{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T11:45:16Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 17.9, "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: 01a0956e-6057-70b0-8930-8effd0a254c7\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: onychogryphosis\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 044: 1001", "usd": 0.0, "recall": true }, "codex": { "seconds": 82.2, "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: 01a0956e-6048-7a43-ad06-139e7a168979\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: onychogryphosis\nRegistry id: vr.tr.onychogryphosis\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": "2026-10-06T08:43:09+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "visual_identification" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:29+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q2495793", "registryId": "vr.tr.onychogryphosis", "name": "onychogryphosis", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q2495793/", "model": { "registry_id": "vr.tr.onychogryphosis", "name": "onychogryphosis", "purpose": "Enable an agent to recognise suspected onychogryphosis, record its nail-specific burden and diagnostic uncertainty, and support clinician-directed care and follow-up.", "definition": "Onychogryphosis is a nail deformity characterized by marked thickening, elongation and excessive curvature of the nail plate, often producing a ram's-horn appearance and most commonly affecting a great toenail.", "scope_statement": "This model owns the onychogryphosis condition concept registered as vr.tr.onychogryphosis in XCT / XCT.STA, its manifestations in individual nails, and the evidence supporting assessments and care decisions; human clinical use is the provisional scope.", "in_scope": [ "Nail plate thickening, elongation, curvature and growth direction", "Affected nail distribution, onset and observed progression", "Diagnostic evidence, competing explanations and coexisting nail disease", "Pain, pressure effects, tissue injury and functional burden", "Contributing circumstances, care suitability and response over time" ], "out_of_scope": [ "The patient's complete health and demographic record", "General nail anatomy and normal nail growth", "Independent models of fungal infection, ingrown nails and inflammatory nail disease", "Underlying vascular, neurological or inherited disorders", "Visits, procedural techniques, prescribing and service administration" ], "distinguishing_features": [ "Look for a thickened nail plate with abnormal elongation and pronounced horn-like curvature; isolated thickening should remain an uncertain match. [Clinical description](https://pmc.ncbi.nlm.nih.gov/articles/PMC6219229/).", "Separate fungal evidence from nail shape: onychomycosis can resemble or coexist with onychogryphosis. [Diagnostic discussion](https://pmc.ncbi.nlm.nih.gov/articles/PMC6219229/).", "Record nail-edge penetration separately from plate deformity; an ingrown nail can complicate onychogryphosis without defining it. [Complications](https://pmc.ncbi.nlm.nih.gov/articles/PMC6219229/).", "For lateral growth present from infancy, investigate congenital nail malalignment rather than treating direction alone as diagnostic. [Differential diagnosis](https://pmc.ncbi.nlm.nih.gov/articles/PMC6219229/)." ], "characteristics": [ { "name": "Affected nail location", "kind": "relation", "unit_or_values": "Person reference, hand or foot, side and digit; multiple nails recorded individually", "why_it_matters": "Keeps observations and treatment outcomes attached to the correct nail." }, { "name": "Plate thickness", "kind": "measurement", "unit_or_values": "Millimetres with measurement site, method and date; unknown if unmeasured", "why_it_matters": "Supports comparison without inventing a diagnostic thickness threshold." }, { "name": "Plate elongation", "kind": "measurement", "unit_or_values": "Millimetres using a stated landmark and straight-line or contour method", "why_it_matters": "Makes overgrowth and changes after care comparable." }, { "name": "Curvature and deviation", "kind": "category", "unit_or_values": "Described curvature, growth direction and adjacent-tissue contact; dated photographs when available", "why_it_matters": "Captures the deformity that thickness alone misses." }, { "name": "Diagnostic assessment", "kind": "state", "unit_or_values": "Suspected, clinician-confirmed, disputed or excluded; assessor, date and evidence required", "why_it_matters": "Separates a visual observation from a diagnostic assertion." }, { "name": "Fungal investigation", "kind": "state", "unit_or_values": "Not investigated, pending, positive, negative or inconclusive; specimen, method and date", "why_it_matters": "Prevents appearance from substituting for evidence of infection." }, { "name": "Symptom and activity burden", "kind": "measurement", "unit_or_values": "Pain on a named scale; reported footwear, walking or hand-use limitations", "why_it_matters": "Records consequences separately from appearance." }, { "name": "Local tissue condition", "kind": "state", "unit_or_values": "Intact, inflamed, breached, draining or otherwise abnormal; location and assessment date", "why_it_matters": "Supports assessment of complications and review urgency." }, { "name": "Onset and trajectory", "kind": "state", "unit_or_values": "Reported onset date or age; stable, progressing, improved or recurrent; uncertainty recorded", "why_it_matters": "Distinguishes longstanding deformity from interval change." }, { "name": "Contributing-factor evidence", "kind": "relation", "unit_or_values": "Links to documented trauma, pressure, care barriers or associated conditions; suspected contribution distinguished from established cause", "why_it_matters": "Supports explanation without inferring causation from association." }, { "name": "Care response", "kind": "state", "unit_or_values": "Change in plate dimensions, symptoms, function and tissue condition relative to a dated intervention", "why_it_matters": "Separates cosmetic reduction, symptom relief and recurrence." } ], "affordances": [ "Assemble a nail-specific recognition record for clinical review.", "Identify missing evidence needed to distinguish deformity from infection or another nail disorder.", "Compare dated observations to detect progression or recurrence.", "Flag documented tissue injury or worsening symptoms for clinician review under the applicable pathway.", "Support discussion of care options using symptoms, relevant assessments and patient preferences.", "Link follow-up observations to prior care and assess whether its intended benefit occurred." ], "agent_conduct": { "may": [ "Explain the condition and the care it needs in general terms.", "Remind carers of older or immobile people to arrange regular foot care by a qualified practitioner." ], "must_not": [ "Cut or file a thickened nail on someone without training and consent.", "Share images of a person's feet or neglect without consent.", "Mock a person's appearance or blame them for the condition.", "Diagnose a fungal infection or other cause for a specific person." ], "requires_human": [ "Reporting suspected neglect of a dependent person.", "Removing a nail or treating the nail bed." ] }, "ethics": { "considerations": [ "Severe cases often reflect neglect of older or disabled people who cannot reach their feet.", "People with the condition may feel ashamed and avoid care." ], "affected_parties": [ "Older people", "People with disabilities or diabetes", "Carers" ] }, "owners": { "steward": "Nobody owns the condition; the person and their foot care practitioner answer for care.", "master_systems": [] }, "visual_identification": [ "A very thick, long nail curving like a ram's horn, usually on the big toe.", "Yellow or brown discoloration with a rough, layered surface." ], "failure_modes_and_hazards": [ "The curved nail can dig into the skin and cause wounds and infection.", "Makes walking and wearing shoes painful, increasing the risk of falls." ], "what_it_is_for": [ "Onychogryphosis is encountered in foot care, dermatology and assessments of people who have difficulty maintaining their nails.", "Recognising the deformity supports documentation of discomfort, footwear interference and limitations in walking or personal care." ], "standards_and_regulation": [ "The International Classification of Diseases, Tenth Revision, issued by the World Health Organization, classifies onychogryphosis under code L60.2." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q2495793: onychogryphosis", "url": "https://www.wikidata.org/wiki/Q2495793", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Onychogryphosis", "url": "https://en.wikipedia.org/wiki/Onychogryphosis", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "nail-deformity", "name": "Nail deformity", "description": "Record the location and visible geometry of suspected onychogryphosis.", "rationale": "Recognition requires a specific pattern of plate change, not merely a label of abnormal nail.", "layers": [ { "id": "nail-distribution", "name": "Nail distribution", "description": "Identify which nails carry the observed deformity.", "findings": [ { "id": "affected-nail-map", "name": "Affected nail map", "description": "Maintain individual nail identity and distinguish examined normal nails from unexamined nails.", "questions": [ { "text": "Which hand or foot, side and digit shows the suspected deformity?", "kind": "measurement", "id": "affected-nail-map-q01" }, { "text": "Which other nails were examined, and which remain unassessed?", "kind": "boundary", "id": "affected-nail-map-q02" } ] } ] }, { "id": "plate-geometry", "name": "Plate geometry", "description": "Describe thickness, elongation and curvature together.", "findings": [ { "id": "documented-growth-pattern", "name": "Documented growth pattern", "description": "Retain reproducible observations and photographs without imposing an unvalidated severity score.", "questions": [ { "text": "What thickness, length, curvature and growth direction were observed, using which landmarks?", "kind": "measurement", "id": "documented-growth-pattern-q01" }, { "text": "Was the observation made before or after trimming, and is a dated image available?", "kind": "provenance", "id": "documented-growth-pattern-q02" } ] } ] } ] }, { "id": "diagnostic-boundaries", "name": "Diagnostic boundaries", "description": "Separate the observed nail phenotype, diagnostic assertion and competing explanations.", "rationale": "A thick or discoloured nail does not by itself establish onychogryphosis or fungal infection.", "layers": [ { "id": "clinical-assertion", "name": "Clinical assertion", "description": "Record who interpreted the morphology and on what basis.", "findings": [ { "id": "diagnosis-and-terminology", "name": "Diagnosis and terminology", "description": "Keep diagnostic confidence, criteria provenance and terminology mappings explicit.", "questions": [ { "text": "Who assessed onychogryphosis, when, and which observations supported that assessment?", "kind": "provenance", "id": "diagnosis-and-terminology-q01" }, { "text": "If formal criteria are claimed, what issuing body and version support them; otherwise, is clinical judgement identified?", "kind": "definition", "id": "diagnosis-and-terminology-q02" }, { "text": "For any ICD or SNOMED mapping, what code, edition, jurisdiction and exact or broader relationship were verified?", "kind": "boundary", "id": "diagnosis-and-terminology-q03" } ] } ] }, { "id": "alternative-and-coexisting-disease", "name": "Alternative and coexisting disease", "description": "Preserve evidence for other explanations without forcing mutually exclusive diagnoses.", "findings": [ { "id": "differential-evidence", "name": "Differential evidence", "description": "Record the reasoning distinguishing fungal disease, isolated thickening, ingrowing edges and congenital malalignment.", "questions": [ { "text": "Which alternative explanation remains plausible, and what observation or investigation would distinguish it?", "kind": "boundary", "id": "differential-evidence-q01" }, { "text": "If fungal testing was performed, what specimen, method, date and result support its interpretation?", "kind": "provenance", "id": "differential-evidence-q02" }, { "text": "Is another nail condition considered an alternative, a contributor or a separate coexisting condition?", "kind": "boundary", "id": "differential-evidence-q03" } ] } ] } ] }, { "id": "onset-and-contributors", "name": "Onset and contributors", "description": "Record how the deformity developed and which contextual explanations have evidence.", "rationale": "A useful model must distinguish observed history from assumptions about causation or inadequate care.", "layers": [ { "id": "developmental-history", "name": "Developmental history", "description": "Establish onset, duration and the sequence of nail changes.", "findings": [ { "id": "onset-sequence", "name": "Onset sequence", "description": "Separate reported early-life abnormalities from later acquired changes.", "questions": [ { "text": "When were thickening, elongation and abnormal curvature first noticed, and by whom?", "kind": "provenance", "id": "onset-sequence-q01" }, { "text": "Were abnormal nail direction or similar family nail changes present from early life?", "kind": "boundary", "id": "onset-sequence-q02" } ] } ] }, { "id": "mechanical-and-care-context", "name": "Mechanical and care context", "description": "Capture possible local contributors and practical barriers to nail maintenance.", "findings": [ { "id": "contributor-assessment", "name": "Contributor assessment", "description": "Request evidence for pressure, injury and care-access explanations rather than assigning blame.", "questions": [ { "text": "What documented injury, footwear contact or other repeated pressure preceded the affected nail's change?", "kind": "provenance", "id": "contributor-assessment-q01" }, { "text": "What limits safe nail maintenance, such as reach, vision, dexterity, equipment or access to assistance?", "kind": "action", "id": "contributor-assessment-q02" }, { "text": "Which proposed contributors are supported by temporal evidence, and which remain hypotheses?", "kind": "boundary", "id": "contributor-assessment-q03" } ] } ] } ] }, { "id": "burden-and-local-complications", "name": "Burden and local complications", "description": "Assess what the deformed nail does to comfort, activity and surrounding tissue.", "rationale": "Care decisions need the experienced burden and local findings, not appearance alone.", "layers": [ { "id": "symptoms-and-function", "name": "Symptoms and function", "description": "Record nail-attributed limitations and the person's priorities.", "findings": [ { "id": "activity-specific-burden", "name": "Activity-specific burden", "description": "Separate pain, footwear difficulty, activity restriction and cosmetic concern.", "questions": [ { "text": "What pain occurs at rest, with footwear or during use, and on what named scale?", "kind": "measurement", "id": "activity-specific-burden-q01" }, { "text": "Which activities are limited, and what improvement matters most to the person?", "kind": "action", "id": "activity-specific-burden-q02" } ] } ] }, { "id": "tissue-contact-and-injury", "name": "Tissue contact and injury", "description": "Locate pressure contact and abnormalities around or beneath the nail.", "findings": [ { "id": "local-complication-assessment", "name": "Local complication assessment", "description": "Distinguish observed inflammation or skin damage from a separately diagnosed complication.", "questions": [ { "text": "Does the nail contact an adjacent digit, penetrate a fold or overlie a skin breach, and where?", "kind": "measurement", "id": "local-complication-assessment-q01" }, { "text": "What new pain, redness, drainage or tissue change requires review under the applicable clinical pathway?", "kind": "action", "id": "local-complication-assessment-q02" } ] } ] } ] }, { "id": "care-choice-and-follow-up", "name": "Care choice and follow-up", "description": "Connect clinician-directed care to suitability, goals and subsequent nail behaviour.", "rationale": "Reducing the abnormal plate and changing future growth are different care objectives.", "layers": [ { "id": "care-suitability", "name": "Care suitability", "description": "Record the assessment and preferences behind a proposed intervention.", "findings": [ { "id": "care-option-rationale", "name": "Care option rationale", "description": "Options discussed in the literature include pressure reduction, mechanical debridement and nail removal with or without matrix treatment; selection depends on clinical context. [Management review](https://pmc.ncbi.nlm.nih.gov/articles/PMC6219229/).", "questions": [ { "text": "What goal supports the proposed option: comfort, tissue protection, appearance or prevention of regrowth?", "kind": "action", "id": "care-option-rationale-q01" }, { "text": "What current circulation, sensation, skin and relevant health assessments support its suitability?", "kind": "provenance", "id": "care-option-rationale-q02" }, { "text": "What clinician recommendation and patient preference support the choice, including any intended permanent nail loss?", "kind": "action", "id": "care-option-rationale-q03" } ] } ] }, { "id": "longitudinal-response", "name": "Longitudinal response", "description": "Compare outcomes at the same nail across interventions and review dates.", "findings": [ { "id": "response-and-recurrence", "name": "Response and recurrence", "description": "Track symptom relief, plate regrowth and tissue recovery independently of whether a care episode has ended.", "questions": [ { "text": "How have plate dimensions, pain, function and surrounding tissue changed since the dated intervention?", "kind": "measurement", "id": "response-and-recurrence-q01" }, { "text": "Does the record show persistent deformity, new abnormal regrowth or insufficient observation to distinguish them?", "kind": "boundary", "id": "response-and-recurrence-q02" }, { "text": "Who will reassess the nail, when, and which changes should trigger earlier review?", "kind": "action", "id": "response-and-recurrence-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 source-verified research; confirm the applicable ICD revision and national coding modification.", "Congenital cases are rare; verify their classification and associations before treating them as a formal subtype system.", "No standardized diagnostic criteria, severity stages or population-specific prevalence estimates are asserted here; the condition is distinct from its diagnosis and any episode of treatment." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of onychogryphosis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Acquired onychogryphosis", "Congenital onychogryphosis, a rare form" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of onychogryphosis 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": "ICD-10", "value_or_pattern": "L60.2", "note": "World Health Organization classification code for onychogryphosis; national modifications and revision dates should be recorded when coding." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of onychogryphosis 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": [ "World Health Organization ICD-10 classifies onychogryphosis under nail disorders; this classification is not a diagnostic criteria set." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of onychogryphosis 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": [ "Clinical documentation of a characteristic nail deformity in dermatology, podiatry and geriatric care.", "Assessment of pain, footwear interference, walking difficulty and ability to perform nail care.", "Evaluation of contributing factors such as repeated trauma, footwear pressure, impaired circulation and difficulty maintaining nail care.", "Distinguishing structural nail deformity from fungal infection, which may coexist." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of onychogryphosis 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": "Nail plate thickness", "typical_range": "No universal diagnostic threshold recalled", "unit": "mm" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of onychogryphosis 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": [ "Pain and pressure injury from contact with footwear or adjacent toes.", "Difficulty wearing shoes or walking comfortably.", "Secondary skin breakdown and infection.", "Misidentification as fungal nail disease solely on the basis of thickening or discoloration.", "Injury during nail trimming, particularly when sensation or circulation is impaired." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of onychogryphosis 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": "Onychomycosis", "difference": "Onychomycosis is fungal infection of the nail, supported by mycological testing; onychogryphosis describes nail shape and growth and does not establish infection." }, { "name": "Onychauxis", "difference": "Onychauxis denotes nail thickening without necessarily having the marked elongation and horn-like curvature of onychogryphosis." }, { "name": "Pincer nail deformity", "difference": "Pincer nails have excessive transverse curvature that compresses the nail bed; onychogryphosis chiefly involves thickened, elongated, horn-like growth." }, { "name": "Onychocryptosis", "difference": "An ingrown nail involves penetration or impingement of a nail edge into the surrounding nail fold; horn-like nail overgrowth is not required." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of onychogryphosis this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Which current ICD-10, ICD-11 and SNOMED CT concepts map to this registry entry, with what editions, jurisdictions and mapping precision?", "Does an issuing body provide validated diagnostic criteria or severity stages, including reproducible boundaries for early onychogryphosis versus isolated nail thickening?", "What prevalence estimates are supported by primary studies with explicit population, setting, study year and case definition, and how transferable are they?", "What comparative evidence establishes care outcomes, recurrence and follow-up intervals across differing symptoms and clinical risk profiles?", "Does the registry intend human disease only or also veterinary claw abnormalities, and does an existing world model already own the intended concept?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 18, "questions": 33 } }