{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T10:32:51Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 19.3, "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: 01a0952b-fbe5-79a1-aea9-1d36dbe8fcfc\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: intestinal atresia\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: 1", "usd": 0.0, "recall": true }, "codex": { "seconds": 89.0, "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: 01a0952b-fbeb-7400-802a-2c7f30f637d7\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: intestinal atresia\nRegistry id: vr.tr.intestinal-atresia\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this en" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:11:55+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "visual_identification" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:31+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q4597494", "registryId": "vr.tr.intestinal-atresia", "name": "intestinal atresia", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q4597494/", "model": { "registry_id": "vr.tr.intestinal-atresia", "name": "intestinal atresia", "purpose": "Enable an agent to recognize suspected intestinal atresia, record its anatomical and functional consequences, and support clinician-directed evaluation, repair planning, and follow-up.", "definition": "Intestinal atresia is a congenital absence or complete occlusion of a segment of the intestinal lumen, causing mechanical obstruction at the affected site.", "scope_statement": "This model owns vr.tr.intestinal-atresia in XCT / XCT.STA as a congenital condition involving complete interruption of intestinal luminal continuity, provisionally covering duodenal, jejunal, ileal, and colonic sites within one registry concept; it tracks suspected, confirmed, and repaired states without treating repair as erasure of the congenital diagnosis.", "in_scope": [ "Location, number, and morphology of congenital intestinal occlusions", "Evidence supporting or challenging an atresia diagnosis", "Obstruction manifestations and physiological consequences attributable to the lesion", "Associated anomalies and etiological hypotheses linked to the affected individual", "Repair status, retained bowel anatomy, and subsequent intestinal function" ], "out_of_scope": [ "Intestinal stenosis with a residual patent lumen", "Acquired intestinal strictures and postoperative adhesions as independent conditions", "Malrotation, volvulus, meconium ileus, and Hirschsprung disease as independent causes of obstruction", "Esophageal, pyloric, biliary, and anorectal malformations as separately governed concepts, pending registry boundary verification", "General surgical technique, neonatal resuscitation protocols, and individualized medication prescribing", "Short bowel syndrome and intestinal failure as independent diagnoses, linked when present" ], "distinguishing_features": [ "Require evidence of congenital complete luminal closure or discontinuity; partial narrowing alone supports stenosis. [CHOP: Small Bowel Atresia](https://www.chop.edu/conditions-diseases/small-bowel-atresia)", "Identify an intrinsic anatomical interruption rather than equating any complete intestinal obstruction with atresia.", "Distinguish congenital interruption from a segment that became obstructed after inflammation, injury, or surgery.", "Treat prenatal bowel dilation, vomiting, and radiographic obstruction patterns as supporting observations rather than stand-alone proof of the precise lesion.", "Distinguish repaired intestinal atresia from currently obstructed bowel by retaining both the original diagnosis and present continuity state." ], "characteristics": [ { "name": "Diagnostic certainty", "kind": "state", "unit_or_values": "suspected | confirmed | excluded | unresolved, with date and supporting evidence", "why_it_matters": "Prevents a prenatal suspicion or nonspecific obstruction pattern from becoming an unsupported definitive diagnosis." }, { "name": "Affected intestinal segments", "kind": "category", "unit_or_values": "duodenum | jejunum | ileum | colon | multiple regions | undetermined", "why_it_matters": "Makes anatomical differences explicit within the single registered condition." }, { "name": "Atretic lesion count", "kind": "measurement", "unit_or_values": "integer lesions, with examined extent and unknown permitted", "why_it_matters": "Separates a documented solitary lesion from incomplete assessment for additional interruptions." }, { "name": "Lesion morphology", "kind": "category", "unit_or_values": "occluding membrane | cord-connected blind ends | separated blind ends | other described morphology | unknown; named classification recorded separately", "why_it_matters": "Preserves the observed anatomy without applying one regional classification indiscriminately." }, { "name": "Mesenteric and vascular anatomy", "kind": "category", "unit_or_values": "documented mesenteric continuity, defects, vascular arrangement, and bowel viability | unassessed", "why_it_matters": "Provides anatomical context for a clinician's assessment of reconstructive options." }, { "name": "Evidence provenance", "kind": "relation", "unit_or_values": "links to dated prenatal imaging, postnatal imaging, operative observations, pathology, and interpreting clinician", "why_it_matters": "Allows every diagnostic and anatomical assertion to be checked against its evidence." }, { "name": "Bowel continuity state", "kind": "state", "unit_or_values": "unrepaired interruption | reconstructed continuity | temporary diversion | recurrent obstruction suspected | unknown", "why_it_matters": "Distinguishes the congenital lesion from the current configuration of the intestine." }, { "name": "Retained bowel configuration", "kind": "measurement", "unit_or_values": "small-bowel length in cm with measurement method and date; retained segments, ileocecal valve, and colon continuity recorded alongside", "why_it_matters": "Makes postoperative anatomy available for interpretation of nutritional progress." }, { "name": "Nutrition dependence", "kind": "state", "unit_or_values": "parenteral | mixed parenteral and enteral | fully enteral; oral or tube route and assessment date", "why_it_matters": "Tracks functional recovery beyond anatomical repair." }, { "name": "Associated conditions", "kind": "relation", "unit_or_values": "links to confirmed or suspected congenital, chromosomal, genetic, and intestinal conditions, each with evidence status", "why_it_matters": "Records coexistence without automatically asserting causation." } ], "affordances": [ "Assemble an evidence-linked account of suspected or confirmed atresia and expose contradictory observations.", "Produce a lesion map showing affected segments, assessed bowel extent, and unresolved anatomical questions.", "Flag suspected neonatal intestinal obstruction for urgent clinician review through the applicable care pathway.", "Prepare a clinician-reviewable summary of anatomy, physiological status, and associated conditions relevant to repair.", "Track reconstructed continuity, nutritional dependence, growth, and possible postoperative complications.", "Link regional subtypes and sequelae to existing catalogue models while preserving one source of truth for this registry entry." ], "agent_conduct": { "may": [ "Explain intestinal atresia, its types and usual treatment from medical sources.", "Help families find specialist paediatric surgical and support services." ], "must_not": [ "Diagnose or rule out intestinal atresia in a baby instead of a clinician.", "Advise delaying care for a newborn with vomiting, especially green vomit, or a swollen abdomen.", "Disclose a child's diagnosis or genetic findings without the family's consent.", "Give feeding or treatment instructions that contradict the care team." ], "requires_human": [ "Any decision on surgery, feeding or palliative care for an affected baby." ] }, "ethics": { "considerations": [ "Newborns cannot speak for themselves; delays in recognising obstruction can be fatal.", "Families face stressful decisions and deserve clear, honest information." ], "affected_parties": [ "Affected babies", "Parents and families" ] }, "owners": { "steward": "Parents decide for the child with the clinical team, which answers for diagnosis and treatment.", "master_systems": [ "Congenital anomaly registries" ] }, "visual_identification": [ "Not settled by sight: diagnosis needs imaging and clinical assessment.", "Signs in a newborn may include bile-stained vomiting and a swollen abdomen." ], "failure_modes_and_hazards": [ "Bowel perforation or death when obstruction is not treated in time.", "Short bowel and feeding problems after surgery." ], "what_it_is_for": [ "Intestinal atresia is encountered in prenatal assessment, newborn care, and pediatric surgery as a congenital cause of intestinal obstruction.", "Its anatomical description supports specialist evaluation, surgical planning, and follow-up of feeding, growth, and intestinal function." ], "standards_and_regulation": [ "The International Classification of Diseases, Tenth Revision, issued by the World Health Organization, classifies congenital absence, atresia, and stenosis of the small intestine under Q41 and of the large intestine under Q42." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q4597494: intestinal atresia", "url": "https://www.wikidata.org/wiki/Q4597494", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Intestinal atresia", "url": "https://en.wikipedia.org/wiki/Intestinal_atresia", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "atresia-identity-and-boundaries", "name": "Atresia identity and boundaries", "description": "Establish what qualifies as this congenital condition and how anatomical variants remain within the registered concept.", "rationale": "Obstruction, stenosis, and atresia are not interchangeable, and clinical sources vary in the breadth of the term.", "layers": [ { "id": "complete-congenital-interruption", "name": "Complete congenital interruption", "description": "Separate the defining anatomical defect from symptoms and working diagnoses.", "findings": [ { "id": "atresia-versus-stenosis", "name": "Atresia versus stenosis", "description": "Complete closure or absent continuity distinguishes atresia from a narrowed but patent lumen. [CHOP: Small Bowel Atresia](https://www.chop.edu/conditions-diseases/small-bowel-atresia)", "questions": [ { "text": "What evidence establishes complete interruption rather than residual luminal patency?", "kind": "definition", "id": "atresia-versus-stenosis-q01" }, { "text": "What supports congenital origin rather than an acquired obstructing lesion?", "kind": "boundary", "id": "atresia-versus-stenosis-q02" } ] } ] }, { "id": "regional-scope", "name": "Regional scope", "description": "Locate the lesion while preserving the registry's authoritative granularity.", "findings": [ { "id": "segment-and-catalogue-ownership", "name": "Segment and catalogue ownership", "description": "Record regional labels as manifestations of this entry unless an existing authoritative model owns the same concept.", "questions": [ { "text": "Which intestinal segment or segments are affected, and how were their boundaries identified?", "kind": "measurement", "id": "segment-and-catalogue-ownership-q01" }, { "text": "Does an existing world model already cover this concept or establish its boundary with pyloric and anorectal atresias?", "kind": "boundary", "id": "segment-and-catalogue-ownership-q02" } ] } ] } ] }, { "id": "lesion-and-bowel-anatomy", "name": "Lesion and bowel anatomy", "description": "Describe each interruption and the bowel and mesentery surrounding it.", "rationale": "A location label alone cannot express multiple lesions, discontinuity morphology, or remaining usable intestine.", "layers": [ { "id": "interruption-map", "name": "Interruption map", "description": "Capture the number, positions, and directly observed forms of lesions.", "findings": [ { "id": "lesion-distribution-and-morphology", "name": "Lesion distribution and morphology", "description": "Keep descriptive anatomy alongside any named classification, including the classification's anatomical applicability.", "questions": [ { "text": "How many interruptions were identified, at which positions, and what bowel extent was actually examined?", "kind": "measurement", "id": "lesion-distribution-and-morphology-q01" }, { "text": "What morphology was observed at each interruption, and which source supports its assigned classification?", "kind": "provenance", "id": "lesion-distribution-and-morphology-q02" } ] } ] }, { "id": "bowel-and-mesenteric-context", "name": "Bowel and mesenteric context", "description": "Record adjacent bowel caliber, mesenteric anatomy, and the assessed condition of retained intestine.", "findings": [ { "id": "reconstruction-relevant-anatomy", "name": "Reconstruction-relevant anatomy", "description": "Represent documented dilation, caliber mismatch, mesenteric defects, vascular arrangement, and viability without inferring unobserved anatomy.", "questions": [ { "text": "What proximal and distal bowel dimensions, mesenteric findings, and viability assessments were documented?", "kind": "measurement", "id": "reconstruction-relevant-anatomy-q01" }, { "text": "Which anatomical uncertainties must the surgical team resolve before choosing a reconstruction?", "kind": "action", "id": "reconstruction-relevant-anatomy-q02" } ] } ] } ] }, { "id": "recognition-and-obstruction-state", "name": "Recognition and obstruction state", "description": "Connect prenatal and postnatal observations to diagnostic confidence and current obstruction consequences.", "rationale": "An agent must distinguish suspected atresia from confirmed anatomy while recognizing that unresolved obstruction can require urgent assessment.", "layers": [ { "id": "diagnostic-evidence", "name": "Diagnostic evidence", "description": "Preserve what each investigation actually showed and which interpretations remain provisional.", "findings": [ { "id": "observation-versus-confirmation", "name": "Observation versus confirmation", "description": "Prenatal ultrasound can raise suspicion; postnatal investigations depend on the suspected obstruction level. [Cincinnati Children's: Intestinal Atresia and Stenosis](https://www.cincinnatichildrens.org/health/i/intestinal-atresia-stenosis)", "questions": [ { "text": "Which prenatal, radiographic, or operative observations support the diagnosis, and when were they obtained?", "kind": "provenance", "id": "observation-versus-confirmation-q01" }, { "text": "Which competing explanations, including stenosis, volvulus, or meconium-related obstruction, remain unresolved?", "kind": "boundary", "id": "observation-versus-confirmation-q02" } ] } ] }, { "id": "physiological-impact", "name": "Physiological impact", "description": "Record the infant's current condition separately from certainty about the anatomical cause.", "findings": [ { "id": "obstruction-consequences-and-escalation", "name": "Obstruction consequences and escalation", "description": "Capture feeding intolerance, emesis characteristics, abdominal findings, stool passage, fluid balance, and clinician-assessed deterioration.", "questions": [ { "text": "What are the timing and progression of vomiting, distension, feeding intolerance, and stool passage?", "kind": "measurement", "id": "obstruction-consequences-and-escalation-q01" }, { "text": "Has urgent neonatal or pediatric surgical assessment occurred, and what clinician-directed stabilization remains outstanding?", "kind": "action", "id": "obstruction-consequences-and-escalation-q02" } ] } ] } ] }, { "id": "developmental-and-associated-context", "name": "Developmental and associated context", "description": "Separate proposed developmental explanations from documented associated conditions.", "rationale": "The umbrella diagnosis should not impose one mechanism or one associated-anomaly profile on every intestinal region.", "layers": [ { "id": "etiological-evidence", "name": "Etiological evidence", "description": "Identify the evidential status of any proposed developmental, vascular, familial, or genetic explanation.", "findings": [ { "id": "mechanism-without-causal-overreach", "name": "Mechanism without causal overreach", "description": "A mechanism described for a regional subtype is not automatically an established cause in an individual.", "questions": [ { "text": "Which mechanism is proposed for this lesion, and is its support subtype-level literature or individual evidence?", "kind": "provenance", "id": "mechanism-without-causal-overreach-q01" }, { "text": "What family history or additional findings prompted specialist consideration of a genetic explanation?", "kind": "provenance", "id": "mechanism-without-causal-overreach-q02" } ] } ] }, { "id": "associated-condition-assessment", "name": "Associated condition assessment", "description": "Track relevant assessments without converting unperformed tests into negative findings.", "findings": [ { "id": "association-status-and-care-effects", "name": "Association status and care effects", "description": "Link suspected and confirmed associated diagnoses to their own models and record their implications for this episode.", "questions": [ { "text": "Which associated conditions were assessed, confirmed, excluded, or left unassessed, and on what evidence?", "kind": "provenance", "id": "association-status-and-care-effects-q01" }, { "text": "How do confirmed associated conditions alter the treating team's evaluation, repair planning, or follow-up?", "kind": "action", "id": "association-status-and-care-effects-q02" } ] } ] } ] }, { "id": "repair-and-intestinal-function", "name": "Repair and intestinal function", "description": "Follow the transition from congenital interruption to reconstructed anatomy and longer-term bowel function.", "rationale": "Restored continuity and adequate nutritional function are distinct outcomes that both require explicit representation.", "layers": [ { "id": "operative-transition", "name": "Operative transition", "description": "Connect confirmed anatomy to the intervention performed and the resulting bowel configuration.", "findings": [ { "id": "repair-and-retained-anatomy", "name": "Repair and retained anatomy", "description": "Operative choices depend on lesion anatomy and available intestine; preserve the actual procedure and retained configuration. [Cincinnati Children's: Intestinal Atresia and Stenosis](https://www.cincinnatichildrens.org/health/i/intestinal-atresia-stenosis)", "questions": [ { "text": "What reconstruction, resection, or diversion was performed, and what operative reasoning was documented?", "kind": "provenance", "id": "repair-and-retained-anatomy-q01" }, { "text": "What bowel length, segments, ileocecal valve status, and continuity remain after the procedure?", "kind": "measurement", "id": "repair-and-retained-anatomy-q02" } ] } ] }, { "id": "functional-recovery-and-sequelae", "name": "Functional recovery and sequelae", "description": "Track nutrition, growth, and complications separately from procedural completion.", "findings": [ { "id": "enteral-progress-and-follow-up", "name": "Enteral progress and follow-up", "description": "Follow-up assesses growth and nutrition; possible sequelae include malabsorption, functional obstruction, and short bowel syndrome. [Cincinnati Children's: Intestinal Atresia and Stenosis](https://www.cincinnatichildrens.org/health/i/intestinal-atresia-stenosis)", "questions": [ { "text": "How are enteral tolerance, parenteral support requirements, and measured growth changing over time?", "kind": "measurement", "id": "enteral-progress-and-follow-up-q01" }, { "text": "What evidence supports a postoperative complication or separate intestinal-failure diagnosis, and what review has been arranged?", "kind": "action", "id": "enteral-progress-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": [ "The registry provides no sense definition; confirm whether its scope includes anorectal atresia.", "Developmental mechanisms and associated anomalies differ by location; duodenal and jejunoileal atresias should not be assigned one universal cause.", "ICD-10 categories listed also include absence and stenosis; precise coding requires anatomical details and the applicable national modification." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of intestinal atresia 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": [ "Duodenal atresia", "Jejunal atresia", "Ileal atresia", "Colonic atresia", "Multiple intestinal atresia" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of intestinal atresia 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": "Q41", "note": "WHO category for congenital absence, atresia and stenosis of the small intestine; subcategories distinguish anatomical sites." }, { "scheme": "ICD-10", "value_or_pattern": "Q42", "note": "WHO category for congenital absence, atresia and stenosis of the large intestine; includes anorectal defects, so the specific subcategory matters." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of intestinal atresia 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": [ "Diagnosis considered in newborns with vomiting, abdominal distension or failure to pass meconium.", "Prenatal assessment when ultrasound shows findings suggesting intestinal obstruction.", "Anatomical classification used to plan neonatal surgical repair.", "Assessment of associated congenital anomalies and postoperative nutritional requirements." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of intestinal atresia 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": [ "Complete intestinal obstruction, often presenting soon after birth.", "Vomiting with dehydration and electrolyte disturbances.", "Bowel perforation and peritonitis.", "Short bowel syndrome when extensive bowel loss or resection limits absorption.", "Postoperative anastomotic leakage, narrowing or persistent intestinal dysfunction." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of intestinal atresia 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": "Intestinal stenosis", "difference": "Stenosis narrows the lumen but retains an opening; atresia completely interrupts luminal passage." }, { "name": "Intestinal malrotation with volvulus", "difference": "Obstruction results from abnormal intestinal rotation and twisting rather than a congenitally absent or occluded lumen." }, { "name": "Hirschsprung disease", "difference": "Obstruction results from absent enteric ganglion cells in the affected bowel, rather than anatomical closure of the lumen." }, { "name": "Meconium ileus", "difference": "Obstruction is caused by inspissated meconium within the intestinal lumen; associated atresia can also occur." }, { "name": "Anorectal malformation", "difference": "The defining defect concerns development of the anus and rectum, often with abnormal connections; these defects are generally classified separately from more proximal intestinal atresias." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of intestinal atresia this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Does the authoritative registry or an existing world model define intestinal atresia broadly enough to include colonic, rectal, or pyloric lesions, and where should links replace coverage?", "Which regional classification systems should be accepted, and how should their non-equivalent type labels map to shared anatomical descriptions?", "What evidence should distinguish suspected, probable, and confirmed atresia when direct operative documentation is unavailable?", "Which subtype-specific findings justify genetic or associated-anomaly evaluation under the applicable clinical guidance?", "Which age-adjusted growth measures and definitions of enteral autonomy should support comparable follow-up across different retained bowel configurations?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 16, "questions": 26 } }