{ "model": { "rank": 2126, "code": "thing-q83345", "model_id": "vr.tr.circumcision", "name": "circumcision", "purpose": "Enable an AI agent to recognise a circumcision episode, assess its documented state and determine which review, coordination or follow-up actions are supported by the available evidence and authority.", "family": "Thing Registry", "category": "Activities and processes", "status": "research-draft", "kind": "thing", "plane": "ACT", "domain": "ACT.ACT", "industry": "", "version": "", "url": "/models/thing/q83345/", "tier": 2, "score": 114, "payload": { "layer": "wikidata", "aliases": [ "circumcision in Africa", "Unicirc", "forced circumcision", "partial circumcision", "religious male circumcision", "circumcision in Madagascar" ], "aliasCount": 6, "merged": 7, "knownIn": 114, "facets": null, "markers": [], "lexicalClass": "", "senseRank": null, "alsoRegisteredAs": null, "source": { "dataset": "wikidata", "item": "Q83345", "url": "https://www.wikidata.org/wiki/Q83345", "license": "CC0 1.0" } }, "research": { "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-07T10:01:55Z", "providers": [ "Codex", "Grok" ], "missingProviders": [], "pass": 2, "cost": { "grok": { "usd": 0.01428986, "turns": 1, "seconds": 173.7, "error": null }, "codex": { "seconds": 86.8, "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: 01a07b4c-1367-7273-91d8-5874f89dfd64\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: circumcision\nRegistry id: vr.tr.circumcision\nPlane / domain: ACT / ACT.ACT\nRegistry definition: (none recorded)\nNames folded into this entry: (none)\n" } } }, "metaModel": { "id": "THING-Q83345", "registryId": "vr.tr.circumcision", "name": "circumcision", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "ACT.ACT" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q83345/", "model": { "registry_id": "vr.tr.circumcision", "name": "circumcision", "purpose": "Enable an AI agent to recognise a circumcision episode, assess its documented state and determine which review, coordination or follow-up actions are supported by the available evidence and authority.", "definition": "Circumcision is the surgical or ritual excision of part or all of the penile prepuce so that the glans remains uncovered, performed as a religious or cultural rite, as treatment of preputial disease, or as a public-health intervention against heterosexually acquired HIV.", "scope_statement": "This model owns a proposed, attempted or completed act of removing penile foreskin, including its intended extent, rationale, authorisation, execution and episode-specific outcomes; this anatomical interpretation remains provisional because the registry supplies no definition.", "in_scope": [ "The intended removal of penile foreskin and the anatomical result actually documented", "The indication or nonmedical purpose recorded for the particular episode", "The person's decision-making participation, consent or other asserted authorisation", "Readiness, performance, interruption and completion of the procedure", "Healing, complications, follow-up and revision associated with the episode" ], "out_of_scope": [ "Longitudinal diagnosis and management of underlying genital conditions", "A person's complete medical history or general sexual and reproductive health", "Religious traditions, community membership and ceremonial events beyond their relationship to the procedure", "Credentialing systems, healthcare facilities and device product specifications", "Other genital modifications, including acts described elsewhere as female circumcision, pending clarification of registry boundaries" ], "distinguishing_features": [ "The intended anatomical target is penile foreskin; a shared cultural label alone does not establish that an act belongs here.", "The intended endpoint includes foreskin removal, distinguishing the act from retraction, dilation or incision without intended removal.", "A proposed procedure is distinguishable from an observed circumcised anatomical state: an episode record identifies an intended or actual act, even if some historical details are unknown.", "A revision references an earlier circumcision and specifies the additional anatomical change sought.", "Ritual attendance or naming does not establish that tissue removal occurred; intention, performance and outcome require separate evidence." ], "characteristics": [ { "name": "Episode state", "kind": "state", "unit_or_values": "proposed | under assessment | scheduled | underway | interrupted | completed | cancelled | historical report | unknown", "why_it_matters": "Separates an intention or historical assertion from a documented performed act." }, { "name": "Intended and observed anatomical extent", "kind": "category", "unit_or_values": "documented foreskin target and intended extent; observed result; unknown or disputed where applicable", "why_it_matters": "Establishes identity and whether the reported result matches the intended procedure." }, { "name": "Age at procedure", "kind": "measurement", "unit_or_values": "days, months or years, with precision and whether estimated", "why_it_matters": "Provides context for assessment, participation and applicable authorisation requirements." }, { "name": "Recorded rationale", "kind": "category", "unit_or_values": "therapeutic | preventive | religious | cultural | personal preference | mixed | unspecified", "why_it_matters": "Preserves the episode's stated purpose without treating that purpose as proof of clinical necessity." }, { "name": "Decision-making and authorisation status", "kind": "state", "unit_or_values": "documented | awaiting review | disputed | withdrawn | absent | unknown; identify whose decision and its scope", "why_it_matters": "Makes unresolved authority, participation or refusal visible before an agent coordinates further action." }, { "name": "Operator and setting", "kind": "relation", "unit_or_values": "links to the actual or intended operator, responsible clinician where applicable, and location", "why_it_matters": "Connects the episode to accountable people and the setting in which assessment and follow-up occur." }, { "name": "Technique and device", "kind": "category", "unit_or_values": "named technique and device as documented, with unknown permitted", "why_it_matters": "Supports interpretation of the procedure record and any device-related follow-up obligations." }, { "name": "Pain-control record", "kind": "relation", "unit_or_values": "links to planned and delivered anaesthesia or analgesia records and their assessments", "why_it_matters": "Distinguishes a pain-control plan from documented delivery and response." }, { "name": "Healing and complication status", "kind": "state", "unit_or_values": "not assessed | healing under review | concern reported | complication assessed | healed as documented | unknown", "why_it_matters": "Supports follow-up decisions while keeping reported concerns separate from clinical conclusions." }, { "name": "Related circumcision episode", "kind": "relation", "unit_or_values": "prior procedure, interrupted procedure, revision or corrective follow-up", "why_it_matters": "Prevents revision and later outcomes from being mistaken for an unrelated initial act." } ], "affordances": [ "Classify a reported act against the foreskin-removal boundary and flag ambiguous terminology.", "Compare intended removal, documented performance and observed anatomy without inferring one from another.", "Identify missing assessments, disputed authorisation or withdrawn consent for review by the responsible person.", "Track planned versus delivered pain control, procedural completion and outstanding device-related follow-up.", "Route reported postoperative concerns through an applicable clinician-approved pathway without independently diagnosing them.", "Link healing assessments and revision decisions to the originating episode while preserving uncertainty and attribution." ] }, "sources": [ { "id": "aap-2012", "title": "Male Circumcision (Technical Report of the Task Force on Circumcision)", "url": "https://publications.aap.org/pediatrics/article/130/3/e756/30244/Male-Circumcision", "what_it_supports": "Medical definition, neonatal practice in the United States, complication spectrum, and the 2012 AAP policy position that health benefits outweigh risks but fall short of a universal recommendation.", "url_status": "blocked" }, { "id": "who-unaids-2007", "title": "New data on male circumcision and HIV prevention: policy and programme implications (WHO/UNAIDS technical consultation, Montreux)", "url": "https://www.who.int/publications/i/item/9789241595988", "what_it_supports": "Public-health use of adult/adolescent VMMC after the three African randomised trials, and WHO/UNAIDS as the issuing bodies for subsequent VMMC guidance.", "url_status": "live" }, { "id": "auvert-2005", "title": "Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial", "url": "https://doi.org/10.1371/journal.pmed.0020298", "what_it_supports": "The Orange Farm (South Africa) RCT that first showed about 60% relative reduction in female-to-male HIV acquisition after adult circumcision.", "url_status": "live" }, { "id": "bailey-2007", "title": "Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial", "url": "https://doi.org/10.1016/S0140-6736(07)60312-2", "what_it_supports": "Kenyan RCT of adult circumcision and HIV incidence; supports the ~50-60% relative-risk-reduction range used in VMMC policy.", "url_status": "live" }, { "id": "gray-2007", "title": "Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial", "url": "https://doi.org/10.1016/S0140-6736(07)60313-4", "what_it_supports": "Ugandan RCT completing the three-trial evidence base for VMMC, including adult adverse-event and healing observations.", "url_status": "live" }, { "id": "who-fgm-factsheet", "title": "Female genital mutilation (fact sheet)", "url": "https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation", "what_it_supports": "WHO's separation of FGM/C from male circumcision despite the shared folk name 'female circumcision', and the four WHO types.", "url_status": "live" }, { "id": "bgb-1631d", "title": "Bürgerliches Gesetzbuch § 1631d - Beschneidung des männlichen Kindes", "url": "", "what_it_supports": "German civil-law rule (2012) that parents may consent to male circumcision of a child if it is performed according to medical standards; a European regulatory landmark after the Cologne judgment." }, { "id": "wikidata-q170280", "title": "Wikidata item Q170280 (circumcision)", "url": "", "what_it_supports": "Stable public identifier for male circumcision as a procedure/practice.", "url_status": "dead" } ], "structure": { "bundles": [ { "id": "foreskin-removal-identity", "name": "Foreskin removal identity", "description": "Establishes which anatomical act is proposed or reported and whether it falls within this model.", "rationale": "The term circumcision can conceal differences between labels, intended removal and observed anatomy.", "layers": [ { "id": "anatomical-target", "name": "Anatomical target", "description": "Identifies the tissue and change that define the act.", "findings": [ { "id": "intended-foreskin-removal", "name": "Intended foreskin removal", "description": "Record the stated anatomical target and intended extent without deriving them solely from the procedure label.", "questions": [ { "text": "Does the proposed or reported act specifically involve removing penile foreskin?", "kind": "definition", "id": "intended-foreskin-removal-q01" }, { "text": "What distinguishes this act from foreskin incision, retraction or another genital procedure in the available record?", "kind": "boundary", "id": "intended-foreskin-removal-q02" } ] } ] }, { "id": "episode-and-anatomical-evidence", "name": "Episode and anatomical evidence", "description": "Separates evidence of an act from evidence of its anatomical result.", "findings": [ { "id": "procedure-versus-observed-state", "name": "Procedure versus observed state", "description": "Record whether the episode is directly documented, retrospectively reported or inferred from an examination, and link any previous procedure.", "questions": [ { "text": "Which source establishes that a circumcision episode occurred, and which details remain unknown?", "kind": "provenance", "id": "procedure-versus-observed-state-q01" }, { "text": "Is this an initial circumcision, completion of an interrupted act or revision of an earlier result?", "kind": "boundary", "id": "procedure-versus-observed-state-q02" } ] } ] } ] }, { "id": "rationale-and-person-specific-assessment", "name": "Rationale and person-specific assessment", "description": "Connects the proposed act to its stated purpose and the assessment of the particular person.", "rationale": "A therapeutic indication, preventive aim and religious or personal purpose require distinct evidence and must not be conflated.", "layers": [ { "id": "stated-purpose", "name": "Stated purpose", "description": "Preserves the motivations and claimed benefits attributed to the episode.", "findings": [ { "id": "rationale-and-support", "name": "Rationale and support", "description": "Record who requested the circumcision, why it was requested and what evidence supports any clinical indication.", "questions": [ { "text": "What therapeutic, preventive, religious, cultural or personal purposes are recorded, and whose purposes are they?", "kind": "provenance", "id": "rationale-and-support-q01" }, { "text": "If clinical necessity or benefit is asserted, which assessment supports that assertion for this person?", "kind": "provenance", "id": "rationale-and-support-q02" } ] } ] }, { "id": "suitability-and-alternatives", "name": "Suitability and alternatives", "description": "Captures professional assessment relevant to proceeding, deferring or selecting another approach.", "findings": [ { "id": "individual-assessment-disposition", "name": "Individual assessment disposition", "description": "Record assessment of genital anatomy, bleeding history and other relevant circumstances, together with alternatives and unresolved review needs.", "questions": [ { "text": "What person-specific findings have the responsible professional documented as affecting suitability, timing or specialist review?", "kind": "provenance", "id": "individual-assessment-disposition-q01" }, { "text": "What alternatives, including deferral or no procedure where applicable, were considered and what decision was recorded?", "kind": "action", "id": "individual-assessment-disposition-q02" } ] } ] } ] }, { "id": "participation-and-authorisation", "name": "Participation and authorisation", "description": "Records whose body is affected, how that person participates and the authority asserted for the act.", "rationale": "Circumcision may be proposed for people with differing decision-making capacities and family or community expectations; these cannot substitute for a documented authorisation assessment.", "layers": [ { "id": "person-wishes-and-understanding", "name": "Person's wishes and understanding", "description": "Represents the person's expressed preferences and documented involvement in the decision.", "findings": [ { "id": "participation-consent-and-dissent", "name": "Participation, consent and dissent", "description": "Record understanding, capacity assessment where relevant, consent, assent, refusal or withdrawal without inferring agreement from silence.", "questions": [ { "text": "What wishes has the person expressed about foreskin removal, and how and when were those wishes recorded?", "kind": "provenance", "id": "participation-consent-and-dissent-q01" }, { "text": "What assessment establishes the person's role in the decision, and is any refusal, dissent or withdrawal unresolved?", "kind": "action", "id": "participation-consent-and-dissent-q02" } ] } ] }, { "id": "authority-and-scope", "name": "Authority and scope", "description": "Identifies the basis and limits of authorisation for the particular procedure.", "findings": [ { "id": "authorisation-basis-and-disputes", "name": "Authorisation basis and disputes", "description": "Record the authorising parties, the procedure covered and the applicable professional or legal review, including disagreement.", "questions": [ { "text": "Who has authorised the act, for what extent of removal, and on what documented basis?", "kind": "provenance", "id": "authorisation-basis-and-disputes-q01" }, { "text": "Does an authority dispute, changed plan or withdrawn decision require the episode to be paused for responsible review?", "kind": "action", "id": "authorisation-basis-and-disputes-q02" } ] } ] } ] }, { "id": "procedure-and-immediate-result", "name": "Procedure and immediate result", "description": "Distinguishes the planned circumcision from the act performed and its immediate documented result.", "rationale": "A scheduled or labelled circumcision does not establish what technique, pain control or tissue removal actually occurred.", "layers": [ { "id": "procedural-readiness", "name": "Procedural readiness", "description": "Connects the intended technique, operator, setting and pain-control plan to the recorded decision to proceed.", "findings": [ { "id": "plan-and-readiness-review", "name": "Plan and readiness review", "description": "Record the planned technique or device, responsible operator and readiness determination without supplying operative instructions.", "questions": [ { "text": "Which technique or device, operator, setting and pain-control plan are documented for this episode?", "kind": "provenance", "id": "plan-and-readiness-review-q01" }, { "text": "Who confirmed readiness, and what unresolved assessment or authorisation issue affects proceeding?", "kind": "action", "id": "plan-and-readiness-review-q02" } ] } ] }, { "id": "actual-performance", "name": "Actual performance", "description": "Captures what was performed, any departure from the plan and the immediate assessment.", "findings": [ { "id": "completion-and-deviations", "name": "Completion and deviations", "description": "Record actual removal, technique, delivered pain control, interruptions, retained devices and immediate concerns as documented.", "questions": [ { "text": "What does the procedure record establish about actual foreskin removal and whether the intended act was completed?", "kind": "provenance", "id": "completion-and-deviations-q01" }, { "text": "What deviations, immediate concerns or device-related obligations require a named follow-up action?", "kind": "action", "id": "completion-and-deviations-q02" } ] } ] } ] }, { "id": "healing-and-later-outcomes", "name": "Healing and later outcomes", "description": "Tracks recovery and later assessments attributable to the circumcision episode.", "rationale": "Procedural completion does not establish healing, satisfaction or absence of complications.", "layers": [ { "id": "recovery-surveillance", "name": "Recovery surveillance", "description": "Separates reported symptoms, clinical observations and assessed complications during recovery.", "findings": [ { "id": "healing-concerns-and-response", "name": "Healing concerns and response", "description": "Record time-stamped observations of the wound, bleeding, pain, urination and any device status, with source and responsible review.", "questions": [ { "text": "What recovery observations are available, when were they made and were they reported by the person or assessed by a professional?", "kind": "measurement", "id": "healing-concerns-and-response-q01" }, { "text": "What response is required by the applicable postoperative instructions or clinician-approved pathway, and who is responsible?", "kind": "action", "id": "healing-concerns-and-response-q02" } ] } ] }, { "id": "outcome-and-revision", "name": "Outcome and revision", "description": "Records assessed results and any proposed further procedure without treating all later genital concerns as caused by circumcision.", "findings": [ { "id": "assessed-result-and-further-care", "name": "Assessed result and further care", "description": "Distinguish anatomical assessment, person-reported experience, unresolved concerns and professionally assessed reasons for revision.", "questions": [ { "text": "What evidence supports the recorded healing and anatomical outcome, and whose assessment of the result is represented?", "kind": "provenance", "id": "assessed-result-and-further-care-q01" }, { "text": "If revision or further treatment is proposed, what specific concern motivates it and how is it linked to this episode?", "kind": "action", "id": "assessed-result-and-further-care-q02" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "Neonatal male circumcision with a clamp or bell device (Gomco, Mogen, Plastibell)", "Freehand or sleeve-resection surgical circumcision in childhood or adulthood", "Voluntary medical male circumcision (VMMC) of adolescents and men for HIV prevention", "Therapeutic circumcision for pathologic phimosis, lichen sclerosus/BXO, recurrent balanoposthitis, or paraphimosis", "Jewish brit milah (traditionally on the eighth day of life)", "Islamic khitan / sunat (timing from infancy to puberty, by school and region)", "Traditional initiation circumcision (for example Xhosa ulwaluko, Filipino tuli)", "Device-assisted adult methods used in programmes (for example ShangRing; historically PrePex)" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of circumcision 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": "Q170280", "note": "Male circumcision as a medical/cultural procedure; FGM is a different item (Q7600)." }, { "scheme": "MeSH", "value_or_pattern": "D002994", "note": "Heading Circumcision, Male. Female cutting is D005128 (Circumcision, Female)." }, { "scheme": "SNOMED CT", "value_or_pattern": "30811009", "note": "Circumcision (procedure); more specific technique and age descendants exist." }, { "scheme": "CPT", "value_or_pattern": "54150 | 54160 | 54161", "note": "US professional procedure codes: clamp/device with block; surgical neonate; surgical older than neonate." }, { "scheme": "ICD-10-CM", "value_or_pattern": "Z41.2", "note": "Encounter for routine and ritual male circumcision (reason for encounter, not the operative code)." }, { "scheme": "ICD-9-CM", "value_or_pattern": "64.0", "note": "Historic US procedure code Circumcision." }, { "scheme": "ICD-10-PCS", "value_or_pattern": "0VBT***", "note": "Resection of prepuce; 0VBT0ZZ is the common open-approach code." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of circumcision 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": [ "American Academy of Pediatrics - 2012 policy statement and technical report on male circumcision (benefits judged to outweigh risks; not a recommendation that all newborn males be circumcised).", "Centers for Disease Control and Prevention - counseling recommendations on male circumcision and HIV/STI risk for patients and parents of male infants.", "World Health Organization and UNAIDS - VMMC for HIV prevention (Montreux 2007 consultation and later programme/sustainability guidance) and the WHO Manual for Male Circumcision under Local Anaesthesia.", "German Civil Code § 1631d (Bundestag / Federal Republic of Germany) - parental consent for male circumcision of a child, subject to medical standard of care (post-2012 Cologne ruling).", "British Medical Association - guidance on non-therapeutic male circumcision of children; NHS does not commission it as a routine service.", "KNMG (Royal Dutch Medical Association) - 2010 standpoint opposing non-therapeutic circumcision of male minors.", "South Africa Children's Act 38 of 2005, section 12 - circumcision of male children prohibited under 16 except for religious or medical grounds, with further rules on initiation schools.", "WHO/OHCHR and related UN agencies - FGM elimination standards; many states criminalise FGM (for example 18 U.S.C. § 116 in the United States). These instruments treat FGM as distinct from male circumcision despite overlapping popular names." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of circumcision 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": [ "Hospital or clinic neonatal procedure in the United States, parts of Canada, South Korea and historically Australia, usually on the first days of life with Gomco, Mogen or Plastibell.", "Eighth-day brit milah in Jewish communities, performed by a mohel, sometimes in a medical setting when the child is unwell or the family prefers a physician.", "Islamic khitan/sunat as a religious duty or strongly encouraged sunnah, timed from neonate to pre-adolescence depending on madhhab and local custom.", "Scale-up of adolescent and adult VMMC in eastern and southern Africa (PEPFAR/WHO priority countries) as part of HIV combination prevention, often with surgical forceps-guided, dorsal-slit or ShangRing methods.", "Urology indication: pathologic phimosis that fails topical steroid, balanitis xerotica obliterans, recurrent infection, or emergency reduction/circumcision after paraphimosis.", "Rites of passage outside Abrahamic religion, including Xhosa ulwaluko (initiation schools) and Filipino tuli, which may be clinical or traditional and carry a different risk profile when unregulated." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of circumcision 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": "Age at procedure", "typical_range": "1-10 days (US neonatal); 8 days (brit milah unless delayed); childhood to mid-adolescence (many Islamic and traditional settings); 15-49 years (VMMC programmes)", "unit": "days or years" }, { "quantity": "Procedure duration (skin-to-skin)", "typical_range": "5-15 minutes (neonatal clamp); 15-45 minutes (adult surgical); device methods vary", "unit": "minutes" }, { "quantity": "Healing time to epithelialisation", "typical_range": "7-14 (neonate); 28-42 (adult surgical VMMC)", "unit": "days" }, { "quantity": "Perioperative adverse-event rate", "typical_range": "about 0.2-0.6 in large US neonatal series (mostly minor bleeding/infection); about 1-4 in adult VMMC programmes, higher in some traditional settings", "unit": "percent of procedures" }, { "quantity": "Relative reduction in female-to-male HIV acquisition (three RCTs)", "typical_range": "50-60", "unit": "percent relative risk reduction" }, { "quantity": "Residual inner (mucosal) prepuce after a 'high' versus 'low' cut", "typical_range": "from a few millimetres (low) to a centimetre-scale mucosal collar (high); not standardised in routine records", "unit": "millimetres" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of circumcision 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": [ "Early bleeding or hematoma, including rare haemorrhage requiring return to theatre or transfusion.", "Wound infection, including necrotising infection in neglected or non-sterile traditional settings.", "Too little skin left (redundant prepuce, recurrent phimosis, adhesions) or too much removed (penile skin shortage, buried penis, chordee, painful erections).", "Injury to the glans, urethra or frenular artery; meatal stenosis after neonatal circumcision; urethrocutaneous fistula.", "Device-specific failures: Plastibell ring retained too long or too proximal; rare catastrophic glans amputation with Mogen clamps.", "Anaesthesia and systemic events (local-anaesthetic toxicity, methemoglobinemia from benzocaine, rare deaths in traditional initiation or poorly supervised settings).", "Incomplete HIV-risk reduction if treated as a substitute for condoms; increased HIV/STI risk during the healing window if sex resumes early.", "Sexual, sensory or identity dissatisfaction in some circumcised men, and ethical/legal dispute over non-therapeutic procedures on minors who cannot consent." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of circumcision 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": [ "United States: still the high-income country with the largest neonatal medical circumcision programme; prevalence is lower in western states and among uninsured/Latino families than in the Midwest, and has fallen from late-20th-century peaks.", "Western and northern Europe: uncommon outside Jewish, Muslim and some African-diaspora communities; several medical associations advise against non-therapeutic childhood circumcision; Germany explicitly re-legalised it under § 1631d after a 2012 criminal judgment.", "Israel: near-universal among Jewish males via brit milah; Muslim citizens follow khitan.", "Muslim-majority countries from North Africa through the Middle East to Indonesia/Malaysia (sunat): very high male prevalence, with age at cutting highly local.", "Eastern and southern Africa: ethnic traditional circumcision in some groups, historically low rates in others; large VMMC campaigns since 2007 in WHO/PEPFAR priority countries.", "East and Southeast Asia: high historic rates in South Korea (often later childhood/adolescence) and the Philippines (tuli); routine neonatal circumcision is not the East Asian default.", "Naming: brit/bris, khitan, sunat, khtana/khatna, tuli, ulwaluko, 'cut', posthectomy (older surgical English). 'Female circumcision' remains a community name for FGM/C in some languages and is rejected as a synonym by WHO." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of circumcision 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": "Preputioplasty (including limited dorsal slit)", "difference": "The prepuce is incised or remodelled and retained; circumcision removes it. Postoperative coverage of the glans is the practical test." }, { "name": "Superincision (Pacific dorsal slit, for example Samoan or Tongan practice)", "difference": "A dorsal opening without circular excision of the prepuce; the foreskin remains as flaps rather than being amputated." }, { "name": "Frenuloplasty", "difference": "Only the frenulum is released; the preputial collar is left intact." }, { "name": "Female genital mutilation/cutting (FGM/C), sometimes called female circumcision", "difference": "Targets clitoral and/or labial tissue, not the penile prepuce; WHO types I-IV, widely criminalised, and not medically analogous to male circumcision despite the shared English folk name." }, { "name": "Hypospadias repair using preputial flaps", "difference": "Prepuce is a donor graft or flap for urethral reconstruction, not an elective uncovering of a normally formed glans; look for a hypospadias diagnosis and urethroplasty, not a circumcision code alone." }, { "name": "Circumcision revision (recircumcision)", "difference": "A second excision after incomplete primary circumcision or redundant skin; history of a prior procedure and residual preputial collar distinguish it from a first circumcision." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of circumcision this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Does the registry intend circumcision to mean penile foreskin removal exclusively, and does an existing world model already own this concept?", "Which anatomical terminology and evidence reliably distinguish extent of removal, interrupted circumcision and revision without imposing unsupported completeness thresholds?", "Which jurisdiction-specific and professional sources govern consent, capacity, assent, proxy authorisation and disputes across ages and stated purposes?", "Which authoritative clinical sources should define assessment requirements, technique-specific follow-up and escalation criteria for different ages and settings?", "Which outcome measures and follow-up periods adequately capture healing, complications and person-reported experience while distinguishing association from causation?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 18, "questions": 28 } }, "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 circumcision, record what state it is in, and decide what may be done with it.", "whatItIs": "Enable an AI agent to recognise a circumcision episode, assess its documented state and determine which review, coordination or follow-up actions are supported by the available evidence and authority.", "characteristics": { "substance": "activity", "origin": "conceptual", "agency": "inert" }, "whatYouCanDoWithIt": [ "observed and measured" ], "distinguishingFeatures": [ "Names folded into this entry, which a task may need to split apart again: circumcision in Africa, Unicirc, forced circumcision, partial circumcision, religious male circumcision, circumcision in Madagascar.", "7 finer distinctions are held as aliases rather than separate entries, because telling them apart needs a task that asks for it.", "Described in 114 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 circumcision, and on what evidence are they told apart?" ], "whatItIsMadeOf": "something that happens over time", "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": [ "circumcision in Africa", "Unicirc", "forced circumcision", "partial circumcision", "religious male circumcision", "circumcision in Madagascar" ] } ], "standing": "Described in 114 Wikipedia languages, which measures how widely it is written about rather than how important or how common it is. 7 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 circumcision from another, and a circumcision 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 circumcision, 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 circumcision, 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 circumcision 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 circumcision, 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 circumcision, 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 circumcision 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 circumcision 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 circumcision, 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 circumcision, 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 circumcision 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 circumcision from the things most often confused with it.", "questions": [ { "id": "distinguishing-features-q01", "text": "What identifies and describes what distinguishes a circumcision, 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 circumcision, 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 circumcision 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 circumcision 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 circumcision between them.", "questions": [ { "id": "stages-and-transitions-q01", "text": "What identifies and describes the lifecycle of a circumcision, 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 circumcision, 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 circumcision 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 circumcision, how often and by whom.", "findings": [ { "id": "observation-record", "name": "Observation record", "description": "How an observation of a circumcision 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 circumcision, 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 circumcision, 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 circumcision is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "process-and-outcome", "name": "Process, inputs and outcome", "description": "How a circumcision proceeds, what it needs and what it leaves behind.", "rationale": "An activity is known by its steps and its results, and both have to be recordable while it is still running.", "layers": [ { "id": "steps-and-sequence", "name": "Steps and sequence", "description": "The steps of a circumcision, their order and what may run in parallel.", "findings": [ { "id": "steps-and-preconditions", "name": "Steps, preconditions and completion", "description": "What has to be true before each step of a circumcision and what marks it done.", "questions": [ { "id": "steps-and-preconditions-q01", "text": "What identifies and describes a step of a circumcision, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "steps-and-preconditions-q02", "text": "Who or what asserted this about a step of a circumcision, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "steps-and-preconditions-q03", "text": "What may an agent decide or do once a step of a circumcision is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "inputs-and-results", "name": "Inputs, resources and results", "description": "What a circumcision consumes and what it produces.", "findings": [ { "id": "inputs-and-outputs", "name": "Inputs, outputs and side effects", "description": "The resources a circumcision takes and the results it leaves, wanted or not.", "questions": [ { "id": "inputs-and-outputs-q01", "text": "What identifies and describes the inputs and results of a circumcision, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "inputs-and-outputs-q02", "text": "Who or what asserted this about the inputs and results of a circumcision, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "inputs-and-outputs-q03", "text": "What may an agent decide or do once the inputs and results of a circumcision 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 circumcision 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 circumcision 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 circumcision 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 circumcision 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 circumcision?", "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 circumcision?", "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 circumcision 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 circumcision and how confident it is.", "questions": [ { "id": "claim-provenance-q01", "text": "What identifies and describes a claim about a circumcision, 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 circumcision, 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 circumcision 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 circumcision is retired without being erased.", "questions": [ { "id": "validity-and-supersession-q01", "text": "What identifies and describes the validity of a claim about a circumcision, 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 circumcision, 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 circumcision 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 } } } }