{ "model": { "rank": 6288, "code": "thing-q537297", "model_id": "vr.tr.heartburn", "name": "heartburn", "purpose": "Enable an AI agent to recognise reported heartburn, assess its course and impact, and identify appropriate next actions without treating the symptom as a confirmed diagnosis.", "family": "Thing Registry", "category": "Information and virtual systems", "status": "research-draft", "kind": "thing", "plane": "INF", "domain": "INF.KNW", "industry": "", "version": "", "url": "/models/thing/q537297/", "tier": 2, "score": 61, "payload": { "layer": "wikidata", "aliases": [ "heartburn in pregnancy", "functional heartburn", "pregnancy-induced GERD" ], "aliasCount": 3, "merged": 3, "knownIn": 61, "facets": null, "markers": [], "lexicalClass": "", "senseRank": null, "alsoRegisteredAs": "vr.tr.heartburn", "source": { "dataset": "wikidata", "item": "Q537297", "url": "https://www.wikidata.org/wiki/Q537297", "license": "CC0 1.0" } }, "research": { "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-07T13:36:18Z", "providers": [ "Codex", "Grok" ], "missingProviders": [], "pass": 2, "cost": { "grok": { "usd": 0.00420172, "turns": 1, "seconds": 55.5, "error": null }, "codex": { "seconds": 80.8, "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: 01a07c14-441b-7c60-9786-efc9450fdac2\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: heartburn\nRegistry id: vr.tr.heartburn\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this entry: (none)\n\nA Ver" } } }, "metaModel": { "id": "THING-Q537297", "registryId": "vr.tr.heartburn", "name": "heartburn", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q537297/", "model": { "registry_id": "vr.tr.heartburn", "name": "heartburn", "purpose": "Enable an AI agent to recognise reported heartburn, assess its course and impact, and identify appropriate next actions without treating the symptom as a confirmed diagnosis.", "definition": "Heartburn is a retrosternal burning sensation produced when acidic gastric contents reflux into the oesophagus, typically after meals or when recumbent, and is the cardinal symptom of gastro-oesophageal reflux rather than a disease in its own right.", "scope_statement": "This model owns the subjective burning symptom registered as vr.tr.heartburn in XCT / XCT.STA, including individual episodes, recurrent patterns, associated observations and action boundaries; underlying diseases and treatments remain linked entities.", "in_scope": [ "Reported burning behind the breastbone, including location and upward spread", "Episode onset, duration, recurrence and current symptom state", "Intensity and interference with sleep, eating and daily activity", "Temporal associations with meals, posture, exposures and attempted relief", "Associated symptoms, unresolved diagnostic attribution and escalation needs" ], "out_of_scope": [ "Gastroesophageal reflux events and GERD as physiological and disease models", "Cardiac disease and other causes of chest pain", "Dyspepsia, regurgitation and swallowing disorders as separate symptoms", "Esophagitis, Barrett's esophagus and other tissue abnormalities", "Medication prescribing, dosing and interaction management", "The person's complete medical history and longitudinal care plan" ], "distinguishing_features": [ "Ask whether the sensation is burning behind the breastbone, possibly rising toward the throat; a label such as 'indigestion' alone is insufficient to establish this phenotype. [NIDDK symptom description](https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes)", "Ask separately whether stomach contents return to the throat or mouth: regurgitation can accompany heartburn but is a distinct observation. [NIDDK symptom description](https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes)", "Locate upper-abdominal discomfort separately from retrosternal burning; record co-occurring symptoms rather than assuming every report of indigestion means heartburn.", "Separate the symptom from its proposed cause: heartburn does not independently establish GERD, and reflux can occur without symptoms. [NIDDK definitions](https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/definition-facts)", "Do not use burning quality or resemblance to indigestion to exclude a cardiac emergency; sudden persistent chest discomfort requires an emergency safety assessment. [NHS chest pain guidance](https://www.nhs.uk/conditions/chest-pain/)" ], "characteristics": [ { "name": "Symptom location and spread", "kind": "category", "unit_or_values": "Retrosternal; rising toward throat; upper abdominal only; other; unclear; multiple locations permitted", "why_it_matters": "Supports recognition while retaining observations that do not fit the usual symptom description." }, { "name": "Reported sensation", "kind": "category", "unit_or_values": "Burning; pressure; squeezing; mixed; other; unclear, with the person's own wording", "why_it_matters": "Prevents an inherited heartburn label from obscuring a different or mixed chest symptom." }, { "name": "Episode duration", "kind": "measurement", "unit_or_values": "Minutes or hours, with onset, end and ongoing status", "why_it_matters": "Distinguishes a brief resolved episode from persistent or changing discomfort." }, { "name": "Recurrence", "kind": "measurement", "unit_or_values": "Episodes and symptomatic days per explicitly dated observation window", "why_it_matters": "Makes changes interpretable without silently equating recurrence with a disease diagnosis." }, { "name": "Reported intensity", "kind": "measurement", "unit_or_values": "Person-reported 0-10 rating with stated anchors, or a named verbal scale", "why_it_matters": "Allows within-person comparison while preserving the subjectivity and scale used." }, { "name": "Functional interference", "kind": "category", "unit_or_values": "Sleep interruption; eating restriction; activity interruption; none reported; unknown", "why_it_matters": "Captures burden that intensity alone may miss." }, { "name": "Current course", "kind": "state", "unit_or_values": "Active; resolved; recurrent between episodes; improving; worsening; uncertain", "why_it_matters": "Separates immediate symptom status from the longer recurrence pattern." }, { "name": "Meal and posture association", "kind": "relation", "unit_or_values": "Time-linked meal, lying-down or bending event; reported association strength; unknown", "why_it_matters": "Supports investigation of individual patterns without asserting causation." }, { "name": "Associated safety findings", "kind": "state", "unit_or_values": "Each relevant finding recorded as present, explicitly absent, unknown or not assessed", "why_it_matters": "Prevents missing information from being interpreted as reassurance." }, { "name": "Attribution evidence", "kind": "relation", "unit_or_values": "Linked clinical assessment or investigation; suspected or established attribution; author and date", "why_it_matters": "Keeps recognition of the symptom separate from evidence about its cause." }, { "name": "Response to attempted relief", "kind": "relation", "unit_or_values": "Linked intervention, timing, before-and-after symptom report, recurrence and adverse effects", "why_it_matters": "Supports follow-up without treating improvement as proof of reflux." } ], "affordances": [ "Elicit and record a person's chest-burning description while preserving uncertainty about the label.", "Track episodes, symptomatic days, nighttime waking and changes from the person's usual pattern.", "Compare meal, posture and exposure timing with symptom timing to generate individual hypotheses.", "Screen for concerning associated symptoms and route to an appropriate clinical or emergency pathway.", "Document attempted relief and assess reported benefit, recurrence and unwanted effects.", "Prepare a concise clinical handoff that separates observed symptoms, suspected causes and unanswered questions." ] }, "sources": [ { "id": "niddk-gerd", "title": "Acid Reflux (GER & GERD) in Adults", "url": "https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults", "what_it_supports": "Specialist definition of heartburn as a reflux symptom, typical triggers, and distinction from GERD as a disease", "url_status": "live" }, { "id": "nice-cg184", "title": "Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management (CG184)", "url": "https://www.nice.org.uk/guidance/cg184", "what_it_supports": "UK diagnostic and management pathway, alarm-feature thresholds, and PPI trial as a real-world use of the symptom", "url_status": "live" }, { "id": "rome-iv-fh", "title": "Rome IV Criteria for Functional Heartburn and Reflux Hypersensitivity", "url": "https://theromefoundation.org/rome-iv/rome-iv-criteria/", "what_it_supports": "Practice kinds: functional heartburn vs reflux hypersensitivity vs GERD on pH-impedance and endoscopy", "url_status": "live" }, { "id": "icd11-md92", "title": "ICD-11 MMS: MD92 Heartburn", "url": "https://icd.who.int/browse/2025-01/mms/en#2052946955", "what_it_supports": "WHO symptom code MD92 and its placement among digestive symptoms rather than as a disease entity", "url_status": "live" } ], "structure": { "bundles": [ { "id": "heartburn-recognition", "name": "Heartburn recognition", "description": "Establish what the person means by heartburn and whether the reported sensation fits the symptom.", "rationale": "Everyday labels can conceal different chest and upper-abdominal experiences.", "layers": [ { "id": "burning-phenotype", "name": "Burning phenotype", "description": "Describe the sensation before accepting a diagnostic or colloquial label.", "findings": [ { "id": "location-quality-and-spread", "name": "Location, quality and spread", "description": "Record the person's wording, anatomical location, burning quality and direction of spread, including atypical or mixed features.", "questions": [ { "text": "Where exactly is the sensation, and does it rise toward the throat or spread elsewhere?", "kind": "definition", "id": "location-quality-and-spread-q01" }, { "text": "Is it burning, pressure, squeezing or another sensation in the person's own words?", "kind": "definition", "id": "location-quality-and-spread-q02" }, { "text": "Is this a direct report, an observer's interpretation or a label copied from an earlier record?", "kind": "provenance", "id": "location-quality-and-spread-q03" } ] } ] }, { "id": "neighbouring-symptoms", "name": "Neighbouring symptoms", "description": "Separate heartburn from overlapping symptoms without forcing exclusivity.", "findings": [ { "id": "regurgitation-and-abdominal-discomfort", "name": "Regurgitation and abdominal discomfort", "description": "Record returning contents, sour taste and upper-abdominal discomfort independently from chest burning.", "questions": [ { "text": "Are contents returning to the throat or mouth, and is burning also present?", "kind": "boundary", "id": "regurgitation-and-abdominal-discomfort-q01" }, { "text": "Does 'indigestion' mean chest burning, upper-abdominal discomfort, fullness or several symptoms?", "kind": "definition", "id": "regurgitation-and-abdominal-discomfort-q02" } ] } ] } ] }, { "id": "episodes-and-burden", "name": "Episodes and burden", "description": "Represent the current episode and the longer pattern of symptom interference.", "rationale": "An isolated resolved episode and recurrent disruptive burning require different follow-up decisions.", "layers": [ { "id": "episode-timing", "name": "Episode timing", "description": "Establish onset, persistence, resolution and recurrence over a known window.", "findings": [ { "id": "duration-and-recurrence", "name": "Duration and recurrence", "description": "Record episode boundaries and symptomatic days, retaining uncertainty when recollection cannot support exact counts.", "questions": [ { "text": "When did the current or latest episode begin, and has it completely ended?", "kind": "measurement", "id": "duration-and-recurrence-q01" }, { "text": "How many episodes and symptomatic days occurred during the stated observation window?", "kind": "measurement", "id": "duration-and-recurrence-q02" }, { "text": "Is the pattern new, increasing or different from the person's usual burning?", "kind": "boundary", "id": "duration-and-recurrence-q03" } ] } ] }, { "id": "experienced-impact", "name": "Experienced impact", "description": "Describe symptom intensity alongside consequences for ordinary activities.", "findings": [ { "id": "intensity-and-interference", "name": "Intensity and interference", "description": "Capture current and worst reported intensity, sleep disruption and changes to eating or activity.", "questions": [ { "text": "How intense is the burning now and at its worst, using the same stated scale?", "kind": "measurement", "id": "intensity-and-interference-q01" }, { "text": "Has it awakened the person, interrupted activity or caused them to avoid eating?", "kind": "measurement", "id": "intensity-and-interference-q02" } ] } ] } ] }, { "id": "meal-posture-and-exposure-patterns", "name": "Meal, posture and exposure patterns", "description": "Capture possible associations with the circumstances around episodes.", "rationale": "Useful heartburn pattern recognition requires timing and repeatability, not an assumed universal trigger list.", "layers": [ { "id": "meal-and-position-timing", "name": "Meal and position timing", "description": "Relate burning to eating, lying down and bending.", "findings": [ { "id": "repeated-temporal-associations", "name": "Repeated temporal associations", "description": "Record the interval between a contextual event and burning, including comparable occasions without symptoms.", "questions": [ { "text": "How long after eating, lying down or bending did burning begin or worsen?", "kind": "measurement", "id": "repeated-temporal-associations-q01" }, { "text": "Has the same sequence occurred repeatedly, and are there occasions when it does not?", "kind": "boundary", "id": "repeated-temporal-associations-q02" } ] } ] }, { "id": "exposure-and-context-changes", "name": "Exposure and context changes", "description": "Link relevant changes in intake, medicines and personal circumstances.", "findings": [ { "id": "candidate-contributors", "name": "Candidate contributors", "description": "Record suspected food, drink, tobacco or medication associations and relevant context such as pregnancy as hypotheses for review.", "questions": [ { "text": "What changed in food, drink, tobacco exposure, medicines or pregnancy status near the onset of the pattern?", "kind": "provenance", "id": "candidate-contributors-q01" }, { "text": "Which suspected contributors have a documented timing relationship, and which are assumptions?", "kind": "boundary", "id": "candidate-contributors-q02" }, { "text": "Which suspected medication contributions need pharmacist or clinician review?", "kind": "action", "id": "candidate-contributors-q03" } ] } ] } ] }, { "id": "chest-symptom-safety", "name": "Chest symptom safety", "description": "Identify observations that change urgency despite a heartburn label.", "rationale": "Calling discomfort heartburn must not terminate assessment of serious chest or digestive symptoms.", "layers": [ { "id": "emergency-overlap", "name": "Emergency overlap", "description": "Check the current chest symptom against an applicable emergency pathway.", "findings": [ { "id": "urgent-chest-discomfort", "name": "Urgent chest discomfort", "description": "Sudden persistent chest discomfort, including burning, and accompanying breathlessness, sweating, lightheadedness or spreading pain can require emergency action. [NHS chest pain guidance](https://www.nhs.uk/conditions/chest-pain/)", "questions": [ { "text": "Is there sudden chest discomfort that does not go away, or associated breathlessness, sweating, lightheadedness or pain spreading to the arms, jaw, neck or back?", "kind": "boundary", "id": "urgent-chest-discomfort-q01" }, { "text": "Does the applicable emergency pathway require immediate help before further heartburn assessment?", "kind": "action", "id": "urgent-chest-discomfort-q02" }, { "text": "Which emergency features were explicitly checked, and which remain unknown?", "kind": "provenance", "id": "urgent-chest-discomfort-q03" } ] } ] }, { "id": "digestive-alarm-features", "name": "Digestive alarm features", "description": "Record accompanying findings requiring clinical assessment and urgency determination.", "findings": [ { "id": "swallowing-bleeding-and-systemic-change", "name": "Swallowing, bleeding and systemic change", "description": "Difficulty or pain with swallowing, persistent vomiting, digestive bleeding and unexplained weight loss warrant medical review; urgency depends on the presentation. [NIDDK guidance](https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes)", "questions": [ { "text": "Are swallowing difficulty, painful swallowing, persistent vomiting, blood in vomit, black tarry stool or unexplained weight loss present?", "kind": "boundary", "id": "swallowing-bleeding-and-systemic-change-q01" }, { "text": "What urgency and destination does the applicable clinical pathway assign to the reported findings?", "kind": "action", "id": "swallowing-bleeding-and-systemic-change-q02" } ] } ] } ] }, { "id": "cause-attribution-and-evidence", "name": "Cause attribution and evidence", "description": "Represent what is known about the cause without converting a symptom report into a disease diagnosis.", "rationale": "The same symptom label can coexist with different clinical explanations and levels of evidence.", "layers": [ { "id": "symptom-disease-boundary", "name": "Symptom-disease boundary", "description": "Keep the heartburn observation separate from linked diagnoses.", "findings": [ { "id": "attribution-status", "name": "Attribution status", "description": "Distinguish unassessed symptoms, a suspected cause and a clinician-recorded diagnosis; retain who made the attribution and when.", "questions": [ { "text": "Is reflux merely suspected, or is there a documented clinical diagnosis linked to this symptom?", "kind": "boundary", "id": "attribution-status-q01" }, { "text": "Who established the attribution, when, and on what stated evidence?", "kind": "provenance", "id": "attribution-status-q02" } ] } ] }, { "id": "investigation-context", "name": "Investigation context", "description": "Link relevant investigations while retaining the conditions under which they were interpreted.", "findings": [ { "id": "clinical-evidence-and-unresolved-cause", "name": "Clinical evidence and unresolved cause", "description": "Link available endoscopy, reflux-monitoring or other clinical reports without independently deriving a diagnosis from isolated results.", "questions": [ { "text": "What investigations and clinician interpretations are available, and did they address these episodes?", "kind": "provenance", "id": "clinical-evidence-and-unresolved-cause-q01" }, { "text": "What cause remains unresolved, and what further assessment has the clinician recommended?", "kind": "action", "id": "clinical-evidence-and-unresolved-cause-q02" } ] } ] } ] }, { "id": "relief-and-follow-up", "name": "Relief and follow-up", "description": "Record attempted relief, its observed effects and the next review decision.", "rationale": "Symptom management needs a traceable response history and explicit reassessment criteria.", "layers": [ { "id": "attempted-relief", "name": "Attempted relief", "description": "Relate specific actions to subsequent symptom changes.", "findings": [ { "id": "intervention-response", "name": "Intervention response", "description": "Record positional or meal-timing changes and medicines actually used, linking medication details to the medication model; improvement alone does not establish the cause.", "questions": [ { "text": "What was tried, when, and under whose advice?", "kind": "provenance", "id": "intervention-response-q01" }, { "text": "How much did burning change, how quickly, and when did it recur?", "kind": "measurement", "id": "intervention-response-q02" }, { "text": "Were unwanted effects or problems following the agreed plan reported?", "kind": "boundary", "id": "intervention-response-q03" } ] } ] }, { "id": "review-and-handoff", "name": "Review and handoff", "description": "Determine the next permitted action from current symptoms, safety findings and the existing care plan.", "findings": [ { "id": "next-step-and-reassessment", "name": "Next step and reassessment", "description": "Record whether continued observation, pharmacist advice, clinical review or emergency escalation is indicated, with a named pathway or care-plan basis.", "questions": [ { "text": "Given persistence, burden, response and safety findings, what next step is supported by the applicable pathway?", "kind": "action", "id": "next-step-and-reassessment-q01" }, { "text": "When should symptoms be reassessed, and which changes should trigger earlier help?", "kind": "action", "id": "next-step-and-reassessment-q02" }, { "text": "What symptom timeline, attempted relief and unresolved concerns must accompany a clinical handoff?", "kind": "action", "id": "next-step-and-reassessment-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": [ "Postprandial (meal-related) heartburn", "Nocturnal/recumbent heartburn", "Episodic/occasional heartburn", "Frequent heartburn (two or more days per week, the GERD-defining threshold in many guidelines)", "Pregnancy-associated heartburn", "Refractory heartburn (persisting despite optimised acid suppression)", "Functional heartburn (Rome IV: burning retrosternal discomfort without reflux or mucosal injury on investigation)", "Reflux hypersensitivity (Rome IV: heartburn with normal acid exposure but positive symptom-reflux association)" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of heartburn 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": "Q183552", "note": "item labelled Heartburn" }, { "scheme": "ICD-11 MMS", "value_or_pattern": "MD92", "note": "Heartburn as a digestive symptom/sign, not a disease chapter code" }, { "scheme": "ICD-10-CM", "value_or_pattern": "R12", "note": "Heartburn (symptoms and signs involving the digestive system)" }, { "scheme": "SNOMED CT", "value_or_pattern": "16331000", "note": "Heartburn (finding)" }, { "scheme": "MeSH", "value_or_pattern": "D006356", "note": "Heartburn" }, { "scheme": "UMLS CUI", "value_or_pattern": "C0018834", "note": "Heartburn" } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of heartburn 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": [ "NICE CG184 - Gastro-oesophageal reflux disease and dyspepsia in adults (National Institute for Health and Care Excellence, UK)", "ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease (American College of Gastroenterology)", "Rome IV diagnostic criteria for functional esophageal disorders, including functional heartburn and reflux hypersensitivity (Rome Foundation)", "FDA OTC monograph / labelling for antacids, H2-receptor antagonists and PPIs indicated for heartburn (U.S. Food and Drug Administration)", "EMA product information for PPIs and antacids authorised for heartburn/GERD (European Medicines Agency)" ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of heartburn 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": [ "Self-reported symptom that drives OTC antacid, alginate, H2-blocker and PPI purchases without a clinic visit", "Cardinal complaint used in primary care to start an empirical PPI trial and to decide whether endoscopy is needed", "Inclusion and outcome symptom in GERD trials and in pH-impedance studies (symptom-reflux association)", "Alarm-feature screen (dysphagia, GI bleeding, anaemia, weight loss, persistent vomiting) that converts 'heartburn' from self-care to urgent investigation", "Pregnancy symptom managed with lifestyle measures and pregnancy-compatible antacids before stepping up therapy" ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of heartburn 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": "Episode frequency", "typical_range": "occasional (<1 day/week) to frequent (≥2 days/week; GERD-defining in many guidelines)", "unit": "days per week" }, { "quantity": "Episode duration", "typical_range": "minutes to a few hours after a meal or while recumbent", "unit": "minutes" }, { "quantity": "Symptom intensity (VAS or Likert)", "typical_range": "0-10 (patient-reported)", "unit": "score" }, { "quantity": "Oesophageal acid exposure time (AET) on pH monitoring (when investigated)", "typical_range": "normal <4%; borderline 4-6%; abnormal >6% of recording", "unit": "percent of time pH <4" }, { "quantity": "GERD-HRQL / RDQ questionnaire score", "typical_range": "instrument-specific; used to track treatment response", "unit": "points" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of heartburn 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": [ "Misattribution of cardiac ischaemia (angina, ACS) as 'heartburn', delaying emergency care", "Chronic untreated reflux leading to erosive oesophagitis, peptic stricture, Barrett oesophagus and, rarely, oesophageal adenocarcinoma", "Alarm features ignored while the person continues OTC acid suppression", "PPI overuse for functional heartburn that will not respond to acid suppression", "Nocturnal reflux with aspiration risk, sleep disruption and worsening of asthma or laryngopharyngeal symptoms", "Drug and food triggers (NSAIDs, calcium-channel blockers, late large meals) unrecognised" ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of heartburn 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 'heartburn' vs British/clinical 'pyrosis'; many languages use a 'fire/burning in the chest' calque (French brûlures d'estomac, German Sodbrennen, Spanish acidez/pirosis)", "NICE (UK) emphasises empirical PPI and endoscopy red flags; US ACG guidance is more explicit about pH-impedance phenotyping of refractory symptoms", "OTC PPI availability and permitted duration of unsupervised use differ by regulator (FDA vs national EU rules)", "Prevalence and healthcare-seeking are higher in Western and high-BMI populations; dietary fat, late dinner and recumbency patterns vary by culture" ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of heartburn 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": "Gastro-oesophageal reflux disease (GERD)", "difference": "GERD is the disease (troublesome reflux or mucosal injury); heartburn is a symptom that may occur with or without GERD" }, { "name": "Functional heartburn (Rome IV)", "difference": "Same burning complaint but normal endoscopy, normal acid exposure, and no symptom-reflux association on pH-impedance" }, { "name": "Cardiac ischaemia / angina", "difference": "Exertional, radiation to arm/jaw, dyspnoea or diaphoresis, ECG/troponin positive; heartburn is meal/recumbency-related and often relieved by antacids" }, { "name": "Dyspepsia (epigastric pain/burn)", "difference": "Located in the epigastrium and related to gastroduodenal disease; heartburn is retrosternal and rises toward the throat" }, { "name": "Eosinophilic oesophagitis", "difference": "Dysphagia and food impaction dominate; diagnosis is by oesophageal eosinophilia on biopsy, not by acid reflux" }, { "name": "Biliary colic / peptic ulcer pain", "difference": "Right-upper-quadrant or epigastric, often post-fatty-meal or nocturnal, not a rising retrosternal burn relieved by antacid" } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of heartburn this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Does an existing Vercy world model already own heartburn or an equivalent symptom concept, requiring a registry link rather than a separate publication?", "Which validated symptom and impact measures should be adopted for different ages, languages and communication abilities?", "What episode-separation rule and observation window best support reliable recurrence tracking without imposing a diagnostic threshold?", "Which jurisdiction-specific escalation pathways should govern chest discomfort, digestive alarm features and persistent symptoms?", "How should specialist diagnoses such as functional heartburn and reflux hypersensitivity link to this symptom model, and what evidence is required before recording those attributions?" ], "statistics": { "bundles": 7, "layers": 13, "findings": 20, "questions": 38 } }, "draft": { "generator": "vr.draft.v3", "status": "draft-generated", "researched": false, "archetype": "discipline or field of knowledge", "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 heartburn, record what state it is in, and decide what may be done with it.", "whatItIs": "Enable an AI agent to recognise reported heartburn, assess its course and impact, and identify appropriate next actions without treating the symptom as a confirmed diagnosis.", "characteristics": { "substance": "information", "origin": "conceptual", "agency": "inert" }, "whatYouCanDoWithIt": [ "read and interpreted" ], "distinguishingFeatures": [ "Names folded into this entry, which a task may need to split apart again: heartburn in pregnancy, functional heartburn, pregnancy-induced GERD.", "3 finer distinctions are held as aliases rather than separate entries, because telling them apart needs a task that asks for it.", "Described in 61 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 heartburn, and on what evidence are they told apart?" ], "whatItIsMadeOf": "content that has to be carried by something else", "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": [ "read it and act on what it says" ], "howItIsRecognised": [], "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": [ "heartburn in pregnancy", "functional heartburn", "pregnancy-induced GERD" ] } ], "standing": "Described in 61 Wikipedia languages, which measures how widely it is written about rather than how important or how common it is. 3 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 heartburn from another, and a heartburn 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 heartburn, 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 heartburn, 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 heartburn 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 heartburn, 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 heartburn, 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 heartburn 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 heartburn 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 heartburn, 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 heartburn, 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 heartburn 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 heartburn from the things most often confused with it.", "questions": [ { "id": "distinguishing-features-q01", "text": "What identifies and describes what distinguishes a heartburn, 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 heartburn, 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 heartburn 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 heartburn 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 heartburn between them.", "questions": [ { "id": "stages-and-transitions-q01", "text": "What identifies and describes the lifecycle of a heartburn, 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 heartburn, 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 heartburn 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 heartburn, how often and by whom.", "findings": [ { "id": "observation-record", "name": "Observation record", "description": "How an observation of a heartburn 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 heartburn, 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 heartburn, 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 heartburn is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "content-and-access", "name": "Content, encoding and access", "description": "What a heartburn says, how it is encoded and who may read it.", "rationale": "An informational thing carries content that can be copied, versioned and withheld, none of which its physical carrier explains.", "layers": [ { "id": "content-and-encoding", "name": "Content and encoding", "description": "The content itself, its format and its language.", "findings": [ { "id": "content-and-format", "name": "Content, format and language", "description": "What a heartburn contains and in what form it is held.", "questions": [ { "id": "content-and-format-q01", "text": "What identifies and describes the content of a heartburn, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "content-and-format-q02", "text": "Who or what asserted this about the content of a heartburn, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "content-and-format-q03", "text": "What may an agent decide or do once the content of a heartburn is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "access-and-rights", "name": "Access, rights and retention", "description": "Who may read, copy or change it, and for how long it is kept.", "findings": [ { "id": "access-rules", "name": "Access rules and retention", "description": "The permissions attached to a heartburn and the period it survives.", "questions": [ { "id": "access-rules-q01", "text": "What identifies and describes access to a heartburn, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "access-rules-q02", "text": "Who or what asserted this about access to a heartburn, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "access-rules-q03", "text": "What may an agent decide or do once access to a heartburn is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "subject-and-method", "name": "Subject matter and method", "description": "What heartburn studies and how it establishes anything.", "rationale": "A field is identified by its questions and its methods, and those are what distinguish it from the fields next to it.", "layers": [ { "id": "subject", "name": "Subject matter", "description": "The questions it takes as its own.", "findings": [ { "id": "subject-record", "name": "Questions and objects of study", "description": "What it is about, stated so a neighbouring field can be told apart.", "questions": [ { "id": "subject-record-q01", "text": "What questions and objects does heartburn take as its own?", "kind": "definition" }, { "id": "subject-record-q02", "text": "Which questions does it share with a neighbouring field, and who claims them?", "kind": "boundary" } ] } ] }, { "id": "method", "name": "Method and evidence", "description": "How claims are established and what counts as evidence.", "findings": [ { "id": "method-record", "name": "Methods and standards of evidence", "description": "The methods used and what they are taken to establish.", "questions": [ { "id": "method-record-q01", "text": "By what methods does heartburn establish claims, and what counts as sufficient evidence?", "kind": "provenance" }, { "id": "method-record-q02", "text": "What kind of claim can this field not settle, and where should an agent look instead?", "kind": "action" } ] } ] } ] }, { "id": "institutions-and-classification", "name": "Institutions and classification", "description": "Where heartburn is practised and how catalogues place it.", "rationale": "The institutional footprint is the evidence that a field exists as a field rather than as a topic.", "layers": [ { "id": "institutions", "name": "Institutional markers", "description": "Societies, journals, degrees and departments.", "findings": [ { "id": "institution-record", "name": "Bodies and venues", "description": "Where the field organises itself.", "questions": [ { "id": "institution-record-q01", "text": "Which societies, journals or degrees mark heartburn as an established field?", "kind": "provenance" }, { "id": "institution-record-q02", "text": "What would show that it is emerging or dissolving rather than established?", "kind": "boundary" } ] } ] }, { "id": "classification", "name": "Classification schemes", "description": "Where library and research classifications put it.", "findings": [ { "id": "classification-record", "name": "Codes and their disagreements", "description": "The classification codes that place it, and where they differ.", "questions": [ { "id": "classification-record-q01", "text": "Which classification schemes place heartburn, under what codes?", "kind": "definition" }, { "id": "classification-record-q02", "text": "Where do those schemes disagree about its scope?", "kind": "boundary" } ] } ] } ] }, { "id": "provenance-and-evidence", "name": "Provenance, evidence and time", "description": "Where every claim about a heartburn 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 heartburn and how confident it is.", "questions": [ { "id": "claim-provenance-q01", "text": "What identifies and describes a claim about a heartburn, 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 heartburn, 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 heartburn 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 heartburn is retired without being erased.", "questions": [ { "id": "validity-and-supersession-q01", "text": "What identifies and describes the validity of a claim about a heartburn, 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 heartburn, 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 heartburn is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] } ] }, "statistics": { "bundles": 6, "layers": 12, "findings": 14, "questions": 38 } } } }