{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T08:35:51Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 22.0, "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: 01a094c1-0199-74c1-8839-be91ef325e5c\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: chemotherapy-induced acral erythema\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 thing", "usd": 0.0, "recall": true }, "codex": { "seconds": 79.5, "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: 01a094c1-018f-74a1-88a0-91c3858924ba\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: chemotherapy-induced acral erythema\nRegistry id: vr.tr.chemotherapy-induced-acral-erythema\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none r" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:44:31+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "standards_and_regulation", "visual_identification" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:31+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q593277", "registryId": "vr.tr.chemotherapy-induced-acral-erythema", "name": "chemotherapy-induced acral erythema", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q593277/", "model": { "registry_id": "vr.tr.chemotherapy-induced-acral-erythema", "name": "chemotherapy-induced acral erythema", "purpose": "Enable an agent to recognise, characterise and track chemotherapy-induced acral erythema, assess its functional consequences and support clinician-directed responses.", "definition": "Chemotherapy-induced acral erythema, also called hand-foot syndrome or palmar-plantar erythrodysesthesia, is a treatment-related cutaneous toxicity characterized by usually symmetric redness, swelling, altered sensation and pain of the palms and soles, sometimes progressing to blistering or desquamation.", "scope_statement": "This model owns the identity, attribution, manifestations, severity and course of chemotherapy-induced acral erythema under registry id vr.tr.chemotherapy-induced-acral-erythema, preserving its XCT / XCT.STA placement and linking to separate models for the patient, anticancer regimen and treatment decisions.", "in_scope": [ "Recognition of suspected or clinician-assessed episodes of chemotherapy-associated hand-foot syndrome.", "Distribution and evolution of acral skin changes and sensory symptoms.", "Temporal association with chemotherapy exposure and competing explanations.", "Pain, skin integrity and effects on walking, hand use and self-care.", "Episode-specific management decisions, reassessment and recurrence." ], "out_of_scope": [ "The underlying malignancy, its staging and treatment effectiveness.", "Chemotherapy drug specifications, prescribing and complete regimen management.", "Kinase-inhibitor-associated hand-foot skin reaction as an independently established condition.", "Peripheral neuropathy without the relevant cutaneous syndrome.", "Independent models of infection, contact dermatitis and other causes of acral inflammation." ], "distinguishing_features": [ "Compatible hand or foot pain, swelling, altered sensation and skin changes support a hand-foot syndrome phenotype; no single symptom establishes chemotherapy causation. [NCI definition](https://www.cancer.gov/publications/dictionaries/cancer-terms/def/hand-foot-syndrome)", "Gradual, broadly symmetric palm or sole involvement supports the classic chemotherapy-associated pattern; focal pressure-site hyperkeratosis raises the neighbouring diagnosis of kinase-inhibitor-associated hand-foot skin reaction. [eviQ clinical summary](https://www.eviq.org.au/clinical-resources/side-effect-and-toxicity-management/hair-skin-and-nails/1416-hand-foot-syndrome-associated-with-chemothera)", "The assessment must connect the episode to a documented chemotherapy exposure and timeline rather than infer causation from a cancer diagnosis.", "Sensory complaints require separate skin findings and neurological assessment to determine whether acral erythema, neuropathy or both are being recorded.", "Marked asymmetry, systemic symptoms or an exposure-specific rash should prompt documentation of competing explanations rather than automatic classification." ], "characteristics": [ { "name": "Episode assessment status", "kind": "state", "unit_or_values": "suspected | clinician-assessed | attribution unresolved | alternative diagnosis favoured", "why_it_matters": "Separates recognition of a compatible phenotype from a clinical attribution." }, { "name": "Implicated chemotherapy exposure", "kind": "relation", "unit_or_values": "Links to administered agent, formulation, regimen, cycle and administration dates", "why_it_matters": "Makes the proposed drug relationship traceable to actual exposure." }, { "name": "Onset interval", "kind": "measurement", "unit_or_values": "Days from regimen initiation and from the most recent administration, with date uncertainty", "why_it_matters": "Supports temporal assessment without imposing a universal latency threshold." }, { "name": "Acral distribution", "kind": "category", "unit_or_values": "Left/right palm and sole; additional sites; symmetric/asymmetric; diffuse/focal", "why_it_matters": "Helps distinguish a compatible pattern from overlapping acral reactions." }, { "name": "Cutaneous manifestations", "kind": "category", "unit_or_values": "Observed colour change, swelling, dryness, peeling, blistering, fissuring, ulceration or hyperkeratosis; absent or unassessed", "why_it_matters": "Preserves the actual examination rather than reducing the episode to its diagnostic label." }, { "name": "Acral pain intensity", "kind": "measurement", "unit_or_values": "0-10 on a stated scale, assessed separately at rest and during hand use or walking", "why_it_matters": "Allows symptom trajectories and activity-related burden to be compared." }, { "name": "Functional limitation", "kind": "state", "unit_or_values": "Specific affected tasks and required assistance, relative to baseline", "why_it_matters": "Records consequences that visible skin changes alone do not capture." }, { "name": "Clinical severity assessment", "kind": "category", "unit_or_values": "Named grading system, version, assigned grade, supporting observations and assessor; ungraded if unavailable", "why_it_matters": "Prevents unsupported grading and comparisons between incompatible scales." }, { "name": "Episode trajectory", "kind": "state", "unit_or_values": "emerging | worsening | stable | improving | resolved | recurrent; assessment date required", "why_it_matters": "Distinguishes present status from a historical adverse event." }, { "name": "Management authority", "kind": "relation", "unit_or_values": "Links to responsible clinician, applicable protocol and documented care decision", "why_it_matters": "Keeps chemotherapy changes tied to authorised clinical decisions." } ], "affordances": [ "Organise an acral symptom report into a suspected episode with explicit missing observations.", "Compare distribution, morphology and exposure history with competing explanations.", "Track pain, skin integrity and task limitations across treatment cycles.", "Prepare a clinician review summary showing severity evidence and unresolved attribution.", "Retrieve applicable regimen-specific guidance and record the clinician's management decision.", "Evaluate documented improvement or recurrence without treating temporal association as proof of causation." ], "agent_conduct": { "may": [ "Explain what hand-foot syndrome is and which treatments are associated with it, from medical sources.", "Encourage patients to report symptoms to their oncology team." ], "must_not": [ "Diagnose or grade the condition in a person.", "Advise stopping or changing chemotherapy doses.", "Recommend treatments in place of the care team's advice." ], "requires_human": [ "Any change to cancer treatment, made by the oncologist." ] }, "ethics": { "considerations": [ "Side effects affect quality of life and can force cancer treatment to change.", "Patients' health information must stay private." ], "affected_parties": [ "Cancer patients", "Caregivers", "Oncology teams" ] }, "owners": { "steward": "Nobody owns the condition; the treating oncologist answers for each patient's care.", "master_systems": [] }, "visual_identification": [ "Redness and swelling on the palms and soles, usually on both sides.", "Later stages may show blistering, peeling or cracking of the skin." ], "failure_modes_and_hazards": [ "Pain can limit walking and daily activities.", "Skin breakdown can lead to infection." ], "standards_and_regulation": [ "Common Terminology Criteria for Adverse Events (CTCAE), US National Cancer Institute, which grades palmar-plantar erythrodysesthesia syndrome." ], "what_it_is_for": [ "Chemotherapy-induced acral erythema is encountered during monitoring of skin toxicity in people receiving certain anticancer medicines.", "Its characterization helps clinicians document effects on walking, hand use and daily activities and assess changes during treatment." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q593277: chemotherapy-induced acral erythema", "url": "https://www.wikidata.org/wiki/Q593277", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Chemotherapy-induced acral erythema", "url": "https://en.wikipedia.org/wiki/Chemotherapy-induced_acral_erythema", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "syndrome-identity-and-boundaries", "name": "Syndrome identity and boundaries", "description": "Establish what condition the episode represents and how confidently it belongs to this registry entry.", "rationale": "Hand-foot terminology can conceal clinically relevant differences between treatment-associated acral reactions.", "layers": [ { "id": "clinical-term-mapping", "name": "Clinical term mapping", "description": "Preserve the reported diagnostic wording and its intended meaning.", "findings": [ { "id": "hand-foot-label-context", "name": "Hand-foot label context", "description": "Record whether the source uses acral erythema, hand-foot syndrome or palmar-plantar erythrodysesthesia and whether it explicitly attributes the condition to chemotherapy.", "questions": [ { "text": "What term did the clinician or source use, and what manifestations did that term denote?", "kind": "definition", "id": "hand-foot-label-context-q01" }, { "text": "Who assigned the label, when, and with what stated confidence?", "kind": "provenance", "id": "hand-foot-label-context-q02" } ] } ] }, { "id": "overlapping-acral-conditions", "name": "Overlapping acral conditions", "description": "Make the differential assessment explicit.", "findings": [ { "id": "alternative-or-coexisting-process", "name": "Alternative or coexisting process", "description": "Record evidence considered for hand-foot skin reaction, neuropathy, dermatitis, infection and other relevant explanations, allowing coexistence.", "questions": [ { "text": "Which observations favour chemotherapy-induced acral erythema over each plausible alternative?", "kind": "boundary", "id": "alternative-or-coexisting-process-q01" }, { "text": "Which findings require a coexisting diagnosis or further clinical assessment?", "kind": "action", "id": "alternative-or-coexisting-process-q02" } ] } ] } ] }, { "id": "chemotherapy-exposure-and-attribution", "name": "Chemotherapy exposure and attribution", "description": "Connect the episode to administered treatment while preserving uncertainty about causation.", "rationale": "The chemotherapy relationship is part of this thing's identity and cannot be inferred from morphology alone.", "layers": [ { "id": "exposure-timeline", "name": "Exposure timeline", "description": "Locate symptom onset within the actual treatment history.", "findings": [ { "id": "episode-linked-administrations", "name": "Episode-linked administrations", "description": "Link implicated agents, formulations and administration records to the earliest reported symptoms and subsequent changes.", "questions": [ { "text": "Which chemotherapy agents and formulations were actually administered before onset?", "kind": "provenance", "id": "episode-linked-administrations-q01" }, { "text": "How many days separated treatment initiation, recent administrations and the first acral symptoms?", "kind": "measurement", "id": "episode-linked-administrations-q02" } ] } ] }, { "id": "causal-assessment", "name": "Causal assessment", "description": "Separate the clinician's attribution from the observations supporting it.", "findings": [ { "id": "attribution-evidence-and-confounders", "name": "Attribution evidence and confounders", "description": "Capture the proposed culprit, competing exposures and symptom changes after treatment changes that occurred for clinical reasons.", "questions": [ { "text": "What evidence supports the proposed culprit, and what competing drugs or local exposures remain plausible?", "kind": "boundary", "id": "attribution-evidence-and-confounders-q01" }, { "text": "If treatment was interrupted or resumed, what happened to the acral symptoms and what else changed concurrently?", "kind": "provenance", "id": "attribution-evidence-and-confounders-q02" } ] } ] } ] }, { "id": "acral-phenotype", "name": "Acral phenotype", "description": "Describe the location, appearance and sensations of the episode.", "rationale": "The model needs concrete observations to recognise the syndrome and compare successive assessments.", "layers": [ { "id": "distribution-and-morphology", "name": "Distribution and morphology", "description": "Map affected surfaces and the character of their skin changes.", "findings": [ { "id": "site-specific-skin-observations", "name": "Site-specific skin observations", "description": "Record each affected palm or sole, symmetry, focality, colour relative to baseline and skin-surface changes.", "questions": [ { "text": "Which surfaces are affected, and are changes diffuse, pressure-localised, symmetric or asymmetric?", "kind": "measurement", "id": "site-specific-skin-observations-q01" }, { "text": "What changes from the person's baseline skin appearance and texture are documented at each site?", "kind": "measurement", "id": "site-specific-skin-observations-q02" } ] } ] }, { "id": "sensory-and-temporal-pattern", "name": "Sensory and temporal pattern", "description": "Relate patient-reported sensations to visible changes and activity.", "findings": [ { "id": "acral-symptom-sequence", "name": "Acral symptom sequence", "description": "Capture pain, burning, tingling or numbness, including their sequence and relationship to walking or hand use.", "questions": [ { "text": "Which sensations preceded, accompanied or persisted after the visible skin changes?", "kind": "measurement", "id": "acral-symptom-sequence-q01" }, { "text": "How do symptom location and intensity differ at rest and during specific activities?", "kind": "measurement", "id": "acral-symptom-sequence-q02" } ] } ] } ] }, { "id": "severity-and-functional-consequences", "name": "Severity and functional consequences", "description": "Assess the episode through symptoms, tissue integrity and everyday function.", "rationale": "A useful state assessment must express what the person can do and what needs clinical attention.", "layers": [ { "id": "activity-impact-and-grading", "name": "Activity impact and grading", "description": "Ground severity classifications in observed and reported consequences.", "findings": [ { "id": "task-limitation-evidence", "name": "Task limitation evidence", "description": "Record effects on walking, grasping, dressing, washing and other relevant tasks, then preserve the clinician's grading rationale.", "questions": [ { "text": "Which tasks are painful, restricted or dependent on assistance compared with baseline?", "kind": "measurement", "id": "task-limitation-evidence-q01" }, { "text": "Which grading system and version were used, and what observations support the assigned grade?", "kind": "provenance", "id": "task-limitation-evidence-q02" } ] } ] }, { "id": "skin-integrity-and-review-needs", "name": "Skin integrity and review needs", "description": "Identify findings that need additional assessment beyond routine symptom tracking.", "findings": [ { "id": "complication-review-triggers", "name": "Complication review triggers", "description": "Record open skin, worsening pain, impaired mobility or systemic symptoms and the clinical response they prompted, without assuming their cause.", "questions": [ { "text": "Are blistering, fissures, ulceration or other skin-barrier defects present, and where?", "kind": "measurement", "id": "complication-review-triggers-q01" }, { "text": "Do new local or systemic findings require urgent review under the patient's oncology instructions?", "kind": "action", "id": "complication-review-triggers-q02" } ] } ] } ] }, { "id": "management-and-episode-course", "name": "Management and episode course", "description": "Record authorised responses and evaluate the episode over time.", "rationale": "The agent must connect observed state to a traceable clinical decision and subsequent outcome.", "layers": [ { "id": "episode-care-decisions", "name": "Episode care decisions", "description": "Connect symptom care and treatment-modification decisions to their clinical authority.", "findings": [ { "id": "care-plan-and-regimen-decision", "name": "Care plan and regimen decision", "description": "Record prescribed skin care, symptom relief, activity advice and any clinician-directed chemotherapy change, with the applicable guidance.", "questions": [ { "text": "What episode-specific care was recommended, by whom, and using which drug- or regimen-specific guidance?", "kind": "provenance", "id": "care-plan-and-regimen-decision-q01" }, { "text": "What clinician-approved action and reassessment criteria apply to continuing, interrupting or modifying treatment?", "kind": "action", "id": "care-plan-and-regimen-decision-q02" } ] } ] }, { "id": "resolution-and-recurrence", "name": "Resolution and recurrence", "description": "Follow recovery and distinguish recurrence from persistent symptoms.", "findings": [ { "id": "longitudinal-acral-outcome", "name": "Longitudinal acral outcome", "description": "Compare follow-up observations with the episode baseline and document recovery criteria, residual impairment and subsequent flares.", "questions": [ { "text": "How have skin findings, pain and task performance changed since the previous assessment?", "kind": "measurement", "id": "longitudinal-acral-outcome-q01" }, { "text": "What documented recovery interval distinguishes a new episode from persistence or worsening of the existing episode?", "kind": "boundary", "id": "longitudinal-acral-outcome-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 account is based on recall; no sources were consulted.", "Terminology sometimes groups classic hand-foot syndrome and targeted-therapy hand-foot skin reaction together; their intended boundary should be checked.", "Verify the applicable CTCAE version and current MedDRA term before formal coding; no disease-classification code is asserted here." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of chemotherapy-induced acral erythema 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": "MedDRA", "value_or_pattern": "Palmar-plantar erythrodysaesthesia syndrome", "note": "An adverse-event reporting term; the numeric identifier is not supplied from recall." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of chemotherapy-induced acral erythema 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": [ "The US National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) provide severity grading for palmar-plantar erythrodysesthesia syndrome." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of chemotherapy-induced acral erythema 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": [ "Recognition and monitoring of skin toxicity during treatment with agents such as capecitabine, fluorouracil and pegylated liposomal doxorubicin.", "Adverse-event documentation in oncology clinical trials and pharmacovigilance.", "Assessment of treatment tolerability and clinician-directed decisions about treatment interruption or dose modification." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of chemotherapy-induced acral erythema 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": "CTCAE severity grade for palmar-plantar erythrodysesthesia syndrome", "typical_range": "1-3; grading incorporates skin changes, pain and limitations in activities of daily living", "unit": "ordinal grade" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of chemotherapy-induced acral erythema this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Pain and skin damage can impair walking, hand function and daily activities.", "Severe cases can produce blistering, peeling, fissures or ulceration.", "Disrupted skin can develop secondary infection.", "Toxicity can require interruption or reduction of anticancer treatment.", "Misclassification as infection, contact dermatitis or another drug eruption can delay appropriate assessment." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of chemotherapy-induced acral erythema 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": "Hand-foot skin reaction", "difference": "Typically associated with certain targeted anticancer agents and characterized by focal, painful hyperkeratotic lesions at pressure or friction sites, whereas classic chemotherapy-associated hand-foot syndrome is generally more diffuse." }, { "name": "Hand, foot and mouth disease", "difference": "An infectious enteroviral illness, commonly involving oral lesions, rather than chemotherapy-associated toxicity." }, { "name": "Peripheral neuropathy", "difference": "Primarily a nerve disorder causing sensory or motor dysfunction; acral erythema includes inflammatory skin changes, although both conditions can coexist." }, { "name": "Toxic erythema of chemotherapy", "difference": "A broader category of chemotherapy-associated skin reactions that can involve flexural and other sites; acral erythema describes the predominantly palm-and-sole presentation." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of chemotherapy-induced acral erythema this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "How should this registry entry relate to the broader concept of toxic erythema of chemotherapy when acral and non-acral findings coexist?", "Which operational criteria best separate chemotherapy-associated hand-foot syndrome from kinase-inhibitor-associated hand-foot skin reaction in mixed treatment regimens?", "Which severity instrument and version should be preferred, and how should historical grades be compared without losing their original definitions?", "What observation methods best capture early disease across different baseline skin tones and in people with pre-existing neuropathy?", "Which preventive measures, supportive treatments and recovery thresholds have sufficient evidence for each implicated agent and formulation?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 17, "questions": 27 } }