{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T10:44:42Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 20.5, "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: 01a09537-3d09-7962-a054-14d11bcc2868\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: keratomalacia\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 r", "usd": 0.0, "recall": true }, "codex": { "seconds": 62.8, "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: 01a09537-3d19-7210-875e-f4278413cb39\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: keratomalacia\nRegistry id: vr.tr.keratomalacia\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this entry: (none" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:53:58+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "standards_and_regulation", "visual_identification" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-09T07:30:02+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q379418", "registryId": "vr.tr.keratomalacia", "name": "keratomalacia", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q379418/", "model": { "registry_id": "vr.tr.keratomalacia", "name": "keratomalacia", "purpose": "Enable an agent to recognize suspected keratomalacia, record corneal destruction and its nutritional basis, and support urgent clinical escalation and follow-up.", "definition": "Keratomalacia is softening and necrotic breakdown of the cornea associated with severe vitamin A deficiency, representing advanced xerophthalmia and potentially causing perforation and irreversible blindness.", "scope_statement": "This model owns the recognition, evidence, eye-specific severity, progression, and management status of keratomalacia for vr.tr.keratomalacia in XCT / XCT.STA, using vitamin A deficiency-associated corneal softening and necrosis as its working clinical boundary.", "in_scope": [ "Corneal softening, stromal necrosis, and tissue loss attributable or provisionally attributable to vitamin A deficiency", "Separate assessment of each eye, including lesion extent, structural integrity, and visual function", "Evidence supporting nutritional attribution and competing explanations for corneal melting", "Relationships to other manifestations of xerophthalmia", "Urgent care status, treatment response, and residual ocular damage" ], "out_of_scope": [ "Vitamin A deficiency without keratomalacia as a complete systemic condition model", "The full xerophthalmia spectrum without corneal softening or necrosis", "Infectious, autoimmune, traumatic, or postoperative corneal melting as independent disease models", "Comprehensive models of malnutrition, malabsorption, and liver disease", "Population supplementation programmes and detailed surgical or medication protocols" ], "distinguishing_features": [ "Corneal softening or necrotic stromal loss distinguishes keratomalacia from ocular dryness alone.", "Night blindness, conjunctival xerosis, or Bitot spots may support vitamin A deficiency but do not individually establish keratomalacia.", "A corneal ulcer requires assessment of tissue destruction and nutritional attribution before it is classified as keratomalacia.", "Corneal melting alone does not establish a nutritional cause; infection and other causes require separate consideration.", "Residual corneal scarring records a consequence of prior disease and must be distinguished from active corneal destruction." ], "characteristics": [ { "name": "Diagnostic certainty", "kind": "state", "unit_or_values": "suspected | clinician-established | disputed | excluded", "why_it_matters": "Separates a working emergency diagnosis from a settled attribution." }, { "name": "Affected eye", "kind": "category", "unit_or_values": "right | left | bilateral | undocumented", "why_it_matters": "Each eye may have different damage and management needs." }, { "name": "Corneal tissue state", "kind": "state", "unit_or_values": "softening | stromal necrosis | tissue loss | healing | residual scar; multiple states may coexist", "why_it_matters": "Identifies the defining lesion and distinguishes activity from sequelae." }, { "name": "Corneal lesion extent", "kind": "measurement", "unit_or_values": "percentage of corneal surface affected, with examination method and timestamp", "why_it_matters": "Supports severity assessment and longitudinal comparison." }, { "name": "Residual corneal thickness", "kind": "measurement", "unit_or_values": "micrometres where safely measurable; otherwise qualitative estimate or unknown", "why_it_matters": "Records structural loss beyond surface area alone." }, { "name": "Globe integrity", "kind": "state", "unit_or_values": "intact | threatened perforation | perforated | uncertain", "why_it_matters": "Directly affects the urgency and nature of specialist care." }, { "name": "Visual function", "kind": "measurement", "unit_or_values": "per-eye acuity with notation, correction, test method, or age-appropriate assessment", "why_it_matters": "Tracks functional consequences independently of anatomical healing." }, { "name": "Vitamin A deficiency evidence", "kind": "relation", "unit_or_values": "links to dietary history, ocular signs, laboratory results, systemic conditions, and clinician interpretation", "why_it_matters": "Makes nutritional attribution inspectable without relying on an isolated finding." }, { "name": "Care escalation status", "kind": "state", "unit_or_values": "required | initiated | accepted | assessed | treatment underway | access blocked", "why_it_matters": "Distinguishes recognition of urgency from actual receipt of care." } ], "affordances": [ "Flag suspected active keratomalacia for emergency clinical assessment.", "Assemble evidence for vitamin A deficiency while preserving competing or coexisting causes.", "Compare timestamped corneal findings and visual function separately for each eye.", "Track clinician-directed vitamin replacement, ocular care, and barriers to treatment.", "Identify unresolved nutritional drivers and continuing risks after corneal healing." ], "agent_conduct": { "may": [ "Describe keratomalacia, its link to vitamin A deficiency and the need for urgent care.", "Point people to eye or child health services when they report symptoms." ], "must_not": [ "Diagnose keratomalacia in a person from a description or photo.", "Advise high-dose vitamin A dosing for a person without a clinician.", "Discourage a family from seeking urgent care for a child's eye problem.", "Share images of affected children without consent." ], "requires_human": [ "Any treatment decision for a person with suspected corneal damage." ] }, "ethics": { "considerations": [ "The condition is preventable; it mostly affects poor and malnourished children.", "Delay in care can lead to permanent blindness." ], "affected_parties": [ "Malnourished children", "Families in low-income settings", "Health workers" ] }, "owners": { "steward": "The treating clinician; public health authorities run prevention programmes.", "master_systems": [] }, "visual_identification": [ "A cloudy, softened cornea in a person with signs of malnutrition.", "Often preceded by dry eyes and night blindness." ], "failure_modes_and_hazards": [ "The cornea can perforate, causing irreversible blindness.", "Vitamin A deficiency also raises the risk of death from infections." ], "standards_and_regulation": [ "Guideline on vitamin A supplementation in infants and children, World Health Organization." ], "what_it_is_for": [ "Keratomalacia is encountered in clinical and public health settings concerned with severe vitamin A deficiency and associated corneal damage.", "It is relevant to ophthalmic assessment, nutritional evaluation and documentation of preventable visual impairment.", "The term distinguishes destructive corneal disease within the broader spectrum of eye changes associated with vitamin A deficiency." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q379418: keratomalacia", "url": "https://www.wikidata.org/wiki/Q379418", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Keratomalacia", "url": "https://en.wikipedia.org/wiki/Keratomalacia", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "recognition-and-diagnostic-boundary", "name": "Recognition and diagnostic boundary", "description": "Establish whether an observed corneal lesion belongs to this registered condition.", "rationale": "Dryness, ulceration, and corneal melting are related observations with different diagnostic implications.", "layers": [ { "id": "defining-corneal-lesion", "name": "Defining corneal lesion", "description": "Record the tissue changes that justify considering keratomalacia.", "findings": [ { "id": "softening-and-necrosis", "name": "Softening and necrosis", "description": "The working definition requires destructive corneal involvement within vitamin A deficiency-associated ocular disease. WHO places corneal necrosis, termed keratomalacia, at the severe end of xerophthalmia. [WHO](https://www.who.int/data/nutrition/nlis/info/vitamin-a-deficiency)", "questions": [ { "text": "What observed softening, necrosis, or stromal loss supports keratomalacia in each eye?", "kind": "definition", "id": "softening-and-necrosis-q01" }, { "text": "Who documented the lesion, when, and by what examination method?", "kind": "provenance", "id": "softening-and-necrosis-q02" } ] } ] }, { "id": "adjacent-and-competing-diagnoses", "name": "Adjacent and competing diagnoses", "description": "Separate the defining lesion from supporting signs and alternative causes.", "findings": [ { "id": "nutritional-versus-other-corneal-melt", "name": "Nutritional versus other corneal melt", "description": "Record whether nutritional attribution is established, provisional, or challenged, and distinguish supporting xerophthalmic signs from the destructive lesion itself.", "questions": [ { "text": "Does the record show active corneal destruction, earlier xerophthalmia alone, or only a healed scar?", "kind": "boundary", "id": "nutritional-versus-other-corneal-melt-q01" }, { "text": "Which findings support infection, autoimmune disease, exposure, or injury as an alternative or additional cause?", "kind": "boundary", "id": "nutritional-versus-other-corneal-melt-q02" } ] } ] } ] }, { "id": "nutritional-attribution-and-drivers", "name": "Nutritional attribution and drivers", "description": "Connect the corneal disease to evidence of vitamin A deficiency and its underlying causes.", "rationale": "Recognizing the corneal lesion alone does not explain why deficiency developed or whether it will persist.", "layers": [ { "id": "deficiency-evidence", "name": "Deficiency evidence", "description": "Preserve the evidence and interpretation supporting vitamin A deficiency.", "findings": [ { "id": "converging-deficiency-evidence", "name": "Converging deficiency evidence", "description": "Record clinical, dietary, and laboratory evidence together, including sampling time and interpretive limitations, without making laboratory confirmation a prerequisite for recording clinical suspicion.", "questions": [ { "text": "Which dietary history, ocular signs, and laboratory findings support vitamin A deficiency?", "kind": "provenance", "id": "converging-deficiency-evidence-q01" }, { "text": "If serum retinol was measured, what were its value, units, sampling time relative to treatment, and relevant inflammatory context?", "kind": "measurement", "id": "converging-deficiency-evidence-q02" } ] } ] }, { "id": "deficiency-mechanism", "name": "Deficiency mechanism", "description": "Identify conditions that explain or sustain inadequate vitamin A availability.", "findings": [ { "id": "intake-absorption-and-systemic-context", "name": "Intake, absorption, and systemic context", "description": "Vitamin A deficiency may reflect inadequate intake or impaired absorption, storage, or transport; the model links these drivers to their own clinical records. [MSD Manual](https://www.msdmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-a-deficiency?ruleredirectid=742)", "questions": [ { "text": "What evidence identifies restricted intake, malabsorption, or impaired storage or transport in this episode?", "kind": "provenance", "id": "intake-absorption-and-systemic-context-q01" }, { "text": "Which suspected drivers need clinical investigation or continuing nutritional support?", "kind": "action", "id": "intake-absorption-and-systemic-context-q02" } ] } ] } ] }, { "id": "corneal-severity-and-progression", "name": "Corneal severity and progression", "description": "Describe eye-specific anatomical damage, its trajectory, and functional consequences.", "rationale": "Surface extent, depth of tissue loss, perforation, and vision represent different aspects of severity.", "layers": [ { "id": "anatomical-integrity", "name": "Anatomical integrity", "description": "Capture where tissue is lost and whether the globe remains structurally intact.", "findings": [ { "id": "extent-depth-and-perforation", "name": "Extent, depth, and perforation", "description": "Record lesion location, affected surface area, thinning, and perforation status separately for each eye, retaining uncertainty when examination cannot safely establish a measurement.", "questions": [ { "text": "What proportion and region of each cornea are affected, and how much stromal tissue remains?", "kind": "measurement", "id": "extent-depth-and-perforation-q01" }, { "text": "What examination evidence establishes intact cornea, threatened perforation, or actual perforation?", "kind": "measurement", "id": "extent-depth-and-perforation-q02" } ] } ] }, { "id": "temporal-and-visual-course", "name": "Temporal and visual course", "description": "Track active destruction, stabilization, healing, and visual consequences over time.", "findings": [ { "id": "anatomical-and-functional-trajectory", "name": "Anatomical and functional trajectory", "description": "Compare dated examinations using compatible methods and distinguish anatomical closure from recovery of visual function.", "questions": [ { "text": "Between examinations, has tissue loss progressed, stabilized, or begun to heal in each eye?", "kind": "measurement", "id": "anatomical-and-functional-trajectory-q01" }, { "text": "How has per-eye visual function changed, and which assessment limitations affect that comparison?", "kind": "measurement", "id": "anatomical-and-functional-trajectory-q02" } ] } ] } ] }, { "id": "urgent-care-and-lasting-outcomes", "name": "Urgent care and lasting outcomes", "description": "Connect recognition to emergency care and track the consequences after active disease subsides.", "rationale": "The model must show whether urgent care occurred and whether structural, visual, or nutritional problems remain.", "layers": [ { "id": "emergency-care-coordination", "name": "Emergency care coordination", "description": "Record escalation, specialist assessment, and clinician-directed treatment.", "findings": [ { "id": "urgent-assessment-and-treatment-status", "name": "Urgent assessment and treatment status", "description": "Keratomalacia requires emergency treatment because corneal destruction can progress rapidly. Track vitamin A replacement and ocular management as clinician-directed interventions. [AAO EyeWiki](https://eyewiki.aao.org/Xerophthalmia)", "questions": [ { "text": "When was emergency assessment requested and received, and what barriers remain?", "kind": "action", "id": "urgent-assessment-and-treatment-status-q01" }, { "text": "What vitamin replacement and ocular interventions were prescribed and actually delivered, under whose supervision?", "kind": "provenance", "id": "urgent-assessment-and-treatment-status-q02" } ] } ] }, { "id": "sequelae-and-recurrence", "name": "Sequelae and recurrence", "description": "Preserve residual damage and unresolved causes after the destructive episode.", "findings": [ { "id": "healing-with-residual-risk", "name": "Healing with residual risk", "description": "Record residual scarring, visual impairment, and structural consequences separately from active keratomalacia, while retaining links to unresolved deficiency drivers.", "questions": [ { "text": "Which findings show that active destruction has ceased, and what anatomical or visual deficits remain?", "kind": "boundary", "id": "healing-with-residual-risk-q01" }, { "text": "What follow-up addresses visual rehabilitation and persistent risk of vitamin A deficiency?", "kind": "action", "id": "healing-with-residual-risk-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; no sources were consulted.", "WHO X3A and X3B classify corneal ulceration together with keratomalacia rather than defining separate pathological subtypes.", "Check the applicable ICD edition and national modification before using the code operationally." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of keratomalacia 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": [ "Corneal ulceration or keratomalacia involving less than one-third of the corneal surface (WHO category X3A)", "Corneal ulceration or keratomalacia involving at least one-third of the corneal surface (WHO category X3B)" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of keratomalacia 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": "E50.4", "note": "Vitamin A deficiency with keratomalacia." }, { "scheme": "WHO xerophthalmia classification", "value_or_pattern": "X3A or X3B", "note": "These categories include corneal ulceration and keratomalacia, distinguished by the proportion of cornea involved." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of keratomalacia 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 clinical classification of xerophthalmia." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of keratomalacia 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 recognition of severe vitamin A deficiency requiring urgent ophthalmic and nutritional management.", "Assessment of nutritional blindness and vitamin A deficiency in public health programmes." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of keratomalacia 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": "Proportion of corneal surface affected", "typical_range": "Classification thresholds, not a typical range: X3A is less than one-third; X3B is one-third or more.", "unit": "fraction of corneal surface" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of keratomalacia 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": [ "Rapid corneal tissue destruction and perforation.", "Permanent corneal scarring and irreversible loss of vision.", "Secondary ocular infection.", "Underlying severe malnutrition or malabsorption may remain unrecognised." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of keratomalacia 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": [ "Associated particularly with settings where childhood undernutrition and vitamin A deficiency are prevalent.", "Can occur in any region in people with severe dietary restriction or disorders causing fat malabsorption." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of keratomalacia 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": "Xerophthalmia", "difference": "Xerophthalmia encompasses the ocular manifestations of vitamin A deficiency; keratomalacia specifically denotes destructive corneal softening and necrosis." }, { "name": "Corneal xerosis", "difference": "Corneal xerosis denotes corneal surface dryness, without necessarily having the stromal destruction characteristic of keratomalacia." }, { "name": "Infectious keratitis", "difference": "Infectious keratitis is driven by microbial infection; keratomalacia is associated with severe vitamin A deficiency, although secondary infection can coexist." }, { "name": "Corneal melt", "difference": "Corneal melt describes destructive stromal breakdown from multiple causes, including autoimmune disease and infection; nutritional keratomalacia is a more specific clinical condition." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of keratomalacia this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Does the registry intend the conventional vitamin A deficiency-associated condition exclusively, or also historical uses of keratomalacia for corneal softening of other causes?", "Which clinical classification and version should govern lesion extent categories, including the handling of boundary values and unmeasurable lesions?", "What minimum evidence should distinguish suspected from clinician-established nutritional attribution when laboratory results are unavailable or difficult to interpret?", "How should combined nutritional and infectious corneal destruction be represented without assigning an unsupported single cause?", "What evidence and observation interval should define episode resolution while preserving ongoing visual disability and recurrence risk?" ], "statistics": { "bundles": 5, "layers": 9, "findings": 17, "questions": 25 } }