{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T11:47:45Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 21.7, "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: 01a09570-bdff-7b83-897e-c26042e0ca6b\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: organic brain 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 04", "usd": 0.0, "recall": true }, "codex": { "seconds": 76.4, "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: 01a09570-be0c-71a3-805c-fb2c32c07641\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: organic brain syndrome\nRegistry id: vr.tr.organic-brain-syndrome\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T11:00:00Z", "ingestedAt": "2026-10-06T08:00:52+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:30+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q360341", "registryId": "vr.tr.organic-brain-syndrome", "name": "organic brain syndrome", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q360341/", "model": { "registry_id": "vr.tr.organic-brain-syndrome", "name": "organic brain syndrome", "purpose": "Enable an agent to interpret an organic brain syndrome label, record the associated mental dysfunction and causal evidence, and identify what requires clinical clarification before acting.", "definition": "Organic brain syndrome is a historical umbrella term for disturbances of cognition, consciousness, behaviour or emotion attributed to brain dysfunction from disease, injury or physiological disturbance, rather than a single disease with uniform diagnostic criteria.", "scope_statement": "This model owns the syndrome-level interpretation of vr.tr.organic-brain-syndrome within XCT / XCT.STA, preserving the original terminology while linking supported contemporary diagnoses. MedlinePlus lists organic brain syndrome as an alternative name for neurocognitive disorder; this provides orientation rather than a universal diagnostic equivalence. [MedlinePlus](https://medlineplus.gov/ency/article/001401.htm)", "in_scope": [ "Meaning and provenance of an organic brain syndrome label in its original clinical context", "Cognitive, attentional, behavioral and functional changes relative to the person's baseline", "Evidence attributing the syndrome to brain dysfunction and an underlying medical condition or exposure", "Onset, fluctuation, persistence and documented recovery or progression", "Versioned diagnostic mappings, unresolved alternatives and syndrome-specific action constraints" ], "out_of_scope": [ "The patient as a person and their complete longitudinal health record", "The underlying neurological or systemic disease as an independently modeled condition", "The anatomy of the brain or the physical lesion itself", "The clinical encounter, admission or episode of care", "Detailed treatment protocols and medication prescribing", "Independent models of delirium, dementia or other neighboring syndromes already represented in the catalogue" ], "distinguishing_features": [ "Require the source's intended meaning: the label alone does not establish a specific cause, severity or contemporary diagnosis.", "Separate an observed syndrome of mental dysfunction from a brain lesion or medical disease without documented mental effects.", "Check change from prior functioning instead of equating lifelong cognitive differences or an isolated low test score with this syndrome.", "Distinguish acute, fluctuating changes from persistent impairment and record possible superimposition rather than treating these patterns as interchangeable.", "Require evidence for causal attribution; the word organic alone must not exclude psychiatric contributors or establish a structural lesion." ], "characteristics": [ { "name": "Original label and intended meaning", "kind": "category", "unit_or_values": "Verbatim term; source-defined meaning; ambiguous or unspecified", "why_it_matters": "Preserves what the author actually asserted before translating older terminology." }, { "name": "Diagnostic assertion status", "kind": "state", "unit_or_values": "Historical record only; suspected; clinician-established; disputed; superseded", "why_it_matters": "Prevents a copied label from becoming an independently confirmed diagnosis." }, { "name": "Onset relative to baseline", "kind": "measurement", "unit_or_values": "Date or estimated interval in hours, days, months or years; uncertainty recorded", "why_it_matters": "Supports interpretation of new dysfunction and its temporal relationship to possible causes." }, { "name": "Affected mental domains", "kind": "category", "unit_or_values": "Attention; awareness; memory; executive function; language; perceptual-motor function; behavior; other documented domain", "why_it_matters": "Makes the syndrome recognizable beyond the nonspecific umbrella label." }, { "name": "Assessment result", "kind": "measurement", "unit_or_values": "Instrument-specific score with instrument, version, date, reference population and testing conditions", "why_it_matters": "Allows qualified comparison without inventing a universal organic brain syndrome score." }, { "name": "Temporal course", "kind": "state", "unit_or_values": "Fluctuating; improving; stable; progressive; episodic; unresolved", "why_it_matters": "Separates observed trajectory from assumptions about permanence." }, { "name": "Functional effect", "kind": "category", "unit_or_values": "Affected daily task; prior ability; current assistance required; contribution of noncognitive limitations", "why_it_matters": "Records practical consequences without inferring global incapacity." }, { "name": "Attributed cause", "kind": "relation", "unit_or_values": "Linked condition, injury, medication or exposure with supporting evidence and attribution confidence", "why_it_matters": "Separates syndrome recognition from explanation of its cause." }, { "name": "Classification mapping", "kind": "relation", "unit_or_values": "Target concept and code; issuing body; system edition or release; jurisdiction; mapping relationship", "why_it_matters": "Prevents unsupported one-to-one conversion into ICD or SNOMED CT." } ], "affordances": [ "Extract the original label and distinguish historical documentation from an active diagnostic assertion.", "Organize baseline, observations and assessment results into a time-linked syndrome profile.", "Compare proposed causes with supporting, contradictory and missing evidence.", "Suggest candidate contemporary concepts for clinician review while preserving mapping uncertainty.", "Flag documented acute changes for review under an applicable clinical escalation pathway.", "Track reassessment and link to a more specific existing model when the syndrome is clarified." ], "agent_conduct": { "may": [ "Explain the historical meaning of the term and how current classifications replace it.", "Direct people with confusion or memory changes to medical care." ], "must_not": [ "Diagnose a person or label their behaviour with this term.", "Use the term to dismiss a person's capacity or decisions without assessment.", "Present the historical label as a current diagnosis.", "Share a person's cognitive condition without consent." ], "requires_human": [ "Any judgement about a person's mental capacity.", "Treatment decisions for acute confusion." ] }, "ethics": { "considerations": [ "Older and ill people with cognitive changes risk losing a say over their own lives.", "Sudden confusion can signal a treatable emergency that labelling may hide." ], "affected_parties": [ "People with cognitive impairment", "Families and carers", "Older people" ] }, "owners": { "steward": "The treating clinician; health records belong to the patient's health service.", "master_systems": [] }, "failure_modes_and_hazards": [ "Missed treatable causes such as infection or poisoning.", "Falls and wandering during acute confusion." ], "what_it_is_for": [ "This historical label appears in older clinical records and administrative documents describing mental dysfunction attributed to brain disease, injury or physiological disturbance.", "Interpreting the label requires clarification of the actual symptoms, time course and evidence for an underlying cause because it does not identify a single disorder." ], "standards_and_regulation": [ "The World Health Organization's ICD-10 includes the F00-F09 category of organic, including symptomatic, mental disorders, although this historical umbrella label alone does not establish a specific code." ], "facets_not_applicable": { "recognition": "This clinical umbrella concept has no distinctive visible appearance, and observed behaviour alone cannot establish its cause." } }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q360341: organic brain syndrome", "url": "https://www.wikidata.org/wiki/Q360341", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Organic brain syndrome", "url": "https://en.wikipedia.org/wiki/Organic_brain_syndrome", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "label-meaning-and-classification", "name": "Label meaning and classification", "description": "Establish what organic brain syndrome means in the particular record before assigning a modern interpretation.", "rationale": "The broad label cannot by itself supply diagnostic criteria, severity or a unique classification code.", "layers": [ { "id": "original-clinical-usage", "name": "Original clinical usage", "description": "Preserve the wording, author and context of the syndrome assertion.", "findings": [ { "id": "intended-syndrome-meaning", "name": "Intended syndrome meaning", "description": "Determine whether the term denotes a specified syndrome, a provisional explanation or an unexplained historical label.", "questions": [ { "text": "What did the originating clinician or source mean by organic brain syndrome in this record?", "kind": "definition", "id": "intended-syndrome-meaning-q01" }, { "text": "Who applied the label, when, and was it subsequently copied without reassessment?", "kind": "provenance", "id": "intended-syndrome-meaning-q02" } ] } ] }, { "id": "versioned-concept-mapping", "name": "Versioned concept mapping", "description": "Evaluate contemporary classification candidates without assuming equivalence.", "findings": [ { "id": "supported-diagnostic-crosswalk", "name": "Supported diagnostic crosswalk", "description": "Retain the issuing authority, release and evidence supporting any proposed replacement concept.", "questions": [ { "text": "Which ICD-10 variant, ICD-11 release or SNOMED CT edition contains a candidate concept, and what is the mapping relationship?", "kind": "provenance", "id": "supported-diagnostic-crosswalk-q01" }, { "text": "Which criteria and issuing body support the candidate diagnosis, and which required elements remain undocumented?", "kind": "definition", "id": "supported-diagnostic-crosswalk-q02" }, { "text": "Does an existing Vercy model own the clarified concept, requiring a link instead of a duplicate publication?", "kind": "boundary", "id": "supported-diagnostic-crosswalk-q03" } ] } ] } ] }, { "id": "mental-change-and-functional-expression", "name": "Mental change and functional expression", "description": "Describe the actual dysfunction behind the organic brain syndrome label.", "rationale": "Recognition requires evidence of mental change and its consequences rather than reliance on terminology alone.", "layers": [ { "id": "baseline-and-domain-profile", "name": "Baseline and domain profile", "description": "Relate current observations to prior functioning across relevant mental domains.", "findings": [ { "id": "documented-mental-change", "name": "Documented mental change", "description": "Separate reported change, directly observed impairment and uncertainty about baseline.", "questions": [ { "text": "Which changes in attention, awareness, memory, reasoning, language or behavior are documented relative to baseline?", "kind": "measurement", "id": "documented-mental-change-q01" }, { "text": "Which observations come from the person, an informant, examination or testing, and where do they disagree?", "kind": "provenance", "id": "documented-mental-change-q02" } ] } ] }, { "id": "assessment-and-daily-function", "name": "Assessment and daily function", "description": "Interpret assessment findings alongside concrete daily abilities.", "findings": [ { "id": "interpretable-impairment-evidence", "name": "Interpretable impairment evidence", "description": "Record measurement conditions and avoid attributing every functional limitation to cognition.", "questions": [ { "text": "Which instruments and versions were used, and how did language, education, sensory limitations or testing conditions affect interpretation?", "kind": "measurement", "id": "interpretable-impairment-evidence-q01" }, { "text": "Which daily activities now require assistance because of mental dysfunction rather than physical limitations or environmental barriers?", "kind": "boundary", "id": "interpretable-impairment-evidence-q02" } ] } ] } ] }, { "id": "onset-course-and-superimposition", "name": "Onset, course and superimposition", "description": "Represent when dysfunction appeared and how successive states relate.", "rationale": "An umbrella label must not collapse a new episode, longstanding impairment and their coexistence into one undifferentiated state.", "layers": [ { "id": "onset-and-fluctuation", "name": "Onset and fluctuation", "description": "Establish the timing and variability of the presenting change.", "findings": [ { "id": "temporal-syndrome-pattern", "name": "Temporal syndrome pattern", "description": "Build an evidence-linked timeline without assigning a subtype from timing alone.", "questions": [ { "text": "When was the person last at their usual baseline, and how certain is the onset estimate?", "kind": "measurement", "id": "temporal-syndrome-pattern-q01" }, { "text": "What repeated observations establish fluctuation, persistence or discrete episodes?", "kind": "measurement", "id": "temporal-syndrome-pattern-q02" } ] } ] }, { "id": "longitudinal-state-and-overlap", "name": "Longitudinal state and overlap", "description": "Distinguish continuing impairment from additional acute changes and subsequent outcomes.", "findings": [ { "id": "episode-on-background-impairment", "name": "Episode on background impairment", "description": "Preserve the distinction between the underlying syndrome trajectory and superimposed changes.", "questions": [ { "text": "Is the current change a new episode on pre-existing cognitive impairment, and what evidence separates the two?", "kind": "boundary", "id": "episode-on-background-impairment-q01" }, { "text": "What follow-up demonstrates recovery, residual impairment, stability or progression, and over what interval?", "kind": "measurement", "id": "episode-on-background-impairment-q02" } ] } ] } ] }, { "id": "causal-attribution-and-alternatives", "name": "Causal attribution and alternatives", "description": "Evaluate the evidence behind the organic attribution and competing explanations.", "rationale": "The syndrome label and the underlying cause are separate assertions that require separate support.", "layers": [ { "id": "medical-and-exposure-attribution", "name": "Medical and exposure attribution", "description": "Connect candidate causes to the observed dysfunction and its timeline.", "findings": [ { "id": "supported-causal-contributors", "name": "Supported causal contributors", "description": "Record each proposed contributor with evidence, contradictions and unresolved attribution.", "questions": [ { "text": "Which medical conditions, injuries, medications or exposures are proposed contributors, and what supports each causal link?", "kind": "provenance", "id": "supported-causal-contributors-q01" }, { "text": "Does the timeline support each attribution, or is the candidate merely a coexisting condition?", "kind": "boundary", "id": "supported-causal-contributors-q02" }, { "text": "Which examination, laboratory, imaging or other findings support or challenge the proposed explanation?", "kind": "measurement", "id": "supported-causal-contributors-q03" } ] } ] }, { "id": "differential-and-coexisting-states", "name": "Differential and coexisting states", "description": "Keep alternative and concurrent explanations visible.", "findings": [ { "id": "unresolved-explanatory-boundaries", "name": "Unresolved explanatory boundaries", "description": "Avoid treating organic and psychiatric explanations as mutually exclusive categories.", "questions": [ { "text": "Which alternative or coexisting psychiatric, developmental, sleep-related or substance-related explanations remain under consideration?", "kind": "boundary", "id": "unresolved-explanatory-boundaries-q01" }, { "text": "What additional evidence would distinguish these explanations without assuming that the label proves a structural brain lesion?", "kind": "action", "id": "unresolved-explanatory-boundaries-q02" } ] } ] } ] }, { "id": "clinical-review-and-reassessment", "name": "Clinical review and reassessment", "description": "Connect the syndrome description to justified review, support and updating.", "rationale": "An agent needs action boundaries that reflect current observations and diagnostic uncertainty.", "layers": [ { "id": "acute-change-review", "name": "Acute change review", "description": "Identify whether a current change requires escalation through an applicable clinical pathway.", "findings": [ { "id": "review-trigger-and-responsibility", "name": "Review trigger and responsibility", "description": "Attach escalation decisions to observed changes and an identified clinical authority.", "questions": [ { "text": "Do documented new confusion, altered awareness or other acute changes meet the applicable pathway's escalation criteria?", "kind": "action", "id": "review-trigger-and-responsibility-q01" }, { "text": "Which clinician or service should review the change, and which observations and timeline must accompany the handoff?", "kind": "action", "id": "review-trigger-and-responsibility-q02" } ] } ] }, { "id": "support-and-label-revision", "name": "Support and label revision", "description": "Track practical support needs and the evidence required to update the syndrome interpretation.", "findings": [ { "id": "bounded-support-and-follow-up", "name": "Bounded support and follow-up", "description": "Tie assistance to demonstrated limitations and preserve the history when a diagnosis changes.", "questions": [ { "text": "Which observed limitations justify communication or daily-task support without assuming global decision-making incapacity?", "kind": "action", "id": "bounded-support-and-follow-up-q01" }, { "text": "What reassessment and responsible reviewer will determine whether to retain, qualify or replace the organic brain syndrome label?", "kind": "action", "id": "bounded-support-and-follow-up-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, without consulted sources; the term has varied historically and does not define a uniform modern diagnosis.", "Acute and chronic are historical distinctions, not a complete or current diagnostic taxonomy.", "Verify any code against the original clinical documentation and the jurisdiction's classification revision; prevalence and measurement ranges cannot be assigned reliably to this umbrella term." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of organic brain syndrome 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": [ "Acute organic brain syndrome, commonly associated with delirium", "Chronic organic brain syndrome, commonly associated with persistent cognitive impairment or dementia" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of organic brain 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": "ICD-10", "value_or_pattern": "F00-F09", "note": "The WHO category group for organic, including symptomatic, mental disorders covers related conditions; it is not a single equivalent code for this historical umbrella term." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of organic brain 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": [ "WHO International Classification of Diseases, ICD-10 and ICD-11: classification requires identifying the specific syndrome and using the applicable revision.", "American Psychiatric Association DSM-5-TR: related presentations are classified under specific diagnoses, including delirium and major or mild neurocognitive disorder." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of organic brain 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": [ "Interpreting historical medical records and older diagnostic terminology.", "Describing mental changes associated with conditions such as brain injury, neurodegeneration, infection, toxic exposure or metabolic disturbance.", "Providing a broad descriptive label pending clarification of the clinical syndrome and its cause." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of organic brain 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": [ "Treating the label as a specific diagnosis can conceal a reversible or urgent cause of altered mental function.", "Confusing acute delirium with chronic cognitive impairment can delay recognition of an acute illness.", "Assuming that organic means permanent or that structural brain damage must be visible on imaging.", "Using an organic-versus-functional distinction as if psychiatric disorders lacked biological mechanisms.", "Mapping the term directly to a modern diagnostic code without checking the documented presentation and coding revision." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of organic brain 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": [ "Terminology and coding depend on jurisdiction, classification revision and national modifications of ICD." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of organic brain 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": "Delirium", "difference": "An acute, fluctuating disturbance of attention and awareness distinguishes delirium from the broader historical umbrella." }, { "name": "Dementia", "difference": "Dementia describes acquired cognitive decline that interferes with independent functioning; organic brain syndrome also includes acute and potentially reversible disturbances." }, { "name": "Encephalopathy", "difference": "Encephalopathy denotes brain dysfunction in neurological or medical terms; organic brain syndrome historically emphasises its cognitive, behavioural or psychiatric manifestations, with substantial overlap." }, { "name": "Traumatic brain injury", "difference": "Traumatic brain injury identifies an injury mechanism and condition; organic brain syndrome describes possible mental manifestations arising from that or other causes." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of organic brain syndrome this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "What source supplied this registry entry, and did it intend a broad historical umbrella or a narrower syndrome definition?", "Which authoritative ICD-10, ICD-11 and SNOMED CT mappings are valid for that intended meaning, with which editions and jurisdictions?", "What criteria and issuing authorities support any proposed equivalence with delirium, neurocognitive disorder, encephalopathy or an organic mental disorder category?", "Which prevalence estimates use an explicit definition of organic brain syndrome and specify population, setting, ascertainment method and year?", "Does an existing Vercy world model already cover the intended concept, and should this entry resolve to that publication?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 18, "questions": 30 } }