{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T08:46:30Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 22.4, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094cb-04d3-79d1-855e-53d02c3ba483\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: Cohen syndrome\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 043: 1001 ", "usd": 0.0, "recall": true }, "codex": { "seconds": 63.4, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094cb-04c4-7121-b2ea-611f7c25be2e\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: Cohen syndrome\nRegistry id: vr.tr.cohen-syndrome\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this entry: (no" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:42:16+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "standards_and_regulation" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T12:16:28+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q1107087", "registryId": "vr.tr.cohen-syndrome", "name": "Cohen syndrome", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q1107087/", "model": { "registry_id": "vr.tr.cohen-syndrome", "name": "Cohen syndrome", "purpose": "Enable an agent to recognise Cohen syndrome, assess the evidence for its diagnosis and manifestations, and identify appropriate evaluation and support needs.", "definition": "Cohen syndrome is a rare autosomal recessive disorder caused by biallelic pathogenic variants in VPS13B, characterized by developmental delay and intellectual disability, hypotonia, characteristic facial features, progressive retinal dystrophy, and frequently neutropenia and truncal obesity.", "scope_statement": "This model owns the disease concept vr.tr.cohen-syndrome in XCT / XCT.STA, including its defining evidence, variable expression and condition-specific decision boundaries; patient records and care encounters remain linked entities.", "in_scope": [ "VPS13B-associated disease identity and diagnostic evidence", "Age-dependent developmental, ocular, haematological and growth manifestations", "Autosomal recessive inheritance and interpretation of familial evidence", "Condition-specific monitoring needs and functional consequences", "Versioned terminology mappings and limits of population evidence" ], "out_of_scope": [ "The patient's complete clinical record", "Laboratory procedures and general variant-classification standards", "Individual infection episodes and their treatment records", "Detailed ophthalmic procedures and rehabilitation service delivery", "Other syndromes sharing developmental delay, obesity or retinal disease" ], "distinguishing_features": [ "Suggestive manifestations together with biallelic pathogenic or likely pathogenic VPS13B variants support molecular diagnosis; record classification and phase evidence. [GeneReviews](https://www.ncbi.nlm.nih.gov/books/NBK1482/)", "Developmental impairment accompanied by progressive myopia and retinal dystrophy is more discriminating than developmental delay alone. [GeneReviews](https://www.ncbi.nlm.nih.gov/books/NBK1482/)", "Neutropenia adds diagnostic discrimination to the developmental and ocular pattern, but requires measured evidence. [GeneReviews](https://www.ncbi.nlm.nih.gov/books/NBK1482/)", "Early feeding and weight-gain difficulties followed by later truncal adiposity should be represented as a trajectory. [GeneReviews](https://www.ncbi.nlm.nih.gov/books/NBK1482/)", "Historical Cohen-like labels require reassessment rather than automatic equivalence with VPS13B-related disease. [GeneReviews](https://www.ncbi.nlm.nih.gov/books/NBK1482/)" ], "characteristics": [ { "name": "Diagnostic evidence status", "kind": "state", "unit_or_values": "suspected; molecularly established; unresolved; alternative diagnosis supported", "why_it_matters": "Separates a working hypothesis from an established diagnosis." }, { "name": "VPS13B molecular evidence", "kind": "relation", "unit_or_values": "variant reports with transcript, genome assembly, zygosity, phase, classification, laboratory and date", "why_it_matters": "Makes the molecular conclusion traceable and reviewable." }, { "name": "Manifestation ascertainment", "kind": "state", "unit_or_values": "present; assessed absent; not assessed; uncertain; with age and assessment method", "why_it_matters": "Prevents missing observations from becoming negative findings." }, { "name": "Developmental and adaptive function", "kind": "measurement", "unit_or_values": "milestone ages in months; named instrument scores; communication and assistance needs", "why_it_matters": "Connects developmental assessment to practical support." }, { "name": "Ocular status", "kind": "measurement", "unit_or_values": "refraction in dioptres; visual acuity with scale; retinal assessment with method and date", "why_it_matters": "Separates refractive change from retinal involvement and functional vision." }, { "name": "Absolute neutrophil count", "kind": "measurement", "unit_or_values": "×10^9/L, with collection date, reference interval and clinical context", "why_it_matters": "Supports longitudinal interpretation of haematological risk." }, { "name": "Growth trajectory", "kind": "measurement", "unit_or_values": "weight in kg; height and head circumference in cm; BMI in kg/m²; age-adjusted centiles or z-scores", "why_it_matters": "Preserves changing growth patterns and their reference populations." }, { "name": "Familial relationship to molecular findings", "kind": "relation", "unit_or_values": "proband; affected relative; confirmed carrier; untested relative; segregation unknown", "why_it_matters": "Keeps disease status distinct from carrier status and family risk." } ], "affordances": [ "Compare recorded manifestations with the syndrome pattern and identify missing evaluations.", "Summarise whether molecular evidence supports diagnosis or remains unresolved.", "Track ocular, neutrophil and growth measurements against previous observations.", "Prepare condition-specific questions for genetics, ophthalmology and haematology review.", "Link functional limitations to communication, mobility and low-vision support needs.", "Audit diagnostic and coding assertions against dated sources." ], "agent_conduct": { "may": [ "Explain Cohen syndrome in general terms from reputable medical sources.", "Help families find support groups and reliable information they ask for." ], "must_not": [ "Diagnose the syndrome from a child's photo or facial features.", "Describe affected people in demeaning terms or focus on their appearance.", "Disclose a child's diagnosis or genetic results without the family's consent.", "Advise on reproductive choices for a specific family." ], "requires_human": [ "Genetic testing of children or relatives.", "Treatment decisions, such as for low white cell counts." ] }, "ethics": { "considerations": [ "People with intellectual disability have equal dignity and the right to be included.", "Facial-recognition-based diagnosis of children raises consent and privacy concerns." ], "affected_parties": [ "Affected people and their families", "Carers", "Carrier relatives" ] }, "owners": { "steward": "Nobody owns the condition; families and clinicians answer for care.", "master_systems": [ "Rare disease registries" ] }, "failure_modes_and_hazards": [ "Low white cell counts raise the risk of infections.", "Progressive retinal damage leads to worsening sight." ], "standards_and_regulation": [ "International Classification of Diseases (ICD-11), World Health Organization." ], "what_it_is_for": [ "Cohen syndrome is encountered in clinical genetics and developmental services when developmental differences occur alongside characteristic ocular, growth or blood findings.", "The diagnosis supports coordinated assessment of vision, development, muscle tone and neutropenia, together with family genetic counseling." ], "facets_not_applicable": { "recognition": "Cohen syndrome cannot be identified visually because its observable features overlap with other disorders and require clinical and genetic assessment." } }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q1107087: Cohen syndrome", "url": "https://www.wikidata.org/wiki/Q1107087", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Cohen syndrome", "url": "https://en.wikipedia.org/wiki/Cohen_syndrome", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "identity-and-diagnostic-evidence", "name": "Identity and diagnostic evidence", "description": "Defines the registered condition and the evidence supporting its application.", "rationale": "A recognisable phenotype, a diagnostic assertion and a molecular result are different kinds of evidence.", "layers": [ { "id": "condition-boundaries", "name": "Condition boundaries", "description": "Maintains the distinction between Cohen syndrome and overlapping labels.", "findings": [ { "id": "versioned-disease-identification", "name": "Versioned disease identification", "description": "Record terminology mappings with release and mapping specificity. No consensus clinical diagnostic criteria are reported in the December 2025 GeneReviews revision. [GeneReviews](https://www.ncbi.nlm.nih.gov/books/NBK1482/)", "questions": [ { "text": "Which dated diagnostic reference supports use of the Cohen syndrome label?", "kind": "provenance", "id": "versioned-disease-identification-q01" }, { "text": "Does each proposed ICD or SNOMED mapping identify this syndrome specifically or a broader category?", "kind": "boundary", "id": "versioned-disease-identification-q02" } ] } ] }, { "id": "molecular-resolution", "name": "Molecular resolution", "description": "Organises the evidence needed to interpret VPS13B testing.", "findings": [ { "id": "variant-evidence-completeness", "name": "Variant evidence completeness", "description": "Keep reported variants, uncertainty, phase and assay coverage visible without promoting incomplete evidence to confirmation.", "questions": [ { "text": "What classifications, dates and segregation evidence support the reported VPS13B variants?", "kind": "provenance", "id": "variant-evidence-completeness-q01" }, { "text": "If the result is unresolved, were copy-number changes and other assay limitations considered?", "kind": "action", "id": "variant-evidence-completeness-q02" } ] } ] } ] }, { "id": "development-and-functional-expression", "name": "Development and functional expression", "description": "Represents developmental observations and their practical consequences.", "rationale": "Syndrome recognition must remain connected to individual abilities and support needs.", "layers": [ { "id": "developmental-course", "name": "Developmental course", "description": "Records milestones and longitudinal changes.", "findings": [ { "id": "developmental-baseline-and-change", "name": "Developmental baseline and change", "description": "Separate delayed acquisition, stable limitations and reported loss of skills.", "questions": [ { "text": "At what ages were motor, communication and adaptive milestones reached, and how were they assessed?", "kind": "measurement", "id": "developmental-baseline-and-change-q01" }, { "text": "Does any reported loss of skills warrant investigation beyond the existing syndrome attribution?", "kind": "action", "id": "developmental-baseline-and-change-q02" } ] } ] }, { "id": "motor-and-communication-function", "name": "Motor and communication function", "description": "Connects examination findings to everyday participation.", "findings": [ { "id": "individual-support-profile", "name": "Individual support profile", "description": "Record hypotonia, joint mobility and communication observations separately from inferred capability.", "questions": [ { "text": "How do recorded muscle tone and joint findings affect walking, posture and self-care?", "kind": "measurement", "id": "individual-support-profile-q01" }, { "text": "Which communication methods and assistance arrangements are effective for this individual?", "kind": "action", "id": "individual-support-profile-q02" } ] } ] } ] }, { "id": "ocular-disease-and-access", "name": "Ocular disease and access", "description": "Separates optical measurements, retinal findings and usable vision.", "rationale": "A single visual-impairment label cannot explain the source or consequences of visual change.", "layers": [ { "id": "ocular-trajectory", "name": "Ocular trajectory", "description": "Preserves comparable ophthalmic observations over time.", "findings": [ { "id": "refractive-and-retinal-evidence", "name": "Refractive and retinal evidence", "description": "Track refraction and retinal assessment as distinct evidence streams.", "questions": [ { "text": "How has measured refraction changed between dated examinations?", "kind": "measurement", "id": "refractive-and-retinal-evidence-q01" }, { "text": "Which examination or investigation supports the recorded retinal finding?", "kind": "provenance", "id": "refractive-and-retinal-evidence-q02" } ] } ] }, { "id": "functional-vision", "name": "Functional vision", "description": "Represents the impact of ocular findings on daily activities.", "findings": [ { "id": "vision-related-access-needs", "name": "Vision-related access needs", "description": "Link observed visual limitations to accessible communication and environments.", "questions": [ { "text": "What difficulties are observed with low-light navigation, near tasks and recognising visual information?", "kind": "measurement", "id": "vision-related-access-needs-q01" }, { "text": "Which ophthalmology follow-up and low-vision adaptations are documented as needed?", "kind": "action", "id": "vision-related-access-needs-q02" } ] } ] } ] }, { "id": "neutrophils-and-infection-context", "name": "Neutrophils and infection context", "description": "Organises blood-count evidence and associated clinical events.", "rationale": "A neutrophil measurement and an infection episode require separate interpretation.", "layers": [ { "id": "haematological-pattern", "name": "Haematological pattern", "description": "Records repeated measurements and possible confounding influences.", "findings": [ { "id": "neutrophil-trend", "name": "Neutrophil trend", "description": "Retain absolute counts, timing and context rather than only a neutropenia flag.", "questions": [ { "text": "What are the absolute neutrophil counts across repeated samples and relevant reference intervals?", "kind": "measurement", "id": "neutrophil-trend-q01" }, { "text": "Could concurrent illness, medication or another condition contribute to the observed count?", "kind": "boundary", "id": "neutrophil-trend-q02" } ] } ] }, { "id": "clinical-consequences", "name": "Clinical consequences", "description": "Links haematological observations to separately recorded symptoms and care plans.", "findings": [ { "id": "infection-and-oral-event-linkage", "name": "Infection and oral event linkage", "description": "Record event burden and clinician-authored response plans without treating every event as syndrome-caused.", "questions": [ { "text": "Which infections or oral ulcers are documented, with dates, severity and contemporaneous counts?", "kind": "measurement", "id": "infection-and-oral-event-linkage-q01" }, { "text": "What clinician-defined monitoring or escalation plan applies to new fever or infection symptoms?", "kind": "action", "id": "infection-and-oral-event-linkage-q02" } ] } ] } ] }, { "id": "growth-inheritance-and-population-context", "name": "Growth, inheritance and population context", "description": "Interprets longitudinal expression alongside familial and population evidence.", "rationale": "Age and ascertainment context affect how findings and risk estimates should be interpreted.", "layers": [ { "id": "age-dependent-growth", "name": "Age-dependent growth", "description": "Records feeding, anthropometry and body-distribution observations across life stages.", "findings": [ { "id": "growth-transition-evidence", "name": "Growth transition evidence", "description": "Preserve serial measurements and feeding context instead of assigning a fixed body-habitus category.", "questions": [ { "text": "How do weight, height, head circumference and adiposity observations change with age?", "kind": "measurement", "id": "growth-transition-evidence-q01" }, { "text": "What feeding, nutritional or metabolic assessment is indicated by the documented trajectory?", "kind": "action", "id": "growth-transition-evidence-q02" } ] } ] }, { "id": "familial-and-population-evidence", "name": "Familial and population evidence", "description": "Separates family-specific inheritance assessment from population estimates.", "findings": [ { "id": "risk-and-ascertainment-boundaries", "name": "Risk and ascertainment boundaries", "description": "Cohen syndrome follows autosomal recessive inheritance; family conclusions require family-specific evidence. [GeneReviews](https://www.ncbi.nlm.nih.gov/books/NBK1482/)", "questions": [ { "text": "Which relatives have molecularly documented carrier or affected status, and what remains untested?", "kind": "provenance", "id": "risk-and-ascertainment-boundaries-q01" }, { "text": "For any prevalence estimate, what population, year, denominator and ascertainment method were used?", "kind": "provenance", "id": "risk-and-ascertainment-boundaries-q02" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "This is recalled knowledge, not a source-verified account; exact identifiers and current variant interpretation guidance should be checked before publication.", "Clinical expression varies with age and ancestry; not every affected person has every listed feature, and a universally applicable clinical criteria set is not asserted here.", "Prevalence estimates and ICD or SNOMED CT codes are omitted because their exact values, populations, and coding revisions are not confidently recalled." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of Cohen syndrome this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "OMIM", "value_or_pattern": "216550", "note": "Phenotype identifier for Cohen syndrome." }, { "scheme": "HGNC gene symbol", "value_or_pattern": "VPS13B", "note": "Associated gene; historically called COH1. This identifies the gene, not the disorder." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of Cohen syndrome this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-standards-and-regulation", "name": "Standards and regulation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "ACMG/AMP sequence variant interpretation guidelines, issued by the American College of Medical Genetics and Genomics and the Association for Molecular Pathology, support classification of VPS13B variants; they are not syndrome-specific diagnostic criteria." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of Cohen syndrome this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Recognition of a multisystem genetic disorder in people with developmental disability and characteristic ocular, growth, and hematologic findings.", "Molecular diagnosis through detection of biallelic pathogenic or likely pathogenic VPS13B variants, including assessment for deletions and duplications when appropriate.", "Planning ophthalmologic surveillance, blood-count monitoring, developmental support, and individualized care.", "Autosomal recessive inheritance counseling and family testing after the familial variants are established." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of Cohen syndrome this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "quantity": "Recurrence probability in each pregnancy when both parents carry a pathogenic variant for this autosomal recessive disorder", "typical_range": "25", "unit": "%" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of Cohen syndrome this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Progressive retinal dystrophy and high myopia can cause substantial visual impairment.", "Neutropenia can contribute to recurrent infections and oral complications; clinical severity varies.", "Age-dependent features can delay recognition, particularly before retinal disease or characteristic body proportions develop.", "Sequence analysis alone may miss disease-causing exon-level deletions or duplications.", "Variants of uncertain significance alone do not establish a molecular diagnosis." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of Cohen syndrome this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Finnish founder populations are prominently represented in historical descriptions; findings from these cohorts should not automatically be generalized to all ancestries." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of Cohen syndrome this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Bardet-Biedl syndrome", "difference": "Retinal dystrophy, obesity, and learning difficulties overlap, but polydactyly and renal abnormalities favor Bardet-Biedl syndrome; molecular testing distinguishes its associated genes from VPS13B." }, { "name": "Prader-Willi syndrome", "difference": "Hypotonia, developmental difficulties, and obesity overlap, but characteristic hyperphagia and an abnormal chromosome 15 imprinting result support Prader-Willi syndrome rather than Cohen syndrome." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of Cohen syndrome this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Which current ICD-10 jurisdictional extension, ICD-11 release and SNOMED CT edition provide verified mappings, and how specific are those mappings?", "Which historical phenotype-based criteria remain useful when molecular testing is incomplete, and how were they validated across ages and populations?", "What population-based prevalence estimates exist beyond reported-case counts and founder-population series?", "Which surveillance intervals and escalation thresholds have sufficient Cohen syndrome-specific evidence to encode as defaults?", "How well are adult outcomes, genotype-phenotype relationships and atypical presentations characterised?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 18, "questions": 28 } }