{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T10:44:10Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 19.7, "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: 01a09536-6e6e-7880-948c-efbb69925344\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: Kashin-Beck disease\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 043: ", "usd": 0.0, "recall": true }, "codex": { "seconds": 83.4, "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: 01a09536-6e7a-7df2-941b-12aab1acdfb4\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: Kashin-Beck disease\nRegistry id: vr.tr.kashin-beck-disease\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this " } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:44:00+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-Q500314", "registryId": "vr.tr.kashin-beck-disease", "name": "Kashin–Beck disease", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q500314/", "model": { "registry_id": "vr.tr.kashin-beck-disease", "name": "Kashin–Beck disease", "purpose": "Enable an agent to recognise Kashin-Beck disease, assess its growth and joint consequences, and support evidence-based diagnostic, surveillance and care decisions.", "definition": "Kashin-Beck disease is an endemic, chronic osteochondropathy beginning mainly in childhood, characterized by damage and necrosis of growth-plate and articular cartilage that can cause joint enlargement, deformity, restricted movement and impaired growth.", "scope_statement": "This model owns the disease-specific recognition rules, manifestations, exposure hypotheses, progression and intervention evidence for vr.tr.kashin-beck-disease in XCT / XCT.STA, distinguishing the condition from a diagnostic assertion, the affected person and an episode of care.", "in_scope": [ "Clinical and radiographic evidence of endemic osteochondropathy affecting growing bone and joints", "Diagnostic criteria, differential diagnosis and versioned terminology mappings", "Childhood onset, growth disturbance and persistent adult joint disability", "Residence and exposure histories relevant to endemic disease", "Population surveillance and evidence for prevention or management" ], "out_of_scope": [ "The patient's complete identity, history and unrelated conditions", "Appointments, admissions, billing and other episode-of-care administration", "General models of osteoarthritis, inflammatory arthritis and skeletal dysplasia", "Keshan disease and other cardiac conditions", "Independent models of nutrient deficiency, grain contamination and water quality" ], "distinguishing_features": [ "Assess the combination of developmental skeletal abnormalities and joint disease; adult joint degeneration alone does not establish Kashin-Beck disease.", "Examine the distribution and symmetry of joint enlargement, deformity and restricted movement together with radiographs and childhood residence history.", "Evaluate metaphyseal and epiphyseal abnormalities against the selected diagnostic standard rather than treating short stature or joint pain as specific findings.", "Require consideration of inflammatory, traumatic, nutritional and inherited skeletal alternatives before attributing abnormalities to Kashin-Beck disease.", "Disambiguate Kashin-Beck disease from the similarly named Keshan disease; the intended concept concerns osteoarticular disease." ], "characteristics": [ { "name": "Diagnostic assertion", "kind": "state", "unit_or_values": "Suspected, meets specified criteria, indeterminate, excluded; assessor and assessment date", "why_it_matters": "Separates disease recognition from a screening result or an unverified historical label." }, { "name": "Diagnostic standard", "kind": "relation", "unit_or_values": "Issuing body, document identifier, revision, jurisdiction and applicable age group", "why_it_matters": "Makes diagnostic and severity claims interpretable when criteria differ." }, { "name": "Terminology mapping", "kind": "relation", "unit_or_values": "Verified ICD-10, ICD-11 or SNOMED CT identifier with release, national modification or edition, and mapping precision", "why_it_matters": "Prevents a broad arthropathy code from being treated as an exact disease identification." }, { "name": "Onset and recognition ages", "kind": "measurement", "unit_or_values": "Years, recorded separately with uncertainty", "why_it_matters": "Distinguishes childhood disease from its recognition or consequences in adulthood." }, { "name": "Joint involvement pattern", "kind": "category", "unit_or_values": "Joint, side, symmetry, enlargement, deformity, pain and movement restriction", "why_it_matters": "Supports differential diagnosis and identifies functional consequences." }, { "name": "Growth consequences", "kind": "measurement", "unit_or_values": "Height in cm; height-for-age z score with reference; segment proportions and digit shortening", "why_it_matters": "Captures growth impairment without assuming that all short stature is disease-related." }, { "name": "Radiographic phenotype", "kind": "category", "unit_or_values": "Anatomical site, metaphyseal or epiphyseal abnormality, joint change, acquisition date and reader confidence", "why_it_matters": "Separates developmental abnormalities from later degenerative damage." }, { "name": "Endemic exposure history", "kind": "relation", "unit_or_values": "Locality and residence dates, childhood food and water sources, locality-specific evidence period", "why_it_matters": "Links plausible exposure windows to onset without equating residence with diagnosis." }, { "name": "Functional burden", "kind": "measurement", "unit_or_values": "Joint range in degrees; pain and function scores with instrument; walking and hand-use limitations", "why_it_matters": "Supports care planning and outcome assessment beyond radiographic grade." } ], "affordances": [ "Assemble a disease-specific evidence summary for clinician review and identify missing diagnostic observations.", "Compare a diagnostic assertion with its cited standard and flag unsupported coding or grading.", "Track growth, joint structure and function separately across childhood and adulthood.", "Compare geographically and temporally matched surveillance estimates using explicit case definitions.", "Evaluate prevention and treatment evidence against the person's age, disease status and nutritional context.", "Identify needs for specialist assessment, rehabilitation or environmental investigation without autonomously prescribing treatment." ], "agent_conduct": { "may": [ "Explain Kashin-Beck disease and its suspected environmental causes from reputable sources.", "Report public health data on affected regions with dates and sources." ], "must_not": [ "Blame affected communities or describe them in demeaning terms.", "Present contested causes as settled.", "Diagnose the disease in a specific child.", "Promote supplements or remedies as cures." ], "requires_human": [ "Public health interventions such as changing diet, water or grain supplies." ] }, "ethics": { "considerations": [ "The disease affects poor rural communities whose environment and diet shaped their risk.", "Children disabled young lose chances in education and work." ], "affected_parties": [ "Children in affected regions", "Rural communities", "Families" ] }, "owners": { "steward": "Nobody owns the disease; public health authorities answer for prevention programmes.", "master_systems": [ "Public health surveillance records" ] }, "visual_identification": [ "Enlarged, stiff finger and other joints in children and adults.", "Short stature and shortened limbs in severe cases." ], "failure_modes_and_hazards": [ "Permanent joint deformity and disability from childhood.", "Limited mobility affects farm work and livelihoods." ], "what_it_is_for": [ "Kashin-Beck disease is encountered in clinical assessment and public health surveillance in affected endemic regions.", "Assessment focuses on childhood growth, joint changes, pain, mobility and lasting functional limitations.", "Records of residence and exposure context help interpret findings alongside examination and imaging." ], "standards_and_regulation": [ "The International Classification of Diseases, Tenth Revision, issued by the World Health Organization, classifies Kashin-Beck disease under code M12.1." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q500314: Kashin–Beck disease", "url": "https://www.wikidata.org/wiki/Q500314", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Kashin–Beck disease", "url": "https://en.wikipedia.org/wiki/Kashin%E2%80%93Beck_disease", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "recognition-and-diagnostic-boundaries", "name": "Recognition and diagnostic boundaries", "description": "Determine what evidence supports identifying this endemic osteoarticular condition.", "rationale": "Neither a residence history nor nonspecific joint symptoms can establish the disease by themselves.", "layers": [ { "id": "clinical-radiographic-concordance", "name": "Clinical and radiographic concordance", "description": "Connect examination findings with age-appropriate skeletal imaging.", "findings": [ { "id": "concordant-osteoarticular-pattern", "name": "Concordant osteoarticular pattern", "description": "Record symptoms, movement restriction, deformity and imaging findings separately before assessing agreement; published research has used explicit clinical case definitions. [Tibetan population study](https://www.nejm.org/doi/full/10.1056/NEJM199810153391604).", "questions": [ { "text": "Which joints and skeletal regions show abnormalities, and how do examination and imaging agree?", "kind": "measurement", "id": "concordant-osteoarticular-pattern-q01" }, { "text": "Which findings could instead be explained by trauma, inflammatory arthritis or another skeletal disorder?", "kind": "boundary", "id": "concordant-osteoarticular-pattern-q02" } ] } ] }, { "id": "criteria-and-concept-mapping", "name": "Criteria and concept mapping", "description": "Bind the diagnosis to a named standard and the intended disease concept.", "findings": [ { "id": "versioned-case-assertion", "name": "Versioned case assertion", "description": "Retain the issuing body, revision, applicable population and supporting observations for each diagnosis; resolve terminology mappings independently of the clinical decision.", "questions": [ { "text": "Which issuing body and exact criteria revision support this diagnostic assertion?", "kind": "provenance", "id": "versioned-case-assertion-q01" }, { "text": "Which verified ICD-10, ICD-11 and SNOMED CT mappings identify this concept in the required editions?", "kind": "definition", "id": "versioned-case-assertion-q02" }, { "text": "Is this record a suspected case, an established diagnosis or only a screening observation?", "kind": "boundary", "id": "versioned-case-assertion-q03" } ] } ] } ] }, { "id": "skeletal-course-and-disability", "name": "Skeletal course and disability", "description": "Describe growth-related damage and subsequent joint consequences over time.", "rationale": "Age at recognition, structural damage and current disability answer different questions.", "layers": [ { "id": "growth-and-developmental-damage", "name": "Growth and developmental damage", "description": "Relate skeletal abnormalities to the period of growth.", "findings": [ { "id": "developmental-trajectory", "name": "Developmental trajectory", "description": "Record onset estimates, serial growth and metaphyseal or epiphyseal observations without inferring childhood onset solely from adult deformity.", "questions": [ { "text": "What evidence dates symptom onset and skeletal abnormalities relative to growth and skeletal maturity?", "kind": "provenance", "id": "developmental-trajectory-q01" }, { "text": "How have height, body proportions and affected digits changed against an identified growth reference?", "kind": "measurement", "id": "developmental-trajectory-q02" } ] } ] }, { "id": "persistent-joint-burden", "name": "Persistent joint burden", "description": "Separate fixed deformity, changing joint damage and functional limitation.", "findings": [ { "id": "structural-functional-state", "name": "Structural and functional state", "description": "Record structural grade under its own standard alongside pain, mobility and participation; do not use a severity grade as proof of ongoing progression.", "questions": [ { "text": "Which dated observations demonstrate progression, stability or improvement?", "kind": "measurement", "id": "structural-functional-state-q01" }, { "text": "Which walking, hand-use or daily activities are limited, and which changes warrant clinical reassessment?", "kind": "action", "id": "structural-functional-state-q02" } ] } ] } ] }, { "id": "endemic-setting-and-causal-evidence", "name": "Endemic setting and causal evidence", "description": "Represent exposure context while preserving uncertainty about causation.", "rationale": "Geographic clustering and nutritional associations must not become unsupported individual causal diagnoses.", "layers": [ { "id": "childhood-exposure-setting", "name": "Childhood exposure setting", "description": "Reconstruct where and when relevant exposures could have occurred.", "findings": [ { "id": "dated-residence-and-supply-history", "name": "Dated residence and supply history", "description": "Link childhood residence, food sourcing and water supply to contemporaneous local evidence rather than present-day address.", "questions": [ { "text": "Where did the person live during growth, and what evidence describes disease occurrence there during those years?", "kind": "provenance", "id": "dated-residence-and-supply-history-q01" }, { "text": "Which food or water exposures were measured directly, reported retrospectively or inferred from locality?", "kind": "boundary", "id": "dated-residence-and-supply-history-q02" } ] } ] }, { "id": "nutritional-and-environmental-hypotheses", "name": "Nutritional and environmental hypotheses", "description": "Distinguish measured nutritional status from proposed disease mechanisms.", "findings": [ { "id": "association-versus-causation", "name": "Association versus causation", "description": "Keep selenium and iodine measurements separate from causal attribution; research has assessed these nutritional factors in affected Tibetan populations. [Population study](https://www.nejm.org/doi/full/10.1056/NEJM199810153391604).", "questions": [ { "text": "Which nutritional or environmental factors have direct measurements, with specimen, method, units and date?", "kind": "measurement", "id": "association-versus-causation-q01" }, { "text": "Does the cited evidence establish association, an experimental effect or a causal mechanism, and what competing explanations remain?", "kind": "provenance", "id": "association-versus-causation-q02" } ] } ] } ] }, { "id": "population-burden-and-surveillance", "name": "Population burden and surveillance", "description": "Interpret disease occurrence by locality, cohort and ascertainment method.", "rationale": "Existing adult disability and newly affected children represent different surveillance outcomes.", "layers": [ { "id": "population-and-case-definition", "name": "Population and case definition", "description": "Make estimates reproducible and comparable.", "findings": [ { "id": "bounded-burden-estimate", "name": "Bounded burden estimate", "description": "Require geography, observation year, age range, numerator, denominator, sampling method and diagnostic definition for every burden estimate.", "questions": [ { "text": "What population, year and case definition produced this prevalence or incidence estimate?", "kind": "measurement", "id": "bounded-burden-estimate-q01" }, { "text": "Were cases found through clinical screening, radiography or existing records, and who was missed?", "kind": "provenance", "id": "bounded-burden-estimate-q02" } ] } ] }, { "id": "incident-disease-and-residual-burden", "name": "Incident disease and residual burden", "description": "Distinguish new disease from longstanding cases newly detected.", "findings": [ { "id": "cohort-specific-surveillance-signal", "name": "Cohort-specific surveillance signal", "description": "Interpret trends using onset evidence, age cohorts and changes in screening coverage or diagnostic criteria.", "questions": [ { "text": "Does a newly reported case represent recent onset or delayed recognition of longstanding disease?", "kind": "boundary", "id": "cohort-specific-surveillance-signal-q01" }, { "text": "Could migration, ageing, screening changes or revised criteria explain the apparent trend?", "kind": "provenance", "id": "cohort-specific-surveillance-signal-q02" } ] } ] } ] }, { "id": "prevention-and-care-decisions", "name": "Prevention and care decisions", "description": "Match proposed actions to disease status, functional needs and applicable evidence.", "rationale": "Preventing new childhood cases, correcting deficiency and managing established damage require distinct evidence.", "layers": [ { "id": "prevention-evidence", "name": "Prevention evidence", "description": "Evaluate population interventions against incident disease and skeletal outcomes.", "findings": [ { "id": "intervention-context-and-endpoint", "name": "Intervention context and endpoint", "description": "Record intervention composition, baseline nutritional status, comparator and endpoints. A Qinghai trial assessed grain replacement and selenium-iodine salt using new cases and radiographic outcomes. [Intervention trial](https://pubmed.ncbi.nlm.nih.gov/25252032/).", "questions": [ { "text": "Did the study measure prevention of new cases, change in existing lesions or correction of nutrient deficiency?", "kind": "boundary", "id": "intervention-context-and-endpoint-q01" }, { "text": "Which population differences, concurrent interventions and study limitations affect applicability here?", "kind": "action", "id": "intervention-context-and-endpoint-q02" } ] } ] }, { "id": "established-disease-management", "name": "Established disease management", "description": "Connect care options to documented impairment and realistic outcomes.", "findings": [ { "id": "care-target-and-response", "name": "Care target and response", "description": "Separate symptom relief, functional improvement and structural change. A Tibetan trial found no added benefit of selenium for established disease after iodine correction, limiting assumptions that supplementation reverses damage. [Randomized trial](https://pubmed.ncbi.nlm.nih.gov/12816783/).", "questions": [ { "text": "Is the proposed action intended to address deficiency, pain, mobility, deformity or another explicit target?", "kind": "action", "id": "care-target-and-response-q01" }, { "text": "What clinician-reviewed evidence supports rehabilitation, medication or surgical assessment for this person's impairment?", "kind": "provenance", "id": "care-target-and-response-q02" }, { "text": "Which baseline and follow-up measures will establish benefit, adverse effects or need to change the care plan?", "kind": "measurement", "id": "care-target-and-response-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 description is based on recall; no sources were consulted.", "Verify the issuing body, current version and thresholds of regional diagnostic and severity-grading criteria before applying them; no grading scheme is asserted here.", "Current prevalence, the relative contributions of proposed causes and the effectiveness of specific preventive interventions require source-based review." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of Kashin-Beck disease this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "WHO ICD-10", "value_or_pattern": "M12.1", "note": "Kashin-Beck disease; national modifications may require additional site-specific characters." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of Kashin-Beck disease 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 International Classification of Diseases, Tenth Revision (ICD-10), provides a disease classification; the applicable revision and national modification should accompany coding claims." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of Kashin-Beck disease this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Clinical and radiographic assessment of children with characteristic joint and growth abnormalities in endemic communities.", "Public-health surveillance of endemic osteochondropathy and evaluation of prevention programmes.", "Assessment of mobility, pain and functional limitations to guide rehabilitation and orthopaedic care." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of Kashin-Beck disease this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Damage to growth plates during childhood can produce permanent shortening of fingers or limbs and reduced stature.", "Articular damage can lead to deformity, restricted movement, chronic pain and secondary osteoarthritis.", "Early disease may be missed if assessment relies only on visible joint deformity.", "Attributing the disease solely to selenium deficiency overstates the evidence: nutritional, food-contamination and other environmental factors have been investigated, and the causal explanation remains incompletely settled." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of Kashin-Beck disease this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Historically described particularly in endemic areas of China, including the Tibetan Plateau, and in parts of Siberia and North Korea.", "Occurrence varies substantially between communities; historical endemicity does not establish current prevalence." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of Kashin-Beck disease this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Keshan disease", "difference": "Keshan disease is an endemic cardiomyopathy affecting heart muscle; Kashin-Beck disease primarily affects cartilage and skeletal growth." }, { "name": "Primary osteoarthritis", "difference": "Kashin-Beck disease typically begins during skeletal growth in an endemic setting and can damage growth plates; primary osteoarthritis generally develops later without this childhood growth-plate disorder." }, { "name": "Rickets", "difference": "Rickets is a disorder of mineralization in the growing skeleton, distinguished through biochemical findings and characteristic radiographic changes rather than the cartilage necrosis characteristic of Kashin-Beck disease." }, { "name": "Juvenile idiopathic arthritis", "difference": "Juvenile idiopathic arthritis involves persistent inflammatory arthritis; Kashin-Beck disease is an endemic osteochondropathy distinguished using exposure history, examination and skeletal imaging." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of Kashin-Beck disease this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Which diagnostic and severity standards are currently authoritative in each relevant jurisdiction, and how should childhood radiographic cases and adult residual disease be reconciled?", "What are the exact verified ICD-10, ICD-11 and SNOMED CT mappings, including edition, national modification and site-specific coding requirements?", "What recent locality- and age-specific surveillance data distinguish incident childhood disease from prevalent adult disability?", "How strong is the causal evidence for selenium deficiency, iodine status, grain-associated mycotoxins and water constituents, individually and in combination?", "Which prevention and management interventions have sufficiently robust, age-specific evidence for durable benefit, and which reported radiographic improvements predict better function?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 17, "questions": 29 } }