-syndrome in XCT / XCT.STA, adding tic phenomenology, developmental history and diagnostic boundaries to the broader concept of syndrome while keeping the condition distinct from a diagnostic assertion, the person and an episode of care.", "in_scope": [ "Motor and vocal tic repertoire, reported experiences and observation context", "Onset, duration, fluctuation and longitudinal course", "Versioned diagnostic criteria, differential assessment and classification mappings", "Tic-related impairment and relationships to co-occurring conditions", "Evidence supporting management choices, individual goals and response assessment", "Aetiological evidence and population estimates with their limitations" ], "out_of_scope": [ "The general meaning and classification of syndrome", "The person's complete identity, health record or social circumstances", "Independent models of ADHD, obsessive-compulsive disorder and other co-occurring conditions", "Full models of other tic disorders or functional neurological disorder", "Encounter administration, billing and care-service operations", "Drug prescribing protocols and the internal specification of therapeutic procedures" ], "distinguishing_features": [ "Under the American Psychiatric Association's DSM-5-TR framework, assess a history of multiple motor tics and at least one vocal tic; motor-only or vocal-only histories require a different classification assessment. [CDC diagnostic overview](https://www.cdc.gov/tourette-syndrome/diagnosis/index.html)", "Establish onset before age 18 and the required duration from first tic onset under the selected criteria version; a shorter history must not automatically receive the Tourette label. [CDC diagnostic overview](https://www.cdc.gov/tourette-syndrome/diagnosis/index.html)", "Assess whether substances, medication or another medical condition explain the manifestations before accepting the diagnostic boundary. [CDC diagnostic overview](https://www.cdc.gov/tourette-syndrome/diagnosis/index.html)", "A presentation described as tic-like, including sudden-onset functional tic-like behaviours, requires assessment rather than automatic classification as Tourette syndrome. [CDC diagnostic overview](https://www.cdc.gov/tourette-syndrome/diagnosis/index.html)", "A single observed movement, sound or tic-free encounter cannot establish the required developmental history; recognition must connect present observations with longitudinal evidence." ], "characteristics": [ { "name": "Diagnostic framework", "kind": "category", "unit_or_values": "Issuing body, framework, edition or release, jurisdiction and applicable criteria", "why_it_matters": "Makes the basis of a diagnostic assertion explicit and prevents criteria from different systems being silently combined." }, { "name": "Tic repertoire", "kind": "category", "unit_or_values": "Motor or vocal; concrete movement or sound; body region; first and last reported occurrence", "why_it_matters": "Supports recognition across changing manifestations rather than treating each new tic as a new condition." }, { "name": "Age at first tic", "kind": "measurement", "unit_or_values": "Years and months, or an estimated interval with confidence and informant", "why_it_matters": "Separates developmental onset from the age at which diagnosis or care began." }, { "name": "Time since first tic", "kind": "measurement", "unit_or_values": "Months or years at a dated assessment, with uncertainty and reported intervals of absence", "why_it_matters": "Supports duration criteria without confusing observation time with symptom history." }, { "name": "Urge and suppression experience", "kind": "state", "unit_or_values": "Reported urge, temporary suppression, associated effort or discomfort; absent, unknown or not assessed", "why_it_matters": "Captures the person's experience without interpreting suppressibility as proof that symptoms are deliberate." }, { "name": "Tic severity", "kind": "measurement", "unit_or_values": "Named instrument, version, component scores, permitted ranges, assessor and recall period", "why_it_matters": "Makes severity comparisons interpretable and distinguishes scale components from overall impact." }, { "name": "Functional impact", "kind": "state", "unit_or_values": "Pain, injury, communication, learning, work, sleep and participation effects; patient-rated priority and assessment date", "why_it_matters": "Connects management decisions to consequences that matter to the person." }, { "name": "Diagnostic assertion", "kind": "relation", "unit_or_values": "Link to assessor, date, supporting evidence, framework and status: suspected, confirmed, disputed or revised", "why_it_matters": "Keeps a clinical judgement distinct from the underlying condition and from a billing code." }, { "name": "Co-occurring condition", "kind": "relation", "unit_or_values": "Linked condition or assessment, certainty, temporal relationship and attributed contribution to impairment", "why_it_matters": "Prevents every difficulty from being attributed to tics." }, { "name": "Population estimate", "kind": "measurement", "unit_or_values": "Proportion or cases per stated denominator, uncertainty, age range, geography, study years and ascertainment method", "why_it_matters": "Distinguishes diagnosed prevalence from estimates based on screening or clinical assessment." } ], "affordances": [ "Assemble a dated motor and vocal tic history and identify evidence missing for clinician assessment.", "Compare documented evidence with a named diagnostic framework while retaining uncertainty and assessor attribution.", "Track tic changes and functional impact using comparable observation periods and measures.", "Flag unresolved alternative explanations or unexplained changes for clinical review.", "Summarise person-selected goals, accommodations and clinician-discussed management options.", "Audit terminology mappings and population claims against their source releases and study definitions." ] }, "sources": [], "structure": { "bundles": [ { "id": "tourette-identity-and-diagnostic-boundaries", "name": "Tourette identity and diagnostic boundaries", "description": "Establishes which condition the registry entry denotes and how diagnostic evidence is evaluated.", "rationale": "Tourette-specific criteria must supplement the wider syndrome concept without turning a label or code into diagnostic proof.", "layers": [ { "id": "condition-and-assertion", "name": "Condition and assertion", "description": "Separates the registered concept from individual diagnostic judgements and terminology mappings.", "findings": [ { "id": "versioned-diagnostic-identity", "name": "Versioned diagnostic identity", "description": "Record the framework behind each diagnostic assertion and verify ICD-10, ICD-11 and SNOMED CT mappings against their own releases.", "questions": [ { "text": "Which issuing body, criteria edition and assessment date support this Tourette diagnostic assertion?", "kind": "provenance", "id": "versioned-diagnostic-identity-q01" }, { "text": "Which verified terminology concept denotes Tourette syndrome in the relevant release, and is the mapping exact or qualified?", "kind": "boundary", "id": "versioned-diagnostic-identity-q02" } ] } ] }, { "id": "criteria-and-alternatives", "name": "Criteria and alternatives", "description": "Connects tic history to the selected diagnostic rules and unresolved alternatives.", "findings": [ { "id": "criterion-level-evidence", "name": "Criterion-level evidence", "description": "Keep evidence for tic types, onset, duration and exclusions individually assessable rather than collapsing missing information into a yes-or-no label.", "questions": [ { "text": "What evidence supports or leaves uncertain each required motor, vocal, onset and duration criterion?", "kind": "definition", "id": "criterion-level-evidence-q01" }, { "text": "What assessment distinguishes this presentation from another tic disorder, functional tic-like behaviours or another explanation?", "kind": "boundary", "id": "criterion-level-evidence-q02" } ] } ] } ] }, { "id": "tic-repertoire-and-lived-experience", "name": "Tic repertoire and lived experience", "description": "Describes the actual movements, sounds and associated experiences being assessed.", "rationale": "A generic symptom count cannot represent changing tic forms, observation limits or the effort involved in managing them.", "layers": [ { "id": "motor-and-vocal-description", "name": "Motor and vocal description", "description": "Makes the reported or observed tic repertoire recognisable.", "findings": [ { "id": "identifiable-tic-manifestations", "name": "Identifiable tic manifestations", "description": "Describe each movement or sound concretely, retaining the distinction between a witnessed event and an informant's report.", "questions": [ { "text": "What movement or sound occurs, which body region is involved, and how is it classified by the assessor?", "kind": "definition", "id": "identifiable-tic-manifestations-q01" }, { "text": "Who observed or reported it, in which setting and over what observation period?", "kind": "provenance", "id": "identifiable-tic-manifestations-q02" } ] } ] }, { "id": "urges-suppression-and-context", "name": "Urges, suppression and context", "description": "Captures experiences and circumstances that may not be visible during an assessment.", "findings": [ { "id": "subjective-and-contextual-evidence", "name": "Subjective and contextual evidence", "description": "Ask about urges, suppression and contextual variation without requiring these experiences to be reported or assuming their absence when unassessed.", "questions": [ { "text": "Does the person describe an urge, temporary suppression or associated discomfort, and how was this elicited?", "kind": "measurement", "id": "subjective-and-contextual-evidence-q01" }, { "text": "How do reported manifestations differ between settings, and could observation conditions explain the discrepancy?", "kind": "boundary", "id": "subjective-and-contextual-evidence-q02" } ] } ] } ] }, { "id": "developmental-course-and-evidence", "name": "Developmental course and evidence", "description": "Places manifestations in time and separates individual history from causal and population claims.", "rationale": "A current snapshot cannot establish developmental onset, long-term course or the applicability of research estimates.", "layers": [ { "id": "onset-and-longitudinal-course", "name": "Onset and longitudinal course", "description": "Reconstructs onset and change without imposing unsupported universal stages.", "findings": [ { "id": "dated-tic-trajectory", "name": "Dated tic trajectory", "description": "Represent first tic onset, subsequent motor and vocal manifestations, fluctuations and assessment dates with their uncertainty.", "questions": [ { "text": "When did the first tic and the first reported motor and vocal manifestations occur, and how reliable are those dates?", "kind": "provenance", "id": "dated-tic-trajectory-q01" }, { "text": "Which changes reflect sustained improvement or worsening, and which may reflect short observation windows or changed reporting?", "kind": "measurement", "id": "dated-tic-trajectory-q02" } ] } ] }, { "id": "aetiology-and-affected-populations", "name": "Aetiology and affected populations", "description": "Qualifies research claims about causes, susceptibility and distribution.", "findings": [ { "id": "bounded-research-inferences", "name": "Bounded research inferences", "description": "Keep family history, proposed mechanisms and epidemiological estimates separate from proof of an individual's cause or diagnosis.", "questions": [ { "text": "Which source supports each aetiological claim, and does it establish causation, association or a proposed mechanism?", "kind": "provenance", "id": "bounded-research-inferences-q01" }, { "text": "For each prevalence estimate, what population, years, case definition, ascertainment method and uncertainty apply?", "kind": "measurement", "id": "bounded-research-inferences-q02" } ] } ] } ] }, { "id": "severity-impact-and-co-occurrence", "name": "Severity, impact and co-occurrence", "description": "Assesses tic burden and its relationship to everyday functioning and other conditions.", "rationale": "Visible tic frequency alone cannot determine the person's priorities or explain all impairment.", "layers": [ { "id": "tic-burden-and-function", "name": "Tic burden and function", "description": "Keeps measured manifestations and experienced consequences separately visible.", "findings": [ { "id": "interpretable-burden-assessment", "name": "Interpretable burden assessment", "description": "Record instrument-specific severity alongside pain, injury, interference and the person's own account of impact.", "questions": [ { "text": "Which severity instrument, version, component and recall interval produced the recorded score?", "kind": "measurement", "id": "interpretable-burden-assessment-q01" }, { "text": "Which tic-related consequences matter most to the person in daily life?", "kind": "measurement", "id": "interpretable-burden-assessment-q02" } ] } ] }, { "id": "co-occurring-and-environmental-contributions", "name": "Co-occurring and environmental contributions", "description": "Separates tic effects from other clinical difficulties and responses in the surrounding environment.", "findings": [ { "id": "attributed-functional-difficulties", "name": "Attributed functional difficulties", "description": "Link assessments of attention, compulsions, anxiety and other concerns to their own condition records; document stigma or exclusion as contextual contributors.", "questions": [ { "text": "Which difficulties are attributed to tics, another assessed condition, environmental responses or an unresolved combination?", "kind": "boundary", "id": "attributed-functional-difficulties-q01" }, { "text": "Which assessment or accommodation could clarify or reduce the most important difficulty?", "kind": "action", "id": "attributed-functional-difficulties-q02" } ] } ] } ] }, { "id": "management-goals-and-response", "name": "Management goals and response", "description": "Connects supported management choices to individual priorities and interpretable follow-up.", "rationale": "Care decisions need an explicit target, applicable evidence and a way to distinguish benefit from ordinary fluctuation.", "layers": [ { "id": "goals-and-option-selection", "name": "Goals and option selection", "description": "Records why a particular support or intervention is being considered.", "findings": [ { "id": "goal-linked-management", "name": "Goal-linked management", "description": "Represent clinician-discussed options such as monitoring, behavioural intervention, medication and accommodations with their rationale and the person's preferences.", "questions": [ { "text": "What outcome does the person want, and which tic-related difficulty is the proposed option intended to address?", "kind": "action", "id": "goal-linked-management-q01" }, { "text": "Which guideline and individual assessment support the option, including its suitability, access requirements and burdens?", "kind": "provenance", "id": "goal-linked-management-q02" } ] } ] }, { "id": "follow-up-and-reassessment", "name": "Follow-up and reassessment", "description": "Assesses outcomes while preserving the distinction between the condition and an episode of care.", "findings": [ { "id": "response-with-attribution-limits", "name": "Response with attribution limits", "description": "Compare agreed outcomes over time, recording concurrent changes and adverse effects before attributing improvement or worsening to an intervention.", "questions": [ { "text": "What changed relative to the agreed baseline in tic burden, functioning, personal goals and unwanted effects?", "kind": "measurement", "id": "response-with-attribution-limits-q01" }, { "text": "Does the evidence support continuing, reviewing or changing the plan with the responsible clinician?", "kind": "action", "id": "response-with-attribution-limits-q02" } ] } ] } ] }, { "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 recall, not source-verified research; the definition follows DSM-5-TR criteria, and other classification systems should be checked separately.", "Tics commonly wax and wane and often lessen during adolescence, but persistence and impairment vary; there is no single established cause or confirmatory laboratory test.", "No prevalence estimate or formal subtype list is supplied; population, age, ascertainment method and study year would need verification." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of Tourette syndrome 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": "F95.2", "note": "WHO category for combined vocal and multiple motor tic disorder, including Tourette syndrome; national modifications should be checked separately." }, { "scheme": "SNOMED CT", "value_or_pattern": "Numeric concept identifier", "note": "The exact concept identifier and applicable edition require verification." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of Tourette syndrome 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": [ "American Psychiatric Association DSM-5-TR: diagnostic criteria for Tourette's disorder.", "World Health Organization ICD-10: classification under tic disorders.", "World Health Organization ICD-11: diagnostic classification; exact code and release should be verified." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of Tourette syndrome 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 assessment of the types, onset, duration and functional effects of tics.", "Assessment of co-occurring ADHD, obsessive-compulsive symptoms, anxiety and learning difficulties.", "Selection and monitoring of behavioral interventions, including comprehensive behavioral intervention for tics.", "Planning school and workplace accommodations according to individual needs.", "Defining participant groups and outcomes in clinical research." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of Tourette syndrome 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": "Yale Global Tic Severity Scale total tic score", "typical_range": "0-50 possible score; this is the instrument range, not a typical patient range", "unit": "points" }, { "quantity": "Yale Global Tic Severity Scale impairment score", "typical_range": "0-50 possible score; assessed separately from tic severity", "unit": "points" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of Tourette syndrome 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": [ "Equating Tourette syndrome with involuntary swearing; coprolalia is not required for diagnosis.", "Mistaking tics for deliberate misconduct, or treating temporary tic suppression as evidence that symptoms are voluntary.", "Confusing tics with compulsions, stereotypies, other movement disorders or functional tic-like behaviors.", "Missing co-occurring conditions that may cause more impairment than the tics themselves.", "Pain, injury, bullying and social exclusion can occur, but severity and functional impact vary substantially." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of Tourette syndrome 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": [ "Diagnostic documentation and administrative coding vary with use of DSM, WHO ICD and national ICD modifications.", "Access to specialist assessment, behavioral treatment and educational accommodations varies across health and education systems." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of Tourette syndrome 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": "syndrome", "difference": "A syndrome is a general grouping of associated clinical features; Tourette syndrome specifies a particular pattern and history of motor and vocal tics." }, { "name": "persistent motor or vocal tic disorder", "difference": "Under DSM-5-TR, motor or vocal tics occur, but not both types over the illness course; Tourette syndrome requires both types at some time, though not necessarily simultaneously." }, { "name": "provisional tic disorder", "difference": "Under DSM-5-TR, less than one year has elapsed since first tic onset, and criteria for Tourette syndrome or persistent motor or vocal tic disorder have never been met." }, { "name": "obsessive-compulsive disorder", "difference": "Compulsions are typically performed in response to obsessions or rules; tics are recurrent movements or vocalizations often associated with premonitory urges, although overlap can complicate assessment." }, { "name": "functional tic-like behaviors", "difference": "Distinction requires assessment of onset, evolution and clinical features; appearance alone is insufficient, and functional symptoms can coexist with Tourette syndrome." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of Tourette syndrome this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Does an existing Vercy world model already cover Tourette syndrome, requiring this registry entry to link to it rather than create a second publication?", "What are the verified ICD-10 jurisdiction-specific, ICD-11 release-specific and SNOMED CT edition-specific mappings, and where do their diagnostic boundaries differ?", "Which validated tic, urge, impairment and quality-of-life measures are suitable across ages, languages and assessment settings, including thresholds for meaningful change?", "What does current evidence establish about aetiology, adult persistence and prevalence across populations when diagnostic ascertainment and study years are accounted for?", "Which current guidelines best support management selection and reassessment, including complex differential presentations and severe or treatment-resistant impairment?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 18, "questions": 28 } }, "draft": { "generator": "vr.draft.v3", "status": "draft-generated", "researched": false, "archetype": "disease or condition", "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 Tourette syndrome, record what state it is in, and decide what may be done with it.", "whatItIs": "Enable an agent to recognise Tourette syndrome, represent its changing manifestations and impact, and support evidence-based assessment and care decisions.", "characteristics": { "substance": "abstract", "origin": "conceptual", "agency": "inert" }, "whatYouCanDoWithIt": [ "observed and measured" ], "distinguishingFeatures": [ "Described in 67 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 Tourette syndrome, 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": [ "Recognised by criteria applied to signs and findings, not by appearance. Two conditions can look identical and be distinguished only by test." ], "relatedModels": [], "standing": "Described in 67 Wikipedia languages, which measures how widely it is written about rather than how important or how common it is.", "structure": { "bundles": [ { "id": "identity-and-classification", "name": "Identity, naming and classification", "description": "How an agent tells one Tourette syndrome from another, and a Tourette syndrome 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 Tourette syndrome, 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 Tourette syndrome, 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 Tourette syndrome 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 Tourette syndrome, 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 Tourette syndrome, 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 Tourette syndrome 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 Tourette syndrome 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 Tourette syndrome, 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 Tourette syndrome, 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 Tourette syndrome 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 Tourette syndrome from the things most often confused with it.", "questions": [ { "id": "distinguishing-features-q01", "text": "What identifies and describes what distinguishes a Tourette syndrome, 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 Tourette syndrome, 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 Tourette syndrome 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 Tourette syndrome 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 Tourette syndrome between them.", "questions": [ { "id": "stages-and-transitions-q01", "text": "What identifies and describes the lifecycle of a Tourette syndrome, 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 Tourette syndrome, 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 Tourette syndrome 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 Tourette syndrome, how often and by whom.", "findings": [ { "id": "observation-record", "name": "Observation record", "description": "How an observation of a Tourette syndrome 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 Tourette syndrome, 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 Tourette syndrome, 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 Tourette syndrome is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "diagnosis-and-criteria", "name": "Diagnosis, criteria and coding", "description": "What makes a case of Tourette syndrome a case, and under which revision.", "rationale": "Criteria change between revisions, so a diagnosis without its coding revision cannot be compared with a later one.", "layers": [ { "id": "criteria", "name": "Diagnostic criteria", "description": "The criteria in force and who issues them.", "findings": [ { "id": "criteria-record", "name": "Criteria, issuer and revision", "description": "What must be true for a diagnosis, according to whom.", "questions": [ { "id": "criteria-record-q01", "text": "What criteria define Tourette syndrome, issued by which body, in which revision?", "kind": "definition" }, { "id": "criteria-record-q02", "text": "What changed between revisions that would reclassify existing cases?", "kind": "boundary" } ] } ] }, { "id": "coding", "name": "Coding and terminology", "description": "The codes used to record it and their mapping.", "findings": [ { "id": "coding-record", "name": "Codes and mappings", "description": "Which classification codes apply and how they map.", "questions": [ { "id": "coding-record-q01", "text": "Which classification and terminology codes cover Tourette syndrome, and how do they map to each other?", "kind": "definition" }, { "id": "coding-record-q02", "text": "What is lost when a case is mapped from one scheme to another?", "kind": "boundary" } ] } ] } ] }, { "id": "course-and-population", "name": "Course, population and care", "description": "How Tourette syndrome develops, whom it affects, and what is done about it.", "rationale": "The condition, the diagnosis and the episode of care are three different things, and an agent must not merge them.", "layers": [ { "id": "course", "name": "Course and stages", "description": "Onset, progression, remission and outcome.", "findings": [ { "id": "course-record", "name": "Stages and transitions", "description": "The stages recorded and what moves a case between them.", "questions": [ { "id": "course-record-q01", "text": "What course does Tourette syndrome typically take, and what marks each stage?", "kind": "definition" }, { "id": "course-record-q02", "text": "What separates the condition itself from an episode of care for it?", "kind": "boundary" } ] } ] }, { "id": "population", "name": "Affected populations", "description": "Who is affected, how often, and on what evidence.", "findings": [ { "id": "epidemiology", "name": "Prevalence and its basis", "description": "Rates with their population, period and source.", "questions": [ { "id": "epidemiology-q01", "text": "What prevalence or incidence is reported for Tourette syndrome, in which population and period?", "kind": "measurement" }, { "id": "epidemiology-q02", "text": "What may an agent not conclude about an individual from a population rate?", "kind": "action" } ] } ] } ] }, { "id": "provenance-and-evidence", "name": "Provenance, evidence and time", "description": "Where every claim about a Tourette syndrome 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 Tourette syndrome and how confident it is.", "questions": [ { "id": "claim-provenance-q01", "text": "What identifies and describes a claim about a Tourette syndrome, 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 Tourette syndrome, 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 Tourette syndrome 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 Tourette syndrome is retired without being erased.", "questions": [ { "id": "validity-and-supersession-q01", "text": "What identifies and describes the validity of a claim about a Tourette syndrome, 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 Tourette syndrome, 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 Tourette syndrome 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 } } } }