{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T10:44:52Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 20.8, "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: 01a09537-216c-7880-b313-9a73ecaf2e2f\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: Kennedy disease\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": 79.5, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a09537-216b-7930-b3d6-f4d5f28aa8e9\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: Kennedy disease\nRegistry id: vr.tr.kennedy-disease\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this entry: (" } }, "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": "2026-10-07T10:10:28+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q1995327", "registryId": "vr.tr.kennedy-disease", "name": "Kennedy disease", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q1995327/", "model": { "registry_id": "vr.tr.kennedy-disease", "name": "Kennedy disease", "purpose": "Enable an agent to recognise Kennedy disease, assess disease-specific evidence and functional change, and identify appropriate clinical review without confusing inherited susceptibility, diagnosis and care delivery.", "definition": "Kennedy disease, also called spinal and bulbar muscular atrophy (SBMA), is an X-linked disorder caused by a CAG-repeat expansion in the androgen receptor gene, producing slowly progressive lower motor neuron and skeletal muscle dysfunction, predominantly in adult males, with features of androgen insensitivity.", "scope_statement": "This model owns the disease concept Kennedy disease, also called spinal and bulbar muscular atrophy (SBMA), for vr.tr.kennedy-disease in XCT / XCT.STA, including recognition, molecular interpretation, manifestations, progression and constraints on action.", "in_scope": [ "Disease identity and boundaries against other motor neuron disorders", "AR CAG-repeat evidence and the basis for diagnostic confidence", "Motor, bulbar, sensory and androgen-related manifestations", "Functional trajectory and complication surveillance", "Inheritance, affected populations and evidence-qualified management" ], "out_of_scope": [ "The person's identity and complete longitudinal health record", "Individual appointments, admissions and episodes of care", "Laboratory specimen handling and sequencing infrastructure", "Independent models of ALS, SMN1-related spinal muscular atrophy and androgen insensitivity syndrome", "Medication products, prescribing workflows and clinical trial protocols" ], "distinguishing_features": [ "Establish whether targeted testing identifies an AR CAG-repeat expansion; a generic spinal muscular atrophy label does not distinguish SBMA from SMN1-related disease.", "Check for a lower motor neuron pattern and assess upper motor neuron signs; their presence warrants reconsideration of an uncomplicated SBMA attribution, including ALS.", "Assess androgen-insensitivity features alongside neuromuscular findings; endocrine findings alone do not establish SBMA.", "Evaluate sensory involvement and an X-linked pedigree as supporting evidence, while allowing an uninformative family history.", "Keep Kennedy disease separate from Foster Kennedy syndrome, a different clinical entity despite the shared surname." ], "characteristics": [ { "name": "AR repeat size", "kind": "measurement", "unit_or_values": "CAG repeats per reported allele, with assay uncertainty", "why_it_matters": "Retains the molecular observation separately from its clinical interpretation." }, { "name": "Repeat interpretation", "kind": "category", "unit_or_values": "Laboratory classification, interpreting authority and revision; uncertain classifications retained", "why_it_matters": "Prevents an unversioned threshold from silently determining diagnosis." }, { "name": "Diagnostic standing", "kind": "state", "unit_or_values": "Suspected; molecularly supported; clinician-confirmed; unresolved; revised", "why_it_matters": "Separates evidence accumulation from a clinician's diagnostic assertion." }, { "name": "Genotype and phenotype relationship", "kind": "relation", "unit_or_values": "Reported AR allele configuration linked to observed manifestations and relevant biological context", "why_it_matters": "Avoids equating an expanded allele with current symptomatic disease." }, { "name": "Motor distribution", "kind": "category", "unit_or_values": "Limb and bulbar regions; weakness, atrophy, fasciculations and reflex findings; present, absent or unassessed", "why_it_matters": "Supports recognition and identifies findings that need another explanation." }, { "name": "Functional trajectory", "kind": "measurement", "unit_or_values": "Dated SBMAFRS scores with instrument version, item results and assessment conditions", "why_it_matters": "Makes change interpretable without inventing a universal disease stage." }, { "name": "Swallowing and respiratory status", "kind": "state", "unit_or_values": "Assessed findings, symptoms, support requirements and unresolved safety concerns", "why_it_matters": "Connects disease burden to timely clinical review." }, { "name": "Population frequency", "kind": "measurement", "unit_or_values": "Cases per stated denominator, population, geography, ascertainment method and observation years", "why_it_matters": "Prevents genetic expansion frequency from being presented as diagnosed disease prevalence." } ], "affordances": [ "Reconcile Kennedy disease and SBMA labels with an existing authoritative model before creating another disease concept.", "Identify missing molecular or clinical evidence and prepare a focused specialist-review request.", "Compare dated functional assessments while exposing instrument and context differences.", "Flag recorded swallowing, breathing or mobility deterioration for clinician assessment.", "Prepare consent-aware genetic counselling questions from documented inheritance evidence.", "Check whether a proposed intervention has relevant evidence and current local authorization." ], "agent_conduct": { "may": [ "Explain Kennedy disease in general terms from reputable medical sources.", "Point people with a family history toward genetic counselling." ], "must_not": [ "Diagnose the disease or interpret a person's genetic test.", "Confuse it with other motor neurone diseases or give a prognosis.", "Disclose a person's genetic status to relatives, employers or insurers without consent.", "Recommend hormone or other treatments for a specific person." ], "requires_human": [ "Predictive genetic testing of relatives.", "Decisions on swallowing safety, such as feeding tubes." ] }, "ethics": { "considerations": [ "Genetic results affect whole families; each person has the right to know or not to know.", "Genetic information can be misused for discrimination in work and insurance." ], "affected_parties": [ "Affected men", "Female carriers", "Families" ] }, "owners": { "steward": "Nobody owns the disease; patients and their clinicians answer for care.", "master_systems": [ "Rare disease registries" ] }, "failure_modes_and_hazards": [ "Weakness of swallowing muscles raises the risk of choking and pneumonia.", "Slowly progressive muscle weakness leads to falls." ], "standards_and_regulation": [ "International Classification of Diseases (ICD-11), World Health Organization." ], "what_it_is_for": [ "Kennedy disease is encountered in adult neuromuscular assessment, inherited disease research and genetic counselling.", "Its clinical context includes slowly progressive weakness and difficulties with speech or swallowing, with diagnosis requiring evidence beyond observable symptoms." ], "facets_not_applicable": { "recognition": "The disorder cannot be identified visually because its observable manifestations overlap with other neuromuscular conditions." } }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q1995327: Kennedy disease", "url": "https://www.wikidata.org/wiki/Q1995327", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Spinal and bulbar muscular atrophy", "url": "https://en.wikipedia.org/wiki/Spinal_and_bulbar_muscular_atrophy", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "identity-and-diagnostic-boundaries", "name": "Identity and diagnostic boundaries", "description": "Anchor the registered thing to SBMA and distinguish its diagnostic assertion from neighbouring entities.", "rationale": "Ambiguous eponyms and broad motor neuron labels can attach evidence to the wrong concept.", "layers": [ { "id": "concept-and-coding", "name": "Concept and coding", "description": "Resolve terminology and classification without assuming every code is disease-specific.", "findings": [ { "id": "sbma-concept-equivalence", "name": "SBMA concept equivalence", "description": "Kennedy disease and SBMA name the same disease concept. Source: [GeneReviews](https://www.ncbi.nlm.nih.gov/books/NBK1333/).", "questions": [ { "text": "Does an existing world model already represent SBMA and therefore own this registry concept?", "kind": "boundary", "id": "sbma-concept-equivalence-q01" }, { "text": "Which ICD-10 national modification, ICD-11 release and SNOMED CT edition support each proposed mapping, and is the mapping exact or broader?", "kind": "provenance", "id": "sbma-concept-equivalence-q02" } ] } ] }, { "id": "differential-evidence", "name": "Differential evidence", "description": "Make the reason for preferring SBMA inspectable.", "findings": [ { "id": "motor-neuron-differential", "name": "Motor neuron differential", "description": "Retain explicit comparisons with ALS and other spinal muscular atrophies rather than inferring SBMA from weakness alone.", "questions": [ { "text": "Which examination and molecular findings distinguish this presentation from ALS and SMN1-related spinal muscular atrophy?", "kind": "boundary", "id": "motor-neuron-differential-q01" }, { "text": "Which discordant findings remain unexplained, and who reviewed their diagnostic significance?", "kind": "provenance", "id": "motor-neuron-differential-q02" } ] } ] } ] }, { "id": "ar-expansion-and-inheritance", "name": "AR expansion and inheritance", "description": "Connect the causal molecular evidence to interpretation and family implications.", "rationale": "Repeat sizing and inheritance are central to SBMA recognition but do not independently describe present disability.", "layers": [ { "id": "repeat-sizing-and-interpretation", "name": "Repeat sizing and interpretation", "description": "Separate the assay result from the rule used to interpret it.", "findings": [ { "id": "repeat-boundary-evidence", "name": "Repeat boundary evidence", "description": "GeneReviews classifies ≥38 repeats as full penetrance, 36-37 as reduced penetrance and 35 as uncertain; retain contextual interpretation. Source: [GeneReviews](https://www.ncbi.nlm.nih.gov/books/NBK1333/).", "questions": [ { "text": "What repeat sizes, assay method, sizing uncertainty and report date were recorded?", "kind": "measurement", "id": "repeat-boundary-evidence-q01" }, { "text": "Which laboratory interpretation and clinical reference revision govern this result, especially near the repeat boundary?", "kind": "provenance", "id": "repeat-boundary-evidence-q02" } ] } ] }, { "id": "familial-expression", "name": "Familial expression", "description": "Represent inherited expansion and observed disease separately.", "findings": [ { "id": "x-linked-expression", "name": "X-linked expression", "description": "SBMA is X-linked and predominantly affects males; heterozygous females may have mild manifestations. Source: [MedlinePlus Genetics](https://medlineplus.gov/genetics/condition/spinal-and-bulbar-muscular-atrophy/).", "questions": [ { "text": "What documented pedigree and molecular evidence support inheritance, and which relatives have unknown status?", "kind": "provenance", "id": "x-linked-expression-q01" }, { "text": "Is the linked individual symptomatic, presymptomatic or identified through family testing, and what supports that distinction?", "kind": "boundary", "id": "x-linked-expression-q02" }, { "text": "What consent and counselling are needed before offering testing or discussing reproductive implications?", "kind": "action", "id": "x-linked-expression-q03" } ] } ] } ] }, { "id": "neuromuscular-course", "name": "Neuromuscular course", "description": "Describe manifestation patterns and observed functional change.", "rationale": "A molecular result does not establish the current distribution, severity or pace of disease.", "layers": [ { "id": "motor-and-sensory-pattern", "name": "Motor and sensory pattern", "description": "Capture a dated examination relevant to SBMA attribution.", "findings": [ { "id": "regional-neuromuscular-findings", "name": "Regional neuromuscular findings", "description": "Record weakness, atrophy, reflexes, fasciculations, tremor and sensory findings by region, distinguishing observed absence from missing assessment.", "questions": [ { "text": "Which limb and bulbar regions were assessed, and what was the distribution of abnormalities?", "kind": "measurement", "id": "regional-neuromuscular-findings-q01" }, { "text": "Do electrodiagnostic findings support the proposed pattern, and what competing explanations remain?", "kind": "boundary", "id": "regional-neuromuscular-findings-q02" } ] } ] }, { "id": "trajectory-and-milestones", "name": "Trajectory and milestones", "description": "Track change without imposing unsupported stage boundaries.", "findings": [ { "id": "observed-functional-change", "name": "Observed functional change", "description": "Anchor trajectory to symptom onset, dated functional assessments and milestones; do not predict individual decline from repeat length alone.", "questions": [ { "text": "When did cramps, weakness, walking limitations and bulbar symptoms first appear, and how reliable are these dates?", "kind": "provenance", "id": "observed-functional-change-q01" }, { "text": "What changed on the same SBMAFRS version or comparable performance measure under documented assessment conditions?", "kind": "measurement", "id": "observed-functional-change-q02" }, { "text": "Could an abrupt decline reflect intercurrent illness, injury or another condition requiring reassessment?", "kind": "action", "id": "observed-functional-change-q03" } ] } ] } ] }, { "id": "bulbar-respiratory-and-systemic-burden", "name": "Bulbar, respiratory and systemic burden", "description": "Connect non-limb manifestations to assessment and disease attribution.", "rationale": "Mobility scores alone cannot represent the risks and multisystem burden relevant to SBMA.", "layers": [ { "id": "swallowing-and-ventilation", "name": "Swallowing and ventilation", "description": "Keep symptom reports, measured impairment and complications distinct.", "findings": [ { "id": "bulbar-respiratory-complications", "name": "Bulbar and respiratory complications", "description": "Dysphagia, aspiration and respiratory weakness are relevant complications. Source: [GeneReviews](https://www.ncbi.nlm.nih.gov/books/NBK1333/).", "questions": [ { "text": "What swallowing assessment, weight trajectory and choking or aspiration history are documented?", "kind": "measurement", "id": "bulbar-respiratory-complications-q01" }, { "text": "What respiratory symptoms and tests were assessed, including posture, units and use of support?", "kind": "measurement", "id": "bulbar-respiratory-complications-q02" }, { "text": "Which findings meet the treating service's criteria for urgent swallowing or respiratory review?", "kind": "action", "id": "bulbar-respiratory-complications-q03" } ] } ] }, { "id": "androgen-and-metabolic-manifestations", "name": "Androgen and metabolic manifestations", "description": "Represent systemic observations without automatically attributing every abnormality to SBMA.", "findings": [ { "id": "systemic-attribution", "name": "Systemic attribution", "description": "Androgen-insensitivity features and metabolic abnormalities can accompany SBMA. Source: [GeneReviews](https://www.ncbi.nlm.nih.gov/books/NBK1333/).", "questions": [ { "text": "Which endocrine, reproductive, metabolic, hepatic or cardiac findings have actually been assessed?", "kind": "measurement", "id": "systemic-attribution-q01" }, { "text": "Which findings are attributed to SBMA, which are independent diagnoses, and what supports each attribution?", "kind": "boundary", "id": "systemic-attribution-q02" } ] } ] } ] }, { "id": "management-and-population-evidence", "name": "Management and population evidence", "description": "Constrain action and population claims to evidence that applies to SBMA.", "rationale": "An agent must distinguish supportive care from disease modification and diagnosed prevalence from expansion frequency.", "layers": [ { "id": "evidence-qualified-actions", "name": "Evidence-qualified actions", "description": "Attach each proposed action to an assessed need and applicable evidence.", "findings": [ { "id": "intervention-status", "name": "Intervention status", "description": "Separate supportive interventions, proposed disease-modifying treatment and trial participation; retain indication, jurisdiction and review date.", "questions": [ { "text": "Which assessed limitation motivates rehabilitation, mobility assistance, communication support or swallowing review?", "kind": "action", "id": "intervention-status-q01" }, { "text": "For a proposed drug or hormonal intervention, what SBMA-specific evidence, safety assessment and current local authorization apply?", "kind": "provenance", "id": "intervention-status-q02" }, { "text": "Which clinician owns the decision, and what outcome and reassessment point would establish benefit or harm?", "kind": "action", "id": "intervention-status-q03" } ] } ] }, { "id": "population-and-ascertainment", "name": "Population and ascertainment", "description": "Qualify frequency and natural-history claims by how populations were identified.", "findings": [ { "id": "clinical-versus-genetic-frequency", "name": "Clinical versus genetic frequency", "description": "Diagnosed SBMA prevalence and AR-expansion frequency measure different quantities. Source: [GeneReviews](https://www.ncbi.nlm.nih.gov/books/NBK1333/).", "questions": [ { "text": "Does the estimate count clinically diagnosed cases, symptomatic expansion carriers or all detected expansions?", "kind": "definition", "id": "clinical-versus-genetic-frequency-q01" }, { "text": "What population, age and sex denominator, geography, observation years and ascertainment method underlie the estimate?", "kind": "measurement", "id": "clinical-versus-genetic-frequency-q02" }, { "text": "How do referral selection, founder effects and age at assessment limit transfer to another population?", "kind": "boundary", "id": "clinical-versus-genetic-frequency-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-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; repeat thresholds and borderline allele interpretation should be checked against current clinical genetics references.", "ICD and SNOMED CT mappings are omitted because the exact code and applicable revision need verification.", "No discrete clinical subtypes are asserted; age at onset, severity and manifestations vary, and heterozygous females may occasionally have mild features." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of Kennedy disease 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": "313200", "note": "Phenotype entry for spinal and bulbar muscular atrophy, X-linked." }, { "scheme": "HGNC gene symbol", "value_or_pattern": "AR", "note": "Identifies the androgen receptor gene; the disease-associated variant is a CAG-repeat expansion." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of Kennedy disease 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": [ "Molecular testing of the AR CAG repeat supports confirmation in a person with compatible clinical findings.", "Family testing and genetic counselling address X-linked inheritance and reproductive implications.", "Clinical follow-up assesses mobility, swallowing, speech, respiratory function and endocrine or metabolic manifestations." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of Kennedy disease 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": "AR CAG-repeat length", "typical_range": "Disease-associated alleles generally contain 38 or more repeats; borderline results require specialist interpretation.", "unit": "CAG repeats" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of Kennedy disease 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 limb weakness can impair walking and increase falls.", "Bulbar weakness can cause dysphagia, choking and aspiration pneumonia.", "Respiratory muscle weakness can contribute to ventilatory impairment.", "Androgen insensitivity can produce gynecomastia, testicular atrophy and reduced fertility.", "Confusion with amyotrophic lateral sclerosis can lead to an incorrect prognosis and inappropriate counselling." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of Kennedy disease 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": [ "Reported frequency varies across populations, partly reflecting founder effects and differences in recognition and genetic testing." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of Kennedy disease 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": "Amyotrophic lateral sclerosis", "difference": "Kennedy disease is supported by an AR repeat expansion and often sensory or endocrine abnormalities; prominent upper motor neuron signs favour ALS." }, { "name": "5q spinal muscular atrophy", "difference": "5q spinal muscular atrophy is associated with biallelic SMN1 defects, whereas Kennedy disease is associated with an X-linked AR repeat expansion." }, { "name": "Androgen insensitivity syndrome", "difference": "Both involve AR, but Kennedy disease specifically involves a polyglutamine-encoding repeat expansion and progressive neuromuscular disease." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of Kennedy disease this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Does the existing world-model catalogue already contain an authoritative SBMA model to which vr.tr.kennedy-disease should link?", "What exact ICD-10, ICD-11 and SNOMED CT mappings are valid in the intended jurisdiction and terminology releases?", "Which current clinical authority should govern interpretation of 35-37 AR repeats and genotype-positive individuals with atypical or absent manifestations?", "Which SBMAFRS version, meaningful-change thresholds and surveillance recommendations are validated for the intended population?", "Which primary population studies and current jurisdiction-specific treatment decisions should supply the model's prevalence estimates and intervention constraints?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 17, "questions": 32 } }