{ "model": { "rank": 2803, "code": "thing-q47790", "model_id": "vr.tr.tetanus", "name": "tetanus", "purpose": "Enable an AI agent to represent a suspected or diagnosed tetanus episode, assess its evolving threats, and support timely clinician-led decisions.", "family": "Thing Registry", "category": "Cross-cutting context", "status": "research-draft", "kind": "thing", "plane": "XCT", "domain": "XCT.QLT", "industry": "", "version": "", "url": "/models/thing/q47790/", "tier": 2, "score": 97, "payload": { "layer": "wikidata", "aliases": [ "tetanus neonatorum" ], "aliasCount": 1, "merged": 1, "knownIn": 97, "facets": null, "markers": [], "lexicalClass": "", "senseRank": null, "alsoRegisteredAs": null, "source": { "dataset": "wikidata", "item": "Q47790", "url": "https://www.wikidata.org/wiki/Q47790", "license": "CC0 1.0" } }, "research": { "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-07T11:53:15Z", "providers": [ "Codex", "Grok" ], "missingProviders": [], "pass": 2, "cost": { "grok": { "usd": 0.03677254, "turns": 2, "seconds": 155.5, "error": null }, "codex": { "seconds": 98.9, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.3\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: 01a07bb4-ca22-72d0-9dba-454ead0791ec\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: tetanus\nRegistry id: vr.tr.tetanus\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this entry: (none)\n\nA Vercy m" } } }, "metaModel": { "id": "THING-Q47790", "registryId": "vr.tr.tetanus", "name": "tetanus", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q47790/", "model": { "registry_id": "vr.tr.tetanus", "name": "tetanus", "purpose": "Enable an AI agent to represent a suspected or diagnosed tetanus episode, assess its evolving threats, and support timely clinician-led decisions.", "definition": "Tetanus is a non-communicable, toxin-mediated neurological disease in which Clostridium tetani spores germinate in anaerobic tissue (typically a contaminated wound or an unclean umbilical stump) and release tetanospasmin, which blocks inhibitory neurotransmission and produces painful muscle rigidity and spasms diagnosed on clinical grounds.", "scope_statement": "For vr.tr.tetanus, this draft owns the recognition, clinical state, exposure context, management dependencies and outcome of human tetanus episodes; human scope is provisional because the registry provides no definition.", "in_scope": [ "Clinical evidence supporting or challenging a tetanus diagnosis", "Generalized, localized and cephalic presentations, with neonatal context recorded separately", "Possible entry sites, exposure chronology and relevant immunization evidence", "Spasm burden, respiratory compromise and autonomic instability", "Episode-specific treatment status, recovery and prevention follow-through" ], "out_of_scope": [ "Clostridium tetani taxonomy, culture collections and environmental reservoirs", "Tetanospasmin molecular structure and laboratory manipulation", "Vaccine and immunoglobulin product specifications and manufacturing", "General wound classification and wound management outside its relationship to tetanus", "Independent models of competing diagnoses, including tetany, dystonia and botulism", "Population vaccination programs and maternal-neonatal elimination programs" ], "distinguishing_features": [ "Distinguish clinical tetanus from wound contamination: recognition depends on a compatible syndrome and assessment of alternatives; laboratory results cannot establish or exclude it. [CDC clinical overview](https://www.cdc.gov/tetanus/hcp/clinical-overview/index.html)", "Distinguish a tetanus-compatible motor pattern from isolated lockjaw: assess rigidity, painful spasms, sensory triggers and anatomical spread together. These observations are supportive rather than individually diagnostic. [CDC clinical features](https://www.cdc.gov/tetanus/hcp/clinical-signs/index.html)", "Distinguish localized and cephalic presentations from a generalized-only concept: document injury-adjacent spasms or cranial nerve palsies and subsequent spread. [CDC clinical features](https://www.cdc.gov/tetanus/hcp/clinical-signs/index.html)", "Distinguish the disease from an exposure requiring prophylaxis: record whether a compatible illness exists, rather than treating a wound or overdue vaccination as a tetanus diagnosis. [CDC clinical overview](https://www.cdc.gov/tetanus/hcp/clinical-overview/index.html)", "Distinguish tetanus disease from physiological muscle tetanus by requiring an illness context and a clinician's diagnostic assessment, rather than sustained contraction alone." ], "characteristics": [ { "name": "Diagnostic assessment", "kind": "state", "unit_or_values": "suspected | clinically diagnosed | alternative diagnosis favored | unresolved; assessor and assessment time", "why_it_matters": "Keeps observations, clinical conclusions and uncertainty distinct." }, { "name": "Clinical distribution", "kind": "category", "unit_or_values": "generalized | localized | cephalic | indeterminate; dated changes", "why_it_matters": "Supports recognition of different presentations and progression." }, { "name": "Neonatal context", "kind": "relation", "unit_or_values": "age in days at onset; linked birth, maternal immunization and cord-care evidence", "why_it_matters": "Preserves neonatal evidence without making it a mutually exclusive anatomical form." }, { "name": "Possible portal of entry", "kind": "relation", "unit_or_values": "linked wound, umbilical site, head or ear lesion, other suspected site, or unidentified; confidence", "why_it_matters": "Connects exposure investigation and source-control decisions without requiring a known wound." }, { "name": "Exposure-to-symptom interval", "kind": "measurement", "unit_or_values": "days, bounded estimate or unknown; exposure and first-symptom timestamps", "why_it_matters": "Makes chronology assessable without inventing an exposure date." }, { "name": "First-symptom-to-first-generalized-spasm interval", "kind": "measurement", "unit_or_values": "hours or days; not yet occurred | unknown", "why_it_matters": "Records progression separately from incubation." }, { "name": "Rigidity and spasm burden", "kind": "measurement", "unit_or_values": "affected regions; episodes per observation hour; duration in seconds; observed triggers", "why_it_matters": "Supports comparison over time with the observation conditions recorded." }, { "name": "Airway and swallowing status", "kind": "state", "unit_or_values": "clinician-assessed airway patency, swallowing safety, laryngospasm and respiratory support; timestamp", "why_it_matters": "Identifies immediate threats and care dependencies." }, { "name": "Autonomic observations", "kind": "measurement", "unit_or_values": "heart rate in beats/min, blood pressure in mmHg, temperature in degrees Celsius; rhythm and sweating observations", "why_it_matters": "Makes instability and its relationship to spasms or interventions visible." }, { "name": "Tetanus immunization evidence", "kind": "relation", "unit_or_values": "dated vaccine records, reported history or unknown; maternal records when relevant", "why_it_matters": "Supports risk interpretation and subsequent vaccination review without assuming protection." }, { "name": "Episode trajectory", "kind": "state", "unit_or_values": "worsening | stable | improving | recovering | resolved | fatal | unknown; clinical basis", "why_it_matters": "Separates an outcome judgment from a single reassuring observation." } ], "affordances": [ "Assemble a tetanus-focused evidence summary with observation times, sources and unresolved alternatives.", "Flag suspected tetanus for urgent clinical assessment and route airway or autonomic threats through the emergency workflow.", "Track changes in distribution, spasm burden and support requirements for clinician review.", "Reconcile prescribed and delivered antitoxin, wound care, antimicrobial and supportive interventions against the applicable clinical protocol.", "Identify missing exposure or immunization information without delaying escalation.", "Prepare recovery, vaccination and jurisdiction-specific reporting handoffs for authorized review." ] }, "sources": [ { "id": "who-fact-sheet", "title": "Tetanus (fact sheet)", "url": "https://www.who.int/news-room/fact-sheets/detail/tetanus", "what_it_supports": "Disease mechanism and environmental spores; maternal and neonatal case definitions; 6-dose TTCV schedule; MNTE remaining-country count (July 2026); 2021 neonatal deaths and DTP3 coverage.", "url_status": "live" }, { "id": "paho-tetanus", "title": "Tetanus", "url": "https://www.paho.org/en/topics/tetanus", "what_it_supports": "Three clinical presentations plus tetanus neonatorum; maternal tetanus window; surveillance case definition for newborns aged 3-28 days.", "url_status": "live" }, { "id": "cdc-pinkbook", "title": "Chapter 21: Tetanus (Pink Book)", "url": "https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-21-tetanus.html", "what_it_supports": "Incubation (about 8 days, range 1-21); clinical forms and frequencies; spasm duration; US TTCV schedules; wound prophylaxis with toxoid and TIG; clinical-only diagnosis and ~30% culture recovery.", "url_status": "live" }, { "id": "cdc-clinical", "title": "Clinical Overview of Tetanus", "url": "https://www.cdc.gov/tetanus/hcp/clinical-overview/index.html", "what_it_supports": "Incubation 3-21 days (average ~8); neonatal onset 4-14 days; cephalic incubation 1-2 days; absence of a confirmatory laboratory test; highest death risk at age 70+.", "url_status": "live" }, { "id": "merck-tetanus", "title": "Tetanus", "url": "https://www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/tetanus", "what_it_supports": "Tetanospasmin as irreversible once bound; localized and cephalic forms; neonatal tetanus; culture sensitivity ~30%; differentials (meningoencephalitis, local causes of trismus, phenothiazine rigidity); cephalic tetanus geography.", "url_status": "live" }, { "id": "who-mnte", "title": "Maternal and Neonatal Tetanus Elimination (MNTE)", "url": "https://www.who.int/initiatives/maternal-and-neonatal-tetanus-elimination-(mnte)", "what_it_supports": "Elimination defined as fewer than one neonatal tetanus case per 1,000 live births in every district; tetanus cannot be eradicated because spores are environmental; immunization plus clean delivery and cord care.", "url_status": "live" } ], "structure": { "bundles": [ { "id": "syndrome-recognition", "name": "Syndrome recognition", "description": "Represent why an episode is considered tetanus and what could overturn that interpretation.", "rationale": "The model must support clinical recognition without inventing a definitive laboratory gate.", "layers": [ { "id": "motor-pattern", "name": "Motor pattern", "description": "Capture the observed distribution and behavior of rigidity, spasms and cranial nerve findings.", "findings": [ { "id": "presentation-evidence", "name": "Presentation evidence", "description": "Record individual observations before assigning a clinical form, including findings obscured by treatment.", "questions": [ { "text": "Which jaw, neck, trunk, limb or cranial nerve findings were observed, by whom and when?", "kind": "provenance", "id": "presentation-evidence-q01" }, { "text": "Are abnormalities localized, generalized or cephalic, and what evidence supports that classification?", "kind": "definition", "id": "presentation-evidence-q02" }, { "text": "Which findings were unassessable because of sedation, paralysis or another examination limitation?", "kind": "measurement", "id": "presentation-evidence-q03" } ] } ] }, { "id": "diagnostic-boundaries", "name": "Diagnostic boundaries", "description": "Preserve competing explanations and the basis of the clinician's judgment.", "findings": [ { "id": "alternative-explanations", "name": "Alternative explanations", "description": "Make the assessment of tetany, drug-related dystonia, poisoning, seizures and other causes explicit rather than applying an automatic symptom match.", "questions": [ { "text": "Which alternative diagnoses were considered, and what evidence favors or weakens each?", "kind": "boundary", "id": "alternative-explanations-q01" }, { "text": "Who judged tetanus suspected or clinically diagnosed, and what observations supported that decision?", "kind": "provenance", "id": "alternative-explanations-q02" }, { "text": "Were laboratory results used to investigate alternatives without treating them as a definitive tetanus test?", "kind": "boundary", "id": "alternative-explanations-q03" } ] } ] } ] }, { "id": "entry-and-susceptibility", "name": "Entry and susceptibility", "description": "Connect the episode to possible inoculation events and documented protection history.", "rationale": "Exposure and immunization evidence inform interpretation, but neither should become an unsupported diagnostic shortcut.", "layers": [ { "id": "inoculation-context", "name": "Inoculation context", "description": "Represent candidate entry sites and uncertainty about their relationship to illness.", "findings": [ { "id": "portal-and-timeline", "name": "Portal and timeline", "description": "Retain multiple candidate exposures when necessary and distinguish unidentified entry from evidence of no exposure.", "questions": [ { "text": "Which wounds, procedures, injections, cord-care events or head and ear lesions are plausible entry contexts?", "kind": "provenance", "id": "portal-and-timeline-q01" }, { "text": "What interval separates each candidate event from the first symptom, and how uncertain are those dates?", "kind": "measurement", "id": "portal-and-timeline-q02" } ] } ] }, { "id": "protection-context", "name": "Protection context", "description": "Record available vaccination and passive-immunization evidence without converting missing records into negative history.", "findings": [ { "id": "immunization-evidence", "name": "Immunization evidence", "description": "Link patient and, where relevant, maternal records to the episode and distinguish documentation from recall.", "questions": [ { "text": "Which tetanus-containing vaccine doses and prior passive-immunization events are documented, reported or unknown?", "kind": "provenance", "id": "immunization-evidence-q01" }, { "text": "For a neonatal episode, what maternal immunization, birth and cord-care evidence is available?", "kind": "provenance", "id": "immunization-evidence-q02" }, { "text": "Which applicable guideline should interpret this history for subsequent prevention decisions?", "kind": "action", "id": "immunization-evidence-q03" } ] } ] } ] }, { "id": "progression-and-threats", "name": "Progression and threats", "description": "Track the evolving motor syndrome and immediate physiological hazards.", "rationale": "A tetanus label alone does not express deterioration, support needs or urgency.", "layers": [ { "id": "spasm-evolution", "name": "Spasm evolution", "description": "Represent time-dependent changes in rigidity and spasms.", "findings": [ { "id": "motor-burden-trend", "name": "Motor burden trend", "description": "Compare observations using explicit time windows and treatment context; document naturally observed triggers without provoking spasms.", "questions": [ { "text": "How have spasm frequency, duration, distribution and observed sensory triggers changed?", "kind": "measurement", "id": "motor-burden-trend-q01" }, { "text": "When did generalized spasms first appear relative to the initial symptom?", "kind": "measurement", "id": "motor-burden-trend-q02" }, { "text": "Could an apparent improvement reflect sedation or neuromuscular blockade rather than reduced disease activity?", "kind": "boundary", "id": "motor-burden-trend-q03" } ] } ] }, { "id": "airway-and-autonomic-threats", "name": "Airway and autonomic threats", "description": "Connect respiratory, swallowing and cardiovascular observations to escalation decisions.", "findings": [ { "id": "urgent-support-needs", "name": "Urgent support needs", "description": "Tetanus requires hospital care; airway loss and autonomic instability are specific management concerns. [CDC clinical care](https://www.cdc.gov/tetanus/hcp/clinical-care/index.html)", "questions": [ { "text": "What evidence indicates airway obstruction, impaired ventilation, unsafe swallowing or autonomic instability?", "kind": "measurement", "id": "urgent-support-needs-q01" }, { "text": "What support is currently required, and which deterioration criteria trigger immediate escalation under the treating service's protocol?", "kind": "action", "id": "urgent-support-needs-q02" } ] } ] } ] }, { "id": "tetanus-treatment-state", "name": "Tetanus treatment state", "description": "Represent the distinct purposes, delivery status and observed effects of episode-specific care.", "rationale": "Antitoxin, source control and supportive care address different problems and cannot be represented by one treated flag.", "layers": [ { "id": "toxin-and-source-control", "name": "Toxin and source control", "description": "Separate antitoxin administration from management of the bacterial source.", "findings": [ { "id": "intervention-purpose-and-delivery", "name": "Intervention purpose and delivery", "description": "TIG acts on unbound toxin; wound care and antibiotics address the source. Record these as separate interventions. [CDC clinical care](https://www.cdc.gov/tetanus/hcp/clinical-care/index.html)", "questions": [ { "text": "What antitoxin was prescribed and administered, at what time, dose and route, under whose authorization?", "kind": "provenance", "id": "intervention-purpose-and-delivery-q01" }, { "text": "What wound assessment, debridement or antimicrobial treatment was completed, pending or judged unnecessary?", "kind": "action", "id": "intervention-purpose-and-delivery-q02" }, { "text": "Which supply constraints, contraindications or uncertainties require specialist review?", "kind": "action", "id": "intervention-purpose-and-delivery-q03" } ] } ] }, { "id": "spasm-and-support-management", "name": "Spasm and support management", "description": "Link symptom-control interventions to their intended effects and observation limitations.", "findings": [ { "id": "support-response", "name": "Support response", "description": "Record clinician-directed spasm control, autonomic management and respiratory support with response and adverse-effect assessments.", "questions": [ { "text": "Which interventions target spasms, autonomic instability or ventilation, and what response has been observed?", "kind": "measurement", "id": "support-response-q01" }, { "text": "Which treatment changes or support reductions require clinician reassessment, and what evidence is needed?", "kind": "action", "id": "support-response-q02" } ] } ] } ] }, { "id": "recovery-and-episode-closure", "name": "Recovery and episode closure", "description": "Represent resolution, remaining disability and tetanus-specific follow-through.", "rationale": "Stopping acute treatment does not by itself establish recovery or future protection.", "layers": [ { "id": "functional-recovery", "name": "Functional recovery", "description": "Assess recovery through sustained function and changing care dependencies.", "findings": [ { "id": "resolution-and-residual-effects", "name": "Resolution and residual effects", "description": "Record remaining spasm activity, swallowing or mobility limitations and linked complications without attributing every impairment to tetanus.", "questions": [ { "text": "What sustained evidence supports resolution, including observations after symptom-suppressing treatment is reduced?", "kind": "measurement", "id": "resolution-and-residual-effects-q01" }, { "text": "Which residual impairments or complications require follow-up, and how certain is their relationship to tetanus?", "kind": "boundary", "id": "resolution-and-residual-effects-q02" } ] } ] }, { "id": "prevention-and-case-disposition", "name": "Prevention and case disposition", "description": "Track future protection needs and distinguish clinical closure from administrative classification.", "findings": [ { "id": "post-episode-follow-through", "name": "Post-episode follow-through", "description": "Recovery does not confer tetanus immunity; retain a vaccination review and follow-up plan. [CDC clinical care](https://www.cdc.gov/tetanus/hcp/clinical-care/index.html)", "questions": [ { "text": "What vaccination plan has the responsible clinician established, and which doses remain outstanding?", "kind": "action", "id": "post-episode-follow-through-q01" }, { "text": "What jurisdiction-specific reporting definition and process apply, separately from the clinical diagnosis?", "kind": "boundary", "id": "post-episode-follow-through-q02" }, { "text": "Who owns outstanding rehabilitation, immunization and reporting tasks at episode closure?", "kind": "action", "id": "post-episode-follow-through-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-kinds", "name": "Kinds and varieties", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "generalized tetanus", "localized tetanus", "cephalic tetanus", "neonatal tetanus", "maternal tetanus" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of tetanus this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "scheme": "Wikidata", "value_or_pattern": "Q180744", "note": "Item for tetanus as a disease (not the bacterium or the toxoid vaccine)." }, { "scheme": "ICD-10", "value_or_pattern": "A33-A35", "note": "A33 neonatal tetanus; A34 obstetrical tetanus; A35 other tetanus (including lockjaw)." }, { "scheme": "MeSH", "value_or_pattern": "D013742", "note": "Heading Tetanus." }, { "scheme": "SNOMED CT", "value_or_pattern": "76902006", "note": "Tetanus (disorder)." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of tetanus this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-standards-and-regulation", "name": "Standards and regulation", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "WHO Position Paper on Tetanus Vaccines (updated February 2017) - World Health Organization / SAGE: six TTCV doses (three-dose primary series from 6 weeks, then boosters at 12-23 months, 4-7 years, and 9-15 years).", "Maternal and Neonatal Tetanus Elimination (MNTE) - WHO, UNICEF and UNFPA: neonatal tetanus no longer a public-health problem when incidence is below one case per 1,000 live births in every district.", "WHO neonatal tetanus surveillance definition - World Health Organization: an infant who sucked and cried normally in the first 2 days of life, then loses that ability between days 3 and 28 and becomes rigid or has spasms.", "ACIP recommendations for tetanus-toxoid-containing vaccines and wound prophylaxis (including TIG) - CDC Advisory Committee on Immunization Practices.", "US nationally notifiable disease surveillance for tetanus - CSTE/CDC (clinical case definition; no confirmatory laboratory criterion)." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of tetanus this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Emergency and surgical wound care: classify the wound and immunization history, then give tetanus toxoid with or without tetanus immune globulin.", "Routine childhood immunization with TTCV combinations (DTP/DTaP, pentavalent and hexavalent products) and later Td or Tdap boosters.", "Antenatal and reproductive-age immunization so newborns have passive protection at birth (protection at birth / PAB).", "MNTE programmes: supplementary immunization of women of reproductive age, promotion of clean delivery and cord care, and neonatal tetanus case investigation.", "Hospital treatment of established disease: airway and spasm control, metronidazole, human TIG, and a full toxoid series at a different site because recovery does not confer immunity." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of tetanus this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "quantity": "incubation period (non-neonatal)", "typical_range": "3-21 (average about 8)", "unit": "days" }, { "quantity": "neonatal symptom onset after birth", "typical_range": "4-14 (average about 7)", "unit": "days" }, { "quantity": "cephalic tetanus incubation", "typical_range": "1-2", "unit": "days" }, { "quantity": "share of cases that are generalized", "typical_range": ">80", "unit": "%" }, { "quantity": "case fatality with modern intensive care (generalized tetanus)", "typical_range": "10-20", "unit": "%" }, { "quantity": "wound-culture recovery of C. tetani in clinically diagnosed tetanus", "typical_range": "about 30", "unit": "%" }, { "quantity": "MNTE elimination threshold", "typical_range": "<1", "unit": "neonatal tetanus cases per 1,000 live births per district" }, { "quantity": "global infant DTP3 coverage (2025, WHO)", "typical_range": "85", "unit": "%" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of tetanus this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Respiratory failure, laryngospasm and asphyxia from generalized spasms, including in neonates who stop sucking.", "Autonomic instability (hypertension, tachycardia, sweating) and secondary ICU complications such as pulmonary embolism and aspiration.", "Case fatality remains 10-20% even with intensive care; it is much higher without ventilation and in neonatal tetanus.", "Localized or cephalic disease can progress to generalized tetanus.", "Tetanospasmin already bound at nerve terminals cannot be neutralized; TIG only mops up circulating toxin.", "Recovery does not confer immunity, so unvaccinated survivors remain susceptible.", "Negative wound culture does not exclude tetanus (organism recovered in only about 30% of cases, and isolation can occur without disease).", "Unclean delivery or cord care in an unimmunized mother produces neonatal tetanus; missed infant doses or adult boosters leave injury-associated tetanus possible wherever spores exist." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of tetanus this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "English common name lockjaw refers to masseter spasm (trismus), not a separate disease.", "As of July 2026 WHO reported eight countries still short of MNTE; neonatal tetanus is now rare in high-income settings such as the United States.", "Merck notes cephalic tetanus incidence highest in Africa and India.", "Infant primary-series calendars differ (examples in use: 6/10/14 weeks; 2/3/4 months; 3/4/5 months; 2/4/6 months).", "WHO recommends six lifetime TTCV doses through adolescence; many high-income schedules add adult Td/Tdap boosters about every 10 years.", "WHO asked countries to replace single-antigen tetanus toxoid (TT) with Td; nearly all had done so by December 2023." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of tetanus this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "name": "bacterial or viral meningoencephalitis", "difference": "Tetanus keeps an intact sensorium and normal cerebrospinal fluid together with muscle spasms; meningoencephalitis typically alters consciousness and CSF." }, { "name": "peritonsillar or retropharyngeal abscess (local trismus)", "difference": "Trismus from a deep neck or tonsillar space infection has a focal ENT source on examination or imaging and lacks descending generalized rigidity and stimulus-triggered spasms." }, { "name": "phenothiazine or other drug-induced dystonia (including neuroleptic malignant syndrome)", "difference": "Drug history (neuroleptics/phenothiazines) and, when present, fever and rigidity of NMS; tetanus is a clinical syndrome after a wound or unclean birth in a person with incomplete TTCV history." }, { "name": "Clostridium tetani colonization or a positive wound culture without tetanus", "difference": "The organism can be isolated from people who do not have tetanus, and is missed in about 70% of true cases; diagnosis follows the clinical syndrome, not culture." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of tetanus this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Does vr.tr.tetanus cover human disease only or veterinary disease as well, and does an existing world model already own this concept?", "Which validated severity framework should be used for each age group and care setting, particularly during sedation or neuromuscular blockade?", "Which specialist-supported differential assessment best separates tetanus from hypocalcemic tetany, strychnine poisoning, dystonia and atypical paralytic presentations?", "Which current jurisdiction-specific protocols govern treatment, neonatal assessment, vaccination follow-through and surveillance classification?", "What operational criteria should distinguish improvement, clinical resolution and persistent disability without mistaking treatment-suppressed signs for recovery?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 18, "questions": 34 } }, "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 tetanus, record what state it is in, and decide what may be done with it.", "whatItIs": "Enable an AI agent to represent a suspected or diagnosed tetanus episode, assess its evolving threats, and support timely clinician-led decisions.", "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: tetanus neonatorum.", "1 finer distinctions are held as aliases rather than separate entries, because telling them apart needs a task that asks for it.", "Described in 97 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 tetanus, 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": [ "tetanus neonatorum" ] } ], "standing": "Described in 97 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 tetanus from another, and a tetanus 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 tetanus, 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 tetanus, 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 tetanus 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 tetanus, 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 tetanus, 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 tetanus 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 tetanus 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 tetanus, 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 tetanus, 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 tetanus 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 tetanus from the things most often confused with it.", "questions": [ { "id": "distinguishing-features-q01", "text": "What identifies and describes what distinguishes a tetanus, 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 tetanus, 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 tetanus 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 tetanus 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 tetanus between them.", "questions": [ { "id": "stages-and-transitions-q01", "text": "What identifies and describes the lifecycle of a tetanus, 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 tetanus, 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 tetanus 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 tetanus, how often and by whom.", "findings": [ { "id": "observation-record", "name": "Observation record", "description": "How an observation of a tetanus 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 tetanus, 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 tetanus, 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 tetanus 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 tetanus 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 tetanus 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 tetanus 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 tetanus 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 tetanus?", "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 tetanus?", "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 tetanus 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 tetanus and how confident it is.", "questions": [ { "id": "claim-provenance-q01", "text": "What identifies and describes a claim about a tetanus, 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 tetanus, 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 tetanus 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 tetanus is retired without being erased.", "questions": [ { "id": "validity-and-supersession-q01", "text": "What identifies and describes the validity of a claim about a tetanus, 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 tetanus, 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 tetanus 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 } } } }